2021/12/16 更新

写真a

カトウ ヒロナリ
加藤 博也
KATOU Hironari
所属
岡山大学病院 准教授
職名
准教授
外部リンク

学位

  • 博士(医学) ( 2010年3月   岡山大学 )

研究分野

  • ライフサイエンス / 消化器内科学

 

論文

  • Accuracy of Endoscopic Transpapillary Gallbladder Drainage with Liquid-Based Cytology for Gallbladder Disease. 国際誌

    Soichiro Kawahara, Takeshi Tomoda, Hironari Kato, Toru Ueki, Yutaka Akimoto, Ryo Harada, Tomohiro Toji, Hiroyuki Okada

    Digestion   1 - 10   2021年11月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    INTRODUCTION: Gallbladder carcinoma is often difficult to distinguish from benign gallbladder diseases. While the diagnostic accuracy of endoscopic transpapillary gallbladder drainage (ETGD) has been reported, these results were obtained retrospectively. This prospective study aimed to evaluate the cytological diagnostic accuracy of ETGD in patients with gallbladder disease. METHODS: This single-arm prospective clinical trial included a total of 35 patients scheduled to undergo ETGD between March 2017 and September 2019. A 5F pigtail nasobiliary drainage tube was inserted into the gallbladder, and bile was collected over 5 times; if ETGD failed, a drainage tube was placed into the bile duct. The endpoints were, first, the cytological diagnostic accuracy of ETGD and, second, technical success rates and adverse events. RESULTS: Of the 35 patients, 19 were finally diagnosed with gallbladder cancer. The success rate of ETGD tube insertion was 85.7%, and the morphological pattern of the cystic duct with the angle down and located on the right side had a significantly lower success rate for ETGD than that of other cystic duct patterns (odds ratio, 13.5; 95% confidence interval, 1.7-143.7; p = 0.02). Cytological samples were collected 5 times on median. The sensitivity, specificity, and accuracy in all patients were 78.9%, 100%, and 88.6%, respectively, while those in 30 patients with successful ETGD were 87.5%, 100%, and 93.3%, respectively. Adverse events occurred in 3 patients: mild pancreatitis in 1 patient and obstructive jaundice in 2 patients; all complications were resolved with conservative therapy. DISCUSSION/CONCLUSIONS: Cytology using an ETGD tube is useful in differentiating benign and malignant gallbladder diseases (Clinical Trial Registry No. UMIN000026929).

    DOI: 10.1159/000519250

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

    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年10月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    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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  • Plasma KRAS mutations predict the early recurrence after surgical resection of pancreatic cancer. 国際誌

    Soichiro Ako, Hironari Kato, Kazuhiro Nouso, Hideaki Kinugasa, Hiroyuki Terasawa, Hiroshi Matushita, Saimon Takada, Yosuke Saragai, Sho Mizukawa, Shinichiro Muro, Daisuke Uchida, Takeshi Tomoda, Kazuyuki Matsumoto, Shigeru Horiguchi, Daisuke Nobuoka, Ryuichi Yoshida, Yuzo Umeda, Takahito Yagi, Hiroyuki Okada

    Cancer biology & therapy   1 - 7   2021年10月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    BACKGROUND: The technique to analyze circulating tumor DNA (ctDNA) in body fluid (so-called "liquid biopsy") is recently developed. AIMS: Our aim was to assess the utility of liquid biopsy for predicting progression of pancreatic ductal adenocarcinoma (PDAC) after surgical resection or chemotherapy. METHODS: A total of 72 patients with PDAC were retrospectively enrolled for this study, 33 treated surgically and 39 given chemotherapy, either FOLFIRINOX (oxaliplatin/irinotecan/fluorouracil/leucovorin) or gemcitabine plus nab-paclitaxel. Prior to treatment, patients were screened for the presence of KRAS mutations (G12D and G12V) in plasma using droplet digital polymerase chain reaction, and outcomes were compared. RESULTS: KRAS mutations were identified in plasma samples of 12 patients (36%) underwent surgical resection. Patients with plasma KRAS mutations had significantly shorter disease-free survival (DFS) and overall survival (p < .01 and p = .01, respectively). Of 10 clinical variables analyzed, plasma KRAS mutation was the factor predictive of DFS in multivariate analysis (RR = 3.58, 95% CI: 1.36-9.60; p = .01). Although 12 patients (31%) given chemotherapy tested positive for plasma KRAS mutations, there was no demonstrable relation between plasma KRAS mutations and progression-free survival (PFS) or overall survival (OS) (p = .35 and p = .68, respectively). CONCLUSIONS: In patients with PDAC, detection of KRAS mutations in plasma proved independently predictive of early recurrence after surgical resection but did not correlate with PFS following chemotherapy.

    DOI: 10.1080/15384047.2021.1980312

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  • Usefulness of contrast-enhanced endoscopic ultrasonography for the treatment of ethanol reinjection in patient with small pancreatic neuroendocrine neoplasm. 国際誌

    Kazuyuki Matsumoto, Hironari Kato, Hiroyuki Okada

    Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society   2021年10月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    DOI: 10.1111/den.14148

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  • Risk of Pancreatitis Following Biliary Stenting With/Without Endoscopic Sphincterotomy: A Randomized Controlled Trial. 国際誌

    Shin Kato, Masaki Kuwatani, Manabu Onodera, Taiki Kudo, Itsuki Sano, Akio Katanuma, Minoru Uebayashi, Kazunori Eto, Mitsuharu Fukasawa, Shunpei Hashigo, Takuji Iwashita, Makoto Yoshida, Yoko Taya, Hiroshi Kawakami, Hironari Kato, Yousuke Nakai, Kasen Kobashigawa, Shuhei Kawahata, Susumu Shinoura, Kei Ito, Kimitoshi Kubo, Hiroaki Yamato, Kazuo Hara, Iruru Maetani, Tsuyoshi Mukai, Goro Shibukawa, Takao Itoi

    Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association   2021年8月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    BACKGROUND & AIMS: The efficacy of endoscopic sphincterotomy (ES) before endoscopic transpapillary biliary drainage in preventing post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) has not been established. The aim of this study was to evaluate the effect of performing ES before biliary stent/tube placement on the occurrence of PEP. METHODS: Three hundred seventy patients with biliary stricture requiring endoscopic biliary stenting were enrolled and randomly allocated to the ES group (n = 185) or non-ES group (n = 185). All participants were followed up for 30 days after the procedure. The data and occurrence of adverse events were prospectively collected. The primary outcome measure of this study was the incidence of PEP within 2 days of initial transpapillary biliary drainage. Secondary outcome measures were the incidence of other adverse events related to biliary stent/tube placement. RESULTS: PEP occurred in 36 patients (20.6%) in the non-ES group and in 7 patients (3.9%) in the ES group (P < .001). The difference in the incidence of PEP between the 2 groups in the per-protocol population was 16.7% (95% confidence interval, 10.1%-23.3%), which was not within the noninferiority margin of 6%. Except for bleeding, the incidences of other adverse events were not significantly different between the groups. CONCLUSION: ES before endoscopic biliary stenting could have the preventive effect on the occurrence of PEP in patients with biliary stricture. University Hospital Medical Information Network Number, UMIN000025727.University Hospital Medical Information Network Clinical Trial Registry URL: https://www.umin.ac.jp/ctr/index.htm.

    DOI: 10.1016/j.cgh.2021.08.016

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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 国際誌

    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年7月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元: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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    その他リンク: 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. 国際誌

    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年7月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    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. 国際誌

    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年7月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    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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  • Study protocol for endoscopic ultrasonography-guided ethanol injection therapy for patients with pancreatic neuroendocrine neoplasm: a multicentre prospective study. 国際誌

    Kazuyuki Matsumoto, Hironari Kato, Masayuki Kitano, Kazuo Hara, Masaki Kuwatani, Reiko Ashida, Mamoru Takenaka, Tatsuhiro Yamazaki, Jun Sakurai, Michihiro Yoshida, Hiroyuki Okada

    BMJ open   11 ( 7 )   e046505   2021年7月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    INTRODUCTION: The management of small pancreatic neuroendocrine neoplasms (PNENs) remains controversial. The standard treatment for PNENs is surgical resection; however, invasiveness of surgical procedure remains higher and the incidence of postoperative adverse events is still high. Recently, the efficacy and safety of endoscopic ultrasonography (EUS)-guided ethanol injection for small PNENs has been preliminarily demonstrated. Thus, a multicentre prospective study is being conducted to evaluate the efficacy and safety of EUS-guided ethanol injection therapy for small PNENs. METHODS AND ANALYSIS: The major eligibility criteria are the presence of pathologically diagnosed grade (G) 1 tumour, a tumour size of ≤15 mm and non-functional PNEN or insulinoma. For treatment, we will use a 25-gauge needle and pure ethanol. Contrast-enhanced CT (CE-CT) will be performed on postoperative day 3-5, and if enhanced areas of the tumour are still apparent, an additional session is scheduled during the same hospitalisation period. We set the total amount of ethanol per session to 2 mL. To evaluate the efficacy and safety, CE-CT will be performed at 1 and 6 months after treatment. The primary endpoint is the percentage of subjects who achieved all of the following evaluated points. Efficacy will be evaluated based on the achievement of complete ablation (defined as no enhanced area within the tumour on CE-CT) at 1 and 6 months. Safety will be evaluated based on the avoidance of severe adverse events within 1 month after treatment, continuing severe pancreatic fistula at 1 month after treatment and the incidence and/or exacerbation of diabetes mellitus at 6 months after treatment. ETHICS AND DISSEMINATION: This protocol has been approved by Okayama University Certified Review Board (approval number. CRB19-007). The results will be submitted to peer-reviewed journals and will be presented at international conferences. TRIAL REGISTRATION NUMBER: jRCTs061200016.

    DOI: 10.1136/bmjopen-2020-046505

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  • Hemosuccus Pancreaticus Due to the Rupture of a Pseudoaneurysm That Developed in an Intraductal Papillary Mucinous Neoplasm.

    Taisuke Obata, Kazuyuki Matsumoto, Hironari Kato, Tatsuhiro Yamazaki, Yuki Fujii, Takeshi Tomoda, Shigeru Horiguchi, Hiroyuki Okada

    Internal medicine (Tokyo, Japan)   60 ( 13 )   2033 - 2038   2021年7月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    A 76-year-old woman with branch duct intraductal papillary mucinous neoplasm (IPMN) was admitted with epigastric pain and vomiting. She had received warfarin due to a history of deep vein thrombosis. A blood test showed decreased serum hemoglobin and elevated serum amylase. Contrast-enhanced computed tomography revealed acute pancreatitis and formation of a pseudoaneurysm in the IPMN. We suspected rupture of a pseudoaneurysm and performed trans-catheter angiography. Angiography showed extravasation from the posterior superior pancreaticoduodenal artery, and coil embolization was performed. It is important to be alert for the formation of pseudoaneurysm in patients with cystic neoplasms.

    DOI: 10.2169/internalmedicine.6445-20

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  • Endoscopic placement of covered versus uncovered self-expandable metal stents for palliation of malignant gastric outlet obstruction. 国際誌

    Kentaro Yamao, Masayuki Kitano, Yasutaka Chiba, Takeshi Ogura, Takaaki Eguchi, Ichiro Moriyama, Yukitaka Yamashita, Hironari Kato, Takahisa Kayahara, Noriyuki Hoki, Yoshinobu Okabe, Hideyuki Shiomi, Yoshitaka Nakai, Yoshinori Kushiyama, Yoshifumi Fujimoto, Shiro Hayashi, Shigeki Bamba, Yasushi Kudo, Nobuaki Azemoto, Toshiharu Ueki, Norimitsu Uza, Masanori Asada, Kazuya Matsumoto, Hiroko Nebiki, Hiroshi Takihara, Chisio Noguchi, Hideki Kamada, Kojiro Nakase, Daisuke Goto, Tsuyoshi Sanuki, Tetsuya Koga, Shinichi Hashimoto, Hidefumi Nishikiori, Masahiro Serikawa, Keiji Hanada, Ken Hirao, Masaya Ohana, Imakiire Kazuyuki, Takao Kato, Motoyuki Yoshida, Hirofumi Kawamoto

    Gut   70 ( 7 )   1244 - 1252   2021年7月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    OBJECTIVE: Stenting is an established endoscopic therapy for malignant gastric outlet obstruction (mGOO). The choice of stent (covered vs uncovered) has been examined in prior randomised studies without clear results. DESIGN: In a multicentre randomised prospective study, we compared covered (CSEMS) with uncovered self-expandable metal stents (UCSEMS) in patients with mGOO; main outcomes were stent dysfunction and patient survival, with subgroup analyses of patients with extrinsic and intrinsic tumours. RESULTS: Overall survival was poor with no difference between groups (probability at 3 months 49.7% for covered vs 48.4% for uncovered stents; log-rank for overall survival p=0.26). Within that setting of short survival, the proportion of stent dysfunction was significantly higher for uncovered stents (35.2% vs 23.4%, p=0.01) with significantly shorter time to stent dysfunction. This was mainly relevant for patients with extrinsic tumours (stent dysfunction rates for uncovered stents 35.6% vs 17.5%, p<0.01). Subgrouping was also relevant with respect to tumour ingrowth (lower with covered stents for intrinsic tumours; 1.6% vs 27.7%, p<0.01) and stent migration (higher with covered stents for extrinsic tumours: 15.3% vs 2.5%, p<0.01). CONCLUSIONS: Due to poor patient survival, minor differences between covered and uncovered stents may be less relevant even if statistically significant; however, subgroup analysis would suggest to use covered stents for intrinsic and uncovered stents for extrinsic malignancies.

    DOI: 10.1136/gutjnl-2020-320775

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  • A Prospective Multicenter Study of "Inside Stents" for Biliary Stricture: Multicenter Evolving Inside Stent Registry (MEISteR). 国際誌

    Hirofumi Kogure, Hironari Kato, Kazumichi Kawakubo, Hirotoshi Ishiwatari, Akio Katanuma, Yoshinobu Okabe, Toru Ueki, Tesshin Ban, Keiji Hanada, Kazuya Sugimori, Yousuke Nakai, Hiroyuki Isayama

    Journal of clinical medicine   10 ( 13 )   2021年6月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    BACKGROUND: Endoscopic biliary stent placement is the standard of care for biliary strictures, but stents across the papilla are prone to duodenobiliary reflux, which can cause stent occlusion. Preliminary studies of "inside stents" placed above the papilla showed encouraging outcomes, but prospective data with a large cohort were not reported. METHODS: This was a prospective multicenter registry of commercially available inside stents for benign and malignant biliary strictures. Primary endpoint was recurrent biliary obstruction (RBO). Secondary endpoints were technical success of stent placement and removal, adverse events, and stricture resolution. RESULTS: A total of 209 inside stents were placed in 132 (51 benign and 81 malignant) cases with biliary strictures in 10 Japanese centers. During the follow-up period of 8.4 months, RBO was observed in 19% of benign strictures. The RBO rate was 49% in malignant strictures, with the median time to RBO of 4.7 months. Technical success rates of stent placement and removal were both 100%. The adverse event rate was 8%. CONCLUSION: This prospective multicenter study demonstrated that inside stents above the papilla were feasible in malignant and benign biliary strictures, but a randomized controlled trial is warranted to confirm its superiority to conventional stents across the papilla.

    DOI: 10.3390/jcm10132936

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

    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年6月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    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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  • Efficacy of low dose rectal diclofenac for preventing post-endoscopic retrograde cholangiopancreatography pancreatitis: Propensity score-matched analysis. 国際誌

    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

    Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society   33 ( 4 )   656 - 662   2021年5月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    BACKGROUND: Acute pancreatitis is a major adverse event of endoscopic retrograde cholangiopancreatography (ERCP). Rectal administration of non-steroidal anti-inflammatory drugs (NSAIDs) decreases the incidence of post-ERCP pancreatitis (PEP). However, the efficacy of low dose rectal NSAIDs for preventing PEP remains controversial. METHODS: We performed a retrospective study of 301 patients with native papilla and a body weight of <50 kg who underwent ERCP between September 2010 and October 2019. After July 2016, a 25 mg dose of rectal diclofenac was routinely administered within 15 min before ERCP (NSAIDs group, n = 72) and the control group (n = 229) consisted of patients undergoing ERCP before this date without treatment. We compared the incidence of PEP between the two groups using propensity score matching. RESULTS: A total of 66 pairs of patients in each group were selected. The patients and procedural-related factors were similar in both groups. In total, 15 patients (11.4%) developed PEP: 12.1% (8/66) in the NSAIDs group and 10.6% (7/66) in the control group (Odds ratio (OR) 1.2; 95% confidence interval (CI) 0.4-3.5; P = 0.78). There was no significant difference in incidence of other adverse events related to ERCP between the two groups. CONCLUSIONS: Prophylactic administration of a 25 mg dose of rectal diclofenac did not reduce the incidence of PEP in patients with a native papilla and a body weight of <50 kg in this study and a certain dose of rectal NSAIDs, such as a 100-mg dose, should be administered regardless of body weight to prevent PEP.

    DOI: 10.1111/den.13828

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  • Best practices for the extraction of genomic DNA from formalin-fixed paraffin-embedded tumor tissue for cancer genomic profiling tests. 国際誌

    Hirofumi Inoue, Shuta Tomida, Shigeru Horiguchi, Hironari Kato, Hiromi Matsuoka, Etsuko Sanehira, Masashi Matsuoka, Hiroyuki Yanai, Akira Hirasawa, Shinichi Toyooka

    Pathology international   71 ( 5 )   360 - 364   2021年5月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    Recently, two cancer genomic profiling tests have been approved in Japan and implemented in routine clinical practice: the FDA-approved FoundationOne CDx test, and the OncoGuide NCC Oncopanel test. The quality and quantity of DNA significantly affects the sequencing results; therefore, preparing a sufficient amount of high-quality DNA for clinical cancer genomic profiling tests is important. We examined the best practices for the extraction of cancer genomic DNA from formalin-fixed paraffin-embedded (FFPE) tumor tissues of pancreatic, lung and colon cancer specimens. We found that the quality of cancer genomic DNA extracted from 10-μm-thick FFPE samples improved significantly, compared with that from 4-μm-thick FFPE samples, suggesting that 10-μm-thick FFPE samples are preferable for clinical cancer genomic profiling tests. For convenience, we created a quick reference table for calculating the required number of FFPE slides.

    DOI: 10.1111/pin.13086

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  • Acute pancreatitis without abdominal pain induced by administration of nivolumab and ipilimumab. 国際誌

    Koichiro Yamamoto, Kosuke Oka, Reina Son, Hiroyuki Honda, Hiroyuki Sakae, Kou Hasegawa, Shigeru Horiguchi, Hironari Kato, Osamu Yamasaki, Fumio Otsuka

    Modern rheumatology case reports   5 ( 2 )   1 - 6   2021年4月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    Immune checkpoint inhibitors (ICIs) such as nivolumab and ipilimumab are emerging agents for the treatment of cancers including melanoma. ICIs are known to cause immune-related adverse events (irAEs), including the development of enterocolitis, dermatitis, and nephritis. However, ICI-induced pancreatitis has seldom been reported, and its pathophysiology and clinical importance remain largely unknown. We describe a 76-year-old man with melanoma who developed acute pancreatitis without abdominal pain after immunotherapy with nivolumab and ipilimumab. The patient was referred due to 2-week-long general fatigue, anorexia, and dermatitis after his second immunotherapy. Laboratory examinations in serum showed high inflammation and renal dysfunction. Plain computed tomography (CT) on admission showed no new lesions including colitis or pancreatitis. On the 4th day of hospitalisation, serum pancreatic enzymes were extremely elevated. Amylase was increased to 683 U/L (normal range: 44-132) and lipase was increased to 1520 U/L (13-55), but he had no abdominal tenderness. Contrast-enhanced CT showed enlarged pancreatic parenchyma and magnetic resonance cholangiopancreatography showed peripancreatic fat stranding, suggesting pancreatitis. Blood culture tests and empirical antibiotic therapy with ceftriaxone indicated no active infectious diseases. We diagnosed ICI-induced pancreatitis and treated him with 0.5 mg/kg/day of prednisolone, which improved his general fatigue, anorexia, dermatitis, and pancreatitis. The potential significance of asymptomatic elevations of pancreatic enzymes has been unclear; however, this case suggested that ICI-induced pancreatitis without abdominal tenderness could be clinically significant. Clinicians should pay attention to the development of latent pancreatitis in patients receiving ICIs, even those without abdominal pain.

    DOI: 10.1080/24725625.2021.1899444

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  • Dramatic Response to Carboplatin Plus Paclitaxel in Pancreatic Mucinous Cystadenocarcinoma with Liver Metastasis.

    Naohiro Oda, Masahiro Tabata, Masatoshi Uno, Yuzo Umeda, Hironari Kato, Toshio Kubo, Satoru Senoo, Takahito Yagi, Toshiyoshi Fujiwara, Yoshinobu Maeda, Katsuyuki Kiura

    Internal medicine (Tokyo, Japan)   60 ( 18 )   2967 - 2971   2021年4月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    Mucinous cystic neoplasm (MCN) of the pancreas is a rare cystic tumor occurring in the pancreatic body and tail in young to middle-aged women that is pathologically characterized by an ovarian-like stroma. Chemotherapy for recurrent/advanced pancreatic MCN has been based on chemotherapy regimens for pancreatic ductal adenocarcinoma, but the prognosis is poor. We herein report a 37-year-old woman with pancreatic mucinous cystadenocarcinoma with liver metastasis that responded dramatically to carboplatin plus paclitaxel therapy (CBDCA + PTX). CBDCA + PTX may be a treatment option for recurrent/advanced pancreatic MCN with an ovarian-like stroma.

    DOI: 10.2169/internalmedicine.6730-20

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  • Endoscopic ultrasonography findings of pancreatic parenchyma for predicting subtypes of intraductal papillary mucinous neoplasms. 国際誌

    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年4月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

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

    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年4月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    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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  • Tissue harmonic versus contrast-enhanced harmonic endoscopic ultrasonography for the diagnosis of pancreatic tumors: Prospective multicenter study. 国際誌

    Shunsuke Omoto, Masayuki Kitano, Mitsuharu Fukasawa, Reiko Ashida, Hironari Kato, Hideyuki Shiomi, Kazuya Sugimori, Atsushi Kanno, Yasutaka Chiba, Shinichi Takano, Naoki Yamamoto, Takeshi Ezaki, Haruo Miwa, Akitaka Yokomura, Masato Hoshikawa, Takamitsu Tanaka, Masatoshi Kudo

    Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society   2021年2月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    OBJECTIVES: This prospective multicenter study aimed to assess and compare the accuracy of tissue harmonic endoscopic ultrasonography (TH-EUS) and contrast-enhanced harmonic endoscopic ultrasonography (CH-EUS) for differentiating pancreatic carcinoma from other pancreatic tumors. METHODS: Consecutive patients with solid pancreatic tumors were prospectively enrolled between August 2013 and December 2014. To assess the accuracy of TH-EUS and CH-EUS, we compared four parameters of TH-EUS (fuzzy edge, irregular periphery, hypoechogenicity, and heterogeneous internal echogenicity) and four parameters of CH-EUS (hypoenhancement and heterogeneous enhancement in the early and late phases, respectively) to investigate which parameter of each method was most suitable to diagnose pancreatic carcinomas. Interobserver agreement and the diagnostic ability of pancreatic carcinoma using TH-EUS and CH-EUS were assessed and compared. RESULTS: A total of 204 patients were enrolled. For the diagnosis of pancreatic carcinoma, interobserver agreement by experts and nonexperts was 0.33-0.50 and 0.35-0.50 for TH-EUS, respectively, and 0.72-0.74 and 0.20-0.54 for CH-EUS, respectively. Irregular periphery was the most accurate diagnostic parameter among TH-EUS findings for differentiating pancreatic carcinomas, with sensitivity, specificity, and accuracy of 95.0%, 42.9%, and 78.9%, respectively. Late phase hypoenhancement was the most accurate diagnostic parameter among CH-EUS findings for differentiating pancreatic carcinomas, with sensitivity, specificity, and accuracy of 90.8%, 74.6%, and 85.8%, respectively. The accuracy of CH-EUS (late phase hypoenhancement) for diagnosis of pancreatic carcinoma was significantly higher than that of TH-EUS (irregular periphery) (p < 0.001). CONCLUSION: In comparison with TH-EUS, CH-EUS increased the diagnostic ability and reproducibility for the diagnosis of pancreatic carcinoma. UMIN (000011124).

    DOI: 10.1111/den.13944

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  • Effectiveness, safety, and factors associated with the clinical success of endoscopic biliary drainage for patients with hepatocellular carcinoma: a retrospective multicenter study. 国際誌

    Akihiro Matsumi, Hironari Kato, Toru Ueki, Etsuji Ishida, Masahiro Takatani, Masakuni Fujii, Masaki Wato, Tatsuya Toyokawa, Ryo Harada, Hirofumi Tsugeno, Minoru Matsubara, Hiroshi Matsushita, Hiroyuki Okada

    BMC gastroenterology   21 ( 1 )   28 - 28   2021年1月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    BACKGROUND: Only a few reports have assessed the effectiveness of endoscopic biliary drainage (EBD) in hepatocellular carcinoma (HCC) patients with obstructive jaundice and liver dysfunction. METHODS: This was a retrospective study based on the clinical databases from the Okayama University Hospital and 10 affiliated hospitals. All patients received EBD for jaundice or liver dysfunction. The indication for EBD was aggravation of jaundice or liver dysfunction with intrahepatic bile duct (IHBD) dilation. The technical and clinical success rate, complications, factors associated with clinical failure, and survival duration were evaluated. RESULTS: A total of 107 patients were enrolled in this study. Technical success was achieved in 105 of 107 patients (98.1%). Clinical success was achieved in 85 of 105 patients (81%). Complications related to endoscopic retrograde cholangiography (ERC) occurred in 3 (2.8%) patients. Child-Pugh class C (odds ratio 3.90, 95% confidence interval [CI] 1.47-10.4, p = 0.0046) was the only factor associated with clinical failure, irrespective of successful drainage. The median survival duration was significantly longer in patients with clinical success than in those without clinical success (5.0 months vs. 0.93 months; hazard ratio [HR] 3.2, 95% CI 1.87-5.37). HCC Stage I/II/III (HR 0.57, CI 0.34-0.95, p = 0.032), absence of portal thrombosis (HR 0.52, CI 0.32-0.85, p = 0.0099), and clinical success (HR 0.39, CI 0.21-0.70, p = 0.0018) were significant factors associated with a long survival. CONCLUSIONS: EBD for obstructive jaundice and liver dysfunction in patients with HCC can be performed safely with a high technical success rate. Clinical success can improve the survival duration, even in patients expected to have a poor prognosis. TRIAL REGISTRATION: Retrospectively registered.

    DOI: 10.1186/s12876-020-01594-4

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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. 国際誌

    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年1月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    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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  • Adverse events of endoscopic ultrasound-guided fine-needle aspiration for histologic diagnosis in Japanese tertiary centers: Multicenter retrospective study. 国際誌

    Atsushi Kanno, Ichiro Yasuda, Atsushi Irisawa, Kazuo Hara, Reiko Ashida, Takuji Iwashita, Mamoru Takenaka, Akio Katanuma, Tetsuya Takikawa, Kensuke Kubota, Hironari Kato, Yousuke Nakai, Shomei Ryozawa, Masayuki Kitano, Hiroyuki Isayama, Hideki Kamada, Yoshinobu Okabe, Keiji Hanada, Koushiro Ohtsubo, Shinpei Doi, Hiroyuki Hisai, Goro Shibukawa, Hiroo Imazu, Atsushi Masamune

    Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society   33 ( 7 )   1146 - 1157   2020年12月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    BACKGROUND AND AIMS: Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is used for the histopathological diagnosis of any type of gastrointestinal disease. Few adverse events are experienced with this procedure; however, the actual rate of adverse events remains unclear. This study aimed to clarify the current status of cases that experienced adverse events related to the EUS-FNA procedure used for histopathologic diagnoses. METHODS: A retrospective analysis of cases with EUS-FNA-related adverse events in Japanese tertiary centers was conducted by assessing the following clinical data: basic case information, FNA technique, type of procedural adverse events, and prognosis. RESULTS: Of the 13,566 EUS-FNA cases overall, the total number of cases in which adverse events related to EUS-FNA occurred was 234. The incidence of EUS-FNA-related adverse events was ~1.7%. Bleeding and pancreatitis cases accounted for ~49.1% and 26.5% of all adverse events, respectively. Bleeding was the most common adverse event with only seven cases requiring blood transfusion. In cases with neuroendocrine tumors, pancreatitis was the most frequent adverse event. Needle tract seeding because of EUS-FNA was observed during the follow-up period in only ~0.1% of cases with pancreatic cancer. There was no mortality because of adverse events caused by EUS-FNA. CONCLUSIONS: This study revealed that the adverse events-related EUS-FNA for histopathologic diagnoses were not severe conditions, and had low incidence.

    DOI: 10.1111/den.13912

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  • Hemobilia after bile duct resection: perforation of pseudoaneurysm into intra-pancreatic remnant bile duct: a case report. 国際誌

    Kazuhiro Yoshida, Yuzo Umeda, Masaya Iwamuro, Kazuyuki Matsumoto, Hironari Kato, Mayu Uka, Yusuke Matsui, Ryuichi Yoshida, Takashi Kuise, Kazuya Yasui, Kosei Takagi, Hiroyuki Araki, Takahito Yagi, Toshiyoshi Fujiwara

    BMC surgery   20 ( 1 )   307 - 307   2020年12月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    BACKGROUND: Hemobilia occurs mainly due to iatrogenic factors such as impairment of the right hepatic or cystic artery, and/or common bile duct in hepatobiliary-pancreatic surgery. However, little or no cases with hemobilia from the intra-pancreatic remnant bile duct after bile duct resection (BDR) has been reported. Here, we report a case of massive hemobilia due to the perforation of psuedoaneurysm of the gastroduodenal artery (GDA) to the intra-pancreatic remnant bile duct after hepatectomy with BDR. CASE PRESENTATION: A 68-year-old male underwent extended right hepatectomy with BDR for gallbladder carcinoma. He presented with upper gastrointestinal bleeding 2 months after the initial surgery. Upper endoscopy identified a blood clot from the ampulla of Vater and simultaneous endoscopic balloon tamponade contributed to temporary hemostasis. Abdominal CT and angiography revealed a perforation of the psuedoaneurysm of the GDA to the intra-pancreatic remnant bile duct resulting in massive hemobilia. Subsequent selective embolization of the pseudoaneurysm with micro-coils could achieve complete hemostasis. He survived without any recurrence of cancer and bleeding. CONCLUSION: Hemobilia could occur in a patient with BDR due to perforation of the pseudoaneurysm derived from the GDA to the intra-pancreatic remnant bile duct. Endoscopic balloon tamponade was useful for a temporal hemostasis and a subsequent radiologic interventional approach.

    DOI: 10.1186/s12893-020-00981-8

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  • The efficacy of pancreatic juice cytology with liquid-based cytology for evaluating malignancy in patients with intraductal papillary mucinous neoplasm 国際誌

    Kazuya Miyamoto, Kazuyuki Matsumoto, Hironari Kato, Ryuichi Yoshida, Yuzo Umeda, Hirohumi Inoue, Takehiro Tanaka, Akihiro Matsumi, Yosuke Saragai, Yuki Fujii, Tatsuhiro Yamazaki, Daisuke Uchida, Takeshi Tomoda, Shigeru Horiguchi, Takahito Yagi, Hiroyuki Okada

    BMC Gastroenterology   20 ( 1 )   319 - 319   2020年12月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:Springer Science and Business Media LLC  

    <title>Abstract</title>
    <sec>
    <title>Background</title>
    Pancreatic juice cytology (PJC) is a tool for diagnosing malignant intraductal papillary mucinous neoplasm (IPMN); however, the accuracy is insufficient using the conventional method. Liquid-based cytology (LBC) improves the cell recovery rate, and almost all cells can be evaluated. We evaluated the efficacy of PJC with LBC for malignant IPMN.


    </sec>
    <sec>
    <title>Methods</title>
    We retrospectively analyzed 90 patients with suspected malignant IPMN who underwent PJC before pancreatectomy. PJC with smear and LBC methods was conducted in 52 patients (between June 2003 to December 2011) and 38 patients (between January 2012 to December 2018). Based on the imaging studies, all of the patients were classified according to the international consensus guidelines for IPMN revised in 2017.


    </sec>
    <sec>
    <title>Results</title>
    Of the 90 patients, 43 (48%) had malignant IPMN (high-grade dysplasia or invasive carcinoma), and the remaining patients had non-malignant IPMN (intermediate- or low-grade dysplasia). LBC increased the accuracy of PJC for the diagnosis of malignant IPMN (smear method: 56% [29/52] vs. LBC method: 76% [29/38]; <italic>P</italic> = 0.044). In a multivariate analysis, LBC was a significant factor influencing the accurate diagnosis of PJC (odds ratio: 3.52; <italic>P</italic> = 0.021). Furthermore, LBC increased the accuracy of PJC for malignant IPMN in patients with worrisome features (smear method: 66% [19/29] vs. LBC method: 93% [14/15]; <italic>P</italic> = 0.043).


    </sec>
    <sec>
    <title>Conclusions</title>
    LBC increases the accuracy of PJC for diagnosing malignant IPMN compared with the conventional smear method.


    </sec>

    DOI: 10.1186/s12876-020-01465-y

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    その他リンク: http://link.springer.com/article/10.1186/s12876-020-01465-y/fulltext.html

  • Effectiveness of Menghini-Type Needles for Endoscopic Ultrasound-Guided Fine-Needle Aspiration of Pancreatic Masses. 国際誌

    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   66 ( 9 )   3171 - 3178   2020年10月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    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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  • Predictive model of bleeding following endoscopic sphincterotomy for the treatment of choledocholithiasis in hemodialysis patients: A retrospective multicenter study. 国際誌

    So Nakaji, Yoshihiro Okawa, Kenji Nakamura, Masahiro Itonaga, Masami Inase, Harutoshi Sugiyama, Rei Suzuki, Kenji Yamauchi, Hiroki Matsui, Nobuto Hirata, Junko Saito, Naoki Ishii, Toshio Tsuyuguchi, Hironari Kato, Masayuki Kitano, Naoya Kato, Hiromasa Ohira, Hiroyuki Okada, Takuji Torimura, Hiroyuki Maguchi

    JGH open : an open access journal of gastroenterology and hepatology   4 ( 5 )   915 - 922   2020年10月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    Background and Aim: Although hemodialysis (HD) is a strong risk factor for postendoscopic sphincterotomy (ES) bleeding, additional risk factors in HD patients remain unclear. There is no model for predicting post-ES bleeding risk in HD patients. Therefore, we conducted a retrospective multicenter study to reveal these risk factors and develop a predictive model of post-ES bleeding in HD patients. Methods: We retrospectively reviewed the medical records of HD patients who underwent ES at eight hospitals between January 2006 and December 2016, with post-ES bleeding as the main outcome measure. Univariate analyses were performed to extract possible risk factors for post-ES bleeding. Factors that were clinically important and statistically significant in our univariate analyses were then included in our logistic regression analysis for the development of a multivariate predictive model of post-ES bleeding. This predictive model was visualized using a predictive nomogram. Results: Post-ES bleeding occurred in 20 (16.3%) of 123 HD patients. Based on clinically important factors and the results of our univariate analyses, platelet count, prothrombin time (international normalized ratio), and HD duration were included in our predictive model of post-ES bleeding. Receiver operating characteristic analysis found that this model had an area under the curve of 0.715 (95% confidence interval, 0.609-0.822). We developed a predictive nomogram based on these results. Conclusions: We demonstrated that post-ES bleeding is more common in HD patients than in the general population and succeeded in constructing a predictive model that can effectively identify HD patients at risk of post-ES bleeding.

    DOI: 10.1002/jgh3.12363

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  • Evaluation of Local Recurrence of Pancreatic Cancer by KRAS Mutation Analysis Using Washes from Endoscopic Ultrasound-Guided Fine-Needle Aspiration. 国際誌

    Kazuyuki Matsumoto, Hironari Kato, Kazuhiro Nouso, Soichiro Ako, Hideaki Kinugasa, Shigeru Horiguchi, Yosuke Saragai, Saimon Takada, Shuntaro Yabe, Shinichiro Muro, Daisuke Uchida, Takeshi Tomoda, Hiroyuki Okada

    Digestive diseases and sciences   65 ( 10 )   2907 - 2913   2020年10月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    BACKGROUND AND AIMS: The sensitivity of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) for diagnosing the recurrence of pancreatic cancer is usually low because of difficulties in obtaining adequate samples for pathological examinations. We evaluated the efficacy of highly sensitive KRAS mutation analysis using EUS-FNA washes to detect cancer recurrence. METHODS: Nineteen consecutive patients with suspected pancreatic cancer recurrence after surgical resection were enrolled. All underwent EUS-FNA, and samples were obtained for pathological examination. After the first session, the inside of the FNA needle was washed with saline for DNA extraction. KRAS mutations were examined using digital droplet PCR (dPCR). RESULTS: The median needle puncture number used to obtain adequate pathological samples was two (range 1-6). In ten patients pathologically diagnosed with malignant pancreatic cancer, nine patients tested positive for a KRAS mutation. All patients who were not diagnosed with a malignant pancreatic cancer tested negative for a KRAS mutation. About half of surgically resected primary cancers (9/19) showed double KRAS mutations (G12V and G12D); however, all but one wash sample showed a single KRAS mutation, G12D. After including one patient who showed a malignant recurrence during follow-up, the sensitivities of a pathological diagnosis and KRAS analysis to detect recurrence were 90.9% and 81.8%, respectively. CONCLUSIONS: KRAS mutation analysis of needle wash samples using dPCR is a new methodology for the diagnosis of the local recurrence of pancreatic cancer. The diagnostic ability of dPCR with a one-time needle wash sample was comparable to a pathological diagnosis with multiple samplings.

    DOI: 10.1007/s10620-019-06006-6

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  • Multicenter randomized trial of endoscopic papillary large balloon dilation without sphincterotomy versus endoscopic sphincterotomy for removal of bile duct stones: MARVELOUS trial. 国際誌

    Hirofumi Kogure, Shuhei Kawahata, Tsuyoshi Mukai, Shinpei Doi, Takuji Iwashita, Tesshin Ban, Yukiko Ito, Hiroshi Kawakami, Tsuyoshi Hayashi, Naoki Sasahira, Kensuke Kubota, Osamu Togawa, Hironari Kato, Yoshinobu Okabe, Saburo Matsubara, Hiroshi Yagioka, Tomotaka Saito, Yousuke Nakai, Hiroyuki Isayama

    Endoscopy   52 ( 9 )   736 - 744   2020年9月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    BACKGROUND : Endoscopic papillary large balloon dilation (EPLBD) has been increasingly used for the management of large common bile duct (CBD) stones. Although EPLBD is often preceded by endoscopic sphincterotomy (EST), EPLBD alone without EST has been increasingly reported as an alternative to EST for large CBD stones. METHODS : This multicenter randomized trial was conducted at 19 Japanese institutions to compare the efficacy and safety of EPLBD alone versus EST for the removal of large (≥ 10 mm) CBD stones. The primary end point was complete stone removal in a single session. The secondary end points included: overall complete stone removal, lithotripsy use, procedure time, adverse events, and cost. RESULTS:  171 patients with large CBD stones were included in the analysis. The rate of single-session complete stone removal was significantly higher in the EPLBD-alone group than in the EST group (90.7 % vs. 78.8 %; P = 0.04). Lithotripsy use was significantly less frequent in the EPLBD group than in the EST group (30.2 % vs. 48.2 %; P = 0.02). The rates of early adverse events were comparable between the two groups: rates of overall adverse events were 9.3 % vs. 9.4 % and of pancreatitis were 4.7 % vs. 5.9 % in the EPLBD and EST groups, respectively. The procedure costs were $1442 vs. $1661 in the EPLBD and EST groups, respectively (P = 0.12). CONCLUSION : EPLBD without EST for the endoscopic treatment of large CBD stones achieved a significantly higher rate of complete stone removal in a single session compared with EST, without increasing adverse events.

    DOI: 10.1055/a-1145-3377

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  • Propofol sedation with a target-controlled infusion pump in elderly patients undergoing ERCP. 国際誌

    Taiji Ogawa, Takeshi Tomoda, Hironari Kato, Yutaka Akimoto, Shoichi Tanaka, Hiroyuki Okada

    Gastrointestinal endoscopy   92 ( 2 )   301 - 307   2020年8月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    BACKGROUND AND AIMS: Advanced age is an important risk factor for adverse events (AEs) during propofol sedation for endoscopic procedures. This study aimed to evaluate the safety and efficacy of nonanesthesiologist-administered propofol (NAAP) sedation with a target-controlled infusion (TCI) system in elderly patients during ERCP. METHODS: This study retrospectively analyzed 482 patients who underwent ERCP under propofol sedation with a TCI system at Iwakuni Medical Center between January 2014 and October 2016. Patients were divided into 3 groups according to their age: group A, <70 years (n = 130); group B, ≥70 and <85 years (n = 224); and group C, ≥85 years (n = 125). We compared the propofol dose and AEs during ERCP. RESULTS: The median total infusion dose and minimum and maximum target blood concentrations of propofol were 336 mg, 2.2 μg/mL, and 2.2 μg/mL in group A; 184 mg, 1.0 μg/mL, and 1.4 μg/mL in group B; and 99 mg, .6 μg/mL, and 1.0 μg/mL in group C, respectively, with older groups requiring a lower dose (P < .0001). Hypotension was observed in 23 patients (4.8%), with no significant difference between groups (group A, 2.3%; group B, 6.3%; group C, 4.8%; P = .24). Hypoxemia was observed in 16 patients (3.3%), with no significant difference between groups (group A, 3.1%; group B, 4.9%; group C, .8%; P = .17). All AEs were immediately resolved, and no procedures were aborted. CONCLUSIONS: NAAP sedation with a TCI system during ERCP may be acceptable in elderly patients with a lower dose of propofol than that used in younger patients.

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  • The Long-Term Outcomes of Endoscopic Papillectomy and Management of Cases of Incomplete Resection: A Single-Center Study. 査読 国際誌

    Shinichiro Muro, Hironari Kato, Akihiro Matsumi, Yuki Ishihara, Yosuke Saragai, Shuntaro Yabe, Saimon Takata, Daisuke Uchida, Takeshi Tomoda, Kazuyuki Matsumoto, Shigeru Horiguchi, Hiroyuki Okada

    Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract   25 ( 5 )   1247 - 1252   2020年6月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    BACKGROUND: Endoscopic papillectomy is increasingly performed as an alternative to surgery for early ampullary tumors. AIM: This retrospective study aimed to evaluate the long-term results of endoscopic papillectomy, the management of cases with incomplete endoscopic resection, and the long-term recurrence rates. METHODS: All 46 patients who underwent endoscopic papillectomy for ampullary tumors between November 2003 and March 2018 were retrospectively evaluated. RESULTS: The final pathological diagnoses were adenoma (n = 44) and adenocarcinoma (n = 2). Histopathological evaluations after endoscopic papillectomy revealed that complete resection was achieved in 19 patients (19/46, 41.3%). Among the 27 patients with incomplete resection, the margin was histopathologically positive in 14 patients and difficult to evaluate in 13. Additional surgery was performed for 2 of the 14 patients with positive margins. Excluding 2 patients who received additional surgery, 7 of the 25 patients with incomplete resection had recurrence, and 18 had no recurrence during the follow-up period. Ten (77%) of the 13 patients in whom the margin was difficult to evaluate had no recurrence. CONCLUSION: Approximately 80% of the patients in whom the histopathological evaluation of the resected margin was difficult had no recurrence even after approximately 5 years of follow-up. Thus, careful observation may be considered for these patients.

    DOI: 10.1007/s11605-020-04532-7

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  • Efficacy and safety of scheduled early endoscopic ultrasonography-guided ethanol reinjection for patients with pancreatic neuroendocrine tumors: Prospective pilot study. 国際誌

    Kazuyuki Matsumoto, Hironari Kato, Seiji Kawano, Hiroyasu Fujiwara, Kenji Nishida, Ryo Harada, Masakuni Fujii, Ryuichi Yoshida, Yuzo Umeda, Shiro Hinotsu, Takahito Yagi, Hiroyuki Okada

    Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society   32 ( 3 )   425 - 430   2020年3月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    Endoscopic ultrasonography (EUS)-guided ethanol injection was recently proposed for treatment of patients with small pancreatic neuroendocrine tumors (p-NET); however, tips on how to carry out safe and effective procedures are unclear. We launched a pilot study for scheduled early EUS-guided ethanol reinjection for small p-NET. Major eligibility criteria were presence of pathologically diagnosed grade (G) 1 or G2, tumor size ≤2 cm and being a poor or rejected candidate for surgery. For the treatment, we used a 25-gauge needle and pure ethanol. Contrast-enhanced computed tomography (CE-CT) was carried out on postoperative day 3, and if enhanced areas of the tumor were still apparent, an additional session was scheduled during the same hospitalization period. Primary endpoint was complete ablation rate at 1 month after treatment, and secondary endpoint was procedure-related adverse events. A total of five patients were treated. Median size of the tumor was 10 (range: 7-14) mm. Of the five patients, three underwent an additional session. Median volume of ethanol injection per session was 0.8 (range: 0.3-1.0) mL, and the total was 1.0 (0.9-1.8) mL. Complete ablation was achieved in four of the five tumors (80%) with no adverse events. During 1 year of follow up, none of the patients reported any procedure-related adverse events, and no recurrence of tumor. Scheduled early EUS-guided ethanol reinjection appears to be safe and effective for treating small p-NET (UMIN number: 000018834).

    DOI: 10.1111/den.13552

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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. 査読 国際誌

    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   35 ( 1 )   239 - 240   2020年2月

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    記述言語:英語  

    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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  • 【膵癌診療ガイドライン2019改訂のポイント】ステント療法部門

    花田 敬士, 糸井 隆夫, 加藤 博也, 伊佐山 浩通, 中井 陽介, 坂本 康成

    膵臓   35 ( 1 )   75 - 78   2020年2月

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    記述言語:日本語   出版者・発行元:(一社)日本膵臓学会  

    膵癌診療ガイドラインが2019年7月に改訂された。ステント療法部門では合計5項目のクリニカルクエスチョン(CQ)および1つのコラムが作成され、今回、2016年版と比較して一部を新設および変更が加えられた。SSt1として切除不能膵癌に対する胆道ドレナージのアプローチルートに関するCQを作成した。従来の経皮的、内視鏡的経乳頭的なルートに加えて、超音波内視鏡を用いた内視鏡的経消化管的ルートの検討を行った。SSt2として閉塞性黄疸を伴う膵癌術前症例に対するステント療法のCQを作成した。SSt3として閉塞性黄疸を伴う切除不能膵癌に対する胆道ドレナージに関するステントの選択について2つのCQを作成した。SSt4として消化管閉塞をきたした切除不能膵癌に対する外科的胃空腸吻合術と消化管ステント挿入術に関するCQを作成した。また化学・放射線療法を意識したステント療法に関するコラムを記載した。(著者抄録)

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    その他リンク: https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2020&ichushi_jid=J02025&link_issn=&doc_id=20200512360007&doc_link_id=%2Fcq0pancr%2F2020%2F003501%2F015%2F0075-0078%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fcq0pancr%2F2020%2F003501%2F015%2F0075-0078%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

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

    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   35 ( 1 )   232 - 238   2020年1月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    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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  • Promising Gene Therapy Using an Adenovirus Vector Carrying REIC/Dkk-3 Gene for the Treatment of Biliary Cancer. 査読 国際誌

    Emi Tanaka, Daisuke Uchida, Hidenori Shiraha, Hironari Kato, Atsushi Ohyama, Masaya Iwamuro, Masami Watanabe, Hiromi Kumon, Hiroyuki Okada

    Current gene therapy   20 ( 1 )   64 - 70   2020年

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    BACKGROUND: We previously demonstrated that the reduced expression in immortalized cells (REIC)/dikkopf-3 (Dkk-3) gene was downregulated in various malignant tumors, and that an adenovirus vector carrying the REIC/Dkk-3 gene, termed Ad-REIC induced cancer-selective apoptosis in pancreatic cancer and hepatocellular carcinoma. OBJECTIVE: In this study, we examined the therapeutic effects of Ad-REIC in biliary cancer using a second- generation Ad-REIC (Ad-SGE-REIC). METHODS: Human biliary cancer cell lines (G-415, TFK-1) were used in this study. The cell viability and apoptotic effect of Ad-SGE-REIC were assessed in vitro using an MTT assay and Hoechst staining. The anti-tumor effect in vivo was assessed in a mouse xenograft model. We also assessed the therapeutic effects of Ad-SGE-REIC therapy with cisplatin. Cell signaling was assessed by Western blotting. RESULTS: Ad-SGE-REIC reduced cell viability, and induced apoptosis in biliary cancer cell lines via the activation of the c-Jun N-terminal kinase pathway. Ad-SGE-REIC also inhibited tumor growth in a mouse xenograft model. This effect was further enhanced in combination with cisplatin. CONCLUSION: Ad-SGE-REIC induced apoptosis and inhibited tumor growth in biliary cancer cells. REIC/Dkk-3 gene therapy using Ad-SGE-REIC is an attractive therapeutic tool for biliary cancer.

    DOI: 10.2174/1566523220666200309125709

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  • Utility of Endoscopic Ultrasound-Guided Fine Needle Aspiration in the Diagnosis of Local Recurrence of Pancreaticobiliary Cancer after Surgical Resection. 査読 国際誌

    Matsumoto K, Kato H, Horiguchi S, Tomoda T, Matsumi A, Ishihara Y, Saragai Y, Takada S, Muro S, Uchida D, Okada H

    Gut and liver   14 ( 5 )   652 - 658   2019年12月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    DOI: 10.5009/gnl19200

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  • Single-session esophagogastroduodenoscopy and endoscopic ultrasound using a forward-viewing radial scan ultrasonic endoscope. 査読 国際誌

    Uchida D, Kato H, Matsumoto K, Ishihara Y, Matsumi A, Saragai Y, Takada S, Yabe S, Muro S, Tomoda T, Horiguchi S, Okada H

    BMC gastroenterology   19 ( 1 )   220 - 220   2019年12月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    DOI: 10.1186/s12876-019-1141-7

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  • 【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) 査読

    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年11月

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    記述言語:日本語   出版者・発行元:(株)東京医学社  

    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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  • The relationship between the PD-L1 expression of surgically resected and fine-needle aspiration specimens for patients with pancreatic cancer. 査読

    Kazuyuki Matsumoto, Toshiaki Ohara, Masayoshi Fujisawa, Akinobu Takaki, Masahiro Takahara, Noriyuki Tanaka, Hironari Kato, Shigeru Horiguchi, Ryuichi Yoshida, Yuzo Umeda, Soichiro Fushimi, Takahito Yagi, Akihiro Matsukawa, Hiroyuki Okada

    Journal of gastroenterology   54 ( 11 )   1019 - 1028   2019年11月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    BACKGROUND: Recently, therapeutic antibodies against programmed death-1/programmed death-ligand 1 (PD-1/PD-L1) have shown promising clinical results for several solid tumors, including pancreatic cancer. In this study, we evaluated the relationship between the PD-L1 expression of surgical resected and fine-needle aspiration (FNA) specimens for patients with pancreatic cancer. METHODS: Of 121 patients who underwent endoscopic ultrasound-guided (EUS)-FNA before surgery for pancreatic cancer in an academic center, the 94 (78%) with adequate FNA specimens for a histological evaluation were retrospectively analyzed. All the patients had undergone upfront surgery without any chemotherapy or radiotherapy. We performed immunohistochemistry (IHC) staining to investigate the PD-L1 expression in both resected and FNA specimens. The positive-stained cells were counted, and their percentage was used for the investigation. RESULTS: Of the 94 patients, 16 (17%) and 11 (10%) were defined as positive on resected cancer specimens using cutoff points of 5% and 10% positively stained cancer cell counts, respectively. The concordance rates for the positive frequency of PD-L1 expression between resected and FNA specimens were 44% (7/16) and 55% (6/11) when the positivity was set to ≥ 5% and ≥ 10%, respectively. The concordance rates for the negative frequency of PD-L1 expression between two specimens were 97% (76/78) and 99% (82/83) when the positivity was set to ≥ 5% and ≥ 10%, respectively. CONCLUSIONS: Approximately, half of the patients with PD-L1 expression positive and almost all the patients with PD-L1 expression negative could be diagnosed on FNA specimens.

    DOI: 10.1007/s00535-019-01586-6

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  • プラスティックステントによる悪性遠位胆管狭窄の術前ドレナージの検討

    高田 斎文, 吉田 龍一, 安井 和也, 加藤 博也, 松三 明宏, 石原 祐基, 皿谷 洋祐, 室 信一郎, 内田 大輔, 友田 健, 堀口 繁, 八木 孝仁, 岡田 裕之

    Gastroenterological Endoscopy   61 ( Suppl.2 )   2191 - 2191   2019年10月

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    記述言語:日本語   出版者・発行元:(一社)日本消化器内視鏡学会  

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  • Diagnostic Ability of Convex-Arrayed Endoscopic Ultrasonography for Major Vascular Invasion in Pancreatic Cancer. 国際誌

    Yuki Fujii, Kazuyuki Matsumoto, Hironari Kato, Yosuke Saragai, Saimon Takada, Sho Mizukawa, Shinichiro Muro, Daisuke Uchida, Takeshi Tomoda, Shigeru Horiguchi, Noriyuki Tanaka, Hiroyuki Okada

    Clinical endoscopy   52 ( 5 )   479 - 485   2019年9月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    BACKGROUND/AIMS: This study aimed to examine the diagnostic ability of endoscopic ultrasonography (EUS) for major vascular invasion in pancreatic cancer and to evaluate the relationship between EUS findings and pathological distance. METHODS: In total, 57 consecutive patients who underwent EUS for pancreatic cancer before surgery were retrospectively reviewed. EUS image findings were divided into four types according to the relationship between the tumor and major vessel (types 1 and 2: invasion, types 3 and 4: non-invasion). We also compared the EUS findings and pathologically measured distances between the tumors and evaluated vessels. RESULTS: The sensitivity, specificity, and accuracy of EUS diagnosis for vascular invasion were 89%, 92%, and 91%, respectively, in the veins and 83%, 94%, and 93%, respectively, in the arteries. The pathologically evaluated distances of cases with type 2 EUS findings were significantly shorter than those of cases with type 3 EUS findings in both the major veins (median [interquartile range], 96 [0-742] µm vs. 2,833 [1,076-5,694] µm, p=0.012) and arteries (623 [0-854] µm vs. 3,097 [1,396-6,000] µm, p=0.0061). All cases with a distance of ≥1,000 µm between the tumors and main vessels were correctly diagnosed. CONCLUSION: Tumors at a distance ≥1,000 µm from the main vessels were correctly diagnosed by EUS.

    DOI: 10.5946/ce.2018.163

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  • Successful removal of impacted large bile duct stones using electrohydraulic lithotripsy with an ultraslim endoscope after Billroth II gastrectomy. 国際誌

    Kazuyuki Matsumoto, Hironari Kato, Shigeru Horiguchi, Daisuke Uchida, Takeshi Tomoda, Shinichiro Muro, Hiroyuki Okada

    Endoscopy   51 ( 9 )   E265-E266   2019年9月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    DOI: 10.1055/a-0896-2498

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  • Comparison of the efficacy and safety of endoscopic ultrasound-guided choledochoduodenostomy and hepaticogastrostomy for malignant distal biliary obstruction: Multicenter, randomized, clinical trial. 査読 国際誌

    Kosuke Minaga, Takeshi Ogura, Hideyuki Shiomi, Hajime Imai, Noriyuki Hoki, Mamoru Takenaka, Hidefumi Nishikiori, Yukitaka Yamashita, Takeshi Hisa, Hironari Kato, Hideki Kamada, Atsushi Okuda, Ryota Sagami, Hiroaki Hashimoto, Kazuhide Higuchi, Yasutaka Chiba, Masatoshi Kudo, Masayuki Kitano

    Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society   31 ( 5 )   575 - 582   2019年9月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    BACKGROUND AND AIM: Endoscopic ultrasound-guided biliary drainage (EUS-BD) can be carried out by two different approaches: choledochoduodenostomy (CDS) and hepaticogastrostomy (HGS). We compared the efficacy and safety of these approaches in malignant distal biliary obstruction (MDBO) patients using a prospective, randomized clinical trial. METHODS: Patients with malignant distal biliary obstruction after failed endoscopic retrograde cholangiopancreatography were randomly selected for either CDS or HGS. The procedures were carried out at nine tertiary centers from September 2013 to March 2016. Primary endpoint was technical success rate, and the noninferiority of HGS to CDS was examined with a one-sided significance level of 5%, where the noninferiority margin was set at 15%. Secondary endpoints were clinical success, adverse events (AE), stent patency, survival time, and overall technical success including alternative EUS-BD procedures. RESULTS: Forty-seven patients (HGS, 24; CDS, 23) were enrolled. Technical success rates were 87.5% and 82.6% in the HGS and CDS groups, respectively, where the lower limit of the 90% confidence interval of the risk difference was -12.2% (P = 0.0278). Clinical success rates were 100% and 94.7% in the HGS and CDS groups, respectively (P = 0.475). Overall AE rate, stent patency, and survival time did not differ between the groups. Overall technical success rates were 100% and 95.7% in the HGS and CDS groups, respectively (P = 0.983). CONCLUSIONS: This study suggests that HGS is not inferior to CDS in terms of technical success. When one procedure is particularly challenging, readily switching to the other could increase technical success.

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  • Acute pancreatitis associated with massive bleeding due to a duodenal ulcer.

    Daisuke Uchida, Yoshinari Kawai, Hironari Kato, Hiroyuki Okada

    Clinical journal of gastroenterology   12 ( 4 )   301 - 306   2019年8月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    A 74-year-old man presented to the emergency department with acute abdominal pain in addition to anemia and melena, which were suspected to be due to gastrointestinal bleeding. Computed tomography (CT) revealed a blood-filled duodenum and acute pancreatitis. We prioritized treatments for pancreatitis, as the vital signs were stable, and temporary hemostasis was achieved. Two days later, esophagogastroduodenoscopy revealed a duodenal ulcer with an exposed vessel, and endoscopic hemostasis was performed. We urge clinicians to consider the possibility of pancreatitis associated with massive bleeding due to a duodenal ulcer.

    DOI: 10.1007/s12328-019-00942-6

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  • Adenomyomatosis hyperplasia arising in the bile duct. 国際誌

    Kazuyuki Matsumoto, Hironari Kato, Kenji Nishida, Hiroyuki Okada

    Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver   51 ( 7 )   1060 - 1060   2019年7月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    DOI: 10.1016/j.dld.2019.03.006

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  • Endoscopic Ultrasound-Guided Transgastric Drainage of an IntraAbdominal Abscess following Gastrectomy. 国際誌

    Satoru Kikuchi, Tetsushi Kubota, Shinji Kuroda, Masahiko Nishizaki, Shunsuke Kagawa, Hironari Kato, Hiroyuki Okada, Toshiyoshi Fujiwara

    Clinical endoscopy   52 ( 4 )   373 - 376   2019年7月

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    記述言語:英語  

    Endoscopic ultrasound (EUS)-guided transgastric drainage has been performed as a less invasive procedure for pancreatic fistulas and intra-abdominal abscesses occurring after surgery in recent years. However, there are no reports of EUS-guided transgastric drainage of intra-abdominal abscesses following gastrectomy. This case report describes 2 patients who developed an intra-abdominal abscess following gastrectomy and underwent EUS-guided transgastric drainage. Both patients underwent laparoscopy-assisted distal gastrectomy with Billroth-I reconstruction for gastric cancer. The intra-abdominal abscesses were caused by postoperative pancreatic fistula that developed following gastrectomy. One patient underwent naso-cystic drainage and the other underwent only a needle puncture of the abscess cavity. EUS-guided drainage was performed safely and effectively, although 1 patient developed gastroduodenal anastomotic leakage related to this procedure. In summary, EUS-guided transgastric drainage is safe and technically feasible even in post-gastrectomy patients. However, it is necessary to be careful if this procedure is performed in the early period following gastrectomy.

    DOI: 10.5946/ce.2018.134

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  • Combination of Diclofenac and Sublingual Nitrates Is Superior to Diclofenac Alone in Preventing Pancreatitis After Endoscopic Retrograde Cholangiopancreatography. 国際誌

    Takeshi Tomoda, Hironari Kato, Toru Ueki, Yutaka Akimoto, Hidenori Hata, Masakuni Fujii, Ryo Harada, Tsuneyoshi Ogawa, Masaki Wato, Masahiro Takatani, Minoru Matsubara, Yoshinari Kawai, Hiroyuki Okada

    Gastroenterology   156 ( 6 )   1753 - 1760   2019年5月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    BACKGROUND & AIMS: Acute pancreatitis is a major adverse event of endoscopic retrograde cholangiopancreatography (ERCP). Rectal administration of nonsteroidal anti-inflammatory drugs (NSAIDs) decreases the incidence of post-ERCP pancreatitis (PEP). Little is known about the combined effects of sublingual nitrate and NSAIDs. We performed a randomized trial to assess whether the combination of NSAIDs and sublingual nitrate is more effective than NSAIDs alone in preventing PEP. METHODS: In a prospective superiority trial, eligible patients underwent ERCP at 12 endoscopic units in Japan, from March 2015 through May 2018. Patients were randomly assigned to groups given diclofenac suppositories (50 mg) within 15 minutes after the endoscopic procedure alone (diclofenac-alone group, n = 442) or in combination with sublingual isosorbide dinitrate (5 mg) 5 minutes before the endoscopic procedure (combination group, n = 444). The primary endpoint was the occurrence of PEP. RESULTS: PEP developed in 25 patients in the combination group (5.6%), and in 42 patients in the diclofenac-alone group (9.5%) (relative risk 0.59; 95% confidence interval 0.37-0.95; P = .03). Moderate to severe pancreatitis developed in 4 patients (0.9%) in the combination group, and 10 patients (2.3%) in the diclofenac-alone group (relative risk 0.12; 95% confidence interval 0.13-1.26; P = .12). There was no serious adverse event related to the additional administration of sublingual nitrate. CONCLUSIONS: In a randomized controlled trial, we found that prophylaxis with rectal diclofenac and sublingual nitrate significantly reduces the overall incidence of PEP compared with diclofenac suppository alone. ClinicalTrials.gov, no: UMIN 000016274.

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  • Current problems and clinical results of endoscopic necrosectomy for walled-off pancreatic necrosis. 国際誌

    Kazuyuki Matsumoto, Hironari Kato, Hiroyuki Okada

    Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society   31 Suppl 1   67 - 68   2019年4月

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    記述言語:英語  

    DOI: 10.1111/den.13358

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  • Long-term outcomes after therapeutic endoscopic retrograde cholangiopancreatography using balloon-assisted enteroscopy for anastomotic stenosis of choledochojejunostomy/pancreaticojejunostomy. 国際誌

    Itsuki Sano, Akio Katanuma, Masaki Kuwatani, Hiroshi Kawakami, Hironari Kato, Takao Itoi, Michihiro Ono, Atsushi Irisawa, Yoshinobu Okabe, Takuji Iwashita, Ichiro Yasuda, Shomei Ryozawa, Seiji Kaino, Naoya Sakamoto

    Journal of gastroenterology and hepatology   34 ( 3 )   612 - 619   2019年3月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    BACKGROUND AND AIM: Data on long-term outcomes after therapeutic endoscopic retrograde cholangiopancreatography (ERCP) using balloon-assisted enteroscopy (BAE) for choledochojejunal anastomotic stenosis (CJS) or pancreaticojejunal anastomotic stenosis (PJS) remain limited. We retrospectively assessed the long-term results of patients who achieved clinical success using BAE for CJS and PJS. METHODS: Patients who achieved technical and clinical success for CJS or PJS by BAE-ERCP and were followed up for more than 6 months after the initial BAE-ERCP therapy were retrospectively identified at 11 Japanese institutions. The primary end-point was CJS or PJS recurrence rates. The secondary end-points were initial therapy details, initial therapy complications, and CJS or PJS recurrence treatment details. We also evaluated restenosis-associated factors. RESULTS: From September 2008 to December 2015, 67 patients (CJS, 61; PJS, six) were included. The overall CJS and PJS recurrence rates were 34.4% and 33.3%, respectively. The 1-year CJS recurrence rate was 18.5% (95% confidence interval, 10.7-31.0). Of all the patients, 88.1% underwent balloon dilation at the anastomotic stenosis site; stent placement was performed in 15 of 67 patients (22.4%). The complication rate was 8.2% in CJS and 0% in PJS. In patients who underwent balloon dilation, "remaining waist" was significantly associated with CJS recurrence after anastomotic balloon dilation (P = 0.001). CONCLUSIONS: The long-term outcomes of BAE-ERCP were comparable with those of percutaneous transhepatic treatment or surgical re-anastomosis.

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  • Prospective multicenter study of primary EUS-guided choledochoduodenostomy using a covered metal stent

    Hiroyuki Isayama, Yousuke Nakai, Hiroshi Kawakami, Hirotoshi Ishiwatari, Masayuki Kitano, Yukiko Ito, Ichiro Yasuda, Hironari Kato, Saburo Matsubara, Atsushi Irisawa, Takao Itoi

    Endoscopic Ultrasound   8 ( 2 )   111 - 111   2019年

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    掲載種別:研究論文(学術雑誌)   出版者・発行元:Medknow  

    DOI: 10.4103/eus.eus_17_18

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  • Clinical Efficacy and Safety of endoscopic ultrasound-guided Gallbladder Drainage Replacement of Percutaneous Drainage: A Multicenter Retrospective Study. 査読

    Minaga K, Yamashita Y, Ogura T, Takenaka M, Shimokawa Y, Hisa T, Itonaga M, Kato H, Nishikiori H, Okuda A, Matsumoto H, Uenoyama Y, Watanabe T, Chiba Y, Higuchi K, Kudo M, Kitano M

    Dig Endosc   31 ( 2 )   180 - 187   2019年

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    DOI: 10.1111/den.13242

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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. 査読 国際誌

    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年10月

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    記述言語:英語  

    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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  • Overexpression of folate receptor alpha is an independent prognostic factor for outcomes of pancreatic cancer patients 査読

    Shizuma Omote, Katsuyoshi Takata, Takehiro Tanaka, Tomoko Miyata-Takata, Yoshiyuki Ayada, Mai Noujima-Harada, Rika Omote, Tetsuya Tabata, Yasuharu Sato, Tatsuya Toyokawa, Hironari Kato, Takahito Yagi, Hiroyuki Okada, Tadashi Yoshino

    Medical Molecular Morphology   1 - 7   2018年6月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:Springer Tokyo  

    Pancreatic cancer has a poor prognosis
    hence, novel prognostic markers and effective therapeutic targets should be identified. We aimed to evaluate folate receptor alpha (FR-α) expression in pancreatic cancer and examine its association with clinicopathological features. We utilized tissue samples from 100 primary pancreatic cancer patients who underwent surgery. FR-α was expressed in 37 of 100 cases (37%). The FR-α-positive group (median, 18.8 months) had a significantly poorer prognosis than the FR-α-negative group [median 21.3 months
    HR 1.89 (1.12–3.12)
    P = 0.017]. These groups were not significantly different regarding progression-free survival (P = 0.196). Furthermore, other serum tumor markers including CA19-9 (mean, 186 vs. 822 U/ml
    P = 0.001), Dupan-2 (286 vs. 1133 U/ml
    P = 0.000), and Span-1 (69.7 vs. 171.9 U/ml
    P = 0.006) were significantly downregulated in the FR-α-positive group. CA19-9 was another prognostic factor, in addition to FR-α, and patient prognosis showed clear stratification curves with the expression of these two molecules. Along with CA19-9, FR-α expression was an independent prognostic factor for the overall survival. FR-α and CA19-9 helped predict patient prognosis based on stratification curves.

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  • SIMILAR EFFICACY AND SAFETY OF ENDOSCOPIC ULTRASOUND-GUIDED BILIARY DRAINAGE VIA HEPATICOGASTROSTOMY AND CHOLEDOCHODUODENOSTOMY APPROACHES FOR MALIGNANT DISTAL BILIARY OBSTRUCTION: A MULTICENTER, PROSPECTIVE, RANDOMIZED TRIAL 査読

    Minaga Kosuke, Kitano Masayuki, Ogura Takeshi, Shiomi Hideyuki, Hoki Noriyuki, Nishikiori Hidefumi, Yamashita Yukitaka, Hisa Takeshi, Kato Hironari, Kamada Hideki, Takenaka Mamoru, Higuchi Kazuhide, Chiba Yasutaka, Kudo Masatoshi

    GASTROINTESTINAL ENDOSCOPY   87 ( 6 )   AB147   2018年6月

  • Epidermoid Cyst in an Intrapancreatic Accessory Spleen Diagnosed by Typical Radiographic Images and Endoscopic Ultrasound Fine-Needle Aspiration Findings With Contrast Agent 査読

    Kazuyuki Matsumoto, Hironari Kato, Hiroyuki Okada

    Clinical Gastroenterology and Hepatology   16 ( 2 )   e13 - e14   2018年2月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:W.B. Saunders  

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  • Indications for Endoscopic Ultrasound-Guided Pancreatic Drainage: For Benign or Malignant Cases? 査読

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

    Canadian Journal of Gastroenterology and Hepatology   2018   8216109   2018年

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:Hindawi Limited  

    Background and Aims. Recurrent pancreatitis associated with pancreatic strictures requires treatment with endoscopic retrograde pancreatography (ERP), but it is sometimes technically unsuccessful. Endoscopic ultrasound-guided pancreatic drainage (EUS-PD) was developed as an alternative to a surgical approach after failed ERP
    however, the indications for EUS-PD are unclear. In this study, we evaluated the outcomes of EUS-PD and established the indications for EUS-PD. Methods. A total of 15 patients had indications for EUS-PD for recurrent pancreatitis due to pancreatic strictures. There were eight patients with benign pancreatic strictures and seven with malignant pancreatic strictures. The success rate, adverse events, and long-term outcomes were evaluated. Results. The technical success rates of benign and malignant strictures were 75% (6/8) and 100% (7/7), respectively, and clinical success was achieved in 100% (6/6) and 87.5% of cases (6/7), respectively. Rendezvous procedures were performed in two patients with benign strictures. The adverse event (AE) rate was 26.7% (4/15) and included cases of peritonitis, bleeding, and stent migration. Reinterventions were performed in three patients with benign strictures and two with malignant strictures. Conclusions. EUS-PD was an appropriate treatment for not only benign strictures but also malignant strictures with recurrent pancreatitis after failed ERP. However, the AE rate was high, and reinterventions were required in some cases during long-term follow-up. The indications for EUS-PD should be considered carefully, and careful follow-up is needed.

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  • Usefulness of a Cannula with a Flexible Tip (Swing Tip) for Managing Severe Biliary Stricture. 査読

    Uchida D, Kato H, Saragai Y, Takada S, Muro S, Tomoda T, Matsumoto K, Horiguchi S, Okada H

    Canadian journal of gastroenterology & hepatology   2018   7125714   2018年

  • Recurrent bleeding from a hepatic artery pseudoaneurysm after biliary stent placement 査読

    Kenji Yamauchi, Daisuke Uchida, Hironari Kato, Hiroyuki Okada

    Internal Medicine   57 ( 1 )   49 - 52   2018年

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:Japanese Society of Internal Medicine  

    A 78-year-old woman was admitted with benign biliary stenosis. A plastic stent was placed at the left branch to prevent obstructive cholangitis. Two weeks after the procedure, the patient was readmitted with cholangitis caused by hemobilia. However, computed tomography (CT), endoscopic retrograde cholangiopan-creatography (ERCP), peroral cholangioscopy, and abdominal angiography failed to establish the bleeding source. At the seventh bleeding, CT revealed a hepatic artery pseudoaneurysm for which coil embolization was successfully performed. Hemobilia after plastic stent placement is extremely rare. We urge clinicians to consider the possibility of a pseudoaneurysm near the stent when trying to identify the bleeding source.

    DOI: 10.2169/internalmedicine.8983-17

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

    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年12月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:GEORG THIEME VERLAG KG  

    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.

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

    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年11月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:GEORG THIEME VERLAG KG  

    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 査読

    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年10月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:WILEY  

    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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  • 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 査読

    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年7月

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    記述言語:日本語   出版者・発行元:(一社)日本消化器内視鏡学会  

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

    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   29 ( 5 )   617 - 625   2017年7月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:WILEY  

    Background and AimFew 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.
    MethodsEighty-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.
    ResultsOverall 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 &lt; 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).
    ConclusionsSome 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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  • Predictive factors for outcomes of patients undergoing endoscopic therapy for bile leak after hepatobiliary surgery 査読

    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   29 ( 3 )   353 - 361   2017年5月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:WILEY  

    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. 査読 国際誌

    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年5月

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    記述言語:英語  

    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 査読

    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年4月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:WILEY  

    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&lt;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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  • Utility of serum DNA as a marker for KRAS mutations in pancreatic cancer tissue 査読

    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年3月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:Elsevier B.V.  

    Background/Objectives The detection of cancer-specific DNA in peripheral blood, known as a liquid biopsy, has been reported recently. Most such studies have used plasma as a sample
    however, whether or not serum can be used as effectively is unclear. We attempted to clarify suitable samples for detecting KRAS mutations in circulating DNA in the blood of pancreatic cancer patients using droplet digital polymerase chain reaction (PCR). Methods DNA was extracted from the tissue, plasma, and serum of 40 pancreatic cancer patients. The presence of KRAS mutations G12D, G12V, and G12R was analyzed by droplet digital PCR. Results The amount of DNA isolated from the serum was much higher than that from plasma (1.0- to 42.0-fold). At least 1 KRAS mutation was observed in 93% of cancer tissues, whereas we detected the mutations in only 48% of the serum and plasma DNA samples. The G12D mutation was the most prevalent of the three mutations, followed by the G12V mutation. The presence of the G12D KRAS mutation in the plasma, serum, or tissue did not correlate to the overall survival
    however, the prognosis of the patients with a KRAS mutation at G12V in the plasma or serum was significantly poorer than that of the patients without the mutation (P &lt
     0.01). Conclusions Serum and plasma were found to be good materials for detecting cancer-specific DNA in the peripheral blood and the presence of KRAS mutations in blood-derived DNA may be used as a prognostic biomarker for patients with pancreatic cancer.

    DOI: 10.1016/j.pan.2016.12.011

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

    Koichiro Tsutsumi, Hironari Kato, Hiroyuki Okada

    GUT AND LIVER   11 ( 2 )   306 - 311   2017年3月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:EDITORIAL OFFICE GUT & LIVER  

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

    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年1月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:SAGE PUBLICATIONS LTD  

    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 &lt; 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.

    DOI: 10.1177/1756283X16674633

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

    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 AND OTHER INTERVENTIONAL TECHNIQUES   30 ( 12 )   5338 - 5344   2016年12月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:SPRINGER  

    To evaluate the outcomes of management for biliary stricture (BS) after living donor liver transplantation (LDLT) using short-type double-balloon enteroscopy.
    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.
    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).
    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.

    DOI: 10.1007/s00464-016-4886-x

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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 査読

    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

    AMERICAN JOURNAL OF GASTROENTEROLOGY   111 ( 12 )   1750 - 1758   2016年12月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:NATURE PUBLISHING GROUP  

    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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  • 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 査読

    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年10月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:OKAYAMA UNIV MED SCHOOL  

    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 (R) is a newly designed needle with original features. This randomized study will compare the tissue collection rate of EUS Sonopsy CY (R) to that of a conventional needle in EUS-FNA. The major eligibility criteria are as follows: Patients with a pancreatic mass referred for EUS-FNA; age &gt;= 20 years, and performance status &lt; 4. The primary outcome is the tissue collection rate. This study will elucidate the efficacy of EUS Sonopsy CY (R).

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  • miR-1246 and miR-4644 in salivary exosome as potential biomarkers for pancreatobiliary tract cancer 査読

    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 - 2381   2016年10月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:SPANDIDOS PUBL LTD  

    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.

    DOI: 10.3892/or.2016.5021

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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 査読

    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年10月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:OKAYAMA UNIV MED SCHOOL  

    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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  • Novel REIC/Dkk-3-encoding adenoviral vector as a promising therapeutic agent for pancreatic cancer 査読

    H. Sawahara, H. Shiraha, D. Uchida, H. Kato, T. Nagahara, M. Iwamuro, J. Kataoka, S. Horiguchi, M. Watanabe, M. Sakaguchi, A. Takaki, K. Nouso, Y. Nasu, H. Kumon, H. Okada

    CANCER GENE THERAPY   23 ( 8 )   278 - 283   2016年8月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:NATURE PUBLISHING GROUP  

    Reduced expression in immortalized cells (REIC)/dickkopf-3 (Dkk-3), a tumor suppressor gene, is downregulated in various cancers. We previously reported the tumor-inhibitory effects of the REIC/Dkk-3 gene, delivered by a conventional adenoviral vector (Ad-CAG-REIC) in pancreatic cancer. Here, we developed an Ad-REIC vector with a novel gene expression system, termed the super gene expression (SGE) system, and assessed its therapeutic effects relative to those of Ad-CAG-REIC in pantreatic cancer cells. Human pancreatic cancer cell lines ASPC1 and MIAPaCa2 were used. REIC/Dkk-3 expression was assessed by western blot analysis. Relative cell viability and apoptotic effects were examined in vitro. The anti-tumor effects of Ad-REIC treatment were assessed in the mouse xenograft model. Compared with Ad-CAG-REIC, Ad-SGE-REIC elicited a significant increase in REIC protein expression in the cells studied, Relative to Ad-CAG-REIC, Ad-SGE-REIC reduced cell viability and induced apoptosis in the ASPC1 and MIAPaCa2 cell lines in vitro, and achieved superior tumor growth inhibition in the mouse xenograft model. Compared with conventional Ad-REIC agents, Ad-SGE-REIC provided enhanced inhibitory effects against tumor growth. Our results indicate that Ad-SGE-REIC is an innovative therapeutic tool for pancreatic cancer.

    DOI: 10.1038/cgt.2016.31

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

    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 - 325   2016年8月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:OKAYAMA UNIV MED SCHOOL  

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

    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 - 316   2016年8月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:OKAYAMA UNIV MED SCHOOL  

    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 &lt;= 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. 査読

    Kato H, Kawamoto H, Matsumoto K, Moriyama I, Kamada H, Tsutsumi K, Goto D, Fukuba N, Kato K, Sonoyama H, Isomoto H, Okada H

    Journal of digestive diseases   17 ( 8 )   518 - 525   2016年8月

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

    Daisuke Uchida, Koichiro Tsutsumi, Hironari Kato, Hiroyuki Okada

    JOURNAL OF MEDICAL ULTRASONICS   43 ( 3 )   421 - 426   2016年7月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:SPRINGER JAPAN KK  

    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.

    DOI: 10.1007/s10396-016-0720-2

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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. 査読 国際誌

    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年7月

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    記述言語:英語  

    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.

    DOI: 10.1097/TP.0000000000001187

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  • Synergistic anti-pancreatic cancer immunological effects by treatment with reduced expression in immortalized cells/dickkopf-3 protein and peripheral blood mononuclear cells 査読

    Daisuke Uchida, Hidenori Shiraha, Hironari Kato, Hiroaki Sawahara, Teruya Nagahara, Masaya Iwamuro, Junro Kataoka, Shigeru Horiguchi, Masami Watanabe, Akinobu Takaki, Kazuhiro Nouso, Yasutomo Nasu, Hiromi Kumon, Kazuhide Yamamoto

    Journal of Gastroenterology and Hepatology (Australia)   31 ( 6 )   1154 - 1159   2016年6月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:Blackwell Publishing  

    Background and Aim: Reduced expression in immortalized cells/dickkopf-3 (REIC/DKK3) is a reported tumor suppressor gene and has potential to become an innovative therapy for various cancers. We examined the antitumor immunological effects of human REIC/DKK3 protein against pancreatic cancer. Methods: Activation of extracellular signal-regulated kinases 1 and 2, mammalian target of rapamycin, and signal transducer and activator of transcription 3 by REIC/DKK3 protein was assessed in human peripheral blood mononuclear cells using immunoblotting. Pancreatic cancer cell lines (AsPC-1 and MIA Paca-2) were cocultured with peripheral blood mononuclear cells, and the anticancer effects of REIC/DKK3 protein were assessed using the methyl thiazole tetrazolium, cytotoxicity, and enzyme-linked immunospot assays. The antitumor immunological effects of the combined treatment with REIC/DKK3 protein and peripheral blood mononuclear cells were also assessed in a pancreatic cancer model using non-obese diabetic/severe combined immunodeficiency mice. Results: The REIC/DKK3 protein activated extracellular signal-regulated kinases 1 and 2, mammalian target of rapamycin, and signal transducer and activator of transcription 3 in peripheral blood mononuclear cells. REIC/DKK3 protein inhibited in vitro cancer cell viability and enhanced cytotoxicity when incubated with peripheral blood mononuclear cells. REIC/DKK3 protein induced significant production of interferon gamma from lymphocytes incubated with pancreatic cancer cells, indicating that CD8+ T cells were activated in the peripheral blood mononuclear cells when cocultured with AsPC-1 and MIA Paca-2 in the presence of REIC/DKK3 protein. Combined treatment with REIC/DKK3 protein and peripheral blood mononuclear cells produced in vivo anticancer immunostimulatory effects on pancreatic cancer cells. Conclusions: The REIC/DKK3 protein and peripheral blood mononuclear cells synergistically enhanced anticancer immunological effects against pancreatic cancer cells. The observed immunomodulatory effect of combined treatment likely occurs in adenovirus-mediated REIC/DKK3 gene therapy and provides important clues to the therapeutic mechanisms involving immune cells.

    DOI: 10.1111/jgh.13259

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  • A precut fistulotomy technique for difficult biliary cannulation 査読

    Hironari Kato, Koichiro Tsutsumi, Hiroyuki Okada

    DIGESTIVE ENDOSCOPY   28   103 - 103   2016年4月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:WILEY-BLACKWELL  

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  • Development of a Novel REIC/DKK-3-Encoding Adenoviral Agent: Its Robust and Promising Therapeutic Effects in Pancreatic Cancer 査読

    Uchida Daisuke, Shiraha Hidenori, Kato Hironari, Hiroaki Sawahara, Sakaguchi Masakiyo, Watanabe Masami, Nasu Yasutomo, Kumon Hiromi, Okada Hiroyuki

    GASTROENTEROLOGY   150 ( 4 )   S294   2016年4月

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

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

    SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES   30 ( 3 )   1249 - 1254   2016年3月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:SPRINGER  

    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.

    DOI: 10.1007/s00464-015-4323-6

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

    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年1月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:GEORG THIEME VERLAG KG  

    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&lt;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&lt;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.

    DOI: 10.1055/s-0034-1393563

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

    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年

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:Elsevier B.V.  

    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 AIP.

    DOI: 10.1016/j.pan.2015.11.002

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

    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年

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    記述言語:英語  

    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.

    DOI: 10.2169/internalmedicine.55.6741

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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. 査読 国際誌

    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年7月

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    記述言語:英語  

    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 査読

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

    SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES   29 ( 7 )   1944 - 1951   2015年7月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:SPRINGER  

    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.
    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.
    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 (128A degrees (n = 42) vs. 113A degrees (n = 15); p = 0.037), and that was also revealed in 11 patients (15 %) who underwent repeated ERCP by each route (123A degrees vs. 96A degrees; p = 0.003).
    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.

    DOI: 10.1007/s00464-014-3889-8

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

    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年7月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:KARGER  

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

    Kinugasa H, Nouso K, Miyahara K, Morimoto Y, Dohi C, Tsutsumi K, Kato H, Matsubara T, Okada H, Yamamoto K

    Cancer   121 ( 13 )   2271 - 2280   2015年7月

  • Successful biliary drainage using a metal stent through the gastric stoma 査読

    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 - 7597   2015年6月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:BAISHIDENG PUBLISHING GROUP INC  

    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 intrahepatic 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 査読

    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 - 556   2015年5月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:LIPPINCOTT WILLIAMS & WILKINS  

    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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  • Double-balloon enteroscopy for choledochojejunal anastomotic stenosis after hepato-biliary-pancreatic operation 査読

    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   27 ( 1 )   146 - 154   2015年1月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:WILEY-BLACKWELL  

    Background and AimThere 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.
    MethodsForty-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.
    ResultsInsertion 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.
    ConclusionDilation 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.

    DOI: 10.1111/den.12332

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  • Serum Anti-60S Ribosomal Protein L29 Antibody as a Novel Prognostic Marker for Unresectable Pancreatic Cancer 査読

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

    DIGESTION   91 ( 2 )   164 - 173   2015年

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:KARGER  

    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 &gt; cut-off and 7.4 months in 56 patients showing serum anti-RPL29 level &lt;= cutoff. In locally advanced disease, MST was 17.9 months in 22 patients showing serum anti-RPL29 level &gt; cut-off and 10.0 months in 19 patients showing serum anti-RPL29 level &lt;= cutoff. In metastatic disease, MST was 8.7 months in 27 patients showing serum anti-RPL29 level &gt; cut-off and 5.9 months in 37 patients showing serum anti-RPL29 level &lt;= cut-off. In the multivariate Cox proportional hazard model, serum anti-RPL29 level &gt; 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 un-resectable pancreatic cancer. (c) 2015 S. Karger AG, Basel

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  • Endoscopic transgastric drainage of postoperative abdominal abscess after laparoscopic-assisted distal gastrectomy 査読

    Tetsushi Kubota, Shunsuke Kagawa, Satoru Kikuchi, Shinji Kuroda, Masahiko Nishizaki, Yoshiko Mori, Hiroyuki Kishimoto, Takeshi Nagasaka, Hironari Kato, Toshiyoshi Fujiwara

    Japanese Journal of Gastroenterological Surgery   48 ( 3 )   208 - 214   2015年

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    記述言語:日本語   掲載種別:研究論文(学術雑誌)   出版者・発行元:Japanese Society of Gastroenterological Surgery  

    Although rare, intra-abdominal abscess is one possible postoperative complication of gastrectomy for gastric cancer that requires proper management. Generally, CT-guided or echo-guided percutaneous drainage is the first choice as a less-invasive approach, but percutaneous puncture is sometimes difficult because of surrounding viscera. In our case, an obese woman developed intra-abdominal abscess after laparoscopic distal gastrectomy for gastric cancer. The abscess was surrounded by abdominal organs and was difficult to puncture percutaneously. The patient was therefore treated by endoscopic ultrasonography (EUS)-guided drainage through the wall of the remnant stomach. We successfully achieved safe EUS-guided drainage, because EUS clearly showed perigastric abscess and the common hepatic artery. This case demonstrates trans-gastric drainage of perigastric abscess as a safe, less-invasive procedure, even for the remnant stomach after laparoscopic distal gastrectomy.

    DOI: 10.5833/jjgs.2014.0054

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  • Prompt Resolution of Hypoglycemia by Hepatic Transarterial Embolization for Malignant Insulinoma with Multiple Liver Metastases 査読

    Shinichiro Muro, Junichiro Nasu, Ryo Harada, Minoru Matsubara, Asuka Nakarai, Hiromitsu Kanzaki, Kouichiro Tsutsumi, Hironari Kato, Takehiro Tanaka, Hiroyasu Fujiwara, Masatoshi Uno, Hiroyuki Okada, Kazuhide Yamamoto

    ACTA MEDICA OKAYAMA   68 ( 5 )   307 - 311   2014年10月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:OKAYAMA UNIV MED SCHOOL  

    A 45-year-old female who presented with loss of consciousness and a cold sweat was found to have a pancreatic tumor and multiple liver metastases. Laboratory studies showed marked hypoglycemia and inappropriately elevated serum insulin, C-peptide, and serum tumor markers. Fine needle aspiration revealed Grade 3 small-cell type primary pancreatic neuroendocrine carcinoma. Consequently, the diagnosis of malignant insulinoma was made. Transarterial embolization (TAE) for hepatic metastases resulted in the reduction of tumor volume and prompt resolution of hypoglycemic attacks, whereas diazoxide and systemic chemotherapy had been ineffective for controlling blood glucose levels, and octreotide was unavailable due to the allergic effect. This case report highlights the potential usefulness of TAE for malignant insulinomas in the management of hypoglycemia.

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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 査読

    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 - 1779   2014年9月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:H G E UPDATE MEDICAL PUBLISHING S A  

    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, wit a, pancreatic head mass, 3 cases of false negative ELTS-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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  • An expanded training program for endosonographers improved self-diagnosed accuracy of endoscopic ultrasound-guided fine-needle aspiration cytology of the pancreas. 査読 国際誌

    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年9月

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    記述言語:英語  

    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.

    DOI: 10.3109/00365521.2014.915051

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  • Potential of adenovirus-mediated REIC/Dkk-3 gene therapy for use in the treatment of pancreatic cancer 査読

    Daisuke Uchida, Hidenori Shiraha, Hironari Kato, Teruya Nagahara, Masaya Iwamuro, Junro Kataoka, Shigeru Horiguchi, Masami Watanabe, Akinobu Takaki, Kazuhiro Nouso, Yasutomo Nasu, Takahito Yagi, Hiromi Kumon, Kazuhide Yamamoto

    JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY   29 ( 5 )   973 - 983   2014年5月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:WILEY-BLACKWELL  

    Background and AimThe reduced expression in immortalized cells REIC/the dickkopf 3 (Dkk-3) gene, tumor suppressor gene, is downregulated in various malignant tumors. In a prostate cancer study, an adenovirus vector carrying the REIC/Dkk-3 gene (Ad-REIC) induces apoptosis. In the current study, we examined the effects of REIC/Dkk-3 gene therapy in pancreatic cancer.
    MethodsREIC/Dkk-3 expression was assessed by immunoblotting and immunohistochemistry in the pancreatic cancer cell lines (ASPC1, MIAPaCa2, Panc1, BxPC3, SUIT-2, KLM1, and T3M4) and pancreatic cancer tissues. The Ad-REIC agent was used to investigate the apoptotic effect in vitro and antitumor effects in vivo. We also assessed the therapeutic effects of Ad-REIC therapy with gemcitabine.
    ResultsThe REIC/Dkk-3 expression was lost in the pancreatic cancer cell lines and decreased in pancreatic cancer tissues. Ad-REIC induced apoptosis and inhibited cell growth in the ASPC1 and MIAPaCa2 lines in vitro, and Ad-REIC inhibited tumor growth in the mouse xenograft model using ASPC1 cells. The antitumor effect was further enhanced in combination with gemcitabine. This synergistic effect may be caused by the suppression of autophagy via the enhancement of mammalian target of rapamycin signaling.
    ConclusionsAd-REIC induces apoptosis and inhibits tumor growth in pancreatic cancer cell lines. REIC/Dkk-3 gene therapy is an attractive therapeutic tool for pancreatic cancer.

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  • Multicenter retrospective study of endoscopic ultrasound-guided biliary drainage for malignant biliary obstruction in Japan 査読

    Kazumichi Kawakubo, Hiroyuki Isayama, Hironari Kato, Takao Itoi, Hiroshi Kawakami, Keiji Hanada, Hirotoshi Ishiwatari, Ichiro Yasuda, Hirofumi Kawamoto, Fumihide Itokawa, Masaki Kuwatani, Tomohiro Iiboshi, Tsuyoshi Hayashi, Shinpei Doi, Yousuke Nakai

    JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES   21 ( 5 )   328 - 334   2014年5月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:SPRINGER JAPAN KK  

    BackgroundEndoscopic ultrasound-guided biliary drainage (EUS-BD) is considered to be an effective salvage procedure for failed endoscopic retrograde cholangiopancreatography in patients with unresectable malignant biliary obstruction. The aim of this retrospective study was to evaluate the efficacy and feasibility of EUS-BD.
    MethodsFrom November 2006 to May 2012, a total of 64 patients who underwent EUS-BD (44 EUS-guided choledochoduodenostomy [EUS-CDS] and 20 EUS-guided hepaticogastrostomy [EUS-HGS]) at seven tertiary-care referral centers in Japan were included. The primary outcome was the technical success rate, and the secondary outcomes were the incidence of complications, stent dysfunction rate, time to stent dysfunction, and overall survival.
    ResultsThe technical success rate for both EUS-CDS and EUS-HGS was 95%. The reasons for technical failure were two failed dilations of the anastomosis in EUS-CDS and one puncture failure in EUS-HGS. The stent dysfunction rate and 3-month dysfunction-free patency rate were 21% and 80% for EUS-CDS and 32% and 51% for EUS-HGS. There were 12 (six in EUS-CDS and six in EUS-HGS) procedure-related complications (19%): five cases of bile leakage (3/2), three stent misplacements (1/2), one pneumoperitoneum (1/0), two cases of bleeding (1/1), one perforation (1/0), and one biloma (0/1). Bile leakage was more frequently observed in patients who underwent plastic stent placement (11%) than in those with covered metal stents (4%).
    ConclusionsThis Japanese multicenter study revealed a high success rate in EUS-BD. However, the complication rate was as high as that in previous series. Covered metal stents may be useful to reduce bile leakage in EUS-BD.

    DOI: 10.1002/jhbp.27

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

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

    DIGESTIVE ENDOSCOPY   26   130 - 135   2014年4月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:WILEY-BLACKWELL  

    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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  • Usefulness of Early-phase Peritoneal Lavage for Treating Severe Acute Pancreatitis 査読

    Kazuyuki Matsumoto, Yasuhiro Miyake, Morihito Nakatsu, Tatsuya Toyokawa, Masaharu Ando, Mamoru Hirohata, Hironari Kato, Kazuhide Yamamoto

    INTERNAL MEDICINE   53 ( 1 )   1 - 6   2014年

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:JAPAN SOC INTERNAL MEDICINE  

    Objective To improve the prognosis of severe acute pancreatitis, preventing infectious complications, particularly infected pancreatic necrosis, is important. The present study evaluated the efficacy of peritoneal lavage for improving the prognosis of patients with severe acute pancreatitis.
    Patients We retrospectively reviewed the cases of 23 consecutive patients with severe acute pancreatitis who were treated with peritoneal lavage.
    Results Peritoneal lavage was started within 72 hours after the initial onset of symptoms in 20 patients (87%). The duration of peritoneal lavage, which was significantly correlated with the number of prognostic factors according to the revised Japanese criteria, Ranson score and serum C-reactive protein level at the start of peritoneal lavage, was a median of seven (3-22) days. There were no adverse events associated with the peritoneal lavage. Eight patients (35%) concurrently underwent continuous regional arterial infusion. Five days after starting peritoneal lavage, the patients' clinical conditions significantly improved. Overall, the survival rate was 96%. One patient (4%) died due to rupture of a pseudoaneurysm of the splenic artery. Complications occurred in seven patients (30%). Infectious complications were observed in three patients (13%) (one patient developed infected pancreatic necrosis and bacteremia, and two patients developed bacteremia). Pseudocysts and pancreatic fistulas developed in five and one patient, respectively. The incidence of complications was lower in the patients receiving peritoneal lavage within 72 hours from the initial onset of symptoms than in the remaining patients (20% vs. 100%; p= 0.005).
    Conclusion We speculate that peritoneal lavage reduces the mortality and incidence of complications in patients with severe acute pancreatitis.

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  • Endoscopic papillary large balloon dilation後の胆道出血に対してSelf-expandable metallic stent留置が有用であった1例

    皿谷 洋祐, 田中 盛富, 日吉 智子, 平田 尚志, 谷岡 大輔, 横峰 和典, 藤本 剛, 宮下 真奈備, 田中 彰一, 加藤 博也

    日本消化器内視鏡学会雑誌   56 ( 12 )   3980 - 3987   2014年

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    記述言語:日本語   出版者・発行元:Japan Gastroenterological Endoscopy Society  

    症例は82歳男性.高度な腎機能障害を認めていた.径18×13mmの総胆管結石に対する治療目的でERCPを施行した.Endoscopic sphincterotomyを施行し,10-12mmの胆道拡張用バルーンカテーテルを用いてEndoscopic papillary large balloon dilationを施行したところ,胆道から噴出性の出血を認めた.圧迫止血による止血は困難であったがpartial covered Self-expandable metallic stent(SEMS)留置により止血が得られ,手術や血管内治療を回避できた.SEMSは21日後に偶発症なく抜去した.

    DOI: 10.11280/gee.56.3980

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

    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 - 1179   2013年10月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:SPRINGER JAPAN KK  

    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.
    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.
    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 &lt; 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).
    Comprehensive glycome analysis can be used to know the presence of pancreatic cancer, distant metastasis, and patient prognosis, simultaneously.

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  • Management of Occluded Metallic Stents in Malignant Hilar Biliary Stricture 査読

    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 - 451   2013年5月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:H G E UPDATE MEDICAL PUBLISHING S A  

    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 査読

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

    DIGESTIVE ENDOSCOPY   25   75 - 80   2013年5月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:WILEY-BLACKWELL  

    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 usingthe 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.

    DOI: 10.1111/den.12061

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  • Interventional EUS の現況と展望

    伊佐山 浩通, 糸井 隆夫, 河上 洋, 加藤 博也, 潟沼 朗生, 良沢 昭銘

    日本消化器病學會雜誌 = The Japanese journal of gastro-enterology   110 ( 4 )   592 - 614   2013年4月

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    記述言語:日本語   出版者・発行元:The Japanese Society of Gastroenterology  

    DOI: 10.11405/nisshoshi.110.592

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

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

    HEPATO-GASTROENTEROLOGY   60 ( 122 )   286 - 290   2013年3月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:H G E UPDATE MEDICAL PUBLISHING S A  

    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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  • 胆管-胆管吻合による生体肝移植後胆管狭窄に対する内視鏡治療

    加藤 博也, 榊原 一郎, 岡田 裕之, 山本 和秀

    日本消化器内視鏡学会雑誌 = Gastroenterological endoscopy   55 ( 2 )   316 - 328   2013年2月

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    記述言語:日本語   出版者・発行元:Japan Gastroenterological Endoscopy Society  

    胆管-胆管吻合による生体肝移植後(LDLT)の胆道合併症は重大な術後合併症の1つであり,患者の予後に関わるものである.なかでも術後の胆管狭窄は頻度も高く,そのマネージメントが重要である.LDLT後の胆管狭窄に対する内視鏡治療はまず行うべき治療であるが,その解剖学的な特徴から脳死肝移植後や通常の外科手術後の胆管狭窄に対する内視鏡治療と比較して手技的な難易度が高い.内視鏡治療は胆管造影から,ガイドワイヤーによる狭窄の突破,バルーン拡張,プラスチックステントの留置まで行うが,それぞれの段階でのポイントを理解しておく必要がある.また,LDLTでは移植肝のローテーションや肥大のために,胆管の走行の理解がしばしば困難となるため,内視鏡治療前の外科医からの情報や事前のMRCPなどの画像検査が重要である.各々の症例によって狭窄の程度や胆管の走行が異なるため,症例に応じた治療が重要であるのとともに,よりコンセンサスの得られた手技の確立が必要である.

    DOI: 10.11280/gee.55.316

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  • Diagnosis of a Solid Pseudopapillary Neoplasm Using EUS-FNA 査読

    Masakuni Fujii, Hiroaki Saito, Hironari Kato, Toru Kojima, Mamoru Ito, Shuhei Ishiyama, Akiko Fujiwara, Takefumi Niguma, Masao Yoshioka, Junji Shiode, Tetsushige Mimura, Kazuhide Yamamoto

    INTERNAL MEDICINE   52 ( 15 )   1703 - 1708   2013年

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:JAPAN SOC INTERNAL MEDICINE  

    A woman in her 50s was found to have a pancreatic mass on abdominal ultrasound. The tumor measured 40 mm in diameter and included a cystic lesion and calcification. In this case, we suspected a diagnosis of solid pseudopapillary neoplasm (SPN) due to the findings observed on various images. However, we were unable to exclude the possibility that the lesion was a neuroendocrine tumor. Therefore, we performed endoscopic ultrasound (EUS)-guided fine-needle aspiration (EUS-FNA). In addition, in order to confirm the diagnosis of SPN, we performed minimized resection (segmental pancreatectomy). Obtaining a definitive preoperative diagnosis of SPN using EUS-FNA can guide the surgical approach.

    DOI: 10.2169/internalmedicine.52.0238

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  • Loss of runt-related transcription factor 3 induces gemcitabine resistance in pancreatic cancer 査読

    Shigeru Horiguchi, Hidenori Shiraha, Teruya Nagahara, Jyunnro Kataoka, Masaya Iwamuro, Minoru Matsubara, Shinichi Nishina, Hironari Kato, Akinobu Takaki, Kazuhiro Nouso, Takehiro Tanaka, Koichi Ichimura, Takahito Yagi, Kazuhide Yamamoto

    Molecular Oncology   7 ( 4 )   840 - 849   2013年

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:John Wiley and Sons Ltd  

    Background &amp
    Aim: Runt-related transcription factor 3 (RUNX3) is a tumor suppressor gene that is expressed in gastric and other cancers including pancreatic cancer. However, the precise function of RUNX3 in pancreatic cancer has not been fully elucidated. In this study, we aimed to determine the effect of decreased RUNX3 expression in pancreatic cancer. Methods: This study included 36 patients with primary pancreatic cancer, who had undergone pancreaticoduodenectomy. All patients were treated with 1000mg/m2 gemcitabine after the surgery. The pancreatic cancer cell lines PANC-1, MIAPaCa-2, BxPC-3, SUIT-2, and KLM-1 were used for immunoblotting analysis of RUNX3 and multidrug resistance protein (MRP) expressions. Ectopic RUNX3 expression was achieved by cDNA transfection of the cells, and small interfering RNA (siRNA) against RUNX3 was used to knock down endogenous RUNX3. Cell growth in the presence of gemcitabine was assessed using the MTT assay. Results: Patients with RUNX3-positive and RUNX3-negative pancreatic cancer had a median survival of 1006 and 643 days, respectively. Exogenous RUNX3 expression reduced the expression of MRP1, MRP2, and MRP5 in endogenous RUNX3-negative cells, whereas RUNX3 siRNA increased the expressions of these genes in endogenous RUNX3-positive cells. Exogenous RUNX3 expression decreased gemcitabine IC50 in RUNX3-negative cells. Conclusion: Loss of RUNX3 expression contributes to gemcitabine resistance by inducing MRP expression, thereby resulting in poor patient survival. © 2013 Federation of European Biochemical Societies.

    DOI: 10.1016/j.molonc.2013.04.004

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  • Japanese multicenter experience of endoscopic necrosectomy for infected walled-off pancreatic necrosis: The JENIPaN study 査読

    I. Yasuda, M. Nakashima, T. Iwai, H. Isayama, T. Itoi, H. Hisai, H. Inoue, H. Kato, A. Kanno, K. Kubota, A. Irisawa, H. Igarashi, Y. Okabe, M. Kitano, H. Kawakami, T. Hayashi, T. Mukai, N. Sata, M. Kida, T. Shimosegawa

    Endoscopy   45 ( 8 )   627 - 634   2013年

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

    Background and study aims: Only a few large cohort studies have evaluated the efficacy and safety of endoscopic necrosectomy for infected walled-off pancreatic necrosis (WOPN). Therefore, a multicenter, large cohort study was conducted to evaluate the efficacy and safety of endoscopic necrosectomy and to examine the procedural details and follow-up after successful endoscopic necrosectomy. Patients and methods: A retrospective review was conducted in 16 leading Japanese institutions for patients who underwent endoscopic necrosectomy for infected WOPN between August 2005 and July 2011. The follow-up data were also reviewed to determine the long-term outcomes of the procedures. Results: Of 57 patients, 43 (75 %) experienced successful resolution after a median of 5 sessions of endoscopic necrosectomy and 21 days of treatment. Complications occurred in 19 patients (33 %) during the treatment period. Six patients died (11 %): two due to multiple organ failure and one patient each from air embolism, splenic aneurysm, hemorrhage from a Mallory - Weiss tear, and an unknown cause. Of 43 patients with successful endoscopic necrosectomy, recurrent cavity formation was observed in three patients during a median follow-up period of 27 months. Conclusions: Endoscopic necrosectomy can be an effective technique for infected WOPN and requires a relatively short treatment period. However, serious complications can arise, including death. Therefore, patients should be carefully selected, and knowledgeable, skilled, and experienced operators should perform the procedure. Further research into safer technologies is required in order to reduce the associated morbidity and mortality. © Georg Thieme Verlag KG Stuttgart · New York.

    DOI: 10.1055/s-0033-1344027

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  • Partial stent-in-stent placement of biliary metallic stents using a short double-balloon enteroscopy 査読

    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 - 6676   2012年12月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:BAISHIDENG PUBL GRP CO LTD  

    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. (C) 2012 Baishideng. All rights reserved.

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

    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   24 ( 5 )   370 - 373   2012年9月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:WILEY-BLACKWELL  

    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.

    DOI: 10.1111/j.1443-1661.2012.01300.x

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

    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年9月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:KARGER  

    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 UP 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 (C) 2012, IAP and EPC. Published by Elsevier India, a division of Reed Elsevier India Pvt. Ltd. All rights reserved.

    DOI: 10.1016/j.pan.2012.07.009

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

    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年1月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:ELSEVIER IRELAND LTD  

    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 10 mm 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. (C) 2010 Elsevier Ireland Ltd. All rights reserved.

    DOI: 10.1016/j.ejrad.2010.11.027

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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 査読

    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年12月

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    記述言語:日本語   出版者・発行元:(一社)日本移植学会  

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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 査読

    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 - 645   2011年12月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:SPRINGER TOKYO  

    This randomized phase II study compared the efficacy and toxicity between 4-week and 3-week schedules of gemcitabine monotherapy in advanced pancreatic cancer.
    Patients with advanced pancreatic cancer were randomly assigned to either a 4-week schedule (gemcitabine at 1000 mg/mA(2) as a 30-min infusion weekly for 3 consecutive weeks every 4 weeks) or a 3-week schedule (gemcitabine at 1000 mg/mA(2) 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.
    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 &lt; 70000/mmA(3)) 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/mA(2)/week (p = 0.14).
    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.

    DOI: 10.1007/s10147-011-0237-z

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  • Effect of Low-Dose Gemcitabine on Unresectable Pancreatic Cancer in Elderly Patients 査読

    Kazuyuki Matsumoto, Yasuhiro Miyake, Hironari Kato, Hirofumi Kawamoto, Atsushi Imagawa, Tatsuya Toyokawa, Morihito Nakatsu, Masaharu Ando, Mamoru Hirohata, Kazuhide Yamamoto

    DIGESTION   84 ( 3 )   230 - 235   2011年

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:KARGER  

    Background/Aims: The efficacy of gemcitabine (GEM) on unresectable pancreatic cancer has been reported. However, in elderly patients, severe toxicities are frequently observed. In this study we aimed to assess the efficacy of low-dose GEM on unresectable pancreatic cancer in elderly patients. Methods: We reviewed 68 elderly patients (6 65 years) with unresectable pancreatic cancer. Thirty-six patients were treated with low-dose GEM (600-800 mg/m(2); GEM group), and the other 32 received best supportive care (BSC group). Results: Median survival was 7.6 and 2.3 months in the GEM and BSC groups, respectively. In the GEM group, the median survival period was longer in 24 patients showing partial response or stable disease than in 12 patients showing progressive disease (11.4 vs. 5.3 months). Furthermore, the patients showing progressive disease had better 6-month survival than patients in the BSC group. Thirteen patients (36%) developed severe toxicities (grade 3 or 4). Low-dose GEM, stage of disease and performance status were associated with the prognosis. Conclusions: Low-dose GEM may improve the prognosis of elderly patients with un-resectable pancreatic cancer. Furthermore, frequencies of severe toxicity seem lower in patients treated with low-dose GEM compared with previous reports. Copyright (C) 2011 S. Karger AG, Basel

    DOI: 10.1159/000330384

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  • Single-Pattern Convergence of K-ras Mutation Correlates With Surgical Indication of Intraductal Papillary Mucinous Neoplasms 査読

    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 - 621   2010年7月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:LIPPINCOTT WILLIAMS & WILKINS  

    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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  • COMBINED DUODENAL STENT PLACEMENT AND ENDOSCOPIC ULTRASONOGRAPHY-GUIDED BILIARY DRAINAGE FOR MALIGNANT DUODENAL OBSTRUCTION WITH BILIARY STRICTURE 査読

    Masaya Iwamuro, Hirofumi Kawamoto, Ryo Harada, Hironari Kato, Ken Hirao, Osamu Mizuno, Etsuji Ishida, Tsuneyoshi Ogawa, Hiroyuki Okada, Kazuhide Yamamoto

    DIGESTIVE ENDOSCOPY   22 ( 3 )   236 - 240   2010年7月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:WILEY-BLACKWELL  

    Patients with malignant pancreatobiliary neoplasm sometimes manifest duodenal obstruction and biliary stricture synchronously or metachronously. In this paper, we reviewed our experience with and technique for combined endoscopic duodenal stent placement and endoscopic ultrasonography (EUS)-guided biliary drainage. Between May 2007 and September 2009, this combined technique was performed on seven patients with distal biliary strictures and duodenal obstructions. The clinical success rate of the procedure, complications, patency periods of duodenal stents and patency periods of biliary stents were retrospectively evaluated. Clinical success was achieved in all seven cases for both procedures. Complications related to EUS-biliary drainage, namely localized peritonitis due to bile leakage, occurred in two cases. Both patients recovered without additional interventions. Occlusion of a duodenal stent was observed in one patient, but additional intervention could not be performed due to sepsis. Occlusion of both a duodenal stent and a biliary stent was also observed in one patient, and this was resolved with the insertion of an additional duodenal stent and a biliary stent exchange. In conclusion, combined duodenal stent placement and EUS-guided biliary drainage is a therapeutic option in case of failed endoscopic retrograde cannulation of malignant strictures with a malignant duodenal obstruction.

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  • Nonprevention of Post-Endoscopic Retrograde Cholangiopancreatographic Pancreatitis by Pancreatic Stent After Aspiration of Pure Pancreatic Juice in Patients With Intraductal Papillary Mucinous Neoplasms of the Pancreas 査読

    Ryo Harada, Hirofumi Kawamoto, Hirotoshi Fukatsu, Hironari Kato, Ken Hirao, Naoko Kurihara, Osamu Mizuno, Tsuneyoshi Ogawa, Etsuji Ishida, Hiroyuki Okada, Kazuhide Yamamoto, Hiroshi Yamamoto

    PANCREAS   39 ( 3 )   340 - 344   2010年4月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:LIPPINCOTT WILLIAMS & WILKINS  

    Objectives: The objective of this study was to evaluate the efficacy of a pancreatic stent regarding the prevention of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis after aspiration of pure pancreatic juice in patients with intraductal papillary mucinous neoplasms.
    Methods: A retrospective study was made to assess the outcome in 121 consecutive patients with intraductal papillary mucinous neoplasms who underwent endoscopic aspiration of pure pancreatic juice for cytologic examination between July 2001 and October 2007. From July 2001 to March 2004, 58 patients did not undergo pancreatic stent insertion (the no-stent [nS] group). The remaining 63 patients did undergo stent insertion (stent [S] group).
    Results: The overall incidences of post-ERCP pancreatitis was 11 (9.1%). The incidences of post-ERCP pancreatitis in the S and nS groups were 8 (12.7%) and 3 (5.2%; P = 0.21), respectively. In the male patients and the patients with a smaller diameter of the main pancreatic ducts, post-ERCP pancreatitis was seen more frequently in those in the S group (13% and 21%, respectively) than in those in the nS group (0% and 0%, respectively; P = 0.04, 0.03).
    Conclusions: The pancreatic stent did not seem to decrease the incidence of post-ERCP pancreatitis in patients with intraductal papillary mucinous neoplasms. Furthermore, the pancreatic stent seems to be potentially detrimental in male patients and in patients with small-diameter main pancreatic ducts.

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  • Prevention of biliary complication in radiofrequency ablation for hepatocellular carcinoma-Cooling effect by endoscopic nasobiliary drainage tube 査読

    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 - 390   2010年2月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:ELSEVIER IRELAND LTD  

    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 1 ml/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. (C) 2008 Elsevier Ireland Ltd. All rights reserved.

    DOI: 10.1016/j.ejrad.2008.10.021

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

    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   22 ( 9 )   914 - 921   2009年9月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:WILEY-BLACKWELL PUBLISHING, INC  

    P&gt;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.

    DOI: 10.1111/j.1432-2277.2009.00895.x

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  • Quantitative assessment of technical proficiency in performing needle-knife precut papillotomy 査読

    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 AND OTHER INTERVENTIONAL TECHNIQUES   23 ( 9 )   2066 - 2072   2009年9月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:SPRINGER  

    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.
    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).
    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 &lt; 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.
    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.

    DOI: 10.1007/s00464-008-9969-x

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  • Santorinicele in a patient with unresectable pancreatic cancer.

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

    Internal medicine (Tokyo, Japan)   47 ( 1 )   33-35   2008年8月

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    掲載種別:研究論文(学術雑誌)  

    DOI: 10.2169/internalmedicine.47.0090

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

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

    Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association   6 ( 4 )   401-408   2008年4月

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    掲載種別:研究論文(学術雑誌)  

    DOI: 10.1016/j.cgh.2007.12.036

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  • Evaluation of needle-knife precut papillotomy after unsuccessful biliary cannulation, especially with regard to postoperative anatomic factors 査読

    Hirotoshi Fukatsu, Hirofumi Kawamoto, Hironari Kato, Ken Hirao, Naoko Kurihara, Takashi Nakanishi, Osamu Mizuno, Yuko Okamoto, Tsuneyoshi Ogawa, Etsuji Ishida, Hiroyuki Okada, Kohsaku Sakaguchi

    SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES   22 ( 3 )   717 - 723   2008年3月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:SPRINGER  

    Background Biliary cannulation is the first step in therapeutic endoscopic retrograde cholangiopancreatography. This study aimed to evaluate unsuccessful cases of biliary cannulation in which the standard procedure was changed to a needle-knife precut papillotomy (NKPP), with particular attention given to postoperative anatomic factors.
    Methods Between October 2002 and February 2006, a total of 501 consecutive patients with an intact duodenal papilla were retrospectively investigated. After biliary cannulation using standard maneuvers was unsuccessful within 20 min, NKPP was performed in 80 cases (16%). The clinical backgrounds for difficult biliary cannulation were compared between patients who had standard maneuvers (n = 421, 84%) and those who underwent NKPP.
    Results For 76 difficult cannulation cases (95%), successful cannulation after NKPP was accomplished, and the total success rate reached 99% (497/501). Multivariate analysis indicated that female gender (odds ratio [OR], 2.25; 95% confidence interval [CI], 1.34-3.79), left lobe hypertrophy after hepatectomy (OR, 6.25; 95% CI, 2.52-15.54), history of Billroth I reconstruction after gastrectomy (OR, 7.49; 95% CI, 2.55-22.02), and malignant biliary stricture (OR, 2.31; 95% CI, 1.21- 4.41) were significant risk factors associated with unsuccessful standard procedures used for biliary cannulation. Complications after NKPP were observed in nine cases (11%), all of which were pancreatitis.
    Conclusions Difficult biliary cannulation was strongly associated with postoperative anatomic factors. In these situations, early introduction of NKPP should be recommended if the conventional biliary cannulation promises to be difficult.

    DOI: 10.1007/s00464-007-9473-8

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  • Endoscopic 3-branched partial stent-in-stent deployment of metallic stents in high-grade malignant hilar biliary stricture 査読

    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 - 1037   2007年11月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:MOSBY-ELSEVIER  

    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 biliaty 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.

    DOI: 10.1016/j.gie.2007.06.055

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MISC

  • 【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年6月

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    記述言語:日本語   出版者・発行元:医学図書出版(株)  

    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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  • 【消化器ステンティングのすべて】胆膵 良性胆管狭窄における経乳頭的アプローチ

    加藤 博也, 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 ( 5 )   812 - 818   2019年5月

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    記述言語:日本語   出版者・発行元:(株)東京医学社  

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  • 膵・胆管合流異常に合併した胆嚢癌術後に膵管内乳頭粘液性腺癌(IPMC)を発生した1例

    池田 愛璃, 松本 和幸, 加藤 博也, 田中 顕之, 赤穂 宗一郎, 室 信一郎, 内田 大輔, 友田 健, 堀口 繁, 岡田 裕之

    日本消化器病学会雑誌   116 ( 3 )   241 - 248   2019年3月

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    記述言語:日本語   出版者・発行元:(一財)日本消化器病学会  

    症例は71歳、女性。胆管非拡張型の膵・胆管合流異常(PBM)および胆嚢隆起性病変に対して5年前に腹腔鏡下胆嚢摘出術を施行し、病理結果は胆嚢癌であった。術後、緩徐に主膵管が拡張し、頭部の主膵管内に腫瘤が出現したため膵頭十二指腸切除術を施行した。病理では主膵管内に乳頭状に発育する腫瘍であり、免疫染色で膵胆道型の膵管内乳頭粘液性腺癌と診断した。PBMでは膵臓の悪性腫瘍にも注意が必要である。(著者抄録)

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  • 【エキスパートへの道-胆・膵】ERCP関連 治療手技 胆管・膵管ドレナージ 術後胆管狭窄 内外瘻の選択、inside stent、CSEMS

    加藤 博也, 岡田 裕之

    消化器内視鏡   31 ( 3 )   433 - 439   2019年3月

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    記述言語:日本語   出版者・発行元:(株)東京医学社  

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  • 膵癌におけるFNA検体と切除検体とのPD-L1発現の検討

    松本和幸, 高木章乃夫, 大原利章, 藤澤真義, 高原政宏, 加藤博也, 吉田龍一, 楳田祐三, 八木孝仁, 松川昭博, 岡田裕之

    日本消化器病学会雑誌(Web)   116   2019年

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  • 【Biliary access大辞典】経乳頭的biliary access カニュレーションテクニック ESTナイフを用いたカニュレーションテクニック

    加藤 博也, 松三 明宏, 石原 裕基, 矢部 峻太郎, 室 信一郎, 内田 大輔, 友田 健, 松本 和幸, 堀口 繁, 岡田 裕之

    胆と膵   39 ( 臨増特大 )   975 - 980   2018年11月

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    記述言語:日本語   出版者・発行元:医学図書出版(株)  

    ESTナイフを用いたカニュレーションは、極端な見下ろしや見上げなど、乳頭の位置が通常のカテーテルでは挿管困難な位置にくる場合や、術後や腫瘍の浸潤のために消化管が固定され、スコープの動きが制限される場合に有用である。ESTナイフのスペックは、ブレードまでの先端長、ブレードの長さによってさまざまである。ブレード長については、基本的にブレードを鉗子口から完全に出した状態で操作するため、長くないほうが乳頭との距離を離さずにすむが、逆にあまりに短いとESTが困難となるのでバランスのとれたものを使用するとよい。造影法による挿管、wire-guidedによる挿管、両者を組み合わせての挿管、さまざまな方法があるが、カテーテルの向きを胆管軸に合わせるという基本的な部分は造影法と同様であるが、ESTナイフをカテーテルとして使用する独自のポイントもおさえておかなければならない。(著者抄録)

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  • 【胆膵ドレナージupdate】[胆道ドレナージ] 肝門部悪性胆道狭窄に対する経乳頭的胆道ドレナージ

    加藤 博也, 矢部 俊太郎, 室 信一郎, 内田 大輔, 友田 健, 松本 和幸, 堀口 繁, 岡田 裕之

    消化器内視鏡   30 ( 11 )   1523 - 1530   2018年11月

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    記述言語:日本語   出版者・発行元:(株)東京医学社  

    肝門部悪性胆道狭窄に対する経乳頭的胆道ドレナージは切除、非切除によってドレナージ領域や使用するステントが異なる。切除症例に対しては、残肝側をドレナージするのが原則であり、内視鏡的経鼻胆管ドレナージ(ENBD)を基本としたプラスチックステントによるドレナージを行う。非切除症例に対しては、re-interventionを含め手技的に可能であれば金属ステントによる両葉ドレナージを行う。金属ステントの両葉留置の方法として、従来のpartial stent-in-stent法(PSIS)に加え、デリバリーの細径化によりside-by-side法(SBS)による留置を行うことが可能となった。PSISでは、2本目の留置の際のステントの間隙をガイドワイヤーやカテーテル、さらにはステントデリバリーを通過させることが、また、SBSでは展開の際ステントの乳頭側を一致させることが手技上のポイントである。いずれの手技も普段からガイドワイヤーや金属ステントの扱いに慣れておくことが重要である。(著者抄録)

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  • 【胆膵疾患内視鏡アトラス】胆管 狭窄 胆管癌以外の悪性胆道狭窄

    松本 和幸, 田中 顕之, 加藤 博也

    消化器内視鏡   30 ( 増刊 )   126 - 129   2018年10月

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    記述言語:日本語   出版者・発行元:(株)東京医学社  

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  • 良性胆道狭窄に対する内視鏡治療の現況

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

    胆道   32 ( 4 )   732 - 742   2018年10月

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    記述言語:日本語   出版者・発行元:日本胆道学会  

    良性胆管狭窄の内視鏡治療は、ガイドワイヤーによる狭窄突破、狭窄部拡張、ステント留置が基本的な流れである。ステントについてはメタリックステント(MS)の有用性の報告が多く見られる。狭窄の改善率や再狭窄率において、プラスティックステント(PS)の複数本留置とMS留置に大きな差はないが、手技的にはMS留置の方が容易であり、交換頻度も少ないという点で有用である。実際の治療においては原疾患によって治療のストラテジーが異なることを理解しておかなければならない。慢性膵炎は術後胆管狭窄と比較して狭窄の改善率が低く、再狭窄率も高いため、症例によっては手術も選択肢の一つとなる。一方、術後胆管狭窄はいったん改善すれば長期予後も良好であるが、生体肝移植後は手技成功率やステント抜去率が低く治療が難しい傾向にある。原発性硬化性胆管炎に伴う胆管狭窄は、PS留置の前に胆管拡張のみで経過をみることが感染回避に重要である。(著者抄録)

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  • 経口胆道鏡診療の現況と今後 ERCPでは判別不能な病変の診断、直視下での治療が可能。関連処置具のさらなる改良・開発が望まれる

    石田 祐介, 加藤 博也

    日本医事新報   ( 4912 )   57 - 58   2018年6月

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    記述言語:日本語   出版者・発行元:(株)日本医事新報社  

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  • 術後腸管症例に対する胆膵内視鏡治療の現状と今後 バルーン内視鏡、超音波内視鏡により多くの症例が施術の対象に

    加藤 博也, 中井 陽介

    日本医事新報   ( 4909 )   54 - 54   2018年5月

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    記述言語:日本語   出版者・発行元:(株)日本医事新報社  

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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

    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年3月

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    記述言語:日本語   出版者・発行元:(一社)日本医療薬学会  

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

    Shigeru Horiguchi, Koichiro Tsutsumi, Hironari Kato, Hiroyuki Okada

    ENDOSCOPY   49 ( 9 )   E204 - E205   2017年9月

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    記述言語:英語   出版者・発行元:GEORG THIEME VERLAG KG  

    DOI: 10.1055/s-0043-108543

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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

    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年8月

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    記述言語:日本語   出版者・発行元:(一社)日本消化器内視鏡学会  

    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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  • A Multicenter, Prospective, Randomized Controlled Trial Evaluating the Efficacy of Rectal Diclofenac and Sublingual Nitroglycerin as a Combined Prophylactic Treatment for Post-ERCP Pancreatitis (vol 70, pg 405, 2016)

    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 - +   2017年8月

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    記述言語:英語   出版者・発行元:OKAYAMA UNIV MED SCHOOL  

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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

    Koichiro Tsutsumi, Hironari Kato, Hiroyuki Okada

    DIGESTIVE ENDOSCOPY   29 ( 5 )   642 - 643   2017年7月

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    記述言語:英語   掲載種別:速報,短報,研究ノート等(学術雑誌)   出版者・発行元:WILEY  

    DOI: 10.1111/den.12881

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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年7月

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    記述言語:英語   掲載種別:研究発表ペーパー・要旨(国際会議)   出版者・発行元:LIPPINCOTT WILLIAMS & WILKINS  

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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年5月

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    記述言語:日本語   出版者・発行元:(株)東京医学社  

    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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  • Mid- to Long-Term Outcomes After Therapeutic Ercp Using Balloon-Assisted Enteroscopy for Anastomotic Stenosis of Choledochojejunostomy or Pancreaticojejunostomy: A Multicenter Observation Study in Japan

    Itsuki Sano, Akio Katanuma, Masaki Kuwatani, Hiroshi Kawakami, Hironari Kato, Takao Itoi, Michihiro Ono, Atsushi Irisawa, Yoshinobu Okabe, Takuji Iwashita, Ichiro Yasuda, Shomei Ryozawa, Seiji Kaino, Naoya Sakamoto

    GASTROINTESTINAL ENDOSCOPY   85 ( 5 )   AB228 - AB229   2017年5月

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    記述言語:英語   掲載種別:研究発表ペーパー・要旨(国際会議)   出版者・発行元:MOSBY-ELSEVIER  

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  • THE DEVELOPMENT OF NON-INVASIVE METHOD FOR THE MOLECULAR DIAGNOSIS OF GALLBLADDER CANCER

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

    GASTROENTEROLOGY   152 ( 5 )   S299 - S299   2017年4月

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    記述言語:英語   掲載種別:研究発表ペーパー・要旨(国際会議)   出版者・発行元:W B SAUNDERS CO-ELSEVIER INC  

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  • SUITABLE LIQUID BIOPSY SAMPLES FOR DETECTING KRAS MUTATIONS IN PATIENTS WITH PANCREATIC CANCER

    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 - S490   2017年4月

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    記述言語:英語   掲載種別:研究発表ペーパー・要旨(国際会議)   出版者・発行元:W B SAUNDERS CO-ELSEVIER INC  

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  • Recent advancements in stent therapy in patients with malignant gastroduodenal outlet obstruction. 国際誌

    Hironari Kato, Koichiro Tsutsumi, Hiroyuki Okada

    Annals of translational medicine   5 ( 8 )   186 - 186   2017年4月

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    記述言語:英語  

    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.

    DOI: 10.21037/atm.2017.02.11

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  • EPLBD診療ガイドライン

    糸井 隆夫, 良沢 昭銘, 潟沼 朗生, 岡部 義信, 洞口 淳, 加藤 博也, 土屋 貴愛, 藤田 直孝, 安田 健治朗, 五十嵐 良典, 後藤田 卓志, 藤本 一眞, 金 俊文, 日本消化器内視鏡学会, EPLBD診療ガイドラインワーキング委員会

    Gastroenterological Endoscopy   59 ( 3 )   337 - 365   2017年3月

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    記述言語:日本語   出版者・発行元:(一社)日本消化器内視鏡学会  

    日本消化器内視鏡学会は、新たに科学的な手法で作成した基本的な指針として、「EPLBD診療ガイドライン」を作成した。EPLBDは近年普及している総胆管結石に対する治療法の一つである。この分野においてはエビデンスレベルが低いものが多く、専門家のコンセンサスに基づき推奨の強さを決定しなければならないものが多かった。本診療ガイドラインは「EST診療ガイドライン」に準じて、定義と適応、手技、特殊な症例への対処、偶発症、治療成績、術後経過観察の6つの項目に分け、現時点での指針とした。(著者抄録)

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  • Tubular adenoma arising in a choledochocele

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

    GASTROINTESTINAL ENDOSCOPY   84 ( 6 )   1066 - 1067   2016年12月

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    記述言語:英語   出版者・発行元:MOSBY-ELSEVIER  

    DOI: 10.1016/j.gie.2016.07.010

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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年11月

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    記述言語:英語   掲載種別:研究発表ペーパー・要旨(国際会議)   出版者・発行元:WILEY-BLACKWELL  

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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年11月

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    記述言語:日本語   出版者・発行元:医学図書出版(株)  

    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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  • 【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年10月

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    記述言語:日本語   出版者・発行元:(株)東京医学社  

    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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  • 【膵癌分子診断研究の最前線:リキッドバイオプシーから次世代DNAシークエンシングまで】膵癌診断におけるリキッドバイオプシーの可能性

    衣笠 秀明, 能祖 一裕, 赤穂 宗一郎, 加藤 博也, 岡田 裕之

    胆と膵   37 ( 9 )   841 - 845   2016年9月

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    記述言語:日本語   出版者・発行元:医学図書出版(株)  

    膵癌は早期発見が非常に困難であることが知られている。また、膵癌組織を得るにも侵襲を伴い、また十分量の組織量を確保することが難しい。このような背景のなかで、従来のBiopsyに対して、新たに非侵襲的な手法としてLiquid biopsyが注目されている。膵癌は他の癌種と比較しても、比較的Driver mutationが明らかにされている癌種であり、膵癌診断において血液中のCTCやctDNAをターゲットとしたLiquid biopsyは非常に有用である。また、癌診断、癌治療を困難にしている原因の一つである腫瘍の不均一性という観点からも、腫瘍の一部を評価する従来のBiopsyとは違い、腫瘍全体を一括に評価できる可能性も秘めている。今後、診断だけでなく、病勢モニタリング、薬剤耐性メカニズム、予後予測、薬剤開発などにも応用が期待される。(著者抄録)

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  • 肝門部悪性胆道狭窄に対する内視鏡的マルチステンティング

    河本 博文, 谷川 朋広, 浦田 矩代, 岡 好仁, 中村 純, 末廣 満彦, 西野 謙, 川中 美和, 春間 賢, 加藤 博也

    Gastroenterological Endoscopy   58 ( 8 )   1354 - 1366   2016年8月

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    記述言語:日本語   出版者・発行元:(一社)日本消化器内視鏡学会  

    肝門部悪性胆道狭窄に対する内視鏡的マルチステンティングとは、屈曲狭窄した胆管に、内視鏡を用いて様々な剛性を持ったdeviceを選択的に繰り返し挿入し、複数本のstentを留置することで、肝のfunctional volumeをより多く確保する手技である。単に右左にステントを入れるということではない。この手技は難易度が高く、不適切なステンティングから胆管炎を来すと、感染コントロールが困難となり患者の予後を悪化させる。この手技を安全確実に行うには、まず適切な分枝を選択するために肝門部胆管の解剖を理解し、胆管の合流パターンを読み解くことである。次に手技的にはガイドワイヤー操作で目的とする枝を探りステントを留置していくことから、使用するデバイスの性質を理解し、難易度に応じてデバイスを選択し使い分けることも重要である。これらに基づき戦略を立て実行することが、マルチステンティングのコツである。(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年5月

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    記述言語:英語   掲載種別:研究発表ペーパー・要旨(国際会議)   出版者・発行元:MOSBY-ELSEVIER  

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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年5月

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    記述言語:日本語   出版者・発行元:日本胆道学会  

    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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  • 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年4月

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    記述言語:英語   掲載種別:研究発表ペーパー・要旨(国際会議)   出版者・発行元:W B SAUNDERS CO-ELSEVIER INC  

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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

    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年4月

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    記述言語:日本語   出版者・発行元:日本膵臓学会  

    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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  • A case of polypoid lesions of the common bile duct observed on peroral video cholangioscopy

    Shinichiro Muro, Hironari Kato, Soichiro Fushimi, Hiroyuki Okada

    DIGESTIVE AND LIVER DISEASE   48 ( 4 )   453 - 453   2016年4月

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    記述言語:英語   出版者・発行元:ELSEVIER SCIENCE INC  

    DOI: 10.1016/j.dld.2015.12.010

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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

    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年2月

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    記述言語:日本語   出版者・発行元:日本膵臓学会  

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

    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年

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    記述言語:英語  

    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.

    DOI: 10.3332/ecancer.2016.663

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  • A Case of Capillary Malformation of the Retroperitoneum

    Kazuyuki Matsumoto, Hironari Kato, Ryo Harada, Hiroyuki Okada

    INTERNAL MEDICINE   55 ( 2 )   203 - 205   2016年

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    記述言語:英語   出版者・発行元:JAPAN SOC INTERNAL MEDICINE  

    DOI: 10.2169/internalmedicine.55.5550

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  • Pancreatitis due to Radiolucent Pancreatolithiasis Mimicking Gallstone Pancreatitis

    Koichiro Tsutsumi, Hironari Kato, Hiroyuki Okada

    INTERNAL MEDICINE   55 ( 15 )   2109 - 2110   2016年

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    記述言語:英語   出版者・発行元:JAPAN SOC INTERNAL MEDICINE  

    DOI: 10.2169/internalmedicine.55.6790

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  • Oxidative stress balance is dysregulated and represents an additional target for treating cholangiocarcinoma

    Uchida D, Takaki A, Ishikawa H, Tomono Y, Kato H, Tsutsumi K, Tamaki N, Maruyama T, Tomofuji T, Tsuzaki R, Yasunaka T, Koike K, Matsushita H, Ikeda F, Miyake Y, Shiraha H, Nouso K, Yoshida R, Umeda Y, Shinoura S, Yagi T, Fujiwara T, Morita M, Fukushima M, Yamamoto K, Okada H

    Free Radic Res   50 ( 7 )   732 - 743   2016年

  • 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年12月

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    記述言語:英語   掲載種別:研究発表ペーパー・要旨(国際会議)   出版者・発行元:WILEY-BLACKWELL  

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  • EST診療ガイドライン

    良沢 昭銘, 糸井 隆夫, 潟沼 朗生, 岡部 義信, 加藤 博也, 洞口 淳, 藤田 直孝, 安田 健治朗, 露口 利夫, 藤本 一眞, 日本消化器内視鏡学会, 日本消化器内視鏡学会ガイドライン委員会

    Gastroenterological Endoscopy   57 ( 12 )   2721 - 2759   2015年12月

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    記述言語:日本語   出版者・発行元:(一社)日本消化器内視鏡学会  

    日本消化器内視鏡学会は、新たに科学的な手法で作成した基本的な指針として、「EST診療ガイドライン」を作成した。本ガイドラインにおける手技の具体的な手順や機器、デバイスの種類や使用法など実臨床的な部分については、すでに日本消化器内視鏡学会卒後教育委員会編「消化器内視鏡ハンドブック」が2015年5月に刊行されているので、可能な限り重複を避けた。また、本診療ガイドラインでは膵管口切開術、EPBD、EPLBDについては取り上げない。「EPLBD診療ガイドライン」については、別途作成される予定である。この分野においてはエビデンスレベルが低いものが多く、専門家のコンセンサスに基づき推奨の強さを決定しなければならないものが多かった。適応、手技、特殊な症例への対処、偶発症、治療成績、術後経過観察の6つの項目に分け、現時点での指針とした。(著者抄録)

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

    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年11月

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    記述言語:日本語  

    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.

    DOI: 10.11405/nisshoshi.112.2024

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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

    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年11月

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    記述言語:日本語   出版者・発行元:(一財)日本消化器病学会  

    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年11月

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    記述言語:英語   掲載種別:研究発表ペーパー・要旨(国際会議)   出版者・発行元:OXFORD UNIV PRESS  

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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年10月

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    記述言語:日本語   出版者・発行元:医学図書出版(株)  

    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

    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年10月

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    記述言語:日本語   出版者・発行元:(一社)日本病院総合診療医学会  

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

    Koichiro Tsutsumi, Hironari Kato, Hiroyuki Okada

    DIGESTIVE ENDOSCOPY   27 ( 6 )   708 - 708   2015年9月

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    記述言語:英語   掲載種別:速報,短報,研究ノート等(学術雑誌)   出版者・発行元:WILEY-BLACKWELL  

    DOI: 10.1111/den.12487

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  • Current status of endoscopic biliary drainage for unresectable malignant hilar biliary strictures. 国際誌

    Hironari Kato, Koichiro Tsutsumi, Hirofumi Kawamoto, Hiroyuki Okada

    World journal of gastrointestinal endoscopy   7 ( 11 )   1032 - 8   2015年8月

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    記述言語:英語  

    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.

    DOI: 10.4253/wjge.v7.i11.1032

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

    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年8月

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    記述言語:英語  

    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.

    DOI: 10.1007/s12328-015-0580-0

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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年8月

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    記述言語:日本語   出版者・発行元:医学図書出版(株)  

    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年5月

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    記述言語:英語   掲載種別:研究発表ペーパー・要旨(国際会議)   出版者・発行元:MOSBY-ELSEVIER  

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  • Current Issues and Future Perspective of Gastroduodenal Metal Stent Placement for Malignant GOO: Multicenter Experience

    Hideki Kamada, Hirofumi Kawamoto, Hironari Kato, Kazuya Matsumoto, Ichiro Moriyama

    GASTROINTESTINAL ENDOSCOPY   81 ( 5 )   AB252 - AB252   2015年5月

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    記述言語:英語   掲載種別:研究発表ペーパー・要旨(国際会議)   出版者・発行元:MOSBY-ELSEVIER  

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  • A Prospective Multicenter Study of EUS-Guided Choledochoduodenostomy Using a Covered Metallic Stent As a Primary Biliary Drainage in Unresectable Malignant Biliary Obstruction

    Yousuke Nakai, Hiroyuki Isayama, Hiroshi Kawakami, Hirotoshi Ishiwatari, Masayuki Kitano, Yukiko Ito, Ichiro Yasuda, Hironari Kato, Saburo Matsubara, Atsushi Irisawa, Takao Itoi, Masaki Kuwatani, Michihiro Ono, Hajime Imai, Takuji Iwashita, Goro Shibukawa, Takayoshi Tsuchiya

    GASTROINTESTINAL ENDOSCOPY   81 ( 5 )   AB423 - AB423   2015年5月

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    記述言語:英語   掲載種別:研究発表ペーパー・要旨(国際会議)   出版者・発行元:MOSBY-ELSEVIER  

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  • Effectiveness of tissue harmonic echo imaging and contrast-enhanced endoscopic ultrasound for diagnosing mural nodules of intraductal papillary mucinous neoplasms

    Hironari Kato, Naoki Yamamoto, Kazuhide Yamamoto

    DIGESTIVE ENDOSCOPY   27   74 - 74   2015年4月

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    記述言語:英語   掲載種別:速報,短報,研究ノート等(学術雑誌)   出版者・発行元:WILEY-BLACKWELL  

    DOI: 10.1111/den.12438

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  • Serum N-Glycan Profiles in Patients With Intraductal Papillary Mucinous Neoplasms of Pancreas

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

    GASTROENTEROLOGY   148 ( 4 )   S518 - S518   2015年4月

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    記述言語:英語   掲載種別:研究発表ペーパー・要旨(国際会議)   出版者・発行元:W B SAUNDERS CO-ELSEVIER INC  

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  • Adenovirus-Mediated Overexpression of REIC/DKK-3 Inhibits Cell Growth and Induces Apoptosis in Pancreatic Cancer and Hepatocellular Carcinoma

    Sawahara Hiroaki, Hidenori Shiraha, Daisuke Uchida, Hironari Kato, Masami Watanabe, Hiromi Kumon, Yasutomo Nasu, Kazuhide Yamamoto

    GASTROENTEROLOGY   148 ( 4 )   S954 - S954   2015年4月

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    記述言語:英語   掲載種別:研究発表ペーパー・要旨(国際会議)   出版者・発行元:W B SAUNDERS CO-ELSEVIER INC  

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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年4月

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    記述言語:英語   掲載種別:研究発表ペーパー・要旨(国際会議)   出版者・発行元:W B SAUNDERS CO-ELSEVIER INC  

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  • 腹腔鏡補助下幽門側胃切除後の腹腔内膿瘍に対して内視鏡的経残胃ドレナージが有効であった1例

    久保田 哲史, 香川 俊輔, 菊地 覚次, 黒田 新士, 西崎 正彦, 母里 淑子, 岸本 浩行, 永坂 岳司, 加藤 博也, 藤原 俊義

    日本消化器外科学会雑誌   48 ( 3 )   208 - 214   2015年3月

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    記述言語:日本語   出版者・発行元:(一社)日本消化器外科学会  

    胃切除後の合併症としてまれながら腹腔内膿瘍があり,治療にはドレナージが必要であることが多い.CT・US下の経皮ドレナージが低侵襲で第一選択となるが,腹腔内臓器に囲まれた深部の膿瘍は穿刺がしばしば困難である.今回,我々は腹腔鏡補助下幽門側胃切除術後,腹腔内膿瘍を合併した症例を経験した.膿瘍は残胃の背側にありCT・US下の経皮ドレナージが困難であったが,超音波内視鏡により膿瘍ならびに近接する総肝動脈も明瞭に観察され,超音波内視鏡ガイド下に経残胃ドレナージを安全に施行可能であった.胃切除後であっても腹腔内膿瘍に対する経胃的ドレナージの施行は,低侵襲な治療手段としての一選択肢となりうると考えられたので報告する.(著者抄録)

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  • 肝門部悪性胆道狭窄に対するステント留置術

    河本 博文, 後藤 大輔, 加藤 博也

    胆道   29 ( 1 )   85 - 93   2015年3月

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    記述言語:日本語   出版者・発行元:日本胆道学会  

    肝門部悪性胆道狭窄とは悪性疾患により肝外胆管のBc領域を巻き込んだ胆道狭窄である。この狭窄に対するステント留置術は技術的難度が高く、区域性胆管炎をどのようにしてマネージするかが最大の課題となる。その際、問題となるのは(1)アプローチルート、(2)ステントの種類、(3)ステントの留置形式である。アプローチルートに関しては非切除例であれば、内視鏡を用いる方が患者負担は少ないが、技術的難度は高くなる。ステントの種類では開存期間を優先すればmetallic stentだが、閉塞時の対応はやや困難となってくる。また、ステントの留置形式に関しては片葉または両葉の優位性ははっきりとしていない。つまり、どの選択をしても長所と短所があり、患者の予後、併用療法、閉塞時の対応も含めた術者の技量、コスト面での判断が大切である。患者の肝門部胆管の分岐パターンを十分認識した上で、最良のデバイスを選択し、安全なステント留置を心掛ける必要がある。(著者抄録)

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  • Endoscopic papillary large balloon dilation後の胆道出血に対してSelf-expandable metallic stent留置が有用であった1例

    皿谷 洋祐, 田中 盛富, 日吉 智子, 平田 尚志, 谷岡 大輔, 横峰 和典, 藤本 剛, 宮下 真奈備, 田中 彰一, 加藤 博也

    Gastroenterological Endoscopy   56 ( 12 )   3980 - 3987   2014年12月

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    記述言語:日本語   出版者・発行元:(一社)日本消化器内視鏡学会  

    症例は82歳男性。高度な腎機能障害を認めていた。径18×13mmの総胆管結石に対する治療目的でERCPを施行した。Endoscopic sphincterotomyを施行し、10-12mmの胆道拡張用バルーンカテーテルを用いてEndoscopic papillary large balloon dilationを施行したところ、胆道から噴出性の出血を認めた。圧迫止血による止血は困難であったがpartial covered Self-expandable metallic stent(SEMS)留置により止血が得られ、手術や血管内治療を回避できた。SEMSは21日後に偶発症なく抜去した。(著者抄録)

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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年11月

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    記述言語:英語   掲載種別:研究発表ペーパー・要旨(国際会議)   出版者・発行元:WILEY-BLACKWELL  

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  • Loss of runt-related transcription factor 3 induces gemcitabine resistance in pancreatic cancer (vol 7, pg 840, 2013)

    Shigeru Horiguchi, Hidenori Shiraha, Teruya Nagahara, Jyunnro Kataoka, Masaya Ituamuro, Minoru Matsubara, Shinichi Nishina, Hironari Kato, Akinobu Takaki, Kazuhiro Nouso, Takehiro Tanaka, Koichi Ichimura, Takahito Yagi, Kazuhide Yamamoto

    MOLECULAR ONCOLOGY   8 ( 5 )   1054 - 1054   2014年7月

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    記述言語:英語   出版者・発行元:ELSEVIER SCI LTD  

    DOI: 10.1016/j.molonc.2014.03.007

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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年6月

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    記述言語:日本語   出版者・発行元:医学図書出版(株)  

    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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  • The Efficacy of REIC/DKK-3 Gene Therapy for Pancreatic Cancer

    Daisuke Uchida, Hidenori Shiraha, Hironari Kato, Teruya Nagahara, Masaya Iwamuro, Junro Kataoka, Sigeru Horiguchi, Masami Watanabe, Yasutomo Nasu, Hiromi Kumon, Kazuhide Yamamoto

    GASTROENTEROLOGY   146 ( 5 )   S301 - S301   2014年5月

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    記述言語:英語   掲載種別:研究発表ペーパー・要旨(国際会議)   出版者・発行元:W B SAUNDERS CO-ELSEVIER INC  

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  • Transplanted liver graft ischemia caused by pediatric ERCP in the prone position

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

    ENDOSCOPY   46   E594 - E595   2014年

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    記述言語:英語   出版者・発行元:GEORG THIEME VERLAG KG  

    DOI: 10.1055/s-0034-1390732

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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

    Koichiro Tsutsumi, Hironari Kato, Hiroyuki Okada, Kazuhide Yamamoto

    ENDOSCOPY   46   E619 - E620   2014年

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    記述言語:英語   出版者・発行元:GEORG THIEME VERLAG KG  

    DOI: 10.1055/s-0034-1390754

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

    Koichiro Tsutsumi, Hironari Kato, Hiroyuki Okada, Kazuhide Yamamoto

    ENDOSCOPY   46   E417 - E418   2014年

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    記述言語:英語   出版者・発行元:GEORG THIEME VERLAG KG  

    DOI: 10.1055/s-0034-1377408

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

    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年10月

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    記述言語:日本語  

    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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  • 【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年10月

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    記述言語:日本語   出版者・発行元:医学図書出版(株)  

    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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  • 【ドレナージ大全】胆道ドレナージ術 悪性肝門部胆道閉塞 肝門部胆管の合流パターンから考える、肝門部悪性胆道狭窄に対する内視鏡的マルチステンティングの実際とコツ

    河本 博文, 後藤 大輔, 加藤 博也

    胆と膵   34 ( 臨増特大 )   869 - 878   2013年10月

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    記述言語:日本語   出版者・発行元:医学図書出版(株)  

    マルチステンティングとは、肝機能的側面から見た場合、なるべく多くの機能的肝容積を安全に確保する手技である。また、技術的にマルチステンティングとは、屈曲、狭窄した胆管にdeviceの中では剛性の高いintroducerを挿入し、複数本のメタリックステントを選択的に留置する手技である。したがって技術的要求値は高く、内視鏡を介したIVRと理解すべきである。一方、安全で確実なドレナージを行うには、胆管の合流パターンの知識は非常に大切である。合流パターンを理解するうえで大切なのは「肝門板」、竜らの言う「肝の左右対称性」である。内視鏡医は技術的要求を満たした上で、胆管の合流パターンを理解し、適切なステンティングを心掛ける必要がある。(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年10月

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    記述言語:日本語   出版者・発行元:(一財)日本消化器病学会  

    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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  • Dilation of a severe bilioenteric or pancreatoenteric anastomotic stricture using a Soehendra Stent Retriever. 国際誌

    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年8月

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    記述言語:英語  

    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.

    DOI: 10.4253/wjge.v5.i8.412

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  • 【胆管・膵管拡張をみたら】胆管拡張をみたら[典型的症例] 中部胆管に狭窄を有する胆管拡張

    加藤 博也, 岡田 裕之, 山本 和秀

    消化器内視鏡   25 ( 2 )   243 - 244   2013年2月

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    記述言語:日本語   出版者・発行元:(株)東京医学社  

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  • 非切除胆膵癌に対する内視鏡的interventionの進歩 EUSガイド下胆道ドレナージ術(ESU-BD)の日本の多施設での経験(Japanese Multicenter experience of EUS-guide Biliary Drainage (EUS-BD))

    伊佐山 浩通, 川久保 和道, 加藤 博也, 日本EUS-BD研究グループ

    日本消化器病学会雑誌   110 ( 臨増総会 )   A58 - A58   2013年2月

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    記述言語:日本語   出版者・発行元:(一財)日本消化器病学会  

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  • A case of acute afferent loop syndrome treated by transgastric drainage with EUS

    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 - 132   2013年1月

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    記述言語:英語   出版者・発行元:MOSBY-ELSEVIER  

    DOI: 10.1016/j.gie.2012.09.016

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  • 【とことん知りたいERCPの手技のコツ もう迷わない!後方斜視鏡の挿入から、乳頭の観察、深部挿管まで】胆管挿管 プレカットはどれくらい経験したら行ってよいのですか?

    河本 博文, 後藤 大輔, 加藤 博也

    消化器内視鏡レクチャー   1 ( 3 )   505 - 512   2013年1月

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    記述言語:日本語   出版者・発行元:(株)総合医学社  

    <ポイント>フリーハンドによるニードルナイフを用いたプレカットは、胆管側の括約筋を切開し胆管口を露出させる手技である。確実な胆管口の露出のためには、口側隆起を長めに粘膜切開し、粘膜下の白色索状物である括約筋を視認することである。したがってプレカットの適応となる乳頭は括約筋が粘膜下を走行する隔壁型と共通管型である。括約筋を同定できない状況として、切開する部位の誤り、「口側隆起下」に括約筋が存在しない場合がある。重篤な合併症である穿孔は解剖学的異常がある場合、十二指腸筋層より深く切り込んだ場合に発生する。括約筋同定のため深部に切り込む場合、乳頭から一度離れて十二指腸筋層を意識し直すことが重要である。(著者抄録)

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  • 【とことん知りたいERCPの手技のコツ もう迷わない!後方斜視鏡の挿入から、乳頭の観察、深部挿管まで】乳頭観察法 上手に乳頭の正面視をするポイントは?(pullとpush)

    加藤 博也, 岡田 裕之, 山本 和秀

    消化器内視鏡レクチャー   1 ( 3 )   449 - 454   2013年1月

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    記述言語:日本語   出版者・発行元:(株)総合医学社  

    <ポイント>乳頭の正面視は基本的にpull(スコープをストレッチした状態)で行う。左右アングルの動きを理解して上手に使う。スコープのトルクを併用する。pushとはスコープを押し込んで胃内にたわませた状態のまま乳頭を観察する方法である。pullで正面視できない場合はpushも試してみる。(著者抄録)

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  • 【胆膵ステントの新しい潮流-開発コンセプトとステント選択を学ぶ-】Metallic stent閉塞に対するthrough-the-mesh stent(TTM stent)のデザインコンセプト

    河本 博文, 後藤 大輔, 加藤 博也

    胆と膵   33 ( 10 )   817 - 821   2012年10月

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    記述言語:日本語   出版者・発行元:医学図書出版(株)  

    Through-the-mesh stent(TTM stent)は先端をhook状にしてtaperingをかけた7Frのplastic stentである。肝門部悪性胆道狭窄症に対してpartial stent-in-stent(PSIS)法で挿入したmetallic stent(MS)が閉塞した際のリカバリーステントとしてデザインされた。先端形状は胆管内の屈曲部で生じた狭窄を通過しMSのメッシュをかわすためにデザインされている。ステント径は7Frと10Fr、長さは17cm、19cm、21cm、22cmである。フラップは無く、2本以上入れることによるステント間の干渉で逸脱を予防している。留置の際は太めの肝内胆管末梢奥まで挿入することが大切である。(著者抄録)

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  • 【胆膵内視鏡のビデオライブデモ2012】マスターによるテクニックの解説とビデオライブデモ 肝門部悪性胆道狭窄に対する内視鏡的マルチステンティング

    河本 博文, 後藤 大輔, 加藤 博也

    胆と膵   33 ( 臨増特大 )   965 - 972   2012年10月

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    記述言語:日本語   出版者・発行元:医学図書出版(株)  

    切除不能肝門部悪性胆道狭窄に対する内視鏡的マルチステンティングは他部位の狭窄よりも高度なテクニックを要する手技であり、肝門部解剖、高性能のdevice、deviceの知識と理論、そして内視鏡医と助手の技術が手技の成功に必要である。とくにガイドワイヤーの知識が非常に重要であり、胆管枝の選択(seeking)、deviceの誘導(leading)、選択すべき胆管の目安(landmark)、それぞれに求められる役割と性質を理解し使い分けることが肝要である。また、胆管の分岐パターンを術前に理解しておくことでstentingが容易な胆管枝、困難な胆管枝を判別し、stentingを行う順序を決定する必要がある。(著者抄録)

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  • 【非切除胆道癌の治療】切除不能胆道癌に対する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

    加藤 博也, 岡田 裕之, 山本 和秀

    消化器内科   55 ( 3 )   392 - 397   2012年9月

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    記述言語:日本語   出版者・発行元:(有)科学評論社  

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  • A case of celiac artery dissection diagnosed with EUS

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

    GASTROINTESTINAL ENDOSCOPY   76 ( 2 )   424 - 424   2012年8月

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    記述言語:英語   出版者・発行元:MOSBY-ELSEVIER  

    DOI: 10.1016/j.gie.2012.03.1398

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  • 感染性膵壊死に対する直接内視鏡挿入下壊死巣除去術の日本における治療成績調査

    中島 賢憲, 安田 一朗, 岩井 知久, 伊佐山 浩通, 糸井 隆夫, 久居 弘幸, 井上 宏之, 加藤 博也, 菅野 敦, 窪田 賢輔, 入澤 篤志, 五十嵐 久人, 岡部 義信, 北野 雅之, 河上 洋, 林 毅, 向井 強, 木田 光弘, 佐田 尚宏, 下瀬川 徹, JENIPaN studyグループ

    Gastroenterological Endoscopy   54 ( Suppl.1 )   1274 - 1274   2012年4月

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    記述言語:日本語   出版者・発行元:(一社)日本消化器内視鏡学会  

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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

    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年3月

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    記述言語:日本語   出版者・発行元:日本胆道学会  

    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年2月

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    記述言語:日本語   出版者・発行元:(一社)日本消化器内視鏡学会  

    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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  • A case of gastric aberrant pancreas diagnosed with EUS-guided FNA. 国際誌

    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年8月

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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年

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    記述言語:英語   掲載種別:速報,短報,研究ノート等(学術雑誌)  

    DOI: 10.1055/s-0030-1256318

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  • 【Stenting Bible】胆管狭窄に対するStenting Strategy 悪性肝門部胆管狭窄 マルチステンティングの手技の実際とコツ(動画付)

    加藤 博也, 河本 博文, 山本 和秀

    胆と膵   31 ( 臨増特大 )   985 - 994   2010年10月

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    記述言語:日本語   出版者・発行元:医学図書出版(株)  

    悪性肝門部胆管狭窄に対する内視鏡下のマルチステンティングを成功させるには肝門部胆管の解剖やdeviceの知識が重要である。ステンティングする胆管の選択と順序に関しては竜らの提唱する肝区域の分類を参考にすれば一見複雑な肝門部胆管の走行も理解可能である。そしてステンティングが容易な胆管、困難な胆管を理解することで、ステンティングを行う順序も決定することができる。Deviceについてはステントを複数留置するために、Metallic stent、Plastic stent、それぞれに求められる性質の理解が必要となる。また、ガイドワイヤーの知識も非常に重要であり、seeking wire、leading guide wire、landmark guide wire、それぞれに必要な役割と性質を理解し、使い分けることが手技の成功につながる。(著者抄録)

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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年4月

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    記述言語:英語   掲載種別:研究発表ペーパー・要旨(国際会議)   出版者・発行元:MOSBY-ELSEVIER  

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  • 【やっぱり大切、基本手技】胆膵[治療] 経消化管ドレナージの基本

    加藤 博也, 河本 博文, 岡田 裕之, 山本 和秀

    消化器内視鏡   22 ( 4 )   736 - 740   2010年4月

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    記述言語:日本語   出版者・発行元:(株)東京医学社  

    コンベックス型超音波内視鏡(linear array endoscopic ultrasound sonography:L-EUS)下の経消化管的膵嚢胞ドレナージは、穿刺ルートの決定が安全にできるため、出血や穿孔などの偶発症の軽減の点から有用である。本稿では、EUSガイド下の経消化管的膵嚢胞ドレナージの手技の実際について述べる。(著者抄録)

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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年4月

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    記述言語:英語   掲載種別:研究発表ペーパー・要旨(国際会議)   出版者・発行元:MOSBY-ELSEVIER  

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  • 術後再建腸管を有する胆道疾患症例におけるダブルバルーン内視鏡の使用経験

    川野 誠司, 石田 悦嗣, 河本 博文, 原田 亮, 加藤 博也, 平尾 謙, 水野 修, 小川 恒由, 山本 和秀

    胆道   23 ( 5 )   734 - 739   2009年12月

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    記述言語:日本語   出版者・発行元:日本胆道学会  

    従来は内視鏡治療が困難とされていた術後再建腸管を有する胆道疾患症例でダブルバルーン内視鏡を用いた治療を経験し、その有用性と問題点について検討した。対象は2008年1月から2008年9月までに当科に入院した術後再建腸管を有する胆道疾患5症例で再建方式はRoux-en-Y 3例、Billroth II法2例であった。スコープはフジノン社製EC450-BI5を使用し、内視鏡挿入とERCPでそれぞれに精通した術者が交代して行った。5症例すべてにおいて処置可能であり、重篤な偶発症は認めなかった。術後の観察期間は平均8ヵ月と短いが、胆管炎の再燃などは現在まで認めていない。術後再建腸管を有する胆道疾患症例においてダブルバルーン内視鏡を用いた検査処置は安全かつ有用であることが示唆された。(著者抄録)

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  • 【胆膵治療内視鏡のエキスパートテクニック】ERCP関連手技 胆道ドレナージ術 内視鏡による肝門部悪性胆道狭窄に対するマルチステンティング

    加藤 博也, 河本 博文, 山本 和秀

    胆と膵   30 ( 臨増特大 )   1137 - 1145   2009年10月

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    記述言語:日本語   出版者・発行元:医学図書出版(株)  

    肝門部悪性胆道狭窄に対する内視鏡下のマルチステンティングを行うには肝門部胆管の解剖やDeviceの知識が重要である。肝門部胆管の解剖はバリエーションが多く、それらを十分理解した上でステンティングをしなければならない。特に、「北回り胆管」、「南回り胆管」の理解は重要であり、それぞれの特徴、および、それらがマルチステンティングを行う際、ステント留置の順序という点でどのように関わってくるか理解する必要がある。メタリックステントは留置のしやすいものが良く、プラスチックステントでは種類ごとの使い分けが必要である。また、それらを複数留置するために必要なガイドワイヤーの知識も非常に重要であり、seeking wire、leading guide wire、landmark guide wire、それぞれに必要な性質を理解し、使い分けることが手技の成功につながる。(著者抄録)

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  • 【腹腔鏡下胆嚢摘出術・生体部分肝移植術後胆管狭窄の原因と対策】胆管胆管吻合による生体肝移植後胆管狭窄に対する内視鏡治療

    加藤 博也, 河本 博文, 山本 和秀

    胆と膵   30 ( 8 )   869 - 875   2009年8月

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    記述言語:日本語   出版者・発行元:医学図書出版(株)  

    胆管胆管吻合による生体肝移植後(LDLT)の胆管狭窄に対する内視鏡治療は単純なstent留置、inside stent、バルーン拡張など様々な報告がある。当院ではPlastic stent(PS)を乳頭から露出する一般的な形で留置する治療を行い、41症例に対し、35例(85%)で臨床的に改善が得られた。しかし、PS抜去までに至った症例は21例(51%)と約半数であった。また、抜去できた症例の留置期間の中央値は397日(21〜1,189)であり、長い治療期間が必要であった。治療困難の原因として、解剖学的に吻合部である肝門部は胆管の血流が乏しくなりやすいこと、現状のPSはサイズ、形状が限られていることなどが挙げられた。また、狭窄が長い症例や胆汁漏の合併例など、個々の病態により治療の難しさや治療期間も異なっていた。LDLT後の胆管狭窄に対する内視鏡治療は最初に試みる治療として有用であるが、改善していかなければならない点も多い。(著者抄録)

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  • Are Patients with Intraductal Papillary Mucinous Neoplasm (IPMN) of Pancreas Likely to Carry Colorectal Neoplasia?

    Shin Ishikawa, Jun Kato, Hideyuki Suzuki, Joichiro Horii, Shunsuke Saito, Reiji Higashi, Ken Hirao, Hironari Kato, Motoaki Kuriyama, Eisuke Kaji, Toshio Uraoka, Sakiko Hiraoka, Kazuhide Yamamoto

    GASTROINTESTINAL ENDOSCOPY   69 ( 5 )   AB289 - AB290   2009年4月

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    記述言語:英語   掲載種別:研究発表ペーパー・要旨(国際会議)   出版者・発行元:MOSBY-ELSEVIER  

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  • Three- or Four-Branched Endoscopic Deployment of Multiple Metallic Stems in the Patients with High Grade Hilar Biliary Strictures Due to Biliary Tract Carcinoma-Its Feasibility and Limitation

    Hirofumi Kawamoto, Hironari Kato, Naoko Kurihara, Ken Hirao, Osamu Mizuno, Etsuji Ishida, Tsuneyoshi Ogawa, Kazuhide Yamamoto

    GASTROINTESTINAL ENDOSCOPY   69 ( 5 )   AB145 - AB145   2009年4月

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    記述言語:英語   掲載種別:研究発表ペーパー・要旨(国際会議)   出版者・発行元:MOSBY-ELSEVIER  

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  • EUS-FNA is more advantageous than ERCP in tissue sampling for pathological diagnosis of pancreatic cancer

    Tsuneyoshi Ogawa, Hirofumi Kawamoto, Ryo Harada, Naoko Kurihara, Hironari Kato, Ken Hirao, Osamu Mizuno, Etsuji Ishida, Kazuhide Yamamoto

    GASTROINTESTINAL ENDOSCOPY   69 ( 2 )   S258 - S258   2009年2月

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    記述言語:英語   掲載種別:研究発表ペーパー・要旨(国際会議)   出版者・発行元:MOSBY-ELSEVIER  

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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

    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年12月

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    記述言語:日本語   出版者・発行元:日本胆道学会  

    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年4月

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    記述言語:英語   掲載種別:研究発表ペーパー・要旨(国際会議)   出版者・発行元:W B SAUNDERS CO-ELSEVIER INC  

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  • 内視鏡的粘膜下層剥離術にて治療をおこなった陥凹型早期十二指腸癌の1例

    石山 修平, 塩出 純二, 吉岡 正雄, 大家 昌源, 藤原 明子, 伊藤 守, 加藤 博也, 山本 久美子, 村上 尚子, 糸島 達也, 高畑 隆臣

    岡山済生会総合病院雑誌   39   46 - 51   2007年12月

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    記述言語:日本語   出版者・発行元:岡山済生会総合病院  

    50歳代男性。患者は検診にて貧血を指摘され、上部消化管内視鏡にて十二指腸腫瘍を認め、精査加療目的で著者らの施設へ入院となった。所見では上部消化管内視鏡で十二指腸前壁に中心部陥凹傾向のある15mm大の病変が認められ、生検にて高分化型腺癌であった。以上より、本症例は陥凹型早期十二指腸癌と診断され、内視鏡的粘膜下剥離術を行ったところ、完全一括切除が可能であった。尚、経過は良好で、術後20ヵ月の現在、再発はみられていない。

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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年2月

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    記述言語:英語   出版者・発行元:GEORG THIEME VERLAG KG  

    DOI: 10.1055/s-2006-945159

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  • 【消化器科医のリスクマネージメント】当院内視鏡センターにおけるインシデントアクシデントレポートおよび偶発症の解析

    大家 昌源, 山本 久美子, 村上 尚子, 加藤 博也, 水野 修, 伊藤 守, 石山 修平, 藤原 明子, 吉岡 正雄, 塩出 純二, 糸島 達也

    消化器科   44 ( 1 )   8 - 12   2007年1月

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    記述言語:日本語   出版者・発行元:(有)科学評論社  

    消化器内視鏡センターより提出されたインシデントアクシデントレポートの解析と偶発症の多い内視鏡検査、処置である内視鏡的逆行性膵胆管造影、大腸ポリペクトミー、粘膜切除と胃の内視鏡的粘膜下層剥離術における偶発症について解析した。平成15年から17年までの間に提出されたインシデントアクシデントレポート総数は3456件で、内視鏡センターより提出されたインシデントアクシデントレポート数は27件であった。レポート内容の内訳は事務的ミス7件、検査処置中のトラブル6件、前投薬や検査中投薬や介助に関するミス6件、待ち時間の苦情3件、抗凝固薬、禁忌薬確認ミス2例、機材破損2件、その他1件であった。いくら注意して施行したとしても偶発症をゼロにするのは困難と思われた。

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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年12月

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    記述言語:日本語   出版者・発行元:岡山済生会総合病院  

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  • Intraductal papillary mucinous adenocarcinoma of the bile ducts

    Hirotoshi Fukatsu, Hirofumi Kawamoto, Hironari Kato, Ken Hirao, Naoko Kurihara, Takashi Nakanishi, Osamu Mizuno, Yuko Okamoto, Jun Kato, Hiroyuki Okada, Yasushi Shiratori

    GASTROINTESTINAL ENDOSCOPY   64 ( 3 )   438 - 439   2006年9月

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    記述言語:英語   出版者・発行元:MOSBY, INC  

    DOI: 10.1016/j.gie.2006.01.060

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  • Analysis of Factors Associated with Difficult Biliary Cannulation: Especially Regarding Post Operative Anatomical Factors

    Hirotoshi Fukatsu, Hirofumi Kawamoto, Hironari Kato, Ken Hirao, Naoko Kurihara, Takashi Nakanishi, Osamu Mizuno, Yuko Okamoto, Etsuji Ishida, Tsuneyoshi Ogawa, Yasushi Shiratori

    GASTROINTESTINAL ENDOSCOPY   63 ( 5 )   AB302 - AB302   2006年4月

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    記述言語:英語   掲載種別:研究発表ペーパー・要旨(国際会議)   出版者・発行元:MOSBY-ELSEVIER  

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  • Efficacy and Outcomes of Endoscopic Therapy for Biliary Complications After Duct-to-Duct Biliary Reconstruction in Adult Living-Donor Liver Transplantation

    Hironari Kato, Hirofumi Kawamoto, Ken Hirao, Naoko Kurihara, Yuko Okamoto, Hirotoshi Fukatsu, Jun Kato, Hiroyuki Okada, Yasushi Shiratori, Takahito Yagi

    GASTROINTESTINAL ENDOSCOPY   63 ( 5 )   AB282 - AB282   2006年4月

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    記述言語:英語   掲載種別:研究発表ペーパー・要旨(国際会議)   出版者・発行元:MOSBY-ELSEVIER  

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  • Evaluation of prognostic factors in chemotherapy for patients with advanced pancreatic cancer

    Ken Hirao, Hirofumi Kawamoto, Hironari Kato, Naoko Kurihara, Yuko Okamoto, Hirotoshi Fukatsu, Jun Kato, Hiroyuki Okada, Yasushi Shiratori

    GASTROENTEROLOGY   130 ( 4 )   A468 - A469   2006年4月

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    記述言語:英語   掲載種別:研究発表ペーパー・要旨(国際会議)   出版者・発行元:W B SAUNDERS CO-ELSEVIER INC  

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  • The Metallic Stent for the Patients with Malignant Biliary Stenosis Induced By Advanced Pancreatic Cancer - Covered Stent Or Uncovered Stent in Chemotherapy Cases?

    Hirofumi Kawamoto, Hironari Kato, Ken Hirao, Naoko Kurihara, Etsushi Ishida, Tsuneyoshi Ogawa, Yuko Okamoto, Hirotoshi Fukatsu, Yasushi Shiratori

    GASTROINTESTINAL ENDOSCOPY   63 ( 5 )   AB305 - AB305   2006年4月

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    記述言語:英語   掲載種別:研究発表ペーパー・要旨(国際会議)   出版者・発行元:MOSBY-ELSEVIER  

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  • 【BCS,ALDの結節病変】アルコール性肝硬変に合併し長期間経過を追えた多発性過形成結節の1例

    金吉 俊彦, 池田 弘, 藤井 雅邦, 藤原 大介, 藤井 澄, 加藤 博也, 足立 恵美, 吉澤 はづき, 狩山 和也, 若林 肇, 清野 哲司, 島村 淳之輔

    Liver Cancer   7 ( 2 )   155 - 164   2001年11月

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    記述言語:日本語   出版者・発行元:(株)アークメディア  

    42歳女.肝不全で腹部超音波により全肝に10〜20mm大の低エコー腫瘤を認めた.CTは造影前でやや高吸収域,後期相では等吸収域であり,MRIではT1強調像で高信号,T2強調像で等信号を呈した.左右肝動脈からのdigital subtraction angiographyでは明らかな腫瘍濃染を認めず,左右肝動脈から炭酸ガスを動注した造影エコーでは肝内占拠病変(SOL)全体が淡くenhanceされた.腫瘍生検では細胞密度の上昇は認めるが細胞異型,構造異型は認めず,腫瘤内に強い壊死炎症反応や動脈性の異常血管も認めた.1年後の炭酸ガス造影エコーでは前回と同様にenhanceされたが,門脈造影下CTでは門脈血流の低下を認めた.生検所見は変化がなかった.2年後には胃静脈瘤に対して内視鏡的硬化療法を施行し,大量飲酒による肝不全はその後殆ど認めなくなった.dynamic CTで腫瘤はhypervascularであった.3年後以降は急速にvascularityが失われ,腫瘤も不明瞭化した

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▼全件表示

共同研究・競争的資金等の研究

  • 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

    研究課題/領域番号:21K07962  2021年04月 - 2024年03月

    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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    配分額:4160000円 ( 直接経費:3200000円 、 間接経費:960000円 )

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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

    研究課題/領域番号:19K08423  2019年04月 - 2022年03月

    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)

    堤 康一郎, 白羽 英則, 加藤 博也

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    配分額:4290000円 ( 直接経費:3300000円 、 間接経費:990000円 )

    本年度の目標は、IPMN患者のFFPE組織を用いた網羅的プロテオーム解析の結果から得られた悪性IPMN診断マーカーの候補タンパク質に関して、ターゲット・プロテオミクスや免疫組織染色で検証し、絞り込みを行うことであった。当初予定していたターゲット・プロテオミクスの試薬が入手困難となり、免疫染色での評価を行った。その結果、悪性マーカーの候補として抽出したタンパク質Aに関して、プロテオーム解析に使用した症例と同一の検体で免疫染色にて評価したところ、その陽性率は、良性病変(low~moderate dysplasia)で22%(2/9)、悪性病変(high grade dysplasia)で100%(9/9)と矛盾はなかった。さらに10症例追加した検証でも同様の傾向があり、悪性マーカーとしての有用性が強く示唆された。

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  • 消化器癌における新規癌関連遺伝子REICの機能解析と臨床応用に関する研究

    研究課題/領域番号:15K09001  2015年04月 - 2018年03月

    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, 内田 大輔, 白羽 英則, 那須 保友, 堤 康一郎, 松下 浩志, 岩室 雅也

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    配分額:4680000円 ( 直接経費:3600000円 、 間接経費:1080000円 )

    肝細胞癌、胆道癌の細胞株における実験で、REIC遺伝子の導入による癌細胞特異的なアポトーシスが誘導されることが証明された。また肝細胞癌手術検体を用いた免疫組織染色では、癌部でのREIC発現が低下していることが証明された。
    膵癌細胞株にヒトPBMCとREIC蛋白を加えることで、PBMCの樹状細胞への分化誘導を促進し、CTLの活性化を介した腫瘍免疫誘導効果をもたらすことが証明された。
    これらの結果をもとに、肝癌に対するREIC遺伝子導入治療の医師主導治験が開始された。

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  • 消化器癌における新規癌関連遺伝子REICの機能解析と臨床応用に関する研究

    研究課題/領域番号:24590977  2012年04月 - 2015年03月

    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, 白羽 英則, 山本 和秀, 那須 保友, 内田 大輔

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    配分額:5200000円 ( 直接経費:4000000円 、 間接経費:1200000円 )

    REIC/Dkk-3遺伝子(以下REIC)は、様々な固形癌において、その発現が低下している。今回我々は消化器癌の中でも難治である膵臓癌におけるREIC遺伝子治療の有効性について検証した。膵癌においても他の癌腫同様、REICの発現低下が認められた。また膵癌細胞に対するREIC遺伝子導入により、著明な細胞死が誘導され、動物実験においても有意な腫瘍縮小効果を認めた。REIC遺伝子治療は膵癌に対する有効な補助療法となる可能性がある。

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担当授業科目

  • 先端医療疾病管理論 (2021年度) 前期  - その他