論文 - 河上 洋
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Kuwatani M., Kawakami H., Hayashi T., Eto K., Yamato H., Onodera M., Naruse H., Oba K.
Endoscopic Ultrasound 3 ( 3 ) 167 - 173 2014年
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：Endoscopic Ultrasound
Background and Objective: Antispasmodic drugs (ADs) have been used to reduce examination time or improve the quality of gastrointestinal endoscopy, although the practice is controversial. No evidence about the efficacy of AD for endoscopic ultrasonography/EUS-guided fine-needle aspiration (EUS/EUS-FNA) is available. This study was aimed to evaluate the efficacy of AD in EUS/EUS-FNA. Patients and Methods: A total of 400 patients with pancreaticobiliary, peripancreatic, or peribiliary disease or disorder undergoing EUS/EUS-FNA were prospectively and evenly randomized to undergo EUS/EUS-FNA with AD (w-AD) or without AD (w/o-AD). The primary endpoint was total EUS/EUS-FNA examination time. The secondary endpoints were visual analogue scale (VAS) scores of endoscopists (patient body motion, gastrointestinal peristalsis, and accomplishment of the purpose) and patients (pain, discomfort, and willingness to undergo re-examination), vital sign changes, adverse events, and sedative dose. Results: Two hundred patients in the w-AD group and 197 patients in the w/o-AD group were ultimately analyzed. The total examination time was similar between the groups (2299 ± 937 vs. 2259 ± 1019 s). The difference in total examination time from w/o-AD group to w-AD group was -40 s (95% confidence interval, -234-153 s), which was within the noninferiority margin. No statistical differences were observed in endoscopist and patient VAS scores, changes in vital signs, adverse events, or total sedative dose other than fentanyl between the groups. Conclusion: EUS/EUS-FNA can be effectively and safely performed w/o-AD. Further, randomized controlled trials on EUS/EUS-FNA in various disease entities may be required to confirm the results of this study (UMIN000008047).
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Kubota Y., Kawakami H., Natsuizaka M., Kawakubo K., Marukawa K., Kudo T., Abe Y., Kubo K., Kuwatani M., Hatanaka Y., Mitsuhashi T., Matsuno Y., Sakamoto N.
Journal of Gastroenterology 50 ( 2 ) 203 - 210 2014年
記述言語：日本語 掲載種別：研究論文（学術雑誌） 出版者・発行元：Journal of Gastroenterology
© 2014, Springer Japan. Background: Solid-pseudopapillary neoplasm (SPN), a rare neoplasm of the pancreas, frequently harbors mutations in exon 3 of the cadherin-associated protein beta 1 (CTNNB1) gene. Here, we analyzed SPN tissue for CTNNB1 mutations by deep sequencing using next-generation sequencing (NGS). Methods: Tissue samples from 7 SPNs and 31 other pancreatic lesions (16 pancreatic ductal adenocarcinomas (PDAC), 11 pancreatic neuroendocrine tumors (PNET), 1 acinar cell carcinoma, 1 autoimmune pancreatitis lesion, and 2 focal pancreatitis lesions) were analyzed by NGS for mutations in exon 3 of CTNNB1. Results: A single-base-pair missense mutations in exon 3 of CTNNB1 was observed in all 7 SPNs and in 1 of 11 PNET samples. However, mutations were not observed in the tissue samples of any of the 16 PDAC or other four pancreatic disease cases. The variant frequency of CTNNB1 ranged from 5.4 to 48.8 %. Conclusions: Mutational analysis of CTNNB1 by NGS is feasible and was achieved using SPN samples obtained by endoscopic ultrasound-guided fine needle aspiration.
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Nakai Y., Isayama H., Mukai T., Itoi T., Maetani I., Kawakami H., Yasuda I., Maguchi H., Ryozawa S., Hanada K., Hasebe O., Ito K., Kawamoto H., Mochizuki H., Igarashi Y., Irisawa A., Sasaki T., Togawa O., Hara T., Kamada H., Toda N., Hamada T., Kogure H.
Journal of Gastroenterology 48 ( 11 ) 1293 - 1299 2013年11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 Gastroenterology
Background: In patients with unresectable malignant biliary obstruction (MBO), anticancer treatment is often administered. The impact of anticancer treatment on recurrent biliary obstruction in covered self-expandable metallic stents (SEMS) has not been fully elucidated. Methods: Data on 279 patients enrolled in a multicenter prospective cohort study of two different covered SEMS for distal MBO, WATCH study (141 partially covered WallFlex stents and 138 partially covered Wallstents) were retrospectively analyzed. The rates and causes of recurrent biliary obstruction (stent occlusion or migration) were compared between anticancer treatment group (n = 173) and best supportive care alone (BSC) group (n = 106). Cumulative time and prognostic factors for recurrent biliary obstruction were analyzed, using a proportional hazards model with death without recurrent biliary obstruction as a competing risk. Results: The overall rate (43 vs. 25 %, P = 0.002) and the cumulative incidence (16.1 vs. 8.2, 27.9 vs. 18.9 and 44.1 vs. 26.6 % at 3, 6 and 12 months, P = 0.030 by Gray's test) of recurrent biliary obstruction were significantly higher in anticancer treatment group compared with BSC group. The multivariate analysis revealed anticancer treatment [subdistribution hazard ratio (SHR) 1.93, P = 0.007) as well as the use of a partially covered WallFlex stent (SHR 0.65, P = 0.049) as prognostic factors. Conclusions: Anticancer treatment was a risk factor for recurrent biliary obstruction in covered SEMS for distal MBO. The superiority of a partially covered WallFlex stent was again confirmed in this competing risk analysis; UMIN-CTR: UMIN000002293. © 2013 Springer Japan.
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Kobayashi T., Ozasa M., Miyashita K., Saga A., Miwa K., Saito M., Morioka M., Takeuchi M., Takenouchi N., Yabiku T., Kanno H., Yuzawa S., Tanino M., Tanaka S., Kawakami H., Asaka M., Sakamoto N.
Internal Medicine 52 ( 18 ) 2051 - 2056 2013年9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：Internal Medicine
Solid-pseudopapillary neoplasms (SPN) are rare pancreatic tumors. The etiology of SPN involves mutations in the gene that encodes β-catenin (CTNNB1). We herein report the case of a 23-year-old woman with a large SPN with proliferating tumor cells that displayed both solid and pseudo-papillary patterns. The simultaneous nuclear accumulation and loss of membrane localization of β-catenin and E-cadherin was specifically observed in the tumor cells. Further, the tumor cells were shown to harbor a missense mutation in exon 3 of CTNNB1. We also present a review of the literature describing the clustering of CTNNB1 mutations in patients with SPN. © 2013 The Japanese Society of Internal Medicine.
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Haba S., Yamao K., Bhatia V., Mizuno N., Hara K., Hijioka S., Imaoka H., Niwa Y., Tajika M., Kondo S., Tanaka T., Shimizu Y., Yatabe Y., Hosoda W., Kawakami H., Sakamoto N.
Journal of Gastroenterology 48 ( 8 ) 973 - 981 2013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 Gastroenterology
Background: Several studies have investigated the diagnostic accuracy of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) for pancreatic lesions, but they have included only limited patient populations. This study aimed to clarify the diagnostic accuracy of EUS-FNA in a large number of pancreatic lesions, and to describe the factors that influence it. Methods: From March 1997 to May 2010, 944 consecutive patients who had undergone EUS-FNA for pancreatic solid lesions were evaluated retrospectively. Factors affecting EUS-FNA accuracy were then analyzed. Results: A total of 996 solid pancreatic lesions were sampled by EUS-FNA. The overall sampling adequacy and diagnostic accuracy of these lesions were 99.3 % (989/996) and 91.8 % (918/996), respectively. The sensitivity and specificity for differentiating malignant from benign lesions were 91.5 % (793/867) and 97.7 % (126/129), respectively. The diagnostic performance was significantly higher when both cytological and cell-block examinations were carried out than with only cytological examination. In multivariate analysis, final diagnosis, location of lesion, lesion size, availability of on-site cytopathological evaluation, and experience of EUS-FNA procedure were independent factors affecting the accuracy of EUS-FNA. On-site cytopathological evaluation and lesion size were found to be the most weighted factors affecting diagnostic accuracy. Conclusions: EUS-FNA for pancreatic solid lesions yielded a high accuracy and low complication rate. Both cytological and cell-block preparations and on-site cytopathological evaluation contributed to improve the accuracy. The diagnostic ability of EUS-FNA was less for smaller lesions, and repeated procedures may be needed if malignancy is suspected. © 2012 Springer Japan.
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Catheter tract recurrence after percutaneous biliary drainage for hilar cholangiocarcinoma 査読あり
Kawakami H.
World Journal of Surgery 37 ( 7 ) 1743 - 1744 2013年7月
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Kawakami H., Kuwatani M., Sakamoto N.
Digestive Endoscopy 25 ( 4 ) 2013年7月
記述言語：日本語 掲載種別：研究論文（学術雑誌）
DOI： 10.1111/den.12090
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Yasuda I., Nakashima M., Iwai T., Isayama H., Itoi T., Hisai H., Inoue H., Kato H., Kanno A., Kubota K., Irisawa A., Igarashi H., Okabe Y., Kitano M., Kawakami H., Hayashi T., Mukai T., Sata N., Kida M., Shimosegawa T.
Endoscopy 45 ( 8 ) 627 - 634 2013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：Endoscopy
Background and study aims: Only a few large cohort studies have evaluated the efficacy and safety of endoscopic necrosecto my for infected walled-off pancreatic necrosis (WOPN). Therefore, a multicenter, large cohort study was conducted to evaluate the efficacy and safety of endoscopic necrosectomy and to examine the procedural details and follow-up after successful endoscopic necrosectomy. Patients and methods: A retrospective review was conducted in 16 leading Japanese institutions for patients who underwent endoscopic necrosectomy for infected WOPN between August 2005 and July 2011. The follow-up data were also reviewed to determine the long-term outcomes of the procedures. Results: Of 57 patients, 43 (75 %) experienced successful resolution after a median of 5 sessions of endoscopic necrosectomy and 21 days of treatment. Complications occurred in 19 patients (33 %) during the treatment period. Six patients died (11 %): two due to multiple organ failure and one patient each from air embolism, splenic aneurysm, hemorrhage from a Mallory - Weiss tear, and an unknown cause. Of 43 patients with successful endoscopic necrosectomy, recurrent cavity formation was observed in three patients during a median follow-up period of 27 months. Conclusions: Endoscopic necrosectomy can be an effective technique for infected WOPN and requires a relatively short treatment period. However, serious complications can arise, including death. Therefore, patients should be carefully selected, and knowledgeable, skilled, and experienced operators should perform the procedure. Further research into safer technologies is required in order to reduce the associated morbidity and mortality. © Georg Thieme Verlag KG Stuttgart · New York.
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Doi S., Yasuda I., Kawakami H., Hayashi T., Hisai H., Irisawa A., Mukai T., Katanuma A., Kubota K., Ohnishi T., Ryozawa S., Hara K., Itoi T., Hanada K., Yamao K.
Endoscopy 45 ( 5 ) 362 - 369 2013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：Endoscopy
Background and study aims: No prospective comparison of endoscopic ultrasonography-guided direct celiac ganglia neurolysis (EUS - CGN) vs. EUS-guided celiac plexus neurolysis (EUS - CPN) has been reported. The aim of the current study was to compare the effectiveness of EUS - CGN and EUS - CPN in providing pain relief from upper abdominal cancer pain in a multicenter randomized controlled trial. Patients and methods: Patients with upper abdominal cancer pain were randomly assigned to treatment using either EUS - CGN or EUS - CPN. Evaluation was performed at Day 7 postoperatively using a pain scale of 0 to 10. Patients for whom pain decreased to ≤ 3 were considered to have a positive response, and those experiencing a decrease in pain to ≤ 1 were considered to be completely responsive. Comparison between the two groups was performed using intention-to-treat analysis. The primary endpoint was the difference in treatment response rates between EUS - CGN and EUS - CPN at postoperative Day 7. Secondary endpoints included differences in complete response rates, pain scores, duration of pain relief, and incidence of adverse effects. Results: A total of 34 patients were assigned to each group. Visualization of ganglia was possible in 30 cases (88 %) in the EUS - CGN group. The positive response rate was significantly higher in the EUS - CGN group (73.5 %) than in the EUS - CPN group (45.5 %; P = 0.026). The complete response rate was also significantly higher in the EUS - CGN group (50.0 %) than in the EUS - CPN group (18.2 %; P = 0.010). There was no difference in adverse events or duration of pain relief between the two groups. Conclusions: EUS - CGN is significantly superior to conventional EUS - CPN in cancer pain relief. Clinical trial registration: http://www.umin.ac.jp/ctr/index.htm (ID: UMIN-000002536). © Georg Thieme Verlag KG Stuttgart - New York.
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Kawakami H., Kuwatani M., Sakamoto N.
Digestive Endoscopy 25 ( 3 ) 339 - 340 2013年5月
記述言語：日本語 掲載種別：研究論文（学術雑誌）
DOI： 10.1111/den.12034
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Kawakami H., Kuwatani M., Sakamoto N.
Digestive Endoscopy 25 ( 3 ) 343 - 344 2013年5月
記述言語：日本語 掲載種別：研究論文（学術雑誌）
DOI： 10.1111/den.12051
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Yamamoto N., Isayama H., Kawakami H., Sasahira N., Hamada T., Ito Y., Takahara N., Uchino R., Miyabayashi K., Mizuno S., Kogure H., Sasaki T., Nakai Y., Kuwatani M., Hirano K., Tada M., Koike K.
Gastrointestinal Endoscopy 77 ( 5 ) 809 - 814 2013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：Gastrointestinal Endoscopy
Background: Endoscopic transluminal treatment of pancreatic fluid collections (PFC) has been reported as an effective alternative approach to surgical treatment. A wide, short stent with an anti-migration system has been developed. Objective: To evaluate a newly developed, fully covered, self-expandable metal stent (FCSEMS) customized for cystogastrostomy. Design: Retrospective case series. Setting: Tertiary-care academic medical centers and affiliated hospitals. Patients: Nine patients who underwent endoscopic treatment of PFCs (5 with pseudocysts and 4 with walled-off pancreatic necrosis). Intervention: Stent deployment after endoscopic US-guided puncture. Irrigation and necrosectomy were performed at the discretion of the endoscopist. Main Outcome Measurements: Technical and clinical success rate, complications, and removability. Results: The FCSEMS was inserted successfully in all cases (9/9, 100%). Clinical success was achieved in 7 of 9 cases (77.8%). No early complications associated with the procedure were observed. Late complications were observed in 2 cases (bleeding and asymptomatic migration). The FCSEMS was removed without any complications in all 6 cases where it was attempted after the procedure had been completed (100%). Limitations: This was a retrospective evaluation of a small number of cases. The FCSEMS was always inserted via the transgastric route. Follow-up duration was short. Conclusion: The endoscopic approach that uses this new FCSEMS is feasible for the treatment of PFCs. However, further evaluation is required. © 2013 American Society for Gastrointestinal Endoscopy.
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Eto K., Kawakami H., Kuwatani M., Kudo T., Abe Y., Kawahata S., Takasawa A., Fukuoka M., Matsuno Y., Asaka M., Sakamoto N.
British Journal of Cancer 108 ( 7 ) 1488 - 1494 2013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：British Journal of Cancer
Background:Pancreatic ductal carcinoma (PDC) is one of the most lethal human carcinomas. Expression patterns of some genes may predict gemcitabine (GEM) treatment efficacy. We examined predictive indicators of survival in GEM-treated patients by quantifying the expression of several genes in pre-treatment endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) samples from patients with PDC.Methods:The expressions of human equilibrative nucleoside transporter 1 (hENT1), deoxycitidine kinase, ribonucleoside reductase 1, ribonucleoside reductase 2 and Notch3 in EUS-FNA tissue samples from 71 patients with unresectable PDC were quantified using real-time reverse transcription-polymerase chain reactions and examined for correlations with GEM sensitivity.Results:The log-rank test detected no significant differences in overall survival between GEM-treated patients with low and high mRNA levels of all genes examined. However, low Notch3 mRNA expression was significantly associated with longer overall survival in a multivariate analysis for survival (P=0.0094). High hENT1 expression level was significantly associated with a longer time to progression (P=0.039). Interaction tests for GEM administration and hENT1 or Notch3 mRNA expression were statistically significant (P=0.0054 and 0.0047, respectively).Conclusion:hENT1 and Notch3 mRNA expressions in EUS-FNA specimens were the key predictive biomarkers of GEM effect and GEM sensitivity in patients with unresectable PDC. © 2013 Cancer Research UK. All rights reserved.
DOI： 10.1038/bjc.2013.108
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Isayama H., Nakai Y., Kawakubo K., Kawakami H., Itoi T., Yamamoto N., Kogure H., Koike K.
Journal of hepato-biliary-pancreatic sciences 20 ( 4 ) 413 - 420 2013年4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：Journal of hepato-biliary-pancreatic sciences
Steady progress is being made in endoscopic biliary intervention, especially endoscopic ultrasonography (EUS)-guided procedures. The EUS-guided rendezvous technique (EUS-RV) is a salvage method for failed selective biliary cannulation. The overall success rate of EUS-RV in 247 cases from seven published articles was 74 % and the incidence of complications was 11 %. The main cause of failed rendezvous cannulation was difficulty passing a biliary stricture or papilla due to poor guidewire (GW) manipulation. A recent large study found a 98.3 % success rate and superiority to precutting. This report suggested using a hydrophilic guidewire. Major complications were bleeding (0.8 %), bile leakage (1.2 %), peritonitis (0.4 %), pneumoperitoneum (0.2 %), and pancreatitis (1.6 %). The approach routes for EUS-RV were transgastric, transduodenal short position, and transduodenal long position. The appropriate route for each patient should be used. GW selection for EUS-RV is critical, and a hydrophilic GW might be the most useful. The catheter can be inserted through the papilla alongside or over the wire. Alongside cannulation is convenient, but difficult. The problem with the over-the-wire technique is withdrawal of the GW in the accessory channel. EUS-RV is effective and safe, but is not established. The efficacy should be confirmed in a prospective comparative trial, and the necessary specialist equipment should be developed.
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Matsusaki S., Kikuyama M., Kawakami H., Kubota K., Maguchi H.
Journal of Japanese Society of Gastroenterology 110 ( 4 ) 615 - 621 2013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：Journal of Japanese Society of Gastroenterology
To clarify the clinical features and CT findings of IgG4-related sclerosing cholangitis (IgG4-SC), we reviewed 16 cases of IgG4-SC and 10 cases of cholangiocarcinoma concerning patient background, treatment, outcomes and CT findings. The median age of IgG4-SC cases was 70 (range 54-79) years, and only 1 was a woman. Serum IgG4 level of all IgG4-SC patients were elevated and in 13 patients steroid therapy proved effective. The CT findings were analyzed with regard to the biliary strictures (symmetry, outer margin, inner margin), wall enhancement pattern and pancreas size. The CT findings of symmetric wall thickness and total scores were significantly higher in IgG4-SC than in cholangiocarcinoma. Although the small number of patients in this study is a limitation, the CT findings may help distinguish IgG4-SC from cholangiocarcinoma.
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The role of peroral video cholangioscopy in patients with IgG4-related sclerosing cholangitis 査読あり
Itoi T., Kamisawa T., Igarashi Y., Kawakami H., Yasuda I., Itokawa F., Kishimoto Y., Kuwatani M., Doi S., Hara S., Moriyasu F., Baron T.
Journal of Gastroenterology 48 ( 4 ) 504 - 514 2013年4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：Journal of Gastroenterology
Background The cholangioscopic features of IgG4-related sclerosing cholangitis (IgG4-SC) remain undefined. The aim of this study was to clarify these endoscopic features using peroral video cholangioscopy (PVCS) in IgG4-SC patients. Methods PVCS was performed in 33 patients: IgG4-SC (n = 13); primary sclerosing cholangitis (PSC; n = 5); and cholangiocarcinoma (n = 15), which included hilar cholangiocarcinoma (HCCA; n = 5) and distal cholangiocarcinoma (DCCA; n = 10). Results The most frequent findings on PVCS in the IgG4- SC patients were dilated (62 %) and tortuous (69 %) vessels, and absence of partially enlarged vessels. The incidence of dilated and tortuous vessels was significantly higher in IgG4-SC patients than in PSC patients (p = 0.015). Scarring and pseudodiverticula were found significantly more often in PSC patients than in IgG4-SC patients (p = 0.001 and p = 0.0007, respectively). The incidence of partially enlarged vessels was significantly higher in DCCA patients than in IgG4-SC patients (p = 0.004). In contrast, the incidence of dilated vessels was significantly higher in IgG4-SC patients than in HCCA patients (p = 0.015). PVCS performed after corticosteroid therapy showed resolution of bile duct stenosis and dilated, tortuous, or partially enlarged vessels, as well as resolution of friability in all patients with IgG4-SC. Conclusion Cholangioscopy was useful in differentiating IgG4-SC from PSC. In addition, monitoring the patterns of proliferative vessels on PVCS may be useful to differentiate IgG4-SC from cholangiocarcinoma. © Springer 2012.
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Spontaneous intraductal stent migration after endoscopic ultrasound-guided choledochogastrostomy 査読あり
Kawakubo K., Kawakami H., Kuwatani M., Haba S., Kudo T., Abe Y., Sakamoto N.
Endoscopy 45 ( SUPPL.2 ) 2013年3月
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Kuwatani M., Kawakami H., Sakamoto N.
Digestive Endoscopy 25 ( 2 ) 2013年3月
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Kawakubo K., Kawakami H., Sakamoto N.
Pancreatology 13 ( 1 ) 2013年1月
記述言語：日本語 掲載種別：研究論文（学術雑誌）
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Response 査読あり
Kawakami H., Isayama H., Maguchi H., Kuwatani M., Nakai Y., Kawakubo K., Haba S., Kudo T., Abe Y., Koike K., Sakamoto N.
Gastrointestinal Endoscopy 76 ( 4 ) 920 - 921 2012年10月