Language：Japanese   Publisher：Japanese Society of Otorhinolaryngology-Head and Neck Surgery  

DOI： 10.3950/jibiinkotokeibu.127.1_54

Language：Japanese   Publisher：Japan Gastroenterological Endoscopy Society  

<p>Objectives: Endoscopic ultrasound-guided tissue acquisition (EUS-TA) plays a crucial role in the diagnosis of pancreatic tumors. The present study aimed to investigate the current status of needle tract seeding (NTS) after EUS-TA of pancreatic tumors based on a nationwide survey in Japan.</p><p>Methods: Patients who underwent surgical resection of primary pancreatic tumors after EUS-TA performed between April 2010 and March 2018 were surveyed. The incidence rates of NTS were determined, and compared in patients with pancreatic ductal adenocarcinomas (PDACs) and other tumors, and in patients who underwent transgastric and transduodenal EUS-TA of PDACs. The detailed features and prognosis of patients with NTS were also assessed.</p><p>Results: A total of 12,109 patients underwent surgical resection of primary pancreatic tumors after EUS-TA. The overall incidence rate of NTS was 0.330%, and the NTS rate was significantly higher in patients with PDAC than in those with other tumors (0.409% vs. 0.071%, <i>P</i> = 0.004). NTS was observed in 0.857% of patients who underwent transgastric EUS-TA, but in none of those who underwent transduodenal EUS-TA. Of the patients with NTS of PDACs, the median time from EUS-TA to occurrence of NTS and median patient survival were 19.3 and 44.7 months, respectively, with 97.4% of NTS located in the gastric wall and 65.8% of NTS resected. The patient survival was significantly longer in patients who underwent NTS resection than in those without NTS resection (<i>P</i> = 0.037).</p><p>Conclusions: Needle tract seeding appeared only after transgastric not after transduodenal EUS-TA. Careful follow-up provides an opportunity to remove localized NTS lesions by gastrectomy.</p>

DOI： 10.11280/gee.66.312

Scopus

Language：Japanese   Publisher：Endoscopy  

DOI： 10.1055/a-1974-9436

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PubMed

Language：Japanese   Publisher：Trials  

Background: With the increasing popularity of endoscopic ultrasound (EUS)-guided transmural interventions, walled-off necrosis (WON) of the pancreas is increasingly managed via non-surgical endoscopic interventions. However, there has been an ongoing debate over the appropriate treatment strategy following the initial EUS-guided drainage. Direct endoscopic necrosectomy (DEN) removes intracavity necrotic tissue, potentially facilitating early resolution of the WON, but may associate with a high rate of adverse events. Given the increasing safety of DEN, we hypothesised that immediate DEN following EUS-guided drainage of WON might shorten the time to WON resolution compared to the drainage-oriented step-up approach. Methods: The WONDER-01 trial is a multicentre, open-label, superiority, randomised controlled trial, which will enrol WON patients aged ≥ 18 years requiring EUS-guided treatment in 23 centres in Japan. This trial plans to enrol 70 patients who will be randomised at a 1:1 ratio to receive either the immediate DEN or drainage-oriented step-up approach (35 patients per arm). In the immediate DEN group, DEN will be initiated during (or within 72 h of) the EUS-guided drainage session. In the step-up approach group, drainage-based step-up treatment with on-demand DEN will be considered after 72–96 h observation. The primary endpoint is time to clinical success, which is defined as a decrease in a WON size to ≤ 3 cm and an improvement of inflammatory markers (i.e. body temperature, white blood cell count, and C-reactive protein). Secondary endpoints include technical success, adverse events including mortality, and recurrence of the WON. Discussion: The WONDER-01 trial will investigate the efficacy and safety of immediate DEN compared to the step-up approach for WON patients receiving EUS-guided treatment. The findings will help us to establish new treatment standards for patients with symptomatic WON. Trial registration: ClinicalTrials.gov NCT05451901, registered on 11 July 2022. UMIN000048310, registered on 7 July 2022. jRCT1032220055, registered on 1 May 2022.

DOI： 10.1186/s13063-023-07377-y

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PubMed

Language：Japanese   Publisher：Esophagus  

Background: The rate of metachronous recurrence after endoscopic submucosal dissection for early-stage esophageal squamous cell carcinoma and hypopharynx squamous cell carcinoma is as high (10–15%). The acetaldehyde breath test may detect acetaldehyde dehydrogenase 2 gene polymorphisms. Therefore, we evaluated its usefulness in assessing metachronous recurrence in patients with esophageal squamous cell carcinoma and hypopharynx squamous cell carcinoma. Methods: A total of 76 patients underwent endoscopic submucosal dissection for esophageal squamous cell carcinoma and hypopharynx squamous cell carcinoma and were followed up for at least 3 years (non-recurrence group: 52 patients; recurrence group: 24 patients). The risk factors for carcinogenesis were compared between the recurrence and non-recurrence groups, and the acetaldehyde-to-ethanol ratio was assessed. The cutoff acetaldehyde-to-ethanol ratio that correlated with recurrence was established, and the cumulative recurrence rate was evaluated. Results: The recurrence group had a higher acetaldehyde-to-ethanol ratio, daily alcohol consumption, and Lugol-voiding lesion grade than the non-recurrence group in the univariate analysis. The cutoff acetaldehyde-to-ethanol ratio for recurrence was 28.1 based on the receiver operating characteristic curve. The multivariate analysis revealed an acetaldehyde-to-ethanol ratio of > 28.1 and a Lugol-voiding lesion grade associated with carcinogenesis. Patients with an acetaldehyde-to-ethanol ratio of ≥ 28.1 had a significantly high recurrence rate using the Kaplan–Meier method. Conclusions: The acetaldehyde-to-ethanol ratio detected using the acetaldehyde breath test could be a novel biomarker of metachronous recurrence after endoscopic submucosal dissection in patients with esophageal squamous cell carcinoma and hypopharynx squamous cell carcinoma. Trial registration number: UMIN000040615.

DOI： 10.1007/s10388-023-01024-w

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PubMed

Language：English   Publisher：シュプリンガー・ジャパン(株)  

アセトアルデヒド呼気試験はアセトアルデヒド脱水素酵素2の遺伝子多型を同定する可能性があるため、食道および下咽頭扁平上皮癌患者における異時性再発を発見する上での有用性を評価した。内視鏡的粘膜下層剥離術を受けた76例の食道および下咽頭扁平上皮癌患者を少なくとも3年間経過観察した。再発が認められなかった症例が52例(非再発群)、認められた症例が24例(再発群)であった。癌発生の危険因子を再発群と非再発群で比較し、アセトアルデヒド-エタノール比を測定した。再発と関連するアセトアルデヒド-エタノール比のカットオフ値を設定し、累積再発率を評価した。単変量解析の結果、再発群では、アセトアルデヒド-エタノール比、1日当たりのアルコール消費量、ルゴール不染帯グレードが非再発群と比較して高かった。受信者動作特性曲線解析を用いた。その結果、アセトアルデヒド-エタノール比のカットオフ値は28.1であった。多変量解析の結果、アセトアルデヒド-エタノール比>28.1およびルゴール不染帯グレードが癌の発生と関連していた。カプランマイヤー法による検討では、アセトアルデヒド-エタノール比≧28.1の症例の再発率が有意に高かった。以上より、アセトアルデヒド呼気試験により求められるアセトアルデヒド-エタノール比が、食道および下咽頭扁平上皮癌患者における内視鏡的粘膜下層剥離術後の異時性再発に対する新規バイオマーカーとなる可能性が示された。

Language：English   Publisher：The Japanese Society of Internal Medicine  

<p>A 51-year-old man was referred to our hospital for the further examination of main pancreatic duct interruption. Imaging findings showed a 25-mm-diameter mass lesion located in the pancreatic head. Endoscopic ultrasonography (EUS)-guided fine-needle aspiration (FNA) was performed on the mass. Cytology suggested adenocarcinoma, but the histological diagnosis was not confirmed. We made a comprehensive diagnosis of resectable pancreatic cancer. The mass shrank after preoperative adjuvant chemotherapy, and the patient underwent surgery. The final pathological diagnosis was type 2 autoimmune pancreatitis (AIP). Two years after surgery, AIP had not recurred in the remaining pancreas. </p>

DOI： 10.2169/internalmedicine.0224-22

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PubMed

Language：English   Publisher：(一社)日本内科学会  

症例は51歳男性で、MR胆管膵管撮影で主膵管途絶が明らかになり、精査目的で紹介来院した。入院時に腹部症状はなく、バイタルサインは安定していた。全身造影CTでは、膵頭に径25mmの腫瘤性病変が認められ、膵頭での主膵管途絶および膵尾領域での主膵管拡張が判明した。FDG-PETでは膵頭病変で異常蓄積が認められた。超音波内視鏡ガイド下穿刺吸引を行い、細胞診では膵腺癌が示唆されたが、組織学的診断は確定できなかった。炎症性腸疾患がないことを確認後、包括的に切除可能膵癌と診断した。ゲムシタビン+TS-1による術前補助化学療法を3コース行った。その結果、腫瘍径が25mmから16mmに縮小した。幽門輪温存膵頭十二指腸切除術を行って腫瘍を切除した。最終的な病理学的診断は2型自己免疫性膵炎(AIP)であった。術後2年時点で残存膵にAIP再発は認めていない。

Publisher：メジカルビュー社  

DOI： 10.18885/ci.0000001345

Language：English   Publisher：シュプリンガー・ジャパン(株)  

切除した膵神経内分泌腫瘍(PanNEN)は再発率が高いので、その予測因子を検索した。22医療機関で1987年1月～2020年7月に切除したPanNEN573例のデータベースを作成した。局在性の非機能性膵神経内分泌腫瘍(G1/G2)の371名の患者の臨床的特徴を分析した。再発を決定付ける特徴を分析するため、機械学習予測モデルを構築した。経過観察中に患者52名に再発がみられ、再発までの中央値は33.7ヵ月であった。ランダムサバイバルフォレスト(RSF)モデルはCox比例ハザード回帰モデルよりもHarrell C指数が優れていた。Ki-67指数、残存腫瘍、WHOグレード、腫瘍サイズ、リンパ節転移がRSFモデルの上位5予測因子で、腫瘍サイズ20mm以上が再発の可能性の上昇する分岐点で、Ki-67指数の上昇とともに5年無増悪生存率が直線的に低下した。

Language：Japanese   Publisher：Journal of Gastroenterology  

Background: Pancreatic neuroendocrine neoplasms (PanNENs) are a heterogeneous group of tumors. Although the prognosis of resected PanNENs is generally considered to be good, a relatively high recurrence rate has been reported. Given the scarcity of large-scale reports about PanNEN recurrence due to their rarity, we aimed to identify the predictors for recurrence in patients with resected PanNENs to improve prognosis. Methods: We established a multicenter database of 573 patients with PanNENs, who underwent resection between January 1987 and July 2020 at 22 Japanese centers, mainly in the Kyushu region. We evaluated the clinical characteristics of 371 patients with localized non-functioning pancreatic neuroendocrine tumors (G1/G2). We also constructed a machine learning-based prediction model to analyze the important features to determine recurrence. Results: Fifty-two patients experienced recurrence (14.0%) during the follow-up period, with the median time of recurrence being 33.7 months. The random survival forest (RSF) model showed better predictive performance than the Cox proportional hazards regression model in terms of the Harrell’s C-index (0.841 vs. 0.820). The Ki-67 index, residual tumor, WHO grade, tumor size, and lymph node metastasis were the top five predictors in the RSF model; tumor size above 20 mm was the watershed with increased recurrence probability, whereas the 5-year disease-free survival rate decreased linearly as the Ki-67 index increased. Conclusions: Our study revealed the characteristics of resected PanNENs in real-world clinical practice. Machine learning techniques can be powerful analytical tools that provide new insights into the relationship between the Ki-67 index or tumor size and recurrence.

DOI： 10.1007/s00535-023-01987-8

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PubMed

Language：Japanese   Publisher：Journal of Hepato-Biliary-Pancreatic Sciences  

Background/Purpose: The benefits of anti-reflux metal stents, used for treating biliary obstruction in patients receiving neoadjuvant chemotherapy (NAC) for pancreatic cancer, are yet unknown. Herein, the safety and efficacy of the novel duckbill-type anti-reflux metal stent (D-ARMS) were prospectively evaluated for biliary drainage. Additionally, the incidence of recurrent biliary obstruction (RBO) after placement of D-ARMS vs conventional covered self-expandable metal stents (CCSEMSs) was retrospectively compared. Methods: Patients who received D-ARMS (n = 33) for treatment of distal biliary obstruction before NAC between September 2019 and January 2021 and those that received CCSEMSs (n = 38) between January 2013 and August 2019 were included in the historical control group. Technical and clinical successes, rate of RBO, and cumulative incidence of RBO were compared between the two groups. Results: The technical success rate was 100% for both the D-ARMS and CCSEMS groups, and the clinical success rate were not significantly different (93.9% and 89.5%, respectively; P =.68). In the multivariate analysis, D-ARMS was identified as the independent factor for cumulative incidence of RBO (P =.03). The cumulative incidence of RBO was significantly lower in the D-ARMS group than that in the CCSEMS group (P =.04). Conclusions: D-ARMS is safe and effective for patients receiving NAC.

DOI： 10.1002/jhbp.1239

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PubMed

Language：English   Publisher：John Wiley & Sons Australia, Ltd  

新規ダックビル型逆流防止弁付き金属ステント(D-ARMS)による胆道ドレナージの安全性および有効性を前向きに評価した。ネオアジュバント化学療法施行予定のD-ARMS治療が実施された切除可能または境界切除可能膵癌患者33例(男性23例、中央値68歳)、従来の被覆自己拡張型金属ステント(CCSEMS)による治療が実施された38例(男性27例、中央値67.5歳)を解析対象とした。評価項目は技術的・臨床的成功、Recurrent biliary obstruction(RBO)発生率、RBO累積発生率とした。その結果、技術的成功率は両群ともに100%であり、臨床的成功率にも有意差は認められなかった(93.9%対89.5%、P=0.68)。多変量解析の結果、D-ARMSはRBO累積発生の独立した予測因子であった(P=0.03)。RBO累積発生率はCCSEMS群と比較してD-ARMS群で有意に低かった(P=0.04)。以上から、D-ARMSはネオアジュバント化学療法施行患者にとって安全かつ有用であることが示された。

Language：Japanese   Publisher：Digestion  

Introduction: Sprayable wound dressings containing hydrophobized microparticles (hMPs) are characterized by strong adhesiveness. We examined the effect of hMPs derived from Alaska pollock gelatin on endoscopic submucosal dissection (ESD) ulcers. Methods: (1) In an in vivo model of miniature swine gastric ESD, gastric ulcers were created by ESD and then sprayed with hMPs or untreated followed by microscopic examination. (2) In an ex vivo ESD model of resected stomach, a pinhole-shaped perforation was created on the ESD ulcer of resected stomach; hMPs were then sprayed on the perforation; and air leakage and intragastric pressure were measured. (3) In an in vivo duodenal ESD model of miniature swine, duodenal artificial ESD ulcers with pinhole-shaped perforation were examined; ulcers were classified into hMPs-sprayed and nonsprayed groups, and inflammation in the intrinsic muscle layer and serosa were compared between the groups. Results: (1) Histological observation of submucosal tissues showed a decreased number of invading inflammatory cells in hMP-sprayed tissues compared with the control in miniature swine gastric ESD (p < 0.05). In addition, the rates of anti-alpha smooth muscle actin and type I collagen positivity were significantly lower in the hMPs group than in the control group (p < 0.05). (2) Intragastric pressure could not be measured in the nonsprayed group, whereas no air leakage was observed in the sprayed group when pressurized up to 26 mm Hg in the resected stomach model. (3) The sprayed group showed suppressed inflammation of the intrinsic muscular layer and serosa in both cases compared with the nonsprayed group in miniature swine duodenal ESD (p < 0.05). Conclusions: Sprayable, tissue-adhesive hMPs are a promising medical material for intraoperative and postoperative treatment of ESD-induced wound via anti-inflammation and strong adhesiveness.

DOI： 10.1159/000526650

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PubMed

Language：Japanese   Publisher：Diagnostics  

This study evaluated the feasibility and clinical utility of liquid-based cytology (LBC) specimens via endoscopic ultrasound–guided fine-needle biopsy (EUS-FNB) for next-generation sequencing (NGS) of pancreatic cancer (PC). We prospectively evaluated the performance of DNA extraction and NGS using EUS-FNB samples obtained from PC. Thirty-three consecutive patients with PC who underwent EUS-FNB at our hospital were enrolled. DNA samples were obtained from 96.8% of the patients. When stratified with a variant allele frequency (VAF) > 10% tumor burden, the NGS success rate was 76.7% (n = 23) in formalin-fixed paraffin-embedded (FFPE), 83.3% (n = 25) in LBC, and 76.7% (n = 23) in frozen samples. The overall NGS success rate was 86.7% (n = 26) using FFPE, LBC, or frozen samples. The detection rates for the main mutated genes were as follows: 86.7% for KRAS, 73.3% for TP53, 66.7% for CDKN2A, 36.7% for SMAD4, and 16.7% for ARID1A. LBC had the highest median value of VAF (23.5%) for KRAS and TP53. PC mutation analysis using NGS was successfully performed using LBC compared with FFPE and frozen samples. This approach provides an alternative and affordable source of molecular testing materials.

DOI： 10.3390/diagnostics13061078

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PubMed

Language：Japanese   Publisher：Endoscopic Ultrasound  

Background and Objectives: In transpapillary biliary drainage, metal stents (MSs) exhibit a lower incidence of a biliary obstruction than plastic stents (PSs). However, few studies have compared recurrent biliary obstruction (RBO) when MSs and PSs are used in EUS-guided hepaticogastrostomy (EUS-HGS) and choledochoduodenostomy (EUS-CDS). We retrospectively evaluated the RBO for both stents in each procedure. Patients and Methods: Between November 2012 and December 2020, 85 and 53 patients who underwent EUS-HGS and EUS-CDS for unresectable malignant biliary obstruction, respectively, were enrolled. Factors associated with RBO were assessed. Clinical outcomes were compared between the MS and PS groups using propensity score matching. Results: The clinical success rate and procedure-related adverse events were similar in the MS and PS groups. Multivariate analysis identified the use of PS as a factor associated with RBO (EUS-HGS, P = 0.03; EUS-CDS, P = 0.02). After matching, the median time to RBO in EUS-HGS (MS: 313; PS: 125 days; P = 0.01) in the MS group was longer than that in the PS group. The cumulative incidence of RBO at 1, 3, and 6 months in the MS group was significantly lower than that in the PS group for EUS-HGS (MS: 4.0%, 8.2%, and 8.2%; PS: 12.4%, 24.9%, and 39.5%, respectively, P = 0.01). Conclusions: MS exhibited a lower rate of RBO than PS for EUS-HGS and EUS-CDS.

DOI： 10.4103/EUS-D-21-00251

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PubMed

Language：Japanese   Publisher：Pancreas  

Objective The aim of the study is to evaluate the usefulness of virtual monoenergetic imaging (VMI) generated from dual-energy computed tomography (DECT) in detecting small pancreatic ductal adenocarcinomas (PDACs). Methods This study included 82 patients pathologically diagnosed with small PDAC (≤30 mm) and 20 without pancreatic tumors who underwent triple-phase contrast-enhanced DECT. To assess diagnostic performance for small PDAC detection via a receiver operating characteristic analysis, 3 observers reviewed 2 image sets (conventional computed tomography [CT] set and combined image set [conventional CT + 40-keV VMI from DECT]). The tumor-To-pancreas contrast-To-noise ratio was compared between conventional CT and 40-keV VMI from DECT. Results The area under the receiver operating characteristic curve of the 3 observers were 0.97, 0.96, and 0.97 in conventional CT set and 0.99, 0.99, and 0.99 in combined image set (P = 0.017-0.028), respectively. The combined image set yielded a better sensitivity than the conventional CT set (P = 0.001-0.023), without a loss of specificity (all P > 0.999). The tumor-To-pancreas contrast-To-noise ratios of 40-keV VMI from DECT were approximately threefold higher than those of conventional CT at all phases. Conclusions The addition of 40-keV VMI from DECT to conventional CT had better sensitivity for detecting small PDACs without compromising specificity.

DOI： 10.1097/MPA.0000000000002207

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PubMed

Language：Japanese   Publisher：Digestive Endoscopy  

Objectives: Endoscopic ultrasound-guided tissue acquisition (EUS-TA) plays a crucial role in the diagnosis of pancreatic tumors. The present study aimed to investigate the current status of needle tract seeding (NTS) after EUS-TA of pancreatic tumors based on a nationwide survey in Japan. Methods: Patients who underwent surgical resection of primary pancreatic tumors after EUS-TA performed between April 2010 and March 2018 were surveyed. The incidence rates of NTS were determined, and compared in patients with pancreatic ductal adenocarcinomas (PDACs) and other tumors, and in patients who underwent transgastric and transduodenal EUS-TA of PDACs. The detailed features and prognosis of patients with NTS were also assessed. Results: A total of 12,109 patients underwent surgical resection of primary pancreatic tumors after EUS-TA. The overall incidence rate of NTS was 0.330%, and the NTS rate was significantly higher in patients with PDAC than in those with other tumors (0.409% vs. 0.071%, P = 0.004). NTS was observed in 0.857% of patients who underwent transgastric EUS-TA, but in none of those who underwent transduodenal EUS-TA. Of the patients with NTS of PDACs, the median time from EUS-TA to occurrence of NTS and median patient survival were 19.3 and 44.7 months, respectively, with 97.4% of NTS located in the gastric wall and 65.8% of NTS resected. The patient survival was significantly longer in patients who underwent NTS resection than in those without NTS resection (P = 0.037). Conclusions: Needle tract seeding appeared only after transgastric not after transduodenal EUS-TA. Careful follow-up provides an opportunity to remove localized NTS lesions by gastrectomy.

DOI： 10.1111/den.14346

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PubMed

Language：English   Publisher：John Wiley & Sons Australia, Ltd  

原発膵臓腫瘍に対する超音波内視鏡ガイド下組織採取(EUS-TA)後の穿刺経路播種(NTS)の現状を、日本の全国調査を基に明らかにした。EUS-TA後に膵臓腫瘍の外科的切除を施行された患者12109例を対象に、NTSの全発生率を調査した。また当該患者を、膵管腺癌(PDAC)とその他の膵臓腫瘍群、PDACに対する経胃的および経十二指腸的EUS-TAを行った患者群に分け、播種発生率を比較した。さらにNTS患者の特徴と予後も評価した。NTSの全発生率は0.330%で、PDAC患者で有意に高かった。NTSは、経胃的EUS-TA施行患者の0.857%で観察されたが、経十二指腸的EUS-TA施行患者では観察されなかった。PDACのEUS-TA後にNTSを発生した患者38例(男性23例、女性15例、年齢中央値71歳)では、36例の原発腫瘍が膵体および膵尾部に位置し、EUS-TAからNTSの発生まで時間中央値は19.3ヵ月、生存期間中央値は44.7ヵ月であった。またNTSの97.4%が胃壁にあり、65.8%が切除された。患者生存率は、NTS切除非施行患者よりもNTS切除施行患者の方が有意に長かった。NTSは経胃的EUS-TA後のPDAC患者の約0.9%で検出されたが、経十二指腸的EUS-TA施行患者では検出されなかった。

Language：Japanese   Publisher：Diagnostic Cytopathology  

Background: As liquid-based cytology (LBC) specimens preserve high-quality DNA, clinical sequencing of LBC specimens using next-generation sequencing (NGS) is becoming a common strategy. This study aimed to evaluate the feasibility of NGS-based custom-made panels for evaluating MUC promoter methylation in LBC specimens. Methods: Thirty-one patients with pancreatic cancer were enrolled in the study. Cancer tissue samples were obtained using endoscopic ultrasound-guided fine-needle aspiration/biopsy (EUS-FNA/FNB). LBC, formalin-fixed paraffin-embedded (FFPE), and fresh frozen specimens were prepared for DNA extraction after pathological diagnosis. These specimens were then subjected to NGS analysis using custom-made cancer gene screening and methylation panels comprising 28 cancer-related genes and 13 gene promoter regions, including MUC1, MUC2, and MUC4. Results: The success rate of NGS using the cancer gene panel was comparable among the LBC, FFPE, and frozen specimens, and the presence of cancer cell-derived somatic mutations in each specimen was confirmed. The specimens were then tested using a methylation panel that revealed the sequential methylation status of CpG islands located in the promoter regions of MUC genes. The methylation status results obtained from LBC specimens were almost comparable with those from FFPE and frozen specimens. Conclusions: MUC and other gene methylation analyses using an NGS-based panel were successfully performed in residual LBC specimens obtained by EUS-FNA/FNB. Therefore, this approach provides an alternative source of molecular tests for gene mutations and methylation, especially in the pancreatic cancers, which are often unresectable and unsuitable for obtaining FFPE specimens.

DOI： 10.1002/dc.25022

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PubMed

Language：Japanese   Publisher：Auris Nasus Larynx  

Objectives: A histopathological tumor thickness of ≥1000 μm has been reported as one of many risk factors for recurrent lymph node metastasis in superficial pharyngeal cancer (SPC). However, methods for assessing this risk factor preoperatively have not yet been established. Hence, the current study aimed to evaluate the efficacy of endoscopic ultrasonography (EUS) in measuring tumor thickness preoperatively in patients with SPC. Methods: This single-center retrospective study included 44 consecutive patients with 47 lesions who underwent endoscopic submucosal dissection (ESD). Prior to surgery, EUS examination was performed while under general anesthesia. Further, microvascular irregularity in the target lesion was evaluated using the Japan Esophageal Society (JES) magnification endoscopic classification system. Results: A significant correlation was noted between histopathological and EUS tumor thickness (Spearman's correlation r == 0.879, p < 0.001). In tumors ≥1000 µm thick on histopathology, the cutoff value for EUS tumor thickness was 2.6 mm, and the following values were obtained: sensitivity, 100%; specificity, 81.8%; positive predictive value (PPV), 70%; negative predictive value (NPV), 100%; and accuracy, 87.2%. In B2 lesions ≥1000-μm thick, the following values were obtained: sensitivity, 85.7%; specificity, 90.9%; PPV, 80%; NPV, 93.8%; and accuracy, 89.4%. The diagnostic accuracy rate of combined EUS and the JES magnifying endoscopic classification system was 95.7%. Conclusions: Tumor thickness assessed using EUS was effective in diagnosing histopathological tumor thickness of ≥1000 μm. The combined use of EUS and the JES magnifying endoscopic classification system may be useful for assessing preoperative risk factors for lymph node metastasis in SPC.

DOI： 10.1016/j.anl.2021.11.003

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PubMed

Language：English   Publisher：(一社)日本耳鼻咽喉科頭頸部外科学会  

咽頭表在癌では腫瘍の厚さがリンパ節転移再発の危険因子の一つであることが報告されている。その厚さを術前に測定する目的で超音波内視鏡検査(EUS)が示す有用性を評価した。2010年12月～2018年3月に当院で咽頭表在癌に対し内視鏡的粘膜下層剥離術を施行し、その直前に全身麻酔下でEUSも実施していた連続患者44名(男性43名、平均67.8±8.7歳)の47病変を組み入れた。EUSで測定した腫瘍厚と、術後、病理組織学的に評価された腫瘍厚とは有意に相関していた(Spearmanの相関係数r=0.88、p<0.001)。病理評価の厚が1000μm以上であることの予測に最適となるEUS測定厚のカットオフ値を受信者動作特性(ROC)解析で求めたところ2.6mmと決定された。そのカットオフ値が示した感度は100%、特異度は82%、陽性的中率は70%、陰性的中率は100%、精度は89%となった。さらに日本食道学会の拡大内視鏡分類システムをEUSと組み合わせて使用した場合、その診断精度は96%となった。EUS評価による腫瘍厚は、病理組織学的計測での腫瘍厚が1000μm以上であることを診断するのに有効であった。咽頭表在癌に対しEUSと拡大内視鏡分類システムを併用すれば、リンパ節転移再発の術前危険因子の評価に有用であると考えられた。

Language：Japanese   Publisher：PLoS ONE  

Background Capsule endoscopy has been widely used to investigate obscure gastrointestinal bleeding (OGIB) in the small intestine since its approval in 2001. However, the clinical features of OGIB remain unclear. Aim We retrospectively examined the clinical features and risk factors of OGIB in patients who underwent capsule endoscopy in our hospital. Methods We included 420 of the 431 patients who underwent capsule endoscopy from June 2014 to May 2021, in whom the small intestine could be observed. We retrospectively compared the clinical features and treatment of OGIB cases, with or without active small bowel bleeding (n = 173), with other cases (n = 247). Patient sex, age, diabetes mellitus, and heart failure histories were matched for the analysis. Results The male/female ratio was 247/173 and the average age was 51.54 years. In multivariate analysis, the use of direct oral anticoagulants was significant (P = 0.016), and vascular lesions (P = 0.018) were observed in OGIB cases. When OGIB cases with and without active small bowel bleeding were compared, serum albumin level was lower in cases with active bleeding (P = 0.031). When treatment of OGIB cases were compared, those without vascular lesions could be treated conservatively (P = 0.0047). In the 1:1 propensity score matching analysis, serum creatinine level was elevated in cases of active bleeding (P = 0.029), and cases without vascular lesions were treated conservatively (P = 0.010). Conclusions Use of direct oral anticoagulants is frequently associated with OGIB. OGIB patients without vascular lesions may be treated conservatively.

DOI： 10.1371/journal.pone.0265903

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PubMed

Publisher：東京医学社  

DOI： 10.24479/endo.0000000020

Language：Japanese   Publisher：Biomedical Reports  

Type 1 autoimmune pancreatitis (AIP) is a pancreatic manifestation of IgG4-related disease (IgG4-RD) and is a unique chronic inflammatory disease characterized by fibrosis. IgG4-RD is caused by an autoimmune mechanism that mimics malignant tumors and inflammatory disorders. Apoptosis inhibitor of macrophages (AIM) can function as a biomarker of autoimmune or inflammatory diseases with tissue fibrosis, including in inflammatory bowel disease and chronic liver disease. Therefore, the aim of the present study was to clarify the role of serum AIM levels and the clinical characteristics of patients with IgG4-RD and AIP. For this purpose, serum AIM concentrations were assessed using ELISA and the association between AIM and the laboratory and clinical data from patients with IgG4-RD/AIP, patients with pancreatic cancer (PC) and healthy controls (HCs), was determined. The results demonstrated that the serum AIM concentrations were not associated with the laboratory data. However, the serum AIM levels were significantly elevated in patients with AIP compared with the HCs and patients with PC. Furthermore, the serum AIM levels significantly decreased following steroid therapy in patients with AIP who were in remission. Overall, the present study demonstrates that serum AIM levels may be a potentially useful biomarker for the differential diagnosis of AIP and for evaluating the therapeutic reactivity of affected patients.

DOI： 10.3892/br.2022.1565

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PubMed

Language：Japanese   Publisher：Clinical Journal of Gastroenterology  

A 64-year-old man presented to our hospital with abdominal pain and 4–5 episodes of watery diarrhea per day for 2 months. Abdominal ultrasound examination revealed a mass in the peritoneal cavity, and computed tomography showed a 13.4 cm mass in the mesentery and a 3 cm mass in the mesocolon. The patient underwent laparoscopic partial resection for diagnosis. Microscopically, abundant fibrosis and numerous immunoglobulin (Ig) G4-positive plasma cells were observed. The serum level of IgG4 was 665 mg/dl postoperatively. These findings suggested that the lesion was consistent with IgG4-related sclerosing mesenteritis. Oral steroids resulted in rapid disappearance of symptoms and a decrease in masses. Recently, sclerosing mesenteritis are reported as IgG4-related disease or mimicking IgG4-related disease but multiple lesions rarely occur in the same organ. We report a case of IgG4-related sclerosing mesenteritis with multiple lesions without involvement of other organs, such as the pancreas and salivary glands.

DOI： 10.1007/s12328-021-01451-1

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PubMed

Language：English   Publisher：シュプリンガー・ジャパン(株)  

症例は64歳男性で、2ヵ月前から臍部周辺の腹痛と毎週4～5回の水様便を呈して当院を受診した。身体所見では腹部は軟性で軽度圧痛があり、頻回な腸管運動がみられた。また、臨床検査で軽度貧血、CRPの軽度上昇、可溶性IL-2の増加が認められた。腹部超音波検査にて腹腔内に10cm大の腫瘤が検出され、造影CTでは上腸間膜と横行結腸間膜に軟部組織腫瘤を認め、多発性の小結節が腫瘤周囲に存在していた。このほか、MRI検査にてT1強調像で低信号、脂肪抑制T2強調像で軽度高信号を呈する上腸間膜腫瘤が認められた。なお、造影CTでは他臓器侵襲は確認されず、PET-CTは施行しなかった。腹腔鏡アプローチにて病理診断を行ったところ、術中所見では小腸間膜に腫瘍を認め腹膜腫瘤を形成しており可動性に乏しかった。腫瘍末梢側に多数の黄色結節がみられ、術中迅速病理検査で非定型細胞が検出された。組織診では多量のIgG4陽性形質細胞が中隔に観察され、IgG4関連硬化性腸間膜炎を示唆する所見であった。経口ステロイド療法としてプレドニゾロン0.5mg/kgを開始したところ、下痢と腹部症状は急速に改善し、1ヵ月後には完全消失が得られた。治療開始6ヵ月後、症状の再燃や腫瘤の再増殖は認めていない。

Language：English  

DOI： 10.1055/a-1512-9758

PubMed

Language：Japanese   Publisher：BMJ Open  

Introduction Neoadjuvant chemotherapy or neoadjuvant chemoradiotherapy (NAC/NACRT) for resectable/borderline resectable pancreatic cancers was recently performed to improve clinical outcomes and led to good results, although it remains controversial whether NAC/NACRT is beneficial for resectable pancreatic cancer. A few recent studies revealed longer patency and lower cost related to the stent occlusion of a metal stent than those of a plastic stent during NAC/NACRT. It also remains controversial which type of self-expandable metal stent (SEMS) is the most suitable for patients with resectable/borderline resectable pancreatic cancer during NAC/NACRT: an uncovered SEMS (USEMS), a fully covered SEMS (FCSEMS) or a partially covered SEMS (PCSEMS). So far, two randomised controlled trials indicated that a USEMS and an FCSEMS were similar in preoperative stent dysfunction and adverse event rate. Thus, we aimed to verify the non-inferiority of a PCSEMS to a USEMS in this multicentre randomised controlled trial. Methods and analysis We designed a multicentre randomised controlled trial, for which we will recruit 100 patients with resectable/borderline resectable pancreatic cancer and distal biliary obstruction scheduled for NAC/NACRT from 13 high-volume institutions. Patients will be randomly allocated to the PCSEMS group or USEMS group. The primary outcome measure is the preoperative biliary event rate. Data will be analysed after completion of the study. We will calculate the 95% CIs of the incidence of preoperative biliary events in each group and analyse whether the difference between them is within the non-inferiority margin (10%). Ethics and dissemination This study has been approved by the institutional review board of Hokkaido University Hospital. The results will be submitted for presentation at an international medical conference and published in a peer-reviewed journal. Trial registration number UMIN000041737; jRCT1012200002.

DOI： 10.1136/bmjopen-2020-045698

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PubMed

Language：Japanese   Publisher：Anticancer Research  

Background/Aim: The aim of the study was to evaluate gemcitabine plus nanoparticle albumin-bound paclitaxel (GnP) and FOLFIRINOX for recurrent pancreatic cancer (rPC) after resection. Patients and Methods: Forty-four patients with rPC and 211 with de novo metastatic pancreatic cancer (mPC) who received GnP or FOLFIRINOX as first-line chemotherapy were retrospectively analyzed. Results: On crude analysis, the median overall survival (OS) was significantly longer in the rPC group than in the mPC group (14.0 vs. 10.6 months, respectively; p=0.02). However, the difference was not significant on adjusted analysis using the Cox proportional hazards model (adjusted p=0.90). Patients receiving FOLFIRINOX (n=10) and GnP (n=34) in the rPC group had comparable OS (medians, 12.2 vs. 14.4 months, respectively; p=0.82) even after adjusting for covariates using the Cox model (adjusted p=0.18). Conclusion: The outcomes of patients in the rPC and mPC groups were comparable following chemotherapy. Both FOLFIRINOX and GnP may be reasonable options for treating rPC.

DOI： 10.21873/anticanres.15145

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PubMed

Language：Japanese   Publisher：Japan Biliary Association  

<p>A 66-year-old woman was referred to our department for the examination of a pancreatic cyst. Endoscopic ultrasonography showed a tumor in the bile duct and another duct communicating with the bile duct. Cholangiography revealed the bile ducts forming a circuit, double cystic ducts, and a defect suspected of the bile duct tumor. Communicating accessory bile ducts (CABDs) and a fibrous polyp were diagnosed based on the imaging and pathological findings. After subtotal stomach-preserving pancreaticoduodenectomy, CABDs were histologically confirmed. We report a rare case of CABD with double cystic ducts and a bile duct fibrous polyp.</p>

DOI： 10.11210/tando.35.188

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

症例は66歳女性.腹部超音波検査で膵頭部嚢胞が疑われ当科を受診した.MRCP,EUSで総胆管および近傍に胆管と思われる管腔構造を認めた.造影EUSでは,胆管内に多血性の低エコー腫瘤を認め,胆管腫瘍の合併も疑われた.胆管造影では,胆管内は隔壁様の構造で隔たれ環状構造を形成しており,副交通胆管枝(communicating accessory bile duct:CABD)と診断した.また,胆嚢管は2本に分岐し,それぞれの胆管に合流し,重複胆嚢管類似の胆道走行を認めた.胆管内には輪郭不整な透亮像を認め,腫瘍生検結果は線維性ポリープであった.亜全胃温存膵頭十二指腸切除術が施行され,術後病理標本では,膵上縁より上流のレベルで重複した胆管上皮を認め,CABDに矛盾しない所見であった.CABDと重複胆嚢管類似の複雑な胆道構造および,胆管線維性ポリープを合併した症例を報告する.(著者抄録)

Language：Japanese   Publisher：Clinical and translational gastroenterology  

INTRODUCTION:DEFA1A3 encodes human neutrophil peptides (HNPs) 1-3 and has multiple copy number variations (CNVs). HNPs are associated with innate immunity. Ulcerative colitis (UC), a chronic inflammatory gastrointestinal disorder, is a life-threatening condition, and predictive markers of UC severity are needed. This study investigated the relationship between DEFA1A3 CNV and UC severity.METHODS:This study enrolled 165 patients with UC. The relationship between DEFA1A3 CNV and disease severity was analyzed based on Mayo score, patient characteristics, and treatment methods. In addition, serum and stimulated neutrophil-derived HNP concentrations were also measured in patients with high and low DEFA1A3 CNV.RESULTS:DEFA1A3 CNV was significantly correlated with Mayo score and white blood cell count (R = 0.46, P < 0.0001; R = 0.29, P = 0.003, respectively), and only high copy numbers of DEFA1A3 were independent factors for severe UC (P < 0.001, odds ratio: 1.88, 95% confidence interval, 1.34-2.61). The number of severe UC patients with high DEFA1A3 CNV was significantly greater than those with low CNV. We confirmed the associations between DEFA1A3 and UC severity using a validation cohort. In addition, the HNP concentration in high-copy number patients was significantly higher after neutrophil stimulation than that in low-copy number patients.DISCUSSION:This study demonstrated that there is a correlation between DEFA1A3 copy number and severity in patients with UC. In addition, neutrophils from UC patients with higher DEFA1A3 CNV had high reactivity of secretion of HNPs after stimulation. DEFA1A3 CNV may be a novel severity marker and a potential therapeutic target for UC.

DOI： 10.14309/ctg.0000000000000331

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PubMed

Language：Japanese   Publisher：Pancreatology  

Background: /Objectives: Identifying reliable pretreatment imaging biomarkers for pancreatic neuroendocrine neoplasm (PanNEN) is a key imperative. Extracellular volume (ECV) fraction quantified with equilibrium contrast-enhanced CT can be easily integrated into routine examinations. This study aimed to determine whether ECV fraction with equilibrium contrast-enhanced computed tomography (CECT) could predict long-term outcomes in patients with PanNEN. Methods: This study was a retrospective observational study of 80 patients pathologically diagnosed with PanNEN at a single institution. ECV fraction of the primary lesion was calculated using region-of-interest measurement within PanNEN and the aorta on unenhanced and equilibrium CECT. The impact of clinical factors and tumor ECV fraction on progression-free survival (PFS) and overall survival (OS) was assessed with univariate and multivariate analyses using Cox proportional hazards models. The correlation between WHO classification and tumor ECV fraction was evaluated using Kendall rank correlation coefficients. Results: PFS and OS rates were estimated as 93.4% and 94.6%, 78.7% and 86.2%, 78.7% and 77.0%, and 78.7% and 66.6% at 1, 3, 5, and 10 years, respectively. Multivariate analysis revealed that Union for International Cancer Control (UICC) stage (hazard ratio [HR] = 3.95, P = 0.003), WHO classification (HR = 12.27, P = 0.003), and tumor ECV fraction (HR = 11.93, P = 0.039) were independent predictors of PFS. Patient age (HR = 1.11, P < 0.001), UICC stage (HR = 3.14, P = 0.001), and tumor ECV fraction (HR = 5.27, P = 0.024) were independent significant variables for predicting OS. Tumor ECV fraction had a weak inverse relationship with WHO classification (P = 0.045, τ = −0.178). Conclusions: ECV fraction determined by equilibrium CECT and UICC stage may predict survival in patients with PanNEN.

DOI： 10.1016/j.pan.2021.02.020

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PubMed

Language：Japanese   Publisher：PLoS ONE  

Patients with inactive acetaldehyde dehydrogenase 2 (ALDH2) are at high risk for esophageal squamous cell carcinoma (ESCC) and hypopharyngeal squamous cell carcinoma (HPSCC). The acetaldehyde breath test (ABT) may demonstrate ALDH2 gene polymorphisms. We evaluated the usefulness of the ABT in patients with ESCC and HPSCC. The squamous cell carcinoma (SCC) group consisted of 100 patients who were treated with endoscopic submucosal dissection (ESD) for ESCC or HPSCC, and the control group (HC) consisted of 275 healthy subjects. The SCC group comprised the "single subgroup"(n = 63), in which a single lesion was initially treated with ESD, and the "multiple subgroup"(n = 31), in which multiple lesions were initially treated with ESD. First, we compared the groups' risk factors for carcinogenesis and measured the acetaldehyde-to-ethanol (A/E) ratio. Then we tested the groups' differences in the abovementioned carcinogenic risk factors. We found that the proportion of individuals in the SCC group with inactive ALDH2 (A/E ratio ≥ 23.3) was significantly higher than that in the HC group (p = 0.035), as was the A/E ratio (p < 0.001). Also, the proportion of individuals with inactive ALDH2 in the multiple subgroup was significantly higher than that in single subgroup (p = 0.015), as was the A/E ratio (p = 0.008). In conclusion, ABT may be a potential screening tool for detecting people at risk of ESCC and HPSCC. In addition, it could be a useful tool in detecting patients at risk of multiple or double carcinomas among patients with ESCC and HPSCC.

DOI： 10.1371/journal.pone.0251457

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PubMed

Language：Japanese   Publisher：Journal of Geriatric Oncology  

Objectives: Few studies have investigated factors influencing the efficacy of chemotherapy in older patients with cancer. This study aimed to evaluate the usefulness of G8, geriatric assessment (GA), and factors measured in general clinical practice for evaluating progression-free survival (PFS) of first-line palliative chemotherapy in older patients with advanced gastrointestinal cancer. Materials and methods: This was a prospective observational study of older patients (age ≥70 years) with advanced gastrointestinal cancer. The modified cut-off value of G8 was determined by referring to two or more abnormal GA conditions. The usefulness of baseline GA and G8 (conventional and modified cut-off value) was assessed according to the efficacy (PFS and disease control rate) of the administered first-line palliative chemotherapy. Results: Overall, 93 patients were evaluated between March 2017 and February 2019. A modified G8 cut-off value of ≤12 had a sensitivity and specificity of 68.9% and 46.9%, respectively. PFS was significantly prolonged in the patients with G8 > 12, serum albumin ≥3.5 g/dl, and in whom grade ≥3 adverse events occurred. There was no significant difference in the PFS between monotherapy and combination therapy. GA was not useful for predicting PFS prolongation or the occurrence of serious adverse events in first-line treatment. Conclusion: Among older patients with advanced gastrointestinal cancer who receive first-line chemotherapy, a modified G8 cut-off value of 12 points, occurrence of grade 3 or higher adverse events, albumin levels, rather than age or performance status were predictors of PFS prolongation.

DOI： 10.1016/j.jgo.2021.05.006

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PubMed

Publisher：(一社)日本膵臓学会  

症例は46歳女性.心窩部痛,嘔気を主訴に受診した.膵酵素の上昇を認め,急性膵炎の診断で保存的に加療された.画像所見で膵体尾部実質の不均一な造影効果と尾側膵管の拡張を認め,膵腫瘍が疑われた.EUS-FNAにおける組織診断で確定診断が得られなかったが,膵体部癌の可能性が否定できず,手術治療を行った.切除標本にて特徴的な組織所見を示し,2型自己免疫性膵炎の診断に至った.(著者抄録)

Publisher：Frontiers in Immunology  

DOI： 10.3389/fimmu.2020.02135

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PubMed

DOI： 10.2169/internalmedicine.4336-19

PubMed

Publisher：(一社)日本膵臓学会  

膵原発の悪性リンパ腫は,節外性悪性リンパ腫の2%以下,膵悪性腫瘍の0.5%未満と稀である.画像所見のみでは鑑別が難しく,病理組織学的評価による正確な診断が重要である.今回,膵腫瘤に対し超音波内視鏡下穿刺吸引法(EUS-FNA)でB細胞リンパ腫と診断した3例を経験し,うち2例は化学放射線療法で改善した.EUS-FNAは,リンパ腫の病型診断および治療方針決定に有用と考えられた.(著者抄録)

Publisher：Gastrointestinal Endoscopy  

DOI： 10.1016/j.gie.2019.10.012

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PubMed

Publisher：Japan Pancreas Society  

<p>Three patients with pancreatic lymphoma were seen. Primary pancreatic lymphoma accounts for less than 2% of extranodal malignant lymphomas and less than 0.5% of malignant tumors of the pancreas. In patients with pancreatic lymphoma, an accurate diagnosis is crucial because the tumor is difficult to distinguish from other pancreatic tumors-especially pancreatic cancer-based on imaging findings alone, and because the treatment depends on the specific type of lymphoma. Two of these patients improved after chemoradiation therapy. EUS-FNA was useful for determining the type of lymphoma and determining the treatment strategy.</p>

DOI： 10.2958/suizo.35.213

Publisher：Japan Pancreas Society  

<p>The patient is a 46-year-old woman admitted with epigastric pain and nausea. She was found to have elevated pancreatic enzymes and treated for acute pancreatitis. Imaging findings showed uneven contrast enhancement of the pancreatic body to tail and enlargement of the caudal pancreatic duct. A pancreatic tumor was suspected. Although no definitive histologic diagnosis was obtained using endoscopic ultrasonography-guided fine needle aspiration (EUS-FNA), the possibility of pancreatic body cancer could not be ruled out, and resection was performed. The resected specimen showed characteristic histologic findings, leading to a diagnosis of type 2 autoimmune pancreatitis.</p>

DOI： 10.2958/suizo.35.447

Publisher：Gastroenterology Research and Practice  

DOI： 10.1155/2020/3108690

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Publisher：Molecular Medicine Reports  

DOI： 10.3892/mmr.2020.10925

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PubMed

Language：Japanese   Publisher：Gut  

Objective Stenting is an established endoscopic therapy for malignant gastric outlet obstruction (mGOO). The choice of stent (covered vs uncovered) has been examined in prior randomised studies without clear results. Design In a multicentre randomised prospective study, we compared covered (CSEMS) with uncovered self-expandable metal stents (UCSEMS) in patients with mGOO; main outcomes were stent dysfunction and patient survival, with subgroup analyses of patients with extrinsic and intrinsic tumours. Results Overall survival was poor with no difference between groups (probability at 3 months 49.7% for covered vs 48.4% for uncovered stents; log-rank for overall survival p=0.26). Within that setting of short survival, the proportion of stent dysfunction was significantly higher for uncovered stents (35.2% vs 23.4%, p=0.01) with significantly shorter time to stent dysfunction. This was mainly relevant for patients with extrinsic tumours (stent dysfunction rates for uncovered stents 35.6% vs 17.5%, p<0.01). Subgrouping was also relevant with respect to tumour ingrowth (lower with covered stents for intrinsic tumours; 1.6% vs 27.7%, p<0.01) and stent migration (higher with covered stents for extrinsic tumours: 15.3% vs 2.5%, p<0.01). Conclusions Due to poor patient survival, minor differences between covered and uncovered stents may be less relevant even if statistically significant; however, subgroup analysis would suggest to use covered stents for intrinsic and uncovered stents for extrinsic malignancies.

DOI： 10.1136/gutjnl-2020-320775

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Language：Japanese   Publisher：Digestion  

Background and Aims: Hexanoyl (Hx:C6) group-modified alkaline-treated gelatin porous film (HAG) is a newly developed degradable hydrogel characterized by strong adhesiveness and high affinity for vascular endothelial growth factor (VEGF). The aim of this study was to clarify the effect of HAG sheets on the healing process of post-endoscopic submucosal dissection (ESD) porcine gastric artificial ulcers. Methods: (1) To evaluate the adhesiveness of HAG sheets over time, we performed ESD to create 1 artificial ulcer and covered the lesion with 1 HAG sheet using 1 miniature swine. We observed 2 ulcers by endoscopic and microscopic examinations. (2) To examine the effect of HAG sheets on post-ESD ulcer healing, we performed ESD using 5 miniature swine. The artificial ulcers were covered with HAG sheets, or left uncovered after ESD (day 0), followed by macroscopic and microscopic examinations. On days 7 and 14, we observed 2 ulcers by endoscopic examinations. On day 14, the animals were sacrificed, and histological examination was performed on the 3 stomachs that could be extirpated. Results: (1) On day 7, adhesion of HAG sheets was observed. (2) Gastric ulcer area on day 7 was significantly larger in the covered ulcers than in the non-covered ulcers (p = 0.046). On day 14, although there was no significant difference in ulcer area irrespective of covering (p = 0.357), the covered ulcers tended to repair less fold convergence than non-covered ulcers. The covered ulcer sheets significantly decreased inflammatory cell infiltration (p = 0.011), but significantly increased the abundance of macrophages (p = 0.033), in submucosal layers. Also, the abundance of alpha-smooth muscle actin-positive cells in submucosal layers of the covered ulcers was significantly reduced (p = 0.044), leading to a decrease in collagen accumulation. In addition, fibrosis and atrophy of the muscularis propria were significantly lower for covered ulcers than for non-covered ulcers. Furthermore, microvessels and VEGF-positive cells were significantly more abundant in the submucosal layers of the covered ulcers (p < 0.001 and p = 0.024, respectively). Conclusions: HAG sheets induced post-ESD ulcer healing with less submucosal inflammation and muscularis propria injury and have the potential to decrease excess scarring.

DOI： 10.1159/000509056

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Publisher：Oncology Letters  

DOI： 10.3892/ol.2019.11101

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Publisher：Biochemistry and Biophysics Reports  

DOI： 10.1016/j.bbrep.2019.100691

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PubMed

Publisher：日本胆道学会  

症例は67歳、男性。2011年11月に前医で十二指腸乳頭部腺腫に対して内視鏡的乳頭部切除術を施行された。病理結果は管状腺腫であった。2012年2月に局所再発をきたし内視鏡的に切除されたが、遺残があり外科的乳頭部切除術が施行された。2013年5月にも局所再発に対し内視鏡的焼灼術が施行された。以後は再発なく経過したが、2015年7月に急性膵炎を契機に主膵管内に再発が疑われ、当科紹介となった。EUSで膵頭部主膵管内に腫瘤を認め、ERP下の膵管口周囲・膵管内生検で腺腫を認めたことから、十二指腸乳頭部腺腫の局所再発・主膵管内進展と診断し、亜全胃温存膵頭十二指腸切除術を行った。病理組織では膵頭部主膵管内に腺腫腺管の増殖を認め、乳頭部近傍で十二指腸壁及び膵実質への浸潤を呈する浸潤癌に発展していた。乳頭部腺腫局所切除後に再発を繰り返す例では、早期の膵頭十二指腸切除術を考慮する必要があると考えられる。(著者抄録)

Publisher：Digestive Endoscopy  

DOI： 10.1111/den.13463

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PubMed

Publisher：(一社)日本内科学会  

症例は87歳女性で、アルツハイマー型認知症に罹患していて寝たきりとなっており、介護施設にて全介助状態にあった。発熱と嘔吐出現のため近医に入院し、腸閉塞と診断された。経鼻胃管チューブを留置され保存的に加療されたが症状は改善せず、画像検査にて小腸に腫瘍疑いの陰影が認められたため、当院に転院となった。腹部超音波検査などの所見から腸石、胆石、ベゾアールなどの結石の存在を疑った。腸閉塞解除のため超細径経鼻内視鏡を用いてイレウス管を挿入したが、小腸内に何らかの物質塊が閉塞しており、胃内には少量の毛髪を含む数個の結石を認めた。ベゾアールに起因にした小腸閉塞を疑い手術を勧めたが患者は同意しなかったため、代わりに経イレウス管コーラ溶解療法を施行した。500mLのコカ・コーラ(pH 1.9)を30分かけて注入する処置を1日2回行ったところ、開始翌日には小腸内の物質塊は半減し、6日目には小腸閉塞とイレウスは完全消退して元の病院へ戻った。回収した石で溶解実験を行ったところ、pH 1.9のコカ・コーラ、pH 1.0および2.0の塩酸、pH 2.6の食用酢のいずれにも溶解することが確認された。

DOI： 10.1055/a-0810-0398

PubMed

Publisher：Digestion  

DOI： 10.1159/000491876

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PubMed

Publisher：International Journal of Molecular Medicine  

DOI： 10.3892/ijmm.2018.4040

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PubMed

Publisher：Japan Biliary Association  

<p>A 67-year-old man underwent endoscopic papillectomy for ampullary adenoma. The histological findings revealed a tubular adenoma. Endoscopic re-resection and transduodenal resection were performed because the local recurrence of adenoma. Three years later, the patient developed acute pancreatitis, and recurrence in the pancreatic duct was suspected. EUS revealed a low echoic mass in the pancreatic duct, and the pathological findings revealed an adenoma of biopsies from the orifice and pancreatic duct. We diagnosed the recurrence of ampullary adenoma and intraductal extension, and the patient underwent subtotal stomach-preserving pancreaticoduodenectomy. The pathological findings of the resected specimen revealed growth of adenoma in the main pancreatic duct and adenocarcinoma with invasion into the pancreatic parenchyma and duodenal wall. For cases suspected of repeated recurrence after local resection for ampullary adenoma, early pancreaticoduodenectomy should be considered.</p>

DOI： 10.11210/tando.33.752

Publisher：Gastroenterology Research and Practice  

DOI： 10.1155/2019/5928040

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PubMed

Publisher：一般社団法人 日本内科学会  

<p>An 87-year-old bedridden woman developed intestinal obstruction caused by an enterolith or bezoar. Since the patient refused surgery, we administered 1,000 mL/day of cola via an ileus tube to dissolve the stone. Occlusion of the small intestine disappeared on day 6. The excreted stones contained calcium phosphate, which is typical of enteroliths. We later confirmed that the retrieved stones could be dissolved in cola (Coca-Cola^®, pH 1.9) as well as 0.10 and 0.010 mol/L hydrochloric acid (pH 1.0 and 2.0, respectively) and food-grade vinegar (pH 2.6). These findings suggest that the enteroliths were dissolved by an acid-base reaction. </p>

DOI： 10.2169/internalmedicine.2745-19

Scopus

PubMed

Publisher：Pancreas  

DOI： 10.1097/MPA.0000000000001132

Scopus

PubMed

Publisher：(一社)日本内科学会  

症例は63歳女性で、高熱と心窩部痛が3ヵ月間続いており、上部消化管内視鏡検査で胃十二指腸の浮腫性肥厚が明らかになった。入院時の臨床検査で好酸球増加症と肝胆道系酵素値の上昇などが認められた。十二指腸の超音波内視鏡検査では十二指腸粘膜および筋肉壁が極度に肥厚しており、カプセル内視鏡では空腸の肥厚・浮腫がみられた。画像所見および病理学的所見から混合型の好酸球性胃腸炎と診断した。入院後に黄疸が出現し、腹部CTおよびMRIで総胆管内への十二指腸の陥凹が認められ、この陥凹による胆管閉塞が胆管炎や肝膿瘍の原因であると推測した。十二指腸壁の陥凹は保存療法後に改善したが、十二指腸内腔の狭窄により胆管ドレナージは不可能であった。ステロイドおよび抗アレルギー薬の投与により好酸球性胃腸炎は改善し、再発はみられなかった。

Publisher：(一財)日本消化器病学会  

65歳男性。進行胃癌術後3年目に、嘔吐、体重減少が出現した。各種検査で食道アカラシア様の所見を認めた。(1)壮年層の発症、(2)短い有症状期間、(3)著明な体重減少を三徴とするTucker's criteriaを満たし、二次性アカラシアを疑った。原因として胃癌術後再発を疑い、審査腹腔鏡にて確定診断に至った。二次性アカラシアの診断には、Tucker's criteriaが有用であると考えられた。(著者抄録)

Publisher：The Japanese Society of Gastroenterology  

<p>A 65-year-old man underwent subtotal gastrectomy for advanced gastric cancer. The histological type of the cancer was signet-ring cell carcinoma, and the clinical stage was stage IB (T2N0M0). Three years after surgery, the patient had the following symptoms:dysphagia, odynophagia, and weight loss. Esophageal endoscopy and esophagography revealed a circular stenosis covered with the normal mucosa between the middle esophagus and the esophagogastric junction. Histologically, the samples obtained by staging laparoscopy revealed signet-ring cell carcinoma. Tucker's criteria are an important tool for differentiating secondary achalasia from primary achalasia with clinical value. Therefore, we suggest that staging laparoscopy is useful for the histological diagnosis of recurrent gastric cancer.</p>

DOI： 10.11405/nisshoshi.115.394

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PubMed

Publisher：一般社団法人 日本内科学会  

<p>A 63-year-old woman was admitted with epigastric pain, eosinophilia, and elevated hepatobiliary enzyme levels. An upper gastrointestinal endoscopic examination showed that the mucosa of the gastroduodenal wall was edematous. Eosinophilic gastroenteritis (EGE) was diagnosed based on eosinophilic infiltration of the gastroduodenal mucosa. Computed tomography showed invagination of the duodenal wall into the common bile duct. The invagination of the duodenal wall improved after conservative therapy, while bile duct drainage was impossible due to the narrowing of the duodenal lumen. EGE was successfully treated without recurrence with steroids and antiallergic therapy. We herein report a rare case of EGE with obstructive jaundice. </p>

DOI： 10.2169/internalmedicine.9312-17

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PubMed

Publisher：Medicine (United States)  

DOI： 10.1097/MD.0000000000009507

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PubMed

Publisher：Digestive Endoscopy  

DOI： 10.1111/den.12827

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PubMed

Publisher：John Wiley & Sons Australia, Ltd  

超音波内視鏡下穿刺吸引法(EUS-FNA)で採取した膵腫瘤性病変検体に対するliquid-based cytology(LBC)法とconventional Papanicolaou smear(CPS)法の診断的有効性を比較するため後向き研究を実施した。対象は2009年1月〜2014年8月に当院で腫瘤性病変に対して初回EUS-FNAを施行した患者126例で、このうち63例は2012年5月迄にCPSによる細胞診を施行し、その後63例にLBCによる細胞診を施行した。悪性腫瘍の全発生率は86%であった。LBCはCPSと比較して感度および正診率が高かった。LBCは膵頭部病変の診断において感度が高かった。膵管腺癌(PDAC)の感度もLBCが高かった。多変量解析により、PDAC以外の悪性腫瘍と20mm以下の病変は全参加者においてLBCによる誤診の危険因子であることが明らかになった。以上から、膵腫瘤性病変に対するEUS-FNAにおいてLBCは悪性腫瘍の診断に有用であるが、PDAC以外の悪性腫瘍と小型腫瘍の場合はEUS-FNAとLBCの診断は困難であることが示された。

Publisher：BMC Gastroenterology  

DOI： 10.1186/s12876-017-0591-z

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PubMed

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

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Language：English   Publishing type：Doctoral thesis  

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

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

鹿児島県は高齢化率が高く、離島を含むため、患者背景や交通事情、地域医療施設の診療体制などに応じたマネージメントが必要となる。胆膵疾患は早急な対応が必要であることも多く、各科情報共有しながら症例に応じた精査加療を行っている。病院の性格上、悪性腫瘍の紹介が多く、事前に方針を確認し、切除症例では術前加療と手術、切除不能症例では化学療法を導入している。当院で決定した方針を基に、中核医療施設に経過観察や治療をお願いしていることから地域の内科・外科医との連携も重要になる。胆膵専門医は少数精鋭であるが、膵癌に対する共同研究を行っており、学術的活動にも力を入れている。地方大学で当院関連の医局員、OBが多く院内外で連携を取りやすいという点が、胆膵診療を行ううえで最大の利点である。(著者抄録)

Language：Japanese   Publisher：Endoscopy  

DOI： 10.1055/a-1216-0809

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PubMed

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

Publisher：医学図書出版(株)  

2017年に改訂されたIPMN/MCN国際診療ガイドラインの診療方針選択アルゴリズムにおいて、壁在結節、隔壁肥厚、主膵管径、嚢胞径は重要な悪性化予測因子として位置付けられている。それらを画像で評価するうえで、EUSの果たす役割は大きく、全観察期間において必須のmodalityとなりつつある。壁在結節≧5mmと壁肥厚の所見はIPMNの切除適応を判断する際に幅広く活用されているが、現状においても術後病理結果がlow grade dysplasiaであった症例が少なからず存在するため、悪性化の鑑別についてはさらなる工夫が必要である。近年、IPMN併存膵癌が注目されているが、現行ガイドラインにおける嚢胞サイズに応じた経過観察法はIPMN自体の悪性化に主眼が置かれており、そのため、IPMN併存膵癌を含めたスクリーニング法の構築が今後の課題である。(著者抄録)

Language：Japanese   Publisher：Endoscopy  

DOI： 10.1055/a-1244-9482

Scopus

PubMed

Publisher：John Wiley & Sons Australia, Ltd  

Publisher：Digestive Endoscopy  

DOI： 10.1111/den.13345

Scopus

PubMed

Publisher：John Wiley & Sons Australia, Ltd  

Publisher：(株)東京医学社  

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