Language：Japanese   Publisher：(株)日本メディカルセンター  

＜文献概要＞近年,化学療法におけるサルコペニアの重要性が注目されている.胆道癌と膵癌の患者においても,サルコペニアは予後に悪影響を及ぼすことが示唆されている.切除可能な胆道癌患者において,サルコペニアを有する患者は生存期間が短く,再発率,合併症の発生率が高くなることが報告されている.切除不能な胆道癌患者においても,サルコペニアは化学療法への影響に関連しており,化学療法の効果や生存期間に悪影響を及ぼす可能性が示唆されている.膵癌の化学療法においても,サルコペニアが治療効果や生存期間に影響を及ぼすことが報告されている.化学療法自体が筋力低下などの影響を及ぼすことも考慮され,サルコペニアを適切に評価し,予防することが重要である.

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BACKGROUND: The risk and prognosis of pancreatobiliary cancer and in patients with autoimmune pancreatitis (AIP) and IgG4-related sclerosing cholangitis (IgG4-SC) remain unclear. Therefore, we retrospectively investigated the risk of pancreatobiliary cancer and prognosis in patients with AIP and IgG4-SC. METHODS: Patients with AIP and IgG4-SC at seven centers between 1998 and 2022 were investigated. The following data were evaluated: (1) the number of cancers diagnosed and standardized incidence ratio (SIR) for pancreatobiliary and other cancers during the observational period and (2) prognosis after diagnosis of AIP and IgG4-SC using standardized mortality ratio (SMR). RESULTS: This study included 201 patients with AIP and IgG4-SC. The mean follow-up period was 5.7 years. Seven cases of pancreatic cancer were diagnosed, and the SIR was 8.11 (95% confidence interval [CI]: 7.29-9.13). Three cases of bile duct cancer were diagnosed, and the SIR was 6.89 (95% CI: 6.20-7.75). The SMR after the diagnosis of AIP and IgG4-SC in cases that developed pancreatobiliary cancer were 4.03 (95% CI: 2.83-6.99). CONCLUSIONS: Patients with autoimmune pancreatitis and IgG4-SC were associated with a high risk of pancreatic and bile duct cancer. Patients with AIP and IgG4-SC have a worse prognosis when they develop pancreatobiliary cancer.

DOI： 10.1002/jhbp.1404

PubMed

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND AND AIMS: Fully covered self-expandable metallic stents (SEMS) are laser-cut (L) or braided (B); however, which is more effective for distal malignant biliary obstruction (DMBO) has been unclear. We compared the clinical outcomes of using L- type and B-type stents because we believe that recurrent biliary obstruction (RBO) is less likely to occur with L-type stents. METHODS: Patients diagnosed with unresectable DMBO were randomly assigned to groups L and B in a stratified block fashion, and outcomes were compared. The primary outcome was the rate of RBO within 1 year; secondary outcomes were adverse events, clinical success rate, time to RBO (TRBO), and overall survival. RESULTS: Of the 60 enrolled participants, 56 (group L: 27, group B: 29) were included. The rates of RBO within 1 year were 44.4% and 17.2% in groups L and B, respectively (odds ratio 2.57 [95% confidence interval {CI}: 1.045-6.353]). Early adverse events, which improved with conservative treatment, included pancreatitis (n=4) in group L and pancreatitis (n=3) and cholecystitis (n=1) in group B (p=0.913). The median TRBO (220 days [95% CI: 56-272] versus 418 days [95% CI: 232-454]) was significantly longer in group B than in group L (log-rank test, p=0.0118). The median overall survival (L: 158 days, B: 204 days) after stenting was not significantly different between the groups (p=0.8544). CONCLUSIONS: In the setting of DMBO, braided (B)-type stents are associated with less recurrent obstruction than laser-cut-type (L) stents, although there was no difference in safety.

DOI： 10.1016/j.gie.2023.11.057

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Language：Japanese   Publisher：(一社)日本消化器内視鏡学会-関東支部  

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BACKGROUND/PURPOSE: There is currently no consensus on the use of endoscopic papillectomy (EP) for early stage duodenal ampullary adenocarcinoma. This study aimed to evaluate the feasibility of EP for patients with early stage duodenal ampullary adenocarcinoma. METHODS: Patients who underwent EP for ampullary adenocarcinomas were investigated. Complete and clinical complete resection rates were evaluated. Clinical complete resection was defined as either complete resection or resection with positive or unknown margins but no cancer in the surgically resected specimen, or no recurrence on endoscopy after at least a 1-year follow-up. RESULTS: Adenocarcinoma developed in 30 patients (carcinoma in situ [Tis]: 21, mucosal tumors [T1a(M)]: 4, tumors in the sphincter of Oddi [T1a(OD)]: 5). The complete resection rate was 60.0% (18/30) (Tis: 66.7% [14/21], T1a[M]: 50.0% [2/4], and T1a[OD]: 40.0% [2/5]). The mean follow-up period was 46.8 months. The recurrence rate for all patients was 6.7% (2/30). The clinical complete resection rates of adenocarcinoma were 89.2% (25/28); rates for Tis, T1a(M), and T1a(OD) were 89.4% (17/19), 100% (4/4), and 80% (4/5), respectively. CONCLUSIONS: EP may potentially achieve clinical complete resection of early stage (Tis and T1a) duodenal ampullary adenocarcinomas.

DOI： 10.1002/jhbp.1398

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Language：Japanese   Publisher：医学図書出版(株)  

ステロイド治療に良好の反応を示すIgG4関連硬化性胆管炎(IgG4-SC)の診断基準は,2012年に本邦で作成された。その後,MRCP所見を取り入れるなど,国際化を反映し柔軟な改定案が2020年に策定された。それに伴い診療ガイドラインが2019年に作成され,診断・治療のCQ・アルゴリズムがわかりやすく示された。本ガイドラインは42ページにも渡りややヘビーとなっている。そのエッセンスはIgG4-SCは胆道狭窄を呈するが,病変の主座は間質にある病理学的特徴と,それを反映したある程度の長さをもった胆道粘膜肥厚所見である。今後もreal time dataの蓄積により,改訂されることが期待される。(著者抄録)

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Language：Japanese   Publisher：医学図書出版(株)  

ステロイド治療に良好の反応を示すIgG4関連硬化性胆管炎(IgG4-SC)の診断基準は,2012年に本邦で作成された。その後,MRCP所見を取り入れるなど,国際化を反映し柔軟な改定案が2020年に策定された。それに伴い診療ガイドラインが2019年に作成され,診断・治療のCQ・アルゴリズムがわかりやすく示された。本ガイドラインは42ページにも渡りややヘビーとなっている。そのエッセンスはIgG4-SCは胆道狭窄を呈するが,病変の主座は間質にある病理学的特徴と,それを反映したある程度の長さをもった胆道粘膜肥厚所見である。今後もreal time dataの蓄積により,改訂されることが期待される。(著者抄録)

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Language：Japanese   Publisher：(一財)日本消化器病学会  

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Language：Japanese   Publisher：(一社)日本消化器内視鏡学会  

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Language：Japanese   Publisher：(一社)日本消化器内視鏡学会  

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Language：Japanese   Publisher：(一社)日本消化器内視鏡学会  

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Language：Japanese   Publisher：(一社)日本消化器内視鏡学会  

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Language：Japanese   Publisher：日本消化器病学会-関東支部  

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Language：Japanese   Publisher：(一社)日本胆道学会  

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Language：Japanese   Publisher：(一社)日本胆道学会  

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Language：Japanese   Publisher：(一社)日本膵臓学会  

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Language：Japanese   Publisher：(一社)日本膵臓学会  

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Language：Japanese   Publisher：(一社)日本膵臓学会  

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Language：Japanese   Publisher：(一社)日本膵臓学会  

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Language：Japanese   Publisher：(一社)日本膵臓学会  

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Language：Japanese   Publisher：(一社)日本膵臓学会  

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Language：Japanese   Publisher：(一社)日本膵臓学会  

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Language：Japanese   Publisher：(一社)日本膵臓学会  

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Language：Japanese   Publisher：(一社)日本膵臓学会  

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Language：Japanese   Publisher：(一社)日本膵臓学会  

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Publishing type：Research paper (scientific journal)   Publisher：Wiley  

DOI： 10.1002/deo2.130

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Other Link： https://onlinelibrary.wiley.com/doi/full-xml/10.1002/deo2.130

Language：Japanese   Publisher：(一財)日本消化器病学会  

胆道癌は肝内胆管癌,胆管癌,胆嚢癌,乳頭部癌に分類され,胆管癌がさらに肝門部領域胆管癌と遠位胆管癌に分類され,それぞれの癌占拠部位・生物学的特性から悪性度・進展様式が異なる.正確な画像診断において,MDCT(multi detector CT)所見は,内科・外科・放射線診断科医が共通認識可能であるため,artifactのない状態で撮像することで最強の診断ツールとなる.腫瘍の肝門側・十二指腸乳頭側への進展および周辺動脈への浸潤の術前診断が重要である.病理検体採取は,ほぼ内視鏡を用いて行われる.最近,癌ゲノムや,表層進展診断にはFISH(fluorescence in situ hybridization),共焦点レーザー内視鏡が応用され,報告されている.胆道癌の精査から切除までは,胆道の内視鏡診療・切除に特化した施設で行われるのが望ましい.(著者抄録)

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2023&ichushi_jid=J01118&link_issn=&doc_id=20230425410003&doc_link_id=%2Fck8syokb%2F2023%2F012004%2F003%2F0297-0308%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fck8syokb%2F2023%2F012004%2F003%2F0297-0308%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：(一社)日本消化器内視鏡学会  

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Language：Japanese   Publisher：(一財)日本消化器病学会  

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Language：Japanese   Publisher：(一財)日本消化器病学会  

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Language：English   Publishing type：Research paper (scientific journal)  

Diagnosing distal bile duct obstruction remains challenging. This study aimed to examine the diagnostic ability of artificial intelligence (AI) based on clinical biomarkers in diagnosing malignant distal bile duct obstruction. A total of 206 patients with distal bile duct obstruction were included in this study. Clinical laboratory parameters were collected from the patients and evaluated using AI. All clinical parameters were input into the AI algorithm, and the AI value for malignant distal bile duct obstruction was calculated. The benign and malignant diagnostic capabilities of AI and other factors (alkaline phosphatase [ALP], intrahepatic bile duct [IHBD] diameters, and total bile duct [CBD] diameters) were compared. Benign and malignant bile duct obstruction were diagnosed in 142 and 64 patients, respectively. The median AI value of malignant distal bile duct obstruction was significantly greater than that of benign distal bile duct obstruction (0.991 vs. 0.002, p < 0.001). The area under the receiver operating characteristic curve of AI, ALP, IHBD diameter, and CBD diameter were 0.908, 0.795, 0.794, and 0.775, respectively. AI showed a sensitivity, specificity, and accuracy of 83.1%, 87.2%, and 85.9%. AI-based on clinical biomarkers could serve as an auxiliary for diagnosing malignant bile duct obstruction.

DOI： 10.1038/s41598-023-28058-5

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Objectives: For suspected common bile duct stone (CBDS) missed on computed tomography (CT), there is no clear evidence on whether endoscopic ultrasound (EUS) or magnetic resonance cholangiopancreatography (MRCP) is the better diagnostic tool. We aimed to compare the diagnostic accuracy of EUS and MRCP for cases of missed CBDS on CT. Methods: Patients suspected of having CBDS were enrolled and randomly allocated to the EUS or MRCP group. Upon the initial examination, those having CBDS or sludge formation underwent endoscopic retrograde cholangiopancreatography (ERCP), while those who were CBDS-negative underwent a second examination with either MRCP or EUS, which was distinct from the initial diagnostic procedure. The primary outcome was diagnostic accuracy, and the secondary outcomes were diagnostic ability, detection rate and characteristics of CBDS in the second examination, and the frequency of adverse events. Results: Between April 2019 and January 2021, 50 patients were enrolled in the study. The accuracy was 92.3% for EUS and 68.4% for MRCP (P = 0.055). EUS showed 100% sensitivity, 88.2% specificity, 81.8% positive predictive value, and 100% negative predictive value, and MRCP showed 33.3% sensitivity, 84.6% specificity, 50% positive predictive value, and 73.3% negative predictive value. The CBDS detection rate in the second examination was 0% for MRCP after a negative EUS and 35.7% for EUS after a negative MRCP (P=0.041). No adverse events occurred in any of the patients. Conclusions: Endoscopic ultrasound may be a superior diagnostic tool compared to MRCP for the detection of CBDS that are undetected on CT. (UMIN000036357).

DOI： 10.11280/gee.65.486

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DOI： 10.2169/internalmedicine.E002-23

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Language：Japanese   Publishing type：Research paper (scientific journal)  

DOI： 10.11405/nisshoshi.120.297

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A 51-year-old man who had been receiving steroid therapy for type 1 autoimmune pancreatitis (AIP) for 3 years contracted coronavirus disease 2019 (COVID-19). As he had a high-grade fever and dry cough, and because his SpO2 level had dropped below 95% in the supine position, he was considered as being at a high risk for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2); therefore, he received combined REGN-COV2 antibody therapy. The patient's fever resolved immediately after this treatment, and he went into remission. A high cumulative steroid dose is associated with an increased susceptibility to infection. Early antibody cocktail therapy may be effective and rewarding for steroid-dependent type 1 AIP patients with a potential risk for SARS-CoV-2.

DOI： 10.2169/internalmedicine.1421-22

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Language：Japanese   Publisher：(一社)日本消化器内視鏡学会-関東支部  

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Language：English   Publishing type：Research paper (scientific journal)  

OBJECTIVE: IgG4-related sclerosing cholangitis (IgG4-SC) is recognized as a benign steroid-responsive disease; however, little is known about the risk of development of cancer in patients with IgG4-SC and about how to counter this risk. DESIGN: We conducted a retrospective review of the data of 924 patients with IgG4-SC selected from a Japanese nationwide survey. The incidence, type of malignancy, and risk of malignancy in these patients were examined. Then, the standardized incidence ratio (SIR) of cancer in patients with IgG4-SC was calculated. RESULTS: Relapse was recognized in 19.7% (182/924) of patients, and cancer development was noted in 15% (139/924) of patients. Multivariate analysis identified only relapse as an independent risk factor for the development of cancer. In most of these patients with pancreato-biliary cancer, the cancer developed within 8 years after the diagnosis of IgG4-SC. The SIR for cancer after the diagnosis of IgG4-SC was 12.68 (95% confidence interval [CI] 6.89-8.79). The SIRs of cancers involving the biliary system and pancreas were 27.35 and 18.43, respectively. The cumulative survival rate was significantly better in the group that received maintenance steroid treatment (MST) than in the group that did not; thus, MST influenced the prognosis of these patients. CONCLUSION: Among the cancers, the risk of pancreatic and biliary cancers is the highest in these patients. Because of the elevated cancer risk, surveillance after the diagnosis and management to prevent relapse are important in patients with IgG4-SC to reduce the risk of development of cancer.

DOI： 10.1111/jgh.16066

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DOI： 10.1055/a-1960-3363

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BACKGROUND: The clinical outcomes of everolimus rechallenge in patients with pancreatic neuroendocrine neoplasms (PNENs) are unknown. This study aimed to investigate the treatment outcomes and safety of everolimus rechallenge treatment with PNENs. METHODS: Clinical data of everolimus-treated patients with PNENs at two institutions were collected. Patients who underwent everolimus rechallenge were included in the study. We analyzed the progression-free survival (PFS) and treatment response associated with everolimus rechallenge and the adverse events. RESULTS: Between 2008 and 2020, 117 patients received initial treatment with everolimus, of which 14 patients received everolimus rechallenge. With regard to the grade of PNENs, there were 2 cases of G1, 11 cases of G2, and 1 case of G3. The median rechallenge PFS was 5.7 months. The objective response rate was 21.4%. the disease control rate was 71.4%. The only major grade 3 or 4 adverse event was neutropenia (n = 1, 7.1%). No other severe adverse event was observed. CONCLUSION: The outcomes and safety of everolimus rechallenge were verified, and it was deemed an acceptable treatment. Everolimus rechallenge may provide a new drug therapy for patients with advanced PNENs for whom no other drug treatment option is available.

DOI： 10.3390/cancers14225669

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND/PURPOSE: This study aimed to investigate the efficacy of intensive fluid-loading therapy post-endoscopic retrograde cholangiopancreatography (ERCP) for the prevention of post-ERCP pancreatitis (PEP) in at-risk patients. METHODS: In this retrospective study, data of 1200 patients at risk for PEP were investigated. After propensity score matching, 404 patients were included in the normal (n = 202) and hydration (n = 202) groups. On the day of ERCP, patients in both groups were infused with 2000 ml/24 h of fluid before ERCP. Meanwhile, the hydration group received an additional 1000 ml/10 h of lactated Ringer's solution postoperatively. RESULTS: The incidence of PEP was lower in the hydration group (12.4%) than in the normal group (24.3%) (odds ratio [OR]: 0.44; 95% CI: 0.26-0.75, p = .003). The incidence of severe PEP was 2.0% and 6.9% in the hydration and normal groups (OR: 0.27; 95% CI: 0.09-0.84, p = .027), respectively. The incidence of fatal PEP was 0% and 2.0% in the hydration and normal groups (OR: N.A.: p = .123), respectively. CONCLUSIONS: Post-ERCP hydration may be an effective method of preventing PEP, including severe PEP, in at-risk patients.

DOI： 10.1002/jhbp.1267

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Language：Japanese   Publisher：医学図書出版(株)  

自己免疫性膵炎(AIP)は,しばしば嚢胞性病変を形成する。AIPに伴う非腫瘍性膵嚢胞の形成は,慢性膵炎にみられる不可逆的線維化による膵液停滞のみならず,AIPの炎症の活性化に関連して発生している可能性が示唆されている。AIPに合併した膵嚢胞性病変に対してステロイド治療は奏功するが,難治性の経過をたどる症例も存在する。そのため早期にステロイド導入を行い,将来的にAIPによる膵嚢胞形成をきたし,ステロイド治療に不応となるような難治性経過を防ぐことが重要と考えられる。一方で,感染や出血を合併する症例やステロイドに抵抗性をきたすケースにおいては症例に応じて内視鏡的ドレナージ,IVR,手術の検討が必要となる。(著者抄録)

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Language：Japanese   Publisher：(一社)日本消化器内視鏡学会  

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Language：Japanese   Publisher：(一社)日本消化器内視鏡学会  

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Language：Japanese   Publisher：(一財)日本消化器病学会  

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Language：Japanese   Publisher：(一財)日本消化器病学会  

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Language：Japanese   Publisher：(一社)日本消化器内視鏡学会  

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BACKGROUND AND PURPOSE: During endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS), tract dilation is one of the most important steps, and the placement of conventional metal stents with 8.5 Fr delivery devices is difficult due to the large outer shape of the device. Fine-gauge balloon catheters have become popular because of their stricture penetration ability and ease of dilation. This study aimed to evaluate the utility of fine-gauge balloon catheters. PATIENTS AND METHODS: This retrospective study involved 38 patients who underwent conventional metal stent placement. The patients were classified into two groups: those who underwent dilation with a fine-gauge balloon catheter before initial metal stenting (balloon dilation group) and those who underwent bougie dilation only (non-balloon dilation group). We evaluated the stenting success rate after initial dilation and adverse events. RESULTS: Seventeen and twenty-one patients were included in the balloon dilation and non-balloon dilation groups, respectively. The stenting success rate after initial dilation was 100% (17/17) in the balloon dilation group and 71.4% (15/21) in the non-balloon dilation group (p = 0.024). As adverse events, peritonitis was observed in one case (4.8%) in the balloon dilation group, and in three cases (14.3%) in the non-balloon dilation group (p = 0.613). CONCLUSIONS: Dilation using a fine-gauge balloon catheter before conventional metal stent with 8.5 Fr delivery device placement is considered effective in EUS-HGS.

DOI： 10.3390/jcm11195681

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Language：Japanese   Publisher：(一社)日本胆道学会  

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Language：Japanese   Publisher：(一社)日本胆道学会  

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Language：Japanese   Publisher：日本消化器病学会-関東支部  

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: In IgG4-related sclerosing cholangitis (IgG4-SC), the necessity of biliary drainage (BD) is unclear. In this study, we aimed to retrospectively investigate the improvement of liver damage and jaundice in cases of IgG4-SC with and without BD, before starting steroids. METHODS: Fifty-two patients with IgG4-SC were investigated in the study. The study endpoints were the normalization rate of alkaline phosphatase (ALP)/total bilirubin (T-Bil) after 8 weeks of steroids, with and without BD. RESULTS: Propensity score matching was performed based on ALP and T-Bil, and 28 patients were included. There were 14 patients each in the BD and non-BD groups. Before initiation of steroids, the mean ALP in the BD group and the non-BD group was 378/461 (p = 0.541); the mean T-Bil was 2.5/1.8 (p = 0.401). Eight weeks after initiation of steroids, ALP improvement rate in BD group/non-BD group was 69.2%/61.5% (p = 1.000), and T-Bil improvement rate was 100%/100% (p = Ns). CONCLUSIONS: Steroids for IgG4-SC could prove effective in improving liver damage and jaundice, regardless of the presence or absence of BD. BD for IgG4-SC aimed to improve jaundice may not be necessary.

DOI： 10.1002/jhbp.1230

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BACKGROUND: We attempted to determine the indications and limitations of steroid therapy as the 1st line therapy in patients with autoimmune pancreatitis (AIP) with cyst formation (ACF). METHODS: This Japanese multicenter survey was conducted to examine the merits/demerits of steroid treatment as the initial therapy for ACF. RESULT: Data of a total of 115 patients with ACF were analyzed. Complete remission was achieved in 86% (86/100) of patients who had received steroid treatment, but only 33.3% (5/15) of patients who had not received steroids. Relapse after the remission (n=86) occurred in 7.6% (6/86) of patients who had received steroid therapy, but 40% (2/5) of patients who had not received steroid therapy. Multivariate analysis identified adoption of the wait&watch approach without steroid treatment (odds ratio=0.126, p<0.001) as a significant and independent negative predictor of remission of ACF. As for predictors of relapse, the presence of varix (odds ratio=5.83, p=0.036) was identified as an independent risk factor. CONCLUSION: Steroid therapy plays an important role as 1st line therapy in AIP patients with pancreatic cyst formation, however, varix formation, besides the diameter of the cyst(s), is a risk factor for refractoriness to steroid therapy.

DOI： 10.1002/jhbp.1227

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Language：Japanese   Publisher：(株)アークメディア  

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Language：Japanese   Publisher：(株)日本メディカルセンター  

＜文献概要＞術後再建腸管を有する胆膵疾患に対するERCPは困難な手技とされてきたが,バルーン内視鏡(BAE)の登場により,術後再建腸管に対するERCPは多くの症例で可能となった.しかしながら,Billroth-II再建法やRoux-en-Y再建法など,再建術式により内視鏡挿入のポイントは異なり,乳頭部到達後の胆管カニュレーションも通常解剖のERCPとは異なる戦略をおさえておく必要がある.さらに鉗子起上装置がない点や,内視鏡長・鉗子口径により使用可能なデバイスに制約がある点なども含め,BAEを用いたERCPは困難な内視鏡手技として位置付けられており今後のさらなる発展と工夫が期待される.

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Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is useful in diagnosing subepithelial lesions (SELs), and adequate tissue sampling is necessary to differentiate between benign and malignant diseases to determine therapeutic strategies. This study aimed to evaluate sampling adequacy and diagnostic performance of EUS-FNA for SELs with Franseen needles. This retrospective study enrolled 130 patients who underwent EUS-FNA with a 22-gauge needle for SELs from January 2010 to March 2021. We compared sampling adequacy and predictive factors influencing the sampling adequacy of EUS-FNA for SELs between Franseen and conventional needles. The sampling adequacy rates were 95.0% (38/40) with Franseen needles and 76.7% (69/90) with conventional needles (p = 0.011). The mean number of punctures with Franseen needles (2.80) was significantly less than that with conventional needles (3.42) (p &lt; 0.001). In the multivariate analysis, the use of Franseen needles (p = 0.029; odds ratio [OR], 5.37; 95% confidence interval [CI], 1.18-23.36) was an independent factor influencing the sampling adequacy. Compared to conventional needles, the Franseen needle could play a vital role in accurately diagnosing SELs by yielding better sampling adequacy and reducing the number of passes.

DOI： 10.3390/diagnostics12071667

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DOI： 10.1055/a-1847-7745

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OBJECTIVES: For suspected common bile duct stone (CBDS) missed on computed tomography (CT), there is no clear evidence on whether endoscopic ultrasound (EUS) or magnetic resonance cholangiopancreatography (MRCP) is the better diagnostic tool. We aimed to compare the diagnostic accuracy of EUS and MRCP for cases of missed CBDS on CT. METHODS: Patients suspected of having CBDS were enrolled and randomly allocated to the EUS or MRCP group. Upon the initial examination, those having CBDS or sludge formation underwent endoscopic retrograde cholangiopancreatography (ERCP), while those who were CBDS-negative underwent a second examination with either MRCP or EUS, which was distinct from the initial diagnostic procedure. The primary outcome was diagnostic accuracy, and the secondary outcomes were diagnostic ability, detection rate and characteristics of CBDS in the second examination, and the frequency of adverse events. RESULTS: Between April 2019 and January 2021, 50 patients were enrolled in the study. The accuracy was 92.3% for EUS and 68.4% for MRCP (P = 0.055). EUS showed 100% sensitivity, 88.2% specificity, 81.8% positive predictive value, and 100% negative predictive value, and MRCP showed 33.3% sensitivity, 84.6% specificity, 50% positive predictive value, and 73.3% negative predictive value. The CBDS detection rate in the second examination was 0% for MRCP after a negative EUS and 35.7% for EUS after a negative MRCP (P = 0.041). No adverse events occurred in any of the patients. CONCLUSIONS: Endoscopic ultrasound may be a superior diagnostic tool compared to MRCP for the detection of CBDS that are undetected on CT. (UMIN000036357).

DOI： 10.1111/den.14193

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PURPOSE: The diagnosis of gallbladder lesions remains challenging. The efficacy of computed diffusion-weighted imaging (DWI) with high b-values and apparent diffusion coefficient (ADC) for the diagnosis of gallbladder cancer remains unknown. We aimed to investigate the usefulness of computed DWI with high b-values and the combination of computed DWI and ADC in differentiating malignant and benign gallbladder lesions. METHODS: Sixty patients (comprising 30 malignant and 30 benign lesions) who underwent magnetic resonance imaging for gallbladder lesions were included in this retrospective study. Qualitative evaluations were performed using conventional DWI with b1000, computed DWI with b1500, b1000 DWI/ADC, and computed b1500 DWI/ADC, and their diagnostic performances were compared. RESULTS: The sensitivity, specificity, and accuracy of computed b1500 DWI/ADC were 90% (27/30), 80% (24/30), and 85% (51/60), respectively. The accuracy of computed b1500 DWI/ADC was higher than that of conventional b1000 DWI (52%, 31/60, p < 0.001), computed b1500 DWI (72%, 43/60, p = 0.008), and b1000 DWI/ADC (78%, 47/60, p = 0.125). The specificity of computed b1500 DWI/ADC was also higher than that of conventional b1000 DWI (7%, 2/30, p < 0.001), computed b1500 DWI (47%, 14/30, p = 0.002), and b1000 DWI/ADC (67%, 20/30, p = 0.125). No significant difference was observed in the sensitivity between the groups. CONCLUSION: This study shows that computed DWI with high b-values combined with ADC can improve diagnostic performance when differentiating malignant and benign gallbladder lesions. Computed diffusion-weighted magnetic resonance imaging with high b-values in the diagnosis of gallbladder lesions. *Computed DWI with b1500 combined with ADC can improve diagnostic performance when differentiating gallbladder lesions compared with conventional methods (b1000 DWI).

DOI： 10.1007/s00261-022-03586-2

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Objective The effectiveness of everolimus for the management of pancreatic neuroendocrine neoplasms (PNENs), including the G3/NEC types, remains unclear. We therefore investigated the effectiveness of the drug for the management of PNENs. Methods We analyzed the progression-free survival (PFS) and overall survival (OS) associated with everolimus and factors influencing the PFS and OS. Results One hundred patients were evaluated. The PFS associated with the G1/G2 types tended to be significantly longer than that associated with the G3/NEC types (hazard ratio [HR], 0.45; p =0.005). A multivariate analysis showed that the significant factors influencing the PFS were age (<65 years old; HR, 0.44; p =0.002), grade (G1/G2; HR, 0.42; p =0.006), everolimus treatment line (≤2nd; HR, 0.55; p =0.031), and presence of treatment with metformin (yes; HR, 0.29; p =0.044). The median OS was 63.8 months. In the multivariate analysis, the significant factors influencing the OS were grade (G1/G2; HR, 0.21; p <0.001), volume of liver metastasis (≤25%; HR, 0.27; p <0.001), everolimus treatment line (≤2nd; HR, 0.27; p <0.001), and presence of primary tumor resection (yes; HR, 0.33; p =0.005). Conclusions The effectiveness of everolimus in the management of G3/NEC types and prognoses tended to be poorer than those associated with the G1/G2 types. Everolimus combined with metformin and early-line treatment with everolimus may be effective for managing advanced PNENs.

DOI： 10.2169/internalmedicine.9416-22

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BACKGROUND/PURPOSE: The detection ability and role of different imaging modalities to detect pancreatic neuroendocrine neoplasms (PNENs) including small lesions is unclear. This study aimed to compare the ability of endoscopic ultrasound (EUS) and computed tomography (CT) to detect PNENs. METHODS: Data of patients who underwent EUS and contrast-enhanced CT and were diagnosed with PNENs were analyzed. The detection rates of pancreatic lesions with EUS and CT based on tumor size and influencing factors were investigated. RESULTS: For 256 PNEN lesions, the detection rate of EUS was better than that of CT (94.5% vs. 86.3%; p < 0.001). EUS was significantly superior to CT for PNENs ≤ 5 mm (58.3% vs 16.7%; p = 0.006) and 5-10 mm (97.7% vs 79.5%; p = 0.008). There was no significant difference in the detection rate between EUS and CT for PNENs > 10 mm (98.4% vs 96.4%; p = 0.375). Size (≤ 5 mm) and insulinoma were independent factors associated with poor EUS and CT detection rates. CONCLUSIONS: EUS exhibited better detection ability than CT, with an excellent detection rate for PNENs > 5 mm, except for insulinomas. CT could detect PNENs > 10 mm, which are amenable to treatment.

DOI： 10.1002/jhbp.1144

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Language：Japanese   Publisher：(一社)日本消化器内視鏡学会  

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Language：Japanese   Publisher：(一社)日本消化器内視鏡学会  

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Language：Japanese   Publisher：(一社)日本消化器内視鏡学会  

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Language：Japanese   Publisher：(一財)日本消化器病学会  

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Language：Japanese   Publisher：(一財)日本消化器病学会  

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Language：Japanese   Publisher：日本消化器病学会-関東支部  

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BACKGROUND: Endoscopic retrograde cholangiopancreatography (ERCP) in patients with surgically altered anatomy is technically difficult. Extensive training is required to develop the ability to perform this procedure. AIMS: To investigate the learning curve of single-balloon-assisted enteroscopy ERCP (SBE-ERCP). METHODS: We conducted a retrospective, observational case series at a single center. We evaluated the SBE-ERCP procedures between April 2011 and February 2021. The main outcomes were the rate of reaching the target site and the success rate of the entire procedure. These parameters were additionally expressed as a learning curve. RESULTS: A total of 687 SBE-ERCP procedures were analyzed. The learning curve was analyzed in blocks of 10 cases. In this study, seven endoscopists, experts in conventional ERCP, were included. The overall SBE-ERCP procedural success rate was 92.2% (634/687 cases). Combining all data from individual endoscopists' evaluation periods, the insertion and success rates of the SBE-ERCP procedures gradually increased with increased experience performing SBE-ERCP. The insertion success rates for the number of SBE-ERCP cases (< 20, 21-30, > 30) were 82.9%, 92.9%, and 94.3%, respectively; the procedure success rates were 74.3%, 81.4%, and 92.9%, respectively. The endoscopists who had performed > 30 SBE-ERCP cases had a success rate of ≥ 90%. CONCLUSIONS: Our results suggest that performing > 30 cases is one of the targets for conventional ERCP experts to become competent in performing SBE-ERCP in patients with a surgically altered anatomy.

DOI： 10.1007/s10620-021-07342-2

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Language：Japanese   Publisher：(株)東京医学社  

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Language：Japanese   Publisher：(一社)日本消化器内視鏡学会  

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Language：Japanese   Publisher：(一財)日本消化器病学会  

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Language：Japanese   Publisher：(一社)日本消化器内視鏡学会  

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Language：Japanese   Publisher：(一財)日本消化器病学会  

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Language：Japanese   Publisher：(一財)日本消化器病学会  

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Language：Japanese   Publisher：(一社)日本消化器内視鏡学会  

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Obstructive jaundice is a major symptom of pancreatic head cancer, and although its amelioration is required before scheduling chemotherapy, the decision to perform biliary drainage for resectable pancreatic cancer has remained controversial. In recent years, the effectiveness of neoadjuvant therapy for pancreatic cancer has been reported. Preoperative biliary drainage has become increasingly necessary, making the choice of stent an important one; thus, the longer the waiting period extends through neoadjuvant chemotherapy, the more durable stents - such as self-expandable metallic stents, rather than plastic stents - would be desired as an option. Still, there is insufficient evidence regarding surgical outcomes and long-term prognosis, and further confirmatory studies are needed. Through this review, we aim to provide an update on the characteristics of biliary stents and preoperative biliary drainage for potentially resectable pancreatic cancer.

DOI： 10.1111/den.14107

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Language：Japanese   Publisher：(一社)日本胆道学会  

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Language：Japanese   Publisher：(一社)日本膵臓学会  

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Language：Japanese   Publisher：(一社)日本膵臓学会  

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Language：Japanese   Publisher：(一社)日本胆道学会  

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Language：Japanese   Publisher：(一社)日本膵臓学会  

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Language：Japanese   Publisher：(一社)日本膵臓学会  

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Language：Japanese   Publisher：(一社)日本胆道学会  

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BACKGROUND: Chronic pancreatitis is a known risk factor of pancreatic cancer (PDAC). A similar association has been suggested but not demonstrated for autoimmune pancreatitis (AIP). OBJECTIVE: The aim of our study was to identify and analyse all published cases of AIP and PDAC co-occurrence, focusing on the interval between the diagnoses and the cancer site within the pancreas. METHODS: Relevant studies were identified through automatic searches of the MEDLINE, EMBASE, Scopus, and Web of Science databases, and supplemented by manual checks of reference lists in all retrieved articles. Missing/unpublished data were obtained from the authors of relevant publications in the form of pre-prepared questionnaires. RESULTS: A total of 45 cases of PDAC in AIP patients were identified, of which 12 were excluded from the analysis due to suspicions of duplicity or lack of sufficient data. Thirty-one patients (94%) had type 1 AIP. Synchronous occurrence of PDAC and AIP was reported in 11 patients (33%), metachronous in 22 patients (67%). In the metachronous group, the median period between diagnoses was 66.5 months (2-186) and a majority of cancers (86%) occurred more than two years after AIP diagnosis. In most patients (70%), the cancer originated in the part of the pancreas affected by AIP. CONCLUSIONS: In the literature, there are reports on numerous cases of PDAC in AIP patients. PDAC is more frequent in AIP type 1 patients, typically metachronous in character, and generally found in the part of the pancreas affected by AIP.

DOI： 10.1016/j.pan.2021.03.007

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Language：Japanese   Publisher：(一社)日本胆道学会  

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Language：Japanese   Publisher：日本消化器病学会-関東支部  

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Language：Japanese   Publisher：(NPO)日本高齢消化器病学会  

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Background/Aims: The use of endoscopic intervention (EI) for acute biliary pancreatitis (ABP) remains controversial because the severity of biliary obstruction/cholangitis/pancreatitis is not reflected in the indications for early EI (EEI). Methods: A total of 148 patients with ABP were included to investigate 1) the differences in the rate of worsening cholangitis/pancreatitis between the EEI group and the early conservative management (ECM) group, especially for each severity of cholangitis/pancreatitis, and 2) the diagnostic ability of imaging studies, including endoscopic ultrasound (EUS), to detect common bile duct stones (CBDSs) in the ECM group. Results: No differences were observed in the rate of worsening cholangitis between the EEI and ECM groups, regardless of the severity of cholangitis and/or the existence of impacted CBDSs. Among patients without impacted CBDSs and moderate/severe cholangitis, worsening pancreatitis was significantly more frequent in the EEI group (18% vs. 4%, p=0.048). In patients in the ECM group, the sensitivity and specificity for detecting CBDSs were 73% and 98%, respectively, for EUS, whereas the values were 13% and 92%, respectively, for magnetic resonance cholangiopancreatography. Conclusions: EEI should be avoided in the absence of moderate/severe cholangitis and/or impacted CBDSs because of the high rate of worsening pancreatitis. EUS can contribute to the accurate detection of residual CBDSs, for the determination of the need for elective EI.

DOI： 10.5946/ce.2020.271

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Language：Japanese   Publisher：(株)日本メディカルセンター  

＜文献概要＞自己免疫性膵炎(AIP),IgG4関連硬化性胆管炎(IgG4-SC)の標準治療はステロイドであり,いずれも寛解導入後,最低2〜3年の維持療法を行う.予後は良好であるが,再燃はおよそ30%に認める.再発例にもステロイド投与が有効である.自然寛解はAIPの一部の疾患活動性の低い症例で認めるが,再燃することが多い.再燃を繰り返す症例は,嚢胞形成や,膵石を伴い慢性化することがある.癌化はまれであるが,膵癌はAIPの診断3〜8年後に散見され,慢性膵炎の発癌とは異なる機序も推定される.IgG4-SCでは,ほぼ90%にAIPが合併するため,予後はAIPに類似する.しかし一部はisolated IgG4-SCとして発症し,鑑別困難なため,切除となることがある.長期予後はおおむね良好である.

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BACKGROUND/PURPOSE: The relationship between autoimmune pancreatitis (AIP) and malignancy has been reported. However, the potential risk for cancer in patients with immunoglobulin 4 (IgG4)-related sclerosing cholangitis (IgG4-SC) is unclear. The present study aimed to evaluate the incidence of cancer in IgG4-SC patients. METHODS: We retrospectively collected clinical data for 121 patients diagnosed with IgG4-SC from 7 hospitals. We calculated the standardized incidence ratio (SIR) of cancer in IgG4-SC patients based on the national cancer rates. The SIR of the period after the diagnosis of IgG4-SC were calculated. RESULTS: The mean follow-up period was 6.4 years, with 121 IgG4-SC patients. During the follow-up period, 26 patients had cancer, and 29 cancers were diagnosed. The SIR of cancer after the diagnosis of IgG4-SC was 1.90 (95% confidence interval [CI] 1.67-2.21). The SIR of pancreatic and bile duct cancer was 10.30 and 8.88, respectively. The SIR of cancer in <1 year, 1-5 years, and >5 years after diagnosis of IgG4-SC were 2.58, 1.01, and 2.44, respectively. CONCLUSIONS: IgG4-SC patients have a high risk of cancer including pancreatic and bile duct cancer. The risk of cancer was high less <1 year and >5 years after diagnosis of IgG4-SC. Therefore, IgG4-SC patients may require careful long-term follow-up.

DOI： 10.1002/jhbp.957

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Language：Japanese   Publisher：(一社)日本消化器内視鏡学会  

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Language：Japanese   Publisher：(一社)日本消化器内視鏡学会  

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Language：Japanese   Publisher：(一社)日本消化器内視鏡学会  

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BACKGROUND/PURPOSE: The role of endoscopic preoperative biliary drainage for pancreatic head cancer is controversial because of the high incidence of stent occlusion before surgery. We sought to validate a suitable stent for biliary drainage in patients with pancreatic cancer undergoing neoadjuvant chemotherapy (NAC)/neoadjuvant chemoradiotherapy (NAC-RT). METHODS: We evaluated patients who received preoperative neoadjuvant therapy for pancreatic head cancer between January 2013 and December 2019. A covered metal (CMS) or plastic stent (PS) was inserted in symptomatic patients for biliary drainage. Recurrent biliary obstruction (RBO), success rate of endoscopic drainage, adverse events, and surgical outcomes were compared between the CMS and PS groups. RESULTS: Occurrence rate of RBO was significantly higher with PS (97%) vs CMS (15%, P < .001), and time to RBO was significantly longer with CMS vs PS (not reached vs 40.5 days, P < .001). Delayed schedule associated with RBO for neoadjuvant chemotherapy was significantly lower in CMS vs PS (14% vs 50%, P < .05). There was no difference in postoperative bleeding, operation time, complications, and rate of a microscopically margin-negative resection between groups. CONCLUSIONS: Use of CMS during NAC/NAC-RT allows for safe chemotherapy without causing cholangitis or biliary obstruction and for surgery to be performed.

DOI： 10.1002/jhbp.958

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Language：Japanese   Publisher：(一財)日本消化器病学会  

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Language：Japanese   Publisher：(一財)日本消化器病学会  

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Language：Japanese   Publisher：(一財)日本消化器病学会  

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The biopsy-based diagnosis of autoimmune pancreatitis (AIP) is difficult but is becoming imperative for pathologists due to the increased amount of endoscopic ultrasound-guided biopsy tissue. To cope with this challenge, we propose guidance for the biopsy diagnosis of type 1 AIP. This guidance is for pathologists and comprises three main parts. The first part includes basic issues on tissue acquisition, staining, and final diagnosis, and is intended for gastroenterologists as well. The second part is a practical guide for diagnosing type 1 AIP based on the AIP clinical diagnostic criteria 2018. Inconsistent histological findings, tips for evaluating IgG4 immunostaining and key histological features including the ductal lesion and others are explained. Storiform fibrosis and obliterative phlebitis are diagnostic hallmarks but are sometimes equivocal. Storiform fibrosis is defined as spindle-shaped cells, inflammatory cells and fine collagen fibers forming a flowing arrangement. Obliterative phlebitis is defined as fibrous venous obliteration with inflammatory cells. Examples of each are provided. The third part describes the differentiation of AIP from pancreatic ductal adenocarcinoma (PDAC), focusing on histological features of acinar-ductal metaplasia in AIP, which is an important mimicker of PDAC. This guidance will help standardize pathology reports of pancreatic biopsies for diagnosing type 1 AIP.

DOI： 10.1111/pin.12994

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BACKGROUND/PURPOSE: Placement of uncovered self-expandable metallic stents (U-SEMSs) of patients with unresectable perihilar cholangiocarcinoma (UPHC) is recommended as the treatment of first choice to address bile stasis. The aim of this study was to determine which of the following two endoscopic stents might be the stent of first choice for the treatment of biliary stasis in patients with UPHC: plastic stents (PSs) or U-SEMSs. METHODS: U-SEMSs, deployed as a stent-in-stent, were selected as the stents of first choice from 2013 and 2014, while PSs began to be selected as the stents of first choice from 2015 onward. RESULTS: The median time to recurrent biliary obstruction were 66 days in the PS group (N = 38) and 105 days in the U-SEMS group (N = 37; P = .04). Emergency endoscopy was necessitated in 76.3% (29/38) of patients of the PS group and 54.1% (20/37) of patients of the U-SEMS group (P = .0434). The success rate of the first reintervention was 96.5% (27/29) in the PS group and 55% (11/20) in the U-SEMS group (P = .0002). Sustainable chemotherapy could be carried out in 55.2% of patients in the PS group and 32.4% of patients in the U-SEMS group (P = .0472). Multivariate analysis identified selection of U-SEMS as the stent of first choice as the only independent factor predictive of successful reintervention (P = .0016, odds ratio = 0.058). However, the stent selection was not an independent factor for feasible chemotherapy. CONCLUSIONS: Plastic stent placement could enhance the success rate of reintervention in patients with UPHC and might be facilitated by sustainable chemotherapy. However, stent selection might not have an influence on the prognosis.

DOI： 10.1002/jhbp.804

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Language：Japanese   Publisher：(一財)日本消化器病学会  

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Language：Japanese   Publisher：(一社)日本消化器内視鏡学会  

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Language：Japanese   Publisher：(一社)日本消化器内視鏡学会  

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Language：Japanese   Publisher：(一財)日本消化器病学会  

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Publishing type：Research paper (scientific journal)   Publisher：Wiley  

DOI： 10.1002/jhbp.793

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Other Link： https://onlinelibrary.wiley.com/doi/full-xml/10.1002/jhbp.793

Language：Japanese   Publisher：(一社)日本胆道学会  

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Language：Japanese   Publisher：(一社)日本消化器内視鏡学会  

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Language：Japanese   Publisher：(一社)日本胆道学会  

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Language：Japanese   Publisher：(一社)日本膵臓学会  

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OBJECTIVES: We examined the efficacy and limitations of acquiring large specimens by endoscopic ultrasound-guided fine needle biopsy (EUS-FNB) for diagnosing type 1 autoimmune pancreatitis (AIP). METHODS: Patients from 12 institutions with non-neoplastic diseases or pancreatic ductal adenocarcinoma (PDAC) with large EUS-FNB specimens were investigated. Slides stained with hematoxylin-eosin, elastic, IgG4, and IgG stains were evaluated. The IgG4- and IgG-positive cell numbers were counted in three foci. The diagnoses were based on the Japan Pancreas Society 2011 (JPS 2011) criteria and the International Consensus Diagnostic Criteria (ICDC). RESULTS: We analyzed 85 non-neoplastic (definite type 1 AIP in 73/85 based on the ICDC) cases and 64 PDAC cases. IgG4-positive cells were numerous (>10 in 85.9%), and the IgG4/IgG ratios were high (>40% in 81.2%). Plasma cell crushing by an artifact caused unsuccessful immunostaining, notably in smaller samples. Tissue lengths were an important factor for the presence of storiform fibrosis and obliterative phlebitis, but storiform fibrosis was equivocal even in large tissues. A definite or possible histological diagnosis was achieved in 45.9% (39/85) and 41.2% (35/85), respectively, and contributed to the definite final diagnosis of type 1 AIP in 33.3% (ICDC) and 55.6% (JPS 2011) in cases with segmental/focal lesions. In the PDAC group, >10 IgG4-positive cells was rare (2/58), but elastic stains revealed fibrous venous occlusions in 10.3% (6/58). CONCLUSIONS: EUS-FNB with large tissue amounts was useful for diagnosing type 1 AIP, notably by facilitating successful IgG4 immunostaining, but definite diagnosis may not be achieved even in cases with large specimens.

DOI： 10.1016/j.pan.2020.05.026

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Language：Japanese   Publisher：(一社)日本膵臓学会  

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Language：Japanese   Publisher：(一社)日本膵臓学会  

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Language：Japanese   Publisher：(一社)日本膵臓学会  

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Japan Gastroenterological Endoscopy Society  

An accurate diagnosis of the extent of progression of hilar cholangiocarcinoma should be required in cases where radical hepatectomy will be performed. However, since the endoscopic examination was invasive and traumatic, it would be necessary to discuss the extent of excision of the liver corresponding to the extent of tumor progression using radiographic examination in advance. There are many endoscopic examinations such as endoscopic ultrasonography (EUS), endoscopic retrograde cholangiopancreatography (ERCP) and related procedures including cholangioscopy, and we have to accurately diagnose the extent of tumor progression by integrating the results of various examinations. EUS is useful for diagnosing the extent of tumor spread in the extrahepatic bile ducts, and evaluation by cholangiography is indispensable to assess the Bismuth classification. Furthermore, information on tumor progression could be enhanced by adding intraductal ultrasonography (IDUS) and mapping biopsy, and cholangioscopic images could directly make a difference in the macroscopic diagnosis of the extent of tumor spread in bile duct epithelia.

DOI： 10.11280/gee.62.579

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BACKGROUND: The treatment of small (≤ 2 cm), sporadic localized non-functional pancreatic neuroendocrine neoplasms (PNENs) is often controversial. This study aimed to investigate the clinical outcomes with observation and surgical resection in small PNENs. METHODS: Seventy-five patients with small localized sporadic non-functional PNENs ≤ 2 cm, who underwent observation or surgical resection, were retrospectively reviewed. Changes in tumor size during follow-up in the observation group were also investigated. RESULTS: The median age of the cohort was 61 (range 35-81) years. The tumor grades were G1, G2, and unknown, in 61 (81.3%), 8 (10.7%), and 6 (8.0%) patients, respectively. The mean follow-up periods in the observation (n = 23) and surgical resection groups (n = 52) were 52.3 (range 6.8-133.3) months and 73.0 (range 9.1-179.9) months, respectively. The median overall survival was not reached. During follow-up, no patient died of PNENs, two died of other diseases, three had lymph node metastases, and one experienced recurrence after surgical resection. There was no significant difference in overall survival between the observation and surgical resection groups (hazard ratio: 0.031, P = 0.417). The mean change in tumor size in the observation group was + 0.30 mm (range - 1.6 to + 3.0 mm). No deaths, tumor progression, lymph node metastases, distant metastases, or recurrence were noted in patients with PNENs ≤ 1 cm (n = 36). CONCLUSIONS: The prognosis of small localized PNENs is good. Observation may be an alternative to surgery in high-risk patients and those with small G1 tumors, particularly those measuring ≤ 1 cm.

DOI： 10.1007/s00535-019-01655-w

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Language：Japanese   Publisher：(株)医学出版  

自己免疫性膵炎(AIP)の標準治療はステロイド投与であり、その適応は有症状例である。寛解率は98%程度であるが、再燃は20〜40%である。2013年の日本の診療ガイドラインでは、再燃抑制のため3年間程度の維持療法が推奨されている。維持療法は5mg以上で行われることが多い。一方、2019年にIgG4関連硬化性胆管炎に対する診療ガイドラインも日本で作成された。AIPに倣いステロイド投与が有効である。胆道閉塞に関しては、無黄疸症例ではドレナージが不要な可能性がある。AIP、IgG4関連硬化性胆管炎ともにステロイド治療抵抗例や繰り返す再燃例で、免疫調節薬、抗CD20抗体(キメラ型抗CD20抗体:リツキシマブ)の有用性が報告されている。しかし日本では保険外診療となり、使用に際し慎重な対応が必要である。(著者抄録)

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BACKGROUND AND AIM: The usefulness of preventive closure of the frenulum after endoscopic papillectomy (EP) could reduce bleeding. The feasibility and safety of clipping were evaluated in this prospective pilot study. METHODS: This study involved 40 consecutive patients who underwent preventive closure of the frenulum by clipping just after EP. The outcome data were compared with those of the previous 40 patients in whom no preemptive closure had been performed (no-closure group) (UMIN000014783). Additionally, the bleeding sites were examined. RESULTS: The clipping procedure was successful in all patients. As compared to the no-closure group, the rate of bleeding (P = 0.026) and period of hospital stay (P < 0.001) were significantly reduced in the closure group. There was no difference in the procedure time between the two groups. Furthermore, the incidence rates of pancreatitis and perforation were comparable in the two groups. The bleeding was noted in the frenulum area rather than at any other site in 90.9% of cases. CONCLUSION: Preventive closure of the frenulum after EP is an effective, safe, rational, and economical method to reduce the incidence of delayed bleeding, without prolonging the procedure time or increasing the risk of post-procedure pancreatitis perforation.

DOI： 10.1111/jgh.14922

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BACKGROUND AND AIM: In chronic pancreatitis (CP) patients, diagnosis of small pancreatic lesions by endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is challenging. Thus, the aim of the present study was to investigate whether CP influences the diagnostic ability of EUS-FNA for pancreatic lesions ≤10 mm. METHODS: One hundred and seventeen patients who underwent EUS-FNA for pancreatic lesions ≤10 mm in size were enrolled. Patients were classified into two groups based on features of CP observed by EUS (EUS-CP features) in accordance with the Rosemont classification. The CP group was defined as cases consistent with CP or suggestive of CP, and the non-CP group was defined as cases indeterminate for CP or normal. Factors influencing the diagnostic accuracy of EUS-FNA and CP status in pancreatic tumors were also investigated. RESULTS: Diagnostic ability of EUS-FNA (overall cases, non-CP vs CP) had sensitivity (80.4%, 96.7% vs 57.1%; P < 0.001), specificity (100%, 100% vs 100%; P > 0.05), and accuracy (91.5%, 98.6% vs 80.4%; P = 0.001). In multivariate analysis of factors influencing the accuracy of EUS-FNA, CP significantly lowered the accuracy (P = 0.048; odds ratio [OR] = 9.21). Among pancreatic cancer patients, the number of CP patients was significantly higher than the number of patients with benign lesions (P = 0.023). In multivariate analysis, lobularity without honeycombing was more frequently observed in cases of pancreatic cancer (P = 0.018; OR, 12.65). CONCLUSION: Endoscopic ultrasound-guided FNA offers high accuracy for small pancreatic lesions ≤10 mm. However, in cases with CP, the diagnostic ability of EUS-FNA is significantly reduced.

DOI： 10.1111/den.13497

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Language：Japanese   Publisher：日本消化器病学会-関東支部  

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Language：Japanese   Publisher：(一財)日本消化器病学会  

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© 2019 Elsevier Ltd Background: IgG4-related disease is a newly recognised immunopathological entity that includes autoimmune pancreatitis, IgG4-related sialadenitis, and IgG4-related kidney disease. To understand the genetic landscape of IgG4-related disease, we did a genome-wide association study. Methods: We did a genome-wide association study of Japanese individuals, initially screening 857 patients with IgG4-related disease at 50 Japanese research institutions and DNA samples from 2082 healthy control participants from the Nagahama Prospective Genome Cohort for the Comprehensive Human Bioscience. From Oct 27, 2008, to July 22, 2014, we enrolled 835 patients and used data from 1789 healthy participants. Only patients with confirmed diagnosis of IgG4-related disease according to the international diagnostic criteria were included. Genotyping was done with the Infinium HumanOmni5Exome, HumanOmni2.5Exome, or HumanOmni2.5 Illumina arrays, and genomic distributions were compared between case and control samples for 958 440 single nucleotide polymorphisms. The HLA region was extensively analysed using imputation of HLA alleles and aminoacid residues. Fine mapping of the FCGR2B region was also done. Associations between clinical manifestations of disease and the genetic variations identified in these two genes were examined. Findings: We identified the HLA-DRB1 (p=1·1×10−11) and FCGR2B (p=2·0×10−8) regions as susceptibility loci for IgG4-related disease. We also identified crucial aminoacid residues in the β domain of the peptide-binding groove of HLA-DRB1, in which the seventh aminoacid residue showed the strongest association signal with IgG4-related disease (p=1·7×10−14), as has been reported with other autoimmune diseases. rs1340976 in FCGR2B showed an association with increased FCGR2B expression (p=2·7×10−10) and was in weak linkage disequilibrium with rs1050501, a missense variant of FCGR2B previously associated with systemic lupus erythematosus. Furthermore, rs1340976 was associated with the number of swollen organs at diagnosis (p=0·011) and IgG4 concentration at diagnosis (p=0·035). Interpretation: Two susceptibility loci for IgG4-related disease were identified. Both FCGR2B and HLA loci might have important roles in IgG4-related disease development. Common molecular mechanisms might underlie IgG4-related disease and other immune-related disorders Funding: The Japanese Ministry of Health, Labour, and Welfare, the Japanese Agency of Medical Research and Development, and Kyoto University Grant for Top Global University Japan Project.

DOI： 10.1016/S2665-9913(19)30006-2

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Language：Japanese   Publisher：(公社)日本超音波医学会  

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OBJECTIVE: Autoimmune pancreatitis (AIP) has the potential to transform into chronic pancreatitis with pancreatic stone involvement. This retrospective investigation sought to clarify the risk factors for stone formation in type 1 AIP. METHODS: Questionnaires on patients with type 1 AIP were sent to 22 high-volume medical centers across Japan to compare the clinical features of patients with and without pancreatic stone formation. RESULTS: Of the completed records on 624 type 1 AIP patients, 31 (5%) had experienced pancreatic stones. Median follow-up duration was 1853 days. Bentiromide test values at diagnosis were significantly lower, and hemoglobin A1c values after corticosteroid treatment were significantly higher in patients with pancreatic stones. Imaging results disclosed that pancreatic atrophy and hilar or intrahepatic bile duct stenosis were significantly more frequent in patients with pancreatic stone formation. Pancreatic head swelling tended to be more frequent in this group as well. On the other hand, a shorter follow-up period was associated with the nonformation of pancreatic stones. CONCLUSIONS: The increased frequency of pancreatic head swelling in type 1 AIP patients exhibiting pancreatic stones indicated a propensity for pancreatic juice stasis with subsequent stone development and pancreatic dysfunction occurring over longer periods of disease duration.

DOI： 10.1097/MPA.0000000000001210.

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BACKGROUND/OBJECTIVES: FOLFIRINOX is the reliable treatments for pancreatic cancer, but it has a relatively high toxicity and the selection of suitable patients for this regimen remains challenge. On the other hand, sarcopenia is one of the important prognostic factors of pancreatic cancer. The aim of this study was to investigate the effect of sarcopenia on overall survival (OS) and time to treatment failure (TTF) in patients with pancreatic cancer who received FOLFIRINOX. METHODS: Clinical data of consecutive patients treated with FOLFIRINOX at our institution from 2011 to 2017 was retrospectively reviewed. Skeletal muscle index (SMI) and adipose tissue index (ATI) at the third lumbar spine level was calculated from computed tomography (CT) images. The association between clinical factors (SMI and ATI), and OS and TTF were determined using univariate and multivariate analyses. RESULTS: We assessed 82 patients. The median OS of sarcopenia and the non-sarcopenia patients were 11.3 and 17.0 months, respectively (hazard ratio [HR], 2.49; 95% confidence interval [CI], 1.43-4.32; p = 0.001). Median TTF was 3.0 and 6.1 months in the sarcopenia and the non-sarcopenia patients, respectively (HR, 1.67; 95% CI, 1.03-2.71; p = 0.032). Multivariate analyses revealed that sarcopenia (HR, 1.37; 95% CI, 1.01-1.87; p = 0.045) was an independent prognostic factor of OS. High ATI (p = 0.022) and sarcopenic obesity (p = 0.008) were significantly associated with hematologic toxicity. CONCLUSIONS: Sarcopenia is an independent indicator of poor prognosis in patients with pancreatic cancer who received FOLFIRINOX, while ATI and sarcopenic obesity predicted severe hematologic toxicity.

DOI： 10.1016/j.pan.2018.11.001

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IgG4-related sclerosing cholangitis (IgG4-SC) is a distinct type of cholangitis frequently associated with autoimmune pancreatitis and currently recognized as a biliary manifestation of IgG4-related disease. Although clinical diagnostic criteria of IgG4-SC were established in 2012, differential diagnosis from primary sclerosing cholangitis and cholangiocarcinoma is sometimes difficult. Furthermore, no practical guidelines for IgG4-SC are available. Because the evidence level of most articles retrieved through searching the PubMed, Cochrane Library, and Igaku Chuo Zasshi databases was below C based on the systematic review evaluation system of clinical practice guidelines MINDS 2014, we developed consensus guidelines using the modified Delphi approach. Three committees (a guideline creating committee, an expert panelist committee for rating statements according to the modified Delphi method, and an evaluating committee) were organized. Eighteen clinical questions (CQs) with clinical statements were developed regarding diagnosis (14 CQs) and treatment (4 CQs). Recommendation levels for clinical statements were set using the modified Delphi approach. The guidelines explain methods for accurate diagnosis, and safe and appropriate treatment of IgG4-SC.

DOI： 10.1002/jhbp.596

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DOI： 10.11405/nisshoshi.116.305

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Language：English   Publishing type：Part of collection (book)   Publisher：Springer Singapore  

DOI： 10.1007/978-981-10-4548-6_13

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BACKGROUND: Sporadic autoimmune pancreatitis (AIP) cases showing remission without steroid treatment have been reported, however, the clinical course of these patients has not been clarified. This study sought to clarify the clinical course in AIP patients with hesitation for steroid treatment. METHODS: We collected clinical data for AIP patients from high-volume centers in Japan. Data for AIP patients with and those without steroid treatment (steroid treatment vs. wait and see policy or W&S) were then compared. The primary point was the relapse-free survival rate (RFS) in patients with and those without steroid treatment, as determined using Kaplan-Meier curve. The secondary point was the identification of predictors of remission and risks of relapse in AIP patients without steroid treatment. RESULTS: There were 510 AIP patients in the steroid treatment group and 97 patients in the W&S group. Overall, 55.7% (54/97) of type 1 AIP patients in the W&S group experienced transient remission without steroid treatment. The W&S group had a significantly higher patient age and significantly lower incidences of jaundice, diffuse pancreas swelling, proximal-type sclerosing cholangitis, and stent placement and a lower remission rate than the steroid treatment group (each P < 0.05). The RFS reached a plateau at 10 years in both the W&S group (50%) and steroid treatment group (52.9%). As for the RFS (W&S vs. group with steroid), 89.4% vs. 74.4% within 3 years, 81.8% vs. 65.3% within 5 years, and 50% vs. 52.9% within 10 years (log-rank, P = 0.064). Female gender (OR 0.340, P = 0.027) and stent placement for jaundice (OR 4.552, P = 0.008) were identified as predictors of transient remission in the W&S group. New-onset diabetes mellitus (OR 8.333, P = 0.012) and the presence of extensive multi-organ involvement (OR 35, P = 0.006) were identified as risks of relapse in the W&S group. CONCLUSION: Some type 1 AIP patients without steroid treatment experience transient remission. These cases tend to have lower disease activities than AIP patients receiving steroids. Female gender and stent placement for jaundice may be predictors of transient remission among patients not receiving steroid treatment, however, relapses can occur in these patients with new-onset diabetes mellitus and the presence of extensive multi-organ involvement. Therefore, steroid treatment is still imperative for these patients.

DOI： 10.1002/jhbp.541

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Language：Japanese   Publisher：(一社)日本消化器内視鏡学会  

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BACKGROUND: The effect of maintenance steroid treatment (MST) in reducing the risk of relapse in patients with autoimmune pancreatitis (AIP) remains under debate. The aim of this study was to validate the effect of MST on AIP administered in accordance with the 2010 Japanese consensus guidelines. METHODS: The clinical data of patients with (n = 510) from 22 high-volume centers in Japan were studied. The primary endpoints were the relapse rates (RRs) in patients administered MST versus those not administered MST. The secondary endpoints were the optimal dose and duration of MST in terms of steroid toxicity and the predictors of relapse. RESULTS: The RRs were 10.0% within 1 year, 25.8% within 3 years and 35.1% within 5 years. The RR in the steroid therapy group reached a plateau at 42.7% at 7 years. In terms of the optimal dosage, the overall RR in the MST 5 mg/day group was 26.1%, which was significantly lower than that in the group which had discontinued steroid therapy (45.2%; p = 0.023) or was receiving MST at 2.5 mg/day (43.4%, p = 0.001). The RRs in the group receiving MST at ≥5 mg/day versus the patient group receiving MST at <5 mg/day were 10.6 vs. 10.3% within 1 year, 23.5 vs. 32.9% within 3 years and 32.2 vs. 41.3% within 5 years, respectively (log-rank, p = 0.028). The best cutoff value of the total steroid dose for serious steroid toxicity was 6405 mg, with a moderate accuracy of 0.717 determined using the area under the curve. Presence of diffuse pancreatic swelling [odds ratio OR) 1.745; p = 0.008) and MST at >5 mg/day were identified as predictors of relapse (OR 0.483; p = 0.001). CONCLUSIONS: The RR could continue to increase for 7 years even under MST. Based on our analysis of the side effects of steroid therapy, MST at 5 mg/day for 2 (total 4625 mg) to 3 (total 6425 mg) years might be a rational and safe therapeutic strategy in terms of keeping the RR to <30% while avoiding potential steroid toxicity.

DOI： 10.1007/s00535-016-1302-1

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BACKGROUND: Predicting chemosensitivity to neoadjuvant chemoradiotherapy (NACRT) in pancreatic cancer is desired. The present study aimed to examine the relationship between intratumoral expression of human equilibrative nucleoside transporter 1 (hENT1), thymidylate synthase (TS), and dihydropyrimidine dehydrogenase (DPD) and the outcomes of NACRT with gemcitabine (GEM) combined with S-1 in patients with borderline-resectable pancreatic cancer (BRPC). MATERIALS AND METHODS: Forty-seven patients who underwent NACRT with GEM plus S-1, following curative surgery, were recruited in our Institution between 2009 and 2012. Immunohistochemical expressions of hENT1, TS, and DPD in fine-needle aspiration (FNA) biopsies and resected specimens were examined. The correlation between these enzyme expressions and long-term outcome was analyzed. RESULTS: In 21 FNA specimens, no relationship between clinical responses to NACRT and long-term survival was found. However, in 47 resected specimens, patients were classified according to the number of favorable hENT1, TS, and DPD expression factors (hENT1 positive/TS negative/DPD negative). The presence of three favorable factors was strongly associated with improved partial response rates to NACRT (p=0.002). Patients with 2 or more favorable factors showed a significantly longer overall survival than the other patients (p=0.002). CONCLUSION: Combined expression analyses of hENT1, TS, and DPD may predict long-term outcomes in patients with BRPC after NACRT.

DOI： 10.21873/anticanres.11587

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Language：Japanese   Publisher：(一社)日本膵臓学会  

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Language：Japanese   Publisher：(一社)日本消化器内視鏡学会  

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Language：Japanese   Publisher：(一社)日本消化器内視鏡学会  

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Language：Japanese   Publisher：(一財)日本消化器病学会  

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Background/Aims: There is no consensus for using endoscopic papillary large balloon dilation (EPLBD) in patients without dilatation of the lower part of the bile duct (DLBD). We evaluated the feasibility and safety of EPLBD for the removal of difficult bile duct stones (diameter ≥10 mm) in patients without DLBD. Methods: We retrospectively reviewed the records of 209 patients who underwent EPLBD for the removal of bile duct stones from October 2009 to July 2014. Primary outcomes were the clearance rate and additional mechanical lithotripsy. Secondary outcomes were the incidence of complications and recurrence rate. Results: Fiftyseven patients had DLBD (27.3%), and 152 did not have DLBD (72.7%). There were no significant differences in the overall success rate or the use of mechanical lithotripsy. Success rate during the first session and procedure time were better in the DLBD than the without-DLBD group (75.7% vs 66.7%, 48.1±23.0 minutes vs 58.4±31.7 minutes, respectively). As for complications, there were no significant differences in the incidence of pancreatitis, perforation or bleeding after endoscopic retrograde cholangiopancreatography. The recurrence rate did not differ significantly between the two groups. Conclusions: EPLBD is a useful and safe method for common bile duct stone removal in patients without DLBD.

DOI： 10.5009/gnl15634

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Language：Japanese   Publisher：(株)東京医学社  

これまで、癌性疼痛や腰部椎間板ヘルニアに伴う腰痛に対して、麻酔科、整形外科専門医によりX線透視下に、患者背側からawakeのまま神経ブロックがブラインドで行われてきた。一方、超音波内視鏡ガイド下腹腔神経ブロック術は鎮静下で、超音波内視鏡ガイド下穿刺吸引法(EUS-FNA)と同様、苦痛なく安全に施行可能で、有効性の高い手技として注目されている。癌性疼痛については、WHOラダーに沿って鎮痛薬はできる限り内服で少量から始め、疼痛が消える量に漸増し、なるべく定時処方で、必要に応じて鎮痛補助薬の併用も考慮すべきとされている。ほとんどの疼痛はWHOラダーに沿った治療でコントロール可能であるが、麻薬を希望しない、または麻薬不耐性などの場合に本法は有効である。超音波内視鏡ガイド下腹腔神経ブロック術には、腹腔神経叢ブロック(EUS-CPB)と神経節ブロック(EUS-CGN)がある。現状では、EUS-CPNはWHOの疼痛コントロールのstep3の選択肢の一つとして施行されている。(著者抄録)

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Language：Japanese   Publisher：(一社)日本消化器内視鏡学会  

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Background and study aims: Several meta-analyses and randomized control trials have demonstrated the efficacy of rectal nonsteroidal anti-inflammatory drugs for preventing post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP). Diclofenac or indomethacin was administered at a dose of 100 mg in those studies, which may be too high for Asian population. In addition, rectal administration can be considered complicated. Patients and methods: This study was a prospective, randomized, placebo-controlled trial. Patients with a PEP risk score ≥ 1 were randomly assigned to receive intravenous injection of 50 mg flurbiprofen axetil (flurbiprofen group) or saline only (placebo group). The primary outcome was reduced PEP. The secondary outcome was amylase level after 2 hours of ERCP as a predictor of PEP. (Clinical Trials.gov, ID UMIN000011322) Results: In total, 144 patients were enrolled from August 2013 to March 2015. We performed an interim analysis of the first 100 patients: 47 received flurbiprofen axetil and 53 received placebo. PEP occurred in 11 patients (11 %): 2 of 47 (4.3 %) in the flurbiprofen group and 9 of 53 (17 %) in the placebo group (P = 0.042). Relative risk reduction was 62.4 %. Hyperamylasemia did not differ significantly (17.0 % vs. 26.4 %, P = 0.109). This analysis resulted in early termination of the study for ethical reasons. Conclusions: Intravenous injection of low-dose flurbiprofen axetil after ERCP can reduce the incidence of PEP in high-risk patients.

DOI： 10.1055/s-0042-115172

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Language：Japanese   Publisher：(一社)日本消化器内視鏡学会  

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DOI： 10.1007/s00535-016-1160-x

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Language：Japanese   Publisher：(一財)日本消化器病学会  

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DOI： 10.3748/wjg.v22.i26.5909

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DOI： 10.1111/den.12662

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BACKGROUND AND STUDY AIMS: Neoadjuvant chemotherapy (NAC) may lead to a successful margin-negative resection in patients with initially unresectable locally advanced Klatskin tumor (IULAKT). Use of removable plastic stents is preferable for the safe implementation of NAC in patients with IULAKT to reduce the risk of recurrent cholangitis. Our aim was to evaluate the efficacy associated with the use of plastic stents placed across the stenosis and above the papilla (above stent) during NAC. PATIENTS AND METHODS: In this study, we stratified the patients into two groups chronologically with respect to the period of stent placement: above stent group (n = 17) and across stent group (n = 23) (plastic stent across the sphincter of Oddi). RESULTS: The median stent patency period was 99 days in the above stent group and 31 days in the across stent group (P < 0.0001). The number of stents (P = 0.017) and the rate of emerging undrained cholangitis areas (P = 0.025) were significantly reduced in the above stent group than the counterpart. Regarding time to recurrent biliary obstruction, the above stent group had a longer duration than the across stent group (log rank test, P = 0.004). Length of hospital stay was significantly shorter for the above stent group than the across stent group (P = 0.0475). Multivariate analysis revealed that above stent placement (odds ratio = 33.638, P = 0.0048) was significantly associated with stent patency over a period of 90 days. CONCLUSIONS: Above stent placement should be considered for the relief of biliary obstruction and potentially reduces the cost for patients with IULAKT scheduled to receive NAC.

DOI： 10.1055/s-0042-102246

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DOI： 10.1097/MCG.0000000000000397

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Language：English   Publisher：The Japanese Society of Internal Medicine  

<p><b>Objective </b>Some patients with malignant gastric outlet obstruction require combined biliary and gastroduodenal stenting (double stenting). However, biliary stent dysfunction can often disturb biliary route maintenance, thus making the optimal biliary stenting for these patients unclear. The present study was designed to assess the factors associated with the long-term maintenance of biliary drainage routes. </p><p><b>Methods </b>The clinical features and long-term outcomes were assessed in patients who underwent double stenting. </p><p><b>Patients </b>The outcomes were reviewed in 43 consecutive patients who successfully underwent endoscopic double stenting with metallic stents. </p><p><b>Results </b>An univariate analysis of all patients with biliary stent dysfunction showed the separate type of double stenting (two stents placed in a non-crossed position) to be the only predictive factor related to successful biliary re-intervention for stent dysfunction (odds ratio 73.67, p=0.001). A comparison of the clinical features in patients who underwent separate and cross (two stents placed in a crossed position) stenting showed the functional success rate to be higher for the separate (93.3%) than for the cross (61.5%) stent type, with the median times to biliary stent dysfunction differing significantly (330 vs. 298 days, respectively; p=0.048). The success rates of re-intervention in patients with separate and cross type stents were 88.9% and 0.0%, respectively (p=0.001), and the initial biliary route maintenance rates were 96.7% and 53.8%, respectively (p=0.002). </p><p><b>Conclusion </b>The separate type of double stenting may enhance successful biliary re-intervention for stent dysfunction and also maintain the initial drainage route longer. The biliary drainage outcomes should therefore be considered when choosing the type of double stenting. </p>

DOI： 10.2169/internalmedicine.55.6410

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Language：Japanese   Publisher：Japan Gastroenterological Endoscopy Society Kanto Chapter  

A 63-year-old male was conducted Corticosteroid Therapy (CST) in the diagnosis of autoimmune pancreatitis (AIP) . After recurrence as AIP with IgG4-SC, CST was resumed. Serum IgG4 level was deteriorated at the maintenance corticosteroid dose at 7.5mg then, enhanced computed tomography indicated thickening of hilar bile duct. Endoscopic retrograde cholangiographic image showed a long stricture of the bile duct, except for the lower bile duct. IDUS showed uniformity thickening of the bile duct wall. Endoscopic examination of the bile duct failed to obtain histopathological diagnosis. Steroid trial was started. At 14 days after CST, ERC showed improvement. Therefore the case was diagnosed as probable IgG4-SC. It is not easy to discriminate IgG4-SC without AIP from primary sclerosing cholangitis (PSC) , and cholangiocarcinoma. This case suggests the effectiveness of IDUS and steroid trial for diagnosis of IgG4-SC.

DOI： 10.11641/pde.88.1_174

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Other Link： http://search.jamas.or.jp/link/ui/2016386623

Language：Japanese   Publisher：(一社)日本膵臓学会  

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DOI： 10.5754/hge13850

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BACKGROUND: Endoscopic biliary stenting (EBS) is one of the most important palliative treatments for biliary tract cancer. However, reflux cholangitis arising from bacterial adherence to the inner wall of the stent must be avoided. We evaluated the use of EBS above the sphincter of Oddi to determine whether reflux cholangitis could be prevented in preoperative cases. METHODS: Fifty-seven patients with primary biliary tract cancer were retrospectively recruited for the evaluation of stent placement either above (n = 25; inside stent group) or across (n = 32; conventional stent group) the sphincter of Oddi. We compared the stent patency periods prior to the time of surgical resection. RESULTS: The preoperative periods were 96.3 days in the conventional stent group and 96.8 days in the inside stent group (P = 0.979). Obstructive jaundice and/or acute cholangitis occurred in 7 patients (28.0%) in the inside stent group and in 15 patients (46.9%) in the conventional stent group during the preoperative period (P = 0.150). The average patency periods of the stents were 85.2 days (range, 13-387 days) for the inside stent group and 49.1 days (range, 9-136 days) for the conventional stent group (log-rank test: P = 0.009). The mean numbers of re-interventions because of stent occlusion were 0.32 for the inside stent group and 1.03 for the conventional stent group (P = 0.026). Post-endoscopic retrograde cholangiopancreatography complications occurred in 2 patients in the inside stent group and 4 patients in the conventional stent group (P = 0.516). Postoperative liver abscess occurred in 1 patient in the inside stent group and 5 patients in the conventional stent group (P = 0.968). Inside stent placement was the only significant preventative factor associated with stent obstruction based on univariate (hazard ratio [HR], 0.286; 95% confidence interval [CI], 0.114-0.719; P = 0.008) and multivariate (HR, 0.292; 95% CI, 0.114-0.750; P = 0.011) analyses. CONCLUSION: Temporary plastic stent placement above the sphincter of Oddi is a better bridging treatment than conventional stent placement in preoperative primary biliary tract cancer.

DOI： 10.1186/s12876-015-0233-2

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DOI： 10.5754/hge13136

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：BIOMED CENTRAL LTD  

Background: The influence of size on the effectiveness of nasobiliary catheters has not yet been studied. We compared biliary drainage effectiveness and procedure-related discomfort and adverse events in 5 French (Fr) and 7 Fr nasobiliary catheters.
Methods: We prospectively studied 100 patients undergoing endoscopic biliary drainage for obstructive jaundice, who were randomly allocated to a 5 Fr or 7 Fr nasobiliary catheter group. As the primary endpoint, the effectiveness was evaluated by the serum total bilirubin decreasing rate and the success rate of jaundice relief. As the secondary endpoint, the degree of discomfort was investigated using a questionnaire survey after catheter removal.
Results: The bilirubin decrease rate was significantly higher in the 7 Fr catheter group than in the 5 Fr group (53.0 +/- 21.4% vs 40.5 +/- 29.9%, respectively; P = 0.019). The success rate of jaundice relief tended to be higher in the 7 Fr catheter group, although the difference was not statistically significant (98% vs 88%, respectively; P = 0.056). The questionnaire survey demonstrated that total discomfort was significantly greater in the 7 Fr group (3.9 +/- 1.5 vs 3.2 +/- 1.4, respectively; P = 0.018). Larger-diameter catheters tended to increase difficulty in eating, although the difference between the groups was not statistically significant.
Conclusions: 7 Fr nasobiliary catheters are recommended for patients requiring rapid and reliable relief of obstructive jaundice. However, because they can cause greater discomfort, 5 Fr nasobiliary catheters are preferred in other settings.

DOI： 10.1186/1471-230X-14-161

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：SPRINGER JAPAN KK  

Background Endoscopic papillary large-balloon dilation (EPLBD) became popular for the treatment of large common bile-duct stones (CBDS), and its feasibility has been reported in comparison to endoscopic sphincterotomy. However, the comparison between EPLBD and endoscopic papillary regular-balloon dilation (EPBD) has not been reported. In the present study, the efficacy and complications of EPLBD were compared with those of EPBD.
Methods We retrospectively assessed 334 consecutive patients with CBDS of any size that were treated by either EPLBD or EPBD between January 2008 and December 2012.
Results In cases with large CBDS (&gt;10 mm), EPLBD and EPBD had similar results in terms of the success rate of stone removal in the first (65% vs. 84%) and total attempts (100% vs. 95%), use of mechanical lithotripter (64% vs. 80%), and procedure time (48.0 +/- 17.8 min vs. 44.1 +/- 17.1 min). The necessity for crushing stones with a mechanical lithotripter was significantly decreased in EPLBD compared to EPBD (25% vs. 80%). In all cases with CBDS, there was no significant difference in complication rates between EPLBD and EPBD (3.3% vs. 4.7%).
Conclusions Compared to EPBD, EPLBD appears safe and effective for removing large CBDS and decreases the necessity of lithotripsy.

DOI： 10.1002/jhbp.42

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DOI： 10.1002/jhbp.10

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：WILEY-BLACKWELL  

BackgroundPatients with borderline resectable pancreatic head cancer (BRPHC) have been treated with neoadjuvant chemoradiation therapy (NACRT) using metallic stents. The aim of the present study was to evaluate the efficacy and complications of covered self-expanding metallic stents (CSEMS) during the NACRT and surgical period.
Patients and MethodsWe reviewed the outcomes of patients with BRPHC, then divided them chronologically into three groups as follows. Group A: upfront surgery with plastic stent (PS) deployment; group B: PS deployment plus neoadjuvant chemotherapy (NAC) and/or NACRT; group C: CSEMS deployment plus NAC/NACRT. Patients were categorized as borderline resectable based on National Comprehensive Cancer Network Guidelines, 2010. Days to reintervention (DR), reintervention rate, and the rate of R0 and complications were studied. Safe margin-negative resection (R0) surgery was defined as R0 surgery without reintervention during the NACRT period and no postoperative complications.
ResultsDR were as follows. Groups A, B and C were 32, 55 and 97 days, respectively (P&lt;0.05). R0 surgery obtained in groups A, B and C was 53% (9/17), 100% (17/17) and 93% (14/15), respectively. CSEMS did not interfere with surgery. Safe R0 surgery obtained in groups B and C was 11% (2/19) and 67% (10/15), respectively (P&lt;0.05). Multivariate analysis showed that the odds ratio for safe R0 surgery was 16.210 (95% CI 2.457-106.962, P=0.003) for CSEMS placement.
ConclusionCSEMS should be considered to relieve symptomatic biliary obstruction in patients with BRPHC receiving NACRT in view of the high attainability rate of safe R0 surgery compared to that with PS deployment.

DOI： 10.1111/den.12049

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Language：Japanese   Publisher：Japan Gastroenterological Endoscopy Society Kanto Chapter  

Xanthogranulomatous cholecystitis (XGC) is difficult to differentiate from malignant tumors, such as gallbladder and bile duct carcinoma. We report a case of XGC which was diagnosed preoperatively by recognizing the continuity of the mucosal layer in the gallbladder wall on multi-detector computed tomography (MDCT) . A 63-year-old man was admitted to the hospital because of jaundice. Abdominal ultrasound showed intrahepatic bile duct dilatation and stones in the gallbladder. MDCT showed diffuse thickening of the gallbladder wall and stenosis of the upper biliary tract. ERC showed bile duct stricture extending from the common bile duct to both hepatic ducts. Positron emission tomography (PET) showed abnormal accumulation in the bile duct stricture, with a standardized uptake value (SUV) of 5.0. The serum levels of the tumor markers CA19-9, DUPAN2 and SUPAN1 were also elevated. Based on these findings, the diagnosis of gallbladder carcinoma infiltrating the bile duct was suspected.<br> On the other hand, ERCP brush cytology and EUSFNA did not reveal any evidence of malignancy. Furthermore, we recognized continuity of the mucosal layer in the gallbladder wall on MDCT. Although XGC was strongly suspected based on the imaging findings, we performed resection of the gallbladder bed. Intraoperative pathological examination confirmed the diagnosis of XGC and ruled out malignancy. The findings on MDCT allowed us to avoid unnecessary extended operation.

DOI： 10.11641/pde.85.1_140

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Other Link： http://search.jamas.or.jp/link/ui/2015124787

DOI： 10.1055/s-0033-1344330

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Language：Japanese   Publisher：(一社)日本膵臓学会  

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Language：Japanese   Publisher：(一社)日本胆道学会  

症例は70歳女性。USで肝内胆管、総胆管の拡張を認めた。CTで下部胆管に造影効果を有する腫瘍を認めた。内視鏡で十二指腸乳頭部の口側隆起は球状に腫大し、開口部粘膜の潰瘍性病変と十二指腸粘膜の襞集中を認めた。胆管深部挿管は困難でありsuprapapillary incisionを施行した。ERCで胆管末端の嚢腫状拡張を認めた。EUS、IDUSでは胆管末端は12mm径の嚢腫状の拡張を認め、十二指腸乳頭部に腫瘍の筋層浸潤を認めた。乳頭部生検は腺癌であった。術前画像診断でAbから発生した浸潤癌と診断した。非共通管拡張型のCholedochoceleの合併も示唆された。手術施行されたが開腹時、肝臓に微小結節が多発していたため試験開腹のみとなった。(著者抄録)

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2013&ichushi_jid=J02149&link_issn=&doc_id=20130607100012&doc_link_id=%2Fdw1tando%2F2013%2F002702%2F012%2F0240-0246%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fdw1tando%2F2013%2F002702%2F012%2F0240-0246%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

DOI： 10.5754/hge12285

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DOI： 10.1016/j.pan.2012.12.364

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Medical Association of Yokohama City University  

From November 1997 to December 2012, 56 cases of living donor liver transplantation were performed at Yokohama City University Hospital. Of these 56 donors, 37 were male and 19 were female. The mean age of donors was 43.2 years. The mean operation-time was 447 minutes. The mean blood loss was 557ml. The mean hospital stay was 13 days. Complications occurred in 14 of the 56 (25%) donors. Two of the 14 complications were grade I (14. 3%) and 6 (42.9%) were grade II. Five (35.75 of the major complications were grade Ilia, and 1 (7.1%) was grade Illb. 90% of donors had returned to work within 3 months after surgery. However, seven donors were forced to change jobs and two donors took more than a year to return to work because of complications. The donor's quality of life was decreased by the complications. Therefore, cadaveric liver transplantation should be promoted to solve these living donor problems.

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DOI： 10.1055/s-0033-1344416

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DOI： 10.1007/s00595-012-0333-3

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BACKGROUND: The differences in the small intestinal toxicity of low-dose aspirin based on the type of aspirin used remains unclear. The purpose of this study was to evaluate the differences in the small bowel mucosal injury between buffered and enteric-coated aspirin users by capsule endoscopy. METHODS: We retrospectively reviewed the findings in chronic low-dose aspirin users (>3 months) who underwent capsule endoscopy for the investigation of obscure gastrointestinal bleeding. The patients were classified into two groups based on the type of low-dose aspirin that they had been prescribed (enteric-coated aspirin group or buffered aspirin group), and evaluated the numbers of small bowel lesions and the Lewis score. RESULTS: Capsule-endoscopic findings of a total of 70 patients taking low-dose aspirin were reviewed. Significant differences in the number of erosions and ulcers were observed between the buffered and enteric-coated aspirin groups (P=0.017 and P=0.037, respectively). The median Lewis score for the small bowel mucosal inflammatory change was significantly higher in the enteric-coated aspirin group than in the buffered aspirin group (P=0.035). CONCLUSIONS: The results of this study suggested that enteric-coated aspirin might be more injurious to the small bowel mucosa than buffered aspirin.

DOI： 10.1016/j.dld.2012.05.016

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Language：English   Publisher：WILEY-BLACKWELL  

DOI： 10.1111/j.1443-1661.2011.01230.x

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Language：Japanese   Publisher：(一社)日本消化器内視鏡学会  

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DOI： 10.3748/wjg.v18.i16.1933

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DOI： 10.1016/j.pan.2011.12.008

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BACKGROUND: The ideal medication for acid-related diseases should have a rapid onset of action to promote hemostasis and cause efficient resolution of symptoms. The aim of our study was to comparatively investigate the inhibitory effect on gastric acid secretion of a single oral administration of omeprazole plus mosapride with that of omeprazole alone. METHODS: Ten Helicobacter pylori-negative male subjects participated in this randomized, two-way crossover study. Intragastric pH was monitored continuously for 6 hours after a single oral administration of omeprazole 20 mg or that of omeprazole 20 mg plus mosapride 5 mg (the omeprazole being administered one hour after the mosapride). Each administration was separated by a 7-days washout period. RESULTS: The average pH during the 6-hour period after administration of omeprazole 20 mg plus mosapride 5 mg was higher than that after administration of omeprazole 20 mg alone (median: 3.22 versus 4.21, respectively; p = 0.0247). CONCLUSIONS: In H. pylori -negative healthy male subjects, an oral dose of omeprazole 20 mg plus mosapride 5 mg increased the intragastric pH more rapidly than omeprazole 20 mg alone.

DOI： 10.1186/1471-230X-12-25

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：ZHEJIANG UNIV  

Objective: The ideal medication for the treatment of acid-related diseases, e.g., peptic ulcers, stress-related gastric bleeding, functional dyspepsia, and gastroesophageal reflux disease, should have a rapid onset of action to promote hemostasis and relieve the symptoms. The aim of our study was to investigate the inhibitory effects on gastric acid secretion of a single oral administration of a proton pump inhibitor, omeprazole 20 mg, and an H-2-receptor antagonist, roxatidine 75 mg. Methods: Ten Helicobacterpylori-negative male subjects participated in this randomized, two-way crossover study. Intragastric pH was monitored continuously for 6 h after single oral administration of omeprazole 20 mg and roxatidine 75 mg. Each administration was separated by a 7-d washout period. Results: During the 6-h study period, the average pH after administration of roxatidine was higher than that after administration of omeprazole (median: 4.45 vs. 2.65; P=0.0367). Also during the 6-h study period, a longer duration of maintenance at pH above 2, 5, and 6 was observed after administration of roxatidine 75 mg than after administration of omeprazole 20 mg (median: 90.6% vs. 55.2%, P=0.0284; 43.7% vs. 10.6%, P=0.0125; 40.3% vs. 3.3%, P=0.0125; respectively). Conclusions: In Helicobacter pylori-negative healthy male subjects, oral administration of roxatidine 75 mg increased the intragastric pH more rapidly than that of omeprazole 20 mg.

DOI： 10.1631/jzus.B1100078

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DOI： 10.1007/s00595-011-0037-0

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Language：English   Publisher：The Japanese Society of Internal Medicine  

<b>Objectives</b> The aim of this study was to characterize the pancreatic cystic lesions in von Hippel-Lindau (VHL) disease and to document the changes that occur in the pancreas.<br> <b>Methods</b> We retrospectively analyzed the medical records and the computed tomography (CT) and magnetic resonance imaging (MRI) findings of 20 VHL patients who were diagnosed between 1996 and 2010 at our hospital. The clinical findings, family history and type of tumors and/or cysts were reviewed for each patient. We also analyzed the imaging findings for the pancreas in detail.<br> <b>Results</b> Pancreatic involvement was noted in 16 of the 20 patients (80%). Eleven patients had multiple cysts diffusely distributed in the pancreas, and one patient had a single cyst in the pancreas head. Two patients had serous cystic neoplasms (SCNs) with multiple cysts, and another two patients had neuroendocrine tumors (NETs) which were conventional radiological findings. The largest cysts of four patients (26.7%) increased in size and that of three patients (20%) decreased in size during the follow-up period. We performed surgical resections for the pancreatic tumors (one NET and one SCN) and also performed endoscopic treatment for a pancreatic cyst in one VHL patient with obstructive jaundice. None of the patients died as a result of pancreatic disease.<br> <b>Conclusion</b> The most common type of pancreatic lesions was multiple cysts. SCNs were present in only 10% of the VHL patients. Pancreatic cysts showed positive and/or negative growth according to the CT and MRI findings. The pancreatic cystic lesions did not influence the outcome of the VHL patients.<br>

DOI： 10.2169/internalmedicine.51.7194

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Other Link： http://search.jamas.or.jp/link/ui/2013215038

DOI： 10.1007/s12328-011-0240-y

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DOI： 10.1007/s00535-011-0393-y

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DOI： 10.1007/s00534-010-0359-0

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：INT SCIENTIFIC LITERATURE, INC  

Background: Pretreatment with a proton pump inhibitor (PPI) reportedly decreases the efficacy of Helicobacter pylori (H. pylori) eradication, however, the effect of pretreatment with an H2 receptor antagonist (H2RA) on H. pylori eradication has not yet been studied. We compared the efficacy of eradication regimen (lansoprazole/amoxicillin/clarithromycin) in patients with H. pylori infection with or without H2RA pretreatment.
Material/Methods: In this retrospective study conducted at three centers, 310 patients with H. pylori infection were treated. The diagnosis of H. pylori infection was made using the rapid urease test, bacterial cultures and histological examination of endoscopic biopsy specimens. The patients were assigned to receive an eradication regimen first or following pretreatment with H2RA. Eradication was assessed using the C-13-urea breath test more than 4 weeks after the completion of therapy.
Results: Overall, H. pylori was eradicated in 79.7% of the cases: the eradication rate was 81.6% in the pretreatment group, and 77.6% in the eradication first group (p=0.3799, chi-square test). No significant difference in the eradication rate was observed between the two groups.
Conclusions: Pretreatment with H2RA had no significant influence on the efficacy of H. pylori eradication therapy.

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：KOREAN SOC NEUROGASTERONTEROL & MOTILITY  

Background/Aims
There are few reports on the correlation between chewing gum and the gastrointestinal functions. But previous report showed use of chewing gum to be an effective method for controlling gastrointestinal symptoms. The aim of this study was to determine the correlation between chewing gum and gastric emptying using the continuous real time C-13 breath test (BreathID system).
Methods
Ten healthy male volunteers participated in this randomized, 2-way crossover study. The subjects fasted overnight and were randomly assigned to chewing gum (Xylish, 2-3/1 tablet) for an hour following intake of a test meal (200 kcal/200 mL) or intake of the test meal alone. Gastric emptying was monitored for 4 hours after administration of the test meal by the C-13-acetic acid breath test performed continually using the BreathID system.
Results
No significant differences in the calculated parameters, namely, T-1/2 (median, 111.82 vs 109.26 minutes; P = 0.575), T-lag (median, 53.28 vs 56.53 minutes; P = 0.333), gastric emptying coefficient (median, 3.58 vs 3.65; P = 0.285), regression-estimated constant beta (median, 1.85 vs 1.80; P = 0.575) and regression-estimated constant kappa (median, 0.61 vs 0.62; P = 0.959) were observed between the test meal alone group and the test meal and chewing gum group.
Conclusions
This study showed that chewing gum had no effect on the rate of gastric emptying. Therefore, since chewing gum did not enhance the speed of gastric emptying, it may ameliorate gastrointestinal symptoms through other mechanisms, such as saliva and autonomic nervous system.

DOI： 10.5056/jnm.2011.17.2.174

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DOI： 10.1007/s00534-010-0330-0

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Language：English   Publisher：JAPANESE PHARMACOLOGICAL SOC  

The factors involved in the progression of non-alcoholic fatty liver (NAFL) to nonalcoholic steatohepatitis (NASH) are not fully understood and thus it is urgently needed to elucidate these factors. Steatosis is not causal in the development of NASH, but rather it sensitizes the liver to the damaging effects of second hits such that stressors innocuous to a healthy liver lead to the development of NASH in the steatotic liver. In the previous study, most of the hepatic lipid metabolite profiles were similar in the NAFL and NASH groups. However, very-low-density lipoprotein (VLDL) synthesis, especially hepatic microsomal triglyceride transfer protein (MTP) mRNA expression, was impaired in the NASH group. Moreover, NASH showed significantly higher incidence of minor alley appearance compared with NAFL, indicating the possibility of association between NASH pathogenesis and decreased congenital MTP activity. MTP is one of the enzymes that transfer triglycerides to nascent apolipoprotein B, producing VLDL and removing lipid from the hepatocyte. A growing body of literature suggests that the measurement of hepatic MTP expression may be helpful for diagnosis; and moreover, hepatic MTP activator may be a possible therapeutic agent for the treatment of NASH.

DOI： 10.1254/jphs.10R14FM

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DOI： 10.1111/j.1443-1661.2010.01039.x

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BACKGROUND/AIMS: To determine the correlation between domperidone and gastric emptying using the continuous real time 13C breath-test (BreathID system), a novel non-invasive technique for measuring gastric emptying. METHODOLOGY: Six healthy male volunteers participated in this randomized, two-way crossover study. Subjects fasted overnight and were randomly assigned to receive a test meal (400kcal per 400mL) 30 minutes after intake of domperidone (10mg) with 50 mL of water or intake of 50 mL of water alone. Gastric emptying was monitored for 4h after administration of the test meal by 13C-acetic acid breath test continually performed using the BreathID system. The time taken for emptying of 50% of the labeled meals (T1/2), the analog to the scintigraphy lag time for 10% emptying of the labeled meal (T lag), the gastric emptying coefficient (GEC), and the regression-estimated constants (beta and kappa) were calculated. Differences in the parameters measured at two time-points were analyzed using the Wilcoxon's signed-rank test. RESULTS: No significant differences in calculated parameters (T lag, T1/2, GEC, beta or kappa) were observed between the treated and non-treated groups. CONCLUSIONS: This study showed that domperidone had no effect on gastric emptying. The drug ameliorates nausea and vomiting via its antagonic activity against dopamine receptor. Therefore, domperidone probably ameliorates nausea through other mechanisms.

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Language：English   Publisher：KARGER  

DOI： 10.1159/000313695

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：International Scientific Literature Inc.  

Background: A visceral fat area of more than 100 cm2 as measured by computed tomography (CT) at the umbilical level has been included as a criterion for obesity in all the proposed criteria for metabolic syndrome. However, CT cannot be used frequently because of radiation exposure. We evaluated the usefulness of measurement of the serum levels of nitric oxide (NO), instead of CT and the waist circumference, as a marker of abdominal visceral fat accumulation. Material/Methods: The study was carried out in 80 subjects. The serum levels of NO metabolites (nitrate/nitrite) were measured using the Griess reagent. Results: Simple and multiple regression analysis revealed that the serum levels of NO metabolites showed the greatest degree of correlation with the visceral fat area (r=0.743, p&lt
0.0001), and corresponded to a visceral fat area of 100 cm2, as determined using the ROC curve, was 21.0 μmol/ml (sensitivity 88%, specificity 82%)
this method was more sensitive than the waist circumference for evaluation of the visceral fat accumulation. Conclusions: Measurement of the serum levels of NO metabolites may be a simple, safe, convenient and reliable method for the evaluation of visceral fat accumulation in clinical diagnostic screening. © Med Sci Monit.

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：KARGER  

Aim: Capsule endoscopy is limited by the poor image quality of the distal bowel and incomplete small bowel transit. The aim of this study was to establish an optimal medication protocol for capsule endoscopy performed using a real-time viewer. Methods: A total of 80 patients were prospectively recruited. The patients were randomized into two groups: the &apos;conventional group&apos; (without any preparation) and the &apos;real-time group&apos; (in which a real-time viewer was attached). At 60 min after swallowing the capsule, if the capsule had reached the small bowel, 500 ml of polyethylene glycol was administered; if the capsule was still located in the stomach, 10 mg of metoclopramide was given intramuscularly, followed by 500 ml of polyethylene glycol solution. Results: The completion rate was significantly higher in the real-time group as compared with that in the conventional group (72.5 vs. 90.0%). Our protocol yielded a significantly improved image quality of the distal small bowel [image quality score = 1.6 vs. 3.0 (max 4.0)]. The detection rate of lesions in the distal small bowel was higher in the real-time group than in the conventional group. Conclusions: The present study clearly showed that our protocol yielded an improved completion rate and also improved image quality. Copyright (C) 2011 S. Karger AG, Basel

DOI： 10.1159/000323225

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DOI： 10.1111/j.1365-2893.2009.01253.x

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Language：Japanese   Publisher：Japan Biliary Association  

Cancer of ampulla of Vater showed a favorable prognosis compared to that with the other periampullaly lesions. Ampullary tumor tends to show local invasions without skip lesion along with the mucosa of extra-hepatic bile duct. We reported a first case with early ampullary cancer with skip lesion. Main and minor lesions existed together intermitted with normal mucosa of the bile duct. Regarding the detection for lesions, EUS had a diagnostic value. IDUS failed the accurate depth of the main lesion due to the inflammatory change. For a difficult case to diagnose, it was thought that 3D restructuring was necessary. There were no differences as for p53 immune reactivity in the resected specimen between the major and the minor tumors.<br>

DOI： 10.11210/tando.24.617

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Language：Japanese   Publisher：Japan Gastroenterological Endoscopy Society  

AIM : We evaluated the characteristic endoscopic ultrasonography (EUS) findings of early autoimmune pancreatitis (AIP).<BR>Methods : Nineteen patients with AIP who underwent EUS and endoscopic retrograde cholangiopancreatography (ERCP) were identified from our database. We reviewed the following features of EUS as being potentially characteristic of early AIP : hyperechoic foci, hyperechoic strands, lobularity, hyperechoic duct margins and reduced echogenicity. According to the Cambridge classification for chronic pancreatitis, we classified AIP into early AIP (Cambridge Grade 0-2) and advanced AIP (Grade 3-5) and examined the histopathological findings in each stage of AIP.<BR>Results : Here were 9 cases of early AIP and 10 cases of advanced AIP. Five of the 9 early cases of AIP showed spontaneous remission without corticosteroid therapy (<I>p</I><0.05). The EUS findings were as follows (early vs. advanced) ; hyperechoic foci, 100% (9/9) vs. 100% (10/10) ; hyperechoic strands, 66.7% (6/9) vs. 70% (7/10) ; lobularity, 77.8% (7/9) vs. 20% (2/10) ; hyperechoic duct margin, 90% (8/9) vs. 30% (3/10) ; and reduced echogenicity, 88.9% (8/9) vs. 90% (9/10). Lobularity and hyperechoic duct margins were detected at a significantly higher frequency in the early AIP than in advanced AIP patients (<I>p</I><0.05). In relation to the histopathologic findings, acinar cells were preserved to a better extent in the cases of early AIP, whereas the acinar cells were reduced in number and replaced by massive fibrosis in the patients with advanced AIP.<BR>Conclusions : Lobularity and hyperechoic duct margin are characteristic EUS features of early AIP, which has a more favorable prognosis, showing a higher frequency of spontaneous remission and preservation of acinar cells, than advanced AIP.

DOI： 10.11280/gee.52.2745

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Language：Japanese   Publisher：(一財)日本消化器病学会  

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DOI： 10.1186/1752-1947-4-302

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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DOI： 10.1111/j.1872-034X.2010.00643.x

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DOI： 10.1016/j.gie.2010.01.033

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Language：Japanese   Publisher：(一社)日本肝胆膵外科学会  

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：TAYLOR & FRANCIS AS  

Objective. The role of gastric acid reflux is difficult to separate from that of pancreatic-biliary reflux in the pathogenesis of erosive esophagitis (EE) and Barrett&apos;s esophagus (BE). Gastric surgery patients provide a good mode. for both significant pancreatic-biliary reflux and marked gastric acid inhibition. We assessed the risk of EE and BE after distal gastrectomy in a case-controlled study. Material and methods. One hundred and sixty patients (121 men, 39 women; median age 68 years; range 32-86 years) with distal gastrectomies (Billroth-I) and 160 sex- and age-matched controls with intact stomachs were enrolled. The presence of EE and BE were diagnosed based on the Los Angeles Classification and the Prague C & M Criteria, respectively. A conditional logistic regression model with adjustments for potential confounding factors was used to assess the associations. Results. According to the multivariate analyses, patients with distal gastrectomies tended to have inverse associations with the risks of EE and BE, and the inverse association with the risk of BE reached a significant level. Conclusions. Distal gastrectomy is not a risk factor for the development of BE and BE. This lack of a. positive association between distal gastrectomy and BE and BE may suggest that pancreatic-biliary reflux with a limited amount of acid is not sufficient to damage the esophageal mucosa.

DOI： 10.3109/00365520903536507

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DOI： 10.1111/j.1365-2893.2009.01179.x

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DOI： 10.1111/j.1443-1661.2010.00939.x

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Language：Japanese   Publisher：日本臨床外科学会  

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DOI： 10.1007/s10620-009-0771-y

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Language：Japanese   Publisher：(一財)日本消化器病学会  

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DOI： 10.1097/MPA.0b013e3181bc119d

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AIM: To test the hypothesis that the shape and length of Barrett's epithelium are associated with prevalence of erosive esophagitis. METHODS: A total study population comprised 869 patients who underwent endoscopy during a health checkup at our hospital. The presence and extent of Barrett's epithelium were diagnosed based on the Prague C & M Criteria. We originally classified cases of Barrett's epithelium into two types based on its shape, namely, flame-like and lotus-like Barrett's epithelium, and into two groups based on its length, its C extent < 2 cm, and > or = 2 cm. Correlation of shape and length of Barrett's epithelium with erosive esophagitis was examined. RESULTS: Barrett's epithelium was diagnosed in 374 cases (43%). Most of these were diagnosed as short-segment Barrett's epithelium. The prevalence of erosive esophagitis was significantly higher in subjects with flame-like than lotus-like Barrett's epithelium, and in those with a C extent of > or = 2 cm than < 2 cm. CONCLUSION: Flame-like rather than lotus-like Barrett's epithelium, and Barrett's epithelium with a longer segment were more strongly associated with erosive esophagitis.

DOI： 10.3748/wjg.v16.i4.484

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DOI： 10.1159/000308966

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DOI： 10.1159/000288508

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DOI： 10.1055/s-0030-1255772

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DOI： 10.1055/s-0029-1215119

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DOI： 10.1159/000297160

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DOI： 10.1111/j.1872-034X.2009.00539.x

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：7  

BackgroundNonalcoholic fatty liver disease (NAFLD) is one of the most common causes of chronic liver injury in many countries. Genetic factors are important for the development of NAFLD, as well as environmental factors. Recently an angiotensin II type 1 receptor (AGTR1) has been recognized as important in the aetiology of fibrosis in the liver.ObjectiveIn this study we investigated the association between angiotensin II type 1 receptor gene polymorphism (ATGR1) and NAFLD.MethodsOne hundred and sixty-seven NAFLD patients [106 with nonalcoholic steatohepatitis (NASH) and 61 with simple steatosis] with a positive diagnosis by liver biopsy and 435 healthy control subjects were recruited in this study.Results:We investigated 12 single nucleotide polymorphisms (SNPs) of the ATGR1 gene, among which rs3772622 showed the lowest P-value of allele frequency model (P=0.0000012) with an odds ratio (95% confidence interval) of 1.95 (1.49-2.55). Five SNPs (rs3772622, rs3772633, rs2276736, rs3772630 and rs3772627) were significantly associated with NAFLD, even when the most conservative Bonferroni's correction was applied. Linkage disequilibrium analysis revealed that SNP rs3772622 and another four SNPs (rs3772633, rs2276736, rs3772630 and rs3772627) were in the same block. We investigated the association between rs3772622 genotypes and the fibrosis index. The results of the analysis revealed an additive increase of the fibrosis index in the patients with the A allele of rs3772622.ConclusionsThis is the first report to demonstrate the genetic variations in ATGR1 that may influence the risk of NAFLD and liver fibrosis in NAFLD.

DOI： 10.1111/j.1478-3231.2009.01988.x

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Language：Japanese   Publisher：医学図書出版(株)  

胆管の解剖学的研究は現在でも未解決の臨床的問題が存在するため継続されている。腹腔鏡下胆摘を初回手術とする胆管狭窄症例のうちBismuth4型の5例全例に右肝動脈切離を認めた。5例とも左肝動脈から右肝動脈に至る側副血行路を認めたが、2例には肝右葉切除が必要であった。この側副血行路は尾状葉胆管枝にまとわりつくように肝門板の頭背側を走行する。瘢痕狭窄を呈した胆管を切除して健常な胆管で吻合するためには、可及的に肝門板を大きく切開する必要があるが、この側副路を温存することが肝要である。生体肝移植40例(胆管胆管吻合33例、胆管空腸吻7例)中11例(27.5%)に胆管狭窄が発生した。縫合不全症例は全例胆管狭窄となった。胆管胆管吻合症例に限ると10/33例(30.3%)の発生率で、1次分枝では2例(12.5%)に対して2次分枝では8例(47%)と高率であった。解剖学的観点からは右、左肝管に分布する細動脈枝を可及的に温存することが重要と思われた。また虚血胆管は肉眼的には区別できないので、2次分枝以上、疎血時間が長いなど術後胆管狭窄の高危険群と判断されれば胆道ドレナージを全ての胆管に入れてダメージを最小限にすることが術後対策として推奨される。(著者抄録)

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BACKGROUND: The association between obesity and the risk of Barrett's esophagus (BE) is unclear. Furthermore, the association between visceral obesity and the risk of BE is entirely unknown. METHODS: We conducted a retrospective study in 163 patients with non-alcoholic fatty liver disease (NAFLD) who underwent both endoscopy and abdominal CT at an interval of less than a year at our institution. BE was endoscopically diagnosed based on the Prague C & M Criteria. The surface areas of visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) were calculated from CT images at the level of the umbilicus. The correlations between the BMI, VAT, and SAT and the risk of BE were examined by univariate and multivariate analyses. RESULTS: Sixty-nine of the 163 study participants (42.3%) were diagnosed to have endoscopic BE, which was classified as short-segment BE (SSBE) in almost all of the cases. There were no significant differences in the age or gender distribution between the groups with and without BE. According to the results of the univariate analysis, VAT was significantly associated with the risk of BE; the BMI tended to be higher in the group with BE than in the group without BE, but this relation did not reach statistical significance. VAT was independently associated with the risk of BE even after adjustment for the BMI. CONCLUSION: In Japanese patients with NAFLD, obesity tended to be associated with the risk of BE, and this risk appeared to be mediated for the most part by abdominal visceral adiposity.

DOI： 10.1186/1471-230X-9-56

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DOI： 10.1111/j.1443-1661.2009.00879.x

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AIM: Hepatocellular carcinoma (HCC) is one of the most commonly occurring malignances worldwide. Curative therapies such as resection, percutaneous ethanol injection (PEI) and radiofrequency ablation (RFA) have been applied to patients with early-stage HCC. Patients with more advanced cancers require local or systemic therapies. We present the results of our retrospective review conducted to evaluate whether transarterial chemoembolization (TACE) alone and combined TACE with percutaneous ablation for HCC exhibited superior efficacy to palliative treatment. METHODS: The effects of TACE and of the combined therapies (TACE + PEI or TACE + RFA) on the long-term survival rates were evaluated in 268 untreated HCC patients by various statistical analyses. RESULTS: The cumulative survival rates in the TACE alone group were significantly superior to those in the palliative treatment group. Further, the cumulative survival rates in the combined TACE + PEI/RFA group were significantly superior to those in the TACE alone group. When the comparison among the groups was restricted to patients with two or three tumors fulfilling the Milan criteria, significantly greater prolongation of survival was observed in the combined TACE + PEI/RFA group than in the PEI/RFA alone group. CONCLUSIONS: The aforementioned treatment modalities yielded greater improvements of the survival rate and survival duration as compared to palliative treatment in HCC patients. Furthermore, in terms of the effect on the survival period, combined TACE + PEI/RFA therapy was more effective than TACE monotherapy, and also more effective than PEI or RFA monotherapy in cases with multiple tumors fulfilling the Milan criteria.

DOI： 10.1111/j.1872-034X.2009.00490.x

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：H G E UPDATE MEDICAL PUBLISHING S A  

Background/Aims: Coffee is one of the most popular beverages worldwide, however, few studies have examined the effects of coffee on the gastrointestinal system. The aim of this study was to determine whether there was a correlation between coffee intake and gastric emptying using a novel non-invasive technique for measuring gastric emptying with a continuous real time C-13 breath test (BreathID system: Oridion, Israel).
Methodology: Six healthy male volunteers participated in this randomized, two-way crossover study. The subjects were randomly assigned to receive a test meal (200kcal per 200mL) plus postprandial 190mL black coffee or the test meal alone after fasting overnight. A C-13-acetic acid breath test was continuously performed using the BreathID system, which monitors gastric emptying, for 4 hours after the administration of the test meal. Using Oridion Research Software (13 version), the time for emptying of 50% of the labeled meals (T 1/2) and the analog to the scintigraphy lag time for 10% emptying of the labeled meal (T lag) were calculated. The parameters between two occasions were compared using the Wilcoxon signed-rank test.
Results: After coffee intake the T 1/2 and T lag constant were significantly decreased.
Conclusions: The decrease in the T 1/2 and T lag suggests the acceleration of gastric emptying. This study showed that postprandial coffee intake enhances gastric emptying, suggesting the potential use of coffee in clinical settings for patients with functional gastrointestinal disorders.

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Language：Japanese   Publisher：(一財)日本消化器病学会  

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DOI： 10.1159/000227044

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Language：English   Publisher：The Japanese Society of Internal Medicine  

DOI： 10.2169/internalmedicine.48.2229

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Other Link： http://search.jamas.or.jp/link/ui/2010041262

DOI： 10.1016/j.gie.2008.08.013

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：WILEY-BLACKWELL  

DOI： 10.1111/j.1440-1746.2008.05662.x

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Language：Japanese   Publisher：Japan Pancreas Society  

A-59-year-old man was readmitted to our hospital because of jaundice for two years interval. ERP showed diffuse narrowing in the main pancreatic duct and CT revealed focal swelling in the head of the pancreas. Serum IgG4 was 334mg/d<i>l</i>. A diagnosis of relapse of autoimmune pancreatitis (AIP) was made. After initiating PSL therapy for six months, pancreatic tail cancer with multiple liver and bone metastasis was depicted on PET/CT with raise of CA19-9. Although systemic chemotherapy was performed, the result showed disease progression. AIP has been regarded as clinically characterized by response to steroid therapy and a favorable prognosis. However, AIP cases could develop pancreatic cancer. We have to bare in mind that AIP may predispose to pancreatic cancer. Close follow-up examinations are mandatory for AIP cases even after the remission.<br>

DOI： 10.2958/suizo.23.608

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Other Link： http://search.jamas.or.jp/link/ui/2009022177

DOI： 10.1007/s10620-008-0219-9

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Language：Japanese   Publisher：(一社)日本胆道学会  

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：BMC  

Background: Genetic factors as well as environmental factors are important in the development of NAFLD and in this study we investigated associations between polymorphisms of peroxisome proliferators-activated receptor gamma coactivator 1 alpha polymorphism (PPARGC1A) and NAFLD.Aims: We recruited 115 patients with biopsy-proven NAFLD, 65 with NASH and 50 with simple steatosis, and 441 healthy control subjects and investigated 15 SNPs of PPARGC1A.Results: SNP rs2290602 had the lowest p value in the dominant mode (p = 0.00095), and the odds ratio for NAFLD (95% CI) was 2.73 (1.48-5.06). rs2290602 was significantly associated with NAFLD even when the most conservative Bonferroni's correction was applied (p = 0.0143). The frequency of the T allele of rs2290602 was significantly higher in the NASH patients than in the control subjects (p = 0.00093, allele frequency mode), and its frequency in the NASH patients tended to be higher than in the simple steatosis patients (p = 0.09). The results of the real-time RT-PCR study showed that intrahepatic mRNA expression of PPARGC1A was lower in the TT group than in the GG or GT group at SNP rs2290602 (p = 0.0454).Conclusion: This is the first study to demonstrate a significant association between genetic variations in PPARGC1A and NAFLD. This finding suggested that PPARGC1A polymorphism and lower expression of PPARGC1A mRNA in the liver are an important genetic contribution to etiology of NAFLD.

DOI： 10.1186/1471-230X-8-27

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Background: Liver fibrosis is the main predictor of the progression of nonalcoholic fatty liver disease. Transient elastography (FibroScan), which measures liver stiffness, is a novel, noninvasive method to assess liver fibrosis. Aim: We investigated the usefulness of liver stiffness measurement in the evaluation of liver fibrosis in nonalcoholic fatty liver disease patients. Study population: A total of 97 nonalcoholic fatty liver disease patients. Methods: Transient elastography was performed for liver stiffness measurement in 97 nonalcoholic fatty liver disease patients. And the relationship between histological parameters and liver stiffness measurement was studied by multivariate analysis. Moreover, we investigated the relationship between liver stiffness measurement and the serum levels of hyaluronic acid and type IV collagen 7s domain. Results: The liver stiffness was well correlated with the stage of liver fibrosis (Kruskal-Wallis test p < 0.0001). The areas under the receiver-operating characteristic curves were 0.927 for ≥F1, 0.865 for ≥F2, 0.904 for ≥F3, 0.991 for ≥F4. Only fibrosis stage was correlated significantly with liver stiffness measurement by multiple regression analysis. Liver stiffness was also strongly correlated with the serum levels of type IV collagen 7s domain (r = 0.525, p < 0.0001) and hyaluronic acid (r = 0.457, p < 0.0001). Conclusions: Our results show a significant correlation between liver stiffness measurement and fibrosis stage in nonalcoholic fatty liver disease patients, as confirmed by the results of liver biopsy, which remains the gold standard for evaluation of the severity of liver fibrosis in patients with nonalcoholic steatohepatitis. © 2007.

DOI： 10.1016/j.dld.2007.10.019

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Blackwell Publishing  

DOI： 10.1111/j.1440-1746.2008.05493.x

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Language：English   Publishing type：Research paper (international conference proceedings)   Publisher：MEDIMOND S R L  

The contribution of duodenogastroesophageal reflex (DGER) to the development of Barrett&apos;s esophagus (BE) has remained a controversial topic. Animal models suggest that bile reflex may result in BE. Clinical studies demonstrated that reflux played only it synergistic role in bile and it major role in the acidity of the refluxate, but the amount of bile reflex correlate with the severity of gastroesophageal reflex disease (GERD). Those studies which evaluated the association between previous gastric surgery, as it good model for both bile reflex and acid inhibition, and the development of BE have shown that gastric surgery does not pose any risk. DGER Without Simultaneous acid reflux does not cause BE, but the synergy between acid and DGER shows a graded increase in severity across the GERD spectrum, enhancing the damage to esophagus.0

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Language：English   Publishing type：Research paper (international conference proceedings)   Publisher：MEDIMOND S R L  

We compared the convenience of the Quality-of-Life and Utility Evaluation Survey Technology (QUEST) questionnaire and the Frequency Scale for the Symptoms of Gastro-esophageal Reflux Disease (FSSG) questionnaire. The subjects were 40 healthy adult volunteers (22-52 years old). They were asked to complete the QUEST and FSSG themselves. The time required to complete the questionnaire, whether the subjects asked any questions as they filled in the questionnaires, and the questionnaire scores were analyzed. The comparison between the QUEST and FSSG revealed significant differences in the completion time (82.5 sec vs 42.5 sec, respectively: P &lt; 0.0001) and whether the subjects asked any questions (13 subjects vs 2 subjects, respectively: P=0.0031). The FSSG was more convenient to complete than the QUEST.

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OBJECTIVES: To evaluate the clinical significance of a swollen main duodenal papilla and the associated immunohistopathologic findings in patients with autoimmune pancreatitis (AIP). METHODS: Seventeen consecutive patients with AIP registered between April 2001 and October 2005 who underwent both endoscopic retrograde cholangiopancreatography and endoscopic biopsy were enrolled in this study. The endoscopic features, stromal inflammatory cell infiltrate (SICI), and results of immunohistochemical examination of the duodenal papilla using IgG4, CD3, and CD79a antibodies were retrospectively reviewed. These findings in the AIP patients were compared with those in 12 patients with chronic alcoholic tumor-forming pancreatitis (CAP). The numbers of cells in the SICI and of IgG4-positive plasma cells per high-power field were counted in all the histopathologic specimens. RESULTS: A swollen main duodenal papilla was observed in 11 (11 [64.7%]/17) patients with AIP and 4 (4 [33.3%]/12) patients with CAP (P < 0.05). Resolution of the swollen main duodenal papilla was observed in all of these 11 patients with AIP (11 [100%]/11) in response to treatment with corticosteroids. On the other hand, the 6 patients without elevated serum IgG4 or a swollen duodenal papilla, but with a swollen pancreas, improved even without corticosteroid treatment. The number of cells in the SICI in the AIP patients was significantly higher than that in the CAP patients. Although in 13 of 17 AIP patients, infiltration by IgG4-positive plasma cells was detected in the duodenal papilla, no such significant infiltration of the duodenal papilla by IgG4-positive plasma cells was observed in the patients with CAP (P < 0.05). More predominant T-cell infiltration of the duodenal papilla was recognized in the AIP patients than in the CAP patients (P < 0.05). CONCLUSIONS: These results suggest that a swollen main duodenal papilla with IgG4-positive plasma cell and T-cell-dominant infiltration and an abundant stromal cell infiltrate are characteristic findings in AIP. We suggest that these findings may be valuable adjuncts to the diagnosis of AIP as well as for selecting suitable candidates for corticosteroid therapy.

DOI： 10.1097/mpa.0b013e31812575b4

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：SPRINGER JAPAN KK  

Background. The changes in nonalcoholic fatty liver disease (NAFLD) range over a wide spectrum, extending from steatosis to steatohepatitis (NASH). However, it has remained difficult to differentiate between NASH and nonprogressive NAFLD by clinical examination. We investigated the interrelationships between serum high-sensitivity C-reactive protein (hs-CRP) and the pathogenesis and progression of NASH. Methods. Hs-CRP was measured in 100 patients with histologically verified NAFLD (29 with steatosis and 71 with NASH), and a real-time reverse transcriptase-polymerase chain reaction (RT-PCR) analysis was performed to measure the intrahepatic mRNA expressions of CRP and interleukin (IL)-6. Results. The results of a multiple regression analysis revealed that in comparison with cases of steatosis, hs-CRP was significantly elevated (P = 0.0048) in cases of NASH. Furthermore, among patients with NASH, hs-CRP was significantly elevated in those with advanced fibrosis compared with that in those with mild fibrosis (P = 0.0384), even after adjustment for age, sex, presence of diabetes, body mass index, visceral fat area, subcutaneous fat area, homeostasis model assessment for insulin resistance, high-density lipoprotein cholesterol, triglyceride, and low-density lipoprotein cholesterol. The results of the RT-PCR analysis showed that intrahepatic mRNA expression of CRP, but not IL-6, was increased in patients with NASH compared with those with steatosis (P = 0.0228). Conclusions. This is the first report to demonstrate consistent and profound elevation of hs-CRP in cases of NASH compared with in cases of simple nonprogressive steatosis. Our results suggest that hs-CRP may be a clinical feature that not only distinguishes NASH from simple nonprogressive steatosis but also indicates the severity of hepatic fibrosis in cases of NASH.

DOI： 10.1007/s00535-007-2060-x

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Language：Japanese   Publisher：(株)癌と化学療法社  

切除不能膵臓癌18例に初回化学療法としてgemcitabineを投与し,その治療効果および有効例の検討を行った.投与開始4週後の腫瘍縮小効果は,PR0例,SD11例(61.1%),PD5例(27.8%),判定不能2例(11.1%)であった.治療例18例の平均生存期間(Kaplan-Meier法)は268.0日であり,また抗腫瘍効果をCA19-9が治療前値より4週後の時点で10%以上減少しているresponder 8例とそれ以外のnon-responder 8例の2群で比較したところ前者のMST416.6日,後者のMST138.3日でありp=0.009と,有意差が認められた.また,初診時より肝転移を認める5例のMST131.6日と認めない12例のMST324.9日とにp=0.0045と有意差が認められた.GEM1コース後の効果判定にCA19-9が有用であること,治療前に肝転移を伴う症例は,GEM治療においても予後不良であると考えられた(著者抄録)

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2006&ichushi_jid=J00296&link_issn=&doc_id=20060221390009&doc_link_id=%2Fab8gtkrc%2F2006%2F003302%2F009%2F0207-0212%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fab8gtkrc%2F2006%2F003302%2F009%2F0207-0212%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

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Language：Japanese   Publisher：Japan Gastroenterological Endoscopy Society Kanto Chapter  

DOI： 10.11641/pde.68.2_166

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Other Link： http://search.jamas.or.jp/link/ui/2007006189

Language：Japanese   Publisher：日本内科学会-関東地方会  

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A 52-year old man was admitted to the hospital because of epigastralgia after heavy drinking. Computer tomography (CT) revealed segmental pancreas swelling suggestive of pancreas head carcinoma. We evaluated this pancreas head mass by 18F-fluorodexyglucose positron emission tomography (FDG-PET) using the standardized uptake value (SUV). Accumulation of FDG in this mass was very high and the SUV was 6. 61. We could not completely role out a malignant lesion but treated the case as acute pancreatitis because of the clinical symptoms. We followed this mass for 6 months by CT and FDG-PET. The pancreas head mass gradually diminished in size and finally vanished from the CT findings. FDG-PET accumulation also decreased with the recovery from acute pancreatitis. FDG-PET is a useful and sensitive means for evaluating pancreas carcinoma. But FDG accumulation also occurs in acute, chronic, tumor-forming, and autoimmune-related case of pancreatitis. So it is important to follow up a pancreas mass when observed by FDG-PET.

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Language：Japanese   Publisher：(一財)日本消化器病学会  

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Language：Japanese   Publisher：日本胆道学会  

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Language：English   Publishing type：Research paper, summary (international conference)   Publisher：W B SAUNDERS CO-ELSEVIER INC  

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良性狭窄には炎症性胆道狭窄、慢性膵炎に伴う膵、胆道狭窄、術後の膵、胆道狭窄などがある。肝移植後、肝切除後では内視鏡操作がやや困難となる。B-1法以外の胃切除後、膵頭十二指腸切除後(PD後)、肝門部胆管空腸吻合症例ではバルーン内視鏡が有効である。閉塞部位に対し、ガイドワイヤー操作(GW)を行い、狭窄部以遠にGWを留置し、dilator(6、7Er)で狭窄解除を行う。Dilatorが狭窄部を超えない場合は、Soehendra stent retriever(SSR)による強制的狭窄解除、拡張術を行う。SSRの回転に際し、術者と助手の手の動きがシンクロすることが重要である。さらに経皮またはEUS-guidedのrendez-vous法、最終兵器としての山之内法(磁石法)も選択肢の一つとなる。いずれの方法も基本的にはプラスチックステント挿入を目標としている。(著者抄録)

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当科で経験した胆管癌111例(肝内胆管癌23例、肝外胆管癌88例)を対象に、その危険因子について検討した。多変量解析の結果、胆管癌の危険因子として糖尿病は肝内・肝外胆管癌共通の独立した危険因子であることが判明した。

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膵癌の予後改善のために有効な治療は、R0手術の達成である。Borderline resectableもしくはlocally advancedの膵頭部癌の診療において、術前抗癌剤放射線療法(NACRT)導入により、根治治療の可能性が高まってきている。閉塞性黄疸、胆管炎で発症した膵頭部癌のNACRT期間を安定、確実に遂行するため、partial cover metaric stent(PCMS)の早期導入が肝要である。MDCT診断に立脚したNCCNガイドライン2012をもとに、診断を行い、およそ3ヵ月の治療期間を中断なく行うことで、R0達成率を高められる可能性がある。さらにPCMSはcost面からも、今後の術前内視鏡的内瘻術の、第一選択となる可能性がある。(著者抄録)

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Language：Japanese   Publisher：(一財)日本消化器病学会  

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Language：Japanese   Publisher：(一社)日本消化器内視鏡学会  

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Language：Japanese   Publisher：日本膵臓学会  

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Language：Japanese   Publisher：日本膵臓学会  

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Language：Japanese   Publisher：日本膵臓学会  

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Language：English   Publishing type：Research paper, summary (international conference)   Publisher：W B SAUNDERS CO-ELSEVIER INC  

Web of Science

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Language：Japanese   Publisher：(一社)日本消化器内視鏡学会  

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Language：Japanese   Publisher：(一社)日本消化器内視鏡学会  

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Language：Japanese   Publisher：(一財)日本消化器病学会  

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Language：Japanese   Publisher：(一財)日本消化器病学会  

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Language：Japanese   Publisher：(一財)日本消化器病学会  

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Language：Japanese   Publisher：(一財)日本消化器病学会  

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Language：Japanese   Publisher：(一社)日本消化器内視鏡学会-関東支部  

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Language：Japanese   Publisher：横浜市立大学医学会  

【目的】分枝型膵管内乳頭粘液性腫瘍(以下、分枝型IPMNs)の手術例、経過観察例の検討を行った。【対象・方法】当院における手術例(n=41経過観察後切除を含む)と経過観察例(n=249)を対象とした。手術例は、術前の超音波内視鏡(以下、EUS)所見と術後の病理所見との対比を行い、経過観察例では、IPMN由来癌の発生と通常型膵管がんの発生に関して検討を行った。【結果】切除例による検討から、絶対的に切除が必要なhigh risk group(上皮内癌と浸潤癌)の術前診断において、EUSによる嚢胞内の結節高10mm以上(正診率88.9%)と結節横径15mm以上(正診率91.7%)が極めて重要な所見であることが明らかとなった。また経過観察例のうち、IPMN由来癌は1例のみ認められた。一方の通常型膵管がんは5例にみられた。このうち高齢(75歳以上:n=3)、男性(n=4)、IPMNの手術の既往歴(n=3)が通常型膵管がん合併の危険因子と考えられた。【結語】分枝型IPMNはEUSによる、のう胞内の結節径が手術適応の重要な所見であると考えられた。また経過観察例では、IPMN由来癌よりもむしろ通常型膵管がんの合併に注意を払うべきと考えられた。(著者抄録)

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Language：Japanese   Publisher：(一財)日本消化器病学会  

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Language：Japanese   Publisher：(一社)日本消化器内視鏡学会  

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Language：Japanese   Publisher：(一社)日本消化器内視鏡学会  

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Language：Japanese   Publisher：(一社)日本消化器内視鏡学会  

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Language：Japanese   Publisher：(有)科学評論社  

膵癌と診断された149名(男性84名、平均66.6歳、女性65名、平均69.2歳)を対象に、年齢・性別を一致させた非膵疾患患者547名(男性312名、女性235名)を対照群として膵癌とメタボリックシンドローム関連因子との関係について検討した。膵癌群は対照群に比べ、男性ではBMI、喫煙歴、糖尿病罹患率が有意に高値であり、女性では膵癌の家族歴、糖尿病罹患率が有意に高値であった。血液検査では男女とも空腹時血糖値、HbA1cが膵癌群で有意に高値を示し、画像検査では女性で脂肪肝、膵小嚢胞の併存が膵癌群で有意に多かった。脂肪面積では女性で内臓脂肪面積が膵癌群で有意に高値であった。ロジスティック回帰分析による多変量解析では、膵癌発症の有意な危険因子は男女とも糖尿病(OR:男性2.22、女性2.77)、女性の内臓肥満(OR:1.04)であった。

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Language：English   Publishing type：Research paper, summary (international conference)   Publisher：W B SAUNDERS CO-ELSEVIER INC  

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Language：English   Publishing type：Research paper, summary (international conference)   Publisher：W B SAUNDERS CO-ELSEVIER INC  

Web of Science

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Language：English   Publishing type：Research paper, summary (international conference)   Publisher：W B SAUNDERS CO-ELSEVIER INC  

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Language：Japanese   Publisher：日本膵臓学会  

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Language：English   Publishing type：Research paper, summary (international conference)   Publisher：W B SAUNDERS CO-ELSEVIER INC  

Web of Science

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Language：English   Publishing type：Research paper, summary (international conference)   Publisher：MOSBY-ELSEVIER  

Web of Science

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Language：English   Publishing type：Research paper, summary (international conference)   Publisher：MOSBY-ELSEVIER  

Web of Science

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Language：Japanese   Publisher：(一社)日本消化器内視鏡学会  

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Language：Japanese   Publisher：(一社)日本消化器内視鏡学会  

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Language：Japanese   Publisher：(一社)日本消化器内視鏡学会  

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Language：Japanese   Publisher：(一社)日本消化器内視鏡学会  

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Language：Japanese   Publisher：(一社)日本消化器内視鏡学会  

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Language：English   Publishing type：Research paper, summary (international conference)   Publisher：MOSBY-ELSEVIER  

Web of Science

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Language：Japanese   Publisher：(一財)日本消化器病学会  

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Language：Japanese   Publisher：(株)日本メディカルセンター  

従来は悪性膵胆道腫瘍の切除例においてplastic stent(PS)が,非切除例においてはendoscopic metal stent(EMS)が用いられてきた.近年,抗癌剤治療により悪性膵胆道疾患において,down-stagingや予後の延長が認められ,borderline resectableあるいはlocally advanced cancerは,neoadjuvant chemotherapy(NAC)が施行されることもあり,PSによりステント閉塞,逆行性胆管炎をきたすことなく安定した状態での抗癌剤治療が求められるようになった.inside stent(IS)はこういったNAC症例や術後良性胆道狭窄に有用な可能性がある.EMSは肝門部症例においてBismuth分類に応じ,片葉,両葉,さらにmultistentが留置される.中下部悪性胆道閉塞においては乳頭部から2cm程度のmarginがあれば乳頭処理をすることなくEMSを留置する.さもなければ6cm長のcovered metallic stent/uncovered metallic stent(CMS/UMS)を選択することが多い.(著者抄録)

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Language：Japanese   Publisher：(一財)日本消化器病学会  

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Language：Japanese   Publisher：(一社)日本消化器内視鏡学会-関東支部  

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Language：Japanese   Publisher：(一社)日本消化器内視鏡学会-関東支部  

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Language：Japanese   Publisher：日本内科学会-関東地方会  

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Language：Japanese   Publisher：医学図書出版(株)  

選択的胆管挿管困難例に対するNeedle Knifeを用いたprecutは、治療ERCPにおける最終手段の一つである。われわれが実践しているTriple lumenのprecut knifeを用いたprecutting techniqueについて概説した。Precutの前に胆管口を想定し、切開の方向、始点、終点を確認する。Precut knifeは先端硬性部が長く、ぶれやすい。Needle先端を、乳頭に引っ掛けon-and touchで切開を開始する。切開の方向性の確認と、合併症の軽減のため、可能な限り膵管ステントを先行させる。Precutにあたり、十二指腸乳頭部から胆管までは最外層の十二指腸粘膜、その直下の共通管を内包する筋、線維組織による中間層、胆管壁の三層構造を有すると考えている。このためcutはlayer-by-layerで行い、この三層を順次、開放して行き、一期的に大きく、深く切り進まない。膵管ステントが先行可能な場合、precutは小さく済む。そうでない場合は、鉢巻襞を超える大きな切開を要することがある。(著者抄録)

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Language：Japanese   Publisher：(一財)日本消化器病学会  

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Language：Japanese   Publisher：(一社)日本消化器内視鏡学会  

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Language：Japanese   Publisher：(一社)日本消化器内視鏡学会  

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Language：Japanese   Publisher：日本胆道学会  

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Language：Japanese   Publisher：日本胆道学会  

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Language：Japanese   Publisher：(株)メディカルレビュー社  

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Language：Japanese   Publisher：(株)へるす出版  

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Language：Japanese   Publisher：日本膵臓学会  

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Language：Japanese   Publisher：(一社)日本消化器内視鏡学会-関東支部  

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Language：Japanese   Publisher：(株)医学書院  

IgG4関連硬化性胆管炎(IgG4-SC)の膵癌併発の2例を提示した.[症例1]は72歳,男性.68歳時に肝門部胆管癌を疑われ,左葉切除術を施行された.その2年後,閉塞性黄疸が再発した.切除標本の検討からIgG4-SCと診断された.ステロイド維持療法中に膵頭部癌を併発したが,既に進行癌であった.[症例2]は61歳時に黄疸で発症し,維持療法(5mg/day)を2年間行った.66歳時に黄疸が再発し,ステロイド治療で寛解したが,その1年後,肝転移を伴う進行膵尾部癌が発見された.AIPに併発する膵癌は同時性,異時性で認められる.前者はby chanceであるが,後者ではAIPの急性,慢性炎症,ステロイド投与などが発癌に関与している可能性もある.AIPにおける膵癌併発は報告例をみると,ステロイド治療による寛解後,3〜5年の経過に膵体尾部に比較的多く発症していた.(著者抄録)

DOI： 10.11477/mf.1428100397

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Language：English   Publishing type：Research paper, summary (international conference)   Publisher：W B SAUNDERS CO-ELSEVIER INC  

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Language：Japanese  

CiNii Books

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Language：English   Publishing type：Research paper, summary (international conference)   Publisher：AMER ASSOC CANCER RESEARCH  

DOI： 10.1158/1538-7445.AM2011-3107

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Language：Japanese   Publisher：(一財)日本消化器病学会  

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Language：Japanese   Publisher：(一財)日本消化器病学会  

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Language：Japanese   Publisher：(一社)日本消化器内視鏡学会  

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Language：English   Publisher：WILEY-BLACKWELL  

Liver abscess is recognized as a life-threatening disease. However, even in recent years, approximately 50% of liver abscess cases are considered to be cryptogenic. Here, we report a case of liver abscess associated with periodontal bacterial infection by Fusobacterium necrophorum, which is commonly found in the oropharyngeal flora. A 36-year-old man presented with fever and contrast-enhanced abdominal computed tomography revealed multiple liver abscesses. F.necrophorum was isolated from oral smears, liver aspirates and blood samples. Liver abscesses caused by periodontal bacterial infection are rare, however, the incidence is expected to increase in the future, as periodontitis is extremely common and is on the rise as one of the most common chronic infections in the world. A systemic survey including periodontitis may be required for the exact diagnosis of the source of infection.

DOI： 10.1111/j.1872-034X.2010.00748.x

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Language：Japanese   Publisher：(一社)日本消化器内視鏡学会-関東支部  

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Language：Japanese   Publisher：(一財)日本消化器病学会  

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Language：Japanese   Publisher：(一社)日本消化器内視鏡学会