記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1055/a-2598-4784

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

INTRODUCTION: Preoperative biliary drainage (PBD) is often required for patients with pancreatic cancer accompanied by biliary obstruction to ensure the safe administration of neoadjuvant chemotherapy or to manage cholangitis and jaundice. Although endoscopic retrograde cholangiopancreatography (ERCP) is the standard approach for PBD, it carries a significant risk of post-ERCP pancreatitis. Endoscopic ultrasound-guided biliary drainage (EUS-BD), particularly via hepaticogastrostomy (EUS-HGS), offers a promising alternative that avoids papillary manipulation. However, the clinical utility of EUS-BD as primary drainage for PBD remains unclear due to a lack of prospective studies. This multicentre prospective trial aims to evaluate the safety and efficacy of EUS-HGS as primary drainage for PBD in patients with resectable or borderline resectable pancreatic cancer. METHODS AND ANALYSIS: This multicentre prospective study involves seven institutions in Japan. Eligible patients will undergo EUS-HGS using a 7Fr plastic stent. The primary endpoint is clinical success, defined by improvements in bilirubin or liver enzyme levels within 14 days postprocedure. Secondary endpoints include technical success rate, adverse event incidence, stent patency and surgical outcomes. A total of 30 patients will be enrolled, considering an expected clinical success rate of 90% and a 10% dropout allowance. ETHICS AND DISSEMINATION: This study has been approved by the National Cancer Center Institutional Review Board (Research No. 2024-084). The results of this study will be reported at an international conference and published in an international peer-reviewed journal. TRIAL REGISTRATION NUMBER: UMIN ID: 000055173.

DOI： 10.1136/bmjopen-2025-106543

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: Diagnosing pancreatic tumors ≤ 10 mm is challenging due to limited visualization and low sampling sensitivity. This study aimed to evaluate the cumulative diagnostic performance of repeated endoscopic ultrasound-guided tissue acquisition (EUS-TA) and surrogate repeated endoscopic retrograde pancreatography (ERP). METHODS: This study analyzed 40 patients with suspected pancreatic tumors ≤ 10 mm who underwent EUS-TA and/or ERP retrospectively. When a diagnosis could not be determined based on the initial EUS-TA or ERP procedure, EUS-TA or ERP was repeated as necessary. The cumulative diagnostic performance of EUS-TA and ERP for pancreatic tumors was evaluated. RESULTS: EUS-TA was performed once for 35 cases, twice for seven cases, and three times for one case. ERP was performed for 15 cases, and the median number of ERP attempts was two (range, 1-8). The cumulative sensitivity of EUS-TA increased from 56.7% to 70.0% after three attempts, while ERP sensitivity increased from 54.5% to 72.7% after two attempts. The cumulative diagnostic performance of repeated EUS-TA and ERP combined by case included sensitivity and accuracy rates of 87.9% and 90.0%. When limited to pancreatic cancer, the sensitivity and accuracy rates were 95.8% and 96.8%, respectively. No severe adverse events occurred. CONCLUSION: Repeated EUS-TA and ERP showed good diagnostic sensitivity for small pancreatic cancers ≤ 10 mm. When malignancy is suspected but not confirmed by a single procedure, repeating both may be an option in selected cases. Performing EUS-TA and ERP at least twice may be reasonable when small pancreatic cancer is suspected.

DOI： 10.1007/s10620-025-09373-5

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Treatment strategies for patients with unresectable or recurrent pancreatic neuroendocrine tumors (pNETs) have been investigated, and combination therapy with capecitabine plus temozolomide (CAPTEM) has demonstrated favorable outcomes. In response to these results, the CAPTEM regimen has been widely used in several countries, including Western nations. However, it is yet to be approved in Japan, and its efficacy and safety in the Japanese population remain unclear. In the present study, we examined the efficacy and safety of CAPTEM in Japanese patients with unresectable or recurrent pNETs. METHODS: Data were retrospectively collected from the medical records of the National Cancer Center Hospital. RESULTS: Fifteen patients with pNETs had received CAPTEM therapy, and 47% of the patients had WHO Grade 2 disease and 47% had WHO Grade 3 disease. The objective response rates and disease control rates were 26.7 and 66.7%, respectively. The median observation period was 20.8 months. The median progression-free survival was 5.3 months (95% confidence interval [CI]: 0.9-NA), and 1-year survival rate was 81.2% (95% CI: 41.5-95.2%). The most common adverse events (AEs) associated with CAPTEM therapy were hematologic and gastrointestinal toxicities. One patient experienced CTCAE grade 3 neutropenia, but no AE-related deaths were observed. CONCLUSIONS: This is the first study conducted to demonstrate CAPTEM is a valuable regimen also in the Japanese population, consistent with its established efficacy outside Japan. As reported previously, CAPTEM therapy was associated with high disease control rates, and it could be a valuable regimen in the Japanese population.

DOI： 10.1007/s10147-025-02779-1

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVES: Assessing para-aortic lymph node (PALN) metastasis in solid tumors is crucial for accurate staging. In clinical practice, PALN metastasis is typically diagnosed based on imaging findings; however, the efficacy of endoscopic ultrasound-guided tissue acquisition (EUS-TA) in diagnosing PALN metastasis remains insufficiently understood. METHODS: This single-center, retrospective study included patients who underwent EUS-TA of PALNs and computed tomography (CT). Final diagnoses were based on pathological findings or 12-month imaging follow-up. RESULTS: Among 167 patients, technical success was achieved in 162 (97.0%). EUS-TA demonstrated a sensitivity, specificity, and accuracy of 85.1% (63/74), 100% (88/88), and 93.2% (151/162), respectively, for PALN metastasis. These results showed significantly higher sensitivity (28.4% vs. 85.1%, P < 0.001) and accuracy (64.8% vs. 93.2%, P < 0.001) than those of CT. The accuracy of CT and EUS-TA was 86.8% vs. 89.5% for PALNs measuring <5 mm, 51.5% vs. 92.9% for those measuring 5-10 mm, and 84.0% vs. 96.0% for those measuring ≥10 mm, with a significant difference in the 5-10 mm category (P < 0.001). Among the 44 patients diagnosed with resectable pancreatic cancer using CT, the final diagnosis confirmed PALN metastasis in 10 (22.7%) patients, and EUS-TA preoperatively identified PALN metastasis in eight (18.2%) patients. EUS-TA significantly reduced unnecessary surgeries compared with CT-only diagnoses (P = 0.013). CONCLUSION: Endoscopic ultrasound-guided tissue acquisition of PALNs offers high diagnostic accuracy and can detect PALN metastasis often missed by CT alone. Integrating EUS-TA into preoperative assessments has the potential to substantially reduce unnecessary surgeries, improve patient outcomes, and plan treatment strategies.

DOI： 10.1111/den.15009

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVES: This study aimed to investigate the diagnostic performance and safety of endoscopic ultrasound-guided tissue acquisition (EUS-TA) for perivascular soft-tissue cuffing (PSTC). METHODS: This single-center, retrospective study evaluated patients in whom EUS-TA was performed for PSTC in pancreatic or bile duct cancer lesions between October 2017 and March 2024. PSTC was defined as a perivascular soft-tissue area contiguous with nearby blood vessels from the suspected primary tumor. EUS-TA procedures and outcomes, including technical success, diagnostic performance, adverse events, and comparison with contrast-enhanced computed tomography (CECT), were analyzed. RESULTS: Of 1803 patients, 53 underwent EUS-TA for PSTC. The sensitivity, specificity, and accuracy were 92.1%, 100%, and 92.5%, respectively. The technical success rate was 98.1% (52/53). The adverse event rate was 1.9%. EUS-TA for PSTC was significantly superior to CECT for PSTC in terms of diagnostic accuracy. Furthermore, the diagnostic performance and adverse event rates for EUS-TA for PSTC were comparable to those for TA in solid tumors. Shorter puncture lengths were associated with lower accuracy. CONCLUSION: EUS-TA for PSTC in pancreatic or bile duct cancer demonstrates high diagnostic accuracy and a low rate of adverse events, showing superior diagnostic performance compared to CECT. These findings suggest that EUS-TA for PSTC can be performed safely and is a clinically beneficial procedure. Despite the technical challenges, EUS-TA for PSTC can influence clinical judgment and should be considered in skilled institutions for future patient treatment decisions. Prospective multicenter studies are warranted to further evaluate its efficacy and safety.

DOI： 10.1111/den.14983

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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: Diagnosing early-stage pancreatic ductal adenocarcinoma, particularly high-grade pancreatic intraepithelial neoplasia (HG-PanIN), remains challenging. Serial pancreatic juice aspiration cytologic examination (SPACE) using an endoscopic nasopancreatic drainage tube has demonstrated high diagnostic accuracy, but its application in surgically altered anatomy is technically demanding. We present a case in which balloon enteroscopy-assisted SPACE led to the diagnosis of HG-PanIN and successful resection. METHODS: A 70-year-old man with a history of distal gastrectomy and Roux-en-Y reconstruction for gastric cancer underwent follow-up imaging, which revealed localized main pancreatic duct (MPD) stricture and parenchymal atrophy in the pancreatic tail. EUS identified a faint hypoechoic area around the stricture, but no distinct mass. EUS-guided tissue acquisition was inconclusive. Double-balloon enteroscopy-assisted endoscopic retrograde pancreatography was performed, revealing MPD stricture and distal dilation. A 5F endoscopic nasopancreatic drainage tube was placed across the stricture, and SPACE was conducted. RESULTS: Twelve pancreatic juice cytology samples were aspirated every 2 to 3 hours over 3 days, each exceeding 1 mL. One sample (10th) was classified as Class IV, "suspicious for adenocarcinoma," with cytology revealing nuclear enlargement and atypia. The patient was diagnosed preoperatively with pancreatic cancer (TisN0M0 stage 0) and underwent distal pancreatectomy without neoadjuvant chemotherapy. Pathology confirmed HG-PanIN of the MPD. The patient had no postoperative adverse events and remained recurrence-free at the 9-month follow-up. CONCLUSIONS: This case highlights the effectiveness of balloon enteroscopy-assisted SPACE in diagnosing HG-PanIN in surgically altered anatomy. However, given the relatively high risk of pancreatitis, SPACE should be reserved for patients with imaging or clinical findings suggestive of malignancy. By overcoming technical obstacles, this method offers a promising diagnostic strategy for early-stage pancreatic ductal adenocarcinoma in surgically altered anatomy.

DOI： 10.1016/j.vgie.2025.02.006

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND/PURPOSE: Diagnostic yields of endoscopic ultrasound-guided tissue acquisition (EUS-TA) for biliary lesions have not been fully established due to limited evidence. We aimed to clarify the efficacy of EUS-TA for biliary lesions. METHODS: Diagnostic yields and adverse event rates of EUS-TA for biliary lesions were evaluated. The subject cases were only limited to cases in which the biliary lesions itself was punctured. Diagnostic yields of endoscopic retrograde cholangiography (ERC)-guided biopsy/cytology performed within the same period were also evaluated to assess the additional effect of EUS-TA. RESULTS: EUS-TA was attempted in 71 cases (28 hilar bile duct, 19 distal bile duct, 4 ampulla of Vater, and 20 gallbladder), and the final diagnosis was malignant in 54 cases (76.1%). The sensitivity, specificity, and accuracy of EUS-TA were 96.3% (52/54), 100% (17/17), and 97.2% (69/71), respectively. Adverse events were observed in one case (1.4%, peritonitis). The accuracy of ERC biopsy/cytology was 82.5% (212/257 cases); additional EUS-TA diagnosed 30 cases as malignant additionally and improved the accuracy (94.2%; 242/257 cases; p < .01). CONCLUSIONS: EUS-TA is an accurate and safe diagnostic test for biliary lesions. The addition of EUS-TA may be considered when there is a suspicion of a false-negative ERC result.

DOI： 10.1002/jhbp.12143

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVES: The safety and effectiveness of propofol in more complex endoscopic procedures, such as endoscopic retrograde cholangiopancreatography, remain unknown. Thus, we aimed to evaluate propofol sedation during endoscopic cholangiopancreatography, ultrasound-guided intervention, and gastroduodenal stenting and examine risk factors for excessive sedation. METHODS: We retrospectively analyzed data from 870 patients who underwent endoscopic treatment with propofol sedation for biliary and pancreatic disease between October 2020 and September 2021. Sedation included propofol and fentanyl, with continuous monitoring of vital signs and the bispectral index. The assessed risk factors included age, complications, body mass index, treatment duration, and specialty. RESULTS: Distal bile duct treatment (n = 367), hilar bile duct treatment (n = 197), post-small-intestinal reconstruction treatment (n = 75), endoscopic ultrasound-guided intervention (n = 140), and gastrointestinal obstruction treatment (n = 91) were performed. The rates of excessive sedation, hypoxemia, and hypotension were 7.8%, 6.0%, and 1.8%, respectively. Post-small-intestinal reconstruction treatment had the highest incidence rate of excessive sedation (16%), whereas endoscopic ultrasound-guided intervention had the lowest incidence rate (4.3%). Multivariate analysis revealed significant associations between excessive sedation and comorbid sleep apnea, obesity, and prolonged procedural time. CONCLUSIONS: Obesity, sleep apnea syndrome, and prolonged procedure time are risk factors for excessive sedation related to propofol use. Thus, sedation techniques should be tailored for these patients.

DOI： 10.1002/deo2.417

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE: Whether metal stents (MS) or plastic stents (PS) yield better outcomes for malignant biliary obstruction in endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) is controversial. We aimed to compare outcomes of initial EUS-HGS performed with MS or PS. METHODS: In this single-center retrospective study, we included patients (MS/PS groups: n = 151/72) with unresectable malignant biliary obstruction and performed multivariable analysis. The landmark date was defined as day 100 and used to evaluate the time to recurrent biliary obstruction (TRBO). RESULTS: The clinical success rate was similar in both groups. The mean total bilirubin percentage decrease at week 2 was significantly higher in the MS group than in the PS group (-45.1% vs. -23.7%, P = 0.016). Median TRBO was significantly different between the MS and PS groups (183 and 92 days, respectively; P = 0.017). TRBO within 100 days was comparable in both groups but was significantly shorter only after 100 days in the PS group (adjusted hazard ratio 12.8, P < 0.001). Adverse events were significantly more common in the MS group (23.8% vs. 9.7%, P = 0.012), although they occurred relatively frequently even with PS in the cholangitis subgroup (Pinteraction = 0.034). After endoscopic re-intervention, TRBO tended to be longer with revision PS (hazard ratio 0.40, P = 0.47). CONCLUSIONS: Although MS provided early improvement of jaundice and long stent patency, PS provided a better safety profile and comparable stent patency until 100 days. PS might also be an adequate and optimal palliation method in EUS-HGS.

DOI： 10.1111/den.14956

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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 date, only thinner-diameter metal stents have been evaluated for unresectable malignant distal biliary obstruction (UR-MDBO). This study investigated the outcomes and optimal cohorts for a 6-mm-diameter fully covered self-expandable metal stent (FCSEMS) compared with those for a 10-mm-diameter FCSEMS. METHODS: This single-center retrospective cohort study included patients who underwent initial transpapillary metal stenting for UR-MDBO. Propensity score matching (1:1) analysis was performed. RESULTS: Of 133/68 patients who underwent 6-mm/10-mm-diameter FCSEMS deployment, 59 in each group were selected. The median time to recurrent biliary obstruction was not significantly different between the groups (p=0.46). In contrast, use of the 6-mm-diameter FCSEMS resulted in a significantly reduced incidence of stent-related adverse events (AEs) (p=0.016), especially cholecystitis (p=0.032), and patients aged <70 years were particularly affected by this significant reduction. Among the patients in the end-stage cohort who were unable to continue chemotherapy after FCSEMS deployment, the free rate of stent-related events, including recurrent biliary obstruction and stent-related AEs, was significantly higher in the 6-mm group (p=0.027). CONCLUSIONS: For UR-MDBO, a 6-mm-diameter FCSEMS can be an optimal and safe option in the younger cohort with a relatively high risk of AEs and in the end-stage cohort requiring safer drainage without interference from stent-related events during times of poor prognosis.

DOI： 10.5946/ce.2024.044

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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) may not provide adequate drainage for patients with malignant hilar biliary obstruction (MHBO). Endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) is a salvage method for malignant distal biliary obstruction (MDBO); however, its effectiveness for MHBO remains unclear. OBJECTIVES: We aimed to evaluate the short- and long-term outcomes of EUS-HGS for MHBO. DESIGN: This was a single-center retrospective cohort study. METHODS: Unresectable patients who underwent initial EUS-HGS because of ERCP failure were recruited. Distal biliary stenosis or Bismuth types I and II-IV were defined as MDBO and MHBO, respectively. We defined EUS-HGS for MDBO as the control and analyzed the outcomes for MHBO. RESULTS: The MDBO group (n = 208) was treated using EUS-HGS alone. In the MHBO group (n = 63), EUS-HGS alone (unilateral drainage, n = 26), EUS-HGS with bridging (EUS-HGSB, bilateral drainage, n = 21), and ERCP + EUS-HGS (bilateral drainage, n = 16) were performed. In EUS-HGS (MDBO), EUS-HGS (MHBO), EUS-HGSB, and ERCP + EUS-HGS, the technical success rates were 98.6%, 96.3%, 95.5%, and 94.1%; clinical success rates were 88.5%, 76.9%, 85.7%, and 75.0%; adverse event rates were 19.7%, 15.4%, 9.5%, and 25.0%; and non-recurrent biliary obstruction (RBO) rates at 180 days were 45.5%, 19.8%, 61.9%, and 68.4%, respectively. In multivariate analysis of the MHBO group, EUS-HGSB tended to have a lower risk of RBO (adjusted hazard ratio (aHR), 0.39; p = 0.09), and ERCP + EUS-HGS showed a significantly lower risk (aHR, 0.25; p = 0.03) compared to EUS-HGS alone (unilateral drainage). CONCLUSION: ERCP + EUS-HGS followed by EUS-HGSB, providing bilateral drainage, can offer preferred palliation for MHBO. These drainages may serve as potential salvage options in the management of MHBO.

DOI： 10.1177/17562848251356099

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND AND STUDY AIMS: Biliary drainage for unresectable malignant hilar biliary obstruction (MHBO) can be technically challenging; therefore, there is a requirement for new treatment methods. This study evaluated the efficacy and safety of a novel bilateral drainage method-endoscopic ultrasound-guided hepaticoduodenostomy plus hepaticogastrostomy (EUS-HDGS)-which combines EUS-guided hepaticoduodenostomy (EUS-HDS) and hepaticogastrostomy (EUS-HGS). PATIENTS AND METHODS: From 2018 to 2024, we reviewed eight cases of EUS-HDGS from 749 EUS procedures. Both EUS-HDS and EUS-HGS were performed simultaneously. The study outcomes were technical success, clinical success (reduced bilirubin levels or improved cholangitis within 14 days), and adverse events. RESULTS: Technical success was achieved in 87.5% cases (7/8), whereas clinical success was observed in 75.0% (6/8). Mild peritonitis occurred in 25% of patients (2/8) and 75.0% of patients (6/8) experienced recurrent biliary obstruction, with successful reintervention achieved in all cases. Median stent patency period was 90 days (95% confidence interval: 47.0-133). CONCLUSIONS: EUS-HDGS is a safe and effective drainage method for treating refractory MHBO and has potential as a viable treatment option.

DOI： 10.1055/a-2565-8206

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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-2361-2944

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background/Objectives: Endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) often requires fistula dilation owing to the placement of a large diameter of the delivery stent. The recently developed delivery devices, which are as thin as 5.9/6.0 Fr, may save the need for fistula dilation. Therefore, we investigated whether large fistula dilation would be required or not in the case of this newly developed thin-diameter delivery stents. Methods: We conducted a retrospective study involving 33 patients implemented with a self-expandable metal stent (SEMS) during EUS-HGS. The patients were categorized based on the delivery device diameter into thin (n = 13; delivery device diameter: 5.9/6.0 Fr) and thick (n = 20; delivery device diameter: 8.5 Fr) groups. We compared the initial rate of success, technical success, and clinical success between the thin and thick groups. The initial rate of success was defined as successful stent placement without a balloon or large diameter mechanical dilation. Results: The rate of the initial stenting success was significantly higher in the thin group (100% [13/13]) compared with that in the thick group (65.0% [13/20]) (p = 0.027). In the thick group, seven cases with technical difficulty in terms of stent placement could be successfully completed with additional fistula dilation with a 9 Fr bougie dilator or 4 mm balloon dilator; this resulted in a technical success of 100% in both groups ultimately. The rate of clinical success was 100% and 95.0% in the thin and thick groups, respectively (p = 1.00). Conclusions: Thin delivery stents may facilitate stent placement without the need for a balloon fistula or large-diameter mechanical dilation.

DOI： 10.3390/jcm13216328

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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: Endoscopic ultrasound-guided gastroenterostomy is a procedure used to connect the stomach and dilated afferent loop using a stent under endoscopic ultrasound for afferent loop syndrome. However, the actual efficacy and safety of this procedure remain unclear. Therefore, this retrospective study aimed to evaluate the efficacy and safety of endoscopic ultrasound-guided gastroenterostomy using a laser-cut-type fully covered self-expandable metallic stent and an anchoring plastic stent for afferent loop syndrome. METHODS: Technical and clinical success rates, adverse events, recurrent intestinal obstruction rates, time to recurrent intestinal obstruction, and technical and clinical success rates of re-intervention were evaluated in intended patients who underwent endoscopic ultrasound-guided gastroenterostomy for afferent loop syndrome from October 2018 to August 2022. RESULTS: In 25 intended patients with afferent loop syndrome who intended endoscopic ultrasound-guided gastroenterostomy, the technical success rate was 100% (25/25), whereas the clinical success rate was 96% (24/25). Two patients experienced grade ≥ 3 early adverse events, including one with intra-abdominal abscess and one with hypotension. Both events were attributed to intestinal fluid leakage. No late adverse events were observed. The recurrent intestinal obstruction rate was 32% (8/25), and the median time to recurrent intestinal obstruction was 6.5 months (95% confidence interval: 2.8-not available). The technical and clinical success rates of re-intervention were both 100% (8/8). CONCLUSIONS: Endoscopic ultrasound-guided gastroenterostomy using a fully covered self-expandable metallic stent and an anchoring plastic stent is effective and safe as a treatment procedure for afferent loop syndrome.

DOI： 10.1111/jgh.16649

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

EUS-TA in unresectable pancreatic cancer requires not only a tissue diagnosis but also tissue collection in anticipation of comprehensive genomic profiling. However, the optimal puncture target remains controversial. Therefore, the Primary and Metastatic Lesions in Pancreatic Cancer (PRIMATE) study was designed to clarify the optimal target by comparing the success rates for meeting OncoGuide NCC Oncopanel (NOP) analysis criteria on pre-check primary and metastatic lesion specimens obtained during the same EUS-TA session in patients with invasive pancreatic ductal adenocarcinoma. In this ongoing prospective study, two specimens, each from primary and metastatic lesions, are obtained by EUS-TA (typically using a 19G fine-needle biopsy needle) in patients with invasive pancreatic ductal adenocarcinoma. The primary endpoint is the proportion of EUS-TA specimens that meet NOP analysis criteria during pre-check (i.e., tumor cellularity of ≥20% and a tissue area of ≥4 mm2), which are then compared between primary and metastatic lesions. This study has been approved by the National Cancer Center Institutional Review Board (Research No. 2022-168). The results of this study will be reported at an international conference and published in an international peer-reviewed journal. The trial registration number is UMIN 000048966.

DOI： 10.3390/diseases12080182

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Tissue sampling in biliary tract cancer (BTC) is generally performed through transpapillary biopsy (TPB) or endoscopic ultrasound-guided tissue acquisition (EUS-TA). For the first time, we compared the suitability of specimens obtained using TPB and EUS-TA to determine the optimal tissue-sampling method for comprehensive genome profiling (CGP) analysis in patients with unresectable BTC (UR-BTC). Pathology precheck criteria for CGP analysis comprised the OncoGuide NCC Oncopanel System (NCCOP) and FoundationOne CDx (F1CDx). Seventy-eight patients with UR-BTC (35 TPB and 43 EUS-TA) were included. The NCCOP analysis suitability achievement rate was higher in EUS-TA specimens than in TPB specimens (34.9% vs. 8.6%, p = 0.007), whereas that of F1CDx was 0% in both groups. EUS-TA was identified as an independent factor that contributed to the suitability of the NCCOP analysis. The suitability of the NCCOP analysis of EUS-TA specimens showed a tendency to be higher for mass lesions (43.8% vs. 9.1%, p = 0.065), especially for target size ≥ 18.5 mm, and lower for perihilar cholangiocarcinoma (0% vs. 41.7%, p = 0.077). In TPB, papillary-type lesions (66.7% vs. 3.2%, p = 0.016) and peroral cholangioscopy-assisted biopsies (50.0% vs. 3.3%, p = 0.029) showed better potential for successful NCCOP analysis. EUS-TA is suitable for NCCOP analysis in UR-BTC and may be partially complemented by TPB.

DOI： 10.3390/cancers16162819

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background and study aims Endoscopic ultrasound-guided hepaticogastrostomy with bridging between the left and right bile ducts is an alternative to endoscopic transpapillary drainage for malignant hilar biliary obstruction. We aimed to analyze the long-term stent patency of endoscopic ultrasound-guided hepaticogastrostomy with bridging. Patients and methods Patients who underwent endoscopic ultrasound-guided hepaticogastrostomy with bridging between April 2018 and July 2023 were retrospectively analyzed. We retrospectively compared the stent patency of these patients with that of the individuals who underwent endoscopic transpapillary drainage-multi-stenting using unmatched (entire) and propensity score-matched cohorts. Results Endoscopic ultrasound-guided hepaticogastrostomy with bridging had a technical success rate of 90% (18/20). Adverse events were minimal. The number of clinical success cases was 17 and 82 for endoscopic ultrasound-guided hepaticogastrostomy with bridging using metallic stent and endoscopic transpapillary drainage-multi-stenting, respectively. The recurrent biliary obstruction rate was 17.6% and 58.5% for endoscopic ultrasound-guided hepaticogastrostomy with bridging and endoscopic transpapillary drainage-multi-stenting, respectively; the median time to recurrent biliary obstruction (days) was significantly longer for endoscopic ultrasound-guided hepaticogastrostomy with bridging in the entire (not reached vs. 104, P =0.03) and propensity score-matched (183 vs. 79, P =0.05) cohorts. The non-recurrent biliary obstruction rate for endoscopic ultrasound-guided hepaticogastrostomy with bridging was 91.6% at 3 and 6 months and 57% at 12 months. Multivariate analyses revealed that endoscopic ultrasound-guided hepaticogastrostomy with bridging contributed to a lower recurrent biliary obstruction incidence (hazard ratio, 0.31, P =0.05) without significant difference. Conclusions Stent patency was significantly better for endoscopic ultrasound-guided hepaticogastrostomy with bridging. However, future prospective studies are needed.

DOI： 10.1055/a-2333-7898

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background and study aims Endoscopic ultrasound-guided pancreatic duct drainage (EUS-PD) is emerging as an effective alternative treatment for obstructive pancreatitis after unsuccessful endoscopic retrograde pancreatography (ERP). However, the high incidence of adverse events associated with EUS-PD (approximately 20%) remains an issue. Recently, we developed a novel plastic stent for EUS-PD, with a radiopaque marker positioned at approximately one-third of the length from the distal end of the stent and side holes positioned exclusively distal to the marker. This study aimed to evaluate the feasibility and safety of using this stent in EUS-PD. Patients and methods We retrospectively reviewed data from 10 patients who underwent EUS-PD with the novel plastic stent at the National Cancer Center Hospital between March 2021 and October 2023. Technical and clinical success, procedure times, adverse events (AEs), recurrent pancreatic duct obstruction (RPO), and time to RPO were assessed. Results Of the 10 patients, five had postoperative benign pancreaticojejunal anastomotic strictures and five had malignant pancreatic duct obstruction. The technical and clinical success rates were both 100% (10/10). An AE (self-limited abdominal pain) occurred in one patient (10.0%). Two patients (20.0%) died of their primary disease during the follow-up period (median, 44 days; range, 25-272 days). The incidence of RPO was 10.0% (1/10), and the 3-month non-RPO rate was 83.3%. Conclusions The novel plastic stent shows potential as a useful and safe tool in EUS-PD.

DOI： 10.1055/a-2294-8517

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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 (SEMSs) are laser-cut (L) or braided (B); however, it remains unclear which approach is more effective for distal malignant biliary obstruction (DMBO). This study 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, n = 27; group B, n = 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 = .913). The median TRBO (220 days [95% CI, 56-272] vs 418 days [95% CI, 232-454]) was significantly longer in group B than in group L (log-rank test, P = .0118). The median overall survival (group L, 158 days; group B, 204 days) after stenting was not significantly different between groups (P = .8544). CONCLUSIONS: In the setting of DMBO, B-type stents are associated with less recurrent obstruction than L-type stents, although there was no difference in safety. (UMIN Clinical Trials Registry number: UMIN000027239.).

DOI： 10.1016/j.gie.2023.11.057

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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

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background and study aims Endoscopic gastroduodenal stent (GDS) deployment is currently a standard treatment for malignant gastric outlet obstruction (mGOO) in patients with limited life expectancy; however, stent dysfunction (SD) and complicated pancreatitis often occur after GDS deployment. We investigated incidence and contributing factors of SD and complicated pancreatitis. Patients and methods We retrospectively reviewed 203 patients who underwent initial GDS deployment for palliation of mGOO symptoms between October 2017 and July 2022, including 109 who underwent GDS deployment across the duodenal papilla (sub-cohort). Results SDs, including tumor ingrowth (n = 26), kinking (n = 14), and migration (n = 13), occurred in 68 patients (33.5%). Cumulative SD incidence was 41.1% (95% confidence interval, 32.6-49.4%). SD incidence increased to 0.4%, 0.16%, and 0.06% per day at < 8, 8-16, and>16 weeks, respectively. On multivariate analysis, Niti-S pyloric/duodenal stent deployment (sub-distribution hazard ratio [sHR] 0.26, P = 0.01) and survival length ≥ 90 days (sHR 2.5, P = 0.01) were respectively identified as favorable and risk factors significantly associated with SD. Pancreatitis developed in 14 patients (12.8%) in the sub-cohort, which had significantly higher parenchymal diameter ( P < 0.01) and lower main pancreatic duct (MPD) caliber ( P < 0.01) than the non-pancreatitis cohort. On multivariate analysis, MPD caliber < 3 mm independently predicted pancreatitis (odds ratio 6.8, P = 0.03). Conclusions Deployment of the Niti-S pyloric/duodenal stent, with conformability even for angulated strictures, significantly reduced the incidence of SD. Stent selection, life expectancy, and MPD caliber should be taken into consideration during decision-making for GDS deployment for mGOO.

DOI： 10.1055/a-2261-2833

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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

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

INTRODUCTION: The current endoscopic treatment for postoperative benign hepaticojejunostomy anastomotic stricture (HJAS) has a high technical success rate and is highly effective in the short term. However, long-term results have shown a high rate of stenosis recurrence, which indicates an insufficient response to treatment. Three prospective studies on fully covered self-expandable metallic stent (FC-SEMS) treatment for benign HJAS used the stenosis resolution rate as the primary endpoint, and no study has yet used the long-term non-stenosis rate (at 12 months) as the primary endpoint. METHODS AND ANALYSIS: We launched the 'saddle-cross study', which will be conducted as a multicentre, prospective intervention of endoscopic treatment using two modified FC-SEMSs (BONASTENT️ M-Intraductal) that have been improved for benign stenosis in patients with benign HJAS, with the long-term non-restenosis rate (at 12 months) as the primary endpoint. This study aims to evaluate the long-term non-restenosis rate (at 12 months) and safety of the saddle-cross technique for benign HJAS. We plan to enrol 50 participants. ETHICS AND DISSEMINATION: This study has been approved by the Certified Review Board of the National Cancer Center, Japan (CRB3180009). The results will be reported at various conferences and published in international peer-reviewed journals.

DOI： 10.1136/bmjopen-2023-078967

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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

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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

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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: A total of 52 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 = .541); the mean T-Bil was 2.5/1.8 (P = .401). Eight weeks after initiation of steroids, ALP improvement rate in the BD group/non-BD group was 69.2%/61.5% (P = 1.000), and T-Bil improvement rate was 100%/100% (P = Ns). CONCLUSIONS: Steroids for IgG4-SC could prove effective in improving liver damage and jaundice, regardless of the presence or absence of BD. BD for IgG4-SC aimed to improve jaundice may not be necessary.

DOI： 10.1002/jhbp.1230

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1055/a-1847-7745

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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

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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 < .001). EUS was significantly superior to CT for PNENs ≤5 mm (58.3% vs 16.7%; P = .006) and 5-10 mm (97.7% vs 79.5%; P = .008). There was no significant difference in the detection rate between EUS and CT for PNENs >10 mm (98.4% vs 96.4%; P = .375). Size (≤5 mm) and insulinoma were independent factors associated with poor EUS and CT detection rates. CONCLUSIONS: Endoscopic ultrasound 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：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 < 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）  

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：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：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：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1111/den.13874

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Patients with inflammatory bowel disease (IBD) occasionally require central venous catheter (CVC) placement to support a therapeutic plan. Given that CVC can predispose patients to infection, this investigation was undertaken to assess the incidence, risk factors, and outcomes of CVC-related blood stream infection (CRBSI) in patients with IBD during routine clinical practice. METHODS: Data were compiled using retrospective chart reviews of 1367 patients treated at our IBD center between 2007 and 2012 during routine clinical practice. Among the 1367 patients, 314 who had received CVC placements were included. Patients with positive blood culture were considered as "definite" CRBSI, whereas "possible" CRBSI was defined as patients in whom fever alleviated within 48 hours post-CVC without any other infection. Patients' demographic variables including age, body mass index, serum albumin, duration of CVC placement, use of antibiotics, medications for IBD, and perioperative status between CRBSI and non-CRBSI subgroups were compared by applying a multivariate Poisson logistic regression model. RESULTS: Among the 314 patients with CVC placement, there were 83 CRBSI cases (26.4%). The average time to the onset of CRBSI was 22.5 days (range 4-105 days). The jugular vein access was found to be the most serious risk of CRBSI (risk ratio 2.041 versus subclavian vein). All patients with CRBSI fully recovered. CONCLUSIONS: In this investigation, regardless of the patients' demographic features including immunosuppressive therapy, up to 30% of febrile IBD patients with CVC showed CRBSI. It is believed that CVC placement per se is a risk of CRBSI in patients with IBD.

DOI： 10.1097/MIB.0000000000001230

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