研究者詳細 - 中村　正直

An initial trial of quantitative evaluation of autoimmune pancreatitis using shear wave elastography and shear wave dispersion in transabdominal ultrasound

Suzuki Hirotaka, Ishikawa Takuya, Ohno Eizaburo, Iida Tadashi, Uetsuki Kota, Yashika Jun, Yamada Kenta, Yoshikawa Masakatsu, Furukawa Kazuhiro, Nakamura Masanao, Honda Takashi, Ishigami Masatoshi, Kawashima Hiroki, Fujishiro Mitsuhiro

PANCREATOLOGY 21 巻 ( 4 ) 頁： 682 - 687 2021年6月

記述言語：英語出版者・発行元：Pancreatology

Background/Objectives: We aimed to examine therapeutic efficacy and prognosis prediction of autoimmune pancreatitis (AIP) using shear wave elastography (SWE) and shear wave dispersion (SWD) in transabdominal ultrasound (US). Methods: The subjects were 23 patients with diffuse type 1 AIP who underwent SWE and SWD, and 34 controls with a normal pancreas. Elasticity and dispersion were defined as the pancreatic elastic modulus (PEM) and dispersion slope, respectively. PEM and dispersion slope were compared between AIP and control cases, and the short-term therapeutic effect and long-term prognosis were examined. Results: PEM (30.9 vs. 6.6 kPa, P < 0.001) and dispersion slope (15.3 vs. 13.0 (m/sec)/kHz, P = 0.011) were significantly higher in AIP cases than in controls. Among the 17 AIP patients followed-up in two weeks after treatment, these parameters were 12.7 kPa and 10.5 (m/sec)/kHz with median decrease rate of 37.2% and 32.8%, respectively, which were significantly higher than the change in the size of pancreatic parenchyma (14.4%, P = 0.026). Fourteen of these subjects were followed up for >12 months, during which 2 had relapse; diabetes improved in 5 and worsened in 2; in 60% of cases, the pancreatic parenchyma was atrophied. The % change in PEM after two weeks was tended to be higher in non-atrophy cases. Conclusion: SWE and SWD measurement in US may be useful for quantitative assessment of AIP and evaluation of short-term treatment efficacy.

DOI： 10.1016/j.pan.2021.02.014

An evaluation of resectability among endoscopic treatment methods for rectal neuroendocrine tumors <10 mm 国際誌

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

ARAB JOURNAL OF GASTROENTEROLOGY 22 巻 ( 2 ) 頁： 104 - 110 2021年6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：Arab Journal of Gastroenterology

Background and Study Aims: With respect to rectal neuroendocrine tumor (NET) resection, it remains unclear which of the following methods is the most effective: conventional endoscopic mucosal resection (cEMR), EMR using a fitted cap (EMR-C), EMR with a ligation band device (EMR-L), or endoscopic submucosal dissection (ESD). Thus, in this study, we aim to retrospectively evaluate the most effective endoscopic resection for rectal NETs < 10 mm. Patients and methods: In total, 61 consecutive patients with primary rectal NETs < 10 mm in diameter were included in this study; they were then divided into three groups: those with cEMR; those with modified EMR (mEMR) involving EMR-C and EMR-L; and those with ESD. The primary endpoint was to evaluate the difference in the complete en bloc resection rate. The secondary endpoint was to investigate differences in procedure time and complications. Results: Among the three groups, a significant difference was found in procedure time (cEMR vs ESD, P < .01; mEMR vs ESD, P < .01), en bloc resection rate (cEMR vs mEMR, P = .015), tumor size (mEMR vs ESD, P < .01), percentage of tumor diameter ≥ 5 mm (mEMR vs ESD, P < .01), and complete en bloc resection rate (cEMR vs mEMR, P = .014). Meanwhile, no significant difference was noted in terms of complication rate among the three groups. Conclusion: The mEMR was the most suitable resection method for rectal NETs < 10 mm with respect to the risks and benefits from procedure-related factors, such as complete en bloc resection rate, procedure time, and complication rate.

DOI： 10.1016/j.ajg.2021.05.007

Endoscopic removal of a fish bone piercing the bile duct after pancreaticoduodenectomy

Ishikawa Takuya, Kawashima Hiroki, Ohno Eizaburo, Nakamura Masanao, Yamada Suguru, Hayashi Masamichi, Fujishiro Mitsuhiro

ENDOSCOPY 53 巻 ( 05 ) 頁： E164 - E165 2021年5月

Effects of endoscopy-related procedure time on musculoskeletal disorders in Japanese endoscopists: a cross-sectional study

Matsuzaki Ippei, Ebara Takeshi, Tsunemi Mafu, Hatta Yoshifumi, Yamamoto Kojiro, Baba Akemi, Hattori Masashi, Nakamura Masanao, Fujishiro Mitsuhiro

ENDOSCOPY INTERNATIONAL OPEN 09 巻 ( 05 ) 頁： E674 - E683 2021年5月

Clinical Features of Ischemic Enteritis Diagnosed by Double-Balloon Endoscopy 国際誌

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

CANADIAN JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY 2021 巻頁： 8875564 - 8875564 2021年4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

Introduction. Ischemic enteritis (IE) is a relatively rare small bowel disease that is diagnosed via double-balloon endoscopy (DBE), although the lack of established diagnostic criteria can make it difficult to confirm the diagnosis. This study aimed to describe the clinical characteristics, endoscopic imaging features, and treatments for IE at our center. Patients and Methods. We retrospectively searched the DBE database (1,521 patients) at Nagoya University Hospital for patients with IE and collected data regarding endoscopic findings, clinical background, and histological findings. The cases were categorized according to whether they involved transient or stenotic IE. Results. The DBE database included 24 patients (14 men) with IE. Transient IE was identified in 9 patients, and stenotic IE was identified in 15. Half of the patients had a history of cerebrovascular and cardiovascular disease. A granular structure at the ulcer base was the most frequently observed DBE finding at the stenotic site. Enterography using the contrast medium revealed that transient IE had a similar stenotic lesion length, relative to stenotic IE, although stenotic IE had a significantly higher stenosis ratio (81% vs. 63%, P=0.033). Small bowel enteroclysis revealed the "lead pipe"sign (11 patients), thumbprinting (3 patients), and the serrated lumen sign (1 patient). Only 1 patient with stenotic IE experienced recurrence after conservative treatment. Conclusion. During DBE, IE was characterized by cannular stenosis with extended and variable ulceration types, which spread over the edge of the stenosis, and a granular appearance at the ulcer base. These findings may help guide the diagnosis of IE.

DOI： 10.1155/2021/8875564

Variability measurements provide additional value to shear wave elastography in the diagnosis of pancreatic cancer

Yoshikawa Masakatsu, Ishikawa Takuya, Ohno Eizaburo, Iida Tadashi, Furukawa Kazuhiro, Nakamura Masanao, Honda Takashi, Ishigami Masatoshi, Kinoshita Fumie, Kawashima Hiroki, Fujishiro Mitsuhiro

SCIENTIFIC REPORTS 11 巻 ( 1 ) 頁： 7409 2021年4月

記述言語：英語出版者・発行元：Scientific Reports

Shear wave elastography (SWE) is a technique to non-invasively and quantitatively evaluate tissue stiffness. We aimed to investigate whether we can differentiate pancreatic cancer (PC) from normal pancreatic parenchyma (NPP) by SWE using transabdominal ultrasound. We investigated a total of 106 patients (84 with NPP and 22 with PC) whose pancreatic elastic modulus was measured by two-dimensional SWE (2D-SWE). Intra-rater reliability in this study was examined, and three measurements were sufficiently reliable. There were no differences between the two groups in factors that could affect SWE measurements. The median value of the elastic modulus was 5.70 kPa in the PC patients and 5.66 kPa in the NPP group, which was not significantly different (P = 0.785). On the contrary, the range was 8.64 kPa and 4.72 kPa, with a significantly greater range in the PC patients (P = 0.001). In conclusion, the median elastic modulus measured by 2D-SWE was not significantly different between PC and NPP, and evaluating the obtained elastic modulus itself is not useful in differentiation. However, the variability was significantly greater in PC than in NPP. Evaluating the range of elasticities will provide additional information in SWE, which may be useful in the diagnosis of PC.

DOI： 10.1038/s41598-021-86979-5

The relationship between oral-origin bacteria in the fecal microbiome and albumin-bilirubin grade in patients with hepatitis C

Yamamoto Kenta, Honda Takashi, Ito Takanori, Ishizu Yoji, Kuzuya Teiji, Nakamura Masanao, Miyahara Ryoji, Kawashima Hiroki, Ishigami Masatoshi, Fujishiro Mitsuhiro

JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY 36 巻 ( 3 ) 頁： 790 - 799 2021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 and Hepatology (Australia)

Background: Bacteria of oral origin (BO) in the gut are associated with prognosis in patients with cirrhosis. The Greengenes database (gg_13_8) is widely used in microbiome analysis, but the expanded Human Oral Microbiome Database (eHOMD), a specialized database for BO, can add more detailed information. We used each database to evaluate the relationship between the albumin–bilirubin grade (ALBI) and the microbiome in patients with hepatitis C. Methods: Eighty patients were classified into the low ALBI group (LA; n = 34) or high ALBI group (HA; n = 46). Isolated DNA from stool was amplified to target the V3–4 regions of 16S rRNA. The microbiomes of the two groups were compared using gg_13_8 or eHOMD. We evaluated the associations between microbiomes and prognoses using Cox proportional hazards models. Results: At the genus level, the two groups differed significantly regarding 6 (gg_13_8) and 7 (eHOMD) types of bacteria. All types except Akkermansia are classified as BO. Both databases showed an increase in Streptococcus and Veillonella. eHOMD showed a decrease in Fusobacterium and an increase in Fretibacterium; both produce various types of short-chain fatty acids. At the species level, the two groups demonstrated significant differences in 2 (gg_13_8) and 6 (eHOMD) bacterial types. Selenomonas noxia and Streptococcus salivarius were related to poor prognosis in univariate analysis. Conclusion: The HA group demonstrated increased BO, most of which produce lactic acid or acetic acid. The correlation between the microbiome and metabolism might be related to prognosis. eHOMD was a useful database for analyzing BO.

DOI： 10.1111/jgh.15206

Diagnostic yield of colon capsule endoscopy for Crohn's disease lesions in the whole gastrointestinal tract 国際誌

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

BMC GASTROENTEROLOGY 21 巻 ( 1 ) 頁： 75 - 75 2021年2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: Crohn’s disease (CD) can involve the upper gastrointestinal (GI) tract as well as the small and large bowel. PillCam colon capsule endoscopy (PCCE-2) enables observation of the whole GI tract, but its diagnostic yield for CD lesions in the whole GI tract remains unknown. Aim: To elucidate the diagnostic yield of PCCE-2 in patients with CD. Methods: Patients with CD who underwent PCCE-2 and double-balloon endoscopy (DBE) using oral and anal approaches were evaluated for CD lesions in the whole GI tract. We divided the small bowel into three segments (jejunum, ileum, and terminal ileum), and the large bowel into four segments (right colon, transverse colon, left colon, rectum). Detection of ulcer scars, erosion, ulcers, bamboo joint-like appearance, and notch-like appearance was assessed in each segment. The diagnostic yield of PCCE-2 was analyzed based on the DBE results as the gold standard. Results: Of the total 124 segments, the sensitivities of PCCE-2 for ulcer scars, erosion, and ulcers were 83.3%, 93.8%, and 88.5%, respectively, and the specificities were 76.0%, 78.3%, and 81.6%, respectively. For the 60 small bowel segments, the sensitivities were 84.2%, 95.5%, and 90.0%, respectively, and the specificities were 63.4%, 86.8%, and 87.5%, respectively. For the 64 large bowel segments, the sensitivities were 80.0%, 90.0%, and 83.3%, respectively, and the specificities were 84.7%, 72.2%, and 77.6%, respectively. Conclusion: PCCE-2 provides a high diagnostic yield for lesions in the whole GI tract of patients with CD. Thus, we recommend its use as a pan-enteric tool in clinical settings.

DOI： 10.1186/s12876-021-01657-0

Ustekinumab is effective against small bowel lesions in Crohn's disease: two case reports

Murate Kentaro, Nakamura Masanao, Yamamura Takeshi, Maeda Keiko, Sawada Tsunaki, Mizutani Yasuyuki, Ishikawa Eri, Kakushima Naomi, Furukawa Kazuhiro, Ohno Eizaburo, Honda Takashi, Kawashima Hiroki, Ishigami Masatoshi, Fujishiro Mitsuhiro

CLINICAL JOURNAL OF GASTROENTEROLOGY 14 巻 ( 1 ) 頁： 129 - 135 2021年2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 Journal of Gastroenterology

We encountered two patients with Crohn’s disease (CD) for whom induction of ustekinumab was effective for the management of small intestinal lesions with stenosis. The first symptomatic CD case was a 40-year-old female with longitudinal ulcers in the small bowel found at double-balloon endoscopy. She was in a biologic-naïve condition. Her symptoms improved immediately after ustekinumab induction. We confirmed the condition of intestinal mucosa by double-balloon endoscopy. Deep ulcers remained open at 24 weeks and were scarred at 72 weeks. The second case was a 50-year-old male who failed to respond to treatment with anti-TNFα agents. The lumen was narrow caused by circumferential ulcer, and an endoscope could not pass the site before induction. The circumferential ulcer had been healed by ustekinumab induction, and an endoscope passed through at 72 weeks. These two cases support the therapeutic efficacy of ustekinumab in alleviating small bowel lesions in CD patients.

DOI： 10.1007/s12328-020-01242-0

A Prospective Study Evaluating the Clinical Utility of the Tag-Less Patency Capsule with Extended Time for Confirming Functional Patency 国際誌

Watanabe Kenji, Ohmiya Naoki, Nakamura Masanao, Fujiwara Yasuhiro

DIGESTION 102 巻 ( 2 ) 頁： 180 - 187 2021年2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：Digestion

Background: Patency confirmation is useful for avoiding the retention of capsule endoscopy (CE). We first evaluated the clinical utility of the tag-less PillCamTM Patency Capsule (PPC) for up to 72 h after ingestion prospectively. Methods: Excretion of an intact capsule or intact body within 72 h, or positive PPC image in the colon or negative PPC image by abdominal X-ray at 30 h was defined as confirmed functional patency. In patients with unconfirmed functional patency, balloon-assisted enteroscopy was performed to evaluate the reason. Results: Functional patency was confirmed in 44 of 57 patients. Patency was confirmed in 38 patients (66.7%) at 30 h. In 6 of 19 patients (31.6%) in whom patency was not confirmed at 30 h, patency was confirmed within 72 h and no capsule retention (CR) occurred. The rate of pan-enteroscopy did not differ between patients whose patency was confirmed at 30 h and those whose patency was confirmed within 72 h. Excretion time of the PPC significantly correlated with that of the capsule (r = 0.650). Severe adhesions (>5 cm) interfered with PPC passage in 2 patients, despite the absence of critical stricture. The rate of no CR in patients with functional patency confirmed by prior PPC was 97.7%. Misjudgment of the location of the PPC is a risk for CR. Conclusions: Extending the time to confirm functional patency to 72 h may be acceptable and increase the possibility to perform CE safely in whom CE can perform intrinsically. University Hospital Medical Information Network registration No: 000002564.

DOI： 10.1159/000503027

Systematic review and meta-analysis of the diagnostic and therapeutic yield of small bowel endoscopy in patients with overt small bowel bleeding

Uchida Genta, Nakamura Masanao, Yamamura Takeshi, Furukawa Kazuhiro, Kawashima Hiroki, Honda Takashi, Ishigami Masatoshi, Fujishiro Mitsuhiro

DIGESTIVE ENDOSCOPY 33 巻 ( 1 ) 頁： 66 - 82 2021年1月

記述言語：英語出版者・発行元：Digestive Endoscopy

Background: Small bowel endoscopy, including small bowel capsule endoscopy (SBCE) and balloon-assisted endoscopy (BAE), is useful for small bowel bleeding (SBB) assessment. However, the specific management strategy for overt SBB is not well established. This meta-analysis aimed to evaluate the pooled diagnostic yields (DYs) and therapeutic yields (TYs) of small bowel endoscopy in overt SBB and to determine the optimal endoscopy timing. Methods: A comprehensive literature search was performed of studies examining the DY and/or TY of small bowel endoscopy in overt SBB. Data on the DY, TY, and timing of small bowel endoscopy were extracted, pooled, and analyzed. The pooled DY and TY of small bowel endoscopy for patients with overt SBB were calculated. Meta-regression and subgroup analysis were performed. Results: Twenty-two studies were included. The pooled DY was 65.2% and 74.0% for SBCE and BAE, respectively. The pooled TY of SBCE and BAE was 55.9% and 35.8%, respectively. A meta-regression model showed that the timing of endoscopy was significantly associated with the DY of BAE and the TY of SBCE and BAE. Conclusions: Small bowel capsule endoscopy and BAE would be useful diagnostic and therapeutic modalities in overt SBB. According to the subgroup analysis, in which the TY seemed to be higher within 2 days after bleeding for SBCE and BAE, the optimal timing of endoscopy would be within 2 days.

DOI： 10.1111/den.13669

自己免疫性膵炎の活動性評価を目的とした超音波内視鏡下shear-wave測定の臨床的実現可能性と有用性の検討前向き探索的研究

大野栄三郎, 廣岡芳樹, 川嶋啓揮, 石川卓哉, 田中浩敬, 酒井大輔, 石津洋二, 葛谷貞二, 中村正直, 本多隆

超音波医学 48 巻 ( 1 ) 頁： 35 - 44 2021年1月

記述言語：日本語出版者・発行元：(公社)日本超音波医学会

目的：自己免疫性膵炎（AIP）の診断および治療における，新開発された超音波内視鏡検査（EUS）のshear-wave（せん断波）elastography法（EUS shear-wave測定：EUS-SWM）の臨床的実現可能性と有用性を評価する．方法：患者160名の膵臓の組織弾性を測定した．EUS-SWMの成功率，shear-wave速度（Vs, m/s），およびVs測定の信頼度指数（VsN）を評価し，弾性（平均Vs）をAIP群（n＝14）および正常対照群との間で比較した．結果：有害事象はなく合計3,837件のEUS-SWMを実施した．全体の測定成功率は97.6％（3,743/3,837）であった．平均VsNは74％であった．膵臓の平均Vsは，次のとおりであった．膵頭部（十二指腸球部より観察：プッシュポジション）では2.22 m/s，膵頭部（十二指腸下行脚より観察：プルポジション）では2.36 m/s，膵体部では1.99 m/s，そして膵尾部では2.25 m/s．AIP群（2.57 m/s）の平均Vsは，正常対照群の平均Vs（1.89 m/s）（P＝0.0185）に比べて有意に高かった．平均Vsは，ステロイド治療（n＝6）（P＝0.0234）後，3.32 m/sから2.46 m/sへと有意に減少した．結論：EUS-SWMは臨床的に実現可能な手技であり，信頼性のある結果が得られた．EUS-SWMは，AIP患者へのステロイド治療の効果を評価する上で有効な方法である．

DOI： 10.3179/jjmu.jjmu.k.22

Gastrointestinal tract metastasis of lung cancer: The PD-L1 expression and correlated clinicopathological variables 国際誌

Ishikawa Eri, Nakaguro Masato, Nakamura Masanao, Yamamura Takeshi, Sawada Tsunaki, Mizutani Yasuyuki, Maeda Keiko, Furukawa Kazuhiro, Shimoyama Yoshie, Kawashima Hiroki, Fujishiro Mitsuhiro

PATHOLOGY INTERNATIONAL 71 巻 ( 1 ) 頁： 33 - 41 2021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：Pathology International

The gastrointestinal tract is a rare site for metastatic lung cancer. Programmed cell death-ligand 1 (PD-L1) expression in lung cancer is a biomarker for the response to anti-PD-1/PD-L1 therapy. We investigated clinicopathological features and PD-L1 expression in 25 gastrointestinal metastatic tumors from the lung and primary adenocarcinoma of the small bowel. The small bowel was the most common site (16/25; 64%) of gastrointestinal tract lung cancer metastasis. A total of 19 (76%) of the gastrointestinal metastasis showed PD-L1 expression in ≥5% of tumor cells, with 14 (56%) showing high expression levels (≥50%). In contrast, 21 (84%) expressed PD-L1 in ≥5% immune cells, including 4 (16%) showing a high expression levels (≥50%). The PD-L1 expression on tumor cells and immune cells in primary lung cancer and corresponding gastrointestinal metastasis was concordant in 13 (68%) and 11 (58%) of the 19 paired cases, respectively. Small-bowel metastasis of lung cancer was characterized by a higher incidence of perforation (31% vs. 0%), ulcerated mass (83% vs. 60%), and neoplastic PD-L1 expression (75% vs. 0%) compared to primary small-bowel adenocarcinoma. Gastrointestinal metastasis from lung cancer might be a potential target for immune checkpoint inhibitor therapy, given its high expression of PD-L1.

DOI： 10.1111/pin.13048

上皮性変化が乏しく筋層肥厚を呈した好酸球性食道炎亜型の１例

室井航一, 古川和宏, 鈴木智彦, 廣瀬崇, 伊藤信仁, 古根聡, 角嶋直美, 中村正直, 大林友彦, 藤城光弘

日本消化器内視鏡学会雑誌 63 巻 ( 3 ) 頁： 279 - 286 2021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74歳，男性．つかえ感を主訴に当院を受診．上部消化管内視鏡検査（EGD）を施行したが，異常は認めなかった．エソメプラゾールの内服を開始するものの，症状は持続し，半年後に食事をすることが困難となり入院となった．EGDを再検したところ，中下部食道に粘膜白濁浮腫，輪状狭窄を認め通過障害をきたしていた．各種検査から好酸球性食道炎（EoE）を疑ったが，生検で食道上皮に好酸球浸潤は認めなかった．超音波内視鏡検査（EUS）では筋層を含む食道壁の肥厚を認め，複数回の生検にて上皮下層に浸潤した好酸球を確認した．今回われわれは，半年間で重度の通過障害をきたし，EUSによる食道壁評価が診断に有用であった好酸球性食道炎亜型の１例を経験したため報告する．

DOI： 10.11280/gee.63.279

過誤腫性ポリポーシスの診断と治療

大宮直木, 中村正直, 柴田知行

日本消化器内視鏡学会雑誌 63 巻 ( 7 ) 頁： 1323 - 1335 2021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

過誤腫性ポリポーシスを来す疾患にはPeutz-Jeghers症候群（PJS），若年性ポリポーシス症候群，Cowden症候群，結節性硬化症がある．その中でPJSは口唇，口腔，指趾の色素沈着と小腸ポリープ重積や慢性貧血を特徴とする．従って，早期に診断しバルーン小腸内視鏡により小腸全域のポリープを摘除することで開腹手術を回避することが可能である．他にCowden症候群，結節性硬化症も皮膚所見が特徴的であり，詳細な身体診察が診断に結びつく．過誤腫性ポリポーシスは消化管のみならず消化管外の悪性腫瘍合併リスクが高いため，消化管の検索をするのと同時に，定期的な全身のサーベイランスが必須である．本稿では各疾患の臨床病理学的特徴，診断，治療について概説する．

DOI： 10.11280/gee.63.1323

Survey of chemotherapy-induced nausea and vomiting in patients with urothelial carcinoma

Yoshimi A., Shiroma Y., Iwata M., Nakamura M., Torii-Goto A., Hida H., Tanaka N., Miyazaki M., Yamada K., Noda Y.

Molecular and Clinical Oncology 15 巻 ( 4 ) 2021年

記述言語：日本語出版者・発行元：Molecular and Clinical Oncology

Chemotherapy-induced nausea and vomiting (CINV) can cause anorexia, weight loss and deterioration of patient quality of life. It is one of the most unpleasant adverse effects of chemotherapy treatment regimens. For the optimal treatment of gastrointestinal symptoms during urothelial carcinoma chemotherapy, the present study investigated the association between gastrointestinal symptoms and therapeutic effects of gemcitabine plus platinum [cisplatin (GC) or carboplatin (GCa)] therapies. The incidence and frequency of nausea/vomiting with GC split therapy (gemcitabine, 1,000 mg/m2 on days 1 and 8; split-dose cisplatin, 35 mg/m2 on days 1 and 8; 21-day schedule) and GCa therapy [gemcitabine, 750-1,000 mg/m2 on days 1, 8 and 15; carboplatin, area under the blood concentration-time curve=5 mg min/ml (Calvert formula) on day 2; 28-day schedule] were lower compared with those of GC therapy (gemcitabine, 1,000 mg/m2 on days 1, 8 and 15; single-dose cisplatin 70 mg/m2 on day 2; 28-day schedule). However, no differences in therapeutic outcomes were observed among therapies. GCa therapy, regardless of renal function, and GC split therapy demonstrated significant increases compared with GC therapy in alleviating gastrointestinal symptoms associated with cancer chemotherapy in patients with urothelial carcinoma. Overall, these results suggested that split-dose cisplatin administration or the use of carboplatin instead of cisplatin may be useful in patients who experience CINV without compromising treatment effectiveness.

DOI： 10.3892/mco.2021.2384

顕性小腸出血患者における小腸内視鏡の診断能と治療能に関するシステマティックレビューとメタ解析

内田元太, 中村正直, 山村健史, 古川和宏, 川嶋啓揮, 本多隆, 石上雅敏, 藤城光弘

日本消化器内視鏡学会雑誌 63 巻 ( 9 ) 頁： 1649 - 1665 2021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】小腸カプセル内視鏡（SBCE）やバルーン内視鏡（BAE）といった小腸内視鏡は小腸出血（SBB）の診療において有用である．しかしながら，特に顕性小腸出血（overt SBB）に対するマネジメント方法は未だ確立されていない．本メタ解析は，overt SBB診療における小腸内視鏡の統合された診断能（DYs）と統合された治療能（TYs）を評価し，内視鏡の適切なタイミングを決定することを目的とした．【方法】Overt SBBにおける小腸内視鏡のDYまたはTYを評価した研究を検索した．DY，TY，内視鏡のタイミングに関するデータが抽出され，統合そして解析された．Overt SBB患者における小腸内視鏡の統合されたDYと統合されたTYが算出された．さらにメタ回帰分析とサブグループ解析が行われた．【結果】22個の研究が選択された．統合されたDYはSBCEとBAEでそれぞれ65.2％，74.0％であった．統合されたTYはSBCEとBAEでそれぞれ55.9％，35.8％であった．メタ回帰分析では，内視鏡のタイミングがBAEのDY，さらにSBCEとBAEのTYと有意に関連していた．【結論】SBCEとBAEはovert SBB診療において有用な診断と治療のモダリティと思われた．サブグループ解析ではSBCEとBAEのTYは出血後２日以内でより高い傾向にあり，適切な内視鏡のタイミングは出血後２日以内と考えられた．

DOI： 10.11280/gee.63.1649

新型コロナウイルス感染症パンデミック状況下における大腸癌スクリーニングプログラム遅延による診断時癌進行度と生命予後への影響

中村正直

日本消化器内視鏡学会雑誌 63 巻 ( 12 ) 頁： 2525 - 2525 2021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】新型コロナウイルス感染症によるパンデミックは医療全体にも重大な影響を及ぼしている．イタリアにおいては，パンデミックが起こって以来，大腸癌スクリーニングプログラムの運用が延期を余儀なくされている．本研究の目的は，スクリーニング自体が遅れることによって大腸癌スクリーニングプログラムのアウトカムにどのような影響があるか評価をすることであった．【方法】筆者らは大腸癌診断の遅れに関するメタ解析モデルを作成した．イタリアにおける大腸癌統計をベースに，大腸癌診断の遅れ，大腸内視鏡までの期間など既報を収集したうえでモデルに当てはめて時間経過による大腸癌の進行に伴った生命予後への影響を評価した．【結果】集積されたスクリーニングプログラムの既報によって発見された大腸癌患者の５年生存率は，ステージⅠ，Ⅱ，ステージⅢ，Ⅳで各々0.85（0.81-0.88），0.39（0.33-0.44）であった．プログラムの０-３カ月の遅れであればステージⅠ，Ⅱ，ステージⅢ，Ⅳの大腸癌は各々74％，26％であるが，７-12カ月，12カ月以上ではステージⅢ，Ⅳが各々29％，33％とその割合が有意に増えた．12カ月以上遅れた際には全大腸癌死亡が有意に増え（12％，P＝0.005），生存曲線が有意に変化した．【結論】４-６カ月のプログラムの遅延は進行癌の増加リスクを認め，12カ月以上の遅延は生命予後に影響を与えるかもしれない．本研究では新型コロナウイルス感染症や他のパンデミック状況下における大腸癌のような重要な疾患の診断過程を含めたマネッジメントの強化の必要性を提言した．

DOI： 10.11280/gee.63.2525