研究者詳細 - 中村　正直

カプセル内視鏡読影支援センターの現状と課題

西川貴広, 野々垣浩二, 中村正直

日本消化器内視鏡学会雑誌 64 巻 ( 3 ) 頁： 239 - 248 2022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

カプセル内視鏡は低侵襲かつ簡便に消化管精査が可能であり，小腸疾患の診断に不可欠な検査となっている．また大腸カプセル内視鏡は，大腸内視鏡が困難な患者において，大腸腫瘍のスクリーニング検査の一翼を担っている．一方で，カプセル内視鏡の読影には多くの時間を要し業務負担となっている，画像診断には習熟が必要である，読影医が不足しているといった課題がある．これらの課題の解決策として，カプセル内視鏡読影支援ネットワークやカプセル内視鏡読影支援技師制度がある．カプセル内視鏡読影支援ネットワークは，連携した検査実施施設で行ったカプセル内視鏡画像を，読影支援施設にて遠隔読影を行うシステムであり，検査実施施設での読影の業務負担軽減や診断の標準化が可能となる．読影支援施設においては，多数のカプセル内視鏡画像を正確かつ迅速に読影することが求められ，カプセル内視鏡読影支援技師を含めた効率的な読影体制の整備と読影能の向上維持のための教育体制の整備が必要不可欠となる．本稿では，カプセル内視鏡読影支援センターの現状と課題について概説する．

DOI： 10.11280/gee.64.239

小腸Dieulafoy病変（矢野-山本分類Type 2a）の診断と治療についての臨床的検討

CiNii Research

シングルバルーン小腸内視鏡における水浸法と二酸化炭素送気法のランダム化比較試験

中村正直

日本消化器内視鏡学会雑誌 64 巻 ( 11 ) 頁： 2441 - 2441 2022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】シングルバルーン内視鏡検査（SBE）は小腸疾患に対する有効な検査であるが，診療に難渋することがある．大腸内視鏡挿入において，水浸法を使用することでその挿入がスムーズになるが小腸では十分な成果は得られていない．本研究ではSBE関連手技における水浸法の効果を評価する．【方法】本ランダム化比較試験は中国の高次機能施設で行われた．SBE予定の患者が無作為に水浸群と二酸化炭素送気群（CO2群）に割り当てられた．すべての患者は，経口的，経肛門的アプローチの両方を受ける予定であった．主要評価項目は全小腸観察率であり，副次的評価項目は最大挿入距離，陽性所見，検査時間および偶発症であった．【結果】合計で110名の患者が登録された（各グループ55）．両者の臨床的背景は同等であった．水浸群とCO2群の全小腸観察率は各々58.2％（32/55）と36.4％（20/55）であった（P＝0.02）．水浸群とCO2群の平均挿入長（標準偏差）は521.2（101.4）cmと481.6（95.2）cmであった（P＝0.04）．挿入時間は水浸群で有意に長かった（178.9［45.1］分 vs. 154.2［27.6］分；P＜0.001）．内視鏡所見と偶発症は同等であった．【結論】水浸法は，偶発症を増やすことなく全小腸観察率を高め，挿入距離を延ばした．

DOI： 10.11280/gee.64.2441

CiNii Research

中村正直, 山村健史, 前田啓子, 澤田つな騎, 石川恵里, 川嶋啓揮

日本小腸学会学術集会プログラム・抄録集 6 巻 ( 0 ) 頁： 65 - 65 2022年

記述言語：日本語出版者・発行元：日本小腸学会

【背景】小腸Dieulafoy病変は、内視鏡観察時に自然止血されている可能性があるため確定診断と治療が遅れる傾向を有する。一方では、Dieulafoy病変の臨床的特徴を把握しておくことによって診断のタイミングや治療戦略を事前に検討できるかもしれない。本研究の目的は、当院で経験された同病変の臨床的特徴を後方視的に調査し、その最適な診断と治療につき検討することであった。【対象・方法】対象は当院において2003年6月から2022年7月の間に小腸出血が疑われダブルバルーン内視鏡（以下DBE）を施行し、Dieulafoy病変と診断、内視鏡治療を受けた36例であった。本研究におけるDieulafoy病変の定義は、粘膜面の変化は露出血管部のみとし、付着する血栓を認める場合と露出血管からの噴出性かそれに準じる活動性出血を認める場合とした。臨床的背景、治療方法などを検討した。【結果】男性/女性は19/17例、平均年齢は71±10歳であった。33例でなんらかの基礎疾患を有していた。抗血栓薬の使用を19例で認め、ワーファリン10例、バイアスピリン7例（重複あり）の順で多かった。累計の出血エピソードは中央値で2回（1-18回）であった。最低血中ヘモグロビン値は5.9±1.7g/dl、赤血球輸血は2例以外の全例で行われていた。症状発現からDBEまでは中央値18日（2-63日）であった。DBE時の所見について、病変部位は深部十二指腸、上部空腸、中部空腸、下部空腸、中部回腸、下部回腸で各々3、18、8、2、2,6例で認められた（重複あり）。治療はクリッピング34例、APC凝固2例であった。偶発症は再出血10例（27.7％）、急性膵炎1例であった。【結語】小腸Dieulafoy病変は診断に苦慮し、治療までに時間と輸血処置などを多く要していた。本病変が疑われた際には早めの内視鏡検査が検討される。

DOI： 10.32264/shocho.6.0_65

CiNii Research

特集小腸内視鏡が変えた疾患マネージメント小腸疾患に対するアプローチ

中村正直, 大宮直木, 山村健史, 前田啓子, 澤田つな騎, 石川恵里

消化器内視鏡 33 巻 ( 12 ) 頁： 1792 - 1798 2021年12月

Real-world local recurrence rate after cold polypectomy in colorectal polyps less than 10 mm using propensity score matching 国際誌

Saito Masashi, Yamamura Takeshi, Nakamura Masanao, Maeda Keiko, Sawada Tsunaki, Ishikawa Eri, Mizutani Yasuyuki, Ishikawa Takuya, Kakushima Naomi, Furukawa Kazuhiro, Ohno Eizaburo, Kawashima Hiroki, Ishigami Masatoshi, Fujishiro Mitsuhiro

WORLD JOURNAL OF GASTROENTEROLOGY 27 巻 ( 47 ) 頁： 8182 - 8193 2021年12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：World Journal of Gastroenterology

BACKGROUND Cold polypectomy (CP) is a simple and safe procedure for polyps less than 10 mm in size; however, there is concern about local recurrence following CP because of unidentified margins of excised specimens and the lack of tumor suppression effect by coagulation. Some clinical trials have evaluated local persistent recurrence; their results suggest that a higher rate of local recurrence has not been documented so far. There were few reports that observed the course over long periods of time after CP in clinical practice. AIM To evaluate the presence of local recurrence following CP and hot polypectomy (HP) using propensity score matching. METHODS We analyzed 275 patients who underwent polypectomy for non-pedunculated colorectal polyps less than 10 mm (959 Lesions) between October 2016 and 2017 and underwent follow-up endoscopy subsequently. We divided them into the CP group (706 Lesions), wherein CP was performed, and the HP group (253 Lesions), wherein HP was performed. Using propensity score matching, we extracted 215 Lesions in each group and evaluated the local recurrence and content of CP in the real clinic and adverse events using medical records. RESULTS After propensity score matching, there were no significant differences in the patients’ and their endoscopic background (age, use of antithrombotics, indications, size, morphology, location of polyps, and polypectomy device) between the groups. The mean duration between colorectal polypectomy and the next follow-up colonoscopy was 17.5 ± 7.1 (range, 6-39) mo in the CP group and 15.7 ± 6.0 (range, 6-35) mo in the HP group, which was significantly longer in the CP group (P = 0.005). The local recurrence rate was 0.93% in the CP group and 0.93% in the HP group, without a significant difference (P = 0.688). Additionally, no differences were observed in the macroscopic en bloc resection rate, histopathological complete resection rate, and pathological results between the groups. Adverse events did not occur in either group. CONCLUSION Local recurrence after CP was equivalent to that following HP in clinical practice. CP is useful and safe in the treatment of non-pedunculated polyps of less than 10 mm.

DOI： 10.3748/wjg.v27.i47.8182

特集 Cold polypectomyの課題 4.症例からみえた課題(1)小腸ポリープに対するcold polypectomy

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

臨床消化器内科 37 巻 ( 1 ) 頁： 93 - 96 2021年12月

Changes in the gut microbiota after hepatitis C virus eradication 国際誌

Honda Takashi, Ishigami Masatoshi, Yamamoto Kenta, Takeyama Tomoaki, Ito Takanori, Ishizu Yoji, Kuzuya Teiji, Nakamura Masanao, Kawashima Hiroki, Miyahara Ryoji, Ishikawa Tetsuya, Hirooka Yoshiki, Fujishiro Mitsuhiro

SCIENTIFIC REPORTS 11 巻 ( 1 ) 頁： 23568 - 23568 2021年12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：Scientific Reports

The gut microbiota interacts with infectious diseases and affects host immunity. Liver disease is also reportedly associated with changes in the gut microbiota. To elucidate the changes in the gut microbiota before and after hepatitis C virus (HCV) eradication through direct-acting antiviral (DAA) treatment in patients with chronic hepatitis C (CHC), we investigated 42 samples from 14 patients who received DAA therapy for HCV. Fecal samples were obtained before treatment (Pre), when treatment ended (EOT), and 24 weeks after treatment ended (Post24). The target V3–4 region of the 16S rRNA gene from fecal samples was amplified using the Illumina Miseq sequencing platform. The diversity of the gut microbiota did not significantly differ between Pre, EOT, and Post24. Principal coordinates analysis showed that for each patient, the values at Pre, EOT, and Post24 were concentrated within a small area. The linear discriminant analysis of effect size showed that the relative abundances of Faecalibacterium and Bacillus increased at EOT, further increased at Post24, and were significantly increased at Post24 compared to Pre. These suggest that changes in the gut microbiota should be considered as among the various effects observed on living organisms after HCV eradication.

DOI： 10.1038/s41598-021-03009-0

Obesity and myosteatosis: the two characteristics of dynapenia in patients with cirrhosis

Sugiyama, Y; Ishizu, Y; Ando, Y; Yokoyama, S; Yamamoto, K; Ito, T; Imai, N; Nakamura, M; Honda, T; Kawashima, H; Ishikawa, T; Ishigami, M

EUROPEAN JOURNAL OF GASTROENTEROLOGY & HEPATOLOGY 33 巻 ( 1S Suppl 1 ) 頁： E916 - E921 2021年12月

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

Objective In patients with liver cirrhosis, the clinical characteristics of dynapenia, a condition in which skeletal muscle mass is maintained but muscle strength is reduced, are not yet known. This study aimed to clarify the characteristics of dynapenia and its impact on quality of life (QOL) in patients with liver cirrhosis. Methods We retrospectively analyzed 116 patients with cirrhosis. Based on grip strength and skeletal muscle mass measured by the bioelectrical impedance analysis method, patients were divided into four groups: normal muscle status, dynapenia, pre-sarcopenia (a condition involving only low muscle mass), and sarcopenia. The characteristics of dynapenia and its influence on QOL were examined. Results Fourteen patients had dynapenia. Liver function did not differ among the four groups. In patients with dynapenia, BMI was highest and computed tomography attenuation of skeletal muscle at the third lumbar spine vertebra was lowest among the four groups. The percentage of patients with both BMI ≥25 kg/m2and myosteatosis was significantly higher in patients with dynapenia [9/14 (64.3%)] than in those with sarcopenia [2/23 (8.7%), P = 0.004] and pre-sarcopenia [0/18 (0%), P < 0.001] and tended to be higher than those with normal muscle status [16/61 (26.2%), P = 0.065]. The physical QOL in patients with dynapenia was as low as that in those with sarcopenia and significantly lower than that in those with normal muscle status. Conclusion Cirrhotic patients with dynapenia had high BMI and myosteatosis, and impaired physical QOL.

DOI： 10.1097/MEG.0000000000002303

Clinical characteristics of gastrointestinal immune-related adverse events of immune checkpoint inhibitors and their association with survival 国際誌

Yamada Kentaro, Sawada Tsunaki, Nakamura Masanao, Yamamura Takeshi, Maeda Keiko, Ishikawa Eri, Iida Tadashi, Mizutani Yasuyuki, Kakushima Naomi, Ishikawa Takuya, Furukawa Kazuhiro, Ohno Eizaburo, Honda Takashi, Kawashima Hiroki, Ishigami Masatoshi, Furune Satoshi, Hase Tetsunari, Yokota Kenji, Maeda Osamu, Hashimoto Naozumi, Akiyama Masashi, Ando Yuichi, Fujishiro Mitsuhiro

WORLD JOURNAL OF GASTROENTEROLOGY 27 巻 ( 41 ) 頁： 7190 - 7206 2021年11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：World Journal of Gastroenterology

BACKGROUND Despite the popularity of immune checkpoint inhibitors (ICIs) in the treatment of advanced cancer, patients often develop gastrointestinal (GI) and non-GI immune- related adverse events (irAEs). The clinical characteristics and survival outcomes of GI-irAEs have not been fully elucidated in previous reports. This necessitates the evaluation of the impact of GI-irAEs on patients receiving ICI treatment. AIM To evaluate the clinical characteristics of GI-irAEs and their impact on survival in patients treated with ICIs. METHODS In this single-center, retrospective, observational study, we reviewed the records of 661 patients who received ICIs for various cancers at Nagoya University Hospital from September 2014 to August 2020. We analyzed the clinical characteristics of patients who received ICI treatment. We also evaluated the correlation between GI-irAE development and prognosis in non-small cell lung cancer (LC) and malignant melanoma (MM). Kaplan-Meier analysis was used to compare the median overall survival (OS). Multivariate Cox proportional hazards models were used to identify prognostic factors. A P value < 0.05 was considered statistically significant. RESULTS GI-irAEs occurred in 34 of 605 patients (5.6%) treated with an anti-programmed cell death-1/programmed death-ligand 1 (anti-PD-1/PD-L1) antibody alone and in nine of 56 patients (16.1%) treated with an anti-cytotoxic T-lymphocyte antigen 4 (CTLA-4) antibody alone or a combination of anti-PD-1 and anti-CTLA-4 antibodies. The cumulative incidence and median daily diarrhea frequency were significantly higher in patients receiving anti-CTLA-4 antibodies (P < 0.05). In 130 patients with MM, OS was significantly prolonged in the group that continued ICI treatment despite the development of GI-irAEs compared to the group that did not experience GI-irAEs (P = 0.035). In contrast, in 209 patients with non-small cell LC, there was no significant difference in OS between the groups. The multivariate analyses showed that a performance status of 2-3 (hazard ratio: 2.406; 95% confidence interval: 1.125-5.147; P = 0.024) was an independent predictive factor for OS in patients with MM. CONCLUSION Patients receiving anti-CTLA-4 antibodies develop GI-irAEs more frequently and with higher severity than those receiving anti-PD-1/PD-L1 antibodies. Continuing ICI treatment in patients with MM with GI-irAEs have better OS.

DOI： 10.3748/wjg.v27.i41.7190

Microbiome, fibrosis and tumor networks in a non-alcoholic steatohepatitis model of a choline-deficient high-fat diet using diethylnitrosamine 国際誌

Yamamoto Kenta, Honda Takashi, Yokoyama Shinya, Ma Lingyun, Kato Asuka, Ito Takanori, Ishizu Yoji, Kuzuya Teiji, Nakamura Masanao, Kawashima Hiroki, Ishigami Masatoshi, Tsuji Noriko M., Fujishiro Mitsuhiro

DIGESTIVE AND LIVER DISEASE 53 巻 ( 11 ) 頁： 1443 - 1450 2021年11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 and Liver Disease

Background & aims: Hepatocellular carcinoma in nonalcoholic steatohepatitis is caused by the complex factors of inflammation, fibrosis and microbiomes. We used network analysis to examine the interrelationships of these factors. Methods: C57Bl/6 mice were categorized into groups: choline-sufficient high-fat (CSHF, n = 8), choline-deficient high-fat (CDHF, n = 9), and CDHF+ diethylnitrosamine (DEN, n = 8). All mice were fed CSHF or CDHF for 20 weeks starting at week 8, and mice in the CDHF + DEN group received one injection of DEN at 3 weeks of age. Bacterial gene was isolated from feces and analyzed using Miseq. Results: The CSHF group had less fibrosis than the other groups. Tumors were found in 22.2% and 87.5% of the CDHF group and CDHF + DEN groups, respectively. Gene expression in the liver of Cdkn1a (p21: tumor-suppressor) and c-jun was highest in the CDHF group. Bacteroides, Roseburia, Odoribacter, and Clostridium correlated with fibrosis. Streptococcus and Dorea correlated with inflammation and tumors. Akkermansia and Bilophila were inversely correlated with fibrosis and Bifidobacterium was inversely correlated with tumors. Conclusions: DEN suppressed the overexpression of p21 caused by CDHF. Some bacteria formed a relationship networking associated with their progression and inhibition for tumors and fibrosis.

DOI： 10.1016/j.dld.2021.02.013

The role of early video capsule endoscopy in the diagnosis and prognosis of obscure gastrointestinal bleeding: A multi-center propensity score matching study 国際共著

Zhao Ran, Nakamura Masanao, Wu Shan, Uchida Genta, Yamamura Takeshi, Gao Yun-Jie, Goto Hidemi, Fujishiro Mitsuhiro, Ge Zhi-Zheng

JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY 36 巻 ( 9 ) 頁： 2540 - 2548 2021年9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: Video capsule endoscopy (VCE) is a first-line procedure for the diagnosis of obscure gastrointestinal bleeding (OGIB). The opinions on the timing for such diagnostic evaluation remain unclear. We aimed to explore the role of early VCE in OGIB patients. Methods: A total of 997 patients that underwent VCE at Renji Hospital and Nagoya University from May 15, 2002, to December 28, 2016, were included in this study. We matched patients that underwent early VCE within 14 days of bleeding (early group, n = 678) to patients that did not (late group, n = 319) via 1:1 propensity score matching (PSM). We then compared VCE diagnostic rates and the prevalence of post-VCE rebleeding in patients with initial negative VCE findings within 1 year between these groups before and after PSM. Results: Following PSM, early VCE was associated with a significantly higher rate of OGIB diagnosis (56.4% vs 45.5%, P = 0.001) and with a significantly lower incidence of rebleeding within 1 year following treatment (24.7% vs 36.7%, P = 0.041). In univariate and multivariate analyses, VCE timing (odds ratio 0.648; 95% confidence interval 0.496–0.847, P = 0.001 and odds ratio 0.666; 95% confidence interval 0.496–0.894, P = 0.007, respectively) was found to be linked with a higher rate of positive findings. Conclusion: Early VCE can improve the reliability of OGIB diagnosis while also reducing rates of post-VCE rebleeding. This suggests that timely and accurate diagnosis can help to improve OGIB patient treatment and prognosis.

DOI： 10.1111/jgh.15491

A forward-viewing radial-array echoendoscope is useful for diagnosing the depth of colorectal neoplasia invasion 国際誌

Kuno Takeshi, Yamamura Takeshi, Nakamura Masanao, Maeda Keiko, Sawada Tsunaki, Mizutani Yasuyuki, Esaki Masaya, Ishikawa Takuya, Furukawa Kazuhiro, Ohno Eizaburo, Kawashima Hiroki, Fujishiro Mitsuhiro

SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES 35 巻 ( 8 ) 頁： 4389 - 4398 2021年8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：Surgical Endoscopy

Background: It is important to accurately diagnose the depth of colorectal neoplasia invasion. We aimed to evaluate the usefulness of a new forward-viewing radial-array echoendoscope (FRE), relative to the pit pattern method. Methods: In this prospective study, the invasion depth of suspected early-stage carcinoma was diagnosed using the pit pattern and FRE methods. The diagnoses were classified as T1a (submucosal invasion distance < 1,000 μm) or shallower and T1b (≥ 1,000 μm) or deeper. Pathological diagnoses were used to compare the diagnostic capabilities of the two methods. Results: The final analyses included 110 lesions. The FRE was successfully inserted to the lesion in all cases. There were no significant differences between the two methods regarding the correct prediction rate (79.1% vs. 75.5%, P = 0.57), accuracy (81.3% vs. 79.0%, P = 0.68), specificity (81.3% vs. 70.8%, P = 0.135), positive predictive value (65.0% vs. 60.4%, P = 0.649), negative predictive value (91.0% vs. 98.1%, P = 0.108), or frequency of unevaluable cases (2.7% vs. 4.5%, P = 0.471). The correct prediction rate was calculated by adding the number of unevaluable cases to the denominator of accuracy. Relative to the pit pattern method, the FRE method offered significantly higher sensitivity for predicting T1b or deeper invasion (81.3% vs. 97.0%, P = 0.048). The pit pattern method had significantly poorer accuracy for large lesions (> 36 mm) than for smaller lesions (≤ 36 mm). In contrast, the accuracy of the FRE method did not differ significantly with lesion size. When using the FRE method, no cases were unevaluable because of attenuation. The FRE method provided correct diagnoses in 2 of 3 cases that were unevaluable using the pit pattern method. Conclusions: The pit pattern and FRE methods offered similar diagnostic performance for invasion depth. Furthermore, the FRE method may be used to correctly diagnose cases that are unevaluable using the pit pattern method.

DOI： 10.1007/s00464-020-07936-3

Detection of Colorectal Neoplasms Using Linked Color Imaging: A Prospective, Randomized, Tandem Colonoscon Trial 国際誌

Hasegawa Issei, Yamamura Takeshi, Suzuki Hiroto, Maeda Keiko, Sawada Tsunaki, Mizutani Yasuyuki, Ishikawa Eri, Ishikawa Takuya, Kakushima Naomi, Furukawa Kazuhiro, Ohno Eizaburo, Kawashima Hiroki, Nakamura Masanao, Fujishiro Mitsuhiro

CLINICAL GASTROENTEROLOGY AND HEPATOLOGY 19 巻 ( 8 ) 頁： 1708 - + 2021年8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：Clinical Gastroenterology and Hepatology

Background and aims: A higher adenoma detection rate (ADR) has been shown to be related to a lower incidence and mortality of colorectal cancer. We analyzed the efficacy of linked color imaging (LCI) by assessing the detection, miss, and visibility of various featured adenomas as compared with white light imaging (WLI). Methods: This was a prospective, randomized, tandem trial. The participants were randomly assigned to 2 groups: first observation by LCI, then second observation by WLI (LCI group); or both observations by WLI (WLI group). Suspected neoplastic lesions were resected after magnifying image-enhanced endoscopy. The primary outcome was to compare the ADR during the first observation. Secondary outcomes included evaluation of adenoma miss rate (AMR) and visibility score. Results: A total of 780 patients were randomized, 700 of whom were included in the final analysis. The ADR was 69.6% and 63.2% in the LCI and WLI groups, respectively, with no significant difference. However, LCI improved the average ADR in low-detectors compared with high-detectors (76.0% vs 55.1%; P < .001). Total AMR was 20.6% in the LCI group, which was significantly lower than that in the WLI group (31.1%) (P < .001). AMR in the LCI group was significantly lower, especially for diminutive adenomas (23.4% vs 35.1%; P < .001) and nonpolypoid lesions (25.6% vs 37.9%; P < .001) compared with the WLI group. Conclusion: Although both methods provided a similar ADR, LCI had a lower AMR than WLI. LCI could benefit endoscopists with lower ADR, an observation that warrants additional study. (UMIN Clinical Trials Registry, Number: UMIN000026359).

DOI： 10.1016/j.cgh.2021.04.004

Novel ultrathin double-balloon endoscopy for the diagnosis of small-bowel diseases: a multicenter nonrandomized study 国際誌

Nakamura Masanao, Yano Tomonori, Esaki Motohiro, Oka Shiro, Mitsui Keigo, Hirai Fumihito, Kawasaki Keisuke, Fujishiro Mitsuhiro, Torisu Takehiro, Tanaka Shinji, Iwakiri Katsuhiko, Kishi Masahiro, Matsumoto Takayuki, Yamamoto Hironori

ENDOSCOPY 53 巻 ( 8 ) 頁： 802 - 814 2021年8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：Endoscopy

Background This study aimed to compare the markers of potential pancreatic injury during antegrade double-balloon endoscopy (DBE) using the newly developed ultrathin EN-580XP system and the conventional EN-580T system. Methods Patients who were scheduled for antegrade DBE during daily clinical practice were enrolled. Clinical background, adverse events, and laboratory data of patients were compared between those who underwent endoscopy using the EN-580XP system and those in whom the EN-580T system was used. The primary end points were pancreatic hyperamylasemia and hyperlipasemia after DBE. Results A total of 295 cases were registered. Pancreatic hyperamylasemia occurred in 2 of 92 patients (2.2%) in the EN-580XP group and in 28 of 147 patients (19.1%) in the EN-580T diagnosis group (P <0.001). Hyperlipasemia was significantly different between the two groups (1.1% [EN-580XP] vs. 13.6% [EN-580T diagnosis]; P <0.001). Acute pancreatitis occurred in four patients (7.1%) in the EN-580T therapy group.Multiple logistic regression analyses revealed that the endoscope type EN-580T was significantly associated with pancreatic hyperamylasemia (adjusted odds ratio [OR] 8.63, 95% confidence interval [CI] 1.97-37.70; P <0.01) and hyperlipasemia (adjusted OR 13.10, 95%CI 1.70-100.70; P =0.01). Conclusions The EN-580XP system seemed less harmful to the pancreas during antegrade DBE.

DOI： 10.1055/a-1243-0226

Feasibility of patency capsule and colon capsule endoscopy in patients with suspected gastrointestinal stenosis: a prospective study

Otsuka Hiroyuki, Nakamura Masanao, Yamamura Takeshi, Maeda Keiko, Sawade Tsunaki, Mizutani Yasuyuki, Ishikawa Eri, Ishikawa Takuya, Kakushima Naomi, Furukawa Kazuhiro, Ohno Eizaburo, Kawashima Iliroki, Honda Takashi, Ishigami Masatoshi, Fujishiro Mitsuhiro

NAGOYA JOURNAL OF MEDICAL SCIENCE 83 巻 ( 3 ) 頁： 419 - 430 2021年8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：Nagoya Journal of Medical Science

Patency capsule (PC) can evaluate the patency of gastrointestinal (GI) tract. We hypothesized preceding patient selection using PC would improve the successful rate of colon capsule endoscopy (CCE). Therefore, a prospective single-arm study using PC followed by CCE was conducted with a control group of CCE alone. Patients with suspected or known GI stenosis scheduled for CCE were enrolled. CCE was performed only when the PC was excreted out of the body within 33 hours of ingestion. Primary endpoint was the rate of observation of the entire GI tract within the duration of examination. The secondary endpoints were complications and CCE findings. Twenty-three patients (17 men) were enrolled. The mean age was 50.5±19.8 years. Suspected stenotic sites were 8, 5, and 10 in the small, large, and small and large bowel, respectively. Sixteen, 12, and 10 patients had abdominal pain, active inflammatory bowel disease, and history of surgery for suspected stenosis, respectively. Patency of GI tract was confirmed in 96% (22/23) of the patients by administered PC. Of the 22 patients who underwent CCE, the entire GI tract was observed in 86% (19/22). No complications were observed. The median transit times in the small bowel and colon were 99 (21–682) and 160 (5–328) minutes, respectively. CCE findings revealed ulcers, erosions, and diverticula in 5, 9, and 4 patients, respectively. In conclusion, CCE with PC might be a safer and useful modality to observe the large colon for patients with suspected GI stenosis.

DOI： 10.18999/nagjms.83.3.419

Epstein-Barr Virus Positive B-Cell Lymphoproliferative Disorder of the Gastrointestinal Tract

Ishikawa Eri, Satou Akira, Nakamura Masanao, Nakamura Shigeo, Fujishiro Mitsuhiro

CANCERS 13 巻 ( 15 ) 2021年8月

記述言語：英語出版者・発行元：Cancers

Epstein-Barr virus positive B-cell lymphoproliferative disorder (EBV+ B-LPD) encompasses a broad clinicopathological spectrum and distinct clinical behavior that relatively favors the gastrointestinal (GI) tract. In this review, we provide an update on the clinicopathological features and biological behavior of EBV-positive mucocutaneous ulcer (EBVMCU) and primary EBV+ diffuse large B-cell lymphoma (DLBCL) of the GI tract. EBVMCU is a newly recognized entity but well known as an indolent and self-limited EBV+ B-LPD occurring in various immunodeficiencies. In contrast, EBV+ DLBCL constitutes the largest group of EBV+ B-LPDs and is regarded as an aggressive neoplasm. These two distinct diseases have historically been distinguished in the reappraisal of age-related EBV-associated B-LPDs but are challenging in routine practice regarding their differential diagnostic and therapeutic approaches. An increasing number of reports indicate that they are epidemiologically prevalent beyond western and eastern countries, but their comprehensive analysis is still limited. We also describe the PD-L1 positivity of tumorous large cells and non-malignant immune cells, which is relevant for the prognostic delineation among patients with primary DLBCL of the GI tract with and without EBV on tumor cells.

DOI： 10.3390/cancers13153815