論文 - 河上 洋
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Kawakami H., Maguchi H., Mukai T., Hayashi T., Sasaki T., Isayama H., Nakai Y., Yasuda I., Irisawa A., Niido T., Okabe Y., Ryozawa S., Itoi T., Hanada K., Kikuyama M., Arisaka Y., Kikuchi S.
Gastrointestinal Endoscopy 75 ( 2 ) 362 - 372 2012年2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: Wire-guided cannulation (WGC) with a sphincterotome (S) for selective bile duct cannulation (SBDC) has been reported to have a higher success rate and lower incidence of post-ERCP pancreatitis (PEP) than conventional methods in some randomized, controlled trials (RCTs) that were both single center and limited to only a few endoscopists. Objective: To estimate the difference in SBDC according to the method and catheter used in a multicenter and multiendoscopist study. Design: A prospective, multicenter RCT with a 2 × 2 factorial design. Setting: Fifteen referral endoscopy units. Patients: In total, 400 consecutive patients with naive papillae who were candidates for ERCP were enrolled and randomized. Interventions: Patients were assigned to 4 groups according to combined catheter (S or catheter [C]) and method (with/without guidewire [GW] ). Main Outcome Measurements: Success rate of SBDC performed in 10 minutes, SBDC time, fluoroscopy time, and incidence of complications. Results: There was no significant difference in the SBDC success rate between the groups with and without GW, between C and S, or among the 4 groups (C+GW, C, S+GW, S). WGC had a tendency to significantly shorten ca nnulation and fluoroscopy times only in approximately 70% of patients in this study in whom SBDC was achieved in 10 minutes or less (P =.036 and.00004, respectively). All 4 groups resulted in similar outcomes in PEP (4%, 5.9%, 2%, and 2.1%, respectively). Limitations: Nondouble-blind study. Conclusions: WGC appears to significantly shorten cannulation and fluoroscopy times. However, neither the method nor type of catheter used resulted in significant differences in either SBDC success rate or incidence of PEP in this RCT. © 2012 American Society for Gastrointestinal Endoscopy.
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Kawakami H., Kuwatani M., Tanaka E., Hirano S.
Journal of Gastroenterology 47 ( 1 ) 90 - 91 2012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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Kuwatani M., Kawakami H., Hayashi T., Ishiwatari H., Kudo T., Yamato H., Ehira N., Haba S., Eto K., Kato M., Asaka M.
Surgical Endoscopy and Other Interventional Techniques 25 ( 12 ) 3784 - 3790 2011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：Surgical Endoscopy and Other Interventional Techniques
Background: Endoscopic retrograde cholangiopancreatography (ERCP) and related procedures can cause abdominal pain and discomfort. Two clinical trials have indicated, using the visual analogue scale (VAS) score, that CO 2 insufflation during ERCP ameliorates the suffering of patients without complications, compared with air insufflation. However, differences in patient suffering between CO 2 and air insufflation after ERCP under deep conscious sedation have not been reported. We focused on the gas volume score (GVS) as an objective indicator of gas volume, and designed a multicenter, prospective, double-blind, randomized, controlled study with CO 2 and air insufflation during ERCP. Methods: Between March 2010 and August 2010, 80 patients who required ERCP were enrolled and evenly randomized to receive CO 2 insufflation (CO 2 group) or air insufflation (air group). ERCP and related procedures were performed under deep conscious sedation with fentanyl citrate or pethidine and midazolam or diazepam. The GVS was evaluated as the primary endpoint in addition to the VAS score as the secondary endpoint. Results: The GVS after ERCP and related procedures in the CO 2 group was significantly lower than that in the air group (0.14 ± 0.06 vs. 0.31 ± 0.11, P < 0.01), as well as the rate of increase in GVS ([GVS after - GVS before]/[GVS before ERCP and related procedures] × 100) (3.8 ± 5.9 vs. 21 ± 11.1%, P < 0.01). VAS scores 3 and 24 h after ERCP and related procedures were comparable between the CO 2 and air groups for abdominal pain, abdominal distension, and nausea. Additionally, VAS scores were not correlated with the GVS. Conclusions: CO 2 insufflation during ERCP reduces GVS (bowel gas volume) but not the VAS score of suffering compared with air insufflation. Deep and sufficient sedation during ERCP and related procedures is important for the palliation of patients' pain and discomfort. © 2011 Springer Science+Business Media, LLC.
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Sofuni A., Maguchi H., Mukai T., Kawakami H., Irisawa A., Kubota K., Okaniwa S., Kikuyama M., Kutsumi H., Hanada K., Ueki T., Itoi T.
Clinical Gastroenterology and Hepatology 9 ( 10 ) 851 - 858 2011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：Clinical Gastroenterology and Hepatology
Background & Aims: Pancreatitis is the most common and potentially serious complication of post-endoscopic retrograde cholangiopancreatography (ERCP). Post-ERCP pancreatitis (PEP) is caused mostly by postprocedural papillary edema and retention of pancreatic juice. We conducted a randomized controlled trial to determine whether placement of a temporary-type, pancreatic duct stent prevents PEP and to identify risk factors for PEP. Methods: We analyzed data from 426 consecutive patients who underwent ERCP-related procedures at 37 endoscopic units. The patients were assigned randomly to groups that received stents (S group, n = 213) or did not (nS group, n = 213). The stent used was temporary, 5F in diameter, 3 cm long, and straight with an unflanged inner end. Results: The overall frequency of PEP was 11.3%. The frequencies of PEP in the S and nS groups were 7.9% and 15.2%, respectively; the lower incidence of PEP in the S group was statistically significant based on the full analysis set (P = .021), although there was no statistically significant differences in an intention-to-treat analysis (P = .076). There were significant differences in PEP incidence between groups in multivariate analysis for the following risk factors: pancreatography first, nonplacement of a pancreatic duct stent after ERCP, procedure time of 30 minutes or more, sampling of pancreatic tissue by any method, intraductal ultrasonography, and difficulty of cannulation (≥15 min). Patients with more than 3 risk factors had a significantly greater incidence of pancreatitis. Conclusions: Placement of a pancreatic duct stent reduces the incidence of PEP. Several risk factors are associated with PEP. © 2011 AGA Institute.
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Itoi T., Isayama H., Sofuni A., Itokawa F., Kurihara T., Tsuchiya T., Tsuji S., Ishii K., Ikeuchi N., Tanaka R., Umeda J., Moriyasu F., Kawakami H.
Journal of Hepato-Biliary-Pancreatic Sciences 18 ( 5 ) 664 - 672 2011年9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
Endoscopic ultrasonography-guided biliary drainage (EUS-BD) has been carried out as an alternative to the percutaneous or surgical approach when endoscopic retrograde cholangiopancreatography fails. However, there is no standard technique or device for EUS-BD. In this review, we focus on how we choose the stents and described our tips on this EUS-BD technique. The plastic stent (PS) and the self-expandable metallic stent (SEMS) are used for EUS-BD. The latter is further divided into the fully covered SEMS (FCSEMS), partially covered SEMS (PCSEMS), and uncovered SEMS (UCSEMS) types. Although PS is not expensive, the duration of stent patency is short. SEMS is expensive but the duration of stent patency is long. With UCSEMS, basically there is no stent malpositioning; however, if the gap between the bile duct and the GI tract becomes displaced, bile leakage from the mesh of the stent is likely to occur. Though there is no bile leakage with FCSEMS, the side branch of the bile duct may become occluded, and migration and dislocation sometimes occur. PCSEMS is basically similar to FCSEMS. When EUS-BD was first developed, drainage by PS was common, although reports on drainage by SEMS have increased recently. © Japanese Society of Hepato-Biliary-Pancreatic Surgery and Springer 2011.
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Preoperative biliary drainage for hilar cholangiocarcinoma: Which stent should be selected?
Kawakami H., Kondo S., Kuwatani M., Yamato H., Ehira N., Kudo T., Eto K., Haba S., Matsumoto J., Kato K., Tsuchikawa T., Tanaka E., Hirano S., Asaka M.
Journal of Hepato-Biliary-Pancreatic Sciences 18 ( 5 ) 630 - 635 2011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
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 10% 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 f or major surgical resection of the liver and that major surgery should be performed only after the recovery of hepatic function. 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, however, has been reached regarding which drainage method is more appropriate. No reported study has compared the effectiveness of PTBD, endoscopic biliary stenting (EBS), and endoscopic nasobiliary drainage (ENBD) in patients with HCA. This review summarizes the results of our study comparing the three methods and outlines the preoperative endoscopic management of segmental cholangitis (SC) in HCA patients undergoing PBD. © Japanese Society of Hepato-Biliary-Pancreatic Surgery and Springer 2011.
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Endoscopic naso-pancreatic drainage for the treatment of pancreatic fistula occurring after LDLT
Nagatsu A., Taniguchi M., Shimamura T., Suzuki T., Yamashita K., Kawakami H., Abo D., Kamiyama T., Furukawa H., Todo S.
World Journal of Gastroenterology 17 ( 30 ) 3560 - 3564 2011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：World Journal of Gastroenterology
Pancreatic fistula is a quite rare complication in patients who undergo living donor liver transplantation (LDLT). However, in the cases that show pancreatic fistula, the limited volume of the graft and the resultant inadequate liver function may complicate the management of the fistula. As a result, the pancreatic fistula may result in the death of the patient. We present 2 cases in which endoscopic treatment was effective against pancreatic fistulas that developed after LDLT. In case 1, a 61-yearold woman underwent LDLT for primary biliary cirrhosis. Because of a portal venous thrombus caused by a splenorenal shunt, the patient underwent portal ve in reconstruction, and a splenorenal shunt was ligated on postoperative day (POD) 7. The main pancreatic duct was injured during the manipulation to achieve hemostasis, thereby necessitating open drainage. However, discharge of pancreatic fluid continued even after POD 300. Endoscopic naso-pancreatic drainage (ENPD) was performed, and this procedure resulted in a remarkable decrease in drain output. The refractory pancreatic fistula healed on day 40 after ENPD. In case 2, a 58-year-old man underwent LDLT for cirrhosis caused by the hepatitis C virus. When the portal vein was exposed during thrombectomy, the pancreatic head was injured, which led to the formation of a pancreatic fistula. Conservative therapy was ineffective; therefore, ENPD was performed. The pancreatic fistula healed on day 38 after ENPD. The findings in these 2 cases show that endoscopic drainage of the main pancreatic duct is a less invasive and effective treatment for pancreatic fistulas that develop after LDLT. © 2011 Baishideng. All rights reserved.
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Three cases of retroperitoneal schwannoma diagnosed by EUS-FNA 査読あり
Kudo T., Kawakami H., Kuwatani M., Ehira N., Yamato H., Eto K., Kubota K., Asaka M.
World Journal of Gastroenterology 17 ( 29 ) 3459 - 3464 2011年8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：World Journal of Gastroenterology
Schwannomas are peripheral nerve tumors that are typically solitary and benign. Their diagnosis is largely based on surgically resected specimens. Recently, a number of case reports have indicated that retroperitoneal schwannomas could be diagnosed with endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA). We report the diagnosis of three cases of schwannoma using EUS-FNA. Subjects were two males and one female, ages 22, 40, and 46 years, respectively, all of whom were symptom-free. Imaging findings showed well-circumscribed round tumors. However, as the tumors could not be diagnosed using these findings alone, EUS-FNA was performed. Hematoxylin-eosin staining of the resulting tissue fragments revealed bland spindle cells with nuclear palisading. There was no disparity in nuclear sizes. Immunostaining revealed S-100 protein positivity and all cases were diagnosed as schwannomas. Ki-67 index were 3%-15%, 2%-3%, and 3%, respectively. No case showed any signs of malignancy. As most schwannomas are benign tumors and seldom become malignant, we observed these patients without therapy. All tumors demonstrated- no enlargement and no change in characteristics. Schwannomas are almost always benign and can be observed following diagnosis by EUS-FNA. © 2011 Baishideng. All rights reserved.
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Ohshima Y., Yasuda I., Kawakami H., Kuwatani M., Mukai T., Iwashita T., Doi S., Nakashima M., Hirose Y., Asaka M., Moriwaki H.
Journal of Gastroenterology 46 ( 7 ) 921 - 928 2011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：Journal of Gastroenterology
Background: Endoscopic transpapillary brush cytology and forceps biopsy are widely used for the pathological diagnosis of suspected malignant biliary strictures (MBS). However, the sensitivity of these methods remains insufficient, and it can be difficult to confirm the diagnosis. We aimed to evaluate the diagnostic ability of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) and the impact of this technique on clinical management in patients with suspected MBS where endoscopic brush cytology and biopsy yielded negative results. Methods: This study included 225 consecutive patients with suspected MBS, who underwent endoscopic brush cytology and biopsy at our institutions. Negative results were obtained for these pathological tests in 75 patients, and EUS-FNA was performed in 22 of these patients. We retrospectively compared the EUS-FNA results with the final diagnosis and examined the infl uence of the EUS-FNA diagnosis on treatment selection. Results: FNA specimens were successfully obtained in all patients, and the pathological results confirmed malignancy in 16 cases and predicted that the other 6 cases were benign. Of the 6 cases that were suspected to be benign, 3 patients were diagnosed with xanthogranulomatous cholecystitis by surgical pathology, and the remaining 3 patients were diagnosed with benign diseases at a follow-up after 12-18 months. Thus, the EUS-FNA-based diagnosis was proven correct for all the patients. In addition, the treatment strategy was altered as a result of the EUS-FNA results in the above 6 patients (27%). Conclusions: EUS-FNA is a sensitive and safe diagnostic modality for patients with suspected MBS and can be an additional option in cases where endoscopic brush cytology and biopsy have produced negative results. © 2011 Springer.
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Kawakami H., Kuwatani M., Kudo T., Ehira N., Yamato H., Asaka M.
Endoscopy 43 ( SUPPL. 2 ) 2011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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Kawakami H., Kuwatani M., Onodera M., Haba S., Eto K., Ehira N., Yamato H., Kudo T., Tanaka E., Hirano S., Kondo S., Asaka M.
Journal of Gastroenterology 46 ( 2 ) 242 - 248 2011年2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: Controversy exists over the preferred technique of preoperative biliary drainage (PBD) in patients with hilar cholangiocarcinoma (HCA). The goal of this retrospective study was to identify the preferred technique of PBD for HCA. Methods: A total of 128 consecutive patients with HCA diagnosed between September 1999 and December 2009 who underwent PBD were included in this study. The study compared outcomes of endoscopic nasobiliary drainage (ENBD), endoscopic biliary stenting (EBS), and percutaneous transhepatic biliary drainage (PTBD) in patients with HCA. Results: There were no significant differences in preoperative laboratory data, rates of major hepatectomy, or decompression periods among the 3 groups. Complications were significantly more frequent in the EBS group compared with either the ENBD or PTBD group (p < 0.05). Drainage tube occlusion with cholangitis was significantly more common in the EBS group compared with either the ENBD or PTBD group (p < 0.0001). Patients in the PTBD group experienced serious complications including vascular injury (8%) and cancer dissemination (4%). Patients in the ENBD and EBS groups had mild post-endoscopic retrograde cholangiopancreatography pancreatitis (5%). Conversion procedures were significantly more common in the EBS group compared with the ENBD and PTBD groups (p < 0.05). There was no significant difference in postsurgical morbidity or mortality among the 3 groups. Conclusions: Drainage tube occlusion with cholangitis was a frequent complication associated with EBS. PTBD was associated with serious complications such as vascular injury and cancer dissemination. ENBD was found to be the most suitable method for initial PBD management in patients with HCA. © 2010 Springer.
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Kobayashi T., Ishida J., Musashi M., Ota S., Yoshida T., Shimizu Y., Chuma M., Kawakami H., Asaka M., Tanaka J., Imamura M., Kobayashi M., Itoh H., Edamatsu H., Sutherland L., Brachmann R.
International Journal of Cancer 128 ( 2 ) 304 - 318 2011年1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：International Journal of Cancer
RBM5 (RNA-binding motif protein 5) is a nuclear RNA binding protein containing 2 RNA recognition motifs. The RBM5 gene is located at the tumor suppressor locus 3p21.3. Deletion of this locus is the most frequent genetic alteration in lung cancer, but is also found in other human cancers. RBM5 is known to induce apoptosis and cell cycle arrest but the molecular mechanisms of RBM5 function are poorly understood. Here, we show that RBM5 is important for the activity of the tumor suppressor protein p53. Overexpression of RBM5 enhanced p53-mediated inhibition of cell growth and colony formation. Expression of RBM5 augmented p53 transcriptional activity in reporter gene assays and resulted in increased mRNA and protein levels for endogenous p53 target genes. In contrast, shRNA-mediated knockdown of endogenous RBM5 led to decreased p53 transcriptional activity and reduced levels of mRNA and protein for endogenous p53 target genes. RBM5 affected protein, but not mRNA, levels of endogenous p53 after DNA damage suggest that RBM5 contributes to p53 activity through post-transcriptional mechanisms. Our results show that RBM5 contributes to p53 transcriptional activity after DNA damage and that growth suppression and apoptosis mediated by RBM5 are linked to activity of the tumor suppressor protein p53. Copyright © 2010 UICC.
DOI： 10.1002/ijc.25345
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Kawakami H., Zen Y.
Gastrointestinal Endoscopy 72 ( 6 ) 2010年12月
記述言語：日本語 掲載種別：研究論文（学術雑誌）
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Localized lymphoplasmacytic sclerosing cholecystitis in a patient with autoimmune pancreatitis
Kawakami H., Eto K., Kuwatani M., Asaka M.
Internal Medicine 49 ( 21 ) 2359 - 2360 2010年11月
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Kawakami H., Zen Y., Kuwatani M., Eto K., Haba S., Yamato H., Shinada K., Kubota K., Asaka M.
Journal of Gastroenterology and Hepatology (Australia) 25 ( 10 ) 1648 - 1655 2010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：Journal of Gastroenterology and Hepatology (Australia)
Background and Aim: Autoimmune pancreatitis is commonly associated with immunoglobulin (Ig) G4-related sclerosing cholangitis (IgG4-SC). The discrimination between IgG4-SC and pancreatobiliary malignancies or primary sclerosing cholangitis (PSC) is now an important issue. The present study was carried out to examine the usefulness of endoscopic biopsies from Vater's ampulla and the bile duct to diagnose IgG4-SC. Methods: The present study included 29 IgG4-SC patients (26 with both pancreatitis and cholangitis, and 3 with cholangitis only), 6 PSC patients, and 27 pancreatobiliary carcinoma patients. All patients underwent endoscopic biopsies from Vater's ampulla and the common bile duct. Biopsied specimens were histologically examined using immunostaining for IgG4. Results: For the ampullary and bile duct biopsies, the IgG4-SC samples had a significantly greater number of IgG4-positive plasma cells than the PSC or pancreatobiliary carcinoma specimens. In addition, bile duct biopsies from five patients (17%) with IgG4-SC showed diffuse inflammatory cell infiltration with irregular fibrosis corresponding to the histological features of lymphoplasmacytic sclerosing pancreatocholangitis. Based on the threshold of 10 IgG4-positive plasma cells per high power field, the diagnostic rates of the ampullar and bile duct biopsies were both 52% (15/29 cases). Twenty-one patients (72%) had more than 10 IgG4-positive plasma cells in at least one biopsy. The bile duct biopsy was significantly valuable for IgG4-SC patients with swelling of the pancreatic head. Conclusion: The present study suggested that ampullar and bile duct biopsies are useful for diagnosing IgG4-SC. © 2010 Journal of Gastroenterology and Hepatology Foundation and Blackwell Publishing Asia Pty Ltd.
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Kawakami H., Kuwatani M., Onodera M., Haba S., Asaka M.
Digestive Endoscopy 22 ( SUPPL. 1 ) 2010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：Digestive Endoscopy
Endoscopic treatment is highly effective for extracting common bile duct (CBD) stones and is the most common therapeutic method for CBD stones. For patients with CBD stones, the treatment goal is to completely clear the biliary duct. In general, the successful extraction rate using a basket and/or balloon catheter is as high as 90%. However, stones that are resistant to conventional endoscopic treatment procedures can be both challenging and time-consuming to treat; and successful treatment can require a combination of techniques, including mechanical lithotripsy or extracorporeal shock-wave lithotripsy. We performed needle knife sphincterotomy and attempted to remove a CBD stone using biopsy forceps and alligator grasping forceps without a lithotripter in a patient with a large impacted stone at Vater's ampulla. After attempting several techniques, the stone was successfully removed with balloon extraction. © 2010 Japan Gastroenterological Endoscopy Society.
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Osteonecrosis and Panniculitis as Life-Threatening Signs
Kuwatani M., Kawakami H., Yamada Y.
Clinical Gastroenterology and Hepatology 8 ( 5 ) 2010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：Clinical Gastroenterology and Hepatology
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Kuwatani M., Kawakami H., Haba S., Eto K., Onodera M., Asaka M.
Internal Medicine 49 ( 6 ) 627 - 628 2010年3月
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Nakanishi Y., Kondo S., Zen Y., Yonemori A., Kubota K., Kawakami H., Tanaka E., Hirano S., Itoh T., Nakanuma Y.
Journal of Hepato-Biliary-Pancreatic Sciences 17 ( 2 ) 166 - 173 2010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：Journal of Hepato-Biliary-Pancreatic Sciences
Purpose The aim of this study was to determine the impact of the presence of carcinoma in situ at the bile duct stump on postoperative survival in patients who underwent resection of extrahepatic bile duct carcinoma. Methods The patients with resected extrahepatic bile duct carcinoma were divided into three groups according to resected margin status: No evidence of residual carcinoma (Negative group, n = 96); carcinoma in situ at the bile duct stump (CIS group, n = 10); and invasive carcinoma at any surgical margin (Invasive group, n = 19). Cause-specific survival for these groups was compared statistically. Results Surgical margin status was identified as a prognostic factor on univariate analysis (p = 0.005) and was an independent prognostic factor on multivariate analysis (p = 0.018). The CIS group displayed significantl y better survival than the Invasive group (p = 0.006), and the survival was comparable to that for the Negative group (p = 0.533). Two of three patients in the CIS group with local recurrence died > 5 years after surgical resection. Conclusions Patients with positive ductal margins of carcinoma in situ of the extrahepatic bile duct do not appear to show different survival after resection compared to patients with negative margins, but remnant carcinoma in situ is likely to develop late local recurrence. © Japanese Society of Hepato-Biliary-Pancreatic Surgery and Springer 2009.
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Kawakami H., Kuwatani M., Etoh K., Haba S., Yamato H., Shinada K., Nakanishi Y., Tanaka E., Hirano S., Kondo S., Kubota K., Asaka M.
Endoscopy 41 ( 11 ) 959 - 964 2009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：Endoscopy
Background and study aims: Localized-type bile duct carcinoma (LBDC) is often accompanied by extensive intraepithelial tumor spread (ITS) of 2cm or more, which makes radical resection more difficult. This retrospective case review compares the diagnostic accuracy of endoscopic retrograde cholangiography (ERC) and peroral cholangioscopy (POCS) to detect ITS beyond the visible LBDC. Patients and methods: Forty-four consecutive patients with LBDC diagnosed between April 2004 and October 2008 who underwent radical resection with histopathological analysis were included in this study. Extensive ITS was found histopathologically in one-third of the cases (32%). The outcome parameters were the presence or absence of extensive ITS and the extent of extensive ITS proximal and distal to the main tumor. Results: In six cases it was not possible to pass the cholangioscope through the tumor sites. ERC correctly identified the presence of extensive ITS in 11/14 cases and did not yield any false-positive results. The three cases in which ERC was negative were all correctly identified by POCS plus biopsy since the cholangioscope could be passed in all three cases. The extent of extensive ITS was correctly diagnosed by ERC alone, ERC with POCS, and ERC with POCS plus mapping biopsy in 22%, 77%, and 100% of cases, respectively. Conclusions: The presence of extensive ITS was correctly detected in 80% of cases by ERC alone. POCS with mapping biopsy provided perfect diagnostic accuracy not only of the presence or absence but also of the extent of extensive ITS. However, POCS has the limitation that the cholangioscope cannot be passed through the tumor sites in approximately 15% of cases. © Georg Thieme Verlag KG Stuttgart.