Faculty Profiles - NAKAMURA, Masanao

Papers - NAKAMURA, Masanao

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DETECTION OF COLORECTAL POLYP USING IMAGED-ENHANCED ENDOSCOPY

YAMAMURA Takeshi, NAKAMURA Masanao, KAWASHIMA Hiroki

GASTROENTEROLOGICAL ENDOSCOPY Vol. 65 ( 1 ) page： 63 - 75 2023

Language：Japanese Publisher：Japan Gastroenterological Endoscopy Society

<p>Studies report that endoscopic resection of adenomatous polyps lowers the risk of colorectal cancer (CRC) and death. Therefore, colonoscopy plays a key role in preventing CRCs. In addition, high-quality colonoscopy is required to fulfill its role effectively and improve the adenoma detection rate for endoscopists. In contrast, since most post-colonoscopy CRCs (PCCRC) are caused by missed lesions, missed lesions as well as new lesions should be evaluated henceforth. Imaged-enhanced endoscopy (IEE) utilizing the optical digital method can be performed with a single click without using other devices or staining. Recent advances in endoscopic technology and the development of new IEEs have demonstrated the usefulness of IEEs in the detection and prevention of missed lesions in addition to their characterization. In this article, we describe the current state of colorectal polyp detection as well as the procedure and evidence for IEE observation during a colonoscopy. It is necessary to pursue the optimal observation method using IEE.</p>

DOI： 10.11280/gee.65.63

TISSUE SAMPLING METHODS FOR GASTRIC SUBEPITHELIAL TUMORS

FURUKAWA Kazuhiro, NAKAMURA Masanao, KAWASHIMA Hiroki

GASTROENTEROLOGICAL ENDOSCOPY Vol. 65 ( 3 ) page： 214 - 228 2023

Language：Japanese Publisher：Japan Gastroenterological Endoscopy Society

<p>Gastric subepithelial tumors (SET) represent one of the most frequently encountered lesions during routine endoscopy. Although EUS is essential for diagnosis of SET, EUS alone cannot accurately diagnose mesenchymal tumors. Histopathological evaluation and immunohistochemical analysis are essential to conclusively diagnose SET; therefore, various tissue collection techniques such as a boring biopsy, endoscopic ultrasound-guided fine needle aspiration/biopsy (EUS-FNA/B), and mucosal incision-assisted biopsy (MIAB) are used in clinical practice. In this article, we present an overview of EUS-FNA/B and MIAB for gastric SET, focused on the findings of current clinical research in this field.</p>

DOI： 10.11280/gee.65.214

MODIFIED N SCORE IS HELPFUL FOR IDENTIFYING PATIENTS WHO NEED ENDOSCOPIC INTERVENTION AMONG THOSE WITH BLACK STOOLS WITHOUT HEMATEMESIS

ITO Nobuhito, FUNASAKA Kohei, FUJIYOSHI Toshihisa, FURUKAWA Kazuhiro, KAKUSHIMA Naomi, FURUNE Satoshi, ISHIKAWA Eri, MIZUTANI Yasuyuki, SAWADA Tsunaki, MAEDA Keiko, ISHIKAWA Takuya, YAMAMURA Takeshi, OHNO Eizaburo, NAKAMURA Masanao, KAWASHIMA Hiroki, MIYAHARA Ryoji, HIROOKA Yoshiki, HARUTA Jun-Ichi, FUJISHIRO Mitsuhiro

GASTROENTEROLOGICAL ENDOSCOPY Vol. 65 ( 6 ) page： 1165 - 1174 2023

Language：Japanese Publisher：Japan Gastroenterological Endoscopy Society

<p>Objectives: Although black stools are one of the signs of upper gastrointestinal bleeding, not all patients without hematemesis need endoscopic intervention. There is no apparent indicator to select who needs treatment thus far. The aim of this study was to establish a novel score that predicts the need for endoscopic intervention in patients with black stools without hematemesis.</p><p>Methods: We retrospectively enrolled 721 consecutive patients with black stools without hematemesis who underwent emergency endoscopy from two facilities. In the development stage (from January 2016 to December 2018), risk factors that predict the need for endoscopic intervention were determined from the data of 422 patients by multivariate logistic regression analysis, and a novel scoring system, named the modified Nagoya University score (modified N score), was developed. In the validation stage (from January 2019 to September 2020), we evaluated the diagnostic value of the modified N score for 299 patients.</p><p>Results: Multivariate logistic regression analysis revealed four predictive factors for endoscopic intervention: syncope, the blood urea nitrogen (BUN) level, and the BUN/creatinine ratio as positive indicators and anticoagulant drug use as a negative indicator. In the validation stage, the area under the curve of the modified N score was 0.731, and the modified N score showed a sensitivity of 82.0% and a specificity of 58.8%.</p><p>Conclusions: Our modified N score, which consists of only four factors, can identify patients who need endoscopic intervention among those with black stools without hematemesis.</p>

DOI： 10.11280/gee.65.1165

SMALL INTESTINAL GANGLIONEUROMATOSIS IN A PATIENT WITH NEUROFIBROMATOSIS TYPE 1: A CASE REPORT

KIDA Yuichi, SAWADA Tsunaki, ISHIKAWA Eri, SAKAKIBARA Ayako, YAMAMURA Takeshi, MAEDA Keiko, ESAKI Masaya, HAMAZAKI Motonobu, MURATE Kentaro, NAKAMURA Masanao

GASTROENTEROLOGICAL ENDOSCOPY Vol. 65 ( 7 ) page： 1232 - 1238 2023

Language：Japanese Publisher：Japan Gastroenterological Endoscopy Society

<p>A 50-year-old woman with neurofibromatosis type 1 who hospitalized for chronic diarrhea was transferred to our hospital for evaluation of small intestinal dilatation and thickening. Transoral double-balloon enteroscopy revealed jejunal dilatation and suppressed peristalsis; however, mucosal inflammation, such as ulcers or erosions were not detected. Transanal double-balloon enteroscopy detected the intestinal stenosis with inflammatory polyps and a longitudinal ulcer. Histopathological evaluation of duodenal, jejunal, and ileal specimens by biopsy revealed ganglion cells and Schwannian cells; therefore, the patient was diagnosed with ganglioneuromatosis with neurofibromatosis type 1. Small intestinal dilatation was associated with suppressed peristalsis caused by ganglioneuromatosis and was diagnosed as secondary chronic intestinal pseudo-obstruction. Abdominal distention persisted despite conservative therapy. However, she remained asymptomatic, and oral intake remained unaffected. Ganglioneuromatosis is rare; however, clinicians should be mindful that ganglioneuromatosis is an abdominal complication associated with systemic disease such as neurofibromatosis type 1 and multiple endocrine neoplasia type 2B.</p>

DOI： 10.11280/gee.65.1232

名古屋大学医学部附属病院消化器内科光学医療診療部

川嶋啓揮, 中村正直

日本消化器内視鏡学会雑誌 Vol. 65 ( 9 ) page： 1493 - 1497 2023

Real-world effectiveness of ustekinumab for patients with ulcerative colitis: a systematic review and meta-analysis

Uchida G., Nakamura M., Yamamura T., Tsuzuki T., Kawashima H.

Nagoya Journal of Medical Science Vol. 85 ( 3 ) page： 402 - 427 2023

Publisher：Nagoya Journal of Medical Science

Ustekinumab has recently been approved for the treatment of ulcerative colitis (UC) based on data from clinical trials. However, the effectiveness of ustekinumab in patients with UC in a real-world setting remains unclear. Hence, in this meta-analysis, we aimed to evaluate the effectiveness of ustekinumab in a real-world setting and to investigate the predictors of its effectiveness. A comprehensive literature search was performed to examine the effectiveness of ustekinumab in UC patients admitted between January 2019 and December 2021. Data on clinical remission, response, and corticosteroid-free clinical remission rates were extracted, pooled, and analyzed. Meta-regression analysis was performed to investigate the source of heterogeneity and the impact of moderators on the outcomes of interest. A total of 14 eligible studies were identified. The pooled clinical remission rate was 55.0% at week 8, 36.1% at week 16, 46.6% at month 6, and 38.6% at month 12. The meta-regression analysis showed that prior use of anti-tumor necrosis factor (TNF) agents and vedolizumab and the publication style were significant moderators. Additionally, out of 258 patients, there were 28 adverse events (AEs) (10.9%). The effectiveness of ustekinumab in real-world patients with UC was consistent with the results clinical trials. Moreover, previous treatment with anti-TNF agents and vedolizumab might have affected the effectiveness of ustekinumab.

DOI： 10.18999/nagjms.85.3.402

特集消化管内視鏡治療のリスク克服に向けて 1.待機的内視鏡治療に潜むリスクとそのマネジメント(6)大腸EMR/ESD

山村健史, 中村正直, 前田啓子, 澤田つな騎, 石川恵里, 古川和宏, 川嶋啓揮

臨床消化器内科 Vol. 38 ( 1 ) page： 42 - 47 2022.12

Network Analysis of Gut Microbiota Including <i>Fusobacterium</i> and Oral Origin Bacteria and Their Distribution on Tumor Surface, Normal Mucosa, and in Feces in Patients with Colorectal Cancer

Ohashi Ayako, Yamamura Takeshi, Nakamura Masanao, Maeda Keiko, Sawada Tsunaki, Ishikawa Eri, Yamamoto Kenta, Ishikawa Takuya, Kakushima Naomi, Furukawa Kazuhiro, Ohno Eizaburo, Honda Takashi, Kawashima Hiroki, Ishigami Masatoshi, Fujishiro Mitsuhiro

DIGESTION Vol. 103 ( 6 ) page： 451 - 461 2022.12

Language：English Publisher：Digestion

Introduction: Fusobacterium and several bacteria are reported to be associated with colorectal cancer (CRC). However, their relationship and whether they cause CRC or are just adapted to the cancerous environment is not known. We approached this subject by investigating the correlation and distribution of the bacteria throughout the colon in patients with CRC and elucidated the relationship between microbiota and CRC. Methods: Twenty-five patients with CRC who underwent colonoscopy for endoscopic submucosal dissection or surgery were prospectively enrolled. Fecal samples were taken before bowel preparation, and mucosal samples were collected from three sites (tumor surface, tumor-adjacent mucosa, and cecum) during colonoscopy using a cytology brush. The microbiota was identified and analyzed by sequencing of the 16S rRNA gene of the V3-V4 region. We evaluated the correlation between the bacteria based on network analysis and the distribution of Fusobacterium in the colon. Results: A network consisting of many bacteria was found in all sites; especially, oral origin bacteria including Fusobacterium formed a positively correlated network on tumor surface. Streptococcus showed a significantly higher relative abundance on tumor surface than in feces. The relative abundance of Fusobacterium had significant positive correlations between tumor surface and feces, tumor-adjacent mucosa, and cecum. Conclusion: In patients with CRC, many bacteria were correlated with each other, and Fusobacterium and oral origin bacteria formed a positively correlated network on tumor surface. Fusobacterium was equally distributed on tumor surface and throughout the lumen and mucus in the colon. In the colon where Fusobacterium is widely distributed, Fusobacterium would adhere to the tumor surface and be correlated with oral origin bacteria to make a microenvironment that is favorable for CRC.

DOI： 10.1159/000527170

The effects of ustekinumab on small intestinal lesions and stenotic lesions

Wada Hirotaka, Murate Kentaro, Nakamura Masanao, Furukawa Kazuhiro, Kakushima Naomi, Yamamura Takeshi, Maeda Keiko, Sawada Tsunaki, Ishikawa Eri, Ishikawa Takuya, Ohno Eizaburo, Honda Takashi, Kawashima Hiroki, Nakayama Goro, Hattori Norifumi, Umeda Shinichi, Ishigami Masatoshi

NAGOYA JOURNAL OF MEDICAL SCIENCE Vol. 84 ( 4 ) page： 825 - 838 2022.11

Language：English Publisher：Nagoya Journal of Medical Science

Crohn’s disease patients suffer from symptoms originating from small bowel lesions, including strictures. As many of these patients also have a potential risk of surgery, it is important to consider various therapeutic strategies for small bowel lesions. We retrospectively analyzed the therapeutic effects of ustekinumab, interleukin-12 and -23 blocker, for small intestinal lesions and intestinal stenosis in order to contribute to the optimal management of Crohn’s disease. Patients who underwent total colonoscopy or small bowel endoscopy before and after the introduction of ustekinumab were enrolled in this study. The colonoscopy findings were evaluated by the simple endoscopic score for Crohn’s disease, and small bowel endoscopy findings were evaluated using the modified simple endoscopic score for Crohn’s disease. Endoscopic scores were compared before and after the introduction of ustekinumab and between the responders and non-responders to ustekinumab. Responders were defined as those whose Crohn’s disease activity index score at 24 weeks fell below 150 points, or those whose score decreased by more than 100 points from the pre-induction level. A total of 50 patients were enrolled in the study, and the number of responders was 35. Pre-induction simple endoscopic scores were lower for responders, but no significant difference was observed in the modified simple endoscopic scores. The total decrease in the endoscopic score was significantly higher in the responders for both the small and large intestine. Use of ustekinumab as a first-line treatment for patients with small bowel lesions or stricture-prone lesions may be a new treatment consideration in the future.

DOI： 10.18999/nagjms.84.4.825

Analysis of immunologic comorbidities in ulcerative colitis patients: a tool to prevent exacerbations in ulcerative colitis cases

Meza Miguel Ricardo Rodriguez, Nakamura Masanao, Yamamura Takeshi, Maeda Keiko, Sawada Tsunaki, Ishikawa Eri, Kakushima Naomi, Furukawa Kazuhiro, Iida Tadashi, Mizutani Yasuyuki, Ishikawa Takuya, Ohno Eizaburo, Honda Takashi, Kawashima Hiroki, Ishigami Masatoshi

NAGOYA JOURNAL OF MEDICAL SCIENCE Vol. 84 ( 4 ) page： 733 - 745 2022.11

Language：English Publisher：Nagoya Journal of Medical Science

There have been previous studies, especially in Western countries and even in some areas in Asia, about extra-intestinal manifestations (EIMs) and its link with the outcome of inflammatory bowel disease (IBD), which includes Crohn’s disease (CD), and ulcerative colitis (UC). This link is crucial when discussing a patient’s prognosis and important when dealing with UC management. The aim of this study was to clarify the most common comorbidities associated with UC, emphasizing immunologic comorbidities in Japan. This study was a retrospective analysis performed at Nagoya University Hospital. The data collection started in March, 2019, and continued for two years. We retrieved the medical records of 105 patients with UC diagnosis, from which the data of 176 EIMs were extracted and analyzed. Results showed that EIMs with UC in the active phase accounted for 43.7% of total EIMs. Twenty-six patients with immune-mediated inflammatory disease frequently had an active phase (odds ratio [OR] 3.84, 99% CI, 1.44–10.27). Comorbidities showing an active manifestation of symptoms and UC in the active phase were significantly correlated in patients with immunological comorbidities, such as peripheral arthritis (r = 0.97, p < 0.01) and rheumatoid arthritis (RA) (r = 0.99, p < 0.01), as well as in patients with primary sclerosis cholangitis (PSC) (r = 0.98, p < 0.01). In conclusion, this analysis suggests the importance of having full comprehension of how immunological comorbidities affect the natural development of UC, which is of vital importance to prevent further UC complications and properly adjust the management of the disease.

DOI： 10.18999/nagjms.84.4.733

An improved method to assess skeletal muscle mass in patients with liver cirrhosis based on computed tomography images

Sugiyama Yoshiaki, Ishizu Yoji, Ando Yusuke, Yokoyama Shinya, Yamamoto Kenta, Ito Takanori, Imai Norihiro, Nakamura Masanao, Honda Takashi, Kawashima Hiroki, Ishikawa Tetsuya, Ishigami Masatoshi

HEPATOLOGY RESEARCH Vol. 52 ( 11 ) page： 937 - 946 2022.11

Language：English Publisher：Hepatology Research

Aim: Conventionally, the skeletal muscle area with computed tomography (CT) attenuation ranging from −29 to +150 Hounsfield unit (HU) divided by height squared (the conventional skeletal muscle index [SMI]) was used as an index of skeletal muscle mass. However, it includes fat-infiltrated skeletal muscle, which is known to have poor function. This study aims to determine whether the low-fat SMI, which uses skeletal muscle mass with CT attenuation ranging from +30 to +150 HU, or conventional SMI appropriately reflects the function of skeletal muscle. Methods: We retrospectively analyzed 120 patients with cirrhosis whose handgrip strength was measured. Among them, 48 patients underwent a physical performance assessment such as liver frailty index (LFI) and short physical performance battery (SPPB), and 80 underwent quality of life (QOL) assessment. The relationships between each SMI and handgrip strength, LFI, SPPB, and QOL were evaluated. Results: Low-fat SMI was significantly correlated with handgrip strength (males, R = 0.393, p = 0.002; females, R = 0.423, p < 0.001) and LFI (males, R = −0.535, p = 0.035; females, R = −0.368, p = 0.039), whereas conventional SMI was not. When using low-fat SMI, patients with low skeletal muscle mass had significantly low handgrip strength, LFI, SPPB, and physical and social-related QOL score than those without. By contrast, no significant differences were found for any items when using conventional SMI. Conclusions: Low-fat SMI is a good index of skeletal muscle mass that appropriately reflects skeletal muscle function.

DOI： 10.1111/hepr.13820

The role of EUS elastography-guided fine needle biopsy in the histological diagnosis of solid pancreatic lesions: a prospective exploratory study

Ohno Eizaburo, Kawashima Hiroki, Ishikawa Takuya, Mizutani Yasuyuki, Iida Tadashi, Nishio Ryo, Uetsuki Kota, Yashika Jun, Yamada Kenta, Yoshikawa Masakatsu, Gibo Noriaki, Aoki Toshinori, Kataoka Kunio, Mori Hiroshi, Takada Yoshihisa, Aoi Hironori, Takahashi Hidekazu, Yamamura Takeshi, Furukawa Kazuhiro, Nakamura Masanao, Shimoyama Yoshie, Hirooka Yoshiki, Fujishiro Mitsuhiro

SCIENTIFIC REPORTS Vol. 12 ( 1 ) page： 16603 2022.10

Language：English Publisher：Scientific Reports

This study aimed to evaluate the feasibility and efficacy of Endoscopic ultrasound elastography-guided fine needle biopsy (EUS-EG-FNB) for the diagnosis of pancreatic mass lesions. EUS-EG images were classified into heterogeneous and homogeneous groups. For the heterogeneous group, EUS-FNB was separately performed in both hard areas and soft areas. Only samples obtained during the first two passes (hard/soft areas) were used to compare the diagnostic accuracy as well as the quality and quantity of the specimens. We investigated the association of EUS-EG findings using strain histogram analysis with the histological findings. Fifty-five patients were enrolled including 25 patients with heterogeneous group. The homogeneous group had significantly lower mean strain value (hard) lesions. The adequate sampling rates from hard and soft areas were 88 and 92%, respectively (P = 0.6374). Comparison of the diagnostic accuracy and the quality and quantity of the histological core between hard and soft areas showed no significant differences. In pancreatic adenocarcinoma cases, the proportion of fibrous stroma in the core tissue was significantly correlated with the elasticity of the region. (R2 = 0.1226: P = 0.0022) EUS-EG may reflect tissue composition in pancreatic tumors, however, EUS-EG did not affect either the quality and quantity of the tissues obtained. Clinical Trial Registry No: UMIN-000033073.

DOI： 10.1038/s41598-022-21178-4

Author Correction: Variability measurements provide additional value to shear wave elastography in the diagnosis of pancreatic cancer.

Yoshikawa M, Ishikawa T, Ohno E, Iida T, Furukawa K, Nakamura M, Honda T, Ishigami M, Kinoshita F, Kawashima H, Fujishiro M

Scientific reports Vol. 12 ( 1 ) page： 16190 2022.9

Language：English Publisher：Scientific Reports

The original version of this Article contained an error. In the Materials and methods section, under the subheading ‘Study design’, the approval number of the Ethics Committee was incorrect. As a result, “The study was conducted with the approval of the Ethics Committee of Nagoya University Hospital and enrolled in the jRCT (CRB4180004).” now reads: “The study was conducted with the approval of the Ethics Committee of Nagoya University Hospital (approval number: 2014-0399).” The original Article has been corrected.

DOI： 10.1038/s41598-022-21219-y

特集消化管EUSのすべて [各論　上部消化管疾患のEUS診療] 《TOPICS》EUSエラストグラフィーによる上部消化管疾患の診断

丸川高弘, 古川和宏, 中村正直, 川嶋啓揮

消化器内視鏡 Vol. 34 ( 9 ) page： 1497 - 1499 2022.9

Examination of Abnormal Alpha-synuclein Aggregates in the Enteric Neural Plexus in Patients with Ulcerative Colitis

Gibo Noriaki, Hamaguchi Tomonari, Miki Yasuo, Yamamura Takeshi, Nakaguro Masato, Ito Mikako, Nakamura Masanao, Kawashima Hiroki, Hirayama Masaaki, Hirooka Yoshiki, Wakabayashi Koichi, Ohno Kinji

JOURNAL OF GASTROINTESTINAL AND LIVER DISEASES Vol. 31 ( 3 ) page： 290 - 300 2022.9

Publisher：Journal of Gastrointestinal and Liver Diseases

Background & Aims: Parkinson’s disease (PD) is the second most neurodegenerative disease after Alzheimer’s disease. Accumulating knowledge points to the notion that abnormal aggregation of alpha-synuclein (αSyn) starts in the gut and ascends to the substantia nigra via the vagus nerve in about a half of PD patients. Epidemiological studies revealed that ulcerative colitis (UC) increased the a risk for PD 1.3 to 1.8-folds. However, it remains unknown whether αSyn is abnormally aggregated in the enteric neurons in UC patients. Methods: We first inspected and optimized the immunostaining protocols with an anti-phosphorylated αSyn antibody, pSyn#64, using the brain and the gut of eight autopsied cases (five with PD and three without PD). Then, we examined abnormal αSyn aggregation in the enteric neurons in 23 and 18 colectomized patients with and without UC, respectively. Five or more sections were stained for αSyn in each of 87 and 25 paraffin-embedded blocks in patients with and without UC, respectively. Results: Ten different protocols of epitope exposure appropriately stained aggregated αSyn in the brain, but only a complete lack of epitope exposure stained aggregated αSyn in the colon with low background. Abnormal αSyn aggregates, which was confirmed by co-localization of p62, in the enteric neurons were detected in a single patient with UC but in no patient without UC. Conclusions: Omission of epitope exposure enabled us to immunostain aggregated αSyn in the colon by pSyn#64 with low nonspecific staining, but the number of 23 UC patients was not high enough to discern whether abnormal αSyn aggregation in the colonic neural plexus was increased in UC or not.

DOI： 10.15403/jgld-4313

Endoscopic management of perihilar cholangiocarcinoma

Kawashima Hiroki, Ohno Eizaburo, Ishikawa Takuya, Mizutani Yasuyuki, Iida Tadashi, Yamamura Takeshi, Kakushima Naomi, Furukawa Kazuhiro, Nakamura Masanao

DIGESTIVE ENDOSCOPY Vol. 34 ( 6 ) page： 1147 - 1156 2022.9

Language：English Publisher：Digestive Endoscopy

Endoscopic management for perihilar cholangiocarcinoma (PHCC) is evolving toward more accurate diagnosis and safer drainage. In imaging, it is important to diagnose the entire lesion using multidetector-row computed tomography to determine resectability and optimal surgical planning, followed by local diagnosis using endoscopic retrograde cholangiopancreatography. Video peroral cholangioscopy and probe-based confocal laser endomicroscopy have been newly introduced as diagnostic imaging methods and are being applied clinically. In transpapillary forceps biopsy for PHCC diagnosis, the location in the bile duct (for mapping biopsy) and the number of biopsy samples should be determined depending on resectability, the morphological type, and future surgical planning. Preoperative drainage has shifted from percutaneous transhepatic biliary drainage to endoscopic nasobiliary drainage given the possibility of seeding metastasis. In addition, considering potential patient discomfort from a nasal tube, the usefulness of the placement of a plastic stent above the papilla (inside stent) as a bridging therapy for surgery has been reported. For drainage of unresectable PHCC, the improved prognosis due to advances in chemotherapy has necessitated a strategy that accounts for reintervention. Thus, in addition to uncovered self-expandable metallic stents (SEMS), exchangeable slim fully covered SEMS and inside stents have started to be used. In addition to the conventional transpapillary approach, an endoscopic ultrasonography-guided approach has been introduced, and a combination of both methods has also been proposed. To improve the quality of life and prognosis of PHCC patients, endoscopists need to understand and be able to use the various methods of endoscopic management for PHCC.

DOI： 10.1111/den.14317

Comparison of outcomes between secondary fully covered and uncovered self-expandable metal stents in the treatment of recurrent biliary obstruction of pancreatic cancer

Kataoka Kunio, Kawashima Hiroki, Ohno Eizaburo, Ishikawa Takuya, Mizutani Yasuyuki, Iida Tadashi, Furukawa Kazuhiro, Nakamura Masanao, Honda Takashi, Ishigami Masatoshi, Fujishiro Mitsuhiro

SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES Vol. 36 ( 8 ) page： 5676 - 5683 2022.8

Language：English Publisher：Surgical Endoscopy

Background: The overall survival (OS) of pancreatic cancer (PC) has been prolonged by advances in chemotherapy, and the number of cases of recurrent biliary obstruction (RBO) after self-expandable metal stent (SEMS) placement is expected to increase. We herein compared outcomes between secondary fully covered SEMS (FC) and uncovered SEMS (UC) for RBO of PC with FC placed as the 1st SEMS. Methods: Between May 2010 and March 2021, 62 PC patients who underwent SEMS exchange to FC (n = 34) or UC (n = 28) for RBO were retrospectively analyzed. Patient characteristics, OS, time to RBO (TRBO), and stent-related adverse events were compared between the FC and UC groups. Cox’s proportional hazard model was used to identify risk factors for RBO with the 2nd SEMS. Results: There was a significant difference between the FC and UC groups only in the 2nd SEMS diameter. Median OS and TRBO were 195 and 238 days in FC patients and 306 and 455 days in UC patients, respectively, with no significant differences between the two groups. No significant differences were observed in the stent-related adverse event rate. In multivariate analyses, only the 2nd SEMS diameter was significant (P = 0.009). Median TRBO were 455, 238, and 103 days in 10-mm UC, 10-mm FC, and 8-mm UC patients, with 10-mm UC patients having significantly longer TRBO than 10-mm FC and 8-mm UC patients (P = 0.020 and 0.001). Conclusion: SEMS exchange to 10-mm UC may be appropriate for RBO of PC with FC as the 1st SEMS.

DOI： 10.1007/s00464-021-08981-2

特集症例から学ぶ胃ESD-改訂ガイドラインwith and beyond- [各論　痛恨の症例から学ぶ] 胃ESD後狭窄および蠕動障害の管理

室井航一, 角嶋直美, 鈴木孝弘, 鈴木智彦, 廣瀬崇, 伊藤信仁, 古根聡, 古川和宏, 中村正直

消化器内視鏡 Vol. 34 ( 7 ) page： 1212 - 1216 2022.7

Endoscopic sphincterotomy and endoscopic biliary stenting do not affect the sensitivity of transpapillary forceps biopsy for the diagnosis of bile duct adenocarcinoma. International journal

Toshinori Aoki, Eizaburo Ohno, Takuya Ishikawa, Yasuyuki Mizutani, Tadashi Iida, Kentaro Yamao, Takeshi Yamamura, Kazuhiro Furukawa, Masanao Nakamura, Takashi Honda, Masatoshi Ishigami, Hiroshi Yatsuya, Hiroki Kawashima

BMC gastroenterology Vol. 22 ( 1 ) page： 329 - 329 2022.7

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

Background: The pathological evaluation of tissues with cholangitis is considered difficult, which can often occur after endoscopic sphincterotomy (EST) and endoscopic biliary stenting (EBS). This study aimed to evaluate the influence of a history of EST and EBS on the sensitivity of transpapillary forceps bile duct biopsy (TB) for bile duct adenocarcinoma. Methods: This retrospective study included consecutive cases of bile duct adenocarcinoma in which TB was performed before July 2020 until the number exceeded that required to support statistical and noninferiority analyses of the sensitivity of TB between patients with and without each variable. The incidence of postprocedural adverse events related to each factor was also investigated. Results: Overall, 280 samples were required in each group, and 437 subjects (792 samples) were included. The sensitivity of TB was 63.6% for the subjects and 59.6% for the biopsy samples. For the biopsy samples, the sensitivity did not differ significantly between samples from patients with and without a history of EST (59.1% vs. 58.9%, P = 0.952) and EBS (62.1% vs. 55.4%, P = 0.065). The sensitivity was significantly higher for samples from patients with jaundice (67.9% vs. 57.0%, P = 0.008). There were significantly fewer procedure-related adverse events in patients with a history of EST (10.8% vs. 19.0%, P = 0.017) and EBS (12.0% vs. 21.7%, P = 0.005). Conclusions: A history of EST or EBS did not influence sensitivity of TB but significantly decreased the incidence of adverse events. To safely and reliably perform TB to diagnose bile duct adenocarcinoma, planning, including for EST and EBS, is necessary.

DOI： 10.1186/s12876-022-02402-x

Comparison of an Inside Stent and a Fully Covered Self-Expandable Metallic Stent as Preoperative Biliary Drainage for Patients with Resectable Perihilar Cholangiocarcinoma. International journal

Hiroshi Mori, Hiroki Kawashima, Eizaburo Ohno, Takuya Ishikawa, Kentaro Yamao, Yasuyuki Mizutani, Tadashi Iida, Masanao Nakamura, Masatoshi Ishigami, Shunsuke Onoe, Takashi Mizuno, Tomoki Ebata, Mitsuhiro Fujishiro

Canadian journal of gastroenterology & hepatology Vol. 2022 page： 3005210 - 3005210 2022.7

Language：English Publishing type：Research paper (scientific journal) Publisher：Canadian Journal of Gastroenterology and Hepatology

Background. There is a need for a more tolerable preoperative biliary drainage (PBD) method for perihilar cholangiocarcinoma (PHCC). In recent years, inside stents (ISs) have attracted attention as a less suffering PBD method. Few studies have compared IS with a fully covered self-expandable metallic stent (FCSEMS) as PBD for resectable PHCC. The aim of this study is to compare them. Methods. This study involved 86 consecutive patients (IS: 51; FCSEMS: 35). The recurrent biliary obstruction (RBO) rate until undergoing surgery or being diagnosed as unresectable, time to RBO, factors related to RBO, incidence of adverse events related to endoscopic retrograde cholangiography, and postoperative complications associated with each stent were evaluated retrospectively. Results. There was no significant difference between the two groups in the incidence of adverse events after stent insertion. After propensity score matching, the mean (SD) time to RBO was 37.9 (30.2) days in the IS group and 45.1 (35.1) days in the FCSEMS group, with no significant difference (P=0.912, log-rank test). A total of 7/51 patients in the IS group and 3/35 patients in the FCSEMS group developed RBO. The only risk factor for RBO was bile duct obstruction of the future excisional liver lobe(s) due to stenting (HR 29.8, P=0.008) in the FCSEMS group, but risk factors could not be indicated in the IS group. There was no significant difference in the incidence of bile leakage or liver failure. In contrast, pancreatic fistula was significantly more common in the FCSEMS group (13/23 patients) than in the IS group (3/28 patients) (P<0.001), especially in patients who did not undergo pancreatectomy (P=0.001). Conclusions. As PBD, both IS and FCSEMS achieved low RBO rates. Compared with FCSEMS, IS shows no difference in RBO rate, is associated with fewer postoperative complications, and is considered an appropriate means of PBD for resectable PHCC. This trail is registered with UMIN000025631.

DOI： 10.1155/2022/3005210

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