論文 - 中村　正直

A preliminary result of three-dimensional microarray technology to gene analysis with endoscopic ultrasound-guided fine-needle aspiration specimens and pancreatic juices. 査読有り

Nonogaki K, Itoh A, Kawashima H, Ohno E, Ishikawa T, Matsubara H, Itoh Y, Nakamura Y, Nakamura M, Miyahara R, Ohmiya N, Ishigami M, Katano Y, Goto H, Hirooka Y.

J Exp Clin Cancer Res.   25 巻   頁： 29-36   2010年

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Usefulness of EUS combined with contrast-enhancement in the differential diagnosis of malignant versus benign and preoperative localization of pancreatic endocrine tumors. 査読有り

Ishikawa T, Itoh A, Kawashima H, Ohno E, Matsubara H, Itoh Y, Nakamura Y, Nakamura M, Miyahara R, Hayashi K, Ishigami M, Katano Y, Ohmiya N, Goto H, Hirooka Y.

Gastrointest Endosc.   75 巻   頁： 951-959   2010年

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Confocal endomicroscopy for phenotypic diagnosis of gastric cancer. 査読有り

Banno K, Niwa Y, Miyahara R, Nakamura M, Nagaya T, Nagasaka T, Watanabe O, Ando T, Kawashima H, Ohmiya N, Itoh A, Hirooka Y, Goto H.

J Gastroenterol Hepatol.   25 巻   頁： 712-718   2010年

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Restriction-modification systems may be associated with Helicobacter pylori virulence. 査読有り

Ando T, Ishiguro K, Watanabe O, Miyake N, Kato T, Hibi S, Mimura S, Nakamura M, Miyahara R, Ohmiya N, Niwa Y, Goto H.

J Gastroenterol Hepatol.   25 巻   頁： S95-98   2010年

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Route selection for double-balloon endoscopy, based on capsule transit time, in obscure gastrointestinal bleeding. 査読有り

Nakamura M, Ohmiya N, Shirai O, Takenaka H, Morishima K, Miyahara R, Ando T, Watanabe O, Kawashima H, Itoh A, Hirooka Y, Goto H.

J Gastroenterol.   45 巻   頁： 592-599   2010年

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担当区分：筆頭著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

Establishment of an interpretation system for video capsule endoscopy for obscure gastrointestinal bleeding. 査読有り

Goto H, Nakamura M, Ohmiya N, Hirooka Y, Itoh A.

J Gastroenterol.   45 巻   頁： 468-469   2010年

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記述言語：英語  

Advance of Video Capsule Endoscopy and the Detection of Anatomic Landmarks. 査読有り

Nakamura M, Ohmiya N, Shirai O, Takenaka H, Kenji, Morishima, Miyahara R, Ando T,Watanabe O, Kawashima H, Itoh A, Hirooka Y, Niwa Y, Goto H.

Hepatogastroenterology.   56 巻   頁： 1600-1605   2009年

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担当区分：筆頭著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

Pilot study on confocal endomicroscopy for determination of the depth of squamous cell esophageal cancer on vivo. 査読有り

Iguchi Y, Niwa Y, Miyahara R, Nakamura M, Banno K, Nagaya T, Nagasaka T, Watanabe O, Ando T, Kawashima H, Ohmiya N, Itoh A, Hirooka Y, Goto H.

J Gastroenterol and Hepatol.   24 巻   頁： 1733-1739   2009年

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Role of endoscopic ultrasonography in predicting the response to cyclosporin A in ulcerative colitis refractory to steroids. 査読有り

Watanabe O, Ando T, El-Omar EM, Shimada M, Ina K, Ishiguro K, Hasegawa M, Miyake N, Nakamura M, Miyahara R, Ohmiya N, Niwa Y, Goto H.

Dig Liver Dis.   41 巻   頁： 735-739   2009年

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Diagnosis of Pancreatic Discorders Using Contrast-Enhanced Endoscopic Ultrasonography and Endoscopic Elastography. 査読有り

Hirooka Y, Itoh A, Kawashima H, Ohno E, Ishikawa T, Matsubara H, Itoh Y, Nakamura M, Miyahara R, Ohmiya N, Niwa Y, Ishigami M, Katano Y, Goto H.

Clin Gastroenterol and Hepatol.   7 巻   頁： S63-67   2009年

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

原因不明の消化管出血例におけるカプセル内視鏡の診断的意義 査読有り

中村正直、大宮直木、宮原良二、安藤貴文、渡辺修、川嶋啓揮、伊藤彰浩、廣岡芳樹、丹羽康正、後藤秀実

日本消化器内視鏡学会雑誌   51 巻 ( 11 ) 頁： 2866-2875   2009年11月

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担当区分：筆頭著者   記述言語：日本語   掲載種別：研究論文（学術雑誌）  

Geranylgeranylacetone Protects against Diclofenac-Induced Gastric and Small Intestinal Mucosal Injuries in Healthy Subjects: A Prospective Randomized Placebo-Controlled Double-Blind Cross-Over Study. 査読有り

Niwa, Y., Nakamura, M., Miyahara, R., Ohmiya, N., Watanabe, O., Ando, T., Kawashima, H., Itoh, A., Hirooka, Y., Goto, H..

Digestion   80 巻 ( 4 ) 頁： 260-266   2009年10月

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担当区分：筆頭著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

Outcome after enteroscopy for patients with obscure GI bleeding: diagnostic comparison between double-balloon endoscopy and videocapsule endoscopy. 査読有り

Gastrointestinal Endoscopy   69 巻 ( 4 ) 頁： 875-876   2009年4月

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Small-bowel obstruction: diagnostic comparison between double-balloon endoscopy and fluoroscopic enteroclysis, and the outcome of enteroscopic treatment. 査読有り

Ohmiya, N., Arakawa, D., Nakamura, M., Honda, W.,Shirai, O., Taguchi, A., Itoh, A., Hirooka, Y., Niwa, Y., Maeda, O., Ando, T., Goto, H.,

Gastrointestinal Endoscopy   69 巻 ( 1 ) 頁： 84-93   2009年1月

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

"NEW INSTRUMENTS AND TECHNIQUESNEW OBJECTIVE EVALUATION METHOD FOR FUNCTIONAL BOWEL DISORDER USING VIDEO CAPSULE ENDSCOPY" 査読有り

Nakamura, M., Niwa, Y., Yagihara, M., Ohmiya, N.,Miyahara, R., Ando, T., Watanabe, O., Kawashima, H., Itoh, A., Hirooka, Y., Fujimoto. H., Goto, H.,

Digestive Endoscopy   21 巻 ( 1 ) 頁： 29-33   2009年1月

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担当区分：筆頭著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

Observation of Deworming Process in Intestinal Diphyllobothrium latum Parasitism by Gastrografin Injection Into Jejunum Through Double-Balloon Enteroscope 査読有り

Ko S, Ohmiya N, Nakamura M, Honda W, Shirai O, Takenaka H, Niwa Y, Goto H.

Am J Gastroenterol   103 巻   頁： 2149-2150   2008年

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Efficacy of rebamipide for diclofenac-induced small-intestinal mucosal injuries in healthy subjects: a prospective,rando mized,double-blinded,placebo-controlled,cross-over study 査読有り

Niwa, Y., Nakamura, M., Ohmiya, N., Maeda, O., Ando, T., Itoh, A., Hirooka, Y., Goto, H.,

J Gastroenterol   43 巻 ( 4 ) 頁： 270-276   2008年4月

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Which route should we select when performing double-ballon enteroscopy? 査読有り

Nakamura, M., Niwa, Y., Ohmiya, N., Goto, H.

Gastrointestinal Endoscopy   3 巻 ( 67 ) 頁： 577-578   2008年3月

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担当区分：筆頭著者   記述言語：英語  

Analysis of Large Bowel Peristalsis with Video Capsule Endoscopy. 査読有り

Yagihashi M, Niwa Y, Nakamura M, Goto H, Fujimoto H.

Complex Medical Engineering     頁： 766–769   2007年

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Small bowel tuberculosis diagnosed by the combination of video capsule endoscopy and double balloon enteroscopy 査読有り

Nakamura, M., Niwa, Y., Ohmiya, N., Arakawa, D., Honda, W., Miyahara, R., Matsuura, T., Ando, T., Maeda, O., Itoh, A., Hirooka, Y., Goto, H.

European Journal of Gastroenterology & Hepatology   19 巻 ( 7 ) 頁： 595-598   2007年7月

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担当区分：筆頭著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

Diagnosis and treatment of obscure GI bleeding at double balloon endoscopy 査読有り

Naoki Ohmiya,Tomonori Yano,Hironori Yamamoto,Daigo Arakawa, Masanao Nakamura,Wataru Honda,Akihiro Itoh,Yoshiki Hirooka,Yasumasa Niwa,Osamu Maeda,Takafumi Ando,Tsuneyoshi Matsui,Mitsuo Iida,Shinji Tanaka,Tsutomu Chiba,Choitsu Sakamoto,Kantaro Sugano,Hidemi Goto.

Gastrointestinal Endoscopy   66 巻 ( 3 ) 頁： S72-S77   2007年3月

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Ilealcancer and erosions in small intestine revealed by capsule endoscopy. 査読有り

Niwa Y, Nakamura M, Omiya N, Itoh A, Hirooka Y, Goto H

Endoscopy   38 巻   頁： E91-92   2006年

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

* Preliminary comparison of Capsule Endoscopy and Double-Balloon Enteroscopy in Patients with suspected Small-Bowel Bleeding 査読有り

Nakamura, M., Niwa, Y., Ohmiya, N., Miyahara, R., Ohashi, A., Itoh, A., Hirooka, Y., Goto, H.

Endoscopy   38 巻 ( 1 ) 頁： 59-66   2006年1月

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担当区分：筆頭著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

Endscopic resection of Peutz-Jeghers polips throughout the small intestine at double-balloon enteroscopy without laparotomy 査読有り

Ohmiya,N., Taguchi, A., Shirai, K., Mabuchi, N., Arakawa, D., Kanazawa, H., Ozeki, M., Yamada, M.,Nakamura, M., Itoh, A., Hirooka, Y., Niwa, Y., (Nagasaka, T., Ito, M., Ohashi, S., Okamura, S.,Goto, H.,

Gastrointestinal Endoscopy   61 巻 ( 1 ) 頁： 140-148   2005年1月

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Usefulness of endoscopic ultrasonography for differentiating between non-functional pancreatic neuroendocrine neoplasm and intrapancreatic accessory spleen.

Kano Y, Ishikawa T, Yamao K, Mizutani Y, Iida T, Uetsuki K, Yamamura T, Furukawa K, Nakamura M, Kawashima H

Scientific reports   15 巻 ( 1 ) 頁： 6385   2025年2月

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記述言語：英語  

DOI： 10.1038/s41598-025-91272-w

PubMed

Prognostic Role of Enhancing Mural Nodules in Intraductal Papillary Mucinous Neoplasms with High-Risk Stigmata.

Kumano R, Ohno E, Ishikawa T, Yamao K, Mizutani Y, Iida T, Uetsuki K, Yamamura T, Furukawa K, Nakamura M, Honda T, Kawashima H

Annals of surgery     2025年2月

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記述言語：英語  

DOI： 10.1097/SLA.0000000000006674

PubMed

New drug-delivery balloon catheter for easy and fast injection of triamcinolone after esophageal endoscopic submucosal dissection.

Hirose T, Shibata H, Furukawa K, Yamamura T, Ishikawa T, Nakamura M, Kawashima H

Endoscopy   56 巻 ( S 01 ) 頁： E634 - E635   2024年12月

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記述言語：英語  

DOI： 10.1055/a-2353-5973

PubMed

Nationwide multicenter prospective study on the usefulness, safety, and acceptability of colon capsule endoscopy in Japan.

Hotta N, Ohmiya N, Hiraga H, Nakaji K, Osawa S, Omori T, Mitsufuji S, Hosoe N, Nouda S, Kobayashi T, Nakamura M, Oka S, Nonogaki K, Baba Y, Mukai R, Matsumoto H, Ikebuchi Y, Shimada M, Togashi K, Katsuki S, Sasaki Y, Sawada R, Kawano S, Furuta T, Tajiri H, Tanaka S, ColoCam-J Study Group

Gastrointestinal endoscopy     2024年11月

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記述言語：英語  

DOI： 10.1016/j.gie.2024.11.004

PubMed

Clinical factors influencing patency capsule excretion and confirmation in patients with intestinal patency.

Ikegami S, Yamamura T, Nakamura M, Maeda K, Sawada T, Ishikawa E, Ishikawa T, Furukawa K, Hirose T, Kawashima H

Revista espanola de enfermedades digestivas     2024年11月

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記述言語：英語  

DOI： 10.17235/reed.2024.10706/2024

PubMed

特集 炎症性腸疾患update [Chapter 2]　IBD治療のupdate CD内科治療 ②(腸管狭窄に対する内視鏡治療)

中村 正直, 山村 健史, 澤田 つな騎, 石川 恵里, 川嶋 啓揮

内科   134 巻 ( 5 ) 頁： 1065 - 1067   2024年11月

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出版者・発行元：南江堂  

DOI： 10.15106/j_naika134_1065

CiNii Research

特集 炎症性腸疾患update [Chapter 2]　IBD治療のupdate UC内科治療 ③(ステロイド後)

澤田 つな騎, 中村 正直, 山村 健史, 川嶋 啓揮

内科   134 巻 ( 5 ) 頁： 1042 - 1049   2024年11月

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出版者・発行元：南江堂  

DOI： 10.15106/j_naika134_1042

CiNii Research

Chronic obstructive pulmonary disease, asthma, and mechanical ventilation are risk factors for dyspnea in patients with long COVID: A Japanese nationwide cohort study.

Matsuyama E, Miyata J, Terai H, Miyazaki N, Iwasaki T, Nagashima K, Watase M, Sunata K, Namkoong H, Asakura T, Masaki K, Chubachi S, Ohgino K, Kawada I, Minami K, Hagiwara R, Ueda S, Yoshiyama T, Kokuto H, Kusumoto T, Oashi A, Miyawaki M, Saito F, Tani T, Ishioka K, Takahashi S, Nakamura M, Ishii M, Sato Y, Fukunaga K

Respiratory investigation   62 巻 ( 6 ) 頁： 1094 - 1101   2024年11月

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記述言語：英語  

DOI： 10.1016/j.resinv.2024.09.009

PubMed

Predicting early rebleeding and mortality after endoscopic hemostasis of esophagogastric varices: Diagnostic performance of aspartate aminotransferase-to-platelet ratio index and model for end-stage liver disease-Na score.

Yokoyama S, Honda T, Ishizu Y, Imai N, Ito T, Yamamoto K, Mizuno K, Nakamura M, Kawashima H

Journal of hepato-biliary-pancreatic sciences   31 巻 ( 11 ) 頁： 830 - 839   2024年11月

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記述言語：英語  

DOI： 10.1002/jhbp.12057

PubMed

特集 小腸疾患に対する最新の内視鏡臨床 10.腫瘍性疾患に対する最新の診断治療戦略

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

臨床消化器内科   39 巻 ( 12 ) 頁： 1545 - 1552   2024年10月

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出版者・発行元：日本メディカルセンター  

DOI： 10.19020/cg.0000003262

CiNii Research

New Role of the Serotonin as a Biomarker of Gut-Brain Interaction.

Liu HN, Nakamura M, Kawashima H

Life (Basel, Switzerland)   14 巻 ( 10 )   2024年10月

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記述言語：英語  

DOI： 10.3390/life14101280

PubMed

Monoclonal Antibodies Against Mature Interleukin-18 Ameliorate Colitis and Repair Goblet Cell Function.

Mu J, Maeda K, Ohashi A, Urano T, Nariai Y, Kamino H, Nakamura M, Yamamura T, Sawada T, Ishikawa E, Murate K, Yamamoto K, Hirose T, Furukawa K, Fujishiro M, Kawashima H

Digestive diseases and sciences   69 巻 ( 7 ) 頁： 2573 - 2585   2024年7月

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記述言語：英語   出版者・発行元：Digestive Diseases and Sciences  

Background: Numerous biological interventions and small molecules are used to treat Crohn’s disease; however, the effectiveness of these treatments varies largely. Non-responsiveness to biological therapies is associated with interleukin (IL)-18 gene polymorphisms and high IL-18 expression has been implicated in the pathogenesis of Crohn’s disease. Aims: The aim of this study was to elucidate the expression of precursor and mature IL-18 in patients with Crohn’s disease who exhibited varied responses to cytokine-targeted treatments and determine whether selective inhibition of mature IL-18 offers a novel therapeutic avenue. Methods: We generated a monoclonal antibody that specifically recognizes the neoepitope of caspase-cleaved mature IL-18. Expression of precursor and mature IL-18 was analyzed in patients with Crohn’s disease. Anti-mature IL-18 monoclonal antibodies were intraperitoneally administered in an acute colitis mouse model, and the disease activity index, body weight loss, tissue pathology, proinflammatory cytokine expression, goblet cell function, and microbiota composition were assessed. Results: Precursor and mature IL-18 expression was upregulated and goblet cell function was impaired in patients with Crohn’s disease who were unresponsive to biological therapies. Administration of anti-mature IL-18 antibodies ameliorated induced colitis by repairing goblet cell function and restoring the mucus layer. Conclusions: The newly developed monoclonal antibody holds promise as a therapeutic alternative for Crohn’s disease.

DOI： 10.1007/s10620-024-08453-2

Scopus

PubMed

Reply - Letter to the editor.

Yokoyama S, Honda T, Ishizu Y, Imai N, Ito T, Yamamoto K, Mizuno K, Kojima T, Kariya N, Nakamura M, Kawashima H

Clinical nutrition (Edinburgh, Scotland)   43 巻 ( 8 ) 頁： 1855 - 1856   2024年6月

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記述言語：英語   出版者・発行元：Clinical Nutrition  

DOI： 10.1016/j.clnu.2024.06.031

Scopus

PubMed

Outcomes of surgical treatment for enterovesical fistula in Crohn's disease.

Hattori N, Nakayama G, Umeda S, Nakamura M, Yamamura T, Sawada T, Nakanishi K, Shimizu D, Kanda M, Hayashi M, Tanaka C, Kodera Y

Nagoya journal of medical science   86 巻 ( 2 ) 頁： 280 - 291   2024年5月

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記述言語：英語   出版者・発行元：Nagoya Journal of Medical Science  

Enterovesical fistula (EVF) in Crohn’s disease (CD) often does not improve with medical treatment and requires surgical treatment. The surgical treatment strategy for EVF in CD is definitive resection of the intestinal tract side, and performing a leak test using dye injection into the bladder after EVF dissection to determine the appropriate surgical procedure for the bladder side. This study aimed to evaluate the outcomes of surgical treatment for EVF in CD. Twenty-one patients who underwent surgery for EVF between 2006 and 2021 were included and retrospectively evaluated for clinical background, surgical procedures, and postoperative complications. The most common origin of EVF was the ileum (17 cases; 81%), and the most common site of EVF formation was the apex (12; 57%). Surgical approaches were laparotomy in 11 (52%) cases and laparoscopy in 10 (48%). Surgical procedures on the bladder side were fistula dissection in 13 (62%) cases and sutured closure of fistula in 8 (38%). A comparison of approaches revealed no significant difference in operative time, but the amount of blood loss was significantly less in the laparoscopy (p < 0.01). There was no significant difference in the occurrence of postoperative complications between approaches. Postoperative anti-TNF-a antibody agents were used in 17 (81%) cases, and there were no cases of recurrent EVF. In conclusion, definitive resection of the intestinal tract and minimal treatment on the bladder side were sufficient to achieve satisfactory outcomes for EVF in CD.

DOI： 10.18999/nagjms.86.2.280

Scopus

PubMed

特集 外科医必携　患者さんとのトラブルを防ぐためのハンドブック 各論 上部消化管内視鏡検査における鎮静と患者説明

柴田 寛幸, 古川 和宏, 古根 聡, 廣瀨 崇, 中村 正直, 川嶋 啓揮

臨床外科   79 巻 ( 3 ) 頁： 308 - 312   2024年3月

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出版者・発行元：株式会社医学書院  

DOI： 10.11477/mf.1407214472

CiNii Research

特集 IBD診療-ますます増えた薬剤の選択とさらなる進化の展望 1.治療薬の使い分けの総論と各論(4)中等症UCにおけるバイオ製剤/JAK阻害薬の使い分け-抗IL-23抗体も含めて

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

臨床消化器内科   39 巻 ( 2 ) 頁： 140 - 146   2024年1月

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出版者・発行元：日本メディカルセンター  

DOI： 10.19020/cg.0000002926

CiNii Research

バルーン内視鏡を用いたクローン病小腸病変の評価

澤田 つな騎, 中村 正直, 川嶋 啓揮

日本消化器内視鏡学会雑誌   66 巻 ( 1 ) 頁： 16 - 28   2024年

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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>クローン病の小腸病変は容易に通過障害などを来し，手術率が高いことが知られており，そのマネジメントは重要な課題である．バルーン内視鏡のクローン病診療における役割として，従来の大腸内視鏡検査では観察不可能な部位にしか病変を持たないクローン病の診断や，小腸病変の治療効果判定やモニタリングとして内視鏡的寛解の有無の評価に有用であるとする報告がみられる．また，症候性の小腸狭窄におけるバルーン拡張術は，潰瘍が無いなどの適応基準を満たした病変においては高い手技成功率と，良好な長期成績が示されている．他の小腸評価法と比較して，検査精度が高く，組織生検・内視鏡治療が可能な唯一の検査である一方，侵襲性が高く，消化管穿孔や出血，膵炎などの偶発症が報告されている．小腸病変の評価において，バルーン内視鏡を含めた各種モダリティの中から，状況に応じてどの検査を用いていくか，議論をすすめる必要がある．</p>

DOI： 10.11280/gee.66.16

Scopus

CiNii Research

ESDで診断に至った深在性囊胞性大腸炎の１例

山田 健太朗, 山村 健史, 中村 正直, 前田 啓子, 澤田 つな騎, 石川 恵里, 梶川 豪, 長谷川 一成, 横井 太紀雄, 川嶋 啓揮

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

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

DOI： 10.11280/gee.66.279

Scopus

CiNii Research

大腸ポリープに対するコールドスネアポリペクトミーで腹腔内出血をきたした１例

池上 脩二, 山村 健史, 中村 正直, 前田 啓子, 澤田 つな騎, 石川 恵里, 山下 彩子, 河村 達哉, 横井 太紀雄, 川嶋 啓揮

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

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

DOI： 10.11280/gee.66.1236

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CiNii Research

内視鏡を活用した小腸疾患のマネッジメント

中村 正直

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

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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  

DOI： 10.11280/gee.66.684

CiNii Research

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

中村 正直

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

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

DOI： 10.11280/gee.66.1813

CiNii Research

腸管リンパ腫の診断と治療

石川 恵里, 中村 正直, 川嶋 啓揮

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

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

DOI： 10.11280/gee.66.2533

CiNii Research

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

中村 正直, 山村 健史, 前田 啓子, 澤田 つな騎, 石川 恵里, 村手 健太郎, 長谷川 一成, 池上 脩二, 山下 彩子, 河村 達哉, 大岩 恵祐, 八田 勇輔, 平松 美緒, 廣瀬 崇, 古川 和宏, 川嶋 啓揮

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

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出版者・発行元：株式会社医学書院  

DOI： 10.11477/mf.1403203399

CiNii Research

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

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

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

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出版者・発行元：Journal of Gastroenterology  

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

DOI： 10.1007/s00535-023-02017-3

Scopus

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

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

HEPATOLOGY INTERNATIONAL     2023年9月

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

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

DOI： 10.1007/s12072-023-10581-2

Web of Science

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PubMed

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

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

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

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記述言語：英語   出版者・発行元：BMC Gastroenterology  

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

DOI： 10.1186/s12876-023-02913-1

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PubMed

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

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

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

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

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

DOI： 10.1007/s00535-023-02029-z

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PubMed

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

Ikegami S, Nakamura M, Honda T, Kawashima H

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

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記述言語：英語   出版者・発行元：Alimentary Pharmacology and Therapeutics  

DOI： 10.1111/apt.17443

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PubMed

ENDOSCOPIC TREATMENT OF DUODENAL NEUROENDOCRINE TUMORS

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

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

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Web of Science

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

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

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

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記述言語：英語   出版者・発行元：Esophagus  

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

DOI： 10.1007/s10388-022-00963-0

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PubMed

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

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

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

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

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

DOI： 10.1007/s00535-022-01949-6

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PubMed

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

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

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

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

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

DOI： 10.1111/jgh.16112

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Factors Related to Delayed Adverse Events of Endoscopic Submucosal Dissection in the Duodenum 国際誌

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

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

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

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

DOI： 10.1159/000522362

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

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

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

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記述言語：英語   出版者・発行元：Digestive Diseases  

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

DOI： 10.1159/000524298

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

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

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

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

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

DOI： 10.1111/den.14464

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

中村 正直

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

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

DOI： 10.11280/gee.65.2249

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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  

DOI： 10.11280/gee.65.1493

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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

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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

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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

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出版者・発行元：日本メディカルセンター  

DOI： 10.19020/cg.0000002478

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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出版者・発行元：東京医学社  

DOI： 10.24479/endo.0000000317

CiNii Research

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

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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

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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

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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

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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

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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

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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

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出版者・発行元：東京医学社  

DOI： 10.24479/endo.0000000259

CiNii Research

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

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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

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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

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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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Effects of steroid use for stenosis prevention after endoscopic submucosal dissection for cervical esophageal cancer

Muroi Koichi, Kakushima Naomi, Furukawa Kazuhiro, Furune Satoshi, Ito Nobuhito, Hirose Takashi, Ishikawa Eri, Mizutani Yasuyuki, Sawada Tsunaki, Maeda Keiko, Yamamura Takeshi, Ishikawa Takuya, Ohno Eizaburo, Nakamura Masanao, Kawashima Hiroki, Funasaka Kohei, Miyahara Ryoji, Fujishiro Mitsuhiro

INTERNATIONAL JOURNAL OF CLINICAL ONCOLOGY   27 巻 ( 5 ) 頁： 940 - 947   2022年5月

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

Background and aim: Esophageal stenosis is a serious complication after endoscopic submucosal dissection (ESD) for thoracic esophageal cancer (TEC), and steroid has been applied for stenosis prevention. However, the rate of stenosis and effect of steroid for ESD of cervical esophageal cancer (CEC) remain unknown. The aim was to clarify the rate and managements of post-ESD stenosis for CEC. Methods: A total of 325 lesions with 272 patients who underwent ESD for esophageal cancers were enrolled and were divided to the CEC group (43 lesions) or the TEC group (282 lesions). Patient characteristics, clinicopathological features, procedure-related outcomes of esophageal ESD, stenosis rate and clinical outcome of steroid use cases were evaluated. Results: More patients in the CEC group received preventive steroid treatment compared to the TEC group (37.2% vs 14.5%, P = 0.001). The rate of post-ESD stenosis tended to be higher in the CEC group (11.6%) than in the TEC group (6.7%). For cases of 3/4 ≤ of circumference, local injection with oral steroid had lower stenosis rate than local injection only in both groups (CEC 40% vs 100%, TEC 30.7% vs 56.3%). More sessions and longer duration of dilation were needed to release the stenosis in the CEC group (20 times vs. 5 times, P = 0.015; 196 days vs. 55 days, P = 0.043). Conclusion: The post-ESD stenosis rate of CEC tended to be higher than that of TEC. More intensive preventive measures for post-ESD stenosis may be needed for CEC than TEC.

DOI： 10.1007/s10147-022-02139-3

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Relationship between psoas muscle index and long-term survival in older patients aged ≥ 80 years after endoscopic submucosal dissection for gastric cancer

Ito Nobuhito, Funasaka Kohei, Miyahara Ryoji, Furukawa Kazuhiro, Yamamura Takeshi, Ishikawa Takuya, Ohno Eizaburo, Nakamura Masanao, Kawashima Hiroki, Hirooka Yoshiki, Fujishiro Mitsuhiro

INTERNATIONAL JOURNAL OF CLINICAL ONCOLOGY   27 巻 ( 4 ) 頁： 729 - 738   2022年4月

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

Background: In Japan, endoscopic submucosal dissection (ESD) has been widely performed for ESD-adapted gastric cancer, but little is known about the prognostic factors after ESD for gastric cancer in older patients. The psoas muscle index (PMI) is an indicator of sarcopenia calculated from computed tomography images and reportedly related to the prognosis of some diseases. This study aimed to explore factors related to long-term survival after ESD for gastric cancer in patients aged ≥ 80 years. Methods: We retrospectively reviewed 88 patients (63 men, 25 women) with early gastric cancer who underwent ESD at ≥ 80 years. Possible factors related to death after gastric ESD were analyzed by univariate and multivariate analyses using a Cox proportional hazards model. The estimated overall survival (OS) was compared between the groups stratified by significant factors. Results: The 5-year OS rate was 73.9% (median follow-up period, 5.4 years). In the multivariate analysis, a low PMI (< 6.36 in men, < 3.92 in women) (hazard ratio [HR] 2.89, 95% confidence interval [CI] 1.11–7.54) and high Charlson comorbidity index (CCI) (≥ 3) (HR 1.87, 95% CI 1.14–3.09) were independently related to death after ESD. The 5-year OS rates were significantly higher in the high PMI group (82.3% vs. 70.7%, P = 0.026) and the low CCI group (76.0% vs. 37.9%, P = 0.002). Conclusion: In addition to low CCI, high PMI is a predictor of long-term survival after ESD for gastric cancer in patients aged ≥ 80 years.

DOI： 10.1007/s10147-021-02112-6

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Patients with low muscle mass have characteristic microbiome with low potential for amino acid synthesis in chronic liver disease

Yamamoto Kenta, Ishizu Yoji, Honda Takashi, Ito Takanori, Imai Norihiro, Nakamura Masanao, Kawashima Hiroki, Kitaura Yasuyuki, Ishigami Masatoshi, Fujishiro Mitsuhiro

SCIENTIFIC REPORTS   12 巻 ( 1 ) 頁： 3674   2022年3月

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記述言語：英語   出版者・発行元：Scientific Reports  

Sarcopenia is thought to be related to the microbiome, but not enough reports in chronic liver disease (CLD) patients. In addition to the differences in microbiome, the role of the microbiome in the gut is also important to be clarified because it has recently been shown that the microbiome may produce branched-chain amino acids (BCAAs) in the body. In this single-center study, sixty-nine CLD patients were divided by skeletal muscle mass index (SMI) into low (L-SMI: n = 25) and normal (N-SMI: n = 44). Microbiome was analyzed from stool samples based on V3-4 region of bacterial 16S rRNA). L-SMI had a lower Firmicutes/Bacteroidetes ratio than N-SMI. At the genus level, Coprobacillus, Catenibacterium and Clostridium were also lower while the Bacteroides was higher. Predictive functional profiling of the L-SMI group showed that genes related to nitrogen metabolism were enriched, but those related to amino acid metabolism, including BCAA biosynthesis, were lower. The genes related to 'LPS biosynthesis' was also higher. The microbiome of CLD patients with low muscle mass is characterized not only by high relative abundance of gram-negative bacteria with LPS, but also by the possibility of low potential for amino acid synthesis including BCAAs.

DOI： 10.1038/s41598-022-07810-3

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Changes in the gut microbiome in relation to the degree of gastric mucosal atrophy before and after Helicobacter pylori eradication

Furune Satoshi, Yamamoto Kenta, Honda Takashi, Fujiyoshi Toshihisa, Kakushima Naomi, Furukawa Kazuhiro, Ohno Eizaburo, Nakamura Masanao, Miyahara Ryoji, Kawashima Hiroki, Ishigami Masatoshi, Hirooka Yoshiki, Fujishiro Mitsuhiro

SCANDINAVIAN JOURNAL OF GASTROENTEROLOGY   57 巻 ( 3 ) 頁： 266 - 273   2022年3月

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

Objectives: Helicobacter pylori infection causes atrophic gastritis, which affects the gut microbiome; the gastric acid concentration depends on the degree of atrophic gastritis. Helicobacter pylori eradication also affects gastric acidity. Here, we determined the differences in the post-eradication changes in the gut microbiome in relation to the progression of gastric atrophy. Materials and Methods: Ten patients were included in the closed group and five in the open group, consisting of patients with non-progressive and progressive atrophy, respectively, diagnosed by endoscopy. The faecal microbiome was analysed and compared among three time-points: before eradication, 8 weeks after eradication, and 6 months after eradication. The microbiome was analysed by targeting 16S rRNA using Illumina Miseq. Results: The relative abundance of 14 genera significantly differed between the closed and open groups before eradication, but only 12 and 6 genera presented a significant difference in the relative abundance at 8 weeks and 6 months after eradication, respectively. Of the 12 genera that differed between the closed and open groups before eradication, 8 genera, namely, Actinomyces, Aggregatibacter, Campylobacter, Granulicatella, Pyramidobacter, Streptococcus, Cardiobacterium, and Haemophilus, were oral-origin bacteria. Longitudinal changes showed that Haemophilus and Catenibacterium were consistently significantly more abundant in the open group than in the closed group during the follow-up period. Conclusion: The gut microbiome substantially differed depending on the progression of gastric atrophy, but this difference was decreased by eradication, especially the differences in the number of oral bacteria in the gut. Eradication therapy may improve dysbiosis that result from gastric atrophy.

DOI： 10.1080/00365521.2021.2005135

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Fecal incontinence and oral regurgitation during duodenal endoscopic submucosal dissection using the water pressure method 国際誌

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

DIGESTIVE ENDOSCOPY   34 巻 ( 3 ) 頁： 526 - 534   2022年3月

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

Objectives: Endoscopic submucosal dissection (ESD) in the duodenum is challenging. The water pressure method (WP-ESD) has been developed with a decreased rate of perforation. However, details of perioperative adverse events of WP-ESD are unknown. The purpose of this study was to clarify the frequency and related factors of fecal incontinence and oral regurgitation during WP-ESD. Methods: A chart-based retrospective analysis was performed on 43 patients who underwent duodenal WP-ESD. The saline volume given into the body was calculated in all cases. All adverse events during WP-ESD until 6 weeks were extracted, and factors related to intraoperative fecal incontinence or oral regurgitation were analyzed. The frequency of fecal incontinence and oral regurgitation was also compared to those of 83 conventional ESD cases. Results: In WP-ESD, intraoperative fecal incontinence occurred in 12 (28%), oral regurgitation in six (14%), and aspiration pneumonia in one patient. For fecal incontinence, the infusion speed (saline volume divided by resection time) around 17 mL/min was a significant factor in multivariable analysis. For oral regurgitation, only tumor size was a significant factor in univariate analysis (P = 0.027). Significant difference was observed in the frequency of fecal incontinence between WP-ESD and conventional ESD (28% vs. 0%, P < 0.001), but no difference was observed in oral regurgitation or aspiration pneumonia. Conclusions: Intraoperative fecal incontinence is a unique adverse event of WP-ESD related to the infusion speed. WP-ESD did not pose a risk for oral regurgitation, but we should be aware of the risk in large tumor cases.

DOI： 10.1111/den.14070

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Safety and efficacy of the endoscopic delivery of capsule endoscopes in adult and pediatric patients: Multicenter Japanese study (AdvanCE-J study)

Ohmiya Naoki, Oka Shiro, Nakayama Yoshiko, Iwama Itaru, Nakamura Masanao, Shimizu Hirotaka, Sumioka Akihiko, Abe Naoki, Kudo Takahiro, Osawa Satoshi, Honma Hitoshi, Okuhira Takeru, Mtsufuji Shoji, Imaeda Hiroyuki, Ota Kazuhiro, Matsuoka Ryo, Hotta Naoki, Inoue Mikihiro, Nakaji Konosuke, Takamaru Hiroyuki, Ozeki Keiji, Kobayashi Taku, Hosoe Naoki, Tajiri Hisao, Tanaka Shinji

DIGESTIVE ENDOSCOPY   34 巻 ( 3 ) 頁： 543 - 552   2022年3月

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

Background and Aim: We retrospectively determined the safety and efficacy of the endoscopic delivery (ED) of capsule endoscopes. Methods: We enrolled 10,156 patients who underwent small bowel capsule endoscopy (SBCE), 3182 who underwent patency capsule (PC), and 1367 who underwent colon capsule endoscopy (CCE), at 11 gastroenterological and nine pediatric centers. Results: Small bowel capsule endoscopies, PCs, and CCEs were endoscopically delivered to 546 (5.4%), 214 (6.7%), and 14 (1.0%) patients, respectively. Only mild complications occurred for 21.6% (167/774), including uneventful mucosal damage, bleeding, and abdominal pain. Successful ED of SBCE to the duodenum or jejunum occurred in 91.8% and 90.7% of patients aged <16 years and ≥16 years, respectively (P = 0.6661), but the total enteroscopy rate was higher in the first group (91.7%) than in the second (76.2%, P < 0.0001), for whom impossible ingestion (87.3%) was significantly more common than prolonged lodging in the stomach (64.2%, P = 0.0010). Successful PC and CCE delivery to the duodenum occurred in 84.1% and 28.6%, thereafter the patency confirmation rate and total colonoscopy rate was 100% and 61.5%, respectively. The height, weight, and age cutoff points in predicting spontaneous ingestion were 132 cm, 24.8 kg, and 9 years 2 months, respectively, in patients aged <16 years. Patients aged ≥16 years could not swallow the SBCEs mainly due to dysphagia (75.0%); those who retained it in the esophagus due to cardiac disease (28.6%), etc. and in the stomach due to diabetes mellitus (15.7%), etc. Conclusions: This large-scale study supports the safety and efficacy of ED in adult and pediatric patients. UMIN000042020.

DOI： 10.1111/den.14104

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The impact of the age-adjusted Charlson comorbidity index as a prognostic factor for endoscopic papillectomy in ampullary tumors

Takada Yoshihisa, Kawashima Hiroki, Ohno Eizaburo, Ishikawa Takuya, Mizutani Yasuyuki, Iida Tadashi, Yamamura Takeshi, Kakushima Naomi, Furukawa Kazuhiro, Nakamura Masanao, Honda Takashi, Ishigami Masatoshi, Ito Akihiro, Hirooka Yoshiki

JOURNAL OF GASTROENTEROLOGY   57 巻 ( 3 ) 頁： 199 - 207   2022年3月

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

Background: The prognostic nutritional index (PNI) and Charlson comorbidity index (CCI) have been useful for predicting the prognosis based on nutritional condition and comorbidities in surgery and endoscopic mucosal dissection. The age-adjusted CCI (ACCI) has also been reported to be useful in surgery, but it has not been applied to endoscopic treatment. We therefore clarified the prognostic factors associated with ampullary tumors treated with endoscopic papillectomy (EP). Methods: From January 2003 to December 2020, 236 patients who underwent EP for sporadic ampullary tumors at Nagoya University Hospital were included in this study. The 5-year survival and ability to predict the prognosis were evaluated in terms of the sex, PNI, ACCI, final pathological diagnosis, and intraductal extension. Results: During a median follow-up period of 1558 days, 17 patients died. No patient died of the primary disease. The 5-year survival rate was 91.1%. In a univariate analysis, only a high ACCI (≥ 5) was extracted as a significant prognostic factor (Odds ratio, 12.2; 95% confidence interval, 3.81–39.3; p < 0.001). The 5-year survival rates for a low ACCI (≤ 4) and high ACCI were 96.6% and 73.5%, respectively (p < 0.001). Conclusions: A high ACCI is an important prognostic factor associated with the 5-year survival and a risk of death from other illness. Ampullary tumors suitable for EP are less likely to be a prognostic factor, and treatment-free follow-up may be acceptable in patients with a high ACCI.

DOI： 10.1007/s00535-022-01853-z

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Artificial intelligence-based diagnosis of upper gastrointestinal subepithelial lesions on endoscopic ultrasonography images

Hirai Keiko, Kuwahara Takamichi, Furukawa Kazuhiro, Kakushima Naomi, Furune Satoshi, Yamamoto Hideko, Marukawa Takahiro, Asai Hiromitsu, Matsui Kenichi, Sasaki Yoji, Sakai Daisuke, Yamada Koji, Nishikawa Takahiro, Hayashi Daijuro, Obayashi Tomohiko, Komiyama Takuma, Ishikawa Eri, Sawada Tsunaki, Maeda Keiko, Yamamura Takeshi, Ishikawa Takuya, Ohno Eizaburo, Nakamura Masanao, Kawashima Hiroki, Ishigami Masatoshi, Fujishiro Mitsuhiro

GASTRIC CANCER   25 巻 ( 2 ) 頁： 382 - 391   2022年3月

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

Background: Endoscopic ultrasonography (EUS) is useful for the differential diagnosis of subepithelial lesions (SELs); however, not all of them are easy to distinguish. Gastrointestinal stromal tumors (GISTs) are the commonest SELs, are considered potentially malignant, and differentiating them from benign SELs is important. Artificial intelligence (AI) using deep learning has developed remarkably in the medical field. This study aimed to investigate the efficacy of an AI system for classifying SELs on EUS images. Methods: EUS images of pathologically confirmed upper gastrointestinal SELs (GIST, leiomyoma, schwannoma, neuroendocrine tumor [NET], and ectopic pancreas) were collected from 12 hospitals. These images were divided into development and test datasets in the ratio of 4:1 using random sampling; the development dataset was divided into training and validation datasets. The same test dataset was diagnosed by two experts and two non-experts. Results: A total of 16,110 images were collected from 631 cases for the development and test datasets. The accuracy of the AI system for the five-category classification (GIST, leiomyoma, schwannoma, NET, and ectopic pancreas) was 86.1%, which was significantly higher than that of all endoscopists. The sensitivity, specificity, and accuracy of the AI system for differentiating GISTs from non-GISTs were 98.8%, 67.6%, and 89.3%, respectively. Its sensitivity and accuracy were significantly higher than those of all the endoscopists. Conclusion: The AI system, classifying SELs, showed higher diagnostic performance than that of the experts and may assist in improving the diagnosis of SELs in clinical practice.

DOI： 10.1007/s10120-021-01261-x

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今月の主題 炎症性腸疾患の粘膜治癒を再考する 主題 Crohn病における小腸粘膜治癒評価の意義-小腸カプセル内視鏡の立場から

中村 正直, 山村 健史, 前田 啓子, 澤田 つな騎, 石川 恵里, 角嶋 直美, 古川 和宏, 飯田 忠, 水谷 泰之, 石川 卓哉, 大野 栄三郎, 川嶋 啓揮, 藤城 光弘

胃と腸   57 巻 ( 2 ) 頁： 183 - 189   2022年2月

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出版者・発行元：株式会社医学書院  

DOI： 10.11477/mf.1403202660

CiNii Research

Gastrointestinal: Idiopathic omental hemorrhage

Furukawa K., Yamamura T., Nakamura M., Kawashima H., Fujishiro M.

JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY   37 巻 ( 2 ) 頁： 282 - 282   2022年2月

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記述言語：英語   出版者・発行元：Journal of Gastroenterology and Hepatology (Australia)  

DOI： 10.1111/jgh.15639

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Initial experience of tofacitinib for treating refractory moderate-to-severe ulcerative colitis

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

NAGOYA JOURNAL OF MEDICAL SCIENCE   84 巻 ( 1 ) 頁： 169 - 179   2022年2月

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記述言語：英語   出版者・発行元：Nagoya Journal of Medical Science  

Ulcerative colitis (UC) is an incurable, chronic inflammatory disease of the large bowel whose etiology and pathogenesis have not yet been comprehensively explained. Tofacitinib is a small molecule Janus kinase inhibitor that was introduced for treating refractory UC. We aimed to examine the efficacy and safety of tofacitinib for the treatment of 18 patients with UC. Continuous treatment rates were 50, 38, and 33% at 8, 24, and 52 weeks, respectively. Overall, 83.3% of these patients showed tumor necrosis factor (TNF) antibody failure status. When the effective status was defined as a Lichtiger index (LI) that decreased by 3 points or more or was less than 4 points and remission status was defined as an LI less than 4 points, the effective and remission rates (%) at 2, 8, and 16 weeks were 55.5 (10/18) and 22.2 (4/18), 38.8 (7/18) and 33.3 (6/18), and 38.8 (7/18) and 38.8 (7/18), respectively. Background characteristics of 2-week responders and non-responders were compared. C-reactive protein level in responders was significantly lower than that in non-responders, and the hemoglobin level in responders was significantly higher than that in non-responders. This study provides preliminary results of the effectiveness of tofacitinib even for TNF antibody and tacrolimus failure patients.

DOI： 10.18999/nagjms.84.1.169

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Usefulness of Macroscopic On-Site Evaluation Using a Stereomicroscope during EUS-FNB for Diagnosing Solid Pancreatic Lesions

Ishikawa Takuya, Ohno Eizaburo, Mizutani Yasuyuki, Iida Tadashi, Uetsuki Kota, Yashika Jun, Yamada Kenta, Gibo Noriaki, Aoki Toshinori, Kataoka Kunio, Mori Hiroshi, Takada Yoshihisa, Takahashi Hidekazu, Aoi Hironori, Kato Katsuyuki, Yamamura Takeshi, Kakushima Naomi, Furukawa Kazuhiro, Nakamura Masanao, Hirooka Yoshiki, Kawashima Hiroki

CANADIAN JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY   2022 巻   頁： 2737578   2022年1月

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

Background/Aims. The usefulness of macroscopic on-site evaluation (MOSE) during endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) has been reported, but a specific method for MOSE has not been established. We aimed to investigate the usefulness of MOSE using a stereomicroscope (S-MOSE) for the diagnosis of solid pancreatic lesions (SPLs). Methods. We reviewed a total of 60 consecutive patients who underwent both S-MOSE and rapid on-site cytopathological evaluation (ROSE) during EUS-FNB between July 2019 and October 2020, and the usefulness of S-MOSE in comparison with histology was evaluated. A 22-gauge Franseen needle was used to perform EUS-FNB in all patients, and only the specimens obtained by the first pass were evaluated. The final diagnosis was based on the surgical specimen or the clinical course consistent with the EUS-FNB results. Results. The final diagnoses of the 60 patients included 45 patients with pancreatic ductal adenocarcinoma, 6 with autoimmune pancreatitis, 4 with mass-forming pancreatitis, 1 with pancreatic metastasis, 2 with pancreatic neuroendocrine tumor, and 2 with intraductal papillary mucinous carcinoma. The histological diagnostic accuracy of the first pass of EUS-FNB was 83.3% (50/60). The agreement between the S-MOSE and the histological diagnosis was 90% (54/60). The positive predictive value of S-MOSE for histological diagnosis was 90.7%, which can be an indicator of when to stop the EUS-FNB procedure. There were no immediate or delayed adverse events reported after the FNB based on the chart and medical visit history review. Conclusion. In the EUS-FNB of SPLs, S-MOSE can be an alternative to ROSE for specimen evaluation and has the potential to shorten the procedure time.

DOI： 10.1155/2022/2737578

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Evaluation of ulcerative colitis activity using transabdominal ultrasound shear wave elastography 国際誌

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

QUANTITATIVE IMAGING IN MEDICINE AND SURGERY   12 巻 ( 1 ) 頁： 618 - 626   2022年1月

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Quantitative Imaging in Medicine and Surgery  

Background: Transabdominal ultrasound (US) has been reported to be effective in the evaluation of ulcerative colitis (UC). US can measure shear wave elastography (SWE) and shear wave dispersion (SWD), which may be correlated with inflammation and necrosis. We aimed to investigate the relationship between UC activity and SWE and SWD. Methods: Patients with UC who underwent US within 2 days before or after a colonoscopy between April 2019 and March 2020 were included. SWE and SWD were measured in the sigmoid colon; the correlations of SWE and SWD with the Lichtiger index and the Ulcerative Colitis Endoscopic Index of Severity (UCEIS) were investigated. We also compared SWE and SWD between patients with mucosal healing and those in the active phase according to the UCEIS. Results: Twenty-six UC patients were enrolled. The median Lichtiger index, UCEIS, SWE values, and SWD values were 8 [interquartile range (IQR), 5.3–10.8], 4 (IQR, 3.3–5), 1.69 (IQR, 1.49–2.16) m/s, and 11.9 (IQR, 10.9–13.3) (m/s)/kHz, respectively. The Lichtiger index and UCEIS were negatively correlated with the SWE values (rs=−0.404 and rs=−0.506) but not with the SWD values (rs=0.004 and rs=0.002). The SWE values differed significantly between the mucosal healing and active phase groups [2.40 (IQR, 2.18–3.38) vs. 1.62 (IQR, 1.44–1.95) m/s, P=0.007], whereas the SWD values did not [13.1 (IQR, 7.05–21.6) vs. 11.9 (IQR, 11.1–13.2) (m/s)/kHz, P=0.918]. Conclusions: SWE may be useful for the evaluation of UC activity and could be a noninvasive method of assessing disease severity.

DOI： 10.21037/qims-21-403

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Mucosa-Associated Lymphoid Tissue (MALT) Lymphoma in the Gastrointestinal Tract in the Modern Era

Ishikawa Eri, Nakamura Masanao, Satou Akira, Shimada Kazuyuki, Nakamura Shotaro

CANCERS   14 巻 ( 2 )   2022年1月

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記述言語：英語   出版者・発行元：Cancers  

Extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma) typically arises from sites such as the stomach, where there is no organized lymphoid tissue. Close associations between Helicobacter pylori and gastric MALT lymphoma or Campylobacter jejuni and immunoproliferative small intestinal disease (IPSID) have been established. A subset of tumors is associated with chromosomal rearrangement and/or genetic alterations. This disease often presents as localized disease, requiring diverse treatment approaches, from antibiotic therapy to radiotherapy and immunochemotherapy. Eradication therapy for H. pylori effectively cures gastric MALT lymphoma in most patients. However, treatment strategies for H. pylori-negative gastric MALT lymphoma are still challenging. In addition, the effectiveness of antibiotic therapy has been controversial in intestinal MALT lymphoma, except for IPSID. Endoscopic treatment has been noted to usually achieve complete remission in endoscopically resectable colorectal MALT lymphoma with localized disease. MALT lymphoma has been excluded from post-transplant lymphoproliferative disorders with the exception of Epstein–Barr virus (EBV)-positive marginal zone lymphoma (MZL). We also describe the expanding spectrum of EBV-negative MZL and a close association of the disease with the gastrointestinal tract.

DOI： 10.3390/cancers14020446

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Feasibility of endoscopic ultrasonography using a 60-MHz ultrasound miniature probe in the upper gastrointestinal tract

Asai Hiromitsu, Furukawa Kazuhiro, Miyahara Ryoji, Funasaka Kohei, Furune Satoshi, Nakamura Masanao, Kawashima Hiroki, Ishigami Masatoshi, Hirooka Yoshiki, Fujishiro Mitsuhiro

JOURNAL OF MEDICAL ULTRASONICS   49 巻 ( 1 ) 頁： 61 - 69   2022年1月

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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 Medical Ultrasonics  

Purpose: The use of higher frequencies in ultrasound allows for a more detailed image. This study aimed to investigate the feasibility of delineating the gastrointestinal wall using a 60-MHz miniature ultrasound probe. Methods: A phantom study was performed using a multipurpose ultrasonic phantom model, and the depth of imaging was evaluated using 60-MHz and 20-MHz miniature probes and 7.5-MHz conventional convex-type endoscopic ultrasonography. A total of 25 visualized areas from a total of 16 specimens from 16 patients were enrolled. The structures of the layers of the esophagus, stomach, and duodenum were evaluated using a 60-MHz probe and a pathological specimen created from endoscopically or surgically resected specimens. Results: The 60-MHz probe was able to render to a depth of 2 mm and visualize the esophagus, stomach, and duodenum in five layers, respectively, within the depiction range. The depiction ranges of the 20-MHz probe and 7.5-MHz conventional endoscopic ultrasonography were 5 mm and 60 mm, respectively. The 60-MHz probe visualized the muscularis mucosae as the fourth layer in the esophagus, the fourth layer in the stomach, and the second layer in the duodenum. Muscularis mucosae were delineated in almost all cases, except in two cases where the layered structure disappeared. Conclusion: The 60-MHz probe provided good visualization of the muscularis mucosae and structure of the layers down to the submucosa, which improves the ability to diagnose the depth of early cancer invasion of the upper gastrointestinal tract, leading to more appropriate treatments.

DOI： 10.1007/s10396-021-01172-5

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Differentiation Between Solid Pseudopapillary Neoplasm of the Pancreas and Nonfunctional Pancreatic Neuroendocrine Neoplasm Using Endoscopic Ultrasound

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

PANCREAS   51 巻 ( 1 ) 頁： 106 - 111   2022年1月

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記述言語：英語   出版者・発行元：Pancreas  

Objectives We investigated the utility of endoscopic ultrasound (EUS) for differentiating between solid pseudopapillary neoplasm of the pancreas (SPN) and pancreatic neuroendocrine neoplasm (PanNEN). Methods A retrospective analysis was performed on 29 and 77 consecutive patients with pathologically proven SPN and nonfunctional PanNEN. In patients who underwent contrast-enhanced harmonic EUS (CH-EUS), lesions were classified into 3 vascular patterns (hypoechoic/isoechoic/hyperechoic), and the presence of "the alveolus nest sign,"which we previously reported as a characteristic feature of SPN on CH-EUS, was also assessed. Results Conventional EUS findings showed that calcification echoes were significantly more frequent in SPN lesions than in PanNEN lesions (19/29 [66%] vs 21/77 [27%], P = 0.001) as was internal isoechogenicity or hyperechogenicity (10/29 [34%] vs 11/77 [14%], P = 0.029). Contrast-enhanced harmonic EUS findings showed that SPN lesions more frequently had the isoechoic or hypoechoic vascular pattern, and significantly more frequently had the alveolus nest sign (18/25 [72%] vs 4/60 [7%], P < 0.001). In a multivariate analysis, the presence of the alveolus nest sign contributed the most to the SPN diagnosis (odds ratio, 70; 95% confidence interval, 6.2-786). Conclusions Endoscopic ultrasound, particularly the presence of the alveolus nest sign on CH-EUS, is useful for differentiating SPN from PanNEN.

DOI： 10.1097/MPA.0000000000001966

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Endoscopic resection of a duodenal neuroendocrine tumor

Furukawa Kazuhiro, Nakamura Masanao, Kawashima Hiroki, Fujishiro Mitsuhiro

REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS   114 巻 ( 5 ) 頁： 291 - 292   2022年

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記述言語：英語   出版者・発行元：Revista espanola de enfermedades digestivas : organo oficial de la Sociedad Espanola de Patologia Digestiva  

A 50-year-old female with a histologically-proven duodenal neuroendocrine tumor (d-NET) was referred to our hospital for further examination. Esophagogastroduodenoscopy revealed a reddened, hemispheric lesion in the anterior wall of the duodenal bulb. Magnifying endoscopy with narrow-band imaging showed dilatated vessels without variable calibers on the surface. Endoscopic ultrasonography confirmed a 6-mm hypoechoic lesion extending into the submucosa.

DOI： 10.17235/reed.2021.8232/2021

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Indications and Limitations Associated with the Patency Capsule Prior to Capsule Endoscopy

Nakamura Masanao, Kawashima Hiroki, Ishigami Masatoshi, Fujishiro Mitsuhiro

INTERNAL MEDICINE   61 巻 ( 1 ) 頁： 5 - 13   2022年

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記述言語：英語   出版者・発行元：一般社団法人 日本内科学会  

The retention of the capsule used during small bowel capsule endoscopy (SBCE) is a serious complication that can occur in patients with known or suspected small bowel stenosis, and a prior evaluation of the patency of the gastrointestinal (GI) tract is therefore essential. Patency capsule (PC) is a non-diagnostic capsule the same size as the diagnostic SBCE. To date, there are no clear guidelines regarding the contraindications for undergoing a PC evaluation prior to SBCE. Each small bowel disorder has specific occasions to inhibit the progress of PC and SBCE, even though they do not have any stenotic symptoms or abnormalities on imaging. In this review, we summarize the indications and limitations of PC prior to SBCE, especially the contraindications, and discuss clinical scenarios in which even PC should be avoided, and therefore such areas of stenosis should be evaluated by alternative modalities. We thus propose this new algorithm to evaluate the patency of the GI tract for patients with suspected and known small bowel stenosis in order that they may undergo SBCE safely.

DOI： 10.2169/internalmedicine.6823-20

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Immunoproliferative Small Intestinal Disease Diagnosed by Double-balloon Endoscopy with Biopsy Sampling

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

INTERNAL MEDICINE   61 巻 ( 17 ) 頁： 2593 - 2599   2022年

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：一般社団法人 日本内科学会  

We herein report an 80-year-old man diagnosed with immunoproliferative small intestine disease (IPSID) via small bowel endoscopy with a biopsy. He developed persistent diarrhea and subsequently presented with hypoproteinemia and moderate anemia. Transanal double-balloon endoscopy showed prominent villous edema in the middle and lower ileum, while a histological examination showed high lymphocyte/plasma cell infiltration in the mucosal layer. Furthermore, an immunostaining analysis showed that Cluster of differentiation (CD)3 and CD20 were partially positive, while CD138 was diffusely positive. Immunoglobulin A positivity was also observed. He was diagnosed with IPSID and received a nutritional agent and minocycline. After three months, the patients’ symptoms improved.

DOI： 10.2169/internalmedicine.8847-21

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クローン病に対するカプセル内視鏡の役割

中村 正直, 山村 健史

日本消化器内視鏡学会雑誌   64 巻 ( 2 ) 頁： 131 - 142   2022年

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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>小腸カプセル内視鏡（small bowel capsule endoscopy：CE）は小腸全域を非侵襲的に一度で観察できるためクローン病（Crohnʼs disease：CD）に良い適応があると考える．一方では小腸狭窄によりCEが滞留するリスクについて患者背景と消化管開通性から事前に評価することが重要である．臨床診療におけるCEの役割として，①CD初回診断，他の炎症性疾患の鑑別，②CD小腸病変の存在診断，範囲診断，③CD治療の効果判定，臨床的寛解患者の内視鏡モニタリングが挙げられる．CDの診断は空腸から回腸にかけてびらんから小潰瘍が目立ち縦列する所見があれば特徴的とされる．CD小腸病変検索モダリティのなかで最も検出感度が高いのがCEである．CD治療の効果判定は治療開始後６カ月でCEを行い，活動性が低いか内視鏡的寛解であれば定期的に採血でモニタリングを継続し，次の２年以内にCEを検討する．CD診療は，CEを含め各患者に適切なモダリティで診断とモニタリングを行うことにより長期の臨床寛解維持と外科手術の回避を導くことができる．</p>

DOI： 10.11280/gee.64.131

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Preliminary Comparison of Endoscopic Brush and Net Catheters as the Sampling Tool to Analyze the Intestinal Mucus in the Rectum with Ulcerative Colitis Patients 国際誌

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

DIGESTION   103 巻 ( 3 ) 頁： 232 - 243   2022年

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記述言語：英語   出版者・発行元：Digestion  

Background: The pathophysiology of ulcerative colitis (UC) remains unclear, but early lesions on the colorectal mucosal surface may play an important role in its etiology. Intestinal mucus samples, including inner and outer layers, are collected by net or brush catheters, but the quality of the samples obtained by each method has not been fully investigated. Objective: The purpose of this study was to compare the microbiome and protein content of intestinal mucus collected by net and brush catheters during colonoscopy. Methods: Intestinal mucus samples from the lower rectum of 4 patients with UC were collected using a net catheter, a brush catheter, and intestinal fluid suction. Microbiome and protein content were analyzed using 16S rRNA gene sequencing and mass spectrometry. Results: The patients demonstrated significant differences in microbiome alpha diversity (p < 0.05), but this difference was not observed between the sampling methods. Net catheter samples demonstrated higher total protein concentrations than brush catheter samples. The brush catheter group had more Lachnospira, a butyrate-producing bacterium, when compared to the net group. The brush catheter group also had more oral bacteria of Staphylococcus and Dialister in those with active phase when compared to the net group. Conclusions: Brush catheters are more likely to collect the intestinal mucus inner layer, whereas net catheters are more likely to collect larger samples that include the outer mucus layer, as well as the intestinal fluid. Two sampling methods with different types of collection of the mucosa may lead to different results among patients with mucosal vulnerabilities.

DOI： 10.1159/000521929

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PubMed

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

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

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記述言語：日本語   出版者・発行元：日本小腸学会  

<p>【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。</p><p>【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。</p><p>【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。</p><p>【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。</p>

DOI： 10.32264/shocho.6.0_65

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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

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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>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．</p>

DOI： 10.11280/gee.64.239

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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

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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>【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．</p><p>【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．</p><p>【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（<i>P</i>＝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（<i>P</i>＝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；<i>P</i>＜0.001）．内視鏡所見と偶発症は同等であった．</p><p>【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．</p>

DOI： 10.11280/gee.64.2441

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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

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出版者・発行元：(株)東京医学社  

DOI： 10.24479/j02312.2022082023

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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

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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

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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

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出版者・発行元：日本メディカルセンター  

DOI： 10.19020/cg.0000002065

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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Difference of efficacy for small bowel lesion in Crohn

Sawada T., Nakamura M., Yamamura T., Maeda K., Ishikawa E., Fujishiro M.

JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY   36 巻   頁： 116 - 116   2021年8月

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記述言語：日本語  

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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

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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

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Difference of efficacy for small bowel lesion in Crohn

Sawada T, Nakamura M, Yamamura T, Maeda K, Ishikawa E, Fujishiro M

JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY   36 巻   頁： 116 - 116   2021年8月

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Difference of efficacy for small bowel lesion in Crohn

Sawada T, Nakamura M, Yamamura T, Maeda K, Ishikawa E, Fujishiro M

JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY   36 巻   頁： 116 - 116   2021年8月

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記述言語：日本語  

Difference of efficacy for small bowel lesion in Crohn

Sawada T, Nakamura M, Yamamura T, Maeda K, Ishikawa E, Fujishiro M

JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY   36 巻   頁： 116 - 116   2021年8月

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記述言語：日本語  

Lewis score on capsule endoscopy can predict the prognosis in patients with small bowel lesions of Crohn's disease 国際誌

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

JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY   36 巻 ( 7 ) 頁： 1851 - 1858   2021年7月

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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: Endoscopic evaluation of disease activity, including mucosal healing, is poorly established in Crohn's disease. We previously reported that patients with a Lewis score (LS) on capsule endoscopy < 270 had a lower risk of exacerbation without additional treatment. This study investigated prognostic predictors in patients undergoing capsule endoscopy and determined the optimal LS cut-off value. Methods: In a retrospective single-center study, 102 patients with Crohn's disease who underwent capsule endoscopy were reviewed. We reviewed the clinical course and the patients' characteristics, Crohn's Disease Activity Index, laboratory findings, LS, and Prognostic Nutritional Index (PNI) for factors potentially associated with Crohn's disease-related emergency hospitalization. Subsequently, we prospectively enrolled 66 patients with Crohn's disease and analyzed clinical outcomes according to these factors. Results: In the retrospective study, LS ≥ 270 and PNI < 45 were identified as independent predictors of Crohn's disease-related emergency hospitalization with hazard ratios of 9.48 and 3.01, respectively. Even in patients with LS ≥ 270, cumulative hospitalization rates decreased after intervention based on capsule endoscopy findings. The prospective study confirmed that patients with LS ≥ 270 or PNI < 45 had a significantly higher risk of Crohn's disease-related emergency hospitalization and that additional treatment reduced the risk of relapse. Conclusions: LS and PNI are the best available prognostic predictors in patients with Crohn's disease without gastrointestinal stenosis and can guide decisions on treatment escalation. Patients with LS ≥ 270 and PNI < 45 were at increased risk for exacerbation, and additional treatments should be considered for this group.

DOI： 10.1111/jgh.15366

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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

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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

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An evaluation of resectability among endoscopic treatment methods for rectal neuroendocrine tumors &lt;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

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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

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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

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記述言語：英語   出版者・発行元：Endoscopy  

DOI： 10.1055/a-1224-3724

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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

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記述言語：英語  

DOI： 10.1055/a-1352-3850

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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記述言語：日本語   出版者・発行元：(公社)日本超音波医学会  

<p><b>目的</b>：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．<b>方法</b>：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（<I>n</I>＝14）および正常対照群との間で比較した．<b>結果</b>：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）（<I>P</I>＝0.0185）に比べて有意に高かった．平均Vsは，ステロイド治療（<I>n</I>＝6）（<I>P</I>＝0.0234）後，3.32 m/sから2.46 m/sへと有意に減少した．<b>結論</b>：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．</p>

DOI： 10.3179/jjmu.jjmu.k.22

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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

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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

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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

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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．</p>

DOI： 10.11280/gee.63.279

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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

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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>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．</p>

DOI： 10.11280/gee.63.1323

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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

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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

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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

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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>【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．</p><p>【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．</p><p>【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．</p><p>【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．</p>

DOI： 10.11280/gee.63.1649

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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

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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>【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．</p><p>【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．</p><p>【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．</p><p>【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．</p>

DOI： 10.11280/gee.63.2525

CiNii Research

本邦における小腸狭窄が疑われた患者に対するタグ非搭載パテンシーカプセル検査の全国多施設前向き調査

中村 正直, 渡辺 憲治, 大宮 直木, 平井 郁仁, 大森 鉄平, 徳原 大介, 中路 幸之助, 能田 貞治, 江﨑 幹宏, 鮫島 由規則, 後藤 秀実, 寺野 彰, 田尻 久雄, 松井 敏幸, J-POP スタディグループ

日本消化器内視鏡学会雑誌   63 巻 ( 10 ) 頁： 2242 - 2252   2021年

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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】ピルカムパテンシーカプセル（PillCam^TM patency capsule：PPC）は，消化管の開通性を評価するために使用される検査である．本研究の目的は小腸カプセル内視鏡（small bowel capsule endoscopy：SBCE）滞留を防ぐためのPPCの適正使用を検討することであった．</p><p>【方法】この前向き多施設共同研究では，小腸狭窄が疑われる，または既知の小腸狭窄を有するSBCEの適応となる患者を継続的に登録した．PPCの原形排出または大腸における存在は，消化管開通性ありとみなされた．本研究の主要評価項目と副次評価項目は消化管開通性が確認された後のSBCE滞留率と，開通性，SBCE滞留に影響する因子の検討であった．</p><p>【結果】研究に登録された1,096人の患者のうち，開通性は976名（89.1％）で確認された．PPC原形排出は579名の患者で認めた．残りの517名のうち，401名は画像診断法を使用して開通性が確認された（77.5％）．SBCEの滞留は，SBCEを受けた963名の患者のうち５名（0.51％）で認め，既知のクローン病（Crohnʼs disease：CD）患者1.0％，CD疑い例０％，腫瘍０％，および原因不明の消化管出血1.6％であった．これらはPPCの局在を画像診断で誤って解釈されていた．消化管開通性なしは，既知のCD，画像上狭窄，腹部膨満，血清アルブミンレベル＜4.0g/dL，および以前の小腸閉塞（調整オッズ比：4.21，2.60，2.47，2.12，および2.00）に関連した（95％信頼区間：それぞれ2.62-6.78，1.62-4.17，1.43-4.27，1.32-3.40，および1.15-3.47）．</p><p>【結論】PPCは，ほとんどの患者でSBCEの滞留を防ぐために有用であったが，PPC未排出症例では，その正確な位置特定が不可欠であった（StudyはUniversity Hospital Medical Information Network，＃UMIN000010513に登録されていた）．</p>

DOI： 10.11280/gee.63.2242

Scopus

CiNii Research

内視鏡的小腸カプセル内視鏡 (CE) 留置術の安全性・有効性に関する全国多施設共同研究

大宮 直木, 岡 志郎, 中山 佳子, 岩間 達, 中村 正直, 田中 信治

日本小腸学会学術集会プログラム・抄録集   5 巻 ( 0 ) 頁： 48 - 48   2021年

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記述言語：日本語   出版者・発行元：日本小腸学会  

<p>【目的】今回、小児・成人例におけるCE挿入補助器具の使用実態について調査し、その有効性および安全性を遡及的に多施設共同で検討した。【方法】REDCap^®を用いて、１．CE検査数、２．CE内服不可または不可と予測された件数、３．内服不可（予測含む）および挿入補助具使用の内訳：性別、年齢、身長、体重、検査契機、病名、既往歴、CE嚥下可能・不可・不可（予測）、嚥下不可（予測含む）であった理由、補助具種類、カプセル留置部位、有害事象、全小腸観察の有無をオンライン登録した。【結果】全国20施設（消化器内科11施設、小児科9施設）で施行されたCE 10,156件のうち、内視鏡的留置術を行ったCEは546件(5.4%)。有害事象は治療不要な出血、粘膜損傷等の軽微なもののみで163件（29.9％）。十二指腸または空腸へのCE留置成功率は16歳未満で92.0% (335/364)、16歳以上で92.3% (168/182) と有意差なかったが、全小腸観察率は16歳未満で91.7%、16歳以上で76.2%と有意差あり（P<0.0001）。16歳以上でCE嚥下不可能の全小腸観察率は87.3%、胃内停滞例の全小腸観察率は64.2%と有意に低下していた（P=0.0010）。CEの食道停滞例は28例（5.1％）で、28.6％が心疾患、胃停滞例は69例（12.6％）で、糖尿病（15.7％）、腹部術後（15.7％) 等の基礎疾患。16歳未満のCE嚥下不可能（予測も含む）を推測するカットオフ値は身長132cm、体重24.8kg、年齢9歳2ヶ月。【結語】小児・成人に対する内視鏡的経口ＣＥ留置術は安全かつ有用な手技であるが、食道・胃停滞例では蠕動を促す他の処置も必要である。</p>

DOI： 10.32264/shocho.5.0_48

CiNii Research

炎症性腸疾患に対するインフラマソーム標的治療法の開発

池上 脩二, 前田 啓子, 中村 正直

日本小腸学会学術集会プログラム・抄録集   5 巻 ( 0 ) 頁： 51 - 51   2021年

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記述言語：日本語   出版者・発行元：日本小腸学会  

<p>【背景と目的】近年, 炎症性腸疾患（IBD）患者の急増とともに, 治療抵抗性の難治例が増加し, 病態に応じた新規治療薬開発が課題となっている．その病態には粘膜免疫の破綻，腸内細菌の関与とともに，両者を制御するインフラマソーム経路の重要性が認識されている．私達は, 治療抵抗性のIBD患者の血液, 腸管組織においてインフラマソーム関連サイトカインであるインターロイキン18（IL-18）の発現の上昇を見出した．本研究の目的は, 難治性IBDへの治療応用を見据え, 抗ヒト活性型IL-18モノクローナル抗体を作成し, IBDモデルマウスを用いて腸炎抑制効果, 作用機序の解明を行うことである．【方法】ヒトIL-18プロ体をカスパーゼで切断し活性型IL-18を作製し，ヒト活性型IL-18に対するモノクローナル抗体を樹立した．構造解析，機能阻害アッセイを行い, 阻害効果を持つ抗体を選別した．DSS誘導性腸炎モデルマウスを作成し, 抗IL-18抗体の腹腔内投与を行い, 腸炎スコア, 体重減少率を評価した．病理学的評価, 炎症性サイトカインの発現, FITC-Dextranの透過量の測定, NGSによる腸内細菌叢の解析を行った．【結果】高い親和性でIL-18と結合し, IL-18が誘導するIFN-<i>γ</i>産生を強力に抑制する抗ヒト活性型IL-18抗体の作成に成功した．抗体投与により腸炎の改善を認め, IFN-<i>γ</i>, TNF-<i>α</i>の発現抑制, FITC-Dextranの透過量の低下, 腸炎により増加したEnterococcus属, Staphylococcus属の低下を認めた. 更に抗TNF-<i>α</i>抗体との併用ではより強力に腸炎を抑制した．【結論】抗IL-18抗体は, 炎症性サイトカインの分泌抑制に加え, 腸内細菌叢の制御，腸管上皮透過性亢進の改善を介して腸炎を改善させた. 既存治療薬との併用により腸炎抑制効果の増強が認められ，難治例への治療応用が期待される．</p>

DOI： 10.32264/shocho.5.0_51

CiNii Research

A novel Lugol's iodine staining technique to visualize the upper margin of the surgical anal canal intraoperatively for Hirschsprung disease: a case series

Yokota Kazuki, Amano Hizuru, Kudo Toyoki, Yamamura Takeshi, Tanaka Yujiro, Tainaka Takahisa, Shirota Chiyoe, Sumida Wataru, Makita Satoshi, Takimoto Aitaro, Nakamura Masanao, Fujishiro Mitsuhiro, Hinoki Akinari, Uchida Hiroo

BMC SURGERY   20 巻 ( 1 ) 頁： 317   2020年12月

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記述言語：英語   出版者・発行元：BMC Surgery  

Background: In cases of Hirschsprung disease, complete and reproducible resection of the aganglionic bowel is ideal to achieve good postoperative bowel function. Reliable identification of the upper margin of the surgical anal canal, which is the squamous-columnar junction, is necessary during transanal pull-through. Here, we describe a novel staining technique using Lugol’s iodine stain to visualize the upper margin of the surgical anal canal. Methods: Lugol’s iodine staining was performed in five patients with Hirschsprung disease treated using a single-stage laparoscopic transanal pull-through modified Swenson procedure. In two of these patients, endocytoscopic observation with ultra-high magnification was performed using methylene blue and crystal violet to mark the border of the squamous epithelium at 1 week before surgery. The alignment between the incisional line, which was revealed using Lugol’s iodine staining and endocytoscopic marking, was evaluated. Complications, including postoperative bowel dysfunction, were evaluated. Results: In all cases, Lugol’s iodine staining produced a well-demarcated line. The endocytoscopic marking of the upper margin of the surgical anal canal was aligned with the line revealed by Lugol’s iodine staining. There were no complications associated with the transanal pull-through procedure, including postoperative bowel dysfunction. Conclusions: Lugol’s iodine staining could be a safe and practical method to visualize the upper margin of the surgical anal canal intraoperatively. This finding may be useful for surgeons to make a consistent removal of the aganglionic bowel during surgery for Hirschsprung disease.

DOI： 10.1186/s12893-020-00986-3

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Scopus

PubMed

Glycoproteomic analysis identifies cryptdin-related sequence 1 as <i>O</i>-glycosylated protein modified with α1,2-fucose in the small intestine

Hashiguchi Hiroki, Tsukamoto Yohei, Ogawa Mitsutaka, Tashima Yuko, Takeuchi Hideyuki, Nakamura Masanao, Kawashima Hiroki, Fujishiro Mitsuhiro, Okajima Tetsuya

ARCHIVES OF BIOCHEMISTRY AND BIOPHYSICS   695 巻   頁： 108653   2020年11月

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記述言語：英語   出版者・発行元：Archives of Biochemistry and Biophysics  

The modification of galactose with α1,2-fucose is involved in symbiosis with intestinal bacteria and elimination of pathogenic bacteria. It is postulated that α1,2-fucosylated mucin secreted from goblet cells is involved in defending an organism against infections, but the detailed molecular mechanisms are yet to be elucidated. It was previously reported that Paneth cells of the small intestine were positive for UEA-1 lectin staining. However, glycoproteins in Paneth cells carrying α1,2-fucose have not yet been identified. Glycoproteomic analysis of ileal lysates identified 3212 O-linked and 2962 N-linked glycopeptides. In particular, cryptdin-related sequence 1 (CRS1) expressed in Paneth cells was found to be α1,2-fucosylated. Unlike other antimicrobial α-defensin proteins, CRS1 contains unique Thr residues, which are modified with O-glycans, with 3HexNAc2Hex1Fuc1NeuAc being the main glycoform. Identification of α1,2-fucose on the O-glycans of CRS1 expressed in Paneth cells will pave the way for a mechanistic understanding of α1,2-fucose-dependent symbiosis with intestinal bacteria and elimination of pathogenic bacteria in the intestine.

DOI： 10.1016/j.abb.2020.108653

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PubMed

Accuracy of carbon dioxide insufflation for endoscopic retrograde cholangiopancreatography using double-balloon endoscopy 国際誌

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

WORLD JOURNAL OF GASTROENTEROLOGY   26 巻 ( 42 ) 頁： 6669 - 6678   2020年11月

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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 Retrograde cholangiopancreatography using double-balloon endoscopic retrograde cholangiography (DBERC) is a valuable technique to treat biliary stone and jejunobiliary anastomotic stenosis in patients with altered gastrointestinal anatomy. The accurate selection of the route at the anastomosis branch is one of the most important factors in reaching the target in a timely manner. AIM To determine the accuracy of carbon dioxide insufflation enterography (CDE) at the branch for selecting the correct route during DBERC. METHODS We enrolled 52 consecutive patients scheduled for DBERC at our institution from June 2015 to November 2017. Route selection via two methods (visual observation and CDE) was performed in each patient. We determined the correct rate of route selection using CDE. RESULTS Thirty-three patients had a jejunojejunal anastomosis and 19 patients had a gastrojejunal anastomosis. The therapeutic target region was reached in 50 patients. The mean procedure times from the teeth to the target (total insertion time), from the teeth to the branch, and from the branch to the target, and the mean total examination time were 15.2, 5.0, 8.2, and 60.3 min, respectively. The rate of correct route selection using visual observation and CDE were 36/52 (69.2%) and 48/52 (92.3%), respectively (P = 0.002). The rate of correct route selection using CDE in patients with a jejunojejunal anastomosis was 29/33 (87.8%), and the rate in patients with a gastrojejunal anastomosis was 19/19 (100%). CONCLUSION CDE is helpful in selecting the route at the branch in the anastomosis for more timely access to the target in patients with altered gastrointestinal anatomy undergoing DBERC.

DOI： 10.3748/wjg.v26.i42.6669

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Scopus

PubMed

特集 除菌後時代を迎えた胃癌診療　-残された課題を巡って 1 .除菌後胃癌を巡る課題(3)除菌後胃癌の診断を巡って　e.除菌後胃癌-診断困難例を巡って　② 除菌による側方進展への影響

伊藤 信仁, 舩坂 好平, 古川 和宏, 角嶋 直美, 中村 正直, 藤城 光弘

臨床消化器内科   35 巻 ( 12 ) 頁： 1459 - 1464   2020年10月

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出版者・発行元：日本メディカルセンター  

DOI： 10.19020/cg.0000001420

CiNii Research

特集 ガイドラインには書いていない-胃癌治療のCQ -ESD後の追加胃切除の真の適応-消化器内科医はどのような場合に心から追加胃切除を勧めるか?

伊藤 信仁, 古川 和宏, 角嶋 直美, 柴田 寛幸, 平井 恵子, 飛田 恵美子, 鈴木 孝弘, 鈴木 智彦, 室井 航一, 廣瀨 崇, 和田 啓孝, 古根 聡, 中村 正直, 藤城 光弘

臨床外科   75 巻 ( 10 ) 頁： 1147 - 1151   2020年10月

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出版者・発行元：株式会社医学書院  

DOI： 10.11477/mf.1407213069

CiNii Research

特集 食道胃接合部癌update III. 治療 1.食道胃接合部癌の内視鏡治療適応と根治基準

鈴木 孝弘, 古川 和宏, 角嶋 直美, 古根 聡, 伊藤 信仁, 和田 啓孝, 廣瀬 崇, 室井 航一, 鈴木 智彦, 飛田 恵美子, 平井 恵子, 柴田 寛幸, 中村 正直, 藤城 光弘

外科   82 巻 ( 11 ) 頁： 1120 - 1123   2020年10月

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出版者・発行元：南江堂  

DOI： 10.15106/j_geka82_1120

CiNii Research

特集 ESDアフターケアが一番大事! [胃　中長期のマネージメント]治癒切除後のサーベイランス

廣瀬 崇, 古川 和宏, 角嶋 直美, 中村 正直, 藤城 光弘

消化器内視鏡   32 巻 ( 9 ) 頁： 1320 - 1324   2020年9月

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出版者・発行元：(株)東京医学社  

DOI： 10.24479/j02312.2021013107

CiNii Research

特集 分子標的時代のIBD 診療 -IBD の寛解導入,寛解維持の実践 3.IBD 治療における寛解導入と寛解維持に関するトピック(6)IBD センターの構想と効果,社会的役割

中村 正直, 中山 吾郎, 山村 健史, 服部 憲史, 澤田 つな騎, 佐藤 雄介, 藤城 光弘

臨床消化器内科   35 巻 ( 10 ) 頁： 1275 - 1279   2020年8月

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出版者・発行元：日本メディカルセンター  

DOI： 10.19020/cg.0000001326

CiNii Research

J-GLOBAL

特集 クローン病小腸狭窄病変に対する内視鏡的バルーン拡張術─基本からピットフォールまで Ⅱ.クローン病小腸狭窄病変に対するバルーン拡張術(4)クローン病におけるバルーン拡張術のコツ　a.ダブルバルーン内視鏡の立場から

中村 正直, 山村 健史, 前田 啓子, 澤田 つな騎, 水谷 泰之, 石川 恵里, 古川 和宏, 角嶋 　直美, 藤城 光弘

INTESTINE   24 巻 ( 3 ) 頁： 197 - 202   2020年8月

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出版者・発行元：日本メディカルセンター  

DOI： 10.19020/int.0000000486

CiNii Research

特集 分子標的時代のIBD 診療 -IBD の寛解導入,寛解維持の実践 3.IBD 治療における寛解導入と寛解維持に関するトピック(5)UC 関連腫瘍の早期診断と治療

山村 健史, 中村 正直, 前田 啓子, 澤田 つな騎, 石川 恵里, 喜田 裕一, 古川 和宏, 川嶋 啓揮, 藤城 光弘

臨床消化器内科   35 巻 ( 10 ) 頁： 1267 - 1273   2020年8月

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出版者・発行元：日本メディカルセンター  

DOI： 10.19020/cg.0000001325

CiNii Research

J-GLOBAL

特集 薬剤性消化器疾患の診療 4 .その他の薬剤性消化器疾患(4)免疫チェックポイント阻害薬による消化器障害

伊藤 隆徳, 澤田 つな騎, 中村 正直, 本多 隆, 石上 雅敏, 藤城 光弘

臨床消化器内科   35 巻 ( 7 ) 頁： 759 - 765   2020年6月

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出版者・発行元：日本メディカルセンター  

DOI： 10.19020/cg.0000001205

CiNii Research

TOPICS 文献紹介〈炎症関連＊〉 クローン病診断に有用なカプセル内視鏡所見に関する検討─本邦多施設症例対照研究〔Review from ─ J Gastroenterol　2019;54:249-260〕

江﨑 幹宏, 松本 主之, 大宮 直木, 鷲尾 恵万, 森下 寿文, 坂本 圭, 安倍 弘生, 山本 章二朗, 金城 徹, 冨樫 一智, 渡辺 憲治, 平井 郁仁, 中村 正直, 能田 貞治, 芦塚 伸也, 大森 鉄平, 河内 修司, 梁井 俊一, 冬野 雄太, 平野 敦士, 梅野 淳嗣, 北園 孝成, 金城 福則, 渡辺 守, 松井 敏幸, 鈴木 康夫

INTESTINE   24 巻 ( 2 ) 頁： 157 - 159   2020年6月

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出版者・発行元：日本メディカルセンター  

DOI： 10.19020/int.0000000466

CiNii Research

連載 手技の解説 Sit‒stand endoscopic workstation-人間工学から考える内視鏡

松崎 一平, 服部 昌志, 山本 孔次郎, 榎原 毅, 中村 正直, 藤城 光弘

臨床消化器内科   35 巻 ( 6 ) 頁： 661 - 666   2020年5月

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出版者・発行元：日本メディカルセンター  

DOI： 10.19020/cg.0000001177

CiNii Research

Nonexposed wall-inversion surgery as a novel local resection method for neoplasms in the gastrointestinal tract

Fujishiro Mitsuhiro, Furukawa Kazuhiro, Yamamura Takeshi, Nakamura Masanao, Honda Takashi, Maeda Osamu, Ishigami Masatoshi, Kawashima Hiroki

NAGOYA JOURNAL OF MEDICAL SCIENCE   82 巻 ( 2 ) 頁： 175 - 182   2020年5月

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記述言語：英語   出版者・発行元：Nagoya Journal of Medical Science  

Nonexposed wall-inversion surgery was invented for the treatment of node-negative gastrointestinal tumors that are difficult to be resected using the endoluminal approach alone. The advantages of this surgery include 1. full-thickness resection procedure of gastrointestinal wall with minimum necessary tumor-negative margins and 2. less risk of bacterial contamination and tumor seeding into the abdominal cavity. We conducted a PubMed search to select relevant articles published until the end of October 2019 for pooled case analyses using the keyword "nonexposed wall-inversion surgery, " Based on our search, we enrolled the data of 88 gastric lesions and 1 duodenal lesion retrieved from 7 case report articles and 4 original articles of clinical cases. The gastric lesions consisted of 59 gastrointestinal stromal tumors, 7 ectopic pancreases, 5 leiomyomas, 3 early gastric cancers, and 14 others, with a mean maximal tumor diameter of 25.0 mm. In 5 lesions (5.7%), intraoperative perforation was performed, and 2 lesions (2.3%) were retrieved by the transabdominal route. All 4 major postoperative complications (4.5%) were managed without resurgical interventions. The duodenal case, neuroendocrine tumor, measuring 13 mm in size, was curatively resected without complications. Nonexposed wall-inversion surgery appears to be an acceptable treatment for node-negative gastric and duodenal tumors; however, further accumulation of cases is necessary to confirm the feasibility.

DOI： 10.18999/nagjms.82.2.175

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PubMed

An International Study on the Diagnostic Accuracy of the Japan Narrow-Band Imaging Expert Team Classification for Colorectal Polyps Observed with Blue Laser Imaging

Suzuki Hiroto, Yamamura Takeshi, Nakamura Masanao, Hsu Chen-Ming, Su Ming-Yao, Chen Tsung-Hsing, Chiu Cheng-Tang, Hirooka Yoshiki, Goto Hidemi

DIGESTION   101 巻 ( 3 ) 頁： 339 - 346   2020年5月

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記述言語：英語   出版者・発行元：Digestion  

Background: The Japan narrow-band imaging Expert Team (JNET) classification of colorectal polyps based on magnifying endoscopy is used in Japan, but not worldwide. The objective of this study was to clarify differences of diagnostic accuracy between JNET users in Japan and non-JNET users in other countries. Methods: A total of 185 colorectal tumors were assessed. Six endoscopists (3 each from Japan and Taiwan) participated in the study. The Japanese endoscopists normally used the JNET classification and the Taiwanese endoscopists normally used the narrow-band imaging International Colorectal Endoscopic classification for diagnosis of colorectal tumors. After receiving a lecture on the JNET classification, they all observed one blue laser imaging magnified image per lesion and performed diagnosis based on the JNET classification. Results: Diagnostic ability was equivalent for Type 1, Type 2A, and Type 2B. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value of Type 3 for deep submucosal invasive carcinoma was, respectively, 44.4, 98.3, 57.1, and 97.2% in Group J and 70.0, 94.7, 40.4, and 98.4% in Group T. The PPV for diagnosis of Type 3 with a high confidence was significantly higher in Group J than in Group T (81.8% [55.4-94.6] vs. 44.4% [33.6-50.9], p < 0.05). Conclusions: The PPV for Type 3 differed between the 2 groups, suggesting the need to become familiar with differentiation between Type 2B and Type 3.

DOI： 10.1159/000499856

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PubMed

特集 ここまで明らかになった小腸疾患 小腸の各疾患　血管性病変

澤田 つな騎, 中村 正直, 藤城 光弘

診断と治療   108 巻 ( 1 ) 頁： 67 - 72   2020年1月

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出版者・発行元：(株)診断と治療社  

DOI： 10.34433/j00697.2020120530

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８mm径と10mm径のFully covered Self-Expandable Metal Stentsの比較試験―切除不能遠位胆管悪性狭窄患者に対する多施設共同前向き試験―

川嶋 啓揮, 橋本 千樹, 大野 栄三郎, 石川 卓哉, 森島 大雅, 松原 浩, 杉本 啓之, 野々垣 浩二, 金森 明, 原 和生, 桑原 崇通, 中村 正直, 宮原 良二, 石上 雅敏, 安藤 昌彦, 廣岡 芳樹, ―The Nagoya Biliary Stent Study（NABIS）―01 Group―

日本消化器内視鏡学会雑誌   62 巻 ( 5 ) 頁： 593 - 603   2020年

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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>【背景と目的】一般的に切除不能悪性遠位胆道狭窄のドレナージには内径が太いself-expandable metal stent（SEMS）の方が閉塞再発までの時間（time to recurrence obstruction；TRBO）が長いと考えられているが，fully covered SEMS（FCSEMS）において内径別のTRBOについての検討はない．この多施設前向き研究の目的は，切除不能遠位胆管悪性狭窄患者における８mm径と10mm径のFCSEMSのTRBOと胆嚢炎や膵炎などの偶発症の頻度を比較検討することである．</p><p>【方法】この多施設前向き研究には18施設が参加した．エントリーされた患者は８mm径群と10mm径群に割付けされた．この両群においてTRBO，８mm径FCSEMSの10mm径に対する非劣性の有無の検討，全生存期間，偶発症の頻度とその種類，死亡時ステント開存率を比較検討した．</p><p>【結果】TRBOの中央値は８mm径群（<i>n</i>＝102）と10mm径群（<i>n</i>＝100）で有意差を認めなかった（275日と293日，<i>P</i>＝0.971）．８mm径群の10mm径群に対するハザード比は0.90であった（80％信頼区間は0.77-1.04であり上限が帰無仮説の許容ハザード比1.33より小さかった）．この結果によってTRBOにおいて８mm径ステントは10mm径ステントに対して統計的に非劣勢であると判断された．全生存期間，偶発症の発症率，死亡時ステント開存率に有意差は認めなかった．</p><p>【結論】８mm径FCSEMSは10mm径FCSEMSにTRBOにおいて非劣性であった．この結果は今後のSEMS新規開発に重要である．</p><p>（UMIN 000013560）</p>

DOI： 10.11280/gee.62.593

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表在型食道扁平上皮癌におけるLinked Color Imagingで観察される色情報と深達度および血管径との相関に関する検討

小林 健一, 宮原 良二, 舩坂 好平, 古川 和宏, 澤田 つな騎, 前田 啓子, 山村 健史, 石川 卓也, 大野 栄三郎, 中村 正直, 川嶋 啓揮, 中黒 匡人, 奥村 結希, 廣岡 芳樹, 藤城 光弘

日本消化器内視鏡学会雑誌   62 巻 ( 9 ) 頁： 1624 - 1633   2020年

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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>【背景】食道扁平上皮癌の治療方針決定に正確な深達度診断が重要であるが，MM/SM1の正診率は低く解決すべき課題となっている．本研究の目的はLED光源を用いたLCIにおける食道表在癌に対する色と深達度の関連性について検討することである．</p><p>【方法】表在型食道癌と診断された病変に対し白色光につづいてLCIで観察を行った．色合いの評価についてはCIE-L^＊a^＊b^＊空間を用いて色値を算出し，深達度ごとの癌部と非癌部の色差を算出した．血管径およびintrapapillary capillary loopの分岐角を病理的に算出し，色合いとの相関を検討した．</p><p>【結果】48症例52病変が登録された．深達度別の正常と病変部の色差において，MM/SM1以深群ではEP/LPM群に比べて有意に色差が大きかった（<i>P</i>＝0.025）．血管径はb^＊値と弱い正の相関を認めた（相関係数＝0.302，<i>P</i>＝0.033）．</p><p>【結論】LED光源を用いたLCI観察は，表在型食道癌における深達度診断の向上に有用である可能性があるが，その有用性を示すのにはさらなる検討が必要である．</p>

DOI： 10.11280/gee.62.1624

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Refractory Ulcerative Colitis Improved by Scheduled Combination Therapy of Vedolizumab and Granulocyte and Monocyte Adsorptive Apheresis

Nakamura Masanao, Yamamura Takeshi, Maeda Keiko, Sawada Tsunaki, Mizutani Yasuyuki, Ishikawa Eri, Ohashi Ayako, Kajikawa Go, Furukawa Kazuhiro, Ohno Eizaburo, Honda Takashi, Kawashima Hiroki, Ishigami Masatoshi, Fujishiro Mitsuhiro

INTERNAL MEDICINE   59 巻 ( 23 ) 頁： 3009 - 3014   2020年

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：一般社団法人 日本内科学会  

Granulocyte and monocyte adsorptive apheresis (GMA) is occasionally introduced as an alternative combination therapy after loss of response to biologics in ulcerative colitis (UC) patients. However, there have been no reports of the concomitant use of vedolizumab (VDZ) and GMA for the initial induction of UC. A 20- year-old man with refractory UC was admitted for recrudescence. VDZ monotherapy had previously been introduced but was ineffective. Therefore, he received scheduled combination of VDZ and GMA and achieved clinical remission. The combination of two different approaches to inhibit the migration of leukocytes into the inflamed tissue led to satisfactory clinical outcomes.

DOI： 10.2169/internalmedicine.5302-20

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単発性小腸Peutz-Jeghers型ポリープに関する臨床的検討

鳥山 和浩, 中村 正直, 山村 健史, 前田 啓子, 澤田 つな騎, 水谷 泰之, 石川 恵里, 梶川 豪, 村手 健太郎, 喜田 裕一, 江崎 正哉, 濱崎 元伸, 角嶋 直美, 古川 和宏, 藤城 光弘

日本小腸学会学術集会プログラム・抄録集   4 巻 ( 0 ) 頁： 39 - 39   2020年

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記述言語：日本語   出版者・発行元：日本小腸学会  

<p>【背景】Peutz-Jeghers症候群（PJS）は食道を除く全消化管において上皮の過形成と粘膜筋板のポリープ内への樹枝状増生を特徴とする過誤腫性ポリポーシスと皮膚、粘膜の色素斑を特徴とする常染色体優性遺伝性疾患である。一方、家族歴や皮膚、粘膜の色素沈着を伴わない単発性のPeutz-Jeghers型ポリープ（PJP）を認めることがあるが、その臨床的特徴に関する報告は少ないのが現状である。</p><p>【目的】単発性小腸PJPにおける臨床的特徴を明らかにする。</p><p>【対象】2007年4月から2020年5月までに当院で内視鏡治療を施行し、病理組織学的にPJPと診断された単発性小腸PJP16症例。</p><p>【結果】レトロスペクティブにカルテ、内視鏡画像をレビューした。性別は男性10例、女性6例、診断時年齢中央値（範囲）は61（18-82）歳。診断契機は貧血7例、黒色便5例、腹痛1例、イレウス症状1例、他疾患精査時の偶発的発見が2例。原発部位は空腸14例、回腸2例で、腫瘍径中央値（範囲）は25（4-35）mm。切除したPJP全病変で病変内に悪性腫瘍の併存は認めなかった。癌の既往歴を有したのは6例（前立腺癌2例、舌癌1例、大腸癌1例、胃癌1例、子宮体癌1例）。観察期間中央値（範囲）は4.6（0.1-53.7）ヶ月で再発並びに関連死は認めなかった。</p><p>【考察】単発性小腸PJPにおいては診断時の年齢が高く、発見契機としては出血関連症状が多く、病変部位は空腸に多い特徴があった。</p><p>【結語】当院で経験した単発性小腸PJPの臨床的特徴を検討した。今後更なる症例の蓄積が必要である。</p>

DOI： 10.32264/shocho.4.0_39

CiNii Research

A Prospective Study of Factors Associated with Abdominal Pain in Patients during Unsedated Colonoscopy Using a Magnifying Endoscope

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

INTERNAL MEDICINE   59 巻 ( 15 ) 頁： 1795 - 1801   2020年

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：一般社団法人 日本内科学会  

Objective With the advent of endoscopic treatment, the detailed diagnosis of colorectal neoplasms made using magnifying colonoscopy has become increasingly important. However, insertion difficulty causes pain in unsedated colonoscopy. The aim of this prospective observational study was to clarify the factors associated with a patient’s pain in unsedated colonoscopy using a magnifying endoscope. Methods Patient pain was assessed using a numerical rating scale (0-10) immediately after the procedure. We defined 5 as mild enough pain that patients would not be reluctant to undergo another colonoscopy. Acceptable pain was defined as 5 or less and severe pain was defined as 8 to 10. Univariate and multivariate linear regression analyses were performed using the pain scale score as a dependent variable. Results A total of consecutive 600 patients undergoing unsedated colonoscopies were evaluated to assess their abdominal pain. The completion rate was 99.5% (597/600). The mean pain scale score was 3.88±2.38. The rate of acceptable pain was 80.5% (483/600). The rate of severe pain was 6.7% (40/600) including the incomplete cases. A comparison of polyp-positive and polyp-negative cases revealed no marked difference in patient pain (3.82±2.24 vs. 3.94±2.49, respectively; p=0.590) or insertion time (6.62±3.98 vs. 6.29±4.21, p= 0.090), while more observation time was needed in polyp-positive cases than in polyp-negative ones (16.30± 4.95 vs. 13.08±4.69, p<0.01). Univariate and multivariate linear regression analyses revealed that an older age, colectomy, antispasmodic agent use, and a small-diameter endoscope were significant factors associated with less patient pain. In particular, a small-diameter endoscope induces significantly more acceptable pain than a non-small diameter endoscope [85.63% (274/320) vs. 73.93% (207/280), p=0.00003]. Conclusion Unsedated colonoscopy using a magnifying endoscope by an expert may result in acceptable pain levels. The use of an antispasmodic agent, particularly hyoscine N-butyl bromide, and a small-diameter endoscope are recommended for reducing abdominal pain during unsedated colonoscopy.

DOI： 10.2169/internalmedicine.4267-19

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カプセル内視鏡内服不可能および内視鏡的挿入補助具に関する全国多施設共同調査（AdvanCE-J study）

大宮 直木, 岡 志郎, 中村 正直, 中山 佳子, 岩間 達, 田中 信治, 田尻 久雄

日本小腸学会学術集会プログラム・抄録集   4 巻 ( 0 ) 頁： 45 - 45   2020年

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記述言語：日本語   出版者・発行元：日本小腸学会  

<p>【背景・目的】カプセル内視鏡は乳児・年少児や稀に成人でも内服困難で、また長時間食道内や胃内に停滞することもある。その際、上部消化管内視鏡下でネットやスネア、挿入補助器具のAdvanCE®（US Endoscopy社製、国内販売：富士フイルムメディカル）を用いて十二指腸に誘導する必要がある。AdvanCEは2013年に薬事承認されたが、現在保険未承認である。本邦小児例におけるAdvanCEの有用性については、すでにIwamaらが2013～2017年に18歳未満でAdvanCEによる挿入補助を行った154例を対象に、90％で十二指腸への誘導が可能であり、89％でカプセル内視鏡による全小腸観察が可能で重篤な有害事象の発生はなかったと報告している（Eur J Gastroenterol Hepatol 2019; 31:1502-1507）。ただ、これまで成人例でのカプセル内視鏡の内服困難例、食道・胃内での停滞例での挿入補助具の使用報告は少ない。そこで、本研究ではAdvanCEの手技料加算承認を目標とし、本邦小児・成人例におけるカプセル内視鏡挿入補助器具の使用実態について調査し、その有効性および安全性を遡及的に多施設共同で検討する（課題名：カプセル内視鏡内服不可能および内視鏡的挿入補助具に関する全国多施設共同調査、Multicenter survey of impossible swallowing of capsule endoscopy and use of capsule delivery system including AdvanCE system in Japan：AdvanCE-J study）。</p><p>【方法】小腸・大腸カプセル内視鏡検査、パテンシーカプセルによる消化管通過性検査を行った症例を対象に以下の項目を調査する。今後倫理委員会承認後に藤田医科大学のREDCap®を用いたオンライン登録で入力を行う予定である。1．検査数（導入開始～直近）、2．そのうちカプセル内服不可または不可と予測された件数、3．内服不可（予測含む）および挿入補助具使用した各症例の内訳：性別、年齢、身長、体重、検査契機、病名、既往歴、カプセル内視鏡前のパテンシーカプセルによる消化管通過性検査の有無、カプセル嚥下可能・不可・不可（予測）、嚥下不可（予測含む）であった理由、対応（カプセル検査中止、使用機材種類）、補助具使用の理由、鎮静の有無、補助具挿入の施行場所、デリバリー時間、カプセル留置部位、有害事象、全小腸（大腸）観察の有無、カプセル内視鏡所見、各施設の補助具使用ルール。</p>

DOI： 10.32264/shocho.4.0_45

CiNii Research

[Endoscopic screening for gastric cancer].

Furukawa K, Nakamura M, Fujishiro M

Nihon Shokakibyo Gakkai zasshi = The Japanese journal of gastro-enterology   117 巻 ( 6 ) 頁： 469 - 476   2020年

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記述言語：日本語   出版者・発行元：一般財団法人 日本消化器病学会  

<p>国立がん研究センターがん情報サービス「がん登録・統計」の2019年がん統計予測によると，胃がんの罹患数は第2位，死亡者数は第3位を占めており，依然本邦におけるがん対策において，最重要がん腫の1つに位置付けられている．「有効性評価に基づく胃がん検診ガイドライン2014年版」において，胃内視鏡検診の胃がん死亡率減少効果が認められ，対策型・任意型検診としての実施が推奨されるようになった．胃内視鏡検診の精度管理を行うためには，がん検診受診率，要精検率，がん発見率，陽性反応適中度といったプロセス指標や感度・特異度の算出が必要である．本稿では胃がんの内視鏡検診の現状と今後の展望について概説する．</p>

DOI： 10.11405/nisshoshi.117.469

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A Case Where Administration of Ustekinumab Maintained the Intestinal Patency After Balloon Dilation for Small Intestinal Stenosis Caused by Crohn's Disease

Murate Kentaro, Nakamura Masanao, Fujishiro Mitsuhiro

INFLAMMATORY BOWEL DISEASES   25 巻 ( 11 ) 頁： E140 - E140   2019年11月

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記述言語：英語   出版者・発行元：Oxford University Press (OUP)  

DOI： 10.1093/ibd/izz166

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Learning curve for mastery of colorectal endoscopic submucosal dissection: Perspectives from a Japanese cohort of more than 500 procedures

Pu L. Zorron Cheng Tao, Yamamura T., Kaosombatwattana U., Esaki M., Nakamura M., Edwards S., Burt A., Hirooka Y., Singh R., Fujishiro M.

JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY   34 巻   頁： 20 - 21   2019年9月

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記述言語：日本語  

Web of Science

Narrow-band imaging for scar (NBI-SCAR) classification: From conception to multicenter validation

Pu L. Zorron Cheng Tao, Chiam K., Yamamura T., Nakamura M., Berzin T., Mir F., De Moura E., Madruga Neto A., Koay D., Loong C., Ovenden A., Edwards S., Hirooka Y., Fujishiro M., Burt A., Singh R.

JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY   34 巻   頁： 227 - 228   2019年9月

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Web of Science

Learning curve for mastery of colorectal endoscopic submucosal dissection: Perspectives from a Japanese cohort of more than 500 procedures

Pu L. Zorron Cheng Tao, Yamamura T, Kaosombatwattana U, Esaki M, Nakamura M, Edwards S, Burt A, Hirooka Y, Singh R, Fujishiro M

JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY   34 巻   頁： 20 - 21   2019年9月

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記述言語：日本語  

Narrow-band imaging for scar (NBI-SCAR) classification: From conception to multicenter validation

Pu L. Zorron Cheng Tao, Chiam K, Yamamura T, Nakamura M, Berzin T, Mir F, De Moura E, Madruga Neto A, Koay D, Loong C, Ovenden A, Edwards S, Hirooka Y, Fujishiro M, Burt A, Singh R

JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY   34 巻   頁： 227 - 228   2019年9月

Learning curve for mastery of colorectal endoscopic submucosal dissection: Perspectives from a Japanese cohort of more than 500 procedures

Pu L. Zorron Cheng Tao, Yamamura T, Kaosombatwattana U, Esaki M, Nakamura M, Edwards S, Burt A, Hirooka Y, Singh R, Fujishiro M

JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY   34 巻   頁： 20 - 21   2019年9月

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記述言語：日本語  

Learning curve for mastery of colorectal endoscopic submucosal dissection: Perspectives from a Japanese cohort of more than 500 procedures

Pu L. Zorron Cheng Tao, Yamamura T, Kaosombatwattana U, Esaki M, Nakamura M, Edwards S, Burt A, Hirooka Y, Singh R, Fujishiro M

JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY   34 巻   頁： 20 - 21   2019年9月

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記述言語：日本語  

Learning curve for mastery of colorectal endoscopic submucosal dissection: Perspectives from a Japanese cohort of more than 500 procedures

Pu L. Zorron Cheng Tao, Yamamura T, Kaosombatwattana U, Esaki M, Nakamura M, Edwards S, Burt A, Hirooka Y, Singh R, Fujishiro M

JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY   34 巻   頁： 20 - 21   2019年9月

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記述言語：日本語  

Narrow-band imaging for scar (NBI-SCAR) classification: From conception to multicenter validation

Pu L. Zorron Cheng Tao, Chiam K, Yamamura T, Nakamura M, Berzin T, Mir F, De Moura E, Madruga Neto A, Koay D, Loong C, Ovenden A, Edwards S, Hirooka Y, Fujishiro M, Burt A, Singh R

JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY   34 巻   頁： 227 - 228   2019年9月

Learning curve for mastery of colorectal endoscopic submucosal dissection: Perspectives from a Japanese cohort of more than 500 procedures

Pu L. Zorron Cheng Tao, Yamamura T, Kaosombatwattana U, Esaki M, Nakamura M, Edwards S, Burt A, Hirooka Y, Singh R, Fujishiro M

JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY   34 巻   頁： 20 - 21   2019年9月

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記述言語：日本語  

NATIONWIDE MULTICENTER PROSPECTIVE STUDY ON USEFULNESS, SAFETY, AND ACCEPTABILITY OF COLON CAPSULE ENDOSCOPY IN JAPAN

Ohmiya Naoki, Hotta Naoki, Nakaji Konosuke, Hiraga Hiroto, Osawa Satoshi, Hosoe Naoki, Omori Takafumi, Oka Shiro, Nakamura Masanao, Mitsufuji Shoji, Kobayashi Taku, Furuta Takahisa, Ogata Haruhiko, Tanaka Shinji, Fukuda Shinsaku, Hibi Toshifumi, Tajiri Hisao

GASTROINTESTINAL ENDOSCOPY   89 巻 ( 6 ) 頁： AB513 - AB514   2019年6月

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DOI： 10.1016/j.gie.2019.03.859

Web of Science

Effect of time of day and specialty on polyp detection rates in Australia

Pu Leonardo Zorron Cheng Tao, Lu Kevin, Ovenden Amanda, Rana Khizar, Singh Gurfarmaan, Krishnamurthi Sudarshan, Edwards Suzanne, Wilson Bill, Nakamura Masanao, Yamamura Takeshi, Ruszkiewicz Andrew, Hirooka Yoshiki, Burt Alastair D., Singh Rajvinder

JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY   34 巻 ( 5 ) 頁： 899 - 906   2019年5月

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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: Adenoma detection rate (ADR) is an important quality metric in colonoscopy. However, there is conflicting evidence around factors that influence ADR. This study aims to investigate the effect of time of day and endoscopist background on ADR and sessile serrated adenoma/polyp detection rate (SSA/P-DR) for screening colonoscopies. Methods: Consecutive patients undergoing colonoscopy in 2016 were retrospectively evaluated. Primary outcome was the effect of time of day and endoscopist specialty on screening ADR. Secondary outcomes included evaluation of the same factors on SSA/P-DR and other metrics and collinearity of ADR and SSA/P-DR. Linear regression models were used for association between ADR, time of day, and endoscopist background. Bowel preparation, endoscopist, session, patient age, and gender were adjusted for. Linear regression model was also used for comparing ADR and SSA/P-DR. Chi-square was used for difference of proportions. Results: Two thousand six hundred fifty-seven colonoscopies, of which 558 were screening colonoscopies, were performed. The adjusted mean ADR (screening) was 36.8% in the morning compared with 30.5% in the afternoon (P < 0.0001) and was 36.8% for gastroenterologists compared with 30.4% for surgeons (P < 0.0001). For every 1-h delay in commencing the procedure, there was a reduction in mean ADR by 3.4%. Using a linear regression model, a statistically significant positive association was found between ADR and SSA/P-DR (P < 0.0001). Conclusions: Morning and afternoon sessions and gastroenterologists and surgeons achieved the minimum standards recommended for ADR. Afternoon lists and surgeons were associated with a lower ADR compared with morning and gastroenterologists, respectively. Additionally, SSA/P-DR showed collinearity with ADR.

DOI： 10.1111/jgh.14566

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PubMed

今月の主題 知っておきたい小腸疾患 主題 小腸の非腫瘍性疾患-小腸リンパ管拡張症

中村 正直, 山村 健史, 前田 啓子, 澤田 つな騎, 水谷 泰之, 丹羽 慶樹, 石川 恵里, 大塚 裕之, 鈴木 悠土, 西川 貴広, 石田 哲也, 久野 剛史, 服部 峻, 山田 啓策, 廣岡 芳樹, 藤城 光弘

胃と腸   54 巻 ( 4 ) 頁： 532 - 536   2019年4月

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出版者・発行元：株式会社医学書院  

DOI： 10.11477/mf.1403201630

CiNii Research

Neoadjuvant CAPOX and bevacizumab alone for locally advanced rectal cancer: long-term results from the N-SOG 03 trial.

Tomida A, Uehara K, Hiramatsu K, Maeda A, Sakamoto E, Okada Y, Kurumiya Y, Nakayama G, Nakamura M, Aiba T, Nagino M, Of the Nagoya Surgical Oncology Group.

International journal of clinical oncology   24 巻 ( 4 ) 頁： 403 - 410   2019年4月

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記述言語：英語   出版者・発行元：International Journal of Clinical Oncology  

Background: Neoadjuvant chemotherapy (NAC) alone for locally advanced rectal cancer (LARC) remains an experimental treatment, and the efficacy in terms of long-term outcome has not been fully elucidated. The N-SOG 03 trial examined the safety and efficacy of neoadjuvant CAPOX and bevacizumab (Bev) without radiotherapy in patients with poor-risk LARC. Methods: Thirty-two patients with MRI-defined LARC received neoadjuvant CAPOX and Bev followed by curative resection between 2010 and 2011. The overall survival (OS), progression-free survival (PFS), and local-relapse rate (LRR) were calculated using the Kaplan–Meier method, and the risk factors were evaluated by multivariate analysis using the Cox proportional hazard models. This trial is registered with UMIN, number 000003507. Results: In the entire cohort, the 5-year OS was 81.3%. Because of disease progression during chemotherapy, 3 patients ultimately did not undergo curative surgery. As a result, 29 patients underwent R0/1 resection. Among these 29 patients, the 5-year OS, PFS, and LRR were 89.7%, 72.4% and 13.9%, respectively. In multivariate analysis, cT4b tumor was an independent poor prognostic factor for OS and LRR, and ypT4b tumor and absence of N down-staging were independent poor prognostic factors for PFS. Conclusions: Patients with cT4b tumor were not suitable for NAC alone. However, the long-term outcomes of the other patients were satisfactory, and NAC alone might be an option for treatment of LARC. N down-staging was likely to bring favorable PFS, even in patients with cStage III.

DOI： 10.1007/s10147-018-1372-6

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PubMed

腸リンパ管拡張症の診断と治療

中村 正直, 山村 健史, 前田 啓子, 澤田 つな騎, 水谷 泰之, 藤城 光弘

日本小腸学会学術集会プログラム・抄録集   3 巻 ( 0 ) 頁： 34_2 - 34_2   2019年

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記述言語：日本語   出版者・発行元：日本小腸学会  

<p>【背景・目的】　小腸内視鏡診断の進歩により腸リンパ管拡張症（Intestinal lymphangiectasia：IL）を含む蛋白漏出性腸症の小腸精査が可能になった。本研究の目的はILの臨床経過を後ろ向きに評価し、その特徴を明らかにしたうえでより良い治療法を模索することであった。</p><p>【対象と方法】　対象は2003年6月から2019年6月までにILと診断された17例（男性9例、女性8例、発症年齢は中央値37歳、0-75歳）であった。ILの診断は蛋白漏出性腸症と診断され且つ内視鏡下生検もしくは剖検にて病理学的に腸リンパ管拡張を認めたもので、他疾患が否定的であったものとした。白色絨毛、散布性白点を有する白色絨毛群（WV）と、異常なしもしくは軽度絨毛腫大、ケルクリング襞腫大を認める非白色絨毛群（NWV）に分けて臨床成績を比較検討した。</p><p>【結果】　WV、NWVは10例、7例であった。平均血清アルブミン値（g/dl）はWV：NWV = 2.0：1.2でNWVにおいて有意に低かった（P = 0.0061）。平均<i>α</i>1アンチトリプシンクリアランスはWV：NWV = 132：284（P = 0.0509）であった。ステロイド治療への反応はWV：NWV = 2/7：6/6 例でみられた。平均観察期間48箇月において1例のILが影響した死亡例を経験したが、重篤な真菌感染症によるものであった。</p><p>【結論】　NWV群は蛋白漏出は多いがステロイドへの反応がWV群よりも良好であった。治療のゴールドスタンダードは存在せず可能な可能で効果があるものを続けることが現状であった。</p>

DOI： 10.32264/shocho.3.0_34_2

CiNii Research

大腸カプセル内視鏡におけるヒマシ油を用いた腸管洗浄の多施設共同研究

大宮 直木, 堀田 直樹, 光藤 章二, 中村 正直, 大森 崇史, 前田 晃平, 奥田 孝太郎, 八谷 寛, 田尻 久雄

日本消化器内視鏡学会雑誌   61 巻 ( 12 ) 頁： 2646 - 2655   2019年

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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>【背景と目的】大腸カプセル内視鏡検査（CCE）の問題点は下剤の量が多いこと，記録時間内排泄率が低いことである．本研究の目的はヒマシ油のブースターとしての有効性を調べることである．</p><p>【方法】日本の４病院で，CCE検査を行った319人が遡及的に登録された．ヒマシ油の導入前後で，他の薬剤は変えなかった．</p><p>【結果】319人中，152人（2013年11月～2016年６月）がヒマシ油なし，167人（2015年10月～2017年９月）がヒマシ油有りのレジメンを使用した．ヒマシ油群とヒマシ油未使用群の記録時間内カプセル排泄率は97％と81％であった（<i>P</i>＜0.0001）．多変量解析で年齢65歳未満（調整オッズ比3.00；<i>P</i>＝0.0048），男性（調整オッズ比3.20；<i>P</i>＝0.0051），ヒマシ油使用（調整オッズ比6.29；<i>P</i>＝0.0003）が記録時間内カプセル排泄の予測因子であった．また，ヒマシ油群は小腸通過時間が有意に短く，腸管洗浄剤および水分摂取総量は有意に少なかった（<i>P</i>＝0.0154，0.0013）．ヒマシ油群とヒマシ油未使用群の適切な内視鏡的腸管洗浄は，それぞれ74％と83％で達成されており，有意差はなかった（<i>P</i>＝0.0713）．ヒマシ油の有無にかかわらず６mm以上のポリープに対する被験者当たりの感度は83％および85％，特異度は80％および78％であった．</p><p>【結論】ヒマシ油を用いた腸管洗浄は，記録時間内カプセル排泄率を向上させ，腸管洗浄剤の減量に有効であった（UMIN 000031234）．</p>

DOI： 10.11280/gee.61.2646

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ダブルバルーン小腸内視鏡を用いた硬化療法にて治療効果を得た小腸多発血管腫の１例

山田 啓策, 山村 健史, 中村 正直, 澤田 つな騎, 水谷 泰之, 前田 啓子, 古川 和宏, 宮原 良二, 横井 太紀雄, 廣岡 芳樹

日本消化器内視鏡学会雑誌   61 巻 ( 6 ) 頁： 1231 - 1236   2019年

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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>70歳代男性．１カ月間持続する黒色便にて当科紹介となった．上下部消化管内視鏡検査では，明らかな出血源を認めなかった．小腸出血を疑いカプセル内視鏡検査を施行したところ，全小腸にわたり多発する隆起性病変を認めた．ダブルバルーン小腸内視鏡検査を行いジャンボバイオプシー目的の内視鏡的粘膜切除術（Endoscopic mucosal resection：EMR）にて海綿状血管腫と診断した．後日多発する血管腫に対してpolidocanol（Aethoxysklerol^Ⓡ）による硬化療法を行った．４日後の内視鏡観察では，血管腫は縮小を認め，以後黒色便も消失した．小腸に多発する血管腫に対して内視鏡的硬化療法が有用であった１例を経験したので報告する．</p>

DOI： 10.11280/gee.61.1231

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Vascular responses to abrupt blood flow change after bypass surgery for complex intracranial aneurysms

Kataoka H, Makino Y, Takanishi K, Kimura Y, Takamura K, Yagi T, Iguchi S, Yamamoto A, Iida H, Ogata S, Nishimura K, Nakamura M, Umezu M, Iihara K, Takahashi J.C

Acta Neurochirurgica   160 巻 ( 10 ) 頁： 1945 - 1953   2018年10月

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

Background: Bypass surgery for complex intracranial aneurysms (IAs) results in drastic blood flow changes in intracranial arteries. The aim of the study was to elucidate how vessels adapt to blood flow changes after bypass surgery with phase-contrast magnetic resonance imaging (PC-MRI). Methods: This is a prospective observational study to assess changes of the blood flow in intracranial arteries after bypass surgery for IAs. Flow rates and vessel diameters were measured with PC-MRI in 52 intracranial arteries of 7 healthy volunteers and 31 arteries of 8 IA patients who underwent bypass surgery. Wall shear stress (WSS) was calculated with the Hagen-Poiseuille formula. In 18 arteries of 5 patients, the same measurement was performed 1, 3, and 12 months after surgery. Results: PC-MRI showed a strong positive correlation between the flow rate and the third power of vessel diameter in both healthy volunteers (r = 0.82, P < 0.0001) and IA patients (r = 0.90, P < 0.0001), indicating the constant WSS. Of the 18 arteries in 5 patients, WSS increased in 7 arteries and decreased in 11 arteries immediately after surgery. In the WSS-increased group, WSS returned to the preoperative value in the third postoperative month. In the WSS-decreased group, WSS increased in the 12th month, but did not return to the preoperative level. Conclusions: In a physiological state, WSS was constant in intracranial arteries. Changed WSS after bypass surgery tended to return to the preoperative value, suggesting that vessel diameter and flow rate might be controlled so that WSS remains constant.

DOI： 10.1007/s00701-018-3653-2

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MULTICENTER RETROSPECTIVE ANALYSIS OF BOWEL PREPARATION INCLUDING CASTOR-OIL FOR COLON CAPSULE ENDOSCOPY

Nakamura Masanao, Ohmiya Naoki, Hotta Naoki, Mitsufuji Shoji, Omori Takafumi, Okuda Kotaro, Goto Hidemi, Tajiri Hisao

GASTROINTESTINAL ENDOSCOPY   87 巻 ( 6 ) 頁： AB527 - AB527   2018年6月

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Web of Science

MULTICENTER PROSPECTIVE CASE-CROSSOVER STUDY ON THE ASSOCIATION BETWEEN OVERT SMALL-BOWEL BLEEDING AND DRUGS USING CAPSULE ENDOSCOPY DATABASE IN JAPAN

Ohmiya Naoki, Fujimori Shunji, Nakamura Masanao, Yamada Atsuo, Oka Shiro, Esaki Motohiro, Nakajima Atsushi, Matsumoto Takayuki, Tanaka Shinji, Kubota Kiyoshi, Sakamoto Choitsu

GASTROINTESTINAL ENDOSCOPY   87 巻 ( 6 ) 頁： AB64 - AB65   2018年6月

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MULTICENTER RETROSPECTIVE ANALYSIS OF BOWEL PREPARATION INCLUDING CASTOR-OIL FOR COLON CAPSULE ENDOSCOPY

Nakamura Masanao, Ohmiya Naoki, Hotta Naoki, Mitsufuji Shoji, Omori Takafumi, Okuda Kotaro, Goto Hidemi, Tajiri Hisao

GASTROINTESTINAL ENDOSCOPY   87 巻 ( 6 ) 頁： AB527 - AB527   2018年6月

MULTICENTER PROSPECTIVE CASE-CROSSOVER STUDY ON THE ASSOCIATION BETWEEN OVERT SMALL-BOWEL BLEEDING AND DRUGS USING CAPSULE ENDOSCOPY DATABASE IN JAPAN

Ohmiya Naoki, Fujimori Shunji, Nakamura Masanao, Yamada Atsuo, Oka Shiro, Esaki Motohiro, Nakajima Atsushi, Matsumoto Takayuki, Tanaka Shinji, Kubota Kiyoshi, Sakamoto Choitsu

GASTROINTESTINAL ENDOSCOPY   87 巻 ( 6 ) 頁： AB64 - AB65   2018年6月

MULTICENTER PROSPECTIVE CASE-CROSSOVER STUDY ON THE ASSOCIATION BETWEEN OVERT SMALL-BOWEL BLEEDING AND DRUGS USING CAPSULE ENDOSCOPY DATABASE IN JAPAN

Ohmiya Naoki, Fujimori Shunji, Nakamura Masanao, Yamada Atsuo, Oka Shiro, Esaki Motohiro, Nakajima Atsushi, Matsumoto Takayuki, Tanaka Shinji, Kubota Kiyoshi, Sakamoto Choitsu

GASTROINTESTINAL ENDOSCOPY   87 巻 ( 6 ) 頁： AB64 - AB65   2018年6月

MULTICENTER RETROSPECTIVE ANALYSIS OF BOWEL PREPARATION INCLUDING CASTOR-OIL FOR COLON CAPSULE ENDOSCOPY

Nakamura Masanao, Ohmiya Naoki, Hotta Naoki, Mitsufuji Shoji, Omori Takafumi, Okuda Kotaro, Goto Hidemi, Tajiri Hisao

GASTROINTESTINAL ENDOSCOPY   87 巻 ( 6 ) 頁： AB527 - AB527   2018年6月

特集 緊急内視鏡の適応と実際 5 .小腸出血

中村 正直, 大宮 直木, 廣岡 芳樹, 後藤 秀実

臨床消化器内科   33 巻 ( 5 ) 頁： 505 - 511   2018年4月

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記述言語：日本語   出版者・発行元：日本メディカルセンター  

＜文献概要＞小腸出血の診断はカプセル内視鏡(capsuleendoscopy;CE)とバルーン内視鏡(balloon-assisted endoscopy;BAE)を中心に行う.2015年12月に小腸内視鏡診療ガイドラインが提唱された.小腸出血が疑われた場合,まず問診により,年齢,基礎疾患,薬剤内服歴,既往歴などをチェックする.上下腹部造影CT検査を施行し,腸管内への造影剤の漏出がないか,出血源となる炎症疾患,腫瘍や憩室がないか,またCE滞留の原因になるような閉塞機転がないかを確認する.CTで異常があればダイレクトでBAEを,CTで異常がなければ小病変を考慮しCEを行う.小腸出血における緊急内視鏡では,持続出血と画像による出血の所見がその適応となる.持続出血は今もまさに出血中,もしくは最後の出血から48時間以内の場合である.緊急内視鏡によって診断される出血源は血管性病変が半数以上であり,緊急内視鏡時には血管性病変を念頭に検査に臨む.

DOI： 10.19020/cg.0000000317

CiNii Research

薬剤と小腸粘膜障害，小腸出血との関連：多施設カプセル内視鏡研究

新倉 量太, 山田 篤生, 馬來 康太郎, 中村 正直, 渡部 宏嗣, 藤城 光弘, 岡 志郎, 江崎 幹宏, 藤森 俊二, 中島 淳, 大宮 直木, 松本 主之, 田中 信治, 小池 和彦, 坂本 長逸

日本消化器内視鏡学会雑誌   60 巻 ( 11 ) 頁： 2428 - 2439   2018年

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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>【背景・目的】いくつかの薬剤は小腸粘膜障害を引き起こすことが知られているが，これらの粘膜障害が小腸出血と関連しているかについては明らかではない．本研究は薬剤と小腸粘膜障害の関連と小腸粘膜障害と小腸出血の関連を検討することである．</p><p>【方法】2010-13年に小腸カプセル内視鏡検査が行われた患者を後ろ向きに解析した．薬剤使用，併存疾患，喫煙，飲酒を評価した．小腸粘膜障害に対する補正オッズ比と信頼区間，小腸出血に対する補正オッズ比と信頼区間を各々算出した．</p><p>【結果】850人を解析した．平均年齢は64歳，男性544人（64％）であった．小腸粘膜障害患者60人と小腸粘膜障害を認めない患者705人の比較において，NSAIDs使用者は非使用者と比べて小腸粘膜障害のリスク（補正オッズ比1.8）の増加に有意に関連していた．小腸粘膜障害患者において，小腸出血患者85人と小腸出血を認めない患者60人の比較において，NSAIDsを含むすべての薬剤は小腸出血のリスクの増加と関連を認めなかった．</p><p>【結論】NSAIDsは小腸粘膜障害のリスクを有意に増加させたが，これらの薬剤と小腸出血の間には有意な関連は認めなかった．</p>

DOI： 10.11280/gee.60.2428

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特集 小腸の炎症性病変を見直す Ⅱ.各論　　( 6 )小腸リンパ管拡張症の臨床像と治療

中村 正直, 大宮 直木, 廣岡 芳樹, 後藤 秀実

INTESTINE   21 巻 ( 6 ) 頁： 531 - 535   2017年11月

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出版者・発行元：日本メディカルセンター  

DOI： 10.19020/int.0000000117

CiNii Research

Multicenter retrospective analysis of bowel preparation including castor oil for colon capsule endoscopy

Ohmiya Naoki, Hotta Naoki, Mitsufuji Shoji, Nakamura Masanao, Ohmori Takafumi, Okuda Kotaro, Goto Hidemi, Tajiri Hisao

JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY   32 巻   頁： 222 - 222   2017年9月

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Web of Science

Multicenter retrospective analysis of bowel preparation including castor oil for colon capsule endoscopy

Ohmiya Naoki, Hotta Naoki, Mitsufuji Shoji, Nakamura Masanao, Ohmori Takafumi, Okuda Kotaro, Goto Hidemi, Tajiri Hisao

JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY   32 巻   頁： 222 - 222   2017年9月

Multicenter retrospective analysis of bowel preparation including castor oil for colon capsule endoscopy

Ohmiya Naoki, Hotta Naoki, Mitsufuji Shoji, Nakamura Masanao, Ohmori Takafumi, Okuda Kotaro, Goto Hidemi, Tajiri Hisao

JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY   32 巻   頁： 222 - 222   2017年9月

The Study of Diagnostic Ability for the Colorectal Neoplasms by Imaged Enhanced Endoscopy Using by JNET (Japan NBI Expert Team) Classification

Yamamura Takeshi, Watanabe Osamu, Nakamura Masanao, Matsushita Masanobu, Oshima Hiroshi, Sato Junichi, Matsuura Rinzaburo, Saito Masashi, Mizutani Yasuyuki, Sawada Tsunaki, Niwa Yoshiki, Ishikawa Eri, Uchida Genta, Otsuka Hiroyuki, Suzuki Hiroto, Nishikawa Takahiro, Ishida Tetsuya, Ishikawa Takuya, Furukawa Kazuhiro, Funasaka Kohei, Ohno Eizaburo, Kawashima Hiroki, Miyahara Ryoji, Hirooka Yoshiki, Goto Hidemi

GASTROINTESTINAL ENDOSCOPY   85 巻 ( 5 ) 頁： AB402 - AB402   2017年5月

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1016/j.gie.2017.03.932

Web of Science

Establishment of a New Scoring System for Predicting the Necessity of Double-Balloon Endoscopy in Obscure Gastrointestinal Bleeding

Uchida Genta, Watanabe Osamu, Nakamura Masanao, Yamamura Takeshi, Matsushita Masanobu, Oshima Hiroshi, Sato Junichi, Saito Masashi, Matsuura Rinzaburo, Mizutani Yasuyuki, Sawada Tsunaki, Niwa Yoshiki, Ishikawa Eri, Otsuka Hiroyuki, Suzuki Hiroto, Nishikawa Takahiro, Ishida Tetsuya, Ishikawa Takuya, Furukawa Kazuhiro, Funasaka Kohei, Ohno Eizaburo, Kawashima Hiroki, Miyahara Ryoji, Goto Hidemi, Hirooka Yoshiki

GASTROINTESTINAL ENDOSCOPY   85 巻 ( 5 ) 頁： AB300 - AB300   2017年5月

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1016/j.gie.2017.03.687

Web of Science

The Outcome of Treatment in Hypopharyngeal and Cervical Esophageal Carcinoma

Fujiyoshi Toshihisa, Miyahara Ryoji, Funasaka Kohei, Furukawa Kazuhiro, Matsushita Masanobu, Yamamura Takeshi, Ishikawa Takuya, Ohno Eizaburo, Nakamura Masanao, Kawashima Hiroki, Watanabe Osamu, Hirooka Yoshiki, Goto Hidemi

GASTROINTESTINAL ENDOSCOPY   85 巻 ( 5 ) 頁： AB597 - AB598   2017年5月

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DOI： 10.1016/j.gie.2017.03.1377

Web of Science

One Year Follow-Up After Cold Polypectomy Compared With Hot Polypectomy for Small Colorectal Polyps - a Prospective Randomized Controlled Trial

Saito Masashi, Yamamura Takeshi, Watanabe Osamu, Nakamura Masanao, Matsushita Masanobu, Oshima Hiroshi, Sato Junichi, Matsuura Rinzaburo, Mizutani Yasuyuki, Sawada Tsunaki, Niwa Yoshiki, Ishikawa Eri, Uchida Genta, Otsuka Hiroyuki, Suzuki Hiroto, Nishikawa Takahiro, Ishida Tetsuya, Ishikawa Takuya, Furukawa Kazuhiro, Funasaka Kohei, Ohno Eizaburo, Kawashima Hiroki, Miyahara Ryoji, Goto Hidemi, Hirooka Yoshiki

GASTROINTESTINAL ENDOSCOPY   85 巻 ( 5 ) 頁： AB365 - AB366   2017年5月

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DOI： 10.1016/j.gie.2017.03.845

Web of Science

Novel EMR Technique for Preoperative Diagnosis and Treatment of Submucosal Tumor in the Small Bowel at Double-Balloon Endoscopy

Nakamura Masanao, Watanabe Osamu, Yamamura Takeshi, Matsushita Masanobu, Oshima Hiroshi, Sato Junichi, Saito Masashi, Matsuura Rinzaburo, Mizutani Yasuyuki, Sawada Tsunaki, Niwa Yoshiki, Ishikawa Eri, Uchida Genta, Otsuka Hiroyuki, Suzuki Hiroto, Nishikawa Takahiro, Ishida Tetsuya, Ishikawa Takuya, Furukawa Kazuhiro, Funasaka Kohei, Ohno Eizaburo, Kawashima Hiroki, Miyahara Ryoji, Goto Hidemi, Hirooka Yoshiki

GASTROINTESTINAL ENDOSCOPY   85 巻 ( 5 ) 頁： AB300 - AB300   2017年5月

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DOI： 10.1016/j.gie.2017.03.685

Web of Science

Objective Assessment of Jejunal Villous Blood Flow for Evaluating Pancreas-Jejunum Functional Correlation Using a Novel Image Analyzing System

Takeyama Tomoaki, Hirooka Yoshiki, Kawashima Hiroki, Ohno Eizaburo, Ishikawa Takuya, Kawai Manabu, Suhara Hiroki, Hashizume Kiyotaka, Koya Toshinari, Tanaka Hiroyuki, Sakai Daisuke, Matsushita Masanobu, Yamamura Takeshi, Furukawa Kazuhiro, Funasaka Kohei, Nakamura Masanao, Miyahara Ryoji, Watanabe Osamu, Goto Hidemi

GASTROINTESTINAL ENDOSCOPY   85 巻 ( 5 ) 頁： AB319 - AB320   2017年5月

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DOI： 10.1016/j.gie.2017.03.736

Web of Science

Clinical Factors Related to False Positive Rates of Patency Capsule Examination

Sawada Tsunaki, Nakamura Masanao, Watanabe Osamu, Yamamura Takeshi, Matsushita Masanobu, Oshima Hiroshi, Sato Junichi, Saito Masashi, Matsuura Rinzaburo, Mizutani Yasuyuki, Niwa Yoshiki, Ishikawa Eri, Uchida Genta, Otsuka Hiroyuki, Suzuki Hiroto, Nishikawa Takahiro, Ishida Tetsuya, Ishikawa Takuya, Furukawa Kazuhiro, Funasaka Kohei, Ohno Eizaburo, Miyahara Ryoji, Kawashima Hiroki, Goto Hidemi, Hirooka Yoshiki

GASTROINTESTINAL ENDOSCOPY   85 巻 ( 5 ) 頁： AB305 - AB305   2017年5月

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DOI： 10.1016/j.gie.2017.03.699

Web of Science

Prospective, Multicenter Study for Evaluation of the Clinical Efficacy and Safety of Pillcam Patency Capsule in 1,096 Cases With Suspected Small Bowel Stenosis

Nakamura Masanao, Watanabe Kenji, Ohmiya Naoki, Hirai Fumihito, Omori Teppei, Tokuhara Daisuke, Nakaji Konosuke, Nouda Sadaharu, Washio Ema, Sameshima Yukinori, Mannami Tomohiko, Maeda Kohei, Ninomiya Kazeo, Wakamatsu Takahiro, Araki Akihiro, Ishii Manabu, Higaki Shingo, Abe Takashi, Handa Osamu, Kawano Seiji, Iwamoto Maho, Kato Shingo, Kagaya Takashi, Goto Hidemi, Matsui Toshiyuki

GASTROINTESTINAL ENDOSCOPY   85 巻 ( 5 ) 頁： AB53 - AB53   2017年5月

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DOI： 10.1016/j.gie.2017.03.050

Web of Science

A Nationwide Multicenter Study on Adverse Events Associated With a Patency Capsule: Additional Survey for the Japanese Association for Capsule Endoscopy-Oriented Appropriate Use Survey for Patency Capsule (J-Pop) Study

Omori Teppei, Watanabe Kenji, Ohmiya Naoki, Hirai Fumihito, Nakamura Masanao, Kagaya Takashi, Oka Shiro, Ozeki Keiji, Kawano Seiji, Ninomiya Kazeo, Nakaji Konosuke, Iimuro Masaki, Handa Osamu, Tokuhara Daisuke, Sagawa Tamotsu, Wakamatsu Takahiro, Kato Shingo, Araki Akihiro, Koike Yuji, Hashimoto Shinichi, Mannami Tomohiko, Higaki Shingo, Hayashida Mari, Sameshima Yukinori, Hasegawa Daisuke, Tokushige Katsutoshi, Matsui Toshiyuki

GASTROINTESTINAL ENDOSCOPY   85 巻 ( 5 ) 頁： AB294 - AB294   2017年5月

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記述言語：英語  

DOI： 10.1016/j.gie.2017.03.670

Web of Science

今月の主題 消化管結核の診断と治療─最近の進歩 主題症例 抗結核薬による診断的治療が奏効した小腸多発潰瘍の1例

齋藤 雅之, 中村 正直, 渡辺 修, 山村 健史, 松下 正伸, 中野 有泰, 大島 啓嗣, 佐藤 淳一, 松浦 倫三郎, 舩坂 好平, 大野 栄三郎, 川嶋 啓揮, 宮原 良二, 廣岡 芳樹, 後藤 秀実

胃と腸   52 巻 ( 2 ) 頁： 233 - 238   2017年2月

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出版者・発行元：株式会社医学書院  

DOI： 10.11477/mf.1403200839

CiNii Research

Risk factors

Uchida G., Nakamura M., Watanabe O., Yamamura T., Matsushita M., Ishikawa T., Furukawa K., Funasaka K., Ohno K., Kawashima H., Miyahara R., Goto H., Hirooka Y.

Journal of Japanese Society of Gastroenterology   114 巻 ( 10 ) 頁： 1819 - 1828   2017年

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出版者・発行元：Journal of Japanese Society of Gastroenterology  

Capsule endoscopy (CE) and double-balloon endoscopy (DBE) have revolutionized the diagnosis and treatment of obscure gastrointestinal bleeding (OGIB). Although CE and DBE provide access to the small bowel and OGIB can be effectively treated by the identification of specific bleeding lesions, some patients experience rebleeding after small bowel investigation. There are no definite algorithms to determine the best follow-up period for patients with OGIB. The purpose of this study was to investigate the long-term outcomes and risk factors for rebleeding and to develop a follow-up strategy for patients with overt OGIB. Among 386 patients who underwent CE for OGIB at Nagoya University Hospital between June 2004 and December 2015, 318 patients with overt OGIB were enrolled in this retrospective study. The clinical characteristics and risk factors for rebleeding were analyzed, and a predictive model for the same was developed. Rebleeding occurred in 45 patients (14.2%) during a median follow-up period of 16.8 months. Multivariable regression analysis identified the following factors as significant independent predictors of rebleeding : vascular lesions seen during CE, transfusion requirement, and patients aged ≥60 years. The predictive model for rebleeding was developed using these factors to identify patients who had a high risk of rebleeding and to provide useful information to physicians in clinical practice. The C-statistic of the predictive model was 0.698. A risk-based approach to follow-up patients with OGIB can help clinicians determine a follow-up period for patients after small bowel investigation.

Scopus

Endoscopic ultrasound-guided drainage using a forward-viewing echoendoscope for peripancreatic fluid collection after Child resection. 国際誌

Ishikawa T, Yamao K, Mizutani Y, Iida T, Uetsuki K, Nakamura M, Kawashima H

Endoscopy   56 巻 ( S 01 ) 頁： E83 - E84   2024年12月

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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  

DOI： 10.1055/a-2234-4075

Scopus

PubMed

Endoscopic Papillectomy for Ampullary Gangliocytic Paraganglioma: A Case Series and Literature Review.

Takada Y, Ishikawa T, Yamao K, Mizutani Y, Iida T, Uetsuki K, Nakamura M, Furukawa K, Yamamura T, Kawashima H

Internal medicine (Tokyo, Japan)   advpub 巻 ( 0 )   2024年9月

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：一般社団法人 日本内科学会  

DOI： 10.2169/internalmedicine.4102-24

PubMed

CiNii Research

A prospective study on the histological evaluation of type 1 autoimmune pancreatitis using endoscopic ultrasound-guided fine needle biopsy with a 19-gauge Franseen needle.

Ishikawa T, Yamao K, Mizutani Y, Iida T, Uetsuki K, Shimoyama Y, Nakamura M, Furukawa K, Yamamura T, Kawashima H

Journal of hepato-biliary-pancreatic sciences   31 巻 ( 8 ) 頁： 581 - 590   2024年8月

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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 Hepato-Biliary-Pancreatic Sciences  

Background/Purpose: To assess the diagnostic efficacy and safety of endoscopic ultrasound-guided fine needle biopsy (EUS-FNB) using a 19-gauge Franseen needle for autoimmune pancreatitis (AIP). Methods: Twenty patients suspected of having type 1 AIP were prospectively enrolled and underwent EUS-FNB with a 19-gauge Franseen needle. Their data were compared with those of historical controls: a total of 29 type 1 AIP patients had EUS-FNB with a 22-gauge Franseen needle. Results: Specimens suitable for histological evaluation were obtained from 19 of the 20 patients (95%), and the median total tissue area was 11.9 mm2. The histological diagnosis rate of AIP was 65% (95% CI: 43.2%–82%). Adverse events were observed in three patients (15%), and a switch to 22-gauge needles occurred during transduodenal puncture in two patients. Compared to those punctured with 22-gauge needles, patients punctured with 19-gauge needles had greater prevalence of each characteristic feature of lymphoplasmacytic sclerosing pancreatitis, but the difference was not statistically significant. Conclusions: EUS-FNB using a 19-gauge Franseen needle demonstrated favorable performance for the histological diagnosis of AIP and allowed for large tissue samples, potentially facilitating pathological diagnosis. However, during transduodenal puncture, maneuverability is reduced; therefore, the needle may need to be selected according to the puncture site.

DOI： 10.1002/jhbp.1438

Scopus

PubMed

Predictors of the efficacy of vedolizumab in patients with ulcerative colitis.

Kajikawa G, Sawada T, Nakamura M, Yamamura T, Maeda K, Ishikawa E, Uetsuki K, Hirose T, Iida T, Mizutani Y, Yamao K, Ishikawa T, Furukawa K, Kawashima H

Nagoya journal of medical science   86 巻 ( 3 ) 頁： 407 - 421   2024年8月

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.18999/nagjms.86.3.407

PubMed

What is the appropriate method of pathological specimen collection for cholangiocarcinoma detection in primary sclerosing cholangitis?

Kano Y, Ishikawa T, Yamao K, Mizutani Y, Iida T, Uetsuki K, Yamamura T, Furukawa K, Nakamura M, Kawashima H

Journal of gastroenterology   59 巻 ( 7 ) 頁： 621 - 628   2024年7月

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

Background: In primary sclerosing cholangitis (PSC), it is important to understand the cholangiographic findings suggestive of malignancy, but it is difficult to determine whether cholangiocarcinoma is present due to modifications caused by inflammation. This study aimed to clarify the appropriate method of pathological specimen collection during endoscopic retrograde cholangiopancreatography for surveillance of PSC. Methods: A retrospective observational study was performed on 59 patients with PSC. The endpoints were diagnostic performance for benign or malignant on bile cytology and transpapillary bile duct biopsy, cholangiographic findings of biopsied bile ducts, diameters of the strictures and upstream bile ducts, and their differences. Results: The sensitivity (77.8% vs. 14.3%, P = 0.04), specificity (97.8% vs. 83.0%, P = 0.04), and accuracy (94.5% vs. 74.1%, P = 0.007) were all significantly greater for bile duct biopsy than for bile cytology. All patients with cholangiocarcinoma with bile duct stricture presented with dominant stricture (DS). The diameter of the upstream bile ducts (7.1 (4.2–7.2) mm vs. 2.1 (1.2–4.1) mm, P < 0.001) and the diameter differences (6.6 (3.1–7) mm vs. 1.5 (0.2–3.6) mm, P < 0.001) were significantly greater in the cholangiocarcinoma group than in the noncholangiocarcinoma group with DS. For diameter differences, the optimal cutoff value for the diagnosis of benign or malignant was 5.1 mm (area under the curve = 0.972). Conclusion: Transpapillary bile duct biopsy should be performed via localized DS with upstream dilation for the detection of cholangiocarcinoma in patients with PSC. Especially when the diameter differences are greater than 5 mm, the development of cholangiocarcinoma should be strongly suspected.

DOI： 10.1007/s00535-024-02105-y

Scopus

PubMed

Characteristics of microbiomes of the saliva, duodenal bulb, and descending portion of superficial nonampullary duodenal epithelial tumors. 国際誌

Shibata H, Yamamoto K, Hirose T, Furune S, Kakushima N, Furukawa K, Nakamura M, Honda T, Fujishiro M, Kawashima H

Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver   56 巻 ( 6 ) 頁： 941 - 950   2024年6月

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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  

Introduction: Nonampullary duodenal epithelial tumors are rare, but their prevalence is increasing. Various gastrointestinal cancers have been associated with microbiomes. We evaluated the characteristics of the salivary and duodenal microbiomes of patients with nonampullary duodenal epithelial tumors. Methods: Saliva and biopsy samples from the duodenal bulb and descending portion were obtained from 15 patients with nonampullary duodenal epithelial tumors and 10 controls. Next-generation sequencing was performed to identify bacteria for comparison. Results: Saliva samples had higher Amplicon Sequence Variants (ASVs) and more observed species than duodenal samples. Saliva samples from patients with nonampullary duodenal epithelial tumor were dominated by Bacteroidetes and Prevotella, whereas Proteobacteria and Neisseria were dominant in the control samples. The relative abundance of bacteria was higher in patients with nonampullary duodenal epithelial tumors. Most bacteria were classified as bacteria of oral origin. Oribacterium and Stomatobaculum were significantly higher in the saliva, duodenal bulb, and descending portion of patients with nonampullary duodenal epithelial tumors. Conclusion: Patients with nonampullary duodenal epithelial tumors had different salivary and duodenal microbiomes than controls. Bacteria types differed between groups at each site, and most bacteria of oral origin were more abundant in patients with nonampullary duodenal epithelial tumors.

DOI： 10.1016/j.dld.2024.01.212

Scopus

PubMed

Risk factors for decreased bone mineral density in patients with metabolic dysfunction-associated steatotic liver disease: A cross-sectional study at a health examination center. 国際誌

Yokoyama S, Honda T, Ishizu Y, Imai N, Ito T, Yamamoto K, Mizuno K, Kojima T, Kariya N, Nakamura M, Kawashima H

Clinical nutrition (Edinburgh, Scotland)   43 巻 ( 6 ) 頁： 1425 - 1432   2024年6月

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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 Nutrition  

Background & aims: Steatotic liver disease (SLD) is often detected in health examinations. However, although individuals with metabolic dysfunction-associated SLD (MASLD) may have decreased bone mineral density (BMD), the specific risk factors remain unclarified. The objective of this study was to identify the factors associated with decreased BMD in patients with MASLD. Methods: Individuals who underwent abdominal ultrasonography and BMD measurements at our healthcare center were included. The BMD of the calcaneus was assessed using an AOS-10SA bone densitometer. Decreased BMD was defined as a T-score below −1.0 SD or the administration of osteoporosis treatment. SLD was diagnosed based on specific ultrasonographic criteria. Results: A total of 1410 patients were diagnosed with MASLD. The median age was 52 years. Multivariate analysis using a logistic regression model revealed that the independent predictors of decreased BMD were a low body mass index (BMI) or a small waist circumference (odds ratio (OR): 0.48, 95% confidence interval (CI): 0.34–0.67), hypertriglyceridemia (OR: 1.29, 95% CI: 1.00–1.65), and a weak grip strength (OR: 0.98, 95% CI: 0.97–1.00). Subgroup analyses of individuals aged 50 years or older, men, and individuals with a FIB-4 index of 1.3 or greater revealed that the absence of a high BMI or a large waist circumference was associated with decreased BMD. The subgroup analysis of men revealed that a weaker grip strength was associated with decreased BMD. Conclusion: The present study suggested several potential risk factors for decreased BMD in patients with MASLD. Individuals with the abovementioned risk factors should be encouraged to undergo BMD measurement from the perspective of preventive medicine.

DOI： 10.1016/j.clnu.2024.04.034

Scopus

PubMed

大腸ポリープに対するコールドスネアポリペクトミーで腹腔内出血をきたした1例

池上 脩二, 山村 健史, 中村 正直, 前田 啓子, 澤田 つな騎, 石川 恵里, 山下 彩子, 河村 達哉, 横井 太紀雄, 川嶋 啓揮

Gastroenterological Endoscopy   66 巻 ( 5 ) 頁： 1236 - 1241   2024年5月

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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

Intestinal Microbiome Associated with Efficacy of Atezolizumab and Bevacizumab Therapy for Hepatocellular Carcinoma. 国際誌

Inukai Y, Yamamoto K, Honda T, Yokoyama S, Ito T, Imai N, Ishizu Y, Nakamura M, Ishigami M, Kawashima H

Cancers   16 巻 ( 9 )   2024年4月

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

The combination of atezolizumab and bevacizumab has become the first-line treatment for patients with unresectable hepatocellular carcinoma (HCC). However, no studies have reported on specific intestinal microbiota associated with the efficacy of atezolizumab and bevacizumab. In this study, we analyzed fecal samples collected before treatment to investigate the relationship between the intestinal microbiome and the efficacy of atezolizumab and bevacizumab. A total of 37 patients with advanced HCC who were treated with atezolizumab and bevacizumab were enrolled. Fecal samples were collected from the patients, and they were divided into responder (n = 28) and non-responder (n = 9) groups. We compared the intestinal microbiota of the two groups and analyzed the intestinal bacteria associated with prognosis using QIIME2. The alpha and beta diversities were not significantly different between both groups, and the proportion of microbiota was similar. The relative abundance of Bacteroides stercoris and Parabacteroides merdae was higher in the responder group than in the non-responder group. When the prognosis was analyzed by the presence or absence of those bacteria, patients without both had a significantly poorer prognosis. Differences in intestinal microbiome are involved in the therapeutic effect of atezolizumab and bevacizumab.

DOI： 10.3390/cancers16091675

Scopus

PubMed

【十二指腸・小腸疾患アトラス】その他 血管性病変 小腸多発血管腫

河村 達哉, 山村 健史, 中村 正直, 前田 啓子, 澤田 つな騎, 石川 恵里, 横井 太紀雄, 川嶋 啓揮

消化器内視鏡   36 巻 ( 4 ) 頁： 652 - 653   2024年4月

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記述言語：日本語   出版者・発行元：(株)東京医学社  

その他リンク： https://search.jamas.or.jp/default/link?pub_year=2024&ichushi_jid=J02312&link_issn=&doc_id=20240507090105&doc_link_id=10.24479%2Fendo.0000001405&url=https%3A%2F%2Fdoi.org%2F10.24479%2Fendo.0000001405&type=%E5%8C%BB%E6%9B%B8.jp_%E3%82%AA%E3%83%BC%E3%83%AB%E3%82%A2%E3%82%AF%E3%82%BB%E3%82%B9&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

【十二指腸・小腸疾患アトラス】腫瘍,腫瘍様病変 リンパ増殖性病変 MALT lymphoma

中村 正直, 山村 健史, 前田 啓子, 澤田 つな騎, 石川 恵里, 村手 健太郎, 古川 和宏, 廣瀬 崇, 川嶋 啓揮

消化器内視鏡   36 巻 ( 4 ) 頁： 480 - 481   2024年4月

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記述言語：日本語   出版者・発行元：(株)東京医学社  

その他リンク： https://search.jamas.or.jp/default/link?pub_year=2024&ichushi_jid=J02312&link_issn=&doc_id=20240507090020&doc_link_id=10.24479%2Fendo.0000001320&url=https%3A%2F%2Fdoi.org%2F10.24479%2Fendo.0000001320&type=%E5%8C%BB%E6%9B%B8.jp_%E3%82%AA%E3%83%BC%E3%83%AB%E3%82%A2%E3%82%AF%E3%82%BB%E3%82%B9&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

【十二指腸・小腸疾患アトラス】炎症性疾患 自己免疫疾患・膠原病・血管炎など 腸リンパ管拡張症

山下 彩子, 中村 正直, 山村 健史, 前田 啓子, 澤田 つな騎, 石川 恵里, 村手 健太郎, 加留部 謙之輔, 川嶋 啓揮

消化器内視鏡   36 巻 ( 4 ) 頁： 622 - 623   2024年4月

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記述言語：日本語   出版者・発行元：(株)東京医学社  

その他リンク： https://search.jamas.or.jp/default/link?pub_year=2024&ichushi_jid=J02312&link_issn=&doc_id=20240507090091&doc_link_id=10.24479%2Fendo.0000001391&url=https%3A%2F%2Fdoi.org%2F10.24479%2Fendo.0000001391&type=%E5%8C%BB%E6%9B%B8.jp_%E3%82%AA%E3%83%BC%E3%83%AB%E3%82%A2%E3%82%AF%E3%82%BB%E3%82%B9&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

Artificial intelligence-based diagnostic imaging system with virtual enteroscopy and virtual unfolded views to evaluate small bowel lesions in Crohn's disease. 国際誌

Furukawa K, Oda M, Watanabe O, Nakamura M, Yamamura T, Maeda K, Mori K, Kawashima H

Revista espanola de enfermedades digestivas     2024年3月

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.17235/reed.2024.10405/2024

PubMed

Identification of the Microbiome Associated with Prognosis in Patients with Chronic Liver Disease. 国際誌

Yamamoto K, Honda T, Inukai Y, Yokoyama S, Ito T, Imai N, Ishizu Y, Nakamura M, Kawashima H

Microorganisms   12 巻 ( 3 )   2024年3月

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

We investigated the prognostic role of the gut microbiome and clinical factors in chronic liver disease (hepatitis, cirrhosis, and hepatocellular carcinoma [HCC]). Utilizing data from 227 patients whose stool samples were collected over the prior 3 years and a Cox proportional hazards model, we integrated clinical attributes and microbiome composition based on 16S ribosomal RNA sequencing. HCC was the primary cause of mortality, with the Barcelona Clinic Liver Cancer staging system-derived B/C significantly increasing the mortality risk (hazard ratio [HR] = 8.060; 95% confidence interval [CI]: 3.6509–17.793; p < 0.001). Cholesterol levels < 140 mg/dL were associated with higher mortality rates (HR = 4.411; 95% CI: 2.0151–9.6555; p < 0.001). Incertae sedis from Ruminococcaceae showed a protective effect, reducing mortality risk (HR = 0.289; 95% CI: 0.1282 to 0.6538; p = 0.002), whereas increased Veillonella presence was associated with a higher risk (HR = 2.733; 95% CI: 1.1922–6.2664; p = 0.017). The potential of specific bacterial taxa as independent prognostic factors suggests that integrating microbiome data could improve the prognosis and treatment of chronic liver disease. These microbiome-derived markers have prognostic significance independently and in conjunction with clinical factors, suggesting their utility in improving a patient’s prognosis.

DOI： 10.3390/microorganisms12030610

Scopus

PubMed

ESDで診断に至った深在性嚢胞性大腸炎の1例

山田 健太朗, 山村 健史, 中村 正直, 前田 啓子, 澤田 つな騎, 石川 恵里, 梶川 豪, 長谷川 一成, 横井 太紀雄, 川嶋 啓揮

Gastroenterological Endoscopy   66 巻 ( 3 ) 頁： 279 - 285   2024年3月

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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

その他リンク： https://search.jamas.or.jp/default/link?pub_year=2024&ichushi_jid=J00192&link_issn=&doc_id=20240405340006&doc_link_id=10.11280%2Fgee.66.279&url=https%3A%2F%2Fdoi.org%2F10.11280%2Fgee.66.279&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_2.gif

最先端医療の今 潰瘍性大腸炎患者の腸粘液解析

中村 正直, 山村 健史, 前田 啓子, 澤田 つな騎, 石川 恵里, 村手 健太郎, 川嶋 啓揮

Medical Science Digest   50 巻 ( 3 ) 頁： 156 - 157   2024年3月

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記述言語：日本語   出版者・発行元：(株)ニュー・サイエンス社  

潰瘍性大腸炎(UC)の発症は,慢性の精神ストレスが腸粘膜内の神経-免疫系に影響し,粘膜神経系因子の不安定さと食事が影響した粘液バリアの破綻が重なった際に起こり得る粘膜固有層内免疫細胞の過剰応答,上皮バリア破綻,腸内環境との過剰コンタクトが一因と考えられる。臨床的にはベースに食事変化による腸粘液粘膜バリアの脆弱化があるなかで,メンタルストレスの変動によりその閾値を越えたときに目にみえて症状が現れるのがひとつのルートと考える。この分野において今までは粘膜を材料とした研究に限られていた。筆者らは大腸内視鏡時に,生検組織に加え同部位でのブラシ鉗子による腸粘液採取も行った。寛解時と再燃時で神経系因子を含めた各検出因子発現変化量,免疫細胞,サイトカイン量,蛋白質分布を比較している。粘膜粘液炎症機序相関図を作成,炎症の根源で治療ターゲットとなるキーファクターを同定することができればUC原因機序解明の新たな一歩となり得る。(著者抄録)

【IBD診療-ますます増えた薬剤の選択とさらなる進化の展望】治療薬の使い分けの総論と各論 中等症UCにおけるバイオ製剤/JAK阻害薬の使い分け-抗IL-23抗体も含めて

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

臨床消化器内科   39 巻 ( 2 ) 頁： 140 - 146   2024年1月

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記述言語：日本語   出版者・発行元：(株)日本メディカルセンター  

＜文献概要＞中等症の潰瘍性大腸炎(UC)患者に対する治療の現状においては,とくにステロイド依存例,抵抗例となった難治例への治療薬が多く導入されたことで治療効果の底上げがなされたと考えられる.一方,実際の臨床現場においては適切な治療選択が求められる.現在難治例には9種の薬剤が使用され,作用機序面から抗TNF-α抗体製剤,Non TNF-α抗体製剤,低分子化合物の3タイプに分けた.初めてのバイオ製剤/JAK阻害薬選択方法の一案として,(1)臨床的活動性が軽症に近いか,重症寄りか,(2)使用薬剤における禁忌の回避,(3)利便性,受容性を考えている.バイオ製剤/JAK阻害薬の切り換えは,前治療の治療効果と作用機序も考慮して薬剤選択に臨む必要がある.

小腸疾患治療の最前線 腸リンパ管拡張症の臨床的・内視鏡的特徴と治療法の検討

山下 彩子, 中村 正直, 山村 健史, 前田 啓子, 澤田 つな騎, 石川 恵里, 村手 健太郎, 廣瀬 崇, 古川 和宏, 川嶋 啓揮

日本消化管学会雑誌   8 巻 ( Suppl. ) 頁： 208 - 208   2024年1月

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記述言語：日本語   出版者・発行元：(一社)日本消化管学会  

Long-Term Monitoring and Clinical Implications of Small Bowel Capsule Endoscopy in Patients with Crohn's Disease with Small Bowel Lesions: A Retrospective Analysis. 国際誌

Nakamura M, Yamamura T, Maeda K, Sawada T, Ishikawa E, Murate K, Furukawa K, Hirose T, Uetsuki K, Iida T, Mizutani Y, Yamao K, Ishizu Y, Ishikawa T, Honda T, Kawashima H

Digestion   105 巻 ( 5 ) 頁： 380 - 388   2024年

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1159/000539745

PubMed

Initial Tumor Size and Narrow-Band Image Findings Estimate Growth Speed in Duodenal Tumors. 国際誌

Hirose T, Kakushima N, Minami Y, Furune S, Ishikawa E, Sawada T, Maeda K, Yamamura T, Furukawa K, Nakamura M, Nakaguro M, Kawashima H

Digestive diseases (Basel, Switzerland)   42 巻 ( 6 ) 頁： 512 - 521   2024年

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1159/000540544

PubMed

Analysis of Neuropeptides in the Intestinal Mucus of Patients with Ulcerative Colitis Using RNA Sequencing. 国際誌

Nakamura M, Murate K, Maeda K, Yamamura T, Sawada T, Ishikawa E, Furukawa K, Hirose T, Uetsuki K, Iida T, Mizutani Y, Yamao K, Ishizu Y, Ishikawa T, Honda T, Kawashima H

Digestion   105 巻 ( 5 ) 頁： 400 - 410   2024年

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1159/000540052

PubMed

大腸ポリープに対するCold snare polypectomyで腹腔内出血をきたした1例

池上 脩二, 山村 健史, 中村 正直, 前田 啓子, 澤田 つな騎, 石川 恵里, 古川 和宏, 石川 卓哉, 山雄 健太郎, 水谷 泰之, 飯田 忠, 植月 康太, 廣瀬 崇, 横井 太紀雄, 川嶋 啓揮

日本消化器内視鏡学会東海支部例会   66回 巻   頁： 113 - 113   2023年12月

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記述言語：日本語   出版者・発行元：日本消化器内視鏡学会-東海支部  

腸内微生物叢からみた消化器疾患の病態解明 腸管上皮細胞の腸内細菌叢に対する認識機構の解明と炎症性腸疾患における機能解析

前田 啓子, 中村 正直, 川嶋 啓揮

日本消化器病学会雑誌   120 巻 ( 臨増大会 ) 頁： A716 - A716   2023年10月

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

Risk factors for rebleeding in gastroduodenal ulcers 国際誌

Ito Nobuhito, Funasaka Kohei, Fujiyoshi Toshihisa, Nishida Kazuki, Satta Yusuke, Furukawa Kazuhiro, Kakushima Naomi, Furune Satoshi, Ishikawa Eri, Mizutani Yasuyuki, Sawada Tsunaki, Maeda Keiko, Ishikawa Takuya, Yamamura Takeshi, Ohno Eizaburo, Nakamura Masanao, Miyahara Ryoji, Sasaki Yoji, Haruta Jun-Ichi, Fujishiro Mitsuhiro, Kawashima Hiroki

IRISH JOURNAL OF MEDICAL SCIENCE     2023年7月

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

Background: Rebleeding after hemostasis of the gastroduodenal ulcer (GDU) is one of the indicators associated with death among GDU patients. However, there are few studies on risk score that contribute to rebleeding after endoscopic hemostasis of bleeding peptic ulcers. Aims: The aim of this study was to identify factors associated with rebleeding, including patient factors, after endoscopic hemostasis of bleeding gastroduodenal ulcers and to stratify the risk of rebleeding. Methods: We retrospectively enrolled 587 consecutive patients who were treated for Forrest Ia to IIa bleeding gastroduodenal ulcers with endoscopic hemostasis at three institutions. Risk factors associated with rebleeding were assessed using univariate and multivariate logistic regression analyses. The Rebleeding Nagoya University (Rebleeding-N) scoring system was developed based on the extracted factors. The Rebleeding-N score was internally validated using bootstrap resampling methods. Results: Sixty-four patients (11%) had rebleeding after hemostasis of gastroduodenal ulcers. Multivariate logistic regression analysis revealed four independent rebleeding risk factors: blood transfusion, albumin <2.5, duodenal ulcer, and diameter of the exposed vessel ≧2 mm. Patients with 4 risk factors in the Rebleeding-N score had a 54% rebleeding rate, and patients with 3 risk factors had 44% and 25% rebleeding rates. In the internal validation, the mean area under the curve of the Rebleeding-N score was 0.830 (95% CI = 0.786–0.870). Conclusions: Rebleeding after clip hemostasis of bleeding gastroduodenal ulcers was associated with blood transfusion, albumin <2.5, diameter of the exposed vessel ≧2 mm, and duodenal ulcer. The Rebleeding-N score was able to stratify the risk of rebleeding.

DOI： 10.1007/s11845-023-03450-2

Web of Science

Scopus

PubMed

Randomized trial comparing 15 <i>vs</i> 5 actuations per pass during endoscopic ultrasound-guided fine-needle biopsy for specimen acquisition of solid pancreatic lesions 国際誌

Kataoka Kunio, Ishikawa Takuya, Ohno Eizaburo, Yamao Kentaro, Mizutani Yasuyuki, Iida Tadashi, Kato Katsuyuki, Kinoshita Fumie, Yamamura Takeshi, Furukawa Kazuhiro, Nakamura Masanao, Kawashima Hiroki

JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY   38 巻 ( 9 ) 頁： 1647 - 1655   2023年6月

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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: There is currently no established number of actuations (to-and-fro movements) per pass during endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB). This study aimed to compare 15 vs 5 actuations in terms of adequate specimen acquisition of solid pancreatic lesions. Methods: In this prospective, randomized, crossover, noninferiority, single-center study, eligible patients underwent EUS-FNB using a 22-G Franseen needle with both 15 and 5 actuations per pass, performed in a randomized order, from October 2020 to December 2021. The acquired specimens from each pass were separately evaluated. The primary outcome was the accuracy of the histological diagnosis per pass. The noninferiority margin was set as 15%. Results: Data from 85 patients were analyzed, revealing pancreatic cancer in 73 patients. The accuracy of the histological diagnosis in the 15 and 5 actuations groups was 83.5% (71/85) and 77.7% (66/85), respectively. The difference was −5.8% (95% confidence interval −15.6–3.4), which does not indicate noninferiority of the five actuations group. Among the secondary outcomes, the 15 actuations group was significantly superior to the five actuations group in terms of the obtained core tissues (1.88 [interquartile range 0.89–3.64] mm2 vs 1.66 [0.83–2.71] mm2 [P = 0.031]) and subjective evaluation of cytology specimens for pancreatic cancer (69.0% vs. 31.0%, P = 0.005). Conclusions: The noninferiority of five actuations in the accuracy of the histological diagnosis was not confirmed, and 15 actuations are preferred during EUS-FNB for solid pancreatic lesions.

DOI： 10.1111/jgh.16258

Web of Science

Scopus

PubMed

Diagnostic Performance of Endocytoscopy for Esophageal Eosinophilia 国際誌

Hida Emiko, Muroi Koichi, Kakushima Naomi, Furune Satoshi, Ishikawa Eri, Mizutani Yasuyuki, Sawada Tsunaki, Keiko Maeda, Yamamura Takeshi, Ishikawa Takuya, Furukawa Kazuhiro, Ohno Eizaburo, Nakamura Masanao, Nishida Kazuki, Fujishiro Mitsuhiro, Kawashima Hiroki

DIGESTION   104 巻 ( 3 ) 頁： 202 - 211   2023年6月

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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  

Introduction: Eosinophils in the esophageal epithelium are unevenly distributed in eosinophilic esophagitis (EoE). Esophageal eosinophilia (EE) may be observable by endocytoscopy (EC). This study aimed to evaluate the diagnostic performance of EC for the diagnosis of EE. Methods: A total of 33 EoE patients underwent EC with methylene blue staining from March 2020 to April 2021. A total of 194 EC images with corresponding biopsies were obtained. Three findings of EC, increased squamous cells (item I), increased inflammatory cells (item II), and cells with bilobed nuclei (item III), were established. These findings were reviewed by two endoscopists to diagnose EE. Another four endoscopists reviewed the images for interobserver agreement. Results: When all three items were met by EC, the sensitivity and the accuracy for the diagnosis of EE were 88% and 76%, respectively. The integrated diagnostic odds ratios (ORs) for the diagnosis of EE of the four endoscopists were significant (OR: 3.98, 95% CI: 2.94-5.40, p < 0.001). The results were similar when only item III was met. Interobserver agreement was good for item III to diagnose EE (kappa value = 0.653). Discussion/Conclusion: The diagnostic performance of EC for EE is acceptable and has good interobserver agreement. It may be useful for targeted biopsy in EoE patients.

DOI： 10.1159/000528174

Web of Science

Scopus

PubMed

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

Gastroenterological Endoscopy   65 巻 ( 6 ) 頁： 1165 - 1174   2023年6月

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

【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.【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.【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.【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.(著者抄録)

その他リンク： https://search.jamas.or.jp/default/link?pub_year=2023&ichushi_jid=J00192&link_issn=&doc_id=20230629350011&doc_link_id=10.11280%2Fgee.65.1165&url=https%3A%2F%2Fdoi.org%2F10.11280%2Fgee.65.1165&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_2.gif

膵腫瘍(嚢胞性疾患も)の超音波およびEUS診断 膵腫瘍に対するEUS-FNBにおける実体顕微鏡および精密電子天秤による検体量評価

石川 卓哉, 山雄 健太郎, 植月 康太, 宜保 憲明, 森 裕, 本多 隆, 中村 正直, 石津 洋二, 山本 健太, 川嶋 啓揮

超音波医学   50 巻 ( Suppl. ) 頁： S232 - S232   2023年4月

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記述言語：日本語   出版者・発行元：(公社)日本超音波医学会  

超音波による膵実質評価と病態との関連性 体外式超音波検査による腹臥位での膵尾部描出能の検討

熊野 良平, 石川 卓哉, 山雄 健太郎, 植月 康太, 宜保 憲明, 本多 隆, 中村 正直, 石津 洋二, 山本 健太, 川嶋 啓揮

超音波医学   50 巻 ( Suppl. ) 頁： S240 - S240   2023年4月

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記述言語：日本語   出版者・発行元：(公社)日本超音波医学会  

がんゲノム医療における超音波の役割 EUS-FNA検体でMSI-Highと判定しPembrolizumabにより長期生存を得ている膵体部癌の一例

石川 卓哉, 山雄 健太郎, 植月 康太, 宜保 憲明, 森 裕, 本多 隆, 中村 正直, 石津 洋二, 山本 健太, 川嶋 啓揮

超音波医学   50 巻 ( Suppl. ) 頁： S177 - S177   2023年4月

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記述言語：日本語   出版者・発行元：(公社)日本超音波医学会  

血友病患者における上部消化管内視鏡的止血術の検討

武藤 久哲, 今井 則博, 水野 史崇, 松田 宣賢, 犬飼 庸介, 山本 崇文, 水野 和幸, 横山 晋也, 山本 健太, 伊藤 隆徳, 石津 洋二, 本多 隆, 古川 和宏, 中村 正直, 石上 雅敏, 川嶋 啓揮

Gastroenterological Endoscopy   65 巻 ( Suppl.1 ) 頁： 942 - 942   2023年4月

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

Accuracy of Serum Leucine-Rich Alpha-2 Glycoprotein in Evaluating Endoscopic Disease Activity in Crohn's Disease 国際誌

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

INFLAMMATORY BOWEL DISEASES   29 巻 ( 2 ) 頁： 245 - 253   2023年2月

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

Background: Mucosal healing, confirmed by endoscopic evaluation, is the long-term goal of treatment for Crohn’s disease (CD). Leucine-rich alpha-2 glycoprotein (LRG) is a new serum biomarker correlated with disease activity in inflammatory bowel disease. However, studies evaluating its relationship with CD, particularly in the context of small intestinal lesions, are scarce.The aim of this study was to investigate the accuracy of LRG in assessing endoscopic activity, especially remission, in patients with CD. Methods: Between July 2020 and March 2021, 72 patients with CD who underwent LRG testing and double-balloon endoscopy at the same time were included. Endoscopic activity was evaluated using the applied Simple Endoscopic Score for Crohn’s disease, including small intestine lesions.The relationship of LRG with clinical symptoms and endoscopic activity was assessed, and its predictive accuracy was evaluated. Results: Leucine-rich alpha-2 glycoprotein showed a significant positive correlation with endoscopic activity (r = 0.619, P < .001), even in patients with active lesions in the small intestine (r = 0.626, P < .001). Multivariate logistic regression revealed that LRG was the only factor associated with endoscopic remission. An LRG cutoff value of 8.9 μg/mL had a sensitivity of 93.3%; specificity of 83.3%; positive predictive value of 96.6%; negative predictive value of 71.4%; accuracy of 91.7%; and area under the curve of 0.904 for the prediction of endoscopic remission. Conclusions: Leucine-rich alpha-2 glycoprotein can be used in assessing endoscopic activity and is a reliable marker of endoscopic remission in CD patients. It can be an intermediate target in the treatment of CD.

DOI： 10.1093/ibd/izac076

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Efficacy of 1-kestose supplementation in patients with mild to moderate ulcerative colitis: A randomised, double-blind, placebo-controlled pilot study 国際誌

Ikegami Shuji, Nakamura Masanao, Honda Takashi, Yamamura Takeshi, Maeda Keiko, Sawada Tsunaki, Ishikawa Eri, Yamamoto Kenta, Furune Satoshi, Ishikawa Takuya, Furukawa Kazuhiro, Ohno Eizaburo, Ishigami Masatoshi, Kinoshita Fumie, Kadota Yoshihiro, Tochio Takumi, Shimomura Yoshiharu, Hirooka Yoshiki, Kawashima Hiroki

ALIMENTARY PHARMACOLOGY & THERAPEUTICS   57 巻 ( 11 ) 頁： 1249 - 1257   2023年1月

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Alimentary Pharmacology and Therapeutics  

Background: Ulcerative colitis involves an excessive immune response to intestinal bacteria. Whether administering prebiotic 1-kestose is effective for active ulcerative colitis remains controversial. Aims: This randomised, double-blind, placebo-controlled pilot trial investigated the efficacy of 1-kestose against active ulcerative colitis. Methods: Forty patients with mild to moderate active ulcerative colitis were randomly treated with 1-kestose (N = 20) or placebo (maltose, N = 20) orally for 8 weeks in addition to the standard treatment. The Lichtiger clinical activity index and Ulcerative Colitis Endoscopic Index of Severity were determined. Faecal samples were analysed to evaluate the gut microbiome and metabolites. Results: The clinical activity index at week 8 was significantly lower in the 1-kestose group than in the placebo group (3.8 ± 2.7 vs. 5.6 ± 2.1, p = 0.026). Clinical remission and response rates were higher in the 1-kestose group than in the placebo group (remission: 55% vs. 20%, p = 0.048; response: 60% vs. 25%, p = 0.054). The Ulcerative Colitis Endoscopic Index of Severity at week 8 was not significantly different (2.8 ± 1.6 vs. 3.5 ± 1.6, p = 0.145). Faecal analysis showed significantly reduced alpha-diversity in the 1-kestose group, with a decreased relative abundance of several bacteria, including Ruminococcus gnavus group. The short-chain fatty acid levels were not significantly different between the groups. The incidence of adverse events was comparable between the groups. Discussion: Oral 1-kestose is well tolerated and provides clinical improvement for patients with mild to moderate ulcerative colitis through modulation of the gut microbiome.

DOI： 10.1111/apt.17387

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Scoring system for predicting the prognosis of elderly gastric cancer patients after endoscopic submucosal dissection 国際誌

Ito Nobuhito, Funasaka Kohei, Fujiyoshi Toshihisa, Nishida Kazuki, Furukawa Kazuhiro, Kakushima Naomi, Furune Satoshi, Ohno Eizaburo, Nakamura Masanao, Horiguchi Noriyuki, Shibata Tomoyuki, Miyahara Ryoji, Haruta Jun-Ichi, Hirooka Yoshiki, Fujishiro Mitsuhiro, Kawashima Hiroki

DIGESTIVE ENDOSCOPY   35 巻 ( 1 ) 頁： 67 - 76   2023年1月

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

Objectives: Comprehensive assessments of the long-term outcomes of endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) in the elderly are unavailable. We aimed to create a scoring system to predict the long-term prognosis after ESD for EGC among patients aged ≥75 years. Methods: We conducted retrospective studies of two cohorts: a single-center cohort (2006–2011) for developing the scoring system, and a multicenter cohort for validating the developed system (2012–2016). In the development cohort, factors related to death after ESD were identified using multivariable Cox regression analysis, and a predictive scoring system was developed. In the validation cohort, the scoring system was validated in 295 patients. Results: In the development cohort, Charlson comorbidity index (CCI) ≥3 (hazard ratio [HR] 3.017), high psoas muscle index (PMI) (HR 2.206), and age ≥80 years (HR 1.978) were significantly related to overall survival after ESD. Therefore, high CCI, low PMI, and age ≥80 years were assigned 1 point each. The patients were categorized into low (≤1 point) and high (≥2 points) score groups based on their total scores. In the validation cohort, 184 and 111 patients were assigned to the low- and high-score groups, respectively. In comparisons based on Kaplan–Meier curves, the 5-year survival rate was 91.5% in the low-score group and 57.8% in the high-score group (log-rank test; P < 0.001). Conclusion: Our scoring system including high CCI, low PMI, and age ≥80 years could stratify the long-term prognosis of elderly patients aged ≥75 years after ESD for EGC.

DOI： 10.1111/den.14416

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Adrenomedullin for biologic-resistant Crohn's disease: A randomized, double-blind, placebo-controlled phase 2a clinical trial 国際誌

Kita Toshihiro, Ashizuka Shinya, Takeda Teruyuki, Matsumoto Takayuki, Ohmiya Naoki, Nakase Hiroshi, Motoya Satoshi, Ohi Hidehisa, Mitsuyama Keiichi, Hisamatsu Tadakazu, Kanmura Shuji, Kato Naoya, Ishihara Shunji, Nakamura Masanao, Moriyama Tomohiko, Saruta Masayuki, Nozaki Ryoichi, Yamamoto Shojiro, Inatsu Haruhiko, Watanabe Koji, Kitamura Kazuo

JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY   37 巻 ( 11 ) 頁： 2051 - 2059   2022年11月

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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: Adrenomedullin is a bioactive peptide with many pleiotropic effects, including mucosal healing and immunomodulation. Adrenomedullin has shown beneficial effects in rodent models of inflammatory bowel disease and, more importantly, in clinical trials including patients with ulcerative colitis. We performed a successive clinical trial to investigate the efficacy and safety of adrenomedullin in patients with Crohn's disease (CD). Methods: This was a multicenter, double-blind, placebo-controlled phase 2a trial that evaluated 24 patients with biologic-resistant CD in Japan. Patients were randomly assigned to three groups and were given an infusion of 10 or 15 ng/kg/min of adrenomedullin or placebo for 8 h per day for 7 days. The primary endpoint was the change in the CD activity index (CDAI) at 8 weeks. The main secondary endpoints included changes in CDAI from week 4 to week 24. Results: No differences in the primary or secondary endpoints were observed between the three groups by the 8th week. Changes in CDAI in the placebo group gradually decreased and disappeared at 24 weeks, but those in the adrenomedullin-treated groups (10 or 15 ng/kg/min group) remained at steady levels for 24 weeks. Therefore, a significant difference was observed between the placebo and adrenomedullin-treated groups at 24 weeks (P = 0.043) in the mixed-effects model. We noted mild adverse events caused by the vasodilatory effect of adrenomedullin. Conclusion: In this trial, we observed a long-lasting (24 weeks) decrease in CDAI in the adrenomedullin-treated groups. Adrenomedullin might be beneficial for biologic-resistant CD, but further research is needed.

DOI： 10.1111/jgh.15945

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クローン病深部小腸狭窄に対する内視鏡的バルーン拡張術の成績

大宮 直木, 中村 正直

Gastroenterological Endoscopy   64 巻 ( Suppl.2 ) 頁： 1850 - 1850   2022年10月

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

クローン病深部小腸狭窄に対する内視鏡的バルーン拡張術の成績

大宮 直木, 中村 正直

Gastroenterological Endoscopy   64 巻 ( Suppl.2 ) 頁： 1850 - 1850   2022年10月

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

当院におけるPeutz-Jeghers症候群症例に併存する膵疾患,悪性疾患の頻度に関する検討

大野 栄三郎, 石川 卓哉, 水谷 泰之, 飯田 忠, 植月 康太, 八鹿 潤, 宜保 憲明, 青木 聡典, 片岡 邦夫, 森 裕, 高田 善久, 高橋 秀和, 青井 広典, 石川 恵里, 澤田 つな騎, 前田 啓子, 山村 健史, 古川 和宏, 中村 正直, 川嶋 啓揮

日本消化器病学会雑誌   119 巻 ( 臨増大会 ) 頁： A793 - A793   2022年10月

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

Modified N score is helpful for identifying patients who need endoscopic intervention among those with black stools without hematemesis 国際誌

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

DIGESTIVE ENDOSCOPY   34 巻 ( 6 ) 頁： 1157 - 1165   2022年9月

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

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. 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. 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%. 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.

DOI： 10.1111/den.14323

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Fecal microbiota transplantation in the treatment of irritable bowel syndrome: a single-center prospective study in Japan 国際誌

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

BMC GASTROENTEROLOGY   22 巻 ( 1 ) 頁： 342 - 342   2022年7月

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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: Fecal microbiota transplantation (FMT) is a potential treatment for irritable bowel syndrome (IBS), but its efficacy in Japanese IBS patients is unknown. This study aimed to evaluate the efficacy, side effects, and microbiome changes following FMT in Japanese IBS patients. Methods: Seventeen Japanese patients with refractory IBS received FMT (4 donors) under colonoscopy. Responders were defined by an improvement in the IBS severity index (IBS-SI) of 50 points or more after 12 weeks. We evaluated the IBS-SI and Bristol Stool Form Scale (BSFS) and compared the diversity and microbiome before and 12 weeks after FMT. For the microbiome, we analyzed the V3–V4 region of the 16S rRNA gene. Results: IBS-SI decreased an average of 115.58 points after 12 weeks, and 10 patients (58.8%) were considered responders. Eight patients with diarrhea (66.7%) and three patients with constipation (60.0%) showed improvement in the BSFS. Two patients complained of mild abdominal pain, but there were no cases with severe side-effects. α-diversity was increased only in the responder group (p = 0.017). Patients who closely paralleled the donor microbiome had a higher rate of IBS-SI improvement. The relative abundance of Neisseria and Akkermansia increased and Desulfovibrio and Delftia were decreased in the responder group after FMT. Conclusions: Following FMT, about 60% of Japanese patients with IBS showed improvement in both the IBS-SI and BSFS, without severe side effects. Increased α-diversity and similarity to the donor microbiome after FMT may be associated with better treatment effects. Trial registration: This study was registered in the University Hospital Medical Information Network Clinical Trial Registration (UMIN000026363). Registered 31 May 2017, https://rctportal.niph.go.jp/s/detail/um?trial_id=UMIN000026363. The study was registered prospectively.

DOI： 10.1186/s12876-022-02408-5

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(I章)消化管(上・下) 小腸腫瘍に対する診療の進歩

中村 正直, 大宮 直木

消化器内科学レビュー   2022-'23 巻   頁： 48 - 53   2022年7月

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記述言語：日本語   出版者・発行元：(株)総合医学社  

＜最近の動向とガイドライン＞●2000年以降に導入されたカプセル内視鏡とバルーン内視鏡による小腸内視鏡診断の進歩に伴って、小腸腫瘍の内視鏡所見から病態までが明らかにされてきた。2015年には「小腸内視鏡診療ガイドライン」が発表されたことで、一般臨床への導入が進んだ。●小腸内視鏡の導入から20年が経った現在において、インパクトの高い臨床研究は少ないが、ガイドラインに追加、補完できる臨床研究、症例報告を多数認めた。小腸腫瘍の存在について画像診断が単独のモダリティでは困難であることも検討し、小腸腫瘍が疑われた場合は、複数の画像診断によって正確な診断が得られる。●gastrointestinal stromal tumor(GIST)の診断について、内視鏡分類が提案された。GISTは悪性ポテンシャル、消化管出血といったリスクを有するため、今後は治療前に分類化され診療ストラテジーが確立されることを期待する。●内視鏡治療についても新たなアイディアが発表された。Peutz-Jeghers syndrome(PJS)における小腸ポリポーシスに対する内視鏡治療の意義は大きいが、治療時間の長いことや腸穿孔、後出血のリスクを有するためさらに有効な治療法が望まれる。大きなポリープについては基部にクリップを留置するもしくは留置スネアを用いて基部を絞扼する治療が報告された。PJSは術後例が多いので、腹腔鏡によって小腸内視鏡の進行をアシストする報告もあった。(著者抄録)

【小腸疾患-診断・治療の最新動向-】血行障害・血管性病変 血管性病変 動静脈奇形

山村 健史, 澤田 つな騎, 石川 恵里, 前田 啓子, 中村 正直

日本臨床   80 巻 ( 増刊7 小腸疾患 ) 頁： 305 - 311   2022年7月

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記述言語：日本語   出版者・発行元：(株)日本臨床社  

【転移性消化管腫瘍】転移性小腸腫瘍の画像診断・形態学的特徴

山田 健太朗, 山村 健史, 中村 正直, 前田 啓子, 澤田 つな騎, 石川 恵里, 飯田 忠, 水谷 泰之, 山雄 健太郎, 石川 卓哉, 古川 和宏, 大野 栄三郎, 川嶋 啓揮

胃と腸   57 巻 ( 8 ) 頁： 1018 - 1026   2022年7月

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記述言語：日本語   出版者・発行元：(株)医学書院  

＜文献概要＞転移性小腸腫瘍は小腸腫瘍の中でもまれな疾患であるが,カプセル内視鏡検査やバルーン内視鏡検査といった小腸内視鏡検査が普及してきたことにより遭遇する機会が増加している.本稿では転移性小腸腫瘍を診断するのに有用な臨床的特徴を病態,検査,転移様式別(脈管性転移,直接浸潤,播種性転移)に,既報と自験例に基づいて概説した.転移性小腸腫瘍はさまざまな形態を呈するため,小腸腫瘍の鑑別疾患として念頭に置き,患者背景と検査所見から総合的に診断していく必要がある.

膵胆道領域のピットフォールと対策 膵嚢胞性腫瘍に対するEUS診断 EUS形態診断にて鑑別が困難な病変の特徴

大野 栄三郎, 石川 卓哉, 植月 康太, 山田 健太, 八鹿 潤, 宜保 憲明, 片岡 邦夫, 中村 正直, 本多 隆, 川嶋 啓揮

超音波医学   49 巻 ( Suppl. ) 頁： S207 - S207   2022年4月

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記述言語：日本語   出版者・発行元：(公社)日本超音波医学会  

胆膵:超音波像の成り立ちと解釈:病理との対応 IPMNにおける粘液塊の性状と病理像との関連性に関する検討

八鹿 潤, 大野 栄三郎, 石川 卓哉, 植月 康太, 山田 健太, 宜保 憲明, 片岡 邦夫, 中村 正直, 本多 隆, 川嶋 啓揮

超音波医学   49 巻 ( Suppl. ) 頁： S218 - S218   2022年4月

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記述言語：日本語   出版者・発行元：(公社)日本超音波医学会  

膵癌診療における超音波の役割～存在・鑑別・進行度・予後診断～ 膵癌肝転移診断における造影MRIと比較した造影EUS後経腹壁超音波検査の有用性

石川 卓哉, 大野 栄三郎, 植月 康太, 山田 健太, 宜保 憲明, 本多 隆, 中村 正直, 石津 洋二, 山本 健太, 川嶋 啓揮

超音波医学   49 巻 ( Suppl. ) 頁： S201 - S201   2022年4月

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記述言語：日本語   出版者・発行元：(公社)日本超音波医学会  

Gelsolin as a Potential Biomarker for Endoscopic Activity and Mucosal Healing in Ulcerative Colitis 査読有り 国際誌

Maeda Keiko, Nakamura Masanao, Yamamura Takeshi, Sawada Tsunaki, Ishikawa Eri, Oishi Akina, Ikegami Shuji, Kakushima Naomi, Furukawa Kazuhiro, Iida Tadashi, Mizutani Yasuyuki, Ishikawa Takuya, Ohno Eizaburo, Honda Takashi, Ishigami Masatoshi, Kawashima Hiroki

BIOMEDICINES   10 巻 ( 4 )   2022年4月

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

The therapeutic goal in ulcerative colitis is mucosal healing, which requires improved non-invasive biomarkers to evaluate disease activity. Gelsolin is associated with several autoimmune diseases, and here, we aimed to analyze its usefulness as a serological biomarker for clinical and endoscopic activities in ulcerative colitis. Patients with ulcerative colitis (n = 138) who had undergone blood tests and colonoscopy were included. Serum gelsolin was measured using enzyme-linked immunosorbent assay, and correlation between the gelsolin level and clinical and endoscopic activities was examined. The serum gelsolin level in patients with ulcerative colitis was significantly lower than that in healthy subjects, and it decreased in proportion to increasing Mayo score and Mayo endoscopic subscore. The area under the curve for correlation between clinical and endoscopic remission and serum gelsolin level was higher than that for C-reactive protein. Furthermore, in C-reactive protein-negative patients, the serum gelsolin level was lower in the active phase than in remission. Our findings indicate that the serum gelsolin level correlates with clinical and endoscopic activities in ulcerative colitis, has a higher sensitivity and specificity than C-reactive protein, and can detect mucosal healing, suggesting that gelsolin can be used as a biomarker for ulcerative colitis.

DOI： 10.3390/biomedicines10040872

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Diagnostic performance of endoscopic classifications for neoplastic lesions in patients with ulcerative colitis: A retrospective case-control study 国際誌

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

WORLD JOURNAL OF GASTROENTEROLOGY   28 巻 ( 10 ) 頁： 1055 - 1066   2022年3月

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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 It is unclear whether the Japan Narrow-Band Imaging Expert Team (JNET) classification and pit pattern classification are applicable for diagnosing neoplastic lesions in patients with ulcerative colitis (UC). AIM To clarify the diagnostic performance of these classifications for neoplastic lesions in patients with UC. METHODS This study was conducted as a single-center, retrospective case-control study. Twenty-one lesions in 19 patients with UC-associated neoplasms (UCAN) and 23 lesions in 22 UC patients with sporadic neoplasms (SN), evaluated by magnifying image-enhanced endoscopy, were retrospectively and separately assessed by six endoscopists (three experts, three non-experts), using the JNET and pit pattern classifications. The results were compared with the pathological diagnoses to evaluate the diagnostic performance. Inter- and intra-observer agreements were calculated. RESULTS In this study, JNET type 2A and pit pattern type III/IV were used as indicators of low-grade dysplasia, JNET type 2B and pit pattern type VI low irregularity were used as indicators of highgrade dysplasia to shallow submucosal invasive carcinoma, JNET type 3 and pit pattern type VI high irregularity/VN were used as indicators of deep submucosal invasive carcinoma. In the UCAN group, JNET type 2A and pit pattern type III/IV had a low positive predictive value (PPV; 50.0% and 40.0%, respectively); however, they had a high negative predictive value (NPV; 94.7% and 100%, respectively). Conversely, in the SN group, JNET type 2A and pit pattern type III/IV had a high PPV (100% for both) but a low NPV (63.6% and 77.8%, respectively). In both groups, JNET type 3 and pit pattern type VI-high irregularity/VN showed high specificity. The interobserver agreement of JNET classification and pit pattern classification for UCAN among experts were 0.401 and 0.364, in the same manner for SN, 0.666 and 0.597, respectively. The intra-observer agreements of JNET classification and pit pattern classification for UCAN among experts were 0.387, 0.454, for SN, 0.803 and 0.567, respectively. CONCLUSION The accuracy of endoscopic diagnosis using both classifications was lower for UCAN than for SN. Endoscopic diagnosis of UCAN tended to be underestimated compared with the pathological results.

DOI： 10.3748/wjg.v28.i10.1055

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A novel scoring system to predict therapeutic intervention for non-variceal upper gastrointestinal bleeding 国際誌

Ito Nobuhito, Funasaka Kohei, Furukawa Kazuhiro, Kakushima Naomi, Hirose Takashi, Muroi Koichi, Suzuki Tomohiko, Suzuki Takahiro, Hida Emiko, Ishikawa Takuya, Yamamura Takeshi, Ohno Eizaburo, Nakamura Masanao, Kawashima Hiroki, Miyahara Ryoji, Fujishiro Mitsuhiro

INTERNAL AND EMERGENCY MEDICINE   17 巻 ( 2 ) 頁： 423 - 430   2022年3月

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Internal and Emergency Medicine  

Various scoring systems have been developed to predict the need for endoscopic treatment in patients with non-variceal upper gastrointestinal bleeding (NVUGIB). However, they have rarely been applied in clinical practice because the processes are complicated. The aim of this study was to establish a simple scoring system that predicts the need for endoscopic intervention in patients with NVUGIB. We retrospectively enrolled 509 consecutive patients with suspected NVUGIB who underwent emergency endoscopy. In the development cohort (from January 2016 to December 2018), risk factors that predict the need for endoscopic intervention were determined from 349 patients’ data by multivariate logistic regression analysis. This led to the development of a novel scoring system named the Nagoya University score (N score). In the validation cohort (from January 2019 to September 2020), we evaluated the diagnostic value of the N score, the Hirosaki score, and the Glasgow-Blatchford scores (GBS) by receiver operating characteristic (ROC) curves using another 160 patients’ data. Multivariate logistic regression analysis revealed syncope, hematemesis, blood urea nitrogen (BUN), and BUN/Cr as significant predictive factors for endoscopic intervention. In the validation study, the N score was superior to the GBS and equal to the Hirosaki score in predicting the endoscopic intervention (AUC, N score 0.776 [95% CI 0.702–0.851] vs. GBS 0.615 [0.523–0.708], Hirosaki 0.719 [0.636–0.803]). The N score revealed a sensitivity of 84.5% and a specificity of 61.8%. Our N score, which is consisted of only four factors, would select patients who require endoscopic intervention with high probability.

DOI： 10.1007/s11739-021-02822-9

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炎症性腸疾患の病態からみた診療を考える クローン病深部小腸狭窄に対する内視鏡的バルーン拡張術における抗体製剤の意義

大宮 直木, 中村 正直

日本消化器病学会雑誌   119 巻 ( 臨増総会 ) 頁： A111 - A111   2022年3月

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

消化器疾患診療に必要なバイオマーカー開発のための研究 潰瘍性大腸炎の内視鏡的活動性と粘膜治癒を反映するバイオマーカーの同定

前田 啓子, 中村 正直, 石上 雅敏

日本消化器病学会雑誌   119 巻 ( 臨増総会 ) 頁： A170 - A170   2022年3月

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

炎症性消化管疾患の最前線 IBD治療と外科・内科のコラボレーション クローン病深部小腸狭窄に対する内視鏡的バルーン拡張術の成績

大宮 直木, 中村 正直

日本消化管学会雑誌   6 巻 ( Suppl. ) 頁： 106 - 106   2022年1月

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記述言語：日本語   出版者・発行元：(一社)日本消化管学会  

Comparison of Endoscopic Ultrasonography and Conventional Endoscopy for Prediction of Tumor Depth in Superficial Nonampullary Duodenal Epithelial Tumors 国際誌

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

DIGESTION   103 巻 ( 4 ) 頁： 319 - 328   2022年

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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: The utility of endoscopic ultrasonography (EUS) in predicting tumor depth among superficial nonampullary duodenal epithelial tumors (SNADETs) is unclear. The aim was to compare EUS with conventional endoscopy (CE) for the evaluation of tumor invasion of SNADETs. Methods: A retrospective analysis was performed on consecutive 174 lesions/169 patients with duodenal dysplasia or adenocarcinoma with invasion up to submucosa who underwent both CE and EUS before endoscopic (n = 133) or surgical (n = 41) treatment. Endoscopic staging by CE was performed based on the characteristic endoscopic criteria of submucosal invasion (irregular surface, submucosal tumor [SMT]-like marginal elevation, and fusion of converging folds). The diagnostic performance of each test was compared with the final histology. Results: The sensitivity and accuracy of estimating the depth were higher for CE compared to that of EUS (99.4% vs. 89.4%, p < 0.01 and 97.7% vs. 87.9%, p < 0.01, respectively). Univariate analysis of endoscopic factors revealed that tumor diameter, red color, SMT-like appearance, and hypoechogenicity were factors related to advanced histology. Multivariate analysis revealed that the presence of SMT-like appearance based on CE was an independent factor to predict submucosal invasion (p = 0.025). Gross morphology of the combined type was associated to incorrect diagnosis of EUS (p = 0.007). Among 3 cases in which EUS overestimated the tumor depth, carcinoma extension in submucosal Brunner's gland or nontumorous submucosal cystic dilation was observed. Conclusion: EUS may not be necessary, and CE may be sufficient for determining the optimal therapeutic strategy for SNADETs.

DOI： 10.1159/000524841

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当院における活動期潰瘍性大腸炎に対するトファシチニブの治療成績

池上 脩二, 前田 啓子, 中村 正直, 山村 健史, 澤田 つな騎, 石川 恵里, 飯田 忠, 水谷 泰之, 石川 卓哉, 古川 和宏, 角嶋 直美, 大野 栄三郎, 川嶋 啓揮, 石上 雅敏

日本消化器病学会東海支部例会プログラム抄録集   135回 巻   頁： 79 - 79   2021年12月

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記述言語：日本語   出版者・発行元：日本消化器病学会-東海支部  

Endocytoscopy Is Useful for the Diagnosis of Superficial Nonampullary Duodenal Epithelial Tumors 国際誌

Hirose Takashi, Kakushima Naomi, Furukawa Kazuhiro, Furune Satoshi, Ishikawa Eri, Sawada Tsunaki, Maeda Keiko, Yamamura Takeshi, Ishikawa Takuya, Ohno Eizaburo, Nakamura Masanao, Nishida Kazuki, Yokoi Takio, Kawashima Hiroki, Fujishiro Mitsuhiro

DIGESTION   102 巻 ( 6 ) 頁： 895 - 902   2021年11月

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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  

Introduction: Endoscopic criteria for the diagnosis of superficial nonampullary duodenal epithelial tumors (SNADETs) are lacking. The aim of this study was to explore the usefulness of endocytoscopy (ECS) in the duodenum. Methods: A total of 77 ECS images stained by methylene blue and 58 images with double staining of methylene blue and crystal violet were obtained from 20 patients. Images were classified into 3 grades based on nuclear and villi atypia: EC A, B, and C. Diagnostic performance of ECS classification to predict histology and interobserver agreement was evaluated. The performance was compared between staining methods and ×520 or ×936 zoom. Results: With methylene blue staining, high rates of accuracy, sensitivity, specificity, and positive predictive value (PPV) over 90% were achieved for tumor and nontumor diagnosis as assessed by EC A versus EC B. High rates of accuracy, sensitivity, PPV, and negative predictive value over 90% were achieved for the differentiation between the diagnosis of the Vienna category 3 and 4/5 as assessed by EC B versus C. The accuracy rate of interpreting ECS images with ×936 zoom among 10 endoscopists was 82%, and the interobserver agreement rate was 0.803 (Kendall's coefficient of concordance). In the ×936 zoom group, methylene blue staining was significantly associated with higher accuracy rate (odds ratio 1.76 [1.06-2.92], p value 0.0297). No benefit was observed by double staining. Conclusions: ECS diagnosis with methylene blue provides a high accuracy rate and good interobserver agreement to predict histology of SNADETs.

DOI： 10.1159/000516512

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Differentiation between pancreatic metastases from renal cell carcinoma and pancreatic neuroendocrine neoplasm using endoscopic ultrasound 国際誌

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

PANCREATOLOGY   21 巻 ( 7 ) 頁： 1364 - 1370   2021年10月

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記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Pancreatology  

Objectives: Pancreatic metastases from renal cell carcinoma (PRCC) often appear many years after treatment of the primary tumor, and differentiation from pancreatic neuroendocrine neoplasm (PanNEN) can be challenging due to their hypervascularity. Here, we investigated the utility of endoscopic ultrasound (EUS) for differentiation of these conditions. Methods: A retrospective analysis was performed in 17 and 79 consecutive patients with pathologically proven PRCC and non-functional PanNEN who were examined by EUS. In cases examined by EUS elastography or contrast-enhanced harmonic EUS (CH-EUS), the lesions were classified as stiff or soft, or into three vascular patterns as hypoechoic, isoechoic, and hyperechoic. CH-EUS images at 20 s, 40 s, 60 s, 3 min and 5 min were used for evaluation. EUS images were independently reviewed by two readers who were blinded to all clinical information. Results: The patients with PRCC were significantly older than those with PanNEN (median, 71 (range, 45–81) vs. 58 (22–76), P = 0.001) and more often had multiple tumors (6/17 (35%) vs. 7/79 (9%), P = 0.010). In EUS findings, PRCC lesions significantly more frequently had a marginal hypoechoic zone (MHZ) (11/17 (65%) vs. 27/79 (34%), P = 0.028), being classified as soft (12/13 (92%) vs. 26/58 (45%), P = 0.002), and showed sustained hyperechoic vascular patterns at 5 min (7/8 (88%) vs. 4/59 (7%), P < 0.001) compared to PanNEN lesions. Conclusions: The presence of a MHZ, a soft lesion, and a sustained hyperechoic vascular pattern in EUS may be useful for differentiating PRCC from PanNEN.

DOI： 10.1016/j.pan.2021.07.001

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【クローン病診療の診断から治療をマスターする】クローン病の活動性はどのように評価するのか? 内視鏡検査と検査のタイミング

喜田 裕一, 山村 健史, 前田 啓子, 澤田 つな騎, 石川 恵里, 角嶋 直美, 古川 和宏, 中村 正直

消化器・肝臓内科   10 巻 ( 4 ) 頁： 429 - 435   2021年10月

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記述言語：日本語   出版者・発行元：(有)科学評論社  

炎症性腸疾患治療におけるアフェレシスの現状と未来 難治性潰瘍性大腸炎における生物学的製剤とGMAの併用療法

中村 正直, 山村 健史, 前田 啓子, 澤田 つな騎, 石川 恵里, 小杉 智規, 丸山 彰一, 梅田 晋一, 服部 憲史, 中山 吾郎

日本アフェレシス学会雑誌   40 巻 ( Suppl. ) 頁： 49 - 49   2021年10月

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記述言語：日本語   出版者・発行元：(一社)日本アフェレシス学会  

Endoscopic Ultrasound Elastography as a Novel Diagnostic Method for the Assessment of Hardness and Depth of Invasion in Colorectal Neoplasms 国際誌

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

DIGESTION   102 巻 ( 5 ) 頁： 701 - 713   2021年9月

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記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Digestion  

Introduction: We aimed to compare the efficacy of endoscopic ultrasound elastography (EUS-EG) with that of magnifying chromoendoscopy (MCE) and endoscopic ultrasonography (EUS) for the diagnosis of the depth of invasion in colorectal neoplasms. This is an important clinical issue as the depth of invasion is associated with the risk of metastasis. Methods: Consecutive patients with suspected superficial colorectal neoplasms, evaluated by MCE, EUS, and EUS-EG, for whom endoscopic submucosal dissection was considered, were enrolled in 2018 (derivation study) and in 2019-2020 (validation study). The primary clinical endpoint was the diagnostic yield differentiating intramucosal and shallow submucosal neoplasms from deep submucosal (dSM) and advanced colorectal cancers. In addition, inter- and intra-observer agreements of the elastic score of colorectal neoplasm (ES-CRN) were evaluated by 2 expert and 2 non-expert endoscopists. Results: Thirty-one (33 lesions) and 50 (55 lesions) patients were enrolled in the derivation and validation studies, respectively. Sensitivity, specificity, positive, and negative predictive values, and accuracy of assessment of the depth of submucosal or deeper invasion in the derivation and validation groups were as follows: EUS-EG, 100/88.2/86.7/100/93.3% and 77.8/86.1/73.7/88.6/83.3%; MCE, 66.7/94.4/90.9/77.3/81.8% and 84.2/91.4/84.2/91.4/88.9%; and EUS, 93.3/77.8/77.8/93.3/84.8% and 89.5/65.7/58.6/92.0/74.1%, respectively. For the 2 expert endoscopists, interobserver agreement for the ES-CRN (first and second assessments) in the derivation group was 0.84 and 0.78, respectively; these values were 0.73 and 0.49, respectively, for the 2 non-expert endoscopists. Discussion/Conclusion: All 3 modalities presented similar diagnostic yield. Inter- and intra-observer agreements of the ES-CRN were substantial, even for non-expert endoscopists. Therefore, EUS-EG may be a useful modality in determining the depth of invasion in colorectal neoplasms.

DOI： 10.1159/000511589

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Subjective Symptoms in Patients with Eosinophilic Esophagitis Are Related to Esophageal Wall Thickness and Esophageal Body Pressure 国際誌

Muroi Koichi, Kakushima Naomi, Furukawa Kazuhiro, Ishikawa Eri, Sawada Tsunaki, Ishikawa Takuya, Maeda Keiko, Yamamura Takeshi, Ohno Eizaburo, Nakamura Masanao, Kawashima Hiroki, Funasaka Kohei, Miyahara Ryoji, Fujishiro Mitsuhiro

DIGESTIVE DISEASES AND SCIENCES   66 巻 ( 7 ) 頁： 2291 - 2300   2021年7月

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記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Digestive Diseases and Sciences  

Background: Endoscopic ultrasonography (EUS) and high-resolution manometry (HRM) can be used in the evaluation of eosinophilic esophagitis (EoE) for frequent symptoms such as dysphagia. However, the role of these examinations is not clear. Aims: The aim of this study was to objectively evaluate the subjective symptoms of EoE patients with EUS and HRM. Methods: Patients who had endoscopic findings indicative of EoE and matched the number of eosinophil infiltrates used as diagnostic criteria were recruited between September 2018 and August 2019. Evaluable subjects underwent EUS and HRM and completed the Gastrointestinal Symptom Rating Scale (GSRS) questionnaire. The esophageal wall thickness (evaluated with EUS) and HRM parameters between patients with and without symptoms were retrospectively compared. Symptomatic patients were re-examined using EUS and HRM 6 months after treatment. Results: A total of 35 patients (29 males, median age of 49 years) were divided into symptomatic (20 patients) and asymptomatic groups (15 patients). The esophageal wall was thicker, and the distal contractile integral (DCI) values were higher in the symptomatic group (P < 0.001). In addition, DCI values were positively correlated with esophageal wall thickness. After treatment, the GSRS scores showed an improving trend for each item. Esophageal wall thickness and DCI values were significantly decreased (Ps < 0.001). Conclusions: Esophageal wall thickening and increased esophageal body pressure may be involved in subjective symptoms. In addition, treatment may reduce esophageal thickness and pressure along with improvement of subjective symptoms.

DOI： 10.1007/s10620-020-06527-5

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Endoscopic papillectomy for ampullary adenoma and early adenocarcinoma: Analysis of factors related to treatment outcome and long-term prognosis

Kawashima Hiroki, Ohno Eizaburo, Ishikawa Takuya, Iida Tadashi, Tanaka Hiroyuki, Furukawa Kazuhiro, Nakamura Masanao, Honda Takashi, Hashimoto Senju, Itoh Akihiro, Ishigami Masatoshi, Hirooka Yoshiki, Fujishiro Mitsuhiro

DIGESTIVE ENDOSCOPY   33 巻 ( 5 ) 頁： 858 - 869   2021年7月

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

Objectives: There are few reports on the long-term prognosis of papillary tumors after endoscopic papillectomy. Here, we report a retrospective study of the therapeutic effects, long-term prognosis, and affecting factors. Methods: The inclusion criteria were papillary adenoma with/without an adenocarcinoma component on biopsy results and ≤10 mm intraductal extension, and the exclusion criteria were moderate to poorly differentiated adenocarcinoma on biopsy results. If no residual lesion was confirmed ≥6 months after the last endoscopic treatment, remission was defined. Subsequently, follow-up endoscopy was scheduled once a year. Surgery was required in the case of adenocarcinoma recurrence or intraductal lesions >10 mm. The rates of adverse events, remission, recurrence, and need for surgery were examined. The affecting factors were calculated. Results: There were a total of 253 subjects, including 65 with adenocarcinoma. Pancreatitis (7.5%), bleeding (9.1%) and perforation (2.8%) were observed as adverse events. Among 221 subjects with ≥6 months of follow-up, 212 (95.9%) were in remission. The cumulative recurrence rate using the Kaplan–Meier analysis at 5 years was 16.9% (22 cases), with the need for surgery in 5.9% (5 cases). Intraductal extension on preoperative diagnosis was the only significant risk factor for both recurrence (P < 0.001) and the need for surgery (P = 0.005). The presence of adenocarcinoma had no significant effect. Conclusion: Although remission was achieved in more than 95% of our patients, we observed a high rate of recurrence at the long-term follow-up, which was significantly associated with intraductal extension but not with the presence of adenocarcinoma.

DOI： 10.1111/den.13881

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その他リンク： https://onlinelibrary.wiley.com/doi/full-xml/10.1111/den.13881

【消化管がん検診・スクリーニングの手引き】(第VI章)下部消化管の検診でしばしば遭遇する腫瘍性疾患 大腸ポリープ

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, 藤城 光弘

臨床消化器内科   36 巻 ( 8 ) 頁： 1022 - 1028   2021年7月

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記述言語：日本語   出版者・発行元：(株)日本メディカルセンター  

＜文献概要＞大腸がんは本邦でがん罹患数1位,がん死亡数2位と増加傾向を示しており,世界でもがん疾患のなかで大きな割合を占めている.大腸がんは検診による死亡抑制効果が実証されており,世界の多くの地域で実施されている.本邦では便潜血免疫法(fecal immunohistochemical test;FIT)が開発され,1992年から対策型検診として行われているが,検診受診率および精検受診率の低さが問題として挙げられている.一方,任意型検診では全大腸内視鏡(total colonoscopy;TCS)を用いることができるが,対策型検診として組み込むには安全性と質の担保,医療者側の検査処理能力,費用効果,アドヒアランスなど多くの課題が残されている.しかし大腸内視鏡による腺腫性ポリープ切除は,大腸がんの罹患率・死亡率を減少させることが報告されており,TCSが早期発見・治療に関しては非常に有効な手段であることに異論はないと思われる.大腸がんは検診により死亡抑制効果を期待できるうえに内視鏡的腺腫性ポリープ切除術により死亡率・罹患率を減少させることなど,二次予防の効果(早期発見・早期治療)も高いことが特徴であり,検診で遭遇する大腸ポリープを適切に取り扱うことは大変重要な課題である.本稿ではガイドラインを中心にして,大腸ポリープの取り扱いについて解説する.

Comparison of High-Resolution Manometry in Patients Complaining of Dysphagia among Patients with or without Diabetes Mellitus 国際誌

Muroi Koichi, Miyahara Ryoji, Funasaka Kohei, Furukawa Kazuhiro, Sawada Tsunaki, Maeda Keiko, Yamamura Takeshi, Ishikawa Takuya, Ohno Eizaburo, Nakamura Masanao, Kawashima Hiroki, Onoue Takeshi, Arima Hiroshi, Hirooka Yoshiki, Fujishiro Mitsuhiro

DIGESTION   102 巻 ( 4 ) 頁： 554 - 562   2021年6月

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記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Digestion  

Introduction: Dysphagia is a common symptom that occurs in patients with diabetes mellitus (DM). There have been few prospective observational studies on esophageal motility disorders in DM using high-resolution manometry (HRM). This study aimed to clarify the characteristics of esophageal motility disorders using HRM in patients with dysphagia and compare them between DM and non-DM patients. Methods: Patients with dysphagia were prospectively recruited between October 2018 and July 2019. Patients (n = 89) underwent esophagogastroduodenoscopy and HRM and completed the Gastrointestinal Symptom Rating Scale (GSRS) questionnaire. Manometry parameters and motility disorder classifications were compared between DM and non-DM patients. We also investigated the differences in clinical backgrounds and questionnaire scores among DM patients with normal and abnormal manometry results. Results: A higher prevalence of esophageal motility disorder was observed in DM patients (60%, 21/35) compared to non-DM patients (29.6%, 16/54) (p = 0.001). The prevalence of minor disorders such as ineffective esophageal motor disorder and fragmented peristalsis was significantly higher (45 vs. 11%), and the distal contractile integral, integrated relaxation pressure, and contractile front velocity values were lower in the DM group. Among DM patients, those with abnormal esophageal motility had a significantly higher prevalence of neuropathy, retinopathy, and nephropathy, as well as higher reflux or constipation scores on the GSRS, than those with normal results. Conclusions: Among patients with dysphagia, the frequency of minor esophageal motility disorders was higher in DM patients than in non-DM patients. Abnormal esophageal motility related to poor esophageal clearance was associated with higher prevalence of diabetic complications.

DOI： 10.1159/000510081

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Long-Term Prognostic Predictors of Esophageal Squamous Cell Carcinoma Potentially Indicated for Endoscopic Submucosal Dissection 国際誌

Suzuki Tomohiko, Furukawa Kazuhiro, Funasaka Kohei, Ishikawa Eri, Sawada Tsunaki, Maeda Keiko, Yamamura Takeshi, Ishikawa Takuya, Ohno Eizaburo, Nakamura Masanao, Kawashima Hiroki, Miyahara Ryoji, Fujishiro Mitsuhiro

DIGESTION   102 巻 ( 4 ) 頁： 563 - 571   2021年6月

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記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Digestion  

Introduction: Patients with esophageal squamous cell carcinoma (ESCC) have various comorbidities. Thus, it is necessary to determine the appropriateness of performing treatment based on the patient's general condition. Aim: This study aimed to clarify the prognostic predictors of ESCC indicated for endoscopic submucosal dissection (ESD). Methods: This retrospective study enrolled 241 patients with superficial ESCC endoscopically diagnosed as ESD-indicated lesions at the Nagoya University Hospital between January 2007 and December 2017. We evaluated the 3- and 5-year overall survival (OS) rates and prognostic predictors, such as the Prognostic Nutritional Index (PNI), Charlson Comorbidity Index (CCI), Psoas Muscle Index, and Controlling Nutritional Status score. Furthermore, we created a score-based classification using the prognostic predictors identified by multivariate analysis, and the 3- and 5-year OS rates were compared among the calculated scores. Results: In the multivariate analysis, PNI < 45 (hazard ratio [HR]: 2.39; 95% confidence interval [CI]: 1.28-4.46; p = 0.006) and CCI ≥ 3 (HR: 4.42; 95% CI: 2.40-8.12; p < 0.001) were significantly associated with the OS. Based on the HR, 0 and 1 were assigned to PNI and 0, 2, and 4 were assigned to CCI, and the score classification of 0-5 points was created. The 3- and 5-year OS rates in patients with a score 3 were significantly higher than in those with scores 4 and 5. As a result of scoring, the prognosis was stratified; the 3- and 5-year OS rates in patients with scores 4 and 5, that is, CCI ≥ 6, were clearly low, at approximately 10%. Conclusions: CCI and PNI can be prognostic predictors of patients with superficial ESCC indicated for ESD. Observation without ESD might be an acceptable strategy among patients with CCI ≥ 6.

DOI： 10.1159/000510091

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Immunohistochemical staining for IMP3 in patients with duodenal papilla tumors: assessment of the potential for diagnosing endoscopic resectability and predicting prognosis 国際誌

Tanaka Hiroyuki, Kawashima Hiroki, Ohno Eizaburo, Ishikawa Takuya, Iida Tadashi, Ishikawa Eri, Furukawa Kazuhiro, Nakamura Masanao, Honda Takashi, Shimoyama Yoshie, Miyahara Ryoji, Kawabe Naoto, Kuzuya Teiji, Hashimoto Senju, Ishigami Masatoshi, Hirooka Yoshiki, Fujishiro Mitsuhiro

BMC GASTROENTEROLOGY   21 巻 ( 1 ) 頁： 224 - 224   2021年5月

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記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：BMC Gastroenterology  

Background: Endoscopic papillectomy of duodenal papillary tumors (PT) is indicated for adenomas or well-differentiated adenocarcinomas that do not involve the sphincter of Oddi. However, there is currently no reliable pre-operative method to diagnose the infiltration in the sphincter of Oddi.’ Insulin-like growth factor 2 mRNA protein 3 (IMP3) staining is reportedly associated with advanced disease stage and clinical outcomes in many carcinomas. The aim of this retrospective study was to investigate the ability of diagnosing sphincter of Oddi involvement in PT and predicting the prognoses using IMP3 immunohistochemistry. Methods: Twenty-five resected specimens from patients with PT and 24 biopsy specimens from the same patients excluding one were immunostained for IMP3. The percentage of positive cells in the tumor was evaluated and compared with the final pathological diagnosis and prognosis. Results: The final pathological diagnoses were adenoma in 5 patients and adenocarcinoma in 20 patients (no sphincter of Oddi involvement in 5 and involvement in 15). The ability to diagnose sphincter of Oddi involvement based on the percentage of IMP3-positive cells in resected specimens and tissue biopsies was the area under the curve 0.8 and 0.78, respectively, of the receiver operating characteristic curve, and the accuracies were 80.0% and 75.0% (cutoff value: 10%), respectively. Moreover, patients with an IMP3-positive cell rate of ≥ 10% had a significantly worse prognosis (log-rank test P = 0.01). Conclusion: IMP3 immunostaining of resected and biopsy specimens from PT patients enables the diagnosis of sphincter of Oddi involvement objectively and is also effective in predicting the prognosis.

DOI： 10.1186/s12876-021-01811-8

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Measurement of fasting breath hydrogen concentration as a simple diagnostic method for pancreatic exocrine insufficiency 国際誌

Uetsuki Kota, Kawashima Hiroki, Ohno Eizaburo, Ishikawa Takuya, Iida Tadashi, Yamamoto Kenta, Furukawa Kazuhiro, Nakamura Masanao, Honda Takashi, Ishigami Masatoshi, Hirooka Yoshiki, Fujishiro Mitsuhiro

BMC GASTROENTEROLOGY   21 巻 ( 1 ) 頁： 211 - 211   2021年5月

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記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：BMC Gastroenterology  

Background: Pancreatic exocrine insufficiency (PEI) is associated with the outcome of pancreatic disease. However, there is no method for assessing PEI that can be used noninvasively and easily for outpatient. It has been reported that changes in intestinal bacteria caused by PEI may increase breath hydrogen concentration (BHC) levels during glucose or lactose loading. We have evaluated the usefulness of fasting breath hydrogen concentration (FBHC) measurement without glucose loading for the evaluation of PEI. Methods: Sixty patients underwent FBHC measurement, BT-PABA testing, and microbiome analysis. They were classified into PEI group (PABA excretion rate < 73.4%, n = 30) and non-PEI group (n = 30). The FBHC of the two groups were compared, and the diagnostic ability of PEI by them was evaluated. The 16 s rRNA (V3–V4) from fecal samples was analyzed by MiSeq. Results: FBHC levels was higher in the PEI group 15.70 (1.4 to 77.0) ppm than in the non-PEI group 2.80 (0.7 to 28.2) ppm (P < 0.0001). FBHC was negatively correlated with PABA excretion rate (r = − 0.523, P < 0.001). The cutoff value of FBHC of 10.7 ppm (95% CI: 0.678–0.913, P < 0.001) showed a sensitivity of 73.3% and specificity of 83.3% for PEI diagnosis. In the PEI group, there was a significant increase of relative abundance of phylum Firmicutes (P < 0.05) and the genus Clostridium (P < 0.05). Conclusion: FBHC shows good potential as a simple and repeatable test for the diagnosis of PEI. The elevated FBHC levels may be caused by hydrogen-producing bacteria such as Clostridium.

DOI： 10.1186/s12876-021-01776-8

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New modality for the quantitative evaluation of tissue elasticity using a forward-viewing radial-array echoendoscope for colorectal neoplasms 国際誌

Esaki Masaya, Yamamura Takeshi, Nakamura Masanao, Maeda Keiko, Sawada Tsunaki, Mizutani Yasuyuki, Ishikawa Eri, Furukawa Kazuhiro, Kawashima Hiroki, Hirooka Yoshiki, Fujishiro Mitsuhiro

INTERNATIONAL JOURNAL OF COLORECTAL DISEASE   36 巻 ( 5 ) 頁： 919 - 927   2021年5月

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記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：International Journal of Colorectal Disease  

Purpose: Sound speed correction (SSC) is a non-invasive modality that quantifies the hardness of neoplasms. The aim of our study was to evaluate the usefulness of SSC for the diagnostic accuracy of colorectal neoplasms and to differentiate the depth of invasion. Methods: Forty colorectal neoplasms, contributed by 40 patients, were included in the analysis. The primary outcome was the diagnostic ability of SSC for the depth of invasion of colorectal neoplasms, with the secondary endpoint being the clinical efficacy of SSC to distinguish between a neoplasm and normal mucosa. Results: The median sound speeds for colorectal neoplasms and normal mucosa were 1580 m/s and 1515 m/s, respectively (p < 0.001), with a median sound speed of 1583 m/s for lesions with a depth shallower than that of the muscularis propria and 1610 m/s for depths deeper than that of the muscularis propria (p = 0.002). The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 80.0%, 100%, 100%, 83.3%, 90.0%, and 100%, respectively, for the diagnosis of neoplasms (using a cut-off sound speed of 1557 m/s) and 100%, 77.8%, 33.3%, 100%, 80.0%, respectively, for the diagnosis of the depth of invasion (using a cut-off of 1590 m/s). Conclusion: We identified absolute sound speeds for colorectal neoplasms and the depth of invasion of neoplasms which yielded a good diagnostic performance. SSC provides an objective evaluation of colorectal neoplasms and the depth of invasion of neoplasms and, thus, might be a useful modality in practice. Trial registration : UMIN000038235, Date of registration; October 8, 2019

DOI： 10.1007/s00384-020-03790-w

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Diagnostic performance of endoscopic ultrasonography-guided elastography for solid pancreatic lesions: Shear-wave measurements versus strain elastography with histogram analysis 国際誌

Ohno Eizaburo, Kawashima Hiroki, Ishikawa Takuya, Iida Tadashi, Suzuki Hirotaka, Uetsuki Kota, Yashika Jun, Yamada Kenta, Yoshikawa Masakatsu, Gibo Noriaki, Aoki Toshinori, Kataoka Kunio, Mori Hiroshi, Yamamura Takeshi, Furukawa Kazuhiro, Nakamura Masanao, Hirooka Yoshiki, Fujishiro Mitsuhiro

DIGESTIVE ENDOSCOPY   33 巻 ( 4 ) 頁： 629 - 638   2021年5月

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

Background and aims: Endoscopic ultrasound (EUS) elastography (EUS-EG) is a minimally invasive diagnostic method for evaluating tissue elasticity. The aim of this study was to evaluate the feasibility of newly developed EUS shear-wave measurement (EUS-SWM) and to compare diagnostic performance between EUS-SWM and the conventional strain elastography (SE) for the measurement of elasticity of solid pancreatic lesions (SPLs). Methods: From December 2017 until August 2019, we retrospectively reviewed 64 consecutive cases with SPLs who underwent both EUS-SWM and SE. EUS-SWM was used to measure the shear-wave velocity, Vs (m/s), and the unique measurement reliability index, VsN (%), in the target lesion. SE images were assessed by strain histogram (SH) analysis, and the mean strain value of the elasticity index was measured. We evaluated the diagnostic performance of EUS-SWM and SE with SH to characterize the SPLs. Results: The Vs (m/s) values of SPLs were 2.19 for pancreatic cancer (PC), 1.31 for pancreatic neuroendocrine neoplasm (PanNEN), 2.56 for mass-forming pancreatitis (MFP) and 1.58 for metastatic tumors. Vs showed no significant difference based on the disease. The mean strain values were 45.5 for PC, 47.3 for PanNEN, and 74.5 for MFP. In the comparison of tissue elasticity between PC and MFP, Vs showed no significant difference (P = 0.5687); however, the mean strain value was significantly lower in PC cases (45.4 vs 74.5: P = 0.0007). Conclusion: Endoscopic ultrasound SWM tended to be unstable for the measurement of elasticity of SPLs, and conventional SE with SH was superior for their characterization.

DOI： 10.1111/den.13791

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膵癌診療における超音波の位置づけ 膵癌診断におけるEUS-FNB時の実体顕微鏡を用いた肉眼的検体評価の有用性

石川 卓哉, 川嶋 啓揮, 大野 栄三郎, 鈴木 博貴, 本多 隆, 中村 正直, 石津 洋二, 山本 健太, 宜保 憲明, 藤城 光弘

超音波医学   48 巻 ( Suppl. ) 頁： S302 - S302   2021年4月

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記述言語：日本語   出版者・発行元：(公社)日本超音波医学会  

Filtrated Adipose Tissue-Derived Mesenchymal Stem Cell Lysate Ameliorates Experimental Acute Colitis in Mice 国際誌

Nishikawa Takahiro, Maeda Keiko, Nakamura Masanao, Yamamura Takeshi, Sawada Tsunaki, Mizutani Yasuyuki, Ito Takanori, Ishikawa Takuya, Furukawa Kazuhiro, Ohno Eizaburo, Miyahara Ryoji, Kawashima Hiroki, Honda Takashi, Ishigami Masatoshi, Yamamoto Tokunori, Matsumoto Seiji, Hotta Yuji, Fujishiro Mitsuhiro

DIGESTIVE DISEASES AND SCIENCES   66 巻 ( 4 ) 頁： 1034 - 1044   2021年4月

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記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Digestive Diseases and Sciences  

Background: Inflammatory bowel disease (IBD) is a chronic, persistent, and intractable enteritis; however, an effective treatment strategy is yet to be established. Mesenchymal stem cells (MSCs) and their paracrine factors exhibit anti-inflammatory actions and have been proposed as a new therapeutic candidate for IBD treatment, although the efficacy of MSC lysate on enteritis is unclear. Aims: Here, we examined the efficacy and appropriate regimen of filtrated murine adipose-derived mesenchymal stem cell lysate (FADSTL) in an acute colitis mouse model as a novel cell-free MSC therapy. Methods: To confirm the clinical effects of FADSTL, survival rate, body weight, and disease activity index (DAI) were investigated in the DSS-induced colitis mouse model. Further, differences in efficacy with dosing frequency were assessed to optimize the proper regimen. Colon length, histological findings, gene expression of inflammatory mediators and tight junction proteins in colon tissues, and anti-apoptotic effects were also compared in 3-day continuous FADSTL administration and PBS groups. Results: Three-day continuous FADSTL administration significantly improved weight loss and DAI score compared to those in the PBS-treated group, whereas the effect was not observed with single administration. Additionally, colon shortening and histological inflammation were suppressed in the FADSTL-treated group. Further, this treatment decreased gene expression of inflammatory mediators, maintained expression of tight junction proteins in the colon, and showed anti-apoptotic effects. Conclusions: FADSTL effects were dependent on its administration frequency, suggesting the requirement of continuous FADSTL administration. FADSTL improved colitis by maintaining the intestinal barrier function through its anti-inflammatory and anti-apoptotic actions.

DOI： 10.1007/s10620-020-06359-3

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Utility of multiphase contrast enhancement patterns on CEH-EUS for the differential diagnosis of IPMN-derived and conventional pancreatic cancer 国際誌

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

PANCREATOLOGY   21 巻 ( 2 ) 頁： 390 - 396   2021年3月

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記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Pancreatology  

Background: Intraductal papillary mucinous neoplasm (IPMN) is reported as a high-risk factor for pancreatic cancer (PC) that includes IPMN-derived cancers (IPMC) and the development of invasive pancreatic ductal adenocarcinoma (PDAC) concomitant with IPMN. Since invasive IPMC and PDAC exhibit different oncological behaviors, their differentiation is clinically important. We aimed to investigate the use of contrast-enhanced harmonic endoscopic ultrasound (CEH-EUS) for the differential diagnosis between invasive IPMC and PDAC. Methods: This study involved 183 consecutive patients with PC (invasive IPMC: 42, PDAC concomitant with IPMN: 9, without IPMN: 132) who underwent CEH-EUS preoperatively. While investigating the patterns, enhanced effects in the solid part of the tumor were compared with those in the surrounding pancreatic parenchyma after administration of Sonazoid® and evaluated as hyperenhanced, isoenhanced, or hypoenhanced. We retrospectively compared the enhanced pattern of CEH-EUS by using multiphasic analysis and clinicopathological factors between invasive IPMC and PDAC. Results: In multiphase evaluations at 20, 40 and 60 s in CEH-EUS, 75.2% (106/141) of PDACs were hypoenhanced (−) at ≥2 of the 3 time points, with significant differences from those of invasive IPMC (P < 0.001). The solid tumor diameter was significantly larger in PDAC than in invasive IPMC, and the tumor stage and preoperative serum carbohydrate antigen 19-9 level were higher. After propensity score matching of stage and solid tumor diameter, contrast enhancement patterns were significantly more persistent in invasive IPMC than in PDAC (P = 0.0013). Conclusions: Multiphase evaluation using CEH-EUS is a useful method for differentiating between invasive IPMC and PDAC.

DOI： 10.1016/j.pan.2020.12.022

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Endoscopic ultrasound elastography for small solid pancreatic lesions with or without main pancreatic duct dilatation 国際誌

Kataoka Kunio, Ishikawa Takuya, Ohno Eizaburo, Iida Tadashi, Suzuki Hirotaka, Uetsuki Kota, Furukawa Kazuhiro, Nakamura Masanao, Honda Takashi, Ishigami Masatoshi, Kawashima Hiroki, Hirooka Yoshiki, Fujishiro Mitsuhiro

PANCREATOLOGY   21 巻 ( 2 ) 頁： 451 - 458   2021年3月

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記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Pancreatology  

Background: /Objectives: Endoscopic ultrasound elastography (EUS-EG) is useful for diagnosis of small solid pancreatic lesions (SPLs), particularly in excluding pancreatic cancer (PC), but its dependence on main pancreatic duct dilatation (MPDD) has not been examined. We aimed to investigate EUS-EG for diagnosis of small SPLs with and without MPDD. Methods: Patients with pathologically diagnosed SPLs of ≤20 mm were included and retrospectively analyzed. Using the blue:green ratio, an EUS-EG image was classified as blue-dominant, equivalent, or green-dominant. Using multiple EUS-EG images per patient, a lesion with a greater number of blue-dominant than green-dominant images was classified as stiff, and the others as soft. EUS-EG images in random order were judged by three raters. Considering stiff SPLs as PC, diagnostic performance of EUS-EG was examined for SPLs with and without MPDD. Results: Of 126 cases analyzed, 65 (52%) were diagnosed as PC, and 63 (50%) had MPDD. A total of 1077 EUS-EG images were examined (kappa coefficient = 0.783). Lesions were classified as stiff in 91 cases and soft in 35 (kappa coefficient = 0.932). The ratio of stiff to soft lesions was significantly higher in PC than in non-PC (62:3 vs. 29:32, P < 0.001). The sensitivity, specificity, and negative predictive value of a stiff lesion with vs. without MPDD for diagnosis of PC were 94%, 23%, and 50% vs. 100%, 60%, and 100%, respectively. Conclusions: Using the EUS-EG stiffness classification for small SPLs, PC can be excluded with high confidence and concordance for a soft lesion without MPDD.

DOI： 10.1016/j.pan.2020.12.012

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Clinical characteristics and long-term prognosis of autoimmune pancreatitis with renal lesions 国際誌

Ishikawa Takuya, Kawashima Hiroki, Ohno Eizaburo, Iida Tadashi, Suzuki Hirotaka, Uetsuki Kota, Yashika Jun, Yamada Kenta, Yoshikawa Masakatsu, Gibo Noriaki, Aoki Toshinori, Kataoka Kunio, Mori Hiroshi, Yamamura Takeshi, Furukawa Kazuhiro, Nakamura Masanao, Hirooka Yoshiki, Fujishiro Mitsuhiro

SCIENTIFIC REPORTS   11 巻 ( 1 ) 頁： 406 - 406   2021年1月

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記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Scientific Reports  

Autoimmune pancreatitis (AIP) is recognized as the pancreatic manifestation of a systemic IgG4-related disease that can involve various organs, including the kidney. However, renal lesions tend to be overlooked when AIP is diagnosed, and the clinical characteristics and long-term prognosis of AIP with renal lesions are unclear. We retrospectively reviewed 153 patients with AIP diagnosed at our hospital with a median follow-up period of 41 months (interquartile range, 10–86) and classified them into two groups: the KD group (n = 17), with characteristic renal imaging features, and the non-KD group (n = 136). Serum IgG4 levels were significantly higher in the KD group (663 vs. 304.5 mg/dl, P = 0.014). No differences were observed between the two groups in terms of steroid treatment [14/17 (82.4%) vs. 112/136 (82.4%), P = 1] or in the number of patients who exhibited exacerbation of renal function during treatment [1/17 (5.9%) vs. 8/136 (5.9%), P = 1]. However, the cumulative relapse rate was significantly higher in the KD group [61% vs. 21.9% (3 years), P < 0.001]. Patients in the KD group had different clinical features with high relapse rates compared with those in the non-KD group, and thus, it is important to confirm the presence of renal lesions in AIP patients.

DOI： 10.1038/s41598-020-79899-3

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Tag-less patency capsule for suspected small bowel stenosis: Nationwide multicenter prospective study in Japan 査読有り

Nakamura Masanao, Watanabe Kenji, Ohmiya Naoki, Hirai Fumihito, Omori Teppei, Tokuhara Daisuke, Nakaji Konosuke, Nouda Sadaharu, Esaki Motohiro, Sameshima Yukinori, Goto Hidemi, Terano Akira, Tajiri Hisao, Matsui Toshiyuki

DIGESTIVE ENDOSCOPY   33 巻 ( 1 ) 頁： 151 - 161   2021年1月

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

Study aims: The PillCam patency capsule (PPC) is an Agile tag-less patency capsule used to evaluate gastrointestinal (GI) patency. We determined the appropriate use of PPC to preclude subsequent small bowel capsule endoscopy (SBCE) retention. Methods: This prospective multicenter study consecutively enrolled patients indicated for SBCE with suspected or established small bowel stenosis. Excretion of an intact PPC or its radiologic visualization in the large bowel was considered GI patency. Primary and secondary study endpoints were SBCE retention rates in patients with confirmed patency and identification of factors associated with patency and SBCE retention, respectively. Results: Of 1096 patients enrolled in the study, patency was confirmed in 976 (89.1%). PPC excretion occurred in 579 patients. Of the remaining 517 patients, patency was confirmed using imaging modalities in 401 (77.5%). SBCE retention occurred in five (0.51%) of 963 patients who underwent SBCE: 1.0% in established Crohn’s disease (CD) patients, 0% in suspected CD, 0% in tumors, and 1.6% in patients with obscure GI bleeding, for which PPC localization had been radiographically misinterpreted. The non-confirmation of patency was associated with established CD, stenosis identified using imaging modalities, abdominal fullness, serum albumin levels <4.0 g/dL, and previous small bowel obstruction (adjusted odds ratios: 4.21, 2.60, 2.47, 2.12, and 2.00; 95% confidence intervals: 2.62–6.78, 1.62–4.17, 1.43–4.27, 1.32–3.40, and 1.15–3.47, respectively). Conclusions: The PillCam™ patency capsule helped preclude SBCE retention in most patients, but its accurate localization was essential for cases without excretion (Study registered the University Hospital Medical Information Network, #UMIN000010513).

DOI： 10.1111/den.13673

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その他リンク： https://onlinelibrary.wiley.com/doi/full-xml/10.1111/den.13673

【潰瘍性大腸炎診療の診断から治療をマスターする】潰瘍性大腸炎の活動性はどのように評価するのか? 内視鏡検査と検査のタイミング

中村 正直, 山村 健史, 前田 啓子, 澤田 つな騎, 石川 恵里, 角嶋 直美, 古川 和宏, 藤城 光弘

消化器・肝臓内科   9 巻 ( 1 ) 頁： 31 - 35   2021年1月

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記述言語：日本語   出版者・発行元：(有)科学評論社  

Collision Tumors of Gastric Adenocarcinoma and Mucosa-associated Lymphoid Tissue Lymphoma

Kobayashi Kenichi, Furukawa Kazuhiro, Ishikawa Eri, Mitsuma Ayako, Funasaka Kohei, Kakushima Naomi, Furune Satoshi, Ito Nobuhito, Wada Hirotaka, Hirose Takashi, Muroi Koichi, Suzuki Tomohiko, Suzuki Takahiro, Hida Emiko, Hirai Keiko, Shibata Hiroyuki, Koya Toshinari, Nakamura Masanao, Kawashima Hiroki, Miyahara Ryoji, Fujishiro Mitsuhiro

INTERNAL MEDICINE   60 巻 ( 15 ) 頁： 2419 - 2424   2021年

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記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：一般社団法人 日本内科学会  

A 65-year-old woman with a history of treatment for splenic marginal zone B-cell lymphoma and gastric mucosa-associated lymphoid tissue (MALT) lymphoma underwent esophagogastroduodenoscopy. A reddish elevated lesion was found in the fundus of the stomach. On image-enhanced endoscopy, several findings, such as glandular structures of varying sizes suggesting well-differentiated adenocarcinoma, pruned blood vessels, and dilated blood vessels in deeper mucosa suggesting MALT lymphoma, were observed. The final pathological diagnosis after surgical resection was collision tumors of well-differentiated adenocarcinoma and MALT lymphoma. The features of both tumors could be observed simultaneously with image-enhanced endoscopy.

DOI： 10.2169/internalmedicine.6124-20

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The microbiome can predict mucosal healing in small intestine in patients with Crohn's disease

Hattori Shun, Nakamura Masanao, Yamamura Takeshi, Maeda Keiko, Sawada Tsunaki, Mizutani Yasuyuki, Yamamoto Kenta, Ishikawa Takuya, Furukawa Kazuhiro, Ohno Eizaburo, Honda Takashi, Kawashima Hiroki, Ishigami Masatoshi, Hirooka Yoshiki, Fujishiro Mitsuhiro

JOURNAL OF GASTROENTEROLOGY   55 巻 ( 12 ) 頁： 1138 - 1149   2020年12月

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

Background: Mucosal healing is the main treatment goal for Crohn’s disease. In this situation, some patients have difficulty with endoscopic evaluation of the entire small intestine. Crohn’s disease is closely associated with the gut microbiota, but the relationship between the microbiome and disease activity in the small intestine remains unclear. We examined the association between the microbiome and endoscopic findings in the small intestine and determined whether the microbiome can predict mucosal healing. Methods: The patients with Crohn’s disease who were scheduled for capsule or balloon-assisted endoscopy were included in this prospective study. Patients whose entire small intestine was evaluated were divided into two groups based on ulcerative findings. The microbiomes in the fecal samples were analyzed using 16S rRNA sequencing. Results: The 38 enrolled patients were divided into the ulcer group (24) and mucosal healing group (14). The ulcer group exhibited lower α diversity. Six genera, namely Faecalibacterium (P = 0.008), Lachnospira (P = 0.009), Paraprevotella (P = 0.01), Dialister (P = 0.012), Streptococcus (P = 0.025), and Clostridium (P = 0.028) were enriched in the mucosal healing group. A predictive score for mucosal healing was defined using these six genera. The area under the curve was 0.795 and the sensitivity and specificity for predicting mucosal healing were 0.643 and 0.917, respectively. Conclusions: Fecal microbiome is corelated with disease activity in the entire small intestine in Crohn’s disease patients. The predictive score proposed by microbiota characteristics was a potential biomarker for mucosal healing in the small intestine.

DOI： 10.1007/s00535-020-01728-1

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Mutation analysis of gastrointestinal stromal tumors using RNA obtained via endoscopic ultrasound-guided fine-needle aspiration 国際誌

Funasaka Kohei, Miyahara Ryoji, Furukawa Kazuhiro, Sawada Tsunaki, Maeda Keiko, Yamamura Takeshi, Ishikawa Takuya, Ohno Eizaburo, Nakamura Masanao, Kawashima Hiroki, Hirooka Yoshiki, Ohmiya Naoki, Fujishiro Mitsuhiro

TRANSLATIONAL ONCOLOGY   13 巻 ( 11 ) 頁： 100848 - 100848   2020年11月

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記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Translational Oncology  

Endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS-FNA) is useful for pathologically diagnosing gastrointestinal stromal tumor (GIST) before surgery. However, its role in mutation analysis remains unclear. To examine the feasibility of analyzing GIST mutations using mRNA obtained with EUS-FNA, we prospectively enrolled 41 patients with subepithelial lesion from which EUS-FNA was successfully acquired tissue sample. Thirty-two, 5, and 4 subepithelial lesions were diagnosed as GISTs, schwannomas, and leiomyomas, respectively. After RNA was extracted from FNA sample, RNA was converted to cDNA. Full-length sequence of the KIT cDNA amplified via the polymerase chain reaction (PCR) was successful in 31 (96.9%) out of 32 GIST and three out of 9 non-GIST (33.3%). The KIT mutation statuses of 31 GISTs in which KIT cDNA was amplified were successfully determined through directional sequencing. Furthermore, 15 of 16 surgically excised GISTs exhibited the same mutation status in both the EUS-FNA and resected samples. In vitro experiment, the minimum number of cells required to amplify full-length of KIT cDNA from RNA was one-tenth of that required to amplify KIT exon11 gene from DNA. This study clarifies that mutation analysis using RNA obtained with EUS-FNA is feasible and reliable. Moreover, our data would support that RNA-based mutation is superior to DNA-based mutation analysis in GIST.

DOI： 10.1016/j.tranon.2020.100848

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Endoscopic Activity and Serum TNF-α Level at Baseline Are Associated With Clinical Response to Ustekinumab in Crohn's Disease Patients 査読有り

Murate Kentaro, Maeda Keiko, Nakamura Masanao, Sugiyama Daisuke, Wada Hirotaka, Yamamura Takeshi, Sawada Tsunaki, Mizutani Yasuyuki, Ishikawa Takuya, Furukawa Kazuhiro, Ohno Eizaburo, Honda Takashi, Kawashima Hiroki, Miyahara Ryoji, Ishigami Masatoshi, Nishikawa Hiroyoshi, Fujishiro Mitsuhiro

INFLAMMATORY BOWEL DISEASES   26 巻 ( 11 ) 頁： 1669 - 1681   2020年11月

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

Background and Aims: The therapeutic efficacy and safety of ustekinumab for Crohn's disease (CD) have been reported from randomized controlled trials and real-world data. However, there are few studies describing the identification of patients most suitable for ustekinumab therapy. The aim of this study was to prospectively evaluate the patients receiving ustekinumab and identify predictors of the treatment efficacy. Methods: Patients with moderate to severe active CD scheduled to receive ustekinumab were enrolled. The responders and nonresponders were compared at weeks 0, 8, 24, and 48 by evaluating patient demographics, simple endoscopic scores (SES-CD), ustekinumab and cytokine concentrations, and cellular fractions. Results: The clinical response and clinical remission rates in the 22 enrolled patients were 59.1% and 31. 8% at week 8, 68.2% and 45.5% at week 24, and 54.4% and 40.9% at week 48, respectively. There were no significant differences in patients' demographic and disease characteristics at baseline between responders and nonresponders. A combination of low SES-CD and high serum TNF-α concentration at baseline showed a good correlation with the clinical response. Serum TNF-α concentration was decreased because of the therapy. The ratio of CD4+TNF-α cells at baseline was significantly higher in responders than in nonresponders; however, the ratios of CD45+CD11b+TNF-α and CD45+CD11c+TNF-α cells were not different. The ratio of CD4+ TNF-α cells decreased with the treatment in the responders but not in the nonresponders. Conclusions: The combination of 2 factors, namely higher serum TNF-α concentration and lower SES-CD at baseline, may assist clinicians in selecting the appropriate therapy for patients with moderate to severe CD.

DOI： 10.1093/ibd/izaa086

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What is the role of measuring shear wave dispersion using shear wave elastography in pancreatic parenchyma?

Suzuki, H; Kawashima, H; Ohno, E; Ishikawa, T; Hashimoto, S; Nakamura, M; Miyahara, R; Ishigami, M; Hirooka, Y; Fujishiro, M

JOURNAL OF MEDICAL ULTRASONICS   47 巻 ( 4 ) 頁： 575 - 581   2020年10月

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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 Medical Ultrasonics  

Purpose: Shear wave elastography (SWE) using transabdominal ultrasonography (US) is widely used for diagnosis of tissue stiffness. Ultrasound shear wave dispersion (SWD) enables evaluation of tissue viscosity using SWE. The objective of this study was to investigate the reliability and clinical significance of SWD in pancreatic screening. Methods: SWE and SWD were measured in 76 patients examined by US in pancreatic screenings performed between November 2017 and November 2018. The median pancreatic elastic modulus (PEM) and dispersion slope were obtained from at least five measurements. The reproducibility of these values and their correlations with patient characteristics, pancreatic echogenicity, and the pancreas-to-spleen attenuation ratio (P/S) on plain CT, which is associated with fatty change in pancreatic parenchyma, were investigated retrospectively. Results: The median PEM and dispersion slope were 7.4 kPa and 15.7 (m/sec)/kHz, respectively, and both values had high intraclass correlation coefficients, showing high reproducibility (ρ = 0.869 and ρ = 0.867, respectively). The interquartile range/median value of PEM and dispersion slope were 0.36 and 0.28, respectively. PEM had a positive correlation with age (rs = 0.348, p = 0.002), and dispersion slope was positively correlated with age (rs = 0.278, p = 0.016) and BMI (rs = 0.397, p < 0.001). The hyperechoic pancreas had significantly higher PEM (6.6 vs. 7.8 kPa, p = 0.037) and dispersion slope (13.2 vs. 16.3 (m/sec)/kHz, p < 0.001). On plain CT performed in 50 patients, the P/S was not correlated with PEM (rs = − 0.180, p = 0.221), but was inversely correlated with dispersion slope (rs = − 0.338, p = 0.019). Conclusion: Measurement of SWD in pancreatic screening was highly reproducible and may permit objective evaluation of fatty change of the pancreas.

DOI： 10.1007/s10396-020-01033-7

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Comparison of different virtual chromoendoscopy classification systems for the characterization of colorectal lesions 国際誌

Pu Leonardo Zorron Cheng Tao, Yamamura Takeshi, Nakamura Masanao, Koay Doreen S. C., Ovenden Amanda, Edwards Suzanne, Burt Alastair D., Hirooka Yoshiki, Fujishiro Mitsuhiro, Singh Rajvinder

JGH OPEN   4 巻 ( 5 ) 頁： 818 - 826   2020年10月

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記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：JGH Open  

Background and Aim: Commonly used classifications for colorectal lesions (CLs) include the Narrow Band Imaging (NBI) International Colorectal Endoscopic (NICE) and Japan NBI Expert Team (JNET) classifications. However, both lack a sessile serrated adenoma/polyp (SSA/P) category. This has been addressed by the modified Sano's (MS) and Workgroup serrAted polypS and Polyposis (WASP) classifications. This study aims to compare the accuracy of wNICE and wJNET (WASP added to both) with the stand-alone MS classification. Methods: Patients undergoing colonoscopy at an Australian tertiary hospital who had at least one CL detected were prospectively enrolled. In the exploratory phase, CLs were characterized in real time with NBI and magnification using all classifications. In the validation phase, CLs were assessed with both NBI and Blue Laser Imaging (BLI) by four external endoscopists in Japan. The primary outcome was the comparison of wJNET and MS. Secondary outcomes included comparisons among all classifications and the calculation of interrater reliability. Results: A total of 483 CLs were evaluated in real time in the exploratory phase, and four sets of 30 CL images (80 on NBI and 40 on BLI) were scored in the validation phase. For high-confidence diagnoses, MS accuracy was superior to wJNET in both the exploratory (86% vs 79%, P < 0.05) and validation (85% vs 69%, P < 0.05) phases. The interrater reliability was substantial for all classifications (κ = 0.74, 0.69, and 0.63 for wNICE, wJNET, and MS, respectively). Conclusions: MS classification achieved the highest accuracy in both the exploratory and validation phases. MS can differentiate serrated and adenomatous polyps as a stand-alone classification.

DOI： 10.1002/jgh3.12382

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Computer-aided diagnosis for characterization of colorectal lesions: comprehensive software that includes differentiation of serrated lesions 国際誌

Pu Leonardo Zorron Cheng Tao, Maicas Gabriel, Tian Yu, Yamamura Takeshi, Nakamura Masanao, Suzuki Hiroto, Singh Gurfarmaan, Rana Khizar, Hirooka Yoshiki, Burt Alastair D., Fujishiro Mitsuhiro, Carneiro Gustavo, Singh Rajvinder

GASTROINTESTINAL ENDOSCOPY   92 巻 ( 4 ) 頁： 891 - 899   2020年10月

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記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Gastrointestinal Endoscopy  

Background and Aims: Endoscopy guidelines recommend adhering to policies such as resect and discard only if the optical biopsy is accurate. However, accuracy in predicting histology can vary greatly. Computer-aided diagnosis (CAD) for characterization of colorectal lesions may help with this issue. In this study, CAD software developed at the University of Adelaide (Australia) that includes serrated polyp differentiation was validated with Japanese images on narrow-band imaging (NBI) and blue-laser imaging (BLI). Methods: CAD software developed using machine learning and densely connected convolutional neural networks was modeled with NBI colorectal lesion images (Olympus 190 series - Australia) and validated for NBI (Olympus 290 series) and BLI (Fujifilm 700 series) with Japanese datasets. All images were correlated with histology according to the modified Sano classification. The CAD software was trained with Australian NBI images and tested with separate sets of images from Australia (NBI) and Japan (NBI and BLI). Results: An Australian dataset of 1235 polyp images was used as training, testing, and internal validation sets. A Japanese dataset of 20 polyp images on NBI and 49 polyp images on BLI was used as external validation sets. The CAD software had a mean area under the curve (AUC) of 94.3% for the internal set and 84.5% and 90.3% for the external sets (NBI and BLI, respectively). Conclusions: The CAD achieved AUCs comparable with experts and similar results with NBI and BLI. Accurate CAD prediction was achievable, even when the predicted endoscopy imaging technology was not part of the training set.

DOI： 10.1016/j.gie.2020.02.042

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Low ETV1 mRNA expression is associated with recurrence in gastrointestinal stromal tumors 国際誌

Sakamaki Keiichi, Funasaka Kohei, Miyahara Ryoji, Furukawa Kazuhiro, Yamamura Takeshi, Ohno Eizaburo, Nakamura Masanao, Kawashima Hiroki, Hirooka Yoshiki, Fujishiro Mitsuhiro, Goto Hidemi

SCIENTIFIC REPORTS   10 巻 ( 1 ) 頁： 14767 - 14767   2020年9月

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記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Scientific Reports  

Although the majority of gastrointestinal stromal tumors (GISTs) possess KIT mutations that induce constitutive signal transduction, the clinical outcomes are variable. The ETS translocation variant 1 (ETV1) gene encodes a transcription factor that is reported to cooperate with KIT in GISTs. However, the clinical role of ETV1 is largely unknown. The aim of this study was to examine ETV1 expression and its associations with clinical features in GISTs. We conducted a cohort study involving 64 patients with GISTs who underwent surgical resection between October 2008 and February 2015. ETV1 mRNA expression was compared with that in non-GISTs and was analyzed among risk classifications or clinical outcomes. The GIST samples exhibited significantly higher ETV1 mRNA expression than the non-GIST samples (P < 0.0001). Sixty-four GISTs were stratified into high or low ETV1 mRNA expression groups based on the median relative abundance of ETV1 mRNA. The multivariate analysis showed that low ETV1 expression, as well as tumor size and mitotic index, was an independent factor of recurrence (hazard ratio: 8.1). Patients with high ETV1 expression achieved significantly longer recurrence-free survival (RFS) times than those with low ETV1 expression (P = 0.025). Our study revealed that low ETV1 expression is an independent factor of recurrence after surgery in patients with GISTs, and thus, low ETV1 expression might be a marker of more aggressive malignant GISTs.

DOI： 10.1038/s41598-020-71719-y

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診断に苦慮した広範囲胆管癌の1例

芳川 昌功, 川嶋 啓揮, 大野 栄三郎, 石川 卓哉, 小屋 敏也, 田中 浩敬, 酒井 大輔, 飯田 忠, 西尾 亮, 鈴木 博貴, 植月 康太, 八鹿 潤, 山田 健太, 澤田 つな騎, 前田 啓子, 山村 健史, 古川 和宏, 舩坂 好平, 中村 正直, 宮原 良二, 廣岡 芳樹

肝胆膵治療研究会誌   16 巻 ( 1 ) 頁： 93 - 93   2020年9月

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記述言語：日本語   出版者・発行元：肝胆膵治療研究会  

Reappraisal of Primary Epstein-Barr Virus (EBV)-positive Diffuse Large B-Cell Lymphoma of the Gastrointestinal Tract Comparative Analysis Among Immunosuppressed and Nonimmunosuppressed Stage I and II-IV Patients 査読有り 国際誌

Miyagi Shouhei, Ishikawa Eri, Nakamura Masanao, Shimada Kazuyuki, Yamamura Takeshi, Furukawa Kazuhiro, Tanaka Tsutomu, Mabuchi Seiyo, Tsuyuki Yuta, Kohno Kei, Sakakibara Ayako, Satou Akira, Kato Seiichi, Fujishiro Mitsuhiro, Nakamura Shigeo

AMERICAN JOURNAL OF SURGICAL PATHOLOGY   44 巻 ( 9 ) 頁： 1173 - 1183   2020年9月

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記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：American Journal of Surgical Pathology  

Epstein-Barr virus (EBV)-positive diffuse large B-cell lymphoproliferation encompasses a broad range of clinicopathologic findings, including specific subtypes, for example, EBV+ mucocutaneous ulcer. Here we reassessed 36 cases of primary EBV+ diffuse large B-cell lymphomas (16 men and 20 women; median age, 69.5 y; range, 35 to 84 y), including 8 immunosuppressed patients (Lugano stage II-IV; median age, 74 y), 7 nonimmunosuppressed patients with stage I disease (median age, 69 y), and 21 nonimmunosuppressed patients with stage II-IV disease (median age, 69 y). All immunosuppressed patients exhibited iatrogenic immunodeficiency and an ulcerative appearance, with ulcer sites including the stomach (1 patient), small intestine (6 patients), and rectum (1 patient). Four patients were in the setting of treated lymphoma-associated immunosuppression. Immunosuppressed patients had higher incidences of intestinal involvement (P=0.001) and perforation (n=2) compared with advanced stage nonimmunosuppressed patients. Among nonimmunosuppressed stage I patients, lesions were restricted to the stomach, none showed multiple lesions or elevated serum lactate dehydrogenase, and the overall survival curve plateaued, although it was not statistically significant (P=0.0581). One nonimmunosuppressed stage I patient with a polypoid lesion exhibited spontaneous regression within 2 months after diagnosis, while another with bulky disease pursued an aggressive clinical course. Nonimmunosuppressed stage I cases without bulky masses may be considered EBV mucocutaneous ulcer with local progression. Our results demonstrated that primary EBV+ gastrointestinal diffuse large B-cell lymphoma could be delineated into 3 groups based on immune status and clinical stage, revealing distinguishing features useful as a pragmatic guide for diagnostic and therapeutic approaches.

DOI： 10.1097/PAS.0000000000001499

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Learning curve for mastery of colorectal endoscopic submucosal dissection: Perspectives from a large Japanese cohort 国際誌

Pu Leonardo Zorron Cheng Tao, Yamamura Takeshi, Nakamura Masanao, Esaki Masaya, Kaosombatwattana Uayporn, Rodriguez Miguel R., Edwards Suzanne, Burt Alastair D., Singh Rajvinder, Hirooka Yoshiki, Fujishiro Mitsuhiro

JGH OPEN   4 巻 ( 4 ) 頁： 611 - 616   2020年8月

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記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：JGH Open  

Background and Aim: Endoscopic submucosal dissection (ESD) is a challenging procedure. A dissection speed of ≥9 cm2/h has been acknowledged as a mark for expertise, alongside a complication rate of ≤5% and en bloc resection rate of ≥90%. However, there is lack of objective information on whether the three measures correlate with each other. This study aims to evaluate the dissection speed, safety, and efficacy of colorectal ESDs performed by experts and trainees. Methods: Consecutive patients undergoing colorectal ESD at a Japanese hospital (2006–2017) were included in a prospectively collected database. Information on patient demographics, proceduralist, and intra-/postprocedure data was retrieved. The primary outcome was the comparison in dissection speed. The secondary outcomes included differences in safety and efficacy. Log-linear regression models adjusted for confounders (e.g. R0 resection) were used to assess the differences in dissection speed. Results: Five hundred ninety procedures (514 patients) performed by 26 endoscopists were analyzed. Experts performed a higher number of difficult lesions (e.g. F2 fibrosis) but achieved higher dissection speed (10.3 vs 6.7 cm2/h). The difference was statistically significant for both unadjusted and adjusted models (P < 0.0001). The en bloc resection rates were similar for both groups (experts = 95.6%; trainees = 94.7%, P = 0.61). Although nonexperts damaged more of the muscularis propria (18.6 vs 12.5%, P = 0.04), this did not translate into a significant difference in perforation (experts = 3.7%; trainees = 6.9%, P = 0.09) or delayed bleeding (experts = 2.9%; trainees = 4.4%, P = 0.34). The dissection speed steadily increased with expertise. Conclusion: Although dissection speed for colorectal ESD was significantly higher for experts, ESDs could be safely and efficaciously performed by ESD trainees.

DOI： 10.1002/jgh3.12298

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Polyp Detection Rate as a Surrogate for Adenoma and Sessile Serrated Adenoma/Polyp Detection Rates 国際誌

Zorron Cheng Tao Pu Leonardo, Singh Gurfarmaan, Rana Khizar, Nakamura Masanao, Yamamura Takeshi, Krishnamurthi Sudarshan, Ovenden Amanda, Edwards Suzanne, Ruszkiewicz Andrew, Hirooka Yoshiki, Fujishiro Mitsuhiro, Burt Alastair D., Singh Rajvinder

GASTROINTESTINAL TUMORS   7 巻 ( 3 ) 頁： 74 - 82   2020年7月

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1159/000505622

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【消化器疾患とステント治療】胃・十二指腸狭窄に対するステント治療

鈴木 智彦, 鈴木 孝弘, 森 裕, 石川 卓哉, 古川 和宏, 石川 恵里, 澤田 つな騎, 前田 啓子, 山村 健史, 大野 栄三郎, 中村 正直, 川嶋 啓揮, 藤城 光弘

消化器・肝臓内科   8 巻 ( 1 ) 頁： 18 - 25   2020年7月

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記述言語：日本語   出版者・発行元：(有)科学評論社  

Use of Immunostaining for the diagnosis of Lymphovascular invasion in superficial Barrett's esophageal adenocarcinoma 国際誌

Hosono Isao, Miyahara Ryoji, Furukawa Kazuhiro, Funasaka Kohei, Sawada Tsunaki, Maeda Keiko, Yamamura Takeshi, Ishikawa Takuya, Ohno Eizaburo, Nakamura Masanao, Kawashima Hiroki, Yokoi Takio, Hirooka Yoshiki, Fujishiro Mitsuhiro, Tsukamoto Tetsuya

BMC GASTROENTEROLOGY   20 巻 ( 1 ) 頁： 175 - 175   2020年6月

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記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：BMC Gastroenterology  

Background: The prevalence of Barrett's esophageal adenocarcinoma (BEA) is increasing in Japan. Accurate assessment of lymphovascular invasion (LVI) after endoscopic resection or surgery is essential in evaluating treatment response. This study aimed to assess the usefulness of immunostaining in determining the extent of LVI in superficial BEA. Methods: We retrospectively included 41 patients who underwent endoscopic resection or surgery between January 2007 and July 2018. In all cases, 3-μm serial sections from paraffin-embedded resected specimens were used for hematoxylin and eosin (H-E) staining and immunostaining for D2-40 and CD31. Two specialized gastrointestinal pathologists (T.Y. and T.T.), blinded to clinical information, independently evaluated the extent of LVI from these specimens. The LVI-positivity rate was evaluated with respect to the depth of invasion, changes in the positivity rate on immunostaining, pathological characteristics of patients with LVI, lymph node metastasis or relapse, and course after treatment. Results: H-E staining alone identified LVI in 7 patients (positivity rate: 17.1%). Depths of invasion were categorized based on extension to the submucosa (SM) or deeper. On immunostaining for D2-40 and CD31, additional positivity was detected in 2 patients with SM1 and 1 SM3, respectively; LVI was detected in 10 patients (positivity rate: 24.4%). LVI-positivity rates with invasion of the superficial muscularis mucosa (SMM)/lamina propria mucosa (LPM)/deep muscularis mucosa (DMM), SM 1, 2, and 3 were 0, 75, 28.6, and 55.6%, respectively. Conclusions: Combined H-E staining and immunostaining is useful in diagnosing LVI in superficial BEA, particularly in endoscopically resected specimens.

DOI： 10.1186/s12876-020-01319-7

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PROSPECTIVE MULTICENTER STUDY ON THE USEFULNESS OF EUS-GUIDED FINE NEEDLE BIOPSY FOR THE DIAGNOSIS OF AUTOIMMUNE PANCREATITIS USING A 22-GAUGE FRANSEEN NEEDLE

Ishikawa Takuya, Kawashima Hiroki, Ohno Eizaburo, Nishio Ryo, Iida Tadashi, Suzuki Hirotaka, Uetsuki Kota, Yamada Kenta, Yashika Jun, Yoshikawa Masakatsu, Gibo Noriaki, Aoki Toshinori, Kataoka Kunio, Mori Hiroshi, Keiko Maeda, Sawada Tsunaki, Yamamura Takeshi, Furukawa Kazuhiro, Nakamura Masanao, Fujishiro Mitsuhiro

GASTROINTESTINAL ENDOSCOPY   91 巻 ( 6 ) 頁： AB172 - AB172   2020年6月

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NOVEL METHOD TO DETERMINE THE DEPTH OF INVASION IN COLORECTAL NEOPLASMS WITH ULTRASOUND ELASTOGRAPHY USING A FORWARD-VIEWING RADIAL-ARRAY ECHOENDOSCOPE

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

GASTROINTESTINAL ENDOSCOPY   91 巻 ( 6 ) 頁： AB430 - AB430   2020年6月

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EVALUATION OF RESECTABILITY BETWEEN ENDOSCOPIC TREATMENT METHODS FOR RECTAL NEUROENDOCRINE TUMOR

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

GASTROINTESTINAL ENDOSCOPY   91 巻 ( 6 ) 頁： AB101 - AB101   2020年6月

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ENDOSCOPIC DIAGNOSIS USING MAGNIFYING IMAGE-ENHANCED ENDOSCOPY FOR SUPERFICIAL NON-AMPULLARY DUODENAL EPITHELIAL TUMORS

Furukawa Kazuhiro, Miyahara Ryoji, Funasaka Kohei, Sawada Tsunaki, Keiko Maeda, Yamamura Takeshi, Ishikawa Takuya, Ohno Eizaburo, Nakamura Masanao, Kawashima Hiroki, Fujishiro Mitsuhiro

GASTROINTESTINAL ENDOSCOPY   91 巻 ( 6 ) 頁： AB618 - AB618   2020年6月

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Clinical Factors Associated with Missing Colorectal Polyp on Colon Capsule Endoscopy 国際誌

Yamada Keisaku, Nakamura Masanao, Yamamura Takeshi, Maeda Keiko, Sawada Tsunaki, Mizutani Yasuyuki, Ishikawa Takuya, Furukawa Kazuhiro, Ohno Eizaburo, Miyahara Ryoji, Kawashima Hiroki, Hotta Naoki, Hirooka Yoshiki

DIGESTION   101 巻 ( 3 ) 頁： 316 - 322   2020年5月

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記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Digestion  

Background: There are a number of reports that demonstrate the high diagnostic accuracy of colon capsule endoscopy (CCE) for polyp detection. However, some colorectal polyps are missed on CCE, and the clinical factors influencing those missed polyps are still unknown. Objective: The aim of this study was to elucidate the clinical factors related to missing colorectal polyp on CCE by using per-polyp analysis. Methods: We performed a retrospective multi-center study of 53 consecutive patients who underwent both CCE and colonoscopy (CS) within 3 months from January 2014 to-December 2017. Of those patients, we analyzed 151 polyps detected on CCE, and 149 polyps detected on CS diagnosed as neoplasm according to histopathological result. Results: The capsule excretion rate was 81%. One hundred three polyps were detected on both CS and CCE, 46 polyps (31%) were missed on CCE, and 48 polyps were considered false positive on CCE when CS result was considered as the gold standard. Per-polyp sensitivity and positive predictive value on CCE were 69.1 and 68%. On multiple logistic analysis, only the segmental transit time on CCE was identified as the independent factor influencing missed polyp on CCE. Conclusions: The clinical factor related to missing colorectal polyp on CCE was the segmental transit time.

DOI： 10.1159/000498942

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Different factors are associated with conventional adenoma and serrated colorectal neoplasia

Pu Leonardo Zorron Cheng Tao, Rana Khizar, Singh Gurfarmaan, Nakamura Masanao, Yamamura Takeshi, Koay Doreen Siew Ching, Ovenden Amanda, Edwards Suzanne, Ruszkiewicz Andrew, Hirooka Yoshiki, Fujishiro Mitsuhiro, Burt Alastair D., Singh Rajvinder

NAGOYA JOURNAL OF MEDICAL SCIENCE   82 巻 ( 2 ) 頁： 335 - 343   2020年5月

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記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Nagoya Journal of Medical Science  

Current data shows there are differences in factors associated with colorectal neoplasia based on geographical location and cultural settings. There are no studies focusing on the association between environmental factors and colorectal polyps in Australia. The aim of this study was to prospectively evaluate the association of various factors with different colorectal neoplasia histology. We utilized a simplified one-page questionnaire for patients undergoing colonoscopy for information on age; gender; comorbidities; family history of colorectal cancer; physical activity; smoking; diet; alcohol intake; and body mass index. Factors were then evaluated for association with the presence of: (1) neoplastic lesions; (2) conventional adenomas; (3) neoplastic serrated polyps; (4) any lesions (past and present); and (5) hyperplastic polyps. 291 procedures and 260 patients were included. Factors with a p-value < 0.2 in a univariate regression were included in an initial multivariable regression model. Backwards elimination was then performed, removing one predictor at a time until only significant predictors remained. In the final multivariable model, age≥65, male gender, type-2 diabetes mellitus, active smoking and family history of colorectal cancer were found to be statistically significant predictors for the presence of colorectal neoplasia. However, the significant predictors found for conventional adenomas (older age, male gender and smoking) were different from the significant predictors for neoplastic serrated polyps (type-2 diabetes mellitus and family history of colorectal cancer). Older age, male gender, type-2 diabetes mellitus, and smoking were significantly associated with the presence of colorectal neoplasia. The factors associated with conventional adenomas differed from those associated with neoplastic serrated polyps.

DOI： 10.18999/nagjms.82.2.335

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Narrow-band imaging for scar (NBI-SCAR) classification: from conception to multicenter validation 国際誌

Pu Leonardo Zorron Cheng Tao, Chiam Keng Hoong, Yamamura Takeshi, Nakamura Masanao, Berzin Tyler M., Mir Fahad F., Hourneaux de Moura Eduardo Guimaraes, Madruga Neto Antonio Coutinho, Koay Doreen Siew Ching, Loong Cheong Kuan, Ovenden Amanda, Edwards Suzanne, Burt Alastair D., Hirooka Yoshiki, Fujishiro Mitsuhiro, Singh Rajvinder

GASTROINTESTINAL ENDOSCOPY   91 巻 ( 5 ) 頁： 1146 - +   2020年5月

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記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Gastrointestinal Endoscopy  

Background and Aims: Surveillance post–endoscopic resection (ER) currently warrants biopsy samples from the resection site scar in most cases, although clinical practice is variable. A classification with standard criteria for scars has not yet been established. We aimed to create and validate a novel classification for post-ER scars by using specific criteria based on advanced imaging. Methods: Key endoscopic features for scars with and without recurrence were (1) dark brown color, elongated/branched pit pattern, and dense capillary pattern and (2) whitish, pale appearance, round/slightly large pits, and irregular sparse vessels. Scars were first assessed with high-definition white-light endoscopy (HD-WLE) followed by interrogation with narrow-band imaging (NBI). Scars with at least 2 concordant characteristics were diagnosed with “high confidence” for NBI for scar (NBI-SCAR) classification. The final endoscopic predictions were correlated with histopathology. The primary outcome was the difference in sensitivity between NBI-SCAR and HD-WLE predictions. Secondary outcomes included the validation of our findings in 6 different endoscopy settings (Australia, United States, Japan, Brazil, Singapore, and Malaysia). The validation took place in 2 sessions separated by 2 to 3 weeks, each with 10 one-minute videos of post-ER scars on underwater NBI with dual focus. Inter-rater and intrarater reliability were calculated with Fleiss’ free-marginal kappa and Bennett et al. S score, respectively. Results: One hundred scars from 82 patients were included. Ninety-five scars were accurately predicted with high confidence by NBI-SCAR in the exploratory phase. NBI-SCAR sensitivity was significantly higher compared with HD-WLE (100% vs 73.7%, P < .05). In the validation phase, similar results were found for endoscopists who routinely perform colonoscopies and use NBI (sensitivity of 96.4%). The inter-rater and intrarater reliability throughout all centers were, respectively, substantial (κ = .61) and moderate (average S = .52) for this subset. Conclusions: NBI-SCAR has a high sensitivity and negative predictive value for excluding recurrence for endoscopists experienced in colonoscopy and NBI. In this setting, this approach may help to accurately evaluate or resect scars and potentially mitigate the burden of unnecessary biopsy samples.

DOI： 10.1016/j.gie.2019.08.036

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Diagnosis of vascular invasion in pancreatic ductal adenocarcinoma using endoscopic ultrasound elastography 国際誌

Yamada Kenta, Kawashima Hiroki, Ohno Eizaburo, Ishikawa Takuya, Tanaka Hiroyuki, Nakamura Masanao, Miyahara Ryoji, Ishigami Masatoshi, Hirooka Yoshiki, Fujishiro Mitsuhiro

BMC GASTROENTEROLOGY   20 巻 ( 1 ) 頁： 81 - 81   2020年3月

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記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：BMC Gastroenterology  

Background: Vascular invasion is an important criterion for resectability and deciding the therapeutic strategy for pancreatic ductal adenocarcinoma (PDAC), but imaging diagnosis is currently difficult. Endoscopic ultrasound (EUS) elastography (EG) images have band-like artifacts on the border between tumor and vessel due to different movement if the tumor is not connected to the vessel, i.e., no invasion. Based on this phenomenon, we assessed the usefulness of EUS-EG in the diagnosis of vascular invasion in PDAC. Methods: The subjects were 44 out of 313 patients with PDAC who underwent EUS between January 2015 and November 2018, followed by surgery, no chemotherapy or radiotherapy, and pathological evaluation. Diagnostic accuracies of vascular invasion using dynamic computed tomography (CT), EUS B-mode and EUS-EG were compared with histopathological diagnosis. Results: In 44 subjects (48 sites) who underwent both dynamic CT and EUS-B mode, the sensitivity, specificity and accuracy were 0.733, 0.697 and 0.708 on dynamic CT (48 sites); 0.733, 0.606 and 0.646 in EUS B-mode (48 sites); and 0.917, 0.900 and 0.906 in EUS-EG (32 sites). In 27 subjects (29 sites) with a tumor contacting a vessel with no vascular obstruction or stenosis on dynamic CT, the sensitivity, specificity and accuracy were 0.556, 0.750 and 0.690 on dynamic CT; 0.667, 0.700 and 0.690 in EUS B-mode; and 0.889, 0.850 and 0.862 in EUS-EG. Conclusions: These results suggest that EUS combined with EG improves diagnostic performance of vascular invasion in PDAC, especially in cases of which vascular invasion cannot be clearly assessed by dynamic CT.

DOI： 10.1186/s12876-020-01228-9

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Double-balloon endoscopic retrograde cholangiopancreatography for patients who underwent liver operation: A retrospective study 国際誌

Nishio Ryo, Kawashima Hiroki, Nakamura Masanao, Ohno Eizaburo, Ishikawa Takuya, Yamamura Takeshi, Maeda Keiko, Sawada Tsunaki, Tanaka Hiroyuki, Sakai Daisuke, Miyahara Ryoji, Ishigami Masatoshi, Hirooka Yoshiki, Fujishiro Mitsuhiro

WORLD JOURNAL OF GASTROENTEROLOGY   26 巻 ( 10 ) 頁： 1056 - 1066   2020年3月

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

BACKGROUND Double-balloon endoscopic retrograde cholangiography (DB-ERC) is widely performed for biliary diseases after reconstruction in gastrointestinal surgery, but there are few reports on DB-ERC after hepatectomy or living donor liver transplantation (LDLT). AIM To examine the success rates and safety of DB-ERC after hepatectomy or LDLT. METHODS The study was performed retrospectively in 26 patients (45 procedures) who underwent hepatectomy or LDLT (liver operation: LO group) and 40 control patients (59 procedures) who underwent pancreatoduodenectomy (control group). The technical success (endoscope reaching the choledochojejunostomy site), diagnostic success (performance of cholangiography), therapeutic success (completed interventions) and overall success rates, insertion and procedure (completion of DB-ERC) time, and adverse events were compared between these groups. RESULTS There were no significant differences between LO and control groups in the technical [93.3% (42/45) vs 96.6% (57/59), P = 0.439], diagnostic [83.3% (35/42) vs 83.6% (46/55), P = 0.968], therapeutic [97.0% (32/33) vs 97.7% (43/44), P = 0.836], and overall [75.6% (34/45) vs 79.7% (47/59), P = 0.617] success rates. The median insertion time (22 vs 14 min, P < 0.001) and procedure time (43.5 vs 30 min, P = 0.033) were significantly longer in the LO group. The incidence of adverse events showed no significant difference [11.1% (5/45) vs 6.8% (4/59), P = 0.670]. CONCLUSION DB-ERC after liver operation is safe and useful but longer time is required, so should be performed with particular care.

DOI： 10.3748/wjg.v26.i10.1056

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Microbiota profile is different for early and invasive colorectal cancer and is consistent throughout the colon 査読有り

Pu Leonardo Zorron Cheng Tao, Yamamoto Kenta, Honda Takashi, Nakamura Masanao, Yamamura Takeshi, Hattori Shun, Burt Alastair D., Singh Rajvinder, Hirooka Yoshiki, Fujishiro Mitsuhiro

JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY   35 巻 ( 3 ) 頁： 433 - 437   2020年3月

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記述言語：日本語   出版者・発行元：Journal of Gastroenterology and Hepatology (Australia)  

Background and Aim: Microbiota have been associated with several diseases including colorectal cancer (CRC). This study aimed to evaluate the microbiota in early/invasive CRC utilizing stool and cytological brushes to determine differences in relative abundance (RA). Methods: Colonoscopy patients referred for endoscopic submucosal dissection or previous to CRC surgery were prospectively enrolled. Stool was collected pre-bowel preparation; and brush samples were taken during colonoscopy (three regions). DNA extraction, 16S rRNA next generation sequencing, and biostatistics (qiime and stamp software packages) followed. Primary outcome was the difference in RA of the Fusobacterium genus between the groups. Secondary outcomes included analyses of other microbiota. Results: Twenty-five patients were included, of which 14 had invasive cancer (≥ 1000 mm into the submucosa). The three major genera for invasive cancer were Bacterioides, Oribacterium, and Fusobacterium, whereas for early cancer were Oribacterium, Bacterioides, and Prevotella (decreasing order of RA). There was a significantly higher RA of Fusobacterium in the invasive cancer group (9.65% vs 0.95%, respectively, P < 0.001). The RA of all genera was similar throughout the colon. In addition to Fusobacterium, the genera Corynebacterium, Enterococcus, Neisseria, Porphyromonas, and Sclegelella showed statistically higher RA in the invasive cancer group. Conversely, the genera Oribacterium, Desulfovibrio, Clostridiales, and Lactobacillus showed lower RA in the invasive cancer group. Conclusions: The RA of Fusobacterium is higher with invasive CRC than in early CRC patients. In addition, five other bacteria genera were found to be increased, and four decreased in invasive CRC patients. The microbiota per patient was similar throughout the colon.

DOI： 10.1111/jgh.14868

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Usefulness of Endoscopic Ultrasound Elastography Combined With the Strain Ratio in the Estimation of Treatment Effect in Autoimmune Pancreatitis 国際誌

Ishikawa Takuya, Kawashima Hiroki, Ohno Eizaburo, Tanaka Hiroyuki, Maeda Keiko, Sawada Tsunaki, Yamamura Takeshi, Furukawa Kazuhiro, Nakamura Masanao, Miyahara Ryoji, Ishigami Masatoshi, Fujishiro Mitsuhiro

PANCREAS   49 巻 ( 2 ) 頁： E21 - E22   2020年2月

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記述言語：英語   出版者・発行元：Pancreas  

DOI： 10.1097/MPA.0000000000001481

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Relationship Between Adverse Events and Microbiomes in Advanced Hepatocellular Carcinoma Patients Treated With Sorafenib 国際誌

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

ANTICANCER RESEARCH   40 巻 ( 2 ) 頁： 665 - 676   2020年2月

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

Background/Aim: Sorafenib results in several adverse events, the mechanism and predictors of which are unknown. Recently, it was reported that metabolism by microbiome changes the structure and effects of drugs. The blood levels of sorafenib may be affected by enterohepatic recycling of sorafenib due to microbial enzymes in the gut. We evaluated the relationship between adverse events caused by sorafenib treatment and microbiome in patients with advanced hepatocellular carcinoma. Materials and Methods: Twenty-five patients were classified into two groups based on the presence of hand-foot syndrome (HFS) or diarrhea within 12 weeks post-sorafenib treatment. Before sorafenib treatment, the fecal samples were analyzed targeting the V3- V4 region of 16s ribosomal RNA. Microbiome and predicted functional gene were compared between two groups. Results: The non-HFS group had a richer abundance of Veillonella, Bacillus, Enterobacter, Faecalibacterium, Lachnospira, Dialister, and Anaerostipes than the HFS group at genus level. Carotenoid biosynthesis and bacterial invasion of epithelial cells were enriched in the HFS group. The former three bacteria are classified as oral-origin bacteria, and the two predicted functions are associated with dysbiosis. The non-diarrhea group had a higher abundance of Butyricimonas and a lower abundance of Citrobacter, Peptostreptococcus, and Staphylococcaceae than the diarrhea group. Eight categories of predicted functional genes were detected with differences between the two groups. Conclusion: The non-HFS group had a higher relative abundance of oral-origin bacteria, which likely led to more robust dysbiosis in the gut. This dysbiosis may affect enterohepatic recycling. Additionally, the metabolism of these short-chain fatty acids in the gut may be different between the diarrhea and non-diarrhea groups.

DOI： 10.21873/anticanres.13996

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Generation of magnifying endoscopic images of gastric neoplasms based on an all-in-focus algorithm 国際誌

Matsui Kenichi, Funasaka Kohei, Miyahara Ryoji, Furukawa Kazuhiro, Matsushita Masanobu, Yamamura Takeshi, Ishikawa Takuya, Ohno Eizaburo, Nakamura Masanao, Kawashima Hiroki, Watanabe Osamu, Ohara Kenichi, Hirooka Yoshiki, Goto Hidemi

JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY   35 巻 ( 1 ) 頁： 65 - 70   2020年1月

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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: Magnifying endoscopy is useful for diagnosis of early gastrointestinal neoplasms by visualizing microvascular (MV) and microsurface (MS) structures of the mucosa when combined with image-enhanced endoscopy. However, precise control of the endoscope is needed because the depth of focus is narrow and the target may move. These problems may be overcome by the all-in-focus (AIF) technique, which was developed in the engineering field. The aim of the study was to evaluate magnifying endoscopic image with AIF algorithm. Methods: Twenty gastric neoplasms were examined. Images were acquired at 80× magnification and converted to endoscopic images with an AIF algorithm (EI-AIF). The focus area and MV and MS patterns in the original image and the EI-AIF were compared on a 5-point Likert scale, where 5 indicates that the EI-AIF was superior. Intraclass correlation coefficients (ICCs) were used to assess the inter-evaluator reliability. An image quality measurement value was calculated for each image as an indicator of the degree of focus. Results: The scores for focus area, MV, and MS were 4.78 ± 0.45 (ICC = 0.63), 4.12 ± 0.76 (ICC = 0.70), and 4.72 ± 0.52 (ICC = 0.45), respectively, with the EI-AIF significantly superior for all three items (P < 0.05 by Student's t-test). ICCs for the focus area and MV were > 0.60, indicating strong inter-evaluator reliability. Image quality measurement was higher for the EI-AIF compared with the original image in every case. Conclusions: Endoscopic observation with AIF algorithm gives a better image quality that allows easier evaluation of MV and MS patterns. This technique may resolve the difficulties with magnifying endoscopic observation.

DOI： 10.1111/jgh.14792

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Color information from linked color imaging is associated with invasion depth and vascular diameter in superficial esophageal squamous cell carcinoma 査読有り

Kobayashi Kenichi, Miyahara Ryoji, Funasaka Kohei, Furukawa Kazuhiro, Sawada Tsunaki, Maeda Keiko, Yamamura Takeshi, Ishikawa Takuya, Ohno Eizaburo, Nakamura Masanao, Kawashima Hiroki, Nakaguro Masato, Okumura Yuki, Hirooka Yoshiki, Fujishiro Mitsuhiro

DIGESTIVE ENDOSCOPY   32 巻 ( 1 ) 頁： 65 - 73   2020年1月

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記述言語：英語   出版者・発行元：Digestive Endoscopy  

Objectives: Accurate diagnosis of invasion depth is important for reliable treatment of esophageal squamous cell carcinoma (ESCC), but it is limited to the muscularis mucosae to slight submucosal invasion (MM/SM1). The diagnostic accuracy of invasion depth is unsatisfactory and remains to be improved. We aimed to investigate the association between the color of the superficial ESCC and invasion depth using linked color imaging (LCI) under light-emitting diode (LED) light sources. Methods: Lesions diagnosed as superficial ESCC were observed using white light imaging and then by LCI. The color values were calculated using Commission Internationale de l'Eclariage – L*a*b* color space, and the color difference was calculated according to invasion depth. The vascular diameters and vascular angles of the intrapapillary capillary loops were pathologically analyzed. Their correlation with mucosal color was also investigated by LCI. Results: In all, 52 lesions from 48 patients were analyzed. On the basis of invasion depth, the color difference between the normal mucosa and the lesion was larger in the MM/SM1 or deeper group than in the epithelium and the lamina propria mucosa (EP/LPM) group using LCI (P = 0.025). The vascular diameter was positively correlated with the b* color value (correlation coefficient = 0.302, P = 0.033). Conclusion: Observation using LCI under LED light sources may improve the endoscopic diagnosis of the invasion depth of superficial ESCC. Further research is needed to validate its usefulness. (UMIN000024615).

DOI： 10.1111/den.13469

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Prognostic impact of PD-L1 expression in primary gastric and intestinal diffuse large B-cell lymphoma 査読有り

Ishikawa Eri, Nakamura Masanao, Shimada Kazuyuki, Tanaka Tsutomu, Satou Akira, Kohno Kei, Sakakibara Ayako, Furukawa Kazuhiro, Yamamura Takeshi, Miyahara Ryoji, Nakamura Shigeo, Kato Seiichi, Fujishiro Mitsuhiro

JOURNAL OF GASTROENTEROLOGY   55 巻 ( 1 ) 頁： 39 - 50   2020年1月

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

Background: Diffuse large B-cell lymphoma (DLBCL) is a heterogeneous disease and the most common gastrointestinal lymphoma. The prognostic/predictive indicators among patients with gastric and intestinal DLBCL (giDLBCL) are controversial beyond their anatomical sites. We compared giDLBCL cases and investigated the clinical utility of newly emerging indicators with an emphasis on programmed cell death ligand 1 (PD-L1) expression. Methods: This retrospective study included 174 patients with primary gastric (n = 129) or intestinal (n = 45) DLBCL treated with rituximab-containing chemotherapy between 1995 and 2018. Results: Compared with gastric DLBCL (gDLBCL) cases, patients with intestinal DLBCL (iDLBCL) had a significantly higher rate of advanced Lugano stage (71% vs 37%, P < 0.001), perforation (13% vs. 0.8%, P = 0.001), PD-L1 expression on microenvironment immune cells (miPD-L1, 70% vs 46%, P = 0.008), CD10 positivity (47% vs 28%, P = 0.027), and CD5 positivity (9% vs 1.6%, P = 0.040). The iDLBCL patients showed significantly worse progression-free survival (PFS) and overall survival (OS) than gDLBCL cases (P = 0.0338 and P = 0.0077, respectively). PD-L1 expression on tumor cells was detected in only 3 (2%) of 174 cases with early relapse and/or an aggressive clinical course; whereas, miPD-L1-positive cases had significantly better OS than the miPD-L1-negative gDLBCL and iDLBCL cases (P = 0.0281 and P = 0.0061, respectively). Multivariate analysis revealed that miPD-L1 negativity (P = 0.030) was an independent adverse prognostic factor for OS in giDLBCL. Conclusions: The anatomical site of disease did not influence outcome in giDLBCL cases treated with rituximab-containing chemotherapy; while, miPD-L1 expression had a favorable impact on the outcome.

DOI： 10.1007/s00535-019-01616-3

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炎症性腸疾患の最新治療の現状と今後 当院での潰瘍性大腸炎における生物学的製剤の治療

澤田 つな騎, 中村 正直, 山村 健史, 前田 啓子, 水谷 泰之, 石川 恵理, 西川 貴広, 服部 峻, 山田 啓策, 久野 剛史, 梶川 豪, 橋口 裕樹, 江崎 正哉, 喜田 裕一, 濱崎 元伸, 村手 健太郎, 藤城 光弘

日本消化管学会雑誌   4 巻 ( Suppl. ) 頁： 239 - 239   2020年1月

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記述言語：日本語   出版者・発行元：(一社)日本消化管学会  

Nasal patency as a factor for successful transnasal endoscopy

Nagaya Toshihiko, Miyahara Ryoji, Funasaka Kohei, Furukawa Kazuhiro, Yamamura Takeshi, Ishikawa Takuya, Ohno Eizaburo, Nakamura Masanao, Kawashima Hiroki, Nakashima Tsutomu, Nakata Sciichi, Hirooka Yoshiki

NAGOYA JOURNAL OF MEDICAL SCIENCE   81 巻 ( 4 ) 頁： 587 - 595   2019年11月

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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  

In recent years, transnasal endoscopy had been more widely accepted for its safety and convenience, and although it can lead to a weaker pharyngeal reflex, compared with the effects of transoral endoscopy, examinees often suffer intolerable pain and discomfort during passage of the endoscope through the nasal cavity. The aim of this study was to estimate the relationship between the uncomfortable factors during transnasal endoscopy and nasal patency. The subjects comprised 23 consecutive patients who underwent transnasal endoscopy from October 2007 to April 2009 at our Gastroenterology and Otorhinolaryngology Departments. Immediately prior to endoscopy, the left and right nasal resistance was measured with an active anterior rhinomanometer; a value of 100 Pa was determined as nasal resistance. The transnasal endoscope was inserted in the subjectively preferred side by the examinee. Thereafter, the subjects were asked to fill in a questionnaire on physical tolerance during the procedure, to quantify the sensations of nasal pain, nausea, and choking on a 10-point visual analogue scale. The mean scores were 3.0 ± 2.7 for nasal pain, 1.7 ± 2.0 for choking, and 1.6 ± 1.9 for nausea. The most intolerable factor among the complaints was pain (45%), which was followed by nausea (18%) and choking (9%). Unilateral nasal resistance was significantly related with nasal pain only (P = 0.0135). In conclusion, the most difficult problem during transnasal endoscopy was pain, which was related to nasal patency. We successfully demonstrated the clinical significance of nasal patency in determining the side of insertion for transnasal endoscopy.

DOI： 10.18999/nagjms.81.4.587

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Feasibility and usefulness of endoscopic ultrasonography-guided shear-wave measurement for assessment of autoimmune pancreatitis activity: a prospective exploratory study

Ohno Eizaburo, Hirooka Yoshiki, Kawashima Hiroki, Ishikawa Takuya, Tanaka Hiroyuki, Sakai Daisuke, Ishizu Yoji, Kuzuya Teiji, Nakamura Masanao, Honda Takashi

JOURNAL OF MEDICAL ULTRASONICS   46 巻 ( 4 ) 頁： 425 - 433   2019年10月

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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 Medical Ultrasonics  

Purpose: To assess the feasibility and the clinical usefulness of a newly developed endoscopic ultrasonography (EUS) shear-wave elastography technique (EUS shear-wave measurement: EUS-SWM) in the diagnosis and treatment of autoimmune pancreatitis (AIP). Methods: Tissue elasticity was measured in the pancreas in 160 patients. The success rate of EUS-SWMs, the velocity of the shear wave (Vs, m/s), and the reliability index of the Vs measurement (VsN) were evaluated, and the elasticity (median Vs) was compared between AIP patients (n = 14) and normal controls. Results: A total of 3837 EUS-SWMs were performed without adverse events. Overall, 97.6% (3743/3837) were successful. The median VsN was 74%. The median Vs values of the pancreas were as follows: 2.22 m/s in the pancreatic head (push position), 2.36 m/s in the head (pull position), 1.99 m/s in the body, and 2.25 m/s in the tail. The median Vs of the AIP group (2.57 m/s) was significantly higher than that of the normal controls (1.89 m/s) (P = 0.0185). The mean Vs significantly decreased from 3.32 m/s to 2.46 m/s after steroid therapy (n = 6) (P = 0.0234). Conclusion: EUS-SWM is feasible and generates credible results. EUS-SWM was a useful method for assessment of the effect of steroid therapy in AIP patients.

DOI： 10.1007/s10396-019-00944-4

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EUS Elastographyを用いた膵癌の脈管浸潤診断

山田 健太, 廣岡 芳樹, 川嶋 啓揮, 大野 栄三郎, 石川 卓哉, 田中 浩敬, 酒井 大輔, 飯田 忠, 西尾 亮, 鈴木 博貴, 植月 康太, 八鹿 潤, 芳川 昌功, 宜保 憲明, 青木 聡典, 中村 正直, 宮原 良二, 石上 雅敏, 藤城 光弘

Gastroenterological Endoscopy   61 巻 ( Suppl.2 ) 頁： 2196 - 2196   2019年10月

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

Specific members of gut microbiota predict mucosal healing in Crohn's disease

Hattori S., Nakamura M., Yamamura T., Maeda K., Sawada T., Mizutani Y., Yamamoto K., Pu L. Zorron Cheng Tao, Honda T., Ishikawa T., Furukawa K., Ohno E., Miyahara R., Kawashima H., Fujishiro M.

JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY   34 巻   頁： 152 - 152   2019年9月

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Objective evaluation of the therapeutic effect of ustekinumab on Crohn's disease

Yamamura T., Nakamura M., Murate K., Maeda K., Sawada T., Mizutani Y., Nishikawa T., Hattori S., Yamamoto K., Pu L. Zorron Cheng Tao, Ishikawa T., Furukawa K., Ohno E., Miyahara R., Kawashima H., Fujishiro M.

JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY   34 巻   頁： 145 - 145   2019年9月

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THE PROPAGATION DISPLAY METHOD IMPROVES THE REPRODUCIBILITY OF PANCREATIC SHEAR WAVE ELASTOGRAPHY 国際誌

Hashizume Kiyotaka, Hirooka Yoshiki, Kawashima Hiroki, Ohno Eizaburo, Ishikawa Takuya, Kawai Manabu, Suhara Hiroki, Takeyama Tomoaki, Koya Toshinari, Tanaka Hiroyuki, Sakai Daisuke, Yamamura Takeshi, Furukawa Kazuhiro, Funasaka Kohei, Nakamura Masanao, Miyahara Ryoji, Watanabe Osamu, Ishigami Masatoshi, Kuwahara Takamichi, Hashimoto Senju, Goto Hidemi

ULTRASOUND IN MEDICINE AND BIOLOGY   45 巻 ( 8 ) 頁： 2242 - 2247   2019年8月

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Ultrasound in Medicine and Biology  

Evaluation of the pancreatic elastic modulus (PEM) using shear wave elastography (SWE) requires at least 5 measurements to ensure reproducibility. The aim of this study was to evaluate improvement in reproducibility of SWE, using the propagation display method in normal pancreas ([NP] phase 1) and to examine the differences in PEM between NP and chronic pancreatitis (CP), intraductal papillary mucinous neoplasm (IPMN) and autoimmune pancreatitis ([AIP] phase 2). In phase 1, the measurement success rate, median PEM in repeated measurements and appropriate number of SWE measurements were determined in 109 cases with NP. In phase 2, PEM was measured in CP (n = 10), IPMN (n = 31) and AIP (n = 5), using the required number of SWE measurements determined in phase 1. In phase 1, the measurement success rate was 93.9% (92/109 cases). The median PEM for NP was 14.6 kPa and the appropriate number of SWE measurements was at least 3. In phase 2, the median PEMs in CP, IPMN and AIP were 19.6, 18.1 and 17.2 kPa, respectively, with significant differences between NP and CP (p = 0.0133) and between NP and IPMN (p = 0.0436). Use of the propagation display method in SWE improves the reproducibility of measurement of PEM.

DOI： 10.1016/j.ultrasmedbio.2019.04.003

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Comparison of 8-and 10-mm diameter fully covered self-expandable metal stents: A multicenter prospective study in patients with distal malignant biliary obstruction 国際誌

Kawashima Hiroki, Hashimoto Senju, Ohno Eizaburo, Ishikawa Takuya, Morishima Tomomasa, Matsubara Hiroshi, Sugimoto Hiroyuki, Nonogaki Koji, Kanamori Akira, Hara Kazuo, Kuwahara Takamichi, Nakamura Masanao, Miyahara Ryoji, Ishigami Masatoshi, Ando Masahiko, Hirooka Yoshiki

DIGESTIVE ENDOSCOPY   31 巻 ( 4 ) 頁： 439 - 447   2019年7月

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

Objectives: The time to recurrent biliary obstruction (TRBO) of unresectable distal malignant biliary obstruction is generally thought to be longer when a self-expandable metal stent (SEMS) with a thicker inner diameter is used for drainage, but the dependence on the inner diameter using a fully covered SEMS (FCSEMS) is uncertain. The objective of this multicenter prospective study was to compare TRBO and adverse events, such as cholecystitis and pancreatitis, in treatment of patients with unresectable malignant biliary obstruction using 8- and 10-mm diameter FCSEMS. Methods: Eighteen tertiary-care centers participated in the study. Patients were allocated to the 8- and 10-mm diameter groups. TRBO, non-inferiority of the 8-mm FCSEMS, overall survival time, frequency and type of adverse events, and non-recurrent biliary obstruction (RBO) rate at the time of death were compared between the two groups. Results: Median TRBO did not differ significantly between the 8-mm (n = 102) and 10-mm (n = 100) groups (275 vs 293 days, P = 0.971). The hazard ratio of the 8- to 10-mm groups was 0.90 (80% confidence interval, 0.77–1.04; upper limit lower than the acceptable hazard ratio [1.33] of the null hypothesis). Based on these findings, the 8-mm diameter stent was determined to be non-inferior to the 10-mm diameter stent. Survival time, incidence of adverse events and non-RBO rate at the time of death did not differ significantly between the two groups. Conclusions: Time to RBO with an 8-mm diameter FCSEMS was non-inferior to that with a 10-mm diameter FCSEMS. This finding is important for development of future SEMS.

DOI： 10.1111/den.13366

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USEFULNESS OF THE FORWARD-VIEWING RADIAL-ARRAY ECHOENDOSCOPE IN THE DIAGNOSIS OF INVASION DEPTH OF COLORECTAL NEOPLASIA

Kuno Takeshi, Yamamura Takeshi, Nakamura Masanao, Maeda Keiko, Sawada Tsunaki, Mizutani Yasuyuki, Suzuki Hiroto, Esaki Masaya, Ishikawa Takuya, Furukawa Kazuhiro, Ohno Eizaburo, Kawashima Hiroki, Miyahara Ryoji, Hirooka Yoshiki

GASTROINTESTINAL ENDOSCOPY   89 巻 ( 6 ) 頁： AB324 - AB324   2019年6月

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USEFULLNESS OF EUS-GUIDED SHEAR-WAVE MEASUREMENT (EUS-SWM) FOR THE ASSESSMENT OF ACTIVITIES OF AUTOIMMUNE PANCREATITIS; A PROSPECTIVE EXPLORATORY STUDY

Ohno Eizaburo, Hirooka Yoshiki, Kawashima Hiroki, Ishikawa Takuya, Tanaka Hiroyuki, Sakai Daisuke, Iida Tadashi, Nishio Ryo, Suzuki Hirotaka, Uetsuki Kota, Yashika Jun, Yamada Kenta, Yoshikawa Masakatsu, Gibo Noriaki, Aoki Toshinori, Yamamura Takeshi, Furukawa Kazuhiro, Nakamura Masanao, Miyahara Ryoji

GASTROINTESTINAL ENDOSCOPY   89 巻 ( 6 ) 頁： AB608 - AB608   2019年6月

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CLINICAL SIGNIFICANCE OF THE PATENCY OF GASTROINTESTINAL TRACT IN CROHN'S DISEASE EVALUATED BY PATENCY CAPSULE

Nakamura Masanao, Yamamura Takeshi, Maeda Keiko, Sawada Tsunaki, Mizutani Yasuyuki, Kuno Takeshi, Yamada Keisaku, Ishikawa Takuya, Furukawa Kazuhiro, Ohno Eizaburo, Miyahara Ryoji, Kawashima Hiroki, Hirooka Yoshiki

GASTROINTESTINAL ENDOSCOPY   89 巻 ( 6 ) 頁： AB333 - AB333   2019年6月

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ダブルバルーン小腸内視鏡を用いた硬化療法にて治療効果を得た小腸多発血管腫の1例

山田 啓策, 山村 健史, 中村 正直, 澤田 つな騎, 水谷 泰之, 前田 啓子, 古川 和宏, 宮原 良二, 横井 太紀雄, 廣岡 芳樹

Gastroenterological Endoscopy   61 巻 ( 6 ) 頁： 1231 - 1236   2019年6月

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

70歳代男性。1ヵ月間持続する黒色便にて当科紹介となった。上下部消化管内視鏡検査では、明らかな出血源を認めなかった。小腸出血を疑いカプセル内視鏡検査を施行したところ、全小腸にわたり多発する隆起性病変を認めた。ダブルバルーン小腸内視鏡検査を行いジャンボバイオプシー目的の内視鏡的粘膜切除術(Endoscopic mucosal resection:EMR)にて海綿状血管腫と診断した。後日多発する血管腫に対してpolidocanol(Aethoxysklerol)による硬化療法を行った。4日後の内視鏡観察では、血管腫は縮小を認め、以後黒色便も消失した。小腸に多発する血管腫に対して内視鏡的硬化療法が有用であった1例を経験したので報告する。(著者抄録)

The utility of ultrathin endoscopy with flexible spectral imaging color enhancement for early gastric cancer 査読有り

Yokoyama Takafumi, Miyahara Ryoji, Funasaka Kohei, Furukawa Kazuhiro, Yamamura Takeshi, Ohno Eizaburo, Nakamura Masanao, Kawashima Hiroki, Watanabe Osamu, Hirooka Yoshiki, Hirakawa Akihiro, Goto Hidemi

NAGOYA JOURNAL OF MEDICAL SCIENCE   81 巻 ( 2 ) 頁： 241 - 248   2019年5月

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記述言語：英語   出版者・発行元：Nagoya journal of medical science  

Many researchers suggested that ultrathin endoscopy improves patient acceptance of endoscopic examinations. However, ultrathin endoscopy provides less image resolution and luminous intensity. Therefore, we focused on the visibility of early gastric cancer on ultrathin endoscopy with Flexible spectral imaging color enhancement (FICE) in this study. Thirty-six patients with early gastric cancer were prospectively enrolled. One endoscopist performed the endoscopic examinations by white light conventional endoscopy (W-CE), white light ultrathin endoscopy (W-UE), FICE ultrathin endoscopy (F-UE) and white light plus FICE ultrathin endoscopy (WF-UE) in the patients. Four other endoscopists were asked to evaluate the visibility of gastric cancer on the W-CE, W-UE, F-UE and WF-UE images with a 5-point Likert scale. The lesions were classified as uncolored, normocolored or reddish. We examined the color difference between early gastric cancer and the surrounding mucosa. To examine the relationship between the color difference and the vessel density, we also measured the difference in vessel density using pathologic specimens stained with hematoxylin and eosin. The Likert score of WF-UE was significantly higher than those of the other three methods (p<0.001). The color difference of F-UE was higher than that of W-CE in the reddish group (p=0.049). The difference in vessel density was higher in the reddish group than in the normocolored group (p=0.048). In conclusion, the visibility of early gastric cancer from the surrounding mucosa using ultrathin endoscopy with FICE was better than that using white light conventional endoscopy, especially for reddish lesions.

DOI： 10.18999/nagjms.81.2.241

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Colorectal endoscopic submucosal dissection in special locations

Kaosombatwattana Uayporn, Yamamura Takeshi, Nakamura Masanao, Hirooka Yoshiki, Goto Hidemi

WORLD JOURNAL OF GASTROINTESTINAL ENDOSCOPY   11 巻 ( 4 ) 頁： 262 - 270   2019年4月

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記述言語：英語  

DOI： 10.4253/wjge.v11.i4.262

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Preoperative endoscopic predictors of severe submucosal fibrosis in colorectal tumors undergoing endoscopic submucosal dissection

Kaosombatwattana Uayporn, Yamamura Takeshi, Limsrivilai Julajak, Nakamura Masanao, Leelakusolvong Somchai, Hirooka Yoshiki, Goto Hidemi

ENDOSCOPY INTERNATIONAL OPEN   7 巻 ( 4 ) 頁： E421 - E430   2019年4月

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記述言語：英語  

DOI： 10.1055/a-0848-8225

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Development of a Comorbidity Index to Identify Patients With Small Bowel Bleeding at Risk for Rebleeding and Small Bowel Vascular Diseases 査読有り 国際誌

Ohmiya Naoki, Nakamura Masanao, Osaki Hayato, Yamada Hyuga, Tahara Tomomitsu, Nagasaka Mitsuo, Nakagawa Yoshihito, Shibata Tomoyuki, Tsukamoto Tetsuya, Kuroda Makoto

CLINICAL GASTROENTEROLOGY AND HEPATOLOGY   17 巻 ( 5 ) 頁： 896 - +   2019年4月

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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 & Aims: We aimed to establish a comorbidity index for small bowel vascular diseases (SBVD) associated with small bowel bleeding (SBB) and recurrent bleeding. Methods: We performed a retrospective analysis of 404 patients diagnosed with SBB via double-balloon enteroscopy, at 2 hospitals in Japan from June 2003 through July 2016. We collected data on comorbidities, computed Charlson Comorbidity Index and anticoagulation and risk factors in atrial fibrillation (ATRIA) scores, and analyzed associations with SBVD, rebleeding, and overall survival associated with bleeding and/or comorbidities. We used these data to develop a comorbidity index to identify patients at risk for SBVD, rebleeding, and reduced survival time. We validated our findings in a separate, prospective cohort of 88 patients with SBB. Results: We developed a weighted index (the Ohmiya index) that identified patients who developed SBVD with an area under the receiver operating characteristic (AUROC) curve of 0.7758; this value was higher than that of the Charlson index score (0.6828; P <.0001) or ATRIA score (0.6728; P <.0001) alone. Among the 51 patients taking oral anticoagulants, there was no significant difference in AUROCs for the Ohmiya score (0.5254) vs the outcomes registry for better informed treatment score (0.5857; P =.4300). In the retrospective cohort, the Ohmiya index identified patients with SBVD with 68% sensitivity (93/137), 84% specificity (223/267), and 78% accuracy (316/404); in the validation cohort, these values were 63% (22/35), 85% (45/53), and 76% (67/88), respectively. Onset age <50 years and index score <2 identified patients with Meckel's diverticulum and Crohn's disease with 53% accuracy. Onset age ≥50 years and index score <2 identified patients with inflammatory diseases, drug-induced injuries, or tumors with 72% accuracy. An index score ≥2 identified patients with SBVD with 68% accuracy, regardless of age. Among patients with Ohmiya index scores ≥2, 33% had rebleeding; among patients with scores <2, 15% had rebleeding (hazard ratio for score ≥2, 1.729; 95% CI, 1.038–2.882; P =.0355). Conclusion: We developed an index, based on comorbidities and age of onset of SBB, that identified patients at risk for rebleeding and vascular disease (for example, enteroscopic hemostasis for SBVD, medication for inflammatory diseases, surgery with enteroscopic tattooing for tumors and diverticula). UMIN: 000025693.

DOI： 10.1016/j.cgh.2018.08.034

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Utility of linked color imaging for endoscopic diagnosis of early gastric cancer 査読有り

Fujiyoshi Toshihisa, Miyahara Ryoji, Funasaka Kohei, Furukawa Kazuhiro, Sawada Tsunaki, Maeda Keiko, Yamamura Takeshi, Ishikawa Takuya, Ohno Eizaburo, Nakamura Masanao, Kawashima Hiroki, Nakaguro Masato, Nakatochi Masahiro, Hirooka Yoshiki

WORLD JOURNAL OF GASTROENTEROLOGY   25 巻 ( 10 ) 頁： 1248 - 1258   2019年3月

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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: Linked color imaging (LCI) is a method of endoscopic imaging that emphasizes slight differences in red mucosal color. AIM: To evaluate LCI in diagnostic endoscopy of early gastric cancer and to compare LCI and pathological findings. METHODS: Endoscopic images were obtained for 39 patients (43 lesions) with early gastric cancer. Three endoscopists evaluated lesion recognition with white light imaging (WLI) and LCI. Color values in Commission Internationale de l'Eclairage (CIE) 1976 L*a*b* color space were used to calculate the color difference (ΔE) between cancer lesions and non-cancer areas. After endoscopic submucosal dissection, blood vessel density in the surface layer of the gastric epithelium was evaluated pathologically. The identical region of interest was selected for analyses of endoscopic images (WLI and LCI) and pathological analyses. RESULTS: LCI was superior for lesion recognition (P < 0.0001), and ΔE between cancer and non-cancer areas was significantly greater with LCI than WLI (29.4 vs 18.6, P < 0.0001). Blood vessel density was significantly higher in cancer lesions (5.96% vs 4.15%, P = 0.0004). An a* cut-off of ≥ 24 in CIE 1976 L*a*b* color space identified a cancer lesion using LCI with sensitivity of 76.7%, specificity of 93.0%, and accuracy of 84.9%. CONCLUSION: LCI is more effective for recognition of early gastric cancer compared to WLI as a result of improved visualization of changes in redness. Surface blood vessel density was significantly higher in cancer lesions, and this result is consistent with LCI image analysis.

DOI： 10.3748/wjg.v25.i10.1248

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Capsule endoscopy findings for the diagnosis of Crohn's disease: a nationwide case-control study 査読有り

Esaki Motohiro, Matsumoto Takayuki, Ohmiya Naoki, Washio Ema, Morishita Toshifumi, Sakamoto Kei, Abe Hiroo, Yamamoto Shojiro, Kinjo Tetsu, Togashi Kazutomo, Watanabe Kenji, Hirai Fumihito, Nakamura Masanao, Nouda Sadaharu, Ashizuka Shinya, Omori Teppei, Kochi Shuji, Yanai Shunichi, Fuyuno Yuta, Hirano Atsushi, Umeno Junji, Kitazono Takanari, Kinjo Fukunori, Watanabe Mamoru, Matsui Toshiyuki, Suzuki Yasuo

JOURNAL OF GASTROENTEROLOGY   54 巻 ( 3 ) 頁： 249 - 260   2019年3月

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

Background: Capsule endoscopy can be used to identify the early stage of small bowel Crohn’s disease (CD). We evaluated significant small bowel capsule endoscopy (SBCE) findings that can lead to early diagnosis of CD. Methods: We retrospectively accumulated clinical and SBCE data of 108 patients (63 with and 45 without CD). Types of small bowel mucosal injuries, including erosion, ulceration, and cobblestone appearance, and the alignment of diminutive lesions were compared between patients with and without CD. Inter- and intra-observer agreement in the determination of lesions was assessed in 25 pairs of SBCE from the two groups. Results: Under SBCE, cobblestone appearance (33% vs. 2%, p < 0.0001), longitudinal ulcers (78% vs. 20%, p < 0.0001), and irregular ulcers (84% vs. 60%, p < 0.01) were more frequently found in patients with CD. Linear erosion (90% vs. 38%, p < 0.0001) and irregular erosion (89% vs. 64%, p < 0.005) were also more frequent in patients with CD. Furthermore, circumferential (75% vs. 9%, p < 0.0001) and longitudinal (56% vs. 7%, p < 0.0001) alignment of diminutive lesions, mainly observed in the 1st tertile of the small bowel, was more frequent in patients with CD. Good intra-observer agreement was found for ulcers, cobblestone appearance, and lesion alignment. However, inter-observer agreement of SBCE findings differed among observers. Conclusions: Circumferential or longitudinal alignment of diminutive lesions, especially in the upper small bowel, may be a diagnostic clue for CD under SBCE, while inter-observer variations should be cautiously considered when using SBCE.

DOI： 10.1007/s00535-018-1507-6

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Multicenter feasibility study of bowel preparation with castor oil for colon capsule endoscopy 査読有り 国際誌

Ohmiya Naoki, Hotta Naoki, Mitsufuji Shoji, Nakamura Masanao, Omori Takafumi, Maeda Kohei, Okuda Kotaro, Yatsuya Hiroshi, Tajiri Hisao

DIGESTIVE ENDOSCOPY   31 巻 ( 2 ) 頁： 164 - 172   2019年3月

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

Background and Aim: Extensive use of laxatives and incomplete excretion rates are problematic for colon capsule endoscopy (CCE). The aim of the present study was to determine the effectiveness of castor oil as a booster. Methods: At four Japanese hospitals, 319 examinees undergoing CCE were enrolled retrospectively. Before and after the introduction of castor oil, other preparation reagents were unchanged. Results: Of 319 examinees who underwent CCE, 152 and 167 examinees took regimens with castor oil (between November 2013 and June 2016) and without castor oil (between October 2015 and September 2017), respectively. Capsule excretion rates within its battery life in the groups with and without castor oil were 97% and 81%, respectively (P < 0.0001). Multivariate analysis showed that ages younger than 65 years (adjusted odds ratio [OR], 3.00; P = 0.0048), male gender (adjusted OR, 3.20; P = 0.0051), and use of castor oil (adjusted OR, 6.29; P = 0.0003) were predictors of capsule excretion within its battery life. Small bowel transit time was shorter and total volume of lavage and fluid intake was lower with castor oil than without (P = 0.0154 and 0.0013, respectively). Overall adequate cleansing level ratios with and without castor oil were 74% and 83%, respectively (P = 0.0713). Per-examinee sensitivity for polyps ≥6 mm with and without castor oil was 83% and 85%, respectively, with specificities of 80% and 78%, respectively. Conclusion: Bowel preparation with castor oil was effective for improving capsule excretion rate and reducing liquid loading.

DOI： 10.1111/den.13259

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Transabdominal ultrasound elastography of the esophagogastric junction predicts reflux esophagitis 査読有り

Suhara Hiroki, Hirooka Yoshiki, Kawashima Hiroki, Ohno Eizaburo, Ishikawa Takuya, Nakamura Masanao, Miyahara Ryoji, Ishigami Masatoshi, Hashimoto Senju, Goto Hidemi

JOURNAL OF MEDICAL ULTRASONICS   46 巻 ( 1 ) 頁： 99 - 104   2019年1月

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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 Medical Ultrasonics  

Purpose: Abdominal ultrasound (US) can visualize the esophagogastric junction (EGJ) as a hyperechoic area in the dorsal portion of the lateral segment of the liver. We prospectively evaluated the EGJ using US elastography (US-EG) in patients with reflux esophagitis (RE) to examine prediction of distal esophageal function. Methods: Of 108 patients undergoing US-EG and esophagogastroduodenoscopy, 102 in whom the EGJ was observed for ≥ 15 s were included. The subjects were divided into a RE group (n = 41, Grade M/A/B:24/13/4 according to modified Los Angeles Classification) and a non-RE group (n = 61). Direct strain elastography (LOGIQ E9, GE Healthcare), which gives a semi-quantitative elasticity index within a region of interest including the lateral segment, was used as a standard for measurement of the change in stiffness (CS) at the EGJ. Results: The number of CS as determined by US-EG was 6.0 (5.5–6.7) in the RE group and 8.6 (6.6–10.0) in the non-RE group (P < 0.0001). In ROC analysis, the AUC was 0.8415 for diagnosis of RE using the number of CS. At a cut-off of 7.7, the sensitivity, specificity, and accuracy for diagnosis were 92.7, 65.6, and 74.5%, respectively. Conclusion: The presence of RE can be predicted based on US-EG.

DOI： 10.1007/s10396-018-0890-1

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Plummer-Vinson Syndrome with Esophageal Web Formation in which Detailed Endoscopic Images Were Obtained

Hirose Takashi, Funasaka Kohei, Furukawa Kazuhiro, Yamamura Takeshi, Ishikawa Takuya, Ohno Eizaburo, Nakamura Masanao, Kawashima Hiroki, Miyahara Ryoji, Hirooka Yoshiki

INTERNAL MEDICINE   58 巻 ( 6 ) 頁： 785 - 789   2019年

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：一般社団法人 日本内科学会  

Plummer-Vinson syndrome is a rare entity, characterized by dysphagia, esophageal web formation, and iron deficiency anemia. The patient was a 63-year-old woman with a clinical history of iron deficiency anemia and glossitis in her 20s to 40s and who had experienced swallowing difficulties for the past 20 years. A membranous stricture was found in the cervical esophagus during a fluoroscopic examination. An endoscopic examination conducted under general anesthesia revealed an oblique linear scar on the proximal surface of the stricture. Sequential balloon dilation was performed successfully. We suggest that the esophageal web formation might have been related to the healing of an esophageal ulcer.

DOI： 10.2169/internalmedicine.1628-18

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CiNii Research

Lewis Score on Capsule Endoscopy as a Predictor of the Risk for Crohn's Disease-Related Emergency Hospitalization and Clinical Relapse in Patients with Small Bowel Crohn's Disease 国際誌

Nishikawa Takahiro, Nakamura Masanao, Yamamura Takeshi, Maeda Keiko, Sawada Tsunaki, Mizutani Yasuyuki, Ishikawa Takuya, Furukawa Kazuhiro, Ohno Eizaburo, Miyahara Ryoji, Kawashima Hiroki, Hirooka Yoshiki

GASTROENTEROLOGY RESEARCH AND PRACTICE   2019 巻   頁： 4274257 - 4274257   2019年

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Gastroenterology Research and Practice  

Background. Small bowel capsule endoscopy (CE) is a useful tool for evaluating the mucosal changes in patients with Crohn’s disease (CD). The Lewis score (LS) on CE could be used to objectively assess the inflammatory activity of the small bowel mucosa. However, only few reports on the correlation between the LS and CD prognosis exist. This study is aimed at evaluating the clinical significance of the LS by determining the cutoff value of the LS that could predict CD-related emergency hospitalization. Methods. This retrospective single-center study included 125 patients who underwent CE for small bowel CD. Eighty-six patients whose treatment was not changed after CE were analyzed. Inflammatory activity was assessed with the LS. We examined the clinical course of the patients who could be observed for 1 year after CE and investigated the LS cutoff value that could predict CD-related emergency hospitalization within 1 year. We also examined the hospitalization-free and clinical relapse-free rates using the LS cutoff value and evaluated the factors related to emergency hospitalization. Results. The LS cutoff value that could predict CD-related emergency hospitalization within 1 year was 264 (area under the curve, 0.92 (P < 0 001); sensitivity, 0.80; and specificity, 0.94). The cumulative hospitalization-free rate and cumulative clinical relapse-free rate were significantly higher in patients with a LS < 264 (P < 0 001). Multivariate analysis showed that a LS < 264 was a statistically significant factor (P = 0 001; 95% CI, 0.010–0.308). Conclusion. A LS of 264 is a useful cutoff value that could predict CD-related emergency hospitalization. This LS cutoff value may help determine treatment strategies for CD.

DOI： 10.1155/2019/4274257

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Clinical Impact of EUS-Guided Fine Needle Biopsy Using a Novel Franseen Needle for Histological Assessment of Pancreatic Diseases

Ishikawa Takuya, Kawashima Hiroki, Ohno Eizaburo, Tanaka Hiroyuki, Sakai Daisuke, Iida Tadashi, Nishio Ryo, Yamamura Takeshi, Furukawa Kazuhiro, Nakamura Masanao, Miyahara Ryoji, Hashimoto Senju, Ishigami Masatoshi, Hirooka Yoshiki

CANADIAN JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY   2019 巻   頁： 8581743 - 8   2019年

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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 and Aims. Several studies have shown the benefits of endoscopic ultrasound-guided fine needle biopsy (EUS-FNB) using a Franseen needle for histological assessment. However, studies focusing on pancreatic diseases are limited and the safety of this method has not been well assessed. We aimed to assess the current status and issues of EUS-FNB in the diagnosis of pancreatic diseases. Materials and Methods. We retrospectively reviewed 87 consecutive EUS-FNB specimens using either a 22-gauge Franseen needle (Group A, N = 51) or a conventional 22-gauge fine-needle aspiration needle (Group B, N = 36) for pancreatic diseases, and the diagnostic accuracy and safety were compared. Final diagnoses were obtained based on surgical pathology or a minimum six-month clinical follow-up. Results. Although the diagnostic accuracy for malignancy was 96.1% in Group A versus 88.9% in Group B, with no statistically significant difference (P = 0.19), the median sample area was significantly larger in Group A (4.07 versus 1.31mm 2 , P < 0.0001). There were no differences between the two needles in the locations from which the specimens were obtained. Adverse events occurred in one case (2%) in Group A (mild pancreatitis) and none in Group B with no statistical significance (P = 0.586). Although there was no case of bleeding defined as adverse events, 2 cases in Group A showed active bleeding during the procedure with increase in the echo-free space, which required CT scanning to rule out extravasation. Eventually, the bleeding stopped spontaneously. Conclusions. Given its guaranteed ability to obtain core specimens and comparable safety, and although the risk of bleeding should be kept in mind, EUS-FNB using a Franseen needle is likely to become a standard procedure for obtaining pancreatic tissue in the near future.

DOI： 10.1155/2019/8581743

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その他リンク： http://downloads.hindawi.com/journals/cjgh/2019/8581743.xml

Clinicopathological analysis of primary intestinal diffuse large B-cell lymphoma: Prognostic evaluation of CD5, PD-L1, and Epstein-Barr virus on tumor cells

Ishikawa Eri, Kato Seiichi, Shimada Kazuyuki, Tanaka Tsutomu, Suzuki Yuka, Satou Akira, Kohno Kei, Sakakibara Ayako, Yamamura Takeshi, Nakamura Masanao, Miyahara Ryoji, Goto Hidemi, Nakamura Shigeo, Hirooka Yoshiki

CANCER MEDICINE   7 巻 ( 12 ) 頁： 6051 - 6063   2018年12月

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

Background: Primary intestinal diffuse large B-cell lymphoma (iDLBCL) is rare. In this study, we investigated the clinicopathological features of this disease to further understand the prognostic value of CD5, programmed cell death ligand 1 (PD-L1), and Epstein-Barr virus (EBV) on tumor cells. Methods: Tumor specimens from 62 patients consecutively diagnosed with primary iDLBCL at a single institution were analyzed. Results: Our series consisted of EBV-positive (EBV + ) iDLBCL (n = 10), de novo CD5 + iDLBCL (n = 4), and DLBCL, not otherwise specified (DLBCL-NOS; n = 48). Notably, seven of 10 EBV + cases had treated lymphoma-associated (n = 4) or iatrogenic immunodeficiency (n = 3). Two of 10 EBV + cases expressed PD-L1 on tumor cells, whereas the remaining eight were positive for PD-L1 on microenvironment immune cells. Only one DLBCL-NOS case had neoplastic PD-L1 expression with a giant cell-rich appearance. Both EBV-harboring and PD-L1 expression on tumor cells, but not CD5, were associated with worse overall survival (OS) in iDLBCL patients receiving rituximab-containing chemotherapy (P = 0.0354, P = 0.0092, and P = 0.1097, respectively). Multivariate analysis identified PD-L1 positivity on tumor cells (P = 0.0106), PD-L1 negativity on microenvironment immune cells (P = 0.0193), and EBV positivity (P = 0.0324) as poor independent prognostic factors for OS. Among iDLBCL cases without any EBV association, CD5 positivity, or neoplastic PD-L1 expression, high PD-L1 expression (≥40%) on microenvironment immune cells predicted an extremely favorable outcome. Conclusion: EBV + iDLBCL mainly comprised immunodeficiency-associated patients, which may highlight the specificity of the intestine. PD-L1 expression on tumor cells or microenvironment immune cells was found to have an opposite prognostic impact in iDLBCL.

DOI： 10.1002/cam4.1875

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Validity of Capsule Endoscopy in Monitoring Therapeutic Interventions in Patients with Crohn's Disease 査読有り 国際誌

Nakamura Masanao, Yamamura Takeshi, Maeda Keiko, Sawada Tsunaki, Mizutani Yasuyuki, Ishikawa Takuya, Furukawa Kazuhiro, Ohno Eizaburo, Kawashima Hiroki, Miyahara Ryoji, Koulaouzidis Anastasios, Hirooka Yoshiki

JOURNAL OF CLINICAL MEDICINE   7 巻 ( 10 )   2018年10月

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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 Clinical Medicine  

Mucosal healing in Crohn’s disease (CD) can be evaluated by capsule endoscopy (CE). However, only a few studies have utilized CE to demonstrate the therapeutic effect of medical treatment. We sought to evaluate the validity of using CE to monitor the effect of medical treatment in patients with CD. One hundred (n = 100) patients with CD were enrolled. All patients had a gastrointestinal (GI) tract patency check prior to CE. Patients with baseline CE Lewis score (LS) ≤ 135 were included in the non-active CD group and ended the study. In those with LS > 135 (active CD group), additional treatment was administered, regardless of symptoms, as per the treating clinician’s advice. Patients of the active CD group underwent follow-up CE assessment 6 months later. Out of 92 patients with confirmed GI patency who underwent CE, 40 (43.4%) had CE findings of active inflammation. Of 29 patients with LS > 135 who received additional medications and underwent follow-up CE, improvement of the LS was noted in 23 (79.3%) patients. Eleven patients were asymptomatic but received additional medications; 8 (72.7%) had improvement of the LS. This study demonstrated that additional treatment even for patients with CD in clinical remission and active small-bowel inflammation on CE can reduce mucosal damage.

DOI： 10.3390/jcm7100311

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Prospective study predicting histology in colorectal lesions using wNICE, wJNET, and MS classifications

Pu L. Zorron Cheng Tao, Yamamura T., Nakamura M., Koay D. S. C., Ovenden A., Edwards S., Hoong C. K., Burt A. D., Hirooka Y., Singh R.

JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY   33 巻   頁： 14 - 14   2018年9月

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Web of Science

Prevalence and distribution of serrated polyps in the colon

Pu L. Zorron Cheng Tao, Singh G., Krishnamurthi S., Ovenden A., Nakamura M., Yamamura T., Rana K., Lu K., Edwards S., Ruszkiewicz A., Hoong C. K., Hirooka Y., Burt A. D., Singh R.

JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY   33 巻   頁： 185 - 186   2018年9月

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Web of Science

Effect of training and time of the day on polyp detection rates

Pu L. Zorron Cheng Tao, Lu K., Ovenden A., Rana K., Singh G., Krishnamurthi S., Edwards S., Wilson B., Nakamura M., Yamamura T., Ruszkiewicz A., Hoong C. K., Hirooka Y., Burt A. D., Singh R.

JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY   33 巻   頁： 184 - 185   2018年9月

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Prospective study predicting histology in colorectal lesions using wNICE, wJNET, and MS classifications

Pu L. Zorron Cheng Tao, Yamamura T, Nakamura M, Koay D. S. C, Ovenden A, Edwards S, Hoong C. K, Burt A. D, Hirooka Y, Singh R

JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY   33 巻   頁： 14 - 14   2018年9月

Effect of training and time of the day on polyp detection rates

Pu L. Zorron Cheng Tao, Lu K, Ovenden A, Rana K, Singh G, Krishnamurthi S, Edwards S, Wilson B, Nakamura M, Yamamura T, Ruszkiewicz A, Hoong C. K, Hirooka Y, Burt A. D, Singh R

JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY   33 巻   頁： 184 - 185   2018年9月

Prevalence and distribution of serrated polyps in the colon

Pu L. Zorron Cheng Tao, Singh G, Krishnamurthi S, Ovenden A, Nakamura M, Yamamura T, Rana K, Lu K, Edwards S, Ruszkiewicz A, Hoong C. K, Hirooka Y, Burt A. D, Singh R

JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY   33 巻   頁： 185 - 186   2018年9月

Prospective study predicting histology in colorectal lesions using wNICE, wJNET, and MS classifications

Pu L. Zorron Cheng Tao, Yamamura T, Nakamura M, Koay D. S. C, Ovenden A, Edwards S, Hoong C. K, Burt A. D, Hirooka Y, Singh R

JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY   33 巻   頁： 14 - 14   2018年9月

Effect of training and time of the day on polyp detection rates

Pu L. Zorron Cheng Tao, Lu K, Ovenden A, Rana K, Singh G, Krishnamurthi S, Edwards S, Wilson B, Nakamura M, Yamamura T, Ruszkiewicz A, Hoong C. K, Hirooka Y, Burt A. D, Singh R

JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY   33 巻   頁： 184 - 185   2018年9月

Prevalence and distribution of serrated polyps in the colon

Pu L. Zorron Cheng Tao, Singh G, Krishnamurthi S, Ovenden A, Nakamura M, Yamamura T, Rana K, Lu K, Edwards S, Ruszkiewicz A, Hoong C. K, Hirooka Y, Burt A. D, Singh R

JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY   33 巻   頁： 185 - 186   2018年9月

Effect of training and time of the day on polyp detection rates

Pu L. Zorron Cheng Tao, Lu K, Ovenden A, Rana K, Singh G, Krishnamurthi S, Edwards S, Wilson B, Nakamura M, Yamamura T, Ruszkiewicz A, Hoong C. K, Hirooka Y, Burt A. D, Singh R

JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY   33 巻   頁： 184 - 185   2018年9月

Prevalence and distribution of serrated polyps in the colon

Pu L. Zorron Cheng Tao, Singh G, Krishnamurthi S, Ovenden A, Nakamura M, Yamamura T, Rana K, Lu K, Edwards S, Ruszkiewicz A, Hoong C. K, Hirooka Y, Burt A. D, Singh R

JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY   33 巻   頁： 185 - 186   2018年9月

Prospective study predicting histology in colorectal lesions using wNICE, wJNET, and MS classifications

Pu L. Zorron Cheng Tao, Yamamura T, Nakamura M, Koay D. S. C, Ovenden A, Edwards S, Hoong C. K, Burt A. D, Hirooka Y, Singh R

JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY   33 巻   頁： 14 - 14   2018年9月

Objective evaluation of blood flow in the small-intestinal villous: quantification of findings from dynamic endoscopy with concomitant narrow-band imaging 査読有り 国際誌

Takeyama Tomoaki, Hirooka Yoshiki, Kawashima Hiroki, Ohno Eizaburo, Ishikawa Takuya, Yamamura Takeshi, Furukawa Kazuhiro, Funasaka Kohei, Nakamura Masanao, Miyahara Ryoji, Ishigami Masatoshi, Goto Hidemi

ENDOSCOPY INTERNATIONAL OPEN   6 巻 ( 8 ) 頁： E941 - E949   2018年8月

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1055/a-0619-4965

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groove膵癌の1症例

橋詰 清孝, 廣岡 芳樹, 川嶋 啓揮, 大野 栄三郎, 石川 卓哉, 桑原 崇通, 河合 学, 須原 寛樹, 竹山 友章, 小屋 敏也, 松下 正伸, 山村 健史, 古川 和宏, 舩坂 好平, 中村 正直, 宮原 良二, 渡辺 修, 後藤 秀実

肝胆膵治療研究会誌   15 巻 ( 1 ) 頁： 39 - 46   2018年8月

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記述言語：日本語   出版者・発行元：肝胆膵治療研究会  

症例は60歳代男性。膵頭部腫大と肝胆道系酵素高値にて当院紹介受診となった。造影CT検査ではgroove領域に正常膵実質と比較し、早期動脈相・後期動脈相では低吸収、門脈相でほぼ等吸収、平衡相でやや高吸収な腫瘤様所見を認めた。肝内・肝外胆管は拡張しており、膵内胆管に狭窄を認めたが、主膵管拡張は認めなかった。ERCP施行時、副乳頭周囲の十二指腸粘膜に発赤・襞のひきつれ所見を認めた。膵管像は膵頭部の主膵管に不整所見を認め、副膵管は造影されなかった。胆管像では膵内胆管の狭窄は平滑であった。EUSでは膵頭部に径約30mmの輪郭不明瞭な低エコー腫瘤を認めた。Sonazoidを用いた造影では全体が均一に染影されたが、内部に造影効果が著明に減弱する部位を認めた。診断目的にEUS-FNAを施行したが悪性所見は認めず、ERCP施行時の副乳頭周囲と胆管狭窄部からの生検でも悪性所見は認めなかった。画像診断(特に膵管造影所見)より悪性疾患の可能性が否定できず、十分な説明のもと膵頭十二指腸切除術を施行した。病理結果はgroove膵癌であった。(著者抄録)

groove膵癌の一例

橋詰 清孝, 廣岡 芳樹, 川嶋 啓揮, 大野 栄三郎, 桑原 崇通, 森島 大雅, 河合 学, 須原 寛樹, 竹山 友章, 小屋 敏也, 山村 健史, 舩坂 好平, 中村 正直, 宮原 良二, 渡辺 修, 後藤 秀実

肝胆膵治療研究会誌   15 巻 ( 1 ) 頁： 101 - 101   2018年8月

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記述言語：日本語   出版者・発行元：肝胆膵治療研究会  

主膵管と交通した膵漿液性嚢胞腺腫の1症例

酒井 大輔, 廣岡 芳樹, 川嶋 啓揮, 大野 栄三郎, 石川 卓哉, 須原 寛樹, 竹山 友章, 小屋 敏也, 田中 浩敬, 飯田 忠, 西尾 亮, 鈴木 博貴, 植月 康太, 松下 正伸, 山村 健史, 古川 和宏, 舩坂 好平, 中村 正直, 宮原 良二, 渡辺 修, 石上 雅敏, 後藤 秀実

肝胆膵治療研究会誌   15 巻 ( 1 ) 頁： 71 - 78   2018年8月

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記述言語：日本語   出版者・発行元：肝胆膵治療研究会  

症例は70歳代男性。近医にて膵頭部に多房性嚢胞性病変、主膵管拡張を指摘。2年の経過で嚢胞性病変の増大を認め当科紹介となった。腹部造影CT検査では、膵頭部に70mm大で中心部が早期動脈相から平衡相まで均一に淡く造影される多房性嚢胞性病変を認め、主膵管は径15mmと拡張を認めた。EUSでは膵頭部病変はhoneycomb appearanceを認める多房性嚢胞性病変として描出された。また主膵管は嚢胞との交通が疑われ最大径17mmと著明に拡張していた。ERPでは膵頭部主膵管の腫瘍による圧排性狭窄と同部位で嚢胞との交通を認めた。画像診断上は膵漿液性腫瘍が第一に考えられたが70mm大の巨大な腫瘤で増大傾向があり、主膵管との交通を認めることから膵管内乳頭粘液性腫瘍を完全には否定できず亜全胃温存膵頭十二指腸切除術を施行した。手術標本の病理組織学的診断は漿液性嚢胞腺腫で、悪性所見は認めなかった。(著者抄録)

【知っておこう!遺伝性消化器疾患】Peutz-Jeghers症候群

中村 正直, 大宮 直木, 廣岡 芳樹, 後藤 秀実

消化器内視鏡   30 巻 ( 8 ) 頁： 1031 - 1034   2018年8月

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記述言語：日本語   出版者・発行元：(株)東京医学社  

Peutz-Jeghers症候群(PJS)は、食道を除く全消化管の過誤腫性ポリポーシスと、口唇、口腔、指趾の色素沈着を特徴とする常染色体優性遺伝性疾患である。消化管ポリポーシスでは小腸で最もポリープ数が多く、サイズも大きくなる。ポリープは有茎性であり頭部は分葉傾向を有する。組織学的には過誤腫であるが、上皮の過形成と粘膜筋板のポリープ内への樹枝状増生が他のポリポーシスと異なる。PJSの臨床経過中、腸重積の合併と、諸臓器における悪性疾患の合併に注意が必要である。他消化管と比較し小腸は管腔が狭く、ポリープの発育が速いため腸重積を起こしやすい。腸重積の好発年齢は若年であり、約30%は10歳までに起こるといわれる。一方、悪性腫瘍の合併は30歳以降で多く、消化管以外にも乳腺、子宮、卵巣、膵臓、肺などで発生する。消化管の状態の把握、腹部超音波、胸腹部CTや婦人科受診を行い、経年的な経過観察が重要である。(著者抄録)

主膵管と交通した膵漿液性嚢胞腫瘍の一例

酒井 大輔, 廣岡 芳樹, 川嶋 啓揮, 大野 栄三郎, 石川 卓哉, 須原 寛樹, 竹山 友章, 橋詰 清孝, 小屋 敏也, 田中 浩敬, 飯田 忠, 西尾 亮, 鈴木 博貴, 松下 正伸, 山村 健史, 古川 和宏, 舩坂 好平, 中村 正直, 宮原 良二, 渡辺 修, 後藤 秀実

肝胆膵治療研究会誌   15 巻 ( 1 ) 頁： 116 - 116   2018年8月

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記述言語：日本語   出版者・発行元：肝胆膵治療研究会  

Increase in breath hydrogen concentration was correlated with the main pancreatic duct stenosis

Sakai Daisuke, Hirooka Yoshiki, Kawashima Hiroki, Ohno Eizaburo, Ishikawa Takuya, Suhara Hiroki, Takeyama Tomoaki, Koya Toshinari, Tanaka Hiroyuki, Iida Tadashi, Nishio Ryo, Suzuki Hirotaka, Uetsuki Kota, Matsushita Masanobu, Yamamura Takeshi, Furukawa Kazuhiro, Funasaka Kohei, Nakamura Masanao, Miyahara Ryoji, Watanabe Osamu, Ishigami Masatoshi, Tsuruta Akihiro, Shin Woosuck, Goto Hidemi

JOURNAL OF BREATH RESEARCH   12 巻 ( 3 ) 頁： 036004   2018年7月

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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 Breath Research  

Background. Hydrogen is produced from unabsorbed carbohydrates in the intestine through degradation and metabolism by hydrogenase of intestinal bacteria. The hydrogen is then partially diffused into blood flow and released and detected in exhaled breath. Pancreatic juice production is decreased in patients with reduced pancreatic exocrine function, including those with pancreatic cancer, thus decreasing digestion and absorption of nutrients including carbohydrates, which may increase undigested carbohydrates in the intestine and increase breath hydrogen concentration (BHC). The aim of this study was to investigate the association between BHC and pancreatic diseases. Methods. A retrospective study was designed and 68 patients underwent morning fasting breath hydrogen test. Since there is no clear standard, normal BHC, the median of the measured values from the subjects (9 ppm) was adopted as the standard. The subjects were classified into those with a value exceeding the median (BHC high group: 32 patients) and a value equal to or below the median (BHC low group: 36 patients). Patients characteristics, blood test results and imaging findings characteristic of pancreatic diseases were compared between the groups. Results. The age was significantly higher (P = 0.010) and the incidences of pancreatic ductal adenocarcinoma and autoimmune pancreatitis were significantly higher (P = 0.018 and P = 0.004, respectively) in the BHC high group. With respect to the blood test items, the Alb level was significantly lower in the BHC high group (P = 0.005). With respect to the characteristic imaging findings of pancreatic diseases, the proportions of patients with pancreatic enlargement, the main pancreatic duct (MPD) stenosis, and the MPD dilatation were significantly higher in the BHC high group (P = 0.022, P < 0.001, and P = 0.002, respectively). On univariate analysis, only the MPD stenosis was extracted as an independent factor (P = 0.014). Conclusion. It was suggested that the fasting BHC is associated with pancreatic diseases causing stenosis of the MPD, including pancreatic cancer (UMIN000020777).

DOI： 10.1088/1752-7163/aaaf77

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A prognostic model, including the EBV status of tumor cells, for primary gastric diffuse large B-cell lymphoma in the rituximab era 査読有り 国際誌

Ishikawa Eri, Tanaka Tsutomu, Shimada Kazuyuki, Kohno Kei, Satou Akira, EladI Ahmed E., Sakakibara Ayako, Furukawa Kazuhiro, Funasaka Kohei, Miyahara Ryoji, Nakamura Masanao, Goto Hidemi, Nakamura Shigeo, Kato Seiichi, Hirooka Yoshiki

CANCER MEDICINE   7 巻 ( 7 ) 頁： 3510 - 3520   2018年7月

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

EBV-positive diffuse large B-cell lymphoma (DLBCL), not otherwise specified (NOS), often affects the gastrointestinal tract. However, the prognostic significance of EBV associated with primary gastric DLBCL (gDLBCL) has not been established. This retrospective study included 240 patients with primary gDLBCL, diagnosed between 1995 and 2015. Tumor specimens were analyzed with EBER in situ hybridization. In 25 (10%) cases, tumor cells harbored EBV. The EBV+ group more frequently exhibited programmed death-ligand 1 (PD-L1) expression in microenvironment immune cells, but not tumor cells, compared to the EBV− group (86% vs 43%, P =.006). Among 156 patients that received rituximab-containing chemotherapy, the EBV+ group had a significantly worse overall survival (OS) than the EBV− group (P =.0029). Multivariate analyses identified 3 independent adverse prognostic factors of OS: multiple gastric lesions (P =.002), EBER positivity (P =.003), and B symptoms (P =.018). These factors were combined to develop a gDLBCL prognostic (gDLP) model that significantly stratified the patients into 3 distinct risk groups (Scores: good = 0, intermediate = 1, and poor = 2/3, P <.0001) with 5-year OS rates of 100%, 81%, and 39%, respectively. Patients with EBV+ gDLBCL commonly exhibited microenvironmental PD-L1 expression and showed a significantly worse prognosis than subjects with EBV− gDLBCL. Our gDLP model, which included EBV+ tumor cells, provided good predictions of clinical outcome and may be useful for selecting patients in trials in the immune-oncology era.

DOI： 10.1002/cam4.1595

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EVALUATION OF LOCAL RECURRENCE AFTER COLD POLYPECTOMY COMPARED WITH CONVENTIONAL HOT POLYPECTOMY IN A PROSPECTIVE RANDOMIZED CONTROLLED TRIAL

Yamamura Takeshi, Saito Masashi, Watanabe Osamu, Nakamura Masanao, Matsushita Masanobu, Sawada Tsunaki, Mizutani Yasuyuki, Niwa Yoshiki, Ishikawa Eri, Suzuki Hiroto, Otsuka Hiroyuki, Uchida Genta, Nishikawa Takahiro, Ishida Tetsuya, Kuno Takeshi, Yamada Keisaku, Hattori Shun, Hashiguchi Hiroki, Suhara Hiroki, Ishikawa Takuya, Furukawa Kazuhiro, Funasaka Kohei, Ohno Eizaburo, Miyahara Ryoji, Kawashima Hiroki, Hirooka Yoshiki, Goto Hidemi

GASTROINTESTINAL ENDOSCOPY   87 巻 ( 6 ) 頁： AB478-AB478   2018年6月

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Web of Science

ENDOSCOPIC TREATMENT FOR SUPERFICIAL NON-AMPULLARY DUODENAL TUMORS

Furukawa Kazuhiro, Miyahara Ryoji, Funasaka Kohei, Suhara Hiroki, Matsushita Masanobu, Yamamura Takeshi, Ishikawa Takuya, Ohno Eizaburo, Nakamura Masanao, Kawashima Hiroki, Watanabe Osamu, Hirooka Yoshiki, Goto Hidemi

GASTROINTESTINAL ENDOSCOPY   87 巻 ( 6 ) 頁： AB315-AB316   2018年6月

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Web of Science

USEFULNESS OF HISTOLOGICAL ASSESSMENT WITH EUS-GUIDED FINE NEEDLE BIOPSY USING A NEW CORE NEEDLE IN PANCREATIC DISEASES

Ishikawa Takuya, Hirooka Yoshiki, Kawashima Hiroki, Ohno Eizaburo, Suhara Hiroki, Takeyama Tomoaki, Koya Toshinari, Tanaka Hiroyuki, Sakai Daisuke, Nishio Ryo, Iida Tadashi, Suzuki Hirotaka, Uetsuki Kota, Matsushita Masanobu, Yamamura Takeshi, Furukawa Kazuhiro, Funasaka Kohei, Nakamura Masanao, Miyahara Ryoji, Watanabe Osamu, Goto Hidemi

GASTROINTESTINAL ENDOSCOPY   87 巻 ( 6 ) 頁： AB432 - AB433   2018年6月

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PROSPECTIVE STUDY OF SMALL BOWEL CAPSULE ENDOSCOPY FOR EVALUATING THE THERAPEUTIC EFFECTS IN PATIENTS WITH CROHN'S DISEASE

Nakamura Masanao, Hirooka Yoshiki, Watanabe Osamu, Yamamura Takeshi, Matsushita Masanobu, Suhara Hiroki, Ishikawa Takuya, Furukawa Kazuhiro, Funasaka Kohei, Ohno Eizaburo, Kawashima Hiroki, Miyahara Ryoji, Koulaouzidis Anastasios, Goto Hidemi

GASTROINTESTINAL ENDOSCOPY   87 巻 ( 6 ) 頁： AB393 - AB393   2018年6月

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Web of Science

THE DIAGNOSTIC ABILITY AND PITFALL OF JNET(JAPAN NBI EXPERT TEAM)CLASSIFICATION IN TRAINEES

Suzuki Hiroto, Yamamura Takeshi, Watanabe Osamu, Nakamura Masanao, Matsushita Masanobu, Sawada Tsunaki, Mizutani Yasuyuki, Ishikawa Eri, Niwa Yoshiki, Uchida Genta, Otsuka Hiroyuki, Nishikawa Takahiro, Ishida Tetsuya, Yamada Keisaku, Hattori Shun, Kajikawa Go, Hashiguchi Hiroki, Suhara Hiroki, Ishikawa Takuya, Furukawa Kazuhiro, Funasaka Kohei, Ohno Eizaburo, Kawashima Hiroki, Miyahara Ryoji, Hirooka Yoshiki, Goto Hidemi

GASTROINTESTINAL ENDOSCOPY   87 巻 ( 6 ) 頁： AB489 - AB490   2018年6月

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USEFULLNESS OF CONTRAST-ENHANCED HARMONIC EUS(CH-EUS) FOR THE PREOPERATIVE ASSESSMENT OF MPD INVOLVEMENT IN IPMN; A RETROSPECTIVE COMPARISON STUDY OF CH-EUS AND IDUS

Ohno Eizaburo, Hirooka Yoshiki, Kawashima Hiroki, Ishikawa Takuya, Suhara Hiroki, Takeyama Tomoaki, Koya Toshinari, Tanaka Hiroyuki, Sakai Daisuke, Nishio Ryo, Iida Tadashi, Suzuki Hirotaka, Uetsuki Kota, Matsushita Masanobu, Furukawa Kazuhiro, Yamamura Takeshi, Funasaka Kohei, Nakamura Masanao, Miyahara Ryoji, Watanabe Osamu, Goto Hidemi

GASTROINTESTINAL ENDOSCOPY   87 巻 ( 6 ) 頁： AB426 - AB427   2018年6月

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Web of Science

OUTCOMES AND PREDICTORS OF SEVERE SUBMUCOSAL FIBROSIS IN COLORECTAL ENDOSCOPIC SUBMUCOSAL DISSECTION

Kaosombatwattana Uayporn, Yamamura Takeshi, Limsrivilai Julajak, Watanabe Osamu, Nakamura Masanao, Matsushita Masanobu, Suhara Hiroki, Ishikawa Takuya, Furukawa Kazuhiro, Funasaka Kohei, Ohno Eizaburo, Miyahara Ryoji, Kawashima Hiroki, Leelakusolvong Somchai, Hirooka Yoshiki, Goto Hidemi

GASTROINTESTINAL ENDOSCOPY   87 巻 ( 6 ) 頁： AB377 - AB377   2018年6月

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Web of Science

DIAGNOSTIC IMAGING SYSTEM WITH VIRTUAL ENTEROSCOPY AND COMPUTER-AIDED DETECTION FOR EVALUATION OF SMALL BOWEL LESIONS OF CROHN'S DISEASE

Furukawa Kazuhiro, Miyahara Ryoji, Funasaka Kohei, Suhara Hiroki, Matsushita Masanobu, Yamamura Takeshi, Ishikawa Takuya, Ohno Eizaburo, Nakamura Masanao, Kawashima Hiroki, Watanabe Osamu, Oda Masahiro, Mori Kensaku, Hirooka Yoshiki, Goto Hidemi

GASTROINTESTINAL ENDOSCOPY   87 巻 ( 6 ) 頁： AB304 - AB304   2018年6月

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Web of Science

ENDOSCOPIC TREATMENT FOR SUPERFICIAL NON-AMPULLARY DUODENAL TUMORS

Furukawa Kazuhiro, Miyahara Ryoji, Funasaka Kohei, Suhara Hiroki, Matsushita Masanobu, Yamamura Takeshi, Ishikawa Takuya, Ohno Eizaburo, Nakamura Masanao, Kawashima Hiroki, Watanabe Osamu, Hirooka Yoshiki, Goto Hidemi

GASTROINTESTINAL ENDOSCOPY   87 巻 ( 6 ) 頁： AB315-AB316   2018年6月

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

USEFULNESS OF HISTOLOGICAL ASSESSMENT WITH EUS-GUIDED FINE NEEDLE BIOPSY USING A NEW CORE NEEDLE IN PANCREATIC DISEASES

Ishikawa Takuya, Hirooka Yoshiki, Kawashima Hiroki, Ohno Eizaburo, Suhara Hiroki, Takeyama Tomoaki, Koya Toshinari, Tanaka Hiroyuki, Sakai Daisuke, Nishio Ryo, Iida Tadashi, Suzuki Hirotaka, Uetsuki Kota, Matsushita Masanobu, Yamamura Takeshi, Furukawa Kazuhiro, Funasaka Kohei, Nakamura Masanao, Miyahara Ryoji, Watanabe Osamu, Goto Hidemi

GASTROINTESTINAL ENDOSCOPY   87 巻 ( 6 ) 頁： AB432-AB433   2018年6月

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

PROSPECTIVE STUDY OF SMALL BOWEL CAPSULE ENDOSCOPY FOR EVALUATING THE THERAPEUTIC EFFECTS IN PATIENTS WITH CROHN'S DISEASE

Nakamura Masanao, Hirooka Yoshiki, Watanabe Osamu, Yamamura Takeshi, Matsushita Masanobu, Suhara Hiroki, Ishikawa Takuya, Furukawa Kazuhiro, Funasaka Kohei, Ohno Eizaburo, Kawashima Hiroki, Miyahara Ryoji, Koulaouzidis Anastasios, Goto Hidemi

GASTROINTESTINAL ENDOSCOPY   87 巻 ( 6 ) 頁： AB393-AB393   2018年6月

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OUTCOMES AND PREDICTORS OF SEVERE SUBMUCOSAL FIBROSIS IN COLORECTAL ENDOSCOPIC SUBMUCOSAL DISSECTION

Kaosombatwattana Uayporn, Yamamura Takeshi, Limsrivilai Julajak, Watanabe Osamu, Nakamura Masanao, Matsushita Masanobu, Suhara Hiroki, Ishikawa Takuya, Furukawa Kazuhiro, Funasaka Kohei, Ohno Eizaburo, Miyahara Ryoji, Kawashima Hiroki, Leelakusolvong Somchai, Hirooka Yoshiki, Goto Hidemi

GASTROINTESTINAL ENDOSCOPY   87 巻 ( 6 ) 頁： AB377-AB377   2018年6月

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

EVALUATION OF LOCAL RECURRENCE AFTER COLD POLYPECTOMY COMPARED WITH CONVENTIONAL HOT POLYPECTOMY IN A PROSPECTIVE RANDOMIZED CONTROLLED TRIAL

Yamamura Takeshi, Saito Masashi, Watanabe Osamu, Nakamura Masanao, Matsushita Masanobu, Sawada Tsunaki, Mizutani Yasuyuki, Niwa Yoshiki, Ishikawa Eri, Suzuki Hiroto, Otsuka Hiroyuki, Uchida Genta, Nishikawa Takahiro, Ishida Tetsuya, Kuno Takeshi, Yamada Keisaku, Hattori Shun, Hashiguchi Hiroki, Suhara Hiroki, Ishikawa Takuya, Furukawa Kazuhiro, Funasaka Kohei, Ohno Eizaburo, Miyahara Ryoji, Kawashima Hiroki, Hirooka Yoshiki, Goto Hidemi

GASTROINTESTINAL ENDOSCOPY   87 巻 ( 6 ) 頁： AB478-AB478   2018年6月

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

クローン病小腸術後患者に対するエレンタールの使用効果と内視鏡診断

中村 正直, 山村 健史, 前田 啓子, 澤田 つな騎, 水谷 泰之, 石川 卓哉, 古川 和宏, 舩坂 好平, 大野 栄三郎, 川嶋 啓揮, 宮原 良二, 廣岡 芳樹

Biomedical Research on Trace Elements   29 巻 ( 1 ) 頁： 50 - 51   2018年6月

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記述言語：日本語   出版者・発行元：日本微量元素学会  

DIAGNOSTIC IMAGING SYSTEM WITH VIRTUAL ENTEROSCOPY AND COMPUTER-AIDED DETECTION FOR EVALUATION OF SMALL BOWEL LESIONS OF CROHN'S DISEASE

Furukawa Kazuhiro, Miyahara Ryoji, Funasaka Kohei, Suhara Hiroki, Matsushita Masanobu, Yamamura Takeshi, Ishikawa Takuya, Ohno Eizaburo, Nakamura Masanao, Kawashima Hiroki, Watanabe Osamu, Oda Masahiro, Mori Kensaku, Hirooka Yoshiki, Goto Hidemi

GASTROINTESTINAL ENDOSCOPY   87 巻 ( 6 ) 頁： AB304 - AB304   2018年6月

USEFULLNESS OF CONTRAST-ENHANCED HARMONIC EUS(CH-EUS) FOR THE PREOPERATIVE ASSESSMENT OF MPD INVOLVEMENT IN IPMN; A RETROSPECTIVE COMPARISON STUDY OF CH-EUS AND IDUS

Ohno Eizaburo, Hirooka Yoshiki, Kawashima Hiroki, Ishikawa Takuya, Suhara Hiroki, Takeyama Tomoaki, Koya Toshinari, Tanaka Hiroyuki, Sakai Daisuke, Nishio Ryo, Iida Tadashi, Suzuki Hirotaka, Uetsuki Kota, Matsushita Masanobu, Furukawa Kazuhiro, Yamamura Takeshi, Funasaka Kohei, Nakamura Masanao, Miyahara Ryoji, Watanabe Osamu, Goto Hidemi

GASTROINTESTINAL ENDOSCOPY   87 巻 ( 6 ) 頁： AB426 - AB427   2018年6月

USEFULLNESS OF CONTRAST-ENHANCED HARMONIC EUS(CH-EUS) FOR THE PREOPERATIVE ASSESSMENT OF MPD INVOLVEMENT IN IPMN; A RETROSPECTIVE COMPARISON STUDY OF CH-EUS AND IDUS

Ohno Eizaburo, Hirooka Yoshiki, Kawashima Hiroki, Ishikawa Takuya, Suhara Hiroki, Takeyama Tomoaki, Koya Toshinari, Tanaka Hiroyuki, Sakai Daisuke, Nishio Ryo, Iida Tadashi, Suzuki Hirotaka, Uetsuki Kota, Matsushita Masanobu, Furukawa Kazuhiro, Yamamura Takeshi, Funasaka Kohei, Nakamura Masanao, Miyahara Ryoji, Watanabe Osamu, Goto Hidemi

GASTROINTESTINAL ENDOSCOPY   87 巻 ( 6 ) 頁： AB426 - AB427   2018年6月

DIAGNOSTIC IMAGING SYSTEM WITH VIRTUAL ENTEROSCOPY AND COMPUTER-AIDED DETECTION FOR EVALUATION OF SMALL BOWEL LESIONS OF CROHN'S DISEASE

Furukawa Kazuhiro, Miyahara Ryoji, Funasaka Kohei, Suhara Hiroki, Matsushita Masanobu, Yamamura Takeshi, Ishikawa Takuya, Ohno Eizaburo, Nakamura Masanao, Kawashima Hiroki, Watanabe Osamu, Oda Masahiro, Mori Kensaku, Hirooka Yoshiki, Goto Hidemi

GASTROINTESTINAL ENDOSCOPY   87 巻 ( 6 ) 頁： AB304 - AB304   2018年6月

DIAGNOSTIC IMAGING SYSTEM WITH VIRTUAL ENTEROSCOPY AND COMPUTER-AIDED DETECTION FOR EVALUATION OF SMALL BOWEL LESIONS OF CROHN'S DISEASE

Furukawa Kazuhiro, Miyahara Ryoji, Funasaka Kohei, Suhara Hiroki, Matsushita Masanobu, Yamamura Takeshi, Ishikawa Takuya, Ohno Eizaburo, Nakamura Masanao, Kawashima Hiroki, Watanabe Osamu, Oda Masahiro, Mori Kensaku, Hirooka Yoshiki, Goto Hidemi

GASTROINTESTINAL ENDOSCOPY   87 巻 ( 6 ) 頁： AB304 - AB304   2018年6月

USEFULLNESS OF CONTRAST-ENHANCED HARMONIC EUS(CH-EUS) FOR THE PREOPERATIVE ASSESSMENT OF MPD INVOLVEMENT IN IPMN; A RETROSPECTIVE COMPARISON STUDY OF CH-EUS AND IDUS

Ohno Eizaburo, Hirooka Yoshiki, Kawashima Hiroki, Ishikawa Takuya, Suhara Hiroki, Takeyama Tomoaki, Koya Toshinari, Tanaka Hiroyuki, Sakai Daisuke, Nishio Ryo, Iida Tadashi, Suzuki Hirotaka, Uetsuki Kota, Matsushita Masanobu, Furukawa Kazuhiro, Yamamura Takeshi, Funasaka Kohei, Nakamura Masanao, Miyahara Ryoji, Watanabe Osamu, Goto Hidemi

GASTROINTESTINAL ENDOSCOPY   87 巻 ( 6 ) 頁： AB426 - AB427   2018年6月

Fecal calprotectin reflects endoscopic activity in patients with small-bowel Crohn's disease according to double-balloon endoscopy findings

Matsuura, R; Watanabe, O; Nakamura, M; Yamamura, T; Matsushita, M; Suhara, H; Furukawa, K; Ishikawa, T; Funasaka, K; Ohno, E; Kawashima, H; Miyahara, R; Hirooka, Y; Goto, H

NAGOYA JOURNAL OF MEDICAL SCIENCE   80 巻 ( 2 ) 頁： 257 - 266   2018年5月

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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  

Fecal calprotectin (FC) has drawn attention as a biomarker in the evaluation of Crohn's disease (CD). However, few reports have provided a detailed examination of the relationship between small-bowel CD lesions and FC levels. The present study aimed to examine the entire small bowel using double-balloon endoscopy (DBE) and to determine the relationship between the endoscopic activity in small-bowel CD and FC levels. Twenty small-bowel CD patients, who underwent DBE, were prospectively enrolled. Endoscopic evaluation was based on the simple endoscopic score for CD, with the small bowel divided into four regions. This score was defined as the double-balloon endoscopic score for CD (DES-CD). Furthermore, to focus on mucosal membrane damage, we used the partial DES-CD (pDES-CD), in which presence of stenosis was excluded from DES-CD. DES-CD revealed a correlation with FC (γ = 0.691, P = 0.001) and C-reactive protein (CRP) (γ = 0.631, P = 0.003) levels. Furthermore, pDES-CD showed a correlation with the FC level (γ = 0.747, P < 0.001), erythrocyte sedimentation rate (γ = 0.492, P = 0.028), and the CRP level (γ = 0.605, P = 0.005). CD Activity Index and endoscopic score showed no correlation. Our results revealed a correlation between the endoscopic activity in small-bowel CD and FC levels. Furthermore, pDES-CD showed a strong correlation with FC levels. This may be because FC levels were elevated due to mucosal membrane damages, rather than stenoses.

DOI： 10.18999/nagjms.80.2.257

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Nomogram-based prediction of rebleeding in small bowel bleeding patients: the 'PRSBB' score 査読有り

Uchida Genta, Hirooka Yoshiki, Nakamura Masanao, Watanabe Osamu, Yamamura Takeshi, Matsushita Masanobu, Suhara Hiroki, Ishikawa Takuya, Furukawa Kazuhiro, Funasaka Kohei, Ohno Eizaburo, Kawashima Hiroki, Miyahara Ryoji, Goto Hidemi

SCIENTIFIC REPORTS   8 巻 ( 1 ) 頁： 6378   2018年4月

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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  

Small bowel capsule endoscopy (SBCE) and balloon-assisted endoscopy (BAE) have revolutionized the diagnosis and treatment of small bowel bleeding (SBB), allowing access to the small bowel and identification of specific bleeding lesions. However, some patients experience rebleeding after small bowel investigation, and there are no definitive algorithms for determining the most appropriate follow-up strategy in SBB patients. We developed and validated a nomogram that can predict rebleeding risk and be used to develop a risk-stratified follow-up strategy in SBB patients. A retrospective study was performed using data from 401 SBB patients who underwent SBCE at Nagoya University Hospital. We developed and internally validated a predictive model for rebleeding in the form of a nomogram using Cox regression models and a bootstrap resampling procedure. Optimal risk factors were selected according to the least absolute shrinkage and selection operator (LASSO). The LASSO method identified 8 independent predictors of rebleeding that could be assessed to obtain a 'predicting rebleeding in SBB', or 'PRSBB' score: age, sex, SBB type, transfusion requirement, cardiovascular disease, liver cirrhosis, SBCE findings, and treatment. The c-statistic for the predictive model was 0.681. In conclusion, our PRSBB score can help clinicians devise appropriate follow-up plans.

DOI： 10.1038/s41598-018-24868-0

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Multiphase evaluation of contrast-enhanced endoscopic ultrasonography in the diagnosis of pancreatic solid lesions

Ishikawa Takuya, Hirooka Yoshiki, Kawashima Hiroki, Ohno Eizaburo, Hashizume Kiyotaka, Funasaka Kohei, Nakamura Masanao, Miyahara Ryoji, Watanabe Osamu, Ishigami Masatoshi, Goto Hidemi

PANCREATOLOGY   18 巻 ( 3 ) 頁： 291 - 297   2018年4月

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

Background/Objectives: Time-intensity curve (TIC) under contrast-enhanced EUS (CE-EUS) allows continuous and quantitative evaluation of targeted area in the pancreas. However, TIC is not always available and the procedure is complicated. We aimed to propose a simplified method by evaluating multiple phases of CE-EUS in the diagnosis of pancreatic solid lesions. Methods: We retrospectively reviewed 210 patients with pancreatic solid lesions including 142 with pancreatic ductal cancer (PDAC), 31 with pancreatic neuroendocrine neoplasm, 13 with solid pseudopapillary neoplasm and 24 with mass-forming pancreatitis who underwent CE-EUS and achieved final diagnoses. The CE-EUS images were continuously recorded for 60 s, and each image at 20, 40 and 60 s was used for the evaluation. The images were classified into three patterns as hypoechoic, hyperechoic and isoechoic vascular patterns compared with the surrounding pancreas, and the relevance between the multiphase evaluation of CE-EUS and each disease group was investigated. Results: In PDAC group, majority of the lesions showed hypovascular pattern at 20 or 40 s after injection of contrast medium following early enhancement. The sensitivity, specificity and accuracy of PDAC pattern in the differentiation of PDAC from other lesions was 83.1%, 86.8% and 84.3%, respectively. On histopathological analysis, significant differences were seen in histologic types, infiltration (INF), and neural invasion (ne) between those who showed PDAC pattern and those who didn't. Conclusions: Multiphase evaluation of CE-EUS is convenient and useful method for the differentiation of pancreatic solid lesions which can be alternatively used for TIC.

DOI： 10.1016/j.pan.2018.02.002

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【薬剤と消化管疾患】抗血栓薬と小腸出血

中村 正直, 大宮 直木, 廣岡 芳樹, 後藤 秀実

消化器・肝臓内科   3 巻 ( 4 ) 頁： 367 - 370   2018年4月

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記述言語：日本語   出版者・発行元：(有)科学評論社  

Usefulness of shear wave elastography as a quantitative diagnosis of chronic pancreatitis 国際誌

Kuwahara Takamichi, Hirooka Yoshiki, Kawashima Hiroki, Ohno Eizaburo, Ishikawa Takuya, Yamamura Takeshi, Furukawa Kazuhiro, Funasaka Kohei, Nakamura Masanao, Miyahara Ryoji, Watanabe Osamu, Ishigami Masatoshi, Hashimoto Senju, Goto Hidemi

JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY   33 巻 ( 3 ) 頁： 756 - 761   2018年3月

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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: Chronic pancreatitis (CP) is sometimes diagnosed at the progressed stage. For the early diagnosis of CP, endoscopic ultrasonography (EUS) may be a useful method, but its diagnostic criteria is based on subjective judgment. Shear wave elastography (SW-EG) using transabdominal ultrasonography, which quantifies tissue elasticity as an absolute value, may be an objective and noninvasive method for the diagnosis of CP. Methods: Eighty-five patients with known or suspected CP who underwent both EUS and SW-EG from October 2012 to July 2016 were included in this study. Patients were categorized into four stages using Rosemont classification and into three stages using Japan Pancreas Society clinical diagnostic criteria 2009 that was EUS-based criteria for the diagnosis of CP. SW-EG was measured five times in the pancreatic parenchyma, and the median value was defined as the pancreatic elastic modulus (PEM). Results: Pancreatic elastic modulus was significantly positively correlated with Rosemont classification stage (rs = 0.54), Japan Pancreas Society stage (rs = 0.41), and the number of EUS features (rs = 0.47). Area under the receiver operating characteristic curve for the accuracy of SW-EG (consistent with CP and suggestive of CP vs normal and indeterminate for CP) was 0.77 (sensitivity 77.1%, specificity 64.9%). In a multivariate linear regression analysis including various EUS features related to PEM, hyperechoic foci with shadowing and lobularity with honeycombing were independent features related to PEM. Conclusions: Chronic pancreatitis may be diagnosed noninvasively and objectively using SW-EG without performing EUS.

DOI： 10.1111/jgh.13926

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Clinical significance of gastrointestinal patency evaluation by using patency capsule in Crohn's disease

Yoshimura Toru, Hirooka Yoshiki, Nakamura Masanao, Watanabe Osamu, Yamamura Takeshi, Matsushita Masanobu, Ishikawa Takuya, Furukawa Kazuhiro, Funasaka Kohei, Ohno Eizaburo, Kawashima Hiroki, Miyahara Ryoji, Goto Hidemi

NAGOYA JOURNAL OF MEDICAL SCIENCE   80 巻 ( 1 ) 頁： 121 - 128   2018年2月

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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  

Capsule endoscopy (CE) enables noninvasive visualization of the small bowel in Crohn's disease (CD), but should not be conducted in patients with bowel obstruction. Patency capsule (PC) can be ingested before conducting the CE examination to ensure patency of the gastrointestinal (GI) tract. This study aimed to evaluate the clinical significance of GI patency which the PC demonstrated. A retrospective review of the medical records was conducted with 99 consecutive patients with CD who underwent PC and CE at Nagoya University Hospital from January 2010 to May 2015. By using the Cox proportional hazards model, the association between the GI patency evaluated using the PC and the outcome in terms of the rate of patients who needed admission or surgery during the 2-year follow-up was examined. Of all 99 patients who ingested the PC, 84 (84.8%) were diagnosed as not having bowel obstruction, and therefore were eligible for CE (P group). Of the 15 patients in whom bowel obstruction was suspected (NP group), 12 patients underwent either the balloon-assisted endoscopy (n=10) or enteroclysis (n=2), and 11 were confirmed to have small bowel stricture. Non-admission rates of the P and NP groups during the 2-year observation period were 74/84 (88.0%) and 8/15 (53.3%), respectively (P<0.001). Non-operation rates of the P and NP groups during the 2-year observation period were 80/84 (95.2%) and 9/15 (60.0%), respectively (P<0.001). In conclusion, GI patency as diagnosed using the PC was associated with a significantly lower incidence of admission or surgical intervention.

DOI： 10.18999/nagjms.80.1.121

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Multiple keratotic papules and plaques on the trunk in Cowden's disease with MALT lymphoma 査読有り 国際誌

Mizuno Sayaka, Takeichi Takuya, Sato Junichi, Nakamura Masanao, Goto Hidemi, Sugiura Kazumitsu, Akiyama Masashi

JOURNAL OF DERMATOLOGY   45 巻 ( 2 ) 頁： 238 - 240   2018年2月

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記述言語：日本語   出版者・発行元：Wiley  

DOI： 10.1111/1346-8138.13851

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Associations between drugs and small-bowel mucosal bleeding: Multicenter capsule-endoscopy study 査読有り

Niikura Ryota, Yamada Atsuo, Maki Koutarou, Nakamura Masanao, Watabe Hirotsugu, Fujishiro Mitsuhiro, Oka Shiro, Esaki Motohiro, Fujimori Shunji, Nakajima Atsushi, Ohmiya Naoki, Matsumoto Takayuki, Tanaka Shinji, Koike Kazuhiko, Sakamoto Choitsu

DIGESTIVE ENDOSCOPY   30 巻 ( 1 ) 頁： 79 - 89   2018年1月

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記述言語：英語   出版者・発行元：Digestive Endoscopy  

Background and Aim: Although several drugs may induce small-bowel mucosal injuries, it is unclear whether these injuries contribute to overt small-bowel bleeding. This study was designed to evaluate the associations between drug use and small-bowel mucosal injury and between these mucosal injuries and overt bleeding in a disease-relevant population. Methods: We retrospectively studied patients with suspected small-bowel diseases who underwent capsule endoscopy between 2010 and 2013. Drug exposure, Charlson Comorbidity Index, smoking, and alcohol consumption were assessed before capsule endoscopy. Adjusted odds ratios (AOR) and confidence intervals (CI) were estimated for small-bowel mucosal injury and small-bowel overt bleeding. Results: In total, 850 patients were analyzed during the study period. Median age was 64 years, and 544 patients (64.0%) were men. Among the patients with small-bowel mucosal injury (n = 60) and without mucosal injury (n = 705), use of non-steroidal anti-inflammatory drugs (NSAIDs) (AOR 1.8, 95% CI 1.01–3.31) was significantly associated with an increased risk of small-bowel mucosal injury compared with non-use. Patients with small-bowel mucosal injury with overt bleeding (n = 85) and without overt bleeding (n = 60) were compared, and no significant difference between the groups in the usage rates for NSAIDs, thienopyridine, other antiplatelets, anticoagulants, acetaminophen, tramadol hydrochloride, or steroids was revealed, even after adjusting for confounders. Conclusion: Although the use of NSAIDs was significantly associated with an increased risk of small-bowel mucosal injury, no significant associations were observed between the use of such drugs and small-bowel overt bleeding.

DOI： 10.1111/den.12922

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Functional Correlation Between the Pancreas and the Small Intestine in Humans: The First Evaluation Using a Newly Developed Enteroscopy 査読有り

Hayashi Daijuro, Hirooka Yoshiki, Kawashima Hiroki, Ohno Eizaburo, Ishikawa Takuya, Kuwahara Takamichi, Kawai Manabu, Yamamura Takeshi, Furukawa Kazuhiro, Funasaka Kohei, Nakamura Masanao, Miyahara Ryoji, Watanabe Osamu, Ishigami Masatoshi, Hashimoto Senju, Goto Hidemi

PANCREAS   47 巻 ( 5 ) 頁： 601 - 608   2018年

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出版者・発行元：Pancreas  

Objectives: The aim of this study is to evaluate a functional correlation between the pancreas and the small intestine and the association of this relationship with nutritional status, using magnifying enteroscopy. Methods: The subjects were adults aged 20 years or older who underwent upper gastrointestinal endoscopy. An endoscope was inserted into the jejunum, and 10% glucose was sprayed under magnifying observation to evaluate changes in blood flow in the villous capillary network. Mucosal biopsy was performed before and after spraying to evaluate the incretin response in the jejunal mucosa. Results: A total of 124 patients participated in the study. There was a positive correlation between villous blood flow change and exocrine pancreas function (R = 0.4337, P < 0.0001). Changes of gastric inhibitory polypeptide and glucagon-like peptide messenger RNAs in biopsy samples were positively correlated with endocrine pancreas function in 88 patients without treatment for diabetes (R = 0.4314, P = 0.0012; R = 0.4112, P = 0.0081). In patients with lower villous blood flow change and decreased pancreatic exocrine function, the prognostic nutritional index were significantly lower (P = 0.0098), compared with other patients. Conclusions: This study provides the first evidence of a close functional correlation between the pancreas and the small intestine.

DOI： 10.1097/MPA.0000000000001039

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Endoscopic ultrasound in diagnosis of solid pancreatic lesions: Elastography or contrast-enhanced harmonic alone versus the combination.

Chantarojanasiri T, Hirooka Y, Kawashima H, Ohno E, Kuwahara T, Yamamura T, Funasaka K, Nakamura M, Miyahara R, Ishigami M, Watanabe O, Hashimoto S, Hirakawa A, Ratanachu-Ek T, Goto H

Endoscopy international open   5 巻 ( 11 ) 頁： E1136 - E1143   2017年11月

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1055/s-0043-118829

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Development and validation of a new scoring system to determine the necessity of small-bowel endoscopy in obscure gastrointestinal bleeding 査読有り

Uchida Genta, Nakamura Masanao, Watanabe Osamu, Yamamura Takeshi, Ishikawa Takuya, Furukawa Kazuhiro, Funasaka Kohei, Ohno Eizaburo, Kawashima Hiroki, Miyahara Ryoji, Goto Hidemi, Hirooka Yoshiki

DIGESTIVE AND LIVER DISEASE   49 巻 ( 11 ) 頁： 1218 - 1224   2017年11月

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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 Small bowel capsule endoscopy (SBCE) is the recommended first-line procedure for obscure gastrointestinal bleeding (OGIB). However, a method for predicting the necessity of subsequent double-balloon endoscopy (DBE) has not been established. Aims We aimed to develop a new scoring system that predicts the necessity of DBE in OGIB. Methods A retrospective study was performed in 330 patients who underwent SBCE for OGIB at Nagoya University Hospital. The enrolled patients were randomly assigned to either a development or a validation dataset. The former was used to construct a prediction scoring system to assess the necessity of DBE using independent predictors selected by logistic regression. The diagnostic yield of the prediction model was assessed using the validation dataset. Results Multivariate logistic regression analysis of the development dataset identified OGIB type, blood transfusion, and SBCE findings as independent predictors of the necessity of DBE. A prediction score gave an area under the receiver operating characteristics curve of 0.77. The sensitivity, specificity, positive predictive value, and negative predictive value at a cutoff ≥2.5 points were 72.5%, 74.6%, 72.6%, and 74.5%, respectively. Conclusion Our scoring system may aid clinicians in deciding when to recommend DBE for patients with OGIB.

DOI： 10.1016/j.dld.2017.08.036

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【臓器間ネットワークからみた肝胆膵の恒常性とその破綻】正常状態での肝胆膵領域の臓器間ネットワーク 小腸内視鏡拡大観察を用いた機能的膵小腸相関の解明

酒井 大輔, 廣岡 芳樹, 川嶋 啓揮, 大野 栄三郎, 石川 卓哉, 須原 寛樹, 竹山 友章, 橋詰 清孝, 小屋 敏也, 田中 浩敬, 飯田 忠, 西尾 亮, 鈴木 博貴, 松下 正伸, 山村 健史, 古川 和宏, 舩坂 好平, 中村 正直, 宮原 良二, 渡辺 修, 後藤 秀実

肝胆膵   75 巻 ( 5 ) 頁： 929 - 936   2017年11月

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記述言語：日本語   出版者・発行元：(株)アークメディア  

<i>In vivo</i> histological diagnosis for gastric cancer using endocytoscopy 査読有り

Tsurudome Issei, Miyahara Ryoji, Funasaka Kohei, Furukawa Kazuhiro, Matsushita Masanobu, Yamamura Takeshi, Ishikawa Takuya, Ohno Eizaburo, Nakamura Masanao, Kawashima Hiroki, Watanabe Osamu, Nakaguro Masato, Satou Akira, Hirooka Yoshiki, Goto Hidemi

WORLD JOURNAL OF GASTROENTEROLOGY   23 巻 ( 37 ) 頁： 6894 - 6901   2017年10月

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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  

Aim To examine usefulness of virtual biopsy using endocytoscopy by comparing the in vivo endocytoscopic and histopathological images of gastric cancers. METHODS Endocytoscopy was performed in 30 patients with early gastric cancer. Of these, 26 patients showed well differentiated adenocarcinomas, while 4 patients showed poorly differentiated adenocarcinomas (including one signet ring cell carcinoma). Cancerous and non-cancerous areas were observed after double staining with 0.05% crystal violet and 0.1% methylene blue. The endocytoscopic images obtained were evaluated by an expert endoscopist and an expert pathologist without knowledge of patient clinical data, and endocytoscopic and histopathological diagnoses were compared. RESULTS The endocytoscopic images of the cancerous area were assessed as evaluable in 25 (83.3%) and 27 (90%) patients by endoscopist A and pathologist B, respectively, and those of the non-cancerous area as evaluable in 28 (93.3%) and 23 (76.7%) patients by the endoscopist and pathologist, respectively. The sensitivity, specifcity, and diagnostic accuracy of gastric cancer diagnosis using evaluable endocytoscopic images were 88.0% and 92.9%, and 90.6% by endoscopist A, and 88.9% and 91.3%, and 90.0% by pathologist B, respectively. Evaluation of the diagnostic concordance rate between the endoscopist and the pathologist by inter-observer agreement calculation revealed no significant difference between the two observers. The inter-observer agreement (-value) for endocytoscopic diagnosis was 0.745. CONCLUSION Endocytoscopy is useful for the differentiation of cancerous from non-cancerous gastric mucosa, making it a promising tool for virtual biopsy.

DOI： 10.3748/wjg.v23.i37.6894

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ETV1 expression would be a predictive marker of malignancy in GIST

Funasaka Kohei, Miyahara Ryoji, Furukawa Kazuhiro, Matsushita Masanobu, Yamamura Takeshi, Ishikawa Takuya, Ohno Eizaburo, Nakamura Masanao, Kawashima Hiroki, Watanabe Osamu, Hirooka Yoshiki, Goto Hidemi

JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY   32 巻   頁： 79-80   2017年9月

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Web of Science

Making decision to treat with infliximab by the result of periodic surveillance with double-balloon endoscopy after ilectomy can obtain mucosal healing and avoid re-operation on patients with Crohn's disease for a long-term follow-up study

Watanabe Osamu, Nakamura Masanao, Yamamura Takeshi, Matsushita Masanobu, Saito Masashi, Matsuura Rinzaburou, Sawada Tsunaki, Mizutani Yasuyuki, Niwa Yoshiki, Ishikawa Eri, Uchida Genta, Otsuka Hiroyuki, Suzuki Hiroto, Nishikawa Takahiro, Ishida Tetsuya, Yamada Keishi, Kuno Takeshi, Hattori Shun, Ishikawa Takuya, Furukawa Kazuhiro, Funasaka Kohei, Ohno Eizaburo, Miyahara Ryoji, Kawashima Hiroki, Hirooka Yoshiki, Goto Hidemi

JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY   32 巻   頁： 287 - 287   2017年9月

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Web of Science

ETV1 expression would be a predictive marker of malignancy in GIST

Funasaka Kohei, Miyahara Ryoji, Furukawa Kazuhiro, Matsushita Masanobu, Yamamura Takeshi, Ishikawa Takuya, Ohno Eizaburo, Nakamura Masanao, Kawashima Hiroki, Watanabe Osamu, Hirooka Yoshiki, Goto Hidemi

JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY   32 巻   頁： 79-80   2017年9月

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Making decision to treat with infliximab by the result of periodic surveillance with double-balloon endoscopy after ilectomy can obtain mucosal healing and avoid re-operation on patients with Crohn's disease for a long-term follow-up study

Watanabe Osamu, Nakamura Masanao, Yamamura Takeshi, Matsushita Masanobu, Saito Masashi, Matsuura Rinzaburou, Sawada Tsunaki, Mizutani Yasuyuki, Niwa Yoshiki, Ishikawa Eri, Uchida Genta, Otsuka Hiroyuki, Suzuki Hiroto, Nishikawa Takahiro, Ishida Tetsuya, Yamada Keishi, Kuno Takeshi, Hattori Shun, Ishikawa Takuya, Furukawa Kazuhiro, Funasaka Kohei, Ohno Eizaburo, Miyahara Ryoji, Kawashima Hiroki, Hirooka Yoshiki, Goto Hidemi

JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY   32 巻   頁： 287-287   2017年9月

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Proton pump inhibitor therapy did not increase the prevalence of small-bowel injury: A propensity-matched analysis 国際誌

Yamada Atsuo, Niikura Ryota, Maki Koutarou, Nakamura Masanao, Watabe Hirotsugu, Fujishiro Mitsuhiro, Oka Shiro, Fujimori Shunji, Nakajima Atsushi, Ohmiya Naoki, Matsumoto Takayuki, Tanaka Shinji, Koike Kazuhiko, Sakamoto Choitsu

PLOS ONE   12 巻 ( 8 ) 頁： e0182586   2017年8月

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

Background: Previous studies have reported that the suppression of acid secretion by using proton pump inhibitors (PPIs) results in dysbiosis of the small-bowel microbiota, leading to exacerbated small-bowel injuries, including erosions and ulcers. This study was designed to assess the association between PPI therapy and small-bowel lesions after adjustment for the differences in baseline characteristics between users and non-users of PPIs. Methods: We retrospectively studied patients suspected to be suffering from small-bowel diseases, who underwent capsule endoscopy between 2010 and 2013. We used propensity matching to adjust for the differences in baseline characteristics between users and non-users of PPIs. The outcomes included the prevalence of small-bowel lesions: erosion, ulcer, angioectasia, varices, and tumor. Results: We selected 327 patient pairs for analysis after propensity matching, and found no significant differences in the prevalence of small-bowel injuries, including erosions and ulcers, between users and non-users of PPIs. Two subgroup analyses of the effect of the type of PPI and the effect of PPI therapy in users and non-users of nonsteroidal anti-inflammatory drugs indicated no significant differences in the prevalence of small-bowel injuries in these two groups. Conclusion: PPI therapy did not increase the prevalence of small-bowel injury, regardless of the type of PPI used and the use of nonsteroidal anti-inflammatory drugs.

DOI： 10.1371/journal.pone.0182586

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Clinical factors related to false-positive rates of patency capsule examination 査読有り

Sawada Tsunaki, Nakamura Masanao, Watanabe Osamu, Yamamura Takeshi, Ishikawa Takuya, Furukawa Kazuhiro, Funasaka Kohei, Ohno Elzaburo, Kawashima Hiroki, Miyahara Ryoji, Goto Hidemi, Hirooka Yoshiki

THERAPEUTIC ADVANCES IN GASTROENTEROLOGY   10 巻 ( 8 ) 頁： 589 - 598   2017年8月

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Therapeutic Advances in Gastroenterology  

Background Retention is the most common complication of capsule endoscopy (CE), and is reported to occur in 0-13% of cases. To avoid retention, a PillCam patency capsule (PC) is used in patients with suspected intestinal stenosis. However, a relatively low positive predictive value of the PC examination has been reported previously. The aims of this study were to clarify the accuracy of PC examination and to evaluate clinical factors related to cases of false-positive detection. Methods We performed a retrospective single-center study of 282 consecutive patients referred for PC examination. Patients in which the PC could not pass through the small bowel within 33 h were classified into the 'no patency' group. The 'no patency' group was investigated for evidence of significant stenosis upon further examinations, including CE, double-balloon endoscopy, and small bowel follow-through after PC examination. Clinical factors related to small bowel patency and false-positive cases were evaluated. Results We included 161 male (57.1%) and 121 female (42.9%) patients with a mean age of 47.5 ± 17.7 years. Of the 282 patients enrolled, 27 patients exhibited 'no patency' upon PC examination. Multivariate analysis showed that clinical factors related to 'no patency' included Crohn's disease, abdominal symptoms, stenosis upon imaging, and previous abdominal surgery. Upon further examination, nine cases in the 'no patency' group had significant stenosis. Sensitivity, specificity, and negative and positive predictive values of PC examination for detecting small bowel stenosis were 93.8%, 96.6%, 99.6%, and 62.5%, respectively, and the only clinical factor related to false-positive cases was constipation (p < 0.05). Conclusion We found a relatively low positive predictive value of PC examination and that constipation was related to false-positive results. To extend the implications of CE indications, clinical study focusing on these results is expected.

DOI： 10.1177/1756283X17722744

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Quantitative diagnosis of chronic pancreatitis using EUS elastography

Kuwahara Takamichi, Hirooka Yoshiki, Kawashima Hiroki, Ohno Eizaburo, Ishikawa Takuya, Kawai Manabu, Suhara Hiroki, Takeyama Tomoaki, Hashizume Kiyotaka, Koya Toshinari, Tanaka Hiroyuki, Sakai Daisuke, Yamamura Takeshi, Furukawa Kazuhiro, Funasaka Kohei, Nakamura Masanao, Miyahara Ryoji, Watanabe Osamu, Ishigami Masatoshi, Hashimoto Senju, Goto Hidemi

JOURNAL OF GASTROENTEROLOGY   52 巻 ( 7 ) 頁： 868 - 874   2017年7月

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

Background: It is difficult to diagnose chronic pancreatitis (CP) objectively because of a lack of standard diagnostic criteria. Endoscopic ultrasonography (EUS) has been used to assess the severity of CP, but the diagnosis of CP using EUS depends on an endosnonographer. The aim of this study was to establish an objective diagnostic method for CP using EUS elastography (EUS-EG). Methods: A retrospective study was designed and 96 patients underwent EUS-EG for follow-up of known CP, or who were clinically suspected as having CP. CP patients were categorized CP patients as 4 stages using the Rosemont classification (RC). EUS-EG was performed and the “Mean value”, which was negatively correlated with pancreatic fibrosis, was calculated using histogram analysis. Results: The “Mean value” of each RC stage (normal, indeterminate for CP, suggestive of CP, and consistent with CP) was 90.1 ± 19.3, 73.2 ± 10.6, 63.7 ± 14.2, and 56.1 ± 13.6, respectively, and showed significant differences for each stage (p < 0.001). There was a significant negative correlation between the “Mean value” and the number of EUS features (rs = −0.59, p < 0.001). Multiple linear regression analysis was used to assess the diagnostic finding of the “Mean value” and showed that hyperechoic foci with shadowing and lobularity with honeycombing maintained their independent diagnostic findings. Conclusions: EUS-EG was an objective diagnostic apparatus for CP and provided objective information to support EUS features.

DOI： 10.1007/s00535-016-1296-8

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Inhibition of KDM4A activity as a strategy to suppress interleukin-6 production and attenuate colitis induction 査読有り

Ishiguro Kazuhiro, Watanabe Osamu, Nakamura Masanao, Yamamura Takeshi, Matsushita Masanobu, Goto Hidemi, Hirooka Yoshiki

CLINICAL IMMUNOLOGY   180 巻   頁： 120 - 127   2017年7月

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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 Immunology  

4-Chloro-7-nitro-2,1,3-benzoxadiazole (NBD-Cl) functions as a hapten and fluoresces upon binding to proteins. Therefore, fluorescence visualization of hapten-proteins is a feature of the colitis induced by NBD-Cl. Using this colitis model, we located activated fibroblasts in the vicinity of hapten-proteins upon colitis induction and observed interleukin (IL)-6 production in the activated fibroblasts. We screened herbal ingredients using primary fibroblasts stimulated with tumor necrosis factor α (TNF-α) and found the suppressive action of Atractylodin on IL-6 production. Under TNF-α stimulation, Atractylodin induced the tri-methylation of histone H3 at lysine residue 9, which impaired the binding between NF-κB and the IL-6 promoter on the genomic DNA. Atractylodin inhibited KDM4A but not KDM6A activity. Atractylodin administration attenuated colitis induction. The KDM4A inhibitor ML324 showed similar actions on IL-6 production and colitis induction. We propose the inhibition of KDM4A activity as a strategy to suppress IL-6 production and attenuate colitis induction.

DOI： 10.1016/j.clim.2017.05.014

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Combinational use of lipid-based reagents for efficient transfection of primary fibroblasts and hepatoblasts 査読有り

Ishiguro Kazuhiro, Watanabe Osamu, Nakamura Masanao, Yamamura Takeshi, Matsushita Masanobu, Goto Hidemi, Hirooka Yoshiki

BIOTECHNIQUES   63 巻 ( 1 ) 頁： 37 - 39   2017年7月

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

Commercially available lipid-based transfection reagents are widely used to deliver DNA to cells. However, these lipid-based transfection reagents show poor gene transfer efficiency in primary cells. Here, we demonstrate a simple method to improve gene transfer efficiency in primary fibroblasts and hepatoblasts using a combination of lipid-based transfection reagents. Our data show that combined use of Lipofectamine LTX and FuGENE HD increases the efficiency of gene transfer compared with the use of either reagent alone, and this combination achieves the best result of any pairwise combination of Lipofectamine LTX, FuGENE HD, TransFectin, and Fibroblast Transfection Reagent.

DOI： 10.2144/000114569

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CiNii Research

Predicting the Depth of Invasion of Esophageal Squamous Cell Carcinoma: Under Experience of Linked Colored Imaging With LED Light Source

Kobayashi Kenichi, Miyahara Ryoji, Funasaka Kohei, Furukawa Kazuhiro, Matsushita Masanobu, Yamamura Takeshi, Ishikawa Takuya, Ohno Eizaburo, Nakamura Masanao, Kawashima Hiroki, Watanabe Osamu, Hirooka Yoshiki, Goto Hidemi

GASTROINTESTINAL ENDOSCOPY   85 巻 ( 5 ) 頁： AB527 - AB527   2017年5月

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記述言語：英語  

DOI： 10.1016/j.gie.2017.03.1214

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A prospective randomised study comparing double-balloon colonoscopy and conventional colonoscopy in pre-defined technically difficult cases

Despott Edward J., Murino Alberto, Nakamura Masanao, Bourikas Leonidas, Fraser Chris

DIGESTIVE AND LIVER DISEASE   49 巻 ( 5 ) 頁： 507 - 513   2017年5月

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記述言語：英語   出版者・発行元：Digestive and Liver Disease  

Backgrounds and aim Technically ‘difficult’ (TD) colonoscopy is associated with incomplete colonoscopy, discomfort and longer procedures. Double-balloon colonoscopy (DBC) may facilitate TD colonoscopy. The primary outcome was to compare the time taken to achieve caecal intubation during conventional colonoscopy (CC) and DBC in patient with a TD colon. Methods We performed a prospective, randomised study comparing DBC and CC for TD colonoscopy. Patients were screened for parameters predictive of TD colonoscopy using an original scoring system and randomised to DBC or CC. Pain, sedation dose, colonoscopy completeness, time taken for cecal intubation, procedure completion, recovery time and patient satisfaction were recorded. Results Forty-four patients were recruited (DBC = 22; CC = 22). DBC facilitated total colonoscopy in 22 cases whereas 9 CC procedures were incomplete (P = 0.019). Median pre-procedure difficulty scores were equal for both groups (4.0 vs. 4.0). Mean patient discomfort, pain scores and recovery time were significantly lower for the DBC group (2.3 vs. 5.5, P = 0.001; 2.0 vs. 5.9, P = 0.005; 5 vs. 20 min, P = 0.014 respectively). Mean time taken for cecal intubation was similar (17.5 vs. 14 min, P = 0.18); Conclusion DBC facilitates colonoscopy completion and may be a more comfortable alternative to CC for TD cases although the time taken to achieve caecal intubation was similar.

DOI： 10.1016/j.dld.2017.01.139

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Comparison of the diagnostic ability of blue laser imaging magnification versus pit pattern analysis for colorectal polyps.

Nakano A, Hirooka Y, Yamamura T, Watanabe O, Nakamura M, Funasaka K, Ohno E, Kawashima H, Miyahara R, Goto H

Endoscopy international open   5 巻 ( 4 ) 頁： E224 - E231   2017年4月

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1055/s-0043-102400

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当院におけるInsideStentの現状

田中 浩敬, 廣岡 芳樹, 川嶋 啓揮, 大野 栄三郎, 石川 卓哉, 河合 学, 須原 寛樹, 竹山 友章, 橋詰 清孝, 小屋 敏也, 酒井 大輔, 松下 正伸, 山村 健史, 古川 和宏, 舩坂 好平, 中村 正直, 宮原 良二, 渡辺 修, 後藤 秀実

Gastroenterological Endoscopy   59 巻 ( Suppl.1 ) 頁： 926 - 926   2017年4月

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

【消化管結核の診断と治療-最近の進歩】抗結核薬による診断的治療が奏効した小腸多発潰瘍の1例

齋藤 雅之, 中村 正直, 渡辺 修, 山村 健史, 松下 正伸, 中野 有泰, 大島 啓嗣, 佐藤 淳一, 松浦 倫三郎, 舩坂 好平, 大野 栄三郎, 川嶋 啓揮, 宮原 良二, 廣岡 芳樹, 後藤 秀実

胃と腸   52 巻 ( 2 ) 頁： 233 - 238   2017年2月

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記述言語：日本語   出版者・発行元：(株)医学書院  

患者は60歳代,女性.下痢,食欲不振にて受診.腹部CT検査で腸間膜リンパ節腫大,腸管壁肥厚を認め,大腸内視鏡検査で回腸末端のびらんを認めた.小腸カプセル内視鏡検査およびバルーン内視鏡検査で中部空腸〜回腸末端までほぼ全域で多発する網目状潰瘍を認めた.生検では陰窩膿瘍を認めていた.Crohn病としてステロイド薬が投与されたが,病状悪化,血中サイトメガロウイルス(CMV)アンチゲネミアが陽転化し,CMV腸炎の診断で,ガンシクロビルが投与されたが,潰瘍治癒は得られなかった.結核菌,乾酪性肉芽腫は未検出,抗結核特異INF-γ陰性であったが,腸結核の可能性を考慮し,抗結核薬による診断的治療を行った.4ヵ月後に行った小腸内視鏡にて小腸潰瘍の消失を確認した.(著者抄録)

自己免疫性膵炎における造影超音波内視鏡(CE-EUS)を用いた血行動態の検討

橋詰 清孝, 廣岡 芳樹, 川嶋 啓揮, 大野 栄三郎, 石川 卓哉, 河合 学, 本多 隆, 中村 正直, 山本 健太, 後藤 秀実

超音波医学   44 巻 ( 1 ) 頁： 64 - 64   2017年1月

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記述言語：日本語   出版者・発行元：(公社)日本超音波医学会  

Specific characteristics of hemorrhagic Meckel's diverticulum at double-balloon endoscopy.

Mizutani Y, Nakamura M, Watanabe O, Yamamura T, Funasaka K, Ohno E, Kawashima H, Miyahara R, Murino A, Goto H Professor, Hirooka Y

Endoscopy international open   5 巻 ( 1 ) 頁： E35 - E40   2017年1月

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1055/s-0042-119810

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Prospective study of factors important to achieve observation of the entire colon on colon capsule endoscopy 査読有り

Sato Junichi, Nakamura Masanao, Watanabe Osamu, Yamamura Takeshi, Funasaka Kohei, Ohno Eizaburo, Miyahara Ryoji, Kawashima Hiroki, Goto Hidemi, Hirooka Yoshiki

THERAPEUTIC ADVANCES IN GASTROENTEROLOGY   10 巻 ( 1 ) 頁： 20 - 31   2017年1月

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Therapeutic Advances in Gastroenterology  

Background: Colon capsule endoscopy (CCE) is a procedure in which capsule swallowing facilitates observation of the lumen of the entire digestive tract. It does not require an air supply, and is a noninvasive procedure with a markedly low risk of adverse events in comparison with conventional colonoscopy (CS). It reduces patient stress, and may be acceptable to patients. A limitation of this procedure is that the entire colon observation rate (CCE excretion rate, completed CCE rate) is not 100%. In this study, we prospectively investigated clinical factors important to achieve observation of the entire colon on CCE. Methods: The participants were 70 patients for whom CCE was scheduled, and from whom written informed consent regarding participation in this study was obtained. We selected patient background/examination factors, and analyzed all factors involved in observation of the entire colon and factors for completion of the CCE within 4 h after the start of examination using multivariate analysis. Results: Of the 70 enrolled patients, 64 were analyzed, excluding 6. On multiple logistic analysis, only a water intake of ≥12.0 ml/min during examination [p = 0.025, odds ratio (OR): 46.753, 95% confidence interval (CI): 1.630-1341.248] was identified as an independent predictive factor involved in observation of the entire colon. With respect to factors involved in the completion of CCE within 4 h, multiple logistic analysis showed that a body mass index (BMI) of ≥25 (p = 0.039, OR: 13.723, 95% CI: 1.135-165.913), the absence of constipation (p = 0.030, OR: 13.988, 95% CI: 1.287-152.047), and a water intake of ≥12.0 ml/min during examination (p = 0.004, OR: 12.028, 95% CI: 2.225-65.029) were independent predictive factors. Conclusions: Completion of a CCE was most closely related to water intake per hour. In addition to water intake, CCE-promoting factors included a high BMI and the absence of constipation.

DOI： 10.1177/1756283X16673556

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Endoscopic Characteristics, Risk Grade, and Prognostic Prediction in Gastrointestinal Stromal Tumors of the Small Bowel 査読有り

Nakano Arihiro, Nakamura Masanao, Watanabe Osamu, Yamamura Takeshi, Funasaka Kohei, Ohno Eizaburo, Kawashima Hiroki, Miyahara Ryoji, Goto Hidemi, Hirooka Yoshiki

DIGESTION   95 巻 ( 2 ) 頁： 122 - 131   2017年

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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/Aims: Balloon-assisted endoscopy allows us to diagnose gastrointestinal (GI) stromal tumors (GISTs) in the small bowel including endoscopic ultrasonography and taking biopsy. The aim of this study was to retrospectively clarify clinical and endoscopic characteristics of small bowel GISTs using double-balloon endoscopy (DBE). Methods: We reviewed 25 patients who underwent DBE and were diagnosed with GISTs. The risk of GISTs was stratified using the National Institute of Health (NIH) consensus criteria. We evaluated the available DBE route, the diagnostic yield of biopsy examination, and the relationship between endoscopic characteristics and recurrence-free survival (RFS). Results: Of all 25 patients, 23 had any endoscopic findings related to GIST. They were detected using the antegrade approach in 91.3%. GISTs were classified into high risk (n = 7), intermediate risk (n = 4), low risk (n = 10), and very low risk (n = 4) based on surgical specimens. The diagnostic result of biopsy was 46.7% (7/15), but it was difficult to predict the NIH risk group. Endoscopic characteristics were not associated with RFS. The NIH risk group was significantly associated with RFS. Conclusions: Antegrade DBE was preferable for exploring small bowel GIST, but the diagnostic ability of biopsy examination was limited.

DOI： 10.1159/000454728

Web of Science

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PubMed

Dexmedetomidine provides less body motion and respiratory depression during sedation in double-balloon enteroscopy than midazolam.

Oshima H, Nakamura M, Watanabe O, Yamamura T, Funasaka K, Ohno E, Kawashima H, Miyahara R, Goto H, Hirooka Y

SAGE open medicine   5 巻   頁： 2050312117729920   2017年

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SAGE Open Medicine  

Objectives: Patients undergoing double-balloon enteroscopy require sedatives such as midazolam; however, patient’s body motion often hampers the outcome of double-balloon enteroscopy. Recently, dexmedetomidine has been used for endoscopic sedation and was reported to effectively reduce body motion. This study aimed to evaluate the efficacy and safety of sedation with dexmedetomidine in double-balloon enteroscopy (UMIN ID000015785). Methods: A prospective, observational study was conducted in 81 patients who underwent 111 double-balloon enteroscopy from July to December 2015 (dexmedetomidine group). The medical records of 112 patients who underwent 166 double-balloon enteroscopy with midazolam and pentazocine sedation from January 1 to October 31, 2014, were used for comparison (midazolam group). After propensity score matching, 182 double-balloon enteroscopy (91 double-balloon enteroscopy for each group) were analyzed. Results: There were 13 cases (11.7%) with body movements in the dexmedetomidine group. Comparison of the two groups matched by propensity score showed that the dexmedetomidine group had less body movement (12.1% vs 34.1%, p = 0.001) and less respiratory depression (50.5% vs 68.1%, p = 0.023). Hypotension (8.8% vs 4.4%, p = 0.232) and bradycardia (2.2% vs 0%, p = 0.497) were not significantly different in the two groups. Conclusion: Using dexmedetomidine for conscious sedation can reduce body motion and respiratory depression compared to our previous records.

DOI： 10.1177/2050312117729920

Web of Science

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PubMed

原因不明消化管出血精査後における再出血予測因子と適切な経過観察期間に関する検討

内田 元太, 中村 正直, 渡辺 修, 山村 健史, 松下 正伸, 石川 卓哉, 古川 和宏, 舩坂 好平, 大野 栄三郎, 川嶋 啓揮, 宮原 良二, 後藤 秀実, 廣岡 芳樹

日本消化器病学会雑誌   114 巻 ( 10 ) 頁： 1819 - 1829   2017年

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記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：一般財団法人 日本消化器病学会  

<p>原因不明消化管出血（OGIB）の長期予後に基づくマネジメント方法について検討した．対象は，2004年6月から2015年12月にOGIBに対して当院にて小腸カプセル内視鏡（CE）を施行した386例のうち，可視的出血をともなうovert OGIB症例318例で，その臨床的特徴と再出血予測因子について後方視的に検討し，再出血予測モデルを作成した．Overt OGIBの再出血予測因子は，CEにおける小腸血管性病変の存在，輸血歴，年齢60歳以上であり，それらの予測因子の保有数を参考にすることで，再出血率の推測が可能となり，個々の症例に対する適切なフォローアップ期間を提案できる可能性が示唆された．</p>

DOI： 10.11405/nisshoshi.114.1819

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PubMed

CiNii Research

Usefulness of flexible spectral imaging color enhancement (FICE) for the detection of angiodysplasia in the preview of capsule endoscopy. 査読有り

Nakamura M, Ohmiya N, Miyahara R, Ando T, Watanabe O, Kawashima H, Itoh A, Hirooka Y, Goto H.

Hepatogastroenterology   59 巻 ( 117 ) 頁： 1474-1477   2012年7月

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担当区分：筆頭著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

Are symptomatic changes in irritable bowel syndrome correlated with the capsule endoscopy transit time? A pilot study using the 5-HT4 receptor agonist mosapride.

Nakamura M, Ohmiya N, Miyahara R, Ando T, Watanabe O, Kawashima H, Itoh A, Hirooka Y, Niwa Y, Goto H.

  58 巻 ( 106 ) 頁： 453-458   2011年3月

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記述言語：英語   掲載種別：研究論文（学術雑誌）