Centers & Services

Gastroenterology and Hepatology Department

What is the Gastroenterology and Hepatology Department?

We diagnose disease such as inflammation and tumor in the esophagus, stomach, duodenum, small intestine, large intestine, liver, gallbladder, bile duct and pancreas, and treat them using procedures such as drug therapy, endoscopy, ultrasonography, and angiography

Our physicians

Director, Department of Gastroenterology and Hepatology

Hiroyuki Okada, Professor
 

Staff

Hiroyuki Okada Professor (Department of Endoscopy) [Gastroenterology and oncology]
Kazuhiro Nouso Visiting Researcher [Liver]
Akinobu Takaki Associate Professor [Liver]
Yoshiro Kawahara Associate Professor (Department of Endoscopy) [Gastroenterology and oncology]
Hidenori Shiraha Lecturer [Liver]
Shinichiro Nakamura Lecturer [Liver]
Sakiko Hiraoka Assistant Professor [Gastroenterology, inflammatory bowel disease]
Fusao Ikeda Assistant Professor [Liver]
Hideki Onishi Assistant Professor [Liver]
Hironari Kato Assistant Professor [Pancreas and biliary tract]
Keita Harada Assistant Professor (Department of Endoscopy) [Gastroenterology and oncology]
Seiji Kawano Assistant Professor [Gastroenterology and oncology]
Koichiro Tsutsumi Assistant Professor [Pancreas and biliary tract]
Masaya Iwamuro Assistant Professor (General Medicine) [Gastroenterology and liver regeneration research]
Hiromitsu Kanzaki Assistant Professor [Gastroenterology and oncology]
Kazuyuki Matsumoto Assistant Professor [Pancreas and biliary tract]
Yusaku Sugihara Assistant Professor [Gastroenterology]
Yasuhito Takeuchi Assistant Professor [Liver]
Tetsuya Yasunaka Assistant Professor [Liver]

*Specialty shown in [ ]

Weekly schedule of outpatient physicians

  Monday Tuseday Wednesday Thursday Friday
Outpatient physicians Associate Professor Lecturer Assistant Professor Doctor Professor Lecturer Assistant Professor Doctor Assistant Professor Doctor Assistant Professor Doctor Professor Lecturer Assistant Professor Doctor
Clinical sections available
by day of the week
Gastrointestinal disease (gastrointestinal tract, liver, pancreas and biliary tract) Gastrointestinal disease (gastrointestinal tract, liver, pancreas and biliary tract) Gastrointestinal disease (gastrointestinal tract, liver, pancreas and biliary tract) Gastrointestinal disease (gastrointestinal tract, liver, pancreas and biliary tract) Gastrointestinal disease (gastrointestinal tract and liver)

Treatment system

Our specialized staff members treat the three fields of the liver, the gastrointestinal tract, and the pancreas and biliary tract. We receive outpatient visits during Monday - Friday. Attending doctors including professors, associate professors, lecturers, ,assistant professors and residents provide treatment for each patient.

Treatment policy

We provide treatment according to established evidences and policies determined in conferences of the Department of Gastroenterology and Hepatology and of the joint conferences with other departments. We endeavor for treatment of high quality, provided efficiently using critical paths to the greatest extent possible.

Specialties

  • Liver: Diagnosis of liver cancer by ultrasonography, radiofrequency ablation treatment of hepatocellular carcinoma, transcatheter arterial embolization, anticancer treatment, antiviral therapy for chronic hepatitis B, direct acting antivirals (DAA) for chronic hepatitis C, and diagnosis and treatment of autoimmune liver diseases
  • Upper gastrointestinal tract: Endoscopic submucosal dissection (ESD) for pharyngeal cancer, esophageal cancer and gastric cancer, endoscopic sclerotherapy for esophageal varices, and endoscopic hemostasis
  • Lower gastrointestinal tract: ESD for large intestinal polyp and early cancer, treatment for refractory ulcerative colitis, and treatment for Crohn's disease
  • Pancreas and biliary tract: Endoscopic therapy for gallstone and pancreatitis, and endoscopic stent implantation for malignant biliary tract tumor
  • Inoperable advanced gastrointestinal cancer: Systemic chemotherapy

Description of medical care

For half a century, we have been the core medical institution in the local community to treat liver disease. Progress has been forthcoming year-by-year in the treatment of acute hepatitis and chronic hepatitis. We always endeavor to develop better therapies by participating in clinical trials of new drugs for hepatitis B and C emerging one after another. Life-threatening fulminant hepatitis is treated multidisciplinarily based on fast and accurate diagnosis. Liver transplantation is also performed actively in collaboration with the departments of surgery. Autoimmune liver diseases such as autoimmune hepatitis, primary biliary cirrhosis (PBC), and primary sclerosing cholangitis (PSC) are diagnosed and treated appropriately depending on the patient disease stage. Non-alcoholic steatohepatitis (NASH), which is recently showing an increasing trend, is also treated by therapies selected based on detailed symptom evaluation. For end-stage liver disease, the evaluation for the application of liver transplantation as well as pre-operative and postoperative management are performed in collaboration with the departments of surgery for the whole Chugoku - Shikoku region.
In addition, liver cancer is treated mainly by radiofrequency ablation, adopting new methods such as hepatic arterial infusion and molecular targeted drug therapy for better therapeutic effects and simultaneously for better QOL of patients.
The Department of Gastroenterology and Hepatology provides treatment specialized in gastrointestinal disease, gastrointestinal liver disease, and pancreatic-biliary disease.
We perform not only endoscopic diagnosis but also the endoscopic treatment of gastrointestinal disease such as esophagitis, esophageal varices, esophageal cancer, gastric and duodenal ulcer, gastric cancer,small intestinal disease, colorectal cancer, colorectal polyp, ulcerative colitis and Crohn's disease, and pancreatitis, pancreatic cancer, gallstone, and bile duct cancer. Helicobacter pylori infection, which has been attracting attention for its relation with gastric and duodenal ulcers, gastric cancers and malignant lymphomas, is also diagnosed and treated in cooperation with the medical school departments of bacteriology and pathology. Moreover, we have actively introduced special therapies such as leukocyte apheresis for recently increasing inflammatory bowel disease (ulcerative colitis and Crohn's disease).

For outpatient visits

For first visits

  • Patients are received at the General Reception Desk by 11 A.M. (as early as possible) during Monday - Friday, and are examined at the outpatients' ward. Basically, only patients with a referral letter are received.
  • Patients can make an appointment in advance via the General Patient Support Center (Office of Regional Medical Cooperation) (Phone 086-235-7205, Fax 086-235-6761).

For revisiting outpatients

  • The date and time of the consultation is registered into the computer during consultation. A note that shows the date and time of the next consultation appointment is given after consultation. Visit the clinic on the date and time of appointment.

Highly advanced/special medical treatments

Techniques covered by health insurance programs

  • Esophageal and gastric endoscopic submucosal dissection (ESD)
  • ESD for large intestinal tumor
  • Multiple metal stent implantation for malignant biliary stricture
  • Radiofrequency ablation with artificial ascites for hepatocellular carcinoma

Treatment not covered by health insurance programs

  • Outpatient special care for Helicobacter pylori

Eradication of Helicobacter pylori infection has been newly covered by health insurance programs in February 2013. Eradication treatment by health insurance is applicable to all patients who show chronic gastritis by endoscopy and who are positive in the H. pylori infection test.
However, eradication treatment is available only two times.
The third and further eradication treatment is not covered by health insurance programs (about 3% of patients who receive the treatment).
Outpatient special care for Helicobacter pylori (not covered by health insurance programs) is available to patients who want third and further eradication treatment.

Scope of application

Patients who are H. pylori-positive after having eradication treatment twice as a disease covered by health insurance programs and who want the third eradication treatment.

Medical costs

Not all medical costs are covered by health insurance programs. They are calculated in accordance with those in health insurance programs.
The costs are approximately \20,000, which might vary depending on the tests to be performed.

Contact address

Department of Endoscopy, Okayama University Hospital
Phone) 086-235-7670; Fax) 086-235-7670
Outpatients' ward, Department of Gastroenterology and Hepatology, Okayama University Hospital
Phone) 086-223-7151 (main); Fax) 086-235-6943
Office of Regional Medical Cooperation, Okayama University Hospital
Phone) 086-235-7205; Fax) 086-235-6761

Main testing methods and explanations

  • Abdominal ultrasonography
  • Laparoscopy
  • Abdominal angiography
  • Upper gastrointestinal endoscopy: This is performed for screening or to confirm the presence or absence of disease in the esophagus, stomach, or duodenum.
  • Double-balloon small intestinal endoscopy: This is performed for the diagnosis and treatment of small intestinal hemorrhage and tumors.
  • Capsule endoscopy: This is performed as a detailed examination of gastrointestinal hemorrhage of unknown origin and tumors.
  • Colonoscopy: This is performed as a detailed examination for fecal occult blood, or to examine the presence or absence of disease in the large intestine.
  • Endoscopic retrograde cholangiopancreatography: This is performed as a detailed examination of biliary-pancreatic disease for patients with gallstone, pancreatitis, obstructive jaundice, etc.

Main testing methods, medical care and medical equipment

Liver biopsy and laparoscopy

These are testing methods to ascertain the stage and the activity of liver disease. The methods are useful in the diagnosis and management of viral hepatitis and autoimmune hepatitis. The liver tissue is subjected to immunostaining in addition to normal tissue staining to ascertain the level of inflammation and to identify viruses. Appointments for hospitalization for testing are also available.

Abdominal ultrasonography

The Ultrasound Diagnosis Center was opened on the second floor of the Central Clinical Ward in April 2011. Technicians and doctors who are specialized in the abdomen perform testing every day in the Ultrasound Diagnosis Center. Testing of better quality has been made possible by introducing high-end ultrasonographs from Toshiba and Hitachi-Aloka Medical.
Highly specialized cases from our various hospital departments are also tested in collaboration with doctors in other departments.
For the diagnosis of liver cancer, we particularly strive for early detection and early diagnosis, and perform testing related to CT and MRI images. Ultrasonography is also performed as appropriate for the diagnosis of hepatocellular carcinoma, and metastatic liver cancer, the detection of residual lesions after the treatment of liver cancer, and the diagnosis of biliary - pancreatic tumor lesions.

Radiofrequency ablation: RFA

For the treatment of liver cancer, RFA, a radical treatment requiring no laparotomy, has been used since 2001.
Artificial pleural fluid, artificial ascites, and images to assist treatment, etc. are used in combination as appropriate to perform safe, accurate, and less painful treatment. We also provide treatment for lesions for which treatments at other institutions are difficult to obtain.

IVR examination and treatment

The IVR Center was opened in the first floor of the Central Clinical Ward in April 2013. For most liver cancer cases, CT-angiographs are taken with IVR-CT. The cancer location of is identified accurately before performing transcatheter arterial chemoembolization (TACE).

Treatment for advanced liver cancer

For advanced liver cancer, hepatic arterial infusion chemotherapy from implanted reservoir to the hepatic artery and the one-shot infusion of anticancer agents for hepatic arterial infusion are performed. Moreover, in collaboration with outpatient oral chemotherapy support team consisting of nurses and pharmacists, molecular target drug therapy is performed for outpatients. Intraportal tumor embolism and lesions for which IVR treatment is difficult are treated with radiotherapy including stereotactic radiotherapy in collaboration with the Department of Radiology. We aim to improve QOL and prognosis via multidisciplinary treatment by the combination of these.

Plasmapheresis and hemodiafiltration

In fulminant hepatitis, there are toxic products and substances that inhibit liver cell regeneration accumulated in the blood. Hemodiafiltration is performed in intensive care unit (ICU) to remove them, and plasmapheresis is performed to supplement decreased coagulation factors and regeneration promoting factors. More than half of patients can be saved now in acute fulminant hepatitis. Living-donor partial liver transplantation and deceased-donor liver transplantation have been available, but these are indicated for cases in which plasmapheresis has no effect.

Gastrointestinal endoscopy

Upper gastrointestinal tract (esophagus, stomach and duodenum): In addition to upper gastrointestinal endoscopy examinations for screening (for health checkup), we provide endoscopic therapy using state-of-the-art instruments, including sclerotherapy and ligation for ruptured esophageal varices, hemostasis for ulcer bleeding, and resection of polyp and early pharyngeal cancer, esophageal cancer, and gastric cancer.

Small intestine: The diagnosis of bleeding and tumor in the small intestine, and hemostasis for bleeding and polyp resection are performed using a double-balloon enteroscopy.
Lower gastrointestinal tract (large intestine): Colonoscopy is performed actively to detect colon cancer at the early stage in patients who visited us for positive occult blood detected in health screening, etc. Endoscopic treatment for colorectal polyp and early colon cancer is also performed.

Pancreatic and biliary: In this field, we use state-of-the-art techniques and instruments so that we can address every pathological condition in pancreatic and biliary disease such as by endoscopic lithotripsy for choledocholithiasis, endoscopic drainage for obstructive jaundice, and stent implantation (IVR). Moreover, we provide treatment for inoperable pancreatic and biliary cancer using anticancer agents, IVR, and therapeutic endoscopy (IVE) to improve the QOL of patients.

Biliary and pancreatic disease

Target disease: We actively perform treatment for pancreatic and biliary malignant tumors such as pancreatic cancer, bile duct cancer, gallbladder cancer, and duodenum papillary cancer.
We also provide treatment for choledocholithiasis, acute cholecystitis, acute pancreatitis, chronic pancreatitis,autoimmune pancreatitis, pancreatolithiasis, and postoperative bile duct stricture.

Testing procedures: Endoscopic retrograde cholangio-pancreatography (ERCP) is an extremely difficult procedure, which is conducted in over 600 cases annually in our hospital. Safe and secure operation can be conducted here at our high-volume center.
Difficult cases from other institutions are also referred to us for treatment.
Endoscopic ultrasonography (EUS) has recently become an indispensable procedure for examination and treatment in the biliary-pancreatic region, although there are not many institutions where EUS is available in the present situation. We perform the examination and treatment procedure in about 500 cases annually.
Double-balloon ERCP (DB-ERCP) is a special ERCP procedure that makes it possible to perform ERCP in cases where normal ERCP is difficult because of surgical resection of the stomach.