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Role of stereotactic body radiation therapy for hepatocellular carcinoma

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World Journal of Gastroenterology 2014年第12期20卷 3100-3111页

作者： Naoko Sanuki Atsuya Takeda Etsuo Kunieda Radiation Oncology Center Ofuna Chuo Hospital Department of Radiation Oncology Tokai University

The integration of new technologies has raised an interest in liver tumor radiotherapy,with literature evolving to support its *** advances,particularly stereotactic body radiation therapy(SBRT),have been critical in improving local control or potential cure in liver lesions not amenable to first-line surgical resection or radiofrequency *** investigation of SBRT,particularly for hepatocellular carcinoma(HCC),has recently started,yielding promising local control *** addition,data suggest a possibility that SBRT can be an alternative option for HCC unfit for other local ***,information on optimal treatment indications,doses,and methods remains *** HCC,significant differences in patient characteristics and treatment availability exist by *** addition,the prognosis of HCC is greatly influenced by underlying liver dysfunction and treatment itself in addition to tumor *** they are closely linked to treatment approach,it is important to understand these differences in interpreting outcomes from various *** studies are required to validate and maximize the efficacy of SBRT by a large,multi-institutional setting.

关键词： Hepatocellular carcinoma Liver cirrhosis Liver neoplasms Radiation therapy Stereotactic body radiation therapy

Effect of Helicobacter pylori eradication on elder cases:Observational study in community-based medicine

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World Journal of Clinical Cases 2017年第12期5卷 412-418页

作者： Masaki Maruyama Kenya Kamimura Ayako Hoshiyama Koki Hoshiyama Mari Hoshiyama Yoshihiro Hoshiyama Shuji Terai Department of Gastroenterology Kashiwazaki General Hospital and Medical Center Department of Internal Medicine Kashiwazaki Chuo Hospital Division of Gastroenterology and Hepatology Graduate School of Medical and Dental SciencesNiigata University Department of Surgery Kashiwazaki Chuo Hospital

AIM To examine the effect of Helicobacter pylori(***)eradication therapy on the extra-gastrointestinal factors in elderly patients by a before-after observational study in community *** records(1 May 2013-31 January 2014)of 130patients who underwent *** eradication therapy with 2-year after-eradication observation in our institute were *** on sex;age;body weight;body mass index(BMI);mean corpuscular volume(MCV);total protein;low-density lipoprotein cholesterol,triglyceride,haemoglobin A1c and haemoglobin levels and gastric hyperplastic polyps(GHPs)at eradication was ***-year after-eradication change in data was analysed by paired-sample t-test;relationship between GHPs and subclinical iron deficiency anaemia(IDA)improvement was *** mean patient age(median,interquartile range)at eradication was 69.6(71.5,64-77)***-sample t-tests showed that body weight,BMI and MCV increased by 0.52 kg(P=0.018),0.25 kg/m^2(P=0.006)and 0.83f L(P<0.001),*** nonparametric MannWhitney test showed no significant difference in the change rate of MCV after eradication between the groups with and without GHPs(P=0.892).*** eradication therapy prevented weight loss and subclinical IDA in elderly *** were not associated with subclinical IDA.

关键词： Helicobacter pylori Iron deficiency anaemia Body weight Elderly Polyp

Does massive intraabdominal free gas require surgical intervention?

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World Journal of Gastroenterology 2016年第32期22卷 7383-7388页

作者： Tadashi Furihata Makoto Furihata Kunibumi Ishikawa Masato Kosaka Naoki Satoh Keiichi Kubota Department of General Surgery Kyouwa Chuo Hospital Department of Gastroenterological Surgery Dokkyo Medical University

We describe a rare case of an 81-year-old man who presented with severe epigastralgia. A chest radiograph showed massive free gas bilaterally in the diaphragmatic spaces. Computed tomography(CT) scan also showed massive free gas in the peritoneal cavity with portal venous gas. We used a wait-andsee approach and carefully considered surgery again when the time was appropriate. The patient received conservative therapy with fasting, an intravenous infusion of antibiotics, and nasogastric intubation. The patient soon recovered and was able to start eating meals 4 d after treatment; thus, surgical intervention was avoided. Thereafter, colonoscopy examination showed pneumatosis cystoides intestinalis in the ascending colon. On retrospective review, CT scan demonstrated sporadic air-filled cysts in the ascending colon. The present case taught us a lesson: the presence of massive intraabdominal free gas with portal venous gas does not necessarily require surgical intervention. Pneumatosis cystoides intestinalis should be considered as a potential causative factor of free gas with portal venous gas when making the differential diagnosis.

关键词： Case reports Portal vein Pneumatosis cystoides intestinalis Colonoscopy General surgery

Questionnaire survey regarding the current status of superextended lymph node dissection in Japan

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World Journal of Gastrointestinal Oncology 2016年第9期8卷 707-714页

作者： Shinji Morita Takeo Fukagawa Hisataka Fujiwara Hitoshi Katai Department of Surgical Oncology National Cancer Center HospitalChuo-kuTokyo

AIM To verify the current status of super-extended lymph node dissection for advanced gastric cancer according to a questionnaire *** One-hundred and five institutions responded to the *** survey included the following items: Number of experiences,whether performed prophylactically and/or therapeutically,whether preoperative chemotherapy was provided,number of preoperative chemotherapy rounds,and therapeutic options after *** Eighty-seven of the 105 institutions(83%) had performed D3 gastrectomy in the past or continued to perform D3 gastrectomy at ***,D3 gastrectomy was rarely performed prophylactically in clinical ***-eight institutions(74%) indicated that preoperative chemotherapy with curative intent was required for patients suspected of having para-aortic node(PAN) *** chemotherapy,a D3 gastrectomy was scheduled for patients with a complete or partial response,stable disease,and progressive disease at 36(46%),28(36%),and 13(17%) of the institutions,*** For patients with apparent PAN metastasis,a D3 gastrectomy is typically planned if a few courses of preoperative chemotherapy yield at least a stable disease condition.

关键词： Questionnaire survey Advanced gastric cancer Radical surgery Para-aortic nodal dissection Preoperative chemotherapy

Chromoendoscopy of gastric adenoma using an acetic acid indigocarmine mixture

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World Journal of Gastroenterology 2014年第17期20卷 5092-5097页

作者： Yoshiyasu Kono Ryuta Takenaka Yoshiro Kawahara Hiroyuki Okada Keisuke Hori Seiji Kawano Yasushi Yamasaki Koji Takemoto Takayoshi Miyake Shigeatsu Fujiki Kazuhide Yamamoto Department of Gastroenterology and Hepatology Okayama University Graduate School of MedicineDentistry and Pharmaceutical SciencesOkayama 700-8558Japan 2~(nd) Department of Internal Medicine Tsuyama Chuo HospitalOkayama 708-0841Japan Department of Internal Medicine Tsuyama Chuo HospitalOkayama 708-0841Japan Department of Endoscopy Okayama University HospitalOkayama 700-8558Japan Department of Pathology Tsuyama Chuo HospitalOkayama 708-0841Japan

AIM: To investigate the usefulness of chromoendoscopy, using an acetic acid indigocarmine mixture (AIM), for gastric adenoma diagnosed by forceps biopsy.

关键词： Acetic acid indigocarmine mixture Early gastric cancer Gastric adenoma Reddish change Endoscopic submucosal dissection

Endoscopic management of unresectable malignant gastroduodenal obstruction with a nitinol uncovered metal stent: a prospective Japanese multicenter study

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World Journal of Gastroenterology 2016年第14期22卷 3837-3844页

作者： Reina Sasaki Yuji Sakai Toshio Tsuyuguchi Takao Nishikawa Tatsuya Fujimoto Shigeru Mikami Harutoshi Sugiyama Osamu Yokosuka Department of Gastroenterology and Nephrology Graduate School of Medicine Chiba University Department of Gastroenterology Kimitsu Chuo Hospital Department of Gastroenterology Kikkoman General Hospital

AIM: To determine the safety and efficacy of endoscopic duodenal stent placement in patients with malignant gastric outlet ***: This prospective, observational, multicenter study included 39 consecutive patients with malignant gastric outlet obstruction. All patients underwent endoscopic placement of a nitinol, uncovered, selfexpandable metal stent. The primary outcome was clinical success at 2 wk after stent placement that was defined as improvement in the Gastric Outlet Obstruction Scoring System score relative to the ***: Technical success was achieved in all duodenal stent procedures. Procedure-related complications occurred in 4 patients(10.3%) in the form of mild pneumonitis. No other morbidities or mortalitieswere observed. The clinical success rate was 92.3%. The mean survival period after stent placement was 103 d. The mean period of stent patency was 149 d and the patency remained acceptable for the survival period. Stent dysfunction occurred in 3 patients(7.7%) on account of tumor ***: Endoscopic management using duodenal stents for patients with incurable malignant gastric outlet obstruction is safe and improved patients' quality of life.

关键词： Duodenal stenosis Gastrointestinal stent Gastric stenosis Malignant tumors Metallic stent

Esophageal diverticulum: New perspectives in the era of minimally invasive endoscopic treatment

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World Journal of Gastroenterology 2019年第12期25卷 1457-1464页

作者： Hiroki Sato Manabu Takeuchi Satoru Hashimoto Ken-ichi Mizuno Koichi Furukawa Akito Sato Junji Yokoyama Shuji Terai Division of Gastroenterology Niigata University Medical and Dental Hospital Division of Gastroenterology Nagaoka Red Cross Hospital Division of Gastroenterology Niigata City General Hospital Division of Gastroenterology Nagaoka Chuo General Hospital

Esophageal diverticula are rare conditions that cause esophageal symptoms, such as dysphagia, regurgitation, and chest pain. They are classified according to their location and characteristic pathophysiology into three types: epiphrenic diverticulum, Zenker's diverticulum, and Rokitansky diverticulum. The former two disorders take the form of protrusions, and symptomatic cases require interventional treatment. However, the esophageal anatomy presents distinct challenges to surgical resection of the diverticulum, particularly when it is located closer to the oral orifice. Since the condition itself is not malignant,minimally invasive endoscopic approaches have been developed with a focus on alleviation of symptoms. Several types of endoscopic devices and techniques are currently employed, including peroral endoscopic myotomy(POEM). However,the use of minimally invasive endoscopic approaches, like POEM, has allowed the development of new disorder called iatrogenic esophageal diverticula. In this paper, we review the pathophysiology of each type of diverticulum and the current state-of-the-art treatment based on our experience.

关键词： Diverticulum Esophagus Epiphrenic diverticulum Zenker's diverticulum Rokitansky diverticulum Iatrogenic disease Esophageal achalasia Peroral endoscopic myotomy Diverticulectomy

Malignant biliary obstruction due to metastatic non-hepatopancreato-biliary cancer

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World Journal of Gastroenterology 2022年第10期28卷 985-1008页

作者： Takeshi Okamoto Department of Gastroenterology St.Luke’s International HospitalChuo-ku 104-8560TokyoJapan

Malignant biliary obstruction generally results from primary malignancies of the pancreatic head,bile duct,gallbladder,liver,and ampulla of *** lesions from other primaries to these organs or nearby lymph nodes are rarer causes of biliary *** most common primaries include renal cancer,lung cancer,gastric cancer,colorectal cancer,breast cancer,lymphoma,and *** may be difficult to differentiate from primary hepato-pancreatobiliary cancer based on imaging studies,or even on *** is also no consensus on the optimal method of treatment,including the feasibility and effectiveness of endoscopic intervention or surgery.A thorough review of the literature on pancreato-biliary metastases and malignant biliary obstruction due to metastatic non-hepato-pancreato-biliary cancer is *** diagnostic modality and clinical characteristics may differ significantly depending on the type of primary *** primaries also cause malignant biliary obstruction in different ways,including direct invasion,pancreatic or biliary metastasis,hilar lymph node metastasis,liver metastasis,and peritoneal *** may hold promise for some types of pancreato-biliary *** review aims to elucidate the current knowledge in this area,which has received sparse attention in the *** aging population,advances in diagnostic imaging,and improved treatment options may lead to an increase in these rare occurrences going forward.

关键词： Bile duct obstruction Obstructive jaundice Pancreas Metastasis Endoscopic retrograde cholangiopancreatography

Poorly differentiated endocrine carcinoma of the pancreas responded to gemcitabine:Case report

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World Journal of Gastroenterology 2010年第30期16卷 3853-3856页

作者： Shoichi Nakazuru Toshiyuki Yoshio Shigeki Suemura Mari Itoh Manabu Araki Chiaki Yoshioka Makiyo Ohta Yuka Sueyoshi Takashi Ohta Hiroko Hasegawa Kaori Morita Takashi Toyama Noriyoshi Kuzushita Yoshinori Kodama Masayuki Mano Eiji Mita Department of Gastroenterology and Hepatology National Hos- pital OrganizationOsaka National Hospital2-1-14 HouenzakaChuo-kuOsaka CityOsaka 540-0006Japan Department of Pathology National Hospital OrganizationOsaka National Hospital2-1-14 HouenzakaChuo-kuOsaka CityOsaka 540-0006Japan

Poorly differentiated endocrine carcinoma (PDEC) of the pancreas is a rare and aggressive tumor. First-line treatment is commonly a combination of etoposide and cisplatin, but there is no consensus regarding further treatment recommendations. In this report, we describe a case of pancreatic PDEC treated with gemcitabine as third-line chemotherapy. A 62-year-old man with pancreatic PDEC was administered etoposide plus cisplatin as first-line treatment; he then received irinotecan for tumor relapse. However, because irinotecan induced ileus in this patient, we chose gemcitabine as thirdline chemotherapy. After two cycles of gemcitabine (1000 mg/m2 on days 1, 8 and 15 every 4 wk), a partialtumor response was noted by computed tomography (approximately 68% reduction in tumor size). Our patient survived for 15 mo after diagnosis. This is a rare case of unresectable pancreatic PDEC, which showed a partial response to gemcitabine after the failure of two other regimens. Gemcitabine could be an effective treatment option for pancreatic PDEC that is resistant to other treatments.

关键词： Poorly differentiated endocrine carcinoma Pancreatic endocrine tumor Gemcitabine Chemotherapy