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Current status of endoscopic retrograde cholangiopancreatography in patients with surgically altered anatomy

World Journal of Gastroenterology 2019年第26期25卷 3313-3333页

作者： Chonlada Krutsri Mitsuhiro Kida hiroshi yamauchi Tomohisa Iwai hiroshi Imaizumi Wasaburo Koizumi Department of Surgery Faculty of MedicineRamathibodi HospitalMahidol UniversityBangkok 10400Thailand Department of Gastroenterology Graduate School of MedicineKitasato University HospitalKanagawa 252-0375Japan

Endoscopic retrograde cholangiopancreatography(ERCP)in patients with surgically altered anatomy must be performed by a highly experienced *** challenges are accessing the afferent limb in different types of reconstruction,cannulating a papilla with a reverse orientation,and performing therapeutic interventions with uncommon endoscopic *** development of endoscopic techniques has led to higher success rates in this group of ***-assisted ERCP is the endoscopic procedure of choice for high success rates in short-limb reconstruction;however,these success rate is lower in long-limb *** assisted by endoscopic ultrasonography is now popular because it can be performed independent of the limb length;however,it must be performed by a highly experienced and skilled *** deployment and small stone removal can be performed immediately after ERCP assisted by endoscopic ultrasonography,but the second session is needed for other difficult procedures such as cholangioscopy-guided electrohydraulic ***-assisted ERCP has an almost 100%success rate in longlimb reconstruction because of the use of a conventional side-view duodenoscope,which is compatible with standard *** requires cooperation between the surgeon and endoscopist and is suitable in urgent situations requiring concomitant *** review focuses on the advantages,disadvantages,and outcomes of various procedures that are suitable in different situations and reconstruction *** new techniques and their outcomes are also discussed.

关键词： Endoscopic retrograde cholangiopancreatography Surgically altered anatomy Endoscopic retrograde cholangiopancreatography in Billroth II Endoscopic retrograde cholangiopancreatography post-Whipple Endoscopic ultrasonography-guided endoscopic retrograde cholangiopancreatography

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Clinical implications of doubling time of gastrointestinal submucosal tumors

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World Journal of Gastroenterology 2016年第45期22卷 10015-10023页

作者： Shuko Koizumi Mitsuhiro Kida hiroshi yamauchi Kosuke Okuwaki Tomohisa Iwai Shiro Miyazawa Miyoko Takezawa hiroshi Imaizumi Wasaburo Koizumi Department of Gastroenterology Kitasato University School of Medicine

AIM To evaluate the efficacy of doubling time(DT) of gastrointestinal submucosal tumors(GIST).METHODS From April 1987 through November 2012, a total of 323 patients were given a final histopathological diagnosis of GISTs on surgical resection or endoscopic ultrasound-guided fine-needle aspiration(EUS-FNA) in Kitasato University East Hospital or Kitasato University Hospital. We studied 53 of these patients(34 with resected tumors and 19 with unresected tumors) whose tumors could be measured on EUS on at least two successive occasions. The histopathological diagnosis was GIST in 34 patients, leiomyoma in 5, schwannoma in 3, ectopic pancreas in 1, hamartoma in 1, cyst in 1, Brunner's adenoma in 1, and spindle-cell tumor in 7. We retrospectively calculated the DT of GISTs on the basis of the time course of EUS findings to estimate the growth rate of such *** The DT was 17.2 mo for GIST, as compared with 231.2 mo for leiomyoma, 104.7 mo for schwannoma, 274.9mo for ectopic pancreas, 61.2 mo for hamartoma, 49.0 mo for cyst, and 134.7 mo for Brunner's adenoma. The GISTs were divided into risk classes on the basis of tumor diameters and mitotic figures(Fletcher's classification). The classification was extremely low risk or low risk in 28 patients, intermediate risk in 3, and high risk in 3. DT of GIST according to risk was 24.0 mo for extremely low-risk plus low-risk GIST, 17.1 mo for intermediate-risk GIST, and 3.9 mo for high-risk GIST. DT of GIST was significantly shorter than that of leiomyoma plus schwannoma(P < 0.05), and DT of high-risk GIST was significantly shorter than that of extremely low-risk plus low-risk GIST(P < 0.05).CONCLUSION For GIST, a higher risk grade was associated with a significantly shorter DT. Small SMTs should initially be followed up within 6 mo after detection.

关键词： Gastrointestinal submucosal tumor Doubling time Submucosal tumor Initial observational duration Endoscopic ultrasonography Endoscopic ultrasonography-guided fine needle aspiration Fletcher’s classification

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First case of IgG4-related sclerosing cholangitis associated with autoimmune hemolytic anemia

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World Journal of Gastroenterology 2014年第26期20卷 8740-8744页

作者： Hironori Masutani Kosuke Okuwaki Mitsuhiro Kida hiroshi yamauchi hiroshi Imaizumi Shiro Miyazawa Tomohisa Iwai Miyoko Takezawa Wasaburo Koizumi Department of Gastroenterology Kitasato University East Hospital

To our knowledge,patients with immunoglobulin G4-related sclerosing cholangitis(IgG4-SC)associated with autoimmune hemolytic anemia(AIHA)have not been reported *** patients with IgG4-SC have autoimmune pancreatitis(AIP)and respond to steroid ***,isolated cases of IgG4-SC are difficult to *** describe our experience with a patient who had IgG4-SC without AIP in whom the presence of AIHA led to *** patient was a73-year-old man who was being treated for *** dysfunction was diagnosed on blood tests at another *** studies suggested the presence of carcinoma of the hepatic hilus and primary sclerosing cholangitis,but a rapidly progressing anemia developed *** the diagnosis of AIHA,steroid treatment was begun,and the biliary stricture ***4-SC without AIP was thus diagnosed.

关键词： IgG4-related sclerosing cholangitis Immunoglobulin G4-related sclerosing cholangitis Autoimmune hemolytic anemia Autoimmune hemolytic anemia Autoimmune pancreatitis

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Innovations and techniques for balloon-enteroscopeassisted endoscopic retrograde cholangiopancreatography in patients with altered gastrointestinal anatomy

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World Journal of Gastroenterology 2015年第21期21卷 6460-6469页

作者： hiroshi yamauchi Mitsuhiro Kida hiroshi Imaizumi Kosuke Okuwaki Shiro Miyazawa Tomohisa Iwai Wasaburo Koizumi Department of Gastroenterology Kitasato University Hospital

Endoscopic retrograde cholangiopancreatography(ERCP) remains challenging in patients who have undergone surgical reconstruction of the ***,many studies have reported that balloonenteroscope-assisted ERCP(BEA-ERCP) is a safe and effective ***,further improvements in outcomes and the development of simplified procedures are *** treatment,Laparoscopy-assisted ERCP,endoscopic ultrasoundguided anterograde intervention,and open surgery are effective ***,treatment should be noninvasive,effective,and *** believe that these procedures should be performed only in difficult-to-treat patients because of many potential ***-ERCP still requires high expertiselevel techniques and is far from a routinely performed *** techniques have been proposed to facilitate scope insertion(insertion with percutaneous transhepatic biliary drainage(PTBD) rendezvous technique,Short type single-balloon enteroscopes with passive bending section,Intraluminal injection of indigo carmine,CO2 inflation guidance),cannulation(PTBD or percutaneous transgallbladder drainage rendezvous technique,Dilation using screw drill,Rendezvous technique combining DBE with a cholangioscope,endoscopic ultrasound-guided rendezvous technique),and treatment(overtube-assisted technique,Short type balloon enteroscopes) during *** use of these techniques may allow treatment to be performed by BEA-ERCP in many patients.A standard procedure for ERCP yet to be established for patients with a reconstructed *** present,BEA-ERCP is considered the safest and most effective procedure and is therefore likely to be recommended as firstline *** this article,we discuss the current status of BEA-ERCP in patients with surgically altered gastrointestinal anatomy.

关键词： Balloon enteroscopy Endoscopic retrogradecholangiopancreatography Altered gastrointestinal anatomy Balloon-enteroscope-assisted endoscopicretrograde cholangiopancreatography

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Passive-bending,short-type single-balloon enteroscope for endoscopic retrograde cholangiopancreatography in Roux-en-Y anastomosis patients

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World Journal of Gastroenterology 2015年第5期21卷 1546-1553页

作者： hiroshi yamauchi Mitsuhiro Kida Kosuke Okuwaki Shiro Miyazawa Tomohisa Iwai Shuko Tokunaga Miyoko Takezawa hiroshi Imaizumi Wasaburo Koizumi Department of Gastroenterology Kitasato University East HospitalKana-gawa 252--0380Japan

AIM:To evaluate short-type-single-balloon enteroscope(SBE) with passive-bending,high-force transmission functions for endoscopic retrograde cholangiopancreatography(ERCP) in patients with Roux-en-Y ***:Short-type SBE with this technology(SIF-Y0004-V01; working length,1520 mm; channel diameter,3.2 mm) was used to perform 50 ERCP procedures in 37 patients with Roux-en-Y *** rate of reaching the blind end,time required to reach the blind end,diagnostic and therapeutic success rates,and procedure time and complications were studied retrospectively and compared with the results of 34 sessions of ERCP performed using a short-type SBE without this technology(SIF-Y0004; working length,1520 mm; channel diameter,3.2 mm) in 25 ***:The rate of reaching the blind end was 90% with SIF-Y0004-V01 and 91% with SIF-Y0004(P = 0.59).The median time required to reach the papilla was significantly shorter with SIF-Y0004-V01 than with SIF-Y0004(16 min vs 24 min,P = 0.04).The diagnostic success rate was 93% with SIFY0004-V01 and 84% with SIF-Y0004(P = 0.17).The therapeutic success rate was 95% with SIF-Y0004-V01 and 96% with SIF-Y0004(P = 0.68).The median procedure time was 40 min with SIF-Y0004-V01 and 36 min with SIF-Y0004(P = 0.50).The incidence of hyperamylasemia was 6.0% in the SIF-Y0004-V01 group and 14.7% in the SIF-Y0004 group(P = 0.723).The incidence of pancreatitis was 0% in the SIFY0004-V01 group and 5.9% in the SIF-Y0004 group(P > 0.999).The incidence of gastrointestinal perforation was 2.0%(1/50) in the SIF-Y0004-V01 group and 2.9%(1/34) in the SIF-Y0004 group(P > 0.999).CONCLUSION:SIF-Y0004-V01 is useful for ERCP inpatients with Roux-en-Y anastomosis and may reduce the time required to reach the blind end.

关键词： Passive bending Roux-en-Y anastomosis Endoscopic r

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Short-type single balloon enteroscope for endoscopic retrograde cholangiopancreatography with altered gastrointestinal anatomy

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World Journal of Gastroenterology 2013年第11期19卷 1728-1735页

作者： hiroshi yamauchi Mitsuhiro Kida Kosuke Okuwaki Shiro Miyazawa Tomohisa Iwai Miyoko Takezawa Hidehiko Kikuchi Maya Watanabe hiroshi Imaizumi Wasaburo Koizumi Department of Gastroenterology Kitasato University East HospitalSagamiharaKanagawa 252-0380Japan

AIM:To evaluate the effectiveness of a short-type single-balloon-enteroscope(SBE) for endoscopic retrograde cholangiopancreatography(ERCP) in patients with a reconstructed ***:Short-type SBE was developed to perform ERCP in postoperative patients with a reconstructed ***-type SBE is a direct-viewing endoscope with the following specifications:working length,1520 mm;total length,1840 mm;channel diameter,3.2 *** addition,short-type SBE has a water-jet *** study group comprised 22 patients who underwent 31 sessions of short-type SBE-assisted ERCP from June 2011 through May *** was performed by Billroth-Ⅱ(B-Ⅱ) gastrectomy in 6 patients(8 sessions),Roux-en-Y(R-Y) gastrectomy in 14 patients(21 sessions),and R-Y hepaticojejunostomy in 2 patients(2 sessions).We retrospectively studied the rate of reaching the blind end(papilla of Vater or choledochojejunal anastomosis),mean time required to reach the blind end,diagnostic success rate(defined as the rate of successfully imaging the bile and pancreatic ducts),therapeutic success rate(defined as the rate of successfully completing endoscopic treatment),mean procedure time,and ***:Among the 31 sessions of ERCP,the rate of reaching the blind end was 88% in B-Ⅱ gastrectomy,91% in R-Y gastrectomy,and 100% in R-Y *** mean time required to reach the papilla was 18.3 min in B-Ⅱ gastrectomy,21.1 min in R-Y gastrectomy,and 32.5 min in R-Y *** diagnostic success rates in all patients and those with an intact papilla were respectively 86% and 86% in B-Ⅱ gastrectomy,90% and 87% in R-Y gastrectomy,and 100% in R-Y *** therapeutic success rates in all patients and those with an intact papilla were respectively 100% and 100% in B-Ⅱ gastrectomy,94% and 92% in R-Y gastrectomy,and 100% in R-Y *** the channel diameter was 3.2 mm,stone extraction could be performed with a wire-guided basket in 12

关键词： Endoscopic retrograde cholangiopancreatography Single-balloon-enteroscope Short type BillrothII gastrectomy Roux-en-Y gastrectomy

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Usefulness of serum lipase for early diagnosis of post-endoscopic retrograde cholangiopancreatography pancreatitis

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World Journal of Gastrointestinal Endoscopy 2019年第9期11卷 477-485页

作者： Masayoshi Tadehara Kosuke Okuwaki hiroshi Imaizumi Mitsuhiro Kida Tomohisa Iwai hiroshi yamauchi Toru Kaneko Rikiya Hasegawa Eiji Miyata Yusuke Kawaguchi Hironori Masutani Wasaburo Koizumi Department of Gastroenterology Kitasato University School of Medicine

BACKGROUND Post-endoscopic retrograde cholangiopancreatography(ERCP)pancreatitis(PEP)is new onset acute pancreatitis after *** complication is sometimes *** such,PEP should be diagnosed early so that therapeutic interventions can be carried *** lipase(s-Lip)is useful for diagnosing acute ***,its usefulness for diagnosing PEP has not been sufficiently *** This study aimed to retrospectively examine the usefulness of s-Lip for the early diagnosis of *** We retrospectively examined 4192 patients who underwent ERCP at our two hospitals over the last 5 *** primary outcomes were a comparison of the areas under the receiver operating characteristic(ROC)curves(AUCs)of s-Lip and serum amylase(s-Amy),s-Lip and s-Amy cutoff values based on the presence or absence of PEP in the early stage after ERCP via ROC curves,and the diagnostic properties[sensitivities,specificities,positive predictive values(PPV),and negative predictive value(NPV)]of these cutoff values for PEP *** Based on the eligibility and exclusion criteria,804 cases were *** the entire course,PEP occurred in 78 patients(9.7%).It occurred in the early stage after ERCP in 40 patients(51.3%)and in the late stage after ERCP in 38 patients(48.7%).The AUCs were 0.908 for s-Lip[95%confidence interval(CI):0.880-0.940,P<0.001]and 0.880 for s-Amy(95%CI:0.846-0.915,P<0.001),indicating both are useful for early *** comparing the AUCs,s-Lip was found to be significantly more useful for the early diagnosis of PEP than s-Amy(P=0.023).The optimal cutoff values calculated from the ROC curves were 342 U/L for s-Lip(sensitivity,0.859;specificity,0.867;PPV,0.405;NPV,0.981)and 171 U/L for s-Amy(sensitivity,0.859;specificity,0.763;PPV,0.277;NPV,0.979).CONCLUSION S-Lip was significantly more useful for the early diagnosis of *** s-Lip after ERCP could help diagnose PEP earlier;hence,therapeutic interventions can be provided earlier.

关键词： Endoscopic retrograde cholangiopancreatography Post-endoscopic retrograde cholangiopancreatography pancreatitis Pancreatitis Lipase Amylase

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Superconducting joints using reacted multifilament MgB_(2)wires:A technology toward cryogen-free MRI magnets

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Journal of Magnesium and Alloys 2024年第1期12卷 159-170页

作者： Dipak Patel Akiyoshi Matsumoto Hiroaki Kumakura Yuka Hara Toru Hara Minoru Maeda Hao Liang Yusuke yamauchi Seyong Choi Jung Ho Kim Md Shahriar A.Hossain School of Mechanical and Mining Engineering The University of QueenslandSt LuciaQueensland 4072Australia National Institute for Materials Science(NIMS) 1-2-1 SengenTsukubaIbaraki 305-0047Japan Department of Electrical Engineering and Kangwon High Magnetic Field Center Institute of Quantum Convergence TechnologyKangwon National UniversityGangwon 24341Republic of Korea Australian Institute for Bioengineering and Nanotechnology(AIBN) The University of QueenslandSt LuciaQueensland 4072Australia Department of Materials Process Engineering Graduate School of EngineeringNagoya UniversityNagoyaAichi 464-8603Japan Institute for Superconducting and Electronic Materials Australian Institute for Innovative MaterialsUniversity of WollongongNorth WollongongNew South Wales 2500Australia

The development of superconducting joining technology for reacted magnesium diboride(MgB_(2))conductors remains a critical challenge for the advancement of cryogen-free MgB_(2)-based magnets for magnetic resonance imaging(MRI).Herein,the fabrication of superconducting joints using reacted carbon-doped multifilament MgB_(2)wires for MRI magnets is *** achieve successful superconducting joints,the powder-in-mold method was employed,which involved tuning the filament protection mechanism,the powder compaction pressure,and the heat treatment *** fabricated joints demonstrated clear superconducting-to-normal transitions in self-field,with effective magnetic field screening up to 0.5 T at 20 *** evaluate the interface between one of the MgB_(2)filaments and the MgB_(2)bulk within the joint,serial sectioning was conducted for the first time in this type of superconducting *** serial sectioning revealed space formation at the interface,potentially caused by the volume shrinkage associated with the MgB_(2)formation or the combined effect of the volume shrinkage and the different thermal expansion coefficients of the MgB_(2)bulk,the filament,the mold,and the sealing *** findings are expected to be pivotal in developing MgB_(2)superconducting joining technology for MRI magnet applications through interface engineering.

关键词： Mg B2 superconducting joint MgB_(2)conductor MRI applications Cryogen-free magnet Persistent-mode operation

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新型淀粉样蛋白成像PET显像剂18F-FPYBF-2的生物分布和辐射剂量:首次在人体中的测定评估

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中华核医学与分子影像杂志 2018年第9期38卷 646-647页

作者：李雪娜 Ryuichi Nishii Tatsuya Higashi Shinya Kagawa Chio Okuyama Yoshihiko Kishibe Masaaki Takahashi Tomoko Okina Norio Suzuki hiroshi Hasegawa Yasuhiro Nagahama Koichi Ishizu Naoya Oishi Hiroyuki Kimura Hiroyuki Watanabe Masahiro Ono Hideo Saji hiroshi yamauchi 中国医科大学附属第一医院核医学科 Shiga Medical Center Research Institute Dept.of Molecular Imaging and Theranostics National Institute of Radiological Sciences (NIRS)National Institutes for Quantum and Radiological Science and Technology( QST)

目的近年来,苯并呋喃衍生物5-(5-(2-(2-(2-18F-氟乙氧基)乙氧基)乙氧基)苯并呋喃-2-基)-N-甲基吡啶-2-胺(18F-FPYBF-2)被证实是淀粉样蛋白成像的显像剂。已发现18F-FPYBF-2PET/CT是评估阿尔茨海默病（AD）有用且可靠的诊断工具（Higashi... 详细信息

目的近年来,苯并呋喃衍生物5-(5-(2-(2-(2-18F-氟乙氧基)乙氧基)乙氧基)苯并呋喃-2-基)-N-甲基吡啶-2-胺(18F-FPYBF-2)被证实是淀粉样蛋白成像的显像剂。已发现18F-FPYBF-2PET/CT是评估阿尔茨海默病（AD）有用且可靠的诊断工具（Higashi等,Ann Nucl Med,https://***/10.1007/s12149-018-1236-1,2018）。该研究首次在健康志愿者中评估诊断剂量18F-FPYBF-2的生物分布和辐射。方法 4名健康志愿者[男3名,女1名;平均年龄（40±17）岁,年龄范围25～56岁]行18FFPYBF-2 PET/CT显像,以评估辐射暴露和药代动力学。注射后0～10 min进行身体（胸部和腹部）的动态PET/CT显像,在注射18F-FPYBF-2后进行6次15 min的全身静态显像。重建PET和CT图像数据后,通过拟合动态显像和全身显像的感兴趣体积数据来估量个体器官时间-活度曲线。用OLINDA/EXM 2.0软件判定全身有效剂量（ED）。结果动态PET显像示肝胆系统和肾是18F-FPYBF-2清除的主要途径。肝脏、胆囊、胃和肾脏呈放射性高摄取,其次是肠和膀胱。成人剂量学模型估测的ED为（8.48±1.25）μSv/MBq。男性和女性中较高吸收剂量的器官为:肝脏[（28.98±12.49）和（36.21±15. 64）μGy/MBq],大脑[（20.93±4.56）和（23.05±5.03）μGy/MBq],成骨细胞[（9.67±1.67）和（10.29±1.70）μGy/MBq],小肠[（9.12±2.61）和（11.12±3.15）μGy/MBq]和肾脏[（7.81±2.62）和（8.71±2.90）μGy/MBq]。结论成人剂量学模型的ED与用于淀粉样蛋白PET显像的其他药物所致ED相似。18F-FPYBF-2作为评估AD的诊断工具,其诊断剂量185～370 MBq对患者而言是可耐受的。

关键词：阿尔茨海默病淀粉样蛋白显像健康志愿者正电子发射断层显像术生物分布辐射剂量测定 OLINDA/EXM

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Phase Ⅰ trial of combination chemotherapy with gemcitabine, cisplatin, and S-1 in patients with advanced biliary tract cancer

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World Journal of Gastroenterology 2015年第19期21卷 5979-5984页

作者： Akinori Watanabe Mitsuhiro Kida Shiro Miyazawa Tomohisa Iwai Kosuke Okuwaki Toru Kaneko hiroshi yamauchi Miyoko Takezawa hiroshi Imaizumi Wasaburo Koizumi Department of Gastroenterology Kitasato University School of Medicine

AIM: To evaluate the dose-limiting toxicities(DLTs)and determine the maximum-tolerated dose(MTD) and recommended dose(RD) of combination chemotherapy with gemcitabine, cisplatin and S-1 which is an oral fluoropyrimidine pro-drug in patients with advanced biliary tract ***: Patients with histologically or cytologically confirmed unresectable or recurrent biliary tract cancer were enrolled. The planned dose levels of gemcitabine(mg/m2), cisplatin(mg/m2), and S-1(mg/m2 per day) were as follows: level-1, 800/20/60;level 0, 800/25/60; level 1, 1000/25/60; and level 2,1000/25/80. In each cycle, gemcitabine and cisplatin were administered intravenously on days 1 and 15,and S-1 was administered orally twice daily on days 1to 7 and days 15 to 21, every 4 ***: Twelve patients were enrolled, and level0 was chosen as the starting dose. None of the first three patients had DLTs at level 0, and the dose was escalated to level 1. One of six patients had DLTs(grade 4 febrile neutropenia, leucopenia, and neutropenia; grade 3 thrombocytopenia) at level *** then proceeded to level 2. None of three patients had DLTs during the first cycle. Although the MTD was not determined, level 2 was designated at the RD for a subsequent phase Ⅱ ***: The RD was defined as gemcitabine1000 mg/m2(days 1, 15), cisplatin 25 mg/m2(days1, 15), and S-1 80 mg/m2 per day(days 1-7, 15-21),every 4 weeks. A phase Ⅱ study is planned to evaluate the effectiveness of combination chemotherapy withgemcitabine, cisplatin, and S-1 in advanced biliary tract cancer.

关键词： Gemcitabine Cisplatin, S-1 Advancedbiliary tract cancer

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