Faculty Profiles - IIDA Tadashi

Papers - IIDA Tadashi

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

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

ENDOSCOPY Vol. 56 ( S 01 ) page： E83 - E84 2024.12

Gastrointestinal: Pancreatic intra-epithelial neoplasia from partial parenchymal atrophy

Yamao, K; Ishikawa, T; Mizutani, Y; Iida, T; Uetsuki, K; Kawashima, H

JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY Vol. 39 ( 9 ) page： 1711 - 1712 2024.9

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 Vol. 31 ( 8 ) page： 581 - 590 2024.8

Publisher：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

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 Vol. 86 ( 3 ) page： 407 - 421 2024.8

Publisher：Nagoya Journal of Medical Science

Vedolizumab is a treatment option for ulcerative colitis but data on predictors of treatment response remain insufficient to establish personalized treatment strategies. We aimed to investigate the real-world effectiveness of vedolizumab in adult patients with ulcerative colitis and explore factors involved in predicting treatment response. This single-center, single-arm, prospective observational study included 26 patients with clinically active ulcerative colitis patients’ characteristics at baseline, epidemiological information, existing treatment, clinical activity index score, endoscopic score, and blood test data were collected. Serum levels of tumor necrosis factors alpha, interferon gamma, interleukin-4, interleukin-6, interleukin-10, interleukin-17, soluble mucosal addressin cell adhesion molecule 1, and soluble vascular cell adhesion molecule 1 were measured. Patient characteristics in the remission and non-remission groups were compared based on these parameters. Clinical remission at 6 weeks of treatment occurred in 9 (35%) of the 26 patients. At 14 weeks, clinical remission was observed in 11 patients (42%). There were no significant differences pertaining to age, sex, duration of disease, extent of disease, steroid resistance, or prior treatment with biological agents among the two groups after 14 weeks of treatment. Hemoglobin ≥ 11.5 g/dL (odds ratio, 15.0; 95% confidence interval, 1.50–149; P=0.014) and soluble mucosal addressin cell adhesion molecule 1 ≥ 765 pg/mL (odds ratio, 17.3; 95% confidence interval, 2.36–127; P=0.004) were significant factors. In conclusion, hemoglobin and serum soluble mucosal addressin cell adhesion molecule 1 levels are factors correlated with the therapeutic efficacy of vedolizumab.

DOI： 10.18999/nagjms.86.3.407

Risk factors for recurrent biliary obstruction following suprapapillary placement of a plastic stent as preoperative biliary drainage for perihilar biliary malignancy

Kataoka, K; Ishikawa, T; Yamao, K; Mizutani, Y; Iida, T; Uetsuki, K; Onoe, S; Mizuno, T; Ebata, T; Kawashima, H

JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2024.7

Publisher：Journal of Hepato-Biliary-Pancreatic Sciences

Background/Purpose: The usefulness of endoscopic biliary stenting by deploying a plastic stent suprapapillary, called inside-stent (IS) placement, as preoperative biliary drainage (PBD) for perihilar biliary malignancy (PHBM) has been demonstrated. This study investigated risk factors for recurrent biliary obstruction (RBO) after IS placement. Methods: Consecutive patients with potentially resectable PHBM treated with IS placement as PBD between 2017 and 2023 at Nagoya University Hospital were retrospectively reviewed. Results: A total of 157 patients were included, with RBO occurring in 34 (22%) patients. The non-RBO rates were 83% at 30 days, 77% at 60 days, and 57% at 90 days. The most common cause of RBO was stent occlusion (n = 14), followed by segmental cholangitis (n = 12) and stent migration (n = 8). Stent migration and occlusion occurred more frequently within and after 1 week post-stenting, respectively. In multivariate analysis, biliary infection before IS was the sole risk factor for RBO, with a hazard ratio of 2.404 (95% confidence interval 1.163–4.972; p =.018). This risk was reduced by temporary endoscopic nasobiliary drainage prior to definitive IS placement. Conclusions: Biliary infection before IS was identified as an independent risk factor for RBO in patients with PHBM with IS as PBD. Clinical Trial Register: Clinical trial registration number: UMIN000025631.

DOI： 10.1002/jhbp.12043

Synthetic retinoid-mediated preconditioning of cancer-associated fibroblasts and macrophages improves cancer response to immune checkpoint blockade

Owaki, T; Iida, T; Miyai, Y; Kato, K; Hase, T; Ishii, M; Ando, R; Hinohara, K; Akashi, T; Mizutani, Y; Ishikawa, T; Mii, S; Shiraki, Y; Esaki, N; Yamamoto, M; Tsukamoto, T; Nomura, S; Murakami, T; Takahashi, M; Yuguchi, Y; Maeda, M; Sano, T; Sassa, N; Matsukawa, Y; Kawashima, H; Akamatsu, S; Enomoto, A

BRITISH JOURNAL OF CANCER Vol. 131 ( 2 ) page： 372 - 386 2024.7

Publisher：British Journal of Cancer

Background: The proliferation of cancer-associated fibroblasts (CAFs) hampers drug delivery and anti-tumor immunity, inducing tumor resistance to immune checkpoint blockade (ICB) therapy. However, it has remained a challenge to develop therapeutics that specifically target or modulate CAFs. Methods: We investigated the involvement of Meflin+ cancer-restraining CAFs (rCAFs) in ICB efficacy in patients with clear cell renal cell carcinoma (ccRCC) and urothelial carcinoma (UC). We examined the effects of Am80 (a synthetic retinoid) administration on CAF phenotype, the tumor immune microenvironment, and ICB efficacy in cancer mouse models. Results: High infiltration of Meflin+ CAFs correlated with ICB efficacy in patients with ccRCC and UC. Meflin+ CAF induction by Am80 administration improved ICB efficacy in the mouse models of cancer. Am80 exerted this effect when administered prior to, but not concomitant with, ICB therapy in wild-type but not Meflin-deficient mice. Am80-mediated induction of Meflin+ CAFs was associated with increases in antibody delivery and M1-like tumor-associated macrophage (TAM) infiltration. Finally, we showed the role of Chemerin produced from CAFs after Am80 administration in the induction of M1-like TAMs. Conclusion: Our data suggested that Am80 administration prior to ICB therapy increases the number of Meflin+ rCAFs and ICB efficacy by inducing changes in TAM phenotype. (Figure presented.)

DOI： 10.1038/s41416-024-02734-3

Cutting edge of endoscopic ultrasound-guided fine-needle aspiration for solid pancreatic lesions (NOV, 10.1007/s10396-023-01375-y, 2023)

Ishikawa, T; Yamao, K; Mizutani, Y; Iida, T; Kawashima, H

JOURNAL OF MEDICAL ULTRASONICS Vol. 51 ( 3 ) page： 539 - 539 2024.7

Publisher：Journal of Medical Ultrasonics

The article “Cutting edge of endoscopic ultrasound-guided fine-needle aspiration for solid pancreatic lesions”, written by Takuya Ishikawa, Kentaro Yamao, Yasuyuki Mizutani, Tadashi Iida and Hiroki Kawashima, was originally published electronically on the publisher’s internet portal on 1 November 2023 without open access. With the author(s)’ decision to opt for Open Choice the copyright of the article changed on 16 February 2024 to © The Author(s) 2023 and the article is forthwith distributed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0. The original article has been corrected.

DOI： 10.1007/s10396-024-01434-y

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 Vol. 59 ( 7 ) page： 621 - 628 2024.7

Publisher：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

Endoscopic diagnosis of perihilar cholangiocarcinoma

Kawashima Hiroki, Ishikawa Takuya, Yamao Kentaro, Mizutani Yasuyuki, Iida Tadashi, Uetsuki Kota

Tando Vol. 38 ( 1 ) page： 19 - 24 2024.3

Language：Japanese Publisher：Japan Biliary Association

<p>Diagnosis of biliary stricture lesions involves distinguishing between benign and malignant conditions and assessing the extent of progression in operable cases. Using dynamic CT for lesions detected through blood tests or abdominal ultrasound, the macroscopic features, progression extent, and degree of vascular infiltration are evaluated. In cases with a high likelihood of cancer, consideration is given to the feasibility of surgical intervention and, if possible, the anticipated surgical approach. Subsequently, endoscopic retrograde cholangiopancreatography (ERCP), along with intraductal ultrasound (IDUS), peroral cholangioscopy (POCS), and/or biliary biopsies and bile cytology, is employed for differentiating between benign and malignant diagnoses and assessing the longitudinal progression of the biliary duct. For challenging cases, such as flat-type strictures, a focus is placed on obtaining biopsies from the narrowed segment, while for nodular or papillary types prone to superficial progression, mapping biopsies are performed at appropriate locations considering the planned surgical approach. Endoscopic diagnostic techniques, including ERCP, carry the risk of adverse events. Therefore, understanding the advantages and disadvantages of various diagnostic methods, such as cytology, biopsy, peroral cholangioscopy, and ultrasound-guided fine-needle aspiration, is crucial for efficiently and reliably reaching a diagnosis.</p>

DOI： 10.11210/tando.38.19

Outcomes of endoscopic papillectomy of ampullary carcinoma and factors affecting additional surgery

Takada, Y; Ishikawa, T; Yamao, K; Mizutani, Y; Iida, T; Uetsuki, K; Gibo, N; Ohno, E; Kawashima, H

JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES Vol. 31 ( 2 ) page： 110 - 119 2024.2

Language：English Publisher：Journal of Hepato-Biliary-Pancreatic Sciences

Background/Purpose: Data on the prognosis of endoscopic papillectomy (EP) for ampullary carcinoma (AC) is limited; therefore, we aimed to identify the factors associated with endoscopically controlled AC. Methods: Between January 2003 and October 2022, 75 patients underwent EP for ampullary tumors and were diagnosed with AC based on the pathological features of the resected tissue. The factors associated with additional surgery after EP were also evaluated. Results: A total of 67 patients had ACs ranging from carcinoma in situ to tumors limited to the mucosa (M group), and eight patients had ACs ranging from those limited to the sphincter of Oddi to those invading the duodenal muscularis propria (OD group). The 3-year endoscopic tumor control (condition not requiring additional surgery) rates in the M and OD groups were 90.8% and 84.6% (p =.033), respectively. In the M group, the presence of tumor components in the resection margins was the only significant factor associated with additional surgeries (p =.010) in the univariate analysis. The 3-year endoscopic tumor control rates were 100% for negative and uncertain resection margins and 76.6% for positive margins (p =.009). Conclusions: If the AC is confined to the mucosa and the resection margins are negative or uncertain, the tumor can be well-controlled endoscopically.

DOI： 10.1002/jhbp.1375

An atypical case of isolated immunoglobulin G4-related sclerosing cholangitis with a cholangiogram resembling primary sclerosing cholangitis

Takada, Y; Ishikawa, T; Yamao, K; Mizutani, Y; Iida, T; Uetsuki, K; Kawashima, H

CLINICAL JOURNAL OF GASTROENTEROLOGY 2024.1

Language：English Publisher：Clinical Journal of Gastroenterology

An asymptomatic 77-year-old man with intrahepatic bile duct dilation was referred to our hospital. Cholangiography revealed alternations between strictures and dilated segments from the right and left hepatic ducts to the lower bile ducts, with findings of a pruned tree, beaded, shaggy appearance, and diverticulum-like outpouching. Histopathology revealed abundant immunoglobulin G4 (IgG4)-positive plasma cells (> 10 per high-power field) with an IgG4/IgG-positive cell ratio of 40–50%. After 2 weeks of steroid therapy, the cholangiography markedly improved. Because the cholangiographic findings resembled those of primary sclerosing cholangitis, steroid therapy proved useful in differentiating IgG4-related sclerosing cholangitis from primary sclerosing cholangitis.

DOI： 10.1007/s12328-023-01903-w

Meflin is a marker of pancreatic stellate cells involved in fibrosis and epithelial regeneration in the pancreas

Ando, R; Shiraki, Y; Miyai, Y; Shimizu, H; Furuhashi, K; Minatoguchi, S; Kato, K; Kato, A; Iida, T; Mizutani, Y; Ito, K; Asai, N; Mii, S; Esaki, N; Takahashi, M; Enomoto, A

JOURNAL OF PATHOLOGY Vol. 262 ( 1 ) page： 61 - 75 2024.1

Language：English Publisher：Journal of Pathology

Pancreatic stellate cells (PSCs) are stromal cells in the pancreas that play an important role in pancreatic pathology. In chronic pancreatitis (CP) and pancreatic ductal adenocarcinoma (PDAC), PSCs are known to get activated to form myofibroblasts or cancer-associated fibroblasts (CAFs) that promote stromal fibroinflammatory reactions. However, previous studies on PSCs were mainly based on the findings obtained using ex vivo expanded PSCs, with few studies that addressed the significance of in situ tissue-resident PSCs using animal models. Their contributions to fibrotic reactions in CP and PDAC are also lesser-known. These limitations in our understanding of PSC biology have been attributed to the lack of specific molecular markers of PSCs. Herein, we established Meflin (Islr), a glycosylphosphatidylinositol-anchored membrane protein, as a PSC-specific marker in both mouse and human by using human pancreatic tissue samples and Meflin reporter mice. Meflin-positive (Meflin+) cells contain lipid droplets and express the conventional PSC marker Desmin in normal mouse pancreas, with some cells also positive for Gli1, the marker of pancreatic tissue-resident fibroblasts. Three-dimensional analysis of the cleared pancreas of Meflin reporter mice showed that Meflin+ PSCs have long and thin cytoplasmic protrusions, and are localised on the abluminal side of vessels in the normal pancreas. Lineage tracing experiments revealed that Meflin+ PSCs constitute one of the origins of fibroblasts and CAFs in CP and PDAC, respectively. In these diseases, Meflin+ PSC-derived fibroblasts showed a distinctive morphology and distribution from Meflin+ PSCs in the normal pancreas. Furthermore, we showed that the genetic depletion of Meflin+ PSCs accelerated fibrosis and attenuated epithelial regeneration and stromal R-spondin 3 expression, thereby implying that Meflin+ PSCs and their lineage cells may support tissue recovery and Wnt/R-spondin signalling after pancreatic injury and PDAC development. Together, these data indicate that Meflin may be a marker specific to tissue-resident PSCs and useful for studying their biology in both health and disease. © 2023 The Pathological Society of Great Britain and Ireland.

DOI： 10.1002/path.6211

Impact of sarcopenia on biliary drainage during neoadjuvant therapy for pancreatic cancer

Kataoka, K; Ohno, E; Ishikawa, T; Yamao, K; Mizutani, Y; Iida, T; Takami, H; Maeda, O; Yamaguchi, J; Yokoyama, Y; Ebata, T; Kodera, Y; Kawashima, H

CLINICAL ENDOSCOPY Vol. 57 ( 1 ) page： 112 - 121 2024.1

Language：English Publisher：Clinical Endoscopy

Background/Aims: Since the usefulness of neoadjuvant chemo(radiation) therapy (NAT) for pancreatic cancer has been demonstrated, recurrent biliary obstruction (RBO) in patients with pancreatic cancer with a fully covered self-expandable metal stent (FCSEMS) during NAT is expected to increase. This study investigated the impact of sarcopenia on RBO in this setting. Methods: Patients were divided into normal and low skeletal muscle index (SMI) groups and retrospectively analyzed. Patient characteristics, overall survival, time to RBO (TRBO), stent-related adverse events, and postoperative complications were compared between the two groups. A Cox proportional hazard model was used to identify the risk factors for short TRBO. Results: A few significant differences were observed in patient characteristics, overall survival, stent-related adverse events, and postoperative complications between 38 patients in the normal SMI group and 17 in the low SMI group. The median TRBO was not reached in the normal SMI group and was 112 days in the low SMI group (p=0.004). In multivariate analysis, low SMI was the only risk factor for short TRBO, with a hazard ratio of 5.707 (95% confidence interval, 1.148-28.381; p=0.033). Conclusions: Sarcopenia was identified as an independent risk factor for RBO in patients with pancreatic cancer with FCSEMS during NAT.

DOI： 10.5946/ce.2022.278

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

Takada Yoshihisa, Ishikawa Takuya, Yamao Kentaro, Mizutani Yasuyuki, Iida Tadashi, Uetsuki Kota, Nakamura Masanao, Furukawa Kazuhiro, Yamamura Takeshi, Kawashima Hiroki

Internal Medicine Vol. advpub ( 0 ) 2024

Language：English Publisher：The Japanese Society of Internal Medicine

<p><b>Background </b>Gangliocytic paraganglioma (GP) significantly affects patients' quality of life. However, studies on endoscopic papillectomy (EP) for ampullary GP are limited. We therefore evaluated the safety and efficacy of EP for treating ampullary GP. </p><p><b>Methods </b>We retrospectively reviewed the clinicopathological characteristics of patients with GP who underwent EP at Nagoya University Hospital and conducted a literature survey. </p><p><b>Results </b>We enrolled six patients with a median tumor diameter of 17 mm. Complications related to EP were observed in three patients: two experienced bleeding, one had mild acute pancreatitis, and one had perforation (duplicate patients included), all of whom improved conservatively. Five resected specimens were confined to the submucosal layer, and one was beyond the submucosal layer. All patients were monitored without surgery, and no disease recurrence was observed after a median follow-up of 73 months. A literature review identified 14 patients, and additional surgery due to a positive vertical margin after EP revealed lymph node metastasis in 2 patients. There was no disease recurrence or death. </p><p><b>Conclusion </b>EP led to good long-term outcomes and effectively treated ampullary GP. Considering the potential for lymph node metastasis, additional surgery is recommended if the tumor exceeds the submucosal layer. </p>

DOI： 10.2169/internalmedicine.4102-24

Monoclonal Antibody Against Mature Interleukin-18 Ameliorates Colitis in Mice and Improves Epithelial Barrier Function

Ikegami, S; Maeda, K; Urano, T; Mu, JX; Nakamura, M; Yamamura, T; Sawada, T; Ishikawa, E; Yamamoto, K; Muto, H; Oishi, A; Iida, T; Mizutani, Y; Ishikawa, T; Kakushima, N; Furukawa, K; Ohno, E; Honda, T; Ishigami, M; Kawashima, H

INFLAMMATORY BOWEL DISEASES 2023.12

Cutting edge of endoscopic ultrasound-guided fine-needle aspiration for solid pancreatic lesions

Ishikawa, T; Yamao, K; Mizutani, Y; Iida, T; Kawashima, H

JOURNAL OF MEDICAL ULTRASONICS 2023.11

Language：English Publisher：Journal of Medical Ultrasonics

This article provides an extensive review of the advancements and future perspectives related to endoscopic ultrasound-guided tissue acquisition (EUS-TA) for the diagnosis of solid pancreatic lesions (SPLs). EUS-TA, including fine-needle aspiration (EUS-FNA) and fine-needle biopsy (EUS-FNB), has revolutionized the collection of specimens from intra-abdominal organs, including the pancreas. Improvements in the design of needles, collection methods, and specimen processing techniques have improved the diagnostic performance. This review highlights the latest findings regarding needle evolution, actuation number, sampling methods, specimen evaluation techniques, application of artificial intelligence (AI) for diagnostic purposes, and use of comprehensive genomic profiling (CGP). It acknowledges the rising use of Franseen and fork-tip needles for EUS-FNB and emphasizes that the optimal number of actuations requires further study. Methods such as the door-knocking and fanning techniques have shown promise for increasing diagnostic performance. Macroscopic on-site evaluation (MOSE) is presented as a practical rapid specimen evaluation method, and the integration of AI is identified as a potentially impactful development. The study also underscores the importance of optimal sampling for CGP, which can enhance the precision of cancer treatment. Ongoing research and technological innovations will further improve the accuracy and efficacy of EUS-TA.

DOI： 10.1007/s10396-023-01375-y

Current status of and future issues related to endoscopic papillectomy

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

NAGOYA JOURNAL OF MEDICAL SCIENCE Vol. 85 ( 4 ) page： 648 - 658 2023.11

Language：English Publisher：Nagoya Journal of Medical Science

Endoscopic papillectomy is widely performed to treat duodenal papillary tumors, particularly at highvolume centers. It is indicated for adenomas without intraductal extension of the bile or pancreatic ducts. However, despite numerous reports of carcinomas that expand the indications to include well-differentiated adenocarcinomas that do not invade the sphincter of Oddi, the low agreement between biopsy and final pathological diagnosis, as well as the current inability of imaging modalities to diagnose sphincter of Oddi invasion, makes it difficult to consider expanding indications. Although complications can be prevented by certain methods, such as pancreatic duct stenting, and the frequency of severe complications has decreased, the safety of the procedure remains unconfirmed. In the future, this technology is expected to progress and enable wider applications, including those in tumors with extensive horizontal spread and those with intraductal extension of the bile and pancreatic ducts. Such technology may also improve the safety and accuracy of diagnosis.

DOI： 10.18999/nagjms.85.4.648

Clinical Features and Long-term Prognosis of Type 1 Autoimmune Pancreatitis Based on the Location of Biliary Stenosis

Ishikawa Takuya, Yamao Kentaro, Mizutani Yasuyuki, Iida Tadashi, Uetsuki Kota, Gibo Noriaki, Kataoka Kunio, Mori Hiroshi, Takada Yoshihisa, Aoi Hironori, Minami Yoshiyuki, Kawashima Hiroki

Tando Vol. 37 ( 4 ) page： 754 - 762 2023.10

Language：Japanese Publisher：Japan Biliary Association

<p>We compared the clinical features and long-term prognosis of 159 patients with type 1 autoimmune pancreatitis (AIP) with and without bile duct involvement. Eighty-nine (56%) patients had bile duct involvement. Forty-nine patients (30.8%) had relapse, with a significantly higher cumulative relapse rate in patients with stenosis or wall thickening upstream of the intrapancreatic bile duct (3 years: 24% vs. 37.1%, <i>P</i><0.001). A significantly higher rate of two or more relapses (5.1% vs. 19.5%, <i>P</i>=0.01) was also found in these patients. Two patients with stenosis/dilatation up to the intrahepatic bile ducts became steroid-dependent and were treated with azathioprine. Type 1 AIP patients with stenosis and wall thickening upstream of the intrapancreatic bile ducts have a high relapse rate and may become steroid-dependent, especially in cases with stenosis and dilation extending into the intrahepatic bile ducts.</p>

DOI： 10.11210/tando.37.754

Real-World Effectiveness and Risk Factors for Discontinuation of Ustekinumab in Ulcerative Colitis.

Uchida G, Nakamura M, Yamamura T, Maeda K, Sawada T, Ishikawa E, Furukawa K, Iida T, Mizutani Y, Yamao K, Ishikawa T, Ishizu Y, Honda T, Ishigami M, Kawashima H

Inflammatory intestinal diseases Vol. 8 ( 2 ) page： 60 - 68 2023.10

Language：English Publisher：Inflammatory Intestinal Diseases

Introduction: Ustekinumab (UST) has been approved for the treatment of moderate-to-severe ulcerative colitis (UC). Real-world data showing the effectiveness and safety of UST are necessary to confirm the results of clinical trials for applicability in daily clinical practice. Although some studies have reported real-world evidence of UST, only few studies have confirmed its effectiveness in the real world. The aim of this study was to assess the short- and long-term effectiveness, durability, safety, and risk factors for discontinuation of UST in UC in clinical practice. Methods: This was a retrospective, single-center, observational study. From March 2020 to January 2023, all consecutive patients with active UC who were treated with UST at Nagoya University Hospital were included. The primary outcome was the clinical remission rate at weeks 2-8 and weeks 24-48. The secondary outcomes included clinical response, persistence of UST therapy, endoscopic changes during follow-up, risk factors for UST discontinuation, and occurrence of any adverse events. The clinical effectiveness was evaluated using the Lichtiger score. Results: A total of 31 patients were included in this study. The clinical remission rates were 9.7%, 29.0%, 54.8%, and 64.5% at weeks 2, 8, 24, and 48, respectively. Twelve (38.7%) patients discontinued UST during the follow-up period. The probability of continuing UST was 93.5%, 80.6%, 77%, and 70% at weeks 2, 8, 24, and 48, respectively. The major reason for discontinuation of UST was primary failure (75.0%). A high baseline C-reactive protein (CRP) level was a significant risk factor for the discontinuation of UST. No adverse events were observed in this study. Conclusion: UST is effective for patients with UC. High CRP levels were identified as a risk factor for UST discontinuation. The findings of this study would help clinicians to select appropriate treatment options for patients with UC by identifying the risk factors for treatment discontinuation.

DOI： 10.1159/000531497

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

Kataoka, K; Ishikawa, T; Ohno, E; Yamao, K; Mizutani, Y; Iida, T; Kato, K; Kinoshita, F; Yamamura, T; Furukawa, K; Nakamura, M; Kawashima, H

JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY Vol. 38 ( 9 ) page： 1647 - 1655 2023.9

Language：English Publisher：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

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