記述言語：英語  

DOI： 10.1159/000550396

Web of Science

PubMed

記述言語：英語  

DOI： 10.1159/000550811

PubMed

記述言語：日本語   出版者・発行元：一般社団法人 日本消化器内視鏡学会  

<p>十二指腸乳頭部腫瘍もしくは十二指腸乳頭を巻き込んだ腫瘍に対するESDは非常に先進的な治療である．十二指腸ESDというだけでも十分に高難度な治療である事に加えて，Oddi括約筋の切除，その後の胆管膵管開口部へのカニュレーション，治療後のドレナージなどのマネジメントも必要であり，基本的には十二指腸の解剖学的構造の特徴や適切な周術期管理を理解したhigh volume centerで行うべき治療である．しかし，外科切除と比較して侵襲性は低く，適切にマネジメントを行えば安全性も十分担保できる治療法である．治療手技の実際に文献的考察を加えて解説する．</p>

DOI： 10.11280/gee.68.240

CiNii Research

記述言語：日本語   出版者・発行元：一般社団法人　日本胆道学会  

<p>当院では2020年から20mm以上の側方進展を有する乳頭部腫瘍に対し水圧法を用いた内視鏡的粘膜下層剥離術（WP-ESD）を行っているが，癌症例に対する有効性は明らかでない．本研究はT1a（M）までの乳頭部癌76例を対象に，内視鏡的乳頭切除術（EP）群70例とWP-ESD群6例の治療成績を検討した．R0切除率はEP群44%，WP-ESD群83%，垂直断端陰性はEP群で54%，WP-ESD群で100%で得られた．偶発症は両群で同程度（約16%）であり，全て保存的に軽快した．症例全体の腫瘍陰転化率は89.6%，内視鏡腫瘍制御率は80%，追加手術施行率は11%，疾患特異的生存率は100%であった．早期乳頭部癌に対する内視鏡治療の成績は良好で，WP-ESDは偶発症を増加させず高いR0切除率が得られた．高難易度で時間もかかるが，側方進展例に有用と考えられ，更なる症例集積と長期予後の検証が期待される．</p>

DOI： 10.11210/tando.39.604

CiNii Research

出版者・発行元：JAMA Cardiology  

Importance: Antithrombotic therapy is crucial for older patients with coronary artery disease (CAD) and atrial fibrillation (AF) who are at a high risk of bleeding and thrombotic events. Objective: To examine the age-stratified effects of rivaroxaban monotherapy compared with those of rivaroxaban plus antiplatelet agent combination therapy. Design, Setting, and Participants: This was a post hoc secondary analysis of the Atrial Fibrillation and Ischemic Events With Rivaroxaban in Patients With Stable Coronary Artery Disease (AFIRE) open-label randomized clinical trial. This was a multicenter study conducted in Japan from February 23, 2015, to July 31, 2018. Patients with AF and stable CAD who had undergone percutaneous coronary intervention or coronary artery bypass grafting 1 or more years earlier or who had angiographically confirmed CAD that did not require revascularization were enrolled. Participants were stratified into 4 groups by age (<70 years, 70-74 years, 75-79 years, and ≥80 years). Study data were analyzed from August 2024 to July 2025. Interventions: Rivaroxaban monotherapy or rivaroxaban plus antiplatelet agent therapy. Main Outcomes and Measures: The primary efficacy end point was a major adverse cardiovascular event, defined as a composite of stroke, systemic embolism, myocardial infarction, unstable angina requiring revascularization, or death from any cause. The primary safety end point was major bleeding. Results: This study included a total of 2215 participants (mean [SD] age, 74.3 [8.2] years; 1751 male [79.1%]). The incidence of primary efficacy end points per patient-year for rivaroxaban monotherapy vs rivaroxaban plus antiplatelet agent therapy was 3.2% vs 4.3% (<70 years), 3.2% vs 2.8% (70-74 years), 3.8% vs 5.3% (75-79 years), and 6.2% vs 10.3% (≥80 years). The hazard ratios were 0.74 (95% CI, 0.40-1.37) for those younger than 70 years, 1.16 (95% CI, 0.55-2.45) for those aged 70 to 74 years, 0.72 (95% CI, 0.41-1.26) for those aged 75 to 79 years, and 0.61 (95% CI, 0.40-0.93) for those 80 years and older (P for interaction =.51). For the primary safety end points, the incidence was 0.5% vs 2.3% (<70 years), 2.2% vs 2.4% (70-74 years), 1.1% vs 2.1% (75-79 years), and 2.9% vs 4.3% (≥80 years). The hazard ratios were 0.23 (95% CI, 0.06-0.79) for those younger than 70 years, 0.91 (95% CI, 0.39-2.15) for those aged 70 to 74 years, 0.52 (95% CI, 0.19-1.42) for those aged 75 to 79 years, and 0.67 (95% CI, 0.35-1.27) for those 80 years and older (P for interaction =.33). Conclusions and Relevance: Results of this post hoc analysis of the AFIRE randomized clinical trial reveal that rivaroxaban monotherapy reduced the risk of major cardiovascular events and major bleeding across the broad range of age in patients with AF and stable CAD. Possible age-related differences in trends, with more pronounced efficacy in older patients and more pronounced safety in younger patients, should be considered as hypothesis generating and require further research.

DOI： 10.1001/jamacardio.2025.2611

Scopus

記述言語：英語   出版者・発行元：Esophagus  

Objectives: Since the efficacy of salvage photodynamic therapy (PDT) for locally recurrent esophageal cancer after definitive chemoradiotherapy (CRT) was proven for the first time in an investigator-initiated clinical trial, various reports have supported the clinical utility of PDT for these lesions. However, the clinical trial had limited indications, including a luminal circumference of ≤1/2, maximum longitudinal lesion length of 3 cm, and no invasion into the cervical esophagus, and there have been few reports of treatment outcomes for lesions exceeding the indications used in the investigator-initiated clinical trial. Therefore, this study was performed to assess the outcomes of treating lesions exceeding the above indications. Methods: We retrospectively enrolled 34 consecutive esophageal cancer patients with 38 lesions who underwent PDT with talaporfin sodium. Lesions were classified as meeting (within-indications group; 23 patients, 25 lesions) or exceeding (beyond-indications group; 11 patients, 13 lesions) the indications in the investigator-initiated clinical trial. The local complete response rate (L-CR), overall survival (OS), progression-free survival (PFS), and incidence of PDT-related adverse events were compared between the groups. Results: The L-CR rate was 88.0 and 92.3% in the within- and beyond-indications groups, respectively. The 2-year OS rate was 69.5% and 90.0% and the 2-year PFS rate was 43.3 and 56.6% in the within- and beyond-indications groups, respectively. In terms of adverse events, there were no serious adverse events in either group. Conclusion: Salvage PDT might be effective for local recurrence after CRT for lesions exceeding the indications in the investigator-initiated clinical trial.

DOI： 10.1007/s10388-025-01134-7

Web of Science

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PubMed

記述言語：英語   出版者・発行元：Journal of Hepato Biliary Pancreatic Sciences  

Background and Study Aim: Endoscopic papillectomy (EP) is widely performed for avoiding high-risk surgeries. However, recurrence rates are high, and lateral extension is a risk for recurrence. With endoscopic submucosal dissection (ESD), even lesions with lateral extensions are able to be en bloc resected, and may reduce that risk. The aim of this study is to validate the adequacy and safety of the new strategy. Patients and Methods: This is an exploratory observational study with prospective case enrollment and retrospective analysis. Inclusion criteria: patients aged 20–85 years with a diagnosis of ampullary tumor or superficial nonampullary duodenal epithelial tumors extending into papilla, and endoscopically resected between December 2020 and April 2023. EP was performed with a lateral extension of < 20 mm, and ESD was performed with 20 mm or more, and the validity of these strategies was verified. Results: In total, 40 patients were enrolled, 29 EP and 11 ESD underwent. The en bloc resection rate was 95% (38/40) and endoscopic control was 97.5% (39/40). Adverse events were observed in 27.5% (11/40), with no significant difference in both groups. No serious adverse event was observed. Conclusions: This strategy based on lateral extension performed very well, and ESD is a useful treatment.

DOI： 10.1002/jhbp.12165

Open Access

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Scopus

PubMed

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

Background and Aim: Resection of non-ampullary duodenal neuroendocrine tumors presents technical challenges. This study investigated the efficacy and safety of endoscopic mucosal resection using an over-the-scope clip compared to endoscopic mucosal resection with a ligation device and endoscopic submucosal dissection. Methods: This retrospective multicenter study included 65 lesions (63 patients), categorized by resection method: endoscopic mucosal resection using an over-the-scope clip (n = 26), endoscopic mucosal resection using a ligation device (n = 17), and endoscopic submucosal dissection (n = 22). Patient characteristics, tumor details, and outcomes were systematically evaluated, with significance at p < 0.05. Results: Endoscopic mucosal resection using an over-the-scope clip had a significantly shorter procedure time than endoscopic submucosal dissection (16 min [7–30] vs. 60 min [28–119], p < 0.001) and recorded no perforations. Endoscopic mucosal resection using a ligation device was employed for smaller lesions, while endoscopic submucosal dissection had challenges in achieving clear margins. Hospitalization duration was the longest for the endoscopic submucosal dissection group (endoscopic mucosal resection using an over-the-scope clip: 4 [3–7] days, endoscopic mucosal resection using a ligation device: 5 [4–8] days, endoscopic submucosal dissection: 7 [4–15] days, p < 0.001). Endoscopic mucosal resection using an over-the-scope clip exhibited a unique advantage for full-thickness resection. Conclusions: Endoscopic mucosal resection using an over-the-scope clip allows for full-thickness resection with fewer complications. While effective, endoscopic mucosal resection using a ligation device is less reliable for achieving clear vertical margins, and endoscopic submucosal dissection, suitable for larger tumors, has a longer duration and higher complication rate.

DOI： 10.1111/jgh.17005

Open Access

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Scopus

PubMed

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

Shear wave elastography provides quantitative data on tissue stiffness, but was not available for endoscopic ultrasound until recently. The present study investigated the utility of a newly developed endoscopic ultrasound-guided shear wave measurement for diagnosing upper gastrointestinal subepithelial lesions. Shear wave velocity (Vs) was measured as an indicator of tissue stiffness, and the total amount of effective shear waves (VsN) was used as a reliability index for Vs values obtained by endoscopic ultrasound-guided shear wave measurements. Among the Vs values obtained, the five with the highest VsN were selected, and their median was defined as the median Vs (Vs-med). The median VsN of the five Vs values was defined as the median VsN (VsN-med). Endoscopic ultrasound-guided shear wave measurements were performed on 23 patients, with no complications occurring in any procedure. Histopathological diagnoses included 12 gastrointestinal stromal tumors, seven leiomyomas, and four schwannomas. Vs-med values for gastrointestinal stromal tumors, leiomyomas, and schwannomas were 2.46, 1.73, and 2.85 m/s, respectively, indicating that gastrointestinal stromal tumors and schwannomas were significantly stiffer than leiomyomas. VsN-med values for gastrointestinal stromal tumors, leiomyomas, and schwannomas were 40.5, 39, and 35.5%, respectively, with no significant differences. Endoscopic ultrasound-guided shear wave measurements are feasible for upper gastrointestinal subepithelial lesions and allow for the objective, non-invasive quantification of lesion stiffness. These results suggest the potential of endoscopic ultrasound-guided shear wave measurements as a valuable tool for the differential diagnosis of upper gastrointestinal subepithelial lesions.

DOI： 10.18999/nagjms.87.3.462

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Scopus

PubMed

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

Understanding the complex interplay between intestinal microbiomes and ampullary tumors is crucial for distinguishing between adenomas and carcinomas, especially when considering the role of Fusobacterium. We characterized the microbiome associated with ampullary tumors using samples collected from the tumor surface (tumor samples, TSs) and surrounding normal duodenal mucosa (normal samples, NSs) via brush rubbing. In total, samples from 17 patients, divided into an adenoma group (n = 11) and a carcinoma group (n = 6), were analyzed. The Shannon α-diversity index was significantly higher in the carcinoma group compared with the adenoma group, indicating a more diverse bacterial community in the carcinoma environment. The TSs of the carcinoma group exhibited enrichment of Fusobacterium, Leptotrichia, Methylorubrum, and Micrococcus. The relative abundance of Fusobacterium increased as the tumor progressed. The NSs of the carcinoma group showed a higher presence of Fusobacterium, Porphyromonas, Granulicatella, Rikenellaceae RC9 gut group, and Solobacterium, whereas Bergeyella was more prevalent in the adenoma group. These results suggest that ampullary carcinomas exhibit a characteristic microbiome compared to adenomas. Fusobacterium is enriched in the tumor and surrounding normal duodenal mucosa, increases in abundance as the tumor progresses, and may be associated with ampullary tumors.

DOI： 10.1038/s41598-025-99899-5

Open Access

Web of Science

Scopus

PubMed

記述言語：英語  

DOI： 10.17235/reed.2025.11237/2025

PubMed

記述言語：英語   出版者・発行元：Revista Espanola De Enfermedades Digestivas  

Suturing of a mucosal defect after gastric endoscopic submucosal dissection (ESD) reduces the incidence of adverse events and shortens hospitalization. However, post-ESD mucosal defects are circular, large, and with a thick mucosal layer, which are difficult to suture using conventional clips alone. The MANTIS Clip (Boston Scientific Japan, Tokyo, Japan) is a reopenable, rotatable through-the-scope clip designed for large defect closure. It uses anchor prongs to securely grasp wound edges. The initial use of the MANTIS Clip significantly reduces mucosal defects, which then allows for easy suturing with conventional clips. We herein report a case in which the MANTIS Clip was useful for suturing a mucosal defect after gastric ESD.

DOI： 10.17235/reed.2023.10120/2023

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Scopus

PubMed

記述言語：英語   出版者・発行元：Therapeutic Advances in Gastroenterology  

Background: Crohn’s disease (CD) is a chronic inflammatory bowel disease. Monitoring the disease activity and providing appropriate treatment are essential for improving long-term prognosis. Endoscopy remains the gold standard for assessing disease activity; however, it is invasive and costly. Recently, we identified gelsolin as a promising serum biomarker for endoscopic disease activity in ulcerative colitis. Objective: To investigate serum gelsolin levels as a potential biomarker for mucosal activity in the small bowel and colon of patients with CD. Furthermore, we aimed to compare the performance of gelsolin with that of C-reactive protein (CRP) in detecting mucosal activity. Design: A retrospective observational study at a single tertiary care center. Methods: Serum gelsolin and CRP were measured in 82 patients with CD and 16 healthy controls. Endoscopic disease activity was assessed using the Applied Simple Endoscopic Score for CD (aSES-CD). We conducted receiver operating characteristic curves and correlation analyses. In addition, subgroup analyses were performed to evaluate differences in the biomarker performance between ileal and ileocolonic types of CD. Results: Serum gelsolin levels were significantly lower in patients with CD than in healthy controls (p < 0.001). Gelsolin levels were negatively correlated with aSES-CD, particularly in patients with the ileocolonic-type CD, and showed a stronger correlation with endoscopic activity than CRP. The area under the curve for gelsolin was 0.8377, with a cutoff of 13 µg/mL, yielding 75% and 83% sensitivity and specificity, respectively. Conclusion: Serum gelsolin is a prospective noninvasive biomarker that outperforms CRP in detecting endoscopic disease activity in patients with ileocolonic-type CD.

DOI： 10.1177/17562848251362570

Open Access

Web of Science

Scopus

PubMed

記述言語：英語   出版者・発行元：Revista Espanola De Enfermedades Digestivas  

Ectopic pancreas (EP) is defined as pancreatic tissue that lacks anatomical or vascular connections to the normal pancreas. EP is generally asymptomatic and is detected incidentally during endoscopy. However, due to pseudocyst formation, inflammation, or malignant transformation, it may cause non-specific gastrointestinal symptoms, such as abdominal pain, abdominal discomfort, nausea, vomiting, and bleeding. Pseudocyst formation in EP may result from the retention of exocrine secretions in the absence of connections between the glandular epithelium and gastric lumen. We herein report a case of EP with a pseudocyst associated with epigastric pain. EP with a pseudocyst, although rare, needs to be considered in a differential diagnosis of cystic lesions of the stomach.

DOI： 10.17235/reed.2024.10339/2024

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Scopus

PubMed

記述言語：英語   出版者・発行元：Revista Espanola De Enfermedades Digestivas  

When performing endoscopic submucosal dissection (ESD) beyond stenoses, there have only been two choices: balloon dilation until a conventional therapeutic endoscope passes through or the use of an ultrathin endoscope. However, balloon dilation has a risk of perforation and an ultrathin endoscope limits the devices that may be used. The novel thin-therapeutic endoscope has an outer diameter of 7.9 mm and instrument channel diameter of 3.2 mm; therefore, there are no restrictions on the ESD device that may be used, and the procedure may be performed in the same manner as regular ESD. We herein report a case in which the thin-therapeutic endoscope was useful for esophageal ESD beyond a stenosis.

DOI： 10.17235/reed.2023.10118/2023

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Scopus

PubMed

記述言語：英語   出版者・発行元：Revista Espanola De Enfermedades Digestivas  

Introduction: the PillCam™ patency capsule is useful to prevent capsule endoscope retention; however, visual confirmation of patency capsule excretion is challenging for many patients. Objective: we investigated the factors related to the patency capsule remaining in the colon after 33 hours and the factors hindering the visual confirmation of its excretion. Methods: we retrospectively analyzed 498 patients with intestinal patency who underwent patency capsule examination. Patients were categorized into the “excretion group” and “colon group,” depending on whether the capsule was excreted or remained in the colon after 33 hours, respectively. Patients were further classified into self-confirmed and non-self-confirmed groups within the excretion group. Univariate and multivariate logistic regression analyses were used to analyze the factors associated with the colon and non-self-confirmed groups. Results: overall, 49 % of patients visually confirmed capsule excretion within 33 hours, whereas 51 % did not and required radiological examination. Among those without capsule excretion, 34 % of patients had a detectable capsule in the colon, whereas 16 % had no detectable capsule. In the excretion group, 75 % and 25 % of patients were self-confirmed and non-self-confirmed, respectively. Female sex, inpatient status, constipation, and capsule in the colon during the previous examination were independent factors associated with the colon group. Male sex and younger age were the independent factors associated with the non-self-confirmed group. Conclusions: our findings highlight the need for new approaches to facilitate patency capsule excretion to avoid radiation exposure, especially in females, inpatients, those with constipation, and those with capsule remaining in the colon from the previous examination.

DOI： 10.17235/reed.2024.10706/2024

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PubMed

記述言語：英語   出版者・発行元：Endoscopy  

DOI： 10.1055/a-2353-5973

Open Access

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Scopus

PubMed

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

Small bowel stenosis in patients with Crohn’s disease leads to abdominal symptoms and can affect prognosis. The Simple Endoscopic Score for Crohn’s Disease for the large bowel has been applied to the small bowel; however, stenosis scoring may be overestimated since it has a long diameter. This retrospective study aimed to devise a new endoscopic scoring system including the small bowel and evaluate whether it predicts the prognosis of Crohn’s disease. The study included 103 patients with Crohn’s disease at our hospital. We modified the Simple Endoscopic Score for Crohn’s Disease and proposed a new scoring system; the modified applied Simple Endoscopic Score for Crohn’s Disease was created by subtracting one point for stricture from the Simple Endoscopic Score for Crohn’s Disease. Receiver operating characteristic curve analysis was performed to assess the accuracy of the modified applied score for Crohn’s disease in predicting disease worsening within 1 year. Results were validated using the log-rank test. For the modified applied score, the area under the receiver operating characteristic curve for disease worsening within 1 year in 57 cases was 0.850. When the cutoff score was set to 9 points, the sensitivity and specificity were 72.7% and 80.6%, respectively. The log-rank test showed a significant difference (P = 0.027) in the risk of worsening within 1 year between the low (<9 points) and high (≥9 points) score groups. Thus, a higher modified applied Simple Endoscopic Score for Crohn’s Disease may be associated with a significantly increased risk of disease worsening within 1 year.

DOI： 10.18999/nagjms.86.4.608

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Scopus

PubMed

出版者・発行元：Journal of Antimicrobial Chemotherapy  

Objectives: Area under the concentration–time curve (AUC)–guided dosing of vancomycin was introduced in a clinical setting; however, the target range of non–steady-state AUCs, such as Day 1 AUC and Day 2 AUC, remains controversial. Therefore, we sought to determine pharmacokinetic parameter thresholds and identify independent risk factors associated with acute kidney injury (AKI) to establish a safe initial dosing design for vancomycin administration. Methods: A single-centre, retrospective, cohort study of hospitalized patients treated with vancomycin was conducted to determine the threshold of both non–steady-state AUCs (Day 1 and 2 AUCs) and trough levels at the first blood sampling point (therapeutic drug monitoring, TDM). In addition, independent risk factors associated with AKI were evaluated using univariate and multivariate logistic regression analyses. Results: The thresholds for predicting AKI were estimated as 456.6 mg·h/L for AUC<inf>0-24h</inf>, 554.8 mg·h/L for AUC<inf>24-48h</inf>, 1080.8 mg·h/L for AUC<inf>0-48h</inf> and 14.0 μg/mL for measured trough levels, respectively. In a multivariate analysis, Day 2 AUC ≥ 554.8 mg·h/L [adjusted odds ratio (OR), 57.16; 95% confidence interval (CI), 11.95–504.05], piperacillin/tazobactam (adjusted OR, 15.84; 95% CI, 2.73–127.70) and diuretics (adjusted OR, 4.72; 95% CI, 1.13–21.01) were identified as risk factors for AKI. Conclusions: We identified thresholds for both AUCs in the non–steady-state and trough levels at the first TDM. Our results highlight the importance of monitoring not only the AUC but also trough levels during vancomycin treatment to reduce the likelihood of AKI.

DOI： 10.1093/jac/dkae249

Scopus

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

Introduction: Superficial non-ampullary duodenal epithelial tumors (SNADETs) include low-grade adenoma (LGA) and high-grade adenoma or carcinoma (HGA/Ca) and are classified into two different epithelial subtypes, gastric-type (G-type) and intestinal-type (I-type). We attempted to distinguish them by endoscopic characteristics including magnifying endoscopy with narrow-band imaging (M-NBI). Methods: Various endoscopic and M-NBI findings of 286 SNADETs were retrospectively reviewed and compared between G- and I-types and histological grades. M-NBI findings were divided into four patterns based on the following vascular patterns; absent, network, intrastructural vascular (ISV), and unclassified. Lesions displaying a single pattern were classified as mono-pattern and those displaying multiple patterns as mixed-pattern. Lesions showing CDX2 positivity were categorized as I-types and those showing MUC5AC or MUC6 positivity were categorized as G-types based on immunohistochemistry. Results: Among 286 lesions, 23 (8%) were G-type and 243 (85%) were I-type. More G-type lesions were located oral to papilla (91.3 vs. 45.6%, p < 0.001), and had protruding morphology compared to those of I-types (65.2 vs. 14.4%, p < 0.001). The major M-NBI pattern was ISV in G-type (78.2 vs. 26.3%, p < 0.001), and absent for I-type (0 vs. 34.5%, p = 0.003). Three endoscopic characteristics; location oral to papilla, protruding morphology, and major M-NBI pattern (ISV) were independent predictors for G-type. Mixed-pattern was more common in HGA/Ca than LGA for I-type (77.0 vs. 58.8%, p = 0.01); however, there was no difference for those in G-type. Conclusion: Endoscopic findings including M-NBI are useful to differentiate epithelial subtypes.

DOI： 10.1159/000539308

Open Access

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PubMed

記述言語：英語   出版者・発行元：Digestion  

Introduction: Crohn's disease (CD) induces persistent inflammation throughout the gastrointestinal (GI) tract, potentially resulting in complications such as intestinal stenosis and fistulas, particularly in the small bowel. Small bowel capsule endoscopy (SBCE) is recommended for monitoring CD, especially when GI tract patency is maintained. This study aimed to retrospectively assess patients with CD who underwent SBCE to determine the timing of clinical changes and address the current lack of evidence regarding GI tract patency loss during CD treatment. Methods: Of the 166 consecutive patients who underwent SBCE at our institution, 120 were followed up and included in this study. Forty-six patients were excluded due to colitis type or immediate treatment changes post-SBCE. This study focused on the primary and secondary endpoints, including the cumulative stricture-free rate of the GI tract, emergency hospitalization post-SBCE, and post-SBCE treatment strategies, at the discretion of the attending physicians. Results: Demographic data revealed that the mean age of the study population was 43 years and that there was a male predominance (75%). The median disease duration was 12 years and themean Crohn's Disease Activity Index was 98. During a 1,486- day observation period, 37% of patients experienced treatment changes. A Lewis score of >264 and perianal lesions were identified as independent risk factors for additional treatment needs. Emergency hospitalization occurred in 6% of patients and GI patency failure in 11%. Female sex and Lewis score >264 were associated with higher risks. GI patency rate declined 2 years after SBCE. Conclusions: For patients who experienced no treatment changes based on SBCE results, it is recommended to undergo SBCE monitoring at intervals of no longer than 2 years.

DOI： 10.1159/000539745

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PubMed

記述言語：英語   出版者・発行元：Digestion  

Introduction: Inflammation in ulcerative colitis (UC) originates in the colorectal mucosa. Transcriptome sequencing analysis of the colorectal mucosa allows the identification of potential neuropeptides related to local neurotransmission. The intestinal mucus lining the surface of the mucosa may harbor biomarkers of mucosal inflammation; however, this has not been sufficiently investigated, given the difficulty in obtaining human samples. We previously reported the feasibility of obtaining mucin samples for proteomic analysis by brushing during colonoscopy. Herein, we aimed to investigate the composition of the intestinal mucus and detect neuropeptides characteristic of UC. Methods: Mucus and mucosal samples were collected from patients with UC from the colorectum in areas showing remission or active UC using a brush catheter and biopsy forceps during colonoscopy. RNA sequencing findings of mucus samples of active and remission areas were compared. RNA and protein expression levels of significantly upregulated neuropeptides were analyzed. Results: Of the neuropeptides associated with UC, somatostatin (SST) was significantly elevated in areas of remission, according to RNA sequencing results of mucus and expression levels in mucus RNA and proteins. Conversely, SST expression in the mucosa was increased in the inflamed areas. Flow cytometry revealed that the fluorescence intensity of SST-positive cells in the remission zone was higher in the mucus than in the mucosa. Conclusion: SST expression in the mucus is considered to be an important factor associated with UC activity.

DOI： 10.1159/000540052

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PubMed

記述言語：英語   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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PubMed

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

Introduction: Recently, the detection of superficial nonampullary duodenal epithelial tumors (SNADETs) including adenomas and superficial duodenal carcinomas has increased. Various endoscopic treatment methods have also been reported for SNADETs, but there are few reports on the natural history. The aim of this study was to analyze factors related to tumor growth and determine the characteristics of SNADETs which need early therapeutic intervention. Methods: A single-center, retrospective study was performed on the medical records of 309 patients with SNADETs who underwent endoscopic or surgical resection between January 2010 and May 2021. Of these, 41 patients who were followed up for more than 1 year by endoscopy were analyzed. The primary outcome was an analysis of the tumor growth speed. Secondary outcomes were the relationship between the tumor growth speed and mucin phenotype, tumor size and findings of magnifying endoscopy with narrow-band imaging (M-NBI). Results: The observation period was 24 months (13.182). Tumor growth speed was 1.1mm/year (0.21.6). Tumor diameter ≥10mmat first detection (p = 0.004; odds ratio 19.5 [2.03.186.96]) and mixed type by M-NBI (p = 0.036; odds ratio 9.69 [1.05.89.88]) were identified as risk factors of tumors growing at a rate of ≥3 mm/year. There was no statistically significant difference in the speed of tumor growth between the different mucin immunohistochemical phenotypes. Conclusion: Initial tumor size and findings of M-NBI are useful to predict tumor growth and consider early intervention.

DOI： 10.1159/000540544

Web of Science

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PubMed

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

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

DOI： 10.1007/s10620-024-08453-2

Open Access

Web of Science

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PubMed

記述言語：英語   出版者・発行元：Digestive and Liver Disease  

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

DOI： 10.1016/j.dld.2024.01.212

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PubMed

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

Background and Aim: Prophylactic closure with the over-the-scope clip (OTSC) after endoscopic submucosal dissection (ESD) of superficial non-ampullary duodenal epithelial tumors (SNADETs) has been reported to reduce postoperative adverse events (AEs). However, there are few evidences regarding AEs-associated factors and long-term outcomes of OTSCs. Methods: From January 2011 to December 2020, 139 consecutive patients with SNADETs who underwent ESD followed by OTSC closure in five institutions were extracted in this retrospective study. The primary endpoint was the rate of postoperative AEs after prophylactic OTSC closure. The secondary endpoints were the complete closure rate, residual rate, and long-term AEs associated with residual OTSCs. Results: The rate of complete closure of the mucosal defect was 97.3% (142) in 146 SNADETs, which were completely resected by ESD. Postoperative AEs, including delayed bleeding, delayed perforation, and localized peritonitis, occurred in 6.2%, 3.4%, and 2.1% of patients, respectively; however, all of the cases improved without surgical treatment. In the multivariate logistic regression analysis, the use of two or more OTSCs was a significant independent risk factor for postoperative AEs (odds ratio, 2.94; 95% confidence interval, 1.02–8.46; P = 0.046). The residual OTSC rate was 46.4% at 1 year postoperatively, and long-term AEs included duodenal erosions and ulcers associated with residual OTSCs. Conclusions: Prophylactic closure with OTSCs after duodenal ESD can provide acceptable short-and long-term outcomes for preventing postoperative AEs. However, multiple OTSCs were the independent risk factors of postoperative AEs due to the gaps between and near the OTSCs.

DOI： 10.1111/jgh.16464

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PubMed

出版者・発行元：株式会社医学書院  

DOI： 10.11477/mf.1407214472

CiNii Research

出版者・発行元：株式会社医学書院  

DOI： 10.11477/mf.1403203399

CiNii Research

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

With the recent increase in the frequency of duodenal tumor detection, significant progress has been made in endoscopic diagnosis and treatment. Although the first guidelines were issued in Japan, patient treatment varies widely among institutions. There is a need for improving the quality of endoscopic diagnosis and more curative and safer treatments. Biopsy is the standard diagnostic method; however, the diagnostic accuracy of endoscopic biopsy is not so high. Therefore, the differentiation of superficial non-ampullary duodenal epithelial tumors from non-neoplastic lesions is being developed. The incidence of lymph node and distant metastases of duodenal epithelial tumors is extremely rare in intramucosal carcinomas, and they are considered good candidates for endoscopic treatment if the technical difficulties can be resolved. Adverse events associated with endoscopic treatment are greatly reduced at advanced facilities through novel resection and closure methods, and further improvements are expected in the future. Clarifying the risk of metastatic recurrence may lead to the development of more appropriate treatments and curative resection criteria.

DOI： 10.1093/jjco/hyad073

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PubMed

記述言語：英語   出版者・発行元：Esophagus  

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

DOI： 10.1007/s10388-022-00963-0

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PubMed

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

Circumferential resection of a >5-cm longitudinal mucosal defect following esophageal endoscopic submucosal dissection (ESD) is a risk factor for refractory stenosis. Circumferential ESD was performed in 3 patients with 64, 69, and 70 mm longitudinal mucosal defects. A local steroid injection was used to treat the postoperative ulcer, followed by an oral steroid. In all three cases, the ulcer healed without the need for endoscopic dilation. A combination of local injection and oral steroids effectively prevented esophageal stenosis in patients with high-risk stenosis after ESD.

DOI： 10.18999/nagjms.85.1.134

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PubMed

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

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

DOI： 10.1159/000522362

Open Access

Web of Science

Scopus

PubMed