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

2009 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, 准教授 (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

内視鏡受診者の約15%が生検不能な抗血栓薬内服中である高齢化社会を迎え、生検無しで瞬時に診断が可能な超拡大内視鏡診断、さらに病理学知識のない内視鏡医でも診断可能な自動診断の確立が望まれる。本研究では、光学顕微鏡と同様の原理で観察可能な超拡大内視鏡による最適観察条件の検討よりはじめ、最適な染色液は、食道(重層扁平上皮)では1%メチレンブルー60秒染色が、胃、大腸(円柱上皮)では0.2%トルイジンブルー60秒染色であるとの結論を得た。切除臓器での本検討を生体ビーグル犬に適用したところ、食道、大腸では安定した良好画像が得られたが、胃では各種蛋白分解酵素を前処置に用いるも厚い粘液層の影響で観察条件が安定せず、胃における更なる検討は断念し、以後は食道を中心に検討を行った。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、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るため、超拡大内視鏡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た。本研究期間中、超拡大内視鏡自体に、鉗子口から挿入するプローブタイプ(従来型)から通常拡大内視鏡に組み込まれた一体型内視鏡への技術革新がみられ、従来型画像と一体型内視鏡画像の相同性を確認し、実際の臨床例において、通常白色光観察、NBI観察、拡大観察、本超拡大観察により、食道における良悪性の質的診断、範囲診断、深達度診断が可能であることをパイロット的に確認した。今後は臨床例の集積による更なる有用性の検討と自動診断法の確立を行う予定である。

Research Products

• [Journal Article] Multi-center survey regarding the management of anticoagulation and anti platelet 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: J Gastroenterol Hepatol 24 Pages: 214-218
  • Peer Reviewed
• [Journal Article] Endoscopic submucosal dissection for esophageal squamous cell neoplasms (2009)
  • Author(s): Fujishiro M, Kodashima S, Goto O, Ono S, Niimi K, Yamamichi N, Oka M, Ichinose M, Omata M
  • Journal Title: Dig Endosc. 21 Pages: 109-115
  • Peer Reviewed
• [Journal Article] Indications, techniques, and outcomes of endoscopic submucosal dissection for esophageal squamous cell carcinoma (2009)
  • Author(s): Fujishiro M, Kodashima S
  • Journal Title: Esophagus 6 Pages: 143-148
  • Peer Reviewed
• [Journal Article] Japan aims toward appropriate concomitant use of antiplatelets and antis ecretory aaents? (2009)
  • Author(s): Fujishiro M
  • Journal Title: Internal Medicine 48 Pages: 1845-1846
  • Peer Reviewed
• [Journal Article] Endoscopic submucosal dissection for colorectal neoplasms (2009)
  • Author(s): Fujishiro M
  • Journal Title: World J Gastrointest Endosc 1 Pages: 32-38
  • Peer Reviewed
• [Journal Article] Locked nucleic acid in situ hybridization analysis of miR-21 expression during colorectal cancer development (2009)
  • Author(s): Yamamichi N, Shimomura R, Inada K, Sakurai K, Haraguchi T, Ozaki Y, Fujita S, Mizutani T, Furukawa C, Fujishiro M, Ichinose M, Shiogama K, Tsutsumi Y, Omata M, Iba H
  • Journal Title: Clin Cancer Res 15 Pages: 4009-4016
  • Peer Reviewed
• [Journal Article] Cdx2 and the Brm-type SWI/SNF complex cooperatively regulate villin expression in gastrointestinal cells (2009)
  • Author(s): Yamamichi N, Inada K, Furukawa C, Sakurai K, Tando T, Ishizaka A, Haraguchi T, Mizutani T, Fujishiro M, Shimomura R, Oka M, Ichinose M, Tsutsumi Y, Omata M, Iba H
  • Journal Title: Exp Cell Res. 315 Pages: 1779-1789
  • Peer Reviewed
• [Journal Article] Novel image-enhanced endoscopy with i-scan technology (2009)
  • Author(s): Kodashima S, Fujishiro M
  • Journal Title: World J Gastroenterol. 16 Pages: 1043-1049
  • Peer Reviewed
• [Journal Article] Endoscopic submucosal dissection for colonic laterally spreading tumors is difficult after target tattooing (2009)
  • Author(s): Ono S, Fujishiro M, Goto O, Kodashima S.Omata M
  • Journal Title: Gastrointest Endosc 69 Pages: 763-766
  • Peer Reviewed
• [Journal Article] Technical feasibility of endoscopic submucosal dissection for early gastric cancer in patients taking anti-coagulants or anti-platelet agents (2009)
  • Author(s): Ono S, Fujishiro M, Niimi K, Goto O, Kodashima S, Yamamichi N.Omata M
  • Journal Title: Dig Liver Dis 41 Pages: 725-728
  • Peer Reviewed
• [Journal Article] Long-term outcomes of endoscopic submucosal dissection for superficial esophageal squamous cell neoplasms (2009)
  • Author(s): Ono S, Fujishiro M, Niimi K, Goto O, Kodashima S, Yamamichi N, Omata M
  • Journal Title: Gastrointest Endosc 70 Pages: 860-866
  • Peer Reviewed
• [Journal Article] Predictors of postoperative stricture after esophageal endoscopic submucosal dissection for superficial squamous cell neoplasms (2009)
  • Author(s): Ono S, Fujishiro M, Niimi K, Goto O, Kodashima S, Yamamichi N, Omata M
  • Journal Title: Endoscopy. 41 Pages: 661-665
  • Peer Reviewed
• [Journal Article] Retrospective analysis on the management of anticoagulants and antiplatelet agents for scheduled endoscopy (2009)
  • Author(s): Ono S, Fujishiro M, Hirano K, Niimi K, Goto O, Kodashima S, Yamamichi N, Koike K
  • Journal Title: J Gastroenterol. 44 Pages: 1185-1189
  • Peer Reviewed
• [Journal Article] En bloc resection of cardia cancer and lipoma with endoscopic submucosal dissection (2009)
  • Author(s): Ono S, Fujishiro M, Goto O, Kodashima S, Omata M
  • Journal Title: Dig Liver Dis. 41 Pages: 237
  • Peer Reviewed
• [Journal Article] Curative ESD for intraepithelial esophageal carcinoma with leiomyoma mimicking submucosal invasive carcinoma (2009)
  • Author(s): Niimi K, Kodashima S, Ono S, Goto O, Yamamichi N, Fujishiro M
  • Journal Title: World J Gastrointest Endosc 1 Pages: 68-71
  • Peer Reviewed
• [Journal Article] Subserosal injection of hyaluronic acid may prevent perforation after end oscopic resection (2009)
  • Author(s): Niimi K, Kodashima S, Ono S, Goto O, Yamamichi N, Fujishiro M
  • Journal Title: World J Gastrointest Endosc 1 Pages: 61-64
  • Peer Reviewed
• [Journal Article] Feasibility of electrocautery snaring as the final step of endoscopic submucosal dissection for stomach epithelial neoplasms (2009)
  • Author(s): Goto O, Fujishiro M, Kodashima S, Kakushima N, Ono S, Yahagi N, Omata M
  • Journal Title: Dig Liver Dis 41 Pages: 26-30
  • Peer Reviewed
• [Journal Article] Is it possible to predict procedural time of endoscopic submucosal dissection for early gastric cancer? (2009)
  • Author(s): Goto O, Fujishiro M, Kodashima S, Ono S, Omata M
  • Journal Title: J Gastroenterol Hepatol. 24 Pages: 379-383
  • Peer Reviewed
• [Journal Article] A second-look endoscopy after endoscopic submucosal dissection(ESD)for gastric epithelial neoplasm may be unnecessary : a retrospective analysis of post-ESD bleeding (2009)
  • Author(s): Goto O, Fujishiro M, Kodashima S, Ono S, Niimi K, Hirano K, Yamamichi N, Koike K
  • Journal Title: Gastrointest Endosc 71 Pages: 241-248
  • Peer Reviewed
• [Journal Article] Outcomes of endoscopic submucosal dissection for early gastric cancer with special reference to validation for curability criteria (2009)
  • Author(s): Goto O, Fujishiro M, Kodashima S, Ono S, Omata M
  • Journal Title: Endoscopy 41 Pages: 118-122
  • Peer Reviewed
• [Presentation] A second-look endoscopy after endoscopic submucosal dissection(ESD)for gastric epithelial neoplasm may be unnecessary : a retrospective analysis of post-ESD bleeding (2009)
  • Author(s): Osamu Goto, Mitsuhiro Fujishiro
  • Organizer: UEGW
  • Place of Presentation: Londono, イギリス
  • Year and Date: 2009-11-21
• [Presentation] s it necessary for elderly population to undergo additional colonoscopy after negative colonoscopy? (2009)
  • Author(s): Keiko Niimi, Mitsuhiro Fujishiro
  • Organizer: UEGW
  • Place of Presentation: London, イギリス
  • Year and Date: 2009-11-21
• [Presentation] A More Effect System for Gastric Cancer Screening Using the Combination Assay of Serum Anti-Helico-Bacter pylori IgG Antibody and Serum Peosinogen Levels (2009)
  • Author(s): Mitsuhiro Fujishiro
  • Organizer: American College of Gastroenterology
  • Place of Presentation: San Diego, USA
  • Year and Date: 2009-10-26
• [Presentation] Long-term outcomes of endoscopic submucosal dissection for superficial esophageal squamous cell carcinoma (2009)
  • Author(s): Satoshi Ono, Mitsuhiro Fujishiro
  • Organizer: DDW
  • Place of Presentation: Chicago, USA
  • Year and Date: 2009-05-31