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Clinical significance of hypoechoic submandibular gland lesions in type 1 autoimmune pancreatitis

World Journal of Gastroenterology 2017年第18期23卷 3295-3300页

作者： Shinichi Takano Mitsuharu Fukasawa Makoto Kadokura Hiroko Shindo ei takahashi Sumio Hirose Yoshimitsu Fukasawa Satoshi Kawakami Tadashi Sato Nobuyuki Enomoto First Department of Internal Medicine Faculty of Medicine University of Yamanashi

To assess the role of ultrasonography of submandibular glands (SGs) in the diagnosis of type 1 autoimmune pancreatitis (AIP).METHODSThirty-seven patients who were definitively diagnosed with type 1 AIP according to the international consensus diagnostic criteria (ICDC) for AIP at our institution between December 1990 and April 2016 were retrospectively reviewed. Findings by physical examination, ultrasonography, and scintigraphy of SGs were analyzed to reach a diagnosis based on the ICDC for AIP. The efficacy of corticosteroid treatment in the resolution of hypoechoic lesions in SGs was also evaluated by assessment with ultrasonography before and after treatment in 18 *** sensitivity of multiple hypoechoic lesions in SGs by ultrasonography for the diagnosis of sialadenitis in type 1 AIP (84%) was higher than that of physical examination (46%), scintigraphy (28%), and SGs thickness (49%). Ultrasonographic evidence of hypoechoic lesions in SGs improved the definitive diagnosis of sialadenitis and type 1 AIP by the ICDC criteria in 11 (30%) and 2 (5.4%) cases, respectively. Multiple hypoechoic lesions in SGs were resolved or disappear by corticosteroid administration in 14 of 16 cases with hypoechoic lesions in SGs, whereas the ultrasonographic findings in the remaining 2 cases with hypoechoic lesions in SGs and the 2 cases with homogenous SG parenchyma remained unchanged after corticosteroid *** ultrasonography to detect multiple hypoechoic lesions might be useful for type 1 AIP diagnosis by improving diagnostic accuracy together with the ICDC sialadenitis criteria.

关键词： Autoimmune pancreatitis Ultrasonography Submandibular glands International consensus diagnostic criteria Sialadenitis

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Risk factors for perforation during endoscopic retrograde cholangiopancreatography in post-reconstruction intestinal tract

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World Journal of Clinical Cases 2019年第1期7卷 10-18页

作者： Shinichi Takano Mitsuharu Fukasawa Hiroko Shindo ei takahashi Sumio Hirose Yoshimitsu Fukasawa Satoshi Kawakami Hiroshi Hayakawa Hiroshi Yokomichi Makoto Kadokura Tadashi Sato Nobuyuki Enomoto First Department of Internal Medicine Faculty of Medicine University of Yamanashi Yamanashi 409-3898 Japan Department of Health Sciences Interdisciplinary Graduate School and Engineering University of Yamanashi Yamanashi 409-3898 Japan

BACKGROUND Endoscopic retrograde cholangiopancreatography(ERCP) in patients with surgically altered anatomy has been a major challenge to gastrointestinal endoscopists with low success rates for reaching the target site as well as high complication rates. The knowledge of ERCP-related risk factors is important for reducing unexpected *** To identify ERCP-related risk factors for perforation in patients with surgically altered *** The medical records of 187 patients with surgically altered anatomy who underwent ERCP at our institution between April 2009 and December 2017 were retrospectively reviewed. An analysis of patient data, including age, sex, type of reconstruction, cause of surgery, aim of ERCP, success rate of reaching target site,success rate of procedure, adverse events, type of scope, time to reach the target site, and duration of procedure, was performed. In patients with Billroth-Ⅱ reconstruction, additional potential risk factors were the shape of the inserted scope and whether the anastomosis was antecolic or *** All patients(n = 187) had surgical anatomy, such as Billroth-Ⅰ(n = 22), Billroth-Ⅱ(n = 33), Roux-en-Y(n = 54), Child, or Whipple reconstruction(n = 75). ERCP was performed for biliary drainage in 43 cases(23%), stone removal in 29 cases(16%),and stricture dilation of anastomosis in 59 cases(32%). The scope was unable to reach the target site in 17 cases(9%), and an aimed procedure could not be accomplished in 54 cases(29%). Adverse events were pancreatitis(3%),hyperamylasemia(10%), cholangitis(6%), cholestasis(4%), excessive sedation(1%), perforation(2%), and others(3%). Perforation occurred in three cases, all of which were in patients with Billroth-Ⅱ reconstruction; in these patients, further analysis revealed loop-shaped insertion of the scope to be a significant risk for perforation(P = 0.01).CONCLUSION Risk factors for perforation during ERCP in patients with surgically altered anatomy were Billro

关键词： Surgically altered anatomy Billroth-Ⅱ Endoscopic retrograde cholangiopancreatography Perforation

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Biliary drainage strategy of unresectable malignant hilar strictures by computed tomography volumetry

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World Journal of Gastroenterology 2015年第16期21卷 4946-4953页

作者： ei takahashi Mitsuharu Fukasawa Tadashi Sato Shinichi Takano Makoto Kadokura Hiroko Shindo Yudai Yokota Nobuyuki Enomoto First Department of Internal Medicine Faculty of MedicineUniversity of Yamanashi

AIM:To identify criteria for predicting successful drainage of unresectable malignant hilar biliary strictures(UMHBS) because no ideal strategy currently ***:We examined 78 patients with UMHBS who underwent biliary *** was considered effective when the serum bilirubin level decreased by ≥ 50% from the value before stent placement within 2 wk after drainage, without additional *** that occurred within 7 d after stent placement were considered as early *** drainage, the liver volume of each section(lateral and medial sections of the left liver and anterior and posterior sections of the right liver) was measured using computed tomography(CT) *** liver volume was calculated based on the volume of each liver section and the type of bile duct stricture(according to the Bismuth classification).Tumor volume, which was calculated by using CT volumetry, was excluded from the volume of each *** operating characteristic(ROC) analysis was performed to identify the optimal cutoff values for drained liver *** addition, factors associated with the effectiveness of drainage and early complications were ***:Multivariate analysis showed that drained liver volume [odds ratio(OR) = 2.92, 95%CI:1.648-5.197; P < 0.001] and impaired liver function(with decompensated liver cirrhosis)(OR = 0.06, 95%CI:0.009-0.426; P = 0.005) were independent factors contributing to the effectiveness of *** analysis for effective drainage showed cutoff values of 33% of liver volume for patients with preserved liver function(with normal liver or compensated livercirrhosis)and 50%for patients with impaired liver function(with decompensated liver cirrhosis).The sensitivity and specificity of these cutoff values were82%and 80%for preserved liver function,and 100%and 67%for impaired liver function,*** patients who met these criteria,the rate of effective drainage among those with

关键词： Biliary drainage Computed tomographyvolumetry Hilar biliary stricture Cholangiocarcinoma Liver function Cholangitis

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