Details of a Researcher - Mikami, Yohei

Papers - Mikami, Yohei

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Radiomics prediction of surgery in ulcerative colitis refractory to medical treatment

Sakamoto K., Okabayashi K., Seishima R., Shigeta K., Kiyohara H., Mikami Y., Kanai T., Kitagawa Y.

Techniques in Coloproctology 29 ( 1 ) 113 2025.12

ISSN 11236337

Background: The surgeries in drug-resistant ulcerative colitis are determined by complex factors. This study evaluated the predictive performance of radiomics analysis on the basis of whether patients with ulcerative colitis in hospital were in the surgical or medical treatment group by discharge from hospital. Methods: This single-center retrospective cohort study used CT at admission of patients with US admitted from 2015 to 2022. The target of prediction was whether the patient would undergo surgery by the time of discharge. Radiomics features were extracted using the rectal wall at the level of the tailbone tip of the CT as the region of interest. CT data were randomly classified into a training cohort and a validation cohort, and LASSO regression was performed using the training cohort to create a formula for calculating the radiomics score. Results: A total of 147 patients were selected, and data from 184 CT scans were collected. Data from 157 CT scans matched the selection criteria and were included. Five features were used for the radiomics score. Univariate logistic regression analysis of clinical information detected a significant influence of severity (p < 0.001), number of drugs used until surgery (p < 0.001), Lichtiger score (p = 0.024), and hemoglobin (p = 0.010). Using a nomogram combining these items, we found that the discriminatory power in the surgery and medical treatment groups was AUC 0.822 (95% confidence interval (CI) 0.841–0.951) for the training cohort and AUC 0.868 (95% CI 0.729–1.000) for the validation cohort, indicating a good ability to discriminate the outcomes. Conclusions: Radiomics analysis of CT images of patients with US at the time of admission, combined with clinical data, showed high predictive ability regarding a treatment strategy of surgery or medical treatment.

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Gut Microbiota and Interorgan Communication among the Gut, Brain, and Beyond.

Shigehara A, Kiyohara H, Teratani T, Nakamoto N, Mikami Y, Kanai T

Internal medicine (Tokyo, Japan) 2025.05

ISSN 0918-2918

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Post-marketing surveillance of tofacitinib in patients with ulcerative colitis in Japan: a final report of safety and effectiveness data

Matsuoka, K; Motoya, S; Yamamoto, T; Matsuura, M; Fujii, T; Shinzaki, S; Mikami, Y; Arai, S; Oshima, J; Endo, Y; Yuasa, H; Hoshi, M; Sato, K; Hisamatsu, T

JOURNAL OF GASTROENTEROLOGY 2025.04

ISSN 0944-1174

Background: We present the final analysis of a tofacitinib post-marketing surveillance (PMS) study in Japanese patients with ulcerative colitis (UC). Methods: Safety/effectiveness data were evaluated (through Sept/30/2022). All patients with UC in Japan receiving tofacitinib were registered (60-week observation period). Adverse events (AEs) were recorded. Per protocol, several AEs were identified as clinically important/potential risks; all treatment-period data were used to calculate incidence rates (IRs; unique patients with events/100 patient-years [PY] of exposure). Effectiveness was assessed (partial/total Mayo score), with last observation carried forward for imputation of missing data. Results: Overall, 2043 patients were enrolled (safety analysis set: n = 1982/effectiveness analysis set: n = 1969). Data were excluded for 13 patients from two hospitals from which consent was not obtained for publication and which, therefore, were not permitted for publication. AEs and serious AEs were observed in 33.4% and 5.2% of patients, respectively; one death occurred (intestinal abscess). Herpes zoster (HZ; non-serious and serious) was the most reported infection (n = 92 [IR 5.93/100 PY, 95% confidence interval 4.78, 7.27]). Serious infection, malignancy, cardiovascular and venous thromboembolic events IRs were 1.51/100 PY, 0.62/100 PY, 0.13/100 PY, and 0.31/100 PY, respectively. Overall, 52.4% of patients discontinued treatment, mostly due to inadequate clinical response (48.9%). At Week 60, 1151/1969 patients (58.5%) achieved partial Mayo score remission. Conclusion: The overall safety profile was generally comparable with tofacitinib data from PMS reports from Japan, worldwide and the tofacitinib UC clinical program. However, HZ IR was higher than in the tofacitinib UC clinical program. Tofacitinib effectiveness was consistent with data from the tofacitinib UC clinical program. ClinicalTrials.gov: NCT03643211.

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Factors Contributing to the Efficacy of Fecal Microbiota Transplantation for Diarrhea-Dominant Functional Bowel Disorders

Yamane, T; Masaoka, T; Ishii, C; Masuoka, H; Suda, W; Kurokawa, S; Kishimoto, T; Mikami, Y; Fukuda, S; Kanai, T

DIGESTION 1 - 11 2025.04

ISSN 0012-2823

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The gut–organ axis: Clinical aspects and immune mechanisms

Fukasawa N., Tsunoda J., Sunaga S., Kiyohara H., Nakamoto N., Teratani T., Mikami Y., Kanai T.

Allergology International 74 ( 2 ) 197 - 209 2025.04

ISSN 13238930

The gut-brain axis exemplifies the bidirectional connection between the intestines and the brain, as evidenced by the impact of severe stress on gastrointestinal symptoms including abdominal pain and diarrhea, and conversely, the influence of abdominal discomfort on mood. Clinical observations support the notion of the gut–brain connection, including an increased prevalence of inflammatory bowel disease (IBD) in patients with depression and anxiety, as well as the association of changes in the gut microbiota with neurological disorders such as multiple sclerosis, Parkinson's disease, stroke and Alzheimer's disease. The gut and brain communicate via complex mechanisms involving inflammatory cytokines, immune cells, autonomic nerves, and gut microbiota, which contribute to the pathogenesis in certain gut and brain diseases. Two primary pathways mediate the bidirectional information exchange between the intestinal tract and the brain: signal transduction through bloodstream factors, such as bacterial metabolites and inflammatory cytokines, and neural pathways, such as neurotransmitters and inflammatory cytokines within the autonomic nervous system through the interaction between the nerve cells and beyond. In recent years, the basic mechanisms of the pathophysiology of the gut-brain axis have been gradually elucidated. Beyond the gut-brain interaction, emerging evidence suggests the influence of the gut extends to other organs, such as the liver and lungs, through intricate inter-organ communication pathways. An increasing number of reports on this clinical and basic cross-organ interactions underscore the potential for better understanding and novel therapeutic strategies targeting inter-organs networks. Further clarification of interactions between multiorgans premises transformative insights into cross-organ therapeutic strategies.

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First-line biologics as a treatment for ulcerative colitis: a multicenter randomized control study

Naganuma M., Shiga H., Shimoda M., Matsuura M., Takenaka K., Fujii T., Yamamoto S., Matsubayashi M., Kobayashi T., Aoyama N., Saito D., Yokoyama K., Moriya K., Tsuchiya K., Shibui S., Kawamoto A., Shimizu H., Okamoto R., Sakamoto K., Yaguchi K., Kunisaki R., Akiyama S., Hayashi R., Hasui K., Kanmura S., Bamba S., Mishima Y., Kakimoto K., Sugimoto S., Nakazawa A., Abe T., Ogata H., Hisamatsu T., Matsuoka K., Omori T., Nakase H., Wagatsuma K., Uchiyama K., Takagi T., Fujiya M., Ueno N., Sasaki M., Takashima Y., Nanjyo S., Handa O., Shiotani A., Kanai T., Mikami Y., Sujino T., Kiyohara H., Nakamura S., Miyazaki T., Ishihara S., Andoh A., Sakuraba H., Tanaka S., Oka S., Takasago K., Kobayashi K., Betto T., Otsuka K., Nagahori M., Saito E., Fukata N.

Journal of Gastroenterology 60 ( 4 ) 430 - 441 2025.04

ISSN 09441174

Background: Despite the availability of several biologics for ulcerative colitis (UC), there remains a critical need to identify first-line treatment biologics. The superiority of infliximab (IFX) over vedolizumab (VED) and ustekinumab (UST) was evaluated as initial UC treatments in patients with biologic-naïve UC. Methods: This multicenter, randomized control trial was conducted across 20 Japanese medical institutions. An independent center randomly allocated patients with UC (Mayo score ≥ 6) who had not previously used biologics to three treatment groups (IFX, VED, UST). The primary endpoint was the clinical remission (CR) rate at week 12, with other endpoints including the treatment continuation rate at week 26 and adverse events (AEs). Results: From May 2021 to June 2023, 107 cases were registered, including 104 for safety and 97 for efficacy evaluation. CR rate at week 12 was 36.4% (95%CI:20.4–54.9), 32.4% (95%CI:17.4–50.5) and 43.3% (95%CI:25.5–62.6) in IFX, VED, and UST group, respectively. Continuation rates at week 26 were 50.0%(IFX), 58.3% (VED), and 82.4% (UST). AEs related to study medication were 14.7% (IFX), 16.7% (VED), and 5.9% (UST). Predictors for CR at week 12 were thiopurine use in IFX (p = 0.04), lower baseline Mayo score (p = 0.007), and lower Patient report outcome 2 (p = 0.003) at week 2 in VED. Conclusion: Due to small sample size, it is challenging to make conclusions for main endpoints from this study while our study suggested that use of thiopurines in IFX group and lower activity at enrollment in VED group may enhance treatment efficacy. (jRCT1031200329; available at https://jrct.niph.go.jp/).

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Feasibility of anticancer treatment using scalp cooling for patients with gynecological cancer in Japan: A case series study

Oki, S; Ishihara, Y; Takahashi, S; Kato, T; Ietani, K; Makabe, T; Kurihara, M; Ohno, A; Mikami, Y; Yamashita, H

JOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH 51 ( 3 ) e16270 2025.03

ISSN 1341-8076

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Maternal circadian rhythms during pregnancy dictate metabolic plasticity in offspring

Yao N., Kinouchi K., Katoh M., Ashtiani K.C., Abdelkarim S., Morimoto H., Torimitsu T., Kozuma T., Iwahara A., Kosugi S., Komuro J., Kato K., Tonomura S., Nakamura T., Itoh A., Yamaguchi S., Yoshino J., Irie J., Hashimoto H., Yuasa S., Satoh A., Mikami Y., Uchida S., Ueki T., Nomura S., Baldi P., Hayashi K., Itoh H.

Cell Metabolism 37 ( 2 ) 395 - 412.e6 2025.02

ISSN 15504131

Tissue-level oscillation is achieved by tissue-intrinsic clocks along with network-dependent signals originating from distal organs and organismal behavior. Yet, it remains unexplored whether maternal circadian rhythms during pregnancy influence fetal rhythms and impact long-term susceptibility to dietary challenges in offspring. Here, we demonstrate that circadian disruption during pregnancy decreased placental and neonatal weight yet retained transcriptional and structural maturation. Intriguingly, diet-induced obesity was exacerbated in parallel with arrhythmic feeding behavior, hypothalamic leptin resistance, and hepatic circadian reprogramming in offspring of chronodisrupted mothers. In utero circadian desynchrony altered the phase-relationship between the mother and fetus and impacted placental efficiency. Temporal feeding restriction in offspring failed to fully prevent obesity, whereas the circadian alignment of caloric restriction with the onset of the active phase virtually ameliorated the phenotype. Thus, maternal circadian rhythms during pregnancy confer adaptive properties to metabolic functions in offspring and provide insights into the developmental origins of health and disease.

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Leucine-rich alpha-2 glycoprotein in combination with C-reactive protein for predicting endoscopic activity in Crohn’s disease: a single-centre, cross-sectional study

Takada Y., Kiyohara H., Mikami Y., Taguri M., Sakakibara R., Aoki Y., Nanki K., Kawaguchi T., Yoshimatsu Y., Sugimoto S., Sujino T., Takabayashi K., Hosoe N., Ogata H., Kato M., Iwao Y., Nakamoto N., Kanai T.

Annals of Medicine 57 ( 1 ) 2453083 2025

ISSN 07853890

Background and objective: Leucine-rich alpha-2 glycoprotein (LRG) is a novel biomarker for Crohn’s disease (CD). The utility of combination use of LRG and C-reactive protein (CRP) has not been reported. This study aimed to investigate the diagnostic performance of LRG in combination with CRP to predict endoscopic activity. Methods: A single-centre, retrospective, cross-sectional study was conducted. Patients with CD who had serum LRG concentrations measured at least once between June 2020 and May 2021 were enrolled. Clinical activity was evaluated with the Harvey–Bradshaw Index (HBI). Spearman’s rank correlation coefficient (rs) was used to analyse the correlations between the HBI, LRG concentrations and CRP concentrations. In patients undergoing ileocolonoscopy or balloon-assisted enteroscopy within 60 days before or after LRG measurement, endoscopic activity was evaluated with the simple endoscopic score for Crohn’s disease (SES-CD). The diagnostic performance of LRG and CRP for endoscopic activity was evaluated using receiver operating characteristic (ROC) analysis. Results: Four hundred and eighty-nine measurements in 343 patients were analysed. Although a strong correlation was found between LRG and CRP concentrations (rs = 0.75), the HBI did not well correlate with LRG or CRP concentrations. Endoscopic activity was analysed in 56 patients. In diagnosing endoscopically moderate to severe activity (SES-CD > 6), the area under the ROC curve of LRG was greater than that of CRP (0.74 vs. 0.63; p = .037). The optimal cut-off value estimated by Youden’s index was 15.5 µg/mL for LRG, and 0.13 mg/dL for CRP. LRG and CRP concentrations were considered positive when they were above these cut-off values, and the sensitivity and specificity for an SES-CD > 6 were 58.3% and 93.8%, respectively. Dual positivity of LRG and CRP showed the highest specificity. Conclusions: Combination use of dual positive LRG and CRP is useful for diagnosing endoscopically moderate to severe disease.

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Interleukin-17A Inhibitor-induced Pouchitis

Kiyohara H., Mikami Y., Kanai T.

Clinical Gastroenterology and Hepatology 2025

ISSN 15423565

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Clinical outcomes of patients with remitting ulcerative colitis after discontinuation of indigo naturalis

Shimada F., Yoshimatsu Y., Sujino T., Fukuda T., Aoki Y., Hayashi Y., Tojo A., Kawaguchi T., Kiyohara H., Sugimoto S., Nanki K., Mikami Y., Miyamoto K., Takabayashi K., Hosoe N., Kato M., Ogata H., Naganuma M., Kanai T.

Scientific Reports (Scientific Reports) 14 ( 1 ) 5778 2024.12

ISSN 2045-2322

Indigo naturalis is an effective treatment for ulcerative colitis. However, long-term use of indigo naturalis causes adverse events, such as pulmonary hypertension. The natural history of patients with ulcerative colitis who discontinued indigo naturalis after induction therapy is unknown. Moreover, the clinical features of patients who relapsed within 52 weeks after the discontinuation of indigo naturalis are unclear. This study aimed to assess the clinical outcomes of patients with ulcerative colitis after discontinuation of indigo naturalis and to identify potential markers responsible for relapse. This single-center retrospective study investigated the follow-up of 72 patients who achieved a clinical response 8 weeks after indigo naturalis treatment. We observed relapse in patients with ulcerative colitis after the discontinuation of indigo naturalis. We analyzed the factors predicting long-term outcomes after discontinuation of indigo naturalis. Relapse was observed in 24%, 57%, and 71% of patients at 8, 26, and 52 weeks, respectively. There were no predictive markers in patients who relapsed within 52 weeks after the discontinuation of indigo naturalis. The ulcerative colitis relapse rate after indigo naturalis discontinuation was high. Follow-up treatment is required after the discontinuation of indigo naturalis in patients with ulcerative colitis.

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Evaluation of Serum Leucine-Rich α2-Glycoprotein Levels in Racial Differences

Aoki, Y; Mikami, Y; Kanai, T

JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY 39 104 - 105 2024.11

ISSN 0815-9319

Usefulness of Underwater EMR for neoplastic lesions in ulcerative colitis

Takabayashi, K; Imura, Y; Murata, S; Minezaki, D; Tojo, A; Sakurai, H; Iwata, K; Miyazaki, K; Masunaga, T; Mizutani, M; Akimioto, T; Takatori, Y; Yoshimatsu, Y; Sugimoto, S; Kiyohara, H; Kawasaki, S; Mikami, Y; Matsuura, N; Sujino, T; Nakayama, A; Yahagi, N; Kato, M; Kanai, T

JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY 39 331 - 331 2024.11

ISSN 0815-9319

USEFULNESS OF UNDERWATER ENDOSCOPIC MUCOSAL RESECTION FOR SPORADIC NEOPLASM IN ULCERATIVE COLITIS

Takabayashi, K; Imura, Y; Murata, S; Sato, M; Morioka, K; Sakurai, H; Okuzawa, A; Miyazaki, K; Iwata, K; Masunaga, T; Kubosawa, Y; Mizutani, M; Akimoto, T; Takatori, Y; Yoshimatsu, Y; Sugimoto, S; Kiyohara, H; Kawasaki, S; Mikami, Y; Matsuura, N; Sujino, T; Nakayama, A; Kanai, T; Kato, M

GASTROINTESTINAL ENDOSCOPY 99 ( 6 ) AB490 - AB491 2024.06

ISSN 0016-5107

USEFULNESS OF UNDERWATER ENDOSCOPIC MUCOSAL RESECTION FOR SPORADIC NEOPLASM IN ULCERATIVE COLITIS

GASTROINTESTINAL ENDOSCOPY 99 ( 6 ) AB572 - AB572 2024.06

ISSN 0016-5107

A CTCF-binding site in the Mdm1-Il22-Ifng locus shapes cytokine expression profiles and plays a critical role in early Th1 cell fate specification

Liu C., Nagashima H., Fernando N., Bass V., Gopalakrishnan J., Signorella S., Montgomery W., Lim A.I., Harrison O., Reich L., Yao C., Sun H.W., Brooks S.R., Jiang K., Nagarajan V., Zhao Y., Jung S., Phillips R., Mikami Y., Lareau C.A., Kanno Y., Jankovic D., Aryee M.J., Pękowska A., Belkaid Y., O'Shea J., Shih H.Y.

Immunity (Immunity) 57 ( 5 ) 1005 - 1018.e7 2024.05

ISSN 10747613

Cytokine expression during T cell differentiation is a highly regulated process that involves long-range promoter-enhancer and CTCF-CTCF contacts at cytokine loci. Here, we investigated the impact of dynamic chromatin loop formation within the topologically associating domain (TAD) in regulating the expression of interferon gamma (IFN-γ) and interleukin-22 (IL-22); these cytokine loci are closely located in the genome and are associated with complex enhancer landscapes, which are selectively active in type 1 and type 3 lymphocytes. In situ Hi-C analyses revealed inducible TADs that insulated Ifng and Il22 enhancers during Th1 cell differentiation. Targeted deletion of a 17 bp boundary motif of these TADs imbalanced Th1- and Th17-associated immunity, both in vitro and in vivo, upon Toxoplasma gondii infection. In contrast, this boundary element was dispensable for cytokine regulation in natural killer cells. Our findings suggest that precise cytokine regulation relies on lineage- and developmental stage-specific interactions of 3D chromatin architectures and enhancer landscapes.

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Ulcerative colitis-associated neoplasms often harbor poor prognostic histologic components with low detection by biopsy

Sakakibara, R; Sugimoto, S; Takabayashi, K; Kiyohara, H; Wakisaka, Y; Kaieda, Y; Kawaida, M; Yoshimatsu, Y; Sujino, T; Hosoe, N; Kato, M; Shimoda, M; Mikami, Y; Iwao, Y; Kanai, T

INTESTINAL RESEARCH 22 ( 4 ) 428 - 438 2024.05

ISSN 1598-9100

Background/Aims: Poorly differentiated adenocarcinoma, signet-ring cell carcinoma, and mucinous adenocarcinoma (por/sig/muc), which are considered to be histologic subtypes with a poor prognosis, occur more frequently with colitis-associated cancer than with sporadic tumors. However, their invasiveness and manifestations are unclear. This study aimed to determine the prevalence of the por/sig/muc component in ulcerative colitis-associated neoplasms (UCANs) and its association with invasiveness and to clarify its clinicohistologic and endoscopic features. Methods: This retrospective observational study included patients diagnosed with ulcerative colitis-associated high-grade dysplasia or adenocarcinoma from 1997 to 2022 who were divided according to the presence or absence of a por/sig/muc component. Results: Thirty-five patients had UCAN with a por/sig/muc component and 66 had UCAN without this component. The 5-year survival rate was significantly lower in the por/sig/muc group than in the tub group (67% vs. 96%, P=0.001), which was attributed to disease above stage III and depth to below the subserosa. Biopsy-based diagnosis before resection detected a por/sig/muc component in only 40% of lesions (14/35). Lesions with a por/sig/muc component were prevalent even in the early stages: stage 0 (4/36, 11%), I (8/20, 40%), II (7/12, 58%), III (10/14, 71%), and IV (6/8, 75%). Conclusions: This is the first investigation that shows UCANs with a por/sig/muc component tended to be deeply invasive and were often not recognized preoperatively. Endoscopists should be aware that UCAN often has a por/sig/muc component that is not always recognized on biopsy, and the optimal treatment strategy needs to be carefully considered.

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Efficacy of Dose Escalation of Oral 5-Aminosalicylic Acid for Ulcerative Colitis With a Mayo Endoscopic Subscore of 1: An Open Label Randomized Controlled Trial

Fukuda, T; Aoki, Y; Kiyohara, H; Yokoyama, A; Nakazawa, A; Yoshimatsu, Y; Sugimoto, S; Nanki, K; Mikami, Y; Fukuhara, K; Mizuno, S; Sujino, T; Mutaguchi, M; Takabayashi, K; Morohoshi, Y; Hosoda, Y; Ogata, H; Iwao, Y; Naganuma, M; Kanai, T

INFLAMMATORY BOWEL DISEASES 31 ( 3 ) 716 - 724 2024.04

ISSN 1078-0998

Background: Endoscopic healing is generally defined as Mayo endoscopic subscore (MES) ≤1 in ulcerative colitis (UC). However, patients with an MES of 1 are at higher relapse risk than those with an MES of 0. This study evaluated the therapeutic efficacy of proactive dose escalation of oral 5-aminosalicylic acid (5-ASA) in UC patients with an MES of 1. Methods: An open-label, randomized controlled trial was conducted in 5 hospitals between 2018 and 2022. Ulcerative colitis patients in clinical remission under oral 5-ASA therapy and diagnosed as having an MES of 1 were enrolled. Patients receiving maintenance therapy other than 5-ASA and immunomodulator were excluded. Patients were randomly assigned in a 1:1 ratio to receive either a dose-escalated (intervention) or constant dose (control) of 5-ASA. Concomitant immunomodulator was used as the stratification factor in the randomization. The primary end point was relapse within 1 year. The subgroup analysis was stratified for the use of immunomodulators. Results: The full analysis set included 79 patients (39 intervention and 40 control). Immunomodulators were used in 20 (25.3%) patients. Relapse was less in the intervention group (15.4%) than the control group (37.5%; P = .026). In the subgroup with concomitant immunomodulators, relapse was also less in the intervention group (10.0%) than the control group (70.0%; P = .020). In patients without immunomodulators, the difference was not significant between 2 groups (intervention, 17.2%; control, 26.7%; P = .53). Conclusions: Dose escalation of 5-ASA reduced relapse within 1 year in UC patients in clinical remission with an MES of 1.

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Video capsule endoscopy in overt and occult obscure gastrointestinal bleeding: Insights from a single-center, observational study in Japan

Tojo A., Sujino T., Hayashi Y., Kamiya K.J.L.L., Sato M., Hinako S., Yoshimatsu Y., Kinoshita S., Kiyohara H., Mikami Y., Takabayashi K., Kato M., Ogata H., Kanai T., Hosoe N.

DEN Open (DEN Open) 4 ( 1 ) e354 2024.04

ISSN 2692-4609

Objective: This study aimed to evaluate the use of video capsule endoscopy (VCE) in patients with obscure gastrointestinal bleeding (OGIB), compare cases of overt and occult OGIB, assess the rates of balloon-assisted enteroscopy (BAE) interventions and rebleeding, and identify predictive markers of positive VCE findings. Methods: Medical records of 430 patients who underwent VCE for OGIB between 2004 and 2022 were analyzed. Occult OGIB was defined as IDA or positive fecal occult blood, whereas overt OGIB was defined as clinically imperceptible bleeding. We retrospectively analyzed demographics, VCE findings based on Saurin classification (P0, P1, and P2), outcome of BAE interventions, and rebleeding rates. Results: A total of 253 patients with overt OGIB and 177 with occult OGIB were included. P1 findings were predominant in both groups, with a similar distribution. The percentage of patients receiving conservative therapy was higher in P1 than in P2 for both overt and occult OGIB. BAE was more frequently performed in P2 than in P1 VCE (83.0% vs. 35.3% in overt OGIB, 84.4% vs. 24.4% in occult OGIB). The percentage of positive findings and intervention in total BAE performed patients were comparable in P1 and P2 of overt OGIB, whereas these percentages in P2 were more than P1 of occult OGIB. Conclusion: VCE effectively identified OGIB lesions requiring intervention, particularly occult OGIB lesions, potentially reducing unnecessary BAE. Rebleeding rates varied according to the VCE findings, emphasizing the importance of follow-up in high-risk patients.

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Characteristics of flat-type ulcerative colitis-associated neoplasia on chromoendoscopic imaging with indigo carmine dye spraying

Takabayashi K., Sugimoto S., Nanki K., Yoshimatsu Y., Kiyohara H., Mikami Y., Sujino T., Kato M., Hosoe N., Shimoda M., Yahagi N., Ogata H., Iwao Y., Kanai T.

Digestive Endoscopy (Digestive Endoscopy) 36 ( 4 ) 446 - 454 2024.04

ISSN 09155635

Objectives: Despite recent advances in endoscopic equipment and diagnostic techniques, early detection of ulcerative colitis-associated neoplasia (UCAN) remains difficult because of the complex background of the inflamed mucosa of ulcerative colitis and the morphologic diversity of the lesions. We aimed to describe the main diagnostic patterns for UCAN in our cohort, including lateral extension surrounding flat lesions. Methods: Sixty-three lesions in 61 patients with flat-type dysplasia that were imaged with dye chromoendoscopy (DCE) were included in this analysis. These DCE images were analyzed to clarify the dye-chromoendoscopic imaging characteristics of flat dysplasia, and the lesions were broadly classified into dysplastic and nondysplastic mucosal patterns. Results: Dysplastic mucosal patterns were classified into two types: small round patterns with round to roundish structures, and mesh patterns with intricate mesh-like structures. Lesions with a nondysplastic mucosal pattern were divided into two major types: a ripple-like type and a gyrus-like type. Of note, 35 lesions (55.6%) had a small round pattern, and 51 lesions (80.9%) had some type of mesh pattern. About 70% of lesions with small round patterns and 49% of lesions with mesh patterns were diagnosed as high-grade dysplasia or carcinoma, while about 30% of lesions with small round patterns and 51% of lesions with mesh patterns were diagnosed as low-grade dysplasia. Conclusion: When a characteristic mucosal pattern, such as a small round or mesh pattern, is found by DCE, the possibility of UCAN should be considered.

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