研究者詳細 - 藤井　佑樹

論文 - 藤井　佑樹

分割表示 >> ／全件表示 60 件中 1 - 60 件目

Effectiveness of data-augmentation on deep learning in evaluating rapid on-site cytopathology at endoscopic ultrasound-guided fine needle aspiration. 国際誌

Yuki Fujii, Daisuke Uchida, Ryosuke Sato, Taisuke Obata, Matsumi Akihiro, Kazuya Miyamoto, Kosaku Morimoto, Hiroyuki Terasawa, Tatsuhiro Yamazaki, Kazuyuki Matsumoto, Shigeru Horiguchi, Koichiro Tsutsumi, Hironari Kato, Hirofumi Inoue, Ten Cho, Takayoshi Tanimoto, Akimitsu Ohto, Yoshiro Kawahara, Motoyuki Otsuka

Scientific reports 14 ( 1 ) 22441 - 22441 2024年9月

記述言語：英語掲載種別：研究論文（学術雑誌）

Rapid on-site cytopathology evaluation (ROSE) has been considered an effective method to increase the diagnostic ability of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA); however, ROSE is unavailable in most institutes worldwide due to the shortage of cytopathologists. To overcome this situation, we created an artificial intelligence (AI)-based system (the ROSE-AI system), which was trained with the augmented data to evaluate the slide images acquired by EUS-FNA. This study aimed to clarify the effects of such data-augmentation on establishing an effective ROSE-AI system by comparing the efficacy of various data-augmentation techniques. The ROSE-AI system was trained with increased data obtained by the various data-augmentation techniques, including geometric transformation, color space transformation, and kernel filtering. By performing five-fold cross-validation, we compared the efficacy of each data-augmentation technique on the increasing diagnostic abilities of the ROSE-AI system. We collected 4059 divided EUS-FNA slide images from 36 patients with pancreatic cancer and nine patients with non-pancreatic cancer. The diagnostic ability of the ROSE-AI system without data augmentation had a sensitivity, specificity, and accuracy of 87.5%, 79.7%, and 83.7%, respectively. While, some data-augmentation techniques decreased diagnostic ability, the ROSE-AI system trained only with the augmented data using the geometric transformation technique had the highest diagnostic accuracy (88.2%). We successfully developed a prototype ROSE-AI system with high diagnostic ability. Each data-augmentation technique may have various compatibilities with AI-mediated diagnostics, and the geometric transformation was the most effective for the ROSE-AI system.

DOI： 10.1038/s41598-024-72312-3

【膵・胆道癌の発生・進展メカニズムを探る】膵癌の薬剤耐性メカニズム

寺澤裕之, 堤康一郎, 原田圭, 服部直, 菊池達也, 小幡泰介, 佐藤亮介, 織田崇志, 松三明宏, 宮本和也, 藤井佑樹, 赤穂宗一郎, 内田大輔, 松本和幸, 堀口繁, 大塚基之

胆と膵 45 ( 8 ) 801 - 806 2024年8月

記述言語：日本語出版者・発行元：医学図書出版(株)

膵癌は予後不良な難治癌であるが,その一因として薬剤耐性があげられる。薬剤耐性のメカニズムとして,標的治療が難しいKRAS変異の存在やエピジェネティック機構などの遺伝子変異や薬物代謝の変化,転移・浸潤を促進するEMT,膵癌に特徴的な間質成分の多い腫瘍微小環境,さらにnon-coding RNAによる遺伝子発現の調整などがあり,それらが複合的に影響していると考えられている。この複雑な薬剤耐性メカニズムのさらなる解明がその克服において重要である。(著者抄録)

【膵・胆道癌の発生・進展メカニズムを探る】胆道癌の薬剤耐性メカニズム

堤康一郎, 小幡泰介, 織田崇志, 松三明宏, 宮本和也, 寺澤裕之, 藤井佑樹, 内田大輔, 松本和幸, 堀口繁, 大塚基之

胆と膵 45 ( 8 ) 857 - 862 2024年8月

記述言語：日本語出版者・発行元：医学図書出版(株)

胆道癌の多くは根治切除が難しく,主に抗癌剤や分子標的薬を用いた薬物療法が行われるが,5年生存率は20%程度であり予後不良な疾患である。この一因として,癌細胞が抗腫瘍効果を有する薬剤から逃れて生存を維持しようとする機構,つまり癌の薬剤耐性保有やその獲得があげられる。これまでに胆道癌における七つの薬剤耐性メカニズム(mechanisms of chemoresistance:MOC)が報告されており,これらの複数が相互にまたは独立して関与していることが明らかとなっている。さまざまな遺伝子異常が基盤となって生じる薬剤耐性メカニズムの理解を深めることは,胆道癌に対する新規の治療戦略や治療法開発につながり,個々の患者における予後改善に寄与することが期待される。(著者抄録)

膵EUS-FNA診断の功罪嚢胞・壊死を伴う膵管癌に対するFNA/B合併症リスクの検討

寺澤裕之, 松本和幸, 田中健大, 友田健, 小川泰司, 石原裕基, 菊池達也, 小幡泰介, 織田崇志, 松三明宏, 宮本和也, 森本光作, 藤井佑樹, 山崎辰洋, 内田大輔, 堀口繁, 堤康一郎, 加藤博也, 大塚基之

膵臓 39 ( 3 ) A234 - A234 2024年7月

Virtual indigo carmine chromoendoscopy images: A novel modality for peroral cholangioscopy using artificial intelligence technology (with video). 国際誌

Ryosuke Sato, Kazuyuki Matsumoto, Hideaki Kinugasa, Masahiro Tomiya, Takayoshi Tanimoto, Akimitsu Ohto, Kei Harada, Nao Hattori, Taisuke Obata, Akihiro Matsumi, Kazuya Miyamoto, Kosaku Morimoto, Hiroyuki Terasawa, Yuki Fujii, Daisuke Uchida, Koichiro Tsutsumi, Shigeru Horiguchi, Hironari Kato, Yoshiro Kawahara, Motoyuki Otsuka

Gastrointestinal endoscopy 2024年6月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND AND AIMS: Accurately diagnosing biliary strictures is crucial for surgical decisions, and although peroral cholangioscopy (POCS) aids in visual diagnosis, diagnosing malignancies or determining lesion margins via this route remains challenging. Indigo carmine is commonly used to evaluate lesions during gastrointestinal endoscopy. We aimed to establish the utility of virtual indigo carmine chromoendoscopy (VICI) converted from POCS images using artificial intelligence. METHODS: This single-center, retrospective study analyzed 40 patients with biliary strictures who underwent POCS using white light imaging (WLI) and narrow-band imaging (NBI). A "cycle-consistent adversarial network" (CycleGAN) was used to convert the WLI into VICI of POCS images. Three experienced endoscopists evaluated WLI, NBI, and VICI via POCS in all patients. The primary outcome was the visualization quality of surface structures, surface microvessels, and lesion margins. The secondary outcome was diagnostic accuracy. RESULTS: VICI showed superior visualization of the surface structures and lesion margins compared with WLI (P<0.001) and NBI (P<0.001). The diagnostic accuracies were 72.5%, 87.5%, and 90.0% in WLI alone, WLI and VICI simultaneously, and WLI and NBI simultaneously, respectively. WLI and VICI simultaneously tended to result in higher accuracy than WLI alone (P=0.083) and the results were not significantly different from WLI and NBI simultaneously (P=0.65). CONCLUSIONS: VICI in POCS proved valuable for visualizing surface structures and lesion margins and contributed to higher diagnostic accuracy comparable to NBI. In addition to NBI, VICI may be a novel supportive modality for POCS.

DOI： 10.1016/j.gie.2024.06.013

Increased phosphatidylcholine and its hydroperoxides in serum low-density lipoproteins from patients with non-alcoholic steatohepatitis. 国際誌

Nanao Murakami, Toshihiro Sakurai, Arisa Yamahata, Akiko Sakurai, Kazuhiro Nouso, Yuki Fujii, Hitoshi Chiba, Shu-Ping Hui

Annals of clinical biochemistry 45632241259658 - 45632241259658 2024年5月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: Non-alcoholic fatty liver disease is classified into simple steatosis (SS) and non-alcoholic steatohepatitis (NASH) according to histological findings from liver biopsies. Phosphatidylcholine (PC), the main component of phospholipids in serum lipoproteins, is easily oxidized to phosphatidylcholine hydroperoxide (PC-OOH). Although a lipid composition in the low-density lipoproteins (LDL) from patients with NASH could be abnormal, it remains unclear. Here, to better understand the characteristics of lipids in the LDL from NASH and SS, we compared the composition of PC and PC-OOH species in LDL particles (LDL-PC, LDL-PCOOH) from these patients, then clarified the association between these lipids and NASH severity. METHODS: The serum samples from patients with NASH (female, n = 9) and SS (female, n = 4; male, n = 2) were used for isolation of LDL. Total lipids were extracted from isolated LDL, and the species of PC and PC-OOH were measured using liquid chromatography-mass spectrometry/mass spectrometry. RESULTS: The sum of LDL-PC and the sum of LDL-PCOOH were significantly higher in NASH than in SS. Several LDL-PC (PC 32:0, 32:1, 32:2, 34:3, 36:2, sum of PC with saturated fatty acyl chains and sum of LDL-PC with polyunsaturated fatty acyl chains) and several LDL-PCOOH (34:2, 36:2, 36:3 and total) were increased significantly with increasing fibrosis score. In particular, a series of LDL-PCOOH were more reflective of the severity of fibrosis score. CONCLUSIONS: LDL-PC and LDL-PCOOH species were strongly correlated with the fibrosis score in NASH, which suggests that abnormal LDL is involved in the development of liver fibrosis.

DOI： 10.1177/00045632241259658

Detection of residual stones by peroral direct cholangioscopy in patients with intrahepatic stones after hepaticojejunostomy: A prospective study (with video). 国際誌

Kazuyuki Matsumoto, Hironari Kato, Akihiro Matsumi, Kazuya Miyamoto, Kosaku Morimoto, Yuki Fujii, Ryosuke Sato, Nao Hattori, Taisuke Obata, Hiroyuki Terasawa, Daisuke Uchida, Shigeru Horiguchi, Koichiro Tsutsumi, Motoyuki Otsuka

Gastrointestinal endoscopy 2024年4月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND AND AIMS: The difficulty of radiographic confirmation of the presence of stones remains a challenge in the treatment of intrahepatic bile duct (IHBD) stones in patients after hepaticojejunostomy (HJ). Peroral direct cholangioscopy (PDCS) enables direct observation of the bile duct and is useful for detecting and removing residual stones; however, its effectiveness is not clearly established in this clinical context. METHODS: This single-center, single-arm, prospective study included 44 patients with IHBD who underwent bowel reconstruction with HJ during the study period. Stone removal was performed by short-type double-balloon enteroscopy (DBE). Following balloon-occluded cholangiography, the DBE was exchanged for an ultraslim endoscope through the balloon overtube for PDCS. The primary endpoint was the rate of residual stones detected by PDCS. Secondary endpoints were success rate of PDCS, residual stone removal with PDCS, procedure time for PDCS, procedure-related adverse events, and stone recurrence rate. RESULTS: PDCS was successful in 39/44 patients (89%), among whom residual stones were detected in 16 (41%) (95% CI: 28%-54%). Twelve patients (75%) had residual stones <5 mm. Stone removal was successful in 15 (94%) patients and median procedure time for PDCS was 16 (IQR: 10-26) min. The rate of procedure-related adverse events was 7% (3/44), all of which improved with conservative treatment. During median follow-up of 2.1 years (IQR: 1.4-3.3), the overall probability of recurrence-free status at 1, 2, and 3 years was 100%, 92%, and 86%, respectively. CONCLUSIONS: PDCS is a safe and effective procedure for complete stone removal in patients with IHBD stones after HJ.

DOI： 10.1016/j.gie.2024.04.014

経口胆道鏡検査におけるAIを用いた色素内視鏡画像への疑似変換

佐藤亮介, 松本和幸, 冨谷昌弘, 谷本太郁由, 大戸彰三, 原田圭, 服部直, 小幡泰介, 松三明宏, 宮本和也, 森本光作, 寺澤裕之, 藤井佑樹, 内田大輔, 衣笠秀明, 堤康一郎, 堀口繁, 加藤博也, 河原祥朗, 大塚基之

日本消化器病学会雑誌 121 ( 臨増総会 ) A356 - A356 2024年3月

神経内分泌腫瘍の新しい治療戦略膵消化管神経内分泌腫瘍肝転移に対するPRRTの治療効果予測因子についての検討

堀口繁, 加藤博也, 寺澤裕之, 藤井佑樹, 山崎辰洋, 松本和幸, 堤康一郎, 大塚基之

日本消化器病学会雑誌 121 ( 臨増総会 ) A108 - A108 2024年3月

膵癌の分子異常と個別化治療切除不能進行膵癌治療において生殖細胞BRCA病的変異は体細胞CGP結果によらず白金製剤治療効果予測因子となる

堀口繁, 加藤博也, 寺澤裕之, 藤井佑樹, 山崎辰洋, 松本和幸, 堤康一郎, 大塚基之

日本消化器病学会雑誌 121 ( 臨増総会 ) A87 - A87 2024年3月

MicroRNA-451a inhibits gemcitabine-refractory biliary tract cancer progression by suppressing the MIF-mediated PI3K/AKT pathway. 国際誌

Taisuke Obata, Koichiro Tsutsumi, Eijiro Ueta, Takashi Oda, Tatsuya Kikuchi, Soichiro Ako, Yuki Fujii, Tatsuhiro Yamazaki, Daisuke Uchida, Kazuyuki Matsumoto, Shigeru Horiguchi, Hironari Kato, Hiroyuki Okada, Motoyuki Otsuka

Molecular therapy. Nucleic acids 34 102054 - 102054 2023年12月

記述言語：英語掲載種別：研究論文（学術雑誌）

Gemcitabine is an effective chemotherapeutic agent for biliary tract cancers (BTCs), including gallbladder cancer (GBC) and cholangiocarcinoma (CCA). However, few other effective agents are currently available, particularly for GEM-refractory BTCs. We previously identified microRNA-451a (miR-451a) as a potential therapeutic target in GBC. To elucidate the antineoplastic effects of miR-451a and its underlying mechanisms, we transfected miR-451a into GBC, gemcitabine-resistant GBC (GR-GBC), and gemcitabine-resistant CCA (GR-CCA) cell lines. Furthermore, mimicking in vivo conditions, tumorigenic GBC organoids and three-dimensional (3D) cell culture systems were employed to investigate the anti-proliferative effects of miR-451a on BTCs, and its effect on stem cell properties. We found that miR-451a significantly inhibited cell proliferation, induced apoptosis, and reduced chemoresistant phenotypes, such as epithelial-mesenchymal transition, in both GBC and GR-GBC. The principal mechanism is probably the negative regulation of the phosphatidylinositol 3-kinase/AKT pathway, partially accomplished by directly downregulating macrophage migration inhibitory factor. The Gene Expression Omnibus database revealed that miR-451a was the most significantly downregulated microRNA in CCA tissues. The introduction of miR-451a resulted in similar antineoplastic effects in GR-CCA. Furthermore, miR-451a reduced cell viability in 3D spheroid models and tumorigenic GBC organoids. These findings suggest that the supplementation of miR-451a is a potential treatment strategy for GEM-refractory BTCs.

DOI： 10.1016/j.omtn.2023.102054

Usefulness of red dichromatic imagining for peroral cholangioscopy. 査読国際誌

Kazuyuki Matsumoto, Yuki Fujii, Daisuke Uchida, Shigeru Horiguchi, Koichiro Tsutsumi, Hironari Kato

Endoscopy 55 ( S 01 ) E264-E265 2023年12月

ロボット支援下膵頭十二指腸切除術後の捻転を伴う輸入脚症候群に対して内視鏡的整復を行った1例

原田圭, 藤井佑樹, 小幡泰介, 佐藤亮介, 松三明宏, 宮本和也, 森本光作, 寺澤裕之, 山崎辰洋, 内田大輔, 松本和幸, 堀口繁, 堤康一郎, 加藤博也, 大塚基之

日本消化器病学会中国支部例会・日本消化器内視鏡学会中国支部例会プログラム・抄録集 120回・131回 112 - 112 2023年11月

膵神経内分泌腫瘍の治療中にうっ血性左側結腸炎を発症した1例

佐藤亮介, 堀口繁, 小幡泰介, 松三明宏, 宮本和也, 森本光作, 寺澤裕之, 藤井佑樹, 山崎辰洋, 内田大輔, 松本和幸, 堤康一郎, 加藤博也, 大塚基之

日本消化器病学会中国支部例会・日本消化器内視鏡学会中国支部例会プログラム・抄録集 120回・131回 84 - 84 2023年11月

Cysts or necrotic components in pancreatic ductal adenocarcinoma is associated with the risk of EUS-FNA/B complications including needle tract seeding. 国際誌

Hiroyuki Terasawa, Kazuyuki Matsumoto, Takehiro Tanaka, Takeshi Tomoda, Taiji Ogawa, Yuki Ishihara, Tatsuya Kikuchi, Taisuke Obata, Takashi Oda, Akihiro Matsumi, Kazuya Miyamoto, Kosaku Morimoto, Yuki Fujii, Tatsuhiro Yamazaki, Daisuke Uchida, Shigeru Horiguchi, Koichiro Tsutsumi, Hironari Kato, Motoyuki Otsuka

Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.] 2023年10月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: EUS-FNA/B for pancreatic ductal adenocarcinoma (PDAC) is generally considered to be safe; however, while the incidence is low, there are occurrences of complications. Among these complications, there are serious ones like needle tract seeding (NTS), and it is not known than which types of tumors have the risks of EUS-FNA/B complications. This study aimed to evaluate the risk of EUS-FNA/B complications in patients with PDAC, focusing on morphological features. METHODS: Overall, 442 patients who underwent EUS-FNA/B for solid pancreatic masses between January 2018 and May 2022 in four institutions were retrospectively surveyed. Finally, 361 patients histopathologically diagnosed with PDAC were analyzed. Among these patients, 79 tumors with cysts or necrotic components were compared with 282 tumors without cysts or necrotic components. The incidence and risk of EUS-FNA/B complications including NTS were evaluated. RESULTS: There were 9 (2.4 %) of total EUS-FNA/B complications and 3 (0.8 %) of NTS. The incidence of total complication rate and NTS in tumors with cysts or necrotic components were significantly higher than in those without cysts or necrotic components (total complication 6.3 % vs. 1.4 %, p = 0.026, NTS 3.7 % vs. 0 %, p = 0.01). The transgastric route of puncture (OR: 93.3, 95 % CI: 3.81-2284.23) and the existence of cysts or necrotic components (OR: 7.3, 95 % CI: 1.47-36.19) were risk factors for EUS-FNA/B complications identified by the multivariate analysis. CONCLUSIONS: We should pay attention to the risks of EUS-FNA/B complications, including NTS, when the tumor has cysts or necrotic components.

DOI： 10.1016/j.pan.2023.10.018

Association between BRCA Gene Variants and the Response to Modified FOLFIRINOX in Patients with Unresectable Pancreatic Cancer.

Shigeru Horiguchi, Kazuyuki Matsumoto, Kosaku Morimoto, Akihiro Matsumi, Hiroyuki Terasawa, Yuki Fujii, Tatsuhiro Yamazaki, Koichiro Tsutsumi, Hironari Kato

Acta medica Okayama 77 ( 5 ) 517 - 525 2023年10月

記述言語：英語掲載種別：研究論文（学術雑誌）

We investigated the effect of modified FOLFIRINOX (mFFX) in unresectable pancreatic cancer by retrospectively analyzing the cases of 43 patients who underwent BRCA testing (germline, n=11; somatic, n=26; both germline and somatic, n=6). The association between BRCA mutations and therapeutic effect was clarified. Six patients tested positive for germline pathogenic variants. Familial pancreatic cancer (33% vs. 3%, p=0.006) and peritoneal disseminated lesions (66% vs. 8%, p<0.001) were significantly more common in patients with germline pathogenic variants. The partial response (PR) rate was 100% in the germline BRCA-positive patients, and 27% in the germline BRCA-negative patients (p<0.001). The median progression-free survival (PFS) was not reached for any germline BRCA-positive patients but was 9.0 months for the germline BRCA-negative patients (p=0.042). Patients with stage IV BRCA-associated pancreatic cancer had better overall survival than those with non-BRCA-associated pancreatic cancer, although the difference was nonsignificant (not reached vs. 655 days, p=0.061). Our results demonstrate that a PR and prolonged PFS can be expected in germline BRCA-positive patients after treatment with mFFX. Our findings also suggest that germline BRCA pathogenic variants may be useful as biomarkers for the therapeutic effect of mFFX in patients with pancreatic cancer.

DOI： 10.18926/AMO/65974

The efficacy of non-anesthesiologist-administered propofol sedation with a target-controlled infusion system during double-balloon endoscopic retrograde cholangiopancreatography. 国際誌

Kazuya Miyamoto, Kazuyuki Matsumoto, Taisuke Obata, Ryosuke Sato, Akihiro Matsumi, Kosaku Morimoto, Taiji Ogawa, Hiroyuki Terasawa, Yuki Fujii, Tatsuhiro Yamazaki, Daisuke Uchida, Shigeru Horiguchi, Koichiro Tsutsumi, Hironari Kato, Motoyuki Otsuka

BMC gastroenterology 23 ( 1 ) 296 - 296 2023年9月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: The sedation method used during double-balloon endoscopic retrograde cholangiopancreatography (DB-ERCP) differs among countries and/or facilities, and there is no established method. This study aimed to evaluate the efficacy of non-anesthesiologist-administered propofol (NAAP) sedation using a target-controlled infusion (TCI) system during DB-ERCP. METHODS: This retrospective study was conducted between May 2017 and December 2020 at an academic center. One hundred and fifty-six consecutive patients who underwent DB-ERCP were sedated by gastroenterologists using diazepam (n = 77) or propofol with a TCI system (n = 79), depending on the period. The primary endpoint was a comparison of poor sedation rates between the two groups. Poor sedation was defined as a condition requiring the use of other sedative agents or discontinuation of the procedure. Secondary endpoints were sedation-related adverse events and risk factors for poor sedation. RESULTS: Poor sedation occurred significantly more often in the diazepam sedation group (diazepam sedation, n = 12 [16%] vs. propofol sedation, n = 1 [1%]; P = 0.001). Vigorous body movements (3 or 4) (diazepam sedation, n = 40 [52%] vs. propofol sedation, n = 28 [35%]; P = 0.038) and hypoxemia (< 85%) (diazepam sedation, n = 7 [9%] vs. propofol sedation, n = 1 [1%]; P = 0.027) occurred significantly more often in the diazepam sedation group. In the multivariate analysis, age < 70 years old (OR, 10.26; 95% CI, 1.57-66.98; P = 0.015), BMI ≥ 25 kg/m2 (OR, 11.96; 95% CI, 1.67-85.69; P = 0.014), and propofol sedation (OR, 0.06; 95% CI, 0.01-0.58; P = 0.015) were associated factors for poor sedation. CONCLUSIONS: NAAP sedation with the TCI system during DB-ERCP was safer and more effective than diazepam sedation.

DOI： 10.1186/s12876-023-02936-8

先天性胆道拡張症術後の肝内胆管狭窄に対し内視鏡的胆道拡張術が有効であった一例

宮本和也, 加藤博也, 小幡泰介, 佐藤亮介, 松三明宏, 森本光作, 藤井佑樹, 山崎辰洋, 内田大輔, 松本和幸, 堀口繁, 堤康一郎, 大塚基之

日本膵・胆管合流異常研究会プロシーディングス 46 76 - 76 2023年9月

成人における偽胆石形成のリスク因子の検討

松三明宏, 友田健, 小幡泰介, 佐藤亮介, 宮本和也, 森本光作, 藤井佑樹, 山崎辰洋, 内田大輔, 松本和幸, 堀口繁, 堤康一郎, 加藤博也

胆道 37 ( 3 ) 690 - 690 2023年8月

当院における術後膵空腸吻合部狭窄に対する内視鏡治療成績の検討

森本光作, 山崎辰洋, 小幡泰介, 佐藤亮介, 織田崇志, 菊池達也, 松三明宏, 宮本和也, 寺澤裕之, 藤井佑樹, 内田大輔, 松本和幸, 堀口繁, 堤康一郎, 加藤博也, 大塚基之

膵臓 38 ( 3 ) A337 - A337 2023年7月

結節を有するIPMNの良悪性診断における新規TIC解析プログラムを用いた造影EUSの有用性

宮本和也, 松本和幸, 内田大輔, 小幡泰介, 佐藤亮介, 織田崇志, 菊池達也, 松三明宏, 森本光作, 寺澤裕之, 藤井佑樹, 山崎辰洋, 堀口繁, 堤康一郎, 加藤博也, 大塚基之

膵臓 38 ( 3 ) A345 - A345 2023年7月

悪性輸入脚症候群に対して超音波内視鏡下消化管ドレナージが有効であった1例

森本光作, 松本和幸, 小幡泰介, 佐藤亮介, 織田崇志, 菊池達也, 松三明宏, 宮本和也, 寺澤裕之, 藤井佑樹, 山崎辰洋, 内田大輔, 堀口繁, 堤康一郎, 加藤博也, 大塚基之

日本消化器内視鏡学会中国支部例会 130回 83 - 83 2023年6月

進行胆道癌に対するゲムシタビン・シスプラチン・S-1併用療法の治療成績についての検討

小幡泰介, 松本和幸, 佐藤亮介, 菊池達也, 織田崇志, 松三明宏, 宮本和也, 森本光作, 寺澤裕之, 藤井佑樹, 山崎辰洋, 内田大輔, 堀口繁, 堤康一郎, 加藤博也, 大塚基之

日本消化器病学会中国支部例会プログラム・抄録集 119回 65 - 65 2023年6月

肝内結石に対して内視鏡用イントロデューサーEndoSheatherが有用であった1例

佐藤亮介, 藤井佑樹, 小幡泰介, 松三明宏, 宮本和也, 森本光作, 寺澤裕之, 山崎辰洋, 内田大輔, 松本和幸, 堤康一郎, 堀口繁, 加藤博也, 大塚基之

日本消化器内視鏡学会中国支部例会 130回 83 - 83 2023年6月

長期経過を追えた膵Intraductal oncocytic papillary neoplasm(IOPN)の1例

藤井佑樹, 佐藤亮介, 小幡泰介, 松三明宏, 宮本和也, 森本光作, 寺澤裕之, 山崎辰洋, 内田大輔, 松本和幸, 堀口繁, 堤康一郎, 加藤博也, 大塚基之

日本消化器病学会中国支部例会プログラム・抄録集 119回 67 - 67 2023年6月

A Comparison of the Efficacy of Plastic Stent Placement Above and Across the Sphincter of Oddi for Benign Biliary Hilar Stricture. 査読

Hitomi Himei, Hironari Kato, Yosuke Saragai, Yuki Fujii, Tatsuhiro Yamazaki, Daisuke Uchida, Kazuyuki Matsumoto, Shigeru Horiguchi, Koichiro Tsutsumi, Hiroyuki Okada

Acta medica Okayama 77 ( 3 ) 291 - 299 2023年6月

記述言語：英語掲載種別：研究論文（学術雑誌）

We investigated the efficacy and safety of endoscopic plastic stent (PS) placement for hilar benign biliary strictures (BBSs) and compared cases with PS placement above (inside stent, IS) and across (usual stent, US) the sphincter of Oddi. Patients who underwent initial endoscopic PS placement for hilar BBSs between August 2012 and December 2021 were retrospectively analyzed. Hilar BBSs in 88 patients were investigated. Clinical success was achieved in 81 of these cases (92.0%), including 38 patients in the IS group and 43 patients in the US group. Unexpected stent exchange (uSE) before the first scheduled PS exchange occurred in 18 cases (22.2%). The median time from first stent placement to uSE was 35 days. There was no significant difference in the rate and median time to uSE between the two groups. The rates of adverse events such as pancreatitis or cholangitis in the two groups did not significantly differ. However, the rate of difficult stent removal in the IS group (15.8%) was significantly higher than that in the US group (0%) (p=0.0019). US placement is preferable to IS placement for scheduled stent exchange, as it offers the same effectiveness and risk of adverse events with easier stent removal.

DOI： 10.18926/AMO/65494

進行胆道癌に対するゲムシタビン・シスプラチン・S-1併用療法の治療成績についての検討

小幡泰介, 松本和幸, 佐藤亮介, 菊池達也, 織田崇志, 松三明宏, 宮本和也, 森本光作, 寺澤裕之, 藤井佑樹, 山崎辰洋, 内田大輔, 堀口繁, 堤康一郎, 加藤博也, 大塚基之

日本消化器病学会中国支部例会プログラム・抄録集 119回 65 - 65 2023年6月

悪性輸入脚症候群に対して超音波内視鏡下消化管ドレナージが有効であった1例

森本光作, 松本和幸, 小幡泰介, 佐藤亮介, 織田崇志, 菊池達也, 松三明宏, 宮本和也, 寺澤裕之, 藤井佑樹, 山崎辰洋, 内田大輔, 堀口繁, 堤康一郎, 加藤博也, 大塚基之

日本消化器内視鏡学会中国支部例会 130回 83 - 83 2023年6月

当院の胆膵内視鏡診療における放射線量の検討

山崎辰洋, 松本和幸, 小幡泰介, 松三明宏, 宮本和也, 森本光作, 寺澤裕之, 藤井佑樹, 内田大輔, 堀口繁, 堤康一郎, 加藤博也

Gastroenterological Endoscopy 65 ( Suppl.1 ) 875 - 875 2023年4月

選択的胆管seekingのためのデバイス選択

小幡泰介, 内田大輔, 加藤博也, 佐藤亮介, 松三明宏, 宮本和也, 森本光作, 寺澤裕之, 藤井佑樹, 山崎辰洋, 松本和幸, 堀口繁, 堤康一郎, 大塚基之

Gastroenterological Endoscopy 65 ( Suppl.1 ) 971 - 971 2023年4月

高齢者に対する内視鏡治療高齢者におけるバルーン内視鏡下ERCP時のジアゼパムとミダゾラムの有効性・安全性の比較検討

藤井佑樹, 松本和幸, 加藤博也

Gastroenterological Endoscopy 65 ( Suppl.1 ) 755 - 755 2023年4月

Risk Factors for Ceftriaxone-Associated Pseudolithiasis in Adults. 査読国際誌

Akihiro Matsumi, Takeshi Tomoda, Hiroyuki Terasawa, Yuki Fujii, Tatsuhiro Yamazaki, Daisuke Uchida, Kazuyuki Matsumoto, Shigeru Horiguchi, Koichiro Tsutsumi, Hironari Kato

Digestion 1 - 7 2023年3月

記述言語：英語掲載種別：研究論文（学術雑誌）

INTRODUCTION: Ceftriaxone (CTRX) is known to occasionally cause pseudolithiasis. This condition is often observed in children; however, few studies have reported the incidence and risk factors for CTRX-associated pseudolithiasis. METHODS: In this single-center retrospective study, we investigated the incidence of and risk factors for CTRX-associated pseudolithiasis in adults. All patients underwent computed tomography to confirm pseudolithiasis before and after CTRX administration. RESULTS: The study included 523 patients. Pseudolithiasis was detected in 89 patients (17%). Data analysis showed that abdominal area-related biliary diseases at the site of infection (odds ratio [OR] 0.19, 95% confidence interval [CI] 0.064-0.53, p = 0.0017), CTRX administration for >3 days (OR 5.0, 95% CI: 2.5-9.9, p < 0.0001), CTRX dose of 2 mg (OR 5.2, 95% CI: 2.8-9.6, p < 0.0001), fasting period >2 days (OR 3.2, 95% CI: 1.6-6.4, p = 0.0010), and estimated glomerular filtration rate <30 mL/min/1.73 m2 (OR 3.4, 95% CI: 1.6-7.5, p = 0.0022) were independent factors for pseudolithiasis. CONCLUSIONS: CTRX-associated pseudolithiasis may occur in adults and should be considered in the differential diagnosis in patients who develop abdominal pain or liver enzyme elevation after CTRX administration, particularly in patients with chronic kidney disease, in those who are fasting, in and those who receive high-dose CTRX therapy.

DOI： 10.1159/000529522

EUS-HGSにおけるダブルガイドワイヤー法の有用性

松三明宏, 藤井佑樹, 小幡泰介, 佐藤亮介, 織田崇志, 菊池達也, 宮本和也, 森本光作, 寺澤裕之, 山崎辰洋, 内田大輔, 松本和幸, 堀口繁, 堤康一郎, 加藤博也, 大塚基之

日本消化器病学会雑誌 120 ( 臨増総会 ) A321 - A321 2023年3月

後期高齢者におけるIPMNの治療移行割合についての検討

宮本和也, 松本和幸, 小幡泰介, 佐藤亮介, 織田崇志, 菊池達也, 松三明宏, 森本光作, 寺澤裕之, 藤井佑樹, 山崎辰洋, 内田大輔, 堀口繁, 堤康一郎, 加藤博也, 大塚基之

日本消化器病学会雑誌 120 ( 臨増総会 ) A378 - A378 2023年3月

胆嚢オルガノイドを用いた発癌モデルより同定したmiR-34a-5p補充による胆嚢癌治療の開発

織田崇志, 堤康一郎, 小幡泰介, 菊池達也, 松三明宏, 宮本和也, 森本光作, 寺澤裕之, 藤井佑樹, 山崎辰洋, 赤穂宗一郎, 内田大輔, 松本和幸, 堀口繁, 加藤博也, 大塚基之

日本消化器病学会雑誌 120 ( 臨増総会 ) A328 - A328 2023年3月

Optimal liver drainage rate for survival in patients with unresectable malignant hilar biliary obstruction using 3D-image volume analyzer. 国際誌

Kosaku Morimoto, Kazuyuki Matsumoto, Taisuke Obata, Takashi Oda, Kazuya Miyamoto, Akihiro Matsumi, Hiroyuki Terasawa, Yuki Fujii, Tatsuhiro Yamazaki, Shigeru Horiguchi, Koichiro Tsutsumi, Hironari Kato, Motoyuki Otsuka

Therapeutic advances in gastroenterology 16 17562848231206980 - 17562848231206980 2023年

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: Drainage exceeding 50% of total liver volume is a beneficial prognostic factor in patients with unresectable malignant hilar biliary obstruction (UMHBO). However, it is unclear what threshold percentage of total liver volume drained ('liver drainage rate') significantly improves survival in patients with UMHBO who received systemic chemotherapy. OBJECTIVES: We aimed to assess the optimal liver drainage rate that improves survival in patients with UMHBO receiving chemotherapy using a three-dimensional (3D)-image volume analyzer. DESIGN: This study was a single-center retrospective cohort study. METHODS: Data from 90 patients with UMHBO who received chemotherapy after endoscopic biliary drainage using metal stents at Okayama University Hospital from January 2003 to December 2020 were reviewed. The liver drainage rate was calculated by dividing the drained liver volume by the total liver volume using a 3D-image volume analyzer. The primary endpoint was overall survival by liver drainage rate. The secondary endpoints were time to recurrent biliary obstruction (TRBO) and prognostic factors. RESULTS: The median total liver volume was 1172 (range: 673-2032) mL, and the median liver drainage rate was 83% (range: 50-100). Overall survival was 376 (95% CI: 271-450) days, and patients with >80% drainage (n = 67) had significantly longer survival than those with <80% drainage (n = 23) (450 days versus 224 days, p = 0.0033, log-rank test). TRBO was 201 (95% CI: 155-327) days and did not differ significantly by liver drainage rate. Multivariate Cox proportional hazards regression analysis revealed >80% liver drainage [hazard ratio (HR): 0.35, 95% CI: 0.20-0.62, p = 0.0003] and hilar cholangiocarcinoma (HR: 0.30, 95% CI: 0.17-0.50, p < 0.0001) as significant prognostic factors. CONCLUSION: In patients with UMHBO scheduled for chemotherapy, >80% drainage is associated with improved survival. Further prospective multicenter studies are needed to verify the results of this study. TRAIL REGISTRATION: Okayama University Hospital, IRB number: 2108-011.

DOI： 10.1177/17562848231206980

Endoscopic treatment for duodenal perforation due to biliary stent dislocation: A case report and brief review of the literature. 国際誌

Yuki Fujii, Kazuyuki Matsumoto, Kazuya Miyamoto, Akihiro Matsumi, Kosaku Morimoto, Hiroyuki Terasawa, Tatsuhiro Yamazaki, Shigeru Horiguchi, Koichiro Tsutsumi, Hironari Kato

Medicine 101 ( 48 ) e31868 2022年12月

記述言語：英語掲載種別：研究論文（学術雑誌）

RATIONALE: Duodenal wall perforation by a dislocated biliary stent placed for biliary structure is rare but can be life-threatening. There are few reports on the management of stent-related duodenal perforation. PATIENT CONCERNS: Three cases included in this study had undergone endoscopic retrograde cholangiopancreatography with placement of a plastic stent for biliary stricture. Two cases had symptoms (fever or abdominal pain), while other case showed no symptom after biliary stent placement. DIAGNOSES: Dislocation of plastic stents was revealed on computed tomography or endoscopic images. Two patients were diagnosed with duodenal perforation due to distal migration of long stents with a straight shape on the distal side. One patient was diagnosed with fistula formation between the intrahepatic bile duct and duodenum due to perforation of a pigtail stent. INTERVENTIONS: All cases could successfully be managed endoscopically with closure by hemoclips or stent replacement. OUTCOMES: All 3 cases were improved after endoscopic treatment without any subsequent intervention. LESSONS: Longer stents with a straight distal side are associated with a higher risk of duodenal perforation. Endoscopic management is appropriate as a first-line approach for a clinically stable patient. At the time of stent placement, we should pay attention to the length and type of stent.

DOI： 10.1097/MD.0000000000031868

Double guidewire technique stabilization procedure for endoscopic ultrasound-guided hepaticogastrostomy involving modifying the guidewire angle at the insertion site. 国際誌

Yuki Fujii, Hironari Kato, Hitomi Himei, Eijiro Ueta, Taiji Ogawa, Hiroyuki Terasawa, Tatsuhiro Yamazaki, Kazuyuki Matsumoto, Shigeru Horiguchi, Koichiro Tsutsumi, Hiroyuki Okada

Surgical endoscopy 36 ( 12 ) 8981 - 8991 2022年12月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND AND AIMS: Endoscopic ultrasonography-guided hepaticogastrostomy (EUS-HGS) is often performed using a single guidewire (SGW), but the efficacy of the double guidewire (DGW) technique during endoscopic ultrasonography-guided biliary drainage has been reported. We evaluated the efficacy of the DGW technique for EUS-HGS, focusing on the guidewire angle at the insertion site. METHODS: This retrospective cohort study included consecutive patients who underwent EUS-HGS between April 2012 and March 2021. We measured the guidewire angle at the insertion site using still fluoroscopic imaging. We compared the clinical outcomes of EUS-HGS with the DGW and SGW techniques. The factors associated with successful cannula insertion, need for additional fistula dilation and adverse event rate were assessed by a logistic regression multivariable analysis. RESULTS: The DGW group showed higher technical (p = 0.020) and clinical success rates (p = 0.016) than the SGW group, which showed more adverse events (p = 0.017) than the DGW group. Successful cannula insertion was associated with a guidewire angle > 137° and an uneven double-lumen cannula. The DGW technique made the guidewire angle obtuse at the insertion site (p < 0.0001). A guidewire angle ≤ 137° (OR, 35.6; 95% CI, 1.70-744; p = 0.0045) and intrahepatic bile duct diameter of the puncture site ≤ 3.0 mm (OR, 14.4; 95% CI, 1.37-152; p = 0.0056) were risk factors for needing additional fistula dilation in a multivariate analysis, and additional dilation was a significant predictive factor for adverse events (OR, 8.3; 95% CI, 0.9-77; p = 0.026). CONCLUSIONS: The DGW technique can modify the guidewire angle at the insertion site and facilitate stent deployment with few adverse events.

DOI： 10.1007/s00464-022-09350-3

Gastric linitis plastica with autoimmune pancreatitis diagnosed by an endoscopic ultrasonography-guided fine-needle biopsy: A case report. 査読国際誌

Ryosuke Sato, Kazuyuki Matsumoto, Hiromitsu Kanzaki, Akihiro Matsumi, Kazuya Miyamoto, Kosaku Morimoto, Hiroyuki Terasawa, Yuki Fujii, Tatsuhiro Yamazaki, Daisuke Uchida, Koichiro Tsutsumi, Shigeru Horiguchi, Hironari Kato

World journal of clinical cases 10 ( 31 ) 11607 - 11616 2022年11月

記述言語：英語

BACKGROUND: Gastric linitis plastica (GLP) is a subset of gastric cancer with a poor prognosis. It is difficult to obtain a definitive diagnosis by endoscopic mucosal biopsies, and the usefulness of an endoscopic ultrasonography-guided fine-needle biopsy (EUS-FNB) for GLP has been recently reported. Meanwhile, autoimmune diseases are occasionally known to coexist with malignant tumors as paraneoplastic syndrome. We herein report the usefulness of an EUS-FNB for detecting GLP and the possibility of paraneoplastic syndrome coexisting with GLP. CASE SUMMARY: An 81-year-old man was admitted to our hospital for a 1-mo history of epigastric pain that increased after eating. His laboratory data revealed high levels of serum carbohydrate antigen 19-9 and immunoglobulin-G4. Endoscopic examinations showed giant gastric folds and reddish mucosa; however, no epithelial changes were observed. The gastric lumen was not distensible by air inflation, suggesting GLP. Computed tomography showed the thickened gastric wall, the diffuse enlargement of the pancreas, and the peripancreatic rim, which suggested autoimmune pancreatitis (AIP) coexisting with GLP. Because the pathological findings of the endoscopic biopsy showed no malignancy, he underwent an EUS-FNB and was diagnosed with GLP. He received chemotherapy for unresectable gastric cancer due to peritoneal metastasis, after which both the gastric wall thickening and diffuse enlargement of the pancreas were improved. CONCLUSION: An EUS-FNB for GLP with a negative endoscopic biopsy is useful, and AIP may develop as a paraneoplastic syndrome.

DOI： 10.12998/wjcc.v10.i31.11607

アンメットメディカルニーズへの挑戦当院における膵消化管神経内分泌腫瘍に対するペプチド受容体放射性核種療法(PRRT)導入後の現状

藤井佑樹, 堀口繁, 内田大輔, 松本和幸, 加藤博也

日本消化器病学会中国支部例会・日本消化器内視鏡学会中国支部例会プログラム・抄録集 118回・129回 77 - 77 2022年11月

Bilateral verses bilateral with tri-segmental endoscopic drainage using metal stents for high-grade malignant hilar biliary obstructions: A multicenter, randomized controlled trial: BRAVE study (BRAVE study). 国際誌

Kazuyuki Matsumoto, Toshiharu Mitsuhashi, Hirofumi Kawamoto, Etsuji Ishida, Masakuni Fujii, Yutaka Akimoto, Hiroyuki Seki, Yuki Ishihara, Taiji Ogawa, Tatsuhiro Yamazaki, Yuki Fujii, Hironari Kato

Medicine 101 ( 40 ) e30857 2022年10月

記述言語：英語掲載種別：研究論文（学術雑誌）

INTRODUCTION: Bilateral endoscopic drainage with self-expanding metallic stent (SEMS) can be used to manage hilar malignant biliary obstruction (HMBO) more effectively in comparison to unilateral drainage. An increased drainage area is predicted to prolong stent patency and patient survival. However, few reports have described the utility of trisegmental drainage and the benefits of using trisegmental drainage remain unknown. Thus, we launched a randomized clinical trial (RCT) to compare the clinical outcomes between bilateral and trisegmental drainage using SEMSs in patients with high-grade HMBO. METHODS AND ANALYSIS: This study was conducted as a multicenter randomized control trial (RCT) in 8 high-volume medical centers in Japan, and will prove the non-inferiority of bilateral drainage to trisegmental drainage. Patients with unresectable HMBO with Bismuth type IIIa or IV who pass the inclusion and exclusion criteria will be randomized to receive bilateral or trisegmental drainage at a 1:1 ratio. At each center, the on-site study investigators will obtain informed consent from the candidates, and will use an electronic data capture system (REDCap) to input necessary information, and register candidates with the registration secretariat. The primary endpoint is the rate of non-recurrent biliary obstruction (RBO) at 180 days after SEMSs placement. A -10% non-inferiority margin is assumed in the statistical analysis of the primary endpoint. Secondary endpoints include the rate of technical and clinical success, time to recurrent biliary obstruction (TRBO), causes of RBO, procedure-related adverse events (AEs), procedure time, TRBO with or without endoscopic sphincterotomy, overall survival, and the technical and clinical success rates at reintervention. DISCUSSION: If the non-inferiority of bilateral drainage is demonstrated, it is predicted that the procedure time will be shortened and the medical cost will be reduced, which will be beneficial to the patient and the medical economy. TRIAL REGISTRATION: Registered in Japan Registry of Clinical Trial-Registration (trial number. jRCTs062220038). This version number 1. Protocol dated Jun 23, 2022.

DOI： 10.1097/MD.0000000000030857

A case of endoscopic retrograde cholangiopancreatography-related main pancreatic duct perforation salvaged by endoscopic ultrasonography-guided pancreatic duct drainage. 査読

Ryosuke Sato, Kazuyuki Matsumoto, Akihiro Matsumi, Kosaku Morimoto, Hiroyuki Terasawa, Yuki Fujii, Tatsuhiro Yamazaki, Koichiro Tsutsumi, Shigeru Horiguchi, Hironari Kato

Clinical journal of gastroenterology 15 ( 6 ) 1179 - 1184 2022年9月

記述言語：英語掲載種別：研究論文（学術雑誌）

We herein report a 78-year-old man who underwent endoscopic retrograde cholangiopancreatography (ERCP) to examine main pancreatic duct (MPD) stenosis. During ERCP, MPD perforation occurred due to the cytology brush maneuver. Endoscopic pancreatic stenting to bridge the perforated site failed because the MPD was bent and formed a loop. Thus, we placed the stent at the proximal perforated side. The patient developed retroperitoneal perforation and pancreatic fistula with infection, showing a worsening condition. Pancreatic duct drainage was not effective, so we performed endoscopic ultrasonography-guided pancreatic duct drainage. Subsequently, he gradually improved and was discharged 3 months after initial ERCP.

DOI： 10.1007/s12328-022-01699-1

十二指腸乳頭部腫瘍の内視鏡切除術における非完全切除例の取り扱いに関する検討

藤井佑樹, 松本和幸, 加藤博也

胆道 36 ( 3 ) 402 - 402 2022年9月

生体肝移植後胆管狭窄に対する内視鏡治療

山崎辰洋, 松本和幸, 加藤博也, 松三明宏, 宮本和也, 寺澤裕之, 藤井佑樹, 内田大輔, 堀口繁, 堤康一郎

胆道 36 ( 3 ) 344 - 344 2022年9月

Stent-in-stent techniqueにて抜去した胆管金属ステントの2例

松三明宏, 松本和幸, 小幡泰介, 織田崇志, 菊池達也, 宮本和也, 森本光作, 寺澤裕之, 藤井佑樹, 山崎辰洋, 内田大輔, 堀口繁, 堤康一郎, 加藤博也

胆道 36 ( 3 ) 349 - 349 2022年9月

Endoscopic ultrasonography-guided bilateral drainage with antegrade stenting in patient with malignant hilar biliary obstruction after bowel reconstruction. 国際誌

Ryosuke Sato, Kazuyuki Matsumoto, Hiroyuki Terasawa, Yuki Fujii, Tatsuhiro Yamazaki, Shigeru Horiguchi, Hironari Kato

Endoscopy 54 ( S 02 ) E1026-E1027 2022年8月

『胆膵疾患と性差』分枝型IPMNの性差による画像的特徴と長期経過の検討

宮本和也, 松本和幸, 松三明宏, 森本光作, 寺澤裕之, 藤井佑樹, 山崎辰洋, 内田大輔, 堀口繁, 堤康一郎, 加藤博也

日本高齢消化器病学会誌 25 ( 1 ) 161 - 161 2022年7月

胃切後Roux-en-Y再建腸管を有する患者の総胆管結石治療におけるバルーン内視鏡下ERCPの治療戦略

小幡泰介, 堤康一郎, 加藤博也, 織田崇志, 森本光作, 姫井人美, 松三明宏, 上田英次郎, 小川泰司, 寺澤裕之, 藤井佑樹, 山崎辰洋, 松本和幸, 堀口繁, 岡田裕之

Gastroenterological Endoscopy 64 ( Suppl.1 ) 820 - 820 2022年4月

術後腸管症例におけるステント迷入に対するダブルバルン内視鏡を用いたステント抜去法

織田崇志, 松本和幸, 加藤博也, 小幡泰介, 上田英次郎, 姫井人美, 松三明宏, 森本光作, 小川泰司, 寺澤裕之, 藤井佑樹, 山崎辰洋, 堀口繁, 堤康一郎

Gastroenterological Endoscopy 64 ( Suppl.1 ) 765 - 765 2022年4月

胆管空腸吻合術後の肝内結石に対する直接胆道鏡の有用性の検討

松三明宏, 松本和幸, 加藤博也, 小幡泰介, 織田崇志, 上田英次郎, 姫井人美, 森本光作, 小川泰司, 寺澤裕之, 藤井佑樹, 山崎辰洋, 堀口繁, 堤康一郎, 岡田裕之

Gastroenterological Endoscopy 64 ( Suppl.1 ) 821 - 821 2022年4月

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

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

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

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

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

EUS画像に基づいたIPMN組織亜型予測診断に関する研究国際誌

藤井佑樹

21 ( 3 ) 622 - 629 2021年4月

Low-Density Lipoprotein (LDL)-Triglyceride and Its Ratio to LDL-Cholesterol as Diagnostic Biomarkers for Nonalcoholic Steatohepatitis. 国際誌

Yuki Fujii, Kazuhiro Nouso, Hiroshi Matsushita, Kazuya Kariyama, Toshihiro Sakurai, Yuji Takahashi, Hitoshi Chiba, Shu-Ping Hui, Yasuki Ito, Motoko Ohta, Hiroyuki Okada

The journal of applied laboratory medicine 5 ( 6 ) 1206 - 1215 2020年11月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) is the most common type of liver disease, but it is difficult to distinguish its pathogenic phenotype, nonalcoholic steatohepatitis (NASH), from nonalcoholic fatty liver (NAFL) without a liver biopsy. We analyzed serum lipids, including low-density lipoprotein triglyceride (LDL-TG), to elucidate their usefulness for diagnosing NASH. PATIENTS AND METHODS: Serum samples obtained from 35 NASH and 9 NAFL biopsy-confirmed patients and 6 healthy volunteers (HLT) were studied for 13 lipid-related markers and compared between HLT, NAFL, and NASH groups. The relationship between histological findings and the lipid markers was also analyzed. RESULTS: There were significant differences in triglyceride, LDL-TG, the ratio of LDL-TG to the LDL-cholesterol (LDL-TG/LDL-C), small dense LDL-C, and apolipoprotein E between the three groups. Among the 5 lipid components, serum LDL-TG level and the ratio of LDL-TG to the LDL-cholesterol (LDL-TG/LDL-C) were significantly elevated in NASH. The median concentrations of LDL-TG in HLT, NAFL, and NASH were 9, 15, and 20 mg/dL (P < 0.001), and those of LDL-TG/LDL-C were 0.097, 0.102, and 0.173 (P < 0.001), respectively. Although the degree of steatosis was not correlated with the LDL-TG/LDL-C, the ratio was significantly higher in patients with lobular inflammation (P = 0.071), ballooning (P = 0.031), and fibrosis (P < 0.001). The area under the receiver operating characteristic curve of the ratio for distinguishing NASH from NAFL was 0.857. The rest of studied markers showed no significant utility. CONCLUSION: Serum LDL-TG levels and the LDL-TG/LDL-C ratio might serve as simple and noninvasive diagnostic biomarkers for NASH.

DOI： 10.1093/jalm/jfaa044

当院における肝門部領域良性胆道狭窄に対するInside stentの有用性の検討

皿谷洋祐, 加藤博也, 上田英次郎, 松三明宏, 宮本和也, 藤井佑樹, 山崎辰洋, 内田大輔, 友田健, 堀口繁, 堤康一郎, 岡田裕之

胆道 34 ( 3 ) 582 - 582 2020年8月

[Synchronous double primary cancers of a mixed adenoneuroendocrine carcinoma of the distal bile duct and a carcinoma in situ in the perihilar bile duct].

Yuki Fujii, Shinsuke Koshita, Yoshihide Kanno, Takahisa Ogawa, Kaori Masu, Masaya Oikawa, Takaho Okada, Yutaka Noda, Takashi Sawai, Kei Ito

Nihon Shokakibyo Gakkai zasshi = The Japanese journal of gastro-enterology 117 ( 2 ) 178 - 188 2020年

記述言語：日本語掲載種別：研究論文（学術雑誌）

We report the rare case of a 69-year-old man who underwent resection of a mixed adenoneuroendocrine carcinoma (MANEC) of the distal bile duct and a carcinoma in situ in the perihilar bile duct. The patient was admitted to our hospital for obstructive jaundice. Imaging studies revealed a mass in the distal bile duct, and an abnormal epithelium was detected in the perihilar bile duct using peroral cholangioscopy. Bile cytology and transpapillary biopsy of the tumor revealed adenocarcinoma. We diagnosed this patient with distal cholangiocarcinoma with extensive intraepithelial progression toward the perihilar bile duct and performed a subtotal stomach-preserving pancreaticoduodenectomy and left hepatectomy. According to the histological examination of the resected specimens, we found a MANEC in the distal bile duct and a carcinoma in situ in the perihilar bile duct. Together, they were diagnosed as synchronous double primary cancers due to the lack of pathological transition between them.

DOI： 10.11405/nisshoshi.117.178

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

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

Intracholecystic papillary-tubular neoplasm of the gallbladder originating in the cystic duct with extensive intraepithelial progress in the common bile duct.

Yuki Fujii, Yutaka Noda, Shinsuke Koshita, Yoshihide Kanno, Takahisa Ogawa, Hiroaki Kusunose, Kaori Masu, Toshitaka Sakai, Keisuke Yonamine, Yujiro Kawakami, Toji Murabayashi, Fumisato Kozakai, Takashi Sawai, Toru Furukawa, Kei Ito

Clinical journal of gastroenterology 12 ( 3 ) 197 - 204 2019年6月

記述言語：英語掲載種別：研究論文（学術雑誌）

A 59-year-old man with anorexia who had a history of cholecystectomy was referred to our hospital. Imaging examinations revealed a contrast-enhanced tumor in the residual cystic duct and a part of the common bile duct. Endoscopic retrograde cholangiopancreatography and peroral-cholangioscopy showed a papillary tumor with movement and a change in the shape. Under a diagnosis of primary cystic duct cancer, subtotal stomach-preserving pancreaticoduodenectomy was performed. The microscopic examination of a resected specimen revealed intracholecystic papillary-tubular neoplasm located in the residual cystic duct, forming a polypoid protrusion to the common bile duct and extensive intraepithelial progress in the common bile duct.

DOI： 10.1007/s12328-018-0927-4

Predictive Factors for Inaccurate Diagnosis of Swollen Lymph Nodes in Endoscopic Ultrasound-Guided Fine Needle Aspiration. 国際誌

Yuki Fujii, Yoshihide Kanno, Shinsuke Koshita, Takahisa Ogawa, Hiroaki Kusunose, Kaori Masu, Toshitaka Sakai, Keisuke Yonamine, Yujiro Kawakami, Toji Murabayashi, Fumisato Kozakai, Yutaka Noda, Hiroyuki Okada, Kei Ito

Clinical endoscopy 52 ( 2 ) 152 - 158 2019年3月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND/AIMS: This study aimed to identify the predictive factors for inaccurate endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) diagnosis of swollen lymph nodes without rapid on-site cytopathological evaluation. METHODS: Eighty-three consecutive patients who underwent EUS-FNA for abdominal or mediastinal lymph nodes from January 2008 to June 2017 were included from a prospectively maintained EUS-FNA database and retrospectively reviewed. The sensitivity, specificity, and accuracy of EUS-FNA for the detection of neoplastic diseases were calculated. Candidate factors for inaccurate diagnosis (lymph node size and location, needle type, puncture route, number of passes, and causative disease) were evaluated by comparison between accurately diagnosed cases and others. RESULTS: The final diagnosis of the punctured lymph node was classified as neoplastic (65 cases: a metastatic lymph node, malignant lymphoma, or Crow-Fukase syndrome) or non-neoplastic (18 cases: a reactive node or amyloidosis). The sensitivity, specificity, and accuracy were 83%, 94%, and 86%, respectively. On multivariate analyses, small size of the lymph node was the sole predictive factor for inaccurate EUS-FNA diagnosis with a significant difference (odds ratios, 19.8; 95% confidence intervals, 3.15-124; p=0.0015). CONCLUSION: The lymph node size of <16 mm was the only independent factor associated with inaccurate EUS-FNA diagnosis of swollen lymph nodes.

DOI： 10.5946/ce.2018.125

Percutaneous transhepatic cholangioscopy using SpyGlassDS for an anastomotic stenosis after choledochojejunostomy. 国際誌

Yuki Fujii, Shinsuke Koshita, Kei Ito

Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society 30 ( 6 ) 806 - 807 2018年11月

　前のページ - 次のページ　

1