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A body mass index ≥25 kg/m2 is associated with a poor prognosis in patients with acute pancreatitis: a study of Japanese patients

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Hepatobiliary & Pancreatic Diseases International 2017年第6期16卷 645-651页

作者： Tsukasa Ikeura Kota Kato Makoto Takaoka masaaki shimatani Masanobu Kishimoto Kenichiro Nishi Shuji Kariya Kazuichi Okazaki Department of Gastroenterology and Hepatology Kansai Medical University 2-5-1 Shinmachi Hirakata Osaka 5731010 Japan Department of Emergency and Critical Care Medicine Kansai Medical University 2-5-1 Shinmachi Hirakata Osaka 5731010 Japan Department of Anesthesiology Kansai Medical University 2-5-1 Shinmachi Hirakata Osaka 5731010 Japan Department of Radiology Kansai Medical University 2-5-1 Shinmachi Hirakata Osaka 5731010 Japan

BACKGROUND:In Asian population, there is limited infor mation on the relevance between obesity and poor outcomes in acute pancreatitis(AP). The objective of this study was to examine the clinical impact of obesity based on body mass index(BMI) on prognosis of AP in Japanese ***:A total of 116 patients with AP were enrolled in this study. Univariate and multivariate logistic regression analyses were performed to examine relations between BMI and patients’ outcomes. Additionally, to investigate whether including obesity as a prognostic factor improved the predic tive accuracy of a Japanese prognostic factor score(PF score)a receiver-operating characteristic(ROC) curve analysis of mortality was ***:Multiple logistic regression analyses revealed that BMI ≥25 kg/m2was associated with a significant higher mor tality [odds ratio(OR)=15.8; 95% confidence interval(CI):1.1-227; P=0.043]. The area under the ROC curve(AUC) for the combination of PF score and BMI ≥25 kg/m2(AUC=0.881;95% CI:0.809-0.952) was higher than that for the PF score alone(AUC=0.820; 95% CI:0.713-0.927)(P=0.034).CONCLUSIONS:The negative impact of a high BMI on the prognosis of AP was confirmed in a Japanese population Including BMI ≥25 kg/m2 as an additional parameter to PF score enhanced the predictive value of the PF score for AP-related mortality.

关键词： acute pancreatitis obesity body mass index severity criteria prognostic factor score

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Long-term outcomes of autoimmune pancreatitis

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World Journal of Gastroenterology 2016年第34期22卷 7760-7766页

作者： Tsukasa Ikeura Hideaki Miyoshi masaaki shimatani Kazushige Uchida Makoto Takaoka Kazuichi Okazaki Department of Gastroenterology and Hepatology Kansai Medical University

Autoimmune pancreatitis(AIP) has been considered a favorable-prognosis disease; however,currently,there is limited information on natural course of AIP during long-term follow-up. Recently published studies regarding the long-term outcomes of AIP has demonstrated the developments of pancreatic stone formation,exocrine insufficiency,and endocrine insufficiency are observed in 5%-41%,34%-82%,and 38%-57% of patients having the disease. Furthermore,the incidence rate of developing pancreatic cancer ranges from 0% to 4.8% during the long-term followup. The event of death from AIP-related complications other than accompanying cancer is likely to be rare. During follow-up of AIP patients,careful surveillance for not only relapse of the disease but also development of complications at regular intervals is needed.

关键词： Autoimmune pancreatitis Outcome Cancer Prognosis

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Intrahepatic cholangiocarcinoma diagnosed via endoscopic retrograde cholangiopancreatography with a short double-balloon enteroscope

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World Journal of Gastroenterology 2013年第27期19卷 4427-4431页

作者： Tsukasa Ikeura masaaki shimatani Makoto Takaoka Mitsunobu Matsushita Hideaki Miyoshi Akiko Kurishima Kimi Sumimoto Sachi Miyamoto Kazuichi Okazaki Third Department of Internal Medicine Kansai Medical University

Endoscopic retrograde cholangiopancreatography (ERCP) using a double-balloon enteroscope (DBE) in patients with bowel reconstruction due to a previous abdominal surgery is now widely accepted. In particular, a short DBE, which has a 2.8-mm working channel and 152-cm working length, is useful for ERCP because of its good rotational and straightening ability and the availability of various conventional ERCP accessories through the working channel. Herein we report a case of intrahepatic cholangiocarcinoma via ERCP with a short DBE. This is the first report in which the pre-cutting and the brush cytological examination were performed successfully under a DBE to diagnose intrahepatic cholangiocarcinoma pathologically. The short DBE allowed us to perform all diagnostic and therapeutic procedures accepted in conventional ERCP in patients with surgically altered anatomies.

关键词： Double-balloon enteroscope Diagnosis Endoscopic retrograde cholangiopancreatography Intrahepatic cholangiocarcinoma Cytology

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Review of diagnostic and therapeutic endoscopic retrograde cholangiopancreatography using several endoscopic methods in patients with surgically altered gastrointestinal anatomy

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World Journal of Gastrointestinal Endoscopy 2015年第6期7卷 617-627页

作者： masaaki shimatani Makoto Takaoka Mitsuo Tokuhara Hideaki Miyoshi Tsukasa Ikeura Kazuichi Okazaki Third Department of Internal Medicine Kansai Medical University

The endoscopic approach for biliary diseases in patients with surgically altered gastrointestinal anatomy(SAGA) had been generally deemed impractical. However, it was radically made feasible by the introduction of double balloon endoscopy(DBE) that was originally developed for diagnosis and treatments for small-bowel diseases. Followed by the subsequent development of singleballoon endoscopy(SBE) and spiral endoscopy(SE), interventions using several endoscopes for biliary disease in patients with SAGA widely gained an acceptance as a new modality. Many studies have been made on this new technique. Yet, some problems are to be solved. For instance, the mutual unavailability among devices due to different working lengths and channels, and unestablished standardization of procedural techniques can be raised. Additionally, in an attempt to standardize endoscopic procedures, it is important to evaluate biliary cannulating methods by case with existence of papilla or not. A full comprehension of the features of respective scope types is also required. However there are not many papers written as a review. In our manuscript, we would like to evaluate and make a review of the present status of diagnostic and therapeutic endoscopic retrograde cholangiopancreatography applying DBE, SBE and SE for biliary diseases in patients with SAGA for establishment of these modalities as a new technology and further improvement of the scopes and devices.

关键词： Double balloon endoscopy Single balloonendoscopy Spiral endoscopy Endoscopic retrogradecholangiopancreatography Roux-en-Y reconstruction

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Endoscopic retrograde pancreatography: When should we do it?

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World Journal of Gastrointestinal Endoscopy 2015年第11期7卷 1023-1031页

作者： masaaki shimatani Makoto Takaoka Mitsuo Tokuhara Hideaki Miyoshi Tsukasa Ikeura Kazuichi Okazaki Third Department of Internal Medicine Kansai Medical University

Endoscopic retrograde pancreatography(ERP) is an accurate imaging modality in the diagnosis of pancreatobiliary diseases. However, its use has been substantially reduced due to the invasiveness of procedure, the risk of complications and the widespread availability of non-invasive cross-section imaging techniques(computed tomography, magnetic resonance imaging, and endoscopic ultrasound). Since the introduction of endoscopic sphincterotomy, ERP has transformed from diagnostic method to an almost exclusively therapeutic procedure. Pancreatic duct injection substantially increased the risk of post-ERP pancreatitis(1.6%-15.7%); therefore, according to international guidelines ERP is recommended only in cases where biliary intervention is required. However, the role of ERP in the management of pancreatic diseases is currently not clearly defined, but in some cases the filling of pancreatic duct may provide essential information complementing the results of non-invasive imaging techniques. The aim of this publication is to systematically summarize the literature dealing with the diagnostic yield of ERP. We would like to define the precise indications of ERP and overview a diagnostic protocol of pancreatic diseases depending on international guidelines and the opinion of Hungarian experts, because it may improve the diagnostic accuracy, minimize of burden of patients and reduce the risk of procedure related complications.

关键词： Endoscopic retrograde cholangiopancreatography End

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