Title Alternative Achalasia treated with per-oral endoscopic myotomy (POEM)
Author Sugihara, Yuusaku| Harada, Keita| Kato, Ryo| Yamauchi, Kenji| Takashima, Shiho| Takei, Daisuke| Inokuchia, Toshihiro| Takahara, Masahiro| Kawano, Seiji| Hiraoka, Sakiko| Tanabe, Shunsuke| Noma, Kazuhiro| Shirakawa, Yasuhiro| Manabe, Noriaki| Inoue, Haruhiro| Okada, Hiroyuki|
Abstract Esophageal achalasia is a disorder of the lower esophageal sphincter muscle. Patients present with dysphagia, chest pain, vomiting, and aspiration. Esophageal achalasia had traditionally been treated with esophageal achalasia balloon dilatation and the Heller-Dor method, but in recent years, the use of per-oral endoscopic myotomy (POEM) has increased. Our patient, a 39-yr-old male, began experiencing dysphagia 4 years prior to his referral to our hospital. Based on the results of esophagogastroduodenoscopy, esophageal radiography and high-resolution manometry, we made the diagnosis of esophageal achalasia (Chicago classification type I) . After informed consent from the patient and his family and approval from our hospital's ethics committee were obtained, we performed a POEM. The patient was discharged on the 4th day post-surgery. At the 1-year post-operative examination, no worsening of symptoms and no relapse were observed. POEM is an excellent treatment method for esophageal achalasia from the perspective of therapeutic effect and prevention of invasion. We recommend that it be considered as the first-choice treatment for achalasia. However, accessibility to the procedure itself is limited due to the few adequately trained operators worldwide. POEM should thus be performed by an expert operator at a high-volume center.
Keywords POEM 食道アカラシア (esophageal achalasia)
Publication Title Journal of Okayama Medical Association
Published Date 2017-08-01
Volume volume129
Issue issue2
Start Page 115
End Page 121
ISSN 0030-1558
Related Url https://doi.org/10.4044/joma.129.115
language 日本語
Copyright Holders Copyright (c) 2017 岡山医学会
File Version publisher
DOI 10.4044/joma.129.115
JaLCDOI 10.18926/AMO/54981
FullText URL 71_2_127.pdf
Author Shirakawa, Yasuhiro| Noma, Kazuhiro| Maeda, Naoaki| Tanabe, Shunsuke| Kuroda, Shinji| Kagawa, Shunsuke| Katsui, Kuniaki| Katayama, Norihisa| Kanazawa, Susumu| Fujiwara, Toshiyoshi|
Abstract Currently, chemoradiation is the most widely used nonsurgical treatment for esophageal cancer. However, some patients, particularly the very elderly or those with severe vital organ dysfunction, face difficulty with the chemotherapy component. We therefore examined the outcome of radiation therapy (RT) alone for patients with esophageal cancer at our facility. Between January 2005 and December 2014, 84 patients underwent RT at our hospital, and 78 of these patients received concomitant chemotherapy. The remaining 6 patients underwent RT alone; these patients were considered to be high-risk and to have no lymph node metastasis (stage I). Five of them received irradiation up to a curative dose: 4 showed a complete response (CR) and 1 showed a partial response (PR). Of the patients exhibiting CR, 3 are currently living recurrence-free, whereas 1 patient underwent endoscopic submucosal dissection (ESD) as salvage therapy for local recurrence, with no subsequent recurrence. High-risk stage I esophageal cancer patients can be treated radically with RT alone under certain conditions. In the future, to broaden the indications for RT monotherapy to include some degree of advanced cancers, a novel concurrent therapy should be identified.
Keywords esophageal cancer radiation therapy high-risk patient
Amo Type Original Article
Published Date 2017-04
Publication Title Acta Medica Okayama
Volume volume71
Issue issue2
Publisher Okayama University Medical School
Start Page 127
End Page 133
ISSN 0386-300X
NCID AA00508441
Content Type Journal Article
language 英語
Copyright Holders CopyrightⒸ 2017 by Okayama University Medical School
File Version publisher
Refereed True
PubMed ID 28420894
Title Alternative Thoracoscopic esophagectomy was effective in a case of lower esophageal stenosis due to recurrence of achalasia after myotomy 40 years previously
Author Katsura, Yuki| Shirakawa, Yasuhiro| Tanabe, Shunsuke| Maeda, Naomi| Noma, Kazuhiro| Fujiwara, Toshiyoshi|
Abstract When planning surgery for achalasia, it is important to plan for adequate myotomy and prevention of reflux. However, achalasia may recur if the procedure was inadequate or in patients with a long-term course. The present case is a 68-year-old woman who underwent myotomy of the lower esophageal sphincter 40 years ago, but recently reported difficulty in swallowing. Dilatation of the thoracic esophagus and stenosis of the abdominal esophagus were identified by examination, and the patient was diagnosed with recurrence of achalasia. After percutaneous endoscopic gastrostomy was performed to recover nutritional status, thoracoscopic esophagectomy was carried out. The patient'spost-operative course was uneventful and oral intake was enabled. At the time of writing, there has been no re-recurrence. There is no standard therapy for post-operative recurrence of achalasia. We believe that thoracoscopic esophagectomy for the recurrence of achalasia is a safe and minimally invasive alternative to conventional surgery.
Keywords 食道アカラシア (achalasia) 再手術 (reoperation) 食道亜全摘 (esophagectomy)
Publication Title Journal of Okayama Medical Association
Published Date 2017-04-03
Volume volume129
Issue issue1
Start Page 41
End Page 44
ISSN 0030-1558
language 日本語
Copyright Holders Copyright (c) 2017 岡山医学会
File Version publisher
DOI 10.4044/joma.129.41
Author Gotoda, Tatsuhiro| Kawano, Seiji| Kono, Yoshiyasu| Miura, Kou| Kanzaki, Hiromitsu| Iwamuro, Masaya| Kawahara, Yoshiro| Tanaka, Takehiro| Yoshino, Tadashi| Shirakawad, Yasuhiro| Tabata, Masahiro| Tanimoto, Mitsune| Okada, Hiroyuki|
Published Date 2016-12-01
Publication Title Journal of Okayama Medical Association
Volume volume128
Issue issue3
Content Type Journal Article
JaLCDOI 10.18926/AMO/54421
FullText URL 70_3_213.pdf
Author Kikuchi, Satoru| Kagawa, Shunsuke| Ohara, Toshiaki| Kubota, Tetsushi| Kuwada, Kazuya| Kagawa, Tetsuya| Kuroda, Shinji| Shirakawa, Yasuhiro| Nishizaki, Masahiko| Fujiwara, Toshiyoshi|
Abstract A 69-year-old man underwent endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) at the lesser curvature in the angle of stomach. Histological examination revealed tub1, pM, ly0, v0, pLM(-), pVM(-), and the resection was considered curative. The scar after ESD was followed by esophagogastroduodenoscopy (EGD) and biopsy. Twenty months later, EGD showed an ulcerative lesion in the vicinity of the ESD scar, and histological examination of the biopsy specimen showed adenocarcinoma. A distal gastrectomy with lymph node dissection was then performed. Postoperative pathology showed tub1, pM, pN0, ly0, v0, and Stage 1A. Skip lesions were seen in the specimen resected by ESD, and the histological review confirmed so-called “dysplasia-like atypia” (DLA) between the lesions. It has been reported recently that in DLA, the dysplasia-like change involves only the bases of the pits, without upper pit or surface epithelium involvement, and it is said that the rate of DLA is higher in gastric cancer patients. We speculated that a precancerous lesion close to the resected cancer developed into a local recurrence.
Keywords dysplasia-like atypia early gastric cancer endoscopic submucosal dissection local recurrence
Amo Type Case Report
Published Date 2016-06
Publication Title Acta Medica Okayama
Volume volume70
Issue issue3
Publisher Okayama University Medical School
Start Page 213
End Page 216
ISSN 0386-300X
NCID AA00508441
Content Type Journal Article
language 英語
Copyright Holders CopyrightⒸ 2016 by Okayama University Medical School
File Version publisher
Refereed True
PubMed ID 27339211
Web of Sience KeyUT 000379406100009
JaLCDOI 10.18926/AMO/53524
FullText URL 69_3_173.pdf
Author Shirakawa, Yasuhiro| Noma, Kazuhiro| Ohara, Toshiaki| Kashima, Hajime| Maeda, Naoaki| Tanabe, Shunsuke| Kagawa, Shunsuke| Fujiwara, Toshiyoshi|
Abstract A chyle leak can occur as a complication after neck or chest surgery. Such a leak prolongs the hospital stay and is sometimes life-threatening. The treatment options are conservative management, interventional radiologic embolization, and surgery. Thoracoscopic ligation of the thoracic duct has emerged as a promising and definitive treatment. The case of a 65-year-old Japanese male patient with a rare congenital right aortic arch (typeⅢB1 of Edwardʼs classification) and a severe chyle leak that occurred after a total pharyngolaryngo-esophagectomy (TPLE) is described. The chyle leak was successfully managed by thoracoscopic ligation of the thoracic duct via a left-side approach with the patient in the prone position.
Keywords chyle leak thoracic duct thoracoscopy prone position
Amo Type Case Report
Published Date 2015-06
Publication Title Acta Medica Okayama
Volume volume69
Issue issue3
Publisher Okayama University Medical School
Start Page 173
End Page 176
ISSN 0386-300X
NCID AA00508441
Content Type Journal Article
language 英語
Copyright Holders CopyrightⒸ 2015 by Okayama University Medical School
File Version publisher
Refereed True
PubMed ID 26101193
Web of Sience KeyUT 000356903000006
Author Kikuchi, Satoru| Kishimoto, Hiroyuki| Tazawa, Hiroshi| Hashimoto, Yuuri| Kuroda, Shinji| Nishizaki, Masahiko| Nagasaka, Takeshi| Shirakawa, Yasuhiro| Kagawa, Shunsuke| Urata, Yasuo| Robert M Hoffman| Fujiwara, Toshiyoshi|
Published Date 2014-12-19
Publication Title Molecular Therapy
Content Type Journal Article
Author Yamada, Eiji| Shirakawa, Yasuhiro| Yamatsuji, Tomoki| Sakuma, Leon| Takaoka, Munenori| Yamada, Takako| Noma, Kazuhiro| Sakurama, Kazufumi| Fujiwara, Yasuhiro| Tanabe, Shunsuke| Nagasaka, Takeshi| Fujiwara, Toshiyoshi| Naomoto, Yoshio|
Published Date 2012-12
Publication Title Journal of Surgical Research
Volume volume178
Issue issue2
Content Type Journal Article
Author Yano, Shuya| Tazawa, Hiroshi| Hashimoto, Yuuri| Shirakawa, Yasuhiro| Kuroda, Shinji| Nishizaki, Masahiko| Kishimoto, Hiroyuki| Uno, Futoshi| Nagasaka, Takeshi| Urata, Yasuo| Kagawa, Shunsuke| Hoffman, Robert M.| Fujiwara, Toshiyoshi|
Published Date 2013-12-01
Publication Title Clinical Cancer Research
Volume volume19
Issue issue23
Content Type Journal Article
JaLCDOI 10.18926/AMO/52407
FullText URL 68_2_111.pdf
Author Shirakawa, Yasuhiro| Noma, Kazuhiro| Maeda, Naoaki| Katsube, Ryoichi| Tanabe, Shunsuke| Ohara, Toshiaki| Sakurama, Kazufumi| Fujiwara, Toshiyoshi|
Abstract Thoracoscopic esophagectomy in the prone position (TEPP) might enable solo-surgery in cases requiring resection of the esophagus and the surrounding lymph nodes due to the associated advantages of good exposure of the surgical field and ergonomic considerations for the surgeon. However, no one approach can be for all patients requiring extensive lymphadenectomy. We recently developed an assistant-based procedure to standardize exposure of the surgical field. Patients were divided into 1 of 2 groups:a pre-standardization group (n=37) and a post-standardization group (n=28). The thoracoscopic operative time was significantly shorter (p=0.0037) in the post-standardization group (n=28; 267±31min) than in the pre-standardization group (n=37;301±53min). Further, learning curve analysis using the moving average method showed stabilization of the thoracoscopic operative time after the standardization. No significant differences were found in the number of mediastinal lymph nodes dissected or intraoperative blood loss between the 2 groups. There were also no significant differences in the complication rate. Assistant-based surgery and standardization of the procedure resulted in a well-exposed and safe surgical field. TEPP decreased the operative time, even in patients requiring extensive lymphadenectomy.
Keywords thoracoscopic esophagectomy prone position standardization
Amo Type Original Article
Published Date 2014-04
Publication Title Acta Medica Okayama
Volume volume68
Issue issue2
Publisher Okayama University Medical School
Start Page 111
End Page 117
ISSN 0386-300X
NCID AA00508441
Content Type Journal Article
language 英語
Copyright Holders CopyrightⒸ 2014 by Okayama University Medical School
File Version publisher
Refereed True
PubMed ID 24743786
Web of Sience KeyUT 000334652700006
Author Fujiwara, Y.| Yamada, T.| Naomoto, Y.| Yamatsuji, T.| Shirakawa, Y.| Tanabe, S.| Noma, K.| Kimura, T.| Aoki, H.| Matsukawa, H.| Kimura, M.| Nonaka, Y.| Sasaki, H.| Onoda, T.| Otawa, Y.| Takaoka, M.| Fukazawa, T.| Ohno, Y.| Fujiwara, T.|
Published Date 2013-12
Publication Title Journal of Hospital Infection
Volume volume85
Issue issue4
Content Type Journal Article
Title Alternative A patient with primary malignant melanoma of the esophagus who underwent esophagectomy
FullText URL 126_45.pdf
Author Maeda, Naoaki| Shirakawa, Yasuhiro| Koujima, Takeshi| Ohara, Toshiaki| Tanabe, Shunsuke| Noma, Kazuhiro| Sakurama, Kazuhumi| Fujiwara, Toshiyosi|
Abstract  We report the case of a 61-old-man with a primary malignant melanoma of the esophagus, an extremely rare and highly aggressive malignancy. He presented with dysphagia, and we performed an upper gastrointestinal endoscopy that detected a tumor in the thoracic part of the esophagus. The biopsy showed malignant melanoma. PET/CT, endoscopy and an esophagogram showed that a 70-mm scaled type 2+1 tumor in the thoracic esophagus and no metastases. We diagnosed a cT3cN0cM0 cStage II tumor. We then performed a subtotal esophagectomy with two-field lymph node dissection and esophagogastrostomy via a retrosternal route. The pathological examination of the resected specimens confirmed that the type 2+1 tumor was PMME (pT2N0M0 pStage II). We administered six courses of postoperative adjuvant chemotherapy with dacarbazine, and the patient has had no recurrence for 17 months after the surgery.
Keywords 食道(esophagus) 悪性黒色腫(malignant melanoma)
Publication Title 岡山医学会雑誌
Published Date 2014-04-01
Volume volume126
Issue issue1
Start Page 45
End Page 48
ISSN 0030-1558
Related Url http://www.okayama-u.ac.jp/user/oma/
language 日本語
Copyright Holders Copyright (c) 2014 岡山医学会
File Version publisher
DOI 10.4044/joma.126.45
Title Alternative Complete response of primary esophageal endocrine cell carcinoma resected after neoadjuvant chemotherapy with docetaxel/cisplatin/5-fluorouracil
FullText URL 126_39.pdf
Author Maeda, Naoaki| Shirakawa, Yasuhiro| Koujima, Takeshi| Ohara, Toshiaki| Tanabe, Shunsuke| Noma, Kazuhiro| Sakurama, Kazuhumi| Fujiwara, Toshiyosi|
Abstract  Esophageal endocrine cell carcinoma is extremely rare. We report a case of esophageal endocrine cell carcinoma showing histological complete response to neoadjuvant chemotherapy with docetaxel/cisplatin/5-fluorouracil (DCF). A 66-year-old man had been experiencing epigastralgia, and a type 2 tumor in the thoracic part of esophagus was detected by upper endoscopy. The biopsy showed endocrine cell carcinoma. PET/CT, endoscopy and an esophagogram showed that the patient had a 70-mm scaled type 2 tumor in the middle thoracic esophagus, and they also revealed lymph node metastases (no. 106recR). We diagnosed a cT3cN1cM0 cStage III tumor. With two courses of DCF treatment, both the primary tumor and lymph node metastases showed a partial response. We performed a subtotal esophagectomy with three-field lymph node dissection. The pathological examination of the resected specimens revealed no malignant cells in the esophagus or lymph nodes, and we concluded that the pathological effect of the DCF treatment was Grade 3.
Keywords 食道癌(esophageal cancer) 内分泌細胞癌(endocrine cell carcinoma) DCF療法(DCF treatment)
Publication Title 岡山医学会雑誌
Published Date 2014-04-01
Volume volume126
Issue issue1
Start Page 39
End Page 43
ISSN 0030-1558
Related Url http://www.okayama-u.ac.jp/user/oma/
language 日本語
Copyright Holders Copyright (c) 2014 岡山医学会
File Version publisher
DOI 10.4044/joma.126.39
Author Nishikawa, Toshio| Takaoka, Munenori| Ohara, Toshiaki| Tomono, Yasuko| Hao, Huifang| Bao, Xiaohong| Fukazawa, Takuya| Wang, Zhigang| Sakurama, Kazufumi| Fujiwara, Yasuhiro| Motoki, Takayuki| Shirakawa, Yasuhiro| Yamatsuji, Tomoki| Tanaka, Noriaki| Fujiwara, Toshiyoshi| Naomoto, Yoshio|
Published Date 2013-03
Publication Title Cancer Biology & Therapy
Volume volume14
Issue issue3
Content Type Journal Article
Author Yoshida, Ryosuke| Tazawa, Hiroshi| Hashimoto, Yuuri| Yano, Shuya| Onishi, Teppei| Sasaki, Tsuyoshi| Shirakawa, Yasuhiro| Kishimoto, Hiroyuki| Uno, Futoshi| Nishizaki, Masahiko| Kagawa, Shunsuke| Fujiwara, Toshiyoshi|
Published Date 2012-11
Publication Title Cancer Immunology, Immunotherapy
Volume volume61
Issue issue11
Content Type Journal Article
Author Tanabe, Shunsuke| Shirakawa, Yasuhiro| Maeda, Naoaki| Ohara, Toshiaki| Noma, Kazuhiro| Sakurama, Kazufumi| Yanai, Hiroyuki| Yamatsuji, Tomoki| Naomoto, Yoshio| Fujiwara, Toshiyoshi|
Published Date 2012-08-01
Publication Title 岡山医学会雑誌
Volume volume124
Issue issue2
Content Type Journal Article
Author Kuroda, Shinji| Fujiwara, Toshiya| Shirakawa, Yasuhiro| Yamasaki, Yasumoto| Yano, Syuya| Uno, Futoshi| Tazawa, Hiroshi| Hashimoto, Yuuri| Watanabe, Yuichi| Noma, Kazuhiro| Urata, Yasuo| Kagawa, Shunsuke| Fujiwara, Toshiyoshi|
Published Date 2011-08-01
Publication Title 岡山医学会雑誌
Volume volume123
Issue issue2
Content Type Journal Article
Author Watanabe, Nobuyuki| Takaoka, Munenori| Sakurama, Kazufumi| Tomono, Yasuko| Hatakeyama, Shinji| Ohmori, Osamu| Motoki, Takayuki| Shirakawa, Yasuhiro| Yamatsuji, Tomoki| Haisa, Minoru| Matsuoka, Junji| Beer, David G.| Nagatsuka, Hitoshi| Tanaka, Noriaki| Naomoto, Yoshio|
Published Date 2010-04-01
Publication Title 岡山医学会雑誌
Volume volume122
Issue issue1
Content Type Journal Article
Author Kusuhara, Toshimasa| Nakamura, Takao| Mori, Keiko| Yamamoto, Yoshitake| Shirakawa, Yasuhiro| Naomoto, Yoshio|
Published Date 2004-12-15
Publication Title 岡山大学医学部保健学科紀要
Volume volume15
Issue issue1
Content Type Departmental Bulletin Paper
Author Matsuoka, Junji| Naomoto, Yoshio| Tabata, Masahiro| Shirakawa, Yasuhiro| Hotta, Katsuyuki| Tanimoto, Mitsune| Tanaka, Noriaki|
Published Date 2009-04-01
Publication Title 岡山医学会雑誌
Volume volume121
Issue issue1
Content Type Journal Article