論文 - 河上 洋
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Kai K., Imamura N., Hiyoshi M., Hamada T., Uchise Y., Hatada H., Kawakami H., Mukai S., Kamoto T., Nanashima A.
Asian journal of endoscopic surgery 15 ( 1 ) 211 - 215 2022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：Asian journal of endoscopic surgery
Pancreatic metastasis from renal cell carcinoma (RCC) is relatively rare. Surgical resection of the lesion is recommended if no residual tumor remains. Although there is no clear standard for surgical procedures, enucleation can be considered for small lesions. Lesion identification is important for enucleation, and contrast-enhanced ultrasound which takes advantage of the characteristics of hypervascular lesions was useful in a 68-year-old woman who underwent a left nephrectomy for RCC 11 years ago that was pathologically diagnosed as clear cell carcinoma. Recent computed tomography checkup showed a hypervascular tumor of 6 mm in the uncinated process and 10 mm in the pancreatic tail. Endoscopic ultrasonography-guided fine-needle aspiration was performed for the tail lesion, a diagnosis of clear cell carcinoma was made, and laparoscopic enucleation of the pancreatic tumors was performed aided by intraoperative contrast-enhanced ultrasound. The postoperative course was uneventful, and no pancreatic fistula occurred.
DOI： 10.1111/ases.12974
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膵インスリノーマに対するEUSガイド下ラジオ波焼灼術：三次医療センター２施設の経験
河上 洋
日本消化器内視鏡学会雑誌 64 ( 8 ) 1519 - 1519 2022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：一般社団法人 日本消化器内視鏡学会
【背景と目的】インスリノーマは膵神経内分泌腫瘍の中でもっとも頻度が高く，温存手術が適応となる．EUSガイド下ラジオ波焼灼術（EUS-guided radiofrequency ablation：EUS-RFA）は限局性腫瘍に対する新たな治療法である．本研究は20mm未満の膵インスリノーマに対するEUS-RFAの安全性と有効性に関するプレリミナリーな臨床研究である．【方法】三次医療センター２施設で膵インスリノーマに対してEUS-RFAを施行した臨床経過を解析した．【結果】2017年11月～2020年12月の期間中，７例（男：女＝１：６，年齢中央値：66歳）が登録された．EUS-RFA １回の焼灼により全例で速やかに低血糖が改善し，画像診断では７例中６例が完全寛解に至り，無症候を維持していた（観察期間中央値：21カ月（範囲：３～38カ月））．３例で軽症合併症がみられた．高齢者の１例では15日目に胃後部に液体貯留を生じ，１カ月後に死亡した．【結論】２cm未満の膵インスリノーマに対するEUS-RFAは有効で，安全性は許容範囲と考えられる．長期予後や再発に関してはさらなるエビデンスの蓄積が必要である．
DOI： 10.11280/gee.64.1519
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メインデバイスとしてのHookKnifeJの効果的な手技とコツ
三池 忠, 河上 洋, 小山 恒男
日本消化器内視鏡学会雑誌 64 ( 10 ) 2295 - 2307 2022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：一般社団法人 日本消化器内視鏡学会
HookKnifeは2003年に小山らにより開発されたESDのデバイスである．シンプルなデザインにもかかわらず，咽頭，食道，胃，十二指腸，大腸等のあらゆる臓器に有用である．先端部のHook partでの細かい操作のみならず，根本部のArm partでの大胆な操作が特徴的であり，また他のナイフの苦手な垂直病変へのアプローチや瘢痕合併症例で剝離に対しての繊細な操作も可能である．2015年には送水機能を完備し，HookKnifeJ（オリンパス社）と生まれ変わり，その有用性はさらに進化した．難易度の高いESDの際には使用することが多いデバイスであり，是非，普段からメインデバイスとして手技を熟練し習得しておくべきであり，その手技を解説する．
DOI： 10.11280/gee.64.2295
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河上 洋
日本消化器内視鏡学会雑誌 64 ( 11 ) 2391 - 2411 2022年
担当区分：筆頭著者, 責任著者 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 日本消化器内視鏡学会
Precutは本邦では選択的胆管挿管困難例に対して施行されることが多く，エキスパートのみが行うサルベージ手技として位置づけられている．近年，エキスパートの術者が行うearly precutの有用性が欧米から報告され，最近ではdirectすなわちprimary precutの有用性がアジア（韓国，インド）から報告された．トレイニーが習得するにはハードルが高い手技の１つであるが，今後はその有用性からエキスパートのみではなく，エキスパートの監督下であればトレイニーも行うべき手技の１つとなる大きな転換期を迎える可能性がある．しかし，precutは用語を始め，手技に至るまでその詳細は確立していない．そこで，本稿ではprecutの用語の整理，現時点での動向などを解説する．また，precut施行時の観察ポイントや処置具の選択，具体的な手技の解説を行う．
DOI： 10.11280/gee.64.2391
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Biliary drainage for malignant perihilar biliary obstruction
Kawakami H.
Journal of Japanese Society of Gastroenterology 119 ( 4 ) 310 - 320 2022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 Japanese Society of Gastroenterology
悪性肝門部領域胆管閉塞に対する胆道ドレナージは，切除の可否にかかわらず経乳頭的が第一選択である．切除例であれば術前に内視鏡的経鼻胆道ドレナージ（endoscopic nasobiliary drainage；ENBD）を予定残肝側の片葉へ留置する．一方，切除不能例であればプラスチックステントあるいはアンカバードタイプの金属ステントを留置する．片葉あるいは両葉留置の優越性については結論が出ていない．最近，筆者は肝門部領域胆管閉塞用にENBDと胆管内留置用のinsideステントを一体化した2 in 1ステントを開発した．切除あるいは切除不能例や急性胆管炎例に対する新たな方法として注目されつつある．本稿では，悪性肝門部領域胆管閉塞に対する胆道ドレナージの実際について解説する．
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大園 芳範, 中村 憲一, 岩切 久芳, 蓮池 悟, 末田 光恵, 三池 忠, 山本 章二朗, 永田 賢治, 河上 洋
BMC Gastroenterology 22 ( 1 ) 210 2022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：Springer Nature
Background
It is estimated that approximately 50% of patients with hepatitis C virus (HCV) infection in Japan are currently over 75 years old. However, patients aged ≥ 75 years are typically underrepresented in clinical trials of direct-acting antivirals. This study aimed to evaluate the efficacy and safety of glecaprevir and pibrentasvir (G/P) treatment in Japanese patients with HCV infection aged ≥ 75 years.
Methods
This multicenter, retrospective study included 271 Japanese patients with HCV infection from 12 centers in Miyazaki Prefecture, Japan. Demographic, clinical, virological, and adverse events (AEs) data obtained during and after G/P treatment were collected from medical records. The patients were divided into two groups: younger (n = 199, aged < 75 years) and older (n = 72, aged ≥ 75 years). Virological data and AEs were analyzed according to the age group.
Results
In intention-to-treat (ITT) and per-protocol analyses, the overall sustained virological response 12 (SVR12) rates were 93% and 98.8%, respectively. Two patients in the older group and 14 patients in the younger group dropped out before SVR12 assessment. Although patients in the older group tended to have liver cirrhosis, 95.8% in the older group and 92% in the younger group achieved SVR12 in the ITT analysis (P = 0.404). In total, 48 (17.7%) patients experienced treatment-related AEs. Common AEs during treatment included pruritus, headache, and fatigue. The AEs were not significantly different between the two groups.
Conclusions
Compared with younger patients, older patients showed similar virological response and tolerance to G/P treatment. -
Kawakami H, Kubota Y, Ban T, Hatada H, Ogawa S, Uchiyama N, Kuroki D
Endoscopy 53 ( 12 ) E455 - E456 2021年12月
担当区分：筆頭著者, 責任著者 記述言語：英語 掲載種別：研究論文（学術雑誌） 出版者・発行元：Endoscopy
DOI： 10.1055/a-1327-1813
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Kawakami H, Hatada H, Kubota Y, Ogawa S, Tamura H, Yoshida N, Uchiyama N
Endoscopy 53 ( 11 ) E398 - E400 2021年11月
担当区分：筆頭著者, 責任著者 記述言語：英語 掲載種別：研究論文（学術雑誌） 出版者・発行元：Endoscopy
DOI： 10.1055/a-1314-9818
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炎症性腸疾患診療にあたって注意すべき腸管感染症の内視鏡像
山本章二朗，芦塚伸也，河上 洋
日本消化器内視鏡学会雑誌 2021年10月
記述言語：日本語 掲載種別：研究論文（学術雑誌）
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A novel endoscopic submucosal dissection training model using skinned chicken meat with gel
Suzuki S, Kawakami H, Miike T, Ishikawa Y, Hirata T, Ichinari N, Komura A
Endoscopy 53 ( 9 ) E334 - E335 2021年9月
担当区分：責任著者 記述言語：英語 掲載種別：研究論文（学術雑誌） 出版者・発行元：Endoscopy
DOI： 10.1055/a-1287-8567
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Hatada H., Kawakami H., Uchiyama N., Ogawa S., Kubota Y., Ban T., Akaki M., Sato Y.
Journal of Japanese Society of Gastroenterology 118 ( 5 ) 480 - 489 2021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 Japanese Society of Gastroenterology
A 66-year-old man was admitted to our department with hypercalcemia, pancreatic and liver tumors, and periportal lymph node enlargement. Contrast-enhanced computed tomography revealed a tumor in the pancreatic tail and the right hepatic lobe along with periportal lymphadenopathy. Laboratory data revealed hypercalcemia and high serum parathyroid hormone-related protein (PTHrP) levels. Using a 22-gauge Fran-seen needle, we performed endoscopic ultrasonography-guided fine-needle biopsy of the pancreatic mass and an enlarged lymph node. Histopathological examination of the biopsy specimen revealed moderately to well-differentiated pancreatic adenocarcinoma with poorly differentiated squamous cell elements, as well as squamous cell carcinoma of the lymph node. Immunohistochemical examination showed that the pancreatic tissue was weakly immunopositive and the lymph node was strongly immunopositive for anti-PTHrP antibody. We diagnosed the patient with pancreatic adenosquamous carcinoma with liver and lymph node metastasis, associated with hypercalcemia of malignancy secondary to PTHrP secretion. We administered systemic chemotherapy comprising gemcitabine and nab-paclitaxel. Unfortunately, the patient died 8 months after being diagnosed with this malignancy. PTHrP-producing adenosquamous carcinoma of the pancreas is rare ; only 14 cases are reported in the literature. Based on immunohistochemical evaluation, this case report suggests that metastatic lymph nodes may lead to the overproduction of PTHrP in such cases.
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特集 胆道ドレナージを極める 特殊例 IPNBにおける胆管ドレナージ
河上 洋, 久保田 良政, 内山 尚美, 小川 宗一郎, 畑田 紘志, 田村 穂高, 吉田 直樹
消化器内視鏡 33 ( 3 ) 643 - 647 2021年3月
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Kuroki D., Kawakami H., Nakashima K., Suzuki S., Miike T., Ashizuka S., Abe H., Yamamoto S., Inatsu H., Hosokawa A.
Gastroenterological Endoscopy 63 ( 2 ) 188 - 194 2021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：Gastroenterological Endoscopy
A 37-year-old man underwent thymectomy for myasthenia gravis and subsequently received oral medication. Screening upper gastrointestinal endoscopy revealed a 20mm fading concave lesion on the posterior wall of the greater curvature of the stomach. He was diagnosed with signet-ring cell carcinoma based on histopathological examination of a biopsy specimen and was referred to our hospital for further management. Preoperative evaluation led to a diagnosis of early gastric cancer and he was scheduled for endoscopic submucosal dissection (ESD). Benzodiazepines are contraindicated for sedation in patients with myasthenia gravis, and a drug that does not cause muscle relaxation should be administered. Therefore, in this patient, we performed successful ESD using a combination of dexmedetomidine, pentazocine, and hydroxyzine for sedation. Dexmedetomidine is useful for limited sedation that is required during endoscopic procedures in patients with myasthenia gravis.
DOI： 10.11280/gee.63.188
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Sho Suzuki, Hiroshi Kawakami, Tadashi Miike
DEN Video Article 33 ( 3 ) e28 - e30 2021年1月
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Hakuta R., Kogure H., Nakai Y., Kawakami H., Maguchi H., Mukai T., Iwashita T., Saito T., Togawa O., Matsubara S., Hayashi T., Maetani I., Ito Y., Hasebe O., Itoi T., Hanada K., Isayama H.
Journal of Clinical Medicine 10 ( 2 ) 1 - 11 2021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：Journal of Clinical Medicine
(1) Background: Endoscopic management of hilar biliary obstruction is still challenging. Compared with unilateral drainage, bilateral drainage could preserve larger functional liver volume and potentially improve clinical outcomes. To evaluate the effectiveness of bilateral drainage, we conducted this multicenter randomized controlled study. (2) Methods: Patients with unresectable malignant hilar biliary obstruction were assigned to unilateral or bilateral group. At first, patients underwent endoscopic nasobiliary drainage (ENBD), and subsequently underwent self-expandable metallic stent (SEMS) deployment. Primary outcomes were the functional success rate of ENBD and time to recurrent biliary obstruction (TRBO) after SEMS deployment. (3) Results: During the study period, 38 and 39 patients were enrolled in the unilateral and bilateral groups. The functional success rate was similar in the uni-and bi-ENBD group (57% vs. 56%; p = 0.99), but the rate of additional drainage was higher in uni-ENBD group. Although TRBO and overall survival time after SEMS deployment were not different between the groups (p = 0.11 and 0.78, respectively), the incidence of early adverse events tended to be higher in the bi-SEMS group (5.3% vs. 28%; p = 0.11). (4) Conclusions: Our study failed to demonstrate the superiority of bilateral over unilateral biliary drainage in terms of functional success rate and TRBO.
DOI： 10.3390/jcm10020206
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食道壁両側に穿孔した４cm長の鶏骨を内視鏡的に摘出し手術を回避した1例 査読あり
米澤瑛美，河上 洋，三池 忠，坂元一樹，野田貴穂，鈴木 翔，山本章二朗，河野文彰，七島篤志，武野慎祐
日本消化器内視鏡学会雑誌 2021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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Yonezawa E., Kawakami H., Miike T., Sakamoto K., Noda T., Suzuki S., Yamamoto S., Kawano F., Nanashima A., Takeno S.
Gastroenterological Endoscopy 63 ( 1 ) 31 - 37 2021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：Gastroenterological Endoscopy
A 40-year-old man presented to the emergency room of our hospital with precordial pain after eating chicken for dinner. Computed tomography showed a high-density linear shadow of 40 mm in length in the lower esophagus. Mediastinal emphysema was noted around the mediastinal tip of the foreign body. The patient was diagnosed with bilateral perforation of the lower esophagus by chicken bone, and was referred to our department. After making preparations for on-site surgical backup, endoscopic removal of the foreign body was attempted. Upper endoscopy showed bilateral perforation of the side walls of the lower esophagus. We attempted to remove the foreign body, which was adjacent to the descending aorta, with a grasping forceps from the left side. The foreign body was pulled into the attachment and extracted without aortic injury. Esophageal perforation was managed conservatively and curatively. The patient was discharged 20 days after endoscopic extraction without surgery. Esophageal perforation may cause severe or fatal complications. A foreign body in the esophagus is often removed surgically. Furthermore, in the case of esophageal perforation by a sharp foreign object, severe bleeding may occur during endoscopic extraction. Therefore, it is necessary to devise a technique for endoscopic extraction.
DOI： 10.11280/gee.63.31
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Yamamoto S., Ashizuka S., Kawakami H.
Gastroenterological Endoscopy 63 ( 1 ) 18 - 30 2021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：Gastroenterological Endoscopy
When diagnosing inflammatory bowel disease (IBD), it is important to distinguish it from other intestinal infections as clinical treatments may differ completely. In addition, when there are signs of IBD relapse, it is important to accurately distinguish among IBD relapse, onset of infectious disease, or a combination of both. Intestinal infections can be an aggravating factor for IBD, and intestinal infections should always be considered when treating IBD. In this paper, we explain the etiology of this condition and show endoscopic findings of major intestinal infections that need to be differentiated from IBD when treating IBD.
DOI： 10.11280/gee.63.18
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Ogawa S., Kawakami H., Suzuki S., Kuroki D., Uchiyama N., Hatada H., Gi T., Sato Y.
Internal Medicine 60 ( 17 ) 2783 - 2791 2021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：Internal Medicine
Although cases of gastrointestinal toxicity of pembrolizumab have been reported, cases of acute immune-mediated colitis accompanied with metachronous esophageal disorders (esophagitis and ulcer) are rare. We herein report a case of acute colitis and metachronous esophageal ulcers due to an immune-related adverse event following concomitant pembrolizumab chemotherapy for lung adenocarcinoma. To our knowledge, there have so far been no reports of cases in which both acute immune-mediated colitis and metachronous esophageal ulcers developed. We therefore report the details of this case along with a review of the pertinent literature.
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三池 忠，河上 洋，山本 章二朗
Gastroentelogical Endoscopy 63 ( 6 ) 1218 - 1231 2021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：Gastroenterological Endoscopy
Adult T-cell leukemia/lymphoma (ATLL) is a peripheral T-cell malignancy caused by human T-cell leukemia virus type 1 (HTLV-1). The clinical characteristics of ATLL are very heterogeneous, and ATLL is a systemic disease with an unfavorable prognosis. It is difficult to perform gastrointestinal (GI) endoscopy in all ATLL patients due to the poor condition of some ATLL patients. However, we observed that the characteristic endoscopic findings of the GI tract of ATLL patients consist of multiple mucosal protrusions and ulcers, GI wall thickening, and the presence of similar macroscopic findings in various GI organs such as the stomach and colon. The endoscopist should organize current classification methods and endoscopic findings to assist in the diagnosis of ATLL, because patients with ATLL have heterogeneous GI lesions as part of the systemic disease of ATLL. We searched PubMed for articles published between 1965 and 2020 using the terms "adult T-cell leukemia/lymphoma" and "gastrointestinal tract". We also review endoscopic and characteristic findings of ATLL infiltration in the GI tract.
DOI： 10.11280/gee.63.1218