研究者詳細 - 中村　正直

論文 - 中村　正直

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画像強調観察を用いた大腸ポリープの拾い上げ診断

山村健史, 中村正直, 川嶋啓揮

日本消化器内視鏡学会雑誌 65 巻 ( 1 ) 頁： 63 - 75 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

<p>腺腫性ポリープを内視鏡切除することで将来的に大腸がんの罹患や死亡のリスクを減らすことができるとされており，大腸内視鏡が大腸がん予防のために果たす役割は重要である．また大腸内視鏡がしっかりとその効果を発揮するためには検査の質も求められており，腺腫発見率などの向上は内視鏡医に求められている．一方Post-colonoscopy colorectal cancer（PCCRC）の原因の多くが見逃し病変に起因することを考えると，今後は病変の発見だけでなく，見逃しの要素も考慮されるべきである．光デジタル法による画像強調観察（Imaged-enhanced endoscopy；IEE）はデバイスや染色も不要でボタン操作だけで施行可能である．近年の内視鏡技術の進歩や新たなIEEの開発に伴い，IEE観察が大腸病変の発見や見逃しの防止など拾い上げ診断に有用であることが示されてきている．本稿では大腸ポリープの拾い上げ診断の現状からIEE観察の手順やエビデンスについて述べた．今後もIEE観察も併用した最適な大腸内視鏡の観察方法を模索することが求められている．</p>

DOI： 10.11280/gee.65.63

胃粘膜下腫瘍に対する組織採取法

古川和宏, 中村正直, 川嶋啓揮

日本消化器内視鏡学会雑誌 65 巻 ( 3 ) 頁： 214 - 228 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

<p>粘膜下腫瘍（subepithelial tumor；SET）は日常臨床でしばしば遭遇する疾患の一つである．EUSは腫瘍径や局在層，内部エコーレベル，内部エコーパターン，辺縁の形状などの観察が可能であり，SETの診断にとって不可欠な検査の一つだが，間葉系腫瘍をEUS所見のみで診断することは困難である．確定診断のためには組織診や免疫染色が必要なものの，delleを伴う病変を除くと正常粘膜で覆われているため，内視鏡下生検では腫瘍組織を得ることはできない．そのため，ボーリング生検や超音波内視鏡下穿刺吸引法/生検法（endoscopic ultrasound-guided fine needle aspiration；EUS-FNA/endoscopic ultrasound-guided fine needle biopsy；EUS-FNB），粘膜切開生検（mucosal incision-assisted biopsy；MIAB）など，様々な組織採取法が行われている．本稿では，これまでの臨床研究の成績を中心に，胃SETに対するEUS-FNA/BとMIABについて概説する．</p>

DOI： 10.11280/gee.65.214

Modified Nスコアは，吐血を伴わない黒色便患者において内視鏡的止血処置が必要な患者を予測するのに有用である

伊藤信仁, 舩坂好平, 藤吉俊尚, 古川和宏, 角嶋直美, 古根聡, 石川恵里, 水谷泰之, 澤田つな騎, 前田啓子, 石川卓哉, 山村健史, 大野栄三郎, 中村正直, 川嶋啓揮, 宮原良二, 廣岡芳樹, 春田純一, 藤城光弘

日本消化器内視鏡学会雑誌 65 巻 ( 6 ) 頁： 1165 - 1174 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

<p>【目的】黒色便は上部消化管出血を疑う症状の１つであるが，吐血を伴わない黒色便患者のすべてに内視鏡的止血処置を必要とするわけではない．これまでに内視鏡的止血処置が必要な患者を予測するための明らかな指標は報告されていない．本研究の目的は，吐血を伴わない黒色便患者において，内視鏡的止血処置が必要な患者を予測する新規のスコアを確立することである．</p><p>【方法】われわれは，２施設において，吐血を伴わない黒色便を主訴として緊急内視鏡検査を行った連続721例の患者をレトロスペクティブに登録した．開発コホート（2016年１月～2018年12月）422例の患者データから内視鏡的止血処置が必要な患者を予測するリスク因子を多変量ロジスティック回帰分析により決定し，modified Nagoya University score （modified Nスコア）と名付けた新規スコアリングシステムを作成した．検証コホート（2019年１月～2020年12月）299名の患者データを用いmodified Nスコアの診断能について評価した．</p><p>【結果】ロジスティック回帰分析による多変量解析により，内視鏡的止血処置が必要な患者を予測する因子として，失神，血中BUN値，BUN/クレアチニン比が正の予測因子として，抗凝固薬内服が負の予測因子として，計４因子が抽出された．検証コホートにおいてmodified NスコアのROC曲線によるAUCは0.731であり，modified Nスコアの内視鏡的止血処置予測感度は82.0％，特異度は58.8％であった．</p><p>【結論】４因子からなるmodified Nスコアは，吐血を伴わない黒色便患者において内視鏡的止血処置を必要とする患者を予測することができる．</p>

DOI： 10.11280/gee.65.1165

小腸内視鏡下生検により診断した神経線維腫症１型に合併した腸管diffuse ganglioneuromatosisの１例

喜田裕一, 澤田つな騎, 石川恵里, 榊原綾子, 山村健史, 前田啓子, 江﨑正哉, 濱崎元伸, 村手健太郎, 中村正直

日本消化器内視鏡学会雑誌 65 巻 ( 7 ) 頁： 1232 - 1238 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

<p>症例は50歳女性．基礎疾患に神経線維腫症１型があり，42歳時に前医で小腸の壁肥厚と拡張を指摘されたが原因不明とされた．今回，下痢に伴う電解質異常のため前医に入院となったが，腸管拡張も高度となり，精査のため当院へ転院となった．ダブルバルーン内視鏡検査を施行したところ空腸は高度に拡張し，回腸末端に炎症性ポリープと縦走潰瘍を認めた．非潰瘍部の生検組織よりganglioneuromatosisの診断を得た．腸管のびまん性ganglioneuromatosisは神経線維腫症１型の稀な合併症であり，小腸病変を内視鏡で観察，診断し得た貴重な症例と考えられた．</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 65 巻 ( 9 ) 頁： 1493 - 1497 2023年

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 85 巻 ( 3 ) 頁： 402 - 427 2023年

出版者・発行元：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 38 巻 ( 1 ) 頁： 42 - 47 2022年12月

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 103 巻 ( 6 ) 頁： 451 - 461 2022年12月

記述言語：英語出版者・発行元：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 84 巻 ( 4 ) 頁： 825 - 838 2022年11月

記述言語：英語出版者・発行元：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

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 52 巻 ( 11 ) 頁： 937 - 946 2022年11月

記述言語：英語出版者・発行元：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

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 84 巻 ( 4 ) 頁： 733 - 745 2022年11月

記述言語：英語出版者・発行元：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

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 12 巻 ( 1 ) 頁： 16603 2022年10月

記述言語：英語出版者・発行元：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 12 巻 ( 1 ) 頁： 16190 2022年9月

記述言語：英語出版者・発行元：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 34 巻 ( 9 ) 頁： 1497 - 1499 2022年9月

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 31 巻 ( 3 ) 頁： 290 - 300 2022年9月

出版者・発行元：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 34 巻 ( 6 ) 頁： 1147 - 1156 2022年9月

記述言語：英語出版者・発行元：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 36 巻 ( 8 ) 頁： 5676 - 5683 2022年8月

記述言語：英語出版者・発行元：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 34 巻 ( 7 ) 頁： 1212 - 1216 2022年7月

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

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

BMC GASTROENTEROLOGY 22 巻 ( 1 ) 頁： 329 - 329 2022年7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：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 国際誌

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

CANADIAN JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY 2022 巻頁： 3005210 - 3005210 2022年7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：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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