Faculty Profiles - HASHIMOTO Shinichi

Papers - HASHIMOTO Shinichi

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Hashimoto S., Taguchi H., Araki N., Yamazato Y., Iwata H., Tabira Y., Shibata R., Kamikihara Y., Toyodome K., Kojima I., Hamada T., Tsuneyoshi K., Nakamura Y., Yano H., Hinokuchi M., Arima S., Tanoue S., Sasaki F., Kanmura S., Ido A. . Dilation Device Use and Concomitant Antegrade Stenting are Associated With Procedure-related Early Adverse Events After Endoscopic Ultrasound-guided Hepaticogastrostomy: A Retrospective Multicenter Study . Den Open6 ( 1 ) e70211 2026.4Reviewed International journal

Authorship：Lead author,　Corresponding author Language：English Publishing type：Research paper (scientific journal) Publisher：Den Open

Objectives: Endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) is useful in cases of endoscopic retrograde cholangiopancreatography failure. However, the procedure has a high incidence of procedure-related early adverse events (PRAEs). This study retrospectively evaluated risk factors for such events post-EUS-HGS. Methods: This multicenter study included 222 patients (120 males and 102 females; median age = 73 years) who underwent initial EUS-HGS. The clinical success rate and PRAE incidence, and risk factors were analyzed. PRAEs were defined as AEs occurring within 2 weeks. Results: The median procedure time was 41 min. Metal or plastic stents were used for EUS-HGS in 107 and 115 patients, respectively. Fistula dilation and concomitant antegrade stenting (AGS) were performed in 166 and 45 patients, respectively. The clinical success rate and PRAE incidence were 85.1% and 22.1%, respectively. Identified PRAEs included acute peritonitis (9.5%), fever (6.8%), abdominal pain (2.3%), and acute pancreatitis (1.4%). Multivariate analysis identified dilation device use (p = 0.01) and AGS (p = 0.03) as PRAE risk factors. AGS in patients who underwent fistula dilation (p = 0.02) and procedure time ≥41 min in those who underwent EUS-HGS with AGS (p = 0.01) were PRAE risk factors. Conclusions: Fistula dilation and AGS are associated with an increased risk of PRAEs post-EUS-HGS. Careful postoperative follow-up for such events is required in patients undergoing fistula dilation for EUS-HGS with AGS and prolonged procedure time.

DOI： 10.1002/deo2.70211

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PubMed

Kojima I, Hashimoto S, Yamazato Y, Shibata R, Kamikihara Y, Toyodome K, Hamada T, Hinokuchi M, Arima S, Tanoue S, Sasaki S, Ejima F, Takumi K, Yoshiura T, Kanmura S. . Hypoattenuation Pattern on Contrast-Enhanced Computed Tomography Predicts Poor Prognosis in Patients with Pancreatic Neuroendocrine Tumors. . Journal of clinical medicine15 2252 2026.3Reviewed

YAMAZATO Yu, HASHIMOTO Shinichi . Atypical pancreatic cystic lesion . Nippon Shokakibyo Gakkai Zasshi122 ( 10 ) 723 - 726 2025.10

Uehara S., Sasaki F., Sahara H., Tanaka A., Hinokuchi M., Maeda H., Arima S., Hashimoto S., Kanmura S., Ido A. . Establishment of a swine model of delayed bleeding after endoscopic procedure . DEN Open5 ( 1 ) e411 2025.4

Language：Japanese Publisher：DEN Open

Objectives: Although delayed bleeding after endoscopic procedures has become a problem, currently, there are no appropriate animal models to validate methods for preventing it. This study aimed to establish an animal model of delayed bleeding after endoscopic procedures of the gastrointestinal tract. Methods: Activated coagulation time (ACT) was measured using blood samples drawn from a catheter inserted into the external jugular vein of swine (n = 7; age, 6 months; mean weight, 13.8 kg) under general anesthesia using the cut-down method. An upper gastrointestinal endoscope was inserted orally, and 12 mucosal defects were created in the stomach by endoscopic mucosal resection using a ligating device. Hemostasis was confirmed at this time point. The heparin group (n = 4) received 50 units/kg of unfractionated heparin via a catheter; after confirming that the ACT was ≥200 s 10 min later, continuous heparin administration (50 units/kg/h) was started. After 24 h, an endoscope was inserted under general anesthesia to evaluate the blood volume in the stomach and the degree of blood adherence at the site of the mucosal defect. Results: Delayed bleeding was observed in three swine (75%) in the heparin-treated group, who had a maximum ACT of >220 s before the start of continuous heparin administration. In the non-treated group (n = 3), no prolonged ACT or delayed bleeding was observed at 24 h. Conclusion: An animal model of delayed bleeding after an endoscopic procedure in the gastrointestinal tract was established using a single dose of heparin and continuous heparin administration after confirming an ACT of 220 s.

DOI： 10.1002/deo2.411

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PubMed

Uehara Shohei, Sasaki Fumisato, Sahara Hisashi, Tanaka Akihito, Hinokuchi Makoto, Maeda Hidehito, Arima Shiho, Hashimoto Shinichi, Kanmura Shuji, Ido Akio . Establishment of a swine model of delayed bleeding after endoscopic procedure(タイトル和訳中) . DEN Open5 ( 1 ) deo2.411 - deo2.411 2025.4

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

消化管内視鏡手技後にみられる遅延性出血のブタモデルの作成を試みた。Cut-down法を用いて、全身麻酔下にブタ7匹(月齢6ヵ月、平均体重13.8kg)の外頸静脈に挿入したカテーテルから採取した血液サンプルを用いて活性化凝固時間(ACT)を測定し、上部消化管内視鏡を経口的に挿管して胃内に12ヶ所の粘膜欠損部を作成、止血処理を施した。ブタ4匹に対して未分画ヘパリン50ユニット/kg/hを投与し、10分後にACTが200s以上に達していることを確認し、さらにヘパリン50ユニット/kg/hを持続静注、24時間後に内視鏡を用いて胃血流量と粘膜欠損部における血液付着度を評価した。ヘパリンを投与されたブタ4匹のうち3匹は10分後にACTが200s以上に達し、それぞれ227s、252s、201sを示しており、内視鏡検査で遅延性出血を認めたのはACTが227sと252sを示した2匹であった。24時間後の内視鏡所見で大型の胃内血栓を認めたのはヘパリン投与群4匹のうち3匹(75%)であり、非投与群3匹には血栓形成やACTの延長はみられなかった。ヘパリンの単回投与とACT 220s以上を確認後のヘパリン持続投与によって、遅延性出血のブタモデルを作成することができた。

HASHIMOTO Shinichi, OHTSUKA Takao, IDO Akio . Clinical practice of the IPMN on the basis of the guideline . Nippon Shokakibyo Gakkai Zasshi122 ( 1 ) 1 - 8 2025.1

Yano Hiroki, Sasaki Fumisato, Maeda Hidehito, Uehara Shohei, Kabayama Masayuki, Fujino Yusuke, Tanaka Akihito, Hinokuchi Makoto, Arima Shiho, Hashimoto Shinichi, Kanmura Shuji, Ito Shima, Nishiguchi Akihiro, Taguchi Tetsushi, Ido Akio . スプレー式、高癒着性疎水化ゼラチン微小粒子の食道粘膜下層剥離術後の食道狭窄に対する影響　豚モデルを用いた実験的研究(Effect of sprayable, highly adhesive hydrophobized gelatin microparticles on esophageal stenosis after endoscopic submucosal dissection: an experimental study in a swine model) . Esophagus22 ( 1 ) 95 - 104 2025.1

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

疎水化微小粒子の食道粘膜下層剥離術後食道狭窄に対する予防的効果について検討することを目的に、ミニブタ(6頭)に対して全周性の食道内視鏡的粘膜下層剥離術を施行した。ブタに疎水化微小粒子スプレーを行った群(スプレー群)とスプレーしなかった群(非スプレー群)に分けた。スプレー群では、疎水化微小粒子を処置当日、および3、7日後に散布した。非スプレー群では同じ日程で内視鏡検査を施行した。食道狭窄率、粘膜下層炎症細胞浸潤、粘膜下層線維化、筋層の肥厚を、粘膜下層剥離術施行後14日目に両群間で比較した。疎水化微小粒子のスプレーは既存の内視鏡的散布器具により容易に施行可能であった。食道狭窄率はスプレー群が非スプレー群と比較して有意に低かった(76.1%対90.6%、P<0.05)。スプレー群では粘膜下層の炎症細胞浸潤(P<0.01)と筋層の肥厚(P<0.01)が抑制された。スプレー式癒着性疎水化微小粒子は、炎症細胞浸潤、粘膜下層線維化、筋層肥厚の抑制により食道ESD後の狭窄率を低下させた。以上より、内視鏡的粘膜下層剥離術後の食道狭窄を予防するために疎水化微小粒子を用いることは、患者の治療成績を向上させる可能性があり、内視鏡処置における臨床応用として有望である。

Maeda H., Sasaki F., Koyoshi N., Uehara S., Sakae T., Tanaka A., Hinokuchi M., Arima S., Hashimoto S., Kanmura S. . Impact of waiting time for treatment on the progression of superficial esophageal squamous cell carcinoma: a single-center retrospective study . Esophagus 2025

Language：Japanese Publisher：Esophagus

Background: We aimed to identify an acceptable waiting period between the diagnosis of superficial esophageal squamous cell carcinoma (SESCC) and endoscopic submucosal dissection (ESD). Methods: This retrospective, single-center study included 423 patients with 514 SESCC lesions. All patients underwent image-enhanced magnifying endoscopy at initial evaluation and on the day of ESD. Following three outcomes were assessed: the diagnostic accuracy of tumor invasion depth on the day of ESD using the Japanese Esophageal Society classification; changes in diagnosis between initial and final evaluations across different waiting intervals; and 5-year survival rates based on intrapapillary capillary loop patterns (B1 vs. B2) and waiting duration. Results: The diagnostic accuracy was 96.6% for B1 vessels (EP/LPM), 59.6% for B2 vessels (MM/SM1), and 84.6% for B3 vessels (SM2 or deeper). Among B1 lesions, 100% remained B1 on the day of ESD across all time groups. For B2 lesions, stability was observed in 100% of cases within one month, 98.2% in one to two months, 92.9% in two to three months, and 100% after three months. Five-year survival rates showed no significant differences among waiting period groups in both B1 and B2 categories. Conclusions: A waiting period of 3 months is acceptable for patients with SESCC classified as B1 vessels, provided the diagnostic accuracy is maintained. Thorough endoscopic evaluation supports safe scheduling flexibility without adversely affecting long-term outcomes.

DOI： 10.1007/s10388-025-01156-1

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PubMed

Saito T., Takenaka M., Kuwatani M., Doi S., Ohyama H., Fujisawa T., Masuda A., Iwashita T., Shiomi H., Hayashi N., Iwata K., Maruta A., Mukai T., Matsubara S., Hamada T., Inoue T., Matsumoto K., Hirose S., Fujimori N., Kashiwabara K., Kamada H., Hashimoto S., Shiratori T., Yamada R., Kogure H., Nakahara K., Ogura T., Kitano M., Yasuda I., Isayama H., Nakai Y., Omoto S., Uemura S., Nakano R., Kawase Y., Takahashi S., Okuno M., Iwasa Y., Yoshida K., Ota S., Tsujimae M., Sakai A., Suda K., Takahara N., Ishigaki K., Hakuta R., Sato T., Kitano R., Kan M., Nagashima H., Iino Y., Takahashi K., Kawakubo K., Sugiura R., Kishi K., Yonemura H., Nozawa S., Nakabayashi R., Daisuke N., Hinokuchi M., Nakaji S., Nose K., Saito K., Nomura S., Fujisawa M., Kuniyoshi N., Okuda A., Ueno S., Miyano A., Nishioka N., Satta Y., Katsukura N., Itonaga M., Ashida R., Tamura T., Shishimoto T., Kawaji Y., Kato H., Sato R., Ueda K., Teramatsu K., Matsumoto K. . WONDER-02: plastic stent vs. lumen-apposing metal stent for endoscopic ultrasound-guided drainage of pancreatic pseudocysts—study protocol for a multicentre randomised non-inferiority trial . Trials25 ( 1 ) 559 2024.12

Language：Japanese Publisher：Trials

Background: Endoscopic ultrasound (EUS)-guided transluminal drainage has become a first-line treatment modality for symptomatic pancreatic pseudocysts. Despite the increasing popularity of lumen-apposing metal stents (LAMSs), plastic stents may resolve non-necrotic fluid collections effectively with lower costs and no LAMS-specific adverse events. To date, there has been a paucity of data on the appropriate stent type in this setting. This trial aims to assess the non-inferiority of plastic stents to a LAMS for the initial EUS-guided drainage of pseudocysts. Methods: The WONDER-02 trial is a multicentre, open-label, non-inferiority, randomised controlled trial, which will enrol pancreatic pseudocyst patients requiring EUS-guided treatment in 26 centres in Japan. This trial plans to enrol 80 patients who will be randomised at a 1:1 ratio to receive either plastic stents or a LAMS (40 patients per arm). In the plastic stent group, EUS-guided drainage will be performed using two 7-Fr double pigtail stents. In the LAMS group, the treatment will be performed in the same way except for LAMS use. The step-up treatment will be performed via endoscopic and/or percutaneous procedures at the trial investigator’s discretion. The primary endpoint is clinical success, which is defined as a decrease in a pseudocyst size to ≤ 2 cm and an improvement in inflammatory indicators (i.e. body temperature, white blood cell count, and serum C-reactive protein). Secondary endpoints include technical success, adverse events including mortality, pseudocyst recurrence, and medical costs. Discussion: The WONDER-02 trial will investigate the efficacy and safety of plastic stents compared to a LAMS in EUS-guided treatment of symptomatic pancreatic pseudocysts with a particular focus on the non-inferior efficacy of plastic stents. The findings will help establish a new treatment algorithm for this population. Trial registration: ClinicalTrials.gov NCT06133023 registered on 9 November 2023. UMIN000052647 registered on 30 October 2023. jRCT1032230444 registered on 7 November 2023.

DOI： 10.1186/s13063-024-08373-6

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PubMed

Yano H, Sasaki F, Maeda H, Uehara S, Kabayama M, Fujino Y, Tanaka A, Hinokuchi M, Arima S, Hashimoto S, Kanmura S, Ito S, Nishiguchi A, Taguchi T, Ido A . Effect of sprayable, highly adhesive hydrophobized gelatin microparticles on esophageal stenosis after endoscopic submucosal dissection: an experimental study in a swine model. . Esophagus : official journal of the Japan Esophageal Society22 ( 1 ) 95 - 104 2024.10

Language：English Publisher：Esophagus

Background: Esophageal mucosal resection for superficial esophageal cancer can lead to postoperative esophageal stricture, with current preventive measures being insufficient. Sprayable wound dressings containing hydrophobized microparticles exhibit strong adhesion. This study aimed to investigate the preventive effects of hydrophobized microparticles on esophageal stenosis following endoscopic submucosal dissection. Methods: Circumferential esophageal endoscopic submucosal dissection was performed on miniature swine (n = 6). Swine were categorized into two groups: those sprayed with hydrophobized microparticles (sprayed group) and those not sprayed (non-sprayed group). Hydrophobized microparticles were sprayed onto the sprayed group on Days 0, 3, and 7 of endoscopic submucosal dissection. The non-sprayed group underwent endoscopy on the same days. Esophageal stricture rate, submucosal inflammatory cell infiltration, submucosal fibrosis, and thickening of the muscular layer were compared between the groups on Day 14 of endoscopic submucosal dissection. Results: Spraying of hydrophobized microparticles was easily performed using an existing endoscopic spraying device. The esophageal stricture rate was significantly lower in the sprayed group than in the non-sprayed group (76.1% versus 90.6%, p < 0.05). The sprayed group showed suppression of inflammatory cell infiltration in the submucosal layer (p < 0.01) and thickening of the muscular layer (p < 0.01). Conclusions: Sprayable tissue-adhesive hydrophobized microparticles reduce the stricture rate after esophageal ESD by inhibiting inflammatory cell infiltration, submucosal fibrosis, and thickening of the muscular layer. The use of hydrophobized microparticles for preventing post-endoscopic submucosal dissection esophageal stenosis offers a promising avenue for clinical applications in endoscopic procedures, potentially improving patient outcomes.

DOI： 10.1007/s10388-024-01090-8

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PubMed

北野雅之, 吉田真誠, 蘆田玲子, 喜多絵美里, 潟沼朗生, 糸井隆夫, 三方林太郎, 西川健一郎, 松林宏行, 高山敬子, 加藤博也, 竹中完, 植木亨, 川嶌洋平, 中井陽介, 橋元慎一, 重川稔, 根引浩子, 津村英隆, 岡部義信, 良沢昭銘, 原田宜幸, 美登路昭, 佐々木民人, 保田宏明, 三浦夏希, 池本哲也, 小澤栄介, 塩路和彦, 山口厚, 奥薗徹, 森山一郎, 久居弘幸, 藤田光一, 後藤拓磨, 白幡名香雄, 岩田恵典, 岡部純弘, 原和生, 橋本裕輔, 桑谷将城, 伊佐山浩通, 藤森尚, 正宗淳, 幡丸景一, 下川敏雄, 岡崎和一, 竹山宜典, 山上裕機, 日本膵臓学会臨床研究推進委員会 . 超音波内視鏡下組織採取後の穿刺経路腫瘍細胞播種に関する全国調査 . Gastroenterological Endoscopy66 ( 3 ) 312 - 326 2024.3

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

【背景・目的】超音波内視鏡下組織採取法(EUS-guided tissue acquisition:EUS-TA)は,膵腫瘍の診断において重要な役割を担っている.本研究では,膵腫瘍のEUS-TA後の穿刺経路腫瘍細胞播種(Needle tract seeding:NTS)の現状を本邦の全国調査から明らかにすることを目的とした.【方法】2010年4月から2018年3月までに実施した原発性膵腫瘍に対するEUS-TA後に外科的切除を受けた患者を調査対象とした.NTSの発生率を求め,浸潤性膵管癌(Pancreatic ductal adenocarcinoma:PDAC)およびその他の腫瘍の患者,PDACの経胃・経十二指腸EUS-TAを受けた患者の間で比較した.さらに,NTS患者の詳細な特徴や予後も評価した.【結果】合計12,109人の患者が,EUS-TA後に原発性膵腫瘍の外科的切除を受けた.NTSの全発生率は0.330%であり,その発生率は他の腫瘍を有する患者よりもPDACを有する患者で有意に高かった(0.409% vs. 0.071%,P=0.004).NTSは,経胃EUS-TAを受けた患者の0.857%で観察されたが,経十二指腸EUS-TAを受けた患者の中では観察されなかった.PDACのNTSを認めた患者のうち,EUS-TAからNTSの発生までの期間の中央値および患者の生存期間の中央値は,それぞれ19.3ヵ月および44.7ヵ月であり,NTSの97.4%が胃壁に発生し,65.8%が切除された.患者生存期間は,NTS切除を行った患者では,NTS切除を行わなかった患者よりも有意に長かった(P=0.037).【結論】NTSは,経十二指腸EUS-TA後では発生せず,経胃EUS-TA後にのみ出現した.慎重な経過観察により,局所的なNTS病変を胃切除術で治療する機会が得られる.(著者抄録)

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

Maeda Hidehito, Sasaki Fumisato, Kabayama Masayuki, Iwaya Hiromichi, Komaki Yuga, Arima Shiho, Tanoue Shiroh, Hashimoto Shinichi, Kanmura Shuji, Miyashita Keiichi, Ohori Junichiro, Yamashita Masaru, Ido Akio . Efficacy of endoscopic ultrasonography in evaluating tumor thickness in patients with superficial pharyngeal carcinoma: A pilot study . Nippon Jibiinkoka Tokeibugeka Gakkai Kaiho(Tokyo)127 ( 1 ) 54 - 56 2024.1

KITANO Masayuki, YOSHIDA Makoto, ASHIDA Reiko, KITA Emiri, KATANUMA Akio, ITOI Takao, MIKATA Rintaro, NISHIKAWA Kenichiro, MATSUBAYASHI Hiroyuki, TAKAYAMA Yukiko, KATO Hironari, TAKENAKA Mamoru, UEKI Toru, KAWASHIMA Yohei, NAKAI Yousuke, HASHIMOTO Shinichi, SHIGEKAWA Minoru, NEBIKI Hiroko, TSUMURA Hidetaka, OKABE Yosinobu, RYOZAWA Shomei, HARADA Yoshiyuki, MITORO Akira, SASAKI Tamito, YASUDA Hiroaki, MIURA Natsuki, IKEMOTO Tetsuya, OZAWA Eisuke, SHIOJI Kazuhiko, YAMAGUCHI Atsushi, OKUZONO Toru, MORIYAMA Ichiro, HISAI Hiroyuki, FUJITA Koichi, GOTO Takuma, SHIRAHATA Nakao, IWATA Yoshinori, OKABE Yoshihiro, HARA Kazuo, HASHIMOTO Yusuke, KUWATANI Masaki, ISAYAMA Hiroyuki, FUJIMORI Nao, MASAMUNE Atsushi, HATAMARU Keiichi, SHIMOKAWA Toshio, OKAZAKI Kazuichi, TAKEYAMA Yoshifumi, YAMAUE Hiroki, Clinical Research Japan Pancreas Society on behalf of the Committee of . NEEDLE TRACT SEEDING AFTER ENDOSCOPIC ULTRASOUND-GUIDED TISSUE ACQUISITION OF PANCREATIC TUMORS: NATIONWIDE SURVEY IN JAPAN . GASTROENTEROLOGICAL ENDOSCOPY66 ( 3 ) 312 - 326 2024

Language：Japanese Publisher：Japan Gastroenterological Endoscopy Society

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： 10.11280/gee.66.312

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CiNii Research

Hashimoto S., Yamauchi T., Hamada T., Kojima I., Hinokuchi M., Tanoue S., Ido A. . A double-guidewire technique for endoscopic ultrasonography-guided pancreatic drainage after pancreaticoduodenectomy . Endoscopy55 ( S 01 ) E270 - E271 2023.12

Sato T., Saito T., Takenaka M., Iwashita T., Shiomi H., Fujisawa T., Hayashi N., Iwata K., Maruta A., Mukai T., Masuda A., Matsubara S., Hamada T., Inoue T., Ohyama H., Kuwatani M., Kamada H., Hashimoto S., Shiratori T., Yamada R., Kogure H., Ogura T., Nakahara K., Doi S., Chinen K., Isayama H., Yasuda I., Nakai Y. . WONDER-01: immediate necrosectomy vs. drainage-oriented step-up approach after endoscopic ultrasound-guided drainage of walled-off necrosis—study protocol for a multicentre randomised controlled trial . Trials24 ( 1 ) 352 2023.12

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

和田竣太郎, 福森光, 梶原涼, 井上和彦, 森内昭博, 櫻井一宏, 野元三治, 橋元慎一, 井戸章雄 . 術後病理検査で淡明細胞型腎細胞癌の膵転移と診断されたが,原発巣が同定できなかった1例 . 日本消化器病学会九州支部例会・日本消化器内視鏡学会九州支部例会プログラム・抄録集122回・116回 150 - 150 2023.11

庄彬亘, 柊元洋紀, 藤田俊浩, 秋元遥, 田平悠二, 宮之前優香, 灰床裕介, 川平真知子, 鮫島洋一, 福田芳生, 徳重浩一, 田中啓仁, 橋元慎一, 井戸章雄 . 閉塞性黄疸を契機に発見された子宮体癌術後・総胆管転移の一例 . 日本消化器病学会九州支部例会・日本消化器内視鏡学会九州支部例会プログラム・抄録集122回・116回 146 - 146 2023.11

Sasaki F., Mawatari S., Oda K., Yano H., Maeda H., Tanaka A., Arima S., Kumagai K., Tanoue S., Hashimoto S., Kanmura S., Ido A. . Usefulness of the aldehyde breath test for predicting metachronous recurrence in patients with esophageal squamous cell carcinoma and hypopharyngeal squamous cell carcinoma . Esophagus20 ( 4 ) 749 - 756 2023.10

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

Scopus

PubMed

Sasaki Fumisato, Mawatari Seiichi, Oda Kohei, Yano Hiroki, Maeda Hidehito, Tanaka Akihito, Arima Shiho, Kumagai Kotaro, Tanoue Shiroh, Hashimoto Shinichi, Kanmura Shuji, Ido Akio . 食道扁平上皮癌および下咽頭扁平上皮癌の患者における異時性再発の予測に対するアルデヒド呼気試験の有用性(Usefulness of the aldehyde breath test for predicting metachronous recurrence in patients with esophageal squamous cell carcinoma and hypopharyngeal squamous cell carcinoma) . Esophagus20 ( 4 ) 749 - 756 2023.10

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。

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