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Clinical benefit of radiation therapy and metallic stenting for unresectable hilar cholangiocarcinoma

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World Journal of Gastroenterology 2012年第19期18卷 2364-2370页

作者： Hiroyuki Isayama Takeshi Tsujino Yousuke Nakai Takashi Sasaki Keiichi Nakagawa Hideomi Yamashita Taku Aoki Kazuhiko Koike Department of Gastroenterology Graduate School of MedicineThe University of TokyoTokyo 113-8655Japan Department of Radiology Graduate School of MedicineThe University of TokyoTokyo 113-8655Japan Division of Hepato-Biliary-Pancreatic and Transplantation Surgery Department of SurgeryGraduate School of MedicineUniversity of TokyoTokyo 113-8655Japan

AIM:To determine the efficacy of external beam radiotherapy(EBRT),with or without intraluminal brachytherapy(ILBT),in patients with non-resected locally advanced hilar cholangiocarcinoma.METHODS:We analyzed 64 patients with locally advanced hilar cholangiocarcinoma,including 25 who underwent resection(17 curative and 8 non-curative),28 treated with radiotherapy,and 11 who received best supportive care(BSC).The radiotherapy group received EBRT(50 Gy,30 fractions),with 11 receiving an additional 24 Gy(4 fractions) ILBT by iridium-192 with remote after loading.ILBT was performed using percutaneous transhepatic biliary drainage(PTBD) route.Uncovered metallic stents(UMS) were inserted into nonresected patients with obstructive jaundice,with the exception of four patients who received percutaneous transhepatic biliary drainage only.UMS were placed endoscopically or percutaneously,depending on the initial drainage procedure.The primary endpoints were patient death or stent occlusion.Survival time of patients in the radiotherapy group was compared with that of patients in the resection and BSC groups.Stent patency was compared in the radiotherapy and BSC groups.RESULTS:No statistically significant differences in patient characteristics were found among the resection,radiotherapy,and BSC groups.Three patients in the radiotherapy group and one in the BSC group did not receive UMS insertion but received PTBD alone;cholangitis occurred after endoscopic stenting,and patients were treated with PTBD.A total of 16 patients were administered additional systemic chemotherapy(5-fluorouracil-based regimen in 9,S-1 in 6,and gemcitabine in 1).Overall survival varied significantly among groups,with median survival times of 48.7 mo in the surgery group,22.1 mo in the radiotherapy group,and 5.7 mo in the BSC group.Patients who underwent curative resection survived significantly longer than those who were not candidates for surgery(P = 0.0076).Cumulative survival in the radiotherapy group was significantly longer than in the BSC group(P =

关键词：金属支架放射治疗手术切除胆管平均存活时间肝临床癌

Anchor-wire technique for multiple plastic biliary stents to prevent stent dislocation

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World Journal of Gastroenterology 2011年第28期17卷 3366-3368页

作者： Tsuyoshi Hamada Yousuke Nakai Saburo Matsubara Hiroyuki Isayama Akiko Narita Kazuhiro Watanabe Yukihiro Koike Shigeo Matsukawa Tateo Kawase Kazuhiko Koike Department of Gastroenterology Kanto Central Hospital Department of Gastroenterology Graduate School of MedicineThe University of Tokyo

In endoscopic placement of multiple plastic biliary stents (PBSs),we sometimes experience proximal dislocation of the first PBS at the time of subsequent PBS insertion.We describe the case of a 79-year-old male with obstructive jaundice caused by cholangiocarcinoma who needed to receive multiple PBS placements for management of cholangitis.Although proximal dislocation of the first PBS was observed,we prevented the dislocation via our technique of using guidewire inserted from the distal end of the first PBS to the side hole as the anchor-wire.We could complete this technique only by inserting guidewire through the side hole of the first PBS during the process of releasing the first PBS and pulling out the guidewire and the inner sheath.It did not matter whether the anchor-wire went towards the third portion of the duodenum or the duodenal bulb.Here we introduce this "anchor-wire technique",which is useful for the prevention of PBS proximal dislocation in placing multiple PBSs.

关键词：技术支架错位胆道塑料锚 PBS 十二指肠

Clinical features of cardiac nodularity-like appearance induced by Helicobacter pylori infection

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World Journal of Gastroenterology 2020年第35期26卷 5354-5361页

作者： Toshihiro Nishizawa Kosuke Sakitani Hidekazu Suzuki Shuntaro Yoshida Yosuke Kataoka Yousuke Nakai Hirotoshi Ebinuma Takanori Kanai Osamu Toyoshima Kazuhiko Koike Department of Gastroenterology Toyoshima Endoscopy ClinicTokyo 1570066Japan Department of Gastroenterology Narita HospitalInternational University of Health and WelfareChiba 2868520Japan Department of Gastroenterology Sakitani Endoscopy ClinicChiba 2740825Japan Department of Internal Medicine Tokai University School of MedicineKanagawa 2591193Japan Department of Gastroenterology Graduate School of MedicineThe University of TokyoTokyo 1138655Japan Department of Internal Medicine Keio University School of MedicineTokyo 1608582Japan

We have previously reported that Helicobacter pylori(H.pylori)-associated nodular gastritis could occur in both the antrum and the cardia.Cardiac nodularity-like appearance(hereafter,called as cardiac nodularity)had a high predictive accuracy for the diagnosis of H.pylori infection.In the previous study,we included only the patients who were evaluated for H.pylori infection for therst time,and excluded patients with a history of eradication.Therefore,the prevalence and clinical features of cardiac nodularity remains unknown.AIM To perform this cross-sectional study to explore the characteristics of cardiac nodularity.METHODS Consecutive patients who underwent esophagogastroduodenoscopy betweenMay,2017 and August,2019 in the Toyoshima Endoscopy Clinic were enrolled in this study.We included H.pylori-negative,H.pylori-positive,and H.pylorieradicated patients,and excluded patients with unclear H.pylori status and eradication failure.H.pylori infection was diagnosed according to serum anti-H.pylori antibody and the urea breath test or histology.Cardiac nodularity was defined as a miliary nodular appearance or the presence of scattered whitish circular small colorations within 2 cm of the esophagogastric junction.Nodularity was visualized as whitish in the narrow-band imaging mode.We collected data on the patients’baseline characteristics.RESULTS A total of 1078 patients were finally included.Among H.pylori-negative patients,cardiac nodularity and antral nodularity were recognized in 0.14%each.Among H.pylori-positive patients,cardiac nodularity and antral nodularity were recognized in 54.5%and 29.5%,respectively.Among H.pylori-eradicated patients,cardiac nodularity and antral nodularity were recognized in 4.5%and 0.6%,respectively.The frequency of cardiac nodularity was significantly higher than that of antral nodularity in H.pylori-positive and-eradicated patients.The frequencies of cardiac nodularity and antral nodularity in H.pylori-eradicated patients were significantly lower than those in H.pylori-positive patie

关键词： Cardia Nodularity Helicobacter pylori Diagnosis Gastritis

Endoscopy-based Kyoto classification score of gastritis related to pathological topography of neutrophil activity

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World Journal of Gastroenterology 2020年第34期26卷 5146-5155页

作者： Osamu Toyoshima Toshihiro Nishizawa Shuntaro Yoshida Yoshiki Sakaguchi Yousuke Nakai Hidenobu Watanabe Hidekazu Suzuki Chizu Tanikawa Koichi Matsuda Kazuhiko Koike Department of Gastroenterology Toyoshima Endoscopy ClinicTokyo 157-0066Japan Department of Gastroenterology Graduate School of MedicineThe University of TokyoTokyo 113-8655Japan Department of Gastroenterology and Hepatology International University of Health and WelfareNarita HospitalChiba 286-8520Japan Department of Endoscopy and Endoscopic Surgery Graduate School of MedicineThe University of TokyoTokyo 113-8655Japan Department of Pathology Pathology and Cytology Laboratory JapanTokyo 166-0003Japan Department of Gastroenterology and Hepatology Tokai University School of MedicineKanagawa 259-1193Japan Laboratory of Molecular Medicine Human Genome CenterInstitute of Medical ScienceThe University of TokyoTokyo 108-8639Japan Department of Computational Biology and Medical Sciences Laboratory of Clinical Genome SequencingGraduate School of Frontier SciencesThe University of TokyoTokyo 108-8639Japan

BACKGROUND Endoscopy-based Kyoto classification for gastritis and pathological topographic distribution of neutrophil infiltration are correlated with gastric cancer risk.AIM To investigate the association between Kyoto classification and the topographic distribution of neutrophil activity.METHODS Kyoto classification score,ranging from 0 to 8,consisted of atrophy,intestinal metaplasia,enlarged folds,nodularity,and diffuse redness.Neutrophil activity was scored according to the updated Sydney System using biopsy samples obtained from the greater curvature of the corpus and the antrum.The participants were divided into four categories,inactive stomach,antrumpredominant gastritis,pangastritis,and corpus-predominant gastritis,based on the topographic distribution of neutrophil activity.Effects of sex,age,body mass index,drinking habit,smoking habit,family history of gastric cancer,serum Helicobacter pylori(H.pylori)antibody,and Kyoto score on topography of neutrophil infiltration were analyzed.RESULTS A total of 327 patients(comprising 50.7%women,with an average age of 50.2 years)were enrolled in this study.H.pylori infection rate was 82.9%with a mean Kyoto score of 4.63.The Kyoto score was associated with the topographic distribution of neutrophil activity.Kyoto scores were significantly higher in the order of inactive stomach,antrum-predominant gastritis,pangastritis,and corpuspredominant gastritis(3.05,4.57,5.21,and 5.96,respectively).Each individual score of endoscopic findings(i.e.,atrophy,intestinal metaplasia,enlarged folds,nodularity,and diffuse redness)was correlated with the topographic distribution of neutrophil activity.On multivariate analysis,the Kyoto score,age,and serum H.pylori antibody were independently associated with the topographic distribution of neutrophil activity.CONCLUSION The Kyoto classification score was associated with the topographic distribution of neutrophil activity.

关键词： Kyoto classification Helicobacter pylori Neutrophil activity Updated Sydney System Gastritis Gastric cancer Endoscopy Pathology

Clinical analysis of high serum IgE in autoimmune pancreatitis

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World Journal of Gastroenterology 2010年第41期16卷 5241-5246页

作者： Kenji Hirano Minoru Tada Hiroyuki Isayama Kazumichi Kawakubo Hiroshi Yagioka Takashi Sasaki Hirofumi Kogure Yousuke Nakai Naoki Sasahira Takeshi Tsujino Nobuo Toda Kazuhiko Koike Department of Gastroenterology University of Tokyo 7-3-1 HongoBunkyo-ku Tokyo 113-8655 Japan De-partment of Gastroenterology University of Tokyo 7-3-1 HongoBunkyo-ku Tokyo 113-8655 Japan Department of Gastroenterology JR Tokyo General Hospital Tokyo 151-8528 Japan Department of Gastroenterology Mitsui Memo-rial Hospital Tokyo 101-8643 Japan

AIM: To clarify the clinical significance of high serum IgE in autoimmune pancreatitis (AIP). METHODS: Forty-two AIP patients, whose IgE was measured before steroid treatment, were analyzed. To evaluate the relationship between IgE levels and the disease activity of AIP, we examined (1) Frequency of high IgE (> 170 IU/mL) and concomitant allergic dis-eases requiring treatment; (2) Correlations between IgG, IgG4, and IgE; (3) Relationship between the presence of extrapancreatic lesions and IgE; (4) Re-lationship between clinical relapse and IgE in patients treated with steroids, and (5) Transition of IgE before and after steroid treatment. RESULTS: IgE was elevated in 36/42 (86%) patients.Concomitant allergic disease was observed in seven patients (allergic rhinitis in three, bronchial asthma in three, and urticaria in one). There were no signifi-cant correlations between IgG, IgG4, and IgE (r = -0.168 for IgG, and r = -0.188 for IgG4). There was no significant difference in IgE in the patients with and without extrapancreatic lesions (526 ± 531 IU/mL vs 819 ± 768 IU/mL, P = 0.163), with and without clini-cal relapse (457 ± 346 IU/mL vs 784 ± 786 IU/mL, P = 0.374). There was no significant difference in IgE between before and after steroid treatment (723 ± 744 IU/mL vs 673 ± 660 IU/mL, P = 0.633). CONCLUSION: Although IgE does not necessarily reflect the disease activity, IgE might be useful for the diagnosis of AIP in an inactive stage.

关键词： IgE IgG4 IgG Autoimmune pancreatitis

Treatment outcomes of chemotherapy between unresectable and recurrent biliary tract cancer

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World Journal of Gastroenterology 2014年第48期20卷 18452-18457页

作者： Takashi Sasaki Hiroyuki Isayama Yousuke Nakai Yukiko Ito Ichiro Yasuda Nobuo Toda Hiroshi Yagioka Saburo Matsubara Keiji Hanada Hiroyuki Maguchi Hideki Kamada Osamu Hasebe Tsuyoshi Mukai Yoshihiro Okabe Iruru Maetani Kazuhiko Koike Department of Gastroenterology Graduate School of Medicine the University of Tokyo Tokyo 113-8655 Japan Department of Gastroenterology Japanese Red Cross Medical Center Tokyo 150-8935 Japan First Department of Internal Medicine Gifu University Hospital Gifu 501-1194 Japan Department of Gastroenterology Mitsui MemorialHospital Tokyo 101-8643 Japan Department of Gastroenterology JR Tokyo General Hospital Tokyo 151-8528 Japan Department of Gastroenterology Kanto Central Hospital Tokyo 158-8531 Japan Center for Gastroendoscopy Onomichi General Hospital Hiroshima 722-8508 Japan Center for Gastroenterology Teine-Keijinkai Hospital Hokkaido 006-8555 Japan Department of Gastroenterology and Neurology Faculty of Medicine Kagawa University Kagawa 761-0793 Japan Department of Gastroenterology Nagano Municipal Hospital Nagano 381-8551 Japan Department of Gastroenterology Gifu Municipal Hospital Gifu 500-8513 Japan Department of Gastroenterology Osaka Red Cross Hospital Osaka 543-8555 Japan Division of Gastroenterology Department ofInternal Medicine Toho University Ohashi Medical CenterTokyo 153-8515 Japan

AIM:To evaluate the differences in the treatment outcomes between the unresectable and recurrent biliary tract cancer patients who received chemotherapy.METHODS:Patients who were treated with gemcitabine and S-1 combination therapy in the previous prospective studies were divided into groups of unresectable and recurrent cases.The tumor response,time-toprogression,overall survival,toxicity,and dose intensity were compared between these two groups.RESULTS:Response rate of the recurrent group was higher than that of the unresectable group(40.0%vs25.5%;P=0.34).Median time-to-progression of the recurrent and unresectable groups were 8.7 mo(95%CI),1.2 mo,not reached)and 5.7 mo(95%CI:4.0-7.0 mo),respectively(P=0.14).Median overall survival of the recurrent and the unresectable groups were 16.1 mo(95%CI:2.0 mo-not reached)and 9.6 mo(95%CI:7.1-11.7 mo),respectively(P=0.10).Dose intensities were significantly lower in the recurrent groups(gemcitabine:recurrent group 83.5%vs unresectable group 96.8%;P<0.01,S-1:Recurrent group 75.9%vs unresectable group 91.8%;P<0.01).Neutropenia occurred more frequently in recurrent group(recurrent group 90%vs unresectable group 55%;P=0.04).CONCLUSION:Not only the efficacy but also the toxicity and dose intensity were significantly different between unresectable and recurrent biliary tract cancer.

关键词： Biliary tract cancer Unresectable Recurrent Pooled

Short term results of endoscopic submucosal dissection in superficial esophageal squamous cell neoplasms

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World Journal of Gastrointestinal Endoscopy 2010年第2期2卷 69-74页

作者： Kouichi Nonaka Shin Arai Keiko Ishikawa Masamitsu Nakao Yousuke Nakai Osamu Togawa Koji Nagata Michio Shimizu Yutaka Sasaki Hiroto Kita Department of Gastroenterology Saitama Medical University International Medical Center Saitama 350-1298 Japan Department of Pathology Saitama Medical University International Medical Center Saitama 350-1298 Japan Department of Gastroenterology Faculty of Medicine Kumamoto University Kumamoto 860-0856 Japan

AIM: To evaluate the efficacy of endoscopic submucosal dissection for superficial esophageal squamous cell neoplasms. METHODS: Between July 2007 and March 2009, 27 consecutive superficial esophageal squamous cell neoplasms in 25 enrolled patients were treated by endoscopic submucosal dissection. The therapeutic efficacy, complications, and follow-up results were assessed. RESULTS: The mean size of the lesions was 21 ± 13 mm (range 2-55 mm); the mean size of the resection specimens was 32 ± 12 mm (range 10-70 mm). The enblock resection rate was 100% (27/27), and en block resection with tumor-free lateral/basal margins was 88.9% (24/27). Perforation occurred in 1 patient who was managed by conservative medical treatments. None of the patients developed local recurrence or distant metastasis in the follow-up period. CONCLUSION: Endoscopic submucosal dissection is applicable to superficial esophageal squamous cell neoplasms with promising results.

关键词： Endoscopic submucosal dissection Esophageal cancer Squamous cell Neoplasm Endoscopy

Kyoto classification in patients who developed multiple gastric carcinomas after Helicobacter pylori eradication

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World Journal of Gastrointestinal Endoscopy 2020年第9期12卷 276-284页

作者： Kosuke Sakitani Toshihiro Nishizawa Akira Toyoshima Shuntaro Yoshida Tatsuya Matsuno Tomoharu Yamada Masatoshi Irokawa Yoshiyuki Takahashi Yousuke Nakai Osamu Toyoshima Kazuhiko Koike Department of Gastroenterology Toyoshima Endoscopy ClinicTokyo 157-0066Japan Department of Gastroenterology Sakitani Endoscopy ClinicChiba 275-0026Japan Department of Gastroenterology International University of Health and WelfareNarita HospitalChiba286-8520Japan Department of Colorectal Surgery Japanese Red Cross Medical CenterTokyo 150-8935Japan Department of Gastroenterology Graduate School of Medicinethe University of TokyoTokyo 113-8655Japan

BACKGROUND Endoscopic Kyoto classification predicts gastric cancer risk;however,the score in the patients with primary gastric cancer after Helicobacter pylori(H.pylori)eradication therapy is unknown.AIM To elucidate the Kyoto classification score in patients with both single gastric cancer and multiple gastric cancers developed after H.pylori eradication.METHODS The endoscopist recorded the Kyoto classification at the endoscope and the Kyoto classification score at the time of the first diagnosis of gastric cancer after H.pylori eradication.The score was compared between single gastric cancer group and multiple gastric cancers group.RESULTS The Kyoto score at the time of diagnosis of 45 cases of gastric cancer after H.pylori eradication was 4.0 points in average.The score was 3.8 points in the single gastric cancer group,and 5.1 points in the multiple gastric cancers group.The multiple group had a significantly higher score than the single group(P=0.016).In the multiple gastric cancers group,all the patients(7/7)had 5 or higher Kyoto score,while in single gastric cancer group,the proportion of patients with a score of 5 or higher was less than half,or 44.7%(17/38).CONCLUSION Patients diagnosed with gastric cancer after H.pylori eradication tended to have advanced gastritis.In particular,in cases of multiple gastric cancers developed after H.pylori eradication,the endoscopic Kyoto classification score tended to be 5 or higher in patients with an open type atrophic gastritis and the intestinal metaplasia extended to the corpus.

关键词： Kyoto classification Gastric cancer Helicobacter pylori Eradication therapy Metachronous Intestinal metaplasia

Improvement of prognosis for unresectable biliary tract cancer

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World Journal of Gastroenterology 2013年第1期19卷 72-77页

作者： Takashi Sasaki Hiroyuki Isayama Yousuke Nakai Naminatsu Takahara Naoki Sasahira Hirofumi Kogure Suguru Mizuno Hiroshi Yagioka Yukiko Ito Natsuyo Yamamoto Kenji Hirano Nobuo Toda Minoru Tada Masao Omata Kazuhiko Koike Department of Gastroenterology Graduate School of MedicineThe University of TokyoTokyo 113-8655Japan Department of Gastroenterology Kanto Central HospitalTokyo 158-8531Japan Department of Gastroenterology JR Tokyo General HospitalTokyo 151-8528Japan Department of Gastroenterology Japanese Red Cross Medical CenterTokyo 150-8935Japan Department of Gastroenterology Mitsui Memorial HospitalTokyo 101-8643Japan Yamanashi Prefectural Hospital Organization Yamanashi 400-8506Japan

AIM:To evaluate the chemotherapeutic outcomes and confirm the recent improvement of prognosis for unresectable biliary tract cancer.METHODS:A total of 186 consecutive patients with unresectable biliary tract cancer,who had been treated with chemotherapy between 2000 and 2009 at five institutions in Japan,were retrospectively analyzed.These patients were divided into three groups based on the year beginning chemotherapy:Group A(2000-2003),Group B(2004-2006),and Group C(2007-2009).The data were fixed at the end of December 2011.Overall survival and time-to-progression were analyzed and compared chronologically.RESULTS:No patient characteristics were significantly different among the three groups.The gallbladder was involved in about half of the patients in each group,and metastatic biliary tract cancer was present in three quarters of the enrollees.In Group A,5-fluorouracilbased chemotherapies were primarily selected as firstline chemotherapy,and only 24% were treated with second-line chemotherapy.In Group B,gemcitabine or S-1 monotherapy was mainly introduced as firstline chemotherapy,and 51% of the patients who were refractory to first-line chemotherapy were treated with second-line chemotherapy mainly with monotherapy.In Group C,the combination therapy with gemcitabine and S-1 was mainly chosen as first-line chemotherapy,and 53% of the patients refractory to first-line chemotherapy were treated with second-line chemotherapy mainly with combination therapy.The median timeto-progressions were 4.4 mo,3.5 mo and 5.9 mo in Groups A,B and C,respectively(4.4 mo vs 3.5 mo vs 5.9 mo,P < 0.01).The median overall survivals were 7.1,7.3,and 11.7 mo in Groups A,B and C(7.1 mo vs 7.3 mo vs 11.7 mo,P = 0.03).Induction rates of all three drugs(gemcitabine,platinum analogs,and fluoropyrimidine) in Groups A,B and C were 4%,2% and 27%(4% vs 2% vs 27%,P < 0.01).CONCLUSION:The prognosis of unresectable biliary tract cancer has improved recently.Using three effective drugs(gemcitabine,platinum analogs,and fluoropyrimidine) may improv

关键词： Unresectable Biliary tract cancer Gemcitabine Platinum analogs Fluoropyrimidine