論文 - 河上 洋
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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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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
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Hasuike S, Nagata K, Sasaki H, Hirata T, Suzuki S, Komaki Y, Ozono Y, Nakamura K, Miike T, Iwakiri H, Sueta M, Yamamoto S, Maekawa K, Kawakami H
Internal medicine (Tokyo, Japan) 62 ( 21 ) 3143 - 3149 2023年11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：一般社団法人 日本内科学会
We reported a notable case of inflammatory hepatocellular adenoma that grew during pregnancy, consequently changing its appearance on magnetic resonance imaging remarkably. A 5-months-pregnant 35-year-old woman presented with a 37-mm liver nodule that had been diagnosed as focal nodular hyperplasia 3 years earlier. She had never used oral contraceptives. After 2 months, the nodule grew to 57 mm. The patient delivered a full-term infant without complications. Gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging performed after delivery revealed markedly different findings compared with the first images. A liver biopsy was performed, and the tumor was diagnosed as inflammatory hepatocellular adenoma.
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Ozono Y, Kawakami H, Uchiyama N, Hatada H, Ogawa S
Journal of Gastroenterology 58 ( 11 ) 1081 - 1093 2023年11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 Gastroenterology
Comprehensive genomic profiling based on next-generation sequencing has recently been used to provide precision medicine for various advanced cancers. Endoscopic ultrasound (EUS)-guided fine-needle aspiration (EUS-FNA) and EUS-guided fine-needle biopsy (EUS-FNB) play essential roles in the diagnosis of abdominal masses, mainly pancreatic cancers. In recent years, CGP analysis using EUS-FNA/FNB specimens for hepatobiliary–pancreatic cancers has increased; however, the success rate of CGP analysis is not clinically satisfactory, and many issues need to be resolved to improve the success rate of CGP analysis. In this article, we review the transition from EUS-FNA to FNB, compare each test, and discuss the current status and issues in genomic analysis of hepatobiliary–pancreatic cancers using EUS-FNA/FNB specimens.
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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
Internal medicine (Tokyo, Japan) advpub ( 0 ) 903 - 910 2023年8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：一般社団法人 日本内科学会
<b>Introduction </b>Photodynamic therapy (PDT) is a salvage treatment for local failure after chemoradiotherapy for esophageal cancer. Salvage PDT is the treatment available for vulnerable patients with various comorbidities at risk of salvage esophagectomy. This study assessed the impact of the Charlson comorbidity index (CCI) on the outcomes of salvage PDT using talaporfin sodium (TS) for esophageal cancer. <b>Patients and methods </b>Consecutive patients with esophageal cancer who underwent salvage TS-PDT from 2016 to 2022 were included in this retrospective study. We investigated the local complete response (L-CR), progression-free survival (PFS) and overall survival (OS) and evaluated the relationship between the CCI and therapeutic efficacy. <b>Results </b>In total, 25 patients were enrolled in this study. Overall, 12 patients (48%) achieved an L-CR, and the 2-year PFS and OS rates were 24.9% and 59.4%, respectively. In a multivariate analysis, a CCI ≥1 (p=0.041) and deeper invasion (p=0.048) were found to be significant independent risk factors for not achieving an L-CR. To evaluate the efficacy associated with comorbidities, we divided the patients into the CCI=0 group (n=11) and the CCI ≥1 group (n=14). The rate of an L-CR (p=0.035) and the 2-year PFS (p=0.029) and OS (p=0.018) rates in the CCI ≥1 group were significantly lower than those in the CCI=0 group. <b>Conclusion </b>This study found that the CCI was negatively associated with the efficacy of salvage TS-PDT for esophageal cancer.
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Newly developed dedicated guide sheath system for selective pancreatobiliary biopsy 査読あり
Kawakami H, Uchiyama N, Hatada H
Digestive Endoscopy 35 ( 5 ) e100 - e102 2023年7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 Endoscopy
DOI： 10.1111/den.14593
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食道亜全摘術の胃管吻合完全閉塞に対しランデブー内視鏡法にて再開通した１例 査読あり
鈴木 翔, 河上 洋, 三池 忠, 内田 圭佑, 田村 穂高, 吉田 直樹, 内山 尚美, 小川 宗一郎, 畑田 紘志, 田代 耕盛
日本消化器内視鏡学会雑誌 65 ( 2 ) 117 - 124 2023年
担当区分：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
症例は76歳，男性．食道胃接合部癌に対し食道亜全摘術および胃管再建術を施行された．術後７日目に嚥下障害がみられ，各種検査により吻合部の完全閉塞と診断した．対側の食道粘膜を巻き込むように縫合したことが原因と考えられ，口側および胃側からの内視鏡的アプローチ（ランデブー内視鏡法）を試みる方針とした．全身麻酔下に手術時の腹部創より胃管を小切開して胃側内視鏡の挿入経路を確保した．完全閉塞部は各々の内視鏡の透過光が対側の内視鏡で確認された．ESDナイフ（Hook knife-J）で閉塞部を切開後，ガイドワイヤを挿入し，バルーンカテーテルで拡張術を行い，偶発症はなく終了した．術後食道完全閉塞に対してはランデブー内視鏡法により外科的再吻合術を回避し得る可能性がある．
DOI： 10.11280/gee.65.117
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Klebsiella pneumoniaeによる侵襲性肝膿瘍症候群を発症し、眼内炎から失明に至った1例
田村 穂高，大園 芳範，内山 尚美，畑田 紘志，中村 憲一，岩切 久芳，蓮池 悟，永田 賢治，河上 洋
日本消化器病学会雑誌 120 ( 6 ) 500 - 507 2023年
担当区分：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：Journal of Japanese Society of Gastroenterology
An 82-year-old female patient was admitted to our hospital for visual acuity loss in both eyes. The patient was diagnosed with invasive liver abscess syndrome and bilateral endophthalmitis due to Klebsiella pneumoniae 4 days after the onset of ocular symptoms. The liver abscess improved by broad-spectrum antibiotics and intravitreal injection, but bilateral blindness occurred. Most literature reported fever as the first symptom of invasive abscess syndrome, but this case had no fever at the onset of ocular symptoms. Delayed invasive liver abscess syndrome diagnosis might cause poor visual acuity prognosis.
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悪性遠位胆管閉塞に対するフルカバー付き金属ステント留置の際のアンカリングプラスチックステント先行留置による開存期間延長効果
河上 洋
日本消化器内視鏡学会雑誌 65 ( 9 ) 1498 - 1498 2023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】悪性遠位胆管閉塞に対するフルカバー付き金属ステント（fully covered self-expandable metal stents：FCSEMSs）は汎用されている．本研究目的は悪性遠位胆管閉塞に対するFCSEMS留置時のアンカリング用プラスチックステントの有用性を検討することである．【方法】多施設コホート研究により，悪性遠位胆管閉塞に対するFCSEMS留置時にアンカリングプラスチックステント追加留置の有無の有用性を後方視的に比較した．アンカリングの方法は，選択的胆管挿管後に２本のガイドワイヤを留置した後，7-Frのダブルピッグテールプラスチックステント（double-pigtail plastic stent：DPPS）を先行留置させた．次いでFCSEMSをside-by-sideに留置した．DPPSの近位端はFCSEMSを跨ぐように，10cm以上のステントを選択した．FCSEMS長は内視鏡医が選択した．【結果】185例中120例がDPPS留置の併施（アンカリング群），65例がFCSEMS単独留置（単独群）であった．基礎疾患は両群ともに膵癌がもっとも多かった（72.5 vs 80％，NS）．FCSEMS長は５ or ６cmが多く，ステント開存期間中央値はアンカリング併施群で単独群と比較して有意に延長した（342日 vs 240日，<i>P</i>＝0.04）．ステント迷入はアンカリング併施群で単独群と比較して有意に少なかった（10.8％ vs 27.7％，<i>P</i>＝0.01）．ステント閉塞や偶発症（膵炎，胆嚢炎など）は両群間で有意差は認められなかった．【結語】DPPSによるアンカリングはシンプルな方法でありながらFCSEMSの開存期間を延長させるだけでなく，偶発症も増加しなかった．FCSEMSの迷入リスクを減少させる可能性も示唆された．
DOI： 10.11280/gee.65.1498
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鈴木 翔, 河上 洋, 三池 忠
日本消化器内視鏡学会雑誌 65 ( 10 ) 2145 - 2158 2023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
消化器内視鏡は消化器診療において必要不可欠な医療機器で，検査・診断のみならず治療でも大きな役割を担っている．ルーチンのEGDや全大腸内視鏡検査（total colonoscopy：TCS）の他，胆膵内視鏡，EUS，ESDや止血処置・異物除去など内視鏡スキルは多岐に渡るが，内視鏡技術を向上させるには経験と時間が必要である．現在，様々なタイプのトレーニングモデルやシミュレーターが開発されており，初学者の練習や研修医・学生指導に用いられている．トレーニングモデルは簡便性や低コストが長所で，シミュレーターは豊富な種類の内視鏡検査・手技のトレーニングができる点で優れている．練習や指導の中でトレーニングモデルやシミュレーターを上手に活用して，個々のスキルアップ，実際の内視鏡診療の向上に繋がることが期待される．
DOI： 10.11280/gee.65.2145
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Duodenoscope insertion difficulty due to perigastric adhesions overcome using an overtube
Kawakami H., Uchiyama N., Ogawa S.
Journal of Hepato-Biliary-Pancreatic Sciences 30 ( 12 ) e84 - e85 2023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：Journal of Hepato-Biliary-Pancreatic Sciences
DOI： 10.1002/jhbp.1362
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HOPS-R01 phase II trial evaluating neoadjuvant S-1 therapy for resectable pancreatic adenocarcinoma 査読あり
Nakamura T., Hayashi T., Kimura Y., Kawakami H., Takahashi K., Ishiwatari H., Goto T., Motoya M., Yamakita K., Sakuhara Y., Ono M., Tanaka E., Omi M., Murakawa K., Iida T., Sakurai T., Haba S., Abiko T., Ito Y.M., Maguchi H., Hirano S., Nakamura T., Hayashi T., Kimura Y., Kawakami H., Takahashi K., Ishiwatari H., Goto T., Ono M., Tanaka E., Omi M., Murakawa K., Iida T., Sakurai T., Haba S., Abiko T., Ito Y.M., Maguchi H., Hirano S., Sasajima J., Kitano Y., Yanagawa N., Matsumoto K., Tanno S., Imamura M., Shitani M., Takahashi M., Miyakawa H., Nakamura F., Ambo Y., Kamachi H., Taketomi A.
Scientific Reports 12 ( 1 ) 9966 2022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：Scientific Reports
Although neoadjuvant therapy (Nac) is recommended for high-risk resectable pancreatic cancer (R-PDAC), evidence regarding specific regimes is scarce. This report aimed to investigate the efficacy of S-1 Nac for R-PDAC. In a multicenter phase II trial, we investigated the efficacy of Nac S-1 (an oral fluoropyrimidine agent containing tegafur, gimeracil, and oteracil potassium) in R-PDAC patients. The protocol involved two cycles of preoperative S-1 chemotherapy, followed by surgery, and four cycles of postoperative S-1 chemotherapy. Two-year progression-free survival (PFS) rates were the primary endpoint. Overall survival (OS) rates and median survival time (MST) were secondary endpoints. Forty-nine patients were eligible, and 31 patients underwent resection following Nac, as per protocol (31/49; 63.3%). Per-protocol analysis included data from 31 patients, yielding the 2-year PFS rate of 58.1%, and 2-, 3-, and 5-year OS rates of 96.8%, 54.8%, and 44.0%, respectively. MST was 49.2 months. Intention-to-treat analysis involved 49 patients, yielding the 2-year PFS rate of 40.8%, and the 2-, 3-, and 5-year OS rates of 87.8%, 46.9%, and 33.9%, respectively. MST was 35.5 months. S-1 single regimen might be an option for Nac in R-PDAC; however, the high drop-out rate (36.7%) was a limitation of this study.
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Komaki Y., Ozono Y., Nakamura K., Iwakiri H., Hasuike S., Sueta M., Miike T., Yamamoto S., Uto H., Kusumoto K., Ochiai T., Kato J., Komada N., Kuroki K., Eto T., Shigehira M., Hirono S., Nagata K., Kawakami H.
BMC Gastroenterology 22 ( 1 ) 210 2022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：BMC Gastroenterology
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.
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Kitano M., Yoshida M., Ashida R., Kita E., Katanuma A., Itoi T., Mikata R., Nishikawa K., Matsubayashi H., Takayama Y., Kato H., Takenaka M., Ueki T., Kawashima Y., Nakai Y., Hashimoto S., Shigekawa M., Nebiki H., Tsumura H., Okabe Y., Ryozawa S., Harada Y., Mitoro A., Sasaki T., Yasuda H., Miura N., Ikemoto T., Ozawa E., Shioji K., Yamaguchi A., Okuzono T., Moriyama I., Hisai H., Fujita K., Goto T., Shirahata N., Iwata Y., Okabe Y., Hara K., Hashimoto Y., Kuwatani M., Isayama H., Fujimori N., Masamune A., Hatamaru K., Shimokawa T., Okazaki K., Takeyama Y., Yamaue H., Abue M., Aiura K., Akashi T., Akiyama T., Aoyagi H., Araki M., Arizumi T., Aruga Y., Asada M., Asai S., Baba T., Ban S., Chinen K., Doi S., Eguchi T., Endo M., Endo S., Ezaki T., Fujii K., Fujii M., Fujimori M., Fujimoto Y., Fujita Y., Fujita Y., Fukasawa M., Fukuba N., Fukuchi S., Fukuda K., Furukawa M., Furumatsu K., Hakamada K., Hanada K., Harada K., Harano M., Hashigo S., Hashiguchi K., Hayashi K., Hayashi N., Hayatsu S., Hijioka S., Hirano A., Hirao M., Hirooka Y., Hirota M., Horino K., Hotta Y., Ijima M., Ikuta Y., Imakiire K., Imamura T., Inatomi O.
Digestive Endoscopy 34 ( 7 ) 1442 - 1455 2022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：Digestive Endoscopy
Objectives: Endoscopic ultrasound-guided tissue acquisition (EUS-TA) plays a crucial role in the diagnosis of pancreatic tumors. The present study aimed to investigate the current status of needle tract seeding (NTS) after EUS-TA of pancreatic tumors based on a nationwide survey in Japan. Methods: Patients who underwent surgical resection of primary pancreatic tumors after EUS-TA performed between April 2010 and March 2018 were surveyed. The incidence rates of NTS were determined, and compared in patients with pancreatic ductal adenocarcinomas (PDACs) and other tumors, and in patients who underwent transgastric and transduodenal EUS-TA of PDACs. The detailed features and prognosis of patients with NTS were also assessed. Results: A total of 12,109 patients underwent surgical resection of primary pancreatic tumors after EUS-TA. The overall incidence rate of NTS was 0.330%, and the NTS rate was significantly higher in patients with PDAC than in those with other tumors (0.409% vs. 0.071%, P = 0.004). NTS was observed in 0.857% of patients who underwent transgastric EUS-TA, but in none of those who underwent transduodenal EUS-TA. Of the patients with NTS of PDACs, the median time from EUS-TA to occurrence of NTS and median patient survival were 19.3 and 44.7 months, respectively, with 97.4% of NTS located in the gastric wall and 65.8% of NTS resected. The patient survival was significantly longer in patients who underwent NTS resection than in those without NTS resection (P = 0.037). Conclusions: Needle tract seeding appeared only after transgastric not after transduodenal EUS-TA. Careful follow-up provides an opportunity to remove localized NTS lesions by gastrectomy.
DOI： 10.1111/den.14346
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Mandai K., Tsuchiya T., Kawakami H., Ryozawa S., Saitou M., Iwai T., Ogawa T., Tamura T., Doi S., Okabe Y., Chiba Y., Itoi T.
Journal of Hepato-Biliary-Pancreatic Sciences 29 ( 11 ) 1185 - 1194 2022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：Journal of Hepato-Biliary-Pancreatic Sciences
Background/Purpose: Whether a fully covered self-expanding metal stent (FCSEMS) or plastic stent (PS) is preferable for preoperative biliary drainage in patients with resectable pancreatic cancer (RPC) is controversial. This study aimed to evaluate the safety and efficacy of drainage with FCSEMS for obstructive jaundice caused by RPC without neoadjuvant chemotherapy. Methods: Seventy patients with RPC who required preoperative biliary drainage were randomly assigned 1:1 to the FCSEMS or PS group. The primary endpoint was endoscopic re-intervention rate during the waiting period for surgery. Secondary endpoints were drainage procedure time, drainage-related adverse events (AE), waiting period for surgery, operative time, intraoperative blood loss, surgery-related AE, and postoperative hospital stay. Results: Thirty-nine patients underwent surgery. None required re-intervention in the FCSEMS group, whereas five PS patients underwent re-intervention (P =.023). The FCSEMS group had significantly more intraoperative blood loss (P =.0068) and AE (P =.011) than the PS group. Postoperative hospital stay was significantly longer in the FCSEMS group (P =.016). Conclusions: Fully covered self-expanding metal stent had a lower rate of endoscopic re-intervention during the waiting period for surgery than PS, but showed more intraoperative blood loss, higher incidence of surgery-related AE, and longer postoperative hospital stays.
DOI： 10.1002/jhbp.1090
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特集 胃疾患アトラス 改訂版 各論 Ⅲ. 陥凹を呈する病変 1. 上皮性･非腫瘍性陥凹病変 胃Dieulafoy潰瘍
山本 章二朗, 三池 忠, 河上 洋
消化器内視鏡 34 ( 13 ) 194 - 195 2022年10月
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Uchida K., Ozono Y., Uchiyama N., Hatada H., Nakamura K., Komaki Y., Iwakiri H., Hasuike S., Nagata K., Sato Y., Kawakami H.
Medicine (United States) 101 ( 35 ) e30486 2022年9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：Medicine (United States)
Rationale: Hepatocellular carcinoma (HCC) is the sixth most common type of cancer globally. Since 2020, combination treatment with atezolizumab and bevacizumab were approved in patients with unresectable HCC in Japan, and atezolizumab plus bevacizumab is the first-line treatment for unresectable HCC. Patient concerns: A 73-year-old Japanese man diagnosed with a large HCC was treated with atezolizumab plus bevacizumab. After 2 cycles, he had fever and fatigue and was admitted to the hospital. Diagnosis: Abdominal contrast-enhanced computed tomography revealed tumor necrosis in HCC with gas formation in the necrotic area. Laboratory examination revealed a white blood cell (WBC) count of 16,340/μL and C-reactive protein (CRP) level of 33.0 mg/dL. Based on the above findings, he was diagnosed with a liver abscess. Interventions: Percutaneous transhepatic liver abscess drainage and broad-spectrum antibiotics treatment were performed. Outcomes: Despite liver abscess drainage, persistent fever and no improvement in the WBC count or CRP level was observed. The patient's respiratory condition and renal function gradually worsened; The patient's general condition did not improve despite the ventilator support and continuous hemodiafiltration, and he died on day 37. Lessons: We report the first case of liver abscess after atezolizumab plus bevacizumab treatment for unresectable HCC.
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特集 胆道ドレナージのすべて-適応･方法 2.各論(7)経皮的胆囊ドレナージ
河上 洋, 畑田 紘志, 内山 尚美, 小川 宗一郎, 田村 穂高, 大園 芳範
臨床消化器内科 37 ( 10 ) 1342 - 1349 2022年8月
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特集 肝門部領域胆管ドレナージを極める [各論] 肝門部領域胆管狭窄に対するENBD
河上 洋, 畑田 紘志, 内山 尚美, 小川 宗一郎, 内田 圭祐, 田村 穂高, 吉田 直樹, 市成 直樹, 大園 芳範
消化器内視鏡 34 ( 6 ) 1079 - 1083 2022年6月
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Kato S., Kuwatani M., Onodera M., Kudo T., Sano I., Katanuma A., Uebayashi M., Eto K., Fukasawa M., Hashigo S., Iwashita T., Yoshida M., Taya Y., Kawakami H., Kato H., Nakai Y., Kobashigawa K., Kawahata S., Shinoura S., Ito K., Kubo K., Yamato H., Hara K., Maetani I., Mukai T., Shibukawa G., Itoi T.
Clinical Gastroenterology and Hepatology 20 ( 6 ) 1394 - 1403.e1 2022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
Background & Aims: The efficacy of endoscopic sphincterotomy (ES) before endoscopic transpapillary biliary drainage in preventing post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) has not been established. The aim of this study was to evaluate the effect of performing ES before biliary stent/tube placement on the occurrence of PEP. Methods: Three hundred seventy patients with biliary stricture requiring endoscopic biliary stenting were enrolled and randomly allocated to the ES group (n = 185) or non-ES group (n = 185). All participants were followed up for 30 days after the procedure. The data and occurrence of adverse events were prospectively collected. The primary outcome measure of this study was the incidence of PEP within 2 days of initial transpapillary biliary drainage. Secondary outcome measures were the incidence of other adverse events related to biliary stent/tube placement. Results: PEP occurred in 36 patients (20.6%) in the non-ES group and in 7 patients (3.9%) in the ES group (P < .001). The difference in the incidence of PEP between the 2 groups in the per-protocol population was 16.7% (95% confidence interval, 10.1%–23.3%), which was not within the noninferiority margin of 6%. Except for bleeding, the incidences of other adverse events were not significantly different between the groups. Conclusion: ES before endoscopic biliary stenting could have the preventive effect on the occurrence of PEP in patients with biliary stricture. University Hospital Medical Information Network Number, UMIN000025727.University Hospital Medical Information Network Clinical Trial Registry URL: https://www.umin.ac.jp/ctr/index.htm
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Hematochezia Due to Panitumumab-induced Colitis with Vitamin K Deficiency. 査読あり
Tamura H, Nakashima K, Uchiyama N, Ogawa S, Hatada H, Yoshida N, Uchida K, Ozono Y, Tanaka H, Yamamto K, Kawakami H
Internal medicine (Tokyo, Japan) 61 ( 10 ) 1503 - 1509 2022年5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：一般社団法人 日本内科学会
Panitumumab, a fully human anti-epidermal growth factor receptor (EGFR) monoclonal antibody, has been shown to be useful in treating either advanced or recurrent <i>KRAS/NRAS/BRAF</i> wild-type colorectal cancer. We herein report the case of a 60-year-old man with short bowel syndrome who developed hematochezia due to panitumumab-induced colitis with vitamin K deficiency during third-line chemotherapy. The cause of vitamin K deficiency was the lack of intravenous vitamin K supplementation following a change from central venous nutrition to peripheral venous nutrition. We advise clinicians to carefully check for colitis and manage the infusions of chemotherapy patients with short bowel syndrome.
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EUS-GUIDED BILIARY AND JEJUNAL DRAINAGE FOR RECURRENT GALLBLADDER CANCER: A CASE REPORT
Uchiyama N., Kawakami H., Kubota Y., Hatada H., Ogawa S., Tamura H., Yoshida N.
Gastroenterological Endoscopy 64 ( 3 ) 270 - 276 2022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：Gastroenterological Endoscopy
A 65-year-old man with small bowel obstruction (SBO) and obstructive jaundice due to recurrence of cystic duct cancer was admitted to our division. He had history of gallbladder bed and extrahepatic bile duct resection (partial liver resection) with Roux-en-Y reconstruction. We performed EUS-guided hepaticogastrostomy (EUS-HGS) for biliary drainage and EUS-guided transluminal drainage of dilated jejunal limb. Obstructive jaundice and abdominal pain were resolved, thereby improving the patient's QOL. We searched PubMed for articles published between October 2000 and October 2021 using the terms "EUS-guided transluminal drainage, gastrojejunostomy, or gastroenterostomy" and "small bowel obstruction". On the basis of search results, this is the first report on EUS-guided transmural drainage for SBO and jaundice due to recurrence of cystic duct cancer. It is difficult to improve prognosis and QOL of patients with SBO caused by recurrent cancer with surgical treatment. Thus, endoscopic internal drainage is desirable. In the future, the development of dedicated devices and elaborate indications for currently available devices are required.
DOI： 10.11280/gee.64.270
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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
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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<sup> 2）</sup>）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，<i>P</i>＝0.53）．輸液関連合併症（同0.99，0.59-1.64，<i>P</i>＝1.00），ERCP関連合併症（同0.9，0.62-1.31，<i>P</i>＝0.62），ICUへの入院（同0.37，0.07-1.80，<i>P</i>＝0.22），30日死亡率（同0.95，0.50-1.83，<i>P</i>＝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
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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
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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）
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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
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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
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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）
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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）
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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）
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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.
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Kogure H., Kawahata S., Mukai T., Doi S., Iwashita T., Ban T., Ito Y., Kawakami H., Hayashi T., Sasahira N., Kubota K., Togawa O., Kato H., Okabe Y., Matsubara S., Yagioka H., Saito T., Nakai Y., Isayama H.
Endoscopy 52 ( 9 ) 736 - 744 2020年9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
Background Endoscopic papillary large balloon dilation (EPLBD) has been increasingly used for the management of large common bile duct (CBD) stones. Although EPLBD is often preceded by endoscopic sphincterotomy (EST), EPLBD alone without EST has been increasingly reported as an alternative to EST for large CBD stones. Methods This multicenter randomized trial was conducted at 19 Japanese institutions to compare the efficacy and safety of EPLBD alone versus EST for the removal of large (≥ 10 mm) CBD stones. The primary end point was complete stone removal in a single session. The secondary end points included: Overall complete stone removal, lithotripsy use, procedure time, adverse events, and cost. Results 171 patients with large CBD stones were included in the analysis. The rate of single-session complete stone removal was significantly higher in the EPLBD-alone group than in the EST group (90.7 % vs. 78.8 %; P = 0.04). Lithotripsy use was significantly less frequent in the EPLBD group than in the EST group (30.2 % vs. 48.2 %; P = 0.02). The rates of early adverse events were comparable between the two groups: Rates of overall adverse events were 9.3 % vs. 9.4 % and of pancreatitis were 4.7 % vs. 5.9 % in the EPLBD and EST groups, respectively. The procedure costs were $1442 vs. $1661 in the EPLBD and EST groups, respectively (P = 0.12). Conclusion EPLBD without EST for the endoscopic treatment of large CBD stones achieved a significantly higher rate of complete stone removal in a single session compared with EST, without increasing adverse events.
DOI： 10.1055/a-1145-3377
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Diarrhea, Fever, and Polyarthralgia with Colitis
Yamamoto S, Miike T, Kawakami H
American Journal of Gastroenterology 115 ( 8 ) 1161 2020年8月
担当区分：最終著者, 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：American Journal of Gastroenterology
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膵・胆管合流異常症
河上 洋
Medical Practice 2020年8月
記述言語：日本語 掲載種別：学位論文（その他）
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今月の主題 H. pylori未感染胃の上皮性腫瘍 主題 H. pylori未感染胃上皮性腫瘍の臨床的特徴
鈴木 翔, 上堂 文也, 河上 洋, 石原 立
胃と腸 55 ( 8 ) 981 - 987 2020年7月
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Nanashima, A., Imamura, N., Hiyoshi, M., Hamada, T., Yano, K., Wada, T., Kawakami, H., Ban, T., Kubota ,Y., Sato, Y. and Harada, K.
Clinical Journal of Gastroenterology 13 ( 2 ) 233 - 239 2020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：Clinical Journal of Gastroenterology
Intraductal papillary neoplasm of the bile duct (IPNB) is defined as a non-invasive malignancy; however, since there are disparities in its histological diagnosis, the operative strategy for typical IPNB has not yet been established. A 69-year-old male was diagnosed with a bile duct mass lesion at the confluence of the cystic duct by ultrasonography without clinical symptoms. Liver functional parameters and tumor markers were within normal ranges. Computed tomography showed an enhanced tumor with no findings of ductal invasion or node metastasis. The tumor was exposed in the hepatic duct lumen and biopsy via SpyGlass DS cholangiography revealed that it was a low-grade papillary lesion, indicating type 1 IPNB. Under preoperative diagnostic modalities, limited resection of the extrahepatic bile duct with D2 lymphadenectomy was planned and R0 resection was achieved. The postoperative histological diagnosis was type 1 IPNB without node metastasis. The postoperative course was uneventful and a good prognosis is expected at this stage. In the field of biliary surgery, although extended resection is generally performed for bile duct carcinomas, satisfactory limited surgical resection is possible for type 1 IPNB with lower malignant behavior.
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Hiroshi Kawakami, Tadashi Miike, Shojiro Yamamoto, Hiroo Abe, Kazuya Shimoda, Shinya Ashizuka, Haruhiko Inatsu, Yoshimasa Kubota, Tesshin Ban, Kenji Yorita, Hiroaki Kataoka
Internal Medicine 30 ( 3 ) 400 - 402 2020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：Internal Medicine
Although a few reports of neuroendocrine tumor (NET) in the stomach or appendix with surrounding micronests have been published, cases of rectal NET are rare. We herein report a unique case of a patient with single rectal NET treated endoscopically. A pathological examination revealed multiple endocrine cell micronests (ECMs) in the submucosal layer around the main NET lesion. Neither lymph node metastasis nor distant metastasis in computed tomography was observed six years after the treatment. Because case reports of multiple ECM are very rare, the significance of malignancy is unclear. It therefore appears to be necessary to accumulate similar cases.
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Kawakami H., Itoi T.
Journal of Hepato-Biliary-Pancreatic Sciences 27 ( 3 ) 149 - 150 2020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：Journal of Hepato-Biliary-Pancreatic Sciences
DOI： 10.1002/jhbp.693
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A novel integrated inside biliary stent and nasobiliary drainage catheter system for biliary drainage (with video). 査読あり
Kawakami H, itoi T.
J Hepatobiliary Pancreat Sci 27 ( 3 ) 149 - 150 2020年3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., Hiyoshi M., Imamura N., Hamada T., Nishida T., Kawakami H., Ban T., Kubota Y., Nakashima K., Yano K., Wada T., Takeno S., Kai M.
Clinical Journal of Gastroenterology 13 ( 1 ) 102 - 109 2020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：Clinical Journal of Gastroenterology
The efficacy of adjuvant photodynamic therapy (PDT) using the new photosensitizer, talaporfin sodium (TPS) has been clinically examined in some patients with bile duct carcinoma (BDC). Based on our previous cohorts, a prospective clinical trial was attempted; however, only two cases were ultimately enrolled in 27 months. A 664-nm semiconductor laser (100 J/cm2) was applied through an endoscope to the tumor lesion within 6 h of an intravenous injection of 40 mg/m2 TPS according to the protocol for lung cancer. Case 1 was an 82-y.o. female patient with BDC at the left hepatic duct with biliary obstruction, percutaneous transhepatic biliary drainage (PTBD) was achieved, and the patient did not consent to surgery. She was followed up for 15 months to search for non-surgical treatments and eventually received PDT. Although mild photosensitivity occurred, she was discharged without severe adverse events. Biliary stenosis markedly extended and a PTBD tube was scheduled at 1 month. However, cancer immediately metastasized to the liver and she died 155 days after PDT. Case 2 was a 70-y.o. female with perihilar BDC and multiple biliary stenoses. Multiple biliary stenting was considered to be difficult. She received PDT and no adverse events were observed. Biliary stenoses markedly improved and multiple stenting was successfully performed. On day 132, she died of cancer progression. These two cases demonstrated the safety and efficacy of biliary malignant stenosis soon after PDT; however, long-term survival and a sufficient quality of life were not achieved. The combination of the PDT protocol and system chemotherapy or brachytherapy needs to be examined in clinical trials for advanced stage BDC.
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Kawakami H, Itoi T, Ban T
Journal of Hepato-Biliary-Pancreatic Sciences 27 ( 2 ) E11 - E12 2020年2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：Journal of Hepato-Biliary-Pancreatic Sciences
DOI： 10.1002/jhbp.676
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Intrahepatic biliary stones extraction via an EUS-guided hepaticogastrostomy route confirmed by peroral video cholangioscopy. 査読あり
Kawakami H, Itoi T, Ban T.
J Hepatobiliary Pancreat Sci 27 ( 2 ) E11 - E12 2020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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Kurita A., Yasukawa S., Zen Y., Yoshimura K., Ogura T., Ozawa E., Okabe Y., Asada M., Nebiki H., Shigekawa M., Ikeura T., Eguchi T., Maruyama H., Ueki T., Itonaga M., Hashimoto S., Shiomi H., Minami R., Hoki N., Takenaka M., Itokawa Y., Uza N., Hashigo S., Yasuda H., Takada R., Kamada H., Kawamoto H., Kawakami H., Moriyama I., Fujita K., Matsumoto H., Hanada K., Takemura T., Yazumi S.
Gastrointestinal Endoscopy 91 ( 2 ) 373 - 381.e2 2020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：Gastrointestinal Endoscopy
Background and Aims: Histologic diagnosis of autoimmune pancreatitis (AIP) using EUS-guided FNA (EUS-FNA) is difficult. To address this issue, new fine-needle biopsy (FNB) needles were recently developed. Here, we prospectively evaluated 2 newly designed EUS-FNB needles for histologic evaluation in patients with type 1 AIP. Methods: This was a prospective, randomized, multicenter trial comparing biopsy specimens obtained with a 22-gauge Franseen needle or a 20-gauge forward-bevel needle in patients with suspected type 1 AIP. AIP was diagnosed according to international consensus diagnostic criteria. The primary endpoint was the sensitivity of EUS-FNB needles, and secondary endpoints were the amount of specimen obtained, histology of the pancreas based on evaluation of lymphoplasmacytic sclerosing pancreatitis (LPSP), and contribution of histologic findings to the diagnosis of AIP. Results: One hundred ten patients were randomly assigned to the Franseen group (22-gauge Franseen needle) or the forward-bevel group (20-gauge forward-bevel needle). EUS-FNB sampling was successful in all patients. Nine patients were excluded because of diagnoses other than AIP. Compared with the forward-bevel needle, the Franseen needle obtained a significantly greater number of high-power fields. Of 101 patients, 39 patients (78%) in the Franseen group and 23 patients (45%) in the Forward-bevel group were diagnosed with level 1 or 2 LPSP (P =.001). Thirty-six patients could not be diagnosed with type 1 AIP without EUS-FNB specimen results. Conclusions: The 22-gauge Franseen needle should be routinely used for histologic diagnosis of type 1 AIP. (Clinical trial registration number: UMIN 000027668.)
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胆嚢のヘリコバクター・ピロリ感染と慢性胆嚢炎，胆石のリスク：システマティック・レビューとメタアナリシス
河上 洋
Helicobacter日本語抄訳版 2020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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炎症性腸疾患類縁疾患の内視鏡診断
芦塚伸也，山本章二朗，河上 洋
日本消化器内視鏡学会雑誌 2020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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Endoscopic ultrasonography-guided fine-needle biopsy from ascending colon using a novel curved linear echoendoscope. 査読あり
Kawakami H, Ban T, Kubota Y, Noda T, Oshikawa K.
Endoscopy 52 ( 1 ) E24 - E26 2020年1月
記述言語：英語 掲載種別：研究論文（学術雑誌）
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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 62 ( 10 ) 2330 - 2330 2020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】通常，PrecutはERCP後膵炎（PEP）の危険因子の１つである選択的胆管挿管困難例に対して施行される．近年，primary precutの有用性が報告されているが，これまで報告は少ない．今回はprimary precutの安全性と有用性を評価する目的に研究を計画した．【方法】very early precut群（A群：パピロトームを用いたwire-guided cannulationにより胆管挿管を２回試行しても困難であった群）とprimary precut群（B群：direct precut群）を単施設で無作為化比較試験（RCT）を行った．術者はエキスパートが行い，主要評価項目はPEPの発生率とした．【結果】303例をA：B群＝152：151に割付した．背景やERCPの適応に有意差はなかった．PEP発生率はA：B群＝5.2：0.67％（<i>P</i>＝0.04），高アミラーゼ血症はA：B群＝12.5：2.6％（<i>P</i>＝0.01）とB群で有意に低く，選択的胆管挿管時間はA：B群＝13.8±2.2：7.2±1.7分（<i>P</i>＝0.001）とB群で有意に短時間であった．最終胆管挿管率はA：B群＝98：98.6％（<i>P</i>＝0.001）と両群に有意差はなかった．【結語】エキスパートの内視鏡医によるprimary precutはPEPの発生頻度は低かった．
DOI： 10.11280/gee.62.2330
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Endoscopic diagnosis of inflammatory bowel disease-related diseases
Ashizuka S., Yamamoto S., Kawakami H.
Gastroenterological Endoscopy 62 ( 1 ) 15 - 33 2020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
The diagnosis of inflammatory bowel disease (IBD) including ulcerative colitis (UC) and Crohn's disease (CD) in the absence of typical endoscopic features is often challenging. In such cases, UC or CD cannot be definitively diagnosed, and these conditions are categorized as "nflammatory bowel disease-unclassified". Recent technological advances have introduced balloon-assisted endoscopy and capsule endoscopy for the management of patients with chronic enteritis. These techniques enable the detection of mucosal lesions in the small intestine. Furthermore, these innovations have changed the diagnostic strategy of IBD and IBD-related diseases. In this review, we present an overview, as well as the clinical characteristics and endoscopic diagnosis of IBD-related diseases including intestinal Behçet's disease with simple ulcer, trisomy 8-associated enteritis, chronic enteropathy associated with the SLCO2A1 gene, and familial Mediterranean fever with enteritis.
DOI： 10.11280/gee.62.15
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Kawakami H, Ban T, Kubota Y, Noda T, Oshikawa K
Endoscopy 52 ( 1 ) E24 - E26 2020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：Endoscopy
DOI： 10.1055/a-0982-2688
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抗血小板薬・抗凝固薬内服患者に対するEUS-FNA
川久保和道，河上 洋，坂本直哉
日本消化器内視鏡学会雑誌 2019年12月
記述言語：日本語 掲載種別：研究論文（学術雑誌）
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Huge enterolithiasis in Crohn's disease. 査読あり
Hirata T, Kawakami H, Kubota Y.
Clinical Gastroenterology and Hepatology 17 ( 12 ) e141 - e141 2019年12月
記述言語：英語 掲載種別：研究論文（学術雑誌）
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Phase 2 Study of Neoadjuvant Treatment of Sequential S-1-Based Concurrent Chemoradiation Therapy Followed by Systemic Chemotherapy with Gemcitabine for Borderline Resectable Pancreatic Adenocarcinoma (HOPS-BR 01). 査読あり
Hayashi T, Nakamura T, Kimura Y, Yoshida M, Someya M, Kawakami H, Sakuhara Y, Kato N, Takahashi K, Ambo Y, Miura K, Motoya M, Tanaka E, Murakawa K, Yamabuki T, Yamazaki H, Katanuma A, Hirano S.
Int J Radiat Oncol Biol Phys 105 ( 3 ) 606 - 617 2019年11月
記述言語：英語 掲載種別：研究論文（学術雑誌）
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Endoscopic biliary intervention using traction devices for periampullary diverticulum: a case report. 査読あり
Inoue R, Kawakami H, Kubota Y, Ban T.
Internal Medicine 58 ( 19 ) 2797 - 2801 2019年10月
記述言語：英語 掲載種別：研究論文（学術雑誌）
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Laser cut type uncovered self-expandable metallic stent
河上 洋，内山尚美，小川宗一郎，畑田紘志，鈴木 翔，久保田良政，中島孝治，芦塚伸也，三池 忠，坂 哲臣，田原良博，安倍弘生，山本章二朗，稲津東彦
胆と膵 2019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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Antegrade stenting combined with hepaticogastrostomy using a 5.4-Fr novel ultra-slim metallic stent and dedicated stent under EUS guidance (with video). 査読あり
Kawakami H, Kubota Y, Ban T.
Endosc Ultrasound. 8 ( 5 ) 352 - 353 2019年10月
記述言語：英語 掲載種別：研究論文（学術雑誌）
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Verification of the effectiveness of fucosylated haptoglobin as a pancreatic cancer marker in clinical diagnosis. 査読あり
Kuwatani M, Kawakami H, Kubota Y, Kawakubo K, Ito Y, Togo S, Ikeda T, Kusama K, Kobayashi Y, Murata T, Sakamoto N.
Pancreatology 19 ( 4 ) 569 - 577 2019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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高度膵管狭窄突破困難例への内視鏡的アプローチ法－基本処置具から通電ダイレイターまでを使いこなす
河上 洋，久野田良政，坂 哲臣，芦塚伸也，中島孝治，三池 忠，安倍弘生，山本章二朗，稲津東彦
消化器・肝臓内科 2019年5月
記述言語：日本語 掲載種別：研究論文（学術雑誌）
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Short- and long-term outcomes of a novel transpapillary dilation technique using a diathermic dilator for severe benign bile duct stricture. 査読あり
Kato S, Kuwatani M, Kawakubo K, Sugiura R, Hirata K, Nakajima M, Hirata H, Kawakami H, Sakamoto N.
Digestive Endoscopy 31 ( 4 ) 448 - 452 2019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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経口胆道鏡－こう使い，こう視る
河上 洋
消化器内視鏡 2019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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Hepatic Portal Venous Gas Following Colonic ESD. 査読あり
Suzuki S, Takeuchi Y, Ishihara R, Kawakami H.
Internal Medicine 58 ( 5 ) 755 - 756 2019年3月
記述言語：英語 掲載種別：研究論文（学術雑誌）
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Primary Hepatic Diffuse Large B-cell Lymphoma Mimicking Intrahepatic Cholangiocarcinoma. 査読あり
Kawakami H, Kubota Y, Ban T.
Internal Medicine 58 ( 1 ) 143 - 144 2019年1月
記述言語：英語 掲載種別：研究論文（学術雑誌）
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悪性胆道閉塞に対する経乳頭的胆道ドレナージ：本邦と欧米のガイドラインを読み解く 査読あり
河上 洋
胆道 2019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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Two cases of bile duct carcinoma patients who underwent the photodynamic therapy using talaporfin sodium (Laserphyrin®). 査読あり
Nanashima A, Hiyoshi M, Imamura N, Hamada T, Nishida T, Kawakami H, Ban T, Kubota Y, Nakashima K, Yano K, Wada T, Takeno S, Kai M.
Clinical Journal of Gastroenterology 13 ( 1 ) 102 - 109 2019年1月
記述言語：英語 掲載種別：研究論文（学術雑誌）
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Primary hepatic diffuse large B-cell lymphoma mimicking intrahepatic cholangiocarcinoma. 査読あり
Kawakami H, Kubota Y, Ban T.
Internal Medicine 58 ( 1 ) 143 - 144 2019年1月
記述言語：英語 掲載種別：研究論文（学術雑誌）
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Hamada T., Nanashima A., Hiyoshi M., Ikenoue M., Imamura N., Yano K., Fujii Y., Kubota Y., Ban T., Kawakami H., Sato Y.
International Journal of Surgery Case Reports 42 274 - 279 2018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：International Journal of Surgery Case Reports
© 2018 Introduction This is a case report on the advances in preoperative endoscopic-guided fine-needle-aspiration (FNA) diagnosis for pancreatic carcinoma to achieve a curative operation even in patients who have a history of total gastrectomy. Case presentation A 65-year-old man, who underwent total gastrectomy for gastric cancer 13 years ago, had discomfort in the left lateral abdomen. A 3-cm hypovascular mass accompanying a large distal pseudocyst in the pancreatic tail was observed on computed tomography. Endoscopic ultrasonography via elevation of the jejunal loop on esophago-jejunostomy also revealed similar lesions, and FNA for the proximal-side hypoechoic mass was successful. The cytological diagnosis with immunohistochemistry was acinar cell carcinoma of the pancreas. Distal pancreatectomy with splenectomy was successfully performed. Histology of the resected specimen also showed the acinar cell carcinoma, similar with preoperative cytology, which involved the splenic vein and had extra-pancreatic extension but no lymph node metastasis. The tumor stage was IIA by the 2009 UICC classification. He had no tumor relapse on imaging follow-up until 12 months after the operation. Discussion There have been marked technical advancements in endoscopic ultrasonography-guided diagnosis, including FNA, even in patients with prior digestive tract surgery. However, the risk of complication is still a concern. Accurate histological diagnosis is useful in the field of pancreatic surgery, especially in cases of rare or small malignant lesions. Conclusion Curative pancreatectomy was possible in a case of acinar cell carcinoma, a rare pancreatic malignancy, which was diagnosed by preoperative endoscopic FNA diagnosis via esophago-jejunostomy after previous total gastrectomy.
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Curative distal pancreatectomy in patients with acinar cell carcinoma of pancreas diagnosed by endoscopic aspiration via esophago-jejunostomy: A successful case report. 査読あり
Hamada T, Nanashima A, Hiyoshi M, Ikenoue M, Imamura N, Yano K, Fujii Y, Kubota Y, Ban T, Kawakami H, Sato Y.
International Journal of Surgery Case Reports 42 274 - 279 2018年12月
記述言語：英語 掲載種別：研究論文（学術雑誌）
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Transgastric reintervention for self-expandable metallic stent dysfunction following endoscopic ultrasonography-guided hepaticogastrostomy. 査読あり
Ban T, Kawakami H, Kubota Y.
Digestive Endoscopy 30 ( 5 ) 682 - 683 2018年9月
記述言語：英語 掲載種別：研究論文（学術雑誌）
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A Prospective Multicenter Study of a Fully Covered Metal Stent in Patients with Distal Malignant Biliary Obstruction: WATCH-2 Study. 査読あり
Kogure H, Ryozawa S, Maetani I, Nakai Y, Kawakami H, Yasuda I, Mochizuki H, Iwano H, Maguchi H, Kida M, Kubota K, Mulai T, hasebe O, Igarashi Y, Hanada K, Irisawa A, Ito K, Itoi T, Isayama H.
Digestive Disease and Sciences 63 ( 9 ) 2466 - 2473 2018年9月
記述言語：英語 掲載種別：研究論文（学術雑誌）
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Endoscopic ultrasonography-guided fine-needle biopsy from the pancreatic head of a patient with Roux-en-Y reconstruction. 査読あり
Ban T, Kawakami H, Kubota Y, Ashizuka S, Oshikawa K.
Endoscopy 50 ( 8 ) E202 - E204 2018年8月
記述言語：英語 掲載種別：研究論文（学術雑誌）
DOI： 10.1055/a-0624-1319
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Iatrogenic hepatic portal venous gas following balloon endoscopy in a patient with hepaticojejunostomy stricture. 査読あり
Kawakami H, Ban T, Kubota Y
Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society 2018年7月
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Combined use of a two-channel endoscope and a flexible tip catheter for difficult biliary cannulation. 査読あり
Kuwatani M, Kubota Y, Kawahata S, Kubo K, Kawakubo K, Kawakami H, Sakamoto N.
Gastrointestinal Intervention 2018年7月
記述言語：英語 掲載種別：研究論文（学術雑誌）
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Rendezvous biliary recanalization with combined percutaneous transhepatic cholangioscopy and double-balloon endoscopy. 査読あり
Kawakami H, Ban T, Kubota Y, Ashizuka S, Sannomiya I, Imamura N, Hamada T.
Endoscopy 50 ( 7 ) E146 - E148 2018年7月
記述言語：英語 掲載種別：研究論文（学術雑誌）
DOI： 10.1055/a-0591-2109
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Iatrogenic hepatic portal venous gas following balloon endoscopy in a patient with hepaticojejunostomy stricture. 査読あり
Kawakami H, Ban T, Kubota Y.
Digestive Endoscopy 30 ( 4 ) 527 - 528 2018年7月
記述言語：英語 掲載種別：研究論文（学術雑誌）
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Ultra-early occlusion of the normal bile duct after uncovered self-expandable metallic stent placement in unresectable perihilar bile duct cancer. 査読あり
Kawakami H, Kubota Y, Ban T.
Digestive Endoscopy 30 ( 4 ) 533 - 534 2018年7月
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Lenvatinib-induced acute pancreatitis associated with a pancreatic pseudocyst and splenic pseudoaneurysms. 査読あり
Kawakami H, Kubota Y, Ban T, Shibata N, Hosokawa A.
Pancreas 47 ( 6 ) e34 - e35 2018年7月
記述言語：英語 掲載種別：研究論文（学術雑誌）
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Impact of Franseen needle on rapid onsite evaluation and histological examination following endoscopic ultrasonography-guided tissue acquisition in patients with splenic malignant lymphoma. 査読あり
Ban T, Kawakami H, Kubota Y, Sato Y.
Arab Journal of Gastroenterology 19 ( 2 ) 91 - 95 2018年6月
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Novel short curved sphincterotome for wire-guided cannulation and endoscopic sphincterotomy. 査読あり
Kawakami H, Kubota Y, Ban T
Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society 2018年5月
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Novel short curved sphincterotome for wire-guided cannulation and endoscopic sphincterotomy. 査読あり
Kawakami H, Kubota Y, Ban T.
Digestive Endoscopy 30 ( 3 ) 400 - 402 2018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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Preoperative biliary drainage using a fully covered self-expandable metallic stent for pancreatic head cancer: A prospective feasibility study. 査読あり
Togawa O, Isayama H, Kawakami H, Nakai Y, Mohri D, Hamada T, Kogure H, Kawakubo K, Sakamoto N, Koike K, Kita H.
Saudi Journal of Gastroenterology 24 ( 3 ) 151 - 156 2018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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A Prospective Multicenter Study Evaluating Bleeding Risk after Endoscopic Ultrasound-Guided Fine Needle Aspiration in Patients Prescribed Antithrombotic Agents. 査読あり
Kawakubo K, Yane K, Eto K, Ishiwatari H, Ehira N, Haba S, Matsumoto R, Shinada K, Yamato H, Kudo T, Onodera M, Okuda T, Abe Y, Kawahata S, Kubo K, Kubota Y, Kuwatani M, Kawakami H, Katanuma A, Ono M, Hayashi T, Uebayashi M, Sakamoto N.
Gut and Liver 12 ( 3 ) 353 - 359 2018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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New curved linear echoendoscope for endoscopic ultrasonography-guided fine-needle aspiration in patients with Roux-en-Y reconstruction. 査読あり
Kawakami H, Kubota Y, Ban T.
Endoscopic Ultrasound 7 ( 2 ) 128 - 129 2018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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Ultra-early occlusion of the normal bile duct after uncovered self-expandable metallic stent placement in unresectable perihilar bile duct cancer. 査読あり
Kawakami H, Kubota Y, Ban T
Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society 2018年3月
記述言語：英語 掲載種別：研究論文（学術雑誌）
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Kawakami H., Kubota Y., Ban T.
Endoscopy 49 ( 11 ) E285 - E287 2017年11月
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Malignant melanoma metastatic to the gallbladder diagnosed by endoscopic ultrasonography-guided fine-needle aspiration 査読あり
Kawakami H, Kubota Y
Endoscopic Ultrasound 2017年11月
記述言語：英語 掲載種別：研究論文（学術雑誌）
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Kawakami H., Kubota Y., Makiyama H., Sato S., Ban T.
Endoscopy 49 ( 10 ) E264 - E265 2017年10月
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A Case of Pancreatic Lipoma with Morphological Change during Long-Term Follow-up 査読あり
Kawahata S, Kawakami H, Kubota Y
Pancreas 2017年9月
記述言語：英語 掲載種別：研究論文（学術雑誌）
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Ban T., Kawakami H., Kubota Y.
Arab Journal of Gastroenterology 18 ( 3 ) 169 - 171 2017年9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：Arab Journal of Gastroenterology
© 2017 Pan-Arab Association of Gastroenterology The SpyGlass DS system is currently used as a direct video cholangioscope for biliary diagnostic and therapeutic procedures. In general, the SpyGlass DS cholangioscope is passed through the working channel of a duodenoscope and inserted into a bile duct via duodenal papilla. However, the procedure has been challenging in patients with altered gastrointestinal anatomy due to the retrograde route through a potentially tortuous afferent limb. A therapeutic colonoscope with variable stiffness can offer alternative guidance for SpyGlass DS cholangioscope in patients with surgically altered gastrointestinal anatomy.
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New curved linear echoendoscope for endoscopic ultrasonography-guided fine-needle aspiration in patients with Roux-en-Y reconstruction (with videos). 査読あり
Kawakami H, Kubota Y
Endoscopic ultrasound 2017年7月
記述言語：英語 掲載種別：研究論文（学術雑誌）
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Muranaka T., Kuwatani M., Komatsu Y., Sawada K., Nakatsumi H., Kawamoto Y., Yuki S., Kubota Y., Kubo K., Kawahata S., Kawakubo K., Kawakami H., Sakamoto N.
Journal of Gastrointestinal Oncology 8 ( 3 ) 566 - 571 2017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：Journal of Gastrointestinal Oncology
© Journal of Gastrointestinal Oncology. All rights reserved. Background: Irinotecan, oxaliplatin and leucovorin-modulated fluorouracil (FOLFIRINOX) and the combination regimen of gemcitabine and nanoparticle albumin-bound paclitaxel (GnP) (nab-PTX) improve the prognosis of patients with metastatic pancreatic cancer. However, no study has compared the efficacy of the two regimens. We compared retrospectively the efficacy and safety of the two regimens in patients with unresectable pancreatic cancer. Methods: Thirty-eight patients with unresectable locally advanced or metastatic pancreatic cancer received FOLFIRINOX or GnP as first-line chemotherapy between December 2013 and September 2015. In the FOLFIRINOX group, patients received 85 mg/m 2 oxaliplatin followed by 180 mg/m 2 irinotecan and 200 mg/m 2 L-leucovorin, and by 400 mg/m2 fluorouracil as a bolus and 2,400 mg/m 2 fluorouracil as a 46-h continuous infusion every 14 days. In the GnP group, patients received 125 mg/m 2 nab-PTX followed by 1 g/m 2 , and gemcitabine on days 1, 8 and 15, repeated every 28 days. Results: Response rate was 6.3% in the FOLFIRINOX group and 40.9% in the GnP group (P=0.025). Median progression-free survival (PFS) was 3.7 months [95% confidence interval (CI), 3.0-4.5] in the FOLFIRINOX group and 6.5 months (95% CI, 6.2-6.9 months) in the GnP group (P=0.031). Drug toxicity in the GnP group was less than in the FOLFIRINOX group. Conclusions: Efficacy and safety of GnP compare favorably to those of FOLFIRINOX in patients with pancreatic cancer. Additional prospective trials are warranted
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Gastrointestinal: Severe congestive heart failure and acute gastric mucosal necrosis 査読あり
Kawakami H, Kubota Y, Takeno S, Miyazaki Y, Wada T, Hamada R, Nanashima A
Journal of Gastroenterology and Hepatology 2017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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New rescue technique of endoscopic ultrasonography-guided rendezvous procedure (with video) 査読あり
Kawakami H, Kubota Y
Digestive Endoscopy 2017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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Decreased RNA-binding motif 5 expression is associated with tumor progression in gastric cancer 査読あり
Kobayashi T., Ishida J., Shimizu Y., Kawakami H., Suda G., Muranaka T., Komatsu Y., Asaka M., Sakamoto N.
Tumor Biology 39 ( 3 ) 2017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：Tumor Biology
© 2017, © The Author(s) 2017. RNA-binding motif 5 is a putative tumor suppressor gene that modulates cell cycle arrest and apoptosis. We recently demonstrated that RNA-binding motif 5 inhibits cell growth through the p53 pathway. This study evaluated the clinical significance of RNA-binding motif 5 expression in gastric cancer and the effects of altered RNA-binding motif 5 expression on cancer biology in gastric cancer cells. RNA-binding motif 5 protein expression was evaluated by immunohistochemistry using the surgical specimens of 106 patients with gastric cancer. We analyzed the relationships of RNA-binding motif 5 expression with clinicopathological parameters and patient prognosis. We further explored the effects of RNA-binding motif 5 downregulation with short hairpin RNA on cell growth and p53 signaling in MKN45 gastric cancer cells. Immunohistochemistry revealed that RNA-binding motif 5 expression was decreased in 29 of 106 (27.4%) gastric cancer specimens. Decreased RNA-binding motif 5 expression was correlated with histological differentiation, depth of tumor infiltration, nodal metastasis, tumor–node–metastasis stage, and prognosis. RNA-binding motif 5 silencing enhanced gastric cancer cell proliferation and decreased p53 transcriptional activity in reporter gene assays. Conversely, restoration o f RNA-binding motif 5 expression suppressed cell growth and recovered p53 transactivation in RNA-binding motif 5–silenced cells. Furthermore, RNA-binding motif 5 silencing reduced the messenger RNA and protein expression of the p53 target gene p21. Our results suggest that RNA-binding motif 5 downregulation is involved in gastric cancer progression and that RNA-binding motif 5 behaves as a tumor suppressor gene in gastric cancer.
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Peroral video cholangioscopic findings in a biliary intraductal mucinous cystic neoplasm 査読あり
Kawakami H, Kubota Y, Kubo K, Sato D, Mitsuhashi T, Hirano S, Sakamoto N
Endoscopy 2017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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Rescue technique using a diathermic dilator for an unremovable stent in malignant perihilar biliary obstruction 査読あり
Sugiura R, Kawakami H, Ehira N, Iwanaga I, Uebayashi M, Kuwatani M, Sakamoto N
Endoscopy 2017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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Novel wire-guided fine-gauge bougie dilator for transpapillary or endoscopic ultrasonography-guided biliary drainage 査読あり
Kawakami H, Kubota Y
Endoscopy 2017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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Balloon enteroscopy-assisted biliary drainage using a diathermic dilator followed by placement of a novel ultra-slim metallic stent 査読あり
Kawakami H, Kubota Y, Ashizuka S, Haraguchi M, Sannomiya I.
Endoscopy 2017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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Endoscopic ultrasonography-guided antegrade stenting combined with hepaticogastrostomy/hepaticojejunostomy using ultraslim instruments 査読あり
Kawakami H, Kubota Y
Endoscopy 2017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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Nursing care management of photodynamic therapy in digestive tract carcinomas at a single cancer center. 査読あり
Nanashima A, Nakashima K, Kawakami H, Ashizuka S, Kubota Y.
Photodiagnosis and Photodynamic Therapy 2017年1月
記述言語：英語 掲載種別：研究論文（学術雑誌）
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非切除悪性遠位胆管閉塞に対する大口径fully‒covered self‒expandable metallic stentの多施設共同観察研究 査読あり
向井 強，安田 一朗，伊佐山 浩通，岩下 拓司，糸井 隆夫，河上 洋，木暮 宏史，中井 陽介
日本消化器内視鏡学会雑誌 59 ( 10 ) 2546 - 2556 2017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
目的：非切除悪性遠位胆管閉塞に対するcovered self-expandable metallic stent（CSEMS）はtumor ingrowthを予防できるため，uuncovered self-expandable metallic stentより長期の開存期間が期待できる．また，CSEMSのrecurrent biliary obstruction（RBO）の主因であるsludgeによるステント閉塞は，ステント径が大きいほど低率になると報告されている．そこで，われわれは12mm径のfully-covered SEMS（FCSEMS-12）を開発し，臨床的安全性および有用性に関する前向きの多施設共同観察研究を行った．方法：2011年６月から2012年11月の期間に非切除悪性遠位胆管閉塞38例に対してFCSEMS-12を留置した．主要評価項目はステント留置から６カ月後のnon-RBO率とした．結果：手技的および臨床的成功率ともに100％であり，ステント留置６カ月後のnon-RBO率は50％であった．TRBO中央値は184日，生存期間中央値は241日であり，６カ月以内にRBOなく死亡されたのは12例（32％）であった．RBOは10例（26％）で認められ，ステント閉塞は７例（18％），migration ３例（８％）であり，30日以内の早期偶発症を６例（16％；胆嚢炎１例，膵炎１例，高アミラーゼ血症１例，膵管炎１例，腹痛２例）に認めた．reinterventionの際にステント抜去を試みた８例全例で抜去に成功した．結語：われわれが開発したFCSEMS-12の使用は安全で有効性も高く，偶発症発生率も容認できると考える．（Clinical trial registration number：UMIN000007061）
DOI： 10.11280/gee.59.2546
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Ishii M., Takeno S., Nishida T., Nanashima A., Kubota Y., Kawakami H., Umekita Y., Akiyama Y.
International Journal of Surgery Case Reports 34 49 - 55 2017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：International Journal of Surgery Case Reports
© 2017 The Authors Introduction We report a relatively rare case of esophageal leiomyoma in the upper thoracic esophagus enucleated by thoracoscopic procedures. The usefulness of preoperative diagnosis and an adequate surgical approach are described along with a review of the relevant literature. Presentaion of case A submucosal tumor 45 mm in diameter was detected in the upper thoracic esophagus of a 69-year-old man. The tumor was preoperatively diagnosed from histopathological biopsy under endoscopic ultrasound-guided fine needle aspiration. Thoracoscopic enucleation was therefore preoperatively scheduled under the left decubitus position in consideration of the low risk of malignant disease. Histopathological diagnosis of the resected specimen was benign leiomyoma and patient outcomes were good. Discussion The need for preoperative biopsy of esophageal submucosal tumor is a controversial issue. However, preoperative biopsy provided the benefits to decide the operative procedure or confirm adequate resection, and our experience suggested that preoperative biopsy did not adversely influence subsequent enucleation. Conclusion Precise preoperative diagnosis is necessary to avoid excessive surgery when managing esophageal submucosal tumor.
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No Benefit of Oral Diclofenac on Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis 査読あり
Ishiwatari H, Urata T, Yasuda I, Matsusaki S, Hisai H, Kawakami H, Ono M, Iwashita T, Doi S, Kawakubo K, Hayashi T, Sonoda T, Sakamoto N, Kato J.
Ｄｉｇｅｓｔｉｖe disease and sciences 2016年11月
記述言語：英語 掲載種別：研究論文（学術雑誌）
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Kubo K., Kawakami H., Kuwatani M., Nishida M., Kawakubo K., Kawahata S., Taya Y., Kubota Y., Amano T., Shirato H., Sakamoto N.
BMC Gastroenterology 16 ( 1 ) 116 2016年9月
記述言語：日本語 掲載種別：研究論文（学術雑誌）
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The Asian consensus statements on endoscopic management of walled-off necrosis Part2: Endoscopic management. 査読あり
Isayama H, Nakai Y, Perknimitr R, Kohr C, Lau J, Wang HP, Seo DW, Ratanachu-ek T, Lakhtakia S, Ang TL, Ryozawa S, Hayashi T, Kawakami H, Yamamoto N, Iwashita T, Itokawa F, Kuwatani M, Kitano M, Hanada K, Ponnudurai R, Moon JH, Itoi T, Yasuda I, Irisawa A,
Journal of Gastroenterology and Hepatology 2016年9月
記述言語：英語 掲載種別：研究論文（学術雑誌）
DOI： 10.1111/jgh.13398
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The Asian consensus statements on endoscopic management of walled-off necrosis Part1: Epidemiology, diagnosis and treatment. 査読あり
Isayama H, Nakai Y, Perknimitr R, Kohr C, Lau J, Wang HP, Seo DW, Ratanachu-ek T, Lakhtakia S, Ang TL, Ryozawa S, Hayashi T, Kawakami H, Yamamoto N, Iwashita T, Itokawa F, Kuwatani M, Kitano M, Hanada K, Ponnudurai R, Moon JH, Itoi T, Yasuda I, Irisawa A,
Journal of Gastroenterology and Hepatology 2016年9月
記述言語：英語 掲載種別：研究論文（学術雑誌）
DOI： 10.1111/jgh.13394
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Reply to Kadayifci et al 査読あり
Ishiwatari H, Kawakami H, Hisai H, Yane K, Onodera M, Eto K, Haba S, Okuda T, Ihara H, Kukitsu T, Matsumoto R, Kitaoka K, Sonoda T, Hayashi T
Endoscopy 2016年9月
記述言語：英語 掲載種別：研究論文（学術雑誌）
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Kubo K., Kawakami H., Kuwatani M., Nishida M., Kawakubo K., Kawahata S., Taya Y., Kubota Y., Amano T., Shirato H., Sakamoto N.
BMC Gastroenterology 16 ( 1 ) 65 2016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：BMC Gastroenterology
© 2016 The Author(s). Background: Obstructive jaundice has been reported to influence liver elasticity, independent of liver fibrosis. The aim of our prospective study was to evaluate the changes in liver elasticity, before and after biliary drainage, in patients with obstructive jaundice, and to evaluate the correlation between elasticity measures and serum markers of liver fibrosis. Methods: This is a prospective cohort study of 20 patients with obstructive jaundice. Liver elasticity was assessed by Transient Elastography (TE) and Virtual Touch™ Quantification (VTQ). Serum total bilirubin (T-Bil) level was measured before biliary drainage (Day 0), with measures repeated at 2 days (Day 2) and 7 days (Day 7) after biliary drainage. Serum levels of the following markers of liver fibrosis were also obtained on Day 0 and Day 7: hyaluronic acid (HA), procollagen-III-peptide (P-III-P). Results: T-Bil, TE, and VTQ for the left (VTQ-L) and right (VTQ-R) lobes of the liver were all elevated before biliary drainage, with respective levels, measured at Day 0, of 11.9 ± 1.5 mg/dl, 12.1 ± 0.9 kPa, 2.23 ± 0.10 m/s, and 1.85 ± 0.10 m/s. All values decreased on Day 7 after drainage: T-Bil, 4.7 ± 1.0 mg/dl (P < 0.001); TE, 7.6 ± 0.6 kPa (P < 0.001); VTQ-L, 1.53 ± 0.08 m/s (P < 0.001); and VTQ-R, 1.30 ± 0.05 m/s (P < 0.001). Similar changes were observed in serum markers of liver fibrosis. Liver elasticity measures correlated with serum levels of T-Bil, P-III-P, and HA (r = 0.35-0.67, P < 0.001). Conclusions: This study confirmed decreases in liver elasticity, measured by TE and VTQ, after biliary drainage. Measures of liver elasticity correlated to levels of T-Bil and serum markers of liver fibrosis. (UMIN ID: UMIN00001284313). Trial registration: Registration number: University Hospital Medical Information Network (UMIN) Clinical Trials Registry (UMIN ID: UMIN00001284313); Registration date: 2014-01-14.
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Reply to Rimbas, Kunda 査読あり
Kawakami H, Kawakubo K, Kubota Y, Kuwatani M, Sakamoto N
Endoscopy 2016年7月
記述言語：英語 掲載種別：研究論文（学術雑誌）
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Reply to Saritas, Ulku
Kawakami H, Kawakubo K, Kubota Y, Kuwatani M, Sakamoto N
Endoscopy 2016年7月
記述言語：英語 掲載種別：研究論文（学術雑誌）
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A pilot study of a novel, large-bore, fully covered self-expandable metallic stent for unresectable distal biliary malignancies 査読あり
Mukai T, Yasuda I, Isayama H, Iwashita T, Kawakami H, Itoi T, Kogure H, Nakai Y.
Digestive Endoscopy 2016年6月
記述言語：英語 掲載種別：研究論文（学術雑誌）
DOI： 10.1111/den.12643
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Balloon catheter versus basket catheter for endoscopic bile duct stone extraction: a multicenter randomized trial 査読あり
Ishiwatari H, Kawakami H, Hisai H, Yane K, Onodera M, Eto K, Haba S, Okuda T, Ihara H, Kukitsu T, Matsumoto R, Kitaoka K, Sonoda T, Hayashi T; Hokkaido Interventional EUS/ERCP Study (HONEST) Group
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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Transpapillary selective bile duct cannulation technique: Review of Japanese randomized controlled trials since 2010 and an overview of clinical results in precut sphincterotomy since 2004. 査読あり
Kawakami H, Kubota Y, Kawahata S, Kubo K, Kawakubo K, Kuwatani M, Sakamoto N.
Digestive Endoscopy 2016年4月
記述言語：英語 掲載種別：研究論文（学術雑誌）
DOI： 10.1111/den.12621
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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.
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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.)
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Kudo T., Kawakami H., Hayashi T., Yasuda I., Mukai T., Inoue H., Katanuma A., Kawakubo K., Ishiwatari H., Doi S., Yamada R., Maguchi H., Isayama H., Mitsuhashi T., Sakamoto N.
Gastrointestinal Endoscopy 80 ( 6 ) 1030 - 1037.e1 2014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：Gastrointestinal Endoscopy
© 2014 by the American Society for Gastrointestinal Endoscopy. Background EUS-guided FNA (EUS-FNA) has a high diagnostic accuracy for pancreatic diseases. However, although most reports have typically focused on cytology, histological tissue quality has rarely been investigated. The effectiveness of EUS-FNA combined with high negative pressure (HNP) suction was recently indicated for tissue acquisition, but has not thus far been tested in a prospective, randomized clinical trial. Objective To evaluate the adequacy of EUS-FNA with HNP for the histological diagnosis of pancreatic lesions by using 25-gauge needles. Design Prospective, single-blind, randomized, controlled crossover trial. Setting Seven tertiary referral centers. Patients Patients referred for EUS-FNA of pancreatic solid lesions. From July 2011 to April 2012, 90 patients underwent EUS-FNA of pancreatic solid masses by using normal negative pressure (NNP) and HNP with 2 respective passes. The order of the passes was randomized, and the sample adequacy, quality, and histology were evaluated by a single expert pathologist. Intervention EUS-FNA by using NNP and HNP. Main Outcome Measurements The adequacy of tissue acquisition and the accuracy of histological diagnoses made by using the EUS-FNA technique with HNP. Results We found that 72.2% (65/90) and 90% (81/90) of the specimens obtained using NNP and HNP, respectively, were adequate for histological diagnosis (P =.0003, McNemar test). For 73.3% (66/90) and 82.2% (74/90) of the specimens obtained by using NNP and HNP, respectively, an accurate diagnosis was achieved (P =.06, McNemar test). Pancreatitis developed in 1 patient after this procedure, which subsided with conservative therapy. Limitations This was a single-blinded, crossover study. Conclusion Biopsy procedures that combine the EUS-FNA with HNP techniques are superior to EUS-FNA with NNP procedures for tissue acquisition. (Clinical trial registration number: UMIN000005939.).
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Kuwatani M., Kawakami H., Zen Y., Kawakubo K., Kudo T., Abe Y., Kubo K., Sakamoto N.
Hepato-gastroenterology 61 ( 135 ) 1852 - 1856 2014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：Hepato-gastroenterology
BACKGROUND/AIMS: IgG4-related sclerosing cholangitis (IgG4-SC) is a newly established entity. The purpose of this study was to investigate the differences in intraductal ultrasonography (IDUS) findings between IgG4-SC and bile duct (BD) cancer (BDC) as well as the relationship among BD wall thickness, serological and pathological findings in IgG4-SC. METHODOLOGY: Based on the diagnostic criteria of IgG4-SC, we reviewed patients in our hospital between April 2005 and June 2013, and analyzed the data obtained from 32 patients with IgG4-SC and 40 patients with BDC. RESULTS: Regarding IDUS findings, significantly more cases in BDC indicated rigid/papillary inner margin than in IgG4-SC, while biopsy was more efficient. There were no significant correlations between BD wall thickness and serum IgG/IgG4 levels or the number of IgG4-positive cells of the BD specimens. All the IgG4-SC patients without steroid treatment revealed discordant results in the shifts of IgG, IgG4 and BD wall thickness between the 1st and 2nd examinations, while all patients with steroid had completely concordant results of the shifts. CONCLUSIONS: IDUS findings alone are insufficient for differentiation between IgG4-SC and BDC. BD wall thickness, serum IgG and IgG4 proportionally shift and reflect the effect of steroid on IgG4-SC after steroid treatment, not before it.
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Hirano S., Tanaka E., Tsuchikawa T., Matsumoto J., Kawakami H., Nakamura T., Kurashima Y., Ebihara Y., Shichinohe T.
Journal of Hepato-Biliary-Pancreatic Sciences 21 ( 8 ) 533 - 540 2014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：Journal of Hepato-Biliary-Pancreatic Sciences
Due to advances in endoscopic equipment and techniques, preoperative endoscopic biliary drainage (EBD) has been developed to serve as an alternative to percutaneous transhepatic biliary drainage (PTBD). This study sought to clarify the benefit of EBD in comparison to PTBD in patients who underwent radical resections of hilar cholangiocarcinoma. One hundred and forty-one patients underwent radical surgery for hilar cholangiocarcinoma between 2000 and 2008 were retrospectively divided into two groups based on the type of preoperative biliary drainage, PTBD (n = 67) or EBD (n = 74). We investigated if the different biliary drainage methods affected postoperative survival and mode of recurrence after median observation period of 82 months. The survival rate for patients who underwent EBD was significantly higher than those who had PTBD (P = 0.004). Multivariate analysis revealed that PTBD was one of the independent factors predictive of poor survival (hazard ratio: 2.075, P = 0.003). Patients with PTBD more frequently developed peritoneal seeding in comparison to those who underwent EBD (P = 0.0003). PTBD was the only independent factor predictive of peritoneal seeding. In conclusion, EBD might confer an improved prognosis over PTBD due to prevention of peritoneal seeding, and is recommended as the initial procedure for preoperative biliary drainage in patients with hilar cholangiocarcinoma. © 2014 Japanese Society of Hepato-Biliary-Pancreatic Surgery.
DOI： 10.1002/jhbp.76
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Kawakami H., Itoi T., Sakamoto N.
Gut and Liver 8 ( 4 ) 341 - 355 2014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：Gut and Liver
Endoscopic drainage for pancreatic and peripancreatic fluid collections (PFCs) has been increasingly used as a minimally invasive alternative to surgical or percutaneous drainage. Recently, endoscopic ultrasound-guided transluminal drainage (EUS-TD) has become the standard of care and a safe procedure for nonsurgical PFC treatment. EUS-TD ensures a safe puncture, avoiding intervening blood vessels. Single or multiple plastic stents (combined with a nasocystic catheter) were used for the treatment of PFCs for EUS-TD. More recently, the use of covered self-expandable metallic stents (CSEMSs) has provided a safer and more efficient approach route for internal drainage. We focused our review on the best approach and stent to use in endoscopic drainage for PFCs. We reviewed studies of EUS-TD for PFCs based on the original Atlanta Classification, including case reports, case series, and previous review articles. Data on clinical outcomes and adverse events were collected retrospectively. A total of 93 patients underwent EUS-TD of pancreatic pseudocysts using CSEMSs. The treatment success and adverse event rates were 94.6% and 21.1%, respectively. The majority of complications were of mild severity and resolved with conservative therapy. A total of 56 patients underwent EUS-TD using CSEMSs for pancreatic abscesses or infected walled-off necroses. The treatment success and adverse event rates were 87.8% and 9.5%, respectively. EUS-TD can be performed safely and efficiently for PFC treatment. Larger diameter CSEMSs without additional fistula tract dilation for the passage of a standard scope are needed to access and drain for PFCs with solid debris.
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Kawakubo K., Kawakami H., Kuwatani M., Haba S., Kudo T., Abe Y., Kawahata S., Onodera M., Ehira N., Yamato H., Eto K., Sakamoto N.
Gut and Liver 8 ( 3 ) 329 - 332 2014年5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：Gut and Liver
Endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) are essential for diagnosing and treating pancreatobiliary diseases. Single-session EUS and ERCP are considered to be essential in reducing the duration of hospital stays; however, complications are a primary concern. The aim of this study was to evaluate the safety and efficacy of single-session EUS and ERCP. Sixty-eight patients underwent single-session EUS and ERCP at a tertiary referral center between June 2008 and December 2012. We retrospectively reviewed patient data from a prospectively maintained EUS-ERCP database and evaluated the procedural characteristics and complications. Thirty-eight patients (56%) underwent diagnostic EUS, and 30 patients (44%) underwent EUS fine-needle aspiration, which had an overall accuracy of 100%. Sixty patients (89%) underwent therapeutic ERCP, whereas the remaining eight procedures were diagnostic. Thirteen patients underwent biliary stone extraction, and 48 underwent biliary drainage. The median total procedural time was 75 minutes. Complications were observed in seven patients (10%). Six complications were post-ERCP pancreatitis, which were resolved using conservative management. One patient developed Mallory-Weiss syndrome, which required endoscopic hemostasis. No sedation-related cardiopulmonary complications were observed. Single-session EUS and ERCP provided accurate diagnosis and effective management with a minimal complication rate.
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Kawakubo K., Isayama H., Kato H., Itoi T., Kawakami H., Hanada K., Ishiwatari H., Yasuda I., Kawamoto H., Itokawa F., Kuwatani M., Iiboshi T., Hayashi T., Doi S., Nakai Y.
Journal of Hepato-Biliary-Pancreatic Sciences 21 ( 5 ) 328 - 334 2014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 Hepato-Biliary-Pancreatic Sciences
Background Endoscopic ultrasound-guided biliary drainage (EUS-BD) is considered to be an effective salvage procedure for failed endoscopic retrograde cholangiopancreatography in patients with unresectable malignant biliary obstruction. The aim of this retrospective study was to evaluate the efficacy and feasibility of EUS-BD. Methods From November 2006 to May 2012, a total of 64 patients who underwent EUS-BD (44 EUS-guided choledochoduodenostomy [EUS-CDS] and 20 EUS-guided hepaticogastrostomy [EUS-HGS] ) at seven tertiary-care referral centers in Japan were included. The primary outcome was the technical success rate, and the secondary outcomes were the incidence of complications, stent dysfunction rate, time to stent dysfunction, and overall survival. Results The technical success rate for both EUS-CDS and EUS-HGS was 95%. The reasons for technical failure were two failed dilations of the anastomosis in EUS-CDS and one puncture failure in EUS-HGS. The stent dysfunction rate and 3-month dysfunction-free patency rate were 21% and 80% for EUS-CDS and 32% and 51% for EUS-HGS. There were 12 (six in EUS-CDS and six in EUS-HGS) procedure-related complications (19%): five cases of bile leakage (3/2), three stent misplacements (1/2), one pneumoperitoneum (1/0), two cases of bleeding (1/1), one perforation (1/0), and one biloma (0/1). Bile leakage was more frequently observed in patients who underwent plastic stent placement (11%) than in those with covered metal stents (4%). Conclusions This Japanese multicenter study revealed a high success rate in EUS-BD. However, the complication rate was as high as that in previous series. Covered metal stents may be useful to reduce bile leakage in EUS-BD. © 2013 Japanese Society of Hepato-Biliary-Pancreatic Surgery.
DOI： 10.1002/jhbp.27
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Kudo T., Kawakami H., Kuwatani M., Eto K., Kawahata S., Abe Y., Onodera M., Ehira N., Yamato H., Haba S., Kawakubo K., Sakamoto N.
World Journal of Gastroenterology 20 ( 13 ) 3620 - 3627 2014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：World Journal of Gastroenterology
AIM: To evaluate the safety and diagnostic accuracy of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) in a cohort of pancreatic cancer patients. METHODS: Of 213 patients with pancreatic cancer evaluated between April 2007 and August 2011, 82 were thought to have resectable pancreatic cancer on the basis of cross-sectional imaging findings. Of these, 54 underwent EUS-FNA before surgery (FNA+ group) and 28 underwent surgery without preoperative EUSFNA (FNA- group). RESULTS: All 54 lesions were visible on EUS, and all 54 attempts at FNA were technically successful. The diagnostic accuracy according to cyto logy and histology findings was 98.1% (53/54) and 77.8% (42/54), respectively, and the total accuracy was 98.1% (53/54). One patient developed mild pancreatitis after EUS-FNA but was successfully treated by conservative therapy. No severe complications occurred after EUS-FNA. In the FNA+ and FNA- groups, the median relapse-free survival (RFS) was 742 and 265 d, respectively (P = 0.0099), and the median overall survival (OS) was 1042 and 557 d, respectively (P = 0.0071). RFS and OS were therefore not inferior in the FNA+ group. These data indicate that the use of EUS-FNA did not influence RFS or OS, nor did it increase the risk of peritoneal recurrence. Conclusion: In patients with resectable pancreatic cancer, preoperative EUS-FNA is a safe and accurate diagnostic method. © 2014 Baishideng Publishing Group Co., Limited. All rights reserved.
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Endoscopic ultrasound-guided rendezvous technique for difficult cannulation into the bile duct
Kawakubo K., Kawakami H., Isayama H., Sakamoto N.
Gastroenterological Endoscopy 56 ( 3 ) 504 - 514 2014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：Gastroenterological Endoscopy
The endoscopic ultrasound (EUS)-guided rendezvous technique was reported to be a useful salvage method for patients with failed cannulation. In such patients, after bile duct puncture under EUS guidance, cholangiography was obtained. Then the guidewire was inserted through the needle into the bile duct and further antegradely advanced through the papilla into the duodenum. The echoendoscope was removed leaving the guidewire in place, followed by duodenoscope insertion. Finally, the bile duct was cannulated alongside of the guidewire or over the guidewire. The EUS-guided rendezvous technique is a complicated procedure and not yet standardized due to the absence of dedicated devices. However, the EUS-guided rendezvous technique allows reliable bile duct cannulation because of bile duct access under ultrasonographic guidance compared to conventional retrograde bile duct cannulation using the ERCP technique. However, the possibility of serious complications, such as bile leak or peritonitis, should be of concern due to bile duct access through the peritoneum or retroperitoneum. To gain familiarity with various approach routes in the EUS-guided rendezvous technique is essential for a successful procedure.
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Kawakami H., Isayama H., Maguchi H., Kuwatani M., Kawakubo K., Kudo T., Abe Y., Kawahata S., Kubo K., Koike K., Sakamoto N.
Endoscopy 46 ( 2 ) 2014年2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., Kawakubo K., Eto K., Haba S., Kudo T., Abe Y., Kawahata S., Sakamoto N.
Gastrointestinal Endoscopy 79 ( 2 ) 338 - 343 2014年2月
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Acute pancreatitis caused by Anisakis 査読あり
Yamato H., Kawakami H., Takagi K., Ogawa K., Hatanaka K., Yamamoto Y., Naruse H., Kawakubo K., Sakamoto N.
Gastrointestinal Endoscopy 79 ( 4 ) 676 - 678 2014年1月
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Kawakami H., Abo D., Kawakubo K., Kuwatani M., Yoshino Y., Kubota Y., Abe Y., Kawahata S., Kubo K., Sakuhara Y., Shirato H., Sakamoto N.
Endoscopy 46 E460 - E461 2014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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Kawakubo K., Kawakami H., Kuwatani M., Sakamoto N.
American Journal of Gastroenterology 109 ( 3 ) 446 - 447 2014年1月
記述言語：日本語 掲載種別：研究論文（学術雑誌）
DOI： 10.1038/ajg.2013.468
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Kawakami H., Kuwatani M., Sakamoto N.
Digestive Endoscopy 26 ( 1 ) 121 - 122 2014年1月
記述言語：日本語 掲載種別：研究論文（学術雑誌）
DOI： 10.1111/den.12180
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Kawakami H., Kuwatani M., Kawakubo K., Kudo T., Abe Y., Kubo K., Kubota Y., Sakamoto N.
Endoscopy 46 ( SUPPL. 1 ) 2014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., Kawakubo K., Kuwatani M., Kubota Y., Abe Y., Kawahata S., Kubo K., Sakamoto N.
Endoscopy 46 E982 - E983 2014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., Kawakubo K., Kubota Y., Abe Y., Kawahata S., Kubo K., Sakamoto N.
Endoscopy 46 E517 - E518 2014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., Kawakubo K., Kudo T., Abe Y., Kubo K., Sakamoto N.
Endoscopy 46 ( SUPPL 1 ) 2014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., Okamoto M., Kuwatani M., Kubota Y., Kawakubo K., Abe Y., Kawahata S., Kubo K., Sakamoto N.
Endoscopy 46 E566 - E567 2014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., Kawakubo K., Kudo T., Abe Y., Kubo K., Kubota Y., Sakamoto N.
Endoscopy 46 E406 - E407 2014年1月
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Kuwatani M., Kawakami H., Hayashi T., Eto K., Yamato H., Onodera M., Naruse H., Oba K.
Endoscopic Ultrasound 3 ( 3 ) 167 - 173 2014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：Endoscopic Ultrasound
Background and Objective: Antispasmodic drugs (ADs) have been used to reduce examination time or improve the quality of gastrointestinal endoscopy, although the practice is controversial. No evidence about the efficacy of AD for endoscopic ultrasonography/EUS-guided fine-needle aspiration (EUS/EUS-FNA) is available. This study was aimed to evaluate the efficacy of AD in EUS/EUS-FNA. Patients and Methods: A total of 400 patients with pancreaticobiliary, peripancreatic, or peribiliary disease or disorder undergoing EUS/EUS-FNA were prospectively and evenly randomized to undergo EUS/EUS-FNA with AD (w-AD) or without AD (w/o-AD). The primary endpoint was total EUS/EUS-FNA examination time. The secondary endpoints were visual analogue scale (VAS) scores of endoscopists (patient body motion, gastrointestinal peristalsis, and accomplishment of the purpose) and patients (pain, discomfort, and willingness to undergo re-examination), vital sign changes, adverse events, and sedative dose. Results: Two hundred patients in the w-AD group and 197 patients in the w/o-AD group were ultimately analyzed. The total examination time was similar between the groups (2299 ± 937 vs. 2259 ± 1019 s). The difference in total examination time from w/o-AD group to w-AD group was -40 s (95% confidence interval, -234-153 s), which was within the noninferiority margin. No statistical differences were observed in endoscopist and patient VAS scores, changes in vital signs, adverse events, or total sedative dose other than fentanyl between the groups. Conclusion: EUS/EUS-FNA can be effectively and safely performed w/o-AD. Further, randomized controlled trials on EUS/EUS-FNA in various disease entities may be required to confirm the results of this study (UMIN000008047).
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Kubota Y., Kawakami H., Natsuizaka M., Kawakubo K., Marukawa K., Kudo T., Abe Y., Kubo K., Kuwatani M., Hatanaka Y., Mitsuhashi T., Matsuno Y., Sakamoto N.
Journal of Gastroenterology 50 ( 2 ) 203 - 210 2014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 Gastroenterology
© 2014, Springer Japan. Background: Solid-pseudopapillary neoplasm (SPN), a rare neoplasm of the pancreas, frequently harbors mutations in exon 3 of the cadherin-associated protein beta 1 (CTNNB1) gene. Here, we analyzed SPN tissue for CTNNB1 mutations by deep sequencing using next-generation sequencing (NGS). Methods: Tissue samples from 7 SPNs and 31 other pancreatic lesions (16 pancreatic ductal adenocarcinomas (PDAC), 11 pancreatic neuroendocrine tumors (PNET), 1 acinar cell carcinoma, 1 autoimmune pancreatitis lesion, and 2 focal pancreatitis lesions) were analyzed by NGS for mutations in exon 3 of CTNNB1. Results: A single-base-pair missense mutations in exon 3 of CTNNB1 was observed in all 7 SPNs and in 1 of 11 PNET samples. However, mutations were not observed in the tissue samples of any of the 16 PDAC or other four pancreatic disease cases. The variant frequency of CTNNB1 ranged from 5.4 to 48.8 %. Conclusions: Mutational analysis of CTNNB1 by NGS is feasible and was achieved using SPN samples obtained by endoscopic ultrasound-guided fine needle aspiration.
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Nakai Y., Isayama H., Mukai T., Itoi T., Maetani I., Kawakami H., Yasuda I., Maguchi H., Ryozawa S., Hanada K., Hasebe O., Ito K., Kawamoto H., Mochizuki H., Igarashi Y., Irisawa A., Sasaki T., Togawa O., Hara T., Kamada H., Toda N., Hamada T., Kogure H.
Journal of Gastroenterology 48 ( 11 ) 1293 - 1299 2013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：Journal of Gastroenterology
Background: In patients with unresectable malignant biliary obstruction (MBO), anticancer treatment is often administered. The impact of anticancer treatment on recurrent biliary obstruction in covered self-expandable metallic stents (SEMS) has not been fully elucidated. Methods: Data on 279 patients enrolled in a multicenter prospective cohort study of two different covered SEMS for distal MBO, WATCH study (141 partially covered WallFlex stents and 138 partially covered Wallstents) were retrospectively analyzed. The rates and causes of recurrent biliary obstruction (stent occlusion or migration) were compared between anticancer treatment group (n = 173) and best supportive care alone (BSC) group (n = 106). Cumulative time and prognostic factors for recurrent biliary obstruction were analyzed, using a proportional hazards model with death without recurrent biliary obstruction as a competing risk. Results: The overall rate (43 vs. 25 %, P = 0.002) and the cumulative incidence (16.1 vs. 8.2, 27.9 vs. 18.9 and 44.1 vs. 26.6 % at 3, 6 and 12 months, P = 0.030 by Gray's test) of recurrent biliary obstruction were significantly higher in anticancer treatment group compared with BSC group. The multivariate analysis revealed anticancer treatment [subdistribution hazard ratio (SHR) 1.93, P = 0.007) as well as the use of a partially covered WallFlex stent (SHR 0.65, P = 0.049) as prognostic factors. Conclusions: Anticancer treatment was a risk factor for recurrent biliary obstruction in covered SEMS for distal MBO. The superiority of a partially covered WallFlex stent was again confirmed in this competing risk analysis; UMIN-CTR: UMIN000002293. © 2013 Springer Japan.
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Kobayashi T., Ozasa M., Miyashita K., Saga A., Miwa K., Saito M., Morioka M., Takeuchi M., Takenouchi N., Yabiku T., Kanno H., Yuzawa S., Tanino M., Tanaka S., Kawakami H., Asaka M., Sakamoto N.
Internal Medicine 52 ( 18 ) 2051 - 2056 2013年9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：Internal Medicine
Solid-pseudopapillary neoplasms (SPN) are rare pancreatic tumors. The etiology of SPN involves mutations in the gene that encodes β-catenin (CTNNB1). We herein report the case of a 23-year-old woman with a large SPN with proliferating tumor cells that displayed both solid and pseudo-papillary patterns. The simultaneous nuclear accumulation and loss of membrane localization of β-catenin and E-cadherin was specifically observed in the tumor cells. Further, the tumor cells were shown to harbor a missense mutation in exon 3 of CTNNB1. We also present a review of the literature describing the clustering of CTNNB1 mutations in patients with SPN. © 2013 The Japanese Society of Internal Medicine.
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Haba S., Yamao K., Bhatia V., Mizuno N., Hara K., Hijioka S., Imaoka H., Niwa Y., Tajika M., Kondo S., Tanaka T., Shimizu Y., Yatabe Y., Hosoda W., Kawakami H., Sakamoto N.
Journal of Gastroenterology 48 ( 8 ) 973 - 981 2013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：Journal of Gastroenterology
Background: Several studies have investigated the diagnostic accuracy of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) for pancreatic lesions, but they have included only limited patient populations. This study aimed to clarify the diagnostic accuracy of EUS-FNA in a large number of pancreatic lesions, and to describe the factors that influence it. Methods: From March 1997 to May 2010, 944 consecutive patients who had undergone EUS-FNA for pancreatic solid lesions were evaluated retrospectively. Factors affecting EUS-FNA accuracy were then analyzed. Results: A total of 996 solid pancreatic lesions were sampled by EUS-FNA. The overall sampling adequacy and diagnostic accuracy of these lesions were 99.3 % (989/996) and 91.8 % (918/996), respectively. The sensitivity and specificity for differentiating malignant from benign lesions were 91.5 % (793/867) and 97.7 % (126/129), respectively. The diagnostic performance was significantly higher when both cytological and cell-block examinations were carried out than with only cytological examination. In multivariate analysis, final diagnosis, location of lesion, lesion size, availability of on-site cytopathological evaluation, and experience of EUS-FNA procedure were independent factors affecting the accuracy of EUS-FNA. On-site cytopathological evaluation and lesion size were found to be the most weighted factors affecting diagnostic accuracy. Conclusions: EUS-FNA for pancreatic solid lesions yielded a high accuracy and low complication rate. Both cytological and cell-block preparations and on-site cytopathological evaluation contributed to improve the accuracy. The diagnostic ability of EUS-FNA was less for smaller lesions, and repeated procedures may be needed if malignancy is suspected. © 2012 Springer Japan.
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Catheter tract recurrence after percutaneous biliary drainage for hilar cholangiocarcinoma 査読あり
Kawakami H.
World Journal of Surgery 37 ( 7 ) 1743 - 1744 2013年7月
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Kawakami H., Kuwatani M., Sakamoto N.
Digestive Endoscopy 25 ( 4 ) 2013年7月
記述言語：日本語 掲載種別：研究論文（学術雑誌）
DOI： 10.1111/den.12090
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Yasuda I., Nakashima M., Iwai T., Isayama H., Itoi T., Hisai H., Inoue H., Kato H., Kanno A., Kubota K., Irisawa A., Igarashi H., Okabe Y., Kitano M., Kawakami H., Hayashi T., Mukai T., Sata N., Kida M., Shimosegawa T.
Endoscopy 45 ( 8 ) 627 - 634 2013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：Endoscopy
Background and study aims: Only a few large cohort studies have evaluated the efficacy and safety of endoscopic necrosecto my for infected walled-off pancreatic necrosis (WOPN). Therefore, a multicenter, large cohort study was conducted to evaluate the efficacy and safety of endoscopic necrosectomy and to examine the procedural details and follow-up after successful endoscopic necrosectomy. Patients and methods: A retrospective review was conducted in 16 leading Japanese institutions for patients who underwent endoscopic necrosectomy for infected WOPN between August 2005 and July 2011. The follow-up data were also reviewed to determine the long-term outcomes of the procedures. Results: Of 57 patients, 43 (75 %) experienced successful resolution after a median of 5 sessions of endoscopic necrosectomy and 21 days of treatment. Complications occurred in 19 patients (33 %) during the treatment period. Six patients died (11 %): two due to multiple organ failure and one patient each from air embolism, splenic aneurysm, hemorrhage from a Mallory - Weiss tear, and an unknown cause. Of 43 patients with successful endoscopic necrosectomy, recurrent cavity formation was observed in three patients during a median follow-up period of 27 months. Conclusions: Endoscopic necrosectomy can be an effective technique for infected WOPN and requires a relatively short treatment period. However, serious complications can arise, including death. Therefore, patients should be carefully selected, and knowledgeable, skilled, and experienced operators should perform the procedure. Further research into safer technologies is required in order to reduce the associated morbidity and mortality. © Georg Thieme Verlag KG Stuttgart · New York.
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Doi S., Yasuda I., Kawakami H., Hayashi T., Hisai H., Irisawa A., Mukai T., Katanuma A., Kubota K., Ohnishi T., Ryozawa S., Hara K., Itoi T., Hanada K., Yamao K.
Endoscopy 45 ( 5 ) 362 - 369 2013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
Background and study aims: No prospective comparison of endoscopic ultrasonography-guided direct celiac ganglia neurolysis (EUS - CGN) vs. EUS-guided celiac plexus neurolysis (EUS - CPN) has been reported. The aim of the current study was to compare the effectiveness of EUS - CGN and EUS - CPN in providing pain relief from upper abdominal cancer pain in a multicenter randomized controlled trial. Patients and methods: Patients with upper abdominal cancer pain were randomly assigned to treatment using either EUS - CGN or EUS - CPN. Evaluation was performed at Day 7 postoperatively using a pain scale of 0 to 10. Patients for whom pain decreased to ≤ 3 were considered to have a positive response, and those experiencing a decrease in pain to ≤ 1 were considered to be completely responsive. Comparison between the two groups was performed using intention-to-treat analysis. The primary endpoint was the difference in treatment response rates between EUS - CGN and EUS - CPN at postoperative Day 7. Secondary endpoints included differences in complete response rates, pain scores, duration of pain relief, and incidence of adverse effects. Results: A total of 34 patients were assigned to each group. Visualization of ganglia was possible in 30 cases (88 %) in the EUS - CGN group. The positive response rate was significantly higher in the EUS - CGN group (73.5 %) than in the EUS - CPN group (45.5 %; P = 0.026). The complete response rate was also significantly higher in the EUS - CGN group (50.0 %) than in the EUS - CPN group (18.2 %; P = 0.010). There was no difference in adverse events or duration of pain relief between the two groups. Conclusions: EUS - CGN is significantly superior to conventional EUS - CPN in cancer pain relief. Clinical trial registration: http://www.umin.ac.jp/ctr/index.htm (ID: UMIN-000002536). © Georg Thieme Verlag KG Stuttgart - New York.
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Kawakami H., Kuwatani M., Sakamoto N.
Digestive Endoscopy 25 ( 3 ) 339 - 340 2013年5月
記述言語：日本語 掲載種別：研究論文（学術雑誌）
DOI： 10.1111/den.12034
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Kawakami H., Kuwatani M., Sakamoto N.
Digestive Endoscopy 25 ( 3 ) 343 - 344 2013年5月
記述言語：日本語 掲載種別：研究論文（学術雑誌）
DOI： 10.1111/den.12051
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Yamamoto N., Isayama H., Kawakami H., Sasahira N., Hamada T., Ito Y., Takahara N., Uchino R., Miyabayashi K., Mizuno S., Kogure H., Sasaki T., Nakai Y., Kuwatani M., Hirano K., Tada M., Koike K.
Gastrointestinal Endoscopy 77 ( 5 ) 809 - 814 2013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：Gastrointestinal Endoscopy
Background: Endoscopic transluminal treatment of pancreatic fluid collections (PFC) has been reported as an effective alternative approach to surgical treatment. A wide, short stent with an anti-migration system has been developed. Objective: To evaluate a newly developed, fully covered, self-expandable metal stent (FCSEMS) customized for cystogastrostomy. Design: Retrospective case series. Setting: Tertiary-care academic medical centers and affiliated hospitals. Patients: Nine patients who underwent endoscopic treatment of PFCs (5 with pseudocysts and 4 with walled-off pancreatic necrosis). Intervention: Stent deployment after endoscopic US-guided puncture. Irrigation and necrosectomy were performed at the discretion of the endoscopist. Main Outcome Measurements: Technical and clinical success rate, complications, and removability. Results: The FCSEMS was inserted successfully in all cases (9/9, 100%). Clinical success was achieved in 7 of 9 cases (77.8%). No early complications associated with the procedure were observed. Late complications were observed in 2 cases (bleeding and asymptomatic migration). The FCSEMS was removed without any complications in all 6 cases where it was attempted after the procedure had been completed (100%). Limitations: This was a retrospective evaluation of a small number of cases. The FCSEMS was always inserted via the transgastric route. Follow-up duration was short. Conclusion: The endoscopic approach that uses this new FCSEMS is feasible for the treatment of PFCs. However, further evaluation is required. © 2013 American Society for Gastrointestinal Endoscopy.
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Eto K., Kawakami H., Kuwatani M., Kudo T., Abe Y., Kawahata S., Takasawa A., Fukuoka M., Matsuno Y., Asaka M., Sakamoto N.
British Journal of Cancer 108 ( 7 ) 1488 - 1494 2013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：British Journal of Cancer
Background:Pancreatic ductal carcinoma (PDC) is one of the most lethal human carcinomas. Expression patterns of some genes may predict gemcitabine (GEM) treatment efficacy. We examined predictive indicators of survival in GEM-treated patients by quantifying the expression of several genes in pre-treatment endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) samples from patients with PDC.Methods:The expressions of human equilibrative nucleoside transporter 1 (hENT1), deoxycitidine kinase, ribonucleoside reductase 1, ribonucleoside reductase 2 and Notch3 in EUS-FNA tissue samples from 71 patients with unresectable PDC were quantified using real-time reverse transcription-polymerase chain reactions and examined for correlations with GEM sensitivity.Results:The log-rank test detected no significant differences in overall survival between GEM-treated patients with low and high mRNA levels of all genes examined. However, low Notch3 mRNA expression was significantly associated with longer overall survival in a multivariate analysis for survival (P=0.0094). High hENT1 expression level was significantly associated with a longer time to progression (P=0.039). Interaction tests for GEM administration and hENT1 or Notch3 mRNA expression were statistically significant (P=0.0054 and 0.0047, respectively).Conclusion:hENT1 and Notch3 mRNA expressions in EUS-FNA specimens were the key predictive biomarkers of GEM effect and GEM sensitivity in patients with unresectable PDC. © 2013 Cancer Research UK. All rights reserved.
DOI： 10.1038/bjc.2013.108
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Isayama H., Nakai Y., Kawakubo K., Kawakami H., Itoi T., Yamamoto N., Kogure H., Koike K.
Journal of hepato-biliary-pancreatic sciences 20 ( 4 ) 413 - 420 2013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
Steady progress is being made in endoscopic biliary intervention, especially endoscopic ultrasonography (EUS)-guided procedures. The EUS-guided rendezvous technique (EUS-RV) is a salvage method for failed selective biliary cannulation. The overall success rate of EUS-RV in 247 cases from seven published articles was 74 % and the incidence of complications was 11 %. The main cause of failed rendezvous cannulation was difficulty passing a biliary stricture or papilla due to poor guidewire (GW) manipulation. A recent large study found a 98.3 % success rate and superiority to precutting. This report suggested using a hydrophilic guidewire. Major complications were bleeding (0.8 %), bile leakage (1.2 %), peritonitis (0.4 %), pneumoperitoneum (0.2 %), and pancreatitis (1.6 %). The approach routes for EUS-RV were transgastric, transduodenal short position, and transduodenal long position. The appropriate route for each patient should be used. GW selection for EUS-RV is critical, and a hydrophilic GW might be the most useful. The catheter can be inserted through the papilla alongside or over the wire. Alongside cannulation is convenient, but difficult. The problem with the over-the-wire technique is withdrawal of the GW in the accessory channel. EUS-RV is effective and safe, but is not established. The efficacy should be confirmed in a prospective comparative trial, and the necessary specialist equipment should be developed.
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Matsusaki S., Kikuyama M., Kawakami H., Kubota K., Maguchi H.
Journal of Japanese Society of Gastroenterology 110 ( 4 ) 615 - 621 2013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 Japanese Society of Gastroenterology
To clarify the clinical features and CT findings of IgG4-related sclerosing cholangitis (IgG4-SC), we reviewed 16 cases of IgG4-SC and 10 cases of cholangiocarcinoma concerning patient background, treatment, outcomes and CT findings. The median age of IgG4-SC cases was 70 (range 54-79) years, and only 1 was a woman. Serum IgG4 level of all IgG4-SC patients were elevated and in 13 patients steroid therapy proved effective. The CT findings were analyzed with regard to the biliary strictures (symmetry, outer margin, inner margin), wall enhancement pattern and pancreas size. The CT findings of symmetric wall thickness and total scores were significantly higher in IgG4-SC than in cholangiocarcinoma. Although the small number of patients in this study is a limitation, the CT findings may help distinguish IgG4-SC from cholangiocarcinoma.
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The role of peroral video cholangioscopy in patients with IgG4-related sclerosing cholangitis 査読あり
Itoi T., Kamisawa T., Igarashi Y., Kawakami H., Yasuda I., Itokawa F., Kishimoto Y., Kuwatani M., Doi S., Hara S., Moriyasu F., Baron T.
Journal of Gastroenterology 48 ( 4 ) 504 - 514 2013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 Gastroenterology
Background The cholangioscopic features of IgG4-related sclerosing cholangitis (IgG4-SC) remain undefined. The aim of this study was to clarify these endoscopic features using peroral video cholangioscopy (PVCS) in IgG4-SC patients. Methods PVCS was performed in 33 patients: IgG4-SC (n = 13); primary sclerosing cholangitis (PSC; n = 5); and cholangiocarcinoma (n = 15), which included hilar cholangiocarcinoma (HCCA; n = 5) and distal cholangiocarcinoma (DCCA; n = 10). Results The most frequent findings on PVCS in the IgG4- SC patients were dilated (62 %) and tortuous (69 %) vessels, and absence of partially enlarged vessels. The incidence of dilated and tortuous vessels was significantly higher in IgG4-SC patients than in PSC patients (p = 0.015). Scarring and pseudodiverticula were found significantly more often in PSC patients than in IgG4-SC patients (p = 0.001 and p = 0.0007, respectively). The incidence of partially enlarged vessels was significantly higher in DCCA patients than in IgG4-SC patients (p = 0.004). In contrast, the incidence of dilated vessels was significantly higher in IgG4-SC patients than in HCCA patients (p = 0.015). PVCS performed after corticosteroid therapy showed resolution of bile duct stenosis and dilated, tortuous, or partially enlarged vessels, as well as resolution of friability in all patients with IgG4-SC. Conclusion Cholangioscopy was useful in differentiating IgG4-SC from PSC. In addition, monitoring the patterns of proliferative vessels on PVCS may be useful to differentiate IgG4-SC from cholangiocarcinoma. © Springer 2012.
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Spontaneous intraductal stent migration after endoscopic ultrasound-guided choledochogastrostomy 査読あり
Kawakubo K., Kawakami H., Kuwatani M., Haba S., Kudo T., Abe Y., Sakamoto N.
Endoscopy 45 ( SUPPL.2 ) 2013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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Kuwatani M., Kawakami H., Sakamoto N.
Digestive Endoscopy 25 ( 2 ) 2013年3月
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Kawakubo K., Kawakami H., Sakamoto N.
Pancreatology 13 ( 1 ) 2013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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Response 査読あり
Kawakami H., Isayama H., Maguchi H., Kuwatani M., Nakai Y., Kawakubo K., Haba S., Kudo T., Abe Y., Koike K., Sakamoto N.
Gastrointestinal Endoscopy 76 ( 4 ) 920 - 921 2012年10月
記述言語：英語 掲載種別：研究論文（学術雑誌）
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Kawakami H., Kuwatani M., Eto K., Kudo T., Tanaka E., Hirano S.
World Journal of Surgery 36 ( 9 ) 2265 - 2266 2012年9月
記述言語：日本語 掲載種別：研究論文（学術雑誌）
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Itoi T., Isayama H., Sofuni A., Itokawa F., Tamura M., Watanabe Y., Moriyasu F., Kahaleh M., Habib N., Nagao T., Yokoyama T., Kasuya K., Kawakami H.
Journal of Hepato-Biliary-Pancreatic Sciences 19 ( 5 ) 543 - 547 2012年9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 Hepato-Biliary-Pancreatic Sciences
Background: The effects of ablation with various settings of powers and times using a newly developed radiofrequency (RF) ablation device, the HabibTM EndoHPB catheter, are not well known. In the present study, we examined the effects of a novel RF ablation catheter using resected fresh pig livers and evaluated the macroand microscopic effects of RF ablation under various conditions. Materials and methods: The RF application was performed step by step at 5, 10, 15, and 20 W power and 60, 90, 120 s, respectively. Macroscopic and microscopic findings of the ablation area were evaluated at each setting. Results The mean lengths of the short axis of the ablation area at 10 W and 60, 90 and 120 s were 8.0 ± 1.0, 8.3 ± 1.2, and 9.7 ± 0.6 mm, respectively. The mean lengths of the long axis at 10 W power and 60, 90 and 120 s were 20.3 ± 0.6, 21.3 ± 1.6, and 28.3 ± 2.1 mm, respectively. Although the lengths of the short and long axes at 5 and 10 W increased gradually with power, there were no obvious differences in either short or long axis lengths between 15 and 20 W. Of all the settings, only at 5 W and 60 and 90 s did the long axis of the ablation show separate areas around the 2 ring electrodes. Conclusions: Although other sequelae including hemorrhage, pancreatitis, acute inflammatory changes, perforation and late fibrosis could not be investigated in our ex-vivo pig model, our study clarified the relationship between ablation powers and times and the effects concerning depth and longitudinal spread of ablation. Although the clinical ablation setting at 7-10 W power and 2 min is suitable, ultimately the ablation power and time should be adjusted according to the size of masses using examples from the present results. © Japanese Society of Hepato-Biliary-Pancreatic Surgery and Springer 2011.
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Wire-guided cannulation is not an ideal technique for preventing post-ERCP pancreatitis 査読あり
Kawakami H., Isayama H., Kuwatani M., Eto K., Kudo T., Abe Y., Kawahata S., Nakai Y., Sasahira N., Koike K., Kato M.
Gastrointestinal Endoscopy 76 ( 1 ) 2012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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Isayama H., Mukai T., Itoi T., Maetani I., Nakai Y., Kawakami H., Yasuda I., Maguchi H., Ryozawa S., Hanada K., Hasebe O., Ito K., Kawamoto H., Mochizuki H., Igarashi Y., Irisawa A., Sasaki T., Togawa O., Hara T., Kamada H., Toda N., Kogure H.
Gastrointestinal Endoscopy 76 ( 1 ) 84 - 92 2012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：Gastrointestinal Endoscopy
Background: Covered self-expandable metal stents (CSEMSs) were developed to prevent tumor ingrowth, but stent migration is one of the problems with CSEMSs. Objective: To evaluate a new, commercially available CSEMS with flared ends and low axial force compared with a commercially available CSEMS without the anti-migration system and high axial force. Design: Multicenter, prospective study with a historical cohort. Setting: Twenty Japanese referral centers. Patients: This study involved patients with unresectable distal malignant biliary obstruction. Intervention: Placement of a new, commercially available, partially covered SEMS. Main Outcome Measurements: Recurrent biliary obstruction rate, time to recurrent biliary obstruction, stent-related complications, survival. Results: Between April 2009 and March 2010, 141 patients underwent partially covered nitinol stent placement, and between May 2001 and January 2007, 138 patients underwent placement of partially covered stainless stents as a historical control. The silicone cover of the partially covered nitinol stents prevented tumor ingrowth. There were no significant differences in survival (229 vs 219 days; P = .250) or the rate of recurrent biliary obstruction (33% vs 38%; P = .385) between partially covered nitinol stents and partially covered stainless stents. Stent migration was less frequent (8% vs 17%; P = .019), and time to recurrent biliary obstruction was significantly longer (373 vs 285 days; P = .007) with partially covered nitinol stents. Stent removal was successful in 26 of 27 patients (96%). Limitations: Nonrandomized, controlled trial. Conclusion: Partially covered nitinol stents with an anti-migration system and less axial force demonstrated longer time to recurrent biliary obstruction with no tumor ingrowth and less stent migration. (Clinical trial registration number: UMIN000002293.) © 2012 American Society for Gastrointestinal Endoscopy.
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Preoperative biliary drainage for hilar cholangiocarcinoma
Kawakami H., Kato M., Hirano S., Sakamoto N.
Gastroenterological Endoscopy 54 ( 7 ) 1975 - 1990 2012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
The controversy over whether and how to perform preoperative biliary drainage (PBD) in patients with hilar cholangiocarcinoma (HCA) remains unsettled. Arguments against PBD before pancreatoduodenectomy have recently been gaining momentum. However, the complication-related mortality rate is as high as 5% for patients with HCA who have undergone major liver resection, and liver failure is a major cause of postoperative death. This suggests the need for PBD to treat jaundice in HCA patients scheduled for major surgical resection of the liver and to perform major surgery only after recovery of the hepatic function. However, no definite criteria or guidelines outlining indications for PBD are currently available. In patients with HCA, PBD may be performed by either percutaneous transhepatic biliary drainage (PTBD) or endoscopic biliary drainage (EBD). No consensus has been reached regarding which PBD method is more appropriate. No reported study has compared the effectiveness of PTBD, endoscopic biliary stenting and endoscopic nasobiliary drainage in patients with HCA. Recently, a few Japanese high-volume centers have recommended EBD of the future remnant lobe for PBD in patients expected to undergo definitive surgery for HCA. This review summarizes the purpose, transition, current situation, and future of PBD in HCA patients undergoing PBD.
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Onodera M., Kawakami H., Kuwatani M., Kudo T., Haba S., Abe Y., Kawahata S., Eto K., Nasu Y., Tanaka E., Hirano S., Asaka M.
Surgical Endoscopy and Other Interventional Techniques 26 ( 6 ) 1710 - 1717 2012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：Surgical Endoscopy and Other Interventional Techniques
Background Endoscopic ultrasound (EUS)-guided drainage is widely used to manage pancreatic pseudocysts. Several studies have reported the use of EUS-guided drainage for pancreatic fistula and stasis of pancreatic juice caused by stricture of the pancreatic duct after pancreatic resection. Methods At the authors' hospital, 262 patients underwent surgery involving pancreatic resection from April 2005 to March 2010. In 90 of these patients (34%), a grade B or C postoperative pancreatic fistula developed that required additional treatment. The authors performed EUS-guided transmural drainage (EUS-TD) for six patients (2.1%) with a pancreatic fistula or dilation of the main pancreatic duct visible by EUS. Percutaneous drainage was provided for 18 patients (6.8%). The success rates for EUS-TD and percutaneous drainage were compared in a retrospective analys is. Results In all six cases, EUS-TD was performed successfully without complications. Five of the six patients were successfully treated with only one trial of EUS-TD. The final technical success rate was 100% for both EUSTD and percutaneous drainage. Both the short- and longterm clinical success rates for EUS-TD were 100% and those for percutaneous drainage were 61.1 and 83%, respectively. The differences in these rates were not significant (short-term success, P = 0.091 vs. long-term success, P = 0.403). However, the time to clinical success was significantly shorter with EUS-TD (5.8 days) than with percutaneous drainage (30.4 days; P = 0.0013) in the current series. Conclusions The EUS-TD approach appears to be a safe and technically feasible alternative to percutaneous drainage and may be considered as first-line therapy for pancreatic fistulas visible by EUS. © 2011 Springer Science+Business Media, LLC.
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Kuwatani M., Kawakami H., Kato M.
Internal Medicine 51 ( 10 ) 2012年5月
記述言語：日本語 掲載種別：研究論文（学術雑誌）
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Covered metallic stent for ischemic hilar biliary stricture
Kawakami H., Kuwatani M., Eto K., Kudo T., Asaka M.
Digestive Endoscopy 24 ( SUPPL. 1 ) 49 - 54 2012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：Digestive Endoscopy
Compared with surgery, endoscopic treatment is safe and highly effective for a postoperative hilar benign bile duct stricture (BDS). However, the long-term outcome of conventional placement of a single biliary stent for hilar benign BDS is generally poor. Although the placement of multiple biliary stents is preferred, multiple stenting in a BDS is difficult. Alternatively, single or multiple stent placement above the papilla ('inside stent') or fully-covered self-expandable metallic stents (SEMS) are feasible approaches for benign BDS. Nevertheless, controversy remains regarding whether and how to perform endoscopic biliary drainage for a hilar benign BDS. In patients with hilar benign BDS, endoscopic biliary drainage can be performed by placing conventional plastic stents across the papilla, plastic stents above the papilla or fully-covered SEMS. Individualized treatment should be considered. We report the placement of a fully-covered SEMS for a hilar benign biliary stricture after extended left hepatectomy. © 2012 Japan Gastroenterological Endoscopy Society.
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Resolution of a refractory severe biliary stricture using a diathermic sheath 査読あり
Kawakami H., Kuwatani M., Eto K., Kudo T., Abe Y., Kawahata S., Kato M.
Endoscopy 44 ( SUPPL. 2 ) 2012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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Kawakami H., Maguchi H., Mukai T., Hayashi T., Sasaki T., Isayama H., Nakai Y., Yasuda I., Irisawa A., Niido T., Okabe Y., Ryozawa S., Itoi T., Hanada K., Kikuyama M., Arisaka Y., Kikuchi S.
Gastrointestinal Endoscopy 75 ( 2 ) 362 - 372 2012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：Gastrointestinal Endoscopy
Background: Wire-guided cannulation (WGC) with a sphincterotome (S) for selective bile duct cannulation (SBDC) has been reported to have a higher success rate and lower incidence of post-ERCP pancreatitis (PEP) than conventional methods in some randomized, controlled trials (RCTs) that were both single center and limited to only a few endoscopists. Objective: To estimate the difference in SBDC according to the method and catheter used in a multicenter and multiendoscopist study. Design: A prospective, multicenter RCT with a 2 × 2 factorial design. Setting: Fifteen referral endoscopy units. Patients: In total, 400 consecutive patients with naive papillae who were candidates for ERCP were enrolled and randomized. Interventions: Patients were assigned to 4 groups according to combined catheter (S or catheter [C]) and method (with/without guidewire [GW] ). Main Outcome Measurements: Success rate of SBDC performed in 10 minutes, SBDC time, fluoroscopy time, and incidence of complications. Results: There was no significant difference in the SBDC success rate between the groups with and without GW, between C and S, or among the 4 groups (C+GW, C, S+GW, S). WGC had a tendency to significantly shorten ca nnulation and fluoroscopy times only in approximately 70% of patients in this study in whom SBDC was achieved in 10 minutes or less (P =.036 and.00004, respectively). All 4 groups resulted in similar outcomes in PEP (4%, 5.9%, 2%, and 2.1%, respectively). Limitations: Nondouble-blind study. Conclusions: WGC appears to significantly shorten cannulation and fluoroscopy times. However, neither the method nor type of catheter used resulted in significant differences in either SBDC success rate or incidence of PEP in this RCT. © 2012 American Society for Gastrointestinal Endoscopy.
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Kawakami H., Kuwatani M., Tanaka E., Hirano S.
Journal of Gastroenterology 47 ( 1 ) 90 - 91 2012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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Kuwatani M., Kawakami H., Hayashi T., Ishiwatari H., Kudo T., Yamato H., Ehira N., Haba S., Eto K., Kato M., Asaka M.
Surgical Endoscopy and Other Interventional Techniques 25 ( 12 ) 3784 - 3790 2011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：Surgical Endoscopy and Other Interventional Techniques
Background: Endoscopic retrograde cholangiopancreatography (ERCP) and related procedures can cause abdominal pain and discomfort. Two clinical trials have indicated, using the visual analogue scale (VAS) score, that CO 2 insufflation during ERCP ameliorates the suffering of patients without complications, compared with air insufflation. However, differences in patient suffering between CO 2 and air insufflation after ERCP under deep conscious sedation have not been reported. We focused on the gas volume score (GVS) as an objective indicator of gas volume, and designed a multicenter, prospective, double-blind, randomized, controlled study with CO 2 and air insufflation during ERCP. Methods: Between March 2010 and August 2010, 80 patients who required ERCP were enrolled and evenly randomized to receive CO 2 insufflation (CO 2 group) or air insufflation (air group). ERCP and related procedures were performed under deep conscious sedation with fentanyl citrate or pethidine and midazolam or diazepam. The GVS was evaluated as the primary endpoint in addition to the VAS score as the secondary endpoint. Results: The GVS after ERCP and related procedures in the CO 2 group was significantly lower than that in the air group (0.14 ± 0.06 vs. 0.31 ± 0.11, P < 0.01), as well as the rate of increase in GVS ([GVS after - GVS before]/[GVS before ERCP and related procedures] × 100) (3.8 ± 5.9 vs. 21 ± 11.1%, P < 0.01). VAS scores 3 and 24 h after ERCP and related procedures were comparable between the CO 2 and air groups for abdominal pain, abdominal distension, and nausea. Additionally, VAS scores were not correlated with the GVS. Conclusions: CO 2 insufflation during ERCP reduces GVS (bowel gas volume) but not the VAS score of suffering compared with air insufflation. Deep and sufficient sedation during ERCP and related procedures is important for the palliation of patients' pain and discomfort. © 2011 Springer Science+Business Media, LLC.
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Sofuni A., Maguchi H., Mukai T., Kawakami H., Irisawa A., Kubota K., Okaniwa S., Kikuyama M., Kutsumi H., Hanada K., Ueki T., Itoi T.
Clinical Gastroenterology and Hepatology 9 ( 10 ) 851 - 858 2011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：Clinical Gastroenterology and Hepatology
Background & Aims: Pancreatitis is the most common and potentially serious complication of post-endoscopic retrograde cholangiopancreatography (ERCP). Post-ERCP pancreatitis (PEP) is caused mostly by postprocedural papillary edema and retention of pancreatic juice. We conducted a randomized controlled trial to determine whether placement of a temporary-type, pancreatic duct stent prevents PEP and to identify risk factors for PEP. Methods: We analyzed data from 426 consecutive patients who underwent ERCP-related procedures at 37 endoscopic units. The patients were assigned randomly to groups that received stents (S group, n = 213) or did not (nS group, n = 213). The stent used was temporary, 5F in diameter, 3 cm long, and straight with an unflanged inner end. Results: The overall frequency of PEP was 11.3%. The frequencies of PEP in the S and nS groups were 7.9% and 15.2%, respectively; the lower incidence of PEP in the S group was statistically significant based on the full analysis set (P = .021), although there was no statistically significant differences in an intention-to-treat analysis (P = .076). There were significant differences in PEP incidence between groups in multivariate analysis for the following risk factors: pancreatography first, nonplacement of a pancreatic duct stent after ERCP, procedure time of 30 minutes or more, sampling of pancreatic tissue by any method, intraductal ultrasonography, and difficulty of cannulation (≥15 min). Patients with more than 3 risk factors had a significantly greater incidence of pancreatitis. Conclusions: Placement of a pancreatic duct stent reduces the incidence of PEP. Several risk factors are associated with PEP. © 2011 AGA Institute.
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Itoi T., Isayama H., Sofuni A., Itokawa F., Kurihara T., Tsuchiya T., Tsuji S., Ishii K., Ikeuchi N., Tanaka R., Umeda J., Moriyasu F., Kawakami H.
Journal of Hepato-Biliary-Pancreatic Sciences 18 ( 5 ) 664 - 672 2011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：Journal of Hepato-Biliary-Pancreatic Sciences
Endoscopic ultrasonography-guided biliary drainage (EUS-BD) has been carried out as an alternative to the percutaneous or surgical approach when endoscopic retrograde cholangiopancreatography fails. However, there is no standard technique or device for EUS-BD. In this review, we focus on how we choose the stents and described our tips on this EUS-BD technique. The plastic stent (PS) and the self-expandable metallic stent (SEMS) are used for EUS-BD. The latter is further divided into the fully covered SEMS (FCSEMS), partially covered SEMS (PCSEMS), and uncovered SEMS (UCSEMS) types. Although PS is not expensive, the duration of stent patency is short. SEMS is expensive but the duration of stent patency is long. With UCSEMS, basically there is no stent malpositioning; however, if the gap between the bile duct and the GI tract becomes displaced, bile leakage from the mesh of the stent is likely to occur. Though there is no bile leakage with FCSEMS, the side branch of the bile duct may become occluded, and migration and dislocation sometimes occur. PCSEMS is basically similar to FCSEMS. When EUS-BD was first developed, drainage by PS was common, although reports on drainage by SEMS have increased recently. © Japanese Society of Hepato-Biliary-Pancreatic Surgery and Springer 2011.
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Preoperative biliary drainage for hilar cholangiocarcinoma: Which stent should be selected?
Kawakami H., Kondo S., Kuwatani M., Yamato H., Ehira N., Kudo T., Eto K., Haba S., Matsumoto J., Kato K., Tsuchikawa T., Tanaka E., Hirano S., Asaka M.
Journal of Hepato-Biliary-Pancreatic Sciences 18 ( 5 ) 630 - 635 2011年9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 Hepato-Biliary-Pancreatic Sciences
The controversy over whether and how to perform preoperative biliary drainage (PBD) in patients with hilar cholangiocarcinoma (HCA) remains unsettled. Arguments against PBD before pancreatoduodenectomy have recently been gaining momentum. However, the complication-related mortality rate is as high as 10% for patients with HCA who have undergone major liver resection, and liver failure is a major cause of postoperative death. This suggests the need for PBD to treat jaundice in HCA patients scheduled f or major surgical resection of the liver and that major surgery should be performed only after the recovery of hepatic function. No definite criteria or guidelines outlining indications for PBD are currently available. In patients with HCA, PBD may be performed by either percutaneous transhepatic biliary drainage (PTBD) or endoscopic biliary drainage (EBD). No consensus, however, has been reached regarding which drainage method is more appropriate. No reported study has compared the effectiveness of PTBD, endoscopic biliary stenting (EBS), and endoscopic nasobiliary drainage (ENBD) in patients with HCA. This review summarizes the results of our study comparing the three methods and outlines the preoperative endoscopic management of segmental cholangitis (SC) in HCA patients undergoing PBD. © Japanese Society of Hepato-Biliary-Pancreatic Surgery and Springer 2011.
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Endoscopic naso-pancreatic drainage for the treatment of pancreatic fistula occurring after LDLT
Nagatsu A., Taniguchi M., Shimamura T., Suzuki T., Yamashita K., Kawakami H., Abo D., Kamiyama T., Furukawa H., Todo S.
World Journal of Gastroenterology 17 ( 30 ) 3560 - 3564 2011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
Pancreatic fistula is a quite rare complication in patients who undergo living donor liver transplantation (LDLT). However, in the cases that show pancreatic fistula, the limited volume of the graft and the resultant inadequate liver function may complicate the management of the fistula. As a result, the pancreatic fistula may result in the death of the patient. We present 2 cases in which endoscopic treatment was effective against pancreatic fistulas that developed after LDLT. In case 1, a 61-yearold woman underwent LDLT for primary biliary cirrhosis. Because of a portal venous thrombus caused by a splenorenal shunt, the patient underwent portal ve in reconstruction, and a splenorenal shunt was ligated on postoperative day (POD) 7. The main pancreatic duct was injured during the manipulation to achieve hemostasis, thereby necessitating open drainage. However, discharge of pancreatic fluid continued even after POD 300. Endoscopic naso-pancreatic drainage (ENPD) was performed, and this procedure resulted in a remarkable decrease in drain output. The refractory pancreatic fistula healed on day 40 after ENPD. In case 2, a 58-year-old man underwent LDLT for cirrhosis caused by the hepatitis C virus. When the portal vein was exposed during thrombectomy, the pancreatic head was injured, which led to the formation of a pancreatic fistula. Conservative therapy was ineffective; therefore, ENPD was performed. The pancreatic fistula healed on day 38 after ENPD. The findings in these 2 cases show that endoscopic drainage of the main pancreatic duct is a less invasive and effective treatment for pancreatic fistulas that develop after LDLT. © 2011 Baishideng. All rights reserved.
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Three cases of retroperitoneal schwannoma diagnosed by EUS-FNA 査読あり
Kudo T., Kawakami H., Kuwatani M., Ehira N., Yamato H., Eto K., Kubota K., Asaka M.
World Journal of Gastroenterology 17 ( 29 ) 3459 - 3464 2011年8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：World Journal of Gastroenterology
Schwannomas are peripheral nerve tumors that are typically solitary and benign. Their diagnosis is largely based on surgically resected specimens. Recently, a number of case reports have indicated that retroperitoneal schwannomas could be diagnosed with endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA). We report the diagnosis of three cases of schwannoma using EUS-FNA. Subjects were two males and one female, ages 22, 40, and 46 years, respectively, all of whom were symptom-free. Imaging findings showed well-circumscribed round tumors. However, as the tumors could not be diagnosed using these findings alone, EUS-FNA was performed. Hematoxylin-eosin staining of the resulting tissue fragments revealed bland spindle cells with nuclear palisading. There was no disparity in nuclear sizes. Immunostaining revealed S-100 protein positivity and all cases were diagnosed as schwannomas. Ki-67 index were 3%-15%, 2%-3%, and 3%, respectively. No case showed any signs of malignancy. As most schwannomas are benign tumors and seldom become malignant, we observed these patients without therapy. All tumors demonstrated- no enlargement and no change in characteristics. Schwannomas are almost always benign and can be observed following diagnosis by EUS-FNA. © 2011 Baishideng. All rights reserved.
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Ohshima Y., Yasuda I., Kawakami H., Kuwatani M., Mukai T., Iwashita T., Doi S., Nakashima M., Hirose Y., Asaka M., Moriwaki H.
Journal of Gastroenterology 46 ( 7 ) 921 - 928 2011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：Journal of Gastroenterology
Background: Endoscopic transpapillary brush cytology and forceps biopsy are widely used for the pathological diagnosis of suspected malignant biliary strictures (MBS). However, the sensitivity of these methods remains insufficient, and it can be difficult to confirm the diagnosis. We aimed to evaluate the diagnostic ability of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) and the impact of this technique on clinical management in patients with suspected MBS where endoscopic brush cytology and biopsy yielded negative results. Methods: This study included 225 consecutive patients with suspected MBS, who underwent endoscopic brush cytology and biopsy at our institutions. Negative results were obtained for these pathological tests in 75 patients, and EUS-FNA was performed in 22 of these patients. We retrospectively compared the EUS-FNA results with the final diagnosis and examined the infl uence of the EUS-FNA diagnosis on treatment selection. Results: FNA specimens were successfully obtained in all patients, and the pathological results confirmed malignancy in 16 cases and predicted that the other 6 cases were benign. Of the 6 cases that were suspected to be benign, 3 patients were diagnosed with xanthogranulomatous cholecystitis by surgical pathology, and the remaining 3 patients were diagnosed with benign diseases at a follow-up after 12-18 months. Thus, the EUS-FNA-based diagnosis was proven correct for all the patients. In addition, the treatment strategy was altered as a result of the EUS-FNA results in the above 6 patients (27%). Conclusions: EUS-FNA is a sensitive and safe diagnostic modality for patients with suspected MBS and can be an additional option in cases where endoscopic brush cytology and biopsy have produced negative results. © 2011 Springer.
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Kawakami H., Kuwatani M., Kudo T., Ehira N., Yamato H., Asaka M.
Endoscopy 43 ( SUPPL. 2 ) 2011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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Kawakami H., Kuwatani M., Onodera M., Haba S., Eto K., Ehira N., Yamato H., Kudo T., Tanaka E., Hirano S., Kondo S., Asaka M.
Journal of Gastroenterology 46 ( 2 ) 242 - 248 2011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：Journal of Gastroenterology
Background: Controversy exists over the preferred technique of preoperative biliary drainage (PBD) in patients with hilar cholangiocarcinoma (HCA). The goal of this retrospective study was to identify the preferred technique of PBD for HCA. Methods: A total of 128 consecutive patients with HCA diagnosed between September 1999 and December 2009 who underwent PBD were included in this study. The study compared outcomes of endoscopic nasobiliary drainage (ENBD), endoscopic biliary stenting (EBS), and percutaneous transhepatic biliary drainage (PTBD) in patients with HCA. Results: There were no significant differences in preoperative laboratory data, rates of major hepatectomy, or decompression periods among the 3 groups. Complications were significantly more frequent in the EBS group compared with either the ENBD or PTBD group (p < 0.05). Drainage tube occlusion with cholangitis was significantly more common in the EBS group compared with either the ENBD or PTBD group (p < 0.0001). Patients in the PTBD group experienced serious complications including vascular injury (8%) and cancer dissemination (4%). Patients in the ENBD and EBS groups had mild post-endoscopic retrograde cholangiopancreatography pancreatitis (5%). Conversion procedures were significantly more common in the EBS group compared with the ENBD and PTBD groups (p < 0.05). There was no significant difference in postsurgical morbidity or mortality among the 3 groups. Conclusions: Drainage tube occlusion with cholangitis was a frequent complication associated with EBS. PTBD was associated with serious complications such as vascular injury and cancer dissemination. ENBD was found to be the most suitable method for initial PBD management in patients with HCA. © 2010 Springer.
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Kobayashi T., Ishida J., Musashi M., Ota S., Yoshida T., Shimizu Y., Chuma M., Kawakami H., Asaka M., Tanaka J., Imamura M., Kobayashi M., Itoh H., Edamatsu H., Sutherland L., Brachmann R.
International Journal of Cancer 128 ( 2 ) 304 - 318 2011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：International Journal of Cancer
RBM5 (RNA-binding motif protein 5) is a nuclear RNA binding protein containing 2 RNA recognition motifs. The RBM5 gene is located at the tumor suppressor locus 3p21.3. Deletion of this locus is the most frequent genetic alteration in lung cancer, but is also found in other human cancers. RBM5 is known to induce apoptosis and cell cycle arrest but the molecular mechanisms of RBM5 function are poorly understood. Here, we show that RBM5 is important for the activity of the tumor suppressor protein p53. Overexpression of RBM5 enhanced p53-mediated inhibition of cell growth and colony formation. Expression of RBM5 augmented p53 transcriptional activity in reporter gene assays and resulted in increased mRNA and protein levels for endogenous p53 target genes. In contrast, shRNA-mediated knockdown of endogenous RBM5 led to decreased p53 transcriptional activity and reduced levels of mRNA and protein for endogenous p53 target genes. RBM5 affected protein, but not mRNA, levels of endogenous p53 after DNA damage suggest that RBM5 contributes to p53 activity through post-transcriptional mechanisms. Our results show that RBM5 contributes to p53 transcriptional activity after DNA damage and that growth suppression and apoptosis mediated by RBM5 are linked to activity of the tumor suppressor protein p53. Copyright © 2010 UICC.
DOI： 10.1002/ijc.25345
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Kawakami H., Zen Y.
Gastrointestinal Endoscopy 72 ( 6 ) 2010年12月
記述言語：日本語 掲載種別：研究論文（学術雑誌）
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Localized lymphoplasmacytic sclerosing cholecystitis in a patient with autoimmune pancreatitis
Kawakami H., Eto K., Kuwatani M., Asaka M.
Internal Medicine 49 ( 21 ) 2359 - 2360 2010年11月
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Kawakami H., Zen Y., Kuwatani M., Eto K., Haba S., Yamato H., Shinada K., Kubota K., Asaka M.
Journal of Gastroenterology and Hepatology (Australia) 25 ( 10 ) 1648 - 1655 2010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：Journal of Gastroenterology and Hepatology (Australia)
Background and Aim: Autoimmune pancreatitis is commonly associated with immunoglobulin (Ig) G4-related sclerosing cholangitis (IgG4-SC). The discrimination between IgG4-SC and pancreatobiliary malignancies or primary sclerosing cholangitis (PSC) is now an important issue. The present study was carried out to examine the usefulness of endoscopic biopsies from Vater's ampulla and the bile duct to diagnose IgG4-SC. Methods: The present study included 29 IgG4-SC patients (26 with both pancreatitis and cholangitis, and 3 with cholangitis only), 6 PSC patients, and 27 pancreatobiliary carcinoma patients. All patients underwent endoscopic biopsies from Vater's ampulla and the common bile duct. Biopsied specimens were histologically examined using immunostaining for IgG4. Results: For the ampullary and bile duct biopsies, the IgG4-SC samples had a significantly greater number of IgG4-positive plasma cells than the PSC or pancreatobiliary carcinoma specimens. In addition, bile duct biopsies from five patients (17%) with IgG4-SC showed diffuse inflammatory cell infiltration with irregular fibrosis corresponding to the histological features of lymphoplasmacytic sclerosing pancreatocholangitis. Based on the threshold of 10 IgG4-positive plasma cells per high power field, the diagnostic rates of the ampullar and bile duct biopsies were both 52% (15/29 cases). Twenty-one patients (72%) had more than 10 IgG4-positive plasma cells in at least one biopsy. The bile duct biopsy was significantly valuable for IgG4-SC patients with swelling of the pancreatic head. Conclusion: The present study suggested that ampullar and bile duct biopsies are useful for diagnosing IgG4-SC. © 2010 Journal of Gastroenterology and Hepatology Foundation and Blackwell Publishing Asia Pty Ltd.
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Kawakami H., Kuwatani M., Onodera M., Haba S., Asaka M.
Digestive Endoscopy 22 ( SUPPL. 1 ) 2010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：Digestive Endoscopy
Endoscopic treatment is highly effective for extracting common bile duct (CBD) stones and is the most common therapeutic method for CBD stones. For patients with CBD stones, the treatment goal is to completely clear the biliary duct. In general, the successful extraction rate using a basket and/or balloon catheter is as high as 90%. However, stones that are resistant to conventional endoscopic treatment procedures can be both challenging and time-consuming to treat; and successful treatment can require a combination of techniques, including mechanical lithotripsy or extracorporeal shock-wave lithotripsy. We performed needle knife sphincterotomy and attempted to remove a CBD stone using biopsy forceps and alligator grasping forceps without a lithotripter in a patient with a large impacted stone at Vater's ampulla. After attempting several techniques, the stone was successfully removed with balloon extraction. © 2010 Japan Gastroenterological Endoscopy Society.
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Osteonecrosis and Panniculitis as Life-Threatening Signs
Kuwatani M., Kawakami H., Yamada Y.
Clinical Gastroenterology and Hepatology 8 ( 5 ) 2010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：Clinical Gastroenterology and Hepatology
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Kuwatani M., Kawakami H., Haba S., Eto K., Onodera M., Asaka M.
Internal Medicine 49 ( 6 ) 627 - 628 2010年3月
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Nakanishi Y., Kondo S., Zen Y., Yonemori A., Kubota K., Kawakami H., Tanaka E., Hirano S., Itoh T., Nakanuma Y.
Journal of Hepato-Biliary-Pancreatic Sciences 17 ( 2 ) 166 - 173 2010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：Journal of Hepato-Biliary-Pancreatic Sciences
Purpose The aim of this study was to determine the impact of the presence of carcinoma in situ at the bile duct stump on postoperative survival in patients who underwent resection of extrahepatic bile duct carcinoma. Methods The patients with resected extrahepatic bile duct carcinoma were divided into three groups according to resected margin status: No evidence of residual carcinoma (Negative group, n = 96); carcinoma in situ at the bile duct stump (CIS group, n = 10); and invasive carcinoma at any surgical margin (Invasive group, n = 19). Cause-specific survival for these groups was compared statistically. Results Surgical margin status was identified as a prognostic factor on univariate analysis (p = 0.005) and was an independent prognostic factor on multivariate analysis (p = 0.018). The CIS group displayed significantl y better survival than the Invasive group (p = 0.006), and the survival was comparable to that for the Negative group (p = 0.533). Two of three patients in the CIS group with local recurrence died > 5 years after surgical resection. Conclusions Patients with positive ductal margins of carcinoma in situ of the extrahepatic bile duct do not appear to show different survival after resection compared to patients with negative margins, but remnant carcinoma in situ is likely to develop late local recurrence. © Japanese Society of Hepato-Biliary-Pancreatic Surgery and Springer 2009.
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Kawakami H., Kuwatani M., Etoh K., Haba S., Yamato H., Shinada K., Nakanishi Y., Tanaka E., Hirano S., Kondo S., Kubota K., Asaka M.
Endoscopy 41 ( 11 ) 959 - 964 2009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：Endoscopy
Background and study aims: Localized-type bile duct carcinoma (LBDC) is often accompanied by extensive intraepithelial tumor spread (ITS) of 2cm or more, which makes radical resection more difficult. This retrospective case review compares the diagnostic accuracy of endoscopic retrograde cholangiography (ERC) and peroral cholangioscopy (POCS) to detect ITS beyond the visible LBDC. Patients and methods: Forty-four consecutive patients with LBDC diagnosed between April 2004 and October 2008 who underwent radical resection with histopathological analysis were included in this study. Extensive ITS was found histopathologically in one-third of the cases (32%). The outcome parameters were the presence or absence of extensive ITS and the extent of extensive ITS proximal and distal to the main tumor. Results: In six cases it was not possible to pass the cholangioscope through the tumor sites. ERC correctly identified the presence of extensive ITS in 11/14 cases and did not yield any false-positive results. The three cases in which ERC was negative were all correctly identified by POCS plus biopsy since the cholangioscope could be passed in all three cases. The extent of extensive ITS was correctly diagnosed by ERC alone, ERC with POCS, and ERC with POCS plus mapping biopsy in 22%, 77%, and 100% of cases, respectively. Conclusions: The presence of extensive ITS was correctly detected in 80% of cases by ERC alone. POCS with mapping biopsy provided perfect diagnostic accuracy not only of the presence or absence but also of the extent of extensive ITS. However, POCS has the limitation that the cholangioscope cannot be passed through the tumor sites in approximately 15% of cases. © Georg Thieme Verlag KG Stuttgart.
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Nakanishi Y., Zen Y., Hirano S., Tanaka E., Takahashi O., Yonemori A., Doumen H., Kawakami H., Itoh T., Nakanuma Y., Kondo S.
Journal of Hepato-Biliary-Pancreatic Surgery 16 ( 6 ) 869 - 873 2009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：Journal of Hepato-Biliary-Pancreatic Surgery
We report herein the first case of intraductal oncocytic papillary neoplasm of the bile duct arising from a peribiliary gland of the left hepatic duct. The patient was a 63-year-old Japanese man. Radiological and cholangioscopic examinations revealed intraductal tumor of the left hepatic duct. After pathological diagnosis of adenocarcinoma by cholangioscopic biopsy, a surgical hepatobiliary resection was performed. Pathological examination revealed papillary tumor in the left hepatic duct. Histologically, the tumor was identified as papillary neoplasm comprising oncocytic cells and delicate fibrovascular cores. Interestingly, this tumor originated from the cystic space in the bile duct wall. This cystic space was histologically identified as a cystically dilated peribiliary gland. Carcinoma in situ was observed in this cystic peribiliary gland at the bottom of the tumor, but not on any areas of biliary epithelium. This case suggests that intraductal papillary neoplasm can arise from both biliary epithelium and peribiliary glands. © 2009 Springer.
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Kawakami H., Maguchi H., Hayashi T., Yanagawa N., Chiba A., Hisai H., Amizuka H.
Journal of Gastroenterology 44 ( 11 ) 1140 - 1146 2009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：Journal of Gastroenterology
Background: In duodenoscopy, during endoscopic retrograde cholangiopancreatography (ERCP), a backward-oblique angle duodenoscope (BOAD) is generally used. In Japan, 15° BOAD are mainly used, but in Western countries, 5° BOAD are mostly used. In bile duct cannulation associated with ERCP, a catheter for contrast imaging is used in Japan, but wire-guided cannulation (WGC) using a papillotome is standard in Western countries. We conducted a randomized controlled multicenter trial to evaluate the contributions of different duodenoscopes using WGC to selective common bile duct cannulation. Methods: Subjects comprised 179 consecutive patients who underwent ERCP. Patients were randomized into the 15° BOAD group (15° group, n = 90) or the 5° BOAD group (5° group, n = 89). Results: The duodenal papilla could not be accessed endoscopically in two cases from each group. Success rates for bile duct cannulation by WGC without bow-up for the 15° and 5° groups were 85.6 and 56.2%, respectively (P < 0.01). Success rates for bile duct cannulation by WGC with bow-up for the 15° and 5° groups were 88.9 and 78.7%, respectively. Total rates of bile duct cannulation for the 15° and 5° groups were 94.4 and 92.1%, respectively. As for accidents, incidences of acute pancreatitis for the 15° and 5° groups were 5.6 and 9.0%, respectively, with no significant difference seen. Conclusions: With 15° BOAD, bile duct cannulation was favorable without papillotome bow-up. With 5° BOAD, the success rate of WGC may be improved by adjusting the angle based on papillotome bow-up. © 2009 Springer.
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Kuwatani M., Kawakami H., Eto K., Haba S., Shiga T., Tamaki N., Asaka M.
Internal Medicine 48 ( 11 ) 867 - 875 2009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：Internal Medicine
Objective: It has recently been reported that 18 F-fluorodeoxyglucose positron emission tomography (FDG-PET) is useful for estimation of the chemotherapy effect. Thus, we examined the value of FDG-PET in assessing the efficacy of chemotherapy in advanced pancreatic cancer, and compared this modality with tumor markers (TMs) and CT. Patients and Methods: Nineteen patients with unresectable pancreatic adenocarcinoma were enrolled. All patients received chemotherapy with gemcitabine and S-1, an oral derivative of 5-fluorouracil, and underwent FDG-PET, CT, and serological examination for TMs before and after chemotherapy. Results: Standardized uptake value in FDG-PET before treatment and survival time were not correlated. A good prognosis was seen after 1 course of chemotherapy in patients whose tumors were in partial or complete remission as assessed by FDG-PET [median of survival time (MST), 12.5 months] or TMs (MST, 13.5 months), but not in CT responders (MST, 10.3 months). Furthermore, patient prognosis correlated with PET and TM assessment of the best tumor response through all courses. Namely, both PET and TM were useful for the prediction of survival or chemotherapy sensitivity of the patients. Conclusion: FDG-PET and TMs can each play an adjunct role to CT for estimating the effect of chemotherapy and predicting survival by distinguishing between responders and non-responders among patients with advanced pancreatic cancer. © 2009 The Japanese Society of Internal Medicine.
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Pancreatic carcinoma associated with portal vein tumor thrombus: Three case reports
Yamato H., Kawakami H., Kuwatani M., Shinada K., Kondo S., Kubota K., Asaka M.
Internal Medicine 48 ( 3 ) 143 - 150 2009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：Internal Medicine
Pancreatic carcinoma associated with portal vein tumor thrombus (PVTT) is rare. Here, we report three cases of resected pancreatic carcinoma associated with PVTT. In all three cases, preoperative images obtained using computed tomography and endoscopic ultrasonography revealed a tumor thrombus in the portal vein, which was connected to an irregular mass in the pancreas. All cases underwent surgical resection of the primary lesion and the PVTT. The pathological diagnoses of the tumors were two cases of tubular adenocarcinoma and one case of nonfunctioning endocrine carcinoma. We also retrospectively examined other patients who underwent surgical excision with portal vein resection. © 2009 The Japanese Society of Internal Medicine.
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Kuwatani M., Kawakami H., Yamato H., Shinada K., Tanaka E., Hirano S., Kondoh S., Itoh T., Asaka M.
Japanese Journal of Gastroenterology 105 ( 7 ) 1061 - 1069 2008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：Japanese Journal of Gastroenterology
We had three cases of pancreatic groove carcinoma. All cases developed obstructive jaundice. Duodenoscopy showed stenosis of the second portion of the duodenum in every case. Thus, endoscopic bile duct drainage could not be performed in two cases. CT revealed a mass between the duodenum and head of the pancreas, which was not well-defined by contrast-enhancement. Endoscopic ultrasonograghy revealed a hypoechoic mass which was adjacent to the common bile duct and duodenum in the pancreas head in all cases. Therefore, we could diagnose pancreatic groove carcinoma.
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Kuwatani M., Kawakami H., Asaka M., Marukawa K., Matsuno Y., Hosaka M.
Diagnostic Cytopathology 36 ( 11 ) 840 - 842 2008年11月
記述言語：日本語 掲載種別：研究論文（学術雑誌）
DOI： 10.1002/dc.20924
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Autoimmune pancreatitis associated with hemorrhagic pseudocysts: A case report and literature review
Kawakami H., Kuwatani M., Shinada K., Yamato H., Hirano S., Kondo S., Yonemori A., Itoh T., Matsuno Y., Asaka M.
Internal Medicine 47 ( 7 ) 603 - 608 2008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：Internal Medicine
Autoimmune pancreatitis (AIP) is a new category of pancreatic diseases. AIP associated with pseudocysts is rare; only 8 cases have been reported in the literature. A 63-year-old man was admitted to our department because of upper left abdominal pain and back pain. Various imaging studies demonstrated swelling of the tail of the pancreas with hemorrhagic pseudocysts. The patient underwent a surgical operation. A pancreatogram of the specimen revealed total occlusion of the main pancreatic duct in the tail of the pancreas. Histopathological examination revealed that it was AIP with hemorrhagic pseudocysts. © 2008 The Japanese Society of Internal Medicine.
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Nakanishi Y., Zen Y., Kawakami H., Kubota K., Itoh T., Hirano S., Tanaka E., Nakanuma Y., Kondo S.
Modern Pathology 21 ( 7 ) 807 - 816 2008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：Modern Pathology
Extrahepatic bile duct carcinoma occasionally presents with intraepithelial spread for a considerable area around the main tumor. In this study, we compared clinicopathological features of extrahepatic bile duct carcinoma with and without extensive intraepithelial spread (≥20 mm from the main tumor). Out of 117 cases of extrahepatic bile duct carcinoma, 21 (18%) were found to have extensive intraepithelial spread. Those cases were pathologically characterized by a papillary or nodular main tumor, a more differentiated histological grade, less deep invasion, and infrequent portal vein or hepatic invasion in comparison with cases without intraepithelial spread. Areas of intraepithelial spread his tologically consisted of low-papillary growth (17 cases, 81%) and completely flat growth (4 cases, 19%) of carcinoma cells. The former histology corresponded to a macroscopic granular mucosa, whereas the latter growth was hardly detected by gross examination. Immunohistochemically, in 16 of 21 cases (76%), at least one of p53, CEA, and MUC1 was expressed in both the main tumor and the spreading area. Interestingly, patients with intraepithelial spread had a better postoperative prognosis than those without intraepithelial spread (P=0.009). However, three patients had anastomotic recurrence 54-130 months after surgery. In conclusion, intraepithelial-spreading bile duct carcinoma is characterized by papillary or nodular main lesions, a more differentiated histological grade, and less invasiveness. The presence of intraepithelial spread was not an indicator of a poor prognosis, but carcinoma in situ at the bile duct stump could cause late anastomotic recurrence after surgery. © 2008 USCAP, Inc All rights reserved.
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A rare complication with extraction of proximally migrated biliary stent by using a basket catheter
Kawakami H., Uebayashi M., Konishi K., Kuwatani M., Shinada K., Yamato H., Asaka M.
Gastrointestinal Endoscopy 67 ( 7 ) 1170 - 1172 2008年6月
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Pancreatic metastasis from renal cell carcinoma with intraportal tumor thrombus
Kawakami H., Kuwatani M., Yamato H., Shinada K., Hirano S., Kondo S., Yonemori A., Matsuno Y., Asaka M.
Internal Medicine 47 ( 22 ) 1967 - 1970 2008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
A 68-year-old woman with a history of renal cell carcinoma (RCC) resected curatively 12 years previously was admitted to our department for scrutiny of pancreatic tumors. Various unaging studies demonstrated heterogeneously well-enhanced masses in the head and tail of the pancreas. The well-enhanced mass in the head of the pancreas was connected with the tumor thrombus in the portal vein. To differentially diagnose the multiple pancreatic lesions, we performed endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS-FNAB). Histopathologic findings of the EUS-FNAB specimens were similar to those of the renal clear cell carcinoma previously resected. The patient underwent a surgical operation with segmental resection of the portal vein with the preoperative diagnosis of RCC metastasis to the pancreas with intraportal growth. Histopathological examination of the resected specimen revealed that the masses in the pancreas were multiple pancreatic metastases with intraportal tumor thrombus of RCC. The pancreas is a rare target for metastasis. This is a rare case of pancreatic metastasis from RCC with intraportal extension, and is the first preoperatively definitely diagnosed case using EUS-FNAB. © 2008 The Japanese Society of Internal Medicine.
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Villous adenoma arising in choledochocele 査読あり
Kawakami H., Kuwatani M., Onodera M., Asaka M., Hirano S., Kondo S.
Gastrointestinal Endoscopy 66 ( 6 ) 1231 - 1232 2007年12月
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Kuwatani M., Kawakami H., Makiyama H., Onodera M., Matsumoto K., Karasawa G., Asaka M.
Internal Medicine 46 ( 18 ) 1557 - 1564 2007年9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：Internal Medicine
A 58-year-old male had been diagnosed as having autoimmune pancreatitis (AIP) from the results of serological examinations and image findings. He was treated with prednisolone (PSL) for 3.5 months. Fifteen months later, follow-up CT revealed the main pancreatic duct (MPD) dilatation in the pancreas body to tail and right hydronephrosis caused by complicated retroperitoneal mass. We diagnosed him as having recurrent AIP with retroperitoneal fibrosis, and restarted PSL treatment. After one month, Examinations indicated amelioration of the MPD dilatation and right hydronephrosis, but not the right renal failure. This case indicates the importance of maintenance of PSL treatment. © 2007 The Japanese Society of Internal Medicine.
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Kawakami H., Kuwatani M., Onodera M., Hirano S., Kondo S., Nakanishi Y., Itoh T., Asaka M.
Internal Medicine 46 ( 15 ) 1191 - 1195 2007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：Internal Medicine
Hepatolithiasis associated with cholangiocellular carcinoma is occasionally a calcium bilirubinate stone. Primary cholesterol hepatolithiasis associated with cholangiocellular carcinoma is rare; only 6 cases have been reported in the literature. A 55-year-old man was admitted to our hospital because of an elevated level of carbohydrate antigen 19-9. Various imaging studies demonstrated a mass in the segment VII of the liver. The patient underwent a curative surgical operation. Histopathological examination revealed that it was cholangiocellular carcinoma located in the periphery of the liver. A cholesterol stone was present, encircled by the cholangiocellular carcinoma. Minor inflammatory changes were observed around the stone. © 2007 The Japanese Society of Internal Medicine.
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Nakanishi Y., Ito T., Kubota K., Takeda H., Yonemori A., Kawakami H., Zen Y., Kondo S.
Surgery Today 37 ( 8 ) 708 - 712 2007年8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：Surgery Today
Spindle cell-type undifferentiated carcinoma arising from the extrahepatic bile duct is extremely rare. We herein report a case of this type of carcinoma in the common bile duct of the hepatic hilus. A 59-year-old man was admitted to our hospital complaining of jaundice. The laboratory data revealed an elevation of the serum carbohydrate antigen 19-9 level. Cholangiography revealed a complete obliteration of the left hepatic bile duct and stenosis of the bile duct from the superior to the right hepatic bile duct. Computed tomography showed the tumor to measure 15 × 12 mm in the hepatic hilus, with the obliteration of the right to main trunk of the portal vein and a swollen lymph node in the hepato-duodenum ligament. Arteriography revealed a kink of the right hepatic artery; therefore an encasement of the right hepatic artery was suspected. We preoperatively diagnosed hilus bile duct carcinoma and scheduled a right trisection hepatectomy. Intraoperative frozen sections taken from the tumor and tissues around the hepatic arteries showed spindle and inflammatory cells; therefore an inflammatory pseudotumor was diagnosed intraoperatively. As the right hepatic bile duct was occluded, a right lobe hepatectomy was performed. However, a permanent section revealed both spindle cells and poorly differentiated tubular adenocarcinoma cells positive for CAM5.2, AE1/AE3, and vimentin. On the basis of these findings, the tumor was finally diagnosed to be spindle cell-type undifferentiated carcinoma. Unfortunately, the patient died of pulmonary infarction 11 days after the operation. © 2007 Springer-Verlag.
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Primary acinar cell carcinoma of the ampulla of Vater
Kawakami H., Kuwatani M., Onodera M., Hirano S., Kondo S., Nakanishi Y., Itoh T., Asaka M.
Journal of Gastroenterology 42 ( 8 ) 694 - 697 2007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：Journal of Gastroenterology
Acinar cell carcinoma of the pancreatobiliary system is a relatively rare malignant neoplasm arising usually in the pancreatic parenchyma. We experienced a 68-year-old woman who presented with obstructive jaundice due to an ampullary mass 1.0 cm in diameter, detected by abdominal computed tomography and endoscopic examination. The patient underwent a curative surgical operation, and histopathological examination revealed that the tumor was confined to the ampulla of Vater with no continuity to the pancreatic parenchyma. The tumor cells showed acinar or tubular arrangement with eosinophilic to basophilic granular cytoplasm, findings identical to those of acinar cell carcinoma of the pancreas. Immunohistochemically, the tumor cells were positive for lipase. From these findings, we concluded that the tumor was primary acinar cell carcinoma arising in the ampulla of Vater, probably originating from heterotopic pancreatic tissue. This is the first reported case of primary acinar cell carcinoma in the ampulla of Vater. © Springer-Verlag Tokyo 2007.
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Kitagami H., Kondo S., Hirano S., Kawakami H., Egawa S., Tanaka M.
Pancreas 35 ( 1 ) 42 - 46 2007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：Pancreas
OBJECTIVES: Acinar cell carcinoma (ACC) of the pancreas is a rare tumor, and many aspects remain unclear because no large-scale clinical studies have been conducted. METHODS: The present study investigated the clinical characteristics, treatment, and therapeutic outcomes of 115 patients registered in the Pancreatic Cancer Registry of the Japan Pancreas Society, and therapeutic plans were reviewed. RESULTS: Although ACC has been associated with advanced stage and poor prognosis, this tumor was resectable in 76.5% of the patients, and the 5-year survival rate after resection was favorable, being 43.9%. CONCLUSIONS: Confirming the diagnosis of ACC preoperatively is difficult, but this diagnosis should be kept in mind while planning surgery for ordinary pancreatic cancer. Once the diagnosis has been confirmed, a possibility of surgical resection should be pursued to achieve better prognosis. If ACC is unresectable or recurrent, chemotherapy is likely to prove useful. Multidisciplinary therapy centering on the role of surgery will need to be established. © 2007 Lippincott Williams & Wilkins, Inc.
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膵漿液性嚢胞腺腫solid-variant typeと考えられた１例—自験例と報告例の画像所見の検討— 査読あり
Kuwatani M., Kawakami H., Onodera M., Hirano S., Kondo S., Itoh T., Koshiyama T., Kawakami A., Asaka M.
Gastroenterological Endoscopy 49 ( 5 ) 1303 - 1309 2007年5月
担当区分：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：Gastroenterological Endoscopy
A 70-year-old female was admitted to our hospital for workup and treatment of a 23 X 16mm mass in the pancreas head. Ultrasonography showed a hypoechoic solid lesion, whereas, abdominal CT revealed a hypervascular tumor with clear boundaries. Endoscopic ultrasonography demonstrated a hypoechoic mass with lateral shadow and a tiny anechoic lesion. According to these findings, we diagnosed it as endocrine tumor of the pancreas head and performed subtotal stomach preserving pancreatoduodenectomy. The final diagnosis was 'solid-variant type of serous cystadenoma'. When we diagnose a hypervascular and well-demarcated tumor, we need to notice sporadic hyperechoic spots in US, acoustic enhancement in EUS and high-intensity area in MRCP, which seem to represent solid-variant type of SCA.
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Kawakami H., Kuwatani M., Hirano S., Kondo S., Nakanishi Y., Itoh T., Asaka M.
Internal Medicine 46 ( 6 ) 273 - 277 2007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：Internal Medicine
Pancreatic endocrine tumors are rare tumors classified into "functioning" and "nonfunctioning" tumors. A 68-year-old man was admitted to our hospital with the chief compliant of abdominal pain. Various imaging studies demonstrated a mass in the head of the pancreas with intraductal growth into the main pancreatic duct and an intraportal mass. The patient underwent a curative surgical operation. Histopathological examination revealed that it was nonfunctioning endocrine carcinoma of the pancreas. This is the first reported case of a pancreatic endocrine tumor with intraductal growth into the main pancreatic duct and tumor thrombus within the portal vein. © 2007 The Japanese Society of Internal Medicine.
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G-CSF産生膵管癌の1例 査読あり
河上 洋，桑谷将城，藤谷好弘，上林 実，小西康平，牧山裕顯，橋野 聡，久保田佳奈子，伊藤智雄，浅香正博
日本消化器病学会雑誌 104 ( 2 ) 233 - 238 2007年2月
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：Japanese Journal of Gastroenterology
We report a case of pancreatic ductal adenocarcinoma producing granulocyte-colony stimulating factor (G-CSF). A 56-year-old Japanese man was admitted to our hospital with back pain and high fever. An abdominal CT scan revealed masses in the pancreatic body to the tail, and both lobes of the liver. A biopsy specimen of the hepatic tumor demonstrated metastatic poorly differentiated adenocarcinoma We administered oral S-1 in combination with gemcitabine. However, his general condition gradually worsened, and a high serum level of G-CSF persisted. He died 135 days after admission. The diagnosis of autopsy was pancreatic ductal adenocarcinoma. Immunohistochemical staining showed the presence of G-CSF in tumor cells. The final diagnosis was G-CSF-producing pancreatic carcinoma.
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Miseki T., Kawakami H., Natsuizaka M., Darmanin S., Cui H., Chen J., Fu Q., Okada F., Shindo M., Higashino F., Asaka M., Hamuro J., Kobayashi M.
Cancer Gene Therapy 14 ( 1 ) 39 - 44 2007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：Cancer Gene Therapy
We have recently reported that the intra-tumoral injection of adrenomedullin (AM) antagonist (AMA; AM (22-52)) peptides significantly reduced the in vivo growth of a pancreatic cancer cell line in severely combined immunodeficient (SCID) mice. In the present study, we examined the effects of intra-tumoral and intra-muscular transfers of naked DNA encoding AMA on the in vivo growth of cancer cell lines. We demonstrate that these treatments induce the regression of a pancreatic cancer cell line and a breast cancer cell line inoculated in SCID mice. Furthermore, CD31-positive cells disappear completely from tumor tissues, following treatment, indicating that neo-vascularization is entirely inhibited. These results suggest that the intra-tumoral or intra-muscular transfer of naked DNA encoding AMA might be a promising alternative modality for treating human cancers. © 2007 Nature Publishing Group All rights reserved.
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Kato M., Asaka M., Ono S., Nakagawa M., Nakagawa S., Shimizu Y., Chuma M., Kawakami H., Komatsu Y., Hige S., Takeda H.
Journal of Gastroenterology 42 ( SUPPL.17 ) 16 - 20 2007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 Gastroenterology
Because most gastric cancers develop from a background of Helicobacter pylori-infected gastric mucosa, H. pylori plays an important role in gastric carcinogenesis. Therefore, eradication of H. pylori may inhibit the incidence of gastric cancers. In experimental studies, H. pylori eradication has proved to act as a prophylaxis against gastric cancer. However, the results of recent randomized controlled studies are absolutely contradictory. In Japan, mucosal gastric cancer is usually resected by endoscopic treatment. As only a small part of the gastric mucosa is resected, secondary gastric cancer after endoscopic resection of the primary gastric cancer often develops at another site in the stomach. A nonrandomized Japanese study involving 132 early gastric cancer patients reported that eradication of H. pylori after endoscopic resection tended to reduce the development of secondary gastric cancer. Also, a retrospective multicenter survey indicated that the incidence rate of secondary gastric cancer in H. pylori-eradicated patients was about one-third that among patients in the noneradication group. We conducted a large-scale multicenter randomized trial to confirm the effect of H. pylori eradication on secondary and residual gastric cancer after endoscopic resection. This study was begun in 2003 and is ongoing at present. Diagnosis of a new carcinoma at another site of the stomach is defined as the primary end point, and recurrence of tumors at the resection site as a secondary end point. A total of 542 subjects have been enrolled in the study. This study will have the statistical power to demonstrate whether H. pylori eradication decreases the incidence and recurrence of gastric cancer. © Springer-Verlag Tokyo 2007.
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Neutrophils secrete MIP-1β after adhesion to laminin contained in basement membrane of blood vessels
Chiba K., Zhao W., Chen J., Wang J., Cui H., Kawakami H., Miseki T., Satoshi H., Tanaka J., Asaka M., Kobayashi M.
British Journal of Haematology 127 ( 5 ) 592 - 597 2004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：British Journal of Haematology
We have recently demonstrated that granulocyte colony-stimulating factor (G-CSF) stimulated the production of epithelial-cell-derived-neutrophil attractant-78 (ENA-78) by neutrophils and that ENA-78 might promote the accumulation of neutrophils that had migrated from the intravascular space into inflammatory tissues. In this study, we examined whether other chemokines could be secreted by neutrophils that had accumulated after migrating from the intravascular space into the inflammatory tissues. We demonstrated that adhesion to laminin contained in the basement membrane and Matrigel, which is an artificial basement membrane model, induced macrophage inflammatory protein-1β (MIP-1β) in neutrophils and that MIP-1β secreted by neutrophils induced the chemotaxis of dendritic cells. These findings suggest that neutrophils transmigrating through the basement membrane are stimulated to secrete MIP-1β by the basement membrane, inducing the transmigration of dendritic cells from the intravascular space into inflammatory tissues. We propose that neutrophils intervene between innate immune response and specific immune response by secreting MIP-1β during the transmigration through the basement membrane.
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Osanai M., Maguchi H., Katanuma A., Kawakami H., Amizuka H., Itoh H., Takahashi K., Koizumi K., Mitsui S., Izumi S., Watanabe S., Nomura M., Yoshida H., Sakurai Y., Tsuji K., Jong-Hong K.
Gastroenterological Endoscopy 44 ( 5 ) 904 - 911 2002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
A 46-year-old man was admitted to the hospital with alcoholic chronic pancreatitis complicated by infectious pseudocysts. As multiple pseudocysts were seen, both transduodenal and percutaneous drainage of the cysts were performed to improve the general condition. The ERCP finding revealed some strictures of the main pancreatic duct in the head. It was highly suspected that multiple pseudocysts were caused by those pancreatic ductal strictures. Then we performed endoscopic transpapillary stenting of the pancreatic duct. The postoperative course was uneventful without recurrence of the pseudocysts.
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特発性筋肉内血腫を発症したアルコール性肝硬変の2例 査読あり
Yoshida H., Tsuji K., Kawakami H., Katanuma A., Sakurai Y., Jong-Hon K., Koizumi K., Mitsui S., Gotoh M., Yoshida A., Hayashi T., Tanaka Y., Izumi S., Watanabe S., Takahashi K., Nomura M., Maguchi H., Shinohara T.
Japanese Journal of Gastroenterology 99 ( 11 ) 1350 - 1354 2002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：Japanese Journal of Gastroenterology
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Kawakami H., Nomura M., Amizuka H., Haruyama Y., Izumi S., Watanabe S., Osanai M., Katanuma A., Itoh H., Takahashi K., Yoshida H., Sakurai Y., Tsuji K., Kang J., Maguchi H., Nakamura F., Dohke M., Shinohara T.
Japanese Journal of Gastroenterology 99 ( 9 ) 1063 - 1068 2002年9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：Japanese Journal of Gastroenterology
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Kawakami H., Maguchi H., Takahashi K., Itoh H., Katanuma A., Osanai M., Amizuka H., Yoshida H., Hayashi T.
Gastroenterological Endoscopy 44 ( 10 ) 1843 - 1849 2002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
We report a case in which endoscopic pancreatic stenting was effective for the postoperative stricture of the anastomosis of the main pancreatic duct and the duodenal bulb. A 32-year -old Japanese male with a history of reccurent acute pancreatitis was admitted to our hospital with severe abdominal pain and back pain, and the serum level of pancreatic enzymes was elevated. He had been injured by traffic accident and undergone operation of the pancreas twice at the age 20. He was treated by the conservative therapy, and the condition was improved biochemically. However, endoscopic retrograde pancreatography showed a stricture of the anastomosis of the main pancreatic duct and the duodenal bulb, and dilatation of the distal pancreatic duct. The stricture was considered to be the cause of recurrent acute pancreatitis and endoscopic pancreatic stent placing was performed. General condition got better after treatment, and the serum level of pancreatic enzymes was normalized. The stent was naturally removed after 3 months with no recurrence. MRCP revealed no recurrence of the stricture. He has been free from complications after the stent removal. In conclusion, endoscopic pancreatic stenting can be one of the therapeutic alternatives for the postoperative stricture of the anastomosis of the main pancreatic duct and digestive tract. © 2002, Japan Gastroenterological Endoscopy Society. All rights reserved.
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短期間にIs型からIIa+IIc型へと肉眼形態が変化したS状結腸sm癌の1例 査読あり
Izumi S., Nomura M., Kawakami H.
Stomach and Intestine 36 ( 13 ) 2001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：Stomach and Intestine
A 49-year-old woman was referred to our center for positive fecal occult blood. Colonoscopic examination revealed a sessile lesion (Is type), approximately 10 mm in size, in the sigmoid colon. Morphologically, it was considered to be an elevated lesion due to massive submucosal invasion. Colonoscopic examination 30 days later revealed that the lesion had metamorphosed to a flat lesion with disappearance of the elevation in the center. In the area where the elevation had disappeared, an irregular shallow depression with uneven surface was observed. From these colonoscopic findings, it was diagnosed as a superficial depressed cancer (IIa + IIc type) with massive submucosal invasion. Barium enema radiograph revealed a round radiolucent lesion with a thin, irregular barium collection in the center, 10 mm in size. The profile view showed a semilunar deformity. From these findings combined with high-frequency ultrasound probe findings, the lesion was finally diagnosed as IIa + IIc type cancer with massive submucosal invasion at the center. Laparoscopic sigmoidectomy was perfomed. In the resected specimen, there was a IIa + IIc type lesion measuring 8×8 mm in size. Histologically, it was a well differentiated adenocarcinoma with massive submucosal invasion at the center. The tumor border was covered with normal mucosa. The case was thought to be noteworthy for considering the natural course of colorectal cancer.
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Bone marrow dysplasia with basophilic cells in a patient with angiocentric lymphoma
Mori A., Hashino S., Imamura M., Kahata K., Kawakami H., Kobayashi S., Tanaka J., Musashi M., Asaka M.
Acta Haematologica 99 ( 2 ) 98 - 101 1998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：Acta Haematologica
We report a 46-year-old man suffering from angiocentric lymphoma of the skin. On admission, he had atypical cells rich in basophilic granules in the bone marrow and peripheral blood, in addition to skin eruptions and bone marrow dysplasia. Immediately after diagnosis, the patient was treated with multidrug combination chemotherapy. At first, the chemotherapy markedly relieved the skin eruption and bone marrow dysplasia, and atypical cells in the bone marrow and peripheral blood disappeared rapidly. However, the disease gradually became resistant to chemotherapy, resulting in a gradual deterioration of the skin eruption and bone marrow dysplasia, and reappearance of atypical cells. The levels of serum cytokines such as interleukin-4 and interleukin-6, and of soluble interleukin-2 receptor correlated well with the disease states. These results suggest that the lymphoma cells directly or indirectly induce the production of these cytokines and that a dysregulated cytokine network, which might be caused by lymphoma cells, induces an increase in atypical cells.
DOI： 10.1159/000040820
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Mori A., Hashino S., Imamura M., Kahata K., Kawakami H., Shibata M., Kobayashi S., Tanaka J., Asaka M.
Bone Marrow Transplantation 21 ( 6 ) 615 - 617 1998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：Bone Marrow Transplantation
We report a case of bone marrow infarction in a 20-year-old woman with acute lymphocytic leukemia (ALL) who underwent unrelated bone marrow transplantation (BMT). Hematopoietic engraftment occurred on day 9 and, thereafter, the patient developed acute dermal and hepatic graft-versus-host disease (GVHD). She also experienced severe arthralgia in her knee joints on day 21. Immunosuppressive therapy with prednisolone (PSL) for acute GVHD was given, and the arthralgia improved rapidly, correlating with the improvement in dermal and hepatic GVHD. Based on the laboratory findings and analysis of magnetic resonance images, she was diagnosed as having bone marrow infarction. The cause of the bone marrow infarction was thought to be acute CVHD-related microangiopathy.