Establishment of scoring system of gastrointestinal bleeding risk in relation with profile of intestinal flora and pharmacokinetics for patients receiving direct oral anticoagulants

• Project/Area Number: 21K07949
• Research Category: Grant-in-Aid for Scientific Research (C)
• Allocation Type: Multi-year Fund
• Section: 一般
• Review Section: Basic Section 53010:Gastroenterology-related
• Research Institution: Oita University (2023); Tokyo Medical University (2021-2022)
• Principal Investigator: 杉本 光繁 大分大学, グローカル感染症研究センター, 教授 (80397398)
• Project Period (FY): 2021-04-01 – 2025-03-31
• Project Status: Granted (Fiscal Year 2023)
• Budget Amount: ¥4,160,000 (Direct Cost: ¥3,200,000、Indirect Cost: ¥960,000); Fiscal Year 2024: ¥780,000 (Direct Cost: ¥600,000、Indirect Cost: ¥180,000); Fiscal Year 2023: ¥780,000 (Direct Cost: ¥600,000、Indirect Cost: ¥180,000); Fiscal Year 2022: ¥1,300,000 (Direct Cost: ¥1,000,000、Indirect Cost: ¥300,000); Fiscal Year 2021: ¥1,300,000 (Direct Cost: ¥1,000,000、Indirect Cost: ¥300,000)
• Keywords: DOAC / 消化管出血 / 遺伝子多型 / 血中濃度 / 腸内細菌 / 内視鏡治療 / 薬物動態学 / 薬物動態学的関連因子 / H. pylori

Outline of Research at the Start

本研究はDOAC内服予定者と健常者を対象に、DOAC内服前後に薬物動態関連因子を血液で評価するとともに、糞便を使用して腸内細菌叢を調べ、内視鏡検査で胃内の評価を行う侵襲を伴う介入研究、DOACを内服して早期消化管腫瘍に対してESDを施行した症例をカルテベースで抽出し、薬物動態関連因子と腸内細菌叢との関連性を調べる軽度の侵襲を伴う観察研究、DOAC内服者の中で治療内視鏡を行う症例を対象に薬物動態関連因子と腸内細菌叢を調査して術後の消化管出血を調査する前向き多施設研究を行う予定である。

Outline of Annual Research Achievements

高齢化社会が進行し抗血栓薬の内服者が急増している。抗血栓薬は脳循環器疾患の予防や治療の第一選択治療薬であるが、薬理学的特性より大出血のリスクが臨床上問題となる。薬物療法は薬効が適切にモニタリングされ、必要最低用量での調整が必要だが、直接経口抗凝固薬(DOAC)には投与量を規定する基準はない。近年、DOACの薬物動態や薬効の個人差が抗凝固作用や大出血の出現に影響を及ぼす可能性に注目が集まり、原因として薬物投与量、年齢、腎機能、薬物代謝酵素やトランスポーターの遺伝子多型、腸内細菌叢プロファイル、胃酸度、薬物種などが考えられている。更に腸内細菌叢の乱れが脳循環器疾患のリスクを増加し、DOACの薬物動態にも影響する可能性が報告されている。本研究は、DOAC内服時の抗凝固作用に対する腸内細菌叢と薬物動態学的関連因子との関係性を大規模臨床試験で明確にし、大出血のリスクの層別化スコアリング法を確立することを目的とした。
(1)抗血栓薬内服者の薬物動態関連因子と腸内細菌叢プロファイルの評価
(2)薬物動態や腸内細菌叢を考慮した層別化スコアリング法の有用性の検討
研究の概要: 本研究はDOAC内服予定者と健常者を対象に、DOAC内服前後に薬物動態関連因子を血液で評価するとともに、糞便を使用して腸内細菌叢を調べ、内視鏡検査で胃内の評価を行う侵襲を伴う介入研究、DOACを内服して早期消化管腫瘍に対してESDを施行した症例を抽出し、薬物動態関連因子と腸内細菌叢との関連性を調べる軽度の侵襲を伴う観察研究を行う予定である。
令和５年度は、ガイドラインに準拠して早期癌に対して内視鏡的粘膜下層剥離術を施行したDOAC内服患者を対象に、内視鏡治療後の消化管出血に対するDOACの薬理学的な影響に関する検討を行い、内視鏡治療後の出血には高齢であること抗凝固作用が高い症例が高リスク群であることを証明した。

Current Status of Research Progress

2: Research has progressed on the whole more than it was originally planned.

Reason

全国規模の多施設共同前向き研究を立ち上げ、(1)ガイドラインに準拠して早期癌に対して内視鏡的粘膜下層剥離術(ESD)を施行したDOAC内服患者、あるいは(2)大腸ポリープに対するEMRを施行したDOC内服患者を対象に、内視鏡治療後の消化管出血に対するDOACの薬理学的な影響に関する検討を行っている。それぞれの臨床研究に全国15施設以上が本研究に参加し、目標症例数に達して解析を行なっている。ESD研究は論文も学術誌に掲載され、現在はEMR研究につきDOACの血中濃度、DOACの代謝に関連する遺伝子多型の測定、抗Xa活性などの測定の測定を行い、今後は解析作業を行う段階になっている。

Strategy for Future Research Activity

全国規模の多施設共同前向き研究として十二指腸Vater乳頭切開術における検討を行なっており、次年度は残りの集積を行う予定である。前研究と同様に集積後はDOACの血中濃度、DOACの代謝に関連する遺伝子多型の測定、抗Xa活性などの測定の測定を行う予定である。

Research Products

• [Journal Article] Association of direct oral anticoagulant and delayed bleeding with pharmacokinetics after endoscopic submucosal dissection (2024)
  • Author(s): Murata M, Sugimoto M, et al.
  • Journal Title: Gastrointest Endosc Volume: 99 Issue: 5 Pages: 721-732
  • DOI: 10.1016/j.gie.2023.11.048
  • Peer Reviewed
• [Journal Article] Risk of map‐like redness development after eradication therapy for Helicobacter pylori infection (2024)
  • Author(s): Matsumoto Sho、Sugimoto Mitsushige、Fukuzawa Masakatsu、Uesugi Nana、Iwata Eri、Kagawa Yasuyuki、Madarame Akira、Koyama Yohei、Morise Takashi、Uchida Kumiko、Yamaguchi Hayato、Kono Shin、Naito Sakiko、Kawai Takashi、Itoi Takao
  • Journal Title: Helicobacter Volume: 29 Issue: 1
  • DOI: 10.1111/hel.13046
  • Peer Reviewed
• [Journal Article] Improvement in dyspeptic symptoms after Helicobacter pylori eradication therapy in Japanese (2023)
  • Author(s): Iwata E, Sugimoto M, et al.
  • Journal Title: JGH Open Volume: 7 Issue: 12 Pages: 855-862
  • DOI: 10.1002/jgh3.12986
  • Peer Reviewed / Open Access
• [Journal Article] Assessment of delayed bleeding after endoscopic submucosal dissection of early-stage gastrointestinal tumors in patients receiving direct oral anticoagulants (2023)
  • Author(s): Sugimoto M, et al.
  • Journal Title: World J Gastroenterologist Volume: 29 Issue: 19 Pages: 2916-2931
  • DOI: 10.3748/wjg.v29.i19.2916
  • Peer Reviewed / Open Access
• [Journal Article] Efficacy of high-vision transnasal endoscopy using texture and colour enhancement imaging and narrow-band imaging to evaluate gastritis: a randomized controlled trial (2022)
  • Author(s): Sugimoto M, Kawai Y, Morino Y, Hamada M, Iwata E, Niikura R, Nagata N, Koyama Y, Fukuzawa M, Itoi T, Kawai T
  • Journal Title: Annals of Medicine Volume: 54 Issue: 1 Pages: 1004-1013
  • DOI: 10.1080/07853890.2022.2063372
  • Peer Reviewed / Open Access
• [Journal Article] Third-generation high-vision ultrathin endoscopy using texture and color enhancement imaging and narrow-band imaging to evaluate Barrett’s esophagus (2022)
  • Author(s): Sugimoto M, Kawai Y, Akimoto Y, Hamada M, Iwata E, Murata M, Mizuno H, Niikura R, Nagata N, Fukuzawa M, Itoi T, Kawai T
  • Journal Title: Diagnostics Volume: 12 Issue: 12 Pages: 3149-3149
  • DOI: 10.3390/diagnostics12123149
  • Peer Reviewed / Open Access
• [Journal Article] Using texture and color enhancement imaging to evaluate gastrointestinal diseases in clinical practice: A review (2022)
  • Author(s): Sugimoto M, Koyama Y, Itoi T, Kawai T
  • Journal Title: Ann Med Volume: 54 Issue: 1 Pages: 3315-3332
  • DOI: 10.1080/07853890.2022.2147992
  • Peer Reviewed / Open Access
• [Journal Article] Association between dyspeptic symptoms and endoscopic findings based on the Kyoto classification of gastritis in Japanese male (2022)
  • Author(s): Takahashi K、Sugimoto M、Kawai Y、Hamada M、Iwata E、Niikura R、Nagata N、Fukuzawa M、Itoi T、Ohtsubo T、Kawai T
  • Journal Title: Journal of Clinical Biochemistry and Nutrition Volume: 70 Issue: 1 Pages: 79-85
  • DOI: 10.3164/jcbn.21-79
  • NAID: 130008139102
  • ISSN: 0912-0009, 1880-5086
  • Peer Reviewed / Open Access
• [Journal Article] Risk factors and prediction of bleeding after gastric endoscopic submucosal dissection in patients on anti­thrombotic therapy: newly developed bleeding prediction application software, SAMURAI model (2022)
  • Author(s): Hakoda A, Takeuchi T, Kojima Y, Fujiwara Y, Naito Y, Fukuda S, Koike T, Sugimoto M, Hamada K, Kobara H, Yoshida N, Inaba T, Nagahara A, Koizumi E, Murakami K, Furuta T, Ogasawara N, Isomoto H, Shibagaki K, Kataoka H, Suzuki H, Higuchi K
  • Journal Title: Journal of Clinical Biochemistry and Nutrition Volume: 70 Issue: 2 Pages: 189-196
  • DOI: 10.3164/jcbn.21-136
  • NAID: 130008165944
  • ISSN: 0912-0009, 1880-5086
  • Peer Reviewed / Open Access
• [Journal Article] Linked color imaging effectively detects the endoscopic atrophic border in transnasal endoscopy (2022)
  • Author(s): Kawai Y, Sugimoto M, Hamada M, Iwata E, Niikiura R, Nagata N, Fukuzawa M, Itoi T, Kawai T
  • Journal Title: Journal of Clinical Biochemistry and Nutrition Volume: 70 Issue: 3 Pages: 290-296
  • DOI: 10.3164/jcbn.21-145
  • NAID: 130008150361
  • ISSN: 0912-0009, 1880-5086
  • Peer Reviewed / Open Access
• [Journal Article] Validation of the BEST-J score, a prediction model for bleeding after endoscopic submucosal dissection for early gastric cancer: a multicenter retrospective observational study (2022)
  • Author(s): Kagawa Y, Fukuzawa M, Sugimoto M, Madarame A, Yamaguchi H, Uchida K, Morise T, Koyama Y, Sugimoto A, Yamauchi Y, Kono S, Naito S, Yamamoto K, Kishimoto Y, Inuyama M, Kawai T, Itoi T
  • Journal Title: Surgical Endoscopy Volume: - Issue: 10 Pages: 7240-7249
  • DOI: 10.1007/s00464-022-09096-y
  • Peer Reviewed / Open Access
• [Journal Article] The degree of mucosal atrophy is associated with post‐endoscopic submucosal dissection bleeding in early gastric cancer (2022)
  • Author(s): Hayashi Y, Hatta W, Tsuji Y, Yoshio T, Kakushima N, Hoteya S, Doyama H, Nagami Y, Hikichi T, Kobayashi M, Morita Y, Sumiyoshi T, Iguchi M, Tomida H, Inoue T, Mikami T, Hasatani K, Nishikawa J, Matsumura T, Nebiki H, Nakamatsu D, Ohnita K, Suzuki H, Ueyama H, Sugimoto M, Fujishiro M, Masamune A, Takehara T
  • Journal Title: Journal of Gastroenterology and Hepatology Volume: - Issue: 5 Pages: 870-877
  • DOI: 10.1111/jgh.15793
  • Peer Reviewed / Open Access
• [Journal Article] Prediction of depth of invasion and lymph node metastasis in superficial pharyngeal cancer by magnifying endoscopy using the Japan Esophageal Society Classification (2022)
  • Author(s): Yamaguchi H, Kawai T, Fukuzawa M, Nemoto D, Kagawa Y, Kono S, Naito S, Sato H, Nagata N, Sugimoto M, Tsukahara K, Itoi T
  • Journal Title: DEN open Volume: 3 Issue: 1
  • DOI: 10.1002/deo2.151
  • Peer Reviewed / Open Access
• [Journal Article] The present status and the future of ultrathin endoscopy (2022)
  • Author(s): Kawai T, Kawai Y, Hamada M, Iwata E, Niikura R, Nagata N, Yanagisawa K, Sugimoto M, Fukuzawa M, Yamagishi T, Itoi T
  • Journal Title: Dig Endoscopy Volume: 34 Issue: 6 Pages: 1110-1120
  • DOI: 10.1111/den.14297
  • Peer Reviewed / Open Access
• [Journal Article] Efficacy of a third-generation high-vision ultrathin endoscope for evaluating gastric atrophy and intestinal metaplasia in Helicobacter pylori-eradicated patients (2022)
  • Author(s): Uematsu J, Sugimoto M, Hamada M, Iwata E, Niikura R, Nagata N, Fukuzawa M, Itoi T, Kawai T
  • Journal Title: J Clin Med Volume: 11 Issue: 8 Pages: 2198-2198
  • DOI: 10.3390/jcm11082198
  • Peer Reviewed / Open Access
• [Journal Article] Effectiveness of second-look endoscopy after gastric endoscopic submucosal dissection in patients taking antithrombotic agents: a multicenter propensity score matching analysis (2022)
  • Author(s): Iwatsubo T, Takeuchi T, Hakoda A, Fujiwara Y, Nagami Y, Naito Y, Dohi O, Fukuda S, Sawaya M, Koike T, Kin S, Sugimoto M, Murata M, Okada H, Hamada K, Kobara H, Chiyo T, Yoshida N, Tomatsuri N, Inaba T, Kawai Y, Nagahara A, Ueyama H, Iwakiri K, Koizumi E, Murakami K, Mizukami K, Furuta T, Suzuki T, Kasugai K, et al.
  • Journal Title: Gastric cancer Volume: 25 Issue: 5 Pages: 916-926
  • DOI: 10.1007/s10120-022-01303-y
  • Peer Reviewed / Open Access
• [Journal Article] Bleeding following endoscopic submucosal dissection for early gastric cancer in surgically altered stomach (2022)
  • Author(s): Odagiri H, Hatta W, Tsuji Y, Yoshio T, Yabuuchi Y, Kikuchi D, Tsuji S, Nagami Y, Hikichi T, Kobayashi M, Morita Y, Sumiyoshi T, Iguchi M, Tomida H, Inoue T, Mikami T, Hasatani K, Nishikawa J, Matsumura T, Nebiki H, Nakamatsu D, Ohnita K, Suzuki H, Ueyama H, Hayashi Y, Sugimoto M, Yamaguchi S,et al.
  • Journal Title: Digestion Volume: 103 Issue: 6 Pages: 428-437
  • DOI: 10.1159/000526865
  • Peer Reviewed / Open Access
• [Journal Article] Investigation of the new advantages of colonoscope insertion with an endoscopic position detection unit (2022)
  • Author(s): Kawai T, Kawai Y, Akiyama Y, Hamada M, Iwata E, Niikura R, Nagata N, Sugimoto M, Yanagisawa K, Yamagishi T, Fukuzawa M, Itoi T
  • Journal Title: Diagnostics Volume: 12 Issue: 11 Pages: 2610-2610
  • DOI: 10.3390/diagnostics12112610
  • Peer Reviewed / Open Access
• [Journal Article] Influence of hospital volume on bleeding after endoscopic submucosal dissection for early gastric cancer in Japan: a multicenter propensity score-matched analysis (2021)
  • Author(s): Yabuuchi Y, Hatta W, Tsuji Y, Yoshio T, Kakushima N, Hoteya S, Doyama H, Nagami Y, Hikichi T, Kobayashi M, Morita Y, Sumiyoshi T, Iguchi M, Tomida H, Inoue T, Mikami T, Hasatani K, Nishikawa J, Matsumura T, Nebiki H, Nakamatsu D, Ohnita K, Suzuki H, Ueyama H, Hayashi Y, Sugimoto M, Fujishiro M, Masamune A, Ono H
  • Journal Title: Surgical Endoscopy Volume: - Issue: 6 Pages: 4004-4013
  • DOI: 10.1007/s00464-021-08721-6
  • Peer Reviewed / Open Access
• [Journal Article] A Questionnaire-Based Survey on the Impact of the COVID-19 Pandemic on Gastrointestinal Endoscopy in Asia (2021)
  • Author(s): Otani K, Watanabe T, Higashimori A, Suzuki H, Kamiya T, Shiotani A, Sugimoto M, Nagahara A, Fukudo S, Motoya S, Yamaguchi S, Zhu Q, Chan Francis K.L., Hahm K, Tablante M.C, Prachayakul V, Abdullah M, Ang T. L, Murakami K,The International Gastrointestinal Consensus Symposium Study Group
  • Journal Title: Digestion Volume: 103 Issue: 1 Pages: 7-21
  • DOI: 10.1159/000520287
  • Peer Reviewed / Open Access / Int'l Joint Research
• [Journal Article] Long‐term improvement in constipation‐related symptoms after Helicobacter pylori eradication therapy (2021)
  • Author(s): Murata M、Sugimoto M、Miyamoto S、Kawai T
  • Journal Title: Helicobacter Volume: 27 Issue: 1
  • DOI: 10.1111/hel.12863
  • Peer Reviewed / Open Access
• [Journal Article] Treatment strategies for reducing early and late recurrence of colonic diverticular bleeding based on stigmata of recent hemorrhage: a large multicenter study (2021)
  • Author(s): Suguro GM, Nagata N, Kobayashi K, Yamauchi A, Yamada A, Omori J, Ikeya T, Aoyama T, Tominaga N, Sato Y, Kishino T, Ishii N, Sawada T, Murata M, Takao A, Mizukami K, Kinjo K, Fujimori S, Uotani T, Fujita M, Sato H, Suzuki S, Narasaka T, Uemura N, Itawa E, Sugimoto M, Fukuzawa M, Kawai T, Kaise M, Itoi T
  • Journal Title: Gastrointestinal Endoscopy Volume: - Issue: 6 Pages: 1210-1222
  • DOI: 10.1016/j.gie.2021.12.023
  • Peer Reviewed / Open Access
• [Journal Article] Risk Factors for Bleeding After Endoscopic Submucosal Dissection for Gastric Cancer in Elderly Patients Older Than 80 Years in Japan (2021)
  • Author(s): Sugimoto M, Hatta W, Tsuji Y, Yoshio T, Yabuuchi Y, Hoteya S, Doyama H, Nagami Y, Hikichi T, Kobayashi M, Morita Y, Sumiyoshi T, Iguchi M, Tomida H, Inoue T, Mikami T, Hasatani K, Nishikawa J, Matsumura T, Nebiki H, Nakamatsu D, Ohnita K, Suzuki H, Ueyama H, Hayashi Y, Murata M, Fujishiro M, Masamune A, Kawai T
  • Journal Title: Clinical and Translational Gastroenterology Volume: 12 Issue: 9 Pages: e00404-e00404
  • DOI: 10.14309/ctg.0000000000000404
  • NAID: 120007172343
  • Peer Reviewed / Open Access
• [Journal Article] Risk of reflux-related symptoms and reflux esophagitis after Helicobacter pylori eradication treatment in the Japanese population (2021)
  • Author(s): Sugimoto M, Murata T, Iwata E, Nagata N, Itoi T, Kawai T
  • Journal Title: J Clin Med Volume: 10 Issue: 7 Pages: 1334-1334
  • DOI: 10.3390/jcm10071434
  • Peer Reviewed / Open Access
• [Journal Article] Co-treatment with endoscopic laryngopharyngeal surgery and endoscopic submucosal dissection (2021)
  • Author(s): Yamaguchi H、Sato H、Tsukahara K、Kagawa Y、Okamoto I、Shimizu A、Nagata N、Fukuzawa M、Sugimoto M、Kawai T、Itoi T
  • Journal Title: Auris Nasus Larynx Volume: 48 Issue: 3 Pages: 457-463
  • DOI: 10.1016/j.anl.2020.10.003
  • Peer Reviewed
• [Journal Article] Rebleeding in patients with delayed bleeding after endoscopic submucosal dissection for early gastric cancer (2021)
  • Author(s): Hashimoto M, Hatta W, Tsuji Y, Yoshio T, Yabuuci Y, Hoteya S, Doyama H, Nagami Y, Hikichi T, Kobayashi M, Morita Y, Sumiyoshi T, Iguchi M, Tomida H, Inoue T, Mikami T, Hasatani K, Nishikawa J, Matsumura T, Nebiki H, Nakamatsu D, Ohnita K, Suzuki H, Ueyama H, Hayashi Y, Sugimoto M, Fujishiro M, Masamune A, Ohira H
  • Journal Title: Digestive Endoscopy Volume: 33 Issue: 7 Pages: 1120-1130
  • DOI: 10.1111/den.13943
  • Peer Reviewed
• [Journal Article] Timing of bleeding and thromboembolism associated with endoscopic submucosal dissection for gastric cancer in Japan (2021)
  • Author(s): Shiroma S, Hatta W, Tsuji Y, Yoshio T, Yabuuci Y, Hoteya S, Tsuji S, Nagami Y, Hikichi T, Kobayashi M, Morita Y, Sumiyoshi T, Iguchi M, Tomida H, Inoue T, Mikami T, Hasatani K, Nishikawa J, Matsumura T, Nebiki H, Nakamatsu D, Ohnita K, Suzuki H, Ueyama H, Hayashi Y, Sugimoto M, Fujishiro M, Masamune A, Fujisaki J
  • Journal Title: Journal of Gastroenterology and Hepatology Volume: 36 Issue: 10 Pages: 2769-2777
  • DOI: 10.1111/jgh.15536
  • Peer Reviewed
• [Journal Article] Influence of Cytochrome P450 2C19 Genotype on Helicobacter pylori Proton Pump Inhibitor-Amoxicillin-Clarithromycin Eradication Therapy: A Meta-Analysis (2021)
  • Author(s): Morino Y、Sugimoto M、Nagata N、Niikiura R、Iwata E、Hamada M、Kawai Y、Fujimiya T、Takeuchi H、Unezaki S、Kawai T
  • Journal Title: Frontiers in Pharmacology Volume: 12
  • DOI: 10.3389/fphar.2021.759249
  • Peer Reviewed / Open Access
• [Journal Article] Cumulative evidence for reducing recurrence of colonic diverticular bleeding using endoscopic clipping versus band ligation: Systematic review and meta-analysis. (2020)
  • Author(s): Nagata N, Niikura R, Ishii N, Kaise M, Omata F, Tominaga N, Kitagawa T, Ikeya T, Kobayashi K, Furumoto Y, Narasaka T, Iwata E, Sugimoto M, Itoi T, Uemura N, Kawai T.
  • Journal Title: Journal of Gastroenterology and Hepatology Volume: Epub Issue: 7 Pages: 1738-1743
  • DOI: 10.1111/jgh.15370
  • Peer Reviewed / Open Access
• [Presentation] 直接作用型経口抗凝固薬内服者における内視鏡的粘膜下層剥離術後出血の薬理学的予測因子の探索的研究 (2024)
  • Author(s): 杉本光繁
  • Organizer: 第44回 日本臨床薬理学会学術総会
• [Presentation] 直接作用型経口抗凝固薬内服者における内視鏡的粘膜下層剥離術後出血の薬理学的予測因子の探索的研究 (2023)
  • Author(s): 杉本光繁
  • Organizer: 第19回日本消化管学会総会学術集会
• [Presentation] Evidence-based eradication strategy for H. pylori infection in Japan: Up-dated clinical guideline (2023)
  • Author(s): Mitsushige Sugimoto
  • Organizer: The 19th Korea-Japan Joint Symposium on Helicobacter Research
  • Int'l Joint Research / Invited
• [Presentation] 第三世代経鼻内視鏡を使用した胃癌高危険群の拾い上げにおける画像強調画像の有用性:ランダム化比較試験 (2022)
  • Author(s): 杉本光繁、濱田麻梨子、岩田英里、新倉量太、永田尚義、河合 隆
  • Organizer: 第28回日本ヘリコバクター学会学術集会
• [Presentation] 新規画像強調画像TXIモードを使用した経鼻内視鏡検査によるH. pylori除菌後胃癌高危険群の拾い上げの検討: ランダム化比較試験 (2022)
  • Author(s): 杉本光繁、河合 隆
  • Organizer: JDDW 2022
• [Presentation] H. pylor除菌治療後の逆流性食道炎発症リスク (2021)
  • Author(s): 杉本光繁
  • Organizer: 第27回日本ヘリコバクター学会学術集会
• [Presentation] 85歳以上の超高齢者に対する 早期胃癌ESD後出血のリスク因子の検討: 多施設共同研究 (2021)
  • Author(s): 杉本光繁
  • Organizer: JDDW 2021