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Prognosis of cancer with branch duct type IPMN of the pancreas

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World Journal of Gastroenterology 2010年第15期16卷 1890-1895页

作者： Nobuhito Ikeuchi Takao Itoi Atsushi Sofuni Fumihide Itokawa Takayoshi Tsuchiya toshio kurihara Kentaro Ishii Shujiro Tsuji Junko Umeda Fuminori Moriyasu Akihiko Tsuchida Kazuhiko Kasuya Department of Gastroenterology and Hepatology Tokyo Medical University Department of Surgery Tokyo Medical University

AIM:To examine the coexistence of metachronous and synchronous cancer in branch duct intraductal papillary mucinous neoplasms of the pancreas (IPMN).METHODS: We reviewed the records of 145 patients with branch duct IPMN between January 1991 and April 2008 and assessed the relationship between IPMN and intraor extra-pancreatic carcinoma and the outcome of ***: The mean observation period was 55.9 ± 45.3 mo. Among the 145 patients, the frequency of extra-pancreatic cancer was 29.0%. The frequency of gastric cancer, colon cancer, breast cancer, and pan-creatic cancer were 25.5%, 15.7%, 13.7%, and 9.8%, respectively. Twenty (13.8%) of the patients died. The cause of death was extra-pancreatic carcinoma in 40%,pancreatic cancer in 25%, IPMN per se in 20%, and benign disease in 15% of the ***: The prognosis for IPMN depends not on the IPMN per se, but on the presence of intraor extra-pancreatic cancer.

关键词： Intraductal papillary mucinous neoplasms of the pancreas Long-term follow-up Extra-pancreatic cancer Pancreatic cancer Prognosis

Endoscopic resection of carcinoid of the minor duodenalpapilla

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World Journal of Gastroenterology 2007年第27期13卷 3763-3764页

作者： Takao Itoi Atsushi Sofuni Fumihide Itokawa Takayoshi Tsuchiya toshio kurihara Fuminori Moriyasu Department of Gastroenterology and Hepatology Tokyo Medical University Tokyo Japan

We encountered a 65-year-old man with a carcinoid tumor of the minor duodenal papilla. Since he had liver cirrhosis and completely refused surgery, we performed an endoscopic snare papillectomy. The papillectomy was performed successfully without procedure-related complication. The specimens revealed a carcinoid tumor showing that the margin of the tumor was positive. One week later, upper GI endoscopy was performed and the biopsy specimens obtained from base of ulcer showed no neoplastic cells. We performed a duodenoscopy and CT 3, 6 and 18 mo later, and there was no macroscopic or microscopic evidence of tumor recurrence after more than 4 years.

关键词： Endoscopic papillectomy Carcinoid tumor Minor duodenal papilla Papilla of Vater tumor Duodenal papilla

Safety trial of high-intensity focused ultrasound therapy for pancreatic cancer

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World Journal of Gastroenterology 2014年第28期20卷 9570-9577页

作者： Atsushi Sofuni Fuminori Moriyasu Takatomo Sano Fumihide Itokawa Takayoshi Tsuchiya toshio kurihara Kentaro Ishii Syujiro Tsuji Nobuhito Ikeuchi Reina Tanaka Junko Umeda Ryosuke Tonozuka Mitsuyoshi Honjo Shuntaro Mukai Mitsuru Fujita Takao Itoi Department of Gastroenterology and Hepatology Tokyo Medical University

AIM:To evaluate the safety and clinical application of high-intensity focused ultrasound(HIFU)therapy for unresectable pancreatic cancer(PC).METHODS:Thirty PC patients(16 cases in stage III and 14 cases in stage IV)with visualized pancreatic tumors were admitted for HIFU therapy as an optional local therapy in addition to systemic chemotherapy or *** consent was *** study began at the end of 2008 and was approved by the ethics committee of our hospital[Institutional Review Board(IRB):890].The HIFU device used was the FEP-BY02(Yuande Bio-Medical Engineering,Beijing,China).RESULTS:The mean tumor size after HIFU therapy changed to 30.9±1.7 mm from 31.7±1.7 mm at *** were no significant changes in tumor size,mean number of treatment sessions(2.7±0.1 mm),or mean total treatment time(2.4±0.1 h).The rate of symptom relief effect was 66.7%.The effectiveness of primary lesion treatment was as follows:complete response,0;partial response,4;stable disease,22;progressive disease,*** after HIFU therapy included 2 operations,24 chemotherapy treatments,and 4 best supportive care *** events occurred in 10%of cases,namely pseudocyst formation in 2 cases and mild pancreatitis development in ***,no severe adverse events occurred in this ***:We suggest that HIFU therapy is safe and has the potential to be a new method of combination therapy for PC.

关键词： High-intensity focused ultrasound Pancreatic cancer Safety trial Tumor ablation Ultrasonography

Usefulness of contrast-enhanced ultrasonography in determining treatment efficacy and outcome after pancreatic cancer chemotherapy

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World Journal of Gastroenterology 2008年第47期14卷 7183-7191页

作者： Atsushi Sofuni Takao Itoi Fumihide Itokawa Takayoshi Tsuchiya toshio kurihara Kentaro Ishii Syujiro Tsuji Nobuhito Ikeuchi Fuminori Moriyasu Department of Gastroenterology and Hepatology Tokyo Medical UniversityTokyo 160-0023Japan

AIM:To investigate if contrast-enhanced ultrasonography(CE-US) is useful for determining treatment efficacy and outcome in the early stages of pancreatic cancer chemotherapy by assessing changes in intratumor hemodynamics using CE-US with a contrast ***:The subjects were 34 patients with unresectable advanced pancreatic cancer treated by ***-US was assessed after every treatment(course) completion under the same conditions,and patients were divided into two groups according to the intratumor enhancement pattern:Vascular rich(R) group and vascular poor(P) ***:After the second course of treatment,R group in intratumor hemodynamics had 18 patients,and P group had 16 *** reduction rates of serum CA19-9 level after chemotherapy which decreased to half or less of the baseline level were 2/15(0.1%) in P group,but 11/16(69%) in R group(P = 0.006).When the mean number of courses of chemotherapy and outcome were compared,P group had a mean number of courses of 4.9(R group,10.2) and mean survival time(MST) of 246 d(R group,402 d),showing that outcome was significantly better in R group(P=0.006).CONCLUSION:CE-US revealed that the change in intratumor blood flow correlated with both serum CA19-9 level and *** with serum CA19-9 that decreased to less than half the baseline level,and patients with an abundant intratumor blood flow,had a significantly better ***,CE-US is potentially useful for evaluating treatment efficacy and outcome in the early stages of pancreatic cancer chemotherapy.

关键词： Pancreatic cancer Chemotherapy Gemcitabine Contrast-enhanced ultrasonography Outcome

Evaluation of the Palatability of Dry Syrups and the Bitterness Intensities of Dry Syrups Mixed with Various Beverages

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Pharmacology & Pharmacy 2021年第2期12卷 43-54页

作者： toshio kurihara Honami Kojima Miyako Yoshida Mizuho Oshio Rino Kunikata Haruka Nishikawa Takahiro Uchida Faculty of Pharmaceutical Sciences Mukogawa Women’s University Nishinomiya Japan

The purpose of this study was to evaluate the palatability of dry syrups for pediatric use by human gustatory sensation testing and the artificial taste sensor. The bitterness intensities of dry syrups mixed with various beverages were also evaluated using the taste sensor. Twenty dry-syrup formulations of antibacterial and anti-allergic drugs containing bitter active ingredients, frequently used in pediatric medicine in Japan, were selected for testing. The main factors influencing palatability were determined by factor analysis of data from human gustatory sensation testing using the semantic differential method. It was shown that the bitterness intensity of dry syrups in water could be predicted by the artificial taste sensor. The influence of different beverages (orange juice, milk or cocoa) mixed with the dry syrups was evaluated using the artificial taste sensor. Taste and texture were found to be the principal factors influencing the palatability of dry syrups. While the bitterness intensities of some dry syrups were increased by mixing with orange juice, the bitterness intensities of most dry syrups were decreased by mixing with milk or cocoa. This suggests that one or more constituents of milk or cocoa may reduce the bitterness intensities of dry syrups.

关键词： Palatability Semantic Differential Method Dry Syrup Taste Sensor

Endoscopic ultrasound-guided choledochoduodenostomy in patients with failed endoscopic retrograde cholangiopancreatography

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World Journal of Gastroenterology 2008年第39期14卷 6078-6082页

作者： Takao Itoi Fumihide Itokawa Atsushi Sofuni toshio kurihara Takayoshi Tsuchiya Kentaro Ishii Shujiro Tsuji Nobuhito Ikeuchi Fuminori Moriyasu Department of Gastroenterology and Hepatology Tokyo Medical University HospitalTokyo 160-0023Japan

Endoscopic ultrasonography （EUS）-guided biliary drainage was performed for treatment of patients who have obstructive jaundice in cases of failed endoscopic retrograde cholangiopancreatography （ERCP）. In the present study, we introduced the feasibility and outcome of EUS-guided choledochoduodenostomy in four patients who failed in ERCR We performed the procedure in 2 papilla of Vater, including one resectable case, and 2 cases of cancer of the head of pancreas. Using a curved linear array echoendoscope, a 19 G needle or a needle knife was punctured transduodenally into the bile duct under EUS visualization. Using a biliary catheter for dilation, or papillary balloon dilator, a 7-Fr plastic stent was inserted through the choledochoduodenostomy site into the extrahepatic bile duct. In 3 （75%） of 4 cases, an indwelling plastic stent was placed, and in one case in which the stent could not be advanced into the bile duct, a naso-biliary drainage tube was placed instead. In all cases, the obstructive jaundice rapidly improved after the procedure. Focal peritonitis and bleeding not requiring blood transfusion was seen in one case. In this case, pancreatoduodenectomy was performed and the surgical findings revealed severe adhesion around the choledochoduodenostomy site. Although further studies and development of devices are mandatory, EUS-guided choledochoduodenostomy appears to be an effective alternative to ERCP in selected cases.

关键词： Endoscopic ultrasonography-guided fine needle aspiration Biliary drainage Endoscopic retrograde cholangiopancreatography

Endoscopic removal and trimming of distal self-expandable metallic biliary stents

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World Journal of Gastroenterology 2011年第21期17卷 2652-2657页

作者： Kentaro Ishii Takao Itoi Atsushi Sofuni Fumihide Itokawa Takayoshi Tsuchiya toshio kurihara Shujiro Tsuji Nobuhito Ikeuchi Junko Umeda Fuminori Moriyasu Akihiko Tsuchida Department of Gastroenterology and Hepatology Tokyo Medical University Third Department of Surgery Tokyo Medical University

AIM:To evaluate the efficacy and safety of endoscopic removal and trimming of self-expandable metallic stents(SEMS).METHODS:All SEMS had been placed for distal biliary ***-seven endoscopic procedures were performed in 19 patients in whom SEMS(one uncovered and 18 covered) removal had been attempted,and 8 patients in whom stent trimming using argon plasma coagulation(APC) had been attempted at Tokyo Medical University *** APC settings were:voltage 60-80 W and gas flow at 1.5 L/***:The mean stent indwelling period for all patients in whom stent removal had been attempted was 113.7 ± 77.6 d(range,8-280 d).Of the 19 patients in whom removal of the SEMS had been attempted,the procedure was successful in 14(73.7%) without procedure-related adverse *** indwelling period in the stent removable group was shorter than that in the unremovable group(94.9 ± 71.5 d vs 166.2 ± 76.2 d,P = 0.08).Stent trimming was successful for all patients with one minor adverse event consisting of self-limited *** time ranged from 11 to 16 ***:Although further investigations on larger numbers of cases are necessary to accumulate evidence,the present data suggested that stent removal and stent trimming is feasible and effective for stent-related complications.

关键词： Self-expandable metallic stent Endoscopic biliary stenting Endoscopic stent removal Endoscopic stent trimming

Real-time virtual sonography visualization and its clinical application in biliopancreatic disease

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World Journal of Gastroenterology 2013年第42期19卷 7419-7425页

作者： Atsushi Sofuni Takao Itoi Fumihide Itokawa Takayoshi Tsuchiya toshio kurihara Kentaro Ishii Syujiro Tsuji Nobuhito Ikeuchi Reina Tanaka Junko Umeda Ryosuke Tonozuka Mitsuyoshi Honjo Shuntaro Mukai Fuminori Moriyasu Department of Gastroenterology and Hepatology Tokyo Medical UniversityTokyo 160-0023Japan

AIM:To evaluate the usefulness of real-time virtual sonography(RVS)in biliary and pancreatic ***:This study included 15 patients with biliary and pancreatic *** can be used to observe an ultrasound image in real time by merging the ultrasound image with a multiplanar reconstruction computed tomography(CT)image,using pre-scanned CT volume *** ultrasound used was EUB-8500with a convex probe *** RVS images were evaluated based on 3 levels,namely,excellent,good and poor,by the displacement in ***:By combining the objectivity of CT with free scanning using RVS,it was possible to easily interpret the relationship between lesions and the surrounding organs as well as the position of vascular *** resulting evaluation levels of the RVS images were12 excellent(pancreatic cancer,bile duct cancer,cholecystolithiasis and cholangiocellular carcinoma)and 3 good(pancreatic cancer and gallbladder cancer).Compared with conventional B-mode ultrasonography and CT,RVS images achieved a rate of 80%superior visualization and 20%better ***:RVS has potential usefulness in objective visualization and diagnosis in the field of biliary and pancreatic diseases.

关键词： Biliary and pancreatic disease Computed tomography-multiplanar reconstruction image Navigation Real-time ultrasound image Real-time virtual sonography

Diagnostic and therapeutic single-operator cholangiopancreatoscopy in biliopancreatic diseases:Prospective multicenter study in Japan

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World Journal of Gastroenterology 2016年第5期22卷 1891-1901页

作者： toshio kurihara Ichiro Yasuda Hiroyuki Isayama toshio Tsuyuguchi Taketo Yamaguchi Ken Kawabe Yoshinobu Okabe Keiji Hanada Tsuyoshi Hayashi Takao Ohtsuka Syuhei Oana Hiroshi Kawakami Yoshinori Igarashi Kazuya Matsumoto Kiichi Tamada Shomei Ryozawa Hiroki Kawashima Yutaka Okamoto Iruru Maetani Hiroyuki Inoue Takao Itoi Department of Gastroenterology and Hepatology Tokyo Medical University6-7-1 NishishinjukuShinjuku-kuTokyo 160-0023Japan First Department of Internal Medicine Gifu University HospitalGifu 501-1194Japan Department of Gastroenterology Graduate School of MedicineThe University of TokyoTokyo 113-8655Japan Department of Gastroenterology and Nephrology Chiba University Graduate School of MedicineChiba 260-8677Japan Department of Gastroenterology Chiba Cancer CenterFunabashi Municipal HospitalChiba 260-8717Japan Department of Gastroenterology Clinical Research InstituteNational Hospital OrganizationKyushu Medical CenterFukuoka 810-8563Japan Division of Gastroenterology Department of MedicineKurume University School of MedicineKurume 830-0011Japan Department of Gastroenterology Onomichi General HospitalOnomichi 722-8508Japan Department of Medical Oncology and Hematology Sapporo Medical University School of MedicineSapporo 060-8543Japan Department of Surgery and Oncology Graduate School of Medical SciencesKyushu UniversityFukuoka 812-8582Japan Department of Gastroenterology Iwate Medical UniversityMorioka 020-0023Japan Department of Gastroenterology and Hepatology Graduate School of MedicineHokkaido UniversitySapporo 060-8648Japan Division of Gastroenterology and Hepatology Omori Medical CenterToho UniversityTokyo 143-0015Japan Department of Gastroenterology Tottori University HospitalYonago 683-8504Japan Department of Internal Medicine Division of GastroenterologyJichi Medical UniversityShimotsuke 329-0498Japan Department of Gastroenterology Digestive Disease CenterShowa UniversityNorthern Yokohama HospitalYokohama 224-0032Japan Department of Gastroenterology and Hepatology Graduate School of MedicineNagoya UniversityNagoya 466-8550Japan Department of Gastroenterology Mutsu General HospitalMutsu 035-0071Japan Division of Gastroenterology Department of Internal MedicineOhashi Medical CenterToho UniversityTokyo 153-0044Japan Department of Gastroenterology Mie University

AIM: To assess the utility and safety of single-operator cholangiopancreatoscopy(SOCPS) using the Spy Glass system in widespread clinical application for biliary and pancreatic ***: This study was a prospective case series conducted in 20 referral centers in Japan. There were 148 patients who underwent SOCPS; 124 for biliary diseases and 24 for pancreatic diseases. The attempted interventions were SOCPS examination, SOCPS-directed tissue sampling, and therapy for stone removal, among others. The main outcomes were related to the procedure success rate in terms of visualizing the target lesions, SOCPS-directed adequate tissue sampling, and complete stone removal. RESULTS: A total of 148 patients were enrolled for the diagnosis of indeterminate biliary and pancreatic lesions or treatment of biliary and pancreatic disease. The overall procedure success rate of visualizing the target lesions was 91.2%(135/148). The overall procedural success rates of visualizing the target lesions of diagnostic SOCPS in the bile duct and pancreatic duct were 95.5%(84/89) and 88.2%(15/17), respectively. Diagnosis: the overall adequate tissue for histologic examination was secured in 81.4% of the 86 patients who underwent biopsy under SOCPS(bile duct, 60/75, 80.0%; pancreatic duct, 10/11, 90.9%). The accuracy of histologic diagnosis using SOCPS-directed biopsies in indeterminate bile duct lesions was 70.7%(53/75). In the pancreatic duct, the accuracy of SOCPS visual impression of intraductal papillary mucinous neoplasm was 87.5%(14/16). Stone therapy: complete biliary and pancreatic stone clearance combined with SOCPS-directed stone therapy using electrohydraulic lithotripsy or laser lithotripsy was achieved in 74.2%(23/31) and 42.9%(3/7) of the patients, respectively. Others: SOCPS using the Spy Glass system was used in cannulation of the cystic duct in two patients and for passing across the obstructed self-expandable metallic stent for a malignant biliary stricture in two

关键词： Cholangioscopy Endoscopic retrogradecholangiopancreatography Pancreatoscopy Singleoperator SpyGlass