Updated on 2024/06/24

写真a

 
MATSUMOTO Kazuyuki
 
Organization
Okayama University Hospital Lecturer
Position
Lecturer
External link

Degree

  • Anti-programmed cell death-1 antibody as a new serological marker for type 1 autoimmune hepatitis ( 2015.3   Okayama University )

  • 博士(医学) ( 岡山大学 )

Research Areas

  • Life Science / Gastroenterology

Professional Memberships

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Committee Memberships

  • 日本神経内分泌腫瘍研究会 膵・消化管神経内分泌腫瘍診療ガイドライン   作成委員  

    2024   

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  •   日本胆道学会 胆道癌登録委員会 胆道癌非手術症例のNCD入力項目検討ワーキンググループ構成員  

    2023.4   

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  •   経口胆道鏡診療ガイドライン 作成協力者  

    2023   

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  •   膵癌診療ガイドライン(日本膵臓学会) 作成協力者  

    2022   

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  •   膵癌診療ガイドライン(日本膵臓学会) 作成協力者  

    2019   

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Papers

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

    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   2024.6

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    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

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  • A Duodenal Ulcer and Biliopancreatic Lesions: What is the Culprit? International journal

    Ryosuke Sato, Kazuyuki Matsumoto, Motoyuki Otsuka

    Gastroenterology   2024.5

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    DOI: 10.1053/j.gastro.2024.05.027

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  • Current status of endoscopic ultrasound-guided antitumor treatment for pancreatic cancer. International journal

    Kazuyuki Matsumoto, Hironari Kato, Koichiro Tsutsumi, Motoyuki Otsuka

    Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society   2024.5

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    Endoscopic ultrasound (EUS) was developed in the 1990s and has significantly transformed pancreatic tumor diagnosis. Subsequently, EUS has rapidly shifted from being a purely diagnostic procedure to being used in a wide range of interventional procedures. Recently, new therapeutic techniques, such as EUS-guided fine needle injection (EUS-FNI) or radiofrequency ablation (RFA), have been developed to deliver various antitumor agents. Despite technological advancements, pancreatic cancer (PC) has a poor prognosis and improvements in treatment outcomes are urgently required. One of the reasons for the limited response to antitumor agents in PC is the abundant desmoplasia and hypovascular nature of the tumor, complicating drug delivery into the tumor. Thus, changing the tumor microenvironment may be important to enhance the effectiveness of chemotherapy, and direct injection of antitumor agents into the tumor under EUS guidance can help overcome treatment challenges in PC. Treatment approaches using the EUS-FNI or RFA technique are expected to further improve the prognosis of PC. Therefore, this study reviewed the existing literature on EUS-guided antitumor therapy, specifically highlighting its application in PC to address the current challenges and to identify potential advancements in the field.

    DOI: 10.1111/den.14815

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

    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   2024.4

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    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

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  • MicroRNA-34a-5p: A pivotal therapeutic target in gallbladder cancer. International journal

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

    Molecular therapy. Oncology   32 ( 1 )   200765 - 200765   2024.3

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    Gallbladder cancer incidence has been increasing globally, and it remains challenging to expect long prognosis with the current systemic chemotherapy. We identified a novel nucleic acid-mediated therapeutic target against gallbladder cancer by using innovative organoid-based gallbladder cancer models generated from KrasLSL-G12D/+; Trp53f/f mice. Using comprehensive microRNA expression analyses and a bioinformatics approach, we identified significant microRNA-34a-5p downregulation in both murine gallbladder cancer organoids and resected human gallbladder cancer specimens. In three different human gallbladder cancer cell lines, forced microRNA-34a-5p expression inhibited cell proliferation and induced cell-cycle arrest at the G1 phase by suppressing direct target (CDK6) expression. Furthermore, comprehensive RNA sequencing revealed the significant enrichment of gene sets related to the cell-cycle regulators after microRNA-34a-5p expression in gallbladder cancer cells. In a murine xenograft model, locally injected microRNA-34a-5p mimics significantly inhibited gallbladder cancer progression and downregulated CDK6 expression. These results provide a rationale for promising therapeutics against gallbladder cancer by microRNA-34a-5p injection, as well as a strategy to explore therapeutic targets against cancers using organoid-based models, especially for those lacking useful genetically engineered murine models, such as gallbladder cancer.

    DOI: 10.1016/j.omton.2024.200765

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

    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   2023.12

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    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

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  • Successful removal of a proximally migrated pancreatic stent using a novel device delivery system. International journal

    Akihiro Matsumi, Kazuyuki Matsumoto, Daisuke Uchida, Shigeru Horiguchi, Koichiro Tsutsumi, Hironari Kato, Motoyuki Otsuka

    Endoscopy   55 ( S 01 )   E641-E642   2023.12

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    DOI: 10.1055/a-2063-3408

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  • Usefulness of red dichromatic imagining for peroral cholangioscopy. International journal

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

    Endoscopy   55 ( S 01 )   E264-E265   2023.12

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    DOI: 10.1055/a-1966-0534

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  • Usefulness of the artificial intelligence-mediated virtual chromoendoscopy in peroral cholangioscopy. International journal

    Ryosuke Sato, Kazuyuki Matsumoto, Hideaki Kinugasa, Daisuke Uchida, Shigeru Horiguchi, Hironari Kato, Motoyuki Otsuka

    Endoscopy   55 ( S 01 )   E971-E972   2023.12

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    DOI: 10.1055/a-2142-4555

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  • 特発性肺線維症に対する肺移植後に重症膵炎を発症し、診断に苦慮した膵頭部癌の一例

    矢杉 賢吾, 堀口 しげる, 小幡 泰介, 佐藤 亮介, 織田 崇志, 菊池 達也, 松三 明宏, 宮本 和也, 森本 光作, 寺澤 裕之, 藤井 祐樹, 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   85 - 85   2023.11

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

    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.]   2023.10

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    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

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  • 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   2023.10

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    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

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

    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   2023.9

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    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

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

    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   2023.6

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    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

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  • Endoscopic ablation therapy for the pancreatic neoplasms. International journal

    Kazuyuki Matsumoto, Hironari Kato

    Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society   35 ( 4 )   430 - 442   2023.5

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    Recently, endoscopic ultrasound (EUS)-guided ablation therapy has been reported as a less invasive therapy for patients with pancreatic neoplasms. Some ablation techniques, including injective ablation (using ethanol or other ablative agents), radiofrequency ablation (RFA), photodynamic therapy, and laser ablation, have been described in the literature. Among these, injective ablation and RFA are more frequently used for treating pancreatic neoplasms. Few studies have evaluated the effectiveness of EUS-guided ethanol ablation (EUS-EA) for potentially malignant solid neoplasms (neuroendocrine neoplasms or solid pseudopapillary neoplasms) and have reported a complete response (CR) rate of 60-80%. In addition, the CR rate after EUS-RFA for these lesions has been reported to be 55-100%, with no additional procedure-related adverse events (AEs). Regarding the amelioration of the symptoms of an insulinoma, the success rates of both the therapies were found to be excellent. Regarding complete tumor ablation, EUS-RFA appeared to be superior to EUS-EA. Although EUS-RFA has been reported as a safe treatment for pancreatic cancers, its effectiveness remains inadequate. Some studies have examined the effectiveness of EUS-guided injection ablation therapy for pancreatic cystic neoplasms (PCNs) and have reported CR rates that range from 35% to 79%. Alcohol-free chemotherapeutic agent ablation appears to be effective, with a low risk of AEs. However, studies on the effectiveness of EUS-RFA for PCNs are limited. In the future, EUS-guided ablation therapy could become a more widely used approach for potentially malignant and malignant pancreatic lesions.

    DOI: 10.1111/den.14468

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  • Risk Factors for Ceftriaxone-Associated Pseudolithiasis in Adults. International journal

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

    Digestion   1 - 7   2023.3

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    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

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

    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

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    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

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

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

    Medicine   101 ( 48 )   e31868   2022.12

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    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.

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  • Gastric linitis plastica with autoimmune pancreatitis diagnosed by an endoscopic ultrasonography-guided fine-needle biopsy: A case report. International journal

    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   2022.11

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    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.

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  • 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). International journal

    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   2022.10

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    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.

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  • Optimization of Isolation Method for Extracellular Vesicles from Pancreatic Juice and Impact of Protease Activity. International journal

    Koichiro Tsutsumi, Eijiro Ueta, Hironari Kato, Kazuyuki Matsumoto, Shigeru Horiguchi, Hiroyuki Okada

    Digestive diseases and sciences   67 ( 10 )   4797 - 4804   2022.10

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    BACKGROUNDS: Pancreatic juice (PJ) is directly associated with pancreatic lesions, including pancreatic ductal cancer and intraductal papillary mucinous neoplasm-derived cancer. Therefore, EVs secreted from these lesions into PJ can be promising biomarkers for early diagnosis. However, there are limited data from analysis of EVs in PJ samples. AIMS AND METHODS: We aimed to determine the stability of EVs in PJ collected using endoscopic naso-pancreatic drainage (ENPD) tubes as well as catheter during endoscopic retrograde cholangiography (ERCP), with or without the impact of positive protease activity, and optimize the EV isolation method. RESULTS: Size exclusion chromatography was found to be an optimal isolation method for EVs in PJ as it achieved higher recovery and purity of EVs compared with differential ultracentrifugation and polymer-based precipitation. Approximately 40% of the PJ samples collected during ERCP and more than 90% of those collected using ENPD tubes had positive protease activity. In vitro exposure to room temperature for less than 3 h was harmless to the structure of double-membrane EVs in PJ and the expression levels of TSG101, even with positive protease activity. CONCLUSIONS: We clarified the physiobiological status of EVs in PJ and optimized the EV isolation method using suitable PJ samples; these findings can be utilized to discover biomarkers for cancer diagnosis and elucidate their function.

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  • A Case of Lymphoid Hyperplasia of the Gallbladder Extending to the Bile Duct.

    Kazuya Miyamoto, Kazuyuki Matsumoto, Koki Matsubara, Takayoshi Miyake, Shigeru Horiguchi, Ryuta Takenaka, Susumu Shinoura, Shigeatsu Fujiki

    Internal medicine (Tokyo, Japan)   2022.9

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    A 72-year-old woman was referred for the examination of wall thickening of the bile duct and a polyp-like lesion on the gallbladder. The bile duct and gallbladder lesions were observed to be continuous on abdominal ultrasonography. We performed a bile duct biopsy, and pathological findings showed hyperplasia of the lymphoid follicles without malignancy. We considered these two lesions to be the same lesion, and laparoscopic cholecystectomy was performed to make a definite diagnosis. The pathological examination of the resected gallbladder also showed hyperplasia of the lymphoid follicles. We diagnosed the patient with lymphoid hyperplasia of the gallbladder extending to the bile duct.

    DOI: 10.2169/internalmedicine.0365-22

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

    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   2022.9

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    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.

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  • 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   2022.9

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  • Endoscopic ultrasonography-guided bilateral drainage with antegrade stenting in patient with malignant hilar biliary obstruction after bowel reconstruction. International journal

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

    Endoscopy   54 ( S 02 )   E1026-E1027   2022.8

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    DOI: 10.1055/a-1893-5644

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  • Double guidewire technique stabilization procedure for endoscopic ultrasound-guided hepaticogastrostomy involving modifying the guidewire angle at the insertion site. International journal

    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   2022.8

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    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.

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  • Comparison of Bilateral and Trisegment Drainage in Patients with High-Grade Hilar Malignant Biliary Obstruction: A Multicenter Retrospective Study. International journal

    Kazuyuki Matsumoto, Hironari Kato, Kosaku Morimoto, Kazuya Miyamoto, Yosuke Saragai, Hirofumi Kawamoto, Hiroyuki Okada

    Gut and liver   17 ( 1 )   170 - 178   2022.7

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    Background/Aims: Bilateral endoscopic drainage with self-expanding metallic stent (SEMS) can be used to effectively manage hilar malignant biliary obstruction. However, the benefits of using a trisegment drainage method remain unknown. Methods: This study retrospectively reviewed the data of 125 patients with Bismuth type IIIa or IV unresectable malignant strictures who underwent bilateral endoscopic drainage using SEMSs at four tertiary centers. The patients were divided into the bilateral and trisegment drainage groups for comparison. The primary endpoint was stent patency and the secondary endpoints were technical success, technical and clinical success of reintervention, and overall survival. Results: The technical success rates of the bilateral and trisegment drainage groups were 95% (34/36) and 90% (80/89) (p=0.41), respectively, with median stent patency durations of 226 and 170 days (p=0.26), respectively. Although the technical success of reintervention was not significantly different between the two groups (p=0.51), the clinical success rate of reintrvention was significantly higher in the trisegment drainage group (73% [11/15] vs 96% [47/49], p=0.009). The median survival times were 324 and 323 days in the bilateral and trisegment drainage groups, respectively (p=0.72). Multivariate Cox hazards model revealed no stent patency-associated factor; however, chemotherapy was associated with longer survival. Conclusions: Although no significant difference was noted with respect to stent patency, significantly higher clinical success rates were achieved with reintervention using the trisegment drainage method than using the bilateral drainage method alone.

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  • Efficacy of intraductal placement of non-flared fully-covered metal stent for refractory perihilar benign biliary strictures: A multicenter prospective study with long-term observation.

    Kazuyuki Matsumoto, Hironari Kato, Masakuni Fujii, Toru Ueki, Yosuke Saragai, Hirofumi Tsugeno, Tomohiko Mannami, Hiroyuki Okada

    Journal of hepato-biliary-pancreatic sciences   2022.6

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    BACKGROUND: Endoscopic fully-covered self-expandable metal stents (FCSEMSs) are used to treat benign biliary strictures (BBSs), however, treatment for perihilar BBSs is technically challenging. The aim of this study was to evaluate the usefulness of an unflared FCSEMS designed for intraductal placement in patients with refractory perihilar BBS. METHODS: Twenty-two consecutive patients with perihilar BBS unresolved by endoscopic plastic stent placement at 13 tertiary medical centers were prospectively enrolled. The FCSEMS was placed above the papilla and removed after 4 months. The primary outcome was stricture resolution at 4 months, and the secondary outcomes were technical success, stent removal, adverse events, and recurrence. RESULTS: The technical success rate of intraductal FCSEMS placement was 100%, and plastic stent placement at contralateral or side branch was performed in 86% of patients. The rate of successful stent removal at 4 months was 100%, and stricture resolution was observed in 91% of patients. Stent migration or stent-induced de novo stricture did not occur in any patient. The stricture recurrence rate was 16%, and the median (interquartile range) follow-up duration was 2.8 (1.6-3.3) years. CONCLUSIONS: Intraductal placement of unflared FCSEMS is effective treatment for refractory perihilar BBS.

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  • Successful removal of an uncovered metallic stent using peroral direct cholangioscopy and the stent-in-stent technique. International journal

    Akihiro Matsumi, Kazuyuki Matsumoto, Tatsuhiro Yamazaki, Shigeru Horiguchi, Koichiro Tsutsumi, Hironari Kato, Hiroyuki Okada

    Endoscopy   2022.6

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    DOI: 10.1055/a-1838-3553

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  • Optimal surveillance of intraductal papillary mucinous neoplasms of the pancreas focusing on remnant pancreas recurrence after surgical resection. International journal

    Tomokazu Fuji, Yuzo Umeda, Kosei Takagi, Ryuichi Yoshida, Kazuhiro Yoshida, Kazuya Yasui, Kazuyuki Matsumoto, Hironari Kato, Takahito Yagi, Toshiyoshi Fujiwara

    BMC cancer   22 ( 1 )   588 - 588   2022.5

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    BACKGROUND: The international consensus guidelines for intraductal papillary mucinous neoplasm of the pancreas (IPMN) presented clinical features as indications for surgery. Whereas surveillance for recurrence, including de novo lesions, is essential, optimal surveillance protocols have not been established. AIM AND METHODS: This study aimed to assess the clinical features of recurrence at the remnant pancreas (Rem-Panc) and extra-pancreas (Ex-Panc) after surgery for IPMN. Ninety-one patients of IPMN that underwent detailed preoperative assessment and pancreatectomy were retrospectively analyzed, focusing especially on the type of recurrence. RESULTS: The IPMNs were finally diagnosed as low-grade dysplasia (LDA, n = 42), high-grade dysplasia (HAD, n = 19), and invasive carcinoma (IPMC, n = 30). Recurrence was observed in 26 patients (29%), of which recurrence was seen at Rem-Panc in 19 patients (21%) and Ex-Panc in 7 patients (8%). The frequency of Rem-Panc recurrence was 10% in LDA, 21% in HDA, and 37% in IPMC. On the other hand, Ex-Panc recurrence was observed only in IPMC (23%). Ex-Panc recurrence showed shorter median recurrence-free survival (RFS) and overall survival (OS) than Rem-Panc recurrence (median RFS 8 months vs. 35 months, p < 0.001; median OS 25 months vs. 72 months, p < 0.001). Regarding treatment for Rem-Panc recurrence, repeat pancreatectomy resulted in better OS than no repeat pancreatectomy (MST 36 months vs. 15.5 months, p = 0.033). On multivariate analysis, main duct stenosis or disruption as a preoperative feature (hazard ratio [HR] 10.6, p = 0.002) and positive surgical margin (HR 4.4, p = 0.018) were identified as risk factors for Rem-Panc recurrence. CONCLUSIONS: The risk factors for Rem-Panc and Ex-Panc recurrence differ. Therefore, optimal surveillance on these features is desirable to ensure that repeat pancreatectomy for Rem-Panc recurrence can be an appropriate surgical intervention.

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  • Regulatory T cells induce a suppressive immune milieu and promote lymph node metastasis in intrahepatic cholangiocarcinoma. International journal

    Daisuke Konishi, Yuzo Umeda, Kazuhiro Yoshida, Kunitoshi Shigeyasu, Shuya Yano, Tomohiro Toji, Sho Takeda, Ryuichi Yoshida, Kazuya Yasui, Tomokazu Fuji, Kazuyuki Matsumoto, Hiroyuki Kishimoto, Hiroyuki Michiue, Fuminori Teraishi, Hironari Kato, Hiroshi Tazawa, Hiroyuki Yanai, Takahito Yagi, Ajay Goel, Toshiyoshi Fujiwara

    British journal of cancer   127 ( 4 )   757 - 765   2022.5

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    BACKGROUND: Emerging evidence indicates that immunogenicity plays an important role in intrahepatic cholangiocarcinoma (ICC). Herein, we systematically evaluated the clinical relevance of immunogenicity in ICC. METHODS: Highly immunogenic ICCs identified in the public dataset and the Cancer Immunome Atlas (TCIA) were assessed to determine the prognostic impact of immunogenicity in ICC and key components after curative resection. We also investigated the clinical relevance of the immune milieu in ICC. RESULTS: Using the Gene Expression Omnibus dataset 89749 and TCIA, we identified CD8+/forkhead box P3 (FoxP3)+ tumour-infiltrating lymphocytes (TILs), T-cell immunoglobulin and mucin domain 3 (TIM-3) and human leukocyte antigen-A (HLA-A) in highly immunogenic ICCs. Immunohistochemical analysis of the in-house cohort showed that intratumoral FoxP3+ TILs correlated with CD8+ TILs (P = 0.045, Fisher's exact test) and that high FoxP3+/CD8+ ratio (FCR) was an important marker for poor survival (P < 0.001, log-rank test). Furthermore, the FCR was higher in tumour-free lymph nodes in ICCs with lymph node metastases than in those without lymph node metastases (P = 0.003, Mann-Whitney U test). CONCLUSIONS: FCR should be considered an important biomarker that represents the immune environment of ICC based on its potentially important role in tumour progression, especially lymph node metastasis.

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  • Recent advances regarding endoscopic biliary drainage for unresectable malignant hilar biliary obstruction. International journal

    Hironari Kato, Kazuyuki Matsumoto, Hiroyuki Okada

    DEN open   2 ( 1 )   e33   2022.4

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    Biliary drainage for unresectable malignant hilar biliary obstruction (UMHBO) is still associated with a number of controversies to be resolved. The superiority of bilateral drainage in comparison to unilateral drainage has not been proven obviously yet. However, bilateral drainage is necessary to treat obstructive jaundice in some UMHBO patients, and this may be connected with preservation of the functional liver volume. The partial stent-in-stent (SIS) method and side-by-side (SBS) method developed as bilateral drainage methods. There is no significant difference in the technical or clinical success rates of the SIS and SBS methods. In addition, these methods are comparable in terms of adverse events, patency period, and survival period. On the other hand, reintervention for recurrent biliary obstruction (RBO) after the SBS method seems to be easier in comparison to cases with RBO after the SIS method; however, there is no remarkable difference in the clinical results of these procedures. Endoscopic ultrasound (EUS)-guided biliary drainage also has become an option for patients with UMHBO. Left hepatic drainage using EUS-guided hepaticogastrostomy (EUS-HGS) has become common; however, few studies have reported the results of bridging drainage for the right lobe using the EUS-HGS route or EUS-guided hepaticojejunostomy. A few studies addressed the results of newly designed stents, such as the 6-mm braided metal stent and inside stent. The development of various drainage methods and new devices is necessary for the further advancement of endoscopic biliary drainage for patients with UMHBO, further studies to evaluate those methods and devices are warranted.

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  • Endoscopic removal of proximally migrated stents using a double-balloon enteroscope in patients with bowel reconstruction (with video). International journal

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

    DEN open   2 ( 1 )   e32   2022.4

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    Endoscopic migrated stent removal using a balloon-assisted enteroscope is technically difficult in patients with bowel reconstruction. We report the treatment outcomes and endoscopic removal methods for migrated stents using a double-balloon enteroscope (DBE). We retrospectively studied 12 patients with stent migration into the main pancreatic duct (MPD) or bile duct who underwent bowel reconstruction between January 2012 and June 2020. The successful removal rates in the MPD (n = 3) and the bile duct (n = 9) were 66.7% (2/3) and 88.9% (8/9), respectively. The removal techniques included the indirect method (n = 3), the direct method (n = 4), and a combination of indirect and direct methods (n = 3). The removal devices included an extraction balloon catheter (n = 7), basket catheter (n = 5), biopsy forceps (n = 3), and snare (n = 2). Stent removal using a DBE was feasible and useful as the first treatment for patients with bowel reconstruction. The choice of the direct and/or indirect method according to the situation of the migrated stent is important.

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  • Diagnostic Utility of the PD-L1 Immunostaining in Biopsy Specimens of Patients with Biliary Tract Neoplasms. International journal

    Kazuyuki Matsumoto, Toshiaki Ohara, Masayoshi Fujisawa, Akinobu Takaki, Masahiro Takahara, Hironari Kato, Ryuichi Yoshida, Yuzo Umeda, Takahito Yagi, Akihiro Matsukawa, Hiroyuki Okada

    Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract   26 ( 6 )   1213 - 1223   2022.2

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    BACKGROUND: Anti-programmed death 1/programmed death ligand 1 (PD1/PD-L1) antibodies have been successfully used as treatment agents for several solid tumors; however, it is difficult to predict their effectiveness. We evaluated whether biopsy specimens could predict the positive status of PD-L1 in surgically resected tissue. METHODS: Among 91 patients who underwent tissue sampling with endoscopic or liver biopsy before surgery for biliary tract neoplasms in an academic center, 45 (49%) patients were selected for retrospective analysis because the quality and quantity of their biopsy specimens were adequate for histologic evaluation. We performed immunohistochemical staining to investigate the PD-L1 expression in both resected and biopsy specimens. The percentage of the positively stained cells was calculated for subsequent use in the correlation investigation. RESULTS: The biopsy methods were endoscopic retrograde cholangiopancreatography (ERCP) in 28 cases, percutaneous liver biopsy in 10 cases, and endoscopic ultrasound fine-needle aspiration in 7 cases. Among the 45 patients, when patients with > 10% positive tumor cells in surgically resected tissues were regarded as truly positive PD-L1, the positive and negative concordance rates between surgically resected tissues and biopsy samples were 56% (5/9) and 100% (36/36), respectively. With regard to the use of preoperative biopsy as a diagnostic tool, all (5/5) PD-L1-positive patients had a positive resected specimen. The accuracy of each biopsy method was as follows: ERCP, 89% (25/28); fine-needle aspiration, 86% (6/7); and liver biopsy, 100% (10/10). CONCLUSIONS: Biopsy samples could be a surrogate material for the assessment of the PD-L1 expression with substantial positive and high negative concordance rates.

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  • Successful endoscopic three-branch self-expandable metallic stent placement using a novel device delivery system for malignant hilar biliary stricture. International journal

    Kazuyuki Matsumoto, Hironari Kato, Yuki Fujii, Tatsuhiro Yamazaki, Koichiro Tsutsumi, Shigeru Horiguchi, Hiroyuki Okada

    Endoscopy   2021.12

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  • Pancreatic actinomycosis treated by antibiotics after diagnosis using endoscopic ultrasound-guided fine-needle biopsy.

    Kazuya Miyamoto, Kazuyuki Matsumoto, Kazuki Ocho, Koji Fujita, Shigeru Horiguchi, Ryuta Takenaka, Shigeatsu Fujiki

    Clinical journal of gastroenterology   14 ( 6 )   1785 - 1790   2021.12

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    A 71-year-old man who had undergone total gastrectomy, partial pancreatectomy, and splenectomy with Roux-en-Y reconstruction for gastric cancer was referred for a possible pancreatic tail tumor. Contrast-enhanced computed tomography showed mold-like, poor contrast lesion in the dilated main pancreatic duct in the pancreatic tail. Endoscopic ultrasonography revealed a slightly hyperechoic solid lesion that occupied the lumen of the main pancreatic duct. Linear calcification was observed in the lesions on both computed tomography and endoscopic ultrasonography, and endoscopic ultrasound-guided fine-needle biopsy was performed. Histopathology revealed sulfur grains and inflammatory infiltrates with no malignant findings. We also performed an anaerobic culture using fine-needle biopsy specimens, and Actinomyces meyeri was detected in the culture results. After confirming susceptibility, oral administration of amoxicillin was initiated. After 8 months of treatment, the size of the lesion slightly decreased, and the antibiotics treatment is still ongoing. This shows that such cases could be diagnosed based on histological findings and anaerobic culture using a fine-needle biopsy specimen, and unnecessary surgery may be avoided. In the case of tumors developed in the residual pancreas without typical malignant imaging findings, pancreatic actinomycosis should be considered as a differential diagnosis.

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  • A Rare Complication of Barium Swallow Test. International journal

    Kosei Takagi, Noriyuki Kanehira, Kazuyuki Matsumoto

    Gastroenterology   2021.10

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    DOI: 10.1053/j.gastro.2021.10.019

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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   2021.10

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

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  • Plasma KRAS mutations predict the early recurrence after surgical resection of pancreatic cancer. International journal

    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   22 ( 10-12 )   1 - 7   2021.10

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    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. International journal

    Kazuyuki Matsumoto, Hironari Kato, Hiroyuki Okada

    Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society   34 ( 1 )   e5-e6   2021.10

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    DOI: 10.1111/den.14148

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  • 下痢を契機に発見され大量の漿液性分泌物を伴った肝内胆管由来の嚢胞内充実性腫瘍の1例

    織田 崇志, 松本 和幸, 加藤 博也, 吉田 龍一, 西田 賢司, 藤井 佑樹, 山崎 辰洋, 友田 健, 堀口 繁, 堤 康一郎, 岡田 裕之

    胆道   35 ( 4 )   651 - 659   2021.10

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    症例は45歳,男性.下痢(7〜8回/日)による脱水で当院受診となった.造影CT検査で肝左葉に直径約20cmのだるま状の嚢胞性腫瘤を認め,内部に淡く造影される乳頭状の充実部を伴っていた.内視鏡では乳頭開口部から漿液性の液体が大量に流出しており,胆管造影では腫瘤とB2との交通を認めた.明らかな粘液の存在は認めなかったが,胆管内乳頭状腫瘍(IPNB)を疑い,肝拡大左葉切除術を施行した.病理所見は嚢状に拡張した胆管内に,立方状から低円柱状の異型上皮が主として腺管状に増殖する腫瘍であった.免疫染色はMUC1陰性,MUC2陰性,MUC5AC一部陽性,MUC6陽性であり,増殖形態と免疫染色からIPNBや胆管内管状乳頭状腫瘍とも合致せず,肝内胆管由来の嚢胞内充実性腫瘍と診断した.術後に下痢症状は改善した.腫瘍が大量に漿液性の分泌物を産生し,胆管を通じて,乳頭から排出された事が下痢の原因であったと考える.(著者抄録)

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    Other Link: https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2021&ichushi_jid=J02149&link_issn=&doc_id=20211115300008&doc_link_id=%2Fdw1tando%2F2021%2F003504%2F008%2F0651-0659%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fdw1tando%2F2021%2F003504%2F008%2F0651-0659%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

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

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

    Digestive diseases and sciences   66 ( 9 )   3171 - 3178   2021.9

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

    DOI: 10.1007/s10620-020-06628-1

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

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

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

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

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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. International journal

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

    Journal of clinical medicine   10 ( 15 )   2021.7

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

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

    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   2021.7

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

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

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

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    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).

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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   2021.7

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

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

    Scientific reports   11 ( 1 )   12298 - 12298   2021.6

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

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  • Endoscopic omentum filling for endoscope perforation at the efferent loop. International journal

    Kazuya Miyamoto, Kazuyuki Matsumoto, Hirohumi Tsugeno, Ryuta Takenaka, Shigeatsu Fujiki

    Gastrointestinal endoscopy   93 ( 6 )   1423 - 1424   2021.6

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    DOI: 10.1016/j.gie.2021.01.014

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

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

    Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society   33 ( 4 )   656 - 662   2021.5

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    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.

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

    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   2021.5

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    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.

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

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

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

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

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

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

    Surgical endoscopy   35 ( 4 )   1895 - 1902   2021.4

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

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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. International journal

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

    Surgical endoscopy   35 ( 1 )   239 - 240   2021.1

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

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

    Surgical endoscopy   35 ( 1 )   232 - 238   2021.1

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

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

    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   2020.12

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    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.

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

    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   2020.10

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    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.

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

    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   2020.9

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    BACKGROUND: 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. METHODS: 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. RESULTS: 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]; P = 0.044). In a multivariate analysis, LBC was a significant factor influencing the accurate diagnosis of PJC (odds ratio: 3.52; P = 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]; P = 0.043). CONCLUSIONS: LBC increases the accuracy of PJC for diagnosing malignant IPMN compared with the conventional smear method.

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

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

    Gut and liver   14 ( 5 )   652 - 658   2020.9

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    Background/Aims: Endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA; EUS-FNA) allows for diagnostic tissue specimens from various regions to be analyzed. However, diagnosing recurrent pancreaticobiliary cancer after surgery is sometimes difficult. We evaluated the efficacy of EUS-FNA in the diagnosis of local recurrence of pancreaticobiliary cancer and analyzed the factors associated with falsenegative results. Methods: Fifty-one consecutive patients who underwent EUS-FNA due to suspected recurrence of pancreaticobiliary cancer after surgery in an academic center were retrospectively analyzed. The criteria for EUS-FNA were a resected margin or remnant pancreas mass, round swollen lymph node (≥10 mm in diameter), and soft-tissue enhancement around a major artery. Patients with suspected liver metastasis or malignant ascites were excluded. Results: Thirty-nine of the 51 patients had pancreatic cancer; the remaining 12 had biliary cancer. The target sites for EUS-FNA were the soft tissue around a major artery (n=22, 43%), the resected margin or remnant pancreas (n=12, 24%), and the lymph nodes (n=17, 33%). The median size of the suspected recurrent lesions was 15 mm (range, 8 to 40 mm). The overall sensitivity, specificity and accuracy of EUS-FNA for the diagnosis of recurrence was 84% (32/38), 100% (13/13), and 88% (45/51), respectively. FNA of the soft tissue around major arteries (odds ratio, 8.23; 95% confidence interval, 1.2 to 166.7; p=0.033) was significantly associated with a falsenegative diagnosis in the multivariate analysis. Conclusions: EUS-FNA is useful for diagnosing recurrent cancer, even after pancreaticobiliary surgery. The diagnoses of recurrence at soft-tissue sites should be interpreted with caution.

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

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

    Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract   24 ( 6 )   1352 - 1358   2020.6

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

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

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

    Digestive diseases and sciences   65 ( 5 )   1460 - 1470   2020.5

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

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

    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   2020.3

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    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).

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  • Underwater endoscopic papillectomy using double-balloon endoscopy. International journal

    Tatsuhiro Yamazaki, Daisuke Uchida, Yasushi Yamasaki, Takeshi Tomoda, Kazuyuki Matsumoto, Hironari Kato, Hiroyuki Okada

    Endoscopy   52 ( 2 )   E55-E56   2020.2

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    DOI: 10.1055/a-0992-9084

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  • Single-session esophagogastroduodenoscopy and endoscopic ultrasound using a forward-viewing radial scan ultrasonic endoscope. International journal

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

    BMC gastroenterology   19 ( 1 )   220 - 220   2019.12

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    BACKGROUND: Endoscopic ultrasound is useful for obtaining high-resolution images of pancreaticobiliary diseases, but is not readily available for physical checkups. In this study, we evaluated the safety and efficacy of single-session esophagogastroduodenoscopy and endoscopic ultrasound in the detection of upper-gastrointestinal and pancreaticobiliary diseases using a forward-viewing radial scan ultrasonic endoscope. METHODS: A total of 148 patients who were scheduled for upper-gastrointestinal screening using an endoscope were prospectively included. All patients were examined by EUS in combination with EGD using a forward-viewing radial scan ultrasonic endoscope. The primary endpoint was the safety of the procedures. The secondary endpoints were the prevalence of diseases, the basal imaging capability of EUS, the procedure time, total dose of propofol, and the correlation between background factors and the prevalence of pancreatic disease. The imaging capability at each region was scored as 0 (invisible) to 2 (sufficient visualization to evaluate the organs). RESULTS: Intraoperative hypotension occurred as an adverse event of intravenous anesthesia in one patient. There were 82 pancreaticobiliary findings and 165 upper-gastrointestinal findings (malignancy not included). Follicular lymphoma of the intra-abdominal lymph nodes was detected in one patient. The mean imaging scores of each section were 1.95 (pancreatic head and papilla), 2.0 (pancreatic body), 1.99 (pancreatic tail), and 1.89 (common bile duct and gallbladder). Age, history of diabetes mellitus, and smoking history were significantly associated with the prevalence of pancreatic diseases. CONCLUSION: The simultaneous performance of EGD and EUS using a new ultrasonic endoscope is tolerable and safe for upper-gastrointestinal and pancreaticobiliary screening.

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

    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   2019.11

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    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.

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  • Contrast-enhanced harmonic endoscopic ultrasound using time-intensity curve analysis predicts pathological grade of pancreatic neuroendocrine neoplasm.

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

    Journal of medical ultrasonics (2001)   46 ( 4 )   449 - 458   2019.10

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    PURPOSE: Histological grading is important for the treatment algorithm in pancreatic neuroendocrine neoplasms (PNEN). The present study examined the efficacy of contrast-enhanced harmonic endoscopic ultrasound (CH-EUS) and time-intensity curve (TIC) analysis of PNEN diagnosis and grading. METHODS: TIC analysis was performed in 30 patients using data obtained from CH-EUS, and a histopathological diagnosis was made via EUS-guided fine-needle aspiration or surgical resection. The TIC parameters were analyzed by dividing them into G1/G2 and G3/NEC groups. Then, patients were classified into non-aggressive and aggressive groups and evaluated. RESULTS: Twenty-six patients were classified as G1/G2, and four as G3/NEC. From the TIC analysis, five parameters were obtained (I: echo intensity change, II: time for peak enhancement, III: speed of contrast, IV: decrease rate for enhancement, and V: enhancement ratio for node/pancreatic parenchyma). Three of these parameters (I, IV, and V) showed high diagnostic performance. Using the cutoff value obtained from the receiver-operating characteristic (ROC) analysis, the correct diagnostic rates of parameters I, IV, and V were 96.7%, 100%, and 100%, respectively, between G1/G2 and G3/NEC. A total of 21 patients were classified into the non-aggressive group, and nine into the aggressive group. Using the cutoff value obtained from the ROC analysis, the accurate diagnostic rates of I, IV, and V were 86.7%, 86.7%, and 88.5%, respectively, between the non-aggressive and aggressive groups. CONCLUSION: CH-EUS and TIC analysis showed high diagnostic accuracy for grade diagnosis of PNEN. Quantitative perfusion analysis is useful to predict PNEN grade diagnosis preoperatively.

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

    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   2019.9

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    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.

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

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

    Endoscopy   51 ( 9 )   E265-E266   2019.9

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

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

    Clinical endoscopy   52 ( 4 )   334 - 339   2019.7

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

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  • Adenomyomatosis hyperplasia arising in the bile duct. International journal

    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   2019.7

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  • THE RELATIONSHIP BETWEEN THE PD-L1 EXPRESSION OF SURGICAL RESECTED AND FINE-NEEDLE ASPIRATION SPECIMENS FOR PATIENTS WITH PANCREATIC CANCER Reviewed

    Matsumoto Kazuyuki, Ohara Toshiaki, Fujisawa Masayoshi, Takaki Akinobu, Takahara Masahiro, Kato Hironari, Horiguchi Shigeru, Matsukawa Akihiro, Okada Hiroyuki

    GASTROENTEROLOGY   156 ( 6 )   S758   2019.5

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

    Kazuyuki Matsumoto, Hironari Kato, Hiroyuki Okada

    Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society   31 Suppl 1   67 - 68   2019.4

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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   2019.3

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    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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  • Biliary cannulation technique with ultraslim endoscope for a patient with Billroth II gastrectomy. International journal

    Yosuke Saragai, Daisuke Uchida, Hironari Kato, Takeshi Tomoda, Kazuyuki Matsumoto, Shigeru Horiguchi, Hiroyuki Okada

    Endoscopy   51 ( 2 )   E38-E39   2019.2

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  • Utility of liquid biopsy using urine in patients with pancreatic ductal adenocarcinoma. International journal

    Hiroyuki Terasawa, Hideaki Kinugasa, Soichiro Ako, Mami Hirai, Hiroshi Matsushita, Daisuke Uchida, Takeshi Tomoda, Kazuyuki Matsumoto, Shigeru Horiguchi, Hironari Kato, Kazuhiro Nouso, Hiroyuki Okada

    Cancer biology & therapy   20 ( 10 )   1348 - 1353   2019

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    In recent years, liquid biopsy for blood and body fluid in cancer patients has attracted attention. However, there have been few reports of liquid biopsy focusing on urine of pancreatic ductal adenocarcinoma (PDAC). In 56 patients with PDAC, DNA was extracted from urine and plasma prior to treatment, and KRAS mutations were analyzed with droplet digital PCR to examine the mutation detection rate. Our study showed that KRAS mutations were found in 27 cases (48%) in urine and 27 cases (48%) in plasma. The detection rate of urine KRAS mutations varied by renal functions. The rates were 70% (14/20) and 36% (13/36) in the creatinine clearance rate (CCr) < 70 mL/min group and in the CCr ≥ 70 mL/min group, respectively (P = .024). Whereas, no influence of the CCr was observed in the detection rates of plasma KRAS mutations. The rates were 50% (10/20) and 47% (17/36) in cases with the CCr < 70 mL/min group and the CCr ≥ 70 mL/min group, respectively. Although the sample size was small, this study clearly indicated a new possibility of less invasive urine liquid biopsy in PDAC patients.

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  • [Metachronous intraductal papillary mucinous carcinoma five years after cholecystectomy for gallbladder cancer in a patient with pancreaticobiliary maljunction]. Reviewed

    Ikeda A, Matsumoto K, Kato H, Tanaka N, Ako S, Muro S, Uchida D, Tomoda T, Horiguchi S, Okada H

    Nihon Shokakibyo Gakkai zasshi = The Japanese journal of gastro-enterology   116 ( 3 )   241 - 248   2019

  • Hemostasis with hemostatic forceps for bleeding during endoscopic necrosectomy. International journal

    Akihiro Matsumi, Kazuyuki Matsumoto, Hiroyuki Okada

    Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society   30 ( 6 )   810 - 811   2018.11

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    DOI: 10.1111/den.13255

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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. International journal

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

    BMC gastroenterology   18 ( 1 )   157 - 157   2018.10

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

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

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

    Oncology letters   16 ( 4 )   5426 - 5432   2018.10

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

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  • 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   2018.10

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

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

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

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

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  • Preoperative Detection of Tumor Seeding after Endoscopic Ultrasonography-guided Fine Needle Aspiration for Pancreatic Cancer.

    Kazuyuki Matsumoto, Hironari Kato, Noriyuki Tanaka, Hiroyuki Okada

    Internal medicine (Tokyo, Japan)   57 ( 12 )   1797 - 1798   2018.6

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

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

    Endoscopy international open   6 ( 2 )   E211-E216   2018.2

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

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

    Kazuyuki Matsumoto, Hironari Kato, Hiroyuki Okada

    Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association   16 ( 2 )   e13-e14   2018.2

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

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

    BMC gastroenterology   18 ( 1 )   14 - 14   2018.1

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

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

    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 & hepatology   2018   8216109 - 8216109   2018

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    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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  • Liquid biopsy of bile for the molecular diagnosis of gallbladder cancer. International journal

    Hideaki Kinugasa, Kazuhiro Nouso, Soichiro Ako, Chihiro Dohi, Hiroshi Matsushita, Kazuyuki Matsumoto, Hironari Kato, Hiroyuki Okada

    Cancer biology & therapy   19 ( 10 )   934 - 938   2018

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    INTRODUCTION: Tissue sampling of gallbladder cancer (GBCa) is challenging because of the anatomy of the gallbladder. The aim of this study is to investigate the possibility of diagnosing GBCa patients by performing a liquid biopsy of bile in addition to current diagnostic methods. METHODS: Thirty patients with GBCa were enrolled in this study. Cytological examination was performed in all patients. Using next generation sequencing (NGS), DNA isolated from the bile and tumor tissue was analyzed for mutations in 49 oncogenes. We also compared these mutations with cytology results. RESULTS: 57.1% of DNA samples from tumor tissue were positive for a mutation. In these patients, 87.5% of the bile circulating tumor DNA (ctDNA) samples had the same mutation. The concordance rate between bile ctDNA and tissue DNA samples was 85.7%, and the mutation frequencies detected in ctDNA were approximately half of what was detected in tumor tissue DNA. On the other hand, the sensitivity of the cytological and bile ctDNA analyses was 45.8% and 58.3%, respectively. The concordance rate between cytology and bile ctDNA analyses was 87.5%. CONCLUSIONS: Mutated tumor DNA could be detected in bile by NGS. Liquid biopsy of bile might help us to diagnose GBCa because of higher sensitivity and positive predict value compared to cytology with ERCP.

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  • Endoscopic Ultrasound-Guided Hepaticogastrostomy Is Effective for Repeated Recurrent Cholangitis after Surgery: Two Case Reports. International journal

    Akihiro Matsumi, Hironari Kato, Yousuke Saragai, Sho Mizukawa, Saimon Takada, Shinichiro Muro, Daisuke Uchida, Takeshi Tomoda, Kazuyuki Matsumoto, Masaya Iwamuro, Shigeru Horiguchi, Yoshiro Kawahara, Hiroyuki Okada

    Case reports in gastrointestinal medicine   2018   7201967 - 7201967   2018

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    We report the cases of two patients who underwent endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) using metallic stents (MS) for recurrent cholangitis due to benign biliary stenosis. The patients had repeatedly undergone double-balloon endoscopy and anastomotic stenosis. Thus, EUS-HGS was performed. The procedures were successful, and placement of a covered metallic stent (C-MS) relieved cholangitis. The occurrence of cholangitis was subsequently considerably reduced. For patients with postoperative recurrent cholangitis, EUS-HGS with MS should be considered because of its efficacy and safety.

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

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

    Canadian journal of gastroenterology & hepatology   2018   7125714 - 7125714   2018

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    Background and Aims: Biliary stenting for the treatment of biliary stricture is the most common indication of ERCP, but the procedure is sometimes unsuccessful because of severe strictures. The Swing Tip is useful for passing through severe strictures because it has a manually operable tip. The efficacy of using a Swing Tip was retrospectively evaluated. Methods: The 2353 patients who underwent ERCP for biliary stenting at our facility between January 2012 and July 2018 were enrolled. In all patients, procedures were begun using tapered tip-catheters, and Swing Tips were used if the procedure was found to be difficult with other devices. The indication for switching to the Swing Tip and the technical success rate were retrospectively evaluated. Results: A total of 99 patients (4.2%) underwent ERCP using the Swing Tip, including 49 patients for the selection of biliary branches and 50 for exchanging guidewires for rigid ones. In these patients, biliary stenting was successful in 22 patients (44.9%) and 45 patients (90%), respectively. The other 32 patients with failed endoscopic biliary drainage were treated via alternative approaches, such as percutaneous procedures, surgeries, or conservative treatments. There were no adverse events associated with the Swing Tip. Conclusion: The Swing Tip was technically feasible especially for exchanging guidewires during ERCP. Percutaneous procedures or surgical treatments can be avoided by using the Swing Tip. Ethical Statements: This study was approved by the institutional review board of Okayama University. All subjects provided informed consent. The study was registered in the UMIN protocol registration system (identification number UMIN 000033692).

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

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

    Endoscopy   49 ( 12 )   1256 - 1261   2017.12

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

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

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

    Endoscopy   49 ( 11 )   1087 - 1091   2017.11

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

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

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

    Acta medica Okayama   71 ( 4 )   357 - 362   2017.8

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

    PANCREATOLOGY   17 ( 2 )   285 - 290   2017.3

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    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. (C) 2017 IAP and EPC. Published by Elsevier B.V. All rights reserved.

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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. International journal

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

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

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

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  • ENDOSCOPIC MANAGEMENT OF OCCLUDED METALLIC STENTS DEPLOYED FOR MALIGNANT HILAR BILIARY STRICTURE

    KATO Hironari, TOMODA Takeshi, MATSUMOTO Kazuyuki, HORIGUCHI Shigeru, TSUTSUMI Koichiro, OKADA Hiroyuki

    Gastroenterological Endoscopy   59 ( 7 )   1524 - 1531   2017

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    <p>Endoscopic management of occluded metallic stents deployed for malignant hilar biliary stricture is technically demanding. Understanding the characteristics of devices such as guidewires, catheters, and stents, and handling these devices skillfully are essential for successful management. The passage of catheters and plastic stents (PS) through the mesh of metallic stents (MS) is the most difficult of all procedures for multiple occluded MS that had been deployed by the stent-in-stent method, and requires precise and careful maneuvering of the endoscope and other devices. The order of PS deployment into the occluded MS is also important. The order of PS deployment has to be same as that of the previous MS deployment. Skilled techniques of not only endoscopists but also their assistants are necessary for the successful management of multiple occluded MS deployed at the hilar portion. Therefore, it is important for endoscopists to become skilled in maneuvering guidewires in daily examinations.</p>

    DOI: 10.11280/gee.59.1524

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

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

    Surgical endoscopy   30 ( 12 )   5338 - 5344   2016.12

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

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

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

    JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY   31   221 - 222   2016.11

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

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

    Acta Medica Okayama   70 ( 5 )   405 - 408   2016.10

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    DOI: 10.18926/AMO/54602

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  • Lymphoid Hyperplasia of the Bile Duct Observed on Peroral Video Cholangioscopy. International journal

    Kazuyuki Matsumoto, Hironari Kato, Hiroyuki Okada

    Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association   14 ( 10 )   e127-8   2016.10

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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.

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

    Acta medica Okayama   70 ( 5 )   417 - 420   2016.10

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

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

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

    Acta medica Okayama   70 ( 4 )   323 - 5   2016.8

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

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

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

    Acta medica Okayama   70 ( 4 )   313 - 6   2016.8

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

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

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

    Transplantation   100 ( 7 )   1500 - 6   2016.7

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

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  • 胆嚢神経内分泌癌(NEC)の1例

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

    胆道   30 ( 2 )   290 - 297   2016.5

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

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  • 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   2016.4

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

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

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

    Surgical endoscopy   30 ( 3 )   1249 - 54   2016.3

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

    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. International journal

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

    Endoscopy   48 ( 1 )   26 - 34   2016.1

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

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  • Performance of novel tissue harmonic echo imaging using endoscopic ultrasound for pancreatic diseases. International journal

    Kazuyuki Matsumoto, Akio Katanuma, Hiroyuki Maguchi, Kuniyuki Takahashi, Manabu Osanai, Kei Yane, Toshifumi Kin, Ryo Takaki, Tomoaki Matsumori, Katsushige Gon, Akiko Tomonari, Masanori Nojima

    Endoscopy international open   4 ( 1 )   E42-50   2016.1

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    BACKGROUND AND STUDY AIMS: Recently, tissue harmonic echo (THE) imaging has advanced with the development of a new endoscopic ultrasound (EUS) monitor/processing unit. With this new technology, penetration (THE-P) and resolution (THE-R) images can be obtained. The aim of this study was to investigate the performance of this novel THE imaging using a new processing unit for pancreatic diseases. PATIENTS AND METHODS: Fifty patients with pancreatic lesions (38 cystic, 12 solid) were retrospectively analyzed. At each examination, 3 EUS images of the same pancreatic lesion were obtained using B-mode, THE-P mode, and THE-R mode imaging. Each set of EUS images was randomly arranged and evaluated independently by 4 physicians blinded to the imaging technique. Images were compared using a Likert scale 5-point grading system for each parameter. RESULTS: For cystic lesions, THE-P mode images were significantly superior to conventional B-mode images for visualizing the boundary, septum, nodules, and total image quality (P < 0.05). THE-R mode images were significantly superior to conventional B-mode images for visualizing the boundary, septum, and total image quality (P < 0.05). However, for solid lesions, there was no significant difference in all the evaluation points between THE-P and conventional B-mode images. THE-R mode images were inferior to conventional B-mode images for visualizing the boundary, internal structure, and total image quality (P < 0.05). CONCLUSIONS: For pancreatic cystic lesions, THE mode images provided better lesion characterization than conventional B-mode images. Further research is required to determine if this improvement will result in improved EUS diagnostics.

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

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

    PANCREATOLOGY   16 ( 1 )   44 - 51   2016.1

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

    DOI: 10.1016/j.pan.2015.11.002

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  • A Case of Capillary Malformation of the Retroperitoneum.

    Kazuyuki Matsumoto, Hironari Kato, Ryo Harada, Hiroyuki Okada

    Internal medicine (Tokyo, Japan)   55 ( 2 )   203 - 5   2016

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

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

    Ecancermedicalscience   10   663 - 663   2016

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

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

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

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

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

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  • Utility of serum N-glycan analysis in diagnosis of invasive IPMNs

    AKIMOTO Yutaka, NOUSO Kazuhiro, KATO Hironari, MIYAHARA Koji, MIZUKAWA Shou, YABE Shuntaro, UCHIDA Daisuke, SEKI Hiroyuki, TOMODA Takeshi, MATSUMOTO Kazuyuki, YAMAMOTO Naoki, HORIGUCHI Shigeru, TSUTSUMI Koichiro, OKADA Hiroyuki

    Suizo   31 ( 1 )   25 - 31   2016

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    Glycosylation, -a common post-translational modification of proteins,- is involved in several processes associated with cancer progression, including signaling, cell-cell adhesion, invasion and metastasis. We previously found that levels of multi-branch antennary and fucosylated glycans were elevated in pancreatic cancer and hepatocellular carcinoma. Another potentially malignant disorder of the pancreas, invasive pancreatic intraductal papillary mucinous neoplasm (IPMN), is hard to diagnose pre-operatively. A new serum biomarker for invasive IPMNs would help to diagnosis and identify cases needing high-risk pancreatic resection. In our recent study, we evaluated the potential use of glycans as clinical markers for invasive IPMNs. N-glycan profiles of whole-serum samples were evaluated from patients with a confirmed diagnosis of IPMNs. The serum profiles showed high expression levels of fucosylated glycans with multi-branch antennary structures, suggesting that these complex glycans may serve as biomarkers for the prediction of invasive IPMNs.

    DOI: 10.2958/suizo.31.25

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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   2015.11

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

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  • 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   2015.8

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

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  • Diagnostic ability of EUS-FNA for pancreatic solid lesions with conventional 22-gauge needle using the slow pull technique: a prospective study. International journal

    Toshifumi Kin, Akio Katanuma, Kei Yane, Kuniyuki Takahashi, Manabu Osanai, Ryo Takaki, Kazuyuki Matsumoto, Katsushige Gon, Tomoaki Matsumori, Akiko Tomonari, Hiroyuki Maguchi, Toshiya Shinohara, Masanori Nojima

    Scandinavian journal of gastroenterology   50 ( 7 )   900 - 7   2015.7

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    OBJECTIVE: Endoscopic ultrasonography-guided fine needle aspiration (EUS-FNA) using the slow pull technique (SP-FNA) has recently attracted attention as an effective tissue acquisition technique. However, efficacy of SP-FNA with a 22-gauge conventional needle remains unclear. The aim of this study is to evaluate the diagnostic ability of SP-FNA with a 22-gauge needle. MATERIAL AND METHODS: Patients with a pancreatic solid lesion were prospectively enrolled in this study. SP-FNA was performed at two needle passes with a 22-gauge needle. One dedicated pathologist evaluated the obtained samples in terms of quantity (Grade 0: scant; Grade 1: inadequate; Grade 2: adequate), quality (Grade 0: poor; Grade 1: moderate; Grade 2: good), and blood contamination (Grade 0: significant; Grade 1: moderate; Grade 2: low), and provided a pathological diagnosis. Additional EUS-FNA was performed by applying suction (SA-FNA). The evaluation points were as follows: diagnostic accuracy of SP-FNA compared with that of SA-FNA, and the quantity, quality, and blood contamination level of SP-FNA-obtained samples. RESULTS: We enrolled 40 cases. The diagnostic accuracy of SP-FNA was 90% (36/40). There was no significant difference in the accuracy between SP-FNA and SA-FNA (90% vs. 90%, p = 1.000). The samples obtained using SP-FNA were assessed as Grade 2 for quantity in 29 cases (73%), quality in 31 (78%), and blood contamination in 25 (63%). CONCLUSIONS: Adequate, high-quality, and unsubstantially blood-contaminated samples could be obtained using SP-FNA. The diagnostic ability of SP-FNA was 90%, which appeared to be similar to that of SA-FNA.

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

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

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

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

    DOI: 10.3748/wjg.v21.i24.7594

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  • Feasibility, efficacy, and predictive factors for the technical success of endoscopic nasogallbladder drainage: a prospective study. International journal

    Kei Yane, Hiroyuki Maguchi, Akio Katanuma, Kuniyuki Takahashi, Manabu Osanai, Toshifumi Kin, Ryo Takaki, Kazuyuki Matsumoto, Katsushige Gon, Tomoaki Matsumori, Akiko Tomonari, Masanori Nojima

    Gut and liver   9 ( 2 )   239 - 46   2015.3

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    BACKGROUND/AIMS: Several studies have shown the useful-ness of endoscopic nasogallbladder drainage (ENGBD) in patients with acute cholecystitis. However, the procedure is difficult, and factors that affect technical success have not yet been clarified. We conducted a prospective study to eval-uate the technical feasibility, efficacy, and predictive factors for the technical success of ENGBD in patients with acute cholecystitis. METHODS: All patients with moderate or severe acute cholecystitis who were enrolled underwent ENGBD between April 2009 and April 2011. Patients with surgically altered anatomy or pancreatobiliary malignancies were ex-cluded. The primary outcomes included technical success, clinical success, and complications. Factors that could affect the technical success were also examined. RESULTS: Of the 27 patients who underwent ENGBD during the study period, technical success was achieved in 21 (78%) and clinical improvement was achieved in 20 (95%). Early complications were encountered in four patients (15%). Gallbladder wall thickness (odds ratio [OR], 1.64; 95% confidence interval [CI], 1.08 to 2.47) and age (OR, 1.16; 95% CI, 1.00 to 1.35) were effective predictors of technical failure. CONCLUSIONS: ENGBD was effective in resolving acute cholecystitis; however, this modality was technically challenging and had a limited suc-cess rate. Because of technical difficulties, ENGBD should be reserved for limited indications. (Gut Liver, 2015;9239-246).

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

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

    Endoscopy   47 Suppl 1 UCTN   E497-8   2015

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    DOI: 10.1055/s-0034-1393138

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  • Effectiveness of a balloon catheter with a side hole for introducing a guidewire into an infected pancreatic pseudocyst. International journal

    Toshifumi Kin, Hiroyuki Maguchi, Akio Katanuma, Kuniyuki Takahashi, Manabu Osanai, Ryo Takaki, Kazuyuki Matsumoto, Katsushige Gon, Tomoaki Matsumori, Akiko Tomonari

    Gastrointestinal endoscopy   80 ( 4 )   725 - 725   2014.10

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    DOI: 10.1016/j.gie.2014.01.026

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  • 胆嚢腺筋腫症合併胆嚢癌の特徴

    金 俊文, 真口 宏介, 高橋 邦幸, 潟沼 朗生, 小山内 学, 矢根 圭, 高木 亮, 松本 和幸, 松森 友昭, 権 勉成, 安保 義恭, 篠原 敏也

    胆道   28 ( 4 )   633 - 640   2014.10

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    ADMに合併した胆嚢癌の臨床所見、病理学的所見、画像所見を検討した。ADM合併胆嚢癌は11例(切除胆嚢癌の12%)であり、ADM分類ではF型(Fundal type)5、S型(Segmental type)6、癌の肉眼型ではIIa3、IIb4、結節浸潤型4であった。F型ADM合併胆嚢癌の4例(80%)はADMの範囲内の粘膜側からの発生と考えられたが、1例はRAS内からの発癌が疑われた。S型ADM合併胆嚢癌は頸部ADMから底部側への広範囲進展例が多く、全例に胆石を伴っていた。術前診断が可能であったのはIIa2、結節浸潤4の6例(55%)であり、早期癌ではADM直上の隆起性病変、進行癌では不整な壁肥厚を認めた。ADM合併胆嚢癌は、F型ではADMの直上粘膜、S型では頸部または体部のくびれのADMから体底部側が好発部位であり、診断にはADMの存在する胆嚢内腔側の詳細な観察が重要である。また、胆石合併S型ADM胆嚢癌は術前診断困難であることが多く、予防的な胆嚢摘出術が妥当と考える。(著者抄録)

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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. International journal

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

    Hepato-gastroenterology   61 ( 134 )   1775 - 9   2014.9

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

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  • Endoscopic management of benign biliary stricture: should we treat more aggressively? International journal

    Akio Katanuma, Hiroyuki Maguchi, Kuniyuki Takahashi, Manabu Osanai, Kei Yane, Toshifumi Kin, Kazuyuki Matsumoto, Tomoaki Matsumori, Ryo Takaki, Katsushige Gon, Akiko Tomonari

    Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society   26 ( 4 )   536 - 7   2014.7

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  • Endoscopic removal technique of migrated pancreatic plastic stents.

    Kazuyuki Matsumoto, Akio Katanuma, Hiroyuki Maguchi

    Journal of hepato-biliary-pancreatic sciences   21 ( 6 )   E34-40   2014.6

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    Endoscopic pancreatic stenting (EPS) is used for various pancreatic conditions. With the increasing use of pancreatic stents, many complications have been observed. Especially, proximal stent migration presents a more serious condition because of the possibility of pancreatic duct (PD) damage. However, the removal of proximally migrated stents is technically challenging because of the small PD diameter, the bended PD course, the presence of PD strictures, and the lack of suitable devices for stent removal. Thus, few cases of surgical intervention have been encountered. In this study, we review the endoscopic treatment of proximally migrated pancreatic plastic stents. We classify migrated stent conditions into four types according to stent and PD conditions. In Type A, the main pancreatic duct (MPD) has no stricture. In Type B, the stent is positioned across the stricture on the MPD. In Type C, the stent is positioned further away from the stricture on the MPD. The tip of the proximal stent is located in the MPD in types A thru C. In Type D, the tip of the proximal stent is located in a branch duct. We introduced the strategy of endoscopic removal technique of each type of migrated plastic stents.

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  • Novel tissue harmonic imaging clearly visualizes a case of intraductal papillary mucinous neoplasm with mural nodules. International journal

    Kazuyuki Matsumoto, Akio Katanuma

    JOP : Journal of the pancreas   15 ( 3 )   274 - 5   2014.5

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    Tissue Harmonic Echo (THE) imaging is a sonographic technique that potentially provides images of higher quality than can conventional B-mode images. Potential advantages of THE imaging include improved resolution, improved signal-to-noise ratio, and reduced artifacts [1, 2]. Recently, a novel THE imaging performed using an EUS system with a monitor/processing unit (EU-ME2 PREMIER PLUS; Olympus Medical Systems, Tokyo, Japan) has been developed. Using this technology, we can obtain two THE mode images, namely, THE-P (penetration) and THE-R (resolution). The THE-P mode is suitable for middle range distance observation because it receives a harmonic signal whose frequency is mainly 7.5 MHz. The THE-R mode is suitable for close distance observation from the probe because it receives a harmonic signal whose frequency mainly ranges from 10 to 12 MHz. Here, we report a case of intraductal papillary mucinous neoplasm (IPMN) with mural nodules which could be clearly detected using this novel THE imaging.

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  • Biliary tumor fragment of hepatocellular carcinoma containing lipiodol mimicking a bile duct stone. International journal

    Kazuyuki Matsumoto, Manabu Osanai, Hiroyuki Maguchi

    Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society   26 ( 2 )   295 - 6   2014.3

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    DOI: 10.1111/den.12226

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  • Anti-programmed cell death-1 antibody as a new serological marker for type 1 autoimmune hepatitis. International journal

    Kazuyuki Matsumoto, Yasuhiro Miyake, Hiroshi Matsushita, Atsuyuki Ohnishi, Fusao Ikeda, Hidenori Shiraha, Akinobu Takaki, Kazuhiro Nouso, Kazuhide Yamamoto

    Journal of gastroenterology and hepatology   29 ( 1 )   110 - 5   2014.1

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    BACKGROUND AND AIM: Recently, the association of the dysfunction of programmed cell death (PD)-1 expressed on activated lymphocytes with the pathogenesis of autoimmune hepatitis (AIH) has been speculated. This study aimed to investigate the association of serum anti-PD-1 antibodies with clinical characteristics of type 1 AIH. METHODS: Serum samples before the initiation of prednisolone treatment were obtained from 52 type 1 AIH patients, 24 patients with drug-induced liver injury (DILI), 30 patients with acute viral hepatitis (AVH), 11 patients with primary sclerosing cholangitis (PSC), and 62 healthy volunteers. Titers of serum anti-PD-1 antibodies were measured by indirect enzyme-linked immunosorbent assay. The cutoff level was represented by a mean absorbance + 2 standard deviations in healthy volunteers. RESULTS: Prevalence of serum anti-PD-1 antibodies was 63% in type 1 AIH patients, 8% in DILI patients, 13% in AVH patients, 18% in PSC patients, and 3% in healthy volunteers. In type 1 AIH patients, titers of serum anti-PD-1 antibodies were correlated with serum levels of bilirubin (r = 0.31, P = 0.030) and alanine aminotransferase (r = 0.31, P = 0.027) but not serum immunoglobulin G levels. Positivity for serum anti-PD-1 antibodies was associated with the later normalization of serum alanine aminotransferase levels after the initiation of prednisolone and the disease relapse. CONCLUSIONS: Serum anti-PD-1 antibodies would be useful for the discrimination of type 1 AIH from DILI, AVH, and PSC as an auxiliary diagnostic marker. Furthermore, anti-PD-1 antibodies may be associated with clinical characteristics of type 1 AIH.

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  • Usefulness of early-phase peritoneal lavage for treating severe acute pancreatitis.

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

    Internal medicine (Tokyo, Japan)   53 ( 1 )   1 - 6   2014

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    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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  • A case of delayed bleeding 9 days after endoscopic ultrasound-guided pancreatic pseudocyst drainage. International journal

    Tomoaki Matsumori, Akio Katanuma, Hiroyuki Maguchi, Kuniyuki Takahashi, Manabu Osanai, Kei Yane, Toshifumi Kin, Ryo Takaki, Kazuyuki Matsumoto, Katsushige Gon, Akiko Tomonari

    Endoscopy   46 Suppl 1 UCTN   E245-6   2014

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    DOI: 10.1055/s-0034-1364881

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  • Successful removal of a pancreatic duct stone in a patient with Whipple resection, using a short single-balloon enteroscope with a transparent hood. International journal

    Kei Yane, Akio Katanuma, Manabu Osanai, Hiroyuki Maguchi, Kuniyuki Takahashi, Toshifumi Kin, Ryo Takaki, Kazuyuki Matsumoto, Katsushige Gon, Tomoaki Matsumori, Akiko Tomonari

    Endoscopy   46 Suppl 1 UCTN   E86-7   2014

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  • ENDOSCOPIC BALLOON DILATATION USING A SHORT SINGLE- BALLOON ENTEROSCOPE IN A PATIENT WITH AN ANASTOMOTIC STRICTURE AFTER PANCREATICODUODENECTOMY FOR INTRADUCTAL PAPILLARY MUCINOUS NEOPLASM : A CASE REPORT

    YANE Kei, MAGUCHI Hiroyuki, OSANAI Manabu, TAKAHASHI Kuniyuki, KATANUMA Akio, KIN Toshifumi, TAKAKI Ryo, MATSUMOTO Kazuyuki, GON Katsushige, MATSUMORI Tomoaki, TOMONARI Akiko

    Gastroenterological Endoscopy   56 ( 3 )   477 - 483   2014

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    A 53-year-old woman had undergone pancreaticoduodenectomy (SSPPD-IIA) for an intraductal papillary mucinous neoplasm (IPMN) in November 2009. Nineteen months after the surgery, abdominal CT showed a dilated remnant main pancreatic duct and a small soft tissue density mass. Findings suggested a pancreaticojejunal anastomosis stricture or a recurrent IPMN. Subsequently, the patient was admitted to our hospital with acute pancreatitis. We tried to observe the pancreaticojejunal anastomosis using a prototype short single-balloon enteroscope (Short SBE). However, the first attempt at ERCP was unsuccessful due to difficulty in finding the anastomotic site. In a second attempt 25 months after the surgery it was possible to find the anastomosis using a Short SBE with a transparent hood. We performed balloon dilatation of the anastomotic stricture and removed white protein plugs. The filling defects in the main pancreatic duct disappeared following pancreatography, and it was decided that there was no apparent tumor recurrence. During the following 14 months, no recurrence of the IPMN or pancreatitis has occurred. ERCP using Short SBE is a useful option for the management of a pancreaticojejunal anastomosis stricture.

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  • Serial changes of serum growth factor levels and liver regeneration after partial hepatectomy in healthy humans. International journal

    Kazuyuki Matsumoto, Yasuhiro Miyake, Yuzo Umeda, Hiroshi Matsushita, Hiroaki Matsuda, Akinobu Takaki, Hiroshi Sadamori, Kazuhiro Nouso, Takahito Yagi, Toshiyoshi Fujiwara, Kazuhide Yamamoto

    International journal of molecular sciences   14 ( 10 )   20877 - 89   2013.10

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    This study aimed to investigate the associations of the serial changes of serum levels of various growth factors with liver regeneration after hepatectomy in healthy liver donors. Sixteen healthy liver donors who underwent conventional liver resection were included. Serum levels of various growth factors before hepatectomy and on postoperative day (POD) 1, 3, 5 and 7 were measured. Liver volume data calculated by multi-detector computed tomography using workstation. The ratio of remnant liver volume on POD 0 to liver volume before the operation was 51% ± 20%. The ratio of liver volume on POD 14 to liver volume on POD 0 were inversely correlated with remnant liver volume on POD 0 (r = -0.91). The ratio of liver volume on POD 14 to liver volume on POD 0 were significantly correlated with serum hepatocyte growth factor (HGF) levels on POD 1 (r = 0.54), serum leptin levels on POD 1 (r = 0.54), and serum macrophage colony-stimulating factor (M-CSF) levels on POD 5 (r = 0.76) and POD 7 (r = 0.80). These results suggest that early-phase elevation of serum levels of HGF, leptin and M-CSF may be associated with the acceleration of liver regeneration after hepatectomy in humans.

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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   2013.10

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

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

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

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

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

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

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

    Gastrointestinal endoscopy   77 ( 1 )   132 - 3   2013.1

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  • Efficacy, Safety, and Long-Term Follow-Up Results of EUS-Guided Transmural Drainage for Pancreatic Pseudocyst. International journal

    Shin Kato, Akio Katanuma, Hiroyuki Maguchi, Kuniyuki Takahashi, Manabu Osanai, Kei Yane, Toshifumi Kim, Maki Kaneko, Ryo Takaki, Kazuyuki Matsumoto, Tomoaki Matsumori, Katsushige Gon, Akiko Tomonari

    Diagnostic and therapeutic endoscopy   2013   924291 - 924291   2013

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    Background and Aim. EUS-guided transmural drainage (EUS-GTD) is now considered a minimally invasive and effective alternative to surgery for drainage of symptomatic pancreatic pseudocysts. However, the technique is rather difficult, and sometimes serious complications occur to patients undergoing this procedure. We retrospectively evaluated efficacy, safety, and long-term follow-up results of EUS-GTD for pancreatic pseudocyst. Methods. Sixty-seven patients with pancreatic pseudocyst who underwent EUS-GTD from April 2000 to March 2011 were enrolled. We retrospectively evaluated (1) technical success, (2) clinical success, (3) adverse event of procedure, and (4) long-term follow-up results. Results. Total technical success rate was 88%. Ninety-one percent of external drainage, 79% of internal drainage, and 66% of puncture and aspiration only achieved clinical success. There was only one case with an adverse event, perforation (1.5%). The case required emergency operation. Total recurrence rate was 23.9%. Median follow-up period was 33.9 months. The recurrence rates in the cases of stent remaining, spontaneously dislodged, removed on schedule, external tube removal, and aspiration only were 10.0%, 12.5%, 42.9%, 50%, and 0%, respectively. Conclusion. EUS-GTD is a relatively safe and effective therapeutic method. However, further analysis should be done by larger series to determine the method of EUS-GTD for pancreatic pseudocyst.

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

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

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

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

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  • Peppermint oil solution is useful as an antispasmodic drug for esophagogastroduodenoscopy, especially for elderly patients. International journal

    Atsushi Imagawa, Hidenori Hata, Morihito Nakatsu, Yasunari Yoshida, Keiko Takeuchi, Toshihiro Inokuchi, Takayuki Imada, Yoshiyasu Kohno, Masahiro Takahara, Kazuyuki Matsumoto, Hirokazu Miyatake, Satoru Yagi, Masaharu Ando, Mamoru Hirohata, Shigeatsu Fujiki, Ryuta Takenaka

    Digestive diseases and sciences   57 ( 9 )   2379 - 84   2012.9

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    BACKGROUND: Although hyoscine butyl bromide (HB) and glucagon (GL) are often used as antispasmodic drugs during esophagogastroduodenoscopy (EGD), these agents may cause adverse effects. Recently, it was reported that peppermint oil solution (PO) was very effective and had few side effects. AIM: We clarified the efficacy and usefulness of PO as an antispasmodic during upper endoscopy, especially for elderly patients. METHODS: This study was a non-randomized prospective study. The antispasmodic score (1-5, where 5 represents no spasm) was defined according to the degree of spasms of the antrum and difficulty of biopsy. We compared the antispasmodic scores between non-elderly patients (younger than 70) and elderly patients (70 years old or older) according to the antispasmodic agent. RESULTS: A total of 8,269 (Group PO: HB: GL: NO (no antispasmodic) = 1,893: 6,063: 157: 156) EGD procedures were performed. There was no significant difference in the antispasmodic score between Group PO (mean score ± standard deviation: 4.025 ± 0.925) and Group HB (4.063 ± 0.887). Among the non-elderly patients, those in Group PO (n = 599, 3.923 ± 0.935) had a worse antispasmodic score than those in Group HB (n = 4,583, 4.062 ± 0.876, P < 0.001). However, among the elderly patients, those in Group PO (n = 1,294, 4.073 ± 0.917) had similar scores to those in Group HB (n = 1,480, 4.064 ± 0.921, P = 0.83), and significantly better scores than those in Group GL (n = 69, 3.797 ± 0.933, P < 0.05). CONCLUSION: Peppermint oil was useful as an antispasmodic during EGD, especially for elderly patients.

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  • Hydrogen-rich water prevents progression of nonalcoholic steatohepatitis and accompanying hepatocarcinogenesis in mice. International journal

    Daisuke Kawai, Akinobu Takaki, Atsuko Nakatsuka, Jun Wada, Naofumi Tamaki, Tetsuya Yasunaka, Kazuko Koike, Ryuichiro Tsuzaki, Kazuyuki Matsumoto, Yasuhiro Miyake, Hidenori Shiraha, Manabu Morita, Hirofumi Makino, Kazuhide Yamamoto

    Hepatology (Baltimore, Md.)   56 ( 3 )   912 - 21   2012.9

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    UNLABELLED: Oxidative stress is a strong contributor to the progression from simple fatty liver to nonalcoholic steatohepatitis (NASH). Molecular hydrogen is an effective antioxidant that reduces cytotoxic reactive oxygen species. In this study, we investigated the effects of hydrogen-rich water and the drug pioglitazone on the progression of NASH in mouse models. A methionine-choline-deficient (MCD) diet mouse model was prepared. Mice were divided into three experimental groups and fed for 8 weeks as follows: (1) MCD diet + control water (CW group); (2) MCD diet + hydrogen-rich water (HW group); and (3) MCD diet mixed with pioglitazone (PGZ group). Plasma alanine aminotransferase levels, hepatic expression of tumor necrosis factor-α, interleukin-6, fatty acid synthesis-related genes, oxidative stress biomarker 8-hydroxydeoxyguanosine (8-OHdG), and apoptosis marker terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick-end labeling (TUNEL)-positive cells in the liver were decreased in the HW and PGZ groups. The HW group showed a smaller decrease in hepatic cholesterol; however, stronger antioxidative effects in serum and lower peroxisome proliferator-activated receptor-α expression in the liver were seen in comparison with the PGZ group. We then investigated the effects of hydrogen in the prevention of hepatocarcinogenesis in STAM mice, known as the NASH-related hepatocarcinogenesis model. Eight-week-old male STAM mice were divided into three experimental groups as follows: (1) control water (CW-STAM); (2) hydrogen-rich water (HW-STAM); and (3) pioglitazone (PGZ-STAM). After 8 weeks, hepatic tumors were evaluated. The number of tumors was significantly lower in the HW-STAM and PGZ-STAM groups than in the CW-STAM group. The maximum tumor size was smaller in the HW-STAM group than in the other groups. CONCLUSION: Consumption of hydrogen-rich water may be an effective treatment for NASH by reducing hepatic oxidative stress, apoptosis, inflammation, and hepatocarcinogenesis.

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  • Serum levels of soluble adhesion molecules as prognostic factors for acute liver failure. International journal

    Atsuyuki Ohnishi, Yasuhiro Miyake, Hiroshi Matsushita, Kazuyuki Matsumoto, Akinobu Takaki, Tetsuya Yasunaka, Kazuko Koike, Fusao Ikeda, Hidenori Shiraha, Kazuhiro Nouso, Kazuhide Yamamoto

    Digestion   86 ( 2 )   122 - 8   2012

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    BACKGROUND/AIMS: In patients with septic shock, the degree of liver dysfunction is correlated with serum levels of soluble intercellular adhesion molecule (sICAM)-1. We aimed to assess the usefulness of serum levels of soluble adhesion molecules as prognostic factors for acute liver failure (ALF). METHODS: Serum levels of soluble platelet endothelial cell adhesion molecule (sPECAM)-1, sICAM-3, soluble endothelial (sE) selectin, sICAM-1, soluble platelet selectin, and soluble vascular cell adhesion molecule-1 on admission were measured in 37 ALF patients and 34 healthy controls. RESULTS: Twenty-two ALF patients (59%) reached to fatal outcomes. Serum levels of sPECAM-1, sICAM-3, sE-selectin and sICAM-1 were higher in ALF patients than healthy controls. In 37 ALF patients, by the multivariate logistic regression analysis, ratio of direct to total bilirubin (per 0.1 increase; OR 0.11, 95% CI 0.01-0.99), serum sPECAM-1 level (per 100 ng/ml increase; OR 4.37, 95% CI 1.23-15.5) and serum sICAM-1 level (per 100 ng/ml increase; OR 0.49, 95% CI 0.27-0.89) were associated with fatal outcomes. Using receiver operating characteristics curve, each area under the curve of serum sPECAM-1 and sICMA-1 levels as prognostic factors was 0.71 and 0.74, respectively. CONCLUSION: Serum sPECAM-1 and sICAM-1 levels may be useful for predicting the prognosis of ALF.

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  • Effect of low-dose gemcitabine on unresectable pancreatic cancer in elderly patients. International journal

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

    Digestion   84 ( 3 )   230 - 5   2011

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    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 (≥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 unresectable pancreatic cancer. Furthermore, frequencies of severe toxicity seem lower in patients treated with low-dose GEM compared with previous reports.

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  • Large Waist Circumference Is a Risk Factor for Reflux Esophagitis in Japanese Males Reviewed

    Hisae Yasuhara, Yasuhiro Miyake, Tatsuya Toyokawa, Kazuyuki Matsumoto, Masahiro Takahara, Takayuki Imada, Satoru Yagi, Hirokazu Miyatake, Morihito Nakatsu, Masaharu Ando, Mamoru Hirohata

    DIGESTION   81 ( 3 )   181 - 187   2010

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    Background/Aims: The prevalence of reflux esophagitis, which might lead to development of Barrett&apos;s esophagus and esophageal adenocarcinoma, has been increasing. The aim of this study was to assess risk factors for reflux esophagitis. Methods: We conducted a cross-sectional study of 1,495 Japanese subjects undergoing health checkups (822 males and 673 females; median age 50 years) at a tertiary care center. Results: One hundred and twenty-seven subjects (8%) had reflux esophagitis and hiatal hernia was observed in 292 subjects (20%). Reflux esophagitis (13 vs. 3%) and hiatal hernia (28 vs. 9%) were more frequent in males than females. Significant differences in clinical backgrounds were observed between females and males. Multivariate logistic regression analyses revealed that hiatal hernia (OR 6.63, 95% CI 2.47-17.8; p = 0.0002) was associated with reflux esophagitis in females. In males, age (per 1-year increment: OR 0.96, 95% CI 0.94-0.99; p = 0.007), hiatal hernia (OR 3.16, 95% CI 2.05-4.87; p &lt; 0.0001) and waist circumference (per 1-cm increase: OR 1.09, 95% CI 1.02-1.15; p = 0.006) were associated with reflux esophagitis. Conclusions: Abdominal obesity may be an important risk factor for reflux esophagitis in males compared with females. Copyright (C) 2010 S. Karger AG, Basel

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  • A case of hepatic angiomyolipoma difficult to distinguish from hepatocellular carcinoma. International journal

    Masahiro Takahara, Yasuhiro Miyake, Kazuyuki Matsumoto, Daisuke Kawai, Eisuke Kaji, Tatsuya Toyokawa, Morihito Nakatsu, Masaharu Ando, Mamoru Hirohata

    World journal of gastroenterology   15 ( 23 )   2930 - 2   2009.6

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    We report a case of hepatic angiomyolipoma with uncommon clinical features. A 56-year-old man presented with a hepatic tumor in the caudate lobe. The tumor was hypoechoic on ultrasonography, showed early-phase hyperattenuation on enhanced computed tomography and did not absorb iron on superparamagnetic iron oxide-enhanced magnetic resonance imaging. Hepatocellular carcinoma was highly suspected, and the patient underwent hepatic resection. Histologically, the tumor was mainly composed of smooth muscle cells and contained small amounts of adipose cells and blood vessels. On immunohistochemical staining, the smooth muscle cells were positive for a melanocytic cell-specific monoclonal antibody. In cases with uncommon features of angiomyolipoma, it is quite difficult to distinguish angiomyolipoma from hepatocellular carcinoma.

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  • A combination treatment of entecavir and early-phase corticosteroid in severe exacerbation of chronic hepatitis B. International journal

    Kazuyuki Matsumoto, Yasuhiro Miyake, Hirokazu Miyatake, Masahiro Takahara, Takayuki Imada, Satoru Yagi, Tatsuya Toyokawa, Morihito Nakatsu, Masaharu Ando, Mamoru Hirohata

    World journal of gastroenterology   15 ( 13 )   1650 - 2   2009.4

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    Of patients with severe exacerbation of chronic hepatitis B accompanied by jaundice and coagulopathy, 20%-30% have a fatal outcome. In this report, we describe 2 cases of severe exacerbation of chronic hepatitis B with jaundice and coagulopathy who were successfully treated with a combination of entecavir and corticosteroid. In both cases, rapid reductions in serum hepatitis B virus (HBV)-DNA levels were observed, and corticosteroid was stopped after serum HBV-DNA levels became undetectable. Entecavir treatment was continued. Generally, entecavir treatment reduced serum HBV-DNA levels rapidly, although the improvement in liver function was delayed by a few weeks. During this time lag, liver cell injury continued and the disease progressed. Corticosteroid suppressed the excessive host immune response and was useful for stopping progressive deterioration. A combination of entecavir and early-phase corticosteroid may be a useful treatment in severe exacerbation of chronic hepatitis B.

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  • R-CHOP療法で完全寛解が得られた肝原発悪性リンパ腫の1例

    浅木 彰則, 三宅 康広, 安東 正晴, 安原 ひさ恵, 松本 和幸, 高原 政宏, 河合 大介, 加地 英輔, 豊川 達也, 大西 亨, 宮谷 克也, 中津 守人

    日本消化器病学会雑誌   106 ( 3 )   389 - 396   2009.3

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    症例は75歳男性、右季肋部痛を主訴に来院し、CTで肝右葉に巨大な腫瘤を認め入院した。腹部超音波で腫瘤内を貫通する脈管を認め、超音波ガイド下腫瘍生検を行い悪性リンパ腫と診断した。骨髄正常で、脾腫がなくPET-CTにて肝以外にFDGの有意な集積を認めなかったことから肝原発と診断した。Rituximabを併用したCHOP療法を8クール施行し、治療後のPET-CTでFDGの有意な集積を認めず完全寛解と判定した。節外性悪性リンパ腫の0.41%と非常にまれな疾患である肝原発悪性リンパ腫の1例を経験し、R-CHOP療法により完全寛解が得られたので報告する。(著者抄録)

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  • Low dose gemcitabine improves the prognosis of elderly patients with unresectable advanced pancreatic cancer Reviewed

    Kazuyuki Matsumoto, Tatsuya Toyokawa, Yasuhiro Miyake, Hisae Yasumara, Masahiro Takahara, Eisuke Kaji, Morihito Nakatsu, Masaharu Ando, Mamoru Hirohata

    GASTROENTEROLOGY   134 ( 4 )   A453 - A454   2008.4

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  • 【胆膵EUSのトラブルシューティング】治療的EUS EUS-guided biliary drainage(EUS-BD) 処置後の腹痛

    加藤 博也, 内田 大輔, 松本 和幸, 堀口 繁, 堤 康一郎

    消化器内視鏡   34 ( 12 )   2011 - 2015   2022.12

  • 【肝門部領域胆管ドレナージを極める】肝門部胆管狭窄に対するマルチステンティングの現況

    加藤 博也, 松本 和幸, 岡田 裕之

    消化器内視鏡   34 ( 6 )   1107 - 1110   2022.6

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  • 【胆・膵領域癌におけるゲノム医療の現状】胆道癌ゲノム医療の現状 中四国地区のがんゲノム医療中核拠点病院における胆道癌ゲノム医療の現状について

    堀口 繁, 加藤 博也, 小幡 泰介, 織田 崇志, 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, 松本 和幸, 堤 康一郎, 岡田 裕之

    胆と膵   43 ( 6 )   537 - 544   2022.6

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    2019年6月から本邦で導入されたがんゲノム医療は、今や一般診療における選択肢の一つとなっている。とくに胆道癌においては従来の殺細胞性抗癌剤の選択肢が極めて乏しいこともあり期待は高い。MSI-H、TMB-HへのペムブロリズマブやFGFR2融合遺伝子へのペミガチニブなど、保険診療内の治療選択肢が増え、また患者申出療養で使用できる薬剤も増えていることから治療へのアクセスは改善しているものと考えられる。一方で、治験施設は都心部をはじめとした一部施設へ集中しており、進行胆道癌症例が中四国地区から参加するのは、COVID-19蔓延下でもあることからとくにハードルが高い。またIDH1/2阻害剤など海外で有用性が示された薬剤の本邦への導入の遅れ、さらに患者申出療養での薬剤提供がいつまで続くかといった問題も山積している。出口戦略の更なる改善とともに、actionable変異を臨床的に予測して効率的にがん遺伝子パネル検査対象を抽出する研究の推進も望まれる。(著者抄録)

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  • 【エキスパートが教える最新胆膵内視鏡診断・治療】現役エキスパートが教える最新胆膵内視鏡のコツ

    糸井 隆夫, 重川 稔, 松本 和幸, 土屋 貴愛

    胆と膵   43 ( 4 )   407 - 419   2022.4

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  • 【胆道疾患研究最前線】胆嚢癌におけるマイクロRNA、エクソソームのかかわりと新規診断、治療への応用

    堤 康一郎, 上田 英次郎, 加藤 博也, 小幡 泰介, 織田 崇志, 松本 和幸, 堀口 繁, 岡田 裕之

    消化器・肝臓内科   11 ( 1 )   51 - 58   2022.1

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  • 【胆道狭窄の診断と治療】各論(治療) 悪性胆道狭窄に対するドレナージ戦略 肝門部(切除・非切除)

    加藤 博也, 松本 和幸, 堀口 繁, 堤 康一郎, 岡田 裕之

    肝胆膵   83 ( 5 )   813 - 818   2021.11

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

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

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

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

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

    肝胆膵   82 ( 1 )   91 - 96   2021.1

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

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

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

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

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

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

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

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

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

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

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

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

    胆と膵   40 ( 6 )   529 - 533   2019.6

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

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  • 【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   2019.5

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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   2018.11

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    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   2018.11

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    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   2018.10

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  • 膵癌術後再発に対するEUS-FNAの有用性 洗浄液を用いた遺伝子変異解析も含めて

    松本 和幸, 加藤 博也, 赤穂 宗一郎, 吉田 龍一, 楳田 祐三, 信岡 大輔, 皿谷 洋祐, 高田 斎文, 室 信一郎, 内田 大輔, 友田 健, 堀口 繁, 能祖 一裕, 八木 孝仁, 岡田 裕之

    膵臓   33 ( 3 )   516 - 516   2018.5

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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   2017.8

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

    胆と膵   36 ( 8 )   751 - 756   2015.8

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

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  • 【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〜】内視鏡的乳頭括約筋切開術(EST)の最新情報 教育モデルとトラブルシューティング

    潟沼 朗生, 糸井 隆夫, 真口 宏介, 矢根 圭, 金 俊文, 友成 暁子, 松森 友昭, 松本 和幸, 高木 亮, 権 勉成, 小山内 学, 高橋 邦幸

    胆と膵   35 ( 6 )   501 - 506   2014.6

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    Endoscopic sphincteromomy(EST)は胆膵内視鏡医にとって最も施行頻度の高い手技である。しかしながら実際のトレーニングの多くは実臨床において施行しているのが現状である。トレーニングモデルには動物あるいはその臓器を用いるwet labと人工品を加工して作製したdry labに分けられる。EST施行可能なwet labにはliving pig、Ex vivo Erlangen model、Neo-Papilla、Simulated papillae、dry labにはコンピュータシミュレーター、X-Vision ERCP Training System、modified ERCP trainerが報告されている。しかしながら、これらのトレーニングモデルによる技術の習得効果は、いまだに不明な点も多く、今後の課題である。ESTの偶発症は穿孔、出血、膵炎が主なものである。穿孔、出血は不適切な方向への切開がなされた場合に生じることが多い。偶発症が生じた場合には、重篤となる前に速やかに対処を行うことが重要である。(著者抄録)

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  • 【乳頭を攻略する-カニュレーションの基本と困難例への対処】胆管カニュレーション カニューレを用いた造影法を基本とする戦略とアルゴリズム

    潟沼 朗生, 真口 宏介, 友成 暁子, 松森 友昭, 権 勉成, 松本 和幸, 高木 亮, 金 俊文, 矢根 圭, 小山内 学, 高橋 邦幸

    消化器内視鏡   26 ( 2 )   160 - 166   2014.2

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    胆管挿管はERCP手技を行うための最初の一歩である。主乳頭は胆管の開口様式、胆管走行などは個体差が大きい。膵胆管の開口様式は、1)膵管と胆管が分離して開口する、2)一つの乳頭に分離して開口する、3)両者が合流して共通管を形成して開口する、の3つの様式に分かれる。胆管挿管を成功させるためには、乳頭の形状を判断し、適切な戦略をたてることが重要である。乳頭の形状は大井の分類(分離型、隔壁型、共通管型)が知られており、さらに猪俣らがこれを基本とし、胆管挿管を意識した分類を提唱している(別開口型、タマネギ型、結節型、絨毛型、平坦型、縦長型)。胆管挿管の基本は乳頭の適切な正面視であり、このためにはスコープ挿入操作が鍵を握る。挿管にあたってはカニューレ操作を愛護的に行い、造影剤の過度の注入は控えることが重要である。(著者抄録)

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  • 【消化管術後例における胆膵治療内視鏡】胆管空腸吻合例に対するSBEを用いた胆道内視鏡治療

    矢根 圭, 真口 宏介, 高橋 邦幸, 潟沼 朗生, 小山内 学, 金 俊文, 高木 亮, 松本 和幸, 権 勉成, 松森 友昭, 友成 暁子, 安保 義恭

    胆と膵   35 ( 2 )   163 - 169   2014.2

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    従来外科的治療や経皮的治療が行われてきた胆管空腸吻合例での吻合部狭窄や肝内結石に対しても、バルーン内視鏡を用いた胆道内視鏡治療は低侵襲で有用性が高い。消化器外科手術後の再建術式のうち、胆管空腸吻合術が行われる代表的なものはPDと胆管切除術後であり、後者はERCP関連手技の難度が最も高い術式のひとつである。シングルバルーン内視鏡(SBE)には、有効長200cmのSIF-Q260とprototypeの有効長152cm・鉗子口径3.2mmのshort SBEがあり、後者では通常の内視鏡処置具の多くが使用可能である。自験例でのSBEによる胆管空腸吻合部への到達率は全体で88%(46/52)、胆管切除術後では83%(20/24)であり、手技成功率はおのおの80%(42/52)、79%(19/24)であった。治療手技の標準化と成績向上のためには、short SBEの市販と長いSBEでも対応可能な処置具の開発が望まれる。(著者抄録)

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  • 【ドレナージ大全】膵疾患に対するドレナージ術 膵嚢胞ドレナージ 膵仮性嚢胞(貯留嚢胞)に対する内視鏡的ドレナージ手技の実際とコツ

    潟沼 朗生, 真口 宏介, 矢根 圭, 金 俊文, 松森 友昭, 松本 和幸, 権 勉成, 高木 亮, 友成 暁子, 小山内 学, 高橋 邦幸

    胆と膵   34 ( 臨増特大 )   935 - 938   2013.10

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    膵仮性嚢胞とは、急性膵炎および慢性膵炎の経過にみられる、最も頻度の高い合併症の一つである。一般には、膵内あるいは膵周囲に形成された中空の構造で、壁に囲まれた内腔に、膵液、粘液、血液などを伴い、嚢胞壁内腔面に上皮細胞を認めないものである。一方、貯留嚢胞とは、慢性膵炎や膵癌、膵管上皮化生などにより膵管の狭窄や閉塞が起こり、膵液うっ滞が生じて末梢膵管が嚢状に拡張して形成される。ともに慢性の膵疾患に伴い、感染や出血などの合併症を伴う場合には、ドレナージの適応となりうる。ドレナージ法は内視鏡的ドレナージが第一選択であり、その方法は経乳頭的ドレナージと経消化管的ドレナージに大別される。一般に主膵管と嚢胞との交通がある場合、さらには主膵管狭窄の治療が必要な場合には、経乳頭的ドレナージを、主膵管と嚢胞との交通がない場合や、早急なドレナージを要する場合には経消化管的ドレナージが選択される。(著者抄録)

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  • 【膵癌の早期発見をめざして】慢性膵炎とIPMNにおける経過観察中に発生した膵癌

    小山内 学, 真口 宏介, 高橋 邦幸, 潟沼 朗生, 矢根 圭, 金 俊文, 高木 亮, 松本 和幸, 権 勉成, 松森 友昭, 友成 暁子

    消化器内科   57 ( 1 )   80 - 86   2013.7

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  • 【胆道癌診療の最前線】胆道癌の診断 胆道鏡と生検診断

    小山内 学, 真口 宏介, 高橋 邦幸, 潟沼 朗生, 矢根 圭, 金 俊文, 高木 亮, 松本 和幸, 松森 友昭, 権 勉成, 友成 暁子

    消化器外科   36 ( 7 )   1053 - 1062   2013.6

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  • 【膵・胆管合流異常アップデート】体外式および超音波内視鏡検査の役割

    松森 友昭, 真口 宏介, 高橋 邦幸, 潟沼 朗生, 小山内 学, 矢根 圭, 金 俊文, 高木 亮, 松本 和幸, 権 勉成

    小児外科   45 ( 6 )   643 - 646   2013.6

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  • 【GEPNETの最前線】診断 P-NETの画像診断(EUS、EUS-FNAを中心に)

    金 俊文, 真口 宏介, 高橋 邦幸, 潟沼 朗生, 小山内 学, 矢根 圭, 高木 亮, 松本 和幸, 松森 友昭, 権 勉成, 友成 暁子

    肝胆膵   66 ( 5 )   795 - 802   2013.5

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  • 自己免疫性肝胆膵疾患の病態解明の進歩 自己免疫性肝炎における新規自己抗体

    三宅 康広, 松本 和幸, 大西 敦之, 松下 浩志, 高木 章乃夫, 山本 和秀

    消化器と免疫   ( 49 )   3 - 6   2013.3

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    抑制性の補助刺激分子programmed cell death-1(PD-1)に対する血清中抗体価を間接ELISA法で測定した。抗PD-1抗体価は、薬物性肝障害(DILI)群や急性ウイルス性肝炎群、健常者群に比べて自己免疫性肝炎(AIH)群で高値であった。また、AIH群では、抗PD-1抗体価とビリルビンやトランスアミナーゼが正に相関しており、抗PD-1抗体陽性例では陰性例に比べて抗核抗体の陽性率が高かった。血清中抗PD-1抗体は、AIHとDILIの鑑別に有用であり、AIHの病態に関与している可能性が推測される。(著者抄録)

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  • 【胆管・膵管拡張をみたら】膵管拡張をみたら[内視鏡的アプローチ] IDUSによるアプローチ

    潟沼 朗生, 真口 宏介, 高橋 邦幸, 小山内 学, 矢根 圭, 金 俊文, 松本 和幸, 松森 友昭, 権 勉成, 高木 亮

    消化器内視鏡   25 ( 2 )   288 - 294   2013.2

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    主膵管拡張をきたす疾患には、主膵管が閉塞・圧排し尾側の膵管が拡張する腫瘍性疾患、慢性膵炎や膵石などの良性疾患、さらには膵管内乳頭粘液性腫瘍(intraductal papillary mucinous neoplasm:IPMN)などの嚢胞性疾患がある。管腔内超音波検査(intraductal ultrasonography:IDUS)は超音波内視鏡(endoscopic ultrasonography:EUS)と並び、膵疾患における重要な診断法に位置づけられる。IDUSの特徴は、高い空間分解能を有することであり、主膵管近傍の詳細な観察に適している。近年の機種の改良により、操作性、画像は格段に進歩してきているが、プローブから離れた病変の観察には限界があり、また、主膵管走行の状態や管腔の狭窄が強い場合には、プローブが通過できないなどの欠点も有している。IDUSの良い適応となる病変は、IPMNにおける診断、嚢胞内または主膵管内における壁在結節の存在診断、主膵管と嚢胞性病変の連続性の証明などであり、術式の決定にも重要である。(著者抄録)

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  • 【外科医必読 膵管内乳頭粘液性腫瘍(IPMN)のすべて】IPMNの最新の画像診断

    高木 亮, 真口 宏介, 小山内 学, 高橋 邦幸, 潟沼 朗生, 矢根 圭, 金 俊文, 松本 和幸, 松森 友昭, 権 勉成

    外科   75 ( 2 )   135 - 140   2013.2

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    膵管内乳頭粘液性腫瘍(IPMN)国際診療ガイドライン2012が報告され,手術適応などが改訂された.IPMNに対する画像診断の中心には,MR胆管膵管撮影(MRCP)とCTそして超音波内視鏡検査(EUS)が位置する.初回診断時には,他疾患との鑑別,特に慢性膵炎あるいは膵癌の除外を行う必要があり,MRCPとCTを行う.IPMNの診断が得られた例には,分類と手術適応としての"high-risk stigmata"の有無の判定を行う.さらに全例もしくは"worrisome feature"を有する例には,EUSでの壁在結節の有無の評価を行うことが推奨される.手術適応例に対しては,術式の選択と切除ライン決定のための主膵管内進展度診断を行う必要があり,MRCP,CT,EUSに加えて内視鏡的膵胆管造影(ERCP)と膵管腔内超音波検査(IDUS)を施行し,必要に応じて経口膵管鏡検査(POPS)を追加する.経過観察に際しては,IPMN自体の進展の評価に加えて,通常型膵癌の出現に留意する必要があり,膵全体を観察していくことが求められる.したがって,MRCP,CT,EUSが必要であり,これらを組み合わせた6ヵ月ごとの経過観察が推奨される.(著者抄録)

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  • 【胆膵内視鏡新潮流】胆道疾患に対する新しい内視鏡手技 巨大結石に対するEPLBD

    金 俊文, 真口 宏介, 高橋 邦幸, 潟沼 朗生, 小山内 学, 矢根 圭, 高木 亮, 松本 和幸, 松森 友昭, 権 勉成

    肝胆膵   66 ( 1 )   99 - 105   2013.1

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  • 【再びIPMNの切除適応を考える】IPMN/MCN国際診療ガイドライン(2006年版)手術適応例の経過観察の結末

    小山内 学, 真口 宏介, 高橋 邦幸, 潟沼 朗生, 矢根 圭, 金 俊文, 高木 亮, 松本 和幸, 松森 友昭, 権 勉成

    胆と膵   33 ( 11 )   1187 - 1194   2012.11

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    2006年に提唱された「IPMN/MCNの国際診療ガイドライン」(GL)での手術適応は、主膵管型と分枝型の中でhigh risk stigmata(悪性を疑う所見)を認める例としている。一方、本邦ではGLでの手術適応因子を有していても手術適応を絞り込み経過観察を行っている例が少なくないが、その長期経過のデータは少ないのが現状である。今回、手術適応因子を有する自験例と報告例から得られた結果として、主膵管型IPMNでは、経過観察例においても進展率が分枝型の報告に比べると高率であり手術適応が妥当と判断される。ただし、主膵管型であっても進展は比較的緩徐であり、浸潤癌に至るまで長期間を要するため待機的な治療が可能であり、全身状態、病変範囲や手術の侵襲などを十分吟味すべきである。一方、分枝型IPMNでは手術適応例であっても進展率は低く、経過観察中に浸潤癌に移行する例は非常にまれである。また進展の危険因子としては拡張分枝径が最も関連性が低いため手術適応因子に適していないと考えられる。よって結節状隆起がより重視されるべきであるが、切除適応とする結節状隆起の大きさには一定の見解が得られていないという問題点が存在する。今後、GLでの手術適応を有する症例の蓄積と長期経過観察例の検討により進展の危険因子の解明および手術適応因子の見直しが必要である。(著者抄録)

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  • 【胆膵内視鏡のビデオライブデモ2012】サルベージ治療 膵管プラスティックステント迷入に対する内視鏡的回収法

    小山内 学, 真口 宏介, 高橋 邦幸, 潟沼 朗生, 矢根 圭, 金 俊文, 高木 亮, 松本 和幸, 松森 友昭, 権 勉成

    胆と膵   33 ( 臨増特大 )   1113 - 1118   2012.10

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    胆膵内視鏡診断・治療において膵管プラスティックステントを用いる機会が増えてきており、さらに、2012年春には膵管ステント留置術が保険収載された。その一方で、膵管ステントの偶発症の一つに、まれではあるがステントの迷入がある。迷入したステントの回収は、内視鏡的回収が最も低侵襲であり、まず試みるべき手技である。しかし、回収専用のデバイスが少ないため、既存のデバイスを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。ただし、回収困難時には回収に固執することなく、一時的に内視鏡的経鼻膵管ドレナージ術やセカンドステントの挿入などの柔軟な対応も必要である。(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 ラジアルEUSによる胆膵標準描出法

    潟沼 朗生, 真口 宏介, 権 勉成, 松森 友昭, 松本 和幸, 高木 亮, 金 俊文, 矢根 圭, 小山内 学, 高橋 邦幸

    胆と膵   33 ( 臨増特大 )   1045 - 1050   2012.10

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    超音波内視鏡は(endoscopic ultrasonography:EUS)は空間分解能が高く、胆膵疾患では最も精度の高い診断法の一つである。ラジアル走査式EUSはスコープを中心に360°の画像情報が得られる。標準的描出法は、胃内、十二指腸下行脚、十二指腸球部の3ヶ所の走査位置に分かれている。また十二指腸走査ぱpull法とpush法があり、pull法は十二指腸下行脚でのスコープの向きにより、縦断法と横断法に分けられる。EUSの描出手技はやや難易度が高く、手技の習得、ならびに適切な画像を得て正確な診断を行うためには、検査前処置、モニターと被験者の配置、基本的なスコープ操作、各走査位置から描出される臓器・管腔を理解するとともに、メルクマールを認識する、ことが重要である。(著者抄録)

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  • Streptozotocin投与NASH発癌モデルマウスにおける病態進行と水素水投与の有効性の検討

    河合 大介, 高木 章乃夫, 山本 和秀, 中司 敦子, 和田 淳, 玉木 直文, 安中 哲也, 小池 和子, 津崎 龍一郎, 松本 和幸, 三宅 康広, 白羽 英則, 森田 学, 槇野 博史

    日本消化器病学会雑誌   109 ( 臨増大会 )   A708 - A708   2012.9

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  • 【膵管癌の危険因子と早期診断法】慢性膵炎とIPMNの経過観察中に発生した膵癌

    金子 真紀, 真口 宏介, 小山内 学, 高橋 邦幸, 潟沼 朗生, 矢根 圭, 金 俊文, 加藤 新, 高木 亮, 松本 和幸, 権 勉成, 松森 友昭

    消化器内科   55 ( 1 )   96 - 101   2012.7

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  • CPC記録 下部食道癌

    香川 健三, 松本 和幸, 豊川 達也, 宮谷 克也

    三豊総合病院雑誌   31   143 - 147   2010.12

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  • 自己免疫性肝炎と原発性硬化性胆管炎のoverlap症候群と考えられた一例

    三宅 康広, 松本 和幸, 山本 和秀

    臨牀と研究   86 ( 11 )   1537 - 1540   2009.11

  • 当院における食道癌化学放射線療法の検討

    松本 和幸, 豊川 達也, 高原 政宏, 今田 貴之, 八木 覚, 宮武 宏和, 中津 守人, 安東 正晴, 廣畑 衛

    香川県内科医会誌   45   36 - 40   2009.6

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    2000年1月から2007年12月までに当院にて治療をした食道癌患者44例を対象とし、化学放射線療法(chemoradiotherapy:CRT)を施行した26例(CRT群)ならびに手術療法を施行した18例(手術群)に層別化しretrospectiveに比較検討した。年齢は45歳から86歳で中央値69歳であった。患者背景として、年齢、腫瘍占拠部位、臨床病期、PSを比較した結果、手術群で臨床病期が早期であった(p<0.01)。CRT群の奏効率は73%であり、CRT群の生存期間は2年生存率38%、4年生存率25%であった。また、根治術可能な臨床病期0〜IIIまででCRT群と手術群の生存期間を比較した結果、2年生存率はCRT群で46%、手術群で53%であり、両群間の生存期間に差異は認めなかった。食道癌に対するCRTは手術療法と比較し遜色ない治療法であった。(著者抄録)

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  • 当院におけるGIST症例の検討

    河野 吉泰, 豊川 達也, 松本 和幸, 高原 政宏, 今田 貴之, 八木 覚, 宮武 宏和, 中津 守人, 安東 正晴, 廣畑 衛

    香川県内科医会誌   45   47 - 52   2009.6

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    Gastrointestinal stromal tumor(以下GIST)は全消化管切除腫瘍の0.5〜1.0%程度を占める稀な腫瘍である。今回我々は当院において病理組織学的にGISTと診断された19例を対象とし、その臨床的および病理学的特徴について検討した。発生部位は胃が14例と最多で、全体的に無症状で発見される例が多かった。手術標本の病理組織で診断されたものが13例と大部分を占めていた。腫瘍の大きさ・核分裂指数により評価した臨床的悪性度に基づきリスク分類を行った。転移・再発に関しては全て高リスク例であり、よく相関していた。予後に関しては、高リスク6例のうち死亡転帰は2例であり、リスク分類のみで予後を推測することは困難であった。予後不良因子として腹膜病変が示唆された。術前・術後化学療法の有効性や術後の適切な経過観察期間など、GISTに関して未だに臨床研究段階の項目は多く、今後さらなる症例数の集積が望まれる。(著者抄録)

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  • インジゴカルミン入りガストログラフィン注腸が診断に有用であったS状結腸膀胱瘻の1例

    高原 政宏, 豊川 達也, 小西 順, 安原 ひさ恵, 松本 和幸, 河合 大介, 加地 英輔, 三宅 康広, 中津 守人, 安東 正晴, 廣畑 衛, 水田 稔, 宮谷 克也

    三豊総合病院雑誌   29   68 - 72   2008.12

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    77歳男。全身倦怠感と発熱を主訴とした。血液検査で炎症反応の上昇、尿検査で膿尿を認め、CTで膀胱内にairと大腸に多発する憩室を認めた。結腸膀胱瘻による有熱性尿路感染を疑い、瘻孔を確認するために膀胱鏡、膀胱造影、大腸内視鏡検査、注腸造影を施行したが、瘻孔は確認できなかった。しかし、注腸検査時に工夫を凝らし、インジゴカルミンを混ぜたガストログラフィンを用いて検査を行ったところ、尿道バルーン内にインジゴカルミンの流出を認め、その直後行ったCTでも膀胱内にガストログラフィンの充満を認め、瘻孔の存在を確認できた。結腸膀胱瘻と診断し、左側結腸切除術および膀胱部分切除術を施行した。病理組織学的所見で膀胱が付着する部位は全層にかけてリンパ球、好中球、形質細胞の炎症細胞が浸潤し、瘻孔が形成されているものと考えられた。また、周囲に憩室を認めたことから、憩室が原因と推測した。

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  • CPC記録 腸閉塞

    松本 和幸, 宮谷 克也

    三豊総合病院雑誌   29   125 - 129   2008.12

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  • 高齢者における手術不能膵癌に対する抗腫瘍療法の検討

    松本 和幸, 豊川 達也, 安原 ひさ恵, 高原 政宏, 河合 大介, 加地 英輔, 三宅 康広, 中津 守人, 安東 正晴, 廣畑 衛

    三豊総合病院雑誌   28   3 - 7   2007.12

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    手術不能膵癌について、特に高齢者における抗腫瘍療法の有用性を検討した。対象は過去約1年間に切除不能と診断された膵癌68症例のうち、75歳以上の32例で、これらを抗腫瘍療法(ACT)が施行された17例(ACT群、平均年齢80.1歳)とACTを施行しなかった15例(BCS群、平均年齢83.0歳)に分け調べた。その結果、1)BCS群はACT群に比べて有意にECOGのPerformance Status(PS)が不良であった。2)全体での検討では、ACT群はBCS群よりも生存期間の延長が認められたが、75歳以上の比較ではACT群はBCS群よりも年齢が若く、PSが良好であり、長期生命予後が望めるにもかかわらず、生存期間の延長を認めなかった。3)有害事象の発現率は、75歳以上群と75歳未満群との間に差異は認められなかったが、詳細に検討すると、75歳以上群では抗腫瘍療法を開始した後に症状が強く発現し、急速に全身状態が不良となる症例を認めており、ACT群17例中4例は80日以内と早期に死亡していた。

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  • 術前診断が困難であった副脾の1例

    高原 政宏, 豊川 達也, 松本 和幸, 安原 ひさ恵, 堀元 直哉, 河合 大介, 加地 英輔, 三宅 康広, 中津 守人, 安東 正晴, 廣畑 衛, 宇高 徹総, 宮谷 克也

    三豊総合病院雑誌   28   58 - 64   2007.12

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    54歳女。患者は右下腹部痛を主訴とした。腹部造影CTでは膵尾部に単純相で膵臓と同程度の吸収値、動脈相で濃染され、平行相でやや膵よりも高い吸収値の腫瘤を認めた。造影MRIではCTで指摘された腫瘤はT1強調画像で低信号、T2強調画像でやや高信号、Gd造影で動脈性濃染を認めた。非機能性膵ラ氏島腫瘍と考え、膵尾部切除、脾臓摘出術、リンパ節生検を施行したところ、病理組織学的所見では腫瘤は線維性皮膜を有し、赤血球が充満した赤脾髄にリンパ球が集族した白脾髄がみられ、脾臓組織であった。また、リンパ節生検の免疫染色では濾胞性リンパ腫と判明、副脾内の白脾髄の腫大が目立つため免疫染色を行うと、副脾内にもリンパ腫が浸潤していた。以上、これらのことからも、本症例は膵内副脾と濾胞性リンパ腫と確定診断された。

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  • マムシ咬傷48例の検討 初診時の腫脹の程度は重症度を反映するか

    内藤 宏道, 松本 和幸, 長江 正晴, 笠井 慎也, 白石 建輔, 森本 直樹, 萩岡 信吾, 杉山 雅俊

    中毒研究   20 ( 1 )   31 - 35   2007.1

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    平成13年から平成17年までにマムシ咬傷で当院にて入院治療した48例につき検討を行った。マムシ咬傷の受傷場所は、田・畑21例、道10例、庭9例、その他8例であった。受傷時期は7月から9月が多かった。受傷部位は手指や足趾が多かった。初診時、24時間後での腫脹の程度の変化については、腫脹が最大となる日数は平均1.1日であり、24時間後の腫脹の程度は重症度の指標となったが、初診時の腫脹の程度では重症度の評価は困難であった。腫脹のgrade分類と血清CPK値の関係では、gradeが高くなるほど血清CPK値が上がる傾向にあったが、明らかな相関関係を示さなかった。血清CPK値が最大値となるまでは平均2.0日かかった。腫脹のgrade分類により、抗毒素の投与を決定するという報告もあるが、初診時の腫脹の程度や血清CPK値で重症度を評価することは困難であり、抗毒素投与を含めた治療方針の選択の指標とはならない。(著者抄録)

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  • 当院における出血性胃十二指腸潰瘍に対する内視鏡的止血術の検討

    河合 大介, 豊川 達也, 松本 和幸, 浅木 彰則, 加地 英輔, 大西 亨, 中津 守人, 安東 正晴, 洲脇 謹一郎, 廣畑 衛

    三豊総合病院雑誌   27   20 - 25   2006.12

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    2003年4月から2006年3月に内視鏡的止血術を要した出血性胃十二指腸潰瘍117例を対象に、内視鏡的止血治療の現状と問題点について検討を行った。症例の内訳は、出血性胃潰瘍80例(男性59例、女性21例)、出血性十二指腸潰瘍37例(男性29例、女性8例)で、全体の平均年齢は73.2歳、胃潰瘍では77.1歳、十二指腸潰瘍では64.8歳であった。出血様式は、Forrest分類のIIaが75例と最も多かった。87例にクリップ法が使用された。70例に局注法を行い、その内訳はHypertonic saline-epinephrineが59例、エタノールが22例で行い、凝固止血法は12例に行い、その内訳はヒータプローブ法が9例、Argon plasma coagulation法が3例であった。クリップ法と局注法は54例で併用された。追加止血術を要した出血部位は、胃角部が9例と多く、次いで十二指腸球部が5例、胃体部が3例、胃前庭部と十二指腸下行脚が各2例であった。追加止血を要した症例では、クリップ法と局注法を併用した例が9例が最も多かったが、初回の止血に難渋した症例ほど追加止血が必要になる症例の割合が多かった。また、追加止血における各止血法による止血率に有意差はなかった。

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  • 胃と瘻孔を形成した膵嚢胞性腫瘍の2例

    松本 和幸, 柘野 浩史, 永原 照也, 西田 知弘, 今川 敦, 藤本 剛, 田中 弘教, 平良 明彦, 三宅 正展, 高畠 弘行, 藤木 茂篤, 渡邉 剛正

    岡山済生会総合病院雑誌   38   111 - 111   2006.12

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  • 高齢者総胆管結石症例に対する内視鏡的胆道ステント留置術(EBD)

    柘野 浩史, 松本 和幸, 永原 照也, 西田 知弘, 藤本 剛, 今川 敦, 田中 弘教, 平良 明彦, 三宅 正展, 高畠 弘行, 藤木 茂篤

    岡山済生会総合病院雑誌   38   113 - 113   2006.12

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  • マムシ咬傷48例の検討

    松本 和幸, 内藤 宏道, 久保田 暢人, 谷本 光隆, 長江 正晴, 笠井 慎也, 萩岡 信吾, 白石 建輔, 森本 直樹

    中毒研究   19 ( 2 )   210 - 210   2006.4

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    Language:Japanese   Publisher:(株)へるす出版  

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Presentations

  • 今,再考するROSEの意義 EUS-FNA検体のゲノム医療における有用性と限界

    井上 博文, 松岡 博美, 實平 悦子, 松岡 昌志, 安村 早優美, 田中 健大, 寺澤 裕之, 松本 和幸, 加藤 博也, 平沢 晃

    日本臨床細胞学会雑誌  2023.5  (公社)日本臨床細胞学会

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    Event date: 2023.5

    Language:Japanese  

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  • 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  2023.4  (一社)日本消化器内視鏡学会

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    Event date: 2023.4

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  • Interventional EUSの現状と課題(胆膵) 膵神経内分泌腫瘍に対するEUSガイド下エタノール注入療法 外科治療成績との比較

    松本 和幸, 吉田 龍一, 加藤 博也

    Gastroenterological Endoscopy  2023.4  (一社)日本消化器内視鏡学会

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    Event date: 2023.4

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  • Innovative Therapeutic Endoscopy:良性胆管狭窄に対する内視鏡治療 難治性肝門部領域良性胆管狭窄に対する金属ステント留置の検討

    松本 和幸, 山崎 辰洋, 加藤 博也

    Gastroenterological Endoscopy  2023.4  (一社)日本消化器内視鏡学会

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    Event date: 2023.4

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  • 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  2023.4  (一社)日本消化器内視鏡学会

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    Event date: 2023.4

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  • 胆膵内視鏡の新技術(胆膵) 当院における胆膵疾患における膵胆管アブレーション治療の現状

    森本 光作, 松本 和幸, 加藤 博也

    Gastroenterological Endoscopy  2023.4  (一社)日本消化器内視鏡学会

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    Event date: 2023.4

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  • 胆管結石:治療困難例への対処(胆膵) 当院における胆管空腸吻合術後の肝内結石治療に関する因子の検討との治療の工夫

    松三 明宏, 松本 和幸, 加藤 博也

    Gastroenterological Endoscopy  2023.4  (一社)日本消化器内視鏡学会

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    Event date: 2023.4

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  • 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  2023.4  (一社)日本消化器内視鏡学会

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  • 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  2023.3  (一財)日本消化器病学会

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  • 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  2023.3  (一財)日本消化器病学会

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    Event date: 2023.3

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  • 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  2023.3  (一財)日本消化器病学会

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  • がんゲノム医療の現状と課題 中四国がんゲノム中核拠点病院における胆膵癌ゲノム医療の現状について

    堀口 繁, 松本 和幸, 加藤 博也

    日本消化器病学会雑誌  2023.3  (一財)日本消化器病学会

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  • 膵神経内分泌腫瘍診療の進歩 小病変かつ低悪性度の膵神経内分泌腫瘍に対するEUSガイド下エタノール注入療法の有用性

    松本 和幸, 堀口 繁, 加藤 博也

    日本消化器病学会雑誌  2023.3  (一財)日本消化器病学会

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  • 膵癌化学療法における血中自己抗体を用いた治療効果予測の可能性

    松本 和幸, 高木 章乃夫, 高原 政宏, 小幡 泰介, 藤井 佑樹, 山崎 辰洋, 内田 大輔, 堀口 繁, 堤 康一郎, 加藤 博也

    日本消化器病学会雑誌  2023.3  (一財)日本消化器病学会

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  • EUS-FNA検体のゲノム医療における有用性と限界

    井上博文, 松岡博美, 實平悦子, 松岡昌志, 安村早優美, 田中健大, 寺澤裕之, 松本和幸, 加藤博也, 平沢晃

    日本臨床細胞学会雑誌(Web)  2023 

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  • 医原性主膵管損傷に対してEUS-PDが有効であった一例

    大里 俊樹, 宮本 和也, 小幡 泰介, 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, 松本 和幸, 堀口 繁, 堤 康一郎, 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  2022.11  日本消化器病学会-中国支部

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    Event date: 2022.11

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  • 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  2022.11  日本消化器病学会-中国支部

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    Event date: 2022.11

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  • 生検検体を用いた胆道癌における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

    日本消化器病学会雑誌  2022.10  (一財)日本消化器病学会

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    Event date: 2022.10

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  • 人工知能を用いた膵癌におけるEUS-FNAの迅速細胞診診断

    藤井 佑樹, 山崎 辰洋, 松本 和幸, 堀口 繁, 堤 康一郎, 井上 博文, 谷本 太郁由, 加藤 博也, 河原 祥朗

    日本消化器病学会雑誌  2022.10  (一財)日本消化器病学会

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  • 胆道癌の新たな治療戦略(遺伝子パネル・分子標的・術前治療) 当院における肝内胆管癌のがんゲノム医療の現状について

    堀口 繁, 松本 和幸, 加藤 博也

    日本消化器病学会雑誌  2022.10  (一財)日本消化器病学会

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  • 術後再建腸管例における胆管結石治療-アプローチ法を含めた治療戦略 胆管空腸吻合術後の肝内結石に対する細径内視鏡を用いた直接胆道鏡の有用性

    松三 明宏, 松本 和幸, 加藤 博也

    Gastroenterological Endoscopy  2022.10  (一社)日本消化器内視鏡学会

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    Event date: 2022.10

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  • Interventional EUS:エビデンスと新たな展開 膵神経内分泌腫瘍に対するEUSガイド下エタノール注入療法

    松本 和幸, 山崎 辰洋, 加藤 博也

    Gastroenterological Endoscopy  2022.10  (一社)日本消化器内視鏡学会

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    Event date: 2022.10

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  • 膵神経内分泌腫瘍に対する超音波内視鏡下エタノール局注療法

    松本 和幸, 加藤 博也

    Gastroenterological Endoscopy  2022.9  (一社)日本消化器内視鏡学会

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    Event date: 2022.9

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  • 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  2022.9  (一社)日本胆道学会

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    Event date: 2022.9

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  • 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  2022.9  (一社)日本胆道学会

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  • 胆道ドレナージの現状と将来展望 3D画像解析システムによる肝臓体積測定に基づく至適胆道ドレナージ法(Current status and future perspective of biliary drainage Optimal Biliary Drainage based on Measuring Liver Volume Using 3D Image Analysis System)

    Morimoto Kosaku, Matsumoto Kazuyuki, Kato Hironari

    胆道  2022.9  (一社)日本胆道学会

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  • 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  2022.9  (一社)日本胆道学会

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  • 『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  2022.7  (NPO)日本高齢消化器病学会

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    Event date: 2022.7

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  • 中国地方におけるがん診療の最先端 当院における切除不能膵癌Conversion surgeryの臨床的特徴

    山崎 辰洋, 加藤 博也, 姫井 人美, 上田 英次郎, 森本 光作, 松三 明宏, 小川 泰司, 寺澤 裕之, 藤井 佑樹, 松本 和幸, 堤 康一郎, 岡田 裕之

    日本消化器病学会中国支部例会プログラム・抄録集  2022.6  日本消化器病学会-中国支部

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  • 急性膵炎を契機として発見された膵頭部mixed type SCNの1例

    佐藤 亮介, 松三 明宏, 上田 英次郎, 寺澤 裕之, 姫井 人美, 森本 光作, 小川 泰司, 藤井 佑樹, 山崎 辰洋, 松本 和幸, 堀口 繁, 堤 康一郎, 加藤 博也, 岡田 裕之

    日本消化器病学会中国支部例会プログラム・抄録集  2022.6  日本消化器病学会-中国支部

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  • 膵管内乳頭粘液性腫瘍由来癌との術前鑑別が困難であった限局型自己免疫性膵炎の一例

    菊池 達也, 藤井 佑樹, 松本 和幸, 松三 明宏, 森本 孝作, 寺澤 裕之, 山崎 辰洋, 堀口 繁, 堤 康一郎, 加藤 博也

    日本消化器病学会中国支部例会プログラム・抄録集  2022.6  日本消化器病学会-中国支部

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  • 膵癌術後肝転移再発による悪性肝門部胆管閉塞に対して超音波内視鏡下両葉肝内胆管ドレナージを行った1例

    佐藤 亮介, 藤井 佑樹, 松本 和幸, 松三 明宏, 森本 光作, 寺澤 裕之, 山崎 辰洋, 堀口 繁, 加藤 博也

    日本消化器内視鏡学会中国支部例会  2022.5  日本消化器内視鏡学会-中国支部

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  • 多発肝腫瘤を伴う胆嚢腫瘤に対してEndosheatherを用いERCP下胆嚢生検を行った1例

    森本 光作, 山崎 辰洋, 小幡 泰介, 織田 崇志, 上田 英次郎, 姫井 人美, 松三 明宏, 小川 泰司, 寺澤 裕之, 藤井 佑樹, 松本 和幸, 堀口 繁, 堤 康一郎, 加藤 博也, 岡田 裕之

    日本消化器内視鏡学会中国支部例会  2022.5  日本消化器内視鏡学会-中国支部

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  • 総胆管結石治療の現状と展望 胃切除後Roux-en-Y再建腸管症例に生じた総胆管結石に対するバルーン内視鏡下ERCPの成績と治療戦略

    小幡 泰介, 堤 康一郎, 松本 和幸, 加藤 博也, 岡田 裕之

    日本消化器内視鏡学会中国支部例会  2022.5  日本消化器内視鏡学会-中国支部

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    Event date: 2022.5

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  • 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  2022.4  (一社)日本消化器内視鏡学会

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    Event date: 2022.4

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  • EUS-FNA診療の新展開 嚢胞・壊死成分を伴う膵腫瘍に対するFNA/Bの偶発症についての検討

    寺澤 裕之, 松本 和幸, 加藤 博也

    Gastroenterological Endoscopy  2022.4  (一社)日本消化器内視鏡学会

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    Event date: 2022.4

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  • 胆膵領域における超音波内視鏡診断と治療 膵神経内分泌腫瘍に対するEUSガイド下エタノール注入療法

    加藤 博也, 松本 和幸, 岡田 裕之

    超音波医学  2022.4  (公社)日本超音波医学会

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    Event date: 2022.4

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  • 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  2022.4  (一社)日本消化器内視鏡学会

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    Event date: 2022.4

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  • 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  2022.4  (一社)日本消化器内視鏡学会

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    Event date: 2022.4

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  • EUS-HGS法におけるダブルガイドワイヤー法の有用性の検討

    上田 英次郎, 藤井 佑樹, 加藤 博也, 姫井 人美, 松三 明宏, 森本 光作, 小川 泰司, 寺澤 裕之, 山崎 辰洋, 松本 和幸, 堀口 繁

    Gastroenterological Endoscopy  2022.4  (一社)日本消化器内視鏡学会

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    Event date: 2022.4

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  • Worrisome featureとHigh-risk stigmataのない分枝型IPMNの長期成績の検討

    山崎 辰洋, 加藤 博也, 岡田 裕之, 姫井 人美, 上田 英次郎, 森本 光作, 松三 明宏, 小川 泰司, 寺澤 裕之, 藤井 佑樹, 松本 和幸, 堀口 繁, 堤 康一郎

    日本消化器病学会雑誌  2022.3  (一財)日本消化器病学会

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    Event date: 2022.3

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  • 胆管結石発症に関する腸内細菌叢の解析

    松本 和幸, 高木 章乃夫, 岡田 裕之

    日本消化器病学会雑誌  2022.3  (一財)日本消化器病学会

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    Event date: 2022.3

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  • 悪性胆道狭窄の病態解明と治療戦略 悪性肝門部胆道閉塞に対する金属ステントによる内視鏡的両葉ドレナージ後のreinterventionの治療成績:多施設共同後向き研究

    森本 光作, 松本 和幸, 岡田 裕之

    日本消化器病学会雑誌  2022.3  (一財)日本消化器病学会

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  • 悪性肝門部胆道閉塞に対する金属ステントによる内視鏡的両葉ドレナージ後のreinterventionの治療成績:多施設共同後向き研究

    森本光作, 松本和幸, 岡田裕之

    日本消化器病学会雑誌(Web)  2022 

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  • 抜去困難であった胆道金属ステントによるcomplex biliary stonesの1例

    松三 明宏, 松本 和幸, 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, 加藤 博也, 岡田 裕之

    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  2021.11  日本消化器病学会-中国支部

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  • 肝門部領域胆管内腫瘍の一例

    小川 泰司, 加藤 博也, 森本 光作, 上田 英次郎, 松三 明宏, 姫井 人美, 寺澤 裕之, 藤井 祐樹, 山崎 辰洋, 松本 和幸, 堀口 繁, 堤 康一郎, 岡田 裕之

    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  2021.11  日本消化器病学会-中国支部

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  • 胆嚢良性リンパ性ポリープと胆管lymphoid hyperplasiaが併存した一例

    松原 弘樹, 宮本 和也, 松本 和幸, 神尾 智宏, 原田 圭, 木村 彰吾, 平田 翔一郎, 石田 正也, 岡本 雄貴, 熊原 加奈, 榮 浩行, 高原 政宏, 竹中 龍太, 藤木 茂篤

    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  2021.11  日本消化器病学会-中国支部

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  • SpyGlass DSを用いた経口胆道鏡により処置具の迷入に対してトラブルシューティングを行えた2例

    森本 光作, 藤井 佑樹, 小幡 泰介, 織田 崇志, 上田 英次郎, 姫井 人美, 松三 明宏, 小川 泰司, 寺澤 裕之, 山崎 辰洋, 松本 和幸, 堀口 繁, 堤 康一郎, 加藤 博也, 岡田 裕之

    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  2021.11  日本消化器病学会-中国支部

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  • 多彩な転移病巣に対して集学的治療を行い長期生存が得られた直腸神経内分泌腫瘍の1例

    姫井 人美, 堀口 繁, 上田 英次郎, 松三 明宏, 森本 光作, 小川 泰司, 寺澤 裕之, 藤井 佑樹, 山崎 辰洋, 松本 和幸, 堤 康一郎, 加藤 博也, 岡田 裕之

    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  2021.11  日本消化器病学会-中国支部

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  • EUS-FNBによる良質なゲノム検体作成のための工夫

    松本 和幸, 加藤 博也, 岡田 裕之

    Gastroenterological Endoscopy  2021.10  (一社)日本消化器内視鏡学会

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  • 胆膵内視鏡診療における新技術 インスリノーマに対するEUSガイド下エタノール注入療法

    松本 和幸, 加藤 博也, 岡田 裕之

    Gastroenterological Endoscopy  2021.10  (一社)日本消化器内視鏡学会

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  • 当院における胆膵内視鏡診療の放射線量の現状

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

    Gastroenterological Endoscopy  2021.10  (一社)日本消化器内視鏡学会

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  • EUSガイド下エタノール焼灼術で寛解したインスリノーマの1例

    小松原 基志, 稲垣 兼一, 松本 和幸, 加藤 博也, 生口 俊浩, 藤澤 諭, 西山 悠紀, 寺坂 友博, 森本 栄作, 原 孝行, 越智 可奈子, 和田 淳

    日本内分泌学会雑誌  2021.10  (一社)日本内分泌学会

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

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

    膵臓  2021.8  (一社)日本膵臓学会

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    Event date: 2021.8

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

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

    膵臓  2021.8  (一社)日本膵臓学会

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

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

    膵臓  2021.8  (一社)日本膵臓学会

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  • 膵疾患に対するEUS診療の現況と新たな展開 膵神経内分泌腫瘍に対するEUSガイド下エタノール注入療法

    松本 和幸, 加藤 博也, 岡田 裕之

    Gastroenterological Endoscopy  2021.4  (一社)日本消化器内視鏡学会

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    Event date: 2021.4

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  • 胆嚢癌診療における血清中エクソソーム内miRNAの有用性

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

    日本消化器病学会雑誌  2021.3  (一財)日本消化器病学会

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    Event date: 2021.3

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  • 通常型膵癌との鑑別が困難であった膵神経内分泌腫瘍の一例

    山崎 辰洋, 加藤 博也, 姫井 人美, 上田 英次郎, 小川 泰司, 河原 聡一郎, 寺澤 裕之, 藤井 佑樹, 友田 健, 松本 和幸, 堀口 繁, 堤 康一朗, 岡田 裕之

    日本消化器病学会中国支部例会プログラム・抄録集  2020.11  日本消化器病学会-中国支部

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  • 潰瘍性大腸炎に合併した2型自己免疫性膵炎準確診の1例

    藤井 佑樹, 加藤 博也, 姫井 人美, 小川 泰司, 河原 聡一郎, 寺澤 裕之, 山崎 辰洋, 友田 健, 松本 和幸, 堀口 繁, 岡田 裕之

    日本消化器病学会中国支部例会プログラム・抄録集  2020.11  日本消化器病学会-中国支部

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  • PTBDによる胸腔内胆汁漏に対してENBDが治療に有効であった1例

    姫井 人美, 松本 和幸, 加藤 博也, 小川 泰司, 河原 聡一郎, 寺澤 裕之, 藤井 佑樹, 山崎 辰洋, 友田 健, 堤 康一郎, 堀口 繁, 岡田 裕之

    日本消化器病学会中国支部例会プログラム・抄録集  2020.11  日本消化器病学会-中国支部

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  • 悪性遠位胆管閉塞に対するself expandable metallic stentを用いた胆管ドレナージの治療成績の検討

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

    日本消化器病学会雑誌  2020.10  (一財)日本消化器病学会

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  • EUS-HGSにおけるダブルガイドワイヤー法の有用性

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

    Gastroenterological Endoscopy  2020.10  (一社)日本消化器内視鏡学会

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  • 動画で見せる達人の技:内視鏡治療関連 術後再建腸管症例に対する細径内視鏡を利用した手技の工夫

    松本 和幸, 加藤 博也, 岡田 裕之

    Gastroenterological Endoscopy  2020.10  (一社)日本消化器内視鏡学会

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  • 急性膵炎後Pancreatic fluid collectionに対する内視鏡治療の現状

    山崎 辰洋, 加藤 博也, 宮本 和也, 松三 明宏, 上田 英次郎, 藤井 佑樹, 皿谷 洋祐, 内田 大輔, 友田 健, 松本 和幸, 岡田 裕之

    Gastroenterological Endoscopy  2020.10  (一社)日本消化器内視鏡学会

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  • 膵切除後膵液漏に対する内視鏡的膵管ドレナージ術の検討

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

    Gastroenterological Endoscopy  2020.10  (一社)日本消化器内視鏡学会

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  • 悪性胆道狭窄に対するMetallic stent留置に伴う胆嚢炎の検討

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

    Gastroenterological Endoscopy  2020.10  (一社)日本消化器内視鏡学会

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  • 消化管狭窄に対する内視鏡診療 進行膵癌に伴う胆管・十二指腸閉塞に対する内視鏡的ダブルステンティング後の化学療法の安全性と有効性

    松本 和幸, 加藤 博也, 岡田 裕之

    Gastroenterological Endoscopy  2020.8  (一社)日本消化器内視鏡学会

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  • ERCP後膵炎発症の予測に適した腹痛スコアの検討

    目春 彩奈, 中田 牧人, 松本 和幸

    胆道  2020.8  日本胆道学会

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  • 胆道癌病理診断のピットホール-臨床と病理の立場から- 術前診断困難であったIgG4-SCの1例

    松本 和幸, 加藤 博也, 岡田 裕之

    胆道  2020.8  日本胆道学会

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  • EUS画像に基づいたIPMN組織亜型予測診断

    藤井 佑樹, 松本 和幸, 加藤 博也, 上田 英次郎, 宮本 和也, 松三 明宏, 皿谷 洋祐, 山崎 辰洋, 内田 大輔, 友田 健, 堀口 繁, 堤 康一郎, 八木 孝仁, 花田 敬士, 岡田 裕之

    膵臓  2020.7  (一社)日本膵臓学会

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  • 膵神経内分泌腫瘍に対するEUSガイド下エタノール焼灼療法

    松本 和幸, 加藤 博也, 岡田 裕之

    日本消化器病学会雑誌  2020.7  (一財)日本消化器病学会

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    Event date: 2020.7

    Language:Japanese  

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  • EUSガイド下エタノール注入療法を施行したインスリノーマの1例

    松本 和幸, 加藤 博也, 稲垣 兼一, 宮本 和也, 山崎 辰洋, 藤井 祐樹, 内田 大輔, 友田 健, 堀口 繁, 岡田 裕之

    膵臓  2020.7  (一社)日本膵臓学会

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  • IPMN国際診療ガイドライン2017の検証 分枝型IPMN経過観察症例におけるHRS出現のリスク因子

    山崎 辰洋, 友田 健, 加藤 博也, 宮本 和也, 松三 明宏, 皿谷 洋祐, 内田 大輔, 松本 和幸, 堀口 繁, 堤 康一朗, 岡田 裕之

    膵臓  2020.7  (一社)日本膵臓学会

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  • 超音波内視鏡を用いた膵疾患の診断と治療 膵神経内分泌腫瘍に対するEUSガイド下計画的エタノール注入療法

    松本 和幸, 加藤 博也, 岡田 裕之

    膵臓  2020.7  (一社)日本膵臓学会

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  • 中国地方の消化器内視鏡学のState of the art 術後再建腸管例に対する経空腸的EUS-FNAの検討

    山崎 辰洋, 友田 健, 宮本 和也, 松三 明宏, 藤井 佑樹, 皿谷 洋祐, 内田 大輔, 松本 和幸, 堀口 繁, 堤 康一朗, 加藤 博也, 岡田 裕之

    日本消化器内視鏡学会中国支部例会  2020.6  日本消化器内視鏡学会-中国支部

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  • 胆管内で断裂したガイドワイヤーに対してSpy Glass DSを用いて回収可能であった一例

    河原 聡一郎, 友田 健, 宮本 和也, 松三 明宏, 藤井 佑樹, 山崎 辰洋, 皿谷 洋祐, 内田 大輔, 松本 和幸, 堀口 繁, 加藤 博也, 岡田 裕之

    日本消化器内視鏡学会中国支部例会  2020.6  日本消化器内視鏡学会-中国支部

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  • 超音波内視鏡検査時の十二指腸穿孔に対しOver-The-Scope Clip(OTSC)Systemによる創閉鎖が有効であった1例

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

    日本消化器内視鏡学会中国支部例会  2020.6  日本消化器内視鏡学会-中国支部

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  • 増大傾向を認める脾原発炎症性偽腫瘍の1例

    姫井 人美, 友田 健, 宮本 和也, 松三 明宏, 皿谷 洋祐, 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, 岡田 裕之

    日本消化器病学会中国支部例会プログラム・抄録集  2020.5  日本消化器病学会-中国支部

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  • 再発性急性膵炎を契機に診断された主膵管型IPMNの1例

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

    日本消化器病学会中国支部例会プログラム・抄録集  2019.11  日本消化器病学会-中国支部

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  • 消化器癌治療の最前線 当院における胃十二指腸悪性狭窄に対する十二指腸ステント留置術の検討

    堀口 繁, 加藤 博也, 友田 健, 松本 和幸, 岡田 裕之

    日本消化器病学会中国支部例会プログラム・抄録集  2019.11  日本消化器病学会-中国支部

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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  2019.11  (一財)日本消化器病学会

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  • 胃全摘後の再建腸管を有する十二指腸乳頭部腺腫に対してUnderwater endoscopic papillectomyを施行した1例

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

    日本消化器病学会中国支部例会プログラム・抄録集  2019.11  日本消化器病学会-中国支部

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  • 胆嚢炎を契機に診断された好酸球性胆管炎の1例

    河本 翔一, 河合 大介, 矢杉 賢吾, 山本 高史, 平田 翔一郎, 小幡 泰介, 倉岡 紗樹子, 平井 伸典, 下村 泰之, 柘野 浩史, 竹中 龍太, 藤木 茂篤, 三宅 孝佳, 松本 和幸

    日本消化器病学会中国支部例会プログラム・抄録集  2019.11  日本消化器病学会-中国支部

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  • Side-by-side(SBS)法による胆道ドレナージ後に仮性動脈瘤を形成した一例

    平田 翔一郎, 室 信一郎, 松本 和幸, 矢杉 賢吾, 山本 高史, 小幡 泰介, 倉岡 紗樹子, 平井 伸典, 後藤田 達洋, 下村 泰之, 河合 大介, 竹中 龍太, 柘野 浩史, 川端 隆寛, 藤木 茂篤

    日本消化器病学会中国支部例会プログラム・抄録集  2019.11  日本消化器病学会-中国支部

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  • 内視鏡的乳頭切除術後膵管狭窄に対してEUSランデブー法を用いて膵管ステント留置を行った一例

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

    日本消化器病学会中国支部例会プログラム・抄録集  2019.11  日本消化器病学会-中国支部

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  • 当院における胆道病変に対するEUS-FNAの現状

    皿谷 洋祐, 松本 和幸, 加藤 博也, 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  2019.10  日本胆道学会

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  • 膵EUS-FNAの精度向上を目指して 胆膵領域の実地臨床におけるEUS-FNAの現状と問題点 ゲノム医療時代を迎えて

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

    日本臨床細胞学会雑誌  2019.10  (公社)日本臨床細胞学会

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  • 胆道再建術後のバルーン内視鏡による肝内結石除去術の治療成績と再発因子の検討

    松本 和幸, 加藤 博也, 岡田 裕之

    Gastroenterological Endoscopy  2019.10  (一社)日本消化器内視鏡学会

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  • DPC公開データからみる日本の胆管結石、胆管炎診療の現状 内科的治療を行った症例での検討

    山崎 辰洋, 加藤 博也, 松三 明宏, 石原 裕基, 皿谷 洋祐, 室 信一郎, 内田 大輔, 友田 健, 松本 和幸, 堀口 繁, 岡田 裕之

    胆道  2019.10  日本胆道学会

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  • 膵頭部領域疾患の術前における閉塞性黄疸の至適マネージメント プラスティックステントによる膵頭部領域癌の術前胆管ドレナージの検討

    高田 斎文, 加藤 博也, 岡田 裕之, 石原 祐基, 松三 明宏, 皿谷 洋祐, 室 信一郎, 内田 大輔, 友田 健, 松本 和幸, 堀口 繁

    膵臓  2019.6  (一社)日本膵臓学会

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  • 切除不能局所進行膵癌:化学療法と化学放射線療法 当院における局所進行膵癌患者に対する化学放射線療法と化学療法の治療成績の検討

    皿谷 洋祐, 堀口 繁, 加藤 博也, 松三 明宏, 石原 裕基, 高田 斎文, 室 信一郎, 内田 大輔, 友田 健, 松本 和幸, 岡田 裕之

    膵臓  2019.6  (一社)日本膵臓学会

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  • 悪性十二指腸・胆管閉塞に対する内視鏡的ダブルステンティング後のステントマネージメント

    松本 和幸, 加藤 博也, 岡田 裕之

    Gastroenterological Endoscopy  2019.5  (一社)日本消化器内視鏡学会

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  • 術後胆管空腸吻合部良性狭窄に対するバルーン拡張単独治療の成績及び再狭窄関連因子に関する検討

    松三 明宏, 友田 健, 岡田 裕之, 加藤 博也, 石原 裕基, 皿谷 洋祐, 矢部 俊太郎, 高田 斎文, 室 信一郎, 内田 大輔, 松本 和幸, 堀口 繁

    Gastroenterological Endoscopy  2019.5  (一社)日本消化器内視鏡学会

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  • 肝胆膵癌治療のup-to-date 当院における切除不能膵癌に対するFOLFIRINOX、GEM+nab-PTX併用についての検討

    皿谷 洋祐, 堀口 繁, 加藤 博也, 松三 明宏, 石原 裕基, 高田 斎文, 室 信一郎, 内田 大輔, 友田 健, 松本 和幸, 岡田 裕之

    日本消化器病学会中国支部例会プログラム・抄録集  2019.5  日本消化器病学会-中国支部

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  • 標準治療無効後に膵癌薬物療法を行い、抗腫瘍効果を示した切除不能p-NET(G2)の1例

    山崎 辰洋, 室 信一郎, 加藤 博也, 松三 明宏, 石原 裕基, 皿谷 洋祐, 高田 斎文, 内田 大輔, 友田 健, 松本 和幸, 堀口 繁, 岡田 裕之

    日本消化器病学会中国支部例会プログラム・抄録集  2019.5  日本消化器病学会-中国支部

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  • 十二指腸乳頭部腫瘍の内視鏡切除術の現況と非完全切除例の取り扱いに関する検討

    室 信一郎, 加藤 博也, 岡田 裕之, 松三 明宏, 石原 裕基, 皿谷 洋祐, 矢部 俊太郎, 高田 斎文, 内田 大輔, 友田 健, 松本 和幸, 堀口 繁

    Gastroenterological Endoscopy  2019.5  (一社)日本消化器内視鏡学会

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  • THE RELATIONSHIP BETWEEN THE PD-L1 EXPRESSION OF SURGICAL RESECTED AND FINE-NEEDLE ASPIRATION SPECIMENS FOR PATIENTS WITH PANCREATIC CANCER

    Matsumoto Kazuyuki, Ohara Toshiaki, Fujisawa Masayoshi, Takaki Akinobu, Takahara Masahiro, Kato Hironari, Horiguchi Shigeru, Matsukawa Akihiro, Okada Hiroyuki

    GASTROENTEROLOGY  2019.5 

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  • 当科における膵癌と血栓症についての検討

    堀口 繁, 加藤 博也, 友田 健, 松本 和幸, 内田 大輔, 室 信一郎, 高田 斎文, 皿谷 洋祐, 岡田 裕之

    日本内科学会雑誌  2019.2  (一社)日本内科学会

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  • IPMN診断における膵液細胞診 Liquid based cytologyの有用性ついての検討

    宮本 和也, 松本 和幸, 加藤 博也, 松三 明宏, 石原 裕基, 皿谷 洋祐, 矢部 俊太郎, 室 信一郎, 高田 斎文, 内田 大輔, 友田 健, 堀口 繁, 岡田 裕之

    日本消化器病学会中国支部例会プログラム・抄録集  2018.12  日本消化器病学会-中国支部

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  • 肝門部悪性胆道狭窄に対してEUS下両葉ドレナージが有用であった1例

    内田 大輔, 加藤 博也, 松三 昭宏, 石原 裕基, 皿谷 洋祐, 高田 斎文, 室 信一郎, 友田 健, 松本 和幸, 堀口 繁, 岡田 裕之

    日本消化器病学会中国支部例会プログラム・抄録集  2018.12  日本消化器病学会-中国支部

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  • 近位空腸の異所性膵から発生した膵腺房細胞癌の1例

    石原 裕基, 内田 大輔, 加藤 博也, 松三 明宏, 皿谷 洋祐, 矢部 俊太郎, 高田 斎文, 室 信一郎, 友田 健, 松本 和幸, 堀口 繁, 岡田 裕之

    日本消化器病学会中国支部例会プログラム・抄録集  2018.12  日本消化器病学会-中国支部

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  • 地域基幹病院における超音波内視鏡下胆管胃吻合術(EUS-HGS)の治療成績

    矢杉 賢吾, 竹中 龍太, 松本 和幸, 石黒 美佳子, 神尾 知宏, 小幡 泰介, 竹井 健介, 倉岡 紗樹子, 平井 伸典, 三浦 公, 河合 大介, 竹本 浩二, 柘野 浩史, 藤木 茂篤

    日本消化器病学会中国支部例会プログラム・抄録集  2018.12  日本消化器病学会-中国支部

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  • IgG4陰性自己免疫性膵炎の臨床的特徴と長期予後についての検討

    室 信一郎, 堀口 繁, 加藤 博也, 皿谷 洋祐, 高田 斎文, 水川 翔, 内田 大輔, 友田 健, 松本 和幸, 植木 亨, 岡田 裕之

    日本消化器病学会雑誌  2018.10  (一財)日本消化器病学会

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  • 当院における出血ハイリスク総胆管結石症例に対する内視鏡治療

    皿谷 洋祐, 加藤 博也, 水川 翔, 高田 斎文, 室 信一郎, 内田 大輔, 友田 健, 松本 和幸, 堀口 繁, 岡田 裕之

    Gastroenterological Endoscopy  2018.10  (一社)日本消化器内視鏡学会

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  • 膵癌術後再発診断におけるEUS-FNA洗浄液を用いたK-RAS変異測定の有用性

    松本 和幸, 能祖 一裕, 加藤 博也, 赤穂 宗一郎, 岡田 裕之

    日本消化器病学会雑誌  2018.10  (一財)日本消化器病学会

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  • 当院における肝内胆管癌術後化学療法の検討

    高田 斎文, 堀口 繁, 岡田 裕之, 皿谷 洋祐, 水川 翔, 室 信一郎, 内田 大輔, 松本 和幸, 加藤 博也, 楳田 祐三, 八木 孝仁

    日本消化器病学会雑誌  2018.10  (一財)日本消化器病学会

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  • 当院における膵NET治療の現状

    松本 和幸, 堀口 繁, 岡田 裕之

    日本消化器病学会雑誌  2018.10  (一財)日本消化器病学会

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  • 肝内結石症の診断と治療up to date 肝内結石除去後の遺残結石に対する細径内視鏡を用いた経口直接胆道鏡の有用性

    室 信一郎, 松本 和幸, 岡田 裕之

    胆道  2018.8  日本胆道学会

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  • 膵癌術後再発に対するEUS-FNAの有用性 洗浄液を用いた遺伝子変異解析も含めて

    松本 和幸, 加藤 博也, 赤穂 宗一郎, 吉田 龍一, 楳田 祐三, 信岡 大輔, 皿谷 洋祐, 高田 斎文, 室 信一郎, 内田 大輔, 友田 健, 堀口 繁, 能祖 一裕, 八木 孝仁, 岡田 裕之

    膵臓  2018.5  (一社)日本膵臓学会

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  • 膵NET術後再発予測におけるダイナミックCTの有用性についての検討

    堀口 繁, 加藤 博也, 松本 和幸, 友田 健, 内田 大輔, 室 信一郎, 水川 翔, 高田 斎文, 皿谷 洋祐, 田中 顕之, 八木 孝仁, 岡田 裕之

    膵臓  2018.5  (一社)日本膵臓学会

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  • 当院における慢性膵炎に対する内視鏡治療戦略

    皿谷 洋祐, 内田 大輔, 水川 翔, 高田 斎文, 室 信一郎, 友田 健, 松本 和幸, 堀口 繁, 加藤 博也, 岡田 裕之

    Gastroenterological Endoscopy  2018.4  (一社)日本消化器内視鏡学会

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  • 胆道再建術後の肝内結石に対するダブルバルーン内視鏡下ERCPの治療成績

    石原 裕基, 松本 和幸, 岡田 裕之

    Gastroenterological Endoscopy  2018.4  (一社)日本消化器内視鏡学会

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  • Swing Tipを用いたERCPトラブルシューティング

    内田 大輔, 加藤 博也, 皿谷 洋祐, 高田 斎文, 水川 翔, 室 信一郎, 友田 健, 松本 和幸, 堀口 繁, 岡田 裕之

    Gastroenterological Endoscopy  2018.4  (一社)日本消化器内視鏡学会

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  • IPMN診療における内視鏡の役割 TIC解析を用いた造影EUSによるIPMN良悪性診断

    高田 斎文, 松本 和幸, 岡田 裕之

    Gastroenterological Endoscopy  2018.4  (一社)日本消化器内視鏡学会

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  • 当院における超音波内視鏡下嚢胞ドレナージ術の現状

    内田 大輔, 加藤 博也, 皿谷 洋祐, 高田 斎文, 水川 翔, 室 信一郎, 友田 健, 松本 和幸, 堀口 繁, 岡田 裕之

    Gastroenterological Endoscopy  2018.4  (一社)日本消化器内視鏡学会

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  • 胆管結石除去後の遺残結石に対する細径内視鏡を用いた経口直接胆道鏡の有用性

    松本 和幸, 加藤 博也, 岡田 裕之

    Gastroenterological Endoscopy  2018.4  (一社)日本消化器内視鏡学会

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  • 切除不能膵癌に対するFOLFIRINOX/GEM+nabPTX投与の後治療についての検討

    水川 翔, 堀口 繁, 加藤 博也, 皿谷 洋祐, 高田 斎文, 室 信一郎, 内田 大輔, 松本 和幸, 友田 健, 岡田 裕之

    日本消化器病学会雑誌  2018.3  (一財)日本消化器病学会

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  • 超音波内視鏡ガイド下治療の現状と問題点 膵神経内分泌腫瘍に対するEUSガイド下エタノール焼灼療法

    松本 和幸, 加藤 博也, 岡田 裕之

    日本消化器病学会雑誌  2018.3  (一財)日本消化器病学会

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  • 急性膵炎後fluid collectionに対する超音波内視鏡下嚢胞ドレナージの治療成績

    松三 明宏, 松本 和幸, 加藤 博也, 内田 大輔, 室 信一郎, 友田 健, 堀口 繁, 岡田 裕之

    日本内科学会雑誌  2018.2  (一社)日本内科学会

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  • 胆管空腸吻合術後の肝内結石に対するDBE-ERCの治療成績と遺残結石確認のための工夫

    松本 和幸, 加藤 博也, 岡田 裕之

    Gastroenterological Endoscopy  2017.9  (一社)日本消化器内視鏡学会

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  • 分枝型IPMNの手術適応について 国際診療ガイドラインの見直しも含めて

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

    Gastroenterological Endoscopy  2017.9  (一社)日本消化器内視鏡学会

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  • 胆道再建術後の肝内結石に対するDBE-ERCの治療成績と結石再発因子の検討

    松本 和幸, 加藤 博也, 岡田 裕之

    胆道  2017.8  日本胆道学会

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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  2017.8  (一社)日本消化器内視鏡学会

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

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    Other Link: https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2017&ichushi_jid=J00192&link_issn=&doc_id=20170912190007&doc_link_id=10.11280%2Fgee.59.1644&url=https%3A%2F%2Fdoi.org%2F10.11280%2Fgee.59.1644&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_2.gif

  • 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

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

    Gastroenterological Endoscopy  2017.7  (一社)日本消化器内視鏡学会

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

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    Other Link: https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2017&ichushi_jid=J00192&link_issn=&doc_id=20170727260008&doc_link_id=10.11280%2Fgee.59.1524&url=https%3A%2F%2Fdoi.org%2F10.11280%2Fgee.59.1524&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_2.gif

  • 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  2017.7  LIPPINCOTT WILLIAMS & WILKINS

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  • 超音波内視鏡を用いた膵疾患診療 基本から応用まで 閉塞性膵炎に対するEUS下膵管ドレナージの有用性に関する検討

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

    膵臓  2017.5  (一社)日本膵臓学会

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  • 膵神経内分泌腫瘍における液状化検体細胞診(LBC)を用いた免疫染色の有用性の検討

    秋元 悠, 加藤 博也, 田中 顕之, 井上 博文, 皿谷 洋祐, 高田 斎文, 水川 翔, 室 信一郎, 内田 大輔, 友田 健, 松本 和幸, 堀口 繁, 堤 康一郎, 岡田 裕之

    膵臓  2017.5  (一社)日本膵臓学会

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  • 膵NETの診療ガイドラインの問題点と今後の展望 PNET術後再発予測因子に関する検討

    堀口 繁, 加藤 博也, 水川 翔, 室 信一郎, 内田 大輔, 友田 健, 松本 和幸, 田中 顕之, 八木 孝仁, 岡田 裕之

    膵臓  2017.5  (一社)日本膵臓学会

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  • 急性膵炎の後期合併症に対する手術・インターベンション治療の現状と課題 急性膵炎後fluid collectionに対する超音波内視鏡下嚢胞ドレナージ術の現状

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

    膵臓  2017.5  (一社)日本膵臓学会

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  • 緩和医療における内視鏡の役割 緩和医療における内視鏡的ダブルステンティングの有用性

    松本 和幸, 加藤 博也, 岡田 裕之

    Gastroenterological Endoscopy  2017.4  (一社)日本消化器内視鏡学会

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  • 経乳頭的に留置した胆管・膵管ステントの迷入症例の検討

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

    Gastroenterological Endoscopy  2017.4  (一社)日本消化器内視鏡学会

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  • 治療に難渋する胆管結石の治療ストラテジー DBE-ERCによる胆管空腸吻合術後の肝内結石治療の有用性と工夫

    松本 和幸, 岡田 裕之

    Gastroenterological Endoscopy  2017.4  (一社)日本消化器内視鏡学会

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  • 当院におけるEUS下胆道ドレナージの現状

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

    Gastroenterological Endoscopy  2017.4  (一社)日本消化器内視鏡学会

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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  2017.4  W B SAUNDERS CO-ELSEVIER INC

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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  2017.4  W B SAUNDERS CO-ELSEVIER INC

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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  2016.11  医学図書出版(株)

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

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  • 膵癌との鑑別を要した膵内副脾の一例

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

    超音波医学  2016.11  (公社)日本超音波医学会

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  • ERCP関連処置合併症に対するcovered self-expandable metallic stentの有用性

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

    Gastroenterological Endoscopy  2016.10  (一社)日本消化器内視鏡学会

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  • 切除不能悪性胆道閉塞に対するEUS-guided biliary drainage(EUS-BD)の現状

    松本 和幸, 加藤 博也, 岡田 裕之

    Gastroenterological Endoscopy  2016.10  (一社)日本消化器内視鏡学会

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  • 術後胆汁漏に対する内視鏡的胆管ドレナージ術の有用性の検討

    矢部 俊太郎, 加藤 博也, 水川 翔, 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

    Gastroenterological Endoscopy  2016.10  (一社)日本消化器内視鏡学会

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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  2016.10  (株)東京医学社

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

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  • PNETの診断治療に関する検討

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

    日本消化器病学会雑誌  2016.9  (一財)日本消化器病学会

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  • 胆道疾患に対する超音波内視鏡の有用性 胆道病変に対するEUS-FNAの有用性

    松本 和幸, 加藤 博也, 岡田 裕之

    胆道  2016.8  日本胆道学会

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  • 化学療法を施行した胆嚢NECの3例

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

    胆道  2016.8  日本胆道学会

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  • 術後再建腸管を有する膵胆道疾患に対する新たなダブルバルーン内視鏡(EI-580BT)の有用性に関する検討

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

    胆道  2016.8  日本胆道学会

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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  2016.5  日本胆道学会

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    Language:Japanese  

    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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    Other Link: https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2016&ichushi_jid=J02149&link_issn=&doc_id=20160620040016&doc_link_id=%2Fdw1tando%2F2016%2F003002%2F016%2F0290-0297%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fdw1tando%2F2016%2F003002%2F016%2F0290-0297%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

  • 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  2016.5  MOSBY-ELSEVIER

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  • 消化管狭窄に対するステント治療の課題と将来展望 進行膵癌に伴う十二指腸・胆管閉塞に対する内視鏡的ダブルステンティングの治療成績

    松本 和幸, 加藤 博也, 岡田 裕之

    Gastroenterological Endoscopy  2016.4  (一社)日本消化器内視鏡学会

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  • 膵胆管病変における内視鏡の役割 胆管結石截石後の遺残結石に対する細径内視鏡を用いた経口直接胆道鏡の有用性

    松本 和幸, 加藤 博也, 岡田 裕之

    Gastroenterological Endoscopy  2016.4  (一社)日本消化器内視鏡学会

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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  2016.4  W B SAUNDERS CO-ELSEVIER INC

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

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

    JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY  2015.12  WILEY-BLACKWELL

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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  2015.11  OXFORD UNIV PRESS

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  • 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

    友田 健, 加藤 博也, 内田 大輔, 秋元 悠, 松本 和幸, 山本 直樹, 堀口 繁, 堤 康一郎, 高木 章乃夫, 岡田 裕之, 八木 孝仁

    移植  2015.10  (一社)日本移植学会

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  • Walled-off necrosisに対するstep-up approachによる内視鏡的治療成績

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

    Gastroenterological Endoscopy  2015.9  (一社)日本消化器内視鏡学会

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  • 当院におけるmodified FOLFIRINOXの治療成績についての検討

    堀口 繁, 加藤 博也, 水川 翔, 矢部 俊太郎, 關 博之, 秋元 悠, 内田 大輔, 友田 健, 松本 和幸, 山本 直樹, 堤 康一郎, 那須 淳一郎, 岡田 裕之, 山本 和秀

    日本消化器病学会雑誌  2015.9  (一財)日本消化器病学会

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  • デバイス突破を目的としたSoehendra stent retrieverを用いた拡張術

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

    Gastroenterological Endoscopy  2015.9  (一社)日本消化器内視鏡学会

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  • 胆道病変に対するEUS-FNAの有用性

    松本 和幸, 加藤 博也, 岡田 裕之

    胆道  2015.8  日本胆道学会

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  • 胆管空腸吻合術後の肝内結石治療における細径内視鏡を用いた経口直接胆道鏡の有用性

    松本 和幸, 堤 康一郎, 加藤 博也, 秋元 悠, 内田 大輔, 友田 健, 山本 直樹, 堀口 繁, 八木 孝仁, 岡田 裕之

    胆道  2015.8  日本胆道学会

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  • 切除不能膵癌の治療選択 進行膵癌に伴う胆管・十二指腸閉塞に対する内視鏡的ダブルステンティングの治療成績

    松本 和幸, 加藤 博也, 岡田 裕之

    膵臓  2015.5  (一社)日本膵臓学会

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  • 膵疾患の分子病態 Basics and Applications 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, 内田 大輔, 友田 健, 松本 和幸, 野間 康宏, 山本 直樹, 堀口 繁, 堤 康一郎, 岡田 裕之, 山本 和秀

    膵臓  2015.5  (一社)日本膵臓学会

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  • PNETの集学的治療 当院及び関連病院におけるPNET治療についての検討

    堀口 繁, 加藤 博也, 秋元 悠, 内田 大輔, 松本 和幸, 友田 健, 野間 康宏, 山本 直樹, 堤 康一郎, 伏見 聡一郎, 藤井 雅邦, 植木 亨, 八木 孝仁, 山本 和秀

    膵臓  2015.5  (一社)日本膵臓学会

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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  2015.5  MOSBY-ELSEVIER

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  • 胆膵におけるInterventional EUS 超音波内視鏡下瘻孔形成術の現状と問題点 Peripancreatic fluid collectionに対する超音波内視鏡下瘻孔形成術の治療成績

    松本 和幸, 加藤 博也, 岡田 裕之

    Gastroenterological Endoscopy  2015.4  (一社)日本消化器内視鏡学会

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  • 胆管空腸吻合術後の肝内結石治療に対するDB-ERCPの有用性と工夫

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

    Gastroenterological Endoscopy  2015.4  (一社)日本消化器内視鏡学会

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  • 巨大結石に対するEPLBDの有用性及び安全性の検討 超高齢者に対してもEPLBDは安全に施行可能か?

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

    Gastroenterological Endoscopy  2015.4  (一社)日本消化器内視鏡学会

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  • IPMNの切除例から見た国際診療ガイドラインの検証

    山本 直樹, 加藤 博也, 秋元 悠, 友田 健, 松本 和幸, 野間 康宏, 堀口 繁, 原田 亮, 堤 康一郎, 岡田 裕之, 山本 和秀

    日本消化器病学会雑誌  2015.3  (一財)日本消化器病学会

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  • 胆管空腸吻合術後に発症した肝内結石に対するDB-ERCPの有用性

    堤 康一郎, 加藤 博也, 秋元 悠, 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, 山本 和秀

    日本消化器病学会雑誌  2015.3  (一財)日本消化器病学会

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  • 膵癌治療の新たな戦略 切除不能膵癌に対する新規バイオマーカー 血清中抗60S ribosomal protein L29抗体

    三宅 康広, 松本 和幸, 加藤 博也

    日本消化器病学会雑誌  2015.3  (一財)日本消化器病学会

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  • Complex-shaped GDCによるアンカーテクニックを用いたDPCAR術前CHA塞栓術

    児玉 芳尚, 櫻井 康雄, 安保 義恭, 松森 友昭, 権 勉成, 松本 和幸, 金 俊文, 高木 亮, 矢根 圭, 小山内 学, 潟沼 朗生, 高橋 邦幸, 真口 宏介

    IVR: Interventional Radiology  2014.12  (一社)日本インターベンショナルラジオロジー学会

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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  2014.11  WILEY-BLACKWELL

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  • 膵・胆道癌の術前胆道ドレナージの是非 膵・胆道癌に対する術前内視鏡的胆道ドレナージの現状と問題点

    松本 和幸, 真口 宏介, 小山内 学

    Gastroenterological Endoscopy  2014.4  (一社)日本消化器内視鏡学会

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  • 膵疾患診断における体外式超音波検査vs.超音波内視鏡検査 膵の小腫瘍に対するUS診断能

    松本 和幸, 真口 宏介, 高橋 邦幸

    超音波医学  2014.4  (公社)日本超音波医学会

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  • Short typeシングルバルーン内視鏡を用いてバルーン拡張術を施行したIPMN術後膵管空腸吻合部狭窄の1例

    矢根 圭, 真口 宏介, 小山内 学, 高橋 邦幸, 潟沼 朗生, 金 俊文, 高木 亮, 松本 和幸, 権 勉成, 松森 友昭, 友成 暁子

    Gastroenterological Endoscopy  2014.3  (一社)日本消化器内視鏡学会

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    症例は53歳女性。2009年11月に分枝型IPMNに対して膵頭十二指腸切除術(SSPPD-IIA)を施行した。2011年6月(術後19ヵ月)のCTにて残膵主膵管の拡張と内部の淡い高吸収域を認め、IPMN再発と膵管空腸吻合部狭窄の鑑別を要した。同年7月に急性膵炎を発症し、プロトタイプシングルバルーン内視鏡(Short SBE)による吻合部の観察を試みたが同定困難であった。2012年2月の再検時には先端フードを装着し詳細に観察することで、狭窄した膵管空腸吻合部の同定が可能となった。バルーンによる吻合部の拡張術を施行したところ、白色の蛋白栓の流出を認め、主膵管内の透亮像も消失したため、再発は否定的と診断し経過観察継続中である。術後膵管空腸吻合部狭窄に対するバルーン内視鏡を用いたアプローチは比較的低侵襲であり、有用な方法の一つと考えられる。(著者抄録)

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    Other Link: https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2014&ichushi_jid=J00192&link_issn=&doc_id=20140402120007&doc_link_id=10.11280%2Fgee.56.477&url=https%3A%2F%2Fdoi.org%2F10.11280%2Fgee.56.477&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_2.gif

  • 検診の腹部超音波検査にて発見された小膵内分泌腫瘍の1例

    松森 友昭, 真口 宏介, 高橋 邦幸, 潟沼 朗生, 小山内 学, 矢根 圭, 金 俊文, 高木 亮, 松本 和幸, 権 勉成, 友成 暁子

    日本消化器がん検診学会雑誌  2013.11  (一社)日本消化器がん検診学会

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  • 胆道癌の胆管ドレナージの標準化 手術症例と非手術症例 膵・胆道癌に対する術前胆道ドレナージの現状と問題点

    松本 和幸, 真口 宏介, 小山内 学

    日本消化器病学会雑誌  2013.9  (一財)日本消化器病学会

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  • Short-SBEを用いた術後胆管空腸吻合部狭窄の治療成績

    矢根 圭, 小山内 学, 真口 宏介, 高橋 邦幸, 潟沼 朗生, 金 俊文, 高木 亮, 松本 和幸, 権 勉成, 松森 友昭, 友成 暁子

    胆道  2013.8  日本胆道学会

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  • 膵癌診断におけるMRI拡散強調画像、ADC-mapの有用性

    櫻井 康雄, 児玉 芳尚, 松森 友昭, 権 勉成, 松本 和幸, 金 俊文, 高木 亮, 矢根 圭, 小山内 学, 高橋 邦幸, 真口 宏介

    膵臓  2013.6  (一社)日本膵臓学会

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  • 抗腫瘍療法後に切除術を施行した膵癌の8例

    高木 亮, 真口 宏介, 高橋 邦幸, 潟沼 朗生, 小山内 学, 矢根 圭, 金 俊文, 松本 和幸, 松森 友昭, 権 勉成

    膵臓  2013.6  (一社)日本膵臓学会

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  • 膵癌術後補助化学療法におけるS1とGEMの検討

    金 俊文, 真口 宏介, 高橋 邦幸, 潟沼 朗生, 小山内 学, 矢根 圭, 高木 亮, 松本 和幸, 権 勉成, 松森 友昭

    膵臓  2013.6  (一社)日本膵臓学会

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  • 膵癌術後再発例に対するEUS-FNAの成績

    矢根 圭, 真口 宏介, 高橋 邦幸, 潟沼 朗生, 小山内 学, 金 俊文, 高木 亮, 松本 和幸, 権 勉成, 松森 友昭

    膵臓  2013.6  (一社)日本膵臓学会

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  • 膵疾患の内視鏡診断と治療 さらなる発展を目指して 主膵管狭窄を伴う慢性膵炎に対する内視鏡的膵管ステンティング(EPS)の有用性と課題

    松本 和幸, 真口 宏介, 小山内 学

    膵臓  2013.6  (一社)日本膵臓学会

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  • Complex-shaped GDCによるアンカーテクニックを用いたPin Point CHA塞栓術

    児玉 芳尚, 櫻井 康雄, 安保 義恭, 松森 友昭, 権 勉成, 松本 和幸, 金 俊文, 高木 亮, 矢根 圭, 小山内 学, 潟沼 朗生, 高橋 邦幸, 真口 宏介

    IVR: Interventional Radiology  2013.4  (一社)日本インターベンショナルラジオロジー学会

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  • 慢性膵炎に対する内視鏡治療の現状 慢性膵炎に伴う主膵管狭窄に対する内視鏡的膵管ステンティング(EPS)の有用性

    松本 和幸, 真口 宏介, 高橋 邦幸

    Gastroenterological Endoscopy  2013.4  (一社)日本消化器内視鏡学会

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  • Stage I膵癌の臨床像と超音波診断

    松本 和幸, 真口 宏介, 高橋 邦幸, 潟沼 朗生, 小山内 学, 矢根 圭, 金 俊文, 加藤 新, 高木 亮, 松森 友昭, 権 勉成

    超音波医学  2013.1  (公社)日本超音波医学会

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  • 通常型膵癌に対するEUS-FNAの成績

    権 勉成, 潟沼 朗生, 真口 宏介, 高橋 邦幸, 小山内 学, 矢根 圭, 金 俊文, 加藤 新, 高木 亮, 松本 和幸, 松森 友昭, 篠原 敏也

    超音波医学  2013.1  (公社)日本超音波医学会

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  • 自己免疫性肝炎 重症・難治例の現状と対処法 血清中抗PD-1抗体を用いた自己免疫性肝炎と薬物性肝障害の鑑別診断

    三宅 康広, 松本 和幸, 山本 和秀

    肝臓  2012.9  (一社)日本肝臓学会

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  • Cyst-Gastro setで超音波内視鏡下胆管十二指腸吻合術を施行した2症例

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

    Gastroenterological Endoscopy  2012.9  (一社)日本消化器内視鏡学会

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  • Streptozotocin投与NASH発癌モデルマウスにおける病態進行と水素水投与の有効性の検討

    河合 大介, 高木 章乃夫, 山本 和秀, 中司 敦子, 和田 淳, 玉木 直文, 安中 哲也, 小池 和子, 津崎 龍一郎, 松本 和幸, 三宅 康広, 白羽 英則, 森田 学, 槇野 博史

    日本消化器病学会雑誌  2012.9  (一財)日本消化器病学会

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  • 切除不能局所進行膵癌に対する全身化学療法の検討

    松原 稔, 加藤 博也, 友田 健, 松本 和幸, 榊原 一郎, 野間 康宏, 山本 直樹, 園山 隆之, 堤 康一郎, 那須 淳一郎, 岡田 裕之, 山本 和秀

    日本消化器病学会雑誌  2012.9  (一財)日本消化器病学会

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  • IPMNの精査における造影EUSの有用性の検討

    山本 直樹, 加藤 博也, 友田 健, 松本 和幸, 榊原 一郎, 野間 康宏, 園山 隆之, 堤 康一郎, 堀 圭介, 田中 健大, 岡田 裕之, 山本 和秀

    日本消化器病学会雑誌  2012.9  (一財)日本消化器病学会

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  • 当院におけるTherapeutic EUSの現状

    内田 大輔, 加藤 博也, 友田 健, 松本 和幸, 榊原 一郎, 山本 直樹, 野間 康弘, 園山 隆之, 堤 康一郎, 山本 和秀

    Gastroenterological Endoscopy  2012.9  (一社)日本消化器内視鏡学会

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  • 非ウイルス性急性肝不全の病態と予後 血清中抗PD-1抗体を用いた自己免疫性急性肝炎の診断

    三宅 康広, 松本 和幸, 山本 和秀

    肝臓  2012.7  (一社)日本肝臓学会

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  • 上部消化管の粘膜下腫瘍に対するEUS-FNA症例の検討

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

    Gastroenterological Endoscopy  2012.4  (一社)日本消化器内視鏡学会

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  • 膵癌診断における迅速細胞診とk-ras点突然変異の有用性

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

    Gastroenterological Endoscopy  2012.4  (一社)日本消化器内視鏡学会

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  • 悪性上部消化管狭窄に対するステント治療の現状と工夫

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

    Gastroenterological Endoscopy  2012.4  (一社)日本消化器内視鏡学会

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  • IPMNの良悪性診断における造影EUSの有用性の検討

    山本 直樹, 加藤 博也, 友田 健, 松本 和幸, 榊原 一郎, 野間 康宏, 園山 隆之, 堤 康一郎, 堀 圭介, 田中 健大, 岡田 裕之, 山本 和秀

    Gastroenterological Endoscopy  2012.4  (一社)日本消化器内視鏡学会

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  • 我が国における自己免疫性肝疾患の現状と展開 自己免疫性肝炎の新規診断補助マーカーとしての抗PD-1抗体及び抗BTLA抗体

    三宅 康広, 松本 和幸, 高木 章乃夫, 山本 和秀

    肝臓  2012.4  (一社)日本肝臓学会

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  • 急性肝不全症例における血清中可溶性接着分子の意義

    大西 敦之, 三宅 康広, 松本 和幸, 安中 哲也, 池田 房雄, 小池 和子, 高木 章乃夫, 山本 和秀

    日本消化器病学会雑誌  2012.3  (一財)日本消化器病学会

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  • Streptozotocin投与NASHモデルマウスにおける病態進行と水素水投与の有効性の検討

    河合 大介, 高木 章乃夫, 山本 和秀, 松本 和幸, 石川 久, 津崎 龍一郎, 安中 哲也, 中司 敦子, 小池 和子, 三宅 康広, 白羽 英則, 和田 淳

    日本消化器病学会雑誌  2012.3  (一財)日本消化器病学会

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  • 重症急性膵炎に対する腹膜灌流の治療成績

    松本 和幸, 三宅 康広, 今川 敦, 中津 守人, 安東 正晴, 広畑 衛, 山本 和秀

    日本腹部救急医学会雑誌  2012.2  (一社)日本腹部救急医学会

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  • 急性肝不全における血清中可溶性接着分子の意義

    大西 敦之, 三宅 康広, 松本 和幸, 安中 哲也, 池田 房雄, 小池 和子, 高木 章乃夫, 山本 和秀

    日本内科学会雑誌  2012.2  (一社)日本内科学会

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  • 急性肝不全症例における血清中可溶性接着分子の意義

    大西 敦之, 三宅 康広, 松本 和幸, 高木 章乃夫, 小池 和子, 安中 哲也, 池田 房雄, 能祖 一裕, 山本 和秀

    肝臓  2011.11  (一社)日本肝臓学会

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  • 膵リンパ上皮嚢胞の2例

    松本 和幸, 加藤 博也, 山本 直樹, 野間 康宏, 園山 隆之, 堤 康一郎, 岡田 裕之, 山本 和秀

    Gastroenterological Endoscopy  2011.9  (一社)日本消化器内視鏡学会

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    Event date: 2011.9

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  • 急性肝不全症例における血清中可溶性接着分子の意義

    大西 敦之, 三宅 康広, 松本 和幸, 高木 章乃夫, 山本 和秀

    日本臨床免疫学会会誌  2011.8  (一社)日本臨床免疫学会

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  • 切除不能胆道癌に対する全身化学療法の有用性

    加藤 博也, 松本 和幸, 野間 康宏, 山本 直樹, 園山 隆之, 堤 康一郎, 岡田 裕之, 山本 和秀

    胆道  2011.8  日本胆道学会

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  • 非アルコール性脂肪性肝炎(NASH)モデルマウスの病態進行に対する水素水の効果の検討

    河合 大介, 高木 章乃夫, 松本 和幸, 津崎 龍一郎, 安中 哲也, 中司 敦子, 小池 和子, 三宅 康広, 白羽 英則, 和田 淳, 山本 和秀

    肝臓  2011.4  (一社)日本肝臓学会

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  • 肝再生医学研究の新展開 正常ヒト肝切除に伴う増殖因子の経時的変動 生体肝移植ドナーにおける検討

    松本 和幸, 三宅 康広, 楳田 祐三, 松田 浩明, 高木 章乃夫, 貞森 裕, 能祖 一裕, 八木 孝仁, 藤原 俊義, 山本 和秀

    肝臓  2011.4  (一社)日本肝臓学会

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  • 水素水はマウスにおけるNASHの進行を抑制する

    河合 大介, 高木 章乃夫, 山本 和秀, 松本 和幸, 津崎 龍一郎, 安中 哲也, 小池 和子, 三宅 康弘, 白羽 秀則

    日本消化器病学会雑誌  2011.3  (一財)日本消化器病学会

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  • 超音波内視鏡下に経胃的ドレナージが有用であった急性輸入脚症候群の2例

    松本 和幸, 河本 博文, 榊原 一郎, 堀口 繁, 山本 直樹, 堤 康一朗, 藤井 雅邦, 栗原 直子, 加藤 博也, 平尾 謙, 山本 和秀

    Gastroenterological Endoscopy  2010.4  (一社)日本消化器内視鏡学会

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  • 当院における胆嚢癌のまとめ

    高原 政宏, 豊川 達也, 松本 和幸, 今田 貴之, 八木 覚, 宮武 宏和, 中津 守人, 安東 正晴, 廣畑 衛

    日本消化器病学会雑誌  2009.9  (一財)日本消化器病学会

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  • H.pylori除菌療法は萎縮粘膜を改善し、特に萎縮の進んだ症例では早期に改善する 長期間のprospective cohort studyの結果から

    豊川 達也, 高原 政宏, 松本 和幸, 今田 貴之, 八木 覚, 中津 守人, 安東 正晴

    日本消化器病学会雑誌  2009.9  (一財)日本消化器病学会

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  • カルペリチド投与により血液透析を離脱しえた急性腎不全の一例

    氏家 はる代, 森本 尚孝, 松本 和幸, 堀元 直哉, 脇 正人, 石津 勉, 廣畑 衛

    日本透析医学会雑誌  2009.5  (一社)日本透析医学会

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  • 血小板低下を伴うC型慢性肝炎患者における部分的脾動脈塞栓術(PSE)はリバビリン(RBV)併用インターフェロン(IFN)治療効果を改善するか?

    高原 政宏, 三宅 康広, 宮武 宏和, 松本 和幸, 今田 貴之, 八木 覚, 豊川 達也, 中津 守人, 安東 正晴, 廣畑 衛

    肝臓  2009.4  (一社)日本肝臓学会

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  • 胃MALTリンパ腫の長期経過 治療後早期にT細胞リンパ腫を発症し予後不良であった症例報告も含めて

    豊川 達也, 今田 貴之, 中津 守人, 高原 政宏, 松本 和幸, 八木 覚, 宮武 宏和, 安東 正晴

    Gastroenterological Endoscopy  2009.4  (一社)日本消化器内視鏡学会

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  • ALK陰性直腸原発anaplastic large cell lymphomaの1例

    高原 政宏, 豊川 達也, 脇 正人, 小西 順, 松本 和幸, 今田 貴之, 八木 覚, 宮武 宏和, 中津 守人, 安東 正晴, 廣畑 衛

    Gastroenterological Endoscopy  2009.4  (一社)日本消化器内視鏡学会

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  • 当院における小腸(十二指腸を含む)腫瘍性疾患の検討

    安原 ひさ恵, 豊川 達也, 高原 政宏, 松本 和幸, 今田 貴之, 八木 覚, 宮武 宏和, 中津 守人, 安東 正晴

    日本消化器病学会雑誌  2009.3  (一財)日本消化器病学会

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  • 当院における切除不能・再発胃がん症例に対するS-1+CDDP併用療法の検討

    今田 貴之, 豊川 達也, 篠井 尚子, 恒光 美穂, 三宅 智子, 河野 吉泰, 中野 由加里, 氏家 はる代, 竹内 洋平, 小西 順, 堀元 直哉, 松本 和幸, 高原 政宏, 八木 覚, 宮武 宏和, 中津 守人, 安東 正晴

    日本消化器病学会雑誌  2009.3  (一財)日本消化器病学会

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  • 当院におけるGIST症例の検討

    河野 吉泰, 豊川 達也, 松本 和幸, 高原 政宏, 今田 貴之, 八木 覚, 宮武 宏和, 中津 守人, 安東 正晴

    日本消化器病学会雑誌  2009.3  (一財)日本消化器病学会

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  • B型慢性肝炎急性増悪重症例に対しエンテカビルとステロイドを併用し奏効した2例

    宮武 宏和, 三宅 康広, 松本 和幸, 河野 吉泰, 竹内 洋平, 氏家 はる代, 中野 由加理, 小西 順, 高原 政宏, 今田 貴之, 八木 覚, 豊川 達也, 中津 守人, 安東 正晴, 廣畑 衛

    日本消化器病学会雑誌  2009.3  (一財)日本消化器病学会

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  • 当院における食道癌化学放射線治療の検討

    松本 和幸, 豊川 達也, 河野 吉泰, 氏家 はる代, 中野 由加里, 小西 順, 高原 政宏, 今田 貴之, 八木 覚, 宮武 宏和, 中津 守人, 安東 正晴, 広畑 衛

    日本消化器病学会雑誌  2009.3  (一財)日本消化器病学会

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  • 腹部超音波検査にて経過観察しえた上腸間膜動脈症候群の一例

    宮武 宏和, 豊川 達也, 松本 和幸, 今田 貴之, 竹内 洋平, 森本 尚孝, 高原 政宏, 八木 覚, 中津 守人, 安東 正晴

    超音波医学  2009.1  (公社)日本超音波医学会

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  • 高齢者の膵癌患者に対する低用量gemcitabine療法は有用である

    松本 和幸, 豊川 達也, 三宅 康広, 安原 ひさ恵, 高原 政宏, 今田 貴之, 八木 寛, 中津 守人, 安東 正晴, 廣畑 衛

    日本消化器病学会雑誌  2008.9  (一財)日本消化器病学会

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  • 十二指腸潰瘍に対しHelicobacter pylori除菌を行い、6年後に胃癌が発覚した1例

    八木 覚, 豊川 達也, 安原 ひさ恵, 高原 政宏, 松本 和幸, 今田 貴之, 三宅 康広, 中津 守人, 安東 正晴, 宮谷 克也

    日本消化器病学会雑誌  2008.9  (一財)日本消化器病学会

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  • 腸管アミロイドーシスの2症例

    安原 ひさ恵, 豊川 達也, 小西 順, 高原 政宏, 松本 和幸, 今田 貴之, 八木 覚, 三宅 康広, 中津 守人, 安東 正晴

    日本消化器病学会雑誌  2008.9  (一財)日本消化器病学会

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  • 血小板減少を伴うC型慢性肝炎症例に対する部分的脾動脈塞栓術(PSE)の有効性

    高原 政宏, 三宅 康広, 安原 ひさ恵, 松本 和幸, 今田 貴之, 八木 覚, 豊川 達也, 中津 守人, 安東 正晴, 廣畑 衛

    肝臓  2008.9  (一社)日本肝臓学会

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  • 術前診断が困難であった副脾の一例

    高原 政宏, 豊川 達也, 安原 ひさ恵, 松本 和幸, 河合 大介, 浅木 彰則, 加地 英輔, 三宅 康宏, 中津 守人, 安東 正晴, 廣畑 衛

    香川県内科医会誌  2008.6  香川県内科医会

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  • 多発肝腫瘤の1例

    安原 ひさ恵, 豊川 達也, 松本 和幸, 河合 大介, 浅木 彰則, 加地 英輔, 大西 亨, 中津 守人, 安東 正晴, 洲脇 謹一郎

    香川県内科医会誌  2008.6  香川県内科医会

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  • 小孔径心房中隔欠損症が関連した若年者脳梗塞の1例

    中野 由加理, 上枝 正幸, 松本 和幸, 高谷 陽一, 旦 一宏, 大西 伸彦, 高石 篤志

    香川県内科医会誌  2008.6  香川県内科医会

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    Event date: 2008.6

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    症例は、20歳代男性。左上肢のしびれ、構音障害を一過性に来たした後、1週間後症状再発で当院救急外来受診。MRI検査で小脳の多発新鮮梗塞を認め緊急入院となった。MRAと脳血管撮影で脳底動脈領域の塞栓と診断された。熱中での仕事をした後で脱水症状を伴っていたが、凝固・線溶系の異常、ANCA上昇、血管炎所見、心房細動はみとめなかった。経胸壁および経食道エコーで7mm径の2次孔型心房中隔欠損症(ASD)を認め、ASD通過流は時相の一部で右→左への血流が認められたため、若年性脳梗塞の原因は心房内シャントによる奇異性塞栓症と考えられた。ASDなどの右→左シャントがある場合には、径の大きさに拘らず塞栓症の原因となることがあり、このような場合にはシャント率あるいは心不全の面からの適応は無くとも、孔閉鎖術を考慮する必要がある症例がある。(著者抄録)

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  • 当院における低未分化大腸癌の検討

    松本 和幸, 豊川 達也, 安原 ひさ恵, 高原 政宏, 河合 大介, 浅木 彰則, 加地 英輔, 三宅 康宏, 中津 守人, 安東 正晴, 廣畑 衛

    香川県内科医会誌  2008.6  香川県内科医会

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  • 胃腫瘍性病変に対するESDの所要時間による検討

    豊川 達也, 加地 英輔, 松本 和幸, 高原 政宏, 安原 ひさ恵, 河合 大介, 三宅 康広, 中津 守人, 安東 正晴

    Gastroenterological Endoscopy  2008.4  (一社)日本消化器内視鏡学会

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  • Low dose gemcitabine improves the prognosis of elderly patients with unresectable advanced pancreatic cancer

    Kazuyuki Matsumoto, Tatsuya Toyokawa, Yasuhiro Miyake, Hisae Yasumara, Masahiro Takahara, Eisuke Kaji, Morihito Nakatsu, Masaharu Ando, Mamoru Hirohata

    GASTROENTEROLOGY  2008.4  W B SAUNDERS CO-ELSEVIER INC

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    Event date: 2008.4

    Language:English  

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  • 腹腔内リンパ節転移を伴う胃MALTリンパ腫に対しR-CHOP療法が奏功した1例

    河合 大介, 豊川 達也, 安原 ひさ恵, 高原 政宏, 松本 和幸, 加地 英輔, 三宅 康広, 中津 守人, 安東 正晴

    日本消化器病学会雑誌  2008.3  (一財)日本消化器病学会

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  • 肝細胞癌との鑑別に苦慮した肝血管筋脂肪腫の2例

    高原 政宏, 三宅 康広, 安原 ひさ恵, 松本 和幸, 河合 大介, 加地 英輔, 豊川 達也, 中津 守人, 安東 正晴, 廣畑 衛

    日本消化器病学会雑誌  2008.3  (一財)日本消化器病学会

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  • PSE施行後にリバビリン併用インターフェロン療法を行ったC型慢性肝炎患者10例の検討

    三宅 康広, 安東 正晴, 高原 政宏, 安原 ひさ恵, 松本 和幸, 河合 大介, 豊川 達也, 中津 守人, 広畑 衛

    肝臓  2007.11  (一社)日本肝臓学会

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  • 高齢者における手術不能膵癌に対する抗腫瘍療法の検討

    松本 和幸, 豊川 達也, 安原 ひさ恵, 高原 政宏, 河合 大介, 加地 英輔, 三宅 康広, 中津 守人, 安東 正晴, 廣畑 衛

    香川県医師会誌  2007.10  (一社)香川県医師会

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  • PSE施行後にリバビリン併用インターフェロン療法を行ったC型慢性肝炎患者10例の検討

    三宅 康広, 安東 正晴, 小西 順, 高原 政宏, 安原 ひさ恵, 松本 和幸, 河合 大介, 加地 英輔, 豊川 達也, 中津 守人, 廣畑 衛

    香川県医師会誌  2007.10  (一社)香川県医師会

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  • 重症肺炎に対する中等量Hydrocortisone併用療法の有効性と安全性

    南木 伸基, 山地 康文, 松本 和幸, 高谷 陽一, 堀元 直哉, 河合 大介

    香川県医師会誌  2007.10  (一社)香川県医師会

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  • 高齢者の上部消化管腫瘍性病変に対する内視鏡的粘膜下層剥離術(ESD)の適応と問題点

    豊川 達也, 加地 英輔, 安原 ひさ恵, 松本 和幸, 高原 政宏, 河合 大介, 三宅 康広, 中津 守人, 安東 正晴, 廣畑 衛

    香川県医師会誌  2007.10  (一社)香川県医師会

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  • 総胆管結石の内視鏡的治療に関する年齢別の検討

    安原 ひさ恵, 豊川 達也, 洲脇 謹一郎, 松本 和幸, 河合 大介, 浅木 彰則, 加地 英輔, 中津 守人, 安東 正晴

    Gastroenterological Endoscopy  2007.9  (一社)日本消化器内視鏡学会

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    Event date: 2007.9

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  • 当院における手術不能膵癌に対する抗腫瘍療法の検討

    松本 和幸, 豊川 達也, 洲脇 謹一郎, 安原 ひさ恵, 河合 大介, 浅木 彰則, 加地 英輔, 中津 守人, 安東 正晴, 廣畑 衛

    日本消化器病学会雑誌  2007.9  (一財)日本消化器病学会

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  • 当院における胃MALTリンパ腫症例の検討

    河合 大介, 豊川 達也, 松本 和幸, 浅木 彰則, 加地 英輔, 中津 守人, 洲脇 謹一郎, 安東 正晴

    日本消化器病学会雑誌  2007.9  (一財)日本消化器病学会

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  • 高齢者の上部消化管腫瘍性病変に対する内視鏡的粘膜下層剥離術(ESD)の適応と問題点

    豊川 達也, 洲脇 謹一郎, 加地 英輔, 安原 ひさ恵, 松本 和幸, 河合 大介, 浅木 彰則, 大西 亨, 中津 守人, 安東 正晴, 広畑 衛

    Gastroenterological Endoscopy  2007.9  (一社)日本消化器内視鏡学会

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  • 胃癌検診における胃X線検査と内視鏡検査の比較

    安原 ひさ恵, 豊川 達也, 松本 和幸, 河合 大介, 浅木 彰則, 加地 英輔, 大西 亨, 中津 守人, 安東 正晴, 洲脇 謹一郎

    Gastroenterological Endoscopy  2007.4  (一社)日本消化器内視鏡学会

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    Event date: 2007.4

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  • 当院のESDにおける局所不完全切除病変の検討

    豊川 達也, 洲脇 謹一郎, 安原 ひさ恵, 松本 和幸, 河合 大介, 浅木 彰則, 加地 英輔, 大西 亨, 中津 守人, 安東 正晴

    Gastroenterological Endoscopy  2007.4  (一社)日本消化器内視鏡学会

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    Event date: 2007.4

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  • 内視鏡的粘膜切除術を施行した同時多発十二指腸癌の1例

    松本 和幸, 豊川 達也, 安原 ひさ恵, 河合 大介, 浅木 彰則, 加地 英輔, 大西 亨, 中津 守人, 安東 正晴, 洲脇 謹一郎, 廣畑 衛

    Gastroenterological Endoscopy  2007.4  (一社)日本消化器内視鏡学会

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    Event date: 2007.4

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  • 当院における出血性胃十二指腸潰瘍に対する内視鏡的止血術の検討

    河合 大介, 豊川 達也, 松本 和幸, 安原 ひさ恵, 浅木 彰則, 加地 英輔, 大西 亨, 中津 守人, 安東 正晴, 洲脇 謹一郎

    Gastroenterological Endoscopy  2007.4  (一社)日本消化器内視鏡学会

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    Event date: 2007.4

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  • 胃と瘻孔を形成した膵嚢胞性腫瘍の2例

    松本 和幸, 柘野 浩史, 永原 照也, 西田 知弘, 今川 敦, 藤本 剛, 田中 弘教, 平良 明彦, 三宅 正展, 高畠 弘行, 藤木 茂篤, 渡邉 剛正

    岡山済生会総合病院雑誌  2006.12  岡山済生会総合病院

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  • 高齢者総胆管結石症例に対する内視鏡的胆道ステント留置術(EBD)

    柘野 浩史, 松本 和幸, 永原 照也, 西田 知弘, 藤本 剛, 今川 敦, 田中 弘教, 平良 明彦, 三宅 正展, 高畠 弘行, 藤木 茂篤

    岡山済生会総合病院雑誌  2006.12  岡山済生会総合病院

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  • PMX-DHP導入基準 穿孔性腹膜炎におけるPMX-DHP導入開始時間の検討

    衛藤 弘城, 白石 建輔, 萩岡 信吾, 笠井 慎也, 内藤 宏道, 長江 正晴, 松本 和幸, 福島 達夫, 森本 直樹

    エンドトキシン血症救命治療研究会誌  2006.12  (株)自然科学社

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  • 当院における出血性胃十二指腸潰瘍に対する内視鏡的止血術の検討

    河合 大介, 中津 守人, 安東 正晴, 洲脇 謹一郎, 廣畑 衛, 豊川 達也, 松本 和幸, 浅木 彰則, 加地 英輔, 大西 亨

    香川県医師会誌  2006.10  (一社)香川県医師会

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  • HCCを合併したBudd-chiari症候群の1例

    浅木 彰則, 中津 守人, 安東 正晴, 洲脇 謹一郎, 廣畑 衛, 安原 ひさ恵, 松本 和幸, 河合 大介, 加地 英輔, 豊川 達也, 大西 亨

    香川県医師会誌  2006.10  (一社)香川県医師会

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  • 当院におけるESD(内視鏡的粘膜下層剥離術)の現況と問題点

    豊川 達也, 洲脇 謹一郎, 中津 守人, 安東 正晴, 廣畑 衛, 松本 和幸, 安原 ひさ恵, 河合 大介, 浅木 彰則, 加地 英輔, 大西 亨

    香川県医師会誌  2006.10  (一社)香川県医師会

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  • 当院における内視鏡的上部消化管異物除去術26例の検討

    松本 和幸, 中津 守人, 安東 正晴, 洲脇 謹一郎, 廣畑 衛, 豊川 達也, 河合 大介, 浅木 彰則, 加地 英輔, 大西 亨

    香川県医師会誌  2006.10  (一社)香川県医師会

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  • 当院における小腸内視鏡検査の現状

    中津 守人, 安東 正晴, 洲脇 謹一郎, 廣畑 衛, 豊川 達也, 安原 ひさ恵, 松本 和幸, 河合 大介, 浅木 彰則, 加地 英輔, 大西 亨

    香川県医師会誌  2006.10  (一社)香川県医師会

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  • マムシ咬傷48例の検討

    松本 和幸, 内藤 宏道, 久保田 暢人, 谷本 光隆, 長江 正晴, 笠井 慎也, 萩岡 信吾, 白石 建輔, 森本 直樹

    中毒研究  2006.4  (株)へるす出版

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  • 当院における上部消化管異物除去術122例の検討

    松本 和幸, 平良 明彦, 衛藤 弘城, 杉原 雄策, 山本 倫子, 春名 正範, 永原 照也, 西田 知弘, 今川 敦, 藤本 剛, 田中 弘教, 三宅 正展, 柘野 浩史, 高畠 弘行, 藤木 茂篤

    Gastroenterological Endoscopy  2006.4  (一社)日本消化器内視鏡学会

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Industrial property rights

  • 抑制性補助刺激分子に対する抗体をマーカーとする慢性炎症性疾患の検査方法

    三宅 康広, 山本 和秀, 松本 和幸

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    Applicant:国立大学法人 岡山大学

    Application no:特願2012-549690  Date applied:2011.11.17

    Patent/Registration no:特許第5996438号  Date registered:2016.9.2 

    J-GLOBAL

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Awards

  • 日本胆道学会国際交流奨励賞

    2022.10  

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  • JDDW若手奨励賞

    2019  

    松本和幸

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  • JDDWポスター優秀演題賞

    2019   日本消化器病学会  

    松本和幸

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  • JDDW若手奨励賞

    2018  

    松本和幸

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  • 日本胆道学会国際交流奨励賞

    2017   日本胆道学会  

    松本和幸

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Research Projects

  • Development of minimally invasive endoscopic therapy aimed at improving cure rate and preserving pancreatic functions in patients with pancreatic neuroendocrine neoplasms

    Grant number:23ck0106900h0001  2023.10 - 2026.03

    Japan Agency for Medical Research and Development(AMED)  革新的がん医療実用化研究事業 

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    Authorship:Principal investigator 

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  • 超音波内視鏡診断支援プログラムの社会実装に向けた基盤整備

    Grant number:23K11932  2023.04 - 2026.03

    日本学術振興会  科学研究費助成事業  基盤研究(C)

    内田 大輔, 松本 和幸, 藤井 佑樹, 宮本 和也

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

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  • 免疫チェックポイント阻害剤の有効性予測バイオマーカー開発ー血中自己抗体の可能性ー

    Grant number:20K17050  2020.04 - 2023.03

    日本学術振興会  科学研究費助成事業 若手研究  若手研究

    松本 和幸

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

    近年、抗PD-1抗体を中心とした癌免疫療法が多くの癌種に効果を示しているが、膵癌の治療反応性は悪い。我々は血液中自己抗体の臨床的意義を検討しているが、その中で、免疫抑制分子であるPD-1に対する抗体反応陽性者が、膵癌患者でも一定数存在することがわかってきた。本研究は、次世代の癌免疫療法の可能性を広げることができるバイオマーカーを同定することを目標にしている。前年度までに、膵癌患者の血清中抗PD-1抗体価をELISA法で測定し、進行期において抗PD-1抗体価が高い群で生命予後の延長を認めることがわかった。今年度の目標は、切除標本を用いて免疫染色を行い、免疫応答の違いを解明していくことであった。
    標本の選定は、StageIII以上は手術適応とならない為、リンパ節転移を有するStageIIB症例とリンパ節転移を有さないStageI-IIA症例とし、膵癌主病巣とリンパ節において、線維化の程度およびリンパ球の免疫応答関連マーカー発現を検討した。線維化の評価はαSMA染色を用い、リンパ球の活性化状態の評価は、PD-1、CD45R0染色を用いた。主病巣の膵癌主病巣では癌は強い線維化を伴っていることが、免疫細胞浸潤を拒絶している可能性があり、癌周囲の線維化関連マーカー発現の程度と免疫細胞の活性化状態について標本評価を行っている。リンパ節では通常線維化を伴っておらず、癌がむき出しの状態であるため、免疫応答が生じやすい状態と考えられる。リンパ節転移の有無により、免疫応答に違いがあるかをリンパ球活性化関連マーカーで検討し、血中の抗PD-1抗体価との関連を明らかにしていく。現在、免疫染色の条件設定は完了でき、病理標本の準備・評価中である

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  • 膵神経内分泌腫瘍に対する超音波内視鏡ガイド下エタノール注入療法:プロトコール作成研究

    2019

    国立研究開発法人日本医療研究開発機構(AMED)  医療研究開発推進事業費補助金 

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  • Investigating intestinal environments as risks for pancreatico-biliary cancers

    Grant number:17K09462  2017.04 - 2020.03

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

    Takaki Akinobu

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    Grant amount:\4550000 ( Direct expense: \3500000 、 Indirect expense:\1050000 )

    Aim: The aim of this study was to investigate microbiome analysis of the stool and saliva in pancreatic cancer patients and high risk patients defining the high risk microbiome for the prevention of the pancreatic cancer development. Methods: We collected 24 cases of pancreatic cancer (PK), 16 cases of intraductal papillary mucinous neoplasm (IPMN). Results: From the stool analysis, the diversity of the PK showed low and there was a reduced genus, Lachnospira, which has been reported to be favorable for guarding patients from side effects under chemotherapy. There was another genus which showed increased frequency in PK group, Mogibacterium, which is known as risk bacteria for colon cancer development. From the saliva analysis, a gingival cancer risk periodontitis related bacteria, Atopobium genus was predominant. Conclusion: The risk bacteria genus were determined from both saliva and stool. To control these microbiome is the next step to decrease the development of PK.

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  • Development of novel anti-cancer autoantibody for control of pancreatic cancer

    Grant number:17K15947  2017.04 - 2020.03

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

    KAzuyuki Matsumoto

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    Grant amount:\4030000 ( Direct expense: \3100000 、 Indirect expense:\930000 )

    We evaluated the anti-RPL antibody in the serum of patients with pancreatic cancer using the ELISA method. The results showed that there was no significantly difference in the survival time between patients with high and low antibody titers. It is considered that anti-RPL antibody is not involved in the prognosis of patients with pancreatic cancer in this study.
    For an additional study, we focused on PD-1 which has been clinically applied as an antibody therapeutic agent. We evaluated the relationship between the PD-L1 expression of surgical resected and FNA specimens for patients with pancreatic cancer. Of the 94 patients,11 (10%) was defined as positive on resected cancer specimens. The concordance rates for the positive and negative frequency of PD-L1 expression between resected and FNA specimens were 55% (6/11) and 99% (82/83), respectively.These results have potential utility in the field of precision medicine for patients with pancreatic cancer.

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