Updated on 2021/12/07

写真a

 
TSUTSUMI Koichiro
 
Organization
Okayama University Hospital Assistant Professor
Position
Assistant Professor
External link

Degree

  • 医学博士 ( 2013.3 )

  • Doctor(Medicine) ( 2013.3   Okayama University )

Research Areas

  • Life Science / Tumor diagnostics and therapeutics

  • Life Science / Gastroenterology

 

Papers

  • A Case Report of Pancreatic Exocrine Insufficiency in Intraductal Papillary Mucinous Carcinoma Presenting with Leg Edema Treated with Pancreatic Exocrine Replacement Therapy. Reviewed

    Emi Tanaka, Tsuneyoshi Ogawa, Koichiro Tsutsumi, Sayo Kobayashi, Toru Nawa, Toru Ueki, Hiroyuki Okada

    Internal medicine (Tokyo, Japan)   2021.11

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    An 89-year-old woman underwent examinations for leg edema. Blood tests indicated low nutrition and low pancreatic enzymes, and a stool examination indicated fatty stool. Computed tomography showed pleural effusion, ascites, and cystic lesions in the pancreatic head and mural nodules within the cysts. Pancreatic juice cytology revealed adenocarcinoma. The diagnosis was pancreatic exocrine insufficiency caused by intraductal papillary mucinous carcinoma. The patient did not wish to undergo surgery. Therefore, diuretics, component nutrients, and pancreatic exocrine replacement therapy using pancrelipase were initiated. After starting treatment, her leg edema, pleural effusion, and ascites disappeared, and her activities of daily living improved markedly.

    DOI: 10.2169/internalmedicine.8611-21

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  • Risk Factors for the Development of High-risk Stigmata in Branch-duct Intraductal Papillary Mucinous Neoplasms. Reviewed

    Tatsuhiro Yamazaki, Takeshi Tomoda, Hironari Kato, Kazuya Miyamoto, Akihiro Matsumi, Eijiro Ueta, Yuki Fujii, Yosuke Saragai, Daisuke Uchida, Kazuyuki Matsumoto, Shigeru Horiguchi, Koichiro Tsutsumi, Hiroyuki Okada

    Internal medicine (Tokyo, Japan)   60 ( 20 )   3205 - 3211   2021.10

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    Objective Strict follow-up is recommended for branch-duct intraductal papillary mucinous neoplasms (BD-IPMNs) to avoid missing the development of high-risk stigmata (HRS) at a premalignant stage. This study explored the risk factors associated with the development of HRS during follow-up. Methods We performed a retrospective analysis of 283 patients with BD-IPMN, treated at Okayama University Hospital in Japan between January 2009 and December 2016. Only patients with imaging studies indicative of classical features of BD-IPMN without HRS and followed for over one year were included in the study. We performed radiological follow-up every six months and collected patients' demographic data, cyst characteristics, and clinical outcomes and used univariate logistic regression models to determine the odds of developing HRS. Results Ten patients (3.5%) developed HRS after a median surveillance period of 55.8 months. The main pancreatic duct (MPD) size (5-9 mm) and cyst growth rate (>2.5 mm/year) were both suggested to be possible risk factors for the development of HRS [odds ratio, 14.2; 95% confidence interval (CI), 3.1-65.2, p=0.0006, and odds ratio, 6.1; 95% CI 1.5-25.5, p=0.014]. Regarding the number of worrisome features (WFs), the rate of HRS development was 2.0% (4/199) in cases with no WF, 1.6% (1/62) in cases with single WF and 22.7% (5/22) in cases with multiple WFs, respectively. The rate of HRS development was significantly higher in cases with multiple WFs than in the other cases (p<0.0001). Conclusion MPD dilation, rapid cyst growth, and multiple WFs were significant risk factors for the development of HRS. In the presence of such features, it is necessary to closely follow the development of HRS and avoid missing the best opportunity to perform surgical intervention.

    DOI: 10.2169/internalmedicine.7168-21

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  • Randomized trial comparing the 25G and 22G Franseen needles in endoscopic ultrasound‐guided tissue acquisition from solid pancreatic masses for adequate histological assessment Reviewed International journal

    Takeshi Tomoda, Hironari Kato, Yuuki Fujii, Tatsuhiro Yamazaki, Kazuyuki Matsumoto, Shigeru Horiguchi, Koichiro Tsutsumi, Hirofumi Inoue, Takehiro Tanaka, Toshiharu Mitsuhashi, Hiroyuki Okada

    Digestive Endoscopy   2021.7

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    Language:English   Publishing type:Research paper (scientific journal)   Publisher:Wiley  

    BACKGROUND: The effects of the Franseen needle size in endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) of solid pancreatic masses remain unclear. This study aimed to compare 25G and 22G Franseen needles in terms of adequate tissue acquisition from solid pancreatic masses. METHODS: In this single-center, crossover, randomized noninferiority trial, eligible patients underwent EUS-FNB with both 25G and 22G Franseen needles in a randomized order between November 2018 and August 2020. Tissue specimens from each pass were separately evaluated based on the cellularity scoring system. The primary outcome was the proportion of acquired specimens allowing adequate histological assessment (cellularity score ≥3). A -15% noninferiority margin was assumed. RESULTS: Data from 88 patients were analyzed, which showed malignant and benign lesions in 84 (95.5%) and four (4.5%) patients, respectively. Of the 88 specimens, 62 (70.5%) and 69 (78.4%) acquired using 25G and 22G needles, respectively, allowed adequate histological assessment. The adjusted proportion difference was -6.6% (95% confidence interval -8.8% to -4.5%), indicating noninferiority of the 25G Franseen needle (P < 0.001). The diagnostic accuracies of the 25G and 22G needles were 86.4% and 89.8%, respectively, with no significant difference (P = 0.180). Adverse events occurred in one patient. CONCLUSIONS: The 25G Franseen needle showed a noninferior adequate tissue acquisition and similar diagnostic performance compared to that of the 22G Franseen needle. However, a 15% noninferiority margin was high for clinical use; thus, further consideration is needed (Clinical Trial Registry no. UMIN000034596).

    DOI: 10.1111/den.14079

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    Other Link: https://onlinelibrary.wiley.com/doi/full-xml/10.1111/den.14079

  • Efficacy of double-balloon enteroscopy-assisted endoscopic balloon dilatation combined with stent deployment for hepaticojejunostomy anastomotic stricture. Reviewed International journal

    Takeshi Tomoda, Hironari Kato, Toru Ueki, Tsuneyoshi Ogawa, Ken Hirao, Yutaka Akimoto, Kazuyuki Matsumoto, Shigeru Horiguchi, Koichiro Tsutsumi, Hiroyuki Okada

    Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society   2021.7

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    BACKGROUND: Hepaticojejunostomy anastomotic stricture (HJAS) is a significant complication of biliary reconstruction surgery. Endoscopic management of HJAS using double-balloon enteroscopy has expanded; however, retrospective reports in this setting are limited. This study aimed to evaluate the efficacy of endoscopic balloon dilatation combined with stent deployment for HJAS. METHODS: This was a single-arm prospective clinical trial involving 40 patients with treatment-naïve HJAS enrolled between March 2016 and August 2019 at four endoscopy units in Japan. For HJAS, plastic stents combined with balloon dilatation were placed for 6 months after initial stenting. The primary outcome was HJ anastomosis patency 12 months after stent removal. RESULTS: The technical success rate was 97.5% (39/40). The failed case required percutaneous transhepatic biliary drainage using the rendezvous technique. All cases achieved successful endoscopic treatment. During the treatment period, four of 40 patients (10%) ended the study protocol due to unrelated causes and were excluded from the primary analysis. Among the 36 patients, clinical success was achieved in 34 (94.4%) patients. The remaining two patients achieved HJAS resolution after an additional 3 months. All 36 patients achieved HJAS resolution. Adverse events were observed in two patients (5.0%) who developed moderate cholangitis. During a median follow-up of 21.3 months, HJAS recurrence was observed in 8.3% (3/36) with a median time to recurrence of 4.3 months and HJ anastomosis patency at 12 months was 94.4%. CONCLUSIONS: Endoscopic balloon dilatation combined with plastic stent deployment for 6 months was a safe and effective strategy for HJAS. (Clinical Trial Registry no. UMIN000020613).

    DOI: 10.1111/den.14097

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  • Balloon Enteroscopy-Assisted Endoscopic Retrograde Cholangiopancreatography for the Treatment of Common Bile Duct Stones in Patients with Roux-en-Y Gastrectomy: Outcomes and Factors Affecting Complete Stone Extraction. Reviewed International journal

    Taisuke Obata, Koichiro Tsutsumi, Hironari Kato, Toru Ueki, Kazuya Miyamoto, Tatsuhiro Yamazaki, Akihiro Matsumi, Yuki Fujii, Kazuyuki Matsumoto, Shigeru Horiguchi, Kengo Yasugi, Tsuneyoshi Ogawa, Ryuta Takenaka, Hiroyuki Okada

    Journal of clinical medicine   10 ( 15 )   2021.7

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    BACKGROUND: Endoscopic retrograde cholangiopancreatography (ERCP) for extraction of common bile duct (CBD) stones in patients with Roux-en-Y gastrectomy (RYG) remains technically challenging. METHODS: Seventy-nine RYG patients (median 79 years old) underwent short-type double-balloon enteroscopy-assisted ERCP (sDBE-ERCP) for CBD stones at three referral hospitals from 2011-2020. We retrospectively investigated the treatment outcomes and potential factors affecting complete stone extraction. RESULTS: The initial success rates of reaching the papilla of Vater, biliary cannulation, and biliary intervention, including complete stone extraction or biliary stent placement, were 92%, 81%, and 78%, respectively. Of 57 patients with attempted stone extraction, complete stone extraction was successful in 74% for the first session and ultimately in 88%. The adverse events rate was 5%. The multivariate analysis indicated that the largest CBD diameter ≥ 14 mm (odds ratio (OR), 0.04; 95% confidence interval (CI), 0.01-0.58; p = 0.018) and retroflex position (OR, 6.43; 95% CI, 1.12-36.81; p = 0.037) were independent predictive factors affecting complete stone extraction achievement. CONCLUSIONS: Therapeutic sDBE-ERCP for CBD stones in a relatively elderly RYG cohort, was effective and safe. A larger CBD diameter negatively affected complete stone extraction, but using the retroflex position may be useful for achieving complete stone clearance.

    DOI: 10.3390/jcm10153314

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  • Extracellular vesicle-shuttled miRNAs as a diagnostic and prognostic biomarker and their potential roles in gallbladder cancer patients. Reviewed International journal

    Eijiro Ueta, Koichiro Tsutsumi, Hironari Kato, Hiroshi Matsushita, Hidenori Shiraha, Masakuni Fujii, Kazuyuki Matsumoto, Shigeru Horiguchi, Hiroyuki Okada

    Scientific reports   11 ( 1 )   12298 - 12298   2021.6

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    Circulating microRNAs (miRNAs) in serum extracellular vesicles (EVs) are a promising biomarker in cancer. We aimed to elucidate the serum EVs miRNA biomarkers to identify patients with gallbladder cancer (GBC) and to clarify their potential roles. One hundred nineteen serum EVs from GBC and non-GBC individuals were isolated by pure-EVs-yieldable size-exclusion chromatography, and then were analyzed using a comprehensive miRNAs array and RT-qPCR-based validation. The functional roles of the identified miRNAs were also investigated using GBC cell lines. Serum EVs miR-1246 and miR-451a were significantly upregulated and downregulated, respectively in GBC patients (P = 0.005 and P = 0.001), in line with their expression levels in cancer tissue according to an in silico analysis. The combination of CEA and CA19-9 with miR-1246 showed the highest diagnostic power (AUC, 0.816; Sensitivity, 72.0%; Specificity, 90.8%), and miR-1246 was an independent prognostic marker of GBC (Hazard ratio, 3.05; P = 0.017) according to a Cox proportional hazards model. In vitro, miR-1246 promoted cell proliferation and invasion, while miR-451a inhibited cell proliferation and induced apoptosis with the targeting of MIF, PSMB8 and CDKN2D. Taken together, miR-1246 in serum EVs has potential application as a diagnostic and prognostic marker and miR-451a may be a novel therapeutic target in GBC.

    DOI: 10.1038/s41598-021-91804-0

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  • Treatment outcomes, including risk factors of stone recurrence, for hepatolithiasis using balloon-assisted endoscopy in patients with hepaticojejunostomy (with video). Reviewed International journal

    Yuki Ishihara, Kazuyuki Matsumoto, Hironari Kato, Koichiro Tsutsumi, Takeshi Tomoda, Akihiro Matsumi, Kazuya Miyamoto, Tatsuhiro Yamazaki, Yosuke Saragai, Yuki Fujii, Daisuke Uchida, Shigeru Horiguchi, Hiroyuki Okada

    Surgical endoscopy   35 ( 4 )   1895 - 1902   2021.4

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    BACKGROUND AND STUDY AIMS: Endoscopic treatment outcomes for hepatolithiasis in patients with altered anatomy are not well known. The aim of this study was to evaluate the treatment outcomes of hepatolithiasis in patients with hepaticojejunostomy (HJ) using short-type double-balloon endoscopy (sDBE) and to assess the risk factors for stone recurrence. PATIENTS AND METHODS: This was a retrospective cohort study that consisted of 73 patients with hepatolithiasis who underwent bowel reconstruction with HJ at an academic center. Stone removal was performed using sDBE. After balloon-occluded cholangiography using sDBE, peroral direct cholangioscopy (PDCS) using ultraslim endoscopy was performed to check for residual stones, depending on the bowel reconstruction method. Recurrence was defined as the development of cholangitis from stones. RESULTS: The success rate of reaching the HJ site was 92% (67/73), and the complete stone removal rate was 93% (62/67) with multiple sessions (mean number 1.5 ± 0.9). The occurrence rate of procedure-related adverse events was 6.8%. Among 58 patients evaluated for stone recurrence, 13 (22%) developed recurrence during a median follow-up period of 2.7 years (interquartile range: 1.5-4.8). Multivariate analyses determined that a stone diameter ≥ 8 mm [odds ratio (OR), 5.57; 95% confidence interval (CI), 1.39-37.2; p = 0.013] and performing PDCS (OR, 0.16; 95% CI, 0.0084-0.90; p = 0.036) were significant factors for stone recurrence. CONCLUSIONS: Endoscopic treatment using sDBE for hepatolithiasis was effective and safe. PDCS might reduce the rate of stone recurrence by detecting stones that are too small to confirm on fluoroscopic images.

    DOI: 10.1007/s00464-020-08139-6

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  • Endoscopic ultrasonography findings of pancreatic parenchyma for predicting subtypes of intraductal papillary mucinous neoplasms. Reviewed International journal

    Yuki Fujii, Kazuyuki Matsumoto, Hironari Kato, Tatsuhiro Yamazaki, Takeshi Tomoda, Shigeru Horiguchi, Koichiro Tsutsumi, Kenji Nishida, Takehiro Tanaka, Keiji Hanada, Hiroyuki Okada

    Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.]   21 ( 3 )   622 - 629   2021.4

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    BACKGROUND AND AIMS: The subtypes of intraductal papillary mucinous neoplasms (IPMNs) are closely associated with the clinicopathological behavior and recurrence after surgical resection. However, there are no established non-invasive methods to confirm the subtypes of IPMNs without surgery. The aim of this study is to predict the subtypes of IPMNs using the findings of endoscopic ultrasonography (EUS). METHODS: Sixty-two consecutive patients with IPMNs who underwent EUS before surgery were retrospectively reviewed. The following EUS findings were analyzed and their relationship with the subtypes was evaluated: diameter of the main pancreatic duct, cyst size, number of cysts, height of mural nodule, early chronic pancreatitis (CP) finding, fatty parenchyma and atrophic parenchyma. RESULTS: The subtypes of IPMNs were as follows: gastric (G)-type 38 (61%), intestinal (I) -type 14 (23%) and pancreatobiliary (PB) -type 10 (16%). Fatty parenchyma was significantly associated with G-type (P < 0.0001). Early CP findings ≥2 and atrophic parenchyma were significantly correlated with I-type (P < 0.0001). PB-type was significantly associated with pancreatic parenchyma without early CP findings or fatty degeneration in comparison to the other subtypes (P < 0.0001). Using the above characteristic EUS findings, the sensitivity, specificity, and accuracy were as follows: 63%, 92% and 74%, respectively, in G-type, 57%, 96% and 87% in I-type, and 90%, 94% and 94% in PB-type. CONCLUSIONS: The evaluation of EUS findings, especially focused on the pancreatic parenchyma, has the potential to predict the subtypes of IPMN.

    DOI: 10.1016/j.pan.2021.01.026

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  • Utility of a 21-gauge Menghini-type biopsy needle with the rolling method for an endoscopic ultrasound-guided histological diagnosis of autoimmune pancreatitis: a retrospective study. Reviewed International journal

    Koichiro Tsutsumi, Toru Ueki, Yasuhiro Noma, Kunihiro Omonishi, Kyotaro Ohno, Soichiro Kawahara, Takashi Oda, Hironari Kato, Hiroyuki Okada

    BMC gastroenterology   21 ( 1 )   21 - 21   2021.1

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    BACKGROUND: The histological diagnosis of autoimmune pancreatitis (AIP) by an endoscopic ultrasound (EUS)-guided approach is still challenging. METHODS: We investigated the utility of the 21-gauge Menghini-type biopsy needle with the rolling method for the histological diagnosis of AIP, in comparison with conventional 22-gauge needles. Among total 28 patients, rate of definitive histological diagnosis, acquired sample area of tissue, rate of histopathological diagnosis of AIP, and adverse events were retrospectively analyzed. RESULTS: Definitive histological diagnoses were successfully accomplished in all 14 patients (100%) treated with a Menghini-type needle, and in 57% of cases (8/14) treated with conventional 22-gauge needles (P < 0.001). The median sample area of the tissue, except for blood contamination, was remarkably larger by the Menghini-type needle than by conventional-type needles (6.2 [IQR, 4.5-8.8] versus 0.7 [IQR, 0.2-2.0] mm2, P < 0.001), and the area per punctures was approximately 4 times larger (1.4 [IQR: 0.9-2.9] versus 0.3 [IQR: 0.1-0.6] mm2/puncture, P < 0.001). Based on the International Consensus Diagnostic Criteria, lymphoplasmacytic infiltration, abundant IgG4-postive cells, storiform fibrosis, and obliterative phlebitis were found in 86%/29%, 64%/0%, 36%/0%, and 7%/0% patients who were treated with the Menghini-type needle and conventional-type needles, respectively. Consequently, histopathological diagnosis with type 1 AIP (lever 1 or 2) was achieved in 9 patients (64%) treated with the Menghini-type needle and in no patient treated with conventional-type needles (P < 0.001). Two patients who had mild post-procedural pancreatitis improved with conservative treatment, and no bleeding occurred in patients treated with the Menghini-type needle. CONCLUSION: EUS-guided rolling method with the 21-gauge Menghini-type biopsy needle is useful for the histopathological diagnosis of AIP, due to its abundant acquisition of good-quality tissue from the pancreas.

    DOI: 10.1186/s12876-020-01590-8

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  • Effectiveness of Menghini-Type Needles for Endoscopic Ultrasound-Guided Fine-Needle Aspiration of Pancreatic Masses. Reviewed International journal

    Sho Mizukawa, Hironari Kato, Kazuyuki Matsumoto, Shinichiro Muro, Yutaka Akimoto, Daisuke Uchida, Takeshi Tomoda, Naoki Yamamoto, Shigeru Horiguchi, Koichiro Tsutsumi, Hirofumi Inoue, Noriyuki Tanaka, Hiroyuki Okada

    Digestive diseases and sciences   2020.10

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    BACKGROUND: Cutting needles are thought to be effective as biopsy needles. A few types of cutting needles are available for endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA), and the Menghini-type needle is an end-type cutting needle. AIMS: A prospective randomized controlled trial was conducted to compare the results of EUS-FNA using a Menghini-type needle (needle M) versus a conventional needle (needle S). METHODS: The main eligibility criteria were as follows: patients with a pancreatic mass referred for EUS-FNA, ≥ 20 years old, and a performance status < 4. The primary outcome was the sample quality. The secondary outcomes were factors associated with the sample quality, diagnostic accuracy, and adverse events. RESULTS: A total of 97 patients were enrolled in this study. The sample quality for total puncture with needle M (92.8%) was significantly higher than that with needle S (81.4%) (p = 0.0305). The tumor size (p = 0.033) and type of needle (p = 0.031) were significant factors associated with adequate tissue collection in univariate and multivariate analyses (odds ratio [OR] 2.71; 95% confidence interval [CI] 1.12-6.54; p = 0.027 for tumor size, and OR 2.93; 95% CI 1.23-8.21; p = 0.0153 for type of needle). The diagnostic accuracy of each needle was 88.7% (86/97) with needle M and 73.2% (71/97) with needle S. Adverse events occurred in 2 of the 97 patients (0.02%). CONCLUSION: A Menghini-type needle was able to obtain core tissue for histology more effectively than a conventional aspiration needle. TRIAL REGISTRATION NUMBERS: UMIN registration number of 000020668.

    DOI: 10.1007/s10620-020-06628-1

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  • Correction to: Outcomes of endoscopic treatment for malignant biliary obstruction in patients with surgically altered anatomy: analysis of risk factors for clinical failure. Reviewed International journal

    Takeshi Tomoda, Hironari Kato, Kazuya Miyamoto, Akihiro Matsumi, Eijiro Ueta, Yuuki Fujii, Yousuke Saragai, Tatsuhiro Yamazaki, Daisuke Uchida, Kazuyuki Matsumoto, Shigeru Horiguchi, Koichiro Tsutsumi, Hiroyuki Okada

    Surgical endoscopy   2020.2

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    There are several places where the P-value and Odds ratio in Table 3 are incorrect: these are shown in the corrected Table 3 below.

    DOI: 10.1007/s00464-020-07399-6

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  • Outcomes of endoscopic treatment for malignant biliary obstruction in patients with surgically altered anatomy: analysis of risk factors for clinical failure. Reviewed International journal

    Takeshi Tomoda, Hironari Kato, Kazuya Miyamoto, Akihiro Matsumi, Eijiro Ueta, Yuuki Fujii, Yousuke Saragai, Tatsuhiro Yamazaki, Daisuke Uchida, Kazuyuki Matsumoto, Shigeru Horiguchi, Koichiro Tsutsumi, Hiroyuki Okada

    Surgical endoscopy   2020.1

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    BACKGROUND: To evaluate the outcomes of endoscopic retrograde cholangiopancreatography (ERCP) for malignant biliary obstruction (MBO) using short-type double-balloon enteroscope (sDBE) in patients with surgically altered anatomy. METHODS: A total of 45 patients with surgically altered anatomy underwent ERCP using sDBE for the treatment of MBO between April 2011 and March 2019. We retrospectively evaluated the clinical and technical success (insertion and biliary intervention success), adverse events, and risk factors for clinical failure. RESULTS: The scope was successfully inserted in the target site in 82.2% of patients (37/45), and among them, biliary intervention success was achieved in 86.4% (32/37). The overall technical success rate was 71.1% (32/45) and clinical success rate was 68.9% (31/45), with an adverse event rate of 11.1%. In multivariate analysis, the presence of peritoneal dissemination (odds ratio, 7.3; 95% confidence interval, 1.5-43.5, p = 0.02) was as an independent risk factor for clinical failure. The clinical success rate was 38.5% in patients with peritoneal dissemination and 81.3% in those without peritoneal dissemination. CONCLUSION: Endoscopic treatment using sDBE in patients without peritoneal dissemination provided favorable outcomes, and it can be an initial treatment for MBO in patients with surgically altered anatomy.

    DOI: 10.1007/s00464-020-07385-y

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  • [Use of a somatostatin analog to improve a patient's condition and the subsequent diagnosis of pancreatic VIPoma:a case report]. Reviewed

    Soichiro Kawahara, Toru Ueki, Koichiro Tsutsumi, Takashi Oda, Sayo Kobayashi, Tomoo Fujisawa, Toru Nawa, Hiroshi Sadamori, Kyotaro Ono, Kunihiro Omonishi

    Nihon Shokakibyo Gakkai zasshi = The Japanese journal of gastro-enterology   117 ( 1 )   84 - 91   2020

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    A 68-year-old woman with an 11-day history of sudden abdominal pain and severe watery diarrhea was transferred to our hospital due to an exacerbation of renal function despite hydration. After treatment for dehydration and acidemia was provided in our intensive care unit, patient's renal function improved. Contrast-enhanced abdominal computed tomography was finally performed, revealing a hypervascular pancreatic mass with multiple hepatic masses. This imaging finding along with her clinical symptoms indicated watery diarrhea hypokalemia achlorhydria (WDHA) syndrome caused by a pancreatic VIPoma. Somatostatin analog was administered immediately leading to the improvement of her diarrhea and her general condition. As a result, endoscopic ultrasonography-guided fine-needle aspiration could be performed. Consequently, she was diagnosed with a pancreatic neuroendocrine tumor. She then underwent surgical resection of the pancreatic tumor and liver metastasis. As revealed in the immunohistochemical analysis of the excised tumor tissue, VIP was highly expressed, resulting in the final diagnosis of pancreatic VIPoma. Therefore, the immediate use of a somatostatin analog is crucial for improving the patient's general condition and achieving a definitive diagnosis pathologically when a patient is suspected of having a pancreatic VIPoma.

    DOI: 10.11405/nisshoshi.117.84

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  • Potential Factors Affecting Results of Short-Type Double-Balloon Endoscope-Assisted Endoscopic Retrograde Cholangiopancreatography. Reviewed International journal

    Daisuke Uchida, Koichiro Tsutsumi, Hironari Kato, Akihiro Matsumi, Yosuke Saragai, Takeshi Tomoda, Kazuyuki Matsumoto, Shigeru Horiguchi, Hiroyuki Okada

    Digestive diseases and sciences   2019.9

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    BACKGROUND: Short-type double-balloon endoscope (DBE)-assisted endoscopic retrograde cholangiopancreatography (ERCP) has been developed as an alternative approach for cases with a surgically altered gastrointestinal anatomy. However, this technique is sometimes technically challenging and carries a risk of severe adverse events. AIMS: To evaluate the factors affecting the technical success rate and adverse events of DBE-ERCP. METHODS: A total of 319 patients (805 procedures) with a surgically altered gastrointestinal anatomy underwent short DBE-ERCP. The factors affecting the technical success rate and adverse events, and the learning curve of the trainees were retrospectively evaluated. RESULTS: The technical success rate of all procedures was 90.7%. Adverse events occurred in 44 (5.5%) procedures. A multivariate analysis indicated that Roux-en-Y reconstruction and first-time short DBE-ERCP were factors affecting the technical failure and adverse event rates, while the modified Child method after subtotal stomach-preserving pancreaticoduodenectomy reconstruction was a non-risk factor for adverse events. The trainee caseload did not affect the technical success or adverse event rates significantly; however, trainees tended to perform cases involving the modified Child method after subtotal stomach-preserving pancreaticoduodenectomy reconstruction. The success rate of scope insertion increased according to experience; however, the overall success rate did not differ to a statistically significant extent. CONCLUSION: Short DBE-ERCP was useful and safe for managing cases with a surgically altered anatomy; however, trainees should concentrate on accumulating experience with easy cases, such as those with the modified Child method after subtotal stomach-preserving pancreaticoduodenectomy reconstruction or a history of DBE-ERCP.

    DOI: 10.1007/s10620-019-05857-3

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  • A "Back Light System" for Identification of Sites for Endoscopic Ultrasound-Guided Fine-Needle Aspiration in Solid Pancreatic Masses: A Prospective, Randomized Study with a Crossover Design. Reviewed International journal

    Ryo Harada, Hironari Kato, Soichiro Fushimi, Hirofumi Inoue, Daisuke Uchida, Yutaka Akimoto, Takeshi Tomoda, Kazuyuki Matsumoto, Yasuhiro Noma, Naoki Yamamoto, Shigeru Horiguchi, Koichiro Tsutsumi, Hiroyuki Okada

    Clinical endoscopy   52 ( 4 )   334 - 339   2019.7

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    BACKGROUND/AIMS: We applied a back light system (BLS) with a magnifying glass to improve the ability to assess the adequacy of specimen sampling using endosonography. We conducted this study to evaluate the efficacy of the BLS in sampling of specimens by endoscopic ultrasound-guided fine needle aspiration of solid pancreatic masses. METHODS: This was a prospective, randomized, crossover, single-center clinical trial. An endosonographer evaluated adequacy on gross visual inspection and identified whitish specimen sampling sites with and without the BLS according to a randomization sequence in the first and second passes with a 25-G needle. On cytological evaluation, the presence of well-defined pancreatic ductal epithelium was evaluated by a cytopathologist who was blinded to any clinical information. RESULTS: A total of 80 consecutive patients were eligible during the study period. Adequacy was observed for 52 specimens (65%) with the BLS and 54 (68%) without the BLS (p=0.88). In assessment of specimen adequacy on gross examination, only fair agreement was observed both with and without BLS (kappa score 0.40 and 0.29, respectively). CONCLUSION: The BLS did not influence the ability to identify specimen sampling sites or reliable assessment of specimen site adequacy using gross visual inspection.

    DOI: 10.5946/ce.2019.004

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  • Comparison Between Endoscopic Biliary Stenting Combined with Balloon Dilation and Balloon Dilation Alone for the Treatment of Benign Hepaticojejunostomy Anastomotic Stricture. Reviewed International journal

    Takeshi Tomoda, Hironari Kato, Kazuya Miyamoto, Yousuke Saragai, Sho Mizukawa, Shuntaro Yabe, Saimon Takata, Shinichiro Muro, Daisuke Uchida, Kazuyuki Matsumoto, Shigeru Horiguchi, Koichiro Tsutsumi, Ken Hirao, Tsuneyoshi Ogawa, Hiroyuki Okada

    Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract   2019.6

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    BACKGROUND: Hepaticojejunostomy anastomotic stricture (HJAS) is an important complication of biliary reconstructive surgery but has no standard treatment. We aimed to evaluate the outcomes of endoscopic treatment for benign HJAS and identify the risk factors for its recurrence. METHODS: This study retrospectively analyzed 176 patients who underwent endoscopic retrograde cholangiopancreatography (ERCP) for HJAS between April 2008 and March 2016. The outcome of endoscopic biliary stenting combined with balloon dilation (EBS group) and balloon dilation alone (balloon group) was evaluated. RESULTS: The scope was successfully inserted into the HJ site in 93.8% patients (165/176), and 139 patients underwent endoscopic treatment after HJAS was confirmed. Successful biliary drainage was achieved in 137 patients by using ERCP and rendezvous procedures. Among these, 103 patients were included in balloon group and 34 patients were in EBS group. HJAS was resolved in 132 patients; five died from recurrence of primary disease. The 1 (3)-year bile duct patency rates in the balloon and EBS groups were 62.5% (46.6%) and 89.4% (84.7%), respectively (p = 0.015). Univariate analysis showed that balloon dilation (p = 0.009) and early HJAS formation (time from surgery to ERCP < 1 year) (p = 0.02) were risk factors for HJAS recurrence. In the multivariate analysis, balloon dilatation was identified as independent risk factors for HJAS recurrence. CONCLUSIONS: Balloon dilation without stent deployment and early HJAS formation are risk factors for HJAS recurrence after endoscopic treatment. Stent deployment might be recommended for definite resolution of HJAS.

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  • Efficacy and safety of chemotherapy after endoscopic double stenting for malignant duodenal and biliary obstructions in patients with advanced pancreatic cancer: a single-institution retrospective analysis. Reviewed International journal

    Kazuyuki Matsumoto, Hironari Kato, Shigeru Horiguchi, Koichiro Tsutsumi, Yosuke Saragai, Saimon Takada, Sho Mizukawa, Shinichiro Muro, Daisuke Uchida, Takeshi Tomoda, Hiroyuki Okada

    BMC gastroenterology   18 ( 1 )   157 - 157   2018.10

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    BACKGROUND: Advanced pancreatic cancer is accompanied not only by bile duct obstruction, but also occasionally by duodenal obstruction. With new advances in chemotherapy and improvement in the management of stent dysfunction, the life expectancy of patients with pancreatic cancer has increased. This study aimed to evaluate the efficacy and safety of chemotherapy for advanced pancreatic cancer, as well as to analyze the prognostic factors, following endoscopic double stenting. METHODS: This retrospective study was conducted from January 1, 2007 to October 31, 2015 at an academic center. Fifty consecutive patients with pancreatic cancer who had undergone endoscopic double stenting, comprising duodenal and biliary stenting, were analyzed. We reviewed the patients records and analyzed the data of stent dysfunction rates after double stenting, reintervention for stent dysfunction, chemotherapy after double stenting, adverse events associated with chemotherapy after double stenting, survival times following double stenting, and overall survival times. The hospital's institutional review board for human research approved this study. RESULTS: The overall survival time and the survival time following double stenting were 10.9 months (IQR 6.0-18.4 months) and 2.4 months (IQR 1.4-5.2 months), respectively. After double stenting, duodenal stent dysfunction occurred in 6 patients (12%), and biliary stent dysfunction occurred in 12 patients (24%), respectively. All patients who experienced stent dysfunction underwent endoscopic reintervention, and all of the procedures were successful. Twenty-one (42%) patients were treated with chemotherapy post double stenting; 9 patients received chemotherapy as a first-line treatment, 9 as a second-line treatment, and 3 as a third-line treatment. During chemotherapy, 8 (38%) patients had grade 3-4 adverse events, which were manageable. Chemotherapy post double stenting (OR, 0.19; 95% CI, 0.059-0.60; P = .0051), reintervention for biliary stent dysfunction (OR, 0.21; 95% CI, 0.081-0.50; P = .0002), and performance status (< 2) (OR, 0.28; 95% CI, 0.098-0.71; P = .0064) were significant prognostic factors after double stenting. CONCLUSIONS: Systemic chemotherapy was manageable, even in patients with double stenting. Chemotherapy after double stenting and appropriate reintervention for stent obstructions potentially prolonged the survival of patients with advance pancreatic cancer.

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  • Dipeptide γ-secretase inhibitor treatment enhances the anti-tumor effects of cisplatin against gastric cancer by suppressing cancer stem cell properties. Reviewed International journal

    Ryo Kato, Masaya Iwamuro, Hidenori Shiraha, Shigeru Horiguchi, Emi Tanaka, Ken Matsumoto, Atsushi Ohyama, Hiroaki Sawahara, Teruya Nagahara, Daisuke Uchida, Koichiro Tsutsumi, Hiroyuki Okada

    Oncology letters   16 ( 4 )   5426 - 5432   2018.10

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    The γ-secretase inhibitor blocks Notch activity by preventing its cleavage at the cell surface. In the present study, the effect of the γ-secretase inhibitor on the viability of gastric cancer cells when administered in combination with cisplatin was investigated, with particular focus on CD44highLgr-5high cancer cells. The four gastric cancer cell lines, MKN45, MKN74, SC-6-JCK and SH-10-TC, were used for the experiments. In the MTT assay, treatment with 25 µM dipeptide γ-secretase inhibitor (DAPT) alone did not affect cell proliferation in any of the four cell lines. Gastric cancer cells subjected to combination treatment with DAPT and cisplatin exhibited decreased viability when compared with those treated with cisplatin alone. Flow cytometry was performed to evaluate the expression of cluster of differentiation (CD)-44 and leucine-rich repeat-containing G-protein coupled receptor 5 (Lgr-5), two cancer stem cell markers in gastric cancers. Treatment with cisplatin alone significantly increased the proportion of CD44highLgr-5high cells. However, the addition of DAPT to cisplatin reduced the CD44highLgr-5high fraction, suggesting that DAPT reduced the number of gastric cancer cells. In conclusion, the present study demonstrated the synergistic effects of DAPT in combination with cisplatin by decreasing the survival of gastric cancer cells. In addition, combination treatment with DAPT reduced the number of CD44highLgr-5high cells, which are thought to exhibit cancer stem cell properties. These results highlight the therapeutic potential of DAPT in gastric cancer treatment.

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  • The intra-conduit release method is useful for avoiding migration of metallic stents during EUS-guided hepaticogastrostomy (with video). Reviewed

    Daisuke Uchida, Hirofumi Kawamoto, Hironari Kato, Daisuke Goto, Takeshi Tomoda, Kazuyuki Matsumoto, Naoki Yamamoto, Shigeru Horiguchi, Koichiro Tsutsumi, Hiroyuki Okada

    Journal of medical ultrasonics (2001)   45 ( 3 )   399 - 403   2018.7

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    PURPOSE: Although EUS-guided hepaticogastrostomy (EUS-HGS) with a covered self-expandable metal stent (SEMS) is a useful procedure, it is associated with severe adverse events, including stent migration. We, therefore, developed an intra-conduit release method, and investigated whether the technique yields a safer and more stable procedure. METHODS: The intra-conduit release method is a procedure to release the SEMS in the working channel conduit of the scope for anchoring between the liver and stomach to avoid stent migration. Forty-three patients who underwent EUS-HGS at two high-volume centers in Japan were enrolled in this retrospective study, and the safety and usefulness of this method were evaluated retrospectively. RESULTS: The intra-conduit release method was applied in 36 cases. The technical success rate of EUS-HGS with the intra-conduit release method was significantly higher in comparison with the conventional method. Additionally, the rate of early adverse events was significantly lower than that for the conventional method. CONCLUSION: The intra-conduit release method during EUS-HGS is useful for a stable procedure that avoids early adverse events.

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  • An Intrapancreatic Accessory Spleen That Was Difficult to Diagnose Due to Temporal Changes after Splenectomy. Reviewed

    Daisuke Uchida, Koichiro Tsutsumi, Hironari Kato, Hiroyuki Okada

    Internal medicine (Tokyo, Japan)   57 ( 5 )   681 - 685   2018.3

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    Accessory spleen (AS) is common anomaly, and 20% of AS cases occur in the pancreatic tail. An intrapancreatic AS can be difficult to distinguish from pancreatic neoplasms. In most cases, an AS is described as a hypervascular and solitary tumor, but an AS sometimes takes other forms. We herein report a rare case of an intrapancreatic AS with temporal changes in its appearance after splenectomy, which mimicked aspects of pancreatic cancer. Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) and 99mTc sulfur colloid scintigraphy were useful for the diagnosis.

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  • Efficacy of endoscopic treatment using double-balloon enteroscopy for postoperative bile leakage in patients with hepaticojejunostomy. Reviewed International journal

    Kazuyuki Matsumoto, Koichiro Tsutsumi, Hironari Kato, Shigeru Horiguchi, Yosuke Saragai, Saimon Takada, Sho Mizukawa, Shinichiro Muro, Daisuke Uchida, Takeshi Tomoda, Hiroyuki Okada

    Endoscopy international open   6 ( 2 )   E211-E216   2018.2

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    Background and study aims  Endoscopic treatment for post-operative bile is technically challenging in patients with altered gastrointestinal anatomy. This study evaluated the effectiveness of using a short-type double-balloon enteroscope to treat postoperative bile leakage after hepaticojejunostomy.

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  • Endoscopic balloon dilatation for benign hepaticojejunostomy anastomotic stricture using short double-balloon enteroscopy in patients with a prior Whipple's procedure: a retrospective study. Reviewed International journal

    Sho Mizukawa, Koichiro Tsutsumi, Hironari Kato, Shinichiro Muro, Yutaka Akimoto, Daisuke Uchida, Kazuyuki Matsumoto, Takeshi Tomoda, Shigeru Horiguchi, Hiroyuki Okada

    BMC gastroenterology   18 ( 1 )   14 - 14   2018.1

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    BACKGROUND: Endoscopic retrograde cholangiography using a short double-balloon endoscope (DB-ERC) is a promising minimally-invasive method for accessing hepaticojejunostomy (HJ) anastomosis in patients with surgically altered anatomy. We aimed to evaluate the immediate and long-term outcomes of balloon dilatation for benign HJ anastomotic stricture (HJAS) in patients who had previously undergone Whipple's procedure using a DB-ERC. METHODS: We conducted a retrospective analysis of 46 patients who underwent balloon dilatation alone with a DB-ERC for benign HJAS between November 2008 and November 2014. The median follow-up duration was 3.5 (interquartile range [IQR], 1.9-5.1) years. RESULTS: The technical and clinical success rates were 100%, and adverse events occurred in 7% (3/46, cholangitis). The median hospitalization period was seven (IQR, 5-10) days. Of 42 patients (91%) followed-up for > 1 year, 24 (51%) had recurrent HJAS at a median of 1.2 (IQR, 0.6-2.9) years after balloon dilatation. The cumulative anastomotic patency rates at 1, 2, and 3 years were 73, 55, and 49%, respectively. In univariate analysis, early stricture formation (< 1 year) was a risk factor for recurrent stenosis, although no statistically significant risk factors were observed in multivariate analysis. CONCLUSIONS: Endoscopic balloon dilatation with DB-ERC for benign HJAS is effective and safe, having good immediate technical success and few adverse events. Further improvements to this procedure are needed to prevent recurrent HJAS.

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  • Comparison of two fluoroscopic images to ensure efficient scope insertion for biliary intervention in patients with Roux-en-Y hepaticojejunostomy. Reviewed International journal

    Koichiro Tsutsumi, Hironari Kato, Ken Hirao, Sho Mizukawa, Shinichiro Muro, Yutaka Akimoto, Daisuke Uchida, Kazuyuki Matsumoto, Takeshi Tomoda, Shigeru Horiguchi, Shuntaro Yabe, Hiroyuki Seki, Yasuhiro Noma, Naoki Yamamoto, Ryo Harada, Tsuneyoshi Ogawa, Hiroyuki Okada

    Endoscopy   49 ( 12 )   1256 - 1261   2017.12

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    Background and study aims No standard procedure for endoscopic retrograde cholangiopancreatography is available for patients with Roux-en-Y hepaticojejunostomy (RYHJ) with side-to-end hepaticojejunostomy. We therefore explored methods of efficient scope insertion at a hepaticojejunostomy site. Patients and methods Patients with suspected biliary disease were prospectively enrolled. Based on two fluoroscopic images obtained on scope insertion into each lumen of a two-pronged Roux-en-Y anastomosis, we selected the lumen in which the distal end of the scope progressed toward the patient's liver or head. The accuracy of this method for selecting the correct lumen leading to the hepaticojejunostomy site was investigated. Results Of the 33 included patients, successful insertion to the hepaticojejunostomy site was achieved in 32 (97 %), 26 (81 %) of whom had undergone the imaging method. The accuracy of the method was 88 % (23/26). The time required for insertion between the anastomotic site and the hepaticojejunostomy site was shorter when the lumen selection had been correct (13 minutes [7 - 30] (n = 23) vs. 18 minutes [8 - 28] (n = 9); P = 0.95). Conclusion This method based on two fluoroscopic images was useful for achieving efficient scope insertion in patients with RYHJ.Trial registered at University Hospital Medical Information Network Clinical Trials Registry (UMIN000014183).

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  • Usefulness of a newly designed plastic stent for endoscopic re-intervention in patients with malignant hilar biliary obstruction. Reviewed International journal

    Takeshi Tomoda, Hironari Kato, Hirofumi Kawamoto, Shinichiro Muro, Yutaka Akimoto, Daisuke Uchida, Kazuyuki Matsumoto, Shigeru Horiguchi, Koichiro Tsutsumi, Hiroyuki Okada

    Endoscopy   49 ( 11 )   1087 - 1091   2017.11

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    Background and study aims We designed a new 7-Fr plastic stent for treating self-expandable metal stent (SEMS) obstruction in patients with malignant hilar biliary obstruction (MHBO) via endoscopic re-intervention with the stent-in-stent (SIS) method and evaluated its efficacy. Patients and methods A total of 33 consecutive patients who underwent endoscopic re-intervention for metal stent obstruction after multi-branched SEMS placement were enrolled. The initial SEMSs were placed in two or three biliary branches in 14 and 19 patients, respectively. We retrospectively evaluated the technical and clinical success, and adverse events. Technical success was defined as successful plastic stent placement into all target branches through the lumen of the SEMS. Results The technical success rates were 85.7 % (12/14) and 78.9 % (15/19) in patients who underwent two- or three-branched biliary drainage, respectively. The clinical success rate was 100 % in the 27 patients in whom technical success was achieved. We achieved successful plastic stent placement in more than two branches, using the new plastic stent combined with a conventional plastic stent, in 97.0 % (32/33). Conclusions This new plastic stent was technically feasible for treating stent obstruction via re-intervention with SIS methods.

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  • Promising therapeutic efficacy of a novel reduced expression in immortalized cells/dickkopf-3 expressing adenoviral vector for hepatocellular carcinoma. Reviewed International journal

    Hiroaki Sawahara, Hidenori Shiraha, Daisuke Uchida, Hironari Kato, Ryo Kato, Atsushi Oyama, Teruya Nagahara, Masaya Iwamuro, Shigeru Horiguchi, Koichiro Tsutsumi, Mari Mandai, Tetsushige Mimura, Nozomu Wada, Yasuto Takeuchi, Kenji Kuwaki, Hideki Onishi, Shinichiro Nakamura, Masami Watanabe, Masakiyo Sakaguchi, Akinobu Takaki, Kazuhiro Nouso, Takahito Yagi, Yasutomo Nasu, Hiromi Kumon, Hiroyuki Okada

    Journal of gastroenterology and hepatology   32 ( 10 )   1769 - 1777   2017.10

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    BACKGROUND AND AIM: Reduced expression in immortalized cells (REIC)/dickkopf-3 (Dkk-3) is a tumor suppressor gene that is downregulated in various cancers. In our previous study of prostate cancer, the REIC/Dkk-3-expressing adenoviral vector (Ad-REIC) was found to induce cancer-selective apoptosis. This study recently developed a novel super gene expression (SGE) system and used this system to re-construct an Ad-REIC vector, termed the Ad-SGE-REIC, to achieve more effective therapeutic outcomes. In this study, the therapeutic effects of Ad-SGE-REIC on hepatocellular carcinoma (HCC) was assessed. METHODS: Human HCC cell lines (HLE, Huh7, HepG2, HLF, SK-Hep1, and PLC), human HCC tissues, and mouse HCC cell line (Hepa1-6) were used in this study. REIC/Dkk-3 expression was assessed by immunoblotting and immunohistochemistry. The relative cell viability and the apoptotic effect were examined in vitro, and the anti-tumor effects of Ad-SGE-REIC treatment were analyzed in the mouse xenograft model. This study additionally assessed anti-tumor immunological effects on the immunocompetent mice. RESULTS: REIC/Dkk-3 expression was decreased in HCC cell lines and HCC tissues. Ad-SGE-REIC reduced cell viability and induced apoptosis in HCC cell lines (HLE and Huh7), inhibited tumor growth in the mouse xenograft model, and demonstrated in vivo anti-cancer immunostimulatory effects on the HCC cell line (Hepa1-6). CONCLUSIONS: Ad-SGE-REIC treatment not only enhanced cell killing effects in vitro but also elicited significant therapeutic effects, with tumor growth suppression, in vivo. REIC/Dkk-3 gene therapy using Ad-SGE-REIC potentially represents an innovative new therapeutic tool for HCC.

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  • Endoscopic gallbladder stenting using a rendezvous technique for cholecystitis after metal stent placement in a patient with malignant hilar biliary stricture. Reviewed International journal

    Shigeru Horiguchi, Koichiro Tsutsumi, Hironari Kato, Hiroyuki Okada

    Endoscopy   49 ( 9 )   E204-E205   2017.9

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  • A Multicenter, Prospective, Randomized Controlled Trial Evaluating the Efficacy of Rectal Diclofenac and Sublingual Nitrate as a Combined Prophylactic Treatment for Post-ERCP Pancreatitis. Reviewed

    Takeshi Tomoda, Hironari Kato, Sho Mizukawa, Shinichiro Muro, Yutaka Akimoto, Daisuke Uchida, Kazuyuki Matsumoto, Naoki Yamamoto, Shigeru Horiguchi, Koichiro Tsutsumi, Hiroyuki Okada

    Acta medica Okayama   71 ( 4 )   357 - 362   2017.8

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    Acute pancreatitis is the major complication of endoscopic retrograde cholangiopancreatography(ERCP). A preliminary research suggested that the administration of nonsteroidal anti-inflammatory drugs (NSAIDs) with nitrate might reduce the incidence of post-ERCP pancreatitis (PEP) more effectively than NSAIDs alone. We conduct a two-arm, multicenter, prospective, randomized, superiority trial to evaluate the additional effect of nitrate for prevention of PEP. A total of 900 patients randomly receive 50 mg diclofenac suppository either alone or with 5 mg isosorbide dinitrate sublingual tablet. The primary endpoint is the occurrence of PEP. This study will clarify whether NSAIDs plus nitrate can prevent PEP.

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  • Long-term outcomes and risk factors of biliary stent dysfunction after endoscopic double stenting for malignant biliary and duodenal obstructions. Reviewed International journal

    Kazuyuki Matsumoto, Hironari Kato, Koichiro Tsutsumi, Sho Mizukawa, Syuntaro Yabe, Hiroyuki Seki, Yutaka Akimoto, Daisuke Uchida, Takeshi Tomoda, Naoki Yamamoto, Shigeru Horiguchi, Kenji Kuwaki, Hiroyuki Okada

    Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society   29 ( 5 )   617 - 625   2017.7

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    BACKGROUND AND AIM: Few reports describe the endoscopic double-stenting procedure for malignant biliary and duodenal obstructions. We evaluated the clinical outcomes from double stenting, and analyzed the risk factors for biliary stent dysfunction following double stenting. METHODS: Eighty-one patients who underwent endoscopic double stenting for malignant biliary and duodenal obstructions were retrospectively analyzed. We determined the stent dysfunction rate and the biliary stent dysfunction risk factors, and analyzed the endoscopic reintervention results. RESULTS: Overall survival time and survival time following double stenting were 365 (38-1673) days and 73 (20-954) days, respectively. After double stenting, the 3-month and 6-month duodenal stent dysfunction rates were 14% and 41%, respectively. Reintervention technical success rate was 100% (10/10), and mean gastric outlet obstruction scoring system scores improved from 0.7 to 2.4 points (P < 0.001). The 3-month and 6-month biliary stent dysfunction rates were 26% and 41%, respectively. The reintervention technical and clinical success rates were 95% (20/21) and 81% (17/21), respectively. Risk factors for biliary stent dysfunction following double stenting were events associated with duodenal stent dysfunction (odds ratio [OR], 11.1; 95% confidence interval [CI], 2.09-87.4; P = 0.0044) and the biliary stent end's location (OR, 6.93; 95% CI, 1.37-40.2; P = 0.0019). CONCLUSIONS: Some patients had stent dysfunction irrespective of the survival period after double stenting. Endoscopic reintervention was technically feasible and clinically effective even after double stenting. Duodenal stent dysfunction and biliary stent end's location were risk factors for biliary stent dysfunction.

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  • Usefulness of short double-balloon enteroscopy for biliary intervention through Vater's papilla in a patient with Roux-en-Y gastrectomy. Reviewed International journal

    Koichiro Tsutsumi, Hironari Kato, Hiroyuki Okada

    Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society   29 ( 5 )   642 - 643   2017.7

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  • Predictive factors for outcomes of patients undergoing endoscopic therapy for bile leak after hepatobiliary surgery. Reviewed International journal

    Shuntaro Yabe, Hironari Kato, Sho Mizukawa, Yutaka Akimoto, Daisuke Uchida, Hiroyuki Seki, Takeshi Tomoda, Kazuyuki Matsumoto, Naoki Yamamoto, Shigeru Horiguchi, Koichiro Tsutsumi, Hiroyuki Okada

    Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society   29 ( 3 )   353 - 361   2017.5

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    BACKGROUND AND AIM: Endoscopic procedures are used as first-line treatment for bile leak after hepatobiliary surgery. Advances have been made in endoscopic techniques and devices, but few reports have described the effectiveness of endoscopic procedures and the management principles based on severity of bile leak. We evaluated the effectiveness of an endoscopic procedure for the treatment of bile leak after hepatobiliary surgery. METHODS: Fifty-eight patients underwent an endoscopic procedure for suspected bile leak after hepatobiliary surgery; the presence of bile leak on endoscopic retrograde cholangiopancreatography (ERCP) was evaluated retrospectively. Two groups were created based on bile leak severity at ERCP. We defined success as follows: technical, successful placement of the plastic stent at the intended bile duct; clinical, improvement in symptoms of bile leak; and eventual, disappearance of bile leak at ERCP. We evaluated several factors that influenced the success of the endoscopic procedure and the differences between bile leak severity. RESULTS: Success rates were as follows: technical, 90%; clinical, 79%; and eventual, 71%. Median interval between first endoscopic procedure and achievement of eventual success was 135 days (IQR, 86-257 days). Bile leak severity was the only independent factor associated with eventual success (P = 0.01). CONCLUSIONS: Endoscopic therapy is safe and effective for postoperative bile leak. Bile leak severity is the most important factor influencing successful endoscopic therapy.

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  • Association between periodontitis and prognosis of pancreatobiliary tract cancer: A pilot study. Reviewed International journal

    Takayuki Maruyama, Takaaki Tomofuji, Tatsuya Machida, Hironari Kato, Koichiro Tsutsumi, Daisuke Uchida, Akinobu Takaki, Toshiki Yoneda, Hisataka Miyai, Hirofumi Mizuno, Daisuke Ekuni, Hiroyuki Okada, Manabu Morita

    Molecular and clinical oncology   6 ( 5 )   683 - 687   2017.5

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    Several studies have indicated that periodontitis is a risk factor for cancer. However, the association between periodontitis and the prognosis of pancreatobiliary tract cancer remains unclear. The aim of this pilot study was to investigate the association between periodontitis and prognosis of pancreatobiliary tract cancer. A total of 22 patients diagnosed with pancreatobiliary tract cancer were analyzed. Oral health status, including severity of periodontitis, general health status and biochemical serum markers were evaluated. The Kaplan-Meier method and Cox proportional hazards model were used to assess factors affecting the prognosis of pancreatobiliary tract cancer. The Kaplan-Meier analysis demonstrated that low body mass index, high concentration of serum C-reactive protein (CRP) and severe periodontitis were significant prognostic factors for survival rate. The Cox proportional hazards model revealed that serum carbohydrate antigen 19-9 concentration [hazard ratio (HR)=1.002; 95% confidence interval (CI): 1.000-1.004] and serum CRP concentration (HR=2.57; 95% CI: 1.15-5.74) were significantly associated with the prognosis of pancreatobiliary tract cancer. In addition, cancer patients with severe periodontitis had higher serum CRP concentrations compared with those without severe periodontitis. Therefore, severe periodontitis indirectly affected the prognosis of pancreatobiliary tract cancer through promoting systemic inflammation.

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  • Dynamic computed tomography is useful for prediction of pathological grade in pancreatic neuroendocrine neoplasm. Reviewed International journal

    Shigeru Horiguchi, Hironari Kato, Hidenori Shiraha, Koichiro Tsutsumi, Naoki Yamamoto, Kazuyuki Matsumoto, Takeshi Tomoda, Daisuke Uchida, Yutaka Akimoto, Syou Mizukawa, Takehiro Tanaka, Koichi Ichimura, Akinobu Takaki, Takahito Yagi, Hiroyuki Okada

    Journal of gastroenterology and hepatology   32 ( 4 )   925 - 931   2017.4

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    BACKGROUND AND AIM: Pathological grading is important in defining the therapeutic strategy in pancreatic neuroendocrine neoplasm (PNEN) but is difficult for unresectable cases. Endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA) is useful in the diagnosis of PNEN, but its usefulness for pathological grading is not well established. No studies have examined the diagnostic ability of dynamic computed tomography (CT) for pathological grading of PNEN. We investigated the usefulness of EUS-FNA and dynamic CT in the diagnosis and pathological grading of PNEN. METHODS: In this retrospective study, 39 PNEN patients finally diagnosed via EUS-FNA and/or surgical resection underwent dynamic CT. Pathological samples were diagnosed based on WHO2010; staging was based on the European Neuroendocrine Tumor Society classification. The proportion of the quantification value in the tumor to the pancreatic parenchyma in arterial phase was defined as the CT ratio. Immunohistochemical staining with CD31 was performed to evaluate microvessel density (MVD). We evaluated the relationship between pathological grade, CT ratio, and MVD. RESULTS: By using EUS-FNA, 35 of 39 (90%) cases were diagnosed as PNEN. As for pathological grade, 15 of 35 (43%) cases could be identified correctly. CT ratio could predict pathological Grade 3 disease. The sensitivity, specificity, and diagnostic accuracy were 100%, 94%, and 95%. MVD was significantly correlated with CT ratio (r = 0.83, P < 0.0001) and pathological grade (P = 0.0074). CONCLUSIONS: Computed tomography ratio has a relationship with pathological grade in PNEN, which would help decide therapeutic strategy in unresectable cases and cases in which pathological grading is difficult.

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  • Recent advancements in stent therapy in patients with malignant gastroduodenal outlet obstruction. Reviewed International journal

    Hironari Kato, Koichiro Tsutsumi, Hiroyuki Okada

    Annals of translational medicine   5 ( 8 )   186 - 186   2017.4

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    Gastric outlet obstruction (GOO) is one of severe comorbidities caused by many kinds of malignant diseases and is associated with not only degradation of patients' quality of life but also mortality. Although surgical bypass is one of the main therapies for malignant GOO, it is often difficult to perform in end-stage patients. The deployment of self-expandable metallic stents (SEMSs) has recently become a viable alternative to surgical bypass for malignant GOO. This technique is less invasive and more effective, particularly in patients with poor prognoses. Many reports have referred to the feasibility, effectiveness, and safety of the placement of SEMSs for malignant GOO. According to these reports, the rates of technical and clinical success were reported to be relatively high and the rate of adverse events to be acceptable. However, precautions against severe adverse events such as massive bleeding and perforation are necessary. Several reports have described the differences in clinical results among different kinds of SEMSs. The presence of a covered design for SEMSs may affect the patency of SEMSs and the rate of stent dysfunction. Selection of the SEMS according to axial force may affect successful achievement of long patency of SEMSs and avoidance of gastroduodenal perforation at the bending site of the duodenum. Compared with high technical success rates nearing 100%, clinical success rates were usually lower than technical success. Therefore, determination of predictive factors for failure of clinical success is important. Several papers reported that low performance status could be associated with failure of clinical success. However, the association of clinical success with other factors such as carcinomatosa and ascites remains controversial, which is a problem to be solved. Reintervention with SEMS using the stent-in-stent method after stent dysfunction can be performed effectively as well as placement of the first SEMS.

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  • Suitable Liquid Biopsy Samples for Detecting Kras Mutations in Patients with Pancreatic Cancer Reviewed

    Soichiro Ako, Kazuhiro Nouso, Hideaki Kinugasa, Chihiro Dohi, Hiroshi Matsushita, Sho Mizukawa, Shinichiro Muro, Yutaka Akimoto, Daisuke Uchida, Takeshi Tomoda, Kazuyuki Matsumoto, Shigeru Horiguchi, Koichiro Tsutsumi, Hironari Kato, Hiroyuki Okada

    Gastroenterology   152 ( 5 )   S490   2017.4

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    Publishing type:Research paper (scientific journal)   Publisher:Elsevier {BV}  

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  • Impact of a Newly Developed Short Double-Balloon Enteroscope on Stent Placement in Patients with Surgically Altered Anatomies. Reviewed International journal

    Koichiro Tsutsumi, Hironari Kato, Hiroyuki Okada

    Gut and liver   11 ( 2 )   306 - 311   2017.3

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    A newly developed short double-balloon enteroscope with a working channel enlarged to a diameter of 3.2 mm is a novel innovation in stent placement for patients with surgically altered anatomies. Herein, we report three patients in whom this new scope contributed to an efficient technique and ideal treatment. In the first case, the double guidewire technique was efficient and effective for multiple stent placements. In the second case, covered self-expandable metal stent (SEMS) placement, which is the standard treatment for malignant biliary obstruction, could be performed in a technologically sound and safe manner. In the third case, SEMS placement was performed as palliative treatment for malignant afferent-loop obstruction; this procedure could be performed soundly and safely using the through-the-scope technique. The wider working channel of this new scope also facilitates a smoother accessory insertion and high suction performance, which reduces procedure time and stress on endoscopists. Furthermore, this new scope, which has advanced force transmission, adaptive bending, and a smaller turning radius, is expected to be highly successful in both diagnosis and therapy for various digestive diseases in patients with surgically altered anatomies.

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  • Balloon Dilation and Electrohydraulic Lithotripsy for Treating an Impacted Duodenal Bezoar. Reviewed International journal

    Masaya Iwamuro, Koichiro Tsutsumi, Hiroyuki Okada

    Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association   15 ( 3 )   e67-e68   2017.3

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  • A comparative evaluation of treatment methods for bile duct stones after hepaticojejunostomy between percutaneous transhepatic cholangioscopy and peroral, short double-balloon enteroscopy. Reviewed International journal

    Koichiro Tsutsumi, Hironari Kato, Shuntaro Yabe, Sho Mizukawa, Hiroyuki Seki, Yutaka Akimoto, Daisuke Uchida, Kazuyuki Matsumoto, Takeshi Tomoda, Naoki Yamamoto, Shigeru Horiguchi, Hirofumi Kawamoto, Hiroyuki Okada

    Therapeutic advances in gastroenterology   10 ( 1 )   54 - 67   2017.1

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    BACKGROUND: Bile duct stones after hepaticojejunostomy are considered a troublesome adverse event. Although percutaneous transhepatic procedures using a cholangioscopy is performed to treat these bile duct stones, a peroral endoscopic procedure using a short, double-balloon enteroscope (sDBE) is an alternative. This study aimed to compare the immediate and long-term outcomes of both treatments for bile duct stones in patients who underwent prior hepaticojejunostomy. METHODS: Between October 2001 and May 2013, 40 consecutive patients were treated for bile duct stones after hepaticojejunostomy at a tertiary care hospital. Initial success with biliary access, biliary intervention-related technical success, clinical success, adverse events, hospitalization duration, and stone-free survival were retrospectively evaluated. RESULTS: The initial success rates for biliary access were 100% (8/8) with percutaneous transhepatic cholangioscopy (PTCS) and 91% (29/32) with sDBE. In three patients in whom biliary access during initial sDBE failed, successful access with subsequent PTCS was achieved, and biliary intervention-related technical success and clinical success were eventually achieved in all 40 patients. The rate of adverse events was significantly lower with sDBE than with PTCS (10% versus 45%; p = 0.025). The median hospitalization duration for complete stone clearance was significantly shorter with sDBE than with PTCS (10 versus 35 days; p < 0.001). During the median 7.2 year or 3.1 year follow up, the probabilities of being stone-free at 1, 2, and 3 years were 100%, 73%, and 64% for PTCS and 85%, 65%, and 59% for sDBE, respectively (p = 0.919). CONCLUSIONS: sDBE was useful, with few adverse events and short hospitalization; therefore, experienced endoscopists can consider it as first-line treatment for bile duct stones in patients with prior hepaticojejunostomy.

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  • Utility of serum DNA as a marker for KRAS mutations in pancreatic cancer tissue. Reviewed

    Soichiro Ako, Kazuhiro Nouso, Hideaki Kinugasa, Chihiro Dohi, Hiroshi Matushita, Sho Mizukawa, Shinichiro Muro, Yutaka Akimoto, Daisuke Uchida, Takeshi Tomoda, Kazuyuki Matsumoto, Shigeru Horiguchi, Koichiro Tsutsumi, Hironari Kato, Hiroyuki Okada

    Pancreatology   17 ( 2 )   285 - 290   2017

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  • Tubular adenoma arising in a choledochocele. Reviewed International journal

    Takeshi Tomoda, Hironari Kato, Koichiro Tsutsumi, Noriyuki Tanaka, Hiroyuki Okada

    Gastrointestinal endoscopy   84 ( 6 )   1066 - 1067   2016.12

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  • Diagnostic and Therapeutic Endoscopic Retrograde Cholangiography Using a Short-Type Double-Balloon Endoscope in Patients With Altered Gastrointestinal Anatomy: A Multicenter Prospective Study in Japan. Reviewed International journal

    Masaaki Shimatani, Hisashi Hatanaka, Hirofumi Kogure, Koichiro Tsutsumi, Hiroki Kawashima, Keiji Hanada, Tomoki Matsuda, Tomoki Fujita, Makoto Takaoka, Tomonori Yano, Atsuo Yamada, Hironari Kato, Kazuichi Okazaki, Hironori Yamamoto, Hideki Ishikawa, Kentaro Sugano

    The American journal of gastroenterology   111 ( 12 )   1750 - 1758   2016.12

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    OBJECTIVES: To evaluate the utility and safety of a short-type double-balloon endoscope (DBE) in the treatment of biliary disease in patients with surgically altered gastrointestinal (GI) anatomy. METHODS: This study was conducted as a multicenter, single-arm, prospective trial at five tertiary academic care centers and three community-based hospitals in Japan. Consecutive patients with biliary disease with altered GI anatomy were prospectively included in this study. RESULTS: A total of 311 patients underwent double-balloon endoscopic retrograde cholangiography (ERC). The success rate of reaching the target site, the primary end point, was 97.7% (95% confidence interval (CI): 95.4-99.1). The success rate of biliary cannulation and contrast injection of the targeted duct, the secondary end point, was 96.4% (95% CI: 93.6-98.2), and the therapeutic success rate was 97.9% (95% CI: 95.4-99.2). Adverse events occurred in 33 patients (10.6%, 95% CI: 7.1-14.0) and were managed conservatively in all patients with the exception of 1 in whom a perforation developed, requiring emergency surgery. CONCLUSIONS: ERC using a short-type DBE resulted in an excellent therapeutic success rate and a low rate of adverse events. This treatment can be a first-line treatment for biliary disease in patients with surgically altered GI anatomy.

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  • Outcomes of management for biliary stricture after living donor liver transplantation with hepaticojejunostomy using short-type double-balloon enteroscopy. Reviewed International journal

    Takeshi Tomoda, Koichiro Tsutsumi, Hironari Kato, Sho Mizukawa, Syuntaro Yabe, Yutaka Akimoto, Hiroyuki Seki, Daisuke Uchida, Kazuyuki Matsumoto, Naoki Yamamoto, Shigeru Horiguchi, Hiroyuki Okada

    Surgical endoscopy   30 ( 12 )   5338 - 5344   2016.12

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    BACKGROUND AND AIMS: To evaluate the outcomes of management for biliary stricture (BS) after living donor liver transplantation (LDLT) using short-type double-balloon enteroscopy. METHODS: This study retrospectively evaluated 20 patients who underwent endoscopic retrograde cholangiography using short-type double-balloon enteroscopy (sDB-ERC) upon suspicion of BS after LDLT with hepaticojejunal (HJ) reconstruction at Okayama University Hospital. RESULTS: Scope insertion to the HJ site and sDB-ERC succeeded in 85 % (17/20) and 82.4 % (14/17) of patients, respectively. Of 14 patients who required treatment for BS, 11 were successfully treated using sDB-ERC, and 3 were successfully treated using sDB-ERC and rendezvous procedures. Adverse events occurred in 2.9 % of all sessions (2/68). After resolution of BS, 7 patients (50 %) experienced a recurrence. Of these, 6 (85.7 %) were treated with only balloon dilation, and 1 (14.3 %) was treated with both balloon dilation and stent deployment (P = 0.029). CONCLUSIONS: sDB-ERC is a useful procedure for diagnosis and treatment for BS after LDLT with HJ reconstruction. Balloon dilation combined with stent deployment might be recommended for definite resolution of BS.

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  • A Multicenter, Prospective, Randomized Controlled Trial Evaluating the Efficacy of Rectal Diclofenac and Sublingual Nitroglycerin as a Combined Prophylactic Treatment for Post-ERCP Pancreatitis Reviewed

    Takeshi Tomoda, Hironari Kato, Sho Mizukawa, Shinichiro Muro, Yutaka Akimoto, Daisuke Uchida, Kazuyuki Matsumoto, Naoki Yamamoto, Shigeru Horiguchi, Koichiro Tsutsumi, Hiroyuki Okada

    ACTA MEDICA OKAYAMA   70 ( 5 )   405 - 408   2016.10

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    Acute pancreatitis is the major complication of endoscopic retrograde cholangiopancreatography (ERCP). A preliminary research suggested that the administration of nonsteroidal anti-inflammatory drugs (NSAIDs) with nitroglycerin might reduce the incidence of post-ERCP pancreatitis (PEP) more effectively than NSAIDs alone. We conduct a two-arm, multicenter, prospective, randomized, superiority trial to evaluate the additional effect of nitroglycerin for prevention of PEP. A total of 900 patients randomly receive 50 mg diclofenac suppository either alone or with 5 mg isosorbide dinitrate sublingual tablet. The primary endpoint is the occurrence of PEP. This study will clarify whether NSAIDs plus nitroglycerin can prevent PEP.

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  • A Prospective Randomized Controlled Study Comparing EUS Sonopsy CY(R) and 22-gauge Biopsy Needles for Endoscopic Ultrasound-guided Fine-Needle Aspiration of Solid Pancreatic Mass Lesions. Reviewed

    Sho Mizukawa, Hironari Kato, Shinichiro Muro, Yutaka Akimoto, Daisuke Uchida, Takeshi Tomoda, Kazuyuki Matsumoto, Naoki Yamamoto, Shigeru Horiguchi, Koichiro Tsutsumi, Hiroyuki Okada, Hirofumi Inoue, Noriyuki Tanaka

    Acta medica Okayama   70 ( 5 )   417 - 420   2016.10

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    Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is a standard procedure for precise histological diagnosis of pancreas tumors, but it is sometimes difficult to obtain adequate specimens. EUS Sonopsy CY® is a newly designed needle with original features. This randomized study will compare the tissue collection rate of EUS Sonopsy CY® to that of a conventional needle in EUS-FNA. The major eligibility criteria are as follows: Patients with a pancreatic mass referred for EUSFNA; age 20 years, and performance status<4. The primary outcome is the tissue collection rate. This study will elucidate the efficacy of EUS Sonopsy CY®.

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  • miR‑1246 and miR‑4644 in salivary exosome as potential biomarkers for pancreatobiliary tract cancer. Reviewed International journal

    Tatsuya Machida, Takaaki Tomofuji, Takayuki Maruyama, Toshiki Yoneda, Daisuke Ekuni, Tetsuji Azuma, Hisataka Miyai, Hirofumi Mizuno, Hironari Kato, Koichiro Tsutsumi, Daisuke Uchida, Akinobu Takaki, Hiroyuki Okada, Manabu Morita

    Oncology reports   36 ( 4 )   2375 - 81   2016.10

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    Pancreatobiliary tract cancer is a highly fatal cancer. Detection of pancreatobiliary tract cancer is difficult because it lacks typical clinical symptoms and because of its anatomical location. Biomarker discovery is therefore important to detect pancreatobiliary tract cancer in its early stage. A study demonstrated that expression levels of miR‑1246, miR‑3976, miR‑4306, and miR‑4644 in serum exosomes were higher in pancreatic cancer patients than these levels in healthy control participants. Supposing that microRNA (miRNA) expression profiles in saliva are similar to those in serum, four miRNAs (miR‑1246, miR‑3976, miR‑4306, and miR‑4644) in salivary exosomes may also be useful for detection of pancreatobiliary tract cancer. In this study, it was examined whether these miRNAs could be used as biomarkers for pancreatobiliary tract cancer. Twelve pancreatobiliary tract cancer patients and 13 healthy control participants were analyzed as a cancer and a control group, respectively. Unstimulated whole saliva was collected, salivary exosomes were isolated, and total RNA was extracted. Using quantitative real‑time PCR (RT‑qPCR), the relative expression ratios of miR‑1246 and miR‑4644 were significantly higher in the cancer group than these ratios in the control group. Receiver operating characteristic (ROC) curves were constructed to analyze the discrimination power of these miRNAs. For miR‑1246, the results yielded an area under the curve (AUC) of 0.814 (P=0.008). For miR‑4644, the results yielded an AUC of 0.763 (P=0.026). For the combination of miR‑1246 and miR‑4644, the results yielded an increased AUC of 0.833 (P=0.005). This pilot study suggests that miR‑1246 and miR‑4644 in salivary exosomes could be candidate biomarkers for pancreatobiliary tract cancer.

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  • Efficacy and Safety of Endoscopic Ultrasound-guided Ethanol Ablation Therapy for Pancreatic Neuroendocrine Tumors. Reviewed

    Kazuyuki Matsumoto, Hironari Kato, Koichiro Tsutsumi, Sho Mizukawa, Syuntaro Yabe, Hiroyuki Seki, Yutaka Akimoto, Daisuke Uchida, Takeshi Tomoda, Naoki Yamamoto, Shigeru Horiguchi, Hiroyuki Okada

    Acta medica Okayama   70 ( 4 )   313 - 6   2016.8

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    Recently, endoscopic ultrasonography (EUS)-guided ethanol ablation for small pancreatic neuroendocrine tumors (p-NETs) has been reported. However, the efficacy and safety of the technique remain unclear. We have launched a prospective pilot study of EUS-guided ethanol ablation for p-NETs. The major eligibility criteria are the presence of a pathologically diagnosed grade (G) 1 or G2 p-NET, a tumor size of 2cm, and being a poor candidate for surgery. A total of 5 patients will be treated. The primary endpoint will be the complete ablation rate at 1 month after treatment.

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  • Outcome of self-expandable metallic stent deployment in patients with malignant gastroduodenal outlet obstruction and Niti-S and WallFlex comparison: a multicenter retrospective clinical study. Reviewed International journal

    Hironari Kato, Hirofumi Kawamoto, Kazuya Matsumoto, Ichiro Moriyama, Hideki Kamada, Koichiro Tsutsumi, Daisuke Goto, Nobuhiko Fukuba, Kiyohito Kato, Hiroki Sonoyama, Hajime Isomoto, Hiroyuki Okada

    Journal of digestive diseases   17 ( 8 )   518 - 525   2016.8

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    OBJECTIVES: Several studies report on the outcomes of self-expandable metallic stents (SEMSs) deployment for malignant gastric outlet obstruction (GOO). However, data was mostly based on the analysis of single-center studies including only a small number of patients. This study aimed to evaluate clinical outcomes after the deployment of SEMS in patients with malignant GOO and to compare the clinical outcomes of two metallic stents with different designs. METHODS: Altogether 125 consecutive patients from five institutions were included. Clinical outcomes were evaluated according to technical success, clinical success, stent patency period, survival period and complications. A comparison of clinical outcomes between Niti-S pyloric/duodenal and WallFlex duodenal stents was also undertaken. RESULTS: Rates for clinical and technical success were 100% and 92.0%, respectively. The median stent patency and survival periods were 72.0 days (range 3-775 days) and 75.0 days (range 3-775 days), respectively. The rate of overall adverse events was 28.8%. The rate of stent dysfunction was 16.8%, and that of adverse events, except stent dysfunction was 12.0%. Massive bleeding occurred in two patients as a late complication. The clinical success rate for Niti-S stent was significantly higher than that for WallFlex stent (96.2% vs 84.8%, P = 0.023). CONCLUSIONS: We successfully deployed a SEMS in malignant GOO. The selection of a SEMS with a lower axial force may be important for patients to resume the oral food intake. Additionally, consideration must be given to the appropriate management of fatal bleeding as a late complication.

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  • Diagnosing Pancreatic Tumors Using Contrast-enhanced Harmonic Endoscopic Ultrasonography with Sonazoid. Reviewed

    Naoki Yamamoto, Hironari Kato, Sho Mizukawa, Shinichiro Muro, Yutaka Akimoto, Daisuke Uchida, Takeshi Tomoda, Kazuyuki Matsumoto, Shigeru Horiguchi, Koichiro Tsutsumi, Hiroyuki Okada

    Acta medica Okayama   70 ( 4 )   323 - 5   2016.8

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    Contrast-enhanced harmonic endoscopic ultrasonography (CH-EUS) with contrast agent enabled us to assess the hemodynamics closely, despite limited data in pancreatic tumors. We have initiated a prospective, single arm, and non-randomized study to clarify the accuracy and safety of CH-EUS with Sonazoid and time-intensity curve (TIC) analysis for diagnosing benign or malignant pancreatic tumors. A total of 200 patients will undergo CH-EUS and TIC analysis. Receiver operating characteristic (ROC) analysis will be used to determine the optimal parameter cutoff values for TIC analysis. This will clarify whether CH-EUS and TIC can further improve the diagnosis of pancreatic tumors over conventional EUS.

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  • Oxidative stress balance is dysregulated and represents an additional target for treating cholangiocarcinoma. Reviewed International journal

    Daisuke Uchida, Akinobu Takaki, Hisashi Ishikawa, Yasuko Tomono, Hironari Kato, Koichiro Tsutsumi, Naofumi Tamaki, Takayuki Maruyama, Takaaki Tomofuji, Ryuichiro Tsuzaki, Tetsuya Yasunaka, Kazuko Koike, Hiroshi Matsushita, Fusao Ikeda, Yasuhiro Miyake, Hidenori Shiraha, Kazuhiro Nouso, Ryuichi Yoshida, Yuzo Umeda, Susumu Shinoura, Takahito Yagi, Toshiyoshi Fujiwara, Manabu Morita, Masaki Fukushima, Kazuhide Yamamoto, Hiroyuki Okada

    Free radical research   50 ( 7 )   732 - 43   2016.7

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    BACKGROUND: Pancreatico-biliary malignancies exhibit similar characteristics, including obesity-related features and poor prognosis, and require new treatment strategies. Oxidative stress is known to induce DNA damage and carcinogenesis, and its reduction is viewed as being favorable. However, it also has anti-infection and anti-cancer functions that need to be maintained. To reveal the effect of oxidative stress on cancer progression, we evaluated oxidative stress and anti-oxidative balance in pancreatic cancer (PC) and cholangiocarcinoma (CC) patients, as well as the effect of add-on antioxidant treatment to chemotherapy in a mouse cholangiocarcinoma model. METHODS: We recruited 84 CC and 80 PC patients who were admitted to our hospital. Serum levels of reactive oxygen metabolites (ROM) and the anti-oxidative OXY-adsorbent test were determined and the balance of these tests was defined as an oxidative index. A diabetic mouse-based cholangiocarcinoma model was utilized to evaluate the effects of add-on antioxidant therapy on cholangiocarcinoma chemotherapy. RESULTS: Serum ROM was higher and anti-oxidant OXY was lower in CC patients with poor outcomes. These parameters were not significantly different in PC patients. In mice, vitamin E administration induced antioxidant hemeoxygenase (HO)-1 protein expression in cancer tissue, while the number of stem-like cells increased. l-carnitine administration improved intestinal microbiome and biliary acid balance, upregulated the hepatic mitochondrial membrane uptake related gene Cpt1 in non-cancerous tissue, and did not alter stem-like cell numbers. CONCLUSION: Oxidative stress balance was dysregulated in cholangiocarcinoma with poor outcome. The mitochondrial function-supporting agent l-carnitine is a good candidate to control oxidative stress conditions.

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  • Biliary Anastomotic Stricture After Adult Living Donor Liver Transplantation With Duct-to-Duct Reconstruction: Outcome After Endoscopic Treatment Including Rendezvous Procedure. Reviewed International journal

    Takeshi Tomoda, Hironari Kato, Sho Mizukawa, Syuntaro Yabe, Yutaka Akimoto, Hiroyuki Seki, Daisuke Uchida, Kazuyuki Matsumoto, Naoki Yamamoto, Shigeru Horiguchi, Koichiro Tsutsumi, Hiroyuki Okada

    Transplantation   100 ( 7 )   1500 - 6   2016.7

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    BACKGROUND: To evaluate the outcomes and investigate the factors associated with restricture after endoscopic treatment. METHODS: Between April 2001 and July 2014, 98 patients experienced biliary anastomotic stricture (BAS) after living donor liver transplantation (LDLT) with duct-to-duct reconstruction, and all were first referred to Okayama University Hospital for endoscopic stent deployment. When deployment was unsuccessful, a percutaneous transhepatic procedure was used. Treatment outcomes, including stricture resolution, BAS recurrence, and risk factors of BAS recurrence, were evaluated retrospectively. RESULTS: Successful stent deployment was achieved in 90 of 98 patients (91.8%) by both procedures. Among the 90 patients, stricture resolution was eventually observed in 72. The median number of endoscopic retrograde cholangiographies performed was 5. After a median follow-up period of 48.8 months from stent removal, BAS recurrence that required intervention occurred in 22 patients (30.6%). In multivariate analysis, portal vein stenosis after LDLT was associated with BAS recurrence after endoscopic treatment (P = 0.03). Among the 22 patients who required reintervention, 16 (73%) had their stents removed, and recurrence after retreatment occurred in 3 patients (18.8%). CONCLUSIONS: Endoscopic treatment is a useful procedure for the treatment for BAS after LDLT with duct-to-duct reconstruction. Portal vein stenosis may be one of the risks associated with the recurrence of BAS.

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  • Endoscopic ultrasonography-guided drainage of intra-abdominal fluid collection after liver transplantation: a case series of six patients. Reviewed

    Daisuke Uchida, Koichiro Tsutsumi, Hironari Kato, Hiroyuki Okada

    Journal of medical ultrasonics (2001)   43 ( 3 )   421 - 6   2016.7

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    Intra-abdominal fluid collection associated with infection is a major complication after liver transplantation (LT). However, post-LT recipients are at high risk for requiring various interventions and surgeries, due to their poor, immunosuppressed conditions. We herein describe six patients with symptomatic or growing intra-abdominal fluid collection after LT who underwent endoscopic ultrasonography (EUS)-guided drainage. There were five males and one female, and the median age was 47 years (24-60 years). All procedures were technically and clinically successful in all patients. The median number of endoscopic sessions was 2.5 (1-4 sessions) until resolution. Procedure-related adverse events occurred in two patients and included peritonitis, bleeding, and stent migration, which improved conservatively or endoscopically. During the median follow-up period of 63 months (17-110 months), recurrence occurred in one patient. EUS-guided drainage is an effective and safe treatment for intra-abdominal fluid collection even in post-LT recipients.

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  • A precut fistulotomy technique for difficult biliary cannulation. Reviewed International journal

    Hironari Kato, Koichiro Tsutsumi, Hiroyuki Okada

    Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society   28 Suppl 1   103 - 103   2016.4

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  • Effectiveness of peroral direct cholangioscopy using an ultraslim endoscope for the treatment of hepatolithiasis in patients with hepaticojejunostomy (with video). Reviewed International journal

    Kazuyuki Matsumoto, Koichiro Tsutsumi, Hironari Kato, Yutaka Akimoto, Daisuke Uchida, Takeshi Tomoda, Naoki Yamamoto, Yasuhiro Noma, Shigeru Horiguchi, Hiroyuki Okada, Kazuhide Yamamoto

    Surgical endoscopy   30 ( 3 )   1249 - 54   2016.3

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    BACKGROUND: Hepatolithiasis is a postoperative complication of hepaticojejunostomy (HJ) performed for various pancreatobiliary diseases. Hepatolithiasis can cause repeated cholangitis. Complete stone removal and bile stasis elimination are therefore necessary. Here, we evaluated the effectiveness of peroral direct cholangioscopy (PDCS) using an ultraslim endoscope for treating hepatolithiasis in HJ patients. METHODS: We studied 14 patients with hepatolithiasis who underwent bowel reconstruction with HJ between April 2012 and May 2014. Diagnostic and therapeutic endoscopic retrograde cholangiography using a short double-balloon enteroscope (DBE) was initially performed. Following stone removal, the DBE was exchanged for an ultraslim endoscope through the balloon overtube for PDCS. RESULTS: The success rate of PDCS procedure was 85.7% (12/14). In 5 of 12 (41.7%) patients with successful PDCS, the residual stones were detected and removed completely using a 5-Fr basket catheter and suction after normal saline irrigation. In the remaining 7 (58.3%) patients, no residual stone was detected. The median procedure time was 14 min (range 8-36) with no serious postoperative complications. The median follow-up time after PDCS was 21 months (range 5-26), and only 1 patient (8.3%) had IHBD stone recurrence with an anastomotic stricture. CONCLUSIONS: PDCS using an ultraslim endoscope appears to be useful for detecting and removing residual stones following hepatolithiasis treatment using a DBE. The combined use of a DBE and PDCS may reduce the risk of hepatolithiasis recurrence in HJ patients.

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  • Contrast-enhanced harmonic endoscopic ultrasonography with time-intensity curve analysis for intraductal papillary mucinous neoplasms of the pancreas. Reviewed International journal

    Naoki Yamamoto, Hironari Kato, Takeshi Tomoda, Kazuyuki Matsumoto, Ichiro Sakakihara, Yasuhiro Noma, Shigeru Horiguchi, Ryo Harada, Koichiro Tsutsumi, Keisuke Hori, Takehiro Tanaka, Hiroyuki Okada, Kazuh de Yamamoto

    Endoscopy   48 ( 1 )   26 - 34   2016.1

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    BACKGROUND AND STUDY AIMS: Preoperative diagnosis of the pathological grade of intraductal papillary mucinous neoplasms (IPMNs) is difficult. This study aimed to evaluate the accuracy of contrast-enhanced harmonic endoscopic ultrasonography (CH-EUS) with time - intensity curve analysis in differentiating between low or intermediate grade dysplasia (LGD/IGD) and high grade dysplasia or invasive carcinoma (HGD/invasive carcinoma) in IPMNs and to assess correlation between the time - intensity curve parameters and tumor microvessel density. PATIENTS AND METHODS: Data from 30 patients with resected IPMNs (14 LGD/IGD, 16 HGD/invasive carcinoma) who underwent CH-EUS with time - intensity curve analysis were evaluated retrospectively. Time - intensity curve parameters and the microvessel density of the mural nodule were compared between the HGD/invasive carcinoma and LGD/IGD groups; the diagnostic accuracy of the time - intensity curve parameters was evaluated. RESULTS: The echo intensity change and echo intensity reduction rate of the mural nodule, and the nodule/pancreatic parenchyma contrast ratio were significantly higher in the HGD/invasive carcinoma group than in the LGD/IGD group (P < 0.05); the accuracies of these parameters were 80 %, 86.7 %, and 93.3 %, respectively. The microvessel density of the mural nodule was significantly higher in the HGD/invasive carcinoma group (P = 0.002). There was a strong positive, linear correlation between the echo intensity change of the mural nodule and the microvessel density (r = 0.803, P < 0.001). CONCLUSIONS: CH-EUS with time - intensity curve analysis is potentially useful for quantitatively evaluating the blood flow of IPMN microvasculature, and for differentiating between HGD/invasive carcinoma and LGD/IGD.

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  • Alteration of serum N-glycan profile in patients with autoimmune pancreatitis Reviewed

    Takeshi Tomoda, Kazuhiro Nouso, Hironari Kato, Koji Miyahara, Chihiro Dohi, Yuki Morimoto, Hideaki Kinugasa, Yutaka Akimoto, Kazuyuki Matsumoto, Naoki Yamamoto, Yasuhiro Noma, Shigeru Horiguchi, Koichiro Tsutsumi, Maho Amano, Shin-Ichiro Nishimura, Kazuhide Yamamoto

    PANCREATOLOGY   16 ( 1 )   44 - 51   2016.1

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    Objectives: The aims of this study were to determine the change in whole-serum N-glycan profile in autoimmune pancreatitis (AIP) patients and to investigate its clinical utility.
    Methods: We collected serum from 21 AIP patients before any treatment, and from 60 healthy volunteers (HLTs). Serum glycan profile was measured by comprehensive and quantitative high-throughput glycome analysis.
    Results: Of the 53 glycans detected, 14 were differentially expressed in AIP patients. Pathway analysis demonstrated that agalactosyl and monogalactosyl bi-antennary glycans were elevated in AIP patients. Among the 14 glycans, #3410, #3510, and #4510 showed high area under receiver operating characteristic (AUROC) values (0.955, 0.964, and 0.968 respectively) for the diagnosis of AIP. These three glycans were mainly bound to immunoglobulin G; however, their serum levels were significantly higher, even in AIP patients who showed lower serum IgG4 levels, than in HLTs.
    Conclusions: We demonstrated, for the first time, whole-serum glycan profiles of AIP patients and showed that the levels of glycans #3410, #3510, and #4510 were increased in AIP patients. These glycans might be valuable biomarkers of AIR Copyright (C) 2015, IAP and EPC. Published by Elsevier India, a division of Reed Elsevier India Pvt. Ltd. All rights reserved.

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  • Time-dependent image changes after ethanol injection into the pancreas: an experimental study using a porcine model. Reviewed International journal

    Kazuyuki Matsumoto, Hironari Kato, Koichiro Tsutsumi, Soichiro Fushimi, Masaya Iwamuro, Shinsuke Oda, Sho Mizukawa, Yutaka Akimoto, Daisuke Uchida, Takeshi Tomoda, Naoki Yamamoto, Shigeru Horiguchi, Hiroyuki Okada

    Ecancermedicalscience   10   663 - 663   2016

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    BACKGROUND: Ethanol, a commonly available agent, has been used to successfully ablate cystic and solid lesions in the pancreas. The aim of this study is to investigate the effects of an ethanol injection into the porcine pancreas and observe the time-dependent image changes in the pancreatic parenchyma. METHODS: Pure ethanol was injected into the pancreatic tail using a 25-gauge EUS needle with direct ultrasound guidance under celiotomy: 1 mL and 2 mL were injected, respectively. The abdomen was closed after the injection. MRI was performed before the procedure, immediately after, and on postoperative day (POD) seven. Blood samples were taken before the procedure and on PODs one, three, five, and seven. The pigs were euthanised on POD seven. RESULTS: Immediately after the injection, linear high signal areas in the pancreatic tail on T2 and rounded speckled high signal areas on DWI images were detected in both animals, measuring 35 × 32 mm in the 1 mL injected pig and 42 × 38mm in the 2 mL injected pig. After POD seven, rounded high signal areas were noted on T2 images, measuring 22 × 18 mm and 36 × 28 mm respectively. On POD one, the 1 mL injected animal had a 53% elevation in serum amylase while the 2 mL injected animal had a 66% elevation. Histologically, cystic and necrotic changes in the parenchyma were observed, measuring 23 × 22 mm and 40 × 35 mm respectively. CONCLUSIONS: Our results, which are limited to normal pancreas, suggested that a 1 mL injection caused localised changes within the pancreas while a 2 mL injection induced more widespread changes beyond the pancreas. The effective area of ethanol was widespread immediately after injection, and then the area was reduced with cystic and necrosis changes.

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  • Pancreatitis due to Radiolucent Pancreatolithiasis Mimicking Gallstone Pancreatitis Reviewed

    Koichiro Tsutsumi, Hironari Kato, Hiroyuki Okada

    INTERNAL MEDICINE   55 ( 15 )   2109 - 2110   2016

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    DOI: 10.2169/internalmedicine.55.6790

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  • Pancreatic Hepatoid Carcinoma Mimicking a Solid Pseudopapillary Neoplasm: A Challenging Case on Endoscopic Ultrasound-guided Fine-needle Aspiration. Reviewed

    Yutaka Akimoto, Hironari Kato, Kazuyuki Matsumoto, Ryo Harada, Shinsuke Oda, Soichiro Fushimi, Shou Mizukawa, Shuntaro Yabe, Daisuke Uchida, Hiroyuki Seki, Takeshi Tomoda, Naoki Yamamoto, Shigeru Horiguchi, Koichiro Tsutsumi, Takahito Yagi, Hiroyuki Okada

    Internal medicine (Tokyo, Japan)   55 ( 17 )   2405 - 11   2016

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    A 59-year-old man was admitted to our hospital for treatment of a 45 mm pancreatic mass found during a medical examination. Endoscopic ultrasound-guided fine-needle aspiration cytology showed polygonal cells with pseudopapillary structures. The tumor cells were positive for nuclear/cytoplasmic β-catenin and CD10, and negative for chromogranin A. After a tentative diagnosis of a solid pseudopapillary neoplasm, middle pancreatectomy was performed. Histologically, polygonal cells with abundant eosinophilic cytoplasm formed in the trabeculae and were immunohistochemically positive for HepPar1 and protein induced by vitamin K absence or antagonist-II. The tumor was finally diagnosed to be pancreatic hepatoid carcinoma. No recurrence occurred for 12 months, even without adjuvant chemotherapy.

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  • [Radical surgery after successful chemotherapy in a case of primary small cell carcinoma of the liver]. Reviewed

    Yutaka Akimoto, Koichiro Tsutsumi, Hironari Kato, Hidenori Hata, Hiroyuki Sakae, Daisuke Uchida, Takeshi Tomoda, Kazuyuki Matsumoto, Yasuhiro Noma, Naoki Yamamoto, Shigeru Horiguchi, Ryo Harada, Hiroyuki Okada, Hiroyuki Yanai, Takahito Yagi, Kazuhide Yamamoto

    Nihon Shokakibyo Gakkai zasshi = The Japanese journal of gastro-enterology   112 ( 11 )   2024 - 34   2015.11

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    A 52-year-old woman was admitted to our hospital with right upper quadrant pain with gallbladder wall thickening and multiple liver tumors. Endoscopic ultrasound-guided biopsy revealed small cell carcinomas of both the gallbladder and liver. After 10 cycles of chemotherapy with etoposide and cisplatin, marked shrinkage of the tumors was evident on computed tomography. The patient subsequently underwent hepatectomy and resection of the extrahepatic bile duct and gallbladder with curative intent. Although no viable tumor cells were found in the resected specimens, we confirmed phagocytosis of tumor cells killed by chemotherapy in the resected liver specimen. Therefore, we suspected that the patient had primary small cell carcinoma of the liver that had been successfully treated. This is a rare case of primary small cell carcinoma of the liver that showed pathological complete response to chemotherapy with etoposide and cisplatin.

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  • Comparison between Roux-en-Y patients with and without gastrectomy during endoscopic retrograde cholangiopancreatography using a short double-balloon enteroscope. Reviewed International journal

    Takeshi Tomoda, Koichiro Tsutsumi, Hiroyuki Okada

    Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society   27 ( 7 )   775 - 775   2015.11

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    DOI: 10.1111/den.12509

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  • Side-to-side jejunojejunostomy is favorable for scope insertion during endoscopic retrograde cholangiopancreatography in patients with Roux-en-Y hepaticojejunostomy. Reviewed International journal

    Koichiro Tsutsumi, Hironari Kato, Hiroyuki Okada

    Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society   27 ( 6 )   708 - 708   2015.9

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    DOI: 10.1111/den.12487

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  • Current status of endoscopic biliary drainage for unresectable malignant hilar biliary strictures. Reviewed International journal

    Hironari Kato, Koichiro Tsutsumi, Hirofumi Kawamoto, Hiroyuki Okada

    World journal of gastrointestinal endoscopy   7 ( 11 )   1032 - 8   2015.8

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    The management of jaundice and cholangitis is important for improving the prognosis and quality of life of patients with unresectable malignant hilar biliary strictures (UMHBS). In addition, effective chemotherapy, such as a combination of gemcitabine and cisplatin, requires the successful control of jaundice and cholangitis. However, endoscopic drainage for UMHBS is technical demanding, and continuing controversies exist in the selection of the most appropriate devices and techniques for stent deployment. Although metallic stents (MS) are superior to the usual plastic stents in terms of patency, an extensive comparison between MS and "inside stents", which are deployed above the sphincter of Oddi, is necessary. Which techniques are preferred remains as yet unresolved: for instance, whether to use a unilateral or bilateral drainage, or a stent-in-stent or side-by-side method for the deployment of bilateral MS, although a new cell design and thin delivery system for MS allowed us to accomplish successful deployments of bilateral MS. The development of techniques and devices for re-intervention after stent occlusion is also imperative. Further critical investigations of more effective devices and techniques, and increased randomized controlled trials are warranted to resolve these important issues.

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  • Endoscopic ultrasonography-guided transjejunal drainage for postoperative pancreatic fistula using forward-viewing echoendoscope. Reviewed

    Takeshi Tomoda, Hironari Kato, Yutaka Akimoto, Kazuyuki Matsumoto, Naoki Yamamoto, Yasuhiro Noma, Ryo Harada, Shigeru Horiguchi, Koichiro Tsutsumi, Hiroyuki Okada

    Clinical journal of gastroenterology   8 ( 4 )   228 - 31   2015.8

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    There are few reports on endoscopic ultrasonography (EUS)-guided transjejunal drainage. Here, we report a case with postoperative pancreatic fistula treated by endoscopic transjejunal drainage using a forward-viewing (FV) echoendoscope. A 69-year-old woman who had undergone pancreaticoduodenectomy was admitted because of pancreatic fistula. Placement of plastic stents into the pancreatic duct using a double-balloon enteroscope and EUS-guided transgastric drainage failed. We attempted EUS-guided transjejunal drainage using an FV echoendoscope that can advance through the acute-angled intestinal tract safely, and drainage was performed. There were no complications, and follow-up computed tomography showed complete resolution.

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  • Detection of K-ras gene mutation by liquid biopsy in patients with pancreatic cancer. Reviewed International journal

    Hideaki Kinugasa, Kazuhiro Nouso, Koji Miyahara, Yuki Morimoto, Chihiro Dohi, Koichiro Tsutsumi, Hironari Kato, Takehiro Matsubara, Hiroyuki Okada, Kazuhide Yamamoto

    Cancer   121 ( 13 )   2271 - 80   2015.7

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    BACKGROUND: Cell-free circulating tumor DNA (ctDNA) in serum has been considered to be a useful candidate for noninvasive cancer diagnosis. The current study was designed to estimate the clinical usefulness of genetic analysis for ctDNA by digital polymerase chain reaction in patients with pancreatic cancer. METHODS: The authors compared K-ras mutations detected in endoscopic ultrasound-guided fine-needle aspiration biopsy tissue DNA and in ctDNA from 75 patients with pancreatic cancer. K-ras mutations in the serum of 66 independent, consecutive patients with pancreatic cancer were also analyzed and the authors compared the results with survival rates. RESULTS: The frequencies of the mutations in tissue samples at G12V, G12D, and G12R in codon 12 were 28 of 75 samples (37.3%), 22 of 75 samples (29.3%), and 6 of 75 samples (8.0%), respectively. Conversely, the rates of the mutations in ctDNA were 26 of 75 samples (34.6%), 29 of 75 samples (38.6%), and 4 of 75 samples (5.3%), respectively. Overall, the K-ras mutation rates in tissue and ctDNA were 74.7% and 62.6%, respectively, and the concordance rate between them was 58 of 75 samples (77.3%). Survival did not appear to differ by the presence of K-ras mutations in tissue DNA, but the survival of patients with K-ras mutations in ctDNA was significantly shorter than that of patients without mutations in both a development set (P = .006) and an independent validation set (P = .002). The difference was especially evident in cases with a G12V mutation. CONCLUSIONS: Analysis of ctDNA is a new useful procedure for detecting mutations in patients with pancreatic cancer. This noninvasive method may have great potential as a new strategy for the diagnosis of pancreatic cancer as well as for predicting survival.

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  • Efficacy of Endoscopic Over 3-branched Partial Stent-in-Stent Drainage Using Self-expandable Metallic Stents in Patients With Unresectable Hilar Biliary Carcinoma. Reviewed International journal

    Daisuke Uchida, Hironari Kato, Shinichiro Muro, Yasuhiro Noma, Naoki Yamamoto, Shigeru Horiguchi, Ryo Harada, Koichiro Tsutsumi, Hirofumi Kawamoto, Hiroyuki Okada, Kazuhide Yamamoto

    Journal of clinical gastroenterology   49 ( 6 )   529 - 36   2015.7

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    BACKGROUND: The treatment of biliary stricture is crucially important for continuing stable chemotherapy for unresectable biliary carcinoma; however, there is no consensus regarding the use of hilar biliary drainage. In this study, we examined the efficacy of endoscopic over 3-branched biliary drainage using self-expandable metallic stents (SEMSs) in patients with unresectable malignant hilar biliary stricture (HBS). METHODS: A total of 77 patients with unresectable HBS treated with a SEMS and chemotherapy were retrospectively reviewed. There were 59 patients with cholangiocarcinoma and 18 patients with gallbladder carcinoma. The patients were divided into 2 groups (4- or 3-branched group and 2- or 1-branched group) and compared with respect to the duration of stent patency and overall survival. RESULTS: A comparison of the patients' baseline characteristics showed no significant differences between the 4- or 3-branched group and the 2- or 1-branched group. Neither the duration of patency nor survival time exhibited significant differences between the 2 groups, although, among the patients achieving disease control , the duration of patency period and survival time of the 4- or 3-branched group were significantly higher than those observed in the 2- or 1-branched group (P=0.0231 and 0.0466). CONCLUSIONS: The use of endoscopic over 3-branched biliary drainage with a SEMS may improve the duration of patency in patients with HBS.

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  • ERCP using a short double-balloon enteroscope in patients with prior pancreatoduodenectomy: higher maneuverability supplied by the efferent-limb route. Reviewed International journal

    Koichiro Tsutsumi, Hironari Kato, Shinichiro Muro, Naoki Yamamoto, Yasuhiro Noma, Shigeru Horiguchi, Ryo Harada, Hiroyuki Okada, Kazuhide Yamamoto

    Surgical endoscopy   29 ( 7 )   1944 - 51   2015.7

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    BACKGROUND: In endoscopic retrograde cholangiopancreatography (ERCP) for patients who have undergone a pancreatoduodenectomy (PD) with a Braun anastomosis, two different approaches are available: the afferent-limb route and the efferent-limb route. This study was to clarify the usefulness of a short double-balloon enteroscope (DBE) in ERCP for prior-PD patients, and to reveal which route was optimal for ERCP. METHODS: Seventy-two consecutive patients with a prior PD underwent diagnostic or therapeutic ERCP using the DBE. This retrospective study evaluated the outcome of the ERCP and assessed the shape of the DBE by fluoroscopic imaging to compare the maneuverability of the two routes. RESULTS: In 71 patients (99%) the bilioenteric anastomosis was reached and cholangiography was performed. Treatment was required in 59 patients (83%) and was performed successfully in all. Complications occurred in two patients (3%) with cholangitis. In three patients, the afferent-limb route had to be changed to the efferent-limb route in the procedure. A gentler arc-shaped angulation of the DBE was induced using the efferent-limb route compared to the afferent-limb route (128° (n = 42) vs. 113° (n = 15); p = 0.037), and that was also revealed in 11 patients (15%) who underwent repeated ERCP by each route (123° vs. 96°; p = 0.003). CONCLUSIONS: The short DBE facilitates ERCP in prior-PD patients. Particularly, ERCP using the efferent-limb route can achieve a maneuverable procedure without unnecessary stress, such as scope insertion to the sharp-angled afferent limb and the handling of various accessories through the narrow scope channel with a sense of resistance.

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  • Serum N-glycan profiles in patients with intraductal papillary mucinous neoplasms of the pancreas Reviewed

    Yutaka Akimoto, Kazuhiro Nouso, Hironari Kato, Koji Miyahara, Chihiro Dohi, Yuki Morimoto, Hideaki Kinugasa, Takeshi Tomoda, Naoki Yamamoto, Koichiro Tsutsumi, Kenji Kuwaki, Hideki Onishi, Fusao Ikeda, Shinichiro Nakamura, Hidenori Shiraha, Akinobu Takaki, Hiroyuki Okada, Maho Amano, Shin-Ichiro Nishimura, Kazuhide Yamamoto

    PANCREATOLOGY   15 ( 4 )   432 - 438   2015.7

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    Background/objectives: Diagnosing the invasiveness of intraductal papillary mucinous neoplasms (IPMNs) is difficult, especially by blood test. Alterations in serum glycan profiles have been reported for several cancers, but changes in serum glycan profiles have not been investigated in patients with IPMNs. The objectives of this study were to determine the serum N-glycan profile and to investigate its clinical utility in patients with IPMNs.
    Methods: We measured serum N-glycan profiles in 79 patients with IPMNs, including 13 invasive IPMNs, by performing comprehensive glycome analysis and assessed the relationship between N-glycan changes and clinical parameters.
    Results: Seventy glycans were identified and their expression profiles were significantly different depending on the cyst size, the presence of an enhancing solid component, and the histological grade of the IPMN. Nine glycans were highly expressed in patients with invasive IPMNs. The glycan m/z 3195, which is a fucosylated tri-antennary glycan, had the highest diagnostic value for distinguishing invasive IPMNs from non-invasive IPMNs (area under the receiver operating characteristic curve = 0.803). Multivariate analyses revealed high levels of m/z 3195 [odds ratio (OR), 20.5; 95% confidence interval (CI) 2.60-486.4] and the presence of enhancing solid components (OR, 35.8; 95% Cl, 5.39-409.6) were significant risk factors for invasive IPMNs.
    Conclusions: We performed a comprehensive evaluation of the changes in serum N-glycan profiles in patients with IPMNs for the first time. We determined that increased expression of fucosylated complex-type glycans, especially m/z 3195, is a potential marker for invasive IPMNs. Copyright (C) 2015, IAP and EPC. Published by Elsevier India, a division of Reed Elsevier India Pvt. Ltd. All rights reserved.

    DOI: 10.1016/j.pan.2015.05.470

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  • Successful biliary drainage using a metal stent through the gastric stoma. Reviewed International journal

    Kazuyuki Matsumoto, Hironari Kato, Koichiro Tsutsumi, Yutaka Akimoto, Daisuke Uchida, Takeshi Tomoda, Naoki Yamamoto, Yasuhiro Noma, Shigeru Horiguchi, Hiroyuki Okada, Kazuhide Yamamoto

    World journal of gastroenterology   21 ( 24 )   7594 - 7   2015.6

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    We report a case of biliary drainage for malignant stricture using a metal stent with an ultrathin endoscope through the gastric stoma. A 78-year-old female was referred to our hospital for jaundice and fever. She had undergone percutaneous endoscopic gastrostomy (PEG) for esophageal obstruction after radiation therapy for cancer of the pharynx. Abdominal contrast-enhanced computed tomography showed a 3-cm enhanced mass in the middle bile duct and dilatation of the intra-hepatic bile duct. We initially performed endoscopic retrograde cholangiopancreatography (ERCP) with a trans-oral approach. However, neither the side-viewing endoscope nor the ultrathin endoscope passed through the esophageal orifice. Thus, we eventually performed ERCP via the PEG stoma using an ultrathin endoscope. We performed biliary drainage with a 6F introducer self-expanding metal stent. The cytology findings obtained by brush cytology showed malignancy. Her laboratory results were restored to normal levels after drainage and no complication occurred.

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  • Prognostic value of altered N-glycosylation of circulating glycoproteins in patients with unresectable pancreatic cancer treated with gemcitabine. Reviewed International journal

    Koji Miyahara, Kazuhiro Nouso, Yuki Morimoto, Hideaki Kinugasa, Hironari Kato, Naoki Yamamoto, Koichiro Tsutsumi, Kenji Kuwaki, Hideki Onishi, Fusao Ikeda, Shinichiro Nakamura, Hidenori Shiraha, Akinobu Takaki, Taku Nakahara, Yoshiaki Miura, Hidehisa Asada, Maho Amano, Shin-Ichiro Nishimura, Kazuhide Yamamoto

    Pancreas   44 ( 4 )   551 - 6   2015.5

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    OBJECTIVES: The objectives of this study were to examine the whole-serum N-glycan profile of patients with unresectable pancreatic cancer and to evaluate the ability of glycans to predict gemcitabine treatment efficacy and patient survival. METHODS: We collected serum from 52 patients with advanced pancreatic cancer before they began gemcitabine monotherapy. The serum glycan profile was measured through comprehensive quantitative high-throughput glycome analysis and compared with the treatment efficacy and patient survival. RESULTS: Of the 61 glycans detected, the serum levels of glycan 4310 (molecular weight [m/z] 1549.566), 6301 (m/z 2032.724), and 9200 (m/z 2010.692) were high in patients with a short time to tumor progression (TTP). Multivariate analysis revealed that a high glycan 9200 concentration was an independent risk factor for shorter TTP (hazard ratio, 2.11; 95% confidence interval, 1.07-4.17) and poor overall survival (hazard ratio, 2.56; 95% confidence interval, 1.08-6.19). The median TTP of patients with up-regulation of 9200 after gemcitabine treatment was shorter than for the remaining patients (91 vs 301 days; P = 0.0005). A similar relationship was observed for overall survival (median, 181 vs 561 days; P = 0.001). CONCLUSIONS: Glycan 9200 is a possible biomarker predicting gemcitabine efficacy survival in patients with unresectable pancreatic cancer.

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  • Serum N-glycan profiles in patients with intraductal papillary mucinous neoplasms of the pancreas. Reviewed

    Yutaka Akimoto, Kazuhiro Nouso, Hironari Kato, Koji Miyahara, Chihiro Dohi, Yuki Morimoto, Hideaki Kinugasa, Takeshi Tomoda, Naoki Yamamoto, Koichiro Tsutsumi, Kenji Kuwaki, Hideki Onishi, Fusao Ikeda, Shinichiro Nakamura, Hidenori Shiraha, Akinobu Takaki, Hiroyuki Okada, Maho Amano, Shin-Ichiro Nishimura, Kazuhide Yamamoto

    Pancreatology   15 ( 4 )   432 - 438   2015.4

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  • Double-balloon enteroscopy for choledochojejunal anastomotic stenosis after hepato-biliary-pancreatic operation. Reviewed International journal

    Ichiro Sakakihara, Hironari Kato, Shinichiro Muro, Yasuhiro Noma, Naoki Yamamoto, Ryo Harada, Shigeru Horiguchi, Koichiro Tsutsumi, Hiroyuki Okada, Kazuhide Yamamoto, Hiroshi Sadamori, Takahito Yagi

    Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society   27 ( 1 )   146 - 54   2015.1

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    BACKGROUND AND AIM: There have been few reports on the success rate of balloon dilation and stent deployment using endoscopic retrograde cholangiopancreatography by double-balloon enteroscopy (DBE-ERCP) or on the follow-up period after stent removal in patients with a reconstructed digestive tract and stenosis of choledochojejunal anastomosis. The present study was designed to evaluate the usefulness of DBE-ERCP in patients with a reconstructed digestive tract and stenosis of choledochojejunal anastomosis. METHODS: Forty-four patients with stenosis of choledochojejunal anastomosis underwent DBE-ERCP at Okayama University Hospital between April 2008 and January 2012 (107 procedures). Rates of reaching choledochojejunal anastomosis, stent deployment, and restenosis after stent removal were retrospectively evaluated. RESULTS: Insertion of DBE into the choledochojejunal anastomotic site succeeded in 38 of 44 patients (86.4%), and anastomotic dilation and stent deployment succeeded in 36 of 44 patients (81.8%). In 32 of 44 patients (72.7%), their anastomotic stenoses were improved, and they achieved stent removal. After stent removal, restenosis of choledochojejunal anastomosis was detected in seven of 32 patients; however, the resolution of restenosis was achieved in all seven of those patients. CONCLUSION: Dilation of choledochojejunal anastomosis combined with stent deployment using DBE-ERCP seems to be a viable first-line treatment for patients with stenosis of choledochojejunal anastomosis.

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  • Serum anti-60S ribosomal protein L29 antibody as a novel prognostic marker for unresectable pancreatic cancer. Reviewed International journal

    Shinichiro Muro, Yasuhiro Miyake, Hironari Kato, Koichiro Tsutsumi, Kazuhide Yamamoto

    Digestion   91 ( 2 )   164 - 73   2015

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    BACKGROUND/AIMS: Recently, we found the presence of anti-60S ribosomal protein L29 antibody (anti-RPL29) in human sera, inhibiting the proliferation of pancreatic cancer cells in vitro. We aimed to estimate the association of serum anti- RPL29 levels with clinical features in patients affected with unresectable pancreatic cancer. METHODS: We retrospectively reviewed 105 patients with unresectable pancreatic cancer. Serum anti-RPL29 levels were measured by the indirect enzyme-linked immunosorbent assay. The cut-off was represented by the 95th percentile in 62 healthy volunteers. RESULTS: Median survival time (MST) was 11.1 months in 49 patients showing serum anti-RPL29 level >cut-off and 7.4 months in 56 patients showing serum anti-RPL29 level ≤ cutoff. In locally advanced disease, MST was 17.9 months in 22 patients showing serum anti-RPL29 level >cut-off and 10.0 months in 19 patients showing serum anti-RPL29 level ≤ cutoff. In metastatic disease, MST was 8.7 months in 27 patients showing serum anti-RPL29 level >cut-off and 5.9 months in 37 patients showing serum anti-RPL29 level ≤ cut-off. In the multivariate Cox proportional hazard model, serum anti- RPL29 level >cut-off, abdominal or back pain, performance status, and metastatic disease were identified as independent prognostic factors. CONCLUSION: Serum anti-RPL29 levels may be a novel candidate for a prognostic marker for unresectable pancreatic cancer.

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  • Successful biliary drainage with peroral direct cholangioscopy in a patient with Roux-en-Y hepaticojejunostomy for congenital biliary dilatation. Reviewed International journal

    Kazuyuki Matsumoto, Koichiro Tsutsumi, Yuki Baba, Koji Takemoto, Hirofumi Tsugeno, Shigeatsu Fujiki, Hiroyuki Okada

    Endoscopy   47 Suppl 1 UCTN   E497-8   2015

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  • An expanded training program for endosonographers improved self-diagnosed accuracy of endoscopic ultrasound-guided fine-needle aspiration cytology of the pancreas. Reviewed International journal

    Ryo Harada, Hironari Kato, Soichiro Fushimi, Masaya Iwamuro, Hirofumi Inoue, Shinichiro Muro, Ichiro Sakakihara, Yasuhiro Noma, Naoki Yamamoto, Shigeru Horiguchi, Koichiro Tsutsumi, Hiroyuki Okada, Kazuhide Yamamoto

    Scandinavian journal of gastroenterology   49 ( 9 )   1119 - 23   2014.9

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    OBJECTIVE: Rapid on-site evaluation (ROSE) of cytologic adequacy improves the diagnostic yield of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA). However, on-site advice from a cytotechnologist or cytopathologist is not always available during EUS-FNA. To enhance endosonographers' ability to assess the adequacy of EUS-FNA specimens, we designed an intensive, 2-h interactive training program. The aim of this study was to determine the usefulness of the program. METHODS: Four cytological pictures were selected by a trained cytotechnologist and board-certified cytopathologist from each of the seven patients who underwent EUS-FNA for pancreatic mass in Okayama University Hospital. In total, 28 pictures were used in this study. Twenty endosonographers and 14 cytologists with different levels of EUS-FNA experience evaluated cytological pictures independently before and after the training program. RESULTS: Endosonographers' skill in evaluating the adequacy of EUS-FNA specimens was significantly improved after the completion of the training program (p < 0.001). In contrast, almost all cytologists correctly judged the adequacy of the specimens before taking the training program. CONCLUSIONS: This intensive, 2-h interactive training program is useful for endosonographers and capable of improving ROSE of EUS-FNA specimens.

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  • The efficacy and safety of single-session endoscopic ultrasound-guided fine needle aspiration and endoscopic retrograde cholangiopancreatography for evaluation of pancreatic masses. Reviewed International journal

    Yasuhiro Noma, Hirofumi Kawamoto, Hironari Kato, Masaya Iwamuro, Ken Hirao, Masakuni Fujii, Koichiro Tsutsumi, Shigeru Horiguchi, Naoki Yamamoto, Ichiro Sakakihara, Takeshi Tomoda, Kazuyuki Matsumoto, Hiroyuki Okada, Kazuhide Yamamoto

    Hepato-gastroenterology   61 ( 134 )   1775 - 9   2014.9

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    BACKGROUND/AIMS: There have been limited studies evaluating single-session EUS-FNA and ERCP for evaluation of pancreatic masses. The aim of this study was to determine the safety of single-session EUS-FNA and ERCP, and to compare the diagnostic accuracies of cytodiagnosis by EUS-FNA, ERCP, and their combination. METHODOLOGY: A total of 100 patients with pancreatic masses were prospectively enrolled. All patients underwent single-session EUS-FNA and ERCP. The main outcome measurement was frequency of post-procedural complications. Another measurement was diagnostic accuracy of cytodiagnosis by EUS-FNA, ERCP, and their combination. RESULTS: Procedure-related pancreatitis occurred in 10 patients, but all patients were conservatively managed. Cytodiagnosis by EUS-FNA was significantly superior to ERCP in accuracy. In patients with a pancreatic head mass, 3 cases of false negative EUS-FNA were positive on ERCP. The combination procedures improved accuracy compared with EUS-FNA alone. By contrast, in the subgroup of the pancreatic body or tail mass, the combination of EUS-FNA and ERCP did not improve cytodiagnosis compared to that with EUS-FNA alone. CONCLUSIONS: Single-session EUS-FNA and ERCP appears to be as safe as performing each procedure separately. EUS-FNA should be considered the principal procedure for cytodiagnosis. ERCP has only a complementary role in patients with pancreatic head mass.

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  • Short double-balloon enteroscopy is feasible and effective for endoscopic retrograde cholangiopancreatography in patients with surgically altered gastrointestinal anatomy. Reviewed International journal

    Hironari Kato, Koichiro Tsutsumi, Ryo Harada, Hiroyuki Okada, Kazuhide Yamamoto

    Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society   26 Suppl 2   130 - 5   2014.4

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    Endoscopic retrograde cholangiopancreatography (ERCP) for patients with digestive tract reconstruction is a difficult procedure from an anatomical point of view. A short-type double-balloon enteroscope has a 2.8-mm working channel and a 152-cm working length, and its advantage is that it can accommodate most conventional devices for ERCP. Although the shorter length compared with the long-type balloon-assisted enteroscope (BAE) was suspected of making it difficult or impossible to reach the blind end, in fact, the success rate of reaching the blind end with the short type is similar to that with the long- type BAE. In addition, the success rate of ERCP-related procedures with the short type is satisfactory. However, it remains controversial as to which BAE is more suitable for this procedure. Further randomized controlled trials by high-volume centers are warranted.

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  • A novel technique for partial stent-in-stent placement of three metal biliary stents using a short double-balloon enteroscope. Reviewed International journal

    Koichiro Tsutsumi, Hironari Kato, Hiroyuki Okada, Kazuhide Yamamoto

    Endoscopy   46 Suppl 1 UCTN   E417-8   2014

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  • Transplanted liver graft ischemia caused by pediatric ERCP in the prone position. Reviewed International journal

    Koichiro Tsutsumi, Hironari Kato, Hiroyuki Okada, Takahito Yagi, Kazuhide Yamamoto

    Endoscopy   46 Suppl 1 UCTN   E594-5   2014

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  • Usefulness of the rendezvous technique for deep scope insertion during endoscopic retrograde cholangiography in a patient with a Roux-en-Y hepaticojejunostomy. Reviewed International journal

    Koichiro Tsutsumi, Hironari Kato, Hiroyuki Okada, Kazuhide Yamamoto

    Endoscopy   46 Suppl 1 UCTN   E619-20   2014

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  • [Two cases of lymphoepithelial cyst of the pancreas confirmed by contrast-enhanced endoscopic ultrasound]. Reviewed

    Kazuyuki Matsumoto, Hironari Kato, Takeshi Tomoda, Ichiro Sakakihara, Yasuhiro Noma, Naoki Yamamoto, Takayuki Sonoyama, Koichiro Tsutsumi, Hiroshi Sadamori, Hiroyuki Okada, Takahito Yagi, Kazuhide Yamamoto

    Nihon Shokakibyo Gakkai zasshi = The Japanese journal of gastro-enterology   110 ( 10 )   1823 - 30   2013.10

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    We report our experience with two cases of lymphoepithelial cysts (LECs) of the pancreas. Both patients were in their sixties. Contrast-enhanced computed tomography revealed masses in the pancreas with multilocular cystic lesions. Endoscopic ultrasound (EUS) findings presented highly echo-dense structures in the cystic masses; however, contrast-enhanced EUS revealed only the septum inside each mass without enhancing the dense structures. Contrast-enhanced EUS was useful for defining the contents in the cystic lesions; therefore, it may be useful for the diagnosis of LEC.

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  • Clinical utility of high-throughput glycome analysis in patients with pancreatic cancer. Reviewed

    Kazuhiro Nouso, Maho Amano, Yoichi M Ito, Koji Miyahara, Yuki Morimoto, Hironari Kato, Koichiro Tsutsumi, Takeshi Tomoda, Naoki Yamamoto, Shinichiro Nakamura, Sayo Kobayashi, Kenji Kuwaki, Hiroaki Hagihara, Hideki Onishi, Yasuhiro Miyake, Fusao Ikeda, Hidenori Shiraha, Akinobu Takaki, Taku Nakahara, Shin-Ichiro Nishimura, Kazuhide Yamamoto

    Journal of gastroenterology   48 ( 10 )   1171 - 9   2013.10

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    BACKGROUND: Most of the glycan changes reported in cancers were based on the examinations of a small number of patients or particular proteins. The aim of this study was to determine the changes of the serum N-glycan profile comprehensively in a large number of pancreatic cancer patients and investigate its clinical utility. METHODS: Glycan levels in the serum of 92 pancreatic cancer patients and 243 healthy volunteers (HLT) were examined by comprehensive quantitative high-throughput glycome analysis and were compared with clinical parameters. RESULTS: Out of 66 glycans detected, 15 were differentially expressed in pancreatic cancer, and 10 out of the 15 glycans were significantly up-regulated in cases with distant metastasis. There was a clear increase in overall expression of serum glycans, especially highly-branched glycans with fucose moieties, in pancreatic cancer. Among these 15 glycans, a tri-antennary complex type glycan (m/z 3195) showed the highest area under the receiver operating characteristic curve (AUROC = 0.799) for the diagnosis of pancreatic cancer. The ratio of pairs of glycans on the same path of the biosynthesis pathway (m/z 3195/1914) was found to be significantly higher in pancreatic cancer than in HLT (median = 1.11 and 0.41, respectively; p < 0.0001, AUROC = 0.831). For this pair ratio, the hazard ratio for survival (2.60, 95 % CI = 1.44-4.79) was higher than that of any single glycan and 1-year survival of patients with a high and low ratio was 36.9 and 69.2 %, respectively, (p = 0.001). CONCLUSIONS: Comprehensive glycome analysis can be used to know the presence of pancreatic cancer, distant metastasis, and patient prognosis, simultaneously.

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  • Dilation of a severe bilioenteric or pancreatoenteric anastomotic stricture using a Soehendra Stent Retriever. Reviewed International journal

    Koichiro Tsutsumi, Hironari Kato, Ichiro Sakakihara, Naoki Yamamoto, Yasuhiro Noma, Shigeru Horiguchi, Ryo Harada, Hiroyuki Okada, Kazuhide Yamamoto

    World journal of gastrointestinal endoscopy   5 ( 8 )   412 - 6   2013.8

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    Bilioenteric or pancreatoenteric anastomotic strictures often occur after surgery for a pancreaticobiliary disorder. Therapeutic endoscopic retrograde cholangiopancreatography using balloon enteroscopy has been shown to be feasible and effective in patients with such strictures. However, when a benign anastomotic stricture is severe, a dilation catheter cannot pass through the stricture despite successful insertion of the guidewire. We report on the usefulness of the Soehendra Stent Retriever over a guidewire for dilating a severe bilioenteric or pancreatoenteric anastomotic stricture under short double-balloon enteroscopy, in two patients with surgically altered anatomies.

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  • Management of occluded metallic stents in malignant hilar biliary stricture. Reviewed International journal

    Masakuni Fujii, Hirofumi Kawamoto, Koichiro Tsutsumi, Hironari Kato, Ken Hirao, Naoko Kurihara, Osamu Mizuno, Etsuji Ishida, Tsuneyoshi Ogawa, Hirotoshi Fukatsu, Kazuhide Yamamoto

    Hepato-gastroenterology   60 ( 123 )   447 - 51   2013.5

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    BACKGROUND/AIMS: Little is known about the management of occluded multiple metallic stent (MS) deployed in malignant hilar biliary strictures (HBS). The purpose of this study was to evaluate the endoscopic management of occluded multiple MSs deployed in HBS. METHODOLOGY: Fifty-five patients with unresectable biliary tract carcinoma had multiple MSs inserted due to HBS. The endoscopic intervention through the duodenal papilla was performed on 30 cases that had MS occlusion. The procedure success rate, the survival time after the procedure and the number of endoscopic interventions before death were analyzed, retrospectively. RESULTS: The causes of MS obstruction were tissue ingrowth (n=20), sludge (n=7), tumor overgrowth (n=2), and hemobilia (n=1). Endoscopic cleaning or deployment of plastic stents or metallic stents was performed on these patients and was successfully accomplished only via the transpapillary approach. The survival time after MS obstruction was 219 days. The median number of endoscopic interventions before death was 3. The median interval of endoscopic intervention after the first plastic stent occlusion was 84 days. CONCLUSIONS: Our long-term data regarding the endoscopic management of occluded MSs deployed in malignant hilar biliary strictures are acceptable although the patency time of plastic stents deployed after MS occlusion was relatively short.

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  • Endoscopic bilateral deployment of multiple metallic stents for malignant hilar biliary strictures. Reviewed International journal

    Hironari Kato, Koichiro Tsutsumi, Ryo Harada, Hiroyuki Okada, Kazuhide Yamamoto

    Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society   25 Suppl 2   75 - 80   2013.5

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    Jaundice and cholangitis are associated with morbidity and mortality for patients with malignant hilar biliary strictures. Endoscopic biliary drainage is considered a useful procedure for palliation of unresectable malignant hilar biliary strictures. However, even today, the devices and methods to effectively achieve the drainage of these strictures are under debate. Endoscopic bilateral deployment of multiple metallic stents for malignant hilar biliary strictures is a feasible and useful procedure, providing long-term patency and the preservation of functional liver volume. We report the cases of two patients who underwent endoscopic bilateral deployment of multiple metallic stents using the partial stent-in-stent method. Both of the patients had malignant hilar biliary stricture due to biliary tract cancer. The cancers were unresectable and the patients decided to receive chemotherapy. Before the chemotherapy, bilateral deployment of metallic stents was carried out and each patient has been receiving chemotherapy without occlusion of the metallic stents for several months.

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  • Dilatation by Soehendra Stent Retriever is Feasible and Effective in Multiple Deployment of Metallic Stents to Malignant Hilar Biliary Strictures Reviewed

    Hironari Kato, Hirofumi Kawamoto, Yasuhiro Noma, Takayuki Sonoyama, Koichiro Tsutsumi, Masakuni Fujii, Hiroyuki Okada, Kazuhide Yamamoto

    HEPATO-GASTROENTEROLOGY   60 ( 122 )   286 - 290   2013.3

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    Background/Aims: The endoscopic management of malignant hilar biliary strictures using multiple metallic stents (MS) is technically demanding, in the initial deployment of MS and the recovery from MS occlusion with deployment of multiple plastic stents (PS). We evaluated the outcomes of the application of a Soehendra stent retriever (SSR) as a dilator of intractable strictures. Methodology: Fifty-nine patients with malignant hilar biliary strictures had multiple MS inserted using a partial stent-in-stent procedure. When we encountered intractable strictures, we adopted SSR to dilate the stricture and the interstice of the MS. We evaluated the success rate of MS or PS deployment after SSR application and procedural complications. Results: Five of 59 patients (8%) were subjected to SSR application for the initial MS deployment. MS were successfully deployed in all of these patients (100%). MS occlusion was noted in 27 patients. We applied SSR to seven patients (26%) for the deployment of multiple PS after MS occlusion. In five patients (71%), successful PS deployment was achieved after the SSR application. No complications related to dilatation using SSR occurred in any patient. Conclusions: SSR proved to be a potent dilator of difficult strictures in the management of malignant hilar biliary strictures.

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  • A case of acute afferent loop syndrome treated by transgastric drainage with EUS. Reviewed International journal

    Kazuyuki Matsumoto, Hironari Kato, Takeshi Tomoda, Ichiro Sakakihara, Naoki Yamamoto, Yasuhiro Noma, Takayuki Sonoyama, Koichiro Tsutsumi, Hiroyuki Okada, Kazuhide Yamamoto, Hirofumi Kawamoto

    Gastrointestinal endoscopy   77 ( 1 )   132 - 3   2013.1

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  • Partial stent-in-stent placement of biliary metallic stents using a short double-balloon enteroscopy. Reviewed International journal

    Koichiro Tsutsumi, Hironari Kato, Takeshi Tomoda, Kazuyuki Matsumoto, Ichiro Sakakihara, Naoki Yamamoto, Yasuhiro Noma, Takayuki Sonoyama, Hiroyuki Okada, Kazuhide Yamamoto

    World journal of gastroenterology   18 ( 45 )   6674 - 6   2012.12

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    Endoscopic intervention is less invasive than percutaneous or surgical approaches and should be considered the primary drainage procedure in most cases with obstructive jaundice. Recently, therapeutic endoscopic retrograde cholangiopancreatography (ERCP) using double-balloon enteroscopy (DBE) has been shown to be feasible and effective, even in patients with surgically altered anatomies. On the other hand, endoscopic partial stent-in-stent (PSIS) placement of self-expandable metallic stents (SEMSs) for malignant hilar biliary obstruction in conventional ERCP has also been shown to be feasible, safe and effective. We performed PSIS placement of SEMSs for malignant hilar biliary obstruction due to liver metastasis using a short DBE in a patient with Roux-en-Y anastomosis and achieved technical and clinical success. This procedure can result in quick relief from obstructive jaundice in a single session and with short-term hospitalization, even in patients with surgically altered anatomies.

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  • Diagnostic usefulness of precise examinations with intraductal ultrasonography, peroral cholangioscopy and laparoscopy of immunoglobulin G4-related sclerosing cholangitis. Reviewed International journal

    Shigeru Horiguchi, Fusao Ikeda, Hidenori Shiraha, Naoki Yamamoto, Ichiro Sakakihara, Yasuhiro Noma, Koichiro Tsutsumi, Hironari Kato, Hiroaki Hagihara, Tetsuya Yasunaka, Shinichiro Nakamura, Haruhiko Kobashi, Hirofumi Kawamoto, Kazuhide Yamamoto

    Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society   24 ( 5 )   370 - 3   2012.9

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    Herein, a case of immunoglobulin G4 (IgG4)-related sclerosing cholangitis is reported. IgG4 was diagnosed based on observations from peroral cholangioscopy and laparoscopy, and these methods are proposed for definitive and precise diagnosis of this disease. A 76-year-old male patient with inguinal Paget's disease had intrahepatic bile duct dilatations detected with computed tomography at his periodic check-up. Magnetic resonance cholangiography showed stenosis of the upper common bile duct and poststenotic dilatation of left intrahepatic bile ducts. The portal tract and bilateral intrahepatic bile ducts were surrounded by a low-density area, facing a tumor-like lesion at segment 2. Cytological examinations of the stenotic and dilated lesions revealed no cellular atypia. Histological examination of the tumor showed normal liver tissue with infiltration of lymphocytes, indicating an inflammatory pseudotumor. Peroral cholangioscopy excluded the possibility of biliary cancer and indicated that the stenotic legion was of submucosal, not mucosal, origin. Laparoscopic observations showed discoloration with wide yellowish-white lobular markings and wide depressed lesions at segments 2 and 7. Liver histology showed mild cholangitis with infiltration of IgG4-positive plasma cells around the bile ducts. Serum IgG4 levels were elevated. From these findings, the patient was diagnosed with IgG4-related sclerosing cholangitis. After treatment with prednisolone, blood liver enzymes and IgG4 rapidly normalized, bile duct dilatations improved, and the hepatic pseudotumor disappeared. The cholangitis did not recur. In this case, biliary cancer was ruled out by observation with peroral cholangioscopy, and the spread of cholangitis in the liver periphery was verified with laparoscopy; this information could not be obtained with other modalities.

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  • A case of celiac artery dissection diagnosed with EUS. Reviewed International journal

    Daisuke Uchida, Kazuhiro Nouso, Hironari Kato, Koichiro Tsutsumi, Kazuhide Yamamoto

    Gastrointestinal endoscopy   76 ( 2 )   424 - 5   2012.8

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  • Vascular patterns in nodules of intraductal papillary mucinous neoplasms depicted under contrast-enhanced ultrasonography are helpful for evaluating malignant potential. Reviewed International journal

    Naoko Kurihara, Hirofumi Kawamoto, Yoshiyuki Kobayashi, Yuko Okamoto, Naoki Yamamoto, Koichiro Tsutsumi, Masakuni Fujii, Hironari Kato, Kazuhide Yamamoto

    European journal of radiology   81 ( 1 )   66 - 70   2012.1

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    OBJECTIVES: The purpose of this study is to evaluate the feasibility of contrast-enhanced ultrasonography (CE-US) to differentiate between benign and malignant intraductal papillary mucinous neoplasms (IPMN). PATIENTS AND METHODS: Contrast-enhanced ultrasonography with a contrast agent was performed on 22 consecutive patients with IPMN suspected of being malignant. This revealed 10 carcinomas, 1 borderline lesion and 11 adenomas. All patients underwent surgery, and the histological diagnosis was confirmed by examination of resected specimens. CE-US was performed using a contrast agent. The detection rates of mural nodules were compared between CE-US and contrast-enhanced computed tomography (CE-CT), and the imaging of mural nodules depicted under CE-US was analyzed. RESULTS: Seventeen of 22 resected specimens (77.3%) had mural nodules. There was no significant difference in the detection rate between CE-US (n=15; 88.2%) and CE-CT (n=12; 70.6%). In 12 (80.0%) of these patients, CE-US revealed small vessels in the mural nodule. The spotty or linear-shaped pattern was detected in 4 patients and the branch-shaped pattern in 8. The branch-shaped pattern lesion was associated with carcinoma. These mural nodules were 10mm or more in height. In the perfusion image phase, cystic walls and mural nodules were also enhanced in all cases. CONCLUSION: The vessel shapes of the mural nodules depicted under CE-US were associated with size and pathological findings. These results suggested that CE-US with a contrast agent is a powerful modality with which to evaluate the malignant potential of IPMN.

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  • Monitoring of CA19-9 and SPan-1 can facilitate the earlier confirmation of progressing pancreatic cancer during chemotherapy Reviewed

    Koichiro Tsutsumi, Hirofumi Kawamoto, Ken Hirao, Ichiro Sakakihara, Naoki Yamamoto, Yasuhiro Noma, Masakuni Fujii, Hironari Kato, Tsuneyoshi Ogawa, Etsuji Ishida, Kenji Kuwaki, Kazuhiro Nouso, Hiroyuki Okada, Kazuhide Yamamoto

    Pancreatology   12 ( 5 )   409 - 416   2012

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    Background: Measurement of objective response to chemotherapy using imaging modalities is sometimes difficult in pancreatic cancer (PC). We aimed to verify whether monitoring of serum tumor markers (TMs), namely carcinoembryonic antigen, CA19-9, DUPAN-2, SPan-1, can facilitate earlier confirmation of treatment failure. Methods: Monitoring of serum TMs and computed tomography were performed every 4 weeks until progression of disease in 90 patients with PC undergoing gemcitabine therapy. In Group A (January 2006 - October 2007), we analyzed the fluctuation rates of TMs with high pretreatment positive rates, and defined the criteria of progressive disease under TM monitoring (TM-PD). In Group B (November 2007 - October 2008), we calculated the time to progression (TTP) under this TM-PD criteria, which was compared with the TTP under the RECIST criteria. Results: CA19-9 and SPan-1 had the highest pretreatment positive rates: 83% and 90%, respectively. In Group A (CA19-9, n = 38
    SPan-1, n = 36), TM-PD criteria were defined as follows: fluctuation rates were &gt
    25% for a month or &gt
    10% for 2 consecutive months in CA19-9, and &gt
    10% for a month in SPan-1. In Group B (CA19-9, n = 18
    SPan-1, n = 17), under these criteria, one-month earlier confirmation of treatment failure was feasible in 61% by CA19-9 and 59% by SPan-1. Furthermore, the combination could facilitate this determination in 72% (35/49), significantly better than CA19-9 alone (P = 0.004). Conclusion: Monitoring of serum CA19-9 and SPan-1 is helpful for earlier confirmation of treatment failure during gemcitabine therapy in PC. Copyright © 2012, IAP and EPC. Published by Elsevier India, a division of Reed Elsevier India Pvt. Ltd. All rights reserved.

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  • A 4-week versus a 3-week schedule of gemcitabine monotherapy for advanced pancreatic cancer: a randomized phase II study to evaluate toxicity and dose intensity. Reviewed

    Ken Hirao, Hirofumi Kawamoto, Ichiro Sakakihara, Yasuhiro Noma, Naoki Yamamoto, Ryo Harada, Koichiro Tsutsumi, Masakuni Fujii, Hironari Kato, Naoko Kurihara, Osamu Mizuno, Tsuneyoshi Ogawa, Etsuji Ishida, Kazuhide Yamamoto

    International journal of clinical oncology   16 ( 6 )   637 - 45   2011.12

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    BACKGROUND: This randomized phase II study compared the efficacy and toxicity between 4-week and 3-week schedules of gemcitabine monotherapy in advanced pancreatic cancer. METHODS: Patients with advanced pancreatic cancer were randomly assigned to either a 4-week schedule (gemcitabine at 1000 mg/m² as a 30-min infusion weekly for 3 consecutive weeks every 4 weeks) or a 3-week schedule (gemcitabine at 1000 mg/m² as a 30-min infusion weekly for 2 consecutive weeks every 3 weeks). The primary endpoint was the compliance rate during the first 8 weeks between the two groups. RESULTS: A total of 90 patients were enrolled. The compliance rate during the first 8 weeks was the same (53.3%). For the 4- and 3-week schedules, the tumor response rates were 14.2 and 17.1% (p = 0.92), median progression free survival was 112 and 114 days (p = 0.82), and median overall survival was 206 and 250 days (p = 0.84), respectively. Grade 3-4 neutropenia was the major adverse event in both schedules: 37.7 and 35.5% (p = 0.82). In contrast, thrombocytopenia (platelet count <70000/mm³) was significantly higher for the 4-week schedule: 26.6 and 4.4% (p = 0.008). The mean received dose intensity was equal: 588 and 550 mg/m²/week (p = 0.14). CONCLUSIONS: The 3-week schedule of gemcitabine did not improve the compliance rate during 8 weeks compared with the 4-week schedule, but it attained a comparable efficacy with lower toxicity. Further investigation will be needed to introduce it into daily practice. CLINICAL TRIAL REGISTRATION NUMBER: UMIN ID 974.

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  • A case of gastric aberrant pancreas diagnosed with EUS-guided FNA. Reviewed International journal

    Masakuni Fujii, Hirofumi Kawamoto, Teruya Nagahara, Koichiro Tsutsumi, Hironari Kato, Susumu Shinoura, Satoshi Seno, Hiroyuki Okada, Kazuhide Yamamoto

    Gastrointestinal endoscopy   74 ( 2 )   407 - 9   2011.8

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  • Single-pattern convergence of K-ras mutation correlates with surgical indication of intraductal papillary mucinous neoplasms. Reviewed International journal

    Osamu Mizuno, Hirofumi Kawamoto, Naoki Yamamoto, Shigeru Horiguchi, Koichiro Tsutsumi, Masakuni Fujii, Hironari Kato, Ken Hirao, Naoko Kurihara, Etsuji Ishida, Tsuneyoshi Ogawa, Hiroyuki Okada, Kazuhide Yamamoto

    Pancreas   39 ( 5 )   617 - 21   2010.7

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    OBJECTIVES: One or more patterns of 6 K-ras mutations are detected in cells from the pancreatic juice of patients with intraductal papillary mucinous neoplasms (IPMNs). We investigated whether these mutations are associated with malignant progression. METHODS: Between January 2002 and December 2007, 53 patients with IPMN were subjected to collection of pure pancreatic juice to evaluate K-ras mutation. According to the histological and radiological findings, the IPMNs were classified into 4 groups: carcinoma group, adenoma group, high-risk group, and low-risk group. We retrospectively investigated the mutation with these groups. RESULTS: In patients with a positive K-ras mutation, a single pattern of K-ras mutation was observed in 80% (8/10) of the carcinoma group, in 71% (5/7) of the adenoma group, in 40% (2/5) of the high-risk group, and in 38% (8/21) of the low-risk group. The rate of a single pattern of K-ras mutation decreased in a stepwise order (P = 0.017). The incidence of a single pattern of K-ras mutation was significantly higher in the patients who received surgical therapy (75%, 12/16) than in those who did not (38%, 10/26; P = 0.033). CONCLUSIONS: The present study suggests that the single-clonal convergence of K-ras mutation is associated with the malignant progression of IPMNs.

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  • Prevention of biliary complication in radiofrequency ablation for hepatocellular carcinoma-Cooling effect by endoscopic nasobiliary drainage tube. Reviewed International journal

    Tsuneyoshi Ogawa, Hirofumi Kawamoto, Yoshiyuki Kobayashi, Shinichiro Nakamura, Hirokazu Miyatake, Ryo Harada, Koichiro Tsutsumi, Masakuni Fujii, Naoko Kurihara, Hironari Kato, Ken Hirao, Osamu Mizuno, Etsuji Ishida, Hiroyuki Okada, Kazuhide Yamamoto

    European journal of radiology   73 ( 2 )   385 - 90   2010.2

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    BACKGROUND AND STUDY AIMS: Biliary stricture after radiofrequency ablation (RFA) for nodules of hepatocellular carcinoma (HCC) close to major bile ducts sometimes causes septic complications and liver failure. Therefore, it may require interventional drainage for decompression during the follow-up period. The purpose of this study is to clarify the feasibility and safety of bile duct cooling using an endoscopic nasobiliary drainage (ENBD) tube in RFA for HCC close to major bile ducts. PATIENTS AND METHODS: Between August 2003 and July 2007, 14 consecutive patients (14 nodules) undergoing RFA with cooling by an ENBD tube for HCCs close to major bile ducts were enrolled in this study. We infused chilled saline solution via the ENBD tube at 1ml/s to prevent heat damage during RFA. As controls, 11 patients (13 nodules) undergoing RFA without cooling close to major bile ducts between April 2001 and August 2003 were reviewed. The major outcomes for evaluation were biliary complications and the secondary outcome was local tumor recurrence. RESULTS: There were no significant differences in tumor recurrence between the two groups. However, the rate of biliary complications was significantly lower in the cooling group than in the non-cooling group (0% vs. 39%, P=0.02). CONCLUSIONS: Cooling of bile ducts via an ENBD tube can prevent biliary complications induced by RFA of HCC close to major bile ducts without increasing local recurrence. This technique increases indication of RFA in difficult cases.

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  • Quantitative assessment of technical proficiency in performing needle-knife precut papillotomy. Reviewed International journal

    Hirotoshi Fukatsu, Hirofumi Kawamoto, Ryo Harada, Koichiro Tsutsumi, Masakuni Fujii, Hironari Kato, Ken Hirao, Takashi Nakanishi, Osamu Mizuno, Tsuneyoshi Ogawa, Etsuji Ishida, Hiroyuki Okada, Kohsaku Sakaguchi

    Surgical endoscopy   23 ( 9 )   2066 - 72   2009.9

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    BACKGROUND: Although needle-knife precut papillotomy (NKPP) is considered a useful alternative for achieving selective biliary cannulation, controversy remains regarding the technical proficiency needed to perform the procedure and its safety. This study evaluated whether procedural experience with NKPP predicted either successful cannulation or the development of complications. METHODS: This study retrospectively investigated 104 patients, out of 589 consecutive patients with native papillary, who underwent NKPP performed by a single endoscopist between October 2002 and July 2006. To demonstrate changes in NKPP, the 104 patients were divided chronologically into two groups according to periods: period A (October 2002 to September 2004) and period B (October 2004 to July 2006). RESULTS: Of the 104 consecutive patients who underwent NKPP, 41 (41/267, 15%) were treated in period A and 63 (63/322, 20%) in period B. There was no significant difference in the overall success rate between periods A (90%) and B (98%) (p = 0.08). However, the initial success rate was higher in period B (95%) than in period A (80%) (p < 0.05). The complication rates were not significantly different between the two groups (10% vs 16%; p = 0.56). Although all complications involved pancreatitis, severe pancreatitis was not observed. CONCLUSION: Whereas the initial success rate for NKPP can increase with procedural experience, the complication rate does not seem to decrease. Furthermore, the need for NKPP does not appear to decrease with increasing endoscopic retrograde cholangiopancreatography (ERCP) experience.

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  • Long-term outcomes of endoscopic management for biliary strictures after living donor liver transplantation with duct-to-duct reconstruction. Reviewed International journal

    Hironari Kato, Hirofumi Kawamoto, Koichiro Tsutsumi, Ryo Harada, Masakuni Fujii, Ken Hirao, Naoko Kurihara, Osamu Mizuno, Etsuji Ishida, Tsuneyoshi Ogawa, Hirotoshi Fukatsu, Kazuhide Yamamoto, Takahito Yagi

    Transplant international : official journal of the European Society for Organ Transplantation   22 ( 9 )   914 - 21   2009.9

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    Biliary strictures after living donor liver transplantation (LDLT) with duct-to-duct (D-D) reconstruction are associated with postoperative morbidity and mortality. The aims of this study were to evaluate the long-term outcomes of endoscopic deployment of plastic stents, and to investigate factors associated with the stent deployment failure. Between April 2001 and May 2007, 96 patients received LDLT with D-D reconstruction at Okayama University Hospital. Among them, 41 patients (43%) had anastomotic biliary strictures, and all were referred first for endoscopic retrograde cholangiography (ERC). When deployment was unsuccessful, a percutaneous transhepatic procedure was employed. Successful stent deployment was achieved in 35 out of total 41 patients (85%) by both procedures. Among the 35 patients, 28 had their stents removed as a result of strictures resolution. Eight patients underwent ERC and repeated stent deployment as a result of recurrence of the strictures. Finally, 21 out of 41 (51%) patients with biliary stricture were completely treated by endoscopic therapy during the observation period (median 873 days: range 77-2060). By multivariate analysis, biliary leakage was associated with stent deployment failure. Endoscopic deployment of plastic stents is a first-line therapy for patients with biliary stricture after LDLT.

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  • Cholesterolosis of the common bile duct with anomalous arrangement of the pancreaticobiliary ductal system. Reviewed International journal

    Hirotoshi Fukatsu, Hirofumi Kawamoto, Ryo Harada, Masakuni Fujii, Koichiro Tsutsumi, Tsuneyoshi Ogawa, Etsuji Ishida, Hiroyuki Okada, Kohsaku Sakaguchi, Takahito Yagi, Hiroyoshi Matsukawa, Hiroshi Sadamori, Masako Ohmori

    Gastrointestinal endoscopy   67 ( 7 )   1172 - 3   2008.6

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  • Endoscopic deployment of multiple JOSTENT SelfX is effective and safe in treatment of malignant hilar biliary strictures. Reviewed International journal

    Hirofumi Kawamoto, Koichiro Tsutsumi, Ryo Harada, Masakuni Fujii, Hironari Kato, Ken Hirao, Naoko Kurihara, Takashi Nakanishi, Osamu Mizuno, Etsuji Ishida, Tsuneyoshi Ogawa, Hirotoshi Fukatsu, Kohsaku Sakaguchi

    Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association   6 ( 4 )   401 - 8   2008.4

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    BACKGROUND & AIMS: For the treatment of unresectable biliary tract carcinoma with hilar biliary stricture, antitumor therapy and biliary stenting should be addressed in terms of prolonged survival with a good quality of life. However, the endoscopic management of malignant hilar biliary strictures is difficult even for an expert endoscopist. We evaluated the efficacy and safety of the endoscopic deployment of multiple JOSTENT SelfX units in patients with hilar biliary strictures treated with or without chemotherapy. METHODS: Between November 2003 and December 2006, endoscopic deployment of multiple JOSTENT SelfX units in hilar biliary strictures by using a partial stent-in-stent procedure was performed on 41 consecutive patients with primary cholangiocarcinoma (n = 34) and gallbladder carcinoma (n = 7) at a gastroenterologic center of Okayama University Hospital. Thirty-three patients were treated with gemcitabine (n = 25) or S-1 (n = 8). RESULTS: Metallic stent deployment was successfully accomplished in all cases via only endoscopic procedures. During the follow-up period (mean, 210 days), mean patency time was 150 days, and metallic stent obstruction occurred in 15 cases (37%). Although a repeat intervention was required in all metallic stent obstructed cases, the deployment of the second metallic or plastic stent was completed successfully. The remaining 26 cases (63%) required no interventions. The median overall survival period was only 235 days. However, that of the patients receiving chemotherapy was 392 days. CONCLUSIONS: Endoscopic partial stent-in-stent deployment with multiple JOSTENT SelfX prostheses is effective and safe for the treatment of malignant hilar biliary stricture even in patients receiving chemotherapy.

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  • Santorinicele in a patient with unresectable pancreatic cancer. Reviewed

    Hirotoshi Fukatsu, Hirofumi Kawamoto, Koichiro Tsutsumi, Masakuni Fujii, Hironari Kato, Ken Hirao, Naoko Kurihara, Tsuneyoshi Ogawa, Etsuji Ishida, Yuko Okamoto, Hiroyuki Okada, Kohsaku Sakaguchi

    Internal medicine (Tokyo, Japan)   47 ( 1 )   33 - 5   2008

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    A santorinicele is defined as a focal cystic dilatation of the terminal portion of the dorsal pancreatic duct at the minor papilla; most cases have been reported in patients with pancreas divisum. It has been suggested that a santorinicele results from a combination of a minor papilla obstruction which prevents the flow of pancreatic juice and a weakness of the duodenal wall where the dorsal pancreatic duct terminates. However, these conditions can occur in patients with invasive ductal cancer in the pancreatic head. We encountered a rare case of a santorinicele with unresectable adenocarcinoma of the pancreatic head in an 81-year-old woman.

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  • Endoscopic 3-branched partial stent-in-stent deployment of metallic stents in high-grade malignant hilar biliary stricture (with videos). Reviewed International journal

    Hirofumi Kawamoto, Koichiro Tsutsumi, Masakuni Fujii, Ryo Harada, Hironari Kato, Ken Hirao, Naoko Kurihara, Takashi Nakanishi, Osamu Mizuno, Etsuji Ishida, Tsuneyoshi Ogawa, Hirotoshi Fukatsu, Kohsaku Sakaguchi

    Gastrointestinal endoscopy   66 ( 5 )   1030 - 7   2007.11

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    BACKGROUND: In view of the recent advancement in endoscopic devices for biliary endoscopic intervention, the expert endoscopist can address complex morbidity. However, endoscopic 3-branched partial stent-in-stent deployment of metallic stents (MS) in patients with malignant hilar biliary stricture is technically demanding. OBJECTIVES: To evaluate the efficacy and safety of endoscopic 3-branched partial stent-in-stent deployment of MS. DESIGN: Case study. SETTING: Gastroenterological Center, Okayama University Hospital. PATIENTS: Nine consecutive patients (mean age 63 years, range 52-84 years, mean follow-up period 5 months) with malignant hilar biliary stricture were enrolled. They had cytologically or histologically proven unresectable biliary-tract carcinoma with hilar biliary stricture type IIIa or IV according to Bismuth's classification. INTERVENTIONS: Endoscopic 3-branched partial stent-in-stent deployment of MS in hilar biliary strictures by using a JOSTENT SelfX stent. MAIN OUTCOME MEASUREMENTS: The success rate of the procedure, stent patency time, reinterventions, and complications. RESULTS: Endoscopic 3-branched partial stent-in-stent deployment was successfully accomplished in all cases. The MS became obstructed in 3 cases (33%), mean 1.5 months, range 1.4 to 2.7 months. However, no MS obstruction occurred in the other 6 patients (67%), mean 11 months, range 4.7 to 16.4 months. In the obstructed cases, the deployment of 2 or 3 tube stents was completed successfully. One case of cholecystitis was observed as a short-term complication. LIMITATION: The small number of cases. CONCLUSIONS: Endoscopic 3-branched partial stent-in-stent deployment of a JOSTENT SelfX stent was effective in selected patients with high-grade malignant hilar biliary stricture.

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  • [Two cases of patients with hepatocellular carcinoma (HCC) that developed in cryptogenic cirrhosis suggestive of nonalcoholic steatohepatitis (NASH) as background liver disease after clinical courses of 26 years]. Reviewed

    Koichiro Tsutsumi, Haruo Nakayama, Yoshitaka Sakai, Yasuhiro Kojima, Naohiro Dairaku, Toshiaki Ojima, Masao Kusano, Shinichi Ikeya, Yoshiki Sugai, Nobuo Hiwatashi

    Nihon Shokakibyo Gakkai zasshi = The Japanese journal of gastro-enterology   104 ( 5 )   690 - 7   2007.5

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    We report two cases of patients with hepatocellular carcinoma (HCC) that developed in cryptogenic cirrhosis suggestive of nonalcoholic steatohepatitis (NASH) as background liver disease. Case 1 was a 68-year-old woman, and case 2 was a 46-year-old man. They were admitted to our department for evaluation and treatment of HCC. The causes of the underlying liver disease were not determined from blood tests. However, histological analysis of non-tumor tissues of the liver revealed cirrhosis with few fat droplets. Both patients had undergone liver biopsy 26 years before the treatment of HCC. Histological review of the biopsy specimens revealed NASH (case 1) and fatty liver (case 2), respectively. It was suggested that these cases progressed from NASH and fatty liver, respectively, to NASH-related cirrhosis (so called burned-out NASH), eventually, developing HCC. These findings suggest that substantial number of burned-out NASH cases may be included in those with cryptogenic cirrhosis. These two patients are indicative cases that may reveal the long-term natural course of fatty liver and NASH.

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  • 盲腸に発生した腺扁平上皮癌の1例

    草野 昌男, 森 菜緒子, 堤 康一郎, 遠藤 克哉, 阿部 靖彦, 小島 康弘, 境 吉孝, 野口 謙治, 小島 敏明, 鹿志村 純也, 池谷 伸一, 樋渡 信夫

    Progress of Digestive Endoscopy   64 ( 2 )   128,9 - 129,9   2004.6

  • 6年5ヵ月の経過観察中に腺腫4病変に癌化がみられた1例

    草野 昌男, 森 菜緒子, 堤 康一郎, 遠藤 克哉, 阿部 靖彦, 小島 康弘, 境 吉孝, 野口 謙治, 小島 敏明, 鹿志村 純也, 池谷 伸一, 樋渡 信夫

    Progress of Digestive Endoscopy   65 ( 1 )   84 - 84   2004.6

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  • 膵管狭細型膵炎と鑑別困難な膵癌の1例

    鹿志村 純也, 境 吉孝, 堤 康一郎, 森 菜緒子, 遠藤 克哉, 阿部 靖彦, 小島 康広, 野口 謙治, 小島 敏明, 草野 昌男, 池谷 伸一, 樋渡 信夫

    Progress of Digestive Endoscopy   64 ( 1 )   102 - 102   2003.11

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  • 盲腸に発生した腺扁平上皮癌の1例

    草野 昌男, 森 菜緒子, 堤 康一郎, 遠藤 克哉, 阿部 靖彦, 小島 康弘, 境 吉孝, 野口 謙治, 小島 敏明, 鹿志村 純也, 池谷 伸一, 樋渡 信夫

    Progress of Digestive Endoscopy   64 ( 1 )   90 - 90   2003.11

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  • 肝細胞癌の腫瘍生検後骨盤内播種を認めた2例

    森 菜緒子, 池谷 伸一, 堤 康一郎, 遠藤 克哉, 阿部 靖彦, 境 吉孝, 野口 謙治, 小島 敏明, 鹿志村 純也, 遠藤 到, 中山 晴夫, 佐藤 勝久, 須貝 吉樹, 樋渡 信夫

    日本消化器病学会雑誌   100 ( 臨増大会 )   A745 - A745   2003.9

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  • 蛋白漏出性腸症の長期経過中に小腸原発Burkittリンパ腫が発生した1例

    遠藤 克哉, 遠藤 到, 堤 康一郎, 森 菜緒子, 阿部 靖彦, 境 吉孝, 野口 謙治, 小島 敏明, 鹿志村 純也, 池谷 伸一, 中山 晴夫, 佐藤 勝久, 須貝 吉樹, 樋渡 信夫

    日本消化器病学会雑誌   100 ( 臨増大会 )   A671 - A671   2003.9

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  • 【膵疾患に対する内視鏡診療のすべて】膵疾患に対する内視鏡治療 内視鏡的膵管ステント留置術の適応と実際

    加藤 博也, 松本 和幸, 堀口 繁, 堤 康一郎, 岡田 裕之

    消化器内視鏡   33 ( 9 )   1437 - 1444   2021.9

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    内視鏡的膵管ステント留置術(EPS)の適応となるのはおもに慢性膵炎による狭窄や膵石であるが、急性膵炎や膵癌、膵外傷など、その他の疾患に伴う膵管狭窄に対してもEPSは適応となる。また、膵炎に伴う仮性嚢胞や術後の膵液瘻にもEPSはしばしば適応となる。胆管ステントと同様、膵管ステントも近年では多くの種類が流通しており、形状、太さ、長さもさまざまで状況に応じた取捨選択が必要となる。また、EPSを行う際には、まず内視鏡的経鼻膵管ドレナージを行ってからEPSに移行する方法がある。さらに、EPSは良性の狭窄に対して行うことが多い点が、悪性疾患で適応となることが多い胆道狭窄とは異なる。そのため、ステント交換・抜去のタイミングなどドレナージのあとのマネジメントも重要である。(著者抄録)

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  • IPMNの発癌機序の解明と診断・治療への応用 IPMN切除組織のプロテオーム解析による悪性化マーカー探索、検証と臨床応用の可能性

    堤 康一郎, 加藤 博也, 上田 英次郎, 姫井 人美, 寺澤 裕之, 小川 泰司, 藤井 佑樹, 山崎 辰洋, 松本 和幸, 堀口 繁, 岡田 裕之

    膵臓   36 ( 3 )   A188 - A188   2021.8

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  • 膵癌ゲノム 膵液中エクソソーム(EV)解析のための最適な膵液採取法、EV回収法の検討

    上田 英次郎, 堤 康一郎, 姫井 人美, 寺澤 裕之, 小川 泰司, 藤井 佑樹, 山崎 辰洋, 松本 和幸, 堀口 繁, 加藤 博也, 岡田 裕之

    膵臓   36 ( 3 )   A286 - A286   2021.8

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  • 膵嚢胞性疾患の診断と治療の最前線 EUS画像に基づいたIPMN組織亜型予測診断

    藤井 佑樹, 松本 和幸, 上田 英次郎, 寺澤 祐之, 小川 泰司, 山崎 辰洋, 堀口 繁, 堤 康一郎, 加藤 博也, 八木 孝仁, 花田 敬士

    膵臓   36 ( 3 )   A262 - A262   2021.8

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  • 【胆道ドレナージを極める】経乳頭的アプローチ 悪性肝門部領域胆管狭窄に対する経乳頭的胆管ドレナージ

    加藤 博也, 友田 健, 松本 和幸, 堀口 繁, 堤 康一郎, 岡田 裕之

    消化器内視鏡   33 ( 3 )   504 - 512   2021.3

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  • 胆嚢癌診療における血清中エクソソーム内miRNAの有用性

    上田 英次郎, 堤 康一郎, 姫井 人美, 小川 泰司, 寺澤 裕之, 藤井 佑樹, 山崎 辰洋, 松本 和幸, 友田 健, 堀口 繁, 加藤 博也, 岡田 裕之, 藤井 雅邦

    日本消化器病学会雑誌   118 ( 臨増総会 )   A344 - A344   2021.3

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  • 【急性膵炎診療up-to-date】治療 ERCP後膵炎は予防可能か 予防に有効な内視鏡手技や薬剤など

    友田 健, 加藤 博也, 藤井 佑樹, 山崎 辰洋, 松本 和幸, 堀口 繁, 堤 康一郎, 岡田 裕之

    肝胆膵   82 ( 1 )   91 - 96   2021.1

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  • 【消化器疾患とステント治療】良性膵管狭窄に対する内視鏡的ステント治療

    松本 和幸, 加藤 博也, 内田 大輔, 堤 康一郎, 堀口 繁, 松三 明宏, 宮本 和也, 藤井 祐樹, 山崎 辰洋, 皿谷 洋祐, 友田 健, 岡田 裕之

    消化器・肝臓内科   8 ( 1 )   50 - 56   2020.7

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  • 【肝膵内視鏡治療におけるトラブルシューティング】EUS下治療における偶発症予防とトラブルシューティング WONに対する内視鏡的ネクロセクトミー こんなときどうする?

    加藤 博也, 内田 大輔, 友田 健, 松本 和幸, 堀口 繁, 堤 康一郎, 岡田 裕之

    消化器内視鏡   32 ( 3 )   431 - 436   2020.3

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  • 化学療法中に生じた右頸部痛を契機に頸部エコーにて内頸静脈への中心静脈カテーテル迷入と診断された1例 Reviewed

    橘高 早紀, 堤 康一郎, 遠藤 久之, 兵頭 剛, 植木 亨, 坂口 孝作

    癌と化学療法   47 ( 1 )   91 - 93   2020.1

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    化学療法中に生じた激しい頸部痛を主訴に救急外来を受診し、頸部エコーにて血栓を合併した内頸静脈への中心静脈(CV)カテーテル迷入と診断された1例を経験した。症例は57歳、男性。直腸癌術後の肝・肺・リンパ節転移、腹膜播種に対して、右鎖骨下静脈経由でのCVポート留置後、modified FOLFOX6[levofolinic acid、5-fluorouracil(5-FU)、oxaliplatin(L-OHP)]とpanitumumabの併用療法を導入した。6コース目を開始した深夜に激しい右頸部痛が出現したため、救急外来へ搬送された。頸部エコーにて右内頸静脈内に線状高エコーとその周囲の血栓を認め、胸部X線にて内頸静脈へのCVカテーテル迷入と診断した。頸部痛はL-OHPおよび5-FUによる静脈炎に伴う症状と考えられ、カテーテル抜去後2日目には消失した。また、血栓に対しては直接経口抗凝固薬にて加療を行った。CVポート留置後の合併症として内頸静脈へのカテーテル迷入があり、化学療法後の頸部痛を生じた際には考慮すべきである。また、本症例は造影剤アレルギー歴があり、頸部エコーはカテーテルの迷入に加え血栓の存在診断にも有用であった。(著者抄録)

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  • ソマトスタチンアナログ投与による全身状態安定化により、診断と治療が可能であった膵神経内分泌腫瘍、Vasoactive Intestinal Polypeptide(VIP)産生腫瘍の1例 Reviewed

    河原 聡一郎, 植木 亨, 堤 康一郎, 織田 崇志, 小林 沙代, 藤澤 智雄, 名和 徹, 貞森 裕, 大野 京太郎, 重西 邦浩

    日本消化器病学会雑誌   117 ( 1 )   84 - 91   2020.1

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    症例は68歳女性。補液にて改善しない水様性下痢と腎不全にて当院転院。ICU管理にて腎機能改善後、造影CTを施行し、膵体部と肝に多血性の腫瘤を認めた。臨床症状と合わせてVIP産生腫瘍と考え、ソマトスタチンアナログを開始。すると下痢は著明に改善し全身状態も安定した。そこでEUS-FNAにて神経内分泌腫瘍と診断後、膵原発巣と肝転移巣の外科的切除を施行した。術後の病理にてVIP産生腫瘍と診断された。(著者抄録)

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  • ソマトスタチンアナログ投与による全身状態安定化により、診断と治療が可能であった膵神経内分泌腫瘍、Vasoactive Intestinal Polypeptide(VIP)産生腫瘍の1例

    河原 聡一郎, 植木 亨, 堤 康一郎, 織田 崇志, 小林 沙代, 藤澤 智雄, 名和 徹, 貞森 裕, 大野 京太郎, 重西 邦浩

    日本消化器病学会雑誌   117 ( 1 )   84 - 91   2020.1

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    症例は68歳女性。補液にて改善しない水様性下痢と腎不全にて当院転院。ICU管理にて腎機能改善後、造影CTを施行し、膵体部と肝に多血性の腫瘤を認めた。臨床症状と合わせてVIP産生腫瘍と考え、ソマトスタチンアナログを開始。すると下痢は著明に改善し全身状態も安定した。そこでEUS-FNAにて神経内分泌腫瘍と診断後、膵原発巣と肝転移巣の外科的切除を施行した。術後の病理にてVIP産生腫瘍と診断された。(著者抄録)

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    Other Link: https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2020&ichushi_jid=J01118&link_issn=&doc_id=20200128570009&doc_link_id=130007784877&url=https%3A%2F%2Fci.nii.ac.jp%2Fnaid%2F130007784877&type=CiNii&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00003_1.gif

  • 【結石除去を極める】胆石 術後再建腸管症例における結石除去(BE-ERCP) Roux-en-Y再建症例(乳頭あり症例)

    加藤 博也, 堤 康一郎, 内田 大輔, 友田 健, 松本 和幸, 堀口 繁, 岡田 裕之

    消化器内視鏡   31 ( 11 )   1648 - 1653   2019.11

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    乳頭を有するRoux-en-Y再建に対するバルーン内視鏡を用いた総胆管結石治療は、スコープの挿入・胆管挿管・乳頭処置・結石除去、それぞれのステップにおいて手技上のコツがある。挿入においては、Y脚を確実に認識し、縫合線を越えて挿入すること、ループを完全に解除せずに挿入することが重要である。挿管の際にもまずはループを残した状態で試みて、スコープのトルクとアングルで挿管に適した位置に乳頭をポジショニングしなければならない。乳頭処置においてEST(内視鏡的乳頭括約筋切開術)を行う際は、通常の解剖と異なり口側隆起の認識が困難であるため出血・穿孔に対しより注意が必要であり、状況に応じてEPBD(内視鏡的乳頭バルーン拡張術)・EPLBD(内視鏡的乳頭ラージバルーン拡張術)を積極的に併用することが重要である。結石除去をスコープの引き抜きのみで行うのは消化管穿孔のリスクがあるため、スコープのアングルも併用しながら行う。(著者抄録)

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  • 【胆膵内視鏡トラブルシューティング-こうやって切り抜けろ-】EUS-HGSにおける手技の工夫 ダブルガイドワイヤー法について

    内田 大輔, 加藤 博也, 松三 明宏, 宮本 和也, 山崎 辰洋, 藤井 佑樹, 皿谷 洋祐, 友田 健, 松本 和幸, 堀口 繁, 堤 康一郎, 岡田 裕之

    胆と膵   40 ( 6 )   529 - 533   2019.6

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    超音波内視鏡下肝内胆管ドレナージ術(EUS-HGS)は、経乳頭的アプローチが困難な症例において、経皮的胆管ドレナージ術や外科的胆道再建術に替わる有用な胆道ドレナージ法であるが、手技的な困難性も相まって、胆汁性腹膜炎、出血、穿孔、ステント逸脱などの重篤な偶発症も報告されている。EUS-HGSの手技は穿刺、拡張、ステント留置と、多くのstepを要する手技であるが、これらの処置をより安全に行ううえで、安定したスコープ保持およびデバイスデリバリーのための処置軸の保持が重要である。当施設では、EUS-HGSをより安全に施行するために、ダブルガイドワイヤー法を用いている。ダブルガイドワイヤー法は、同軸に2本のガイドワイヤーを留置し処置軸を安定させることで、より安全にデバイスデリバリーを行う方法である。本稿では、ダブルガイドワイヤー法によるEUS-HGSの実際について画像を提示しながら解説する。(著者抄録)

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  • 切除不能進行膵がん患者に対するゲムシタビン/nab-パクリタキセル併用療法(GN療法)に起因する好中球減少のリスク因子解析 Reviewed

    槇田 崇志, 力丸 理菜, 神崎 浩孝, 堀口 繁, 加藤 博也, 堤 康一郎, 田中 雄太, 森下 陽介, 西原 茂樹, 村川 公央, 北村 佳久, 岡田 裕之, 千堂 年昭

    医療薬学   44 ( 3 )   107 - 116   2018.3

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    治癒切除不能膵がんと診断され、化学療法としてゲムシタビン/nab-パクリタキセル併用療法(GN療法)を施行した52例(男性61.5%、平均65.7±9.4歳)を対象とした。一次治療群26例、二次治療群26例であった。PSは0および1が全体で86.5%、一次治療群で84.6%、二次治療群で88.5%であった。GN療法1コース施行前後の好中球数平均値は、一次治療群と二次治療群での有意差は認めなかった。一次治療群と二次治療群を比較して、貧血のみ重篤な副作用の発現頻度に有意差を認めた。全例を対象として、重篤な好中球減少の発現リスクとなる因子の解析を行い、性別、年齢、PS、がん発症部位、手術歴、転移の有無との関連は認めなかった。血液検査値から、WBC、HT、ANCは低値を、AST、ALTは高値をリスク因子とした。単変量解析の結果では、WBCまたはANCとPLTが低値で、AST、ALTが高値であることによって、重篤な好中球減少症の発現リスクが上昇することが示された。多重ロジスティック回帰分析を行い、重篤な好中球減少症の発現と関連性の強い因子として、WBC、ANC、ALTが抽出された。

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  • 網羅的プロテオーム解析を用いた膵管内乳頭粘液性腫瘍(IPMN)の悪性化マーカーの探索

    堤 康一郎

    日本膵臓病研究財団研究報告書   24回   75 - 78   2017.12

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    悪性IPMNマーカーの同定を目的として、当院にて切除されたIPMN症例のホルマリン固定パラフィン包埋組織を用いて、レーザーマイクロダイセクションにて、「良性(L)」と「悪性(H)」別に回収後、ショットガン・プロテオーム解析を行った。各サンプルより、おおよそ10,000を超えるタンパク質が同定された。同一症例・同一部位より得られた3回分のスペクトルデータをひとまとめとして、タンパク質解析ソフトウェア(Proteome discoverer 2.0)を用いて、MASCOT(データベースはSwiss Plot)によるタンパク質同定を行ったところ、部位Hからは合計4148個、部位Lからは合計3821個のタンパク質が同定され、両部位から共通して同定されたタンパク質は2765種類であった。また、H部位特異的タンパク質は1383種類、L特異的タンパク質は1056種であった。現在、症例数を増やして解析継続中であり、引き続き、高精度な良悪性鑑別診断法の確立への基盤開発を行っていく。(著者抄録)

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  • "消化管吻合部の縫合線"を利用した、術後再建腸管症例に対するERCPのスコープ挿入手技 Reviewed

    堤 康一郎, 加藤 博也, 堀口 繁, 松本 和幸, 友田 健, 内田 大輔, 秋元 悠, 室 信一郎, 水川 翔, 岡田 裕之

    Gastroenterological Endoscopy   59 ( 8 )   1644 - 1652   2017.8

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    術後再建腸管を有する胆膵疾患に対するERCPは、バルーン内視鏡の開発により可能となった。しかし手技の標準化はなされておらず、複雑な分岐を伴う再建術式(膵頭十二指腸切除後Child変法、胃切除後Billroth-II法、胃切除後および胃温存Roux-en-Y法)に対し、試行錯誤しながら、目的部位への到達を目指して挿入を試みているのが現状である。われわれは、空腸空腸吻合部での挿入方向の判別方法として"吻合部の縫合線"を利用し、高い目的部位到達率を得ている(95.6%[347/363])。正確な挿入陰向の判別によって、術者のストレス軽減に加え、挿入時間の短縮や安全で確実な手技遂行の達成が期待される。(著者抄録)

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  • 手技の解説 悪性肝門部胆管狭窄症例における金属ステント閉塞への対処 Reviewed

    加藤 博也, 友田 健, 松本 和幸, 堀口 繁, 堤 康一郎, 岡田 裕之

    Gastroenterological Endoscopy   59 ( 7 )   1524 - 1531   2017.7

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    悪性肝門部胆管狭窄に対して複数本の金属ステントを留置した後のステント閉塞に対する処置は難易度が高い。処置を成功させるためには、ガイドワイヤー、カテーテル、ステントなど、各処置具の特性を理解して適切に選択することが重要であり、処置を行う際には、それらの処置具を扱ううえでのポイントを理解しておかなければならない。stent-in-stent法で留置した複数の金属ステントが閉塞した場合の処置では、金属ステントのメッシュの隙間にカテーテルやプラスチックステントを通過させることが最大の難関であることを知ったうえで、それぞれの処置具を慎重に操作する必要がある。プラスチックステントを留置する際はそれらを留置する順序も重要であり、基本的には金属ステントを留置した順番で留置する。本手技の成功には術者のみならず、介助者のテクニックも重要であり、日頃からスコープを握るだけではなく、ガイドワイヤーの扱いに慣れておかなければならない。(著者抄録)

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  • Gender Differences in Clinicopathological Features of 20 Cases With Solid Pseudopapillary Neoplasms of the Pancreas

    Yutaka Akimoto, Hironari Kato, Ryo Harada, Daisuke Uchida, Hiroyuki Seki, Takeshi Tomoda, Kazuyuki Matsumoto, Naoki Yamamoto, Shigeru Horiguchi, Koichiro Tsutsumi, Shin-ichiro Muro, Toru Ueki, Shinsuke Oda, Soichiro Fushimi, Takahito Yagi, Hiroyuki Okada

    PANCREAS   46 ( 6 )   831 - 831   2017.7

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  • 【ERCPのエキスパートを目指して】肝門部マルチステンティングの実際とコツ

    加藤 博也, 室 信一郎, 秋元 悠, 内田 大輔, 友田 健, 松本 和幸, 堀口 繁, 堤 康一郎, 河本 博文, 岡田 裕之

    消化器内視鏡   29 ( 5 )   879 - 884   2017.5

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    悪性肝門部胆管狭窄に対するマルチステンティングを成功させるにはデバイスの知識が不可欠であり、特にガイドワイヤーの知識と適切な使い分けは重要である。(1)目的とする胆管を探るためのガイドワイヤー、(2)カテーテルや金属ステント(MS)を目的とする胆管へ運ぶためのガイドワイヤー、(3)2本目、3本目のMSを留置する際の目印となるガイドワイヤー、の3つが必要である。MSを留置する際は、その順序が重要であり、左葉あるいは右後区域の胆管への留置をまず先に行い、最後に右前区域の胆管に留置するのが基本である。細かなテクニックとして、バルーンによる前拡張を行うことや、狭窄突破困難な場合のSoehendra Stent Retriever(SSR)の使用法を理解しておかなければならない。介助者のテクニック、特にガイドワイヤーテクニックは成否を分ける要素となるので、日頃からスコープ操作のみならず、介助者としても技術を磨いておく必要がある。(著者抄録)

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  • 【胆膵内視鏡自由自在〜基本手技を学び応用力をつける集中講座〜】内視鏡システムと内視鏡操作に関する基本知識 術後再建腸管に対するバルーン内視鏡挿入操作の基本と挿入のコツ

    堤 康一郎, 加藤 博也, 水川 翔, 室 信一郎, 秋元 悠, 内田 大輔, 友田 健, 松本 和幸, 山本 直樹, 堀口 繁, 岡田 裕之

    胆と膵   37 ( 臨増特大 )   1137 - 1143   2016.11

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    術後再建腸管を有する胆膵疾患症例に対する内視鏡的アプローチは、バルーン内視鏡の開発、導入により、高い成功率で可能となってきた。また、2016年4月、ERCP関連処置におけるバルーン内視鏡加算が保険収載され、本手技のさらなる普及が期待される。しかし、その第一関門である目的部位(主乳頭や胆管空腸吻合部)への到達は、いまだ難渋することも少なくない。本稿では、術後再建腸管症例に対するバルーン内視鏡の挿入手技を安全、確実、かつ効率よく行うための基本操作とコツについて解説する。手術記録とスケッチの確認は必須で、とくに、"消化管吻合部の縫合線"は挿入ルートを決める際のメルクマールとして非常に有用である。また、アタッチメントの装着、CO2送気、適切な前処置や麻酔の施行が、挿入性向上や安全な手技遂行のために重要である。本手技の標準化に向けて、まずは術式、再建法の理解と、それに基づく挿入手技の確立が必要である。(著者抄録)

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  • Effectiveness and safety of peroral direct cholangioscopy using an ultraslim endoscope for the treatment of hepatolithiasis in patients with hepaticojejunostomy

    Kazuyuki Matsumoto, Koichiro Tsutsumi, Hironari Kato, Naoki Yamamoto, Shigeru Horiguchi, Yutaka Akimoto, Daisuke Uchida, Takeshi Tomoda, Hiroyuki Okada

    JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY   31   221 - 222   2016.11

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  • Diagnostic and therapeutic endoscopic retrograde cholangiography using a short-type double-balloon endoscope in patients with altered gastrointestinal anatomy: A multicenter prospective study in Japan

    Masaaki Shimatani, Hirofumi Kogure, Koichiro Tsutsumi, Tomonori Yano, Kazuichi Okazaki, Hironori Yamamoto, Hideki Ishikawa, Kentaro Sugano

    JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY   31   223 - 223   2016.11

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  • 【Interventional EUSのすべて】胆道病変におけるEUS-FNAの実際

    加藤 博也, 松本 和幸, 水川 翔, 秋元 悠, 内田 大輔, 友田 健, 山本 直樹, 堀口 繁, 堤 康一郎, 岡田 裕之

    消化器内視鏡   28 ( 10 )   1607 - 1612   2016.10

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    胆道病変に対してEUS-FNAを施行する際、常に念頭におく必要があるのは、胆汁漏出の危険性である。胆管のEUS-FNAにおいて、胆管の長軸方向に穿刺する場合には、胆管内にステントを留置して漏出の予防に努める。また、短軸方向に穿刺する場合は穿刺角度をスコープ位置や上下アングルで工夫し、胆管をかすめるように穿刺する。胆嚢のEUS-FNAにおいても、胆嚢壁を穿刺する場合には胆管と同様、内腔が針に当たらない角度、距離を調整して穿刺する。また、胆嚢腫瘍が体部あるいは底部に存在し、肝への浸潤が疑われる場合には、浸潤部を狙って穿刺するのも一つの方法である。また、良・悪性の診断のみであれば、近傍のリンパ節を穿刺して診断する場合もある。手技的に難易度の高い症例もあり、胆汁漏出という重篤な偶発症も起こりうるため、適応を十分考慮して行うことと、場合によっては肝実質やリンパ節の穿刺で代替するという発想が必要である。(著者抄録)

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  • 胆嚢神経内分泌癌(NEC)の1例

    堀口 繁, 加藤 博也, 内田 大輔, 秋元 悠, 関 博之, 友田 健, 松本 和幸, 山本 直樹, 堤 康一郎, 植木 亨, 岡田 裕之

    胆道   30 ( 2 )   290 - 297   2016.5

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    胆嚢神経内分泌癌(Neuroendocrine carcinoma:NEC)は稀な疾患であり、既報の多くは症例報告にとどまっている。今回我々は超音波内視鏡下穿刺吸引法でNECと診断し切除標本にて腺癌成分を含まないことを証明しえた純粋な胆嚢NECを経験したので報告する。画像所見上、MRIの拡散強調画像にて病変部の拡散能の著明な低下がみられ、このことはNECの細胞密度の高さを反映しているものと考えられた。薬物治療は、現在までにプラチナ系薬剤を中心とした化学療法の有用性が報告されており本報告でもVP-16、CDDPを用いた化学療法(EP療法)を施行した。当院では本症例の他に、腺癌成分を併存する可能性のある胆嚢NECに対してEP療法を施行した2例を経験しており併せて考察を行う。本疾患は希少疾患のため未だ診断方法、治療についてコンセンサスを得られておらず、今後症例の集積を行うことが必要と考えられた。(著者抄録)

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  • Treatment of Bile Duct Stones in Patients With Prior Hepaticojejunostomy: A Percutaneous Approach Using Cholangioscopy vs. an Endoscopic Approach Using Short Double-Balloon Enteroscopy

    Koichiro Tsutsumi, Hironari Kato, Shuntaro Yabe, Syo Mizukawa, Hiroyuki Seki, Yutaka Akimoto, Daisuke Uchida, Kazuyuki Matsumoto, Takeshi Tomoda, Naoki Yamamoto, Shigeru Horiguchi, Hiroyuki Okada

    GASTROINTESTINAL ENDOSCOPY   83 ( 5 )   AB619 - AB619   2016.5

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  • 膵Solid Pseudopapillary Neoplasm 20例の臨床病理学的特徴 性別による比較 Reviewed

    秋元 悠, 加藤 博也, 原田 亮, 内田 大輔, 關 博之, 友田 健, 松本 和幸, 山本 直樹, 堀口 繁, 堤 康一郎, 室 信一郎, 植木 亨, 小田 晋輔, 伏見 聡一郎, 八木 孝仁, 岡田 裕之

    膵臓   31 ( 2 )   135 - 144   2016.4

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    当院および当院関連施設における膵Solid pseudopapillary neoplasm(以下、SPN)20例の臨床病理学的特徴につき、男女別に比較検討を行った。男性は4例(20%)、女性は16例(80%)であった。男性の年齢中央値は39歳と女性(年齢中央値29歳)より年齢が高い傾向にあり、男性が全例無症状であったのに対して女性では約半数で腹痛を認めた。画像所見は、男性で嚢胞を伴う症例が1例(25%)、石灰化を認める症例が1例(25%)であったのに対して、女性では嚢胞を伴う症例が13例(81%)、石灰化を認める症例が8例(50%)であった。FNAの正診率は男性で50%であったのに対して女性では92%であった。男性1例女性1例で血管浸潤を認めたが、リンパ節転移や遠隔転移は男女ともに認めなかった。全例で術後無再発生存しており男女間で臨床経過に差を認めなかった。(著者抄録)

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  • New Insight of Liquid Biopsy With Bile Juice in Patients With Gallbladder Cancer

    Hideaki Kinugasa, Kazuyuki Matsumoto, Soichiro Ako, Koichiro Tsutsumi, Hironari Kato, Kazuhiro Nouso, Hiroyuki Okada

    GASTROENTEROLOGY   150 ( 4 )   S515 - S515   2016.4

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  • 【膵疾患の分子病態】網羅的糖鎖解析によるIPMNの悪性度診断能の検討 Reviewed

    秋元 悠, 能祖 一裕, 加藤 博也, 宮原 孝治, 水川 翔, 矢部 俊太郎, 内田 大輔, 關 博之, 友田 健, 松本 和幸, 山本 直樹, 堀口 繁, 堤 康一郎, 岡田 裕之

    膵臓   31 ( 1 )   25 - 31   2016.2

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    糖鎖は、主として細胞表面に存在し細胞接着や情報伝達に関与している。癌に関しては、浸潤、転移の際に構造が変貌することが知られている。我々は、過去に膵癌、肝癌においてフコシル化多分枝糖鎖の高発現が診断や予後予測に有用であることを報告した。膵管内乳頭粘液腫瘍(IPMN)は、ガイドラインの絶対的手術適応にて切除しても、癌でない症例が約3〜4割含まれている。膵切除のリスクを考えると術前診断能は十分とは言えず、新たなバイオマーカーの開発が求められている。我々はIPMNの悪性度診断における網羅的糖鎖解析の有用性を検討し、invasive IPMNでフコシル化多分枝糖鎖の発現が有意に高いことを報告した。興味深いことに、最も診断能が高かったm/z3195糖鎖は、過去に我々が膵管癌の診断や予後との関連を示した糖鎖と同一であった。フコシル化多分枝糖鎖の高発現は、IPMNの悪性度診断に有用である可能性が示唆された。(著者抄録)

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  • Clinical outcome of endoscopic double stenting for the treatment of malignant biliary and duodenal obstruction due to pancreatic cancer

    Kazuyuki Matsumoto, Hironari Kato, Koichiro Tsutsumi, Sho Mizukawa, Shuntaro Yabe, Yutaka Akimoto, Daisuke Uchida, Hiroyuki Seki, Takeshi Tomoda, Naoki Yamamoto, Shigeru Horiguchi, Hiroyuki Okada

    JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY   30   225 - 225   2015.12

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  • エトポシドとシスプラチンの併用療法(EP療法)が著効し組織学的CRが得られた肝原発小細胞癌の1切除例 Reviewed

    秋元 悠, 堤 康一郎, 加藤 博也, 幡 英典, 榮 浩行, 内田 大輔, 友田 健, 松本 和幸, 野間 康宏, 山本 直樹, 堀口 繁, 原田 亮, 岡田 裕之, 柳井 広之, 八木 孝仁, 山本 和秀

    日本消化器病学会雑誌   112 ( 11 )   2024 - 2034   2015.11

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    52歳女性。主訴は右上腹部痛。巨大な肝腫瘤と多発性肝腫瘤、胆嚢壁肥厚を認め、EUS-FNAにて小細胞癌と診断。エトポシド、シスプラチン併用療法が著効したため、根治目的に肝中央二区域・胆管切除術、胆嚢摘出術施行。病理では泡沫細胞の集簇を認め、viableな腫瘍細胞は認めなかった。画像、病理所見より、肝原発小細胞癌と最終診断した。化学療法著効後に根治切除でき、組織学的CRが得られた貴重な1例である。(著者抄録)

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  • FOLFIRINOX with modified regimen therapy for advanced pancreatic cancer in Okayama university hospital

    Shigeru Horiguchi, Hironari Kato, Yutaka Akimoto, Daisuke Uchida, Takeshi Tomoda, Kazuyuki Matsumoto, Naoki Yamamoto, Koichiro Tsutsumi, Junichiro Nasu, Kazuhide Yamamoto

    ANNALS OF ONCOLOGY   26   119 - 120   2015.11

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  • 【ERCPマスターへのロードマップ】トラブルシューティング編 膵管プラスチックステント迷入に対する内視鏡的回収法

    松本 和幸, 加藤 博也, 堤 康一郎, 水川 翔, 矢部 俊太郎, 内田 大輔, 秋元 悠, 關 博之, 友田 健, 山本 直樹, 堀口 繁, 岡田 裕之

    胆と膵   36 ( 臨増特大 )   1081 - 1086   2015.10

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    内視鏡的膵管ステンティング(EPS)は、さまざまな膵疾患の治療に対し広く行われている。その一方で、EPSに伴う偶発症の一つに、まれであるがステント迷入がある。ステントの回収には内視鏡的回収法が最も低侵襲であり、まず試みられるべき手技であるが、膵管は径が細く、屈曲や狭窄も存在する場合があり回収に難渋することが多い。さらに、専用の回収デバイスが少ないため、さまざまなアイデアやテクニックを用いて回収を試みているのが現状である。われわれはステント迷入を迷入したステントの位置と膵管の状態により四つのTypeに分類した。すなわち、Type Aはステントが狭窄のない主膵管内に迷入しているもの、Type Bはステントが主膵管狭窄部を跨いで迷入しているもの、Type Cはステント近位側が主膵管狭窄部より奥に迷入しているもの、Type Dはステント近位側が分枝膵管内に迷入しているものである。それぞれのType別にステントの内視鏡的回収法について紹介する。(著者抄録)

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  • 原発性小腸癌34例の治療成績 Reviewed

    秋元 悠, 那須 淳一郎, 岩室 雅也, 神崎 洋光, 堤 康一郎, 喜多 雅英, 川野 誠司, 原田 馨太, 加藤 博也, 平岡 佐規子, 河原 祥朗, 八木 孝仁, 大塚 文男, 岡田 裕之

    日本病院総合診療医学会雑誌   9 ( 1 )   23 - 29   2015.10

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    当院の原発性小腸癌患者34例の治療成績を解析した。原発部位は十二指腸29例、空腸3例、回腸1例、空腸または回腸1例、臨床病期はStage I 11例、Stage II 5例、Stage III 6例、Stage IV 12例。治療内容は、Stage Iでは内視鏡的切除5例と手術6例、Stage II/Stage IIIでは全例手術、Stage IVでは化学療法のみが3例、化学療法+原発巣切除が3例、原発巣切除+転移巣切除が4例、緩和治療が2例で、5年生存率はStage I/IIが80%、Stage IIIが33%、Stage IVが39%であった。(著者抄録)

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  • 化学療法にて組織学的CRが得られた切除不能肝内胆管原発小細胞癌の1例

    信岡 大輔, 八木 孝仁, 木村 裕司, 高木 弘誠, 須井 健太, 杭瀬 崇, 渡辺 信之, 吉田 龍一, 楳田 祐三, 篠浦 先, 堤 康一郎, 加藤 博也, 柳井 広之, 藤原 俊義

    日本臨床外科学会雑誌   76 ( 増刊 )   1117 - 1117   2015.10

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  • 【EUS下胆道ドレナージ〜EUS-BDの安全な導入へ向けて〜】EUS-BDにおける使用デバイスの選択 超音波内視鏡、穿刺針、ガイドワイヤー、ダイレーター

    加藤 博也, 水川 翔, 矢部 俊太郎, 秋元 悠, 内田 大輔, 關 博之, 友田 健, 松本 和幸, 山本 直樹, 堀口 繁, 堤 康一郎, 岡田 裕之

    胆と膵   36 ( 8 )   751 - 756   2015.8

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    EUS-BDはステント留置にいたるまでに、穿刺、ガイドワイヤーによるseeking、穿刺ルートの拡張、というステップを踏まなければならない。それぞれのステップにおけるデバイスに専用のものはなく、さまざまなデバイスを取捨選択して使用しているのが現状である。穿刺には19GのFNA針を用いるがスコープに負荷がかからない針を選択する必要がある。ガイドワイヤーはseeking性能とleading性能をともに有する0.025インチのガイドワイヤーが望ましいが、状況に応じてそれぞれの性能に秀でたガイドワイヤーに変更しなければならないこともあり、さまざまなガイドワイヤーの特徴を知っておかなければならない。穿刺ルートの拡張には通電による拡張と、非通電による拡張があるが、それぞれの利点、欠点を理解し、適切なデバイスを選択しなければならない。今後、EUS-BDをより普及させるためには専用のデバイスの開発が急務である。(著者抄録)

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  • Efficacy and Safety of Endoscopic Treatment of Hepatolithiasis Using a Short Double-Balloon Enteroscope in Patients With Prior Hepaticojejunostomy

    Koichiro Tsutsumi, Hironari Kato, Daisuke Uchida, Yutaka Akimoto, Kazuyuki Matsumoto, Takeshi Tomoda, Yasuhiro Noma, Naoki Yamamoto, Sigeru Horiguchi, Hiroyuki Okada, Kazuhide Yamamoto

    GASTROINTESTINAL ENDOSCOPY   81 ( 5 )   AB361 - AB361   2015.5

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  • Detection of K-RAS Gene Mutation by Liquid Biopsy in Patients With Pancreatic Cancer

    Hideaki Kinugasa, Kazuhiro Nouso, Koji Miyahara, Yuki Morimoto, Chihiro Dohi, Koichiro Tsutsumi, Hironari Kato, Hiroyuki Okada, Kazuhide Yamamoto

    GASTROENTEROLOGY   148 ( 4 )   S145 - S146   2015.4

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  • Effective peroral direct cholangioscopy with an ultraslim endoscope for treatment of hepatolithiasis in patients with altered gastrointestinal anatomy

    Kazuyuki Matsumoto, Koichiro Tsutsumi, Hironari Kato, Yutaka Akimoto, Takeshi Tomoda, Naoki Yamamoto, Hiroyuki Noma, Shigeru Horiguchi, Hiroyuki Okada, Kazuhide Yamamoto

    JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY   29   295 - 295   2014.11

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  • 【内視鏡的胆管結石治療の新展開〜基本手技から最新情報まで〜】小腸バルーン内視鏡を用いた胆管結石治療

    堤 康一郎, 加藤 博也, 室 信一郎, 野間 康宏, 山本 直樹, 堀口 繁, 原田 亮, 岡田 裕之, 八木 孝仁, 山本 和秀

    胆と膵   35 ( 6 )   557 - 563   2014.6

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    小腸バルーン内視鏡は、これまで困難とされてきたRoux-en Y再建術などの術後再建腸管を有する胆膵疾患への内視鏡的アプローチを大きく進歩させた。とくに胆管結石症例では、経皮的または外科的アプローチによる截石術を行った場合、長期入院を余儀なくされることも少なくなかったが、小腸バルーン内視鏡の導入により、低侵襲かつ安全な内視鏡的截石術が多くの術後再建腸管症例において可能となった。現状では、一期的な截石や内視鏡的截石にこだわり過ぎず、個々の症例で安全かつ効率的な截石を目指した治療ストラテジーを立てることが重要である。今後、専用機器の開発を含めた本治療手技のさらなる進歩、標準化が期待される。(著者抄録)

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  • 自己免疫性膵炎と悪性腫瘍についての検討

    堀口 繁, 加藤 博也, 室 信一郎, 野間 康宏, 山本 直樹, 原田 亮, 堤 康一郎, 友田 健, 植木 亨, 白羽 英則, 八木 孝仁, 山本 和秀

    膵臓   29 ( 3 )   644 - 644   2014.6

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  • PNET診療ガイドラインをめぐって 膵神経内分泌腫瘍(PNET)のGrade診断及び悪性度診断における造影CTの有用性の検討

    堀口 繁, 加藤 博也, 室 信一郎, 野間 康宏, 山本 直樹, 原田 亮, 堤 康一郎, 田中 健大, 伏見 総一郎, 藤井 雅邦, 植木 亨, 白羽 英則, 八木 孝仁, 山本 和秀

    膵臓   29 ( 3 )   457 - 457   2014.6

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  • 膵神経内分泌腫瘍のGrade診断における造影CTの有用性と病理学的背景の検討

    堀口 繁, 加藤 博也, 室 信一郎, 野間 康宏, 山本 直樹, 原田 亮, 堤 康一郎, 白羽 英則, 田中 健大, 八木 孝仁, 岡田 裕之, 山本 和秀

    日本消化器病学会雑誌   111 ( 臨増総会 )   A290 - A290   2014.3

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  • 【ドレナージ大全】胆道ドレナージ術 良性胆道狭窄 術後胆管狭窄に対する内視鏡的ドレナージ術の実際とコツ

    加藤 博也, 室 信一郎, 野間 康弘, 山本 直樹, 原田 亮, 堀口 繁, 堤 康一郎, 岡田 裕之, 八木 孝仁, 山本 和秀

    胆と膵   34 ( 臨増特大 )   885 - 892   2013.10

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    術後胆管狭窄は胆汁鬱滞による胆管炎や肝機能障害を引き起こし、患者の予後に関わるものである。近年、術後胆管狭窄に対する治療として内視鏡的ドレナージが選択される機会が増えつつあるが、悪性胆道狭窄のドレナージとは異なる手技上の難しさがある。肝右葉のみが残っている際の幽門輪の通過、狭窄突破の際のガイドワイヤーの選択、狭窄部の拡張の際のバルーン径の選択などそれぞれの段階での手技上のコツを理解することが重要である。また、新しいdeviceとしてinside stentの使用頻度が増加しつつある。Inside stentはESTを行うことなく複数本留置することが可能であり、術後胆管狭窄には有用なdeviceである。術式の違いがどのような狭窄の違いになり、さらにはそれがどのような手技上の違いになるかを理解し、適切なdeviceを選択することが本手技成功のために重要である。(著者抄録)

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  • 造影EUSで観察した膵lymphoepithelial cystの2例

    松本 和幸, 加藤 博也, 友田 健, 榊原 一郎, 野間 康宏, 山本 直樹, 園山 隆之, 堤 康一郎, 貞森 裕, 岡田 裕之, 八木 孝仁, 山本 和秀

    日本消化器病学会雑誌   110 ( 10 )   1823 - 1830   2013.10

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    60歳代の2例のLECを経験した。2例とも膵から外側に突出する多房性嚢胞性腫瘤像を呈していた。EUSにより、嚢胞内に高エコー構造物あるいは充実様を呈する所見を認めたが、ソナゾイド造影では高エコー構造物および充実様部には造影効果を認めず、隔壁のみが造影された。造影EUSは、病変内部の貯留物の判定に有用であり、LEC診断の一助になる可能性が示唆された。(著者抄録)

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  • REIC/Dkk-3遺伝子導入による膵癌治療の検討

    内田 大輔, 白羽 英則, 加藤 博也, 永原 照也, 岩室 雅也, 片岡 淳郎, 堀口 繁, 堤 康一郎, 那須 保友, 公文 裕巳, 山本 和秀

    膵臓   28 ( 3 )   371 - 371   2013.6

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  • 超音波内視鏡下胆嚢ドレナージ術が有効であった金属ステント留置後の急性胆嚢炎の2例 Reviewed

    園山 隆之, 河本 博文, 加藤 博也, 野間 康宏, 堤 康一郎, 藤井 雅邦

    胆道   26 ( 1 )   114 - 121   2012.3

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    今回我々は超音波内視鏡下胆嚢ドレナージ(endoscopic ultrasonography-guided gallbladder drainage:EUS-GBD)を施行した2例を経験したので報告する。症例1は60歳、男性。胆嚢管癌で胆管マルティステンティング施行後に化学療法中、過去に3度の急性胆嚢炎を発症していた。再発性胆嚢炎に対してEUS-GBDを施行した。症例2は63歳、女性。肝門部胆管癌で胆管マルティステンティング施行し、化学療法継続3年後に急性胆嚢炎を発症した。癌の進行による肝右葉の萎縮および左葉腫大の為、胆嚢は背側に偏位して経皮経肝胆嚢ドレナージは困難と判断、EUS-GBDを施行した。両症例とも治療奏功し、胆嚢炎の再発も認めなかった。EUS-GBDは胆管メタリックステント挿入後などの、従来のアプローチでは治療困難な胆嚢炎に対する選択肢になり得るが、適応・方法については議論の余地があり、標準的治療として確立される為には、今後多施設での検討や専用処置具の開発が望まれる。(著者抄録)

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  • ERCP後重症急性膵炎による下部胆管狭窄に対して、一時的なEndosonography-guided biliary drainageを施行した1例

    衣笠 秀明, 河本 博文, 野間 康宏, 園山 隆之, 堤 康一郎, 藤井 雅邦, 栗原 直子, 加藤 博也, 岡田 裕之, 山本 和秀

    Gastroenterological Endoscopy   54 ( 2 )   281 - 287   2012.2

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    症例は37歳の男性。前医で重症急性膵炎を加療された後、感染性膵周囲膿瘍の治療目的で当院へ搬送された。感染性膵周囲膿瘍に対して経皮的ドレナージ、経胃的ドレナージにより約2年の経過で改善が得られたものの、経過中(膵炎発症426日目)、重症急性膵炎の影響による胆道狭窄で黄疸が生じた。しかし、末梢胆管拡張は乏しく炎症による十二指腸狭窄も併発し、経皮経肝胆道ドレナージ術(PTBD)も内視鏡的経乳頭胆道ドレナージ術(EBD)も困難なため、超音波内視鏡下胆道ドレナージ(ESBD)を施行した。膵炎発症874日目、炎症消失に伴い、ステント抜去が可能となった。今後ESBDのさらなる適応拡大の可能性が示唆された。(著者抄録)

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  • 移植後胆道狭窄に対する治療の長期成績 当院における生体肝移植後の胆管狭窄に対する内視鏡治療 Reviewed

    加藤 博也, 野間 康宏, 園山 隆之, 堤 康一郎, 藤井 正邦, 岡田 裕之, 山本 和秀, 八木 孝仁

    移植   46 ( 6 )   641 - 642   2011.12

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  • A newly designed plastic stent for multiple occluded metallic stents deployed in malignant hilar biliary strictures

    H. Kato, H. Kawamoto, K. Yamamoto, Y. Noma, T. Sonoyama, K. Tsutsumi, M. Fujii, N. Kurihara, H. Okada

    Endoscopy   43 ( 2 )   E225 - E226   2011

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  • ガイドライン 内科シリーズ 急性胆管炎・胆嚢炎の診療ガイドラインについて

    堤 康一郎, 河本 博文, 山本 和秀

    岡山医学会雑誌   122 ( 3 )   243 - 247   2010.12

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  • Endoscopic Multiple Deployment of Metallic Stent Is Effective for the Chemotherapy to the Patients With Unresectable Hilar Biliary Strictures Due to Biliary Tract Carcinoma

    Hironari Kato, Hirofumi Kawamoto, Ichiro Sakakibara, Naoki Yamamoto, Sigeru Horiguchi, Koichiro Tsutsumi, Masakuni Fujii, Ken Hirao, Naoko Kurihra, Hiroyuki Okada, Kazuhide Yamamoto

    GASTROINTESTINAL ENDOSCOPY   71 ( 5 )   AB303 - AB303   2010.4

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  • Occlusion of Multiple Metallic Stents Deployed in Malignant Hilar Biliary Strictures Is Well Managed Using Multiple Plastic Stents

    Masakuni Fujii, Hirofumi Kawamoto, Naoki Yamamoto, Ichiro Sakakibara, Sigeru Horiguchi, Koichiro Tsutsumi, Hironari Kato, Ken Hirao, Naoko Kurihara, Hiroyuki Okada, Kazuhide Yamamoto

    GASTROINTESTINAL ENDOSCOPY   71 ( 5 )   AB308 - AB308   2010.4

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  • 【胆膵内視鏡のトラブルシューティング】EUS 胆道ドレナージ ステント留置が困難

    堤 康一郎, 河本 博文, 山本 和秀

    消化器内視鏡   21 ( 12 )   1902 - 1904   2009.12

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  • 肝門部悪性胆道狭窄を伴った切除不能胆管癌の化学療法 メタリックステントによるマルチステンティングの有用性 Reviewed

    河本 博文, 石田 悦嗣, 藤井 雅邦, 小川 恒由, 堤 康一郎, 原田 亮, 加藤 博也, 平尾 謙, 栗原 直子, 水野 修, 山本 和秀

    胆道   22 ( 5 )   624 - 631   2008.12

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    過去7年間に、肝門部悪性胆道狭窄を伴った切除不能胆管癌症例46例(男性30例、女性16例:平均年齢69歳)を対象に、化学療法、メタリックステント(MS)によるマルチステンティングの有用性について遡及的に検討した。対象は化学療法(ゲムシタビン又はS-1の単剤投与)を行った31例(男性21例、女性10例:平均年齢65歳:化学療法群)と行わなかった15例(男性9例、女性6例:平均年齢78歳:BSC群)に分け、生存期間、MS開存期間、閉塞原因、再内瘻化、合併症について比較検討した。その結果、化学療法群は生存期間が有意に延長し、MS開存期間が延長する傾向を認めた。閉塞は全体の41%に認めたが永久外瘻となった例はなかった。合併症は化学療法群で4例、BSC群で1例認め、化学療法で多い傾向であった。以上より、MSによるマルチステンティング後の化学療法は、肝門部悪性胆道狭窄を伴った切除不能胆管癌症例の生存期間延長に対して安全で有用であると考えられた。

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  • Early dose reduction of gemcitabine based on adverse events is not associated with the survival of the patients with pancreatic cancer

    Ken Hirao, Hirofumi Kawamoto, Ryo Harada, Koichiro Tsutsumi, Masakuni Fujii, Hironari Kato, Naoko Kurihara, Osamu Mizuno, Etsuji Ishida, Tsuneyoshi Ogawa, Hirotoshi Fukatsu, Jun Kato, Hiroyuki Okada, Kazuhide Yamamoto

    GASTROENTEROLOGY   134 ( 4 )   A302 - A302   2008.4

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  • 当院での総胆管結石治療の現状について

    酒井 章裕, 平尾 謙, 菊池 理, 神野 亜希子, 田邊 渉, 寺島 禎彦, 前田 有紀, 土井 顕, 畑 貴子, 山本 直樹, 青山 育雄, 新井 修, 清輔 良江, 堤 康一郎, 片山 幸子, 三好 正嗣, 毛利 裕一, 松枝 和宏, 山本 博

    倉敷中央病院年報   70   35 - 40   2008.3

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    当院での総胆管結石の消化器内科入院患者は、1998年から2006年までの9年間で888例あり、年々増加の一途をたどり2006年は184例あった。そのうち緊急内視鏡的逆行性胆管膵管造影(ERCP)を施行した症例は130例を占め、入院当日に81例(62%)、翌日に39例(30%)、採石率は96%であった。2006年の治療実績を報告する。(著者抄録)

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  • Soehendra stent retrieverが有用であった慢性膵炎による難治性膵管狭窄症の1例 Reviewed

    藤井 雅邦, 河本 博文, 原田 亮, 堤 康一郎, 栗原 直子, 水野 修, 石田 悦嗣, 小川 恒由, 坂口 孝作, 山本 和秀

    膵臓   23 ( 1 )   83 - 88   2008.2

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    症例は73歳男性。アルコール性慢性膵炎の増悪のため当科入院。入院時、膵石、膵管拡張を認めた。内視鏡的治療のためERPを施行したが、膵頭部に22×12mm大、鋳型の膵石が嵌頓し造影できず、内視鏡的膵管口切開術を施行後、ESWLを計8回施行した。結石破砕後ERPを再施行したが、膵頭部の狭窄部膵管に結石は残存しカニューレは通過できない状況であった。ダイレーターとして7FrのSoehendra stent retriever(SSR)を使用し、カニューレの通過は容易となり、7Frの膵管ステントを留置し終了した。その後経過良好のため退院となった。膵石を伴う膵管狭窄に対する内視鏡治療は難治例も多い。本症例では、SSRが難治性膵管狭窄症に対する治療の一つになりうることが示唆された。(著者抄録)

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  • 急性膵炎を契機に診断された総胆管結石合併choledochoceleの1例 Reviewed

    堤 康一郎, 河本 博文, 原田 亮, 藤井 雅邦, 中西 崇, 水野 修, 石田 悦嗣, 小川 恒由, 深津 裕寿, 坂口 孝作

    胆道   21 ( 5 )   670 - 676   2007.12

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    69歳男性。患者は心窩部痛を主訴とし近医を受診、急性膵炎の診断で入院となり、保存的加療により速やかに改善したが、腹部CTおよびMRCPで主膵管拡張を認め、ERCPを試みるも深部挿管不能で、精査加療目的で著者らの施設へ紹介となった。入院時、炎症反応はなく、腫瘍マーカーも正常範囲内であったが、MRCPで総胆管末端に約7mm大の嚢状拡張を認め、Oddi括約筋を介した後には拡張膵管と総胆管が造影され、共通管に発生したCholedochoceleと診断された。また、総胆管下部に結石が確認され、ガイドワイヤーでは深部挿管不能であったため、Needle knifeによる切開にて嚢腫内腔を露出したところ、深部挿管が可能となり、引き続きESTを追加し、バルーン砕石術が行われた。その結果、ERCP時の胆汁中アミラーゼは著明な高値を示し、膵液の胆管内逆流が示唆されたが、術後1ヵ月で低下した。一方、USにて胆嚢の壁肥厚とdebris貯留を認め、膵液の胆管内逆流を生じていたことから、後日、腹腔鏡下胆嚢摘出術を施行したところ、病理組織学的に悪性所見はみられず、経過は以後、良好であった。

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  • NASHおよび脂肪肝を背景に26年の経過で肝硬変から肝細胞癌を発症した2例 Reviewed

    堤 康一郎, 中山 晴夫, 境 吉孝, 小島 康弘, 大楽 尚弘, 小島 敏明, 草野 昌男, 池谷 伸一, 須貝 吉樹, 樋渡 信夫

    日本消化器病学会雑誌   104 ( 5 )   690 - 697   2007.5

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    症例1は68歳女性、症例2は46歳男性。ともにHCCの精査加療目的に当科入院となった。肝硬変の原因は血液検査などからは不明であった。しかしおのおの26年前に肝生検施行歴あり、それらの見直しによりNASH(症例1)および脂肪肝(症例2)からNASH関連肝硬変(いわゆるburned-out NASH)へ進行し、HCCを発症したことが示唆された。原因不明肝硬変にburned-out NASHが含まれていること、また脂肪肝およびNASHの長期経過を知る上でも示唆に富む症例と考えられ報告する。(著者抄録)

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  • Placement of multiple metallic stents before gemcitabine therapy is safe and effective in the treatment of the patients with hilar biliary stenosis caused by biliary tract carcinoma

    Masakuni Fujii, Hirofurni Kawamoto, Ryo Harada, Koichiro Tsutsumi, Naoko Kurihara, Etsuji Ishida, Yuko Okamoto, Tsuneyoshi Ogawa, Hirotoshi Fukatsu, Hiroyuki Okada, Kohsaku Sakaguchi

    GASTROINTESTINAL ENDOSCOPY   65 ( 5 )   AB232 - AB232   2007.4

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  • Triple branched deployment of JOSTENT SelfX to the patients with bismuth type 4 hilar biliary strictures by using endoscopic partial stent-in-stent procedure

    Hirofumi Kawamoto, Ryo Harada, Masakuni Fujii, koichiro Tsutsumi, Etsuji Ishida, Tsuneyoshi Ogawa, Yuko Okamoto, Hirotoshi Fukatsu, Kohsaku Sakaguchi

    GASTROINTESTINAL ENDOSCOPY   65 ( 5 )   AB223 - AB223   2007.4

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  • The advantage of the endoscopic treatment to the hilar biliary stenosis

    Etsuji Ishida, Hirofumi Kawamoto, Ryo Harada, Koichiro Tsutsumi, Masakuni Fujii, Naoko Kurihara, Tsuneyoshi Ogawa, Yuko Okamoto, Hirotoshi Fukatsu, Hiroyuki Okada, Kohsaku Sakaguchi

    GASTROINTESTINAL ENDOSCOPY   65 ( 5 )   AB233 - AB233   2007.4

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  • The advantage of EUS-FNA in the pathological diagnosis of pancreatic cancer in comparison with ERCP tissue sampling

    Tsuneyoshi Ogawa, Hirofumi Kawamoto, Ryo Harada, Koichiro Tsutsumi, Masakuni Fujii, Naoko Kurihara, Etsuji Ishida, Yuko Okamoto, Hirotoshi Fukatsu, Hiroyuki Okada, Kohsaku Sakaguchi

    GASTROINTESTINAL ENDOSCOPY   65 ( 5 )   AB305 - AB305   2007.4

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  • Usefulness of contrast-enhanced ultrasonography in the differential diagnosis of cystic lesions of the pancreas

    Naoko Kurihara, Hirofumi Kawamoto, Yuko Okamoto, Rye Harada, Koichiro Tsutsumi, Masakum Fujii, Tsuneyoshr Ogawa, Etsuji Ishida, Hirotoshi Fukatsu, Kohsaku Sakaguchi

    GASTROENTEROLOGY   132 ( 4 )   A499 - A500   2007.4

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  • Covered versus uncovered metallic stents for malignant biliary obstruction induced by unresectable pancreatic cancer: Comparison with regard to the stent occlusions, biliary complications, and re-interventions

    Koichiro Tsutsumi, Hirofumi Kawamoto, Ryo Harada, Masakuni Fujii, Naoko Kurihara, Etsuji Ishida, Tsuneyoshi Ogawa, Yuko Okamoto, Hirotoshi Fukatsu, Hiroyuki Okada, Kohsaku Sakaguchi

    GASTROINTESTINAL ENDOSCOPY   65 ( 5 )   AB224 - AB224   2007.4

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  • Intraductal tubular adenoma, pyloric gland-type, of the pancreas

    H. Fukatsu, H. Kawamoto, K. Tsutsumi, H. Kato, K. Hirao, N. Kurihara, T. Ogawa, E. Ishida, Y. Okamoto, H. Okada, K. Sakaguchi, H. Yanai

    ENDOSCOPY   39   E88 - E89   2007.2

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    DOI: 10.1055/s-2006-945159

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  • 膵嚢胞と主膵管拡張を認めた興味深い1例

    堤 康一郎, 河本 博文, 加藤 博也, 平尾 謙, 栗原 直子, 石田 悦嗣, 小川 恒由, 岡本 裕子, 深津 裕寿, 白鳥 康史

    岡山済生会総合病院雑誌   38   112 - 112   2006.12

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  • 膀胱浸潤したS状結腸癌の1例

    堤 康一郎

    磐城共立病院医報   25 ( 1 )   99 - 103   2004.12

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Awards

  • 日本胆道学会国際交流奨励賞

    2016  

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Research Projects

  • 正常・腫瘍オルガノイドモデルを活用した胆道癌の高精度早期診断法の開発

    Grant number:21K07962  2021.04 - 2024.03

    日本学術振興会  科学研究費助成事業 基盤研究(C)  基盤研究(C)

    加藤 博也, 堤 康一郎

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    Grant amount:\4160000 ( Direct expense: \3200000 、 Indirect expense:\960000 )

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  • プロテオーム解析に基づくエクソソームを用いたIPMN良悪性診断法の開発

    Grant number:19K08423  2019.04 - 2022.03

    Japan Society for the Promotion of Science  Grants-in-Aid for Scientific Research Grant-in-Aid for Scientific Research (C)  Grant-in-Aid for Scientific Research (C)

    堤 康一郎, 白羽 英則, 加藤 博也

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    Grant amount:\4290000 ( Direct expense: \3300000 、 Indirect expense:\990000 )

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  • エクソソーム中のmicroRNA解析によるIPMN良悪性診断マーカーの探索

    Grant number:18H06223  2018.08 - 2020.03

    Japan Society for the Promotion of Science  Grants-in-Aid for Scientific Research Grant-in-Aid for Research Activity start-up  Grant-in-Aid for Research Activity start-up

    堤 康一郎

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    Grant amount:\2080000 ( Direct expense: \1600000 、 Indirect expense:\480000 )

    IPMNは、画像による主膵管径や壁在結節の有無などの形態学的評価を主体とした良悪性診断が標準的に行われているが、ガイドラインに基づき当院で切除を行った68例の悪性診断精度は6 割程度であり、切除後に悪性ではなかった、またすでに予後不良な浸潤がんであったと判明することも少なくないのが現状である。
    本研究の目的は、IPMN患者の血漿および膵液中のエクソソーム(細胞外小胞)を、標準的な超遠心法に比較して、ハイスループット性、回収率、コストの面で優れたdisposableなカラムを用いた“Size exclusion chromatography(SEC)”による手法により分離、回収し、その中に含まれるmicroRNAの解析をqPCR により行い、悪性診断に有用なマーカーを同定することである。
    本年度は、まず血漿、膵液からSECによるエクソソームの抽出を行い、回収したエクソソームの質的、量的評価、つまり、透過型電子顕微鏡による存在、形態評価、Immuno-blottingによるCD63、CD9、TSG101、Calnexinの発現評価を中心に行った。以上から、これら検体からエクソソームを回収できることを確認した。さらに、これら検体からRNAの抽出を行い、Bioanalyser2100によりsmall RNAが回収できていることを確認した。当初、さらにCancerパネルを用いたqPCRによるmiRNAの解析を予定していたが、2例の症例に関して、miRNAの網羅的解析を行い、膵液中からもmiRNAを多数検出できることを確認した。
    来年度は新たな研究資金を確保できたため、さらに症例を増やして目的達成のためにすすめていく予定である。

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  • 網羅的プロテオーム解析を用いたIPMNの新規良悪性診断法の開発

    Grant number:16K19344  2016.04 - 2018.03

    Japan Society for the Promotion of Science  Grants-in-Aid for Scientific Research Grant-in-Aid for Young Scientists (B)  Grant-in-Aid for Young Scientists (B)

    堤 康一郎

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    Grant amount:\3900000 ( Direct expense: \3000000 、 Indirect expense:\900000 )

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  • The analysis of the function and the clinical application of REIC/ Dkk-3 gene in digestive organ cancer

    Grant number:15K09001  2015.04 - 2018.03

    Japan Society for the Promotion of Science  Grants-in-Aid for Scientific Research Grant-in-Aid for Scientific Research (C)  Grant-in-Aid for Scientific Research (C)

    Kato Hironari

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    Grant amount:\4680000 ( Direct expense: \3600000 、 Indirect expense:\1080000 )

    The reduced expression in immortalized cells REIC/the dickkopf 3 (Dkk-3) gene induced cancer selective apotosis in cell lines of hepatocellular carcinoma and cholangio cell carcinoma. REIC/Dkk‐3 expression was decreased in resected HCC tissues by immunohistochemical staining.
    The REIC/DKK3 protein and peipheral blood mononuclear cells synergistically enhanced anticancer immunological effects against pancreatic cancer cells.
    The clinical trial of REIC/DKK3 gene therapy for the patients with hepatocellular carcinoma started.

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  • Development of molecular imaging of pancreatic cancer by targeting cancer stem cell, mesenchymal stem cell or cancer-specific proteins

    Grant number:26870388  2014.04 - 2016.03

    Japan Society for the Promotion of Science  Grants-in-Aid for Scientific Research Grant-in-Aid for Young Scientists (B)  Grant-in-Aid for Young Scientists (B)

    TSUTSUMI KOICHIRO, UEDA Masashi

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    Grant amount:\3120000 ( Direct expense: \2400000 、 Indirect expense:\720000 )

    To develop early diagnostic method of pancreatic cancer, we investigated molecular imaging of pancreatic cancer by targeting cancer stem cell, mesenchymal stem cell, or cancer-specific proteins. As a result of analyzing expression of stem cell markers and the proteins in clinical samples and cell lines, some proteins such as plectin-1, 14-3-3 σ and lipocalin-2 were over-expressed in cancer lesions, while stem cells markers were not expressed enough. Despite of synthesis of a imaging probe targeting 14-3-3σ and injection of the probe in the mouse xenograft model, accumulation of the probe to the tumor was not enough for utilizing the imaging. Further evaluation of binding-capacity of the probe to 14-3-3σ and creation of a probe with an enhanced capability of accumulation in tumor were needed.

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  • The analysis of the function and the clinical application of REIC/Dkk-3 gene in digestive organ cancer

    Grant number:24590977  2012.04 - 2015.03

    Japan Society for the Promotion of Science  Grants-in-Aid for Scientific Research Grant-in-Aid for Scientific Research (C)  Grant-in-Aid for Scientific Research (C)

    KATO Hironari, TSUTSUMI Koichiro, SHIRAHA Hidenori, YAMAMOTO Kazuhide, NASU Yasutomo, UCHIDA Daisuke

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    Grant amount:\5200000 ( Direct expense: \4000000 、 Indirect expense:\1200000 )

    REIC/Dkk-3, tumor suppressor gene, is down-regulated in various malignant tumors. In the current study, we assessed the effects of REIC/Dkk-3 gene therapy in pancreatic cancer. The REIC/Dkk-3 expression was lost in the pancreatic cancer cells, and tissues. Overexpression of REIC/Dkk-3 induced the apoptosis of the pancreatic cancer cells and inhibited tumor growth in xenograft mice model. REIC/Dkk-3 gene therapy is an attractive therapeutic tool for the pancreatic cancer.

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