研究者詳細 - 河上　洋

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

掲載種別：研究論文（学術雑誌）出版者・発行元：(株)東京医学社

DOI： 10.24479/j02312.2021179978

Successful endoscopic submucosal dissection using dexmedetomidine for sedation in a patient with myasthenia gravis: A case report

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

Using Cusco’s speculum to endoscopically remove a large colonic endoscopic submucosal dissection specimen 査読あり

Sho Suzuki, Hiroshi Kawakami, Tadashi Miike

DEN Video Article 33 ( 3 ) e28 - e30 2021年1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：Digestive Endoscopy

DOI： 10.1111/den.13899

Unilateral versus bilateral endoscopic nasobiliary drainage and subsequent metal stent placement for unresectable malignant hilar obstruction: A multicenter randomized controlled trial

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

A case of bilateral esophageal perforation caused by chicken bone that was extracted via endoscopy without surgery

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）

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

Endoscopic findings of intestinal infections and distinguishing features of inflammatory bowel disease

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

Metachronous esophageal ulcers after immune-mediated colitis due to immune checkpoint inhibitor therapy: A case report and literature review

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.

DOI： 10.2169/internalmedicine.6606-20

成人T細胞白血病/リンパ腫に合併する消化管病変

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

ERCP後膵炎に対する非ステロイド性抗炎症薬と積極的輸液併用と非ステロイド性抗炎症薬単独の比較：多施設共同オープンラベル無作為化比較試験

河上洋

日本消化器内視鏡学会雑誌 63 ( 9 ) 1673 - 1673 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：一般社団法人日本消化器内視鏡学会

【背景】ERCPのもっとも代表的な有害事象はERCP後膵炎（PEP）である．PEPの4.7％は中等度～高度の膵炎に進展し，その死亡率は0.7％と報告されている．PEPのリスクを低減させる標準的方法は非ステロイド性抗炎症薬（NSAIDs）の予防的直腸投与である．また，NSAIDsの直腸投与を行わない例において，積極的輸液によりPEPリスクが低下することがメタ解析とRCTで示されているが，NSAIDsの直腸投与に積極的輸液を上乗せした際の有用性は明らかにされていない．【方法】18～85歳の中等度ないし高度のPEPリスク患者に対してNSAIDsの予防的直腸投与単独群（対照群）と積極的輸液を併用した群（併用群）の２群について，ドイツ国内の22施設が参加した多施設共同オープンラベル無作為化比較試験が実施された（FLUYT試験）．併用群はNSAIDs（ジクロフェナクあるいはインドメタシン）直腸投与に加えてERCP開始後60分以内に乳酸リンゲル液を20mL/kg点滴静注，引き続いて３mL/kg/時間を８時間かけて点滴静注した．対照群はNSAIDs直腸内投与に加えて，最大1.5mL/kg/時間あるいは24時間当たり３Lの生理的食塩水を点滴静注した．プライマリーエンドポイントはPEPの発症とした．【結果】2015年６月～2019年６月に登録された826例を１：１で割付した（併用群388例，対照群425例）．年齢中央値は併用群57歳（範囲：44～71歳），対照群60歳（範囲：49～71歳），男女比は両群ともに３：２，ASA Class Ⅲは両群ともに16％が含まれており，両群間で患者背景に有意差を認めなかった．ERCPの難易度（Schutz分類 2））は両群共ともにGrade 2（単純な治療目的のERCP）が80％以上を占めていた．また，膵管ステント留置は両群共に16％併用していた．偶発症のうちPEPは併用群の30例（８％），対照群の39例（９％）が併発した（相対リスク0.84，95％ CI 0.53-1.33，P＝0.53）．輸液関連合併症（同0.99，0.59-1.64，P＝1.00），ERCP関連合併症（同0.9，0.62-1.31，P＝0.62），ICUへの入院（同0.37，0.07-1.80，P＝0.22），30日死亡率（同0.95，0.50-1.83，P＝1.00）などの重篤な有害事象は２群間に有意差はなかった．また，併用群において積極的輸液に伴う死亡例は認められなかった．【結語】中等度ないし高度のPEPリスク患者に対するNSAIDsの予防的直腸投与と積極的輸液の併用はNSAIDs直腸投与単独群と比べてPEPの発症を抑制しなかった．

DOI： 10.11280/gee.63.1673

Complete remission of colon cancer with ipilimumab monotherapy

Suzuki S, Kawakami H, Miike T, Yamamoto S

Internal Medicine 60 ( 6 ) 957 - 958 2021年

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：Internal Medicine

DOI： 10.2169/internalmedicine.6024-20

遠位胆管癌に対する術前診断のポイント―内視鏡関連手技を中心に―

河上　洋

日本消化器内視鏡学会雑誌 2020年12月

記述言語：日本語掲載種別：研究論文（学術雑誌）

Preoperative diagnosis of distal cholangiocarcinoma: Focusing on the role of endoscopic-related procedures in its evaluation and management

KAWAKAMI H.

Gastroenterological Endoscopy 62 ( 12 ) 3090 - 3104 2020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：Gastroenterological Endoscopy

In cholangiocarcinoma, preoperative diagnosis of local extension including invasion of the vessels and proximal and/or distal intraepithelial tumor spread (ITS) is important. The mode of local extension of cholangiocarcinoma greatly differs depending on the gross type of the main tumor. In general, the mode of local extension of cholangiocarcinoma is classified into two types: I) papillary and nodular type and ii) infiltrating type. The papillary and nodular type grossly appears as an elevated lesion with a relatively clearly formed border. In the papillary and nodular type, the incidence of extensive ITS, which is continuous with the main tumor and extends ≥ 2cm into the mucosal epithelium, is 25-36%. On the other hand, extramural invasion and submucosal intramural spread are common in the infiltrating type. In the infiltrating type, the incidence of extensive ITS is approximately 3-4%. Therefore, in order to perform curative resection, the extent of ITS into the bile duct mucosal epithelia must be accurately diagnosed in the papillary and nodular type, and the extent of submucosal intramural and extramural spread must be evaluated in the infiltrating type. In this article, the role of endoscopy in the evaluation and management of distal cholangiocarcinoma will be discussed.

DOI： 10.11280/gee.62.3090

特集進化するEUS 診断的EUS　超音波内視鏡下穿刺吸引法　細胞診から生検への新たな展開

河上洋, 内山尚美, 小川宗一郎, 畑田紘志, 久保田良政, 坂哲臣

消化器内視鏡 32 ( 11 ) 1657 - 1664 2020年11月

掲載種別：研究論文（学術雑誌）出版者・発行元：(株)東京医学社

DOI： 10.24479/j02312.2021056141

消化管T細胞リンパ腫

三池　忠，山本章二朗，河上　洋

消化器内視鏡 2020年11月

記述言語：日本語掲載種別：研究論文（学術雑誌）

超音波内視鏡ガイド下穿刺吸引法－細胞診から生検への新たな展開

河上　洋，内山尚美，小川宗一郎，畑田紘志，久保田良政，坂　哲臣

消化器内視鏡 2020年11月

記述言語：日本語掲載種別：研究論文（学術雑誌）

ERCP後膵炎発生率の低減を目的としたearlyとprimary precutの無作為化比較試験

河上　洋

日本消化器内視鏡学会雑誌 2020年10月

記述言語：日本語掲載種別：研究論文（学術雑誌）

Clinical characteristics of adult T-cell leukemia/lymphoma infiltration in the gastrointestinal tract 査読あり

Tadashi Miike, Hiroshi Kawakami, Takuro Kameda, Shojiro Yamamoto, Yoshihiro Tahara, Tomonori Hidaka, Yoko Kubuki, Kenji Yorita, Yutaka Akiyama, Yasuji Arimura, Yoshimasa Kubota, Hiroaki Kataoka, Kazuya Shimoda

BMC Gastroenterology 20 ( 1 ) 298 2020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：BMC Gastroenterology

Background: Adult T-cell leukemia/lymphoma (ATLL) is a peripheral T-cell malignancy caused by human T-cell leukemia virus type 1. The clinical course of ATLL is very heterogeneous, and many organs, including the gastrointestinal (GI) tract, can be involved. However, there are few detailed reports on ATLL infiltration in the GI tract. We investigated the clinical characteristics of ATLL infiltration in the GI tract. Methods: This retrospective observational single-center study included 40 consecutive ATLL patients who underwent GI endoscopy. The patients' demographic and clinical characteristics and endoscopic findings were analyzed retrospectively. Patients with ATLL who were diagnosed by histological examination were divided into two groups based on GI tract infiltration. Results: Multivariate analysis revealed that the absence of skin lesions was significantly associated with GI infiltration (P < 0.05). Furthermore, the infiltration group tended to have similar macroscopic lesions in the upper and lower GI tracts, such as diffuse type, tumor-forming type, and giant-fold type. Conclusions: GI endoscopy may be considered for ATLL patients without skin lesions.

DOI： 10.1186/s12876-020-01438-1