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増田 充弘医学部附属病院 光学医療診療部准教授
研究活動情報
■ 受賞- 2019年01月 兵庫県科学技術振興財団 研究助成 個人
- 2017年03月 兵庫県医師会 研究助成 個人
- 2016年12月 財団法人膵臓病研究財団 膵臓病研究財団研究奨励賞 個人
- 2014年12月 2nd International MPE meeting MPE trainee award
- 2010年12月 財団法人膵臓病研究財団, 膵臓病研究財団研究奨励賞, 個人
- OBJECTIVES: Covered self-expandable metal stents are commonly used for unresectable malignant distal biliary obstruction. Partially covered self-expandable metal stents have uncovered sections at both ends; however, their anti-migration effect remains unclear. The objective of this study was to evaluate that effect by comparing such stents with fully covered self-expandable metal stents for patients with unresectable malignant distal biliary obstruction. METHODS: This was a multicenter, retrospective comparative study of partially covered stents with fully covered stents for unresectable malignant distal biliary obstruction. Stent migration, recurrent biliary obstruction, and the time to recurrent biliary obstruction were compared between them. RESULTS: Thirty-nine patients with partially covered stents were included and compared with 42 patients with fully covered stents. The partially covered group had a significantly lower stent migration rate (3% vs. 36%; p < 0.001). The recurrent biliary obstruction rate was significantly lower in the partially covered group (21% vs. 43%; p = 0.036). The non-recurrent biliary obstruction rate at 6 months was 90% and 68% in the partially and fully covered groups, respectively. The time to recurrent biliary obstruction was significantly longer in the partially covered group (Gray's test, p = 0.016). Only partially covered stent placement was significantly associated with a lower risk of stent migration (subdistribution hazard ratio = 0.077; 95% confidence interval = 0.01-0.60; p = 0.014) in the multivariable analysis. CONCLUSIONS: The anti-migration effect of partially covered self-expandable metal stents was associated with a reduced recurrence of biliary obstruction and prolonged time to such obstruction.2025年04月, DEN open, 5(1) (1), e70100, 英語, 国際誌研究論文（学術雑誌）
- BACKGROUND AND AIMS: Endoscopic ultrasound-guided peripancreatic fluid drainage (EUS-PFD) with on-demand endoscopic necrosectomy, increasingly utilized to manage walled-off necrosis (WON), is associated with substantial morbidity and mortality. This multicenter study aimed to externally validate recently developed quadrant (an abdominal quadrant distribution), necrosis, and infection (QNI) criteria for risk stratification in this setting. METHODS: Of 423 patients with pancreatic fluid collections treated in a large multi-institutional cohort between 2010 and 2020, 212 with available preprocedural computed tomography images were included. Clinical outcomes between high- and low-risk groups defined according to QNI criteria were compared. RESULTS: The clinical success rate did not differ significantly between the QNI-high and QNI-low groups (74.4% vs. 83.5%, respectively; P = 0.12). Time to clinical success was longer in the QNI-high group compared with the QNI-low group (median, 68 vs. 46 days, respectively; P = 0.0016). Compared with the QNI-low group, the QNI-high group was associated with higher rates of percutaneous interventions, direct endoscopic necrosectomy, mortality, and adverse events. The QNI-high group was independently associated with time to clinical success (hazard ratio 0.64, 95% confidence interval 0.46-0.87; P =0.005) in multivariable Cox proportional hazards regression analysis, and with the risk of ≥grade III adverse events (odds ratio 2.93, 95% confidence interval 1.04-8.20; P = 0.04) in multivariable logistic regression analysis. CONCLUSIONS: The QNI criteria effectively stratified time to clinical success and the risk of adverse outcomes for patients receiving EUS-PFD of WON. Further investigations could elucidate appropriate management strategies based on QNI-based risk stratification.2025年01月, Gastrointestinal endoscopy, 英語, 国際誌研究論文（学術雑誌）
- BACKGROUND AND AIMS: Endoscopic ultrasound (EUS)-guided transmural drainage with on-demand endoscopic necrosectomy (EN) is increasingly utilized to manage walled-off necrosis (WON). It has not been fully elucidated how EN and its timing are correlated with treatment outcomes compared to the drainage-based approach. METHODS: Within a multi-institutional cohort of 423 patients with pancreatic fluid collections including 227 patients with WON, we identified 153 patients who received the step-up treatment following the initial EUS-guided drainage of symptomatic WON, including 102 EN patients and 51 non-EN (drainage) patients. Using the competing-risks multivariable proportional hazards regression model with adjustment for potential confounders, we calculated subdistribution hazard ratios (SHRs) for clinical treatment success (WON resolution) by the use of EN and its timing. RESULTS: Compared to drainage alone, the EN-based treatment was associated with a shorter time to clinical success with a multivariable SHR of 1.66 (95% confidence interval, 1.12-2.46). Despite a higher risk of procedure-related bleeding in the EN group, there were no differences in the rates of severe adverse events (7.8% vs. 5.9% in the EN and non-EN groups, respectively) and mortality (6.9% vs. 9.8%). In the EN-treated patients, the timing of EN was not statistically significantly associated with the time to clinical success (Ptrend = 0.34) CONCLUSION: Among patients receiving EUS-guided treatment of symptomatic WON, the use of EN in addition to drainage procedures was associated with earlier disease resolution. Further research is desired to determine the optimal timing of initiating EN considering a risk-benefit balance and cost-effectiveness.2024年11月, Gastrointestinal endoscopy, 英語, 国際誌研究論文（学術雑誌）
- (一社)日本消化器内視鏡学会, 2024年10月, Gastroenterological Endoscopy, 66(Suppl.2) (Suppl.2), 2309 - 2309, 日本語WONに対する内視鏡下ドレナージ後step up治療の因子についての多施設共同研究 WONDERFUL study group
- (一財)日本消化器病学会, 2024年10月, 日本消化器病学会雑誌, 121(臨増大会) (臨増大会), A732 - A732, 日本語
- INTRODUCTION: Disconnected pancreatic duct syndrome (DPDS) is a pathological condition that causes various symptoms due to the continuous secretion of pancreatic enzymes from the pancreas upstream, which has been separated due to disconnection of the pancreatic duct (DPD) for various reasons.Acute necrotizing pancreatitis includes a certain probability of DPDS appearance, which makes it necessary to provide various treatments for DPDS. Furthermore, DPDS can impact long-term results, such as recurrence and impaired pancreatic function. Although the development of various modalities has contributed to diagnosis and treatment, especially less invasive endoscopic therapy, DPDS is often overlooked, and the diagnosis can be delayed due to the lack of consensus on its definition and classification. This review summarizes the current knowledge and challenges of DPDS and discusses the optimal strategy for its diagnosis and treatment, as well as future perspectives. AREAS COVERED: Given the lack of established definition, diagnosis, and treatment of DPDS, we conducted a thorough review of the existing literature. EXPERT OPINION: It is emphasized that a standardized definition and classification of DPDS is essential for designing and conducting clinical studies to address current unmet needs in managing patients with DPDS.2024年10月, Expert review of gastroenterology & hepatology, 18(10) (10), 631 - 645, 英語, 国際誌研究論文（学術雑誌）
- OBJECTIVES: The appropriate holistic management is mandatory for successful endoscopic ultrasound (EUS)-guided treatment of pancreatic fluid collections (PFCs). However, comorbidity status has not been fully examined in relation to clinical outcomes of this treatment. METHODS: Using a multi-institutional cohort of 406 patients receiving EUS-guided treatment of PFCs in 2010-2020, we examined the associations of Charlson Comorbidity Index (CCI) with in-hospital mortality and other clinical outcomes. Multivariable logistic regression analysis was conducted with adjustment for potential confounders. The findings were validated using a Japanese nationwide inpatient database including 4053 patients treated at 486 hospitals in 2010-2020. RESULTS: In the clinical multi-institutional cohort, CCI was positively associated with the risk of in-hospital mortality (Ptrend < 0.001). Compared to patients with CCI = 0, patients with CCI of 1-2, 3-5, and ≥6 had adjusted odds ratios (95% confidence intervals) of 0.76 (0.22-2.54), 5.39 (1.74-16.7), and 8.77 (2.36-32.6), respectively. In the nationwide validation cohort, a similar positive association was observed; the corresponding odds ratios (95% confidence interval) were 1.21 (0.90-1.64), 1.52 (0.92-2.49), and 4.84 (2.63-8.88), respectively (Ptrend < 0.001). The association of higher CCI with longer length of stay was observed in the nationwide cohort (Ptrend < 0.001), but not in the clinical cohort (Ptrend = 0.18). CCI was not associated with the risk of procedure-related adverse events. CONCLUSIONS: Higher levels of CCI were associated with a higher risk of in-hospital mortality among patients receiving EUS-guided treatment of PFCs, suggesting the potential of CCI in stratifying the periprocedural mortality risk. TRIAL REGISTRATION: The research based on the clinical data from the WONDERFULcohort was registered with UMIN-CTR (registration number UMIN000044130).2024年09月, Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society, 英語, 国際誌研究論文（学術雑誌）
- BACKGROUND: Focal pancreatic parenchymal atrophy (FPPA) and upstream pancreatic atrophy (UPA) may indicate the presence of early pancreatic cancer. In early pancreatic cancer, the tumor occasionally spreads laterally along the main pancreatic duct, presenting challenges in determining the extent of surgical resection. This study aimed to investigate the association of pancreatic atrophy pattern and intraductal cancer extension. METHODS: Thirty-two patients with early-stage pancreatic cancer who underwent surgery at five participating centers were enrolled. Pancreatic atrophy was defined as the narrowing of parenchyma compared to the surrounding parenchyma and was classified as either FPPA (partial atrophy surrounding the pancreatic duct stenosis) or UPA (global atrophy caudal to the site of duct stenosis). Intraductal cancer extension was defined as an extension exceeding 10 mm. RESULTS: Preoperative computed tomography revealed FPPA, UPA, and no parenchymal atrophy in 13, 13, and 6 patients. Cases with FPPA or UPA showed significantly longer cancer extensions than those without atrophy (P = 0.005 and P = 0.03, respectively). Intraductal cancer extension was present in all but one case of FPPA. 69% (9/13) of the cases with UPA showed intraductal cancer extension, whereas cases without atrophy showed no intraductal cancer extension. Importantly, two patients with FPPA or UPA showed positive resection margins during surgery and three patients with FPPA or UPA showed recurrence in the remnant pancreas. CONCLUSIONS: The presence of FPPA and UPA indicates lateral cancer extension in early-stage pancreatic cancer. Preoperative assessment of the pancreatic parenchyma may provide valuable insights for determining the extent of surgical resection.2024年09月, Journal of gastroenterology, 英語, 国内誌研究論文（学術雑誌）
- (一社)日本癌学会, 2024年09月, 日本癌学会総会記事, 83回, J - 2054, 英語膵癌の腫瘍免疫・予後に関連する腫瘍内細菌叢の探索(Association of Intratumoral Microbiome with Tumor Immunity and Prognosis in Human Pancreatic Cancer)
- BACKGROUND: Endoscopic ultrasound (EUS)-guided transluminal drainage has become a first-line treatment modality for symptomatic pancreatic pseudocysts. Despite the increasing popularity of lumen-apposing metal stents (LAMSs), plastic stents may resolve non-necrotic fluid collections effectively with lower costs and no LAMS-specific adverse events. To date, there has been a paucity of data on the appropriate stent type in this setting. This trial aims to assess the non-inferiority of plastic stents to a LAMS for the initial EUS-guided drainage of pseudocysts. METHODS: The WONDER-02 trial is a multicentre, open-label, non-inferiority, randomised controlled trial, which will enrol pancreatic pseudocyst patients requiring EUS-guided treatment in 26 centres in Japan. This trial plans to enrol 80 patients who will be randomised at a 1:1 ratio to receive either plastic stents or a LAMS (40 patients per arm). In the plastic stent group, EUS-guided drainage will be performed using two 7-Fr double pigtail stents. In the LAMS group, the treatment will be performed in the same way except for LAMS use. The step-up treatment will be performed via endoscopic and/or percutaneous procedures at the trial investigator's discretion. The primary endpoint is clinical success, which is defined as a decrease in a pseudocyst size to ≤ 2 cm and an improvement in inflammatory indicators (i.e. body temperature, white blood cell count, and serum C-reactive protein). Secondary endpoints include technical success, adverse events including mortality, pseudocyst recurrence, and medical costs. DISCUSSION: The WONDER-02 trial will investigate the efficacy and safety of plastic stents compared to a LAMS in EUS-guided treatment of symptomatic pancreatic pseudocysts with a particular focus on the non-inferior efficacy of plastic stents. The findings will help establish a new treatment algorithm for this population. TRIAL REGISTRATION: ClinicalTrials.gov NCT06133023 registered on 9 November 2023. UMIN000052647 registered on 30 October 2023. jRCT1032230444 registered on 7 November 2023.2024年08月, Trials, 25(1) (1), 559 - 559, 英語, 国際誌研究論文（学術雑誌）
- Background Pancreatic duct (PD) disruption can occasionally be attributed to pancreatic cancer. Therapeutic interventions for PD disruption due to pancreatic cancer and their influence on pancreatic cancer prognosis remain unclear. This study investigated the therapeutic modalities and prognostic implications of PD disruption in pancreatic cancer. Methods This retrospective study included 15 patients with PD disruption concomitant with pancreatic cancer between April 2011 and March 2023. As an endoscopic intervention for PD disruption, endoscopic pancreatic stenting (EPS) or endoscopic ultrasonography-guided pancreatic fluid collection drainage (EUS-PFD) was performed. Technical success was defined as stent placement and clinical success was defined as an improvement in PD disruption. Results Of the 15 cases of PD disruption, two involved only pancreatic juice leakage without symptoms, four involved pancreatic pseudocyst (PPC) without infection, and nine involved PPC with infection. Four patients underwent EPS, nine underwent EUS-PFD, and two underwent lumen-apposing metal stent placement. All patients achieved both technical and clinical success without complications. The clinical stage of pancreatic cancer ranged from carcinoma in situ to the metastatic phase. For the treatment of pancreatic cancer, five patients underwent surgical resection, and eight underwent chemotherapy. There was no obvious recurrence of peritoneal sowing. The median overall survival from the diagnosis of pancreatic cancer in the resected and non-resected cases was 74 and 9.6 months, respectively. Conclusion Endoscopic intervention was effective in all cases of PD disruption due to pancreatic cancer. Furthermore, even in cases of pancreatic cancer after PD disruption, survival rates were similar to those in cases without PD disruption and were achieved through surgical resection or chemotherapy.2024年08月, Cureus, 16(8) (8), e67482, 英語, 国際誌研究論文（学術雑誌）
- (一社)日本膵臓学会, 2024年07月, 膵臓, 39(3) (3), A199 - A199, 日本語
- (一社)日本膵臓学会, 2024年07月, 膵臓, 39(3) (3), A206 - A206, 日本語
- (一社)日本膵臓学会, 2024年07月, 膵臓, 39(3) (3), A262 - A262, 日本語
- (一社)日本膵臓学会, 2024年07月, 膵臓, 39(3) (3), A294 - A294, 日本語
- (一社)日本膵臓学会, 2024年07月, 膵臓, 39(3) (3), A336 - A336, 日本語
- (一社)日本膵臓学会, 2024年07月, 膵臓, 39(3) (3), A440 - A440, 日本語
- Elsevier BV, 2024年07月, iGIE研究論文（学術雑誌）
- This study investigated the utility of imaging features, such as rim enhancement on contrast-enhanced CT (CECT), in predicting the prognosis of pancreatic ductal adenocarcinoma (PDAC). This retrospective study included 158 patients (84 men; mean age, 68 years) with pathologically confirmed PDAC. The following imaging features were evaluated on CECT by two radiologists: tumor size, tumor attenuation, and the presence of rim enhancement. Cox proportional hazards analysis was performed to identify the imaging and clinicopathological features for predicting disease-free survival (DFS) and overall survival (OS). Pathological features were compared with the presence of rim enhancement. Among the 158 patients, 106 (67%) underwent curative surgery (surgery group) and 52 (33%) received conservative treatment (non-surgery group). Rim enhancement was observed more frequently in the non-surgery group than in the surgery group (44% vs. 20%; p < 0.001). Rim enhancement showed significant associations with shorter DFS and OS in the surgery group (hazard ratios (HRs), 3.03 and 2.99; p < 0.001 and p = 0.003, respectively), whereas tumor size showed significant associations with shorter OS (HR per 1 mm increase, 1.08; p < 0.001). PDACs with rim enhancement showed significant associations with higher histological tumor grades (p < 0.001). PDAC with rim enhancement on CECT could predict poorer prognosis and more aggressive tumor grades.MDPI AG, 2024年04月, Diagnostics, 14(8) (8), 782 - 782研究論文（学術雑誌）
- (一社)日本消化器内視鏡学会, 2024年04月, Gastroenterological Endoscopy, 66(Suppl.1) (Suppl.1), 993 - 993, 日本語Walled-off necrosisに対するEUS-guided drainage後のstep-up治療法別の成績 WONDERFUL study group
- BACKGROUND: Focal parenchymal atrophy and main pancreatic duct (MPD) dilatation have been identified as early signs of pancreatic ductal adenocarcinoma. However, limited evidence exists regarding their temporal progression due to previous study limitations with restricted case numbers. OBJECTIVE: To ascertain a more precise frequency assessment of suspicious pancreatic ductal adenocarcinoma findings as well as delineate the temporal progression of them. METHODS: A multicenter retrospective study was conducted on patients diagnosed with pancreatic ductal adenocarcinoma between 2015 and 2021. We included patients who had undergone at least one computed tomography (CT) scan ≥6 months before diagnosing pancreatic ductal adenocarcinoma. The temporal progression of suspicious pancreatic ductal adenocarcinoma findings on CT was investigated. RESULTS: Out of 1832 patients diagnosed with pancreatic ductal adenocarcinoma, 320 had a previous CT before their diagnosis. Suspicious pancreatic ductal adenocarcinoma findings were detected in 153 cases (47.8%), with focal parenchymal atrophy (26.6%) being the most common followed by MPD dilatation (11.3%). Focal parenchymal atrophy was the earliest detectable sign among all suspicious findings and became visible on average 2.7 years before diagnosis, and the next most common, MPD dilatation, 1.1 years before diagnosis. Other findings, such as retention cysts, were less frequent and appeared around 1 year before diagnosis. Focal parenchymal atrophy followed by MPD dilatation was observed in 10 patients but not in reverse order. Focal parenchymal atrophy was more frequently detected in the pancreatic body/tail. No significant relationship was found between the pathological pancreatic ductal adenocarcinoma differentiation or tumor stage and the time course of the CT findings. All cases of focal parenchymal atrophy progressed just prior to diagnosis, and the atrophic area was occupied by tumor at diagnosis. Main pancreatic duct dilatation continued to progress until diagnosis. CONCLUSION: This large-scale study revealed that the temporal progression of focal parenchymal atrophy is the earliest detectable sign indicating pancreatic ductal adenocarcinoma. These results provide crucial insights for early pancreatic ductal adenocarcinoma detection.2024年03月, United European gastroenterology journal, 英語, 国際誌研究論文（学術雑誌）
- (一財)日本消化器病学会, 2024年03月, 日本消化器病学会雑誌, 121(臨増総会) (臨増総会), A81 - A81, 日本語
- (一財)日本消化器病学会, 2024年03月, 日本消化器病学会雑誌, 121(臨増総会) (臨増総会), A187 - A187, 日本語
- (一財)日本消化器病学会, 2024年03月, 日本消化器病学会雑誌, 121(臨増総会) (臨増総会), A330 - A330, 日本語
- (一財)日本消化器病学会, 2024年03月, 日本消化器病学会雑誌, 121(臨増総会) (臨増総会), A431 - A431, 日本語
- Background and study aims Recent advances in endoscopic transmural treatment have improved the clinical outcomes of patients with pancreatic fluid collections (PFCs). However, there is still a debate about the preventive effect of long-term placement of a transmural plastic stent (PS) on recurrence after successful endoscopic ultrasound (EUS)-guided treatment of PFCs. We conducted a systematic review and meta-analysis to evaluate PFC recurrence rates with and without a transmural PS after EUS-guided treatment. Patients and methods A systematic literature search of PubMed, Embase, and the Cochrane database was conducted to identify clinical studies comparing outcomes with and without transmural PS published until September 2022. Data on PFC recurrence and adverse events (AEs) were pooled using a random-effects model. Results Nine studies including 380 patients with long-term transmural PS and 289 patients without PS were identified. The rate of PFC recurrence was significantly lower in patients with transmural PS (pooled odds ratio [OR] = 0.23, 95% confidence interval [CI] [0.08-0.65], P = 0.005). In a subgroup analysis limited to studies focusing on patients with disconnected pancreatic duct syndrome, which has been reported to be a risk factor for PFC recurrence, the OR was numerically lower than that for the entire cohort (OR = 0.14, 95% CI [0.04-0.46]). The rate of AEs was significantly higher with long-term transmural PS (OR = 14.77, 95% CI [4.21-51.83]). Conclusions In this meta-analysis, long-term PS placement reduced the risk of PFC recurrence. Given the potential AEs of indwelling PS, further research is required to evaluate the overall benefits of long-term PS placement.2024年02月, Endoscopy international open, 12(2) (2), E188-E198, 英語, 国際誌研究論文（学術雑誌）
- BACKGROUND: The impact of extended steroid administration on patients with autoimmune pancreatitis after a 3-year maintenance period remains poorly understood. This study analyzed the advantage and disadvantage of continuing steroid therapy beyond 3 years. METHODS: In this retrospective multicenter study across 17 institutions, patients who successfully completed 3 years of maintenance therapy without experiencing relapse were categorized into two groups: the maintenance therapy discontinuation group, who discontinued steroid therapy after the initial 3-year period, and maintenance therapy continuation group, who continued steroid therapy beyond 3 years. The cumulative relapse rate after 3 years of maintenance therapy was the primary outcome. Relapse predictors were compared using the Gray test for cumulative relapse incidence by specific factor. RESULTS: Of 211 patients, 105 experienced no relapse during the 3-year maintenance therapy and were divided into two groups: 69 in the maintenance therapy discontinuation group and 36 in the maintenance therapy continuation group. The relapse rate was lower in the maintenance therapy continuation group than in the maintenance therapy discontinuation group (P = 0.035). Predictors of relapse after 3 years included cessation of maintenance therapy (hazard ratio [HR] = 3.76; 95 % confidence interval [CI] = 1.07-13.3, P = 0.040) and renal involvement (HR = 2.88; 95 % CI = 1.04-7.99, P = 0.042). The maintenance therapy continuation group showed a significantly higher prevalence of macrovascular complications, compared with the maintenance therapy discontinuation group (P = 0.005). CONCLUSIONS: Cessation of steroid maintenance therapy and renal involvement were predictors of relapse after 3 years of maintenance therapy. However, the long-term use of steroids may increase the risk of macrovascular complications.2024年01月, Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.], 英語, 国際誌研究論文（学術雑誌）
- BACKGROUND: Recent evidence suggests that the presence of microbiome within human pancreatic ductal adenocarcinoma (PDAC) tissue potentially influences cancer progression and prognosis. However, the significance of tumor-resident microbiome remains unclear. We aimed to elucidate the impact of intratumoral bacteria on the pathophysiology and prognosis of human PDAC. METHODS: The presence of intratumoral bacteria was assessed in 162 surgically resected PDACs using quantitative polymerase chain reaction (qPCR) and in situ hybridization (ISH) targeting 16S rRNA. The intratumoral microbiome was explored by 16S metagenome sequencing using DNA extracted from formalin-fixed paraffin-embedded tissues. The profile of intratumoral bacteria was compared with clinical information, pathological findings including tumor-infiltrating T cells, tumor-associated macrophage, fibrosis, and alterations in four main driver genes (KRAS, TP53, CDKN2A/p16, SMAD4) in tumor genomes. RESULTS: The presence of intratumoral bacteria was confirmed in 52 tumors (32%) using both qPCR and ISH. The 16S metagenome sequencing revealed characteristic bacterial profiles within these tumors, including phyla such as Proteobacteria and Firmicutes. Comparison of bacterial profiles between cases with good and poor prognosis revealed a significant positive correlation between a shorter survival time and the presence of anaerobic bacteria such as Bacteroides, Lactobacillus, and Peptoniphilus. The abundance of these bacteria was correlated with a decrease in the number of tumor-infiltrating T cells positive for CD4, CD8, and CD45RO. CONCLUSIONS: Intratumoral infection of anaerobic bacteria such as Bacteroides, Lactobacillus, and Peptoniphilus is correlated with the suppressed anti-PDAC immunity and poor prognosis.2024年01月, Journal of gastroenterology, 英語, 国内誌研究論文（学術雑誌）
- 日本消化器病学会-近畿支部, 2024年01月, 日本消化器病学会近畿支部例会プログラム・抄録集, 120回, 70 - 70, 日本語
- 膵周囲液体貯留は，急性膵炎後局所合併症として発生することが多く，臨床経過が悪い場合には致死的となる可能性もある病態であり，症候性の被包化膵壊死や膵仮性囊胞ではインターベンションが必要となる．壊死性膵炎とその後の被包化壊死に対する治療では，外科的治療や経皮的治療から，近年では超音波内視鏡下ドレナージやStep-up approachとしての内視鏡的ネクロセクトミーがより低侵襲であることから選択されるようになっている．Lumen-apposing metal stentをはじめとした治療機器の開発もあり膵周囲液体貯留に対する内視鏡的治療はある程度確立されたものの，ネクロセクトミーの開始あるいは終了時期，ステントの抜去時期を含む様々な治療時期など標準化されていない点が多く残されている．また抗菌薬，栄養療法などの支持療法についてのエビデンスも増えつつあるが，同じく適切な治療時期に関するデータは限られている．本総説では，インターベンション・支持療法の両面からその適応と治療タイミングの現在のエビデンスを提示するとともに，今後検討が必要な課題についても概説する．一般社団法人 日本消化器内視鏡学会, 2024年, 日本消化器内視鏡学会雑誌, 66(9) (9), 1726 - 1737, 日本語
- 2024年01月, Journal of medical ultrasonics (2001), 51(1) (1), 143 - 144, 英語, 国内誌研究論文（学術雑誌）
- BACKGROUND: Postoperative pancreatic fluid collections (POPFCs) are common adverse events (AEs) after pancreatic surgery and may need interventions. Endoscopic ultrasound (EUS)-guided drainage for POPFCs is increasingly reported, but its appropriate timing has not been fully elucidated. The aim of this meta-analysis was to evaluate treatment outcomes of POPFCs according to the timing of EUS-guided drainage. METHODS: Using PubMed, Embase, Web of Science, and the Cochrane database, we identified clinical studies published until December 2022 with data comparing outcomes of early and delayed EUS-guided drainage for POPFCs. We pooled data on AEs, mortality, and technical and clinical success rates, using the random-effects model. RESULTS: From 1415 papers identified in the initial literature search, we identified 6 retrospective studies, including 128 and 107 patients undergoing early and delayed EUS-guided drainage for POPFCs. The threshold of early and delayed drainage ranged from 14 to 30 days. Distal pancreatectomy was the major cause of POPFCs, ranging from 44 to 100%. The pooled odds ratio (OR) for AEs was 0.81 (95% confidence interval [CI] 0.40-1.64, P = 0.55) comparing early to delayed drainage. There was no procedure-related mortality. Technical success was achieved in all cases and a pooled OR of clinical success was 0.60 (95% CI 0.20-1.83, P = 0.37). CONCLUSION: POPFCs can be managed by early EUS-guided drainage without an increase in AEs.2024年01月, Surgical endoscopy, 38(1) (1), 47 - 55, 英語, 国際誌研究論文（学術雑誌）
- 日本消化器内視鏡学会-近畿支部, 2023年11月, 日本消化器内視鏡学会近畿支部例会プログラム・抄録集, 111回, 109 - 109, 日本語経口胆道鏡が有用であった胆嚢管癌の一例
- OBJECTIVES: Aging is associated with a high prevalence of pancreatic cysts and intraductal papillary mucinous neoplasms (IPMNs). Metabolic syndrome (MS) may increase the risk of neoplasms, including those that develop in the pancreas. However, the influence of factors associated with MS on the development of IPMN remains unclear. METHODS: A total of 9363 patients who underwent abdominal ultrasound examinations between April 2012 and May 2013 were included in this study. Multivariate logistic regression analysis was performed to identify factors associated with the presence of IPMN by age. RESULTS: Pancreatic cysts were detected in 198 of 9363 patients, of whom 129 were found to have IPMNs. The presence of IPMN significantly correlated with age (10-year increments; odds ratio, 2.73; 95% CI, 2.28-3.29; P < 0.001). High body mass index, history of smoking, hyperlipidemia, hypertension, and MS were associated with a higher prevalence of IPMN with advancing age. In multivariate analysis, the presence of IPMN was more frequent in elderly patients with MS (odds ratio, 3.14; 95% CI, 3.14-6.72; P = 0.003). CONCLUSIONS: The present study suggests that the incidence of IPMN increases with age and is accelerated in the presence of MS.2023年10月, Pancreas, 英語, 国際誌研究論文（学術雑誌）
- Intraductal papillary mucinous neoplasm (IPMN) is a premalignant lesion of the pancreas that can occasionally manifest as recurrent acute pancreatitis. In this report, we discuss a unique case of a 49-year-old woman who presented with recurrent acute pancreatitis of an unknown cause for several years. Workup using peroral pancreatoscopy eventually showed main-duct IPMN with high-grade dysplasia as the obscure cause of recurrent acute pancreatitis. This case report highlights the clinical course of main-duct IPMN and the evolving role of peroral pancreatoscopy in patients with recurrent acute pancreatitis.2023年10月, ACG case reports journal, 10(10) (10), e01165, 英語, 国際誌
- OBJECTIVES: No comprehensive study has examined short- and long-term adverse outcomes of endoscopic ultrasound (EUS)-guided treatment of pancreatic fluid collections (PFCs) including walled-off necrosis (WON) and pseudocysts. METHODS: In a multi-institutional cohort of 357 patients receiving EUS-guided treatment of PFCs (228 with WON and 129 with pseudocysts), we examined PFC type-specific risk factors for procedure-related adverse events (AEs), clinical failure, and recurrence. Odds ratios (ORs) and hazard ratios (HRs) with 95% confidence intervals (CIs) were computed using the logistic and Cox regression models, respectively, adjusting for potential confounders. RESULTS: AEs were observed predominantly in WON, and risk factors were WON extension to the pelvis (OR, 2.49; 95% CI, 1.00-6.19) and endoscopic necrosectomy (OR, 5.15; 95% CI, 1.61-16.5). Risk factors for clinical failure in WON treatment included higher Charlson Comorbidity Index (OR for ≥3 vs. ≤2, 2.58; 95% CI, 1.05-6.35), extension to the pelvis (OR, 3.63; 95% CI, 1.57-8.43), non-use of a lumen-apposing metal stent (OR, 2.88; 95% CI, 1.10-7.54), and percutaneous drainage (OR, 3.73; 95% CI, 1.27-10.9). Patients with pseudocysts extending to the paracolic gutter and need for more than two endoscopic / percutaneous procedures had ORs for clinical failure of 5.28 (95% CI, 1.10-25.3) and 5.52 (95% CI, 1.61-18.9), respectively. Pseudocysts requiring the multigateway approach were associated with high risk of recurrence (HR, 4.00; 95% CI, 1.11-11.6). CONCLUSIONS: The adverse outcomes at various phases of EUS-guided PFC treatment may be predictable based on clinical parameters. Further research is warranted to optimize treatment strategies for high-risk patients (registration number, UMIN000044130).2023年09月, Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society, 英語, 国際誌研究論文（学術雑誌）
- (一社)日本癌学会, 2023年09月, 日本癌学会総会記事, 82回, 1929 - 1929, 英語膵癌の腫瘍間質膠原線維量と分子病理学的特徴、腫瘍免疫、予後との関連性(Association of Tumor-Stromal Collagen Quantity in PDAC with Molecular Pathology, Tumor Immunity, and Prognosis)
- (一社)日本癌学会, 2023年09月, 日本癌学会総会記事, 82回, 1993 - 1993, 英語同時性・異時性多発膵癌のクローン起源について(Clonal origin of synchronous or metachronous multiple pancreatic cancers)
- BACKGROUND AND AIM: Endoscopic placement of self-expandable metal stents (SEMSs) for malignant distal biliary obstruction (MDBO) may be accompanied by several types of adverse events. The present study analyzed the adverse events occurring after SEMS placement for MDBO. METHODS: The present study retrospectively investigated the incidence and types of adverse events in patients who underwent SEMS placement for MDBO between April 2018 and March 2021 at 26 hospitals. Risk factors for acute pancreatitis, cholecystitis, and recurrent biliary obstruction (RBO) were evaluated by univariate and multivariate analyses. RESULTS: Of the 1425 patients implanted with SEMS for MDBO, 228 (16.0%) and 393 (27.6%) experienced early adverse events and RBO, respectively. Pancreatic duct without tumor involvement (p = 0.023), intact papilla (p = 0.025), and SEMS placement across the papilla (p = 0.037) were independent risk factors for acute pancreatitis. Tumor involvement in the orifice of the cystic duct (OCD) was an independent risk factor for cholecystitis (p < 0.001). Fully and partially covered SEMSs were independent risk factors for food impaction and/or sludge. Fully covered SEMS was an independent risk factor for stent migration. Uncovered SEMS and laser-cut SEMS were independent risk factors for tumor ingrowth. CONCLUSIONS: Pancreatic duct without tumor involvement, intact papilla, and SEMS placement across the papilla were independent risk factors for acute pancreatitis, and tumor involvement to the OCD was an independent risk factor for cholecystitis. The risk factors for food impaction and/or sludge, stent migration, and tumor ingrowth differed among types of SEMS.2023年08月, Gastrointestinal endoscopy, 英語, 国際誌研究論文（学術雑誌）
- (一社)日本胆道学会, 2023年08月, 胆道, 37(3) (3), 393 - 393, 日本語
- Pancreatic cancer primarily arises from microscopic precancerous lesions, such as pancreatic intraepithelial neoplasia (PanIN) and acinar-to-ductal metaplasia (ADM). However, no established method exists for predicting pancreatic precancerous conditions. Endoscopic ultrasonography (EUS) can detect changes in pancreatic parenchymal histology, including fibrosis. This study aimed to elucidate the relationship between pancreatic parenchymal EUS findings and microscopic precancerous lesions. We retrospectively analyzed 114 patients with pancreatobiliary tumors resected between 2010 and 2020 and evaluated the association between pancreatic parenchymal EUS findings and the number of PanIN, ADM, and pancreatic duct gland (PDG). Of the 114 patients, 33 (29.0%), 55 (48.2%), and 26 (22.8%) had normal EUS findings, hyperechoic foci/stranding without lobularity, and hyperechoic foci/stranding with lobularity, respectively. Multivariate analyses revealed that abnormal EUS findings were significantly associated with the frequency of PanIN (hyperechoic foci/stranding without lobularity: OR [95% CI] = 2.7 [1.0-7.3], with lobularity: 6.5 [1.9-22.5], Ptrend = 0.01) and ADM (hyperechoic foci/stranding without lobularity: 3.1 [1.1-8.2], with lobularity: 9.7 [2.6-36.3], Ptrend = 0.003) but not with PDG (hyperechoic foci/stranding without lobularity: 2.2 [0.8-5.8], with lobularity: 3.2 [1.0-10.2], Ptrend = 0.12). We observed a trend toward a significantly higher number of precancerous lesions in the following order: normal findings, hyperechoic foci/stranding without lobularity, and hyperechoic foci/stranding with lobularity. Pancreatic parenchymal EUS findings were associated with the increased frequency of PanIN and ADM. Lobularity may help predict the increased number of precancerous lesions.2023年07月, Scientific reports, 13(1) (1), 12052 - 12052, 英語, 国際誌研究論文（学術雑誌）
- BACKGROUND: Abundant collagen deposition is a hallmark of pancreatic ductal adenocarcinomas (PDACs). This study clarified the interactive relationship between tumor-stromal collagen, molecular and immune characteristics, and tumor pr ogression in human PDAC. METHODS: We performed a comprehensive examination using an integrative molecular pathological epidemiology database on 169 cases with resected PDAC . The amount of tumor-stromal collagen was quantified through digital imaging analysis for Elastica van Gieson-stained whole-section tumor slides. We analyzed the association of tumor-stromal collagen with gene alterations (KRAS, TP53, CDKN2A/p16, and SMAD4), immune parameters (CD4+ tumor-infiltrating lymphocytes [TILs], CD8+ TILs, FOXP3+ TILs, and tertiary lymphoid structures), and patient prognosis. RESULTS: Low amounts of tumor-stromal collagen were associated with poor differentiation (multivariable OR = 3.82, 95%CI = 1.41-12.2, P = 0.008) and CDKN2A/p16 alteration (OR [95%CI] = 2.06 [1.08-4.02], P = 0.03). Tumors with low collagen levels had shorter overall survival (HR [95%CI] = 2.38 [1.59-3.56], P < 0.0001). In the S-1 and gemcitabine (GEM) treatment groups, low tumor-stromal collagen was linked to poor prognosis of patients with PDAC (S-1 group: multivariable HR [95%CI] = 2.76 [1.36-5.79], P = 0.005; GEM group: multivariate HR [95%CI] = 2.91 [1.34-6.71], P = 0.007). Additionally, low amounts of tumor-stromal collagen were also linked to low levels of CD4+ TILs (P = 0.046), CD8+ TILs (P = 0.09), and tertiary lymphoid structures (P = 0.001). CONCLUSIONS: Tumor-stromal collagen deposition may play a crucial role in modulating tumor-immune microenvironment and determining response to adjuvant chemotherapy and patient survival outcomes.2023年07月, Journal of gastroenterology, 58(10) (10), 1055 - 1067, 英語, 国内誌研究論文（学術雑誌）
- Objective We assessed the factors associated with overlap between functional dyspepsia (FD) and nonerosive reflux disease (NERD) in endoscopy-based Helicobacter pylori-uninfected Japanese health checkup participants. Methods We utilized baseline data from 3,085 individuals who underwent upper endoscopy for health screening in a prospective, multicenter cohort study. The participants were asked to complete a questionnaire detailing their upper abdominal symptoms and lifestyle. Anxiety was assessed using the State-Trait Anxiety Inventory (STAI) score. FD, postprandial distress syndrome (PDS), and epigastric pain syndrome (EPS) were defined according to the Rome III criteria. NERD was defined as heartburn or regurgitation ≥1 day/week without erosive esophagitis. Results Of the 3,085 participants, 73 (2.4%), 97 (3.1%), and 84 (2.7%) had FD alone, NERD alone, and FD-NERD overlap, respectively. Factors associated with FD-NERD-overlap participants compared with participants with neither FD nor NERD were women [odds ratio (OR): 2.08, 95% confidence interval (CI) 1.24-3.52], body mass index (BMI) <18.5 (OR: 2.87, 95% CI: 1.56-5.07), alcohol consumption ≥20 g/day (OR: 1.85, 95% CI: 1.06-3.15), and a high STAI score (OR: 2.53, 95% CI: 1.62-4.00). Increasing age (OR: 1.06, 95% CI: 1.01-1.11) and EPS symptoms [pure EPS (OR: 3.67, 95% CI: 1.65-8.51) and PDS-EPS overlap (OR: 11.6, 95% CI: 4.09-37.2)] were associated with FD-NERD overlap vs. FD alone. Women (OR: 3.17, 95% CI: 1.47-7.04), BMI <18.5 (OR: 3.03, 95% CI: 1.04-9.90), and acid reflux symptoms ≥2 days a week (OR: 3.57, 95% CI: 1.83-7.14) were associated with FD-NERD overlap vs. NERD alone. Conclusion Understanding the clinical features of overlap between FD and NERD will lead to better management.2023年07月, Internal medicine (Tokyo, Japan), 英語, 国内誌研究論文（学術雑誌）
- (一社)日本膵臓学会, 2023年07月, 膵臓, 38(3) (3), A369 - A369, 日本語
- 2023年06月, Annals of surgical oncology, 30(9) (9), 5790 - 5791, 英語, 国際誌研究論文（学術雑誌）
- BACKGROUND: With the increasing popularity of endoscopic ultrasound (EUS)-guided transmural interventions, walled-off necrosis (WON) of the pancreas is increasingly managed via non-surgical endoscopic interventions. However, there has been an ongoing debate over the appropriate treatment strategy following the initial EUS-guided drainage. Direct endoscopic necrosectomy (DEN) removes intracavity necrotic tissue, potentially facilitating early resolution of the WON, but may associate with a high rate of adverse events. Given the increasing safety of DEN, we hypothesised that immediate DEN following EUS-guided drainage of WON might shorten the time to WON resolution compared to the drainage-oriented step-up approach. METHODS: The WONDER-01 trial is a multicentre, open-label, superiority, randomised controlled trial, which will enrol WON patients aged ≥ 18 years requiring EUS-guided treatment in 23 centres in Japan. This trial plans to enrol 70 patients who will be randomised at a 1:1 ratio to receive either the immediate DEN or drainage-oriented step-up approach (35 patients per arm). In the immediate DEN group, DEN will be initiated during (or within 72 h of) the EUS-guided drainage session. In the step-up approach group, drainage-based step-up treatment with on-demand DEN will be considered after 72-96 h observation. The primary endpoint is time to clinical success, which is defined as a decrease in a WON size to ≤ 3 cm and an improvement of inflammatory markers (i.e. body temperature, white blood cell count, and C-reactive protein). Secondary endpoints include technical success, adverse events including mortality, and recurrence of the WON. DISCUSSION: The WONDER-01 trial will investigate the efficacy and safety of immediate DEN compared to the step-up approach for WON patients receiving EUS-guided treatment. The findings will help us to establish new treatment standards for patients with symptomatic WON. TRIAL REGISTRATION: ClinicalTrials.gov NCT05451901, registered on 11 July 2022. UMIN000048310, registered on 7 July 2022. jRCT1032220055, registered on 1 May 2022.2023年05月, Trials, 24(1) (1), 352 - 352, 英語, 国際誌研究論文（学術雑誌）
- A 75-year-old Japanese woman visited a hospital with a stomachache. The patient was diagnosed with localized mild acute pancreatitis. Blood tests revealed elevated serum IgG4 levels. Contrast-enhanced computed tomography showed a hypovascular mass, 3 cm in size, in the pancreatic body with dilation of the upstream duct. Additionally, it showed another tumorous lesion of 10 mm in size in the anterior wall of the stomach, and endoscopic examination confirmed a submucosal tumor (SMT) sized 10 mm in the anterior wall of the stomach. Endoscopic ultrasound-guided fine needle aspiration biopsy (EUS-FNAB) of the pancreas revealed an adenocarcinoma concomitant with marked IgG4-positive cell infiltration. Hence, distal pancreatectomy with local gastrectomy was performed, and the final diagnosis was concluded as pancreatic ductal adenocarcinoma (PDAC) complicated by IgG4-related diseases (IgG4-RD) in the pancreas and stomach. IgG4-RD of the digestive tract is exceedingly rare. The correlation between PDAC and autoimmune pancreatitis or malignancy and IgG4-RD is controversial. However, the clinical course and histopathological examination, in this case, provide valuable suggestive findings for further discussion.2023年05月, Clinical journal of gastroenterology, 16(5) (5), 785 - 790, 英語, 国内誌研究論文（学術雑誌）
- Pancreatic fluid collections (PFCs) typically develop as local complications of acute pancreatitis and complicate the clinical course of patients with acute pancreatitis and potentially fatal clinical outcomes. Interventions are required in cases of symptomatic walled-off necrosis (WON) (matured PFCs with necrosis) and pancreatic pseudocysts (matured PFCs without necrosis). In the management of necrotizing pancreatitis and WON, endoscopic ultrasound-guided transluminal drainage combined with on-demand endoscopic necrosectomy (i.e. the step-up approach) is increasingly used as a less invasive treatment modality compared with a surgical or percutaneous approach. Through the substantial research efforts and development of specific devices and stents (e.g. lumen-apposing metal stents), endoscopic techniques of PFC management have been standardized to some extent. However, there has been no consensus about timing of carrying out each treatment step; for instance, it is uncertain when direct endoscopic necrosectomy should be initiated and finished and when a plastic or metal stent should be removed following clinical treatment success. Despite emerging evidence for the effectiveness of noninterventional supportive treatment (e.g. antibiotics, nutritional support, irrigation of the cavity), there has been only limited data on the timing of starting and stopping the treatment. Large studies are required to optimize the timing of those treatment options and improve clinical outcomes of patients with PFCs. In this review, we summarize the current available evidence on the indications and timing of interventional and supportive treatment modalities for this patient population and discussed clinical unmet needs that should be addressed in future research.2023年05月, Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society, 35(6) (6), 700 - 710, 英語, 国際誌研究論文（学術雑誌）
- BACKGROUND: Sarcopenia, defined as a loss of skeletal muscle mass and quality, is found in 30-65% of patients with pancreatic ductal adenocarcinoma (PDAC) at diagnosis, and is a poor prognostic factor. However, it is yet to be evaluated why sarcopenia is associated with poor prognosis. Therefore, this study elucidated the tumor characteristics of PDAC with sarcopenia, including driver gene alterations and tumor microenvironment. PATIENTS AND METHODS: We retrospectively analyzed 162 patients with PDAC who underwent pancreatic surgery between 2008 and 2017. We defined sarcopenia by measuring the skeletal muscle mass at the L3 level using preoperative computed tomography images and evaluated driver gene alteration (KRAS, TP53, CDKN2A/p16, and SMAD4) and tumor immune (CD4+, CD8+, and FOXP3+) and fibrosis status (stromal collagen). RESULTS: In localized-stage PDAC (stage ≤ IIa), overall survival (OS) and recurrence-free survival were significantly shorter in the sarcopenia group than in the non-sarcopenia group (2-year OS 89.7% versus 59.1%, P = 0.03; 2-year RFS 74.9% versus 50.0%, P = 0.02). Multivariate analysis revealed that sarcopenia was an independent poor prognostic factor in localized-stage PDAC. Additionally, tumor-infiltrating CD8+ T cells in the sarcopenia group were significantly less than in the non-sarcopenia group (P = 0.02). However, no difference was observed in driver gene alteration and fib.rotic status. These findings were not observed in advanced-stage PDAC (stage ≥ IIb). CONCLUSIONS: Sarcopenia was associated with a worse prognosis and decreased tumor-infiltrating CD8+ T cells in localized-stage PDAC. Sarcopenia may worsen a patient's prognosis by suppressing local tumor immunity.2023年05月, Annals of surgical oncology, 30(9) (9), 5776 - 5787, 英語, 国際誌研究論文（学術雑誌）
- BACKGROUND: There is no consensus on the necessity of endoscopic sphincterotomy (ES) to prevent post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) after endoscopic stenting in patients with malignant biliary obstruction. We investigated the incidence of PEP after endoscopic biliary stenting for malignant biliary obstruction with or without ES in a multicenter prospective cohort study. METHODS: We enrolled 807 patients who underwent endoscopic biliary stenting for malignant biliary obstruction with a native papilla at 36 hospitals between April 2017 and March 2018. The incidence of PEP in patients with or without ES was compared for subgroups based on stent type, placement method, and patient background. Univariate and multivariate analysis was performed to investigate the incidence of PEP in all stenting patients. RESULTS: Plastic and metal stents (MS) were inserted in 598 and 209 patients, respectively. The incidence of PEP in patients with or without ES was 7.9% and 7.4%, respectively among all stenting patients. The incidences of PEP with or without ES in plastic stent insertion patients, patients with MS insertion, stent insertions across the papilla, stent insertions across the papilla in patients without main pancreatic duct obstruction, and fully covered MS insertions across the papilla were compared. There was no overall significant difference in the incidence of PEP between those with or without ES. Multivariate logistic regression analysis for the incidence of PEP in all stenting patients revealed obstruction of the main pancreatic duct at the pancreatic head and epinephrine spraying on the papilla were significant factors; there was no significant difference in the incidence of PEP between patients with or without ES. CONCLUSION: Endoscopic sphincterotomy may not contribute to the prevention of PEP after endoscopic biliary stenting for malignant biliary obstruction, even in cases of insertion with a fully covered MS across the papilla.2023年05月, Surgical endoscopy, 37(5) (5), 3463 - 3470, 英語, 国際誌研究論文（学術雑誌）
- (一社)日本消化器内視鏡学会, 2023年04月, Gastroenterological Endoscopy, 65(Suppl.1) (Suppl.1), 923 - 923, 日本語3次元画像解析を用いて測定した被包化膵壊死の体積と内視鏡治療成績との関係
- OBJECTIVES: Interventions for necrotizing pancreatitis are generally postponed until 4 weeks after the onset of acute pancreatitis, but there remains controversy about whether we should always wait >4 weeks or can intervene early when necessary. This meta-analysis was conducted to evaluate treatment outcomes of necrotizing pancreatitis according to the cut-off defined in the revised Atlanta classification (≤4 vs. >4 weeks). METHODS: Using PubMed, Web of Science, and the Cochrane database, we identified clinical studies published until March 2022 with data comparing outcomes of early and delayed interventions of necrotizing pancreatitis. We pooled data on adverse events, mortality, technical and clinical success rates, and needs for necrosectomy and open surgery, using the random-effects model. RESULTS: We identified 11 retrospective studies, including 775 patients with early interventions and 725 patients with delayed interventions. Patients with early interventions tended to be complicated by organ failure. The rate of adverse events was comparable (OR 1.41, 95% CI 0.66-3.01; p = 0.38) but the rate of mortality was significantly higher (OR 1.70, 95% CI 1.21-2.40; p < 0.01) in early interventions. Technical success rates were similarly high but clinical success rates tended to be low (OR 0.39, 95% CI 0.15-1.00; p = 0.05) in early interventions, though not statistically significant. Pooled ORs for necrosectomy and open surgery were 2.14 and 1.23, respectively. CONCLUSIONS: Early interventions for necrotizing pancreatitis were associated with higher mortality rates and did not reduce adverse events or improve clinical success. However, our results should be confirmed in prospective studies.2023年04月, DEN open, 3(1) (1), e171, 英語, 国際誌研究論文（学術雑誌）
- BACKGROUND: Intracholecystic papillary neoplasm (ICPN) is one of the precursors of gallbladder cancer defined in the 2010 World Health Organization classification of tumors. We herein report ICPN with pancreaticobiliary maljunction (PBM), which is a high-risk factor for biliary cancer. CASE PRESENTATION: A 57-year-old female presented with abdominal pain. Computed tomography showed a swollen appendix and gallbladder nodules with bile duct dilatation. Endoscopic ultrasonography revealed a gallbladder tumor spreading into the cystic duct confluence accompanying PBM. Based on papillary tumors around the cystic duct detected using the SpyGlass DS II Direct Visualization System (SpyGlass DS), ICPN was suspected. We performed extended cholecystectomy, extrahepatic bile duct resection, and appendectomy with a diagnosis of ICPN and PBM. The pathological diagnosis was ICPN (90 × 50 mm) with high-grade dysplasia spreading into the common bile duct. The absence of residual cancer in the resected specimen was pathologically confirmed. P53 staining was totally negative in both the tumor and normal epithelium. The overexpression of CTNNB1 was not observed. CONCLUSIONS: We encountered a patient with a very rare gallbladder tumor, ICPN with PBM. SpyGlass DS contributed to a precise assessment of the extent of the tumor as well as a qualitative diagnosis.2023年03月, Clinical journal of gastroenterology, 16(3) (3), 476 - 481, 英語, 国内誌研究論文（学術雑誌）
- (一財)日本消化器病学会, 2023年03月, 日本消化器病学会雑誌, 120(臨増総会) (臨増総会), A36 - A36, 日本語
- Pancreatic fluid collections (PFCs) commonly develop as complications of acute pancreatitis and ductal disruption due to chronic pancreatitis. In the revised Atlanta classification, PFCs were classified based on the presence of necrosis and duration following the onset of acute pancreatitis. Interventions are required in cases of symptomatic pancreatic pseudocysts or walled-off necrosis (WON). In the management of these PFCs, endoscopic ultrasound-guided transluminal drainage and subsequent direct endoscopic necrosectomy for WON are increasingly utilized as less invasive treatment modalities compared to surgical debridement. To date, researchers have focused predominantly on the technical aspects of endoscopic therapy for symptomatic PFCs. Given the poor physical condition of patients receiving endoscopic treatment for PFCs, systemic support may have a substantial impact on the short- and long-term outcomes of these patients. A multidisciplinary approach is required to improve the clinical outcomes of patients with infected PFCs and their associated comorbidities. However, non-interventional support during the periprocedural period of endoscopic treatment of PFCs has not been fully discussed, and there have been considerable variations in the selection of treatment options between endoscopists and centers. To address these unmet needs in the clinical management of PFCs and promote future research to improve the clinical outcomes, we conducted a review of the literature within a multicenter consortium of expert endoscopists with specific expertise in the endoscopic treatment of PFCs. In this review, we summarize the current evidence on non-interventional supportive care (e.g., continuous lavage, medications, nutritional support, and antimicrobials) and propose potential topics for future research.2023年02月, Journal of gastroenterology, 58(2) (2), 98 - 111, 英語, 国内誌研究論文（学術雑誌）
- BACKGROUND: Tertiary lymphoid structure (TLS) reflects an intense immune response against cancer, which correlates with favorable patient survival. However, the association of TLS with tumor-infiltrating lymphocytes (TILs) and clinical outcomes has not been investigated comprehensively in pancreatic ductal adenocarcinoma (PDAC). METHODS: We utilized an integrative molecular pathological epidemiology database on 162 cases with resected PDAC, and examined TLS in relation to levels of TILs, patient survival, and treatment response. In whole-section slides, we assessed the formation of TLS and conducted immunohistochemistry for tumor-infiltrating T cells (CD4, CD8, CD45RO, and FOXP3). As confounding factors, we assessed alterations of four main driver genes (KRAS, TP53, CDKN2A [p16], and SMAD4) using next-generation sequencing and immunohistochemistry, and tumor CD274 (PD-L1) expression assessed by immunohistochemistry. RESULTS: TLSs were found in 112 patients with PDAC (69.1%). TLS was associated with high levels of CD4+ TILs (multivariable odds ratio [OR], 3.50; 95% confidence interval [CI] 1.65-7.80; P = 0.0002), CD8+ TILs (multivariable OR, 11.0; 95% CI 4.57-29.7, P < 0.0001) and CD45RO+ TILs (multivariable OR, 2.65; 95% CI 1.25-5.80, P = 0.01), but not with levels of FOXP3+ TILs. TLS was associated with longer pancreatic cancer-specific survival (multivariable hazard ratio, 0.37; 95% CI 0.25-0.56, P < 0.0001) and favorable outcomes of adjuvant S-1-treatment. TLS was not associated with driver gene alterations but tumor CD274 negative expression. CONCLUSIONS: Our comprehensive data supports the surrogacy of TLS for vigorous anti-tumor immune response characterized by high levels of helper and cytotoxic T cells and their prognostic role.2023年01月, Journal of gastroenterology, 58(3) (3), 277 - 291, 英語, 国内誌研究論文（学術雑誌）
- When the etiology of pancreatitis cannot be determined despite sufficient investigation, recurrence and progression to chronic pancreatitis often involve genetic mutations. Herein, we describe a case of recurrent pancreatitis with the IVS3+2T>C mutation in the serine protease inhibitor Kazal type 1 (SPINK1) gene that progressed to chronic pancreatitis in only 3 years. A 35-year-old man was referred to our hospital, where he was diagnosed with mild pancreatitis and was treated conservatively. However, the patient experienced recurrent episodes of pancreatitis, which progressed to become chronic pancreatitis with a pancreatic calcification 1 year later. After 3 years, the patient developed pancreatic duct stenosis and required a pancreatic duct stent placement. Regarding the cause of chronic pancreatitis, alcohol abuse was ruled out based on history taking. Considering the course of treatment, autoimmune pancreatitis and obstructive pancreatitis, such as pancreatic divisum, were also ruled out. Finally, a germline genetic test was performed to determine the etiology of pancreatitis, which revealed the IVS3+2T>C mutation in SPINK1. This case shows the importance of genetic testing in patients with idiopathic pancreatitis to determine their etiology and is a rare incident that can report the progression of the disease from acute to chronic pancreatitis.2023年, Case reports in gastroenterology, 17(1) (1), 49 - 55, 英語, 国際誌
- BACKGROUND AND OBJECTIVES: Although the use of a long metal stent is favored for EUS-guided hepaticogastrostomy (EUS-HGS) for the relief of malignant biliary obstruction (MBO), endoscopic reintervention (E-RI) at the time of recurrent biliary obstruction (RBO) is challenging due to a long intragastric portion. This study evaluated the feasibility and safety of E-RI after a long partially covered metal stent (L-PCMS) placement during EUS-HGS. MATERIALS AND METHODS: We performed a multicenter retrospective study between January 2015 and December 2019 examining patients with MBO who underwent E-RI for RBO through the EUS-HGS route after the L-PCMS placement. Technical and clinical success rates, details of E-RI, adverse events (AEs), stent patency, and survival time were evaluated. RESULTS: Thirty-three patients at eight referral centers in Japan who underwent E-RI through the EUS-HGS route were enrolled. The location of MBO was distal in 54.5%. The median intragastric length of the L-PCMS was 5 cm. As the first E-RI attempt, E-RI via the distal end of the existing L-PCMS was successful in 60.6%. The overall technical and clinical success rates of E-RI were 100% and 81.8%, respectively. Liver abscess was noted in one patient. A proximal biliary stricture was associated with the clinical ineffectiveness of E-RI in multivariable analysis (odds ratio, 12.5, P = 0.04). The median survival and stent patency duration after E-RI were 140 and 394 days, respectively. CONCLUSIONS: Our study findings suggest that E-RI for RBO after EUS-HGS with a L-PCMS is technically feasible and clinically effective, without any severe AEs, especially for patients with distal MBO.2022年12月, Endoscopic ultrasound, 英語, 国際誌研究論文（学術雑誌）
- 医学図書出版(株), 2022年11月, 胆と膵, 43(特別号) (特別号), 1385 - 1390, 日本語
- BACKGROUND AND AIM: Endoscopic ultrasonography (EUS) findings of the pancreatic parenchyma, such as hyperechoic foci/stranding and lobularity, may be associated with the severity of chronic pancreatitis (CP). However, the correlation between parenchymal EUS findings and histology remains unclear. We designed a large-scale retrospective study analyzing over 200 surgical specimens to elucidate the association between parenchymal EUS findings and histological features. METHODS: Clinical data of 221 patients with pancreatobiliary tumors who underwent preoperative EUS and pancreatic surgery between January 2010 and November 2020 were reviewed to investigate the association between parenchymal EUS findings and histological features at the pancreatic body. None of these patients met the definition of CP. RESULTS: Of the 221 patients, 87 (39.4%), 89 (40.2%), and 45 (20.4%) had normal EUS findings, hyperechoic foci/stranding without lobularity, and hyperechoic foci/stranding with lobularity, respectively. In the multivariate analyses, parenchymal EUS findings significantly correlated with histological CP findings of fibrosis, inflammation, and atrophy (hyperechoic foci/stranding without lobularity vs hyperechoic foci/stranding with lobularity, odds ratio [95% confidence interval]: 4.1 [2.2-7.9] vs 31.3 [9.3-105.6], Ptrend < 0.001; 3.9 [1.9-8.2] vs 21.8 [8.0-59.4], Ptrend < 0.001; and 4.0 [2.0-7.8] vs 22.9 [7.0-74.5], Ptrend < 0.001, respectively). Further, a trend toward higher histological grade was observed in the following order: normal findings, hyperechoic foci/stranding without lobularity, and hyperechoic foci/stranding with lobularity. CONCLUSIONS: Endoscopic ultrasonography findings of the pancreatic parenchyma may be associated with the histological conditions in CP, such as pancreatic fibrosis, inflammation, and atrophy. Lobularity reflects more severe histological conditions than does hyperechoic foci/stranding.2022年10月, Journal of gastroenterology and hepatology, 38(1) (1), 103 - 111, 英語, 国際誌研究論文（学術雑誌）
- (一財)日本消化器病学会, 2022年10月, 日本消化器病学会雑誌, 119(臨増大会) (臨増大会), A536 - A536, 日本語ガイドライン改訂後の膵炎診療の現状と課題 背景膵のEUS所見による組織学的進行度と発癌高リスク膵の予測
- BACKGROUND: A step-up approach is recommended as a new treatment algorithm for pancreatic fluid collections (PFCs). However, determining which patients with PFCs require a step-up approach after endoscopic ultrasound-guided transmural drainage (EUS-TD) is unclear. If the need for a step-up approach could be predicted, it could be performed early for relevant patients. We aimed to identify PFC-related predictive factors for a step-up approach after EUS-TD. METHODS: This retrospective cohort study included consecutive patients who had undergone EUS-TD for PFCs from January 2008 to May 2020. Multivariable logistic regression analyses were performed to investigate PFC factors related to requiring a step-up approach. A step-up approach was performed for patients who did not respond clinically to EUS-TD. RESULTS: We enrolled 81 patients, of whom 25 (30.9%) required a step-up approach. In multivariate logistic regression analysis, the pre-EUS-TD number of PFC-occupied regions ≥ 3 (multivariate odds ratio [OR] 16.2, 95% confidence interval [CI] 2.68-97.6, P = 0.002), the post-EUS-TD PFC-remaining percentage ≥ 35% (multivariate OR 19.9, 95% CI 2.91-136.1, P = 0.002), and a positive sponge sign, which is a distinctive computed tomography finding in the early stage after EUS-TD (multivariate OR 6.26, 95% CI 1.33-29.3, P = 0.020), were independent predictive factors associated with requiring a step-up approach for PFCs. CONCLUSION: Pre-EUS-TD PFC-occupied regions, post-EUS-TD PFC-remaining percentage, and a positive sponge sign were predictors of the need for a step-up approach. Patients with PFC with these findings should be offered a step-up approach whereas conservative treatment is recommended for patients without these findings. CLINICAL REGISTRATION NUMBER: UMIN 000030898.2022年09月, Surgical endoscopy, 37(2) (2), 1096 - 1106, 英語, 国際誌研究論文（学術雑誌）
- (一社)日本癌学会, 2022年09月, 日本癌学会総会記事, 81回, P - 3214, 英語同時性・異時性多発膵癌の遺伝子解析(Genetic analysis of synchronous or metachronous multiple pancreatic cancers)
- 2022年09月, SCIENTIFIC REPORTS, 12(1) (1), 英語研究論文（学術雑誌）
- 2022年09月, SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES, 英語研究論文（学術雑誌）
- 医学図書出版(株), 2022年08月, 胆と膵, 43(8) (8), 751 - 757, 日本語
- 医学図書出版(株), 2022年08月, 胆と膵, 43(8) (8), 751 - 757, 日本語
- BACKGROUND: Secondary sclerosing cholangitis, characterized by biliary obstruction, can be caused by drugs such as immune checkpoint inhibitors (ICIs). While there a few reports of sclerosing cholangitis after immune checkpoint inhibitor administration, no case has been reported after discontinuation of such drugs. CASE SUMMARY: A 68-year-old man who underwent chemotherapy for lung adenocarcinoma with bone metastasis presented with abdominal pain and fever 4 mo after the final administration of pembrolizumab. Computed tomography revealed thickening of the gallbladder wall and dilatation of the common bile duct. Endoscopic retro-grade cholangiopancreatography revealed an irregularly narrowed intrahepatic bile duct. Biopsy of the bile duct demonstrated that CD8+ T cells were predominant over CD4+ T cells. Liver biopsy showed dominant infiltration of CD8+ T in the portal tract, but onion-skin lesions were not observed. The patient was diagnosed with immune-related sclerosing cholangitis induced by pembrolizumab. Administration of methylprednisolone and endoscopic nasobiliary drainage were performed, but the cholangiography and laboratory test findings did not improve. No further treatment was administered due to disease progression, and the patient was referred for palliative care. CONCLUSION: Immune-related sclerosing cholangitis may have a late onset, and such cases occurring after discontinuation of ICIs should be carefully managed.2022年07月, World journal of gastroenterology, 28(28) (28), 3732 - 3738, 英語, 国際誌
- 日本消化器内視鏡学会-近畿支部, 2022年06月, 日本消化器内視鏡学会近畿支部例会プログラム・抄録集, 108回, 50 - 50, 日本語胆膵内視鏡治療の工夫とリスクマネージメント 急性膵炎局所合併症における治療困難例の特徴と早期インターベンションの可能性
- 日本消化器内視鏡学会-近畿支部, 2022年06月, 日本消化器内視鏡学会近畿支部例会プログラム・抄録集, 108回, 85 - 85, 日本語胆管空腸吻合部狭窄に対して直視型EUSを用いて再建腸管からの胆管空腸瘻孔形成術に成功した1例
- Objectives Small proline-rich protein 1A (SPRR1A) is recognized as a squamous differentiation marker but is also upregulated in some non-squamous cancers. However, its expression in pancreatic ductal adenocarcinoma (PDAC) has not been investigated. This study elucidated the expression of SPRR1A in PDAC and its effect on the prognosis and malignant behavior of PDAC. Methods We examined the SPRR1A expression by immunohistochemistry in 86 surgical PDAC cases and revealed the relationship between its expression and the prognosis of the PDAC patients. Furthermore, we overexpressed SPRR1A in pancreatic cancer cell lines (PK-1 and Panc-1) and assessed the phenotype and gene expression changes in vitro. Results Among the 84 cases, excluding 2 with squamous differentiation, 31 (36.9%) had a high SPRR1A expression. The overall survival (median 22.1 months vs. 33.6 months, p = 0.0357) and recurrence-free survival (median 10.7 months vs. 15.5 months, p = 0.0298) were significantly lower in the high-SPRR1A-expression group than in the low-SPRR1A-expression group. A multivariate analysis indicated that a high SPRR1A expression (HR 1.706, 95% CI 1.018 to 2.862, p = 0.0427) and residual tumor status (HR 2.687, 95% CI 1.487 to 4.855, p = 0.00106) were independent prognostic factors. The analysis of TCGA transcriptome data demonstrated that the high-SPRR1A-expression group had a significantly worse prognosis than the low-SPRR1A-expression group, which supported our data. SPRR1A overexpression in PK-1 and Panc-1 did not result in remarkable changes to in vitro phenotypes, such as the cell proliferation, chemo-resistance, EMT, migration or global gene expression. Conclusion Increased expression of SPRR1A is associated with a poor prognosis in PDAC and may serve as a novel prognostic marker. However, our in vitro study suggests that the SPRR1A expression may be a consequence, not a cause, of the aggressive behavior of PDAC.Public Library of Science (PLoS), 2022年05月, PLOS ONE, 17(5) (5), e0266620 - e0266620, 英語, 国際誌研究論文（学術雑誌）
- BACKGROUND: Pancreatic ductal adenocarcinoma (PDAC) concomitant with intraductal papillary mucinous neoplasm (IPMN) is defined as PDAC occurring apart from IPMN. This study comprehensively investigated the molecular biologic characteristics of PDAC concomitant with IPMN in major genetic alterations, tumor microenvironment, and prognosis by contrast with those of conventional PDAC. METHODS: The study retrospectively reviewed the data of 158 surgically resected PDAC patients. The driver gene alteration status (KRAS, TP53, CDKN2A, SMAD4, and GNAS) together with the immune and fibrotic status in tumor was evaluated. The prognosis of PDAC concomitant with IPMN and that of conventional PDAC also were compared. RESULTS: No statistically significant difference was found between PDAC concomitant with IPMN and conventional PDAC in the alteration frequency analysis of the major driver genes and the immune and fibrotic status in the tumor microenvironment. Overall survival and disease-free survival between patients who had PDAC concomitant with IPMN and those who had conventional PDAC did not show statistically significant differences in propensity-matched subjects. Furthermore, the co-existence of IPMN was not a poor prognostic factor in the multivariable-adjusted Cox proportional hazards model (hazard ratio, 0.95; 95 % confidence interval, 0.51-1.78). CONCLUSIONS: In this study, PDAC concomitant with IPMN had tumor characteristics similar to those of conventional PDAC in terms of the major driver gene alterations, tumor microenvironment, and prognosis.2022年05月, Annals of surgical oncology, 29(8) (8), 4924 - 4934, 英語, 国際誌研究論文（学術雑誌）
- 2022年05月, Annals of surgical oncology, 英語, 国際誌研究論文（学術雑誌）
- (一社)日本消化器内視鏡学会, 2022年04月, Gastroenterological Endoscopy, 64(Suppl.1) (Suppl.1), 810 - 810, 日本語悪性輸入脚狭窄に対する内視鏡的ステント留置術の検討
- (一社)日本消化器内視鏡学会, 2022年04月, Gastroenterological Endoscopy, 64(Suppl.1) (Suppl.1), 596 - 596, 日本語IgG4関連疾患の診断・治療における胆膵内視鏡の現状と問題点 自己免疫性膵炎診断におけるEUS-FNAの位置づけに関する多機関共同研究
- (一社)日本消化器内視鏡学会, 2022年04月, Gastroenterological Endoscopy, 64(Suppl.1) (Suppl.1), 766 - 766, 日本語Pancreatic fluid collectionに対する早期インターベンションの可能性
- (一社)日本消化器内視鏡学会, 2022年04月, Gastroenterological Endoscopy, 64(Suppl.1) (Suppl.1), 810 - 810, 日本語悪性輸入脚狭窄に対する内視鏡的ステント留置術の検討
- (一財)日本消化器病学会, 2022年03月, 日本消化器病学会雑誌, 119(臨増総会) (臨増総会), A88 - A88, 日本語
- OBJECTIVE: To investigate the diagnostic performance of the extracellular volume (ECV) fraction in multiphasic contrast-enhanced computed tomography (CE-CT) for estimating histologic pancreatic fibrosis and predicting postoperative pancreatic fistula (POPF). METHODS: Eighty-five patients (49 men; mean age, 69 years) who underwent multiphasic CE-CT followed by pancreaticoduodenectomy with pancreaticojejunal anastomosis between January 2012 and December 2018 were retrospectively included. The ECV fraction was calculated from absolute enhancements of the pancreas and aorta between the precontrast and equilibrium-phase images, followed by comparisons among histologic pancreatic fibrosis grades (F0‒F3). The diagnostic performance of the ECV fraction in advanced fibrosis (F2‒F3) was evaluated using receiver operating characteristic curve analysis. Multivariate logistic regression analysis was used to evaluate the associations of the risk of POPF development with patient characteristics, histologic findings, and CT imaging parameters. RESULTS: The mean ECV fraction of the pancreas was 34.4% ± 9.5, with an excellent intrareader agreement of 0.811 and a moderate positive correlation with pancreatic fibrosis (r = 0.476; p < 0.001). The mean ECV fraction in advanced fibrosis was significantly higher than that in no/mild fibrosis (44.4% ± 10.8 vs. 31.7% ± 6.7; p < 0.001), and the area under the receiver operating characteristic curve for the diagnosis of advanced fibrosis was 0.837. Twenty-two patients (25.9%) developed clinically relevant POPF. Multivariate logistic regression analysis demonstrated that the ECV fraction was a significant predictor of POPF. CONCLUSIONS: The ECV fraction can offer quantitative information for assessing pancreatic fibrosis and POPF after pancreaticojejunal anastomosis. KEY POINTS: • There was a moderate positive correlation of the extracellular volume (ECV) fraction of the pancreas in contrast-enhanced CT with the histologic grade of pancreatic fibrosis (r = 0.476; p < 0.001). • The ECV fraction was higher in advanced fibrosis (F2‒F3) than in no/mild fibrosis (F0‒F1) (p < 0.001), with an AUC of 0.837 for detecting advanced fibrosis. • The ECV fraction was an independent risk factor for predicting subclinical (odds ratio, 0.81) and clinical (odds ratio, 0.80) postoperative pancreatic fistula.2022年03月, European radiology, 32(3) (3), 1770 - 1780, 英語, 国際誌研究論文（学術雑誌）
- BACKGROUND AND OBJECTIVES: Although the use of a long metal stent is favored for EUS-guided hepaticogastrostomy (EUS-HGS) for the relief of malignant biliary obstruction (MBO), endoscopic reintervention (E-RI) at the time of recurrent biliary obstruction (RBO) is challenging due to a long intragastric portion. This study evaluated the feasibility and safety of E-RI after a long partially covered metal stent (L-PCMS) placement during EUS-HGS. MATERIALS AND METHODS: We performed a multicenter retrospective study between January 2015 and December 2019 examining patients with MBO who underwent E-RI for RBO through the EUS-HGS route after the L-PCMS placement. Technical and clinical success rates, details of E-RI, adverse events (AEs), stent patency, and survival time were evaluated. RESULTS: Thirty-three patients at eight referral centers in Japan who underwent E-RI through the EUS-HGS route were enrolled. The location of MBO was distal in 54.5%. The median intragastric length of the L-PCMS was 5 cm. As the first E-RI attempt, E-RI via the distal end of the existing L-PCMS was successful in 60.6%. The overall technical and clinical success rates of E-RI were 100% and 81.8%, respectively. Liver abscess was noted in one patient. A proximal biliary stricture was associated with the clinical ineffectiveness of E-RI in multivariable analysis (odds ratio, 12.5, P = 0.04). The median survival and stent patency duration after E-RI were 140 and 394 days, respectively. CONCLUSIONS: Our study findings suggest that E-RI for RBO after EUS-HGS with a L-PCMS is technically feasible and clinically effective, without any severe AEs, especially for patients with distal MBO.2022年, Endoscopic ultrasound, 11(6) (6), 478 - 486, 英語, 国際誌研究論文（学術雑誌）
- (株)東京医学社, 2021年09月, 消化器内視鏡, 33(9) (9), 1467 - 1475, 日本語
- 日本消化器病学会-近畿支部, 2021年09月, 日本消化器病学会近畿支部例会プログラム・抄録集, 115回, 91 - 91, 日本語自己免疫性膵炎を背景とした膵頭部に肺癌転移を来した一例
- Purpose To evaluate the effectiveness and safety of the double-guidewire technique (DGT) using a new double-guidewire-supported sphincterotome (MagicTome) for patients who required endoscopic retrograde cholangiopancreatography (ERCP) for biliary cannulation. Methods This prospective multicenter randomized feasibility trial involved patients with difficult biliary cannulation at any of the three study sites from June 2017 to October 2018. Patients were assigned to the DGT with MagicTome (MDGT) initially performed group and the conventional DGT (CDGT) initially performed group. The success rates of biliary cannulation by MDGT and CDGT and the ERCP-related complications were evaluated. Results Twenty-eight patients were included in this study. No significant difference was observed in the success rates of first attempts and crossover attempts between the groups (p=0.69 and p=1.00). Furthermore, no significant difference was observed in the success rate of biliary cannulation between MDGT and CDGT (62.5% and 75.0%, respectively; p=0.48). CDGT was successful in two of four patients with malignant biliary obstruction. MDGT was successful in all four patients with malignant biliary obstruction, including the two for whom CDGT was unsuccessful. Post-ERCP pancreatitis occurred in only one MDGT case. Conclusion MDGT is safe for biliary cannulation and can be used in cases where biliary cannulation by CDGT is difficult.2021年08月, Internal medicine (Tokyo, Japan), 英語, 国内誌研究論文（学術雑誌）
- (一社)日本膵臓学会, 2021年08月, 膵臓, 36(3) (3), A209 - A209, 日本語IgG4関連疾患up-to-date:病態、診断、治療の最新知見 当院における自己免疫性膵炎の長期予後と悪性腫瘍の発症および再燃リスク因子の検討
- Afferent loop obstruction (ALO) is defined as duodenal or jejunal mechanical obstruction at the proximal anastomosis site of a gastrojejunostomy. With advances in chemotherapy, the incidence of malignant ALO is increasing. Malignant ALO can be complicated by ischemia, gangrenous bowel, pancreatitis, and ascending cholangitis. Moreover, the general condition of patients with recurrent cancer is often poor. Therefore, accurate and rapid diagnosis and minimally invasive treatments are required. However, no review articles on the diagnosis and treatment of malignant ALO have been published. Through literature searching, we reviewed related articles published between 1959 and 2020 in the PubMed database. Herein, we present recent advances in the diagnosis and treatment of malignant ALO and describe future perspectives. Endoscopic transluminal self-expandable metal stent (SEMS) placement is considered the standard treatment for malignant ALO, as this procedure is well established and less invasive. However, with the development of interventional endoscopic ultrasound (EUS) in recent years, the usefulness of EUS-guided gastrojejunostomy has been reported. Moreover, through indirect comparison, this approach has been reported to be superior to transluminal SEMS placement. It is expected that a safer and less invasive treatment method will be established through the continued advancement and innovation of interventional endoscopy techniques.2021年07月, World journal of gastrointestinal oncology, 13(7) (7), 684 - 692, 英語, 国際誌研究論文（学術雑誌）
- A 78-year-old man who underwent right nephrectomy for renal cell carcinoma (RCC) 18 years ago visited our hospital complaining of abdominal pain. Imaging revealed that the pancreatic head tumor obstructed the Santorini duct. We suspected a pancreatic intraductal tumor, such as an intraductal tubulopapillary neoplasm or intraductal papillary mucinous neoplasm. Thus, the patient underwent subtotal stomach-preserving pancreaticoduodenectomy. Pathological findings confirmed the diagnosis of metastatic RCC. Herein, we report a case of pancreatic metastasis of an RCC that presented with a tumor in the pancreatic duct.2021年06月, Clinical journal of gastroenterology, 14(3) (3), 905 - 909, 英語, 国内誌研究論文（学術雑誌）
- Highlight Atalla and colleagues present a novel dumbbell-shaped fully covered self-expandable metal stent which, with its anti-migration property and relatively lower cost, is a feasible and cost-effective option as an alternative to lumen-apposing metal stents for endoscopic ultrasound-guided transduodenal gallbladder drainage for acute cholecystitis in patients who are ineligible for surgery.2021年05月, Journal of hepato-biliary-pancreatic sciences, 28(5) (5), e19-e20, 英語, 国内誌研究論文（学術雑誌）
- (一社)日本消化器内視鏡学会, 2021年04月, Gastroenterological Endoscopy, 63(Suppl.1) (Suppl.1), 892 - 892, 日本語胆道出血に対する内視鏡治療の現状と課題 特に肝細胞癌からの胆道出血に関して
- (一社)日本消化器内視鏡学会, 2021年04月, Gastroenterological Endoscopy, 63(Suppl.1) (Suppl.1), 907 - 907, 日本語EUS-hepaticogastrostomyにおけるトラブルを未然に回避するためのダブルガイドワイヤー法
- INTRODUCTION: In patients with malignant distal bile duct obstruction and normal gastrointestinal anatomy, endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) is indicated when endoscopic retrograde cholangiopancreatography (ERCP) fails. The ERCP drainage route passes through the tumor, whereas the EUS-CDS route does not. Therefore, EUS-CDS is expected to have a longer stent patency than ERCP. However, for first-line biliary drainage, it remains unclear whether EUS-CDS or ERCP is superior in terms of stent patency. To reduce the frequency of highly adverse events (AEs) such as bile peritonitis or stent migration following EUS-CDS, we developed an antimigration metal stent with a thin delivery system for tract dilatation. This study is designed to assess whether EUS-CDS with this novel stent is superior to ERCP with a traditional metal stent in terms of stent patency when the two techniques are used for first-line drainage of malignant distal biliary obstruction. METHODS/DESIGN: This study is a multicenter single-blinded randomized controlled trial (RCT) involving 95 patients in four tertiary centers. Patients with malignant distal biliary obstruction that is unresectable or presents a very high surgical risk and who pass the inclusion and exclusion criteria will be randomized to EUS-CDS or ERCP in a 1:1 proportion. The primary endpoint is the stent patency rate 180 days after stent insertion. Secondary outcomes include the rates of technical success, clinical success, technical success in cases not requiring fistulous-tract dilation (only EUS-CDS group), procedure-related AEs, re-intervention success, patients receiving post-drainage chemotherapy, procedure time, and overall survival time. DISCUSSION: If EUS-CDS is superior to ERCP in terms of stent patency and safety for the first-line drainage of malignant distal biliary obstruction, it is expected that the first-line drainage method will be changed from ERCP to EUS-CDS, and that interruption of chemotherapy due to stent dysfunction can be avoided. TRIAL REGISTRATION: University Hospital Medical Information Network Clinical Trials Registry (UMIN-CTR), ID: UMIN000041343. Registered on August 6, 2020. https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000047201Version number: 1.2, December 7, 2020.2021年03月, Medicine, 100(12) (12), e25268, 英語, 国際誌研究論文（学術雑誌）
- BACKGROUND: Surgical resection of intraductal papillary mucinous neoplasm (IPMN) is strongly recommended for patients exhibiting high-risk stigmata (HRS). However, determining surgical indications for elderly patients with comorbidities is challenging, as clinical outcomes are not well characterized. This multicenter observational study elucidated the clinical outcomes of patients with IPMN exhibiting HRS who did not undergo surgery. METHODS: This study enrolled 101 IPMN patients exhibiting HRS with follow-up observations at 11 hospitals in Japan (2011-2016). The median observation period was 37 months (maximum: 86 months). Primary outcomes were estimated 5-year overall survival (OS) and disease-specific survival (DSS). Survival was also stratified based on HRS features. RESULTS: Of 101 patients, 32 (31.7%) had the main pancreatic duct (MPD) measuring ≥ 10 mm and 80 (79.2%) had mural nodules measuring ≥ 5 mm. The estimated 5-year OS and DSS were 74% and 91%, respectively. In the stratified analysis, the co-presence of MPD ≥ 10 mm and mural nodules ≥ 5 mm or mural nodule ≥ 10 mm were related to worse 5-year DSS (MPD ≥ 10 mm and mural nodules ≥ 5 mm vs other characteristics: 60% vs 95%, log-rank test: p = 0.049; mural nodules ≥ 10 mm vs < 10 mm: 77% vs 95%, log-rank test: p = 0.003). CONCLUSIONS: The estimated 5-year DSS of conservatively managed IPMN patients with mural nodules and main duct dilation was 91%. Only IPMN patients with plural HRS or large nodule formation might have an increased mortality risk. This is an important insight that can help facilitate appropriate clinical decision-making, especially in the elderly or high-surgical risk IPMN patients.2021年03月, Journal of gastroenterology, 56(3) (3), 285 - 292, 英語, 国内誌研究論文（学術雑誌）
- 2021年02月, VideoGIE : an official video journal of the American Society for Gastrointestinal Endoscopy, 6(2) (2), 87 - 89, 英語, 国際誌研究論文（学術雑誌）
- 2021年02月, Endoscopy, 53(2) (2), E52-E53, 英語, 国際誌研究論文（学術雑誌）
- Drug-induced pancreatitis is often mild to moderate in severity, but severe and even fatal cases can occur. Here, we report a 74-year-old woman undergoing chemotherapy for recurrent renal cell carcinoma, who presented with abdominal pain after administration of pazopanib following nivolumab and was diagnosed with severe acute pancreatitis. Administration of methylprednisolone and conservative treatment were initiated, but clinical findings and laboratory tests rapidly worsened. When she died, an autopsy was performed. The autopsy findings suggested the possibility of pancreatitis as immune-related adverse events. To the best of our knowledge, no fatal cases of acute pancreatitis due to nivolumab or pazopanib have been reported. We considered that the effects of nivolumab were sustained in the pancreas, and pazopanib administration might have worsened the toxicity.2021年01月, Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.], 21(1) (1), 21 - 24, 英語, 国際誌研究論文（学術雑誌）
- BACKGROUND: Intraductal papillary mucinous neoplasm (IPMN) of the pancreas is associated with acute pancreatitis (AP) in some cases, however its causes have not been fully elucidated. We investigated the association of the incidence of AP with epithelial subtypes and pancreatic volume in IPMN. METHODS: This retrospective study included 182 consecutive surgically resected IPMN patients between January 2000 and December 2018. The relationship between the incidence of AP and epithelial subtypes of IPMN and pancreatic volume was investigated. Epithelial subtypes of IPMN were classified into gastric (G type: N = 116), intestinal (I type: N = 49), pancreatobiliary (PB type: N = 14), and oncocytic types (O type: N = 3). Pancreatic volume of the contrast-enhanced computed tomography scan was measured using Ziostation2 software. Histological pancreatic parenchymal atrophy was also evaluated. RESULTS: AP occurred more frequently in I-types (I-type vs. G-type, 22.4% [11/49] vs 3.4% [4/116], P = 0.003) and PB-types (PB type vs. G-type, 35.7% [5/14] vs. 3.4% [4/116], P = 0.007) in comparison with G-types, which constituted the majority of the resected IPMNs. AP occurred more frequently in I-type patients with high pancreatic volumes (I-type with high pancreatic volume vs. I-type with low pancreatic volume, 37.0% [10/27] vs. 4.7% [1/21], P = 0.02). However, histological atrophy did not show an additional influence on the association between the incidence of AP and epithelial subtypes. The elevation of serum pancreatic enzymes was not significantly related to epithelial subtypes. CONCLUSION: Epithelial subtypes and the degree of pancreatic volume may be closely associated with the incidence of AP in IPMN.2021年01月, Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.], 21(1) (1), 138 - 143, 英語, 国際誌研究論文（学術雑誌）
- A 60-year-old male visited a previous hospital with upper abdominal pain. He was diagnosed with localized mild acute pancreatitis. Three months later, abdominal contrast-enhanced computed tomography showed focal parenchymal atrophy of the pancreas with distal pancreatic duct dilation. No obvious solid mass could be found at the site of the pancreatic duct stenosis on imaging examinations. Endoscopic retrograde pancreatography showed focal mild stenosis with distal pancreatic duct dilation in the tail of the pancreas. Carcinoma in situ of the pancreas was strongly suspected, especially based on the presence of focal atrophy of the pancreas around the site of stenosis of the main pancreatic duct and the distal pancreatic duct dilation. Laparoscopic distal pancreatectomy was performed. Histologically, high-grade pancreatic intraepithelial neoplasia was found in the epithelium of the stenotic main pancreatic duct and its branches. This case suggests that localized acute pancreatitis and focal atrophy of the pancreas with distal dilation of the pancreatic duct could be important clinical manifestations of pancreatic carcinoma in situ.2020年12月, Clinical journal of gastroenterology, 13(6) (6), 1338 - 1342, 英語, 国内誌研究論文（学術雑誌）
- Non-Alcoholic Fatty Liver Disease Is Strongly Associated with Smoking Status and Is Improved by Smoking Cessation in Japanese Males: A Retrospective Study.BACKGROUND: Cigarette smoking is known to be a significant risk factor associated with non-alcoholic fatty liver disease (NAFLD). We aimed to examine the association between smoking status and the severity of fatty liver with regard to sex and smoking cessation. METHODS: In total, 13,466 subjects (6,642 males and 6,824 females) who had undergone abdominal ultrasonography for health check-up, multivariable logistic regression analysis was retrospectively conducted to assess the association between smoking status and the prevalence of NAFLD stratified by sex after adjusting for other potential confounders. RESULTS: Male sex (odds ratio [OR] 3.27, 95% confidence interval [CI] 3.00-3.57) and smoking history (former smoker: OR 1.23, 95% CI 1.10-1.38, current smoker: OR 1.31, 95% CI 1.17-1.47) were significantly associated with NAFLD. In males with a smoking history, an increased pack-year was strongly associated with the prevalence and severity of NAFLD (prevalence of moderate to severe fatty liver: Pack-year from 0.01 to 9.99, 21.3%; Pack-year from 10.00 to 19.99, 27.2%; Pack-year ≥20.00, 33.7%; P<0.0001), although the prevalence of moderate to severe fatty liver was inversely associated with the duration of smoking cessation (more than 10 years vs. within 5 years, OR 0.71, 95% CI 0.53-0.96). In female subjects, light current smoking was negatively associated with NAFLD (current smoker with a pack-year from 0.01 to 9.99 vs. never smoker, OR 0.41, 95% CI 0.19-0.76). CONCLUSIONS: Smoking status and pack-year were strongly associated with the prevalence and severity of NAFLD, especially in Japanese males. However, smoking cessation improved NAFLD in this population.2020年11月, The Kobe journal of medical sciences, 66(3) (3), E102-E112, 英語, 国内誌研究論文（学術雑誌）
- A 66-year-old Japanese man was referred to our hospital with multiple giant liver cysts. The cysts had already been detected as multiple 3-cm cysts with small nodules at another hospital 12 years prior to this presentation. The cysts were diagnosed as an intraductal papillary neoplasms of the bile duct (IPNB) occupying the right lobe of the liver. Extended right lobectomy was performed. Based on the pathological findings, the tumor was diagnosed to be an oncocytic-type IPNB with minimal invasion. This experience suggests that the progression of IPNBs occur relatively slowly. The present case might provide important information for understanding the natural history of IPNBs.2020年11月, Internal medicine (Tokyo, Japan), 59(22) (22), 2879 - 2883, 英語, 国内誌研究論文（学術雑誌）
- Wiley, 2020年10月, Journal of Gastroenterology and Hepatology, 35(10) (10), 1667 - 1667研究論文（学術雑誌）
- Background and Aim: Upper gastrointestinal symptoms (UGSs), including reflux and dyspeptic symptoms (postprandial distress syndrome [PDS] and epigastric pain syndrome [EPS]), affect health-related quality of life. However, the influence of sex on the relationship between body mass index (BMI) and UGSs remains controversial. This study investigates the influence of sex on this association in healthy subjects. Methods and Results: We utilized the database of a prospective, multicenter, cohort study of 7112 subjects who underwent upper endoscopy for health screening. A multivariable logistic regression analysis was conducted to assess the association between BMI and UGSs stratified by sex, adjusting for clinical features. The influence of sex on the association between the overlapping of UGSs and BMI in symptomatic subjects was also investigated. Reflux symptoms were significantly associated with high BMI (multivariable odds ratio [OR] 1.36; 95% confidence interval [CI] 1.10-1.67, P = 0.004). PDS symptoms were significantly associated with low BMI (OR 2.37; 95% CI 1.70-3.25; P < 0.0001), but EPS symptoms were not associated with BMI. The association between reflux symptoms and higher BMI was limited to men (men: OR 1.40; 95% CI 1.10-1.77; P = 0.005, women: P = 0.40). sex did not influence the association between the presence of PDS symptoms and lower BMI. The percentage of overlapping of all three symptoms (reflux, PDS, and EPS) was higher in women than in men (19.9% [58/292] vs 10.5% [49/468], P = 0.0002). Conclusions: The influence of BMI on the presence of UGSs was significantly different according to sex in this large-scale cohort.2020年10月, JGH open : an open access journal of gastroenterology and hepatology, 4(5) (5), 937 - 944, 英語, 国際誌研究論文（学術雑誌）
- Apolipoprotein A2-ATQ/AT (apoA2-ATQ/AT) has been identified as a minimally invasive biomarker for detecting pancreatic cancer (PC) and high-risk (HR) individuals for PC. To establish an efficient enrichment strategy for HR, we carried out a plasma apoA2-ATQ/AT level-based prospective screening study among the general population. The subjects for the screening study were recruited at six medical check-up facilities in Japan between October 2015 and January 2017. We evaluated the positive predictive value (PPV) of the plasma apoA2-ATQ/AT level of ≤35 μg/mL for detecting PC and HR. Furthermore, we prospectively confirmed its diagnostic accuracy with another post-diagnosis population in a cross-sectional study. We enrolled 5120 subjects in experimental screening, with 84 subjects (1.3%) showing positive results for apoA2-ATQ/AT. Pancreatic abnormalities were recognized in 26 of the 84 subjects from imaging examinations. Pancreatic abnormalities detected included 1 PC and 15 HR abnormalities, such as cystic lesions including intraductal papillary mucinous neoplasm. The PPV of apoA2-ATQ/AT for detecting PC and HR was 33.3%. Moreover, a combination study with another cross-sectional study revealed that the area under the curve for apoA2-ATQ/AT to distinguish PC from healthy controls was 0.903. ApoA2-ATQ/AT has the potential to enrich PC and HR by increasing the diagnostic probability before imaging examinations.2020年09月, Cancers, 12(9) (9), 英語, 国際誌研究論文（学術雑誌）
- American Association for Cancer Research (AACR), 2020年09月, Cancer Research, 80(17) (17), 3620 - 3630[査読有り]研究論文（学術雑誌）
- 2020年09月, Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society, 32(6) (6), 992 - 992, 英語, 国際誌
- Pancreatic neuroendocrine tumors (PanNET) were classified into grades (G) 1 to 3 by the World Health Organization in 2017, but the precise mechanisms of PanNET initiation and progression have remained unclear. In this study, we used a genetically engineered mouse model to investigate the mechanisms of PanNET formation. Although pancreas-specific deletion of the Rb gene (Pdx1-Cre;Rbf/f ) in mice did not affect pancreatic exocrine cells, the α-cell/β-cell ratio of islet cells was decreased at 8 months of age. During long-term observation (18-20 months), mice formed well-differentiated PanNET with a Ki67-labeling index of 2.7%. In contrast, pancreas-specific induction of a p53 mutation (Pdx1-Cre;Trp53R172H ) had no effect on pancreatic exocrine and endocrine tissues, but simultaneous induction of a p53 mutation with Rb gene deletion (Pdx1-Cre;Trp53R172H;Rb f/f ) resulted in the formation of aggressive PanNET with a Ki67-labeling index of 24.7% over the short-term (4 months). In Pdx1-Cre;Trp53R172H;Rbf/f mice, mRNA expression of Pten and Tsc2, negative regulators of the mTOR pathway, significantly decreased in the islet cells, and activation of the mTOR pathway was confirmed in subsequently formed PanNET. Thus, by manipulating Rb and p53 genes, we established a multistep progression model from dysplastic islet to indolent PanNET and aggressive metastatic PanNET in mice. These observations suggest that Rb and p53 have distinct roles in the development of PanNET. SIGNIFICANCE: Pancreas-specific manipulation of Rb and p53 genes induced malignant transformation of islet cells, reproducing stepwise progression from microadenomas to indolent (grade 1) and subsequent aggressive PanNETs (grade 2-3).2020年09月, Cancer research, 80(17) (17), 3620 - 3630, 英語, 国際誌研究論文（学術雑誌）
- 2020年08月, JGH open : an open access journal of gastroenterology and hepatology, 4(4) (4), 677 - 683, 英語, 国際誌[査読有り]研究論文（学術雑誌）
- In this study, we assessed a series of our cases in which endoscopic self-expandable metal stents (SEMSs) were used to treat malignant afferent loop obstruction (ALO) that arose after pancreaticoduodenectomy (PD). We retrospectively examined the records of 7 patients who underwent endoscopic SEMS placement for malignant ALO following PD. Clinical success was achieved in all cases. The median procedure time was 30 min (range, 15-50 min). There were no cases of stent occlusion, and no procedure-related adverse events were encountered. All patients died of their primary disease, and the median overall survival period was 155 days (range, 96-374 days). A re-intervention involving endoscopic ultrasound-guided hepaticogastrostomy combined with antegrade stenting was performed for obstructive jaundice and acute cholangitis in 1 case. In conclusion, endoscopic SEMS placement may be an effective and safe treatment for malignant ALO that arises after PD.2020年07月, Clinical endoscopy, 53(4) (4), 491 - 496, 英語, 国際誌
- 2020年07月, Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society, 32(5) (5), e112-e113, 英語, 国際誌研究論文（学術雑誌）
- A 60-year-old female was admitted to hospital with a continuous fever, a decreased appetite, and abdominal pain. Laboratory tests showed an elevated peripheral leukocyte count (13,800/μl) and increased C-reactive protein (19.1 mg/dl) and carbohydrate antigen 19-9 (4057 U/ml) levels. Abdominal contrast-enhanced computed tomography showed multiple bulky hypovascular nodules in the liver, swelling of the paraaortic lymph nodes, and a hypovascular mass (diameter 3.0 cm) in the pancreatic body. The serum concentrations of granulocyte colony-stimulating factor (G-CSF) and interleukin-6 were 172 pg/μl and 541 pg/µl, respectively. Liver biopsy specimens revealed an adenosquamous carcinoma, which was positively immunostained for G-CSF. We diagnosed the patient with G-CSF-producing pancreatic cancer with multiple metastases. Four courses of gemcitabine with dexamethasone and one course of nab-paclitaxel and gemcitabine were administered. Although the pancreatic tumor and paraaortic lymph node metastases decreased in size, the liver metastases continued to grow. The patient died 4 months after the diagnosis of pancreatic cancer. An autopsy resulted in the tumor being diagnosed as poorly differentiated adenosquamous pancreatic carcinoma, which was histopathologically G-CSF-positive. Although G-CSF-producing pancreatic adenosquamous carcinomas are extremely rare, they have been encountered more frequently in recent years. In such cases, chemotherapy combined with dexamethasone might be effective at temporarily improving the patient's condition.2020年06月, Clinical journal of gastroenterology, 13(3) (3), 448 - 454, 英語, 国内誌研究論文（学術雑誌）
- 2020年01月, Trials, 21(1) (1), 97 - 97, 英語, 国際誌[査読有り]研究論文（学術雑誌）
- Georg Thieme Verlag KG, 2019年11月, Endoscopy, 51(11) (11), E327 - E328研究論文（学術雑誌）
- 2019年09月, Endoscopic ultrasound, 8(6) (6), 398 - 403[査読有り]
- BACKGROUND AND AIM: Chronic pancreatitis is a risk factor for pancreatic cancer. Pancreatic calcification is a characteristic of chronic pancreatitis; however, its significance for intraductal papillary mucinous neoplasm (IPMN) oncogenesis remains unknown. Therefore, we investigated the relationship between pancreatic calcification and invasive IPMN. METHODS: This study included 157 patients who underwent resection for IPMN between April 2001 and October 2016 (intraductal papillary mucinous adenoma, n = 76; noninvasive intraductal papillary mucinous carcinoma [IPMC], n = 32; and invasive IPMC, n = 49). We divided the subjects on the basis of the presence/absence of pancreatic calcification on preoperative computed tomography (CT). The factors associated with pancreatic calcification were investigated in univariate analyses. Then, multivariate logistic regression analyses of the relationship between pancreatic calcification and invasive IPMC (after adjusting for clinical or imaging characteristics) were conducted. RESULTS: Preoperative CT revealed pancreatic calcification in 17.2% (27/157) of the resected IPMN. In the univariate analyses, jaundice, high serum carbohydrate antigen 19-9 levels, and invasive IPMC were significantly associated with pancreatic calcification (4/27 [14.8%] vs 4/130 [3.1%], 0.01; 12/27 [44.4%] vs 31/130 [23.8%], 0.03; and 15/27 [55.6%] vs 34/130 [26.2%], 0.001, respectively). Pancreatic calcification was significantly associated with invasive IPMC (multivariate odds ratio = 2.88, 95% confidence interval [95% CI] = 1.15-7.21, 0.03, adjusted for clinical characteristics; odds ratio = 5.50, 95% CI = 1.98-15.3, 0.001, adjusted for imaging characteristics). CONCLUSIONS: Pancreatic calcification on CT is associated with invasive IPMC. Pancreatic calcification might be a predictor of invasive IPMC.2019年09月, Journal of gastroenterology and hepatology, 34(9) (9), 1648 - 1655, 英語, 国際誌[査読有り]
- Eosinophilic cholangitis (EC) is an uncommon, benign, self-limiting disease, which typically causes bile duct stricture with eosinophil infiltration. We report the case of a 70-year-old woman who presented with abdominal pain diagnosed with EC after treatment for eosinophilic esophagitis. All previous reported cases of EC had bile duct stricture seen on magnetic resonance cholangiopancreatography or cholangiogram during endoscopic retrograde cholangiopancreatography, but only wall thickness of the common bile duct was noted in our case. Although rare, EC should be considered when wall thickening of the bile duct is observed, even without stricture.2019年06月, ACG case reports journal, 6(6) (6), e00099, 英語, 国際誌
- 2019年05月, Case reports in gastroenterology, 13(2) (2), 265 - 270[査読有り]
- 2019年04月, Pancreatology, 19(3) (3), 424 - 428, 英語[査読有り]研究論文（学術雑誌）
- 2019年03月, Digestive Endoscopy, 31(2) (2), e50 - e51, 英語[査読有り]研究論文（学術雑誌）
- BACKGROUND:Endoscopic papillectomy (EP) for benign ampullary neoplasms could be a less-invasive alternative to pancreatoduodenectomy (PD). There are some problems and limitations with EP. The post-EP resection margins of ampullary tumors are often positive or uncertain because of the burning effect of EP. The clinical outcomes of resected margin positive or uncertain cases after EP remain unknown. AIM:To investigate the clinical outcomes of resected margin positive or uncertain cases after EP. METHODS:Between January 2007 and October 2018, all patients with ampullary tumors who underwent EP at Kobe University Hospital were included in this study. The indications for EP were as follows: adenoma, as determined by preoperative endoscopic biopsy, without bile/pancreatic duct extension, according to endoscopic ultrasound or intraductal ultrasound. The clinical outcomes of resected margin positive or uncertain cases after EP were retrospectively investigated. RESULTS:Of the 45 patients, 29 were male, and 16 were female. The mean age of the patients was 65 years old. Forty-one patients (89.5%) underwent en bloc resection, and 4 patients (10.5%) underwent piecemeal resection. After EP, 33 tumors were histopathologically diagnosed as adenoma, and 12 were diagnosed as adenocarcinoma. The resected margins were positive or uncertain in 24 patients (53.3%). Of these cases, 15 and 9 were diagnosed as adenoma and adenocarcinoma, respectively. Follow-up observation was selected for all adenomas and 5 adenocarcinomas. In the remaining 4 adenocarcinoma cases, additional PD was performed. Additional PD was performed in 4 cases, and residual carcinoma was found after the additional PD in 1 of these cases. In the follow-up period, local tumor recurrence was detected in 3 cases. Two of these cases involved primary EP-diagnosed adenoma. The recurrent tumors were also adenomas detected by biopsy. The remaining case involved primary EP-diagnosed adenocarcinoma. The recurrent tumor was also an adenocarcinoma. All of the recurrent tumors were successfully treated with argon plasma coagulation (APC). There was no local or lymph node recurrence after the APC. The post-APC follow-up periods lasted for 57.1 to 133.8 mo. No ampullary tumor-related deaths occurred in all patients. CONCLUSION:Resected margin positive or uncertain cases after EP could be managed by endoscopic treatment including APC, even in cases of adenocarcinoma. EP could become an effective less-invasive first-line treatment for early stage ampullary tumors.2019年03月, World journal of gastroenterology, 25(11) (11), 1387 - 1397, 英語[査読有り]研究論文（学術雑誌）
- 2019年02月, Pituitary, 22(1) (1), 54 - 61, 英語[査読有り]研究論文（学術雑誌）
- OBJECTIVE: Autoimmune pancreatitis (AIP) has the potential to transform into chronic pancreatitis with pancreatic stone involvement. This retrospective investigation sought to clarify the risk factors for stone formation in type 1 AIP. METHODS: Questionnaires on patients with type 1 AIP were sent to 22 high-volume medical centers across Japan to compare the clinical features of patients with and without pancreatic stone formation. RESULTS: Of the completed records on 624 type 1 AIP patients, 31 (5%) had experienced pancreatic stones. Median follow-up duration was 1853 days. Bentiromide test values at diagnosis were significantly lower, and hemoglobin A1c values after corticosteroid treatment were significantly higher in patients with pancreatic stones. Imaging results disclosed that pancreatic atrophy and hilar or intrahepatic bile duct stenosis were significantly more frequent in patients with pancreatic stone formation. Pancreatic head swelling tended to be more frequent in this group as well. On the other hand, a shorter follow-up period was associated with the nonformation of pancreatic stones. CONCLUSIONS: The increased frequency of pancreatic head swelling in type 1 AIP patients exhibiting pancreatic stones indicated a propensity for pancreatic juice stasis with subsequent stone development and pancreatic dysfunction occurring over longer periods of disease duration.2019年01月, Pancreas, 48(1) (1), 49 - 54, 英語, 国際誌[査読有り]研究論文（学術雑誌）
- 2019年, Journal of Gastroenterology and Hepatology (Australia), 34(8) (8), 1274, 英語[査読有り]研究論文（学術雑誌）
- 2018年07月, Genetics in medicine : official journal of the American College of Medical Genetics, 21(1) (1), 213 - 223, 英語[査読有り]研究論文（学術雑誌）
- Elsevier {BV}, 2018年06月, Pancreatology, 18(4) (4), 399 - 406[査読有り]研究論文（学術雑誌）
- Elsevier {BV}, 2018年06月, Pancreatology, 18(4) (4), 399 - 406, 英語[査読有り]研究論文（学術雑誌）
- 2018年06月, Endoscopy, 50(8) (8), E229 - E230, 英語[査読有り]研究論文（学術雑誌）
- Elsevier {BV}, 2018年03月, Biochemical and Biophysical Research Communications, 497(3) (3), 903 - 907, 英語[査読有り]研究論文（学術雑誌）
- BACKGROUND: Endoscopic ultrasound-guided rendezvous technique (EUS-RV) has emerged as an effective salvage method for unsuccessful biliary cannulation. However, its application for benign and resectable malignant biliary disorders has not been fully evaluated. AIMS: To assess the efficacy and safety of EUS-RV for benign and resectable malignant biliary disorders. METHODS: This was a multicenter prospective study from 12 Japanese referral centers. Patients who underwent EUS-RV after failed biliary cannulation for biliary disorder were candidates for this study. Inclusion criteria were unsuccessful biliary cannulation for therapeutic endoscopic retrograde cholangiopancreatography with benign and potentially resectable malignant biliary obstruction. Exclusion criteria included unresectable malignant biliary obstruction, inaccessible papillae due to surgically altered upper gastrointestinal anatomy or duodenal stricture, and previous sphincterotomy and/or biliary stent placement. The primary outcome was the technical success rate of biliary cannulation; procedure time, adverse events, and clinical outcomes were secondary outcomes. RESULTS: Twenty patients were prospectively enrolled. The overall technical success rate and median procedure time were 85% and 33 min, respectively. Guidewire manipulation using a 4-Fr tapered tip catheter contributed to the success in advancing the guidewire into the duodenum. Adverse events were identified in 15% patients, including 2 with biliary peritonitis and 1 mild pancreatitis. EUS-RV did not affect surgical maneuvers or complications associated with surgery, or postoperative course. CONCLUSIONS: EUS-RV may be a safe and feasible salvage method for unsuccessful biliary cannulation for benign or resectable malignant biliary disorders. Use of a 4-Fr tapered tip catheter may improve the overall EUS-RV success rate.2018年03月, Digestive diseases and sciences, 63(3) (3), 787 - 796, 英語, 国際誌[査読有り]研究論文（学術雑誌）
- 2018年03月, JAMA Oncol, 4(3) (3), e173420, 英語Association of Alterations in Main Driver Genes With Outcomes of Patients With Resected Pancreatic Ductal Adenocarcinoma[査読有り]研究論文（学術雑誌）
- BACKGROUND: We aimed to clarify the factors associated with the presentation of erosive esophagitis (EE) symptoms in subjects undergoing health checkups. METHODS: We utilized baseline data from 7,552 subjects who underwent upper endoscopy for health screening in a prospective, multicenter cohort study. The subjects were asked to complete a questionnaire detailing their upper abdominal symptoms and lifestyle. Based on the heartburn and/or acid regurgitation frequency, the EE subjects were stratified into the following three groups: (1) at least one day a week (symptomatic EE [sEE]), (2) less than one day a week (mild symptomatic EE [msEE]), and (3) never (asymptomatic EE [aEE]). Postprandial distress syndrome (PDS) and epigastric pain syndrome (EPS) were defined according to the Rome III criteria. RESULTS: Of the 1,262 (16.7%) subjects (male 83.8%, mean age 52.6 years) with EE, the proportions of sEE, msEE and aEE were 15.0%, 37.2% and 47.9%, respectively. The sEE group showed significant associations with overlapping EPS (OR: 58.4, 95% CI: 25.2-160.0), overlapping PDS (OR: 9.96, 95% CI: 3.91-26.8), severe hiatal hernia (OR: 2.43, 95% CI: 1.43-4.05), experiencing high levels of stress (OR: 2.20, 95% CI: 1.43-3.40), atrophic gastritis (OR: 1.57, 95% CI: 1.03-2.36) and Los Angeles (LA) grade B or worse (OR: 1.72, 95% CI: 1.12-2.60) in the multivariate analysis. CONCLUSIONS: Approximately one-sixth of EE subjects were symptomatic. A multifactorial etiology, including factors unrelated to gastric acid secretion, was associated with the symptom presentation of EE subjects.2018年, PloS one, 13(5) (5), e0196848, 英語, 国際誌[査読有り]研究論文（学術雑誌）
- 2018年, Nihon Shokakibyo Gakkai zasshi = The Japanese journal of gastro-enterology, 115(6) (6), 563 - 572[査読有り]
- Elsevier {BV}, 2018年01月, Pancreatology, 18(1) (1), 54 - 60, 英語[査読有り]研究論文（学術雑誌）
- Mosby Inc., 2018年, Gastrointestinal Endoscopy, 英語[査読有り]研究論文（学術雑誌）
- BACKGROUND: The association of alcohol intake with the incidence of Barrett's esophagus (BE) has been inconsistent. Although hiatal hernia and male sex are well-known risk factors of BE, its effect on the association of alcohol intake with the incidence of BE remains unknown. AIM: To investigate whether the influence of alcohol intake on the occurrence of BE might differ depending on male sex and presence of hiatal hernia. METHODS: We utilized a database of 8031 patients that underwent upper endoscopy for health screening in a prospective, multicenter, cohort study (the Upper Gastro Intestinal Disease study). The incidence of endoscopic columnar-lined esophagus (eCLE; endoscopically diagnosed BE) was the outcome variable. Multivariable logistic regression analysis was conducted to assess the association between alcohol intake and eCLE stratified by male sex and hiatal hernia, adjusting for clinical features and other potential confounders. RESULTS: Alcohol intake (≥20 g/day) showed a marginally significant association with the incidence of eCLE in participants without hiatal hernia (0 vs. ≥20 g/day; odds ratio [OR], 1.62; 95% confidence interval [CI], 0.92-2.85, P = 0.09) but not in participants with hiatal hernia (0 vs. ≥20/day; OR, 0.99; 95% CI, 0.59-1.65; P = 0.95). Furthermore, alcohol intake (≥20 g/day) was significantly associated with the incidence of eCLE in male participants without hiatal hernia (0 vs. ≥20 g/day; OR, 1.98; 95% CI, 1.04-4.03; P = 0.04) but not in female participants without hiatal hernia (0 vs. ≥20 g/day; OR, 0.47; 95% CI, 0.03-2.37; P = 0.42). CONCLUSIONS: The effect of alcohol intake on the incidence of eCLE might be associated with hiatal hernia status and male sex.2018年, PloS one, 13(2) (2), e0192951, 英語, 国際誌[査読有り]研究論文（学術雑誌）
- 2017年08月, AMERICAN JOURNAL OF SURGICAL PATHOLOGY, 41(8) (8), 1129 - 1138, 英語[査読有り]研究論文（学術雑誌）
- 2017年05月, The Kobe journal of medical sciences, 63History of Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis and Acute Pancreatitis as Risk Factors for Post-ERCP Pancreatitis.研究論文（学術雑誌）
- 2017年03月, WORLD JOURNAL OF GASTROENTEROLOGY, 23(11) (11), 2060 - 2067, 英語[査読有り]研究論文（学術雑誌）
- 症例は73歳男性．膵体部腫瘤の精査目的で入院した．造影CTでは尾側膵管の拡張を伴う境界明瞭な30mmの乏血性腫瘤であった．EUSでは境界が明瞭，辺縁はやや不整で，内部エコー均一な低エコー腫瘤として描出された．膵神経内分泌癌が疑われたが，通常型膵管癌との鑑別が困難であった．同腫瘤に対してEUS-FNAを行い，小細胞型神経内分泌癌と診断した．MRIで肝内に多発する結節を認めたため，多発肝転移を伴う膵神経内分泌癌と診断し，Irinotecan＋Cisplatinのレジメンで化学療法を行った．原疾患の進行のため，化学療法開始より6ヶ月後に永眠された．一般社団法人 日本膵臓学会, 2017年, 膵臓, 32(5) (5), 829 - 835, 日本語
- 症例は74歳男性．膵頭部腫瘤による閉塞性黄疸で近医に入院し，内視鏡的胆管ドレナージが行われ，当科に紹介となった．造影CT，MRCP，超音波内視鏡検査（EUS）では膵頭部に50mm大の辺縁が造影効果を有し中心部が造影されない腫瘤を認め，嚢胞変性を来した膵内分泌腫瘍の疑いで亜全胃温存膵頭十二指腸切除術を施行した．病理組織診断ではintraductal papillary mucinous neoplasm with an associated carcinoma, pancreatobiliary typeであった．Pancreatobiliary-type intraductal papillary mucinous neoplasmの画像所見に関する報告は少なく，文献的考察を加えて報告する．一般社団法人 日本膵臓学会, 2017年, 膵臓, 32(4) (4), 727 - 735, 日本語
- 【目的】内視鏡的乳頭切除術（Endoscopic Papillectomy：EP）に関連した出血に対する，有効で安全な止血法を明らかにする．【方法】EPを行った24例中，偶発症として出血を認め内視鏡的止血術を行なった13例をretrospectiveに検討した．【結果】出血時期はEP当日9例，翌日3例，翌々日1例で，初回止血法は，アルゴンプラズマ凝固法（APC）2例，Clip法3例，エピネフリン加高張食塩水局注法（HSE）2例，これらの併用が6例であった．13例中4例で再出血を認め，そのうち1例は仮性動脈瘤出血を来し動脈塞栓術を要したが，他は再度内視鏡的止血術を行い止血成功し得た．止血処置に伴う偶発症として5例に膵炎を認め，HSE併用例で多く認められた．【結論】止血効果はAPC併用例に比べClipやHSE併用例で良好であったが，HSE併用例では膵炎に注意が必要である．日本胆道学会, 2017年, 胆道, 31(5) (5), 793 - 801, 日本語
- Elsevier {BV}, 2017年01月, Pancreatology, 17(1) (1), 123 - 129研究論文（学術雑誌）
- 2017年, Oncology, 93(Suppl 1) (Suppl 1), 61 - 68, 英語[査読有り]研究論文（学術雑誌）
- 2017年, Pancreas, 46(4) (4), 582 - 588, 英語[査読有り]研究論文（学術雑誌）
- 2016年11月, CANCER IMMUNOLOGY RESEARCH, 4(11) (11), 927 - 935, 英語[査読有り]研究論文（学術雑誌）
- 2016年11月, PANCREAS, 45(10) (10), 1386 - 1393, 英語[査読有り]研究論文（学術雑誌）
- Elsevier {BV}, 2016年09月, Pancreatology, 16(5) (5), 893 - 899研究論文（学術雑誌）
- 2016年06月, Hepatology Research, 46(7) (7), 713 - 718, 英語, 国際誌
- 2016年04月, JNCI-JOURNAL OF THE NATIONAL CANCER INSTITUTE, 108(4) (4), 英語[査読有り]研究論文（学術雑誌）
- SpringerOpen, 2016年, Progress in biomaterials, 5(2) (2), 111 - 116, 英語[査読有り]
- 2016年01月, CANCER IMMUNOLOGY RESEARCH, 4(1) (1), 33 - 40, 英語[査読有り]研究論文（学術雑誌）
- 2015年08月, JAMA ONCOLOGY, 1(5) (5), 653 - 661, 英語[査読有り]研究論文（学術雑誌）
- 2015年04月, J Natl Cancer Inst, 107(4) (4), 英語[査読有り]研究論文（学術雑誌）
- 2015年03月, PANCREAS, 44(2) (2), 356 - 356, 英語Prognostic Significance of CDKN1B (p27) Expression in Gastroenteropancreatic Neuroendocrine Tumors[査読有り]
- 2014年09月, PANCREATOLOGY, 14(5) (5), 361 - 365, 英語[査読有り]研究論文（学術雑誌）
- 2014年04月, JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES, 21(4) (4), 275 - 280, 英語[査読有り]研究論文（学術雑誌）
- 2014年, DIGESTION, 90(1) (1), 10 - 17, 英語[査読有り]研究論文（学術雑誌）
- 2013年11月, PANCREATOLOGY, 13(6) (6), 583 - 588, 英語[査読有り]研究論文（学術雑誌）
- 2013年10月, JOURNAL OF GASTROENTEROLOGY, 48(10) (10), 1144 - 1150, 英語[査読有り]研究論文（学術雑誌）
- 2012年12月, Clinical Journal of Gastroenterology, 5(6) (6), 388 - 392, 英語[査読有り]研究論文（学術雑誌）
- 2012年11月, DIGESTIVE ENDOSCOPY, 24(6) (6), 484 - 484, 英語[査読有り]研究論文（学術雑誌）
- We report the case of a 56-year-old female with lipomatous hypertrophy of the pancreas. Abdominal CT and MRI showed fatty replacement over the entire pancreas. The pancreatic parenchyma was completely absent. ERCP showed no abnormal findings in the main pancreatic duct. EUS-FNA was performed to achieve a definitive diagnosis. Histological features of the FNA specimens revealed that adipose tissue generally replaced the pancreatic parenchyma, and pancreatic acini were identified with a scattered distribution. To consider the differential diagnosis of lipomatous pseudohypertrophy of the pancreas, it is necessary to distinguish it from obesity, diabetes, and age-related pancreatic fat infiltration and liposarcoma. By performing EUS-FNA, it was possible to obtain a definitive diagnosis in this patient. In conclusion, EUS-FNA may be helpful to make a definitive diagnosis in patients with lipomatous hypertrophy of the pancreas.2012年08月, Clinical journal of gastroenterology, 5(4) (4), 282 - 6, 英語, 国内誌[査読有り]研究論文（学術雑誌）
- 2012年05月, ARCHIVES OF BIOCHEMISTRY AND BIOPHYSICS, 521(1-2) (1-2), 95 - 101, 英語[査読有り]研究論文（学術雑誌）
- 2012年05月, BIOCHEMICAL AND BIOPHYSICAL RESEARCH COMMUNICATIONS, 421(4) (4), 768 - 772, 英語[査読有り]研究論文（学術雑誌）
- 2012年03月, DIGESTIVE ENDOSCOPY, 24(2) (2), 100 - 109, 英語[査読有り]研究論文（学術雑誌）
- 2012年03月, INTERNATIONAL JOURNAL OF CANCER, 130(5) (5), 1011 - 1020, 英語[査読有り]研究論文（学術雑誌）
- 2011年04月, Journal of Japanese Society of Gastroenterology, 108(4) (4), 640 - 649, 日本語[査読有り]研究論文（学術雑誌）
- 2011年02月, ARCHIVES OF BIOCHEMISTRY AND BIOPHYSICS, 506(2) (2), 223 - 235, 英語, 国際誌[査読有り]研究論文（学術雑誌）
- OBJECTIVES: The discovery of novel and effective treatment methods would be of great help to patients with acute pancreatitis. The aims of this study were to determine the inhibitory effects of vitamin K3 (VK3) against cerulein-induced acute pancreatitis in mice and to examine the mechanisms behind these effects. METHODS: Acute pancreatitis in mice was induced by intraperitoneal injection of cerulein 6 times at hourly intervals. Vitamin K3 was administered once before the first injection of cerulein or twice before and after the first injection of cerulein. The degrees of inflammation and autophagy in the pancreatic tissue were estimated by histological examination, measurement of enzyme activity, confocal microscopy, and Western blotting. The inhibitory effects of VK3 against rapamycin-induced autophagy were also examined using HeLa cells stably expressing green fluorescent protein LC3. RESULTS: Cerulein-induced acute pancreatitis was markedly attenuated by the administration of VK3. In addition, VK3 led to the inhibition of cerulein-evoked autophagic changes and colocalization of autophagosomes and lysosomes in the pancreatic tissue. Vitamin K3 also reduced rapamycin-induced autophagy in HeLa/green fluorescent protein LC3 cells. CONCLUSIONS: Our data suggest that the administration of VK3 reduces pancreatic inflammation in acute pancreatitis through inhibition of the autophagic pathway. Vitamin K3 may be an effective therapeutic strategy against acute pancreatitis.2011年01月, Pancreas, 40(1) (1), 84 - 94, 英語, 国際誌[査読有り]研究論文（学術雑誌）
- Immunoglobulins (Igs) play important immunomodulatory effects on allergic asthma. Among these, IgG has been reported to regulate allergic inflammation in previous studies about immunotherapy and intravenous immunoglobulin therapy. In this study, to examine the immunomodulatory mechanisms of IgG and FcRs we evaluated the effects of intravenous (i.v.) rabbit IgG administration (IVIgG) on allergic airway inflammation and lung antigen-presenting cells (APCs) in a murine model of ovalbumin (OVA) sensitization and challenge. In OVA-challenged mice, IVIgG attenuated airway eosinophilia, airway hyperresponsiveness and goblet cell hyperplasia and also inhibited the local T helper type (Th) 2 cytokine levels. Additionally, IVIgG attenuated the proliferation of OVA-specific CD4(+) T cells transplanted into OVA-challenged mice. Ex vivo co-culture with OVA-specific CD4(+) cells and lung CD11c(+) APCs from mice with IVIgG revealed the attenuated transcription level of Th2 cytokines, suggesting an inhibitory effect of IVIgG on CD11c(+) APCs to induce Th2 response. Next, to analyse the effects on Fcγ receptor IIb and dendritic cells (DCs), asthmatic features in Fcγ receptor IIb-deficient mice were analysed. IVIgG failed to attenuate airway eosinophilia, airway inflammation and goblet cell hyperplasia. However, the lacking effects of IVIgG on airway eosinophilia in Fcγ receptor IIb deficiency were restored by i.v. transplantation of wild-type bone marrow-derived CD11c(+) DCs. These results demonstrate that IVIgG attenuates asthmatic features and the function of lung CD11c(+) DCs via Fcγ receptor IIb in allergic airway inflammation. Targeting Fc portions of IgG and Fcγ receptor IIb on CD11c(+) DCs in allergic asthma is a promising therapeutic strategy.2010年11月, Clinical and experimental immunology, 162(2) (2), 315 - 24, 英語, 国際誌研究論文（学術雑誌）
- 2010年10月, Alimentary Pharmacology and Therapeutics, 32(7) (7), 908 - 915, 英語[査読有り]研究論文（学術雑誌）
- 2010年10月, Journal of clinical gastroenterology, 44(9) (9), e224 - 9[査読有り]
- Citrobacter rodentium, a murine model pathogen for enteropathogenic Escherichia coli, colonizes the surface of intestinal epithelial cells and causes mucosal inflammation. This bacterium is an ideal model for investigating pathogen-host immune interactions in the gut. It is well known that gene transcripts for Th1 cytokines are highly induced in colonic tissue from mice infected with C. rodentium. However, it remains to be seen whether the Th1 or Th2 cytokines produced by antigen-specific CD4(+) T cells provide effective regulation of the host immune defense against C. rodentium infection. To investigate the antigen-specific immune responses, C. rodentium expressing ovalbumin (OVA-C. rodentium), a model antigen, was generated and used to define antigen-specific responses under gamma interferon (IFN-gamma)-deficient or interleukin-4 (IL-4)-deficient conditions in vivo. The activation of antigen-specific CD4(+) T cells and macrophage phagocytosis were evaluated in the presence of IFN-gamma or IL-4 in vitro. IFN-gamma-deficient mice exhibited a loss of body weight and a higher bacterial concentration in feces during OVA-C. rodentium infection than C57BL/6 (wild type) or IL-4-deficient mice. This occurred through the decreased efficiency of macrophage phagocytosis and the activation of antigen-specific CD4(+) T cells. Furthermore, a deficiency in antigen-specific CD4(+) T-cell-expressed IFN-gamma led to a higher susceptibility to mucosal and gut-derived systemic OVA-C. rodentium infection. These results show that the IFN-gamma produced by antigen-specific CD4(+) T cells plays an important role in the defense against C. rodentium.2010年06月, Infection and immunity, 78(6) (6), 2653 - 66, 英語, 国際誌[査読有り]研究論文（学術雑誌）
- 2010年05月, CLINICAL AND EXPERIMENTAL IMMUNOLOGY, 160(2) (2), 283 - 292, 英語[査読有り]研究論文（学術雑誌）
- 2010年05月, INTERNATIONAL JOURNAL OF MOLECULAR MEDICINE, 25(5) (5), 761 - 767, 英語[査読有り]研究論文（学術雑誌）
- 2010年01月, INFLAMMATORY BOWEL DISEASES, 16(1) (1), 87 - 95, 英語[査読有り]研究論文（学術雑誌）
- 2009年10月, GASTRIC CANCER, 12(3) (3), 158 - 163, 英語研究論文（学術雑誌）
- 2009年04月, Seikagaku. The Journal of Japanese Biochemical Society, 81(4) (4), 308 - 14, 日本語, 国内誌[Intracellular traffic and the immune surveillance by neonatal Fcgamma receptor for IgG].[査読有り]研究論文（学術雑誌）
- 2008年04月, Infect Immun, 76(4) (4), 1728 - 1737, 英語, 国際誌[査読有り]研究論文（学術雑誌）
- OBJECTIVE: Recently guidelines for the treatment and prevention of ulcers induced by nonsteroidal anti-inflammatory drugs (NSAIDs) have been established. The aim of the present study was to examine factors influencing orthopedists in Japan in the use of cytoprotective drugs to prevent NSAID-associated gastrointestinal adverse events. METHODS: We sent a questionnaire to 402 orthopedists in Hyogo Prefecture. A standardized 10-item questionnaire was used to collect information on NSAID prescriptions (drug name, pharmaceutical form, doses, and duration of use) and associated drugs, especially gastroprotective drugs. RESULTS: Two hundred eight (51.7%) orthopedists returned the questionnaire. The most frequently used NSAIDs, in descending order, were loxoprofen sodium, diclofenac sodium, and etodolac. Most doctors (80%) reported patients with abdominal symptoms associated with NSAIDs. Of these doctors, 59% treated the symptoms by themselves, and prescribed gastroprotective agents (32.2%), histamine H2-receptor antagonists (H2RAs) (26.4%), prostaglandin analogues (PAs) (17.0%), or proton pump inhibitors (PPIs) (16.2%). Sixty-seven percent of doctors reported that those drugs reduced the symptoms. Most orthopedists (96%) prescribed some type of drug to prevent NSAID-associated gastrointestinal events, including gastroprotective drugs (44.6%), H2RAs (19.5%), PAs (17.4%), and PPIs (10.8%). The doctors reported that they prescribed medicines for NSAID-associated gastrointestinal events on the basis of their experience (23%), by considering medical insurance restrictions (17%), and by referring to information provided by pharmaceutical company representatives (16%). CONCLUSION: Most orthopedists prescribe some type of drug to prevent NSAID-induced ulcers but do not refer to the guidelines. We therefore strongly recommend that the guidelines be made more widely known to gastroenterologists and to physicians in every field of clinical practice, including orthopedics.2007年, Internal medicine (Tokyo, Japan), 46(13) (13), 927 - 31, 英語, 国内誌[査読有り]研究論文（学術雑誌）
- (一財)日本消化器病学会, 2023年10月, 日本消化器病学会雑誌, 120(臨増大会) (臨増大会), A848 - A848, 日本語
- 2022年06月, GASTROINTESTINAL ENDOSCOPY, 95(6) (6), AB42 - AB43, 英語A MULTICENTER RETROSPECTIVE STUDY OF ENDOSCOPIC TREATMENT FOR PANCREATIC FLUID COLLECTIONS: WONDERFUL STUDY GROUP研究発表ペーパー・要旨（国際会議）
- (株)アークメディア, 2022年03月, 肝胆膵, 84(3) (3), 335 - 342, 日本語【診療ガイドライン改訂後の膵炎診療】EUS所見は何を見ているのか 組織像との対比など
- (株)アークメディア, 2021年06月, 肝胆膵, 82(6) (6), 787 - 790, 日本語【分枝型IPMNの長期予後と進展様式】IPMNの長期予後 High risk stigmata非切除例の予後
- (株)アークメディア, 2021年06月, 肝胆膵, 82(6) (6), 797 - 802, 日本語【分枝型IPMNの長期予後と進展様式】IPMN由来癌と併存癌 IPMN併存癌の特徴 予後、遺伝子異常など通常型膵癌と比較して
- 医学図書出版(株), 2021年04月, 胆と膵, 42(4) (4), 285 - 292, 日本語
- (株)日本臨床社, 2021年04月, 日本臨床, 別冊(肝・胆道系症候群III) (肝・胆道系症候群III), 145 - 148, 日本語【肝・胆道系症候群(第3版)-その他の肝・胆道系疾患を含めて-肝外胆道編】肝外胆管(胆管、胆嚢管、総胆管) その他 Oddi括約筋機能不全
- (株)東京医学社, 2021年03月, 消化器内視鏡, 33(3) (3), 635 - 641, 日本語
- John Wiley and Sons Inc, 2021年, Journal of Gastroenterology and Hepatology (Australia), 英語書評論文,書評,文献紹介等
- 2021年, 胆と膵, 42(8) (8)膵癌,膵炎の病態解明と新規治療開発にむけた研究の最前線 膵癌のメタボローム解析によるバイオマーカーと新規治療の開発
- 2021年, 日本臨床膵炎 1型自己免疫性膵炎(IgG4関連膵炎)
- (一社)日本膵臓学会, 2020年12月, 膵臓, 35(6) (6), 465 - 550, 日本語
- (株)メディカルレビュー社, 2020年12月, 胆膵Oncology Forum, 1(1) (1), 15 - 19, 日本語誌上ディベート 胆膵がん術前胆道ステント留置 メタリックステントの立場から
- (一社)日本膵臓学会, 2020年12月, 膵臓, 35(6) (6), 465 - 550, 日本語
- (株)診断と治療社, 2020年08月, 診断と治療, 108(8) (8), 970 - 975, 日本語
- 日本胆道学会, 2020年05月, 胆道, 34(2) (2), 244 - 250, 日本語
- (株)東京医学社, 2020年03月, 消化器内視鏡, 32(3) (3), 385 - 390, 日本語
- 医学図書出版(株), 2020年03月, 胆と膵, 41(3) (3), 301 - 305, 日本語
- (株)東京医学社, 2019年11月, 消化器内視鏡, 31(11) (11), 1694 - 1699, 日本語
- (株)日本臨床社, 2019年10月, 日本臨床, 77(10) (10), 1734 - 1739, 日本語【機能性消化管疾患:上部-最新の診断と治療-】上腹部症状を有する患者の膵疾患を見落とさないために
- 2019年, 兵庫県医師会医学雑誌, 61(2) (2)膵癌の造影超音波内視鏡による客観的血流動態指標と化学療法感受性の関連性
- 科学評論社, 2018年12月, 消化器・肝臓内科 = Gastroenterology & hepatology / 消化器・肝臓内科編集委員会 編, 4(6) (6), 492 - 498, 日本語Peri-pancreatic fluid collection drainageにおける偶発症予防と対処—The management of adverse event for peri-pancreatic fluid collection drainage—特集 Interventional EUSの偶発症予防と対処
- (有)科学評論社, 2018年12月, 消化器・肝臓内科, 4(6) (6), 492 - 498, 日本語【Interventional EUSの偶発症予防と対処】Peri-pancreatic fluid collection drainageにおける偶発症予防と対処
- 2018年11月, JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, 33, 194 - 194, 英語Significance of pancreatic calcification on preoperative CT image of intraductal papillary mucinous neoplasm研究発表ペーパー・要旨（国際会議）
- (株)アークメディア, 2018年11月, 肝・胆・膵, 77(5) (5), 957 - 963, 日本語[招待有り]記事・総説・解説・論説等（商業誌、新聞、ウェブメディア）
- 医学図書出版(株), 2018年11月, 胆と膵, 39(臨増特大) (臨増特大), 1179 - 1186, 日本語【Biliary access大辞典】アクセスルートの確保 EST困難例への対処[招待有り]記事・総説・解説・論説等（商業誌、新聞、ウェブメディア）
- (株)東京医学社, 2018年10月, 消化器内視鏡, 30(増刊) (増刊), 74 - 77, 日本語【胆膵疾患内視鏡アトラス】膵臓 嚢胞性 膵漿液性嚢胞腫瘍 microcystic type、macrocystic type、solid type[招待有り]記事・総説・解説・論説等（商業誌、新聞、ウェブメディア）
- (一社)日本総合健診医学会, 2018年01月, 総合健診, 45(1) (1), 283 - 283, 日本語
- (有)科学評論社, 2017年12月, 消化器・肝臓内科, 2(6号) (6号), 596 - 603, 日本語【膵疾患に対する内視鏡治療の新展開】 膵頭十二指腸切除術後の膵管空腸吻合部狭窄に対するInterventional EUS[招待有り]記事・総説・解説・論説等（商業誌、新聞、ウェブメディア）
- 医学図書出版(株), 2017年10月, 胆と膵, 38(臨増特大) (臨増特大), 1021 - 1028, 日本語【胆膵EUSを極める-私ならこうする(There is always a better way)-】 治療 術後再建腸管症例に対する肝内胆管ドレナージ術(HGS、HJS) 私はこうする記事・総説・解説・論説等（商業誌、新聞、ウェブメディア）
- (株)東京医学社, 2017年10月, 消化器内視鏡, 29(10号) (10号), 1910 - 1915, 日本語[招待有り]記事・総説・解説・論説等（商業誌、新聞、ウェブメディア）
- 医学図書出版(株), 2017年10月, 胆と膵, 38(10号) (10号), 1221 - 1226, 日本語[招待有り]記事・総説・解説・論説等（商業誌、新聞、ウェブメディア）
- (有)科学評論社, 2017年09月, 消化器・肝臓内科, 2(3号) (3号), 282 - 293, 日本語【Interventional EUSの最新情報-適応、手技、デバイス-】 Pancreatic fluid collection(膵・膵周囲液体貯留)に対するInterventional EUS[招待有り]記事・総説・解説・論説等（商業誌、新聞、ウェブメディア）
- 医学図書出版(株), 2016年11月, 胆と膵, 37(臨増特大) (臨増特大), 1121 - 1129, 日本語
- (株)アークメディア, 2016年10月, 肝・胆・膵, 73(4号) (4号), 541 - 550, 日本語[査読有り][招待有り]記事・総説・解説・論説等（商業誌、新聞、ウェブメディア）
- 日本膵臓学会, 2014年06月, 膵臓, 29(3) (3), 605 - 605, 日本語慢性膵炎に対する膵管ステントの臨床効果の検討 全国多施設共同調査(中間報告)
- (一社)日本消化器内視鏡学会, 2014年04月, Gastroenterological Endoscopy, 56(Suppl.1) (Suppl.1), 1192 - 1192, 日本語当院における85歳以上の超高齢者に対する胆膵内視鏡検査の現状[査読有り]
- (一社)日本消化器内視鏡学会, 2014年04月, Gastroenterological Endoscopy, 56(Suppl.1) (Suppl.1), 1137 - 1137, 日本語主膵管狭窄を伴う慢性膵炎症例に対する膵管ステント留置術の臨床効果の検討 全国多施設共同調査(中間報告)
- (一財)日本消化器病学会, 2014年03月, 日本消化器病学会雑誌, 111(臨増総会) (臨増総会), A292 - A292, 日本語経乳頭的胆嚢胆汁細胞診の検討
- (一財)日本消化器病学会, 2014年03月, 日本消化器病学会雑誌, 111(臨増総会) (臨増総会), A228 - A228, 日本語消化管再建後胆膵疾患症例に対するダブルバルーン内視鏡によるアプローチの現状と課題
- (株)東京医学社, 2014年02月, 消化器内視鏡, 26(2号) (2号), 280 - 288, 日本語[招待有り]記事・総説・解説・論説等（商業誌、新聞、ウェブメディア）
- 2014年, 難治性膵疾患に関する調査研究 平成25年度 総括・分担研究報告書難治性膵疾患に関する調査研究 自己免疫性膵炎切除例におけるPanIN病変の検討
- 2013年12月, 膵臓, 28(6号) (6号), 717 - 783, 日本語記事・総説・解説・論説等（学術雑誌）
- (一財)日本消化器病学会, 2013年01月, 日本消化器病学会雑誌, 110(1) (1), 88 - 94, 日本語
- 2013年, 胆道, 27(2) (2)術前診断に苦慮したIgG4関連硬化性胆管炎の1例
- 2012年10月, 炎症と免疫, 20(6号) (6号), 596 - 600, 日本語粘膜免疫におけるFc受容体の役割[査読有り][招待有り]記事・総説・解説・論説等（学術雑誌）
- 2012年09月, 肝胆膵画像, 14(6号) (6号), 519 - 523, 日本語[招待有り]記事・総説・解説・論説等（学術雑誌）
- 2012年07月, 胆と膵, 33(7号) (7号), 597 - 601, 日本語【膵臓の画像診断update】 CO2 MDCT pancreatographyとvirtual pancreatoscopy 二酸化炭素送気経口膵管内視鏡への応用[査読有り][招待有り]記事・総説・解説・論説等（学術雑誌）
- 2012年03月, 胆と膵, 33(3号) (3号), 249 - 254, 日本語【十二指腸乳頭部癌-診断・治療の最前線-】 早期乳頭部癌の臨床的特徴と治療[査読有り][招待有り]記事・総説・解説・論説等（学術雑誌）
- (有)科学評論社, 2011年02月, 消化器内科, 52(2) (2), 188 - 194, 日本語【重症急性膵炎の病態解明と治療の新展開】 ビタミンK3による膵炎抑制効果
- 科学評論社, 2011年02月, 消化器内科, 52巻, 2号, pp. 188-194(2) (2), 182 - 187, 日本語【重症急性膵炎の病態解明と治療の新展開】 ビタミンK3による膵炎抑制効果記事・総説・解説・論説等（学術雑誌）
- 2011年, 日本小児外科学会雑誌, 47(1) (1)膵仮性嚢胞に対し超音波内視鏡下経胃膵嚢胞ドレナージ術を施行した1例
- 2011年, 兵庫県医師会医学雑誌, 53(2) (2)疾患動向からみた新しい胃癌検診のあり方-胃癌集団検診「要精査」群における,HP感染と前癌病変の検討-
- (一社)日本消化器内視鏡学会, 2010年08月, Gastroenterological Endoscopy, 52(8) (8), 1895 - 1900, 日本語
- 2010年, Endoscopy, 42(SUPPL. 2) (SUPPL. 2)[査読有り]
- (公社)日本生化学会, 2009年04月, 生化学, 81(4) (4), 308 - 314, 日本語胎児性Fcγ受容体による細胞内トラフィックと免疫監視機構
- 2009年03月, 分子消化器病, 6巻, 1号, pp. 69-75, 日本語消化管上皮細胞の機能分子とその解析法 消化管上皮における免疫グロブリンレセプターの役割とその解析法[査読有り]記事・総説・解説・論説等（学術雑誌）
- (有)科学評論社, 2008年05月, 臨床免疫・アレルギー科, 49(5) (5), 599 - 605, 日本語腸内細菌防御とFcγレセプター記事・総説・解説・論説等（学術雑誌）
- 医学図書出版(株), 2008年01月, 胆と膵, 29巻, 1号, pp. 39-44(1) (1), 39 - 44, 日本語【ERCP関連手技をより安全に行うために】 プレカットによる胆管深部挿管 膵管ステント併用の有用性
- (株)先端医学社, 2007年09月, IBD Research, 1(3) (3), 184 - 188, 日本語【分子メカニズムから探るIBDの病態と治療アプローチ】腸管免疫監視機構におけるIgGの役割とIBD
- 2006年09月, 実験医学, 24巻, 14号, pp. 2116-2121, 日本語【神経・免疫・内分泌系へ拡がるメンブレントラフィック】 FcRnによるIgG,抗原-IgG複合体の輸送機構記事・総説・解説・論説等（学術雑誌）
- (一社)日本消化器内視鏡学会, 2006年04月, Gastroenterological Endoscopy, 48(Suppl.1) (Suppl.1), 751 - 751, 日本語胃腫瘍に対する内視鏡的粘膜下層剥離術(ESD法)の有用性と今後の展望について
- (株)癌と化学療法社, 2006年04月, 癌と化学療法, 33(4) (4), 505 - 508, 日本語Second-Line治療としての粉末Cisplatin製剤肝動注が効果的であった肝細胞癌の1例
- (一財)日本消化器病学会, 2005年03月, 日本消化器病学会雑誌, 102(臨増総会) (臨増総会), A350 - A350, 日本語急性膵炎11例の検討
- 日本消化器内視鏡学会近畿支部例会プログラム・抄録集, 2022年06月, 日本語, 日本消化器内視鏡学会-近畿支部胆管空腸吻合部狭窄に対して直視型EUSを用いて再建腸管からの胆管空腸瘻孔形成術に成功した1例
- 日本消化器内視鏡学会近畿支部例会プログラム・抄録集, 2022年06月, 日本語, 日本消化器内視鏡学会-近畿支部「胆膵内視鏡診断の現況と展望」 胆道癌の術前診断における経口胆道鏡の役割
- 日本消化器内視鏡学会近畿支部例会プログラム・抄録集, 2022年06月, 日本語, 日本消化器内視鏡学会-近畿支部胆膵内視鏡治療の工夫とリスクマネージメント 急性膵炎局所合併症における治療困難例の特徴と早期インターベンションの可能性
- 日本消化器病学会雑誌, 2022年03月, 日本語, (一財)日本消化器病学会自己免疫性肝胆膵疾患の新展開 自己免疫性膵炎の長期経過における再燃・ステロイド依存のリスク因子および悪性腫瘍の発症に関する検討
- 日本消化器病学会雑誌, 2022年03月, 日本語, (一財)日本消化器病学会IPMNの病態解明にもとづくマネージメント IPMNの膵体積測定による悪性化予測およびHRSに対する上乗せ効果の検討
- 日本消化器病学会雑誌, 2022年03月, 日本語, (一財)日本消化器病学会病態に基づくInterventional EUSによる診療戦略 当院の膵炎局所合併症における治療困難例の特徴 内視鏡治療後の予後の解析から
- 日本消化器病学会近畿支部例会プログラム・抄録集, 2022年02月, 日本語, 日本消化器病学会-近畿支部免疫チェックポイント阻害剤をめぐる諸問題 当院での免疫チェックポイント阻害剤投与患者におけるirAE膵障害についての検討
- 日本消化器病学会近畿支部例会プログラム・抄録集, 2022年02月, 日本語, 日本消化器病学会-近畿支部膵癌診療の進歩と今後の展望 膵癌の腫瘍内線維化の予後における意義
- 日本消化器内視鏡学会近畿支部例会プログラム・抄録集, 2021年12月, 日本語, 日本消化器内視鏡学会-近畿支部膵臓に多発結節を認めEUS-FNAで診断し得たAIDS関連バーキットリンパ腫の一例
- 日本消化器内視鏡学会近畿支部例会プログラム・抄録集, 2021年12月, 日本語, 日本消化器内視鏡学会-近畿支部合流部結石による胆嚢結腸瘻の一例
- 日本消化器内視鏡学会近畿支部例会プログラム・抄録集, 2021年12月, 日本語, 日本消化器内視鏡学会-近畿支部胆膵内視鏡 治療困難症例を克服するための工夫 治療困難な膵石症に対する内視鏡治療における工夫
- 日本消化器内視鏡学会近畿支部例会プログラム・抄録集, 2021年12月, 日本語, 日本消化器内視鏡学会-近畿支部難治性胆膵疾患に対する内視鏡診療の取り組み 当院における膵癌に対する術前診断法の現状と課題
- 日本消化器病学会雑誌, 2021年10月, 日本語, (一財)日本消化器病学会膵癌切除例における腫瘍内線維化と術後化学療法感受性および予後との関連性
- 日本消化器病学会雑誌, 2021年10月, 日本語, (一財)日本消化器病学会膵癌の進展機構の解明と新たな治療 膵癌のTLS(Tertiary lymphoid structure)を介した腫瘍免疫機構の解明
- 日本癌学会総会記事, 2021年09月, 英語, (一社)日本癌学会肝胆膵がんにおける基礎および臨床研究の進展 同時性・異時性多発膵癌の遺伝子解析
- Gastroenterological Endoscopy, 2021年04月, 日本語, (一社)日本消化器内視鏡学会内視鏡的乳頭切除術を行った早期十二指腸乳頭部腫瘍の予後に関する検討
- Gastroenterological Endoscopy, 2021年04月, 日本語, (一社)日本消化器内視鏡学会乳酸リンゲル液の投与によるERCP後膵炎発症予防効果の検討
- Gastroenterological Endoscopy, 2021年04月, 日本語, (一社)日本消化器内視鏡学会EUS-hepaticogastrostomyにおけるトラブルを未然に回避するためのダブルガイドワイヤー法
- Gastroenterological Endoscopy, 2021年04月, 日本語, (一社)日本消化器内視鏡学会胆道出血に対する内視鏡治療の現状と課題 特に肝細胞癌からの胆道出血に関して
- 日本消化器病学会雑誌, 2021年03月, 日本語, (一財)日本消化器病学会治療困難胆管結石に対する電気衝撃波結石破砕術(EHL)の当院における現状と治療成績の検討
- 日本消化器病学会雑誌, 2021年03月, 日本語, (一財)日本消化器病学会慢性膵炎を巡る諸問題:早期慢性膵炎から外科治療まで 膵切除検体を用いたEUSにおける早期慢性膵炎所見の妥当性の検証
- 日本消化器病学会雑誌, 2021年03月, 日本語, (一財)日本消化器病学会予後向上を目指した膵癌診療 膵癌手術例における治療選択マーカーとしてのTLS(Tertiary lymphoid structure)の有用性
- 日本消化器病学会近畿支部例会プログラム・抄録集, 2021年02月, 日本語, 日本消化器病学会-近畿支部膵管内腫瘍様の形態を呈した腎癌膵臓転移症例の一例
- 超音波医学 Supplement, 2021年良性胆膵疾患に対するInterventional EUSの検討
- 日本消化器病学会雑誌(Web), 2021年膵切除検体を用いたEUSにおける早期慢性膵炎所見の妥当性の検証
- 日本消化器病学会雑誌(Web), 2021年膵癌手術例における治療選択マーカーとしてのTLS(Tertiary lymphoid structure)の有用性
- 日本消化器病学会雑誌(Web), 2021年治療困難胆管結石に対する電気衝撃波結石破砕術(EHL)の当院における現状と治療成績の検討
- 日本消化器内視鏡学会近畿支部例会プログラム・抄録集, 2020年12月, 日本語, 日本消化器内視鏡学会-近畿支部縦隔内膵仮性嚢胞に対し内視鏡的ドレナージが奏功した1例
- 日本消化器内視鏡学会近畿支部例会プログラム・抄録集, 2020年12月, 日本語, 日本消化器内視鏡学会-近畿支部胆膵内視鏡診断の工夫 EUS-FNAによる膵がん遺伝子診断の実現可能性の検討
- 日本消化器病学会近畿支部例会プログラム・抄録集, 2020年10月, 日本語, 日本消化器病学会-近畿支部胆嚢癌との鑑別が困難であったIgG4関連硬化性胆嚢炎の一例
- 日本消化器病学会近畿支部例会プログラム・抄録集, 2020年10月, 日本語, 日本消化器病学会-近畿支部胆膵領域癌に対する診断の取り組み 当院における十二指腸乳頭部腫瘍に対する内視鏡的十二指腸乳頭切除術の術前診断の評価
- 日本消化器病学会雑誌, 2020年10月, 日本語, (一財)日本消化器病学会消化器領域から見たIgG4関連疾患研究の進歩 造影CTによる自己免疫性膵炎ステロイド治療後の耐糖能異常予測
- 胆道, 2020年08月, 日本語, 日本胆道学会十二指腸乳頭部腫瘍に対する診断と治療戦略 十二指腸乳頭部腫瘍に対する内視鏡的乳頭切除術後の病理学的評価と予後
- 日本消化器病学会雑誌, 2020年07月, 日本語, (一財)日本消化器病学会肝門部領域胆管癌の術前診断におけるSpyGlassDSの有用性
- 日本消化器病学会雑誌, 2020年07月, 日本語, (一財)日本消化器病学会膵癌早期発見に向けての取り組み 当院における膵癌患者の診断前過去CT画像の検討
- 日本消化器病学会雑誌, 2020年07月, 日本語, (一財)日本消化器病学会健診受診者における無症候性びらん性食道炎の4年間の自然経過
- 日本消化器病学会雑誌, 2020年07月, 日本語, (一財)日本消化器病学会自己免疫性膵胆道疾患診療の課題と展望 自己免疫性膵炎での造影CTによるfECVを用いた膵萎縮の予測
- 日本消化器病学会雑誌, 2020年07月, 日本語, (一財)日本消化器病学会機能性消化管疾患に対する新しい治療戦略 機能性消化管疾患診療を考える上でのBMIと性別の影響
- 膵臓, 2020年07月, 日本語, (一社)日本膵臓学会特異な画像を呈した膵神経内分泌癌の1例
- 膵臓, 2020年07月, 日本語, (一社)日本膵臓学会膵癌の予後におけるTLS(Tertiary lymphoid structure)の意義
- 膵臓, 2020年07月, 日本語, (一社)日本膵臓学会IPMN国際診療ガイドライン2017の検証 High risk stigmataを有するIPMN経過観察症例の予後からみたガイドラインの検証
- 膵臓, 2020年07月, 日本語, (一社)日本膵臓学会IPMNに併存する浸潤性膵管癌の特徴 IPMN併存膵癌とIPMN非併存膵癌の分子病理学的特徴と予後の相違
- 膵臓, 2020年07月, 日本語, (一社)日本膵臓学会慢性膵炎の診断基準改訂の意義 膵切除例を用いた早期慢性膵炎のEUS所見と背景膵の病理所見との対比
- 日本消化器内視鏡学会近畿支部例会プログラム・抄録集, 2020年06月, 日本語, 日本消化器内視鏡学会-近畿支部急性膵炎を契機に診断した膵上皮内癌の一例
- 日本消化器内視鏡学会近畿支部例会プログラム・抄録集, 2020年06月, 日本語, 日本消化器内視鏡学会-近畿支部EUS関連手技のトラブルシューティング Double-guidewire techniqueを用いた超音波内視鏡下胆道ドレナージ術
- 胆道, 2020年05月, 日本語, 日本胆道学会肝外胆管に発育したIntraductal papillary neoplasm of the bile duct(IPNB)
- 肝臓, 2020年造影CTによる自己免疫性膵炎ステロイド治療後の耐糖能異常予測
- 膵臓(Web), 2020年IPMN併存膵癌とIPMN非併存膵癌の分子病理学的特徴と予後の相違
- 膵臓(Web), 2020年膵切除例を用いた早期慢性膵炎のEUS所見と背景膵の病理所見との対比
- 膵臓(Web), 2020年High risk stigmataを有するIPMN経過観察症例の予後からみたガイドラインの検証
- 日本消化器病学会近畿支部例会プログラム・抄録集, 2019年10月, 日本語, 日本消化器病学会-近畿支部正中弓状靱帯症候群に脾動脈瘤と膵体部腫瘤を合併した例
- 日本消化器病学会近畿支部例会プログラム・抄録集, 2019年10月, 日本語, 日本消化器病学会-近畿支部膵管内乳頭粘液性腺癌との鑑別が困難であった自己免疫性膵炎の1例
- 胆道, 2019年10月, 日本語, 日本胆道学会胃および十二指腸球部に瘻孔を形成し、上部消化管内視鏡で胆管内を観察し得たIPNBと考えられる胆道腫瘍の一例
- 胆道, 2019年10月, 日本語, 日本胆道学会12年の経過観察ののち外科手術を行ったIntraductal papillary neoplasm of the bile duct(IPNB)の1例
- 胆道, 2019年10月, 日本語, 日本胆道学会抗PD-1抗体Pembrolizumabの免疫関連有害事象と考えられる胆管炎の1例
- 日本高齢消化器病学会誌, 2019年07月, 日本語, (NPO)日本高齢消化器病学会高齢者におけるERCP後膵炎のリスク解析
- 膵臓, 2019年06月, 日本語, 日本膵臓学会死亡の転帰となった薬剤性重症急性膵炎の一例
- 膵臓, 2019年06月, 日本語, 日本膵臓学会IPMN術後の残膵再発に関与する因子の検討 糖尿病の新規発症及び増悪の関連性
- 膵臓, 2019年06月, 日本語, 日本膵臓学会膵石症に対する内視鏡治療を軸とした治療戦略
- Gastroenterological Endoscopy, 2019年05月, 日本語, (一社)日本消化器内視鏡学会十二指腸乳頭部腫瘍に対する内視鏡的乳頭切除術(EP)後の病理学的評価と予後の検討
- Gastroenterological Endoscopy, 2019年05月, 日本語, (一社)日本消化器内視鏡学会悪性輸入脚狭窄に対する内視鏡的金属ステント留置術の検討
- Gastroenterological Endoscopy, 2019年05月, 日本語, (一社)日本消化器内視鏡学会膵嚢胞性腫瘍に対する内視鏡診断 膵管内乳頭粘液産生腫瘍に対するERCP下膵液細胞診の役割 腫瘍の病理学的特徴との対比を含めて
- 日本消化器病学会雑誌, 2019年03月, 日本語, (一財)日本消化器病学会ERCP・EUS関連手技のトラブルシューティング 超音波内視鏡下胆道ドレナージ術を安全に成功へと導くDouble-guidewire technique
- 総合健診, 2019年03月, 日本語, (一社)日本総合健診医学会, 【目的】健診受診者における上腹部症状の性別と年齢による違いを明らかにすることを目的とした。【方法】多施設共同前向き研究に登録された上部消化管内視鏡検診受診者7,278例を対象とした。自己記入式の問診票を用いて上腹部症状として、胃食道逆流症(GERD)症状:胸やけ・胃酸の逆流・食後愁訴症候群(PDS)症状:食べきれない・もたれ感、心窩部痛症候群(EPS)症状:みぞおちの焼ける感じや痛み、の頻度を調査した。性別や年代別の上腹部症状の違いについてカイ二乗検定にて統計学的に検討した。【成績】GERD症状、PDS症状、EPS症状を何等かの頻度で認める受診者の割合は37.4%、28.4%、21.2%、週1日以上を認める割合はそれぞれ、7.3%、5.7%、3.4%であった。3つの上腹部症状のいずれかを認めたのは48.9%、週1日以上認めたのは10.8%であった。GERD症状は全体としては男性に多かったが、60歳代以降は男性における頻度が低下するのに対し女性では加齢とともに頻度は上がり、70歳代以上では女性の方が男性より頻度は高くなっていた。PDS症状、EPS症状については、すべての年齢層で女性に多かった。男性では60歳以上で頻度は低くなっており男女差が大きくなっていた。女性ではGERD症状、PDS症状、EPS症状が3つともオーバーラップしている受診者が最も多かったのに対し、男性ではGERD症状のみを認める受診者が最も多かった。【結論】健診受診者の約半数に上腹部症状を認めていた。性別と年齢により上腹部症状のパターンに違いが認められた。(著者抄録)健診受診者における上腹部症状の性別と年齢による違い
- 日本消化器病学会近畿支部例会プログラム・抄録集, 2019年02月, 日本語, 日本消化器病学会-近畿支部術前に癌の確定診断困難であったT1a膵癌の1例
- 日本消化器病学会近畿支部例会プログラム・抄録集, 2019年02月, 日本語, 日本消化器病学会-近畿支部異所性膵を伴うHamartomatous inverted polypにより胃通過障害を来した一例
- 日本消化器病学会雑誌(Web), 2019年超音波内視鏡下胆道ドレナージ術を安全に成功へと導くDouble-guidewire technique
- 日本消化器病学会雑誌(Web), 2019年無症状群におけるGERD症状発生の自然経過についての検討
- Gastroenterological Endoscopy (Web), 2019年膵管内乳頭粘液産生腫瘍に対するERCP下膵液細胞診の役割-腫瘍の病理学的特徴との対比を含めて-
- 日本消化器画像診断研究会プログラム・抄録集, 2019年主膵管内に充満した粘液産生に乏しいpancreato-biliary type IPMNの1例
- 膵臓(Web), 2019年IPMN術後の残膵再発に関与する因子の検討-糖尿病の新規発症及び増悪の関連性-
- 日本消化器病学会雑誌, 2018年10月, 日本語, (一財)日本消化器病学会IPMNにおける外科治療のタイミング リンパ節転移予測因子の検討
- 日本消化器病学会雑誌, 2018年10月, 日本語, (一財)日本消化器病学会バレット食道新規発症と食道裂孔ヘルニアとの関連性多施設共同前向き研究による経年変化
- 日本消化器病学会雑誌, 2018年10月, 日本語, (一財)日本消化器病学会胆膵領域におけるIgG4関連疾患の研究と診療の進歩 自己免疫性膵炎における造影CT平衡相のCT値によるステロイド治療後の膵萎縮の予測の試み
- 胆道, 2018年08月, 日本語, 日本胆道学会稀な胆管狭窄 明らかな胆管狭窄を認めない好酸球性胆管炎の一例
- 胆道, 2018年08月, 日本語, 日本胆道学会術後胆汁漏・胆道狭窄に対する治療戦略-内科、外科の立場から- 術後胆汁漏に対する内視鏡治療の有用性
- 日生病院医学雑誌, 2018年07月, 日本語, (公財)日本生命済生会日本生命病院, 症例は51歳女性で、肺結核、頸部結核性リンパ節炎、気管支鏡下洗浄液PCR検査で結核菌陽性、頸部リンパ節生検で乾酪壊死と周囲に類上皮細胞を認めた。抗結核療法後に完治と診断した。心窩部痛で受診し、肝膿瘍を認めた。経皮的肝膿瘍ドレナージで肝膿瘍は改善したが、CT検査で膵臓に隣接する低吸収域を認めた。造影CT検査では、膵体部背側で上腸間膜静脈と脾静脈に接し、境界不明瞭で造影効果の乏しい25mm大の腫瘤を認め、膵頭部にも同様に境界不明瞭で造影効果の乏しい腫瘤を認めた。MRIでは、膵腫瘤は脂肪抑制T1強調像で低信号、T2強調像では信号強度は低く周囲膵組織とほぼ等信号に描出され、造影MRIでは造影効果はほとんど認めなかった。PET-CTでは、膵体部と膵頭部にと集積亢進を認めた。超音波内視鏡では、内部に一部高エコーの構造物を伴う淡い低エコー腫瘤として描出された。確定診断目的に超音波内視鏡下穿刺吸引法を施行し、結核性リンパ節炎による炎症性偽腫瘍と診断した。抗結核療法の追加は定期通院が難しく再治療導入が困難であった。半年後に施行した造影CTでは病変はやや縮小傾向で、炎症性偽腫瘍の診断を支持する結果であった。EUS-FNAが有用であった結核性リンパ節炎の1例
- 日本消化器病学会雑誌, 2018年06月, 日本語, (一財)日本消化器病学会, 症例は57歳男性。前医で膵頭部に悪性腫瘍が疑われ、超音波内視鏡下穿刺吸引術(EUS-FNA)を施行されたが確定診断には至らなかった。当院で施行した超音波内視鏡下エラストグラフィーおよび造影ハーモニック超音波内視鏡検査において悪性所見に乏しく、腫瘤形成性膵炎や自己免疫性膵炎が疑われた。再検したEUS-FNAの検体にて好中球性膵管障害を認め、2型自己免疫性膵炎と診断しステロイド治療が奏功した。(著者抄録)超音波内視鏡下エラストグラフィーおよび造影ハーモニック超音波内視鏡検査が診断の一助となった2型自己免疫性膵炎の1例
- 膵臓, 2018年05月, 日本語, 日本膵臓学会抗PD-1抗体ニボルマブの免疫関連有害事象と思われる膵炎の1例
- 膵臓, 2018年05月, 日本語, 日本膵臓学会自己免疫性膵炎におけるアポリポ蛋白AIIアイソフォーム測定の意義
- 膵臓, 2018年05月, 日本語, 日本膵臓学会膵疾患におけるInterventional endoscopy Pancreatic fluid collectionに対するInterventional endoscopyの成績
- Gastroenterological Endoscopy, 2018年04月, 日本語, (一社)日本消化器内視鏡学会自己免疫性膵炎に合併した胆管病変に対する内視鏡的胆道ドレナージ術の必要性
- Gastroenterological Endoscopy, 2018年04月, 日本語, (一社)日本消化器内視鏡学会IPMN診療におけるERCP下膵液細胞診の意義
- 日本消化器病学会雑誌, 2018年03月, 日本語, (一財)日本消化器病学会当院における膵石に対する内視鏡的治療の成績と課題
- 日本消化器病学会雑誌, 2018年03月, 日本語, (一財)日本消化器病学会健診受診者における上腹部症状と不安特性との関連
- 日本消化器病学会雑誌, 2018年03月, 日本語, (一財)日本消化器病学会IPMNの新展開 多発IPMNと併存膵癌の関連性 IPMN併存膵癌ハイリスク症例の絞り込み戦略
- 日本消化器病学会雑誌, 2018年03月, 日本語, (一財)日本消化器病学会バレット腺癌の基礎と臨床 バレット食道新規発症の頻度とリスク因子の検討 多施設前向き研究による経年変化
- 日本消化器病学会雑誌, 2018年03月, 日本語, (一財)日本消化器病学会IgG4関連消化器疾患における現状と課題 自己免疫性膵炎における若年発症と再燃の関連性
- 日本消化管学会雑誌, 2018年02月, 日本語, (一社)日本消化管学会食道アカラシアの診断と治療戦略 POEMにおけるTwo penetrating vessels(TPVs)の有用性
- 総合健診, 2018年01月, 日本語, (一社)日本総合健診医学会健診受診者における上腹部症状とBMIとの関連
- 胆道, 2017年12月, 日本語, 日本胆道学会, 【目的】内視鏡的乳頭切除術(Endoscopic Papillectomy:EP)に関連した出血に対する、有効で安全な止血法を明らかにする。【方法】EPを行った24例中、偶発症として出血を認め内視鏡的止血術を行なった13例をretrospectiveに検討した。【結果】出血時期はEP当日9例、翌日3例、翌々日1例で、初回止血法は、アルゴンプラズマ凝固法(APC)2例、Clip法3例、エピネフリン加高張食塩水局注法(HSE)2例、これらの併用が6例であった。13例中4例で再出血を認め、そのうち1例は仮性動脈瘤出血を来し動脈塞栓術を要したが、他は再度内視鏡的止血術を行い止血成功し得た。止血処置に伴う偶発症として5例に膵炎を認め、HSE併用例で多く認められた。【結論】止血効果はAPC併用例に比べClipやHSE併用例で良好であったが、HSE併用例では膵炎に注意が必要である。(著者抄録)内視鏡的乳頭切除術に伴う出血に対する内視鏡的止血法の検討
- UEGW 2017, 2017年11月, 英語, Organizing committee of the 2017 United European gastroenterology Week, バルセロナ, スペイン, 国際会議The predictor’s factor of step up approach using EUS-guided transmural drainage for walled-off necrosisポスター発表
- JDDW2017, 2017年10月, 日本語, 日本消化器関連学会機構, 福岡, 国内会議Walled-off necrosisに対する内視鏡的step-up approachの妥当性の検討シンポジウム・ワークショップパネル（公募）
- 日本消化器関連学会週間, 2017年10月, 日本語, 日本消化器病学会, 福岡, 国内会議GERD診断におけるFSSGスコアの有用性の検証ポスター発表
- Gastroenterological Endoscopy, 2017年09月, 日本語, (一社)日本消化器内視鏡学会IPMN由来浸潤癌および併存膵癌におけるEUS背景膵所見の有用性
- Gastroenterological Endoscopy, 2017年09月, 日本語, (一社)日本消化器内視鏡学会内視鏡的乳頭切除術後に診断された早期十二指腸乳頭部癌の予後
- Gastroenterological Endoscopy, 2017年09月, 日本語, (一社)日本消化器内視鏡学会Innovative therapeutic endoscopy 膵仮性嚢胞・感染性WONに対する内視鏡的治療 Walled off necrosisに対する内視鏡的step-up approachの妥当性の検討
- 日本消化器病学会雑誌, 2017年09月, 日本語, (一財)日本消化器病学会GERD診断におけるFSSGスコアの有用性の検証
- 日本消化器病学会雑誌, 2017年09月, 日本語, (一財)日本消化器病学会Innovative therapeutic endoscopy 膵仮性嚢胞・感染性WONに対する内視鏡的治療 Walled off necrosisに対する内視鏡的step-up approachの妥当性の検討
- 日本超音波医学会第44回関西地方会学術集会, 2017年09月, 日本語, 日本超音波医学会, 大阪, 国内会議膵リンパ上皮嚢胞（Lymphoepithelial cyst;LEC）の一例口頭発表（一般）
- 第53回日本胆道学会学術集会, 2017年09月, 日本語, 日本胆道学会, 山形, 国内会議十二指腸乳頭部腫瘍に対する内視鏡的乳頭切除術の成績口頭発表（一般）
- APDW2017, 2017年09月, 英語, Organizing committee of the 2017 Asia pacific Digestive Week, 香港, 中国, 国際会議Validation of Rome IV criteria for sphincter of Oddi disorder and therapeutic effect of endoscopic sphincterotomy by using the new method of sphincter of Oddi manometryポスター発表
- 第53回日本胆道学会学術集会, 2017年09月, 日本語, 日本胆道学会, 山形, 国内会議Sonazoidを用いた造影超音波内視鏡検査による胆嚢疾患鑑別の試みシンポジウム・ワークショップパネル（公募）
- 膵臓, 2017年08月, 日本語, 日本膵臓学会, 症例は74歳男性。膵頭部腫瘤による閉塞性黄疸で近医に入院し、内視鏡的胆管ドレナージが行われ、当科に紹介となった。造影CT、MRCP、超音波内視鏡検査(EUS)では膵頭部に50mm大の辺縁が造影効果を有し中心部が造影されない腫瘤を認め、嚢胞変性を来した膵内分泌腫瘍の疑いで亜全胃温存膵頭十二指腸切除術を施行した。病理組織診断ではintraductal papillary mucinous neoplasm with an associated carcinoma、pancreatobiliary typeであった。Pancreatobiliary-type intraductal papillary mucinous neoplasmの画像所見に関する報告は少なく、文献的考察を加えて報告する。(著者抄録)特異な画像所見を呈し術前診断に苦慮したPancreatobiliary-type Intraductal Papillary Mucinous Neoplasmの1例
- 胆道, 2017年08月, 日本語, 日本胆道学会膵胆管合流異常に合併した胆嚢管癌の1例
- 胆道, 2017年08月, 日本語, 日本胆道学会十二指腸乳頭部腫瘍に対する内視鏡的乳頭切除術の成績
- 胆道, 2017年08月, 日本語, 日本胆道学会切除企図肝門部胆道癌に対する術前胆道ドレナージの検討
- 胆道, 2017年08月, 日本語, 日本胆道学会良性胆嚢疾患 胆嚢癌との鑑別困難例に対する診断・治療戦略 Sonazoidを用いた造影超音波内視鏡検査による胆嚢疾患鑑別の試み
- 第48会日本膵臓大会, 2017年07月, 日本語, 日本膵臓学会, 京都, 国内会議自己免疫性膵炎ステロイド治療中の胆管病変の長期管理シンポジウム・ワークショップパネル（公募）
- 第48会日本膵臓大会, 2017年07月, 日本語, 日本膵臓学会, 京都, 国内会議1型自己免疫性膵炎のステロイド治療後の再燃と発症年齢の関連性シンポジウム・ワークショップパネル（公募）
- 第98回日本消化器内視鏡学会近畿支部, 2017年06月, 日本語, 神戸大学, 神戸, 国内会議総胆管に逸脱した多発性胆嚢腫瘍の一例口頭発表（一般）
- 膵臓, 2017年05月, 日本語, 日本膵臓学会IPMNの手術適応と術式を再考する 膵IPMN手術例におけるリンパ節転移の術前予測因子の検討
- 膵臓, 2017年05月, 日本語, 日本膵臓学会膵癌の早期診断・治療の現状と展望 小膵癌発見に向けての治療戦略
- 膵臓, 2017年05月, 日本語, 日本膵臓学会急性膵炎の後期合併症に対する手術・インターベンション治療の現状と課題 Walled off necrosisに対する内視鏡的step-up approachの妥当性の検討
- 膵臓, 2017年05月, 日本語, 日本膵臓学会自己免疫性膵炎に対する診療の現状と長期予後 自己免疫性膵炎ステロイド治療中の胆管病変の長期管理
- 膵臓, 2017年05月, 日本語, 日本膵臓学会自己免疫性膵炎の病因・病態解明の最前線 1型自己免疫性膵炎のステロイド治療後の再燃と発症年齢の関連性
- 第93回日本消化器内視鏡学会総会, 2017年05月, 日本語, 日本消化器内視鏡学会, 大阪, 国内会議膵癌の術前診断法としてのEUS-FNAおよびERCPの役割 2cm以下の小膵癌の術前診断法についてシンポジウム・ワークショップパネル（公募）
- 第93回日本消化器内視鏡学会総会, 2017年05月, 日本語, 日本消化器内視鏡学会, 大阪, 国内会議胆膵内視鏡における安全かつ効果的な教育法 動物モデルを用いたEUSのトレーニングシンポジウム・ワークショップパネル（公募）
- 第93回日本消化器内視鏡学会総会, 2017年05月, 日本語, 日本消化器内視鏡学会, 大阪, 国内会議悪性輸入脚狭窄に対する内視鏡的治療シンポジウム・ワークショップパネル（公募）
- Gastroenterological Endoscopy, 2017年04月, 日本語, (一社)日本消化器内視鏡学会画像所見に応じた膵癌術前診断法とは 内視鏡検査を用いた確定診断 膵癌の術前診断法としてのEUS-FNAおよびERCPの役割 2cm以下の小膵癌の術前診断法について
- Gastroenterological Endoscopy, 2017年04月, 日本語, (一社)日本消化器内視鏡学会術後再建腸管症例における超音波内視鏡観察 Radial型vs Convex型
- Gastroenterological Endoscopy, 2017年04月, 日本語, (一社)日本消化器内視鏡学会ERCP後膵炎の発症リスクにおける膵炎既往と手技因子との関連ERCP後膵炎既往と急性膵炎既往の比較検討
- Gastroenterological Endoscopy, 2017年04月, 日本語, (一社)日本消化器内視鏡学会緩和医療における内視鏡の役割 悪性輸入脚狭窄に対する内視鏡治療
- Gastroenterological Endoscopy, 2017年04月, 日本語, (一社)日本消化器内視鏡学会胆膵内視鏡における安全かつ効果的な教育法 動物モデルを用いたEUSのトレーニング
- 第103回日本消化器病学会総会, 2017年04月, 日本語, 日本消化器病学会, 東京, 国内会議造影EUSを用いた膵癌の血流動態と化学療法感受性における検討口頭発表（一般）
- 第103回日本消化器病学会総会, 2017年04月, 日本語, 日本消化器病学会, 東京, 国内会議新たな乳頭括約筋圧測定法を用いた十二指腸乳頭括約筋機能不全におけるRome IV診断基準の妥当性の検証シンポジウム・ワークショップパネル（公募）
- 第103回日本消化器病学会総会, 2017年04月, 日本語, 日本消化器病学会, 東京, 国内会議アルコール飲酒とバレット食道発生の関連性における性別と食道裂孔ヘルニアの影響 前向き多施設共同研究シンポジウム・ワークショップパネル（公募）
- 第103回日本消化器病学会総会, 2017年04月, 日本語, 日本消化器病学会, 東京, 国内会議IPMN多発性とIPMN併存膵癌との関連シンポジウム・ワークショップパネル（公募）
- 第103回日本消化器病学会総会, 2017年04月, 日本語, 日本消化器病学会, 東京, 国内会議Helicobacter. pylori除菌による食道炎とディスペプシア症状の変化についての検討口頭発表（一般）
- 第103回日本消化器病学会総会, 2017年04月, 日本語, 日本消化器病学会, 東京, 国内会議H.pylori感染状況からみた内視鏡所見とディスペプシア症状についての検討口頭発表（一般）
- 日本消化器病学会雑誌, 2017年03月, 日本語, (一財)日本消化器病学会造影EUSを用いた膵癌の血流動態と化学療法感受性における検討
- 日本消化器病学会雑誌, 2017年03月, 日本語, (一財)日本消化器病学会H.pylori感染状況からみた内視鏡所見とディスペプシア症状についての検討
- 日本消化器病学会雑誌, 2017年03月, 日本語, (一財)日本消化器病学会Helicobacter. pylori除菌による食道炎とディスペプシア症状の変化についての検討
- 日本消化器病学会雑誌, 2017年03月, 日本語, (一財)日本消化器病学会バレット食道診療におけるトピックス アルコール飲酒とバレット食道発生の関連性における性別と食道裂孔ヘルニアの影響 前向き多施設共同研究
- 日本消化器病学会雑誌, 2017年03月, 日本語, (一財)日本消化器病学会消化管機能検査の活用の実際 新たな乳頭括約筋圧測定法を用いた十二指腸乳頭括約筋機能不全におけるRome IV診断基準の妥当性の検証
- 日本消化器病学会雑誌, 2017年03月, 日本語, (一財)日本消化器病学会IPMNの診断と治療の進歩 IPMN多発性とIPMN併存膵癌との関連
- Asian Pacific Digestive Week(APDW), 2016年11月, 英語, Kobe convention center, Kobe, 国際会議Clinical impact of endoscopic ultrasonography imaging of chronic pancreatitis in the pancreatic parenchyma in patients with intraductal papillary mucinous neoplasmsポスター発表
- 第43回関西地方会学術集会, 2016年10月, 日本語, 日本超音波医学会, 大阪, 国内会議造影超音波検査が血流評価に有用であった胃腺内分泌癌の多発肝転移の一例口頭発表（一般）
- Gastroenterological Endoscopy, 2016年04月, 日本語, (一社)日本消化器内視鏡学会PEP高リスク群へのERCPでは何に留意すべきか 膵炎既往群における手技側因子の解析
- Gastroenterological Endoscopy, 2016年04月, 日本語, (一社)日本消化器内視鏡学会造影ハーモニックEUSを用いた膵の小腫瘤性病変の診断
- Gastroenterological Endoscopy, 2016年04月, 日本語, (一社)日本消化器内視鏡学会乳頭部病変の深達度診断にEUSとIDUSはいずれも必要なのか 当院における乳頭部病変の深達度診断に関する検討
- Gastroenterological Endoscopy, 2016年04月, 日本語, (一社)日本消化器内視鏡学会悪性輸入脚狭窄に対する内視鏡的消化管金属ステント留置術の検討
- 日本消化器病学会雑誌, 2016年03月, 日本語, (一財)日本消化器病学会背景膵萎縮変化がIPMNの悪性予測因子となる-IPMNにおける膵実質評価(EUS)の有用性
- 第104回日本消化器病学会近畿支部例会, 2016年02月, 日本語, 日本消化器病学会, 大阪, 国内会議EUSソノプシーCYを用いた自己免疫性膵炎の病理学的診断能の検討シンポジウム・ワークショップパネル（公募）
- 超音波医学, 2016年膵腫瘍と鑑別が困難であった十二指腸GISTの一例
- 日本消化器画像診断研究会プログラム・抄録集, 2016年嚢胞変性を伴う充実性腫瘍との鑑別が困難であったIPMNの1例
- 日本消化器画像診断研究会プログラム・抄録集, 2016年胆道出血を契機に診断された腎細胞癌胆嚢転移の1例
- 日本消化器内視鏡学会近畿支部第95回支部例会, 2015年11月, 日本語, 日本消化器内視鏡学会, 大阪, 国内会議EUS-FNAで診断し得た骨肉腫膵転移の1例口頭発表（一般）
- UEGW2015, 2015年10月, 英語, United European Gastroenterology, バルセロナ, スペイン, 国際会議Novel pig model of bile and pancreatic duct dilatation for EUS trainingポスター発表
- 日本超音波医学会第42回関西地方会学術集会, 2015年09月, 日本語, 日本超音波医学会, 大阪, 国内会議膵腫瘍と鑑別が困難であった十二指腸GISTの一例口頭発表（一般）
- 日本消化器画像診断研究会, 2015年09月, 日本語, 日本消化器画像診断研究会, 鎌倉, 国内会議多発肝転移をきたした膵Solid Pseudopapillary Neoplasmの1切除例口頭発表（一般）
- 日本消化器病学会近畿支部第103回例会, 2015年09月, 日本語, 日本消化器病学会, 大阪, 国内会議EUS-FNAが治療方針決定に有用であった膵悪性腫瘍の1例口頭発表（一般）
- 第46回日本膵臓学会大会, 2015年06月, 日本語, 日本膵臓学会, 名古屋, 国内会議自己免疫性膵炎治療の現状と課題 ステロイド治療後の膵萎縮と糖尿病との関連についてシンポジウム・ワークショップパネル（公募）
- 第89回日本消化器内視鏡学会総会, 2015年05月, 日本語, 日本内視鏡学会, 名古屋, 国内会議肝門部胆管癌に対する術前胆道ドレナージ中の急性胆管炎の現状と対策口頭発表（一般）
- Gastroenterological Endoscopy, 2015年04月, 日本語, (一社)日本消化器内視鏡学会肝門部胆管癌に対する術前胆道ドレナージ中の急性胆管炎の現状と対策
- 第115回日本外科学会定期学術集会, 2015年04月, 日本語, 日本外科学会, 名古屋, 国内会議術前内視鏡的膵管ステントによる尾側膵切除術後膵液瘻予防効果の前向き臨床試験口頭発表（一般）
- 第101回日本消化器病学会総会, 2015年04月, 日本語, 日本消化器病学会, 仙台, 国内会議混合型IPMNは分枝型と一括して扱ってよいか? MUC染色による混合型IPMNの検討シンポジウム・ワークショップパネル（公募）
- 第101回日本消化器病学会総会, 2015年04月, 日本語, 日本消化器病学会, 仙台, 国内会議ガイドワイヤー型圧モニターを用いた十二指腸乳頭括約筋圧測定口頭発表（一般）
- The Second International Molecular Pathological Epidemiology (MPE) Meeting, 2014年12月, 英語, boston, USA, 国際会議Processed meat intake, PIK3CA mutation, and immunity in colorectal cancerポスター発表
- 第88回日本消化器内視鏡学会総会, 2014年10月, 日本語, 日本消化器内視鏡学会, 神戸, 国内会議膵頭十二指腸切除術後の悪性輸入脚狭窄に対する内視鏡的消化管金属ステント治療の有用性ポスター発表
- JDDW 2014, 2014年10月, 日本語, 日本消化器学会関連機構, 福岡, 国内会議膵腫瘤性病変における造影ハーモニックEUSの有用性ポスター発表
- 第88回日本消化器内視鏡学会総会, 2014年10月, 日本語, 日本消化器内視鏡学会, 神戸, 国内会議膵腫瘤性病変における造影ハーモニックEUSの有用性ポスター発表
- 第56回日本消化器病学会大会, 2014年10月, 日本語, 日本消化器病学会, 神戸, 国内会議胆管外病変のないIgG4関連硬化性胆管炎に対する肝生検の有用性の検討ポスター発表
- 日本消化器病学会雑誌, 2014年09月, 日本語, (一財)日本消化器病学会胆管外病変のないIgG4関連硬化性胆管炎に対する肝生検の有用性の検討
- Gastroenterological Endoscopy, 2014年09月, 日本語, (一社)日本消化器内視鏡学会膵頭十二指腸切除術後の悪性輸入脚狭窄に対する内視鏡的消化管金属ステント治療の有用性
- Gastroenterological Endoscopy, 2014年09月, 日本語, (一社)日本消化器内視鏡学会膵腫瘤性病変における造影ハーモニックEUSの有用性
- 第50回日本胆道学会学術集会, 2014年09月, 日本語, 日本胆道学会, 東京, 国内会議膵頭十二指腸切除術後の悪性輸入脚狭窄による胆管炎に対する内視鏡治療ポスター発表
- 第50回日本胆道学会学術集会, 2014年09月, 日本語, 日本胆道学会, 東京, 国内会議管状乳頭状増殖を呈した粘液低産生IPNBの1例ポスター発表
- 胆道, 2014年08月, 日本語, 日本胆道学会管状乳頭状増殖を呈した粘液低産生IPNBの1例
- 第45回日本膵臓学会大会, 2014年07月, 日本語, 日本膵臓学会, 福岡, 国内会議膵腫瘍の診断における造影EUSの有用性[招待有り]口頭発表（招待・特別）
- 第45回日本膵臓学会大会, 2014年07月, 日本語, 日本膵臓学会, 北九州, 国内会議早期膵癌診断における造影ハーモニックEUSの有用性口頭発表（一般）
- 第45回日本膵臓学会大会, 2014年07月, 日本語, 日本膵臓学会, 北九州, 国内会議血清メタボロミクスによる膵癌スクリーニング法の検討口頭発表（一般）
- 第45回日本膵臓学会大会, 2014年07月, 日本語, 日本膵臓学会, 北九州, 国内会議Walled off necrosisに対するEUSガイド下治療口頭発表（一般）
- 第45回日本膵臓学会大会, 2014年07月, 日本語, 日本膵臓学会, 小倉, 国内会議Walled-off necrosis(WON)に対するEUSガイド下治療口頭発表（一般）
- 膵臓, 2014年06月, 日本語, 日本膵臓学会早期膵癌診断における造影ハーモニックEUSの有用性
- 膵臓, 2014年06月, 日本語, 日本膵臓学会膵癌早期診断を目指して 血清メタボロミクスによる膵癌スクリーニング法の検討
- 第87回日本消化器内視鏡学会総会, 2014年05月, 日本語, 九州大学, 福岡, 国内会議当院における分枝型IPMNに対する細胞診の工夫口頭発表（一般）
- 第87回日本消化器内視鏡学会総会, 2014年05月, 日本語, 日本消化器内視鏡学会, 福岡, 国内会議当院におけるEST+EPLBDの現状と問題点ポスター発表
- 第87回日本消化器内視鏡学会総会, 2014年05月, 日本語, 日本消化器内視鏡学会, 福岡, 国内会議当院での総胆管結石治療におけるEPLBD法の現状と問題点ポスター発表
- 第87回日本消化器内視鏡学会総会, 2014年05月, 日本語, 九州大学, 福岡, 国内会議肝門部胆管癌の術前ドレナージ法と胆管炎の関連性口頭発表（一般）
- 第87回日本消化器内視鏡学会総会, 2014年05月, 日本語, 日本消化器内視鏡学会, 福岡, 国内会議ガイドワイヤー型圧モニターを用いた十二指腸乳頭括筋圧測定シンポジウム・ワークショップパネル（公募）
- Gastroenterological Endoscopy, 2014年04月, 日本語, (一社)日本消化器内視鏡学会当院での総胆管結石治療におけるEPLBD法の現状と問題点
- 第100回日本消化器病学会総会, 2014年04月, 日本語, 日本消化器病学会, 東京, 国内会議消化管再建後胆膵疾患症例に対するダブルバルーン内視鏡によるアプローチの現状と課題口頭発表（一般）
- 第100回日本消化器病学会総会, 2014年04月, 日本語, 日本消化器病学会, 東京, 国内会議経乳頭的胆囊胆汁細胞診の検討口頭発表（一般）
- 日本消化器病学会雑誌, 2014年03月, 日本語, (一財)日本消化器病学会消化管再建後胆膵疾患症例に対するダブルバルーン内視鏡によるアプローチの現状と課題
- IHPBA World Congress 2014, 2014年03月, 英語, International Hepato-Pancreato-Biliary Association, Seoul, Korea, 国際会議The clinical characteristics of autoimmune pancreatitis and Mikulicz's disease as IgG4-related diseasesポスター発表
- IHPBA world Congress 2014, 2014年03月, 英語, International Hepato-Pancreato-Biliary Association, Seoul, Korea, 国際会議Guide-wire-type manometer is feasible for diagnosis of sphoncter of Oddi disorder口頭発表（一般）
- Gastroenterological Endoscopy, 2014年傾向スコア解析を用いた脱落型膵管ステントが最も推奨されるリスク群の検討
- Gastroenterological Endoscopy, 2014年当院における85歳以上の超高齢者に対する胆膵内視鏡検査の現状
- 胆道, 2014年内視鏡的十二指腸乳頭切除術の出血例に対する内視鏡的止血法の検討
- 膵臓, 2014年早期膵癌診断を目指したIPMN症例における細胞診の工夫
- Gastroenterological Endoscopy, 2014年当院における慢性膵炎に対する内視鏡的治療の現状および手術移行例の要因の検討
- JDDW2013, 2013年10月, 日本語, 日本消化器病学会、日本消化器内視鏡学会, 東京, 国内会議内視鏡的乳頭切除術翌日のsecond lookは有用か？ポスター発表
- JDDW2013, 2013年10月, 日本語, 日本消化器病学会、日本消化器内視鏡学会, 東京, 国内会議自己免疫性膵炎とPanIN病変との関係シンポジウム・ワークショップパネル（公募）
- 日本消化器病学会近畿支部第99回例会, 2013年09月, 日本語, 日本消化器病学会, 大阪, 国内会議膵石による主膵管拡張を伴う慢性膵炎に発生した分枝型IPMCの1例その他
- GASTRO 2013 APDW/WCOG Shanghai, 2013年09月, 英語, Asia Pacific Digestive Week Federation, Shanghai, China, 国際会議Guide-wire-type manometer is feasible for diagnosis of sphoncter of Oddi disorder口頭発表（一般）
- 第85回日本消化器内視鏡学会総会, 2013年05月, 日本語, 日本消化器内視鏡学会, 京都, 国内会議慢性膵炎に対する膵管ステントは全例ステントフリー可能か？ポスター発表
- 第85回日本消化器内視鏡学会総会, 2013年05月, 日本語, 日本消化器内視鏡学会, 京都, 国内会議乳頭部腫瘍に対するコンベックス型EUSを用いた深達度および進展度診断-IDUSと比較して-その他
- 第85回日本消化器内視鏡学会総会, 2013年05月, 日本語, 日本消化器内視鏡学会, 京都, 国内会議乳頭部腫瘍に対するコンベックス型EUSを用いた深達度および進展度診断 ―IDUSと比較して―口頭発表（一般）
- 第85回日本消化器内視鏡学会総会, 2013年05月, 日本語, 日本消化器内視鏡学会, 京都, 国内会議混合型IPMNは分枝型と一括して扱ってよいか？-MUC染色による混合型IPMNの検討-口頭発表（一般）
- 第85回日本消化器内視鏡学会総会, 2013年05月, 日本語, 日本消化器内視鏡学会, 京都, 国内会議ダブルバルーン内視鏡を用いたroux-Y再建後胆膵疾患症例に対する内視鏡的アプローチの現状と問題点口頭発表（一般）
- Immunology 2013, 2013年05月, 英語, The American Association of Immunologist, Hawaii, USA, 国際会議Cell type-specific role of autophagy against Citrobacter rodentium infectious colitisポスター発表
- 第99回日本消化器病学会総会, 2013年03月, 日本語, 日本消化器病学会, 鹿児島, 国内会議メタボロミクスを用いた膵炎治療薬の探索口頭発表（一般）
- 第99回日本消化器病学会総会, 2013年03月, 日本語, 日本消化器病学会, 鹿児島, 国内会議IgG4関連硬化性胆管炎(IgG4-SC)臨床診断基準2012の問題点 IgG4-SC確定診断困難症例の特徴口頭発表（一般）
- 第99回日本消化器病学会総会, 2013年03月, 日本語, 日本消化器病学会, 鹿児島, 国内会議IgG4関連硬化性胆管炎(IgG4-SC)診断における肝生検の有用性～IgG4関連硬化性胆管炎臨床診断基準2012を踏まえて～シンポジウム・ワークショップパネル（公募）
- 日本消化器病学会雑誌, 2013年02月, 日本語, (一財)日本消化器病学会メタボロミクスを用いた膵炎治療薬の探索
- 日本消化器病学会近畿支部第98回例会, 2013年02月, 日本語, 日本消化器病学会近畿支部, 神戸, 国内会議進行胃癌との鑑別に苦慮した好酸球性胃腸炎の1症例口頭発表（一般）
- 日本消化器病学会近畿支部第98回例会, 2013年02月, 日本語, 日本消化器病学会近畿支部, 神戸, 国内会議重症急性膵炎を契機に発見された膵管内腫瘍の1例口頭発表（一般）
- 日本消化器病学会近畿支部第98回例会, 2013年02月, 日本語, 日本消化器病学会近畿支部, 神戸, 国内会議自己免疫性膵炎のステロイドパルス症例の検討口頭発表（一般）
- 日本消化器病学会雑誌, 2013年MUC染色による混合型IPMNにおけるhigh risk群の抽出~International consensus guideline2012を踏まえて~
- 第89回日本消化器内視鏡学会近畿支部例会, 2012年11月, 日本語, 日本消化器内視鏡学会, 大阪, 国内会議分枝型IPMN に併存したPanIN3様病変の1例口頭発表（一般）
- 日本消化器内視鏡学会近畿支部第89会支部例会, 2012年11月, 日本語, 日本消化器内視鏡学会近畿支部, 大阪, 国内会議診断に難渋した原発性虫垂癌の一例口頭発表（一般）
- 第89回日本消化器内視鏡学会近畿支部例会, 2012年11月, 日本語, 日本消化器内視鏡学会, 大阪, 国内会議術前診断に苦慮したIgG4関連硬化性胆管炎の1例口頭発表（一般）
- 第84回日本消化器内視鏡学会総会, 2012年10月, 日本語, 日本消化器内視鏡学会, 神戸, 国内会議慢性膵炎に対する内視鏡的膵管ステント留置術(EPS)の検討ポスター発表
- JDDW 2012 (Japan Digestive Disease Week 2012) 第20 回日本消化器関連学会週間（消化器外科学会）, 2012年10月, 日本語, 日本消化器関連学会, 神戸, 国内会議胆道癌におけるERC下細胞診および生検の術前診断における役割ポスター発表
- 第54回日本消化器病学会大会, 2012年10月, 日本語, 日本消化器病学会, 神戸, 国内会議術後膵炎を予防するためにはhigh risk症例のどのような症例に膵管ステントを挿入すればよいか？ポスター発表
- 第48回日本胆道学会学術集会, 2012年09月, 日本語, 日本胆道学会, 東京, 国内会議早期乳頭部癌の臨床的特徴と治療口頭発表（一般）
- 日本消化器病学会近畿支部第97回例会, 2012年09月, 日本語, 日本消化器病学会近畿支部, 京都, 国内会議EUS-FNAで診断可能であった腎細胞癌多発膵転移の1例口頭発表（一般）
- 第16回腸内細菌学会, 2012年06月, 日本語, 日本ビフィズス菌センター, 神戸, 国内会議腸管のオートファジーによるCitrobacter rodentium感染の制御口頭発表（一般）
- 第83回日本消化器内視鏡学会総会, 2012年05月, 日本語, 日本消化器内視鏡学会, 東京, 国内会議膵管内発育を呈した膵原発癌肉腫の一例ポスター発表
- 第98回日本消化器病学会総会, 2012年04月, 日本語, 日本消化器病学会, 東京, 国内会議造影ハーモニックEUSによる膵腫瘍性病変の診断ポスター発表
- 第88回日本消化器内視鏡学会近畿地方会, 2012年03月, 日本語, 日本消化器内視鏡学会, 大阪, 国内会議内視鏡的necrosectomyが有用であった膵仮性嚢胞の1例口頭発表（一般）
- 難治性膵疾患に関する調査研究 平成23年度 総括・分担研究報告書, 2012年難治性膵疾患に関する調査研究 I.急性膵炎 傾向スコア解析(propensity score analysis)を用いた脱落型膵管ステントのERCP後膵炎予防効果の検討
- 第96回日本消化器病学会近畿支部例会, 2012年01月, 日本語, 日本消化器病学会, 大阪, 国内会議胆嚢癌を合併したcholedochoceleの一例口頭発表（一般）
- 第回82回日本消化器内視鏡学会総会, 2011年10月, 日本語, 日本消化器内視鏡学会, 福岡, 国内会議分枝型IPMN手術適応における擦過細胞診の有用性の検討ポスター発表
- 第82回日本消化器内視鏡学会総会, 2011年10月, 日本語, 日本消化器内視鏡学会, 福岡, 国内会議分枝型IPMNの悪性予測因子の検討～EUSを用いた壁在結節高評価を中心に～ポスター発表
- 第53回日本消化器病学会大会, 2011年10月, 日本語, 日本消化器病学会, 福岡, 国内会議APIBの腫瘍発生における役割ポスター発表
- 第47回日本胆道学会学術集会, 2011年09月, 日本語, 日本胆道学会, 宮崎, 国内会議切除不能悪性肝門部胆道狭窄の集学的治療におけるMetalic stent の有用性口頭発表（一般）
- 第81回日本消化器内視鏡学会総会, 2011年08月, 日本語, 日本消化器内視鏡学会, 名古屋, 国内会議膵胆道疾患に対するソナゾイド造影ハーモニックEUSの経験口頭発表（一般）
- 第95回日本消化器病学会近畿支部例会, 2011年08月, 日本語, 日本消化器病学会, 大阪, 国内会議膵管ブラシ細胞診が診断に有用であった分枝型IPMC由来微小浸潤癌の一例口頭発表（一般）
- 日本消化器病学会近畿支部 第95回例会, 2011年08月, 日本語, 日本消化器病学会, 大阪, 国内会議膵管ブラシ細胞診が診断に有効であった分枝型IPMC由来微小浸潤癌の一例口頭発表（一般）
- 第95回日本消化器病学会近畿支部例会, 2011年08月, 日本語, 日本消化器病学会, 大阪, 国内会議超音波内視鏡下穿刺吸引生検(EUS-FNAB)にて診断し得た十二指腸原発悪性リンパ腫の1例口頭発表（一般）
- 第81回日本消化器内視鏡学会総会, 2011年08月, 日本語, 日本消化器内視鏡学会, 名古屋, 国内会議消化管および膵病変診断におけるEUS-FNAの有用性の検討口頭発表（一般）
- 第95回日本消化器病学会近畿支部例会, 2011年08月, 日本語, 日本消化器病学会, 大阪, 国内会議経乳頭的ドレナージ術が奏功した胃切除後の巨大膵仮性嚢胞の2例口頭発表（一般）
- 第2回消化器内視鏡検診研究会, 2011年08月, 日本語, 消化器内視鏡検診研究会, 名古屋, 国内会議胃癌検診(ABC検診)のD群における検討口頭発表（一般）
- 第81回日本消化器内視鏡学会総会, 2011年08月, 日本語, 日本消化器内視鏡学会, 名古屋, 国内会議Flush knifeを用いた乳頭プレカット手技口頭発表（一般）
- 第97回日本消化器病学会総会, 2011年05月, 日本語, 日本消化器病学会, 東京, 国内会議自己免疫性膵炎診断基準から見た膵癌との鑑別口頭発表（一般）
- 第97回日本消化器病学会総会, 2011年05月, 日本語, 日本消化器病学会, 東京, 国内会議血清メタボロミクスを用いた 膵がん新規診断法の開発口頭発表（一般）
- 日本消化器病学会雑誌, 2011年03月, 日本語, (一財)日本消化器病学会血清メタボロミクスを用いた膵がん新規診断法の開発
- Gastroenterological Endoscopy, 2011年03月, 日本語, (一社)日本消化器内視鏡学会Flush knifeを用いた乳頭プレカット手技
- 日本消化器病学会近畿支部第94回例会, 2011年02月, 日本語, 日本消化器病学会近畿支部, 大阪, 国内会議内視鏡治療が有効であったcholedochoceleの1例口頭発表（一般）
- 日本消化器病学会近畿支部第94回例会, 2011年02月, 日本語, 日本消化器病学会近畿支部, 大阪, 国内会議胆膵疾患に対するソナゾイド造影ハーモニックEUSの経験口頭発表（一般）
- 日本消化器病学会近畿支部第94回例会, 2011年02月, 日本語, 日本消化器病学会近畿支部, 大阪, 国内会議術前診断が困難であった膵lymphoepithelial cystの1例口頭発表（一般）
- 日本消化器病学会近畿支部第94回例会, 2011年02月, 日本語, 日本消化器病学会近畿支部, 大阪, 国内会議びまん性膵脂肪置換の一例口頭発表（一般）
- 日本消化器病学会雑誌, 2011年自己免疫性膵炎診断基準からみた膵癌との鑑別
- Gastroenterological Endoscopy, 2011年分枝型IPMNの悪性予測因子の検討~EUSを用いた壁在結節高評価を中心に~
- 第85回日本消化器内視鏡学会近畿地方会, 2010年10月, 日本語, 日本消化器内視鏡学会近畿地方会, 大阪, 国内会議膵性胸水に対して内視鏡治療が奏功した1例口頭発表（一般）
- 第52回日本消化器病学会大会, 2010年10月, 日本語, 日本消化器病学会, 横浜, 国内会議膵癌の発生母地としてのIPMNの意義ポスター発表
- 第80回日本消化器内視鏡学会総会, 2010年10月, 日本語, 日本消化器内視鏡学会, 横浜, 国内会議膵仮性嚢胞に対する内視鏡治療の限界ポスター発表
- 第80回日本消化器内視鏡学会総会, 2010年10月, 日本語, 日本消化器内視鏡学会, 横浜, 国内会議十二指腸乳頭括約筋機能不全(SOD)に対しEST後再燃した一例ポスター発表
- 第80回日本消化器内視鏡学会総会, 2010年10月, 日本語, 日本消化器内視鏡学会, 横浜, 国内会議ヘリコバクター胃炎からの発癌 内視鏡医の視点update 胃癌高危険群のHP除菌前後の内視鏡所見の変化と病理学的相関に対する前向き検討口頭発表（一般）
- UEGW 2010, 2010年10月, 英語, The United European Gastroenterology Federation, バルセロナ, スペイン, 国際会議Evaluation of measuring sphincter of Oddi pressure using guide-wire type manometerポスター発表
- 日本消化器病学会近畿支部第93回例会, 2010年09月, 日本語, 日本消化器病学会近畿支部, 大阪, 国内会議膵仮性嚢胞を併発した自己免疫性膵炎の1例口頭発表（一般）
- 日本消化器病学会近畿支部第93回例会, 2010年09月, 日本語, 日本消化器病学会近畿支部, 大阪, 国内会議自己免疫性膵炎患者におけるアレルギー疾患合併の検討口頭発表（一般）
- 第46回日本胆道学会学術集会, 2010年09月, 日本語, 日本胆道学会, 広島, 国内会議肝門部胆管癌におけるERBD後の胆管炎 metallic stentとtube stentとの比較口頭発表（一般）
- 日本消化器病学会近畿支部第93回例会, 2010年09月, 日本語, 日本消化器病学会近畿支部, 大阪, 国内会議EST後に症状が再燃した乳頭機能不全(SOD)の2例口頭発表（一般）
- Asian Pacific Digestive Week 2010, 2010年09月, 英語, アジア太平洋消化器病学会, クアラルンプール, マレーシア, 国際会議Autoimmune pancreatitis and Mikulicz's diseaseポスター発表
- Gastroenterological Endoscopy, 2010年08月, 日本語, (一社)日本消化器内視鏡学会, 55歳男。患者は左上顎洞の限局性の髄外性形質細胞腫に対し放射線療法を受けるも、半年後に心窩部痛、背部痛を自覚した。腹部CTでは膵頭体部に境界が比較的明瞭な約70mm大の塊状腫瘤が認められ、腹腔動脈から分岐する総肝動脈、脾動脈が腫瘍内部を貫通していた。また、ERCPでは比較的長い膵管狭細像を呈し、血清IgGが高値であった。このことから悪性リンパ腫、自己免疫性膵炎、膵腺房細胞癌との鑑別を要し、患者が以前51歳時に早期胃癌で幽門側胃切除術(Billroth-II法再建)を施行されていたことから、開腹生検が行われた。その結果、膵頭体部にみられた腫瘤の組織診は形質細胞腫で、骨髄には異型形質細胞は認められなかった。以上より、本症例は上顎洞にみられた髄外性形質細胞腫の転移と診断され、VAD療法とMP療法が施行された。だが、腫瘍の縮小は得られず、膵病変の発見から1年4ヵ月後に患者は死亡となった。膵頭体部に巨大腫瘤性病変を呈した膵形質細胞腫の1例
- 第46回日本小児外科学会近畿地方会, 2010年08月, 日本語, 日本小児外科学会近畿地方会, 大津, 国内会議膵仮性嚢胞に対し超音波内視鏡下経胃膵嚢胞ドレナージ術を施行した1例口頭発表（一般）
- 第79回日本消化器内視鏡学会総会, 2010年05月, 日本語, 日本消化器内視鏡学会, 東京, 国内会議分枝優位型IPMNの手術適応決定のための診断アルゴリズムの確立口頭発表（一般）
- 第79回日本消化器内視鏡学会総会, 2010年05月, 日本語, 日本消化器内視鏡学会, 東京, 国内会議食道表在癌の深達度診断におけるNBI併用拡大内視鏡観察口頭発表（一般）
- 第79回日本消化器内視鏡学会総会, 2010年05月, 日本語, 日本消化器内視鏡学会, 東京, 国内会議食道・胃・大腸ESD 早期胃癌に対する安全確実なESDを目指して スプリットバレルによるDouble scope-ESD口頭発表（一般）
- 第1回消化器内視鏡検診研究会, 2010年05月, 日本語, 日本消化器内視鏡学会, 東京, 国内会議胃癌検診の精度管理に必要な内視鏡所見項目の提案口頭発表（一般）
- 第79回日本消化器内視鏡学会総会, 2010年05月, 英語, 日本消化器内視鏡学会, 東京, 国内会議Evalution of flush knife and ball tipped flush knife in ESD for the treatment of early colorectal tumors口頭発表（一般）
- 第96回日本消化器病学会総会, 2010年04月, 日本語, 日本消化器病学会, 新潟, 国内会議抗原特異的CD4陽性T細胞から産生されるIFN-γは病原性大腸菌感染症を制御する口頭発表（一般）
- 胆道, 2010年肝門部胆管癌におけるERBD後の胆管炎-metallic stentとtube stentとの比較
- 第45回日本胆道学会学術集会, 2009年09月, 日本語, 日本胆道学会, 東京, 国内会議肝門部胆管癌に対する胆管炎抑制のためのドレナージ法の工夫口頭発表（一般）
- 第82回日本消化器内視鏡学会近畿地方会, 2009年03月, 日本語, 日本消化器内視鏡学会, 大阪, 国内会議ESDにおけるボールチップ型Flushナイフの有用性シンポジウム・ワークショップパネル（公募）
- 第76回 日本消化器内視鏡学会総会, 2008年10月, 日本語, 日本消化器内視鏡学会, 東京, 国内会議内視鏡的乳頭切除術前におけるＮＢＩ観察およびコンベックス型ＥＵＳの有用性シンポジウム・ワークショップパネル（公募）
- JDDW2008, 2008年10月, 日本語, 日本消化器病学会, 東京, 国内会議当院におけるERCP後膵炎の現状と対策ポスター発表
- JDDW2008, 2008年10月, 日本語, 日本消化器病学会, 東京, 国内会議当院で経験した膵管内乳頭粘液性腫瘍（IPMN)の他臓器癌の合併についての検討ポスター発表
- JDDW2008, 2008年10月, 日本語, 日本消化器病学会, 東京, 国内会議胆管深部挿管困難例に対する膵管ステント併用プレカットの有用性、安全性に関する検討ポスター発表
- UEGW2008, 2008年10月, 英語, UEGW, ウィーン, オーストリア, 国際会議“THE NEW APPROACH FOR THE DIFFICULT CASES IN EARLY GASTRIC CANCER TREATMENT- DEVELOPMENT OF DOUBLE SCOPE-ESD METHOD WITH “SPLIT BARREL”口頭発表（一般）
- 第44回 日本胆道学会学術集会, 2008年09月, 日本語, 日本胆道学会, 名古屋, 国内会議胆管深部挿管困難例に対する膵管ステント併用プレカットの有用性、安全性に関する検討口頭発表（一般）
- 第94回 日本消化器病学会総会, 2008年05月, 日本語, 日本消化器病学会, 福岡, 国内会議自己免疫性膵炎はミクリッツ病を高率に合併する？口頭発表（一般）
- DDW2008, 2008年05月, 英語, 米国消化器学会, サンディエゴ, アメリカ, 国際会議Fc gamma receptors on antigen presenting cells can regulate the mucosal defense against enteric bacteriaポスター発表
- DDW2008, 2008年05月, 英語, 米国消化器学会, サンディエゴ, アメリカ, 国際会議Bacterial localization and antigen-specific immune response in Citrobacter rodentium infectionポスター発表
- 第88回消化器病学会近畿支部例会, 2008年02月, 日本語, 消化器病学会, 大阪, 国内会議膵管内乳頭粘液性腫瘍（IPMN）に早期胃癌を合併した２例その他
- 日本消化器病学会近畿支部第88回例会, 2008年02月, 日本語, 日本消化器病学会, 大阪, 国内会議自己免疫性膵炎の経過中に特発性血小板減少性紫斑病を発症した一例口頭発表（一般）
- JUCC, 2007年11月, 英語, Japan & US Collaboration Conference in Gastroenterology, 東京, 国際会議The role of Fc receptor for IgG in defending against enteric bacteria口頭発表（一般）
- 日本免疫学会総会, 2007年11月, 日本語, 日本免疫学会, 東京, 国内会議The role of Fc receptor for IgG in defending against enteric bacteria口頭発表（一般）
- 第1回JUCC, 2007年11月, 英語, 大塚製薬, 東京, 国内会議The effect of an anti-inflammatory lipid mediator Resolvin E1, derived from eicosapentaenoic acid in mouse colitis model口頭発表（一般）
- ＤＤＷ, 2007年10月, 日本語, 日本消化器関連学会機構, 兵庫, 国内会議良性単クローン性ガンマグロブリン血症に合併した慢性偽性腸閉塞の一例口頭発表（一般）
- JDDW2007, 2007年10月, 日本語, 日本消化器病学会, 神戸, 国内会議粘膜下の抗原提示細胞上のIgG-Fc受容体は腸管感染症を制御する口頭発表（一般）
- 第49回日本消化器病学会大会, 2007年10月, 日本語, 日本消化器病学会, 神戸, 国内会議遺伝子改変Citrobacter rodentiumを用いた病原性大腸菌感染症の病態と抗原特異的免疫応答の解析ポスター発表
- 第回DDW-Japan, 2007年10月, 日本語, 日本消化器病学会, 神戸, 国内会議マウスクローン病モデルを用いた不飽和脂肪酸由来生理的活性物質の有効性の検討ポスター発表
- 第49回日本消化器病学会大会, 2007年10月, 日本語, 日本消化器病学会, 神戸, 国内会議マウスクローン病モデルを用いた不飽和脂肪酸由来生理活性物質の有効性の検討ポスター発表
- 日本消化器病学会雑誌, 2007年09月, 日本語, (一財)日本消化器病学会マウスクローン病モデルを用いた不飽和脂肪酸由来生理的活性物質の有効性の検討
- ICMI, 2007年07月, 英語, ICMI, 東京, 国際会議The role of Fc gamma receptor in defending against enteric bacteriaポスター発表
- 第13回国際粘膜免疫学会総会, 2007年07月, 英語, 粘膜免疫学会, 東京, 国際会議Omega-3 fatty acid-derived lipid mediators, Resolvin E1 protects against murine colitis modelポスター発表
- AGA（DDW2007）, 2007年05月, 英語, AGA，AASLD,ASGE,SSAT, ワシントン, アメリカ, 国際会議The role of IgG Fc receptor in defending against enteric bacteriaポスター発表
- 第回DDW-America, 2007年05月, 英語, 米国消化器病学会, ワシントンD.C, アメリカ, 国際会議New Therapy for Crohn's Disease With Anti-inflammatory Lipid Mediator from eicosapentaenoic acidポスター発表
- 第９３回消化器病学会総会, 2007年04月, 日本語, 日本消化器病学会, 弘前, 国内会議病原性大腸菌感染症におけるIgG Fc受容体の役割口頭発表（一般）
- 日本消化器病学会雑誌, 2007年03月, 日本語, (一財)日本消化器病学会病原性大腸菌感染症におけるIgG Fc受容体の役割
- 日本学術振興会, 科学研究費助成事業, 基盤研究(B), 神戸大学, 2022年04月01日 - 2025年03月31日自己抗原の同定に基づいた消化器系難病の病態解明と新しい診療体系の確立
- 日本学術振興会, 科学研究費助成事業, 基盤研究(C), 神戸大学, 2022年04月01日 - 2025年03月31日人工知能を用いた膵癌CT自動診断システム開発とスクリーニング・早期診断への応用腹部造影CT画像に対して画像AI技術を用い、膵腫瘤および膵癌に付随する頻度の高い二次所見（主膵管拡張、主膵管狭窄、膵萎縮）の自動検出による膵癌自動診断システムの構築を試みた。深層学習を用いて、膵実質、膵管、腫瘤の各領域を自動抽出し、抽出結果に基づき膵腫瘤性病変ならびに二次所見の有無を判定可能なAIエンジンを構築した。トレーニングセット・バリデーションセットとして膵癌群587例、対照群432例を用い、テストデータとして関連施設より収集した膵癌群62例、対照群90症例を対象に、膵腫瘤検出AI単独による膵癌検出精度ならびに膵腫瘤検出AIと二次所見検出AIの組合せによる膵癌検出精度を評価・算出した。 テストデータにおける腫瘤検出AIのみによる膵癌検出能は、感度73.3%、特異度96.7%であった。腫瘤検出AIと二次所見検出AIの組合せによる膵癌検出能は、感度93.5%、特異度84.4%であった。二次所見検出AIを組み合わせることにより検出感度が向上するとともに、腫瘤検出AI単独では検出できなかったTisやT1等の小膵癌に対しても検出成功例が増加した。
- 日本学術振興会, 科学研究費助成事業, 基盤研究(C), 兵庫医科大学, 2021年04月01日 - 2024年03月31日早期膵癌オルガノイドの樹立による腫瘍進展機構の解明膵癌は極めて予後不良な癌であるが、早期に発見し切除する事により一定の予後が見込める事が明らかとなってきた。しかし実際の臨床現場において膵癌を早期に発見することは困難である。膵癌の発生と進展機構の解明は早期発見へ寄与することが期待されるが、正常から軽度異型病変、上皮内癌、進行癌までの各段階を模倣するようなヒトモデルは存在しない。我々は早期膵がんモデルとしてオルガノイド培養技術に着目した。オルガノイドは患者由来の細胞から元の組織をよく模倣した３次元細胞である。現在、使用可能な膵癌患者由来オルガノイドの大部分は主に膵癌手術検体から樹立されたものであった。一部、内視鏡検査の１つである超音波内視鏡下穿刺吸引法 （EUS-FNA）検体から樹立された膵癌オルガノイド細胞株も存在するが、いずれの膵癌オルガノイド株もいわゆる進行癌から作成されており膵癌の前癌段階を模倣しているモデルとは考えにくい。膵癌は膵管の上皮の異型である膵上皮内腫瘍性病変（PanIN）から段階的に膵癌化する過程をとると考えられており、特に本研究では膵管の内腔側から細胞を採取できる膵管擦過細胞診から得られる検体からのオルガノイド樹立に着目して細胞採取を実施した。これまでに17検体の患者試料を用いてオルガノイド樹立を試みた。その内訳はEUS-FNA検体7例、膵管擦過細胞診検体8例、膵液検体3例である。そのうち擦過細胞診から樹立した1例では6カ月以上の長期培養に成功している。これまでに保存・蓄積しているしている膵癌患者由来オルガノイドも含めて今後DNAシーケンシングを実施し、トランスクリプトーム、プロテオーム解析を通じて早期膵癌オルガノイドを用いた早期膵癌から進行膵癌への腫瘍進展機構の解明を目指す。
- 日本学術振興会, 科学研究費助成事業, 基盤研究(C), 神戸大学, 2020年04月01日 - 2023年03月31日免疫チェックポイント阻害剤による免疫関連有害事象の病態解明とバイオマーカーの探索近年、各種の悪性腫瘍に対する免疫チェックポイント阻害剤の使用により、その自己免疫賦活化作用による免疫関連有害事象(immune-related adverse events: irAE)が問題となっている。 消化器内科領域では、irAEの5-10%を占めるirAE大腸炎が問題となっているが、irAE大腸炎は、自己免疫の関与が示唆される炎症性 腸疾患である潰瘍性大腸炎(ulcerative colitis: UC)と類似した内視鏡所見や臨床経過を呈することが明らかとなってきた。UCとirAEには自己免疫機序という 共通の病態が関与しているものと考え、研究を進めている。 申請者の所属している研究室では、UCに特異的な自己抗体Xをすでに確認している。またirAE大腸炎を発症した患者の血清も収集している。ELISA法を用いて、 血清中の自己抗体Xの有無について測定を行っている。またUCの自己抗原Xの類縁抗原を中心とした自己抗体の網羅的な探索についても現在計画中である。 またそれら自己抗体の臨床的意義を確認するため、現在神戸大学で免疫チェックポイント阻害剤を使用した患者の血清を前向きに収集することも開始してい る。モデルマウスを用いた実験については現在準備中である。
- 日本学術振興会, 科学研究費助成事業, 基盤研究(C), 神戸大学, 2019年04月01日 - 2023年03月31日ヨードマップを用いた膵癌の線維性間質定量による悪性度および治療抵抗性の予測法確立本研究の目的は、Dual-Energy CTで撮像したダイナミック造影CTから得られるヨードマップを用いて膵癌内部の線維性間質の多寡を定量測定することにより、非侵襲的に膵癌の悪性度ならびに治療抵抗性の予測を行うことである． 外科的切除が行われた通常型膵管癌162症例に対してCollagen量を評価するEVG染色、活性化膵星細胞を評価するα-SMA染色を行い評価したところ、Collagen fiberおよびα-SMA陽性細胞が高度の膵癌は生存率が延長する傾向にあった。また線維化高度な膵癌では腫瘍内のCD8陽性T細胞が多いことも判明した。この結果から、膵癌においては線維化が高度な症例で予後が良く、腫瘍内免疫状態とも関連している可能性が示唆された。平衡相画像から線維性間質の詳細な評価を行うためにRadiomics解析を行うべくソフトウェアの開発を行った。MatLabをベースとして、5mmスライス厚のCT画像から、2nd orderまでのRadiomics解析が可能なソフトウェア開発を行い、膵管癌162症例に対して解析を行う予定であったが、データ欠損を認める症例を除外し症例数は102例となった。また、ソフトウェアの開発に時間を要しているため、十分数の解析を行うことはできていない。
- 日本学術振興会, 科学研究費助成事業, 基盤研究(B), 神戸大学, 2019年04月01日 - 2022年03月31日指定難病「IgG4関連疾患」の自己抗原同定による病態解明と新しい診療体系の確立申請者らは原因不明であったIgG4関連疾患の一つである自己免疫性膵炎の自己抗原ラミニン511を同定した。本研究では、IgG4関連疾患の他の臓器における自己抗原を探索し、同疾患の病態解明と診断法の確立を目指した。その結果、新規自己抗原候補としてラミニン511と結合するインテグリンファミリー分子を同定し、マウスモデルによる検証を行なった。また、これらの自己抗原に対する自己抗体測定キットのプロトタイプを作成した。これらの自己抗体は、細胞接着を阻害することにより病態へ寄与する病因自己抗体と考えられた。
- 日本学術振興会, 科学研究費助成事業, 基盤研究(C), 神戸大学, 2019年04月01日 - 2022年03月31日膵癌における腸内細菌叢を介した腫瘍免疫機構の解明近年、膵癌局所に細菌感染が認められることが明らかとなり、膵発癌やその進展に重要な役割を果たしている事が示唆されている。しかし、どのような菌種がどのように膵発癌と進展に関与するかについては不明な点が多い。本研究ではヒト膵癌の病理組織を用いて癌の微生物叢プロファイルと病理像・臨床像との関連を調査した。正常膵組織と比較して膵癌では16SrDNAの高い増幅反応を認め、次世代シークエンサーによる解析では既報と同様の菌を同定し得た。さらにLPSの免疫染色を行いLPS陽性膵癌は予後不良である事、腫瘍免疫が抑制されている事を見出した。現在、in situ hybridizationを追加し検討を進めている。
- 学術研究助成基金助成金／若手研究(B), 2015年04月 - 2017年03月, 研究代表者競争的資金