論文 - 河上 洋
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Randomized trial comparing a side-port needle and standard needle for EUS-guided histology of pancreatic lesions. 査読あり
Ishiwatari H, Hayashi T, Kawakami H, Isayama H, Itoi T, Ono M, Kawakubo K, Yamamoto N, Tanaka M, Itokawa F, Oshiro H, Sonoda T, Hasegawa T.
Gastrointestinal Endoscopy 2016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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久保 公利，河上 洋，久保田 良政，川畑 修平，川久保 和道，桒谷 将城，上野 峰，三橋 智子，坂本 直哉 査読あり
久保公利，河上 洋，久保田良政，川畑修平，川久保和道，桒谷将城，上野 峰，三橋智子，坂本直哉．
胆道学会誌 2016年4月
記述言語：日本語 掲載種別：研究論文（学術雑誌）
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IgG4-related sclerosing cholangitis: all we need to know. 招待あり 査読あり
Zen Y, Kawakami H, Kim JH
Journal of Gastroenterology 51 ( 4 ) 295 - 312 2016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：Springer
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Kawakami H, Kubota Y, Sakamoto N
Digestive Diseases and Sciences 61 ( 3 ) 660 - 662 2016年3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：Digestive Diseases and Sciences
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Double penetrated duodenal wall during endoscopic ultrasound-guided choledochoduodenostomy
Kawakami H., Kuwatani M., Sakamoto N.
Gut and Liver 10 ( 2 ) 318 - 319 2016年3月
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Kurihara T., Yasuda I., Isayama H., Tsuyuguchi T., Yamaguchi T., Kawabe K., Okabe Y., Hanada K., Hayashi T., Ohtsuka T., Oana S., Kawakami H., Igarashi Y., Matsumoto K., Tamada K., Ryozawa S., Kawashima H., Okamoto Y., Maetani I., Inoue H., Itoi T.
World Journal of Gastroenterology 22 ( 5 ) 1891 - 1901 2016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：World Journal of Gastroenterology
© 2016 Baishideng Publishing Group Inc. All rights reserved. AIM: To assess the utility and safety of single-operator cholangiopancreatoscopy (SOCPS) using the SpyGlass system in widespread clinical application for biliary and pancreatic diseases. METHODS: This study was a prospective case series conducted in 20 referral centers in Japan. There were 148 patients who underwent SOCPS; 124 for biliary diseases and 24 for pancreatic diseases. The attempted interventions were SOCPS examination, SOCPS-directed tissue sampling, and therapy for stone removal, among others. The main outcomes were related to the procedure success rate in terms of visualizing the target lesions, SOCPS-directed adequate tissue sampling, and complete stone removal. RESULTS: A total of 148 patients were enrolled for the diagnosis of indeterminate biliary and pancreatic lesions or treatment of biliary and pancreatic disease. The overall procedure success rate of visualizing the target lesions was 91.2% (135/148). The overall procedural success rates of visualizing the target lesions of diagnostic SOCPS in the bile duct and pancreatic duct were 95.5% (84/89) and 88.2% (15/17), respectively. Diagnosis: the overall adequate tissue for histologic examination was secured in 81.4% of the 86 patients who underwent biopsy under SOCPS (bile duct, 60/75, 80.0%; pancreatic duct, 10/11, 90.9%). The accuracy of histologic diagnosis using SOCPS-directed biopsies in indeterminate bile duct lesions was 70.7% (53/75). In the pancreatic duct, the accuracy of SOCPS visual impression of intraductal papillary mucinous neoplasm was 87.5% (14/16). Stone therapy: complete biliary and pancreatic stone clearance combined with SOCPS-directed stone therapy using electrohydraulic lithotripsy or laser lithotripsy was achieved in 74.2% (23/31) and 42.9% (3/7) of the patients, respectively. Others: SOCPS using the SpyGlass system was used in cannulation of the cystic duct in two patients and for passing across the obstructed self-expandable metallic stent for a malignant biliary stricture in two patients. All procedures were successful in both SOCPS-guided therapies. The incidence of procedure-related adverse events was 5.4% (8/148). CONCLUSION: SOCPS with direct visualization and biopsy for diagnosis and SOCPS-directed therapy for biliary and pancreatic diseases can be safely performed with a high success rate.
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Kawakubo K., Kawakami H., Kuwatani M., Kubota Y., Kawahata S., Kubo K., Sakamoto N.
Endoscopy 48 ( 2 ) 164 - 169 2016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：Endoscopy
© Georg Thieme Verlag KG. Background and study aims: Endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) has gained popularity as an alternative to percutaneous biliary drainage for patients in whom endoscopic retrograde cholangiopancreatography has failed. There are no previous studies comparing EUS-CDS with endoscopic transpapillary stenting (ETS) as first-line treatment for distal malignant obstruction. The aim of this study was to compare the clinical efficacy and safety of EUS-CDS and ETS as first-line treatment in patients with distal malignant biliary obstruction. Patients and methods: A total of 82 patients with distal malignant biliary obstruction underwent initial biliary drainage using self-expandable metal stents at a tertiary care university hospital. ETS was performed between June 2009 and May 2012, and EUS-CDS was performed between May 2012 and March 2014. Clinical success rates, adverse event rates, and reintervention rates were retrospectively evaluated for EUS-CDS and ETS. Results: A total of 26 patients underwent EUS-CDS and 56 underwent ETS. Clinical success rates were equivalent between the groups (EUS-CDS 96.2%, ETS 98.2%; P=0.54). The mean procedure time was significantly shorter with EUS-CDS than with ETS (19.7 vs. 30.2 minutes; P < 0.01). The rate of overall adverse events was not significantly different between the groups (EUS-CDS 26.9%, ETS 35.7%; P=0.46). Post-procedural pancreatitis was only observed in the ETS group (0% vs. 16.1%; P=0.03). The reintervention rate at 1 year was 16.6% and 13.6% for EUS-CDS and ETS, respectively (P=0.50). Conclusions: EUS-CDS performed by expert endoscopists was associated with a short procedure time and no risk of pancreatitis, and would therefore be feasible as a first-line treatment for patients with distal malignant biliary obstruction.
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Kawakubo K., Ohnishi S., Hatanaka Y., Hatanaka K., Hosono H., Kubota Y., Kamiya M., Kuwatani M., Kawakami H., Urano Y., Sakamoto N.
Molecular Imaging and Biology 18 ( 3 ) 463 - 471 2016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：Molecular Imaging and Biology
© 2015, World Molecular Imaging Society. Purpose: Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is the most reliable method for the histological diagnosis of pancreatic tumors. Rapid on-site fluorescence-guided histological diagnosis was evaluated by topically applying an enzymatically activatable probe onto the EUS-FNA samples; the probe fluoresces in the presence of γ-glutamyltranspeptidase (GGT). Procedures: We evaluated GGT expression in pancreatic cancer cell lines in vitro. EUS-FNA was performed in 10 pancreatic tumors. After topical application of the probe, signal intensity was measured using a fluorescence imaging system for 13 min. Results: GGT was expressed in Panc-1, AsPC-1, and AR42J, but not in KP4 cells. In samples from six cases, several regions of the specimens fluoresced and contained adequate tissue for pathological diagnosis. The remaining four non-fluorescent samples contained very small amounts of carcinoma, normal epithelial cells, or no epithelial cells. The signal intensity at 5 min was 25.5 ± 7.7 and 7.7 ± 0.5 in fluorescent and non-fluorescent regions, respectively (p < 0.05). Conclusions: Application of enzymatically activatable probe onto EUS-FNA samples would be feasible for the rapid evaluation of tissues suitable for histological diagnosis.
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Kawakami H., Kubota Y., Kawahata S., Kubo K., Okabayashi S., Tatsumi R., Sakamoto N.
Endoscopy 48 E146 - E147 2016年
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Eto K., Kawakami H., Haba S., Yamato H., Okuda T., Yane K., Hayashi T., Ehira N., Onodera M., Matsumoto R., Matsubara Y., Takagi T., Sakamoto N.
Journal of Hepato-Biliary-Pancreatic Sciences 22 ( 12 ) 825 - 830 2015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：Journal of Hepato-Biliary-Pancreatic Sciences
© 2015 Japanese Society of Hepato-Biliary-Pancreatic Surgery. Background Two-stage treatment involving stone removal after drainage is recommended for mild to moderate acute cholangitis associated with choledocholithiasis. However, single-stage treatment has some advantages. We aimed to assess the efficacy and safety of single-stage endoscopic treatment for mild to moderate acute cholangitis associated with choledocholithiasis. Methods A multicenter, non-randomized, open-label, exploratory clinical trial was performed in 12 institutions. A total of 50 patients with a naïve papilla and a body temperature ≥37 °C who were diagnosed with mild to moderate cholangitis associated with choledocholithiasis were enrolled between August 2012 and February 2014. Results Of the 50 patients, 15 had mild cholangitis and 35 had moderate cholangitis. The median number of common bile duct stones was 2 (range, 1-8), and the median diameter of the common bile duct stones was 7.5 mm (range, 1-18). The cure rate of acute cholangitis within 4 days after single-stage treatment was 90% (45/50) based on a body temperature < 37 °C for ≥24 h. The incidence of complications was 10% (5/50). Conclusion Single-stage endoscopic treatment may be effective and safe for mild to moderate acute cholangitis associated with choledocholithiasis (clinical trial registration number: UMIN000008494). Highlight Eto and colleagues demonstrated high cure rates and low complication rates in the first multicenter prospective study to verify the still controversial efficacy and safety of single-stage endoscopic treatment involving endoscopic retrograde cholangiopancreatography and sphincterotomy for mild to moderate acute cholangitis associated with choledocholithiasis according to the TG07.
DOI： 10.1002/jhbp.296
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Abe Y., Kawakami H., Oba K., Hayashi T., Yasuda I., Mukai T., Isayama H., Ishiwatari H., Doi S., Nakashima M., Yamamoto N., Kuwatani M., Mitsuhashi T., Hasegawa T., Hirose Y., Yamada T., Tanaka M., Sakamoto N., Kawakami H., Abe Y., Kuwatani M., Kawakubo K., Haba S., Kudo T., Kawahata S., Kubo K., Kubota Y., Sakamoto N., Mitsuhashi T., Marukawa K., Moriya J., Oba K., Hayashi T., Ishiwatari Y., Ono M., Hasegawa T., Nakanishi K., Ogino J., Sanuma H., Yasuda I., Doi S., Iwashita T., Hirose Y., Mukai T., Nakashima M., Yamada T., Etori M., Isayama H., Yamamoto N., Tanaka M.
Gastrointestinal Endoscopy 82 ( 5 ) 837 - 844e1 2015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：Gastrointestinal Endoscopy
© 2015 American Society for Gastrointestinal Endoscopy. Background EUS-guided FNA (EUS-FNA) has become the most efficacious way to obtain specimens from a solid lesion adjacent to the GI tract. Previous reports regarding the use of a stylet during EUS-FNA were all based on cytological diagnosis and have showed no significant superiority in terms of diagnostic yield. Objective To clarify the noninferiority of EUS-FNA without a stylet (S-) compared with EUS-FNA with a stylet (S+) on histological assessment. Design A prospective, single-blind, randomized, controlled crossover study. Setting Five tertiary referral centers in Japan. Patients Patients referred for EUS-FNA of a solid lesion. Intervention EUS-FNA S+ and S- in a total of 4 alternate passes with randomization to S+ first or S- first. Main Outcome Measurements The primary endpoint was the acquisition rate of an appropriate and sufficient specimen for histological assessment. The secondary endpoints were cellularity, contamination, bloodiness, diagnostic ability, and diagnostic accuracy. Results We enrolled 107 patients (110 lesions) and analyzed 220 specimens each in the S+ and S- groups. The acquisition rate of appropriate and sufficient specimens in the S+ group was 121 of 220 (55.0%) and 122 of 220 (55.5%) in the S- group. The difference in the acquisition rate of the specimen (S- minus S+) based on the generalized estimating equation was 0.42% (95% confidence interval, -6.72% to 7.56%), which was less than 10% of the prespecified noninferiority margin of this study. With regard to cellularity, contamination, bloodiness score, diagnostic ability, and diagnostic accuracy, there were no significant differences between both groups. There were no dropouts in the study. Limitations A variety of target lesions, multiple pathologists, lack of an assessment of intraobserver and interobserver variability, and a single-blind study for the pathologists. Conclusion EUS-FNA S- is noninferior to EUS-FNA S+ on histological assessment. (Clinical trial registration number: UMIN000008695.)
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Recent advances in endoscopic ultrasonography-guided biliary interventions
Kawakubo K., Kawakami H., Kuwatani M., Haba S., Kawahata S., Abe Y., Kubota Y., Kubo K., Isayama H., Sakamoto N.
World Journal of Gastroenterology 21 ( 32 ) 9494 - 9502 2015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
© The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved. Interventional endoscopic ultrasonography (EUS) based on EUS-guided fine-needle aspiration has rapidly spread as a minimally invasive procedure. Especially in patients with failed endoscopic retrograde cholangiopancreatography, EUS-guided biliary intervention is reported to be useful as salvage therapy. EUS-guided biliary interventions are carried out using three techniques: EUS-guided bilioenteric anastomosis, EUS-guided rendezvous procedure, and EUS-guided antegrade treatment. Although interventional EUS is not yet a standardized procedure, there have been recent advances in this field that address various biliary diseases. Here, we sum marize the indications, techniques, clinical results of previous studies, and future perspectives.
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Kawakami H., Kuwatani M., Kawakubo K., Kubota Y., Kawahata S., Kubo K., Sakamoto N.
Endoscopy 47 E346 - E347 2015年7月
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Kawakami H., Kuwatani M., Kubota Y., Kawahata S., Kubo K., Kawakubo K., Sakamoto N.
Endoscopy 47 E340 - E341 2015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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Kawakami H., Kuwatani M., Kawahata S.
Journal of Hepato-Biliary-Pancreatic Sciences 22 ( 7 ) 571 - 572 2015年7月
記述言語：日本語 掲載種別：研究論文（学術雑誌）
DOI： 10.1002/jhbp.253
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Kawakami H., Kuwatani M., Kawahata S., Kubota Y., Kubo K., Kawakubo K., Sakamoto N.
Endoscopy 47 E265 - E266 2015年6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., Abe Y., Kawahata S., Kawakubo K., Kubo K., Sakamoto N.
Endoscopy 47 E217 - E218 2015年6月
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Hayashi T., Kawakami H., Osanai M., Ishiwatari H., Naruse H., Hisai H., Yanagawa N., Kaneto H., Koizumi K., Sakurai T., Sonoda T.
Clinical Gastroenterology and Hepatology 13 ( 6 ) 1151 - 1158.e2 2015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：Clinical Gastroenterology and Hepatology
© 2015 AGA Institute. Background & Aims: Endoscopic sphincterotomy (ES) is performed routinely before self-expandable metallic stents (SEMS) are placed in malignant distal biliary strictures to prevent postprocedural pancreatitis. However, it is not clear whether ES actually prevents pancreatitis or affects other adverse events (AEs). We conducted a noninferiority trial to examine the necessity of ES before SEMS placement. Methods: Two hundred patients with distal biliary strictures caused by unresectable pancreatic cancer were assigned randomly to groups that received ES or did not receive ES (non-ES) before SEMS placement, at 25 hospitals in Hokkaido, Japan, from August 2010 through November 2012. The primary outcome was early AEs (≤30 d) specifically related to the presence or absence of ES (pancreatitis, bleeding, or perforation). Secondary outcomes measured included the effect of ES omission on time to SEMS dysfunction and patient survival times. Results: The proportions of patients with early AEs were 9.2% in the non-ES group and 10.4% in the ES group (a difference of 1.2%, noninferior). The median times to SEMS dysfunction was longer than 594 days in the non-ES group and 541 days in the ES group (P= .88). The median overall survival times were 202 in the ES group vs 255 days in the non-ES group; P= .20). Conclusions: ES before SEMS does not affect the incidence of AEs, SEMS patency, or patient survival times. Our data provide no evidence for a benefit of ES to patients undergoing SEMS placement forabiliary stricture caused by pancreatic cancer. UMIN clinical trials registry number:000004044.
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Pazopanib-induced severe acute pancreatitis
Kawakubo K., Hata H., Kawakami H., Kuwatani M., Kawahata S., Kubo K., Imafuku K., Kitamura S., Sakamoto N.
Case Reports in Oncology 8 356 - 358 2015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：Case Reports in Oncology
© 2015 The Author(s). Published by S. Karger AG, Basel. Pazopanib is an oral angiogenesis inhibitor targeting vascular endothelial growth factor receptors, platelet-derived growth factor receptors, and c-Kit approved for the treatment of renal cell carcinoma and soft tissue sarcoma. Nonselective kinase inhibitors, such as sunitinib and sorafenib, are known to be associated with acute pancreatitis. There are few case reports of severe acute pancreatitis induced by pazopanib treatment. We present a case of severe acute pancreatitis caused by pazopanib treatment for cutaneous angiosarcoma. The patient was an 82-year-old female diagnosed with cutaneous angiosarcoma. She had been refractory to docetaxel treatment and began pazopanib therapy. Three months after pazopanib treatment, CT imaging of the abdomen showed the swelling of the pancreas and surrounding soft tissue inflammation without abdominal pain. After she continued pazopanib treatment for 2 months, she presented with nausea and appetite loss. Abdominal CT showed the worsening of the surrounding soft tissue inflammation of the pancreas. Serum amylase and lipase levels were 296 and 177 IU/l, respectively. She was diagnosed with acute pancreatitis induced by pazopanib treatment and was managed conservatively with discontinuation of pazopanib, but the symptoms did not improve. Subsequently, an abdominal CT scan demonstrated the appearance of a pancreatic pseudocyst. She underwent endoscopic ultrasound-guided pseudocyst drainage using a flared-end fully covered self-expandable metallic stent. Then, the symptoms resolved without recurrence. Due to the remarkable progress of molecular targeted therapy, the oncologist should know that acute pancreatitis was recognized as a potential adverse event of pazopanib treatment and could proceed to severe acute pancreatitis.
DOI： 10.1159/000439124
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Sasahira N., Kawakami H., Isayama H., Uchino R., Nakai Y., Ito Y., Matsubara S., Ishiwatari H., Uebayashi M., Yagioka H., Togawa O., Toda N., Sakamoto N., Kato J., Koike K.
Endoscopy 47 ( 5 ) 421 - 429 2015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：Endoscopy
© Georg Thieme Verlag KG. Background and study aims: There are no guidelines for the timing of conversion from a single-guidewire to a double-guidewire technique to facilitate selective bile duct cannulation and reduce post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP), when using wire-guided cannulation. We investigated whether early conversion to the double-guidewire method, at first unintentional insertion of a guidewire into the pancreatic duct, facilitated selective bile duct cannulation and reduced PEP compared with repeated single-guidewire attempts. Patients and methods: A multicenter prospective randomized controlled trial included 274 patients with a naive papilla, undergoing endoscopic retrograde cholangiography (ERC) using wire-guided cannulation in whom there was unintentional insertion of the guidewire into the pancreatic duct. With the guidewire still in the duct, patients were randomly assigned to undergo the double-guidewire technique or repeated single-wire cannulation. Main outcomes were success rates for selective bile duct cannulation and PEP frequency. Results: Success rates for selective bile duct cannulation within 10 attempts and 10 minutes were 75% and 70%, respectively, for the early double-guidewire (EDG) and repeated single-guidewire (RSG) cannulation groups (relative rate 1.07, 95% confidence interval [95%CI] 0.93-1.24, P=0.42). Corresponding final selective bile duct cannulation rates were 98% and 97% (relative rate 1.01, 95%CI 0.97-1.05, P=1.00). PEP rates were 20% and 17%, respectively, for the EDG and RSG cannulation groups (relative risk 1.17, 95%CI 0.71-1.94, P=0.53). Double-guidewire cannulation was more effective in patients with malignant biliary stricture (relative rate 1.36, 95%CI 1.05-1.77, P=0.02). Conclusions: During therapeutic ERC using wire-guided cannulation, converting to a double-guidewire technique neither facilitated selective bile duct cannulation nor decreased PEP incidence compared with repeated use of a single-wire technique.