竹中　完 （タケナカ　マモル）

コミュニケーション情報 byコメンテータガイド

• コメント

  ・膵がん早期発見 ・胆道疾患解説：胆石、胆嚢炎、胆管がん（乳頭部腫瘍）など ・膵臓疾患解説：膵臓がん、急性膵炎、慢性膵炎、膵のう胞性腫瘍など ・ERCP、EUS、サルコペニアなど

• 報道関連出演・掲載一覧

  ＜報道関連出演・掲載一覧＞ ●2020/2/19 　朝日放送「おはよう朝日です」今朝のクローズアップ 　冬のおなかの不調　原因と対策 　

研究者情報

学位

• 博士(医学)（神戸大学）

ホームページURL

https://jglobal.jst.go.jp/detail?JGLOBAL_ID=201501004072721243

J-Global ID

• 201501004072721243

プロフィール

• 近畿大学医学部を2001年に卒業後、淀川キリスト教病院で研修を行い、初期研修、救急診療、ホスピス緩和医療を学び、卒後3年目以降同消化器内科に所属しました。2008年より神戸大学大学院医学系研究科（博士課程）に入学し、主に胃MALTリンパ腫発生へのヘリコバクター属の関与に関する基礎実験と胆膵領域疾患に関する臨床研究を行いました。2013年に博士過程修了後は神戸大学消化器内科学教室助教に就任し胆膵領域を専門とした実臨床と臨床研究を行いました。教室内では教育部門を担当し、学生指導並びに研修医指導を行い、経産省事業としてインドネシアのチプト大学にて胆膵内視鏡の導入及び指導を行ました。
  
  2016年より出身大学である近畿大学消化器内科に講師（胆膵班責任者）として赴任し、胆膵疾患の診断と治療、研究を担当しております。胆膵内視鏡治療を中心としておりますが、急性膵炎の臨床、放射線被ばく問題にも興味を持ち研究テーマとしております。

研究キーワード

• EUS下ドレナージ   造影EUS   EUS-FNA   EUS   ERCP   膵癌   サルコペニア   医療放射線被曝   慢性膵炎   急性膵炎   

現在の研究分野（キーワード）

・膵がん早期発見
・胆道疾患解説：胆石、胆嚢炎、胆管がん（乳頭部腫瘍）など
・膵臓疾患解説：膵臓がん、急性膵炎、慢性膵炎、膵のう胞性腫瘍など
・ERCP、EUS、サルコペニアなど

研究分野

• ライフサイエンス / 消化器内科学

経歴

• 2016年04月 - 現在  近畿大学医学部消化器内科講師
• 2013年10月 - 2016年03月  神戸大学医学部消化器内科特定助教
• 2009年04月 - 2013年09月  神戸大学医学部消化器内科医員
• 2008年04月 - 2013年09月  神戸大学大学院医学系研究科（博士課程）
• 2001年04月 - 2009年03月  淀川キリスト教病院

学歴

•         - 2013年09月   神戸大学 大学院医学研究科博士課程医科学専攻修了   Graduate School of Medicine

所属学協会

• 臨床腫瘍学会   日本医学教育学会   日本サルコペニア・フレイル学会   日本超音波学会   日本肝臓学会   日本胆道学会   日本膵臓学会   日本消化器内視鏡学会   日本消化器病学会   日本内科学会   

研究活動情報

論文

• Prognostic Factors for Severe-to-Fatal Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis: A Multicenter Prospective Cohort Study.

  Kazuya Matsumoto; Hisashi Noma; Koichi Fujita; Takeshi Tomoda; Takumi Onoyama; Keiji Hanada; Akihito Okazaki; Ken Hirao; Daisuke Goto; Ichiro Moriyama; Yoshinori Kushiyama; Mamoru Takenaka; Toru Maruo; Hisakazu Matsumoto; Masanori Asada; Hiroko Nebiki; Toshihiro Katayama; Takashi Kawamura; Akira Kurita; Toshiharu Ueki; Masahiro Tsujimae; Tokuhiro Matsubara; Satoshi Yamada; Takashi Tamura; Saiko Marui; Akira Mitoro; Hajime Isomoto; Shujiro Yazumi; Hirofumi Kawamoto

  Journal of clinical medicine 13 4 2024年02月 

  The prognostic factors associated with severe-to-fatal post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) remain unclear despite the extensive number of studies on PEP. In total, 3739 ERCP patients with biliary disease with an intact papilla and indicated for ERCP were prospectively enrolled at 36 centers from April 2017 to March 2018. Those with acute pancreatitis diagnosed before ERCP, altered gastrointestinal anatomy, and an American Society of Anesthesiologists (ASA) physical status > 4 were excluded. Univariate and multivariate logistic regression analyses were performed on patient-related factors, operator-related factors, procedure-related factors, and preventive measures to identify potential prognostic factors for severe-to-fatal PEP. Multivariate analyses revealed pancreatic guidewire-assisted biliary cannulation (OR 13.59, 95% CI 4.21-43.83, p < 0.001), post-ERCP non-steroidal anti-inflammatory drug (NSAID) administration (OR 11.54, 95% CI 3.83-34.81, p < 0.001), and previous pancreatitis (OR 6.94, 95% CI 1.45-33.33, p = 0.015) as significant risk factors for severe-to-fatal PEP. Preventive measures included endoscopic biliary sphincterotomy (EST; OR 0.29, 95% CI, 0.11-0.79, p = 0.015) and prophylactic pancreatic stents (PPSs; OR 0.11, 95% CI, 0.01-0.87, p = 0.036). In biliary ERCP, pancreatic guidewire-assisted biliary cannulation, NSAID administration after ERCP, and previous pancreatitis were risk factors for severe-to-fatal PEP, whereas EST and PPS were significant preventive measures for severe-to-fatal PEP.
• Emergency digital cholangioscopy-assisted electrohydraulic lithotripsy for basket impaction with an entrapped bile duct stone.

  Akane Hara; Kosuke Minaga; Yasuo Otsuka; Hidekazu Tanaka; Mamoru Takenaka; Masatoshi Kudo

  Endoscopy international open 12 2 E271-E273  2024年02月
• Early versus delayed EUS-guided drainage for postoperative pancreatic fluid collections: a systematic review and meta-analysis.

  Tsuyoshi Mukai; Yousuke Nakai; Tsuyoshi Hamada; Saburo Matsubara; Takashi Sasaki; Hirotoshi Ishiwatari; Susumu Hijioka; Hideyuki Shiomi; Mamoru Takenaka; Takuji Iwashita; Atsuhiro Masuda; Tomotaka Saito; Hiroyuki Isayama; Ichiro Yasuda

  Surgical endoscopy 38 1 47 - 55 2024年01月 

  BACKGROUND: Postoperative pancreatic fluid collections (POPFCs) are common adverse events (AEs) after pancreatic surgery and may need interventions. Endoscopic ultrasound (EUS)-guided drainage for POPFCs is increasingly reported, but its appropriate timing has not been fully elucidated. The aim of this meta-analysis was to evaluate treatment outcomes of POPFCs according to the timing of EUS-guided drainage. METHODS: Using PubMed, Embase, Web of Science, and the Cochrane database, we identified clinical studies published until December 2022 with data comparing outcomes of early and delayed EUS-guided drainage for POPFCs. We pooled data on AEs, mortality, and technical and clinical success rates, using the random-effects model. RESULTS: From 1415 papers identified in the initial literature search, we identified 6 retrospective studies, including 128 and 107 patients undergoing early and delayed EUS-guided drainage for POPFCs. The threshold of early and delayed drainage ranged from 14 to 30 days. Distal pancreatectomy was the major cause of POPFCs, ranging from 44 to 100%. The pooled odds ratio (OR) for AEs was 0.81 (95% confidence interval [CI] 0.40-1.64, P = 0.55) comparing early to delayed drainage. There was no procedure-related mortality. Technical success was achieved in all cases and a pooled OR of clinical success was 0.60 (95% CI 0.20-1.83, P = 0.37). CONCLUSION: POPFCs can be managed by early EUS-guided drainage without an increase in AEs.
• Is preoperative pancreatic juice cytology useful for determining therapeutic strategies for patients with intraductal papillary mucinous neoplasm of the pancreas?

  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.
• Medical radiation exposure during gastrointestinal enteral metallic stent placement: Post hoc analysis of the REX‐GI study

  Junki Tokura; Toshiyuki Yoshio; Shiro Hayashi; Masashi Yamamoto; Satoshi Asai; Takayuki Yakushijin; Kenji Ikezawa; Koji Nagaike; Tadayuki Takagi; Toshio Fujisawa; Takuya Yamada; Hidetaka Tsumura; Iruru Maetani; Yasuki Hori; Hideyuki Ihara; Kazuhiro Matsunaga; Toshio Kuwai; Yukiko Ito; Kenkei Hasatani; Yoriaki Komeda; Akira Kurita; Shinjiro Yamaguchi; Hirotsugu Maruyama; Takuji Iwashita; Mamoru Takenaka; Makoto Hosono; Tsutomu Nishida

  JGH Open 2023年12月 

  Abstract Background and Aim Recently, the use of various endoscopic procedures performed under X‐ray fluoroscopy guidance has increased. With the popularization of such procedures, diagnostic reference levels (DRLs) have been widely accepted as the global standard for various procedures with ionizing radiation. The Radiation Exposure from Gastrointestinal Fluoroscopic Procedures (REX‐GI) study aimed to prospectively collect actual radiation exposure (RE) data and establish DRLs in gastrointestinal endoscopy units. In this post hoc analysis of the REX‐GI study, we established DRLs for each disease site by analyzing cases of gastrointestinal enteral metallic stent placement. Methods The REX‐GI study was a multicenter, prospective observational study conducted to collect actual RE data during gastrointestinal enteral metallic stent placement. To establish DRL values for three disease sites, namely the esophagus, gastroduodenum, and colon, we examined fluoroscopy time (FT; min), number of X‐ray images, air kerma at the patient entrance reference point (K_a,r; mGy), and the air kerma–area product (P_KA; Gy cm²) during enteral metallic stent placement. Results Five‐hundred and twenty‐three stenting procedures were performed. The DRL values of FT (min) and the number of X‐ray images for the esophagus/gastroduodenum/colon were 9/16/18 min and 9/15/11 min, respectively. Furthermore, the DRL values of K_a,r and P_KA for each disease site were 43.3/120/124 mGy and 10.3/36.6/48.4 Gy cm², respectively. Among the procedures, esophageal stents were significantly associated with the lowest values (P < 0.001). Conclusion The characteristics of RE vary according to disease site among gastrointestinal enteral metallic stent placements. Thus, it is desirable to set DRL values based on the disease site.
• Endoscopic nasobiliary drainage versus endoscopic biliary stenting for preoperative biliary drainage in patients with malignant hilar biliary obstruction: Propensity score‐matched multicenter comparative study

  Hirotoshi Ishiwatari; Takanori Kawabata; Hiroki Kawashima; Yousuke Nakai; Shin Miura; Hironari Kato; Hideyuki Shiomi; Nao Fujimori; Takeshi Ogura; Osamu Inatomi; Kensuke Kubota; Toshio Fujisawa; Mamoru Takenaka; Hiroshi Mori; Kensaku Noguchi; Yuki Fujii; Teiichi Sugiura; Noboru Ideno; Tomoki Nakafusa; Atsushi Masamune; Hiroyuki Isayama; Naoki Sasahira

  Digestive Endoscopy 2023年11月 

  Objectives For preoperative biliary drainage (PBD) of malignant hilar biliary obstruction (MHBO), current guidelines recommend endoscopic nasobiliary drainage (ENBD) due to the higher risk of cholangitis after endoscopic biliary stenting (EBS) during the waiting period before surgery. However, few studies have supported this finding. Therefore, we aimed to compare the outcomes of preoperative ENBD and EBS in patients with MHBO. Methods Patients with MHBO who underwent laparotomy for radical surgery after ENBD or EBS were included from retrospectively collected data from 13 centers (January 2014 to December 2018). We performed a 1:1 propensity score matching between the ENBD and EBS groups. These patients were compared for the following: cholangitis and all adverse events (AEs) after endoscopic biliary drainage (EBD) until surgery, time to cholangitis development after EBD, postsurgical AEs, and in‐hospital death after surgery. Results Of the 414 patients identified, 355 were analyzed in this study (226 for ENBD and 129 for EBS). The matched cohort included 63 patients from each group. The proportion of cholangitis after EBD was similar between the two groups (20.6% vs. 25.4%, P = 0.67), and no significant difference was observed in the time to cholangitis development. The proportions of surgical site infections, bile leaks, and in‐hospital mortality rates were similar between the groups. Conclusion For PBD of MHBO, the proportion of AEs, including cholangitis, after EBD until surgery was similar when either ENBD or EBS was used.
• Postprocedure serum amylase or lipase levels predict postendoscopic retrograde cholangiopancreatography pancreatitis: Meta-analysis of diagnostic test accuracy studies and utility assessment.

  Morihisa Hirota; Takao Itoi; Toshio Morizane; Akinobu Koiwai; Ichiro Yasuda; Shomei Ryozawa; Shuntaro Mukai; Tsukasa Ikeura; Atsushi Irisawa; Eisuke Iwasaki; Akio Katanuma; Katsuya Kitamura; Mamoru Takenaka; Tetsuhide Ito; Atsushi Masamune; Toshihiko Mayumi; Yoshifumi Takeyama

  Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society 2023年11月 

  OBJECTIVES: We aimed to clarify the clinical utility of measuring serum pancreatic enzymes after endoscopic retrograde cholangiopancreatography (ERCP) for the purpose of predicting post-ERCP pancreatitis (PEP) by a meta-analysis of diagnostic test accuracy studies. METHODS: Studies on the prediction accuracy of PEP by serum amylase or lipase measured at 2, 3, and 4 h after ERCP were collected. A literature search was performed in PubMed and the Cochrane Library database for studies published between January 1980 and March 2023. The quality of individual studies was evaluated using the Quality Assessment of Diagnostic Accuracy Studies-2. Data were analyzed using Meta-DiSc 2.0 software. RESULTS: We searched the databases and identified 20 observational studies (12,313 participants). PEPs were defined according to criteria by Cotton or modified Cotton, revised Atlanta criteria, or the Japanese criteria. Meta-analysis of eight studies (4389 participants) showed a pooled sensitivity of 71.1% (95% confidence interval [CI] 56.1-82.5) and pooled specificity of 91.2% (95% CI 85.9-94.6) for the serum amylase cut-off value at 3 times the upper limit of normal (ULN). Another meta-analysis of five studies (1970 participants) showed a pooled sensitivity of 85.8% (95% CI 61.9-95.7) and pooled specificity of 85.3% (95% CI 81.9-88.1) for the serum lipase cut-off value at 3 times ULN. CONCLUSION: Despite a high risk of bias due to various reference standards, this updated meta-analysis and the utility assessment by a decision tree showed the utility of serum amylase or lipase levels more than 3 times ULN measured 2-4 h after ERCP for predicting PEP.
• Real-World Data on Short-Term and Long-Term Treatment Results of Ustekinumab in Patients with Steroid-Resistant/Dependent Ulcerative Colitis

  Yoriaki Komeda; George Tribonias; Masashi Kono; Kohei Handa; Shunsuke Omoto; Mamoru Takenaka; Satoru Hagiwara; Naoko Tsuji; Naoshi Nishida; Hiroshi Kashida; Masatoshi Kudo

  Inflammatory Intestinal Diseases 2023年10月 

  Introduction: Ustekinumab is an IgG1 kappa monoclonal antibody directed against the common p40 subunit of interleukin-12 and interleukin-23, which activate Th1- and Th17-mediated immune responses, respectively. It has proven efficacy for the treatment of moderate to severe ulcerative colitis (UC) in the UNIFI Phase III clinical trial; however, data on its efficacy in the real world is limited. In this study, we aimed to assess the real-world efficacy of ustekinumab.Methods: This observational study included 30 patients with UC who received ustekinumab from April 2020 to April 2022. We examined demographic information, disease type and activity (Mayo score, partial Mayo score [PMS]), use of biologics, concomitant use of predonisolone (PSL), 8-week ustekinumab clinical response rate, remission induction rate, 44- and 152-week remission maintenance rate, continuation rate, and 44-week steroid-free remission rate. The primary outcomes were the short- and long-term efficacy of ustekinumab.Results: Included patients (53% women; mean age: 41.2 years [16–80 years]) had an average disease duration of 86 weeks. Mayo’s score (median) was 7.4 and the PMS was 5.4. Two (7%), 24 (80%), and four (13%) patients had a Mayo endoscopic sub-score (MES) of MES1, MES2, and MES3, respectively. The median serum CRP was 1.0 mg/dL. Five patients had no history of biotherapy (naive), while 8 and 17 had a history of one and two or more biologic agents, respectively. Eight patients were PSL-resistant and 22 were PSL-dependent. The 8-week clinical response rate was 73%, and the clinical remission induction rate was 70%. The remission maintenance rates at 44 and 152 weeks were 67% and 63%, respectively. The ustekinumab retention rate was 67% (86-week mean follow-up period). Regarding biologic failure cases, the clinical response rate in the failure group with up to one biologic agent (including naive cases) was 84.6%, which was higher than the 58.0% rate in the failure group with two or more biologic agents (p=0.06). Steroid-free remission rates at 44 and 152 weeks were 63% each. In the logistic regression analysis parameters for discontinuation of ustekinumab, only PMS remained significant after multivariate analysis (p=0.018).Conclusion: Our study showed short-term and long-term ustekinumab effectiveness, especially with comparative low disease activity.
• 【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)
• Risk factors for adverse outcomes at various phases of endoscopic ultrasound-guided treatment of pancreatic fluid collections: data from a multi-institutional consortium.

  Tomotaka Saito; Shunsuke Omoto; Mamoru Takenaka; Masahiro Tsujimae; Atsuhiro Masuda; Tatsuya Sato; Tsuyoshi Hamada; Shogo Ota; Hideyuki Shiomi; Sho Takahashi; Toshio Fujisawa; Keito Nakagawa; Saburo Matsubara; Shinya Uemura; Takuji Iwashita; Kensaku Yoshida; Akinori Maruta; Mitsuru Okuno; Keisuke Iwata; Nobuhiko Hayashi; Tsuyoshi Mukai; Hiroyuki Isayama; Ichiro Yasuda; Yousuke Nakai

  Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society 2023年09月 

  OBJECTIVES: No comprehensive study has examined short- and long-term adverse outcomes of endoscopic ultrasound (EUS)-guided treatment of pancreatic fluid collections (PFCs) including walled-off necrosis (WON) and pseudocysts. METHODS: In a multi-institutional cohort of 357 patients receiving EUS-guided treatment of PFCs (228 with WON and 129 with pseudocysts), we examined PFC type-specific risk factors for procedure-related adverse events (AEs), clinical failure, and recurrence. Odds ratios (ORs) and hazard ratios (HRs) with 95% confidence intervals (CIs) were computed using the logistic and Cox regression models, respectively, adjusting for potential confounders. RESULTS: AEs were observed predominantly in WON, and risk factors were WON extension to the pelvis (OR, 2.49; 95% CI, 1.00-6.19) and endoscopic necrosectomy (OR, 5.15; 95% CI, 1.61-16.5). Risk factors for clinical failure in WON treatment included higher Charlson Comorbidity Index (OR for ≥3 vs. ≤2, 2.58; 95% CI, 1.05-6.35), extension to the pelvis (OR, 3.63; 95% CI, 1.57-8.43), non-use of a lumen-apposing metal stent (OR, 2.88; 95% CI, 1.10-7.54), and percutaneous drainage (OR, 3.73; 95% CI, 1.27-10.9). Patients with pseudocysts extending to the paracolic gutter and need for more than two endoscopic / percutaneous procedures had ORs for clinical failure of 5.28 (95% CI, 1.10-25.3) and 5.52 (95% CI, 1.61-18.9), respectively. Pseudocysts requiring the multigateway approach were associated with high risk of recurrence (HR, 4.00; 95% CI, 1.11-11.6). CONCLUSIONS: The adverse outcomes at various phases of EUS-guided PFC treatment may be predictable based on clinical parameters. Further research is warranted to optimize treatment strategies for high-risk patients (registration number, UMIN000044130).
• Low‐dose gemcitabine plus nab‐paclitaxel versus standard‐dose gemcitabine plus nab‐paclitaxel in elderly patients with metastatic pancreatic cancer: A randomized Phase II trial

  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 [in press] 2023年09月 [査読有り]
   

  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.
• 【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
• Piercing technique for mucosal hyperplasia at an uncovered part of a partially covered stent after endoscopic ultrasound-guided hepaticogastrostomy.

  Yasuo Otsuka; Kosuke Minaga; Akane Hara; Yasuhiro Masuta; Mamoru Takenaka; Masatoshi Kudo

  Endoscopy international open 11 9 E811-E813  2023年09月
• Glove box method: Simple and effective right-hand free method for interventional endoscopy.

  Mamoru Takenaka; Tae Hoon Lee; Masatoshi Kudo

  Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society 2023年08月
• Diagnosis of an intraductal papillary neoplasm of the bile duct with fibrovascular stalks using detective flow imaging

  Shunsuke Omoto; Mamoru Takenaka; Tomohiro Fukunaga; Ayana Okamoto; Yoriaki Komeda; Seok Jeong; Masatoshi Kudo

  Endoscopy 55 S 01 E1012 - E1014 2023年08月
• Hemostasis of small-intestinal diverticular bleeding with the over-the-scope clip method

  Hiroshi Tanabe; Koichiro Kawano; Reiko Kawano; Takao Katoh; Katsuhisa Nishi; Yoriaki Komeda; Mamoru Takenaka

  Endoscopy 55 S 01 E1001 - E1002 2023年08月
• Adverse events of self-expandable metal stent placement for malignant distal biliary obstruction: A large multicenter study.

  Takashi Tamura; Takuo Yamai; Norimitsu Uza; Tomoaki Yamasaki; Atsuhiro Masuda; Fumimasa Tomooka; Hirotsugu Maruyama; Minoru Shigekawa; Takeshi Ogura; Katsutoshi Kuriyama; Masanori Asada; Hisakazu Matsumoto; Mamoru Takenaka; Koichiro Mandai; Yui Osaki; Kengo Matsumoto; Tsuyoshi Sanuki; Hideyuki Shiomi; Yosuke Yamagata; Toshifumi Doi; Osamu Inatomi; Fumihiko Nakanishi; Tomoya Emori; Masaaki Shimatani; Satoshi Asai; Seiji Fujigaki; Toshio Shimokawa; Masayuki Kitano

  Gastrointestinal endoscopy 2023年08月 

  BACKGROUND AND AIM: Endoscopic placement of self-expandable metal stents (SEMSs) for malignant distal biliary obstruction (MDBO) may be accompanied by several types of adverse events. The present study analyzed the adverse events occurring after SEMS placement for MDBO. METHODS: The present study retrospectively investigated the incidence and types of adverse events in patients who underwent SEMS placement for MDBO between April 2018 and March 2021 at 26 hospitals. Risk factors for acute pancreatitis, cholecystitis, and recurrent biliary obstruction (RBO) were evaluated by univariate and multivariate analyses. RESULTS: Of the 1425 patients implanted with SEMS for MDBO, 228 (16.0%) and 393 (27.6%) experienced early adverse events and RBO, respectively. Pancreatic duct without tumor involvement (p = 0.023), intact papilla (p = 0.025), and SEMS placement across the papilla (p = 0.037) were independent risk factors for acute pancreatitis. Tumor involvement in the orifice of the cystic duct (OCD) was an independent risk factor for cholecystitis (p < 0.001). Fully and partially covered SEMSs were independent risk factors for food impaction and/or sludge. Fully covered SEMS was an independent risk factor for stent migration. Uncovered SEMS and laser-cut SEMS were independent risk factors for tumor ingrowth. CONCLUSIONS: Pancreatic duct without tumor involvement, intact papilla, and SEMS placement across the papilla were independent risk factors for acute pancreatitis, and tumor involvement to the OCD was an independent risk factor for cholecystitis. The risk factors for food impaction and/or sludge, stent migration, and tumor ingrowth differed among types of SEMS.
• True diagnostic ability of endoscopic ultrasound-guided fine needle aspiration/biopsy for small pancreatic cancer ≤10 mm and salvage diagnosis by pancreatic juice cytology: A multicenter study.

  Ryota Sagami; Jun Nakahodo; Ryuki Minami; Kentaro Yamao; Akihiro Yoshida; Hidefumi Nishikiori; Mamoru Takenaka; Kazuhiro Mizukami; Kazunari Murakami

  Gastrointestinal endoscopy 2023年08月 

  BACKGROUND AND AIMS: The diagnostic performance of endoscopic ultrasound-guided fine-needle aspiration/biopsy (EUS-FNAB) for pancreatic ductal adenocarcinoma (PDAC) ≤ 10 mm in diameter is relatively low. Pancreatic juice cytology (PJC) has gained attention owing to its high sensitivity for small PDAC. We aimed to clarify the diagnostic ability of EUS-FNAB and the salvage ability of PJC for PDAC ≤ 10 mm. METHODS: The data obtained from attempted EUS-FNAB for patients with EUS-confirmed pancreatic tumors ≤ 10 mm (excluding pancreatic metastases/malignant lymphomas) were retrospectively analyzed. Patients who experienced technical failure/negative EUS-FNAB result and had a strong likelihood of PDAC based on imaging characteristics underwent PJC. PDAC was diagnosed using resected histological specimens, EUS-FNAB-positive tumor growth on the imaging examination, or additional EUS-FNAB-positive results after increase in tumor size. The primary endpoint was the diagnostic ability of EUS-FNAB for PDAC ≤ 10 mm. The salvage ability of PJC was also assessed. RESULTS: Overall, 86 patients were diagnosed with PDAC of 271 patients with pancreatic tumors ≤ 10 mm who underwent attempted EUS-FNAB. The technical success rate, sensitivity, specificity, and accuracy of EUS-FNAB for PDAC ≤ 10 mm was 80.8%, 82.3%, 94.9%, and 91.3%, respectively. Among the 35 PDAC patients who experienced technical failure/false-negative result of EUS-FNAB, 26 (74.3%) were correctly diagnosed using salvage PJC. CONCLUSIONS: The true success rate/sensitivity of EUS-FNAB for PDAC ≤ 10 mm was relatively low. When EUS-FNAB for a pancreatic lesion ≤ 10 mm strongly suspected to be PDAC is unsuccessful or yields a negative result, PJC is recommended.
• Impact of Smad4 and p53 mutations on the prognosis of patients with pancreatic ductal adenocarcinoma undergoing chemotherapy.

  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.
• Serum leucine‐rich alpha‐2 glycoprotein in monitoring disease activity and intestinal mucosal healing for biotherapy‐naïve cases with ulcerative colitis

  Masashi Kono; Yoriaki Komeda; George Tribonias; Saki Yoshida; Kenji Nomura; Kohei Handa; Tomoyuki Nagai; Satoru Hagiwara; Shunsuke Omoto; Mamoru Takenaka; Naoshi Nishida; Naoko Tsuji; Hiroshi Kashida; Masatoshi Kudo

  JGH Open 2023年08月 

  Abstract Background and Aim Serum leucine‐rich alpha‐2 glycoprotein level has been reported to be a useful biomarker in assessing mucosal healing in patients undergoing biotherapy, where mucosal lesions caused by ulcerative colitis are difficult to assess endoscopically. However, no such reports have been reported in biotherapy‐naïve cases. Methods Sixty‐eight patients with ulcerative colitis (UC) who were biotherapy‐naïve at Kindai University Hospital between October 2021 and October 2022 were enrolled. We prospectively examined the correlation between leucine‐rich alpha‐2 glycoprotein (LRG), C‐reactive protein (CRP), erythrocyte sedimentation rate (ESR), and Geboes scores with clinical endoscopic activity using the Mayo endoscopic subscore (MES). Results Mucosal healing was achieved in 39 (57%) patients. Univariate analysis revealed that the factors associated with mucosal healing were LRG (P = 0.0024), CRP (P = 0.1078), ESR (P = 0.0372), and Geboes scores (P = 0.0075). Logistic regression analysis identified LRG and Geboes scores as independent factors associated with mucosal healing assessed using MES (P = 0.0431 for LRG and P = 0.0166 for Geboes scores). Conclusion LRG was found to be the easiest marker to monitor disease activity and mucosal inflammation in UC patients with biotherapy‐naïve cases, with a performance equivalent to that of Geboes scores.
• Benefits of pancreatic parenchymal endoscopic ultrasonography in predicting microscopic precancerous lesions of pancreatic cancer.

  Kohei Yamakawa; Noriko Inomata; Atsuhiro Masuda; Mamoru Takenaka; Hirochika Toyama; Keitaro Sofue; Arata Sakai; Takashi Kobayashi; Takeshi Tanaka; Masahiro Tsujimae; Shigeto Ashina; Masanori Gonda; Shohei Abe; Shigeto Masuda; Hisahiro Uemura; Shinya Kohashi; Kae Nagao; Yoshiyuki Harada; Mika Miki; Yosuke Irie; Noriko Juri; Hideyuki Shiomi; Maki Kanzawa; Tomoo Itoh; Takumi Fukumoto; Yuzo Kodama

  Scientific reports 13 1 12052 - 12052 2023年07月 

  Pancreatic cancer primarily arises from microscopic precancerous lesions, such as pancreatic intraepithelial neoplasia (PanIN) and acinar-to-ductal metaplasia (ADM). However, no established method exists for predicting pancreatic precancerous conditions. Endoscopic ultrasonography (EUS) can detect changes in pancreatic parenchymal histology, including fibrosis. This study aimed to elucidate the relationship between pancreatic parenchymal EUS findings and microscopic precancerous lesions. We retrospectively analyzed 114 patients with pancreatobiliary tumors resected between 2010 and 2020 and evaluated the association between pancreatic parenchymal EUS findings and the number of PanIN, ADM, and pancreatic duct gland (PDG). Of the 114 patients, 33 (29.0%), 55 (48.2%), and 26 (22.8%) had normal EUS findings, hyperechoic foci/stranding without lobularity, and hyperechoic foci/stranding with lobularity, respectively. Multivariate analyses revealed that abnormal EUS findings were significantly associated with the frequency of PanIN (hyperechoic foci/stranding without lobularity: OR [95% CI] = 2.7 [1.0-7.3], with lobularity: 6.5 [1.9-22.5], Ptrend = 0.01) and ADM (hyperechoic foci/stranding without lobularity: 3.1 [1.1-8.2], with lobularity: 9.7 [2.6-36.3], Ptrend = 0.003) but not with PDG (hyperechoic foci/stranding without lobularity: 2.2 [0.8-5.8], with lobularity: 3.2 [1.0-10.2], Ptrend = 0.12). We observed a trend toward a significantly higher number of precancerous lesions in the following order: normal findings, hyperechoic foci/stranding without lobularity, and hyperechoic foci/stranding with lobularity. Pancreatic parenchymal EUS findings were associated with the increased frequency of PanIN and ADM. Lobularity may help predict the increased number of precancerous lesions.
• 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
• 【肝胆膵癌に対する放射線治療:2023 Update】放射線被曝 胆膵領域における放射線被曝の現状

  竹中 完; 細野 眞; 工藤 正俊

  肝胆膵 87 1 91 - 99 (株)アークメディア 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
• Usefulness of detective flow imaging endoscopic ultrasound for the diagnosis of rectal wall thickening.

  Yasuhiro Masuta; Kosuke Minaga; Yasuo Otsuka; Mamoru Takenaka; Masatoshi Kudo

  Endoscopy international open 11 7 E651-E652  2023年07月
• 【急性膵炎診療ガイドライン改訂とPancreatitis Bundlesを読み解く】重症急性膵炎の担送基準と地域ネットワークの有用性

  竹中 完; 大本 俊介; 工藤 正俊; 松本 逸平; 竹山 宜典

  臨床消化器内科 38 8 1041 - 1048 (株)日本メディカルセンター 2023年06月 

  ＜文献概要＞南大阪地域(面積880km2,25の市町村,人口230万人)における各施設の急性膵炎に対する診療体制の現状の把握,施設間連携の問題点の抽出,連携の強化により,急性膵炎治療の地域連携モデル構築を試みた.南大阪地域101施設へ,年間診療膵炎患者数,各施設での対応可能な膵炎の診療内容,Pancreatitis Bundlesの使用率,受け入れの実際,高次施設への搬送における問題点などについてアンケート調査を行い,「急性膵炎地域連携構築会議」と称して各病院の医師(外科/救命科/内科),医療連携事務が参加する会合を年に一度開催し,地域の現状を把握するとともに搬送に有用な膵炎MAPを作成し,膵炎治療成績向上を図った.Pancreatitis Bundlesの使用率は2016年の29%から2022年は86%にまで上昇した.また,南大阪地域における急性膵炎死亡率も2019年の全体で1.5%,重症膵炎に限定すると16.2%から,2021年は全体で1.1%,重症膵炎7.9%と改善が認められた.南大阪膵炎MAPと,地域連携構築会議を毎年開催することで,南大阪地区において急性膵炎患者の地域連携が構築されつつあり,急性膵炎患者に対する治療成績の向上と予後の改善が期待される.
• WONDER-01: immediate necrosectomy vs. drainage-oriented step-up approach after endoscopic ultrasound-guided drainage of walled-off necrosis-study protocol for a multicentre randomised controlled trial.

  Tatsuya Sato; Tomotaka Saito; Mamoru Takenaka; Takuji Iwashita; Hideyuki Shiomi; Toshio Fujisawa; Nobuhiko Hayashi; Keisuke Iwata; Akinori Maruta; Tsuyoshi Mukai; Atsuhiro Masuda; Saburo Matsubara; Tsuyoshi Hamada; Tadahisa Inoue; Hiroshi Ohyama; Masaki Kuwatani; Hideki Kamada; Shinichi Hashimoto; Toshiyasu Shiratori; Reiko Yamada; Hirofumi Kogure; Takeshi Ogura; Kazunari Nakahara; Shinpei Doi; Kenji Chinen; Hiroyuki Isayama; Ichiro Yasuda; Yousuke Nakai

  Trials 24 1 352 - 352 2023年05月 

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

  Yousuke Nakai; Tsuyoshi Hamada; Tomotaka Saito; Hideyuki Shiomi; Akinori Maruta; Takuji Iwashita; Keisuke Iwata; Mamoru Takenaka; Atsuhiro Masuda; Saburo Matsubara; Tatsuya Sato; Tsuyoshi Mukai; Ichiro Yasuda; Hiroyuki Isayama

  Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society 35 6 700 - 710 2023年05月 

  Pancreatic fluid collections (PFCs) typically develop as local complications of acute pancreatitis and complicate the clinical course of patients with acute pancreatitis and potentially fatal clinical outcomes. Interventions are required in cases of symptomatic walled-off necrosis (WON) (matured PFCs with necrosis) and pancreatic pseudocysts (matured PFCs without necrosis). In the management of necrotizing pancreatitis and WON, endoscopic ultrasound-guided transluminal drainage combined with on-demand endoscopic necrosectomy (i.e. the step-up approach) is increasingly used as a less invasive treatment modality compared with a surgical or percutaneous approach. Through the substantial research efforts and development of specific devices and stents (e.g. lumen-apposing metal stents), endoscopic techniques of PFC management have been standardized to some extent. However, there has been no consensus about timing of carrying out each treatment step; for instance, it is uncertain when direct endoscopic necrosectomy should be initiated and finished and when a plastic or metal stent should be removed following clinical treatment success. Despite emerging evidence for the effectiveness of noninterventional supportive treatment (e.g. antibiotics, nutritional support, irrigation of the cavity), there has been only limited data on the timing of starting and stopping the treatment. Large studies are required to optimize the timing of those treatment options and improve clinical outcomes of patients with PFCs. In this review, we summarize the current available evidence on the indications and timing of interventional and supportive treatment modalities for this patient population and discussed clinical unmet needs that should be addressed in future research.
• Occupational radiation exposure to the lens of the eyes and its protection during endoscopic retrograde cholangiopancreatography.

  Kenji Ikezawa; Shiro Hayashi; Mamoru Takenaka; Takayuki Yakushijin; Koji Nagaike; Ryoji Takada; Takuo Yamai; Kengo Matsumoto; Masashi Yamamoto; Shunsuke Omoto; Kosuke Minaga; Shuji Ishii; Takeshi Shimizu; Kengo Nagai; Makoto Hosono; Tsutomu Nishida

  Scientific reports 13 1 7824 - 7824 2023年05月 

  This study aimed to examine occupational radiation exposure to the lens of the eyes during endoscopic retrograde cholangiopancreatography (ERCP). In this multicenter, prospective, observational cohort study, we collected data regarding occupational radiation exposure to the lens of the eyes during ERCP. We measured radiation exposure of patients and examined its correlation with occupational exposure. In dosimetrically-measured ERCPs (n = 631), the median air kerma at the patient entrance reference point, air kerma-area product, and fluoroscopy time were 49.6 mGy, 13.5 Gycm2, and 10.9 min, respectively. The median estimated annual radiation dose to the lens of the eyes was 3.7, 2.2, and 2.4 mSv for operators, assistants, and nurses, respectively. Glass badge over lead aprons and eye dosimeter results were similar in operators but differed in assistants and nurses. A strong correlation was shown between eye dosimeter measurements and patients' radiation exposure. The shielding rates of the lead glasses were 44.6%, 66.3%, and 51.7% for operators, assistants, and nurses, respectively. This study revealed the actual occupational exposure dose for the lens of the eyes during ERCP and the efficacy of lead glass. Values of radiation exposure to patients can help estimate exposure to the lens of the eyes of medical staff.
• Inverse association of hospital volume with in-hospital mortality rate of patients receiving endoscopic ultrasound-guided interventions for pancreatic fluid collections.

  Tsuyoshi Hamada; Nobuaki Michihata; Tomotaka Saito; Takuji Iwashita; Hideyuki Shiomi; Mamoru Takenaka; Hiroki Matsui; Kiyohide Fushimi; Hiroyuki Isayama; Ichiro Yasuda; Hideo Yasunaga; Yousuke Nakai

  Gastrointestinal endoscopy 2023年05月 

  BACKGROUND AND AIMS: Endoscopic ultrasound (EUS)-guided interventions currently serve as first-line treatment for symptomatic pancreatic fluid collections (PFCs) but require high-level expertise and multidisciplinary care. Hospital caseload has not been fully examined in relation to clinical outcomes of patients with endoscopically managed PFCs. METHODS: Using the Diagnosis Procedure Combination database, a Japanese nationwide inpatient database, we identified 4,053 patients receiving EUS-guided treatment of PFCs at 486 hospitals in 2010-2020 and examined an association of hospital volume (average annual number of cases at a hospital) with in-hospital mortality. Associations with bleeding, length of stay, and total costs were examined as secondary analyses. Multivariable logistic regression analysis was conducted with adjustment for potential confounders. RESULTS: The hospital volume was inversely associated with the risk of in-hospital mortality (Ptrend < .001). The adjusted odds ratio for in-hospital mortality comparing the extreme quintiles of hospital volume was 0.17 (95% confidence interval, 0.09-0.33). A restricted cubic spline analysis yielded no statistically significant evidence on the nonlinear relationship (Pnonlinearity = .19). The types of stents (plastic vs. lumen-apposing metal stent) appeared to have no effect modification on the volume-mortality relationship (Pinteraction = .58). Higher hospital volume was also associated with lower risk of bleeding, shorter length of stay, and lower medical costs of inpatient care. CONCLUSIONS: Higher hospital volume was associated with a lower risk of in-hospital mortality of patients receiving EUS-guided treatment of PFCs. A further investigation is warranted to justify the volume-based selective referral of the patients.
• The “echo-free space” technique: a safe and reliable method for endoscopic ultrasound scope insertion

  Shunsuke Omoto; Mamoru Takenaka; Tomohiro Fukunaga; Kota Takashima; Yoriaki Komeda; Seok Jeong; Masatoshi Kudo

  Endoscopy 55 S 01 E698 - E699 2023年05月
• Does endoscopic sphincterotomy contribute to the prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis after endoscopic biliary stenting for malignant biliary obstruction? A multicenter prospective cohort study.

  Hiroko Nebiki; Koichi Fujita; Shujiro Yazumi; Mamoru Takenaka; Toru Maruo; Kazuya Matsumoto; Masanori Asada; Takaaki Eguchi; Tokuhiro Matsubara; Satoki Yasumura; Hisakazu Matsumoto; Takashi Tamura; Saiko Marui; Kazunori Hasegawa; Akira Mitoro; Atsuhiro Masuda; Ryoji Takada; Ryuki Minami; Takeshi Ogura; Noriyuki Hoki; Eiji Funatsu; Akira Kurita; Takumi Onoyama; Takeshi Tomoda; Toshiharu Ueki; Tomoaki Yamasaki; Yuhei Sakata; Toshihiro Katayama; Takashi Kawamura; Hirofumi Kawamoto

  Surgical endoscopy 37 5 3463 - 3470 2023年05月 

  BACKGROUND: There is no consensus on the necessity of endoscopic sphincterotomy (ES) to prevent post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) after endoscopic stenting in patients with malignant biliary obstruction. We investigated the incidence of PEP after endoscopic biliary stenting for malignant biliary obstruction with or without ES in a multicenter prospective cohort study. METHODS: We enrolled 807 patients who underwent endoscopic biliary stenting for malignant biliary obstruction with a native papilla at 36 hospitals between April 2017 and March 2018. The incidence of PEP in patients with or without ES was compared for subgroups based on stent type, placement method, and patient background. Univariate and multivariate analysis was performed to investigate the incidence of PEP in all stenting patients. RESULTS: Plastic and metal stents (MS) were inserted in 598 and 209 patients, respectively. The incidence of PEP in patients with or without ES was 7.9% and 7.4%, respectively among all stenting patients. The incidences of PEP with or without ES in plastic stent insertion patients, patients with MS insertion, stent insertions across the papilla, stent insertions across the papilla in patients without main pancreatic duct obstruction, and fully covered MS insertions across the papilla were compared. There was no overall significant difference in the incidence of PEP between those with or without ES. Multivariate logistic regression analysis for the incidence of PEP in all stenting patients revealed obstruction of the main pancreatic duct at the pancreatic head and epinephrine spraying on the papilla were significant factors; there was no significant difference in the incidence of PEP between patients with or without ES. CONCLUSION: Endoscopic sphincterotomy may not contribute to the prevention of PEP after endoscopic biliary stenting for malignant biliary obstruction, even in cases of insertion with a fully covered MS across the papilla.
• 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
• 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
• 膵炎後液体貯留治療後のプラスティックステント長期留置の有用性の検討 メタアナリシス

  佐藤 達也; 上村 真也; 岩下 拓司; 塩見 英之; 大本 俊介; 竹中 完; 向井 強; 齋藤 友隆; 濱田 毅; 伊佐山 浩通; 安田 一朗; 中井 陽介

  Gastroenterological Endoscopy 65 Suppl.1 988 - 988 (一社)日本消化器内視鏡学会 2023年04月
• Early versus delayed interventions for necrotizing pancreatitis: A systematic review and meta-analysis.

  Yousuke Nakai; Hideyuki Shiomi; Tsuyoshi Hamada; Shogo Ota; Mamoru Takenaka; Takuji Iwashita; Tatsuya Sato; Tomotaka Saito; Atsuhiro Masuda; Saburo Matsubara; Keisuke Iwata; Tsuyoshi Mukai; Hiroyuki Isayama; Ichiro Yasuda

  DEN open 3 1 e171  2023年04月 

  OBJECTIVES: Interventions for necrotizing pancreatitis are generally postponed until 4 weeks after the onset of acute pancreatitis, but there remains controversy about whether we should always wait >4 weeks or can intervene early when necessary. This meta-analysis was conducted to evaluate treatment outcomes of necrotizing pancreatitis according to the cut-off defined in the revised Atlanta classification (≤4 vs. >4 weeks). METHODS: Using PubMed, Web of Science, and the Cochrane database, we identified clinical studies published until March 2022 with data comparing outcomes of early and delayed interventions of necrotizing pancreatitis. We pooled data on adverse events, mortality, technical and clinical success rates, and needs for necrosectomy and open surgery, using the random-effects model. RESULTS: We identified 11 retrospective studies, including 775 patients with early interventions and 725 patients with delayed interventions. Patients with early interventions tended to be complicated by organ failure. The rate of adverse events was comparable (OR 1.41, 95% CI 0.66-3.01; p = 0.38) but the rate of mortality was significantly higher (OR 1.70, 95% CI 1.21-2.40; p < 0.01) in early interventions. Technical success rates were similarly high but clinical success rates tended to be low (OR 0.39, 95% CI 0.15-1.00; p = 0.05) in early interventions, though not statistically significant. Pooled ORs for necrosectomy and open surgery were 2.14 and 1.23, respectively. CONCLUSIONS: Early interventions for necrotizing pancreatitis were associated with higher mortality rates and did not reduce adverse events or improve clinical success. However, our results should be confirmed in prospective studies.
• A follow-up questionnaire survey 2022 on radiation protection among 464 medical staff from 34 endoscopy-fluoroscopy departments in Japan.

  Shiro Hayashi; Mamoru Takenaka; Hirofumi Kogure; Takayuki Yakushijin; Yousuke Nakai; Kenji Ikezawa; Shinjiro Yamaguhci; Toshio Fujisawa; Yuzuru Tamaru; Iruru Maetani; Hirotsugu Maruyama; Satoshi Asai; Tadayuki Takagi; Koji Nagaike; Yasuki Hori; Tetsuya Sumiyoshi; Hidetaka Tsumura; Hisashi Doyama; Toshiyuki Yoshio; Kazuo Hara; Seiichiro Abe; Ichiro Oda; Motohiko Kato; Hiroko Nebiki; Tatsuya Mikami; Masanori Miyazaki; Kazuhiro Matsunaga; Makoto Hosono; Tsutomu Nishida; Satoshi Egawa; Akihiro Nishihara; Ken Ohnita; Ryuki Minami; Naoya Tada; Katsumasa Kobayashi; Masayuki Kato

  DEN open 3 1 e227  2023年04月 

  OBJECTIVES: We surveyed and reported low protective equipment usage and insufficient knowledge among endoscopy-fluoroscopy departments in Japan in 2020. Two years later, we conducted a follow-up survey of doctors, nurses, and technologists in Japan. METHODS: We conducted a questionnaire survey on radiation protection from May to June 2022. The participants were medical staff, including doctors, nurses, and radiological and endoscopy technicians in endoscopy-fluoroscopy departments. The questionnaire included 17 multiple-choice questions divided into three parts: background, equipment, and knowledge. RESULTS: We surveyed 464 subjects from 34 institutions. There were 267 doctors (58%), 153 nurses (33%), and 44 technologists (9%). The rate of wearing a lead apron was 98% in this study. The rates of wearing a thyroid collar, lead glasses, and radiation dosimeter were 27%, 35%, and 74%, respectively. The trend of the protective equipment rate was similar to that of our previous study; however, radiation dosimetry among doctors was still low at 58%. The percentage of subjects who knew the radiation exposure (REX) dose of each procedure was low at 18%. Seventy-six percent of the subjects attended lectures on radiation protection, and 73% knew about the three principles of radiation protection; however, the concept of diagnostic reference levels was not well known (18%). Approximately 60% of the subjects knew about the exposure dose increasing cancer mortality (63%) and the 5-year lens REX limit (56%). CONCLUSIONS: There was some improvement in radiation protection equipment or education, but relatively little compared to the 2020 survey of endoscopy departments.
• 胆道疾患診療における放射線被ばくの現状と課題

  竹中 完; 工藤 正俊

  胆道 37 1 73 - 82 (一社)日本胆道学会 2023年03月 

  放射線透視下内視鏡手技における職業被ばくに関しては蓄積した放射線線量が健康被害に影響するため,手技に携わる医師は患者と自分自身だけでなく医療スタッフも保護するために最大限の努力を払う義務がある.ERCP関連手技に関しては,治療的ERCPが診断的ERCPよりも放射線被ばく線量が有意に多く,EUS-BDではERCPと比して,手技時間は有意に短かったにも関わらず使用放射線線量が有意に多かったことが報告されている.放射線被ばく防護の3原則である"正当化","最適化","線量制限",及び診断参考レベル:Diagnostic reference level(DRL)のコンセプトが理解され,自施設の透視装置に合わせた被ばく防護対策がとられ,放射線被ばくの低減を目的に日々進歩する技術が広く認識されることが求められる.(著者抄録)
• Interventional EUSの現状と将来展望 Pancreatic fluid collectionに対する内視鏡治療関連adverse eventについての多施設共同研究 WONDERFUL study group

  大本 俊介; 竹中 完; 伊佐山 浩通

  日本消化器病学会雑誌 120 臨増総会 A139 - A139 (一財)日本消化器病学会 2023年03月
• 当院における膵管断裂症候群(DPDS:disconnected pancreatic duct syndrome)に対する治療成績についての検討

  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
• Long-Term Survival of More than 5 Years with Maintenance Therapy Using Single-Agent Pemetrexed in a Patient with Diffuse Malignant Peritoneal Mesothelioma

  Yasuo Otsuka; Yoriaki Komeda; Masayuki Takeda; Takayuki Takahama; Masashi Kono; Mamoru Takenaka; Satoru Hagiwara; Naoshi Nishida; Hiroshi Kashida; Masatoshi Kudo

  Case Reports in Medicine 2023 1 - 4 2023年02月 

  A 76-year-old woman presented with lower abdominal pain and nausea and was referred to the gastroenterology department in our institution. Previous contrast-enhanced computed tomography (CE-CT) for follow-up after breast cancer surgery had indicated a soft tissue mass below the right diaphragm, which was considered a benign change. CE-CT performed at the first visit to our department revealed further thickening of the soft tissue mass with extension to the liver surface. In addition, ascites and nodules were observed in the abdominal cavity. Histopathological examination of a biopsy specimen revealed peritoneal invasion of atypical epithelioid cells with trabecular and glandular patterns. The tumor cells were positive for AE1/AE2, calretinin, WT-1, D2-40, HEG1, EMA, BAP1, and MTAP and negative for carcinoembryonic antigen, MOC-31, Ber-Ep4, ER, PgR, TTF-1, claudin 4, and desmin. A diagnosis of epithelioid mesothelioma was made. The patient received chemotherapy with cisplatin (75 mg/m2) and pemetrexed (500 mg/m2). After six courses of combined chemotherapy, pemetrexed was administered as a single agent. At the time of writing this report, she was undergoing over the 30th course of chemotherapy without any significant side effects. Diffuse malignant peritoneal mesothelioma is a rare, fatal, and progressive disease. Our patient achieved long-term survival of more than 5 years with maintenance therapy using single-agent pemetrexed.
• Supportive treatment during the periprocedural period of endoscopic treatment for pancreatic fluid collections: a critical review of current knowledge and future perspectives.

  Takuji Iwashita; Keisuke Iwata; Tsuyoshi Hamada; Tomotaka Saito; Hideyuki Shiomi; Mamoru Takenaka; Akinori Maruta; Shinya Uemura; Atsuhiro Masuda; Saburo Matsubara; Tsuyoshi Mukai; Sho Takahashi; Nobuhiko Hayashi; Hiroyuki Isayama; Ichiro Yasuda; Yousuke Nakai

  Journal of gastroenterology 58 2 98 - 111 2023年02月 

  Pancreatic fluid collections (PFCs) commonly develop as complications of acute pancreatitis and ductal disruption due to chronic pancreatitis. In the revised Atlanta classification, PFCs were classified based on the presence of necrosis and duration following the onset of acute pancreatitis. Interventions are required in cases of symptomatic pancreatic pseudocysts or walled-off necrosis (WON). In the management of these PFCs, endoscopic ultrasound-guided transluminal drainage and subsequent direct endoscopic necrosectomy for WON are increasingly utilized as less invasive treatment modalities compared to surgical debridement. To date, researchers have focused predominantly on the technical aspects of endoscopic therapy for symptomatic PFCs. Given the poor physical condition of patients receiving endoscopic treatment for PFCs, systemic support may have a substantial impact on the short- and long-term outcomes of these patients. A multidisciplinary approach is required to improve the clinical outcomes of patients with infected PFCs and their associated comorbidities. However, non-interventional support during the periprocedural period of endoscopic treatment of PFCs has not been fully discussed, and there have been considerable variations in the selection of treatment options between endoscopists and centers. To address these unmet needs in the clinical management of PFCs and promote future research to improve the clinical outcomes, we conducted a review of the literature within a multicenter consortium of expert endoscopists with specific expertise in the endoscopic treatment of PFCs. In this review, we summarize the current evidence on non-interventional supportive care (e.g., continuous lavage, medications, nutritional support, and antimicrobials) and propose potential topics for future research.
• Familial Adenomatous Polyposis with Atypical Clinical Morphology and Genetic Variants

  Yoriaki Komeda; Hideki Ishikawa; Teruhiko Yoshida; Mineko Ushiama; Saki Yoshida; Kenji Nomura; Masashi Kono; Shunsuke Omoto; Mamoru Takenaka; Satoru Hagiwara; Hiroshi Kashida; Masatoshi Kudo

  Internal Medicine 2023年
• 【膵癌の早期診断-診療ガイドラインの改訂を踏まえて】Stage 0,IA膵癌の診断と治療 EUSの有用性

  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.
• Successful initial tofacitinib treatment for acute severe ulcerative colitis with steroid resistance: a case series.

  Yoriaki Komeda; Masashi Kono; Hiroshi Kashida; George Tribonias; Sho Masaki; Ryutaro Takada; Tomoyuki Nagai; Satoru Hagiwara; Naoshi Nishida; Mamoru Takenaka; Hajime Honjo; Shigenaga Matsui; Naoko Tsuji; Masatoshi Kudo

  Annals of gastroenterology 36 1 97 - 102 2023年 

  BACKGROUND: The standard therapy for acute severe ulcerative colitis (ASUC) is intravenous corticosteroids; however, 30% of ulcerative colitis (UC) patients do not recover with corticosteroids alone. Few studies have reported the efficacy and safety of tofacitinib for ASUC with steroid resistance. We report a case series of successful first-line treatment consisting of tofacitinib (20 mg/day) administered to ASUC patients with steroid resistance. METHODS: Patients diagnosed with ASUC at our institution between October 2018 and February 2020 were retrospectively evaluated. They were administered a high dose of tofacitinib (20 mg) after showing no response to steroid therapy in a dose of 1-1.5 mg/kg/day. RESULTS: Eight patients with ASUC, 4 (50%) men, median age 47.1 (range 19-65) years, were included. Four patients were newly diagnosed, and the median UC duration was 4 (range 0-20) years. Six of the 8 patients were able to avoid colectomy. One patient (patient 2) had no response; however, remission was achieved after switching from tofacitinib to infliximab. One patient (patient 6) with no response to tofacitinib underwent total colectomy. Only one patient (patient 4) experienced an adverse event, local herpes zoster, treated with acyclovir without tofacitinib discontinuation. CONCLUSIONS: Clinical remission without serious adverse events can be achieved with high probability and colectomy can be avoided by first administering high-dose tofacitinib to steroid-resistant ASUC patients. Tofacitinib may be one of the first-line treatment options for steroid-resistant ASUC.
• Feasibility and efficacy of endoscopic reintervention after covered metal stent placement for EUS-guided hepaticogastrostomy: A multicenter experience.

  Kosuke Minaga; Masayuki Kitano; Yoshito Uenoyama; Keiichi Hatamaru; Hideyuki Shiomi; Kenji Ikezawa; Tsukasa Miyagahara; Hajime Imai; Nao Fujimori; Hisakazu Matsumoto; Yuzo Shimokawa; Atsuhiro Masuda; Mamoru Takenaka; Masatoshi Kudo; Yasutaka Chiba

  Endoscopic ultrasound 2022年12月 

  BACKGROUND AND OBJECTIVES: Although the use of a long metal stent is favored for EUS-guided hepaticogastrostomy (EUS-HGS) for the relief of malignant biliary obstruction (MBO), endoscopic reintervention (E-RI) at the time of recurrent biliary obstruction (RBO) is challenging due to a long intragastric portion. This study evaluated the feasibility and safety of E-RI after a long partially covered metal stent (L-PCMS) placement during EUS-HGS. MATERIALS AND METHODS: We performed a multicenter retrospective study between January 2015 and December 2019 examining patients with MBO who underwent E-RI for RBO through the EUS-HGS route after the L-PCMS placement. Technical and clinical success rates, details of E-RI, adverse events (AEs), stent patency, and survival time were evaluated. RESULTS: Thirty-three patients at eight referral centers in Japan who underwent E-RI through the EUS-HGS route were enrolled. The location of MBO was distal in 54.5%. The median intragastric length of the L-PCMS was 5 cm. As the first E-RI attempt, E-RI via the distal end of the existing L-PCMS was successful in 60.6%. The overall technical and clinical success rates of E-RI were 100% and 81.8%, respectively. Liver abscess was noted in one patient. A proximal biliary stricture was associated with the clinical ineffectiveness of E-RI in multivariable analysis (odds ratio, 12.5, P = 0.04). The median survival and stent patency duration after E-RI were 140 and 394 days, respectively. CONCLUSIONS: Our study findings suggest that E-RI for RBO after EUS-HGS with a L-PCMS is technically feasible and clinically effective, without any severe AEs, especially for patients with distal MBO.
• 【胆膵EUSのトラブルシューティング】治療的EUS Peripancreatic/pancreatic fluid collection(PFC)ドレナージ 穿刺ルートが拡張できない

  三長 孝輔; 大塚 康生; 益田 康弘; 竹中 完; 工藤 正俊

  消化器内視鏡 34 12 1971 - 1975 (株)東京医学社 2022年12月
• How should a therapeutic strategy be constructed for acute cholecystitis after self-expanding metal stent placement for malignant biliary obstruction?

  Mamoru Takenaka; Masatoshi Kudo

  Clinical endoscopy 55 6 757 - 759 2022年11月
• Lobularity rather than hyperechoic foci/stranding on endoscopic ultrasonography is associated with more severe histological features in chronic pancreatitis.

  Noriko Inomata; Atsuhiro Masuda; Kohei Yamakawa; Mamoru Takenaka; Masahiro Tsujimae; Hirochika Toyama; Keitaro Sofue; Arata Sakai; Takashi Kobayashi; Takeshi Tanaka; Yasutaka Yamada; Shigeto Ashina; Masanori Gonda; Shohei Abe; Shigeto Masuda; Hisahiro Uemura; Shinya Kohashi; Kae Nagao; Yoshiyuki Harada; Mika Miki; Ryota Nakano; Hideyuki Shiomi; Maki Kanzawa; Tomoo Itoh; Takumi Fukumoto; Yuzo Kodama

  Journal of gastroenterology and hepatology 38 1 103 - 111 2022年10月 

  BACKGROUND AND AIM: Endoscopic ultrasonography (EUS) findings of the pancreatic parenchyma, such as hyperechoic foci/stranding and lobularity, may be associated with the severity of chronic pancreatitis (CP). However, the correlation between parenchymal EUS findings and histology remains unclear. We designed a large-scale retrospective study analyzing over 200 surgical specimens to elucidate the association between parenchymal EUS findings and histological features. METHODS: Clinical data of 221 patients with pancreatobiliary tumors who underwent preoperative EUS and pancreatic surgery between January 2010 and November 2020 were reviewed to investigate the association between parenchymal EUS findings and histological features at the pancreatic body. None of these patients met the definition of CP. RESULTS: Of the 221 patients, 87 (39.4%), 89 (40.2%), and 45 (20.4%) had normal EUS findings, hyperechoic foci/stranding without lobularity, and hyperechoic foci/stranding with lobularity, respectively. In the multivariate analyses, parenchymal EUS findings significantly correlated with histological CP findings of fibrosis, inflammation, and atrophy (hyperechoic foci/stranding without lobularity vs hyperechoic foci/stranding with lobularity, odds ratio [95% confidence interval]: 4.1 [2.2-7.9] vs 31.3 [9.3-105.6], Ptrend  < 0.001; 3.9 [1.9-8.2] vs 21.8 [8.0-59.4], Ptrend  < 0.001; and 4.0 [2.0-7.8] vs 22.9 [7.0-74.5], Ptrend  < 0.001, respectively). Further, a trend toward higher histological grade was observed in the following order: normal findings, hyperechoic foci/stranding without lobularity, and hyperechoic foci/stranding with lobularity. CONCLUSIONS: Endoscopic ultrasonography findings of the pancreatic parenchyma may be associated with the histological conditions in CP, such as pancreatic fibrosis, inflammation, and atrophy. Lobularity reflects more severe histological conditions than does hyperechoic foci/stranding.
• Gastrojejunostomy versus endoscopic duodenal stent placement for gastric outlet obstruction in patients with unresectable pancreatic cancer: a propensity score-matched analysis.

  Takashi Tamura; Takenaka Mamoru; Taichi Terai; Takeshi Ogura; Masaji Tani; Toshio Shimokawa; Yuji Kitahata; Ippei Matsumoto; Akira Mitoro; Mitsuhiro Asakuma; Osamu Inatomi; Shunsuke Omoto; Masayuki Sho; Saori Ueno; Hiromitsu Maehira; Masayuki Kitano

  Surgical endoscopy 37 3 1890 - 1900 2022年10月 

  BACKGROUND: Treatments for patients with gastric outlet obstruction (GOO) due to unresectable pancreatic cancers (URPC) include gastrojejunostomy (GJJ) and endoscopic duodenal stent placement (EDSP). This study compared the efficacy and safety of GJJ and EDSP in patients with GOO due to URPC. METHODS: This study retrospectively evaluated consecutive patients with GOO due to URPC who underwent GJJ or EDSP between April 2016 and March 2020. The efficacy and safety of GJJ and EDSP were compared with propensity score analysis. Subgroup analyses of overall survival (OS) were compared after propensity matching. RESULTS: Data were obtained from 54 patients who underwent GJJ and from 73 who underwent EDSP at five tertiary care hospitals. After propensity matching, OS was significantly longer in patients who underwent GJJ than EDSP (110 vs. 63 days, respectively; p = 0.019). Evaluation of long-term adverse events showed that the frequency of cholangitis and obstructive jaundice was significantly lower in the matched GJJ than in the matched EDSP group (p = 0.012). Subgroup analyses showed that OS in patients with good performance status (PS; p = 0.041), biliary obstruction (p = 0.007), and duodenal obstruction near the papilla (p = 0.027), and those receiving chemotherapy (p = 0.010), was significantly longer in the matched GJJ group than in matched EDSP group. CONCLUSION: GJJ provides longer OS than EDSP for patients with GOO caused by URPC, especially for patients with good PS, biliary obstruction, and duodenal obstruction near the papilla, and those receiving chemotherapy.
• Clinical Outcomes of Inside Stents and Conventional Plastic Stents as Bridge-to-Surgery Options for Malignant Hilar Biliary Obstruction

  Hirotoshi Ishiwatari; Takanori Kawabata; Hiroki Kawashima; Yousuke Nakai; Shin Miura; Hironari Kato; Hideyuki Shiomi; Nao Fujimori; Takeshi Ogura; Osamu Inatomi; Kensuke Kubota; Toshio Fujisawa; Mamoru Takenaka; Hiroshi Mori; Kensaku Noguchi; Yuki Fujii; Teiichi Sugiura; Noboru Ideno; Tomoki Nakafusa; Atsushi Masamune; Hiroyuki Isayama; Naoki Sasahira

  Digestive Diseases and Sciences 68 4 1139 - 1147 2022年10月 

  BACKGROUND: The appropriate method of preoperative endoscopic biliary drainage (EBD) for cholangiocarcinoma with hilar biliary obstruction remains controversial. The inside-stent technique is a method of placing plastic stents entirely inside the bile duct. Several studies of patients with unresectable stage have reported longer stent patency compared with conventional endoscopic biliary stenting (EBS). Inside-stent techniques have been introduced as a bridge-to-surgery option and as an alternative to conventional EBS. AIMS: We aimed to evaluate the clinical outcomes of inside stent use and conventional EBS. METHODS: During this retrospective multicenter study, we reviewed consecutive patients with cholangiocarcinoma who underwent radical surgery after conventional EBS or inside-stent insertion. Adverse event (AE) rates after EBD and post-surgical AEs were compared. A multivariable analysis was performed to identify factors affecting cholangitis after EBD. RESULTS: Conventional EBS and inside-stent procedures were performed for 56 and 73 patients, respectively. Patient backgrounds were similar between groups, except for percutaneous transhepatic portal vein embolization. The waiting time before surgery was similar between groups (28.5 days vs. 30 days). There were no significant differences in the cholangitis rate (21.4% vs. 26.0%; P = 0.68) and all AEs (25.0% vs. 30.1%; P = 0.56) between groups. The post-surgical AE rate was similar between the groups. The multivariable analysis found that preprocedural cholangitis was a risk factor for cholangitis after EBD (odds ratio: 5.67; 95% confidence interval: 1.61-19.9). CONCLUSIONS: The outcomes of inside-stent techniques and conventional EBS for the management of preoperative EBD are comparable for patients with cholangiocarcinoma.
• 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
• The usefulness of texture and color-enhanced imaging for balloon endoscopy-assisted ERCP for hepatic-jejunal anastomotic stenosis.

  Mamoru Takenaka; Shunsuke Omoto; Tomohiro Fukunaga; Masatoshi Kudo

  Gastrointestinal endoscopy 97 1 146 - 147 2022年09月
• Endoscopic submucosal dissection with reinforcement using a laparoscopic approach for a duodenal cavernous hemangioma

  Sho Masaki; Yoriaki Komeda; Yasumasa Yoshioka; Mamoru Takenaka; Masatoshi Kudo

  VideoGIE 2022年09月
• The "straighten pigtail" technique for selective replacement of a pigtail plastic stent.

  Mamoru Takenaka; Tomohiro Fukunaga; Akihiro Yoshida; Shunsuke Omoto; Masatoshi Kudo

  Endoscopy 54 S 02 E1083-E1085  2022年09月
• Efficacy of an easy loop-forming guidewire in endoscopic transpapillary gallbladder drainage with gallstones impacted in the cystic duct.

  Mamoru Takenaka; Kae Fukunishi; Kota Takashima; Tomohiro Yamazaki; Masatoshi Kudo

  Endoscopy 2022年09月
• Usefulness of the double-guidewire technique for endoscopic procedures in the field of biliary and pancreatic diseases.

  Mamoru Takenaka; Masatoshi Kudo

  Clinical endoscopy 2022年08月 

  The double-guidewire method has been increasingly used in endoscopic procedures for biliary and pancreatic diseases in recent years, including endoscopic retrograde cholangiopancreatography and endoscopic ultrasonography-related procedures. In addition, double-lumen catheters with uneven distal and proximal lumen openings have been introduced, making it possible to easily create a double-guidewire situation, and the usefulness of the double-guidewire technique using uneven double-lumen cannulas has been widely reported. Although the advantages of using two guidewires depend on the particular situation and the appropriate use of the two guidewires, deepening the knowledge of the double-guidewire method will contribute greatly to troubleshooting in daily practice. In this review, the usefulness of the double-guidewire technique is discussed with respect to two main areas: selective insertion of guidewires and devices and biliary cannulation.
• 急性膵炎後のWONに対する画像診断および経皮的ドレナージの役割

  上月 瞭平; 鶴崎 正勝; 浦瀬 篤史; 小寺 卓; 平山 歩; 石井 一成; 大本 俊介; 竹中 完; 工藤 正俊

  日本医学放射線学会秋季臨床大会抄録集 58回 S439 - S440 (公社)日本医学放射線学会 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
• 【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
• Pancreatic neuroendocrine carcinoma with unique morphological features mimicking intraductal papillary mucinous carcinoma: A case report

  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.
• Bispectral index-guided propofol sedation during endoscopic ultrasonography.

  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.
• Utility of contrast-enhanced harmonic EUS for diagnosis of portal vein invasion by pancreatic cancer.

  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.
• 【胆道・膵疾患を診る-早期診断・早期治療のために】Overview 急性膵炎・急性胆管炎update

  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.
• 【胆道・膵疾患を診る-早期診断・早期治療のために】ここまで進んだ膵がん早期診断 早期膵がんを疑う画像所見とは?

  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.
• 日本の三次医療機関における組織学的診断のための超音波内視鏡下穿刺吸引法による有害事象 多施設共同後ろ向き研究

  菅野 敦; 安田 一朗; 入澤 篤志; 原 和生; 蘆田 玲子; 岩下 拓司; 竹中 完; 潟沼 朗生; 滝川 哲也; 窪田 賢輔; 加藤 博也; 中井 陽介; 良沢 昭銘; 北野 雅之; 伊佐山 浩通; 鎌田 英紀; 岡部 義信; 花田 敬士; 大坪 公士郎; 土井 晋平; 久居 弘幸; 渋川 悟朗; 今津 博雄; 正宗 淳

  Gastroenterological Endoscopy 64 7 1371 - 1385 (一社)日本消化器内視鏡学会 2022年07月 

  【背景と目的】EUS-FNAは,様々な種類の消化器疾患の病理組織学的診断に用いられている.EUS-FNAによる有害事象がいくつか報告されているが,実際の有害事象の発生に関する実態は不明である.本研究の目的は,病理組織学的診断目的のEUS-FNAに関連する有害事象が発生した症例の現状を明らかにすることである.【方法】日本の三次医療機関におけるEUS-FNA関連有害事象症例について,臨床データ(基本患者情報,FNAの手技,EUS-FNA関連有害事象の種類,予後など)を後ろ向きに解析した.【結果】全EUS-FNA症例13,566例のうち,EUS-FNA関連有害事象が発生した合計症例数は234例であった.EUS-FNA関連有害事象の発生率は約1.7%であった.出血症例と膵炎症例が全有害事象のそれぞれ約49.1%と26.5%を占めた.最も一般的な有害事象は出血で,輸血を必要としたのは7例のみであった.神経内分泌腫瘍症例で最も頻度の高かった有害事象は膵炎であった.観察期間中,EUS-FNAによるneedle tract seedingが認められたのは,膵癌症例のわずか約0.1%であった.EUS-FNA関連有害事象による死亡は認められなかった.【結論】本研究により,病理組織学的診断目的のEUS-FNAに関連する有害事象は,発生率が低く,重症例も少ないことが明らかとなった.(著者抄録)
• 【胆道・膵疾患を診る-早期診断・早期治療のために】Overview 急性膵炎・急性胆管炎update

  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.
• 【胆道・膵疾患を診る-早期診断・早期治療のために】ここまで進んだ膵がん早期診断 早期膵がんを疑う画像所見とは?

  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.
• Investigator initiated clinical trial to validate usefulness of specific system for endoscopic ultrasound guided hepaticogastrostomy (HG01) in malignant biliary obstruction (HG01).

  Masahiro Itonaga; Masayuki Kitano; Hiroyuki Isayama; Mamoru Takenaka; Takeshi Ogura; Yasunobu Yamashita; Toshio Fujisawa; Kosuke Minaga; Atsushi Okuda; Toshio Shimokawa

  Medicine 101 22 e29408  2022年06月 

  INTRODUCTION: Endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) is a novel drainage option for patients with an inaccessible papilla. Although EUS-HGS has clinical benefits in patients for whom endoscopic retrograde cholangiopancreatography (ERCP) has failed, the rates of adverse events (AEs) associated with EUS-HGS, such as bile peritonitis and stent migration, are higher than for other procedures. The development of a dedicated system for EUS-HGS is therefore desirable to reduce the rate of AEs. We developed a dedicated system for EUS-HGS (HG01 system) which is composed of a 19-gauge needle, 0.025-inch guidewire, a thin delivery system for tract dilation, and an antimigration metal stent. This study is designed to evaluate the efficacy and safety of EUS-HGS using the HG01 system in malignant biliary obstruction. METHODS/DESIGN: This is a single-arm multicenter prospective study involving 40 patients across six tertiary centers in Japan. Patients with an unresectable malignant biliary obstruction in whom biliary drainage with ERCP failed, is not possible, or is very difficult will be registered in the study. The primary endpoint is the clinical success rate. The secondary endpoints are the technical success rate, procedure-related AE rate, procedure time, procedure success rate using only the HG01 system, stent patency rate, re-intervention success rate, re-intervention method, survival rate, and distance of movement of the stent position. DISCUSSION: We expect use of the HG01 system to reduce the rate of AEs during EUS-HGS, especially bile leakage and stent migration. If the efficacy and safety of EUS-HGS using the HG01 system is confirmed in the present study, it is likely to be considered the first-choice device for use during EUS-HGS.
• 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
• What is the most appropriate diagnostic strategy for evaluating a small common bile duct stone?

  Mamoru Takenaka; Masatoshi Kudo

  Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society 2022年05月
• Needle tract seeding after endoscopic ultrasound-guided tissue acquisition of pancreatic tumors: A nationwide survey in Japan.

  Masayuki Kitano; Makoto Yoshida; Reiko Ashida; Emiri Kita; Akio Katanuma; Takao Itoi; Rintaro Mikata; Kenichiro Nishikawa; Hiroyuki Matsubayashi; Yukiko Takayama; Hironari Kato; Mamoru Takenaka; Toru Ueki; Yohei Kawashima; Yousuke Nakai; Shinichi Hashimoto; Minoru Shigekawa; Hiroko Nebiki; Hidetaka Tsumura; Yosinobu Okabe; Shomei Ryozawa; Yoshiyuki Harada; Akira Mitoro; Tamito Sasaki; Hiroaki Yasuda; Natsuki Miura; Tetsuya Ikemoto; Eisuke Ozawa; Kazuhiko Shioji; Atsushi Yamaguchi; Toru Okuzono; Ichiro Moriyama; Hiroyuki Hisai; Koichi Fujita; Takuma Goto; Nakao Shirahata; Yoshinori Iwata; Yoshihiro Okabe; Kazuo Hara; Yusuke Hashimoto; Masaki Kuwatani; Hiroyuki Isayama; Nao Fujimori; Atsushi Masamune; Keiichi Hatamaru; Toshio Shimokawa; Kazuichi Okazaki; Yoshifumi Takeyama; Hiroki Yamaue

  Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society 2022年05月 

  OBJECTIVES: Endoscopic ultrasound-guided tissue acquisition (EUS-TA) plays a crucial role in the diagnosis of pancreatic tumors. The present study aimed to investigate the current status of needle tract seeding (NTS) after EUS-TA of pancreatic tumors based on a nationwide survey in Japan. METHODS: Patients who underwent surgical resection of primary pancreatic tumors after EUS-TA performed between April 2010 and March 2018 were surveyed. The incidence rates of NTS were determined, and compared in patients with pancreatic ductal adenocarcinomas (PDACs) and other tumors, and in patients who underwent transgastric and transduodenal EUS-TA of PDACs. The detailed features and prognosis of patients with NTS were also assessed. RESULTS: A total of 12,109 patients underwent surgical resection of primary pancreatic tumors after EUS-TA. The overall incidence rate of NTS was 0.330%, and the NTS rate was significantly higher in patients with PDAC than in those with other tumors (0.409% vs. 0.071%, P=0.004). NTS was observed in 0.857% of patients who underwent transgastric EUS-TA, but in none of those who underwent transduodenal EUS-TA. Of the patients with NTS of PDACs, the median time from EUS-TA to occurrence of NTS and median patient survival were 19.3 and 44.7 months, respectively, with 97.4% of NTS located in the gastric wall and 65.8% of NTS resected. The patient survival was significantly longer in patients who underwent NTS resection than in those without NTS resection (P=0.037). CONCLUSIONS: NTS appeared only after transgastric not after transduodenal EUS-TA. Careful follow-up provides an opportunity to remove localized NTS lesions by gastrectomy.
• EUS-guided drainage of the gallbladder using a novel 0.018-inch guidewire for preventing bile leakage (with video).

  Mamoru Takenaka; Shunsuke Omoto; Masatoshi Kudo

  Endoscopic ultrasound 2022年05月
• A novel and effective EUS training program that enables visualization of the learning curve: Educational Program of Kindai system (EPOK).

  Shunsuke Omoto; Mamoru Takenaka; Fauze Maluf-Filho; Masatoshi Kudo

  VideoGIE : an official video journal of the American Society for Gastrointestinal Endoscopy 7 5 165 - 168 2022年05月 

  Video 1A novel training method for endoscopic ultrasound operators, the Educational Program of Kindai system enables visualization of a trainee's learning curve and difficult-to-learn areas. This visualization helps both the trainer and the trainee to structure learning and teaching methods in real time.
• Comparison between gradient and spin-echo (GRASE) and compressed sensing sequences for single breath-hold three-dimensional magnetic resonance cholangiopancreatography in patients with T1 hyperintense bile.

  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 

  PURPOSE: To compare image quality and the detectability of gallstones in patients with T1 hyperintense bile between single breath-hold three-dimensional (3D) magnetic resonance cholangiopancreatography (MRCP) with gradient and spin-echo (GRASE) and with compressed sensing (CS). METHODS: We retrospectively evaluated patients who underwent MRCP using GRASE and CS and had hyperintense bile on T1-weighted fat-suppressed images. The relative duct-to-periductal contrast ratios (RCs) of each bile duct segment were calculated. Pancreaticobiliary duct visibility, motion artifacts, background suppression, and overall image quality were scored on a 5-point scale. The Wilcoxon signed-rank test was used to analyze differences in qualitative and quantitative results. Diagnostic performance in detecting common bile duct (CBD) and gallbladder stones was assessed using receiver operating characteristic (ROC) curves. RESULTS: In total, 96 patients were included in the study. RCs of all bile duct segments in GRASE MRCP were significantly lower than those in CS MRCP (p < 0.001). All biliary duct visibility and overall image quality had significantly higher scores in GRASE MRCP than in CS MRCP (p < 0.001-0.003). Area under ROC curves of GRASE MRCP and CS MRCP were 1.00 and 0.88 for CBD stone (p = 0.14) and 0.93 and 0.82 for gallbladder stone (p = 0.08), respectively. CONCLUSIONS: GRASE MRCP provides better image quality than CS MRCP in patients with hyperintense bile on T1-weighted images. The detectability of biliary stones was also higher in GRASE MRCP than in CS MRCP, although not significantly.
• [Measurement as a Personal Dose Equivalent of X-ray Room Scattered Dose in ERCP Inspection].

  Hiroshi Watanabe; Masaya Konno; Yuka Fujita; Sho Kurihara; Kana Todokoro; Miki Hagiwara; Kazuyuki Yamamoto; Hajime Sakamoto; Mamoru Takenaka; Makoto Hosono

  Nihon Hoshasen Gijutsu Gakkai zasshi 78 4 364 - 371 2022年04月 

  PURPOSE: In the revised Regulation on Prevention of Ionizing Radiation Hazards (April 2020), the equivalent dose limit for the lens of the eye was lowered to "100 mSv in 5 years and 50 mSv in 1 year." It is necessary to reduce occupational exposure in the healthcare sector. The purpose of this study was to facilitate comparison with the equivalent dose limit in an endoscopic retrograde cholangiopancreatography (ERCP) examination by measuring the scattered dose in an X-ray room as an individual dose equivalent. METHODS: The scattered dose was measured by dosimeters positioned in a grid pattern in the X-ray room. The dose rate was measured with and without the use of a protective cloth (0.25 mm Pb equivalent) suspended around the X-ray tube extending to the patient. The dose reduction rate of the material was evaluated during the simulated ERCP. RESULTS: The maximum dose rate at the position of the surgeon performing an ERCP inspection in the standing position was 2.9 mSv/h (3 mm dose equivalent rate) at 150 cm from the ground. The number of ERCP examinations to comply with the equivalent dose limit of the equivalent dose of the lens of the eye without the protective cloth was 28 per year. CONCLUSION: The results of this study suggest that individual dose equivalent measurements in the X-ray clinic may facilitate comparison with the equivalent dose limit.
• Efficacy of EUS-guided celiac plexus neurolysis in combination with EUS-guided celiac ganglia neurolysis for pancreatic cancer-associated pain: a multicenter prospective trial.

  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
• 【胆石症の診療方針】関連疾患 胆道ジスキネジア

  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
• 【エキスパートが教える最新胆膵内視鏡診断・治療】ERCP関連手技 ERCP関連デバイスの進歩【動画付】

  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)
• 【内視鏡データリファレンスブック2022】臓器別 胆道・膵臓 良性胆道狭窄に対する内視鏡治療

  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
• 【胆道ドレナージup to date】急性胆管炎における胆道ドレナージ

  竹中 完; 工藤 正俊

  日本消化器病学会雑誌 119 4 285 - 294 (一財)日本消化器病学会 2022年04月 

  急性胆管炎の死亡率は2.7%と報告され,初期対応を誤れば致死的な経過となる可能性がある病態である.急性胆管炎・胆嚢炎診療ガイドライン2018(Tokyo Guidelines 18)には重症度別の急性胆管炎治療が記載されているが,中等症もしくは重症と診断される急性胆管炎には,緊急胆道ドレナージが推奨される.ドレナージ方法にはendoscopic biliary drainage,percutaneous transhepatic biliary drainageがあり,症例に応じた選択が求められる.今後デバイスの改良によりEUS-guided biliary drainageが代替え治療になる可能性はあるが,どのドレナージを選択したとしても,それぞれの特徴,長所・短所,手技内容を十分に理解した上で慎重に行うことには変わりはない.(著者抄録)
• 【胆石症の診療方針】関連疾患 胆道ジスキネジア

  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.
• Cross‐wired metal stents for endoscopic bilateral stent‐in‐stent deployment in malignant hilar biliary obstruction: A multicenter, single‐arm, prospective study

  Kentaro Yamao; Takeshi Ogura; Hideyuki Shiomi; Takaaki Eguchi; Hisakazu Matsumoto; Zhao Liang Li; Hiroaki Hashimoto; Yasutaka Chiba; Mamoru Takenaka; Tomohiro Watanabe; Masatoshi Kudo; Tsuyoshi Sanuki

  DEN Open 2 1 e20  2022年04月 

  Objectives: The endoscopic bilateral stent-in-stent (SIS) deployment is a challenging procedure. Such difficulty is mainly caused by sticking of the tip of the delivery sheath into the self-expandable metal stents (SEMSs) mesh, requiring an additional dilating procedure. Herein, we assessed the clinical results of using cross-wired metal stent for endoscopic bilateral SIS deployment (BONASTENT M-Hilar) in patients with malignant hilar biliary obstruction (MHBO) in both high-volume and non-high-volume centers. Methods: We prospectively enrolled consecutive patients with MHBO between February 2016 and December 2018 at eight centers. Results: Forty-six patients were enrolled during the study period. The proportions of technical success were 93.5% (43/46) and clinical success (CS) on intention-to-treat and per-protocol analyses were 91.3% (42/46) and 93.0% (40/43), respectively. The proportion of an additional dilating procedure during the primary procedure was 50.0% (23/46). Recurrent biliary obstruction (RBO) on intention-to-treat analysis occurred in 32.6% (15/46) of cases. Almost all of the events were caused by stent ingrowth (14/15). The median survival time and time to RBO were 255 and 349 days, respectively. The probability of stent patency at 3, 6, and 12 months was 86.5%, 63.9%, and 47.6%, respectively. Conclusions: The cross-wired metal stent had excellent technical and CS, although non-high-volume centers were included in this study (UMIN000021441).
• Comparison of Radiation Exposure between Endoscopic Ultrasound-Guided Hepaticogastrostomy and Hepaticogastrostomy with Antegrade Stenting.

  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.
• Diagnostic Reference Levels for Fluoroscopy-guided Gastrointestinal Procedures in Japan from the REX-GI Study: A Nationwide Multicentre Prospective Observational Study.

  Shiro Hayashi; Mamoru Takenaka; Makoto Hosono; Hirofumi Kogure; Kenkei Hasatani; Takahiro Suda; Hirotsugu Maruyama; Kazuhiro Matsunaga; Hideyuki Ihara; Toshiyuki Yoshio; Koji Nagaike; Takuya Yamada; Takayuki Yakushijin; Tadayuki Takagi; Hidetaka Tsumura; Akira Kurita; Satoshi Asai; Yukiko Ito; Toshio Kuwai; Yasuki Hori; Iruru Maetani; Kenji Ikezawa; Takuji Iwashita; Kengo Matsumoto; Toshio Fujisawa; Tsutomu Nishida

  The Lancet regional health. Western Pacific 20 100376 - 100376 2022年03月 

  BACKGROUND: Diagnostic reference levels (DRLs) are required to optimize medical exposure. However, data on DRLs for interventional fluoroscopic procedures are lacking, especially in gastroenterology. This study aimed to prospectively collect currently used radiation doses and help establish national DRLs for fluoroscopy-guided gastrointestinal procedures in Japan. METHODS: This multicentre, prospective, observational study collected actual radiation dose data from endoscopic retrograde cholangiopancreatography (ERCP), interventional endoscopic ultrasound (EUS), balloon-assisted enteroscopy (BAE), enteral metallic stent placement, and enteral tube placement from May 2019 to December 2020. The study outcomes were fluoroscopy time (FT: min), air kerma at the patient entrance reference point (Ka,r: mGy), air kerma area product (PKA: Gycm2), and radiation dose rate (RDR: mGy/min). Additionally, the basic settings of fluoroscopy equipment and the factors related to each procedure were investigated. This study was registered in the UMIN Clinical Trial Registry (UMIN 000036525). FINDINGS: Overall, 12959 fluoroscopy-guided gastrointestinal procedures were included from 23 hospitals in Japan. For 11162 ERCPs, the median/third quartile values of Ka,r (mGy), PKA (Gycm2), and FT (min) were 69/145 mGy, 16/32 Gycm2, and 11/20 min, respectively. Similarly, these values were 106/219 mGy, 23/41 Gycm2 and 17/27 min for 374 interventional EUSs; 53/104 mGy, 16/32 Gycm2 and 10/15 min for 523 metallic stents; 56/104 mGy, 28/47 Gycm2, and 12/18 min for 599 tube placements; and 35/81 mGy, 16/43 Gycm2 and 7/15 min for 301 BAEs, respectively. For the overall radiation dose rate, the median/third quartile values of RDR were 5.9/9.4 (mGy/min). The RDR values at each institution varied widely. INTERPRETATION: This study reports the current radiation doses of fluoroscopy-guided gastrointestinal procedures expressed as DRL quantities. This will serve as a valuable reference for national DRL values. FUNDING: This work was supported by a clinical research grant from the Japanese Society of Gastroenterology.
• Endoscopic Reintervention for Recurrence of Malignant Biliary Obstruction: Developing the Best Strategy.

  Mamoru Takenaka; Masatoshi Kudo

  Gut and liver 2022年02月 

  Drainage therapy for malignant biliary obstruction (MBO) includes trans-papillary endoscopic retrograde biliary drainage (ERBD), percutaneous transhepatic biliary drainage (PTBD), and trans-gastrointestinal endoscopic ultrasound-guided biliary drainage (EUS-BD). With the development of chemotherapy, many MBO cases end up needing endoscopic reintervention (E-RI) for recurrent biliary obstruction. To achieve a successful E-RI, it is necessary to understand the various findings regarding E-RI in MBO cases reported to date. Therefore, in this review, we focus on E-RI for ERBD of distal MBO, ERBD of hilar MBO, and EUS-BD. To plan an appropriate E-RI strategy for biliary stent occlusion for MBO, the following must be considered on a case-by-case basis: the urgency of the drainage, the cause of the occlusion, the original route of drainage (PTBD/ERBD/EUS-BD), the initial stent used (plastic stent or self-expandable metallic stent), and in the case of self-expandable metallic stents, the type used (fully covered or uncovered). Regardless of the original method of stent placement, if the inflammation caused by obstructive cholangitis is severe and/or the patient is in shock, PTBD should be considered as the first choice. Finally, it is important to keep in mind that in many cases, performing E-RI will be difficult.
• Comparison of 22-gauge standard and Franseen needles in EUS-guided tissue acquisition for diagnosing solid pancreatic lesions: a multicenter randomized controlled trial.

  Masahiro Itonaga; Satoru Yasukawa; Nobuyasu Fukutake; Takeshi Ogura; Masanori Asada; Toshio Shimokawa; Osamu Inatomi; Yoshitaka Nakai; Hideyuki Shiomi; Hiroko Nebiki; Azumi Suzuki; Koh Kitagawa; Satoshi Asai; Masaaki Shimatani; Tsuyoshi Sanuki; Akira Kurita; Mamoru Takenaka; Motoyuki Yoshida; Noriyuki Hoki; Hiroaki Yasuda; Hirotsugu Maruyama; Hisakazu Matsumoto; Akio Yanagisawa; Masayuki Kitano

  Gastrointestinal endoscopy 96 1 57 - 66 2022年02月 

  BACKGROUND AND AIMS: This large multicenter randomized controlled trial compared the diagnostic yields of 22-gauge standard and 22-gauge Franseen needles for EUS-guided tissue acquisition (EUS-TA) of solid pancreatic lesions. METHODS: Consecutive patients with solid pancreatic lesions were prospectively randomized to EUS-TA using standard or Franseen needles. Samples obtained with the first needle pass and with second and subsequent passes were evaluated separately. The primary endpoint was the rate of accuracy for diagnosis of malignancy. Other endpoints were technical success rate, sample cellularity, adverse events, diagnostic accuracy in patient subgroups, and the diagnostic accuracy and numbers of second and subsequent needle passes. RESULTS: Of 523 patients undergoing EUS-TA, 260 were randomized to using standard 22-gauge needles and 263 to 22-gauge Franseen needles. The technical success rate in each group was 99.6%, with similar adverse event rates in the standard (1.5%) and Franseen (.8%) needle groups. First-pass EUS-TA using the Franseen needle resulted in significantly greater diagnostic accuracy (84.0% vs 71.2%, P < .001) and sensitivity (82.4% vs 66.7%, P < .001) than first-pass EUS-TA using a standard needle and also resulted in superior diagnostic accuracy in patients requiring immunostaining. Second and subsequent EUS-TA using Franseen needles showed significantly greater accuracy (94.7% vs 90.0%, P = .049) and sensitivity (94.0% vs 88.6%, P = .047) and required fewer needle passes (1.81 vs 2.03, P = .008) than using standard needles. CONCLUSIONS: EUS-TA with the Franseen needle is superior to EUS-TA with a standard needle with respect to diagnostic accuracy per pass, particularly in patients who require immunostaining, and number of passes when using macroscopic on-site evaluation. (Clinical trial registration numbers: UMIN000030634 and jRCTs052180062.).
• 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
• 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
• 膵癌診療の進歩と今後の展望 地域連携システムを用いた膵癌早期診断 MAGURO projectの成績

  益田 康弘; 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 116回 57 - 57 日本消化器病学会-近畿支部 2022年02月
• 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.
• Feasibility and efficacy of endoscopic reintervention after covered metal stent placement for EUS-guided hepaticogastrostomy: A multicenter experience.

  Kosuke Minaga; Masayuki Kitano; Yoshito Uenoyama; Keiichi Hatamaru; Hideyuki Shiomi; Kenji Ikezawa; Tsukasa Miyagahara; Hajime Imai; Nao Fujimori; Hisakazu Matsumoto; Yuzo Shimokawa; Atsuhiro Masuda; Mamoru Takenaka; Masatoshi Kudo; Yasutaka Chiba

  Endoscopic ultrasound 11 6 478 - 486 2022年 

  BACKGROUND AND OBJECTIVES: Although the use of a long metal stent is favored for EUS-guided hepaticogastrostomy (EUS-HGS) for the relief of malignant biliary obstruction (MBO), endoscopic reintervention (E-RI) at the time of recurrent biliary obstruction (RBO) is challenging due to a long intragastric portion. This study evaluated the feasibility and safety of E-RI after a long partially covered metal stent (L-PCMS) placement during EUS-HGS. MATERIALS AND METHODS: We performed a multicenter retrospective study between January 2015 and December 2019 examining patients with MBO who underwent E-RI for RBO through the EUS-HGS route after the L-PCMS placement. Technical and clinical success rates, details of E-RI, adverse events (AEs), stent patency, and survival time were evaluated. RESULTS: Thirty-three patients at eight referral centers in Japan who underwent E-RI through the EUS-HGS route were enrolled. The location of MBO was distal in 54.5%. The median intragastric length of the L-PCMS was 5 cm. As the first E-RI attempt, E-RI via the distal end of the existing L-PCMS was successful in 60.6%. The overall technical and clinical success rates of E-RI were 100% and 81.8%, respectively. Liver abscess was noted in one patient. A proximal biliary stricture was associated with the clinical ineffectiveness of E-RI in multivariable analysis (odds ratio, 12.5, P = 0.04). The median survival and stent patency duration after E-RI were 140 and 394 days, respectively. CONCLUSIONS: Our study findings suggest that E-RI for RBO after EUS-HGS with a L-PCMS is technically feasible and clinically effective, without any severe AEs, especially for patients with distal MBO.
• EUS-guided drainage of the gallbladder using a novel 0.018-inch guidewire for preventing bile leakage (with video).

  Mamoru Takenaka; Shunsuke Omoto; Masatoshi Kudo

  Endoscopic ultrasound 11 6 520 - 521 2022年
• 膵管ガイドワイヤー留置法 確実に成功させるコツ

  竹中 完; 工藤 正俊

  Gastroenterological Endoscopy 64 1 70 - 78 (一社)日本消化器内視鏡学会 2022年01月 

  膵管にガイドワイヤーを留置し,乳頭を固定し,胆管末端部の直線化を図って胆管挿管を行う,膵管ガイドワイヤー留置法(PGW法:Pancreatic guidewire法)は挿管困難症例に対するオプションとして臨床の現場で広く用いられている.一方でPGW法を用いても胆管挿管に難渋する症例はよく経験され,"膵管にガイドワイヤーが留置されることで乳頭そのものの可動性を抑えることは少し可能になるが,屈曲の強い乳頭内胆管が完全に直線化しない可能性も十分にあり得る"ことを念頭に胆管挿管に向き合う必要がある.PGW法はあくまでもオプションの一つであり,胆管挿管の成功は膵管ガイドワイヤー留置後の,対峙した乳頭の形態,口側隆起の形状,その症例でとり得るスコープポジション,を踏まえた挿管ストラテジーの構築なくしてはなし得ない.術後膵炎のリスクを常に想定しながら,安全・確実な膵管ガイドワイヤー留置,症例に応じた各種挿管手法の使い分けを,論理的に,かつ愛護的に操る必要がある.(著者抄録)
• Endoscopic ultrasound-guided biliary drainage with a 22-gauge needle and a 0.018-inch guidewire: Can it be the new standard?

  Kosuke Minaga; Mamoru Takenaka; Masatoshi Kudo

  Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society 34 1 79 - 81 2022年01月
• [Current status of biliary drainage for acute cholangitis].

  Mamoru Takenaka; Masatoshi Kudo

  Nihon Shokakibyo Gakkai zasshi = The Japanese journal of gastro-enterology 119 4 285 - 294 2022年
• Multicenter prospective cohort study of adverse events associated with biliary endoscopic retrograde cholangiopancreatography: Incidence of adverse events and preventive measures for post-endoscopic retrograde cholangiopancreatography pancreatitis.

  Koichi Fujita; Shujiro Yazumi; Hisakazu Matsumoto; Masanori Asada; Hiroko Nebiki; Kazuya Matsumoto; Toru Maruo; Mamoru Takenaka; Takeshi Tomoda; Takumi Onoyama; Akira Kurita; Toshiharu Ueki; Toshiro Katayama; Takashi Kawamura; Hirofumi Kawamoto

  Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society 34 6 1198 - 1204 2021年12月 

  OBJECTIVES: The reported incidence of adverse events (AEs) in endoscopic retrograde cholangiopancreatography (ERCP) varies between 2.5% and 14%. The aim of this study was to evaluate the incidence and severity of AEs in biliary ERCP and to specify the risk factors and preventive measures for post-ERCP pancreatitis (PEP). METHODS: Patients with biliary disease with intact papilla were prospectively enrolled at 36 hospitals between April 2017 and March 2018. The primary outcomes were the incidence and severity of AEs. RESULTS: A total of 16,032 ERCP procedures were performed at the 36 hospitals during the study period and 3739 patients were enrolled. The overall incidence of AEs was 10.1% and ERCP-related mortality was 0.08%. PEP developed in 258 cases (6.9%), bleeding in 33 (0.9%), instrumental AEs in 17 (0.5%), infections in 37 (1.0%), cardiovascular AEs in eight (0.2%), pulmonary AEs in eight (0.2%), drug reaction AE in one (0.03%), pain in 15 (0.4%), and other AEs in 15 (0.4%). Multivariable analysis showed significant risk factors for PEP were: female of younger age, pancreatic guidewire-assisted biliary cannulation, temporary guidewire insertion into the pancreatic duct, total procedure time >60 min, and post-ERCP administration of non-steroidal anti-inflammatory drugs. Effective preventive measures were prophylactic pancreatic stenting (PPS) and epinephrine spraying onto the papilla. CONCLUSIONS: In patients with intact papilla who underwent biliary ERCP, the incidence of AEs was 10.1% and the mortality was 0.08%. PPS and epinephrine spraying may prevent PEP. REGISTRATION: This study was registered in the University Hospital Medical Information Network (UMIN000024820).
• 胆膵内視鏡 治療困難症例を克服するための工夫 当院における胆管ステント迷入に対する経乳頭的re-interventionへの取り組み

  大塚 康生; 山雄 健太郎; 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 107回 76 - 76 日本消化器内視鏡学会-近畿支部 2021年12月
• 【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
• 難治性胆膵疾患に対する内視鏡診療の取り組み 膵上皮内癌および良性膵管狭窄症例に特徴的なEUS所見の検討 多施設共同後ろ向き研究

  山雄 健太郎; 竹中 完; 南 竜城; 大花 正也; 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 107回 53 - 53 日本消化器内視鏡学会-近畿支部 2021年12月
• 胆膵内視鏡 治療困難症例を克服するための工夫 当院における胆管ステント迷入に対する経乳頭的re-interventionへの取り組み

  大塚 康生; 山雄 健太郎; 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 107回 76 - 76 日本消化器内視鏡学会-近畿支部 2021年12月
• How should radiation exposure be handled in fluoroscopy-guided endoscopic procedures in the field of gastroenterology?

  Mamoru Takenaka; Makoto Hosono; Shiro Hayashi; Tsutomu Nishida; Masatoshi Kudo

  Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society 2021年11月 

  Fluoroscopy-guided endoscopic procedures (FGEPs) are rapidly gaining popularity in the field of gastroenterology. Radiation is a well-known health hazard. Gastroenterologists who perform FGEPs are required to protect themselves, patients, as well as nurses and radiologists engaged in examinations from radiation exposure. To achieve this, all gastroenterologists must first understand and adhere to the International Commission on Radiological Protection Publication. In particular, it is necessary to understand the three principles of radiation protection (Justification, Optimization, and Dose Limits), the As Low As Reasonably Achievable principle, and the Diagnostic Reference Levels (DRLs) according to them. This review will mainly explain the three principles of radiation exposure protection, DRLs, and occupational radiological protection in interventional procedures while introducing related findings. Gastroenterologists must gain knowledge of radiation exposure protection and keep it updated.
• 【消化器癌の薬物治療up-to-date】肝内胆管がん

  南 康範; 竹中 完; 工藤 正俊

  消化器クリニカルアップデート 3 1 43 - 46 医学図書出版(株) 2021年11月 

  肝内胆管癌は肝内胆管に由来する悪性腫瘍で、肝細胞癌と合わせて「原発性肝癌」として扱われてきた。しかし、肝内胆管癌の多くが腺癌であることから、薬物治療の開発に関して肝内胆管癌は「胆道癌」に含められて実施されてきた経緯がある。肝内胆管癌診療ガイドラインでは切除不能例に推奨される薬物治療(一次治療)として、GCS療法(ゲムシタビン+シスプラチン+S-1)、GC療法、GS療法をあげている。そして、二次治療として、ペミガチニブ(FGFR阻害薬)がFGFR2融合遺伝子を有する治癒切除不能な胆道癌について2021年6月より臨床使用が可能となった。また、肝内胆管癌を対象とした周術期補助療法についての前向き試験は見当たらないが、(肝内胆管癌を含めた)胆道癌の周術期におけるゲムシタビン、S-1、ゲムシタビン+オキサリプラチンの忍容性は確認されている。現在、一次および二次治療に関する新規薬物の開発治験も進んでおり、肝内胆管癌における薬物治療戦略の発展が期待される。(著者抄録)
• Analysis of Progression Time in Pancreatic Cancer including Carcinoma In Situ Based on Magnetic Resonance Cholangiopancreatography Findings.

  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
• 膵癌発癌から上皮内癌・浸潤癌への進展期間の検討 長期間にわたる回顧画像から見えてきたもの

  山雄 健太郎; 竹中 完; 工藤 正俊

  日本消化器病学会雑誌 118 臨増大会 A760 - A760 (一財)日本消化器病学会 2021年10月
• Cumulative radiation doses from recurrent PET-CT examinations.

  Makoto Hosono; Mamoru Takenaka; Hajime Monzen; Mikoto Tamura; Masatoshi Kudo; Yasumasa Nishimura

  The British journal of radiology 94 1126 20210388 - 20210388 2021年10月 

  Positron emission tomography (PET-CT) is an essential imaging modality for the management of various diseases. Increasing numbers of PET-CT examinations are carried out across the world and deliver benefits to patients; however, there are concerns about the cumulative radiation doses from these examinations in patients. Compared to the radiation exposure delivered by CT, there have been few reports on the frequency of patients with a cumulative effective radiation dose of ≥100 mSv from repeated PET-CT examinations. The emerging dose tracking system facilitates surveys on patient cumulative doses by PET-CT because it can easily wrap up exposure doses of PET radiopharmaceuticals and CT. Regardless of the use of a dose tracking system, implementation of justification for PET-CT examinations and utilisation of dose reduction measures are key issues in coping with the cumulative dose in patients. Despite all the advantages of PET/MRI such as eliminating radiation exposure from CT and providing good tissue contrast in MRI, it is expensive and cannot be introduced at every facility; thus, it is still necessary to utilise PET-CT with radiation reduction measures in most clinical situations.
• The radiation doses and radiation protection on the endoscopic retrograde cholangiopancreatography procedures.

  Mamoru Takenaka; Makoto Hosono; Shiro Hayashi; Tsutomu Nishida; Masatoshi Kudo

  The British journal of radiology 94 1126 20210399 - 20210399 2021年10月 

  Although many interventions involving radiation exposure have been replaced to endoscopic procedure in the gastrointestinal and hepatobiliary fields, there remains no alternative for enteroscopy and endoscopic retrograde cholangiopancreatography (ERCP), which requires the use of radiation. In this review, we discuss the radiation doses and protective measures of endoscopic procedures, especially for ERCP. For the patient radiation dose, the average dose area product for diagnostic ERCP was 14-26 Gy.cm², while it increased to as high as 67-89 Gy.cm² for therapeutic ERCP. The corresponding entrance skin doses for diagnostic and therapeutic ERCP were 90 and 250 mGy, respectively. The mean effective doses were 3- 6 mSv for diagnostic ERCP and 12-20 mSv for therapeutic ERCP. For the occupational radiation dose, the typical doses were 94 μGy and 75 μGy for the eye and neck, respectively. However, with an over-couch-type X-ray unit, the eye and neck doses reached as high as 550 and 450 μGy, with maximal doses of up to 2.8 and 2.4 mGy/procedure, respectively.A protective lead shield was effective for an over couch X-ray tube unit. It lowered scattered radiation by up to 89.1% in a phantom study. In actual measurements, the radiation exposure of the endoscopist closest to the unit was reduced to approximately 12%. In conclusion, there is a clear need for raising awareness among medical personnel involved endoscopic procedures to minimise radiation risks to both the patients and staff.
• Disconnected pancreatic duct syndrome and outcomes of endoscopic ultrasound-guided treatment of pancreatic fluid collections: A systematic review and meta-analysis.

  Tsuyoshi Hamada; Takuji Iwashita; Tomotaka Saito; Hideyuki Shiomi; Mamoru Takenaka; Hiroyuki Isayama; Ichiro Yasuda; Yousuke Nakai

  Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society 34 4 676 - 686 2021年09月 

  BACKGROUND: Disconnected pancreatic duct syndrome (DPDS) frequently occurs in patients with acute necrotizing pancreatitis and resultant pancreatic fluid collection (PFC). We performed a systematic review and meta-analysis to evaluate outcomes of endoscopic ultrasound-guided treatment of PFCs according to the presence of DPDS. METHODS: Using PubMed, Embase, and the Cochrane database, we identified clinical studies published until January 2021 with data comparing outcomes of endoscopic ultrasound-guided drainage of PFCs between DPDS and non-DPDS patients. We pooled data on technical and clinical success rates, PFC recurrence, and adverse events using the random-effects model. RESULTS: We identified five eligible articles including 941 PFC patients treated with endoscopic ultrasound-guided interventions. Clinical success, defined as resolution of the PFC and symptoms, was achieved in a majority of the cases irrespective of DPDS (pooled odds ratio [OR] comparing DPDS to non-DPDS patients, 0.77; 95% confidence interval [CI], 0.33-1.81). Compared to patients without DPDS, patients with DPDS were more likely to undergo PFC recurrence (pooled OR, 6.72; 95% CI, 2.72-16.6) after clinical resolution of PFC. Prolonged plastic stent placement following the clinical resolution was more frequently performed in DPDS patients than in non-DPDS patients (pooled OR, 15.9; 95% CI, 2.76-91.9). No statistically significant difference was observed between the groups in terms of the rate of technical success, adverse events, or mortality. CONCLUSION: DPDS was associated with higher rate of PFC recurrence after successful endoscopic treatment of PFCs. Future studies should evaluate effectiveness and optimal duration of long-term placement of transmural plastic stents for PFCs with DPDS.
• 【膵疾患に対する内視鏡診療のすべて】膵疾患に対する内視鏡治療 EUS下膵管ドレナージ術の実際

  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)
• EUS-FNAにて術前診断できた食道schwannomaの1例

  福西 香栄; 松井 繁長; 杉森 啓伸; 高田 隆太郎; 正木 翔; 河野 匡志; 永井 知行; 米田 頼晃; 山崎 友裕; 山雄 健太郎; 竹中 完; 本庶 元; 渡邉 智裕; 辻 直子; 樫田 博史; 工藤 正俊; 白石 治; 安田 卓司

  日本消化器病学会近畿支部例会プログラム・抄録集 115回 79 - 79 日本消化器病学会-近畿支部 2021年09月
• Endoscopic papillotomy and papilloplasty: Effects on sphincter of Oddi functionality and outcomes.

  Mamoru Takenaka; Masatoshi Kudo

  Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society 33 6 924 - 926 2021年09月
• Utility of contrast-enhanced harmonic endoscopic ultrasonography for T-staging of patients with extrahepatic bile duct cancer.

  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.
• Safety of rectal indomethacin (100 mg) for the prevention of post-ERCP pancreatitis in the Japanese population: A single-center prospective pilot study.

  Kotaro Takeshita; Satoshi Asai; Naoki Fujimoto; Takumi Ichinona; Eisuke Akamine; Mamoru Takenaka

  Hepatobiliary & pancreatic diseases international : HBPD INT 2021年08月
• Diagnostic Value of EUS-Guided Fine-Needle Aspiration Biopsy for Gastric Linitis Plastica with Negative Endoscopic Biopsy.

  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.
• 胆嚢病変に対するDetective flow imaging(DFI)の有用性について

  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
• 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
• 胆嚢病変に対するDetective flow imaging(DFI)の有用性について

  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 日本胆道学会 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
• 慢性膵炎による難治性疼痛に対する内科的インターベンション治療と外科治療の比較解析

  松本 逸平; 三長 孝輔; 村瀬 貴昭; 宮田 剛; 川口 晃平; 亀井 敬子; 水野 修吾; 糸井 隆夫; 大原 弘隆; 正宗 淳; 阪上 順一; 佐田 尚宏; 竹中 完; 北野 雅之; 乾 和郎; 竹山 宜典

  膵臓 36 3 A123 - A123 (一社)日本膵臓学会 2021年08月
• Study protocol for endoscopic ultrasonography-guided ethanol injection therapy for patients with pancreatic neuroendocrine neoplasm: a multicentre prospective study.

  Kazuyuki Matsumoto; Hironari Kato; Masayuki Kitano; Kazuo Hara; Masaki Kuwatani; Reiko Ashida; Mamoru Takenaka; Tatsuhiro Yamazaki; Jun Sakurai; Michihiro Yoshida; Hiroyuki Okada

  BMJ open 11 7 e046505  2021年07月 

  INTRODUCTION: The management of small pancreatic neuroendocrine neoplasms (PNENs) remains controversial. The standard treatment for PNENs is surgical resection; however, invasiveness of surgical procedure remains higher and the incidence of postoperative adverse events is still high. Recently, the efficacy and safety of endoscopic ultrasonography (EUS)-guided ethanol injection for small PNENs has been preliminarily demonstrated. Thus, a multicentre prospective study is being conducted to evaluate the efficacy and safety of EUS-guided ethanol injection therapy for small PNENs. METHODS AND ANALYSIS: The major eligibility criteria are the presence of pathologically diagnosed grade (G) 1 tumour, a tumour size of ≤15 mm and non-functional PNEN or insulinoma. For treatment, we will use a 25-gauge needle and pure ethanol. Contrast-enhanced CT (CE-CT) will be performed on postoperative day 3-5, and if enhanced areas of the tumour are still apparent, an additional session is scheduled during the same hospitalisation period. We set the total amount of ethanol per session to 2 mL. To evaluate the efficacy and safety, CE-CT will be performed at 1 and 6 months after treatment. The primary endpoint is the percentage of subjects who achieved all of the following evaluated points. Efficacy will be evaluated based on the achievement of complete ablation (defined as no enhanced area within the tumour on CE-CT) at 1 and 6 months. Safety will be evaluated based on the avoidance of severe adverse events within 1 month after treatment, continuing severe pancreatic fistula at 1 month after treatment and the incidence and/or exacerbation of diabetes mellitus at 6 months after treatment. ETHICS AND DISSEMINATION: This protocol has been approved by Okayama University Certified Review Board (approval number. CRB19-007). The results will be submitted to peer-reviewed journals and will be presented at international conferences. TRIAL REGISTRATION NUMBER: jRCTs061200016.
• Castor oil as booster for colon capsule endoscopy preparation reduction: A prospective pilot study and patient questionnaire.

  Kota Takashima; Yoriaki Komeda; Toshiharu Sakurai; Sho Masaki; Tomoyuki Nagai; Shigenaga Matsui; Satoru Hagiwara; Mamoru Takenaka; Naoshi Nishida; Hiroshi Kashida; Konosuke Nakaji; Tomohiro Watanabe; Masatoshi Kudo

  World journal of gastrointestinal pharmacology and therapeutics 12 4 79 - 89 2021年07月 

  BACKGROUND: Preparation for colon capsule endoscopy (CCE) requires a large liquid laxative volume for capsule excretion, which compromises the procedure's tolerability. AIM: To assess the safety and utility of castor oil-boosted bowel preparation. METHODS: This prospective cohort study including 20 patients (age range, 16-80 years; six men and 14 women) suspected of having colorectal disease was conducted at Kindai University Hospital from September 2017 to August 2019. All patients underwent CCE because of the following inclusion criteria: previous incomplete colonoscopy in other facility (n = 20), history of abdominal surgery (n = 7), or organ abnormalities such as multiple diverticulum (n = 4) and adhesion after surgery (n = 6). The exclusion criteria were as follows: Dysphagia, history of allergic reactions to the drugs used in this study (magnesium citrate, polyethylene glycol, metoclopramide, and castor oil), possibility of pregnancy, possibility of bowel obstruction or stenosis based on symptoms, or scheduled magnetic resonance imaging within 2 wk after CCE. The primary outcome was the capsule excretion rate within the battery life, as evaluated by the total large bowel observation rate, large bowel transit time, and bowel creasing level using a five-grade scale in different colorectal segments. The secondary outcomes were complications, colorectal lesion detection rates, and patients' tolerability. RESULTS: The castor oil-based regimen was implemented in 17 patients. Three patients cancelled CCE because they could tolerate castor oil, but not liquid laxatives. The capsule excretion rate within the battery life was 88% (15/17). The mean large bowel transit time was 236 min. Approximately 70% of patients had satisfactory colon cleansing levels. CCE detected colon polyps (14/17, 82%) and colonic diverticulum (4/12, 33%). The sensitivity, specificity, and diagnostic accuracy rates for detecting colorectal polyps (size ≥ 6 mm) were 76.9%, 75.0%, and 76.4%, respectively. The sensitivity, specificity, and diagnostic accuracy rates for detection of diverticulum were 100% each. Twelve patients (71%) rated CCE as more than "good", confirming the new regimen's tolerability. No serious adverse events occurred during this study. CONCLUSION: The castor oil-based regimen could reduce bowel preparation dose and improve CCE tolerability.
• 胆膵疾患に対する内視鏡診断・治療の工夫 膵上皮内癌におけるEUS所見の検討 多施設共同後ろ向き研究

  山雄 健太郎; 竹中 完; 樫田 博史; 工藤 正俊

  日本消化器内視鏡学会近畿支部例会プログラム・抄録集 106回 59 - 59 日本消化器内視鏡学会-近畿支部 2021年07月
• 胆膵内視鏡のトラブルマネジメント 胆道Plastic StentドレナージのRe-interventionにおけるSnare Over The Guidewire法の有用性

  吉田 晃浩; 竹中 完; 山雄 健太郎; 樫田 博史; 工藤 正俊

  日本消化器内視鏡学会近畿支部例会プログラム・抄録集 106回 77 - 77 日本消化器内視鏡学会-近畿支部 2021年07月
• 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 2021年07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.
• Current status of endoscopic re-intervention for hilar malignant biliary obstruction.

  Mamoru Takenaka; Masatoshi Kudo

  Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society 33 5 746 - 748 2021年07月
• Efficacy of Over-The-Scope Clip Method as a Novel Hemostatic Therapy for Colonic Diverticular Bleeding.

  Koichiro Kawano; Mamoru Takenaka; Reiko Kawano; Daisuke Kagoshige; Yuta Kawase; Tomonori Moriguchi; Hiroshi Tanabe; Takao Katoh; Katsuhisa Nishi; Masatoshi Kudo

  Journal of clinical medicine 10 13 2021年06月 

  Colonic diverticular could bleed recurrently, and, sometimes, fatal massive bleeding could occur. However, the choice of endoscopic hemostasis remains controversial. Although the over-the-scope clip (OTSC) method has been reported to be effective, it has not been fully evaluated due to the small number of cases. This study aimed to evaluate the efficacy of the OTSC method for colonic diverticular bleeding. Between August 2017 and December 2020, 36 consecutive patients, including those who could not be treated using endoscopic band ligation (EBL) and those in whom re-bleeding had occurred after EBL, underwent the OTSC method for hemostasis of colonic diverticular bleeding at Hyogo Prefectural Awaji Medical Center. The procedure success rate, adverse events rate, early phase re-bleeding rate (within 30 days following primary hemostasis), and the requirement rate for additional transcatheter arterial embolization (TAE) or surgery were the outcomes assessed. The outcomes were procedure success rate 100%, adverse events rate 0%, early phase re-bleeding rate 8.3%, and additional TAE or surgery rate 0%. These results suggest that the OTSC method is a safe and effective treatment for managing colonic diverticular bleeding.
• Usefulness of the Novel Snare-over-the-Guidewire Method for Transpapillary Plastic Stent Replacement (with Video).

  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.
• Usefulness of a newly designed laser-cut metal stent with an anchoring hook and thin delivery system for EUS-guided hepaticogastrostomy in experimental settings (with video).

  Yasunobu Yamashita; Masahiro Itonaga; Chimyon Gon; Yuki Kawaji; Takashi Tamura; Keiichi Hatamaru; Kosuke Minaga; Mamoru Takenaka; Takeshi Ogura; Masayuki Kitano

  Gastrointestinal endoscopy 94 5 999 - 1008 2021年06月 

  BACKGROUND AND AIMS: EUS-guided hepaticogastrostomy (EUS-HGS) is associated with high rates of adverse events. The present study evaluated the feasibility of a newly designed stent equipped with a dilatation and antimigration system for EUS-HGS in phantom and animal models. METHODS: The newly designed stent was a partially covered laser-cut stent with antimigration anchoring hooks and a thin tapered tip (7.2F). The feasibility of these stents for biliary obstruction was compared with that of conventional stents. Evaluated outcomes were resistance force to migration in phantom and ex vivo models, rates of technical success and adverse events, and histology in an in vivo model. RESULTS: The resistance forces on the distal (3.59 vs 1.73 N and 6.21 vs 1.74 N) and proximal (3.58 vs 1.5 N and 5.97 vs 1.67 N) sides in phantom and ex vivo models were significantly higher for hook stents than for conventional stents. Although EUS-HGS was successfully performed in all cases with both stents (100% [10/10] vs 100% [8/8]), the success rate of EUS-HGS without using a fistulous tract dilation device was significantly higher with hook stents (100% [10/10]) than with conventional stents (13% [1/8]). No adverse events occurred with either stent. Pathologic examination showed adhesion between the stomach and liver. CONCLUSIONS: The strong resistance to migration and the absence of the dilation step are important advantages of newly designed hook stents. These stents may therefore be feasible and safe for EUS-HGS.
• Novel troubleshooting technique for the migration of a biliary plastic stent using a thin balloon catheter (with video).

  Mamoru Takenaka; Atsushi Nakai; Masatoshi Kudo

  Journal of hepato-biliary-pancreatic sciences 2021年06月
• Initial experience of endoscopic ultrasound-guided antegrade covered stent placement with long duodenal extension for malignant distal biliary obstruction (with video).

  Hoonsub So; Dongwook Oh; Mamoru Takenaka; Kosuke Minaga; Shinya Uemura; Takuji Iwashita; Tomotaka Saito; Yousuke Nakai; Seon Ok Kim; Do Hyun Park

  Journal of hepato-biliary-pancreatic sciences 28 12 1130 - 1137 2021年06月 

  BACKGROUND/PURPOSE: This study aimed to evaluate the feasibility of endoscopic ultrasound (EUS)-guided antegrade covered stent placement with long duodenal extension (EASL) for malignant distal biliary obstruction (MDBO) with duodenal obstruction (DO) or surgically altered anatomy (SAA) after failed endoscopic retrograde cholangiopancreatography (ERCP). METHODS: Outcomes were technical and clinical success, reintervention rate, adverse events, stent patency, and overall survival. Inverse probability of treatment weighting (IPTW) and competing-risk analysis were performed to compare with conventional EUS-BD. RESULTS: Twenty-five patients (DO, n = 18; SAA, n = 7) were included. The technical and clinical success rates were 96% and 84%, respectively. Reintervention occurred in two patients (8.3%). Adverse events occurred in six patients (24%; two cholangitis, 16%; four mild postprocedural pancreatitis [24% (n = 4/17) in patients with non-pancreatic cancers]). The median patency was 9.4 months, and the overall survival was 2.73 months. After IPTW adjustment, the median patency in the EASL (n = 25) and conventional EUS-BD (n = 29) were 10.1 and 6.5 months, respectively (P = .018). CONCLUSIONS: EASL has acceptable clinical outcomes with a low reintervention rate but higher rate of postprocedural pancreatitis in patients with non-pancreatic cancers. Randomized trials comparing EASL and conventional EUS-BD for MDBO with pancreatic cancers and DO/SAA after failed ERCP are needed to validate our findings.
• Prospective multicenter evaluation of moving cell metallic stents in endoscopic multiple stent deployment for hepatic hilar obstruction.

  Junichi Kawai; Takeshi Ogura; Mamoru Takenaka; Hideyuki Shiomi; Kazuya Ueshima; Saori Ueno; Atsushi Okuda; Jun Matsuno; Kousuke Minaga; Shunsuke Omoto; Atsushi Nakai; Takuya Ikegawa; Akitoshi Hakoda; Kazuhide Higuchi

  Journal of hepato-biliary-pancreatic sciences 29 11 1195 - 1203 2021年06月 

  BACKGROUND AND AIM: Bilateral stent deployment for malignant biliary obstruction (MHBO) can be achieved using side-by-side (SBS) or stent-in-stent (SIS) procedures. Compared with SBS techniques, the procedural steps of SIS are technically complex due to the necessity of introducing the delivery system into a contralateral biliary tract through the mesh of the SEMS. To overcome this issue, a novel uncovered SEMS, the HILZO Moving Cell Stent (MCS) has been released. The present study examined the technical feasibility of treating MHBO using bilateral deployment of this novel stent without dilating the mesh of the first stent to achieve insertion of the second stent within a single session, using a prospective, multicenter setting. METHOD: The primary outcome in the present study was the technical success rate. Technical success was defined as deployment of bilateral MCSs into two or more biliary tracts using SIS without a dilation device in a single-session. RESULTS: A total of 27 patients with complications of MHBO were enrolled in this study. Bilateral SIS using two MCS was successfully performed in 23 patients without using dilation devices among 27 patients (initial technical success rate; 85.2%). Median time to recurrent biliary obstruction (TRBO) was 271 days. Stent dysfunction was observed in 12 patients (44.4%), and re-intervention was successfully performed in all patients without one patient who instead received best supportive care. CONCLUSIONS: The SIS technique using MCS without dilation of the mesh may be technically feasible and safe. In addition, this may be useful for re-intervention. Further comparative randomized trials are needed.
• Comparison of radiation exposure between endoscopic ultrasound-guided drainage and transpapillary drainage by endoscopic retrograde cholangiopancreatography for pancreatobiliary diseases.

  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.
• Nontraumatic tube method for detecting a vessel responsible for colonic diverticular hemorrhage.

  Koichiro Kawano; Mamoru Takenaka; Reiko Kawano; Daisuke Kagoshige; Takao Kato; Katsuhisa Nishi; Masatoshi Kudo

  Endoscopy 54 5 E240-E241  2021年06月
• Clinical impact of recombinant thrombomodulin administration on disseminated intravascular coagulation due to severe acute cholangitis (Recover-AC study).

  Takeshi Ogura; Takaaki Eguchi; Kazunari Nakahara; Yoshihide Kanno; Shunsuke Omoto; Masahiro Itonaga; Taira Kuroda; Akitoshi Hakoda; Seitaro Ikeoka; Megumi Takagi; Akihiko Okada; Junya Sato; Ryo Morita; Yousuke Michikawa; Kei Ito; Shinsuke Koshita; Mamoru Takenaka; Masayuki Kitano; Mitsuhito Koizumi; Kazuhide Higuchi

  Journal of hepato-biliary-pancreatic sciences 2021年05月 

  BACKGROUND AND AIM: Recombinant thrombomodulin (rhTM) is potentially effective in the treatment of disseminated intravascular coagulation (DIC). Several studies related to drugs for the treatment of acute cholangitis have shown negative results in improvement of overall survival (OS) with rhTM. The aim of this multicenter study was to evaluate the clinical effectiveness of rhTM in patients with acute cholangitis and sepsis-induced DIC who underwent biliary drainage. METHODS: A total of 284 consecutive patients, who were complicated with sepsis-induced DIC due to severe acute cholangitis, were included (rhTM group, n = 173; non-rhTM, n = 111) in this study. The primary outcome was the DIC resolution rate at 7 days after starting treatment. The 28-day survival rate was secondarily evaluated. RESULTS: DIC scores in the rhTM group improved significantly compared with the non-rhTM group on day 7 (P = .020). According to multivariate analysis, etiology of cholangitis (malignant, HR 2.28), rhTM (non-administration, HR 4.13), and DIC score (≥5, HR 2.46) were significant factors associated with failed DIC resolution on day 7. Propensity score matching created 103 matched pairs. Survival rate at day 28 was significantly higher in rhTM group (94.3%) compared with non-rhTM group (82.6%; P = .048) after propensity score matching. rhTM (non-administration, HR 2.870), DIC score (≥5, HR 2.751), and APACHE II score (≥20, HR 9.310) were significant factors associated with decreasing survival rate at day 28. CONCLUSION: In conclusion, rhTM seemed to improve patient survival, but future studies should only include patients with benign or malignant disease and should be performed according to APACHE II scores.
• Successful use of two guidewires with different properties using a double-lumen catheter for postoperative biliary stricture.

  Mamoru Takenaka; Tomohiro Yamazaki; Yasuo Otsuka; Rei Ishikawa; Masatoshi Kudo

  Endoscopy 54 5 E190-E192  2021年05月
• Should Contrast-Enhanced Harmonic Endoscopic Ultrasound Be Incorporated into the International Consensus Guidelines to Determine the Appropriate Treatment of Intraductal Papillary Mucinous Neoplasm?

  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.
• A questionnaire survey on radiation protection among 282 medical staff from 26 endoscopy‐fluoroscopy departments in Japan

  Shiro Hayashi; Mamoru Takenaka; Hirofumi Kogure; Takayuki Yakushijin; Hirotsugu Maruyama; Yasuki Hori; Toshiyuki Yoshio; Kenji Ikezawa; Tadayuki Takagi; Satoshi Asai; Kazuhiro Matsunaga; Kengo Matsumoto; Hidetaka Tsumura; Shinjiro Yamaguchi; Tetsuya Sumiyoshi; Koji Nagaike; Yuzuru Tamaru; Kazuo Hara; Toshio Fujisawa; Ichiro Oda; Ken Ohnita; Motohiko Kato; Hiroko Nebiki; Tatsuya Mikami; Akihiro Nishihara; Satoshi Egawa; Ryuki Minami; Makoto Hosono; Tsutomu Nishida

  DEN Open 1 1 e5  2021年04月 

  Background and aims: It is essential for endoscopists, technologists, and nurses to understand radiation protection. However, protective equipment usage is still low, and there is little awareness of radiation protection in practice. Methods: We conducted a questionnaire survey on radiation protection from January to February 2020. The participants were medical staff, including medical doctors, nurses, and radiological and endoscopy technician in endoscopy-fluoroscopy departments. The questionnaire included 14 multiple-choice questions divided among three parts: background, equipment, and knowledge. Results: We surveyed a total of 282 subjects from 26 institutions. There were 168 medical doctors (60%), 90 nurses (32%), and 24 technologists (9%). Although almost all staff members (99%) always wore a lead apron, only a few wore a thyroid collar (32%) and lead glasses (21%). The rate of wearing a radiation dosimeter was insufficient (69%), especially among doctors (52%). A few subjects knew the radiation exposure dose of each procedure (15%), and slightly over half had attended lectures on radiation protection (64%) and knew about the three principles of radiation protection (59%). Protection adherence did not differ by years of experience, knowledge of fluoroscopy, awareness of radiation exposure doses, or attendance at basic lectures on radiation protection. However, medical doctors who were aware of the radiation exposure dose of each procedure were significantly more likely to wear dosimeters than those who were not (p = 0.0008). Conclusion: Medical staff in endoscopy departments in Japan do not have enough radiation protection equipment or education.
• Across-the-papilla side-by-side placement of 6-mm fully covered metallic stents for malignant hilar biliary obstruction: a novel concept that may facilitate reintervention.

  Mamoru Takenaka; Tomohiro Yamazaki; Yasuo Otsuka; Kota Takashima; Rei Ishikawa; Masatoshi Kudo

  Endoscopy 54 3 E102-E105  2021年03月
• Comparison of endoscopic ultrasound-guided choledochoduodenostomy and endoscopic retrograde cholangiopancreatography in first-line biliary drainage for malignant distal bile duct obstruction: A multicenter randomized controlled trial.

  Masahiro Itonaga; Masayuki Kitano; Takanori Yoshikawa; Reiko Ashida; Yasunobu Yamashita; Kenichi Hatamaru; Mamoru Takenaka; Tomohiro Yamazaki; Takeshi Ogura; Nobu Nishioka; Arata Sakai; Atsuhiro Masuda; Hideyuki Shiomi; Toshio Shimokawa

  Medicine 100 12 e25268  2021年03月 

  INTRODUCTION: In patients with malignant distal bile duct obstruction and normal gastrointestinal anatomy, endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) is indicated when endoscopic retrograde cholangiopancreatography (ERCP) fails. The ERCP drainage route passes through the tumor, whereas the EUS-CDS route does not. Therefore, EUS-CDS is expected to have a longer stent patency than ERCP. However, for first-line biliary drainage, it remains unclear whether EUS-CDS or ERCP is superior in terms of stent patency. To reduce the frequency of highly adverse events (AEs) such as bile peritonitis or stent migration following EUS-CDS, we developed an antimigration metal stent with a thin delivery system for tract dilatation. This study is designed to assess whether EUS-CDS with this novel stent is superior to ERCP with a traditional metal stent in terms of stent patency when the two techniques are used for first-line drainage of malignant distal biliary obstruction. METHODS/DESIGN: This study is a multicenter single-blinded randomized controlled trial (RCT) involving 95 patients in four tertiary centers. Patients with malignant distal biliary obstruction that is unresectable or presents a very high surgical risk and who pass the inclusion and exclusion criteria will be randomized to EUS-CDS or ERCP in a 1:1 proportion. The primary endpoint is the stent patency rate 180 days after stent insertion. Secondary outcomes include the rates of technical success, clinical success, technical success in cases not requiring fistulous-tract dilation (only EUS-CDS group), procedure-related AEs, re-intervention success, patients receiving post-drainage chemotherapy, procedure time, and overall survival time. DISCUSSION: If EUS-CDS is superior to ERCP in terms of stent patency and safety for the first-line drainage of malignant distal biliary obstruction, it is expected that the first-line drainage method will be changed from ERCP to EUS-CDS, and that interruption of chemotherapy due to stent dysfunction can be avoided. TRIAL REGISTRATION: University Hospital Medical Information Network Clinical Trials Registry (UMIN-CTR), ID: UMIN000041343. Registered on August 6, 2020. https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000047201Version number: 1.2, December 7, 2020.
• Over-the-scope clipping and detachable snare ligation as a novel combination hemostatic therapy for diverticular bleeding.

  Koichiro Kawano; Reiko Kawano; Tomonori Moriguchi; Hiroshi Tanabe; Takao Katoh; Katsuhisa Nishi; Mamoru Takenaka

  Endoscopy 54 2 218 - 219 2021年03月
• A novel method of papilla fixation for difficult biliary cannulation without using a pancreatic duct guidewire: non-guidewire fixation method.

  Mamoru Takenaka; Koichiro Kawano; Reiko Kawano; Takao Katoh; Katsuhisa Nishi; Masatoshi Kudo

  Endoscopy 54 1 101 - 102 2021年03月
• 急性膵炎からアプローチする膵癌早期診断

  山雄 健太郎; 竹中 完; 工藤 正俊

  日本消化器病学会雑誌 118 臨増総会 A397 - A397 (一財)日本消化器病学会 2021年03月
• 胆膵の内視鏡診断と治療 膵腫瘤におけるDetective flow imaging(DFI)の有用性の検討

  大本 俊介; 竹中 完; 工藤 正俊

  日本消化器病学会雑誌 118 臨増総会 A90 - A90 (一財)日本消化器病学会 2021年03月
• Urgent endoscopic ultrasound-guided choledochoduodenostomy for adenocarcinoma of the ampulla of Vater with scirrhous invasion.

  Takamitsu Tanaka; Shunsuke Omoto; Mamoru Takenaka

  Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society 33 3 e43-e44  2021年03月
• Time Trend of the Radiation Exposure Dose in Endoscopic Retrograde Cholangiopancreatography Over an 8-Year Period: A Single-Center Retrospective Study.

  Shiro Hayashi; Tsutomu Nishida; Naoto Osugi; Sho Yamaoka; Aya Sugimoto; Kaori Mukai; Dai Nakamatsu; Kengo Matsumoto; Masashi Yamamoto; Koji Fukui; Mamoru Takenaka; Makoto Hosono; Masami Inada

  The American journal of gastroenterology 116 1 100 - 105 2021年01月 

  INTRODUCTION: The global needs for a reduction in radiation exposure (RE) are increasing. Endoscopic retrograde cholangiopancreatography (ERCP) is a significant fluoroscopic procedure in the gastrointestinal field. However, the actual RE in ERCP and its annual trend are still unclear. Therefore, we examined the yearly trend of RE in ERCP. METHODS: This retrospective, single-center cohort study included consecutive cases of ERCP from September 2012 to June 2019. We measured the air kerma (AK, mGy), dose area product (DAP, Gycm2), and fluoroscopy time (FT, min). We also evaluated the annual trend of the RE before and after the fluoroscopy device update. RESULTS: In total, 2,174 patients receiving ERCP were enrolled. Among these, the mean age was 74.3 years, and 913 patients were women (42.0%). The median/third quartile values of AK (mGy), DAP (Gycm2), and FT (min) were 109/234 mGy, 13.3/25.8 Gycm2, and 18.2/27.7 minutes. The annual AK, DAP, and FT from 2012 to 2019 were 138, 207, 173, 177, 106, 71.0, 45.0, and 33.3 mGy; 23, 21.4, 19, 18.3, 11.9, 9.0, 6.8, and 6.4 Gycm2; and 12.5, 12.1, 9.7, 9.8, 8.2, 10.8, 9.4, and 10.3 minutes, respectively. The corresponding values before and after the update in July 2016 were 177 and 52 mGy (P < 0.0001), 19.2 and 7.6 Gycm2 (P < 0.0001), and 10.2, and 9.9 minutes (P = 0.05), respectively. DISCUSSION: The RE from ERCP tended to decrease every year, especially after fluoroscopy device updates.
• Artificial intelligence-based endoscopic diagnosis of colorectal polyps using residual networks.

  Yoriaki Komeda; Hisashi Handa; Ryoma Matsui; Shohei Hatori; Riku Yamamoto; Toshiharu Sakurai; Mamoru Takenaka; Satoru Hagiwara; Naoshi Nishida; Hiroshi Kashida; Tomohiro Watanabe; Masatoshi Kudo

  PloS one 16 6 e0253585  2021年 

  Convolutional neural networks (CNNs) are widely used for artificial intelligence (AI)-based image classification. Residual network (ResNet) is a new technology that facilitates the accuracy of image classification by CNN-based AI. In this study, we developed a novel AI model combined with ResNet to diagnose colorectal polyps. In total, 127,610 images consisting of 62,510 images with adenomatous polyps, 30,443 with non-adenomatous hyperplastic polyps, and 34,657 with healthy colorectal normal mucosa were subjected to deep learning after annotation. Each validation process was performed using 12,761 stored images of colorectal polyps by a 10-fold cross validation. The efficacy of the ResNet system was evaluated by sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy. The sensitivity, specificity, PPV, NPV, and diagnostic accuracy for adenomatous polyps at WLIs were 98.8%, 94.3%, 90.5%, 87.4%, and 92.8%, respectively. Similar results were obtained for adenomatous polyps at narrow-band imagings (NBIs) and chromoendoscopy images (CEIs) (NBIs vs. CEIs: sensitivity, 94.9% vs. 98.2%; specificity, 93.9% vs. 85.8%; PPV, 92.5% vs. 81.7%; NPV, 93.5% vs. 99.9%; and overall accuracy, 91.5% vs. 90.1%). The ResNet model is a powerful tool that can be used for AI-based accurate diagnosis of colorectal polyps.
• Adverse events of endoscopic ultrasound-guided fine-needle aspiration for histologic diagnosis in Japanese tertiary centers: Multicenter retrospective study.

  Atsushi Kanno; Ichiro Yasuda; Atsushi Irisawa; Kazuo Hara; Reiko Ashida; Takuji Iwashita; Mamoru Takenaka; Akio Katanuma; Tetsuya Takikawa; Kensuke Kubota; Hironari Kato; Yousuke Nakai; Shomei Ryozawa; Masayuki Kitano; Hiroyuki Isayama; Hideki Kamada; Yoshinobu Okabe; Keiji Hanada; Koushiro Ohtsubo; Shinpei Doi; Hiroyuki Hisai; Goro Shibukawa; Hiroo Imazu; Atsushi Masamune

  Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society 33 7 1146 - 1157 2020年12月 

  BACKGROUND AND AIMS: Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is used for the histopathological diagnosis of any type of gastrointestinal disease. Few adverse events are experienced with this procedure; however, the actual rate of adverse events remains unclear. This study aimed to clarify the current status of cases that experienced adverse events related to the EUS-FNA procedure used for histopathologic diagnoses. METHODS: A retrospective analysis of cases with EUS-FNA-related adverse events in Japanese tertiary centers was conducted by assessing the following clinical data: basic case information, FNA technique, type of procedural adverse events, and prognosis. RESULTS: Of the 13,566 EUS-FNA cases overall, the total number of cases in which adverse events related to EUS-FNA occurred was 234. The incidence of EUS-FNA-related adverse events was ~1.7%. Bleeding and pancreatitis cases accounted for ~49.1% and 26.5% of all adverse events, respectively. Bleeding was the most common adverse event with only seven cases requiring blood transfusion. In cases with neuroendocrine tumors, pancreatitis was the most frequent adverse event. Needle tract seeding because of EUS-FNA was observed during the follow-up period in only ~0.1% of cases with pancreatic cancer. There was no mortality because of adverse events caused by EUS-FNA. CONCLUSIONS: This study revealed that the adverse events-related EUS-FNA for histopathologic diagnoses were not severe conditions, and had low incidence.
• 消化器早期がん内視鏡スクリーニング〜検診も含めて〜 微小膵癌診断のためのスクリーニングEUSの意義と位置づけ

  山雄 健太郎; 竹中 完; 樫田 博史; 工藤 正俊

  日本消化器内視鏡学会近畿支部例会プログラム・抄録集 105回 45 - 45 日本消化器内視鏡学会-近畿支部 2020年12月
• Radiation exposure dose of fluoroscopy-guided gastrointestinal procedures: A single-center retrospective study.

  Shiro Hayashi; Tsutomu Nishida; Shinji Kuriki; Li-Sa Chang; Kazuki Aochi; Emi Meren; Tatsuya Sakamoto; Ryo Tomita; Yu Higaki; Naoto Osugi; Aya Sugimoto; Kei Takahashi; Kaori Mukai; Kengo Matsumoto; Dai Nakamatsu; Masahi Yamamoto; Koji Fukui; Mamoru Takenaka; Makoto Hosono; Masami Inada

  Endoscopy international open 8 12 E1872-E1877  2020年12月 

  Background and study aims  Fluoroscopy-guided gastrointestinal procedures (FGPs) are increasingly common. However, the radiation exposure (RE) to patients undergoing FGPs is still unclear. We examined the actual RE of FGPs. Patients and methods  This retrospective, single-center cohort study included consecutive FGPs, including endoscopic retrograde cholangiopancreatography (ERCP), interventional endoscopic ultrasound (EUS), enteral stenting, balloon-assisted enteroscopy, tube placement, endoscopic injection sclerotherapy (EIS), esophageal balloon dilatation and repositioning for sigmoid volvulus, from September 2012 to June 2019. We measured the air kerma (AK, mGy), dose area product (DAP, Gycm 2 ), and fluoroscopy time (FT, min) for each procedure. Results  In total, 3831 patients were enrolled. Overall, 2778 ERCPs were performed. The median AK, DAP, and FT were as follows: ERCP: 109 mGy, 13.3 Gycm 2 and 10.0 min; self-expandable enteral stenting (SEMS): 62 mGy, 12.4 Gycm 2 and 10.4 min; tube placement: 40 mGy, 13.8 Gycm 2 and 11.1 min; balloon-assisted enteroscopy: 43 mGy, 22.4 Gycm 2 and 18.2 min; EUS cyst drainage (EUS-CD): 96 mGy, 18.3 Gycm 2 and 10.4 min; EIS: 36 mGy, 8.1 Gycm 2 and 4.4 min; esophageal balloon dilatation: 9 mGy, 2.2 Gycm 2 and 1.8 min; and repositioning for sigmoid volvulus: 7 mGy, 4.7 Gycm 2 and 1.6 min. Conclusion  This large series reporting actual RE doses of various FGPs could serve as a reference for future prospective studies.
• 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
• 膵癌早期診断のための3D CT解析による膵実質萎縮の検討

  山雄 健太郎; 竹中 完; 石川 嶺; 沼本 勲; 鶴崎 正勝; 渡邉 智裕; 工藤 正俊

  日本消化器病学会雑誌 117 臨増大会 A721 - A721 (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
• KINDAI20を用いたコンベックスEUSの教育について

  大本 俊介; 竹中 完; 工藤 正俊

  Gastroenterological Endoscopy 62 Suppl.2 2164 - 2164 (一社)日本消化器内視鏡学会 2020年10月
• 急性膵炎およびその合併症治療の最前線 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

  竹中 完; 大本 俊介; 竹山 宜典

  日本消化器病学会雑誌 117 臨増大会 A624 - A624 (一財)日本消化器病学会 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
• KINDAI20を用いたコンベックスEUSの教育について

  大本 俊介; 竹中 完; 工藤 正俊

  Gastroenterological Endoscopy 62 Suppl.2 2164 - 2164 (一社)日本消化器内視鏡学会 2020年10月
• Pancreatic neuroendocrine tumor with stenosis of the main pancreatic duct leading to pancreatic pleural effusion: a case report.

  Yuta Yoshida; Ippei Matsumoto; Tomonori Tanaka; Kentaro Yamao; Akihiro Hayashi; Keiko Kamei; Shumpei Satoi; Atsushi Takebe; Takuya Nakai; Mamoru Takenaka; Yoshifumi Takeyama

  Surgical case reports 6 1 222 - 222 2020年09月 

  BACKGROUND: Pancreatic pleural effusion and ascites are defined as fluid accumulation in the thoracic and abdominal cavity, respectively, due to direct leakage of the pancreatic juice. They usually occur in patients with acute or chronic pancreatitis but are rarely associated with pancreatic neoplasm. We present here an extremely rare case of pancreatic neuroendocrine tumor with stenosis of the main pancreatic duct, leading to pancreatic pleural effusion. CASE PRESENTATION: A 51-year-old man complained of dyspnea. Left-sided pleural effusion was detected on the chest X-ray. Pleural puncture was performed, and the pleural fluid indicated a high amylase content (36,854 IU/L). Hence, the patient was diagnosed with pancreatic pleural effusion. Although no tumor was detected, the computed tomography (CT) scan showed a pseudocyst and dilation of the main pancreatic duct in the pancreatic tail. Magnetic resonance cholangiopancreatography showed a fistula from the pseudocyst into the left thoracic cavity. Endoscopic retrograde pancreatic drainage was attempted; however, it failed due to stenosis in the main pancreatic duct in the pancreatic body. Endoscopic ultrasound revealed a hypoechoic mass measuring 15 × 15 mm in the pancreatic body that was not enhanced in the late phase of contrast perfusion and was thus suspected to be an invasive ductal carcinoma. The patient underwent distal pancreatectomy with splenectomy and the postoperative course was uneventful. Histopathological examination confirmed a neuroendocrine tumor of the pancreas (NET G2). The main pancreatic duct was compressed by the tumor. Increased pressure on the distal pancreatic duct by the tumor might have caused formation of the pseudocyst and pleural effusion. To the best of our knowledge, this is the first case report of pancreatic pleural effusion associated with a neuroendocrine tumor. CONCLUSIONS: Differential diagnosis of a pancreatic neoplasm should be considered, especially when a patient without a history of pancreatitis presents with pleural effusion.
• Identification of serum IFN-α and IL-33 as novel biomarkers for type 1 autoimmune pancreatitis and IgG4-related disease.

  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.
• Endoscopic Ultrasound Fine-Needle Biopsy May Contribute to the Diagnosis of Malignant Lymph Nodes.

  Mamoru Takenaka; Shunsuke Omoto; Masatoshi Kudo

  Clinical endoscopy 53 5 508 - 509 2020年09月
• 急性膵炎局所合併症に対する内視鏡治療 当院におけるwalled-off necrosisに対するstep-up approachの成績と内視鏡治療不成功の要因解析

  大本 俊介; 竹中 完; 工藤 正俊

  Gastroenterological Endoscopy 62 Suppl.1 1091 - 1091 (一社)日本消化器内視鏡学会 2020年08月
• WONのCT所見とステップアップアプローチ

  沼本 勲男; 鶴崎 正勝; 小田 晃義; 柳生 行伸; 石井 一成; 大本 俊介; 竹中 完; 工藤 正敏

  日本インターベンショナルラジオロジー学会雑誌 35 Suppl. 205 - 205 (一社)日本インターベンショナルラジオロジー学会 2020年08月
• 急性膵炎局所合併症に対する内視鏡治療 当院におけるwalled-off necrosisに対するstep-up approachの成績と内視鏡治療不成功の要因解析

  大本 俊介; 竹中 完; 工藤 正俊

  Gastroenterological Endoscopy 62 Suppl.1 1091 - 1091 (一社)日本消化器内視鏡学会 2020年08月
• 膵管狭窄症例におけるCT間接所見の検討 微小膵癌と良性膵管狭窄症例の比較

  山雄 健太郎; 竹中 完; 松本 逸平; 竹山 宜典; 沼本 勲男; 鶴崎 正勝; 工藤 正俊

  膵臓 35 3 A345 - A345 (一社)日本膵臓学会 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
• 「KINDAI20」を用いたコンベックスEUSの教育について

  大本 俊介; 竹中 完; 工藤 正俊

  膵臓 35 3 A330 - A330 (一社)日本膵臓学会 2020年07月
• Disconnected pancreatic duct syndromeの外科治療症例の検討

  松本 正孝; 松本 逸平; 吉田 雄太; 山雄 健太郎; 川口 晃平; 村瀬 貴昭; 大本 俊介; 亀井 敬子; 里井 俊平; 竹中 完; 武部 敦志; 中居 卓也; 竹山 宜典

  膵臓 35 3 A337 - A337 (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
• EUS施行時の鎮静方法の検討

  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
• EUS施行時の鎮静方法の検討

  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
• 膵管狭窄症例におけるCT間接所見の検討 微小膵癌と良性膵管狭窄症例の比較

  山雄 健太郎; 竹中 完; 松本 逸平; 竹山 宜典; 沼本 勲男; 鶴崎 正勝; 工藤 正俊

  膵臓 35 3 A345 - A345 (一社)日本膵臓学会 2020年07月
• Partial Pancreatic Parenchymal Atrophy Is a New Specific Finding to Diagnose Small Pancreatic Cancer (≤10 mm) Including Carcinoma in Situ: Comparison with Localized Benign Main Pancreatic Duct Stenosis Patients

  Kentaro Yamao; Mamoru Takenaka; Rei Ishikawa; Ayana Okamoto; Tomohiro Yamazaki; Atsushi Nakai; Shunsuke Omoto; Ken Kamata; Kosuke Minaga; Ippei Matsumoto; Yoshifumi Takeyama; Isao Numoto; Masakatsu Tsurusaki; Takaaki Chikugo; Yasutaka Chiba; Tomohiro Watanabe; Masatoshi Kudo

  Diagnostics 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.
• Improved liver metastasis detection using Kupffer-phase imaging in contrast-enhanced harmonic EUS in patients with pancreatic cancer (with video)

  Kosuke Minaga; Masayuki Kitano; Atsushi Nakai; Shunsuke Omoto; Ken Kamata; Kentaro Yamao; Mamoru Takenaka; Masakatsu Tsurusaki; Takaaki Chikugo; Ippei Matsumoto; Yasutaka Chiba; Tomohiro Watanabe; Masatoshi Kudo

  Gastrointestinal Endoscopy 2020年06月 [査読有り]
  
• Clinical utility of treatment method conversion during single-session endoscopic ultrasound-guided biliary drainage.

  Kosuke Minaga; Mamoru Takenaka; Kentaro Yamao; Ken Kamata; Shunsuke Omoto; Atsushi Nakai; Tomohiro Yamazaki; Ayana Okamoto; Rei Ishikawa; Tomoe Yoshikawa; Yasutaka Chiba; Tomohiro Watanabe; Masatoshi Kudo

  World journal of gastroenterology 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.
• 【肝膵内視鏡治療におけるトラブルシューティング】ERCP関連治療における偶発症予防とトラブルシューティング 失敗しない内視鏡的胆管結石除去術

  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]
  
• Efficacy of a modified double-guidewire technique using an uneven double lumen cannula (uneven method) in patients with surgically altered gastrointestinal anatomy (with video).

  Mamoru Takenaka; Kosuke Minaga; Ken Kamata; Kentaro Yamao; Tomoe Yoshikawa; Rei Ishikawa; Ayana Okamoto; Tomohiro Yamazaki; Atsushi Nakai; Shunsuke Omoto; Yoriaki Komeda; Toshiharu Sakurai; Tomohiro Watanabe; Naoshi Nishida; Yasutaka Chiba; Chang-Il Kwon; Seok Jeong; Tae Hoon Lee; Masatoshi Kudo

  Surgical endoscopy 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.
• Continuous regional arterial infusion versus intravenous administration of the protease inhibitor nafamostat mesilate for predicted severe acute pancreatitis: a multicenter, randomized, open-label, phase 2 trial

  Morihisa Hirota; Tooru Shimosegawa; Katsuya Kitamura; Kazunori Takeda; Yoshifumi Takeyama; Toshihiko Mayumi; Tetsuhide Ito; Mamoru Takenaka; Eisuke Iwasaki; Hirotaka Sawano; Etsuji Ishida; Shin Miura; Atsushi Masamune; Yousuke Nakai; Akira Mitoro; Hiroyuki Maguchi; Kenji Kimura; Tsuyoshi Sanuki; Tetsuya Ito; Hiroki Haradome; Kazuto Kozaka; Toshifumi Gabata; Keisho Kataoka; Masahiko Hirota; Shuji Isaji; Ryoji Nakamura; Koki Yamagiwa; Chie Kayaba; Koji Ikeda

  Journal of Gastroenterology 55 3 342 - 352 2020年03月 [査読有り]
   

  © 2019, The Author(s). Background: Continuous regional arterial infusion (CRAI) of protease inhibitor nafamostat mesilate (NM) is used in the context of predicted severe acute pancreatitis (SAP) to prevent the development of pancreatic necrosis. Although this therapy is well known in Japan, its efficacy and safety remain unclear. Methods: This investigator-initiated and -driven, multicenter, open-label, randomized, controlled trial (UMIN000020868) enrolled 39 patients with predicted SAP and low enhancement of the pancreatic parenchyma on computed tomography (CT). Twenty patients were assigned to the CRAI group, while 19 served as controls and were administered NM at the same dose intravenously (IV group). The primary endpoint was the development of pancreatic necrosis as determined by CT on Day 14, judged by blinded central review. Results: There was no difference between the CRAI and IV groups regarding the percentages of participants who developed pancreatic necrosis (more than 1/3 of the pancreas: 25.0%, range 8.7–49.1% vs. 15.8%, range 3.4–39.6%, respectively, P = 0.694; more than 2/3 of the pancreas: 20%, range 5.7–43.7% vs. 5.3%, range 0.1–26.0%, respectively, P = 0.341). The early analgesic effect was evaluated based on 24-h cumulative fentanyl consumption and additional administration by intravenous patient-controlled analgesia. The results showed that the CRAI group used significantly less analgesic. There were two adverse events related to CRAI, namely bleeding and splenic infarction. Conclusions: CRAI with NM did not inhibit the development of pancreatic necrosis although early analgesic effect of CRAI was superior to that of IV. Less-invasive IV therapy can be considered a viable alternative to CRAI therapy.
• Multicentre prospective observational study protocol for radiation exposure from gastrointestinal fluoroscopic procedures (REX-GI study).

  Tsutomu Nishida; Shiro Hayashi; Mamoru Takenaka; Makoto Hosono; Hirofumi Kogure; Kenkei Hasatani; Shinjiro Yamaguchi; Hirotsugu Maruyama; Hisashi Doyama; Hideyuki Ihara; Toshiyuki Yoshio; Koji Nagaike; Takuya Yamada; Takayuki Yakushijin; Tadayuki Takagi; Hidetaka Tsumura; Akira Kurita; Satoshi Asai; Yukiko Ito; Toshio Kuwai; Yasuki Hori; Iruru Maetani; Kenji Ikezawa; Takuji Iwashita; Kengo Matsumoto; Masami Inada

  BMJ open 10 2 e033604 - 8 2020年02月 [査読有り]
   

  INTRODUCTION: Recently, the use of various endoscopic procedures under X-ray fluoroscopic guidance, such as endoscopic retrograde cholangiopancreatography (ERCP), interventional endoscopic ultrasonography (EUS), enteral endoscopy and stenting, has been rapidly increasing because of the minimally invasive nature of these procedures compared with that of surgical intervention. With the spread of CT and fluoroscopic interventions, including endoscopic procedures under X-ray guidance, high levels of radiation exposure (RE) from medical imaging have led to major concerns throughout society. However, information about RE related to these image-guided procedures in gastrointestinal endoscopy is scarce, and the RE reference levels have not been established. The aim of this study is to prospectively collect the actual RE dose and to help establish diagnostic reference levels (DRLs) in the field of gastroenterology in Japan. METHODS AND ANALYSIS: This is a multicentre, prospective observational study that is being conducted to collect the actual RE from treatments and diagnostic procedures, including ERCP, interventional EUS, balloon-assisted enteroscopy, enteral metallic stent placement and enteral tube placement. We will measure the total fluoroscopy time (min), the total dose-area product (Gycm2) and air-kerma (mGy) of those procedures. Because we are collecting the actual RE data and identifying the influential factors through a prospective, nationwide design, this study will provide guidance regarding the DRLs of ERCP, interventional EUS, balloon-assisted enteroscopy, enteral metallic stent placement and enteral tube placement. ETHICS AND DISSEMINATION: Approval was obtained from the Institutional Review Board of Toyonaka Municipal Hospital (25 April 2019). The need for informed consent will be waived via the opt-out method of each hospital website. TRIAL REGISTRATION NUMBER: The UMIN Clinical Trials Registry, UMIN000036525.
• Utility and Safety of a Novel Fully Covered Metal Stent in Unresectable Distal Malignant Biliary Obstruction.

  Kentaro Yamao; Mamoru Takenaka; Takeshi Ogura; Hiroaki Hashimoto; Hisakazu Matsumoto; Masashi Yamamoto; Tsukasa Ikeura; Akira Kurita; Zhao Liang Li; Hideyuki Shiomi; Yasutaka Chiba; Masatoshi Kudo; Tsuyoshi Sanuki

  Digestive diseases and sciences 65 12 3702 - 3709 2020年02月 [査読有り]
   

  BACKGROUND: Self-expandable metal stents (SEMSs) are widely used in patients with distal malignant biliary obstruction. A SEMS that can avoid occlusion as much as possible is desirable. AIMS: The aim of this multicenter single-arm prospective study was to assess the clinical effectiveness and safety of a novel fully covered braided SEMS. METHODS: We enrolled consecutive patients with distal malignant biliary obstruction between February 2016 and November 2017 at ten tertiary-care medical centers. RESULTS: We included 79 patients with a median age of 76 years; 47 (59.5%) patients were men. The technical and clinical success rate was 98.7% and 93.6%, respectively. Recurrent biliary obstruction occurred in 14 patients (17.9%); stent ingrowth, overgrowth, migration, and other occurred in five (6.4%), four (5.1%), four (5.1%), and one (1.3%) patients, respectively. All reinterventions in patients with recurrent biliary obstruction were successful via the transpapillary approach. Adverse events occurred in 15 patients (19.2%); cholangitis, pancreatitis, and others occurred in ten (12.8%), three (3.8%), and two (2.6%) patients, respectively. The stent patency probability at 6 months was 48.5%. Median time to stent patency was 171 days, median time to recurrent biliary obstruction was 536 days, and median survival time was 195 days. CONCLUSIONS: We confirmed the utility and safety of a novel fully covered braided SEMS with low axial force and high radial force in patients with malignance biliary obstruction. This novel SEMS is recommended in patients with distal malignant biliary obstruction.
• 【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]
  
• 【慢性膵炎診療2020】治療・予後 膵石の内視鏡治療vs.外科治療 最近の知見

  松本 逸平; 松本 正孝; 村瀬 貴昭; 亀井 敬子; 里井 俊平; 武部 敦志; 中居 卓也; 三長 孝輔; 竹中 完; 竹山 宜典

  肝・胆・膵 80 2 355 - 362 (株)アークメディア 2020年02月 [査読有り]
  
• Comparison of a 22-gauge Franseen-tip needle with a 20-gauge forward-bevel needle for the diagnosis of type 1 autoimmune pancreatitis: a prospective, randomized, controlled, multicenter study (COMPAS study).

  Akira Kurita; Satoru Yasukawa; Yoh Zen; Kenichi Yoshimura; Takeshi Ogura; Eisuke Ozawa; Yoshinobu Okabe; Masanori Asada; Hiroko Nebiki; Minoru Shigekawa; Tsukasa Ikeura; Takaaki Eguchi; Hirotsugu Maruyama; Toshiharu Ueki; Masahiro Itonaga; Shinichi Hashimoto; Hideyuki Shiomi; Ryuki Minami; Noriyuki Hoki; Mamoru Takenaka; Yoshio Itokawa; Norimitsu Uza; Shunpei Hashigo; Hiroaki Yasuda; Ryoji Takada; Hideki Kamada; Hirofumi Kawamoto; Hiroshi Kawakami; Ichiro Moriyama; Koichi Fujita; Hisakazu Matsumoto; Keiji Hanada; Tadamasa Takemura; Shujiro Yazumi

  Gastrointestinal endoscopy 91 2 373 - 381 2020年02月 [査読有り]
   

  BACKGROUND AND AIMS: Histologic diagnosis of autoimmune pancreatitis (AIP) using EUS-guided FNA (EUS-FNA) is difficult. To address this issue, new fine-needle biopsy (FNB) needles were recently developed. Here, we prospectively evaluated 2 newly designed EUS-FNB needles for histologic evaluation in patients with type 1 AIP. METHODS: This was a prospective, randomized, multicenter trial comparing biopsy specimens obtained with a 22-gauge Franseen needle or a 20-gauge forward-bevel needle in patients with suspected type 1 AIP. AIP was diagnosed according to international consensus diagnostic criteria. The primary endpoint was the sensitivity of EUS-FNB needles, and secondary endpoints were the amount of specimen obtained, histology of the pancreas based on evaluation of lymphoplasmacytic sclerosing pancreatitis (LPSP), and contribution of histologic findings to the diagnosis of AIP. RESULTS: One hundred ten patients were randomly assigned to the Franseen group (22-gauge Franseen needle) or the forward-bevel group (20-gauge forward-bevel needle). EUS-FNB sampling was successful in all patients. Nine patients were excluded because of diagnoses other than AIP. Compared with the forward-bevel needle, the Franseen needle obtained a significantly greater number of high-power fields. Of 101 patients, 39 patients (78%) in the Franseen group and 23 patients (45%) in the Forward-bevel group were diagnosed with level 1 or 2 LPSP (P = .001). Thirty-six patients could not be diagnosed with type 1 AIP without EUS-FNB specimen results. CONCLUSIONS: The 22-gauge Franseen needle should be routinely used for histologic diagnosis of type 1 AIP. (Clinical trial registration number: UMIN 000027668.).
• Navigator-triggered and breath-hold 3D MRCP using compressed sensing: image quality and method selection factor assessment.

  Daisuke Morimoto; Tomoko Hyodo; Ken Kamata; Tomoya Kadoba; Makoto Itoh; Hiroyuki Fukushima; Yasutaka Chiba; Mamoru Takenaka; Tomohiro Mochizuki; Yu Ueda; Keizou Miyagoshi; Masatoshi Kudo; Kazunari Ishii

  Abdominal radiology (New York) [Epub ahead of print] 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.
• Navigator-triggered and breath-hold 3D MRCP using compressed sensing: image quality and method selection factor assessment.

  Daisuke Morimoto; Tomoko Hyodo; Ken Kamata; Tomoya Kadoba; Makoto Itoh; Hiroyuki Fukushima; Yasutaka Chiba; Mamoru Takenaka; Tomohiro Mochizuki; Yu Ueda; Keizou Miyagoshi; Masatoshi Kudo; Kazunari Ishii

  Abdominal radiology (New York) 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.
• Endoscopic ultrasound-guided biliary drainage for malignant biliary obstruction with surgically altered anatomy: a multicenter prospective registration study.

  Kosuke Minaga; Mamoru Takenaka; Takeshi Ogura; Takashi Tamura; Taira Kuroda; Toyoma Kaku; Yoshito Uenoyama; Chishio Noguchi; Hidefumi Nishikiori; Hajime Imai; Ryota Sagami; Nao Fujimori; Kazuhide Higuchi; Masatoshi Kudo; Yasutaka Chiba; Masayuki Kitano

  Therapeutic advances in gastroenterology 13 1756284820930964 - 1756284820930964 2020年 [査読有り]
   

  Background: Endoscopic treatment for malignant biliary obstruction (MBO) in patients bearing surgically altered anatomy (SAA) is not well-established. Although endoscopic ultrasound-guided biliary drainage (EUS-BD) has emerged as a new treatment option for MBO, limited data are available regarding the efficacy and safety of EUS-BD in patients with SAA. We conducted a multicenter prospective registration study to evaluate the efficacy and safety of EUS-BD in this population. Methods: This study involved 10 referral centers in Japan. Patients with SAA who were scheduled to receive EUS-BD for unresectable MBO between May 2016 and September 2018 were prospectively registered. The primary endpoint was technical success and the secondary outcomes were clinical success, procedure time, procedure-related adverse events (AEs), stent patency, and overall survival. Results: In total, 40 patients were prospectively enrolled. The surgical reconstruction methods were gastrectomy with Roux-en-Y reconstruction (47.5%), gastrectomy with Billroth-II reconstruction (15%), pancreaticoduodenectomy (27.5%), and hepaticojejunostomy with Roux-en-Y reconstruction (10%). EUS-BD was performed for primary biliary drainage in 31 patients and for rescue biliary drainage in nine patients. Transmural stenting alone (60%), antegrade stenting alone (5%), and a combination of the two techniques (35%) were selected for patients treated with EUS-BD. Technical and clinical success rates were 100% (95% confidence interval, 91.2-100.0%) and 95% (95% confidence interval, 83.1-99.4%), respectively. Mean procedure time was 36.5 min. Early AEs were noted in six patients (15%): three self-limited bile leak, one bile peritonitis, and two pneumoperitonea. Late AEs occurred in six patients (15%): one jejunal ulcer and five stent occlusions. Stent patency rate after 3 months of survival was 95.7% (22/23). Median overall survival was 96 days. Conclusion: EUS-BD for MBO in patients with SAA appears to be effective and safe not only as a rescue drainage technique after failed endoscopic retrograde cholangiography but also as a primary drainage technique. Clinical Trial Registration: UMIN000022101.
• 切除不能遠位悪性胆道閉塞に対する超音波内視鏡下胆道ドレナージにおけるcholedochoduodenostomyおよびhepaticogastrostomyのアプローチルートの有効性と安全性を比較検討する多施設共同前向き無作為化試験

  三長 孝輔; 加藤 博也; 鎌田 英紀; 奥田 篤; 佐上 亮太; 橋本 宏明; 樋口 和秀; 千葉 康敬; 工藤 正俊; 北野 雅之; 小倉 健; 塩見 英之; 今井 元; 伯耆 徳之; 竹中 完; 錦織 英史; 山下 幸孝; 比佐 岳史

  日本消化器内視鏡学会雑誌 62 7 817 - 826 一般社団法人 日本消化器内視鏡学会 2020年 [査読有り]
   

  【背景と目的】超音波内視鏡下胆道ドレナージ術（Endoscopic ultrasound-guided biliary drainage；EUS-BD）には，endoscopic ultrasound-guided choledochoduodenostomy（EUS-CDS）およびendoscopic ultrasound-guided hepaticogastrostomy（EUS-HGS）の２つのアプローチ方法が存在する．本研究は，悪性胆道閉塞に対するこれらの２つの手技の有効性と安全性を比較検討した前向き無作為化試験である．

  【方法】ERCPが不成功であった悪性遠位胆道閉塞を有する患者を対象とし，EUS-CDS群およびEUS-HGS群に無作為に割り付けた．本研究は，2013年９月から2016年３月の期間に国内の高次医療機関９施設で行われた．主要評価項目は手技成功率とし，片側有意水準５％，非劣性マージンを15％と設定し，EUS-HGSのEUS-CDSに対する非劣性を検討した．副次的評価項目は，臨床的成功率，偶発症発生率，ステント開存期間，生存時間，および初期治療，二次治療を含めたEUS-BDの手技成功率とした．

  【結果】EUS-HGS群：24例，EUS-CDS群：23例の計47症例が登録された．手技成功率は，EUS-HGS群およびEUS-CDS群で，各々87.5％，82.6％であり，リスク差の90％信頼区間の下限は12.2％であった（P値＝0.0278）．臨床的成功率は，EUS-HGS群およびEUS-CDS群で，各々100％，94.7％であった（P値＝0.475）．偶発症発生率，ステント開存期間，生存期間には両群で差がなかった．EUS-BDの二次治療を含めた全体での手技成功率は，EUS-HGS群およびEUS-CDS群で各々100％，95.7％であった（P値＝0.983）．

  【結語】本研究により手技成功に関してEUS-HGSのEUS-CDSに対する非劣性が示された．いずれかの手技が困難な場合，他のEUS-BD手技に切り替えることが手技成功を高めることにつながる可能性がある．

• A novel teaching tool for visualizing the invisible bile duct axis in 3 dimensions during biliary cannulation (Compact Disc method)

  Mamoru Takenaka; Tomoe Yoshikawa; Kosuke Minaga; Kentaro Yamao; Masatoshi Kudo

  VideoGIE 2020年 [査読有り]
  
• Association between Genetic and Immunological Background of Hepatocellular Carcinoma and Expression of Programmed Cell Death-1

  Naoshi Nishida; Kazuko Sakai; Masahiro Morita; Tomoko Aoki; Masahiro Takita; Satoru Hagiwara; Yoriaki Komeda; Mamoru Takenaka; Yasunori Minami; Hiroshi Ida; Kazuomi Ueshima; Kazuto Nishio; Masatoshi Kudo

  Liver Cancer 2020年 [査読有り]
  
• Comparison of 22G standard and Franseen needles in endoscopic ultrasound-guided fine-needle aspiration for diagnosing pancreatic mass lesions: Study protocol for a controlled trial.

  Masahiro Itonaga; Satoru Yasukawa; Toshio Shimokawa; Mamoru Takenaka; Nobuyasu Fukutake; Takeshi Ogura; Junichi Sakagami; Hideyuki Shiomi; Yasushi Okura; Osamu Inatomi; Hisakazu Matsumoto; Akira Kurita; Azumi Suzuki; Kiyohito Tanaka; Masayuki Kitano

  Trials 20 1 816 - 816 2019年12月 [査読有り]
   

  BACKGROUND: Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) was developed with the aim of further improving the diagnostic performance of endoscopic ultrasound. Although novel puncture needles have been specifically designed for collecting sufficient tissue specimens, clinical studies have indicated no clear difference in diagnostic performance between these novel needles and conventional puncture needles. Recently, a needle with Franseen geometry was developed specifically for EUS-FNA biopsy. Due to the characteristic shape of its tip, the Franseen needle is expected to be effective for scraping tissues, thus potentially increasing the diagnostic accuracy of EUS-FNA biopsy. We plan to carry out a prospective, multicenter, open-labeled, controlled trial to compare conventional and Franseen needles in terms of the diagnostic accuracy of EUS-FNA for evaluating the malignancy of pancreatic mass lesions. METHODS/DESIGN: The study will enroll 520 patients with pancreatic mass managed at any of 21 participating endoscopic centers. Lesion samples obtained using 22G conventional and Franseen needles will be assessed to compare the efficacy and safety of these two types of needles in EUS-FNA for evaluating the malignancy of mass lesions in the pancreas. Tissue samples will be fixed in formalin and processed for histologic evaluation. For the purpose of this study, only samples obtained with the first needle pass will be used for comparing the: (i) accuracy of the malignancy diagnosis, (ii) sensitivity and specificity for the malignancy diagnosis, (iii) procedure completion rate, (iv) sample cellularity, and (v) incidence of complications. Patient enrollment begins on July 17, 2018. DISCUSSION: The outcomes of this study may provide insight into the optimal needle choice for evaluating the malignancy of pancreatic solid lesions, thus aiding in the development of practice guidelines for pancreatic diseases. TRIAL REGISTRATION: University Hospital Medical Information Network Clinical Trials Registry (UMIN-CTR), UMIN000030634. Registered on 29 December 2017. http://www.umin.ac.jp/ Version number: 01.2017.12.28.
• Low-dose rectal diclofenac does not prevent post-ERCP pancreatitis in low- or high-risk patients.

  Katoh T; Kawashima K; Fukuba N; Masuda S; Kobatake H; Masaki K; Araki Y; Kawano K; Nishi K; Takenaka M; Ishihara S; Kinoshita Y

  Journal of gastroenterology and hepatology 35 7 1247 - 1253 2019年12月 [査読有り]
   

  BACKGROUND AND AIM: The most common adverse event following an endoscopic retrograde cholangiopancreatography (ERCP) procedure is post-ERCP pancreatitis (PEP). Rectal nonsteroidal anti-inflammatory drug (NSAID) administration has shown promise to reduce the risk of PEP in high-risk patients. However, in contrast to high-risk patients, the role of NSAID administration in patients with low risk remains controversial. METHODS: We performed a prospective, single-center, single-blinded, two-arm parallel group, randomized controlled trial to clarify the efficacy of low dose (50 mg) rectal NSAID administration for preventing PEP in at-risk patients. Patients scheduled to undergo ERCP were randomized into two groups, those with and without rectal administration of diclofenac. Patients in the diclofenac group received 50 mg of rectal diclofenac 30 min before undergoing ERCP. The primary endpoint was rate of PEP. RESULTS: A total of 303 were randomized into the study groups. Four patients declined participation following randomization, and another two were withdrawn. As a result, a total of 147 patients were assigned to the diclofenac group and 150 to the control group. The baseline and procedural characteristics were similar in both groups. The primary endpoint of PEP occurrence was seen in 13 of 297 patients (4.4%), including eight (5.4%) in the diclofenac group and five (3.3%) in the control group (P = 0.286). Additionally, those results were not significantly different when patients were classified as low or high risk. CONCLUSIONS: Prophylactic low-dose rectal diclofenac did not reduce the incidence of PEP following ERCP in patients classified as low or high risk.
• Revisionary antireflux metal stent placement for stent occlusion after endoscopic ultrasound-guided hepaticojejunostomy.

  Kosuke Minaga; Mamoru Takenaka; Ayana Okamoto; Shunsuke Omoto; Ken Kamata; Kentaro Yamao; Masatoshi Kudo

  Endoscopy 52 5 E152-E153  2019年11月 [査読有り]
  
• Intestinal dysbiosis mediates experimental autoimmune pancreatitis via activation of plasmacytoid dendritic cells.

  Ken Kamata; Tomohiro Watanabe; Kosuke Minaga; Akane Hara; Tomoe Yoshikawa; Ayana Okamoto; Kentaro Yamao; Mamoru Takenaka; Ah-Mee Park; Masatoshi Kudo

  International immunology 31 12 795 - 809 2019年11月 

  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.
• 膵癌/胆道癌における早期診断の進歩 膵癌診断のための新たなアプローチ法の提案 3D CT解析による膵実質萎縮の検討

  山雄 健太郎; 竹中 完; 工藤 正俊

  日本消化器病学会雑誌 116 臨増大会 A573 - A573 (一財)日本消化器病学会 2019年11月
• Conversion of percutaneous transhepatic gallbladder drainage to endoscopic ultrasound‐guided hepaticogastrostomy by the intentional expansion method

  Mamoru Takenaka; Ken Kamata; Masatoshi Kudo

  Digestive Endoscopy 31 6 718 - 718 Wiley 2019年11月 [査読有り]
  
• Novel concept of bared type metallic stent for endoscopic bilateral stent-in-stent placement in patients with hilar malignant biliary obstruction (with video).

  Takenaka M; Nakai A; Kudo M

  Journal of hepato-biliary-pancreatic sciences 27 5 282 - 283 2019年11月 [査読有り]
   

  Highlight Takenaka and colleagues report on a novel bare uncovered self-expandable metal stent developed to be compatible with only 0.025-inch guide wires. This unprecedented feature makes the delivery tip thinner and more flexible than the conventional type and useful for endoscopic bilateral stent-in-stent placement in patients with hilar malignant biliary obstruction.
• Can Localized Stenosis of the Main Pancreatic Duct be a Predictive Factor for Early Detection of Pancreatic Cancer?

  Takenaka M; Yamao K; Kudo M

  Clinical endoscopy 52 6 523 - 524 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]
  
• Prospective study of early chronic pancreatitis diagnosed based on the Japanese diagnostic criteria.

  Atsushi Masamune; Tatsuhide Nabeshima; Kazuhiro Kikuta; Shin Hamada; Eriko Nakano; Kiyoshi Kume; Atsushi Kanno; Ai Sato; Yuichi Tachibana; Osamu Inatomi; Satoshi Yamamoto; Tsukasa Ikeura; Seiji Futagami; Masashi Taguchi; Keiji Hanada; Kyoko Shimizu; Masanobu Kageoka; Tomotaka Saito; Takaaki Eguchi; Kensuke Kubota; Mamoru Takenaka; Atsushi Mima; Atsushi Irisawa; Tetsuhide Ito; Akira Andoh; Kazuo Inui; Yoshifumi Takeyama; Hiroki Yamaue; Kazuichi Okazaki; Tooru Shimosegawa

  Journal of gastroenterology 54 10 928 - 935 2019年10月 

  BACKGROUND: Chronic pancreatitis (CP) is a fibro-inflammatory disease of the pancreas. Early diagnosis and intervention, before CP becomes established and irreversible, are essential to improve the long-term outcomes. The world's first diagnostic criteria for early CP were proposed in Japan in 2009, but their clinical utility remains elusive. This study aimed to clarify whether patients with early CP progress to definite CP. METHODS: This is a multicenter, prospective study. Patients diagnosed as having early CP according to the Japanese diagnostic criteria were prospectively followed for 2 years. Clinical profiles including symptoms, drinking and smoking status, laboratory data, imaging findings and treatments were analyzed. RESULTS: Among the 83 patients who completed the 2-year follow-up period, four (4.8%) patients progressed to definite CP. The diagnosis of 48 (57.8%) patients was unchanged, and that of 31 (37.3%) patients was downgraded. All the four progressive patients were male, alcohol-related, smokers (3 current and 1 ever), and continued drinking. Comparison of the clinical profiles between the progression group (n = 4) and non-progression group (n = 79) revealed that etiology (alcohol-related), smoking status and presence of acute pancreatitis episodes were associated with the progression to definite CP. CONCLUSIONS: The Japanese diagnostic criteria could identify some patients before the progression to definite CP, while the majority of the patients did not progress. TRIAL REGISTRATION NUMBER: UMIN000015992.
• Comparison of the Diagnostic Performance of Newly Designed 21-Gauge and Standard 22-Gauge Aspiration Needles in Patients with Solid Pancreatic Masses

  Kosuke Minaga; Tomoe Yoshikawa; Yukitaka Yamashita; Hiroko Akamatsu; Maiko Ikenouchi; Tatsuya Ishii; Hisakazu Matsumoto; Hiroyoshi Iwagami; Yasuki Nakatani; Keiichi Hatamaru; Mamoru Takenaka; Takuji Akamatsu; Yoshito Uenoyama; Tomohiro Watanabe; Kazuo Ono; Yasutaka Chiba; Masatoshi Kudo

  Digestive Diseases and Sciences 64 10 2982 - 2991 2019年10月 

  © 2019, Springer Science+Business Media, LLC, part of Springer Nature. Background: Although endoscopic ultrasound-guided fine needle aspiration (EUS–FNA) has been widely used for the diagnosis of pancreatic tumors, the ability to obtain adequate pancreatic tumor tissue needs to be improved. Aims: This study was performed to compare a newly designed 21-gauge needle (EUS Sonopsy CY; Hakko Medical, Nagano, Japan) and a standard 22-gauge needle for tissue sampling of solid pancreatic masses. Methods: Consecutive patients with solid pancreatic masses who underwent EUS–FNA with either the EUS Sonopsy CY or the 22-gauge needle from June 2014 to December 2016 were enrolled. The primary outcome was comparison of the diagnostic yield of the FNA samples. The secondary outcomes were comparison of technical success, diagnostic ability for malignancy, and complications. Results: A total of 93 patients (40.9% female; mean age, 70.1 years) underwent EUS–FNA with the EUS Sonopsy CY (n = 47) or the standard 22-gauge needle (n = 46). The technical success rate was 100% in both groups, and the overall diagnostic accuracy for malignancy was similar between the groups (100% in the EUS Sonopsy CY group vs. 95.7% in the 22-gauge needle group, P = 0.242). Nevertheless, the EUS Sonopsy CY resulted in significantly higher scores for cellularity (P = 0.006) and lower scores for blood contamination (P < 0.001). The procedure-related complication rate was comparable between the groups (P = 0.148). Conclusions: The EUS Sonopsy CY provided higher-quality specimens for histological evaluation in terms of both sample cellularity and blood contamination for the diagnosis of solid pancreatic masses. Trial registration: The study was registered in a clinical trial registry, No. UMIN000032598.
• LENVATINIB AS AN INITIAL TREATMENT IN PATIENTS WITH INTERMEDIATE-STAGE HEPATOCELLULAR CARCINOMA BEYOND UP-TO-SEVEN CRITERIA AND CHILD-PUGH A LIVER FUNCTION: A MULTICENTER PROPENSITY-SCORE MATCHED STUDY

  Kudo Masatoshi; Ueshima Kazuomi; Chan Stephen L; Minami Tomohiro; Chishina Hirokazu; Aoki Tomoko; Takita Masahiro; Hagiwara Satoru; Minami Yasunori; Ida Hiroshi; Takenaka Mamoru; Sakurai Toshiharu; Watanabe Tomohiro; Morita Masahiro; Ogawa Chikara; Wada Yoshiyuki; Ikeda Masafumi; Ishii Hiroshi; Izumi Namiki; Nishida Naoshi

  HEPATOLOGY 70 133A - 134A 2019年10月 [査読有り]
  
• Single-session multiple stent deployment using moving cell stent without dilating initial stent mesh to treat malignant hilar biliary obstruction (with videos).

  Ogura T; Takenaka M; Shiomi H; Nishioka N; Ueno S; Miyano A; Kamiyama R; Higuchi K

  Journal of hepato-biliary-pancreatic sciences 27 2 84 - 89 2019年10月 [査読有り]
   

  BACKGROUND: Malignant hilar biliary obstruction (MHBO) can be treated with bilateral self-expandable metal stents (SEMS) deployed using side-by-side (SBS) or stent-in-stent (SIS) techniques. Moving cell stents (MCS) are a novel type of SEMS. The present study evaluated the technical feasibility of treating MHBO using bilateral novel uncovered SEMS to insert an SIS technique without dilating the mesh of a first stent within a single session. METHOD: We retrospectively assessed patients who were complicated with obstructive jaundice due to MHBO between August and December 2018. Technical success was defined as the deployment of a bilateral MCS into two or more biliary tracts using SIS technique without a dilation device. RESULTS: The present study analyzed data from 23 consecutive patients who were complicated with MHBO. Bilateral SIS technique with MCS was deployed in 22 (95.6%) of the 23 patients without dilating the mesh of the first stent. Multiple guidewire insertion failed in one patient with Bismuth-type IV. The median procedural duration was 33.6 min. Time to recurrent biliary obstruction was 230 days. Severe adverse events were not seen in any patients. CONCLUSION: In conclusion, uncovered moving cell SEMS might facilitate bilateral stent deployment using SIS technique.
• Comparison of the efficacy and safety of endoscopic ultrasound-guided choledochoduodenostomy and hepaticogastrostomy for malignant distal biliary obstruction: Multicenter, randomized, clinical trial.

  Kosuke Minaga; Takeshi Ogura; Hideyuki Shiomi; Hajime Imai; Noriyuki Hoki; Mamoru Takenaka; Hidefumi Nishikiori; Yukitaka Yamashita; Takeshi Hisa; Hironari Kato; Hideki Kamada; Atsushi Okuda; Ryota Sagami; Hiroaki Hashimoto; Kazuhide Higuchi; Yasutaka Chiba; Masatoshi Kudo; Masayuki Kitano

  Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society 31 5 575 - 582 2019年09月 

  BACKGROUND AND AIM: Endoscopic ultrasound-guided biliary drainage (EUS-BD) can be carried out by two different approaches: choledochoduodenostomy (CDS) and hepaticogastrostomy (HGS). We compared the efficacy and safety of these approaches in malignant distal biliary obstruction (MDBO) patients using a prospective, randomized clinical trial. METHODS: Patients with malignant distal biliary obstruction after failed endoscopic retrograde cholangiopancreatography were randomly selected for either CDS or HGS. The procedures were carried out at nine tertiary centers from September 2013 to March 2016. Primary endpoint was technical success rate, and the noninferiority of HGS to CDS was examined with a one-sided significance level of 5%, where the noninferiority margin was set at 15%. Secondary endpoints were clinical success, adverse events (AE), stent patency, survival time, and overall technical success including alternative EUS-BD procedures. RESULTS: Forty-seven patients (HGS, 24; CDS, 23) were enrolled. Technical success rates were 87.5% and 82.6% in the HGS and CDS groups, respectively, where the lower limit of the 90% confidence interval of the risk difference was -12.2% (P = 0.0278). Clinical success rates were 100% and 94.7% in the HGS and CDS groups, respectively (P = 0.475). Overall AE rate, stent patency, and survival time did not differ between the groups. Overall technical success rates were 100% and 95.7% in the HGS and CDS groups, respectively (P = 0.983). CONCLUSIONS: This study suggests that HGS is not inferior to CDS in terms of technical success. When one procedure is particularly challenging, readily switching to the other could increase technical success.
• Large balloon expansion method for re-intervention after endoscopic ultrasound-guided hepaticogastrostomy for stent obstruction

  Takenaka Mamoru; Nakai Atsushi; Kudo Masatoshi

  DIGESTIVE ENDOSCOPY 31 5 E99 - E100 Wiley 2019年09月 [査読有り]
  
• Long-term outcomes of EUS-guided transluminal stent deployment for benign biliary disease: Multicenter clinical experience (with videos).

  Ogura T; Takenaka M; Shiomi H; Goto D; Tamura T; Hisa T; Kato H; Nishioka N; Minaga K; Masuda A; Onoyama T; Kudo M; Higuchi K; Kitano M

  Endoscopic ultrasound 2019年09月 [査読有り]
  
• Contrast-enhanced harmonic endoscopic ultrasonography for evaluating the response to chemotherapy in pancreatic cancer.

  Hidekazu Tanaka; Ken Kamata; Mamoru Takenaka; Tomoe Yoshikawa; Rei Ishikawa; Ayana Okamoto; Tomohiro Yamazaki; Atsushi Nakai; Shunsuke Omoto; Kosuke Minaga; Kentaro Yamao; Toshiharu Sakurai; Tomohiro Watanabe; Naoshi Nishida; Yasutaka Chiba; Masayuki Kitano; Masatoshi Kudo

  Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver 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.
• Lenvatinib as an Initial Treatment in Patients with Intermediate-Stage Hepatocellular Carcinoma Beyond Up-To-Seven Criteria and Child-Pugh A Liver Function: A Proof-Of-Concept Study.

  Masatoshi Kudo; Kazuomi Ueshima; Stephan Chan; Tomohiro Minami; Hirokazu Chishina; Tomoko Aoki; Masahiro Takita; Satoru Hagiwara; Yasunori Minami; Hiroshi Ida; Mamoru Takenaka; Toshiharu Sakurai; Tomohiro Watanabe; Masahiro Morita; Chikara Ogawa; Yoshiyuki Wada; Masafumi Ikeda; Hiroshi Ishii; Namiki Izumi; Naoshi Nishida

  Cancers 11 8 2019年07月 [査読有り]
   

  Although transcatheter arterial chemoembolization (TACE) is the standard of care for intermediate-stage hepatocellular carcinoma (HCC), this is a largely heterogeneous disease that includes a subgroup of patients who do not benefit from TACE. The treatment strategy for this subgroup of patients currently remains an unmet need in clinical practice. Here, we performed a proof-of-concept study that lenvatinib may be a more favorable treatment option over TACE as an initial treatment in intermediate-stage HCC patients with large or multinodular tumours exceeding the up-to-seven criteria. This proof-of-concept study included 642 consecutive patients with HCC initially treated with lenvatinib or conventional TACE (cTACE) between January 2006 and December 2018. Of these patients, 176 who received lenvatinib or cTACE as an initial treatment and met the eligibility criteria (unresectable, beyond the up-to-seven criteria, no prior TACE/systemic therapy, no vascular invasion, no extrahepatic spread and Child-Pugh A liver function) were selected for the study. Propensity score matching was used to adjust for patient demographics. After propensity-score matching, the outcome of 30 patients prospectively treated with lenvatinib (14 in clinical trials, one in an early access program and 15 in real world settings) and 60 patients treated with cTACE as the initial treatment was compared. The change of albumin-bilirubin (ALBI) score from baseline to the end of treatment were -2.61 to -2.61 for 30 patients in the lenvatinib group (p = 0.254) and -2.66 to -2.09 in the cTACE group (p < 0.01), respectively. The lenvatinib group showed a significantly higher objective response rate (73.3% vs. 33.3%; p < 0.001) and significantly longer median progression-free survival than the cTACE group (16.0 vs. 3.0 months; p < 0.001). Overall survival was significantly longer in the lenvatinib group than in the cTACE group (37.9 vs. 21.3 months; hazard ratio: 0.48, p < 0.01). In patients with large or multinodular intermediate-stage HCC exceeding the up-to-seven criteria with Child-Pugh A liver function, who usually do not benefit from TACE, lenvatinib provides a more favorable outcome than TACE.
• Usefulness of Ustekinumab for Treating a Case of Myelodysplastic Syndrome-associated Inflammatory Bowel Disease.

  Masashi Kono; Toshiharu Sakurai; Kazuki Okamoto; Tomoyuki Nagai; Yoriaki Komeda; Hiroshi Kashida; Kosuke Minaga; Ken Kamata; Mamoru Takenaka; Satoru Hagiwara; Tomohiro Watanabe; Naoshi Nishida; Eisuke Enoki; Hiroaki Inoue; Itaru Matsumura; Masatoshi Kudo

  Internal medicine (Tokyo, Japan) 58 14 2029 - 2033 2019年07月 

  Autoimmune diseases including inflammatory bowel disease (IBD) occur in association with myelodysplastic syndrome (MDS). MDS-associated IBD frequently demonstrates a complicated course. We herein report the first case with MDS-associated IBD that was successfully treated with ustekinumab (UST), an anti-interleukin (IL) 12/23p40 monoclonal antibody. A 63-year-old man with a 7-year history of MDS was referred for examination of diarrhea, abdominal pain and fever. A blood examination revealed a marked elevation of C-reactive protein. Colonoscopy showed multiple ulcers in the terminal ileum. He was resistant to anti-tumor necrosis factor (TNF)-α antibody and azacitidine. Subsequently, UST treatment reduced colonic IL-17 and IL-6 expression and the patient currently maintains a state of remission.
• Clinical Safety and Efficacy of Secondary Prophylactic Pegylated G-CSF in Advanced Pancreatic Cancer Patients Treated with mFOLFIRINOX: A Single-center Retrospective Study.

  Kentaro Yamao; Mamoru Takenaka; Tomoe Yoshikawa; Rei Ishikawa; Ayana Okamoto; Tomohiro Yamazaki; Atsushi Nakai; Shunsuke Omoto; Ken Kamata; Kosuke Minaga; Satoru Hagiwara; Toshiharu Sakurai; Naoshi Nishida; Yasutaka Chiba; Tomohiro Watanabe; Masatoshi Kudo

  Internal medicine (Tokyo, Japan) 58 14 1993 - 2002 2019年07月 

  Objective Although modified FOLFIRINOX (mFOLFIRINOX, mFFX) is widely used for patients with advanced pancreatic ductal adenocarcinoma (PDAC), maintenance of the standard dose intensity is often difficult due to the high incidence of neutropenic events. Pegylated granulocyte colony-stimulating factor (G-CSF) (Peg G) is a long-lasting G-CSF agent that is applicable for prophylaxis against neutropenic complications. The aim of this study was to assess the clinical safety and efficacy of mFFX combined with secondary prophylaxis using Peg G in advanced PDAC patients. Methods Advanced PDAC patients who had received more than two cycles of mFFX were analyzed. The clinical safety and efficacy were compared between patients in the Peg G group and those in the non-Peg G group in a retrospective manner. Results Among 45 patients treated with mFFX, 28 exhibited grade 3-4 neutropenia or febrile neutropenia. Among these 28 patients, 4 who received only 1 or 2 mFFX cycles were excluded from this study. Finally, 11 patients in the Peg G group and 13 in the non-Peg G group were enrolled. The combination therapy with Peg G and mFFX markedly prolonged the progression-free survival compared with the non-Peg G group, and its effects were associated with a reduced incidence of neutropenic events as well as lower rates of dosage reduction, delayed chemotherapy due to neutropenic events and altered blood cell counts after chemotherapy. Conclusion The scheduled administration of secondary prophylactic Peg G prolonged the progression-free survival in patients treated with mFFX. The combination therapy of Peg G and mFFX may be recommended in patients who exhibit grade 3-4 neutropenic events after prior mFFX cycles.
• Impact of Baseline ALBI Grade on the Outcomes of Hepatocellular Carcinoma Patients Treated with Lenvatinib: A Multicenter Study.

  Kazuomi Ueshima; Naoshi Nishida; Satoru Hagiwara; Tomoko Aoki; Tomohiro Minami; Hirokazu Chishina; Masahiro Takita; Yasunori Minami; Hiroshi Ida; Mamoru Takenaka; Toshiharu Sakurai; Tomohiro Watanabe; Masahiro Morita; Chikara Ogawa; Atsushi Hiraoka; Philip Johnson; Masatoshi Kudo

  Cancers 11 7 2019年07月 

  BACKGROUND: This study investigated the impact of baseline liver function according to the Child-Pugh score and ALBI (albumin-bilirubin) grade on the outcomes of patients with unresectable hepatocellular carcinoma treated with lenvatinib. METHODS: A total of 82 lenvatinib treated patients were included. The correlations of baseline liver function according to the Child-Pugh score and ALBI grade with treatment outcomes, including objective response rate per mRECIST (modified Response Evaluation Criteria in the Solid Tumor), time to treatment failure, treatment duration, and likelihood of treatment discontinuation due to adverse events, were assessed in patients with hepatocellular carcinoma treated with lenvatinib. Patients were divided into four groups: (1) Child-Pugh score 5 and ALBI grade 1 (group 1), (2) Child-Pugh score 5 and ALBI grade 2 (group 2), (3) Child-Pugh score 6 (group 3), and (4) Child-Pugh score ≥7 (group 4). Univariate and multivariate analyses were performed to identify the factors contributing to the objective response rate and likelihood of discontinuation due to adverse events. Results: Among the 82 patients analyzed, group 1 had the highest objective response rate (57.1%) and the lowest likelihood of treatment discontinuation because of adverse events (11.1%) among the four groups (p < 0.05 and p < 0.05). Multivariate analysis identified ALBI grade 1 and baseline AFP level <200 ng/mL as the significant predictors of a high objective response rate (p < 0.05 and p < 0.01), and confirmed that patients with ALBI grade 1 had the lowest probability of treatment discontinuation due to adverse events (p < 0.01). Conclusions: Patients with Child-Pugh score of 5 and ALBI grade 1 predicted a higher response rate and lower treatment discontinuation due to adverse events by lenvatinib treatment.
• 重症度判定基準の改訂中間報告

  廣田 衛久; 竹山 宜典; 池浦 司; 糸井 隆夫; 伊藤 鉄英; 岩崎 栄典; 堀部 昌靖; 岸和田 昌之; 北村 勝哉; 阪上 順一; 白井 邦博; 鈴木 裕; 竹中 完; 辻 喜久; 正宗 淳; 真弓 俊彦

  膵臓 34 3 A108 - A108 日本膵臓学会 2019年06月 [査読有り]
  
• 急性膵炎局所合併症の定義の再検討

  辻 喜久; 池浦 司; 糸井 隆夫; 岩崎 栄典; 岸和田 昌之; 北村 勝哉; 阪上 順一; 白井 邦博; 鈴木 裕; 竹中 完; 廣田 衛久; 正宗 淳; 真弓 俊彦; 堀部 昌靖; 能登原 憲司; 入江 裕之; 蒲田 敏文; 竹山 宜典

  膵臓 34 3 A109 - A110 日本膵臓学会 2019年06月 [査読有り]
  
• CLINICAL UTILITY OF ENDOSCOPIC ULTRASOUND-GUIDED DRAINAGE USING CONTRAST-ENHANCED HARMONIC IMAGING IN CASES WITH DIFFICULTIES

  Minaga Kosuke; Takenaka Mamoru; Yoshikawa Tomoe; Okamoto Ayana; Ishikawa Rei; Yamazaki Tomohiro; Nakai Atsushi; Omoto Shunsuke; Kamata Ken; Yamao Kentaro; Kudo Masatoshi

  GASTROINTESTINAL ENDOSCOPY 89 6 AB299  2019年06月 [査読有り]
  
• ENDOSCOPIC UTRASOUND-GUDED CHOLEDOCHODUODENOSTOMY USING A THIN STENT DELIVERY SYSTEM IN PATIENTS WITH UNRESECTABLE MALIGNANT DISTAL BILIARY OBSTRUCTION: A PROSPECTIVE MYLTICENTER STUDY

  Itonaga Masahiro; Kitano Masayuki; Hatamaru Keiichi; Tamura Takashi; Nuta Junya; Kawaji Yuki; Takenaka Mamoru; Minaga Kosuke; Kudo Masatoshi; Ogura Takeshi; Higuchi Kazuhide; Chiba Yasutaka

  GASTROINTESTINAL ENDOSCOPY 89 6 AB315  2019年06月 [査読有り]
  
• LONG-TERM OUTCOMES OF EUS-GUIDED TRANSLUMINAL STENT DEPLOYEMNT FOR BENIGN BILIARY DISEASE: MULTICENTER CLINICAL EXPERIENCE

  Ogura Takeshi; Takenaka Mamoru; Shiomi Hideyuki; Goto Daisuke; Hisa Takeshi; Tamura Takashi; Kato Hironari; Nishioka Nobu; Minaga Kosuke; Kudo Masatoshi; Higuchi Kazuhide; Kitano Masayuki

  GASTROINTESTINAL ENDOSCOPY 89 6 AB297  2019年06月 [査読有り]
  
• VALUE OF THE BISPECTRAL INDEX MONITOR DURING ENDOSCOPIC ULTRASONOGRAPHY UNDER SEDATION WITH PROPOFOL AND MIDAZOLAM

  Okamoto Ayana; Kamata Ken; Takenaka Mamoru; Yoshikawa Tomoe; Ishikawa Rei; Yamazaki Tomohiro; Nakai Atsushi; Omoto Shunsuke; Minaga Kosuke; Yamao Kentaro; Kudo Masatoshi

  GASTROINTESTINAL ENDOSCOPY 89 6 AB602 - AB603 2019年06月 [査読有り]
  
• LINEAR EUS TRAINING BY USING SYSTEMATIC SCREENING PROTCOL FOR THE PANCREATOBILIARY SYSTEM

  Omoto Shunsuke; Takenaka Mamoru; Ishikawa Rei; Okamoto Ayana; Nakai Atsushi; Yamazaki Tomohiro; Minaga Kosuke; Kamata Ken; Yamao Kentaro; Kudo Masatoshi

  GASTROINTESTINAL ENDOSCOPY 89 6 AB584  2019年06月 [査読有り]
  
• THE USEFULNESS OF NOVEL CANNULATION METHOD USING A UNIQUE, DOUBLE LUMENS CATHETER (UNEVEN METHOD) FOR THE PATIENTS WITH SURGICALLY ALTERED GASTROINTESTINAL ANATOMY

  Takenaka Mamoru; Yoshikawa Tomoe; Ishikawa Rei; Okamoto Ayana; Yamazaki Tomohiro; Nakai Atsushi; Omoto Shunsuke; Minaga Kosuke; Kamata Ken; Yamao Kentaro; Kudo Masatoshi

  GASTROINTESTINAL ENDOSCOPY 89 6 AB223  2019年06月 [査読有り]
  
• EXAMINATION OF ACTUAL RADIATION EXPOSURE DOSE OF THE PATIENTS WHO PERFORMED EUS-GUIDED DRAINAGE (EUS-BD/EUS-PD/EUS-CD)

  Takenaka Mamoru; Hayashi Shiro; Nishida Tsutomu; Hosono Makoto; Yoshikawa Tomoe; Ishikawa Rei; Okamoto Ayana; Yamazaki Tomohiro; Nakai Atsushi; Omoto Shunsuke; Minaga Kosuke; Kamata Ken; Yamao Kentaro; Kudo Masatoshi

  GASTROINTESTINAL ENDOSCOPY 89 6 AB444 - AB445 2019年06月 [査読有り]
  
• The IFN-α-IL-33 Axis as Possible Biomarkers in IgG4-Related Disease

  Kosuke Minaga; Tomohiro Watanabe; Ken Kamata; Mamoru Takenaka; Satoru Yasukawa; Masatoshi Kudo

  American Journal of Gastroenterology 114 6 1002 - 1003 2019年06月
• Intracystic papillary neoplasm preoperatively diagnosed by high-quality cytology derived from endoscopic nasogallbladder drainage.

  Akane Hara; Ken Kamata; Mamoru Takenaka; Takaaki Chikugo; Masatoshi Kudo

  Gastrointestinal endoscopy 89 6 1257 - 1259 2019年06月
• Efficacy and Safety of Chemotherapy Following Anti-PD-1 Antibody Therapy for Gastric Cancer: A Case of Sclerosing Cholangitis

  Masashi Kono; Toshiharu Sakurai; Kazuki Okamoto; Shou Masaki; Tomoyuki Nagai; Yoriaki Komeda; Ken Kamata; Kosuke Minaga; Kentarou Yamao; Mamoru Takenaka; Tomohiro Watanabe; Naoshi Nishida; Masatoshi Kudo

  Internal Medicine 58 9 1263 - 1266 2019年05月 [査読有り]
  
• Evaluation of efficacy of pancreatic juice cytology for risk classification according to international consensus guidelines in patients with intraductal papillary mucinous neoplasm; a retrospective study

  Kohei Yamakawa; Atsuhiro Masuda; Takashi Nakagawa; Hideyuki Shiomi; Hirochika Toyama; Mamoru Takenaka; Arata Sakai; Takashi Kobayashi; Masahiro Tsujimae; Shigeto Ashina; Yasutaka Yamada; Takeshi Tanaka; Shunta Tanaka; Ryota Nakano; Yu Sato; Takuya Ikegawa; Manabu Kurosawa; Seiji Fujigaki; Hiromu Kutsumi; Tomoo Itoh; Takumi Fukumoto; Yuzo Kodama

  Pancreatology 19 3 424 - 428 2019年04月 

  © 2019 IAP and EPC Objectives: Pancreatic juice cytology (PJC) for intraductal papillary mucinous neoplasm (IPMN) is a possible tool to enhance preoperative diagnostic ability by improving risk classification for malignant IPMN, but its efficacy is controversial. This study evaluated the efficacy of PJC for risk classification according to international guidelines. Methods: We retrospectively analyzed 127 IPMN patients who underwent endoscopic retrograde cholangiopancreatography (ERCP) preoperatively. PJC was performed in 125 of the 127 cases. High-risk stigmata (HRS, n = 57), worrisome features (WF, n = 64), and other characteristics (n = 6) were classified according to the 2017 international guidelines. Results: Among the 127 IPMN patients, 71 (55.9%) had malignant IPMN (invasive and non-invasive intraductal papillary mucinous carcinoma). The accuracy of WF for classifying malignant IPMN was increased by the addition of PJC, but the accuracy of HRS was not (WF to WF + PJC: 33.1% [42/127] to 48.8% [61/125], HRS to HRS + PJC: 65.4% [83/127] to 52.8% [66/125]). Post-ERCP pancreatitis (PEP) occurred in 32 (25.2%) of 127 IPMN patients. Severe PEP was not detected. Significant risk factors for PEP were female sex, obesity, and endoscopic naso-pancreatic drainage (ENPD) (P =.03, P =.0006, and P =.02, respectively). In patients with ENPD tube placement, a main pancreatic duct size of <5 mm was a significant risk factor for PEP (P =.02). Conclusion: PJC could increase the accuracy of WF for classifying malignant IPMN. The additive effect of PJC for risk classification may be limited, however, and it is not recommended for all IPMN cases due to the high frequency of PEP.
• Risk factors for local recurrence and appropriate surveillance interval after endoscopic resection

  Yoriaki Komeda; Tomohiro Watanabe; Toshiharu Sakurai; Masashi Kono; Kazuki Okamoto; Tomoyuki Nagai; Mamoru Takenaka; Satoru Hagiwara; Shigenaga Matsui; Naoshi Nishida; Naoko Tsuji; Hiroshi Kashida; Masatoshi Kudo

  World Journal of Gastroenterology 25 12 1502 - 1512 2019年03月 

  © The Author(s) 2019. BACKGROUND Risk factors for local recurrence after polypectomy, endoscopic mucosal resection (EMR), and endoscopic submucosal dissection (ESD) have not been identified. Additionally, the appropriate interval for endoscopic surveillance of colorectal tumors at high-risk of local recurrence has not been established. AIM To clarify the clinicopathological characteristics of recurrent lesions after endoscopic colorectal tumor resection and determine the appropriate interval. METHODS Three hundred and sixty patients (1412 colorectal tumors) who underwent polypectomy, EMR, or ESD and received endoscopic surveillance subsequently for more than one year to detect local recurrence were enrolled in this study. The clinicopathological factors associated with local recurrence were determined via univariate and multivariate analyses. RESULTS Local recurrence was observed in 31 of 360 (8.6%) patients [31 of 1412 (2.2%) lesions] after colorectal tumor resection. Piecemeal resection, tumor size of more than 2 cm, and the presence of villous components were associated with colorectal tumor recurrence after endoscopic resection. Of these three factors, the piecemeal resection procedure was identified as an independent risk factor for recurrence. Colorectal tumors resected into more than five pieces were associated with a high risk of recurrence since the average period from resection to recurrence in these cases was approximately 3 mo. The period to recurrence in cases resected into more than 5 pieces was much shorter than that in those resected into less than 4 pieces (3.8 ± 1.9 mo vs 7.9 ± 5.0 mo, P < 0.05). CONCLUSION Local recurrence of endoscopically treated colorectal tumors depends upon the outcome of first endoscopic procedure. Piecemeal resection was the only significant risk factor associated with local recurrence after endoscopic resection.
• Rendezvous within biloma technique combining percutaneous and endoscopic approaches: a novel biliary recanalization method

  Ayana Okamoto; Kosuke Minaga; Mamoru Takenaka; Tomoe Yoshikawa; Toshimitsu Iwasaki; Masakatsu Tsurusaki; Masatoshi Kudo

  Endoscopy 51 03 E42 - E44 2019年03月 [査読有り]
  
• Clinical efficacy and safety of endoscopic ultrasound‐guided gallbladder drainage replacement of percutaneous drainage: A multicenter retrospective study

  Kosuke Minaga; Yukitaka Yamashita; Takeshi Ogura; Mamoru Takenaka; Yuzo Shimokawa; Takeshi Hisa; Masahiro Itonaga; Hironari Kato; Hidefumi Nishikiori; Atsushi Okuda; Hisakazu Matsumoto; Yoshito Uenoyama; Tomohiro Watanabe; Yasutaka Chiba; Kazuhide Higuchi; Masatoshi Kudo; Masayuki Kitano

  Digestive Endoscopy 31 2 180 - 187 2019年03月 [査読有り]
  
• Novel metallic stent designed for endoscopic bilateral stent-in-stent placement in patients with hilar malignant biliary obstruction.

  Takenaka M; Yamao K; Minaga K; Nakai A; Omoto S; Kamata K; Kudo M

  Endoscopy 51 2 E30 - E31 2019年02月 [査読有り]
  
• The underutilization of EUS-guided biliary drainage: Perception of endoscopists in the East and West.

  Yoon WJ; Park DH; Choi JH; Jang S; Samarasena J; Lee TH; Paik WH; Oh D; Song TJ; Choi JH; Hara K; Iwashita T; Perez-Miranda M; Lee JG; Vazquez-Sequeiros E; Naitoh I; Vila JJ; Brugge WR; Takenaka M; Lee SS; Seo DW; Lee SK; Kim MH

  Endoscopic ultrasound 2019年02月 [査読有り]
  
• 「慢性膵炎臨床診断基準2019」の背景と概要

  正宗 淳; 大原 弘隆; 片岡 慶正; 神澤 輝実; 岸和田 昌之; 北野 雅之; 阪上 順一; 佐田 尚宏; 清水 京子; 竹中 完; 竹山 宜典; 入澤 篤志; 能登原 憲司; 廣岡 芳樹; 松本 逸平; 宮川 宏之; 岡崎 和一; 日本膵臓学会膵炎調査研究委員会慢性膵炎分科会; 菊田 和宏; 池浦 司; 伊佐地 秀司; 石黒 洋; 糸井 隆夫; 伊藤 鉄英; 乾 和郎

  膵臓 34 6 282 - 292 日本膵臓学会 2019年 

  現行の「慢性膵炎臨床診断基準2009」が提唱されてから10年間が経過した．世界ではじめて早期慢性膵炎の概念を取り入れた診断基準であるが，その後蓄積された知見や膵炎診療の変化をふまえて，その改訂が必要となっていた．今回，日本膵臓学会膵炎調査研究委員会慢性膵炎分科会が中心となり，診断基準の改訂を行った．新基準「慢性膵炎臨床診断基準2019」の最大の特徴は，mechanistic definitionを慢性膵炎の概念として取り入れ，早期慢性膵炎の診断項目を危険因子の観点から改訂したことである．新たに膵炎関連遺伝子異常と急性膵炎の既往を診断項目に組み入れ，診断特異度の向上を意図した．さらに，多量飲酒歴の基準を純エタノール換算80g/日から60g/日に変更するとともに，画像診断としてMRCP所見の格上げ，早期慢性膵炎の画像所見の整理を行った．新しい診断基準が慢性膵炎診療のさらなる質の向上や患者の予後改善に寄与することが期待される．

• 膵管内乳頭粘液性腫瘍術後フォローアップにおけるEUSの有用性

  鎌田 研; 千葉 康敬; 渡邉 智裕; 櫻井 俊治; 西田 直生志; 筑後 考章; 松本 逸平; 竹山 宜典; 北野 雅之; 工藤 正俊; 竹中 完; 三長 孝輔; 大本 俊介; 宮田 剛; 山雄 健太郎; 今井 元; 中井 敦史; 田中 秀和

  日本消化器内視鏡学会雑誌 61 4 417 - 426 一般社団法人 日本消化器内視鏡学会 2019年 [査読有り]
   

  【背景と目的】本研究では，造影ハーモニック超音波内視鏡（contrast-enhanced harmonic EUS：CH-EUS）を併用した超音波内視鏡（endoscopic ultrasonography：EUS）による精査が膵管内乳頭粘液性腫瘍（intraductal papillary mucinous neoplasm：IPMN）に対する外科的切除後の残膵フォローアップに有用であるかを検討した．

  【方法】本研究は，単一施設で行われたレトロスペクティブな研究である．2009年４月から2015年３月までにIPMNに対して外科的切除が施行された計134人の患者を対象とした．フォローアップ中における再発率とIPMN併存膵癌の発生率を検討した．また，それらの患者の臨床所見についても検討した．

  【結果】134例のIPMNのうち56例（41.8％）が良性，78例（58.2％）が悪性であった．経過観察期間中央値は29カ月であった．33例（24.6％）に対して，造影剤増強コンピュータ断層撮影法（contrast-enhanced computed tomography：CE-CT）にEUSを併用しフォローアップを行った．一方，101例（75.4％）はCE-CTのみによりフォローアップを行った．再発は13例（9.7％）に認め，うち５例が膵内再発，８例が膵外転移であった．１例において，拡張した主膵管内における造影効果のある壁在結節がEUSのみで描出された．２例において，フォローアップ中にIPMN併存膵癌が発生した．それらは小病変であり，CH-EUSでは検出されたが，CE-CTでは検出されなかった．うち１例においては，EUSでは腫瘍が不明瞭であり，CH-EUSが腫瘍の描出に有用であった．

  【結語】IPMN切除後フォローアップにEUSを加えることが有用であることが示唆された．

• Verrucous antral gastritis in relation to Helicobacter pylori infection, nutrition, and gastric atrophy

  Tsuji N; Umehara Y; Takenaka M; Minami Y; Watanabe T; Nishida N; Kudo M

  Gastroenterology Report 2019年 [査読有り]
  
• Novel concept using a plastic stent for endoscopic ultrasound-guided hepaticogastrostomy adjusting the length according to the patient's anatomy

  Mamoru Takenaka; Kosuke Minaga; Tomoe Yoshikawa; Ayana Okamoto; Atsushi Nakai; Shunsuke Omoto; Masatoshi Kudo

  Endoscopy 51 12 E362-E363  2019年01月
• A novel technique for stent dysfunction after endoscopic ultrasound-guided hepaticogastrostomy with antegrade stenting

  Ayana Okamoto; Kosuke Minaga; Mamoru Takenaka; Tomoe Yoshikawa; Ken Kamata; Kentaro Yamao; Masatoshi Kudo

  Endoscopy 51 9 E255-E256  2019年01月
• Novel sphincterotomy device that orientates blade along the axis of the bile duct in patients with Roux-en-Y anastomosis

  Mamoru Takenaka; Tomoe Yoshikawa; Ayana Okamoto; Atsushi Nakai; Kosuke Minaga; Kentaro Yamao; Masatoshi Kudo

  Endoscopy 51 6 E132-E134  2019年01月
• Current status of radiation exposure to crystalline lens in ERCP (endoscopic retrograde cholangiopancreatography)

  Mamoru Takenaka; Makoto Hosono; Atsushi Nakai; Shunsuke Omoto; Kosuke Minaga; Ken Kamata; Kentaro Yamao; Shiro Hayashi; Tsutomu Nishida; Masatoshi Kudo

  Journal of Japanese Society of Gastroenterology 116 12 1053 - 1055 2019年 [査読有り]
  
• Gankyrin Contributes to Tumorigenesis and Chemoresistance in Sporadic Colorectal Cancer

  Toshiharu Sakurai; Yoriaki Komeda; Tomoyuki Nagai; Ken Kamata; Kosuke Minaga; Kentarou Yamao; Mamoru Takenaka; Satoru Hagiwara; Tomohiro Watanabe; Naoshi Nishida; Hiroshi Kashida; Kazuhiko Nakagawa; Masatoshi Kudo

  Digestion 1 - 9 2018年12月 [査読有り]
  
• 【EUSによる消化管疾患の診断-現状と最新の話題】造影ハーモニックEUSによる消化管粘膜下腫瘍の診断

  鎌田 研; 竹中 完; 石川 嶺; 吉川 智恵; 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; 櫻井 俊治; 松井 繁長; 渡邉 智裕; 西田 直生志; 樫田 博史; 工藤 正俊

  胃と腸 53 13 1795 - 1799 (株)医学書院 2018年12月 [招待有り]
   

  ＜文献概要＞EUSは上部消化管粘膜下腫瘍(SMT)の診断に用いられているが,上部消化管SMTの良悪性鑑別には限界がある.本稿では,造影ハーモニックEUSによる上部消化管粘膜下腫瘍の診断に関する前向き研究1報と後ろ向き研究6報の合計7報の研究をもとに上部消化管SMTの鑑別診断について調べた.造影ハーモニックEUSによるGISTとそれ以外の上部消化管SMTの鑑別診断に関する3つの報告では,hyper-enhancementがGISTの造影ハーモニックEUS所見であり,診断能は感度84.5〜100%,特異度73.3〜100%であった.一方,low-grade malignancy GISTとhigh-grade malignancy GISTの鑑別診断に関する4つの報告では,造影ハーモニックEUSによるhigh-grade malignancy GISTの診断能は感度53.8〜100%,特異度63〜100%であった.またhigh-grade malignancy GISTでは造影ハーモニックEUSにおいてirregular vesselsが高率に認められた.hyper-enhancementか否かおよびirregular vesselsの有無を確認することで上部消化管SMTの鑑別診断が可能であることが示唆された.
• Radiation exposure during image-guided endoscopic procedures: The next quality indicator for endoscopic retrograde cholangiopancreatography

  Shiro Hayashi; Shiro Hayashi; Tsutomu Nishida; Mamoru Takenaka; Makoto Hosono

  World Journal of Clinical Cases 6 16 1087 - 1093 2018年12月 [査読有り]
   

  © The Author(s) 2018. Endoscopic retrograde cholangiopancreatography (ERCP) is one of the most frequently used image-guided procedures in gastrointestinal endoscopy. Post-ERCP pancreatitis is an important concern, and prophylaxis, cannulation and other related technical procedures have been well documented by endoscopists. In addition, medical radiation exposure is of great concern in the general population because of its rapidly increasing frequency and its potential carcinogenic effects. International organizations and radiological societies have established diagnostic reference levels, which guide proper radiation use and serve as global standards for all procedures that use ionizing radiation. However, data on gastrointestinal fluoroscopic procedures are still lacking because the demand for these procedures has recently increased. In this review, we present the current status of quality indicators for ERCP and the methods for measuring radiation exposure in the clinical setting as the next quality indicator for ERCP. To reduce radiation exposure, knowledge of its adverse effects and the procedures for proper measurement and protection are essential. Additionally, further studies on the factors that affect radiation exposure, exposure management and diagnostic reference levels are necessary. Then, we can discuss how to manage medical radiation use in these complex fluoroscopic procedures. This knowledge will help us to protect not only patients but also endoscopists and medical staff in the fluoroscopy unit.
• Hemorrhage from metastasis of a 5-mm renal cell carcinoma lesion to the gallbladder detected by contrast-enhanced endoscopic ultrasonography.

  Takenaka M; Okabe Y; Kudo M

  Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver 51 5 743 - 743 Elsevier {BV} 2018年11月 [査読有り]
  
• Acute Pancreatitis with Disturbed Consciousness Caused by Hyperparathyroidism

  Yasuo Otsuka; Ken Kamata; Kosuke Minaga; Mamoru Takenaka; Tomohiro Watanabe; Masatoshi Kudo

  Internal Medicine 57 21 3075 - 3078 2018年11月 

  © 2018 The Japanese Society of Internal Medicine. Although hyperparathyroidism has been reported to cause acute pancreatitis, little is known about the mechanism involved. This study describes the case of an 86-year-old woman with acute pancreatitis and consciousness disturbance caused by hyperparathyroidism and hypercalcemia, respectively. The consciousness disturbance caused by severe hypercalcemia probably masked the typical symptoms associated with pancreatitis because she did not report abdominal pain during the clinical course.
• Novel method of biliary cannulation for patients with Roux-en-Y anastomosis using a unique, uneven, double-lumen cannula (Uneven method).

  Takenaka M; Yamao K; Kudo M

  Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society 30 6 808 - 809 Wiley 2018年11月 [査読有り]
  
• Endoscopic ultrasound-guided choledochoduodenostomy using a thin stent delivery system in patients with unresectable malignant distal biliary obstruction: a prospective multicenter study.

  Itonaga M; Kitano M; Hatamaru K; Tamura T; Nuta J; Kawaji Y; Takenaka M; Minaga K; Kudo M; Ogura T; Higuchi K; Chiba Y

  Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society 31 3 291 - 298 Wiley 2018年11月 [査読有り]
   

  BACKGROUND AND AIM: When endoscopic retrograde cholangiopancreatography (ERCP) fails in patients with malignant distal biliary obstruction, endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) is an alternative. It has high technical and clinical success rates, but also has high adverse event rates. This prospective cohort study was aimed to evaluate the clinical efficacy and safety of EUS-CDS with our newly developed partially covered self-expandable metal stent with a thin delivery system. METHODS: Patients consisted of all consecutive patients in three tertiary referral centers with unresectable malignant distal obstruction in whom ERCP failed and in whom EUS-CDS with the thin delivery system was selected as the second-line approach. Rates of clinical success, technical success, technical success in cases not requiring fistulous tract dilation, adverse events, and stent dysfunction were determined. RESULTS: In the 20 patients, technical and clinical success rates were 95.0% (19/20) and 100% (19/19), respectively. In 31.6% (6/19), the delivery system was successfully inserted into the bile duct without requiring a fistulous-tract dilatation device. These patients had significantly shorter procedure times than patients requiring fistulous-tract dilatation (12.7 ± 3.1 vs 23.2 ± 2.1 min; P < 0.01). One patient (5.0%) who required fistulous dilation had an adverse event, which was managed conservatively. There were no procedure-related deaths. During follow up, four patients (21.1%) developed stent dysfunction. Reintervention was successful in all cases. CONCLUSIONS: The EUS-CDS approach had 95% technical and 100% clinical success rates, with adverse events reported in 5% of cases. EUS-CDS may become safer if efforts are made to avoid the dilation step (UMIN 000023938).
• Innovative therapeutic endoscopy良性胆管・膵管狭窄に対する内視鏡治療 良性胆道狭窄(慢性膵炎)に対するfully covered metallic stentの有用性

  竹中 完; 山雄 健太郎; 工藤 正俊

  Gastroenterological Endoscopy 60 Suppl.2 2010 - 2010 (一社)日本消化器内視鏡学会 2018年10月
• 良性胆管・膵管狭窄に対する内視鏡治療 良性胆道狭窄(慢性膵炎)に対するfully covered metallic stentの有用性

  竹中 完; 山雄 健太郎; 工藤 正俊

  日本消化器病学会雑誌 115 臨増大会 A630 - A630 (一財)日本消化器病学会 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

  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
• A case of EUS-guided pancreatic duct rendezvous stenting in which initial contrast medium injection was useful for the second puncture.

  Omoto S; Takenaka M; Kudo M

  Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society 31 1 e20 - e21 Wiley 2018年10月 [査読有り]
  
• Molecular Scoring of Hepatocellular Carcinoma for Predicting Metastatic Recurrence and Requirements of Systemic Chemotherapy

  Naoshi Nishida; Takafumi Nishimura; Toshimi Kaido; Kosuke Minaga; Kentaro Yamao; Ken Kamata; Mamoru Takenaka; Hiroshi Ida; Satoru Hagiwara; Yasunori Minami; Toshiharu Sakurai; Tomohiro Watanabe; Masatoshi Kudo

  Cancers 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.
• Value of additional endoscopic ultrasonography for surveillance after surgical removal of intraductal papillary mucinous neoplasms

  Ken Kamata; Mamoru Takenaka; Kosuke Minaga; Shunsuke Omoto; Takeshi Miyata; Kentaro Yamao; Hajime Imai; Atsushi Nakai; Hidekazu Tanaka; Yasutaka Chiba; Tomohiro Watanabe; Toshiharu Sakurai; Naoshi Nishida; Takaaki Chikugo; Ippei Matsumoto; Yoshifumi Takeyama; Masayuki Kitano; Masatoshi Kudo

  Digestive Endoscopy 30 5 659 - 666 2018年09月 

  © 2018 Japan Gastroenterological Endoscopy Society Background and Aim: This study evaluated the utility of endoscopic ultrasonography (EUS) combined with contrast-enhanced harmonic EUS (CH-EUS) for surveillance of the remnant pancreas after surgery for intraductal papillary mucinous neoplasm (IPMN). Methods: This was a single-center, retrospective, descriptive study. A total of 134 consecutive patients who underwent surgical resection for IPMN between April 2009 and March 2015 were evaluated. Rates of recurrence and development of IPMN-concomitant pancreatic ductal adenocarcinoma (PDAC) during follow up were assessed. Clinical findings of patients with recurrence or development of PDAC were also evaluated. Results: Of 134 resected IPMN 56 (41.8%) and 78 (58.2%) were classified as benign and malignant, respectively. Patients were followed up for a median of 29 months, 33 (24.6%) by both contrast-enhanced computed tomography (CE-CT) and EUS, and 101 (75.4%) by computed tomography (CT) alone. Thirteen patients (9.7%) showed tumor recurrence, five with intra-pancreatic recurrence and eight with extra-pancreatic metastases. An enhancing mural nodule within the dilated main pancreatic duct was successfully detected by EUS in one patient, but not by CE-CT. Two patients developed IPMN-concomitant PDAC during follow up. EUS combined with CH-EUS successfully detected small IPMN-concomitant PDAC in two patients, whereas these lesions were not detected by CT. CH-EUS was useful for better visualization of the margins of IPMN-concomitant PDAC in one of these two patients. Conclusion: Endoscopic ultrasonography combined with CH-EUS may improve follow up of patients with resected IPMN.
• Cannulation method for intradiverticular papilla with long oral protrusion using biopsy forceps for axis alignment.

  Takenaka M; Minaga K; Kudo M

  Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society 30 5 700 - 701 2018年09月 [査読有り]
  
• 瀉血治療が奏効した骨髄性プロトポルフィリン症関連肝障害(Erythropoietic Protoporphyria-related Hepatopathy Successfully Treated with Phlebotomy)

  Yoshida Akihiro; Hagiwara Satoru; Watanabe Tomohiro; Nishida Naosihi; Ida Hiroshi; Sakurai Toshiharu; Komeda Yoriaki; Yamao Kentaro; Takenaka Mamoru; Enoki Eisuke; Kimura Masatomo; Miyake Masako; Kawada Akira; Kudo Masatoshi

  Internal Medicine 57 17 2505 - 2509 2018年09月 [査読有り]
   

  症例は27歳男性で、小児期から光線性皮膚症に罹患しており、約1年前に全身性エリテマトーデスと診断されていた。この時点で肝胆道酵素値などが著明に上昇しており、最終的に骨髄性プロトポルフィリン症(EPP)関連肝障害と診断された。今回、全身疲労と血清中のAST、ALT、GGT、総ビリルビン値が再び上昇した。肝生検により、EPP関連肝障害の増悪であると診断した。血漿交換を計5回施行したが血中のAST、ALT、プロトポルフィリン値が低下しなかったため、200〜400mLの瀉血を毎週行ったところ、血清中の肝酵素値、AST、ALT、プロトポルフィリン値は著明に減少し、症状も軽減した。
• Neurilemmoma Mimicking a Multilocular Cystic Lesion of the Liver: A Case Report.

  Yoshida A; Yamao K; Takenaka M; Nakai A; Omoto S; Kamata K; Minaga K; Miyata T; Imai H; Matsumoto I; Takeyama Y; Chikugo T; Kudo M

  Internal medicine (Tokyo, Japan) 57 23 3377 - 3380 2018年08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.
• Endoscopic nasobiliary drainage tube-guided scope insertion technique for internal drainage in a case of difficult selective biliary duct guiding.

  Takenaka M; Minaga K; Kudo M

  Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society 31 1 e1  Wiley 2018年08月 [査読有り]
  
• Reintervention for stent occlusion after endoscopic ultrasound-guided hepaticogastrostomy with novel use of a precut needle-knife

  Kosuke Minaga; Mamoru Takenaka; Ayana Okamoto; Shunsuke Omoto; Takeshi Miyata; Hajime Imai; Masatoshi Kudo

  Endoscopy 50 7 E153 - E154 2018年07月
• Outcomes of endoscopic biliary drainage in pancreatic cancer patients with an indwelling gastroduodenal stent: a multicenter cohort study in West Japan

  Kentaro Yamao; Masayuki Kitano; Mamoru Takenaka; Kosuke Minaga; Toshiharu Sakurai; Tomohiro Watanabe; Takahisa Kayahara; Tomoe Yoshikawa; Yukitaka Yamashita; Masanori Asada; Yoshihiro Okabe; Keiji Hanada; Yasutaka Chiba; Masatoshi Kudo

  Gastrointestinal Endoscopy 88 1 66 - 75.e2 2018年07月 

  © 2018 American Society for Gastrointestinal Endoscopy Background and Aims: Gastroduodenal and biliary obstruction may occur synchronously or asynchronously in advanced pancreatic cancer, and endoscopic double stent placement may be required. EUS-guided biliary drainage (EUS-BD) often is performed after unsuccessful placement of an endoscopic transpapillary stent (ETS), and EUS-BD may be beneficial in double stent placement. This retrospective multicenter cohort study compared the outcomes of ETS placement and EUS-BD in patients with an indwelling gastroduodenal stent (GDS). Methods: We recorded the clinical outcomes of patients at 5 tertiary-care medical centers who required biliary drainage after GDS placement between March 2009 and March 2014. Results: Thirty-nine patients were included in this study. Patients’ mean age was 68.5 years; 23 (59.0%) were men. The GDS overlay the papilla in 23 patients (59.0%). The overall technical success rate was significantly higher with EUS-BD (95.2%) than with ETS placement (56.0%; P <.01). Furthermore, the technical success rate was significantly higher with EUS-BD (93.3%) than with ETS placement (22.2%; P <.01) when the GDS overlies the papilla. The overall clinical success rate of EUS-BD also was significantly higher than for ETS placement (90.5% vs 52.0%, respectively; P =.01), and there was no significant difference in the incidence of adverse events (ETS, 32.0% vs EUS-BD, 42.9%; P =.65). Conclusion: Endoscopic double stent placement with EUS-BD is technically and clinically superior to ETS placement in patients with an indwelling GDS. EUS-BD should be considered the first-line treatment option for patients with an indwelling GDS that overlies the papilla. ETS placement remains a reasonable alternative when the papilla is not covered by the GDS.
• SIMILAR EFFICACY AND SAFETY OF ENDOSCOPIC ULTRASOUND-GUIDED BILIARY DRAINAGE VIA HEPATICOGASTROSTOMY AND CHOLEDOCHODUODENOSTOMY APPROACHES FOR MALIGNANT DISTAL BILIARY OBSTRUCTION: A MULTICENTER, PROSPECTIVE, RANDOMIZED TRIAL

  Minaga Kosuke; Kitano Masayuki; Ogura Takeshi; Shiomi Hideyuki; Hoki Noriyuki; Nishikiori Hidefumi; Yamashita Yukitaka; Hisa Takeshi; Kato Hironari; Kamada Hideki; Takenaka Mamoru; Higuchi Kazuhide; Chiba Yasutaka; Kudo Masatoshi

  GASTROINTESTINAL ENDOSCOPY 87 6 AB147  2018年06月 [査読有り]
  
• A MULTICENTER PROSPECTIVE STUDY OF EUS-GUIDED HEPATICOGASTROSTOMY COMBINED WITH ANTEGRADE STENT PLACEMENT

  Ogura Takeshi; Kitano Masayuki; Takenaka Mamoru; Minaga Kosuke; Yamao Kentaro; Yamashita Yukitaka; Hatamaru Keiichi; Noguchi Chishio; Kuroda Taira; Nishikiori Hidefumi; Higuchi Kazuhide; Chiba Yasutaka

  GASTROINTESTINAL ENDOSCOPY 87 6 AB146  2018年06月 [査読有り]
  
• THE EFFICIENCY AND SAFETY OF ENDOSCPIC SPHINCTEROTOMY TO PREVENT POST-ERCP PANCREATITIS IN BILIARY NEOPLASM; A MULTICENTER RETROSPECTIVE COHORT STUDY

  Tamura Takashi; Itonaga Masahiro; Yamao Kentaro; Imanishi Miyuki; Minaga Kosuke; Hirono Seiko; Okada Ken-ichi; Higuchi Kazuhide; Takenaka Mamoru; Ogura Takeshi; Yamaue Hiroki; Kitano Masayuki

  GASTROINTESTINAL ENDOSCOPY 87 6 AB227 - AB228 2018年06月 [査読有り]
  
• NEW METHOD FOR DIFFICULT BILIARY CANNULATION USING THE NOVEL UNEVEN DOUBLE LUMEN CANNULA (DLC METHOD)

  Takenaka Mamoru; Nakai Atsushi; Omoto Shunsuke; Miyata Takeshi; Minaga Kosuke; Kamata Ken; Yamao Kentaro; Imai Hajime; Kudo Masatoshi

  GASTROINTESTINAL ENDOSCOPY 87 6 AB209 - AB210 2018年06月 [査読有り]
  
• Multifocal cysts and incidence of pancreatic cancer concomitant with intraductal papillary mucinous neoplasm

  Takuya Ikegawa; Atsuhiro Masuda; Arata Sakai; Hirochika Toyama; Yoh Zen; Keitaro Sofue; Takashi Nakagawa; Hideyuki Shiomi; Mamoru Takenaka; Takashi Kobayashi; Masaru Yoshida; Yoshifumi Arisaka; Yoshihiro Okabe; Hiromu Kutsumi; Takumi Fukumoto; Takeshi Azuma

  Pancreatology 18 4 399 - 406 2018年06月 

  © 2018 IAP and EPC Objectives: The present study was conducted in order to elucidate the relationship between the number of cyst-existing regions and incidence of pancreatic ductal adenocarcinoma (PDAC) concomitant with intraductal papillary mucinous neoplasm (IPMN), which currently remains unclear. Methods: Subjects comprised 141 patients undergoing resection for IPMN (Non-invasive IPMN (IPMN with low-to high-grade dysplasia): N = 94, invasive IPMN: N = 31, and PDAC concomitant with IPMN: N = 16) between November 2000 and February 2017. A logistic regression analysis was performed to assess the relationship between the number of cyst-existing regions (one region/two or more regions) and incidence of PDAC concomitant with IPMN, adjusted by clinical characteristics. Cyst-existing regions were defined by the number of anatomical parts of the pancreas: the head/body/tail of the pancreas. Results: Multiple cyst-existing regions (two or more regions) correlated with the incidence of PDAC concomitant with IPMN (PDAC concomitant with IPMN in one region vs. two or more regions: 3/66 vs. 13/75, multivariable odds ratio [OR] = 4.11, 95% confidence interval [CI] = 1.22 to 18.8, P = 0.02). In contrast, multiple cyst-existing regions did not correlate with the incidence of IPMN (invasive IPMN in one region vs. two or more regions: 13/66 vs. 18/75, OR = 1.19, 95% CI = 0.52 to 2.76, P = 0.67). Conclusions: Multifocal cysts correlated with the incidence of PDAC concomitant with IPMN, and may be a high-risk factor for PDAC concomitant with IPMN.
• A novel biliary cannulation method for difficult cannulation cases using a unique, uneven, double-lumen cannula (Uneven method).

  Takenaka M; Arisaka Y; Sakai A; Kobayashi T; Shiomi H; Masuda A; Kudo M

  Endoscopy 50 8 E229 - E230 2018年06月 [査読有り]
  
• Dysbiosis-Associated Polyposis of the Colon—Cap Polyposis

  Kazuki Okamoto; Tomohiro Watanabe; Yoriaki Komeda; Ayana Okamoto; Kosuke Minaga; Ken Kamata; Kentaro Yamao; Mamoru Takenaka; Satoru Hagiwara; Toshiharu Sakurai; Tomonori Tanaka; Hiroki Sakamoto; Kiyoshige Fujimoto; Naoshi Nishida; Masatoshi Kudo

  Frontiers in Immunology 9 2018年05月 

  © 2018 Okamoto, Watanabe, Komeda, Okamoto, Minaga, Kamata, Yamao, Takenaka, Hagiwara, Sakurai, Tanaka, Sakamoto, Fujimoto, Nishida and Kudo. Cap polyposis is a rare gastrointestinal disease characterized by multiple inflammatory polyps located between the distal colon and the rectum. Despite the lack of clarity regarding its pathogenesis, mucosal prolapse, chronic inflammatory responses, and Helicobacter pylori infection are considered key contributors to the development of this disease entity. Although it is now generally accepted that dysbiosis of gut microbiota is associated with intestinal and extra-intestinal diseases, alterations of intestinal microbiota have been poorly defined in cap polyposis. Here, we report a patient with H. pylori-negative cap polyposis who was successfully treated with antibiotics and exhibited dramatic alterations in intestinal microbiota composition after antibiotic treatment. The patient was treated with oral administration of ampicillin and metronidazole and showed regression of cap polyposis 6 months after antibiotic treatment. Fecal microbiota analysis using the next-generation sequencing technology revealed a significant alteration in the intestinal microbiota composition following antibiotic treatment-a marked reduction of Blautia, Dorea, and Sutterella was observed concomitant with a marked increase in Fusobacterium. These data suggest that cap polyposis may originate from dysbiosis and that microbiome-targeted therapy may be useful in this disorder.
• Endoscopic ultrasonography-guided transenteric pancreatic duct drainage without cautery for obstructive pancreatitis as a result of ampullary carcinoma

  Takeshi Miyata; Ken Kamata; Mamoru Takenaka

  Digestive Endoscopy 30 3 403 - 404 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

  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
• Endoscopic Ultrasound-Guided Rendezvous Technique for Failed Biliary Cannulation in Benign and Resectable Malignant Biliary Disorders.

  Hideyuki Shiomi; Kentaro Yamao; Noriyuki Hoki; Takeshi Hisa; Takeshi Ogura; Kosuke Minaga; Atsuhiro Masuda; Kazuya Matsumoto; Hironari Kato; Hideki Kamada; Daisuke Goto; Hajime Imai; Mamoru Takenaka; Chishio Noguchi; Hidefumi Nishikiori; Yasutaka Chiba; Hiromu Kutsumi; Masayuki Kitano

  Digestive diseases and sciences 63 3 787 - 796 2018年03月 

  BACKGROUND: Endoscopic ultrasound-guided rendezvous technique (EUS-RV) has emerged as an effective salvage method for unsuccessful biliary cannulation. However, its application for benign and resectable malignant biliary disorders has not been fully evaluated. AIMS: To assess the efficacy and safety of EUS-RV for benign and resectable malignant biliary disorders. METHODS: This was a multicenter prospective study from 12 Japanese referral centers. Patients who underwent EUS-RV after failed biliary cannulation for biliary disorder were candidates for this study. Inclusion criteria were unsuccessful biliary cannulation for therapeutic endoscopic retrograde cholangiopancreatography with benign and potentially resectable malignant biliary obstruction. Exclusion criteria included unresectable malignant biliary obstruction, inaccessible papillae due to surgically altered upper gastrointestinal anatomy or duodenal stricture, and previous sphincterotomy and/or biliary stent placement. The primary outcome was the technical success rate of biliary cannulation; procedure time, adverse events, and clinical outcomes were secondary outcomes. RESULTS: Twenty patients were prospectively enrolled. The overall technical success rate and median procedure time were 85% and 33 min, respectively. Guidewire manipulation using a 4-Fr tapered tip catheter contributed to the success in advancing the guidewire into the duodenum. Adverse events were identified in 15% patients, including 2 with biliary peritonitis and 1 mild pancreatitis. EUS-RV did not affect surgical maneuvers or complications associated with surgery, or postoperative course. CONCLUSIONS: EUS-RV may be a safe and feasible salvage method for unsuccessful biliary cannulation for benign or resectable malignant biliary disorders. Use of a 4-Fr tapered tip catheter may improve the overall EUS-RV success rate.
• Multicenter prospective evaluation study of endoscopic ultrasound-guided hepaticogastrostomy combined with antegrade stenting (with video)

  Takeshi Ogura; Masayuki Kitano; Mamoru Takenaka; Atsushi Okuda; Kosuke Minaga; Kentaro Yamao; Yukitaka Yamashita; Keiichi Hatamaru; Chishio Noguchi; Yasuhiko Gotoh; Taira Kuroda; Tomoyuki Yokota; Hidefumi Nishikiori; Ryota Sagami; Kazuhide Higuchi; Yasutaka Chiba

  Digestive Endoscopy 30 2 252 - 259 2018年03月 

  Background and Aim: Endoscopic ultrasonography-guided hepaticogastrostomy (EUS-HGS) is often indicated for advanced stage patients. Therefore it is important to prevent adverse events associated with EUS-HGS procedures and obtain long stent patency. EUS-guided antegrade stenting (AS) has been developed as an advanced technique. Thus, to prevent adverse events and achieve long stent patency, EUS-AS combined with EUS-HGS (EUS-HGAS) has been reported. The aim of the present study was to evaluate the technical feasibility and efficacy of EUS-HGAS in a multicenter, prospective study. Methods: This prospective study was carried out at each hospital of the Therapeutic Endoscopic Ultrasound Group. Primary endpoint of this multicenter prospective study was stent patency of EUS-HGAS. Results: A total of 49 patients were enrolled. Technical success rate of EUS-HGS was 95.9% (47/49). EUS-AS failed in five patients because the guidewire could not be advanced into the intestine across the bile duct obstruction site. Therefore, EUS-HGAS was successfully carried out in 40 patients (technical success rate: 85.7%). Median overall survival was 114 days. Median stent patency including stent dysfunction and patient death was 114 days. In contrast, mean stent patency was 320 days. Adverse events were seen in 10.2% (5/49) of cases. Hyperamylasemia was seen in four patients, and bleeding was seen in one patient. Conclusions: The present study is the first to evaluate EUS-HGAS. EUS-HGAS has clinical benefit for obtaining long stent patency and avoiding adverse events, although the possibility of acute pancreatitis as a result of obstruction of the orifice of the pancreatic duct must be considered.
• Transrectal endoscopic ultrasound-guided paracentesis for diagnosis of malignant ascites in the pelvis

  Kosuke Minaga; Mamoru Takenaka; Ken Kamata; Masatoshi Kudo

  Digestive and Liver Disease 50 3 311  2018年03月
• Alleviating pancreatic cancer-associated pain using endoscopic ultrasound-guided neurolysis

  Kosuke Minaga; Mamoru Takenaka; Ken Kamata; Tomoe Yoshikawa; Atsushi Nakai; Shunsuke Omoto; Takeshi Miyata; Kentaro Yamao; Hajime Imai; Hiroki Sakamoto; Masayuki Kitano; Masatoshi Kudo

  Cancers 10 2 2018年02月 

  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.
• 膵・胆管合流異常に合併した共通管内乳頭状腫瘍の1例

  幕谷 悠介; 松本 逸平; 大本 俊介; 筑後 孝章; 川口 晃平; 松本 正孝; 村瀬 貴昭; 亀井 敬子; 里井 俊平; 中居 卓也; 竹中 完; 工藤 正俊; 竹山 宜典

  日本消化器外科学会雑誌 51 2 114 - 121 (一社)日本消化器外科学会 2018年02月 [査読有り]
   

  膵・胆管合流異常に合併した共通管内乳頭状腫瘍の1例を報告する.症例は75歳の男性で,6ヵ月間に2度の急性膵炎を発症し保存的加療で軽快した.急性膵炎の原因精査および加療目的で当院へ紹介となった.ERCPでは膵・胆管合流異常を認め,共通管内に7mmの結節様陰影欠損像を認めた.上部内視鏡検査では乳頭部からの粘液排出は認めず,超音波内視鏡検査では共通管内に乳頭状の腫瘍が描出された.造影CTでは膵頭部に拡張した共通管と内部に増強効果を持つ8mmの腫瘤を認めた.尾側の主膵管の拡張は認めなかった.膵・胆管合流異常に合併した共通管内乳頭状腫瘍と診断し,亜全胃温存膵頭十二指腸切除術を施行した.病理肉眼所見では共通管内に発育する有茎性の乳頭状腫瘍で,組織像は管状構造増生を主体とする腺腫であった.免疫組織学的染色ではMUC1,MUC2陰性,MUC5AC陽性で胃型腺腫と最終診断した.(著者抄録)
• Cystic duct antegrade stenting for cholangitis after the long-term deployment of lumen-apposing metal stents for calculous cholecystitis

  Mamoru Takenaka; Ken Kamata; Kosuke Minaga; Atsushi Nakai; Shunsuke Omoto; Takeshi Miyata; Kentaro Yamao; Hajime Imai; Toshiharu Sakurai; Tomohiro Watanabe; Naoshi Nishida; Masatoshi Kudo

  Endoscopic Ultrasound 7 5 349 - 349 2018年
• Contrast-enhanced harmonic EUS imaging of pancreatic mucinous cystadenocarcinoma

  Hidekazu Tanaka; Ken Kamata; Mamoru Takenaka; Masatoshi Kudo

  Internal Medicine 57 20 3051 - 3052 2018年01月
• Papillary neoplasm in a common channel in patients with pancreaticobiliary maljunction

  Yusuke Makutani; Ippei Matsumoto; Shunsuke Omoto; Takaaki Chikugo; Kohei Kawaguchi; Masataka Matsumoto; Takaaki Murase; Keiko Kamei; Shumpei Satoi; Takuya Nakai; Mamoru Takenaka; Masatoshi Kudo; Yoshifumi Takeyama

  Japanese Journal of Gastroenterological Surgery 51 2 114 - 121 2018年 

  We report a rare case of papillary neoplasm in a common channel with pancreaticobiliary maljunction. A 75-year-old man had acute pancreatitis twice during 6 months. He recovered with conservative treatment. He was admitted to our hospital for further examination. ERCP revealed pancreaticobiliary maljunction with a 7-mm filling defect in a dilated common channel. Gastroduodenoscopy revealed no discharge of mucin. Endoscopic US revealed a 7.9×7.5- mm pedunculated papillary tumor in the common channel. Contrast-enhanced CT revealed an 8.0×6.0 mm tumor in the dilated common channel, 10 mm in diameter. The distal main pancreatic duct was not dilated. Subtotal stomachpreserving pancreaticoduodenectomy was performed with a preoperative diagnosis of papillary neoplasm in the common channel with pancreaticobiliary maljunction. The resected specimen was pathologically diagnosed as a pedunculated papillary adenoma with a fine fibrovascular core in the common channel. Immunohistochemical findings of the tumor were negative for MUC1 and MUC2, and positive for MUC5AC and MUC6. The final diagnosis of gastric-type adenoma was made.
• Multicenter study of early pancreatic cancer in Japan

  Atsushi Kanno; for the Japan Study Group on the Early Detection of Pancreatic Cancer (JEDPAC); Atsushi Masamune; Keiji Hanada; Hiroyuki Maguchi; Yasuhiro Shimizu; Toshiharu Ueki; Osamu Hasebe; Takao Ohtsuka; Masafumi Nakamura; Mamoru Takenaka; Masayuki Kitano; Masataka Kikuyama; Toshifumi Gabata; Koji Yoshida; Tamito Sasaki; Masahiro Serikawa; Toru Furukawa; Akio Yanagisawa; Tooru Shimosegawa

  Pancreatology 18 1 61 - 67 2018年01月 

  Background/Objectives: The diagnosis of early-stage pancreatic ductal adenocarcinoma (PDAC) is still challenging. We conducted a multicenter study to clarify the clinical features of early-stage PDAC in Japan. Methods: We collected patients with stage 0 and stage I PDAC according to the sixth edition of the Japanese Classification of Pancreatic Carcinoma. We retrospectively analyzed the clinical profiles including opportunities for medical examination, imaging modalities and findings, methods of cytological diagnosis, and prognosis according to the stages at diagnosis. Results: Two hundred cases with Stage 0 and stage I PDAC were reported from 14 institutions, which accounted for approximately 0.7% and 3% of all PDAC cases, respectively. Overall, 20% of the early-stage PDAC cases were symptomatic. Indirect imaging findings such as dilatation of the main pancreatic duct were useful to detect early-stage PDAC. In particular, local fatty changes may be specific to early-stage PDAC. For preoperative pathologic diagnosis, cytology during endoscopic retrograde cholangiopancreatography was more commonly applied than endoscopic ultrasound fine-needle aspiration. Although the overall prognosis was favorable, new PDAC lesions developed in the remnant pancreas in 11.5% cases. Conclusions: This multicenter study revealed several key points concerning the diagnosis and management of early-stage PDAC, including screening of asymptomatic cases, importance of indirect imaging findings, application of cytology during endoscopic retrograde cholangiopancreatography, and the risk of carcinogenesis in the remnant pancreas.
• Impact of avascular areas, as measured by contrast-enhanced harmonic EUS, on the accuracy of FNA for pancreatic adenocarcinoma

  Ken Kamata; Mamoru Takenaka; Shunsuke Omoto; Takeshi Miyata; Kosuke Minaga; Kentaro Yamao; Hajime Imai; Toshiharu Sakurai; Naoshi Nishida; Takaaki Chikugo; Yasutaka Chiba; Ippei Matsumoto; Yoshifumi Takeyama; Masatoshi Kudo

  GASTROINTESTINAL ENDOSCOPY 87 1 158 - 163 2018年01月 

  Background and Aims: EUS-guided FNA (EUS-FNA) is used for the diagnosis of pancreatic adenocarcinoma, but sometimes the method results in a false negative. Occasionally, an avascular area may be observed within the pancreatic adenocarcinoma tumor during contrast-enhanced harmonic EUS (CH-EUS). The aim of this study was to evaluate whether the diagnostic sensitivity of EUS-FNA for pancreatic adenocarcinoma was affected by the presence of avascularity on CH-EUS. Methods: Two hundred ninety-two patients with pancreatic adenocarcinoma who presented at Kindai University Hospital for EUS-FNA and CH-EUS between June 2009 and August 2013 were retrospectively evaluated. This was a single-center retrospective analysis of prospectively collected data held in a registry. The overall sensitivity of EUS-FNA for the diagnosis of pancreatic adenocarcinoma was calculated. The sensitivities of cytology, histology, and the combination of cytology and histology were also evaluated. These variables were individually evaluated according to the presence or absence of an avascular area on CH-EUS to assess whether the diagnostic sensitivity of EUS-FNA for pancreatic adenocarcinoma was related to the presence of an avascular area within the tumors. Results: The overall sensitivity of EUS-FNA was 90.8% (265/292). The sensitivities of EUS-FNA for lesions with and without an avascular area were 72.9% (35/48) and 94.3% (230/244), respectively, with the difference being statistically significant (P <.001). Conclusions: EUS-FNA has lower sensitivity for pancreatic adenocarcinoma with avascular areas on CH-EUS.
• Pancreatic inflammation and atrophy are not associated with pancreatic cancer concomitant with intraductal papillary mucinous neoplasm

  Yosuke Yagi; Atsuhiro Masuda; Yoh Zen; Hideyuki Shiomi; Hirochika Toyama; Keitaro Sofue; Mamoru Takenaka; Takashi Kobayashi; Takashi Nakagawa; Kodai Yamanaka; Takuya Ikegawa; Namiko Hoshi; Masaru Yoshida; Yoshifumi Arisaka; Yoshihiro Okabe; Hiromu Kutsumi; Takumi Fukumoto; Yonson Ku; Takeshi Azuma

  Pancreatology 18 1 54 - 60 2018年01月 

  © 2017 IAP and EPC Background Inflammation-induced carcinogenesis in pancreatic ductal adenocarcinoma (PDAC) has been reported; however, its involvement in PDAC with intraductal papillary mucinous neoplasm (IPMN) remains unclear. We herein investigated the relationship between pancreatic atrophy and inflammation and the incidence of PDAC concomitant with IPMN. Methods This study included 178 consecutive patients who underwent surgical resection for PDAC with IPMN (N = 21) and IPMN (N = 157) between April 2001 and October 2016. A multivariable logistic regression analysis was conducted to assess the relationship between pancreatic inflammation and atrophy and the incidence of PDAC concomitant with IPMN, with adjustments for clinical characteristics and imaging features. Pathological pancreatic inflammation and atrophy were evaluated in resected specimens. Results High degrees of pancreatic inflammation and atrophy were not associated with the incidence of PDAC with IPMN (multivariable odds ratio [OR] = 0.5, 95% confidence interval [CI] = 0.07 to 3.33, P =.52, adjusted by clinical characteristics, OR = 0.9, 95% CI = 0.10 to 5.86, P =.91, adjusted by imaging studies; OR = 0.2, 95% CI = 0.009 to 1.31, P =.10, adjusted by clinical characteristics, OR = 0.2, 95% CI = 0.01 to 1.43, P =.12, adjusted by imaging studies, respectively). Conclusions Pancreatic inflammation and atrophy were not associated with pancreatic cancer concomitant with IPMN.
• Contrast-enhanced harmonic endoscopic ultrasonography for differential diagnosis of localized gallbladder lesions

  Ken Kamata; Mamoru Takenaka; Masayuki Kitano; Shunsuke Omoto; Takeshi Miyata; Kosuke Minaga; Kentaro Yamao; Hajime Imai; Tosiharu Sakurai; Naoshi Nishida; Hiroshi Kashida; Takaaki Chikugo; Yasutaka Chiba; Takuya Nakai; Yoshifumi Takeyama; Andrea Lisotti; Pietro Fusaroli; Masatoshi Kudo

  Digestive Endoscopy 30 1 98 - 106 2018年01月 

  Background and Aim: Differential diagnosis of localized gallbladder lesions is challenging. The aim of the present study was to evaluate the utility of contrast-enhanced harmonic endoscopic ultrasonography (CH-EUS) for diagnosis of localized gallbladder lesions. Methods: One hundred and twenty-five patients with localized gallbladder lesions were evaluated by CH-EUS between March 2007 and February 2014. This was a single-center retrospective study. Utilities of fundamental B-mode EUS (FB-EUS) and CH-EUS in the differentiation of gallbladder lesions and sludge plug were initially compared. Thereafter, these two examinations were compared with respect to their accuracy in the diagnosis of malignant lesions. Five reviewers blinded to the clinicopathological results evaluated microcirculation patterns in the vascular and perfusion images. Results: In the differentiation between gallbladder lesions and sludge plug, FB-EUS had a sensitivity, specificity, and accuracy of 82%, 100%, and 95%, respectively, whereas CH-EUS had a sensitivity, specificity, and accuracy of 100%, 99%, and 99%, respectively. FB-EUS-based diagnosis of carcinomas based on tumor size and/or shape had a sensitivity, specificity, and accuracy of 61–87%, 71–88%, and 74–86%, respectively. Additional information regarding irregular vessel patterns in the vascular image and/or heterogeneous enhancement in the perfusion image on CH-EUS increased the sensitivity, specificity, and accuracy for the diagnosis of carcinomas to 90%, 98%, and 96%, respectively. There was a significant difference between FB-EUS and CH-EUS in terms of carcinoma diagnosis. Conclusion: CH-EUS was useful for the evaluation of localized gallbladder lesions.
• A case of successful transluminal drainage of walled-off necrosis under contrast-enhanced harmonic endoscopic ultrasonography guidance

  Kosuke Minaga; Mamoru Takenaka; Shunsuke Omoto; Takeshi Miyata; Ken Kamata; Kentaro Yamao; Hajime Imai; Tomohiro Watanabe; Masayuki Kitano; Masatoshi Kudo

  Journal of Medical Ultrasonics 45 1 161 - 165 2018年01月 

  © 2017, The Japan Society of Ultrasonics in Medicine. We report a case of successful transluminal drainage of walled-off necrosis (WON) under contrast-enhanced harmonic endoscopic ultrasonography (CH-EUS) guidance. Recently, EUS-guided transluminal drainage (EUS-TD) of WON has been increasingly used as a minimally invasive treatment option with reportedly high technical and clinical success rates; however, B-mode EUS occasionally fails to depict the target lesion and its margins, particularly in cases where the target shows a heterogeneous echogenicity. In our case, EUS-TD was attempted for infected WON, but visualization using B-mode EUS imaging was poor. Thus, CH-EUS was performed to enhance the contrast between the targeted WON and its surrounding tissues. Immediately after injecting a sonographic contrast agent, WON and its margins were clearly identified as an avascular area and were punctured under CH-EUS guidance. CH-EUS enables the assessment of the microvasculature and hemodynamics of the target lesion in real time. It may also provide valuable information and could be a useful modality for EUS-TD to clearly visualize target lesions and their margins and to decisively puncture them, even when they could not be identified using B-mode EUS.
• 造影ハーモニックEUSによる孤立性胆嚢病変の鑑別診断

  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．

• 内視鏡的乳頭切除術に伴う出血に対する内視鏡的止血法の検討

  八木洋輔; 有坂好史; 酒井新; 小林隆; 竹中完; 塩見英之; 増田充弘; 岡部純弘

  胆道 31 5号 793 - 801 日本胆道学会 2017年12月 [査読有り]
   

  【目的】内視鏡的乳頭切除術(Endoscopic Papillectomy:EP)に関連した出血に対する、有効で安全な止血法を明らかにする。【方法】EPを行った24例中、偶発症として出血を認め内視鏡的止血術を行なった13例をretrospectiveに検討した。【結果】出血時期はEP当日9例、翌日3例、翌々日1例で、初回止血法は、アルゴンプラズマ凝固法(APC)2例、Clip法3例、エピネフリン加高張食塩水局注法(HSE)2例、これらの併用が6例であった。13例中4例で再出血を認め、そのうち1例は仮性動脈瘤出血を来し動脈塞栓術を要したが、他は再度内視鏡的止血術を行い止血成功し得た。止血処置に伴う偶発症として5例に膵炎を認め、HSE併用例で多く認められた。【結論】止血効果はAPC併用例に比べClipやHSE併用例で良好であったが、HSE併用例では膵炎に注意が必要である。(著者抄録)
• A Case of Pancreatic Carcinoma in situ Diagnosed by Repeated Pancreatic Juice Cytology

  Takeshi Miyata; Mamoru Takenaka; Shunsuke Omoto; Ken Kamata; Kosuke Minaga; Kentaro Yamao; Hajime Imai; Masatoshi Kudo

  Oncology (Switzerland) 93 1 98 - 101 2017年12月 

  Repeated pancreatic juice cytology via endoscopic nasopancreatic drainage (ENPD) has a high diagnostic yield and might be useful for the diagnosis of early-stage pancreatic cancer. A 67-year-old man presented with a pancreatic cyst occasionally detectable in the body of the pancreas by ultrasonography (US). No obvious pancreatic tumor was detected by US, computed tomography (CT), magnetic resonance cholangiopancreatography, and endoscopic ultrasound (EUS) (although the latter did reveal a weak, low echoic area). Endoscopic retrograde pancreatography showed irregular narrowing of the main pancreatic duct (MPD) at the pancreatic body. Pancreatic juice cytology was also performed, but did not give evidence of a malignancy. Therefore, the patient was followed up. CT and EUS performed after 3 months showed the same findings as did endoscopic retrograde pancreatography however, the results of repeated pancreatic juice cytology performed via ENPD tube revealed a suspected malignancy on 2 of 6 occasions. Therefore, we performed a central pancreatectomy. Histopathological examination of a resected specimen revealed carcinoma in situ in the narrow MPD at the body of the pancreas. In the current case, repeated pancreatic juice cytology via ENPD was effective. A weak low echoic area around the MPD stricture on EUS might be related to the inflammatory change accompanying carcinoma in situ of the pancreas.
• Electronic hydraulic lithotripsy by antegrade digital cholangioscopy through endoscopic ultrasound-guided hepaticojejunostomy

  Yasuo Otsuka; Ken Kamata; Mamoru Takenaka; Kosuke Minaga; Hidekazu Tanaka; Masatoshi Kudo

  ENDOSCOPY 49 12 E316 - E318 2017年12月
• Achievement of long-term stent patency in endoscopic ultrasonography-guided right bile duct drainage after left hepatic lobectomy (with video)

  Kosuke Minaga; Mamoru Takenaka; Takeshi Miyata; Kentaro Yamao; Ken Kamata; Masayuki Kitano; Masatoshi Kudo

  ENDOSCOPIC ULTRASOUND 6 6 412 - 413 2017年11月
• Endoscopic ultrasound-guided choledochoduodenostomy with novel use of contrastenhanced harmonic imaging

  Kosuke Minaga; Mamoru Takenaka; Ken Kamata; Takeshi Miyata; Kentaro Yamao; Hajime Imai; Masatoshi Kudo

  ENDOSCOPY 49 11 E281 - E282 2017年11月
• Portal vein stenting for portal vein stenosis caused by bile duct cancer

  Ken Kamata; Mamoru Takenaka; Masakatsu Tsurusaki; Masatoshi Kudo

  DIGESTIVE AND LIVER DISEASE 49 11 1282 - 1282 2017年11月
• Rescue EUS-guided intrahepatic biliary drainage for malignant hilar biliary stricture after failed transpapillary re-intervention

  Kosuke Minaga; Mamoru Takenaka; Masayuki Kitano; Yasutaka Chiba; Hajime Imai; Kentaro Yamao; Ken Kamata; Takeshi Miyata; Shunsuke Omoto; Toshiharu Sakurai; Tomohiro Watanabe; Naoshi Nishida; Masatoshi Kudo

  SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES 31 11 4764 - 4772 2017年11月 

  Treatment of unresectable malignant hilar biliary stricture (UMHBS) is challenging, especially after failure of repeated transpapillary endoscopic stenting. Endoscopic ultrasonography-guided intrahepatic biliary drainage (EUS-IBD) is a recent technique for intrahepatic biliary decompression, but indications for its use for complex hilar strictures have not been well studied. The aim of this study was to assess the feasibility and safety of EUS-IBD for UMHBS after failed transpapillary re-intervention. Retrospective analysis of all consecutive patients with UMHBS of Bismuth II grade or higher who, between December 2008 and May 2016, underwent EUS-IBD after failed repeated transpapillary interventions. The technical success, clinical success, and complication rates were evaluated. Factors associated with clinical ineffectiveness of EUS-IBD were explored. A total of 30 patients (19 women, median age 66 years [range 52-87]) underwent EUS-IBD for UMHBS during the study period. Hilar biliary stricture morphology was classified as Bismuth II, III, or IV in 5, 13, and 12 patients, respectively. The median number of preceding endoscopic interventions was 4 (range 2-14). EUS-IBD was required because the following procedures failed: duodenal scope insertion (n = 4), accessing the papilla after duodenal stent insertion (n = 5), or achieving desired intrahepatic biliary drainage (n = 21). Technical success with EUS-IBD was achieved in 29 of 30 patients (96.7%) and clinical success was attained in 22 of these 29 (75.9%). Mild peritonitis occurred in three of 30 (10%) and was managed conservatively. Stent dysfunction occurred in 23.3% (7/30). There was no procedure-related mortality. On multivariable analysis, Bismuth IV stricture predicted clinical ineffectiveness (odds ratio = 12.7, 95% CI 1.18-135.4, P = 0.035). EUS-IBD may be a feasible and effective rescue alternative with few major complications after failed transpapillary endoscopic re-intervention in patients with UMHBS, particularly for Bismuth II or III strictures.
• Prospective evaluation of digital single-operator cholangioscope for diagnostic and therapeutic procedures (with videos)

  Takeshi Ogura; Miyuki Imanishi; Yoshitaka Kurisu; Saori Onda; Tastsushi Sano; Wataru Takagi; Atsushi Okuda; Akira Miyano; Mio Amano; Nobu Nishioka; Tadahiro Yamada; Daisuke Masuda; Mamoru Takenaka; Masayuki Kitano; Kazuhide Higuchi

  DIGESTIVE ENDOSCOPY 29 7 782 - 789 2017年11月 

  Background and Aim: Recently, the digital single-operator cholangioscope (SPY-DS) has become available. This system may allow diagnosis by direct visualization and allow performance of various therapeutic procedures. The aim of the present study was to prospectively evaluate the clinical utility of DSOCS for diagnostic and therapeutic procedures for biliary disease. Methods: Technical success was defined as successful visualization of target lesions in the biliary tract and carrying out forceps biopsy as a diagnostic procedure, and successfully carrying out treatment such as guidewire insertion for the area of interest, electrohydraulic lithotripsy (EHL), or migrated stent removal. Also, the present study aimed at investigating diagnostic yield of the cholangioscopic findings and biopsy specimens. Results: A total of 55 consecutive patients were prospectively enrolled in this study; a diagnostic procedure was done in 33 patients, and a therapeutic procedure was done in 22 patients. Overall accuracy of visual findings was 93%, with a sensitivity of 83%, a specificity of 89%, positive predictive value (PPV) of 83%, and negative predictive value (NPV) of 100%. However, the overall accuracy of forceps biopsy was 89%, with a sensitivity, specificity, and PPV of 100%, and NPV of 90%. Overall technical success rate of therapeutic procedures such as selective guidewire insertion, EHL or migrated stent removal was 91% (20/22). Finally, adverse events were seen in two cases in the diagnostic group, but were not seen in the therapeutic group. Conclusion: Although additional cases and a randomized, controlled study with another cholangioscope are needed, diagnostic and therapeutic procedures using SPY-DS appear to be feasible and safe.
• Gankyrin induces STAT3 activation in tumor microenvironment and sorafenib resistance in hepatocellular carcinoma

  Toshiharu Sakurai; Norihisa Yada; Satoru Hagiwara; Tadaaki Arizumi; Kosuke Minaga; Ken Kamata; Mamoru Takenaka; Yasunori Minami; Tomohiro Watanabe; Naoshi Nishida; Masatoshi Kudo

  CANCER SCIENCE 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.
• 通常型膵管癌との鑑別が困難であった膵神経内分泌癌の一例

  酒井新; 竹中完; 池田篤紀; 小林隆; 塩見英之; 増田充弘; 有坂好史; 岡部純弘; 原重雄; 全陽, 東健

  膵臓 32 5号 829 - 835 日本膵臓学会 2017年10月 [査読有り]
   

  症例は73歳男性。膵体部腫瘤の精査目的で入院した。造影CTでは尾側膵管の拡張を伴う境界明瞭な30mmの乏血性腫瘤であった。EUSでは境界が明瞭、辺縁はやや不整で、内部エコー均一な低エコー腫瘤として描出された。膵神経内分泌癌が疑われたが、通常型膵管癌との鑑別が困難であった。同腫瘤に対してEUS-FNAを行い、小細胞型神経内分泌癌と診断した。MRIで肝内に多発する結節を認めたため、多発肝転移を伴う膵神経内分泌癌と診断し、Irinotecan+Cisplatinのレジメンで化学療法を行った。原疾患の進行のため、化学療法開始より6ヵ月後に永眠された。(著者抄録)
• Contrast-enhanced harmonic endoscopic ultrasonography for differential diagnosis of submucosal tumors of the upper gastrointestinal tract

  Ken Kamata; Mamoru Takenaka; Masayuki Kitano; Shunsuke Omoto; Takeshi Miyata; Kosuke Minaga; Kentaro Yamao; Hajime Imai; Toshiharu Sakurai; Tomohiro Watanabe; Naoshi Nishida; Takaaki Chikugo; Yasutaka Chiba; Haruhiko Imamoto; Takushi Yasuda; Andrea Lisotti; Pietro Fusaroli; Masatoshi Kudo

  JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY 32 10 1686 - 1692 2017年10月 

  Background and Aim: The study aims to evaluate contrast-enhanced harmonic endoscopic ultrasonography (CH-EUS) for the differential diagnosis of submucosal tumors (SMT) of the upper gastrointestinal tract. Methods: Between June 2008 and May 2015, 157 consecutive patients with submucosal lesions of the upper gastrointestinal tract were evaluated by CH-EUS. This was a single-center retrospective analysis of prospectively collected data in a registry. The data from 73 patients who later underwent surgical resection were analyzed in this study. Surgical specimens served as the final diagnoses. The two CH-EUS variables of blood flow (hyper-enhancement vs hypo-enhancement) and homogeneity of enhancement pattern were evaluated. Results: The final diagnoses were 58 gastrointestinal stromal tumors (GISTs) and 15 benign SMTs (two lipomas, five leiomyomas, five schwannomas, two glomus tumors, and one ectopic pancreas). On CH-EUS, 49 of 58 (84.5%) GISTs presented with hyper-enhancement, whereas 4 of 15 (26.7%) benign SMTs showed hyper-enhancement; 21 of 58 (36.2%) GISTs showed inhomogeneous contrast enhancement, while only 2 of 15 (13.3%) benign SMTs demonstrated inhomogeneous contrast enhancement. If hyper-enhancement was considered to indicate GISTs, the sensitivity, specificity, and accuracy were 84.5%, 73.3%, and 82.2%, respectively. If inhomogeneous enhancement was considered to indicate GISTs, the sensitivity, specificity, and accuracy were 36.2%, 86.7%, and 46.6%, respectively. In lesions of less than 2cm, hyper-enhancement was a more sensitive indicator of GISTs than inhomogeneous enhancement. Conclusions: Hyper-enhancement and inhomogeneous enhancement were found to be a characteristic of GISTs. CH-EUS was useful for discrimination of benign SMTs from GISTs.
• Gankyrin induces STAT3 activation in tumor microenvironment and sorafenib resistance in hepatocellular carcinoma

  Toshiharu Sakurai; Norihisa Yada; Satoru Hagiwara; Tadaaki Arizumi; Kosuke Minaga; Ken Kamata; Mamoru Takenaka; Yasunori Minami; Tomohiro Watanabe; Naoshi Nishida; Masatoshi Kudo

  Cancer Science 108 1996 - 2003 2017年10月 

  © 2017 The Authors. Cancer Science published by John Wiley & Sons Australia, Ltd on behalf of Japanese Cancer Association. Most hepatocellular carcinomas (HCC) develop as a result of chronic liver inflammation. We have shown that the oncoprotein gankyrin is critical for inflammation-induced tumorigenesis in the colon. Although the in vitro function of gankyrin is well known, its role in vivo remains to be elucidated. We investigated the effect of gankyrin in the tumor microenvironment of mice with liver parenchymal cell-specific gankyrin ablation (Alb-Cre;gankyrinf/f) and gankyrin deletion both in liver parenchymal and non-parenchymal cells (Mx1-Cre;gankyrinf/f). Gankyrin upregulates vascular endothelial growth factor expression in tumor cells. Gankyrin binds to Src homology 2 domain-containing protein tyrosine phosphatase-1 (SHP-1), mainly expressed in liver non-parenchymal cells, resulting in phosphorylation and activation of signal transducer and activator of transcription 3 (STAT3). Gankyrin deficiency in non-parenchymal cells, but not in parenchymal cells, reduced STAT3 activity, interleukin (IL)-6 production, and cancer stem cell marker (Bmi1 and epithelial cell adhesion molecule [EpCAM]) expression, leading to attenuated tumorigenic potential. Chronic inflammation enhances gankyrin expression in the human liver. Gankyrin expression in the tumor microenvironment is negatively correlated with progression-free survival in patients undergoing sorafenib treatment for HCC. Thus, gankyrin appears to play a critical oncogenic function in tumor microenvironment and may be a potential target for developing therapeutic and preventive strategies against HCC.
• EUS-guided approaches for bile duct stones: A single-center experience

  Minaga Kosuke; Takenaka Mamoru; Kamata Ken; Miyata Takeshi; Yamao Kentaro; Imai Hajime; Omoto Shunsuke; Nakai Atsushi; Yoshikawa Tomoe; Watanabe Tomohiro; Kudo Masatoshi

  JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY 32 240  2017年09月 [査読有り]
  
• Imaging and clinicopathological features of nivolumab-related cholangitis in patients with non-small cell lung cancer

  Hisato Kawakami; Junko Tanizaki; Kaoru Tanaka; Koji Haratani; Hidetoshi Hayashi; Masayuki Takeda; Ken Kamata; Mamoru Takenaka; Masatomo Kimura; Takaaki Chikugo; Takao Sato; Masatoshi Kudo; Akihiko Ito; Kazuhiko Nakagawa

  INVESTIGATIONAL NEW DRUGS 35 4 529 - 536 2017年08月 

  Background Nivolumab demonstrates promising efficacy for the treatment of non-small cell lung cancer and other malignancies. The clinical benefit of nivolumab, however, may be hampered by specific immune-related adverse events (irAEs), and little is known regarding nivolumab-related cholangitis. Methods A computerized search of our clinical database identified 3 metastatic non-small cell lung cancer patients with nivolumab-related cholangitis. All patients were treated with in-travenous nivolumab monotherapy (3.0 mg/kg) every 2 weeks until disease progression or irAEs occurred. Clinical data regarding the duration of nivolumab treatment, symptoms, laboratory abnormalities, pathological findings of liver parenchyma biopsy specimens, and management of nivolumab-related cholangitis were analyzed. Results Our analysis revealed that nivolumab-related cholangitis was characterized by (1) localized extrahepatic bile duct dilation without obstruction; (2) diffuse hypertrophy of the extrahepatic bile duct wall; (3) a dominant increase in the biliary tract enzymes alkaline phosphatase and gamma-glutamyl transpeptidase relative to the hepatic enzymes aspartate and alanine aminotransferase; (4) normal or reduced levels of the serum immunological markers antinuclear antibody, antimitochondrial antibody, smooth muscle antibody, and immunoglobulin G4; (5) the pathological finding of biliary tract cluster of differentiation 8-positive T cell infiltration from liver biopsy; and (6) amoderate to poor response to steroid therapy. Conclusions Nivolumab-related cholangitis is associated with distinct imaging and clinicopathological features that distinguish it from acute cholangitis of common etiologies and other immune-related cholangitis. Further studies are warranted to establish the optimal management of patients with this irAE.
• Evaluation of resectability for pancreatic cancer using endoscopic ultrasound

  Masayuki Kitano; Mamoru Takenaka; Kosuke Minaga; Takeshi Miyata; Ken Kamata

  Innovation of Diagnosis and Treatment for Pancreatic Cancer 13 - 28 2017年07月
• Stent migration during EUS-guided hepaticogastrostomy in a patient with massive ascites: Troubleshooting using additional EUS-guided antegrade stenting

  Ken Kamata; Mamoru Takenaka; Kosuke Minaga; Shunsuke Omoto; Takeshi Miyata; Kentaro Yamao; Hajime Imai; Masatoshi Kudo

  ARAB JOURNAL OF GASTROENTEROLOGY 18 2 120 - 121 2017年06月 

  EUS-guided hepaticogastrostomy (EUS-HGS) is useful for treating obstructive jaundice. However, stent migration may sometimes occur both during and after the procedure. This report describes a patient with pancreatic cancer and massive ascites who underwent EUS-HGS combined with EUS-guided antegrade stenting (EUS-AS), with additional EUS-AS playing a role in troubleshooting for stent migration during EUS-HGS. (C) 2017 Pan-Arab Association of Gastroenterology. Published by Elsevier B.V. All rights reserved.
• Investigation on the Efficacy of Alteration of Treatment Methods for Difficult Cases in Eus-Bd

  Kosuke Minaga; Mamoru Takenaka; Masayuki Kitano; Hajime Imai; Kentaro Yamao; Ken Kamata; Takeshi Miyata; Shunsuke Omoto; Tomoe Yoshikawa; Masatoshi Kudo

  GASTROINTESTINAL ENDOSCOPY 85 5 AB493 - AB493 2017年05月 [査読有り]
  
• Improved Diagnosis of Liver Metastases Using Kupffer-Phase Image of Contrast-Enhanced Harmonic Endoscopic Ultrasonography in Patients With Pancreatic Cancer

  Kosuke Minaga; Mamoru Takenaka; Masayuki Kitano; Hajime Imai; Kentaro Yamao; Ken Kamata; Takeshi Miyata; Shunsuke Omoto; Tomoe Yoshikawa; Masatoshi Kudo

  GASTROINTESTINAL ENDOSCOPY 85 5 AB53 - AB53 2017年05月 [査読有り]
  
• Outcomes of Biliary Drainage in Pancreatic Cancer Patients With an Indwelling Gastroduodenal Stent: A Multicenter Retrospective Study in West Japan

  Kentaro Yamao; Masayuki Kitano; Takahisa Kayahara; Etsuji Ishida; Hiroshi Yamamoto; Tomoe Yoshikawa; Kosuke Minaga; Yukitaka Yamashita; Masanori Asada; Yoshihiro Okabe; Yukio Osaki; Juri Ikemoto; Keiji Hanada; Mamoru Takenaka; Masatoshi Kudo

  GASTROINTESTINAL ENDOSCOPY 85 5 AB327 - AB328 2017年05月 [査読有り]
  
• History of Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis and Acute Pancreatitis as Risk Factors for Post-ERCP Pancreatitis.

  Funatsu E; Masuda A; Takenaka M; Nakagawa T; Shiomi H; Yoshinaka H; Kobayashi T; Sakai A; Yagi Y; Yoshida M; Arisaka Y; Okabe Y; Kutsumi H; Azuma T

  The Kobe journal of medical sciences 63 2017年05月 

  © 2017, Kobe University School of Medicine. All rights reserved. Background: Previous pancreatitis is a definite patient-related risk factor for pancreatitis after endoscopic retrograde cholangiopancreatography (post-ERCP pancreatitis: PEP). However, the effects of differences in the history of PEP and acute pancreatitis on the occurrence of PEP have not been fully investigated. We examined the relationship between previous PEP or previous acute pancreatitis and procedural factors associated with PEP. Methods: Clinical data on 1,334 consecutive patients undergoing ERCP between April 2006 and June 2010 were collected. A multivariate logistic regression analysis was conducted to assess the relationship between PEP and the cannulation time (<15 min vs. ≥15 min) or total procedure time (<30 min vs. ≥30 min) according to previous pancreatitis (previous PEP: pPEP or previous acute pancreatitis: pAP), with adjustments for clinical characteristics. Results: Longer cannulation times (≥15 min) correlated with the occurrence of PEP in the pPEP group (OR=2.97; 95% CI=1.10 to 8.43, P=0.03) and in patients without previous pancreatitis (non-preP group) (OR=2.43; 95% CI=1.41 to 4.14, P= 0.002), but not in the pAP group (OR=2.78; 95% CI=0.50 to 22.42, P= 0.25). In contrast, longer procedure times correlated with the occurrence of PEP in the pAP group (OR=3.93; 95% CI=1.11 to 16.5, P= 0.03), but not in the pPEP group (OR=2.79; 95% CI=0.92 to 9.18, P= 0.068) or non-preP group (OR=0.71; 95% CI=0.39 to 1.24, P= 0.23). Conclusions: A higher risk of PEP with previous PEP was associated with longer cannulation times, whereas a higher risk of PEP with previous acute pancreatitis was associated with longer procedure times.
• Chronic fibro-inflammatory responses in autoimmune pancreatitis depend on IFN-α and IL-33 produced by plasmacytoid dendritic cells

  Tomohiro Watanabe; Kouhei Yamashita; Yasuyuki Arai; Kosuke Minaga; Ken Kamata; Tomoyuki Nagai; Yoriaki Komeda; Mamoru Takenaka; Satoru Hagiwara; Hiroshi Ida; Toshiharu Sakurai; Naoshi Nishida; Warren Strober; Masatoshi Kudo

  Journal of Immunology 198 10 3886 - 3896 2017年05月 

  © 2017 by The American Association of Immunologists, Inc. 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-a. 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.
• 緩和医療における内視鏡の役割 切除不能悪性胃十二指腸狭窄症例に対する胃十二指腸ステント留置の予後予測因子の検討

  山雄 健太郎; 竹中 完; 工藤 正俊

  Gastroenterological Endoscopy 59 Suppl.1 858 - 858 (一社)日本消化器内視鏡学会 2017年04月
• Endoscopic ultrasonography-guided choledochoduodenostomy using a newly designed laser-cut metal stent: Feasibility study in a porcine model

  Kosuke Minaga; Masayuki Kitano; Chimyon Gon; Kentaro Yamao; Hajime Imai; Takeshi Miyata; Ken Kamata; Shunsuke Omoto; Mamoru Takenaka; Masatoshi Kudo

  DIGESTIVE ENDOSCOPY 29 2 211 - 217 2017年03月 

  Background and AimEndoscopic ultrasonography (EUS)-guided choledochoduodenostomy (EUS-CDS) is increasingly used in the treatment of malignant distal biliary obstruction. Standardized use of this technique requires improvements in instruments, including more convenient and safer devices. The present study was designed to evaluate the resistance force to migration (RFM) of a newly designed laser-cut metal stent and the feasibility of EUS-CDS using this stent. MethodsThis experimental study used a porcine model of biliary dilatation involving five male pigs. The new stent is a fully covered laser-cut stent with anti-migration anchoring hooks. The RFM of the new stents was compared with those of three commercially available covered metal stents using a phantom model. In the animal study, after ligation of Vater's ampulla with endoscopic clips, the dilated common bile duct was punctured under EUS guidance, followed by EUS-CDS using the new stent. One week after the procedure, the stents were removed endoscopically and the fistulas were assessed after the pigs were killed. Technical feasibility and clinical outcomes were evaluated. ResultsAmong the four stents, the new stent had the highest RFM. Metal stent placement was successful in all five pigs, with no procedure-related complications occurring during and 1 week after endoscopic intervention. All stents remained in place without migration and were removed easily using a snare. At necropsy, fistulas were created between the bile duct and duodenum in all pigs. ConclusionEUS-CDS using a newly designed metal stent was feasible and effective in this porcine model of biliary dilatation.
• Chronic Pancreatitis finding by Endoscopic Ultrasonography in the Pancreatic Parenchyma of IPMNs is Associated with Invasive IPMC

  Mamoru Takenaka; Atsuhiro Masuda; Hideyuki Shiomi; Yosuke Yagi; Yoh Zen; Arata Sakai; Takashi Kobayashi; Yoshifumi Arisaka; Yoshihiro Okabe; Hiromu Kutsumi; Hirochika Toyama; Takumi Fukumoto; Yonson Ku; Masatoshi Kudo; Takeshi Azuma

  Oncology Supple in press 2017年 [査読有り]
  
• 膵癌早期診断の現状-膵癌早期診断研究会における多施設研究の結果をもとに

  菅野敦; 正宗淳; 花田敬士; 真口宏介; 清水泰博; 植木敏晴; 長谷部修; 大塚隆夫; 中村雅史; 竹中完; 北野雅之; 菊山正隆; 蒲田敏文; 吉田浩司; 佐々木民人; 芹川正浩; 古川徹; 柳澤昭夫; 下瀬川徹

  膵臓 32 1 16 - 22 2017年
• 膵炎における腸管免疫機構破綻と重症化機序

  渡邉智裕; 三長孝輔; 鎌田研; 山雄健太郎; 竹中完; 工藤正俊

  肝•胆•膵 75 991 - 996 2017年 [招待有り]
  
• The usefulness of endoscopic ultrasonography in the diagnosis of "Early-Stage" chronic pancreatitis

  Mamoru Takenaka; Masayuki Kitano; Masatoshi Kudo

  Gastroenterological Endoscopy 59 255 - 264 2017年01月 

  Chronic pancreatitis is one of the risk factors for pancreatic cancer and is considered to be an irreversible and progressive disease. However, the conventional diagnostic criteria of chronic pancreatitis had the problem of being able to diagnose only advanced chronic pancreatitis. Based on the hypothesis that the early stage of chronic pancreatitis is a reversible disease, the diagnostic criteria of "early-stage" chronic pancreatitis were developed in Japan for early detection and early treatment of chronic pancreatitis. Endoscopic ultrasonography (EUS) plays an important role in detecting "early-stage" chronic pancreatitis. Many EUS image findings of "early-stage" chronic pancreatitis are mentioned in the Rosemont criteria for the EUS diagnosis of chronic pancreatitis.
• Association between serum SPan-1 and lymph node metastasis in invasive intraductal papillary mucinous neoplasm of the pancreas

  Kodai Yamanaka; Atsuhiro Masuda; Hirochika Toyama; Hideyuki Shiomi; Yoh Zen; Keitaro Sofue; Mamoru Takenaka; Takashi Kobayashi; Arata Sakai; Yosuke Yagi; Takashi Nakagawa; Masaru Yoshida; Yoshifumi Arisaka; Yoshihiro Okabe; Hiromu Kutsumi; Takumi Fukumoto; Yonson Ku; Takeshi Azuma

  Pancreatology 17 1 123 - 129 2017年01月 

  © 2016 IAP and EPC Background and aim Lymph node metastasis predicts poorer prognoses in patients with invasive intraductal papillary mucinous neoplasms of the pancreas (IPMNs). Factors associated with lymph node metastasis of invasive IPMN remain unclear. Therefore, this study aimed to define factors associated with lymph node metastasis of invasive IPMN. Methods Between June 2000 to August 2015, 156 consecutive patients with IPMN underwent surgical resection at Kobe University Hospital, and were enrolled in this study. The relationship between lymph node metastasis and clinical characteristics, including imaging studies and serum tumor markers, was evaluated. A multivariate logistic regression analysis was performed to assess the relationship between serum tumor markers and the presence of lymph node metastasis of IPMN, adjusted for clinical characteristics. Results Lymph node metastasis was observed in 7.7% (12/156) of IPMNs via a pathological examination. The multivariate logistic regression analysis revealed that serum SPan-1 was associated with the presence of lymph node metastasis of IPMN (odds ratio [OR] = 7.32; 95% confidence interval [CI] = 1.10 to 56.0; P = 0.04). In addition, survival was poorer among serum SPan-1-positive patients than SPan-1 negative patients (Log-rank test; P = 0.0002). Lymph node enlargement was detected preoperatively on computed tomography scans in only 16.7% (2/12) of cases that were positive for lymph node metastasis. Conclusions Elevated serum SPan-1 was associated with lymph node metastasis in this cohort of patients who underwent resection for invasive IPMN.
• Endoscopic ultrasound-guided gallbladder drainage for acute cholecystitis: Long-term outcomes after removal of a self-expandable metal stent

  Ken Kamata; Mamoru Takenaka; Masayuki Kitano; Shunsuke Omoto; Takeshi Miyata; Kosuke Minaga; Kentaro Yamao; Hajime Imai; Toshiharu Sakurai; Tomohiro Watanabe; Naoshi Nishida; Masatoshi Kudo

  WORLD JOURNAL OF GASTROENTEROLOGY 23 4 661 - 667 2017年01月 

  AIM To assess the long-term outcomes of this procedure after removal of self-expandable metal stent (SEMS). The efficacy and safety of endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) with SEMS were also assessed. METHODS Between January 2010 and April 2015, 12 patients with acute calculous cholecystitis, who were deemed unsuitable for cholecystectomy, underwent EUS-GBD with a SEMS. EUS-GBD was performed under the guidance of EUS and fluoroscopy, by puncturing the gallbladder with a needle, inserting a guidewire, dilating the puncture hole, and placing a SEMS. The SEMS was removed and/or replaced with a 7-Fr plastic pigtail stent after cholecystitis improved. The technical and clinical success rates, adverse event rate, and recurrence rate were all measured. RESULTS The rates of technical success, clinical success, and adverse events were 100%, 100%, and 0%, respectively. After cholecystitis improved, the SEMS was removed without replacement in eight patients, whereas it was replaced with a 7-Fr pigtail stent in four patients. Recurrence was seen in one patient (8.3%) who did not receive a replacement pigtail stent. The median follow-up period after EUS-GBD was 304 d (78-1492). CONCLUSION EUS-GBD with a SEMS is a possible alternative treatment for acute cholecystitis. Long-term outcomes after removal of the SEMS were excellent. Removal of the SEMS at 4-wk after SEMS placement and improvement of symptoms might avoid migration of the stent and recurrence of cholecystitis due to food impaction.
• Smoking Status and the Incidence of Pancreatic Cancer Concomitant with Intraductal Papillary Mucinous Neoplasm

  Nakagawa, T.; Masuda, A.; Toyama, H.; Shiomi, H.; Zen, Y.; Sofue, K.; Takenaka, M.; Kobayashi, T.; Yagi, Y.; Yamanaka, K.; Yoshida, M.; Arisaka, Y.; Okabe, Y.; Kutsumi, H.; Fukumoto, T.; Ku, Y.; Azuma, T.

  Pancreas 46 4 582 - 588 2017年 

  © Wolters Kluwer Health, Inc. All rights reserved. Objectives The effect of smoking status on the incidence of pancreatic ductal adenocarcinoma (PDAC) concomitant with intraductal papillary mucinous neoplasm (IPMN) has not been clarified. This study investigated the association of smoking status with PDAC concomitant with IPMN. Methods The subjects were 124 consecutive patients undergoing resection of IPMNs (intraductal papillary mucinous adenoma (IPMA): N = 77, invasive IPMN: N = 31, and PDAC with IPMN: N = 16) between April 2008 and October 2015. The associations between smoking status (never/former/current smoker) or cumulative pack-years (0-19/20-39/≥40) and the incidence of PDAC concomitant with IPMN or invasive IPMN were evaluated. Results Current smoking, not former smoking, was associated with the incidence of PDAC concomitant with IPMN (PDAC with IPMN vs IPMN alone; P = 0.004, PDAC with IPMN vs IPMA; P = 0.004, PDAC with IPMN vs invasive IPMN; P = 0.04, respectively), but not that of invasive IPMN (invasive IPMN vs IPMA; P = 0.85). Cumulative pack-years were higher in patients who had PDAC concomitant with IPMN than in patients with invasive IPMN (P = 0.04). Cumulative pack-years were not associated with smoking status (current vs former). Conclusions Current smoking, not former smoking, was associated with the incidence of PDAC concomitant with IPMN. Cessation of smoking may be recommended for patients with IPMN.
• The Overall Survival of Patients with Hepatocellular Carcinoma Correlates with the Newly Defined Time to Progression after Transarterial Chemoembolization

  Tadaaki Arizumi; Kazuomi Ueshima; Mina Iwanishi; Tomohiro Minami; Hirokazu Chishina; Masashi Kono; Masahiro Takita; Norihisa Yada; Satoru Hagiwara; Yasunori Minami; Hiroshi Ida; Yoriaki Komeda; Mamoru Takenaka; Toshiharu Sakurai; Tomohiro Watanabe; Naoshi Nishida; Masatoshi Kudo

  LIVER CANCER 6 3 227 - 235 2017年 

  Aim/Background: The ultimate aim of any treatment for hepatocellular carcinoma (HCC) is to improve overall survival (OS); however, the clinical significance of time to progression (TTP) after transarterial chemoembolization (TACE) is unclear. This retrospective study examined the association between OS and the newly defined time to TACE progression (TTTP) to assess whether TTTP can be an alternative to OS in HCC patients with Barcelona Clinic Liver Cancer (BCLC) stage B. Methods: Between January 2006 and December 2013, 592 patients with HCC (BCLC B1, n = 118; BCLC B2, n = 170) underwent TACE. TTTP was then redefined as time to progression from the first image taken after TACE. The relationship between TTTP and OS was then examined based on survival time. Results: Survival analysis revealed significant differences in the OS of patients with BCLC B1 and those with BCLC B2 (median OS: 42.3 months, 95% confidence interval [CI] 34.4-50.7; and 29.3 months, 95% CI 26.1-37.6, respectively, p = 0.0348). The median TTTP values were 9.5 months (95% CI 7.0-10.9) and 5.3 months (95% CI 4.6-6.7), respectively (p = 0.0078). There was a moderate positive correlation between OS and TTTP for both B1 (R-2 = 0.6563, p = 0.0045) and B2 (R-2 = 0.6433, p = 0.0052) substages. There was also a positive correlation between OS and TTTP for the combined B1 and B2 substages (R-2 = 0.6590, p = 0.0024). Conclusions: There was a moderate correlation between the TTTP and OS of patients with HCC after TACE therapy, where the patients with short TTTP represented short OS, indicating that TTTP is an alternative parameter for survival analysis of HCC patients with BCLC stage B tumors who undergo TACE. (C) 2017 S. Karger AG, Basel
• Time to Transcatheter Arterial Chemoembolization Refractoriness in Patients with Hepatocellular Carcinoma in Kinki Criteria Stages B1 and B2

  Tadaaki Arizumi; Tomohiro Minami; Hirokazu Chishina; Masashi Kono; Masahiro Takita; Norihisa Yada; Satoru Hagiwara; Yasunori Minami; Hiroshi Ida; Kazuomi Ueshima; Ken Kamata; Kosuke Minaga; Yoriaki Komeda; Mamoru Takenaka; Toshiharu Sakurai; Tomohiro Watanabe; Naoshi Nishida; Masatoshi Kudo

  DIGESTIVE DISEASES 35 6 589 - 597 2017年 

  Background: Transarterial chemoembolization (TACE) is recommended for patients with hepatocellular carcinoma (HCC) in Barcelona Clinic Liver Cancer (BCLC) stage B. However, because of the heterogeneity of HCC in BCLC stage B; various subclassification systems have been proposed to predict the prognosis of patients. Previously, we proposed the Kinki criteria for precise classification of HCC cases in BCLC stage B. In this study, we compared the time to TACE refractoriness in HCC patients with Kinki criteria substages B1 and B2-HCC. Summary: Between January 2006 and December 2013, 592 HCC patients (substage B1, n = 118; substage B2, n = 170) underwent TACE. Time to progression under TACE treatment was defined as the time to untreatable progression (TTUP). TTUP and changes in liver function were analyzed in patients with substages B1 and B2-HCC. The median TTUP was 25.7 months (95% CI 19.3-37.3) and 16.4 months (95% CI 13.1-20.2) in patients with substage B1-HCC and substage B2-HCC, respectively (p = 0.0050). In patients with substage B2-HCC, median Child-Pugh scores after the first TACE session was significantly different from those after third and fifth TACE sessions (first-third, p = 0.0020; first-fifth, p = 0.0008). Key Message: TACE refractoriness occurred earlier in patients with substage B2-HCC than those with substage B1-HCC; deterioration of liver function with repeated TACE was more obvious in HCC cases with stage-B1 tumor. Shorter TTUP and impaired liver function due to repeated TACE could be responsible for the shorter survival in patients with substage B2-HCC. (C) 2017 S. Karger AG, Basel
• Unique Characteristics Associated with Sustained Liver Damage in Chronic Hepatitis C Patients Treated with Direct Acting Antivirals

  Masashi Kono; Naoshi Nishida; Satoru Hagiwara; Tomohiro Minami; Hirokazu Chishina; Tadaaki Arizumi; Kosuke Minaga; Ken Kamata; Yoriaki Komeda; Toshiharu Sakurai; Mamoru Takenaka; Masahiro Takita; Norihisa Yada; Hiroshi Ida; Yasunori Minami; Kazuomi Ueshima; Tomohiro Watanabe; Masatoshi Kudo

  DIGESTIVE DISEASES 35 6 556 - 564 2017年 

  Background and Aims: Direct-acting antivirals (DAAs) dramatically improve the sustained virological response (SVR) of chronic hepatitis C (CHC) patients. However, continuous liver damage after SVR may be a risk of hepatocellular carcinoma (HCC). We clarified pretreatment characteristics related to sustained liver damage after SVR. Methods: A total of 286 CHC patients were treated with an interferon-free DAA regimen. Among them, 250 patients achieved SVR for 12 weeks after the end of treatment (SVR12); these individuals were classified based on a-fetoprotein (AFP) and alanine transaminase (ALT) levels posttreatment. Baseline characteristics significantly associated with AFP > 5 ng/mL and ALT level >= 20 IU/L after SVR were clarified using multivariate analyses. Results: Among the pretreatment factors examined, serum AFP values and the presence of fatty liver (FL) were significantly associated with abnormal AFP (p < 0.0001) and ALT levels 12 weeks after SVR12 (SVR24; p = 0.0109). For 126 patients who showed an increase in baseline AFP level, FL, fibrosis-4 (FIB-4) index, and albumin levels before treatment were related to abnormal AFP at SVR24 (p = 0.0005, 0.0232, and 0.0400 for FL, FIB-4 index, and albumin, respectively). Similarly, for 150 patients with abnormal baseline ALT levels, FL was associated with an ALT level = 30 IU/L after SVR (p = 0.0430). Conclusions: High FIB-4 index, low albumin level, and FL before DAA treatment were associated with a risk of sustained liver damage with AFP and ALT elevation after SVR; patients with these factors should be carefully monitored for emergence of HCC. (C) 2017 S. Karger AG, Basel
• Impact of Tumor Factors on Survival in Patients with Hepatocellular Carcinoma Classified Based on Kinki Criteria Stage B2

  Tadaaki Arizumi; Tomohiro Minami; Hirokazu Chishina; Masashi Kono; Masahiro Takita; Norihisa Yada; Satoru Hagiwara; Yasunori Minami; Hiroshi Ida; Kazuomi Ueshima; Ken Kamata; Kosuke Minaga; Yoriaki Komeda; Mamoru Takenaka; Toshiharu Sakurai; Tomohiro Watanabe; Naoshi Nishida; Masatoshi Kudo

  DIGESTIVE DISEASES 35 6 583 - 588 2017年 

  Background: Tumors classified based on the Barcelona Clinic Liver Cancer (BCLC) stage B hepatocellular carcinoma (HCC) are heterogeneous in nature. Previously, the Kinki criterion was proposed for a more precise subclassification of tumors in BCLC-stage B. However, tumors in sub-stage B2 include various size and number of HCCs even with the Kinki criteria, which could lead to heterogeneity for overall survival (OS). In this study, we assessed how the size and number of tumors affect the OS and time to progression (TTP) in patients with Kinki criteria stage B2 tumors and treated with transarterial chemoembolization (TACE). Methods: Of 906 HCC patients treated with TACE at Kindai University Hospital, 236 patients with HCC considered as Kinki criteria stage B2 were examined. They were classified into the following 4 groups according to the maximum tumor diameter and number of tumors: B2a group, tumor size <= 6 cm and total number of tumors <= 6; B2b group, size <= 6 cm and number >6; B2c group, size >6 cm and number <= 6; and B2d group, size >6 cm and number >6. The OS and TTP of patients in each group were compared. Results: There were 131 patients (55.5%) in the B2a group, 58 (24.6%) in the B2b group, 41 (17.4%) in the B2c group, and 6 (0.03%) in the B2d group. Comparison of the survivals revealed that the median OS was 2.8 years (95% CI 2.0-3.5) in the B2a group, 2.8 years (95% CI 2.0-3.3) in the B2b group, 1.9 years (95% CI 0.8-4.0) in the B2c group, and 2.3 years (95% CI 1.2-ND [no data]) in the B2d group, respectively (p = 0.896). The median TTP in B2a, B2b, B2c, and B2d sub-substage HCC were13.2, 12.1, 13.8, and 11.5 months, respectively (p = 0.047). The median TTP in B2a + B2c sub-substage patients was longer than that in B2b + B2d sub-substage HCC patients (14.0 months and 10.4 months; p = 0.002). Conclusion: No significant differences were observed in the OS among HCC patients subclassified based on the maximum tumor diameter and tumor number in Kinki criteria stage B2. Consequently, Kinki criteria stage B2 HCC is a homogeneous subgroup in terms of OS prediction. However, shorter TTP in B2b + B2c sub-substage HCC patients than that in B2a + B2c sub-substage HCC patients suggests that different treatment strategy, such as systemic therapy with targeted agents instead of TACE, may be suitable to preserve the liver function. (C) 2017 S. Karger AG, Basel
• Clinical Significance of Bmi1 Expression in Inflammatory Bowel Disease

  Mitsunari Yamada; Toshiharu Sakurai; Yoriaki Komeda; Tomoyuki Nagai; Ken Kamata; Kosuke Minaga; Kentaro Yamao; Mamoru Takenaka; Satoru Hagiwara; Shigenaga Matsui; Tomohiro Watanabe; Naoshi Nishida; Hiroshi Kashida; Masatoshi Kudo

  Oncology 93 1 20 - 26 2017年 

  © 2017 S. Karger AG, Basel. Background: Although the stem cell marker Bmi1 is overexpressed in many malignancies, its role in inflammation-associated cancer is unclear. Colitis-associated cancer (CAC) is caused by chronic intestinal inflammation and often results from refractory inflammatory bowel disease (IBD). Methods: To assess the involvement of Bmi1 in the development of CAC, we analyzed the gene expression of colon tissues collected from 111 patients with IBD and CAC. Results: In the colonic mucosa of patients with ulcerative colitis, the expression of Bmi1 correlated significantly with the expression of inflammatory cytokines such as IL-6, IL-17, IL-23, and tumor necrosis factor α (TNF-α). In the colonic mucosa of patients with Crohn's disease, the expression of Bmi1 correlated significantly with the expression of TNF-α and IL-23. The expression of Bmi1 was enhanced in the colonic mucosae of refractory IBD, suggesting that Bmi1 expression might be related to increased cancer risk. In addition, patients with high Bmi1 expression showed significantly lower response rates upon subsequent anti-TNF-α therapy as compared to patients with low Bmi1 expression. In human CAC specimens, the expression of Bmi1 was upregulated in nontumor tissues as well as tumors. Conclusions: Bmi1 expression is related to a refractory clinical course of IBD and upregulated in refractory IBD and CAC. Measurement of Bmi1 expression is a promising approach for the advanced treatment and personalized management of IBD patients.
• Primary Hepatic Adenosquamous Carcinoma Associated with Primary Sclerosing Cholangitis

  Kentaro Yamao; Mamoru Takenaka; Hajime Imai; Atsushi Nakai; Shunske Omoto; Ken Kamata; Kosuke Minaga; Takeshi Miyata; Toshiharu Sakurai; Tomohiro Watanabe; Naoshi Nishida; Ippei Matsumoto; Yosihumi Takeyama; Takaaki Chikugo; Masatoshi Kudo

  Oncology 93 1 76 - 80 2017年 

  © 2017 S. Karger AG, Basel. Introduction: Primary sclerosing cholangitis (PSC) is a chronic cholestatic liver disorder characterized by multiple fibrotic strictures of the bile duct. More than 40% of deaths in PSC patients are related to malignant tumors, including cholangiocarcinoma. Primary hepatic adenosquamous carcinoma (ASC) is a rare subtype of cholangiocarcinoma containing adenocarcinoma (AC) and squamous cell carcinoma (SCC) components, with a poorer prognosis than other cholangiocarcinomas. We report the first case of a hepatic ASC in a patient with PSC. Case Report: A 28-year-old man was referred for diagnosis and treatment of a liver abscess suspected by contrast-enhanced computed tomography (CE-CT). He had a history of ulcerative colitis and PSC. Abdominal CE-CT revealed a 60-mm-diameter ring-shaped mass with central necrosis in the left lobe. Magnetic resonance imaging demonstrated a poorly circumscribed low-signal-intensity mass in T1-weighted imaging and a high-signal-intensity mass with a scattered low-signal-intensity area in T2-weighted imaging. Abdominal ultrasonography showed a hypoechoic component with a diffuse hyperechoic area in the tumor. Ultrasound-guided biopsy and histological examination showed tumor cells with both squamous and glandular differentiation. Left lobectomy was performed. Microscopic examination revealed 2 components, including moderately differentiated AC and well-differentiated SCC. The final diagnosis was hepatic ASC. Conclusion: This is the first reported case of hepatic ASC in a patient with PSC. Patients with PSC should be recognized as being at a risk of not only general cholangiocarcinoma, hepatocellular carcinoma, and metastatic liver tumor, but also ASC.
• Association between the Risk Factors for Pancreatic Ductal Adenocarcinoma and Those for Malignant Intraductal Papillary Mucinous Neoplasm

  Ken Kamata; Mamoru Takenaka; Atsushi Nakai; Shunsuke Omoto; Takeshi Miyata; Kosuke Minaga; Tomohiro Matsuda; Kentaro Yamao; Hajime Imai; Yasutaka Chiba; Toshiharu Sakurai; Tomohiro Watanabe; Naoshi Nishida; Takaaki Chikugo; Ippei Matsumoto; Yoshifumi Takeyama; Masatoshi Kudo

  Oncology 93 1 102 - 106 2017年 

  © 2017 S. Karger AG, Basel. Background and Aims: Risk factors for pancreatic ductal adenocarcinoma (PDAC) include diabetes mellitus, chronic pancreatitis, obesity, a family history of pancreatic cancer, and a history of smoking or alcohol consumption. The aim of this study was to evaluate the association between risk factors for PDAC and malignant intraductal papillary mucinous neoplasm (IPMN). Methods: The study included 134 consecutive patients with IPMN who underwent surgical resection at Kindai University Hospital between April 2009 and March 2015. Data on the presence or absence of mural nodules (MNs) and risk factors for PDAC were evaluated. Multivariable logistic regression analysis was performed with malignant IPMN as the outcome variable and MNs and risk factors for PDAC as explanatory variables. Results: The odds ratio of malignant IPMN to MNs was 3.88 (95% confidence interval [CI] 1.53-9.84; p = 0.004), whereas that of malignant IPMN to smoking history was 1.66 (95% CI 0.74-3.71; p = 0.22). When the presence of MNs was considered as a predictive factor for malignancy, the sensitivity and specificity were 88.5 and 32.1%, respectively, whereas when the presence of both smoking history and MNs was considered, the specificity improved to 73.2%, with a decrease in sensitivity to 42.3%. Conclusions: The presence of both a smoking history and MNs was a valuable predictive factor for malignant IPMN with high specificity. A smoking history should be considered before surgical resection in addition to the presence of MNs.
• Clinical Analysis of Esophageal Stricture in Patients Treated with Intralesional Triamcinolone Injection after Endoscopic Submucosal Dissection for Superficial Esophageal Cancer

  Kazuki Okamoto; Shigenaga Matsui; Tomohiro Watanabe; Yutaka Asakuma; Yoriaki Komeda; Ayana Okamoto; Ishikawa Rei; Masashi Kono; Mitsunari Yamada; Tomoyuki Nagai; Tadaaki Arizumi; Kosuke Minaga; Ken Kamata; Kentaro Yamao; Mamoru Takenaka; Toshiharu Sakurai; Naoshi Nishida; Hiroshi Kashida; Takaaki Chikugo; Masatoshi Kudo

  Oncology 93 1 9 - 14 2017年 

  © 2017 S. Karger AG, Basel. Introduction: Endoscopic submucosal dissection (ESD) has been widely used in the resection of superficial esophageal cancers. Since its use has been extended to cases involving large esophageal tumors occupying nearly the whole or the whole circumference of the lumen, the occurrence of esophageal stricture has increased. Although endoscopic injection of triamcinolone (TA) is widely used for the prevention of postoperative stricture, a significant number of patients still develop stricture after TA injection therapy. Methods: We performed a retrospective study to identify the clinical parameters that predispose post-ESD patients to esophageal stricture after TA injection therapy. Results: A total of 207 patients who were diagnosed with superficial esophageal cancer and subsequently underwent ESD were enrolled in this study. Among these patients, 53 patients and 57 lesions bearing mucosal defects covering greater than two-thirds of the esophageal circumference after ESD were treated with TA injection therapy. The rate of esophageal stricture was found to be highest in cases involving mucosal defects that covered more than seven-eighths of the circumference. Conclusion: Endoscopic TA injection is not sufficient for preventing esophageal stricture in patients bearing mucosal defects covering more than seven-eighths of the esophageal circumference after ESD.
• Chronic Pancreatitis Finding by Endoscopic Ultrasonography in the Pancreatic Parenchyma of Intraductal Papillary Mucinous Neoplasms Is Associated with Invasive Intraductal Papillary Mucinous Carcinoma.

  Takenaka M; Masuda A; Shiomi H; Yagi Y; Zen Y; Sakai A; Kobayashi T; Arisaka Y; Okabe Y; Kutsumi H; Toyama H; Fukumoto T; Ku Y; Kudo M; Azuma T

  Oncology 93 61 - 68 2017年 

  © 2017 S. Karger AG, Basel. Background/Objectives: The recent guideline for intraductal papillary mucinous neoplasms (IPMNs) focuses on morphological features of the lesion as signs of malignant transformation, but ignores the background pancreatic parenchyma, including features of chronic pancreatitis (CP), which is a risk factor for pancreatic malignancies. Endoscopic ultrasonography frequently reveals evidence of CP (EUS-CP findings) in the background pancreatic parenchyma of patients with IPMNs. Therefore, we investigated whether background EUS-CP findings were associated with malignant IPMN. Methods: The clinical data of 69 consecutive patients with IPMNs who underwent preoperative EUS and surgical resection between April 2010 and October 2014 were collected prospectively. The association of EUS-CP findings (total number of EUS-CP findings; 0 vs. ≥1) with invasive IPMN was examined. The association of EUS-CP findings with pathological changes of the background pancreatic parenchyma (atrophy/inflammation/fibrosis) was also examined. Results: Among patients with EUS-CP findings, invasive intraductal papillary mucinous carcinoma (IPMC) was significantly more frequent than among patients without EUS-CP findings (42.5% [17/40] vs. 3.4% [1/29], p = 0.0002). In addition, patients with EUS-CP findings had higher grades of pancreatic atrophy and inflammation than patients without EUS-CP findings (atrophy: 72.5% [29/40] vs. 34.5% [10/29], p = 0.003; inflammation: 45.0% [18/40] vs. 20.7% [6/29], p = 0.04). Conclusions: In IPMN patients, detection of EUS-CP findings in the background pancreatic parenchyma was associated with a higher prevalence of invasive IPMC. Accordingly, EUS examination should not only assess the morphological features of the lesion itself, but also EUS-CP findings in the background parenchyma.
• Needle Tract Seeding: An Overlooked Rare Complication of Endoscopic Ultrasound-Guided Fine-Needle Aspiration

  Kosuke Minaga; Mamoru Takenaka; Akio Katanuma; Masayuki Kitano; Yukitaka Yamashita; Ken Kamata; Kentaro Yamao; Tomohiro Watanabe; Hiroyuki Maguchi; Masatoshi Kudo

  Oncology 93 1 107 - 112 2017年 

  © 2017 S. Karger AG, Basel. Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) has been widely used for diagnosis of both inflammatory and tumor lesions located in and adjacent to the gastrointestinal tract. EUS-FNA has been considered to be a safe technique with few complications, as shown in recent review articles in which EUS-FNA-related morbidity and mortality rates were reported to be <1%. It should be noted, however, that needle tract seeding, although uncommon, can occur after diagnostic EUS-FNA and that this complication affects the prognosis of patients. Although an accurate value for the frequency of needle tract seeding caused by EUS-FNA has not been reported, the numbers of case reports on needle tract seeding have been rapidly increasing, especially in Japan. These case reports regarding EUS-FNA-related needle tract seeding prompted us to reevaluate the safety of EUS-FNA because this complication may have a significant influence on patients' prognoses. In this review, we summarize the clinical features and outcomes of needle tract seeding after EUS on the basis of the previously reported cases and provide useful information to prevent and reduce this serious complication.
• Magnifying Narrow Band Imaging (NBI) for the Diagnosis of Localized Colorectal Lesions Using the Japan NBI Expert Team (JNET) Classification

  Yoriaki Komeda; Hiroshi Kashida; Toshiharu Sakurai; Yutaka Asakuma; George Tribonias; Tomoyuki Nagai; Masashi Kono; Kosuke Minaga; Mamoru Takenaka; Tadaaki Arizumi; Satoru Hagiwara; Shigenaga Matsui; Tomohiro Watanabe; Naoshi Nishida; Takaaki Chikugo; Yasutaka Chiba; Masatoshi Kudo

  Oncology 93 1 49 - 54 2017年 

  © 2017 S. Karger AG, Basel. Objective: The Japan NBI Expert Team (JNET) proposed a new narrow band imaging (NBI) classification system for colorectal tumors in June 2014. In this classification system, types 1, 2A, 2B, and 3 correspond to hyperplastic polyps (HPs) including sessile serrated polyps (SSPs), low-grade dysplasia (LGD), high-grade dysplasia (HGD) to shallow submucosal invasive (SM-s) carcinomas, and deep submucosal invasive (SM-d) carcinomas, respectively. Methods: To validate this system, we performed a retrospective image evaluation study, in which 199 colorectal tumors previously assessed by NBI magnifying endoscopy were classified by 3 blinded experienced colonoscopists using the JNET system. The results were compared with the final pathological diagnoses to determine the JNET classification's accuracy. The interobserver agreement was calculated, and the intraobserver agreement was assessed after 6 months. Results: The final pathological diagnoses identified 14 HPs/SSPs, 127 LGDs, 22 HGDs, 19 SM-s carcinomas, and 17 SM-d carcinomas. The respective sensitivities, specificities, positive predictive value, negative predictive value, and accuracies were as follows: Type 1, 85.7, 99.5, 92.3, 98.9, and 98.5%; Type 2A, 96.0, 81.9, 90.3, 92.1, and 90.9%; Type 2B, 75.6%, 90.5, 67.3, 93.4, and 87.4%; and Type 3, 29.4%, 100, 100, 93.8, and 94.0%. The interobserver agreement and the intraobserver agreement were moderate (κ value: 0.52) and excellent (κ value: 0.88), respectively. Lesions presenting as Type 2B during NBI comprised a range of colorectal tumors, including HGDs, SM-s, and SM-d. Conclusions: The JNET classification was useful for the diagnosis of HPs/SSPs, LGDs, and SM-d, but not SM-s lesions. For low-confidence cases, magnified chromoendoscopy is recommended to ensure correct diagnoses.
• Utility of Endoscopic Ultrasound-Guided Hepaticogastrostomy with Antegrade Stenting for Malignant Biliary Obstruction after Failed Endoscopic Retrograde Cholangiopancreatography

  Hajime Imai; Mamoru Takenaka; Shunsuke Omoto; Ken Kamata; Takeshi Miyata; Kosuke Minaga; Kentaro Yamao; Toshiharu Sakurai; Naoshi Nishida; Tomohiro Watanabe; Masayuki Kitano; Masatoshi Kudo

  Oncology 93 1 69 - 75 2017年 

  © 2017 S. Karger AG, Basel. Background: Endoscopic ultrasound (EUS)-guided biliary drainage (BD) is a well-recognized alternative BD method after unsuccessful endoscopic transpapillary drainage. EUS-guided hepaticogastrostomy (HGS) with antegrade stenting (AGS) was recently applied to the treatment of malignant obstructive jaundice. Objective: To assess the efficacy and safety of HGS combined with AGS for treatment of malignant biliary stricture-induced obstructive jaundice. Design: Retrospective cohort study. Setting: Single academic tertiary care center. Patients: From January 2006 to December 2014, endoscopic retrograde cholangiopancreatography was attempted in patients with obstructive jaundice; it was successful in 641 patients and impossible in 154 patients (postsurgically altered anatomy or duodenal stenosis, n = 101; difficult cannulation, n = 53). In total, 145 patients underwent EUS-guided BD; HGS and HGS with AGS were attempted in 42 patients (Group A, January 2006-August 2011) and 37 patients (Group B, September 2011-December 2014), respectively. Interventions: Under EUS and fluoroscopy guidance, HGS and HGS with AGS were performed via needle puncture, guidewire insertion, puncture-hole dilation, and stent placement. Main Outcome Measurements: Groups A and B were compared in terms of technical success, functional success, adverse event rates, re-intervention rates, patient survival time, and time to stent dysfunction or patient death. The two groups were also compared in a subgroup analysis of only 28 patients who underwent chemotherapy. Results: The technical success rate was significantly higher in Group A than B (97.6 vs. 83.8%, p = 0.03). The functional success rate was comparable between the two groups (90.2 vs. 90.3%), although the rate of adverse events was significantly higher in Group A than B (26.1 vs. 10.8%, p = 0.03). The re-intervention rate tended to be higher in Group A than B (16.7 vs. 8.1%, p = 0.25). Groups A and B did not differ significantly in terms of median overall patient survival (75 vs. 61 days, p = 0.70) or median time to stent dysfunction or patient death (68 vs. 63 days, p = 0.08). Among patients who underwent chemotherapy, there was no difference in overall patient survival time between the two groups (121 vs. 157 days, p = 0.08), although time to stent dysfunction or patient death was significantly shorter in Group A than B (71 vs. 95 days, p = 0.02). Conclusion: Although the technical success rate of HGS with AGS was lower than that of HGS, HGS with AGS was superior to HGS in terms of adverse event rate and stent patency in patients receiving chemotherapy.
• Computer-Aided Diagnosis Based on Convolutional Neural Network System for Colorectal Polyp Classification: Preliminary Experience

  Yoriaki Komeda; Hisashi Handa; Tomohiro Watanabe; Takanobu Nomura; Misaki Kitahashi; Toshiharu Sakurai; Ayana Okamoto; Tomohiro Minami; Masashi Kono; Tadaaki Arizumi; Mamoru Takenaka; Satoru Hagiwara; Shigenaga Matsui; Naoshi Nishida; Hiroshi Kashida; Masatoshi Kudo

  Oncology 93 1 30 - 34 2017年 

  © 2017 S. Karger AG, Basel. Background and Aim: Computer-aided diagnosis (CAD) is becoming a next-generation tool for the diagnosis of human disease. CAD for colon polyps has been suggested as a particularly useful tool for trainee colonoscopists, as the use of a CAD system avoids the complications associated with endoscopic resections. In addition to conventional CAD, a convolutional neural network (CNN) system utilizing artificial intelligence (AI) has been developing rapidly over the past 5 years. We attempted to generate a unique CNN-CAD system with an AI function that studied endoscopic images extracted from movies obtained with colonoscopes used in routine examinations. Here, we report our preliminary results of this novel CNN-CAD system for the diagnosis of colon polyps. Methods: A total of 1,200 images from cases of colonoscopy performed between January 2010 and December 2016 at Kindai University Hospital were used. These images were extracted from the video of actual endoscopic examinations. Additional video images from 10 cases of unlearned processes were retrospectively assessed in a pilot study. They were simply diagnosed as either an adenomatous or nonadenomatous polyp. Results: The number of images used by AI to learn to distinguish adenomatous from nonadenomatous was 1,200:600. These images were extracted from the videos of actual endoscopic examinations. The size of each image was adjusted to 256 × 256 pixels. A 10-hold cross-validation was carried out. The accuracy of the 10-hold cross-validation is 0.751, where the accuracy is the ratio of the number of correct answers over the number of all the answers produced by the CNN. The decisions by the CNN were correct in 7 of 10 cases. Conclusion: A CNN-CAD system using routine colonoscopy might be useful for the rapid diagnosis of colorectal polyp classification. Further prospective studies in an in vivo setting are required to confirm the effectiveness of a CNN-CAD system in routine colonoscopy.
• Characterization of Pancreatic Tumors with Quantitative Perfusion Analysis in Contrast-Enhanced Harmonic Endoscopic Ultrasonography

  Shunsuke Omoto; Mamoru Takenaka; Masayuki Kitano; Takeshi Miyata; Ken Kamata; Kosuke Minaga; Tadaaki Arizumi; Kentaro Yamao; Hajime Imai; Hiroki Sakamoto; Yogesh Harwani; Toshiharu Sakurai; Tomohiro Watanabe; Naoshi Nishida; Yoshifumi Takeyama; Yasutaka Chiba; Masatoshi Kudo

  Oncology 93 1 55 - 60 2017年 

  © 2017 S. Karger AG, Basel. Objectives: This study evaluated whether quantitative perfusion analysis with contrast-enhanced harmonic (CH) endoscopic ultrasonography (EUS) characterizes pancreatic tumors, and compared the hemodynamic parameters used to diagnose pancreatic carcinoma. Methods: CH-EUS data from pancreatic tumors of 76 patients were retrospectively analyzed. Time-intensity curves (TIC) were generated to depict changes in signal intensity over time, and 6 parameters were assessed: baseline intensity, peak intensity, time to peak, intensity gain, intensity at 60 s (I60), and reduction rate. These parameters were compared between pancreatic carcinomas (n = 41), inflammatory pseudotumors (n = 14), pancreatic neuroendocrine tumors (n = 14), and other tumors (n = 7). All 6 TIC parameters and subjective analysis for diagnosing pancreatic carcinoma were compared. Results: Values of peak intensity and I60 were significantly lower and time to peak was significantly longer in the groups with pancreatic carcinomas than in the other 3 tumor groups (p < 0.05). Reduction rate was significantly higher in pancreatic carcinomas than in pancreatic neuroendocrine tumors (p < 0.05). Areas under the receiver-operating characteristic curves for the diagnosis of pancreatic carcinoma using subjective analysis, baseline intensity, peak intensity, intensity gain, I60, time to peak, and reduction rate, were 0.817, 0.664, 0.810, 0.751, 0.845, 0.777, and 0.725, respectively. I60 was the most accurate parameter for differentiating pancreatic carcinomas from the other groups, giving values of sensitivity/specificity of 92.7/68.6% when optimal cutoffs were chosen. Conclusions: In pancreatic carcinomas, TIC patterns were markedly different from the other tumor types, with I60 being the most accurate diagnostic parameter. Quantitative perfusion analysis is useful for differentiating pancreatic carcinomas from other pancreatic tumors.
• Risk Factors for Postoperative Bleeding in Endoscopic Submucosal Dissection of Colorectal Tumors

  Kazuki Okamoto; Tomohiro Watanabe; Yoriaki Komeda; Tatsuya Kono; Kouta Takashima; Ayana Okamoto; Masashi Kono; Mitsunari Yamada; Tadaaki Arizumi; Ken Kamata; Kosuke Minaga; Kentaro Yamao; Tomoyuki Nagai; Yutaka Asakuma; Mamoru Takenaka; Toshiharu Sakurai; Shigenaga Matsui; Naoshi Nishida; Takaaki Chikugo; Hiroshi Kashida; Masatoshi Kudo

  Oncology 93 1 35 - 42 2017年 

  © 2017 S. Karger AG, Basel. Background: Colonoscopic removal of adenomatous polyps or early cancer prevents death from colorectal cancer. Endoscopic submucosal dissection (ESD), which enables endoscopists to perform en bloc resection of flat or depressed colorectal tumors >20 mm, has recently been introduced and become a standard procedure in Japan. Although postoperative bleeding (POB) is a major complication associated with ESD, risk factors for POB have not been fully identified. Methods: A total of 451 patients (509 lesions) who underwent colorectal ESD were retrospectively analyzed to identify clinical parameters associated with POB. Results: POB occurred in 14 patients, and 7 of them had received antithrombotic therapy before ESD. Uni-and multivariate analyses revealed that antithrombotic therapy and rectal tumor location were strongly associated with POB following colorectal ESD. The incidence of POB was higher in patients on heparin bridge therapy (HBT) for the replacement of antithrombotic therapy than in patients with no HBT. Four of 7 patients (57.1%) on antithrombotic therapy experienced POB from the rectal lesions. Conclusion: Antithrombotic therapy and rectal lesions result in a higher POB incidence after colorectal ESD.
• Prophylactic Suturing Closure Is Recommended after Endoscopic Treatment of Colorectal Tumors in Patients with Antiplatelet/Anticoagulant Therapy

  Toshiharu Sakurai; Teppei Adachi; Masashi Kono; Tadaaki Arizumi; Ken Kamata; Kosuke Minaga; Kentaro Yamao; Yoriaki Komeda; Mamoru Takenaka; Satoru Hagiwara; Tomohiro Watanabe; Naoshi Nishida; Hiroshi Kashida; Masatoshi Kudo

  Oncology 93 1 27 - 29 2017年 

  © 2017 S. Karger AG, Basel. The prophylactic closure of mucosal defects after endoscopic resection is known to prevent postoperative bleeding in colorectal lesions. However, closure of large mucosal defects is difficult with conventional clips only, and several closure techniques have been previously described; use of an Endoloop, 8-ring loop, or loop clip and a small incision around the mucosal defect. Given that the prophylactic closure requires much cost and time, the application should be limited to high-risk cases. Medication of antithrombotics or antiplatelet agents would be one of the reasonable indications for prophylactic closure of mucosal defects after endoscopic resection of colorectal tumors.
• EUS-Guided Pancreatic Duct Drainage for Repeat Pancreatitis in a Patient with Pancreatic Cancer

  Ken Kamata; Mamoru Takenaka; Kosuke Minaga; Toshiharu Sakurai; Tomohiro Watanabe; Naoshi Nishida; Masatoshi Kudo

  Oncology 93 1 87 - 88 2017年 

  © 2017 S. Karger AG, Basel. Endoscopic ultrasound-guided pancreatic drainage (EUS-PD) was performed in a patient with unresectable pancreatic cancer who developed pancreatitis. In this case, EUS-PD was useful as salvage therapy for pancreatitis as the transpapillary approach was difficult.
• Detection of High-Grade Pancreatic Intraepithelial Neoplasia without Morphological Changes of the Main Pancreatic Duct over a Long Period: Importance for Close Follow-Up for Confirmation

  Kentaro Yamao; Mamoru Takenaka; Atsushi Nakai; Shunske Omoto; Ken Kamata; Kosuke Minaga; Takeshi Miyata; Hajime Imai; Toshiharu Sakurai; Tomohiro Watanabe; Naoshi Nishida; Ippei Matsumoto; Yosihumi Takeyama; Takaaki Chikugo; Masatoshi Kudo

  Oncology 93 1 81 - 86 2017年 

  © 2017 S. Karger AG, Basel. Pancreatic intraepithelial neoplasia (PanIN) is a microscopic papillary noninvasive lesion arising from the pancreatic ductal epithelium. However, the natural history and time to progression of high-grade PanIN remain unclear. Herein, we report 2 cases of high-grade PanIN without morphological changes of the main pancreatic duct (MPD) over relatively long periods. In the first case, a 63-year-old man was identified with MPD dilation. Magnetic resonance cholangiopancreatography showed localized stenosis in the pancreatic body with distal MPD dilation. Endoscopic retrograde pancreatography (ERP) was attempted because of possible high-grade PanIN but was unsuccessful. At 15-month follow-up, there was no change in the form of the MPD in various images. However, ERP was re-performed because of possible high-grade PanIN, and cytology showed adenocarcinoma. Postoperative pathology indicated diffuse lesions corresponding to high-grade PanINs in the MPD stenosis and surrounding branches. Final diagnosis was high-grade PanIN. In the second case, a 77-year-old man was identified with MPD dilation. Magnetic resonance cholangiography showed localized stenosis in the MPD of the pancreatic head with distal MPD dilation. He was diagnosed with MPD stenosis caused by chronic pancreatitis, and further examination was not recommended. At 25 months, the patient was referred to our hospital because of a mild change in MPD dilation. ERP showed localized irregular stenosis in the MPD, and cytology showed suspected adenocarcinoma. Postoperative pathology indicated a localized lesion with high-grade PanIN in the branch duct around the MPD stenosis. Final diagnosis was high-grade PanIN. In conclusion, we report 2 cases of high-grade PanIN without morphological changes of the MPD over relatively long periods. Even if a definite diagnosis is not obtained at initial examination, a strict follow-up observational study should be performed. Re-examination, including ERP, should also be considered in cases with risk factors of pancreatic cancer, even if there is no change in MPD form.
• Comparative Study of Clarithromycin- versus Metronidazole-Based Triple Therapy as First-Line Eradication for Helicobacter pylori

  Teppei Adachi; Shigenaga Matsui; Tomohiro Watanabe; Kazuki Okamoto; Ayana Okamoto; Masashi Kono; Mitsunari Yamada; Tomoyuki Nagai; Yoriaki Komeda; Kosuke Minaga; Ken Kamata; Kentaro Yamao; Mamoru Takenaka; Yutaka Asakuma; Toshiharu Sakurai; Naoshi Nishida; Hiroshi Kashida; Masatoshi Kudo

  Oncology 93 1 15 - 19 2017年 

  © 2017 S. Karger AG, Basel. Introduction: Clarithromycin (CAM)-based triple therapy comprising proton pump inhibitors and amoxicillin is administered as first-line eradication treatment against Helicobacter pylori infection. However, the eradication rate achieved with CAM-based triple therapy has decreased to <80% owing to the emergence of CAM-resistant strains. This prospective randomized study aimed to compare the efficacy of CAM-based and metronidazole (MNZ)-based triple therapy in terms of H. pylori eradication. Methods:H. pylori-positive patients were treated with CAM-based triple therapy comprising esomeprazole and amoxicillin (EAC group) or with MNZ-based triple therapy comprising esomeprazole and amoxicillin (EAM group). Results:H. pylori eradication rates achieved in the intention-to-treat (ITT) and per protocol (PP) analyses were 70.6 and 72.7%, respectively, in the EAC group. Eradication rates obtained via ITT and PP analyses were 91.7 and 94.3%, respectively, in the EAM group. In the EAC group, eradication rates were significantly lower in patients harboring CAM-resistant strains than in those harboring CAM-sensitive strains. In contrast, eradication rates were comparable between patients harboring CAM-resistant strains and those harboring CAM-sensitive strains in the EAM group. Conclusion: MNZ-based triple therapy consisting of esomeprazole and amoxicillin is superior to CAM-based triple therapy containing esomeprazole and amoxicillin as first-line eradication treatment against H. pylori.
• The usefulness of computed tomography immediately after ERCP for early detection of post ERCP pancreatitis

  Takeshi Miyata; Mamoru Takenaka; Masayuki Kitano; Tomohiko Matsuda; Syunsuke Omoto; Ken Kamata; Kosuke Minaga; Kentaro Yamao; Hajime Imai; Masatoshi Kudo

  JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY 31 248 - 248 2016年11月 [査読有り]
  
• Through-the-scope enteral metal stent placement using a short-type single-balloon enteroscope for malignant surgically reconstructed jejunal stenosis (with video)

  Kosuke Minaga; Masayuki Kitano; Mamoru Takenaka

  DIGESTIVE ENDOSCOPY 28 7 758 - 758 2016年11月
• Predictive value of low serum pancreatic enzymes in invasive intraductal papillary mucinous neoplasms

  Yosuke Yagi; Atsuhiro Masuda; Yoh Zen; Mamoru Takenaka; Hirochika Toyama; Keitaro Sofue; Hideyuki Shiomi; Takashi Kobayashi; Takashi Nakagawa; Koudai Yamanaka; Namiko Hoshi; Masaru Yoshida; Yoshifumi Arisaka; Yoshihiro Okabe; Hiromu Kutsumi; Takumi Fukumoto; Yonson Ku; Takeshi Azuma

  Pancreatology 16 5 893 - 899 2016年09月 

  © 2016 IAP and EPC Background Despite evidence suggesting a role of chronic pancreatitis in pancreatic carcinogenesis, its relationship with invasive intraductal papillary mucinous neoplasms (IPMN) remains unclear. Low levels of pancreatic enzymes are predictive markers of advanced chronic pancreatitis. We investigated whether low pancreatic enzyme levels were associated with a higher incidence of invasive IPMN. Methods This study included 146 consecutive patients who underwent surgical resection of IPMN between April 2001 and October 2014. Multivariable logistic regression analysis was conducted to assess the association between serum pancreatic enzymes and the incidence of invasive IPMN, with adjustment for clinical characteristics including alcohol consumption. The association of serum pancreatic enzymes with pathological pancreatic atrophy and inflammation in areas adjacent to or distant from the tumor was also evaluated. Results Low serum levels of pancreatic amylase and lipase were associated with a higher incidence of invasive IPMN (multivariable odds ratio [OR] = 9.6, 95% confidence interval [CI] = 2.99 to 35.1, P = 0.0001; OR = 14.2, 95% CI = 2.77 to 112, P = 0.001, respectively). Low serum pancreatic amylase and lipase levels were also associated with higher grade pancreatic atrophy in areas adjacent to the tumor (P = 0.011 and P = 0.017, respectively) and in areas distant from the tumor (P = 0.0002 and P = 0.001, respectively). Furthermore, low serum pancreatic amylase and lipase levels were associated with higher grade inflammation in areas distant from the tumor (P < 0.0001 and P = 0.001, respectively). Conclusions Low serum pancreatic enzymes may be a predictive marker of invasive IPMN. Excessive alcohol consumption did not influence the association of low pancreatic enzyme levels with invasive IPMN.
• 診断に苦慮した好酸球性胃腸炎の1例

  西川 倫子; 大井 充; 寺島 禎彦; 小畑 大輔; 吉江 智朗; 竹中 完; 塩見 英之; 藤田 剛; 東 健; 森永 友紀子

  Gastroenterological Endoscopy 58 7 1215 - 1220 (一社)日本消化器内視鏡学会 2016年07月 [査読有り]
   

  57歳男性。両下腿浮腫と腹部膨満感を主訴に受診し、上部消化管内視鏡(以下EGD)およびCT検査で4型進行胃癌が疑われたが胃粘膜の生検、周囲リンパ節のEUS-FNA(fine needle aspiration)では悪性所見を認めなかった。一方で著明な低蛋白血症を認めていたことより蛋白漏出シンチグラフィーを施行したところ消化管からの漏出を確認できた。大腸内視鏡(以下CS)上大腸粘膜に異常は認めなかったが、回腸から直腸すべての生検標本に好酸球の浸潤を認め、好酸球性胃腸炎に伴う蛋白漏出性胃腸症と診断した。(著者抄録)
• Intraductal tubulopapillary neoplasm of the bile duct: A case report and review of the published work

  Takashi Nakagawa; Yoshifumi Arisaka; Tetsuo Ajiki; Kohei Fujikura; Atsuhiro Masuda; Mamoru Takenaka; Hideyuki Shiomi; Yoshihiro Okabe; Takumi Fukumoto; Yonson Ku; Takeshi Azuma; Yoh Zen

  HEPATOLOGY RESEARCH 46 7 713 - 718 2016年06月 

  Recent studies have suggested that a peculiar tumor mimicking intraductal tubulopapillary neoplasms (ITPN) of the pancreas can develop in the bile duct. Here, we present a similar case and review the published work on the newly proposed biliary neoplasm. A 68-year-old woman was referred to us for further evaluation of a liver mass. On imaging, the tumor was 40 mm in size and intraductal in location, and was enhanced slightly on the contrast-enhanced computed tomography. No mucin overproduction was found. She underwent right hepatectomy for suspected intraductal papillary neoplasm of the bile duct. The tumor histologically consisted of the biliary-type epithelium arranged in a tubular architecture within the dilated bile duct. Tumor cells had features of high-grade dysplasia but no stroma invasion. No expressions of MUC2 and MUC5AC were noted. On molecular studies, KRAS and GNAS appeared to be wild-type genotypes. These features were in keeping with ITPN. In the published work review, "biliary ITPN" described in four manuscripts were characterized by predominantly intrahepatic/hilar in location, histological tubular architecture, negative expressions of MUC2 and MUC5AC, and uncommon alterations of KRAS, GNAS and BRAF. Although invasive malignancy was present in 71%, the outcome was favorable with the 5-year survival expected to be approximately 90%. Biliary ITPN are supposedly uncommon, but a greater awareness of this condition may give more chance to diagnose the underrecognized neoplasm.
• 悪性輸入脚狭窄に対する内視鏡的消化管金属ステント留置術の検討

  家本 孝雄; 酒井 新; 塩見 英之; 八木 洋輔; 小林 隆; 吉中 勇人; 竹中 完; 増田 充弘; 有坂 好史; 岡部 純弘; 東 健

  Gastroenterological Endoscopy 58 Suppl.1 615 - 615 (一社)日本消化器内視鏡学会 2016年04月
• 乳頭部病変の深達度診断にEUSとIDUSはいずれも必要なのか 当院における乳頭部病変の深達度診断に関する検討

  平田 祐一; 竹中 完; 増田 充弘; 佐藤 悠; 吉田 竜太郎; 池川 卓哉; 藤垣 誠治; 山中 広大; 野村 雄大; 家本 孝雄; 八木 洋輔; 那賀川 峻; 小林 隆; 吉中 勇人; 塩見 英之; 有坂 好史; 岡部 純弘; 東 健

  Gastroenterological Endoscopy 58 Suppl.1 706 - 706 (一社)日本消化器内視鏡学会 2016年04月
• 造影ハーモニックEUSを用いた膵の小腫瘤性病変の診断

  江崎 健; 塩見 英之; 黒澤 学; 吉田 竜太郎; 阿部 洋文; 佐藤 悠; 池川 卓哉; 山中 広大; 藤垣 誠治; 平田 祐一; 八木 洋輔; 家本 孝雄; 那賀川 俊; 酒井 新; 小林 隆; 竹中 完; 増田 充弘; 有坂 好史; 岡部 純弘; 東 健

  Gastroenterological Endoscopy 58 Suppl.1 707 - 707 (一社)日本消化器内視鏡学会 2016年04月
• PEP高リスク群へのERCPでは何に留意すべきか 膵炎既往群における手技側因子の解析

  竹中 完; 酒井 新; 小林 隆; 塩見 英之; 増田 充弘; 有坂 好史; 岡部 純弘; 東 健

  Gastroenterological Endoscopy 58 Suppl.1 715 - 715 (一社)日本消化器内視鏡学会 2016年04月
• 当院における80歳以上の高齢者におけるERCP後膵炎のリスク解析

  那賀川 峻; 佐藤 悠; 吉田 竜太郎; 池川 卓也; 藤垣 誠治; 山中 広大; 平田 祐一; 八木 洋輔; 家本 孝雄; 小林 隆; 吉中 勇人; 竹中 完; 増田 充宏; 塩見 英之; 有坂 好史; 岡部 純弘

  Gastroenterological Endoscopy 58 Suppl.1 774 - 774 (一社)日本消化器内視鏡学会 2016年04月
• Evaluation of the xenobiotic reaction against hyaluronate-based bioresorbable membrane in the abdominal cavity.

  Nagata M; Hoshi N; Yoshinaka H; Shiomi H; Takenaka M; Masuda A; Maruyama Y; Uchida R; Azuma T; Kutsumi H

  Progress in biomaterials 5 2 111 - 116 SpringerOpen 2016年 [査読有り]
  
• A case of eosinophilic gastroenteritis with difficulty in its diagnosis

  Michiko Nishikawa; Makoto Ooi; Yoshihiko Terashima; Daisuke Obata; Tomoo Yoshie; Mamoru Takenaka; Hideyuki Shiomi; Tsuyoshi Fujita; Takeshi Azuma; Yukiko Morinaga

  Gastroenterological Endoscopy 58 7 1215 - 1220 2016年 

  A 57-year-old man presented to our hospital with abdominal distention and bilateral leg edema. Upper GI series, endoscopy and abdominal CT scan showed the features of type 4 advanced gastric cancer; however, no malignant cells were observed in biopsy specimen sampled from the thickened wall. Laboratory examination showed significantly decreased serum total protein and albumin levels; therefore, 99m Tc-HSA scintigraphy was performed to investigate the enteric protein loss. It demonstrated the accumulation of radioactivity in the colon, suggesting the presence of protein-losing enteropathy. Colonoscopy showed no abnormal findings from the rectum to the terminal ileum; however, all intestinal biopsy specimens revealed severe eosinophilic infiltration into the mucosal layer. Taken together, the final diagnosis of eosinophilic gastroenteritis was made.
• Through-the-mesh technique after endoscopic ultrasonography-guided hepaticogastrostomy: a novel re-intervention method

  Kosuke Minaga; Mamoru Takenaka; Takeshi Miyata; Yasuhiro Ueda; Masayuki Kitano; Masatoshi Kudo

  ENDOSCOPY 48 E369 - E370 2016年
• Cyst in cyst様構造を呈し、膵粘液性嚢胞腫瘍(mucinous cystic neoplasm;MCN)との鑑別が困難であった膵内副脾に発生したepidermoid cystの1例

  平田祐一; 有坂好史; 久津見弘; 酒井新; 竹中完; 塩見英之; 東健; 松本逸平; 原重雄; 八隅秀二郎

  日本消化器病学会雑誌 112 10 1858 - 1867 2015年10月 [査読有り]
   

  In 2010, a 39-year-old woman presented with a cystic lesion, 16mm in diameter, in the tail of the pancreas. Regular follow-ups were conducted to monitor this lesion its diameter was found to increase to 45mm in 2013. Thus, the patient was admitted to our hospital for further examination and treatment. Abdominal US, abdominal contrast-enhanced CT, and MRI showed a cystic lesion of 45mm in diameter in the tail of the pancreas, which had internal septae and mural nodules inside. EUS revealed a cyst-in-cyst-like structure, with a thickened cystic wall along the entire circumference. Thus, distal pancreatectomy and splenectomy were performed on the basis of a diagnosis of mucinous cystic neoplasm. Histopathological examination of a resected specimen showed that the lesion comprised a substantial component of red-brown tone, with adjacent cystic components. The final diagnosis was an epidermoid cyst in an intrapancreatic accessory spleen.
• A case of epidermoid cyst in an intrapancreatic accessory spleen showing cyst-in-cyst-like structure mimicking mucinous cystic neoplasm

  Yuichi Hirata; Yoshifumi Arisaka; Hiromu Kutsumi; Arata Sakai; Mamoru Takenaka; Hideyuki Shiomi; Takeshi Azuma; Ippei Matsumoto; Shigeo Hara; Shujiro Yazumi

  Journal of Japanese Society of Gastroenterology 112 10 1858 - 1867 2015年10月 

  In 2010, a 39-year-old woman presented with a cystic lesion, 16mm in diameter, in the tail of the pancreas. Regular follow-ups were conducted to monitor this lesion its diameter was found to increase to 45mm in 2013. Thus, the patient was admitted to our hospital for further examination and treatment. Abdominal US, abdominal contrast-enhanced CT, and MRI showed a cystic lesion of 45mm in diameter in the tail of the pancreas, which had internal septae and mural nodules inside. EUS revealed a cyst-in-cyst-like structure, with a thickened cystic wall along the entire circumference. Thus, distal pancreatectomy and splenectomy were performed on the basis of a diagnosis of mucinous cystic neoplasm. Histopathological examination of a resected specimen showed that the lesion comprised a substantial component of red-brown tone, with adjacent cystic components. The final diagnosis was an epidermoid cyst in an intrapancreatic accessory spleen.
• 多発肝転移を伴ったSolid-pseudopapillary neoplasm(SPN)の1例

  八木洋輔; 竹中完; 岡部純弘; 藤垣誠治; 山中広大; 江崎健; 平田祐一; 家本孝雄; 那賀川峻; 小林隆; 酒井新; 塩見英之; 有坂好史; 久津見弘; 外山博近; 具英成; 原重雄, 全陽

  膵臓 30 3号 443 - 443 日本膵臓学会 2015年05月
• ガイドワイヤー型圧モニターを用いた十二指腸乳頭括約筋圧測定

  酒井 新; 小林 隆; 久津見 弘; 藤垣 誠治; 山中 広大; 平田 祐一; 江崎 健; 那賀川 峻; 家本 孝雄; 八木 洋輔; 寺島 禎彦; 竹中 完; 塩見 英之; 有坂 好史; 岡部 純弘; 東 健

  日本消化器病学会雑誌 112 臨増総会 A379 - A379 (一財)日本消化器病学会 2015年03月
• Diagnosis and management for gallbladder polyps

  Yoshifumi Arisaka; Mamoru Takenaka; Hideyuki Shiomi; Takeshi Azuma

  Journal of Japanese Society of Gastroenterology 112 3 444 - 455 2015年03月
• Effectiveness of endoscopic self-expandable metal stent placement for afferent loop obstruction caused by pancreatic cancer recurrence after pancreaticoduodenectomy

  Sakai, A.; Shiomi, H.; Okabe, Y.; Yagi, Y.; Kobayashi, T.; Shiomi, Y.; Takenaka, M.; Hoshi, N.; Arisaka, Y.; Kutsumi, H.; Azuma, T.

  Clinical Journal of Gastroenterology 8 2 103 - 107 2015年 

  © 2015, Springer Japan. Afferent loop obstruction caused by cancer recurrence after pancreaticoduodenectomy (PD) can be managed by either surgical or nonsurgical treatment. The general condition of patients with recurrent pancreaticobiliary cancer is often not good enough for them to undergo surgery, so less invasive nonsurgical treatment is desirable. We report a case of a 66-year-old male who had undergone PD for pancreatic head adenocarcinoma 10 months previously and who presented at our hospital with fever and jaundice due to afferent loop obstruction caused by pancreatic cancer recurrence. An endoscopic self-expandable metal stent (SEMS) was placed for afferent loop obstruction without any complications. He quickly recovered after SEMS placement. He retained a good quality of life by receiving chemotherapy until his death due to cancer progression. Our case indicates that this method could be an easy, effective, safe, and less invasive treatment, which may confer a better quality of life for patients with afferent loop obstruction due to cancer recurrence after PD.
• 膵腫瘤性病変における造影ハーモニックEUSの有用性

  江崎 健; 塩見 英之; 山中 広大; 平田 祐一; 八木 洋輔; 那賀川 俊; 小林 隆; 酒井 新; 竹中 完; 増田 充弘; 有坂 好史; 久津見 弘; 東 健

  Gastroenterological Endoscopy 56 Suppl.2 3052  2014年09月 [査読有り]
  
• 膵頭十二指腸切除術後の悪性輸入脚狭窄に対する内視鏡的消化管金属ステント治療の有用性

  酒井 新; 塩見 英之; 山中 広大; 江崎 健; 平田 祐一; 那賀川 峻; 八木 洋輔; 小林 隆; 竹中 完; 増田 充弘; 有坂 好史; 久津見 弘; 東 健

  Gastroenterological Endoscopy 56 Suppl.2 3056  2014年09月 [査読有り]
  
• The relationship between pancreatic atrophy after steroid therapy and diabetes mellitus in patients with autoimmune pancreatitis

  Atsuhiro Masuda; Hideyuki Shiomi; Tomokazu Matsuda; Mamoru Takenaka; Yoshifumi Arisaka; Takeshi Azuma; Hiromu Kutsumi

  PANCREATOLOGY 14 5 361 - 365 2014年09月 [査読有り]
   

  Background/objectives: Many patients with autoimmune pancreatitis (AIP) have an association with diabetes mellitus. It has not been clarified whether steroid therapy for AIP improves or worsens the condition of diabetes mellitus. The aim of this study was thus to investigate the relationship between pancreatic atrophy after steroid therapy and the clinical course of diabetes. Methods: Thirty-one AIP patients, who were treated by steroid therapy, were included in this study during December 2005 to March 2013. Pancreatic atrophy 6 months after the beginning of steroid therapy was defined to be present when the width of the pancreatic body was less than 10 mm. The relationships between pancreatic atrophy and patient characteristics as well as the course of diabetes were examined. Results: Steroid therapy was effective in all treated patients. Pancreatic atrophy was observed in 12 patients and not in 19 patients after the steroid therapy. AIP patients with pancreatic atrophy showed higher incidences of diabetes mellitus (p = 0.001,9/12 vs. 2/19), diabetes control worsening (p = 0.007,7/12 vs. 2/17), and new onset of diabetes (p = 0.02, 5/7 vs. 1/18) than those without atrophy. It was not associated with gender, other organ involvement, pattern of pancreas swelling (diffuse/focal), serum IgG4 level, alcohol intake, and pancreatic calcification on CT. Patients with new onset of diabetes needed insulin therapy, even in the maintenance therapy of AIR Conclusions: AIP patients with pancreatic atrophy after steroid therapy have a high incidence of diabetes mellitus. New onset of diabetes is closely associated with pancreatic atrophy after steroid therapy. Copyright (C) 2014, IAP and EPC. Published by Elsevier India, a division of Reed Elsevier India Pvt. Ltd. All rights reserved.
• ERCPのトラブルシューティング 選択的胆道挿管困難例に対するDouble Lumen Cannulaを用いた新しいアプローチ

  竹中 完; 有坂 好史; 久津見 弘

  胆道 28 3号 396  2014年08月 [査読有り]
  
• 内視鏡的十二指腸乳頭切除術の出血例に対する内視鏡的止血法の検討

  八木 洋輔; 有坂 好史; 酒井 新; 家本 孝雄; 那賀川 峻; 竹中 完; 塩見 英之; 増田 充弘; 久津見 弘

  胆道 28 3号 493  2014年08月 [査読有り]
  
• 管状乳頭状増殖を呈した粘液低産生IPNBの1例

  那賀川 峻; 山中 広大; 江崎 健; 平田 祐一; 八木 洋輔; 小林 隆; 酒井 新; 竹中 完; 塩見 英之; 増田 充弘; 有坂 好史; 久津見 弘; 東 健

  胆道 28 3号 516  2014年08月
• 膵頭十二指腸切除術後の悪性輸入脚狭窄による胆管炎に対する内視鏡治療

  酒井 新; 塩見 英之; 那賀川 峻; 八木 洋輔; 竹中 完; 増田 充弘; 有坂 好史; 久津見 弘

  胆道 28 3号 532  2014年08月
• 膵癌早期診断を目指して 血清メタボロミクスによる膵癌スクリーニング法の検討

  小林 隆; 塩見 英之; 久津見 弘; 山中 広大; 平田 祐一; 八木 洋輔; 那賀川 峻; 野村 雄大; 江崎 健; 酒井 新; 竹中 完; 増田 充弘; 有坂 好史

  膵臓 29 3号 465  2014年06月 [査読有り]
  
• 膵癌早期診断を目指して 早期膵癌診断を目指したIPMN症例における細胞診の工夫

  竹中 完; 塩見 英之; 増田 充弘; 有坂 好史; 久津見 弘; 東 健; 松本 逸平; 具 英成; 原 重雄; 伊藤 智雄

  膵臓 29 3号 466  2014年06月 [査読有り]
  
• Walled off necrosisに対するEUSガイド下治療

  酒井 新; 塩見 英之; 小林 隆; 竹中 完; 増田 充弘; 有坂 好史; 久津見 弘; 東 健

  膵臓 29 3号 565 - 565 日本膵臓学会 2014年06月 [査読有り]
  
• 早期膵癌診断における造影ハーモニックEUSの有用性

  江崎 健; 塩見 英之; 山中 広大; 平田 祐一; 八木 洋輔; 那賀川 峻; 酒井 新; 小林 隆; 竹中 完; 増田 充弘; 有坂 好史; 久津見 弘; 東 健

  膵臓 29 3号 579  2014年06月 [査読有り]
  
• What is the most adapted indication of prophylactic pancreatic duct stent within the high-risk group of post-endoscopic retrograde cholangiopancreatography pancreatitis? Using the propensity score analysis

  Mamoru Takenaka; Tsuyoshi Fujita; Daisuke Sugiyama; Atsuhiro Masuda; Hideyuki Shiomi; Maki Sugimoto; Tsuyoshi Sanuki; Takanobu Hayakumo; Takeshi Azuma; Hiromu Kutsumi

  JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 21 4 275 - 280 2014年04月 

  BackgroundConducting randomized controlled trial (RCT) for each of the risk factors associated with prophylactic pancreatic duct stent (PPDS) for post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) is difficult owing to the volume of cases and ethical considerations. In this study, we tried to reveal the degree of preventive effects of PPDS for each individual risk factor within the high-risk group of PEP using the propensity score analysis. MethodsThe clinical data of 1131 ERCP practices performed at Kobe University Hospital from April 2006 to February 2009 were collected prospectively. We investigated their clinical characteristics including the risk factors of PEP, the use of PPDS and complications of ERCP. We conducted the stratification analysis using the propensity score matching analysis. ResultsIn 210 propensity score-matched ERCPs, PPDS proved to be effective in preventing PEP in patients with a history of pancreatitis (odds ratio 0.11, 95% CI 0.01-0.76, P = 0.01) and cases of difficult cannulation (requiring more than 30min) (odds ratio 0.13, 95% CI 0.01-1.14, P = 0.08). ConclusionsPatients with a history of pancreatitis and cases of difficult cannulation are strongly recommended for PPDS placement. The propensity score analysis can be adapted to the ERCP-related analysis with many procedure-related factors with using retrospective data, and may be adapted to investigate the matters that are unsuitable for RCT by volume and ethical issue.
• ERCP後膵炎の病態と対策 傾向スコア解析を用いた脱落型膵管ステントが最も推奨されるリスク群の検討

  竹中 完; 増田 充弘; 久津見 弘

  Gastroenterological Endoscopy 56 Suppl.1 971  2014年04月 [査読有り]
  
• 当院における分枝型IPMNに対する細胞診の工夫

  竹中 完; 山中 広大; 平田 祐一; 江崎 健; 那賀川 峻; 小川 博史; 酒井 新; 塩見 英之; 増田 充弘; 有坂 好史; 久津見 弘; 東 健; 松本 逸平; 具 英成; 原 重雄; 伊藤 智雄

  Gastroenterological Endoscopy 56 Suppl.1 1095  2014年04月 [査読有り]
  
• 当院における慢性膵炎に対する内視鏡的治療の現状および手術移行例の要因の検討

  平田 祐一; 山中 広大; 江崎 健; 小川 浩史; 那賀川 峻; 八木 洋輔; 酒井 新; 竹中 完; 塩見 英之; 増田 充弘; 有坂 好史; 久津見 弘; 東 健

  Gastroenterological Endoscopy 56 Suppl.1 1139  2014年04月 [査読有り]
  
• 当院における85歳以上の超高齢者に対する胆膵内視鏡検査の現状

  那賀川 峻; 山中 広大; 平田 祐一; 江崎 健; 八木 洋輔; 小川 浩史; 酒井 新; 竹中 完; 増田 充弘; 塩見 英之; 有坂 好史; 久津見 弘; 東 健

  Gastroenterological Endoscopy 56 Suppl.1 1192  2014年04月 [査読有り]
  
• 肝門部胆管癌の術前ドレナージ法と胆管炎の関連性

  小川 浩史; 山中 広大; 江崎 健; 平田 祐一; 那賀川 峻; 八木 洋輔; 酒井 新; 竹中 完; 塩見 英之; 増田 充弘; 有坂 好史; 久津見 弘; 東 健; 味木 徹夫; 具 英成

  Gastroenterological Endoscopy 56 Suppl.1 1299  2014年04月 [査読有り]
  
• 当院での総胆管結石治療におけるEPLBD法の現状と問題点

  江崎 健; 塩見 英之; 山中 広大; 平田 祐一; 八木 洋輔; 那賀川 峻; 酒井 新; 小林 隆; 竹中 完; 増田 充弘; 有坂 好史; 久津見 弘; 東 健

  Gastroenterological Endoscopy 56 Suppl.1 1303  2014年04月 [査読有り]
  
• 手術例から観たIPMN由来浸潤癌の予後予測因子の検討

  竹中 完; 塩見 英之; 増田 充弘; 有坂 好史; 久津見 弘; 東 健; 松本 逸平; 具 英成; 原 重雄; 伊藤 智雄

  日本消化器病学会雑誌 111 臨増総会 A301  2014年03月 [査読有り]
  
• The Influences of Pepsin Concentrations and pH Levels on the Disinfective Activity of Ozone Nanobubble Water against Helicobacter pylori

  Fumiaki Kawara; Jun Inoue; Mamoru Takenaka; Namiko Hoshi; Atsuhiro Masuda; Shin Nishiumi; Hiromu Kutsumi; Takeshi Azuma; Takeshi Ohdaira

  DIGESTION 90 1 10 - 17 2014年 [査読有り]
   

  Aims: To investigate the utility of ozone nanobubble water (NBW3) for the treatment of Helicobacter pylori in the stomach, we tested the influence of pepsin concentrations and pH levels on the disinfective activity of NBW3, and the cytotoxicity of NBW3 against mammalian cells and mucosa. Methods: Different concentrations of pepsin were dissolved in NBW3, and the bactericidal activity was tested on H. pylori. NBW3 was adjusted to different pH levels (2.0-7.4) and the bactericidal activity on H. pylori was also tested. To examine the cytotoxicity of NBW3, AGS cells, human gastric epithelial cells, were treated with NBW3 and the viability of the cells was evaluated in vitro. Furthermore, NBW3 was administered to mice and gastric mucosal damage was evaluated by histology. Results: Pepsin reduced the disinfective activity of NBW3 on H. pylori in a pepsin concentration-dependent manner. NBW3 showed stable disinfective activity at all pH levels examined. Cytotoxicity of NBW3 against human gastric epithelial cells and gastric mucosa was not observed in our experimental setting. Conclusions: NBW3 can sustain its disinfective activity in wide range of pH levels and show no cytotoxicity on mammalian cells and tissue. Pepsin can inhibit NBW3 activity in a dose-dependent manner. (C) 2014 S. Karger AG, Basel
• MUC2 expression and prevalence of high-grade dysplasia and invasive carcinoma in mixed-type intraductal papillary mucinous neoplasm of the pancreas

  Atsuhiro Masuda; Yoshifumi Arisaka; Shigeo Hara; Ippei Matsumoto; Mamoru Takenaka; Arata Sakai; Hideyuki Shiomi; Nobuyuki Matsuki; Maki Sugimoto; Tsuyoshi Fujita; Takanobu Hayakumo; Yonson Ku; Shuji Ogino; Takeshi Azuma; Hiromu Kutsumi

  PANCREATOLOGY 13 6 583 - 588 2013年11月 

  Background/objectives: Morphological types and mucin protein expressions classify intraductal papillary mucinous neoplasms (IPMNs). Main duct (MD)-IPMN mostly consists of intestinal type (I-type), which expresses MUC2. Branch duct (BD)-IPMN mostly consists of gastric type (G-type), which does not express MUC2. However, the definition of mixed-type IPMN has yet to be clarified and it contains various histological types. The aim of this study was to investigate the relationship between MUC2 expression and the presence of high-grade dysplasia (HGD) and invasive carcinoma, especially in mixed-type IPMN. Methods: This retrospective study included 101 consecutive patients with surgically resected IPMNs between April 2001 and October 2012. All patients were morphologically classified into four distinct types (I-type, G-type, PB-type: pancreatobilliary, O-type: oncocytic) and immunohistochemical reactivity of various anti-mucin antibodies were investigated. Results: According to the classification of the 2012 international guidelines, the numbers (and histomorphological types: I/G/PB/O) of MD, mixed-type, and BD-IPMNs were 16 (12/4/0/0), 45 (16/28/1/0), and 40 (0/38/1/1). Prevalence of MUC2 expression in MD, mixed-type, and BD-IPMNs were 75% (12/16), 36% (16/45), and 0% (0/40). In mixed-type IPMN, the prevalence of HGD and/or invasive carcinoma in MUC2-positive IPMN was significantly higher than that of MUC2-negative IPMN (HGD + invasive carcinoma: 88% vs. 38%, p = 0.0017; invasive carcinoma: 50% vs. 21%, p = 0.042). Multivariate analysis showed that MUC2 expression is an independent predictive factor of HGD and invasive carcinoma in mixed IPMN (odds ratio 14.6, 95% CI 2.5-87.4, p = 0.003). Conclusions: In mixed-type IPMN, MUC2 expression clearly identified HGD and invasive carcinoma and may provide most appropriate surgical indication. Copyright (C) 2013, IAP and EPC. Published by Elsevier India, a division of Reed Elsevier India Pvt. Ltd. All rights reserved.
• MUC染色による混合型IPMNにおけるhigh risk群の抽出 International consensus guideline 2012を踏まえて

  竹中 完; 松木 信之; 塩見 英之; 増田 充弘; 有坂 好史; 久津見 弘; 早雲 孝信; 東 健; 松本 逸平; 具 英成; 原 重雄; 伊藤 智雄

  日本消化器病学会雑誌 110 臨増大会 A872  2013年09月
• 術前診断に苦慮したIgG4関連硬化性胆管炎の1例

  増田 充弘; 角山 沙織; 有坂 好史; 塩見 英之; 竹中 完; 松木 信之; 久津見 弘; 早雲 孝信; 原 重雄; 味木 徹夫; 具 英成; 東 健

  胆道 27 2号 210 - 217 2013年05月 [査読有り]
  
• 乳頭部腫瘍に対するコンベックス型EUSを用いた深達度および進展度診断 IDUSと比較して

  荻巣 恭平; 江崎 健; 酒井 新; 角山 沙織; 松木 信之; 竹中 完; 塩見 英之; 増田 充弘; 有坂 好史; 久津見 弘; 早雲 孝信; 東 健; 味木 徹夫; 具 英成; 原 重雄

  Gastroenterological Endoscopy 55 Suppl.1 1078  2013年04月
• IgG4関連硬化性胆管炎(IgG4-SC)臨床診断基準2012の問題点 IgG4-SC確定診断困難症例の特徴

  増田 充弘; 有坂 好史; 久津見 弘; 塩見 英之; 竹中 完; 松木 信之; 酒井 新; 江崎 健; 角山 沙織; 原 重雄; 早雲 孝信; 味木 徹夫; 具 英成; 東 健

  日本消化器病学会雑誌 110 臨増総会 A303  2013年02月
• A case of lymphoepithelial cyst of pancreas with unique "cheerios-like" appearance in EUS

  Wen Gao; Atsuhiro Masuda; Ippei Matsumoto; Makoto Shinzeki; Hideyuki Shiomi; Mamoru Takenaka; Nobuyuki Matsuki; Eiji Funatsu; Tsuyoshi Fujita; Yoshifumi Arisaka; Takanobu Hayakumo; Shigeo Hara; Yonson Ku; Takeshi Azuma; Hiromu Kutsumi

  Clinical Journal of Gastroenterology 5 6 388 - 392 2012年12月 

  Lymphoepithelial cyst (LEC) of the pancreas is a rare benign lesion, which is difficult to diagnose preoperatively. We describe a case of a 60-year-old male, incidentally diagnosed as having LEC of the pancreas, which was managed by laparoscopic distal pancreatectomy. Most of the reported cases of LEC were asymptomatic and diagnosed incidentally. A high index of suspicion under EUS may help in making a diagnosis and avoiding unnecessary surgery in asymptomatic patients. In particular, the unique "cheerios-like" appearance of the lesion in EUS, which was also found in this case, might be helpful in the differential diagnosis of pancreatic cystic lesions. © 2012 Springer Japan.
• Navigation for adequate MR scan with integrated MR-endoscope system using intraluminal RF coil

  Yuuichiro Matsuoka; Takahashi Akihiro; Kumamoto Etsuko; Morita Yoshinori; Takenaka Mamoru; Sakai Aya; Kutsumi Hiromu; Azuma Takeshi; Kuroda Kagayaki

  Proceedings of 9th International Interventional MRI Symposium 143  2012年09月 [査読有り]
  
• A case of lipomatous pseudohypertrophy of the pancreas diagnosed by EUS-FNA.

  Atsuhiro Masuda; Hiroshi Tanaka; Takuya Ikegawa; Tomokazu Matsuda; Hideyuki Shiomi; Mamoru Takenaka; Nobuyuki Matsuki; Saori Kakuyama; Maki Sugimoto; Tsuyoshi Fujita; Yoshifumi Arisaka; Takanobu Hayakumo; Shigeo Hara; Takeshi Azuma; Hiromu Kutsumi

  Clinical journal of gastroenterology 5 4 282 - 6 2012年08月 

  We report the case of a 56-year-old female with lipomatous hypertrophy of the pancreas. Abdominal CT and MRI showed fatty replacement over the entire pancreas. The pancreatic parenchyma was completely absent. ERCP showed no abnormal findings in the main pancreatic duct. EUS-FNA was performed to achieve a definitive diagnosis. Histological features of the FNA specimens revealed that adipose tissue generally replaced the pancreatic parenchyma, and pancreatic acini were identified with a scattered distribution. To consider the differential diagnosis of lipomatous pseudohypertrophy of the pancreas, it is necessary to distinguish it from obesity, diabetes, and age-related pancreatic fat infiltration and liposarcoma. By performing EUS-FNA, it was possible to obtain a definitive diagnosis in this patient. In conclusion, EUS-FNA may be helpful to make a definitive diagnosis in patients with lipomatous hypertrophy of the pancreas.
• Neonatal Fc receptor for IgG (FcRn) expressed in the gastric epithelium regulates bacterial infection in mice

  Y. Ben Suleiman; M. Yoshida; S. Nishiumi; H. Tanaka; T. Mimura; K. Nobutani; K. Yamamoto; M. Takenaka; A. Aoganghua; I. Miki; H. Ota; S. Takahashi; H. Matsui; M. Nakamura; R. S. Blumberg; T. Azuma

  MUCOSAL IMMUNOLOGY 5 1 87 - 98 2012年01月 

  Neonatal Fc receptors for immunoglobulin (Ig) G (FcRn) assume a central role in regulating host IgG levels and IgG transport across polarized epithelial barriers. We have attempted to elucidate the contribution of FcRn in controlling Helicobacter infection in the stomach. C57BL/6J wild-type or FcRn(-/-) mice were infected with Helicobacter heilmannii, and gastric lesions, bacterial load and the levels of antigen-specific IgG in serum and gastric juice were analyzed. The elevated levels of anti-H. heimannii IgG in gastric juice were observed exclusively in wild-type mice but not in FcRn(-/-) mice. In contrast, an increase in lymphoid follicles and bacterial loads along with deeper gastric epithelium invasion were noted in FcRn(-/-) mice. C57BL/6J wild-type or FcRn(-/-) mice were also infected with Helicobacter pylori SS1, and the results of the bacterial load in stomachs of these mice and the anti-H. pylori IgG levels in serum and gastric juice were similar to those from H. heilmannii infection. Our data suggest that FcRn can be functionally expressed in the stomach, which is involved in transcytosis of IgG, and prevent colonization by H. heilmannii and the associated pathological consequences of infection.
• IFN-γ plays an essential role in the pathogenesis of gastric lymphoid follicles formation caused by Helicobacter suis infection

  Takuya Mimura; Masaru Yoshida; Shin Nishiumi; Hiroshi Tanaka; Kentaro Nobutani; Mamoru Takenaka; Yahaya Ben Suleiman; Koji Yamamoto; Hiroyoshi Ota; Shinichi Takahashi; Hidenori Matsui; Masahiko Nakamura; Ikuya Miki; Takeshi Azuma

  FEMS Immunology and Medical Microbiology 63 1 25 - 34 2011年10月 

  In this study, we aimed to assess the role of helper T cells in the development of gastric lymphoid follicles induced by Helicobacter suis infection. C57BL/6J mice were orally inoculated with H. suis. Six weeks after infection, gastric lymphoid follicles were observed in the gastric mucosa by hematoxylin and eosin staining, and the number of follicles was increased throughout the infection period. An immunohistological examination showed that the lymphoid follicles were composed of B cells, CD4-positive helper T cells, and dendritic cells (DC). It was also revealed that the mRNA expression level of interferon-γ (IFN-γ) in the gastric mucosa was significantly increased at 12 weeks after infection. No gastric lymphoid follicles were detected in IFN-γ-deficient mice that had been infected with H. suis at 12 weeks after infection, although the development of lymphoid follicles in IL-4-deficient mice infected with H. suis was similar to that seen in the wild-type mice. In conclusion, IFN-γ, a Th1 cytokine, is deeply involved in the pathogenesis of gastric lymphoid follicles induced by H. suis infection, and it is suggested that CD4-positive T cells and DC aid in the expansion of gastric lymphoid follicles. © 2011 Federation of European Microbiological Societies. Published by Blackwell Publishing Ltd.
• Helicobacter suis KB1 derived from pig gastric lymphoid follicles induces the formation of gastric lymphoid follicles in mice through the activation of B cells and CD4 positive cells

  Koji Yamamoto; Hiroshi Tanaka; Yosuke Nishitani; Shin Nishiumi; Ikuya Miki; Mamoru Takenaka; Kentaro Nobutani; Takuya Mimura; Yahaya Ben Suleiman; Shigeto Mizuno; Mikihiko Kawai; Ikuo Uchiyama; Masaru Yoshida; Takeshi Azuma

  MICROBES AND INFECTION 13 7 697 - 708 2011年07月 

  "Helicobacter heilmannii" ("H. heilmannii"), which belongs to the genus Helicobacter, is a group of bacterial species that display a long spiral-shaped morphology. Recent studies have demonstrated that "H. heilmannii" type I is actually H. suis, which mainly colonizes the stomachs of various animals and humans. However, the influence of H. suis on gastric diseases remains to be fully elucidated. In this report, we revealed the relationship between natural H. suis infection and follicular gastritis in the pig stomachs. From sequence analysis of the 16S rRNA, urease A, and urease B genes, the presence of H. suis was confirmed in pig gastric lymphoid follicles, and this bacterium was named H. suis KB1. In addition, H. suis KB1 was inoculated into C57BL/6J mice, and the following mouse model of the pathogenesis of follicular gastritis by H. suis infection was established: H. suis KB1 colonizes the mouse stomach, and moreover, induces the development of lymphoid follicles and acquired immune responses characterized by the activation of B cells and CD4 positive cells. These results may lead to better understanding of the relationship between H. suis and gastric diseases, especially follicular gastritis; and furthermore, our findings emphasize the zoonotic aspects of animal-human infection by H. suis. (C) 2011 Institut Pasteur. Published by Elsevier Masson SAS. All rights reserved.
• A case of small pancreatic cancer with intraductal progress

  Nobuhiko Fukuba; Koichi Fujita; Shinji Nakayama; Mamoru Takenaka; Saori Matsui; Masato Ozaka; Kotaro Shibagaki; Hiroshi Yoshinaga; Akira Masuzawa; Akihiko Watanabe; Hitoshi Fujiwara; Atsushi Sugahara; Tsuyoshi Fujita; Hidekazu Mukai; Tadashi Tsukamoto; Kazuhiro Teramura

  Journal of Japanese Society of Gastroenterology 107 5 792 - 797 2010年05月 

  A 60-year-old man was admitted to our department for further evaluation of main pancreatic duct dilatation detected on ultrasonography. Endoscopic retrograde cholangiopancreatography showed stenosis of the main pancreatic duct at the junction of the pancreatic head and body. Brush cytology revealed pancreatic ductal carcinoma Histological examination of the resected pancreas showed a 15-mm in length intraductal growth of carcinoma in situ in the main pancreatic duct, 10mm of which showed microinvasion. There was also atypical hyperplasia at a branch pancreatic duct near the lesion. It was suspected to be an initial stage of pancreatic ductal carcinoma. Intraductal progression type and non-progression type are often suspected in a case showing progression of carcinoma in situ to pancreatic ductal carcinoma, and this case was thought to be intraductal progression.
• Complete response of a pancreatic adenosquamous carcinoma to chemoradiotherapy

  Kotaro Shibagaki; Koichi Fujita; Shinji Nakayama; Mamoru Takenaka; Nobuhiko Fukuba; Saori Matsui; Masato Ozaka; Hiroshi Yoshinaga; Akira Masuzawa; Akihiko Watanabe; Hitoshi Fujiwara; Atsushi Sugawara; Tsuyoshi Fujita; Hidekazu Mukai; Yoshikazu Kinoshita

  INTERNATIONAL JOURNAL OF CLINICAL ONCOLOGY 13 1 74 - 77 2008年02月 [査読有り]
   

  A 51-year-old woman with an unresectable pancreatic tumor that was histologically diagnosed as an adeno-squamous carcinoma underwent chemoradiotherapy with 5-fluourouracil (FU) and low-dose cisplatin (low-dose FP). Because we recognized a partial response to the chemoradiotherapy, we subsequently administered combined chemotherapy with S-1 and cisplatin. After one course of this combined chemotherapy, the tumor was further reduced in size and became difficult to discern on abdominal computed tomography (CT). We have continued to administer the S-1 and cisplatin combined chemotherapy, and the patient is still alive. After 20 months of treatment, the tumor has not recurred (as assessed by abdominal CT). Additionally, we have not seen elevation of tumor markers. This report presents the successful use of chemoradiotherapy with low-dose FP and additional combined chemotherapy with S-1 and cisplatin for unresectable pancreatic adenosquamous carcinoma.

書籍

• 遭遇の機会が増えたIPMN/膵嚢胞―現状と課題 2 IPMN/膵嚢胞の診療(4)悪性IPMNとIPMN併存膵癌の診断におけるEUSの役割

  鎌田研; 原茜; 山雄健太郎; 竹中完; 工藤正俊 (担当:共著範囲:)臨床消化器内科 34(12) 1476‐1481 2019年10月
• コラム (4) : 急性膵炎に伴うWONに対するドレナージ治療

  田村崇; 北野雅之; 竹中完 (担当:共著範囲:)胆と膵 40: 1283-1289 2019年09月
• 術後内視鏡診療のすべて[各論 消化器手術後の内視鏡検査―サーベイランスと異時性病変の診断―]消化管再建術後における超音波内視鏡を用いたスクリーニング検査

  鎌田研; 原茜; 田中秀和; 石川嶺; 岡本彩那; 中井敦史; 大本俊介; 三長孝輔; 山雄健太郎; 竹中完; 工藤正俊 (担当:共著範囲:)消化器内視鏡 31(9) 1331‐1336 2019年09月
• 膵癌における内視鏡診断・治療の最前線 術後膵液瘻に対する内視鏡的ドレナージの現状

  竹中完; 中井敦史; 吉川智恵; 石川嶺; 岡本彩那; 山崎友裕; 大本俊輔; 三長孝輔; 鎌田研; 山雄健太郎; 亀井敬子; 松本逸平; 竹山宜典; 工藤正俊 (担当:単著範囲:)胆と膵 40(9) 807‐814 2019年09月
• エキスパートへの道―胆・膵 ERCP関連 挿管手技 膵管ガイドワイヤー留置法―確実に成功させるコツ―

  竹中完; 中井敦史; 工藤正俊 (担当:共著範囲:)消化器内視鏡 31(3) 348‐353 2019年03月
• 重症急性膵炎のマネジメント - 集中治療と特殊治療の適応について -

  大本俊介; 竹中完; 工藤正俊 (担当:共著範囲:)胆と膵 40(臨時増刊特大): 1283-1289 2019年
• 膵管内乳頭粘液性腫瘍術後フォローアップにおけるEUSの有用性

  鎌田 研; 千葉 康敬; 渡邉 智裕; 櫻井 俊治; 西田 直生志; 筑後 考章; 松本 逸平; 竹山 宜典; 北野 雅之; 工藤 正俊; 竹中 完; 三長 孝輔; 大本 俊介; 宮田 剛; 山雄 健太郎; 今井 元; 中井 敦史; 田中 秀和 (担当:共著範囲:)日本消化器内視鏡学会雑誌 61(4) 417-426 2019年01月
• 乳頭形態別の胆管挿管ストラテジー【動画付】

  竹中完; 向井秀一; 吉川智恵; 石川嶺; 岡本彩那; 山崎友祐; 中井敦史; 大本俊介; 三長孝輔; 鎌田研; 山雄健太郎; 工藤正俊 (担当:単著範囲:)胆と膵 39(12): 1309-1317 2018年12月
• 超音波内視鏡下瘻孔形成術における胆汁漏出の予防 (特集 Interventional EUSの偶発症予防と対処)

  鎌田 研; 竹中 完; 三長 孝輔; 石川 嶺; 吉川 智恵; 岡本 彩那; 山崎 友裕; 中井 敦史; 大本 俊介; 山雄 健太郎; 工藤 正俊 (担当:単著範囲:)消化器・肝臓内科 = Gastroenterology & hepatology 4(6) 470-473 2018年12月
• IPMNに合併・併存する膵癌とその診断法 (特集 膵管内乳頭粘液性腫瘍(IPMN)の診断と経過観察法)

  鎌田 研; 竹中 完; 工藤 正俊 (担当:共著範囲:)日本医事新報 (4940) 36-40 2018年12月
• 胆管・膵管プラスチックステント迷入への対処

  竹中完; 三長孝輔; 鎌田研; 山雄健太郎; 工藤正俊 消化器内視鏡 30(11): 1605-1611 2018年11月
• 胆膵疾患内視鏡アトラス I.膵臓 1.充実性 特殊型膵癌―腺扁平上皮癌,退形成性膵管癌,腺房細胞癌―

  竹中完; 筑後孝章; 工藤正俊 (担当:単著範囲:)消化器内視鏡 30 54‐57 2018年10月
• どうする膵嚢胞[各論 IPMN]IPMNの経過観察におけるEUSの今後

  鎌田研; 竹中完; 中井敦史; 大本俊介; 宮田剛; 三長孝輔; 山雄健太郎; 今井元; 樫田博史; 工藤正俊 (担当:共著範囲:)消化器内視鏡 30(5) 606‐610 2018年05月
• 膵癌の癌性疼痛に対するEUSガイド下神経叢ブロック(融解)術の有用性

  宮田剛; 竹中完; 工藤正俊 (担当:共著範囲:)臨床消化器内科 33(7) 950‐957 2018年05月
• 消化器内科診療レジデントマニュアル 胆膵領域

  竹中完; 工藤正俊 (担当:分担執筆範囲:)消化器内科診療レジデントマニュアル 2018年
• Uneven Double Lumen Cannulaを用いた胆管カニュレーションテクニック (Uneven method) 【動画付】

  竹中完; 吉川智恵; 石川嶺; 岡本彩那; 山崎友祐; 中井敦史; 大本俊介; 三長孝輔; 鎌田研; 山雄健太郎; 有坂好史; 工藤正俊 (担当:単著範囲:)胆と膵 39(臨時増刊特大): 1013-1020 2018年
• 急性胆嚢炎の発症機序と鑑別診断のコツ

  竹中完; 中井敦史; 大本俊介; 宮田剛; 三長孝輔; 鎌田研; 山雄健太郎; 今井元; 工藤正俊 (担当:単著範囲:)胆と膵 38(10): 1137-1145 2017年10月
• EUS-guided pancreatic ductal drainage（EUS-PD）の適応と手技のコツ

  竹中 完 (担当:単著範囲:)消化器・肝臓内科 第2巻第3号 2017年09月
• 膵炎における腸管免疫機構破綻と重症化機序

  渡邉智裕; 三長孝輔; 鎌田研; 山雄健太郎; 竹中完; 工藤正俊 (担当:共著範囲:)肝胆膵 75(5): 991-996 2017年05月
• IPMN経過観察におけるEUSの有用性

  鎌田研; 竹中完; 北野雅之; 工藤正俊 (担当:共著範囲:)肝胆膵 74(4): 583-586 2017年04月
• 胆石膵炎

  竹中 完 (担当:単著範囲:)消化器・肝臓内科 第1巻第3号 2017年03月
• IPMNに併存した小膵癌の解析

  山雄健太郎; 竹中完; 中井敦史; 大本俊介; 鎌田研; 三長孝輔; 宮田剛; 今井元; 松本逸平; 竹山宜典; 筑後孝章; 工藤正俊 (担当:共著範囲:)肝胆膵 75(3): 611-619 2017年03月
• スコープのたわみを意識したセッティングを - 使えるものはティッシュ箱でも使え!

  竹中完; 北野雅之; 工藤正俊 (担当:単著範囲:)消化器内視鏡 29(6): 1108-1109 2017年
• 胆嚢ドレナージ - 私はこうする -

  三長孝輔; 北野雅之; 竹中完; 鎌田研; 中井敦史; 大本俊介; 宮田剛; 山雄健太郎; 今井元; 工藤正俊 (担当:共著範囲:)胆と膵 38(臨時増刊特大): 1071-1078 2017年
• 診断 : IPMN診療におけるEUSの位置付け ~有用性とこれからの課題~

  竹中完; 鎌田研; 北野雅之; Bertrand Napoleon; 工藤正俊 (担当:単著範囲:)胆と膵 37(11): 1475-1480 2016年11月
• EUSガイド下胆嚢ドレナージ術

  竹中完; 北野雅之; 鎌田研; 三長孝輔; 大本俊介; 宮田剛; 山雄健太郎; 今井元; 工藤正俊 (担当:単著範囲:)消化器内視鏡 28(10): 1669-1678 2016年10月
• 早期慢性膵炎

  竹中完; 北野雅之; 工藤正俊 (担当:単著範囲:)成人病と生活習慣病 46(10): 1272-1280 2016年10月
• 早期慢性膵炎の診断基準と臨床的意義

  竹中完; 北野雅之; 門阪薫平; 工藤正俊 (担当:単著範囲:)胆と膵 37(4): 325-332 2016年04月
• 【肝胆膵・術後病態を學ぶ】その他関連疾患 肝膿瘍 胆道疾患関連肝膿瘍を中心に

  竹中 完; 平田 祐一; 八木 洋輔; 那賀川 峻; 塩見 英之; 有坂 好史; 岡部 純弘; 久津見 弘 (担当:共著範囲:)肝胆膵 69(1号) 93-98 2014年07月
• 【乳頭を攻略する-カニュレーションの基本と困難例への対処】 膵管カニュレーションのコツ

  有坂 好史; 竹中 完; 増田 充弘; 塩見 英之; 小林 隆; 酒井 新; 那賀川 峻; 八木 洋輔; 江崎 健; 平田 祐一; 山中 広大; 久津見 弘; 東 健 (担当:単著範囲:)消化器内視鏡 26(2号) 280-288 2014年02月
• 黄疸とその鑑別診断

  向井秀一; 廣吉康秀; 藤元瞳; 松木信之; 氣比恵; 藤田光一; 津村英隆; 阿南隆洋; 稲垣恭和; 足立会美; 竹中完; 叶多篤史; 吉永寛; 渡辺明彦; 菅原淳; 藤田剛 (担当:共著範囲:)消化器内視鏡 20(6): 751-755 2008年06月
• 慢性膵炎に対する副乳頭からのステント留置

  向井秀一; 加藤隆夫; 福庭暢彦; 藤元瞳; 氣比恵; 藤田光一; 津村英隆; 中山新士; 稲垣恭和; 足立会美; 竹中完; 吉永寛; 渡辺明彦; 菅原淳; 藤田剛 消化器内視鏡 19(12): 1715-1721 2007年12月

講演・口頭発表等

• Advances in EUS-related procedures for the pancreatobiliary diseases  [招待講演]

  竹中 完

  第３回中国広州中山大学消化器内視鏡学会 2019年12月 公開講演，セミナー，チュートリアル，講習，講義等
• Usefulness of EU-ME2 premier plus and usage tips  [招待講演]

  竹中 完

  第３回中国広州中山大学消化器内視鏡学会 2019年12月 公開講演，セミナー，チュートリアル，講習，講義等
• 胆膵領域透視下手技に関する被ばくの現状と低減の取り組み  [招待講演]

  Mamoru Takenaka

  第96回日本内視鏡学会総会ランチョンセミナー 2019年11月 日本 日立
  
• 胆管挿管100%の極意  [招待講演]

  Mamoru Takenaka

  第96回日本内視鏡学会総会サテライトセミナー 2019年11月 日本 ガデリウス
  
• Balloon center method for endoscopic cholangiolithotomy  [招待講演]

  竹中 完

  Asian Pancreatobiliary Endoscopist Future Forum 2019年11月 公開講演，セミナー，チュートリアル，講習，講義等
• 血清IFN-α/IL-33が治療効果判定に有用と考えられた自己免疫性膵炎/IgG4関連疾患の1例  [通常講演]

  原 茜; 三長 孝輔; 岡本 彩那; 石川 嶺; 山崎 友裕; 中井 敦史; 大本 俊介; 鎌田 研; 山雄 健太郎; 竹中 完; 渡邉 智裕; 安川 覚; 工藤 正俊

  日本消化器病学会近畿支部例会プログラム・抄録集 2019年10月
• 急性胆嚢炎に対する治療戦略 急性胆嚢炎治療における内視鏡的経乳頭胆嚢ドレナージ(ENGBD)の位置づけ  [通常講演]

  武部 敦志; 竹中 完; 工藤 正俊; 竹山 宜典

  日本消化器病学会近畿支部例会プログラム・抄録集 2019年10月
• 膵癌診断のための新たなアプローチ法の提案―3D CT解析による膵実質萎縮の検討―  [通常講演]

  山雄健太郎; 竹中完; 工藤正俊

  日本消化器がん検診学会雑誌 2019年09月
• How to use image enhancement function in EUS  [招待講演]

  竹中 完

  中国広東省中病院EUS-TTT活動 2019年07月 公開講演，セミナー，チュートリアル，講習，講義等
• What is the cause of treatment failure?  [招待講演]

  竹中 完

  Tokyo Conference of Asian Pancreato-biliary Interventional Endoscopy 2019年06月 シンポジウム・ワークショップパネル（指名）
• Recent advance in biliary metallic stenting for hilar stricture  [通常講演]

  竹中 完

  Tokyo Conference of Asian Pancreato-biliary Interventional Endoscopy 2019年06月 公開講演，セミナー，チュートリアル，講習，講義等
• 胆管挿管にどう挑むか。どのように乳頭と対峙すべきか。 ~スコープが及ぼす影響と新型デバイスの可能性~  [招待講演]

  Mamoru Takenaka

  第95回日本内視鏡学会総会サテライトセミナー 2019年06月 日本 オリンパス
  
• ERCP,EUS下ドレナージにおける被ばくの現状と被ばく低減への取り組み  [招待講演]

  Mamoru Takenaka

  第95回日本内視鏡学会総会ランチョンセミナー 2019年05月 日本 日立
  
• How to learn EUS  [招待講演]

  竹中 完

  中国広州中南大学湘雅二医院EUSサロン 2019年01月 公開講演，セミナー，チュートリアル，講習，講義等
• 肝門部胆管狭窄に対するドレナージ〜新型Braidedステントの可能性  [招待講演]

  竹中 完

  第101回日本消化器内視鏡学会近畿支部例会 コーヒーブレイクセミナー 2018年11月 公開講演，セミナー，チュートリアル，講習，講義等 日本 ゼオンメディカル
  
  ダウンロード
• How to treat cystic neoplasms of the pancreas  [招待講演]

  竹中 完

  広東省中病院EUS-TTT活動 2018年10月 公開講演，セミナー，チュートリアル，講習，講義等
• The useful cannulation method for the intra-diverticular papilla with long oral protrusion using the biopsy forceps for axis alignment  [招待講演]

  竹中 完

  Asian Pancreatobiliary Endoscopist Future Forum 2018年09月 公開講演，セミナー，チュートリアル，講習，講義等
• EUS画像強調機能を使い尽くす！  [招待講演]

  Mamoru Takenaka

  第49回膵臓学会ランチョンセミナー 2018年06月 日本 オリンパス
  
• 胆膵疾患に対する内視鏡手技の進化〜PSは次のステージへ〜  [招待講演]

  Mamoru Takenaka

  第94回日本内視鏡学会総会ランチョンセミナー 2018年05月 日本 ガデリウス
  
• How to manage in patients with duodenal obstruction  [招待講演]

  竹中 完

  New Horizon of biliary SEMS in Korea-Japan 2018年04月 シンポジウム・ワークショップパネル（指名）
• New method of biliary cannulation  [招待講演]

  竹中 完

  Asian Pancreatobiliary Endoscopist Future Forum 2017年12月 公開講演，セミナー，チュートリアル，講習，講義等
• カニュレーション原点回帰、もう一度振り返るカニュレーションの基本  [招待講演]

  Mamoru Takenaka

  第105回日本内視鏡学会関東支部例会エキスパートセミナー 2017年12月 日本 COOK
  
• Hepaticogastrostomy guided by real-time contrast-enhanced harmonic endoscopic ultrasonography: a novel technique.  [招待講演]

  竹中 完

  Asian Pancreatobiliary Endoscopy Conference 2017年11月 公開講演，セミナー，チュートリアル，講習，講義等
• New method for difficult biliary cannulation using a double lumen catheter (DLC method)  [招待講演]

  竹中 完

  Asian Pancreatobiliary Endoscopy Conference 2017 2017年11月 公開講演，セミナー，チュートリアル，講習，講義等
• EUS下ドレナージの実際（EUS-HGS）  [招待講演]

  Mamoru Takenaka

  第93回日本内視鏡学会総会サテライトセミナー 2017年10月 日本 センチュリー
  
• 胆道ドレナージの実際〜こんな時どうする？〜  [招待講演]

  Mamoru Takenaka

  第53回胆道学会ランチョンセミナー 2017年09月 日本 ボストン
  
• Contrast Enhanced EUS  [招待講演]

  竹中 完

  広東省中病院EUS-TTT活動 2017年08月 公開講演，セミナー，チュートリアル，講習，講義等
• ERCP時のカニュレーションの基本と挿入困難例の対処  [招待講演]

  Mamoru Takenaka

  第103回日本消化器内視鏡学会九州支部例会モーニングセミナー 2017年05月 日本 ゼオンメディカル
  
• ザ・プラスチックステント Future &Past  [招待講演]

  Mamoru Takenaka

  第93回日本内視鏡学会総会モーニングセミナー 2017年05月 日本 ガデリウス
  
• 胆管手技の極め…切石&ドレナージ デバイス進化と特性  [招待講演]

  Mamoru Takenaka

  第93回日本内視鏡学会総会ランチョンセミナー 2017年05月 日本 メディコスヒラタ
  
• Contrast enhanced EUS and Interventional EUS  [招待講演]

  竹中 完

  Asian Pancreatobiliary Endoscopy Conference 2016年10月 公開講演，セミナー，チュートリアル，講習，講義等
• Endoscopic ultrasound-guided drainage of intra abdominal abscess  [招待講演]

  竹中 完

  Society of Gastrointestinal Intervention in Korea 2016年10月 公開講演，セミナー，チュートリアル，講習，講義等
• A novel dynamic imaging of gallbladder tumor vessels with contrast-enhanced harmonic EUS  [招待講演]

  竹中 完

  Tokyo Conference of Asian Pancreato-biliary Interventional Endoscopy 2016年06月 シンポジウム・ワークショップパネル（公募）
• 胆管メタリックステントの新潮流〜ダブルメタリックステントってなんだ？〜  [招待講演]

  Mamoru Takenaka

  第89回日本内視鏡学会総会ランチョンセミナー 2015年05月 日本 アダチ
  

MISC

• 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 Supplement 50 2023年
• 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 Supplement 50 2023年
• A MULTICENTER RETROSPECTIVE STUDY OF ENDOSCOPIC TREATMENT FOR PANCREATIC FLUID COLLECTIONS: WONDERFUL STUDY GROUP

  Shunsuke Omoto; Mamoru Takenaka; Tomotaka Saito; Masahiro Tsujimae; Atsuhiro Masuda; Tatsuya Sato; Tsuyoshi Hamada; Shinya Uemura; Takuji Iwashita; Shogo Ota; Hideyuki Shiomi; Keito Nakagawa; Saburo Matsubara; Sho Takahashi; Toshio Fujisawa; Kensaku Yoshida; Akinori Maruta; Mitsuru Okuno; Keisuke Iwata; Nobuhiko Hayashi; Tsuyoshi Mukai; Ichiro Yasuda; Hiroyuki Isayama; Yousuke Nakai GASTROINTESTINAL ENDOSCOPY 95 (6) AB42 -AB43 2022年06月
• 消化管ステント留置における放射線被曝量の検討:REX-GI試験からの検討

  十倉淳紀; 由雄敏之; 藥師神崇行; 庵原秀之; 山口真二郎; 桑井寿雄; 淺井哲; 山田拓哉; 津村英隆; 波佐谷兼慶; 木暮宏史; 松永和大; 前谷容; 高木忠之; 林史郎; 竹中完; 細野眞; 西田勉 Gastroenterological Endoscopy (Web) 64 (Supplement1) 2022年
• 消化管EUSのすべて 造影ハーモニックEUSによる上部消化管疾患の診断

  田中秀和; 鎌田研; 竹中完; 松井繁長; 樫田博史 消化器内視鏡 34 (9) 2022年
• RISK FACTORS AND PREVENTIVE MEASURES FOR POST-ERCP PANCREATITIS IN BILIARY ERCP: A MULTICENTER PROSPECTIVE COHORT STUDY IN JAPAN

  Masanori Asada; Koichi Fujita; Shujiro Yazumi; Hirofumi Kawamoto; Mamoru Takenaka; Toru Maruo; Kazuya Matsumoto; Hisakazu Matsumoto; Hiroko Nebiki; Akira Kurita; Takumi Onoyama; Takeshi Tomoda; Toshiharu Ueki; Keiji Hanada; Masahiro Tsujimae; Tokuhiro Matsubara; Satoki Yasumura; Akihito Okazaki; Ken Hirao; Takashi Tamura; Saiko Marui; Hideki Kamada; Kazunori Hasegawa; Chishio Noguchi; Akira Mitoro; Atsuhiro Masuda; Ichiro Moriyama; Ryoji Takada; Toshiro Katayama; Takashi Kawamura GASTROINTESTINAL ENDOSCOPY 93 (6) AB161 -AB162 2021年06月
• 急性膵炎後の被包化壊死(WON)に対する治療

  竹中完 Japanese Journal of Diagnostic Imaging 39 2021年
• 胆嚢病変に対するDetective flow imaging(DFI)の有用性について

  竹中完; 大本俊介; 工藤正俊 超音波医学 Supplement 48 2021年
• Walled-off necrosisに対するEUS-guided cyst drainageにおける造影EUSの有用性

  竹中完; 工藤正俊 超音波医学 Supplement 48 2021年
• ついつい教えたくなる,とっておきのコツ[胆膵 挿入]穿孔させないERCPスコープ挿入のコツ

  竹中完; 工藤正俊 消化器内視鏡 33 (2) 2021年
• 急性膵炎診療up-to-date IV.治療 急性膵炎診療における地域連携モデルの構築

  大本俊介; 竹中完; 工藤正俊; 松本逸平; 竹山宜典 肝胆膵 82 (1) 2021年
• 肝外胆管癌のT-stagingに対する造影ハーモニックEUSと造影CTの比較検討

  大塚康生; 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 114th 2021年
• 胆道感染症の診断・治療 1 急性胆管炎・胆嚢炎の病態

  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 臨床消化器内科 36 (9) 2021年
• 膵腫瘤におけるDetective flow imaging(DFI)の有用性の検討

  大本俊介; 竹中完; 工藤正俊 日本消化器病学会雑誌(Web) 118 2021年
• 内視鏡的胆道ドレナージ術における放射線被ばく量評価

  竹中完; 工藤正俊 日本消化器病学会雑誌(Web) 118 2021年
• 急性膵炎発症時におけるプレサルコペニアの臨床的意義

  田中隆光; 竹中完; 工藤正俊 日本消化器病学会雑誌(Web) 118 2021年
• 悪性胆道病変に対するDetective flow imaging(DFI)の有用性について

  岡本彩那; 大本俊介; 竹中完 日本消化器病学会雑誌(Web) 118 2021年
• 急性膵炎からアプローチする膵癌早期診断

  山雄健太郎; 竹中完; 工藤正俊 日本消化器病学会雑誌(Web) 118 2021年
• 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; 竹中完 Gastroenterological Endoscopy (Web) 63 (Supplement1) 2021年
• 慢性膵炎による難治性疼痛に対する内科的インターベンション治療と外科治療の比較解析

  松本逸平; 三長孝輔; 村瀬貴昭; 宮田剛; 川口晃平; 亀井敬子; 水野修吾; 糸井隆夫; 大原弘隆; 正宗淳; 阪上順一; 佐田尚宏; 竹中完; 北野雅之; 乾和郎; 竹山宜典 膵臓(Web) 36 (3) 2021年
• 早期慢性膵炎診断における診断基準改定の影響

  竹中完; 大塚康生; 石川嶺; 山崎友裕; 竹山宜典; 工藤正俊 膵臓(Web) 36 (3) 2021年
• 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(Web) 36 (3) 2021年
• 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(Web) 36 (3) 2021年
• IPMNの壁在結節評価におけるDetective flow imaging(DFI)の有用性について

  竹中完; 高島耕太; 岡本彩那; 大本俊介; 工藤正俊 膵臓(Web) 36 (3) 2021年
• 急性膵炎地域連携モデル構築がもたらす膵炎診療への有効性

  竹中完; 大本俊介; 竹山宜典; 工藤正俊 膵臓(Web) 36 (3) 2021年
• A MULTICENTER PROSPECTIVE COHORT STUDY OF ADVERSE EVENTS ASSOCIATED WITH BILIARY ERCP

  Koichi Fujita; Shujiro Yazumi; Hirofumi Kawamoto; Mamoru Takenaka; Toru Maruo; Kazuya Matsumoto; Hisakazu Matsumoto; Masanori Asada; Hiroko Nebiki; Akira Kurita; Takumi Onoyama; Takeshi Tomoda; Toshiharu Ueki; Keiji Hanada; Masahiro Tsujimae; Tokuhiro Matsubara; Satoki Yasumura; Akihito Okazaki; Ken Hirao; Takashi Tamura; Saiko Marui; Hideki Kamada; Kazunori Hasegawa; Chishio Noguchi; Akira Mitoro; Toshiro Katayama; Takashi Kawamura GASTROINTESTINAL ENDOSCOPY 91 (6) AB104 -AB104 2020年06月
• Endoscopic sphincterotomy to prevent post-ERCP pancreatitis in patients with biliary neoplasms: a multicenter retrospective cohort study.

  Takashi Tamura; Takeshi Ogura; Mamoru Takenaka; Kensuke Tanioka; Masahiro Itonaga; Kentaro Yamao; Ken Kamata; Seiko Hirono; Ken-Ichi Okada; Miyuki Imanishi; Kazuhide Higuchi; Hiroki Yamaue; Masayuki Kitano Endoscopy international open 8 (4) E513-E522 2020年04月
• Initial lenvatinib therapy with no prior TACE in patients with intermediate-stage hepatocellular carcinoma beyond up-to-seven criteria and Child-Pugh A liver function: A proof-of-concept study

  Masatoshi Kudo; Kazuomi Ueshima; Stephen Lam Chan; Tomoko Aoki; Satoru Hagiwara; Yasunori Minami; Hiroshi Ida; Mamoru Takenaka; Tomohiro Watanabe; Masahiro Morita; Chikara Ogawa; Yoshiyuki Wada; Masafumi Ikeda; Hiroshi Ishii; Namiki Izumi; Atsushi Hiraoka; Hiroshi Aikata; Naoshi Nishida JOURNAL OF CLINICAL ONCOLOGY 38 (4) 2020年02月
• 知っておきたい新たな処置具-特徴とその開発意図 ERCP関連 Uneven Double Lumen Cannula

  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) 2020年
• 遠隔転移を有する高齢者膵癌に対する標準用量と低用量ゲムシタビン+ナブパクリタキセル併用療法のランダム化第II相試験

  鎌田研; 北野雅之; 竹中完; 今井元; 千葉康敬; 山下幸孝; 西勝久; 加藤隆夫; 工藤正俊 臨床薬理の進歩 (41) 2020年
• 胆膵疾患 これだけは知っておきたい胆膵疾患の基礎知識-専門医受診を勧めるべきケースとは-急性膵炎

  竹中完; 工藤正俊 Medical Practice 37 (8) 2020年
• 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) 2020年
• 胆膵疾患の最新画像診断 3D-CT解析を用いた膵実質萎縮による膵癌早期診断

  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) 2020年
• 胆膵疾患に対する造影ハーモニックEUSの有用性

  中井敦史; 竹中完; 鎌田研; 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 112th 2020年
• 進化するEUS[診断的EUS 各論]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) 2020年
• 膵管狭窄症例におけるCT間接所見の検討-微小膵癌と良性膵管狭窄症例の比較-

  山雄健太郎; 竹中完; 松本逸平; 竹山宜典; 沼本勲男; 鶴崎正勝; 工藤正俊 膵臓(Web) 35 (3) 2020年
• 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(Web) 35 (3) 2020年
• 「KINDAI20」を用いたコンベックスEUSの教育について

  大本俊介; 竹中完; 工藤正俊 膵臓(Web) 35 (3) 2020年
• 術後膵液瘻(POPF)に対するEUS下ドレナージの有用性

  中井敦史; 山雄健太郎; 竹中完; 竹山宜典; 工藤正俊 膵臓(Web) 35 (3) 2020年
• ERCP後膵炎のリスク因子と予防策-多施設共同前向きコホート研究-

  松本久和; 藤田光一; 八隅秀二郎; 竹中完; 丸尾達; 松本和也; 河本博文; 栗田亮; 友田健; 斧山巧; 植木敏晴; 淺田全範; 根引浩子 膵臓(Web) 35 (3) 2020年
• Walled-off necrosisに対するLAMS with10FrENCD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(Web) 35 (3) 2020年
• Disconnected pancreatic duct syndromeの外科治療症例の検討

  松本正孝; 松本逸平; 吉田雄太; 山雄健太郎; 川口晃平; 村瀬貴昭; 大本俊介; 亀井敬子; 里井俊平; 竹中完; 武部敦志; 中居卓也; 竹山宜典 膵臓(Web) 35 (3) 2020年
• 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 113th 2020年
• 膵腫瘤性病変におけるDetective flow imaging(DFI)の有用性について

  田中隆光; 大本俊介; 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 113th 2020年
• 当院における新規胆管ステント留置術”antegrade long PS留置術”の有用性についての検討

  田中秀和; 中井敦史; 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 113th 2020年
• 当院におけるwalled-off necrosisに対するstep-up approachの成績と内視鏡治療不成功の要因解析

  大本俊介; 竹中完; 工藤正俊 Gastroenterological Endoscopy (Web) 62 (Supplement1) 2020年
• Re-interventionを考慮した悪性消化管狭窄における胃・十二指腸ステント療法の検討

  山崎友裕; 竹中完; 工藤正俊 Gastroenterological Endoscopy (Web) 62 (Supplement1) 2020年
• 当院における新規胆管ステント留置術“antegrade long PS留置術“の有用性についての検討

  田中秀和; 中井敦史; 竹中完 Gastroenterological Endoscopy (Web) 62 (Supplement1) 2020年
• 術後再建腸管ERCPにおける胆管挿管困難症例に対するUneven Double Lumen Cannulaを用いた胆管挿管法(Uneven method)の有用性

  竹中完; 工藤正俊 Gastroenterological Endoscopy (Web) 62 (Supplement1) 2020年
• 急性胆管炎に対する初回胆道ドレナージの検討 ENBD vs ERBD

  中井敦史; 竹中完; 工藤正俊 Gastroenterological Endoscopy (Web) 62 (Supplement1) 2020年
• EUS施行時の鎮静方法の検討

  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(Web) 117 2020年
• 胆膵疾患に対する造影ハーモニックEUSの有用性

  中井敦史; 鎌田研; 竹中完; 工藤正俊 Gastroenterological Endoscopy (Web) 62 (Supplement1) 2020年
• KINDAI20を用いたコンベックスEUSの教育について

  大本俊介; 竹中完; 工藤正俊 Gastroenterological Endoscopy (Web) 62 (Supplement2) 2020年
• 膵癌早期診断のための3D CT解析による膵実質萎縮の検討

  山雄健太郎; 竹中完; 石川嶺; 沼本勲; 鶴崎正勝; 渡邉智裕; 工藤正俊 日本消化器病学会雑誌(Web) 117 2020年
• 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(Web) 117 2020年
• 南大阪地域における急性膵炎地域連携モデル構築への取り組み

  竹中完; 大本俊介; 竹山宜典 Gastroenterological Endoscopy (Web) 62 (Supplement2) 2020年
• 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 (Web) 62 (Supplement2) 2020年
• 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; 工藤正俊 胆道(Web) 34 (3) 2020年
• ERCP関連偶発症に関する多施設共同前向き観察研究

  藤田光一; 八隅秀二郎; 河本博文; 竹中完; 丸尾達; 松本和也; 松本久和; 淺田全範; 根引浩子 胆道(Web) 34 (3) 2020年
• 当院におけるERCP・EUSの安全な術前・術中・術後管理への取り組み

  竹中完; 岡本彩那; 工藤正俊 胆道(Web) 34 (3) 2020年
• ERCP(内視鏡的逆行性胆管膵管造影検査)における水晶体被ばくの現状

  竹中 完; 細野 眞; 中井 敦史; 大本 俊介; 三長 孝輔; 鎌田 研; 山雄 健太郎; 林 史郎; 西田 勉; 工藤 正俊 日本消化器病学会雑誌 116 (12) 1053 -1055 2019年12月
• 血清IFN-α/IL-33が治療効果判定に有用と考えられた自己免疫性膵炎/IgG4関連疾患の1例

  原 茜; 三長 孝輔; 岡本 彩那; 石川 嶺; 山崎 友裕; 中井 敦史; 大本 俊介; 鎌田 研; 山雄 健太郎; 竹中 完; 渡邉 智裕; 安川 覚; 工藤 正俊 日本消化器病学会近畿支部例会プログラム・抄録集 111回 78 -78 2019年10月
• 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 2019年10月
• 血清IFN-α/IL-33が治療効果判定に有用と考えられた自己免疫性膵炎/IgG4関連疾患の1例

  原 茜; 三長 孝輔; 岡本 彩那; 石川 嶺; 山崎 友裕; 中井 敦史; 大本 俊介; 鎌田 研; 山雄 健太郎; 竹中 完; 渡邉 智裕; 安川 覚; 工藤 正俊 日本消化器病学会近畿支部例会プログラム・抄録集 111回 78 -78 2019年10月
• 【遭遇の機会が増えたIPMN/膵嚢胞-現状と課題】IPMN/膵嚢胞の診療 悪性IPMNとIPMN併存膵癌の診断におけるEUSの役割

  鎌田 研; 原 茜; 山雄 健太郎; 竹中 完; 工藤 正俊 臨床消化器内科 34 (12) 1476 -1481 2019年10月
• 悪性肝門部胆管閉塞に対するMoving cell uncovered metal stentを用いた一期的複数本留置

  山田 真規; 小倉 健; 竹中 完; 塩見 英之; 樋口 和秀 胆道 33 (3) 468 -468 2019年10月
• 【術後内視鏡診療のすべて】消化器手術後の内視鏡検査 サーベイランスと異時性病変の診断 消化管再建術後における超音波内視鏡を用いたスクリーニング検査

  鎌田 研; 原 茜; 田中 秀和; 石川 嶺; 岡本 彩那; 中井 敦史; 大本 俊介; 三長 孝輔; 山雄 健太郎; 竹中 完; 工藤 正俊 消化器内視鏡 31 (9) 1331 -1336 2019年09月
• 【膵癌における内視鏡診断・治療の最前線】術後膵液瘻に対する内視鏡的ドレナージの現状

  竹中 完; 中井 敦史; 吉川 智恵; 石川 嶺; 岡本 彩那; 山崎 友裕; 大本 俊輔; 三長 孝輔; 鎌田 研; 山雄 健太郎; 亀井 敬子; 松本 逸平; 竹山 宜典; 工藤 正俊 胆と膵 40 (9) 807 -814 2019年09月
• 【術後内視鏡診療のすべて】消化器手術後の内視鏡検査 サーベイランスと異時性病変の診断 消化管再建術後における超音波内視鏡を用いたスクリーニング検査

  鎌田 研; 原 茜; 田中 秀和; 石川 嶺; 岡本 彩那; 中井 敦史; 大本 俊介; 三長 孝輔; 山雄 健太郎; 竹中 完; 工藤 正俊 消化器内視鏡 31 (9) 1331 -1336 2019年09月
• 【膵癌における内視鏡診断・治療の最前線】術後膵液瘻に対する内視鏡的ドレナージの現状

  竹中 完; 中井 敦史; 吉川 智恵; 石川 嶺; 岡本 彩那; 山崎 友裕; 大本 俊輔; 三長 孝輔; 鎌田 研; 山雄 健太郎; 亀井 敬子; 松本 逸平; 竹山 宜典; 工藤 正俊 胆と膵 40 (9) 807 -814 2019年09月
• 南大阪地域における急性膵炎地域連携モデル構築への取り組み

  竹中完; 大本俊介; 吉川智恵; 石川嶺; 岡本彩那; 山崎友裕; 中井敦史; 三長孝輔; 鎌田研; 山雄健太郎; 松本逸平; 竹山宜典; 工藤正俊 膵臓(Web) 34 (3) A30‐A31(J‐STAGE) 2019年06月
• 急性膵炎局所合併症の定義の再検討

  辻喜久; 池浦司; 糸井隆夫; 岩崎栄典; 岸和田昌之; 北村勝哉; 阪上順一; 白井邦博; 鈴木裕; 竹中完; 廣田衛久; 正宗淳; 真弓俊彦; 堀部昌靖; 能登原憲司; 入江裕之; 蒲田敏文; 竹山宜典 膵臓(Web) 34 (3) A109‐A110(J‐STAGE) -A110 2019年06月
• 微小膵癌診断の新たなアプローチ法―3D CTによる膵実質萎縮評価から見えてきたもの―

  山雄健太郎; 竹中完; 吉川智恵; 石川嶺; 岡本彩那; 中井敦; 山崎友宏; 大本俊介; 鎌田研; 三長孝輔; 松本逸平; 竹山宜典; 鶴崎正勝; 渡邉智裕; 工藤正俊 膵臓(Web) 34 (3) A33‐A34(J‐STAGE) 2019年06月
• 重症度判定基準の改訂中間報告

  廣田衛久; 竹山宜典; 池浦司; 糸井隆夫; 伊藤鉄英; 岩崎栄典; 堀部昌靖; 岸和田昌之; 北村勝哉; 阪上順一; 白井邦博; 鈴木裕; 竹中完; 辻喜久; 正宗淳; 真弓俊彦 膵臓(Web) 34 (3) A108(J‐STAGE) -A108 2019年06月
• 重症膵炎症例におけるプレサルコペニアと予後の関連性についての検討

  竹中完; 大本俊介; 竹山宜典; 吉川智恵; 石川嶺; 岡本彩那; 山崎友裕; 中井敦史; 三長孝輔; 鎌田研; 山雄健太郎; 松本逸平; 工藤正俊 膵臓(Web) 34 (3) A101‐A102(J‐STAGE) 2019年06月
• 重症度判定基準の改訂中間報告

  廣田 衛久; 竹山 宜典; 池浦 司; 糸井 隆夫; 伊藤 鉄英; 岩崎 栄典; 堀部 昌靖; 岸和田 昌之; 北村 勝哉; 阪上 順一; 白井 邦博; 鈴木 裕; 竹中 完; 辻 喜久; 正宗 淳; 真弓 俊彦 膵臓 34 (3) A108 -A108 2019年06月
• 急性膵炎局所合併症の定義の再検討

  辻 喜久; 池浦 司; 糸井 隆夫; 岩崎 栄典; 岸和田 昌之; 北村 勝哉; 阪上 順一; 白井 邦博; 鈴木 裕; 竹中 完; 廣田 衛久; 正宗 淳; 真弓 俊彦; 堀部 昌靖; 能登原 憲司; 入江 裕之; 蒲田 敏文; 竹山 宜典 膵臓 34 (3) A109 -A110 2019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

  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 34 (3) A33 -A34 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

  竹中 完; 大本 俊介; 竹山 宜典; 吉川 智恵; 石川 嶺; 岡本 彩那; 山崎 友裕; 中井 敦史; 三長 孝輔; 鎌田 研; 山雄 健太郎; 松本 逸平; 工藤 正俊 膵臓 34 (3) A101 -A102 2019年06月
• 膵嚢胞性腫瘍に対する内視鏡診断 IPMN切除例からみたガイドライン2017の検証と、造影ハーモニックEUSの有用性について

  山崎 友裕; 大本 俊介; 竹中 完 Gastroenterological Endoscopy 61 (Suppl.1) 732 -732 2019年05月
• 胆膵内視鏡診療における偶発症への対策、トラブルシューティング 術後再建腸管ERCPにおける胆管挿管困難症例に対するUneven Double Lumen Cannulaを用いた胆管挿管法(Uneven法)の有用性

  竹中 完; 三長 孝輔; 工藤 正俊 Gastroenterological Endoscopy 61 (Suppl.1) 852 -852 2019年05月
• エキスパートへの道―胆・膵 ERCP関連 挿管手技 膵管ガイドワイヤー留置法―確実に成功させるコツ―

  竹中完; 中井敦史; 工藤正俊 消化器内視鏡 31 (3) 348‐353 2019年03月
• 術前診断に難渋した膵頭部・尾部同時性多発癌の一例

  岡本 彩那; 三長 孝輔; 竹中 完; 吉川 智恵; 石川 嶺; 山崎 友裕; 中井 敦史; 大本 俊介; 鎌田 研; 山雄 健太郎; 松本 逸平; 大谷 知之; 工藤 正俊 日本消化器病学会雑誌 116 (臨増総会) A406 -A406 2019年03月
• ERCP・EUS関連手技のトラブルシューティング Interventional EUSのトラブルシューティング 超音波造影剤の併用

  三長 孝輔; 竹中 完; 工藤 正俊 日本消化器病学会雑誌 116 (臨増総会) A224 -A224 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

  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 116 (臨増総会) A312 -A312 2019年03月
• 術前診断に難渋した膵頭部・尾部同時性多発癌の一例

  岡本 彩那; 三長 孝輔; 竹中 完; 吉川 智恵; 石川 嶺; 山崎 友裕; 中井 敦史; 大本 俊介; 鎌田 研; 山雄 健太郎; 松本 逸平; 大谷 知之; 工藤 正俊 日本消化器病学会雑誌 116 (臨増総会) A406 -A406 2019年03月
• 膵管内乳頭粘液性腫瘍術後フォローアップにおけるEUSの有用性

  鎌田研; 竹中完; 三長孝輔; 大本俊介; 宮田剛; 山雄健太郎; 今井元; 中井敦史; 田中秀和; 千葉康敬; 渡邉智裕; 櫻井俊治; 西田直生志; 筑後考章; 松本逸平; 竹山宜典; 北野雅之; 工藤正俊 Gastroenterological Endoscopy (Web) 61 (4) 2019年
• 膨張性発育により胆嚢から総胆管内にまで連続性充満をぎたした胆管腺扁平上皮癌の一例

  大本俊介; 竹中完; 山雄健太郎; 山崎友裕; 前西修; 筑後孝章; 柳生行伸; 鶴崎正勝; 松本逸平; 竹山宜典; 工藤正俊 日本消化器画像診断研究会プログラム・抄録集 70th 2019年
• 膵癌診断のための新たなアプローチ法の提案-3D CT解析による膵実質萎縮の検討-

  山雄健太郎; 竹中完; 工藤正俊 日本消化器がん検診学会雑誌 57 (Supplement) 2019年
• 膵炎大全 II~膵炎・Up to date~V.膵炎各論 コラム 4):急性膵炎に伴うWONに対するドレナージ治療

  田村崇; 北野雅之; 竹中完 胆と膵 40 2019年
• 膵炎大全 II~膵炎・Up to date~IV.膵炎の治療 重症急性膵炎のマネジメント-集中治療と特殊治療の適応について-

  大本俊介; 竹中完; 工藤正俊 胆と膵 40 2019年
• 3D CTによる膵実質萎縮の評価が進展範囲診断に有用であった8mm膵癌の1例

  山雄健太郎; 三長孝輔; 竹中完; 樫田博史; 松本逸平; 竹山宜典; 鶴崎正勝; 前西修; 筑後孝章; 工藤正俊 日本消化器画像診断研究会プログラム・抄録集 71st 2019年
• ERCP(内視鏡的逆行性胆管膵管造影検査)における水晶体被ばくの現状

  竹中完; 細野眞; 細野眞; 中井敦史; 大本俊介; 三長孝輔; 鎌田研; 山雄健太郎; 林史郎; 西田勉; 工藤正俊 日本消化器病学会雑誌(Web) 116 (12) 2019年
• IPMN切除例からみたガイドライン2017の検証と,造影ハーモニックEUSの有用性について

  山崎友裕; 大本俊介; 竹中完 Gastroenterological Endoscopy (Web) 61 (Supplement1) 2019年
• 「慢性膵炎臨床診断基準2019」の背景と概要

  正宗淳; 入澤篤志; 菊田和宏; 池浦司; 伊佐地秀司; 石黒洋; 糸井隆夫; 伊藤鉄英; 乾和郎; 大原弘隆; 片岡慶正; 神澤輝実; 岸和田昌之; 北野雅之; 阪上順一; 佐田尚宏; 清水京子; 竹中完; 竹山宜典; 能登原憲司; 廣岡芳樹; 松本逸平; 宮川宏之; 岡崎和一 膵臓(Web) 34 (6) 2019年
• 急性胆嚢炎治療における内視鏡的経乳頭胆嚢ドレナージ(ENGBD)の位置づけ

  武部敦志; 竹中完; 工藤正俊; 竹山宜典 日本消化器病学会近畿支部例会プログラム・抄録集 111th 2019年
• 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

  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 110th 2019年
• 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 (Web) 61 (Supplement2) 2019年
• 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

  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(Web) 116 2019年
• 術前診断に難渋した膵頭部・尾部同時性多発癌の一例

  岡本彩那; 三長孝輔; 竹中完; 吉川智恵; 石川嶺; 山崎友裕; 中井敦史; 大本俊介; 鎌田研; 山雄健太郎; 松本逸平; 大谷知之; 工藤正俊 日本消化器病学会雑誌(Web) 116 2019年
• Interventional EUSのトラブルシューティング:超音波造影剤の併用

  三長孝輔; 竹中完; 工藤正俊 日本消化器病学会雑誌(Web) 116 2019年
• 術後再建腸管ERCPにおける胆管挿管困難症例に対するUneven Double Lumen Cannulaを用いた胆管挿管法(Uneven法)の有用性

  竹中完; 三長孝輔; 工藤正俊 Gastroenterological Endoscopy (Web) 61 (Supplement1) 2019年
• 胆道閉塞に対するantegrade long Plastic Stent留置術の有用性

  中井敦史; 竹中完; 工藤正俊 Gastroenterological Endoscopy (Web) 61 (Supplement2) 2019年
• 悪性肝門部胆管閉塞に対するMoving cell uncovered metal stentを用いた一期的複数本留置

  山田真規; 小倉健; 竹中完; 塩見英之; 樋口和秀 胆道(Web) 33 (3) 2019年
• 膵管内乳頭粘液性腫瘍(IPMN)の診断と経過観察法 3 IPMNに合併・併存する膵癌とその診断法

  鎌田研; 竹中完; 工藤正俊 週刊日本医事新報 (4940) 36‐40 2018年12月
• 選択的胆管挿管100%をめざして―We’re gonna do it!―乳頭形態別の胆管挿管ストラテジー【動画付】

  竹中完; 向井秀一; 吉川智恵; 石川嶺; 岡本彩那; 山崎友祐; 中井敦史; 大本俊介; 三長孝輔; 鎌田研; 山雄健太郎; 工藤正俊 胆と膵 39 (12) 1309‐1317 -1317 2018年12月
• 【Interventional EUSの偶発症予防と対処】超音波内視鏡下瘻孔形成術における胆汁漏出の予防

  鎌田 研; 竹中 完; 三長 孝輔; 石川 嶺; 吉川 智恵; 岡本 彩那; 山崎 友裕; 中井 敦史; 大本 俊介; 山雄 健太郎; 工藤 正俊 消化器・肝臓内科 4 (6) 470 -473 2018年12月
• 胆膵ドレナージupdate[3.困難例とトラブルシューティング]胆管・膵管プラスチックステント迷入への対処

  竹中完; 三長孝輔; 鎌田研; 山雄健太郎; 工藤正俊 消化器内視鏡 30 (11) 1605‐1611 2018年11月
• Biliary access大辞典 III.経乳頭的biliary access~salvage technique~Uneven Double Lumen Cannulaを用いた胆管カニュレーションテクニック(Uneven method)【動画付】

  竹中完; 吉川智恵; 石川嶺; 岡本彩那; 山崎友祐; 中井敦史; 大本俊介; 三長孝輔; 鎌田研; 山雄健太郎; 有坂好史; 工藤正俊 胆と膵 39 1013‐1020 2018年11月
• 興味深い造影ハーモニックEUS像を呈した胆嚢癌の1例

  吉川智恵; 鎌田研; 竹中完; 大本俊介; 三長孝輔; 山雄健太郎; 今井元; 榎木英介; 木村雅友; 松本逸平; 竹山宜典; 工藤正俊 胆道 32 (4) 775‐781 -781 2018年10月
• 胆膵疾患内視鏡アトラス I.膵臓 1.充実性 特殊型膵癌―腺扁平上皮癌,退形成性膵管癌,腺房細胞癌―

  竹中完; 筑後孝章; 工藤正俊 消化器内視鏡 30 54‐57,7 2018年10月
• Interventional EUSのトラブルシューティング PTGBDからEUS-GBDへのconversionの有用性・安全性に関する検討 多施設後ろ向き研究

  三長 孝輔; 竹中 完; 山下 幸孝; Therapeutic Endoscopic Ultrasound Group:TEUS 日本消化器病学会雑誌 115 (臨増大会) A681 -A681 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

  中井 敦史; 鎌田 研; 竹中 完; 石川 嶺; 岡本 彩那; 大本 俊介; 三長 孝輔; 山雄 健太郎; 兵頭 朋子; 松本 逸平; 竹山 宜典; 工藤 正俊 Gastroenterological Endoscopy 60 (Suppl.2) 2126 -2126 2018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 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 2018年10月
• Interventional EUSのトラブルシューティング PTGBDからEUS-GBDへのconversionの有用性・安全性に関する検討 多施設後ろ向き研究

  三長 孝輔; 竹中 完; 山下 幸孝; Therapeutic Endoscopic Ultrasou; Group:TEUS 日本消化器病学会雑誌 115 (臨増大会) A681 -A681 2018年10月
• 肝外胆管癌における造影ハーモニックEUSの有用性についての検討

  大塚康生; 鎌田研; 竹中完; 石川嶺; 岡本彩那; 中井敦史; 大本俊介; 三長孝輔; 山雄健太郎; 筑後孝章; 兵頭朋子; 中居卓也; 竹山宜典; 工藤正俊 胆道 32 (3) 567 2018年08月
• 術後膵液瘻(POPF)に対するEUS下ドレナージの有用性

  中井敦史; 竹中完; 山雄健太郎; 松本逸平; 竹山宜典; 工藤正俊 膵臓 33 (3) 399 2018年05月
• 重症急性膵炎の予後不良予測因子および被包化壊死(WON)合併予測因子の検討

  大本俊介; 竹中完; 松本逸平; 竹山宜典; 工藤正俊 膵臓 33 (3) 410 2018年05月
• 造影ハーモニックEUSによる膵神経内分泌腫瘍の悪性度評価

  石川嶺; 鎌田研; 竹中完; 田中秀和; 中井敦史; 大本俊介; 宮田剛; 三長孝輔; 山雄健太郎; 今井元; 工藤正俊 膵臓 33 (3) 346 2018年05月
• 造影ハーモニックEUSは膵癌の術前治療の効果判定に有用か?

  田中秀和; 鎌田研; 竹中完; 石川嶺; 中井敦史; 大本俊介; 三長孝輔; 宮田剛; 山雄健太郎; 今井元; 工藤正俊 膵臓 33 (3) 505 2018年05月
• どうする膵嚢胞[各論 IPMN]IPMNの経過観察におけるEUSの今後

  鎌田研; 竹中完; 中井敦史; 大本俊介; 宮田剛; 三長孝輔; 山雄健太郎; 今井元; 樫田博史; 工藤正俊 消化器内視鏡 30 (5) 606‐610 2018年05月
• 【膵癌update】 トピックス 膵癌の癌性疼痛に対するEUSガイド下神経叢ブロック(融解)術の有用性

  宮田 剛; 竹中 完; 工藤 正俊 臨床消化器内科 33 (7) 950 -957 2018年05月
• 造影ハーモニックEUSによる膵癌の門脈浸潤診断の検討

  中井 敦史; 鎌田 研; 大本 俊介; 宮田 剛; 三長 孝輔; 山雄 健太郎; 今井 元; 竹中 完; 樫田 博史; 工藤 正俊 Gastroenterological Endoscopy 60 (Suppl.1) 738 -738 2018年04月
• 超音波内視鏡ガイド下治療の現状と問題点 膵癌に伴う疼痛に対するEUSガイド下神経ブロックの有用性

  三長 孝輔; 竹中 完; 工藤 正俊 日本消化器病学会雑誌 115 (臨増総会) A68 -A68 2018年04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 2018年04月
• 膵癌に伴う疼痛に対するEUSガイド下神経ブロックの有用性

  三長孝輔; 竹中完; 工藤正俊 日本消化器病学会雑誌(Web) 115 2018年
• 膵胆道腫瘍のリンパ節転移診断における造影ハーモニックEUSの有用性

  中井敦史; 宮田剛; 竹中完; 工藤正俊 日本消化器病学会雑誌(Web) 115 2018年
• 十二指腸穿破をきたした正中球状靭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(Web) 115 2018年
• 術後再建腸管ERCPにおける胆管挿管困難症例に対するUneven Double Lumen Cannulaを用いた胆管挿管法(DLC法)の有用性

  竹中完; 中井敦史; 工藤正俊 Gastroenterological Endoscopy (Web) 60 (Supplement1) 2018年
• 順行性胆管ステント留置術を併用した超音波内視鏡下胆管胃吻合術を評価する多施設前向き臨床試験

  小倉健; 小倉健; 竹中完; 竹中完; 北野雅之; 北野雅之 Gastroenterological Endoscopy (Web) 60 (Supplement1) 2018年
• PTGBDからEUS-GBDへのconversionの有用性・安全性に関する検討:多施設後ろ向き研究

  三長孝輔; 三長孝輔; 竹中完; 竹中完; 山下幸孝; 山下幸孝 Gastroenterological Endoscopy (Web) 60 (Supplement2) 2018年
• 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 (Web) 60 (Supplement2) 2018年
• 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 (Web) 60 (Supplement2) 2018年
• 良性胆道狭窄(慢性膵炎)に対するfully covered metallic stentの有用性

  竹中完; 山雄健太郎; 工藤正俊 Gastroenterological Endoscopy (Web) 60 (Supplement2) 2018年
• 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

  石川嶺; 鎌田研; 竹中完 Gastroenterological Endoscopy (Web) 60 (Supplement2) 2018年
• 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 (Web) 60 (Supplement2) 2018年
• 興味深い造影ハーモニックEUS像を呈した胆囊癌の1例

  吉川 智恵; 松本 逸平; 竹山 宜典; 工藤 正俊; 鎌田 研; 竹中 完; 大本 俊介; 三長 孝輔; 山雄 健太郎; 今井 元; 榎木 英介; 木村 雅友 胆道 32 (4) 775 -781 2018年
• 造影ハーモニックEUSによる膵癌の門脈浸潤診断の検討

  中井敦史; 鎌田研; 大本俊介; 宮田剛; 三長孝輔; 山雄健太郎; 今井元; 竹中完; 樫田博史; 工藤正俊 Gastroenterological Endoscopy (Web) 60 (Supplement1) 738(J‐STAGE) 2018年
• 膵管内に発育した5mmの退形性膵癌の1例

  中井敦史; 山雄健太郎; 竹中完; 松本逸平; 竹山宜典; 鶴崎正勝; 柳生行伸; 筑後孝章; 工藤正俊 日本消化器画像診断研究会プログラム・抄録集 69th 55 2018年
• 術前にIPMN併存癌と診断したlow‐grade PanINの1例

  山雄健太郎; 竹中完; 松本逸平; 竹山宜典; 筑後孝章; 工藤正俊 日本消化器画像診断研究会プログラム・抄録集 68th 21 2018年01月
• 臓器間ネットワークからみた肝胆膵の恒常性とその破綻 臓器間ネットワークの破綻による疾患 膵炎における腸管免疫機構破綻と重症化機序

  渡邉智裕; 三長孝輔; 鎌田研; 山雄健太郎; 竹中完; 工藤正俊 肝胆膵 75 (5) 991‐996 2017年11月
• 【急性胆嚢炎に対する最新のマネージメント】 急性胆嚢炎の発症機序と鑑別診断のコツ

  竹中 完; 中井 敦史; 大本 俊介; 宮田 剛; 三長 孝輔; 鎌田 研; 山雄 健太郎; 今井 元; 工藤 正俊 胆と膵 38 (10) 1137 -1145 2017年10月
• 【胆膵EUSを極める-私ならこうする(There is always a better way)-】 治療 胆嚢ドレナージ 私はこうする

  三長 孝輔; 北野 雅之; 竹中 完; 鎌田 研; 中井 敦史; 大本 俊介; 宮田 剛; 山雄 健太郎; 今井 元; 工藤 正俊 胆と膵 38 (臨増特大) 1071 -1078 2017年10月
• 【胆膵EUSを極める-私ならこうする(There is always a better way)-】 治療 胆嚢ドレナージ 私はこうする

  三長 孝輔; 北野 雅之; 竹中 完; 鎌田 研; 中井 敦史; 大本 俊介; 宮田 剛; 山雄 健太郎; 今井 元; 工藤 正俊 胆と膵 38 (臨増特大) 1071 -1078 2017年10月
• 【急性胆嚢炎に対する最新のマネージメント】 急性胆嚢炎の発症機序と鑑別診断のコツ

  竹中 完; 中井 敦史; 大本 俊介; 宮田 剛; 三長 孝輔; 鎌田 研; 山雄 健太郎; 今井 元; 工藤 正俊 胆と膵 38 (10) 1137 -1145 2017年10月
• 膵・胆道癌の早期診断を目指せ!実質内発生の小膵癌 IPMNに併存した小膵癌の解析

  山雄健太郎; 竹中完; 中井敦史; 大本俊介; 鎌田研; 三長孝輔; 宮田剛; 今井元; 松本逸平; 竹山宜典; 筑後孝章; 工藤正俊 肝胆膵 75 (3) 611‐619 2017年09月
• 膵・胆道癌に対する内視鏡的診断法の新たな展開 膵癌肝転移診断におけるKupffer imageを用いた造影EUSの有用性

  竹中 完; 三長 孝輔; 工藤 正俊 日本消化器病学会雑誌 114 (臨増大会) A612 -A612 2017年09月
• 膵・胆道癌に対する内視鏡的診断法の新たな展開 膵癌肝転移診断におけるKupffer imageを用いた造影EUSの有用性

  竹中 完; 三長 孝輔; 工藤 正俊 Gastroenterological Endoscopy 59 (Suppl.2) 2056 -2056 2017年09月
• 【膵・胆道癌の早期診断を目指せ!】 実質内発生の小膵癌 IPMNに併存した小膵癌の解析

  山雄 健太郎; 竹中 完; 中井 敦史; 大本 俊介; 鎌田 研; 三長 孝輔; 宮田 剛; 今井 元; 松本 逸平; 竹山 宜典; 筑後 孝章; 工藤 正俊 肝・胆・膵 75 (3) 611 -619 2017年09月
• 【Interventional EUSの最新情報-適応、手技、デバイス-】 EUS-guided pancreatic ductal drainage(EUS-PD)の適応と手技のコツ

  竹中 完; 中井 敦史; 大本 俊介; 三長 孝輔; 宮田 剛; 鎌田 研; 山雄 健太郎; 今井 元; 工藤 正俊 消化器・肝臓内科 2 (3) 253 -260 2017年09月
• 特異な画像所見を呈し術前診断に苦慮したPancreatobiliary-type Intraductal Papillary Mucinous Neoplasmの1例

  家本孝雄; 有坂好史; 竹中完; 増田充弘; 塩見英之; 岡部純弘; 外山博近; 全陽 膵臓 32 (4号) 727 -735 2017年08月 [査読有り]
  
• 膵癌の早期診断・治療の現状と展望 膵癌早期診断の現状 膵癌早期診断研究会における多施設研究の結果をもとに

  菅野 敦; 正宗 淳; 花田 敬士; 真口 宏介; 清水 泰博; 植木 敏晴; 長谷部 修; 大塚 隆生; 中村 雅史; 竹中 完; 北野 雅之; 菊山 正隆; 蒲田 敏文; 吉田 浩司; 佐々木 民人; 芹川 正浩; 古川 徹; 柳澤 昭夫; 下瀬川 徹 膵臓 32 (3) 318 -318 2017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

  竹中 完; 大本 俊介; 三長 孝輔; 宮田 剛; 鎌田 研; 山雄 健太郎; 今井 元; 工藤 正俊 膵臓 32 (3) 360 -360 2017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

  竹中 完; 大本 俊介; 三長 孝輔; 宮田 剛; 鎌田 研; 山雄 健太郎; 今井 元; 工藤 正俊 膵臓 32 (3) 377 -377 2017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

  竹中 完; 大本 俊介; 三長 孝輔; 宮田 剛; 鎌田 研; 山雄 健太郎; 今井 元; 工藤 正俊 膵臓 32 (3) 422 -422 2017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

  三長 孝輔; 竹中 完; 北野 雅之; 中井 敦史; 大本 俊介; 宮田 剛; 鎌田 研; 山雄 健太郎; 今井 元; 渡邉 智裕; 工藤 正俊 膵臓 32 (3) 552 -552 2017年05月
• EUS下胆道ドレナージ(戦略と安全な手技) 経乳頭的re-intervention困難例の悪性肝門部胆道閉塞に対するEUS下胆道ドレナージの有用性

  三長 孝輔; 竹中 完; 工藤 正俊 Gastroenterological Endoscopy 59 (Suppl.1) 817 -817 2017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

  中井 敦史; 山雄 健太郎; 大本 俊介; 鎌田 研; 三長 孝輔; 宮田 剛; 今井 元; 竹中 完; 松本 逸平; 竹山 宜典; 筑後 孝章; 工藤 正俊 Gastroenterological Endoscopy 59 (Suppl.1) 1061 -1061 2017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

  竹中 完; 大本 俊介; 三長 孝輔; 宮田 剛; 鎌田 研; 山雄 健太郎; 今井 元; 樫田 博史; 工藤 正俊 超音波医学 44 (Suppl.) S242 -S242 2017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

  鎌田 研; 竹中 完; 大本 俊介; 宮田 剛; 三長 孝輔; 山雄 健太郎; 今井 元; 筑後 孝章; 安田 卓司; 工藤 正俊 超音波医学 44 (Suppl.) S438 -S438 2017年04月
• 【今IPMNをどう診るか】 サーベイランスをめぐる諸問題 IPMN経過観察におけるEUSの有用性

  鎌田 研; 竹中 完; 北野 雅之; 工藤 正俊 肝・胆・膵 74 (4) 583 -586 2017年04月
• 【胆管結石・胆管炎をめぐる諸問題】 胆石膵炎

  竹中 完; 大本 俊介; 三長 孝輔; 宮田 剛; 鎌田 研; 山雄 健太郎; 今井 元; 工藤 正俊 消化器・肝臓内科 1 (3) 247 -256 2017年03月
• 消化器内視鏡-私の流儀 EUS スコープのたわみを意識したセッティングを-使えるものはティッシュ箱でも使え!

  竹中完; 北野雅之; 工藤正俊 消化器内視鏡 29 (6) 2017年
• 早期慢性膵炎のEUS像

  竹中完; 北野雅之; 工藤正俊 Gastroenterological Endoscopy (Web) 59 (3) 2017年
• 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

  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) 2017年
• 特異な画像所見を呈し術前診断に苦慮したPancreatobiliary-type Intraductal Papillary Mucinous Neoplasmの1例

  家本孝雄; 有坂好史; 有坂好史; 竹中完; 増田充弘; 塩見英之; 岡部純弘; 外山博近; 全陽 膵臓 32 (4) 2017年
• 術前に肝原発嚢胞性病変が疑われた腸間膜由来神経鞘腫の1例

  竹中完; 山雄健太郎; 鎌田研; 三長孝輔; 宮田剛; 今井元; 松本逸平; 竹山宜典; 前西修; 工藤正俊 日本消化器画像診断研究会プログラム・抄録集 67th 2017年
• 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~

  鎌田研; 竹中完; 工藤正俊 胆道 31 (3) 2017年
• 膵頭部嚢胞による閉塞性黄疸症例

  大本俊介; 竹中完; 山雄健太郎; 半田康平; 筑後孝章; 松本逸平; 竹山宜典; 工藤正俊 日本消化器病学会雑誌 114 (10) 2017年
• 当院におけるERCP教育の工夫(drawing pictures method/CD method)

  竹中完; 東健; 工藤正俊 Gastroenterological Endoscopy (Web) 59 (Supplement1) 2017年
• 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

  鎌田研; 竹中完; 工藤正俊 Gastroenterological Endoscopy (Web) 59 (Supplement1) 2017年
• 経乳頭処置困難総胆管結石症例に対するEUSガイド下治療の意義

  宮田剛; 竹中完; 工藤正俊 Gastroenterological Endoscopy (Web) 59 (Supplement1) 2017年
• 硬化性胆管炎と診断された膵癌,閉塞性黄疸の1例

  中井敦史; 山雄健太郎; 大本俊介; 鎌田研; 三長孝輔; 宮田剛; 今井元; 竹中完; 松本逸平; 竹山宜典; 筑後孝章; 工藤正俊 Gastroenterological Endoscopy (Web) 59 (Supplement1) 2017年
• 胆膵EUSの進歩 4 EUS-FNAによる治療(6)腹腔神経叢/神経節ブロック

  三長孝輔; 北野雅之; 宮田剛; 今井元; 竹中完; 工藤正俊 臨床消化器内科 32 (8) 2017年
• 経乳頭処置困難総胆管結石症例に対するEUS下rendezvous techniqueの有用性

  竹中完; 山雄健太郎; 工藤正俊 胆道 31 (3) 2017年
• 十二指腸ステント留置下の胆道ドレナージの成績の検討

  山雄健太郎; 竹中完; 工藤正俊 胆道 31 (3) 2017年
• 膵癌治療の最前線-諸問題の解決にむけた取り組み-膵癌の癌性疼痛に対するEUSガイド下神経叢ブロック(融解)術の有用性

  宮田剛; 竹中完; 工藤正俊 胆と膵 38 (8) 2017年
• 経乳頭的re-intervention困難例の悪性肝門部胆道閉塞に対するEUS下胆道ドレナージの有用性

  三長孝輔; 竹中完; 工藤正俊 Gastroenterological Endoscopy (Web) 59 (Supplement1) 2017年
• 切除不能悪性胃十二指腸狭窄症例に対する胃十二指腸ステント留置の予後予測因子の検討

  山雄健太郎; 竹中完; 工藤正俊 Gastroenterological Endoscopy (Web) 59 (Supplement1) 2017年
• 早期慢性膵炎EUS所見の臨床的意義について

  竹中完; 山雄健太郎; 工藤正俊 日本消化器病学会雑誌 114 2017年
• EUSによるIPMN併存膵癌の早期発見と問題点

  鎌田研; 竹中完; 工藤正俊 日本消化器病学会雑誌 114 2017年
• 4.膵癌早期診断におけるEUSの役割

  鎌田研; 竹中完; 北野雅之; 大本俊介; 三長孝輔; 宮田剛; 山雄健太郎; 今井元; 工藤正俊 すい臓 32 (1) 38‐44(J‐STAGE) 2017年
• 4．膵癌早期診断におけるEUSの役割

  鎌田 研; 竹中 完; 北野 雅之; 大本 俊介; 三長 孝輔; 宮田 剛; 山雄 健太郎; 今井 元; 工藤 正俊 膵臓 32 (1) 38 -44 2017年
• Endoscopic ultrasound-guided gallbladder drainage for acute cholecystitis: Long-term outcomes after removal of a self-expandable metal stent

  Ken Kamata; Mamoru Takenaka; Masayuki Kitano; Shunsuke Omoto; Kosuke Minaga; Takeshi Miyata; Kentaro Yamao; Hajime Imai; Masatoshi Kudo JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY 31 341 -341 2016年11月
• Clinical impact of endoscopic ultrasonography imaging of chronic pancreatitis in the pancreatic parenchyma in patients with intraductal papillary mucinous neoplasms

  Mamoru Takenaka; Atsuhiro Masuda; Masayuki Kitano; Yoh Zen; Kentarou Yamao; Hideyuki Shiomi; Yonson Ku; Takeshi Azuma; Masatoshi Kudo JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY 31 240 -241 2016年11月
• EUS-guided choledochoduodenostomy using a newly designed laser-cut metal stent: Feasibility study in a porcine model

  Kosuke Minaga; Mamoru Takenaka; Masayuki Kitano; Hajime Imai; Kentaro Yamao; Ken Kamata; Takeshi Miyata; Shunsuke Omoto; Masatoshi Kudo JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY 31 222 -222 2016年11月
• 【IPMNの診断と治療はどう変わったか?】 診断 IPMN診療におけるEUSの位置付け 有用性とこれからの課題

  竹中 完; 鎌田 研; 北野 雅之; Napoleon Bertrand; 工藤 正俊 胆と膵 37 (11) 1475 -1480 2016年11月
• 【Interventional EUSのすべて】 EUSガイド下胆嚢ドレナージ術

  竹中 完; 北野 雅之; 鎌田 研; 三長 孝輔; 大本 俊介; 宮田 剛; 山雄 健太郎; 今井 元; 工藤 正俊 消化器内視鏡 28 (10) 1669 -1678 2016年10月
• 早期慢性膵炎をめぐって 早期慢性膵炎の診断基準と臨床的意義

  竹中完; 北野雅之; 門阪薫平; 工藤正俊 胆と膵 37 (4) 2016年
• 胆道出血を契機に診断された腎細胞癌胆嚢転移の1例

  竹中完; 岡部純弘; 森永友紀子; 塩見英之; 増田充弘; 有坂好史; 味木徹夫; 伊藤智雄; 具英成; 東健 日本消化器画像診断研究会プログラム・抄録集 64th 2016年
• 早期慢性膵炎EUS所見の臨床的意義について

  竹中完 超音波医学 43 2016年
• 不定愁訴症候群とどう向き合うか 早期慢性膵炎

  竹中完; 北野雅之; 工藤正俊 成人病と生活習慣病 46 (10) 2016年
• 嚢胞変性を伴う充実性腫瘍との鑑別が困難であったIPMNの1例

  家本孝雄; 有坂好史; 竹中完; 塩見英之; 増田充弘; 岡部純弘; 外山博近; 全陽 日本消化器画像診断研究会プログラム・抄録集 65th 2016年
• 膵炎を繰り返すSCNとして切除を行った多房性膵嚢胞性病変の1例

  山雄健太郎; 竹中完; 大本俊介; 松田友彦; 宮田剛; 北野雅之; 工藤正俊; 松本逸平; 竹山宜典; 榎木英介; 筑後孝章 日本消化器画像診断研究会プログラム・抄録集 65th 2016年
• 診断に苦慮した好酸球性胃腸炎の1例

  西川倫子; 西川倫子; 大井充; 寺島禎彦; 小畑大輔; 吉江智朗; 吉江智朗; 竹中完; 塩見英之; 藤田剛; 藤田剛; 東健; 森永友紀子 Gastroenterological Endoscopy (Web) 58 (7) 2016年
• 膵腫瘍と鑑別が困難であった十二指腸GISTの一例

  塩見優紀; 岡部純弘; 塩見英之; 藤垣誠治; 家本孝雄; 池田篤紀; 竹中完; 増田充弘; 有坂好史; 東健 超音波医学 43 (2) 2016年
• 慢性膵炎合併良性胆道狭窄に対するfully covered metallic stentの有用性

  竹中完; 北野雅之; 工藤正俊 胆道 30 (3) 2016年
• 経乳頭的,経皮的治療抵抗性の切除不能肝門部悪性胆道狭窄に対するEUS-guided biliary drainage(EUS-BD)の有用性

  竹中完; 北野雅之; 工藤正俊 胆道 30 (3) 2016年
• 背景膵萎縮変化がIPMNの悪性予測因子となる-IPMNにおける膵実質評価(EUS)の有用性

  竹中完; 阿部洋文; 吉田龍太郎; 佐藤悠; 池川卓哉; 八木洋輔; 酒井新; 小林隆; 塩見英之; 増田充弘; 有坂好史; 岡部純弘; 東健 日本消化器病学会雑誌 113 2016年
• 肝門部胆管癌に対する術前胆道ドレナージ中の急性胆管炎の現状と対策

  小林隆; 竹中完; 有坂好史; 藤垣誠治; 山中広大; 野村雄大; 平田祐一; 江崎健; 家本孝雄; 小川浩史; 八木洋輔; 那賀川峻; 酒井新; 寺島禎彦; 増田充弘; 塩見英之; 岡部純弘; 久津見弘; 東健 Gastroenterological Endoscopy 57 (Supplement 1) 2015年
• 膵に腫瘤を形成した髄外性形質細胞腫の一例

  塩見優紀; 岡部純弘; 山中広大; 小川浩史; 小林隆; 竹中完; 塩見英之; 有坂好史; 久津見弘; 東健 超音波医学 42 (2) 2015年
• 選択的胆道挿管困難例に対するUneven Double Lumen Cannulaを用いた新しいアプローチ

  竹中完; 有坂好史; 山中広大; 藤垣誠治; 平田祐一; 江崎健; 八木洋輔; 那賀川峻; 小川浩史; 家本孝雄; 酒井新; 小林隆; 塩見英之; 岡部純弘; 久津見弘; 東健 Gastroenterological Endoscopy 57 (Supplement 1) 2015年
• MCNとの鑑別が困難であった膵内副脾に発生したepidermoid cystの一例

  平田祐一; 竹中完; 有坂好史; 藤垣誠治; 山中広大; 野村雄大; 江崎健; 家本孝雄; 那賀川峻; 小川浩史; 八木洋輔; 酒井新; 小林隆; 寺島禎彦; 吉中勇人; 塩見英之; 久津見弘; 岡部純弘; 東健 膵臓 30 (3) 2015年
• 小膵腫瘤性病変の診断における造影ハーモニックEUSの有用性

  江崎健; 塩見英之; 山中広大; 藤垣誠治; 平田祐一; 八木洋輔; 那賀川峻; 家本孝雄; 酒井新; 小林隆; 竹中完; 岡部純弘; 久津見弘; 東健 膵臓 30 (3) 2015年
• ERCP胆管挿管率100%を目指して-Uneven Double Lumen Cannulaを用いた胆管挿管法(DLC法)による挿管困難例の克服

  竹中完; 有坂好史; 酒井新 胆道 29 (3) 2015年
• 多発肝転移をきたした膵Solid Pseudopapillary Neoplasmの1切除例

  酒井新; 有坂好史; 八木洋輔; 竹中完; 小林隆; 塩見英之; 増田充弘; 岡部純弘; 東健; 外山博近; 全陽 日本消化器画像診断研究会プログラム・抄録集 63rd 2015年
• 肝門部胆管癌に対する術前胆道ドレナージの検討

  小林隆; 竹中完; 有坂好史 胆道 29 (3) 2015年
• 小膵癌の診断における造影ハーモニックEUSの臨床的有用性

  江崎健; 塩見英之; 酒井新; 寺島禎彦; 小林隆; 竹中完; 有坂好史; 岡部純弘; 久津見弘; 東健 超音波医学 42 2015年
• 膵腫瘤性病変の診断における造影ハーモニックEUSの有用性

  江崎健; 塩見英之; 岡部純弘; 藤垣誠治; 山中広大; 平田祐一; 八木洋輔; 那賀川峻; 家本孝雄; 酒井新; 小林隆; 竹中完; 吉中勇人; 有坂好史; 久津見弘; 東健 Gastroenterological Endoscopy 57 (Supplement 1) 2015年
• 「DLC(Uneven Double Lumen Cannula)を用いた胆管挿管法(DLC法)の実際とコツ」

  竹中完; 酒井新; 有坂好史 Gastroenterological Endoscopy 57 (Supplement 2) 2015年
• Effectiveness of self-expandable metal stent for afferent loop obstruction caused by cancer recurrence after pancreaticoduodenectomy

  Arata Sakai; Hideyuki Shiomi; Seiji Fujigaki; Koudai Yamanaka; Takeshi Ezaki; Yuichi Hirata; Takao Iemoto; Takashi Nakagawa; Yousuke Yagi; Takashi Kobayashi; Toshitatsu Takao; Mamoru Takenaka; Yoshifumi Arisaka; Hiromu Kutsumi; Yoshihiro Okabe; Takeshi Azuma JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY 29 43 -43 2014年11月
• 【肝胆膵・術後病態を學ぶ】 その他関連疾患 肝膿瘍 胆道疾患関連肝膿瘍を中心に

  竹中 完; 平田 祐一; 八木 洋輔; 那賀川 峻; 塩見 英之; 有坂 好史; 岡部 純弘; 久津見 弘 肝・胆・膵 69 (1号) 93 -98 2014年07月 [招待有り]
  
• 【乳頭を攻略する-カニュレーションの基本と困難例への対処】 膵管カニュレーションのコツ

  有坂 好史; 竹中 完; 増田 充弘; 塩見 英之; 小林 隆; 酒井 新; 那賀川 峻; 八木 洋輔; 江崎 健; 平田 祐一; 山中 広大; 久津見 弘; 東 健 消化器内視鏡 26 (2号) 280 -288 2014年02月 [招待有り]
  
• 難治性膵疾患に関する調査研究 自己免疫性膵炎切除例におけるPanIN病変の検討

  増田充弘; 久津見弘; 塩見英之; 竹中完; 有阪好史; 早雲孝信; 東健 難治性膵疾患に関する調査研究 平成25年度 総括・分担研究報告書 2014年
• Evaluation for the indication of prophylactic pancreatic duct stent by propensity score analysis

  Mamoru Takenaka; Arata Sakai; Hideyuki Shiomi; Atsuhiro Masuda; Yoshifumi Arisaka; Tsuyoshi Fujita; Hiromu Kutsumi; Takanobu Hayakumo; Takeshi Azuma JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY 28 17 -17 2013年10月
• ダブルバルーン内視鏡を用いたroux-Y再建後胆膵疾患症例に対する内視鏡的アプローチの現状と問題点

  角山沙織; 増田充弘; 足立聡一郎; 荻巣恭平; 松木信之; 竹中完; 塩見英之; 有坂好史; 久津見弘; 早雲孝信; 東健 Gastroenterological Endoscopy 55 (Supplement 1) 2013年
• 混合型IPMNは分枝型と一括して扱ってよいか?-MUC染色による混合型IPMNの検討-

  竹中完; 増田充弘; 酒井新; 角山沙織; 松木信之; 塩見英之; 有坂好史; 久津見弘; 早雲孝信; 東健 Gastroenterological Endoscopy 55 (Supplement 1) 2013年
• 慢性膵炎に対する膵管ステントは全例ステントフリー可能か?

  松木信之; 増田充弘; 江崎健; 萩巣恭平; 酒井新; 角山沙織; 竹中完; 塩見英之; 杉本真樹; 有坂好史; 藤田剛; 久津見弘; 早雲孝信; 東健 Gastroenterological Endoscopy 55 (Supplement 1) 2013年
• 造影ハーモニックEUSによる膵腫瘍性病変の診断

  松木信之; 塩見英之; 角山沙織; 坂井文; 竹中完; 増田充弘; 岩本彰; 船津英司; 杉本真樹; 藤田剛; 久津見弘; 早雲孝信; 東健 日本消化器病学会雑誌 109 2012年
• 慢性膵炎に対する内視鏡的膵管ステント留置術(EPS)の検討

  松木信之; 増田充弘; 角山沙織; 竹中完; 塩見英之; 杉本真樹; 藤田剛; 久津見弘; 早雲孝信; 東健 Gastroenterological Endoscopy 54 (Supplement 2) 2012年
• 術後膵炎を予防するためにはhigh risk症例のどのような症例に膵管ステントを挿入すればよいか?

  竹中完; 塩見英之; 増田充弘; 藤田剛; 久津見弘; 早雲孝信; 東健 日本消化器病学会雑誌 109 2012年
• 膵管内発育を呈した膵原発癌肉腫の一例

  池川卓哉; 塩見英之; 安冨栄一郎; 角山沙織; 松木信之; 竹中完; 増田充弘; 杉本真樹; 久津見弘; 早雲孝信; 新関亮; 松本逸平; 具英成; 原重雄; 伊藤智雄; 東健 Gastroenterological Endoscopy 54 (Supplement 1) 2012年
• 難治性膵疾患に関する調査研究 I.急性膵炎 傾向スコア解析(propensity score analysis)を用いた脱落型膵管ステントのERCP後膵炎予防効果の検討

  増田充弘; 竹中完; 塩見英之; 藤田剛; 久津見弘; 早雲孝信; 東健 難治性膵疾患に関する調査研究 平成23年度 総括・分担研究報告書 2012年
• Helicobacter Suis Kb1 Derived From Pig Gastric Lymphoid Follicles Induces Formation of Gastric Lymphoid Follicles in Mice Through Activation of B Cells and CD4 Positive Cells

  Mamoru Takenaka; Masaru Yoshida; Takeshi Azuma GASTROENTEROLOGY 140 (5) S312 -S312 2011年05月
• 膵胆道疾患に対するソナゾイド造影ハーモニックEUSの経験

  松木信之; 増田充弘; 塩見英之; 角山沙織; 坂井文; 古松恵介; 三村卓也; 三村美津子; 竹中完; 田中擴址; 吉田志栄; 杉本真樹; 佐貫毅; 藤田剛; 久津見弘; 早雲孝信; 東健 Gastroenterological Endoscopy 53 (Supplement 1) 2011年
• 分枝型IPMNの悪性予測因子の検討~EUSを用いた壁在結節高評価を中心に~

  松木信之; 塩見英之; 角山沙織; 田中擴址; 竹中完; 増田充弘; 杉本真樹; 藤田剛; 久津見弘; 早雲孝信; 東健 Gastroenterological Endoscopy 53 (Supplement 2) 2011年
• 分枝型IPMN手術適応における擦過細胞診の有用性の検討

  竹中完; 坂井文; 松木信之; 塩見英之; 増田充弘; 杉本真樹; 藤田剛; 久津見弘; 早雲孝信; 東健 Gastroenterological Endoscopy 53 (Supplement 2) 2011年
• 自己免疫性膵炎診断基準からみた膵癌との鑑別

  角山沙織; 増田充弘; 塩見英之; 坂井文; 松木信之; 古松恵介; 三村卓也; 三村美津子; 竹中完; 田中擴址; 吉田志栄; 杉本真樹; 佐貫毅; 藤田剛; 久津見弘; 早雲孝信; 東健; 新関亮; 松本逸平; 外山博近 日本消化器病学会雑誌 108 2011年
• 傾向スコア解析(propensity score analysis)を用いた脱落型膵管ステントのERCP後膵炎予防効果の検討

  竹中完; 藤田剛; 早雲孝信 Gastroenterological Endoscopy 53 (Supplement 2) 2011年
• Flush knifeを用いた乳頭プレカット手技

  佐貫毅; 豊永高史; 家本孝雄; 小林隆; 角山沙織; 南晶洋; 松木信之; 井上潤; 坂井文; 竹中完; 古松恵介; 三村卓也; 塩見英之; 吉田志栄; 増田充弘; 杉本真樹; 早雲孝信; 久津見弘; 東健 Gastroenterological Endoscopy 53 (Supplement 1) 2011年
• Preoperative evaluation of Ampullary Neoplasm with the Convex array Echo Endoscope

  A. Masuda; H. Kutsumi; H. Shiomi; S. Yoshida; M. Takenaka; M. Sugimoto; T. Sanuki; M. Yoshida; T. Fujita; T. Hayakumo; T. Azuma JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY 25 A49 -A49 2010年09月
• 膵仮性嚢胞に対する内視鏡治療の限界

  竹中完; 角山沙織; 坂井文; 三村卓也; 古松恵介; 信谷健太郎; 吉田志栄; 増田充宏; 塩見英之; 杉本真樹; 佐貫毅; 久津見弘; 東健 Gastroenterological Endoscopy 52 (Supplement 2) 2010年
• 肝門部胆管癌におけるERBD後の胆管炎-metallic stentとtube stentとの比較

  古松恵介; 藤田剛; 塩見英之; 吉田志栄; 増田充弘; 竹中完; 杉本真樹; 佐貫毅; 久津見弘; 東健 胆道 24 (3) 2010年
• 当院での胃内視鏡検診の現状と標準法との比較検討

  菅原淳; 廣吉康秀; 藤元瞳; 松木信之; 氣比恵; 藤田光一; 津村英隆; 阿南隆洋; 稲垣恭和; 足立絵美; 竹中完; 叶多篤史; 吉永寛; 渡辺明彦; 藤田剛; 向井秀一 Gastroenterological Endoscopy 51 (Supplement 1) 2009年
• 当院における緊急上部消化管内視鏡止血術の現状

  氣比恵; 菅原淳; 廣吉康秀; 藤元瞳; 藤田光一; 松木信之; 津村英隆; 足立会美; 稲垣恭和; 竹中完; 阿南隆洋; 叶多篤史; 吉永寛; 渡辺明彦; 向井秀一 Gastroenterological Endoscopy 51 (Supplement 2) 2009年
• びらん性逆流性食道炎の自覚症状と生活習慣との関連

  松木信之; 藤田剛; 廣吉康秀; 藤元瞳; 氣比恵; 藤田光一; 津村英隆; 足立会美; 阿南隆洋; 稲垣恭和; 竹中完; 叶多篤史; 吉永寛; 渡辺明彦; 菅原淳; 向井秀一 日本消化器病学会雑誌 106 2009年
• 当院におけるキャンピロバクター腸炎の臨床像と内視鏡像の検討

  足立会美; 菅原淳; 藤元瞳; 氣比恵; 藤田光一; 津村英隆; 中山新士; 稲垣恭和; 竹中完; 福庭暢彦; 加藤隆夫; 吉永寛; 渡辺明彦; 藤田剛; 向井秀一 Gastroenterological Endoscopy 50 (Supplement 2) 2008年
• 当直医のための消化器救急診療マニュアル[総論]B.消化器症状とその鑑別診断 黄疸とその鑑別診断

  向井秀一; 廣吉康秀; 藤元瞳; 松木信之; 氣比恵; 藤田光一; 津村英隆; 阿南隆洋; 稲垣恭和; 足立会美; 竹中完; 叶多篤史; 吉永寛; 渡辺明彦; 菅原淳; 藤田剛 消化器内視鏡 20 (6) 2008年
• 胃癌深達度診断におけるEUSの有用性と問題点

  吉永寛; 藤元瞳; 氣比恵; 藤田光一; 津村英隆; 中山新士; 稲垣恭和; 足立会美; 福庭暢彦; 竹中完; 加藤隆夫; 渡辺明彦; 菅原淳; 藤田剛; 向井秀一 Gastroenterological Endoscopy 50 (Supplement 1) 2008年
• 進行胃癌に対する1st lineから2nd lineの化学療法の評価

  渡辺明彦; 菅原淳; 向井秀一; 藤元瞳; 気比恵; 藤田光一; 津村英隆; 中山新士; 稲垣恭和; 足立絵美; 福庭暢彦; 竹中完; 加藤隆夫; 吉永寛; 藤田剛 日本消化器病学会雑誌 105 2008年
• 当院における消化管出血に対するstrategy

  竹中完; 藤元瞳; 気比恵; 藤田光一; 津村英隆; 中山新士; 稲垣恭和; 足立会美; 福庭暢彦; 加藤隆夫; 吉永寛; 渡辺明彦; 菅原淳; 藤田剛; 向井秀一 Gastroenterological Endoscopy 50 (Supplement 1) 2008年
• 難治性潰瘍性大腸炎に対する白血球除去療法(LCAP)の治療成績とその内視鏡像についての検討

  足立会美; 菅原淳; 藤元瞳; 氣比恵; 藤田光一; 津村英隆; 中山新士; 稲垣恭和; 竹中完; 福庭暢彦; 加藤隆夫; 吉永寛; 渡辺明彦; 藤田剛; 向井秀一 Gastroenterological Endoscopy 50 (Supplement 1) 2008年
• 重症急性膵炎に対する蛋白分解酵素阻害薬・抗菌薬膵局所動注療法の検討

  藤田光一; 藤元瞳; 氣比恵; 津村英隆; 中山新士; 足立会美; 稲垣恭和; 竹中完; 福庭暢彦; 加藤隆夫; 吉永寛; 渡辺明彦; 菅原淳; 藤田剛; 向井秀一 日本消化器病学会雑誌 105 2008年
• 進行胃癌に対する1st lineから2nd lineの評価

  渡辺明彦; 藤田光一; 竹中完; 吉永寛; 向井秀一 日本臨床腫瘍学会学術集会プログラム・抄録集 6th 2008年
• 腹部超音波検診で発見された胆嚢癌の一例

  竹中完; 藤元瞳; 藤田光一; 津村英隆; 中山新士; 足立会美; 稲垣恭和; 福庭暢彦; 加藤隆夫; 吉永寛; 渡辺明彦; 菅原淳; 藤田剛; 向井秀一; 塚本忠司; 濱辺豊; 橘真由美; 寺村一裕 日本消化器がん検診学会雑誌 46 (1) 2008年
• 緩和医療における上部消化管ステント留置術の有効性,問題点の検討

  稲垣恭和; 藤元瞳; 氣比恵; 藤田光一; 津村英隆; 中山新士; 足立会美; 竹中完; 福庭暢彦; 加藤隆夫; 吉永寛; 渡辺明彦; 菅原淳; 藤田剛; 向井秀一 Gastroenterological Endoscopy 50 (Supplement 1) 2008年
• 消化器疾患に対するNSTの現状-プレアルブミンでの栄養評価-

  菅原淳; 渡辺明彦; 向井秀一; 藤元瞳; 気比恵; 藤田光一; 津村英隆; 中山新士; 稲垣恭和; 足立絵美; 福庭暢彦; 竹中完; 加藤隆夫; 吉永寛; 藤田剛 日本消化器病学会雑誌 105 2008年
• 悪性中下部胆管狭窄に対するself-expandable metallic stent(SEMS)の検討

  竹中完; 菅原淳; 向井秀一 Gastroenterological Endoscopy 50 (Supplement 2) 2008年
• 膵石治療抵抗例における膵管ステンティングの検討

  加藤隆夫; 藤元瞳; 気比恵; 藤田光一; 津村英隆; 中山新士; 稲垣恭和; 足立会美; 福庭暢彦; 竹中完; 吉永寛; 渡辺明彦; 菅原淳; 藤田剛; 向井秀一 Gastroenterological Endoscopy 49 (Supplement 2) 2007年
• 出血性消化性潰瘍に対する内視鏡的止血術の現状

  吉永寛; 藤田光一; 中山新士; 福庭暢彦; 松井佐織; 竹中完; 加藤隆夫; 尾阪将人; 益澤明; 渡辺明彦; 藤原仁史; 菅原淳; 藤田剛; 向井秀一 Gastroenterological Endoscopy 49 (Supplement 1) 2007年
• 当院の検診発見膵・胆道がんの現状

  中山新士; 藤元瞳; 氣比恵; 藤田光一; 津村英隆; 稲垣恭和; 足立会美; 福庭暢彦; 竹中完; 加藤隆夫; 吉永寛; 渡辺明彦; 菅原淳; 藤田剛; 向井秀一 日本消化器がん検診学会雑誌 45 (5) 2007年
• 膵管ドレナージ最前線 慢性膵炎に対する副乳頭からのステント留置

  向井秀一; 加藤隆夫; 福庭暢彦; 藤元瞳; 氣比恵; 藤田光一; 津村英隆; 中山新士; 稲垣恭和; 足立会美; 竹中完; 吉永寛; 渡辺明彦; 菅原淳; 藤田剛 消化器内視鏡 19 (12) 2007年
• 超音波内視鏡(EUS)診断の実際(51)EUSにより確定診断に至った消化器疾患-胃癌

  吉永寛; 向井秀一; 藤元瞳; 氣比恵; 藤田光一; 津村英隆; 中山新士; 稲垣恭和; 足立会美; 福庭暢彦; 竹中完; 加藤隆夫; 渡辺明彦; 菅原淳; 藤田剛; 橘真由美; 寺村一裕 消化器の臨床 10 (3) 2007年
• 当院における経皮経肝的胆嚢穿刺吸引術(PTGBA)の検討

  竹中完; 藤田光一; 中山新士; 福庭暢彦; 松井佐織; 尾阪将人; 柴垣広太郎; 吉永寛; 益澤明; 渡辺明彦; 藤原仁史; 菅原淳; 藤田剛; 向井秀一; 濱辺豊; 大西律人 日本消化器病学会雑誌 103 2006年
• 当院におけるC型急性肝炎25症例の検討

  益澤明; 藤田光一; 中山新士; 福庭暢彦; 竹中完; 松井佐織; 尾阪将人; 柴垣広太郎; 吉永寛; 渡辺明彦; 藤原仁史; 菅原淳; 藤田剛; 向井秀一 肝臓 47 (Supplement 2) 2006年
• 極細径スコープによる経口挿入は上部内視鏡検査の苦痛を軽減したか?-被検者のアンケート調査から-

  菅原淳; 藤田光一; 中山新士; 福庭暢彦; 竹中完; 松井沙織; 尾阪将人; 柴垣広太郎; 吉永寛; 渡辺明彦; 藤原仁史; 藤田剛; 向井秀一 Gastroenterological Endoscopy 48 (Supplement 2) 2006年
• ESD時代の早期胃癌深達度診断におけるEUSの有用性と問題点

  吉永寛; 藤田光一; 中山新士; 福庭暢彦; 竹中完; 松井佐織; 尾阪将人; 柴垣広太郎; 益澤明; 渡辺明彦; 藤原仁史; 菅原淳; 藤田剛; 向井秀一 Gastroenterological Endoscopy 48 (Supplement 2) 2006年
• 当院における経皮内視鏡的胃ろう造設術(PEG)症例の検討

  松井佐織; 藤田光一; 中山新士; 竹中完; 福庭暢彦; 尾阪将人; 柴垣広太郎; 吉永寛; 益沢明; 渡辺明彦; 藤原仁史; 菅原淳; 藤田剛; 向井秀一 Gastroenterological Endoscopy 48 (Supplement 1) 2006年
• 検診におけるGERD症状と上部消化管検査所見との関連

  藤田剛; 藤田剛; 藤田光一; 福庭暢彦; 竹中完; 松井佐織; 叶多篤史; 柴垣広太郎; 尾阪将人; 吉永寛; 益沢明; 渡辺明彦; 藤原仁史; 菅原淳; 菅原淳; 板垣康; 向井秀一 日本消化器病学会雑誌 102 2005年
• これがBasic technique V すい・胆道 B 治療 すい管ステントの基本とコツ

  向井秀一; 藤田光一; 中山新士; 福庭暢彦; 竹中完; 松井佐織; 尾阪将人; 柴垣広太郎; 吉永寛; 益沢明; 渡辺明彦; 藤原仁史; 菅原淳; 藤田剛 消化器内視鏡 17 (10) 2005年
• 腹部超音波検診におけるNAFLD

  藤田剛; 福庭暢彦; 竹中完; 松井佐織; 叶多篤史; 嵯峨一行; 柴垣広太郎; 尾阪将人; 北村静信 日本消化器病学会雑誌 102 2005年
• 悪性中下部胆管狭窄に対する経乳頭的biliary stenting

  柴垣広太郎; 藤田光一; 中山新士; 松井佐織; 竹中完; 福庭暢彦; 尾阪将人; 吉永寛; 益沢明; 渡辺明彦; 藤原仁史; 菅原淳; 藤田剛; 向井秀一 Gastroenterological Endoscopy 47 (Supplement 2) 2005年
• 健診における脂肪肝の意義 腹部超音波検診における脂肪肝と生活習慣病

  藤田剛; 藤原仁史; 竹中完; 松井佐織; 叶多篤史; 嵯峨一行; 柴垣広太郎; 板垣康; 渡辺直也 月刊消化器科 38 (4) 2004年
• 当院における胃癌化学療法の治療成績

  渡辺明彦; 福庭暢彦; 竹中完; 松井佐織; 叶多篤史; 尾阪将人; 柴垣広太郎; 嵯峨一行; 北村静信 日本消化器病学会雑誌 101 2004年
• すい管内乳頭腫よう(IPMT)の経過観察方針について

  吉永寛; 福庭暢彦; 竹中完; 松井佐織; 叶多篤史; 尾阪将人; 柴垣広太郎; 嵯峨一行; 北村静信 日本消化器病学会雑誌 101 2004年
• 経皮内視鏡的胃ろう造設術の安全性の検討

  北村静信; 福庭暢彦; 竹中完; 松井佐織; 叶多篤史; 尾阪将人; 柴垣広太郎; 嵯峨一行; 吉永寛 Gastroenterological Endoscopy 46 (Supplement 2) 2004年
• 大腸ポリープEMR後のFollow-upのあり方

  高木浩一; 竹中完; 松井佐織; 叶多篤史; 尾坂将人; 柴垣広太郎; 嵯峨一行; 北村静信; 向井秀一 Gastroenterological Endoscopy 45 (Supplement 2) 2003年
• 慢性すい炎の主すい管内結石と主すい管狭窄に対する内視鏡的治療

  渡辺明彦; 竹中完; 松井佐織; 叶多篤史; 尾阪将人; 柴垣広太郎; 嵯峨一行; 北村静信; 向井秀一 Gastroenterological Endoscopy 45 (Supplement 2) 2003年

共同研究・競争的資金等の研究課題

• 消化器疾患領域の透視下医療処置における被ばく線量測定（全国多施設前向き観察研究）

  日本学術振興会：科学研究費助成事業

  研究期間 : 2020年04月 -2023年03月 

  代表者 : 竹中 完; 細野 眞; 工藤 正俊

   

  本研究は各国の医療に用いられる放射線の使用基準に消化器領域の透視下医療処置の記載がほとんどされていないのは、信頼度の高い実際の被ばく量データが存在しないためであり、各透視下処置における、装置から出力される放射線量、患者・医療従事者の被ばく量を明らかにすることは、現在世に存在しない信頼度の高い情報を得られるのみではなく、「消化器領域のさまざまな透視下処置における被ばく量の基準値を定めDRL設定に繋げる」こと、消化器領域のみならず、透視下医療処置全般に関する被ばく量の基準作りにまで繋がることが可能になると考え立案した。唯一の被ばく国として放射線被ばくに関心の高い本邦において、世界に先駆けて、特に消化器領域の透視下医療処置に関する放射線被ばく量の基準を作成し、世界に発信することを目的に立案した。 「実臨床での透視下手技における患者と医療従事者の被ばく線量集計・解析」については当院における患者への透視下内視鏡手技における被ばく線量測定を行い、その数値は十分に防護対策をとらなければ基準値を容易に超える値であることが判明した。この内容は消化器病学会誌の速報に取り上げられ報告し、日本中の消化器内科医の被ばく防護意識改善に寄与したことが予想される。
• 医療分野の放射線業務における被ばくの実態と被ばく低減に関する調査研究

  労災疾病臨床研究事業費補助金研究（分担）：

  研究期間 : 2019年04月 -2022年03月 

  代表者 : 細野 眞

委員歴

• 2020年07月 - 現在   日本胆道学会   評議員
• 2019年11月 - 現在   日本膵臓学会   嚢胞性膵腫瘍委員会
• 2018年01月 - 現在   日本消化器病学会   学会評議員
• 2017年04月 - 現在   日本消化器内視鏡学会   学術評議員
• 2016年04月 - 現在   日本膵臓学会   早期慢性膵炎診断基準ワーキンググループ員
• 2016年04月 - 現在   日本膵臓学会   慢性膵炎分化会員
• 2016年04月 - 現在   日本膵臓学会   急性膵炎分化会員

担当経験のある科目

膵臓癌と化学療法近畿大学看護学部
OSCE講義（腹部診察）近畿大学医学部
ERCPとは近畿大学医学部5学年BSL講義
放射線再教育訓練「被ばく問題のこれから」近畿大学職員講習
看護専門学校講義「胆道」近畿大学看護学部
胆膵の超音波診断近畿大学医学部
胆膵の内視鏡診断近畿大学医学部
胆膵の自己免疫性疾患近畿大学医学部
胆膵の内科的治療近畿大学医学部
臨床総論：消化管を探る内視鏡検査（胆道）近畿大学医学部
臨床総論：消化管を探る内視鏡検査（膵臓）近畿大学医学部

社会貢献活動

• 中国広州TTT(Teach the trainer)活動

  期間 : 2017年08月 - 現在

  役割 : 講師　中国広州の中山腫瘍大学を中心に広州地区での胆膵内視鏡手技の指導者作成プログラム 現地に趣き現地の指導者候補医師に講演、ライブデモンストレーションを行い、技術指導ならびに教育の指導も行うプログラム
• 大阪狭山市医師会講演会

  期間 : 2019年05月07日

  役割 : 講師
• 河内長野市医師会学術講演

  期間 : 2018年04月21日

  役割 : 講師
• 大阪府医師会 学術講演会

  期間 : 2017年07月20日

  役割 : 講師
• 日本消化器病学会近畿支部市民公開講座「胆道がんの早期発見と予防法」

  期間 : 2016年08月28日

  役割 : 講師
• インドネシア内視鏡アドバンス手技普及支援事業

  期間 : 2014年 - 2015年

  役割 : 講師

  主催者・発行元 : 経済産業省事業

  　経済産業省の2013年度補正予算事業により2014年9月に設立されたインドネシア大学附属チプト病院内の内視鏡トレーニングセンターを専門家派遣指導の核として、インドネシア消化器内視鏡学会と協力し、内視鏡機器を用いた上部および下部消化官エリアにおける疾病の早期診断と治療方法について指導を実施した。

その他のリンク

researchmap

https://researchmap.jp/36-1