KINDAI UNIVERSITY


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TAKENAKA Mamoru

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FacultyDepartment of Medicine
PositionLecturer in Medical School
DegreePh. D. in Medicine
Commentator Guidehttps://www.kindai.ac.jp/meikan/2247-takenaka-mamoru.html
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Last Updated :2020/09/30

Education and Career

Education

  •  - 2013 09 , Kobe University, Graduate School of Medicine

Research Activities

Research Areas

  • Life sciences, Gastroenterology

Published Papers

  • COMPARISON OF THE EFFICACY AND SAFETY OF ENDOSCOPIC ULTRASOUND-GUIDED CHOLEDOCHODUODENOSTOMY AND HEPATICOGASTROSTOMY FOR MALIGNANT DISTAL BILIARY OBSTRUCTION: MULTICENTER, RANDOMIZED, CLINICAL TRIAL, MINAGA Kosuke, KATO Hironari, KAMADA Hideki, OKUDA Atsushi, SAGAMI Ryota, HASHIMOTO Hiroaki, HIGUCHI Kazuhide, CHIBA Yasutaka, KUDO Masatoshi, KITANO Masayuki, OGURA Takeshi, SHIOMI Hideyuki, IMAI Hajime, HOKI Noriyuki, TAKENAKA Mamoru, NISHIKIORI Hidefumi, YAMASHITA Yukitaka, HISA Takeshi, GASTROENTEROLOGICAL ENDOSCOPY, GASTROENTEROLOGICAL ENDOSCOPY, 62(7), 817 - 826, 2020 , Refereed
    Summary:

    Background and Aim: Endoscopic ultrasound-guided biliary drainage (EUS-BD) can be carried out by two different approaches: choledochoduodenostomy (CDS) and hepaticogastrostomy (HGS). We compared the efficacy and safety of these approaches in malignant distal biliary obstruction (MDBO) patients using a prospective, randomized clinical trial.

    Methods: Patients with malignant distal biliary obstruction after failed endoscopic retrograde cholangiopancreatography were randomly selected for either CDS or HGS. The procedures were carried out at nine tertiary centers from September 2013 to March 2016. Primary endpoint was technical success rate, and the noninferiority of HGS to CDS was examined with a onesided significance level of 5%, where the noninferiority margin was set at 15%. Secondary endpoints were clinical success, adverse events (AE), stent patency, survival time, and overall technical success including alternative EUS-BD procedures.

    Results: Forty-seven patients (HGS, 24; CDS, 23) were enrolled. Technical success rates were 87.5% and 82.6% in the HGS and CDS groups, respectively, where the lower limit of the 90% confidence interval of the risk difference was -12.2% (P=0.0278). Clinical success rates were 100% and 94.7% in the HGS and CDS groups, respectively (P=0.475). Overall AE rate, stent patency, and survival time did not differ between the groups. Overall technical success rates were 100% and 95.7% in the HGS and CDS groups, respectively (P=0.983).

    Conclusions: This study suggests that HGS is not inferior to CDS in terms of technical success. When one procedure is particularly challenging, readily switching to the other could increase technical success.

  • Association between Genetic and Immunological Background of Hepatocellular Carcinoma and Expression of Programmed Cell Death-1, Naoshi Nishida, Kazuko Sakai, Masahiro Morita, Tomoko Aoki, Masahiro Takita, Satoru Hagiwara, Yoriaki Komeda, Mamoru Takenaka, Yasunori Minami, Hiroshi Ida, Kazuomi Ueshima, Kazuto Nishio, Masatoshi Kudo, Liver Cancer, Liver Cancer, 2020 , Refereed
  • Low-dose rectal diclofenac does not prevent post-ERCP pancreatitis in low- or high-risk patients., Katoh T, Kawashima K, Fukuba N, Masuda S, Kobatake H, Masaki K, Araki Y, Kawano K, Nishi K, Takenaka M, Ishihara S, Kinoshita Y, Journal of gastroenterology and hepatology, Journal of gastroenterology and hepatology, Dec. 2019 , Refereed
  • Conversion of percutaneous transhepatic gallbladder drainage to endoscopic ultrasound‐guided hepaticogastrostomy by the intentional expansion method, Mamoru Takenaka, Ken Kamata, Masatoshi Kudo, Digestive Endoscopy, Digestive Endoscopy, 31(6), 718, Nov. 2019 , Refereed
  • Novel concept of bared type metallic stent for endoscopic bilateral stent-in-stent placement in patients with hilar malignant biliary obstruction (with video)., Takenaka M, Nakai A, Kudo M, Journal of hepato-biliary-pancreatic sciences, Journal of hepato-biliary-pancreatic sciences, Nov. 2019 , Refereed
  • Can Localized Stenosis of the Main Pancreatic Duct be a Predictive Factor for Early Detection of Pancreatic Cancer?, Takenaka M, Yamao K, Kudo M, Clinical endoscopy, Clinical endoscopy, 52(6), 523 - 524, Nov. 2019 , Refereed
  • LENVATINIB AS AN INITIAL TREATMENT IN PATIENTS WITH INTERMEDIATE-STAGE HEPATOCELLULAR CARCINOMA BEYOND UP-TO-SEVEN CRITERIA AND CHILD-PUGH A LIVER FUNCTION: A MULTICENTER PROPENSITY-SCORE MATCHED STUDY, Kudo Masatoshi, Ueshima Kazuomi, Chan Stephen L, Minami Tomohiro, Chishina Hirokazu, Aoki Tomoko, Takita Masahiro, Hagiwara Satoru, Minami Yasunori, Ida Hiroshi, Takenaka Mamoru, Sakurai Toshiharu, Watanabe Tomohiro, Morita Masahiro, Ogawa Chikara, Wada Yoshiyuki, Ikeda Masafumi, Ishii Hiroshi, Izumi Namiki, Nishida Naoshi, HEPATOLOGY, HEPATOLOGY, 70, 133A - 134A, Oct. 2019 , Refereed
  • Single-session multiple stent deployment using moving cell stent without dilating initial stent mesh to treat malignant hilar biliary obstruction (with videos)., Ogura T, Takenaka M, Shiomi H, Nishioka N, Ueno S, Miyano A, Kamiyama R, Higuchi K, Journal of hepato-biliary-pancreatic sciences, Journal of hepato-biliary-pancreatic sciences, Oct. 2019 , Refereed
  • Large balloon expansion method for re-intervention after endoscopic ultrasound-guided hepaticogastrostomy for stent obstruction, Takenaka Mamoru, Nakai Atsushi, Kudo Masatoshi, DIGESTIVE ENDOSCOPY, DIGESTIVE ENDOSCOPY, 31(5), E99 - E100, Sep. 2019 , Refereed
  • Long-term outcomes of EUS-guided transluminal stent deployment for benign biliary disease: Multicenter clinical experience (with videos)., Ogura T, Takenaka M, Shiomi H, Goto D, Tamura T, Hisa T, Kato H, Nishioka N, Minaga K, Masuda A, Onoyama T, Kudo M, Higuchi K, Kitano M, Endoscopic ultrasound, Endoscopic ultrasound, Sep. 2019 , Refereed
  • CLINICAL UTILITY OF ENDOSCOPIC ULTRASOUND-GUIDED DRAINAGE USING CONTRAST-ENHANCED HARMONIC IMAGING IN CASES WITH DIFFICULTIES, Minaga Kosuke, Takenaka Mamoru, Yoshikawa Tomoe, Okamoto Ayana, Ishikawa Rei, Yamazaki Tomohiro, Nakai Atsushi, Omoto Shunsuke, Kamata Ken, Yamao Kentaro, Kudo Masatoshi, GASTROINTESTINAL ENDOSCOPY, GASTROINTESTINAL ENDOSCOPY, 89(6), AB299, Jun. 2019 , Refereed
  • ENDOSCOPIC UTRASOUND-GUDED CHOLEDOCHODUODENOSTOMY USING A THIN STENT DELIVERY SYSTEM IN PATIENTS WITH UNRESECTABLE MALIGNANT DISTAL BILIARY OBSTRUCTION: A PROSPECTIVE MYLTICENTER STUDY, Itonaga Masahiro, Kitano Masayuki, Hatamaru Keiichi, Tamura Takashi, Nuta Junya, Kawaji Yuki, Takenaka Mamoru, Minaga Kosuke, Kudo Masatoshi, Ogura Takeshi, Higuchi Kazuhide, Chiba Yasutaka, GASTROINTESTINAL ENDOSCOPY, GASTROINTESTINAL ENDOSCOPY, 89(6), AB315, Jun. 2019 , Refereed
  • LONG-TERM OUTCOMES OF EUS-GUIDED TRANSLUMINAL STENT DEPLOYEMNT FOR BENIGN BILIARY DISEASE: MULTICENTER CLINICAL EXPERIENCE, Ogura Takeshi, Takenaka Mamoru, Shiomi Hideyuki, Goto Daisuke, Hisa Takeshi, Tamura Takashi, Kato Hironari, Nishioka Nobu, Minaga Kosuke, Kudo Masatoshi, Higuchi Kazuhide, Kitano Masayuki, GASTROINTESTINAL ENDOSCOPY, GASTROINTESTINAL ENDOSCOPY, 89(6), AB297, Jun. 2019 , Refereed
  • VALUE OF THE BISPECTRAL INDEX MONITOR DURING ENDOSCOPIC ULTRASONOGRAPHY UNDER SEDATION WITH PROPOFOL AND MIDAZOLAM, Okamoto Ayana, Kamata Ken, Takenaka Mamoru, Yoshikawa Tomoe, Ishikawa Rei, Yamazaki Tomohiro, Nakai Atsushi, Omoto Shunsuke, Minaga Kosuke, Yamao Kentaro, Kudo Masatoshi, GASTROINTESTINAL ENDOSCOPY, GASTROINTESTINAL ENDOSCOPY, 89(6), AB602 - AB603, Jun. 2019 , Refereed
  • LINEAR EUS TRAINING BY USING SYSTEMATIC SCREENING PROTCOL FOR THE PANCREATOBILIARY SYSTEM, Omoto Shunsuke, Takenaka Mamoru, Ishikawa Rei, Okamoto Ayana, Nakai Atsushi, Yamazaki Tomohiro, Minaga Kosuke, Kamata Ken, Yamao Kentaro, Kudo Masatoshi, GASTROINTESTINAL ENDOSCOPY, GASTROINTESTINAL ENDOSCOPY, 89(6), AB584, Jun. 2019 , Refereed
  • THE USEFULNESS OF NOVEL CANNULATION METHOD USING A UNIQUE, DOUBLE LUMENS CATHETER (UNEVEN METHOD) FOR THE PATIENTS WITH SURGICALLY ALTERED GASTROINTESTINAL ANATOMY, Takenaka Mamoru, Yoshikawa Tomoe, Ishikawa Rei, Okamoto Ayana, Yamazaki Tomohiro, Nakai Atsushi, Omoto Shunsuke, Minaga Kosuke, Kamata Ken, Yamao Kentaro, Kudo Masatoshi, GASTROINTESTINAL ENDOSCOPY, GASTROINTESTINAL ENDOSCOPY, 89(6), AB223, Jun. 2019 , Refereed
  • EXAMINATION OF ACTUAL RADIATION EXPOSURE DOSE OF THE PATIENTS WHO PERFORMED EUS-GUIDED DRAINAGE (EUS-BD/EUS-PD/EUS-CD), Takenaka Mamoru, Hayashi Shiro, Nishida Tsutomu, Hosono Makoto, Yoshikawa Tomoe, Ishikawa Rei, Okamoto Ayana, Yamazaki Tomohiro, Nakai Atsushi, Omoto Shunsuke, Minaga Kosuke, Kamata Ken, Yamao Kentaro, Kudo Masatoshi, GASTROINTESTINAL ENDOSCOPY, GASTROINTESTINAL ENDOSCOPY, 89(6), AB444 - AB445, Jun. 2019 , Refereed
  • The IFN-α-IL-33 Axis as Possible Biomarkers in IgG4-Related Disease, Kosuke Minaga, Tomohiro Watanabe, Ken Kamata, Mamoru Takenaka, Satoru Yasukawa, Masatoshi Kudo, The American Journal of Gastroenterology, The American Journal of Gastroenterology, 114(6), 1002 - 1003, Jun. 2019
  • Novel metallic stent designed for endoscopic bilateral stent-in-stent placement in patients with hilar malignant biliary obstruction., Takenaka M, Yamao K, Minaga K, Nakai A, Omoto S, Kamata K, Kudo M, Endoscopy, Endoscopy, 51(2), E30 - E31, Feb. 2019 , Refereed
  • The underutilization of EUS-guided biliary drainage: Perception of endoscopists in the East and West., Yoon WJ, Park DH, Choi JH, Jang S, Samarasena J, Lee TH, Paik WH, Oh D, Song TJ, Choi JH, Hara K, Iwashita T, Perez-Miranda M, Lee JG, Vazquez-Sequeiros E, Naitoh I, Vila JJ, Brugge WR, Takenaka M, Lee SS, Seo DW, Lee SK, Kim MH, Endoscopic ultrasound, Endoscopic ultrasound, Feb. 2019 , Refereed
  • VALUE OF ADDITIONAL ENDOSCOPIC ULTRASONOGRAPHY FOR SURVEILLANCE AFTER SURGICAL REMOVAL OF INTRADUCTAL PAPILLARY MUCINOUS NEOPLASMS, KAMATA Ken, CHIBA Yasutaka, WATANABE Tomohiro, SAKURAI Toshiharu, NISHIDA Naoshi, CHIKUGO Takaaki, MATSUMOTO Ippei, TAKEYAMA Yoshifumi, KITANO Masayuki, KUDO Masatoshi, TAKENAKA Mamoru, MINAGA Kosuke, OMOTO Shunsuke, MIYATA Takeshi, YAMAO Kentaro, IMAI Hajime, NAKAI Atsushi, TANAKA Hidekazu, GASTROENTEROLOGICAL ENDOSCOPY, GASTROENTEROLOGICAL ENDOSCOPY, 61(4), 417 - 426, 2019 , Refereed
    Summary:

    Background and Aim: This study evaluated the utility of endoscopic ultrasonography (EUS) combined with contrast-enhanced harmonic EUS (CH-EUS) for surveillance of the remnant pancreas after surgery for intraductal papillary mucinous neoplasm (IPMN).

    Methods: This was a single-center, retrospective, descriptive study. A total of 134 consecutive patients who underwent surgical resection for IPMN between April 2009 and March 2015 were evaluated. Rates of recurrence and development of IPMN-concomitant pancreatic ductal adenocarcinoma (PDAC) during follow up were assessed. Clinical findings of patients with recurrence or development of PDAC were also evaluated.

    Results: Of 134 resected IPMN 56 (41.8%) and 78 (58.2%) were classified as benign and malignant, respectively. Patients were followed up for a median of 29 months, 33 (24.6%) by both contrast-enhanced computed tomography (CE-CT) and EUS, and 101 (75.4%) by computed tomography (CT) alone. Thirteen patients (9.7%) showed tumor recurrence, five with intra-pancreatic recurrence and eight with extra-pancreatic metastases. An enhancing mural nodule within the dilated main pancreatic duct was successfully detected by EUS in one patient, but not by CE-CT. Two patients developed IPMN-concomitant PDAC during follow up. EUS combined with CH-EUS successfully detected small IPMN-concomitant PDAC in two patients, whereas these lesions were not detected by CT. CH-EUS was useful for better visualization of the margins of IPMN-concomitant PDAC in one of these two patients.

    Conclusion: Endoscopic ultrasonography combined with CH-EUS may improve follow up of patients with resected IPMN.

  • Verrucous antral gastritis in relation to Helicobacter pylori infection, nutrition, and gastric atrophy, Tsuji N, Umehara Y, Takenaka M, Minami Y, Watanabe T, Nishida N, Kudo M, 2019 , Refereed
  • Novel concept using a plastic stent for endoscopic ultrasound-guided hepaticogastrostomy adjusting the length according to the patient's anatomy, Mamoru Takenaka, Kosuke Minaga, Tomoe Yoshikawa, Ayana Okamoto, Atsushi Nakai, Shunsuke Omoto, Masatoshi Kudo, Endoscopy, Endoscopy, 51, Jan. 01 2019
  • A novel technique for stent dysfunction after endoscopic ultrasound-guided hepaticogastrostomy with antegrade stenting, Ayana Okamoto, Kosuke Minaga, Mamoru Takenaka, Tomoe Yoshikawa, Ken Kamata, Kentaro Yamao, Masatoshi Kudo, Endoscopy, Endoscopy, 51, Jan. 01 2019
  • Novel sphincterotomy device that orientates blade along the axis of the bile duct in patients with Roux-en-Y anastomosis, Mamoru Takenaka, Tomoe Yoshikawa, Ayana Okamoto, Atsushi Nakai, Kosuke Minaga, Kentaro Yamao, Masatoshi Kudo, Endoscopy, Endoscopy, 51, Jan. 01 2019
  • Hemorrhage from metastasis of a 5-mm renal cell carcinoma lesion to the gallbladder detected by contrast-enhanced endoscopic ultrasonography., Takenaka M, Okabe Y, Kudo M, Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver, Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver, 51(5), 743, Nov. 2018 , Refereed
  • Novel method of biliary cannulation for patients with Roux-en-Y anastomosis using a unique, uneven, double-lumen cannula (Uneven method)., Takenaka M, Yamao K, Kudo M, Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society, Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society, 30(6), 808 - 809, Nov. 2018 , Refereed
  • Endoscopic ultrasound-guided choledochoduodenostomy using a thin stent delivery system in patients with unresectable malignant distal biliary obstruction: a prospective multicenter study., Itonaga M, Kitano M, Hatamaru K, Tamura T, Nuta J, Kawaji Y, Takenaka M, Minaga K, Kudo M, Ogura T, Higuchi K, Chiba Y, Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society, Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society, 31(3), 291, Nov. 2018 , Refereed
  • A case of EUS-guided pancreatic duct rendezvous stenting in which initial contrast medium injection was useful for the second puncture., Omoto S, Takenaka M, Kudo M, Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society, Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society, 31(1), e20 - e21, Oct. 2018 , Refereed
  • Cannulation method for intradiverticular papilla with long oral protrusion using biopsy forceps for axis alignment., Takenaka M, Minaga K, Kudo M, Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society, Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society, 30(5), 700 - 701, Sep. 2018 , Refereed
  • Neurilemmoma Mimicking a Multilocular Cystic Lesion of the Liver: A Case Report., Yoshida A, Yamao K, Takenaka M, Nakai A, Omoto S, Kamata K, Minaga K, Miyata T, Imai H, Matsumoto I, Takeyama Y, Chikugo T, Kudo M, Internal medicine (Tokyo, Japan), Internal medicine (Tokyo, Japan), Aug. 2018 , Refereed
  • Endoscopic nasobiliary drainage tube-guided scope insertion technique for internal drainage in a case of difficult selective biliary duct guiding., Takenaka M, Minaga K, Kudo M, Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society, Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society, 31(1), e1, Aug. 2018 , Refereed
  • SIMILAR EFFICACY AND SAFETY OF ENDOSCOPIC ULTRASOUND-GUIDED BILIARY DRAINAGE VIA HEPATICOGASTROSTOMY AND CHOLEDOCHODUODENOSTOMY APPROACHES FOR MALIGNANT DISTAL BILIARY OBSTRUCTION: A MULTICENTER, PROSPECTIVE, RANDOMIZED TRIAL, Minaga Kosuke, Kitano Masayuki, Ogura Takeshi, Shiomi Hideyuki, Hoki Noriyuki, Nishikiori Hidefumi, Yamashita Yukitaka, Hisa Takeshi, Kato Hironari, Kamada Hideki, Takenaka Mamoru, Higuchi Kazuhide, Chiba Yasutaka, Kudo Masatoshi, GASTROINTESTINAL ENDOSCOPY, GASTROINTESTINAL ENDOSCOPY, 87(6), AB147, Jun. 2018 , Refereed
  • A MULTICENTER PROSPECTIVE STUDY OF EUS-GUIDED HEPATICOGASTROSTOMY COMBINED WITH ANTEGRADE STENT PLACEMENT, Ogura Takeshi, Kitano Masayuki, Takenaka Mamoru, Minaga Kosuke, Yamao Kentaro, Yamashita Yukitaka, Hatamaru Keiichi, Noguchi Chishio, Kuroda Taira, Nishikiori Hidefumi, Higuchi Kazuhide, Chiba Yasutaka, GASTROINTESTINAL ENDOSCOPY, GASTROINTESTINAL ENDOSCOPY, 87(6), AB146, Jun. 2018 , Refereed
  • THE EFFICIENCY AND SAFETY OF ENDOSCPIC SPHINCTEROTOMY TO PREVENT POST-ERCP PANCREATITIS IN BILIARY NEOPLASM; A MULTICENTER RETROSPECTIVE COHORT STUDY, Tamura Takashi, Itonaga Masahiro, Yamao Kentaro, Imanishi Miyuki, Minaga Kosuke, Hirono Seiko, Okada Ken-ichi, Higuchi Kazuhide, Takenaka Mamoru, Ogura Takeshi, Yamaue Hiroki, Kitano Masayuki, GASTROINTESTINAL ENDOSCOPY, GASTROINTESTINAL ENDOSCOPY, 87(6), AB227 - AB228, Jun. 2018 , Refereed
  • NEW METHOD FOR DIFFICULT BILIARY CANNULATION USING THE NOVEL UNEVEN DOUBLE LUMEN CANNULA (DLC METHOD), Takenaka Mamoru, Nakai Atsushi, Omoto Shunsuke, Miyata Takeshi, Minaga Kosuke, Kamata Ken, Yamao Kentaro, Imai Hajime, Kudo Masatoshi, GASTROINTESTINAL ENDOSCOPY, GASTROINTESTINAL ENDOSCOPY, 87(6), AB209 - AB210, Jun. 2018 , Refereed
  • Contrast-enhanced harmonic EUS imaging of pancreatic mucinous cystadenocarcinoma, Hidekazu Tanaka, Ken Kamata, Mamoru Takenaka, Masatoshi Kudo, Internal Medicine, Internal Medicine, 57, 3051 - 3052, Jan. 01 2018
  • CONTRAST-ENHANCED HARMONIC ENDOSCOPIC ULTRASONOGRAPHY FOR DIFFERENTIAL DIAGNOSIS OF LOCALIZED GALLBLADDER LESIONS, KAMATA Ken, NISHIDA Naoshi, KASHIDA Hiroshi, CHIKUGO Takaaki, CHIBA Yasutaka, NAKAI Takuya, TAKEYAMA Yoshifumi, LISOTTI Andrea, FUSAROLI Pietro, KUDO Masatoshi, TAKENAKA Mamoru, KITANO Masayuki, OMOTO Shunsuke, MIYATA Takeshi, MINAGA Kosuke, YAMAO Kentaro, IMAI Hajime, SAKURAI Tosiharu, GASTROENTEROLOGICAL ENDOSCOPY, GASTROENTEROLOGICAL ENDOSCOPY, 60(9), 1611 - 1620, 2018
    Summary:

    Background and Aim: Differential diagnosis of localized gallbladder lesions is challenging. The aim of the present study was to evaluate the utility of contrast-enhanced harmonic endoscopic ultrasonography (CH-EUS) for diagnosis of localized gallbladder lesions.

    Methods: One hundred and twenty-five patients with localized gallbladder lesions were evaluated by CH-EUS between March 2007 and February 2014. This was a single-center retrospective study. Utilities of fundamental B-mode EUS (FB-EUS) and CH-EUS in the differentiation of gallbladder lesions and sludge plug were initially compared. Thereafter, these two examinations were compared with respect to their accuracy in the diagnosis of malignant lesions. Five reviewers blinded to the clinicopathological results evaluated microcirculation patterns in the vascular and perfusion images.

    Results: In the differentiation between gallbladder lesions and sludge plug, FB-EUS had a sensitivity, specificity, and accuracy of 82%, 100%, and 95%, respectively, whereas CH-EUS had a sensitivity, specificity, and accuracy of 100%, 99%, and 99%, respectively. FB-EUS-based diagnosis of carcinomas based on tumor size and/or shape had a sensitivity, specificity, and accuracy of 61-87%, 71-88%, and 74-86%, respectively. Additional information regarding irregular vessel patterns in the vascular image and/or heterogeneous enhancement in the perfusion image on CH-EUS increased the sensitivity, specificity, and accuracy for the diagnosis of carcinomas to 90%, 98%, and 96%, respectively. There was a significant difference between FB-EUS and CH-EUS in terms of carcinoma diagnosis.

    Conclusion: CH-EUS was useful for the evaluation of localized gallbladder lesions.

  • Erythropoietic Protoporphyria-related Hepatopathy Successfully Treated with Phlebotomy., Yoshida A, Hagiwara S, Watanabe T, Nishida N, Ida H, Sakurai T, Komeda Y, Yamao K, Takenaka M, Enoki E, Kimura M, Miyake M, Kawada A, Kudo M, Internal medicine (Tokyo, Japan), Internal medicine (Tokyo, Japan), 57(17), 2505 - 2509, 2018 , Refereed
  • Utility of contrast-enhanced harmonic EUS for evaluating the effects of steroid therapy in a case of immunoglobulin G4-negative focal autoimmune pancreatitis, Douglas G. Adler, Massimo Raimondo, GASTROINTESTINAL ENDOSCOPY, GASTROINTESTINAL ENDOSCOPY, 86(6), 1177 - 1179, Dec. 2017
  • Gankyrin induces STAT3 activation in tumor microenvironment and sorafenib resistance in hepatocellular carcinoma, Toshiharu Sakurai, Norihisa Yada, Satoru Hagiwara, Tadaaki Arizumi, Kosuke Minaga, Ken Kamata, Mamoru Takenaka, Yasunori Minami, Tomohiro Watanabe, Naoshi Nishida, Masatoshi Kudo, Cancer Science, Cancer Science, 108, 1996 - 2003, Oct. 01 2017
    Summary:© 2017 The Authors. Cancer Science published by John Wiley & Sons Australia, Ltd on behalf of Japanese Cancer Association. Most hepatocellular carcinomas (HCC) develop as a result of chronic liver inflammation. We have shown that the oncoprotein gankyrin is critical for inflammation-induced tumorigenesis in the colon. Although the in vitro function of gankyrin is well known, its role in vivo remains to be elucidated. We investigated the effect of gankyrin in the tumor microenvironment of mice with liver parenchymal cell-specific gankyrin ablation (Alb-Cre;gankyrinf/f) and gankyrin deletion both in liver parenchymal and non-parenchymal cells (Mx1-Cre;gankyrinf/f). Gankyrin upregulates vascular endothelial growth factor expression in tumor cells. Gankyrin binds to Src homology 2 domain-containing protein tyrosine phosphatase-1 (SHP-1), mainly expressed in liver non-parenchymal cells, resulting in phosphorylation and activation of signal transducer and activator of transcription 3 (STAT3). Gankyrin deficiency in non-parenchymal cells, but not in parenchymal cells, reduced STAT3 activity, interleukin (IL)-6 production, and cancer stem cell marker (Bmi1 and epithelial cell adhesion molecule [EpCAM]) expression, leading to attenuated tumorigenic potential. Chronic inflammation enhances gankyrin expression in the human liver. Gankyrin expression in the tumor microenvironment is negatively correlated with progression-free survival in patients undergoing sorafenib treatment for HCC. Thus, gankyrin appears to play a critical oncogenic function in tumor microenvironment and may be a potential target for developing therapeutic and preventive strategies against HCC.
  • EUS-guided approaches for bile duct stones: A single-center experience, Minaga Kosuke, Takenaka Mamoru, Kamata Ken, Miyata Takeshi, Yamao Kentaro, Imai Hajime, Omoto Shunsuke, Nakai Atsushi, Yoshikawa Tomoe, Watanabe Tomohiro, Kudo Masatoshi, JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, 32, 240, Sep. 2017 , Refereed
  • Evaluation of resectability for pancreatic cancer using endoscopic ultrasound, Masayuki Kitano, Mamoru Takenaka, Kosuke Minaga, Takeshi Miyata, Ken Kamata, Innovation of Diagnosis and Treatment for Pancreatic Cancer, Innovation of Diagnosis and Treatment for Pancreatic Cancer, 13 - 28, Jul. 19 2017
  • Chronic Fibro-Inflammatory Responses in Autoimmune Pancreatitis Depend on IFN-alpha and IL-33 Produced by Plasmacytoid Dendritic Cells, Tomohiro Watanabe, Kouhei Yamashita, Yasuyuki Arai, Kosuke Minaga, Ken Kamata, Tomoyuki Nagai, Yoriaki Komeda, Mamoru Takenaka, Satoru Hagiwara, Hiroshi Ida, Toshiharu Sakurai, Naoshi Nishida, Warren Strober, Masatoshi Kudo, JOURNAL OF IMMUNOLOGY, JOURNAL OF IMMUNOLOGY, 198(10), 3886 - 3896, May 2017
    Summary:In previous studies, we found that human IgG4-related autoimmune pancreatitis (AIP) and murine AIP are driven by activation of plasmacytoid dendritic cells (pDCs) producing IFN-alpha. In the present studies we examined additional roles of pDC-related mechanisms in AIP pathogenesis, particularly those responsible for induction of fibrosis. We found that in murine AIP (MRL/Mp mice treated with polyinosinic-polycytidylic acid) not only the pancreatic infiltration of immune cells but also the development of fibrosis were markedly reduced by the depletion of pDCs or blockade of type I IFN signaling; moreover, such treatment was accompanied by a marked reduction of pancreatic expression of IL-33. Conversely, polyinosinic-polycytidylic acid-induced inflamed pancreatic tissue in murine AIP exhibited increased expression of type I IFNs and IL-33 (and downstream IL-33 cytokines such as IL-13 and TGF-beta 1). pDCs stimulated by type I IFN were the source of the IL-33 because purified populations of these cells isolated from the inflamed pancreas produced a large amount of IL-33 upon activation by TLR9 ligands, and such production was abrogated by the neutralization of type I IFN. The role of IL-33 in murine AIP pathogenesis was surprisingly important because blockade of IL-33 signaling by anti-ST2 Ab attenuated both pancreatic inflammation and accompanying fibrosis. Finally, whereas patients with both conventional pancreatitis and IgG4-related AIP exhibited increased numbers of acinar cells expressing IL-33, only the latter also exhibited pDCs producing this cytokine. These data thus suggest that pDCs producing IFN-alpha and IL-33 play a pivotal role in the chronic fibro-inflammatory responses underlying murine AIP and human IgG4-related AIP.
  • Chronic Pancreatitis finding by Endoscopic Ultrasonography in the Pancreatic Parenchyma of IPMNs is Associated with Invasive IPMC, Mamoru Takenaka, Atsuhiro Masuda, Hideyuki Shiomi, Yosuke Yagi, Yoh Zen, Arata Sakai, Takashi Kobayashi, Yoshifumi Arisaka, Yoshihiro Okabe, Hiromu Kutsumi, Hirochika Toyama, Takumi Fukumoto, Yonson Ku, Masatoshi Kudo, Takeshi Azuma, Oncology, Oncology, Supple(in press), 2017 , Refereed
  • 膵炎における腸管免疫機構破綻と重症化機序, 渡邉智裕, 三長孝輔, 鎌田研, 山雄健太郎, 竹中完, 工藤正俊, 肝•胆•膵, 肝•胆•膵, 75, 991 - 996, 2017
  • The usefulness of endoscopic ultrasonography in the diagnosis of "Early-Stage" chronic pancreatitis, Mamoru Takenaka, Masayuki Kitano, Masatoshi Kudo, Gastroenterological Endoscopy, Gastroenterological Endoscopy, 59, 255 - 264, Jan. 01 2017
    Summary:Chronic pancreatitis is one of the risk factors for pancreatic cancer and is considered to be an irreversible and progressive disease. However, the conventional diagnostic criteria of chronic pancreatitis had the problem of being able to diagnose only advanced chronic pancreatitis. Based on the hypothesis that the early stage of chronic pancreatitis is a reversible disease, the diagnostic criteria of "early-stage" chronic pancreatitis were developed in Japan for early detection and early treatment of chronic pancreatitis. Endoscopic ultrasonography (EUS) plays an important role in detecting "early-stage" chronic pancreatitis. Many EUS image findings of "early-stage" chronic pancreatitis are mentioned in the Rosemont criteria for the EUS diagnosis of chronic pancreatitis.
  • Cyst in cyst様構造を呈し、膵粘液性嚢胞腫瘍(mucinous cystic neoplasm;MCN)との鑑別が困難であった膵内副脾に発生したepidermoid cystの1例, 平田祐一, Arisaka Yoshifumi, 久津見弘, 酒井新, 竹中完, 塩見英之, Azuma Takeshi, 松本逸平, Hara Shigeo, 八隅秀二郎, 日本消化器病学会雑誌, 日本消化器病学会雑誌, 112(10号), 1858 - 1867, Oct. 2015 , Refereed
  • 多発肝転移を伴ったSolid-pseudopapillary neoplasm(SPN)の1例, 八木洋輔, 竹中完, 岡部純弘, 藤垣誠治, 山中広大, 江崎健, 平田祐一, 家本孝雄, 那賀川峻, 小林隆, 酒井新, 塩見英之, 有坂好史, 久津見弘, Toyama Hirochika, 具英成, Hara Shigeo, 全陽, 膵臓, 膵臓, 30(3号), 443, May 2015
  • 膵腫瘤性病変における造影ハーモニックEUSの有用性, Takenaka Mamoru, Gastroenterological Endoscopy, Gastroenterological Endoscopy, 56(Suppl.2), 3052, Sep. 2014 , Refereed
  • 膵頭十二指腸切除術後の悪性輸入脚狭窄に対する内視鏡的消化管金属ステント治療の有用性, Takenaka Mamoru, Gastroenterological Endoscopy, Gastroenterological Endoscopy, 56(Suppl.2), 3056, Sep. 2014 , Refereed
  • ERCPのトラブルシューティング 選択的胆道挿管困難例に対するDouble Lumen Cannulaを用いた新しいアプローチ, Takenaka Mamoru, 胆道, 胆道, 28(3号), 396, Aug. 2014 , Refereed
  • 内視鏡的十二指腸乳頭切除術の出血例に対する内視鏡的止血法の検討, Takenaka Mamoru, 胆道, 胆道, 28(3号), 493, Aug. 2014 , Refereed
  • 管状乳頭状増殖を呈した粘液低産生IPNBの1例, Takenaka Mamoru, 胆道, 胆道, 28(3号), 516, Aug. 2014
  • 膵頭十二指腸切除術後の悪性輸入脚狭窄による胆管炎に対する内視鏡治療, Takenaka Mamoru, 胆道, 胆道, 28(3号), 532, Aug. 2014
  • 膵癌早期診断を目指して 血清メタボロミクスによる膵癌スクリーニング法の検討, Takenaka Mamoru, 膵臓, 膵臓, 29(3号), 465, Jun. 2014 , Refereed
  • 膵癌早期診断を目指して 早期膵癌診断を目指したIPMN症例における細胞診の工夫, Takenaka Mamoru, 膵臓, 膵臓, 29(3号), 466, Jun. 2014 , Refereed
  • Walled off necrosisに対するEUSガイド下治療, Takenaka Mamoru, 膵臓, 膵臓, 29(3号), 565, Jun. 2014 , Refereed
  • 早期膵癌診断における造影ハーモニックEUSの有用性, Takenaka Mamoru, 膵臓, 膵臓, 29(3号), 579, Jun. 2014 , Refereed
  • ERCP後膵炎の病態と対策 傾向スコア解析を用いた脱落型膵管ステントが最も推奨されるリスク群の検討, Takenaka Mamoru, Gastroenterological Endoscopy, Gastroenterological Endoscopy, 56(Suppl.1), 971, Apr. 2014 , Refereed
  • 当院における分枝型IPMNに対する細胞診の工夫, Takenaka Mamoru, Gastroenterological Endoscopy, Gastroenterological Endoscopy, 56(Suppl.1), 1095, Apr. 2014 , Refereed
  • 当院における慢性膵炎に対する内視鏡的治療の現状および手術移行例の要因の検討, Takenaka Mamoru, Gastroenterological Endoscopy, Gastroenterological Endoscopy, 56(Suppl.1), 1139, Apr. 2014 , Refereed
  • 当院における85歳以上の超高齢者に対する胆膵内視鏡検査の現状, Takenaka Mamoru, Gastroenterological Endoscopy, Gastroenterological Endoscopy, 56(Suppl.1), 1192, Apr. 2014 , Refereed
  • 肝門部胆管癌の術前ドレナージ法と胆管炎の関連性, Takenaka Mamoru, Gastroenterological Endoscopy, Gastroenterological Endoscopy, 56(Suppl.1), 1299, Apr. 2014 , Refereed
  • 当院での総胆管結石治療におけるEPLBD法の現状と問題点, Takenaka Mamoru, Gastroenterological Endoscopy, Gastroenterological Endoscopy, 56(Suppl.1), 1303, Apr. 2014 , Refereed
  • 手術例から観たIPMN由来浸潤癌の予後予測因子の検討, Takenaka Mamoru, 日本消化器病学会雑誌, 日本消化器病学会雑誌, 111(臨増総会), A301, Mar. 2014 , Refereed
  • MUC染色による混合型IPMNにおけるhigh risk群の抽出 International consensus guideline 2012を踏まえて, 竹中 完, 松木 信之, 塩見 英之, 増田 充弘, 有坂 好史, 久津見 弘, 早雲 孝信, 東 健, Matsumoto Ippei, Ku Yonson, Hara Shigeo, 伊藤 智雄, 日本消化器病学会雑誌, 日本消化器病学会雑誌, 110(臨増大会), A872, Sep. 2013
  • 術前診断に苦慮したIgG4関連硬化性胆管炎の1例, Masuda Atsuhiro, 角山 沙織, 有坂 好史, Shiomi Hideyuki, 竹中 完, 松木 信之, 久津見 弘, 早雲 孝信, Hara Shigeo, Ajiki Tetsuo, Ku Yonson, Azuma Takeshi, 胆道, 胆道, 27(2号), 210 - 217, May 2013 , Refereed
  • 乳頭部腫瘍に対するコンベックス型EUSを用いた深達度および進展度診断 IDUSと比較して, 荻巣 恭平, 江崎 健, 酒井 新, 角山 沙織, 松木 信之, 竹中 完, 塩見 英之, 増田 充弘, 有坂 好史, 久津見 弘, 早雲 孝信, 東 健, 味木 徹夫, 具 英成, Hara Shigeo, Gastroenterological Endoscopy, Gastroenterological Endoscopy, 55(Suppl.1), 1078, Apr. 2013
  • IgG4関連硬化性胆管炎(IgG4-SC)臨床診断基準2012の問題点 IgG4-SC確定診断困難症例の特徴, 増田 充弘, 有坂 好史, 久津見 弘, 塩見 英之, 竹中 完, 松木 信之, 酒井 新, 江崎 健, 角山 沙織, Hara Shigeo, 早雲 孝信, 味木 徹夫, 具 英成, 東 健, 日本消化器病学会雑誌, 日本消化器病学会雑誌, 110(臨増総会), A303, Feb. 2013
  • Navigation for adequate MR scan with integrated MR-endoscope system using intraluminal RF coil, Yuuichiro Matsuoka, Takahashi Akihiro, Kumamoto Etsuko, Morita Yoshinori, Takenaka Mamoru, Sakai Aya, Kutsumi Hiromu, Azuma Takeshi, Kuroda Kagayaki, Proceedings of 9th International Interventional MRI Symposium, Proceedings of 9th International Interventional MRI Symposium, 143, Sep. 2012 , Refereed
  • IFN-gamma plays an essential role in the pathogenesis of gastric lymphoid follicles formation caused by Helicobacter suis infection, Takuya Mimura, Masaru Yoshida, Shin Nishiumi, Hiroshi Tanaka, Kentaro Nobutani, Mamoru Takenaka, Yahaya Ben Suleiman, Koji Yamamoto, Hiroyoshi Ota, Shinichi Takahashi, Hidenori Matsui, Masahiko Nakamura, Ikuya Miki, Takeshi Azuma, FEMS IMMUNOLOGY AND MEDICAL MICROBIOLOGY, FEMS IMMUNOLOGY AND MEDICAL MICROBIOLOGY, 63(1), 25 - 34, Oct. 2011
    Summary:suis. In this study, we aimed to assess the role of helper T cells in the development of gastric lymphoid follicles induced by Helicobacter suis infection. C57BL/6J mice were orally inoculated with H. suis. Six weeks after infection, gastric lymphoid follicles were observed in the gastric mucosa by hematoxylin and eosin staining, and the number of follicles was increased throughout the infection period. An immunohistological examination showed that the lymphoid follicles were composed of B cells, CD4-positive helper T cells, and dendritic cells (DC). It was also revealed that the mRNA expression level of interferon-g (IFN-gamma) in the gastric mucosa was significantly increased at 12 weeks after infection. No gastric lymphoid follicles were detected in IFN-gamma-deficient mice that had been infected with H. suis at 12 weeks after infection, although the development of lymphoid follicles in IL-4-deficient mice infected with H. suis was similar to that seen in the wild-type mice. In conclusion, IFN-gamma, a Th1 cytokine, is deeply involved in the pathogenesis of gastric lymphoid follicles induced by H. suis infection, and it is suggested that CD4-positive T cells and DC aid in the expansion of gastric lymphoid follicles.
  • 分枝優位型IPMNの手術適応決定のための診断アルゴリズムの確立, Shiomi Hideyuki, Morita Yoshinori, Yoshida Masaru, Fujita Tsuyoshi, Azuma Takeshi, Gastroenterological Endoscopy, Gastroenterological Endoscopy, 52(Suppl.1), 1077 - 1077, Apr. 2010
  • Partial Pancreatic Parenchymal Atrophy Is a New Specific Finding to Diagnose Small Pancreatic Cancer (≤10 mm) Including Carcinoma in Situ: Comparison with Localized Benign Main Pancreatic Duct Stenosis Patients, Kentaro Yamao, Mamoru Takenaka, Rei Ishikawa, Ayana Okamoto, Tomohiro Yamazaki, Atsushi Nakai, Shunsuke Omoto, Ken Kamata, Kosuke Minaga, Ippei Matsumoto, Yoshifumi Takeyama, Isao Numoto, Masakatsu Tsurusaki, Takaaki Chikugo, Yasutaka Chiba, Tomohiro Watanabe, Masatoshi Kudo, Diagnostics, Diagnostics, 10(7), 445 - 445, Jul. 01 2020 , Refereed
    Summary:Background: This study aimed to evaluate and identify the specific CT findings by focusing on abnormalities in the main pancreatic duct (MPD) and pancreatic parenchyma in patients with small pancreatic cancer (PC) including carcinoma in situ (CIS). Methods: Nine CT findings indicating abnormalities of MPD and pancreatic parenchyma were selected as candidate findings for the presence of small PC ≤ 10 mm. The proportions of patients positive for each finding were compared between small PC and benign MPD stenosis groups. Interobserver agreement between two independent image reviewers was evaluated using kappa statistics. Results: The final analysis included 24 patients with small PC (including 11 CIS patients) and 28 patients with benign MPD stenosis. The proportion of patients exhibiting partial pancreatic parenchymal atrophy (PPA) corresponding to the distribution of MPD stenosis (45.8% vs. 7.1%, p < 0.01), upstream PPA arising from the site of MPD stenosis (33.3% vs. 3.6%, p = 0.01), and MPD abrupt stenosis (45.8% vs. 14.3%, p = 0.03) was significantly higher in the small PC group than in the benign MPD stenosis group. Conclusions: The presence of partial PPA, upstream PPA, and MPD abrupt stenosis on a CT image was highly suggestive of the presence of small PCs including CIS.
  • Improved liver metastasis detection using Kupffer-phase imaging in contrast-enhanced harmonic EUS in patients with pancreatic cancer (with video), Kosuke Minaga, Masayuki Kitano, Atsushi Nakai, Shunsuke Omoto, Ken Kamata, Kentaro Yamao, Mamoru Takenaka, Masakatsu Tsurusaki, Takaaki Chikugo, Ippei Matsumoto, Yasutaka Chiba, Tomohiro Watanabe, Masatoshi Kudo, Gastrointestinal Endoscopy, Gastrointestinal Endoscopy, Jun. 2020 , Refereed
  • Clinical utility of treatment method conversion during single-session endoscopic ultrasound-guided biliary drainage., Kosuke Minaga, Mamoru Takenaka, Kentaro Yamao, Ken Kamata, Shunsuke Omoto, Atsushi Nakai, Tomohiro Yamazaki, Ayana Okamoto, Rei Ishikawa, Tomoe Yoshikawa, Yasutaka Chiba, Tomohiro Watanabe, Masatoshi Kudo, World journal of gastroenterology, World journal of gastroenterology, 26(9), 947 - 959, Mar. 07 2020 , Refereed
    Summary:BACKGROUND: Although several techniques for endoscopic ultrasound-guided biliary drainage (EUS-BD) are available at present, an optimal treatment algorithm of EUS-BD has not yet been established. AIM: To evaluate the clinical utility of treatment method conversion during single endoscopic sessions for difficult cases in initially planned EUS-BD. METHODS: This was a single-center retrospective analysis using a prospectively accumulated database. Patients with biliary obstruction undergoing EUS-BD between May 2008 and April 2016 were included. The primary outcome was to evaluate the improvement in EUS-BD success rates by converting the treatment methods during a single endoscopic session. Secondary outcomes were clarification of the factors leading to the conversion from the initial EUS-BD and the assessment of efficacy and safety of the conversion as judged by technical success, clinical success, and adverse events (AEs). RESULTS: A total of 208 patients underwent EUS-BD during the study period. For 18.8% (39/208) of the patients, the treatment methods were converted to another EUS-BD technique from the initial plan. Biliary obstruction was caused by pancreatobiliary malignancies, other malignant lesions, biliary stones, and other benign lesions in 22, 11, 4, and 2 patients, respectively. The reasons for the difficulty with the initial EUS-BD were classified into the following 3 procedures: Target puncture (n = 13), guidewire manipulation (n = 18), and puncture tract dilation (n = 8). Technical success was achieved in 97.4% (38/39) of the cases and clinical success was achieved in 89.5% of patients (34/38). AEs occurred in 10.3% of patients, including bile leakage (n = 2), bleeding (n = 1), and cholecystitis (n = 1). The puncture target and drainage technique were altered in subsequent EUS-BD procedures in 25 and 14 patients, respectively. The final technical success rate with 95%CI for all 208 cases was 97.1% (95%CI: 93.8%-98.9%), while that of the initially planned EUS-BD was 78.8% (95%CI: 72.6%-84.2%). CONCLUSION: Among multi-step procedures in EUS-BD, guidewire manipulation appeared to be the most technically challenging. When initially planned EUS-BD is technically difficult, treatment method conversion in a single endoscopic session may result in successful EUS-BD without leading to severe AEs.
  • Efficacy of a modified double-guidewire technique using an uneven double lumen cannula (uneven method) in patients with surgically altered gastrointestinal anatomy (with video)., Mamoru Takenaka, Kosuke Minaga, Ken Kamata, Kentaro Yamao, Tomoe Yoshikawa, Rei Ishikawa, Ayana Okamoto, Tomohiro Yamazaki, Atsushi Nakai, Shunsuke Omoto, Yoriaki Komeda, Toshiharu Sakurai, Tomohiro Watanabe, Naoshi Nishida, Yasutaka Chiba, Chang-Il Kwon, Seok Jeong, Tae Hoon Lee, Masatoshi Kudo, Surgical endoscopy, Surgical endoscopy, 34(3), 1432 - 1441, Mar. 2020 , Refereed
    Summary:BACKGROUND: Balloon enteroscopy-assisted endoscopic retrograde cholangiopancreatography (BE-ERCP) has been reported to be effective for patients with surgically altered gastrointestinal anatomy. However, selective biliary cannulation remains difficult in BE-ERCP. We examined the usefulness of a modified double-guidewire technique using an uneven double lumen cannula (the uneven method) for BE-ERCP in patients with surgically altered gastrointestinal anatomy. METHODS: To clarify the usefulness of the uneven method for selective biliary cannulation in BE-ERCP in comparison to the pancreatic guidewire (PGW) method, 40 patients with surgically altered gastrointestinal anatomy who underwent BE-ERCP with successful placement of a guidewire in the pancreatic duct were evaluated. The uneven method was used in 18 cases (uneven group) and the PGW method was used in the remaining 22 cases (PGW group). RESULTS: The technical success rate of biliary cannulation was higher in the uneven group than in the PGW group (83.3 vs. 59.0%; P = 0.165). In addition, the time to biliary cannulation were significantly shorter in the uneven group than in the PGW group (6 vs. 18 min; P = 0.004; respectively). In the PGW group, post-ERCP pancreatitis (PEP) occurred in 3 of 22 cases (13.6%). No adverse events, including PEP, occurred in the uneven group. CONCLUSIONS: The uneven method may be a useful option of selective biliary cannulation in BE-ERCP for the patients with surgically altered gastrointestinal anatomy.
  • Continuous regional arterial infusion versus intravenous administration of the protease inhibitor nafamostat mesilate for predicted severe acute pancreatitis: a multicenter, randomized, open-label, phase 2 trial, Morihisa Hirota, Tooru Shimosegawa, Katsuya Kitamura, Kazunori Takeda, Yoshifumi Takeyama, Toshihiko Mayumi, Tetsuhide Ito, Mamoru Takenaka, Eisuke Iwasaki, Hirotaka Sawano, Etsuji Ishida, Shin Miura, Atsushi Masamune, Yousuke Nakai, Akira Mitoro, Hiroyuki Maguchi, Kenji Kimura, Tsuyoshi Sanuki, Tetsuya Ito, Hiroki Haradome, Kazuto Kozaka, Toshifumi Gabata, Keisho Kataoka, Masahiko Hirota, Shuji Isaji, Ryoji Nakamura, Koki Yamagiwa, Chie Kayaba, Koji Ikeda, Journal of Gastroenterology, Journal of Gastroenterology, 55(3), 342 - 352, Mar. 01 2020 , Refereed
    Summary:© 2019, The Author(s). Background: Continuous regional arterial infusion (CRAI) of protease inhibitor nafamostat mesilate (NM) is used in the context of predicted severe acute pancreatitis (SAP) to prevent the development of pancreatic necrosis. Although this therapy is well known in Japan, its efficacy and safety remain unclear. Methods: This investigator-initiated and -driven, multicenter, open-label, randomized, controlled trial (UMIN000020868) enrolled 39 patients with predicted SAP and low enhancement of the pancreatic parenchyma on computed tomography (CT). Twenty patients were assigned to the CRAI group, while 19 served as controls and were administered NM at the same dose intravenously (IV group). The primary endpoint was the development of pancreatic necrosis as determined by CT on Day 14, judged by blinded central review. Results: There was no difference between the CRAI and IV groups regarding the percentages of participants who developed pancreatic necrosis (more than 1/3 of the pancreas: 25.0%, range 8.7–49.1% vs. 15.8%, range 3.4–39.6%, respectively, P = 0.694; more than 2/3 of the pancreas: 20%, range 5.7–43.7% vs. 5.3%, range 0.1–26.0%, respectively, P = 0.341). The early analgesic effect was evaluated based on 24-h cumulative fentanyl consumption and additional administration by intravenous patient-controlled analgesia. The results showed that the CRAI group used significantly less analgesic. There were two adverse events related to CRAI, namely bleeding and splenic infarction. Conclusions: CRAI with NM did not inhibit the development of pancreatic necrosis although early analgesic effect of CRAI was superior to that of IV. Less-invasive IV therapy can be considered a viable alternative to CRAI therapy.
  • Multicentre prospective observational study protocol for radiation exposure from gastrointestinal fluoroscopic procedures (REX-GI study)., Tsutomu Nishida, Shiro Hayashi, Mamoru Takenaka, Makoto Hosono, Hirofumi Kogure, Kenkei Hasatani, Shinjiro Yamaguchi, Hirotsugu Maruyama, Hisashi Doyama, Hideyuki Ihara, Toshiyuki Yoshio, Koji Nagaike, Takuya Yamada, Takayuki Yakushijin, Tadayuki Takagi, Hidetaka Tsumura, Akira Kurita, Satoshi Asai, Yukiko Ito, Toshio Kuwai, Yasuki Hori, Iruru Maetani, Kenji Ikezawa, Takuji Iwashita, Kengo Matsumoto, Masami Inada, BMJ open, BMJ open, 10(2), e033604 - 8, Feb. 26 2020 , Refereed
    Summary:INTRODUCTION: Recently, the use of various endoscopic procedures under X-ray fluoroscopic guidance, such as endoscopic retrograde cholangiopancreatography (ERCP), interventional endoscopic ultrasonography (EUS), enteral endoscopy and stenting, has been rapidly increasing because of the minimally invasive nature of these procedures compared with that of surgical intervention. With the spread of CT and fluoroscopic interventions, including endoscopic procedures under X-ray guidance, high levels of radiation exposure (RE) from medical imaging have led to major concerns throughout society. However, information about RE related to these image-guided procedures in gastrointestinal endoscopy is scarce, and the RE reference levels have not been established. The aim of this study is to prospectively collect the actual RE dose and to help establish diagnostic reference levels (DRLs) in the field of gastroenterology in Japan. METHODS AND ANALYSIS: This is a multicentre, prospective observational study that is being conducted to collect the actual RE from treatments and diagnostic procedures, including ERCP, interventional EUS, balloon-assisted enteroscopy, enteral metallic stent placement and enteral tube placement. We will measure the total fluoroscopy time (min), the total dose-area product (Gycm2) and air-kerma (mGy) of those procedures. Because we are collecting the actual RE data and identifying the influential factors through a prospective, nationwide design, this study will provide guidance regarding the DRLs of ERCP, interventional EUS, balloon-assisted enteroscopy, enteral metallic stent placement and enteral tube placement. ETHICS AND DISSEMINATION: Approval was obtained from the Institutional Review Board of Toyonaka Municipal Hospital (25 April 2019). The need for informed consent will be waived via the opt-out method of each hospital website. TRIAL REGISTRATION NUMBER: The UMIN Clinical Trials Registry, UMIN000036525.
  • Utility and Safety of a Novel Fully Covered Metal Stent in Unresectable Distal Malignant Biliary Obstruction., Kentaro Yamao, Mamoru Takenaka, Takeshi Ogura, Hiroaki Hashimoto, Hisakazu Matsumoto, Masashi Yamamoto, Tsukasa Ikeura, Akira Kurita, Zhao Liang Li, Hideyuki Shiomi, Yasutaka Chiba, Masatoshi Kudo, Tsuyoshi Sanuki, Digestive diseases and sciences, Digestive diseases and sciences, Feb. 08 2020 , Refereed
    Summary:BACKGROUND: Self-expandable metal stents (SEMSs) are widely used in patients with distal malignant biliary obstruction. A SEMS that can avoid occlusion as much as possible is desirable. AIMS: The aim of this multicenter single-arm prospective study was to assess the clinical effectiveness and safety of a novel fully covered braided SEMS. METHODS: We enrolled consecutive patients with distal malignant biliary obstruction between February 2016 and November 2017 at ten tertiary-care medical centers. RESULTS: We included 79 patients with a median age of 76 years; 47 (59.5%) patients were men. The technical and clinical success rate was 98.7% and 93.6%, respectively. Recurrent biliary obstruction occurred in 14 patients (17.9%); stent ingrowth, overgrowth, migration, and other occurred in five (6.4%), four (5.1%), four (5.1%), and one (1.3%) patients, respectively. All reinterventions in patients with recurrent biliary obstruction were successful via the transpapillary approach. Adverse events occurred in 15 patients (19.2%); cholangitis, pancreatitis, and others occurred in ten (12.8%), three (3.8%), and two (2.6%) patients, respectively. The stent patency probability at 6 months was 48.5%. Median time to stent patency was 171 days, median time to recurrent biliary obstruction was 536 days, and median survival time was 195 days. CONCLUSIONS: We confirmed the utility and safety of a novel fully covered braided SEMS with low axial force and high radial force in patients with malignance biliary obstruction. This novel SEMS is recommended in patients with distal malignant biliary obstruction.
  • Comparison of a 22-gauge Franseen-tip needle with a 20-gauge forward-bevel needle for the diagnosis of type 1 autoimmune pancreatitis: a prospective, randomized, controlled, multicenter study (COMPAS study)., Akira Kurita, Satoru Yasukawa, Yoh Zen, Kenichi Yoshimura, Takeshi Ogura, Eisuke Ozawa, Yoshinobu Okabe, Masanori Asada, Hiroko Nebiki, Minoru Shigekawa, Tsukasa Ikeura, Takaaki Eguchi, Hirotsugu Maruyama, Toshiharu Ueki, Masahiro Itonaga, Shinichi Hashimoto, Hideyuki Shiomi, Ryuki Minami, Noriyuki Hoki, Mamoru Takenaka, Yoshio Itokawa, Norimitsu Uza, Shunpei Hashigo, Hiroaki Yasuda, Ryoji Takada, Hideki Kamada, Hirofumi Kawamoto, Hiroshi Kawakami, Ichiro Moriyama, Koichi Fujita, Hisakazu Matsumoto, Keiji Hanada, Tadamasa Takemura, Shujiro Yazumi, Gastrointestinal endoscopy, Gastrointestinal endoscopy, 91(2), 373 - 381, Feb. 2020 , Refereed
    Summary:BACKGROUND AND AIMS: Histologic diagnosis of autoimmune pancreatitis (AIP) using EUS-guided FNA (EUS-FNA) is difficult. To address this issue, new fine-needle biopsy (FNB) needles were recently developed. Here, we prospectively evaluated 2 newly designed EUS-FNB needles for histologic evaluation in patients with type 1 AIP. METHODS: This was a prospective, randomized, multicenter trial comparing biopsy specimens obtained with a 22-gauge Franseen needle or a 20-gauge forward-bevel needle in patients with suspected type 1 AIP. AIP was diagnosed according to international consensus diagnostic criteria. The primary endpoint was the sensitivity of EUS-FNB needles, and secondary endpoints were the amount of specimen obtained, histology of the pancreas based on evaluation of lymphoplasmacytic sclerosing pancreatitis (LPSP), and contribution of histologic findings to the diagnosis of AIP. RESULTS: One hundred ten patients were randomly assigned to the Franseen group (22-gauge Franseen needle) or the forward-bevel group (20-gauge forward-bevel needle). EUS-FNB sampling was successful in all patients. Nine patients were excluded because of diagnoses other than AIP. Compared with the forward-bevel needle, the Franseen needle obtained a significantly greater number of high-power fields. Of 101 patients, 39 patients (78%) in the Franseen group and 23 patients (45%) in the Forward-bevel group were diagnosed with level 1 or 2 LPSP (P = .001). Thirty-six patients could not be diagnosed with type 1 AIP without EUS-FNB specimen results. CONCLUSIONS: The 22-gauge Franseen needle should be routinely used for histologic diagnosis of type 1 AIP. (Clinical trial registration number: UMIN 000027668.).
  • Navigator-triggered and breath-hold 3D MRCP using compressed sensing: image quality and method selection factor assessment., Daisuke Morimoto, Tomoko Hyodo, Ken Kamata, Tomoya Kadoba, Makoto Itoh, Hiroyuki Fukushima, Yasutaka Chiba, Mamoru Takenaka, Tomohiro Mochizuki, Yu Ueda, Keizou Miyagoshi, Masatoshi Kudo, Kazunari Ishii, Abdominal radiology (New York), Abdominal radiology (New York), [Epub ahead of print], Jan. 10 2020 , Refereed
    Summary:PURPOSE: To examine whether MRCP using a combination of compressed sensing and sensitivity encoding with navigator-triggered and breath-hold techniques (NT C-SENSE and BH C-SENSE, respectively) have comparable image quality to that of navigator-triggered MRCP using only sensitivity encoding (NT SENSE) at 1.5-T. METHODS: Fifty-one participants were enrolled in this prospective study between July and October 2018 and underwent the three 3D MRCP sequences each. The acquisition time and relative duct-to-periductal contrast ratios (RC values) of each bile duct segment were obtained. Visualization of the bile and main pancreatic ducts, background suppression, artifacts, and overall image quality were scored on 5-point scales. Mean and median differences in RC values and qualitative scores of NT C-SENSE and BH C-SENSE relative to NT SENSE were calculated with 95% confidence intervals (CIs). RESULTS: Acquisition time of NT SENSE, NT C-SENSE, and BH C-SENSE were 348, 143 (mean for both), and 18 s (for all participants), respectively. The RC value of each bile duct segment was inferior, but the lower limits of the 95% CIs of the mean differences were ≥ - 0.10, for both NT C-SENSE and BH C-SENSE. The visualization score of the intrahepatic duct in BH C-SENSE was inferior to that in NT SENSE (lower 95% CI limit, - 1.5). In both NT C-SENSE and BH C-SENSE, the 95% CIs of the median differences in the other qualitative scores were from - 1.0 to 0.0. CONCLUSION: NT C-SENSE and BH C-SENSE have comparable image quality to NT SENSE at 1.5-T.
  • Navigator-triggered and breath-hold 3D MRCP using compressed sensing: image quality and method selection factor assessment., Daisuke Morimoto, Tomoko Hyodo, Ken Kamata, Tomoya Kadoba, Makoto Itoh, Hiroyuki Fukushima, Yasutaka Chiba, Mamoru Takenaka, Tomohiro Mochizuki, Yu Ueda, Keizou Miyagoshi, Masatoshi Kudo, Kazunari Ishii, Abdominal radiology (New York), Abdominal radiology (New York), Jan. 10 2020 , Refereed
    Summary:PURPOSE: To examine whether MRCP using a combination of compressed sensing and sensitivity encoding with navigator-triggered and breath-hold techniques (NT C-SENSE and BH C-SENSE, respectively) have comparable image quality to that of navigator-triggered MRCP using only sensitivity encoding (NT SENSE) at 1.5-T. METHODS: Fifty-one participants were enrolled in this prospective study between July and October 2018 and underwent the three 3D MRCP sequences each. The acquisition time and relative duct-to-periductal contrast ratios (RC values) of each bile duct segment were obtained. Visualization of the bile and main pancreatic ducts, background suppression, artifacts, and overall image quality were scored on 5-point scales. Mean and median differences in RC values and qualitative scores of NT C-SENSE and BH C-SENSE relative to NT SENSE were calculated with 95% confidence intervals (CIs). RESULTS: Acquisition time of NT SENSE, NT C-SENSE, and BH C-SENSE were 348, 143 (mean for both), and 18 s (for all participants), respectively. The RC value of each bile duct segment was inferior, but the lower limits of the 95% CIs of the mean differences were ≥ - 0.10, for both NT C-SENSE and BH C-SENSE. The visualization score of the intrahepatic duct in BH C-SENSE was inferior to that in NT SENSE (lower 95% CI limit, - 1.5). In both NT C-SENSE and BH C-SENSE, the 95% CIs of the median differences in the other qualitative scores were from - 1.0 to 0.0. CONCLUSION: NT C-SENSE and BH C-SENSE have comparable image quality to NT SENSE at 1.5-T.
  • Endoscopic ultrasound-guided biliary drainage for malignant biliary obstruction with surgically altered anatomy: a multicenter prospective registration study., Kosuke Minaga, Mamoru Takenaka, Takeshi Ogura, Takashi Tamura, Taira Kuroda, Toyoma Kaku, Yoshito Uenoyama, Chishio Noguchi, Hidefumi Nishikiori, Hajime Imai, Ryota Sagami, Nao Fujimori, Kazuhide Higuchi, Masatoshi Kudo, Yasutaka Chiba, Masayuki Kitano, Therapeutic advances in gastroenterology, Therapeutic advances in gastroenterology, 13, 1756284820930964 - 1756284820930964, 2020 , Refereed
    Summary:Background: Endoscopic treatment for malignant biliary obstruction (MBO) in patients bearing surgically altered anatomy (SAA) is not well-established. Although endoscopic ultrasound-guided biliary drainage (EUS-BD) has emerged as a new treatment option for MBO, limited data are available regarding the efficacy and safety of EUS-BD in patients with SAA. We conducted a multicenter prospective registration study to evaluate the efficacy and safety of EUS-BD in this population. Methods: This study involved 10 referral centers in Japan. Patients with SAA who were scheduled to receive EUS-BD for unresectable MBO between May 2016 and September 2018 were prospectively registered. The primary endpoint was technical success and the secondary outcomes were clinical success, procedure time, procedure-related adverse events (AEs), stent patency, and overall survival. Results: In total, 40 patients were prospectively enrolled. The surgical reconstruction methods were gastrectomy with Roux-en-Y reconstruction (47.5%), gastrectomy with Billroth-II reconstruction (15%), pancreaticoduodenectomy (27.5%), and hepaticojejunostomy with Roux-en-Y reconstruction (10%). EUS-BD was performed for primary biliary drainage in 31 patients and for rescue biliary drainage in nine patients. Transmural stenting alone (60%), antegrade stenting alone (5%), and a combination of the two techniques (35%) were selected for patients treated with EUS-BD. Technical and clinical success rates were 100% (95% confidence interval, 91.2-100.0%) and 95% (95% confidence interval, 83.1-99.4%), respectively. Mean procedure time was 36.5 min. Early AEs were noted in six patients (15%): three self-limited bile leak, one bile peritonitis, and two pneumoperitonea. Late AEs occurred in six patients (15%): one jejunal ulcer and five stent occlusions. Stent patency rate after 3 months of survival was 95.7% (22/23). Median overall survival was 96 days. Conclusion: EUS-BD for MBO in patients with SAA appears to be effective and safe not only as a rescue drainage technique after failed endoscopic retrograde cholangiography but also as a primary drainage technique. Clinical Trial Registration: UMIN000022101.
  • A novel teaching tool for visualizing the invisible bile duct axis in 3 dimensions during biliary cannulation (Compact Disc method), Mamoru Takenaka, Tomoe Yoshikawa, Kosuke Minaga, Kentaro Yamao, Masatoshi Kudo, VideoGIE, VideoGIE, 2020 , Refereed
  • Comparison of 22G standard and Franseen needles in endoscopic ultrasound-guided fine-needle aspiration for diagnosing pancreatic mass lesions: Study protocol for a controlled trial., Masahiro Itonaga, Satoru Yasukawa, Toshio Shimokawa, Mamoru Takenaka, Nobuyasu Fukutake, Takeshi Ogura, Junichi Sakagami, Hideyuki Shiomi, Yasushi Okura, Osamu Inatomi, Hisakazu Matsumoto, Akira Kurita, Azumi Suzuki, Kiyohito Tanaka, Masayuki Kitano, Trials, Trials, 20(1), 816 - 816, Dec. 30 2019 , Refereed
    Summary:BACKGROUND: Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) was developed with the aim of further improving the diagnostic performance of endoscopic ultrasound. Although novel puncture needles have been specifically designed for collecting sufficient tissue specimens, clinical studies have indicated no clear difference in diagnostic performance between these novel needles and conventional puncture needles. Recently, a needle with Franseen geometry was developed specifically for EUS-FNA biopsy. Due to the characteristic shape of its tip, the Franseen needle is expected to be effective for scraping tissues, thus potentially increasing the diagnostic accuracy of EUS-FNA biopsy. We plan to carry out a prospective, multicenter, open-labeled, controlled trial to compare conventional and Franseen needles in terms of the diagnostic accuracy of EUS-FNA for evaluating the malignancy of pancreatic mass lesions. METHODS/DESIGN: The study will enroll 520 patients with pancreatic mass managed at any of 21 participating endoscopic centers. Lesion samples obtained using 22G conventional and Franseen needles will be assessed to compare the efficacy and safety of these two types of needles in EUS-FNA for evaluating the malignancy of mass lesions in the pancreas. Tissue samples will be fixed in formalin and processed for histologic evaluation. For the purpose of this study, only samples obtained with the first needle pass will be used for comparing the: (i) accuracy of the malignancy diagnosis, (ii) sensitivity and specificity for the malignancy diagnosis, (iii) procedure completion rate, (iv) sample cellularity, and (v) incidence of complications. Patient enrollment begins on July 17, 2018. DISCUSSION: The outcomes of this study may provide insight into the optimal needle choice for evaluating the malignancy of pancreatic solid lesions, thus aiding in the development of practice guidelines for pancreatic diseases. TRIAL REGISTRATION: University Hospital Medical Information Network Clinical Trials Registry (UMIN-CTR), UMIN000030634. Registered on 29 December 2017. http://www.umin.ac.jp/ Version number: 01.2017.12.28.
  • Revisionary antireflux metal stent placement for stent occlusion after endoscopic ultrasound-guided hepaticojejunostomy., Kosuke Minaga, Mamoru Takenaka, Ayana Okamoto, Shunsuke Omoto, Ken Kamata, Kentaro Yamao, Masatoshi Kudo, Endoscopy, Endoscopy, Nov. 15 2019 , Refereed
  • Intestinal dysbiosis mediates experimental autoimmune pancreatitis via activation of plasmacytoid dendritic cells., Ken Kamata, Tomohiro Watanabe, Kosuke Minaga, Akane Hara, Tomoe Yoshikawa, Ayana Okamoto, Kentaro Yamao, Mamoru Takenaka, Ah-Mee Park, Masatoshi Kudo, International immunology, International immunology, 31(12), 795 - 809, Nov. 08 2019
    Summary:Autoimmune pancreatitis (AIP) is a pancreatic manifestation of a newly proposed disease entity, IgG4-related disease (IgG4-RD), characterized by enhanced IgG4 antibody responses and involvement of multiple organs. We have previously reported that innate immune activation contributes to the development of AIP and IgG4-RD, as these diseases are characterized by the production of IFN-α and IL-33 by plasmacytoid dendritic cells (pDCs) that mediate chronic fibroinflammatory responses. In this study, we investigated the roles played by innate immunity against intestinal microflora in experimental AIP induced in MRL/MpJ mice by repeated administrations of 100 µg of polyinosinic-polycytidylic acid [poly (I:C)]. Bowel sterilization with a broad spectrum of antibiotics inhibited pancreatic accumulation of pDCs producing IFN-α and IL-33, and thereby suppressed the development of AIP. Mice treated with 10 µg of poly (I:C) developed severe AIP equivalent to that induced by 100 µg of poly (I:C) upon co-housing with mice treated with 100 µg of poly (I:C). Fecal microbiota transplantation (FMT) from donor mice treated with 100 µg of poly (I:C) led to the development of severe AIP in the recipient mice upon injection with 10 µg of poly (I:C). Induction of severe AIP in mice with 10 µg of poly (I:C) was associated with pancreatic accumulation of pDCs producing IFN-α and IL-33 in the co-housing and FMT experiments. These data collectively suggest that innate immune responses against intestinal microflora are involved in the development of experimental AIP, and that intestinal dysbiosis increases sensitivity to experimental AIP via activation of pDCs.
  • Prospective study of early chronic pancreatitis diagnosed based on the Japanese diagnostic criteria., Atsushi Masamune, Tatsuhide Nabeshima, Kazuhiro Kikuta, Shin Hamada, Eriko Nakano, Kiyoshi Kume, Atsushi Kanno, Ai Sato, Yuichi Tachibana, Osamu Inatomi, Satoshi Yamamoto, Tsukasa Ikeura, Seiji Futagami, Masashi Taguchi, Keiji Hanada, Kyoko Shimizu, Masanobu Kageoka, Tomotaka Saito, Takaaki Eguchi, Kensuke Kubota, Mamoru Takenaka, Atsushi Mima, Atsushi Irisawa, Tetsuhide Ito, Akira Andoh, Kazuo Inui, Yoshifumi Takeyama, Hiroki Yamaue, Kazuichi Okazaki, Tooru Shimosegawa, Journal of gastroenterology, Journal of gastroenterology, 54(10), 928 - 935, Oct. 2019
    Summary:BACKGROUND: Chronic pancreatitis (CP) is a fibro-inflammatory disease of the pancreas. Early diagnosis and intervention, before CP becomes established and irreversible, are essential to improve the long-term outcomes. The world's first diagnostic criteria for early CP were proposed in Japan in 2009, but their clinical utility remains elusive. This study aimed to clarify whether patients with early CP progress to definite CP. METHODS: This is a multicenter, prospective study. Patients diagnosed as having early CP according to the Japanese diagnostic criteria were prospectively followed for 2 years. Clinical profiles including symptoms, drinking and smoking status, laboratory data, imaging findings and treatments were analyzed. RESULTS: Among the 83 patients who completed the 2-year follow-up period, four (4.8%) patients progressed to definite CP. The diagnosis of 48 (57.8%) patients was unchanged, and that of 31 (37.3%) patients was downgraded. All the four progressive patients were male, alcohol-related, smokers (3 current and 1 ever), and continued drinking. Comparison of the clinical profiles between the progression group (n = 4) and non-progression group (n = 79) revealed that etiology (alcohol-related), smoking status and presence of acute pancreatitis episodes were associated with the progression to definite CP. CONCLUSIONS: The Japanese diagnostic criteria could identify some patients before the progression to definite CP, while the majority of the patients did not progress. TRIAL REGISTRATION NUMBER: UMIN000015992.
  • Comparison of the Diagnostic Performance of Newly Designed 21-Gauge and Standard 22-Gauge Aspiration Needles in Patients with Solid Pancreatic Masses, Kosuke Minaga, Tomoe Yoshikawa, Yukitaka Yamashita, Hiroko Akamatsu, Maiko Ikenouchi, Tatsuya Ishii, Hisakazu Matsumoto, Hiroyoshi Iwagami, Yasuki Nakatani, Keiichi Hatamaru, Mamoru Takenaka, Takuji Akamatsu, Yoshito Uenoyama, Tomohiro Watanabe, Kazuo Ono, Yasutaka Chiba, Masatoshi Kudo, Digestive Diseases and Sciences, Digestive Diseases and Sciences, 64(10), 2982 - 2991, Oct. 2019
    Summary:© 2019, Springer Science+Business Media, LLC, part of Springer Nature. Background: Although endoscopic ultrasound-guided fine needle aspiration (EUS–FNA) has been widely used for the diagnosis of pancreatic tumors, the ability to obtain adequate pancreatic tumor tissue needs to be improved. Aims: This study was performed to compare a newly designed 21-gauge needle (EUS Sonopsy CY; Hakko Medical, Nagano, Japan) and a standard 22-gauge needle for tissue sampling of solid pancreatic masses. Methods: Consecutive patients with solid pancreatic masses who underwent EUS–FNA with either the EUS Sonopsy CY or the 22-gauge needle from June 2014 to December 2016 were enrolled. The primary outcome was comparison of the diagnostic yield of the FNA samples. The secondary outcomes were comparison of technical success, diagnostic ability for malignancy, and complications. Results: A total of 93 patients (40.9% female; mean age, 70.1 years) underwent EUS–FNA with the EUS Sonopsy CY (n = 47) or the standard 22-gauge needle (n = 46). The technical success rate was 100% in both groups, and the overall diagnostic accuracy for malignancy was similar between the groups (100% in the EUS Sonopsy CY group vs. 95.7% in the 22-gauge needle group, P = 0.242). Nevertheless, the EUS Sonopsy CY resulted in significantly higher scores for cellularity (P = 0.006) and lower scores for blood contamination (P < 0.001). The procedure-related complication rate was comparable between the groups (P = 0.148). Conclusions: The EUS Sonopsy CY provided higher-quality specimens for histological evaluation in terms of both sample cellularity and blood contamination for the diagnosis of solid pancreatic masses. Trial registration: The study was registered in a clinical trial registry, No. UMIN000032598.
  • Comparison of the efficacy and safety of endoscopic ultrasound-guided choledochoduodenostomy and hepaticogastrostomy for malignant distal biliary obstruction: Multicenter, randomized, clinical trial., Kosuke Minaga, Takeshi Ogura, Hideyuki Shiomi, Hajime Imai, Noriyuki Hoki, Mamoru Takenaka, Hidefumi Nishikiori, Yukitaka Yamashita, Takeshi Hisa, Hironari Kato, Hideki Kamada, Atsushi Okuda, Ryota Sagami, Hiroaki Hashimoto, Kazuhide Higuchi, Yasutaka Chiba, Masatoshi Kudo, Masayuki Kitano, Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society, Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society, 31(5), 575 - 582, Sep. 2019
    Summary:BACKGROUND AND AIM: Endoscopic ultrasound-guided biliary drainage (EUS-BD) can be carried out by two different approaches: choledochoduodenostomy (CDS) and hepaticogastrostomy (HGS). We compared the efficacy and safety of these approaches in malignant distal biliary obstruction (MDBO) patients using a prospective, randomized clinical trial. METHODS: Patients with malignant distal biliary obstruction after failed endoscopic retrograde cholangiopancreatography were randomly selected for either CDS or HGS. The procedures were carried out at nine tertiary centers from September 2013 to March 2016. Primary endpoint was technical success rate, and the noninferiority of HGS to CDS was examined with a one-sided significance level of 5%, where the noninferiority margin was set at 15%. Secondary endpoints were clinical success, adverse events (AE), stent patency, survival time, and overall technical success including alternative EUS-BD procedures. RESULTS: Forty-seven patients (HGS, 24; CDS, 23) were enrolled. Technical success rates were 87.5% and 82.6% in the HGS and CDS groups, respectively, where the lower limit of the 90% confidence interval of the risk difference was -12.2% (P = 0.0278). Clinical success rates were 100% and 94.7% in the HGS and CDS groups, respectively (P = 0.475). Overall AE rate, stent patency, and survival time did not differ between the groups. Overall technical success rates were 100% and 95.7% in the HGS and CDS groups, respectively (P = 0.983). CONCLUSIONS: This study suggests that HGS is not inferior to CDS in terms of technical success. When one procedure is particularly challenging, readily switching to the other could increase technical success.
  • Contrast-enhanced harmonic endoscopic ultrasonography for evaluating the response to chemotherapy in pancreatic cancer., Hidekazu Tanaka, Ken Kamata, Mamoru Takenaka, Tomoe Yoshikawa, Rei Ishikawa, Ayana Okamoto, Tomohiro Yamazaki, Atsushi Nakai, Shunsuke Omoto, Kosuke Minaga, Kentaro Yamao, Toshiharu Sakurai, Tomohiro Watanabe, Naoshi Nishida, Yasutaka Chiba, Masayuki Kitano, Masatoshi Kudo, Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver, Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver, 51(8), 1130 - 1134, Aug. 2019 , Refereed
    Summary:BACKGROUND AND AIMS: Contrast-enhanced harmonic endoscopic ultrasonography (CH-EUS) is used for the diagnosis of pancreatic cancer (PC). Here, we examined the usefulness of CH-EUS for evaluating therapeutic responses in PC. METHODS: The study included 23 patients with PC who received chemotherapy. Patients underwent contrast-enhanced computed tomography (CE-CT) and CH-EUS before chemotherapy and at the time of evaluation of the therapeutic response. Patients with a ≧50% reduction in serum carbohydrate antigen 19-9 levels after chemotherapy were defined as "super responders". The incidence of an avascular area in the tumor on CH-EUS after chemotherapy was compared between "super responders" and non-super responders. RESULTS: Nine patients were included in the "super responders" group.Tumor reduction rates did not differ significantly between CE-CT and CH-EUS in the "super responders". The appearance of an avascular area was detected in 7 of 9 super responders (77.8%) and in 4 of 14 non-super responders (28.6%), and the difference was significant (P = 0.036). The mean survival time of patients with an avascular area after chemotherapy was longer than that of without an avascular area. CONCLUSIONS: Detection of avascular areas by CH-EUS after chemotherapy may predict long-term survival of patients with PC.
  • Lenvatinib as an Initial Treatment in Patients with Intermediate-Stage Hepatocellular Carcinoma Beyond Up-To-Seven Criteria and Child-Pugh A Liver Function: A Proof-Of-Concept Study., Masatoshi Kudo, Kazuomi Ueshima, Stephan Chan, Tomohiro Minami, Hirokazu Chishina, Tomoko Aoki, Masahiro Takita, Satoru Hagiwara, Yasunori Minami, Hiroshi Ida, Mamoru Takenaka, Toshiharu Sakurai, Tomohiro Watanabe, Masahiro Morita, Chikara Ogawa, Yoshiyuki Wada, Masafumi Ikeda, Hiroshi Ishii, Namiki Izumi, Naoshi Nishida, Cancers, Cancers, 11(8), Jul. 31 2019 , Refereed
    Summary:Although transcatheter arterial chemoembolization (TACE) is the standard of care for intermediate-stage hepatocellular carcinoma (HCC), this is a largely heterogeneous disease that includes a subgroup of patients who do not benefit from TACE. The treatment strategy for this subgroup of patients currently remains an unmet need in clinical practice. Here, we performed a proof-of-concept study that lenvatinib may be a more favorable treatment option over TACE as an initial treatment in intermediate-stage HCC patients with large or multinodular tumours exceeding the up-to-seven criteria. This proof-of-concept study included 642 consecutive patients with HCC initially treated with lenvatinib or conventional TACE (cTACE) between January 2006 and December 2018. Of these patients, 176 who received lenvatinib or cTACE as an initial treatment and met the eligibility criteria (unresectable, beyond the up-to-seven criteria, no prior TACE/systemic therapy, no vascular invasion, no extrahepatic spread and Child-Pugh A liver function) were selected for the study. Propensity score matching was used to adjust for patient demographics. After propensity-score matching, the outcome of 30 patients prospectively treated with lenvatinib (14 in clinical trials, one in an early access program and 15 in real world settings) and 60 patients treated with cTACE as the initial treatment was compared. The change of albumin-bilirubin (ALBI) score from baseline to the end of treatment were -2.61 to -2.61 for 30 patients in the lenvatinib group (p = 0.254) and -2.66 to -2.09 in the cTACE group (p < 0.01), respectively. The lenvatinib group showed a significantly higher objective response rate (73.3% vs. 33.3%; p < 0.001) and significantly longer median progression-free survival than the cTACE group (16.0 vs. 3.0 months; p < 0.001). Overall survival was significantly longer in the lenvatinib group than in the cTACE group (37.9 vs. 21.3 months; hazard ratio: 0.48, p < 0.01). In patients with large or multinodular intermediate-stage HCC exceeding the up-to-seven criteria with Child-Pugh A liver function, who usually do not benefit from TACE, lenvatinib provides a more favorable outcome than TACE.
  • Usefulness of Ustekinumab for Treating a Case of Myelodysplastic Syndrome-associated Inflammatory Bowel Disease., 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), Internal medicine (Tokyo, Japan), 58(14), 2029 - 2033, Jul. 15 2019
    Summary: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.
  • Clinical Safety and Efficacy of Secondary Prophylactic Pegylated G-CSF in Advanced Pancreatic Cancer Patients Treated with mFOLFIRINOX: A Single-center Retrospective Study., Kentaro Yamao, Mamoru Takenaka, Tomoe Yoshikawa, Rei Ishikawa, Ayana Okamoto, Tomohiro Yamazaki, Atsushi Nakai, Shunsuke Omoto, Ken Kamata, Kosuke Minaga, Satoru Hagiwara, Toshiharu Sakurai, Naoshi Nishida, Yasutaka Chiba, Tomohiro Watanabe, Masatoshi Kudo, Internal medicine (Tokyo, Japan), Internal medicine (Tokyo, Japan), 58(14), 1993 - 2002, Jul. 15 2019
    Summary:Objective Although modified FOLFIRINOX (mFOLFIRINOX, mFFX) is widely used for patients with advanced pancreatic ductal adenocarcinoma (PDAC), maintenance of the standard dose intensity is often difficult due to the high incidence of neutropenic events. Pegylated granulocyte colony-stimulating factor (G-CSF) (Peg G) is a long-lasting G-CSF agent that is applicable for prophylaxis against neutropenic complications. The aim of this study was to assess the clinical safety and efficacy of mFFX combined with secondary prophylaxis using Peg G in advanced PDAC patients. Methods Advanced PDAC patients who had received more than two cycles of mFFX were analyzed. The clinical safety and efficacy were compared between patients in the Peg G group and those in the non-Peg G group in a retrospective manner. Results Among 45 patients treated with mFFX, 28 exhibited grade 3-4 neutropenia or febrile neutropenia. Among these 28 patients, 4 who received only 1 or 2 mFFX cycles were excluded from this study. Finally, 11 patients in the Peg G group and 13 in the non-Peg G group were enrolled. The combination therapy with Peg G and mFFX markedly prolonged the progression-free survival compared with the non-Peg G group, and its effects were associated with a reduced incidence of neutropenic events as well as lower rates of dosage reduction, delayed chemotherapy due to neutropenic events and altered blood cell counts after chemotherapy. Conclusion The scheduled administration of secondary prophylactic Peg G prolonged the progression-free survival in patients treated with mFFX. The combination therapy of Peg G and mFFX may be recommended in patients who exhibit grade 3-4 neutropenic events after prior mFFX cycles.
  • Impact of Baseline ALBI Grade on the Outcomes of Hepatocellular Carcinoma Patients Treated with Lenvatinib: A Multicenter Study., Kazuomi Ueshima, Naoshi Nishida, Satoru Hagiwara, Tomoko Aoki, Tomohiro Minami, Hirokazu Chishina, Masahiro Takita, Yasunori Minami, Hiroshi Ida, Mamoru Takenaka, Toshiharu Sakurai, Tomohiro Watanabe, Masahiro Morita, Chikara Ogawa, Atsushi Hiraoka, Philip Johnson, Masatoshi Kudo, Cancers, Cancers, 11(7), Jul. 07 2019
    Summary:BACKGROUND: This study investigated the impact of baseline liver function according to the Child-Pugh score and ALBI (albumin-bilirubin) grade on the outcomes of patients with unresectable hepatocellular carcinoma treated with lenvatinib. METHODS: A total of 82 lenvatinib treated patients were included. The correlations of baseline liver function according to the Child-Pugh score and ALBI grade with treatment outcomes, including objective response rate per mRECIST (modified Response Evaluation Criteria in the Solid Tumor), time to treatment failure, treatment duration, and likelihood of treatment discontinuation due to adverse events, were assessed in patients with hepatocellular carcinoma treated with lenvatinib. Patients were divided into four groups: (1) Child-Pugh score 5 and ALBI grade 1 (group 1), (2) Child-Pugh score 5 and ALBI grade 2 (group 2), (3) Child-Pugh score 6 (group 3), and (4) Child-Pugh score ≥7 (group 4). Univariate and multivariate analyses were performed to identify the factors contributing to the objective response rate and likelihood of discontinuation due to adverse events. Results: Among the 82 patients analyzed, group 1 had the highest objective response rate (57.1%) and the lowest likelihood of treatment discontinuation because of adverse events (11.1%) among the four groups (p < 0.05 and p < 0.05). Multivariate analysis identified ALBI grade 1 and baseline AFP level <200 ng/mL as the significant predictors of a high objective response rate (p < 0.05 and p < 0.01), and confirmed that patients with ALBI grade 1 had the lowest probability of treatment discontinuation due to adverse events (p < 0.01). Conclusions: Patients with Child-Pugh score of 5 and ALBI grade 1 predicted a higher response rate and lower treatment discontinuation due to adverse events by lenvatinib treatment.
  • Intracystic papillary neoplasm preoperatively diagnosed by high-quality cytology derived from endoscopic nasogallbladder drainage., Akane Hara, Ken Kamata, Mamoru Takenaka, Takaaki Chikugo, Masatoshi Kudo, Gastrointestinal endoscopy, Gastrointestinal endoscopy, 89(6), 1257 - 1259, Jun. 2019
  • Efficacy and Safety of Chemotherapy Following Anti-PD-1 Antibody Therapy for Gastric Cancer: A Case of Sclerosing Cholangitis, 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, Internal Medicine, 58(9), 1263 - 1266, May 01 2019 , Refereed
  • Evaluation of efficacy of pancreatic juice cytology for risk classification according to international consensus guidelines in patients with intraductal papillary mucinous neoplasm; a retrospective study, Kohei Yamakawa, Atsuhiro Masuda, Takashi Nakagawa, Hideyuki Shiomi, Hirochika Toyama, Mamoru Takenaka, Arata Sakai, Takashi Kobayashi, Masahiro Tsujimae, Shigeto Ashina, Yasutaka Yamada, Takeshi Tanaka, Shunta Tanaka, Ryota Nakano, Yu Sato, Takuya Ikegawa, Manabu Kurosawa, Seiji Fujigaki, Hiromu Kutsumi, Tomoo Itoh, Takumi Fukumoto, Yuzo Kodama, Pancreatology, Pancreatology, 19(3), 424 - 428, Apr. 2019
    Summary:© 2019 IAP and EPC Objectives: Pancreatic juice cytology (PJC) for intraductal papillary mucinous neoplasm (IPMN) is a possible tool to enhance preoperative diagnostic ability by improving risk classification for malignant IPMN, but its efficacy is controversial. This study evaluated the efficacy of PJC for risk classification according to international guidelines. Methods: We retrospectively analyzed 127 IPMN patients who underwent endoscopic retrograde cholangiopancreatography (ERCP) preoperatively. PJC was performed in 125 of the 127 cases. High-risk stigmata (HRS, n = 57), worrisome features (WF, n = 64), and other characteristics (n = 6) were classified according to the 2017 international guidelines. Results: Among the 127 IPMN patients, 71 (55.9%) had malignant IPMN (invasive and non-invasive intraductal papillary mucinous carcinoma). The accuracy of WF for classifying malignant IPMN was increased by the addition of PJC, but the accuracy of HRS was not (WF to WF + PJC: 33.1% [42/127] to 48.8% [61/125], HRS to HRS + PJC: 65.4% [83/127] to 52.8% [66/125]). Post-ERCP pancreatitis (PEP) occurred in 32 (25.2%) of 127 IPMN patients. Severe PEP was not detected. Significant risk factors for PEP were female sex, obesity, and endoscopic naso-pancreatic drainage (ENPD) (P =.03, P =.0006, and P =.02, respectively). In patients with ENPD tube placement, a main pancreatic duct size of <5 mm was a significant risk factor for PEP (P =.02). Conclusion: PJC could increase the accuracy of WF for classifying malignant IPMN. The additive effect of PJC for risk classification may be limited, however, and it is not recommended for all IPMN cases due to the high frequency of PEP.
  • Risk factors for local recurrence and appropriate surveillance interval after endoscopic resection, 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, World Journal of Gastroenterology, 25(12), 1502 - 1512, Mar. 28 2019
    Summary:© The Author(s) 2019. 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.
  • Rendezvous within biloma technique combining percutaneous and endoscopic approaches: a novel biliary recanalization method, Ayana Okamoto, Kosuke Minaga, Mamoru Takenaka, Tomoe Yoshikawa, Toshimitsu Iwasaki, Masakatsu Tsurusaki, Masatoshi Kudo, Endoscopy, Endoscopy, 51(03), E42 - E44, Mar. 2019 , Refereed
  • Clinical efficacy and safety of endoscopic ultrasound‐guided gallbladder drainage replacement of percutaneous drainage: A multicenter retrospective study, Kosuke Minaga, Yukitaka Yamashita, Takeshi Ogura, Mamoru Takenaka, Yuzo Shimokawa, Takeshi Hisa, Masahiro Itonaga, Hironari Kato, Hidefumi Nishikiori, Atsushi Okuda, Hisakazu Matsumoto, Yoshito Uenoyama, Tomohiro Watanabe, Yasutaka Chiba, Kazuhide Higuchi, Masatoshi Kudo, Masayuki Kitano, Digestive Endoscopy, Digestive Endoscopy, 31(2), 180 - 187, Mar. 2019 , Refereed
  • Current status of radiation exposure to crystalline lens in ERCP (endoscopic retrograde cholangiopancreatography), Mamoru Takenaka, Makoto Hosono, Atsushi Nakai, Shunsuke Omoto, Kosuke Minaga, Ken Kamata, Kentaro Yamao, Shiro Hayashi, Tsutomu Nishida, Masatoshi Kudo, Journal of Japanese Society of Gastroenterology, Journal of Japanese Society of Gastroenterology, 116(12), 1053 - 1055, 2019 , Refereed
  • Gankyrin Contributes to Tumorigenesis and Chemoresistance in Sporadic Colorectal Cancer, Toshiharu Sakurai, Yoriaki Komeda, Tomoyuki Nagai, Ken Kamata, Kosuke Minaga, Kentarou Yamao, Mamoru Takenaka, Satoru Hagiwara, Tomohiro Watanabe, Naoshi Nishida, Hiroshi Kashida, Kazuhiko Nakagawa, Masatoshi Kudo, Digestion, Digestion, 1 - 9, Dec. 04 2018 , Refereed
  • Radiation exposure during image-guided endoscopic procedures: The next quality indicator for endoscopic retrograde cholangiopancreatography, Shiro Hayashi, Shiro Hayashi, Tsutomu Nishida, Mamoru Takenaka, Makoto Hosono, World Journal of Clinical Cases, World Journal of Clinical Cases, 6(16), 1087 - 1093, Dec. 01 2018 , Refereed
    Summary:© The Author(s) 2018. Endoscopic retrograde cholangiopancreatography (ERCP) is one of the most frequently used image-guided procedures in gastrointestinal endoscopy. Post-ERCP pancreatitis is an important concern, and prophylaxis, cannulation and other related technical procedures have been well documented by endoscopists. In addition, medical radiation exposure is of great concern in the general population because of its rapidly increasing frequency and its potential carcinogenic effects. International organizations and radiological societies have established diagnostic reference levels, which guide proper radiation use and serve as global standards for all procedures that use ionizing radiation. However, data on gastrointestinal fluoroscopic procedures are still lacking because the demand for these procedures has recently increased. In this review, we present the current status of quality indicators for ERCP and the methods for measuring radiation exposure in the clinical setting as the next quality indicator for ERCP. To reduce radiation exposure, knowledge of its adverse effects and the procedures for proper measurement and protection are essential. Additionally, further studies on the factors that affect radiation exposure, exposure management and diagnostic reference levels are necessary. Then, we can discuss how to manage medical radiation use in these complex fluoroscopic procedures. This knowledge will help us to protect not only patients but also endoscopists and medical staff in the fluoroscopy unit.
  • Acute Pancreatitis with Disturbed Consciousness Caused by Hyperparathyroidism, Yasuo Otsuka, Ken Kamata, Kosuke Minaga, Mamoru Takenaka, Tomohiro Watanabe, Masatoshi Kudo, Internal Medicine, Internal Medicine, 57(21), 3075 - 3078, Nov. 01 2018
    Summary:© 2018 The Japanese Society of Internal Medicine. Although hyperparathyroidism has been reported to cause acute pancreatitis, little is known about the mechanism involved. This study describes the case of an 86-year-old woman with acute pancreatitis and consciousness disturbance caused by hyperparathyroidism and hypercalcemia, respectively. The consciousness disturbance caused by severe hypercalcemia probably masked the typical symptoms associated with pancreatitis because she did not report abdominal pain during the clinical course.
  • Molecular Scoring of Hepatocellular Carcinoma for Predicting Metastatic Recurrence and Requirements of Systemic Chemotherapy, Naoshi Nishida, Takafumi Nishimura, Toshimi Kaido, Kosuke Minaga, Kentaro Yamao, Ken Kamata, Mamoru Takenaka, Hiroshi Ida, Satoru Hagiwara, Yasunori Minami, Toshiharu Sakurai, Tomohiro Watanabe, Masatoshi Kudo, Cancers, Cancers, 10(10), 367 - 367, Sep. 29 2018 , Refereed
    Summary:Hepatocellular carcinoma (HCC) causes one of the most frequent cancer-related deaths; an HCC subset shows rapid progression that affects survival. We clarify molecular features of aggressive HCC, and establish a molecular scoring system that predicts metastasis after curative treatment. In total, 125 HCCs were examined for TP53, CTNNB1, and TERT promoter mutation, methylation of 8 tumor suppressor genes, and 3 repetitive DNA sequences to estimate promoter hypermethylation and global hypomethylation. A fractional allelic loss (FAL) was calculated to represent chromosomal instability through microsatellite analysis. Molecular subclasses were determined using corresponding and hierarchical clustering analyses. Next, twenty-five HCC patients who underwent liver transplantation were analyzed for associations between molecular characteristics and metastatic recurrence; survival analyses were validated using a publicly available dataset of 376 HCC cases from the Cancer Genome Atlas (TCGA). An HCC subtype characterized by TP53 mutation, high FAL, and global hypomethylation was associated with aggressive tumor characteristics, like vascular invasion; CTNNB1 mutation was a feature of the less-progressive phenotype. A number of molecular risk factors, including TP53 mutation, high FAL, significant global hypomethylation, and absence of CTNNB1 mutation, were noted to predict shorter recurrence-free survival in patients who underwent liver transplantation (p = 0.0090 by log-rank test). These findings were validated in a cohort of resected HCC cases from TCGA (p = 0.0076). We concluded that molecular risks determined by common genetic and epigenetic alterations could predict metastatic recurrence after curative treatments, and could be a marker for considering systemic therapy for HCC patients.
  • Value of additional endoscopic ultrasonography for surveillance after surgical removal of intraductal papillary mucinous neoplasms, Ken Kamata, Mamoru Takenaka, Kosuke Minaga, Shunsuke Omoto, Takeshi Miyata, Kentaro Yamao, Hajime Imai, Atsushi Nakai, Hidekazu Tanaka, Yasutaka Chiba, Tomohiro Watanabe, Toshiharu Sakurai, Naoshi Nishida, Takaaki Chikugo, Ippei Matsumoto, Yoshifumi Takeyama, Masayuki Kitano, Masatoshi Kudo, Digestive Endoscopy, Digestive Endoscopy, 30(5), 659 - 666, Sep. 2018
    Summary:© 2018 Japan Gastroenterological Endoscopy Society Background and Aim: This study evaluated the utility of endoscopic ultrasonography (EUS) combined with contrast-enhanced harmonic EUS (CH-EUS) for surveillance of the remnant pancreas after surgery for intraductal papillary mucinous neoplasm (IPMN). Methods: This was a single-center, retrospective, descriptive study. A total of 134 consecutive patients who underwent surgical resection for IPMN between April 2009 and March 2015 were evaluated. Rates of recurrence and development of IPMN-concomitant pancreatic ductal adenocarcinoma (PDAC) during follow up were assessed. Clinical findings of patients with recurrence or development of PDAC were also evaluated. Results: Of 134 resected IPMN 56 (41.8%) and 78 (58.2%) were classified as benign and malignant, respectively. Patients were followed up for a median of 29 months, 33 (24.6%) by both contrast-enhanced computed tomography (CE-CT) and EUS, and 101 (75.4%) by computed tomography (CT) alone. Thirteen patients (9.7%) showed tumor recurrence, five with intra-pancreatic recurrence and eight with extra-pancreatic metastases. An enhancing mural nodule within the dilated main pancreatic duct was successfully detected by EUS in one patient, but not by CE-CT. Two patients developed IPMN-concomitant PDAC during follow up. EUS combined with CH-EUS successfully detected small IPMN-concomitant PDAC in two patients, whereas these lesions were not detected by CT. CH-EUS was useful for better visualization of the margins of IPMN-concomitant PDAC in one of these two patients. Conclusion: Endoscopic ultrasonography combined with CH-EUS may improve follow up of patients with resected IPMN.
  • Reintervention for stent occlusion after endoscopic ultrasound-guided hepaticogastrostomy with novel use of a precut needle-knife, Kosuke Minaga, Mamoru Takenaka, Ayana Okamoto, Shunsuke Omoto, Takeshi Miyata, Hajime Imai, Masatoshi Kudo, Endoscopy, Endoscopy, 50(7), E153 - E154, Jul. 01 2018
  • Outcomes of endoscopic biliary drainage in pancreatic cancer patients with an indwelling gastroduodenal stent: a multicenter cohort study in West Japan, Kentaro Yamao, Masayuki Kitano, Mamoru Takenaka, Kosuke Minaga, Toshiharu Sakurai, Tomohiro Watanabe, Takahisa Kayahara, Tomoe Yoshikawa, Yukitaka Yamashita, Masanori Asada, Yoshihiro Okabe, Keiji Hanada, Yasutaka Chiba, Masatoshi Kudo, Gastrointestinal Endoscopy, Gastrointestinal Endoscopy, 88(1), 66 - 75.e2, Jul. 2018
    Summary:© 2018 American Society for Gastrointestinal Endoscopy Background and Aims: Gastroduodenal and biliary obstruction may occur synchronously or asynchronously in advanced pancreatic cancer, and endoscopic double stent placement may be required. EUS-guided biliary drainage (EUS-BD) often is performed after unsuccessful placement of an endoscopic transpapillary stent (ETS), and EUS-BD may be beneficial in double stent placement. This retrospective multicenter cohort study compared the outcomes of ETS placement and EUS-BD in patients with an indwelling gastroduodenal stent (GDS). Methods: We recorded the clinical outcomes of patients at 5 tertiary-care medical centers who required biliary drainage after GDS placement between March 2009 and March 2014. Results: Thirty-nine patients were included in this study. Patients’ mean age was 68.5 years; 23 (59.0%) were men. The GDS overlay the papilla in 23 patients (59.0%). The overall technical success rate was significantly higher with EUS-BD (95.2%) than with ETS placement (56.0%; P <.01). Furthermore, the technical success rate was significantly higher with EUS-BD (93.3%) than with ETS placement (22.2%; P <.01) when the GDS overlies the papilla. The overall clinical success rate of EUS-BD also was significantly higher than for ETS placement (90.5% vs 52.0%, respectively; P =.01), and there was no significant difference in the incidence of adverse events (ETS, 32.0% vs EUS-BD, 42.9%; P =.65). Conclusion: Endoscopic double stent placement with EUS-BD is technically and clinically superior to ETS placement in patients with an indwelling GDS. EUS-BD should be considered the first-line treatment option for patients with an indwelling GDS that overlies the papilla. ETS placement remains a reasonable alternative when the papilla is not covered by the GDS.
  • Multifocal cysts and incidence of pancreatic cancer concomitant with intraductal papillary mucinous neoplasm, Takuya Ikegawa, Atsuhiro Masuda, Arata Sakai, Hirochika Toyama, Yoh Zen, Keitaro Sofue, Takashi Nakagawa, Hideyuki Shiomi, Mamoru Takenaka, Takashi Kobayashi, Masaru Yoshida, Yoshifumi Arisaka, Yoshihiro Okabe, Hiromu Kutsumi, Takumi Fukumoto, Takeshi Azuma, Pancreatology, Pancreatology, 18(4), 399 - 406, Jun. 2018
    Summary:© 2018 IAP and EPC Objectives: The present study was conducted in order to elucidate the relationship between the number of cyst-existing regions and incidence of pancreatic ductal adenocarcinoma (PDAC) concomitant with intraductal papillary mucinous neoplasm (IPMN), which currently remains unclear. Methods: Subjects comprised 141 patients undergoing resection for IPMN (Non-invasive IPMN (IPMN with low-to high-grade dysplasia): N = 94, invasive IPMN: N = 31, and PDAC concomitant with IPMN: N = 16) between November 2000 and February 2017. A logistic regression analysis was performed to assess the relationship between the number of cyst-existing regions (one region/two or more regions) and incidence of PDAC concomitant with IPMN, adjusted by clinical characteristics. Cyst-existing regions were defined by the number of anatomical parts of the pancreas: the head/body/tail of the pancreas. Results: Multiple cyst-existing regions (two or more regions) correlated with the incidence of PDAC concomitant with IPMN (PDAC concomitant with IPMN in one region vs. two or more regions: 3/66 vs. 13/75, multivariable odds ratio [OR] = 4.11, 95% confidence interval [CI] = 1.22 to 18.8, P = 0.02). In contrast, multiple cyst-existing regions did not correlate with the incidence of IPMN (invasive IPMN in one region vs. two or more regions: 13/66 vs. 18/75, OR = 1.19, 95% CI = 0.52 to 2.76, P = 0.67). Conclusions: Multifocal cysts correlated with the incidence of PDAC concomitant with IPMN, and may be a high-risk factor for PDAC concomitant with IPMN.
  • A novel biliary cannulation method for difficult cannulation cases using a unique, uneven, double-lumen cannula (Uneven method)., Takenaka M, Arisaka Y, Sakai A, Kobayashi T, Shiomi H, Masuda A, Kudo M, Endoscopy, Endoscopy, 50(8), E229 - E230, Jun. 2018 , Refereed
  • Dysbiosis-Associated Polyposis of the Colon—Cap Polyposis, Kazuki Okamoto, Tomohiro Watanabe, Yoriaki Komeda, Ayana Okamoto, Kosuke Minaga, Ken Kamata, Kentaro Yamao, Mamoru Takenaka, Satoru Hagiwara, Toshiharu Sakurai, Tomonori Tanaka, Hiroki Sakamoto, Kiyoshige Fujimoto, Naoshi Nishida, Masatoshi Kudo, Frontiers in Immunology, Frontiers in Immunology, 9, May 07 2018
    Summary:© 2018 Okamoto, Watanabe, Komeda, Okamoto, Minaga, Kamata, Yamao, Takenaka, Hagiwara, Sakurai, Tanaka, Sakamoto, Fujimoto, Nishida and Kudo. Cap polyposis is a rare gastrointestinal disease characterized by multiple inflammatory polyps located between the distal colon and the rectum. Despite the lack of clarity regarding its pathogenesis, mucosal prolapse, chronic inflammatory responses, and Helicobacter pylori infection are considered key contributors to the development of this disease entity. Although it is now generally accepted that dysbiosis of gut microbiota is associated with intestinal and extra-intestinal diseases, alterations of intestinal microbiota have been poorly defined in cap polyposis. Here, we report a patient with H. pylori-negative cap polyposis who was successfully treated with antibiotics and exhibited dramatic alterations in intestinal microbiota composition after antibiotic treatment. The patient was treated with oral administration of ampicillin and metronidazole and showed regression of cap polyposis 6 months after antibiotic treatment. Fecal microbiota analysis using the next-generation sequencing technology revealed a significant alteration in the intestinal microbiota composition following antibiotic treatment-a marked reduction of Blautia, Dorea, and Sutterella was observed concomitant with a marked increase in Fusobacterium. These data suggest that cap polyposis may originate from dysbiosis and that microbiome-targeted therapy may be useful in this disorder.
  • Endoscopic ultrasonography-guided transenteric pancreatic duct drainage without cautery for obstructive pancreatitis as a result of ampullary carcinoma, Takeshi Miyata, Ken Kamata, Mamoru Takenaka, Digestive Endoscopy, Digestive Endoscopy, 30(3), 403 - 404, May 01 2018
  • Endoscopic Ultrasound-Guided Rendezvous Technique for Failed Biliary Cannulation in Benign and Resectable Malignant Biliary Disorders., Hideyuki Shiomi, Kentaro Yamao, Noriyuki Hoki, Takeshi Hisa, Takeshi Ogura, Kosuke Minaga, Atsuhiro Masuda, Kazuya Matsumoto, Hironari Kato, Hideki Kamada, Daisuke Goto, Hajime Imai, Mamoru Takenaka, Chishio Noguchi, Hidefumi Nishikiori, Yasutaka Chiba, Hiromu Kutsumi, Masayuki Kitano, Digestive diseases and sciences, Digestive diseases and sciences, 63(3), 787 - 796, Mar. 2018
    Summary:BACKGROUND: Endoscopic ultrasound-guided rendezvous technique (EUS-RV) has emerged as an effective salvage method for unsuccessful biliary cannulation. However, its application for benign and resectable malignant biliary disorders has not been fully evaluated. AIMS: To assess the efficacy and safety of EUS-RV for benign and resectable malignant biliary disorders. METHODS: This was a multicenter prospective study from 12 Japanese referral centers. Patients who underwent EUS-RV after failed biliary cannulation for biliary disorder were candidates for this study. Inclusion criteria were unsuccessful biliary cannulation for therapeutic endoscopic retrograde cholangiopancreatography with benign and potentially resectable malignant biliary obstruction. Exclusion criteria included unresectable malignant biliary obstruction, inaccessible papillae due to surgically altered upper gastrointestinal anatomy or duodenal stricture, and previous sphincterotomy and/or biliary stent placement. The primary outcome was the technical success rate of biliary cannulation; procedure time, adverse events, and clinical outcomes were secondary outcomes. RESULTS: Twenty patients were prospectively enrolled. The overall technical success rate and median procedure time were 85% and 33 min, respectively. Guidewire manipulation using a 4-Fr tapered tip catheter contributed to the success in advancing the guidewire into the duodenum. Adverse events were identified in 15% patients, including 2 with biliary peritonitis and 1 mild pancreatitis. EUS-RV did not affect surgical maneuvers or complications associated with surgery, or postoperative course. CONCLUSIONS: EUS-RV may be a safe and feasible salvage method for unsuccessful biliary cannulation for benign or resectable malignant biliary disorders. Use of a 4-Fr tapered tip catheter may improve the overall EUS-RV success rate.
  • Multicenter prospective evaluation study of endoscopic ultrasound-guided hepaticogastrostomy combined with antegrade stenting (with video), Takeshi Ogura, Masayuki Kitano, Mamoru Takenaka, Atsushi Okuda, Kosuke Minaga, Kentaro Yamao, Yukitaka Yamashita, Keiichi Hatamaru, Chishio Noguchi, Yasuhiko Gotoh, Taira Kuroda, Tomoyuki Yokota, Hidefumi Nishikiori, Ryota Sagami, Kazuhide Higuchi, Yasutaka Chiba, Digestive Endoscopy, Digestive Endoscopy, 30(2), 252 - 259, Mar. 01 2018
    Summary:Background and Aim: Endoscopic ultrasonography-guided hepaticogastrostomy (EUS-HGS) is often indicated for advanced stage patients. Therefore it is important to prevent adverse events associated with EUS-HGS procedures and obtain long stent patency. EUS-guided antegrade stenting (AS) has been developed as an advanced technique. Thus, to prevent adverse events and achieve long stent patency, EUS-AS combined with EUS-HGS (EUS-HGAS) has been reported. The aim of the present study was to evaluate the technical feasibility and efficacy of EUS-HGAS in a multicenter, prospective study. Methods: This prospective study was carried out at each hospital of the Therapeutic Endoscopic Ultrasound Group. Primary endpoint of this multicenter prospective study was stent patency of EUS-HGAS. Results: A total of 49 patients were enrolled. Technical success rate of EUS-HGS was 95.9% (47/49). EUS-AS failed in five patients because the guidewire could not be advanced into the intestine across the bile duct obstruction site. Therefore, EUS-HGAS was successfully carried out in 40 patients (technical success rate: 85.7%). Median overall survival was 114 days. Median stent patency including stent dysfunction and patient death was 114 days. In contrast, mean stent patency was 320 days. Adverse events were seen in 10.2% (5/49) of cases. Hyperamylasemia was seen in four patients, and bleeding was seen in one patient. Conclusions: The present study is the first to evaluate EUS-HGAS. EUS-HGAS has clinical benefit for obtaining long stent patency and avoiding adverse events, although the possibility of acute pancreatitis as a result of obstruction of the orifice of the pancreatic duct must be considered.
  • Transrectal endoscopic ultrasound-guided paracentesis for diagnosis of malignant ascites in the pelvis, Kosuke Minaga, Mamoru Takenaka, Ken Kamata, Masatoshi Kudo, Digestive and Liver Disease, Digestive and Liver Disease, 50(3), 311, Mar. 01 2018
  • Alleviating pancreatic cancer-associated pain using endoscopic ultrasound-guided neurolysis, Kosuke Minaga, Mamoru Takenaka, Ken Kamata, Tomoe Yoshikawa, Atsushi Nakai, Shunsuke Omoto, Takeshi Miyata, Kentaro Yamao, Hajime Imai, Hiroki Sakamoto, Masayuki Kitano, Masatoshi Kudo, Cancers, Cancers, 10(2), Feb. 15 2018
    Summary:The most common symptom in patients with advanced pancreatic cancer is abdominal pain. This has traditionally been treated with nonsteroidal anti-inflammatory drugs and opioid analgesics. However, these treatments result in inadequate pain control or drug-related adverse effects in some patients. An alternative pain-relief modality is celiac plexus neurolysis, in which the celiac plexus is chemically ablated. This procedure was performed percutaneously or intraoperatively until 1996, when endoscopic ultrasound (EUS)-guided celiac plexus neurolysis was first described. In this transgastric anterior approach, a neurolytic agent is injected around the celiac trunk under EUS guidance. The procedure gained popularity as a minimally invasive approach and is currently widely used to treat pancreatic cancer-associated pain. We focus on two relatively new techniques of EUS-guided neurolysis: EUS-guided celiac ganglia neurolysis and EUS-guided broad plexus neurolysis, which have been developed to improve efficacy. Although the techniques are safe and effective in general, some serious adverse events including ischemic and infectious complications have been reported as the procedure has gained widespread popularity. We summarize reported clinical outcomes of EUS-guided neurolysis in pancreatic cancer (from the PubMed and Embase databases) with a goal of providing information useful in developing strategies for pancreatic cancer-associated pain alleviation.
  • Cystic duct antegrade stenting for cholangitis after the long-term deployment of lumen-apposing metal stents for calculous cholecystitis, Mamoru Takenaka, Ken Kamata, Kosuke Minaga, Atsushi Nakai, Shunsuke Omoto, Takeshi Miyata, Kentaro Yamao, Hajime Imai, Toshiharu Sakurai, Tomohiro Watanabe, Naoshi Nishida, Masatoshi Kudo, Endoscopic Ultrasound, Endoscopic Ultrasound, 7(5), 349 - 349, 2018
  • Papillary neoplasm in a common channel in patients with pancreaticobiliary maljunction, Yusuke Makutani, Ippei Matsumoto, Shunsuke Omoto, Takaaki Chikugo, Kohei Kawaguchi, Masataka Matsumoto, Takaaki Murase, Keiko Kamei, Shumpei Satoi, Takuya Nakai, Mamoru Takenaka, Masatoshi Kudo, Yoshifumi Takeyama, Japanese Journal of Gastroenterological Surgery, Japanese Journal of Gastroenterological Surgery, 51(2), 114 - 121, 2018
    Summary:We report a rare case of papillary neoplasm in a common channel with pancreaticobiliary maljunction. A 75-year-old man had acute pancreatitis twice during 6 months. He recovered with conservative treatment. He was admitted to our hospital for further examination. ERCP revealed pancreaticobiliary maljunction with a 7-mm filling defect in a dilated common channel. Gastroduodenoscopy revealed no discharge of mucin. Endoscopic US revealed a 7.9×7.5- mm pedunculated papillary tumor in the common channel. Contrast-enhanced CT revealed an 8.0×6.0 mm tumor in the dilated common channel, 10 mm in diameter. The distal main pancreatic duct was not dilated. Subtotal stomachpreserving pancreaticoduodenectomy was performed with a preoperative diagnosis of papillary neoplasm in the common channel with pancreaticobiliary maljunction. The resected specimen was pathologically diagnosed as a pedunculated papillary adenoma with a fine fibrovascular core in the common channel. Immunohistochemical findings of the tumor were negative for MUC1 and MUC2, and positive for MUC5AC and MUC6. The final diagnosis of gastric-type adenoma was made.
  • Multicenter study of early pancreatic cancer in Japan, Atsushi Kanno, for the Japan Study Group on the Early Detection of Pancreatic Cancer (JEDPAC), Atsushi Masamune, Keiji Hanada, Hiroyuki Maguchi, Yasuhiro Shimizu, Toshiharu Ueki, Osamu Hasebe, Takao Ohtsuka, Masafumi Nakamura, Mamoru Takenaka, Masayuki Kitano, Masataka Kikuyama, Toshifumi Gabata, Koji Yoshida, Tamito Sasaki, Masahiro Serikawa, Toru Furukawa, Akio Yanagisawa, Tooru Shimosegawa, Pancreatology, Pancreatology, 18(1), 61 - 67, Jan. 01 2018
    Summary:Background/Objectives: The diagnosis of early-stage pancreatic ductal adenocarcinoma (PDAC) is still challenging. We conducted a multicenter study to clarify the clinical features of early-stage PDAC in Japan. Methods: We collected patients with stage 0 and stage I PDAC according to the sixth edition of the Japanese Classification of Pancreatic Carcinoma. We retrospectively analyzed the clinical profiles including opportunities for medical examination, imaging modalities and findings, methods of cytological diagnosis, and prognosis according to the stages at diagnosis. Results: Two hundred cases with Stage 0 and stage I PDAC were reported from 14 institutions, which accounted for approximately 0.7% and 3% of all PDAC cases, respectively. Overall, 20% of the early-stage PDAC cases were symptomatic. Indirect imaging findings such as dilatation of the main pancreatic duct were useful to detect early-stage PDAC. In particular, local fatty changes may be specific to early-stage PDAC. For preoperative pathologic diagnosis, cytology during endoscopic retrograde cholangiopancreatography was more commonly applied than endoscopic ultrasound fine-needle aspiration. Although the overall prognosis was favorable, new PDAC lesions developed in the remnant pancreas in 11.5% cases. Conclusions: This multicenter study revealed several key points concerning the diagnosis and management of early-stage PDAC, including screening of asymptomatic cases, importance of indirect imaging findings, application of cytology during endoscopic retrograde cholangiopancreatography, and the risk of carcinogenesis in the remnant pancreas.
  • Impact of avascular areas, as measured by contrast-enhanced harmonic EUS, on the accuracy of FNA for pancreatic adenocarcinoma, Ken Kamata, Mamoru Takenaka, Shunsuke Omoto, Takeshi Miyata, Kosuke Minaga, Kentaro Yamao, Hajime Imai, Toshiharu Sakurai, Naoshi Nishida, Takaaki Chikugo, Yasutaka Chiba, Ippei Matsumoto, Yoshifumi Takeyama, Masatoshi Kudo, GASTROINTESTINAL ENDOSCOPY, GASTROINTESTINAL ENDOSCOPY, 87(1), 158 - 163, Jan. 2018
    Summary:Background and Aims: EUS-guided FNA (EUS-FNA) is used for the diagnosis of pancreatic adenocarcinoma, but sometimes the method results in a false negative. Occasionally, an avascular area may be observed within the pancreatic adenocarcinoma tumor during contrast-enhanced harmonic EUS (CH-EUS). The aim of this study was to evaluate whether the diagnostic sensitivity of EUS-FNA for pancreatic adenocarcinoma was affected by the presence of avascularity on CH-EUS. Methods: Two hundred ninety-two patients with pancreatic adenocarcinoma who presented at Kindai University Hospital for EUS-FNA and CH-EUS between June 2009 and August 2013 were retrospectively evaluated. This was a single-center retrospective analysis of prospectively collected data held in a registry. The overall sensitivity of EUS-FNA for the diagnosis of pancreatic adenocarcinoma was calculated. The sensitivities of cytology, histology, and the combination of cytology and histology were also evaluated. These variables were individually evaluated according to the presence or absence of an avascular area on CH-EUS to assess whether the diagnostic sensitivity of EUS-FNA for pancreatic adenocarcinoma was related to the presence of an avascular area within the tumors. Results: The overall sensitivity of EUS-FNA was 90.8% (265/292). The sensitivities of EUS-FNA for lesions with and without an avascular area were 72.9% (35/48) and 94.3% (230/244), respectively, with the difference being statistically significant (P <.001). Conclusions: EUS-FNA has lower sensitivity for pancreatic adenocarcinoma with avascular areas on CH-EUS.
  • Pancreatic inflammation and atrophy are not associated with pancreatic cancer concomitant with intraductal papillary mucinous neoplasm, Yosuke Yagi, Atsuhiro Masuda, Yoh Zen, Hideyuki Shiomi, Hirochika Toyama, Keitaro Sofue, Mamoru Takenaka, Takashi Kobayashi, Takashi Nakagawa, Kodai Yamanaka, Takuya Ikegawa, Namiko Hoshi, Masaru Yoshida, Yoshifumi Arisaka, Yoshihiro Okabe, Hiromu Kutsumi, Takumi Fukumoto, Yonson Ku, Takeshi Azuma, Pancreatology, Pancreatology, 18(1), 54 - 60, Jan. 2018
    Summary:© 2017 IAP and EPC Background Inflammation-induced carcinogenesis in pancreatic ductal adenocarcinoma (PDAC) has been reported; however, its involvement in PDAC with intraductal papillary mucinous neoplasm (IPMN) remains unclear. We herein investigated the relationship between pancreatic atrophy and inflammation and the incidence of PDAC concomitant with IPMN. Methods This study included 178 consecutive patients who underwent surgical resection for PDAC with IPMN (N = 21) and IPMN (N = 157) between April 2001 and October 2016. A multivariable logistic regression analysis was conducted to assess the relationship between pancreatic inflammation and atrophy and the incidence of PDAC concomitant with IPMN, with adjustments for clinical characteristics and imaging features. Pathological pancreatic inflammation and atrophy were evaluated in resected specimens. Results High degrees of pancreatic inflammation and atrophy were not associated with the incidence of PDAC with IPMN (multivariable odds ratio [OR] = 0.5, 95% confidence interval [CI] = 0.07 to 3.33, P =.52, adjusted by clinical characteristics, OR = 0.9, 95% CI = 0.10 to 5.86, P =.91, adjusted by imaging studies; OR = 0.2, 95% CI = 0.009 to 1.31, P =.10, adjusted by clinical characteristics, OR = 0.2, 95% CI = 0.01 to 1.43, P =.12, adjusted by imaging studies, respectively). Conclusions Pancreatic inflammation and atrophy were not associated with pancreatic cancer concomitant with IPMN.
  • Contrast-enhanced harmonic endoscopic ultrasonography for differential diagnosis of localized gallbladder lesions, Ken Kamata, Mamoru Takenaka, Masayuki Kitano, Shunsuke Omoto, Takeshi Miyata, Kosuke Minaga, Kentaro Yamao, Hajime Imai, Tosiharu Sakurai, Naoshi Nishida, Hiroshi Kashida, Takaaki Chikugo, Yasutaka Chiba, Takuya Nakai, Yoshifumi Takeyama, Andrea Lisotti, Pietro Fusaroli, Masatoshi Kudo, Digestive Endoscopy, Digestive Endoscopy, 30(1), 98 - 106, Jan. 01 2018
    Summary:Background and Aim: Differential diagnosis of localized gallbladder lesions is challenging. The aim of the present study was to evaluate the utility of contrast-enhanced harmonic endoscopic ultrasonography (CH-EUS) for diagnosis of localized gallbladder lesions. Methods: One hundred and twenty-five patients with localized gallbladder lesions were evaluated by CH-EUS between March 2007 and February 2014. This was a single-center retrospective study. Utilities of fundamental B-mode EUS (FB-EUS) and CH-EUS in the differentiation of gallbladder lesions and sludge plug were initially compared. Thereafter, these two examinations were compared with respect to their accuracy in the diagnosis of malignant lesions. Five reviewers blinded to the clinicopathological results evaluated microcirculation patterns in the vascular and perfusion images. Results: In the differentiation between gallbladder lesions and sludge plug, FB-EUS had a sensitivity, specificity, and accuracy of 82%, 100%, and 95%, respectively, whereas CH-EUS had a sensitivity, specificity, and accuracy of 100%, 99%, and 99%, respectively. FB-EUS-based diagnosis of carcinomas based on tumor size and/or shape had a sensitivity, specificity, and accuracy of 61–87%, 71–88%, and 74–86%, respectively. Additional information regarding irregular vessel patterns in the vascular image and/or heterogeneous enhancement in the perfusion image on CH-EUS increased the sensitivity, specificity, and accuracy for the diagnosis of carcinomas to 90%, 98%, and 96%, respectively. There was a significant difference between FB-EUS and CH-EUS in terms of carcinoma diagnosis. Conclusion: CH-EUS was useful for the evaluation of localized gallbladder lesions.
  • A case of successful transluminal drainage of walled-off necrosis under contrast-enhanced harmonic endoscopic ultrasonography guidance, Kosuke Minaga, Mamoru Takenaka, Shunsuke Omoto, Takeshi Miyata, Ken Kamata, Kentaro Yamao, Hajime Imai, Tomohiro Watanabe, Masayuki Kitano, Masatoshi Kudo, Journal of Medical Ultrasonics, Journal of Medical Ultrasonics, 45(1), 161 - 165, Jan. 2018
    Summary:© 2017, The Japan Society of Ultrasonics in Medicine. We report a case of successful transluminal drainage of walled-off necrosis (WON) under contrast-enhanced harmonic endoscopic ultrasonography (CH-EUS) guidance. Recently, EUS-guided transluminal drainage (EUS-TD) of WON has been increasingly used as a minimally invasive treatment option with reportedly high technical and clinical success rates; however, B-mode EUS occasionally fails to depict the target lesion and its margins, particularly in cases where the target shows a heterogeneous echogenicity. In our case, EUS-TD was attempted for infected WON, but visualization using B-mode EUS imaging was poor. Thus, CH-EUS was performed to enhance the contrast between the targeted WON and its surrounding tissues. Immediately after injecting a sonographic contrast agent, WON and its margins were clearly identified as an avascular area and were punctured under CH-EUS guidance. CH-EUS enables the assessment of the microvasculature and hemodynamics of the target lesion in real time. It may also provide valuable information and could be a useful modality for EUS-TD to clearly visualize target lesions and their margins and to decisively puncture them, even when they could not be identified using B-mode EUS.
  • A Case of Pancreatic Carcinoma in situ Diagnosed by Repeated Pancreatic Juice Cytology, Takeshi Miyata, Mamoru Takenaka, Shunsuke Omoto, Ken Kamata, Kosuke Minaga, Kentaro Yamao, Hajime Imai, Masatoshi Kudo, Oncology (Switzerland), Oncology (Switzerland), 93(1), 98 - 101, Dec. 01 2017
    Summary:Repeated pancreatic juice cytology via endoscopic nasopancreatic drainage (ENPD) has a high diagnostic yield and might be useful for the diagnosis of early-stage pancreatic cancer. A 67-year-old man presented with a pancreatic cyst occasionally detectable in the body of the pancreas by ultrasonography (US). No obvious pancreatic tumor was detected by US, computed tomography (CT), magnetic resonance cholangiopancreatography, and endoscopic ultrasound (EUS) (although the latter did reveal a weak, low echoic area). Endoscopic retrograde pancreatography showed irregular narrowing of the main pancreatic duct (MPD) at the pancreatic body. Pancreatic juice cytology was also performed, but did not give evidence of a malignancy. Therefore, the patient was followed up. CT and EUS performed after 3 months showed the same findings as did endoscopic retrograde pancreatography however, the results of repeated pancreatic juice cytology performed via ENPD tube revealed a suspected malignancy on 2 of 6 occasions. Therefore, we performed a central pancreatectomy. Histopathological examination of a resected specimen revealed carcinoma in situ in the narrow MPD at the body of the pancreas. In the current case, repeated pancreatic juice cytology via ENPD was effective. A weak low echoic area around the MPD stricture on EUS might be related to the inflammatory change accompanying carcinoma in situ of the pancreas.
  • Electronic hydraulic lithotripsy by antegrade digital cholangioscopy through endoscopic ultrasound-guided hepaticojejunostomy, Yasuo Otsuka, Ken Kamata, Mamoru Takenaka, Kosuke Minaga, Hidekazu Tanaka, Masatoshi Kudo, ENDOSCOPY, ENDOSCOPY, 49(12), E316 - E318, Dec. 2017
  • Achievement of long-term stent patency in endoscopic ultrasonography-guided right bile duct drainage after left hepatic lobectomy (with video), Kosuke Minaga, Mamoru Takenaka, Takeshi Miyata, Kentaro Yamao, Ken Kamata, Masayuki Kitano, Masatoshi Kudo, ENDOSCOPIC ULTRASOUND, ENDOSCOPIC ULTRASOUND, 6(6), 412 - 413, Nov. 2017
  • Endoscopic ultrasound-guided choledochoduodenostomy with novel use of contrastenhanced harmonic imaging, Kosuke Minaga, Mamoru Takenaka, Ken Kamata, Takeshi Miyata, Kentaro Yamao, Hajime Imai, Masatoshi Kudo, ENDOSCOPY, ENDOSCOPY, 49(11), E281 - E282, Nov. 2017
  • Portal vein stenting for portal vein stenosis caused by bile duct cancer, Ken Kamata, Mamoru Takenaka, Masakatsu Tsurusaki, Masatoshi Kudo, DIGESTIVE AND LIVER DISEASE, DIGESTIVE AND LIVER DISEASE, 49(11), 1282 - 1282, Nov. 2017
  • Rescue EUS-guided intrahepatic biliary drainage for malignant hilar biliary stricture after failed transpapillary re-intervention, Kosuke Minaga, Mamoru Takenaka, Masayuki Kitano, Yasutaka Chiba, Hajime Imai, Kentaro Yamao, Ken Kamata, Takeshi Miyata, Shunsuke Omoto, Toshiharu Sakurai, Tomohiro Watanabe, Naoshi Nishida, Masatoshi Kudo, SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES, SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES, 31(11), 4764 - 4772, Nov. 2017
    Summary:Treatment of unresectable malignant hilar biliary stricture (UMHBS) is challenging, especially after failure of repeated transpapillary endoscopic stenting. Endoscopic ultrasonography-guided intrahepatic biliary drainage (EUS-IBD) is a recent technique for intrahepatic biliary decompression, but indications for its use for complex hilar strictures have not been well studied. The aim of this study was to assess the feasibility and safety of EUS-IBD for UMHBS after failed transpapillary re-intervention. Retrospective analysis of all consecutive patients with UMHBS of Bismuth II grade or higher who, between December 2008 and May 2016, underwent EUS-IBD after failed repeated transpapillary interventions. The technical success, clinical success, and complication rates were evaluated. Factors associated with clinical ineffectiveness of EUS-IBD were explored. A total of 30 patients (19 women, median age 66 years [range 52-87]) underwent EUS-IBD for UMHBS during the study period. Hilar biliary stricture morphology was classified as Bismuth II, III, or IV in 5, 13, and 12 patients, respectively. The median number of preceding endoscopic interventions was 4 (range 2-14). EUS-IBD was required because the following procedures failed: duodenal scope insertion (n = 4), accessing the papilla after duodenal stent insertion (n = 5), or achieving desired intrahepatic biliary drainage (n = 21). Technical success with EUS-IBD was achieved in 29 of 30 patients (96.7%) and clinical success was attained in 22 of these 29 (75.9%). Mild peritonitis occurred in three of 30 (10%) and was managed conservatively. Stent dysfunction occurred in 23.3% (7/30). There was no procedure-related mortality. On multivariable analysis, Bismuth IV stricture predicted clinical ineffectiveness (odds ratio = 12.7, 95% CI 1.18-135.4, P = 0.035). EUS-IBD may be a feasible and effective rescue alternative with few major complications after failed transpapillary endoscopic re-intervention in patients with UMHBS, particularly for Bismuth II or III strictures.
  • Prospective evaluation of digital single-operator cholangioscope for diagnostic and therapeutic procedures (with videos), Takeshi Ogura, Miyuki Imanishi, Yoshitaka Kurisu, Saori Onda, Tastsushi Sano, Wataru Takagi, Atsushi Okuda, Akira Miyano, Mio Amano, Nobu Nishioka, Tadahiro Yamada, Daisuke Masuda, Mamoru Takenaka, Masayuki Kitano, Kazuhide Higuchi, DIGESTIVE ENDOSCOPY, DIGESTIVE ENDOSCOPY, 29(7), 782 - 789, Nov. 2017
    Summary:Background and Aim: Recently, the digital single-operator cholangioscope (SPY-DS) has become available. This system may allow diagnosis by direct visualization and allow performance of various therapeutic procedures. The aim of the present study was to prospectively evaluate the clinical utility of DSOCS for diagnostic and therapeutic procedures for biliary disease. Methods: Technical success was defined as successful visualization of target lesions in the biliary tract and carrying out forceps biopsy as a diagnostic procedure, and successfully carrying out treatment such as guidewire insertion for the area of interest, electrohydraulic lithotripsy (EHL), or migrated stent removal. Also, the present study aimed at investigating diagnostic yield of the cholangioscopic findings and biopsy specimens. Results: A total of 55 consecutive patients were prospectively enrolled in this study; a diagnostic procedure was done in 33 patients, and a therapeutic procedure was done in 22 patients. Overall accuracy of visual findings was 93%, with a sensitivity of 83%, a specificity of 89%, positive predictive value (PPV) of 83%, and negative predictive value (NPV) of 100%. However, the overall accuracy of forceps biopsy was 89%, with a sensitivity, specificity, and PPV of 100%, and NPV of 90%. Overall technical success rate of therapeutic procedures such as selective guidewire insertion, EHL or migrated stent removal was 91% (20/22). Finally, adverse events were seen in two cases in the diagnostic group, but were not seen in the therapeutic group. Conclusion: Although additional cases and a randomized, controlled study with another cholangioscope are needed, diagnostic and therapeutic procedures using SPY-DS appear to be feasible and safe.
  • Gankyrin induces STAT3 activation in tumor microenvironment and sorafenib resistance in hepatocellular carcinoma, Toshiharu Sakurai, Norihisa Yada, Satoru Hagiwara, Tadaaki Arizumi, Kosuke Minaga, Ken Kamata, Mamoru Takenaka, Yasunori Minami, Tomohiro Watanabe, Naoshi Nishida, Masatoshi Kudo, CANCER SCIENCE, CANCER SCIENCE, 108(10), 1996 - 2003, Oct. 2017 , Refereed
    Summary:Most hepatocellular carcinomas (HCC) develop as a result of chronic liver inflammation. We have shown that the oncoprotein gankyrin is critical for inflammation-induced tumorigenesis in the colon. Although the invitro function of gankyrin is well known, its role invivo remains to be elucidated. We investigated the effect of gankyrin in the tumor microenvironment of mice with liver parenchymal cell-specific gankyrin ablation (Alb-Cre;gankyrin(f/f)) and gankyrin deletion both in liver parenchymal and non-parenchymal cells (Mx1-Cre;gankyrin(f/f)). Gankyrin upregulates vascular endothelial growth factor expression in tumor cells. Gankyrin binds to Src homology 2 domain-containing protein tyrosine phosphatase-1 (SHP-1), mainly expressed in liver non-parenchymal cells, resulting in phosphorylation and activation of signal transducer and activator of transcription 3 (STAT3). Gankyrin deficiency in non-parenchymal cells, but not in parenchymal cells, reduced STAT3 activity, interleukin (IL)-6 production, and cancer stem cell marker (Bmi1 and epithelial cell adhesion molecule [EpCAM]) expression, leading to attenuated tumorigenic potential. Chronic inflammation enhances gankyrin expression in the human liver. Gankyrin expression in the tumor microenvironment is negatively correlated with progression-free survival in patients undergoing sorafenib treatment for HCC. Thus, gankyrin appears to play a critical oncogenic function in tumor microenvironment and may be a potential target for developing therapeutic and preventive strategies against HCC.
  • Contrast-enhanced harmonic endoscopic ultrasonography for differential diagnosis of submucosal tumors of the upper gastrointestinal tract, Ken Kamata, Mamoru Takenaka, Masayuki Kitano, Shunsuke Omoto, Takeshi Miyata, Kosuke Minaga, Kentaro Yamao, Hajime Imai, Toshiharu Sakurai, Tomohiro Watanabe, Naoshi Nishida, Takaaki Chikugo, Yasutaka Chiba, Haruhiko Imamoto, Takushi Yasuda, Andrea Lisotti, Pietro Fusaroli, Masatoshi Kudo, JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, 32(10), 1686 - 1692, Oct. 2017
    Summary:Background and Aim: The study aims to evaluate contrast-enhanced harmonic endoscopic ultrasonography (CH-EUS) for the differential diagnosis of submucosal tumors (SMT) of the upper gastrointestinal tract. Methods: Between June 2008 and May 2015, 157 consecutive patients with submucosal lesions of the upper gastrointestinal tract were evaluated by CH-EUS. This was a single-center retrospective analysis of prospectively collected data in a registry. The data from 73 patients who later underwent surgical resection were analyzed in this study. Surgical specimens served as the final diagnoses. The two CH-EUS variables of blood flow (hyper-enhancement vs hypo-enhancement) and homogeneity of enhancement pattern were evaluated. Results: The final diagnoses were 58 gastrointestinal stromal tumors (GISTs) and 15 benign SMTs (two lipomas, five leiomyomas, five schwannomas, two glomus tumors, and one ectopic pancreas). On CH-EUS, 49 of 58 (84.5%) GISTs presented with hyper-enhancement, whereas 4 of 15 (26.7%) benign SMTs showed hyper-enhancement; 21 of 58 (36.2%) GISTs showed inhomogeneous contrast enhancement, while only 2 of 15 (13.3%) benign SMTs demonstrated inhomogeneous contrast enhancement. If hyper-enhancement was considered to indicate GISTs, the sensitivity, specificity, and accuracy were 84.5%, 73.3%, and 82.2%, respectively. If inhomogeneous enhancement was considered to indicate GISTs, the sensitivity, specificity, and accuracy were 36.2%, 86.7%, and 46.6%, respectively. In lesions of less than 2cm, hyper-enhancement was a more sensitive indicator of GISTs than inhomogeneous enhancement. Conclusions: Hyper-enhancement and inhomogeneous enhancement were found to be a characteristic of GISTs. CH-EUS was useful for discrimination of benign SMTs from GISTs.
  • Imaging and clinicopathological features of nivolumab-related cholangitis in patients with non-small cell lung cancer, Hisato Kawakami, Junko Tanizaki, Kaoru Tanaka, Koji Haratani, Hidetoshi Hayashi, Masayuki Takeda, Ken Kamata, Mamoru Takenaka, Masatomo Kimura, Takaaki Chikugo, Takao Sato, Masatoshi Kudo, Akihiko Ito, Kazuhiko Nakagawa, INVESTIGATIONAL NEW DRUGS, INVESTIGATIONAL NEW DRUGS, 35(4), 529 - 536, Aug. 2017
    Summary:Background Nivolumab demonstrates promising efficacy for the treatment of non-small cell lung cancer and other malignancies. The clinical benefit of nivolumab, however, may be hampered by specific immune-related adverse events (irAEs), and little is known regarding nivolumab-related cholangitis. Methods A computerized search of our clinical database identified 3 metastatic non-small cell lung cancer patients with nivolumab-related cholangitis. All patients were treated with in-travenous nivolumab monotherapy (3.0 mg/kg) every 2 weeks until disease progression or irAEs occurred. Clinical data regarding the duration of nivolumab treatment, symptoms, laboratory abnormalities, pathological findings of liver parenchyma biopsy specimens, and management of nivolumab-related cholangitis were analyzed. Results Our analysis revealed that nivolumab-related cholangitis was characterized by (1) localized extrahepatic bile duct dilation without obstruction; (2) diffuse hypertrophy of the extrahepatic bile duct wall; (3) a dominant increase in the biliary tract enzymes alkaline phosphatase and gamma-glutamyl transpeptidase relative to the hepatic enzymes aspartate and alanine aminotransferase; (4) normal or reduced levels of the serum immunological markers antinuclear antibody, antimitochondrial antibody, smooth muscle antibody, and immunoglobulin G4; (5) the pathological finding of biliary tract cluster of differentiation 8-positive T cell infiltration from liver biopsy; and (6) amoderate to poor response to steroid therapy. Conclusions Nivolumab-related cholangitis is associated with distinct imaging and clinicopathological features that distinguish it from acute cholangitis of common etiologies and other immune-related cholangitis. Further studies are warranted to establish the optimal management of patients with this irAE.
  • Stent migration during EUS-guided hepaticogastrostomy in a patient with massive ascites: Troubleshooting using additional EUS-guided antegrade stenting, Ken Kamata, Mamoru Takenaka, Kosuke Minaga, Shunsuke Omoto, Takeshi Miyata, Kentaro Yamao, Hajime Imai, Masatoshi Kudo, ARAB JOURNAL OF GASTROENTEROLOGY, ARAB JOURNAL OF GASTROENTEROLOGY, 18(2), 120 - 121, Jun. 2017
    Summary:EUS-guided hepaticogastrostomy (EUS-HGS) is useful for treating obstructive jaundice. However, stent migration may sometimes occur both during and after the procedure. This report describes a patient with pancreatic cancer and massive ascites who underwent EUS-HGS combined with EUS-guided antegrade stenting (EUS-AS), with additional EUS-AS playing a role in troubleshooting for stent migration during EUS-HGS. (C) 2017 Pan-Arab Association of Gastroenterology. Published by Elsevier B.V. All rights reserved.
  • Investigation on the Efficacy of Alteration of Treatment Methods for Difficult Cases in Eus-Bd, Kosuke Minaga, Mamoru Takenaka, Masayuki Kitano, Hajime Imai, Kentaro Yamao, Ken Kamata, Takeshi Miyata, Shunsuke Omoto, Tomoe Yoshikawa, Masatoshi Kudo, GASTROINTESTINAL ENDOSCOPY, GASTROINTESTINAL ENDOSCOPY, 85(5), AB493 - AB493, May 2017 , Refereed
  • Improved Diagnosis of Liver Metastases Using Kupffer-Phase Image of Contrast-Enhanced Harmonic Endoscopic Ultrasonography in Patients With Pancreatic Cancer, Kosuke Minaga, Mamoru Takenaka, Masayuki Kitano, Hajime Imai, Kentaro Yamao, Ken Kamata, Takeshi Miyata, Shunsuke Omoto, Tomoe Yoshikawa, Masatoshi Kudo, GASTROINTESTINAL ENDOSCOPY, GASTROINTESTINAL ENDOSCOPY, 85(5), AB53 - AB53, May 2017 , Refereed
  • Outcomes of Biliary Drainage in Pancreatic Cancer Patients With an Indwelling Gastroduodenal Stent: A Multicenter Retrospective Study in West Japan, Kentaro Yamao, Masayuki Kitano, Takahisa Kayahara, Etsuji Ishida, Hiroshi Yamamoto, Tomoe Yoshikawa, Kosuke Minaga, Yukitaka Yamashita, Masanori Asada, Yoshihiro Okabe, Yukio Osaki, Juri Ikemoto, Keiji Hanada, Mamoru Takenaka, Masatoshi Kudo, GASTROINTESTINAL ENDOSCOPY, GASTROINTESTINAL ENDOSCOPY, 85(5), AB327 - AB328, May 2017 , Refereed
  • History of Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis and Acute Pancreatitis as Risk Factors for Post-ERCP Pancreatitis., Funatsu E, Masuda A, Takenaka M, Nakagawa T, Shiomi H, Yoshinaka H, Kobayashi T, Sakai A, Yagi Y, Yoshida M, Arisaka Y, Okabe Y, Kutsumi H, Azuma T, The Kobe journal of medical sciences, The Kobe journal of medical sciences, 63, May 2017
    Summary:© 2017, Kobe University School of Medicine. All rights reserved. Background: Previous pancreatitis is a definite patient-related risk factor for pancreatitis after endoscopic retrograde cholangiopancreatography (post-ERCP pancreatitis: PEP). However, the effects of differences in the history of PEP and acute pancreatitis on the occurrence of PEP have not been fully investigated. We examined the relationship between previous PEP or previous acute pancreatitis and procedural factors associated with PEP. Methods: Clinical data on 1,334 consecutive patients undergoing ERCP between April 2006 and June 2010 were collected. A multivariate logistic regression analysis was conducted to assess the relationship between PEP and the cannulation time (<15 min vs. ≥15 min) or total procedure time (<30 min vs. ≥30 min) according to previous pancreatitis (previous PEP: pPEP or previous acute pancreatitis: pAP), with adjustments for clinical characteristics. Results: Longer cannulation times (≥15 min) correlated with the occurrence of PEP in the pPEP group (OR=2.97; 95% CI=1.10 to 8.43, P=0.03) and in patients without previous pancreatitis (non-preP group) (OR=2.43; 95% CI=1.41 to 4.14, P= 0.002), but not in the pAP group (OR=2.78; 95% CI=0.50 to 22.42, P= 0.25). In contrast, longer procedure times correlated with the occurrence of PEP in the pAP group (OR=3.93; 95% CI=1.11 to 16.5, P= 0.03), but not in the pPEP group (OR=2.79; 95% CI=0.92 to 9.18, P= 0.068) or non-preP group (OR=0.71; 95% CI=0.39 to 1.24, P= 0.23). Conclusions: A higher risk of PEP with previous PEP was associated with longer cannulation times, whereas a higher risk of PEP with previous acute pancreatitis was associated with longer procedure times.
  • Endoscopic ultrasonography-guided choledochoduodenostomy using a newly designed laser-cut metal stent: Feasibility study in a porcine model, Kosuke Minaga, Masayuki Kitano, Chimyon Gon, Kentaro Yamao, Hajime Imai, Takeshi Miyata, Ken Kamata, Shunsuke Omoto, Mamoru Takenaka, Masatoshi Kudo, DIGESTIVE ENDOSCOPY, DIGESTIVE ENDOSCOPY, 29(2), 211 - 217, Mar. 2017
    Summary:Background and AimEndoscopic ultrasonography (EUS)-guided choledochoduodenostomy (EUS-CDS) is increasingly used in the treatment of malignant distal biliary obstruction. Standardized use of this technique requires improvements in instruments, including more convenient and safer devices. The present study was designed to evaluate the resistance force to migration (RFM) of a newly designed laser-cut metal stent and the feasibility of EUS-CDS using this stent. MethodsThis experimental study used a porcine model of biliary dilatation involving five male pigs. The new stent is a fully covered laser-cut stent with anti-migration anchoring hooks. The RFM of the new stents was compared with those of three commercially available covered metal stents using a phantom model. In the animal study, after ligation of Vater's ampulla with endoscopic clips, the dilated common bile duct was punctured under EUS guidance, followed by EUS-CDS using the new stent. One week after the procedure, the stents were removed endoscopically and the fistulas were assessed after the pigs were killed. Technical feasibility and clinical outcomes were evaluated. ResultsAmong the four stents, the new stent had the highest RFM. Metal stent placement was successful in all five pigs, with no procedure-related complications occurring during and 1 week after endoscopic intervention. All stents remained in place without migration and were removed easily using a snare. At necropsy, fistulas were created between the bile duct and duodenum in all pigs. ConclusionEUS-CDS using a newly designed metal stent was feasible and effective in this porcine model of biliary dilatation.
  • Association between serum SPan-1 and lymph node metastasis in invasive intraductal papillary mucinous neoplasm of the pancreas, Kodai Yamanaka, Atsuhiro Masuda, Hirochika Toyama, Hideyuki Shiomi, Yoh Zen, Keitaro Sofue, Mamoru Takenaka, Takashi Kobayashi, Arata Sakai, Yosuke Yagi, Takashi Nakagawa, Masaru Yoshida, Yoshifumi Arisaka, Yoshihiro Okabe, Hiromu Kutsumi, Takumi Fukumoto, Yonson Ku, Takeshi Azuma, Pancreatology, Pancreatology, 17(1), 123 - 129, Jan. 2017
    Summary:© 2016 IAP and EPC Background and aim Lymph node metastasis predicts poorer prognoses in patients with invasive intraductal papillary mucinous neoplasms of the pancreas (IPMNs). Factors associated with lymph node metastasis of invasive IPMN remain unclear. Therefore, this study aimed to define factors associated with lymph node metastasis of invasive IPMN. Methods Between June 2000 to August 2015, 156 consecutive patients with IPMN underwent surgical resection at Kobe University Hospital, and were enrolled in this study. The relationship between lymph node metastasis and clinical characteristics, including imaging studies and serum tumor markers, was evaluated. A multivariate logistic regression analysis was performed to assess the relationship between serum tumor markers and the presence of lymph node metastasis of IPMN, adjusted for clinical characteristics. Results Lymph node metastasis was observed in 7.7% (12/156) of IPMNs via a pathological examination. The multivariate logistic regression analysis revealed that serum SPan-1 was associated with the presence of lymph node metastasis of IPMN (odds ratio [OR] = 7.32; 95% confidence interval [CI] = 1.10 to 56.0; P = 0.04). In addition, survival was poorer among serum SPan-1-positive patients than SPan-1 negative patients (Log-rank test; P = 0.0002). Lymph node enlargement was detected preoperatively on computed tomography scans in only 16.7% (2/12) of cases that were positive for lymph node metastasis. Conclusions Elevated serum SPan-1 was associated with lymph node metastasis in this cohort of patients who underwent resection for invasive IPMN.
  • Endoscopic ultrasound-guided gallbladder drainage for acute cholecystitis: Long-term outcomes after removal of a self-expandable metal stent, Ken Kamata, Mamoru Takenaka, Masayuki Kitano, Shunsuke Omoto, Takeshi Miyata, Kosuke Minaga, Kentaro Yamao, Hajime Imai, Toshiharu Sakurai, Tomohiro Watanabe, Naoshi Nishida, Masatoshi Kudo, WORLD JOURNAL OF GASTROENTEROLOGY, WORLD JOURNAL OF GASTROENTEROLOGY, 23(4), 661 - 667, Jan. 2017
    Summary:AIM To assess the long-term outcomes of this procedure after removal of self-expandable metal stent (SEMS). The efficacy and safety of endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) with SEMS were also assessed. METHODS Between January 2010 and April 2015, 12 patients with acute calculous cholecystitis, who were deemed unsuitable for cholecystectomy, underwent EUS-GBD with a SEMS. EUS-GBD was performed under the guidance of EUS and fluoroscopy, by puncturing the gallbladder with a needle, inserting a guidewire, dilating the puncture hole, and placing a SEMS. The SEMS was removed and/or replaced with a 7-Fr plastic pigtail stent after cholecystitis improved. The technical and clinical success rates, adverse event rate, and recurrence rate were all measured. RESULTS The rates of technical success, clinical success, and adverse events were 100%, 100%, and 0%, respectively. After cholecystitis improved, the SEMS was removed without replacement in eight patients, whereas it was replaced with a 7-Fr pigtail stent in four patients. Recurrence was seen in one patient (8.3%) who did not receive a replacement pigtail stent. The median follow-up period after EUS-GBD was 304 d (78-1492). CONCLUSION EUS-GBD with a SEMS is a possible alternative treatment for acute cholecystitis. Long-term outcomes after removal of the SEMS were excellent. Removal of the SEMS at 4-wk after SEMS placement and improvement of symptoms might avoid migration of the stent and recurrence of cholecystitis due to food impaction.
  • Smoking Status and the Incidence of Pancreatic Cancer Concomitant with Intraductal Papillary Mucinous Neoplasm, Nakagawa, T., Masuda, A., Toyama, H., Shiomi, H., Zen, Y., Sofue, K., Takenaka, M., Kobayashi, T., Yagi, Y., Yamanaka, K., Yoshida, M., Arisaka, Y., Okabe, Y., Kutsumi, H., Fukumoto, T., Ku, Y., Azuma, T., Pancreas, Pancreas, 46(4), 582 - 588, 2017
    Summary:© Wolters Kluwer Health, Inc. All rights reserved. Objectives The effect of smoking status on the incidence of pancreatic ductal adenocarcinoma (PDAC) concomitant with intraductal papillary mucinous neoplasm (IPMN) has not been clarified. This study investigated the association of smoking status with PDAC concomitant with IPMN. Methods The subjects were 124 consecutive patients undergoing resection of IPMNs (intraductal papillary mucinous adenoma (IPMA): N = 77, invasive IPMN: N = 31, and PDAC with IPMN: N = 16) between April 2008 and October 2015. The associations between smoking status (never/former/current smoker) or cumulative pack-years (0-19/20-39/≥40) and the incidence of PDAC concomitant with IPMN or invasive IPMN were evaluated. Results Current smoking, not former smoking, was associated with the incidence of PDAC concomitant with IPMN (PDAC with IPMN vs IPMN alone; P = 0.004, PDAC with IPMN vs IPMA; P = 0.004, PDAC with IPMN vs invasive IPMN; P = 0.04, respectively), but not that of invasive IPMN (invasive IPMN vs IPMA; P = 0.85). Cumulative pack-years were higher in patients who had PDAC concomitant with IPMN than in patients with invasive IPMN (P = 0.04). Cumulative pack-years were not associated with smoking status (current vs former). Conclusions Current smoking, not former smoking, was associated with the incidence of PDAC concomitant with IPMN. Cessation of smoking may be recommended for patients with IPMN.
  • The Overall Survival of Patients with Hepatocellular Carcinoma Correlates with the Newly Defined Time to Progression after Transarterial Chemoembolization, 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, LIVER CANCER, 6(3), 227 - 235, 2017
    Summary: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 (R-2 = 0.6563, p = 0.0045) and B2 (R-2 = 0.6433, p = 0.0052) substages. There was also a positive correlation between OS and TTTP for the combined B1 and B2 substages (R-2 = 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. (C) 2017 S. Karger AG, Basel
  • Time to Transcatheter Arterial Chemoembolization Refractoriness in Patients with Hepatocellular Carcinoma in Kinki Criteria Stages B1 and B2, 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, DIGESTIVE DISEASES, 35(6), 589 - 597, 2017
    Summary: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. (C) 2017 S. Karger AG, Basel
  • Unique Characteristics Associated with Sustained Liver Damage in Chronic Hepatitis C Patients Treated with Direct Acting Antivirals, 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, DIGESTIVE DISEASES, 35(6), 556 - 564, 2017
    Summary: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 a-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. (C) 2017 S. Karger AG, Basel
  • Impact of Tumor Factors on Survival in Patients with Hepatocellular Carcinoma Classified Based on Kinki Criteria Stage B2, 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, DIGESTIVE DISEASES, 35(6), 583 - 588, 2017
    Summary: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. (C) 2017 S. Karger AG, Basel
  • Clinical Significance of Bmi1 Expression in Inflammatory Bowel Disease, Mitsunari Yamada, Toshiharu Sakurai, Yoriaki Komeda, Tomoyuki Nagai, Ken Kamata, Kosuke Minaga, Kentaro Yamao, Mamoru Takenaka, Satoru Hagiwara, Shigenaga Matsui, Tomohiro Watanabe, Naoshi Nishida, Hiroshi Kashida, Masatoshi Kudo, Oncology, Oncology, 93(1), 20 - 26, 2017
    Summary:© 2017 S. Karger AG, Basel. Background: Although the stem cell marker Bmi1 is overexpressed in many malignancies, its role in inflammation-associated cancer is unclear. Colitis-associated cancer (CAC) is caused by chronic intestinal inflammation and often results from refractory inflammatory bowel disease (IBD). Methods: To assess the involvement of Bmi1 in the development of CAC, we analyzed the gene expression of colon tissues collected from 111 patients with IBD and CAC. Results: In the colonic mucosa of patients with ulcerative colitis, the expression of Bmi1 correlated significantly with the expression of inflammatory cytokines such as IL-6, IL-17, IL-23, and tumor necrosis factor α (TNF-α). In the colonic mucosa of patients with Crohn's disease, the expression of Bmi1 correlated significantly with the expression of TNF-α and IL-23. The expression of Bmi1 was enhanced in the colonic mucosae of refractory IBD, suggesting that Bmi1 expression might be related to increased cancer risk. In addition, patients with high Bmi1 expression showed significantly lower response rates upon subsequent anti-TNF-α therapy as compared to patients with low Bmi1 expression. In human CAC specimens, the expression of Bmi1 was upregulated in nontumor tissues as well as tumors. Conclusions: Bmi1 expression is related to a refractory clinical course of IBD and upregulated in refractory IBD and CAC. Measurement of Bmi1 expression is a promising approach for the advanced treatment and personalized management of IBD patients.
  • Primary Hepatic Adenosquamous Carcinoma Associated with Primary Sclerosing Cholangitis, Kentaro Yamao, Mamoru Takenaka, Hajime Imai, Atsushi Nakai, Shunske Omoto, Ken Kamata, Kosuke Minaga, Takeshi Miyata, Toshiharu Sakurai, Tomohiro Watanabe, Naoshi Nishida, Ippei Matsumoto, Yosihumi Takeyama, Takaaki Chikugo, Masatoshi Kudo, Oncology, Oncology, 93(1), 76 - 80, 2017
    Summary:© 2017 S. Karger AG, Basel. Introduction: Primary sclerosing cholangitis (PSC) is a chronic cholestatic liver disorder characterized by multiple fibrotic strictures of the bile duct. More than 40% of deaths in PSC patients are related to malignant tumors, including cholangiocarcinoma. Primary hepatic adenosquamous carcinoma (ASC) is a rare subtype of cholangiocarcinoma containing adenocarcinoma (AC) and squamous cell carcinoma (SCC) components, with a poorer prognosis than other cholangiocarcinomas. We report the first case of a hepatic ASC in a patient with PSC. Case Report: A 28-year-old man was referred for diagnosis and treatment of a liver abscess suspected by contrast-enhanced computed tomography (CE-CT). He had a history of ulcerative colitis and PSC. Abdominal CE-CT revealed a 60-mm-diameter ring-shaped mass with central necrosis in the left lobe. Magnetic resonance imaging demonstrated a poorly circumscribed low-signal-intensity mass in T1-weighted imaging and a high-signal-intensity mass with a scattered low-signal-intensity area in T2-weighted imaging. Abdominal ultrasonography showed a hypoechoic component with a diffuse hyperechoic area in the tumor. Ultrasound-guided biopsy and histological examination showed tumor cells with both squamous and glandular differentiation. Left lobectomy was performed. Microscopic examination revealed 2 components, including moderately differentiated AC and well-differentiated SCC. The final diagnosis was hepatic ASC. Conclusion: This is the first reported case of hepatic ASC in a patient with PSC. Patients with PSC should be recognized as being at a risk of not only general cholangiocarcinoma, hepatocellular carcinoma, and metastatic liver tumor, but also ASC.
  • Association between the Risk Factors for Pancreatic Ductal Adenocarcinoma and Those for Malignant Intraductal Papillary Mucinous Neoplasm, Ken Kamata, Mamoru Takenaka, Atsushi Nakai, Shunsuke Omoto, Takeshi Miyata, Kosuke Minaga, Tomohiro Matsuda, Kentaro Yamao, Hajime Imai, Yasutaka Chiba, Toshiharu Sakurai, Tomohiro Watanabe, Naoshi Nishida, Takaaki Chikugo, Ippei Matsumoto, Yoshifumi Takeyama, Masatoshi Kudo, Oncology, Oncology, 93(1), 102 - 106, 2017
    Summary:© 2017 S. Karger AG, Basel. Background and Aims: Risk factors for pancreatic ductal adenocarcinoma (PDAC) include diabetes mellitus, chronic pancreatitis, obesity, a family history of pancreatic cancer, and a history of smoking or alcohol consumption. The aim of this study was to evaluate the association between risk factors for PDAC and malignant intraductal papillary mucinous neoplasm (IPMN). Methods: The study included 134 consecutive patients with IPMN who underwent surgical resection at Kindai University Hospital between April 2009 and March 2015. Data on the presence or absence of mural nodules (MNs) and risk factors for PDAC were evaluated. Multivariable logistic regression analysis was performed with malignant IPMN as the outcome variable and MNs and risk factors for PDAC as explanatory variables. Results: The odds ratio of malignant IPMN to MNs was 3.88 (95% confidence interval [CI] 1.53-9.84; p = 0.004), whereas that of malignant IPMN to smoking history was 1.66 (95% CI 0.74-3.71; p = 0.22). When the presence of MNs was considered as a predictive factor for malignancy, the sensitivity and specificity were 88.5 and 32.1%, respectively, whereas when the presence of both smoking history and MNs was considered, the specificity improved to 73.2%, with a decrease in sensitivity to 42.3%. Conclusions: The presence of both a smoking history and MNs was a valuable predictive factor for malignant IPMN with high specificity. A smoking history should be considered before surgical resection in addition to the presence of MNs.
  • Clinical Analysis of Esophageal Stricture in Patients Treated with Intralesional Triamcinolone Injection after Endoscopic Submucosal Dissection for Superficial Esophageal Cancer, 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, Oncology, 93(1), 9 - 14, 2017
    Summary:© 2017 S. Karger AG, Basel. 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.
  • Chronic Pancreatitis Finding by Endoscopic Ultrasonography in the Pancreatic Parenchyma of Intraductal Papillary Mucinous Neoplasms Is Associated with Invasive Intraductal Papillary Mucinous Carcinoma., Takenaka M, Masuda A, Shiomi H, Yagi Y, Zen Y, Sakai A, Kobayashi T, Arisaka Y, Okabe Y, Kutsumi H, Toyama H, Fukumoto T, Ku Y, Kudo M, Azuma T, Oncology, Oncology, 93, 61 - 68, 2017
    Summary:© 2017 S. Karger AG, Basel. Background/Objectives: The recent guideline for intraductal papillary mucinous neoplasms (IPMNs) focuses on morphological features of the lesion as signs of malignant transformation, but ignores the background pancreatic parenchyma, including features of chronic pancreatitis (CP), which is a risk factor for pancreatic malignancies. Endoscopic ultrasonography frequently reveals evidence of CP (EUS-CP findings) in the background pancreatic parenchyma of patients with IPMNs. Therefore, we investigated whether background EUS-CP findings were associated with malignant IPMN. Methods: The clinical data of 69 consecutive patients with IPMNs who underwent preoperative EUS and surgical resection between April 2010 and October 2014 were collected prospectively. The association of EUS-CP findings (total number of EUS-CP findings; 0 vs. ≥1) with invasive IPMN was examined. The association of EUS-CP findings with pathological changes of the background pancreatic parenchyma (atrophy/inflammation/fibrosis) was also examined. Results: Among patients with EUS-CP findings, invasive intraductal papillary mucinous carcinoma (IPMC) was significantly more frequent than among patients without EUS-CP findings (42.5% [17/40] vs. 3.4% [1/29], p = 0.0002). In addition, patients with EUS-CP findings had higher grades of pancreatic atrophy and inflammation than patients without EUS-CP findings (atrophy: 72.5% [29/40] vs. 34.5% [10/29], p = 0.003; inflammation: 45.0% [18/40] vs. 20.7% [6/29], p = 0.04). Conclusions: In IPMN patients, detection of EUS-CP findings in the background pancreatic parenchyma was associated with a higher prevalence of invasive IPMC. Accordingly, EUS examination should not only assess the morphological features of the lesion itself, but also EUS-CP findings in the background parenchyma.
  • Needle Tract Seeding: An Overlooked Rare Complication of Endoscopic Ultrasound-Guided Fine-Needle Aspiration, Kosuke Minaga, Mamoru Takenaka, Akio Katanuma, Masayuki Kitano, Yukitaka Yamashita, Ken Kamata, Kentaro Yamao, Tomohiro Watanabe, Hiroyuki Maguchi, Masatoshi Kudo, Oncology, Oncology, 93(1), 107 - 112, 2017
    Summary:© 2017 S. Karger AG, Basel. Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) has been widely used for diagnosis of both inflammatory and tumor lesions located in and adjacent to the gastrointestinal tract. EUS-FNA has been considered to be a safe technique with few complications, as shown in recent review articles in which EUS-FNA-related morbidity and mortality rates were reported to be <1%. It should be noted, however, that needle tract seeding, although uncommon, can occur after diagnostic EUS-FNA and that this complication affects the prognosis of patients. Although an accurate value for the frequency of needle tract seeding caused by EUS-FNA has not been reported, the numbers of case reports on needle tract seeding have been rapidly increasing, especially in Japan. These case reports regarding EUS-FNA-related needle tract seeding prompted us to reevaluate the safety of EUS-FNA because this complication may have a significant influence on patients' prognoses. In this review, we summarize the clinical features and outcomes of needle tract seeding after EUS on the basis of the previously reported cases and provide useful information to prevent and reduce this serious complication.
  • Magnifying Narrow Band Imaging (NBI) for the Diagnosis of Localized Colorectal Lesions Using the Japan NBI Expert Team (JNET) Classification, 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, Oncology, 93(1), 49 - 54, 2017
    Summary:© 2017 S. Karger AG, Basel. 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.
  • Utility of Endoscopic Ultrasound-Guided Hepaticogastrostomy with Antegrade Stenting for Malignant Biliary Obstruction after Failed Endoscopic Retrograde Cholangiopancreatography, Hajime Imai, Mamoru Takenaka, Shunsuke Omoto, Ken Kamata, Takeshi Miyata, Kosuke Minaga, Kentaro Yamao, Toshiharu Sakurai, Naoshi Nishida, Tomohiro Watanabe, Masayuki Kitano, Masatoshi Kudo, Oncology, Oncology, 93(1), 69 - 75, 2017
    Summary:© 2017 S. Karger AG, Basel. Background: Endoscopic ultrasound (EUS)-guided biliary drainage (BD) is a well-recognized alternative BD method after unsuccessful endoscopic transpapillary drainage. EUS-guided hepaticogastrostomy (HGS) with antegrade stenting (AGS) was recently applied to the treatment of malignant obstructive jaundice. Objective: To assess the efficacy and safety of HGS combined with AGS for treatment of malignant biliary stricture-induced obstructive jaundice. Design: Retrospective cohort study. Setting: Single academic tertiary care center. Patients: From January 2006 to December 2014, endoscopic retrograde cholangiopancreatography was attempted in patients with obstructive jaundice; it was successful in 641 patients and impossible in 154 patients (postsurgically altered anatomy or duodenal stenosis, n = 101; difficult cannulation, n = 53). In total, 145 patients underwent EUS-guided BD; HGS and HGS with AGS were attempted in 42 patients (Group A, January 2006-August 2011) and 37 patients (Group B, September 2011-December 2014), respectively. Interventions: Under EUS and fluoroscopy guidance, HGS and HGS with AGS were performed via needle puncture, guidewire insertion, puncture-hole dilation, and stent placement. Main Outcome Measurements: Groups A and B were compared in terms of technical success, functional success, adverse event rates, re-intervention rates, patient survival time, and time to stent dysfunction or patient death. The two groups were also compared in a subgroup analysis of only 28 patients who underwent chemotherapy. Results: The technical success rate was significantly higher in Group A than B (97.6 vs. 83.8%, p = 0.03). The functional success rate was comparable between the two groups (90.2 vs. 90.3%), although the rate of adverse events was significantly higher in Group A than B (26.1 vs. 10.8%, p = 0.03). The re-intervention rate tended to be higher in Group A than B (16.7 vs. 8.1%, p = 0.25). Groups A and B did not differ significantly in terms of median overall patient survival (75 vs. 61 days, p = 0.70) or median time to stent dysfunction or patient death (68 vs. 63 days, p = 0.08). Among patients who underwent chemotherapy, there was no difference in overall patient survival time between the two groups (121 vs. 157 days, p = 0.08), although time to stent dysfunction or patient death was significantly shorter in Group A than B (71 vs. 95 days, p = 0.02). Conclusion: Although the technical success rate of HGS with AGS was lower than that of HGS, HGS with AGS was superior to HGS in terms of adverse event rate and stent patency in patients receiving chemotherapy.
  • Computer-Aided Diagnosis Based on Convolutional Neural Network System for Colorectal Polyp Classification: Preliminary Experience, 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, Oncology, 93(1), 30 - 34, 2017
    Summary:© 2017 S. Karger AG, Basel. 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.
  • Characterization of Pancreatic Tumors with Quantitative Perfusion Analysis in Contrast-Enhanced Harmonic Endoscopic Ultrasonography, Shunsuke Omoto, Mamoru Takenaka, Masayuki Kitano, Takeshi Miyata, Ken Kamata, Kosuke Minaga, Tadaaki Arizumi, Kentaro Yamao, Hajime Imai, Hiroki Sakamoto, Yogesh Harwani, Toshiharu Sakurai, Tomohiro Watanabe, Naoshi Nishida, Yoshifumi Takeyama, Yasutaka Chiba, Masatoshi Kudo, Oncology, Oncology, 93(1), 55 - 60, 2017
    Summary:© 2017 S. Karger AG, Basel. Objectives: This study evaluated whether quantitative perfusion analysis with contrast-enhanced harmonic (CH) endoscopic ultrasonography (EUS) characterizes pancreatic tumors, and compared the hemodynamic parameters used to diagnose pancreatic carcinoma. Methods: CH-EUS data from pancreatic tumors of 76 patients were retrospectively analyzed. Time-intensity curves (TIC) were generated to depict changes in signal intensity over time, and 6 parameters were assessed: baseline intensity, peak intensity, time to peak, intensity gain, intensity at 60 s (I60), and reduction rate. These parameters were compared between pancreatic carcinomas (n = 41), inflammatory pseudotumors (n = 14), pancreatic neuroendocrine tumors (n = 14), and other tumors (n = 7). All 6 TIC parameters and subjective analysis for diagnosing pancreatic carcinoma were compared. Results: Values of peak intensity and I60 were significantly lower and time to peak was significantly longer in the groups with pancreatic carcinomas than in the other 3 tumor groups (p < 0.05). Reduction rate was significantly higher in pancreatic carcinomas than in pancreatic neuroendocrine tumors (p < 0.05). Areas under the receiver-operating characteristic curves for the diagnosis of pancreatic carcinoma using subjective analysis, baseline intensity, peak intensity, intensity gain, I60, time to peak, and reduction rate, were 0.817, 0.664, 0.810, 0.751, 0.845, 0.777, and 0.725, respectively. I60 was the most accurate parameter for differentiating pancreatic carcinomas from the other groups, giving values of sensitivity/specificity of 92.7/68.6% when optimal cutoffs were chosen. Conclusions: In pancreatic carcinomas, TIC patterns were markedly different from the other tumor types, with I60 being the most accurate diagnostic parameter. Quantitative perfusion analysis is useful for differentiating pancreatic carcinomas from other pancreatic tumors.
  • Risk Factors for Postoperative Bleeding in Endoscopic Submucosal Dissection of Colorectal Tumors, 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, Oncology, 93(1), 35 - 42, 2017
    Summary:© 2017 S. Karger AG, Basel. 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.
  • Prophylactic Suturing Closure Is Recommended after Endoscopic Treatment of Colorectal Tumors in Patients with Antiplatelet/Anticoagulant Therapy, 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, Oncology, 93(1), 27 - 29, 2017
    Summary:© 2017 S. Karger AG, Basel. 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.
  • EUS-Guided Pancreatic Duct Drainage for Repeat Pancreatitis in a Patient with Pancreatic Cancer, Ken Kamata, Mamoru Takenaka, Kosuke Minaga, Toshiharu Sakurai, Tomohiro Watanabe, Naoshi Nishida, Masatoshi Kudo, Oncology, Oncology, 93(1), 87 - 88, 2017
    Summary:© 2017 S. Karger AG, Basel. Endoscopic ultrasound-guided pancreatic drainage (EUS-PD) was performed in a patient with unresectable pancreatic cancer who developed pancreatitis. In this case, EUS-PD was useful as salvage therapy for pancreatitis as the transpapillary approach was difficult.
  • Detection of High-Grade Pancreatic Intraepithelial Neoplasia without Morphological Changes of the Main Pancreatic Duct over a Long Period: Importance for Close Follow-Up for Confirmation, Kentaro Yamao, Mamoru Takenaka, Atsushi Nakai, Shunske Omoto, Ken Kamata, Kosuke Minaga, Takeshi Miyata, Hajime Imai, Toshiharu Sakurai, Tomohiro Watanabe, Naoshi Nishida, Ippei Matsumoto, Yosihumi Takeyama, Takaaki Chikugo, Masatoshi Kudo, Oncology, Oncology, 93(1), 81 - 86, 2017
    Summary:© 2017 S. Karger AG, Basel. Pancreatic intraepithelial neoplasia (PanIN) is a microscopic papillary noninvasive lesion arising from the pancreatic ductal epithelium. However, the natural history and time to progression of high-grade PanIN remain unclear. Herein, we report 2 cases of high-grade PanIN without morphological changes of the main pancreatic duct (MPD) over relatively long periods. In the first case, a 63-year-old man was identified with MPD dilation. Magnetic resonance cholangiopancreatography showed localized stenosis in the pancreatic body with distal MPD dilation. Endoscopic retrograde pancreatography (ERP) was attempted because of possible high-grade PanIN but was unsuccessful. At 15-month follow-up, there was no change in the form of the MPD in various images. However, ERP was re-performed because of possible high-grade PanIN, and cytology showed adenocarcinoma. Postoperative pathology indicated diffuse lesions corresponding to high-grade PanINs in the MPD stenosis and surrounding branches. Final diagnosis was high-grade PanIN. In the second case, a 77-year-old man was identified with MPD dilation. Magnetic resonance cholangiography showed localized stenosis in the MPD of the pancreatic head with distal MPD dilation. He was diagnosed with MPD stenosis caused by chronic pancreatitis, and further examination was not recommended. At 25 months, the patient was referred to our hospital because of a mild change in MPD dilation. ERP showed localized irregular stenosis in the MPD, and cytology showed suspected adenocarcinoma. Postoperative pathology indicated a localized lesion with high-grade PanIN in the branch duct around the MPD stenosis. Final diagnosis was high-grade PanIN. In conclusion, we report 2 cases of high-grade PanIN without morphological changes of the MPD over relatively long periods. Even if a definite diagnosis is not obtained at initial examination, a strict follow-up observational study should be performed. Re-examination, including ERP, should also be considered in cases with risk factors of pancreatic cancer, even if there is no change in MPD form.
  • Comparative Study of Clarithromycin- versus Metronidazole-Based Triple Therapy as First-Line Eradication for Helicobacter pylori, 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, Oncology, 93(1), 15 - 19, 2017
    Summary:© 2017 S. Karger AG, Basel. 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.
  • The usefulness of computed tomography immediately after ERCP for early detection of post ERCP pancreatitis, Takeshi Miyata, Mamoru Takenaka, Masayuki Kitano, Tomohiko Matsuda, Syunsuke Omoto, Ken Kamata, Kosuke Minaga, Kentaro Yamao, Hajime Imai, Masatoshi Kudo, JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, 31, 248 - 248, Nov. 2016 , Refereed
  • Through-the-scope enteral metal stent placement using a short-type single-balloon enteroscope for malignant surgically reconstructed jejunal stenosis (with video), Kosuke Minaga, Masayuki Kitano, Mamoru Takenaka, DIGESTIVE ENDOSCOPY, DIGESTIVE ENDOSCOPY, 28(7), 758 - 758, Nov. 2016
  • Predictive value of low serum pancreatic enzymes in invasive intraductal papillary mucinous neoplasms, Yosuke Yagi, Atsuhiro Masuda, Yoh Zen, Mamoru Takenaka, Hirochika Toyama, Keitaro Sofue, Hideyuki Shiomi, Takashi Kobayashi, Takashi Nakagawa, Koudai Yamanaka, Namiko Hoshi, Masaru Yoshida, Yoshifumi Arisaka, Yoshihiro Okabe, Hiromu Kutsumi, Takumi Fukumoto, Yonson Ku, Takeshi Azuma, Pancreatology, Pancreatology, 16(5), 893 - 899, Sep. 2016
    Summary:© 2016 IAP and EPC Background Despite evidence suggesting a role of chronic pancreatitis in pancreatic carcinogenesis, its relationship with invasive intraductal papillary mucinous neoplasms (IPMN) remains unclear. Low levels of pancreatic enzymes are predictive markers of advanced chronic pancreatitis. We investigated whether low pancreatic enzyme levels were associated with a higher incidence of invasive IPMN. Methods This study included 146 consecutive patients who underwent surgical resection of IPMN between April 2001 and October 2014. Multivariable logistic regression analysis was conducted to assess the association between serum pancreatic enzymes and the incidence of invasive IPMN, with adjustment for clinical characteristics including alcohol consumption. The association of serum pancreatic enzymes with pathological pancreatic atrophy and inflammation in areas adjacent to or distant from the tumor was also evaluated. Results Low serum levels of pancreatic amylase and lipase were associated with a higher incidence of invasive IPMN (multivariable odds ratio [OR] = 9.6, 95% confidence interval [CI] = 2.99 to 35.1, P = 0.0001; OR = 14.2, 95% CI = 2.77 to 112, P = 0.001, respectively). Low serum pancreatic amylase and lipase levels were also associated with higher grade pancreatic atrophy in areas adjacent to the tumor (P = 0.011 and P = 0.017, respectively) and in areas distant from the tumor (P = 0.0002 and P = 0.001, respectively). Furthermore, low serum pancreatic amylase and lipase levels were associated with higher grade inflammation in areas distant from the tumor (P < 0.0001 and P = 0.001, respectively). Conclusions Low serum pancreatic enzymes may be a predictive marker of invasive IPMN. Excessive alcohol consumption did not influence the association of low pancreatic enzyme levels with invasive IPMN.
  • Intraductal tubulopapillary neoplasm of the bile duct: A case report and review of the published work, Takashi Nakagawa, Yoshifumi Arisaka, Tetsuo Ajiki, Kohei Fujikura, Atsuhiro Masuda, Mamoru Takenaka, Hideyuki Shiomi, Yoshihiro Okabe, Takumi Fukumoto, Yonson Ku, Takeshi Azuma, Yoh Zen, HEPATOLOGY RESEARCH, HEPATOLOGY RESEARCH, 46(7), 713 - 718, Jun. 2016
    Summary:Recent studies have suggested that a peculiar tumor mimicking intraductal tubulopapillary neoplasms (ITPN) of the pancreas can develop in the bile duct. Here, we present a similar case and review the published work on the newly proposed biliary neoplasm. A 68-year-old woman was referred to us for further evaluation of a liver mass. On imaging, the tumor was 40 mm in size and intraductal in location, and was enhanced slightly on the contrast-enhanced computed tomography. No mucin overproduction was found. She underwent right hepatectomy for suspected intraductal papillary neoplasm of the bile duct. The tumor histologically consisted of the biliary-type epithelium arranged in a tubular architecture within the dilated bile duct. Tumor cells had features of high-grade dysplasia but no stroma invasion. No expressions of MUC2 and MUC5AC were noted. On molecular studies, KRAS and GNAS appeared to be wild-type genotypes. These features were in keeping with ITPN. In the published work review, "biliary ITPN" described in four manuscripts were characterized by predominantly intrahepatic/hilar in location, histological tubular architecture, negative expressions of MUC2 and MUC5AC, and uncommon alterations of KRAS, GNAS and BRAF. Although invasive malignancy was present in 71%, the outcome was favorable with the 5-year survival expected to be approximately 90%. Biliary ITPN are supposedly uncommon, but a greater awareness of this condition may give more chance to diagnose the underrecognized neoplasm.
  • A case of eosinophilic gastroenteritis with difficulty in its diagnosis, Michiko Nishikawa, Makoto Ooi, Yoshihiko Terashima, Daisuke Obata, Tomoo Yoshie, Mamoru Takenaka, Hideyuki Shiomi, Tsuyoshi Fujita, Takeshi Azuma, Yukiko Morinaga, Gastroenterological Endoscopy, Gastroenterological Endoscopy, 58(7), 1215 - 1220, 2016
    Summary:A 57-year-old man presented to our hospital with abdominal distention and bilateral leg edema. Upper GI series, endoscopy and abdominal CT scan showed the features of type 4 advanced gastric cancer; however, no malignant cells were observed in biopsy specimen sampled from the thickened wall. Laboratory examination showed significantly decreased serum total protein and albumin levels; therefore, 99m Tc-HSA scintigraphy was performed to investigate the enteric protein loss. It demonstrated the accumulation of radioactivity in the colon, suggesting the presence of protein-losing enteropathy. Colonoscopy showed no abnormal findings from the rectum to the terminal ileum; however, all intestinal biopsy specimens revealed severe eosinophilic infiltration into the mucosal layer. Taken together, the final diagnosis of eosinophilic gastroenteritis was made.
  • Through-the-mesh technique after endoscopic ultrasonography-guided hepaticogastrostomy: a novel re-intervention method, Kosuke Minaga, Mamoru Takenaka, Takeshi Miyata, Yasuhiro Ueda, Masayuki Kitano, Masatoshi Kudo, ENDOSCOPY, ENDOSCOPY, 48, E369 - E370, 2016
  • A case of epidermoid cyst in an intrapancreatic accessory spleen showing cyst-in-cyst-like structure mimicking mucinous cystic neoplasm, Yuichi Hirata, Yoshifumi Arisaka, Hiromu Kutsumi, Arata Sakai, Mamoru Takenaka, Hideyuki Shiomi, Takeshi Azuma, Ippei Matsumoto, Shigeo Hara, Shujiro Yazumi, Journal of Japanese Society of Gastroenterology, Journal of Japanese Society of Gastroenterology, 112(10), 1858 - 1867, Oct. 01 2015
    Summary:In 2010, a 39-year-old woman presented with a cystic lesion, 16mm in diameter, in the tail of the pancreas. Regular follow-ups were conducted to monitor this lesion its diameter was found to increase to 45mm in 2013. Thus, the patient was admitted to our hospital for further examination and treatment. Abdominal US, abdominal contrast-enhanced CT, and MRI showed a cystic lesion of 45mm in diameter in the tail of the pancreas, which had internal septae and mural nodules inside. EUS revealed a cyst-in-cyst-like structure, with a thickened cystic wall along the entire circumference. Thus, distal pancreatectomy and splenectomy were performed on the basis of a diagnosis of mucinous cystic neoplasm. Histopathological examination of a resected specimen showed that the lesion comprised a substantial component of red-brown tone, with adjacent cystic components. The final diagnosis was an epidermoid cyst in an intrapancreatic accessory spleen.
  • Diagnosis and management for gallbladder polyps, Yoshifumi Arisaka, Mamoru Takenaka, Hideyuki Shiomi, Takeshi Azuma, Journal of Japanese Society of Gastroenterology, Journal of Japanese Society of Gastroenterology, 112(3), 444 - 455, Mar. 01 2015
  • Effectiveness of endoscopic self-expandable metal stent placement for afferent loop obstruction caused by pancreatic cancer recurrence after pancreaticoduodenectomy, Sakai, A., Shiomi, H., Okabe, Y., Yagi, Y., Kobayashi, T., Shiomi, Y., Takenaka, M., Hoshi, N., Arisaka, Y., Kutsumi, H., Azuma, T., Clinical Journal of Gastroenterology, Clinical Journal of Gastroenterology, 8(2), 103 - 107, 2015
    Summary:© 2015, Springer Japan. Afferent loop obstruction caused by cancer recurrence after pancreaticoduodenectomy (PD) can be managed by either surgical or nonsurgical treatment. The general condition of patients with recurrent pancreaticobiliary cancer is often not good enough for them to undergo surgery, so less invasive nonsurgical treatment is desirable. We report a case of a 66-year-old male who had undergone PD for pancreatic head adenocarcinoma 10 months previously and who presented at our hospital with fever and jaundice due to afferent loop obstruction caused by pancreatic cancer recurrence. An endoscopic self-expandable metal stent (SEMS) was placed for afferent loop obstruction without any complications. He quickly recovered after SEMS placement. He retained a good quality of life by receiving chemotherapy until his death due to cancer progression. Our case indicates that this method could be an easy, effective, safe, and less invasive treatment, which may confer a better quality of life for patients with afferent loop obstruction due to cancer recurrence after PD.
  • The relationship between pancreatic atrophy after steroid therapy and diabetes mellitus in patients with autoimmune pancreatitis, Atsuhiro Masuda, Hideyuki Shiomi, Tomokazu Matsuda, Mamoru Takenaka, Yoshifumi Arisaka, Takeshi Azuma, Hiromu Kutsumi, PANCREATOLOGY, PANCREATOLOGY, 14(5), 361 - 365, Sep. 2014 , Refereed
    Summary:Background/objectives: Many patients with autoimmune pancreatitis (AIP) have an association with diabetes mellitus. It has not been clarified whether steroid therapy for AIP improves or worsens the condition of diabetes mellitus. The aim of this study was thus to investigate the relationship between pancreatic atrophy after steroid therapy and the clinical course of diabetes. Methods: Thirty-one AIP patients, who were treated by steroid therapy, were included in this study during December 2005 to March 2013. Pancreatic atrophy 6 months after the beginning of steroid therapy was defined to be present when the width of the pancreatic body was less than 10 mm. The relationships between pancreatic atrophy and patient characteristics as well as the course of diabetes were examined. Results: Steroid therapy was effective in all treated patients. Pancreatic atrophy was observed in 12 patients and not in 19 patients after the steroid therapy. AIP patients with pancreatic atrophy showed higher incidences of diabetes mellitus (p = 0.001,9/12 vs. 2/19), diabetes control worsening (p = 0.007,7/12 vs. 2/17), and new onset of diabetes (p = 0.02, 5/7 vs. 1/18) than those without atrophy. It was not associated with gender, other organ involvement, pattern of pancreas swelling (diffuse/focal), serum IgG4 level, alcohol intake, and pancreatic calcification on CT. Patients with new onset of diabetes needed insulin therapy, even in the maintenance therapy of AIR Conclusions: AIP patients with pancreatic atrophy after steroid therapy have a high incidence of diabetes mellitus. New onset of diabetes is closely associated with pancreatic atrophy after steroid therapy. Copyright (C) 2014, IAP and EPC. Published by Elsevier India, a division of Reed Elsevier India Pvt. Ltd. All rights reserved.
  • What is the most adapted indication of prophylactic pancreatic duct stent within the high-risk group of post-endoscopic retrograde cholangiopancreatography pancreatitis? Using the propensity score analysis, Mamoru Takenaka, Tsuyoshi Fujita, Daisuke Sugiyama, Atsuhiro Masuda, Hideyuki Shiomi, Maki Sugimoto, Tsuyoshi Sanuki, Takanobu Hayakumo, Takeshi Azuma, Hiromu Kutsumi, JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES, JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES, 21(4), 275 - 280, Apr. 2014
    Summary:BackgroundConducting randomized controlled trial (RCT) for each of the risk factors associated with prophylactic pancreatic duct stent (PPDS) for post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) is difficult owing to the volume of cases and ethical considerations. In this study, we tried to reveal the degree of preventive effects of PPDS for each individual risk factor within the high-risk group of PEP using the propensity score analysis. MethodsThe clinical data of 1131 ERCP practices performed at Kobe University Hospital from April 2006 to February 2009 were collected prospectively. We investigated their clinical characteristics including the risk factors of PEP, the use of PPDS and complications of ERCP. We conducted the stratification analysis using the propensity score matching analysis. ResultsIn 210 propensity score-matched ERCPs, PPDS proved to be effective in preventing PEP in patients with a history of pancreatitis (odds ratio 0.11, 95% CI 0.01-0.76, P = 0.01) and cases of difficult cannulation (requiring more than 30min) (odds ratio 0.13, 95% CI 0.01-1.14, P = 0.08). ConclusionsPatients with a history of pancreatitis and cases of difficult cannulation are strongly recommended for PPDS placement. The propensity score analysis can be adapted to the ERCP-related analysis with many procedure-related factors with using retrospective data, and may be adapted to investigate the matters that are unsuitable for RCT by volume and ethical issue.
  • The Influences of Pepsin Concentrations and pH Levels on the Disinfective Activity of Ozone Nanobubble Water against Helicobacter pylori, Fumiaki Kawara, Jun Inoue, Mamoru Takenaka, Namiko Hoshi, Atsuhiro Masuda, Shin Nishiumi, Hiromu Kutsumi, Takeshi Azuma, Takeshi Ohdaira, DIGESTION, DIGESTION, 90(1), 10 - 17, 2014 , Refereed
    Summary:Aims: To investigate the utility of ozone nanobubble water (NBW3) for the treatment of Helicobacter pylori in the stomach, we tested the influence of pepsin concentrations and pH levels on the disinfective activity of NBW3, and the cytotoxicity of NBW3 against mammalian cells and mucosa. Methods: Different concentrations of pepsin were dissolved in NBW3, and the bactericidal activity was tested on H. pylori. NBW3 was adjusted to different pH levels (2.0-7.4) and the bactericidal activity on H. pylori was also tested. To examine the cytotoxicity of NBW3, AGS cells, human gastric epithelial cells, were treated with NBW3 and the viability of the cells was evaluated in vitro. Furthermore, NBW3 was administered to mice and gastric mucosal damage was evaluated by histology. Results: Pepsin reduced the disinfective activity of NBW3 on H. pylori in a pepsin concentration-dependent manner. NBW3 showed stable disinfective activity at all pH levels examined. Cytotoxicity of NBW3 against human gastric epithelial cells and gastric mucosa was not observed in our experimental setting. Conclusions: NBW3 can sustain its disinfective activity in wide range of pH levels and show no cytotoxicity on mammalian cells and tissue. Pepsin can inhibit NBW3 activity in a dose-dependent manner. (C) 2014 S. Karger AG, Basel
  • MUC2 expression and prevalence of high-grade dysplasia and invasive carcinoma in mixed-type intraductal papillary mucinous neoplasm of the pancreas, Atsuhiro Masuda, Yoshifumi Arisaka, Shigeo Hara, Ippei Matsumoto, Mamoru Takenaka, Arata Sakai, Hideyuki Shiomi, Nobuyuki Matsuki, Maki Sugimoto, Tsuyoshi Fujita, Takanobu Hayakumo, Yonson Ku, Shuji Ogino, Takeshi Azuma, Hiromu Kutsumi, PANCREATOLOGY, PANCREATOLOGY, 13(6), 583 - 588, Nov. 2013
    Summary:Background/objectives: Morphological types and mucin protein expressions classify intraductal papillary mucinous neoplasms (IPMNs). Main duct (MD)-IPMN mostly consists of intestinal type (I-type), which expresses MUC2. Branch duct (BD)-IPMN mostly consists of gastric type (G-type), which does not express MUC2. However, the definition of mixed-type IPMN has yet to be clarified and it contains various histological types. The aim of this study was to investigate the relationship between MUC2 expression and the presence of high-grade dysplasia (HGD) and invasive carcinoma, especially in mixed-type IPMN. Methods: This retrospective study included 101 consecutive patients with surgically resected IPMNs between April 2001 and October 2012. All patients were morphologically classified into four distinct types (I-type, G-type, PB-type: pancreatobilliary, O-type: oncocytic) and immunohistochemical reactivity of various anti-mucin antibodies were investigated. Results: According to the classification of the 2012 international guidelines, the numbers (and histomorphological types: I/G/PB/O) of MD, mixed-type, and BD-IPMNs were 16 (12/4/0/0), 45 (16/28/1/0), and 40 (0/38/1/1). Prevalence of MUC2 expression in MD, mixed-type, and BD-IPMNs were 75% (12/16), 36% (16/45), and 0% (0/40). In mixed-type IPMN, the prevalence of HGD and/or invasive carcinoma in MUC2-positive IPMN was significantly higher than that of MUC2-negative IPMN (HGD + invasive carcinoma: 88% vs. 38%, p = 0.0017; invasive carcinoma: 50% vs. 21%, p = 0.042). Multivariate analysis showed that MUC2 expression is an independent predictive factor of HGD and invasive carcinoma in mixed IPMN (odds ratio 14.6, 95% CI 2.5-87.4, p = 0.003). Conclusions: In mixed-type IPMN, MUC2 expression clearly identified HGD and invasive carcinoma and may provide most appropriate surgical indication. Copyright (C) 2013, IAP and EPC. Published by Elsevier India, a division of Reed Elsevier India Pvt. Ltd. All rights reserved.
  • A case of lymphoepithelial cyst of pancreas with unique "cheerios-like" appearance in EUS, Wen Gao, Atsuhiro Masuda, Ippei Matsumoto, Makoto Shinzeki, Hideyuki Shiomi, Mamoru Takenaka, Nobuyuki Matsuki, Eiji Funatsu, Tsuyoshi Fujita, Yoshifumi Arisaka, Takanobu Hayakumo, Shigeo Hara, Yonson Ku, Takeshi Azuma, Hiromu Kutsumi, Clinical Journal of Gastroenterology, Clinical Journal of Gastroenterology, 5(6), 388 - 392, Dec. 2012
    Summary:Lymphoepithelial cyst (LEC) of the pancreas is a rare benign lesion, which is difficult to diagnose preoperatively. We describe a case of a 60-year-old male, incidentally diagnosed as having LEC of the pancreas, which was managed by laparoscopic distal pancreatectomy. Most of the reported cases of LEC were asymptomatic and diagnosed incidentally. A high index of suspicion under EUS may help in making a diagnosis and avoiding unnecessary surgery in asymptomatic patients. In particular, the unique "cheerios-like" appearance of the lesion in EUS, which was also found in this case, might be helpful in the differential diagnosis of pancreatic cystic lesions. © 2012 Springer Japan.
  • A case of lipomatous pseudohypertrophy of the pancreas diagnosed by EUS-FNA., Atsuhiro Masuda, Hiroshi Tanaka, Takuya Ikegawa, Tomokazu Matsuda, Hideyuki Shiomi, Mamoru Takenaka, Nobuyuki Matsuki, Saori Kakuyama, Maki Sugimoto, Tsuyoshi Fujita, Yoshifumi Arisaka, Takanobu Hayakumo, Shigeo Hara, Takeshi Azuma, Hiromu Kutsumi, Clinical journal of gastroenterology, Clinical journal of gastroenterology, 5(4), 282 - 6, Aug. 2012
    Summary:We report the case of a 56-year-old female with lipomatous hypertrophy of the pancreas. Abdominal CT and MRI showed fatty replacement over the entire pancreas. The pancreatic parenchyma was completely absent. ERCP showed no abnormal findings in the main pancreatic duct. EUS-FNA was performed to achieve a definitive diagnosis. Histological features of the FNA specimens revealed that adipose tissue generally replaced the pancreatic parenchyma, and pancreatic acini were identified with a scattered distribution. To consider the differential diagnosis of lipomatous pseudohypertrophy of the pancreas, it is necessary to distinguish it from obesity, diabetes, and age-related pancreatic fat infiltration and liposarcoma. By performing EUS-FNA, it was possible to obtain a definitive diagnosis in this patient. In conclusion, EUS-FNA may be helpful to make a definitive diagnosis in patients with lipomatous hypertrophy of the pancreas.
  • Neonatal Fc receptor for IgG (FcRn) expressed in the gastric epithelium regulates bacterial infection in mice, Y. Ben Suleiman, M. Yoshida, S. Nishiumi, H. Tanaka, T. Mimura, K. Nobutani, K. Yamamoto, M. Takenaka, A. Aoganghua, I. Miki, H. Ota, S. Takahashi, H. Matsui, M. Nakamura, R. S. Blumberg, T. Azuma, MUCOSAL IMMUNOLOGY, MUCOSAL IMMUNOLOGY, 5(1), 87 - 98, Jan. 2012
    Summary:Neonatal Fc receptors for immunoglobulin (Ig) G (FcRn) assume a central role in regulating host IgG levels and IgG transport across polarized epithelial barriers. We have attempted to elucidate the contribution of FcRn in controlling Helicobacter infection in the stomach. C57BL/6J wild-type or FcRn(-/-) mice were infected with Helicobacter heilmannii, and gastric lesions, bacterial load and the levels of antigen-specific IgG in serum and gastric juice were analyzed. The elevated levels of anti-H. heimannii IgG in gastric juice were observed exclusively in wild-type mice but not in FcRn(-/-) mice. In contrast, an increase in lymphoid follicles and bacterial loads along with deeper gastric epithelium invasion were noted in FcRn(-/-) mice. C57BL/6J wild-type or FcRn(-/-) mice were also infected with Helicobacter pylori SS1, and the results of the bacterial load in stomachs of these mice and the anti-H. pylori IgG levels in serum and gastric juice were similar to those from H. heilmannii infection. Our data suggest that FcRn can be functionally expressed in the stomach, which is involved in transcytosis of IgG, and prevent colonization by H. heilmannii and the associated pathological consequences of infection.
  • Helicobacter suis KB1 derived from pig gastric lymphoid follicles induces the formation of gastric lymphoid follicles in mice through the activation of B cells and CD4 positive cells, Koji Yamamoto, Hiroshi Tanaka, Yosuke Nishitani, Shin Nishiumi, Ikuya Miki, Mamoru Takenaka, Kentaro Nobutani, Takuya Mimura, Yahaya Ben Suleiman, Shigeto Mizuno, Mikihiko Kawai, Ikuo Uchiyama, Masaru Yoshida, Takeshi Azuma, MICROBES AND INFECTION, MICROBES AND INFECTION, 13(7), 697 - 708, Jul. 2011
    Summary:"Helicobacter heilmannii" ("H. heilmannii"), which belongs to the genus Helicobacter, is a group of bacterial species that display a long spiral-shaped morphology. Recent studies have demonstrated that "H. heilmannii" type I is actually H. suis, which mainly colonizes the stomachs of various animals and humans. However, the influence of H. suis on gastric diseases remains to be fully elucidated. In this report, we revealed the relationship between natural H. suis infection and follicular gastritis in the pig stomachs. From sequence analysis of the 16S rRNA, urease A, and urease B genes, the presence of H. suis was confirmed in pig gastric lymphoid follicles, and this bacterium was named H. suis KB1. In addition, H. suis KB1 was inoculated into C57BL/6J mice, and the following mouse model of the pathogenesis of follicular gastritis by H. suis infection was established: H. suis KB1 colonizes the mouse stomach, and moreover, induces the development of lymphoid follicles and acquired immune responses characterized by the activation of B cells and CD4 positive cells. These results may lead to better understanding of the relationship between H. suis and gastric diseases, especially follicular gastritis; and furthermore, our findings emphasize the zoonotic aspects of animal-human infection by H. suis. (C) 2011 Institut Pasteur. Published by Elsevier Masson SAS. All rights reserved.
  • A case of small pancreatic cancer with intraductal progress, Nobuhiko Fukuba, Koichi Fujita, Shinji Nakayama, Mamoru Takenaka, Saori Matsui, Masato Ozaka, Kotaro Shibagaki, Hiroshi Yoshinaga, Akira Masuzawa, Akihiko Watanabe, Hitoshi Fujiwara, Atsushi Sugahara, Tsuyoshi Fujita, Hidekazu Mukai, Tadashi Tsukamoto, Kazuhiro Teramura, Journal of Japanese Society of Gastroenterology, Journal of Japanese Society of Gastroenterology, 107(5), 792 - 797, May 2010
    Summary:A 60-year-old man was admitted to our department for further evaluation of main pancreatic duct dilatation detected on ultrasonography. Endoscopic retrograde cholangiopancreatography showed stenosis of the main pancreatic duct at the junction of the pancreatic head and body. Brush cytology revealed pancreatic ductal carcinoma Histological examination of the resected pancreas showed a 15-mm in length intraductal growth of carcinoma in situ in the main pancreatic duct, 10mm of which showed microinvasion. There was also atypical hyperplasia at a branch pancreatic duct near the lesion. It was suspected to be an initial stage of pancreatic ductal carcinoma. Intraductal progression type and non-progression type are often suspected in a case showing progression of carcinoma in situ to pancreatic ductal carcinoma, and this case was thought to be intraductal progression.
  • Complete response of a pancreatic adenosquamous carcinoma to chemoradiotherapy, Kotaro Shibagaki, Koichi Fujita, Shinji Nakayama, Mamoru Takenaka, Nobuhiko Fukuba, Saori Matsui, Masato Ozaka, Hiroshi Yoshinaga, Akira Masuzawa, Akihiko Watanabe, Hitoshi Fujiwara, Atsushi Sugawara, Tsuyoshi Fujita, Hidekazu Mukai, Yoshikazu Kinoshita, INTERNATIONAL JOURNAL OF CLINICAL ONCOLOGY, INTERNATIONAL JOURNAL OF CLINICAL ONCOLOGY, 13(1), 74 - 77, Feb. 2008 , Refereed
    Summary:A 51-year-old woman with an unresectable pancreatic tumor that was histologically diagnosed as an adeno-squamous carcinoma underwent chemoradiotherapy with 5-fluourouracil (FU) and low-dose cisplatin (low-dose FP). Because we recognized a partial response to the chemoradiotherapy, we subsequently administered combined chemotherapy with S-1 and cisplatin. After one course of this combined chemotherapy, the tumor was further reduced in size and became difficult to discern on abdominal computed tomography (CT). We have continued to administer the S-1 and cisplatin combined chemotherapy, and the patient is still alive. After 20 months of treatment, the tumor has not recurred (as assessed by abdominal CT). Additionally, we have not seen elevation of tumor markers. This report presents the successful use of chemoradiotherapy with low-dose FP and additional combined chemotherapy with S-1 and cisplatin for unresectable pancreatic adenosquamous carcinoma.

Conference Activities & Talks

  • Advances in EUS-related procedures for the pancreatobiliary diseases, TAKENAKA MAMORU, 第3回中国広州中山大学消化器内視鏡学会,   2019 12 07 , 招待有り
  • Usefulness of EU-ME2 premier plus and usage tips, TAKENAKA MAMORU, 第3回中国広州中山大学消化器内視鏡学会,   2019 12 07 , 招待有り
  • 胆膵領域透視下手技に関する被ばくの現状と低減の取り組み, Mamoru Takenaka, 第96回日本内視鏡学会総会ランチョンセミナー,   2019 11 23 , 招待有り, 日立
  • 胆管挿管100%の極意, Mamoru Takenaka, 第96回日本内視鏡学会総会サテライトセミナー,   2019 11 23 , 招待有り, ガデリウス
  • Balloon center method for endoscopic cholangiolithotomy, TAKENAKA MAMORU, Asian Pancreatobiliary Endoscopist Future Forum,   2019 11 16 , 招待有り
  • 血清IFN-α/IL-33が治療効果判定に有用と考えられた自己免疫性膵炎/IgG4関連疾患の1例, 原 茜, 三長 孝輔, 岡本 彩那, 石川 嶺, 山崎 友裕, 中井 敦史, 大本 俊介, 鎌田 研, 山雄 健太郎, 竹中 完, 渡邉 智裕, 安川 覚, 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,   2019 10
  • 急性胆嚢炎に対する治療戦略 急性胆嚢炎治療における内視鏡的経乳頭胆嚢ドレナージ(ENGBD)の位置づけ, 武部 敦志, 竹中 完, 工藤 正俊, 竹山 宜典, 日本消化器病学会近畿支部例会プログラム・抄録集,   2019 10
  • 膵癌診断のための新たなアプローチ法の提案―3D CT解析による膵実質萎縮の検討―, 山雄健太郎, 竹中完, 工藤正俊, 日本消化器がん検診学会雑誌,   2019 09 25
  • How to use image enhancement function in EUS, TAKENAKA MAMORU, 中国広東省中病院EUS-TTT活動,   2019 07 26 , 招待有り
  • What is the cause of treatment failure?, TAKENAKA MAMORU, Tokyo Conference of Asian Pancreato-biliary Interventional Endoscopy,   2019 06 22 , 招待有り
  • Recent advance in biliary metallic stenting for hilar stricture, TAKENAKA MAMORU, Tokyo Conference of Asian Pancreato-biliary Interventional Endoscopy,   2019 06 22
  • 胆管挿管にどう挑むか。どのように乳頭と対峙すべきか。 ~スコープが及ぼす影響と新型デバイスの可能性~, Mamoru Takenaka, 第95回日本内視鏡学会総会サテライトセミナー,   2019 06 01 , 招待有り, オリンパス
  • ERCP,EUS下ドレナージにおける被ばくの現状と被ばく低減への取り組み, Mamoru Takenaka, 第95回日本内視鏡学会総会ランチョンセミナー,   2019 05 31 , 招待有り, 日立
  • How to learn EUS, TAKENAKA MAMORU, 中国広州中南大学湘雅二医院EUSサロン,   2019 01 18 , 招待有り
  • 肝門部胆管狭窄に対するドレナージ〜新型Braidedステントの可能性, Mamoru Takenaka, 第101回日本消化器内視鏡学会近畿支部例会 コーヒーブレイクセミナー,   2018 11 10 , 招待有り, ゼオンメディカル
  • How to treat cystic neoplasms of the pancreas, TAKENAKA MAMORU, 広東省中病院EUS-TTT活動,   2018 10 19 , 招待有り
  • The useful cannulation method for the intra-diverticular papilla with long oral protrusion using the biopsy forceps for axis alignment, TAKENAKA MAMORU, Asian Pancreatobiliary Endoscopist Future Forum,   2018 09 29 , 招待有り
  • EUS画像強調機能を使い尽くす!, Mamoru Takenaka, 第49回膵臓学会ランチョンセミナー,   2018 06 30 , 招待有り, オリンパス
  • 胆膵疾患に対する内視鏡手技の進化〜PSは次のステージへ〜, Mamoru Takenaka, 第94回日本内視鏡学会総会ランチョンセミナー,   2018 05 01 , 招待有り, ガデリウス
  • How to manage in patients with duodenal obstruction, TAKENAKA MAMORU, New Horizon of biliary SEMS in Korea-Japan,   2018 04 07 , 招待有り
  • New method of biliary cannulation, TAKENAKA MAMORU, Asian Pancreatobiliary Endoscopist Future Forum,   2017 12 15 , 招待有り
  • カニュレーション原点回帰、もう一度振り返るカニュレーションの基本, Mamoru Takenaka, 第105回日本内視鏡学会関東支部例会エキスパートセミナー,   2017 12 10 , 招待有り, COOK
  • Hepaticogastrostomy guided by real-time contrast-enhanced harmonic endoscopic ultrasonography: a novel technique., TAKENAKA MAMORU, Asian Pancreatobiliary Endoscopy Conference,   2017 11 18 , 招待有り
  • New method for difficult biliary cannulation using a double lumen catheter (DLC method), TAKENAKA MAMORU, Asian Pancreatobiliary Endoscopy Conference 2017,   2017 11 18 , 招待有り
  • EUS下ドレナージの実際(EUS-HGS), Mamoru Takenaka, 第93回日本内視鏡学会総会サテライトセミナー,   2017 10 14 , 招待有り, センチュリー
  • 胆道ドレナージの実際〜こんな時どうする?〜, Mamoru Takenaka, 第53回胆道学会ランチョンセミナー,   2017 09 28 , 招待有り, ボストン
  • Contrast Enhanced EUS, TAKENAKA MAMORU, 広東省中病院EUS-TTT活動,   2017 08 19 , 招待有り
  • ERCP時のカニュレーションの基本と挿入困難例の対処, Mamoru Takenaka, 第103回日本消化器内視鏡学会九州支部例会モーニングセミナー,   2017 05 20 , 招待有り, ゼオンメディカル
  • ザ・プラスチックステント Future &Past, Mamoru Takenaka, 第93回日本内視鏡学会総会モーニングセミナー,   2017 05 13 , 招待有り, ガデリウス
  • 胆管手技の極め…切石&ドレナージ デバイス進化と特性, Mamoru Takenaka, 第93回日本内視鏡学会総会ランチョンセミナー,   2017 05 12 , 招待有り, メディコスヒラタ
  • Contrast enhanced EUS and Interventional EUS, TAKENAKA MAMORU, Asian Pancreatobiliary Endoscopy Conference,   2016 10 29 , 招待有り
  • Endoscopic ultrasound-guided drainage of intra abdominal abscess, TAKENAKA MAMORU, Society of Gastrointestinal Intervention in Korea,   2016 10 08 , 招待有り
  • A novel dynamic imaging of gallbladder tumor vessels with contrast-enhanced harmonic EUS, TAKENAKA MAMORU, Tokyo Conference of Asian Pancreato-biliary Interventional Endoscopy,   2016 06 17 , 招待有り
  • 胆管メタリックステントの新潮流〜ダブルメタリックステントってなんだ?〜, Mamoru Takenaka, 第89回日本内視鏡学会総会ランチョンセミナー,   2015 05 31 , 招待有り, アダチ

Misc

  • 遭遇の機会が増えたIPMN/膵嚢胞―現状と課題 2 IPMN/膵嚢胞の診療(4)悪性IPMNとIPMN併存膵癌の診断におけるEUSの役割, 鎌田研, 原茜, 山雄健太郎, 竹中完, 工藤正俊, 臨床消化器内科, 34, 12, 1476‐1481,   2019 10 20 , 10.19020/CG.0000000968, https://jglobal.jst.go.jp/detail?JGLOBAL_ID=201902221651242990
  • 悪性肝門部胆管閉塞に対するMoving cell uncovered metal stentを用いた一期的複数本留置, 山田 真規, 小倉 健, 竹中 完, 塩見 英之, 樋口 和秀, 胆道, 33, 3, 468, 468,   2019 10
  • 【膵癌における内視鏡診断・治療の最前線】術後膵液瘻に対する内視鏡的ドレナージの現状, 竹中 完, 中井 敦史, 吉川 智恵, 石川 嶺, 岡本 彩那, 山崎 友裕, 大本 俊輔, 三長 孝輔, 鎌田 研, 山雄 健太郎, 亀井 敬子, 松本 逸平, 竹山 宜典, 工藤 正俊, 胆と膵, 40, 9, 807, 814,   2019 09
    Summary:膵癌術後合併症の膵切除後膵液瘻(POPF)はときに重篤な経過をたどるが、内視鏡的ドレナージはPOPFの治療において外科的治療と並ぶ重要な治療の一つである。内視鏡的ドレナージには、経乳頭的に主膵管内にドレナージチューブを留置して持続吸引を行うTrans-papillary drainageと、EUSガイド下に膵液貯留腔にドレナージを置くEUS-guided drainageがあり、それぞれの長所短所を理解したうえで、状況に応じた使い分けが求められる、EUS-guided drainageの時期は、急性膵炎後のWalled Off Necrosis(WON)に対するEUS-guided drainageの適応が発症4週間以降であることを踏まえ、術後4週間を待たれる症例が多いが、近年4週間以内の早期ドレナージの有効性も報告されており、症例に応じて4週間を待つことなく、EUS-guided drainageを行うことも考慮に入れるべきである。いずれの処置も適応が正しいかどうか、処置後合併症の対応、外科的ドレナージへのconversionの時期を含め、常に外科と内科で密にディスカッションを行い、患者にとってもっともよい治療法を施設として選択できるように取り組むことが肝要である。(著者抄録)
  • 【術後内視鏡診療のすべて】消化器手術後の内視鏡検査 サーベイランスと異時性病変の診断 消化管再建術後における超音波内視鏡を用いたスクリーニング検査, 鎌田 研, 原 茜, 田中 秀和, 石川 嶺, 岡本 彩那, 中井 敦史, 大本 俊介, 三長 孝輔, 山雄 健太郎, 竹中 完, 工藤 正俊, 消化器内視鏡, 31, 9, 1331, 1336,   2019 09
  • 膵癌における内視鏡診断・治療の最前線 術後膵液瘻に対する内視鏡的ドレナージの現状, 竹中完, 中井敦史, 吉川智恵, 石川嶺, 岡本彩那, 山崎友裕, 大本俊輔, 三長孝輔, 鎌田研, 山雄健太郎, 亀井敬子, 松本逸平, 竹山宜典, 工藤正俊, 胆と膵, 40, 9, 807, 814,   2019 09 , https://jglobal.jst.go.jp/detail?JGLOBAL_ID=201902230237493547
    Summary:膵癌術後合併症の膵切除後膵液瘻(POPF)はときに重篤な経過をたどるが、内視鏡的ドレナージはPOPFの治療において外科的治療と並ぶ重要な治療の一つである。内視鏡的ドレナージには、経乳頭的に主膵管内にドレナージチューブを留置して持続吸引を行うTrans-papillary drainageと、EUSガイド下に膵液貯留腔にドレナージを置くEUS-guided drainageがあり、それぞれの長所短所を理解したうえで、状況に応じた使い分けが求められる、EUS-guided drainageの時期は、急性膵炎後のWalled Off Necrosis(WON)に対するEUS-guided drainageの適応が発症4週間以降であることを踏まえ、術後4週間を待たれる症例が多いが、近年4週間以内の早期ドレナージの有効性も報告されており、症例に応じて4週間を待つことなく、EUS-guided drainageを行うことも考慮に入れるべきである。いずれの処置も適応が正しいかどうか、処置後合併症の対応、外科的ドレナージへのconversionの時期を含め、常に外科と内科で密にディスカッションを行い、患者にとってもっともよい治療法を施設として選択できるように取り組むことが肝要である。(著者抄録)
  • 南大阪地域における急性膵炎地域連携モデル構築への取り組み, 竹中完, 大本俊介, 吉川智恵, 石川嶺, 岡本彩那, 山崎友裕, 中井敦史, 三長孝輔, 鎌田研, 山雄健太郎, 松本逸平, 竹山宜典, 工藤正俊, 膵臓(Web), 34, 3, A30‐A31(J‐STAGE),   2019 06 18 , https://jglobal.jst.go.jp/detail?JGLOBAL_ID=201902213270304304
  • 急性膵炎局所合併症の定義の再検討, 辻喜久, 池浦司, 糸井隆夫, 岩崎栄典, 岸和田昌之, 北村勝哉, 阪上順一, 白井邦博, 鈴木裕, 竹中完, 廣田衛久, 正宗淳, 真弓俊彦, 堀部昌靖, 能登原憲司, 入江裕之, 蒲田敏文, 竹山宜典, 膵臓(Web), 34, 3, A109‐A110(J‐STAGE), A110,   2019 06 18 , https://jglobal.jst.go.jp/detail?JGLOBAL_ID=201902230412675509
  • 微小膵癌診断の新たなアプローチ法―3D CTによる膵実質萎縮評価から見えてきたもの―, 山雄健太郎, 竹中完, 吉川智恵, 石川嶺, 岡本彩那, 中井敦, 山崎友宏, 大本俊介, 鎌田研, 三長孝輔, 松本逸平, 竹山宜典, 鶴崎正勝, 渡邉智裕, 工藤正俊, 膵臓(Web), 34, 3, A33‐A34(J‐STAGE),   2019 06 18 , https://jglobal.jst.go.jp/detail?JGLOBAL_ID=201902261491210865
  • 重症度判定基準の改訂中間報告, 廣田衛久, 竹山宜典, 池浦司, 糸井隆夫, 伊藤鉄英, 岩崎栄典, 堀部昌靖, 岸和田昌之, 北村勝哉, 阪上順一, 白井邦博, 鈴木裕, 竹中完, 辻喜久, 正宗淳, 真弓俊彦, 膵臓(Web), 34, 3, A108(J‐STAGE), A108,   2019 06 18 , https://jglobal.jst.go.jp/detail?JGLOBAL_ID=201902267828632579
  • 重症膵炎症例におけるプレサルコペニアと予後の関連性についての検討, 竹中完, 大本俊介, 竹山宜典, 吉川智恵, 石川嶺, 岡本彩那, 山崎友裕, 中井敦史, 三長孝輔, 鎌田研, 山雄健太郎, 松本逸平, 工藤正俊, 膵臓(Web), 34, 3, A101‐A102(J‐STAGE),   2019 06 18 , https://jglobal.jst.go.jp/detail?JGLOBAL_ID=201902288726135241
  • 重症度判定基準の改訂中間報告, 廣田 衛久, 竹山 宜典, 池浦 司, 糸井 隆夫, 伊藤 鉄英, 岩崎 栄典, 堀部 昌靖, 岸和田 昌之, 北村 勝哉, 阪上 順一, 白井 邦博, 鈴木 裕, 竹中 完, 辻 喜久, 正宗 淳, 真弓 俊彦, 膵臓, 34, 3, A108, A108,   2019 06
  • 急性膵炎局所合併症の定義の再検討, 辻 喜久, 池浦 司, 糸井 隆夫, 岩崎 栄典, 岸和田 昌之, 北村 勝哉, 阪上 順一, 白井 邦博, 鈴木 裕, 竹中 完, 廣田 衛久, 正宗 淳, 真弓 俊彦, 堀部 昌靖, 能登原 憲司, 入江 裕之, 蒲田 敏文, 竹山 宜典, 膵臓, 34, 3, A109, A110,   2019 06
  • 急性膵炎の重症度分類を再考する 重症膵炎症例におけるプレサルコペニアと予後の関連性についての検討, 竹中 完, 大本 俊介, 竹山 宜典, 吉川 智恵, 石川 嶺, 岡本 彩那, 山崎 友裕, 中井 敦史, 三長 孝輔, 鎌田 研, 山雄 健太郎, 松本 逸平, 工藤 正俊, 膵臓, 34, 3, A101, A102,   2019 06
  • 膵嚢胞性腫瘍に対する内視鏡診断 IPMN切除例からみたガイドライン2017の検証と、造影ハーモニックEUSの有用性について, 山崎 友裕, 大本 俊介, 竹中 完, Gastroenterological Endoscopy, 61, Suppl.1, 732, 732,   2019 05
  • 胆膵内視鏡診療における偶発症への対策、トラブルシューティング 術後再建腸管ERCPにおける胆管挿管困難症例に対するUneven Double Lumen Cannulaを用いた胆管挿管法(Uneven法)の有用性, 竹中 完, 三長 孝輔, 工藤 正俊, Gastroenterological Endoscopy, 61, Suppl.1, 852, 852,   2019 05
  • エキスパートへの道―胆・膵 ERCP関連 挿管手技 膵管ガイドワイヤー留置法―確実に成功させるコツ―, 竹中完, 中井敦史, 工藤正俊, 消化器内視鏡, 31, 3, 348‐353,   2019 03 25 , http://jglobal.jst.go.jp/public/201902242592293892
  • 術前診断に難渋した膵頭部・尾部同時性多発癌の一例, 岡本 彩那, 三長 孝輔, 竹中 完, 吉川 智恵, 石川 嶺, 山崎 友裕, 中井 敦史, 大本 俊介, 鎌田 研, 山雄 健太郎, 松本 逸平, 大谷 知之, 工藤 正俊, 日本消化器病学会雑誌, 116, 臨増総会, A406, A406,   2019 03
  • 膵管内乳頭粘液性腫瘍(IPMN)の診断と経過観察法 3 IPMNに合併・併存する膵癌とその診断法, 鎌田研, 竹中完, 工藤正俊, 週刊日本医事新報, 4940, 36‐40,   2018 12 29 , http://jglobal.jst.go.jp/public/201902245060413005
  • 選択的胆管挿管100%をめざして―We’re gonna do it!―乳頭形態別の胆管挿管ストラテジー【動画付】, 竹中完, 向井秀一, 吉川智恵, 石川嶺, 岡本彩那, 山崎友祐, 中井敦史, 大本俊介, 三長孝輔, 鎌田研, 山雄健太郎, 工藤正俊, 胆と膵, 39, 12, 1309‐1317, 1317,   2018 12 15 , http://jglobal.jst.go.jp/public/201902226980756200
    Summary:胆管挿管をマスターすることは内視鏡的逆行性胆管膵管造影(ERCP)関連主義の基本中の基本である。胆管挿管の基本は、乳頭部の形態が千差万別であり全く同じものは一つとして存在しないことをまず認識し、これまでに多くの先人が胆管挿管に対する検討を行い、蓄積してきた多くの知見を学び、対峙した乳頭の形態、大きさ、口側隆起の形態から乳頭内の胆管と膵管の合流形式を予想し、その症例でとりうるスコープポジションと胆管挿管との兼ね合いを理解し、難渋することも頭に入れ、挿管のストラテジーを組み立てることが挿管成功率の向上につながり、挿管困難症例克服の重要な鍵となる。すべての処置を愛護的に行うことは言うまでもなく、ERCP歴がある症例はスコープの挿入前に上記内容を把握することが胆管挿管成功につながることは言うまでもなく遂行すべきである。(著者抄録)
  • Interventional EUSの偶発症予防と対処 超音波内視鏡下瘻孔形成術における胆汁漏出の予防, 鎌田研, 竹中完, 三長孝輔, 石川嶺, 吉川智恵, 岡本彩那, 山崎友裕, 中井敦史, 大本俊介, 山雄健太郎, 工藤正俊, 月刊消化器・肝臓内科, 4, 6, 470, 473,   2018 12 , http://jglobal.jst.go.jp/public/201902230701856196
  • 胆膵ドレナージupdate[3.困難例とトラブルシューティング]胆管・膵管プラスチックステント迷入への対処, 竹中完, 三長孝輔, 鎌田研, 山雄健太郎, 工藤正俊, 消化器内視鏡, 30, 11, 1605‐1611,   2018 11 25 , http://jglobal.jst.go.jp/public/201802282333712805
  • Biliary access大辞典 III.経乳頭的biliary access~salvage technique~Uneven Double Lumen Cannulaを用いた胆管カニュレーションテクニック(Uneven method)【動画付】, 竹中完, 吉川智恵, 石川嶺, 岡本彩那, 山崎友祐, 中井敦史, 大本俊介, 三長孝輔, 鎌田研, 山雄健太郎, 有坂好史, 工藤正俊, 胆と膵, 39, 1013‐1020,   2018 11 10 , http://jglobal.jst.go.jp/public/201802250502947678
  • A case of gallbladder carcinoma with interesting contrast-enhanced harmonic EUS image, 吉川智恵, 鎌田研, 竹中完, 大本俊介, 三長孝輔, 山雄健太郎, 今井元, 榎木英介, 木村雅友, 松本逸平, 竹山宜典, 工藤正俊, 胆道, 32, 4, 775‐781, 781,   2018 10 31 , 10.11210/tando.32.775, http://jglobal.jst.go.jp/public/201802278017394530
    Summary:本症例は、胆嚢腺筋腫症におけるRokitansky-Aschoff sinus(RAS)内に進展し、一部で浸潤を認めるpT2(SS)胆嚢癌の1例である。胆嚢内にpolypoidに増殖する乳頭型腫瘍を呈し、内部で領域性に異なる増殖パターンを呈した。病理学的に、乳頭型腺癌の組織像を呈し、不整な乳頭腺管状構築をとりながら増殖している領域と充実性の構造を示し、密な腫瘍細胞の増殖を認める領域に分かれていた。造影ハーモニックEUSでは、腫瘤は造影早期より腫瘍血管構造が描出された後、均一かつ強く濃染される領域と少し遅れて内部に太く蛇行する異常血管が緩徐に造影され、その後不均一に造影される領域に2分された。本症例の胆嚢癌は、異なる組織成分の存在を示唆する興味深い造影ハーモニックEUS画像を呈した。(著者抄録)
  • 胆膵疾患内視鏡アトラス I.膵臓 1.充実性 特殊型膵癌―腺扁平上皮癌,退形成性膵管癌,腺房細胞癌―, 竹中完, 筑後孝章, 工藤正俊, 消化器内視鏡, 30, 54‐57,7,   2018 10 20 , http://jglobal.jst.go.jp/public/201802272450064760
  • 膵癌の門脈浸潤診断における造影ハーモニックEUSと造影CTの診断能の比較検討, 中井 敦史, 鎌田 研, 竹中 完, 石川 嶺, 岡本 彩那, 大本 俊介, 三長 孝輔, 山雄 健太郎, 兵頭 朋子, 松本 逸平, 竹山 宜典, 工藤 正俊, Gastroenterological Endoscopy, 60, Suppl.2, 2126, 2126,   2018 10
  • EUS施行時の鎮静に対するBISモニターの有用性の検討, 岡本 彩那, 鎌田 研, 竹中 完, 石川 嶺, 中井 敦史, 大本 俊介, 三長 孝輔, 山雄 健太郎, 工藤 正俊, Gastroenterological Endoscopy, 60, Suppl.2, 2126, 2126,   2018 10
  • 術前水平方向進展度診断にSpyGlass DSが有用であった遠位胆管癌の2例, 東原 久美, 三長 孝輔, 岡本 彩那, 榎木 英介, 石川 嶺, 中井 敦史, 大本 俊介, 鎌田 研, 山雄 健太郎, 竹中 完, 工藤 正俊, Gastroenterological Endoscopy, 60, Suppl.2, 2153, 2153,   2018 10
  • Interventional EUSのトラブルシューティング PTGBDからEUS-GBDへのconversionの有用性・安全性に関する検討 多施設後ろ向き研究, 三長 孝輔, 竹中 完, 山下 幸孝, Therapeutic Endoscopic Ultrasou, Group:TEUS, 日本消化器病学会雑誌, 115, 臨増大会, A681, A681,   2018 10
  • 肝外胆管癌における造影ハーモニックEUSの有用性についての検討, 大塚康生, 鎌田研, 竹中完, 石川嶺, 岡本彩那, 中井敦史, 大本俊介, 三長孝輔, 山雄健太郎, 筑後孝章, 兵頭朋子, 中居卓也, 竹山宜典, 工藤正俊, 胆道, 32, 3, 567,   2018 08 31 , http://jglobal.jst.go.jp/public/201802258019488993
  • 術後膵液瘻(POPF)に対するEUS下ドレナージの有用性, 中井敦史, 竹中完, 山雄健太郎, 松本逸平, 竹山宜典, 工藤正俊, 膵臓, 33, 3, 399,   2018 05 31 , http://jglobal.jst.go.jp/public/201802210573222566
  • 重症急性膵炎の予後不良予測因子および被包化壊死(WON)合併予測因子の検討, 大本俊介, 竹中完, 松本逸平, 竹山宜典, 工藤正俊, 膵臓, 33, 3, 410,   2018 05 31 , http://jglobal.jst.go.jp/public/201802233190298678
  • 造影ハーモニックEUSによる膵神経内分泌腫瘍の悪性度評価, 石川嶺, 鎌田研, 竹中完, 田中秀和, 中井敦史, 大本俊介, 宮田剛, 三長孝輔, 山雄健太郎, 今井元, 工藤正俊, 膵臓, 33, 3, 346,   2018 05 31 , http://jglobal.jst.go.jp/public/201802267220090235
  • 造影ハーモニックEUSは膵癌の術前治療の効果判定に有用か?, 田中秀和, 鎌田研, 竹中完, 石川嶺, 中井敦史, 大本俊介, 三長孝輔, 宮田剛, 山雄健太郎, 今井元, 工藤正俊, 膵臓, 33, 3, 505,   2018 05 31 , http://jglobal.jst.go.jp/public/201802283935816527
  • どうする膵嚢胞[各論 IPMN]IPMNの経過観察におけるEUSの今後, 鎌田研, 竹中完, 中井敦史, 大本俊介, 宮田剛, 三長孝輔, 山雄健太郎, 今井元, 樫田博史, 工藤正俊, 消化器内視鏡, 30, 5, 606‐610,   2018 05 25 , http://jglobal.jst.go.jp/public/201802263080317448
  • 【膵癌update】 トピックス 膵癌の癌性疼痛に対するEUSガイド下神経叢ブロック(融解)術の有用性, 宮田 剛, 竹中 完, 工藤 正俊, 臨床消化器内科, 33, 7, 950, 957,   2018 05 , 10.19020/CG.0000000420
  • 造影ハーモニックEUSによる膵癌の門脈浸潤診断の検討, 中井 敦史, 鎌田 研, 大本 俊介, 宮田 剛, 三長 孝輔, 山雄 健太郎, 今井 元, 竹中 完, 樫田 博史, 工藤 正俊, Gastroenterological Endoscopy, 60, Suppl.1, 738, 738,   2018 04
  • 超音波内視鏡ガイド下治療の現状と問題点 膵癌に伴う疼痛に対するEUSガイド下神経ブロックの有用性, 三長 孝輔, 竹中 完, 工藤 正俊, 日本消化器病学会雑誌, 115, 臨増総会, A68, A68,   2018 04
  • 十二指腸穿破をきたした正中球状靱帯症候群による膵十二指腸動脈瘤の一例, 高島 耕太, 大本 俊介, 三長 孝輔, 竹中 完, 中井 敦史, 宮田 剛, 鎌田 研, 山雄 健太郎, 今井 元, 米田 頼晃, 松井 繁長, 工藤 正俊, 日本消化器病学会雑誌, 115, 臨増総会, A355, A355,   2018 04
  • A case of gallbladder carcinoma with interesting contrast-enhanced harmonic EUS image, Yoshikawa Tomoe, Matsumoto Ippei, Takeyama Yoshifumi, Kudo Masatoshi, Kamata Ken, Takenaka Mamoru, Omoto Shunsuke, Minaga Kosuke, Yamao Kentaro, Imai Hajime, Enoki Eisuke, Kimura Masatomo, Tando, 32, 4, 775, 781,   2018 , 10.11210/tando.32.775, http://jglobal.jst.go.jp/public/201802278017394530
    Summary:

    This is a case of pT2 (SS) gallbladder carcinoma extending into the Rokitansky-Aschoff sinus and invasive in part. The tumor showed regional difference in proliferation pattern. Pathologically, the tumor had a region with irregular tubular structure tumor cell proliferation pattern and a region with solid structure and dense tumor cell proliferation pattern. Preoperative Contrast-enhanced harmonic EUS showed two regions. One was a region that showed irregular vessel from the early phase and then the whole tumor showing strong enhancement. Another region showed thick tortuous irregular vessels in delay and then the whole tumor was enhanced heterogeneously. This case showed an interesting contrast-enhanced harmonic EUS image that suggests the existence of a different histologic component.

  • 造影ハーモニックEUSによる膵癌の門脈浸潤診断の検討, 中井敦史, 鎌田研, 大本俊介, 宮田剛, 三長孝輔, 山雄健太郎, 今井元, 竹中完, 樫田博史, 工藤正俊, Gastroenterological Endoscopy (Web), 60, Supplement1, 738(J‐STAGE),   2018 , http://jglobal.jst.go.jp/public/201802264963655482
  • 膵管内に発育した5mmの退形性膵癌の1例, 中井敦史, 山雄健太郎, 竹中完, 松本逸平, 竹山宜典, 鶴崎正勝, 柳生行伸, 筑後孝章, 工藤正俊, 日本消化器画像診断研究会プログラム・抄録集, 69th, 55,   2018 , http://jglobal.jst.go.jp/public/201802288018130105
  • 術前にIPMN併存癌と診断したlow‐grade PanINの1例, 山雄健太郎, 竹中完, 松本逸平, 竹山宜典, 筑後孝章, 工藤正俊, 日本消化器画像診断研究会プログラム・抄録集, 68th, 21,   2018 01 , http://jglobal.jst.go.jp/public/201802232630523171
  • 臓器間ネットワークからみた肝胆膵の恒常性とその破綻 臓器間ネットワークの破綻による疾患 膵炎における腸管免疫機構破綻と重症化機序, 渡邉智裕, 三長孝輔, 鎌田研, 山雄健太郎, 竹中完, 工藤正俊, 肝胆膵, 75, 5, 991‐996,   2017 11 28 , http://jglobal.jst.go.jp/public/201702291849270335
  • 【急性胆嚢炎に対する最新のマネージメント】 急性胆嚢炎の発症機序と鑑別診断のコツ, 竹中 完, 中井 敦史, 大本 俊介, 宮田 剛, 三長 孝輔, 鎌田 研, 山雄 健太郎, 今井 元, 工藤 正俊, 胆と膵, 38, 10, 1137, 1145,   2017 10
    Summary:急性胆嚢炎の原因はほとんどが胆嚢結石(胆石)であるが、無症候性胆石保有者の有症状化率は年率1〜3%、生涯で約20%との報告がある。急性胆嚢炎と診断され、然るべき治療が施されれば、その予後は良好であるが、鑑別を要する疾患には、心・血管疾患のような、初期治療の遅れが致死的病態に至るものも含まれており初期診断は慎重を要する。また、少なからず胆石以外の原因による急性胆嚢炎も存在し、それらは胆石性胆嚢炎とは発症機序が異なり、診断方法、治療内容も異なってくる。無石胆嚢炎、術後胆嚢炎などは、重症化しやすい病態が多く、胆石胆嚢炎の死亡率はおおむね0.6%程度であるのに対し、術後胆嚢炎や無石胆嚢炎の死亡率は23〜40%と高いと報告され、早期診断、早期治療介入の是非が予後を左右する。無石胆嚢でも急性胆嚢炎は発症する可能性があること、術後管理、長期経静脈栄養管理患者にそのリスクがあることを知っておくことが肝要である。(著者抄録)
  • 【胆膵EUSを極める-私ならこうする(There is always a better way)-】 治療 胆嚢ドレナージ 私はこうする, 三長 孝輔, 北野 雅之, 竹中 完, 鎌田 研, 中井 敦史, 大本 俊介, 宮田 剛, 山雄 健太郎, 今井 元, 工藤 正俊, 胆と膵, 38, 臨増特大, 1071, 1078,   2017 10
    Summary:EUS-guided gallbladder drainage(EUS-GBD)は、経皮的、内視鏡的経乳頭的ドレナージに次ぐ新たな胆嚢ドレナージ法として近年広まりつつある治療法であり、「急性胆管炎・胆嚢炎診療ガイドライン2013」においても特殊なドレナージ方法の一つとして記載されている。EUS-GBDは、EUSガイド下に、十二指腸球部あるいは胃前庭部から胆嚢を直接穿刺し消化管にドレナージを行う手技であり、内瘻であること、処置関連膵炎のリスクがないことが長所であるが、現時点では使用可能な専用のデバイスが少なく、胆汁性腹膜炎や消化管穿孔などの重篤な偶発症をきたすリスクもあり、先進施設を中心に行われている。主な対象として、悪性胆管狭窄に対する金属ステント留置後や手術リスクの高い胆嚢炎症例に対し施行されてきたが、良好な治療成績の報告が相次ぎ、今後治療適応が拡大していくことが予想される。本稿では、われわれの施設での施行経験を踏まえて、「私はこうする」という視点から、手技のコツや偶発症対策における工夫などについて概説する。(著者抄録)
  • 【胆膵EUSを極める-私ならこうする(There is always a better way)-】 治療 胆嚢ドレナージ 私はこうする, 三長 孝輔, 北野 雅之, 竹中 完, 鎌田 研, 中井 敦史, 大本 俊介, 宮田 剛, 山雄 健太郎, 今井 元, 工藤 正俊, 胆と膵, 38, 臨増特大, 1071, 1078,   2017 10
    Summary:EUS-guided gallbladder drainage(EUS-GBD)は、経皮的、内視鏡的経乳頭的ドレナージに次ぐ新たな胆嚢ドレナージ法として近年広まりつつある治療法であり、「急性胆管炎・胆嚢炎診療ガイドライン2013」においても特殊なドレナージ方法の一つとして記載されている。EUS-GBDは、EUSガイド下に、十二指腸球部あるいは胃前庭部から胆嚢を直接穿刺し消化管にドレナージを行う手技であり、内瘻であること、処置関連膵炎のリスクがないことが長所であるが、現時点では使用可能な専用のデバイスが少なく、胆汁性腹膜炎や消化管穿孔などの重篤な偶発症をきたすリスクもあり、先進施設を中心に行われている。主な対象として、悪性胆管狭窄に対する金属ステント留置後や手術リスクの高い胆嚢炎症例に対し施行されてきたが、良好な治療成績の報告が相次ぎ、今後治療適応が拡大していくことが予想される。本稿では、われわれの施設での施行経験を踏まえて、「私はこうする」という視点から、手技のコツや偶発症対策における工夫などについて概説する。(著者抄録)
  • 【急性胆嚢炎に対する最新のマネージメント】 急性胆嚢炎の発症機序と鑑別診断のコツ, 竹中 完, 中井 敦史, 大本 俊介, 宮田 剛, 三長 孝輔, 鎌田 研, 山雄 健太郎, 今井 元, 工藤 正俊, 胆と膵, 38, 10, 1137, 1145,   2017 10
    Summary:急性胆嚢炎の原因はほとんどが胆嚢結石(胆石)であるが、無症候性胆石保有者の有症状化率は年率1〜3%、生涯で約20%との報告がある。急性胆嚢炎と診断され、然るべき治療が施されれば、その予後は良好であるが、鑑別を要する疾患には、心・血管疾患のような、初期治療の遅れが致死的病態に至るものも含まれており初期診断は慎重を要する。また、少なからず胆石以外の原因による急性胆嚢炎も存在し、それらは胆石性胆嚢炎とは発症機序が異なり、診断方法、治療内容も異なってくる。無石胆嚢炎、術後胆嚢炎などは、重症化しやすい病態が多く、胆石胆嚢炎の死亡率はおおむね0.6%程度であるのに対し、術後胆嚢炎や無石胆嚢炎の死亡率は23〜40%と高いと報告され、早期診断、早期治療介入の是非が予後を左右する。無石胆嚢でも急性胆嚢炎は発症する可能性があること、術後管理、長期経静脈栄養管理患者にそのリスクがあることを知っておくことが肝要である。(著者抄録)
  • 膵・胆道癌の早期診断を目指せ!実質内発生の小膵癌 IPMNに併存した小膵癌の解析, 山雄健太郎, 竹中完, 中井敦史, 大本俊介, 鎌田研, 三長孝輔, 宮田剛, 今井元, 松本逸平, 竹山宜典, 筑後孝章, 工藤正俊, 肝胆膵, 75, 3, 611‐619,   2017 09 28 , http://jglobal.jst.go.jp/public/201702287818722697
  • 膵・胆道癌に対する内視鏡的診断法の新たな展開 膵癌肝転移診断におけるKupffer imageを用いた造影EUSの有用性, 竹中 完, 三長 孝輔, 工藤 正俊, 日本消化器病学会雑誌, 114, 臨増大会, A612, A612,   2017 09
  • 膵・胆道癌に対する内視鏡的診断法の新たな展開 膵癌肝転移診断におけるKupffer imageを用いた造影EUSの有用性, 竹中 完, 三長 孝輔, 工藤 正俊, Gastroenterological Endoscopy, 59, Suppl.2, 2056, 2056,   2017 09
  • 【膵・胆道癌の早期診断を目指せ!】 実質内発生の小膵癌 IPMNに併存した小膵癌の解析, 山雄 健太郎, 竹中 完, 中井 敦史, 大本 俊介, 鎌田 研, 三長 孝輔, 宮田 剛, 今井 元, 松本 逸平, 竹山 宜典, 筑後 孝章, 工藤 正俊, 肝・胆・膵, 75, 3, 611, 619,   2017 09
  • 【Interventional EUSの最新情報-適応、手技、デバイス-】 EUS-guided pancreatic ductal drainage(EUS-PD)の適応と手技のコツ, 竹中 完, 中井 敦史, 大本 俊介, 三長 孝輔, 宮田 剛, 鎌田 研, 山雄 健太郎, 今井 元, 工藤 正俊, 消化器・肝臓内科, 2, 3, 253, 260,   2017 09
  • 膵癌の早期診断・治療の現状と展望 膵癌早期診断の現状 膵癌早期診断研究会における多施設研究の結果をもとに, 菅野 敦, 正宗 淳, 花田 敬士, 真口 宏介, 清水 泰博, 植木 敏晴, 長谷部 修, 大塚 隆生, 中村 雅史, 竹中 完, 北野 雅之, 菊山 正隆, 蒲田 敏文, 吉田 浩司, 佐々木 民人, 芹川 正浩, 古川 徹, 柳澤 昭夫, 下瀬川 徹, 膵臓, 32, 3, 318, 318,   2017 05
  • 慢性膵炎の進展予防を目的とした治療 その適応と限界 早期慢性膵炎のEUS所見の妥当性、早期治療介入の意義について, 竹中 完, 大本 俊介, 三長 孝輔, 宮田 剛, 鎌田 研, 山雄 健太郎, 今井 元, 工藤 正俊, 膵臓, 32, 3, 360, 360,   2017 05
  • 急性膵炎の後期合併症に対する手術・インターベンション治療の現状と課題 当院におけるWONに対するstep-up approachの検討, 竹中 完, 大本 俊介, 三長 孝輔, 宮田 剛, 鎌田 研, 山雄 健太郎, 今井 元, 工藤 正俊, 膵臓, 32, 3, 377, 377,   2017 05
  • 膵疾患診療におけるERCPの役割を見直す 慢性膵炎に対する経乳頭的金属ステント留置、短期間抜去の有用性, 竹中 完, 大本 俊介, 三長 孝輔, 宮田 剛, 鎌田 研, 山雄 健太郎, 今井 元, 工藤 正俊, 膵臓, 32, 3, 422, 422,   2017 05
  • ソナゾイド造影EUSを用いた膵癌肝転移検出に関する検討, 三長 孝輔, 竹中 完, 北野 雅之, 中井 敦史, 大本 俊介, 宮田 剛, 鎌田 研, 山雄 健太郎, 今井 元, 渡邉 智裕, 工藤 正俊, 膵臓, 32, 3, 552, 552,   2017 05
  • EUS下胆道ドレナージ(戦略と安全な手技) 経乳頭的re-intervention困難例の悪性肝門部胆道閉塞に対するEUS下胆道ドレナージの有用性, 三長 孝輔, 竹中 完, 工藤 正俊, Gastroenterological Endoscopy, 59, Suppl.1, 817, 817,   2017 04
  • 硬化性胆管炎と診断された膵癌、閉塞性黄疸の1例, 中井 敦史, 山雄 健太郎, 大本 俊介, 鎌田 研, 三長 孝輔, 宮田 剛, 今井 元, 竹中 完, 松本 逸平, 竹山 宜典, 筑後 孝章, 工藤 正俊, Gastroenterological Endoscopy, 59, Suppl.1, 1061, 1061,   2017 04
  • 慢性膵炎診断における超音波の役割 早期慢性膵炎EUS所見の臨床的意義について, 竹中 完, 大本 俊介, 三長 孝輔, 宮田 剛, 鎌田 研, 山雄 健太郎, 今井 元, 樫田 博史, 工藤 正俊, 超音波医学, 44, Suppl., S242, S242,   2017 04
  • 造影ハーモニックEUSによる上部消化管粘膜下腫瘍の鑑別診断 EUS-FNA診断との併用, 鎌田 研, 竹中 完, 大本 俊介, 宮田 剛, 三長 孝輔, 山雄 健太郎, 今井 元, 筑後 孝章, 安田 卓司, 工藤 正俊, 超音波医学, 44, Suppl., S438, S438,   2017 04
  • 【今IPMNをどう診るか】 サーベイランスをめぐる諸問題 IPMN経過観察におけるEUSの有用性, 鎌田 研, 竹中 完, 北野 雅之, 工藤 正俊, 肝・胆・膵, 74, 4, 583, 586,   2017 04
  • 【胆管結石・胆管炎をめぐる諸問題】 胆石膵炎, 竹中 完, 大本 俊介, 三長 孝輔, 宮田 剛, 鎌田 研, 山雄 健太郎, 今井 元, 工藤 正俊, 消化器・肝臓内科, 1, 3, 247, 256,   2017 03
  • 【膵癌の早期診断最前線】 膵癌早期診断におけるEUSの役割, 鎌田 研, 竹中 完, 北野 雅之, 大本 俊介, 三長 孝輔, 宮田 剛, 山雄 健太郎, 今井 元, 工藤 正俊, 膵臓, 32, 1, 38, 44,   2017 02 , 10.2958/suizo.32.38
    Summary:膵癌早期診断におけるEUSの果たす役割は近年大きくなりつつある。リスクファクターを有する症例や膵管内乳頭粘液性腫瘍の精査あるいは経過観察にEUSを用いることによって実際に早期膵癌が発見されたとする報告が数多くみられる。EUS機器の進歩、EUS-FNAの普及によって膵癌の存在診断・質的診断能は確実に向上してきている。本稿では、膵癌、特に小膵癌の存在診断におけるEUSの役割について解説する。(著者抄録)
  • 4.膵癌早期診断におけるEUSの役割, 鎌田研, 竹中完, 北野雅之, 大本俊介, 三長孝輔, 宮田剛, 山雄健太郎, 今井元, 工藤正俊, すい臓, 32, 1, 38‐44(J‐STAGE),   2017 , 10.2958/suizo.32.38, http://jglobal.jst.go.jp/public/201702262286314537
  • 【IPMNの診断と治療はどう変わったか?】 診断 IPMN診療におけるEUSの位置付け 有用性とこれからの課題, 竹中 完, 鎌田 研, 北野 雅之, Napoleon Bertrand, 工藤 正俊, 胆と膵, 37, 11, 1475, 1480,   2016 11
    Summary:IPMNを疑う症例に初回精査をする場合、まず併存膵癌を除外したうえで、疾患がIPMNであるかどうか、IPMNと診断されれば型分類はどうか、high-risk stigmataかworrisome featureの所見があるか、手術適応があるか、の判定を行い、手術適応症例では術式や切除範囲を精査し、経過観察例に対してはIPMNそのものの評価はもちろんのこと、併存膵癌の出現を常に念頭に置いてフォローを行う必要がある。IPMN診療におけるEUSの位置付けは現行のガイドラインでは、分枝型IPMNのworrisome feature所見を有する病変に対する精査と、拡張分枝2cm以上の病変のフォローに用いるのみとなっている。しかし実臨床の場では、悪性予測因子である壁存結節の造影EUSによる評価、フォロー群からの併存膵癌の診断、本邦では推奨されてはいないEUS-FNAによる評価、今後に有用性が期待されるconfocal laser endo-microscopy(CLE)など、EUSのIPMNに対する意義は多岐にわたる。IPMNに対しEUSは重要性が非常に高い検査であると考えられ、ガイドラインにおける位置付けについても再検討が必要である。(著者抄録)
  • 【Interventional EUSのすべて】 EUSガイド下胆嚢ドレナージ術, 竹中 完, 北野 雅之, 鎌田 研, 三長 孝輔, 大本 俊介, 宮田 剛, 山雄 健太郎, 今井 元, 工藤 正俊, 消化器内視鏡, 28, 10, 1669, 1678,   2016 10
    Summary:近年、interventional EUSの進歩は著しく、多くの関連手技が胆膵疾患に臨床応用されている。その一つに、EUS下吸引生検術を応用したEUSガイド下胆嚢ドレナージ術(EUS-GBD)があり、「急性胆管炎・胆嚢炎診療ガイドライン2013」にも急性胆嚢炎に対するドレナージ治療の一つとして記載されている。EUS-GBDは当初、予後の限られた手術適応外の悪性腫瘍関連急性胆嚢炎に対して行われていたが、その後、通常の胆石胆嚢炎の術前ドレナージとしても、経皮経肝胆嚢ドレナージ術(PTGBD)と同等の有用性がランダム化比較試験(RCT)で示され、その適応は拡がりをみせている。しかし、依然、確立された適応、手技内容はなく、偶発症は重篤な経過をとる可能性があり、現時点ではEUS-GBDは限られた施設のみが行う特殊な治療となっている。今後、手技の確立・デバイスの更なる改良により、EUS-GBDが急性胆嚢炎治療のオプションとして一般化していくことが期待される。(著者抄録)
  • 【肝胆膵・術後病態を學ぶ】 その他関連疾患 肝膿瘍 胆道疾患関連肝膿瘍を中心に, Takenaka Mamoru, 平田 祐一, 八木 洋輔, 那賀川 峻, Shiomi Hideyuki, Arisaka Yoshifumi, Okabe Yoshihiro, 久津見 弘, 肝・胆・膵, 69, 1号, 93, 98,   2014 07 , 招待有り
  • 【乳頭を攻略する-カニュレーションの基本と困難例への対処】 膵管カニュレーションのコツ, Arisaka Yoshifumi, Takenaka Mamoru, 増田 充弘, Shiomi Hideyuki, 小林 隆, 酒井 新, 那賀川 峻, 八木 洋輔, 江崎 健, 平田 祐一, 山中 広大, 久津見 弘, Azuma Takeshi, 消化器内視鏡, 26, 2号, 280, 288,   2014 02 , 招待有り
  • Endoscopic sphincterotomy to prevent post-ERCP pancreatitis in patients with biliary neoplasms: a multicenter retrospective cohort study., Takashi Tamura, Takeshi Ogura, Mamoru Takenaka, Kensuke Tanioka, Masahiro Itonaga, Kentaro Yamao, Ken Kamata, Seiko Hirono, Ken-Ichi Okada, Miyuki Imanishi, Kazuhide Higuchi, Hiroki Yamaue, Masayuki Kitano, Endoscopy international open, 8, 4, E513-E522,   2020 04 , 10.1055/a-1107-2629
    Summary:Background and aims  Treatment of biliary neoplasms often involves multiple endoscopic retrograde cholangiopancreatography (ERCP)-related procedures. Endoscopic sphincterotomy (ES) may prevent post-ERCP pancreatitis (PEP). This retrospective, multicenter cohort study aimed to investigate the effectiveness of ES for prevention of PEP in patients with biliary neoplasm. Methods  Patients with biliary duct neoplasm who underwent ERCP between January 2006 and December 2016 were enrolled. The frequency of PEP was compared between the ES and non-ES groups using propensity score analysis. The effectiveness of ES in subgroups of patients who underwent biliary duct stent placement, intraductal ultrasound (IDUS), and transpapillary biliary duct biopsy was analyzed by logistic regression. Results  Of the 362 patients enrolled, 84 (23.2 %) developed PEP. Propensity score matching for PEP risk factors in 172 ERCP procedures showed that the frequency of PEP in the ES group was lower than that in the non-ES group (19.7 % vs. 33.7 %). Non-ES was also an independent risk factor for PEP in patients who underwent intraductal ultrasound and transpapillary biliary duct biopsy (RR = 4.54 and 5.26), but was not an independent risk factor for PEP in patients with biliary duct stents. In addition, there was no evidence that the frequency of PEP was statistically different between patients with plastic stents and metal stents in the ES and non-ES groups ( P  = 0.14 and 0.10). Conclusions  ES is an effective technique to prevent PEP in patients with biliary neoplasms. In particular, ES is a safe technique to prevent PEP when performing IDUS and transpapillary biliary duct biopsy.
  • Endoscopic ultrasound-guided gallbladder drainage for acute cholecystitis: Long-term outcomes after removal of a self-expandable metal stent, Ken Kamata, Mamoru Takenaka, Masayuki Kitano, Shunsuke Omoto, Kosuke Minaga, Takeshi Miyata, Kentaro Yamao, Hajime Imai, Masatoshi Kudo, JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, 31, 341, 341,   2016 11
  • Clinical impact of endoscopic ultrasonography imaging of chronic pancreatitis in the pancreatic parenchyma in patients with intraductal papillary mucinous neoplasms, Mamoru Takenaka, Atsuhiro Masuda, Masayuki Kitano, Yoh Zen, Kentarou Yamao, Hideyuki Shiomi, Yonson Ku, Takeshi Azuma, Masatoshi Kudo, JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, 31, 240, 241,   2016 11
  • EUS-guided choledochoduodenostomy using a newly designed laser-cut metal stent: Feasibility study in a porcine model, Kosuke Minaga, Mamoru Takenaka, Masayuki Kitano, Hajime Imai, Kentaro Yamao, Ken Kamata, Takeshi Miyata, Shunsuke Omoto, Masatoshi Kudo, JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, 31, 222, 222,   2016 11
  • Effectiveness of self-expandable metal stent for afferent loop obstruction caused by cancer recurrence after pancreaticoduodenectomy, Arata Sakai, Hideyuki Shiomi, Seiji Fujigaki, Koudai Yamanaka, Takeshi Ezaki, Yuichi Hirata, Takao Iemoto, Takashi Nakagawa, Yousuke Yagi, Takashi Kobayashi, Toshitatsu Takao, Mamoru Takenaka, Yoshifumi Arisaka, Hiromu Kutsumi, Yoshihiro Okabe, Takeshi Azuma, JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, 29, 43, 43,   2014 11
  • Evaluation for the indication of prophylactic pancreatic duct stent by propensity score analysis, Mamoru Takenaka, Arata Sakai, Hideyuki Shiomi, Atsuhiro Masuda, Yoshifumi Arisaka, Tsuyoshi Fujita, Hiromu Kutsumi, Takanobu Hayakumo, Takeshi Azuma, JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, 28, 17, 17,   2013 10
  • Helicobacter Suis Kb1 Derived From Pig Gastric Lymphoid Follicles Induces Formation of Gastric Lymphoid Follicles in Mice Through Activation of B Cells and CD4 Positive Cells, Mamoru Takenaka, Masaru Yoshida, Takeshi Azuma, GASTROENTEROLOGY, 140, 5, S312, S312,   2011 05