水谷　真理 （ ミズタニ　マリ ）

Mizutani, Mari

写真a

所属（所属キャンパス）

医学部 腫瘍センター （ 信濃町 ）

職名

助教（有期）
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  • Diagnostic Performance and Reproducibility of Chromoendoscopic Classification (FOCUS Classification: Flat-Type Dysplasia Optical Assessment by Chromoendoscopy in Ulcerative ColitiS) for Flat-Type Dysplasia in Ulcerative Colitis-Associated Neoplasia

    Takabayashi K., Murata S., Sasaki M., Miyazaki K., Masunaga T., Kirita K., Mizutani M., Yoshimatsu Y., Takatori Y., Akimoto T., Kiyohara H., Sugimoto S., Kawasaki S., Mikami Y., Matsuura N., Nakayama A., Sujino T., Ito Y., Yamanoi K., Sekine S., Iwao Y., Yahagi N., Kanai T., Kato M.

    Digestive Endoscopy Official Journal of the Japan Gastroenterological Endoscopy Society 38 （ 9 ）  2026年09月

    　概要を見る

    OBJECTIVES: Ulcerative colitis-associated neoplasia (UCAN) often presents as flat-type dysplasia that is difficult to characterize endoscopically. We developed a FOCUS (Flat-type dysplasia Optical assessment by Chromoendoscopy in Ulcerative colitiS) classification and evaluated its diagnostic performance and reproducibility. METHODS: This single-center retrospective study included 33 UCAN lesions from 26 patients. Prospectively recorded FOCUS classifications at 230 biopsy sites were compared with histopathology. Chromoendoscopic patterns were categorized as Type I ("suggestive of non-dysplasia,"), Type II ("suggestive of dysplasia with low confidence"), or Type III ("suggestive of dysplasia with high confidence"). Diagnostic performance was assessed using two prespecified thresholds: Types II/III versus Type I and Type III versus Types I/II. Eight endoscopists independently classified all images; interobserver and intraobserver agreement were assessed using Fleiss' and Cohen's κ, respectively. RESULTS: The dysplasia-bearing rate increased stepwise from Type I to Type III (Type I 15.5%, Type II 58.3%, Type III 81.8%). Using the primary threshold, sensitivity was 82.0%, and specificity 75.4% (positive likelihood ratio 3.33; negative likelihood ratio 0.24). Interobserver agreement for the three-category classification was moderate to substantial (Fleiss' κ 0.629; 95% CI 0.545-0.712), and median intraobserver agreement was substantial (Cohen's κ 0.738). CONCLUSIONS: The FOCUS classification provides clinically meaningful risk stratification for flat-type dysplasia in a high-risk UCAN cohort, with acceptable interobserver and intraobserver reproducibility.

  • Clinical Outcomes of Underwater Endoscopic Submucosal Dissection for Duodenal Tumors: A Systematic Review and Meta-Analysis

    Kirita K., Akimoto T., Sato Y., Sasaki M., Ishizawa M., Owada M., Katsumi A., Kubo Y., Sugawara M., Mizobe R., Murata S., Imura Y., Sakurai H., Tojo A., Miyazaki K., Masunaga T., Mizutani M., Takatori Y., Kawasaki S., Matsuura N., Nakayama A., Sujino T., Takabayashi K., Yahagi N., Kato M.

    Digestive Endoscopy 38 （ 8 ）  2026年08月

    ISSN  09155635

    　概要を見る

    Background and Study Aim: Underwater endoscopic submucosal dissection (U-ESD) has recently been introduced as a technique that may improve visualization and submucosal layer expansion. However, the clinical outcomes of U-ESD for duodenal tumors have not been systematically evaluated. This study aimed to assess the efficacy and safety of U-ESD for duodenal tumors through a systematic review and meta-analysis. Patients and Methods: A comprehensive literature search was conducted using PubMed, Scopus, and the Cochrane Library from database inception to December 12, 2025. Studies evaluating U-ESD for duodenal tumors were included. Primary outcomes included en bloc resection, R0 resection, procedure time, adverse events, and complete mucosal defect closure. Pooled estimates were calculated using a random-effects model. Results: Four retrospective studies comprising 298 lesions treated with U-ESD were included. The pooled procedure time was 59 min (95% CI, 48–70 min; I<sup>2</sup> = 72%). The pooled en bloc resection rate was 99% (95% CI, 97%–100%; I<sup>2</sup> = 0%), and the pooled R0 resection rate was 89% (95% CI, 81%–93%; I<sup>2</sup> = 54%). The pooled intraoperative perforation rate was 5% (95% CI, 1%–23%; I<sup>2</sup> = 88%). The pooled delayed perforation and delayed bleeding rates were 1% (95% CI, 0%–3%; I<sup>2</sup> = 0%) and 2% (95% CI, 1%–5%; I<sup>2</sup> = 0%), respectively. Conclusion: Current evidence suggests that U-ESD is a feasible treatment option for duodenal tumors and is associated with favorable clinical outcomes. However, the available evidence remains limited, and potential biases and concerns regarding generalizability warrant cautious interpretation of these findings.

  • Predictors of local recurrence and piecemeal resection in duodenal underwater endoscopic mucosal resection

    Minezaki D., Akimoto T., Sasaki M., Murata S., Imura Y., Tojo A., Sakurai H., Iwata K., Miyazaki K., Masunaga T., Mizutani M., Kirita K., Tsutsumi K., Nishikawa M., Takatori Y., Kawasaki S., Matsuura N., Tomida H., Nakayama A., Sujino T., Takabayashi K., Mizukami K., Kato M., Yahagi N.

    Igie 5 （ 2 ） 151 - 160 2026年06月

    　概要を見る

    Background and Aims Underwater endoscopic mucosal resection (UEMR) has been widely adopted for the treatment of superficial nonampullary duodenal epithelial tumors (SNADETs). The aim of this study was to identify predictors of local recurrence and piecemeal resection in UEMR for SNADETs. Methods This is a retrospective single-center study. Patients who underwent UEMR for SNADETs between November 2017 and October 2024 were included. We documented clinicopathologic characteristics of patients and lesions, noted procedure-related outcomes, and evaluated local recurrence. Kaplan-Meier analysis was used to assess recurrence-free survival, and logistic regression analysis was performed to identify the predictors of piecemeal resection. Results Among the 367 patients, the rate of piecemeal resection was 11.2%, and the rate of en bloc resection with histologically tumor-free horizontal and vertical margins (R0) was 65.1%. No intraoperative perforations occurred; intraoperative bleeding was observed in 1.9%. Kaplan-Meier analysis of recurrence-free survival showed significantly poorer outcomes in the piecemeal resection group than the en bloc resection group (log-rank test, P < .001; Wilcoxon test, P < .001). According to multivariate logistic regression analysis, each 1-mm increase in lesion size (odds ratio [OR], 1.20; 95% confidence interval [CI], 1.11-1.31; P < .001) and a flat macroscopic type (OR, 12.49; 95% CI, 1.45-107.98; P = .02) were significant independent predictors of piecemeal resection. Conclusions Piecemeal resection was a risk factor for local recurrence in UEMR for SNADETs. In addition, each 1-mm increase in lesion size and a flat macroscopic type were significant independent predictors of piecemeal resection.

  • Real-World Evaluation of Remimazolam for Sedation During Gastrointestinal Endoscopy: Efficacy, Safety, and Risk Factors

    Sakurai H., Miyazaki K., Nakayama A., Sasaki M., Oowada M., Sugawara M., Kubo Y., Mizobe R., Katsumi A., Ishizawa M., Imura Y., Murata S., Minezaki D., Iwata K., Tojo A., Masunaga T., Kirita K., Mizutani M., Nishikawa M., Takatori Y., Akimoto T., Kawasaki S., Matsuura N., Tomida H., Sujino T., Takabayashi K., Takanori K., Yahagi N., Kato M.

    Jgh Open 10 （ 2 ）  2026年02月

    　概要を見る

    Background and Aim: Remimazolam is a benzodiazepine receptor agonist intravenous anesthetic. This study aimed to evaluate the efficacy and safety of remimazolam for sedation during gastrointestinal endoscopy using real-world clinical data. Methods: This retrospective observational study included 352 patients who underwent esophagogastroduodenoscopy or colonoscopy sedated with remimazolam between January and February 2024 at our institution. Outcomes included the incidence of awakening during procedures, the sedation completion rate, and the incidence and severity of adverse events. Multivariate logistic regression analyses identified factors associated with hypoxia and hypotension. Results: Median patient age was 67 years (IQR: 58–74), and 62.2% were male. Median initial and additional doses were 3 (IQR: 2–3 mg) and 1 mg (IQR: 0–2 mg). Awakening occurred in 19.0% of patients. The sedation completion rate was 100%. Adverse events included hypotension (7.8%), hypoxia (13.1%), and bradycardia (4.0%), and no serious adverse events were observed. The only risk factor for hypoxia was advanced age (Odds ratio 1.04, 95% confidence interval: 1.01–1.08, p = 0.03), and the dose of remimazolam itself was not an independent risk factor for either hypoxia or hypotension. Conclusions: Remimazolam usage for gastrointestinal endoscopic sedation showed a favorable safety profile. Advanced age was associated with an increased risk of hypoxia, suggesting that careful monitoring and individualized sedation protocols are especially necessary for elderly patients. On the other hand, there are still issues regarding the duration of sedation. During long procedures, it is necessary to frequently check the depth of sedation to avoid undersedation.

  • Mucin phenotype stratifies histological malignancy in superficial non-ampullary duodenal epithelial tumors: a prospective study

    Nakayama A., Miyazaki K., Iwata K., Kubosawa Y., Masunaga T., Hayashi Y., Mizutani M., Kiguchi Y., Tsutsumi K., Akimoto T., Takatori Y., Matsuura N., Mutaguchi M., Sujino T., Takabayashi K., Ochiai Y., Maehata T., Matsubara A., Kushima R., Yahagi N., Kato M.

    Journal of Gastroenterology 2026年

    ISSN  09441174

    　概要を見る

    Background: Superficial non-ampullary duodenal epithelial tumors (SNADETs) are being increasingly detected during routine endoscopy. However, biological malignancy and optimal risk stratification remain poorly defined. We aimed to clarify the association between mucin phenotypes and histological malignancies in SNADETs using a prospective study design. Methods: In this prospective observational study, patients with suspected SNADETs underwent a standardized magnified endoscopic examination with image-enhanced endoscopy (IEE-ME), followed by endoscopic resection. All specimens were centrally reviewed by expert gastrointestinal pathologists. Mucin phenotypes were classified as G type (gastric, predominantly gastric, or mixed) or I type (intestinal or predominantly intestinal). Histological malignancy was assessed using the Vienna classification (VCL). Clinicopathological and endoscopic factors associated with mucin phenotype and malignancy were systematically analyzed. Results: Among the 401 SNADETs, adenomas were predominant (72.1%), whereas submucosal invasive cancers were rare (2.5%). G-type SNADETs comprised 15.5% of lesions but demonstrated a markedly higher frequency beyond VCL category 4.1 compared to I-type SNADETs (P < 0.0001). The risk of histological malignancy increased stepwise with the proportion of gastric phenotypic components. Most invasive submucosal cancers exhibit a gastric phenotype. Multivariate analysis of the endoscopic findings identified a closed-loop structure, the absence of a white opaque substance on IEE-ME, and protruding morphology as independent predictors of G-type SNADETs. Conclusion: The gastric phenotype is strongly associated with increased histological malignancy in SNADETs. Specific endoscopic features can predict G-type SNADETs, suggesting that mucin phenotype-oriented endoscopic diagnosis may provide useful information for pretreatment risk stratification and treatment planning.

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