記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1016/j.gie.2018.01.021

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1159/000481237

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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.2016.03.1498

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記述言語：英語  

DOI： 10.1055/s-0034-1393649

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記述言語：英語   出版者・発行元：Endoscopy  

DOI： 10.1055/a-2234-4075

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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

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出版者・発行元：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

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記述言語：英語   出版者・発行元：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

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記述言語：英語  

DOI： 10.1159/000540052

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記述言語：英語   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

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記述言語：英語  

DOI： 10.1159/000539745

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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/a-2317-0520

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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.16571

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記述言語：英語   出版者・発行元：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

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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  

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

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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: In this study we aimed to develop an artificial intelligence-based model for predicting postendoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP). Methods: We retrospectively reviewed ERCP patients at Nagoya University Hospital (NUH) and Toyota Memorial Hospital (TMH). We constructed two prediction models, a random forest (RF), one of the machine-learning algorithms, and a logistic regression (LR) model. First, we selected features of each model from 40 possible features. Then the models were trained and validated using three fold cross-validation in the NUH cohort and tested in the TMH cohort. The area under the receiver operating characteristic curve (AUROC) was used to assess model performance. Finally, using the output parameters of the RF model, we classified the patients into low-, medium-, and high-risk groups. Results: A total of 615 patients at NUH and 544 patients at TMH were enrolled. Ten features were selected for the RF model, including albumin, creatinine, biliary tract cancer, pancreatic cancer, bile duct stone, total procedure time, pancreatic duct injection, pancreatic guidewire-assisted technique without a pancreatic stent, intraductal ultrasonography, and bile duct biopsy. In the three fold cross-validation, the RF model showed better predictive ability than the LR model (AUROC 0.821 vs. 0.660). In the test, the RF model also showed better performance (AUROC 0.770 vs. 0.663, P = 0.002). Based on the RF model, we classified the patients according to the incidence of PEP (2.9%, 10.0%, and 23.9%). Conclusion: We developed an RF model. Machine-learning algorithms could be powerful tools to develop accurate prediction models.

DOI： 10.1111/den.14622

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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  

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記述言語：英語   出版者・発行元：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

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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 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

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記述言語：英語   出版者・発行元：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

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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 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

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Wiley  

Abstract

Background and Aim

A multicenter, open‐label randomized Phase II trial was conducted to determine whether low‐dose gemcitabine plus nab‐paclitaxel (GnP) could improve tolerability and show equivalent efficacy to the standard‐dose GnP for elderly patients with metastatic pancreatic cancer.

Methods

Consecutive patients aged ≥65 years with metastatic pancreatic cancer who presented at one of four Japanese referral centers between November 2016 and January 2021 were enrolled. The 60 patients were randomly assigned to low‐ or standard‐dose groups with a 1:1 ratio. Patients in the low‐dose GnP group received gemcitabine at a dose of 250 mg/m² and nab‐paclitaxel at 125 mg/m².

Results

Low‐dose GnP significantly decreased the rate of cases requiring dose reduction (16.7% vs 63.3%). The response rate (36.7% vs 33.3%) and progression‐free survival (7.3 vs 8 months) were comparable between the low‐ and standard‐dose groups as determined by independent review. The difference in the median overall survival between the two groups was not significant (7.9 vs 12 months). The proportion of patients with hematologic and non‐hematologic treatment‐related adverse events was comparable between the two groups.

Conclusion

Low‐dose GnP had an equivalent efficacy to conventional therapy; however, it did not reduce adverse events.

DOI： 10.1002/jgh3.12966

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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

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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: 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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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: This prospective cohort study evaluated the feasibility of using endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) samples for comprehensive mutational analysis of cancer-related genes using microtissues. METHODS: Fifty patients with suspected pancreatic cancer presenting consecutively at the Kindai University Hospital between January 2018 and January 2019 were enrolled. Cancerous tissues from EUS-FNB were obtained from each tumor and subjected to histological examination and mutational analysis. The primary endpoint was the collection rate of EUS-FNB specimens suitable for comprehensive cancer panels using deep sequencing. Clinical history and genetic variations between the disease control and progressive disease groups of patients on chemotherapy were evaluated as secondary endpoints. RESULTS: The collection rate of EUS-FNB specimens suitable for comprehensive cancer panels using deep sequencing was 93.6%. The cancer panel was sequenced for 25 patients with pancreatic cancer treated initially with systemic chemotherapy. Mutation in p53 and Smad4 were positively and negatively associated, respectively, with disease control at the initial evaluation. The median time to progression in 15 patients with p53 and without Smad4 mutations was 182.0 days; whereas, it was 92.5 days in other 10 patients; this difference was significant (p = 0.020). CONCLUSIONS: Tissue samples from EUS-FNB were suitable for mutational analysis. Pancreatic cancers with p53 and without Smad4 mutations responded better to chemotherapy and had a better prognosis than those others.

DOI： 10.1007/s10147-023-02396-w

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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：Gastrointestinal Endoscopy  

Background and Aims: The diagnostic performance of EUS-guided fine-needle aspiration/biopsy sampling (EUS-FNAB) for pancreatic ductal adenocarcinoma (PDAC) ≤10 mm in diameter is relatively low. Pancreatic juice cytology (PJC) has gained attention because of its high sensitivity for small PDACs. We aimed to clarify the diagnostic ability of EUS-FNAB and the salvage ability of PJC for PDAC ≤10 mm. Methods: Data obtained from attempted EUS-FNAB for patients with EUS-confirmed pancreatic tumors ≤10 mm (excluding pancreatic metastases/malignant lymphomas) were retrospectively analyzed. Patients who experienced technical failure or had a negative EUS-FNAB result and had a strong likelihood of PDAC based on imaging characteristics underwent PJC. PDAC was diagnosed using resected histologic specimens, EUS-FNAB–positive tumor growth on the imaging examination, or additional EUS-FNAB–positive results after increase in tumor size. The primary endpoint was the diagnostic ability of EUS-FNAB for PDAC ≤10 mm. The salvage ability of PJC was also assessed. Results: Overall, 86 of 271 patients with pancreatic tumors ≤10 mm who underwent attempted EUS-FNAB were diagnosed with PDAC. The technical success rate, sensitivity, specificity, and accuracy of EUS-FNAB for PDAC ≤10 mm were 80.8%, 82.3%, 94.9%, and 91.3%, respectively. Among the 35 PDAC patients who experienced technical failure or false-negative results of EUS-FNAB, 26 (74.3%) were correctly diagnosed using salvage PJC. Conclusions: The true success rate and sensitivity of EUS-FNAB for PDAC ≤10 mm were relatively low. When EUS-FNAB for a pancreatic lesion ≤10 mm strongly suspected to be PDAC is unsuccessful or yields a negative result, PJC is recommended. (Clinical trial registration number: UMIN000049965.)

DOI： 10.1016/j.gie.2023.08.006

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Elsevier BV  

DOI： 10.1016/j.gie.2023.04.1087

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掲載種別：研究論文（学術雑誌）   出版者・発行元：The Editorial Office of Gut and Liver  

DOI： 10.5009/gnl220521

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND AND AIMS: Malignant gastric outlet obstruction (GOO) can be palliated by endoscopic placement of self-expandable metal stents (SEMSs). Studies comparing uncovered (USEMSs) and covered (CSEMSs) SEMSs have yielded inconclusive results. This meta-analysis compared USEMSs with CSEMSs in patients with GOO caused by intrinsic and extrinsic tumors. METHODS: Potentially relevant articles were identified by searching PubMed, the Cochrane Library, and Medline. The primary outcome was stent dysfunction. Relationships between characteristics of tumors causing GOO and the stent dysfunction rate following USEMSs and CSEMS placement were assessed. RESULTS: Overall, six randomized controlled trials and 12 observational studies, including 2431 patients, were identified. Rate of stent dysfunction did not differ significantly between USEMSs and CSEMSs (odds ratio [OR], 0.95; 95% confidence interval [CI], 0.73-1.25, I2 = 44%), but there was heterogeneity. Meta-regression analysis showed that heterogeneity of stent dysfunction was caused by a difference in the ratio of intrinsic-to-extrinsic tumors causing GOO between studies (coefficient, 0.944; 95% CI, 0.30-1.58). Studies were divided into intrinsic and extrinsic tumor groups. Subgroup analysis showed that the stent dysfunction rate did not differ between USEMSs and CSEMSs in the intrinsic tumor group (OR, 1.10; 95% CI, 0.85-1.41; I2 = 32%). In the extrinsic tumor group, USEMS was associated with a lower rate of stent dysfunction than CSEMS (OR, 0.64; 95% CI, 0.47-0.87; I2 = 25%). CONCLUSION: USEMS and CSEMS placement generally showed comparable outcomes among patients with GOO. USEMS was more effective than CSEMS for patients with GOO caused by extrinsic tumors.

DOI： 10.1007/s00464-022-09774-x

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記述言語：日本語   出版者・発行元：一般社団法人 日本膵臓学会  

<p>膵癌の特徴として間質の線維化とそれに伴う組織硬化がある．組織硬化は間質内圧上昇と血管虚脱を誘導し，その結果抗癌剤の間質浸透と癌細胞への到達を阻害することが知られている．この間質の線維化に中心的な役割を果たすのが癌関連線維芽細胞（CAF）である．このため，これまで様々な方法でCAFをターゲットにする治療が試みられてきたが未だ成功していない．本研究では癌抑制性CAFのマーカーであり機能分子であるMeflinをCAFに発現誘導することで，膵癌における化学療法への感受性を改善させることを明らかにした．さらにスクリーニングにより合成レチノイドであるAM80がCAFにおけるMeflinの発現を効果的に誘導し，ドラッグデリバリーの改善を伴って化学療法に対する感受性を改善させることを明らかにした．筆者らは本結果を受けて切除不能膵癌に対するAM80と従来の抗癌剤の併用効果を検証する医師主導治験を行っている．</p>

DOI： 10.2958/suizo.38.37

CiNii Research

記述言語：英語   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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PubMed

出版者・発行元：日本メディカルセンター  

DOI： 10.19020/cg.0000002511

CiNii Research

掲載種別：研究論文（学術雑誌）   出版者・発行元：Frontiers Media SA  

Background

Pancreatic neuroendocrine carcinoma (PanNEC) is a rare disease entity with rapid progression and poor prognosis. Here, we report a PanNEC case with unique morphological features mimicking intraductal papillary mucinous carcinoma.

Case presentation

A 69-year-old Japanese man was referred to our hospital for further evaluation of weight loss and deterioration of diabetes mellitus. Contrast-enhanced computed tomography showed a solid and cystic mass with hypo-enhancement at the tail of the pancreas. The main pancreatic duct (MPD) was diffusely dilated without obstruction, accompanied by marked parenchymal atrophy. Multiple peritoneal and omental nodules were observed, suggesting tumor dissemination. Endoscopic retrograde cholangiopancreatography revealed that the mass correlated with the dilated MPD. During pancreatography, a large amount of mucus was extruded from the pancreatic orifice of the ampulla. Based on these imaging findings, intraductal papillary mucinous carcinoma was suspected. Per-oral pancreatoscopy (POPS)-guided tumor biopsies were conducted for the lesion's solid components. Histopathological examination of the biopsied material confirmed small-cell-type PanNEC with a Ki-67 labeling index of 90%. Due to his condition's rapid decline, the patient was given the best supportive care and died 28 days after diagnosis.

Conclusion

Although rare, PanNEC, which correlates with the MPD and is accompanied by marked dilation of the MPD, does exist as one phenotype. In such cases, POPS-guided biopsy could be a useful diagnostic modality.

DOI： 10.3389/fmed.2022.951834

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background/Aims: Bispectral index (BIS) monitors process and display electroencephalographic data and are used to assess the depth of anesthesia. This study retrospectively evaluated the usefulness of BIS monitoring during endoscopic ultrasonography (EUS). Methods: This study included 725 consecutive patients who underwent EUS under sedation with propofol. BIS monitoring was used in 364 patients and was not used in 361. The following parameters were evaluated: (1) median dose of propofol; (2) respiratory and circulatory depression; (3) occurrence of body movements; (4) awakening score >8 at the time; and (5) awakening score 2 hours after leaving the endoscopy room. Results: The BIS group received a significantly lower median dose of propofol than the non-BIS group (159.2 mg vs. 167.5 mg; p=0.015) in all age groups. For patients aged ≥75 years, the reduction in heart rate was significantly lower in the BIS group than in the non-BIS group (1.2% vs. 9.1%; p=0.023). Moreover, the occurrence of body movements was markedly lower in the BIS group than in the non-BIS group (8.5% vs. 39.4%; p<0.001). Conclusions: During EUS examination, BIS monitoring is useful for maintaining a constant depth of anesthesia, especially in patients 75 years of age or older.

DOI： 10.5946/ce.2022.001

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background: The value of contrast-enhanced harmonic EUS (CH-EUS) for diagnosis of portal vein invasion in patients with pancreatic cancer was evaluated. Patients and Methods: This single-center, retrospective study included consecutive patients with pancreatic cancer who underwent both surgical resection after preoperative EUS, CH-EUS, and contrast-enhanced computed tomography (CE-CT) examinations between April 2015 and August 2017. CH-EUS evaluation was performed during the late phase. Portal vein invasion on EUS and CH-EUS was defined as no continuity in the line of the vessel wall. Definition of portal vein invasion on CE-CT was based on the Loyer's criteria. The accuracy of three modalities for diagnosis of invasion into the portal vein was compared using the McNemar's test. Results: Eighty-eight patients (mean age: 71.0 years, ratio of male to female: 48:40) were eligible. Postoperative pathological results were as follows: seven cases of portal vein invasion; 81 cases without. Diagnostic accuracy of EUS, CH-EUS, and CE-CT for diagnosing invasion into the portal vein was 72.7%, 93.2%, and 81.8%, respectively. The differences between CH-EUS and CE-CT (P = 0.0094) and CH-EUS and EUS (P = 0.0022) were significant. EUS and CE-CT were comparable. Conclusion: CH-EUS is useful for diagnosis of portal vein invasion by pancreatic cancer.

DOI： 10.4103/EUS-D-21-00185

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記述言語：英語   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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記述言語：英語   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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記述言語：日本語   出版者・発行元：(株)南江堂  

＜文献概要＞▼膵がんは予後不良ながん腫であり,その改善のためには早期診断・早期治療が必須である.▼早期膵がんを疑う画像所見としては「尾側膵管拡張を伴う限局性主膵管狭窄」がその代表である.しかしながらこの所見は慢性膵炎などの良性膵疾患でも認められる.▼近年,早期膵がん症例のCTにおける「主膵管狭窄部周囲の限局性膵実質萎縮」が良悪性診断に有用との報告が散見される.この所見を認めた場合は早期膵がんの可能性を考慮し,胆膵専門医へ紹介することが推奨される.

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その他リンク： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2022&ichushi_jid=J00974&link_issn=&doc_id=20220624060014&doc_link_id=10.15106%2Fj_naika130_69&url=https%3A%2F%2Fdoi.org%2F10.15106%2Fj_naika130_69&type=%88%E3%8F%91.jp_%83I%81%5B%83%8B%83A%83N%83Z%83X&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1002/deo2.20

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その他リンク： https://onlinelibrary.wiley.com/doi/full-xml/10.1002/deo2.20

記述言語：英語  

DOI： 10.3390/jcm11061705

PubMed

記述言語：英語  

DOI： 10.1111/jgh.15780

PubMed

記述言語：日本語   出版者・発行元：(公社)日本超音波医学会-関西地方会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1007/s00464-021-08637-1

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その他リンク： https://link.springer.com/article/10.1007/s00464-021-08637-1/fulltext.html

記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.3390/jcm10163716

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1111/den.13862

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.3390/jcm10132858

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1111/den.14060

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.3390/jcm10091818

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1053/j.gastro.2021.03.056

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.3390/cancers13050945

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記述言語：日本語   出版者・発行元：(株)東京医学社  

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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  

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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  

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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  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1186/s40792-020-00987-7

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1038/s41598-020-71848-4

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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.vgie.2020.04.015

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PubMed

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記述言語：日本語   出版者・発行元：(一社)日本膵臓学会  

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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  

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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  

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記述言語：日本語   出版者・発行元：(一社)日本膵臓学会  

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記述言語：日本語   出版者・発行元：(一社)日本膵臓学会  

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記述言語：日本語   出版者・発行元：PLoS ONE  

Despite recent advances in clinical treatment, pancreatic cancer remains a highly lethal malignancy. In order to improve the survival rate of patients with pancreatic cancer, the development of non-invasive diagnostic methods using effective biomarkers is urgently needed. Here, we developed a highly sensitive method to detect DNA methylation in cellfree (cf)DNA samples based on the enrichment of methyl-CpG binding (MBD) protein coupled with a digital PCR method (MBD-ddPCR). Five DNA methylation markers for the diagnosis of pancreatic cancer were identified through DNA methylation microarray analysis in 37 pancreatic cancers. The sensitivity and specificity of the five markers were validated in another independent cohort of pancreatic cancers (100% and 100%, respectively; n = 46) as well as in The Cancer Genome Atlas data set (96% and 90%, respectively; n = 137). MBD-ddPCR analysis revealed that DNA methylation in at least one of the five markers was detected in 23 (49%) samples of cfDNA from 47 patients with pancreatic cancer. Further, a combination of DNA methylation markers and the KRAS mutation status improved the diagnostic capability of this method (sensitivity and specificity, 68% and 86%, respectively). Genome-wide MBD-sequencing analysis in cancer tissues and corresponding cfDNA revealed that more than 80% of methylated regions were overlapping; DNA methylation profiles of cancerous tissues and cfDNA significantly correlated with each other (R = 0.97). Our data indicate that newly developed MBD-ddPCR is a sensitive method to detect cfDNA methylation and that using five marker genes plus KRAS mutations may be useful for the detection of pancreatic cancers.

DOI： 10.1371/journal.pone.0233782

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記述言語：日本語   出版者・発行元：Diseases of the Esophagus  

Page 4 Left 38th line (original) On magnified observation of NBI, when we observe the lesion at maximum magnification, the length of the corner of the screen is about 0.5 mm, and the length of one side is about 3 mm (Fig. 3).Using this standard, the size of the AVA can be estimated. (revised) On magnified observation of NBI, when we observe the lesion at maximum magnification, the length of one side is about 3 mm, and the length of the corner of the screen is about 0.5 mm (Fig. 3).Using this standard, the size of the AVA can be estimated. Page 4 Right Fig 3. figure legend (original) Fig 3. Estimate the size of AVA. In magnified observation of NBI, when we observe the lesion by the maximum magnification, the length of the corner of the screen is about 0.5mm[A], and the length of one side is about 3mm [B]. Using this standard, we can estimate the size of AVA. (1 scale is equivalent to 1mm.). NBI, narrow band images; AVA, avascular area. (revised) Fig 3. Estimate the size of AVA. On magnified observation of NBI, when we observe the lesion at maximum magnification, the length of one side is about 3 mm [A], and the length of the corner of the screen is about 0.5 mm [B]. Using this standard, the size of the AVA can be estimated. (1 scale is equivalent to 1mm.). NBI, narrow band images; AVA, avascular area.

DOI： 10.1093/dote/doaa040

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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.2020.06.051

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記述言語：英語  

DOI： 10.1055/a-1107-2629

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.2169/internalmedicine.3958-19

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.3748/wjg.v26.i9.947

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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  

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記述言語：日本語   出版者・発行元：(株)東京医学社  

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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  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1007/s00464-019-07228-5

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.5946/ce.2019.204

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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/a-1032-8272

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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＞IPMNの良悪性鑑別を行ううえで,嚢胞内における壁在結節の有無を診断することが重要である.2017年に「IPMN国際診療ガイドライン」が改訂され,壁在結節に造影効果および結節高に関する基準が新たに設けられた.近年,IPMNの良悪性鑑別を目的とし,造影ハーモニックEUS(CH-EUS)による壁在結節の評価に着目した研究が散見される.CH-EUSは壁在結節と粘液塊の鑑別やIPMNの良悪性診断に有用な診断法となりうる.本邦を中心にIPMNを有する症例にIPMN併存膵癌が発生するリスクが高いことが多数報告されている.自験例において,EUSおよびCH-EUSはIPMN経過観察例やIPMN外科的切除後の残膵フォローアップ例に発生しうるIPMN併存膵癌の早期発見に有用であった.

DOI： 10.19020/cg.0000000968

CiNii Research

J-GLOBAL

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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  

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DOI： 10.1016/j.gie.2019.03.1193

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DOI： 10.1016/j.gie.2019.03.1247

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記述言語：英語  

DOI： 10.1055/a-0858-9831

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DOI： 10.1016/j.gie.2019.03.1006

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DOI： 10.1016/j.gie.2019.03.217

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DOI： 10.1016/j.gie.2019.03.1041

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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/a-0890-3220

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記述言語：日本語  

DOI： 10.11405/nisshoshi.116.1053

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.2169/internalmedicine.1981-18

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記述言語：日本語   出版者・発行元：Investigational New Drugs  

In the original publication of this article, the license subtype should be CC BYand not CC BY-NC. The original article has been corrected.

DOI： 10.1007/s10637-019-00757-9

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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.dld.2019.03.015

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1159/000494969

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記述言語：日本語   出版者・発行元：American Journal of Case Reports  

Objective: Rare co-existance of disease or pathology Background: Mucinous cystic neoplasm (MCN) of the pancreas is a rare mucin-producing cystic neoplasm that has a characteristic histological feature referred to as ovarian-type stroma (OS) underlying the epithelium. Pancreatic ductal carcinoma arises from MCN as a precursor lesion, but data on progression pathways are limited. Case Report: A 40-year-old female was referred to our hospital for further investigation of a pancreatic cyst. Further examination showed a 7.0 cm multilocular cyst in the pancreatic tail and a solid mass in the thick septum of the cystic tumor. Distal pancreatectomy and splenectomy were performed. Histological examination revealed a moderately differentiated invasive ductal carcinoma (IDC) with a diameter of 0.5 cm in the thick septum of the cystic lesion and a cyst wall composed of epithelium with low-grade to severe dysplasia. The epithelium covered an OS. Pathological diagnosis was IDC arising in MCN of the pancreas. Immunohistochemical examination showed that MUC1 expression was negative in MCN but positive in IDC. KRAS mutation was observed in both MCN and IDC regions. Conclusions: We present a rare case of moderately differentiated pancreatic IDC arising in MCN. To elucidate the underlying progression pathway, we explored the correlation between KRAS mutation and MUC expression as a clinicopathological parameter.

DOI： 10.12659/AJCR.914092

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1093/intimm/dxz050

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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：Japan Gastroenterological Endoscopy Society  

Background and Aim: This study evaluated the utility of endoscopic ultrasonography (EUS) combined with contrast-enhanced harmonic EUS (CH-EUS) for surveillance of the remnant pancreas after surgery for intraductal papillary mucinous neoplasm (IPMN). Methods: This was a single-center, retrospective, descriptive study. A total of 134 consecutive patients who underwent surgical resection for IPMN between April 2009 and March 2015 were evaluated. Rates of recurrence and development of IPMN-concomitant pancreatic ductal adenocarcinoma (PDAC) during follow up were assessed. Clinical findings of patients with recurrence or development of PDAC were also evaluated. Results: Of 134 resected IPMN 56 (41.8%) and 78 (58.2%) were classified as benign and malignant, respectively. Patients were followed up for a median of 29 months, 33 (24.6%) by both contrast-enhanced computed tomography (CE-CT) and EUS, and 101 (75.4%) by computed tomography (CT) alone. Thirteen patients (9.7%) showed tumor recurrence, five with intra-pancreatic recurrence and eight with extra-pancreatic metastases. An enhancing mural nodule within the dilated main pancreatic duct was successfully detected by EUS in one patient, but not by CE-CT. Two patients developed IPMN-concomitant PDAC during follow up. EUS combined with CH-EUS successfully detected small IPMN-concomitant PDAC in two patients, whereas these lesions were not detected by CT. CH-EUS was useful for better visualization of the margins of IPMN-concomitant PDAC in one of these two patients. Conclusion: Endoscopic ultrasonography combined with CH-EUS may improve follow up of patients with resected IPMN.

DOI： 10.11280/gee.61.417

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記述言語：日本語  

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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＞EUSは上部消化管粘膜下腫瘍(SMT)の診断に用いられているが,上部消化管SMTの良悪性鑑別には限界がある.本稿では,造影ハーモニックEUSによる上部消化管粘膜下腫瘍の診断に関する前向き研究1報と後ろ向き研究6報の合計7報の研究をもとに上部消化管SMTの鑑別診断について調べた.造影ハーモニックEUSによるGISTとそれ以外の上部消化管SMTの鑑別診断に関する3つの報告では,hyper-enhancementがGISTの造影ハーモニックEUS所見であり,診断能は感度84.5〜100%,特異度73.3〜100%であった.一方,low-grade malignancy GISTとhigh-grade malignancy GISTの鑑別診断に関する4つの報告では,造影ハーモニックEUSによるhigh-grade malignancy GISTの診断能は感度53.8〜100%,特異度63〜100%であった.またhigh-grade malignancy GISTでは造影ハーモニックEUSにおいてirregular vesselsが高率に認められた.hyper-enhancementか否かおよびirregular vesselsの有無を確認することで上部消化管SMTの鑑別診断が可能であることが示唆された.

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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/a-0767-6143

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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  

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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  

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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  

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記述言語：英語  

DOI： 10.3390/cancers10100367

PubMed

Copyright© 2018 Japan Gastroenterological Endoscopy Society. All rights reserved. Background and Aim: Differential diagnosis of localized gallbladder lesions is challenging. The aim of the present study was to evaluate the utility of contrast-enhanced harmonic endoscopic ultrasonography (CH-EUS) for diagnosis of localized gallbladder lesions. Methods: One hundred and twenty-five patients with localized gallbladder lesions were evaluated by CH-EUS between March 2007 and February 2014. This was a single-center retrospective study. Utilities of fundamental B-mode EUS (FB-EUS) and CH-EUS in the differentiation of gallbladder lesions and sludge plug were initially compared. Thereafter, these two examinations were compared with respect to their accuracy in the diagnosis of malignant lesions. Five reviewers blinded to the clinicopathological results evaluated microcirculation patterns in the vascular and perfusion images. Results: In the differentiation between gallbladder lesions and sludge plug, FB-EUS had a sensitivity, specificity, and accuracy of 82％, 100％, and 95％, respectively, whereas CH-EUS had a sensitivity, specificity, and accuracy of 100％, 99％, and 99％, respectively. FB-EUS-based diagnosis of carcinomas based on tumor size and/or shape had a sensitivity, specificity, and accuracy of 61-87％, 71-88％, and 74-86％, respectively. Additional information regarding irregular vessel patterns in the vascular image and/or heterogeneous enhancement in the perfusion image on CH-EUS increased the sensitivity, specificity, and accuracy for the diagnosis of carcinomas to 90％, 98 ％, and 96％, respectively. There was a significant difference between FB-EUS and CH-EUS in terms of carcinoma diagnosis. Conclusion: CH-EUS was useful for the evaluation of localized gallbladder lesions.

DOI： 10.11280/gee.60.1611

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記述言語：英語  

DOI： 10.4103/eus.eus_91_17

PubMed

記述言語：英語  

DOI： 10.1111/den.13253

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.2169/internalmedicine.0881-18

PubMed

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記述言語：日本語   出版者・発行元：日本胆道学会  

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記述言語：日本語  

DOI： 10.1158/1538-7445.AM2018-3331

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記述言語：日本語   出版者・発行元：(一社)日本膵臓学会  

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記述言語：日本語   出版者・発行元：(一社)日本膵臓学会  

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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  

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記述言語：英語  

DOI： 10.1007/s10620-018-4908-8

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記述言語：英語  

DOI： 10.1111/den.12976

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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  

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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  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.3390/cancers10020050

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1007/s10396-017-0784-7

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.3389/fimmu.2018.00918

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.4103/eus.eus_91_17.

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.2169/internalmedicine.0673-17

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.3390/cancers10100367.

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1111/den.13176

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記述言語：英語  

DOI： 10.1007/s10396-017-0850-1

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記述言語：日本語   出版者・発行元：Diseases of the Esophagus  

A new classification of magnifying endoscopy with narrow band imaging (ME-NBI) for diagnosing and staging superficial esophageal squamous cell carcinoma (SESCC) was proposed by the Japan Esophageal Society in 2011. This study aimed to compare the new classification with the conventional classifications (Inoue's classification and Arima's classification). This was a prospective analysis of data from a single cancer center involving 151 consecutive patients with 156 SESCCs that were endoscopically or surgically resected. Initially, only ME-NBI images were selected and reviewed independently by three experienced endoscopists. White light imaging (WLI) was then evaluated separately after an interval. The diagnostic performance of each classification and interobserver agreement were assessed, and the WLI findings that affect the diagnosis by the new classification were identified. The specificity for classifying invasive depth as epithelium (EP)/lamina propria mucosae (LPM) confined was higher with the new classification than with Inoue's classification (0.512 vs. 0.349; P = 0.02) and Arima's classification (0.512 vs. 0.279; P < 0.01). However, the sensitivity was lower (0.902 vs. 1.000; P < 0.01) compared with Arima's classification. The concordance rates of three evaluators (κ values) were 0.52 for the new classification, 0.50 for Inoue's classification, and 0.23 for Arima's classification. On multivariate analysis, thickness on WLI independently affected the accuracy of diagnosis with the new classification (OR 3.23; 95%CI, 1.30-8.03). The new classification is superior to conventional classifications with respect to specificity for diagnosing SESCC with depth EP/LPM. Thickness on WLI was a factor negatively affecting the diagnostic performance of the new classification.

DOI： 10.1093/dote/dox037

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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-0043-117939

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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  

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記述言語：英語  

DOI： 10.4103/eus.eus_9_17

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1111/den.12900

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記述言語：日本語   出版者・発行元：和歌山医学会  

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記述言語：日本語  

DOI： 10.1055/s-0043-106185

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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.2017.05.052

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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.ajg.2017.05.016

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DOI： 10.1016/j.gie.2017.03.049

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DOI： 10.1016/j.gie.2017.03.1140

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記述言語：日本語   出版者・発行元：(一社)日本膵臓学会  

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記述言語：日本語   出版者・発行元：(一社)日本膵臓学会  

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記述言語：日本語   出版者・発行元：(一社)日本膵臓学会  

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記述言語：日本語   出版者・発行元：(一社)日本膵臓学会  

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記述言語：日本語   出版者・発行元：(一社)日本膵臓学会  

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記述言語：英語   出版者・発行元：MOSBY-ELSEVIER  

DOI： 10.1016/j.gie.2017.03.753

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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  

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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  

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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  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1111/den.12741

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1159/000481240

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1111/jgh.13766

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1159/000481224

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1159/000481225

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1159/000481223

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1159/000481231

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1159/000481234

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.3748/wjg.v23.i4.661

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1007/s00464-017-5553-6

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1159/000481226

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1159/000481236

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1159/000481235

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1159/000481228

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1159/000481233

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記述言語：日本語   出版者・発行元：Journal of Hepato-Biliary-Pancreatic Sciences  

Background: There have been no reports showing the incidence of anastomotic stenosis of continuous hepaticojejunostomy (HJ) and identifying its risk factors for patients who underwent pancreaticoduodenectomy (PD). Method: We retrospectively investigated 200 patients whose HJ was established by unified method, single layered continuous suture. HJ stenosis was diagnosed with endoscopic or radiologic examinations. Uni and multivariable unconditional logistic modeling were performed to explore the predictive factors and to estimate odds ratios (ORs) and their 95% confidence intervals (CIs). Results: Sixteen patients (8.0%) were diagnosed as HJ stenosis. Multivariable analysis showed that body mass index (BMI) (OR: 1.24; 95% CI: 1.03–1.51), absence of preoperative biliary stenting (OR: 11.10; 95% CI: 1.22–101.12), operative time (OR: 1.74 per one hour increase; 95% CI: 1.01–2.98), age (OR: 1.58 per 10 years increase; 95% CI: 0.88–2.85), and absence of nodal metastasis (OR: 3.43; 95% CI: 0.90–13.12) correlated with HJ stenosis. Among these, BMI and preoperative biliary stenting were associated with stenosis with a lower P-value than the others (P = 0.026 and 0.033, respectively). Conclusions: The incidence of HJ stenosis was 8.0%. Close attention would be needed especially for patients at high risk of HJ stenosis, such as high BMI or absence of preoperative biliary stenting.

DOI： 10.1002/jhbp.385

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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  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.3748/wjg.v22.i30.6917

PubMed

J-GLOBAL

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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.2015.12.024

PubMed

J-GLOBAL

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1177/1756283X16644248

PubMed

J-GLOBAL

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.14366/usg.15042

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.3748/wjg.v22.i21.5132

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J-GLOBAL

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DOI： 10.1016/j.gie.2016.03.771

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.3748/wjg.v22.i16.4264

PubMed

J-GLOBAL

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記述言語：英語   出版者・発行元：(公社)日本超音波医学会  

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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-0034-1393564

PubMed

J-GLOBAL

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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-0042-109059

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J-GLOBAL

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記述言語：日本語   出版者・発行元：Surgery Today  

Purpose: To clarify the incidence, clinicopathological features and prognosis of pancreatic invasive ductal carcinomas (IDCs) with different tumor origin sites in the pancreatic duct. Methods: Based on the relationship between the invasive cancer area (ICA) and the main pancreatic duct (MPD), IDCs less than 2 cm in diameter were classified into two groups: type I, in which the ICA and MPD were separated, and type II, in which the MPD passed through the ICA. The clinicopathological findings and prognosis of each type were compared in a total of 37 patients. Results: The incidences of IDC types I and II were 18.9 and 81.1 %, respectively. Although there was no difference in local invasion, both node involvement and venous invasion tended to occur more frequently in type I IDC, and the three-year survival rate was significantly lower for type I (28.6 %) than type II (71.8 %) IDC. Conclusions: The prognosis of IDCs that originated in the branching pancreatic duct (BPD) distant from the MPD (type I) was worse than the prognosis of IDCs that originated in either the MPD or the BPD close to the MPD (type II). These data suggest that the progression and degree of malignancy of IDCs may vary depending on the site of tumor origin in the pancreatic duct.

DOI： 10.1007/s00595-014-1075-1

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記述言語：日本語   出版者・発行元：Cancer Prevention Research  

Inactivation of methylcytosine dioxygenase, ten-eleven translocation (TET) is known to be associated with aberrant DNA methylation in cancers. Tumors with a CpG island methylator phenotype (CIMP), a distinct subgroup with extensive DNA methylation, show characteristic features in the case of colorectal cancer. The relationship between TET inactivation and CIMP in colorectal cancers is not well understood. The expression level of TET family genes was compared between CIMP-positive (CIMP-P) and CIMP-negative (CIMP-N) colorectal cancers. Furthermore, DNA methylation profiling, including assessment of the TET1 gene, was assessed in colorectal cancers, as well as colon polyps. The TET1 was silenced by DNA methylation in a subset of colorectal cancers as well as cell lines, expression of which was reactivated by demethylating agent. TET1 methylation was more frequent in CIMP-P (23/55, 42%) than CIMP-N (2/113, 2%, P < 0.0001) colorectal cancers. This trend was also observed in colon polyps (CIMP-P, 16/40, 40%; CIMP-N, 2/24, 8%; P = 0.002), suggesting that TET1 methylation is an early event in CIMP tumorigenesis. TET1 methylation was significantly associated with BRAF mutation but not with hMLH1 methylation in the CIMP-P colorectal cancers. Colorectal cancers with TET1 methylation have a significantly greater number of DNA methylated genes and less pathological metastasis compared to those without TET1 methylation (P = 0.007 and 0.045, respectively). Our data suggest that TET1 methylation may contribute to the establishment of a unique pathway in respect to CIMP-mediated tumorigenesis, which may be incidental to hMLH1 methylation. In addition, our findings provide evidence that TET1 methylation may be a good biomarker for the prediction of metastasis in colorectal cancer.

DOI： 10.1158/1940-6207.CAPR-14-0306

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記述言語：日本語   出版者・発行元：Journal of Hepato-Biliary-Pancreatic Sciences  

Background The Japanese Society of Hepato-Biliary-Pancreatic Surgery launched the clinical practice guidelines for the management of biliary tract and ampullary carcinomas in 2008. Novel treatment modalities and handling of clinical issues have been proposed after the publication. New approaches for editing clinical guidelines, such as the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system, also have been introduced for better and clearer grading of recommendations. Methods Clinical questions (CQs) were proposed in seven topics. Recommendation, grade of recommendation and statement for each CQ were discussed and finalized by evidence-based approach. Recommendation was graded to grade 1 (strong) and 2 (weak) according to the concept of GRADE system. Results The 29 CQs covered seven topics: (1) prophylactic treatment, (2) diagnosis, (3) biliary drainage, (4) surgical treatment, (5) chemotherapy, (6) radiation therapy, and (7) pathology. In 27 CQs, 19 recommendations were rated strong and 11 recommendations weak. Each CQ included the statement of how the recommendation was graded. Conclusions This guideline provides recommendation for important clinical aspects based on evidence. Future collaboration with cancer registry will be a key for assessment of the guidelines and establishment of new evidence. Free full-text articles and a mobile application of this guideline are available via http://www.jshbps.jp/en/guideline/biliary-tract2.html.

DOI： 10.1002/jhbp.233

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記述言語：日本語  

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記述言語：日本語   出版者・発行元：Hepato-Gastroenterology  

Background/Aims: This study evaluated the efficacy and safety of transnasal endoscopy (TNE) with flexible spectral imaging color enhancement (FICE) for detection of superficial cancer in the pharyngeal and esophageal regions for high-risk populations. Methodology: Patients who previously had head and neck or esophageal squamous cell carcinoma were enrolled. Screening was conducted using TNE with conventional white-light endoscopy (WLE) followed by FICE chromoendoscopy. For observation of the pharyngeal region, the Valsalva maneuver was employed. Results: 99 patients were eligible. Six esophageal cancers were detected in four patients (4.0%). The sensitivity, specificity, and accuracy for the detection of cancer were 25.0% (95% CI, 3.4-71.0), 97.8% (95% CI, 92.1-99.8), and 94.9% (95% CI, 88.4-98.1), respectively for WLE; 100% (95% CI, 451%-100%), 96.8% (95% CI, 90.7%-99.3%), and 96.9% (95% CI, 89.3%-99.1%), respectively for FICE chromoendoscopy. Pain in the nose and nasal hemorrhage were observed in 3 (3.0%) and 2 patients (2.0%), respectively. Following the Valsalva maneuver, endoscopic scores significantly increased from a mean of 1.1 (0.8-1.4) to 2.0 (1.3-2.6) (p<0.05). Conclusions: TNE with the Valsalva maneuver is a promising screening method for the pharyngeal and esophageal regions. TNE with FICE chromoendoscopy for detecting pharyngeal and esophageal cancer was more sensitive than WLE. © H.G.E. Update Medical Publishing S.A.

DOI： 10.5754/hge14489

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記述言語：日本語   出版者・発行元：(一社)日本膵臓学会  

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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  

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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  

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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  

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記述言語：日本語   出版者・発行元：Gastroenterology  

Background & Aims Cells of tumors associated with chronic inflammation frequently have altered patterns of DNA methylation, including hepatocellular carcinomas. Chronic hepatitis has also been associated with aberrant DNA methylation, but little is known about their relationship. Methods Pyrosequencing was used to determine the methylation status of cultured Huh7.5.1 hepatoma cells after hepatitis C virus (HCV) infection. We also studied mice with severe combined immunodeficiency carrying the urokinase-type plasminogen activator transgene controlled by an albumin promoter (urokinase-type plasminogen activator/severe combined immunodeficient mice), in which up to 85% of hepatocytes were replaced by human hepatocytes (chimeric mice). Mice were given intravenous injections of hepatitis B virus (HBV) or HCV, liver tissues were collected, and DNA methylation profiles were determined at different time points after infection. We also compared methylation patterns between paired samples of hepatocellular carcinomas and adjacent nontumor liver tissues from patients. Results No reproducible changes in DNA methylation were observed after infection of Huh7.5.1 cells with HCV. Livers from HBV- and HCV-infected mice had genome-wide, time-dependent changes in DNA methylation, compared with uninfected urokinase-type plasminogen activator/severe combined immunodeficient mice. There were changes in 160 ± 63 genes in HBV-infected and 237 ± 110 genes in HCV-infected mice. Methylation of 149 common genes increased in HBV- and HCV-infected mice; methylation of some of these genes also increased in hepatocellular carcinoma samples from patients compared with nontumor tissues. Expression of Ifng, which is expressed by natural killer cells, increased significantly in chimeric livers, in concordance with induction of DNA methylation, after infection with HBV or HCV. Induction of Ifng was reduced after administration of an inhibitor of natural killer cell function (anti-asialo GM1). Conclusions In chimeric mice with humanized livers, infection with HBV and HCV appears to activate a natural kill cell-dependent innate immune response. This contributes to the induction and accumulation of aberrant DNA methylation in human hepatocytes. © 2014 by the AGA Institute.

DOI： 10.1053/j.gastro.2013.10.056

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

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記述言語：日本語   出版者・発行元：Investigational New Drugs  

Background. Pancreatic neuroendocrine tumors (NETs) are rare but are frequently diagnosed at advanced stages and require systemic therapy. Patients and methods. This multicenter, open-label, phase II study evaluated sunitinib in Japanese patients with well-differentiated pancreatic NET. Patients received sunitinib 37.5 mg/day on a continuous daily dosing (CDD) schedule. The primary endpoint was clinical benefit rate (CBR; percentage of complete responses [CRs] plus partial responses [PRs] plus stable disease [SD] ≥24 weeks). Secondary endpoints included objective response rate (ORR), tumor shrinkage, progression-free survival (PFS) probability, safety, pharmacokinetics, and biomarkers. Results. Twelve patients received treatment. The CBR was 75 % (95 % confidence interval [CI], 43-94) and included 6 patients with a PR and 3 with SD. The ORR was 50 % (95 % CI, 21-79). PFS probability was 91 % (95 % CI, 54-99) at 6 months and 71 % (95 % CI, 34-90) at 12 months. Commonly reported treatment-emergent (all-causality), any-grade adverse events included diarrhea (n = 10), hand-foot syndrome and hypertension (both n = 8), fatigue and headache (both n = 7), and neutropenia (n = 6). No deaths on study were reported; one death due to disease progression occurred >28 days after end of treatment. Sunitinib on a CDD schedule resulted in sustained drug concentrations without accumulation across cycles. Tumor responses in all 12 patients did not appear to correlate with decreases in chromogranin A levels. Conclusions. Sunitinib 37.5 mg/day on a CDD schedule demonstrated antitumor activity in Japanese patients with unresectable, well-differentiated pancreatic NET. Commonly reported adverse events were consistent with the known safety profile of sunitinib. © 2012 The Author(s).

DOI： 10.1007/s10637-012-9910-y

Scopus

記述言語：日本語   出版者・発行元：医学図書出版(株)  

急性胆嚢炎に対するドレナージ治療として、EUS下穿刺術を応用したEUS下胆嚢ドレナージ術(EUS-GBD)が報告されている。EUS観察下で胃前庭部または十二指腸球部より腫大した胆嚢を穿刺する。穿刺後、生理食塩水にて胆嚢内を洗浄した上で、胆嚢内にガイドワイヤーをコイリングする要領で留置し、続いて穿刺孔を拡張する。最後に経鼻ドレナージチューブ、両端ピッグテイルステントあるいは金属ステントを留置する。新しい手技のため、報告が少ないが、手技成功率97〜100%、臨床症状改善率100%と良好な成績が得られている。主な偶発症として、胆汁性腹膜炎気腹症、ステントの迷入、逸脱がある。今後、EUS-GBDは経皮経肝胆嚢ドレナージ術、経皮経肝胆嚢吸引穿刺法、内視鏡的経鼻胆嚢ドレナージ術、内視鏡的胆嚢ステント留置術と同様、急性胆嚢炎に対する治療選択肢となりうる。(著者抄録)

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記述言語：日本語   出版者・発行元：日本胆道学会  

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記述言語：日本語   出版者・発行元：Carcinogenesis  

The impact of alcohol on the risk of stomach cancer is controversial. Although aldehyde dehydrogenase 2 (ALDH2) Glu504Lys (rs671) polymorphism has a strong effect on acetaldehyde metabolism, little is known about its impact on stomach cancer risk when combined with alcohol drinking. This case-control study included a total of 697 incident stomach cancer case subjects and 1372 non-cancer control subjects who visited Aichi Cancer Center between 2001 and 2005. We estimated odds ratios (OR) and 95% confidence intervals (CI) for ALDH2 genotypes and alcohol consumption using logistic regression models after adjustment for potential confounders, including Helicobacter pylori infection. The ALDH2 504Lys allele was associated with the risk of stomach cancer, with adjusted ORs of 1.40 (95% CI, 1.11-1.76) for Glu/Lys and 1.73 (1.12-2.68) for Lys/Lys compared with Glu/Glu. Heavy drinking was associated with risk (OR 1.72, 1.17-2.52) after adjustment for ALDH2 genotype and other confounders. Moreover, ORs for heavy drinking were 1.28 (0.77-2.12) for those with ALDH2 Glu/Glu and 3.93 (1.99-5.79) for those with the ALDH2 Lys allele relative to non-drinkers with the Glu/Glu genotype (P for interaction = 0.0054). In conclusion, ALDH2 and alcohol drinking showed interaction for risk factors of stomach cancer, indicating that acetaldehyde plays a role in stomach carcinogenesis. ©The Author 2013.Published by Oxford University Press. All rights reserved.

DOI： 10.1093/carcin/bgt080

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記述言語：日本語   出版者・発行元：Japan Gastroenterological Endoscopy Society  

症例は52歳，男性．しめ鯖を摂取した翌日より間欠的腹痛が出現した．腹部超音波検査および腹部造影CTにて回腸の一部に壁肥厚と腹水を認めた．小腸アニサキス症を強く疑い，経肛門的にダブルバルーン小腸内視鏡検査（DBE）を施行したところ，回腸に浮腫状粘膜を認め，アニサキス虫体の粘膜への刺入を認めた．生検鉗子を用いて摘出し，以後症状は速やかに改善した．本症は，保存的加療のみでは稀ではあるが腸重積症等を引き起こし緊急手術となる場合もあるため，可能であればDBEなどによる診断と治療を行うことが重要と考えられた．

DOI： 10.11280/gee.55.1643

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その他リンク： http://search.jamas.or.jp/link/ui/2013245244

記述言語：日本語   出版者・発行元：Endoscopy  

A prospective clinical study was conducted to evaluate the safety, feasibility, and efficacy of endoscopic ultrasound (EUS)-guided choledochoduodenostomy (CDS) with direct metallic stent placement using a prototype forward-viewing echoendoscope. The indication for EUS - CDS in this study was lower biliary obstruction only, and not failed endoscopic biliary drainage, because the aim was to evaluate EUS - CDS for first-line biliary drainage therapy. The technical and functional success rates were 94 % (17 /18) and 94 % (16 /17), respectively. Early complications (focal peritonitis) were encountered in two patients (11 %). No patients developed late complications. EUS - CDS with direct metallic stent placement using a forward-viewing echoendoscope was generally feasible and effective for malignant distal biliary tract obstruction. The forward-viewing echoendoscope was useful, especially for deploying the metallic stent. © Georg Thieme Verlag KG Stuttgart - New York.

DOI： 10.1055/s-0032-1326076

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記述言語：英語  

DOI： 10.1111/j.1872-034X.2012.01083.x

PubMed

記述言語：日本語   出版者・発行元：Asian Pacific Journal of Cancer Prevention  

Background: Cigarette smoking is a well-established risk factor of pancreatic cancer (PC). Although an association between nicotine dependence phenotype, namely time to first cigarette (TTFC) after waking, and the risk of several smoking-related cancers has been reported, an association between TTFC and PC risk has not been reported. We assessed the impact of smoking behavior, particularly TTFC, on PC risk in a Japanese population. Materials and Methods: We conducted a case-control study using 341 PC and 1,705 non-cancer patients who visited Aichi Cancer Center in Nagoya, Japan. Exposure to risk factors, including smoking behavior, was assessed from the results of a self-administered questionnaire. The impact of smoking on PC risk was assessed with multivariate logistic regression analysis adjusted for potential confounders to estimate odds ratios (ORs) and 95% confidence intervals (CIs). Results: Cigarettes per day (CPD) and/or smoking duration were significantly associated with PC risk, consistent with previous studies. For TTFC and PC risk, we found only a suggestive association: compared with a TTFC of more than 60 minutes, ORs were 1.15 (95%CI, 0.65-2.04) for a TTFC of 30-60 minutes and 1.35 (95%CI, 0.85-2.15) for that of 0-30 minutes (p trend=0.139). After adjustment for CPD or smoking duration, no association was observed between TTFC and PC. Conclusions: In this study, we found no statistically significant association between TTFC and PC risk. Further studies concerning TTFC and PC risk are warranted.

DOI： 10.7314/APJCP.2013.14.7.4409

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記述言語：日本語   出版者・発行元：Journal of Epidemiology  

Background: Although several reports have described a possible association between DNA repair genes and pancreatic cancer (PC) in smokers, this association has not been fully evaluated in an Asian population. We assessed the impact of genetic polymorphisms in the base excision repair (BER) pathway on PC risk among Japanese. Methods: This case-control study compared the frequency of 5 single-nucleotide polymorphisms (SNPs) of BER genes, namely rs1052133 in OGG1, rs1799782 and rs25487 in XRCC1, rs1130409 in APE1, and rs1136410 in PARP1. SNPs were investigated using the TaqMan assay in 185 PC cases and 1465 controls. Associations of PC risk with genetic polymorphisms and gene-environment interaction were examined with an unconditional logistic regression model. Exposure to risk factors was assessed from the results of a self-administered questionnaire. We also performed haplotype-based analysis. Results: We observed that the minor allele of rs25487 in XRCC1 was significantly associated with PC risk in the per-allele model (odds ratio = 1.29, CI = 1.01-1.65; trend P = 0.043). Haplotype analysis of XRCC1 also showed a statistically significant association with PC risk. No statistically significant interaction between XRCC1 polymorphisms and smoking status was seen.Conclusions: Our findings suggest that XRCC1 polymorphisms affect PC risk in Japanese. © 2012 by the Japan Epidemiological Association.

DOI： 10.2188/jea.JE20120010

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記述言語：日本語  

PubMed

記述言語：日本語   出版者・発行元：Gut  

Background and aims: The majority of gastrointestinal stromal tumors (GISTs) have KIT mutations; however, epigenetic abnormalities that could conceivably potentiate the aggressiveness of GISTs are largely unidentified. Our aim was to establish epigenetic profiles associated with the malignant transformation of GISTs. Methods: Methylation of four tumor suppressor genes, RASSF1A, p16, CDH1, and MGMT was analyzed in GISTs. Additionally, genome-wide DNA methylation profiles were compared between small, malignant-prone, and malignant GISTs using methylated GpG island amplification microarrays (MCAM) in a training set (n=40). Relationships between the methylation status of genes identified by MCAM and clinical features of the disease were tested in a validation set (n=75). Results: Methylation of RASSF1A progressively increased from small to malignant GISTs. p16 was specifically methylated in malignant-prone and malignant GISTs. MCAM analysis showed that more genes were methylated in advanced than in small GISTs (average of 473 genes vs 360 genes, respectively, P=0.012). Interestingly, the methylation profile of malignant GISTs was prominently affected by their location. Two genes, REC8 and PAX3, which were newly-identified via MCAM analysis, were differentially methylated in small and malignant GISTs in the training and validation sets. Patients with methylation of at least REC8, PAX3, or p16 had a significantly poorer prognosis (P=0.034). Conclusion: Our results suggest that GIST is not, in epigenetic terms, a uniform disease and that DNA methylation in a set of genes is associated with aggressive clinical behavior and unfavorable prognosis. The genes identified may potentially serve as biomarkers for predicting aggressive GISTs with poor survivability.

DOI： 10.1136/gut.2011.241034

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記述言語：日本語   出版者・発行元：International Journal of Molecular Epidemiology and Genetics  

Although several reports have described a possible association between insulin-like growth factors-1 (IGF-1) and pancreatic cancer (PC) risk, this association has not been evaluated in the non-Caucasian population. To assess the impact of IGF-1 polymorphisms on PC risk in Japanese, we conducted a case-control study which compared the frequency of ten single nucleotide polymorphisms (SNPs) and haplotypes of IGF-1. SNPs were investigated using the TaqMan method in 176 patients with PC and 1402 control subjects. Exposure to risk factors was assessed from the results of a self-administered questionnaire. Associations and gene-environment interactions were examined using an unconditional logistic regression model. We did not observe any significant main effect of IGF-1 loci, but did find interactions between rs5742714 and past and/or current body-mass index (BMI) status. Among patients with BMI ≥ 25 at age 20, an increased PC risk was observed with the addition of the minor allele for rs5742714 (trend P = 0.048) and rs6214 (P = 0.043). Among patients with current BMI ≥ 25, an increased or decreased PC risk was observed with the addition of the minor allele for rs5742714 (trend P = 0.046), rs4764887 (P = 0.031) and rs5742612 (P = 0.038). Haplotype analysis of IGF-1 showed a significant association among patients who were either or both previously or currently overweight. These findings suggest that IGF-1 polymorphisms may affect the development of PC in the Japanese population in combination with obesity. Further studies to confirm these findings are warranted.

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記述言語：日本語   出版者・発行元：Cancer Science  

The insulin-like growth factor (IGF) signaling system plays a central role in cellular growth, differentiation and proliferation. Although the association between IGF1 gene polymorphisms and cancer risk has been evaluated for several carcinomas, this association has not yet been examined for stomach cancer. We investigated the association between IGF1 polymorphisms and the risk of stomach cancer in a Japanese population. A total of 703 patients with stomach cancer and 1462 non-cancer control subjects were enrolled in this case-control study. Associations between polymorphisms of 10 IGF1 loci and the risk of stomach cancer were evaluated using odds ratios (OR) and 95% confidence intervals (CI) in multiple logistic regression models. We observed that the C allele in rs1520220 and the G allele in rs4764887 were significantly associated with stomach cancer risk in the per-allele model after adjusting for other risk factors (OR: 1.14 [95% CI: 1.00-1.30] and OR: 1.18 [95% CI: 1.02-1.36], respectively). We also observed a positive and dose-dependent association between the number of risk alleles and stomach cancer risk (P-trend: 0.019) when examining the two loci in the same model. These associations were still seen after adjusting for potential confounders, including sex, age, smoking status, history of diabetes and family history of stomach cancer. We did not find any significant interaction between these factors and the number of risk alleles. In conclusion, we observed a significant association between IGF1 polymorphisms and stomach cancer risk among a Japanese population. Examination of the biological significance of IGF1 is warranted. © 2011 Japanese Cancer Association.

DOI： 10.1111/j.1349-7006.2011.02062.x

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記述言語：日本語   出版者・発行元：Journal of Japanese Society of Gastroenterology  

We describe a 54-year old woman with oxaliplatin-induced autoimmune hemolytic anemia and review the clinical features of similar published cases. The present patient had metastatic colon cancer and was admitted to our hospital with a floating sensation and general malaise on day 4 after undergoing the last of 4 cycles of a 7 th round of chemotherapy with XELOX. Laboratory data revealed 4.6g/d/ hemoglobin and 8.77 mg/d/ creatinine. Direct and indirect Coombs tests of a blood sample for blood transfusion were both positive. We diagnosed immune hemolysis with acute renal failure based on the clinical course and blood samples showing haptoglobin <10mg/d/. We treated her with hemodialysis, plasmapheresis and immune suppression with prednisolone, which improved the anemia and renal failure.

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記述言語：日本語   出版者・発行元：Cancer Epidemiology Biomarkers and Prevention  

Background: Although several studies have investigated the association between ABO blood type and risk of gastric cancer (GC), atrophic gastritis (AG), and Helicobacter pylori (HP) infection, no study has investigated these associations by using ABO genotype. Methods: We conducted a case-control study in 703 patients with GC and 1,465 noncancer patients. Wealso conducted a cross-sectional study by using 1,406 of these 1,465 controls, who were examined for pepsinogens and anti-HP IgG antibody levels in serum. ABO genotype was determined from single nucleotide polymorphisms in ABO gene. We used rs8176719 to mark the O allele, and rs8176746 and rs8176747 to mark the B allele. ORs and 95% CIs were calculated by a multivariate logistic model. Results: We observed significant associations between ABO genotype and GC, AG, and HP infection. ORs (95% CIs) of GC were 0.70 (0.50-0.99) for OO and 0.53 (0.36-0.77) for BO relative to AA genotype. An increased risk of GC was observed with addition of the A allele (P trend < 0.001), and a decreased risk with that of the B allele (P trend = 0.023). An OR of AG was 0.73 (95% CI, 0.53-0.99) for blood type B relative to blood type A, and an OR of HP infection was 0.39 (95% CI, 0.17-0.87) for BB relative to AA genotype. Conclusion: This study identified a statistically significant association between ABO genotype and GC risk. In addition, ABO gene locus may influence AG prevalence and HP infection. Impact: Further studies are necessary to confirm these findings. ©2011 AACR.

DOI： 10.1158/1055-9965.EPI-11-0213

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記述言語：日本語   出版者・発行元：American Journal of Gastroenterology  

Objectives: Endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) has recently been reported as an alternative to percutaneous transhepatic biliary drainage (PTBD) in cases of biliary obstruction, when endoscopic biliary drainage (EBD) is unsuccessful. However, prospective studies of EUS-CDS have not yet been performed. We conducted a prospective study to evaluate the safety, feasibility, and efficacy of EUS-CDS in patients with malignant lower biliary tract obstruction. Methods: A prospective study to confirm the safety of EUS-CDS was carried out in 6 patients, followed by a trial to evaluate the feasibility and efficacy of EUS-CDS in 12 additional patients. We placed a plastic stent from the duodenal bulb into the extrahepatic bile duct under EUS guidance using an oblique viewing echoendoscope, needle knife, guidewire, and biliary dilators. Results: The site of extrahepatic bile duct puncture was the common hepatic duct in 15 patients and the common bile duct in 3 patients. Mean diameter of the punctured extrahepatic bile ducts was 10 mm (range: 6-20 mm). Technical and functional success rates were 94% (17/18) and 100% (17/17), respectively. Median procedure time was 30 min (range: 10-52 min). Median duration to first oral intake after the procedure was 1 day (range: 1-3 days). Early complications were encountered in three (17%) patients, including focal peritonitis in two patients and hemobilia in one patient. During the follow-up period (median: 163 days; range: 46-484 days), 12 stent occlusion events were observed in nine patients. Re-intervention with exchange of the occluded stent was successful in 8 of 12 (66%) times. Severe early and late complications were not encountered in any patients in this study. Median duration of stent patency by Kaplan-Meier analysis was 272 days. Conclusions: EUS-CDS is safe, feasible, and effective as an alternative to PTBD and EBD in cases of malignant distal biliary tract obstruction. Prospective randomized studies are needed to compare the safety and efficacy of various kinds of endoscopic devices used in EUS-CDS and to compare EUS-CDS with PTBD or EBD. © 2011 by the American College of Gastroenterology.

DOI： 10.1038/ajg.2011.84

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記述言語：日本語   出版者・発行元：Cancer Science  

Several studies have investigated a possible association between the ABO blood group and the risk of pancreatic cancer (PC), but this association has not been fully evaluated in Asian populations. The present study aimed to assess the impact of genotype-derived ABO blood types, particularly ABO alleles, on the risk of PC in a Japanese population. We conducted a case-control study using 185 PC and 1465 control patients who visited Aichi Cancer Center in Nagoya, Japan. Using rs8176719 as a marker for the O allele, and rs8176746 and rs8176747 for the B allele, all participants' two ABO alleles were inferred. The impact of ABO blood type on PC risk was examined by multivariate analysis, with adjustment for potential confounders to estimate odds ratios (OR) and 95% confidence intervals (CI). An increased risk of PC was observed with the addition of any non-O allele (trend P=0.012). Compared with subjects with the OO genotype, those with AO and BB genotypes had significantly increased OR of 1.67 (CI, 1.08-2.57) and 3.28 (CI, 1.38-7.80), respectively. Consistent with earlier reports showing a higher risk of PC for individuals with the non-O blood type, the previously reported protective allele (T) for rs505922 was found to be strongly correlated (r2=0.96) with the O allele. In conclusion, this case-control study showed a statistically significant association between ABO blood group and PC risk in a Japanese population. Further studies are necessary to define the mechanisms by which the ABO gene or closely linked genetic variants influence PC risk. © 2011 Japanese Cancer Association.

DOI： 10.1111/j.1349-7006.2011.01907.x

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記述言語：日本語   出版者・発行元：American Journal of Pathology  

Liver metastasis is a fatal step in the progression of colorectal cancer (CRC); however, the epigenetic evolution of this process is largely unknown. To decipher the epigenetic alterations during the development of liver metastasis, the DNA methylation status of 12 genes, including 5 classical CpG island methylator phenotype (CIMP) markers, was analyzed in 62 liver metastases and in 78 primary CRCs (53 stage I-III; 25 stage IV). Genome-wide methylation analysis was also performed in stage I-III CRCs and in paired primary and liver metastatic cancers. Methylation frequencies of MGMT and TIMP3 increased progressively from stage I-III CRCs to liver metastasis (P = 0.043 and P = 0.028, respectively). The CIMP-positive cases showed significantly earlier recurrence of disease than did CIMPnegative cases with liver metastasis (P = 0.030), whereas no such difference was found in stage I-III CRCs. Genomewide analysis revealed that more genes were methylated in stage I-III CRCs than in paired stage IV samples (P = 0.008). Hierarchical cluster analysis showed that stage I-III CRCs and stage IV CRCs were clustered into two distinct subgroups, whereas most paired primary and metastatic cancers showed similar methylation profiles. This analysis revealed distinct methylation profiles between stage I-III CRCs and stage IV CRCs, whichmayreflect differences in epigenetic evolution during progression of the disease. In addition, most methylation status in stage IV CRCs seems to be established before metastasis. Copyright © 2011 American Society for Investigative Pathology. Published by Elsevier Inc. All rights reserved.

DOI： 10.1016/j.ajpath.2010.12.045

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記述言語：日本語   出版者・発行元：International Journal of Cancer  

Aberrant DNA methylation is involved in colon carcinogenesis. Although the CpG island methylator phenotype (CIMP) is defined as a subset of colorectal cancers (CRCs) with remarkably high levels of DNA methylation, it is not known whether epigenetic processes are also involved in CIMP-negative tumors. We analyzed the DNA methylation profiles of 94 CRCs and their corresponding normal-appearing colonic mucosa with 11 different markers, including the five classical CIMP markers. The CIMP markers were frequently methylated in proximal CRCs (p < 0.01); however, RASSF1A methylation levels were significantly higher in distal CRCs, the majority of which are CIMP-negative (p < 0.05). Similarly, methylation levels of RASSF1A and SFRP1 in the normal-appearing mucosae of distal CRC cases were significantly higher than those in the proximal CRC cases (p < 0.05). They were also positively correlated with age (RASSF1A, p < 0.01; SFRP1, p < 0.01). Microarray-based genome-wide DNA methylation analysis of 18 CRCs revealed that 168 genes and 720 genes were preferentially methylated in CIMP-negative distal CRCs and CIMP-positive CRCs, respectively. Interestingly, more than half of the hypermethylated genes in CIMP-negative distal CRCs were also methylated in the normal-appearing mucosae, indicating that hypermethylation in CIMP-negative distal CRCs is more closely associated with age-related methylation. By contrast, more than 60% of the hypermethylated genes in CIMP-positive proximal CRCs were cancer specific (p < 0.01). These data altogether suggest that CpG island promoters appear to be methylated in different ways depending on location, a finding which may imply the presence of different mechanisms for the acquisition of epigenetic changes during colon tumorigenesis. © 2010 UICC.

DOI： 10.1002/ijc.25225

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記述言語：日本語   出版者・発行元：Gastroenterology  

Background & Aims: Corticosteroids are now widely accepted as a treatment for autoimmune pancreatitis (AIP). However, the molecular mechanism by which steroid treatment improves AIP remains largely unknown. The aim of this study was to elucidate cellular mechanisms by which corticosteroids improve both pancreatic exocrine function and histopathology in AIP. Methods: Pancreatic exocrine function was evaluated by the secretin-stimulated function test and pancreatic biopsy specimens were processed for histologic analysis at the time of diagnosis and 3 months after initiation of steroid treatment. Expression and localization of proteins was assayed by immunohistochemistry. Analysis of immunoglobulin (Ig)G4-positive plasma cells was used to verify inflammation in AIP. Results: The number of IgG4-positive plasma cells in pancreatic sections was decreased by steroid treatment, indicating reduced inflammation. Fluid, bicarbonate (HCO3-), and digestive enzyme secretions all were impaired in most patients with AIP. Corticosteroids improved both HCO3- and digestive enzyme secretion. A large fraction of the cystic fibrosis transmembrane conductance regulator (CFTR), which plays a central role in pancreatic duct HCO3- secretion, was mislocalized to the cytoplasm of duct cells before treatment. Corticosteroids corrected the localization of CFTR to the apical membrane, accounting for the improved HCO3- secretion. Steroid treatment resulted in regeneration of acinar cells, accounting for restored digestive enzyme secretion. Conclusions: Corticosteroids reduce inflammation and restore both digestive enzyme and HCO3- secretion in patients with AIP by regenerating acinar cells and correcting CFTR localization in pancreatic duct cells. Mislocalization of CFTR may explain aberrant HCO3- secretion in other forms of pancreatitis. © 2010 AGA Institute.

DOI： 10.1053/j.gastro.2010.01.001

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記述言語：日本語   出版者・発行元：Journal of Hepato-Biliary-Pancreatic Sciences  

Background: Autoimmune pancreatitis (AIP) is often misdiagnosed as pancreatic cancer (PC). Both conditions accumulate 18F- fluorodeoxyglucose (FDG), so FDG positron emission tomography (FDG-PET) is not discriminatory. This study aimed to evaluate the pattern of FDG accumulation, and the change in FDG uptake after steroid treatment in AIP and PC. Methods: We compared FDG-PET patterns between 18 patients with AIP and 20 patients with PC, and also evaluated the short-term changes in FDG uptake after steroid therapy. Results: FDG uptake was observed in 88.9% in AIP and 90.0% in PC. FDG uptake in extra-abdominal lymph nodes was seen more frequently in AIP, and uptake in salivary glands, eyes and biliary ducts was seen only in AIP. Follow-up PET was performed in 6 AIP patients and in 3 PC patients. Changes in SUVmax after steroid therapy were estimated within 1 week in 5 AIP patients and in all 3 PC patients, retrospectively. In 4 AIP patients, the change in SUV max was more than 10%. On the other hand, in PC, SUVmax increased or remained almost unchanged (within 10%). Conclusions: FDG-PET pattern at baseline, and a decrease in FDG uptake after a short steroid trial can be useful for discriminating AIP from PC. © Japanese Society of Hepato-Biliary-Pancreatic Surgery and Springer 2009.

DOI： 10.1007/s00534-009-0172-9

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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  

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：MOSBY-ELSEVIER  

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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-近畿支部  

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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  

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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  

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記述言語：日本語   出版者・発行元：(一社)日本膵臓学会  

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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-近畿支部  

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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-近畿支部  

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記述言語：日本語   出版者・発行元：(株)東京医学社  

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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  

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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  

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記述言語：日本語   出版者・発行元：(一社)日本膵臓学会  

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記述言語：日本語   出版者・発行元：(株)東京医学社  

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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  

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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  

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記述言語：日本語   出版者・発行元：(株)東京医学社  

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記述言語：日本語   出版者・発行元：(株)東京医学社  

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記述言語：日本語   出版者・発行元：医学図書出版(株)  

膵癌術後合併症の膵切除後膵液瘻(POPF)はときに重篤な経過をたどるが、内視鏡的ドレナージはPOPFの治療において外科的治療と並ぶ重要な治療の一つである。内視鏡的ドレナージには、経乳頭的に主膵管内にドレナージチューブを留置して持続吸引を行うTrans-papillary drainageと、EUSガイド下に膵液貯留腔にドレナージを置くEUS-guided drainageがあり、それぞれの長所短所を理解したうえで、状況に応じた使い分けが求められる、EUS-guided drainageの時期は、急性膵炎後のWalled Off Necrosis(WON)に対するEUS-guided drainageの適応が発症4週間以降であることを踏まえ、術後4週間を待たれる症例が多いが、近年4週間以内の早期ドレナージの有効性も報告されており、症例に応じて4週間を待つことなく、EUS-guided drainageを行うことも考慮に入れるべきである。いずれの処置も適応が正しいかどうか、処置後合併症の対応、外科的ドレナージへのconversionの時期を含め、常に外科と内科で密にディスカッションを行い、患者にとってもっともよい治療法を施設として選択できるように取り組むことが肝要である。(著者抄録)

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記述言語：日本語   出版者・発行元：医学図書出版(株)  

膵癌術後合併症の膵切除後膵液瘻(POPF)はときに重篤な経過をたどるが、内視鏡的ドレナージはPOPFの治療において外科的治療と並ぶ重要な治療の一つである。内視鏡的ドレナージには、経乳頭的に主膵管内にドレナージチューブを留置して持続吸引を行うTrans-papillary drainageと、EUSガイド下に膵液貯留腔にドレナージを置くEUS-guided drainageがあり、それぞれの長所短所を理解したうえで、状況に応じた使い分けが求められる、EUS-guided drainageの時期は、急性膵炎後のWalled Off Necrosis(WON)に対するEUS-guided drainageの適応が発症4週間以降であることを踏まえ、術後4週間を待たれる症例が多いが、近年4週間以内の早期ドレナージの有効性も報告されており、症例に応じて4週間を待つことなく、EUS-guided drainageを行うことも考慮に入れるべきである。いずれの処置も適応が正しいかどうか、処置後合併症の対応、外科的ドレナージへのconversionの時期を含め、常に外科と内科で密にディスカッションを行い、患者にとってもっともよい治療法を施設として選択できるように取り組むことが肝要である。(著者抄録)

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記述言語：日本語   出版者・発行元：日本膵臓学会  

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記述言語：日本語   出版者・発行元：(有)科学評論社  

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記述言語：日本語   出版者・発行元：医学図書出版(株)  

胆管挿管をマスターすることは内視鏡的逆行性胆管膵管造影(ERCP)関連主義の基本中の基本である。胆管挿管の基本は、乳頭部の形態が千差万別であり全く同じものは一つとして存在しないことをまず認識し、これまでに多くの先人が胆管挿管に対する検討を行い、蓄積してきた多くの知見を学び、対峙した乳頭の形態、大きさ、口側隆起の形態から乳頭内の胆管と膵管の合流形式を予想し、その症例でとりうるスコープポジションと胆管挿管との兼ね合いを理解し、難渋することも頭に入れ、挿管のストラテジーを組み立てることが挿管成功率の向上につながり、挿管困難症例克服の重要な鍵となる。すべての処置を愛護的に行うことは言うまでもなく、ERCP歴がある症例はスコープの挿入前に上記内容を把握することが胆管挿管成功につながることは言うまでもなく遂行すべきである。(著者抄録)

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記述言語：日本語   出版者・発行元：医学図書出版(株)  

内視鏡的逆行性胆管膵管造影(ERCP)における胆管挿管困難例、とくに乳頭の固定がゆるい症例において、膵管ガイドワイヤー法(PGW法)の有用性が報告されているが、それでも胆管挿管が困難な症例も経験される。そのような症例に対してわれわれはUDLC(uneven double lumen cannula)を用いた胆管挿管法を開発し、良好な挿管率を得ている(uneven method)。UDLCは0.025インチと0.035インチの内腔をもつdouble lumen catheterであるが、先端細径化のために開口部が段違い(uneven)になっている。この特性を利用し、膵管に留置したガイドワイヤー誘導下に挿入したUDLCで乳頭を固定し、手前のlumenから胆管開口部をWGC(wire-guided cannulation)の要領で探り胆管挿管を行う手法である。Uneven methodは通常のPGW法で経験される、ガイドワイヤーが邪魔で胆管挿管へのアプローチ開始に時間を要することがなく、ガイドワイヤーでなくカテーテルで乳頭を固定するため、PGW法よりも固定力に優れている特徴がある。本稿ではuneven methodについて解説し、実際の処置、コツをビデオで供覧する。(著者抄録)

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記述言語：日本語   出版者・発行元：(株)東京医学社  

胆道狭窄、膵管狭窄に対して行われるプラスチックステントによる経乳頭的ドレナージ術は内視鏡的胆膵疾患治療の中心となる治療であるが、時にステントの迷入を経験する。しかし迷入ステント回収専用のデバイスは少なく、迷入ステント回収目的には作られていない既存のデバイスを工夫しながら使用して対応する必要がある。このため各デバイスの特徴を理解し、さまざまな工夫を知識としてもちあわせているかどうかが成否を分ける。回収に難渋することも少なくなく、その場合は外科的処置の適応になる場合もあり、迷入ステントの対応は非常に重要である。そもそもステント迷入が起きないような、病態にあった適切なステントの選択と留置技術が最も重要であるが、それでもステント迷入に遭遇することはあり、その際に適切に対処できるように常々シミュレーションしておく必要がある。(著者抄録)

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記述言語：日本語   出版者・発行元：日本胆道学会  

本症例は、胆嚢腺筋腫症におけるRokitansky-Aschoff sinus(RAS)内に進展し、一部で浸潤を認めるpT2(SS)胆嚢癌の1例である。胆嚢内にpolypoidに増殖する乳頭型腫瘍を呈し、内部で領域性に異なる増殖パターンを呈した。病理学的に、乳頭型腺癌の組織像を呈し、不整な乳頭腺管状構築をとりながら増殖している領域と充実性の構造を示し、密な腫瘍細胞の増殖を認める領域に分かれていた。造影ハーモニックEUSでは、腫瘤は造影早期より腫瘍血管構造が描出された後、均一かつ強く濃染される領域と少し遅れて内部に太く蛇行する異常血管が緩徐に造影され、その後不均一に造影される領域に2分された。本症例の胆嚢癌は、異なる組織成分の存在を示唆する興味深い造影ハーモニックEUS画像を呈した。(著者抄録)

DOI： 10.11210/tando.32.775

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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  

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記述言語：日本語   出版者・発行元：(株)東京医学社  

膵管内乳頭粘液性腫瘍(IPMN)を疑う病変に対する初回精査として、腹部造影CTや磁気共鳴胆道膵管造影(MRCP)が用いられる。IPMNと診断されれば、次にhigh-risk stigmataやworrisome featureなどの悪性を示唆する所見の有無に関する診断が重要となる。IPMN/MCN国際診療ガイドライン2012年版(GL2012)では、worrisome featureを有する分枝型IPMNに対しては、超音波内視鏡(EUS)による精査が推奨されている。EUSにて悪性を疑う所見がなければ、経過観察の方針となる。GL2012年では、EUSによる経過観察の対象は、嚢胞径2cm以上の分枝型IPMNである。このように比較的大きな病変に対しては、IPMNの詳細な観察が可能なEUSを用いる方針となっている。一方、IPMNの経過観察を行ううえではIPMN併存膵癌の発生にも注意を要する。経過観察群からのIPMN併存膵癌の診断においても、EUSは重要性の高い検査であると考えられる。IPMN併存膵癌の発生の可能性を考慮した場合、EUSによる経過観察の対象や検査間隔については再考の余地がある。本当にリスクの高い症例に対して積極的にEUSを行うこと、これが未来のIPMNの経過観察の形になるであろう。(著者抄録)

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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  

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記述言語：日本語   出版者・発行元：(株)東京医学社  

近年、interventional EUSの進歩は著しく、多くの関連手技が胆膵疾患に臨床応用されている。その一つに、EUS下吸引生検術を応用したEUSガイド下胆嚢ドレナージ術(EUS-GBD)があり、「急性胆管炎・胆嚢炎診療ガイドライン2013」にも急性胆嚢炎に対するドレナージ治療の一つとして記載されている。EUS-GBDは当初、予後の限られた手術適応外の悪性腫瘍関連急性胆嚢炎に対して行われていたが、その後、通常の胆石胆嚢炎の術前ドレナージとしても、経皮経肝胆嚢ドレナージ術(PTGBD)と同等の有用性がランダム化比較試験(RCT)で示され、その適応は拡がりをみせている。しかし、依然、確立された適応、手技内容はなく、偶発症は重篤な経過をとる可能性があり、現時点ではEUS-GBDは限られた施設のみが行う特殊な治療となっている。今後、手技の確立・デバイスの更なる改良により、EUS-GBDが急性胆嚢炎治療のオプションとして一般化していくことが期待される。(著者抄録)

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記述言語：日本語   出版者・発行元：医学図書出版(株)  

メタルステントによる胆管ドレナージには、胆管へのアクセス、ステントの種類・長さの決定、デリバリーシステム挿入、ステント展開のステップがある。メタルステントには多種多様な構造があるが、その目的に応じて使い分ける。切除不能悪性胆管閉塞に対するドレナージには開存期間の長いステントが、術前ドレナージ・良性狭窄改善目的の場合にはステント抜去の行いやすいステントが望まれる。狭窄部までの距離・ステントの短縮率を考慮して、ステント長・位置決めを行い、助手と術者は息を合わせながら展開する。悪性肝門部胆管閉塞の対する両葉ステンティングには、パーシャル・ステント・イン・ステント法とサイド・バイ・サイド法があり、遠位胆管胆管閉塞に対するステンティングと比較すると高度な技術が必要である。(著者抄録)

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記述言語：日本語   出版者・発行元：医学図書出版(株)  

「急性胆管炎・胆嚢炎診療ガイドライン2013」において急性胆嚢炎に対するドレナージ治療の一つとして、EUS下吸引生検術を応用したEUS下胆嚢ドレナージ術(EUS-GBD)がある。胃前庭部もしくは十二指腸球部より胆嚢を穿刺し、穿刺後に胆嚢内を生理食塩水にて洗浄する。続いてガイドワイヤーを留置し穿刺孔を拡張する。最後に両端ピッグテイルステントもしくは金属カバーステントを留置する。症例報告ではあるが、手技成功率は97〜100%、臨床症状改善率は100%と概ね良好な結果が得られており、今後、経皮的経肝胆嚢ドレナージ術、経乳頭的胆嚢ドレナージ術と同等の治療効果が期待できる方法として注目される手技である。(著者抄録)

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会議種別：シンポジウム・ワークショップ パネル（公募）  

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会議種別：ポスター発表  

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会議種別：シンポジウム・ワークショップ パネル（公募）  

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会議種別：口頭発表（一般）  

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会議種別：ポスター発表  

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会議種別：ポスター発表  

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会議種別：シンポジウム・ワークショップ パネル（公募）  

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会議種別：シンポジウム・ワークショップ パネル（公募）  

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会議種別：口頭発表（一般）  

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開催地：大阪国際交流センター, 大阪  

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会議種別：シンポジウム・ワークショップ パネル（公募）  

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会議種別：シンポジウム・ワークショップ パネル（公募）  

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会議種別：シンポジウム・ワークショップ パネル（公募）  

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