研究者詳細 - 河上　洋

論文 - 河上　洋

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High and low negative pressure suction techniques in EUS-guided fine-needle tissue acquisition by using 25-gauge needles: A multicenter, prospective, randomized, controlled trial

Kudo T., Kawakami H., Hayashi T., Yasuda I., Mukai T., Inoue H., Katanuma A., Kawakubo K., Ishiwatari H., Doi S., Yamada R., Maguchi H., Isayama H., Mitsuhashi T., Sakamoto N.

Gastrointestinal Endoscopy 80 ( 6 ) 1030 - 1037.e1 2014年12月

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

© 2014 by the American Society for Gastrointestinal Endoscopy. Background EUS-guided FNA (EUS-FNA) has a high diagnostic accuracy for pancreatic diseases. However, although most reports have typically focused on cytology, histological tissue quality has rarely been investigated. The effectiveness of EUS-FNA combined with high negative pressure (HNP) suction was recently indicated for tissue acquisition, but has not thus far been tested in a prospective, randomized clinical trial. Objective To evaluate the adequacy of EUS-FNA with HNP for the histological diagnosis of pancreatic lesions by using 25-gauge needles. Design Prospective, single-blind, randomized, controlled crossover trial. Setting Seven tertiary referral centers. Patients Patients referred for EUS-FNA of pancreatic solid lesions. From July 2011 to April 2012, 90 patients underwent EUS-FNA of pancreatic solid masses by using normal negative pressure (NNP) and HNP with 2 respective passes. The order of the passes was randomized, and the sample adequacy, quality, and histology were evaluated by a single expert pathologist. Intervention EUS-FNA by using NNP and HNP. Main Outcome Measurements The adequacy of tissue acquisition and the accuracy of histological diagnoses made by using the EUS-FNA technique with HNP. Results We found that 72.2% (65/90) and 90% (81/90) of the specimens obtained using NNP and HNP, respectively, were adequate for histological diagnosis (P =.0003, McNemar test). For 73.3% (66/90) and 82.2% (74/90) of the specimens obtained by using NNP and HNP, respectively, an accurate diagnosis was achieved (P =.06, McNemar test). Pancreatitis developed in 1 patient after this procedure, which subsided with conservative therapy. Limitations This was a single-blinded, crossover study. Conclusion Biopsy procedures that combine the EUS-FNA with HNP techniques are superior to EUS-FNA with NNP procedures for tissue acquisition. (Clinical trial registration number: UMIN000005939.).

DOI： 10.1016/j.gie.2014.04.012

Scopus

Difference from bile duct cancer and relationship between bile duct wall thickness and serum IgG/IgG4 levels in IgG4-related sclerosing cholangitis

Kuwatani M., Kawakami H., Zen Y., Kawakubo K., Kudo T., Abe Y., Kubo K., Sakamoto N.

Hepato-gastroenterology 61 ( 135 ) 1852 - 1856 2014年10月

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：Hepato-gastroenterology

BACKGROUND/AIMS: IgG4-related sclerosing cholangitis (IgG4-SC) is a newly established entity. The purpose of this study was to investigate the differences in intraductal ultrasonography (IDUS) findings between IgG4-SC and bile duct (BD) cancer (BDC) as well as the relationship among BD wall thickness, serological and pathological findings in IgG4-SC. METHODOLOGY: Based on the diagnostic criteria of IgG4-SC, we reviewed patients in our hospital between April 2005 and June 2013, and analyzed the data obtained from 32 patients with IgG4-SC and 40 patients with BDC. RESULTS: Regarding IDUS findings, significantly more cases in BDC indicated rigid/papillary inner margin than in IgG4-SC, while biopsy was more efficient. There were no significant correlations between BD wall thickness and serum IgG/IgG4 levels or the number of IgG4-positive cells of the BD specimens. All the IgG4-SC patients without steroid treatment revealed discordant results in the shifts of IgG, IgG4 and BD wall thickness between the 1st and 2nd examinations, while all patients with steroid had completely concordant results of the shifts. CONCLUSIONS: IDUS findings alone are insufficient for differentiation between IgG4-SC and BDC. BD wall thickness, serum IgG and IgG4 proportionally shift and reflect the effect of steroid on IgG4-SC after steroid treatment, not before it.

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Oncological benefit of preoperative endoscopic biliary drainage in patients with hilar cholangiocarcinoma

Hirano S., Tanaka E., Tsuchikawa T., Matsumoto J., Kawakami H., Nakamura T., Kurashima Y., Ebihara Y., Shichinohe T.

Journal of Hepato-Biliary-Pancreatic Sciences 21 ( 8 ) 533 - 540 2014年8月

記述言語：日本語掲載種別：研究論文（学術雑誌）出版者・発行元：Journal of Hepato-Biliary-Pancreatic Sciences

Due to advances in endoscopic equipment and techniques, preoperative endoscopic biliary drainage (EBD) has been developed to serve as an alternative to percutaneous transhepatic biliary drainage (PTBD). This study sought to clarify the benefit of EBD in comparison to PTBD in patients who underwent radical resections of hilar cholangiocarcinoma. One hundred and forty-one patients underwent radical surgery for hilar cholangiocarcinoma between 2000 and 2008 were retrospectively divided into two groups based on the type of preoperative biliary drainage, PTBD (n = 67) or EBD (n = 74). We investigated if the different biliary drainage methods affected postoperative survival and mode of recurrence after median observation period of 82 months. The survival rate for patients who underwent EBD was significantly higher than those who had PTBD (P = 0.004). Multivariate analysis revealed that PTBD was one of the independent factors predictive of poor survival (hazard ratio: 2.075, P = 0.003). Patients with PTBD more frequently developed peritoneal seeding in comparison to those who underwent EBD (P = 0.0003). PTBD was the only independent factor predictive of peritoneal seeding. In conclusion, EBD might confer an improved prognosis over PTBD due to prevention of peritoneal seeding, and is recommended as the initial procedure for preoperative biliary drainage in patients with hilar cholangiocarcinoma. © 2014 Japanese Society of Hepato-Biliary-Pancreatic Surgery.

DOI： 10.1002/jhbp.76

Scopus

Endoscopic ultrasound-guided transluminal drainage for peripancreatic fluid collections: Where are we now?

Kawakami H., Itoi T., Sakamoto N.

Gut and Liver 8 ( 4 ) 341 - 355 2014年7月

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：Gut and Liver

Endoscopic drainage for pancreatic and peripancreatic fluid collections (PFCs) has been increasingly used as a minimally invasive alternative to surgical or percutaneous drainage. Recently, endoscopic ultrasound-guided transluminal drainage (EUS-TD) has become the standard of care and a safe procedure for nonsurgical PFC treatment. EUS-TD ensures a safe puncture, avoiding intervening blood vessels. Single or multiple plastic stents (combined with a nasocystic catheter) were used for the treatment of PFCs for EUS-TD. More recently, the use of covered self-expandable metallic stents (CSEMSs) has provided a safer and more efficient approach route for internal drainage. We focused our review on the best approach and stent to use in endoscopic drainage for PFCs. We reviewed studies of EUS-TD for PFCs based on the original Atlanta Classification, including case reports, case series, and previous review articles. Data on clinical outcomes and adverse events were collected retrospectively. A total of 93 patients underwent EUS-TD of pancreatic pseudocysts using CSEMSs. The treatment success and adverse event rates were 94.6% and 21.1%, respectively. The majority of complications were of mild severity and resolved with conservative therapy. A total of 56 patients underwent EUS-TD using CSEMSs for pancreatic abscesses or infected walled-off necroses. The treatment success and adverse event rates were 87.8% and 9.5%, respectively. EUS-TD can be performed safely and efficiently for PFC treatment. Larger diameter CSEMSs without additional fistula tract dilation for the passage of a standard scope are needed to access and drain for PFCs with solid debris.

DOI： 10.5009/gnl.2014.8.4.341

Scopus

Safety and utility of single-session endoscopic ultrasonography and endoscopic retrograde cholangiopancreatography for the evaluation of pancreatobiliary diseases 査読あり

Kawakubo K., Kawakami H., Kuwatani M., Haba S., Kudo T., Abe Y., Kawahata S., Onodera M., Ehira N., Yamato H., Eto K., Sakamoto N.

Gut and Liver 8 ( 3 ) 329 - 332 2014年5月

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

Endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) are essential for diagnosing and treating pancreatobiliary diseases. Single-session EUS and ERCP are considered to be essential in reducing the duration of hospital stays; however, complications are a primary concern. The aim of this study was to evaluate the safety and efficacy of single-session EUS and ERCP. Sixty-eight patients underwent single-session EUS and ERCP at a tertiary referral center between June 2008 and December 2012. We retrospectively reviewed patient data from a prospectively maintained EUS-ERCP database and evaluated the procedural characteristics and complications. Thirty-eight patients (56%) underwent diagnostic EUS, and 30 patients (44%) underwent EUS fine-needle aspiration, which had an overall accuracy of 100%. Sixty patients (89%) underwent therapeutic ERCP, whereas the remaining eight procedures were diagnostic. Thirteen patients underwent biliary stone extraction, and 48 underwent biliary drainage. The median total procedural time was 75 minutes. Complications were observed in seven patients (10%). Six complications were post-ERCP pancreatitis, which were resolved using conservative management. One patient developed Mallory-Weiss syndrome, which required endoscopic hemostasis. No sedation-related cardiopulmonary complications were observed. Single-session EUS and ERCP provided accurate diagnosis and effective management with a minimal complication rate.

DOI： 10.5009/gnl.2014.8.3.329

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Multicenter retrospective study of endoscopic ultrasound-guided biliary drainage for malignant biliary obstruction in Japan

Kawakubo K., Isayama H., Kato H., Itoi T., Kawakami H., Hanada K., Ishiwatari H., Yasuda I., Kawamoto H., Itokawa F., Kuwatani M., Iiboshi T., Hayashi T., Doi S., Nakai Y.

Journal of Hepato-Biliary-Pancreatic Sciences 21 ( 5 ) 328 - 334 2014年5月

記述言語：日本語掲載種別：研究論文（学術雑誌）出版者・発行元：Journal of Hepato-Biliary-Pancreatic Sciences

Background Endoscopic ultrasound-guided biliary drainage (EUS-BD) is considered to be an effective salvage procedure for failed endoscopic retrograde cholangiopancreatography in patients with unresectable malignant biliary obstruction. The aim of this retrospective study was to evaluate the efficacy and feasibility of EUS-BD. Methods From November 2006 to May 2012, a total of 64 patients who underwent EUS-BD (44 EUS-guided choledochoduodenostomy [EUS-CDS] and 20 EUS-guided hepaticogastrostomy [EUS-HGS] ) at seven tertiary-care referral centers in Japan were included. The primary outcome was the technical success rate, and the secondary outcomes were the incidence of complications, stent dysfunction rate, time to stent dysfunction, and overall survival. Results The technical success rate for both EUS-CDS and EUS-HGS was 95%. The reasons for technical failure were two failed dilations of the anastomosis in EUS-CDS and one puncture failure in EUS-HGS. The stent dysfunction rate and 3-month dysfunction-free patency rate were 21% and 80% for EUS-CDS and 32% and 51% for EUS-HGS. There were 12 (six in EUS-CDS and six in EUS-HGS) procedure-related complications (19%): five cases of bile leakage (3/2), three stent misplacements (1/2), one pneumoperitoneum (1/0), two cases of bleeding (1/1), one perforation (1/0), and one biloma (0/1). Bile leakage was more frequently observed in patients who underwent plastic stent placement (11%) than in those with covered metal stents (4%). Conclusions This Japanese multicenter study revealed a high success rate in EUS-BD. However, the complication rate was as high as that in previous series. Covered metal stents may be useful to reduce bile leakage in EUS-BD. © 2013 Japanese Society of Hepato-Biliary-Pancreatic Surgery.

DOI： 10.1002/jhbp.27

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Influence of the safety and diagnostic accuracy of preoperative endoscopic ultrasound-guided fine-needle aspiration for resectable pancreatic cancer on clinical performance

Kudo T., Kawakami H., Kuwatani M., Eto K., Kawahata S., Abe Y., Onodera M., Ehira N., Yamato H., Haba S., Kawakubo K., Sakamoto N.

World Journal of Gastroenterology 20 ( 13 ) 3620 - 3627 2014年4月

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

AIM: To evaluate the safety and diagnostic accuracy of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) in a cohort of pancreatic cancer patients. METHODS: Of 213 patients with pancreatic cancer evaluated between April 2007 and August 2011, 82 were thought to have resectable pancreatic cancer on the basis of cross-sectional imaging findings. Of these, 54 underwent EUS-FNA before surgery (FNA+ group) and 28 underwent surgery without preoperative EUSFNA (FNA- group). RESULTS: All 54 lesions were visible on EUS, and all 54 attempts at FNA were technically successful. The diagnostic accuracy according to cyto logy and histology findings was 98.1% (53/54) and 77.8% (42/54), respectively, and the total accuracy was 98.1% (53/54). One patient developed mild pancreatitis after EUS-FNA but was successfully treated by conservative therapy. No severe complications occurred after EUS-FNA. In the FNA+ and FNA- groups, the median relapse-free survival (RFS) was 742 and 265 d, respectively (P = 0.0099), and the median overall survival (OS) was 1042 and 557 d, respectively (P = 0.0071). RFS and OS were therefore not inferior in the FNA+ group. These data indicate that the use of EUS-FNA did not influence RFS or OS, nor did it increase the risk of peritoneal recurrence. Conclusion: In patients with resectable pancreatic cancer, preoperative EUS-FNA is a safe and accurate diagnostic method. © 2014 Baishideng Publishing Group Co., Limited. All rights reserved.

DOI： 10.3748/wjg.v20.i13.3620

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Endoscopic ultrasound-guided rendezvous technique for difficult cannulation into the bile duct

Kawakubo K., Kawakami H., Isayama H., Sakamoto N.

Gastroenterological Endoscopy 56 ( 3 ) 504 - 514 2014年3月

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：Gastroenterological Endoscopy

The endoscopic ultrasound (EUS)-guided rendezvous technique was reported to be a useful salvage method for patients with failed cannulation. In such patients, after bile duct puncture under EUS guidance, cholangiography was obtained. Then the guidewire was inserted through the needle into the bile duct and further antegradely advanced through the papilla into the duodenum. The echoendoscope was removed leaving the guidewire in place, followed by duodenoscope insertion. Finally, the bile duct was cannulated alongside of the guidewire or over the guidewire. The EUS-guided rendezvous technique is a complicated procedure and not yet standardized due to the absence of dedicated devices. However, the EUS-guided rendezvous technique allows reliable bile duct cannulation because of bile duct access under ultrasonographic guidance compared to conventional retrograde bile duct cannulation using the ERCP technique. However, the possibility of serious complications, such as bile leak or peritonitis, should be of concern due to bile duct access through the peritoneum or retroperitoneum. To gain familiarity with various approach routes in the EUS-guided rendezvous technique is essential for a successful procedure.

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Is wire-guided selective bile duct cannulation effective for prevention of post-ERCP pancreatitis by all endoscopists? 査読あり

Kawakami H., Isayama H., Maguchi H., Kuwatani M., Kawakubo K., Kudo T., Abe Y., Kawahata S., Kubo K., Koike K., Sakamoto N.

Endoscopy 46 ( 2 ) 2014年2月

記述言語：日本語掲載種別：研究論文（学術雑誌）

DOI： 10.1055/s-0033-1344896

Transpapillary dilation of refractory severe biliary stricture or main pancreatic duct by using a wire-guided diathermic dilator (with video) 査読あり

Kawakami H., Kuwatani M., Kawakubo K., Eto K., Haba S., Kudo T., Abe Y., Kawahata S., Sakamoto N.

Gastrointestinal Endoscopy 79 ( 2 ) 338 - 343 2014年2月

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

DOI： 10.1016/j.gie.2013.07.055

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