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World Journal of Gastrointestinal Endoscopy 2020年第8期12卷 220-230页

作者： Mitsuru Sugimoto Tadayuki Takagi Rei Suzuki Naoki konno Hiroyuki Asama Yuki Sato Hiroki Irie ko watanabe Jun Nakamura Hitomi Kikuchi Mika Takasumi Minami Hashimoto Tsunetaka Kato TakutoHikichi Hiromasa Ohira Department of Gastroenterology School of MedicineFukushima Medical UniversityFukushima 9601247Japan Department of Endoscopy Fukushima Medical University HospitalFukushima 9601247Japan

BACKGROUND Recently,with the advent of more advanced devices and endoscopic techniques,endoscopic retrograde cholangiopancreatography(ERCP)in Billroth II(B-II)patients has been increasingly ***,the procedures are difficult,and the techniques and strategies have not been *** To reveal the appropriate scope for ERCP in B-II *** Sixty ERCP procedures were performed on B-II patients between June 2005 and May 2018 at Fukushima Medical University Hospital,and in 44 cases,this was the first ERCP procedure performed by esophagogastroduodenoscopy(EGDS)or colonoscopy(CS)after B-II *** cases were divided into two groups:17 cases of ERCP performed by EGDS(EGDS group)and 27 cases of ERCP performed by CS(CS group).The patient characteristics and ERCP procedures were compared between the EGDS and CS *** The procedural time was significantly shorter in the EGDS group than in the CS group[median(range):60(20-100)vs 90(40-128)min,P value<0.01].CS was an independent factor of a longer ERCP procedural time according to the univariate and multivariate analyses(odds ratio:3.97,95%CI:1.05-15.0,P value=0.04).CONCLUSION Compared to CS,EGDS shortened the procedural time of ERCP in B-II patients.

关键词： Endoscopic retrograde cholangiopancreatography Billroth II reconstruction Esophagogastroduodenoscope Colonoscope

Acute inflammation occurring in gastric aberrant pancreas followed up by endoscopic ultrasonography

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World Journal of Gastrointestinal Endoscopy 2012年第7期4卷 331-334页

作者： ko watanabe Atsushi Irisawa Takuto Hikichi Tadayuki Takagi Goro Shibukawa Masaki Sato Katsutoshi Obara Hiromasa Ohira Division of Medicine Department of Gastroenterology and Rheumatology Fukushima Medical University School of MedicineFukushima 960-1295 Japan Department of Gastroen- terology Fukushima Medical University Aizu Medical CenterAizuwakamatsu 965-8555 Japan Department of Endoscopy Fukushima Medical University HospitalFukushima 960-1295 Japan

We describe a case of gastric aberrant pancreas with acute pancreatitis followed up with subsequent endoscopic ultrasound. A 20-year-old woman known to have aberrant pancreas in the stomach was admitted to our hospital because of severe epigastralgia. Laboratory tests showed slight C reactive protein elevation without hyperamylasemia. Esophagogastroduodenoscopy revealed a swollen submucosal lesion (SML) to a greater degree compared with the previous findings. Subsequent endoscopic ultrasonography (EUS) revealed a swollen lesion of 35 mm in diameter. The internal echo-pattern was more hypoechoic than in the previous EUS. The border between the fourth layer (muscularis propria) and the SML was unclear. The anechoic lumen in the mass, considered as the ductal lumen, was dilated. Based on these results, we diagnosed the patient as having acute inflammation, resembling pancreatitis, in the aberrant pancreas.

关键词： Aberrant pancreas Acute pancreatitis Endoscopic ultrasonography Endoscopic ultrasonogra phy-fine needle aspiration Gastric submucosal lesion

Prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis using pancreatic stents: A review of efficacy, diameter and length

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World Journal of Meta-Analysis 2019年第6期7卷 259-268页

作者： Mitsuru Sugimoto Tadayuki Takagi Rei Suzuki Naoki konno Hiroyuki Asama Yuki Sato Hiroki Irie ko watanabe Jun Nakamura Hitomi Kikuchi Mika Takasumi Minami Hashimoto Takuto Hikichi Hiromasa Ohira Department of Gastroenterology Fukushima Medical UniversitySchool of Medicine Fukushima 9601247Japan Department of Endoscopy Fukushima Medical University HospitalFukushima 9601295Japan

Although endoscopic retrograde cholangiopancreatography (ERCP) is an important procedure for the diagnosis and treatment of pancreaticobiliary diseases, post-ERCP pancreatitis (PEP) is the most frequent adverse event that can sometimes be fatal. However, prophylactic pancreatic stent (PS) insertion has been performed to prevent PEP in high-risk patients. In some randomized controlled trials (RCTs) and meta-analyses, the efficacy of prophylactic PS insertion has been shown to prevent PEP. In addition, several types of stents have been used to decrease PEP. In this review, we introduce the details of these RCTs and meta-analyses and reveal the specifications for stent placement, for example, the stent diameter and length and the pancreatic region into which the stent should be inserted.

关键词： Endoscopic retrograde cholangiopancreatography Post-endoscopic retrograde cholangiopancreatography pancreatitis Prophylactic pancreatic stent

Pancreatic stents to prevent post-endoscopic retrograde cholangiopancreatography pancreatitis: A meta-analysis

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World Journal of Meta-Analysis 2019年第5期7卷 249-258页

作者： Mitsuru Sugimoto Tadayuki Takagi Rei Suzuki Naoki konno Hiroyuki Asama Yuki Sato Hiroki Irie ko watanabe Jun Nakamura Hitomi Kikuchi Mika Takasumi Minami Hashimoto Takuto Hikichi Hiromasa Ohira Department of Gastroenterology Fukushima Medical UniversitySchool of MedicineFukushima CityFukushima Prefecture 960-1295Japan Department of Endoscopy Fukushima Medical University HospitalFukushima CityFukushima Prefecture 960-1295Japan

BACKGROUND Endoscopic retrograde cholangiopancreatography(ERCP)plays a major role in the investigation and treatment of pancreaticobiliary ***,post-ERCP pancreatitis(PEP)is a severe adverse *** meta-analyses have shown that prophylactic PS was useful for preventing ***,abstract reports and patients who underwent endoscopic ampullectomy were included in the previous *** addition,two meta-analyses involved non-randomized controlled trials(RCTs).The efficacy of PS for preventing severe PEP was different in each ***,we performed the current metaanalysis,which included only full-text articles,and added new *** To reveal the efficacy of prophylactic pancreatic stent(PS)placement for preventing *** We searched the MEDLINE,Cochrane Library and PubMed databases for related *** the reports retrieved,11 studies were included in this *** full-text articles were published between 1993 and 2016.A total of 1475 patients were enrolled in the included studies;of these patients,734 had a PS inserted,and 741 did not have a PS *** and severe PEP occurrence were evaluated in this *** PEP was observed in all studies and occurred in 39(5.3%)patients who received a *** the other hand,PEP occurred in 141(19%)patients who did not receive a *** occurrence of PEP was significantly lower in the patients who underwent PS placement than in the patients who did not receive a PS(OR=0.32;95%CI:0.23-0.45;P<0.001).In addition,the occurrence of severe PEP was ***,the occurrence of severe PEP was not observed in the stent group;however,the occurrence of severe PEP was observed in 8(1.3%)patients who did not have a PS *** PEP occurred significantly less often in the stent group than in the no stent group(OR=0.24;95%CI:0.06-0.94;P=0.04).CONCLUSION In conclusion,prophylactic PS placement is useful for preventing PEP and severe PEP.

关键词： Endoscopic retrograde cholangiopancreatography Pancreatic stent Postendoscopic retrograde cholangiopancreatography pancreatitis Meta-analysis

Present state of endoscopic ultrasonography-guided fine needle aspiration for the diagnosis of autoimmune pancreatitis type 1

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World Journal of Meta-Analysis 2019年第5期7卷 218-223页

作者： Mitsuru Sugimoto Tadayuki Takagi Rei Suzuki Naoki konno Hiroyuki Asama Yuki Sato Hiroki Irie ko watanabe Jun Nakamura Hitomi Kikuchi Mika Takasumi Minami Hashimoto Takuto Hikichi Hiromasa Ohira Department of Gastroenterology Fukushima Medical UniversitySchool of MedicineFukushima 960-1247Japan Department of Endoscopy Fukushima Medical University HospitalFukushima 960-1247Japan

Autoimmune pancreatitis(AIP)is defined as pancreatitis caused by irregular narrowing of the pancreatic duct accompanied by pancreatic swelling,fibrosis and lymphocyte infiltration,events that are related to autoimmune *** 2010 International Consensus Diagnostic Criteria for AIP defined pancreatitis as“type 1”when increased levels of serum IgG4 were present and other organs were involved;lymphoplasmacytic sclerosing pancreatitis was the main histological *** from surgery,endoscopic ultrasonographyguided fine needle aspiration(EUS-FNA)is the only method for the histological diagnosis of AIP;however,this method is *** use of larger-diameter FNA needles and trucut biopsy did not improve the diagnostic performance of EUS-FNA,but it has improved *** this review,we look back at past efforts to improve the diagnostic performance of EUS-FNA and reveal the present state of EUS-FNA for the histological diagnosis of AIP type 1.

关键词： Autoimmune pancreatitis type 1 Endoscopic ultrasonography-guided fine needle aspiration IgG4-related disease Lymphoplasmacytic sclerosing pancreatitis

An automated spring-loaded needle for endoscopic ultrasound-guided abdominal paracentesis in cancer patients

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World Journal of Gastrointestinal Endoscopy 2014年第2期6卷 55-59页

作者： Rei Suzuki Atsushi Irisawa Manoop S Bhutani Takuto Hikichi Tadayuki Takagi Goro Shibukawa Ai Sato Masaki Sato Tsunehiko Ikeda ko watanabe Jun Nakamura Srinadh Annangi Kazuhiro Tasaki Katsutoshi Obara Hiromasa Ohira Department of Gastroenterology and Rheumatology Division of Medicine Fukushima Medical University School of Medicine Department of Gastroenterology Fukushima Medical University Aizu Medical Center Department of Gastroenterology Hepatology and Nutrition the University of Texas MD Anderson Cancer Center Department of Endoscopy Fukushima Medical University Hospital Department of Pathology Fukushima Medical University Hospital

AIM: To evaluate the feasibility of using an automatedspring-loaded needle device for endoscopic ultrasound(EUS)-guided abdominal paracentesis(EUS-P) to see if this would make it easier to puncture the mobile and lax gastric wall for ***: The EUS database and electronic medical records at Fukushima Medical University Hospital were searched from January 2001 to April 2011. Patients with a history of cancer and who underwent EUS-P using an automated spring-loaded needle device with a 22-gauge puncture needle were included. The needle was passed through the instrument channel and advanced through the gastrointestinal wall under EUS guidance into the echo-free space in the abdominal cavity and ascitic fluid was collected. The confirmed diagnosis of malignant ascites included positive cytology and results from careful clinical observation for at least 6 mo in patients with negative cytology. The technical success rate, cytology results and complications were ***: We found 11 patients who underwent EUS-P with an automated spring-loaded needle device. In 4 cases, ascites was revealed only with EUS but not in other imaging modalities. EUS-P was done in 7 other cases because there was minimal ascitic fluid and no safe window for percutaneous abdominal aspiration. Ascitic fluid was obtained in all cases by EUS-P. The average amount aspirated was 14.1 mL(range 0.5-38 mL) and that was sent for cytological exam. The etiology of ascitic fluid was benign in 5 patients and malignant in 6. In all cases, ascitic fluid was obtained with the first needle pass. No procedure-related adverse effects ***: EUS-P with an automated springloaded needle device is a feasible and safe method for ascites evaluation.

关键词： Ascetic fluid Malignancy Endoscopic ultrasound Paracentesis Fine needle aspiration

Retrocaval liver lifting maneuver and modifications of total hepatic vascular exclusion for liver tumor resection

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World Journal of Hepatology 2016年第8期8卷 411-420页

作者： Saiho ko Yuuki Kirihatayfa Yayoi Matsumoto Tadataka Takagi Masanori Matsusaka Tomohide Mukogawa Hirofumi Ishikawa Akihiko watanabe Department of Surgery Nara Prefecture General Medical Center

AIM: To evaluate the efficacy of technical modifications of total hepatic vascular exclusion(THVE) for hepatectomy involving inferior vena cava(IVC).METHODS: Of 301 patients who underwent hepatectomy during the immediate previous 5-year period, 8(2.7%) required THVE or modified methods of IVC cross-clamping for resection of liver tumors with massive involvement of the IVC. Seven of the patients had diagnosis of colorectal liver metastases and 1 had diagnosis of hepatocellular carcinoma. All tumors involved the IVC, and THVE was unavoidable for combined resection of the IVC in all 8 of the patients. Technical modifications of THVE were applied to minimize the extent and duration of vascular occlusion, thereby reducing the risk of ***: Broad dissection of the space behind the IVC coupled with lifting up of the liver from the retrocaval space was effective for controlling bleeding around the IVC before and during THVE. The procedures facilitate modification of the positioning of the cranial IVC cross-clamp. Switching the cranial IVC cross-clamp from supra- to retrohepatic IVC or to the confluence of hepatic vein decreased duration of the THVE while restoring hepatic blood flow or systemic circulation via the IVC. Oblique cranial IVC cross-clamping avoided ischemia of the remnant hemi-liver. With these technicalmodifications, the mean duration of THVE was 13.4 ± 8.4 min, which was extremely shorter than that previously reported in the literature. Recovery of liver function was smooth and uneventful for all 8 patients. There was no case of mortality, re-operation, or severe complication(i.e., Clavien-Dindo grade of Ⅲ or more).CONCLUSION: The retrocaval liver lifting maneuver and modifications of cranial cross-clamping were useful for minimizing duration of THVE.

关键词： Total hepatic vascular exclusion Retrocaval liver lifting maneuver Oblique clamping Switching the clamp Hepatectomy

Prior minimal endoscopic sphincterotomy to prevent pancreatitis related to endoscopic balloon sphincteroplasty

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World Journal of Gastrointestinal Endoscopy 2016年第18期8卷 663-668页

作者： Ryo Kanazawa Jin Kan Sai Tomoyasu Ito Hiroko Miura Shigeto Ishii Hiroaki Saito ko Tomishima Ryo Shimizu koki Sato Manabu Hayashi Sumio watanabe Shuichiro Shiina Department of Gastroenterology Juntendo University School of Medicine

AIM To investigate the efficacy of prior minimal endoscopic sphincterotomy(EST) to prevent pancreatitis related to endoscopic balloon sphincteroplasty(EBS).METHODS After bile duct access was gained and cholangiogram confirmed the presence of stones < 8 mm in the common bile duct at endoscopic retrograde cholangiography, patients were subjected to minimal EST(up to one-third of the size the papilla) plus 8 mm EBS(ESTEBS group). The incidence of pancreatitis and the difference in serum amylase level after the procedure were examined and compared with those associated with 8-mm EBS alone in 32 patients of historical control(control group).RESULTS One hundred and five patients were included in the EST-EBS group, and complete stone removal was accomplished in all of them. The difference in serum amylase level after the procedure was- 25.0(217.9) IU/L in the EST-EBS group and this value was significantly lower than the 365.5(576.3) IU/L observed in the control group(P < 0.001). The incidence of post-procedure pancreatitis was 0%(0/105) in the EST-EBS group and 15.6%(5/32) in the control group(P < 0.001).CONCLUSION Prior minimal EST might be useful to prevent the elevation of serum amylase level and the occurrence of pancreatitis related to EBS.

关键词： Choledocholithiasis Adverse event Pancreatitis Endoscopic sphincterotomy Endoscopic balloon sphincteroplasty

Loss of NB-3 aggravates cerebral ischemia by impairing neuron survival and neurite growth

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Loss of NB-3 aggravates cerebral ischemia by impairing neuro...

Neuronal protective role of neural recognition molecule NB-3 in mouse cerebral ischemia

中国神经科学学会第九届全国学术会议暨第五次会员代表大会

作者： Kazutada watanabe Department of Bioengineering Nagaoka University of Technology1603-1KamitomiokaNagaokaNiigata 940-2188Japan Nagaoka National College of Technology 888NishikatakaiNagaokaNiigata 940-8532Japan

＜正＞Objective NB-3 is a member of the F3/contactin family of neural recognition molecules,which are crucial for cell morphogenesis and ***-3 is expressed in neurons and plays an important role in axonal extension and neuronal ***,the role of NB-3 in cerebral ischemic injury remains *** Adult male wild-type and NB-3 knockout（ko） mice were subjected to ischemic injury by unilateral middle cerebral carotid artery occlusion for 3 h,6 h and 12 *** infarction volumes were then determined by 2,3,5-triphenyltetrazolium chloride *** dysfunction analysis was also *** culture of neuronal cells from wildtype and knockout animals were also used for analysis of neuronal survival and neurite *** NB-3 expression in the ischemic hemisphere was decreased after transient middle cerebral artery occlusion（MCAO）.NB-3- ko mice developed a 2.6-fold larger infarct volume and exhibited increased neurological deficit scores after transient MCAO compared with control *** with NB-3 promoted neuronal survival and neurite outgrowth in vitro, while neurite outgrowth and neuronal survival were significantly reduced in NB-3-deficient *** addition, NB-3 deficiency renders neurons more susceptible to OGD-induced damage and NB-3 as substrate could partially via homophilic *** These data demonstrate that NB-3 deficiency may aggravate brain damage after MCAO by impairing neuronal survival and neurite growth.

关键词： NB-3 ischemia neuronal survival neurite outgrowth injury

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Neuronal protective role of neural recognition molecule NB-3...