論文 - 河上 洋
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Ozono Y., Kawakami H., Hatada H., Uchiyama N., Ogawa S., Uchida K., Tamura H., Komaki Y., Nakamura K., Iwakiri H., Hasuike S., Nagata K.
BMC Gastroenterology 26 ( 1 ) 108 2026年12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：BMC Gastroenterology
Background: Nonalcoholic fatty liver disease (NAFLD) is a leading cause of chronic liver disease with increasing global prevalence. Although diabetes is a major factor in NAFLD progression, up to 75% of the patients with NAFLD do not have diabetes. Tofogliflozin (Tofo), a sodium-glucose cotransporter type-2 inhibitor, is widely used in patients with type 2 diabetes. Several clinical trials with Tofo have shown its beneficial effects in NAFLD patients with diabetes; however, currently, there are limited data on NAFLD patients without diabetes. Methods: C57Bl/6J mice were fed a choline-deficient, L-amino acid–defined, high-fat diet (CDAHFD) as a model of non-diabetic non-alcoholic steatohepatitis (NASH). The mice were fed either a normal diet or CDAHFD for 12 weeks, and received either vehicle or Tofo based on their assigned group for 12 weeks. Results: Tofo treatment attenuated CDAHFD-induced liver steatosis and fibrosis. The percentage of monocyte-derived macrophages in the liver, which was significantly increased in the CDAHFD-fed mice, was reduced by Tofo treatment. Furthermore, Tofo treatment increased the hepatic protein and mRNA expression levels related to fatty acid oxidation, which was decreased in CDAHFD-fed mice. Additionally, Tofo treatment decreased the hepatic protein and mRNA expression levels related to fatty acid synthesis, which was increased in CDAHFD-fed mice. Conclusion: Tofo may be a potential candidate for inhibiting liver steatosis and fibrosis via an alternative pathway, unlike glucose metabolism, in NAFLD patients without diabetes.
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Nanashima A., Imamura N., Hiyoshi M., Tsuchimochi Y., Wada T., Hamada T., Suzuki Y., Araki Y., Hosokawa A., Kawakami H.
Cancer Diagnosis and Prognosis 6 ( 2 ) 291 - 302 2026年3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：Cancer Diagnosis and Prognosis
Background/Aim: Intraductal papillary mucinous neoplasm (IPMN) of the pancreas is a precursor lesion with variable malignant potential. Due to its heterogeneity, optimal treatment strategies remain controversial, especially regarding surgical resection and surveillance indications. We reviewed our institutional outcomes to reassess the current postoperative strategy and refine management guidelines. Patients and Methods: This study retrospectively and consecutively analyzed the data of 49 IPMN patients who underwent pancreatectomy at an academic institution from 2015 to May 2025. Results: Diagnostic mismatch between preoperative and final pathological findings was observed in 39% of cases, with overdiagnosis (downgrade group) beingmore common than underdiagnosis. Overdiagnosed cases were significantly associated with main pancreatic duct dilation (>5 mm) (p=0.012) and elevated amylase levels (p=0.031), while the only upgraded case involved invasive carcinoma withmural nodule and Sonazoid enhancement. Histological grade strongly influenced prognosis: Patients with adenoma or carcinoma in situ showed favorable outcomes (5-year OS ≥89%), whereas those with invasive IPMN hadmarkedly worse survival (5-year OS 36%; p<0.001). Elevated CA19-9 was a significant negative prognostic factor (p=0.031), while lymph node metastasis (p=0.035) and advanced tumor stage (p=0.0014) were also associated with poor outcomes. Tumors located in the pancreatic tail and those classified as mixed-type IPMN tended to have inferior survival, though without statistical significance. Cancer recurrence occurred in 18% of patients, primarily via peritoneal and hepatic routes. Conclusion: Preoperative diagnostic inaccuracies remain common in IPMN, and invasive transformation, elevated CA19-9, lymph node metastasis, and tumor stage are key prognostic factors. A multimodal diagnostic approach is needed to improve risk stratification and guide appropriate surgical management.
DOI： 10.21873/cdp.10528
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Tanaka Y., Masamune A., Matsumoto R., Takikawa T., Tanaka Y., Hamada S., Miura S., Kume K., Takeyama Y., Kikuta K., Yoshioka R., Yoshimura H., Yoshida N., Yoshida H., Yoshida H., Yoneda K., Yokota T., Yogi T., Yasuda I., Yasuda H., Yashika J., Yamashita S., Yamao K., Yamanouchi K., Yamamoto S., Yamamiya A., Yamagami H., Yamada R., Yamada K., Watanabe S., Urata T., Unno J., Ueno Y., Ueno M., Uchida K., Tuda H., Tsushima K., Tsuruga Y., Tsukamoto Y., Tsukamoto K., Tsujikawa T., Torisu Y., Toki M., Terajima H., Terai S., Tanoue S., Tamoto E., Tamagawa H., Takenaka M., Takasaki Y., Takano Y., Takano S., Takahashi S., Takahashi K., Takahashi K., Takagi T., Takagaki K., Takaesu R., Tabaru A., Suzumura K., Suzuki Y., Suzuki N., Suzuki M., Suzuki K., Suzuki K., Sumida Y., Sumi H., Suenaga S., Suda T., Sogame Y., Sho M., Shirahata N., Shiomi H., Shinohara N., Shinkai T., Shimizu T., Shimatani M., Shiihara M., Shigekawa M., Setsuda M., Sekino Y., Sekine M., Sawai Y., Satoh A., Sato Y., Sato S., Sato M., Satake M., Sasakura Y., Sasaki Y., Sano T., Sakano M., Sakai Y., Sakai T., Saito N., Saito M., Saito K., Saeki A., Oyama T., Otani K.
Journal of Gastroenterology 60 ( 11 ) 1437 - 1448 2025年11月
掲載種別：研究論文（学術雑誌） 出版者・発行元：Journal of Gastroenterology
Objectives: This study aimed to clarify the current clinico-epidemiological characteristics of acute pancreatitis (AP) in Japan. Methods: We conducted a two-stage nationwide survey of patients with AP treated at selected hospitals in 2021, during the COVID-19 pandemic. The first stage estimated the total number of AP patients, while the second collected detailed clinical data. Results: The estimated number of AP patients requiring hospitalization was 61,080, with an overall incidence rate of 49 per 100,000 persons, decreasing from 78,450 in 2016. Detailed clinical data were obtained for 4,375 patients, including 1,362 (31.1%) classified as severe. The male-to-female ratio was 2.0, with mean ages at onset of 60.1 years for males and 65.4 years for females. The three major causes were alcohol (31.2%), gallstones (22.5%), and idiopathic etiology (22.1%). The AP-associated in-hospital mortality rate was 2.1% in all AP and 5.3% in severe cases, down from 6.1% in the 2016 survey. Antibiotics were administered to 61.2% of mild cases, a significant reduction from 94.5% in 2016. Enteral nutrition was provided to 56.9% of severe cases, up from 31.8% in 2016. Among 124 patients undergoing interventional drainage for walled-off necrosis, 57 were treated using a step-up approach. Notably, no patients underwent upfront surgery as the initial treatment. Conclusions: During the pandemic, the estimated number of AP cases requiring hospitalization declined for the first time in nearly four decades. Mortality in severe cases improved, and adherence to clinical guidelines on prophylactic antibiotics and enteral nutrition also improved, indicating enhanced management of AP in Japan.
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第2回 膵・胆管合流異常の診断 査読あり
河上 洋, 畑田 紘志, 内山 尚美, 小川 宗一郎
胆道 39 ( 4 ) 715 - 722 2025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：一般社団法人 日本胆道学会
膵・胆管合流異常（合流異常）は膵管と胆管が十二指腸壁外で合流する先天性の形成異常である．一般的には膵液の胆管内逆流により胆道癌が高頻度に発生することが良く知られている．特に，胆管非拡張型では胆囊癌の発生頻度が高い．合流異常に特異的症状はないが，腹部超音波検査により胆囊壁のびまん性肥厚をみた場合，合流異常の存在を疑い，さらなる精査を行うべきである．
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特集 胆膵内視鏡処置具ガイド2025 [私のミニマルセットはこれ!] 結石除去② 査読あり
河上 洋, 内山 尚美, 畑田 紘志
消化器内視鏡 37 ( 10 ) 1310 - 1311 2025年10月
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特集 経口胆道鏡･膵管鏡を使い熟す! [経口胆道鏡] 経口胆道鏡による胆管癌の水平方向進展範囲診断 査読あり
河上 洋, 畑田 紘志, 内山 尚美, 小川 宗一郎, 金子 博樹, 内田 圭祐, 田村 穂高, 大園 芳範
消化器内視鏡 37 ( 7 ) 918 - 923 2025年7月
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胃 gastrointestinal stromal tumor に対するEUS-FNA 後出血に対する APC 止血により門脈ガス血症を呈した 1 例 査読あり
畑田 紘志, 河上 洋, 内山 尚美, 小川 宗一郎, 田村 穂高, 鈴木 翔, 大園 芳範, 黒木 大介, 三池 忠, 都築 諒
Gastroenterological Endoscopy 67 ( 7 ) 1264 - 1271 2025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
An 81-year-old man with a submucosal gastric tumor was admitted to our hospital. EUS revealed a submucosal tumor, approximately 58 mm in diameter, in the gastric fornix. EUS-FNA using a 22-gauge Franseen needle was performed. After EUS-FNA, EGD revealed gushing bleeding at the puncture site. Therefore, we performed a hemostatic procedure with argon plasma coagulation (APC), which subsided the bleeding. CT showed gastric emphysema and hepatic portal venous gas following the hemostatic procedure. The following day, gastric emphysema improved and portal venous gas disappeared with conservative treatment. During hemostatic treatment with APC, argon plasma gas flowed into the intratumoral vessel, causing portal venous gas. Knowingly, this is the first report on the development of hepatic portal venous gas after APC.
DOI： 10.11280/gee.67.1264
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Optimal Number of Needle Punctures in EUS-FNA/B with ROSE for Solid Pancreatic Lesions 査読あり
Uchiyama N., Kawakami H., Ozono Y., Hatada H., Ogawa S., Sekiguchi S., Noguchi H., Sato Y.
Diagnostics 15 ( 13 ) 2025年7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：Diagnostics
Background and Objectives: Endoscopic ultrasonography (EUS)-guided fine-needle aspiration/biopsy (FNA/B) is widely used for solid pancreatic lesions; however, the optimal number of needle punctures required to achieve high diagnostic accuracy remains unclear. This study aimed to identify the ideal number of punctures required for solid pancreatic lesions using EUS-FNA/B. Methods: This single-center retrospective study included 598 patients who underwent EUS-FNA/B for solid pancreatic lesions. We analyzed the cumulative tissue acquisition rates and diagnostic accuracy rates for cytology and histology, and identified the factors associated with diagnostic accuracy using univariate and multivariate analyses. Rapid on-site cytological evaluation was performed in all cases. Results: Cumulative tissue acquisition rates were 95.6% and 92.5% for cytology and histology, respectively. The diagnostic accuracy for cytology increased from 72.6% in the first puncture to 78.8% in the second puncture (p = 0.0233). In contrast, the diagnostic accuracy of histology increased from 72.0% at the first puncture to 83.2% at the third puncture (p = 0.0412). Statistically significant differences were noted between the first and second punctures for cytology, and between the first, second, and third punctures for histology. Univariate and multivariate analyses were conducted to identify factors associated with diagnostic accuracy. In cytology, sex was identified as a significant contributing factor, whereas no independent predictors were found in histology. Conclusions: These findings suggest that two-needle punctures are optimal for cytology, and three-needle punctures are optimal for the histological diagnosis of solid pancreatic lesions using EUS-FNA/B.
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Clinical significance of para-aortic lymph node metastasis for prognosis in patients with pancreaticobiliary cancer who underwent radical surgical resections. 査読あり
Nanashima A, Arai J, Hiyoshi M, Imamura N, Hamada T, Tsuchimichi Y, Shimizu I, Ochiai T, Kawakami H, Sato Y, Wada T.
Turk J Surg 41 ( 1 ) 5 - 18 2025年2月
記述言語：英語 掲載種別：研究論文（学術雑誌）
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Imamura N., Nanashima A., Tsuchimochi Y., Hamada T., Kawakami H., Hiyoshi M.
Gland Surgery 14 ( 4 ) 714 - 725 2025年
記述言語：英語 掲載種別：研究論文（学術雑誌） 出版者・発行元：Gland Surgery
Background: Neoadjuvant chemotherapy (NAC) has been increasingly used in recent years in patients with pancreatic ductal adenocarcinoma (PDAC). This has forced a change in the practice of preoperative biliary drainage (PBD) is performed in PDAC patients scheduled for pancreatoduodenectomy (PD). What has changed in the NAC era and what is the appropriate method of PBD? To address this question, this study retrospectively reviewed the surgical outcomes and details of PBD in NAC and upfront surgery (US) patients. Methods: The study included consecutive PDAC patients who underwent PD from 2013 to 2021 during the transition from US to NAC, when outcomes were comparable. Clinical factors such as patient background, preoperative examination, surgical procedure, and postoperative complications were compared between the NAC group (40 patients) and the US group (59 patients), and details of PBD such as PBD procedure and adverse events were compared between the NAC and US groups who received PBD (27 NAC patients, 33 US patients). In the comparison test between groups, Fisher’s exact test and Mann-Whitney U test were mainly used. In addition, the outcomes and patency periods of each of the 128 PBD procedures were examined for the 60 patients who underwent PBD. The log-rank test was performed using the Kaplan-Meier method to compare patency period by PBD procedure. Results: There were no differences in patient background between the NAC and US groups. Compared with the US group, the NAC group had higher preoperative albumin (ALB) levels and less blood loss, but there was no difference of postoperative complications (NAC vs. US, 35% vs. 46%, respectively, P=0.29). With respect to PBD, the NAC group had more initial metallic stent (MS) placement (NAC vs. US, 52% vs. 15%, respectively, P=0.009), and fewer PBD-related adverse events (NAC vs. US, 33% vs. 61%, respectively, P=0.04). In a comparison of outcomes by drainage method, the duration of patency was significantly longer with MS placement than plastic stent (PS) placement (median days of patency, MS vs. PS, 68 vs. 15 days, respectively, P<0.001). However, MS placement and PS placement were equally likely to require a delay in the surgical schedule due to PBD-related adverse events (MS vs. PS, 6% vs. 6%, respectively, P>0.99). Conclusions: Prolonged PBD with NAC did not adversely affect surgical outcomes. MS placement provides a long patency period and is currently useful in PBD for PDAC patients undergoing PD after NAC, which requires a prolonged preoperative period. However, MS placement also has adverse events, and further studies are needed.
DOI： 10.21037/gs-2024-507
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Multiple intrahepatic artery aneurysms during the treatment for IgG4-related sclerosing cholangitis: A case report. 査読あり
Tamura H, Ozono Y, Uchida K, Uchiyama N, Hatada H, Ogawa S, Iwakiri H, Kawakami H.
World J Hepatol 16 ( 12 ) 1505 - 1514 2024年12月
担当区分：最終著者, 責任著者 記述言語：英語 掲載種別：症例報告
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The successful posterior sectionectomy accompanied with caudate lobectomy for hepatocellular carcinoma located in segment 1 after LEN-TACE: a case report. 査読あり
Nanashima A, Hamada T, Hiyoshi M, Imamura N, Tsuchimichi Y, Shimizu I, Nagata K, Kawakami H, Sato Y, Wada T.
Clin J Gastroenterol 17 ( 3 ) 490 - 496 2024年6月
記述言語：英語 掲載種別：症例報告
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Association of blood group O with a recurrent risk for acute lower gastrointestinal bleeding from a multicenter cohort study 査読あり
Suzuki S, Tominaga N, Aoki T,….., Kawakami H, Nagata N
Sci Rep. 14 ( 1 ) 13983 2024年6月
記述言語：英語 掲載種別：研究論文（学術雑誌）
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Reactivation of hepatitis C virus caused by steroid monotherapy for sudden deafness. 査読あり
Kaneko H, Ozono Y, Iwakiri H, Hatada H, Uchiyama N, Komaki Y, Nakamura K, Hasuike S, Nagata K, Kawakami. H.
Clin J Gastroenterol 17 ( 3 ) 505 - 510 2024年6月
担当区分：最終著者, 責任著者 記述言語：英語 掲載種別：症例報告
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Clinical significances of several fibrotic markers for prognosis in hepatocellular carcinoma patients who underwent hepatectomy. 査読あり
Nanashima A, Hiyoshi M, Imamura N, Hamada T, Tsuchimichi Y, Shimizu I, Ochiai T, Nagata K, Hasuike S, Nakamura K, Iwakiri H, Kawakami H.
Trans Cancer Res 13 ( 5 ) 2332 - 2345 2024年5月
記述言語：英語 掲載種別：研究論文（学術雑誌）
DOI： 10.21037/tcr-24-94.
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An autopsy case of an adult woman with Rapid-Onset Obesity with Hypoventilation, Hypothalamic, Autonomic Dysregulation, and Neuroendocrine Tumors (ROHHAD(NET)) syndrome developing nonalcoholic steatohepatitis and hepatocellular carcinoma: A case report. 査読あり
Hasuike S, Ozono Y, Uchida K, Ogawa S, Tamura H, Uchiyama N, Hatada H, Komaki Y, Nakamura K, Iwakiri H, Sueta M, Nagata K, Nishimura T, Matsuyama M, Sawada H, Oguri T, Sato Y, Kawakami H.
Medicine (Baltimore) 103 ( 22 ) e38383 2024年5月
担当区分：最終著者, 責任著者 記述言語：英語 掲載種別：症例報告
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Comparison of covered self-expandable metallic stents with 12-mm and 10-mm diameters for unresectable malignant distal biliary obstructions: A prospective randomized trial. 査読あり
Mukai T, Iwata K, Iwashita T, Doi S, Kawakami H, Okuno M, Maruta A, Uemura S, Shimizu M, Yasuda I.
Gastrointest Endosc 99 ( 5 ) 732 - 738 2024年5月
記述言語：英語 掲載種別：研究論文（学術雑誌）
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Clinical impact of the charlson comorbidity index on the efficacy of salvage photodynamic therapy using talaporfin sodium for esophageal cancer. 査読あり
Kai K, Nakashima K, Kawakami H, Takeno S, Hishikawa Y, Ikenoue M, Hamada T, Imamura N, Shibata T, Noritomi T, Sasaki F, Nakamura Y, Nanashima A.
Intern Med 63 ( 7 ) 903 - 910 2024年4月
記述言語：英語 掲載種別：研究論文（学術雑誌）
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Nanashima A, Hamada T, Hiyoshi M, Imamura N, Tsuchimochi Y, Shimizu I, Nagata K, Kawakami H
Clin J Gastoenterol 17 ( 3 ) 490 - 496 2024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：Clinical Journal of Gastroenterology
Nowadays, the novel molecular targeting chemotherapy provides possibility of safe hepatectomy for progressive hepatocellular carcinoma (HCC). Further, combination of the conventional transarterial chemoembolization (TACE) may add an effect of tumor shrink. We present a successful radical hepatectomy for a large HCC located in segment 1 accompanied with the preoperative Lenvatinib (LEN)-TACE sequential treatment. We present a woman patient without any complaints who had a 7 cm-in-size of solitary HCC compressing vena cava and right portal pedicle. To achieve radical hepatectomy by tumor shrinking, LEN-TACE for 2 months. After confirming downsizing or devascularization of the HCC, we scheduled radical posterior sectionectomy combined with caudate lobectomy according to tumor location and expected future remnant liver volume from three-dimensional computed tomography simulation before surgery. Under the thoraco-abdominal incision laparotomy, we safely achieved scheduled radical hepatectomy without any vascular injuries. The postoperative course was uneventful and no tumor recurrence were observed for 1 year. Histological findings showed the Japan TNM stage III HCC with 70% necrosis. The multi-modal strategy of LEN-TACE followed by radical hepatectomy by confirming downsizing or devascularization in tumor is supposed to be useful and would be a preoperative chemotherapy option, and promising for curative treatment in HCC patients with progressive or large HCC, which may lead to safety by prevention surrounding major vascular injury.
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Comparison of covered self-expandable metallic stents with 12-mm and 10-mm diameters for unresectable malignant distal biliary obstructions: A prospective randomized trial. 査読あり
Mukai T, Iwata K, Iwashita T, Doi S, Kawakami H, Okuno M, Maruta A, Uemura S, Shimizu M, Yasuda I
Gastrointestinal endoscopy 2023年11月