論文 - 河上 洋
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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.
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Kawakami H., Itoi T., Kuwatani M., Kawakubo K., Kubota Y., Sakamoto N.
Journal of Hepato-Biliary-Pancreatic Sciences 22 ( 4 ) E12 - E21 2015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：Journal of Hepato-Biliary-Pancreatic Sciences
© 2014 Japanese Society of Hepato-Biliary-Pancreatic Surgery. Unresectable malignant hilar biliary obstruction (MHBO) occurs in various diseases, such as cholangiocarcinoma, gallbladder carcinoma, hepatocellular carcinoma, pancreatic cancer, and lymph node metastasis of the hilum of the liver. The majority of patients with advanced MHBO are not candidates for surgical resection because of the tumor location in the hepatic hilum and adjacent areas, advanced tumor stage, or comorbidities. Therefore, these patients often have a poor prognosis in terms of survival and quality of life. Most of these patients will require non-surgical, palliative biliary drainage. To date, various biliary drainage techniques for unresectable MHBO (UMHBO) have been reported. Of these techniques, endoscopic biliary drainage is currently considered to be the most safe and minimally invasive procedure. However, endoscopic biliary drainage for UMHBO is still not standardized regarding the optimal stent, drainage area, stenting method, and reintervention technique. Recently, towards standardization of this technique for UMHBO, clinical research and trials including randomized controlled trials have been performed. In this article, we reviewed the most important issues regarding endoscopic biliary drainage for UMHBO, focusing on prospective studies. We also described in detail the techniques and future perspectives of endoscopic biliary drainage in patients with UMHBO.
DOI： 10.1002/jhbp.186
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Hepatobiliary and Pancreatic: A splenic artery aneurysm presenting as a calcified pancreatic mass
Kawakubo K., Kawakami H., Kuwatani M., Sakamoto N.
Journal of Gastroenterology and Hepatology (Australia) 30 ( 4 ) 655 - 655 2015年4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)
DOI： 10.1111/jgh.12848
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Kuwatani M., Kawakami H., Abe Y., Kawahata S., Kawakubo K., Kubo K., Sakamoto N.
Gut and Liver 9 ( 2 ) 251 - 252 2015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：Gut and Liver
A 72-year-old man with jaundice by ampullary adenocarcinoma was treated at our hospital. For biliary decompression, a transpapillary, fully covered, self-expandable metal stent (FCSEMS) was deployed. Four days later, the patient developed acute cholangitis. Endoscopic carbon dioxide cholangiography revealed kinking of the common bile duct above the proximal end of the FCSEMS. A 7-F double-pigtail plastic stent was therefore placed through the FCSEMS to correct the kink, straightening the common bile duct (CBD) and improving cholangitis. This is the first report of a unique use of a double-pigtail plastic stent to correct CBD kinking. The placement of a double-pigtail plastic stent can correct CBD kinking, without requiring replacement or addition of a FCSEMS, and can lead to cost savings.
DOI： 10.5009/gnl14286
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Incidental pancreatic cyst is a significant predictor of mortality? What determines life expectancy? 査読あり
Kawakubo K., Kawakami H., Kuwatani M., Sakamoto N.
Radiology 274 ( 3 ) 2015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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Incidental pancreatic cyst is a significant predictor of mortality? What determines life expectancy? 査読あり
Kawakubo K., Kawakami H., Kuwatani M., Sakamoto N.
Radiology 274 ( 3 ) 2015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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Multidisciplinary treatment of gallbladder cancer--biliary and duodenal stenting
Kawakami H., Kuwatani M., Sakamoto N.
Nihon rinsho. Japanese journal of clinical medicine 73 595 - 600 2015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：Nihon rinsho. Japanese journal of clinical medicine
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Kawakubo K., Kawakami H., Kuwatani M., Kudo T., Abe Y., Kawahata S., Kubo K., Kubota Y., Sakamoto N.
Journal of Hepato-Biliary-Pancreatic Sciences 22 ( 2 ) 151 - 155 2015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：Journal of Hepato-Biliary-Pancreatic Sciences
© 2014 Japanese Society of Hepato-Biliary-Pancreatic Surgery. BackgroundBilateral self-expandable metallic stent (SEMS) placement for the management of unresectable malignant hilar biliary obstruction (UMHBO) is technically challenging to perform using the existing metallic stents with thick delivery systems. The recently developed 6-Fr delivery systems could facilitate a single-step simultaneous side-by-side placement through the accessory channel of the duodenoscope. The aim of this study was to evaluate the feasibility of this procedure. MethodsBetween May and September 2013, 13 consecutive patients with UMHBO underwent a single-step simultaneous side-by-side placement of SEMS with the 6-Fr delivery system. The technical success rate, stent patency, and rate of complications were evaluated from the prospectively collected database. ResultsTechnical success was achieved in 11 (84.6%, 95% confidence interval [CI]: 57.8-95.8) patients. The median procedure time was 25-min. Early and late complications were observed in 23% (one segmental cholangitis and two liver abscesses) and 15% (one segmental cholangitis and one cholecystitis) patients, respectively. Median dysfunction free patency was 263 days (95% CI: 37-263). Five patients (38%) experienced stent occlusion that was successfully managed by endoscopic stent placement. ConclusionsA single-step simultaneous side-by-side placement of SEMS with a 6-Fr delivery system was feasible for the management of UMHBO.
DOI： 10.1002/jhbp.173
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Kawakubo K., Kawakami H., Toyokawa Y., Otani K., Kuwatani M., Abe Y., Kawahata S., Kubo K., Kubota Y., Sakamoto N.
Journal of Hepato-Biliary-Pancreatic Sciences 22 ( 1 ) 79 - 85 2015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：Journal of Hepato-Biliary-Pancreatic Sciences
© 2014 Japanese Society of Hepato-Biliary-Pancreatic Surgery. Background Endoscopic double self-expandable metallic stent (SEMS) placement by the partial stent-in-stent (PSIS) method has been reported to be useful for the management of unresectable hilar malignant biliary obstruction. However, it is technically challenging, and the optimal SEMS for the procedure remains unknown. The aim of this study was to identify the risk factors for technical failure of endoscopic double SEMS placement for unresectable malignant hilar biliary obstruction (MHBO). Methods: Between December 2009 and May 2013, 50 consecutive patients with MHBO underwent endoscopic double SEMS placement by the PSIS method. We retrospectively evaluated the rate of successful double SEMS placement and identified the risk factors for technical failure. Results: The technical success rate for double SEMS placement was 82.0% (95% confidence interval [CI]: 69.2-90.2). On univariate analysis, the rate of technical failure was high in patients with metastatic disease and unilateral placement. Multivariate analysis revealed that metastatic disease was a significant risk factor for technical failure (odds ratio: 9.63, 95% CI: 1.11-105.5). The subgroup analysis after double guidewire insertion showed that the rate of technical success was higher in the laser-cut type SEMS with a large mesh and thick delivery system than in the braided type SEMS with a small mesh and thick delivery system. Conclusions: Metastatic disease was a significant risk factor for technical failure of double SEMS placement for unresectable MHBO. The laser-cut type SEMS with a large mesh and thin delivery system might be preferable for the PSIS procedure.
DOI： 10.1002/jhbp.170
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Kawakami H., Kuwatani M., Kubo K., Kubota Y., Kawakubo K., Abe Y., Kawahata S., Homma N., Hida Y., Sakamoto N.
Endoscopy 47 E69 - E70 2015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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Kawakami H., Kuwatani M., Abe Y., Kubota Y., Kawakubo K., Kubo K., Kawahata S., Sakamoto N.
Endoscopy 47 ( 1 ) E43 - E44 2015年1月
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Itoi T., Kawakami H., Katanuma A., Irisawa A., Sofuni A., Itokawa F., Tsuchiya T., Tanaka R., Umeda J., Ryozawa S., Doi S., Sakamoto N., Yasuda I.
Gastrointestinal Endoscopy 81 ( 1 ) 111 - 118 2015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：Gastrointestinal Endoscopy
© 2015 American Society for Gastrointestinal Endoscopy. Background There are currently no prospective, controlled trials of endoscopic transpapillary gallbladder drainage in patients with acute cholecystitis. Objective We evaluated the technical success rate and efficacy of endoscopic transpapillary gallbladder drainage by using either endoscopic nasogallbladder drainage (ENGBD) or endoscopic gallbladder stenting (EGBS) for patients with acute cholecystitis. Design Randomized, controlled study. Setting Tertiary-care referral centers. Patients Seventy-three consecutive patients with acute cholecystitis were randomized. Interventions ENGBD by using a 5F or 7F tube (n = 37) or EGBS (n = 36) by using a 7F stent. Main Outcome and Measurements Technical success, clinical success, adverse events, and procedure-related pain score. Results The overall technical success rates in the ENGBD and EGBS groups were 91.9% and 86.1%, respectively (P > .05). The mean procedure times of ENGBD and EGBS were 20.3 ± 12.1 and 22.2 ± 14.5 minutes, respectively (P > .05). The overall clinical success rates by per protocol analysis were 94.1% and 90.3% in the ENGBD and EGBS groups, respectively, whereas the rates by intention-to-treat analysis were 86.5% and 77.8%, respectively (P > .05). Moderate adverse events were observed in the ENGBD (n = 2) and EGBS (n = 1) groups. The mean visual analog score of postprocedure pain in the ENGBD group was significantly higher than that in the EGBS group (1.3 ± 1.1 vs 0.4 ± 0.8, respectively; P < .001). Limitations Small sample size and the participation of multiple endoscopists who may have different levels of experience in endoscopic transpapillary gallbladder drainage. Conclusions Both ENGBD and EGBS appear to be suitable for the treatment of acute cholecystitis in patients who are poor candidates for emergency cholecystectomy. (Clinical trial registration number: UMIN000012316.)