研究者詳細 - 中村　正直

ESDで診断に至った深在性囊胞性大腸炎の１例

山田健太朗, 山村健史, 中村正直, 前田啓子, 澤田つな騎, 石川恵里, 梶川豪, 長谷川一成, 横井太紀雄, 川嶋啓揮

日本消化器内視鏡学会雑誌 66 巻 ( 3 ) 頁： 279 - 285 2024年

記述言語：日本語出版者・発行元：一般社団法人日本消化器内視鏡学会

症例は46歳，女性．他院でのCSで直腸腫瘤を認めたため精査目的に紹介となった．当院で施行したCSでは直腸に10mm大の粘膜下腫瘍様隆起を認め，EUSで第３層を主座とする輪郭明瞭な10mm大の低エコー腫瘍として描出された．ボーリング生検を施行するも確定診断には至らなかったこと，EUSで粘膜下層までに局在する腫瘍と考えられたことから，診断的治療目的にESDを施行した．病理組織学的検査で深在性囊胞性大腸炎の診断を得た．

DOI： 10.11280/gee.66.279

大腸ポリープに対するコールドスネアポリペクトミーで腹腔内出血をきたした１例

池上脩二, 山村健史, 中村正直, 前田啓子, 澤田つな騎, 石川恵里, 山下彩子, 河村達哉, 横井太紀雄, 川嶋啓揮

日本消化器内視鏡学会雑誌 66 巻 ( 5 ) 頁： 1236 - 1241 2024年

記述言語：日本語出版者・発行元：一般社団法人日本消化器内視鏡学会

症例は51歳男性．CT colonographyで指摘された大腸ポリープの切除目的に施行された大腸内視鏡検査において，脾彎曲部に腺腫性ポリープを認め，Cold Snare Polypectomy（CSP）が施行された．治療２時間後に急激な心窩部痛が出現し，腹部造影CTでは脾彎曲部の結腸壁が腫瘤状に肥厚し，壁内の血管から造影剤の漏出ならびに腹腔内に血性腹水を認めた．CSP手技に伴う腹腔内出血と診断し，同日，横行結腸部分切除術ならびに人工肛門造設術が施行された．手術標本ではCSP施行部位の直下において，筋層内に著明な血腫を認めたが，穿孔所見はなく，CSPの偶発症としての腹腔内出血と診断した．

DOI： 10.11280/gee.66.1236

内視鏡を活用した小腸疾患のマネッジメント

中村正直

日本消化器内視鏡学会雑誌 66 巻 ( Supplement1 ) 頁： 684 - 685 2024年

ディープラーニングを用いたダブルバルーン内視鏡で提示されるクローン病小腸潰瘍性病変の検出と重症度評価

中村正直

日本消化器内視鏡学会雑誌 66 巻 ( 9 ) 頁： 1813 - 1813 2024年

記述言語：日本語出版者・発行元：一般社団法人日本消化器内視鏡学会

【背景と目的】ダブルバルーン内視鏡（DBE；double-balloon endoscopy）はクローン病（CD；Crohn’s disease）の診断に広く用いられている．しかし，内視鏡医が病変を正確に指摘できない場合，CD診断が困難になることがある．また，内視鏡医の主観によりCDの評価が不正確になることもある．本研究では，人工知能（AI；artificial intelligence）を用いて小腸CDを正確に検出し，客観的に評価することで，より精緻な病態把握を行うことを目的とした．【方法】2018年１月から2022年12月までに628名の患者から28,155枚の小腸DBE画像を収集した．４名の消化器内科専門医が画像にラベル付けを行い，少なくとも２名の内視鏡医が同意のうえで最終判定を行った．最先端のディープラーニングモデルであるEfficientNet-b5によって学習させ，CD病変の検出とCD潰瘍の評価を行った．検出には潰瘍，非炎症性狭窄，炎症性狭窄の病変が含まれた．潰瘍の評価には，潰瘍表面，潰瘍サイズ，潰瘍の深さが含まれた．AIモデルと内視鏡医との精度比較が行われた．【結果】EfficientNet-b5は，潰瘍，非炎症性狭窄，炎症性狭窄の検出において，それぞれ96.3％（95％信頼区間［CI］，95.7％-96.7％），95.7％（95％CI，95.1％-96.2％），96.7％（95％CI，96.2％-97.2％）という高い精度を示した．潰瘍のグレードにおいて，EfficientNet-b5は潰瘍表面の評価に87.3％（95％CI，84.6％-89.6％），潰瘍サイズの評価に87.8％（95％CI，85.0％-90.2％），潰瘍の深さの評価に85.2％（95％CI，83.2％-87.0％）の平均精度を示した．【結論】EfficientNet-b5は，CD病変の検出とCD潰瘍自体の評価において高い精度を達成した．このAIモデルは，専門内視鏡医レベルの精度と小腸CDの客観的評価を提供し，治療ストラテジーを最適化することができる．

DOI： 10.11280/gee.66.1813

腸管リンパ腫の診断と治療

石川恵里, 中村正直, 川嶋啓揮

日本消化器内視鏡学会雑誌 66 巻 ( 11 ) 頁： 2533 - 2544 2024年

記述言語：日本語出版者・発行元：一般社団法人日本消化器内視鏡学会

腸管リンパ腫ではB細胞リンパ腫，特にびまん性大細胞型B細胞リンパ腫（diffuse large B-cell lymphoma：DLBCL），濾胞性リンパ腫（follicular lymphoma：FL）が多く，部位や内視鏡所見に基づいてある程度組織型が推察可能である．DLBCLは回盲部に多く，潰瘍型・隆起型を呈し，化学療法中に穿孔リスクを伴うため手術治療の先行も考慮される．FLは主に十二指腸下行脚に白色顆粒状隆起を形成し，緩徐な経過を辿るため無治療経過観察となることが多い．Mucosa-associated lymphoid tissue（MALT）リンパ腫は直腸に好発し，治療は内視鏡切除を含め多岐にわたる．また特殊型として小腸に発生するimmunoproliferative small intestinal disease（IPSID）が挙げられる．マントル細胞リンパ腫はmultiple lymphomatous polyposis（MLP）型が多く，FL・MALTリンパ腫とともに低悪性度B細胞リンパ腫に分類されるが予後不良であり診療上鑑別が重要である．腸管T細胞リンパ腫は最新のWHO第５版で一部名称が変更となった．また後天性免疫不全の症例では，原因薬剤の減量・中止により自然消退が期待できるEBV-positive mucocutaneous ulcerの可能性にも留意する必要がある．

DOI： 10.11280/gee.66.2533

Multicenter prospective registration study of efficacy and safety of capsule endoscopy in Crohn’s disease in Japan (SPREAD-J study)

今月の主題小腸画像診断のトピックス主題バルーン内視鏡:ダブルバルーン内視鏡を中心に-腫瘍性疾患と炎症性疾患に対する診断法の有用性と限界

中村正直, 山村健史, 前田啓子, 澤田つな騎, 石川恵里, 村手健太郎, 長谷川一成, 池上脩二, 山下彩子, 河村達哉, 大岩恵祐, 八田勇輔, 平松美緒, 廣瀬崇, 古川和宏, 川嶋啓揮

胃と腸 58 巻 ( 11 ) 頁： 1462 - 1469 2023年11月

Sakurai T., Omori T., Tanaka H., Ito T., Ando K., Yamamura T., Nanjjo S., Osawa S., Takeda T., Watanabe K., Hiraga H., Yamamoto S., Ozeki K., Tanaka S., Tajiri H., Saruta M., Akutagawa T., Aoyama N., Iguchi T., Endo K., Esaki M., Ogata H., Oka S., Omiya N., Kagaya T., Kakimoto K., Kobayashi T., Sagami S., Sakuraba H., Shinzaki S., Sugimoto K., Takao M., Torisu T., Nakajima A., Nakamichi K., Nakamura M., Nakase H., Nishiyama R., Hayashi Y., Hayashida M., Hiraoka S., Fuijya M., Fukada N., Fukuda M., Mihara H., Yokoyama K., Yoshida Y., Wagatsuma K.

Journal of Gastroenterology 58 巻 ( 10 ) 頁： 1003 - 1014 2023年10月

出版者・発行元：Journal of Gastroenterology

Background: Evidence of small-bowel capsule endoscopy (SBCE) for evaluating lesions in Crohn’s disease (CD) is lacking. We aimed to clarify the effectiveness and safety of SBCE in a large sample of patients with CD. Methods: This multicenter prospective registration study recorded the clinical information and SBCE results of patients with definitive CD (d-CD) or suspected CD (s-CD). The primary outcomes were the rates of successful assessment of disease activity using SBCE, definitive diagnosis of CD, and adverse events. Secondary outcomes were the assessment of SBCE findings in patients with d-CD and s-CD and factors affecting SBCE incompletion and retention; and tertiary outcomes included the association between clinical disease activity or blood examination, endoscopic disease activity, ileal CD, and the questionnaire assessment of patient acceptance of SBCE. Results: Of 544 patients analyzed, 541 underwent SBCE with 7 (1.3%) retention cases. Of 468 patients with d-CD, 97.6% could be evaluated for endoscopic activity. Of 76 patients with s-CD, 15.8% were diagnosed with ‘confirmed CD’. CD lesions were more frequently observed in the ileum and were only seen in the jejunum in 3.4% of the patients. Male sex and stenosis were risk factors for incomplete SBCE, and high C-reactive protein levels and stenosis were risk factors for capsule retention. In L1 (Montreal classification) patients, clinical remission was associated with endoscopic remission but showed low specificity and accuracy. The answers to the acceptability questionnaire showed the minimal invasiveness and tolerability of SBCE. Conclusion: SBCE is practical and safe in patients with CD.

DOI： 10.1007/s00535-023-02017-3

Impact of elobixibat on liver tumors, microbiome, and bile acid levels in a mouse model of nonalcoholic steatohepatitis

Sugiyama Yoshiaki, Yamamoto Kenta, Honda Takashi, Kato Asuka, Muto Hisanori, Yokoyama Shinya, Ito Takanori, Imai Norihiro, Ishizu Yoji, Nakamura Masanao, Asano Tomomi, Enomoto Atsushi, Zaitsu Kei, Ishigami Masatoshi, Fujishiro Mitsuhiro, Kawashima Hiroki

HEPATOLOGY INTERNATIONAL 2023年9月

記述言語：英語出版者・発行元：Hepatology International

Background: Elevated bile acid levels have been associated with liver tumors in fatty liver. Ileal bile acid transporter inhibitors may inhibit bile acid absorption in the distal ileum and increase bile acid levels in the colon, potentially decreasing the serum and hepatic bile acid levels. This study aimed to investigate the impact of these factors on liver tumor. Methods: C57BL/6J mice received a one-time intraperitoneal injection of 25-mg/kg diethylnitrosamine. They were fed a choline-deficient high-fat diet for 20 weeks starting from 8 weeks of age, with or without elobixibat (EA Pharma, Tokyo, Japan). Results: Both groups showed liver fat accumulation and fibrosis, with no significant differences between the two groups. However, mice with elobixibat showed fewer liver tumors. The total serum bile acid levels, including free, tauro-conjugated, glyco-conjugated, and tauro-α/β-muricholic acids in the liver, were noticeably reduced following elobixibat treatment. The proportion of gram-positive bacteria in feces was significantly lower in the group treated with elobixibat (5.4%) than in the group without elobixibat (33.7%). Conclusion: Elobixibat suppressed tumor growth by inhibiting bile acid reabsorption, and decreasing total bile acid and primary bile acid levels in the serum and liver. Additionally, the presence of bile acids in the colon may have led to a significant reduction in the proportion of gram-positive bacteria, potentially resulting in decreased secondary bile acid synthesis.

DOI： 10.1007/s12072-023-10581-2

Clinical characteristics of Dieulafoy's lesion in the small bowel diagnosed and treated by double-balloon endoscopy

Nakamura Masanao, Yamamura Takeshi, Maeda Keiko, Sawada Tsunaki, Ishikawa Eri, Furukawa Kazuhiro, Iida Tadashi, Mizutani Yasuyuki, Yamao Kentaro, Ishikawa Takuya, Honda Takashi, Ishigami Masatoshi, Kawashima Hiroki

BMC GASTROENTEROLOGY 23 巻 ( 1 ) 頁： 290 2023年8月

記述言語：英語出版者・発行元：BMC Gastroenterology

Background: Obscure gastrointestinal bleeding refers to bleeding for which the source cannot be ascertained even through balloon-assisted endoscopy. In certain instances, Dieulafoy’s lesion in the small bowel is presumed to be the underlying cause. Aim: This retrospective study aimed to elucidate the clinical characteristics of Dieulafoy’s lesion in the small bowel as diagnosed via double-balloon endoscopy while also exploring the feasibility of predicting bleeding from Dieulafoy’s lesion prior to endoscopy in cases of obscure gastrointestinal bleeding. Methods: A comprehensive analysis of our database was conducted, identifying 38 patients who received a diagnosis of Dieulafoy’s lesion and subsequently underwent treatment via double-balloon endoscopy. The clinical background, diagnosis, and treatment details of patients with Dieulafoy’s lesion were carefully examined. Results: The median age of the 38 patients was 72 years, and 50% of the patients were male. A total of 26 (68%) patients exhibited a high comorbidity index. The upper jejunum and lower ileum were the most frequently reported locations for the occurrence of Dieulafoy’s lesion in the small bowel. The detected Dieulafoy’s lesions exhibited active bleeding (n = 33) and an exposed vessel with plaque on the surface (n = 5). Rebleeding after endoscopic treatment occurred in 8 patients (21%, median period: 7 days, range: 1-366 days). We conducted an analysis to determine the definitive nature of the initial double-balloon endoscopy diagnosis. Multivariate analysis revealed that hematochezia of ≥ 2 episodes constituted the independent factor associated with ≥ 2 double-balloon endoscopy diagnoses. Additionally, we explored factors associated with rebleeding following endoscopic treatment. Although the number of hemoclips utilized displayed a likely association, multivariate analysis did not identify any independent factor associated with rebleeding. Conclusion: If a patient encounters multiple instances of hematochezia, promptly scheduling balloon-assisted endoscopy, equipped with optional instruments without delay is advised, after standard endoscopic evaluation with esophagogastroduodenoscopy and colonoscopy is unrevealing.

DOI： 10.1186/s12876-023-02913-1

Trajectory analyses to identify persistently low responders to COVID-19 vaccination in patients with inflammatory bowel disease: a prospective multicentre controlled study, J-COMBAT

Watanabe Kenji, Nojima Masanori, Nakase Hiroshi, Sato Toshiyuki, Matsuura Minoru, Aoyama Nobuo, Kobayashi Taku, Sakuraba Hirotake, Nishishita Masakazu, Yokoyama Kaoru, Esaki Motohiro, Hirai Fumihito, Nagahori Masakazu, Nanjo Sohachi, Omori Teppei, Tanida Satoshi, Yokoyama Yoshihiro, Moriya Kei, Maemoto Atsuo, Handa Osamu, Ohmiya Naoki, Tsuchiya Kiichiro, Shinzaki Shinichiro, Kato Shingo, Uraoka Toshio, Tanaka Hiroki, Takatsu Noritaka, Nishida Atsushi, Umeno Junji, Nakamura Masanao, Mishima Yoshiyuki, Fujiya Mikihiro, Tsuchida Kenji, Hiraoka Sakiko, Okabe Makoto, Toyonaga Takahiko, Matsuoka Katsuyoshi, Andoh Akira, Hirota Yoshio, Hisamatsu Tadakazu, J COMBAT Study Grp

JOURNAL OF GASTROENTEROLOGY 58 巻 ( 10 ) 頁： 1015 - 1029 2023年8月

記述言語：英語出版者・発行元：Journal of Gastroenterology

Background: The degree of immune response to COVID-19 vaccination in inflammatory bowel disease (IBD) patients based on actual changes in anti-SARS-CoV-2 antibody titres over time is unknown. Methods: Data were prospectively acquired at four predetermined time points before and after two vaccine doses in a multicentre observational controlled study. The primary outcome was humoral immune response and vaccination safety in IBD patients. We performed trajectory analysis to identify the degree of immune response and associated factors in IBD patients compared with controls. Results: Overall, 645 IBD patients and 199 control participants were analysed. At 3 months after the second vaccination, the seronegative proportions were 20.3% (combination of anti-tumour necrosis factor [TNF]α and thiopurine) and 70.0% (triple combination including steroids), despite that 80.0% receiving the triple combination therapy were seropositive at 4 weeks after the second vaccination. Trajectory analyses indicated three degrees of change in immune response over time in IBD patients: high (57.7%), medium (35.6%), and persistently low (6.7%). In the control group, there was only one degree, which corresponded with IBD high responders. Older age, combined anti-TNFα and thiopurine (odds ratio [OR], 37.68; 95% confidence interval [CI], 5.64–251.54), steroids (OR, 21.47; 95%CI, 5.47–84.26), and tofacitinib (OR, 10.66; 95%CI, 1.49–76.31) were factors associated with persistently low response. Allergy history (OR, 0.17; 95%CI, 0.04–0.68) was a negatively associated factor. Adverse reactions after the second vaccination were significantly fewer in IBD than controls (31.0% vs 59.8%; p < 0.001). Conclusions: Most IBD patients showed a sufficient immune response to COVID-19 vaccination regardless of clinical factors. Assessment of changes over time is essential to optimize COVID-19 vaccination, especially in persistently low responders. Graphical abstract: [Figure not available: see fulltext.].

DOI： 10.1007/s00535-023-02029-z

Letter: 1-kestose, the smallest fructooligosaccharide component, protection for mild to moderate ulcerative colitis patients-authors' reply.

Ikegami S, Nakamura M, Honda T, Kawashima H

Alimentary pharmacology & therapeutics 57 巻 ( 11 ) 頁： 1351 - 1352 2023年6月

ENDOSCOPIC TREATMENT OF DUODENAL NEUROENDOCRINE TUMORS

Furukawa Kazuhiro, Furune Satoshi, Ishikawa Eri, Sawada Tsunaki, Maeda Keiko, Yamamura Takeshi, Ishikawa Takuya, Nakamura Masanao, Kawashima Hiroki

GASTROINTESTINAL ENDOSCOPY 97 巻 ( 6 ) 頁： AB1211 - AB1212 2023年6月

Novel endoscopic approaches using the endocytoscopy for the target biopsy in esophageal eosinophilia

Muroi Koichi, Kakushima Naomi, Furukawa Kazuhiro, Furune Satoshi, Ito Nobuhito, Hirose Takashi, Hida Emiko, Suzuki Tomohiko, Suzuki Takahiro, Hirai Keiko, Shibata Hiroyuki, Ishikawa Eri, Sawada Tsunaki, Maeda Keiko, Yamamura Takeshi, Ohno Eizaburo, Nakamura Masanao, Fujishiro Mitsuhiro, Kawashima Hiroki

ESOPHAGUS 20 巻 ( 2 ) 頁： 325 - 332 2023年4月

記述言語：英語出版者・発行元：Esophagus

Background and aims: Multiple biopsies are recommended for the diagnosis of eosinophilic esophagitis (EoE) because inflammatory changes are frequently patchy. Reports on EoE using endocytoscopy (ECS) are limited. This present study aimed to assess if diagnostic yield improves by adding ECS on conventional white light imaging (WLI) in patients with esophageal eosinophilia (EE). Methods: A total of 284 biopsy specimens from 71 patients with a known diagnosis of EE were enrolled and divided into the WLI group (156 specimens) or the ECS group (128 specimens). Four biopsies from 5 and 10 cm proximal to the esophagogastric junction were taken from each patient. In the ECS group, the biopsy was performed where bilobed nuclei were observed. The biopsy sensitivity for EE, eosinophil count of a single specimen and the biopsy sensitivity of each endoscopic finding were evaluated between both groups. Results: The sensitivity of a single biopsy specimen was higher in the ECS group than that of the WLI group (62.5 vs. 41.7%, P < 0.001). In addition, the median eosinophil count in the ECS group was significantly higher [19 vs. 6.5/high-power field (HPF), P < 0.001]. For each endoscopic finding, ECS-based biopsy had higher sensitivity than that of WLI in the diagnosis of edema (33.1 vs. 11.3%, P = 0.007) and linear furrows (75.8 vs. 52%, P = 0.005). Conclusion: This study showed that adding ECS to WLI improved the biopsy sensitivity and eosinophil detection in patients with EE.

DOI： 10.1007/s10388-022-00963-0

Anxiety and behavioral changes in Japanese patients with inflammatory bowel disease due to COVID-19 pandemic: a national survey

Nakase Hiroshi, Wagatsuma Kohei, Nojima Masanori, Matsumoto Takayuki, Matsuura Minoru, Iijima Hideki, Matsuoka Katsuyoshi, Ohmiya Naoki, Ishihara Shunji, Hirai Fumihito, Takeuchi Ken, Tamura Satoshi, Kinjo Fukunori, Ueno Nobuhiro, Naganuma Makoto, Watanabe Kenji, Moroi Rintaro, Nishimata Nobuaki, Motoya Satoshi, Kurahara Koichi, Takahashi Sakuma, Maemoto Atsuo, Sakuraba Hirotake, Saruta Masayuki, Tominaga Keiichi, Hisabe Takashi, Tanaka Hiroki, Terai Shuji, Hiraoka Sakiko, Takedomi Hironobu, Narimatsu Kazuyuki, Endo Katsuya, Nakamura Masanao, Hisamatsu Tadakazu

JOURNAL OF GASTROENTEROLOGY 58 巻 ( 3 ) 頁： 205 - 216 2023年3月

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

Background: Given the increasing health concerns for patients with inflammatory bowel disease (IBD), amidst the COVID-19 pandemic, we investigated the impact of the pandemic on the anxiety and behavioral changes in Japanese patients with IBD. Methods: We analyzed 3032 questionnaires from patients with IBD, aged 16 years or older visiting 30 hospitals and 1 clinic between March 2020 and June 2021. The primary outcome was the score of the anxiety experienced by patients with IBD during the pandemic. Results: Participants reported a median age of 44 years; 43.3% of the patients were women. Moreover, 60.6% and 39.4% were diagnosed with ulcerative colitis and Crohn’s disease, respectively, with a median disease duration of 10 years. Participants indicated an average of disease-related anxiety score of 5.1 ± 2.5 on a ten-point scale, with a tendency to increase, 1 month after the number of infected persons per population increased. The top three causes for anxiety were the risk of contracting COVID-19 during hospital visits, SARS-CoV-2 infection due to IBD, and infection by IBD medication. Factors associated with anxiety were gender (women), being a homemaker, hospital visit timings, mode of transportation (train), use of immunosuppressive drugs, and nutritional therapy. Most patients continued attending their scheduled hospital visits, taking their medications, experienced the need for a family doctor, and sought guidance and information regarding COVID-19 from primary doctors, television, and Internet news. Conclusions: Patients with IBD experienced moderate disease-related anxiety due to the pandemic and should be proactively informed about infectious diseases to relieve their anxiety.

DOI： 10.1007/s00535-022-01949-6

CO2 enterography in endoscopic retrograde cholangiography using double-balloon endoscopy: A randomized clinical trial 国際誌

Murate Kentaro, Nakamura Masanao, Yamamura Takeshi, Maeda Keiko, Sawada Tsunaki, Ishikawa Eri, Kida Yuichi, Esaki Masaya, Hamazaki Motonobu, Iida Tadashi, Mizutani Yasuyuki, Yamao Kentaro, Ishikawa Takuya, Furukawa Kazuhiro, Ohno Eizaburo, Honda Takashi, Ishigami Masatoshi, Kinoshita Fumie, Ando Masahiko, Kawashima Hiroki

JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY 38 巻 ( 5 ) 頁： 761 - 767 2023年1月

記述言語：英語掲載種別：研究論文（学術雑誌）出版者・発行元：Journal of Gastroenterology and Hepatology (Australia)

Background and Aim: Double-balloon endoscopic retrograde cholangiography (DBERC) is a valuable procedure for patients with altered gastrointestinal anatomy. Nonetheless, it is time-consuming and burdensome for both patients and endoscopists, partly because route selection in the reconstructed bowel with complicating loop is challenging. Carbon dioxide insufflation enterography is reportedly useful for route selection in the blind loop. This prospective randomized clinical trial investigated the usefulness of carbon dioxide insufflation enterography for route selection by comparing it with conventional observation. Methods: Patients scheduled to undergo DBERC were consecutively registered. They were divided into carbon dioxide insufflation enterography and conventional groups via randomization according to stratification factors, type of reconstruction methods, and experience with DBERC. The primary endpoint was the correct rate of initial route selection. The secondary endpoints were the insertion time, examination time, amount of anesthesia drugs, and complications. Results: The correct rate of route selection was significantly higher in the carbon dioxide insufflation enterography group (23/25, 92%) than in the visual method (15/25, 60%) (P = 0.018). The insertion time was significantly shorter in the carbon dioxide insufflation enterography group than in the visual group (10.8 ± 11.1 min vs 29.8 ± 15.7 min; P < 0.001). No significant differences in complications were noted between the two groups. The amounts of sedatives and analgesics used were significantly lower in the carbon dioxide insufflation enterography group (P < 0.001 and P < 0.001, respectively). Conclusions: Carbon dioxide insufflation enterography can reduce the burden of DBERC on patients and endoscopists by shortening the examination time and reducing the amount of medication.

DOI： 10.1111/jgh.16112

Kawamura Tatsuya, Hirose Takashi, Kakushima Naomi, Furukawa Kazuhiro, Furune Satoshi, Ishikawa Eri, Sawada Tsunaki, Keiko Maeda, Yamamura Takeshi, Ishikawa Takuya, Ohno Eizaburo, Nakamura Masanao, Honda Takashi, Ishigami Masatoshi, Kawashima Hiroki, Fujishiro Mitsuhiro

DIGESTIVE DISEASES 41 巻 ( 1 ) 頁： 80 - 88 2023年1月

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

Introduction: Endoscopic submucosal dissection for duodenal neoplasms (D-ESD) is considered a technically demanding procedure regarding the high risk of delayed adverse events. Data regarding optimal managements of ulcers after D-ESD are lacking. Methods: A retrospective analysis was performed on consecutive 145 cases of D-ESD for superficial nonampullary duodenal epithelial tumors at a single referral center. Factors related to delayed adverse events and the healing process of ulcers after D-ESD were analyzed. Results: Complete ulcer suture after D-ESD was performed in 128 cases (88%). Two delayed perforation occurred among cases with incomplete suture. Delayed bleeding occurred in 8 cases (6%) within 3 weeks. The ulcer closure rate at second-look endoscopy (SLE) was significantly low among cases with delayed bleeding (12.5% vs. 75%, p = 0.001). The bleeding rate before SLE was significantly high among patients who did not have complete ulcer closure after D-ESD (0.8% vs. 12%, p = 0.036). The ratio of lesions located in the second oral-Vater was significantly low among ulcers re-opened at SLE (38% vs. 14%, p = 0.044). Proton-pump inhibitors (PPIs) were administered for a median of 7 weeks (range 1-8 weeks). At 3 weeks, active ulcer stages were observed in a few cases, and healing or scarring was observed in most cases. Conclusions: Complete ulcer suture was related to decreased risk of delayed adverse events after D-ESD. From the bleeding period and healing process of D-ESD ulcers, the minimum required length of PPI may be 3 weeks after D-ESD.

DOI： 10.1159/000522362

Differences in the Intestinal Microbiome Associated with Diarrhea during Lenvatinib Treatment for Hepatocellular Carcinoma

Inukai Yosuke, Yamamoto Kenta, Honda Takashi, Ito Takanori, Imai Norihiro, Ishizu Yoji, Nakamura Masanao, Kawashima Hiroki, Ishigami Masatoshi

DIGESTIVE DISEASES 41 巻 ( 1 ) 頁： 138 - 147 2023年1月

記述言語：英語出版者・発行元：Digestive Diseases

Introduction: Lenvatinib has been widely used for the treatment of advanced hepatocellular carcinoma (HCC). Some adverse events, including diarrhea, have been reported for lenvatinib. Diarrhea may be associated with the changes in the intestinal microbiome; however, the underlying mechanism has not been elucidated. Aim: In this study, we aimed to investigate the relationship between the intestinal microbiome and diarrhea caused by lenvatinib via analysis of fecal samples collected before treatment. Methods: A total of 21 patients with advanced HCC who were treated with lenvatinib were enrolled. Fecal samples were collected from patients. The patients were divided into diarrhea (n = 8) and nondiarrhea groups (n = 12). We compared the characteristics of patients, incidence of adverse events, composition of the intestinal microbiome, and enrichment of functional pathways between both groups using QIIME2 and PICRUSt2. Results: The median age of the two groups was 73 years. The nondiarrhea group comprised a relatively higher number of male patients than the diarrhea group; however, there were no significant differences in patient characteristics between both groups. The proportion of the microbiome was similar, and alpha and beta diversities were not significantly different between both groups. The relative abundance of order Bacteroidales, including Parabacteroides and Prevotella, was higher in the diarrhea group than in the nondiarrhea group. PICRUSt2 analysis showed some metabolic pathways, including butanoate (butyrate) metabolism, were enriched in the nondiarrhea group when compared with those in the diarrhea group. Conclusion: Differences in the intestinal microbiomes and their functions may influence the incidence of diarrhea during lenvatinib treatment.

DOI： 10.1159/000524298

Current status of transanal total mesorectal excision for rectal cancer and the expanding indications of the transanal approach for extended pelvic surgeries 国際誌

Uehara Kay, Ogura Atsushi, Murata Yuki, Sando Masanori, Mukai Toshiki, Aiba Toshisada, Yamamura Takeshi, Nakamura Masanao

DIGESTIVE ENDOSCOPY 35 巻 ( 2 ) 頁： 243 - 254 2023年1月

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

Transanal total mesorectal excision (taTME) has been rapidly accepted as a promising surgical approach to the distal rectum. The benefits include ease of access to the bottom of the deep pelvis linearly over a short distance in order to easily visualize the important anatomy. Furthermore, the distal resection margins can be secured under direct vision. Additionally, a two-team approach combining taTME with a transabdominal approach could decrease the operative time and conversion rate. Although taTME was expected to become more rapidly popularized worldwide, enthusiasm for it has stalled due to unfamiliar intraoperative complications, a lack of oncologic evidence from randomized trials, and the widespread use of robotic surgery. While international registries have reported favorable short- and medium-term outcomes from taTME, a Norwegian national study reported a high local recurrence rate of 9.5%. The characteristics of the recurrences included rapid, multifocal growth in the pelvis, which was quite different from recurrences following traditional transabdominal TME; thus, the Norwegian Colorectal Cancer Group reached a consensus for a temporary moratorium on the performance of taTME. To ensure acceptable baseline quality and patient safety, taTME should be performed by well-trained colorectal surgeons. Although the appropriate indications for taTME remain controversial, the transanal approach is extremely important as a means of goal setting in difficult TME cases and as an aid to the transabdominal approach in various types of extended pelvic surgeries. The benefits in transanal lateral lymph node dissection and pelvic exenteration are presented herein.

DOI： 10.1111/den.14464

パテンシーカプセルによる腸管通過可否はクローン病寛解患者の新たな長期予後予測因子となる

中村正直

日本消化器内視鏡学会雑誌 65 巻 ( 10 ) 頁： 2249 - 2249 2023年

記述言語：日本語出版者・発行元：一般社団法人日本消化器内視鏡学会

【背景】パテンシーカプセル（patency capsule：PC）は，小腸カプセル内視鏡（capsule endoscopy：CE）の前に小腸の狭窄を除外するために推奨される検査法である．われわれはPCが不通過であった患者と通過した患者の長期の臨床転帰を調査し，その長期予後を比較検討した．【方法】寛解期の小腸クローン病（Crohn’s disease：CD）の成人患者を対象とした２つの前向きコホート研究の事後解析を行った．論文内では2013年から2020年の間にPCを受けたCD患者を対象としていた．主要アウトカムはフォローアップ期間中の腸管手術または内視鏡拡張術の必要性であった．【結果】合計190名の患者が選択された（47名：PC不通過，143名：PC通過，フォローアップ期間中央値34.12カ月）．PCが不通過であった患者では，主要アウトカムの発生率が高かった（21.3％ vs 1.4％，ハザード比［HR］ 20.3，95％信頼区間［CI］4.4-93.7，P＜0.001）．各々の調査項目についても，PC不通過では腸管手術（14.9％ vs 0.70％，P＜0.001），内視鏡的拡張術（14.9％ vs 0.70％，P＜0.001），入院（23.3％ vs 5.7％，P＜0.001），臨床的再燃（43.9％ vs 27.7％，P＝0.005）の割合が高かった．PC不通過はその後の腸管手術，内視鏡的拡張術の統計学的に唯一の独立した有意な因子として挙げられた．190名のうちPC不通過の１名で自制内の腹部症状の自覚が48時間あった．【結論】寛解期CD患者であってもPCが不通過であれば，そうでない患者よりも長期的な臨床転帰が悪化する．PC自体が安全で安価な新規の予後判定検査として有用であるかもしれない．

DOI： 10.11280/gee.65.2249