記述言語：日本語   出版者・発行元：(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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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

PubMed

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会-関東支部  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

PubMed

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記述言語：日本語   出版者・発行元：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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記述言語：日本語   出版者・発行元：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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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：日本消化器病学会-関東支部  

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記述言語：日本語   出版者・発行元：(一社)日本胆道学会  

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記述言語：日本語   出版者・発行元：(一社)日本胆道学会  

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記述言語：日本語   出版者・発行元：(一社)日本膵臓学会  

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記述言語：日本語   出版者・発行元：(一社)日本膵臓学会  

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記述言語：日本語   出版者・発行元：(一社)日本膵臓学会  

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記述言語：日本語   出版者・発行元：(一社)日本膵臓学会  

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記述言語：日本語   出版者・発行元：(一社)日本膵臓学会  

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記述言語：日本語   出版者・発行元：(一社)日本膵臓学会  

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記述言語：日本語   出版者・発行元：(一社)日本膵臓学会  

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記述言語：日本語   出版者・発行元：(一社)日本膵臓学会  

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記述言語：日本語   出版者・発行元：(一社)日本膵臓学会  

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記述言語：日本語   出版者・発行元：(一社)日本膵臓学会  

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Wiley  

DOI： 10.1002/deo2.130

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その他リンク： https://onlinelibrary.wiley.com/doi/full-xml/10.1002/deo2.130

記述言語：日本語   出版者・発行元：(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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その他リンク： 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

記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

PubMed

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掲載種別：研究論文（学術雑誌）  

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

Scopus

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.2169/internalmedicine.E002-23

PubMed

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

DOI： 10.11405/nisshoshi.120.297

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

PubMed

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会-関東支部  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1055/a-1960-3363

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

PubMed

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記述言語：日本語   出版者・発行元：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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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

PubMed

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記述言語：日本語   出版者・発行元：(一社)日本胆道学会  

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記述言語：日本語   出版者・発行元：(一社)日本胆道学会  

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記述言語：日本語   出版者・発行元：日本消化器病学会-関東支部  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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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記述言語：日本語   出版者・発行元：(株)アークメディア  

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記述言語：日本語   出版者・発行元：(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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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1055/a-1847-7745

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：日本消化器病学会-関東支部  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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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記述言語：日本語   出版者・発行元：(株)東京医学社  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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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記述言語：日本語   出版者・発行元：(一社)日本胆道学会  

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記述言語：日本語   出版者・発行元：(一社)日本膵臓学会  

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記述言語：日本語   出版者・発行元：(一社)日本膵臓学会  

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記述言語：日本語   出版者・発行元：(一社)日本胆道学会  

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記述言語：日本語   出版者・発行元：(一社)日本膵臓学会  

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記述言語：日本語   出版者・発行元：(一社)日本膵臓学会  

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記述言語：日本語   出版者・発行元：(一社)日本胆道学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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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記述言語：日本語   出版者・発行元：(一社)日本胆道学会  

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記述言語：日本語   出版者・発行元：日本消化器病学会-関東支部  

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記述言語：日本語   出版者・発行元：(NPO)日本高齢消化器病学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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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記述言語：日本語   出版者・発行元：(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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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Wiley  

DOI： 10.1002/jhbp.793

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その他リンク： https://onlinelibrary.wiley.com/doi/full-xml/10.1002/jhbp.793

記述言語：日本語   出版者・発行元：(一社)日本胆道学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：(一社)日本胆道学会  

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記述言語：日本語   出版者・発行元：(一社)日本膵臓学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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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記述言語：日本語   出版者・発行元：(一社)日本膵臓学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一社)日本膵臓学会  

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記述言語：日本語   出版者・発行元：(一社)日本膵臓学会  

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記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：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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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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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記述言語：日本語   出版者・発行元：(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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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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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記述言語：日本語   出版者・発行元：日本消化器病学会-関東支部  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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掲載種別：研究論文（学術雑誌）  

© 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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記述言語：日本語   出版者・発行元：(公社)日本超音波医学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1097/MPA.0000000000001210.

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1016/j.pan.2018.11.001

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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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記述言語：英語   掲載種別：論文集(書籍)内論文   出版者・発行元：Springer Singapore  

DOI： 10.1007/978-981-10-4548-6_13

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1002/jhbp.541

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1007/s00535-016-1302-1

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記述言語：英語  

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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記述言語：日本語   出版者・発行元：(一社)日本膵臓学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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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記述言語：日本語   出版者・発行元：(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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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1055/s-0042-115172

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記述言語：日本語   出版者・発行元：(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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記述言語：日本語   出版者・発行元：(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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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1055/s-0042-102246

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DOI： 10.1097/MCG.0000000000000397

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記述言語：英語   出版者・発行元：一般社団法人 日本内科学会  

<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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記述言語：日本語   出版者・発行元：一般社団法人 日本消化器内視鏡学会 関東支部  

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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その他リンク： http://search.jamas.or.jp/link/ui/2016386623

記述言語：日本語   出版者・発行元：(一社)日本膵臓学会  

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DOI： 10.5754/hge13850

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1186/s12876-015-0233-2

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DOI： 10.5754/hge13136

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：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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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SPRINGER 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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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1111/den.12049

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記述言語：日本語   出版者・発行元：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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その他リンク： http://search.jamas.or.jp/link/ui/2015124787

DOI： 10.1055/s-0033-1344330

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記述言語：日本語   出版者・発行元：(一社)日本膵臓学会  

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記述言語：日本語   出版者・発行元：(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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その他リンク： 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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記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：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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記述言語：英語  

DOI： 10.1055/s-0033-1344416

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記述言語：英語  

DOI： 10.1007/s00595-012-0333-3

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：10  

DOI： 10.1016/j.dld.2012.05.016

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記述言語：英語   出版者・発行元：WILEY-BLACKWELL  

DOI： 10.1111/j.1443-1661.2011.01230.x

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記述言語：日本語   出版者・発行元：(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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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1186/1471-230X-12-25

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：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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記述言語：英語   出版者・発行元：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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その他リンク： http://search.jamas.or.jp/link/ui/2013215038

DOI： 10.1007/s12328-011-0240-y

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記述言語：英語  

DOI： 10.1007/s00535-011-0393-y

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DOI： 10.1007/s00534-010-0359-0

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：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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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：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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記述言語：英語  

DOI： 10.1007/s00534-010-0330-0

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記述言語：英語   出版者・発行元：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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記述言語：英語  

DOI： 10.1111/j.1443-1661.2010.01039.x

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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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記述言語：英語   出版者・発行元：KARGER  

DOI： 10.1159/000313695

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：International 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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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：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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出版者・発行元：12  

DOI： 10.1111/j.1365-2893.2009.01253.x

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出版者・発行元：104  

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出版者・発行元：104  

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出版者・発行元：104  

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記述言語：日本語   出版者・発行元：日本胆道学会  

<b>要旨：</b>十二指腸乳頭部癌は，膵頭部領域癌としては切除率が高く，比較的予後良好な癌である．局所進展形式は，一般に連続した浸潤形式を来し，不連続進展（skip lesion）を認めた報告は認められない．<br> 今回，我々は結節型病変が下部胆管にskipした早期十二指腸乳頭部癌の1例を経験した．画像診断として，腫瘍全体像の描出に超音波内視鏡（Endoscopic ultrasonography；EUS）が有用であったが，前医で胆道処置が施行されており，深達度の診断は腔内超音波検査（Intraductal ultrasonography；IDUS）でも困難であった．<br> 切除標本では，腫瘍間に約1cmの正常粘膜を介し，腫瘍の連続性は認められなかった．2つの腫瘍は組織型，悪性度，p53 indexが一致しており，重複癌ではなく，skip lesionであると診断した．先行した癌は腫瘍のlocation，多寡より，十二指腸乳頭部癌と考えられた．<br>

DOI： 10.11210/tando.24.617

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記述言語：日本語   出版者・発行元：一般社団法人 日本消化器内視鏡学会  

【目的】自己免疫性膵炎（AIP）のearly-stageのEUS所見を検討した．【方法】ERCPおよびEUSを施行されたAIP19例を対象とした．AIPのearly-stageにおいて特徴的と思われる所見（hyperechoic foci，hyperechoic strand，lobularity，hyperechoic duct margin，reduced echogenicity）の有無を検討した．慢性膵炎におけるCambridge分類に従い，自験例をearly-stage（Cambridge grade 1-2）とadvanced-stage（grade 3-5）に分類した．さらにそれぞれの病理組織学的検討も行った．【結果】early-stage 9例，advanced-stage 10例であった．early-stageのうち5例は自然寛解を示した．early-stage群/advanced-stage群におけるEUS所見は各々hyperechoic foci，100％（9/9) vs. 100％（10/10），hyperechoic strand，66.7％（6/9) vs. 70％（7/10），lobularity，77.8％（7/9) vs. 20％（2/10），hyperechoic duct margin，88.9％（8/9) vs. 30％（3/10），reduced echogenicity88.9％（8/9) vs. 90％（9/10）．lobularityとhyperechoic duct marginがearly-stageで有意に描出率が高かった（<I>p</I><0.05）．病理ではearly-stageでは膵腺房の小葉構造が保たれていたが，advanced-stageでは膵腺房の小葉構造が脱落し，線維化に置き換わっていた．【結論】lobularityとhyperechoic duct marginはearly-stage AIPに特徴的であり，自然軽快が期待できる．またそれらでは病理組織所見でも膵腺房の小葉構造が保たれていた．

DOI： 10.11280/gee.52.2745

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記述言語：日本語   出版者・発行元：(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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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：英語  

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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記述言語：日本語   出版者・発行元：(一社)日本肝胆膵外科学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：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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出版者・発行元：4  

DOI： 10.1111/j.1365-2893.2009.01179.x

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記述言語：英語  

DOI： 10.1111/j.1443-1661.2010.00939.x

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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出版者・発行元：3  

DOI： 10.1007/s10620-009-0771-y

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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DOI： 10.1097/MPA.0b013e3181bc119d

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.3748/wjg.v16.i4.484

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DOI： 10.1159/000308966

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記述言語：英語  

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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記述言語：英語  

DOI： 10.1159/000297160

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記述言語：英語   出版者・発行元：10  

DOI： 10.1111/j.1872-034X.2009.00539.x

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：7  

DOI： 10.1111/j.1478-3231.2009.01988.x

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記述言語：日本語   出版者・発行元：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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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1186/1471-230X-9-56

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記述言語：英語  

DOI： 10.1111/j.1443-1661.2009.00879.x

PubMed

CiNii Books

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1111/j.1872-034X.2009.00490.x

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：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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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：英語  

DOI： 10.1159/000227044

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記述言語：英語   出版者・発行元：The Japanese Society of Internal Medicine  

DOI： 10.2169/internalmedicine.48.2229

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その他リンク： http://search.jamas.or.jp/link/ui/2010041262

DOI： 10.1016/j.gie.2008.08.013

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：WILEY-BLACKWELL  

DOI： 10.1111/j.1440-1746.2008.05662.x

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記述言語：日本語   出版者・発行元：Japan Pancreas Society  

症例は66歳男性，閉塞性黄疸で発症したAutoimmune pancreatitis（AIP）が，1年6ヶ月のステロイド維持療法後，3年後に閉塞性黄疸で再発した．ステロイド再投与後，AIPは改善したが，その6ヶ月後，脳内出血で再入院した．7ヶ月後CA19-9 364U/m<i>l</i>と急上昇し，PET/CTで膵尾部癌，多発肝転移，骨盤転移と診断された．画像診断で膵炎所見は改善し，血清IgG4値も330から30mg/d<i>l</i>に改善した．抗癌剤投与が行われたが無効であった．最近，AIPの膵癌併発例が散見されるようになった．これまでAIPは予後良好の膵炎と認識されてきたが，今後は，膵炎症状の消退後も癌の存在を常に念頭に起き，ステロイドの長期投与の併発症に注意しながら，厳重に長期観察を行うことが肝要と考えられた．<br>

DOI： 10.2958/suizo.23.608

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その他リンク： http://search.jamas.or.jp/link/ui/2009022177

DOI： 10.1007/s10620-008-0219-9

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記述言語：日本語   出版者・発行元：(一社)日本胆道学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1186/1471-230X-8-27

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掲載種別：研究論文（学術雑誌）  

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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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Blackwell Publishing  

DOI： 10.1111/j.1440-1746.2008.05493.x

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記述言語：英語   掲載種別：研究論文（国際会議プロシーディングス）   出版者・発行元：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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記述言語：英語   掲載種別：研究論文（国際会議プロシーディングス）   出版者・発行元：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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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1097/mpa.0b013e31812575b4

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1007/s00535-007-2060-x

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記述言語：日本語   出版者・発行元：(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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その他リンク： 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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記述言語：日本語   出版者・発行元：Japan Gastroenterological Endoscopy Society Kanto Chapter  

症例は74歳の男性。CTで肝内胆管と総胆管の拡張を認めた。ERCPで深部胆管挿管はAbc領域で胆管が高度に屈曲し不能であった。PTBDを行いrendezvous法で挿管した。下部胆管は10mmに渡り糸状，不整形に狭窄していた。IDUSで腫瘍はほぼSSに局在していたが，膵実質浸潤を伴う下部胆管癌と診断した。腫瘍は径1.4×0.9cmの結節浸潤型の高分化腺癌で，膵との境界の線維化が強くPanc Ⅰ aであった。

DOI： 10.11641/pde.68.2_166

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その他リンク： http://search.jamas.or.jp/link/ui/2007006189

記述言語：日本語   出版者・発行元：日本内科学会-関東地方会  

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掲載種別：研究論文（学術雑誌）  

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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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：MOSBY-ELSEVIER  

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J-GLOBAL

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J-GLOBAL

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：日本胆道学会  

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記述言語：日本語   出版者・発行元：日本胆道学会  

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：MOSBY-ELSEVIER  

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：MOSBY-ELSEVIER  

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記述言語：日本語   出版者・発行元：(一社)日本消化器がん検診学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：W B SAUNDERS CO-ELSEVIER INC  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：医学図書出版(株)  

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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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：日本胆道学会  

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記述言語：日本語   出版者・発行元：日本胆道学会  

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：MOSBY-ELSEVIER  

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：MOSBY-ELSEVIER  

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記述言語：日本語   出版者・発行元：日本膵臓学会  

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：MOSBY-ELSEVIER  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：日本膵臓学会  

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記述言語：日本語   出版者・発行元：日本膵臓学会  

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記述言語：日本語   出版者・発行元：日本膵臓学会  

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記述言語：日本語   出版者・発行元：日本膵臓学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会-関東支部  

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：W B SAUNDERS CO-ELSEVIER INC  

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記述言語：日本語   出版者・発行元：(有)科学評論社  

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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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：医学図書出版(株)  

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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記述言語：日本語   出版者・発行元：(一社)日本癌治療学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：日本膵臓学会  

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記述言語：日本語   出版者・発行元：日本膵臓学会  

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記述言語：日本語   出版者・発行元：日本膵臓学会  

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：W B SAUNDERS CO-ELSEVIER INC  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会-関東支部  

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記述言語：日本語   出版者・発行元：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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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：(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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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：W B SAUNDERS CO-ELSEVIER INC  

Web of Science

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：W B SAUNDERS CO-ELSEVIER INC  

Web of Science

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：W B SAUNDERS CO-ELSEVIER INC  

Web of Science

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記述言語：日本語   出版者・発行元：日本膵臓学会  

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：W B SAUNDERS CO-ELSEVIER INC  

Web of Science

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：MOSBY-ELSEVIER  

Web of Science

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：MOSBY-ELSEVIER  

Web of Science

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：MOSBY-ELSEVIER  

Web of Science

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(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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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会-関東支部  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会-関東支部  

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記述言語：日本語   出版者・発行元：日本内科学会-関東地方会  

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記述言語：日本語   出版者・発行元：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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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：日本胆道学会  

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記述言語：日本語   出版者・発行元：日本胆道学会  

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記述言語：日本語   出版者・発行元：(株)メディカルレビュー社  

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記述言語：日本語   出版者・発行元：(株)へるす出版  

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記述言語：日本語   出版者・発行元：日本膵臓学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会-関東支部  

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記述言語：日本語   出版者・発行元：(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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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：W B SAUNDERS CO-ELSEVIER INC  

Web of Science

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記述言語：日本語  

CiNii Books

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：AMER ASSOC CANCER RESEARCH  

DOI： 10.1158/1538-7445.AM2011-3107

Web of Science

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：英語   出版者・発行元：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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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会-関東支部  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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