鎌田 研(カマタ ケン)

医学科特命准教授

Last Updated :2024/09/14

■教員コメント

コメント

胆道、膵疾患の診断治療

■研究者基本情報

学位

  • 博士医学(近畿大学医学部)

現在の研究分野(キーワード)

胆道、膵疾患の診断治療

研究分野

  • ライフサイエンス / 免疫学 / 自己免疫性膵炎
  • ライフサイエンス / 腫瘍診断、治療学 / 膵癌 胆道癌 胃粘膜下腫瘍 超音波内視鏡 化学療法 緩和医療 造影ハーモニック超音波内視鏡 ソナゾイド
  • ライフサイエンス / 消化器内科学 / 超音波内視鏡下胆道ドレナージ EUS-FNA EUS-FNB EUS-CPN

■経歴

経歴

  • 2022年04月 - 現在  近畿大学医学部 消化器内科 特命准教授
  • 2020年04月 - 現在  近畿大学医学部 医学部講師
  • 2009年04月 - 2020年03月  近畿大学病院 医学部助教
  • 2007年04月 - 2009年03月  近畿大学病院 臨床研修医

学歴

  • 2009年04月 - 2013年03月   近畿大学大学院医学研究科
  • 2001年04月 - 2007年03月   近畿大学医学部   Faculty of Medicine   Department of Medicine
  • 1998年04月 - 2001年03月   近畿大学附属和歌山高等学校
  • 1995年04月 - 1998年03月   近畿大学附属和歌山中学校

委員歴

  • - 現在   膵癌超音波診断基準検討小委員会委員
  • - 現在   JCOG(日本臨床腫瘍研究グループ)肝胆膵領域 施設コーディネーター
  • - 現在   日本消化器病学会 近畿支部評議員
  • - 現在   日本消化器内視鏡学会 近畿支部評議員
  • - 現在   日本消化器内視鏡学会 学術評議員
  • - 現在   JCOG(日本臨床腫瘍研究グループ)肝胆膵グループ 付随研究WGメンバー
  • - 現在   改訂ERCP後膵炎ガイドライン作成協力委員
  • - 現在   近畿大学医学部 がんセンター運営委員
  • - 現在   日本消化器病学会   学会評議員
  • - 現在   一般社団法人日本消化器内視鏡学会   和文誌編集委員会 査読委員
  • - 現在   近畿大学医学部 ゲノム委員
  • - 現在   公益社団法人日本超音波医学会   査読委員および論文賞審査委員
  • 膵癌診療ガイドライン2016作成協力委員
  • 自己免疫性膵炎臨床診断基準2011改訂作成委員
  • Member of AFSUMB guideline committee for CEUS
  • 日本膵臓学会 嚢胞性膵腫瘍委員会 協力委員
  • Member of AFSUMB guideline committee for contrast-enhanced harmonic EUS
  • 膵癌診療ガイドライン2019作成委員
  • JON-HBP(一般社団法人 日本肝胆膵オンコロジーネットワーク) 施設コーディネーター
  • 膵癌診療ガイドライン2022作成委員

■研究活動情報

受賞

  • 2022年04月 独立行政法人日本学術振興会 令和4年度基盤研究(C) (一般)
     
    受賞者: 鎌田研
  • 2021年12月 日本膵臓病研究財団 令和3年度膵臓病研究奨励賞
     
    受賞者: 鎌田研
  • 2020年04月 独立行政法人日本学術振興会 令和2年度若手研究助成
     
    受賞者: 鎌田 研
  • 2019年11月 第27回若手膵臓研究会 優秀演題賞
     
    受賞者: 鎌田 研
  • 2019年05月 Digestive Endoscopy Best Reviewers Award 2018
     
    受賞者: 鎌田 研
  • 2018年11月 第26回日本消化器関連学会週間 若手奨励賞
     
    受賞者: 鎌田 研
  • 2018年11月 日本消化器内視鏡学会 学会賞
     
    受賞者: 鎌田 研
  • 2018年03月 Digestive Endoscopy Best Reviewers Award 2017
     
    受賞者: 鎌田 研
  • 2018年01月 JCOG肝胆膵グループ2017年度年間最多登録者賞
     
    受賞者: 鎌田 研
  • 2018年 日本膵臓病研究財団 平成30年度膵臓病研究奨励賞
     
    受賞者: 鎌田 研
  • 2018年 独立行政法人日本学術振興会 平成30年度若手研究助成
     
    受賞者: 鎌田 研
  • 2017年 臨床薬理研究振興財団 平成29年度研究奨励金助成
     
    受賞者: 鎌田 研
  • 2014年03月 近畿大学校友会 表彰
     
    受賞者: 鎌田 研
  • 2012年10月 International Symposium on Pancreas Cancer 2012 Young Investigator Award Silver Medal
     
    受賞者: 鎌田 研
  • 2010年03月 The 9th Japan-Korea Joint Symposium on Gastrointestinal Endoscopy DISTINGUISHED PRESENTATION AWARD
     
    受賞者: 鎌田 研
  • 2009年 APDW2009 Young Investigator Award
     
    受賞者: 鎌田 研

論文

  • Naoya Omaru; Yasuo Otsuka; Akane Hara; Masayuki Kurimoto; Natsuki Okai; Yasuhiro Masuta; Sho Masaki; Ken Kamata; Kosuke Minaga; Hajime Honjo; Yasuyuki Arai; Kohei Yamashita; Masatoshi Kudo; Tomohiro Watanabe
    Cytokine 183 156748 - 156748 2024年11月
  • Takao Ohtsuka; Hiroyuki Maguchi; Shoji Tokunaga; Susumu Hijioka; Yukiko Takayama; Shinsuke Koshita; Keiji Hanada; Kentaro Sudo; Hiroyuki Uehara; Satoshi Tanno; Minoru Tada; Wataru Kimura; Masafumi Nakamura; Toshifumi Kin; Ken Kamata; Atsushi Masamune; Takuji Iwashita; Kazuya Akahoshi; Toshiharu Ueki; Keiya Okamura; Hironari Kato; Teru Kumagi; Ken Kawabe; Koji Yoshida; Tsuyoshi Mukai; Junichi Sakagami; Seiko Hirono; Makoto Abue; Tomoki Nakafusa; Makiko Morita; Toru Shimosegawa; Masao Tanaka
    Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.] 2024年08月 
    BACKGROUND: The natural history of branch-duct intraductal papillary mucinous cystic neoplasms (BD-IPMNs) in the pancreas remains unclear. This study aimed to answer this clinical question by focusing on the development of concomitant pancreatic ductal adenocarcinomas (cPDAC). METHODS: The Japan Pancreas Society conducted a prospective multicenter surveillance study of BD-IPMN every six months for five years. The primary endpoints were progression of BD-IPMN, progression to high-grade dysplasia/invasive carcinoma (HGD/IC), and cPDAC. Factors predicting the progression of BD-IPMN to HGD/IC and development of cPDAC were also assessed as secondary endpoints. RESULTS: Among the 2104 non-operated patients, 348 (16.5 %) showed progression of primary BD-IPMN. Cumulative incidences of BD-IPMN with HGD/IC and cPDAC during the 5.17-year surveillance period were 1.90 % and 2.11 %, respectively, and standard incidence ratios of BD-IPMN with HGD/IC and cPDAC were 5.28 and 5.73, respectively. Of 38 cPDACs diagnosed during surveillance, 25 (65.8 %) were resectable. The significant predictive characteristics of BD-IPMN for progression to HGD/IC were larger cyst size (p = 0.03), larger main pancreatic duct size (p < 0.01), and mural nodules (p = 0.02). Significant predictive characteristics for the development of cPDAC were male sex (p = 0.03) and older age (p = 0.02), while the size of IPMN was not significant. CONCLUSION: Careful attention should be given to "dual carcinogenesis" during BD-IPMN surveillance, indicating the progression of BD-IPMN to HGD/IC and development of cPDAC distinct from BD-IPMN, although the establishment of risk factors that predict cPDAC development remains a challenge (UMIN000007349).
  • Sho Masaki; Hajime Honjo; Masayuki Kurimoto; Natsuki Okai; Yasuo Otsuka; Yasuhiro Masuta; Ken Kamata; Kosuke Minaga; Masatoshi Kudo; Tomohiro Watanabe
    Clinical Journal of Gastroenterology 2024年07月
  • Tomohiro Yamazaki; Ken Kamata; Tomoko Hyodo; Sung-Woon Im; Hidekazu Tanaka; Akihiro Yoshida; Tomohiro Fukunaga; Shunsuke Omoto; Kosuke Minaga; Mamoru Takenaka; Masatoshi Kudo
    Digestive Diseases and Sciences 2024年06月
  • 三長 孝輔; 原 茜; 大塚 康生; 大本 俊介; 鎌田 研; 竹中 完; 工藤 正俊; 筑後 孝章
    消化器内視鏡 36 5 726 - 731 (株)東京医学社 2024年05月 
    <文献概要>はじめに 膵癌は最も予後不良な固形癌であり,進行した状態で診断されることが多く,過半数の患者が診断後1年以内に死亡する。近年,日本でも罹患数が増加しており,死亡数は増加の一途をたどっている。膵癌は腫瘍径が2cm以下のTS1膵癌で発見されてもその予後はよいとはいいがたく,予後向上には長期予後が見込める上皮内癌(5年生存率86%)や腫瘍径10mm以下の微小浸潤癌(5年生存率80%)の状態でいかに的確に診断できるかが最重要課題といえる。しかしながら,腫瘍径が1cm以下の早期の膵癌症例では症状の出現に乏しいため発見は困難であり,早期診断のためには,どのような対象にどのような画像検査を含む精査を行うのかを考える必要がある。膵癌の画像診断では,腹部US,造影CT,腹部MRI,EUSなどが用いられる。これらの診断モダリティのなかでもEUSは管腔内走査をすることにより,超音波端子を膵臓に近接し固定することができるため,他のモダリティと比較し空間分解能が非常に高く,膵癌の早期発見において欠かすことのできない画像診断検査である。本稿では,膵癌の早期診断においてEUSが果たしている役割,早期診断の精度や限界について概説する。
  • 竹中 完; 高島 耕太; 田中 秀和; 福永 朋洋; 吉田 晃浩; 山崎 友祐; 大本 俊介; 三長 孝輔; 鎌田 研; 工藤 正俊
    胆と膵 45 4 385 - 390 医学図書出版(株) 2024年04月 
    この度IPMN国際ガイドラインがInternational evidence-based Kyoto guidelines for the management of IPMN of the pancreasとして改訂された。今回のもっとも大きな改訂は,非切除IPMNのサーベイランスプロトコルの簡略化と,5年間安定した経過をとっている分枝型IPMN(BD-IPMN)に対するサーベイランスを中止する可能性が提供されたことであるが,worrisome features(WF)に新たに過去1年以内の糖尿病の新規発症あるいは急性増悪が追加され臨床症状に重きを置いた改訂になっている。本稿では,IPMNの悪性予測因子の中から,「閉塞性黄疸」「膵炎」「糖尿病」といった"臨床症状"因子について概説する。(著者抄録)
  • Ken Kamata; Masatoshi Kudo; Tomohiro Watanabe
    Pancreatology 2024年03月
  • Shogo Kobayashi; Kohei Nakachi; Masafumi Ikeda; Masaru Konishi; Gakuto Ogawa; Teiichi Sugiura; Hiroaki Yanagimoto; Soichiro Morinaga; Hiroshi Wada; Kazuaki Shimada; Yu Takahashi; Toshio Nakagohri; Ken Kamata; Yasuhiro Shimizu; Tetsuo Ajiki; Satoshi Hirano; Naoto Gotohda; Makoto Ueno; Takuji Okusaka; Junji Furuse
    European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology 50 2 107324 - 107324 2024年02月 
    INTRODUCTION: Major hepatectomy (MH) may produce the impaired liver function and affect the feasibility of adjuvant chemotherapy in terms of early period after the surgery, but there have not been detailed investigations. JCOG1202 (UMIN000011688) is a randomized phase III trial demonstrating the superiority of adjuvant S-1 chemotherapy for biliary tract cancer (BTC). The aim of this study is to examine the influence of MH for BTC on adjuvant S-1. MATERIALS AND METHODS: Of the total 424 patients, 207 received S-1 (S-1 arm) while the remaining 217 were not. We compared MH with non-major hepatectomy (NMH) for BTC. RESULTS: In the S-1 arm, 42 had undergone MH, and 165 had undergone NMH. MH had similar pretreatment features to NMH, including the proportion of biliary reconstruction, to NMH, except for a lower platelet count (17.7 vs. 23.4 × 104/mm3, p < 0.0001) and lower serum albumin level (3.5 vs. 3.8 g/dL, p < 0.0001). The treatment completion proportion tended to be lower for MH than for NMH (59.5 % vs. 75.8 %; risk ratio, 0.786 [95 % confidence interval, 0.603-1.023], p = 0.0733), and the median dose intensity was lower as well (88.7 % vs. 99.6 %, p = 0.0358). The major reasons for discontinuation were biliary tract infections and gastrointestinal disorders after MH. The frequency of grade 3-4 biliary tract infection was 19.0 % in MH vs. 4.2 % in NMH. CONCLUSION: The treatment completion proportion and dose intensity were lower in MH than in NMH. Caution should be exercised against biliary tract infections and gastrointestinal disorders during adjuvant S-1 after MH for BTC.
  • Tetsuya Takikawa; Kazuhiro Kikuta; Takanori Sano; Tsukasa Ikeura; Nao Fujimori; Takeji Umemura; Itaru Naitoh; Hiroshi Nakase; Hiroyuki Isayama; Atsushi Kanno; Ken Kamata; Yuzo Kodama; Dai Inoue; Akio Ido; Toshiharu Ueki; Hiroshi Seno; Hiroaki Yasuda; Eisuke Iwasaki; Takayoshi Nishino; Kensuke Kubota; Toshihiko Arizumi; Atsushi Tanaka; Kazushige Uchida; Ryotaro Matsumoto; Shin Hamada; Seiji Nakamura; Kazuichi Okazaki; Yoshifumi Takeyama; Atsushi Masamune
    Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.] 2024年01月 
    BACKGROUND/OBJECTIVES: The association between autoimmune pancreatitis (AIP) and pancreatic cancer (PC) remains controversial. This study aimed to clarify the long-term prognosis and risk of malignancies in AIP patients in Japan. METHODS: We conducted a multicenter retrospective cohort study on 1364 patients with type 1 AIP from 20 institutions in Japan. We calculated the standardized incidence ratio (SIR) for malignancies compared to that in the general population. We analyzed factors associated with overall survival, pancreatic exocrine insufficiency, diabetes mellitus, and osteoporosis. RESULTS: The SIR for all malignancies was increased (1.21 [95 % confidence interval: 1.05-1.41]) in patients with AIP. Among all malignancies, the SIR was highest for PC (3.22 [1.99-5.13]) and increased within 2 years and after 5 years of AIP diagnosis. Steroid use for ≥6 months and ≥50 months increased the risk of subsequent development of diabetes mellitus and osteoporosis, respectively. Age ≥65 years at AIP diagnosis (hazard ratio [HR] = 3.73) and the development of malignancies (HR = 2.63), including PC (HR = 7.81), were associated with a poor prognosis, whereas maintenance steroid therapy was associated with a better prognosis (HR = 0.35) in the multivariate analysis. Maintenance steroid therapy was associated with a better prognosis even after propensity score matching for age and sex. CONCLUSIONS: Patients with AIP are at increased risk of developing malignancy, especially PC. PC is a critical prognostic factor for patients with AIP. Although maintenance steroid therapy negatively impacts diabetes mellitus and osteoporosis, it is associated with decreased cancer risk and improved overall survival.
  • 竹中 完; 大本 俊介; 三長 孝輔; 鎌田 研; 工藤 正俊
    消化器内視鏡 36 1 106 - 113 (株)東京医学社 2024年01月 
    <文献概要>はじめに 内視鏡的逆行性胆管膵管造影(endoscopic retrograde cholangiopancreatography:ERCP)において胆管挿管は基本中の基本手技であるが,最も習得が難しく,胆管挿管が不成功となれば想定していた結石治療やドレナージ治療などは施行不可になる。胆管挿管の基本はまずスコープを挿入し,乳頭とカテーテルが見つめあう乳頭正面視を作り,対峙した乳頭の形態をよく観察し,とりうるスコープ形態を確認し,最も挿管成功率が高いと思われる胆管挿管ストラテジーを構築することであるが,それを遂行するためには十二指腸乳頭部分類を十分に理解していることが求められる。本稿では十二指腸乳頭部の解剖学的特徴,本邦で広く用いられる大井分類,猪股分類について解説を行い,近年報告されている新しい乳頭部分類についても概説する。
  • 妊娠37週で高中性脂肪血症による重症急性膵炎を発症し、集学的に治療し得た一例
    福嶋 龍哉; 吉田 晃浩; 竹中 完; 田中 秀和; 福永 朋洋; 山崎 友裕; 大本 俊介; 三長 孝輔; 鎌田 研; 松本 逸平; 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 120回 93 - 93 日本消化器病学会-近畿支部 2024年01月
  • Rintaro Nagayama; Toshiharu Ueki; Yasuhiro Shimizu; Susumu Hijioka; Masafumi Nakamura; Masayuki Kitano; Kazuo Hara; Atsushi Masamune; Toshifumi Kin; Keiji Hanada; Shinsuke Koshita; Reiko Yamada; Mamoru Takenaka; Takao Itoi; Akio Yanagisawa; Takao Otuka; Seiko Hirono; Atsushi Kanno; Noboru Ideno; Takamichi Kuwahara; Akinori Shimizu; Ken Kamata; Yasutsugu Asai; Yoshifumi Takeyama
    Journal of hepato-biliary-pancreatic sciences 2023年12月 
    BACKGROUND: We compared the results of preoperative pancreatic juice cytology (PJC) and final pathological diagnosis after resection in patients who underwent resection of intraductal papillary mucinous neoplasm (IPMN) of the pancreas to determine whether preoperative PJC can help determine therapeutic strategies. METHODS: Of 1130 patients who underwent surgical resection IPMN at 11 Japanese tertiary institutions, the study included 852 patients who underwent preoperative PJC guided by endoscopic retrograde cholangiopancreatography (ERCP). RESULTS: The accuracy of preoperative PJC for differentiation between cancerous and noncancerous lesions were 55% for IPMN overall; 59% for the branch duct type; 49% for the main pancreatic duct type; 53% for the mixed type, respectively. On classifying IPMN according to the diameters of the mural nodule (MN) and main pancreatic duct (MPD), the corresponding values for diagnostic performance were 40% for type 1 (MN ≥5 mm and MPD ≥ 10 mm); 46% for type 2 (MN ≥5 mm and MPD < 10 mm); 61% for type 3 (MN < 5 mm and MPD ≥ 10 mm); 72% for type 4 (MN < 5 mm and MPD < 10 mm), respectively. CONCLUSIONS: PJC in IPMN is not a recommended examination because of its low overall sensitivity and no significant difference in diagnostic performance by type, location, or subclassification. Although the sensitivity is low, the positive predictive value is high, so we suggest that pancreatic juice cytology be performed only in cases where the patient is not sure about surgery.
  • Yasuo Otsuka; Akane Hara; Kosuke Minaga; Ikue Sekai; Masayuki Kurimoto; Yasuhiro Masuta; Ryutaro Takada; Tomoe Yoshikawa; Ken Kamata; Masatoshi Kudo; Tomohiro Watanabe
    Clinical and Experimental Immunology 2023年10月 
    Abstract Translocation of gut bacteria into the pancreas promotes the development of severe acute pancreatitis (SAP). Recent clinical studies have also highlighted the association between fungal infections and SAP. The sensing of gut bacteria by pattern recognition receptors promotes the development of SAP via the production of proinflammatory cytokines; however, the mechanism by which gut fungi mediate SAP remains largely unknown. Leucine-rich repeat kinase 2 (LRRK2) is a multifunctional protein that regulates innate immunity against fungi via Dectin-1 activation. Here, we investigated the role of LRRK2 in SAP development and observed that administration of LRRK2 inhibitors attenuated SAP development. The degree of SAP was greater in Lrrk2 transgenic (Tg) mice than in control mice and was accompanied by an increased production of nuclear factor-kappaB-dependent proinflammatory cytokines. Ablation of the fungal mycobiome by anti-fungal drugs inhibited SAP development in Lrrk2 Tg mice, whereas the degree of SAP was comparable in Lrrk2 Tg mice with or without gut sterilization by a broad range of antibiotics. Pancreatic mononuclear cells from Lrrk2 Tg mice produced large amounts of IL-6 and TNF-α upon stimulation with Dectin-1 ligands, and inhibition of the Dectin-1 pathway by a spleen tyrosine kinase inhibitor protected Lrrk2 Tg mice from SAP. These data indicate that LRRK2 activation is involved in the development of SAP through proinflammatory cytokine responses upon fungal exposure.
  • 竹中 完; 大塚 康生; 益田 康弘; 高島 耕太; 田中 秀和; 福永 朋洋; 吉田 晃浩; 山崎 友祐; 大本 俊介; 三長 孝輔; 鎌田 研; 工藤 正俊
    胆と膵 44 臨増特大 1337 - 1341 医学図書出版(株) 2023年10月 
    遠位悪性胆管狭窄に対する経乳頭的胆道ドレナージにおいて自己拡張型メタリックステント(self-expandable metallic stent:SEMS)の中でもポリウレタンやPTFEなどの膜で被覆されたcovered SEMS(CSEMS)は腫瘍増殖を防ぐことができるとされる一方でさまざまな要因によりCSEMSは逸脱・迷入を起こし,閉塞性黄疸,閉塞性胆管炎の再燃を引き起こす。CSEMS迷入に対する最大のトラブルシューティングは「迷入させないこと」であり,事前議論,胆管造影,適切なデバイス選択がまず行われなくてはならない。迷入に対しては「乳頭拡張をしておく」,「カバーの腐食・ingrowthの可能性を確認する」,「迷入したCSEMSのカバーが外巻きか内巻きかを確認しておく」,「迷入したCSEMSと胆管狭窄部との位置関係を確認する」といったtipsを理解し,引き抜き法か翻転抜去法を選択する対応が求められる。ただしまずはドレナージ不良に対する治療を最優先すべきであり,無理な迷入SEMSの抜去は決して行ってはならない。(著者抄録)
  • 【Stenting Bible~Renewal~ステントと挿入・留置手技にこだわる!!】ステント治療のトラブルシューティングおよび偶発症マネージメント SEMS迷入に対するトラブルシューティング
    竹中 完; 大塚 康生; 益田 康弘; 高島 耕太; 田中 秀和; 福永 朋洋; 吉田 晃浩; 山崎 友祐; 大本 俊介; 三長 孝輔; 鎌田 研; 工藤 正俊
    胆と膵 44 臨増特大 1337 - 1341 医学図書出版(株) 2023年10月 
    遠位悪性胆管狭窄に対する経乳頭的胆道ドレナージにおいて自己拡張型メタリックステント(self-expandable metallic stent:SEMS)の中でもポリウレタンやPTFEなどの膜で被覆されたcovered SEMS(CSEMS)は腫瘍増殖を防ぐことができるとされる一方でさまざまな要因によりCSEMSは逸脱・迷入を起こし,閉塞性黄疸,閉塞性胆管炎の再燃を引き起こす。CSEMS迷入に対する最大のトラブルシューティングは「迷入させないこと」であり,事前議論,胆管造影,適切なデバイス選択がまず行われなくてはならない。迷入に対しては「乳頭拡張をしておく」,「カバーの腐食・ingrowthの可能性を確認する」,「迷入したCSEMSのカバーが外巻きか内巻きかを確認しておく」,「迷入したCSEMSと胆管狭窄部との位置関係を確認する」といったtipsを理解し,引き抜き法か翻転抜去法を選択する対応が求められる。ただしまずはドレナージ不良に対する治療を最優先すべきであり,無理な迷入SEMSの抜去は決して行ってはならない。(著者抄録)
  • Ken Kamata; Hajime Imai; Hisakazu Matsumoto; Yukitaka Yamashita; Takao Kato; Katsuhisa Nishi; Shunsuke Omoto; Kosuke Minaga; Kentaro Yamao; Tomoko Hyodo; Sung‐Woon Im; Akane Hara; Tomoe Yoshikawa; Rei Ishikawa; Ayana Okamoto; Tomohiro Yamazaki; Atsushi Nakai; Kazuomi Ueshima; Yasutaka Chiba; Mamoru Takenaka; Tomohiro Watanabe; Masayuki Kitano; Masatoshi Kudo
    JGH Open 2023年09月 
    Abstract Background and Aim A multicenter, open‐label randomized Phase II trial was conducted to determine whether low‐dose gemcitabine plus nab‐paclitaxel (GnP) could improve tolerability and show equivalent efficacy to the standard‐dose GnP for elderly patients with metastatic pancreatic cancer. Methods Consecutive patients aged ≥65 years with metastatic pancreatic cancer who presented at one of four Japanese referral centers between November 2016 and January 2021 were enrolled. The 60 patients were randomly assigned to low‐ or standard‐dose groups with a 1:1 ratio. Patients in the low‐dose GnP group received gemcitabine at a dose of 250 mg/m2 and nab‐paclitaxel at 125 mg/m2. Results Low‐dose GnP significantly decreased the rate of cases requiring dose reduction (16.7% vs 63.3%). The response rate (36.7% vs 33.3%) and progression‐free survival (7.3 vs 8 months) were comparable between the low‐ and standard‐dose groups as determined by independent review. The difference in the median overall survival between the two groups was not significant (7.9 vs 12 months). The proportion of patients with hematologic and non‐hematologic treatment‐related adverse events was comparable between the two groups. Conclusion Low‐dose GnP had an equivalent efficacy to conventional therapy; however, it did not reduce adverse events.
  • 山崎 友裕; 鎌田 研; 大本 俊介; 三長 孝輔; 竹中 完; 樫田 博史; 工藤 正俊
    消化器内視鏡 35 9 1310 - 1316 (株)東京医学社 2023年09月
  • 心窩部痛を契機に診断・治療し得た傍神経節腫の一例
    中 貴史; 吉田 晃浩; 竹中 完; 田中 秀和; 福永 朋洋; 山崎 友裕; 大本 俊介; 三長 孝輔; 鎌田 研; 松本 逸平; 筑後 孝章; 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 119回 113 - 113 日本消化器病学会-近畿支部 2023年09月
  • 【早わかり消化器内視鏡関連ガイドライン2023】胆膵 IPMN国際診療ガイドライン
    山崎 友裕; 鎌田 研; 大本 俊介; 三長 孝輔; 竹中 完; 樫田 博史; 工藤 正俊
    消化器内視鏡 35 9 1310 - 1316 (株)東京医学社 2023年09月
  • Ken Kamata; Mamoru Takenaka; Naoshi Nishida; Akane Hara; Yasuo Otsuka; Hidekazu Tanaka; Shunsuke Omoto; Kosuke Minaga; Kentaro Yamao; Yasutaka Chiba; Kazuko Sakai; Kazuto Nishio; Tomohiro Watanabe; Masatoshi Kudo
    International journal of clinical oncology 28 11 1511 - 1519 2023年08月 
    BACKGROUND: This prospective cohort study evaluated the feasibility of using endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) samples for comprehensive mutational analysis of cancer-related genes using microtissues. METHODS: Fifty patients with suspected pancreatic cancer presenting consecutively at the Kindai University Hospital between January 2018 and January 2019 were enrolled. Cancerous tissues from EUS-FNB were obtained from each tumor and subjected to histological examination and mutational analysis. The primary endpoint was the collection rate of EUS-FNB specimens suitable for comprehensive cancer panels using deep sequencing. Clinical history and genetic variations between the disease control and progressive disease groups of patients on chemotherapy were evaluated as secondary endpoints. RESULTS: The collection rate of EUS-FNB specimens suitable for comprehensive cancer panels using deep sequencing was 93.6%. The cancer panel was sequenced for 25 patients with pancreatic cancer treated initially with systemic chemotherapy. Mutation in p53 and Smad4 were positively and negatively associated, respectively, with disease control at the initial evaluation. The median time to progression in 15 patients with p53 and without Smad4 mutations was 182.0 days; whereas, it was 92.5 days in other 10 patients; this difference was significant (p = 0.020). CONCLUSIONS: Tissue samples from EUS-FNB were suitable for mutational analysis. Pancreatic cancers with p53 and without Smad4 mutations responded better to chemotherapy and had a better prognosis than those others.
  • 急性膵炎の致命率改善への集学的治療 地域連携モデル構築による重症急性膵炎死亡率低減への取り組み
    竹中 完; 大本 俊介; 高島 耕太; 田中 秀和; 福永 朋洋; 吉田 晃浩; 山崎 友祐; 三長 孝輔; 鎌田 研; 亀井 敬子; 松本 逸平; 竹山 宜典; 工藤 正俊
    膵臓 38 3 A169 - A169 (一社)日本膵臓学会 2023年07月
  • 地域連携システムを用いた南大阪地区早期膵癌発見・診断プロジェクト
    吉田 晃浩; 竹中 完; 高島 耕太; 田中 秀和; 福永 朋洋; 山崎 友裕; 大本 俊介; 三長 孝輔; 鎌田 研; 亀井 敬子; 松本 逸平; 竹山 宜典; 工藤 正俊
    膵臓 38 3 A370 - A370 (一社)日本膵臓学会 2023年07月
  • 急性膵炎の致命率改善への集学的治療 地域連携モデル構築による重症急性膵炎死亡率低減への取り組み
    竹中 完; 大本 俊介; 高島 耕太; 田中 秀和; 福永 朋洋; 吉田 晃浩; 山崎 友祐; 三長 孝輔; 鎌田 研; 亀井 敬子; 松本 逸平; 竹山 宜典; 工藤 正俊
    膵臓 38 3 A169 - A169 (一社)日本膵臓学会 2023年07月
  • 地域連携システムを用いた南大阪地区早期膵癌発見・診断プロジェクト
    吉田 晃浩; 竹中 完; 高島 耕太; 田中 秀和; 福永 朋洋; 山崎 友裕; 大本 俊介; 三長 孝輔; 鎌田 研; 亀井 敬子; 松本 逸平; 竹山 宜典; 工藤 正俊
    膵臓 38 3 A370 - A370 (一社)日本膵臓学会 2023年07月
  • Toshifumi Kin; Yasuhiro Shimizu; Susumu Hijioka; Kazuo Hara; Akio Katanuma; Masafumi Nakamura; Reiko Yamada; Takao Itoi; Toshiharu Ueki; Atsushi Masamune; Seiko Hirono; Shinsuke Koshita; Keiji Hanada; Ken Kamata; Akio Yanagisawa; Yoshifumi Takeyama
    Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.] 2023年05月 
    BACKGROUND/OBJECTIVES: The detection of malignancy is a major concern in the management of intraductal papillary mucinous neoplasm (IPMN). The height of the mural nodule (MN), estimated using endoscopic ultrasound (EUS) and computed tomography (CT), has been considered crucial for predicting malignant IPMN. Currently, whether surveillance using CT or EUS alone is sufficient for detecting MNs remains unclear. This study aimed to compare the ability of CT and EUS to detect MNs in IPMN. METHODS: This multicenter, retrospective observational study was conducted in 11 Japanese tertiary institutions. Patients who underwent surgical resection of IPMN with MN after CT and EUS examinations were eligible to participate. The MN detection rates between CT and EUS were examined. RESULTS: Two-hundred-and-forty patients who underwent preoperative EUS and CT had pathologically confirmed MNs. The MN detection rates of EUS and CT were 83% and 53%, respectively (p < 0.001). Additionally, the MN detection rate of EUS was significantly higher than that of CT regardless of morphological type (76% vs. 47% in branch-duct-type IPMN; 90% vs. 54% in mixed IPMN; 98% vs. 56% in main-duct-type IPMN; p < 0.001). Further, pathologically confirmed MNs ≥5 mm were more frequently observed on EUS than on CT (95% vs. 76%, p < 0.001). CONCLUSIONS: EUS was superior to CT for the detection of MN in IPMN. EUS surveillance is essential for the detection of MNs.
  • Ken Kamata; Akane Hara; Kosuke Minaga; Tomoe Yoshikawa; Masayuki Kurimoto; Ikue Sekai; Natsuki Okai; Naoya Omaru; Yasuhiro Masuta; Yasuo Otsuka; Ryutaro Takada; Shiki Takamura; Masatoshi Kudo; Warren Strober; Tomohiro Watanabe
    Clinical and Experimental Immunology 2023年05月 
    Abstract The aryl hydrocarbon receptor (AhR) is a ligand-activated transcription factor expressed in hematopoietic and non-hematopoietic cells. Activation of the AhR by xenobiotics, microbial metabolites, and natural substances induces immunoregulatory responses. Autoimmune pancreatitis (AIP) is a chronic fibroinflammatory disorder of the pancreas driven by autoimmunity. Although AhR activation generally suppresses pathogenic autoimmune responses, the roles played by the AhR in AIP have been poorly defined. In this study, we examined how AhR activation affected the development of experimental AIP caused by the activation of plasmacytoid dendritic cells producing IFN-α and IL-33. Experimental AIP was induced in MRL/MpJ mice by repeated injections of polyinosinic-polycytidylic acid. Activation of the AhR by indole-3-pyruvic acid and indigo naturalis, which were supplemented in the diet, inhibited the development of experimental AIP, and these effects were independent of the activation of plasmacytoid dendritic cells producing IFN-α and IL-33. Interaction of indole-3-pyruvic acid and indigo naturalis with AhRs robustly augmented the production of IL-22 by pancreatic islet α cells. The blockade of IL-22 signaling pathways completely canceled the beneficial effects of AhR ligands on experimental AIP. Serum IL-22 concentrations were elevated in patients with type 1 AIP after the induction of remission with prednisolone. These data suggest that AhR activation suppresses chronic fibroinflammatory reactions that characterize AIP via IL-22 produced by pancreatic islet α cells.
  • 消化管がんに対する超音波診断(EUS含む) 当院におけるスキルス胃癌および下部消化管粘膜下腫瘍に対するEUS精査症例の検討
    田中 秀和; 鎌田 研; 高田 隆太郎; 三長 孝輔; 竹中 完; 松井 繁長; 樫田 博史; 工藤 正俊
    超音波医学 50 Suppl. S211 - S211 (公社)日本超音波医学会 2023年04月
  • 診断の鍵となる所見 膵・胆管合流異常の診断におけるEUS・造影ハーモニックEUSの意義の検討
    山崎 友裕; 鎌田 研; 高島 耕太; 田中 秀和; 福永 朋洋; 吉田 晃浩; 大本 俊介; 三長 孝輔; 竹中 完; 工藤 正俊
    超音波医学 50 Suppl. S200 - S200 (公社)日本超音波医学会 2023年04月
  • 膵腫瘍(嚢胞性疾患も)の超音波およびEUS診断 膵腫瘍の造影ハーモニックEUS診断
    鎌田 研; 大塚 康生; 田中 秀和; 中井 敦; 山崎 友裕; 大本 俊介; 三長 孝輔; 竹中 完; 北野 雅之; 工藤 正俊
    超音波医学 50 Suppl. S230 - S230 (公社)日本超音波医学会 2023年04月
  • 胆管病変に対するDetective flow imaging(DFI)の有用性について
    大本 俊介; 竹中 完; 吉田 晃浩; 福永 朋洋; 田中 秀和; 高島 耕太; 山崎 友裕; 三長 孝輔; 鎌田 研; 工藤 正俊
    超音波医学 50 Suppl. S586 - S586 (公社)日本超音波医学会 2023年04月
  • 北野 雅之; 花田 敬士; 松林 宏行; 菅野 敦; 鎌田 研; 祖父尼 淳; 芹川 正浩; 高山 敬子; 井上 大; 川井 学
    膵臓 38 2 101 - 106 (一社)日本膵臓学会 2023年04月 
    膵癌診療ガイドラインが2022年に改訂された.診断法では,2019年版と比較して,クリニカルクエスチョン(CQ)に挙げられていた3項目を総論で紹介し,プレシジョンメディスンを含む10項目のCQ,1項目のコラムが追加された.総論で述べられていたリスクファクターから糖尿病,慢性膵炎,膵管内乳頭粘液性腫瘍,遺伝性リスクに関する新規の4項目のCQを作成した.また,健診,検診,人間ドックの果たす役割に関するコラムを追加した.一方,膵癌の診断において造影CTの有用性や有害事象はすでに一般的に知られているため,総論で述べることとなった.診断アルゴリズムのなかで,腹部超音波はファーストステップとして行うこととし,膵全体の描出に限界があることを明記した.病理診断全体の有用性に関するCQは総論へ移行する一方で,腹部超音波ガイド下穿刺生検および遺伝子異常診断目的の針生検に関する2項目のCQを追加した.(著者抄録)
  • 消化管がんに対する超音波診断(EUS含む) 当院におけるスキルス胃癌および下部消化管粘膜下腫瘍に対するEUS精査症例の検討
    田中 秀和; 鎌田 研; 高田 隆太郎; 三長 孝輔; 竹中 完; 松井 繁長; 樫田 博史; 工藤 正俊
    超音波医学 50 Suppl. S211 - S211 (公社)日本超音波医学会 2023年04月
  • Yasuo Otsuka; Ken Kamata; Masatoshi Kudo
    Diagnostics (Basel, Switzerland) 13 6 2023年03月 
    Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is useful for the diagnosis of pancreatic masses. According to three meta-analyses, the sensitivity, specificity, and accuracy of EUS-FNA are 84-92%, 96-98%, and 86-91%, respectively. However, the occurrence of false-negative and false-positive results indicates that the diagnostic performance of EUS-FNA needs to be improved. Contrast-enhanced harmonic endoscopic ultrasonography (CH-EUS) is used for the characterization of pancreatic masses and can be applied to improve the performance of EUS-FNA. When CH-EUS is used to evaluate intratumor blood flow, an avascular area inside the pancreatic mass that is considered to be fibrosis is often detected. This area can be avoided by performing EUS-FNA under CH-EUS guidance. In this review, we summarize the data on contrast-enhanced harmonic endoscopic ultrasound-guided fine-needle aspiration (CH-EUS-FNA), which suggest that its benefit is still a matter of debate. Of eight studies analyzed, only one showed that CH-EUS improved the sensitivity of EUS-FNA. The future challenge is to determine under what circumstances CH-EUS-FNA is useful.
  • 【マイクロバイオームが切り拓く肝胆膵の新未来】膵疾患 マイクロバイオームと自己免疫性膵炎
    三長 孝輔; 吉川 智恵; 原 茜; 瀬海 郁衣; 栗本 真之; 大塚 康生; 益田 康弘; 鎌田 研; 工藤 正俊; 渡邉 智裕
    肝胆膵 86 3 377 - 385 (株)アークメディア 2023年03月
  • 福永 朋洋; 大本 俊介; 竹中 完; 工藤 正俊; 栗本 真之; 大塚 康生; 田中 秀和; 高島 耕太; 吉田 晃浩; 山崎 友裕; 三長 孝輔; 鎌田 研
    日本消化器病学会雑誌 120 臨増総会 A283 - A283 (一財)日本消化器病学会 2023年03月
  • 三長 孝輔; 原 茜; 瀬海 郁衣; 栗本 真之; 大塚 康生; 益田 康弘; 吉川 智恵; 鎌田 研; 工藤 正俊; 渡邉 智裕
    胆と膵 44 3 235 - 241 医学図書出版(株) 2023年03月 
    膵臓に慢性炎症性変化をきたす疾患は慢性膵炎と自己免疫性膵炎に大別される。これらの慢性炎症性膵疾患の病態生理は十分に解明されておらず,病態生理の理解に基づいた根治療法は開発されていない。近年,膵臓の慢性炎症性疾患である慢性膵炎と自己免疫性膵炎の病態形成における腸内細菌の関与を示唆する報告が相次ぎ,注目を浴びている。われわれは主に自然免疫反応の観点から,これらの慢性炎症性膵疾患の病態生理の解明に取り組む過程で,それぞれの病態形成に炎症性サイトカインであるI型IFN・IL-33が重要な役割を果たしていることを見出した。さらに,これらのサイトカインの産生には腸内細菌が深く関与しており,病的な膵臓・腸管間免疫ネットワーク機構が膵臓の慢性炎症や線維化に関与していることを明らかにした。腸内細菌は,根治療法が存在しない慢性膵炎および自己免疫性膵炎の新たな治療標的として有望である可能性があり,今後の研究が期待される。(著者抄録)
  • Kohei Nakachi; Masafumi Ikeda; Masaru Konishi; Shogo Nomura; Hiroshi Katayama; Tomoko Kataoka; Akiko Todaka; Hiroaki Yanagimoto; Soichiro Morinaga; Shogo Kobayashi; Kazuaki Shimada; Yu Takahashi; Toshio Nakagohri; Kunihito Gotoh; Ken Kamata; Yasuhiro Shimizu; Makoto Ueno; Hiroshi Ishii; Takuji Okusaka; Junji Furuse
    Lancet (London, England) 401 10372 195 - 203 2023年01月 [査読有り]
     
    BACKGROUND: S-1 has shown promising efficacy with a mild toxicity profile in patients with advanced biliary tract cancer. The aim of this study was to evaluate whether adjuvant S-1 improved overall survival compared with observation for resected biliary tract cancer. METHODS: This open-label, multicentre, randomised phase 3 trial was conducted in 38 Japanese hospitals. Patients aged 20-80 years who had histologically confirmed extrahepatic cholangiocarcinoma, gallbladder carcinoma, ampullary carcinoma, or intrahepatic cholangiocarcinoma in a resected specimen and had undergone no local residual tumour resection or microscopic residual tumour resection were randomly assigned (1:1) to undergo observation or to receive S-1 (ie, 40 mg, 50 mg, or 60 mg according to body surface area, orally administered twice daily for 4 weeks, followed by 2 weeks of rest for four cycles). Randomisation was performed by the minimisation method, using institution, primary tumour site, and lymph node metastasis as adjustment factors. The primary endpoint was overall survival and was assessed for all randomly assigned patients on an intention-to-treat basis. Safety was assessed in all eligible patients. For the S-1 group, all patients who began the protocol treatment were eligible for a safety assessment. This trial is registered with the University hospital Medical Information Network Clinical Trials Registry (UMIN000011688). FINDINGS: Between Sept 9, 2013, and June 22, 2018, 440 patients were enrolled (observation group n=222 and S-1 group n=218). The data cutoff date was June 23, 2021. Median duration of follow-up was 45·4 months. In the primary analysis, the 3-year overall survival was 67·6% (95% CI 61·0-73·3%) in the observation group compared with 77·1% (70·9-82·1%) in the S-1 group (adjusted hazard ratio [HR] 0·69, 95% CI 0·51-0·94; one-sided p=0·0080). The 3-year relapse-free survival was 50·9% (95% CI 44·1-57·2%) in the observation group compared with 62·4% (55·6-68·4%) in the S-1 group (HR 0·80, 95% CI 0·61-1·04; two-sided p=0·088). The main grade 3-4 adverse events in the S-1 group were decreased neutrophil count (29 [14%]) and biliary tract infection (15 [7%]). INTERPRETATION: Although long-term clinical benefit would be needed for a definitive conclusion, a significant improvement in survival suggested adjuvant S-1 could be considered a standard of care for resected biliary tract cancer in Asian patients. FUNDING: The National Cancer Center Research and the Ministry of Health, Labour, and Welfare of Japan.
  • Natsuki Okai; Yasuhiro Masuta; Yasuo Otsuka; Akane Hara; Sho Masaki; Ken Kamata; Kosuke Minaga; Hajime Honjo; Masatoshi Kudo; Tomohiro Watanabe
    Journal of Clinical Biochemistry and Nutrition 2023年
  • Yasuo Otsuka; Yasuhiro Masuta; Kosuke Minaga; Natsuki Okai; Akane Hara; Ryutaro Takada; Sho Masaki; Ken Kamata; Hajime Honjo; Kouhei Yamashita; Masatoshi Kudo; Tomohiro Watanabe
    Journal of Clinical Biochemistry and Nutrition 2023年
  • 吉田 晃浩; 鎌田 研; 三長 孝輔; 山雄 健太郎; 竹中 完; 工藤 正俊
    臨床消化器内科 38 2 178 - 182 (株)日本メディカルセンター 2023年01月 
    <文献概要>Stage 0,IA(腫瘍径20mm以下)膵癌の診断において,空間分解能に優れる超音波内視鏡(EUS)は膵癌の直接あるいは間接所見の検出に有用である.また,コンベックス型EUSを用いることで病理診断を目的としたEUS下穿刺吸引法(EUS-FNA)も実施可能である.EUSは膵癌診療において,診断や治療方針決定のためには欠かせない検査法といえる.近年,膵癌診断において,造影ハーモニックEUSの有用性が報告されている.EUSとそれに続くEUS-FNAや造影ハーモニックEUS等を駆使してもStage 0,IA膵癌の診断には苦慮することが多く,内視鏡的逆行性胆管膵管造影をはじめとするその他の画像診断を併用し,総合的な診断を行うことが望ましいと考えられる.
  • Masato Ozaka; Kohei Nakachi; Satoshi Kobayashi; Akihiro Ohba; Hiroshi Imaoka; Takeshi Terashima; Hiroshi Ishii; Junki Mizusawa; Hiroshi Katayama; Tomoko Kataoka; Takuji Okusaka; Masafumi Ikeda; Naoki Sasahira; Haruo Miwa; Eishiro Mizukoshi; Naohiro Okano; Nobumasa Mizuno; Tomohisa Yamamoto; Yoshito Komatsu; Akiko Todaka; Ken Kamata; Masayuki Furukawa; Nao Fujimori; Akio Katanuma; Yukiko Takayama; Hidetaka Tsumura; Haruhiko Fukuda; Makoto Ueno; Junji Furuse
    European journal of cancer (Oxford, England : 1990) 181 135 - 144 2022年12月 
    AIM: We compared the efficacy of modified 5-fluorouracil, leucovorin, irinotecan, and oxaliplatin (mFOLFIRINOX) with that of gemcitabine plus nab-paclitaxel (GnP) for locally advanced pancreatic cancer (LAPC). METHODS: Patients with untreated LAPC were randomly assigned (1:1) to receive mFOLFIRINOX or GnP. One-year overall survival (OS) was the primary endpoint. The major secondary end-points included progression-free survival (PFS), response rate (RR), carbohydrate antigen 19-9 (CA19-9) response, and adverse events. The sample size was 124 patients to select a more effective regimen with a minimum probability of 0.85 and to examine the null hypothesis of the 1-year OS <53%. RESULTS: Of the 126 patients enrolled from 29 institutions, 125 were deemed eligible. The 1-year OS was 77.4% (95% CI, 64.9-86.0) and 82.5% (95% CI, 70.7-89.9) in the mFOLFIRINOX and GnP arms, respectively. The median PFS was 11.2 (95% CI, 9.9-15.9) and 9.4 months (95% CI, 7.4-12.8) in the mFOLFIRINOX and GnP arms, respectively. The RR and CA19-9 response rate were 30.9% (95% CI, 19.1-44.8) and 57.1% (95% CI, 41.0-72.3) and 42.1% (95% CI 29.1-55.9) and 85.0% (95% CI, 70.2-94.3) in the mFOLFIRINOX and GnP arms, respectively. Grade 3-4 diarrhoea and anorexia were predominant in the mFOLFIRINOX arm. CONCLUSION: GnP was considered the candidate for a subsequent phase III trial because of its better RR, CA19-9 response, and mild gastrointestinal toxicities. Both regimens displayed higher efficacy in the 1-year survival than in the historical data of gemcitabine monotherapy.
  • Ikue Sekai; Kosuke Minaga; Akane Hara; Yasuo Otsuka; Masayuki Kurimoto; Naoya Omaru; Natsuki Okai; Yasuhiro Masuta; Ryutaro Takada; Tomoe Yoshikawa; Ken Kamata; Masatoshi Kudo; Tomohiro Watanabe
    Biochemical and Biophysical Research Communications 2022年11月
  • Naoya Omaru; Tomohiro Watanabe; Ken Kamata; Kosuke Minaga; Masatoshi Kudo
    Frontiers in Immunology 13 2022年10月 
    Hepatocytes and liver-resident antigen-presenting cells are exposed to microbe-associated molecular patterns (MAMPs) and microbial metabolites, which reach the liver from the gut via the portal vein. MAMPs induce innate immune responses via the activation of pattern recognition receptors (PRRs), such as toll-like receptors (TLRs), nucleotide-binding oligomerization domain 1 (NOD1), and NOD2. Such proinflammatory cytokine responses mediated by PRRs likely contribute to the development of chronic liver diseases and hepatocellular carcinoma (HCC), as shown by the fact that activation of TLRs and subsequent production of IL-6 and TNF-α is required for the generation of chronic fibroinflammatory responses and hepatocarcinogenesis. Similar to TLRs, NOD1 and NOD2 recognize MAMPs derived from the intestinal bacteria. The association between the activation of NOD1/NOD2 and chronic liver diseases is poorly understood. Given that NOD1 and NOD2 can regulate proinflammatory cytokine responses mediated by TLRs both positively and negatively, it is likely that sensing of MAMPs by NOD1 and NOD2 affects the development of chronic liver diseases, including HCC. Indeed, recent studies have highlighted the importance of NOD1 and NOD2 activation in chronic liver disorders. Here, we summarize the roles of NOD1 and NOD2 in hepatocarcinogenesis and liver injury.
  • 胆膵内視鏡施行時のプロポフォールを用いた鎮静における当院での取り組み 胆膵
    田中 秀和; 竹中 完; 高島 耕太; 福永 朋洋; 吉田 晃浩; 山崎 友裕; 大本 俊介; 三長 孝輔; 鎌田 研; 工藤 正俊
    Gastroenterological Endoscopy 64 Suppl.2 2188 - 2188 (一社)日本消化器内視鏡学会 2022年10月
  • 原 茜; 三長 孝輔; 瀬海 郁衣; 栗本 真之; 大塚 康生; 益田 康弘; 吉川 智恵; 鎌田 研; 渡邉 智裕; 工藤 正俊
    胆と膵 43 臨増特大 1049 - 1053 医学図書出版(株) 2022年10月 
    IgG4関連疾患は,全身の罹患臓器へのIgG4陽性形質細胞の浸潤を特徴として,異時性・同時性に多臓器に慢性炎症と線維化をきたす疾患である。自己免疫性膵炎はその膵臓特異的表現型であることが判明しているが,病態生理はあまり解明されていない。われわれは自己免疫性膵炎の発症には形質細胞様樹状細胞の活性化やIFN-αなどの炎症性サイトカインが関与することを見出している。またこの自然免疫経路を活性化させるトリガーとして,好中球細胞外トラップや腸内細菌叢がかかわることも見出した。IgG4関連疾患は多彩な症状を呈する疾患であるが,その治療法は限られており,診断や治療に難渋する症例も多い。自然免疫反応の観点からのメカニズム解明により新たな治療法・予防法の発見が期待される。(著者抄録)
  • Yasuhiro Masuta; Kosuke Minaga; Masayuki Kurimoto; Ikue Sekai; Akane Hara; Naoya Omaru; Natsuki Okai; Yasuo Otsuka; Ryutaro Takada; Tomoe Yoshikawa; Sho Masaki; Ken Kamata; Hajime Honjo; Yasuyuki Arai; Kouhei Yamashita; Masatoshi Kudo; Tomohiro Watanabe
    International Immunology 2022年09月 
    Abstract Mutations in nucleotide-binding oligomerization domain 2 (NOD2) are associated with Crohn’s disease (CD). Although NOD2 activation contributes to the maintenance of intestinal homeostasis through the negative regulation of pro-inflammatory cytokine responses mediated by Toll-like receptors (TLRs), the effects of NOD2 activation on interferon (IFN)-α responses induced by TLR9 have been poorly defined. To explore the cross-talk between NOD2 and TLR9, human monocytes or dendritic cells (DCs) were stimulated with NOD2 and/or TLR9 ligands to measure IFN-α production. The severity of dextran sodium sulfate (DSS)-induced colitis was compared in mice treated with NOD2 and/or TLR9 ligands. Expression of IFN-α and IFN-stimulated genes (ISGs) was examined in the colonic mucosa of patients with inflammatory bowel disease (IBD). NOD2 activation reduced TLR9-induced IFN-α production by monocytes and DCs in a deubiquitinating enzyme A (DUBA)-dependent manner. Activation of DUBA induced by the co-stimulation of TLR9 and NOD2 inhibited Lys63-linked polyubiquitination of TRAF3 and suppressed TLR9-mediated IFN-α production. NOD2 activation in hematopoietic cells protected mice from TLR9-induced exacerbation of DSS-induced colitis by down-regulating IFN-α responses and up-regulating DUBA expression. Colonic mucosa of patients with active and remitted IBD phases was characterized by the enhanced and reduced expression of ISGs, respectively. Expression levels of IFN-α and IL-6 positively correlated in the active colonic mucosa of patients with ulcerative colitis and CD, whereas DUBA expression inversely correlated with that of IFN-α in patients with CD. Collectively, these data suggest that DUBA-dependent negative effect of NOD2 on TLR9-mediated IFN-α responses contributes to the maintenance of intestinal homeostasis.
  • Tomoe Yoshikawa; Kosuke Minaga; Akane Hara; Ikue Sekai; Masayuki Kurimoto; Yasuhiro Masuta; Yasuo Otsuka; Ryutaro Takada; Ken Kamata; Ah-Mee Park; Shiki Takamura; Masatoshi Kudo; Tomohiro Watanabe
    International Immunology 2022年09月 
    Abstract Autoimmune pancreatitis (AIP) and IgG4-related disease (IgG4-RD) are new disease entities characterized by enhanced IgG4 antibody responses and involvement of multiple organs, including the pancreas and salivary glands. Although the immunopathogenesis of AIP and IgG4-RD is poorly understood, we previously reported that intestinal dysbiosis mediates experimental AIP through the activation of IFN-α- and IL-33-producing plasmacytoid dendritic cells (pDCs). Because intestinal dysbiosis is linked to intestinal barrier dysfunction, we explored whether the latter affects the development of AIP and autoimmune sialadenitis in MRL/MpJ mice treated with repeated injections of polyinosinic–polycytidylic acid [poly (I:C)]. Epithelial barrier disruption was induced by the administration of dextran sodium sulfate (DSS) in the drinking water. Mice co-treated with poly (I:C) and DSS, but not those treated with either agent alone, developed severe AIP, but not autoimmune sialadenitis, which was accompanied by the increased accumulation of IFN-α- and IL-33-producing pDCs. Sequencing of 16S ribosomal RNA revealed that Staphylococcus sciuri translocation from the gut to the pancreas was preferentially observed in mice with severe AIP co-treated with DSS and poly (I:C). The degree of experimental AIP, but not of autoimmune sialadenitis, was greater in germ-free mice mono-colonized with S. sciuri and treated with poly (I:C) than in germ-free mice treated with poly (I:C) alone, which was accompanied by the increased accumulation of IFN-α- and IL-33-producing pDCs. Taken together, these data suggest that intestinal barrier dysfunction exacerbates AIP through the activation of pDCs and translocation of S. sciuri into the pancreas.
  • 【肝胆膵疾患とサルコペニア】胆道・膵疾患 急性膵炎とサルコペニア
    竹中 完; 田中 隆光; 山崎 友祐; 大本 俊介; 三長 孝輔; 鎌田 研; 工藤 正俊
    肝胆膵 85 2 229 - 238 (株)アークメディア 2022年08月
  • 【肝胆膵疾患とサルコペニア】胆道・膵疾患 急性膵炎とサルコペニア
    竹中 完; 田中 隆光; 山崎 友祐; 大本 俊介; 三長 孝輔; 鎌田 研; 工藤 正俊
    肝胆膵 85 2 229 - 238 (株)アークメディア 2022年08月
  • Yasuo Otsuka; Ken Kamata; Kosuke Minaga; Tomohiro Watanabe; Masatoshi Kudo
    Frontiers in Cellular and Infection Microbiology 12 2022年07月 
    Acute pancreatitis is a common emergent disorder, a significant population of which develops the life-threatening condition, called severe acute pancreatitis (SAP). It is generally accepted that bacterial infection is associated with the development and persistence of SAP. In addition to bacterial infection, recent clinical studies disclosed a high incidence of fungal infection in patients with SAP. Moreover, SAP patients with fungal infection exhibit a higher mortality rate than those without infection. Although these clinical studies support pathogenic roles played by fungal infection in SAP, beneficial effects of prophylactic anti-fungal therapy on SAP have not been proved. Here we summarize recent clinical findings as to the relationship between fungal infection and the development of SAP. In addition, we discuss molecular mechanisms accounting for the development of SAP in the presence of fungal infection.
  • Natsuki Okai; Tomohiro Watanabe; Kosuke Minaga; Ken Kamata; Hajime Honjo; Masatoshi Kudo
    World Journal of Gastroenterology 28 26 3063 - 3070 2022年07月
  • Hidekazu Tanaka; Kosuke Minaga; Yasuo Otsuka; Yasuhiro Masuta; Ken Kamata; Kentaro Yamao; Mamoru Takenaka; Tomoko Hyodo; Masatomo Kimura; Tomohiro Watanabe; Masatoshi Kudo
    Frontiers in Medicine 9 2022年07月 
    Background Pancreatic neuroendocrine carcinoma (PanNEC) is a rare disease entity with rapid progression and poor prognosis. Here, we report a PanNEC case with unique morphological features mimicking intraductal papillary mucinous carcinoma. Case presentation A 69-year-old Japanese man was referred to our hospital for further evaluation of weight loss and deterioration of diabetes mellitus. Contrast-enhanced computed tomography showed a solid and cystic mass with hypo-enhancement at the tail of the pancreas. The main pancreatic duct (MPD) was diffusely dilated without obstruction, accompanied by marked parenchymal atrophy. Multiple peritoneal and omental nodules were observed, suggesting tumor dissemination. Endoscopic retrograde cholangiopancreatography revealed that the mass correlated with the dilated MPD. During pancreatography, a large amount of mucus was extruded from the pancreatic orifice of the ampulla. Based on these imaging findings, intraductal papillary mucinous carcinoma was suspected. Per-oral pancreatoscopy (POPS)-guided tumor biopsies were conducted for the lesion's solid components. Histopathological examination of the biopsied material confirmed small-cell-type PanNEC with a Ki-67 labeling index of 90%. Due to his condition's rapid decline, the patient was given the best supportive care and died 28 days after diagnosis. Conclusion Although rare, PanNEC, which correlates with the MPD and is accompanied by marked dilation of the MPD, does exist as one phenotype. In such cases, POPS-guided biopsy could be a useful diagnostic modality.
  • Ayana Okamoto; Ken Kamata; Takeshi Miyata; Tomoe Yoshikawa; Rei Ishikawa; Tomohiro Yamazaki; Atsushi Nakai; Shunsuke Omoto; Kosuke Minaga; Kentaro Yamao; Mamoru Takenaka; Yasutaka Chiba; Toshiharu Sakurai; Naoshi Nishida; Masayuki Kitano; Masatoshi Kudo
    Clinical endoscopy 55 4 558 - 563 2022年07月 
    Background/Aims: Bispectral index (BIS) monitors process and display electroencephalographic data and are used to assess the depth of anesthesia. This study retrospectively evaluated the usefulness of BIS monitoring during endoscopic ultrasonography (EUS). Methods: This study included 725 consecutive patients who underwent EUS under sedation with propofol. BIS monitoring was used in 364 patients and was not used in 361. The following parameters were evaluated: (1) median dose of propofol; (2) respiratory and circulatory depression; (3) occurrence of body movements; (4) awakening score >8 at the time; and (5) awakening score 2 hours after leaving the endoscopy room. Results: The BIS group received a significantly lower median dose of propofol than the non-BIS group (159.2 mg vs. 167.5 mg; p=0.015) in all age groups. For patients aged ≥75 years, the reduction in heart rate was significantly lower in the BIS group than in the non-BIS group (1.2% vs. 9.1%; p=0.023). Moreover, the occurrence of body movements was markedly lower in the BIS group than in the non-BIS group (8.5% vs. 39.4%; p<0.001). Conclusions: During EUS examination, BIS monitoring is useful for maintaining a constant depth of anesthesia, especially in patients 75 years of age or older.
  • Atsushi Nakai; Ken Kamata; Tomoko Hyodo; Takaaki Chikugo; Akane Hara; Yasuo Otsuka; Hidekazu Tanaka; Tomoe Yoshikawa; Rei Ishikawa; Ayana Okamoto; Tomohiro Yamazaki; Shunsuke Omoto; Kosuke Minaga; Kentaro Yamao; Mamoru Takenaka; Yasutaka Chiba; Tomohiro Watanabe; Ippei Matsumoto; Yoshifumi Takeyama; Masatoshi Kudo
    Endoscopic ultrasound 11 5 401 - 406 2022年07月 
    Background: The value of contrast-enhanced harmonic EUS (CH-EUS) for diagnosis of portal vein invasion in patients with pancreatic cancer was evaluated. Patients and Methods: This single-center, retrospective study included consecutive patients with pancreatic cancer who underwent both surgical resection after preoperative EUS, CH-EUS, and contrast-enhanced computed tomography (CE-CT) examinations between April 2015 and August 2017. CH-EUS evaluation was performed during the late phase. Portal vein invasion on EUS and CH-EUS was defined as no continuity in the line of the vessel wall. Definition of portal vein invasion on CE-CT was based on the Loyer's criteria. The accuracy of three modalities for diagnosis of invasion into the portal vein was compared using the McNemar's test. Results: Eighty-eight patients (mean age: 71.0 years, ratio of male to female: 48:40) were eligible. Postoperative pathological results were as follows: seven cases of portal vein invasion; 81 cases without. Diagnostic accuracy of EUS, CH-EUS, and CE-CT for diagnosing invasion into the portal vein was 72.7%, 93.2%, and 81.8%, respectively. The differences between CH-EUS and CE-CT (P = 0.0094) and CH-EUS and EUS (P = 0.0022) were significant. EUS and CE-CT were comparable. Conclusion: CH-EUS is useful for diagnosis of portal vein invasion by pancreatic cancer.
  • 竹中 完; 大本 俊介; 三長 孝輔; 鎌田 研; 工藤 正俊
    内科 130 1 13 - 19 (株)南江堂 2022年07月 
    <文献概要>▼急性膵炎と診断した後はまず重症化のリスクを判断し,重症化した場合,もしくは重症化が高率に予想される場合には適切な施設への搬送と適切な治療をシステマティックに行うことが求められ,「Pancreatitis Bundles 2021」の積極的活用が望まれる.▼「Pancreatitis Bundles 2021」で改訂された内容として,軽症急性膵炎には予防的抗菌薬は使用しないこと,経腸栄養は経胃でも可であること,感染性膵壊死に対するステップアップ・アプローチ,などがあげられる.▼急性膵炎診療における地域連携ネットワークの重要性は「急性膵炎診療ガイドライン2021」でも強調されており,各地域それぞれのネットワークづくりが求められる.▼急性胆管炎の診断には長らくCharcot 3徴(発熱・黄疸・腹痛)が用いられてきたが,実際にはCharcot 3徴をきたさない急性胆管炎が多く経験され,「急性胆管炎・胆嚢炎診療ガイドライン2018」では急性胆管炎の診断は「全身の炎症」「胆汁うっ滞」「胆管病変」の3因子を用いて行われている.▼急性膵炎・胆管炎,いずれの病態も重症度評価は頻回に行い,当初は軽症の症例でも重症化する可能性を常に念頭に置き,重症化のタイミングを逃さないようにすることが肝要である.
  • 山雄 健太郎; 竹中 完; 鎌田 研; 三長 孝輔; 工藤 正俊
    内科 130 1 69 - 71 (株)南江堂 2022年07月 
    <文献概要>▼膵がんは予後不良ながん腫であり,その改善のためには早期診断・早期治療が必須である.▼早期膵がんを疑う画像所見としては「尾側膵管拡張を伴う限局性主膵管狭窄」がその代表である.しかしながらこの所見は慢性膵炎などの良性膵疾患でも認められる.▼近年,早期膵がん症例のCTにおける「主膵管狭窄部周囲の限局性膵実質萎縮」が良悪性診断に有用との報告が散見される.この所見を認めた場合は早期膵がんの可能性を考慮し,胆膵専門医へ紹介することが推奨される.
  • 竹中 完; 大本 俊介; 三長 孝輔; 鎌田 研; 工藤 正俊
    内科 130 1 13 - 19 (株)南江堂 2022年07月 
    <文献概要>▼急性膵炎と診断した後はまず重症化のリスクを判断し,重症化した場合,もしくは重症化が高率に予想される場合には適切な施設への搬送と適切な治療をシステマティックに行うことが求められ,「Pancreatitis Bundles 2021」の積極的活用が望まれる.▼「Pancreatitis Bundles 2021」で改訂された内容として,軽症急性膵炎には予防的抗菌薬は使用しないこと,経腸栄養は経胃でも可であること,感染性膵壊死に対するステップアップ・アプローチ,などがあげられる.▼急性膵炎診療における地域連携ネットワークの重要性は「急性膵炎診療ガイドライン2021」でも強調されており,各地域それぞれのネットワークづくりが求められる.▼急性胆管炎の診断には長らくCharcot 3徴(発熱・黄疸・腹痛)が用いられてきたが,実際にはCharcot 3徴をきたさない急性胆管炎が多く経験され,「急性胆管炎・胆嚢炎診療ガイドライン2018」では急性胆管炎の診断は「全身の炎症」「胆汁うっ滞」「胆管病変」の3因子を用いて行われている.▼急性膵炎・胆管炎,いずれの病態も重症度評価は頻回に行い,当初は軽症の症例でも重症化する可能性を常に念頭に置き,重症化のタイミングを逃さないようにすることが肝要である.
  • 山雄 健太郎; 竹中 完; 鎌田 研; 三長 孝輔; 工藤 正俊
    内科 130 1 69 - 71 (株)南江堂 2022年07月 
    <文献概要>▼膵がんは予後不良ながん腫であり,その改善のためには早期診断・早期治療が必須である.▼早期膵がんを疑う画像所見としては「尾側膵管拡張を伴う限局性主膵管狭窄」がその代表である.しかしながらこの所見は慢性膵炎などの良性膵疾患でも認められる.▼近年,早期膵がん症例のCTにおける「主膵管狭窄部周囲の限局性膵実質萎縮」が良悪性診断に有用との報告が散見される.この所見を認めた場合は早期膵がんの可能性を考慮し,胆膵専門医へ紹介することが推奨される.
  • 胆膵内視鏡治療の工夫とリスクマネージメント 胆嚢結石を合併した総胆管結石に対する内視鏡治療戦略の検討 術前にとるか術後にとるか
    高島 耕太; 三長 孝輔; 鎌田 研; 竹中 完; 工藤 正俊
    日本消化器内視鏡学会近畿支部例会プログラム・抄録集 108回 49 - 49 日本消化器内視鏡学会-近畿支部 2022年06月
  • 胆膵内視鏡治療の工夫とリスクマネージメント 胆嚢結石を合併した総胆管結石に対する内視鏡治療戦略の検討 術前にとるか術後にとるか
    高島 耕太; 三長 孝輔; 鎌田 研; 竹中 完; 工藤 正俊
    日本消化器内視鏡学会近畿支部例会プログラム・抄録集 108回 49 - 49 日本消化器内視鏡学会-近畿支部 2022年06月
  • 【膵神経内分泌腫瘍-新たなる胎動2022-】画像診断 膵神経内分泌腫瘍の内視鏡診断
    大塚 康生; 鎌田 研; 山崎 友裕; 大本 俊介; 三長 孝輔; 竹中 完; 樫田 博史; 工藤 正俊
    肝胆膵 84 6 783 - 788 (株)アークメディア 2022年06月
  • 【膵神経内分泌腫瘍-新たなる胎動2022-】画像診断 膵神経内分泌腫瘍の内視鏡診断
    大塚 康生; 鎌田 研; 山崎 友裕; 大本 俊介; 三長 孝輔; 竹中 完; 樫田 博史; 工藤 正俊
    肝胆膵 84 6 783 - 788 (株)アークメディア 2022年06月
  • Tomohiro Watanabe; Kosuke Minaga; Akane Hara; Tomoe Yoshikawa; Ken Kamata; Masatoshi Kudo
    Frontiers in Immunology 13 2022年05月 
    Efficient protection against coronavirus disease 2019 (COVID-19) has been achieved by immunization with mRNA-based vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). However, efficient immune responses against this novel virus by vaccination are accompanied by a wide variety of side effects. Indeed, flares or new-onset of autoimmune disorders have been reported soon after the COVID-19 vaccination. Although pro-inflammatory cytokine responses play pathogenic roles in the development of autoimmunity, cytokines charactering COVID-19 vaccination-related autoimmune responses have been poorly understood. Given that mRNA derived from COVID-19 vaccine is a potent inducer for pro-inflammatory cytokine responses, these cytokines might mediate autoimmune responses after COVID-19 vaccination. Here we report a case with new-onset rheumatoid arthritis (RA) following COVID-19 vaccination. Serum concentrations not only of arthrogenic cytokines, interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α), but also of type I interferon (IFN) were elevated at the active phase in this case. Induction of remission by methotrexate and tocilizumab was accompanied by a marked reduction in serum concentrations of type I IFN, IL-6, and TNF-α. These results suggest that production of type I IFN, IL-6, and TNF-α induced by COVID-19 vaccination might be involved in this case with new-onset RA.
  • Daisuke Morimoto-Ishikawa; Tomoko Hyodo; Mamoru Takenaka; Yuko Matsukubo; Isao Numoto; Makoto Itoh; Masato Ohmi; Ken Kamata; Yu Ueda; Miyuki Wakana; Masatoshi Kudo; Shigeyoshi Saito; Kazunari Ishii
    European Journal of Radiology 150 110279 - 110279 2022年05月
  • Ken Kamata; Makiko Kinoshita; Ikuharu Kinoshita; Hajime Imai; Takeshi Ogura; Hisakazu Matsumoto; Kosuke Minaga; Yasutaka Chiba; Mamoru Takenaka; Masatoshi Kudo; Masayuki Kitano
    International journal of clinical oncology 2022年04月 
    OBJECTIVES: This study evaluated the efficacy of endoscopic ultrasound-guided celiac plexus neurolysis (EUS-CPN) in combination with EUS-guided celiac ganglia neurolysis (EUS-CGN) for pancreatic cancer-associated pain. METHODS: This multicenter prospective trial was registered in the University Hospital Medical Information Network (UMIN000031228). Fifty-one consecutive patients with pancreatic cancer-associated pain who presented at one of five Japanese referral centers between February 2018 and March 2021 were enrolled. EUS-CGN was added in cases of visible celiac ganglia. The primary endpoint was effectiveness, defined as a decrease in the numerical rating scale (NRS) by ≥ 3 points. NRS data were prospectively acquired at 1 week after the procedure to evaluate its effectiveness and the extent of pain relief. RESULTS: The technical success rates of EUS-CPN and EUS-CGN were 100% and 80.4%, respectively. The overall efficacy rate was 82.4% [90% confidence interval (CI) 71.2-90.5, P < 0.0001]. The complete pain relief rate was 27.4%. The adverse events rate was 15.7%. The average pain relief period was 72 days. The efficacy rate was higher in the EUS-CPN plus EUS-CGN group than in the EUS-CPN alone group. EUS-CPN plus EUS-CGN was superior to EUS-CPN alone for achieving complete pain relief (P = 0.045). EUS-CGN did not improve the average length of the pain relief period. CONCLUSIONS: EUS-CPN combined with EUS-CGN is safe, feasible, and effective for pain relief in patients with pancreatic cancer. The patients who received additional EUS-CGN had a better short-term response. CLINICAL TRIAL NUMBER: UMIN000031228.
  • ERCP時の術者被ばく線量、および防護メガネによる水晶体被ばく低減効果の検討 REX-GI試験からの検討
    池澤 賢治; 林 史郎; 竹中 完; 藥師神 崇行; 長生 幸司; 高田 良司; 山井 琢陽; 松本 健吾; 山本 政司; 鎌田 研; 三長 孝輔; 石井 修二; 清水 健史; 長井 健悟; 細野 眞; 西田 勉; REX-GI試験グループ
    Gastroenterological Endoscopy 64 Suppl.1 807 - 807 (一社)日本消化器内視鏡学会 2022年04月
  • 竹中 完; 山崎 友裕; 大本 俊介; 三長 孝輔; 鎌田 研; 工藤 正俊
    臨床消化器内科 37 5 571 - 575 (株)日本メディカルセンター 2022年04月 
    <文献概要>胆道ジスキネジアは胆嚢,総胆管,十二指腸乳頭部に至る胆道系に器質的な病変が認められないにもかかわらず,右季肋部痛を主体とする胆石症様の腹部症状を呈する病態であり,Rome IV診断基準における機能性消化管障害の病型分類の"機能性胆嚢・Oddi乳頭括約筋障害(gallbladder and sphincter of Oddi disorder)"にあたる.問診により胆道痛の定義を満たすが,胆石,総胆管結石や他の器質的疾患を認めない症例のなかで,胆嚢がある症例にgallbladder disorderを疑い,胆嚢摘出後で血液検査にて肝酵素逸脱,もしくは画像検査にて胆管拡張を認める症例に胆道型乳頭括約筋機能異常(SOD)が疑われる.食事療法や生活習慣改善でも症状の改善が認められない場合に薬剤投与治療が施行され,薬物療法が無効な症例には内視鏡的乳頭切開術がおもに行われる.本病態は疑わなければ絶対に診断できない病態であるため,まず疑うことができるか,が最も重要なポイントとなる.
  • ERCP時の術者被ばく線量、および防護メガネによる水晶体被ばく低減効果の検討 REX-GI試験からの検討
    池澤 賢治; 林 史郎; 竹中 完; 藥師神 崇行; 長生 幸司; 高田 良司; 山井 琢陽; 松本 健吾; 山本 政司; 鎌田 研; 三長 孝輔; 石井 修二; 清水 健史; 長井 健悟; 細野 眞; 西田 勉; REX-GI試験グループ
    Gastroenterological Endoscopy 64 Suppl.1 807 - 807 (一社)日本消化器内視鏡学会 2022年04月
  • 竹中 完; 高島 耕太; 田中 秀和; 福永 朋洋; 吉田 晃浩; 山崎 友祐; 大本 俊介; 三長 孝輔; 鎌田 研; 工藤 正俊
    胆と膵 43 4 267 - 279 医学図書出版(株) 2022年04月 
    1969年に世界初の膵・胆道造影が日本で成功されてから50年が経ち、内視鏡的逆行性胆管膵管造影(endoscopic retrograde cholangiopancreatography:ERCP)は今や胆膵領域疾患において不可欠な診断・治療ツールとなっている。この50年の間には、たくさんのERCP関連デバイスの進歩があり、多様化が進み、専門的使用を念頭においた開発が進められている。われわれ胆膵内視鏡医には、日々アップデートしていくデバイス開発に精通し、各デバイスの開発意義と想定される使用イメージを理解し、眼前の患者にもっとも適したものを選択することが求められる。(著者抄録)
  • 竹中 完; 大本 俊介; 三長 孝輔; 鎌田 研; 工藤 正俊
    消化器内視鏡 34 4 813 - 818 (株)東京医学社 2022年04月
  • 竹中 完; 山崎 友裕; 大本 俊介; 三長 孝輔; 鎌田 研; 工藤 正俊
    臨床消化器内科 37 5 571 - 575 (株)日本メディカルセンター 2022年04月 
    <文献概要>胆道ジスキネジアは胆嚢,総胆管,十二指腸乳頭部に至る胆道系に器質的な病変が認められないにもかかわらず,右季肋部痛を主体とする胆石症様の腹部症状を呈する病態であり,Rome IV診断基準における機能性消化管障害の病型分類の"機能性胆嚢・Oddi乳頭括約筋障害(gallbladder and sphincter of Oddi disorder)"にあたる.問診により胆道痛の定義を満たすが,胆石,総胆管結石や他の器質的疾患を認めない症例のなかで,胆嚢がある症例にgallbladder disorderを疑い,胆嚢摘出後で血液検査にて肝酵素逸脱,もしくは画像検査にて胆管拡張を認める症例に胆道型乳頭括約筋機能異常(SOD)が疑われる.食事療法や生活習慣改善でも症状の改善が認められない場合に薬剤投与治療が施行され,薬物療法が無効な症例には内視鏡的乳頭切開術がおもに行われる.本病態は疑わなければ絶対に診断できない病態であるため,まず疑うことができるか,が最も重要なポイントとなる.
  • Kosuke Minaga; Tomohiro Watanabe; Ken Kamata; Masatoshi Kudo; Warren Strober
    Current Protocols 2 4 2022年04月
  • Mamoru Takenaka; Madan M Rehani; Makoto Hosono; Tomohiro Yamazaki; Shunsuke Omoto; Kosuke Minaga; Ken Kamata; Kentaro Yamao; Shiro Hayashi; Tsutomu Nishida; Masatoshi Kudo
    Journal of clinical medicine 11 6 2022年03月 
    Fluoroscopy forms an essential part of endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) and hepaticogastrostomy with antegrade stenting (EUS-HGAS). To date, no study has assessed and compared radiation exposure between EUS-HGS and EUS-HGAS. This study aimed to compare the radiation exposure parameters between EUS-HGS and EUS-HGAS. This retrospective single-center cohort study included consecutive patients who underwent EUS-HGS or EUS-HGAS from October 2017 to March 2019. The air kerma (AK: mGy), kerma-area product (KAP: Gycm2), fluoroscopy time (FT: min), and procedure time (PT: min) were assessed and compared between the two procedures. Altogether, 45 and 24 patients underwent EUS-HGS and EUS-HGAS, respectively. The median AK, KAP, FT, and PT were higher in the EUS-HGAS group than in the EUS-HGS group. A comparison revealed no difference in the technical success rate, complications rate, adverse event occurrence rate, and re-intervention rate between both procedures. This is the first report in which radiation exposure was used as a comparative parameter between EUS-HGS and EUS-HGAS. This study revealed that radiation exposure is significantly higher in EUS-HGAS than in EUS-HGS. Increased awareness on radiation exposure is warranted among gastroenterologists so that they choose the procedure with lower radiation exposure in cases where both procedures are indicated.
  • 鎌田 研; 渡邉 智裕; 吉川 智恵; 原 茜; 三長 孝輔; 工藤 正俊
    Progress in Medicine 42 3 259 - 263 (株)ライフ・サイエンス 2022年03月
  • 腸内細菌に対する炎症性サイトカイン応答の増強を示すクローン病関連脊椎関節炎の一例
    福西 香栄; 本庶 元; 岡井 夏輝; 河野 匡志; 鎌田 研; 三長 孝輔; 米田 頼晃; 辻 成佳; 渡邉 智裕; 工藤 正俊
    日本消化器病学会近畿支部例会プログラム・抄録集 116回 108 - 108 日本消化器病学会-近畿支部 2022年02月
  • 浸潤性膵管癌、腺扁平上皮癌が重複膵管に同時発生した1例
    加藤 弘樹; 大本 俊介; 原 茜; 大塚 康夫; 益田 康弘; 高島 耕太; 吉田 晃浩; 福永 朋洋; 岡本 彩那; 山崎 友裕; 鎌田 研; 三長 孝輔; 竹中 完; 筑後 孝章; 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 116回 111 - 111 日本消化器病学会-近畿支部 2022年02月
  • 制御性T細胞に依存性しない寛解導入が得られたCollagenous Colitisの一例
    瀬海 郁衣; 本庶 元; 今村 瑞貴; 松原 卓哉; 河野 匡志; 原 茜; 栗本 真之; 吉川 馨介; 益田 康弘; 大塚 康生; 高田 隆太郎; 吉川 智恵; 鎌田 研; 三長 孝輔; 松井 繁長; 木村 雅友; 渡邉 智裕; 工藤 正俊
    日本消化器病学会近畿支部例会プログラム・抄録集 116回 117 - 117 日本消化器病学会-近畿支部 2022年02月
  • 腸内細菌に対する炎症性サイトカイン応答の増強を示すクローン病関連脊椎関節炎の一例
    福西 香栄; 本庶 元; 岡井 夏輝; 河野 匡志; 鎌田 研; 三長 孝輔; 米田 頼晃; 辻 成佳; 渡邉 智裕; 工藤 正俊
    日本消化器病学会近畿支部例会プログラム・抄録集 116回 108 - 108 日本消化器病学会-近畿支部 2022年02月
  • 浸潤性膵管癌、腺扁平上皮癌が重複膵管に同時発生した1例
    加藤 弘樹; 大本 俊介; 原 茜; 大塚 康夫; 益田 康弘; 高島 耕太; 吉田 晃浩; 福永 朋洋; 岡本 彩那; 山崎 友裕; 鎌田 研; 三長 孝輔; 竹中 完; 筑後 孝章; 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 116回 111 - 111 日本消化器病学会-近畿支部 2022年02月
  • 制御性T細胞に依存性しない寛解導入が得られたCollagenous Colitisの一例
    瀬海 郁衣; 本庶 元; 今村 瑞貴; 松原 卓哉; 河野 匡志; 原 茜; 栗本 真之; 吉川 馨介; 益田 康弘; 大塚 康生; 高田 隆太郎; 吉川 智恵; 鎌田 研; 三長 孝輔; 松井 繁長; 木村 雅友; 渡邉 智裕; 工藤 正俊
    日本消化器病学会近畿支部例会プログラム・抄録集 116回 117 - 117 日本消化器病学会-近畿支部 2022年02月
  • Ikuhiro Yamada; Chigusa Morizane; Takuji Okusaka; Junki Mizusawa; Tomoko Kataoka; Makoto Ueno; Masafumi Ikeda; Naohiro Okano; Akiko Todaka; Satoshi Shimizu; Nobumasa Mizuno; Mitsugu Sekimoto; Kazutoshi Tobimatsu; Hironori Yamaguchi; Tomohiro Nishina; Hirofumi Shirakawa; Yasushi Kojima; Takamasa Oono; Yasuyuki Kawamoto; Masayuki Furukawa; Tomohisa Iwai; Kentaro Sudo; Keiya Okamura; Tatsuya Yamashita; Naoya Kato; Kazuhiko Shioji; Kyouko Shimizu; Toshio Nakagohri; Ken Kamata; Hiroshi Ishii; Junji Furuse
    Scientific reports 12 1 987 - 987 2022年01月 
    In the FUGA-BT trial (JCOG1113), gemcitabine plus S-1 (GS) showed non-inferiority to gemcitabine plus cisplatin (GC) in overall survival (OS) with good tolerance for patients with advanced biliary tract cancer (BTC). We performed a subgroup analysis focused on the elderly cohort of this trial. All 354 enrolled patients in JCOG1113 were classify into two groups; < 75 (non-elderly) and ≥ 75 years (elderly) group. We investigated the influence of age on the safety analysis, including the incidence of chemotherapeutic adverse events and the efficacy analysis, including OS. There were no remarkable differences in OS between the elderly (n = 60) and the non-elderly groups (n = 294). In the elderly group, median OS was 12.7 and 17.7 months for those who received GC (n = 20) and GS (n = 40), respectively. The prevalence of all-grade adverse events was similar between the elderly and the non-elderly groups. However, among the elderly group, Grade ≥ 3 hematological adverse events were more frequently observed in the GC arm than in the GS arm. The clinical outcomes of combination chemotherapy in elderly patients with advanced BTC were comparable to non-elderly patients. GS may be the more favorable treatment for elderly patients with advanced BTC.
  • Hidekazu Tanaka; Ken Kamata; Rika Ishihara; Hisashi Handa; Yasuo Otsuka; Akihiro Yoshida; Tomoe Yoshikawa; Rei Ishikawa; Ayana Okamoto; Tomohiro Yamazaki; Atsushi Nakai; Shunsuke Omoto; Kosuke Minaga; Kentaro Yamao; Mamoru Takenaka; Tomohiro Watanabe; Naoshi Nishida; Masatoshi Kudo
    Journal of gastroenterology and hepatology 37 5 841 - 846 2022年01月 
    BACKGROUND AND AIM: Contrast-enhanced harmonic endoscopic ultrasonography (CH-EUS) is useful for the diagnosis of lesions inside and outside the digestive tract. This study evaluated the value of artificial intelligence (AI) in the diagnosis of gastric submucosal tumors by CH-EUS. METHODS: This retrospective study included 53 patients with gastrointestinal stromal tumors (GISTs) and leiomyomas, all of whom underwent CH-EUS between June 2015 and February 2020. A novel technology, SiamMask, was used to track and trim the lesions in CH-EUS videos. CH-EUS was evaluated by AI using deep learning involving a residual neural network and leave-one-out cross-validation. The diagnostic accuracy of AI in discriminating between GISTs and leiomyomas was assessed and compared with that of blind reading by two expert endosonographers. RESULTS: Of the 53 patients, 42 had GISTs and 11 had leiomyomas. Mean tumor size was 26.4 mm. The consistency rate of the segment range of the tumor image extracted by SiamMask and marked by the endosonographer was 96% with a Dice coefficient. The sensitivity, specificity, and accuracy of AI in diagnosing GIST were 90.5%, 90.9%, and 90.6%, respectively, whereas those of blind reading were 90.5%, 81.8%, and 88.7%, respectively (P = 0.683). The κ coefficient between the two reviewers was 0.713. CONCLUSIONS: The diagnostic ability of CH-EUS results evaluated by AI to distinguish between GISTs and leiomyomas was comparable with that of blind reading by expert endosonographers.
  • Sho Masaki; Tomohiro Watanabe; Yasuyuki Arai; Ikue Sekai; Akane Hara; Masayuki Kurimoto; Yasuo Otsuka; Yasuhiro Masuta; Tomoe Yoshikawa; Ryutaro Takada; Ken Kamata; Kosuke Minaga; Kouhei Yamashita; Masatoshi Kudo
    Clinical and Experimental Immunology 2022年01月 
    Abstract Cellular inhibitor of apoptosis proteins 1 (cIAP1) and 2 (cIAP2) are involved in signaling pathways mediated by Toll-like receptors (TLRs) and tumor necrosis factor (TNF)-α. Excessive activation of TLRs and TNF-αunderlies the immunopathogenesis of Crohn’s disease (CD) and ulcerative colitis (UC). However, the roles played by cIAP1 and cIAP2 in the development of CD and UC remain poorly understood. In this study, we attempted to clarify the molecular link between cIAP1/cIAP2 and colonic inflammation. Human monocyte-derived dendritic cells (DCs) treated with siRNAs specific for cIAP1 or cIAP2 exhibited reduced pro-inflammatory cytokine responses upon stimulation with TLR ligands. Expression of cIAP1 and cIAP2 in human DCs was suppressed in the presence of interferon regulatory factor 4 (IRF4). This effect was associated with inhibition of cIAP1 and cIAP2 polyubiquitination. To verify these in vitro findings, we created mice overexpressing IRF4 in DCs and showed that these mice were resistant to trinitrobenzene sulfonic acid-induced colitis as compared with wild-type mice; these effects were accompanied by reduced expression levels of cIAP1 and cIAP2. Pro-inflammatory cytokine production by mesenteric lymph node cells upon stimulation with TLR ligands was reduced in mice with DC-specific IRF4 overexpression as compared with that in wild-type mice. Finally, in clinical samples of the colonic mucosa from patients with CD, there was a negative relationship between the percentage of IRF4 + DCs and percentages of cIAP1 + or cIAP2 + lamina propria mononuclear cells. These data suggest that the colitogenic roles of cIAP1 and cIAP2 are negatively regulated by IRF4.
  • 【膵Interventionの最前線】悪性胃十二指腸閉塞に対する内視鏡的消化管ステンティング
    山雄 健太郎; 竹中 完; 高島 耕太; 吉田 晃浩; 岡本 彩那; 山崎 友裕; 大本 俊介; 鎌田 研; 三長 孝輔; 工藤 正俊
    肝胆膵 83 6 899 - 904 (株)アークメディア 2021年12月
  • 【胆膵疾患、一歩進んだ診断のコツ】早期膵癌発見における膵実質萎縮の意義と検出方法
    山雄 健太郎; 竹中 完; 高島 耕太; 田中 秀和; 吉田 晃浩; 岡本 彩那; 山崎 友裕; 大本 俊介; 鎌田 研; 三長 孝輔; 工藤 正俊
    消化器・肝臓内科 10 6 655 - 660 (有)科学評論社 2021年12月
  • Kentaro Yamao; Masakatsu Tsurusaki; Kota Takashima; Hidekazu Tanaka; Akihiro Yoshida; Ayana Okamoto; Tomohiro Yamazaki; Shunsuke Omoto; Ken Kamata; Kosuke Minaga; Mamoru Takenaka; Takaaki Chikugo; Yasutaka Chiba; Tomohiro Watanabe; Masatoshi Kudo
    Diagnostics (Basel, Switzerland) 11 10 2021年10月 
    BACKGROUND: Pancreatic cancer (PC) exhibits extremely rapid growth; however, it remains largely unknown whether the early stages of PC also exhibit rapid growth speed equivalent to advanced PC. This study aimed to investigate the natural history of early PCs through retrospectively assessing pre-diagnostic images. METHODS: We examined the data of nine patients, including three patients with carcinoma in situ (CIS), who had undergone magnetic resonance cholangiopancreatography (MRCP) to detect solitary main pancreatic duct (MPD) stenosis >1 year before definitive PC diagnosis. We retrospectively analyzed the time to diagnosis and first-time tumor detection from the estimated time point of first-time MPD stenosis detection without tumor lesion. RESULTS: The median tumor size at diagnosis and the first-time tumor detection size were 14 and 7.5 mm, respectively. The median time to diagnosis and first-time tumor detection were 26 and 49 months, respectively. CONCLUSIONS: No studies have investigated the PC history, especially that of early PCs, including CIS, based on the initial detection of MPD stenosis using MRCP. Assessment of a small number of patients showed that the time to progression can take several years in the early PC stages. Understanding this natural history is very important in the clinical setting.
  • ここまで進んだEUSとその関連手技 超音波内視鏡ガイド下腹腔神経叢ブロック(EUS-guided celiac plexus neurolysis:EUS-CPN)関連手技の現状
    竹中 完; 岡本 彩那; 山崎 友裕; 大本 俊介; 三長 孝輔; 鎌田 研; 山雄 健太郎; 工藤 正俊
    日本超音波医学会関西地方会学術集会 48回 64 - 64 (公社)日本超音波医学会-関西地方会 2021年10月
  • IPMNの壁在結節におけるDetective flow imaging(DFI)の有用性について
    高島 耕太; 大本 俊介; 吉田 晃浩; 岡本 彩那; 山崎 友裕; 三長 孝輔; 鎌田 研; 山雄 健太郎; 竹中 完; 工藤 正俊
    日本超音波医学会関西地方会学術集会 48回 83 - 83 (公社)日本超音波医学会-関西地方会 2021年10月
  • 【肝胆膵疾患におけるバイオマーカーの意義を探る】膵疾患のバイオマーカー 自然免疫反応からみた自己免疫性膵炎・IgG4関連疾患の血清バイオマーカー IFN-α・IL-33
    原 茜; 三長 孝輔; 吉川 智恵; 鎌田 研; 渡邉 智裕; 工藤 正俊
    肝胆膵 83 4 617 - 623 (株)アークメディア 2021年10月
  • Ryutaro Takada; Tomohiro Watanabe; Akane Hara; Ikue Sekai; Masayuki Kurimoto; Yasuo Otsuka; Yasuhiro Masuta; Tomoe Yoshikawa; Ken Kamata; Kosuke Minaga; Masatoshi Kudo
    Biochemical and biophysical research communications 568 55 - 61 2021年09月 
    Nucleotide-binding oligomerization domain 2 (NOD2) is an intracellular receptor for muramyl dipeptide derived from the intestinal microbiota. Loss-of-function mutations in Nod2 are associated with the development of Crohn's disease, suggesting that NOD2 signaling plays critical roles in the maintenance of intestinal immune homeostasis. Although NOD2 activation prevents the development of short-term experimental colitis, it remains unknown whether the sensitivity to long-term experimental colitis is influenced by NOD2. In this study, we explored the roles played by NOD2 in the development of long-term adoptive transfer colitis. Unexpectedly, we found that Rag1-/-Nod2-/- mice were more resistant to adoptive transfer colitis than Rag1-/- mice and had reduced proinflammatory cytokine responses and enhanced accumulation of regulatory T cells (Tregs) expressing forkhead box P3 in the colonic mucosa. Prevention of colitis in Rag1-/-Nod2-/- mice was mediated by TGF-β1 because neutralization of TGF-β1 resulted in the development of more severe colitis due to reduced accumulation of Tregs. Such paradoxical Treg responses in the absence of NOD2 could explain why Nod2 mutations in humans are not sufficient to cause Crohn's disease.
  • TNF-αおよびIL-6の関与が考えられた好酸球性胃腸炎の1例
    瀬海 郁衣; 吉川 馨介; 高田 隆太郎; 原 茜; 吉川 智恵; 鎌田 研; 三長 孝輔; 渡邉 智裕; 工藤 正俊
    日本消化器病学会近畿支部例会プログラム・抄録集 115回 81 - 81 日本消化器病学会-近畿支部 2021年09月
  • Detective flow imaging(DFI)にて特徴的な血流血管を観察し得たIntraductal papillary neoplasm of bile duct(IPNB)の2例
    上中 大地; 岡本 彩那; 大本 俊介; 原 茜; 大塚 康生; 益田 康弘; 高島 耕太; 吉田 晃浩; 山崎 友裕; 三長 孝輔; 鎌田 研; 山雄 健太郎; 竹中 完; 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 115回 98 - 98 日本消化器病学会-近畿支部 2021年09月
  • 竹中 完; 福永 朋洋; 高島 耕太; 田中 秀和; 吉田 晃浩; 岡本 彩那; 山崎 友裕; 大本 俊介; 三長 孝輔; 鎌田 研; 山雄 健太郎; 工藤 正俊
    消化器内視鏡 33 9 1459 - 1466 (株)東京医学社 2021年09月 
    近年膵管内圧上昇による病態の治療として、外科的減圧治療、内視鏡的逆行性膵管ドレナージに加え、新たなドレナージ方法としてEUS下経消化管的膵管ドレナージ(EUS-PD)が報告されその有用性が報告されている。EUS-PDとは「胃や十二指腸から、EUSを用いて拡張膵管を描出し、EUS-FNAの要領で膵管にアクセスして内視鏡的にドレナージを行う手法」であるが、治療成績に関してはおおむね80%以上と高いものの手技成功率は63〜100%とばらつきがあり、最新のメタ解析では手技成功率は81.4%、臨床改善率は84.6%とされ、偶発症発症率は21.3%とされている。偶発症には出血や穿孔、頻度は低いながら重症膵炎なども報告されており、EUS-PDは同じEUS下ドレナージ治療であるEUS-BDと比較すると依然確立されていない適応を、慎重に検討する必要がある手技であると考えられる。本稿ではその適応と手技の実際について解説を行う。(著者抄録)
  • Yasuo Otsuka; Ken Kamata; Tomoko Hyodo; Takaaki Chikugo; Akane Hara; Hidekazu Tanaka; Tomoe Yoshikawa; Rei Ishikawa; Ayana Okamoto; Tomohiro Yamazaki; Atsushi Nakai; Shunsuke Omoto; Kosuke Minaga; Kentaro Yamao; Mamoru Takenaka; Yasutaka Chiba; Tomohiro Watanabe; Takuya Nakai; Ippei Matsumoto; Yoshifumi Takeyama; Masatoshi Kudo
    Surgical endoscopy 36 5 3254 - 3260 2021年08月 
    BACKGROUND: The value of contrast-enhanced harmonic endoscopic ultrasonography (CH-EUS) for T-staging in patients with extrahepatic bile duct cancer was evaluated. METHODS: This single-center, retrospective study included consecutive patients with extrahepatic bile duct cancer who underwent surgical resection after preoperative EUS, CH-EUS, and contrast-enhanced CT (CE-CT) examinations between June 2014 and August 2017. The capacity of these modalities for T-staging of extrahepatic bile duct cancer was evaluated by assessing invasion beyond the biliary wall into the surrounding tissue, gallbladder, liver, pancreas, duodenum, portal vein system (portal vein and/or superior mesenteric vein), inferior vena cava, and hepatic arteries (proper hepatic artery, right. and/or left. hepatic artery). Blind reading of EUS, CH-EUS, and CE-CT images was performed by two expert reviewers each. RESULTS: 38 patients were eligible for analysis, of which eight had perihilar bile duct cancer and 30 had distal bile duct cancer. Postoperative T-staging was T1 in 6, T2 in 16, and T3 in 16 cases. CH-EUS was superior to CE-CT for diagnosing invasion beyond the biliary wall into surrounding tissue (92.1% vs. 45.9%, P = 0.0002); the ability to detect invasion to other organs did not differ significantly between the two modalities. The accuracy of CH-EUS for T-staging of tumors was better than that of CE-CT (73.7% vs. 39.5%, P = 0.0059). CH-EUS tended to have a better accuracy than EUS for the diagnosis of invasion beyond the biliary wall into the surrounding tissue (92.1% vs. 78.9%, P = 0.074) and T-staging (73.7% vs. 60.5%, P = 0.074). CONCLUSION: CH-EUS is useful for T-staging of extra hepatic bile duct cancer, especially in terms of invasion beyond the biliary wall into the surrounding tissue.
  • Ryutaro Takada; Kosuke Minaga; Akane Hara; Yasuo Otsuka; Shunsuke Omoto; Ken Kamata; Kentaro Yamao; Mamoru Takenaka; Satoru Hagiwara; Hajime Honjo; Shigenaga Matsui; Takaaki Chikugo; Tomohiro Watanabe; Masatoshi Kudo
    Journal of clinical medicine 10 16 2021年08月 
    Due to the tendency of gastric linitis plastica (GLP) to cause extensive submucosal infiltration, a superficial endoscopic biopsy sometimes yields no evidence of malignancy, hindering definite diagnosis. The present study was a single-center retrospective analysis of 54 consecutive patients diagnosed with GLP between 2016 and 2020 to evaluate EUS-guided fine-needle aspiration (EUS-FNA) biopsy outcomes in patients with negative endoscopic biopsy findings. A pathological GLP diagnosis was achieved by endoscopic biopsy in 40 patients (74.1%). EUS-FNA biopsy with a 22-gauge needle was performed in 13 of the remaining 14 patients, and GLP diagnosis was confirmed in 10 patients, with a median of three needle passes. The remaining four patients were laparoscopically diagnosed with GLP. The diagnostic ability of EUS-FNA biopsy for GLP was 76.9%, and EUS-FNA biopsy contributed to GLP diagnosis in 18.5% (10/54) of all cases. None of the 13 patients exhibited EUS-FNA biopsy-related adverse events. Univariable and multivariable analyses revealed an absence of superficial ulcerations as a predictor of false-negative endoscopic biopsy findings in patients with GLP. These results suggest EUS-FNA biopsy as a minimally invasive and safe alternative diagnostic modality for GLP in cases where conventional endoscopic biopsy fails to verify malignancy, although prospective studies with larger cohorts are warranted to confirm these findings.
  • 高島 耕太; 大本 俊介; 大塚 康生; 吉田 晃浩; 吉川 智恵; 岡本 彩那; 山崎 友裕; 三長 孝輔; 鎌田 研; 山雄 健太朗; 竹中 完; 工藤 正俊
    胆道 35 3 519 - 519 (一社)日本胆道学会 2021年08月
  • 局所進行切除不能膵癌に対するConversion surgeryのタイミング〜内科と外科の連携〜 当院における局所進行切除不能膵癌に対するconversion surgeryの短期・長期成績の検討
    吉田 雄太; 松本 逸平; 川口 晃平; 松本 正孝; 李 東河; 村瀬 貴昭; 亀井 敬子; 里井 俊平; 武部 敦志; 中居 卓也; 鎌田 研; 山雄 健太郎; 竹中 完; 竹山 宜典
    膵臓 36 3 A146 - A146 (一社)日本膵臓学会 2021年08月
  • 竹中 完; 高島 耕太; 田中 秀和; 福永 朋洋; 吉田 晃浩; 岡本 彩那; 山崎 友裕; 大本 俊介; 三長 孝輔; 鎌田 研; 山雄 健太郎; 工藤 正俊
    膵臓 36 3 A200 - A200 (一社)日本膵臓学会 2021年08月
  • 膵疾患におけるinterventional endoscopyの進歩 Walled-off necrosisに対するContrast enhanced EUS-guided cyst drainageの有用性
    竹中 完; 高島 耕太; 田中 秀和; 福永 朋洋; 吉田 晃浩; 岡本 彩那; 山崎 友裕; 大本 俊介; 三長 孝輔; 鎌田 研; 山雄 健太郎; 工藤 正俊
    膵臓 36 3 A200 - A200 (一社)日本膵臓学会 2021年08月
  • 膵癌診療ガイドライン2022の改訂作業の概況(診断)
    北野 雅之; 井上 大; 鎌田 研; 川井 学; 菅野 敦; 芹川 正浩; 祖父尼 淳; 高山 敬子; 花田 敬士; 松林 宏行
    膵臓 36 3 A91 - A91 (一社)日本膵臓学会 2021年08月
  • Yasuhiro Masuta; Yoriaki Komeda; Ikue Sekai; Akane Hara; Masayuki Kurimoto; Keisuke Yoshikawa; Yasuo Otsuka; Ryutaro Takada; Tomoe Yoshikawa; Ken Kamata; Kosuke Minaga; Osamu Maenishi; Tomohiro Watanabe; Masatoshi Kudo
    Asian Pacific journal of allergy and immunology 2021年07月 
    BACKGROUND: Granulomatosis with polyangiitis (GPA) is characterized by granulomatous inflammation, vasculitis, and elevated levels of serum proteinase 3 (PR3)-anti-neutrophil cytoplasmic antibody (PR3-ANCA). OBJECTIVE: We tried to characterize immune cells accumulated into the lung lesions of a GPA patient exhibiting spontaneous regression. METHODS: Transbronchial lung biopsy (TBLB) samples were subjected to immunohistochemical analyses. RESULTS: Multiple lung nodules were detected by CT. TBLB showed granulomatous inflammation and small vessel vasculitis. This case was diagnosed as GPA based on pathological findings and elevation of PR-3 ANCA levels. Spontaneous disappearance of multiple lung nodules was observed in CT. CD3+ T cells and CD20+ B cells accumulated in the inflammatory lesions surrounding the vessels whereas granulomatous inflammation was mainly comprised of CD3+ T cells and CD68+ macrophages, but not B cells or myeloperoxidase+ neutrophils. CONCLUSIONS: We characterized immune cell compositions of the lung lesions of a patient with GPA exhibiting spontaneous regression.
  • Rei Ishikawa; Ken Kamata; Tomohiro Watanabe
    Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society 33 5 878 - 879 2021年07月
  • Akihiro Yoshida; Mamoru Takenaka; Kota Takashima; Hidekazu Tanaka; Ayana Okamoto; Tomohiro Yamazaki; Atsushi Nakai; Shunsuke Omoto; Kosuke Minaga; Ken Kamata; Kentaro Yamao; Yoriaki Komeda; Naoshi Nishida; Masatoshi Kudo
    Journal of clinical medicine 10 13 2021年06月 
    Unsuccessful stent replacement in transpapillary biliary drainage with plastic stents (PSs) has a significant impact on patient prognosis; thus, a safe and reliable replacement method is required. We aimed to compare the snare-over-the-guidewire (SOG) method, wherein the PS lumen is used as an access route to the biliary tract and the PS is removed with a snare inserted via the inserted guidewire, with the conventional side-of-stent (SOS) method, wherein the biliary approach is performed from the side of the PS. This retrospective single-center study included 244 consecutive patients who underwent biliary PS replacement between January 2018 and July 2020. The procedural success rates were compared between the two methods. A predictive analysis of unsuccessful PS replacement was also performed. The procedural success rate in the SOG group was significantly higher than that in the SOS group (p = 0.026). In the proximal biliary stenosis lesion, the same trend was observed (p = 0.025). Multivariate analysis also showed that the SOS method (p = 0.0038), the presence of proximal biliary stenosis (p < 0.0001), and parapapillary diverticulum (p = 0.0007) were predictors of unsuccessful PS replacement. The SOG method may be useful for biliary PS replacement, especially in cases of proximal hilar bile duct stenosis.
  • Makoto Ueno; Chigusa Morizane; Takuji Okusaka; Junki Mizusawa; Tomoko Kataoka; Masafumi Ikeda; Masato Ozaka; Naohiro Okano; Kazuya Sugimori; Akiko Todaka; Satoshi Shimizu; Nobumasa Mizuno; Tomohisa Yamamoto; Keiji Sano; Kazutoshi Tobimatsu; Akio Katanuma; Atsushi Miyamoto; Hironori Yamaguchi; Tomohiro Nishina; Hirofumi Shirakawa; Yasushi Kojima; Takamasa Oono; Yasuyuki Kawamoto; Masayuki Furukawa; Tomohisa Iwai; Kentaro Sudo; Hiroyuki Miyakawa; Tatsuya Yamashita; Ichirou Yasuda; Hidenori Takahashi; Naoya Kato; Kazuhiko Shioji; Kyoko Shimizu; Toshio Nakagohri; Ken Kamata; Hiroshi Ishii; Junji Furuse
    Scientific reports 11 1 12885 - 12885 2021年06月 
    JCOG1113 is a randomized phase III trial in patients with advanced biliary tract cancers (BTCs) (UMIN000001685), and gemcitabine plus S-1 (GS) was not inferior to gemcitabine plus cisplatin (GC). However, poor renal function often results in high toxicity of S-1. Therefore, we examined whether GS can be recommended for patients with low creatinine clearance (CCr). Renal function was classified by CCr as calculated by the Cockcroft-Gault formula: high CCr (CCr ≥ 80 ml/min) and low CCr (80 > CCr ≥ 50 ml/min). Of 354 patients, 87 patients on GC and 91 on GS were included in the low CCr group, while there were 88 patients on GC and 88 patients on GS in the high CCr group. The HR of overall survival for GS compared with GC was 0.687 (95% CI 0.504-0.937) in the low CCr group. Although the total number of incidences of all Grade 3-4 non-haematological adverse reactions was higher (36.0% vs. 11.8%, p = 0.0002), the number of patients who discontinued treatment was not different (14.1% vs. 16.9%, p = 0.679) for GS compared with GC in the low CCr group. This study suggests that GS should be selected for the treatment of advanced BTC patients with reduced renal function.
  • Mamoru Takenaka; Makoto Hosono; Madan M Rehani; Yasutaka Chiba; Rei Ishikawa; Ayana Okamoto; Tomohiro Yamazaki; Atsushi Nakai; Shunsuke Omoto; Kosuke Minaga; Ken Kamata; Kentaro Yamao; Shiro Hayashi; Tsutomu Nishida; Masatoshi Kudo
    Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society 34 3 579 - 586 2021年06月 
    OBJECTIVES: The transpapillary drainage by endoscopic retrograde cholangiopancreatography (ERCP-D) cannot be performed without fluoroscopy, and there are many situations in which fluoroscopy is required even in endoscopic ultrasound-guided drainage (EUS-D). Previous studies have compared the efficacy, but not the radiation exposure of EUS-D and ERCP-D. While radiation exposure in ERCP-D has been previously evaluated, there is a paucity of information regarding radiation doses in EUS-D. This study aimed to assess radiation exposure in EUS-D compared with that in ERCP-D. METHODS: This retrospective single-center cohort study included consecutive patients who underwent EUS-D and ERCP-D between October 2017 and March 2019. The air kerma (AK, mGy), kerma-area product (KAP, Gycm2 ), fluoroscopy time (FT, min), and procedure time (PT, min) were assessed. The invasive probability weighting method was used to qualify the comparisons. RESULTS: We enrolled 372 and 105 patients who underwent ERCP-D and EUS-D, respectively. The mean AK, KAP, and FT in the EUS-D group were higher by 53%, 28%, and 27%, respectively, than those in the ERCP-D group, whereas PT was shorter by approximately 11% (AK, 135.0 vs. 88.4; KAP, 28.1 vs. 21.9; FT, 20.4 vs. 16.0; PT, 38.7 vs. 43.5). The sub-analysis limited to biliary drainage cases showed the same trend (AK, 128.3 vs. 90.9; KAP, 27.0 vs. 22.2; FT, 16.4 vs. 16.1; PT, 32.5 vs. 44.4). CONCLUSIONS: This is the first study to assess radiation exposure in EUS-D compared with that in ERCP-D. Radiation exposure was significantly higher in EUS-D than in ERCP-D, despite the shorter procedure time.
  • Masayuki Kitano; Yasunobu Yamashita; Ken Kamata; Tiing Leong Ang; Hiroo Imazu; Eizaburo Ohno; Yoshiki Hirooka; Pietro Fusaroli; Dong-Wan Seo; Bertrand Napoléon; Anthony Yuen Bun Teoh; Tae Hyeon Kim; Christoph F Dietrich; Hsiu-Po Wang; Masatoshi Kudo
    Ultrasound in medicine & biology 47 6 1433 - 1447 2021年06月 
    The Asian Federation of Societies for Ultrasound in Medicine and Biology aimed to provide information on techniques and indications for contrast-enhanced harmonic endoscopic ultrasound (CH-EUS), and to create statements including the level of recommendation. These statements are based on current scientific evidence reviewed by a Consensus Panel of 15 internationally renowned experts. The reliability of clinical questions was measured by agreement rates after voting. Six statements were made on techniques, including suitable contrast agents for CH-EUS, differences between contrast agents, setting of mechanical index, dual imaging and duration and phases for observation. Thirteen statements were made on indications, including pancreatic solid masses, pancreatic cancer staging, pancreatic cystic lesions and mural nodules, detection of subtle pancreatic lesions, gallbladder sludge and polyps, hepatic lesions, lymph nodes, subepithelial lesions, visceral vascular diseases, guidance of fine needle aspiration and evaluation for local therapy. These international expert consensus guidelines will assist endosonographers in conducting CH-EUS according to evidence-based information.
  • Akane Hara; Tomohiro Watanabe; Kosuke Minaga; Tomoe Yoshikawa; Ken Kamata; Masatoshi Kudo
    World journal of gastroenterology 27 19 2257 - 2269 2021年05月 
    Solitary organ autoimmune disorders, formerly known as autoimmune pancreatitis (AIP), autoimmune sialadenitis, and autoimmune sclerosing cholangitis, are now considered organ-specific manifestations of systemic immunoglobulin G4-related disease (IgG4-RD). AIP and IgG4-RD are characterized by elevated serum concentration of IgG4 antibody (Ab), accumulation of IgG4-expressing plasmacytes in the affected organs, and involvement of multiple organs. It is well established that enhanced IgG4 Ab responses are a hallmark of AIP and IgG4-RD for diagnosis and monitoring disease activity. However, a significant fraction of patients with AIP and IgG4-RD who develop chronic fibroinflammatory responses have normal serum concentrations of this IgG subtype. In addition, disease flare-up is sometimes seen even in the presence of normalized serum concentrations of IgG4 Ab after successful induction of remission by prednisolone. Therefore, it is necessary to identify new biomarkers based on the understanding of the pathophysiology of AIP and IgG4-RD. Recently, we found that activation of plasmacytoid dendritic cells producing both interferon-α (IFN-α) and interleukin-33 (IL-33) mediate murine AIP and human IgG4-RD. More importantly, we provided evidence that serum concentrations of IFN-α and IL-33 could be useful biomarkers for the diagnosis and monitoring of AIP and IgG4-RD activity after induction of remission in these autoimmune disorders. In this Frontier article, we have summarized and discussed biomarkers of AIP and IgG4-RD, including Igs, autoAbs, and cytokines to provide useful information not only for clinicians but also for researchers.
  • Satoru Hagiwara; Tomohiro Watanabe; Masatoshi Kudo; Kosuke Minaga; Yoriaki Komeda; Ken Kamata; Masatomo Kimura; Hidetoshi Hayashi; Kazuhiko Nakagawa; Kazuomi Ueshima; Yasunori Minami; Tomoko Aoki; Masahiro Takita; Masahiro Morita; Hirokazu Cishina; Hiroshi Ida; Ah-Mee Park; Naoshi Nishida
    Scientific reports 11 1 9242 - 9242 2021年04月 
    Immune checkpoint inhibitors (ICIs) targeting programmed cell death 1 (PD-1) and cytotoxic T-lymphocyte antigen-4 (CTLA-4) are widely used to treat advanced metastatic cancers. Neutralisation of PD-1 or CTLA-4 by ICIs results in immune-related adverse events (irAEs). The clinicopathological features of twelve patients with hepatic irAEs were evaluated and compared to those of ten patients with autoimmune hepatitis (AIH) or graft-versus-host disease (GVHD). No significant difference was seen in serum levels of transaminases, whereas serum levels of IgG and anti-nuclear antibody were higher in patients with AIH than in those with GVHD or hepatic irAEs. Inflammation was limited to the liver lobes in patients with GVHD or hepatic irAEs, whereas patients with AIH exhibited both portal and lobular inflammation. Immunohistochemical analyses revealed a predominant infiltration of CD8+ T cells and defective accumulation of regulatory T cells (Tregs) expressing forkhead box p3 (FOXP3) in the lobular areas of patients with hepatic irAEs and GVHD. In contrast, periportal lesions of patients with AIH were characterised by an infiltration of CD4+ T cells, CD8+ T cells, CD20+ B cells, and FOXP3+ Tregs. Overall, the activation of CD8+ T cells in the absence of activation of Tregs potentially underlies the immunopathogenesis of hepatic irAEs.
  • Tomohiro Yamazaki; Mamoru Takenaka; Shunsuke Omoto; Tomoe Yoshikawa; Rei Ishikawa; Ayana Okamoto; Atsushi Nakai; Kosuke Minaga; Ken Kamata; Kentaro Yamao; Yoriaki Komeda; Tomohiro Watanabe; Naoshi Nishida; Keiko Kamei; Ippei Matsumoto; Yoshifumi Takeyama; Takaaki Chikugo; Yasutaka Chiba; Masatoshi Kudo
    Journal of clinical medicine 10 9 2021年04月 
    This study aimed to investigate whether the incorporation of contrast-enhanced harmonic endoscopic ultrasound (CH-EUS) into the international consensus guidelines (ICG) for the management of intraductal papillary mucinous neoplasm (IPMN) could improve its malignancy diagnostic value. In this single-center retrospective study, 109 patients diagnosed with IPMN who underwent preoperative CH-EUS between March 2010 and December 2018 were enrolled. We analyzed each malignancy diagnostic value (sensitivity (Se), specificity (Sp), positive predictive value (PPV), and negative predictive value (NPV)) by replacing fundamental B-mode EUS with CH-EUS as the recommended test for patients with worrisome features (WF) (the CH-EUS incorporation ICG) and comparing the results to those obtained using the 2017 ICG. The malignancy diagnostic values as per the 2017 ICG were 78.9%, 42.3%, 60.0%, and 64.7% for Se, Sp, PPV, and NPV, respectively. The CH-EUS incorporation ICG plan improved the malignancy diagnostic values (Se 78.9%/Sp, 53.8%/PPV, 65.2%/NPV 70.0%). CH-EUS may be useful in determining the appropriate treatment strategies for IPMN.
  • Hajime Honjo; Tomohiro Watanabe; Natsuki Okai; Masashi Kono; Ken Kamata; Kosuke Minaga; Yoriaki Komeda; Shigeyoshi Tsuji; Masatoshi Kudo
    Asian Pacific journal of allergy and immunology 2021年04月 
    BACKGROUND: Despite the high incidence of spondyloarthritis (SpA) as an extra-intestinal manifestation of Crohn's disease (CD), the immunopathogenesis of CD-associated SpA remains largely unknown. OBJECTIVE: We tried to explore molecular mechanisms accounting for the development of CD-associated SpA in a patient successfully treated with infliximab. METHODS: Peripheral blood mononuclear cells (PBMCs) before infliximab treatment were stimulated with Toll-like receptor (TLR) ligands to measure pro-inflammatory cytokine responses. Endoscopic biopsy samples before and after infliximab treatment were subjected to quantitative polymerase chain reaction. RESULTS: PBMCs from this CD-associated SpA patient exhibited higher production of pro-inflammatory cytokines upon stimulation with TLR ligands than PBMCs from healthy controls. Induction of remission by infliximab was associated with the downregulation of pro-inflammatory cytokine responses in the small intestinal mucosa, which is continually exposed to TLR ligands. CONCLUSIONS: Excessive pro-inflammatory cytokine responses to TLR ligands might underlie the immunopathogenesis of CD-associated SpA.
  • Tomoe Yoshikawa; Kosuke Minaga; Akane Hara; Ikue Sekai; Yasuo Otsuka; Ryutaro Takada; Ken Kamata; Tomohiro Watanabe; Masatoshi Kudo
    Asian Pacific journal of allergy and immunology 2021年02月 
    BACKGROUND: Type 1 autoimmune pancreatitis (AIP) is a pancreatic manifestation of IgG4-related disease (IgG4-RD). Although AIP and IgG4-RD are characterized by multiple organ involvement including salivary glands, lung, and kidney, co-occurrence of chronic rhinosinusitis (CRS) and AIP/IgG4-RD has been poorly defined. OBJECTIVE: We explored molecular mechanism accounting for the co-occurrence of CRS and AIP/IgG4-RD. METHODS: Serum concentrations of IFN-α and IL-33 were measured by enzyme-linked immune-sorbent assay. RESULTS: We encountered a patient with concurrent type 1 AIP/IgG4-RD and CRS. Induction of remission by prednisolone (PSL) for type 1 AIP/IgG4-RD led to a marked improvement of CRS. Serum cytokine analysis after PSL treatment revealed a marked reduction in serum concentrations of IFN-α and IL-33, both of which are candidate pathogenic cytokines for AIP/IgG4-RD. CONCLUSIONS: Given that IL-33 is shared as one of pathogenic cytokines by type 1 AIP/IgG4-RD and CRS, enhanced IL33 responses may cause concurrent type 1 AIP/IgG4-RD and CRS.
  • Ken Kamata; Akira Kurita; Satoru Yasukawa; Yasutaka Chiba; Hiroko Nebiki; Masanori Asada; Hiroaki Yasuda; Hideyuki Shiomi; Takeshi Ogura; Makoto Takaoka; Noriyuki Hoki; Reiko Ashida; Minoru Shigekawa; Akio Yanagisawa; Masatoshi Kudo; Masayuki Kitano
    Endoscopic ultrasound 2021年02月 
    Background and Objectives: Differential diagnosis to estimate the malignant potential of gastric submucosal tumor (g-SMT) is important for decision-making. This study evaluated the use of a 20G needle with a core trap for EUS-guided fine-needle biopsy (EUS-FNB) for g-SMT. Methods: This multicentric prospective trial was registered in the University Hospital Medical Information Network (UMIN000021410). Consecutive patients with g-SMT who presented at one of the nine Japanese Referral Centers between June 2017 and November 2018 were enrolled. All patients underwent EUS-FNB using a 20G needle with a core trap. Samples obtained with the first-needle pass were used for central pathological review. EUS-FNB was evaluated in terms of (i) technical success rate, (ii) adequacy for histological evaluation, (iii) rate of complications, (iv) accuracy for histological diagnosis of gastrointestinal stromal tumor (GIST), and (v) concordance between GIST mitotic index determined by EUS-FNB and after tumor resection. Results: The study included 52 patients. The technical success rate of EUS-FNB was 100%. The adequacy rate for histological evaluation was 90.4% (P < 0.001). There were no complications related to EUS-FNB. Of the 38/52 patients who underwent surgical resection, 36 were finally diagnosed with GIST. The sensitivity, specificity, and accuracy of EUS-FNB for the histological diagnosis of g-SMT were 80.6%, 100%, and 81.6%, respectively. The concordance rate between the mitotic index on EUS-FNB and that after analysis of the resected tumor was 89.7%. Conclusions: EUS-FNB using a 20G needle with a core trap is feasible, providing histological samples of sufficient quality for diagnosing g-SMT.
  • Ikue Sekai; Tomohiro Watanabe; Keisuke Yoshikawa; Ryutaro Takada; Akane Hara; Tomoe Yoshikawa; Ken Kamata; Kosuke Minaga; Masatoshi Kudo
    Clinical journal of gastroenterology 2021年01月 
    Eosinophilic gastroenteritis (EGE) is a chronic allergic disorder characterized by infiltration of eosinophils in the gastrointestinal (GI) tract and hypereosinophilia. Although T helper type 2 (Th2) responses play pathogenic roles in EGE, roles of innate immunity cytokines including IL-6 and TNF-α have been poorly defined. Here, we describe a case of EGE exhibiting accumulation of eosinophils in the upper GI mucosa and hypereosinophilia. Induction of remission by prednisolone reduced expression levels not only of Th2 cytokines but also of IL-6 and TNF-α in the GI mucosa. Moreover, induction of remission was accompanied by a marked reduction in serum levels of chemokine C-C motif ligand 17 (CCL17, TARC), IL-6 and TNF-α, implicating that both Th2 and innate immune responses were involved in the development of EGE in this case. Collectively, this case suggests possible involvement of IL-6 and TNF-α in the development of EGE.
  • Masayuki Kurimoto; Tomohiro Watanabe; Ken Kamata; Kosuke Minaga; Masatoshi Kudo
    Frontiers in physiology 12 781012 - 781012 2021年 
    IL-33 is a pleiotropic cytokine that promotes inflammation and fibrosis. IL-33 is produced by a broad range of cells, including antigen-presenting cells (APCs), epithelial cells, and fibroblasts. IL-33 produced by the innate immune cells has been shown to activate pro-inflammatory T helper type 1 (Th1) and T helper type 2 (Th2) responses. The intestinal barrier and tolerogenic immune responses against commensal microbiota contribute to the maintenance of gut immune homeostasis. Breakdown of tolerogenic responses against commensal microbiota as a result of intestinal barrier dysfunction underlies the immunopathogenesis of inflammatory bowel diseases (IBD) and pancreatitis. Recent studies have provided evidence that IL-33 is an innate immune cytokine that bridges adaptive Th1 and Th2 responses associated with IBD and pancreatitis. In this Mini Review, we discuss the pathogenic roles played by IL-33 in the development of IBD and pancreatitis and consider the potential of this cytokine to be a new therapeutic target.
  • Tomoe Yoshikawa; Tomohiro Watanabe; Ken Kamata; Akane Hara; Kosuke Minaga; Masatoshi Kudo
    Frontiers in immunology 12 621532 - 621532 2021年 
    Autoimmune pancreatitis (AIP) is a chronic fibro-inflammatory disorder of the pancreas. Recent clinicopathological analysis revealed that most cases of AIP are pancreatic manifestations of systemic IgG4-related disease (IgG4-RD), a newly established disease characterized by enhanced IgG4 antibody responses and the involvement of multiple organs. Although the immuno-pathogenesis of AIP and IgG4-RD has been poorly defined, we recently showed that activation of plasmacytoid dendritic cells (pDCs) with the ability to produce large amounts of IFN-α and IL-33 mediates chronic fibro-inflammatory responses in experimental and human AIP. Moreover, M2 macrophages producing a large amount of IL-33 play pathogenic roles in the development of human IgG4-RD. Interestingly, recent studies including ours provide evidence that compositional alterations of gut microbiota are associated with the development of human AIP and IgG4-RD. In addition, intestinal dysbiosis plays pathological roles in the development of chronic pancreatic inflammation as dysbiosis mediates the activation of pDCs producing IFN-α and IL-33, thereby causing experimental AIP. In this Mini Review, we focus on compositional alterations of gut microbiota in AIP and IgG4-RD to clarify the mechanisms by which intestinal dysbiosis contributes to the development of these disorders.
  • Hajime Honjo; Tomohiro Watanabe; Ken Kamata; Kosuke Minaga; Masatoshi Kudo
    Frontiers in pharmacology 12 650403 - 650403 2021年 
    Inflammatory bowel diseases (IBDs) are becoming more frequent worldwide. A significant fraction of patients with IBD are refractory to various types of therapeutic biologics and small molecules. Therefore, identification of novel therapeutic targets in IBD is required. Receptor-interacting serine/threonine kinase 2 (RIPK2), also known as receptor-interacting protein 2 (RIP2), is a downstream signaling molecule for nucleotide-binding oligomerization domain 1 (NOD1), NOD2, and Toll-like receptors (TLRs). RIPK2 is expressed in antigen-presenting cells, such as dendritic cells and macrophages. Recognition of microbe-associated molecular patterns by NOD1, NOD2, and TLRs leads to the interaction between RIPK2 and these innate immune receptors, followed by the release of pro-inflammatory cytokines such as TNF-α, IL-6, and IL-12/23p40 through the activation of nuclear factor kappa B and mitogen-activated protein kinases. Thus, activation of RIPK2 plays a critical role in host defense against microbial infections. Recent experimental and clinical studies have provided evidence that activation of RIPK2 is involved in the development of autoimmune diseases, especially IBDs. In addition, the colonic mucosa of patients with IBD exhibits enhanced expression of RIPK2 and associated signaling molecules. Furthermore, the blockage of RIPK2 activation ameliorates the development of experimental murine colitis. Thus, activation of RIPK2 underlies IBD immunopathogenesis. In this review, we attempt to clarify the roles played by RIPK2 in the development of IBD by focusing on its associated signaling pathways. We also discuss the possibility of using RIPK2 as a new therapeutic target in IBD.
  • Keisuke Yoshikawa; Tomohiro Watanabe; Ikue Sekai; Ryutaro Takada; Akane Hara; Masayuki Kurimoto; Yasuhiro Masuta; Yasuo Otsuka; Tomoe Yoshikawa; Sho Masaki; Ken Kamata; Kosuke Minaga; Yoriaki Komeda; Takaaki Chikugo; Masatoshi Kudo
    Frontiers in medicine 8 679237 - 679237 2021年 
    Behçet's disease (BD) is a rare inflammatory condition characterized by oral and genital ulcers, skin lesions, as well as ophthalmological, neurological, and gastrointestinal manifestations. BD involving the gastrointestinal tract is known as intestinal BD. The mucosa of the gastrointestinal tract of patients with intestinal BD exhibits enhanced levels of proinflammatory cytokines, such as IL-1β, IL-6, and TNF-α. These proinflammatory cytokines play pathogenic roles in the development of BD, as evidenced by the fact that biologics targeting these cytokines effectively induce BD remission. It should be noted, however, that the molecular mechanisms by which the blockade of these cytokines suppresses chronic inflammatory responses in BD are poorly understood. Herein, we report a case of intestinal BD resistant to prednisolone that was successfully treated with infliximab (IFX). The induction of remission by IFX was accompanied by a marked elevation of IL-6 and forkhead box P3 (FOXP3) at mRNA level. This case suggests that induction of remission by IFX is mediated not only by the suppression of TNF-α-mediated signaling pathways, but also by the promotion of IL-6 expression and accumulation of regulatory T cells expressing FOXP3.
  • Ryutaro Takada; Tomohiro Watanabe; Ikue Sekai; Keisuke Yoshikawa; Akane Hara; Yasuo Otsuka; Tomoe Yoshikawa; Ken Kamata; Kosuke Minaga; Yoriaki Komeda; Takaaki Chikugo; Yasuyuki Arai; Kohei Yamashita; Masatoshi Kudo
    Frontiers in oncology 11 656219 - 656219 2021年 
    Double expressor lymphoma (DEL), defined as overexpression of BCL2 and MYC, is an aggressive subtype of diffuse large B cell lymphoma (DLBCL). Here we report a case of a 64-year-old female diagnosed with abdominal DEL transformed from jejunum follicular lymphoma (FL). 18F-fluorodeoxyglucose (FDG)-positron emission tomography showed diffuse accumulation of FDG into the peritoneum and small bowel wall. Double balloon-assisted enteroscopy revealed whitish submucosal tumors in the proximal jejunum. Aggregation of atypical lymphocytes positive for CD20, CD79a, and BCL2 was seen in the jejunal biopsy samples. These atypical lymphocytes were monoclonal since cell surface expression of Ig light chains was limited to κ chain by flow-cytometry. Thus, immunohistochemical and flowcytometric analyses data were consistent with FL of the jejunum. Neoplastic lymphocytes obtained from ascites were positive for CD10, CD20, CD79a, BCL2, and BCL6. Fluorescence in situ hybridization (FISH) showed formation of BCL2/IgH fusion gene and extra copies of MYC, the former of which is a characteristic chromosomal abnormality of FL. These genetic alterations and protein expression profiles of ascitic fluid cells were consistent with those of DEL transformed from FL. Given that a significant population of patients with indolent FL of the gastrointestinal tract developed into aggressive DLBCL, it is likely that primary FL of the jejunum transformed into the abdominal aggressive DEL in this case. This case is unique in that concurrent occurrence of FL and DEL was confirmed by immunohistochemical and FISH analyses and that abdominal DEL transformed from jejunal FL was highly suspected.
  • Hajime Honjo; Tomohiro Watanabe; Mizuki Tomooka; Takuya Matsubara; Masashi Kono; Ikue Sekai; Akane Hara; Masayuki Kurimoto; Keisuke Yoshikawa; Yasuhiro Masuta; Yasuo Otsuka; Ryutaro Takada; Tomoe Yoshikawa; Ken Kamata; Kosuke Minaga; Shigenaga Matsui; Masatomo Kimura; Masatoshi Kudo
    Frontiers in medicine 8 678268 - 678268 2021年 
    Collagenous colitis (CC), a prototypical microscopic colitis, is a chronic inflammatory disorder of the colon. The diagnosis of CC depends on the pathological examination. The colonic mucosa of patients with CC is characterized by the presence of a substantially thickened collagen band (>10μm) under the surface epithelium. In addition, intraepithelial and lamina propria lymphocytes are markedly increased in patients with CC. However, the roles played by the lymphocytes accumulating in the colonic mucosa of patients with CC are poorly defined. Recent studies indicate that T cells infiltrating the colonic mucosa of patients with CC are mainly represented by CD4+ T cells, CD8+ T cells, and forkhead box P3 (FOXP3)+ regulatory T cells (Tregs). Given that activation of CD4+/CD8+ T cells and FOXP3+ Tregs usually mediates pro-inflammatory and anti-inflammatory responses, respectively, alterations in the colonic numbers of these adaptive T cells might be related to the resolution of colitis in patients with CC. We determined alterations in the composition of colonic T cells by extensive immunohistochemical (IHC) analyses in a case of CC successfully treated with budesonide and metronidazole. Colonic lamina propria immune cells mainly comprised CD3+ T cells, CD4+ T cells, CD8+ T cells, CD68+ macrophages, and FOXP3+ Tregs, but not CD20+ B cells or myeloperoxidase (MPO)+ granulocytes in the active phase. During remission, the numbers of CD3+ T cells, CD4+ T cells, CD8+ T cells, and CD68+ macrophages did not change significantly in the colonic lamina propria, whereas FOXP3+ Tregs were markedly decreased, suggesting that induction of remission was achieved in a Treg-independent manner. Thus, our study indicates that accumulation of FOXP3+ Tregs in the colonic mucosa of patients with CC might be a counter-regulatory mechanism reflecting persistent inflammation and that induction of remission might be achieved without activation of Tregs.
  • Kosuke Minaga; Tomohiro Watanabe; Akane Hara; Tomoe Yoshikawa; Ken Kamata; Masatoshi Kudo
    Frontiers in immunology 12 713779 - 713779 2021年 
    Although plasmacytoid dendritic cells (pDCs) able to produce large amounts of type 1 interferons (IFN-I) play beneficial roles in host defense against viral infections, excessive activation of pDCs, followed by robust production of IFN-I, causes autoimmune disorders including systemic lupus erythematosus (SLE) and psoriasis. Autoimmune pancreatitis (AIP), which is recognized as a pancreatic manifestation of systemic immunoglobulin G4-related disease (IgG4-RD), is a chronic fibroinflammatory disorder driven by autoimmunity. IgG4-RD is a multi-organ autoimmune disorder characterized by elevated serum concentrations of IgG4 antibody and infiltration of IgG4-expressing plasmacytes in the affected organs. Although the immunopathogenesis of IgG4-RD and AIP has been poorly elucidated, recently, we found that activation of pDCs mediates the development of murine experimental AIP and human AIP/IgG4-RD via the production of IFN-I and interleukin-33 (IL-33). Depletion of pDCs or neutralization of signaling pathways mediated by IFN-I and IL-33 efficiently inhibited the development of experimental AIP. Furthermore, enhanced expression of IFN-I and IL-33 was observed in the pancreas and serum of human AIP/IgG4-RD. Thus, AIP and IgG4-RD share their immunopathogenesis with SLE and psoriasis because in all these conditions, IFN-I production by pDCs contributes to the pathogenesis. Because the enhanced production of IFN-I and IL-33 by pDCs promotes chronic inflammation and fibrosis characteristic for AIP and IgG4-RD, neutralization of IFN-I and IL-33 could be a new therapeutic option for these disorders. In this Mini Review, we discuss the pathogenic roles played by the pDC-IFN-I-IL-33 axis and the development of a new treatment targeting this axis in AIP and IgG4-RD.
  • K. Kamata; T. Watanabe; K. Minaga; A. Hara; I. Sekai; Y. Otsuka; T. Yoshikawa; A.‐M. Park; M. Kudo
    Clinical & Experimental Immunology 202 3 308 - 320 2020年12月
  • 三長 孝輔; 原 茜; 田中 秀和; 大本 俊介; 鎌田 研; 山雄 健太郎; 竹中 完; 工藤 正俊
    消化器内視鏡 32 11 1641 - 1649 (株)東京医学社 2020年11月
  • 【進化するEUS】診断的EUS 造影ハーモニックEUS
    三長 孝輔; 原 茜; 田中 秀和; 大本 俊介; 鎌田 研; 山雄 健太郎; 竹中 完; 工藤 正俊
    消化器内視鏡 32 11 1641 - 1649 (株)東京医学社 2020年11月
  • Rei Ishikawa; Ken Kamata; Akane Hara; Hidekazu Tanaka; Ayana Okamoto; Tomohiro Yamazaki; Atsushi Nakai; Shunsuke Omoto; Kosuke Minaga; Kentaro Yamao; Mamoru Takenaka; Yasunori Minami; Tomohiro Watanabe; Yasutaka Chiba; Takaaki Chikugo; Ippei Matsumoto; Yoshifumfi Takeyama; Yuko Matsukubo; Tomoko Hyodo; Masatoshi Kudo
    Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society 33 5 829 - 839 2020年10月 
    BACKGROUND AND AIMS: Pancreatic neuroendocrine neoplasms (PanNENs), including Grade 1 (G1) or G2 tumors, can have a poor prognosis. This study investigated the value of contrast-enhanced harmonic endoscopic ultrasonography (CH-EUS) for predicting the prognosis of PanNENs. METHODS: This single-center, retrospective study included 47 consecutive patients who underwent CH-EUS and were diagnosed with PanNEN by surgical resection or EUS-guided fine needle aspiration between December 2011 and February 2016. Patients were divided into aggressive and non-aggressive groups according to the degree of clinical malignancy. CH-EUS was assessed regarding its capacity for diagnosing aggressive PanNEN, the correspondence between contrast patterns and pathological features, and its ability to predict the prognosis of PanNEN. RESULTS: There were 19 cases of aggressive PanNEN and 28 cases of non-aggressive PanNEN. The aggressive group included three G1, four G2, three G3 tumors, three mixed neuroendocrine non-neuroendocrine neoplasms, and six neuroendocrine carcinomas. CH-EUS was superior to contrast-enhanced computed tomography for the diagnosis of aggressive PanNEN (P < 0.001): hypo-enhancement on CH-EUS was an indicator of aggressive PanNEN, with sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 94.7%, 100%, 100%, 96.6%, and 97.9%, respectively. Among G1/G2 PanNENs, cases with hypo-enhancement on CH-EUS had a poorer prognosis than those with hyper/iso-enhancement (P = 0.0009). Assessment of 36 resected specimens showed that hypo-enhancement on CH-EUS was associated with smaller and fewer vessels and greater degree of fibrosis. CONCLUSION: Contrast-enhanced harmonic endoscopic ultrasonography may be useful for predicting the prognosis of PanNENs.
  • 田中 隆光; 竹中 完; 吉田 晃弘; 田中 秀和; 吉川 智恵; 石川 嶺; 岡本 彩那; 山崎 友裕; 中井 敦史; 大本 俊輔; 三長 孝輔; 鎌田 研; 山雄 健太郎; 松本 逸平; 竹山 宜典; 工藤 正俊
    日本消化器病学会雑誌 117 臨増大会 A789 - A789 (一財)日本消化器病学会 2020年10月
  • 内視鏡的乳頭切除術後胆管狭窄に対する予防的金属ステント留置の有用性
    岡本 彩那; 竹中 完; 田中 隆光; 田中 秀和; 吉田 晃浩; 吉川 智恵; 石川 嶺; 山崎 友裕; 中井 敦史; 大本 俊介; 三長 孝輔; 鎌田 研; 山雄 健太郎; 工藤 正俊
    Gastroenterological Endoscopy 62 Suppl.2 2136 - 2136 (一社)日本消化器内視鏡学会 2020年10月
  • 急性膵炎におけるプレサルコペニアの臨床的意義に関しての検討
    田中 隆光; 竹中 完; 吉田 晃弘; 田中 秀和; 吉川 智恵; 石川 嶺; 岡本 彩那; 山崎 友裕; 中井 敦史; 大本 俊輔; 三長 孝輔; 鎌田 研; 山雄 健太郎; 松本 逸平; 竹山 宜典; 工藤 正俊
    日本消化器病学会雑誌 117 臨増大会 A789 - A789 (一財)日本消化器病学会 2020年10月
  • 内視鏡的乳頭切除術後胆管狭窄に対する予防的金属ステント留置の有用性
    岡本 彩那; 竹中 完; 田中 隆光; 田中 秀和; 吉田 晃浩; 吉川 智恵; 石川 嶺; 山崎 友裕; 中井 敦史; 大本 俊介; 三長 孝輔; 鎌田 研; 山雄 健太郎; 工藤 正俊
    Gastroenterological Endoscopy 62 Suppl.2 2136 - 2136 (一社)日本消化器内視鏡学会 2020年10月
  • Detective flow imaging(DFI)にて特徴的な腫瘍内血流を観察し得たIntraductal papillary neoplasm of the bile duct(IPNB)の1例
    尼崎 雅也; 大本 俊介; 吉田 晃浩; 田中 秀和; 石川 嶺; 岡本 彩那; 山崎 友裕; 中井 敦史; 三長 孝輔; 鎌田 研; 竹中 完; 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 113回 85 - 85 日本消化器病学会-近畿支部 2020年10月
  • Ken Kamata; Reiko Ashida; Satoru Yasukawa; Yasutaka Chiba; Nobuyasu Fukutake; Hiroko Nebiki; Akira Kurita; Makoto Takaoka; Takeshi Ogura; Hideyuki Shiomi; Masanori Asada; Hiroaki Yasuda; Minoru Shigekawa; Akio Yanagisawa; Masatoshi Kudo; Masayuki Kitano
    Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.] 20 7 1428 - 1433 2020年10月 
    OBJECTIVES: Preoperative grading of pancreatic neuroendocrine tumors (PanNET) is challenging. The aim of this study was to prospectively evaluate the use of a 25-gauge needle with a core trap for diagnosis and grading of PanNET. METHODS: This multicenter prospective trial was registered with the University Hospital Medical Information Network (UMIN000021409). Consecutive patients with suspected PanNET between June 2016 and November 2017 were enrolled. All patients underwent endoscopic ultrasound-guided fine needle biopsy (EUS-FNB) using a 25-gauge needle with a core trap. Samples obtained after the first needle pass were used for central pathological review. EUS-FNB was evaluated in terms of (i) technical success rate, (ii) adequacy for histological evaluation, (iii) complication rate during the procedure, and (iv) concordance between PanNET grading on EUS-FNB and that after analysis of the resected tumor. RESULTS: Fifty-two patients were enrolled. Of the 36/52 patients who underwent surgical resection, 31 were finally diagnosed with PanNET and were eligible for analysis. The technical success rate of EUS-FNB was 100%. The rate of adequacy for histological evaluation was 90.3%. There were no complications related to EUS-FNB. The concordance rate between PanNET grading on EUS-FNB and that after analysis of the resected tumor was 82.6% (95% confidence interval = 61.22-95.05, P = 0.579). CONCLUSIONS: EUS-FNB using a 25-gauge needle with a core trap is feasible, providing histological samples are of sufficient quality for diagnosis and grading of PanNET.
  • 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) 45 10 3081 - 3091 2020年10月 [査読有り]
     
    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.
  • Kosuke Minaga; Tomohiro Watanabe; Akane Hara; Ken Kamata; Shunsuke Omoto; Atsushi Nakai; Yasuo Otsuka; Ikue Sekai; Tomoe Yoshikawa; Kentaro Yamao; Mamoru Takenaka; Yasutaka Chiba; Masatoshi Kudo
    Scientific reports 10 1 14879 - 14879 2020年09月 
    IgG4-related disease (IgG4-RD) is a multi-organ autoimmune disease characterized by elevated serum IgG4 concentration. Although serum IgG4 concentration is widely used as a biomarker for IgG4-RD and type 1 autoimmune pancreatitis (AIP), a pancreatic manifestation of IgG4-RD, a significant number of patients have normal serum IgG4 levels, even in the active phase of the disease. Recently, we reported that the development of experimental AIP and human type 1 AIP is associated with increased expression of IFN-α and IL-33 in the pancreas. In this study, we assessed the utility of serum IFN-α and IL-33 levels as biomarkers for type 1 AIP and IgG4-RD. Serum IFN-α and IL-33 concentrations in patients who met the diagnostic criteria for definite type 1 AIP and/or IgG4-RD were significantly higher than in those with chronic pancreatitis or in healthy controls. Strong correlations between serum IFN-α, IL-33, and IgG4 concentrations were observed. Diagnostic performance of serum IFN-α and IL-33 concentrations as markers of type 1 AIP and/or IgG4-RD was comparable to that of serum IgG4 concentration, as calculated by the receiver operating characteristic curve analysis. Induction of remission by prednisolone treatment markedly decreased the serum concentration of these cytokines. We conclude that serum IFN-α and IL-33 concentrations can be useful as biomarkers for type 1 AIP and IgG4-RD.
  • Hajime Honjo; Tomohiro Watanabe; Yasuyuki Arai; Ken Kamata; Kosuke Minaga; Yoriaki Komeda; Kouhei Yamashita; Masatoshi Kudo
    International immunology 33 2 91 - 105 2020年09月 
    Polymorphisms in the autophagy-related protein 16 like 1 (ATG16L1) and nucleotide-binding oligomerization domain 2 (NOD2) genes are associated with Crohn's disease (CD). Impaired interaction between ATG16L1 and NOD2 underlies CD immunopathogenesis. Although activation of the receptor-interacting serine/threonine kinase (RICK, also known as RIP2), a downstream signaling molecule for NOD2 and multiple toll-like receptors (TLRs), plays a pathogenic role in the development of inflammatory bowel disease, the molecular interaction between ATG16L1 and RICK/RIP2 remains poorly understood. In this study, we examined the physical interaction between ATG16L1 and RICK/RIP2 in human embryonic kidney 293 (HEK293) cells and human monocyte-derived dendritic cells (DCs) expressing excessive and endogenous levels of these proteins, respectively. We established that ATG16L1 binds to RICK/RIP2 kinase domain and negatively regulates TLR2-mediated nuclear factor-kappa B (NF-κB) activation and proinflammatory cytokine responses by inhibiting the interaction between TLR2 and RICK/RIP2. Binding of ATG16L1 to RICK/RIP2 suppressed NF-κB activation by downregulating RICK/RIP2 polyubiquitination. Notably, the percentage of colonic DCs expressing ATG16L1 inversely correlated with IL-6 and TNF-α expression levels in the colon of CD patients. These data suggest that the interaction between ATG16L1 and RICK/RIP2 maintains intestinal homeostasis via the downregulation of TLR-mediated proinflammatory cytokine responses.
  • 山雄 健太郎; 竹中 完; 田中 秀和; 田中 隆光; 吉田 晃浩; 石川 嶺; 岡本 彩那; 中井 敦; 山崎 友裕; 大本 俊介; 鎌田 研; 三長 孝輔; 渡邉 智裕; 工藤 正俊
    胆と膵 41 8 713 - 718 医学図書出版(株) 2020年08月 
    膵癌は予後不良な癌腫であり、予後改善が急務である。小膵癌の場合、CTやMRIでの直接指摘が困難であるため、尾側膵管拡張を伴う主膵管狭窄などの間接所見が診断の契機となる。しかしながら主膵管狭窄は慢性膵炎などの良性疾患でも認められる。近年、上皮内癌を含む腫瘍径10mm以下の微小膵癌において膵実質の部分萎縮(やせ)が診断の指標になるとの報告が散見される。ただし膵臓は膵頭部が膨大している、門脈から腹側へ圧排を受けるなどの構造をしているため、通常のCTでは萎縮がやや評価しにくい。3D-CTは本来立体構造をした膵臓をそのまま3D画像として可視化できるため、この技術を用いて膵臓を抽出することで膵実質の萎縮を直感的かつ簡便に評価できる。3D-CTによる膵実質の萎縮評価は膵癌の早期診断および予後改善に寄与すると考える。(著者抄録)
  • 【肝胆膵における結石診療のベストプラクティス】胆嚢結石症 Confluence stoneとMirizzi症候群はどう違うのか Biliobiliary fistulaと合わせて
    竹中 完; 石川 嶺; 岡本 彩那; 山崎 友裕; 中井 敦史; 大本 俊介; 三長 孝輔; 鎌田 研; 山雄 健太郎; 工藤 正俊
    肝・胆・膵 81 2 305 - 312 (株)アークメディア 2020年08月
  • Saki Yoshida; Mariko Matsumura; Kiyoshi Maekawa; Kosuke Minaga; Ken Kamata; Masahiro Nozawa; Tomohiro Watanabe; Masatoshi Kudo
    Clinical journal of gastroenterology 13 4 621 - 625 2020年08月 [査読有り]
     
    Nephroptosis is a benign disorder defined as a significant descent of the affected kidney as the patient moves from supine to erect. Patients with nephroptosis sometimes manifest symptoms including abdominal pain, back pain, nausea and hematuria, while the majority of those are asymptomatic. Downward migration of the affected kidney induced by a postural change from the supine to the upright position underlies the pathophysiology of nephroptosis. The diagnosis of nephroptosis is difficult since routine imaging examinations are conducted in the supine position alone. Here, we report a case presenting recurrent abdominal pain due to unknown causes. This patient was successfully diagnosed as nephroptosis by ultrasonography and drip infusion pyelography, both of which were performed in both supine and upright positions. This case report strongly suggests that we need to take into consideration a possibility of nephroptosis when we encounter with patients complaining abdominal and/or back pain due to unknown causes.
  • Sho Masaki; Tomohiro Watanabe; Kosuke Minaga; Ken Kamata; Yoriaki Komeda; Masatomo Kimura; Masatoshi Kudo
    Clinical journal of gastroenterology 13 4 473 - 476 2020年08月 [査読有り]
     
    Although patients with anorexia nervosa (AN) present with various gastrointestinal disorders, little has been understood regarding the incidence and pathophysiology of gastrointestinal ulcers related to AN. A 20-year-old woman with a past history of AN was hospitalized for further examination of dysphagia and chest pain. Her nutritional status was very poor as evidenced by very low body mass index. Esophagogastroduodenoscopy detected longitudinal and geographical ulcers in the entire circumference of the cervical and upper esophagus. Enhanced expression of autophagy-related proteins, LC3B and p62, was seen in the esophageal epithelium surrounding the active ulcers. Expression of these autophagy markers disappeared from the esophageal epithelium soon after the nutritional rehabilitation. Given the fact that starvation and malnutrition are potent inducers for autophagy, these findings suggest that autophagy might be involved in the development of gastrointestinal ulcers in patients with AN.
  • 原 茜; 三長 孝輔; 吉川 智恵; 鎌田 研; 渡邉 智裕; 工藤 正俊
    日本消化器病学会雑誌 117 臨増総会 A299 - A299 (一財)日本消化器病学会 2020年07月
  • 竹中 完; 石川 嶺; 岡本 彩那; 中井 敦史; 山崎 友裕; 大本 俊介; 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 35 3 A209 - A209 (一社)日本膵臓学会 2020年07月
  • 石川 嶺; 鎌田 研; 田中 秀和; 岡本 彩那; 山崎 友裕; 中井 敦史; 大本 俊介; 三長 孝輔; 竹中 完; 工藤 正俊
    膵臓 35 3 A367 - A367 (一社)日本膵臓学会 2020年07月
  • 岡本 彩那; 鎌田 研; 河野 辰哉; 田中 秀和; 石川 嶺; 山崎 友裕; 中井 敦史; 大本 俊介; 三長 孝輔; 山雄 健太郎; 竹中 完; 工藤 正俊
    日本消化器病学会雑誌 117 臨増総会 A389 - A389 (一財)日本消化器病学会 2020年07月
  • 原 茜; 三長 孝輔; 吉川 智恵; 鎌田 研; 渡邉 智裕; 工藤 正俊
    日本消化器病学会雑誌 117 臨増総会 A299 - A299 (一財)日本消化器病学会 2020年07月
  • 岡本 彩那; 鎌田 研; 河野 辰哉; 田中 秀和; 石川 嶺; 山崎 友裕; 中井 敦史; 大本 俊介; 三長 孝輔; 山雄 健太郎; 竹中 完; 工藤 正俊
    日本消化器病学会雑誌 117 臨増総会 A389 - A389 (一財)日本消化器病学会 2020年07月
  • 急性膵炎に対する局所合併症治療 Walled-off necrosisに対するLAMS with 10 FrENCD持続洗浄治療の有用性について
    竹中 完; 石川 嶺; 岡本 彩那; 中井 敦史; 山崎 友裕; 大本 俊介; 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 35 3 A209 - A209 (一社)日本膵臓学会 2020年07月
  • PanNETG1/G2における造影ハーモニックEUSの悪性度評価の有用性に関する検討
    石川 嶺; 鎌田 研; 田中 秀和; 岡本 彩那; 山崎 友裕; 中井 敦史; 大本 俊介; 三長 孝輔; 竹中 完; 工藤 正俊
    膵臓 35 3 A367 - A367 (一社)日本膵臓学会 2020年07月
  • 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 (Basel, Switzerland) 10 7 445 - 445 2020年07月 [査読有り]
     
    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.
  • Jae Young Lee; Yasunori Minami; Byung Ihn Choi; Won Jae Lee; Yi-Hong Chou; Woo Kyoung Jeong; Mi-Suk Park; Nobuki Kudo; Min Woo Lee; Ken Kamata; Hiroko Iijima; So Yeon Kim; Kazushi Numata; Katsutoshi Sugimoto; Hitoshi Maruyama; Yasukiyo Sumino; Chikara Ogawa; Masayuki Kitano; Ijin Joo; Junichi Arita; Ja-Der Liang; Hsi-Ming Lin; Christian Nolsoe; Odd Helge Gilja; Masatoshi Kudo
    Ultrasonography (Seoul, Korea) 39 3 191 - 220 2020年07月 [査読有り]
     
    The first edition of the guidelines for the use of ultrasound contrast agents was published in 2004, dealing with liver applications. The second edition of the guidelines in 2008 reflected changes in the available contrast agents and updated the guidelines for the liver, as well as implementing some nonliver applications. The third edition of the contrast-enhanced ultrasound (CEUS) guidelines was the joint World Federation for Ultrasound in Medicine and Biology-European Federation of Societies for Ultrasound in Medicine and Biology (WFUMB-EFSUMB) venture in conjunction with other regional US societies such as Asian Federation of Societies for Ultrasound in Medicine and Biology, resulting in a simultaneous duplicate on liver CEUS in the official journals of both WFUMB and EFSUMB in 2013. However, no guidelines were described mainly for Sonazoid due to limited clinical experience only in Japan and Korea. The new proposed consensus statements and recommendations provide general advice on the use of Sonazoid and are intended to create standard protocols for the use and administration of Sonazoid in hepatic and pancreatobiliary applications in Asian patients and to improve patient management.
  • 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 93 2 433 - 441 2020年06月 [査読有り]
     
    BACKGROUND AND AIMS: Kupffer-phase imaging visualized by perfluorobutane (Sonazoid) distribution into normal liver tissues upon phagocytosis by Kupffer cells potentially aids in improving detection of liver metastasis compared with fundamental B-mode EUS (FB-EUS). However, the diagnostic performance of Kupffer-phase imaging in contrast-enhanced harmonic EUS (CH-EUS) remains unclear. Hence, this study aimed to evaluate the usefulness of CH-EUS-based Kupffer-phase imaging for diagnosing liver metastasis from pancreatic cancer. METHODS: We retrospectively analyzed consecutive patients with pancreatic cancer who underwent contrast-enhanced CT (CE-CT) and FB-EUS, followed by CH-EUS, from 2011 to 2017. The diagnostic ability of CH-EUS against that of CE-CT and FB-EUS for metastasis in the left liver lobe was compared. Subsequently, the influences of CH-EUS on the determination of clinical stage and patient management for pancreatic cancer were assessed. RESULTS: We enrolled 426 patients with pancreatic cancer. Metastasis in the left liver lobe was present in 27.2% of patients. The diagnostic accuracy of CE-CT, FB-EUS, and CH-EUS was 90.6%, 93.4%, and 98.4%, respectively. The sensitivity and diagnostic accuracy of CH-EUS for metastasis in the left liver lobe were significantly higher than those of FB-EUS or CE-CT. The sensitivity of CH-EUS for detecting small liver metastasis (<10 mm) was considerably higher than that of CE-CT or FB-EUS (P < .001). In 2.1% of patients, only CH-EUS could detect a single distant metastasis of the left liver lobe, thereby upgrading the tumor staging and altering the clinical management. CONCLUSIONS: CH-EUS-based Kupffer-phase imaging increased the detectability of metastasis in the left liver lobe. This technique could be a reliable pretreatment imaging modality for clinical decision-making in patients with pancreatic cancer.
  • 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 32 6 862 - 864 (株)東京医学社 2020年06月
  • 渡邉 智裕; 吉川 智恵; 原 茜; 鎌田 研; 三長 孝輔; 工藤 正俊
    炎症と免疫 28 4 310 - 314 (株)先端医学社 2020年06月 
    IgG4関連疾患の病態生理については明らかになっていないものの、研究者らは自己抗原の同定・獲得免疫反応の解明・自然免疫反応の解明の3つのアプローチから病態に迫っている。IgG4関連疾患の病態にかかわる自然免疫担当細胞として、形質細胞様樹状細胞・M2マクロファージ・好塩基球が同定されている。さらに、IFN-α・IL-33などのサイトカインが慢性炎症や線維化を誘導すると考えられている。IgG4関連疾患の発症にかかわる自然免疫反応の解明は、病態生理の解明のみならず新規治療法の開発にもつながる可能性がある。(著者抄録)
  • Kosuke Minaga; Tomohiro Watanabe; Yasuyuki Arai; Masahiro Shiokawa; Akane Hara; Tomoe Yoshikawa; Ken Kamata; Kouhei Yamashita; Masatoshi Kudo
    Journal of gastroenterology 55 5 565 - 576 2020年05月 [査読有り]
     
    BACKGROUND: Excessive type I IFN (IFN-I) production by plasmacytoid dendritic cells (pDCs) promotes autoimmunity. Recently, we reported that a prominent feature of both experimental autoimmune pancreatitis (AIP) and human type 1 AIP is pDC activation followed by enhanced production of IFN-I and IL-33. However, the roles played by interferon regulatory factor 7 (IRF7), a critical transcription factor for IFN-I production in pDCs, in these disorders have not been clarified. METHODS: Whole and nuclear extracts were isolated from pancreatic mononuclear cells (PMNCs) from MRL/MpJ mice exhibiting AIP. Expression of phospho-IRF7 and nuclear translocation of IRF7 was examined in these extracts by immunoblotting. Pancreatic expression of IRF7 was assessed by immunofluorescence analysis in experimental AIP. Nuclear translocation of IRF7 upon exposure to neutrophil extracellular traps (NETs) was assessed in peripheral blood pDCs from type 1 AIP patients. Pancreatic IRF7 expression was examined in surgically operated specimens from type 1 AIP patients. RESULTS: IRF7 activation was induced in pancreatic pDCs in experimental AIP. siRNA-mediated knockdown of IRF7 expression prevented AIP development, which was accompanied by a marked reduction in both pancreatic accumulation of pDCs and production of IFN-α and IL-33. Notably, in peripheral blood pDCs isolated from patients with type 1 AIP, nuclear translocation of IRF7 was enhanced as compared with the translocation in pDCs from healthy controls. Furthermore, IRF7-expressing pDCs were detected in the pancreas of patients with type 1 AIP. CONCLUSIONS: These findings suggest that the IRF7-IFN-I-IL-33 axis activated in pDCs drives pathogenic innate immune responses associated with type 1 AIP.
  • Kosuke Minaga; Mamoru Takenaka; Ayana Okamoto; Shunsuke Omoto; Ken Kamata; Kentaro Yamao; Masatoshi Kudo
    Endoscopy 52 5 E152-E153  2020年05月 [査読有り]
  • Jae Young Lee; Yasunori Minami; Byung Ihn Choi; Won Jae Lee; Yi-Hong Chou; Woo Kyoung Jeong; Mi-Suk Park; Nobuki Kudo; Min Woo Lee; Ken Kamata; Hiroko Iijima; So Yeon Kim; Kazushi Numata; Katsutoshi Sugimoto; Hitoshi Maruyama; Yasukiyo Sumino; Chikara Ogawa; Masayuki Kitano; Ijin Joo; Junichi Arita; Ja-Der Liang; Hsi-Ming Lin; Christian Nolsoe; Odd Helge Gilja; Masatoshi Kudo
    Journal of Medical Ultrasound 28 2 59 - 82 2020年04月 
    The first edition of the guidelines for the use of ultrasound contrast agents was published in 2004, dealing with liver applications. The second edition of the guidelines in 2008 reflected changes in the available contrast agents and updated the guidelines for the liver, as well as implementing some nonliver applications. The third edition of the contrast-enhanced ultrasound (CEUS) guidelines was the joint World Federation for Ultrasound in Medicine and Biology-European Federation of Societies for Ultrasound in Medicine and Biology (WFUMB-EFSUMB) venture in conjunction with other regional US societies such as Asian Federation of Societies for Ultrasound in Medicine and Biology, resulting in a simultaneous duplicate on liver CEUS in the official journals of both WFUMB and EFSUMB in 2013. However, no guidelines were described mainly for Sonazoid due to limited clinical experience only in Japan and Korea. The new proposed consensus statements and recommendations provide general advice on the use of Sonazoid and are intended to create standard protocols for the use and administration of Sonazoid in hepatic and pancreatobiliary applications in Asian patients and to improve patient management.
  • 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 26 9 947 - 959 2020年03月 [査読有り]
     
    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.
  • 竹中 完; 中井 敦史; 大本 俊輔; 三長 孝輔; 鎌田 研; 山雄 健太郎; 工藤 正俊
    消化器内視鏡 32 3 358 - 364 (株)東京医学社 2020年03月 [査読有り]
  • 【EUSの現状と将来】診断 造影ハーモニック超音波内視鏡の実際と将来展望
    鎌田 研; 原 茜; 岡本 彩那; 山崎 友裕; 中井 敦史; 大本 俊介; 三長 孝輔; 山雄 健太郎; 竹中 完; 工藤 正俊
    肝・胆・膵 80 3 403 - 411 (株)アークメディア 2020年03月 [査読有り]
  • 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 34 3 1432 - 1441 2020年03月 [査読有り]
     
    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.
  • 【慢性膵炎診療2020】基礎研究・病態 腸内細菌は慢性膵炎発症に関連するのか
    渡邉 智裕; 三長 孝輔; 原 茜; 鎌田 研; 工藤 正俊
    肝・胆・膵 80 2 241 - 246 (株)アークメディア 2020年02月 [査読有り]
  • 【慢性膵炎診療2020】診断 早期慢性膵炎のEUS所見は特異的か 加齢や他疾患の影響は
    竹中 完; 中井 敦史; 大本 俊介; 三長 孝輔; 鎌田 研; 山雄 健太郎; 渡邉 智裕; 松本 逸平; 竹山 宜典; 工藤 正俊
    肝・胆・膵 80 2 295 - 302 (株)アークメディア 2020年02月 [査読有り]
  • 北野 雅之; 糸井 隆夫; 高山 敬子; 鎌田 研; 菅野 敦; 高岡 亮; 芹川 正浩; 川井 学; 高折 恭一; 花田 敬士
    膵臓 35 1 47 - 51 日本膵臓学会 2020年02月 [査読有り]
     
    膵癌診療ガイドラインが2019年7月に改訂された。疾患概念・診断法部門では、2016年版と比較して、一部を変更したうえで新設クリニカルクエスチョン(CQ)7項目、1コラムを追加し、合計14項目のCQおよび2つのコラムが作成された。「疾患概念」と、「診断法」の一部のCQは総論のなかで紹介することとなった。一方で、診断ストラテジーをより詳細に述べるために、「診断法」を「存在・確定診断」、「病期・切除可能性診断」に大別したうえで、ぞれぞれの画像検査に関するCQを作成し、特徴・位置付けを明瞭化した。特に、PET検査は、存在・確定診断には行わないことを提案するが、病期・切除可能性診断には行うことを提案することとなった。病理診断法についても、EUS-FNAおよびERCPに関するCQを追加し、それぞれの使い分けの指針を示すこととした。また、病診連携を生かした膵癌早期診断に関するコラムを記載した。(著者抄録)
  • 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) 45 10 3081 - 3091 2020年01月 [査読有り]
     
    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.
  • Ken Kamata; Tomohiro Watanabe; Kosuke Minaga; Akane Hara; Tomoe Yoshikawa; Ayana Okamoto; Kentaro Yamao; Mamoru Takenaka; Ah-Mee Park; Masatoshi Kudo
    International immunology 31 12 795 - 809 2019年11月 [査読有り]
     
    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.
  • Mamoru Takenaka; Ken Kamata; Masatoshi Kudo
    Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society 31 6 718 - 718 2019年11月 [査読有り]
  • EUS施行時のプロポフォール持続注入による鎮静の有用性の検討
    岡本 彩那; 鎌田 研; 竹中 完; 吉川 智恵; 石川 嶺; 山崎 友裕; 中井 敦史; 大本 俊介; 三長 孝輔; 山雄 健太郎; 工藤 正俊
    Gastroenterological Endoscopy 61 Suppl.2 2182 - 2182 (一社)日本消化器内視鏡学会 2019年10月 [査読有り]
  • Tomohiro Watanabe; Kosuke Minaga; Ken Kamata; Toshiharu Sakurai; Yoriaki Komeda; Tomoyuki Nagai; Atsushi Kitani; Masaki Tajima; Ivan J Fuss; Masatoshi Kudo; Warren Strober
    International immunology 31 10 669 - 683 2019年09月 [査読有り]
     
    Previous studies have shown that inhibition of receptor-interacting serine/threonine kinase (RICK) (also known as RIP2) results in amelioration of experimental colitis. This role has largely been attributed to nucleotide-binding oligomerization domain 2 (NOD2) signaling since the latter is considered a major inducer of RICK activation. In this study, we explored the molecular mechanisms accounting for RICK-mediated inhibition of inflammatory bowel disease (IBD). In an initial series of studies focused on trinitrobenzene sulfonic acid (TNBS)-colitis and dextran sodium sulfate (DSS)-colitis we showed that down-regulation of intestinal RICK expression in NOD2-intact mice by intra-rectal administration of a plasmid expressing RICK-specific siRNA was accompanied by down-regulation of pro-inflammatory cytokine responses in the colon and protection of the mice from experimental colitis. Somewhat surprisingly, intra-rectal administration of RICK-siRNA also inhibited TNBS-colitis and DSS-colitis in NOD2-deficient and in NOD1/NOD2-double deficient mice. In complementary studies of humans with IBD we found that expression of RICK, cellular inhibitor of apoptosis protein 2 (cIAP2) and downstream signaling partners were markedly increased in inflamed tissue of IBD compared to controls without marked elevations of NOD1 or NOD2 expression. In addition, the increase in RICK expression correlated with disease activity and pro-inflammatory cytokine responses. These studies thus suggest that NOD1- or NOD2-independenent activation of RICK plays a major role in both murine experimental colitis and human IBD.
  • Ayana Okamoto; Kosuke Minaga; Mamoru Takenaka; Tomoe Yoshikawa; Ken Kamata; Kentaro Yamao; Masatoshi Kudo
    Endoscopy 51 9 E255-E256  2019年09月 [査読有り]
  • 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 51 8 1130 - 1134 2019年08月 [査読有り]
     
    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.
  • Hidekazu Tanaka; Tomohiro Watanabe; Tomoyuki Nagai; Kosuke Minaga; Ken Kamata; Yoriaki Komeda; Masatoshi Kudo
    Clinical journal of gastroenterology 12 4 316 - 319 2019年08月 [査読有り]
     
    Klebsiella oxytoca (K. oxytoca) is a causative organism for hemorrhagic antibiotic-associated colitis. K. oxytoca infection is a typical example of microbial substitution diseases caused by exposure to antibiotics prior to the onset of diarrhea. Here, we repot a case with ileitis associated with K. oxytoca infection in the absence of preceding antibiotic treatment. Interestingly, abdominal computed tomography revealed wall thickening of the ileum and hepatic portal venous gas (HPVG). K. oxytoca was isolated from the stool. This very elderly patient had been treated with azathioprine for long-standing history of ulcerative colitis. Immuno-compromised state of this patient was considered to allow overgrowth of K. oxytoca in the small bowel to cause not only ileitis but also HPVG.
  • 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) 58 14 1993 - 2002 2019年07月 [査読有り]
     
    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.
  • Masashi Kono; Toshiharu Sakurai; Kazuki Okamoto; Tomoyuki Nagai; Yoriaki Komeda; Hiroshi Kashida; Kosuke Minaga; Ken Kamata; Mamoru Takenaka; Satoru Hagiwara; Tomohiro Watanabe; Naoshi Nishida; Eisuke Enoki; Hiroaki Inoue; Itaru Matsumura; Masatoshi Kudo
    Internal medicine (Tokyo, Japan) 58 14 2029 - 2033 2019年07月 [査読有り]
     
    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.
  • Minaga Kosuke; Takenaka Mamoru; Yoshikawa Tomoe; Okamoto Ayana; Ishikawa Rei; Yamazaki Tomohiro; Nakai Atsushi; Omoto Shunsuke; Kamata Ken; Yamao Kentaro; Kudo Masatoshi
    GASTROINTESTINAL ENDOSCOPY 89 6 AB299  2019年06月 [査読有り]
  • Okamoto Ayana; Kamata Ken; Takenaka Mamoru; Yoshikawa Tomoe; Ishikawa Rei; Yamazaki Tomohiro; Nakai Atsushi; Omoto Shunsuke; Minaga Kosuke; Yamao Kentaro; Kudo Masatoshi
    GASTROINTESTINAL ENDOSCOPY 89 6 AB602 - AB603 2019年06月 [査読有り]
  • Omoto Shunsuke; Takenaka Mamoru; Ishikawa Rei; Okamoto Ayana; Nakai Atsushi; Yamazaki Tomohiro; Minaga Kosuke; Kamata Ken; Yamao Kentaro; Kudo Masatoshi
    GASTROINTESTINAL ENDOSCOPY 89 6 AB584  2019年06月 [査読有り]
  • Takenaka Mamoru; Yoshikawa Tomoe; Ishikawa Rei; Okamoto Ayana; Yamazaki Tomohiro; Nakai Atsushi; Omoto Shunsuke; Minaga Kosuke; Kamata Ken; Yamao Kentaro; Kudo Masatoshi
    GASTROINTESTINAL ENDOSCOPY 89 6 AB223  2019年06月 [査読有り]
  • 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 89 6 AB444 - AB445 2019年06月 [査読有り]
  • Minaga K; Watanabe T; Kamata K; Takenaka M; Yasukawa S; Kudo M
    The American journal of gastroenterology 114 6 1002 - 1003 2019年06月 [査読有り]
  • Ayana Okamoto; Tomohiro Watanabe; Ken Kamata; Kosuke Minaga; Masatoshi Kudo
    Internal medicine (Tokyo, Japan) 58 11 1533 - 1539 2019年06月 [査読有り]
     
    Autoimmune pancreatitis (AIP) is now considered a pancreatic manifestation of a newly proposed disease condition, IgG4-related disease (IgG4-RD). IgG4-RD is characterized by enhanced IgG4 antibody responses and multiple organ involvements. Recent epidemiological studies have addressed the incidence of cancer in patients with AIP and/or IgG4-RD. Surprisingly, a significant number of AIP patients were detected with cancer at or within one year of the diagnosis of AIP. Furthermore, around 50% of all cancers detected in AIP patients comprised mainly 3 types (gastric, lung, and prostate cancer). Thus, AIP appears to be associated with cancer of other organs rather than the pancreas itself, which suggests that AIP is not a pre-cancerous condition of the pancreas. Moreover, the simultaneous occurrence of cancer and AIP in many patients has led to the establishment of an attractive concept that AIP might sometimes arise from co-existing cancers as a paraneoplastic syndrome.
  • Akane Hara; Ken Kamata; Mamoru Takenaka; Takaaki Chikugo; Masatoshi Kudo
    Gastrointestinal endoscopy 89 6 1257 - 1259 2019年06月 [査読有り]
  • Masashi Kono; Toshiharu Sakurai; Kazuki Okamoto; Shou Masaki; Tomoyuki Nagai; Yoriaki Komeda; Ken Kamata; Kosuke Minaga; Kentarou Yamao; Mamoru Takenaka; Tomohiro Watanabe; Naoshi Nishida; Masatoshi Kudo
    Internal medicine (Tokyo, Japan) 58 9 1263 - 1266 2019年05月 [査読有り]
     
    Immunotherapy targeting programmed cell death-1 (PD-1) signaling is becoming the standard of care for advanced gastric cancer. We herein report a patient with gastric adenocarcinoma with peritoneal dissemination who was treated with nab-paclitaxel and ramucirumab following nivolumab and developed sclerosing cholangitis. Endoscopic retrograde cholangiography showed irregular narrowing and widening of the entire intrahepatic biliary system. Intriguingly, the patient receiving second-line chemotherapy with nab-paclitaxel plus ramucirumab prior to being administered nivolumab, however, he had experienced progressive disease. Thereafter, the administration of fourth-line chemotherapy with nab-paclitaxel and ramucirumab following nivolumab resulted in a clinical response. Nivolumab may enhance the efficacy of the subsequent chemotherapy regimens but also induce sclerosing cholangitis.
  • Tomoe Yoshikawa; Tomohiro Watanabe; Kosuke Minaga; Ken Kamata; Masatoshi Kudo
    Modern rheumatology 29 2 219 - 225 2019年03月 [査読有り]
     
    IgG4-related disease (IgG4-RD) is a newly defined multi-organ disease proposed by Japanese physicians. IgG4-RD is characterized by elevated serum levels of IgG4 and massive infiltration of IgG4-expressing plasma cells in the affected organs. Recent studies have shown that abnormal adaptive immune responses mediated by T helper type 2 cells, regulatory T cells, follicular helper T cells, cytotoxic CD4+ T cells, and plasmablasts are involved in IgG4-RD immunopathogenesis. In addition to adaptive immune responses, innate immune responses play pathogenic roles in IgG4-RD. Plasmacytoid dendritic cells (pDCs), M2 macrophages, and basophils are activated to produce various kinds of cytokines in IgG4-RD. Recent studies highlight the importance of type I IFN and IL-33 produced by pDCs in IgG4-RD immunopathogenesis.
  • Mamoru Takenaka; Kentaro Yamao; Kosuke Minaga; Atsushi Nakai; Shunsuke Omoto; Ken Kamata; Masatoshi Kudo
    Endoscopy 51 2 E30-E31 - E31 2019年02月 [査読有り]
  • Ken Kamata; Masayuki Kitano
    Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society 31 1 5 - 15 2019年01月 [査読有り]
     
    Endoscopic methods are increasingly used in the diagnosis of cystic lesions of the pancreas. The two major endoscopic approaches are endoscopic ultrasonography (EUS) and transpapillary diagnosis. EUS-guided fine-needle aspiration cytology and EUS-guided fine needle-based confocal laser endomicroscopy have been used in the differential diagnosis of mucinous and non-mucinous pancreatic cysts. EUS is the most sensitive modality for detecting mural nodules (MN) in intraductal papillary mucinous neoplasms (IPMN). Contrast-enhanced harmonic EUS (CH-EUS), as an add-on to EUS, is useful for identifying and characterizing MN. Recent studies show that CH-EUS has a sensitivity of 60-100% and a specificity of 75-92.9% for diagnosing malignant cysts. Intraductal ultrasonography and peroral pancreatoscopy are especially useful for detecting MN and IPMN. A recent meta-analysis showed that cytological assessment of pancreatic juice using a transpapillary approach had a pooled sensitivity, specificity, and accuracy of 35.1%, 97.2%, and 92.9%, respectively, for diagnosing malignant IPMN. Further studies are warranted to determine the indications for each of these novel techniques in assessing cystic lesions of the pancreas.
  • 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 116 12 1053 - 1055 2019年 [査読有り]
  • 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 100 3 192 - 200 2019年 [査読有り]
     
    BACKGROUND: Although Gankyrin is overexpressed in many malignancies, the role of Gankyrin for tumorigenesis and chemoresistance remains to be elucidated in sporadic colorectal cancer (CRC). AIMS: We investigate whether Gankyrin affects Adenomatous polyposis coli (Apc) inactivation-induced tumorigenesis and therapeutic response to anti-angiogenic agents. METHODS: Epithelial cell-specific APC and/or Gankyrin-deficient mice were used. The patients with metastatic CRC (n = 53) who were enrolled in this study underwent resection of primary cancer followed by systemic chemotherapy containing bevacizumab. We determined whether gene expression in CRC tissues before chemotherapy is associated with radiological responses. RESULTS: Deletion of Gankyrin in epithelial cell reduced the expression of c-Myc, a critical mediator of the APC signaling pathway, and interleukin-6. Gankyrin deficiency decreased the expression of Bmi1, a downstream molecule of c-Myc, and the activity of V-Akt murine thymoma viral oncogene homolog and extracellular signal-regulated protein kinase, leading to reduced Apc inactivation-induced tumorigenesis. Of 53 patients, 38 (72%) had increased Gankyrin expression in tumor cells. The enhanced Gankyrin expression in tumor cells was associated with unfavorable progression-free survival (log-rank test p = 0.026). CONCLUSION: Gankyrin in epithelial cell contributes to the development of sporadic CRC and the expression could serve as a biomarker to predict therapeutic response in patients with metastatic CRC.
  • Akihiro Yoshida; Kentaro Yamao; Mamoru Takenaka; Atsushi Nakai; Shunsuke Omoto; Ken Kamata; Kosuke Minaga; Takeshi Miyata; Hajime Imai; Ippei Matsumoto; Yoshihumi Takeyama; Takaaki Chikugo; Masatoshi Kudo
    Internal medicine (Tokyo, Japan) 57 23 3377 - 3380 2018年12月 [査読有り]
     
    Neurilemmomas are benign tumors arising from the sheaths of peripheral nerves. They appear rarely in the abdominal cavity. We herein report an 80-year-old man with a multilocular cystic neurilemmoma mimicking a liver lesion. Preoperative images showed a lesion in the porta hepatis. Although a preoperative diagnosis was difficult, surgery was undertaken because of the possibility of malignancy. Histologically, the tumor consisted of spindle-shaped cells with positivity for S-100 protein. The final diagnosis was a neurilemmoma. Porta hepatic neurilemmomas are rare. When we encounter a multilocular cystic lesion of the liver, neurilemmoma should be considered in the differential diagnosis.
  • Yasuo Otsuka; Ken Kamata; Kosuke Minaga; Mamoru Takenaka; Tomohiro Watanabe; Masatoshi Kudo
    Internal medicine (Tokyo, Japan) 57 21 3075 - 3078 2018年11月 [査読有り]
     
    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.
  • 肝門部胆管癌における胆道再建後の吻合部再発に対し胆管および門脈にステント留置術を行った2例
    門場 智也; 鶴崎 正勝; 小田 晃義; 沼本 勲男; 柳生 行伸; 柏木 伸夫; 石井 一成; 鎌田 研; 工藤 正俊
    IVR: Interventional Radiology 33 3 318 - 318 (一社)日本インターベンショナルラジオロジー学会 2018年11月
  • Tomohiro Watanabe; Kosuke Minaga; Ken Kamata; Masatoshi Kudo; Warren Strober
    Trends in immunology 39 11 874 - 889 2018年11月 [査読有り]
     
    Autoimmune pancreatitis (AIP) is a pancreatic manifestation of a recently defined disease form known as IgG4-related disease (AIP/IgG4-RD). AIP/IgG4-RD is characterized by elevated systemic IgG4 antibody concentrations and lesional tissues infiltrated by IgG4-expressing plasmacytes. In addition, recent studies have revealed that, in common with other autoimmune diseases, such as systemic lupus erythematosus (SLE) and psoriasis, AIP/IgG4-RD is associated with increased type I IFN (IFN-I) production by plasmacytoid dendritic cells (pDCs). However, unlike SLE, AIP/IgG4-RD is characterized by elevated IFN-I-dependent IL-33 production, the latter emerging as an important contributor to inflammation and fibrotic responses characterizing this disease. On this basis, we propose that blockade of the IFN-I/IL-33 axis might constitute a successful approach to treating this unique type of autoimmunity.
  • Hidekazu Tanaka; Ken Kamata; Mamoru Takenaka; Masatoshi Kudo
    Internal medicine (Tokyo, Japan) 57 20 3051 - 3052 2018年10月 [査読有り]
  • 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 (一社)日本消化器内視鏡学会 2018年10月
  • 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 (一社)日本消化器内視鏡学会 2018年10月
  • 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 (一社)日本消化器内視鏡学会 2018年10月
  • 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 10 10 367 - 367 2018年09月 [査読有り]
     
    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.
  • 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 : official journal of the Japan Gastroenterological Endoscopy Society 30 5 659 - 666 2018年09月 [査読有り]
     
    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.
  • 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 - 567 日本胆道学会 2018年08月
  • Takenaka Mamoru; Nakai Atsushi; Omoto Shunsuke; Miyata Takeshi; Minaga Kosuke; Kamata Ken; Yamao Kentaro; Imai Hajime; Kudo Masatoshi
    GASTROINTESTINAL ENDOSCOPY 87 6 AB209 - AB210 2018年06月 [査読有り]
  • 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 - 346 (一社)日本膵臓学会 2018年05月
  • 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 - 505 (一社)日本膵臓学会 2018年05月
  • Takeshi Miyata; Ken Kamata; Mamoru Takenaka
    Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society 30 3 403 - 404 2018年05月 [査読有り]
  • Kosuke Minaga; Tomohiro Watanabe; Ken Kamata; Naoki Asano; Masatoshi Kudo
    World journal of gastroenterology 24 16 1725 - 1733 2018年04月 [査読有り]
     
    Nucleotide-binding oligomerization domain 1 (NOD1) is an intracellular innate immune sensor for small molecules derived from bacterial cell components. NOD1 activation by its ligands leads to robust production of pro-inflammatory cytokines and chemokines by innate immune cells, thereby mediating mucosal host defense systems against microbes. Chronic gastric infection due to Helicobacter pylori (H. pylori) causes various upper gastrointestinal diseases, including atrophic gastritis, peptic ulcers, and gastric cancer. It is now generally accepted that detection of H. pylori by NOD1 expressed in gastric epithelial cells plays an indispensable role in mucosal host defense systems against this organism. Recent studies have revealed the molecular mechanism by which NOD1 activation caused by H. pylori infection is involved in the development of chronic gastritis and gastric cancer. In this review, we have discussed and summarized how sensing of H. pylori by NOD1 mediates the prevention of chronic gastritis and gastric cancer.
  • Masashi Kono; Yoriaki Komeda; Toshiharu Sakurai; Ayana Okamoto; Kosuke Minaga; Ken Kamata; Satoru Hagiwara; Hiroaki Inoue; Eisuke Enoki; Itaru Matsumura; Tomohiro Watanabe; Masatoshi Kudo
    Journal of Crohn's & colitis 12 4 499 - 502 2018年03月 [査読有り]
     
    Myelodysplastic syndrome [MDS] is a clonal disorder of bone marrow [BM] cells, caused by acquired chromosomal abnormalities and gene mutations. Pro-inflammatory antigen-presenting cells [APCs] originating from BM cells bearing chromosomal abnormalities and gene mutations can cause immune-mediated disorders including inflammatory bowel disease [IBD]. Here, we report the first case with MDS-associated IBD that was successfully treated with the DNA methyltransferase inhibitor, azacitidine [AZA]. A 75-year-old man with a 5-year history of MDS was admitted for examination of diarrhoea and high fever. Blood examination revealed pancytopenia and a marked elevation of C-reactive protein. Colonoscopy revealed multiple round ulcers from the terminal ileum to the sigmoid colon. Pathological examination of the endoscopic biopsy specimens showed destruction of crypt architecture and infiltration of CD3+ T cells and CD68+ macrophages. Surprisingly, administration of AZA, which has been approved for the treatment of high-risk MDS, improved the symptoms, and the multiple round ulcers disappeared. AZA treatment markedly decreased the expressions of tumour necrosis factor-α, interleukin-12 (IL-12)/23p40 and IL-17 in colonic biopsy samples, as assessed by quantitative reverse transcription polymerase chain reaction. In contrast, AZA treatment did not change the expression of forkhead box P3, a master regulator of regulatory T cells. These data suggest that AZA treatment led to complete remission in MDS-associated IBD through suppression of pro-inflammatory cytokine responses.
  • 膵体部の膵神経内分泌腫瘍に合併した膵性胸水の一例
    河野 辰哉; 山雄 健太郎; 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; 田中 伴典; 筑後 孝章; 林 暁洋; 工藤 正俊
    日本消化器病学会雑誌 115 臨増総会 A395 - A395 (一財)日本消化器病学会 2018年03月
  • 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 (一財)日本消化器病学会 2018年03月
  • Kosuke Minaga; Mamoru Takenaka; Ken Kamata; Masatoshi Kudo
    Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver 50 3 311 - 311 2018年03月 [査読有り]
  • Ken Kamata; Tomohiro Watanabe; Kosuke Minaga; Warren Strober; Masatoshi Kudo
    Current protocols in immunology 120 1 15.31.1-15.31.8 - 15.31.8 2018年02月 [査読有り]
     
    Autoimmune pancreatitis (AIP) is a chronic fibro-inflammatory disorder of the pancreas. However, extensive clinico-pathological analyses have revealed that AIP is, in reality, a pancreatic manifestation of a newly described systemic disease known as IgG4-related disease (IgG4-RD). IgG4-RD is characterized by enhanced local and systemic IgG4 antibody (Ab) responses as well as inflammation involving multiple organs, including the pancreas, bile ducts, and salivary glands. Although mice lack the IgG4 Ab subtype, autoimmune-prone MRL/Mp mice treated with repeated injection with polyinosinic-polycytidylic acid (poly (I:C)) provide an experimental model of AIP. These mice exhibit massive destruction of pancreatic architecture associated with pancreatic immune cell infiltration and fibrosis. Moreover, this experimental AIP may be accompanied by involvement of multiple organs as well as elevation of serum levels of autoAbs, resembling humans with IgG4-RD. Thus, elucidation of the molecular mechanisms accounting for the development of experimental AIP can potentially provide new insights into the immuno-pathogenesis of human IgG4-related AIP. © 2018 by John Wiley & Sons, Inc.
  • 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 10 2 2018年02月 [査読有り]
     
    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.
  • 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 7 5 349 - 349 2018年 [査読有り]
  • 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 9 918 - 918 2018年 [査読有り]
     
    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.
  • 鎌田 研; 西田 直生志; 樫田 博史; 筑後 孝章; 千葉 康敬; 中居 卓也; 竹山 宜典; Andrea Lisotti; Pietro Fusaroli; 工藤 正俊; 竹中 完; 北野 雅之; 大本 俊介; 宮田 剛; 三長 孝輔; 山雄 健太郎; 今井 元; 櫻井 俊治
    日本消化器内視鏡学会雑誌 60 9 1611 - 1620 一般社団法人 日本消化器内視鏡学会 2018年 

    【背景と目的】孤立性胆嚢病変の鑑別診断は課題が残されている.本研究の目的は,胆嚢孤立性病変に対する造影ハーモニックEUS(CH-EUS)の有用性を評価すること.

    【方法】2007年3月から2014年2月までの間に,孤立性胆嚢病変を有する125人の患者に対してCH-EUSを施行し,レトロスペクティブにCH-EUSの有用性を検討した.はじめに,胆嚢病変と胆泥の鑑別診断能に関して,通常のBモードEUS(FB-EUS)とCH-EUSを比較検討した.その後,良悪性鑑別に対する診断能を両検査間で比較検討した.CH-EUSのVascular imageおよびPerfusion imageにおける血流パターンを5人の医師によるブラインドリーディングにて評価した.

    【結果】胆嚢病変と胆泥の鑑別診断能に関して,FB-EUSの感度は82%,特異度は100%,正診率は95%であった.一方,CH-EUSの感度は100%,特異度は99%,正診率は99%であった.良悪性鑑別に関して,腫瘍の大きさあるいは形状に基づいて診断した場合のFB-EUSの診断感度は61-87%,特異度は71-88%,正診率は74-86%であった.CH-EUSにてVascular imageにおけるirregular vessel patternあるいはPerfusion imageにおけるheterogeneous enhancementを悪性所見とした場合の診断感度は90%,特異度は98%,正診率は96%であり,FB-EUSの診断能と比較し有意に良好であった.

    【結語】CH-EUSは,孤立性胆嚢病変の鑑別診断において有用である.

  • Kosuke Minaga; Mamoru Takenaka; Shunsuke Omoto; Takeshi Miyata; Ken Kamata; Kentaro Yamao; Hajime Imai; Tomohiro Watanabe; Masayuki Kitano; Masatoshi Kudo
    Journal of medical ultrasonics (2001) 45 1 161 - 165 2018年01月 [査読有り]
     
    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.
  • 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 87 1 158 - 163 2018年01月 [査読有り]
     
    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.
  • 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 : official journal of the Japan Gastroenterological Endoscopy Society 30 1 98 - 106 2018年01月 [査読有り]
     
    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.
  • Yasuo Otsuka; Ken Kamata; Mamoru Takenaka; Kosuke Minaga; Hidekazu Tanaka; Masatoshi Kudo
    Endoscopy 49 12 E316-E318 - E318 2017年12月 [査読有り]
  • Kamata K; Takenaka M; Minaga K; Kudo M
    Gastrointestinal endoscopy 86 6 1177 - 1179 2017年12月 [査読有り]
  • 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 (株)アークメディア 2017年11月
  • 亀井 敬子; 松本 逸平; 幕谷 悠介; 川口 晃平; 松本 正孝; 村瀬 貴昭; 里井 俊平; 中居 卓也; 鎌田 研; 今井 元; 筑後 孝章; 竹山 宜典
    癌と化学療法 44 12 1191 - 1193 (株)癌と化学療法社 2017年11月 [査読有り]
     
    症例は67歳、女性。上腸間膜動静脈浸潤および遠隔リンパ節転移を伴う膵頭部癌に対し、S-1による化学療法を施行した。2コース終了後に腫瘍マーカーの正常化、主病変の著明な縮小を認めた。化学療法を継続したが、増悪所見を認めず治療開始から8ヵ月後に亜全胃温存膵頭十二指腸切除術を施行した。切除後の病理診断では、主腫瘍は著明な線維性変化と軽度異型細胞をわずかに認めるのみでリンパ節転移も認めず、組織学的完全奏効と診断した。術後10ヵ月現在、無再発生存中である。(著者抄録)
  • Keiko Kamei; Ippei Matsumoto; Yusuke Makutani; Kohei Kawaguchi; Masataka Matsumoto; Takaaki Murase; Shumpei Satoi; Takuya Nakai; Ken Kamata; Hajime Imai; Takaaki Chikugo; Yoshifumi Takeyama
    Gan to kagaku ryoho. Cancer & chemotherapy 44 12 1191 - 1193 2017年11月 [査読有り]
     
    We present a case ofa 67-year-old woman with Stage IV pancreatic head cancer with invasion to the superior mesenteric vein and artery, and distant lymph node metastases. The patient received S-1 mono-chemotherapy. After 2 courses of chemotherapy, the tumor marker was decreased to the normal levels, and the tumor size was dramatically reduced with undetectable lymph node metastases on CT. As the disease status was maintained following chemotherapy, the patient underwent subtotal stomach preserving pancreaticoduodenectomy, 8 months after initiation of the chemotherapy. Histopathologically, no cancer cells were found in the main tumor and dissected lymph nodes. Final diagnosis was made with pathological complete response. The patient was alive without recurrence for 10 months after surgery.
  • Kosuke Minaga; Mamoru Takenaka; Ken Kamata; Takeshi Miyata; Kentaro Yamao; Hajime Imai; Masatoshi Kudo
    Endoscopy 49 11 E281-E282 - E282 2017年11月 [査読有り]
  • 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 31 11 4764 - 4772 2017年11月 [査読有り]
     
    BACKGROUND: 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. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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.
  • Ken Kamata; Mamoru Takenaka; Masakatsu Tsurusaki; Masatoshi Kudo
    Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver 49 11 1282 - 1282 2017年11月 [査読有り]
  • Kosuke Minaga; Mamoru Takenaka; Takeshi Miyata; Kentaro Yamao; Ken Kamata; Masayuki Kitano; Masatoshi Kudo
    ENDOSCOPIC ULTRASOUND 6 6 412 - 413 2017年11月 [査読有り]
  • Toshiharu Sakurai; Norihisa Yada; Satoru Hagiwara; Tadaaki Arizumi; Kosuke Minaga; Ken Kamata; Mamoru Takenaka; Yasunori Minami; Tomohiro Watanabe; Naoshi Nishida; Masatoshi Kudo
    CANCER SCIENCE 108 10 1996 - 2003 2017年10月 [査読有り]
     
    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.
  • 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 32 10 1686 - 1692 2017年10月 [査読有り]
     
    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 2 cm, 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.
  • Toshiharu Sakurai; Norihisa Yada; Satoru Hagiwara; Tadaaki Arizumi; Kosuke Minaga; Ken Kamata; Mamoru Takenaka; Yasunori Minami; Tomohiro Watanabe; Naoshi Nishida; Masatoshi Kudo
    Cancer science 108 10 1996 - 2003 2017年10月 [査読有り]
     
    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.
  • 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 32 240  2017年09月 [査読有り]
  • 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 35 4 529 - 536 2017年08月 [査読有り]
     
    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 intravenous 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) a moderate 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.
  • Masayuki Kitano; Mamoru Takenaka; Kosuke Minaga; Takeshi Miyata; Ken Kamata
    Innovation of Diagnosis and Treatment for Pancreatic Cancer 13 - 28 2017年07月
  • Eri Banno; Yosuke Togashi; Marco A de Velasco; Takuro Mizukami; Yu Nakamura; Masato Terashima; Kazuko Sakai; Yoshihiko Fujita; Ken Kamata; Masayuki Kitano; Masatoshi Kudo; Kazuto Nishio
    International journal of oncology 50 6 2049 - 2058 2017年06月 [査読有り]
     
    Akt2 is an isoform of Akt, and an association between Akt2 and resistance to epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) has been suggested in pancreatic cancer (PC) in vitro. In this study, we investigated the association between Akt2 expression as evaluated using immunohistochemistry and the outcome of patients with advanced PC who had received treatment with erlotinib (an EGFR-TKI). Although the difference was not significant, patients with high levels of Akt2 expression tended to have a poorer response and a shorter progression-free survival period after treatment with erlotinib plus gemcitabine than those with low expression levels (P=0.16 and 0.19, respectively). In vitro, an Akt2-amplified PC cell line and Akt2-overexpressed cell lines exhibited resistance to anti-EGFR therapies, including erlotinib, but combined treatment with BYL719 (a PI3K inhibitor) cancelled this resistance. Our findings suggest that Akt2 might be associated with the resistance to anti-EGFR therapies, especially the use of erlotinib against PC, and that this resistance can be overcome by combined treatment with a PI3K inhibitor. Akt2 expression could become a predictive biomarker for erlotinib resistance in PC.
  • Ken Kamata; Mamoru Takenaka; Kosuke Minaga; Shunsuke Omoto; Takeshi Miyata; Kentaro Yamao; Hajime Imai; Masatoshi Kudo
    Arab journal of gastroenterology : the official publication of the Pan-Arab Association of Gastroenterology 18 2 120 - 121 2017年06月 [査読有り]
     
    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.
  • Watanabe T; Yamashita K; Arai Y; Minaga K; Kamata K; Nagai T; Komeda Y; Takenaka M; Hagiwara S; Ida H; Sakurai T; Nishida N; Strober W; Kudo M
    Journal of immunology (Baltimore, Md. : 1950) 198 10 3886 - 3896 2017年05月 [査読有り]
     
    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-α. 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-β1). 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-α and IL-33 play a pivotal role in the chronic fibro-inflammatory responses underlying murine AIP and human IgG4-related AIP.
  • 三長 孝輔; 竹中 完; 宮田 剛; 中井 敦史; 大本 俊介; 鎌田 研; 山雄 健太郎; 今井 元; 渡邉 智裕; 工藤 正俊
    膵臓 32 3 329 - 329 (一社)日本膵臓学会 2017年05月
  • Kosuke Minaga; Mamoru Takenaka; Masayuki Kitano; Hajime Imai; Kentaro Yamao; Ken Kamata; Takeshi Miyata; Shunsuke Omoto; Tomoe Yoshikawa; Masatoshi Kudo
    GASTROINTESTINAL ENDOSCOPY 85 5 AB493 - AB493 2017年05月 [査読有り]
  • Kosuke Minaga; Mamoru Takenaka; Masayuki Kitano; Hajime Imai; Kentaro Yamao; Ken Kamata; Takeshi Miyata; Shunsuke Omoto; Tomoe Yoshikawa; Masatoshi Kudo
    GASTROINTESTINAL ENDOSCOPY 85 5 AB53 - AB53 2017年05月 [査読有り]
  • Kosuke Minaga; Masayuki Kitano; Chimyon Gon; Kentaro Yamao; Hajime Imai; Takeshi Miyata; Ken Kamata; Shunsuke Omoto; Mamoru Takenaka; Masatoshi Kudo
    Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society 29 2 211 - 217 2017年03月 [査読有り]
     
    BACKGROUND AND AIM: Endoscopic 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. METHODS: This 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. RESULTS: Among 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. CONCLUSION: EUS-CDS using a newly designed metal stent was feasible and effective in this porcine model of biliary dilatation.
  • 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 23 4 661 - 667 2017年01月 [査読有り]
     
    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.
  • Masashi Kono; Naoshi Nishida; Satoru Hagiwara; Tomohiro Minami; Hirokazu Chishina; Tadaaki Arizumi; Kosuke Minaga; Ken Kamata; Yoriaki Komeda; Toshiharu Sakurai; Mamoru Takenaka; Masahiro Takita; Norihisa Yada; Hiroshi Ida; Yasunori Minami; Kazuomi Ueshima; Tomohiro Watanabe; Masatoshi Kudo
    Digestive diseases (Basel, Switzerland) 35 6 556 - 564 2017年 [査読有り]
     
    BACKGROUND AND AIMS: Direct-acting antivirals (DAAs) dramatically improve the sustained virological response (SVR) of chronic hepatitis C (CHC) patients. However, continuous liver damage after SVR may be a risk of hepatocellular carcinoma (HCC). We clarified pretreatment characteristics related to sustained liver damage after SVR. METHODS: A total of 286 CHC patients were treated with an interferon-free DAA regimen. Among them, 250 patients achieved SVR for 12 weeks after the end of treatment (SVR12); these individuals were classified based on α-fetoprotein (AFP) and alanine transaminase (ALT) levels posttreatment. Baseline characteristics significantly associated with AFP >5 ng/mL and ALT level ≥20 IU/L after SVR were clarified using multivariate analyses. RESULTS: Among the pretreatment factors examined, serum AFP values and the presence of fatty liver (FL) were significantly associated with abnormal AFP (p < 0.0001) and ALT levels 12 weeks after SVR12 (SVR24; p = 0.0109). For 126 patients who showed an increase in baseline AFP level, FL, fibrosis-4 (FIB-4) index, and albumin levels before treatment were related to abnormal AFP at SVR24 (p = 0.0005, 0.0232, and 0.0400 for FL, FIB-4 index, and albumin, respectively). Similarly, for 150 patients with abnormal baseline ALT levels, FL was associated with an ALT level ≥ 30 IU/L after SVR (p = 0.0430). CONCLUSIONS: High FIB-4 index, low albumin level, and FL before DAA treatment were associated with a risk of sustained liver damage with AFP and ALT elevation after SVR; patients with these factors should be carefully monitored for emergence of HCC.
  • Tadaaki Arizumi; Tomohiro Minami; Hirokazu Chishina; Masashi Kono; Masahiro Takita; Norihisa Yada; Satoru Hagiwara; Yasunori Minami; Hiroshi Ida; Kazuomi Ueshima; Ken Kamata; Kosuke Minaga; Yoriaki Komeda; Mamoru Takenaka; Toshiharu Sakurai; Tomohiro Watanabe; Naoshi Nishida; Masatoshi Kudo
    Digestive diseases (Basel, Switzerland) 35 6 583 - 588 2017年 [査読有り]
     
    BACKGROUND: Tumors classified based on the Barcelona Clinic Liver Cancer (BCLC) stage B hepatocellular carcinoma (HCC) are heterogeneous in nature. Previously, the Kinki criterion was proposed for a more precise subclassification of tumors in BCLC-stage B. However, tumors in sub-stage B2 include various size and number of HCCs even with the Kinki criteria, which could lead to heterogeneity for overall survival (OS). In this study, we assessed how the size and number of tumors affect the OS and time to progression (TTP) in patients with Kinki criteria stage B2 tumors and treated with transarterial chemoembolization (TACE). METHODS: Of 906 HCC patients treated with TACE at Kindai University Hospital, 236 patients with HCC considered as Kinki criteria stage B2 were examined. They were classified into the following 4 groups according to the maximum tumor diameter and number of tumors: B2a group, tumor size ≤6 cm and total number of tumors ≤6; B2b group, size ≤6 cm and number >6; B2c group, size >6 cm and number ≤6; and B2d group, size >6 cm and number >6. The OS and TTP of patients in each group were compared. RESULTS: There were 131 patients (55.5%) in the B2a group, 58 (24.6%) in the B2b group, 41 (17.4%) in the B2c group, and 6 (0.03%) in the B2d group. Comparison of the survivals revealed that the median OS was 2.8 years (95% CI 2.0-3.5) in the B2a group, 2.8 years (95% CI 2.0-3.3) in the B2b group, 1.9 years (95% CI 0.8-4.0) in the B2c group, and 2.3 years (95% CI 1.2-ND [no data]) in the B2d group, respectively (p = 0.896). The median TTP in B2a, B2b, B2c, and B2d sub-substage HCC were13.2, 12.1, 13.8, and 11.5 months, respectively (p = 0.047). The median TTP in B2a + B2c sub-substage patients was longer than that in B2b + B2d sub-substage HCC patients (14.0 months and 10.4 months; p = 0.002). CONCLUSION: No significant differences were observed in the OS among HCC patients subclassified based on the maximum tumor diameter and tumor number in Kinki criteria stage B2. Consequently, Kinki criteria stage B2 HCC is a homogeneous subgroup in terms of OS prediction. However, shorter TTP in B2b+B2c sub-substage HCC patients than that in B2a + B2c sub-substage HCC patients suggests that different treatment strategy, such as systemic therapy with targeted agents instead of TACE, may be suitable to preserve the liver function.
  • Tadaaki Arizumi; Tomohiro Minami; Hirokazu Chishina; Masashi Kono; Masahiro Takita; Norihisa Yada; Satoru Hagiwara; Yasunori Minami; Hiroshi Ida; Kazuomi Ueshima; Ken Kamata; Kosuke Minaga; Yoriaki Komeda; Mamoru Takenaka; Toshiharu Sakurai; Tomohiro Watanabe; Naoshi Nishida; Masatoshi Kudo
    Digestive diseases (Basel, Switzerland) 35 6 589 - 597 2017年 [査読有り]
     
    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.
  • 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 93 Suppl 1 1 55 - 60 2017年 [査読有り]
     
    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.
  • 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 93 Suppl 1 1 69 - 75 2017年 [査読有り]
     
    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.
  • Kosuke Minaga; Mamoru Takenaka; Akio Katanuma; Masayuki Kitano; Yukitaka Yamashita; Ken Kamata; Kentaro Yamao; Tomohiro Watanabe; Hiroyuki Maguchi; Masatoshi Kudo
    Oncology 93 Suppl 1 1 107 - 112 2017年 [査読有り]
     
    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.
  • 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 93 Suppl 1 1 35 - 42 2017年 [査読有り]
     
    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.
  • 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 93 Suppl 1 1 76 - 80 2017年 [査読有り]
     
    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.
  • 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 93 Suppl 1 1 81 - 86 2017年 [査読有り]
     
    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.
  • Takeshi Miyata; Mamoru Takenaka; Shunsuke Omoto; Ken Kamata; Kosuke Minaga; Kentaro Yamao; Hajime Imai; Masatoshi Kudo
    Oncology 93 Suppl 1 1 98 - 101 2017年 [査読有り]
     
    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.
  • 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 93 Suppl 1 1 9 - 14 2017年 [査読有り]
     
    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.
  • Ken Kamata; Mamoru Takenaka; Kosuke Minaga; Toshiharu Sakurai; Tomohiro Watanabe; Naoshi Nishida; Masatoshi Kudo
    Oncology 93 Suppl 1 1 87 - 88 2017年 [査読有り]
     
    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.
  • 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 93 Suppl 1 1 27 - 29 2017年 [査読有り]
     
    The prophylactic closure of mucosal defects after endoscopic resection is known to prevent postoperative bleeding in colorectal lesions. However, closure of large mucosal defects is difficult with conventional clips only, and several closure techniques have been previously described; use of an Endoloop, 8-ring loop, or loop clip and a small incision around the mucosal defect. Given that the prophylactic closure requires much cost and time, the application should be limited to high-risk cases. Medication of antithrombotics or antiplatelet agents would be one of the reasonable indications for prophylactic closure of mucosal defects after endoscopic resection of colorectal tumors.
  • Teppei Adachi; Shigenaga Matsui; Tomohiro Watanabe; Kazuki Okamoto; Ayana Okamoto; Masashi Kono; Mitsunari Yamada; Tomoyuki Nagai; Yoriaki Komeda; Kosuke Minaga; Ken Kamata; Kentaro Yamao; Mamoru Takenaka; Yutaka Asakuma; Toshiharu Sakurai; Naoshi Nishida; Hiroshi Kashida; Masatoshi Kudo
    Oncology 93 Suppl 1 1 15 - 19 2017年 [査読有り]
     
    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.
  • 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 93 Suppl 1 1 102 - 106 2017年 [査読有り]
     
    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.
  • 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 93 Suppl 1 1 20 - 26 2017年 [査読有り]
     
    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.
  • 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 31 248 - 248 2016年11月 [査読有り]
  • Masayuki Kitano; Ken Kamata
    ENDOSCOPIC ULTRASOUND 5 6 351 - 354 2016年11月 [査読有り]
  • Kosuke Minaga; Masayuki Kitano; Hajime Imai; Yogesh Harwani; Kentaro Yamao; Ken Kamata; Takeshi Miyata; Shunsuke Omoto; Kumpei Kadosaka; Toshiharu Sakurai; Naoshi Nishida; Masatoshi Kudo
    World journal of gastroenterology 22 30 6917 - 24 2016年08月 [査読有り]
     
    AIM: To assess anti-migration potential of six biliary covered self-expandable metal stents (C-SEMSs) by using a newly designed phantom model. METHODS: In the phantom model, the stent was placed in differently sized holes in a silicone wall and retracted with a retraction robot. Resistance force to migration (RFM) was measured by a force gauge on the stent end. Radial force (RF) was measured with a RF measurement machine. Measured flare structure variables were the outer diameter, height, and taper angle of the flare (ODF, HF, and TAF, respectively). Correlations between RFM and RF or flare variables were analyzed using a linear correlated model. RESULTS: Out of the six stents, five stents were braided, the other was laser-cut. The RF and RFM of each stent were expressed as the average of five replicate measurements. For all six stents, RFM and RF decreased as the hole diameter increased. For all six stents, RFM and RF correlated strongly when the stent had not fully expanded. This correlation was not observed in the five braided stents excluding the laser cut stent. For all six stents, there was a strong correlation between RFM and TAF when the stent fully expanded. For the five braided stents, RFM after full stent expansion correlated strongly with all three stent flare structure variables (ODF, HF, and TAF). The laser-cut C-SEMS had higher RFMs than the braided C-SEMSs regardless of expansion state. CONCLUSION: RF was an important anti-migration property when the C-SEMS did not fully expand. Once fully expanded, stent flare structure variables plays an important role in anti-migration.
  • Hajime Imai; Masayuki Kitano; Shunsuke Omoto; Kumpei Kadosaka; Ken Kamata; Takeshi Miyata; Kentaro Yamao; Hiroki Sakamoto; Yogesh Harwani; Masatoshi Kudo
    Gastrointestinal endoscopy 84 1 147 - 51 2016年07月 [査読有り]
     
    BACKGROUND AND AIMS: EUS-guided bile duct drainage (EUS-BD) is a well-recognized rescue biliary drainage method after unsuccessful ERCP. EUS-guided gallbladder drainage (EUS-GBD) was recently used to treat acute cholecystitis. The aim of this study was to assess the efficacy and safety of EUS-GBD for malignant biliary stricture-induced obstructive jaundice after unsuccessful ERCP as well as unsuccessful or impractical EUS-BD. METHODS: Between January 2006 and October 2014, 12 patients with obstructive jaundice due to unresectable malignant distal biliary stricture underwent EUS-GBD after ERCP failed. 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 stent. The technical and functional success rates, adverse events rate, overall patient survival time, and stent dysfunction rate during patient survival were measured. RESULTS: The rates of technical success, functional success, adverse events, and stent dysfunction were 100%, 91.7%, 16.7%, and 8.3%, respectively. The median survival time after EUS-GBD was 105 days (range 15 - 236 days). CONCLUSIONS: EUS-GBD is a possible alternative route for decompression of the biliary system when ERCP is unsuccessful.
  • Ken Kamata; Masayuki Kitano; Satoru Yasukawa; Masatoshi Kudo; Yasutaka Chiba; Takeshi Ogura; Kazuhide Higuchi; Nobuyasu Fukutake; Reiko Ashida; Tomoaki Yamasaki; Hiroko Nebiki; Satoru Hirose; Noriyuki Hoki; Masanori Asada; Shujiro Yazumi; Makoto Takaoka; Kazuichi Okazaki; Fumihiro Matsuda; Yoshihiro Okabe; Akio Yanagisawa
    Endoscopy 48 7 632 - 8 2016年07月 [査読有り]
     
    BACKGROUND AND STUDY AIMS: Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) with 25-gauge needles yields small volume samples that are mainly processed for cytology. Using 25-gauge needles with a core trap may overcome this limitation. This trial compared 25-gauge needles with and without a core trap in terms of their ability to obtain histologic samples from solid pancreatic masses. PATIENTS AND METHODS: Consecutive patients with solid pancreatic masses who presented to eight Japanese referral centers for EUS-FNA in April - September 2013 were randomized to undergo sampling with a 25-gauge needle with a core trap (ProCore) or a standard 25-gauge needle. Tissue samples were fixed in formalin and processed for histologic evaluation. For the purpose of this study only samples obtained with the first needle pass were used for comparison of: (i) accuracy for the diagnosis of malignancy, (ii) rate of samples with preserved tissue architecture adequate for histologic evaluation, and (iii) sample cellularity. RESULTS: A total of 214 patients were enrolled. Compared to the first pass with a standard needle (n = 108), the first pass with the ProCore needle (n = 106) provided samples that were more often adequate for histologic evaluation (81.1 % vs. 69.4 %; P = 0.048) and had superior cellularity (rich/moderate/poor, 36 %/27 %/37 % vs. 19 %/26 %/55 %; P = 0.003). There were no significant differences between the two needles in sensitivity (75.6 % vs. 69.0 %, P = 0.337) and accuracy (79.2 % vs. 75.9 %, P = 0.561) for the diagnosis of malignancy. CONCLUSIONS: In patients with solid pancreatic masses, a 25-gauge EUS-FNA needle with a core trap provides histologic samples of better quality than a standard 25-gauge needle. There was no difference in accuracy for the diagnosis of malignancy between the needles. CLINICAL TRIAL NUMBER: UMIN000010021.
  • Ken Kamata; Masayuki Kitano; Shunsuke Omoto; Kumpei Kadosaka; Takeshi Miyata; Kosuke Minaga; Kentaro Yamao; Hajime Imai; Masatoshi Kudo
    Ultrasonography (Seoul, Korea) 35 3 169 - 79 2016年07月 [査読有り]
     
    Endoscopic ultrasonography (EUS) is widely used to evaluate pancreaticobiliary diseases, especially pancreatic masses. EUS has a good ability to detect pancreatic masses, but it is not sufficient for the differential diagnosis of various types of lesions. In order to address the limitations of EUS, new techniques have been developed to improve the characterization of the lesions detected by EUS. EUS-guided fine needle aspiration (EUS-FNA) has been used for diagnosing pancreatic tumors. In order to improve the histological diagnostic yield, a EUS-FNA needle with a core trap has recently been developed. Contrast-enhanced harmonic EUS is a new imaging modality that uses an ultrasonographic contrast agent to visualize blood flow in fine vessels. This technique is useful in the diagnosis of pancreatic solid lesions and in confirming the presence of vascularity in mural nodules for cystic lesions. EUS elastography analyzes several different variables to measure tissue elasticity, color patterns, and strain ratio, using analytical techniques such as hue-histogram analysis, and artificial neural networks, which are useful for the diagnosis of chronic pancreatitis and pancreatic cancer.
  • Kosuke Minaga; Masayuki Kitano; Hiroki Sakamoto; Takeshi Miyata; Hajime Imai; Kentaro Yamao; Ken Kamata; Shunsuke Omoto; Kumpei Kadosaka; Toshiharu Sakurai; Naoshi Nishida; Yasutaka Chiba; Masatoshi Kudo
    Therapeutic advances in gastroenterology 9 4 483 - 94 2016年07月 [査読有り]
     
    BACKGROUND: Interventional endoscopic ultrasound (EUS)-guided procedures such as EUS-guided celiac ganglia neurolysis (EUS-CGN) and EUS-guided broad plexus neurolysis (EUS-BPN) were developed to treat abdominal cancer-associated pain; however, these procedures are not always effective. The aim of this study was to explore predictors of pain response in EUS-guided neurolysis for pancreatic cancer-associated pain. METHODS: This was a retrospective analysis of prospectively collected data of 112 consecutive patients who underwent EUS-BPN in our institution. EUS-CGN was added in cases of visible celiac ganglia. The neurolytic-spread area was divided into six sections and evaluated by post-procedural computed tomography scanning. Pain intensity was assessed using a visual analog scale (VAS), and a decrease in VAS scores by ⩾3 points after neurolysis was considered a good pain response. Univariable and multivariable logistic regression analyses were performed to explore predictors of pain response at 1 and 4 weeks, and complications. RESULTS: A good pain response was obtained in 77.7% and 67.9% of patients at 1 and 4 weeks, respectively. In the multivariable analysis of these patients, the combination method (EUS-BPN plus CGN) was a significant positive predictive factor at 1 week (odds ratio = 3.69, p = 0.017) and 4 weeks (odds ratio = 6.37, p = 0.043). The numbers of neurolytic/contrast spread areas (mean ± SD) were 4.98 ± 1.08 and 4.15 ± 1.12 in patients treated with the combination method and single method, respectively (p < 0.001). There was no significant predictor of complications. CONCLUSIONS: EUS-BPN in combination with EUS-CGN was a predictor of a good pain response in EUS-guided neurolysis for pancreatic cancer-related pain. The larger number of neurolytic/contrast spread areas may lead to better outcomes in patients receiving combination treatment.
  • Kosuke Minaga; Masayuki Kitano; Hajime Imai; Kentaro Yamao; Ken Kamata; Takeshi Miyata; Tomohiko Matsuda; Shunsuke Omoto; Kumpei Kadosaka; Tomoe Yoshikawa; Masatoshi Kudo
    World journal of gastroenterology 22 21 5132 - 6 2016年06月 [査読有り]
     
    We report a successful endoscopic ultrasonography-guided drainage of a huge infected multilocular walled-off necrosis (WON) that was treated by a modified single transluminal gateway transcystic multiple drainage (SGTMD) technique. After placing a wide-caliber fully covered metal stent, follow-up computed tomography revealed an undrained subcavity of WON. A large fistula that was created by the wide-caliber metal stent enabled the insertion of a forward-viewing upper endoscope directly into the main cavity, and the narrow connection route within the main cavity to the subcavity was identified with a direct view, leading to the successful drainage of the subcavity. This modified SGTMD technique appears to be useful for seeking connection routes between subcavities of WON in some cases.
  • Masayuki Kitano; Hajime Imai; Ken Kamata; Masatoshi Kudo
    GASTROINTESTINAL ENDOSCOPY 83 6 1303 - 1303 2016年06月 [査読有り]
  • Kosuke Minaga; Masayuki Kitano; Hajime Imai; Kentaro Yamao; Ken Kamata; Takeshi Miyata; Tomohiko Matsuda; Shunsuke Omoto; Kumpei Kadosaka; Tomoe Yoshikawa; Masatoshi Kudo
    GASTROINTESTINAL ENDOSCOPY 83 5 AB521 - AB521 2016年05月 [査読有り]
  • Kosuke Minaga; Masayuki Kitano; Hajime Imai; Kentaro Yamao; Ken Kamata; Takeshi Miyata; Shunsuke Omoto; Kumpei Kadosaka; Tomoe Yoshikawa; Masatoshi Kudo
    World journal of gastroenterology 22 16 4264 - 9 2016年04月 [査読有り]
     
    Acute obstructive suppurative cholangitis (AOSC) due to biliary lithiasis is a life-threatening condition that requires urgent biliary decompression. Although endoscopic retrograde cholangiopancreatography (ERCP) with stent placement is the current gold standard for biliary decompression, it can sometimes be difficult because of failed biliary cannulation. In this retrospective case series, we describe three cases of successful biliary drainage with recovery from septic shock after urgent endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) was performed for AOSC due to biliary lithiasis. In all three cases, technical success in inserting the stents was achieved and the patients completely recovered from AOSC with sepsis in a few days after EUS-CDS. There were no procedure-related complications. When initial ERCP fails, EUS-CDS can be an effective life-saving endoscopic biliary decompression procedure that shortens the procedure time and prevents post-ERCP pancreatitis, particularly in patients with AOSC-induced sepsis.
  • 消化器疾患の診断と治療におけるEUSの役割 EUSガイド下ドレナージを中心としたWONの治療成績及び内視鏡治療不成功因子の解析(Role of EUS in Diagnosis and Treatment of Digestive Diseases EUS-guided interventions for walled-off pancreatic necrosis: clinical outcomes of a step-up approach and risk factors for failed endoscopic treatment)
    三長 孝輔; 北野 雅之; 今井 元; 山雄 健太郎; 鎌田 研; 宮田 剛; 松田 友彦; 大本 俊介; 門阪 薫平; 工藤 正俊
    超音波医学 43 Suppl. S322 - S322 2016年04月
  • Takeshi Miyata; Masayuki Kitano; Shunsuke Omoto; Kumpei Kadosaka; Ken Kamata; Hajime Imai; Hiroki Sakamoto; Naoshi Nisida; Yogesh Harwani; Takamichi Murakami; Yoshifumi Takeyama; Yasutaka Chiba; Masatoshi Kudo
    World journal of gastroenterology 22 12 3381 - 91 2016年03月 [査読有り]
     
    AIM: To assess the usefulness of contrast-enhanced harmonic endoscopic ultrasonography (CH-EUS) for lymph node metastasis in pancreatobiliary carcinoma. METHODS: All patients suspected of pancreatobiliary carcinoma with visible lymph nodes after standard EUS between June, 2009 and January, 2012 were enrolled. In the primary analysis, patients with successful EUS-fine needle aspiration (FNA) were included. The lymph nodes were assessed by several standard EUS variables (short and long axis lengths, shape, edge characteristic and echogenicity), color Doppler EUS variable [central intranodal blood vessel (CIV) presence] and CH-EUS variable (heterogeneous/homogeneous enhancement patterns). The diagnostic accuracy relative to EUS-FNA was calculated. In the second analysis, N-stage diagnostic accuracy of CH-EUS was compared with EUS-FNA in patients who underwent surgical resection. RESULTS: One hundred and nine patients (143 lymph nodes) fulfilled the criteria. The short axis cut-off ≥ 13 mm predicted malignancy with a sensitivity and specificity of 72% and 85%, respectively. These values were 72% and 63% for the long axis cut-off ≥ 20 mm, 62% and 75% for the round shape variable, 81% and 30% for the sharp edge variable, 66% and 61% for the hypoechogenicity variable, 70% and 72% for the CIV-absent variable, and 83% and 91% for the heterogeneous CH-EUS-enhancement variable, respectively. CH-EUS was more accurate than standard and color Doppler EUS, except the short axis cut-off. Notably, three patients excluded because of EUS-FNA failure were correctly N-staged by CH-EUS. CONCLUSION: CH-EUS complements standard and color Doppler EUS and EUS-FNA for assessment of lymph node metastases.
  • Ken Kamata; Masayuki Kitano; Shunsuke Omoto; Kumpei Kadosaka; Takeshi Miyata; Kentaro Yamao; Hajime Imai; Hiroki Sakamoto; Yogesh Harwani; Takaaki Chikugo; Yasutaka Chiba; Ippei Matsumoto; Yoshifumi Takeyama; Masatoshi Kudo
    Endoscopy 48 1 35 - 41 2016年01月 [査読有り]
     
    BACKGROUND AND STUDY AIM: Comparison of fundamental B-mode endoscopic ultrasonography (FB-EUS) and contrast-enhanced harmonic endoscopic ultrasonography (CH-EUS) in the differential diagnosis of pancreatic cysts according to presence of mural nodules. PATIENTS AND METHODS: Between April 2007 and April 2012, FB-EUS and CH-EUS data were prospectively collected from 581 consecutive patients with pancreatic cysts, and were retrospectively analyzed from 70 with subsequent cyst resection. Presence and height of mural nodules as detected on FB-EUS and CH-EUS were evaluated, and thence accuracies of both methods for diagnosing mucinous versus nonmucinous and malignant versus benign cysts. RESULTS: On pathological examination 48 cysts were mucinous and 22 were nonmucinous; 30 cysts were malignant (high grade dysplasia or invasive carcinoma) and 40 were benign. If presence of a mural nodule was considered to indicate a mucinous cyst, FB-EUS and CH-EUS accuracies did not differ significantly (respectively: sensitivity 85 % vs. 79 %; specificity 46 % vs. 96 %; accuracy 73 % vs. 84 %, P = 0.057). If presence of mural nodule was considered to indicate malignancy, CH-EUS was significantly more accurate than FB-EUS (respectively: sensitivity 97 % vs. 97 %; specificity 75 % vs. 40 %; accuracy 84 % vs. 64 %, P = 0.0001). For diagnosing malignancy by evaluating mural nodule height, the area under the receiver operating characteristic (AUROC) was 0.84 and 0.93 for FB-EUS and CH-EUS, respectively (P = 0.028). Presence of a mural nodule of height ≥ 4 mm on CH-EUS was a sign of malignancy (false-positive fraction 0.2; true-positive fraction 0.93; odds ratio 56.0). CONCLUSIONS: CH-EUS is more accurate than FB-EUS for diagnosing malignant pancreatic cysts.
  • Kosuke Minaga; Masayuki Kitano; Tomoe Yoshikawa; Shunsuke Omoto; Ken Kamata; Kentaro Yamao; Masatoshi Kudo
    Endoscopy 48 Suppl 1 E228-9 - E229 2016年 [査読有り]
  • Shunsuke Omoto; Masayuki Kitano; Hiroki Sakamoto; Hajime Imai; Kentaro Yamao; Ken Kamata; Takeshi Miyata; Kosuke Minaga; Kumpei Kadosaka; Masatoshi Kudo
    JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY 30 141 - 141 2015年12月 [査読有り]
  • Masayuki Kitano; Ken Kamata; Hajime Imai; Takeshi Miyata; Satoru Yasukawa; Akio Yanagisawa; Masatoshi Kudo
    Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society 27 Suppl 1 60 - 7 2015年04月 [査読有り]
     
    The combination of second-generation ultrasound contrast agents and an endoscopic ultrasonography (EUS) system with a broad-band transducer has allowed contrast-enhanced harmonic imaging in the field of EUS. In contrast-enhanced harmonic EUS (CH-EUS), diffuse homogeneous enhancement is obtained in normal parenchyma of the pancreas. The bile duct and pancreatic duct are depicted as non-enhanced ductal structures with strong contrast in comparison to the surrounding parenchyma. CH-EUS identifies pancreatic adenocarcinomas as solid lesions exhibiting hypo-enhancement with a sensitivity and specificity of 88-96% and 88-94%, respectively. In particular, 80-100% of false-negative cases in endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) are correctly classified by CH-EUS, suggesting CH-EUS complements EUS-FNA. Moreover, CH-EUS improves depiction of some subtle lesions in conventional EUS, thus facilitating EUS-FNA. For quantitative perfusion analysis, a time-intensity curve (TIC) for the region of interest can be generated during CH-EUS. The maximum intensity gain and the echo intensity reduction rate from the peak at 1 min obtained by TIC can be used for differentiation of pancreatic adenocarcinoma from other tumors. CH-EUS is also useful for differentiation of invasive intraductal papillary mucinous neoplasms (IPMN) from non-invasive IPMN, identification of malignant lesions in the gallbladder, and T- and N-staging of pancreatobiliary tumors.
  • Masayuki Kitano; Ken Kamata; Masatoshi Kudo
    Nihon rinsho. Japanese journal of clinical medicine 73 Suppl 3 491 - 4 2015年03月
  • Masayuki Kitano; Ken Kamata; Masatoshi Kudo
    Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society 26 5 636 - 7 2014年09月 [査読有り]
  • 大本 俊介; 北野 雅之; 門坂 薫平; 宮田 剛; 鎌田 研; 山雄 健太郎; 今井 元; 坂本 洋城; 工藤 正俊
    膵臓 29 3 545 - 545 (一社)日本膵臓学会 2014年06月
  • Prospective Multicenter Randomized Controlled Trial of Histological Diagnostic Yield Comparing 25G EUS-FNA Needles With and Without a Core Trap in Patients With Solid Pancreatic Masses
    Ashida R; Yasukawa S; Yanagisawa A; Kamata K; Kudo M; Ogura T; Higuchi K; Fukutake N; Nebiki H; Hirose S; Hoki N; Asada M; Yazumi S; Takaoka M; Okazaki K; Matsuda F; Okabe Y; Kitano M
    Gastrointest Endosc 79 AB111  2014年05月 [査読有り]
  • 造影ハーモニックEUS(CH-EUS)における膵腫瘍の血流評価の有用性について
    大本 俊介; 田中 梨絵; 門阪 薫平; 鎌田 研; 宮田 剛; 山雄 健太郎; 今井 元; 坂本 洋城; 北野 雅之; 工藤 正俊
    超音波医学 41 Suppl. S580 - S580 (公社)日本超音波医学会 2014年04月
  • 膵神経内分泌腫瘍に対するEUSの有用性
    今井 元; 北野 雅之; 工藤 正俊; 大本 俊介; 門阪 薫平; 宮田 剛; 鎌田 研; 山雄 健太郎; 坂本 洋城
    Gastroenterological Endoscopy 56 Suppl.1 1132 - 1132 (一社)日本消化器内視鏡学会 2014年04月
  • Masayuki Kitano; Ken Kamata; Masatoshi Kudo
    Endoscopy 46 4 358 - 358 2014年04月 [査読有り]
  • 造影ハーモニックEUS(CH-EUS)における膵腫瘍の血流評価の有用性について
    大本 俊介; 田中 梨絵; 門阪 薫平; 鎌田 研; 宮田 剛; 山雄 健太郎; 今井 元; 坂本 洋城; 北野 雅之; 工藤 正俊
    超音波医学 41 2 245 - 245 (公社)日本超音波医学会 2014年03月
  • Ken Kamata; Masayuki Kitano; Masatoshi Kudo; Hiroki Sakamoto; Kumpei Kadosaka; Takeshi Miyata; Hajime Imai; Kiyoshi Maekawa; Takaaki Chikugo; Masashi Kumano; Tomoko Hyodo; Takamichi Murakami; Yasutaka Chiba; Yoshifumi Takeyama
    Endoscopy 46 4 358  2014年 [査読有り]
  • Ken Kamata; Masayuki Kitano; Masatoshi Kudo; Hiroki Sakamoto; Kumpei Kadosaka; Takeshi Miyata; Hajime Imai; Kiyoshi Maekawa; Takaaki Chikugo; Masashi Kumano; Tomoko Hyodo; Takamichi Murakami; Yasutaka Chiba; Yoshifumi Takeyama
    Endoscopy 46 1 22 - 9 2014年01月 [査読有り]
     
    BACKGROUND AND STUDY AIMS: Pancreatic ductal adenocarcinomas (PDAC) sometimes arise in patients with intraductal papillary mucinous neoplasms (IPMNs). This study examined the incidence of PDACs concomitant to or derived from branch duct IPMNs. The usefulness of endoscopic ultrasonography (EUS) relative to other imaging methods for detecting these tumors was also assessed. PATIENTS AND METHODS: This retrospective study used data from clinical records and imaging studies that were collected prospectively. During 2001-2009, 167 consecutive patients with IPMNs underwent EUS, ultrasonography, computed tomography (CT), and magnetic resonance imaging (MRI). The 102 patients whose branch duct IPMNs lacked mural nodules/symptoms and thus did not qualify for resection were followed up by semiannual EUS and annual ultrasonography, CT, and MRI. The sensitivity and specificity with which the four modalities detected IPMN-derived and -concomitant PDACs at the first examination and throughout the study period were evaluated. The rate of PDAC development during follow-up was analyzed by the Kaplan-Meier method. RESULTS: A total of 17 IPMN-derived and 11 IPMN-concomitant PDACs were diagnosed at the first examination. Lesions that did not qualify for resection or chemotherapy were followed up for a median of 42 months. Seven IPMN-concomitant PDACs and no IPMN-derived PDACs were detected during follow-up. The 3- and 5-year rates of IPMN-concomitant PDAC development were 4.0% and 8.8%, respectively. At the first examination, EUS was superior to other imaging modalities in terms of IPMN-derived and -concomitant PDAC detection. Throughout the study period, including follow-up, EUS was significantly better at detecting IPMN-concomitant PDACs than the other modalities. CONCLUSIONS: IPMN-concomitant PDACs are quite often found at diagnosis and during follow-up. EUS examination of the whole pancreas plays an important role in the management of IPMNs as it allows the early detection of these small invasive carcinomas.
  • 膵癌による閉塞性黄疸に対する乳頭括約筋切開術未施行のカバー付金属ステント留置術の成績
    千品 寛和; 門阪 薫平; 田中 梨絵; 大本 俊介; 宮田 剛; 鎌田 研; 今井 元; 坂本 洋城; 北野 雅之; 工藤 正俊
    Gastroenterological Endoscopy 55 Suppl.2 2929 - 2929 (一社)日本消化器内視鏡学会 2013年09月
  • 田中 梨絵; 宮田 剛; 大本 俊介; 門阪 薫平; 鎌田 研; 山雄 健太郎; 今井 元; 坂本 洋城; 北野 雅之
    胆道 27 3 630 - 630 日本胆道学会 2013年08月
  • 鎌田 研; 北野 雅之; 工藤 正俊; 大本 俊介; 門阪 薫平; 今井 元; 坂本 洋城; 竹山 宜典
    膵臓 28 3 322 - 322 (一社)日本膵臓学会 2013年06月
  • <診療に活かす>膵腫瘍の診断に最も有用な画像診断法は? 画像診断の現状とピットフォール 膵疾患に対する造影超音波検査
    今井 元; 北野 雅之; 大本 俊介; 門阪 薫平; 宮田 剛; 鎌田 研; 坂本 洋城; 工藤 正俊
    超音波医学 40 Suppl. S291 - S291 (公社)日本超音波医学会 2013年04月
  • 超音波内視鏡下胆嚢ドレナージ術の有用性
    今井 元; 北野 雅之; 工藤 正俊; 門坂 薫平; 大本 俊介; 鎌田 研; 宮田 剛; 坂本 洋城
    日本消化器病学会雑誌 110 臨増総会 A208 - A208 (一財)日本消化器病学会 2013年02月
  • 膵仮性嚢胞に対するInterventional EUS
    大本 俊介; 北野 雅之; 山田 光成; 門阪 薫平; 宮田 剛; 鎌田 研; 今井 元; 坂本 洋城; 工藤 正俊
    日本消化器病学会雑誌 110 臨増総会 A335 - A335 (一財)日本消化器病学会 2013年02月
  • Hiroki Sakamoto; Masayuki Kitano; Ken Kamata; Takeshi Miyata; Kunpei Kadosaka; Hajime Imai; Yoshifumi Takeyama; Masatoshi Kudo
    Gastrointestinal endoscopy 76 4 892 - 9 2012年10月 [査読有り]
  • Masayuki Kitano; Masatoshi Kudo; Kenji Yamao; Tadayuki Takagi; Hiroki Sakamoto; Takamitsu Komaki; Ken Kamata; Hajime Imai; Yasutaka Chiba; Masahiro Okada; Takamichi Murakami; Yoshifumi Takeyama
    The American journal of gastroenterology 107 2 303 - 10 2012年02月 [査読有り]
     
    OBJECTIVES: Contrast-enhanced harmonic endoscopic ultrasonography (CH-EUS), a novel technology, visualizes parenchymal perfusion in the pancreas. This study prospectively evaluated how accurately CH-EUS characterizes pancreatic lesions and compared its diagnostic ability with that of contrast-enhanced multidetector-row computed tomography (MDCT) and endoscopic ultrasonography-guided fine needle aspiration (EUS-FNA). METHODS: A total of 277 consecutive patients with pancreatic solid lesions that were detected by conventional EUS underwent CH-EUS for evaluation of vascularity. After infusing an ultrasound contrast, CH-EUS was performed by using an echoendoscope and a specific mode for contrast harmonic imaging. On the basis of the intensity of enhancement, the lesions were categorized into four patterns: nonenhancement, hypoenhancement, isoenhancement, and hyperenhancement. For comparison, all patients underwent MDCT. The ability of CH-EUS to differentiate ductal carcinomas from the other solid tumors, particularly small lesions (≤2 cm in diameter) was assessed, and compared with the differentiating abilities of MDCT and EUS-FNA. RESULTS: In terms of reading the CH-EUS images, the κ-coefficient of the interobserver agreement test was 0.94 (P<0.001). CH-EUS-depicted hypoenhancement diagnosed ductal carcinomas with a sensitivity and specificity of 95.1% (95% confidence interval (CI) 92.7-96.7%) and 89.0% (95% CI 83.0-93.1%), respectively. For diagnosing small carcinomas by CH-EUS, the sensitivity and specificity were 91.2 % (95% CI 82.5-95.1%) and 94.4% (95% CI 86.2-98.1%), respectively. CH-EUS-depicted hypervascular enhancement diagnosed neuroendocrine tumors with a sensitivity and specificity of 78.9% (95% CI 61.4-89.7%) and 98.7% (95% CI 96.7-98.8%), respectively. Although CH-EUS and MDCT did not differ significantly in diagnostic ability with regard to all lesions, CH-EUS was superior to MDCT in diagnosing small (≤2 cm) carcinomas (P<0.05). In 12 neoplasms that MDCT failed to detect, 7 ductal carcinomas and 2 neuroendocrine tumors had hypoenhancement and hyperenhancement on CH-EUS, respectively. When CH-EUS was combined with EUS-FNA, the sensitivity of EUS-FNA increased from 92.2 to 100%. CONCLUSIONS: CH-EUS is useful for characterizing conventional EUS-detected solid pancreatic lesions. EUS equipped with contrast harmonic imaging may play an important role in the characterization of small tumors that other imaging methods fail to depict and may improve the diagnostic yield of EUS-FNA.
  • Hiroki Sakamoto; Masayuki Kitano; Shigenaga Matsui; Ken Kamata; Takamitsu Komaki; Hajime Imai; Kensaku Dote; Masatoshi Kudo
    Gastrointestinal endoscopy 73 2 227 - 37 2011年02月 [査読有り]
     
    BACKGROUND: Contrast-enhanced harmonic EUS (CEH-EUS) is a new sonographic technique that uses US contrast agents and depicts intratumoral vessels in real time. OBJECTIVE: To evaluate whether assessment of tumor vascularity by CEH-EUS can predict the preoperative malignancy risk of GI stromal tumors (GISTs). DESIGN: Prospective study to observe GIST vascularity. SETTING: Kinki University School of Medicine. PATIENTS: Between June 2007 and September 2009, 76 consecutive patients suspected of having subepithelial lesions underwent CEH-EUS. INTERVENTION: CEH-EUS was performed by using a prototype echoendoscope in an extended pure harmonic detection mode. MAIN OUTCOME MEASUREMENTS: Resected GIST specimens in 29 patients who underwent surgical resection were divided into high-grade (n=16) and low-grade (n=13) malignancy groups based on mitotic activity. The abilities of EUS-guided FNA and CEH-EUS to diagnose the malignant potential were compared. The sensitivities with which contrast-enhanced multidetector CT, power-Doppler EUS, and CEH-EUS detected intratumoral vessels in high-grade malignancy GISTs also were compared. RESULTS: CEH-EUS identified irregular vessels and thereby predicted GIST malignancies with a sensitivity, specificity, and accuracy of 100%, 63%, and 83%, respectively. Diagnosis of high-grade malignancy GISTs by EUS-guided FNA had a sensitivity, specificity, and accuracy of 63%, 92%, and 81%, respectively. Contrast-enhanced multidetector CT, power-Doppler EUS, and CEH-EUS detected intratumoral vessels in high-grade malignancy GISTs with sensitivities of 31%, 63%, and 100%, respectively (P<.05). LIMITATIONS: A single center was involved in this study. CONCLUSIONS: CEH-EUS successfully visualized intratumoral vessels and may play an important role in predicting the malignancy risk of GISTs.
  • K. Kamata; M. Kitano; M. Kudo; H. Imai; H. Sakamoto; T. Komaki
    ENDOSCOPY 42 E331 - E332 2010年12月 [査読有り]
  • Hiroki Sakamoto; Masayuki Kitano; Ken Kamata; Takamitsu Komaki; Hajime Imai; Takaaki Chikugo; Yoshifumi Takeyama; Masatoshi Kudo
    The American journal of gastroenterology 105 12 2599 - 606 2010年12月 [査読有り]
     
    OBJECTIVES: Endoscopic ultrasonography (EUS)-guided celiac plexus neurolysis (EUS-CPN) is safe and effective but not beneficial for some patients with extended abdominal cancer. We compared the effectiveness of standard EUS-CPN and EUS-guided broad plexus neurolysis (EUS-BPN) that extends over the superior mesenteric artery (SMA) using a 25-gauge needle. METHODS: Consecutive patients referred to our quaternary EUS centers were eligible for inclusion. To evaluate the neurolytic spread, contrast was mixed with the neurolytic agent and post-procedure computed tomography scanning was performed. The regions containing the celiac, superior, and inferior mesenteric arteries were divided on the frontal plane into six areas: upper right and left, middle right and left, and lower right and left. The number of contrast-bearing areas after EUS-CPN and EUS-BPN were related to the degree of pain relief achieved. RESULTS: A total of 67 patients with advanced abdominal cancer were included (34 EUS-CPN and 33 EUS-BPN). The qualitative variables of the two groups did not differ significantly. The EUS-BPN group had more patients with six contrast-bearing areas (42%) than the EUS-CPN group (0%). These patients had significantly better short-term and long-lasting pain relief than patients with less than five contrast-bearing areas. EUS-BPN patients exhibited significantly greater reductions in days 7 and 30 visual analog pain scale scores than EUS-CPN patients. CONCLUSIONS: Our preliminary data suggested that EUS-BPN using a 25-gauge needle provides patients with advanced abdominal cancer with better pain relief than standard EUS-CPN, and without incurring serious complications. Moreover, it seems that broad neurolysis over the SMA may provide superior analgesia.
  • Yu Xia; Masayuki Kitano; Masatoshi Kudo; Hajime Imai; Ken Kamata; Hiroki Sakamoto; Takamitsu Komaki
    Gastrointestinal endoscopy 72 3 637 - 42 2010年09月 [査読有り]
     
    BACKGROUND: The diagnosis of intra-abdominal lesions of undetermined origin is often a challenge for endoscopists and radiologists. OBJECTIVE: To evaluate the microvasculature of benign and malignant intra-abdominal lesions by contrast-enhanced harmonic EUS (CEH-EUS) and to investigate its usefulness for discriminating between malignant and benign lesions. DESIGN: The vascularity of intra-abdominal lesions of undetermined origin was observed by using CEH-EUS. The lesions were classified according to their vascular patterns. The effectiveness of CEH-EUS in differentiating malignant from benign lesions was evaluated. SETTING: Kinki University School of Medicine, Osaka, Japan. PATIENTS: Forty-three patients, each with a lesion of undetermined origin, were evaluated prospectively by CEH-EUS between March 2007 and March 2009. INTERVENTIONS: CEH-EUS was performed by using a prototype echoendoscope and the extended pure harmonic detection mode (a specific mode for contrast harmonic imaging). MAIN OUTCOME MEASUREMENTS: The lesions were categorized by 2 physicians as having no, homogeneous, or heterogeneous enhancement. A consensus was reached for each case offline. How the benign and malignant groups differed in terms of their enhancement patterns was examined. RESULTS: The kappa coefficient of the interobserver agreement test was 0.953 (P < .001). Of the 27 malignant lesions, 26 (96.3%) exhibited heterogeneous enhancement. The 1 remaining malignant lesion (3.7%) showed homogeneous enhancement. Of the 16 benign lesions, none displayed heterogeneous enhancement, and 12 (75%) and 4 (25%) exhibited homogeneous and no enhancement, respectively. The malignant and benign lesion groups differed significantly in terms of homogeneous and heterogeneous enhancement (P < .001). The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy with which CEH-EUS differentiated malignant from benign lesions were 96.3%, 100%, 100%, 94.1%, and 97.6%, respectively. LIMITATIONS: A single medical unit with a limited number of patients. CONCLUSIONS: CEH-EUS depicted the microvasculature of intra-abdominal lesions of undetermined origin very clearly and may be useful for characterizing such lesions.
  • Hiroki Sakamoto; Masayuki Kitano; Ken Kamata; Muhammad El-Masry; Masatoshi Kudo
    World journal of radiology 2 4 122 - 34 2010年04月 [査読有り]
     
    Pancreatic tumors are highly diverse, as they can be solid or cystic, and benign or malignant. Since their imaging features overlap considerably, it is often difficult to characterize these tumors. In addition, small pancreatic tumors, especially those less than 2 cm in diameter, are difficult to detect and diagnose. For characterizing pancreatic tumors and detecting small pancreatic tumors, endoscopic ultrasonography (EUS) is the most sensitive of the imaging procedures currently available. This technique also provides good results in terms of the preoperative staging of pancreatic tumors. EUS-guided fine needle aspiration (EUS-FNA) has also proved to be a safe and useful method for tissue sampling of pancreatic tumors. Despite these advantages, however, it is still difficult to differentiate between benign and malignant, solid or cystic pancreatic tumors, malignant neoplasms, and chronic pancreatitis using EUS, even when EUS-FNA is performed. Recently, contrast-enhanced EUS with Doppler mode (CE-EUS) employing ultrasound contrast agents, which indicate vascularization in pancreatic lesions, has been found to be useful in the differential diagnosis of pancreatic tumors, especially small pancreatic tumors. However, Doppler ultrasonography with contrast-enhancement has several limitations, including blooming artifacts, poor spatial resolution, and low sensitivity to slow flow. Consequently, an echoendoscope was developed recently that has a broad-band transducer and an imaging mode that was designed specifically for contrast-enhanced harmonic EUS (CEH-EUS) with a second-generation ultrasound contrast agent. The CEH-EUS technique is expected to improve the differential diagnosis of pancreatic disease in the future. This review describes the EUS appearances of common solid and cystic pancreatic masses, the diagnostic accuracy of EUS-FNA, and the relative efficacies and advantages of CE-EUS and CEH-EUS along with their relative advantages and their complementary roles in clinical practice.
  • Hiroki Sakamoto; Masayuki Kitano; Takamitsu Komaki; Hajime Imai; Ken Kamata; Masatomo Kimura; Yoshifumi Takeyama; Masatoshi Kudo
    World journal of gastroenterology 15 43 5489 - 92 2009年11月 [査読有り]
     
    Endoscopic ultrasonography (EUS) is a highly sensitive diagnostic method for the detection of small pancreatic carcinomas. Recently, there have been some reports describing the utility of contrast-enhanced harmonic EUS (CEH-EUS) which uses sonographic contrast agent for differentiation of a pancreatic mass. This report describes a case of small adenocarcinoma of the pancreas distinct from branch duct intraductal papillary mucinous neoplasm (IPMN) in which investigation by EUS took place every 6 mo and diagnosis was made accurately by additional CEH-EUS during the follow-up of the branch duct IPMN. A 68-year-old female was admitted to our hospital because of a branch duct IPMN in the pancreatic body. She had been followed-up by EUS every 6 mo. However, after 2 years EUS demonstrated a low echoic area distinct from the branch duct IPMN which was vaguely discernible by EUS, and accurate sizing and differential diagnosis were considered difficult on the EUS imaging. CH-EUS with Sonazoid revealed a hypovascular tumor and we suspected small pancreatic carcinoma. The histopathological diagnosis was adenocarcinoma (10 mm) in the pancreatic tail, distinct from the branch duct IPMN of the pancreatic body. EUS and CEH-EUS may play an important role in the correct diagnosis of small pancreatic tumors, including synchronous and metachronous occurrence of IPMN and ductal adenocarcinoma of the pancreas.
  • K. Kamata; M. Kitano; T. Komaki; H. Sakamoto; M. Kudo
    ENDOSCOPY 41 E315 - E316 2009年11月 [査読有り]

MISC

書籍等出版物

  • これで完璧!胆膵内視鏡の基本とコツ
    (担当:共著範囲:)羊土社 2021年11月
  • 消化器内科診察 レジデントマニュアル
    (担当:共著範囲:)医学書院 2018年
  • 新世代の膵癌診療・治療バイブル
    (担当:共著範囲:)メディカ出版 2017年
  • Advances in EUS
    (担当:共著範囲:)Springer New York 2015年
  • これだけは知っておきたい膵疾患診療の手引き
    (担当:共著範囲:)中外医学社 2014年

講演・口頭発表等

  • 『疾患概念・診断法』の進歩と明日への提言  [通常講演]
    菅野 敦; 北野 雅之; 糸井 隆夫; 鎌田 研; 川井 学; 芹川 正浩; 高岡 亮; 高折 恭一; 高山 敬子; 花田 敬士; 奥坂 拓志
    膵臓 2019年06月
  • 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  [通常講演]
    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 2019年06月
  • 膵癌早期診断の最前線 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  [通常講演]
    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 2019年06月
  • 急性膵炎:診断と治療の最前線 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  [通常講演]
    竹内 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 2019年06月
  • 術前診断に難渋した膵頭部・尾部同時性多発癌の一例  [通常講演]
    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 2019年03月
  • IPMN切除例からみた新ガイドラインの検証と、造影ハーモニックEUSの有用性について  [通常講演]
    山崎 友裕; 大本 俊介; 竹中 完; 吉川 智恵; 石川 嶺; 岡本 彩那; 中井 敦史; 三長 孝輔; 鎌田 研; 山雄 健太郎
    日本消化器病学会雑誌 2019年03月
  • 胆膵腫瘍診断・治療の進歩と課題 膵神経内分泌腫瘍の悪性度評価における造影ハーモニックEUSの有用性  [通常講演]
    石川 嶺; 鎌田 研; 竹中 完; 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年02月
  • 門場智也; 鶴崎正勝; 小田晃義; 沼本勲男; 柳生行伸; 柏木伸夫; 石井一成; 鎌田研; 工藤正俊
    IVR 2018年11月
  • 胆膵領域におけるIgG4関連疾患の研究と診療の進歩 腸内細菌叢からみたIgG4関連疾患の発症機序の解明  [通常講演]
    鎌田 研; 渡邉 智裕; 工藤 正俊
    日本消化器病学会雑誌 2018年10月
  • 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  [通常講演]
    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 2018年10月
  • EUS施行時の鎮静に対するBISモニターの有用性の検討  [通常講演]
    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 2018年10月
  • 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  [通常講演]
    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 2018年10月
  • 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 2018年08月
  • 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 2018年05月
  • 北野雅之; 糸井隆夫; 鎌田研; 川井学; 菅野敦; 芹川正浩; 高岡亮; 高折恭一; 高山敬子; 花田敬二; 奥坂拓志
    膵臓 2018年05月
  • 木下真樹子; 木下幾晴; 今井元; 鎌田研; 三長孝輔; 大本俊介; 山本佳司; 薮内以和夫
    膵臓 2018年05月
  • EUS-FNAにより診断が得られた肺扁平上皮癌膵・肝転移の1例  [通常講演]
    木下 真樹子; 木下 幾晴; 今井 元; 鎌田 研; 三長 孝輔; 大本 俊介; 山本 佳司; 薮内 以和夫
    膵臓 2018年05月
  • 膵NETの最新の画像診断と治療 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  [通常講演]
    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 2018年05月
  • 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  [通常講演]
    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 2018年04月
  • 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 2018年04月
  • 膵体部の膵神経内分泌腫瘍に合併した膵性胸水の一例  [通常講演]
    河野 辰哉; 山雄 健太郎; 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; 田中 伴典; 筑後 孝章; 林 暁洋; 工藤 正俊
    日本消化器病学会雑誌 2018年04月
  • 良性胆嚢疾患 胆嚢癌との鑑別困難例に対する診断・治療戦略 造影ハーモニックEUSによる胆嚢病変の良悪性鑑別 Vessel imageとPerfusion imageの比較  [通常講演]
    鎌田 研; 竹中 完; 工藤 正俊
    胆道 2017年08月
  • EUS下ドレナージを行った急性閉塞性化膿性胆管炎をきたした総胆管結石の1例  [通常講演]
    三長 孝輔; 大本 俊介; 門阪 薫平; 松田 友彦; 宮田 剛; 鎌田 研; 山雄 健太郎; 今井 元; 北野 雅之; 工藤 正作
    和歌山医学 2017年06月
  • 超音波内視鏡を用いた膵疾患診療 基本から応用まで EUSガイド下神経ブロックの成績と治療効果予測因子の検討  [通常講演]
    三長 孝輔; 竹中 完; 宮田 剛; 中井 敦史; 大本 俊介; 鎌田 研; 山雄 健太郎; 今井 元; 渡邉 智裕; 工藤 正俊
    膵臓 2017年05月
  • 超音波内視鏡を用いた膵疾患診療 基本から応用まで EUSガイド下神経ブロックの成績と治療効果予測因子の検討  [通常講演]
    三長 孝輔; 竹中 完; 宮田 剛; 中井 敦史; 大本 俊介; 鎌田 研; 山雄 健太郎; 今井 元; 渡邉 智裕; 工藤 正俊
    膵臓 2017年05月
  • 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  [通常講演]
    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 2017年05月
  • 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  [通常講演]
    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 2017年05月
  • 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  [通常講演]
    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 2017年05月
  • 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  [通常講演]
    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 2017年05月
  • 上部消化管粘膜下腫瘍のマネージメント 経験とエビデンスに基づく食道・胃粘膜下腫瘍の診断と治療指針 胃粘膜下腫瘍における造影ハーモニックEUSによる悪性抽出能の検討  [通常講演]
    鎌田 研; 竹中 完; 工藤 正俊
    Gastroenterological Endoscopy 2017年04月
  • 硬化性胆管炎と診断された膵癌、閉塞性黄疸の1例  [通常講演]
    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 2017年04月
  • 膵腫瘤性病変に対する新規のcore biopsy needleを用いたEUS-FNAにおける組織診断能の検討  [通常講演]
    土田 幸平; 岩下 拓司; 渋川 悟朗; 井上 宏之; 鎌田 研
    Gastroenterological Endoscopy 2017年04月
  • 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  [通常講演]
    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 2017年04月
  • 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  [通常講演]
    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 2017年04月
  • IPMNの診断と治療の進歩 EUSによるIPMN併存膵癌の早期発見と問題点  [通常講演]
    鎌田 研; 竹中 完; 工藤 正俊
    日本消化器病学会雑誌 2017年03月
  • IPMN併存膵癌における諸問題と対策 IPMN併存膵癌の臨床像と早期発見におけるEUSの有用性  [通常講演]
    鎌田 研; 北野 雅之; 工藤 正俊
    日本消化器病学会雑誌 2016年09月
  • 胆道疾患に対する超音波内視鏡の有用性 急性胆嚢炎に対するEUSガイド下胆嚢ドレナージの長期成績 長期成績からみたSEMS早期抜去の有用性  [通常講演]
    鎌田 研; 北野 雅之; 工藤 正俊
    胆道 2016年08月
  • 胆嚢病変の治療方針決定における造影ハーモニックEUSの有用性  [通常講演]
    鎌田 研; 北野 雅之; 工藤 正俊
    胆道 2016年08月
  • 多職種協同により意思決定支援を行い患者の望む療養場所へ退院できた一例  [通常講演]
    伊藤 武志; 藤原 季美子; 古川 諭; 田守 千夏; 松下 智代; 田村 訓子; 河内 梨紗; 大坪 正敏; 大坪 よし子; 鎌田 研; 森嶋 祥之
    Palliative Care Research 2016年06月
  • 胆膵におけるInterventional EUS 超音波内視鏡下瘻孔形成術 偶発症とその対策 十二指腸アプローチ困難な閉塞性黄疸に対するAntegrade stenting法併用EUS下Hepaticogastrostomyの安全性および開存期間の検討  [通常講演]
    鎌田 研; 北野 雅之; 工藤 正俊
    Gastroenterological Endoscopy 2016年04月
  • 消化器疾患の診断と治療におけるEUSの役割 EUSを主軸にしたIPMNの経過観察の成績(Role of EUS in Diagnosis and Treatment of Digestive Diseases Utility of endoscopic ultrasonography for follow-up of IPMN)  [通常講演]
    鎌田 研; 北野 雅之; 工藤 正俊
    超音波医学 2016年04月
  • 消化器疾患の診断と治療におけるEUSの役割 EUSガイド下ドレナージを中心としたWONの治療成績及び内視鏡治療不成功因子の解析(Role of EUS in Diagnosis and Treatment of Digestive Diseases EUS-guided interventions for walled-off pancreatic necrosis: clinical outcomes of a step-up approach and risk factors for failed e  [通常講演]
    三長 孝輔; 北野 雅之; 今井 元; 山雄 健太郎; 鎌田 研; 宮田 剛; 松田 友彦; 大本 俊介; 門阪 薫平; 工藤 正俊
    超音波医学 2016年04月
  • 胆膵疾患診療におけるEUSの新たな展開 25G-EUS-FNA針の逆刃付側孔の有無による膵腫瘍に対する診断能の多施設共同無作為化比較試験 検体採取と組織診断に影響する因子の解析  [通常講演]
    鎌田 研; 北野 雅之; 柳澤 昭夫
    日本消化器病学会雑誌 2015年09月
  • 国際診療ガイドラインに基づいたIPMN/MCN診療の課題と対策 IPMNの経過観察におけるEUSおよび造影ハーモニックEUSの有用性  [通常講演]
    鎌田 研; 北野 雅之; 工藤 正俊
    日本消化器病学会雑誌 2015年03月
  • 嚢胞性膵疾患の鑑別診断および経過観察におけるEUSの有用性 造影法を含めて  [通常講演]
    鎌田 研; 北野 雅之; 工藤 正俊
    Gastroenterological Endoscopy 2014年09月
  • 膵癌早期診断におけるEUSの位置づけ  [通常講演]
    北野 雅之; 鎌田 研; 工藤 正俊
    膵臓 2014年06月
  • 自己免疫性膵炎の診断、治療におけるEUSの役割  [通常講演]
    大本 俊介; 北野 雅之; 門坂 薫平; 宮田 剛; 鎌田 研; 山雄 健太郎; 今井 元; 坂本 洋城; 工藤 正俊
    膵臓 2014年06月
  • 造影ハーモニックEUS(CH-EUS)における膵腫瘍の血流評価の有用性について  [通常講演]
    大本 俊介; 田中 梨絵; 門阪 薫平; 鎌田 研; 宮田 剛; 山雄 健太郎; 今井 元; 坂本 洋城; 北野 雅之; 工藤 正俊
    超音波医学 2014年04月
  • 分枝型膵IPMNの診断・悪性度の評価における内視鏡の役割 EUSを主としたIPMNの診断および経過観察の成績 IPMN国際診療ガイドライン2012年度版の妥当性の検証  [通常講演]
    鎌田 研; 北野 雅之; 工藤 正俊
    Gastroenterological Endoscopy 2014年04月
  • 膵神経内分泌腫瘍に対するEUSの有用性  [通常講演]
    今井 元; 北野 雅之; 工藤 正俊; 大本 俊介; 門阪 薫平; 宮田 剛; 鎌田 研; 山雄 健太郎; 坂本 洋城
    Gastroenterological Endoscopy 2014年04月
  • IPMNの経過観察、治療のタイミングと予後 分枝型IPMNの経過観察例からみた2012年国際診療ガイドラインの妥当性の検証  [通常講演]
    鎌田 研; 北野 雅之; 工藤 正俊
    日本消化器病学会雑誌 2014年03月
  • 造影ハーモニックEUS(CH-EUS)における膵腫瘍の血流評価の有用性について  [通常講演]
    大本 俊介; 田中 梨絵; 門阪 薫平; 鎌田 研; 宮田 剛; 山雄 健太郎; 今井 元; 坂本 洋城; 北野 雅之; 工藤 正俊
    日本超音波医学会第40回関西地方会学術集会 2013年11月 大阪国際会議場, 大阪 日本超音波医学会第40回関西地方会学術集会
  • walled-off necrosisの術前の管理においてメタリックステントによるドレナージが有用であった  [通常講演]
    中田 有紀; 北野 雅之; 大本 俊介; 門阪 薫平; 宮田 剛; 鎌田 研; 山雄 健太郎; 今井 元; 坂本 洋城; 工藤 正俊
    日本消化器内視鏡学会近畿支部第91回支部例会 2013年11月 大阪国際交流センター, 大阪 日本消化器内視鏡学会近畿支部第91回支部例会
  • 潰瘍性大腸炎に膵胆管合流異常症を合併した1例  [通常講演]
    東 千尋; 山雄 健太郎; 田中 梨絵; 大本 俊介; 門阪 薫平; 鎌田 研; 宮田 剛; 今井 元; 坂本 洋城; 北野 雅之; 工藤 正俊
    日本消化器内視鏡学会近畿支部第91回支部例会 2013年11月 大阪国際交流センター, 大阪 日本消化器内視鏡学会近畿支部第91回支部例会
  • 造影ハーモニックEUSのよる胆嚢病変の鑑別診断. ワークショップ6「胆道疾患の診断・治療に有用な画像診断-内視鏡診断から三次元画像診断」  [通常講演]
    鎌田 研; 北野 雅之; 工藤 正俊
    第86回日本消化器内視鏡学会総会(第21回日本消化器関連学会週間JDDW2013) 2013年10月 グランドプリンスホテル新高輪国際パミール, 東京 第86回日本消化器内視鏡学会総会(第21回日本消化器関連学会週間JDDW2013)
  • IPMN国際診療ガイドライン2012年度版の検証~EUSの位置づけはどこにあるか?~. パネルディスカッション7「IPMN新コンセンサス診療ガイドラインの検証」  [通常講演]
    鎌田 研; 北野 雅之; 工藤 正俊
    第55回日本消化器病学会大会(第21回日本消化器関連学会週間JDDW2013) 2013年10月 グランドプリンスホテル新高輪国際パミール, 東京 第55回日本消化器病学会大会(第21回日本消化器関連学会週間JDDW2013)
  • 胆道疾患の診断・治療に有用な画像診断 内視鏡診断から三次元画像診断 造影ハーモニックEUSによる胆嚢病変の鑑別診断  [通常講演]
    鎌田 研; 北野 雅之; 工藤 正俊
    Gastroenterological Endoscopy 2013年09月
  • 膵癌による閉塞性黄疸に対する乳頭括約筋切開術未施行のカバー付金属ステント留置術の成績  [通常講演]
    千品 寛和; 門阪 薫平; 田中 梨絵; 大本 俊介; 宮田 剛; 鎌田 研; 今井 元; 坂本 洋城; 北野 雅之; 工藤 正俊
    Gastroenterological Endoscopy 2013年09月
  • Walled off necrosisに対してEUS下内外瘻術を施行後に再発を認めた一例  [通常講演]
    古川 健太郎; 北野 雅之; 田中 梨絵; 大本 俊介; 門阪 薫平; 鎌田 研; 宮田 剛; 今井 元; 坂本 洋城; 工藤 正俊
    日本消化器病学会近畿支部第99回例会 2013年09月 大阪国際交流センター, 大阪 日本消化器病学会近畿支部第99回例会
  • 十二指腸狭窄を合併した閉塞性黄疸に対して十二指腸ステント留置術とEUS-guided Choledochoduodenostomyを施行した膵頭部癌の1例  [通常講演]
    田中 梨絵; 宮田 剛; 大本 俊介; 門阪 薫平; 鎌田 研; 山雄 健太郎; 今井 元; 坂本 洋城; 北野 雅之
    胆道 2013年08月
  • Estimation of EUS features of choronic pancreatitis in comparison with clinical symptoms  [通常講演]
    北野 雅之; 門阪 薫平; 坂本 洋城; 今井 元; 鎌田 研; 宮田 剛; 大本 俊介; 山雄 健太郎; 工藤 正俊
    International Pancreatic Research Forum 2013 (IPRF) 2013年07月 Sendai, Japan International Pancreatic Research Forum 2013 (IPRF)
  • IPMN経過観察におけるEUSの有用性~造影EUSによる診断も含めて~. 特別企画1ディベート「分枝型IPMNの診療: 内科vs外科vs病理」  [通常講演]
    鎌田 研; 北野 雅之; 工藤 正俊; 大本 俊介; 門阪 薫平; 今井 元; 坂本 洋城; 竹山 宜典
    第44回日本膵臓学会大会 2013年07月 仙台国際センター, 宮城 第44回日本膵臓学会大会
  • 早期慢性膵炎EUS画像所見と糖尿病との関連  [通常講演]
    門阪 薫平; 北野 雅之; 大本 俊介; 鎌田 研; 宮田 剛; 今井 元; 坂本 洋城; 工藤 正俊
    日本消化器内視鏡学会近畿支部第90回支部例会 2013年06月 大阪国際交流センター, 大阪 日本消化器内視鏡学会近畿支部第90回支部例会
  • 膵疾患に対する造影超音波検査. パネルディスカッション27「膵腫瘍の診断に最も有用な画像診断法は?: 画像診断の現状とピットフォール」  [通常講演]
    今井 元; 北野 雅之; 大本 俊介; 門阪 薫平; 宮田 剛; 鎌田 研; 坂本 洋城; 工藤 正俊
    日本超音波医学会第86回学術集会 2013年05月 大阪国際会議場, 大阪 日本超音波医学会第86回学術集会
  • Role of contrast-enhanced harmonic EUS in differentiating malignant from benign lymphadenopathy.  [通常講演]
    宮田 剛; 北野 雅之; 坂本 洋城; 今井 元; 鎌田 研; 門阪 薫平; 大本 俊介; 工藤 正俊
    Digestive Disease Week(DDW) 2013 2013年05月 Orlando, USA Digestive Disease Week(DDW) 2013
  • EUS-guided drainage for treatment of postoperative complications after pancreatic surgery.  [通常講演]
    北野 雅之; 竹山 宜典; 宮田 剛; 鎌田 研; 坂本 洋城; 今井 元; 門阪 薫平; 大本 俊介; 工藤 正俊
    Digestive Disease Week(DDW) 2013 2013年05月 Orlando, USA Digestive Disease Week(DDW) 2013
  • 膵仮性嚢胞に対するInterventional EUS  [通常講演]
    大本 俊介; 北野 雅之; 山田 光成; 門阪 薫平; 宮田 剛; 鎌田 研; 今井 元; 坂本 洋城; 工藤 正俊
    第99回日本消化器病学会総会 2013年03月 城山観光ホテル, かごしま県民交流センター, 鹿児島 第99回日本消化器病学会総会
  • 超音波内視鏡下胆嚢ドレナージ術の有用性  [通常講演]
    今井 元; 北野 雅之; 工藤 正俊; 門阪 薫平; 大本 俊介; 鎌田 研; 宮田 剛; 坂本 洋城
    第99回日本消化器病学会総会 2013年03月 城山観光ホテル, かごしま県民交流センター, 鹿児島 第99回日本消化器病学会総会
  • Utility of EUS-guided gallbladder drainage for rescue treatment of malignant biliary obstruction.  [通常講演]
    今井 元; 北野 雅之; 門阪 薫平; 鎌田 研; 宮田 剛; 坂本 洋城; 工藤 正俊
    Asian Pacific Digestive Week (APDW) 2012 2012年12月 Bangkok, Thailand Asian Pacific Digestive Week (APDW) 2012
  • Trans-catheter endoscopy for pancreaticobiliary duct diseases.  [通常講演]
    坂本 洋城; 北野 雅之; 今井 元; 宮田 剛; 鎌田 研; 門阪 薫平; 工藤 正俊
    Asian Pacific Digestive Week (APDW) 2012 2012年12月 Bangkok, Thailand Asian Pacific Digestive Week (APDW) 2012
  • A prospective feasibility study on EUS guided broad plexus neurolysis in combination with celiac ganglion neurolysis.  [通常講演]
    坂本 洋城; 北野 雅之; 今井 元; 鎌田 研; 宮田 剛; 門阪 薫平; 工藤 正俊
    Asian Pacific Digestive Week (APDW) 2012 2012年12月 Bangkok, Thailand Asian Pacific Digestive Week (APDW) 2012
  • Diffrential diagnosis of SMT and evaluation of malignant potentioal gists by contrast enhanced harmonic EUS.  [通常講演]
    坂本 洋城; 北野 雅之; 今井 元; 鎌田 研; 宮田 剛; 門阪 薫平; 工藤 正俊
    Asian Pacific Digestive Week (APDW) 2012 2012年12月 Bangkok, Thailand Asian Pacific Digestive Week (APDW) 2012
  • 膵癌診断ストラテジーと各画像検査の比較検討. パネルディスカッション2「超音波検査発見胆膵病変の精密検査のストラテジー」  [通常講演]
    鎌田 研; 北野 雅之; 工藤 正俊
    第20回日本消化器関連学会週間JDDW2012(第16回日本肝臓学会大会・第54回日本消化器病学会大会・第84回日本消化器内視鏡学会総会・第10回日本消化器外科学会大会・第50回日本消化器がん検診学会 2012年10月 神戸国際展示場, 兵庫 第20回日本消化器関連学会週間JDDW2012(第16回日本肝臓学会大会・第54回日本消化器病学会大会・第84回日本消化器内視鏡学会総会・第10回日本消化器外科学会大会・第50回日本消化器がん検診学会
  • EUS下胆道ドレナージ術の工夫. ビデオワークショップ「胆道疾患内視鏡治療困難例に対する手技の工夫」  [通常講演]
    鎌田 研; 北野 雅之; 工藤 正俊
    第48回日本胆道学会学術集会 2012年09月 京王プラザホテル, 東京 第48回日本胆道学会学術集会
  • 巨大胆石が十二指腸球部に穿通し胆石イレウスを起こした一例  [通常講演]
    宮内 正晴; 北野 雅之; 坂本 洋城; 今井 元; 鎌田 研; 宮田 剛; 門阪 薫平; 工藤 正俊
    日本消化器病学会近畿支部第97回例会 2012年09月 京都テルサ, 京都 日本消化器病学会近畿支部第97回例会
  • 上部胆管癌との鑑別を要したIgG4関連胆管炎  [通常講演]
    田中 寛樹; 北野 雅之; 坂本 洋城; 今井 元; 鎌田 研; 宮田 剛; 門阪 薫平; 工藤 正俊
    日本消化器病学会近畿支部第97回例会 2012年09月 京都テルサ, 京都 日本消化器病学会近畿支部第97回例会
  • 造影ハーモニックEUS(CH-EUS)によってのみ存在診断および境界診断が可能であった膵癌の2例  [通常講演]
    大本 俊介; 北野 雅之; 山田 光成; 門阪 薫平; 宮田 剛; 鎌田 研; 今井 元; 坂本 洋城; 工藤 正俊
    日本消化器病学会近畿支部第97回例会 2012年09月 京都テルサ, 京都 日本消化器病学会近畿支部第97回例会
  • 早期慢性膵炎のEUS所見とその臨床所見について  [通常講演]
    門阪 薫平; 北野 雅之; 山田 光成; 大本 俊介; 鎌田 研; 宮田 剛; 今井 元; 坂本 洋城; 工藤 正俊
    日本消化器病学会近畿支部第97回例会 2012年09月 京都テルサ, 京都 日本消化器病学会近畿支部第97回例会
  • 胆管胆汁細胞診にて診断し得た胆嚢癌の1例  [通常講演]
    山田 光成; 北野 雅之; 宮田 剛; 坂本 洋城; 門阪 薫平; 鎌田 研; 今井 元; 工藤 正俊
    日本消化器病学会近畿支部第97回例会 2012年09月 京都テルサ, 京都 日本消化器病学会近畿支部第97回例会
  • 胆道疾患内視鏡治療困難例に対する手技の工夫 EUS下胆道ドレナージ術の工夫  [通常講演]
    鎌田 研; 北野 雅之; 工藤 正俊
    胆道 2012年08月
  • 膵神経内分泌腫瘍診断におけるEUSの有用性  [通常講演]
    今井 元; 北野 雅之; 工藤 正俊; 門阪 薫平; 宮田 剛; 鎌田 研; 坂本 洋城; 安田 武生; 竹山 宜典
    第43回日本膵臓学会大会 2012年06月 ホテルメトロポリタン山形, 山形 第43回日本膵臓学会大会
  • IPMNの手術適応決定と長期的サーベイランスにおけるEUSの役割  [通常講演]
    鎌田 研; 北野 雅之; 工藤 正俊; 門阪 薫平; 宮田 剛; 今井 元; 坂本 洋城; 安田 武生; 竹山 宜典
    膵臓 2012年05月
  • 膵神経内分泌腫瘍診断におけるEUSの有用性  [通常講演]
    今井 元; 北野 雅之; 工藤 正俊; 門阪 薫平; 宮田 剛; 鎌田 研; 坂本 洋城; 安田 武生; 竹山 宜典
    膵臓 2012年05月
  • Detection of small concomitant carcinomas distinct from intraductal papillary mucinous neoplasms under surveillance of the whole pancreas using EUS  [通常講演]
    鎌田 研; 北野 雅之; 工藤 正俊; 今井 元; 坂本 洋城
    Digestive Disease Week(DDW) 2012 2012年05月 San Diego, USA Digestive Disease Week(DDW) 2012
  • Role of contrast-enhanced harmonic EUS in differentiating malignant from benigh lymphadenopathy.  [通常講演]
    宮田 剛; 北野 雅之; 坂本 洋城; 今井 元; 鎌田 研; 門阪 薫平; 工藤 正俊
    The 83rd Congress of the Japan Gastroenterological Endoscopy Society 2012年05月 Tokyo The 83rd Congress of the Japan Gastroenterological Endoscopy Society
  • IPMNの診断・フォローアップにおけるEUSの役割. ワークショップ9「IPMNの診断・治療における内視鏡の役割」  [通常講演]
    鎌田 研; 北野 雅之; 工藤 正俊
    第83回日本消化器内視鏡学会総会 2012年05月 グランドプリンスホテル新高輪, 東京 第83回日本消化器内視鏡学会総会
  • 胆石性膵炎の診断・治療におけるEUSの役割. シンポジウム1「胆・膵疾患の救急医療の現状と治療戦略」  [通常講演]
    鎌田 研; 北野 雅之; 工藤 正俊
    第83回日本消化器内視鏡学会総会 2012年05月 グランドプリンスホテル新高輪, 東京 第83回日本消化器内視鏡学会総会
  • EUS下hepaticogastrostomyの工夫とトラブルシューティング  [通常講演]
    今井 元; 北野 雅之; 坂本 洋城; 門阪 薫平; 鎌田 研; 宮田 剛; 工藤 正俊
    Gastroenterological Endoscopy 2012年04月
  • 限局性腫瘤を形成した自己免疫性膵炎におけるEUS所見の検討. ワークショップ10「IgG4関連肝胆膵疾患の診断と治療-非典型例へのアプローチ」  [通常講演]
    鎌田 研; 北野 雅之; 工藤 正俊
    第98回日本消化器病学会総会 2012年04月 京王プラザ 第98回日本消化器病学会総会
  • Estination of EUS features of chronic pancreatitis in comparison with clinical symptoms  [通常講演]
    門阪 薫平; 北野 雅之; 坂本 洋城; 今井 元; 鎌田 研; 宮田 剛; 工藤 正俊
    The 83rd Congress of the Japan Gastroenterological Endoscopy Society 2012年 Tokyo The 83rd Congress of the Japan Gastroenterological Endoscopy Society
  • Diagnostic utility of contrast enhanced harmonic EUS imaging in patients with submucosal tumor of gastrointersinal tract.  [通常講演]
    坂本 洋城; 北野 雅之; 今井 元; 小牧 孝充; 鎌田 研; 宮田 剛; 門阪 薫平; 工藤 正俊
    19th United European Gastroenterology Week (UEGW) 2011年10月 Stockholm, Sweden 19th United European Gastroenterology Week (UEGW)
  • Endoscopic ultrasonograph (EUS)-guided choledochoduo-denostomy and hepatogastrostomy for treatment of biliary obstruction.  [通常講演]
    今井 元; 北野 雅之; 坂本 洋城; 鎌田 研; 小牧 孝充; 宮田 剛; 門阪 薫平; 工藤 正俊
    19th United European Gastroenterology Week (UEGW) 2011年10月 Stockholm, Sweden 19th United European Gastroenterology Week (UEGW)
  • IPMNの悪性度評価およびフォローアップにおける造影法を含めたEUSの有用性. ワークショップ「嚢胞性膵腫瘍の病態からみた治療」  [通常講演]
    鎌田 研; 北野 雅之; 工藤 正俊
    第19回日本消化器関連学会週間JDDW 2011(第9回日本消化器外科学会大会・第53回日本消化器病学会大会・第82回日本消化器内視鏡学会総会合同) 2011年10月 福岡国際センター, 福岡 第19回日本消化器関連学会週間JDDW 2011(第9回日本消化器外科学会大会・第53回日本消化器病学会大会・第82回日本消化器内視鏡学会総会合同)
  • 癌性疼痛における超音波内視鏡下広範囲腹腔神経叢融解術(EUS-BPN)の有用性.  [通常講演]
    坂本 洋城; 北野 雅之; 今井 元; 鎌田 研; 宮田 剛; 門阪 薫平; 工藤 正俊
    第60回近畿膵疾患談話会 2011年10月 エーザイ株式会社大阪コミュニケーションオフィス, 大阪 第60回近畿膵疾患談話会
  • Does wire guided cannulation reduce the risk of pancreatic disorder?  [通常講演]
    鎌田 研; 北野 雅之; 工藤 正俊; 門阪 薫平; 宮田 剛; 坂本 洋城; 今井 元; 小牧 孝充
    Asian Pacific Digestive Week (APDW) 2011 2011年10月 Singapore Asian Pacific Digestive Week (APDW) 2011
  • Endoscopic ultrasonography (EUS)-guided biliary drainage for treatment of biliary obstruction.  [通常講演]
    今井 元; 北野 雅之; 鎌田 研; 門阪 薫平; 宮田 剛; 坂本 洋城; 小牧 孝充; 工藤 正俊
    Asian Pacific Digestive Week (APDW) 2011 2011年10月 Singapore Asian Pacific Digestive Week (APDW) 2011
  • 造影ハーモニックEUSを用いた腹部リンパ節の良悪性診断の試み.  [通常講演]
    宮田 剛; 坂本 洋城; 北野 雅之; 鎌田 研; 今井 元; 小牧 孝充; 門阪 薫平; 工藤 正俊
    第87回日本消化器内視鏡学会近畿地方会 2011年10月 神戸ポートピアホテル, 兵庫 第87回日本消化器内視鏡学会近畿地方会
  • 嚢胞性膵腫瘍の病態からみた治療 IPMNの悪性度評価およびフォローアップにおける造影法を含めたEUSの有用性  [通常講演]
    鎌田 研; 北野 雅之; 工藤 正俊
    Gastroenterological Endoscopy 2011年09月
  • 胆嚢疾患の鑑別における造影ハーモニックEUSの有用性.  [通常講演]
    鎌田 研; 北野 雅之; 工藤 正俊; 宮田 剛; 今井 元; 坂本 洋城; 小牧 孝充
    第47回日本胆道学会学術集会 2011年09月 ワールドコンベンションセンターサミット, 宮崎 第47回日本胆道学会学術集会
  • EUSによる肝外胆管癌の進展度診断.  [通常講演]
    小牧 孝充; 北野 雅之; 坂本 洋城; 今井 元; 鎌田 研; 宮田 剛; 門阪 薫平; 工藤 正俊; 中居 卓也; 竹山 宜典
    第47回日本胆道学会学術集会 2011年09月 ワールドコンベンションセンターサミット, 宮崎 第47回日本胆道学会学術集会
  • Wire Guided Cannulation法はERCP後膵障害のリスクを減少させるか.  [通常講演]
    鎌田 研; 北野 雅之; 工藤 正俊; 宮田 剛; 今井 元; 坂本 洋城; 小牧 孝充
    第47回日本胆道学会学術集会 2011年09月 ワールドコンベンションセンターサミット, 宮崎 第47回日本胆道学会学術集会
  • 胆嚢疾患の鑑別における造影ハーモニックEUSの有用性  [通常講演]
    鎌田 研; 北野 雅之; 工藤 正俊; 宮田 剛; 今井 元; 坂本 洋城; 小牧 孝充
    胆道 2011年08月
  • 小膵癌におけるUS, MDCT, EUS(CH-EUS)の診断能の比較検討. ワークショップ「膵腫瘍性病変の診断と治療」  [通常講演]
    宮田 剛; 坂本 洋城; 門阪 薫平; 鎌田 研; 今井 元; 小牧 孝充; 北野 雅之; 工藤 正俊
    日本消化器病学会近畿支部第95回例会 2011年08月 大阪国際交流センター, 大阪 日本消化器病学会近畿支部第95回例会
  • 特徴的な画像所見を呈し、肝転移巣からのEUS-FNAにより退形成癌と診断された1例.  [通常講演]
    大西 佐代子; 北野 雅之; 工藤 正俊; 門阪 薫平; 宮田 剛; 鎌田 研; 今井 元; 坂本 洋城; 小牧 孝充
    日本消化器病学会近畿支部第95回例会 2011年08月 大阪国際交流センター, 大阪 日本消化器病学会近畿支部第95回例会
  • FDP-PETにて治療経過を観察しえた腫瘤形成型膵炎像を呈した自己免疫性膵炎の一例.  [通常講演]
    門阪 薫平; 坂本 洋城; 北野 雅之; 小牧 孝充; 今井 元; 鎌田 研; 宮田 剛; 工藤 正俊; 筑後 孝章; 土手 健作; 廣岡 知臣; 高柳
    日本消化器病学会近畿支部第95回例会 2011年08月 大阪国際交流センター, 大阪 日本消化器病学会近畿支部第95回例会
  • 金属ステントが有用であった良性胆道狭窄の2例.  [通常講演]
    宮田 剛; 鎌田 研; 今井 元; 坂本 洋城; 小牧 孝充; 北野 雅之; 工藤 正俊
    第42回日本膵臓学会大会 2011年07月 ホテルニューキャッスル, 青森 第42回日本膵臓学会大会
  • IPMNおよび併存膵癌の診断におけるEUSの役割.  [通常講演]
    鎌田 研; 北野 雅之; 工藤 正俊; 宮田 剛; 今井 元; 坂本 洋城; 小牧 孝充; 安田 武生; 竹山 宜典
    第42回日本膵臓学会大会 2011年07月 ホテルニューキャッスル, 青森 第42回日本膵臓学会大会
  • 当院におけるEUS下膵仮性嚢胞ドレナージ術の成績.  [通常講演]
    今井 元; 北野 雅之; 鎌田 研; 宮田 剛; 門阪 薫平; 坂本 洋城; 小牧 孝充; 工藤 正俊; 竹山 宜典
    第42回日本膵臓学会大会 2011年07月 ホテルニューキャッスル, 青森 第42回日本膵臓学会大会
  • 当院におけるEUS下膵仮性嚢胞ドレナージ術の成績  [通常講演]
    今井 元; 北野 雅之; 鎌田 研; 宮田 剛; 門坂 勲平; 坂本 洋城; 小牧 孝充; 工藤 正俊; 竹山 宜典
    膵臓 2011年06月
  • EUSによる自己免疫性膵炎の検討.  [通常講演]
    小牧 孝充; 北野 雅之; 坂本 洋城; 今井 元; 鎌田 研; 工藤 正俊
    第97回日本消化器病学会総会 ミニシンポジウム 2011年05月 京王プラザホテル, 東京 第97回日本消化器病学会総会 ミニシンポジウム
  • Role of EUS in detection and follow-up of intraductal papillary mucinous neoplasms and concomitant invasive carcinomas.  [通常講演]
    鎌田 研; 北野 雅之; 工藤 正俊; 今井 元; 小牧 孝充; 坂本 洋城
    Digestive Disease Week (DDW) 2011 2011年05月 Chicago, USA Digestive Disease Week (DDW) 2011
  • Dynamic imaging of gallbladder diseases by contrast-enahanced harmonic EUS.  [通常講演]
    鎌田 研; 北野 雅之; 工藤 正俊; 今井 元; 小牧 孝充; 坂本 洋城
    Digestive Disease Week (DDW) 2011 2011年05月 Chicago, USA Digestive Disease Week (DDW) 2011
  • EUS-guided gallbladder drainage as an alternative treatment for malignant biliary obstruction after unsuccessful ERCP: Outcomes of long term follow-up.  [通常講演]
    北野 雅之; 今井 元; 鎌田 研; 小牧 孝充; 坂本 洋城; 工藤 正俊
    Digestive Disease Week (DDW) 2011 2011年05月 Chicago, USA Digestive Disease Week (DDW) 2011
  • Contrast enhanced harmonic EUS imaging of submucosal tumor of gastrointestinal tract.  [通常講演]
    坂本 洋城; 北野 雅之; 鎌田 研; 松井 繁長; 朝隈 豊; 工藤 正俊
    Digestive Disease Week (DDW) 2011 2011年05月 Chicago, USA Digestive Disease Week (DDW) 2011
  • EUS-guided broad plexus-neurolysis over the superior mesenteric artery.  [通常講演]
    坂本 洋城; 北野 雅之; 鎌田 研; 工藤 正俊
    Digestive Disease Week (DDW) 2011 2011年05月 Chicago, USA Digestive Disease Week (DDW) 2011
  • 胆嚢疾患に対する造影ハーモニックEUSを用いたダイナミックイメージング  [通常講演]
    鎌田 研
    超音波医学 2011年04月
  • 切除不能悪性中下部胆道狭窄に対する胆管ステンティングの検討.  [通常講演]
    今井 元; 北野 雅之; 工藤 正俊; 鎌田 研; 坂本 洋城; 小牧 孝充; 宮田 剛
    第81回日本消化器内視鏡学会総会 2011年04月 ホテル青森, 青森 第81回日本消化器内視鏡学会総会
  • コンベックス型EUSによる胆膵領域のスクリーニング. パネルディスカッション 胆膵内視鏡の基本  [通常講演]
    鎌田 研; 北野 雅之; 工藤 正俊
    第81回日本消化器内視鏡学会総会 2011年04月 ホテル青森, 青森 第81回日本消化器内視鏡学会総会
  • 経乳頭的治療困難例におけるEUSガイド下胆道ドレナージ術.  [通常講演]
    宮田 剛; 鎌田 研; 今井 元; 小牧 孝充; 坂本 洋城; 北野 雅之; 工藤 正俊
    第81回日本消化器内視鏡学会総会 2011年04月 ホテル青森, 青森 第81回日本消化器内視鏡学会総会
  • 悪性胃十二指腸狭窄に対するself-expandable-metal-stentの有用性について.  [通常講演]
    今井 元; 北野 雅之; 工藤 正俊; 鎌田 研; 坂本 洋城; 小牧 孝充
    第81回日本消化器内視鏡学会総会 2011年04月 ホテル青森, 青森 第81回日本消化器内視鏡学会総会
  • 悪性胃十二指腸狭窄に対するself-expandable-metal-stentの有用性について  [通常講演]
    今井 元; 北野 雅之; 工藤 正俊; 鎌田 研; 坂本 洋城; 小牧 孝充
    Gastroenterological Endoscopy 2011年03月
  • 経乳頭的治療困難例におけるEUSガイド下胆道ドレナージ術  [通常講演]
    宮田 剛; 鎌田 研; 今井 元; 小牧 孝充; 坂本 洋城; 北野 雅之; 工藤 正俊
    Gastroenterological Endoscopy 2011年03月
  • 膵・胆道がんを克服する新たな道はあるか? 基礎と臨床の双方から具体的解決方法の模索を 造影ハーモニックEUSによる膵小病変の診断  [通常講演]
    鎌田 研; 北野 雅之; 工藤 正俊
    日本消化器病学会雑誌 2011年03月
  • EUSによる自己免疫性膵炎の検討  [通常講演]
    小牧 孝充; 北野 雅之; 坂本 洋城; 今井 元; 鎌田 研; 工藤 正俊
    日本消化器病学会雑誌 2011年03月
  • 腫瘤形成性膵炎と膵癌との鑑別診断に苦慮した一例.  [通常講演]
    小牧 孝充; 北野 雅之; 坂本 洋城; 今井 元; 鎌田 研; 工藤 正俊; 筑後 孝章; 竹山 宜典
    第54回日本消化器画像診断研究会 2011年02月 昭和女子大学, 東京 第54回日本消化器画像診断研究会
  • Endoscopic ultrasound (EUS)-guided transluminal endoscopic removal of gallstones.  [通常講演]
    鎌田 研; 宮田 剛; 今井 元; 坂本 洋城; 小牧 孝充; 北野 雅之; 工藤 正俊
    第9回FNA-Club Japan 2011年02月 東京医科大学, 東京 第9回FNA-Club Japan
  • 胆管挿入困難例に対するEUS下ドレナージ術の位置づけ.  [通常講演]
    今井 元; 北野 雅之; 小牧 孝充; 鎌田 研; 坂本 洋城; 工藤 正俊
    第18回日本消化器関連学会週間(第80回日本消化器内視鏡学会総会) 2010年10月 パシフィコ横浜, 神奈川 第18回日本消化器関連学会週間(第80回日本消化器内視鏡学会総会)
  • EUSを主としたIPMN、IPNBの診療ストラテジー.  [通常講演]
    鎌田 研; 北野 雅之; 工藤 正俊
    第18回日本消化器関連学会週間(第14回日本肝臓学会大会・第52回日本消化器病学会・第8回日本消化器外科学会大会合同)ワークショップ「肝胆膵での上皮内腫瘍: 病態解明と治療戦略」 2010年10月 第18回日本消化器関連学会週間(第14回日本肝臓学会大会・第52回日本消化器病学会・第8回日本消化器外科学会大会合同)ワークショップ「肝胆膵での上皮内腫瘍: 病態解明と治療戦略」
  • 胆膵疾患に対するEUSガイド下ドレナージ術.  [通常講演]
    鎌田 研; 北野 雅之; 工藤 正俊
    第18回日本消化器関連学会週間(第80回日本消化器内視鏡学会総会・第52回日本消化器病学会大会合同)シンポジウム「Interventional EUSの評価」 2010年10月 パシフィコ横浜, 神奈川 第18回日本消化器関連学会週間(第80回日本消化器内視鏡学会総会・第52回日本消化器病学会大会合同)シンポジウム「Interventional EUSの評価」
  • Estimation of malignant potential gist by contrast-enhanced harmonic endoscopic ultrasonography.  [通常講演]
    坂本 洋城; 北野 雅之; 小牧 孝充; 鎌田 研; 今井 元; 工藤 正俊
    18th United European Gastroenterology Week (UEGW) 2010 2010年10月 Barcelona, Spain 18th United European Gastroenterology Week (UEGW) 2010
  • Characterization of small pancreatic neoplasms by contrast-enhanced harmonic EUS.  [通常講演]
    北野 雅之; 坂本 洋城; 小牧 孝充; 今井 元; 鎌田 研; 工藤 正俊; 高木 忠之; 山雄
    18th United European Gastroenterology Week (UEGW) 2010 2010年10月 Barcelona, Spain 18th United European Gastroenterology Week (UEGW) 2010
  • Interventional EUSの評価 胆膵疾患に対するEUSガイド下ドレナージ術  [通常講演]
    鎌田 研; 北野 雅之; 工藤 正俊
    Gastroenterological Endoscopy 2010年09月
  • EUS-FNA穿刺針の使い分けとコツ.  [通常講演]
    北野 雅之; 坂本 洋城; 小牧 孝充; 今井 元; 鎌田 研; 工藤 正俊
    第8回FNA-Club Japan, 特別企画講演「先端施設における膵のEUS-FNA」 2010年09月 三井ガーデンホテル広島, 広島 第8回FNA-Club Japan, 特別企画講演「先端施設における膵のEUS-FNA」
  • Sonazoidを用いた造影EUSによる胆嚢病変の診断  [通常講演]
    鎌田 研; 北野 雅之; 工藤 正俊; 今井 元; 小牧 孝充; 坂本 洋城
    胆道 2010年08月
  • EUSによる肝外胆管癌の進展度診断  [通常講演]
    小牧 孝充; 北野 雅之; 坂本 洋城; 今井 元; 鎌田 研; 工藤 正俊; 中居 卓也; 竹山 宜典
    胆道 2010年08月
  • EUS-guided broad plexus-neurolysis over the superior mesenteric artery using a 25 gauge needle.  [通常講演]
    坂本 洋城; 北野 雅之; 小牧 孝充; 今井 元; 鎌田 研; 竹山 宜典; 中居 卓也; 安田 武生; 亀井 敬子; 工藤 正俊
    Joint Meeting of the International Association of Pancreatology and the Japan Pancreas Society 2010 2010年07月 Fukuoka, Japan Joint Meeting of the International Association of Pancreatology and the Japan Pancreas Society 2010
  • Management of IPMNs by endoscopic ultrasonography.  [通常講演]
    鎌田 研; 北野 雅之; 今井 元; 小牧 孝充; 坂本 洋城; 竹山 宜典; 工藤 正俊
    Joint Meeting of the International Association of Pancreatology and the Japan Pancreas Society 2010 2010年07月 Fukuoka, Japan Joint Meeting of the International Association of Pancreatology and the Japan Pancreas Society 2010
  • Endoscopic ultrasound-guided drainage for pancreatic diseases. JPS Video Symposium 1 “Cutting edge endoscopic procedures for diagnosis and treatment of panvreatic diseases”  [通常講演]
    鎌田 研; 北野 雅之; 小牧 孝充; 今井 元; 坂本 洋城; 竹山 宜典; 工藤 正俊
    Joint Meeting of the International Association of Pancreatology and the Japan Pancreas Society 2010 2010年07月 Fukuoka, Japan Joint Meeting of the International Association of Pancreatology and the Japan Pancreas Society 2010
  • 膵腫瘍に対する腹部超音波, 超音波内視鏡, MDCTの部位別検出率の比較検討.  [通常講演]
    今井 元; 北野 雅之; 鎌田 研; 小牧 孝充; 坂本 洋城; 工藤 正俊
    日本超音波医学会 第83回学術集会 2010年05月 京都国際会議場, 京都 日本超音波医学会 第83回学術集会
  • 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の試み.  [通常講演]
    坂本 洋城; 北野 雅之; 小牧 孝充; 今井 元; 鎌田 研; 工藤 正俊
    日本超音波医学会 第83回学術集会 2010年05月 京都国際会議場, 京都 日本超音波医学会 第83回学術集会
  • 膵疾患に対する超音波内視鏡ガイド下ドレナージ術.  [通常講演]
    北野 雅之; 小牧 孝充; 坂本 洋城; 今井 元; 鎌田 研; 工藤 正俊
    日本超音波医学会 第83回学術集会, ワークショップ「消化器疾患におけるInterventional Sonography」 2010年05月 京都国際会議場, 京都 日本超音波医学会 第83回学術集会, ワークショップ「消化器疾患におけるInterventional Sonography」
  • Sonazoidを用いた造影EUS検査による膵腫瘍性病変の診断.  [通常講演]
    小牧 孝充; 北野 雅之; 今井 元; 鎌田 研; 工藤 正俊
    日本超音波医学会 第83回学術集会, パネルディスカッション「超音波内視鏡の新展開」 2010年05月 京都国際会議場, 京都 日本超音波医学会 第83回学術集会, パネルディスカッション「超音波内視鏡の新展開」
  • EUSを用いたIPMN診療.  [通常講演]
    鎌田 研; 北野 雅之; 工藤 正俊; 坂本 洋城; 小牧 孝充; 今井 元
    日本超音波医学会 第83回学術集会, シンポジウム「膵疾患の超音波診断」 2010年05月 都国際会議場, 京都 日本超音波医学会 第83回学術集会, シンポジウム「膵疾患の超音波診断」
  • 経乳頭的アプローチ困難例に対するEUS下胆道ドレナージ術の有用性.  [通常講演]
    鎌田 研; 北野 雅之; 今井 元; 小牧 孝充; 坂本 洋城; 末冨 洋一郎; 工藤 正俊
    第79回日本消化器内視鏡学会総会 2010年05月 グランドプリンスホテル新高輪, 東京 第79回日本消化器内視鏡学会総会
  • EUSを用いたIPMNの診断~診断ハーモニック法を含めて~.  [通常講演]
    鎌田 研; 北野 雅之; 工藤 正俊
    第79回日本消化器内視鏡学会総会, ワークショップ「国際診療ガイドラインを踏まえたIPMNの内視鏡診断の現状と問題点」 2010年05月 グランドプリンスホテル新高輪, 東京 第79回日本消化器内視鏡学会総会, ワークショップ「国際診療ガイドラインを踏まえたIPMNの内視鏡診断の現状と問題点」
  • EUS-guided choledochoduodenostomy followed by endoscopic antegrade biliary stenting via the fistula for treatment of obstructive jaundice with duodenal stenosis.  [通常講演]
    北野 雅之; 小牧 孝充; 坂本 洋城; 鎌田 研; 今井 元; 工藤 正俊
    2010 Digestive Disease Week 2010年05月 Louisiana, USA 2010 Digestive Disease Week
  • EUS-guided gallbladder drainage for treatment of acute cholecystitis and obstructive jaundice.  [通常講演]
    北野 雅之; 今井 元; 小牧 孝充; 鎌田 研; 坂本 洋城; 工藤 正俊
    2010 Digestive Disease Week 2010年05月 Louisiana, USA 2010 Digestive Disease Week
  • 膵疾患の超音波診断 EUSを用いたIPMN診療  [通常講演]
    鎌田 研; 北野 雅之; 工藤 正俊; 坂本 洋城; 小牧 孝充; 今井 元
    超音波医学 2010年04月
  • 超音波内視鏡の新展開 Sonazoidを用いた造影EUS検査による膵腫瘍性病変の診断  [通常講演]
    小牧 孝充; 北野 雅之; 今井 元; 鎌田 研; 工藤 正俊
    超音波医学 2010年04月
  • 消化器疾患におけるInterventional Sonography 膵疾患に対する超音波内視鏡ガイド下ドレナージ術  [通常講演]
    北野 雅之; 小牧 孝充; 坂本 洋城; 今井 元; 鎌田 研; 工藤 正俊
    超音波医学 2010年04月
  • 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の試み  [通常講演]
    坂本 洋城; 北野 雅之; 小牧 孝充; 今井 元; 鎌田 研; 工藤 正俊
    超音波医学 2010年04月
  • 国際診療ガイドラインを踏まえたIPMNの内視鏡診断の現状と問題点 EUSを用いたIPMNの診断 造影ハーモニック法を含めて  [通常講演]
    鎌田 研; 北野 雅之; 工藤 正俊
    Gastroenterological Endoscopy 2010年04月
  • 経乳頭的アプローチ困難例に対するEUS下胆道ドレナージ術の有用性  [通常講演]
    鎌田 研; 北野 雅之; 今井 元; 小牧 孝充; 坂本 洋城; 末富 洋一郎; 工藤 正俊
    Gastroenterological Endoscopy 2010年04月
  • 当院における根治手術不能な膵小細胞癌の治療成績.  [通常講演]
    小牧 孝充; 北野 雅之; 工藤 正俊; 末冨 洋一郎; 今井 元; 鎌田 研
    第96回日本消化器病学会総会 2010年04月 新潟市民プラザ, 新潟 第96回日本消化器病学会総会
  • 難治性胆管炎を伴った胆管癌に対する低容量ジェムザール治療.  [通常講演]
    小牧 孝充; 北野 雅之; 工藤 正俊; 末冨 洋一郎; 今井 元; 鎌田 研
    第96回日本消化器病学会総会 2010年04月 新潟市民プラザ, 新潟 第96回日本消化器病学会総会
  • 胆膵疾患に対するEUSガイド下ステント治療の成績.  [通常講演]
    鎌田 研; 北野 雅之; 工藤 正俊
    第96回日本消化器病学会総会, パネルディスカッション「消化器ステント治療の進歩と現状」 2010年04月 新潟市民プラザ, 新潟 第96回日本消化器病学会総会, パネルディスカッション「消化器ステント治療の進歩と現状」
  • EUSを用いたIPMNの診断とフォローアップ.  [通常講演]
    鎌田 研; 北野 雅之; 工藤 正俊
    第96回日本消化器病学会総会, シンポジウム「膵IPMNの手術適応の見直し」 2010年04月 新潟市民プラザ, 新潟. 第96回日本消化器病学会総会, シンポジウム「膵IPMNの手術適応の見直し」
  • 消化器ステント治療の進歩と現状 胆膵疾患に対するEUSガイド下ステント治療の成績  [通常講演]
    鎌田 研; 北野 雅之; 工藤 正俊
    日本消化器病学会雑誌 2010年03月
  • 難治性胆管炎を伴った胆管癌に対する低容量ジェムザール治療  [通常講演]
    小牧 孝充; 北野 雅之; 工藤 正俊; 末冨 洋一郎; 今井 元; 鎌田 研
    日本消化器病学会雑誌 2010年03月
  • EUSを主としたIPMNの診断とフォローアップ方法.  [通常講演]
    鎌田 研; 北野 雅之; 工藤 正俊
    第84回日本消化器内視鏡学会近畿地方会, ワークショップ「?胞性膵疾患の鑑別診断と治療法の選択」 2010年03月 大阪国際交流センター, 大阪 第84回日本消化器内視鏡学会近畿地方会, ワークショップ「?胞性膵疾患の鑑別診断と治療法の選択」
  • 癌性疼痛に対しEUS下腹腔神経叢ブロックが有用であった1症例.  [通常講演]
    湯本 妙子; 今井 元; 鎌田 研; 坂本 洋城; 末冨 洋一郎; 小牧 孝充; 北野 雅之; 工藤 正俊
    日本消化器病学会近畿支部第92回例会 2010年02月 大阪国際交流センター, 大阪 日本消化器病学会近畿支部第92回例会
  • C型慢性肝炎SVR後に悪性リンパ腫を発症した一例.  [通常講演]
    高場 雄久; 宮田 剛; 峯 宏昌; 鎌田 研; 有住 忠晃; 田北 雅弘; 早石 宗右; 永井 知行; 上田 泰輔; 辰巳 千栄; 北井 聡; 畑中 絹世; 矢田 典久; 井上 達夫; 石川 恵美; 萩原 智; 鄭 浩柄; 上嶋 一臣; 工藤 正俊
    日本消化器病学会近畿支部第92回例会 2010年02月 大阪国際交流センター, 大阪 日本消化器病学会近畿支部第92回例会
  • 十二指腸ステント留置後にEUS下胆嚢ドレナージ術を行った閉塞性黄疸の一例.  [通常講演]
    今井 元; 北野 雅之; 末冨 洋一郎; 小牧 孝充; 鎌田 研; 坂本 洋城; 工藤 正俊
    日本消化器病学会近畿支部第92回例会 2010年02月 大阪国際交流センター, 大阪 日本消化器病学会近畿支部第92回例会
  • Estimation of the malignant potential of gastrointestinal stromal tumors: for a precise management of SMT by CHE-EUS.  [通常講演]
    坂本 洋城; 北野 雅之; 鎌田 研; 小牧 孝充; 今井 元; 筑後 孝章; 竹山 宜典; 工藤 正俊
    UEGW 2009年11月 London, UK UEGW
  • Detection rates of pancreatic tumors according to location by contrast-enhanced ultrasonography, endosonography and multidetector row CT.  [通常講演]
    今井 元; 北野 雅之; 末冨 洋一郎; 坂本 洋城; 小牧 孝充; 野田 佳寿; 鎌田 研; 竹山 宜典; 工藤 正俊
    East Meets West 40th Anniversary 2009年11月 Honolulu, USA East Meets West 40th Anniversary
  • Pancreas by EUS-guided in vivo microdialysis.  [通常講演]
    北野 雅之; 坂本 洋城; 小牧 孝充; 今井 元; 鎌田 研; 工藤 正俊
    East Meets West 40th Anniversary 2009年11月 Honolulu, USA East Meets West 40th Anniversary
  • EUS-assisted drainage of pancreatic duct for obstructive pancreatitis.  [通常講演]
    北野 雅之; 坂本 洋城; 小牧 孝充; 今井 元; 鎌田 研; 竹山 宜典; 工藤 正俊
    East Meets West 40th Anniversary 2009年11月 Honolulu, USA East Meets West 40th Anniversary
  • EUS-guided broad plexus-neurolysis over the superior mesenteric artery using a 25 gauge needle. Awarded as a (Best submit abstract)  [通常講演]
    坂本 洋城; 北野 雅之; 鎌田 研; 小牧 孝充; 今井 元; 筑後 孝章; 竹山 宜典; 工藤 正俊
    UEGW 2009年11月 London, UK UEGW
  • Utility of contrast-enhanced harmonic EUS on diagnosis of intra-abdominal lesions with undertermined origin.  [通常講演]
    鎌田 研; 北野 雅之; 坂本 洋城; 小牧 孝充; 今井 元; 末冨 洋一郎; 工藤 正俊
    Asia Pacific Digestive Disease Week (APDW) 2009年09月 Taipei, Taiwan Asia Pacific Digestive Disease Week (APDW)
  • EUS-FNA guided by contrast-enhanced harmonic imaging.  [通常講演]
    北野 雅之; 坂本 洋城; 小牧 孝充; 今井 元; 鎌田 研; 工藤 正俊
    Asia Pacific Digestive Disease Week (APDW) 2009年09月 Taipei, Taiwan Asia Pacific Digestive Disease Week (APDW)
  • EUS-BD後の難治性逆行性胆管炎に対するトラブルシューティング.  [通常講演]
    小牧 孝充; 北野 雅之; 末冨 洋一郎; 今井 元; 鎌田 研; 工藤 正俊
    第6回FNA-Club Japan 2009年09月 東京医科大学, 東京 第6回FNA-Club Japan
  • 経乳頭的アプローチ困難例に対するEUSガイド下胆管ドレナージ術の有用性.  [通常講演]
    鎌田 研; 北野 雅之; 末冨 洋一郎; 坂本 洋城; 小牧 孝充; 今井 元; 工藤 正俊
    第45回日本胆道学会学術集会 2009年09月 千葉県がんセンター, 千葉 第45回日本胆道学会学術集会
  • 悪性胆管狭窄に対する胆道ドレナージの新展開 経乳頭的アプローチ困難例に対するEUSガイド下胆管ドレナージ術の有用性  [通常講演]
    鎌田 研; 北野 雅之; 末冨 洋一郎; 坂本 洋城; 小牧 孝充; 今井 元; 工藤 正俊
    胆道 2009年08月
  • 造影ハーモニックEUS検査.  [通常講演]
    北野 雅之; 鎌田 研; 坂本 洋城; 小牧 孝充; 工藤 正俊
    パネルディスカッション「各領域の造影超音波の新展開」, 日本超音波医学会第82回学術集会 2009年05月 東京国際フォーラム, 東京 パネルディスカッション「各領域の造影超音波の新展開」, 日本超音波医学会第82回学術集会
  • 診断に難渋した腹部腫瘤における造影ハーモニック超音波内視鏡検査の有用性.  [通常講演]
    今井 元; 北野 雅之; 坂本 洋城; 小牧 孝充; 野田 佳寿; 末冨 洋一郎; 鎌田 研; 工藤 正俊
    第95回日本消化器病学会総会 2009年05月 北海道厚生年金会館, 北海道 第95回日本消化器病学会総会
  • 各領域の造影超音波の新展開 造影ハーモニックEUS検査  [通常講演]
    北野 雅之; 鎌田 研; 坂本 洋城; 小牧 孝充; 工藤 正俊
    超音波医学 2009年04月
  • 膵頭部癌に伴う下部胆管閉塞に対し超音波内視鏡下胆道ドレナージ術(EUS-BD)が有用であった1例.  [通常講演]
    鎌田 研; 坂本 洋城; 小牧 孝充; 野田 佳寿; 末冨 洋一郎; 北野 雅之; 汐見 幹夫; 工藤 正俊
    第82回日本消化器内視鏡学会近畿地方会 2009年03月 大阪国際交流センター, 大阪 第82回日本消化器内視鏡学会近畿地方会

担当経験のある科目_授業

  • 消化器内科学 (近畿大学医学部)
  • 消化器内科学 (近畿大学医学部)
  • 消化器内科学 (近畿大学医学部)

所属学協会

  • 日本消化器免疫学会会員   日本臨床薬理学会会員   日本膵臓学会指導医   日本内科学会認定医・専門医・指導医   日本肝臓学会専門医   日本胆道学会指導医   日本消化器内視鏡学会専門医・指導医・国内FJGES   日本超音波医学会専門医・指導医   日本消化器病学会専門医・指導医   

共同研究・競争的資金等の研究課題

  • 日本学術振興会:科学研究費助成事業
    研究期間 : 2022年04月 -2025年03月 
    代表者 : 鎌田 研; 渡邉 智裕
  • 日本学術振興会:科学研究費助成事業
    研究期間 : 2020年04月 -2022年03月 
    代表者 : 鎌田 研
     
    芳香族炭化水素受容体(AhR)は、リガンドで活性化される転写因子で、造血系細胞および非造血系細胞に発現している。本研究では、IFN-αとIL-33を産生する形質細胞様樹状細胞(pDC)の活性化によって引き起こされる実験的自己免疫性膵炎(AIP)の発症をAhR活性化が抑制するかどうかを検討することを試みた。インドール-3-ピルビン酸(IPA)およびインジゴ・ナチュラリス(IN)のAhR活性化は、実験的AIPの発症を抑制することが示された。また、膵島α細胞によるIL-22の産生促進が認められた。さらに、プレドニゾロンにより寛解が得られた後のAIP患者において血清IL-22濃度の上昇がみられた。
  • 日本学術振興会:科学研究費助成事業
    研究期間 : 2018年04月 -2020年03月 
    代表者 : 鎌田 研
     
    Aryl hydrocarbon receptor (AhR)は腸内細菌由来代謝産物や環境因子 (ダイオキシン・タバコの煙など) を認識する転写 因子であり、免疫システムの恒常性の維持に重要な役割を果たしている。「腸内細菌叢の変化に伴う細菌由来代謝産物のProfile変化」がAhRの活性化を介して、自己免疫性膵炎の発症を制御するという仮説を検証した結果、AhRリガンドである2, 3, 7, 8-Tetrachlorodibenzodioxin (TCDD)の投与あるいはIndole-3-pyruvic acid (IPA)の給餌により、自己免疫性膵炎の発症は抑制されることを見出した。
  • 独立行政法人日本学術振興会 令和4年度基盤研究(C) (一般)
    代表者 : 鎌田研
  • 独立行政法人日本学術振興会 令和2年度若手研究助成
    代表者 : 鎌田 研

メディア報道

  • 植物由来の青黛等を用いた自己免疫性膵炎の治療メカニズムを解明 指定難病である自己免疫性膵炎の新たな治療法確立に期待
    報道 : 2023年05月15日
    番組・新聞雑誌 : 読売新聞
     新聞・雑誌
  • 腸内フローラーの変化による自己免疫性膵炎の発症メカニズムに関するプレスリリース
    発行元・放送局 : 腸内フローラーの変化による自己免疫性膵炎の発症メカニズムを世界で初めて解明したことに関するプレスリリースの配信、新聞掲載(朝日新聞、産経新聞 他)、NHK放送 NHK総合「ニュース」 2019年8月1日(木)12:00~ 日経新聞オンライン https://www.nikkei.com/article/DGXMZO47133910Z00C19A7CR8000/ 共同通信配信他 https://headlines.yahoo.co.jp/hl?a=20190710-00000003-kyodonews-soci https://www.kyoto-np.co.jp/environment/article/20190710000003

その他

  • 2021年04月 - 2022年03月  自己免疫性膵炎の発症メカニズムの解明と新規治療開発 
    近畿大学 学内研究助成金 奨励研究助成金 SR07 研究内容: 自己免疫性膵炎が全身性のIgG4関連疾患の膵臓特異的表現型であることが明らかになり、本疾患の患者数は増加している。自己免疫性膵炎の発症メカニズムは解明されていないが、申請者は自己免疫性膵炎の発症に腸内細菌叢の変化が関与することを明らかにした。Aryl hydrocarbon receptor (AhR)は、腸内細菌由来代謝産物により活性化される転写因子であり、免疫システムの恒常性の維持に重要な役割を果たしている。自己免疫性膵炎を誘導する腸内細菌叢の変化に伴いその代謝産物のProfileも変動することが予測される。本研究では「腸内細菌叢の変化に伴う細菌由来代謝産物のProfile変化」が自己免疫性膵炎の発症に及ぼす効果をAhRの活性化という視点から明らかにした。
  • 2021年12月  第10回関西消化器内視鏡ライブセミナー 
    術者として超音波内視鏡下腹腔神経叢融解術を実施
  • Editor's Choice論文: Activation of the aryl hydrocarbon receptor inhibits the development of experimental autoimmune pancreatitis through IL-22-mediated signaling pathways 
    Clinical and Experimental Immunology, Volume 212, Issue 3, June 2023, Pages 171–183, https://doi.org/10.1093/cei/uxad040
  • 学位論文指導2 
    Value of artificial intelligence with novel tumor tracking technology in the diagnosis of gastric submucosal tumors by contrast-enhanced harmonic endoscopic ultrasonography. Hidekazu Tanaka, Ken Kamata, Rika Ishihara, Hisashi Handa, Yasuo Otsuka, Akihiro Yoshida, Tomoe Yoshikawa, Rei Ishikawa, Ayana Okamoto, Tomohiro Yamazaki, Atsushi Nakai, Shunsuke Omoto, Kosuke Minaga, Kentaro Yamao, Mamoru Takenaka, Tomohiro Watanabe, Naoshi Nishida, Masatoshi Kudo Journal of gastroenterology and hepatology 37(5) 841-846 2022年1月18日
  • J-OSLER 指導医
  • 学位論文指導1 
    Utility of contrast-enhanced harmonic endoscopic ultrasonography for predicting the prognosis of pancreatic neuroendocrine neoplasms. Rei Ishikawa, Ken Kamata, Akane Hara, Hidekazu Tanaka, Ayana Okamoto, Tomohiro Yamazaki, Atsushi Nakai, Shunsuke Omoto, Kosuke Minaga, Kentaro Yamao, Mamoru Takenaka, Yasunori Minami, Tomohiro Watanabe, Yasutaka Chiba, Takaaki Chikugo, Ippei Matsumoto, Yoshifumfi Takeyama, Yuko Matsukubo, Tomoko Hyodo, Masatoshi Kudo. Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society 33(5) 829-839 2020年10月5日

その他のリンク