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KONO Masashi

    Department of Medicine　Lecturer in Medical School
Last Updated :2024/04/26

Researcher Information

J-Global ID

Research Areas

  • Life sciences / Gastroenterology

Published Papers

  • Yoriaki Komeda; George Tribonias; Masashi Kono; Kohei Handa; Shunsuke Omoto; Mamoru Takenaka; Satoru Hagiwara; Naoko Tsuji; Naoshi Nishida; Hiroshi Kashida; Masatoshi Kudo
    Inflammatory Intestinal Diseases S. Karger AG 2296-9403 2023/10 
    Introduction: Ustekinumab is an IgG1 kappa monoclonal antibody directed against the common p40 subunit of interleukin-12 and interleukin-23, which activate Th1- and Th17-mediated immune responses, respectively. It has proven efficacy for the treatment of moderate to severe ulcerative colitis (UC) in the UNIFI Phase III clinical trial; however, data on its efficacy in the real world is limited. In this study, we aimed to assess the real-world efficacy of ustekinumab.Methods: This observational study included 30 patients with UC who received ustekinumab from April 2020 to April 2022. We examined demographic information, disease type and activity (Mayo score, partial Mayo score [PMS]), use of biologics, concomitant use of predonisolone (PSL), 8-week ustekinumab clinical response rate, remission induction rate, 44- and 152-week remission maintenance rate, continuation rate, and 44-week steroid-free remission rate. The primary outcomes were the short- and long-term efficacy of ustekinumab.Results: Included patients (53% women; mean age: 41.2 years [16–80 years]) had an average disease duration of 86 weeks. Mayo’s score (median) was 7.4 and the PMS was 5.4. Two (7%), 24 (80%), and four (13%) patients had a Mayo endoscopic sub-score (MES) of MES1, MES2, and MES3, respectively. The median serum CRP was 1.0 mg/dL. Five patients had no history of biotherapy (naive), while 8 and 17 had a history of one and two or more biologic agents, respectively. Eight patients were PSL-resistant and 22 were PSL-dependent. The 8-week clinical response rate was 73%, and the clinical remission induction rate was 70%. The remission maintenance rates at 44 and 152 weeks were 67% and 63%, respectively. The ustekinumab retention rate was 67% (86-week mean follow-up period). Regarding biologic failure cases, the clinical response rate in the failure group with up to one biologic agent (including naive cases) was 84.6%, which was higher than the 58.0% rate in the failure group with two or more biologic agents (p=0.06). Steroid-free remission rates at 44 and 152 weeks were 63% each. In the logistic regression analysis parameters for discontinuation of ustekinumab, only PMS remained significant after multivariate analysis (p=0.018).Conclusion: Our study showed short-term and long-term ustekinumab effectiveness, especially with comparative low disease activity.
  • 新型コロナワクチン接種後にIgA血管炎を発症し、コロナ感染を契機に再燃を繰り返した1例
    勝部 滉平; 永井 知行; 駒谷 真; 有山 武尊; 栗本 真之; 岡井 夏輝; 吉田 早希; 半田 康平; 正木 翔; 河野 匡志; 米田 頼晃; 本庶 元; 松井 繁長; 渡邉 智裕; 辻 直子; 樫田 博史; 工藤 正俊
    日本消化器病学会近畿支部例会プログラム・抄録集 日本消化器病学会-近畿支部 119回 91 - 91 2023/09
  • Masashi Kono; Yoriaki Komeda; George Tribonias; Saki Yoshida; Kenji Nomura; Kohei Handa; Tomoyuki Nagai; Satoru Hagiwara; Shunsuke Omoto; Mamoru Takenaka; Naoshi Nishida; Naoko Tsuji; Hiroshi Kashida; Masatoshi Kudo
    JGH Open Wiley 2397-9070 2023/08 
    Abstract Background and Aim Serum leucine‐rich alpha‐2 glycoprotein level has been reported to be a useful biomarker in assessing mucosal healing in patients undergoing biotherapy, where mucosal lesions caused by ulcerative colitis are difficult to assess endoscopically. However, no such reports have been reported in biotherapy‐naïve cases. Methods Sixty‐eight patients with ulcerative colitis (UC) who were biotherapy‐naïve at Kindai University Hospital between October 2021 and October 2022 were enrolled. We prospectively examined the correlation between leucine‐rich alpha‐2 glycoprotein (LRG), C‐reactive protein (CRP), erythrocyte sedimentation rate (ESR), and Geboes scores with clinical endoscopic activity using the Mayo endoscopic subscore (MES). Results Mucosal healing was achieved in 39 (57%) patients. Univariate analysis revealed that the factors associated with mucosal healing were LRG (P = 0.0024), CRP (P = 0.1078), ESR (P = 0.0372), and Geboes scores (P = 0.0075). Logistic regression analysis identified LRG and Geboes scores as independent factors associated with mucosal healing assessed using MES (P = 0.0431 for LRG and P = 0.0166 for Geboes scores). Conclusion LRG was found to be the easiest marker to monitor disease activity and mucosal inflammation in UC patients with biotherapy‐naïve cases, with a performance equivalent to that of Geboes scores.
  • 吉田 早希; 米田 頼晃; 杉森 啓伸; 大丸 直哉; 松原 卓哉; 吉川 馨介; 野村 健司; 半田 康平; 正木 翔; 河野 匡志; 永井 知行; 本庶 元; 松井 繁長; 辻 直子; 樫田 博史; 工藤 正俊
    日本消化器病学会雑誌 (一財)日本消化器病学会 120 (臨増総会) A357 - A357 0446-6586 2023/03
  • Yasuo Otsuka; Yoriaki Komeda; Masayuki Takeda; Takayuki Takahama; Masashi Kono; Mamoru Takenaka; Satoru Hagiwara; Naoshi Nishida; Hiroshi Kashida; Masatoshi Kudo
    Case Reports in Medicine Hindawi Limited 2023 1 - 4 1687-9627 2023/02 
    A 76-year-old woman presented with lower abdominal pain and nausea and was referred to the gastroenterology department in our institution. Previous contrast-enhanced computed tomography (CE-CT) for follow-up after breast cancer surgery had indicated a soft tissue mass below the right diaphragm, which was considered a benign change. CE-CT performed at the first visit to our department revealed further thickening of the soft tissue mass with extension to the liver surface. In addition, ascites and nodules were observed in the abdominal cavity. Histopathological examination of a biopsy specimen revealed peritoneal invasion of atypical epithelioid cells with trabecular and glandular patterns. The tumor cells were positive for AE1/AE2, calretinin, WT-1, D2-40, HEG1, EMA, BAP1, and MTAP and negative for carcinoembryonic antigen, MOC-31, Ber-Ep4, ER, PgR, TTF-1, claudin 4, and desmin. A diagnosis of epithelioid mesothelioma was made. The patient received chemotherapy with cisplatin (75 mg/m2) and pemetrexed (500 mg/m2). After six courses of combined chemotherapy, pemetrexed was administered as a single agent. At the time of writing this report, she was undergoing over the 30th course of chemotherapy without any significant side effects. Diffuse malignant peritoneal mesothelioma is a rare, fatal, and progressive disease. Our patient achieved long-term survival of more than 5 years with maintenance therapy using single-agent pemetrexed.
  • Yoriaki Komeda; Hideki Ishikawa; Teruhiko Yoshida; Mineko Ushiama; Saki Yoshida; Kenji Nomura; Masashi Kono; Shunsuke Omoto; Mamoru Takenaka; Satoru Hagiwara; Hiroshi Kashida; Masatoshi Kudo
    Internal Medicine Japanese Society of Internal Medicine 0918-2918 2023
  • Yoriaki Komeda; Masashi Kono; Hiroshi Kashida; George Tribonias; Sho Masaki; Ryutaro Takada; Tomoyuki Nagai; Satoru Hagiwara; Naoshi Nishida; Mamoru Takenaka; Hajime Honjo; Shigenaga Matsui; Naoko Tsuji; Masatoshi Kudo
    Annals of gastroenterology 36 (1) 97 - 102 2023 
    BACKGROUND: The standard therapy for acute severe ulcerative colitis (ASUC) is intravenous corticosteroids; however, 30% of ulcerative colitis (UC) patients do not recover with corticosteroids alone. Few studies have reported the efficacy and safety of tofacitinib for ASUC with steroid resistance. We report a case series of successful first-line treatment consisting of tofacitinib (20 mg/day) administered to ASUC patients with steroid resistance. METHODS: Patients diagnosed with ASUC at our institution between October 2018 and February 2020 were retrospectively evaluated. They were administered a high dose of tofacitinib (20 mg) after showing no response to steroid therapy in a dose of 1-1.5 mg/kg/day. RESULTS: Eight patients with ASUC, 4 (50%) men, median age 47.1 (range 19-65) years, were included. Four patients were newly diagnosed, and the median UC duration was 4 (range 0-20) years. Six of the 8 patients were able to avoid colectomy. One patient (patient 2) had no response; however, remission was achieved after switching from tofacitinib to infliximab. One patient (patient 6) with no response to tofacitinib underwent total colectomy. Only one patient (patient 4) experienced an adverse event, local herpes zoster, treated with acyclovir without tofacitinib discontinuation. CONCLUSIONS: Clinical remission without serious adverse events can be achieved with high probability and colectomy can be avoided by first administering high-dose tofacitinib to steroid-resistant ASUC patients. Tofacitinib may be one of the first-line treatment options for steroid-resistant ASUC.
  • 非代償性肝硬変による直腸静脈瘤出血に対して内視鏡的組織接着剤注入術を施行した1例
    加藤 弘樹; 松井 繁長; 田北 雅弘; 上中 大地; 今村 瑞貴; 原 茜; 野村 健司; 瀬海 郁衣; 高田 隆太郎; 河野 匡志; 正木 翔; 永井 知行; 本庶 元; 米田 頼晃; 上嶋 一臣; 渡邉 智裕; 西田 直生志; 辻 直子; 樫田 博史; 工藤 正俊
    日本消化器内視鏡学会近畿支部例会プログラム・抄録集 日本消化器内視鏡学会-近畿支部 108回 89 - 89 2022/06
  • 安全に内視鏡治療できた小腸pyogenic granuloma(化膿性肉芽腫)の一例
    有山 武尊; 米田 頼晃; 加藤 弘樹; 瀬海 郁衣; 原 茜; 野村 健司; 高田 隆太郎; 正木 翔; 河野 匡志; 永井 知行; 本庶 元; 松井 繁長; 辻 直子; 樫田 博史; 工藤 正俊
    日本消化器内視鏡学会近畿支部例会プログラム・抄録集 日本消化器内視鏡学会-近畿支部 108回 82 - 82 2022/06
  • 非代償性肝硬変による直腸静脈瘤出血に対して内視鏡的組織接着剤注入術を施行した1例
    加藤 弘樹; 松井 繁長; 田北 雅弘; 上中 大地; 今村 瑞貴; 原 茜; 野村 健司; 瀬海 郁衣; 高田 隆太郎; 河野 匡志; 正木 翔; 永井 知行; 本庶 元; 米田 頼晃; 上嶋 一臣; 渡邉 智裕; 西田 直生志; 辻 直子; 樫田 博史; 工藤 正俊
    日本消化器内視鏡学会近畿支部例会プログラム・抄録集 日本消化器内視鏡学会-近畿支部 108回 89 - 89 2022/06
  • 潰瘍性大腸炎関連腫瘍の臨床学的特徴と内視鏡治療時の取り組み
    米田 頼晃; 樫田 博史; 工藤 正俊; 高田 隆太郎; 正木 翔; 河野 匡志; 永井 知行; 本庶 元; 松井 繁長; 辻 直子
    Gastroenterological Endoscopy (一社)日本消化器内視鏡学会 64 (Suppl.1) 828 - 828 0387-1207 2022/04
  • 腸内細菌に対する炎症性サイトカイン応答の増強を示すクローン病関連脊椎関節炎の一例
    福西 香栄; 本庶 元; 岡井 夏輝; 河野 匡志; 鎌田 研; 三長 孝輔; 米田 頼晃; 辻 成佳; 渡邉 智裕; 工藤 正俊
    日本消化器病学会近畿支部例会プログラム・抄録集 日本消化器病学会-近畿支部 116回 108 - 108 2022/02
  • 制御性T細胞に依存性しない寛解導入が得られたCollagenous Colitisの一例
    瀬海 郁衣; 本庶 元; 今村 瑞貴; 松原 卓哉; 河野 匡志; 原 茜; 栗本 真之; 吉川 馨介; 益田 康弘; 大塚 康生; 高田 隆太郎; 吉川 智恵; 鎌田 研; 三長 孝輔; 松井 繁長; 木村 雅友; 渡邉 智裕; 工藤 正俊
    日本消化器病学会近畿支部例会プログラム・抄録集 日本消化器病学会-近畿支部 116回 117 - 117 2022/02
  • 腸内細菌に対する炎症性サイトカイン応答の増強を示すクローン病関連脊椎関節炎の一例
    福西 香栄; 本庶 元; 岡井 夏輝; 河野 匡志; 鎌田 研; 三長 孝輔; 米田 頼晃; 辻 成佳; 渡邉 智裕; 工藤 正俊
    日本消化器病学会近畿支部例会プログラム・抄録集 日本消化器病学会-近畿支部 116回 108 - 108 2022/02
  • 制御性T細胞に依存性しない寛解導入が得られたCollagenous Colitisの一例
    瀬海 郁衣; 本庶 元; 今村 瑞貴; 松原 卓哉; 河野 匡志; 原 茜; 栗本 真之; 吉川 馨介; 益田 康弘; 大塚 康生; 高田 隆太郎; 吉川 智恵; 鎌田 研; 三長 孝輔; 松井 繁長; 木村 雅友; 渡邉 智裕; 工藤 正俊
    日本消化器病学会近畿支部例会プログラム・抄録集 日本消化器病学会-近畿支部 116回 117 - 117 2022/02
  • 診断に難渋した小腸GISTの一例
    福西 香栄; 永井 知行; 杉森 啓伸; 岡井 夏輝; 高田 隆太郎; 河野 匡志; 正木 翔; 米田 頼晃; 本庶 元; 松井 繁長; 渡邉 智裕; 辻 直子; 樫田 博史; 工藤 正俊
    日本消化器内視鏡学会近畿支部例会プログラム・抄録集 日本消化器内視鏡学会-近畿支部 107回 127 - 127 2021/12
  • EUS-FNAにて術前診断できた食道schwannomaの1例
    福西 香栄; 松井 繁長; 杉森 啓伸; 高田 隆太郎; 正木 翔; 河野 匡志; 永井 知行; 米田 頼晃; 山崎 友裕; 山雄 健太郎; 竹中 完; 本庶 元; 渡邉 智裕; 辻 直子; 樫田 博史; 工藤 正俊; 白石 治; 安田 卓司
    日本消化器病学会近畿支部例会プログラム・抄録集 日本消化器病学会-近畿支部 115回 79 - 79 2021/09
  • 内視鏡で保存的に回収できた胃石の1例
    杉森 啓伸; 本庶 元; 原 茜; 益田 康弘; 吉田 早希; 高田 隆太郎; 河野 匡志; 正木 翔; 永井 知行; 米田 頼晃; 櫻井 俊治; 松井 繁長; 渡邉 智裕; 辻 直子; 樫田 博史; 工藤 正俊
    日本消化器内視鏡学会近畿支部例会プログラム・抄録集 日本消化器内視鏡学会-近畿支部 106回 98 - 98 2021/07
  • カプセルおよびバルーン小腸内視鏡で比較的早期に発見し根治手術を行った原発性小腸癌の1例
    吉田 早希; 米田 頼晃; 原 茜; 益田 康弘; 高田 隆太郎; 正木 翔; 河野 匡志; 永井 知行; 本庶 元; 松井 繁長; 櫻井 俊治; 辻 直子; 樫田 博史; 工藤 正俊
    日本消化器内視鏡学会近畿支部例会プログラム・抄録集 日本消化器内視鏡学会-近畿支部 106回 100 - 100 2021/07
  • 内視鏡で保存的に回収できた胃石の1例
    杉森 啓伸; 本庶 元; 原 茜; 益田 康弘; 吉田 早希; 高田 隆太郎; 河野 匡志; 正木 翔; 永井 知行; 米田 頼晃; 櫻井 俊治; 松井 繁長; 渡邉 智裕; 辻 直子; 樫田 博史; 工藤 正俊
    日本消化器内視鏡学会近畿支部例会プログラム・抄録集 日本消化器内視鏡学会-近畿支部 106回 98 - 98 2021/07
  • カプセルおよびバルーン小腸内視鏡で比較的早期に発見し根治手術を行った原発性小腸癌の1例
    吉田 早希; 米田 頼晃; 原 茜; 益田 康弘; 高田 隆太郎; 正木 翔; 河野 匡志; 永井 知行; 本庶 元; 松井 繁長; 櫻井 俊治; 辻 直子; 樫田 博史; 工藤 正俊
    日本消化器内視鏡学会近畿支部例会プログラム・抄録集 日本消化器内視鏡学会-近畿支部 106回 100 - 100 2021/07
  • Hajime Honjo; Tomohiro Watanabe; Natsuki Okai; Masashi Kono; Ken Kamata; Kosuke Minaga; Yoriaki Komeda; Shigeyoshi Tsuji; Masatoshi Kudo
    Asian Pacific journal of allergy and immunology 2021/04 
    BACKGROUND: Despite the high incidence of spondyloarthritis (SpA) as an extra-intestinal manifestation of Crohn's disease (CD), the immunopathogenesis of CD-associated SpA remains largely unknown. OBJECTIVE: We tried to explore molecular mechanisms accounting for the development of CD-associated SpA in a patient successfully treated with infliximab. METHODS: Peripheral blood mononuclear cells (PBMCs) before infliximab treatment were stimulated with Toll-like receptor (TLR) ligands to measure pro-inflammatory cytokine responses. Endoscopic biopsy samples before and after infliximab treatment were subjected to quantitative polymerase chain reaction. RESULTS: PBMCs from this CD-associated SpA patient exhibited higher production of pro-inflammatory cytokines upon stimulation with TLR ligands than PBMCs from healthy controls. Induction of remission by infliximab was associated with the downregulation of pro-inflammatory cytokine responses in the small intestinal mucosa, which is continually exposed to TLR ligands. CONCLUSIONS: Excessive pro-inflammatory cytokine responses to TLR ligands might underlie the immunopathogenesis of CD-associated SpA.
  • Hajime Honjo; Tomohiro Watanabe; Mizuki Tomooka; Takuya Matsubara; Masashi Kono; Ikue Sekai; Akane Hara; Masayuki Kurimoto; Keisuke Yoshikawa; Yasuhiro Masuta; Yasuo Otsuka; Ryutaro Takada; Tomoe Yoshikawa; Ken Kamata; Kosuke Minaga; Shigenaga Matsui; Masatomo Kimura; Masatoshi Kudo
    Frontiers in medicine 8 678268 - 678268 2021 
    Collagenous colitis (CC), a prototypical microscopic colitis, is a chronic inflammatory disorder of the colon. The diagnosis of CC depends on the pathological examination. The colonic mucosa of patients with CC is characterized by the presence of a substantially thickened collagen band (>10μm) under the surface epithelium. In addition, intraepithelial and lamina propria lymphocytes are markedly increased in patients with CC. However, the roles played by the lymphocytes accumulating in the colonic mucosa of patients with CC are poorly defined. Recent studies indicate that T cells infiltrating the colonic mucosa of patients with CC are mainly represented by CD4+ T cells, CD8+ T cells, and forkhead box P3 (FOXP3)+ regulatory T cells (Tregs). Given that activation of CD4+/CD8+ T cells and FOXP3+ Tregs usually mediates pro-inflammatory and anti-inflammatory responses, respectively, alterations in the colonic numbers of these adaptive T cells might be related to the resolution of colitis in patients with CC. We determined alterations in the composition of colonic T cells by extensive immunohistochemical (IHC) analyses in a case of CC successfully treated with budesonide and metronidazole. Colonic lamina propria immune cells mainly comprised CD3+ T cells, CD4+ T cells, CD8+ T cells, CD68+ macrophages, and FOXP3+ Tregs, but not CD20+ B cells or myeloperoxidase (MPO)+ granulocytes in the active phase. During remission, the numbers of CD3+ T cells, CD4+ T cells, CD8+ T cells, and CD68+ macrophages did not change significantly in the colonic lamina propria, whereas FOXP3+ Tregs were markedly decreased, suggesting that induction of remission was achieved in a Treg-independent manner. Thus, our study indicates that accumulation of FOXP3+ Tregs in the colonic mucosa of patients with CC might be a counter-regulatory mechanism reflecting persistent inflammation and that induction of remission might be achieved without activation of Tregs.
  • 食道平滑筋腫上に発生した表在癌に対して内視鏡的粘膜下層剥離術を施行した1例
    吉田 早希; 松井 繁長; 友岡 瑞貴; 益田 康弘; 高田 隆太郎; 高島 耕太; 河野 匡志; 正木 翔; 永井 知行; 米田 頼晃; 櫻井 俊治; 本庶 元; 辻 直子; 樫田 博史; 工藤 正俊
    日本消化器内視鏡学会近畿支部例会プログラム・抄録集 日本消化器内視鏡学会-近畿支部 105回 66 - 66 2020/12
  • 拡大観察から見たPPI関連胃底腺ポリープの特徴
    友岡 瑞貴; 辻 直子; 高島 耕太; 正木 翔; 河野 匡志; 永井 知之; 米田 頼晃; 本庶 元; 櫻井 俊治; 松井 繁長; 渡邉 智裕; 樫田 博史; 工藤 正俊
    Gastroenterological Endoscopy (一社)日本消化器内視鏡学会 62 (Suppl.2) 2088 - 2088 0387-1207 2020/10
  • 小腸内視鏡診療ガイドラインでのカプセル内視鏡検査の運用の実際
    米田 頼晃; 樫田 博史; 櫻井 俊治; 松村 まり子; 高島 耕太; 正木 翔; 河野 匡志; 山田 光成; 本庶 元; 永井 知行; 松井 繁長; 辻 直子; 渡邉 智裕; 工藤 正俊
    Gastroenterological Endoscopy (一社)日本消化器内視鏡学会 62 (Suppl.2) 2113 - 2113 0387-1207 2020/10
  • 早期胃胎児消化管上皮類似癌の1例
    岡井 夏輝; 松井 繁長; 正木 翔; 栗本 真之; 大丸 直哉; 友岡 瑞貴; 益田 康弘; 高田 隆太郎; 高島 耕太; 河野 匡志; 永井 知行; 米田 頼晃; 本庶 元; 櫻井 俊治; 辻 直子; 樫田 博史; 工藤 正俊
    日本消化器病学会近畿支部例会プログラム・抄録集 日本消化器病学会-近畿支部 113回 94 - 94 2020/10
  • 直腸NENに対する治療の適応と工夫 当院での直腸NENの治療成績からみた治療方法の検討
    永井 知行; 樫田 博史; 益田 康弘; 友岡 瑞貴; 高島 耕太; 高田 隆太郎; 正木 翔; 河野 匡志; 米田 頼晃; 本庶 元; 櫻井 俊治; 松井 繁長; 渡邉 智裕; 辻 直子; 工藤 正俊
    日本大腸肛門病学会雑誌 (一社)日本大腸肛門病学会 73 (9) A70 - A70 0047-1801 2020/09
  • Masashi Kono; Toshiharu Sakurai; Kazuki Okamoto; Tomoyuki Nagai; Yoriaki Komeda; Hiroshi Kashida; Kosuke Minaga; Ken Kamata; Mamoru Takenaka; Satoru Hagiwara; Tomohiro Watanabe; Naoshi Nishida; Eisuke Enoki; Hiroaki Inoue; Itaru Matsumura; Masatoshi Kudo
    Internal medicine (Tokyo, Japan) 58 (14) 2029 - 2033 0918-2918 2019/07 [Refereed]
     
    Autoimmune diseases including inflammatory bowel disease (IBD) occur in association with myelodysplastic syndrome (MDS). MDS-associated IBD frequently demonstrates a complicated course. We herein report the first case with MDS-associated IBD that was successfully treated with ustekinumab (UST), an anti-interleukin (IL) 12/23p40 monoclonal antibody. A 63-year-old man with a 7-year history of MDS was referred for examination of diarrhea, abdominal pain and fever. A blood examination revealed a marked elevation of C-reactive protein. Colonoscopy showed multiple ulcers in the terminal ileum. He was resistant to anti-tumor necrosis factor (TNF)-α antibody and azacitidine. Subsequently, UST treatment reduced colonic IL-17 and IL-6 expression and the patient currently maintains a state of remission.
  • Masashi Kono; Toshiharu Sakurai; Kazuki Okamoto; Shou Masaki; Tomoyuki Nagai; Yoriaki Komeda; Ken Kamata; Kosuke Minaga; Kentarou Yamao; Mamoru Takenaka; Tomohiro Watanabe; Naoshi Nishida; Masatoshi Kudo
    Internal medicine (Tokyo, Japan) Japanese Society of Internal Medicine 58 (9) 1263 - 1266 0918-2918 2019/05 [Refereed]
     
    Immunotherapy targeting programmed cell death-1 (PD-1) signaling is becoming the standard of care for advanced gastric cancer. We herein report a patient with gastric adenocarcinoma with peritoneal dissemination who was treated with nab-paclitaxel and ramucirumab following nivolumab and developed sclerosing cholangitis. Endoscopic retrograde cholangiography showed irregular narrowing and widening of the entire intrahepatic biliary system. Intriguingly, the patient receiving second-line chemotherapy with nab-paclitaxel plus ramucirumab prior to being administered nivolumab, however, he had experienced progressive disease. Thereafter, the administration of fourth-line chemotherapy with nab-paclitaxel and ramucirumab following nivolumab resulted in a clinical response. Nivolumab may enhance the efficacy of the subsequent chemotherapy regimens but also induce sclerosing cholangitis.
  • Yoriaki Komeda; Tomohiro Watanabe; Toshiharu Sakurai; Masashi Kono; Kazuki Okamoto; Tomoyuki Nagai; Mamoru Takenaka; Satoru Hagiwara; Shigenaga Matsui; Naoshi Nishida; Naoko Tsuji; Hiroshi Kashida; Masatoshi Kudo
    World journal of gastroenterology Baishideng Publishing Group Inc. 25 (12) 1502 - 1512 1007-9327 2019/03 [Refereed]
     
    BACKGROUND: Risk factors for local recurrence after polypectomy, endoscopic mucosal resection (EMR), and endoscopic submucosal dissection (ESD) have not been identified. Additionally, the appropriate interval for endoscopic surveillance of colorectal tumors at high-risk of local recurrence has not been established. AIM: To clarify the clinicopathological characteristics of recurrent lesions after endoscopic colorectal tumor resection and determine the appropriate interval. METHODS: Three hundred and sixty patients (1412 colorectal tumors) who underwent polypectomy, EMR, or ESD and received endoscopic surveillance subsequently for more than one year to detect local recurrence were enrolled in this study. The clinicopathological factors associated with local recurrence were determined via univariate and multivariate analyses. RESULTS: Local recurrence was observed in 31 of 360 (8.6%) patients [31 of 1412 (2.2%) lesions] after colorectal tumor resection. Piecemeal resection, tumor size of more than 2 cm, and the presence of villous components were associated with colorectal tumor recurrence after endoscopic resection. Of these three factors, the piecemeal resection procedure was identified as an independent risk factor for recurrence. Colorectal tumors resected into more than five pieces were associated with a high risk of recurrence since the average period from resection to recurrence in these cases was approximately 3 mo. The period to recurrence in cases resected into more than 5 pieces was much shorter than that in those resected into less than 4 pieces (3.8 ± 1.9 mo vs 7.9 ± 5.0 mo, P < 0.05). CONCLUSION: Local recurrence of endoscopically treated colorectal tumors depends upon the outcome of first endoscopic procedure. Piecemeal resection was the only significant risk factor associated with local recurrence after endoscopic resection.
  • Masashi Kono; Yoriaki Komeda; Toshiharu Sakurai; Ayana Okamoto; Kosuke Minaga; Ken Kamata; Satoru Hagiwara; Hiroaki Inoue; Eisuke Enoki; Itaru Matsumura; Tomohiro Watanabe; Masatoshi Kudo
    Journal of Crohn's & colitis Oxford University Press (OUP) 12 (4) 499 - 502 1873-9946 2018/03 [Refereed]
     
    Myelodysplastic syndrome [MDS] is a clonal disorder of bone marrow [BM] cells, caused by acquired chromosomal abnormalities and gene mutations. Pro-inflammatory antigen-presenting cells [APCs] originating from BM cells bearing chromosomal abnormalities and gene mutations can cause immune-mediated disorders including inflammatory bowel disease [IBD]. Here, we report the first case with MDS-associated IBD that was successfully treated with the DNA methyltransferase inhibitor, azacitidine [AZA]. A 75-year-old man with a 5-year history of MDS was admitted for examination of diarrhoea and high fever. Blood examination revealed pancytopenia and a marked elevation of C-reactive protein. Colonoscopy revealed multiple round ulcers from the terminal ileum to the sigmoid colon. Pathological examination of the endoscopic biopsy specimens showed destruction of crypt architecture and infiltration of CD3+ T cells and CD68+ macrophages. Surprisingly, administration of AZA, which has been approved for the treatment of high-risk MDS, improved the symptoms, and the multiple round ulcers disappeared. AZA treatment markedly decreased the expressions of tumour necrosis factor-α, interleukin-12 (IL-12)/23p40 and IL-17 in colonic biopsy samples, as assessed by quantitative reverse transcription polymerase chain reaction. In contrast, AZA treatment did not change the expression of forkhead box P3, a master regulator of regulatory T cells. These data suggest that AZA treatment led to complete remission in MDS-associated IBD through suppression of pro-inflammatory cytokine responses.
  • C型肝炎に対する初回インターフェロンフリー治療不成功例の臨床的特徴
    吉田 晃浩; 萩原 智; 南 知宏; 千品 寛和; 河野 匡; 田北 雅弘; 依田 広; 上嶋 一臣; 南 康範; 西田 直生志; 工藤 正俊
    日本消化器病学会雑誌 (一財)日本消化器病学会 115 (臨増総会) A308 - A308 0446-6586 2018/03
  • Yoriaki Komeda; Tomohiro Watanabe; Shigenaga Matsui; Hiroshi Kashida; Toshiharu Sakurai; Masashi Kono; Kosuke Minaga; Tomoyuki Nagai; Satoru Hagiwara; Eisuke Enoki; Masatoshi Kudo
    JGH open : an open access journal of gastroenterology and hepatology Wiley 1 (2) 74 - 75 2397-9070 2017/10 [Refereed]
     
    This study showed that we need to bear in mind the possibility of gastric adenocarcinoma of the fundic gland type upon encounter with such elevated lesions originating from Helicobacter pylori (H. pylori)-negative gastric mucosa. We believe that our study makes a significant contribution to the literature because small invasive gastric adenocarcinoma of the fundic gland type is a rare disease entity, which exhibits a submucosal tumor-like or superficial flat-type elevated lesion on H. pylori-negative gastric mucosa in the endoscopic examinations.
  • Yoriaki Komeda; Hiroshi Kashida; Toshiharu Sakurai; Masashi Kono; Tomoyuki Nagai; Yutaka Asakuma; Satoru Hagiwara; Shigenaga Matsui; Tomohiro Watanabe; Takaaki Chikugo; Masatoshi Kudo
    The American journal of gastroenterology NATURE PUBLISHING GROUP 112 (6) 833 - 833 0002-9270 2017/06 [Refereed]
  • Tadaaki Arizumi; Kazuomi Ueshima; Mina Iwanishi; Tomohiro Minami; Hirokazu Chishina; Masashi Kono; Masahiro Takita; Norihisa Yada; Satoru Hagiwara; Yasunori Minami; Hiroshi Ida; Yoriaki Komeda; Mamoru Takenaka; Toshiharu Sakurai; Tomohiro Watanabe; Naoshi Nishida; Masatoshi Kudo
    Liver cancer KARGER 6 (3) 227 - 235 2235-1795 2017/06 [Refereed]
     
    AIM/BACKGROUND: The ultimate aim of any treatment for hepatocellular carcinoma (HCC) is to improve overall survival (OS); however, the clinical significance of time to progression (TTP) after transarterial chemoembolization (TACE) is unclear. This retrospective study examined the association between OS and the newly defined time to TACE progression (TTTP) to assess whether TTTP can be an alternative to OS in HCC patients with Barcelona Clinic Liver Cancer (BCLC) stage B. METHODS: Between January 2006 and December 2013, 592 patients with HCC (BCLC B1, n = 118; BCLC B2, n = 170) underwent TACE. TTTP was then redefined as time to progression from the first image taken after TACE. The relationship between TTTP and OS was then examined based on survival time. RESULTS: Survival analysis revealed significant differences in the OS of patients with BCLC B1 and those with BCLC B2 (median OS: 42.3 months, 95% confidence interval [CI] 34.4-50.7; and 29.3 months, 95% CI 26.1-37.6, respectively, p = 0.0348). The median TTTP values were 9.5 months (95% CI 7.0-10.9) and 5.3 months (95% CI 4.6-6.7), respectively (p = 0.0078). There was a moderate positive correlation between OS and TTTP for both B1 (R2 = 0.6563, p = 0.0045) and B2 (R2 = 0.6433, p = 0.0052) substages. There was also a positive correlation between OS and TTTP for the combined B1 and B2 substages (R2 = 0.6590, p = 0.0024). CONCLUSIONS: There was a moderate correlation between the TTTP and OS of patients with HCC after TACE therapy, where the patients with short TTTP represented short OS, indicating that TTTP is an alternative parameter for survival analysis of HCC patients with BCLC stage B tumors who undergo TACE.
  • Yoriaki Komeda; Hiroshi Kashida; Toshiharu Sakurai; George Tribonias; Kazuki Okamoto; Masashi Kono; Mitsunari Yamada; Teppei Adachi; Hiromasa Mine; Tomoyuki Nagai; Yutaka Asakuma; Satoru Hagiwara; Shigenaga Matsui; Tomohiro Watanabe; Masayuki Kitano; Takaaki Chikugo; Yasutaka Chiba; Masatoshi Kudo
    World journal of gastroenterology BAISHIDENG PUBLISHING GROUP INC 23 (2) 328 - 335 1007-9327 2017/01 [Refereed]
     
    AIM: To compare the efficacy and safety of cold snare polypectomy (CSP) and hot forceps biopsy (HFB) for diminutive colorectal polyps. METHODS: This prospective, randomized single-center clinical trial included consecutive patients ≥ 20 years of age with diminutive colorectal polyps 3-5 mm from December 2014 to October 2015. The primary outcome measures were en-bloc resection (endoscopic evaluation) and complete resection rates (pathological evaluation). The secondary outcome measures were the immediate bleeding or immediate perforation rate after polypectomy, delayed bleeding or delayed perforation rate after polypectomy, use of clipping for bleeding or perforation, and polyp retrieval rate. Prophylactic clipping after polyp removal wasn't routinely performed. RESULTS: Two hundred eight patients were randomized into the CSP (102), HFB (106) and 283 polyps were evaluated (CSP: 148, HFB: 135). The en-bloc resection rate was significantly higher with CSP than with HFB [99.3% (147/148) vs 80.0% (108/135), P < 0.0001]. The complete resection rate was significantly higher with CSP than with HFB [80.4% (119/148) vs 47.4% (64/135), P < 0.0001]. The immediate bleeding rate was similar between the groups [8.6% (13/148) vs 8.1% (11/135), P = 1.000], and endoscopic hemostasis with hemoclips was successful in all cases. No cases of perforation or delayed bleeding occurred. The rate of severe tissue injury to the pathological specimen was higher HFB than CSP [52.6% (71/135) vs 1.3% (2/148), P < 0.0001]. Polyp retrieval failure was encountered CSP (7), HFB (2). CONCLUSION: CSP is more effective than HFB for resecting diminutive polyps. Further long-term follow-up study is required.
  • Kwok WY; Hagiwara S; Nishida N; Watanabe T; Sakurai T; Ida H; Minami Y; Takita M; Minami T; Iwanishi M; Chishina H; Kono M; Ueshima K; Komeda Y; Arizumi T; Enoki E; Nakai T; Kumabe T; Nakashima O; Kondo F; Kudo M
    Oncology 92 (Suppl 1) 16 - 28 2017
  • Masashi Kono; Yasunori Minami; Mina Iwanishi; Tomohiro Minami; Hirokazu Chishina; Tadaaki Arizumi; Yoriaki Komeda; Toshiharu Sakurai; Masahiro Takita; Norihisa Yada; Hiroshi Ida; Satoru Hagiwara; Kazuomi Ueshima; Naoshi Nishida; Masatoshi Kudo
    Oncology KARGER 92 Suppl 1 29 - 34 0030-2414 2017 [Refereed]
     
    OBJECTIVE: To compare contrast tissue harmonic imaging (THI) with low mechanical index (MI) and conventional contrast harmonic imaging (CHI) with respect to lesion visibility of hepatocellular carcinoma (HCC). METHODS: One hundred and twenty-five patients (84 men and 41 women, age range 39-94 years, mean age 74 years) with 100 naïve HCCs and 30 lesions after radiofrequency ablation (RFA) for HCC were evaluated. One hundred and four patients had liver cirrhosis of Child-Pugh class A, and the remaining 21 had Child-Pugh class B cirrhosis. The lesion conspicuity and intratumoral echogenicity during the postvascular phase were compared using conventional CHI and contrast THI with low MI. RESULTS: The MI values ranged from 0.20 to 0.30 on conventional CHI and from 0.30 to 0.35 on contrast THI. Regarding HCC lesion conspicuity, contrast THI with low MI was clearer in 79 lesions (60.8%), equal in 34 lesions (26.2%), and less clear in 17 lesions (13.1%) when compared with conventional CHI. The lesion conspicuity with contrast THI was significantly better than that with conventional CHI (p < 0.01). All of the postablative lesions were well delineated in patients who received RFA. CONCLUSION: Low-MI contrast THI was superior to conventional CHI with respect to lesion visibility of HCCs and might offer good imaging for the guiding of RFA.
  • Wing Yee Kwok; Satoru Hagiwara; Naoshi Nishida; Tomohiro Watanabe; Toshiharu Sakurai; Hiroshi Ida; Yasunori Minami; Masahiro Takita; Tomohiro Minami; Mina Iwanishi; Hirokazu Chishina; Masashi Kono; Kazuomi Ueshima; Yoriaki Komeda; Tadaaki Arizumi; Eisuke Enoki; Takuya Nakai; Tsutomu Kumabe; Osamu Nakashima; Fukuo Kondo; Masatoshi Kudo
    Oncology KARGER 92 Suppl 1 16 - 28 0030-2414 2017 [Refereed]
     
    The patient was a 20-year-old male in whom a hepatic hypervascular mass accompanied by intratumoral hemorrhage was detected on examination for epigastric pain. Based on the enlargement of the mass and diagnostic imaging, hepatocellular adenoma (HCA) was suspected and hepatectomy was performed. The lesion was diagnosed as malignant transformation of β-catenin-activated HCA. There are only few reports of cases with malignant transformation of HCA in Japan; it is necessary to accumulate cases to investigate it.
  • Masashi Kono; Naoshi Nishida; Satoru Hagiwara; Tomohiro Minami; Hirokazu Chishina; Tadaaki Arizumi; Kosuke Minaga; Ken Kamata; Yoriaki Komeda; Toshiharu Sakurai; Mamoru Takenaka; Masahiro Takita; Norihisa Yada; Hiroshi Ida; Yasunori Minami; Kazuomi Ueshima; Tomohiro Watanabe; Masatoshi Kudo
    Digestive diseases (Basel, Switzerland) KARGER 35 (6) 556 - 564 0257-2753 2017 [Refereed]
     
    BACKGROUND AND AIMS: Direct-acting antivirals (DAAs) dramatically improve the sustained virological response (SVR) of chronic hepatitis C (CHC) patients. However, continuous liver damage after SVR may be a risk of hepatocellular carcinoma (HCC). We clarified pretreatment characteristics related to sustained liver damage after SVR. METHODS: A total of 286 CHC patients were treated with an interferon-free DAA regimen. Among them, 250 patients achieved SVR for 12 weeks after the end of treatment (SVR12); these individuals were classified based on α-fetoprotein (AFP) and alanine transaminase (ALT) levels posttreatment. Baseline characteristics significantly associated with AFP >5 ng/mL and ALT level ≥20 IU/L after SVR were clarified using multivariate analyses. RESULTS: Among the pretreatment factors examined, serum AFP values and the presence of fatty liver (FL) were significantly associated with abnormal AFP (p < 0.0001) and ALT levels 12 weeks after SVR12 (SVR24; p = 0.0109). For 126 patients who showed an increase in baseline AFP level, FL, fibrosis-4 (FIB-4) index, and albumin levels before treatment were related to abnormal AFP at SVR24 (p = 0.0005, 0.0232, and 0.0400 for FL, FIB-4 index, and albumin, respectively). Similarly, for 150 patients with abnormal baseline ALT levels, FL was associated with an ALT level ≥ 30 IU/L after SVR (p = 0.0430). CONCLUSIONS: High FIB-4 index, low albumin level, and FL before DAA treatment were associated with a risk of sustained liver damage with AFP and ALT elevation after SVR; patients with these factors should be carefully monitored for emergence of HCC.
  • Hiroshi Ida; Satoru Hagiwara; Masashi Kono; Tomohiro Minami; Hirokazu Chishina; Tadaaki Arizumi; Masahiro Takita; Norihisa Yada; Yasunori Minami; Kazuomi Ueshima; Naoshi Nishida; Masatoshi Kudo
    Digestive diseases (Basel, Switzerland) KARGER 35 (6) 565 - 573 0257-2753 2017 [Refereed]
     
    BACKGROUND: Interferon-based antiviral therapies against hepatitis C virus (HCV) infection have been shown to reduce the incidence of hepatocellular carcinoma (HCC) in patients with sustained viral response (SVR). Recently, direct-acting antivirals (DAAs) have been proven to be much more effective in achieving SVR than interferon-based therapies. However, whether DAAs can efficiently prevent the occurrence of HCC after SVR remains controversial. To clarify this issue, we analyzed the clinical features of patients in whom HCC developed after achievement of SVR with DAAs for chronic HCV infection. SUMMARY: Among patients who achieved SVR with daclatasvir and asunaprevir (n = 100), HCC developed in 17 patients (HCC group; n = 17) and did not develop in 83 patients (non-HCC group; n = 83) during a mean observation period of 15 months. A multivariate Cox proportional hazards analysis identified past history of HCC and male sex as significant risk factors for the emergence of HCC after DAAs. Sixteen cases with HCC after DAAs were in the very early or early stage (16/17, 94.1%), and one case was in the advanced stage (1/17, 5.9%) with portal venous tumor thrombus. Radiofrequency ablation and/or transarterial chemoembolization were performed in most cases as curative therapy (16/17, 94.1%). Key Messages: SVR by DAAs did not completely prevent the occurrence of HCC. However, even if HCC did develop after SVR, curative anticancer therapy was applicable in most cases.
  • Tadaaki Arizumi; Tomohiro Minami; Hirokazu Chishina; Masashi Kono; Masahiro Takita; Norihisa Yada; Satoru Hagiwara; Yasunori Minami; Hiroshi Ida; Kazuomi Ueshima; Ken Kamata; Kosuke Minaga; Yoriaki Komeda; Mamoru Takenaka; Toshiharu Sakurai; Tomohiro Watanabe; Naoshi Nishida; Masatoshi Kudo
    Digestive diseases (Basel, Switzerland) KARGER 35 (6) 583 - 588 0257-2753 2017 [Refereed]
     
    BACKGROUND: Tumors classified based on the Barcelona Clinic Liver Cancer (BCLC) stage B hepatocellular carcinoma (HCC) are heterogeneous in nature. Previously, the Kinki criterion was proposed for a more precise subclassification of tumors in BCLC-stage B. However, tumors in sub-stage B2 include various size and number of HCCs even with the Kinki criteria, which could lead to heterogeneity for overall survival (OS). In this study, we assessed how the size and number of tumors affect the OS and time to progression (TTP) in patients with Kinki criteria stage B2 tumors and treated with transarterial chemoembolization (TACE). METHODS: Of 906 HCC patients treated with TACE at Kindai University Hospital, 236 patients with HCC considered as Kinki criteria stage B2 were examined. They were classified into the following 4 groups according to the maximum tumor diameter and number of tumors: B2a group, tumor size ≤6 cm and total number of tumors ≤6; B2b group, size ≤6 cm and number >6; B2c group, size >6 cm and number ≤6; and B2d group, size >6 cm and number >6. The OS and TTP of patients in each group were compared. RESULTS: There were 131 patients (55.5%) in the B2a group, 58 (24.6%) in the B2b group, 41 (17.4%) in the B2c group, and 6 (0.03%) in the B2d group. Comparison of the survivals revealed that the median OS was 2.8 years (95% CI 2.0-3.5) in the B2a group, 2.8 years (95% CI 2.0-3.3) in the B2b group, 1.9 years (95% CI 0.8-4.0) in the B2c group, and 2.3 years (95% CI 1.2-ND [no data]) in the B2d group, respectively (p = 0.896). The median TTP in B2a, B2b, B2c, and B2d sub-substage HCC were13.2, 12.1, 13.8, and 11.5 months, respectively (p = 0.047). The median TTP in B2a + B2c sub-substage patients was longer than that in B2b + B2d sub-substage HCC patients (14.0 months and 10.4 months; p = 0.002). CONCLUSION: No significant differences were observed in the OS among HCC patients subclassified based on the maximum tumor diameter and tumor number in Kinki criteria stage B2. Consequently, Kinki criteria stage B2 HCC is a homogeneous subgroup in terms of OS prediction. However, shorter TTP in B2b+B2c sub-substage HCC patients than that in B2a + B2c sub-substage HCC patients suggests that different treatment strategy, such as systemic therapy with targeted agents instead of TACE, may be suitable to preserve the liver function.
  • Tadaaki Arizumi; Tomohiro Minami; Hirokazu Chishina; Masashi Kono; Masahiro Takita; Norihisa Yada; Satoru Hagiwara; Yasunori Minami; Hiroshi Ida; Kazuomi Ueshima; Ken Kamata; Kosuke Minaga; Yoriaki Komeda; Mamoru Takenaka; Toshiharu Sakurai; Tomohiro Watanabe; Naoshi Nishida; Masatoshi Kudo
    Digestive diseases (Basel, Switzerland) KARGER 35 (6) 589 - 597 0257-2753 2017 [Refereed]
     
    BACKGROUND: Transarterial chemoembolization (TACE) is recommended for patients with hepatocellular carcinoma (HCC) in Barcelona Clinic Liver Cancer (BCLC) stage B. However, because of the heterogeneity of HCC in BCLC stage B; various subclassification systems have been proposed to predict the prognosis of patients. Previously, we proposed the Kinki criteria for precise classification of HCC cases in BCLC stage B. In this study, we compared the time to TACE refractoriness in HCC patients with Kinki criteria substages B1 and B2-HCC. SUMMARY: Between January 2006 and December 2013, 592 HCC patients (substage B1, n = 118; substage B2, n = 170) underwent TACE. Time to progression under TACE treatment was defined as the time to untreatable progression (TTUP). TTUP and changes in liver function were analyzed in patients with substages B1 and B2-HCC. The median TTUP was 25.7 months (95% CI 19.3-37.3) and 16.4 months (95% CI 13.1-20.2) in patients with substage B1-HCC and substage B2-HCC, respectively (p = 0.0050). In patients with substage B2-HCC, median Child-Pugh scores after the first TACE session was significantly different from those after third and fifth TACE sessions (first-third, p = 0.0020; first-fifth, p = 0.0008). Key Message: TACE refractoriness occurred earlier in patients with substage B2-HCC than those with substage B1-HCC; deterioration of liver function with repeated TACE was more obvious in HCC cases with stage-B1 tumor. Shorter TTUP and impaired liver function due to repeated TACE could be responsible for the shorter survival in patients with substage B2-HCC.
  • Kazuki Okamoto; Tomohiro Watanabe; Yoriaki Komeda; Tatsuya Kono; Kouta Takashima; Ayana Okamoto; Masashi Kono; Mitsunari Yamada; Tadaaki Arizumi; Ken Kamata; Kosuke Minaga; Kentaro Yamao; Tomoyuki Nagai; Yutaka Asakuma; Mamoru Takenaka; Toshiharu Sakurai; Shigenaga Matsui; Naoshi Nishida; Takaaki Chikugo; Hiroshi Kashida; Masatoshi Kudo
    Oncology KARGER 93 Suppl 1 (1) 35 - 42 0030-2414 2017 [Refereed]
     
    BACKGROUND: Colonoscopic removal of adenomatous polyps or early cancer prevents death from colorectal cancer. Endoscopic submucosal dissection (ESD), which enables endoscopists to perform en bloc resection of flat or depressed colorectal tumors >20 mm, has recently been introduced and become a standard procedure in Japan. Although postoperative bleeding (POB) is a major complication associated with ESD, risk factors for POB have not been fully identified. METHODS: A total of 451 patients (509 lesions) who underwent colorectal ESD were retrospectively analyzed to identify clinical parameters associated with POB. RESULTS: POB occurred in 14 patients, and 7 of them had received antithrombotic therapy before ESD. Uni- and multivariate analyses revealed that antithrombotic therapy and rectal tumor location were strongly associated with POB following colorectal ESD. The incidence of POB was higher in patients on heparin bridge therapy (HBT) for the replacement of antithrombotic therapy than in patients with no HBT. Four of 7 patients (57.1%) on antithrombotic therapy experienced POB from the rectal lesions. CONCLUSION: Antithrombotic therapy and rectal lesions result in a higher POB incidence after colorectal ESD.
  • Yoriaki Komeda; Hisashi Handa; Tomohiro Watanabe; Takanobu Nomura; Misaki Kitahashi; Toshiharu Sakurai; Ayana Okamoto; Tomohiro Minami; Masashi Kono; Tadaaki Arizumi; Mamoru Takenaka; Satoru Hagiwara; Shigenaga Matsui; Naoshi Nishida; Hiroshi Kashida; Masatoshi Kudo
    Oncology S. Karger AG 93 Suppl 1 (1) 30 - 34 0030-2414 2017 [Refereed]
     
    BACKGROUND AND AIM: Computer-aided diagnosis (CAD) is becoming a next-generation tool for the diagnosis of human disease. CAD for colon polyps has been suggested as a particularly useful tool for trainee colonoscopists, as the use of a CAD system avoids the complications associated with endoscopic resections. In addition to conventional CAD, a convolutional neural network (CNN) system utilizing artificial intelligence (AI) has been developing rapidly over the past 5 years. We attempted to generate a unique CNN-CAD system with an AI function that studied endoscopic images extracted from movies obtained with colonoscopes used in routine examinations. Here, we report our preliminary results of this novel CNN-CAD system for the diagnosis of colon polyps. METHODS: A total of 1,200 images from cases of colonoscopy performed between January 2010 and December 2016 at Kindai University Hospital were used. These images were extracted from the video of actual endoscopic examinations. Additional video images from 10 cases of unlearned processes were retrospectively assessed in a pilot study. They were simply diagnosed as either an adenomatous or nonadenomatous polyp. RESULTS: The number of images used by AI to learn to distinguish adenomatous from nonadenomatous was 1,200:600. These images were extracted from the videos of actual endoscopic examinations. The size of each image was adjusted to 256 × 256 pixels. A 10-hold cross-validation was carried out. The accuracy of the 10-hold cross-validation is 0.751, where the accuracy is the ratio of the number of correct answers over the number of all the answers produced by the CNN. The decisions by the CNN were correct in 7 of 10 cases. CONCLUSION: A CNN-CAD system using routine colonoscopy might be useful for the rapid diagnosis of colorectal polyp classification. Further prospective studies in an in vivo setting are required to confirm the effectiveness of a CNN-CAD system in routine colonoscopy.
  • Yoriaki Komeda; Hiroshi Kashida; Toshiharu Sakurai; Yutaka Asakuma; George Tribonias; Tomoyuki Nagai; Masashi Kono; Kosuke Minaga; Mamoru Takenaka; Tadaaki Arizumi; Satoru Hagiwara; Shigenaga Matsui; Tomohiro Watanabe; Naoshi Nishida; Takaaki Chikugo; Yasutaka Chiba; Masatoshi Kudo
    Oncology S. Karger AG 93 Suppl 1 (1) 49 - 54 0030-2414 2017 [Refereed]
     
    OBJECTIVE: The Japan NBI Expert Team (JNET) proposed a new narrow band imaging (NBI) classification system for colorectal tumors in June 2014. In this classification system, types 1, 2A, 2B, and 3 correspond to hyperplastic polyps (HPs) including sessile serrated polyps (SSPs), low-grade dysplasia (LGD), high-grade dysplasia (HGD) to shallow submucosal invasive (SM-s) carcinomas, and deep submucosal invasive (SM-d) carcinomas, respectively. METHODS: To validate this system, we performed a retrospective image evaluation study, in which 199 colorectal tumors previously assessed by NBI magnifying endoscopy were classified by 3 blinded experienced colonoscopists using the JNET system. The results were compared with the final pathological diagnoses to determine the JNET classification's accuracy. The interobserver agreement was calculated, and the intraobserver agreement was assessed after 6 months. RESULTS: The final pathological diagnoses identified 14 HPs/SSPs, 127 LGDs, 22 HGDs, 19 SM-s carcinomas, and 17 SM-d carcinomas. The respective sensitivities, specificities, positive predictive value, negative predictive value, and accuracies were as follows: Type 1, 85.7, 99.5, 92.3, 98.9, and 98.5%; Type 2A, 96.0, 81.9, 90.3, 92.1, and 90.9%; Type 2B, 75.6%, 90.5, 67.3, 93.4, and 87.4%; and Type 3, 29.4%, 100, 100, 93.8, and 94.0%. The interobserver agreement and the intraobserver agreement were moderate (κ value: 0.52) and excellent (κ value: 0.88), respectively. Lesions presenting as Type 2B during NBI comprised a range of colorectal tumors, including HGDs, SM-s, and SM-d. CONCLUSIONS: The JNET classification was useful for the diagnosis of HPs/SSPs, LGDs, and SM-d, but not SM-s lesions. For low-confidence cases, magnified chromoendoscopy is recommended to ensure correct diagnoses.
  • Kazuki Okamoto; Shigenaga Matsui; Tomohiro Watanabe; Yutaka Asakuma; Yoriaki Komeda; Ayana Okamoto; Ishikawa Rei; Masashi Kono; Mitsunari Yamada; Tomoyuki Nagai; Tadaaki Arizumi; Kosuke Minaga; Ken Kamata; Kentaro Yamao; Mamoru Takenaka; Toshiharu Sakurai; Naoshi Nishida; Hiroshi Kashida; Takaaki Chikugo; Masatoshi Kudo
    Oncology KARGER 93 Suppl 1 (1) 9 - 14 0030-2414 2017 [Refereed]
     
    INTRODUCTION: Endoscopic submucosal dissection (ESD) has been widely used in the resection of superficial esophageal cancers. Since its use has been extended to cases involving large esophageal tumors occupying nearly the whole or the whole circumference of the lumen, the occurrence of esophageal stricture has increased. Although endoscopic injection of triamcinolone (TA) is widely used for the prevention of postoperative stricture, a significant number of patients still develop stricture after TA injection therapy. METHODS: We performed a retrospective study to identify the clinical parameters that predispose post-ESD patients to esophageal stricture after TA injection therapy. RESULTS: A total of 207 patients who were diagnosed with superficial esophageal cancer and subsequently underwent ESD were enrolled in this study. Among these patients, 53 patients and 57 lesions bearing mucosal defects covering greater than two-thirds of the esophageal circumference after ESD were treated with TA injection therapy. The rate of esophageal stricture was found to be highest in cases involving mucosal defects that covered more than seven-eighths of the circumference. CONCLUSION: Endoscopic TA injection is not sufficient for preventing esophageal stricture in patients bearing mucosal defects covering more than seven-eighths of the esophageal circumference after ESD.
  • Toshiharu Sakurai; Teppei Adachi; Masashi Kono; Tadaaki Arizumi; Ken Kamata; Kosuke Minaga; Kentaro Yamao; Yoriaki Komeda; Mamoru Takenaka; Satoru Hagiwara; Tomohiro Watanabe; Naoshi Nishida; Hiroshi Kashida; Masatoshi Kudo
    Oncology KARGER 93 Suppl 1 (1) 27 - 29 0030-2414 2017 [Refereed]
     
    The prophylactic closure of mucosal defects after endoscopic resection is known to prevent postoperative bleeding in colorectal lesions. However, closure of large mucosal defects is difficult with conventional clips only, and several closure techniques have been previously described; use of an Endoloop, 8-ring loop, or loop clip and a small incision around the mucosal defect. Given that the prophylactic closure requires much cost and time, the application should be limited to high-risk cases. Medication of antithrombotics or antiplatelet agents would be one of the reasonable indications for prophylactic closure of mucosal defects after endoscopic resection of colorectal tumors.
  • Teppei Adachi; Shigenaga Matsui; Tomohiro Watanabe; Kazuki Okamoto; Ayana Okamoto; Masashi Kono; Mitsunari Yamada; Tomoyuki Nagai; Yoriaki Komeda; Kosuke Minaga; Ken Kamata; Kentaro Yamao; Mamoru Takenaka; Yutaka Asakuma; Toshiharu Sakurai; Naoshi Nishida; Hiroshi Kashida; Masatoshi Kudo
    Oncology S. Karger AG 93 Suppl 1 (1) 15 - 19 0030-2414 2017 [Refereed]
     
    INTRODUCTION: Clarithromycin (CAM)-based triple therapy comprising proton pump inhibitors and amoxicillin is administered as first-line eradication treatment against Helicobacter pylori infection. However, the eradication rate achieved with CAM-based triple therapy has decreased to <80% owing to the emergence of CAM-resistant strains. This prospective randomized study aimed to compare the efficacy of CAM-based and metronidazole (MNZ)-based triple therapy in terms of H. pylori eradication. METHODS: H. pylori-positive patients were treated with CAM-based triple therapy comprising esomeprazole and amoxicillin (EAC group) or with MNZ-based triple therapy comprising esomeprazole and amoxicillin (EAM group). RESULTS: H. pylori eradication rates achieved in the intention-to-treat (ITT) and per protocol (PP) analyses were 70.6 and 72.7%, respectively, in the EAC group. Eradication rates obtained via ITT and PP analyses were 91.7 and 94.3%, respectively, in the EAM group. In the EAC group, eradication rates were significantly lower in patients harboring CAM-resistant strains than in those harboring CAM-sensitive strains. In contrast, eradication rates were comparable between patients harboring CAM-resistant strains and those harboring CAM-sensitive strains in the EAM group. CONCLUSION: MNZ-based triple therapy consisting of esomeprazole and amoxicillin is superior to CAM-based triple therapy containing esomeprazole and amoxicillin as first-line eradication treatment against H. pylori.
  • Komeda Yoriaki; Kashida Hiroshi; Sakurai Toshiharu; Asakuma Yutaka; Okazaki Yoshihisa; Nagai Tomoyuki; Mine Hiromasa; Adachi Teppei; Tanaka Rie; Yamada Mitsunari; Kono Masashi; Okamoto Toshiki; Matsui Shigenaga; Kudo Masatoshi
    GASTROINTESTINAL ENDOSCOPY Elsevier BV 83 (5) AB392 - AB392 0016-5107 2016/05 [Refereed]
  • Naoshi Nishida; Masashi Kono; Tomohiro Minami; Hirokazu Chishina; Tadaaki Arizumi; Masahiro Takita; Norihisa Yada; Hiroshi Ida; Satoru Hagiwara; Yasunori Minami; Kazuomi Ueshima; Tashiharu Sakurai; Masatoshi Kudo
    DIGESTIVE DISEASES KARGER 34 (6) 632 - 639 0257-2753 2016 [Refereed]
     
    Background: An interferon-free regimen including sofosbuvir and ribavirin (RBV) for patients with hepatitis C virus (HCV) genotype 2 (G2) infection leads to a drastic improvement of sustained virological response (SVR). However, the safety, tolerability, and efficacy in patients aged 75 or older have not been completely understood. Summary: Fifty-six patients with HCV G2 infection who were treated with sofosbuvir and weight-based dose of RBV were enrolled. Thirty-seven patients aged and 19 patients aged were classified as the aged and non-aged groups, respectively. The aged group was characterized by significantly more number of women, history of hepatocellular carcinoma, low serum albumin (ALB) level, low hemoglobin (Hb) concentration, low estimated glomerular filtration rate (eGFR), and high fibrosis-4 index (p = 0.0029). Forty-one patients were evaluated for SVR at 12 weeks after the end of therapy (SVR12); of them, all but one completed the treatment scheduled for 12 weeks. The aged group showed lower SVR12 rate than the non aged group (81.3%for aged and 96.0%for non-aged groups). Although the Hb concentration and eGFR are significantly lower in the aged group throughout the clinical course, all patients in the aged group completed the 12-week treatment with a gradual increase of serum ALB level. Key Messages: The combination of sofosbuvir plus RBV is tolerable and beneficial in patients aged >75. However, intensive management of anemia by dose reduction of RBV is necessary, which could lead to a low SVR12 rate compared to that observed in patients younger than 75 years. (C) 2016 S. Karger AG, Basel
  • Masahiro Takita; Mina Iwanishi; Tomohiro Minami; Masashi Kono; Hirokazo Chishina; Tadaaki Arizumi; Norihisa Yada; Satoru Hagiwara; Yasunori Minami; Hiroshi Ida; Kazuomi Ueshima; Nishida Naoshi; Masatoshi Kudo
    DIGESTIVE DISEASES KARGER 34 (6) 654 - 658 0257-2753 2016 [Refereed]
     
    Objective: The objective of treatment for polycystic liver disease is to reduce the liver volume and reduce or resolve compression symptoms such as abdominal fullness and abdominal pain due to hepatomegaly. Liver cysts are treated internally by puncture and aspiration of the cyst contents or hepatic artery embolization and surgically by cyst fenestration or hepatectomy, but no clear consensus has been reached concerning their selection. We introduced monoethanolamine oleate (EO) sclerotherapy therapy for liver cysts in 1999 and reported its effectiveness. In this study, cases were added, and the results including those of long-term follow-up were evaluated. Subjects: Twenty-two patients (5 males and 17 females, mean age 65.2) who underwent EO infusion therapy for liver cysts between January 1999 and June 2011 were evaluated. Methods: Liver cysts were punctured under ultrasound guidance, and a 7Fr pigtail catheter was inserted. After aspirating the cyst contents, EO was infused, and a clamp was applied for 24 h. Then, the catheter was declamped, cyst contents were aspirated again, and the catheter was removed. After the treatment, the cyst size was measured, and the patients were followed up. Results: Eight simple cysts in 8 patients (simple cyst group) and 21 cysts in 14 patients with multiple cysts (polycystic liver disease group) were treated and followed up over a median of 78 months (0-203 months). The mean volume reduction rate was 99% in the simple cyst group and 91% in the polycystic liver disease group (p = 0.04). One procedural accident resulting in liver abscess formation was observed in 1 patient 1 week after discharge, and it required drain placement and antibiotic administration. While mild abdominal pain was observed in a few patients, it was resolved spontaneously under observation. Conclusion: EO infusion therapy achieves fairly high treatment response in the volume reduction (99%) and sustained shrinkage over long-term follow-up. Therefore, this is a breakthrough technique in the treatment of polycystic liver disease as well as simple cyst and should be a standard of care in the treatment of this disease. (C) 2016 S. Karger AG, Basel
  • Hirokazu Chishina; Satoru Hagiwara; Naoshi Nishida; Kazuomi Ueshima; Toshiharu Sakurai; Hiroshi Ida; Yasunori Minami; Masahiro Takita; Masashi Kono; Tomohiro Minami; Mina Iwanishi; Yasuko Umehara; Tomohiro Watanabe; Yoriaki Komeda; Tadaaki Arizumi; Masotoshi Kudo
    DIGESTIVE DISEASES KARGER 34 (6) 659 - 664 0257-2753 2016 [Refereed]
     
    Objective: Refractory ascites reduces the quality of life of liver cirrhosis patients. Albumin preparation and diuretics, such as furosemide, have been used to treat refractory ascites, but the effect was poor in many patients. In this study, we analyzed patients treated with tolvaptan (TLV) at our hospital and investigated predictors of the effect. Methods: The subjects were 70 patients for whom TLV was introduced to treat refractory ascites who could be analyzed between November 2013 and March 2015 at our hospital. Patient background before initiation of oral TLV treatment, the dose of diuretics, and each item of biochemical tests of blood and urine were investigated, and factors correlated with the treatment effect were analyzed. An increase of >= 1,000 ml in the daily urine volume from the day before oral treatment or a decrease of kg in the body weight within 7 days as an early effect was observed in 33 patients and not observed in 37 patients. TLV treatment was continued for 60 days or longer in 12 of the 37 patients in whom no early effect was observed, and the presence or absence of a delayed effect and predictors of the effect were investigated. A decrease in as cites on abdominal CT with improvement of subjective symptoms at 60 days was defined as a delayed effect. Results: When early predictors of the effect were investigated by univariate analysis, serum blood urea nitrogen (BUN) and serum creatinine (Cr) were significantly higher in the non responder group (BUN: p = 0.03, Cr: p = 0.04), but no factor independently associated with the treatment effect was extracted on multivariate analysis. The delayed effect was noted in 4 (33.3%) of the 12 patients, but no predictor of the effect before treatment was identified. However, reactions, such as an increase in serum Na and reduction of urinary osmotic pressure, were observed early after TLV administration in some patients in whom the delayed effect was observed. Conclusions: The diuretic effect of TLV may decrease in renal hypofunction patients. Since the delayed effect was noted in a specific ratio of patients, continuation of TLV administration is an option even though the early treatment effect is poor unless ascites aggravates or adverse effects develop. (C) 2016 S. Karger AG, Basel
  • Tadaaki Arizumi; Kazuomi Ueshima; Mina Iwanishi; Tomohiro Minami; Hirokazu Chishina; Masashi Kono; Masahiro Takita; Satoshi Kitai; Tatsuo Inoue; Norihisa Yada; Satoru Hagiwara; Yasunori Minami; Hiroshi Ida; Toshiharu Sakurai; Masayuki Kitano; Naoshi Nishida; Masatoshi Kudo
    DIGESTIVE DISEASES KARGER 34 (6) 671 - 678 0257-2753 2016 [Refereed]
     
    Background: The standard treatment option that is available for patients with Barcelona Clinic Liver Cancer (BCLC) stage B hepatocellular carcinoma (HCC) is transarterial chemoembolization (TACE). However, the condition of the patients with BCLC stage B disease is heterogeneous showing different tumor statuses and Child Pugh scores; treatment strategies other than TACE are frequently employed for the patients in this stage. Based on the subclassification system proposed by Bolondi et al. [Semin Liver Dis 2012;32:348-359], we developed the Kinki criteria focusing on a substaging for BCLC stage B disease, which is simpler and should be more suitable in actual clinical setting in Japan. In this study, we evaluated the performance of Kinki criteria. Summary: This study included 1,633 HCC patients who received first line treatment at the Kindai University Hospital. Patients were classified into subgroups based on the Kinki criteria and the survival time was estimated for each group. There were 156 (33.3%) patients in subclass B1, 278 (59.3%) in B2, and 35 (7.4%) in B3. The median overall survival times and 95% CI for BCLC B subclasses B1, B2, and B3 were 4.3 years (3.7-4.9), 2.9 years (2.2-3.4), and 1.1 years (0.5-1.8), respectively (p < 0.001). Key Messages: Classification of HCC patients in BCLC stage B based on the Kinki criteria showed statistically significant differences in survival, indicating the performance of Kinki criteria, which takes Child Pugh score and tumor status into account for determining treatment options for HCC in BCLC stage B. (C) 2016 S. Karger AG, Basel
  • Yasunori Minami; Tomohiro Minami; Hirokazu Chishina; Masashi Kono; Tadaaki Arizumi; Masahiro Takita; Norihisa Yada; Satoru Hagiwara; Hiroshi Ida; Kazuomi Ueshima; Naoshi Nishida; Masatoshi Kudo
    DIGESTIVE DISEASES KARGER 34 (6) 687 - 691 0257-2753 2016 [Refereed]
     
    Objective: Radiofrequency ablation (RFA) induces gas bubbles in ablation zones, and the ablative margin cannot be evaluated accurately on ultrasound (US) during and immediately after RFA. This study assessed the usefulness of US-US fusion imaging to visualize the ablative margin of RFA for liver metastasis. Methods: RFA guided by US-US fusion imaging was performed on 12 targeted tumors in 10 patients. Secondary hepatic malignancies included patients with colorectal cancer (n = 4), breast cancer (n = 2), lung cancer (n = 1), gastrointestinal stromal tumor (n = 1), pancreatic neuroendocrine tumor (n = 1), and adrenocortical carcinoma (n = 1). The maximal diameter of the tumors ranged from 0.8 to 4.0 cm (mean SD 1.6 +/- 0.9 cm). Results: The mean number of electrode insertions was 1.6 per session (range 1-3). Technically, effective ablation was achieved in a single session in all patients, and safety ablative margins were confirmed on contrast-enhanced CT for early assessment of tumor response. There were no serious adverse events or procedure-related complications. During the follow-up period (median 220 days, range 31-417 days), none of the patients showed local tumor progression. Conclusion: US-US fusion imaging could show the tumor images before ablation and the ablative area on US in real time. The image overlay of US-US fusion imaging made it possible to evaluate the ablative margin three dimensionally according to the US probe action. Therefore, US-US fusion imaging can contribute to RFA therapy with a safety margin, that is, the so-called precise RFA. (C) 2016 S. Karger AG, Basel
  • Y. Komeda; H. Kashida; T. Sakurai; Y. Asakuma; Y. Okazaki; T. Nagai; H. Mine; T. Adachi; R. Tanaka; M. Yamada; M. Kono; K. Okamoto; S. Matsui; M. Kudo
    JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY WILEY-BLACKWELL 30 191 - 191 0815-9319 2015/12 [Refereed]
  • Kono Masashi; Matsui Shigenaga; Okamoto Kazuki; Yamada Mitsunari; Tanaka Rie; Mine Teppeiadachi Hiromasa; Nagai Tomoyuki; Okazaki Yoshihisa; Yoriakikomeda; Asakuma Yutaka; Sakurai Toshiharu; Kashida Hiroshi; Kudo Masatoshi
    JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY WILEY-BLACKWELL 30 103 - 103 0815-9319 2015/12 [Refereed]
  • Mitsunari Yamada; Hiroshi Kashida; Yoriaki Komeda; Kazuki Okamoto; Masashi Kono; Rie Tanaka; Teppei Adachi; Hiromasa Mine; Tomoyuki Nagai; Yoshihisa Okazaki; Yutaka Asakuma; Toshiharu Sakurai; Shigenaga Matsui; Masatoshi Kudo
    JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY WILEY-BLACKWELL 30 18 - 18 0815-9319 2015/12 [Refereed]
  • Tadaaki Arizumi; Kazuomi Ueshima; Tomohiro Minami; Masashi Kono; Hirokazu Chishina; Masahiro Takita; Satoshi Kitai; Tatsuo Inoue; Norihisa Yada; Satoru Hagiwara; Yasunori Minami; Toshiharu Sakurai; Naoshi Nishida; Masatoshi Kudo
    Liver cancer KARGER 4 (4) 253 - 62 2235-1795 2015/12 [Refereed]
     
    BACKGROUND AND AIMS: Patients with intermediate-stage hepatocellular carcinoma (HCC) refractory to transcatheter arterial chemoembolization (TACE) are considered to be candidates for sorafenib. The aim of this study was to evaluate the superiority of conversion of treatment to sorafenib on overall survival (OS) for cases refractory to TACE. METHODS: This was a retrospective cohort study carried out on 497 patients with HCC who were treated with TACE therapy at our hospital between January 2008 and December 2013. Fifty-six patients were diagnosed as refractory to TACE during their clinical course and they were divided into two cohorts, (1) those who switched from TACE to sorafenib and (2) those who continued TACE. The overall survival (OS) after the time of being refractory to TACE was evaluated between the two groups. RESULTS: After refractoriness to TACE therapy was confirmed, 24 patients continued with TACE (TACE-group) and 32 patients underwent treatment conversion to sorafenib (sorafenib-group). The median OS was 24.7 months in the sorafenib-group and 13.6 months in the TACE-group (p=0.002). CONCLUSIONS: Conversion to sorafenib significantly improves the OS in patients refractory to TACE therapy with intermediate-stage HCC. Administration of sorafenib is therefore recommended in such circumstances of TACE treatment failure.
  • Tadaaki Arizumi; Kazuomi Ueshima; Mina Iwanishi; Hirokazu Chishina; Masashi Kono; Masahiro Takita; Satoshi Kitai; Tatsuo Inoue; Norihisa Yada; Satoru Hagiwara; Hiroshi Ida; Yasunori Minami; Toshiharu Sakurai; Naoshi Nishida; Masayuki Kitano; Masatoshi Kudo
    Digestive diseases (Basel, Switzerland) KARGER 33 (6) 728 - 34 0257-2753 2015/10 [Refereed]
     
    OBJECTIVES: Sorafenib has become a standard therapy for advanced hepatocellular carcinoma following the demonstration of significant increase in progression-free survival as well as overall survival (OS) in the 2-phase III trials. We examined efficacy and adverse events (AEs) in patients treated with sorafenib over a 6-year period since approval in Japan. METHODS: Two hundred and forty-one patients treated with sorafenib at the Kinki University Hospital were retrospectively analyzed clinically for the factors related to survival periods, tumor response evaluated by the Response Evaluation Criteria In Cancer of the Liver (RECICL) and AEs. RESULTS: OS was 14.3 months. According to the RECICL, the objective response and disease control rates were 18.6% (43 of 241) and 61.1% (137 of 241), respectively. AEs were seen in 77.3% (187 of 241), with Grade 3 or higher in 23.6% (57 of 241). The most frequent AE was hand-foot skin reaction in 109 patients (45.0%), and 28 patients (11.8%) showed Grade 3 or higher. Significant factors contributing to the OS were treatment duration (p = 0.0204), up-to-7 criteria (p = 0.0400), increase of Child-Pugh score (p = 0.0008) and tumor response determined by the RECICL (p = 0.0007). CONCLUSION: Based on the analysis, using many cases at a single center, we concluded that continuation of treatment with sorafenib for ≥90 days without decrease of liver function was critical if tumor response was determined as stable disease or higher.
  • Masashi Kono; Naoko Tsuji; Nobuto Ozaki; Nozomu Matsumoto; Takehisa Takaba; Naoki Okumura; Masanori Kawasaki; Takafumi Tomita; Yasuko Umehara; Satoko Taniike; Shigeru Hatabe; Sadao Funai; Yukihhiko Ono; Ken Ochiai; Shunji Maekura; Masatoshi Kudo
    Clinical journal of gastroenterology Springer Tokyo 8 (4) 217 - 22 1865-7265 2015/08 [Refereed]
     
    Primary leiomyosarcomas of the gastrointestinal (GI) tract are extremely rare and highly aggressive neoplasms, and only a small number of true cases have been reported since the concept of GI stromal tumors was established. Here, we report a case of a primary leiomyosarcoma of the transverse colon. A 46-year-old Japanese male with a large mass in the right upper abdomen was admitted to our hospital. Computed tomography and magnetic resonance imaging revealed long segments of wall thickening of the transverse colon with large consecutive tumors measuring 12 cm in diameter. A projecting irregular mass with marked mucosal necrosis was found on colonoscopy. Pathological examination revealed a spindle cell tumor growing circumferentially and transmurally to replace the muscularis propria in the transverse colon. The spindle cells were positive for smooth muscle actin, and negative for KIT, CD34, DOG-1, and S-100 protein. The patient has shown repeat recurrence in spite of sufficient surgical excision being promptly performed.
  • Naoki Okumura; Naoko Tsuji; Nobuto Ozaki; Nozomu Matsumoto; Takehisa Takaba; Masanori Kawasaki; Takafumi Tomita; Yasuko Umehara; Satoko Taniike; Masashi Kono; Masatoshi Kudo
    Gastroenterology report OXFORD UNIV PRESS 3 (1) 69 - 74 2052-0034 2015/02 [Refereed]
     
    BACKGROUND AND AIMS: Peristomal wound infections are common complications of percutaneous endoscopic gastrostomy (PEG). The Funada-style gastropexy device has two parallel needles with a wire loop and suture thread, and was developed about 20 years ago in Japan. This kit has allowed us to perform dual gastropexy very easily; PEG with gastropexy has become a very popular technique in Japan. The present study aimed to compare the advantages and disadvantages of PEG with the gastropexy technique with the standard 'pull' method. METHODS: We retrospectively reviewed 182 consecutive, non-randomized patients undergoing PEG in our hospital, and a comparative analysis was made between the gastropexy (87 patients) and non-gastropexy (95 patients) groups. RESULTS: The rates of patients having erythema (11.6% vs. 47.9%; P < 0.001), exudates (2.3% vs. 14.9%; P < 0.01) and infection (0% vs. 6.4%; P = 0.01) in the peristomal area were lower in the gastropexy than in the non-gastropexy group. The rate of minor bleeding from the peristomal area was higher in the gastropexy than in the non-gastropexy group (12.8% vs. 2.1%; P < 0.01), but no patient required a blood transfusion. Mean procedure time was longer in the gastropexy group than in the non-gastropexy group (31 vs. 24 min; P < 0.001). The 30-day mortality rates were 4.7% and 5.3% respectively, and these deaths were not related to the gastrostomy procedure. CONCLUSION: PEG with gastropexy markedly reduces peristomal inflammation. Although minor bleeding and a longer procedure time were disadvantages, there were no severe complications. The findings suggested that PEG with Funada-style gastropexy was a safe and feasible method for reducing early complications of PEG.
  • Tadaaki Arizumi; Kazuomi Ueshima; Mina Iwanishi; Tomohiro Minami; Hirokazu Chishina; Masashi Kono; Masahiro Takita; Satoshi Kitai; Tatsuo Inoue; Norihisa Yada; Satoru Hagiwara; Hiroshi Ida; Yasunori Minami; Toshiharu Sakurai; Naoshi Nishida; Masayuki Kitano; Masatoshi Kudo
    Oncology KARGER 89 Suppl 2 4 - 10 0030-2414 2015 [Refereed]
     
    OBJECTIVE: Transarterial chemoembolization (TACE) is recommended as a first-line therapy for hepatocellular carcinoma (HCC) patients ineligible for curative therapy and without portal invasion. The Assessment for Retreatment with TACE (ART) scoring system was recently proposed for identifying patients who would not show sufficient survival benefit from repeated TACE. We reevaluated the performance of ART in HCC patients treated in Japan, where selective TACE is commonly used. METHODS: Between 2000 and 2013, 988 patients with HCC underwent TACE at Kinki University Hospital, and 627 received ≥2 sessions of TACE. Seventy-six patients who underwent ≥2 TACE sessions within 90 days were investigated for their performance of the ART score in the context of overall survival (OS). RESULTS: Only 12% (76/627) of patients underwent ≥2 TACE sessions within 90 days. Of those, 52 patients showed a low ART score (0-1.5), and 24 had a high ART score (≥2.5); the median OS was 20.2 and 37.6 months, respectively (p = 0.8207). CONCLUSION: The ART scoring system did not demonstrate a sufficiently predictive impact on OS among the patients who underwent ≥2 TACE sessions within 90 days. Application of the ART score should be carefully considered because differences in TACE procedures and post-TACE treatment can affect the results while evaluating OS.
  • Tadaaki Arizumi; Kazuomi Ueshima; Mina Iwanishi; Tomohiro Minami; Hirokazu Chishina; Masashi Kono; Masahiro Takita; Satoshi Kitai; Tatsuo Inoue; Norihisa Yada; Satoru Hagiwara; Hiroshi Ida; Yasunori Minami; Toshiharu Sakurai; Masayuki Kitano; Naoshi Nishida; Masatoshi Kudo
    Oncology KARGER 89 Suppl 2 47 - 52 0030-2414 2015 [Refereed]
     
    INTRODUCTION: Barcelona Clinic Liver Cancer (BCLC) stage B, an intermediate stage, includes various conditions of hepatocellular carcinoma (HCC). This heterogeneity of the patients with intermediate-stage HCC makes it difficult to predict their survival rates. In the present study, we examined the validity of the modified Bolondi classification (Kinki criteria) as a subclassification of patients with BCLC stage B HCC. METHODS: Of 906 patients who underwent conventional transarterial chemoembolization at Kinki University Hospital, 753, who met the inclusion criteria, were examined. Of these 753 patients, 425 (56.4%) with BCLC stage B were subclassified using the Kinki criteria to examine the survival rate. RESULTS: According to the Kinki criteria, 158 (37.2%) were subclassified into subclass B1, 236 (55.5%) into B2, and 31 (7.3%) into B3. The comparison of the survival rates showed that the median overall survival was 3.9 years (95% CI, 3.2-4.6) in the BCLC subclass B1 group, 2.5 years (95% CI, 2.2-3.1) in the B2 group, and 1.1 years (95% CI, 0.6-1.5) in the B3 group (p < 0.001). CONCLUSION: When the BCLC stage B patients were subclassified according to the Kinki criteria, survival curves were stratified with significant differences, suggesting that the Kinki criteria were suitable for the subclassification of the intermediate-stage HCC patients.
  • Masahiro Takita; Satoru Hagiwara; Masatoshi Kudo; Masashi Kono; Hirokazu Chishina; Tadaaki Arizumi; Satoshi Kitai; Norihisa Yada; Tatsuo Inoue; Yasunori Minami; Kazuomi Ueshima
    ONCOLOGY KARGER 87 110 - 117 0030-2414 2014 [Refereed]
     
    Background: Telaprevir-based antiviral therapy has been the primary treatment for chronic hepatitis C genotype 1 at a high viral load since November 2011. On the other hand, a number of patients have been reported to require withdrawal from or reduced doses of drugs due to side effects, such as eruptions, anemia, and renal dysfunction. In addition, as hepatitis C patients are growing older, it is imperative to investigate the tolerability of triple combination therapy for elderly patients. Subjects and Methods: The study subjects comprised 35 patients who received telaprevir combination therapy after November 2011. They were divided into group A (age: <65 years; n = 21) and group B (age: >= 65 years; n = 14) in order to compare the treatment completion rate, sustained virological response at week 24 (SVR24), and adverse events between the groups. Results: The treatment completion rate was 82.8% (29/35) in all subjects, 90.4% (19/21) in group A, and 78.5% (11/14) in group B. The rate was lower in group B but without a significant difference between the groups (p = 0.804). The SVR24 rate was 88.5% (31/35) in all subjects, 90.4% (19/21) in group A, and 85.7% (12/14) in group B, without a significant difference between the groups (p = 0.161). Conclusion: Although the incidence of anemia was higher in group B, there was no significant difference in the treatment completion or SVR24 rate between the groups. Telaprevir combination therapy is suggested to be tolerable for elderly hepatitis C patients. (C) 2014 S. Karger AG, Basel
  • Masashi Kono; Tatsuo Inoue; Masatoshi Kudo; Hirokazu Chishina; Tadaaki Arizumi; Masahiro Takita; Satoshi Kitai; Norihisa Yada; Satoru Hagiwara; Yasunori Minami; Kazuomi Ueshima; Naoshi Nishida; Takamichi Murakami
    Digestive diseases (Basel, Switzerland) KARGER 32 (6) 670 - 7 0257-2753 2014 [Refereed]
     
    OBJECTIVE: The purpose of this study was to evaluate the risk factors for local recurrence with radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC) measuring ≤2 cm. METHODS: This study involved 234 patients with 274 HCCs measuring ≤2 cm who had undergone RFA as the initial treatment. The mean tumor diameter was 1.478 cm. The median follow-up period was 829 days. We evaluated the post-RFA cumulative local recurrence rate and analyzed the risk factors contributing to clinical outcomes. RESULTS: Cumulative local recurrence rates were 9, 19 and 19% at 1, 2 and 3 years, respectively. Among the 145 cases with a complete safety margin (SM) after RFA, only 4 developed local tumor recurrence and the cumulative rates of local tumor recurrence at 1, 2 and 3 years were 2, 3 and 3%, respectively. Among the 129 cases with incomplete SM, local tumor recurrence developed in 34 and the cumulative rates of local tumor progression at 1, 2 and 3 years were 14, 36 and 36%, respectively. In multivariate analysis, significant risk factors were tumor location (liver surface), irregular gross type and SM <5 mm. CONCLUSION: Even with HCC measuring ≤2 cm, location and gross type of tumor should be carefully evaluated before RFA is performed.
  • Tadaaki Arizumi; Kazuomi Ueshima; Hirokazu Chishina; Masashi Kono; Mashiro Takita; Satoshi Kitai; Tatsuo Inoue; Norihisa Yada; Satoru Hagiwara; Yasunori Minami; Toshiharu Sakurai; Naoshi Nishida; Masatoshi Kudo
    Digestive diseases (Basel, Switzerland) KARGER 32 (6) 705 - 10 0257-2753 2014 [Refereed]
     
    BACKGROUND: Sorafenib is a molecular-targeting agent showing improved overall survival (OS) for advanced hepatocellular carcinoma (HCC). Although tumor dormancy, characterized by stable tumor status or stable disease (SD) without tumor regression, is a unique feature of sorafenib treatment, the contribution of SD to OS remains debatable. This study aimed to clarify the correlation between SD periods and OS in patients with HCC treated with sorafenib. METHODS: From May 2009 to January 2013, 269 patients with advanced-stage HCC were treated with sorafenib at the Kinki University Hospital. The antitumor response of sorafenib was evaluated in 158 patients using the modified Response Evaluation Criteria in Solid Tumors, and patients with SD were divided into two subgroups according to the median duration of SD: short SD (<3 months) and long SD (≥3 months). The relationship between the duration of SD and OS was analyzed among patients with complete (CR) and partial response (PR), and long and short SD using the Kaplan-Meier method. RESULTS: The median OS was 5.7 months in the short SD, 20.8 months in the long SD and 17.9 months in the CR + PR group. Although the duration of OS was significantly longer in the long SD group than the short SD group, no difference in OS was detected between the patients with CR + PR and patients with long SD. The impact of long SD on OS could be as strong as that of CR + PR. CONCLUSION: Achievement of long SD is one of the important goals for improving survival in patients with HCC treated with sorafenib.
  • Tadaaki Arizumi; Kazuomi Ueshima; Hirokazu Chishina; Masashi Kono; Masahiro Takita; Satoshi Kitai; Tatsuo Inoue; Norihisa Yada; Satoru Hagiwara; Yasunori Minami; Toshiharu Sakurai; Naoshi Nishida; Masatoshi Kudo
    Digestive diseases (Basel, Switzerland) KARGER 32 (6) 733 - 9 0257-2753 2014 [Refereed]
     
    BACKGROUND: Sorafenib is a multikinase inhibitor targeting Raf and protein tyrosine kinases, which are involved in cell growth and tumor angiogenesis. Sorafenib administration induces temporary inhibition of tumor growth and a decrease in arterial blood flow in a considerable number of hepatocellular carcinoma (HCC) patients. We retrospectively evaluated the association between decreased blood flow and the overall survival (OS) of HCC patients after the initiation of sorafenib therapy. PATIENTS AND METHODS: Therapeutic responses of 158 advanced HCC patients with hypervascular tumors who had received sorafenib for more than 1 month were analyzed. To assess their therapeutic response, patients underwent radiological evaluation before and every 4-6 weeks after the initiation of sorafenib treatment. After the classification of patients into three groups based on the change in arterial enhancement during treatment (no change, decrease and disappearance), the OS of each group was compared using the Kaplan-Meier method. RESULTS: Statistically significant differences in OS were observed among the three groups (p < 0.001). A decrease or disappearance of arterial enhancement was significantly associated with improved OS compared to patients with no change in arterial enhancement; the median OS was 19.9 months (95% confidence interval, CI, 16.4-24.5 months) and 6.0 months (95% CI, 4.0-8.8 months), respectively (p < 0.001). However, there was no difference in OS between the decrease and disappearance groups (p = 0.88). CONCLUSION: We conclude that decreased arterial enhancement during sorafenib treatment was associated with the longest OS and could therefore reflect an effective response.
  • Tadaaki Arizumi; Kazuomi Ueshima; Hirokazu Chishina; Masashi Kono; Masahiro Takita; Satoshi Kitai; Tatsuo Inoue; Norihisa Yada; Satoru Hagiwara; Yasunori Minami; Toshiharu Sakurai; Naoshi Nishida; Masatoshi Kudo
    Oncology KARGER 87 Suppl 1 32 - 6 0030-2414 2014 [Refereed]
     
    BACKGROUND: Transcatheter arterial chemoembolization (TACE) failure or refractoriness is an indication for sorafenib therapy in patients with advanced hepatocellular carcinoma. The study evaluated the validity of the definition of TACE failure or refractoriness as proposed by the Liver Cancer Study Group of Japan (LCSGJ) through a retrospective analysis of sorafenib treatment. METHODS: Out of 265 patients with advanced hepatocellular carcinoma who were treated with sorafenib at our hospital, 45 experienced TACE failure or refractoriness and were included in this study and retrospectively analyzed. RESULTS: Multivariate analysis only identified the number of ineffective TACE procedures performed before starting sorafenib treatment as significant factors. Overall survival (OS) after starting sorafenib was statistically longer in patients treated with ≤2 consecutive ineffective TACE procedures before sorafenib administration than in patients treated with ≥3 consecutive ineffective TACE procedures (p < 0.005). This result matched the LCSGJ criteria. CONCLUSION: In patients treated with sorafenib, OS was extended with ≤2 consecutive ineffective TACE procedures compared to that with ≥3 consecutive ineffective TACE procedures. Thus, if tumors are uncontrolled, TACE should not be repeated. The result of this study supports the definition of TACE failure or refractoriness proposed by the LCSGJ.

Conference Activities & Talks

  • 慢性胃炎性変化の乏しいC-0症例のたこいぼびらんに見られる腸上皮化生についての検討  [Not invited]
    辻 直子; 丸山 康典; 河野 匡志; 松本 望; 高場 雄久; 奥村 直己; 山本 典雄; 冨田 崇文; 梅原 康湖; 谷池 聡子; 森村 正嗣; 米田 円; 山田 哲; 落合 健; 前倉 俊治; 本庶 元; 工藤 正俊
    第86回日本消化器内視鏡学会総会（第21回日本消化器関連学会週間JDDW2013）  2014  グランドプリンスホテル新高輪, 東京  第86回日本消化器内視鏡学会総会（第21回日本消化器関連学会週間JDDW2013）
  • 潰瘍性大腸炎の加療中に壊疽性膿皮症および下肢深部静脈血栓症を合併した1例  [Not invited]
    松本 望; 尾崎 信人; 河野 匡志; 丸山 康典; 高場 雄久; 奥村 直己; 山本 典雄; 冨田 崇文; 梅原 康湖; 谷池 聡子; 森村 正嗣; 米田 円; 山田 哲; 辻 直子; 遠藤 英樹; 落合 健; 前倉 俊治; 工藤 正俊
    日本消化器内視鏡学会近畿支部第91回支部例会  2013/11  大阪国際交流センター, 大阪  日本消化器内視鏡学会近畿支部第91回支部例会
  • 胃Inverted hamartomatous polypの一例  [Not invited]
    尾崎 信人; 河野 匡志; 丸山 康典; 松本 望; 高場 雄久; 奥村 直己; 山本 典雄; 冨田 崇文; 梅原 康湖; 谷池 聡子; 森村 正嗣; 米田 円; 山田 哲; 辻 直子; 落合 健; 前倉 俊治; 工藤 正俊
    日本消化器内視鏡学会近畿支部第91回支部例会  2013/11  大阪国際交流センター, 大阪  日本消化器内視鏡学会近畿支部第91回支部例会
  • プロポフォール投与下内視鏡検査における飲酒患者, 睡眠薬・精神安定剤内服患者への注意点  [Not invited]
    梅原 康湖; 河野 匡志; 丸山 康典; 松本 望; 高場 雄久; 奥村 直己; 谷池 聡子; 冨田 崇文; 森村 正嗣; 山田 哲; 米田 円; 辻 直子; 工藤 正俊
    第55回日本消化器病学会大会（第21回日本消化器関連学会週間JDDW2013）  2013/10  グランドプリンスホテル新高輪, 東京  第55回日本消化器病学会大会（第21回日本消化器関連学会週間JDDW2013）
  • プロポフォール投与下内視鏡検査で生じる不随意運動の検討  [Not invited]
    梅原 康湖; 河野 匡志; 丸山 康典; 松本 望; 高場 雄久; 奥村 直己; 谷池 聡子; 冨田 崇文; 森村 正嗣; 山田 哲; 米田 円; 辻 直子; 工藤 正俊
    第86回日本消化器内視鏡学会総会（第21回日本消化器関連学会週間JDDW2013）  2013/10  グランドプリンスホテル新高輪, 東京  第86回日本消化器内視鏡学会総会（第21回日本消化器関連学会週間JDDW2013）
  • 上部消化管内視鏡検査前スクリーニングとして実施した胸部X-rayおよび心電図より得られた所見についての検討  [Not invited]
    谷池 聡子; 河野 匡志; 丸山 康典; 松本 望; 高場 雄久; 奥村 直己; 冨田 崇文; 梅原 康湖; 森村 正嗣; 米田 円; 山田 哲; 辻 直子; 工藤 正俊
    86回日本消化器内視鏡学会総会（第21回日本消化器関連学会週間JDDW2013）  2013/10  グランドプリンスホテル新高輪, 東京  86回日本消化器内視鏡学会総会（第21回日本消化器関連学会週間JDDW2013）
  • 転移性腫瘍との鑑別を要した肝腫瘤を合併した十二指腸乳頭部癌の1例.  [Not invited]
    谷池 聡子; 尾崎 信人; 丸山 康典; 河野 匡志; 松本 望; 高場 雄久; 奥村 直己; 山本 典雄; 冨田 崇文; 梅原 康湖; 森本 正嗣; 米田 円; 山田 哲; 辻 直子; 船井 貞往; 落合 健; 前倉 俊治; 工藤 正俊
    日本消化器病学会近畿支部第99回例会  2013/09  大阪国際交流センター, 大阪  日本消化器病学会近畿支部第99回例会
  • 十二指腸水平部過形成性ポリープをスネアポリペクトミーした1例  [Not invited]
    丸山 康典; 河野 匡志; 松本 望; 高場 雄久; 奥村 直己; 山本 典雄; 冨田 崇文; 梅原 康湖; 谷池 聡子; 森村 正嗣; 山田 哲; 辻 直子; 落合 健; 前倉 俊治; 南 康範; 工藤 正俊
    日本消化器内視鏡学会近畿支部第90回例会  2013/06  日本消化器内視鏡学会近畿支部第90回例会
  • Time trends for helicobactor pylori eradication rate of the first-line and second-line Japanese regimens and clarithromycin resistance.  [Not invited]
    辻 直子; 奥村 直己; 谷池 聡子; 高場 雄久; 松本 望; 河野 匡志; 丸山 康典; 工藤 正俊
    Digestive Disease Week(DDW) 2013  2013/05  Orlando, USA  Digestive Disease Week(DDW) 2013
  • Verrucous antral gastritis is not related to H. pylori-positive chronic gastritis, but is related to a high BMI and barrett's esophagus.  [Not invited]
    辻 直子; 奥村 直己; 谷池 聡子; 高場 雄久; 松本 望; 河野 匡志; 丸山 康典; 工藤 正俊
    Digestive Disease Week(DDW) 2013  2013/05  Orlando, USA  Digestive Disease Week(DDW) 2013
  • 閉塞黄疸を合併した黄色肉芽腫性胆嚢炎の一例  [Not invited]
    河野 匡志; 丸山 康典; 松本 望; 高場 雄久; 奥村 直己; 山本 典雄; 冨田 崇文; 梅原 康湖; 谷池 聡子; 森村 正嗣; 米田 円; 山田 哲; 辻 直子; 船井 貞往; 落合 健; 前倉 俊治; 南 康範; 工藤 正俊
    日本消化器病学会近畿支部第98回例会  2013/02  神戸ポートピアホテル, 兵庫  日本消化器病学会近畿支部第98回例会
  • 閉塞性黄疸を合併した黄色肉芽腫性胆のう炎の1例  [Not invited]
    河野 匡志; 丸山 康典; 松本 望; 高場 雄久; 奥村 直己; 山本 典雄; 冨田 崇文; 梅原 康湖; 谷池 聡子; 森村 正嗣; 米田 円; 山田 哲; 辻 直子; 船井 貞往; 落合 健; 前倉 俊治; 南 康範; 工藤 正俊
    日本消化器病学会近畿支部第98回例会  2013/02  日本消化器病学会近畿支部第98回例会
  • 生検で消失したバレット腺癌の一例  [Not invited]
    丸山 康典; 河野 匡志; 松本 望; 高場 雄久; 奥村 直己; 山本 典雄; 富田 崇文; 梅原 康湖; 谷池 聡子; 森村 正嗣; 山田 哲; 辻 直子; 落合 健; 前倉 俊治; 南 康範; 工藤 正俊
    日本消化器内視鏡学会近畿支部第89回支部例会  2012/11  大阪国際交流センター, 大阪  日本消化器内視鏡学会近畿支部第89回支部例会
  • 当院におけるH.pylori除菌の年次変化（2001年～2010年）  [Not invited]
    丸山 康典; 辻 直子; 河野 匡志; 松本 望; 高場 雄久; 奥村 直己; 山本 典雄; 冨田 崇文; 梅原 康湖; 森村 正嗣; 米田 円; 山田 哲; 落合 健; 南 康範; 工藤 正俊; 本庶 元
    第20回日本消化器関連学会週間JDDW2012（第16回日本肝臓学会大会・第54回日本消化器病学会大会・第84回日本消化器内視鏡学会総会・第10回日本消化器外科学会大会・第50回日本消化器がん検診学会  2012/10  神戸国際展示場, 兵庫  第20回日本消化器関連学会週間JDDW2012（第16回日本肝臓学会大会・第54回日本消化器病学会大会・第84回日本消化器内視鏡学会総会・第10回日本消化器外科学会大会・第50回日本消化器がん検診学会
  • 当院におけるH.pylori CAM耐性の年次変化（2001年～2010年）  [Not invited]
    河野 匡志; 辻 直子; 丸山 康典; 松本 望; 高場 雄久; 奥村 直己; 山本 典雄; 冨田 崇文; 梅原 康湖; 森村 正嗣; 米田 円; 山田 哲; 落合 健; 南 康範; 工藤 正俊; 本庶 元
    第20回日本消化器関連学会週間JDDW2012（第16回日本肝臓学会大会・第54回日本消化器病学会大会・第84回日本消化器内視鏡学会総会・第10回日本消化器外科学会大会・第50回日本消化器がん検診学会  2012/10  神戸国際展示場, 兵庫  第20回日本消化器関連学会週間JDDW2012（第16回日本肝臓学会大会・第54回日本消化器病学会大会・第84回日本消化器内視鏡学会総会・第10回日本消化器外科学会大会・第50回日本消化器がん検診学会
  • Helicobacter pylori除菌前後の内視鏡所見の比較検討  [Not invited]
    奥村 直己; 辻 直子; 工藤 正俊; 山本 典雄; 高場 雄久; 松本 望; 冨田 崇文; 森村 正嗣; 山田 哲; 米田 円; 南 康範; 丸山 康典; 河野 匡志; 梅原 康湖
    第20回日本消化器関連学会週間JDDW2012（第16回日本肝臓学会大会・第54回日本消化器病学会大会・第84回日本消化器内視鏡学会総会・第10回日本消化器外科学会大会・第50回日本消化器がん検診学会  2012/10  神戸国際展示場, 兵庫  第20回日本消化器関連学会週間JDDW2012（第16回日本肝臓学会大会・第54回日本消化器病学会大会・第84回日本消化器内視鏡学会総会・第10回日本消化器外科学会大会・第50回日本消化器がん検診学会
  • 1年以上の下痢，下血で受診した腸重積合併1型S状結腸がんの1例  [Not invited]
    河野 匡志; 丸山 康典; 松本 望; 高場 雄久; 奥村 直己; 冨田 崇文; 梅原 康湖; 谷池 聡子; 森村 正嗣; 米田 円; 山田 哲; 辻 直子; 亀井 敬子; 田中 晃; 落合 健; 前倉 俊治; 南 康範; 工藤 正俊
    日本消化器病学会近畿支部大97会例会  2012/09  京都市  日本消化器病学会近畿支部大97会例会
  • 糖尿病に対しインスリン導入後早期に発症した腫瘤形成性膵炎の1例. Freshman Session「肝胆膵」  [Not invited]
    安達 融; 谷浦 允厚; 河野 匡志; 松本 望; 高場 雄久; 奥村 直己; 山本 典雄; 冨田 崇文; 梅原 康湖; 森村 正嗣; 米田 円; 山田 哲; 辻 直子; 野口 周也; 大野 恭裕; 落合 健; 前倉 俊治; 南 康範; 工藤 正俊
    日本消化器病学会近畿支部第96回例会  2012/01  大阪国際交流センター, 大阪  日本消化器病学会近畿支部第96回例会
  • 成人腸重積で発症した盲腸癌の1例. Freshman Session「消化管」  [Not invited]
    谷浦 允厚; 安達 融; 河野 匡志; 松本 望; 高場 雄久; 奥村 直己; 山本 典雄; 冨田 崇文; 梅原 康湖; 森村 正嗣; 米田 円; 山田 哲; 辻 直子; 亀井 敬子; 北野 義徳; 田中 晃; 落合 健; 前倉 俊治; 南 康範; 工藤 正俊
    日本消化器病学会近畿支部第96回例会  2012/01  大阪国際交流センター, 大阪  日本消化器病学会近畿支部第96回例会
  • 伊藤 裕進; 河野 匡志; 川畑 由美子; 山内 孝哲; 能宗 伸輔; 馬場谷 成; 原田 剛史; 廣峰 義久; 守口 将典; 池上 博司
    第12回日本内分泌学会近畿支部学術集会  2011/10  神戸市  第12回日本内分泌学会近畿支部学術集会

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