超拡大内視鏡を用いた内視鏡的組織診断法の確立と自動診断への応用

2008 Fiscal Year Annual Research Report

• Project/Area Number: 19790469
• Research Institution: The University of Tokyo
• Principal Investigator: 藤城 光弘 The University of Tokyo, 医学部・附属病院, 助教 (70396745)
• Keywords: 超拡大内視鏡 / 内視鏡的組織診断 / 内視鏡的自動診断 / 仮想生検 / 消化管腫瘍

Research Abstract

19年度に得られた知見では、超拡大内視鏡(450倍の拡大により細胞や核観察ができるレベルの拡大内視鏡)観察時の最適な染色液は、重層扁平上皮である食道と円柱上皮である胃、大腸では異なり、食道では1%メチレンブルー60秒染色が、胃、大腸では0.2%トルイジンブルー60秒染色が最適であるとの結論であった。ただ、ここで得られた知見は切除臓器によるものであったため、in vivo条件である全身麻酔下ビーグル犬で超拡大内視鏡観察を行ったところ、食道、大腸では安定した良好画像が得られたが、胃では切除臓器とは異なり、厚い粘液層の除去が不十分のためか、もしくは、持続的に粘液が産生されているためか、染色性が悪く細胞観察が不可能であった。以上から、20年度は、胃における前処置法の検討を第一に行ったが、蛋白分解酵素であるプロナーゼの使用をはじめ、様々な前処置を試行したにもかかわらず、生態観察では安定した良好画像を得ることができず、胃における超拡大内視鏡観察の更なる検討は断念せざるを得なかった。引き続き、20年度の残期間を利用して生体でも良好な画像が得られた食道における詳細な検討に移行した。ヒトにおいても切除臓器と生体観察の超拡大内視鏡所見が相同であることを確認した後、切除臓器を用いた検討から、水平断におけるH&E染色の病理所見と超拡大内視鏡所見が極めて類似しており、従来からの病理診断が超拡大内視鏡診断に応用可能であることを明らかにした。正常部では、均一な小型核を有する扁平上皮細胞が規則正しく配列している一方、癌部では、不均一の大型核を有する癌細胞が密に増殖して観察された。さらに、超拡大内視鏡観察で得られた画像の核密度をコンピューター解析することで、正常部と癌部を自動診断できる可能性があることを示唆する新知見も得られた。

Research Products

• [Journal Article] En bloc resection of cardia cancer and lipoma with endoscopic submucosal dissection (2009)
  • Author(s): Ono S, Fujishiro M, Goto O, K odashima S, Omata M
  • Journal Title: Digestive Liver Disease 41 Pages: 237
  • Peer Reviewed
• [Journal Article] Multi-center survey regarding the management of anticoagulation and antiplatelet therapy for endoscopic procedures in Japan (2009)
  • Author(s): Fujishiro M, Oda I, Yamamoto Y, Akiyama J, Ishii N, Kakushima N, Fujiwara J, Morishita S, Kawachi H, Taniguchi H, Gotoda T
  • Journal Title: Journal of Gastroenterology and Hepatology 24 Pages: 214-218
  • Peer Reviewed
• [Journal Article] Detailed comparison between endo-cytoscopy and horizontal histology of an esophageal intraepithelial squamous cell carcinoma (2008)
  • Author(s): Fujishiro M, Kodashima S, Takubo K, Kakushima N, Omata M
  • Journal Title: Disease of the Esophagus 21 Pages: 181-185
  • Peer Reviewed
• [Journal Article] Endoscopic submucosal dissection for gastric cancer (2008)
  • Author(s): Fujishiro M
  • Journal Title: Current Treatment Options in Gastroenterology 11 Pages: 119-124
  • Peer Reviewed
• [Journal Article] Endoscopic submucosal dissection as a staging measure may not lead to worse prognosis in early gastric cancer patients with additional gastrectomy (2008)
  • Author(s): Goto O, Fujishiro M, Kakushima N, Kodashima S, Ono S, Yamaguchi H, Nomura S, Kaminishi M, Omata M
  • Journal Title: Digestive Liver Diseasd 40 Pages: 293-297
  • Peer Reviewed
• [Journal Article] Cancer high-risk subjects identified by serum pepsinogen tests : outcomes after 10-year follow-up in asymptomatic middle-aged males. Cancer Epidemiol Biomarkers Prev (2008)
  • Author(s): Yanaoka K, Oka M, Mukoubayashi C, Yoshimura N, Enomoto S, Iguchi M, Magari H, Utsunomiya H, Tamai H, Arii Ohata H, Fujishiro M, Takeshita T, Mohara O. Ichinose M
  • Journal Title: Cancer Epidemiology, Biomarkers & Prevention 17 Pages: 838-845
  • Peer Reviewed
• [Journal Article] Efficacy and safety of endoscopic submucosal dissection for gastric cancer in patients with liver cirrhosis (2008)
  • Author(s): Ogura K, Okamoto M, Sugimoto T, Yahagi N, Fujishiro M, Kakushima N, Kodashima S, Kawabe T, Omata M
  • Journal Title: Endoscopy 40 Pages: 443-445
  • Peer Reviewed
• [Journal Article] Successful en bloc resection of superficial esophageal cancer treated by endoscopic submucosal dissection with a splash-needle(with video) (2008)
  • Author(s): Fujishiro M, Kodashima S, Goto O, Ono S, Muraki Y, Kakushima N, Omata M
  • Journal Title: Endoscopy 40 Pages: E81-82
  • Peer Reviewed
• [Journal Article] Feasibility of electrocautery snaring as the final step of endoscopic submuco sal dissection for stomach epithelial neoplasms (2008)
  • Author(s): Goto O, Fujishiro M, Kodashima S, Kakushima N, Ono S, Yahagi N, Omata M
  • Journal Title: Digestive Liver Disease 41 Pages: 26-30
  • Peer Reviewed
• [Journal Article] Endoscopic submucosal dissection for gastrointestinal neoplasms (2008)
  • Author(s): Kakushima N, Fujishiro M
  • Journal Title: World Journal of Gastroenterology 13. 14 Pages: 2362-2367
  • Peer Reviewed
• [Journal Article] Risk of gastric cancer in asymptomatic, middle-aged Japanese subjectsbased on serum pepsinogen and Helicobacter pylori antibody levels (2008)
  • Author(s): Yanaoka K, Oka M, Yoshimura N, Mukoubayashi C, Enomots S, Iguchi M, Isagari H, Utsunomiya H, Tamai H, Arii K, Yamamichi N, Fujishiro M, Takeshita T, Mohara O, Ichinose M
  • Journal Title: International Journal of Cancer 123 Pages: 917-926
  • Peer Reviewed
• [Journal Article] Early gastric cancer shows different associations with adipose tissue volume depending on histological type (2008)
  • Author(s): Otani K, Kitayama J, Kaisaki S, Ishigami H, Hidemura A, Fuiishiro M, Omata M, Nagawa H
  • Journal Title: Gastric Cancer 11 Pages: 86-95
  • Peer Reviewed
• [Journal Article] Perspective on the practical indications of endoscopic submucosal dissection of gastrointestinal neoplasms (2008)
  • Author(s): Fuiishiro M
  • Journal Title: World Journal of Gastroenterology 14 Pages: 4289-4295
  • Peer Reviewed
• [Journal Article] Submucosal injection of normal saline may prevent unexpected deep thermal injury of argon plasma coagulation in an in vivo porcine stomach (2008)
  • Author(s): Fujishiro M, Kodashima S, Ono S, Goto O, Yamamichi N, Yahagi N, Kashimura K, Matsuura T, Iguchi M, Oka M, Ichinose M, Omata M
  • Journal Title: Gut and Liver 2 Pages: 95-98
  • Peer Reviewed
• [Journal Article] Submerging endoscopic submucosal dissection leads to successful en bloc resection of colonic laterally spreading tumor with submucosal fat (2008)
  • Author(s): Ono S, Fujishiro M, Kodashima S, Goto O, Omata M
  • Journal Title: Gut and Liver 2 Pages: 209-212
  • Peer Reviewed
• [Journal Article] Technical feasibility of endoscopic submucosal dissection for the gastroi ntestinal epithelial neoplasms with a splash-needle (2008)
  • Author(s): Fujishiro M, Kodashima S, Goto O, Ono S, Muraki Y, Kakushima N, Omata M
  • Journal Title: Surgical Laparoscopy, Endoscopy & Percutaneous Techniques 18 Pages: 592-597
  • Peer Reviewed
• [Presentation] Is it possible to predict procedural time of endoscopic submucosal dissection for early gastric cancer? (2008)
  • Author(s): Goto O, Fujishiro M, Kodashima S, Ono S. Omata M
  • Organizer: United European Gastroenterology Week 2008
  • Place of Presentation: Vienna
  • Year and Date: 2008-10-21
• [Presentation] Treatment outcomes of endoscopic submucosal dissection for early gastric caneer in patients with anti-coagulants or anti-platelet agents (2008)
  • Author(s): Ono S, Fujishiro M, Kodashima S, Goto O.Omata M
  • Organizer: United European Gastroenterology Week 2008
  • Place of Presentation: Vienna
  • Year and Date: 2008-10-21
• [Presentation] Feasibility of electrocautery snaring as the final step of endoscopic submucos, dissection for stomach epithelial neoplasms (2008)
  • Author(s): Goto O, Fujishiro M, Kodashima S, Ono S, Omata M
  • Organizer: Digestive Disease Week 2008
  • Place of Presentation: San Diego
  • Year and Date: 2008-05-18
• [Book] Stomach. In : Conio M, Siersema P, Repici A, Ponchon T (Eds) : Endoscopic Mucosal Resection (2008)
  • Author(s): Kakushima N, Fujishiro M. Gotoda T
  • Total Pages: 15(97-111)
  • Publisher: Wiley-Blackwell, USA
• [Book] Current perspective on endocytoscopic diagnosis in the esophagus based on the multicenter study at the endoscopy forum Japan. In : Niwa H, Tajiri H, Nakajima M, Yasuda K (Eds) : New challenee in gastrointestinal endoscopy (2008)
  • Author(s): Fujishiro M
  • Total Pages: 6(95-100)
  • Publisher: Springer-Verlag Tokyo, Japan