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Fukuda T, Yamazaki H, Miyatani Y, Sawada T, Shibuya N, Fukuo Y, Kiyohara H, Morikubo H, Tominaga K, Kakimoto K, Imai T, Yaguchi K, Yamamoto S, Ando K, Nishimata N, Yoshihara T, Andoh A, Hibi T, Matsuoka K. Recent steroid use and the relapse risk in ulcerative colitis patients with endoscopic healing. Aliment Pharmacol Ther 2024. [PMID: 38651779 DOI: 10.1111/apt.18013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 12/18/2023] [Accepted: 04/11/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND Endoscopic healing (EH) is a therapeutic target in ulcerative colitis (UC). However, even patients who have achieved EH relapse frequently. AIMS To investigate the association between recent steroid use and relapse risk in UC patients with EH. METHODS This multi-centre cohort study included 1212 UC patients with confirmed EH (Mayo endoscopic subscore ≤1). We excluded patients with current systemic steroid use or history of advanced therapy. We divided patients into a recent steroid group (last systemic steroid use within 1 year; n = 59) and a non-recent or steroid-naïve group (n = 1153). We followed the patients for 2 years to evaluate relapse, defined as induction of systemic steroids or advanced therapy. We used logistic regression to estimate the odds ratio (OR) of relapse. RESULTS Relapse occurred in 28.8% of the recent steroid group and 5.6% of the non-recent/steroid-naïve group (multi-variable-adjusted OR 5.53 [95% CI 2.85-10.7]). The risk of relapse decreased with time since the last steroid use: 28.8% for less than 1 year after steroid therapy, 22.9% for 1 year, 16.0% for 2 years and 7.9% beyond 3 years, approaching 4.0% in steroid-naïve patients. (ptrend <0.001). CONCLUSIONS Even for patients with UC who achieved EH, the risk of relapse remains high following recent steroid therapy. Physicians need to consider the duration since last steroid use to stratify the relapse risk in UC patients with EH.
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Affiliation(s)
- Tomohiro Fukuda
- Department of Gastroenterology, Yokohama Municipal Citizen's Hospital, Kanagawa, Japan
| | - Hajime Yamazaki
- Section of Clinical Epidemiology, Department of Community Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yusuke Miyatani
- Centre for Advanced IBD Research and Treatment, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
| | - Tsunaki Sawada
- Department of Endoscopy, Nagoya University Hospital, Aichi, Japan
| | - Naoki Shibuya
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan
| | - Yuka Fukuo
- Department of Gastroenterology, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Hiroki Kiyohara
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Hiromu Morikubo
- Department of Gastroenterology and Hepatology, Kyorin University School of Medicine, Tokyo, Japan
| | - Keiichi Tominaga
- Department of Gastroenterology, Dokkyo Medical University, Tochigi, Japan
| | - Kazuki Kakimoto
- 2nd Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Takayuki Imai
- Department of Medicine, Shiga University of Medical Science, Shiga, Japan
| | - Katsuki Yaguchi
- Inflammatory Bowel Disease Centre, Yokohama City University Medical Centre, Kanagawa, Japan
| | - Shojiro Yamamoto
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki Hospital, Miyazaki, Japan
| | - Katsuyoshi Ando
- Gastroenterology and Endoscopy, Division of Metabolism and Biosystemic Science, Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Asahikawa, Japan
| | - Nobuaki Nishimata
- Department of Gastroenterology, Sameshima Hospital, Kagoshima, Japan
| | - Takeo Yoshihara
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Akira Andoh
- Department of Medicine, Shiga University of Medical Science, Shiga, Japan
| | - Toshifumi Hibi
- Centre for Advanced IBD Research and Treatment, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
| | - Katsuyoshi Matsuoka
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Toho University Sakura Medical Center, Chiba, Japan
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2
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Kojimahara S, Kanazawa M, Tominaga K, Masuyama S, Matsumoto K, Watanabe S, Yamamiya A, Sugaya T, Goda K, Irisawa A. Symptomatic duodenal intramural hematoma caused by weight training: a report of two cases. Clin J Gastroenterol 2024:10.1007/s12328-024-01970-7. [PMID: 38619759 DOI: 10.1007/s12328-024-01970-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 04/01/2024] [Indexed: 04/16/2024]
Abstract
Symptoms of traumatic duodenal intramural hematoma, a rare disease caused by trauma, blood disease, or antithrombotic therapy, can include abdominal pain. Case 1 is that of a 35-year-old man at a gym who dropped a 100 kg barbell on his abdomen. It was diagnosed as a duodenal obstruction caused by a traumatic intestinal wall hematoma. In Case 2, a 16-year-old male adolescent performing deadlift training at a gym had subsequent abdominal pain. It was diagnosed as intestinal wall hematoma. Both patients improved with conservative treatment. Malignancy is sometimes suspected from imaging findings. Detailed patient history and imaging studies can avoid unnecessary surgery.
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Affiliation(s)
- Shunsuke Kojimahara
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, 880 Kitakobayashi, Mibu, Tochigi, 321-0293, Japan
| | - Mimari Kanazawa
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, 880 Kitakobayashi, Mibu, Tochigi, 321-0293, Japan
| | - Keiichi Tominaga
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, 880 Kitakobayashi, Mibu, Tochigi, 321-0293, Japan.
| | - Satoshi Masuyama
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, 880 Kitakobayashi, Mibu, Tochigi, 321-0293, Japan
| | - Kengo Matsumoto
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, 880 Kitakobayashi, Mibu, Tochigi, 321-0293, Japan
| | - Shoko Watanabe
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, 880 Kitakobayashi, Mibu, Tochigi, 321-0293, Japan
| | - Akira Yamamiya
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, 880 Kitakobayashi, Mibu, Tochigi, 321-0293, Japan
| | - Takeshi Sugaya
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, 880 Kitakobayashi, Mibu, Tochigi, 321-0293, Japan
| | - Kenichi Goda
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, 880 Kitakobayashi, Mibu, Tochigi, 321-0293, Japan
| | - Atsushi Irisawa
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, 880 Kitakobayashi, Mibu, Tochigi, 321-0293, Japan
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3
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Makuuchi M, Kakuta Y, Umeno J, Fujii T, Takagawa T, Ibuka T, Miura M, Sasaki Y, Takahashi S, Nakase H, Kiyohara H, Tominaga K, Shimodaira Y, Hiraoka S, Ueno N, Yanai S, Yoshihara T, Kakimoto K, Matsuoka K, Hayashi R, Nanjo S, Iwama I, Ishiguro Y, Chiba H, Endo K, Kagaya T, Fukuda T, Sakata Y, Kudo T, Takagi T, Takahashi K, Naganuma M, Shinozaki M, Ogata N, Tanaka H, Narimatsu K, Miyazaki H, Ishige T, Onodera M, Hashimoto Y, Nagai H, Shimoyama Y, Naito T, Moroi R, Shiga H, Kinouchi Y, Andoh A, Hisamatsu T, Masamune A. Real-world NUDT15 genotyping and thiopurine treatment optimization in inflammatory bowel disease: a multicenter study. J Gastroenterol 2024:10.1007/s00535-024-02099-7. [PMID: 38589597 DOI: 10.1007/s00535-024-02099-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 03/12/2024] [Indexed: 04/10/2024]
Abstract
BACKGROUND This study evaluated the effectiveness of NUDT15 codon 139 genotyping in optimizing thiopurine treatment for inflammatory bowel disease (IBD) in Japan, using real-world data, and aimed to establish genotype-based treatment strategies. METHODS A retrospective analysis of 4628 IBD patients who underwent NUDT15 codon 139 genotyping was conducted. This study assessed the purpose of the genotyping test and subsequent prescriptions following the obtained results. Outcomes were compared between the Genotyping group (thiopurine with genotyping test) and Non-genotyping group (thiopurine without genotyping test). Risk factors for adverse events (AEs) were analyzed by genotype and prior genotyping status. RESULTS Genotyping test for medical purposes showed no significant difference in thiopurine induction rates between Arg/Arg and Arg/Cys genotypes, but nine Arg/Cys patients opted out of thiopurine treatment. In the Genotyping group, Arg/Arg patients received higher initial doses than the Non-genotyping group, while Arg/Cys patients received lower ones (median 25 mg/day). Fewer AEs occurred in the Genotyping group because of their lower incidence in Arg/Cys cases. Starting with < 25 mg/day of AZA reduced AEs in Arg/Cys patients, while Arg/Arg patients had better retention rates when maintaining ≥ 75 mg AZA. Nausea and liver injury correlated with thiopurine formulation but not dosage. pH-dependent mesalamine reduced leukopenia risk in mesalamine users. CONCLUSIONS NUDT15 codon 139 genotyping effectively reduces thiopurine-induced AEs and improves treatment retention rates in IBD patients after genotype-based dose adjustments. This study provides data-driven treatment strategies based on genotype and identifies risk factors for specific AEs, contributing to a refined thiopurine treatment approach.
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Affiliation(s)
- Motoki Makuuchi
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, 1-1 Seiryo, Aoba, Sendai, 980-8574, Japan
| | - Yoichi Kakuta
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, 1-1 Seiryo, Aoba, Sendai, 980-8574, Japan.
| | - Junji Umeno
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Toshimitsu Fujii
- Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tetsuya Takagawa
- Center for Clinical Research and Education/Center for Inflammatory Bowel Disease, Hyogo Medical University, Nishinomiya, Japan
| | - Takashi Ibuka
- Department of Gastroenterology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Miki Miura
- Department of Gastroenterology and Hepatology, Kyorin University School of Medicine, Tokyo, Japan
| | - Yu Sasaki
- Department of Gastroenterology, Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Sakuma Takahashi
- Department of Gastroenterology, Kagawa Prefectural Central Hospital, Takamatsu, Japan
| | - Hiroshi Nakase
- Department of Gastroenterology and Hepatology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Hiroki Kiyohara
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Keiichi Tominaga
- Department of Gastroenterology, Dokkyo Medical University, Tochigi, Japan
| | - Yosuke Shimodaira
- Department of Gastroenterology and Neurology, Akita University, Akita, Japan
| | - Sakiko Hiraoka
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Nobuhiro Ueno
- Division of General Medicine, Asahikawa Medical University Hospital, Asahikawa, Japan
| | - Shunichi Yanai
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Iwate Medical University, Morioka, Japan
| | - Takeo Yoshihara
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kazuki Kakimoto
- Second Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Katsuyoshi Matsuoka
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Toho University Sakura Medical Center, Chiba, Japan
| | - Ryohei Hayashi
- Department of Gastroenterology, Hiroshima University Hospital, Hiroshima, Japan
| | - Sohachi Nanjo
- Third Department of Internal Medicine, Graduate School of Medicine, University of Toyama, Toyama, Japan
| | - Itaru Iwama
- Division of Gastroenterology and Hepatology, Saitama Children's Medical Center, Saitama, Japan
| | - Yoh Ishiguro
- Division of Clinical Research, Hirosaki General Medical Center, NHO, Hirosaki, Japan
| | - Hirofumi Chiba
- Department of Gastroenterology, Iwate Prefectural Isawa Hospital, Oshu, Japan
| | - Katsuya Endo
- Division of Gastroenterology, Tohoku Medical and Pharmaceutical University School of Medicine, Sendai, Japan
| | - Takashi Kagaya
- Department of Gastroenterology, NHO Kanazawa Medical Center, Kanazawa, Japan
| | - Tomohiro Fukuda
- Center for Advanced IBD Research and Treatment, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
| | - Yasuhisa Sakata
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Takahiro Kudo
- Department of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Tomohisa Takagi
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kenichi Takahashi
- Department of Colorectal Surgery, Tohoku Rosai Hospital, Sendai, Japan
| | - Makoto Naganuma
- Third Department of Internal Medicine, Kansai Medical University, Hirakata, Japan
| | | | - Noriyuki Ogata
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | | | - Kazuyuki Narimatsu
- Department of Internal Medicine, National Defense Medical College, Tokorozawa, Japan
| | - Haruka Miyazaki
- Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takashi Ishige
- Department of Pediatrics, Gunma University Graduate School of Medicine, Maebashi, Japan
| | | | - Yu Hashimoto
- Department of Gastroenterology and Hepatology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Hiroshi Nagai
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, 1-1 Seiryo, Aoba, Sendai, 980-8574, Japan
| | - Yusuke Shimoyama
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, 1-1 Seiryo, Aoba, Sendai, 980-8574, Japan
| | - Takeo Naito
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, 1-1 Seiryo, Aoba, Sendai, 980-8574, Japan
| | - Rintaro Moroi
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, 1-1 Seiryo, Aoba, Sendai, 980-8574, Japan
| | - Hisashi Shiga
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, 1-1 Seiryo, Aoba, Sendai, 980-8574, Japan
| | - Yoshitaka Kinouchi
- Student Healthcare Center, Institute for Excellence in Higher Education, Tohoku University, Sendai, Japan
| | - Akira Andoh
- Division of Gastroenterology and Hematology, Department of Medicine, Shiga University of Medical Science, Otsu, Japan
| | - Tadakazu Hisamatsu
- Department of Gastroenterology and Hepatology, Kyorin University School of Medicine, Tokyo, Japan
| | - Atsushi Masamune
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, 1-1 Seiryo, Aoba, Sendai, 980-8574, Japan
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4
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Nagashima K, Kashima K, Kunogi Y, Sakuma F, Fukushi K, Yamamiya A, Abe Y, Tominaga K, Iijima M, Goda K, Romero-Castro R, Irisawa A. Treatment of endoscopic ultrasound-guided coil deployment for isolated gastric varices using 0.035-inch hydrocoil: Experience of three cases. DEN Open 2024; 4:e252. [PMID: 37325201 PMCID: PMC10267612 DOI: 10.1002/deo2.252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 05/16/2023] [Accepted: 05/29/2023] [Indexed: 06/17/2023]
Abstract
Endoscopic ultrasound (EUS)-guided coil deployment (EUS-coiling) has been newly developed for treating isolated gastric varices (iGV). This report describes three cases of EUS-coiling for iGV using a 0.035-inch hydrocoil (Azur; Terumo Corp., Tokyo, Japan). When used for EUS-coiling, this hydrocoil provides the following benefits: Its electrically detachable system allows pull back. It has smooth and dense deployment. Moreover, it has a strong blood-flow blocking effect because of its long length and large diameter with internal swelling functions of the hydrogel. Technical success of coiling was achieved in all cases. After coiling, additional treatments such as cyanoacrylate and sclerosant injection were performed as deemed appropriate. All iGVs were obliterated successfully. No adverse event occurred during the procedure or during the mean follow-up of six months. Our findings indicate that this 0.035-inch hydrocoil can be used to treat iGV safely and effectively.
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Affiliation(s)
- Kazunori Nagashima
- Department of GastroenterologyDokkyo Medical University School of MedicineTochigiJapan
| | - Ken Kashima
- Department of GastroenterologyDokkyo Medical University School of MedicineTochigiJapan
| | - Yasuhito Kunogi
- Department of GastroenterologyDokkyo Medical University School of MedicineTochigiJapan
| | - Fumi Sakuma
- Department of GastroenterologyDokkyo Medical University School of MedicineTochigiJapan
| | - Koh Fukushi
- Department of GastroenterologyDokkyo Medical University School of MedicineTochigiJapan
| | - Akira Yamamiya
- Department of GastroenterologyDokkyo Medical University School of MedicineTochigiJapan
| | - Yoko Abe
- Department of GastroenterologyDokkyo Medical University School of MedicineTochigiJapan
| | - Keiichi Tominaga
- Department of GastroenterologyDokkyo Medical University School of MedicineTochigiJapan
| | - Makoto Iijima
- Department of GastroenterologyDokkyo Medical University School of MedicineTochigiJapan
| | - Kenichi Goda
- Department of GastroenterologyDokkyo Medical University School of MedicineTochigiJapan
| | - Rafael Romero-Castro
- Endoscopy UnitGastroenterology DivisionVirgen Macarena University HospitalSevilleSpain
| | - Atsushi Irisawa
- Department of GastroenterologyDokkyo Medical University School of MedicineTochigiJapan
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5
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Fujita Y, Tominaga K, Shirakawa Y, Kanazawa M, Suzuki A, Kuwashima S, Yoshihara S. Pediatric Crohn's Disease Presenting with Gastrocnemius Myositis. Indian J Pediatr 2024; 91:408. [PMID: 37318683 DOI: 10.1007/s12098-023-04715-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 06/01/2023] [Indexed: 06/16/2023]
Affiliation(s)
- Yuji Fujita
- Department of Pediatrics, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga, Tochigi, 321-0293, Japan.
| | - Keiichi Tominaga
- Department of Gastroenterology, Dokkyo Medical University, Tochigi, Japan
| | - Yoshiyuki Shirakawa
- Department of Pediatrics, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga, Tochigi, 321-0293, Japan
| | - Mimari Kanazawa
- Department of Gastroenterology, Dokkyo Medical University, Tochigi, Japan
| | - Atsushi Suzuki
- Department of Radiology, Dokkyo Medical University, Tochigi, Japan
| | | | - Shigemi Yoshihara
- Department of Pediatrics, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga, Tochigi, 321-0293, Japan
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6
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Ueki T, Maruo T, Igarashi Y, Yamamiya A, Tominaga K, Irisawa A, Yoshida H, Kamisawa T, Takenaka M, Isayama H. Role of advanced endoscopy in the management of inflammatory digestive diseases (pancreas and biliary tract). Dig Endosc 2024. [PMID: 38475671 DOI: 10.1111/den.14756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 01/09/2024] [Indexed: 03/14/2024]
Abstract
The progress of endoscopic diagnosis and treatment for inflammatory diseases of the biliary tract and pancreas have been remarkable. Endoscopic ultrasonography (EUS) and EUS-elastography are used for the diagnosis of early chronic pancreatitis and evaluation of endocrine and exocrine function in chronic pancreatitis. Notably, extracorporeal shock wave lithotripsy and electrohydraulic shock wave lithotripsy have improved the endoscopic stone removal rate in patients for whom pancreatic stone removal is difficult. Studies have reported the use of self-expanding metal stents for stent placement for pancreatic duct stenosis and EUS-guided pancreatic drainage for refractory pancreatic duct strictures. Furthermore, EUS-guided drainage using a double-pigtailed plastic stent has been performed for the management of symptomatic pancreatic fluid collection after acute pancreatitis. Recently, lumen-apposing metal stents have led to advances in the treatment of walled-off necrosis after acute pancreatitis. EUS-guided biliary drainage is an alternative to refractory endoscopic biliary drainage and percutaneous transhepatic biliary drainage for the treatment of acute cholangitis. The placement of an inside stent followed by switching to uncovered self-expanding metal stents in difficult-to-treat cases has been proposed for acute cholangitis by malignant biliary obstruction. Endoscopic transpapillary gallbladder drainage is an alternative to percutaneous transhepatic gallbladder drainage for severe and some cases of moderate acute cholecystitis. EUS-guided gallbladder drainage has been reported as an alternative to percutaneous transhepatic gallbladder drainage and endoscopic transpapillary gallbladder drainage. However, it is important to understand the advantages and disadvantages of each drainage method and select the optimal drainage method for each case.
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Affiliation(s)
- Toshiharu Ueki
- Department of Gastroenterology, Fukuoka University Chikushi Hospital, Fukuoka, Japan
| | - Toru Maruo
- Department of Gastroenterology, Fukuoka University Chikushi Hospital, Fukuoka, Japan
| | - Yoshinori Igarashi
- Division of Gastroenterology and Hepatology, Toho University Omori Medical Center, Tokyo, Japan
| | - Akira Yamamiya
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, Tochigi, Japan
| | - Keiichi Tominaga
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, Tochigi, Japan
| | - Atsushi Irisawa
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, Tochigi, Japan
| | - Hitoshi Yoshida
- Department of Gastroenterology, Showa University School of Medicine, Tokyo, Japan
| | - Terumi Kamisawa
- Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Mamoru Takenaka
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Kindai University Hospital, Osaka, Japan
| | - Hiroyuki Isayama
- Department of Gastroenterology, Graduate School of Medicine, Juntendo University, Tokyo, Japan
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7
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Fujita Y, Tominaga K, Tanaka T, Yamamiya A, Irisawa A, Ishida K, Ishige T, Yoshihara S. Acute Pancreatitis Leading to the Diagnosis of Presymptomatic Crohn's Disease: A Pediatric Case Report. Cureus 2024; 16:e53397. [PMID: 38435224 PMCID: PMC10908432 DOI: 10.7759/cureus.53397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2024] [Indexed: 03/05/2024] Open
Abstract
A 14-year-old boy presented with fever and abdominal pain and was diagnosed with acute pancreatitis based on computed tomography findings. The patient had neither diarrhea nor bloody stool but was diagnosed with microcytic anemia. Endoscopic examination revealed a cobblestone pattern and longitudinal ulcer scars in the jejunum. However, no abnormal findings were observed in the ileum or colon. Endoscopic ultrasound-guided fine-needle aspiration was performed from pancreatic body-tail. Pathological examination revealed no evidence of autoimmune pancreatitis (AIP). It was unclear from pathological examination whether idiopathic pancreatitis had self-limitedly improved or whether it was AIP localized to the pancreatic head. The patient was diagnosed with asymptomatic small-bowel Crohn's disease (CD), which may have been two unrelated events of acute pancreatitis. Acute pancreatitis may precede a diagnosis of inflammatory bowel disease. CD with only jejunal involvement (Montreal classification L4) is extremely rare, and we were able to diagnose it early.
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Affiliation(s)
- Yuji Fujita
- Department of Pediatrics, Dokkyo Medical University, Mibu, JPN
| | - Keiichi Tominaga
- Department of Gastroenterology, Dokkyo Medical University, Mibu, JPN
| | - Takanao Tanaka
- Department of Gastroenterology, Dokkyo Medical University, Mibu, JPN
| | - Akira Yamamiya
- Department of Gastroenterology, Dokkyo Medical University, Mibu, JPN
| | - Atsushi Irisawa
- Department of Gastroenterology, Dokkyo Medical University, Mibu, JPN
| | - Kazuyuki Ishida
- Department of Diagnostic Pathology, Dokkyo Medical University, Mibu, JPN
| | - Takashi Ishige
- Department of Pediatrics, Gunma University Graduate School of Medicine, Maebashi, JPN
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8
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Ihara K, Nakamura T, Takayanagi M, Fujita J, Maeda Y, Nishi Y, Shibuya N, Hachiya H, Ishizuka M, Tominaga K, Kojima K, Irisawa A. Risk Factors for Stoma Outlet Obstruction after Proctocolectomy for Ulcerative Colitis. J Anus Rectum Colon 2024; 8:18-23. [PMID: 38313747 PMCID: PMC10831979 DOI: 10.23922/jarc.2023-018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 10/19/2023] [Indexed: 02/06/2024] Open
Abstract
Objectives Stoma outlet obstruction (SOO) occurs with an incidence of approximately 40% after proctocolectomy for Ulcerative colitis (UC) with diverting ileostomy. This study aimed to identify the risk factors for SOO after proctocolectomy with diverting ileostomy for patients with UC. Methods We reviewed the data of 68 patients with UC who underwent proctocolectomy and diverting ileostomy between April 2006 and September 2021. These cases were analyzed on the basis of clinicopathological and anatomical factors. SOO was defined as small bowel obstruction displaying symptoms of intestinal obstruction, such as abdominal distention, abdominal pain, insertion of a tube through the stoma. Results The study included 38 (56%) men and 30 (44%) women with a median age of 42 years (range, 21-80). SOO categorized as at least Clavien-Dindo grade II occurred in 11 (16%) patients. Six patients required earlier stoma closure than scheduled. Compared with patients without SOO, patients with SOO had a significantly higher total steroid dose from the onset of UC to surgery (p = 0.02), a small amount of intraabdominal fat (p = 0.04), and a higher rate of laparoscopic surgery (p < 0.01). Conclusions A high preoperative steroid dose, a small amount of intraabdominal fat and laparoscopic surgery were identified as risk factors for SOO. Early detection and treatment for SOO are important for patients at risk.
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Affiliation(s)
- Keisuke Ihara
- Center for Colorectal Surgery, Dokkyo Medical University Hospital, Shimotsuga, Japan
- Department of Surgical Oncology, Dokkyo Medical University, Shimotsuga, Japan
| | - Takatoshi Nakamura
- Center for Colorectal Surgery, Dokkyo Medical University Hospital, Shimotsuga, Japan
- Department of Surgical Oncology, Dokkyo Medical University, Shimotsuga, Japan
| | - Masashi Takayanagi
- Department of Surgical Oncology, Dokkyo Medical University, Shimotsuga, Japan
| | - Junki Fujita
- Center for Colorectal Surgery, Dokkyo Medical University Hospital, Shimotsuga, Japan
- Department of Surgical Oncology, Dokkyo Medical University, Shimotsuga, Japan
| | - Yasunori Maeda
- Center for Colorectal Surgery, Dokkyo Medical University Hospital, Shimotsuga, Japan
- Department of Surgical Oncology, Dokkyo Medical University, Shimotsuga, Japan
| | - Yusuke Nishi
- Center for Colorectal Surgery, Dokkyo Medical University Hospital, Shimotsuga, Japan
| | - Norisuke Shibuya
- Center for Colorectal Surgery, Dokkyo Medical University Hospital, Shimotsuga, Japan
| | - Hiroyuki Hachiya
- Center for Colorectal Surgery, Dokkyo Medical University Hospital, Shimotsuga, Japan
| | - Mitsuru Ishizuka
- Center for Colorectal Surgery, Dokkyo Medical University Hospital, Shimotsuga, Japan
| | - Keiichi Tominaga
- Department of Gastroenterology, Dokkyo Medical University, Shimotsuga, Japan
| | - Kazuyuki Kojima
- Department of Surgical Oncology, Dokkyo Medical University, Shimotsuga, Japan
| | - Atsushi Irisawa
- Center for Colorectal Surgery, Dokkyo Medical University Hospital, Shimotsuga, Japan
- Department of Gastroenterology, Dokkyo Medical University, Shimotsuga, Japan
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9
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Inaba Y, Goda K, Kondo M, Abe K, Kanamori A, Suzuki T, Tominaga K, Nakagawa M, Morita S, Kojima K, Ishida K, Irisawa A. Hereditary Diffuse Gastric Cancer Treated by Prophylactic Total Gastrectomy. Intern Med 2024; 63:235-239. [PMID: 37225495 PMCID: PMC10864090 DOI: 10.2169/internalmedicine.1257-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 04/02/2023] [Indexed: 05/26/2023] Open
Abstract
We herein report a rare case of hereditary diffuse gastric cancer in a Japanese man. A 41-year-old man underwent esophagogastroduodenoscopy which revealed a small gastric erosion. Biopsy specimens showed signet ring cell carcinoma, and endoscopic submucosal dissection was performed. The patient's elder sister had died of gastric cancer at 38 years old. Considering the family history, a genetic test was conducted and revealed a CDH1 germline mutation. Although no carcinomatous lesion was detected endoscopically, prophylactic total gastrectomy was performed. The resection specimen showed seven microlesions of signet ring cell carcinoma confined to the lamina propria mucosae.
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Affiliation(s)
- Yasunori Inaba
- Department of Gastroenterology, Dokkyo Medical University, Japan
| | - Kenichi Goda
- Department of Gastroenterology, Dokkyo Medical University, Japan
| | - Masayuki Kondo
- Department of Gastroenterology, Dokkyo Medical University, Japan
| | - Keiichiro Abe
- Department of Gastroenterology, Dokkyo Medical University, Japan
| | - Akira Kanamori
- Department of Gastroenterology, Dokkyo Medical University, Japan
| | - Tsunehiro Suzuki
- Department of Gastroenterology, Dokkyo Medical University, Japan
| | - Keiichi Tominaga
- Department of Gastroenterology, Dokkyo Medical University, Japan
| | - Masatoshi Nakagawa
- Department of Upper Gastrointestinal Surgery, Dokkyo Medical University, Japan
| | - Shinji Morita
- Department of Upper Gastrointestinal Surgery, Dokkyo Medical University, Japan
| | - Kazuyuki Kojima
- Department of Upper Gastrointestinal Surgery, Dokkyo Medical University, Japan
| | - Kazuyuki Ishida
- Department of Diagnostic Pathology, Dokkyo Medical University, Japan
| | - Atsushi Irisawa
- Department of Gastroenterology, Dokkyo Medical University, Japan
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10
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Kiyohara H, Yamazaki H, Moriya K, Akimoto N, Kawai S, Takenaka K, Fukuda T, Tominaga K, Umeno J, Shinzaki S, Honzawa Y, Takagi T, Ichikawa H, Endo T, Ozaki R, Andoh A, Matsuoka K, Hibi T, Kobayashi T. White Blood Cell Counts and Future Relapse in Ulcerative Colitis under Low-Dose Thiopurine Treatment in Real-World Practice: A 3-Year Japanese Multi-Center Retrospective Cohort Study. Inflamm Intest Dis 2024; 9:1-10. [PMID: 38298887 PMCID: PMC10830139 DOI: 10.1159/000535889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 12/15/2023] [Indexed: 02/02/2024] Open
Abstract
Introduction Whether white blood cell (WBC) counts are predictors for the effectiveness of thiopurine treatment in ulcerative colitis (UC) has been inconclusive in previous studies with small sample sizes. We investigated the association between WBC counts and future relapses in UC patients in a large-scale multi-center study. Methods This retrospective cohort study enrolled a total of 723 UC patients in remission from 33 hospitals and followed up for 3 years. Relapse was defined as a need for treatment intensification. The risk of relapse was compared among patients with the baseline WBC counts <3,000/µL (N = 31), 3,000-4,000/µL (N = 167), 4,000-5,000/µL (N = 241), and ≥5,000/µL (N = 284) using a Cox regression model analysis. Moreover, exploratory analyses were conducted to identify other factors predicting relapse. Results During a median follow-up period of 1,095 (interquartile range, 1,032-1,119) days, relapse occurred in 17.2% (125/723). In a crude analysis, WBC counts were not associated with relapse; hazard ratios (HRs) (95% confidence interval [CI]) were 1.50 (0.74-3.06), 1.02 (0.66-1.59), and 0.67 (0.43-1.05) in WBC <3,000/µL, 3,000-4,000/µL, and 4,000-5,000/µL groups, respectively (WBC ≥5,000/µL group, as reference). Multivariable-adjusted analyses showed similar results; HRs (95% CI) were 1.21 (0.59-2.49), 1.08 (0.69-1.69), and 0.69 (0.44-1.07), in <3,000/µL, 3,000-4,000/µL, and 4,000-5,000/µL groups, respectively. In the exploratory analyses, thiopurine use <1 year and a mean corpuscular volume <90 fL were predictors for relapse. Discussion/Conclusion WBC counts were not predictors for future relapses in patients with UC treated with thiopurine as a maintenance therapy.
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Affiliation(s)
- Hiroki Kiyohara
- Center for Advanced IBD Research and Treatment, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Hajime Yamazaki
- Section of Clinical Epidemiology, Department of Community Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kei Moriya
- Department of Gastroenterology and Hepatology, Nara Medical University, Nara, Japan
| | - Naohiko Akimoto
- Department of Gastroenterology, Nippon Medical School, Graduate School of Medicine, Tokyo, Japan
- Department of Gastroenterology, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
| | - Shoichiro Kawai
- Department of Gastroenterology and Hepatology, Osaka General Medical Center, Osaka, Japan
| | - Kento Takenaka
- Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tomohiro Fukuda
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Keiichi Tominaga
- Department of Gastroenterology, Dokkyo Medical University, Tochigi, Japan
| | - Junji Umeno
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shinichiro Shinzaki
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Osaka, Japan
- Department of Gastroenterology, Hyogo Medical University, Hyogo, Japan
| | - Yusuke Honzawa
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tomohisa Takagi
- Department of Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hitoshi Ichikawa
- Department of Gastroenterology, Tokai University Hachioji Hospital, Tokyo, Japan
| | - Toshiyuki Endo
- Department of Gastroenterology, Showa University Fujigaoka Hospital, Kanagawa, Japan
| | - Ryo Ozaki
- Department of Gastroenterology and Hepatology, Kyorin University School of Medicine, Tokyo, Japan
| | - Akira Andoh
- Department of Gastroenterology, Shiga University of Medical Science, Shiga, Japan
| | - Katsuyoshi Matsuoka
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Toho University Sakura Medical Center, Chiba, Japan
| | - Toshifumi Hibi
- Center for Advanced IBD Research and Treatment, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
| | - Taku Kobayashi
- Center for Advanced IBD Research and Treatment, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
| | - IBD Terakoya Group
- Center for Advanced IBD Research and Treatment, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
- Section of Clinical Epidemiology, Department of Community Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Department of Gastroenterology and Hepatology, Nara Medical University, Nara, Japan
- Department of Gastroenterology, Nippon Medical School, Graduate School of Medicine, Tokyo, Japan
- Department of Gastroenterology, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
- Department of Gastroenterology and Hepatology, Osaka General Medical Center, Osaka, Japan
- Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, Tokyo, Japan
- Department of Gastroenterology, Dokkyo Medical University, Tochigi, Japan
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Osaka, Japan
- Department of Gastroenterology, Hyogo Medical University, Hyogo, Japan
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Department of Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Kyoto, Japan
- Department of Gastroenterology, Tokai University Hachioji Hospital, Tokyo, Japan
- Department of Gastroenterology, Showa University Fujigaoka Hospital, Kanagawa, Japan
- Department of Gastroenterology and Hepatology, Kyorin University School of Medicine, Tokyo, Japan
- Department of Gastroenterology, Shiga University of Medical Science, Shiga, Japan
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Toho University Sakura Medical Center, Chiba, Japan
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11
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Sakuma F, Yamamiya A, Abe Y, Nagashima K, Minaguchi T, Kashima K, Kunogi Y, Fukushi K, Inaba Y, Sugaya T, Tominaga K, Goda K, Irisawa A. Investigating COVID-19 Pandemic Effects on Acute Pancreatitis Development-From the Perspective of Alcohol Sales (Consumption) in a Japanese Regional Hospital. Healthcare (Basel) 2023; 11:2769. [PMID: 37893843 PMCID: PMC10606278 DOI: 10.3390/healthcare11202769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 09/29/2023] [Accepted: 10/17/2023] [Indexed: 10/29/2023] Open
Abstract
[Aim and Background] People's lifestyles changed considerably due to the coronavirus disease 2019 (COVID-19) pandemic. The number of patients with acute pancreatitis (AP) can be expected to decrease as alcohol consumption decreases. This study was conducted to assess COVID-19 pandemic effects on AP patients in a Japanese regional hospital. [Methods] Based on the first and second states of emergency declarations in Tochigi Prefecture, the survey periods were set as follows: period A, 16 April-14 May; period B, 15 May-13 January; period C, 14 January-7 February; and period D, 8 February-15 April. Using data acquired in 2017, 2018, 2019, and 2020, we retrospectively reviewed the number of patients admitted to our hospital with a diagnosis of AP, and their clinical characteristics. [Results] According to a National Tax Agency survey, the average alcohol sales per adult in Tochigi Prefecture were 71.3 L in 2017 before the pandemic, and 64.0 L in 2021 under the pandemic. The number of AP patients in 2020 was 38% lower than in 2017. Comparing 2017 with 2020, the number of alcoholic AP patients was lower in 2020 (p = 0.007). [Conclusions] The findings suggest that COVID-19-pandemic-related lifestyle changes contributed to the decrease in AP patients.
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Affiliation(s)
| | - Akira Yamamiya
- Department of Gastroenterology, School of Medicine, Dokkyo Medical University, 880 Kitakobayashi Mibu, Tochigi 321-0293, Japan; (F.S.); (Y.A.); (K.N.); (T.M.); (K.K.); (Y.K.); (K.F.); (Y.I.); (T.S.); (K.T.); (K.G.); (A.I.)
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12
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Kashima K, Yamamiya A, Abe Y, Nagashima K, Minaguchi T, Kunogi Y, Sakuma F, Fukushi K, Inaba Y, Sugaya T, Tominaga K, Goda K, Irisawa A. Proposal and Validation of New Diagnostic Criteria for Diagnostic Weights of Endoultrasonographic Findings for Early Chronic Pancreatitis. J Clin Med 2023; 12:5320. [PMID: 37629362 PMCID: PMC10455995 DOI: 10.3390/jcm12165320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 07/30/2023] [Accepted: 08/14/2023] [Indexed: 08/27/2023] Open
Abstract
[Background and study aim] A commonly applied method for diagnosing chronic pancreatitis (CP) uses endoscopic ultrasonography (EUS), assigning weights to each EUS diagnostic finding. It is the Rosemont classification (RC). In 2019, to improve EUS diagnostic specificity, Japanese diagnostic criteria for early chronic pancreatitis (ECP) were revised. Nevertheless, the criteria use no weighting of EUS diagnostic findings, as the RC does. This study was undertaken to propose diagnostic criteria that would weight each EUS finding of ECP and that would be more specific than the RC. [Methods] By EUS of the pancreas, 773 patients underwent detailed observation from January 2018 to March 2019 at our institution. An expert finalized all cases when patients were diagnosed. Using data from the medical records, 97 consecutive patients with EUS diagnostic findings of ECP based on the Japanese diagnostic criteria of ECP2009 (JDCECP2009) were selected. The definition under the RC of "Indeterminate for CP" was equivalent to ECP. Each case was diagnosed using (1) JDCECP2009 and (2) the Japanese diagnostic criteria of ECP2019 (JDCECP2019). Moreover, the four diagnostic EUS findings in JDCECP2019 were applied to the RC, weighted (modified-JDCECP2019), and subsequently compared with the earlier diagnostic criteria. As Modified-JDCECP2019, we suggested (3) RC-A-the current four items scored related to the RC, and (4) RC-B-the five items scored by dividing lobularity with and without honeycombing. [Results] Diagnoses produced based on each criterion were normal: ECP = (1) 20:77, (2) 46:51, (3) 52:42, and (4) 60:35. [Conclusions] Modified-JDCECP2019 may provide EUS diagnoses for ECP with higher specificity.
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Affiliation(s)
| | - Akira Yamamiya
- Department of Gastroenterology, School of Medicine, Dokkyo Medical University, 880 Kitakobayashi, Mibu 321-0293, Tochigi, Japan; (K.K.); (Y.A.); (K.N.); (T.M.); (F.S.); (K.F.); (Y.I.); (T.S.); (K.G.); (A.I.)
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13
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Maki T, Irisawa A, Yamamiya A, Tominaga K, Abe Y, Imbe K, Hoshi K, Yamabe A, Igarashi R, Nakajima Y, Sato K, Shibukawa G. Guide Wire Selection (Straight vs. Angled) in Endoscopic Retrograde Cholangiopancreatography Using a Normal Contrast Catheter Performed by a Trainee: A Single-Center Prospective Randomized Controlled Cross-Over Study. J Clin Med 2023; 12:jcm12082917. [PMID: 37109253 PMCID: PMC10143334 DOI: 10.3390/jcm12082917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 03/28/2023] [Accepted: 04/14/2023] [Indexed: 04/29/2023] Open
Abstract
INTRODUCTION Wire-guided cannulation (WGC) during endoscopic retrograde cholangiopancreatography (ERCP) is a selective biliary cannulation technique aimed at improving the successful selective biliary cannulation rate and reducing the rate of post-ERCP pancreatitis (PEP) incidence. This study aimed to evaluate the effectiveness of angled-tip guidewires (AGW) vs. straight-tip guidewires (SGW) for biliary cannulation via WGC by a trainee. METHODS We conducted a prospective, single-center, open-labeled, randomized, and controlled trial. Fifty-seven patients were enrolled in this study and assigned randomly to two groups (Group A to S and Group S to A). In this study, we started selective biliary cannulation via WGC with an AGW or an SGW for 7 min. If cannulation was unsuccessful, the other guidewire was used, and cannulation was continued for another 7 min (cross-over method). RESULTS The selective biliary cannulation success rate over 14 min was significantly higher with an AGW compared with an SGW over 14 min (57.8% vs. 34.3%, p = 0.04) and for the second 7-min segment (36.4% vs. 0%, p = 0.04). No significant difference was found for adverse events such as pancreatitis between the two guidewires. CONCLUSIONS Our results suggest that an AGW is recommended for WGC performed by a trainee.
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Affiliation(s)
- Takumi Maki
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, 21-2 Kawahigashi Aizuwakamatsu, Fukushima 969-3482, Japan
- Department of Internal Medicine, Minamiaizu Prefectural Hospital, 14-1 Nagata Minamiaizu, Fukushima 967-0006, Japan
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, 880 Kitakobayashi Mibu, Tochigi 321-0293, Japan
| | - Atsushi Irisawa
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, 21-2 Kawahigashi Aizuwakamatsu, Fukushima 969-3482, Japan
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, 880 Kitakobayashi Mibu, Tochigi 321-0293, Japan
| | - Akira Yamamiya
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, 880 Kitakobayashi Mibu, Tochigi 321-0293, Japan
| | - Keiichi Tominaga
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, 880 Kitakobayashi Mibu, Tochigi 321-0293, Japan
| | - Yoko Abe
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, 21-2 Kawahigashi Aizuwakamatsu, Fukushima 969-3482, Japan
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, 880 Kitakobayashi Mibu, Tochigi 321-0293, Japan
| | - Koh Imbe
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, 21-2 Kawahigashi Aizuwakamatsu, Fukushima 969-3482, Japan
| | - Koki Hoshi
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, 21-2 Kawahigashi Aizuwakamatsu, Fukushima 969-3482, Japan
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, 880 Kitakobayashi Mibu, Tochigi 321-0293, Japan
| | - Akane Yamabe
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, 21-2 Kawahigashi Aizuwakamatsu, Fukushima 969-3482, Japan
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, 880 Kitakobayashi Mibu, Tochigi 321-0293, Japan
| | - Ryo Igarashi
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, 21-2 Kawahigashi Aizuwakamatsu, Fukushima 969-3482, Japan
| | - Yuki Nakajima
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, 21-2 Kawahigashi Aizuwakamatsu, Fukushima 969-3482, Japan
| | - Kentaro Sato
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, 21-2 Kawahigashi Aizuwakamatsu, Fukushima 969-3482, Japan
| | - Goro Shibukawa
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, 21-2 Kawahigashi Aizuwakamatsu, Fukushima 969-3482, Japan
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14
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Kanamori A, Tominaga K, Masuyama H, Ishikawa M, Masuyama S, Kondo M, Kanazawa M, Tanaka T, Yamaura M, Abe K, Watanabe S, Yamamiya A, Abe Y, Goda K, Irisawa A. Size reduction of gastric fundic gland polyposis by de-escalation of acid-suppressive therapy. DEN Open 2023; 3:e135. [PMID: 35898833 PMCID: PMC9307721 DOI: 10.1002/deo2.135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 05/05/2022] [Accepted: 05/15/2022] [Indexed: 06/15/2023]
Abstract
The patient, a 73-year-old woman, had been taking acid-suppressive therapy for refractory reflux esophagitis for 10 years. A potassium-competitive acid blocker was administered to strengthen acid-suppressive therapy for worsening symptoms of gastroesophageal reflux disease. Esophagogastroduodenoscopy showed an increase in the number and size of fundic gland polyposis (FGPs). When acid-suppressive therapy was changed from potassium-competitive acid blocker to proton pump inhibitor, the FGPs showed reduced size 1 year later. Furthermore, when acid-suppressive therapy was changed from proton pump inhibitor to histamine-2 receptor antagonist, FGPs were even smaller after 1 and 2 years. The patient, who had no flare-up of gastroesophageal reflux disease symptoms, continues to be treated medically with histamine-2 receptor antagonist. This case report describes changes in endoscopic findings of a patient with FGPs caused by acid-suppressive therapy for refractory gastroesophageal reflux disease.
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Affiliation(s)
- Akira Kanamori
- Department of GastroenterologyDokkyo Medical University School of MedicineTochigiJapan
- Masuyama Gastrointestinal ClinicTochigiJapan
| | - Keiichi Tominaga
- Department of GastroenterologyDokkyo Medical University School of MedicineTochigiJapan
- Masuyama Gastrointestinal ClinicTochigiJapan
| | - Hironori Masuyama
- Department of GastroenterologyDokkyo Medical University School of MedicineTochigiJapan
| | - Mutsumi Ishikawa
- Department of GastroenterologyDokkyo Medical University School of MedicineTochigiJapan
| | - Satoshi Masuyama
- Department of GastroenterologyDokkyo Medical University School of MedicineTochigiJapan
| | - Masayuki Kondo
- Department of GastroenterologyDokkyo Medical University School of MedicineTochigiJapan
| | - Mimari Kanazawa
- Department of GastroenterologyDokkyo Medical University School of MedicineTochigiJapan
| | - Takanao Tanaka
- Department of GastroenterologyDokkyo Medical University School of MedicineTochigiJapan
| | - Masamichi Yamaura
- Department of GastroenterologyDokkyo Medical University School of MedicineTochigiJapan
| | - Keiichiro Abe
- Department of GastroenterologyDokkyo Medical University School of MedicineTochigiJapan
| | - Shoko Watanabe
- Department of GastroenterologyDokkyo Medical University School of MedicineTochigiJapan
| | - Akira Yamamiya
- Department of GastroenterologyDokkyo Medical University School of MedicineTochigiJapan
| | - Yoko Abe
- Department of GastroenterologyDokkyo Medical University School of MedicineTochigiJapan
| | - Kenichi Goda
- Department of GastroenterologyDokkyo Medical University School of MedicineTochigiJapan
| | - Atsushi Irisawa
- Department of GastroenterologyDokkyo Medical University School of MedicineTochigiJapan
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15
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Yamamiya A, Irisawa A, Abe Y, Arisaka T, Ohnishi T, Hoshi K, Suzuki T, Nagashima K, Kashima K, Kunogi Y, Sakuma F, Fukushi K, Ishikawa M, Mizuguchi N, Yamaguchi S, Tominaga K, Goda K. Diagnosing chronic pancreatitis by endoscopic ultrasound assessing the association between ultrasound and pathological findings: A narrative review. DEN Open 2023; 3:e164. [PMID: 36176351 PMCID: PMC9478231 DOI: 10.1002/deo2.164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 08/05/2022] [Accepted: 08/19/2022] [Indexed: 11/20/2022]
Abstract
Endoscopic ultrasound (EUS) is widely recognized for its non‐invasiveness and for its usefulness in chronic pancreatitis (CP) diagnosis, including early CP. Although it is desirable to obtain a definitive diagnosis of CP by tissue sampling with EUS‐guided fine needle aspiration, histopathological changes in CP are heterogeneous in terms of the extent and the distribution of lesions. Therefore, histopathological diagnosis of appropriate tissue sampling by EUS‐fine needle aspiration is expected to be difficult. Furthermore, it is virtually impossible to match EUS images with pathological sections, making direct contrast between EUS findings and pathology difficult. This narrative review presents a discussion of the diagnosis of CP/early CP by EUS, particularly assessing the association between ultrasound and pathological findings. Recently, the histological corroboration and correlation of EUS findings related to CP have been clarified by surgical specimens, including those obtained from animal studies. Furthermore, remarkable advances have occurred in the objective and quantitative diagnosis of pancreatic fibrosis by EUS‐elastography. Future technological advances in EUS are expected to improve the accuracy of diagnosis of pancreatic fibrosis at earlier stages.
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Affiliation(s)
- Akira Yamamiya
- Department of Gastroenterology Dokkyo Medical University School of Medicine Tochigi Japan
| | - Atsushi Irisawa
- Department of Gastroenterology Dokkyo Medical University School of Medicine Tochigi Japan
| | - Yoko Abe
- Department of Gastroenterology Dokkyo Medical University School of Medicine Tochigi Japan
| | - Takahiro Arisaka
- Department of Gastroenterology Dokkyo Medical University School of Medicine Tochigi Japan
| | - Toshihiko Ohnishi
- Department of Gastroenterology Dokkyo Medical University School of Medicine Tochigi Japan
| | - Koki Hoshi
- Department of Gastroenterology Dokkyo Medical University School of Medicine Tochigi Japan
| | - Tsunehiro Suzuki
- Department of Gastroenterology Dokkyo Medical University School of Medicine Tochigi Japan
| | - Kazunori Nagashima
- Department of Gastroenterology Dokkyo Medical University School of Medicine Tochigi Japan
| | - Ken Kashima
- Department of Gastroenterology Dokkyo Medical University School of Medicine Tochigi Japan
| | - Yasuhito Kunogi
- Department of Gastroenterology Dokkyo Medical University School of Medicine Tochigi Japan
| | - Fumi Sakuma
- Department of Gastroenterology Dokkyo Medical University School of Medicine Tochigi Japan
| | - Koh Fukushi
- Department of Gastroenterology Dokkyo Medical University School of Medicine Tochigi Japan
| | - Manabu Ishikawa
- Department of Gastroenterology Dokkyo Medical University School of Medicine Tochigi Japan
| | - Nasuka Mizuguchi
- Department of Gastroenterology Dokkyo Medical University School of Medicine Tochigi Japan
| | - Shintaro Yamaguchi
- Department of Gastroenterology Dokkyo Medical University School of Medicine Tochigi Japan
| | - Keiichi Tominaga
- Department of Gastroenterology Dokkyo Medical University School of Medicine Tochigi Japan
| | - Kenichi Goda
- Department of Gastroenterology Dokkyo Medical University School of Medicine Tochigi Japan
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16
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Suzuki Y, Hoshi K, Tominaga K, Inaba Y, Yoshinaga T, Kojimahara S, Maki R, Nemoto R, Tetsuka Y, Kawata Y, Yamamiya A, Sugaya T, Iso Y, Takada‐Owada A, Ishida K, Goda K, Irisawa A. A case of obstructive jaundice caused by metastasis of breast cancer to the intra/extrahepatic bile duct. DEN Open 2023; 3:e144. [PMID: 35898837 PMCID: PMC9307725 DOI: 10.1002/deo2.144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 05/26/2022] [Accepted: 06/05/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Yuka Suzuki
- Department of Gastroenterology Dokkyo Medical University School of Medicine Tochigi Japan
| | - Koki Hoshi
- Department of Gastroenterology Dokkyo Medical University School of Medicine Tochigi Japan
| | - Keiichi Tominaga
- Department of Gastroenterology Dokkyo Medical University School of Medicine Tochigi Japan
| | - Yasunori Inaba
- Department of Gastroenterology Dokkyo Medical University School of Medicine Tochigi Japan
| | - Tomonori Yoshinaga
- Department of Gastroenterology Dokkyo Medical University School of Medicine Tochigi Japan
| | - Shunsuke Kojimahara
- Department of Gastroenterology Dokkyo Medical University School of Medicine Tochigi Japan
| | - Ryuichi Maki
- Department of Gastroenterology Dokkyo Medical University School of Medicine Tochigi Japan
| | - Rena Nemoto
- Department of Gastroenterology Dokkyo Medical University School of Medicine Tochigi Japan
| | - Yugo Tetsuka
- Department of Gastroenterology Dokkyo Medical University School of Medicine Tochigi Japan
| | - Yosuke Kawata
- Department of Gastroenterology Dokkyo Medical University School of Medicine Tochigi Japan
| | - Akira Yamamiya
- Department of Gastroenterology Dokkyo Medical University School of Medicine Tochigi Japan
| | - Takeshi Sugaya
- Department of Gastroenterology Dokkyo Medical University School of Medicine Tochigi Japan
| | - Yukihiro Iso
- Department of Hepato‐Biliary‐Pancreatic Surgery Dokkyo Medical University School of Medicine Tochigi Japan
| | - Atsuko Takada‐Owada
- Department of Diagnostic Pathology Dokkyo Medical University School of Medicine Tochigi Japan
| | - Kazuyuki Ishida
- Department of Diagnostic Pathology Dokkyo Medical University School of Medicine Tochigi Japan
| | - Kenichi Goda
- Department of Gastroenterology Dokkyo Medical University School of Medicine Tochigi Japan
| | - Atsushi Irisawa
- Department of Gastroenterology Dokkyo Medical University School of Medicine Tochigi Japan
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17
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Sakuma F, Irisawa A, Noguchi S, Abe Y, Hoshi K, Yamamiya A, Nagashima K, Kashima K, Kunogi Y, Fukushi K, Inaba K, Oike K, Furuki S, Tominaga K, Goda K. A case in which the tip of a plastic stent placed to prevent recurrence of walled‐off necrosis penetrated the bile duct and formed a stent–stone complex. DEN Open 2023; 3:e220. [PMID: 37009517 PMCID: PMC10050955 DOI: 10.1002/deo2.220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 02/13/2023] [Accepted: 02/19/2023] [Indexed: 03/31/2023]
Abstract
A woman in her 60s underwent endoscopic sphincterotomy for choledocholithiasis. Unfortunately, post‐endoscopic retrograde cholangiopancreatography pancreatitis occurred. In addition, huge walled‐off necrosis (WON) appeared as a late complication. For the infected WON, endoscopic ultrasound‐guided fistuloplasty and endoscopic necrosectomy were performed, and a double pigtail plastic stent (PS) (7Fr, 7 cm) was placed to prevent a recurrence. Plain computed tomography conducted two years later showed that the stent implanted for WON had deviated. The distal end of the stent was found to have migrated into the bile duct. In addition, common bile duct stones with stents as nuclei were observed. Upon performing endoscopic retrograde cholangiography, it was revealed that the stent tip perforated the distal bile duct just above the papilla. After removal of the stent using grasping forceps, we made an incision between the duodenal – bile duct fistula and bile duct orifice using a sphincterotome. Then, the stone was removed by a balloon catheter. Although such late adverse events are rare occurrences, placement of long‐term PS after treatment of WON should be followed up regularly with imaging examination, and if there is no recurrence for several months, removal of the PS at that point may be considered.
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Affiliation(s)
- Fumi Sakuma
- Department of GastroenterologyDokkyo Medical UniversityTochigiJapan
| | - Atsushi Irisawa
- Department of GastroenterologyDokkyo Medical UniversityTochigiJapan
| | - Satoaki Noguchi
- Department of GastroenterologyDokkyo Medical UniversityTochigiJapan
| | - Yoko Abe
- Department of GastroenterologyDokkyo Medical UniversityTochigiJapan
| | - Koki Hoshi
- Department of GastroenterologyDokkyo Medical UniversityTochigiJapan
| | - Akira Yamamiya
- Department of GastroenterologyDokkyo Medical UniversityTochigiJapan
| | | | - Ken Kashima
- Department of GastroenterologyDokkyo Medical UniversityTochigiJapan
| | - Yasuhito Kunogi
- Department of GastroenterologyDokkyo Medical UniversityTochigiJapan
| | - Koh Fukushi
- Department of GastroenterologyDokkyo Medical UniversityTochigiJapan
| | - Kohei Inaba
- Department of GastroenterologyDokkyo Medical UniversityTochigiJapan
| | - Ken Oike
- Department of GastroenterologyDokkyo Medical UniversityTochigiJapan
| | - Saori Furuki
- Department of GastroenterologyDokkyo Medical UniversityTochigiJapan
| | - Keiichi Tominaga
- Department of GastroenterologyDokkyo Medical UniversityTochigiJapan
| | - Kenichi Goda
- Department of GastroenterologyDokkyo Medical UniversityTochigiJapan
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18
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Nakase H, Wagatsuma K, Nojima M, Matsumoto T, Matsuura M, Iijima H, Matsuoka K, Ohmiya N, Ishihara S, Hirai F, Takeuchi K, Tamura S, Kinjo F, Ueno N, Naganuma M, Watanabe K, Moroi R, Nishimata N, Motoya S, Kurahara K, Takahashi S, Maemoto A, Sakuraba H, Saruta M, Tominaga K, Hisabe T, Tanaka H, Terai S, Hiraoka S, Takedomi H, Narimatsu K, Endo K, Nakamura M, Hisamatsu T. Anxiety and behavioral changes in Japanese patients with inflammatory bowel disease due to COVID-19 pandemic: a national survey. J Gastroenterol 2023; 58:205-216. [PMID: 36607399 PMCID: PMC9821342 DOI: 10.1007/s00535-022-01949-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 12/26/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Given the increasing health concerns for patients with inflammatory bowel disease (IBD), amidst the COVID-19 pandemic, we investigated the impact of the pandemic on the anxiety and behavioral changes in Japanese patients with IBD. METHODS We analyzed 3032 questionnaires from patients with IBD, aged 16 years or older visiting 30 hospitals and 1 clinic between March 2020 and June 2021. The primary outcome was the score of the anxiety experienced by patients with IBD during the pandemic. RESULTS Participants reported a median age of 44 years; 43.3% of the patients were women. Moreover, 60.6% and 39.4% were diagnosed with ulcerative colitis and Crohn's disease, respectively, with a median disease duration of 10 years. Participants indicated an average of disease-related anxiety score of 5.1 ± 2.5 on a ten-point scale, with a tendency to increase, 1 month after the number of infected persons per population increased. The top three causes for anxiety were the risk of contracting COVID-19 during hospital visits, SARS-CoV-2 infection due to IBD, and infection by IBD medication. Factors associated with anxiety were gender (women), being a homemaker, hospital visit timings, mode of transportation (train), use of immunosuppressive drugs, and nutritional therapy. Most patients continued attending their scheduled hospital visits, taking their medications, experienced the need for a family doctor, and sought guidance and information regarding COVID-19 from primary doctors, television, and Internet news. CONCLUSIONS Patients with IBD experienced moderate disease-related anxiety due to the pandemic and should be proactively informed about infectious diseases to relieve their anxiety.
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Affiliation(s)
- Hiroshi Nakase
- Department of Gastroenterology and Hepatology, Sapporo Medical University School of Medicine, S-1, W-16, Chuo-Ku, Sapporo, Hokkaido, 060-8543, Japan.
| | - Kohei Wagatsuma
- Department of Gastroenterology and Hepatology, Sapporo Medical University School of Medicine, S-1, W-16, Chuo-Ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Masanori Nojima
- Center for Translational Research, The Institute of Medical Science, The University of Tokyo, Minato-Ku, Japan
| | - Takayuki Matsumoto
- Division of Gastroenterology, Department of Internal Medicine, Iwate Medical University, Shiwa, Japan
| | - Minoru Matsuura
- Department of Gastroenterology and Hepatology, Kyorin University School of Medicine, Mitaka, Japan
| | - Hideki Iijima
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Katsuyoshi Matsuoka
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Toho University Sakura Medical Center, Sakura, Japan
| | - Naoki Ohmiya
- Departments of Gastroenterology and Advanced Endoscopy, Fujita Health University School of Medicine, Toyoake, Japan
| | - Shunji Ishihara
- Department of Internal Medicine II, Faculty of Medicine, Shimane University, Izumo, Japan
| | - Fumihito Hirai
- Department of Gastroenterology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Ken Takeuchi
- Department of Gastroenterology, IBD Center, Tsujinaka Hospital Kashiwanoha, Kashiwa, Japan
| | - Satoshi Tamura
- First Department of Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Fukunori Kinjo
- Center for Gastroenterology, Urasoe General Hospital, Urasoe, Japan
| | - Nobuhiro Ueno
- Division of Metabolism and Biosystemic Science, Gastroenterology, and Hematology/Oncology, Asahikawa Medical University, Asahikawa, Japan
- Department of Medicine, Asahikawa Medical University, Asahikawa, Japan
| | - Makoto Naganuma
- The Third Department of Internal Medicine, Kansai Medical University Hirakata, Hirakata, Japan
| | - Kenji Watanabe
- Center for Inflammatory Bowel Disease, Division of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Rintaro Moroi
- Division of Gastroenterology, Tohoku University Hospital, Sendai, Japan
| | - Nobuaki Nishimata
- Department of Gastroenterology, Sameshima Hospital, Kagoshima, Japan
| | - Satoshi Motoya
- IBD Center, Sapporo Kosei General Hospital, Sapporo, Japan
| | - Koichi Kurahara
- Division of Gastroenterology, Matsuyama Red Cross Hospital, Matsuyama, Japan
| | - Sakuma Takahashi
- Department of Gastroenterology, Kagawa Prefectural Central Hospital, Takamatsu, Japan
| | - Atsuo Maemoto
- Inflammatory Bowel Disease Center, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan
| | - Hirotake Sakuraba
- Department of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Masayuki Saruta
- Department of Gastroenterology and Hepatology, Division of Internal Medicine, The Jikei University School of Medicine, Minato-Ku, Japan
| | - Keiichi Tominaga
- Department of Gastroenterology, Dokkyo Medical University, Shimotsuga, Japan
| | - Takashi Hisabe
- Department of Gastroenterology, Fukuoka University Chikushi Hospital, Chikushino, Japan
| | | | - Shuji Terai
- Division of Gastroenterology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Sakiko Hiraoka
- Department of Gastroenterology and Hepatology, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, Okayama, Japan
| | - Hironobu Takedomi
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Kazuyuki Narimatsu
- Department of Internal Medicine, National Defense Medical College, Tokorozawa, Japan
| | - Katsuya Endo
- Division of Gastroenterology, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Masanao Nakamura
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tadakazu Hisamatsu
- Department of Gastroenterology and Hepatology, Kyorin University School of Medicine, Mitaka, Japan
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19
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Tanaka T, Tominaga K, Yamamiya A, Sugaya T, Kanazawa M, Kondo M, Abe K, Kanamori A, Iijima M, Goda K, Haruyama Y, Irisawa A. Making Hematochezia of Unknown Origin Known: A Retrospective Analysis. Digestion 2022; 103:404-410. [PMID: 35830830 DOI: 10.1159/000525610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 06/15/2022] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Hematochezia is observed frequently in daily practice. However, natural hemostasis often prevents identification of the bleeding source during observations. This study was conducted to clarify risk factors related to rebleeding in hematochezia patients without an identified cause of bleeding. METHODS We analyzed patients who were admitted to Dokkyo Medical University Hospital during April 1, 2009, through March 31, 2015, with the chief complaint of hematochezia. Main outcome measures included the rebleeding rate and the period until rebleeding in hematochezia patients without an identified bleeding source. RESULTS We selected 159 patients for analyses. Rebleeding was observed in 46 (28.9%) of 159 patients. The median period until first rebleeding was 166 days (2-3,046 days). Univariate analysis indicated that risk factors for rebleeding were male gender (p = 0.029), higher age (p = 0.023), antithrombotic medicines (p = 0.047), lower hemoglobin on admission (p = 0.024), and the presence of diverticula (p = 0.002). Multivariate analysis indicated the presence of diverticula (p = 0.023) and male gender (p = 0.043) as rebleeding risk factors. DISCUSSION/CONCLUSION In patients with hematochezia of unknown origin, risk factors for rebleeding indicated in this study, especially the presence of diverticula and male gender, should be given particular attention by physicians.
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Affiliation(s)
- Takanao Tanaka
- Department of Gastroenterology, Dokkyo Medical University, Tochigi, Japan
| | - Keiichi Tominaga
- Department of Gastroenterology, Dokkyo Medical University, Tochigi, Japan
| | - Akira Yamamiya
- Department of Gastroenterology, Dokkyo Medical University, Tochigi, Japan
| | - Takeshi Sugaya
- Department of Gastroenterology, Dokkyo Medical University, Tochigi, Japan
| | - Mimari Kanazawa
- Department of Gastroenterology, Dokkyo Medical University, Tochigi, Japan
| | - Masayuki Kondo
- Department of Gastroenterology, Dokkyo Medical University, Tochigi, Japan
| | - Keiichiro Abe
- Department of Gastroenterology, Dokkyo Medical University, Tochigi, Japan
| | - Akira Kanamori
- Department of Gastroenterology, Dokkyo Medical University, Tochigi, Japan
| | - Makoto Iijima
- Department of Gastroenterology, Dokkyo Medical University, Tochigi, Japan
| | - Kenichi Goda
- Department of Gastroenterology, Dokkyo Medical University, Tochigi, Japan
| | - Yasuo Haruyama
- Integrated Research Faculty for Advanced Medical Sciences, Dokkyo Medical University, Tochigi, Japan
| | - Atsushi Irisawa
- Department of Gastroenterology, Dokkyo Medical University, Tochigi, Japan
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20
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Abe K, Tominaga K, Yamamiya A, Inaba Y, Kanamori A, Kondo M, Suzuki T, Watanabe H, Kawano M, Sato T, Yoshitake N, Ohwada T, Konno M, Hanatsuka K, Masuyama H, Goda K, Haruyama Y, Irisawa A. Natural History of Small Gastric Subepithelial Lesions Less than 20 mm: A Multicenter Retrospective Observational Study (NUTSHELL20 Study). Digestion 2022:1-13. [PMID: 36470211 DOI: 10.1159/000527421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 09/15/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIM Small gastric subepithelial lesions (SELs) are sometimes encountered in daily esophagogastroduodenoscopy (EGD) practice, but whether once-annual or twice-annual endoscopy can provide sufficient follow-up remains unclear. Because follow-up based on small-SEL characteristics is important, this study clarified the natural history of gastric SELs less than 20 mm. METHODS This retrospective multicenter observation study conducted at 24 Japanese hospitals during April 2000 to March 2020 examined small gastric SELs of ≤20 mm diameter. The primary outcome was the rate of size increase of those SELs detected using EGD, with growth times assessed irrespective of SEL pathological diagnoses. RESULTS We examined 824 cases with tumors of 1-5 mm diameter in 298 (36.2%) cases, 6-10 mm in 344 (41.7%) cases, 11-15 mm in 112 (13.6%) cases, and 16-20 mm in 70 (8.50%) cases. An increase of small gastric SELs was observed in 70/824 patients (8.5%). The SELs larger than 6 mm increased, even after 10 years. No-change and increasing groups had no significantly different malignant findings at diagnosis. In cases of gastrointestinal stromal tumors (GISTs), internal cystic change in endoscopic ultrasound (EUS) is a risk factor for an increased tumor size. The predictive tumor growth cutoff size at initial diagnosis was 13.5 mm. CONCLUSIONS Small gastric SELs less than 20 mm have an approximately 8.5% chance of increase. Predictive markers for GIST growth are tumor size ≥13.5 mm and internal cystic change in EUS.
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Affiliation(s)
- Keiichiro Abe
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, Tochigi, Japan
| | - Keiichi Tominaga
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, Tochigi, Japan
| | - Akira Yamamiya
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, Tochigi, Japan
| | - Yasunori Inaba
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, Tochigi, Japan
| | - Akira Kanamori
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, Tochigi, Japan
| | - Masayuki Kondo
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, Tochigi, Japan
| | - Tsunehiro Suzuki
- Department of Internal Medicine, Japanese Red Cross Ashikaga Hospital, Tochigi, Japan
| | | | | | - Takashi Sato
- Department of Gastroenterology, Japanese Red Cross Nasu Hospital, Tochigi, Japan
| | - Naoto Yoshitake
- Department of Gastroenterology, National Hospital Organization Tochigi Medical Center, Tochigi, Japan
| | | | - Maki Konno
- Department of Gastroenterology, Tochigi Cancer Center, Tochigi, Japan
| | | | | | - Kenichi Goda
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, Tochigi, Japan
| | - Yasuo Haruyama
- Integrated Research Faculty for Advanced Medical Sciences, Dokkyo Medical University School of Medicine, Tochigi, Japan
| | - Atsushi Irisawa
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, Tochigi, Japan
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21
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Takimoto Y, Irisawa A, Hoshi K, Yamamiya A, Nagashima K, Minaguchi T, Yamabe A, Izawa N, Haruyama Y, Tominaga K. The impact of endoscopic sphincterotomy incision size on common bile duct stone recurrence: A propensity score matching analysis. J Hepatobiliary Pancreat Sci 2022; 29:1274-1282. [PMID: 34826207 DOI: 10.1002/jhbp.1083] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 10/08/2021] [Accepted: 10/26/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND/PURPOSE The aim of this study is to clarify the relation between the incision size for endoscopic sphincterotomy (EST) and common bile duct stone (CBDS) recurrence. METHODS Patients who underwent elective endoscopic treatment for CBDS between January 2013 and December 2017 were enrolled, excluding those who met the exclusion criteria. The clinical characteristics were investigated using propensity score matching analysis. RESULTS A total of 243 patients were investigated. Propensity scores were calculated using multinomial logistic regression with five relevant variables (age, gender, follow-up time, maximum stone size, and bile duct diameter), which led to extraction of 188 cases to compose cohorts of the small and medium EST incision groups. The CBDS recurrence rate was 17.0% in the small incision group and 6.4% in the medium incision group. Multivariate analysis identified the medium incision as an independent predictor of CBDS recurrence (hazard ratio 0.350, 95% confidence interval 0.133-0.922, P = .034). The CBDS non-recurrence rate of the medium incision group was significantly higher than that of the small incision group (log-rank test P = .019). CONCLUSIONS Our findings suggest that the CBDS recurrence rate was lower in EST with medium incision size than with small incision size.
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Affiliation(s)
- Yoichi Takimoto
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, Tochigi, Japan.,Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Atsushi Irisawa
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, Tochigi, Japan
| | - Koki Hoshi
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, Tochigi, Japan
| | - Akira Yamamiya
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, Tochigi, Japan
| | - Kazunori Nagashima
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, Tochigi, Japan
| | - Takahito Minaguchi
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, Tochigi, Japan
| | - Akane Yamabe
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, Tochigi, Japan
| | - Naoya Izawa
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, Tochigi, Japan
| | - Yasuo Haruyama
- Integrated Research Faculty for Advanced Medical Sciences, Dokkyo Medical University School of Medicine, Tochigi, Japan
| | - Keiichi Tominaga
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, Tochigi, Japan
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22
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Fujita Y, Tominaga K, Tanaka T, Komiyama Y, Ihara K, Ishida K, Yoshihara S. Oral lesions preceding paediatric perianal fistulising Crohn's disease. J Paediatr Child Health 2022; 58:2336-2337. [PMID: 36269610 DOI: 10.1111/jpc.16260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 10/12/2022] [Accepted: 10/12/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Yuji Fujita
- Department of Pediatrics, Dokkyo Medical University, Tochigi, Japan
| | - Keiichi Tominaga
- Department of Gastroenterology, Dokkyo Medical University, Tochigi, Japan
| | - Takanao Tanaka
- Department of Gastroenterology, Dokkyo Medical University, Tochigi, Japan
| | - Yusuke Komiyama
- Department of Oral and Maxillofacial Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Keisuke Ihara
- Center for Colorectal Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Kazuyuki Ishida
- Department of Diagnostic Pathology, Dokkyo Medical University, Tochigi, Japan
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23
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Minaguchi T, Yamamiya A, Tominaga K, Kashima K, Kunogi Y, Sakuma F, Fukushi K, Nagashima K, Izawa N, Yamabe A, Hoshi K, Iijima M, Goda K, Haruyama Y, Irisawa A. Measuring optimal ultrasound speed using endoscopic ultrasound in patients with chronic pancreatitis, including early stage. Dig Endosc 2022; 34:1214-1221. [PMID: 35108413 DOI: 10.1111/den.14261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 01/17/2022] [Accepted: 01/30/2022] [Indexed: 02/08/2023]
Abstract
OBJECTIVES Ultrasound speed (USS) correction improves image quality by estimating the optimal USS correcting the deviation from a predetermined USS. This study assessed USS differences between chronic pancreatitis (CP), early CP (ECP), and normal pancreas when using endoscopic ultrasound (EUS). The usefulness of measuring optimal USS was evaluated for patients with CP, including early stage patients. METHODS This study enrolled 116 consecutive patients for whom USS was measured using an EUS system. The USS correction principle is generation of a B-mode image by changing the USS in all ranges while correcting the delay in the received data. Final diagnoses were made according to the Japanese diagnostic criteria for CP in 2019. They were classified as CP, ECP, or normal. We compared USS applied for these three groups. RESULTS The medians and ranges of USS values for patients in the normal, ECP, and CP groups were 1506.0 (1407-1600) m/s, 1580.0 (1520-1630) m/s, and 1574.0 (1537-1610) m/s, respectively. The USS values of the ECP and CP groups were significantly higher than those of the normal group (P < 0.001). Analyses of the receiver operating characteristic curve in the normal pancreas, ECP, and CP revealed the area as 0.957, with specificity and sensitivity of 95.9% and 87.5%, respectively, using the USS of 1535 m/s as a cut-off. CONCLUSION Measurement of USS might be particularly useful for distinguishing between normal and ECP imaging.
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Affiliation(s)
- Takahito Minaguchi
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, Tochigi, Japan
| | - Akira Yamamiya
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, Tochigi, Japan
| | - Keiichi Tominaga
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, Tochigi, Japan
| | - Ken Kashima
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, Tochigi, Japan
| | - Yasuhito Kunogi
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, Tochigi, Japan
| | - Fumi Sakuma
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, Tochigi, Japan
| | - Koh Fukushi
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, Tochigi, Japan
| | - Kazunori Nagashima
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, Tochigi, Japan
| | - Naoya Izawa
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, Tochigi, Japan
| | - Akane Yamabe
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, Tochigi, Japan
| | - Koki Hoshi
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, Tochigi, Japan
| | - Makoto Iijima
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, Tochigi, Japan
| | - Kenichi Goda
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, Tochigi, Japan
| | - Yasuo Haruyama
- Integrated Research Faculty for Advanced Medical Sciences, Dokkyo Medical University School of Medicine, Tochigi, Japan
| | - Atsushi Irisawa
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, Tochigi, Japan
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Masuyama S, Kanazawa M, Tominaga K, Ishida K, Irisawa A. Alpha-Fetoprotein-Producing Gastric Cancer With Delayed Diagnosis Caused by COVID-19: A Case Report. Cureus 2022; 14:e27392. [PMID: 36046324 PMCID: PMC9419247 DOI: 10.7759/cureus.27392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2022] [Indexed: 11/25/2022] Open
Abstract
A 70-year-old man was diagnosed with coronavirus disease 2019 (COVID-19). The patient had suspected upper gastrointestinal bleeding during the course of the COVID-19 infection. Urgent esophagogastroduodenoscopy (EGD) was performed. However, because of mobility restrictions imposed as a COVID-19 countermeasure, EGD was done in a small hospital room. Hemostatic treatment was successful, but no sufficient close examination could be done. The patient, who was diagnosed as having alpha-fetoprotein-producing gastric cancer, died about three months later.
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25
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Kanamori A, Goda K, Nakamura T, Yamagishi H, Ohwada A, Abe K, Suzuki T, Kondo M, Tanaka T, Yamamiya A, Takimoto Y, Hoshi K, Arisaka T, Sugaya T, Tominaga K, Majima Y, Iijima M, Irisawa A. Salvage Endoscopic Submucosal Dissection for Local Recurrence of Superficial Esophageal Squamous Cell Cancer after Photodynamic Therapy. Intern Med 2022; 61:2149-2153. [PMID: 34980795 PMCID: PMC9381333 DOI: 10.2169/internalmedicine.8573-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Photodynamic therapy is useful as organ-preservation salvage therapy for residual recurrence of esophageal squamous cell carcinoma after chemoradiation therapy. However, the high residual recurrence rate of photodynamic therapy poses a problem. We herein report a patient who underwent photodynamic therapy for recurrence of superficial esophageal squamous cell carcinoma after chemoradiation therapy. The patient later exhibited another episode of recurrence of superficial esophageal squamous cell carcinoma, and R0 curative resection was obtained with endoscopic submucosal dissection. This suggests that endoscopic submucosal dissection may be an effective treatment option that can achieve R0 resection even for residual superficial cancer after salvage photodynamic therapy.
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Affiliation(s)
- Akira Kanamori
- Department of Gastroenterology, Dokkyo Medical University, Japan
| | - Kenichi Goda
- Department of Gastroenterology, Dokkyo Medical University, Japan
| | - Tetsuya Nakamura
- Department of Gastroenterology, Dokkyo Medical University, Japan
| | | | - Atsuko Ohwada
- Department of Diagnostic Pathology, Dokkyo Medical University, Japan
| | - Keiichiro Abe
- Department of Gastroenterology, Dokkyo Medical University, Japan
| | - Tsunehiro Suzuki
- Department of Gastroenterology, Dokkyo Medical University, Japan
| | - Masayuki Kondo
- Department of Gastroenterology, Dokkyo Medical University, Japan
| | - Takanao Tanaka
- Department of Gastroenterology, Dokkyo Medical University, Japan
| | - Akira Yamamiya
- Department of Gastroenterology, Dokkyo Medical University, Japan
| | - Yoichi Takimoto
- Department of Gastroenterology, Dokkyo Medical University, Japan
| | - Koki Hoshi
- Department of Gastroenterology, Dokkyo Medical University, Japan
| | - Takahiro Arisaka
- Department of Gastroenterology, Dokkyo Medical University, Japan
| | - Takeshi Sugaya
- Department of Gastroenterology, Dokkyo Medical University, Japan
| | - Keiichi Tominaga
- Department of Gastroenterology, Dokkyo Medical University, Japan
| | - Yuichi Majima
- Department of Gastroenterology, Dokkyo Medical University, Japan
| | - Makoto Iijima
- Department of Gastroenterology, Dokkyo Medical University, Japan
| | - Atsushi Irisawa
- Department of Gastroenterology, Dokkyo Medical University, Japan
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26
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Hoshi K, Tominaga K, Izawa N, Yamamiya A, Nagashima K, Minaguchi T, Irisawa A. Direct large flow of venous gas into right atrium and ventricle during endoscopic biliary treatment. Endoscopy 2022; 54:E877-E878. [PMID: 35750075 PMCID: PMC9735330 DOI: 10.1055/a-1860-1354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Koki Hoshi
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, Mibu, Tochigi, Japan
| | - Keiichi Tominaga
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, Mibu, Tochigi, Japan
| | - Naoya Izawa
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, Mibu, Tochigi, Japan
| | - Akira Yamamiya
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, Mibu, Tochigi, Japan
| | - Kazunori Nagashima
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, Mibu, Tochigi, Japan
| | - Takahito Minaguchi
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, Mibu, Tochigi, Japan
| | - Atsushi Irisawa
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, Mibu, Tochigi, Japan
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27
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Fujita Y, Tominaga K, Ishida K, Masuyama H, Yoshihara S. Proton Pump Inhibitor to Treat an Eosinophilic Duodenal Ulcer with Esophageal Involvement: A Pediatric Case. TOHOKU J EXP MED 2022; 257:309-313. [PMID: 35661048 DOI: 10.1620/tjem.2022.j045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Yuji Fujita
- Department of Pediatrics, Dokkyo Medical University
| | | | - Kazuyuki Ishida
- Department of Diagnostic Pathology, Dokkyo Medical University
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28
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Okabayashi S, Yamazaki H, Tominaga K, Miura M, Sagami S, Matsuoka K, Yamaguchi Y, Noake T, Ozeki K, Miyazaki R, Kamano T, Fukuda T, Yoshioka K, Ando K, Fukuzawa M, Andoh A, Yamamoto Y, Hibi T, Kobayashi T. Lower effectiveness of intravenous steroid treatment for moderate-to-severe ulcerative colitis in hospitalised patients with older onset: a multicentre cohort study. Aliment Pharmacol Ther 2022; 55:1569-1580. [PMID: 35274323 DOI: 10.1111/apt.16865] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 10/05/2021] [Accepted: 02/22/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND The increasing incidence of older-onset ulcerative colitis (UC), which has a higher risk of surgery, is a global health issue. However, data regarding intravenous steroid treatment, one of the important treatment options to avoid surgery, for older-onset UC is lacking. AIMS To evaluate the association between onset age and effectiveness of intravenous steroids in UC. METHODS This retrospective multicentre (27 facilities) cohort study included moderate-to-severe hospitalised UC patients who underwent their first intravenous steroids between April 2014 and July 2019. The primary outcome was clinical remission at day 30, using two-item patient-reported outcome scoring. The key secondary outcomes were risks of surgery and adverse events (death, infection and venous thrombosis) within 90 days. A modified Poisson regression model was used for analysis. RESULTS Overall, 467 UC patients (384 younger-onset and 83 older-onset) were enrolled. Clinical remission at day 30 was observed in 252 (65.6%) among younger-onset patients and 43 (51.8%) among older-onset patients (adjusted risk difference, -21.7% [95% CI, -36.1% to -7.2%]; adjusted risk ratio [ARR], 0.74 [95% CI, 0.59 to 0.93]). The risks of surgery and adverse events were higher in older-onset UC (20.5% vs. 3.1%; ARR, 8.92 [95% CI, 4.13 to 19.27], 25.3% vs. 9.1%; ARR, 2.19 [95% CI, 1.22 to 3.92], respectively). Four deaths occurred, all involving older-onset UC. The risks of infection and venous thrombosis were also higher in older-onset UC (18.1% vs. 8.6%, 7.2% vs. 0.5%, respectively). CONCLUSIONS Older-onset was associated with a lower effectiveness of intravenous steroids with higher risks of surgery and adverse events in UC.
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Affiliation(s)
- Shinji Okabayashi
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hajime Yamazaki
- Section of Clinical Epidemiology, Department of Community Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Keiichi Tominaga
- Department of Gastroenterology, Dokkyo Medical University, Tochigi, Japan
| | - Miki Miura
- Department of Gastroenterology and Hepatology, Kyorin University School of Medicine, Tokyo, Japan
| | - Shintaro Sagami
- Center for Advanced IBD Research and Treatment, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
| | - Katsuyoshi Matsuoka
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Toho University Sakura Medical Center, Chiba, Japan
| | - Yoshiharu Yamaguchi
- Department of Gastroenterology, Aichi Medical University School of Medicine, Aichi, Japan
| | - Toshihiro Noake
- Department of Surgery, Kurume Coloproctology Center, Fukuoka, Japan
| | - Keiji Ozeki
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Aichi, Japan
| | - Ryosuke Miyazaki
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Toshiaki Kamano
- Department of gastroenterology, Fujita Health University, Aichi, Japan
| | - Tomohiro Fukuda
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Kyoko Yoshioka
- Department of Gastroenterology, Kure Kyosai Hospital, Hiroshima, Japan
| | - Katsuyoshi Ando
- Gastroenterology and Endoscopy, Division of Metabolism and Biosystemic Science, Gastroenterology, and Hematology/Oncology, Asahikawa Medical University, Hokkaido, Japan
| | - Masakatsu Fukuzawa
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Akira Andoh
- Division of Gastroenterology, Shiga University of Medical Science, Shiga, Japan
| | - Yosuke Yamamoto
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Toshifumi Hibi
- Center for Advanced IBD Research and Treatment, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
| | - Taku Kobayashi
- Center for Advanced IBD Research and Treatment, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
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29
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Fujita Y, Tominaga K, Tanaka T, Ishida K, Yoshihara S. Eosinophilic Duodenal Ulcer Exacerbation after Helicobacter pylori Eradication in a 14-Year-Old Boy. TOHOKU J EXP MED 2022; 257:153-156. [PMID: 35444106 DOI: 10.1620/tjem.2022.j031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Yuji Fujita
- Department of Pediatrics, Dokkyo Medical University
| | | | - Takanao Tanaka
- Department of Gastroenterology, Dokkyo Medical University
| | - Kazuyuki Ishida
- Department of Diagnostic Pathology, Dokkyo Medical University
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30
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Yamamiya A, Tominaga K, Hoshi K, Nagashima K, Minaguchi T, Haruyama Y, Irisawa A. The Risk Factors for Progression to Chronic Pancreatitis in Patients with Past-History of Acute Pancreatitis: A Retrospective Analysis Based on Mechanistic Definition. J Clin Med 2022; 11:jcm11082209. [PMID: 35456301 PMCID: PMC9032682 DOI: 10.3390/jcm11082209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 04/09/2022] [Accepted: 04/13/2022] [Indexed: 12/12/2022] Open
Abstract
Background: According to the mechanistic definition, the history of acute pancreatitis (AP) is a risk factor for chronic pancreatitis (CP). However, the etiology and severity of previous AP involved in the progression to CP have not been clarified. Here, we investigated risk factors for the progression to CP in patients with past-history of AP. Methods: Sixty-four patients with AP who were followed-up for at least two years at our institution between April 2009 and March 2017 were enrolled. The multivariate analysis was performed based on the risk factors extracted by univariate analysis. Results: Among the 64 patients, 13 patients (20.3%) progressed to CP (PCP group), while 48 did not (non-PCP group). Regarding the etiology of AP, rate of alcohol AP was significantly higher in the PCP group (76.9% vs. 33.3%, p = 0.003). In univariate analysis, smoking, number of previous AP, and alcohol consumption and drinking habits (Alcohol Use Disorders Identification Test-Concise; AUDIT-C) were identified as factors associated with progression to CP. Furthermore, multivariate analysis showed that AUDIT-C ≥ 6 points (male) and 4 points (female) after AP was a significant risk factor for CP (p = 0.003). Conclusions: Our results indicated that AUDIT-C ≥ 6 points (male) and 4 points (female) after AP was a risk factor in the process of progression to CP in patients with past-history of AP.
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Affiliation(s)
- Akira Yamamiya
- Department of Gastroenterology, School of Medicine, Dokkyo Medical University, 880 Kitakobayashi Mibu, Tochigi 321-0293, Japan; (K.T.); (K.H.); (K.N.); (T.M.); (A.I.)
- Correspondence: ; Tel.: +81-282-87-2147
| | - Keiichi Tominaga
- Department of Gastroenterology, School of Medicine, Dokkyo Medical University, 880 Kitakobayashi Mibu, Tochigi 321-0293, Japan; (K.T.); (K.H.); (K.N.); (T.M.); (A.I.)
| | - Koki Hoshi
- Department of Gastroenterology, School of Medicine, Dokkyo Medical University, 880 Kitakobayashi Mibu, Tochigi 321-0293, Japan; (K.T.); (K.H.); (K.N.); (T.M.); (A.I.)
| | - Kazunori Nagashima
- Department of Gastroenterology, School of Medicine, Dokkyo Medical University, 880 Kitakobayashi Mibu, Tochigi 321-0293, Japan; (K.T.); (K.H.); (K.N.); (T.M.); (A.I.)
| | - Takahito Minaguchi
- Department of Gastroenterology, School of Medicine, Dokkyo Medical University, 880 Kitakobayashi Mibu, Tochigi 321-0293, Japan; (K.T.); (K.H.); (K.N.); (T.M.); (A.I.)
| | - Yasuo Haruyama
- Integrated Research Faculty for Advanced Medical Science, School of Medicine, Dokkyo Medical University, 880 Kitakobayashi Mibu, Tochigi 321-0293, Japan;
| | - Atsushi Irisawa
- Department of Gastroenterology, School of Medicine, Dokkyo Medical University, 880 Kitakobayashi Mibu, Tochigi 321-0293, Japan; (K.T.); (K.H.); (K.N.); (T.M.); (A.I.)
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31
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Goto A, Kokabu S, Dusadeemeelap C, Kawaue H, Matsubara T, Tominaga K, Addison WN. Tongue Muscle for the Analysis of Head Muscle Regeneration Dynamics. J Dent Res 2022; 101:962-971. [PMID: 35193429 DOI: 10.1177/00220345221075966] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Tongue muscle damage impairs speaking and eating, thereby degrading overall health and quality of life. Skeletal muscles of the body are diverse in embryonic origin, anatomic location, and gene expression profiles. Responses to disease, atrophy, aging, or drugs vary among different muscles. Currently, most muscle studies are focused on limb muscles and the tongue is neglected. The regenerative ability of tongue muscle remains unknown, and thus there is need for tongue muscle research models. Here, we present a comprehensive characterization of the spatiotemporal dynamics in a mouse model of tongue muscle regeneration and establish a method for the isolation of primary tongue-derived satellite cells. We compare and contrast our observations with the tibialis anterior (TA) limb muscle. Acute injury was induced by intramuscular injection of cardiotoxin, a cytolytic agent, and examined at multiple timepoints. Initially, necrotic myofibers with fragmented sarcoplasm became infiltrated with inflammatory cells. Concomitantly, satellite cells expanded rapidly. Seven days postinjury, regenerated myofibers with centralized nuclei appeared. Full regeneration, as well as an absence of fibrosis, was evident 21 d postinjury. Primary tongue-derived satellite cells were isolated by enzymatic separation of tongue epithelium from mesenchyme followed by magnetic-activated cell sorting. We observed that tongue displays an efficient regenerative response similar to TA but with slightly faster kinetics. In vitro, tongue-derived satellite cells differentiated robustly into mature myotubes with spontaneous contractile behavior and myogenic marker expression. Comparison of gene expression signatures between tongue and TA-derived satellite cells revealed differences in the expression of positional-identity genes, including the HOX family. In conclusion, we have established a model for tongue regeneration useful for investigations of orofacial muscle biology. Furthermore, we showed that tongue is a viable source of satellite cells with unique properties and inherited positional memory.
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Affiliation(s)
- A Goto
- Division of Molecular Signaling and Biochemistry, Kyushu Dental University, Kitakyushu, Fukuoka, Japan.,Division of Oral and Maxillofacial Surgery, Kyushu Dental University, Kitakyushu, Fukuoka, Japan
| | - S Kokabu
- Division of Molecular Signaling and Biochemistry, Kyushu Dental University, Kitakyushu, Fukuoka, Japan
| | - C Dusadeemeelap
- Division of Molecular Signaling and Biochemistry, Kyushu Dental University, Kitakyushu, Fukuoka, Japan
| | - H Kawaue
- Division of Molecular Signaling and Biochemistry, Kyushu Dental University, Kitakyushu, Fukuoka, Japan
| | - T Matsubara
- Division of Molecular Signaling and Biochemistry, Kyushu Dental University, Kitakyushu, Fukuoka, Japan
| | - K Tominaga
- Division of Oral and Maxillofacial Surgery, Kyushu Dental University, Kitakyushu, Fukuoka, Japan
| | - W N Addison
- Division of Molecular Signaling and Biochemistry, Kyushu Dental University, Kitakyushu, Fukuoka, Japan
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32
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Kanazawa M, Tominaga K, Kanamori A, Tanaka T, Masuyama S, Watanabe S, Abe K, Yamamiya A, Goda K, Irisawa A. A Case of Stevens–Johnson Syndrome Complicated with Multimatrix System Mesalamine in Ulcerative Colitis. Medicina (B Aires) 2022; 58:medicina58020276. [PMID: 35208599 PMCID: PMC8876713 DOI: 10.3390/medicina58020276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 02/02/2022] [Accepted: 02/10/2022] [Indexed: 11/16/2022] Open
Abstract
A 41-year-old man was treated with prednisolone (PSL) and multimatrix (MMX) mesalamine for remission induction therapy of ulcerative colitis. PSL was tapered due to successful remission induction treatment. During the treatment course, ocular foreign body sensation, eyelid swelling, ocular conjunctiva hyperemia, facial redness and swelling, watery nasal discharge, stomatitis, anal pain, and reddish puffiness on the bilateral dorsum of the hands appeared, and he was diagnosed with Stevens–Johnson syndrome (SJS). SJS was improved by PSL treatment and intravenous immunoglobulin. MMX mesalamine was the causative agent by drug-induced lymphocyte stimulation test. This is the first reported case of SJS with MMX mesalamine.
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33
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Fukushi K, Goda K, Kino H, Kondo M, Kanazawa M, Kashima K, Kanamori A, Abe K, Suzuki T, Tominaga K, Yamagishi H, Irisawa A. Curative resection with endoscopic submucosal dissection of early gastric cancer in Helicobacter pylori-negative Ménétrier’s disease: A case report. World J Gastroenterol 2022; 28:594-601. [PMID: 35316958 PMCID: PMC8905015 DOI: 10.3748/wjg.v28.i5.594] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 12/03/2021] [Accepted: 01/20/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Adult-onset Ménétrier’s disease is strongly associated with Helicobacter pylori (H. pylori) infection and an elevated risk of carcinogenesis. Cases of early-stage gastric cancer developed in H. pylori-negative Ménétrier’s disease are extremely rare. We report a case of early gastric cancer in H. pylori-negative Ménétrier’s disease that was curatively resected with endoscopic submucosal dissection (ESD).
CASE SUMMARY A 60-year-old woman was referred to our hospital after her medical examination detected anemia. Contrast-enhanced upper gastrointestinal (UGI) radiography revealed translucency of the nodule-aggregating surface with giant rugae. Blood tests showed hypoproteinemia and were negative for serum H. pylori immunoglobulin G antibodies. The 99mTc-DTPA-human serum albumin scintigraphy showed protein loss from the stomach. UGI endoscopy showed a 40-mm protruding erythematous lesion on giant rugae of the greater curvature of lower gastric body, suggesting early-stage gastric cancer due to Ménétrier’s disease. En bloc resection with ESD was performed for diagnosis and treatment. Histology of ESD showed well-differentiated tubular adenocarcinoma. The cancer was confined to the mucosa, and complete curative resection was achieved. Foveolar hyperplasia and atrophy of the gastric glands were observed in non-tumor areas, histologically corresponding to Ménétrier’s disease. Three years after ESD, gastric cancer had not recurred, and Ménétrier’s disease remained in remission with spontaneous regression of giant gastric rugae.
CONCLUSION Complete curative resection was achieved through ESD in a patient with early-stage gastric cancer and H. pylori-negative Ménétrier’s disease.
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Affiliation(s)
- Koh Fukushi
- Department of Gastroenterology, Dokkyo Medical University, Mibu 321-0293, Tochigi, Japan
| | - Kenichi Goda
- Department of Gastroenterology, Dokkyo Medical University, Mibu 321-0293, Tochigi, Japan
| | - Hitoshi Kino
- Department of Gastroenterology, Dokkyo Medical University, Mibu 321-0293, Tochigi, Japan
| | - Masayuki Kondo
- Department of Gastroenterology, Dokkyo Medical University, Mibu 321-0293, Tochigi, Japan
| | - Mimari Kanazawa
- Department of Gastroenterology, Dokkyo Medical University, Mibu 321-0293, Tochigi, Japan
| | - Ken Kashima
- Department of Gastroenterology, Dokkyo Medical University, Mibu 321-0293, Tochigi, Japan
| | - Akira Kanamori
- Department of Gastroenterology, Dokkyo Medical University, Mibu 321-0293, Tochigi, Japan
| | - Keiichiro Abe
- Department of Gastroenterology, Dokkyo Medical University, Mibu 321-0293, Tochigi, Japan
| | - Tsunehiro Suzuki
- Department of Gastroenterology, Dokkyo Medical University, Mibu 321-0293, Tochigi, Japan
| | - Keiichi Tominaga
- Department of Gastroenterology, Dokkyo Medical University, Mibu 321-0293, Tochigi, Japan
| | - Hidetsugu Yamagishi
- Department of Diagnostic Pathology, Dokkyo Medical University, Mibu 321-0293, Tochigi, Japan
| | - Atsushi Irisawa
- Department of Gastroenterology, Dokkyo Medical University, Mibu 321-0293, Tochigi, Japan
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Inoue T, Yamashita S, Imai S, Fujita M, Yamamichi F, Tominaga K, Fujisawa M. Evaluation of relationship with temperature and laser tip distance in high-power holmium laser use by measurement of thermography and thermometer: Ex-vivo phantom study. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)01263-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Fujita Y, Tominaga K, Tanaka T, Sugaya T, Yoshihara S. Ulcerative colitis relapse after Helicobacter pylori eradication in a 12-year-old boy with duodenal ulcer. BMC Gastroenterol 2021; 21:424. [PMID: 34758726 PMCID: PMC8579552 DOI: 10.1186/s12876-021-02010-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 11/02/2021] [Indexed: 12/24/2022] Open
Abstract
Background Helicobacter pylori (H. pylori) prevalence is lower in patients with inflammatory bowel disease (IBD) than in those without IBD, suggesting that H. pylori plays a protective role in IBD. It has been reported that IBD may occur due to H. pylori eradication; however, it is unclear whether H. pylori eradication increases the incidence of IBD. Moreover, the effect of H. pylori eradication on IBD activity is unclear. Case presentation An 11-year-old boy diagnosed with ulcerative colitis (UC) was in clinical remission, with treatment involving 5-aminosalicylic acid. Fecal calprotectin (FC) level had decreased to 33.2 mg/kg, indicating mucosal healing. At age 12, he experienced epigastric pain on an empty stomach, which was relieved with dietary intake. His FC level was elevated without UC symptoms, such as diarrhea and bloody stools. He was diagnosed with H. pylori duodenal ulcer. H. pylori eradication (clarithromycin and amoxicillin for 7 days and a proton-pump inhibitor) led to symptom improvement the day after treatment initiation. However, he developed diarrhea and his FC level remained high despite improvement in duodenal ulcer symptoms and endoscopic findings of H. pylori eradication. Colonoscopy results indicated UC relapse. Conclusions H. pylori eradication may worsen UC activity. However, further studies are required as this case report involved only one pediatric patient with increased UC activity after H. pylori eradication.
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Affiliation(s)
- Yuji Fujita
- Department of Pediatrics, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga, Tochigi, 321-0293, Japan.
| | - Keiichi Tominaga
- Department of Gastroenterology, Dokkyo Medical University, Tochigi, Japan
| | - Takanao Tanaka
- Department of Gastroenterology, Dokkyo Medical University, Tochigi, Japan
| | - Takeshi Sugaya
- Department of Gastroenterology, Dokkyo Medical University, Tochigi, Japan
| | - Shigemi Yoshihara
- Department of Pediatrics, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga, Tochigi, 321-0293, Japan
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Abe K, Goda K, Kanamori A, Suzuki T, Yamamiya A, Takimoto Y, Arisaka T, Hoshi K, Sugaya T, Majima Y, Tominaga K, Iijima M, Hirooka S, Yamagishi H, Irisawa A. Whole circumferential endoscopic submucosal dissection of superficial adenocarcinoma in long-segment Barrett's esophagus: A case report. World J Gastrointest Surg 2021. [DOI: 10.4240/wjgs.v13.i10.1284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Abe K, Goda K, Kanamori A, Suzuki T, Yamamiya A, Takimoto Y, Arisaka T, Hoshi K, Sugaya T, Majima Y, Tominaga K, Iijima M, Hirooka S, Yamagishi H, Irisawa A. Whole circumferential endoscopic submucosal dissection of superficial adenocarcinoma in long-segment Barrett's esophagus: A case report. World J Gastrointest Surg 2021; 13:1285-1292. [PMID: 34754396 PMCID: PMC8554727 DOI: 10.4240/wjgs.v13.i10.1285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 07/15/2021] [Accepted: 09/17/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Esophageal adenocarcinoma (EAC) derived from long-segment Barrett’s esophagus (LSBE) is extremely rare in Asia. LSBE-related EAC is often difficult to diagnose in the horizontal extent. If the tumor has spread throughout the LSBE, whole circumferential endoscopic submucosal dissection (ESD) should be performed, which is difficult to complete safely. Additionally, whole circumferential ESD can bring refractory postoperative stenosis. We hereby report a case of EAC involving the whole circumference of the LSBE, achieving complete endoscopic removal without complications.
CASE SUMMARY An 85-year-old man with the chief complaint of dysphagia underwent esophagogastroduodenoscopy. We suspected a flat-type cancerous lesion that extended the whole circumference of the LSBE (C 3.5, M 4.0) using narrow-band imaging magnification endoscopy (NBI-M). We achieved circumferential en bloc resection of the lesion safely with special ESD techniques. Histology of the ESD specimens demonstrated that the superficial EAC extended the whole circumference of the LSBE, and papillary or well-differentiated tubular adenocarcinoma was confined in the lamina propria mucosa showing a vertical negative margin. To prevent post-ESD stenosis, we performed endoscopic local injection of steroids, followed by oral administration of steroids. There was no evidence of esophageal refractory stenosis or tumor recurrence 30 mo after ESD. In summary, we experienced a rare case of LSBE-related EAC. The horizontal tumor extent was accurately diagnosed by NBI-M. Additionally, we achieve whole circumferential ESD safely without postoperative refractory stenosis.
CONCLUSION NBI-M, ESD, and steroid therapy enabled the curative resection of superficial full circumferential LSBE-related EAC without refractory postoperative stenosis.
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Affiliation(s)
- Keiichiro Abe
- Department of Gastroenterology, Dokkyo Medical University, Mibu 321-0293, Tochigi, Japan
| | - Kenichi Goda
- Department of Gastroenterology, Dokkyo Medical University, Mibu 321-0293, Tochigi, Japan
| | - Akira Kanamori
- Department of Gastroenterology, Dokkyo Medical University, Mibu 321-0293, Tochigi, Japan
| | - Tsunehiro Suzuki
- Department of Gastroenterology, Dokkyo Medical University, Mibu 321-0293, Tochigi, Japan
| | - Akira Yamamiya
- Department of Gastroenterology, Dokkyo Medical University, Mibu 321-0293, Tochigi, Japan
| | - Yoichi Takimoto
- Department of Gastroenterology, Dokkyo Medical University, Mibu 321-0293, Tochigi, Japan
| | - Takahiro Arisaka
- Department of Gastroenterology, Dokkyo Medical University, Mibu 321-0293, Tochigi, Japan
| | - Koki Hoshi
- Department of Gastroenterology, Dokkyo Medical University, Mibu 321-0293, Tochigi, Japan
| | - Takeshi Sugaya
- Department of Gastroenterology, Dokkyo Medical University, Mibu 321-0293, Tochigi, Japan
| | - Yuichi Majima
- Department of Gastroenterology, Dokkyo Medical University, Mibu 321-0293, Tochigi, Japan
| | - Keiichi Tominaga
- Department of Gastroenterology, Dokkyo Medical University, Mibu 321-0293, Tochigi, Japan
| | - Makoto Iijima
- Department of Gastroenterology, Dokkyo Medical University, Mibu 321-0293, Tochigi, Japan
| | - Shinichi Hirooka
- Department of Pathology, The Jikei University School of Medicine, Nishishimbashi 105-8471, Tokyo, Japan
| | - Hidetsugu Yamagishi
- Academic Institutional Research Center, Dokkyo Medical University, Mibu 321-0293, Tochigi, Japan
| | - Atsushi Irisawa
- Department of Gastroenterology, Dokkyo Medical University, Mibu 321-0293, Tochigi, Japan
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Kanazawa M, Tominaga K, Yamamiya A, Tanaka T, Watanabe S, Sugaya T, Abe K, Kanamori A, Arisaka T, Hoshi K, Iijima M, Goda K, Haruyama Y, Irisawa A. Analysis of Endoscopic Evaluation Reliability for Ulcerative Colitis in Histological Remission. Healthcare (Basel) 2021; 9:healthcare9111405. [PMID: 34828451 PMCID: PMC8620245 DOI: 10.3390/healthcare9111405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 10/16/2021] [Accepted: 10/18/2021] [Indexed: 11/16/2022] Open
Abstract
The Mayo endoscopic subscore (MES) is a major endoscopic scoring system used to assign a status of mucosal inflammation and disease activity to patients with ulcerative colitis (UC). Using interobserver reliability (IOR), this study clarified the difficulties for endoscopic observers imposed by MES parameters used for the endoscopic evaluation of UC in histological remission. First, 42 endoscopists of four observer groups examined each MES parameter, which were evaluated from endoscopically obtained images of 100 cases as Grade 0 or 1 of the Nancy histological index of histopathological inflammation. Then, IOR was assessed using multiple κ statistics for each finding of MES. The results showed that IOR among all the observers was slight or fair for all the parameters, indicating a low IOR. The experts of the UC practice group had "moderate" or higher IOR for seven of the nine parameters, whereas "slight" or "fair" results were found for all parameters by the trainee group. The IOR for each MES parameter was calculated separately for the observer groups. All the groups showed "slight" or "fair" for "Erythema" and "Decreased vascular pattern". Large differences between the endoscopists were found in the IOR for the MES parameters in UC in histological remission. Even among UC practice experts, the IOR was low for "Erythema" and "Decreased vascular pattern".
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Affiliation(s)
- Mimari Kanazawa
- Department of Gastroenterology, Dokkyo Medical University, Tochigi 321-0293, Japan; (M.K.); (A.Y.); (T.T.); (S.W.); (T.S.); (K.A.); (A.K.); (T.A.); (K.H.); (M.I.); (K.G.); (A.I.)
| | - Keiichi Tominaga
- Department of Gastroenterology, Dokkyo Medical University, Tochigi 321-0293, Japan; (M.K.); (A.Y.); (T.T.); (S.W.); (T.S.); (K.A.); (A.K.); (T.A.); (K.H.); (M.I.); (K.G.); (A.I.)
- Correspondence: ; Tel.: +81-282-872147
| | - Akira Yamamiya
- Department of Gastroenterology, Dokkyo Medical University, Tochigi 321-0293, Japan; (M.K.); (A.Y.); (T.T.); (S.W.); (T.S.); (K.A.); (A.K.); (T.A.); (K.H.); (M.I.); (K.G.); (A.I.)
| | - Takanao Tanaka
- Department of Gastroenterology, Dokkyo Medical University, Tochigi 321-0293, Japan; (M.K.); (A.Y.); (T.T.); (S.W.); (T.S.); (K.A.); (A.K.); (T.A.); (K.H.); (M.I.); (K.G.); (A.I.)
| | - Shoko Watanabe
- Department of Gastroenterology, Dokkyo Medical University, Tochigi 321-0293, Japan; (M.K.); (A.Y.); (T.T.); (S.W.); (T.S.); (K.A.); (A.K.); (T.A.); (K.H.); (M.I.); (K.G.); (A.I.)
| | - Takeshi Sugaya
- Department of Gastroenterology, Dokkyo Medical University, Tochigi 321-0293, Japan; (M.K.); (A.Y.); (T.T.); (S.W.); (T.S.); (K.A.); (A.K.); (T.A.); (K.H.); (M.I.); (K.G.); (A.I.)
| | - Keiichiro Abe
- Department of Gastroenterology, Dokkyo Medical University, Tochigi 321-0293, Japan; (M.K.); (A.Y.); (T.T.); (S.W.); (T.S.); (K.A.); (A.K.); (T.A.); (K.H.); (M.I.); (K.G.); (A.I.)
| | - Akira Kanamori
- Department of Gastroenterology, Dokkyo Medical University, Tochigi 321-0293, Japan; (M.K.); (A.Y.); (T.T.); (S.W.); (T.S.); (K.A.); (A.K.); (T.A.); (K.H.); (M.I.); (K.G.); (A.I.)
| | - Takahiro Arisaka
- Department of Gastroenterology, Dokkyo Medical University, Tochigi 321-0293, Japan; (M.K.); (A.Y.); (T.T.); (S.W.); (T.S.); (K.A.); (A.K.); (T.A.); (K.H.); (M.I.); (K.G.); (A.I.)
| | - Koki Hoshi
- Department of Gastroenterology, Dokkyo Medical University, Tochigi 321-0293, Japan; (M.K.); (A.Y.); (T.T.); (S.W.); (T.S.); (K.A.); (A.K.); (T.A.); (K.H.); (M.I.); (K.G.); (A.I.)
| | - Makoto Iijima
- Department of Gastroenterology, Dokkyo Medical University, Tochigi 321-0293, Japan; (M.K.); (A.Y.); (T.T.); (S.W.); (T.S.); (K.A.); (A.K.); (T.A.); (K.H.); (M.I.); (K.G.); (A.I.)
| | - Kenichi Goda
- Department of Gastroenterology, Dokkyo Medical University, Tochigi 321-0293, Japan; (M.K.); (A.Y.); (T.T.); (S.W.); (T.S.); (K.A.); (A.K.); (T.A.); (K.H.); (M.I.); (K.G.); (A.I.)
| | - Yasuo Haruyama
- Integrated Research Faculty for Advanced Medical Science, Dokkyo Medical University, Tochigi 321-0293, Japan;
| | - Atsushi Irisawa
- Department of Gastroenterology, Dokkyo Medical University, Tochigi 321-0293, Japan; (M.K.); (A.Y.); (T.T.); (S.W.); (T.S.); (K.A.); (A.K.); (T.A.); (K.H.); (M.I.); (K.G.); (A.I.)
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Fujita Y, Sugaya T, Tanaka T, Tominaga K, Yoshihara S. Ustekinumab as the First Biological Agent for Crohn's Disease in a 10-Year-Old Girl. TOHOKU J EXP MED 2021; 255:57-60. [PMID: 34588346 DOI: 10.1620/tjem.255.57] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Pediatric inflammatory bowel disease is associated with growth failure due to chronic inflammation, nutrient disorder, and the side effects of drugs, such as corticosteroids. Biological agents are therapeutic drugs that significantly improve the prognosis of patients with inflammatory bowel disease. The effectiveness of ustekinumab has been reported in the management of adult patients with inflammatory bowel disease. There are very few reports regarding the effectiveness and safety of ustekinumab in pediatric patients with inflammatory bowel disease, especially those who are biologically naive. A 10-year-old girl presented with chronic abdominal pain, diarrhea, and weight loss. Colonoscopy showed a longitudinal ulcer and cobblestone appearance in the ileum and discontinuous inflammation of the colon; therefore, she was diagnosed with Crohn's disease. She was prescribed a fat-restricted diet, elemental diet, 5-aminosalicylic acid, transient prednisolone, and ustekinumab. She achieved clinical and endoscopic remission based on the weighted Pediatric Crohn's Disease Activity Index, fecal calprotectin, and colonoscopy findings at week 75. This patient developed no adverse events, such as infusion reaction or susceptibility to infection over the 75 weeks. The use of ustekinumab as the first biological agent may be an effective and safe treatment for pediatric Crohn's disease.
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Affiliation(s)
- Yuji Fujita
- Department of Pediatrics, Dokkyo Medical University School of Medicine
| | - Takeshi Sugaya
- Department of Gastroenterology, Dokkyo Medical University School of Medicine
| | - Takanao Tanaka
- Department of Gastroenterology, Dokkyo Medical University School of Medicine
| | - Keiichi Tominaga
- Department of Gastroenterology, Dokkyo Medical University School of Medicine
| | - Shigemi Yoshihara
- Department of Pediatrics, Dokkyo Medical University School of Medicine
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Yamabe A, Irisawa A, Kunogi Y, Kashima K, Nagashima K, Minaguchi T, Yamamiya A, Izawa N, Takimoto Y, Hoshi K, Nonaka L, Masuda M, Tominaga K, Goda K, Iijima M. Development of biliary stent applying the antibacterial activity of silver: A literature review. Biomed Mater Eng 2021; 32:63-71. [PMID: 33720871 DOI: 10.3233/bme-201163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Endoscopic transpapillary stenting is commonly performed in patients with obstructive jaundice caused by a biliary stricture. Although the plastic stent (PS) is widely used for biliary drainage because of the low-cost and easy procedure, patency is short after placement in the bile duct because of the small diameter. Dysfunction of PS is primarily caused by biliary sludge that forms as a result of bacterial adhesion and subsequent biofilm formation on the inner surface of the stent. It is well known that silver ions have excellent antibacterial activity against a wide range of microorganisms. OBJECTIVE This review provides an overview and perspective of the significance of silver-coated biliary stents. METHODS We collected literature regarding silver-coated biliary stents, reviewed the current research/development status and discussed their possible usefulness. RESULTS To date, several in vivo/vitro studies evaluated the patency of silver-blended or silver-coated biliary stents. These studies suggested that the silver coating on a PS was likely to prolong the patency period. CONCLUSION The development of biliary stents using silver is expected to prolong stent patency and prevent frequent stent replacement.
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Affiliation(s)
- Akane Yamabe
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, Mibu, Japan
| | - Atsushi Irisawa
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, Mibu, Japan
| | - Yasuhito Kunogi
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, Mibu, Japan
| | - Ken Kashima
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, Mibu, Japan
| | - Kazunori Nagashima
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, Mibu, Japan
| | - Takahito Minaguchi
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, Mibu, Japan
| | - Akira Yamamiya
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, Mibu, Japan
| | - Naoya Izawa
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, Mibu, Japan
| | - Yoichi Takimoto
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, Mibu, Japan
| | - Koki Hoshi
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, Mibu, Japan
| | - Lisa Nonaka
- Department of Nutritional Science, Faculty of Human Life Science, Shokei University, Kumamoto, Japan
| | - Michiaki Masuda
- Department of Microbiology, Dokkyo Medical University School of Medicine, Mibu, Japan
| | - Keiichi Tominaga
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, Mibu, Japan
| | - Kenichi Goda
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, Mibu, Japan
| | - Makoto Iijima
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, Mibu, Japan
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Nagashima K, Ijima M, Kimura K, Kurihara E, Tominaga K, Fukushi K, Kanamori A, Otake Y, Irisawa A. Does the Use of Low Osmolality Contrast Medium Reduce the Frequency of Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis: A Comparative Study between Use of Low and High Osmolality Contrast Media. Digestion 2021; 102:283-288. [PMID: 31770751 DOI: 10.1159/000504702] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 11/12/2019] [Indexed: 02/04/2023]
Abstract
INTRODUCTION A few reports stating that differences in the various types of contrast media injected into the pancreatic duct are related to the onset of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) have been published, and it was indicated that iodixanol which is a nonionic iodide radiographic contrast medium with a dimeric (2 dimers) structure may reduce the incidence of PEP. The aim of this retrospective study is to evaluate the usefulness of iodaxanol for prevention PEP in comparison with megulamine amidototrizoate. METHODS Two hundred and ninety-one patients were enrolled and divided into the 2 groups according to the contrast medium used. One hundred and fifty-five patients underwent ERCP with meglumine amidotrizoate, and 136 patients underwent ERCP with iodaxanol. The primary outcome of this study was the incidence of PEP associated with the use of each contrast medium. RESULTS In this study, comparison of the meglumine amidotrizoate treatment and iodaxanol treatment groups showed no significant difference with respect to the incidence of PEP. In addition, there was also no difference between the groups with respect to PEP severity. CONCLUSION Our study suggested that iodaxanol does not necessarily contribute to the prevention of PEP in comparison with meglumine amidotrizoate.
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Affiliation(s)
- Kazunori Nagashima
- Department of Gastroenterology, Dokkyo Medical University, Tochigi, Japan.,Department of Gastroenterology, SUBARU Ota Memorial Hospital, Gunma, Japan
| | - Masashi Ijima
- Department of Gastroenterology, SUBARU Ota Memorial Hospital, Gunma, Japan
| | - Kouichirou Kimura
- Department of Gastroenterology, SUBARU Ota Memorial Hospital, Gunma, Japan
| | - Eishin Kurihara
- Department of Gastroenterology, SUBARU Ota Memorial Hospital, Gunma, Japan
| | - Keiichi Tominaga
- Department of Gastroenterology, Dokkyo Medical University, Tochigi, Japan
| | - Koh Fukushi
- Department of Gastroenterology, Dokkyo Medical University, Tochigi, Japan
| | - Akira Kanamori
- Department of Gastroenterology, Dokkyo Medical University, Tochigi, Japan
| | - Yosuke Otake
- Department of Gastroenterology, SUBARU Ota Memorial Hospital, Gunma, Japan
| | - Atsushi Irisawa
- Department of Gastroenterology, Dokkyo Medical University, Tochigi, Japan,
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Tominaga K, Tanaka T, Kanazawa M, Watanabe S, Nemoto R, Abe K, Kanamori A, Yamamiya A, Goda K, Kushima Y, Chibana K, Masawa T, Fukuda T, Hibi T, Irisawa A. A Case of Crohn's Disease with Cardiac Tamponade Caused by Tuberculous Pericarditis: Assessment of a Rare Phenomenon. Healthcare (Basel) 2021; 9:healthcare9060695. [PMID: 34207677 PMCID: PMC8227572 DOI: 10.3390/healthcare9060695] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 05/26/2021] [Accepted: 06/08/2021] [Indexed: 01/14/2023] Open
Abstract
A 28-year-old woman was hospitalized for cardiac tamponade caused by tuberculous pericarditis. She was taking ustekinumab (UST) for Crohn’s disease. UST is not considered to significantly increase the risk of developing serious infections, including tuberculosis. However, there is still a risk of Mycobacterium tuberculosis reactivation. Therefore, for patients on concurrent UST and antituberculosis medication, a close collaboration among specialists in infectious diseases, cardiology, and gastroenterology is necessary.
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Affiliation(s)
- Keiichi Tominaga
- Department of Gastroenterology, Dokkyo Medical University, Tochigi 321-0293, Japan; (T.T.); (M.K.); (S.W.); (R.N.); (K.A.); (A.K.); (A.Y.); (K.G.); (A.I.)
- Correspondence: ; Tel.: +81-282-872147
| | - Takanao Tanaka
- Department of Gastroenterology, Dokkyo Medical University, Tochigi 321-0293, Japan; (T.T.); (M.K.); (S.W.); (R.N.); (K.A.); (A.K.); (A.Y.); (K.G.); (A.I.)
| | - Mimari Kanazawa
- Department of Gastroenterology, Dokkyo Medical University, Tochigi 321-0293, Japan; (T.T.); (M.K.); (S.W.); (R.N.); (K.A.); (A.K.); (A.Y.); (K.G.); (A.I.)
| | - Shoko Watanabe
- Department of Gastroenterology, Dokkyo Medical University, Tochigi 321-0293, Japan; (T.T.); (M.K.); (S.W.); (R.N.); (K.A.); (A.K.); (A.Y.); (K.G.); (A.I.)
| | - Rena Nemoto
- Department of Gastroenterology, Dokkyo Medical University, Tochigi 321-0293, Japan; (T.T.); (M.K.); (S.W.); (R.N.); (K.A.); (A.K.); (A.Y.); (K.G.); (A.I.)
| | - Keiichiro Abe
- Department of Gastroenterology, Dokkyo Medical University, Tochigi 321-0293, Japan; (T.T.); (M.K.); (S.W.); (R.N.); (K.A.); (A.K.); (A.Y.); (K.G.); (A.I.)
| | - Akira Kanamori
- Department of Gastroenterology, Dokkyo Medical University, Tochigi 321-0293, Japan; (T.T.); (M.K.); (S.W.); (R.N.); (K.A.); (A.K.); (A.Y.); (K.G.); (A.I.)
| | - Akira Yamamiya
- Department of Gastroenterology, Dokkyo Medical University, Tochigi 321-0293, Japan; (T.T.); (M.K.); (S.W.); (R.N.); (K.A.); (A.K.); (A.Y.); (K.G.); (A.I.)
| | - Kenichi Goda
- Department of Gastroenterology, Dokkyo Medical University, Tochigi 321-0293, Japan; (T.T.); (M.K.); (S.W.); (R.N.); (K.A.); (A.K.); (A.Y.); (K.G.); (A.I.)
| | - Yoshitomo Kushima
- Department of Pulmonary Medicine and Clinical Immunology, Dokkyo Medical University, Tochigi 321-0293, Japan; (Y.K.); (K.C.)
| | - Kazuyuki Chibana
- Department of Pulmonary Medicine and Clinical Immunology, Dokkyo Medical University, Tochigi 321-0293, Japan; (Y.K.); (K.C.)
| | - Taito Masawa
- Department of Cardiovascular Medicine, Dokkyo Medical University, Tochigi 321-0293, Japan;
| | - Tomohiro Fukuda
- Center for Advanced IBD Research and Treatment, Kitasato University Kitasato Institute Hospital, Tokyo 108-8642, Japan; (T.F.); (T.H.)
- Department of Gastroenterology and Hepatology, Kitasato University Kitasato Institute Hospital, Tokyo 108-8642, Japan
| | - Toshifumi Hibi
- Center for Advanced IBD Research and Treatment, Kitasato University Kitasato Institute Hospital, Tokyo 108-8642, Japan; (T.F.); (T.H.)
| | - Atsushi Irisawa
- Department of Gastroenterology, Dokkyo Medical University, Tochigi 321-0293, Japan; (T.T.); (M.K.); (S.W.); (R.N.); (K.A.); (A.K.); (A.Y.); (K.G.); (A.I.)
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Kunogi Y, Izawa N, Tominaga K, Irisawa A. Multiple cystic lesions around the bile duct. Pol Arch Intern Med 2021; 131:387-388. [PMID: 33710836 DOI: 10.20452/pamw.15870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Yasuhito Kunogi
- Department of Gastroenterology, Dokkyo Medical University, Tochigi, Japan
| | - Naoya Izawa
- Department of Gastroenterology, Dokkyo Medical University, Tochigi, Japan
| | - Keiichi Tominaga
- Department of Gastroenterology, Dokkyo Medical University, Tochigi, Japan.
| | - Atsushi Irisawa
- Department of Gastroenterology, Dokkyo Medical University, Tochigi, Japan
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Tominaga K, Sugaya T, Tanaka T, Kanazawa M, Iijima M, Irisawa A. Thiopurines: Recent Topics and Their Role in the Treatment of Inflammatory Bowel Diseases. Front Pharmacol 2021; 11:582291. [PMID: 33584261 PMCID: PMC7878672 DOI: 10.3389/fphar.2020.582291] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 12/29/2020] [Indexed: 12/16/2022] Open
Abstract
Ulcerative colitis (UC) and Crohn's disease (CD) are chronic inflammatory bowel diseases (IBD) of unknown etiology, characterized by repeated relapse and remission. The efficacy of thiopurine in IBD was first reported in the late 1960s. Thiopurines are used to alleviate the symptoms of IBD, especially UC. These drugs have a steroid-sparing potential and are widely used for the purpose of maintaining long-term remission in steroid-dependent cases. Therefore, thiopurines tend to be used long-term, but adverse events that accompany long-term use, such as lymphoproliferative disorders, must be monitored with care. In contrast, thiopurine plays a critical role in controlling the immunogenicity of biologics. Furthermore, although thiopurine is an old drug, new findings, including the prediction of serious adverse events such as severe alopecia and acute advanced leukopenia, by nudix hydrolase 15 gene polymorphism analysis, as well as the possibility of appropriate drug monitoring by detailed analysis of 6-thioguanine nucleotides have been clarified. However, the consequences of thiopurine withdrawal have not been determined and further studies, including randomized controlled trials, are necessary to answer the clinical question regarding the scenarios in which thiopurine withdrawal is possible.
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Affiliation(s)
- Keiichi Tominaga
- Department of Gastroenterology, Dokkyo Medical University, Tochigi, Japan
| | - Takeshi Sugaya
- Department of Gastroenterology, Dokkyo Medical University, Tochigi, Japan
| | - Takanao Tanaka
- Department of Gastroenterology, Dokkyo Medical University, Tochigi, Japan
| | - Mimari Kanazawa
- Department of Gastroenterology, Dokkyo Medical University, Tochigi, Japan
| | - Makoto Iijima
- Department of Gastroenterology, Dokkyo Medical University, Tochigi, Japan
| | - Atsushi Irisawa
- Department of Gastroenterology, Dokkyo Medical University, Tochigi, Japan
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Inaba Y, Izawa N, Ishikawa M, Yamamiya A, Hoshi K, Arisaka T, Majima Y, Tominaga K, Iijima M, Goda K, Irisawa A. Huge Amoebic Liver Abscess in the Left Lobe Treated by Oral Administration of Metronidazole. Intern Med 2020; 59:3023-3026. [PMID: 32727992 PMCID: PMC7759695 DOI: 10.2169/internalmedicine.5301-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
A man in his 60s visited a clinic with chief complaints of a fever and general malaise. Suspecting a liver abscess in the left lobe with infiltration into the subcutaneous fat tissue under the rectus abdominis muscle based on computed tomography findings, we performed fine-needle aspiration. An amoebic liver abscess was diagnosed. Remission was achieved by the oral administration of metronidazole alone without placement of a drainage tube. The results obtained in this case suggest that the first line of treatment should be a non-invasive approach with oral administration alone. Invasive intervention should then be considered depending on subsequent progress.
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Affiliation(s)
- Yasunori Inaba
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, Japan
| | - Naoya Izawa
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, Japan
| | - Mutsumi Ishikawa
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, Japan
| | - Akira Yamamiya
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, Japan
| | - Koki Hoshi
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, Japan
| | - Takahiro Arisaka
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, Japan
| | - Yuichi Majima
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, Japan
| | - Keiichi Tominaga
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, Japan
| | - Makoto Iijima
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, Japan
| | - Kenichi Goda
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, Japan
| | - Atsushi Irisawa
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, Japan
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Yamamiya A, Irisawa A, Kashima K, Kunogi Y, Nagashima K, Minaguchi T, Izawa N, Yamabe A, Hoshi K, Tominaga K, Iijima M, Goda K. Interobserver Reliability of Endoscopic Ultrasonography: Literature Review. Diagnostics (Basel) 2020; 10:E953. [PMID: 33203069 PMCID: PMC7696989 DOI: 10.3390/diagnostics10110953] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 11/10/2020] [Accepted: 11/12/2020] [Indexed: 12/12/2022] Open
Abstract
Endoscopic ultrasonography (EUS) has been applied to the diagnosis of various digestive disorders. Although it has been widely accepted and its diagnostic value is high, the dependence of EUS diagnosis on image interpretation done by the endosonographer has persisted as an important difficulty. Consequently, high interobserver reliability (IOR) in EUS diagnosis is important to demonstrate the reliability of EUS diagnosis. We reviewed the literature on the IOR of EUS diagnosis for various diseases such as chronic pancreatitis, pancreatic solid/cystic mass, lymphadenopathy, and gastrointestinal and subepithelial lesions. The IOR of EUS diagnosis differs depending on the disease; moreover, EUS findings with high IOR and those with IOR that was not necessarily high were used as diagnostic criteria. Therefore, to further increase the value of EUS diagnosis, EUS diagnostic criteria with high diagnostic characteristics based on EUS findings with high IOR must be established.
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Affiliation(s)
| | - Atsushi Irisawa
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, 880 Kitakobayashi Mibu, Tochigi 321-0293, Japan; (A.Y.); (K.K.); (Y.K.); (K.N.); (T.M.); (N.I.); (A.Y.); (K.H.); (K.T.); (M.I.); (K.G.)
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Abstract
A 78-year-old man had been undergoing treatment with Cefamezin for pyogenic spondylitis. Because of complication of a urinary tract infection, the medication was switched to ceftriaxone (CTRX) 2 g/day. On day 18 after starting CTRX, the patient began experiencing abdominal pain. Computed tomography (CT) and endoscopic ultrasound led to the identification of calculi in the gallbladder and extrahepatic bile duct with a peculiar formation. We suspected CTRX-associated pseudo-cholecystolithiasis and pseudo-choledocholithiasis, although CT performed at admission had shown no such findings. Therefore, CTRX was discontinued. By day 17 after CTRX cessation, both the pseudo-cholecystolithiasis and pseudo-choledocholithiasis had disappeared.
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Affiliation(s)
- Akane Yamabe
- Department of Gastroenterology, Dokkyo Medical University, Japan
- Department of Gastroenterology, Takeda General Hospital, Japan
| | - Atsushi Irisawa
- Department of Gastroenterology, Dokkyo Medical University, Japan
- Department of Gastroenterology, Takeda General Hospital, Japan
| | | | - Takuya Tsunoda
- Department of Gastroenterology, Takeda General Hospital, Japan
| | - Keiichi Tominaga
- Department of Gastroenterology, Dokkyo Medical University, Japan
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Yokota T, Zenda S, Ota I, Yamazaki T, Yamaguchi T, Ogawa T, Tachibana H, Toshiyasu T, Homma A, Miyaji T, Mashiko T, Hamauchi S, Tominaga K, Ishii S, Otani Y, Orito N, Uchitomi Y. 931P Topical steroid versus placebo for the prevention of radiation dermatitis in head and neck cancer patients receiving chemoradiotherapy: A phase III, randomized, double-blinded trial: J-SUPPORT 1602(TOPICS). Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.1046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Tominaga K, Masuyama H, Kanazawa M, Irisawa A. Multiple colorectal xanthomas in an asymptomatic patient. Pol Arch Intern Med 2020; 130:901-902. [DOI: 10.20452/pamw.15509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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50
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Yamamiya A, Irisawa A, Tsuchida K, Izawa N, Tominaga K, Goda K. Endoscopic narrow-band imaging for the diagnosis of intraductal papillary mucinous neoplasm with duodenal fistula. Pol Arch Intern Med 2020. [DOI: 10.20452/pamw.15336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
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