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Sato A, Watanabe S, Iseki M, Yamada Y, Kobayashi R, Furuya M, Arai K, Ohshina E, Tashiro Y, Nozaka T, Matsuoka M, Yauchi M, Kobayashi K, Matsumoto T, Furumoto Y, Asano T, Azuma S. Anticoagulation against portal vein thrombosis reduces mortality and liver cirrhosis-related complications: A propensity score-matched study. Hepatol Res 2023; 53:1096-1104. [PMID: 37435880 DOI: 10.1111/hepr.13942] [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: 04/30/2023] [Revised: 06/20/2023] [Accepted: 07/06/2023] [Indexed: 07/13/2023]
Abstract
AIM Portal vein thrombosis (PVT) is one of the common complications of liver cirrhosis. Although anticoagulation contributes to thrombus resolution and is considered the first-choice treatment, its impact on patients' prognosis is still controversial. This study aimed to clarify the benefit of anticoagulation on mortality, liver function, and the incidence of liver cirrhosis-related complications in cirrhotic PVT patients. METHODS We conducted a multicenter retrospective review in which we included 78 eligible patients with PVT out of 439. After propensity score matching, 21 cirrhotic PVT patients were included in each one of the untreated control and anticoagulation groups. RESULTS Overall survival was significantly improved in the anticoagulation group compared with the control group (p = 0.041), along with PVT size reduction (53.3% vs. 108.2%, p = 0.009). At the time of CT follow-up, the anticoagulation group showed a lower ALBI score (p = 0.037) and its prevalence of massive ascites was significantly lower (p = 0.043) compared with the control group. The incidence of overt encephalopathy was also lower in the anticoagulation group (p = 0.041). The cumulative incidence of bleeding events did not differ significantly between the two groups. CONCLUSIONS Anticoagulation improves the survival of patients with cirrhotic PVT. Preserved liver function and reduced risks of cirrhosis-related complications under the treatment may have contributed to a better prognosis. Given its efficacy and safety, anticoagulation is worth initiating in patients with PVT.
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Affiliation(s)
- Ayako Sato
- Department of Gastroenterology and Hepatology, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | - Sho Watanabe
- Department of Gastroenterology and Hepatology, Soka Municipal Hospital, Saitama, Japan
| | - Mari Iseki
- Department of Gastroenterology and Hepatology, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | - Yurina Yamada
- Department of Gastroenterology and Hepatology, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | - Ryohei Kobayashi
- Department of Gastroenterology and Hepatology, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | - Makoto Furuya
- Department of Gastroenterology and Hepatology, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | - Katsuhiro Arai
- Department of Gastroenterology and Hepatology, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | - Eri Ohshina
- Department of Gastroenterology and Hepatology, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | - Yoshihiro Tashiro
- Department of Gastroenterology and Hepatology, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | - Takahito Nozaka
- Department of Gastroenterology and Hepatology, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | - Mana Matsuoka
- Department of Gastroenterology and Hepatology, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | - Masato Yauchi
- Department of Gastroenterology and Hepatology, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | - Katsumasa Kobayashi
- Department of Gastroenterology and Hepatology, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | - Taichi Matsumoto
- Department of Gastroenterology and Hepatology, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | - Yohei Furumoto
- Department of Gastroenterology and Hepatology, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | - Toru Asano
- Department of Gastroenterology and Hepatology, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | - Seishin Azuma
- Department of Gastroenterology and Hepatology, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
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Okura Y, Kobayashi K, Yamada Y, Furuya M, Kitano N, Oshina E, Matsuoka M, Nozaka T, Tashiro Y, Sato A, Yauchi M, Matsumoto T, Furumoto Y, Asano T, Azuma S. A case of refractory immune checkpoint inhibitor-induced colitis with Clostridioides difficile infection. DEN Open 2022; 3:e176. [PMID: 36262219 PMCID: PMC9576114 DOI: 10.1002/deo2.176] [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] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 09/06/2022] [Accepted: 09/24/2022] [Indexed: 11/05/2022]
Abstract
The clinical symptoms of an immune checkpoint inhibitor (ICI)‐induced colitis are similar to those of ulcerative colitis. ICI‐induced colitis, like ulcerative colitis, may be complicated by other colitis, such as Clostridioides difficile infection (CDI). A 72‐year‐old man was admitted because of watery and bloody stools 10 times a day after three courses of nivolumab (antibodies against programmed death 1) and ipilimumab (cytotoxic T‐lymphocyte‐associated antigen‐4) for stage IV renal cell carcinoma. Colonoscopy revealed erythema and multiple erosions in the colon. Histopathological examination of colonic mucosa revealed diffuse inflammatory cell infiltration and apoptosis. The initial cytomegalovirus antigen test and C. difficile detection assay results were negative. Based on these findings, we diagnosed the patient with ICI‐induced colitis and discontinued ICI therapy. The symptoms did not improve despite the administration of Prednisolone and infliximab. A repeat colonoscopy revealed a new appearance of pseudomembranes from the sigmoid colon to the rectum one month after the start of these treatments. At this point, the patient tested positive for C. difficile. With treatment with vancomycin for CDI, the abdominal symptoms gradually decreased. Nivolumab alone was cautiously restarted. However, no colitis recurrence and further tumor reduction were observed. Here, we report our experience of a case of refractory ICI‐induced colitis complicated by CDI. ICI‐induced colitis may be complicated by CDI and should be carefully treated with repeated CDI testing if refractory to treatment. We believe that our observation will provide helpful information for determining an appropriate treatment strategy for ICI‐induced colitis.
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Affiliation(s)
- Yukito Okura
- Department of GastroenterologyGyotoku General HospitalChibaJapan,Department of GastroenterologyTokyo Metropolitan Bokutoh HospitalTokyoJapan
| | | | - Yurina Yamada
- Department of GastroenterologyTokyo Metropolitan Bokutoh HospitalTokyoJapan
| | - Makoto Furuya
- Department of GastroenterologyTokyo Metropolitan Bokutoh HospitalTokyoJapan
| | - Naoki Kitano
- Department of GastroenterologyTokyo Metropolitan Bokutoh HospitalTokyoJapan
| | - Eri Oshina
- Department of GastroenterologyTokyo Metropolitan Bokutoh HospitalTokyoJapan
| | - Mana Matsuoka
- Department of GastroenterologyTokyo Metropolitan Bokutoh HospitalTokyoJapan
| | - Takahito Nozaka
- Department of GastroenterologyTokyo Metropolitan Bokutoh HospitalTokyoJapan
| | - Yoshihiro Tashiro
- Department of GastroenterologyTokyo Metropolitan Bokutoh HospitalTokyoJapan
| | - Ayako Sato
- Department of GastroenterologyTokyo Metropolitan Bokutoh HospitalTokyoJapan
| | - Masato Yauchi
- Department of GastroenterologyTokyo Metropolitan Bokutoh HospitalTokyoJapan
| | - Taichi Matsumoto
- Department of GastroenterologyTokyo Metropolitan Bokutoh HospitalTokyoJapan
| | - Yohei Furumoto
- Department of GastroenterologyTokyo Metropolitan Bokutoh HospitalTokyoJapan
| | - Toru Asano
- Department of GastroenterologyTokyo Metropolitan Bokutoh HospitalTokyoJapan
| | - Seishin Azuma
- Department of GastroenterologyTokyo Metropolitan Bokutoh HospitalTokyoJapan
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Furumoto Y, Araki A, Matsumoto T, Nozaka T, Yauchi M, Kobayashi K, Nitta S, Okada E. Experience of disruption of capsule endoscopy after prolonged retention. DEN Open 2022; 2:e57. [PMID: 35310753 PMCID: PMC8828219 DOI: 10.1002/deo2.57] [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] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 08/15/2021] [Accepted: 08/22/2021] [Indexed: 06/14/2023]
Abstract
Capsule endoscopy is an effective tool for evaluating small bowel diseases. Capsule retention is a complication of capsule endoscopy, but capsule disruption after retention has not been thoroughly studied. Only a few cases of capsule disruption have been reported. We report a case of capsule disruption after prolonged retention. A 73-year-old woman underwent capsule endoscopy for the evaluation of anemia. One week later, capsule retention was observed on radiography. Capsule removal was advised, but she refused because she did not have any symptoms. After 20 months, computed tomography revealed disrupted capsule fragments. Capsule removal was strongly recommended, and the patient agreed. All disrupted capsule fragments were removed using double-balloon endoscopy without complications. Intestinal perforation had been prevented by removing the disrupted capsule before the battery fluid leaked into the intestinal tract. Capsule retention, documented by imaging, should be addressed by removing the retained capsule immediately before capsule disruption occurs.
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Affiliation(s)
- Yohei Furumoto
- Department of gastroenterologyTokyo Metropolitan Bokutoh HospitalTokyoJapan
| | - Akihiro Araki
- Department of Health Management CenterToranomon HospitalTokyoJapan
| | - Taichi Matsumoto
- Department of gastroenterologyTokyo Metropolitan Bokutoh HospitalTokyoJapan
| | - Takahito Nozaka
- Department of gastroenterologyTokyo Metropolitan Bokutoh HospitalTokyoJapan
| | - Masato Yauchi
- Department of gastroenterologyTokyo Metropolitan Bokutoh HospitalTokyoJapan
| | | | - Sayuri Nitta
- Department of gastroenterology and HepatologyTokyo Medical and Dental UniversityTokyoJapan
| | - Eriko Okada
- Department of gastroenterology and HepatologyTokyo Medical and Dental UniversityTokyoJapan
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Matsuoka M, Kobayashi K, Okura Y, Mochida T, Nozaka T, Sato A, Yauchi M, Matsumoto T, Furumoto Y, Horiuchi T, Asano T. Endoscopic Closure of an Acute Duodenal Perforation Occurring during Endoscopic Ultrasound Using Endoclips and Polyglycolic Acid Sheets with Fibrin Glue. Case Rep Gastroenterol 2021; 15:253-261. [PMID: 33790712 PMCID: PMC7989665 DOI: 10.1159/000512474] [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: 09/16/2020] [Accepted: 10/16/2020] [Indexed: 11/19/2022] Open
Abstract
Acute duodenal perforation during endoscopic ultrasound (EUS) is a serious complication. The conventional endoscopic treatment for duodenal perforations such as endoscopic clipping is unsatisfactory; recently, the effectiveness of over-the-scope clipping (OTSC) has been reported. A 91-year-old woman was referred to our hospital with the chief complaint of jaundice. Contrast-enhanced computed tomography showed a 2-cm mass in the pancreatic head; we planned EUS-guided fine-needle aspiration. During exploration for a puncture route from the duodenal bulb using a linear echoendoscope under carbon dioxide insufflation, the duodenal lumen was suddenly filled with blood. A perforation <15 mm was identified in the superior duodenal horn. We attempted an endoscopic closure with multiple endoclips but could not completely close the perforation site. Strips of bioabsorbable polyglycolic acid (PGA) sheets were placed over the gaps between the endoclips with biopsy forceps and fixed in place with fibrin glue, completely covering the perforation site. Two days after the procedure, the perforation site had closed. Nine days later, endoscopic biliary stenting was performed. The patient was diagnosed with pancreatic cancer through bile cytology, and the optimal supportive care for her age was selected. Endoscopic tissue shielding with PGA sheets and fibrin glue is increasingly being reported for use during gastrointestinal endoscopic procedures. In this case, surgery was avoided due to successful endoscopic treatment using endoclips and PGA sheets with fibrin glue without OTSC. This method may be useful for repairing acute duodenal perforations during EUS and should therefore be known to pancreatobiliary endoscopists.
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Affiliation(s)
- Mana Matsuoka
- Department of Gastroenterology, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | - Katsumasa Kobayashi
- Department of Gastroenterology, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | - Yukito Okura
- Department of Gastroenterology, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | - Tomohiro Mochida
- Department of Gastroenterology, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | - Takahito Nozaka
- Department of Gastroenterology, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | - Ayako Sato
- Department of Gastroenterology, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | - Masato Yauchi
- Department of Gastroenterology, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | - Taichi Matsumoto
- Department of Gastroenterology, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | - Yohei Furumoto
- Department of Gastroenterology, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | - Takao Horiuchi
- Department of Gastroenterology, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | - Toru Asano
- Department of Gastroenterology, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
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Suzaki K, Kobayashi K, Matsuoka M, Okura Y, Nozaka T, Yauchi M, Watabe T, Matsumoto T, Furumoto Y, Horiuchi T, Asano T, Fujiki K. A case of cytomegalovirus esophagitis during topical steroid therapy for eosinophilic esophagitis. Clin J Gastroenterol 2020; 13:1046-1050. [PMID: 32875424 DOI: 10.1007/s12328-020-01219-z] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 08/24/2020] [Indexed: 10/23/2022]
Abstract
Systemic immune deficiency is a major cause of cytomegalovirus (CMV) esophagitis. We report a case of CMV esophagitis during topical steroid therapy of eosinophilic esophagitis (EoE) in a non-immunodeficient patient. An 85-year-old man with dysphagia was on a 6-year regimen of oral budesonide (1200 mcg daily) for EoE. He underwent right upper lobectomy and postoperative radiotherapy 25 years ago for lung squamous cell carcinoma. Esophageal cicatricial stenosis due to EoE or previous radiation therapy persisted. Esophagogastroduodenoscopy revealed ulcerating mucosa with a thick white coat originating from the fixed stenotic lesion to the oral side. Histopathological examinations revealed CMV esophagitis. All signs of CMV esophagitis rapidly disappeared after reducing the budesonide dose and initiating anti-viral treatment with ganciclovir and valganciclovir for 12 and 2 days, respectively. The patient continued topical budesonide 400 mcg daily after anti-viral therapy. The clinical course was uneventful and without CMV esophagitis recurrence. This suggests that topical steroid therapy, particularly the local stasis of steroids at stenotic lesions, may induce CMV esophagitis. This is the first report of CMV esophagitis complicating the local steroid therapy of EoE with a stenotic lesion. When EoE patients' clinical symptoms worsen with topical steroid therapy, CMV esophagitis should be considered.
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Affiliation(s)
- Ken Suzaki
- Department of Gastroenterology, Tokyo Metropolitan Bokutoh Hospital, 4-23-15, Kotobashi, Sumida-ku, Tokyo, 130-8575, Japan
| | - Katsumasa Kobayashi
- Department of Gastroenterology, Tokyo Metropolitan Bokutoh Hospital, 4-23-15, Kotobashi, Sumida-ku, Tokyo, 130-8575, Japan.
| | - Mana Matsuoka
- Department of Gastroenterology, Tokyo Metropolitan Bokutoh Hospital, 4-23-15, Kotobashi, Sumida-ku, Tokyo, 130-8575, Japan
| | - Yukito Okura
- Department of Gastroenterology, Tokyo Metropolitan Bokutoh Hospital, 4-23-15, Kotobashi, Sumida-ku, Tokyo, 130-8575, Japan
| | - Takahito Nozaka
- Department of Gastroenterology, Tokyo Metropolitan Bokutoh Hospital, 4-23-15, Kotobashi, Sumida-ku, Tokyo, 130-8575, Japan
| | - Masato Yauchi
- Department of Gastroenterology, Tokyo Metropolitan Bokutoh Hospital, 4-23-15, Kotobashi, Sumida-ku, Tokyo, 130-8575, Japan
| | - Taro Watabe
- Department of Gastroenterology, Tokyo Metropolitan Bokutoh Hospital, 4-23-15, Kotobashi, Sumida-ku, Tokyo, 130-8575, Japan
| | - Taichi Matsumoto
- Department of Gastroenterology, Tokyo Metropolitan Bokutoh Hospital, 4-23-15, Kotobashi, Sumida-ku, Tokyo, 130-8575, Japan
| | - Yohei Furumoto
- Department of Gastroenterology, Tokyo Metropolitan Bokutoh Hospital, 4-23-15, Kotobashi, Sumida-ku, Tokyo, 130-8575, Japan
| | - Takao Horiuchi
- Department of Gastroenterology, Tokyo Metropolitan Bokutoh Hospital, 4-23-15, Kotobashi, Sumida-ku, Tokyo, 130-8575, Japan
| | - Toru Asano
- Department of Gastroenterology, Tokyo Metropolitan Bokutoh Hospital, 4-23-15, Kotobashi, Sumida-ku, Tokyo, 130-8575, Japan
| | - Kazuhiko Fujiki
- Department of Gastroenterology, Tokyo Metropolitan Bokutoh Hospital, 4-23-15, Kotobashi, Sumida-ku, Tokyo, 130-8575, Japan
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Yamatani M, Yauchi M, Ohrui K, Arai H, Sasaki H. [Pneumonia in the older people]. Nihon Ronen Igakkai Zasshi 1999; 36:835-43. [PMID: 10689892 DOI: 10.3143/geriatrics.36.835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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