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国立がん研究センター 中央病院

Home > Clincal depts. > Department of Endoscopy, Gastrointestinal Endoscopy Division

Department of Endoscopy, Gastrointestinal Endoscopy Division

Yutaka Saito, Takahisa Matsuda, Ichiro Oda, Yasuo Kakugawa, Takeshi Nakajima, Shigetaka Yoshinaga, Haruhisa Suzuki, Satoru Nonaka, Taku Sakamoto, Seiichiro Abe, Minori Matsumoto, Masayoshi Yamada, Masau Sekiguchi (Gastrointestinal Endoscopy, National Cancer Center Hospital)
Yuji Matsumoto, Takaaki Tsuchida, Takehiro Izumo (Bronchoscopy)

Introduction

Our Endoscopy Division moved to the New Endoscopy Center from 20th January 2014 and we believe this is currently the biggest Endoscopy Center in Japan (15 Endoscopy Rooms (251.112m2) and 136.788m2, and Recovery Rooms on two floors of 1,949.554m2).

The total number of nursing staff increased to 15, and three endoscopy engineers are working with us.

The Gastrointestinal Endoscopy Division has 12 staff physicians in the National Cancer Center Hospital and in the Screening Technology and Development Division, 4 chief residents, 15 residents, 4 trainees and several rotating residents.

The Bronchoscopy Division has three staff members and one resident doctor, and the total number of bronchoscopies and therapeutic procedures has been dramatically increased.

Dramatic developments have recently changed the operational mechanism and design of endoscopes along with a variety of accessory devices and instruments, so clinical applications using the latest equipment are evolving on a continuous basis. In the Gastrointestinal Endoscopy Division, more advanced and technically difficult endoscopic treatments such as endoscopic submucosal dissection (ESD) are being used in place of conventional endoscopic mucosal resection (EMR) not only for early gastric cancer, but also for superficial esophageal and colorectal neoplasms. In addition, educational activities are an important part of our division's activities with many Japanese medical students, residents and staff physicians as well as approximately 100 overseas post-graduate physicians attending our training courses annually.

Routine Activities in GI Endoscopy

Various diagnostic techniques including chromoendoscopy, magnifying endoscopy and endoscopic ultrasonography (EUS) are used to detect and evaluate early malignant lesions. Capsule endoscopy also has been accepted as being far less invasive. In our facility, small intestine capsule endoscopy has been performed since 2005. In order to obtain more accurate endoscopic diagnosis of gastrointestinal disease, we routinely use the recently developed narrow-band imaging (NBI) system. A total of 12,478, 4,450, 537, 97, 250, 83 and 120 screening and/or diagnostic procedures by gastroscopy, colonoscopy, EUS, EUS-fine needle aspiration (EUS-FNA), endoscopic retrograde cholangiopancreatography (ERCP), capsule endoscopy and double balloon endoscopies, respectively, were performed in 2015 (Table 1).

Due to the increasing number of patients with superficial gastrointestinal neoplasms, the number of therapeutic endoscopy procedures is also increasing in this field. In 2015, 2,667 endoscopic resections were carried out (pharynx 9, esophagus 159, stomach 370, duodenum 25 and colon 2,104). Among these, ESD, which was developed for large en-bloc resections with a low-risk of local recurrence, was performed for 91 superficial esophageal cancers, 370 early gastric cancers and 206 superficial colorectal neoplasms. For colorectal ESDs and some esophageal ESDs, the newly developed ball-tip bipolar needle knife (B-knife) and IT-knife nano were used together with CO2 insufflation. Our colleagues originally developed these procedures and devices.


Table 1. Chronological Trend of Total number of Diagnostic and Therapeutic Gastrointestinal Endoscopic Procedures


ESD achieves a higher en-bloc resection rate compared to the standard EMR technique and is less invasive than a surgical operation while EUS FNA provides a less invasive procedure to improve diagnosis for patients with pancreatic tumors, lymph-node swelling, submucosal tumors of the GI tract, etc.

Image-reading conferences are held regularly and we attend all clinical conferences in the Surgery, Oncology, Radiology and Pathology Divisions to discuss and decide on treatment strategies.

Clinical activities in GI Endoscopy (Figure 1)

Our efforts have been focused on new diagnostic and therapeutic strategies. For more accurate endoscopic diagnosis of gastrointestinal disease, we are utilizing the NBI system that enables us to narrow the spectral transmittance bandwidth of the optical filters used in the light source of electronic endoscope systems. In addition, we have conducted a trial study on an autofluorescence imaging (AFI) system. This system can identify lesions based on differences in tissue fluorescence properties and reveal gastrointestinal neoplasms that are not detectable with conventional endoscopy.

Image-enhanced Endoscopy:Detection-Diagnosis-Treatment

Figure 1. Endoscopic Diagnosis Using Image-enhanced Endoscopy (High-resolution Endoscopy, Narrowband Imaging and Autofluorescence Imaging) and Endoscopic Submucosal Dissection (ESD) Procedure for Treating Early Colon Cancer

Clinical trials in GI Endoscopy

We have organized several multicenter study groups in order to evaluate the efficacy and clinical impact of newly developed endoscopies and medical devices prospectively.

Esophagus

A multicenter clinical trial is under way to identify the proper surveillance after EMR for superficial esophageal squamous cell carcinoma. Our Division has cooperated as a participating institution in a phase II study on the efficacy of EMR combined with chemo-radiotherapy for clinical stage I esophageal carcinoma (JCOG 0508). In addition, we are currently enrolling our patients in two multicenter randomized controlled trials. First, a phase II/III study has been introduced to compare endoscopic balloon dilatation combined with steroids to radial incision and cutting combined with steroids for refractory anastomotic stricture after esophagectomy (JCOG1207: RICS study). Second, a phase III study is ongoing to compare oral steroid administration to local steroid injection therapy for the prevention of esophageal stricture after endoscopic submucosal dissection (JCOG1217: Steroid EESD P3).

In collaboration with TWins (Tokyo Women's Medical University), we are going to conduct a clinical trial of cell sheet-based regenerative medicine, which could reduce complications such as severe stenosis and perforation related to intensive balloon dilations. This cell sheet-base regenerative medicine is one of innovation in the gastrointestinal field and we believe that cell-based regenerative medicine would be useful to improve the quality of life of patients after esophageal ESD.

Stomach

A nationwide cancer registry system has been developed for early gastric cancer treated with EMR/ESD. A five-year multicenter prospective cohort study has been ongoing using this cancer registry system since 2010 (J-WEB/EGC). Our division has also cooperated as a participating institution in phase II trials of endoscopic submucosal dissection to expand the indications for early gastric cancer (JCOG 0607) (JCOG1009/1010).

In a recent translational study, it was shown that Helicobacter pylori (H. pylori) infection induces methylation of CpG islands in non-cancerous mucosae and the methylation level in H. pylori negative patients is closely associated with the risk of gastric cancer. A multicenter prospective observational study has confirmed the usefulness of the methylation level as a risk marker for metachronous gastric cancer after EMR/ESD followed by H. pylori eradication. Since 2015, a multicenter prospective observational study has been started to demonstrate the usefulness of the methylation level as a risk marker for gastric cancer developing after H. pylori eradication in healthy people. In addition, we are currently enrolling our patients in two multicenter randomized controlled trials. First, a CONNECT-G trial has been introduced to investigate the usefulness of endoclip connecting dental floss (DFC) during gastric ESD that have a potential efficacy making a better view by traction with DFC. Second, a randomized controlled trial is ongoing to compare the second generation Narrow Band Imaging with White Light Imaging for detection of early gastric cancer (EGC Detection Trial).

Pancreas

We prospectively evaluated the efficacy and safety of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) for pancreatic solid lesions in multicenters in Japan. This study was designed as a prospective cohort study conducted at the following five hospitals in Japan: National Cancer Center Hospital, Tokyo Medical University, Aichi Cancer Center Hospital, Gifu University Hospital and Fukushima Medical University Aizu Medical Center. Two hundred and forty-nine patients were enrolled from November 2011 to June 2013. Diagnostic sensitivity of EUS-FNA in this study was 97.2%. Diagnostic specificity, accuracy, positive predictive value and negative predictive value were 88.0%, 96.2%, 100%, 81.4%, respectively. Complication after seven days was 1.6%. We could confirm the efficacy, and the safety of EUS-FNA for pancreatic solid lesions is quite satisfied.

Colorectum

RCTs concerning colorectal neoplasms are also ongoing.

The Japan Polyp Study (JPS) was started in February 2003. The JPS is a multicenter RCT designed to evaluate colorectal cancer surveillance strategies in patients who have undergone complete colonoscopies on two occasions with the removal of all detected neoplasia including flat and depressed lesions using a high-resolution colonoscope. Finally, about 4,000 patients have been enrolled in this study. This multicenter RCT is completed and analysis of data will help to develop future recommendations for surveillance guidelines in Japan after the excision of polyps including flat and depressed lesions.

Little is known about the long-term outcomes of patients with submucosal invasive colorectal cancer who undergo endoscopic or surgical resection. We performed a retrospective analysis of long-term outcomes of patients treated for submucosal colon and rectal cancer. We collected data from 549 patients with submucosal colon cancer and 209 with submucosal rectal cancer who underwent endoscopic or surgical resection at 6 institutions, over a median follow-up period of 60.5 months. We assessed recurrence rates, fiveyear disease-free survival, and five-year overall survival. As a result, of patients treated with only endoscopic resection, the risk for local recurrence was significantly higher in high-risk patients with submucosal rectal cancer than patients with submucosal colon cancer. The addition of surgery is therefore recommended for patients with submucosal rectal cancer with pathology features indicating a high risk of tumor progression (Gastroenterology 2012). Considering this study result, we have just started a prospective cohort study for the possibility of chemo-radiotherapy for high-risk rectal submucosal cancer after endoscopic resections.

A nationwide cancer registry system has also been developed for early colorectal cancer treated with ESD. A five-year multicenter prospective cohort study has been ongoing using this cancer registry system since 2013. A total of 2,066 patients were enrolled to this multicenter cohort study and this should be the largest cohort study in colorectal ESD in the world.

Molecular and fluorescence Imaging and Database Study

Molecular imaging endoscopy is one of a new era for very early cancer diagnosis and detection of metastasis. We have just started a collaborative study between the Endoscopy Division, Colorectal and Gastric Surgery Division, Pathology Division, Research Institute, Tokyo University and Jikei University.

Probe-based confocal laser endomicroscopy (pCLE) allows real-time, in vivo high resolution imaging of the gastrointestinal epithelium at a cellular level. We are going to conduct a multicenter prospective study supported by the Japan Gastroenterological Endoscopy Society (JGES) to evaluate the diagnostic yield of pCLE for gastric neoplasms.

We have been collaborating with the Japan Gastroenterological Endoscopy Society (JGES) in order to build an All Japan Endoscopy Database (JED) of gastrointestinal endoscopies including not only therapeutic but also diagnostic procedures. This all Japan project is named JED and has the potential to construct the largest and most precise database of all endoscopic procedures. Japanese endoscopists are well known as most excellent endoscopists, and, therefore, from now, we can create a lot of evidence using this huge endoscopy database.

Colon Capsule Endoscopy

We conducted a multicenter prospective study to clarify the sensitivity of colon capsule endoscopy in detecting significant lesions compared with traditional colonoscopy and to evaluate its safety and acceptability in six facilities in Japan. Our study revealed that colon capsule endoscopy with a reduced preparation regimen was safe, with a sensitivity of 94% for detecting significant lesions, including laterally spreading tumors (LSTs). Until now, there has been limited information on the accuracy of colon capsule endoscopy for flat lesions, in particular LSTs, which are contributors to the development of colorectal cancer. Therefore, we think our study is noteworthy to practice colon capsule endoscopy in the screening setting in Japan. Colon capsule endoscopy was also safe and had a high level of patient acceptability. Our study was published in 2015 in gastrointestinal endoscopy (Gastrointestinal Endoscopy 2015).

List of papers published in 2015

Journal

  1. Sato C, Abe S, Saito Y, So Tsuruki E, Takamaru H, Makazu M, Sato Y, Sasaki H, Tanaka H, Ikezawa N, Yamada M, Sakamoto T, Nakajima T, Matsuda T, Kushima R, Kamiya M, Maeda S, Urano Y. A pilot study of fluorescent imaging of colorectal tumors using a γ-glutamyl-transpeptidase-activatable fluorescent probe. Digestion, 91:70-76, 2015
  2. Toyoshima N, Sakamoto T, Makazu M, Nakajima T, Matsuda T, Kushima R, Shimoda T, Fujii T, Inoue H, Kudo SE, Saito Y. Prevalence of serrated polyposis syndrome and its association with synchronous advanced adenoma and lifestyle. Mol Clin Oncol, 3:69-72, 2015
  3. Hotta K, Katsuki S, Ohata K, Abe T, Endo M, Shimatani M, Nagaya T, Kusaka T, Matsuda T, Uraoka T, Yamaguchi Y, Murakami Y, Saito Y. Efficacy and safety of endoscopic interventions using the short double-balloon endoscope in patients after incomplete colonoscopy. Dig Endosc, 27:95-98, 2015
  4. Nakamura F, Saito Y, Sakamoto T, Otake Y, Nakajima T, Yamamoto S, Murakami Y, Ishikawa H, Matsuda T. Potential perioperative advantage of colorectal endoscopic submucosal dissection versus laparoscopy-assisted colectomy. Surg Endosc, 29:596-606, 2015
  5. Nonaka S, Oda I, Tada K, Mori G, Sato Y, Abe S, Suzuki H, Yoshinaga S, Nakajima T, Matsuda T, Taniguchi H, Saito Y, Maetani I. Clinical outcome of endoscopic resection for nonampullary duodenal tumors. Endoscopy, 47:129-135, 2015
  6. Arezzo A, Matsuda T, Rembacken B, Miles WF, Coccia G, Saito Y. Piecemeal mucosectomy, submucosal dissection or transanal microsurgery for large colorectal neoplasm. Colorectal Dis, 171:44-51, 2015
  7. Yoshinaga S, Hilmi IN, Kwek BE, Hara K, Goda K. Current status of endoscopic ultrasound for the upper gastrointestinal tract in Asia. Dig Endosc, 271:2-10, 2015
  8. Sekiguchi M, Kushima R, Oda I, Suzuki H, Taniguchi H, Sekine S, Fukagawa T, Katai H. Clinical significance of a papillary adenocarcinoma component in early gastric cancer: a single-center retrospective analysis of 628 surgically resected early gastric cancers. J Gastroenterol, 50:424-434, 2015
  9. Morino M, Risio M, Bach S, Beets-Tan R, Bujko K, Panis Y, Quirke P, Rembacken B, Rullier E, Saito Y, Young-Fadok T, Allaix ME, European Association for Endoscopic Surgery, European Society of Coloproctology. Early rectal cancer: the European Association for Endoscopic Surgery (EAES) clinical consensus conference. Surg Endosc, 29:755-773, 2015
  10. Ikehara H, Saito Y, Uraoka T, Matsuda T, Miwa H. Specimen retrieval method using a sliding overtube for large colorectal neoplasm following endoscopic submucosal dissection. Endoscopy, 471:E168-E169, 2015
  11. Ikematsu H, Matsuda T, Osera S, Imajoh M, Kadota T, Morimoto H, Sakamoto T, Oono Y, Kaneko K, Saito Y. Usefulness of narrow-band imaging with dual-focus magnification for differential diagnosis of small colorectal polyps. Surg Endosc, 29:844-850, 2015
  12. Tanaka S, Kashida H, Saito Y, Yahagi N, Yamano H, Saito S, Hisabe T, Yao T, Watanabe M, Yoshida M, Kudo SE, Tsuruta O, Sugihara K, Watanabe T, Saitoh Y, Igarashi M, Toyonaga T, Ajioka Y, Ichinose M, Matsui T, Sugita A, Sugano K, Fujimoto K, Tajiri H. JGES guidelines for colorectal endoscopic submucosal dissection/endoscopic mucosal resection. Dig Endosc, 27:417-434, 2015
  13. Wada Y, Kudo SE, Tanaka S, Saito Y, Iishii H, Ikematsu H, Igarashi M, Saitoh Y, Inoue Y, Kobayashi K, Hisabe T, Tsuruta O, Kashida H, Ishikawa H, Sugihara K. Predictive factors for complications in endoscopic resection of large colorectal lesions: a multicenter prospective study. Surg Endosc, 29:1216-1222, 2015
  14. Urabe Y, Tanaka S, Saito Y, Igarashi M, Watanabe T, Sugihara K. Impact of revisions of the JSCCR guidelines on the treatment of T1 colorectal carcinomas in Japan. Z Gastroenterol, 53:291-301, 2015
  15. Uraoka T, Tanaka S, Oka S, Matsuda T, Saito Y, Moriyama T, Higashi R, Matsumoto T. Feasibility of a novel colonoscope with extra-wide angle of view: a clinical study. Endoscopy, 47:444-448, 2015
  16. Abe S, Council L, Cui X, Saito Y, Mönkemüller K. Endoscopic resection and enucleation of gastric submucosal tumor facilitated by subsequent closure of incision using over-the-scope clip. Endoscopy, 471:E153-E154, 2015
  17. Saito Y, Nakajima T, Sakamoto T, Yamada M, Matsuda T, Mönkemüller K. Clinical pathway to discharge three days after colorectal endoscopic submucosal dissection: For whom and for what purpose? Dig Endosc, 27:662-664, 2015
  18. Oka S, Tanaka S, Saito Y, Iishi H, Kudo SE, Ikematsu H, Igarashi M, Saitoh Y, Inoue Y, Kobayashi K, Hisabe T, Tsuruta O, Sano Y, Yamano H, Shimizu S, Yahagi N, Watanabe T, Nakamura H, Fujii T, Ishikawa H, Sugihara K, Colorectal Endoscopic Resection Standardization Implementation Working Group of the Japanese Society for Cancer of the Colon and Rectum, Tokyo, Japan. Local recurrence after endoscopic resection for large colorectal neoplasia: a multicenter prospective study in Japan. Am J Gastroenterol, 110:697-707, 2015
  19. Iacopini F, Saito Y, Yamada M, Grossi C, Rigato P, Costamagna G, Gotoda T, Matsuda T, Scozzarro A. Curative endoscopic submucosal dissection of large nonpolypoid superficial neoplasms in ulcerative colitis (with videos). Gastrointest Endosc, 82:734-738, 2015
  20. Bhatt A, Abe S, Kumaravel A, Vargo J, Saito Y. Indications and Techniques for Endoscopic Submucosal Dissection. Am J Gastroenterol, 110:784-791, 2015
  21. Saito Y, Saito S, Oka S, Kakugawa Y, Matsumoto M, Aihara H, Watari I, Aoyama T, Nouda S, Kuramoto T, Watanabe K, Ohmiya N, Higuchi K, Goto H, Arakawa T, Tanaka S, Tajiri H. Evaluation of the clinical efficacy of colon capsule endoscopy in the detection of lesions of the colon: prospective, multicenter, open study. Gastrointest Endosc, 82:861-869, 2015
  22. Abe S, Oda I, Mori G, Nonaka S, Suzuki H, Yoshianaga S, Saito Y. Complete endoscopic closure of a large gastric defect with endoloop and endoclips after complex endoscopic submucosal dissection. Endoscopy, 471:E374-E375, 2015
  23. Nonaka S, Kawaguchi Y, Oda I, Nakamura J, Sato C, Kinjo Y, Abe S, Suzuki H, Yoshinaga S, Sato T, Saito Y. Safety and effectiveness of propofol-based monitored anesthesia care without intubation during endoscopic submucosal dissection for early gastric and esophageal cancers. Dig Endosc, 27:665-673, 2015
  24. Mori G, Nonaka S, Oda I, Abe S, Suzuki H, Yoshinaga S, Nakajima T, Saito Y. Novel strategy of endoscopic submucosal dissection using an insulation-tipped knife for early gastric cancer: near-side approach method. Endosc Int Open, 3:E425-E431, 2015
  25. Kinjo Y, Nonaka S, Oda I, Abe S, Suzuki H, Yoshinaga S, Maki D, Yoshimoto S, Taniguchi H, Saito Y. The short-term and longterm outcomes of the endoscopic resection for the superficial pharyngeal squamous cell carcinoma. Endosc Int Open, 3:E266-E273, 2015
  26. Abe S, Oda I, Suzuki H, Nonaka S, Yoshinaga S, Nakajima T, Sekiguchi M, Mori G, Taniguchi H, Sekine S, Katai H, Saito Y. Long-term surveillance and treatment outcomes of metachronous gastric cancer occurring after curative endoscopic submucosal dissection. Endoscopy, 47:1113-1118, 2015
  27. Kanesaka T, Uedo N, Yao K, Ezoe Y, Doyama H, Oda I, Kaneko K, Kawahara Y, Yokoi C, Sugiura Y, Ishikawa H, Kato M, Takeuchi Y, Muto M, Saito Y. A significant feature of microvessels in magnifying narrow-band imaging for diagnosis of early gastric cancer. Endosc Int Open, 3:E590-E596, 2015
  28. Suzuki H, Oda I, Sekiguchi M, Abe S, Nonaka S, Yoshinaga S, Nakajima T, Saito Y. Management and associated factors of delayed perforation after gastric endoscopic submucosal dissection. World J Gastroenterol, 21:12635-12643, 2015
  29. Matsuda T, Ono A, Kakugawa Y, Matsumoto M, Saito Y. Impact of screening colonoscopy on outcomes in colorectal cancer. Jpn J Clin Oncol, 45:900-905, 2015
  30. Makazu M, Sakamoto T, So E, Otake Y, Nakajima T, Matsuda T, Kushima R, Saito Y. Relationship between indeterminate or positive lateral margin and local recurrence after endoscopic resection of colorectal polyps. Endosc Int Open, 3:E252-E257, 2015
  31. Oda I, Nonaka S, Abe S, Suzuki H, Yoshinaga S, Saito Y. Is there a need to shield ulcers after endoscopic submucosal dissection in the gastrointestinal tract? Endosc Int Open, 3:E152-E153, 2015
  32. Sakamoto T, Abe S, Nakajima T, Matsuda T, Nakamura F, Kowazaki H, Saito Y. Complete removal of a colonic neoplasm extending into a diverticulum with hybrid endoscopic submucosal dissection-mucosal resection and endoscopic band ligation. Endoscopy, 471:E295-E296, 2015
  33. Yoshinaga S, Oda I, Abe S, Nonaka S, Suzuki H, Takisawa H, Taniguchi H, Saito Y. Evaluation of the margins of differentiated early gastric cancer by using conventional endoscopy. World J Gastrointest Endosc, 7:659-664, 2015
  34. Emura F, Mejía J, Donneys A, Ricaurte O, Sabbagh L, Giraldo-Cadavid L, Oda I, Saito Y, Osorio C. Therapeutic outcomes of endoscopic submucosal dissection of differentiated early gastric cancer in a Western endoscopy setting (with video). Gastrointest Endosc, 82:804-811, 2015
  35. Sekiguchi M, Sekine S, Sakamoto T, Otake Y, Nakajima T, Matsuda T, Taniguchi H, Kushima R, Ohe Y, Saito Y. Excellent prognosis following endoscopic resection of patients with rectal neuroendocrine tumors despite the frequent presence of lymphovascular invasion. J Gastroenterol, 50:1184-1189, 2015
  36. Shirahige A, Suzuki H, Oda I, Sekiguchi M, Mori G, Abe S, Nonaka S, Yoshinaga S, Sekine S, Kushima R, Saito Y, Fukagawa T, Katai H. Fatal submucosal invasive gastric adenosquamous carcinoma detected at surveillance after gastric endoscopic submucosal dissection. World J Gastroenterol, 21:4385-4390, 2015
  37. Yamada M, Sakamoto T, Otake Y, Nakajima T, Kuchiba A, Taniguchi H, Sekine S, Kushima R, Ramberan H, Parra-Blanco A, Fujii T, Matsuda T, Saito Y. Investigating endoscopic features of sessile serrated adenomas/polyps by using narrow-band imaging with optical magnification. Gastrointest Endosc, 82:108-117, 2015
  38. Suzuki S, Gotoda T, Suzuki H, Kono S, Iwatsuka K, Kusano C, Oda I, Sekine S, Moriyasu F. Morphologic and Histologic Changes in Gastric Adenomas After Helicobacter pylori Eradication: A Long-Term Prospective Analysis. Helicobacter, 20:431-437, 2015
  39. Mochizuki S, Uedo N, Oda I, Kaneko K, Yamamoto Y, Yamashina T, Suzuki H, Kodashima S, Yano T, Yamamichi N, Goto O, Shimamoto T, Fujishiro M, Koike K, SAFE Trial Study Group. Scheduled second-look endoscopy is not recommended after endoscopic submucosal dissection for gastric neoplasms (the SAFE trial): a multicentre prospective randomised controlled non-inferiority trial. Gut, 64:397-405, 2015
  40. Kiriyama S, Naitoh H, Fukuchi M, Yuasa K, Horiuchi K, Fukasawa T, Tabe Y, Yamauchi H, Suzuki M, Yoshida T, Saito Y, Kuwano H. Evaluation of abdominal circumference and salivary amylase activities after unsedated colonoscopy using carbon dioxide and air insufflations. J Dig Dis, 16:747-751, 2015
  41. Abe S, Oda I, Nakajima T, Suzuki H, Nonaka S, Yoshinaga S, Sekine S, Taniguchi H, Kushima R, Iwasa S, Saito Y, Katai H. A case of local recurrence and distant metastasis following curative endoscopic submucosal dissection of early gastric cancer. Gastric Cancer, 18:188-192, 2015
  42. Watanabe T, Itabashi M, Shimada Y, Tanaka S, Ito Y, Ajioka Y, Hamaguchi T, Hyodo I, Igarashi M, Ishida H, Ishihara S, Ishiguro M, Kanemitsu Y, Kokudo N, Muro K, Ochiai A, Oguchi M, Ohkura Y, Saito Y, Sakai Y, Ueno H, Yoshino T, Boku N, Fujimori T, Koinuma N, Morita T, Nishimura G, Sakata Y, Takahashi K, Tsuruta O, Yamaguchi T, Yoshida M, Yamaguchi N, Kotake K, Sugihara K, Japanese Society for Cancer of the Colon and Rectum. Japanese Society for Cancer of the Colon and Rectum (JSCCR) Guidelines 2014 for treatment of colorectal cancer. Int J Clin Oncol, 20:207-239, 2015

Book

  1. Saito Y. Indication for colorectal ESD. In: Fukami N (ed), Endoscopic Submucosal Dissection, USA, Springer-Verlag New York, pp 19-24, 2015
  2. Higashi R, Uraoka T, Sakamoto T, Matsuda T, Fujii T, Horimatsu T, Saito Y, Aoki T, Wada Y, Kudo S, Sano W, Kotaka M, lwatate M, Katagiri A, lkematsu H, Ono Y, Watanabe K, Nishishita M, Yamagami H, Hattori S, Fujimori T, Machida H, Yamamoto Y, Nishisaki H, Sano Y. Atlas of neoplastic lesions. In: Muto M, Yao K, Sano Y (eds), Atlas of Endoscopy with Narrow Band Imaging, Japan, Springer Japan, pp 293-340, 2015