論文 - 河上 洋
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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
記述言語：日本語 掲載種別：研究論文（学術雑誌）
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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
記述言語：英語 掲載種別：研究論文（学術雑誌）
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Kawakami H., Kuwatani M., Eto K., Kudo T., Tanaka E., Hirano S.
World Journal of Surgery 36 ( 9 ) 2265 - 2266 2012年9月
記述言語：日本語 掲載種別：研究論文（学術雑誌）
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Itoi T., Isayama H., Sofuni A., Itokawa F., Tamura M., Watanabe Y., Moriyasu F., Kahaleh M., Habib N., Nagao T., Yokoyama T., Kasuya K., Kawakami H.
Journal of Hepato-Biliary-Pancreatic Sciences 19 ( 5 ) 543 - 547 2012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：Journal of Hepato-Biliary-Pancreatic Sciences
Background: The effects of ablation with various settings of powers and times using a newly developed radiofrequency (RF) ablation device, the HabibTM EndoHPB catheter, are not well known. In the present study, we examined the effects of a novel RF ablation catheter using resected fresh pig livers and evaluated the macroand microscopic effects of RF ablation under various conditions. Materials and methods: The RF application was performed step by step at 5, 10, 15, and 20 W power and 60, 90, 120 s, respectively. Macroscopic and microscopic findings of the ablation area were evaluated at each setting. Results The mean lengths of the short axis of the ablation area at 10 W and 60, 90 and 120 s were 8.0 ± 1.0, 8.3 ± 1.2, and 9.7 ± 0.6 mm, respectively. The mean lengths of the long axis at 10 W power and 60, 90 and 120 s were 20.3 ± 0.6, 21.3 ± 1.6, and 28.3 ± 2.1 mm, respectively. Although the lengths of the short and long axes at 5 and 10 W increased gradually with power, there were no obvious differences in either short or long axis lengths between 15 and 20 W. Of all the settings, only at 5 W and 60 and 90 s did the long axis of the ablation show separate areas around the 2 ring electrodes. Conclusions: Although other sequelae including hemorrhage, pancreatitis, acute inflammatory changes, perforation and late fibrosis could not be investigated in our ex-vivo pig model, our study clarified the relationship between ablation powers and times and the effects concerning depth and longitudinal spread of ablation. Although the clinical ablation setting at 7-10 W power and 2 min is suitable, ultimately the ablation power and time should be adjusted according to the size of masses using examples from the present results. © Japanese Society of Hepato-Biliary-Pancreatic Surgery and Springer 2011.
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Wire-guided cannulation is not an ideal technique for preventing post-ERCP pancreatitis 査読あり
Kawakami H., Isayama H., Kuwatani M., Eto K., Kudo T., Abe Y., Kawahata S., Nakai Y., Sasahira N., Koike K., Kato M.
Gastrointestinal Endoscopy 76 ( 1 ) 2012年7月
記述言語：日本語 掲載種別：研究論文（学術雑誌）
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Isayama H., Mukai T., Itoi T., Maetani I., Nakai Y., 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., Kogure H.
Gastrointestinal Endoscopy 76 ( 1 ) 84 - 92 2012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：Gastrointestinal Endoscopy
Background: Covered self-expandable metal stents (CSEMSs) were developed to prevent tumor ingrowth, but stent migration is one of the problems with CSEMSs. Objective: To evaluate a new, commercially available CSEMS with flared ends and low axial force compared with a commercially available CSEMS without the anti-migration system and high axial force. Design: Multicenter, prospective study with a historical cohort. Setting: Twenty Japanese referral centers. Patients: This study involved patients with unresectable distal malignant biliary obstruction. Intervention: Placement of a new, commercially available, partially covered SEMS. Main Outcome Measurements: Recurrent biliary obstruction rate, time to recurrent biliary obstruction, stent-related complications, survival. Results: Between April 2009 and March 2010, 141 patients underwent partially covered nitinol stent placement, and between May 2001 and January 2007, 138 patients underwent placement of partially covered stainless stents as a historical control. The silicone cover of the partially covered nitinol stents prevented tumor ingrowth. There were no significant differences in survival (229 vs 219 days; P = .250) or the rate of recurrent biliary obstruction (33% vs 38%; P = .385) between partially covered nitinol stents and partially covered stainless stents. Stent migration was less frequent (8% vs 17%; P = .019), and time to recurrent biliary obstruction was significantly longer (373 vs 285 days; P = .007) with partially covered nitinol stents. Stent removal was successful in 26 of 27 patients (96%). Limitations: Nonrandomized, controlled trial. Conclusion: Partially covered nitinol stents with an anti-migration system and less axial force demonstrated longer time to recurrent biliary obstruction with no tumor ingrowth and less stent migration. (Clinical trial registration number: UMIN000002293.) © 2012 American Society for Gastrointestinal Endoscopy.
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Preoperative biliary drainage for hilar cholangiocarcinoma
Kawakami H., Kato M., Hirano S., Sakamoto N.
Gastroenterological Endoscopy 54 ( 7 ) 1975 - 1990 2012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：Gastroenterological Endoscopy
The controversy over whether and how to perform preoperative biliary drainage (PBD) in patients with hilar cholangiocarcinoma (HCA) remains unsettled. Arguments against PBD before pancreatoduodenectomy have recently been gaining momentum. However, the complication-related mortality rate is as high as 5% for patients with HCA who have undergone major liver resection, and liver failure is a major cause of postoperative death. This suggests the need for PBD to treat jaundice in HCA patients scheduled for major surgical resection of the liver and to perform major surgery only after recovery of the hepatic function. However, no definite criteria or guidelines outlining indications for PBD are currently available. In patients with HCA, PBD may be performed by either percutaneous transhepatic biliary drainage (PTBD) or endoscopic biliary drainage (EBD). No consensus has been reached regarding which PBD method is more appropriate. No reported study has compared the effectiveness of PTBD, endoscopic biliary stenting and endoscopic nasobiliary drainage in patients with HCA. Recently, a few Japanese high-volume centers have recommended EBD of the future remnant lobe for PBD in patients expected to undergo definitive surgery for HCA. This review summarizes the purpose, transition, current situation, and future of PBD in HCA patients undergoing PBD.
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Onodera M., Kawakami H., Kuwatani M., Kudo T., Haba S., Abe Y., Kawahata S., Eto K., Nasu Y., Tanaka E., Hirano S., Asaka M.
Surgical Endoscopy and Other Interventional Techniques 26 ( 6 ) 1710 - 1717 2012年6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：Surgical Endoscopy and Other Interventional Techniques
Background Endoscopic ultrasound (EUS)-guided drainage is widely used to manage pancreatic pseudocysts. Several studies have reported the use of EUS-guided drainage for pancreatic fistula and stasis of pancreatic juice caused by stricture of the pancreatic duct after pancreatic resection. Methods At the authors' hospital, 262 patients underwent surgery involving pancreatic resection from April 2005 to March 2010. In 90 of these patients (34%), a grade B or C postoperative pancreatic fistula developed that required additional treatment. The authors performed EUS-guided transmural drainage (EUS-TD) for six patients (2.1%) with a pancreatic fistula or dilation of the main pancreatic duct visible by EUS. Percutaneous drainage was provided for 18 patients (6.8%). The success rates for EUS-TD and percutaneous drainage were compared in a retrospective analys is. Results In all six cases, EUS-TD was performed successfully without complications. Five of the six patients were successfully treated with only one trial of EUS-TD. The final technical success rate was 100% for both EUSTD and percutaneous drainage. Both the short- and longterm clinical success rates for EUS-TD were 100% and those for percutaneous drainage were 61.1 and 83%, respectively. The differences in these rates were not significant (short-term success, P = 0.091 vs. long-term success, P = 0.403). However, the time to clinical success was significantly shorter with EUS-TD (5.8 days) than with percutaneous drainage (30.4 days; P = 0.0013) in the current series. Conclusions The EUS-TD approach appears to be a safe and technically feasible alternative to percutaneous drainage and may be considered as first-line therapy for pancreatic fistulas visible by EUS. © 2011 Springer Science+Business Media, LLC.
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Kuwatani M., Kawakami H., Kato M.
Internal Medicine 51 ( 10 ) 2012年5月
記述言語：日本語 掲載種別：研究論文（学術雑誌）
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Covered metallic stent for ischemic hilar biliary stricture
Kawakami H., Kuwatani M., Eto K., Kudo T., Asaka M.
Digestive Endoscopy 24 ( SUPPL. 1 ) 49 - 54 2012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：Digestive Endoscopy
Compared with surgery, endoscopic treatment is safe and highly effective for a postoperative hilar benign bile duct stricture (BDS). However, the long-term outcome of conventional placement of a single biliary stent for hilar benign BDS is generally poor. Although the placement of multiple biliary stents is preferred, multiple stenting in a BDS is difficult. Alternatively, single or multiple stent placement above the papilla ('inside stent') or fully-covered self-expandable metallic stents (SEMS) are feasible approaches for benign BDS. Nevertheless, controversy remains regarding whether and how to perform endoscopic biliary drainage for a hilar benign BDS. In patients with hilar benign BDS, endoscopic biliary drainage can be performed by placing conventional plastic stents across the papilla, plastic stents above the papilla or fully-covered SEMS. Individualized treatment should be considered. We report the placement of a fully-covered SEMS for a hilar benign biliary stricture after extended left hepatectomy. © 2012 Japan Gastroenterological Endoscopy Society.
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Resolution of a refractory severe biliary stricture using a diathermic sheath 査読あり
Kawakami H., Kuwatani M., Eto K., Kudo T., Abe Y., Kawahata S., Kato M.
Endoscopy 44 ( SUPPL. 2 ) 2012年4月
記述言語：英語 掲載種別：研究論文（学術雑誌）