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Masaki Kuwatani
Hokkaido University Hospital　Internal Medicine
Lecturer
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Last Updated :2024/05/09

Researcher Profile and Settings

Affiliation

  • Hokkaido University Hospital　Internal Medicine

Job Title

  • Lecturer

URL

ORCID ID

J-Global ID

Research Interests

  • photoimmunotherapy   内視鏡   胆道癌   膵癌   膵炎   急性膵炎モデル   間葉系幹細胞   

Research Areas

  • Life sciences / Gastroenterology

Educational Organization

Academic & Professional Experience

  • 2021/07 - Today Hokkaido University Hospital
  • 2012/04 - 2021/06 Hokkaido University

Research Activities

Published Papers

  • N Wakabayashi, R Kimura, M Kuwatani, A Matsui, N Ino, T Mitsuhashi, K Kishi, S Tsuneta, J Nakagawa, N Nishioka, K Sakamoto, F Kato, A Shimizu, S Hirano, K Kudo
    Journal of Gastroenterology and Hepatology 2024/04
  • Yasutoshi Kimura, Toru Nakamura, Masafumi Imamura, Minoru Nagayama, Takeshi Murakami, Tsuyoshi Hayashi, Toru Kato, Kimitaka Tanaka, Makoto Yoshida, Kazuharu Kukita, Koji Imai, Makoto Yoshida, Yoshiharu Masaki, Masayo Motoya, Masaki Kuwatani, Masayuki Koyama, Hirofumi Ohnishi, Ichiro Takemasa
    Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.] 2023/12/12 
    BACKGROUND: Pancreatic tail cancer (Pt-PC) is generally considered resectable when metastasis is absent, but doubts persist in clinical practice due to the variability in local tumor extent. We conducted a multicenter retrospective study to comprehensively identify prognostic factors associated with Pt-PC after resection. METHODS: We enrolled 100 patients that underwent distal pancreatectomy. The optimal combination of factors influencing relapse-free survival (RFS) was determined using the maximum likelihood method (MLM) and corrected Akaike and Bayesian information criteria (AICc and BIC). Prognostic elements were then validated to predict oncological outcomes. RESULTS: Therapeutic interventions included neoadjuvant treatment in 16 patients and concomitant visceral resection (CVR) in 37 patients; 89 patients achieved R0. Median RFS and OS after surgery were 23.1 and 37.1 months, respectively. AICc/BIC were minimized in the model with ASA-PS (≥2), CA19-9 (≥112 U/mL at baseline, non-normalized postoperatively), need for CVR, 6 pathological items (tumor diameter ≥19.5 mm, histology G1, invasion of the anterior pancreatic border, splenic vein invasion, splenic artery invasion, lymph node metastasis), and completed adjuvant treatment (cAT) for RFS. Regarding the predictive value of these 11 factors, area under the curve was 0.842 for 5-year RFS. Multivariate analysis of these 11 factors showed that predictors of RFS include CVR (hazard ratio, 2.13; 95 % confidence interval, 1.08-4.19; p = 0.028) and cAT (0.38, 0.19-0.76; p = 0.006). CONCLUSIONS: The MLM identified certain Pt-PC cases warranting consideration beyond resectable during clinical management. Particular attention should be paid to conditions requiring CVR, even though immortal time bias remains unresolved with adjuvant treatment.
  • Kosuke Nagai, Masaki Kuwatani, Yunosuke Takishin, Ryutaro Furukawa, Hajime Hirata, Kazumichi Kawakubo, Naoya Sakamoto
    Endoscopy 2023/12
  • Shin Kato, Yuji Ono, Michio Nakamura, Ryo Fukino, Asako Nomura, Mariko Matsumura, Taichi Murai, Kazufumi Itaya, Yuta Koike, Takaaki Izumi, Ayana Endo, Shuji Nishikawa, Masaki Kuwatani
    Digestive diseases and sciences 2023/11/06 
    BACKGROUND AND AIM: The utility of a passive bending colonoscope (PBCS) in ERCP for patients with surgically altered anatomy has not been established. This study compared the outcome of PBCS-ERCP and balloon-assisted enteroscope (BAE)-ERCP. METHODS: This multicenter observational study included 343 patients with surgically altered anatomy who underwent ERCP. Among these, 110 underwent PBCS-ERCP and 233 underwent BAE-ERCP. Propensity score matching was applied, and a final cohort of 210 (105 in each group) with well-balanced backgrounds was analyzed. The primary outcome was the success rate of reaching anastomosis or ampulla of Vater. Secondary endpoints included the cannulation success rate, completion rate, procedure time (to reach, cannulate, complete), and adverse events. RESULTS: The success rate for reaching the target was 91.4% (96/105) with PBCS and 90.5% (95/105) with BAE (odds ratio [95% CI] 1.12, [0.44-2.89], P = 0.809). The mean time required to reach the target was significantly shorter in PBCS: 10.04 min (SD, 9.62) with PBCS versus 18.77 min (SD, 13.21) with BAE (P < 0.001). There were no differences in the success of cannulation or procedure completion, although the required times for cannulation and procedure completion were significantly shorter in PBCS. The incidence of adverse events was significantly higher in BAE (19.0%) than in PBCS (4.8%; P < 0.001). CONCLUSIONS: In patients with surgically altered anatomy, PBCS-ERCP showed promising results with shorter time to reach, cannulate, and a lower incidence of adverse events compared with BAE-ERCP. The success rate of reaching was favorable through PBCS compared with BAE. CLINICAL TRIAL REGISTRATION: UMIN000045546.
  • Kazuma Kishi, Masaki Kuwatani, Yuki Ohnishi, Yasuhiro Kumaki, Hiroyuki Kumeta, Hajime Hirata, Yunosuke Takishin, Ryutaro Furukawa, Kosuke Nagai, Hiroki Yonemura, Shunichiro Nozawa, Ryo Sugiura, Kazumichi Kawakubo, Tomoyasu Aizawa, Naoya Sakamoto
    Cancers 15 (17) 4370 - 4370 2023/09/01 
    The poor prognosis of malignant biliary diseases is partially caused by their difficult early diagnosis. Therefore, many patients are only diagnosed at advanced stages. This study aimed to improve diagnosis by clarifying the differences in the duodenal juice metabolomes of benign and malignant biliary diseases. From October 2021 to January 2023, duodenal juice was obtained from 67 patients with suspected biliary diseases who required endoscopic ultrasonography and endoscopic retrograde cholangiography for diagnosis/treatment. The samples metabolomes were analyzed via nuclear magnet resonance spectroscopy using an 800-MHz spectrometer. Metabolomes of malignant and benign diseases were then compared, and multivariate analysis was performed to determine the relevant factors for malignancy/benignancy. For benignancy, no significant predictors were observed. For malignancy, acetone was a significant predictor, with higher concentrations in the malignant group than in the benign group. Regarding the receiver operating characteristic curve analysis for biliary tract carcinoma diagnosis, the predictive value of acetone in duodenal juice was comparable with serum CA19-9 levels (area under the curve: 0.7330 vs. 0.691, p = 0.697). In conclusion, duodenal juice metabolomics is a feasible method that is available for differential diagnosis in the biliary disease field.
  • Masaki Kuwatani, Naoya Sakamoto
    Cancers 15 (14) 2023/07/20 
    To overcome the poor prognosis of cholangiocarcinoma (CCA), highly targeted therapies, such as antibody-drug conjugates (ADCs), photodynamic therapy (PDT) with/without systemic chemotherapy, and experimental photoimmunotherapy (PIT), have been developed. Three preclinical trials have investigated the use of ADCs targeting specific antigens, namely HER2, MUC1, and glypican-1 (GPC1), for CCA. Trastuzumab emtansine demonstrated higher antiproliferative activity in CCA cells expressing higher levels of HER2. Similarly, "staphylococcal enterotoxin A-MUC1 antibody" and "anti-GPC1 antibody-monomethyl auristatin F" conjugates showed anticancer activity. PDT is effective in areas where appropriate photosensitizers and light coexist. Its mechanism involves photosensitizer excitation and subsequent reactive oxygen species production in cancer cells upon irradiation. Hematoporphyrin derivatives, temoporfin, phthalocyanine-4, talaporfin, and chlorine e6 derivatives have mainly been used clinically and preclinically in bile duct cancer. Currently, new forms of photosensitizers with nanotechnology and novel irradiation catheters are being developed. PIT is the most novel anti-cancer therapy developed in 2011 that selectively kills targeted cancer cells using a unique photosensitizer called "IR700" conjugated with an antibody specific for cancer cells. PIT is currently in the early stages of development for identifying appropriate CCA cell targets and irradiation devices. Future human and artificial intelligence collaboration has potential for overcoming challenges related to identifying universal CCA cell targets. This could pave the way for highly targeted therapies for CCA, such as ADC, PDT, and PIT.
  • Ryo Sugiura, Masaki Kuwatani, Mutsumi Nishida, Megumi Satoh, Kazumichi Kawakubo, Shin Kato, Koji Hirata, Masahito Nakajima, Hajime Hirata, Yunosuke Takishin, Naoya Sakamoto
    Ultrasound Quarterly Publish Ahead of Print 2023/05/22
  • Yunosuke Takishin, Masaki Kuwatani, Mutsumi Nishida, Tomoko Mitsuhashi, Kazuma Kishi, Kosuke Nagai, Ryutaro Furukawa, Hajime Hirata, Koji Hirata, Shin Kato, Kazumichi Kawakubo, Naoya Sakamoto
    Journal of gastroenterology and hepatology 38 (4) 656 - 663 2023/04 
    BACKGROUND AND AIM: Recently, dispersion imaging by shear wave elastography has been developed to visualize a tissue viscosity-related factor by measuring the dispersion slope. However, clinical significance of dispersion imaging in the field of pancreatic cancer is unknown. This study aimed to investigate the clinical significance of dispersion imaging in the treatment and diagnosis of pancreatic cancer. METHODS: We measured shear wave dispersion slope (SWD) (m/s/kHz) and shear wave elasticity (SWE) (kPa) in patients with pancreatic ductal adenocarcinoma (PDA). The primary endpoint was the relationship between the changes in SWD and SWE values before and after chemotherapy and the response to chemotherapy. Secondary endpoints included SWD and SWE values in relation to differences between PDA and non-PDA sites and histopathological scores of stroma, inflammation, fibrosis, and necrosis in endoscopic ultrasound-guided fine-needle aspiration specimens. RESULTS: Fifty-six patients were included, 30 of whom underwent chemotherapy. There was no relationship between the changes of SWD and SWE values and chemotherapy responses. In 56 patients, the median SWD value was 12.20 m/s/kHz (interquartile range [IQR]: 10.88-13.61) at PDA sites and 13.57 m/s/kHz (IQR: 12.28-16.20) at non-PDA sites (P = 0.005). The median SWE value was 8.18 kPa (IQR: 7.00-9.74) at PDA sites and 6.14 kPa (IQR: 5.40-6.77) at non-PDA sites (P < 0.001). Histopathological evaluation revealed that inflammation scores were correlated with SWD values (rs  = 0.42, P < 0.001). CONCLUSIONS: Dispersion imaging in pancreatic cancer would be useful for diagnosis and assessing inflammation.
  • Ryo Sugiura, Kazuma Kishi, Masaki Kuwatani
    Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society 2023/03/16
  • Yoshihide Kanno, Kei Ito, Kazunari Nakahara, Shinya Kawaguchi, Yoshiharu Masaki, Toru Okuzono, Hironari Kato, Masaki Kuwatani, Shotaro Ishii, Toji Murabayashi, Sho Hasegawa, Masatsugu Nagahama, Yuji Iwashita, Yosuke Michikawa, Shuzo Terada, Yujiro Kawakami, Yuki Fujii, Kazumichi Kawakubo
    Gastrointestinal endoscopy 2023/03/10 
    BACKGROUND AND AIMS: The efficacy of the suprapapillary placement of inside plastic stents (iPSs) for unresectable malignant hilar biliary obstructions (MHOs) has been unknown in comparison with that of inside uncovered metal stents (iMSs). This randomized controlled trial was designed to evaluate the outcomes of endoscopic placement of these stents for unresectable MHOs. METHODS: This was an open-label, randomized study at 12 Japanese institutions. The enrolled patients with unresectable MHOs were allocated to iPS and iMS groups. The primary outcome was defined as the time to recurrent biliary obstruction (RBO) in patients for whom the intervention was both technically and clinically successful. RESULTS: Among 87 enrollments, 38 in the iPS group and 46 in the iMS group were analyzed. The technical success rates were 100% (38) and 96.6% (44/46), respectively (p = 1.00). After transferring 1 unsuccessful iMS-group patient to the iPS group, since iPSs were deployed, the clinical success rates were 90.0% (35/39) for the iPS group and 88.9% (40/45) for the iMS group from a per-protocol analysis (p = 1.00). Among the patients with clinical successes, the median times to RBO were 250 (95% confidence interval [CI], 85-415) and 361 (107-615) days, respectively (p = 0.34; log-rank test). No differences were detected in rates of adverse events. CONCLUSIONS: This phase II randomized trial did not demonstrate any statistically significant difference in stent patency between suprapapillary plastic vs. metal stents. Considering the potential advantages of plastic stents for malignant hilar obstruction, these findings suggest that suprapapillary plastic stents could represent a viable alternative to metal stents for this condition.
  • Kazuma Kishi, Masaki Kuwatani, Naoya Sakamoto
    Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society 2023/02/20
  • H Hirata, M Kuwatani, T Mitsuhashi
    Journal of Gastroenterology and Hepatology 2023/02
  • Ryo Sugiura, Hidetoshi Kagaya, Hideaki Nakamura, Shoichi Horita, Takashi Meguro, Kiyotaka Sasaki, Tatsuya Yoshida, Hironori Aoki, Masaki Kuwatani, Masayuki Fukushima, Takayuki Morita, Miyoshi Fujita, Keisuke Okamura, Eiji Tamoto, Takashi Ueno, Akio Tsutaho, Ayano Inoue, Toshiyuki Takahashi
    Endoscopic Ultrasound 12 (2) 300 - 300 2303-9027 2023
  • Kosuke Nagai, Masaki Kuwatani, Koji Hirata, Goki Suda, Hajime Hirata, Yunosuke Takishin, Ryutaro Furukawa, Kazuma Kishi, Hiroki Yonemura, Shunichiro Nozawa, Ryo Sugiura, Kazumichi Kawakubo, Naoya Sakamoto
    Diagnostics 12 (11) 2704 - 2704 2022/11/05 
    Poor prognosis of pancreaticobiliary malignancies is attributed to intrinsic biological aggressiveness and the lack of reliable methods for early diagnosis. This study aimed to evaluate the feasibility and availability of pancreatic juice- and bile-derived cell-free DNA (cfDNA) for diagnosing pancreaticobiliary strictures. From October 2020 to February 2022, pancreatic juice or bile was obtained from 50 patients with pancreaticobiliary strictures during endoscopic retrograde cholangiopancreatography. cfDNAs extracted from the samples were analyzed using next-generation sequencing and a cancer gene panel. The obtained cfDNAs, genetic data and clinical information were analyzed for diagnosis. cfDNA concentrations in pancreatic juice were higher in the intraductal papillary mucinous neoplasm group than in the other groups, whereas those in bile were similar in all groups. In pancreatic juice, the sensitivity, specificity and positive and negative predictive values of cfDNA analyses were 33%, 100%, 100% and 71.4%, respectively, whereas those of cytological analyses were 0%, 100%, 0% and 62.5%, respectively. In bile, those of cell-free DNA analyses were 53%, 75%, 89.5% and 28.6%, respectively, whereas those of cytological analyses were 19%, 100%, 100% and 16%, respectively. In conclusion, pancreatic juice- and bile-derived cfDNA is a novel liquid biopsy tool that can diagnose pancreaticobiliary strictures.
  • Masaki Kuwatani, Naoya Sakamoto
    Digestive Endoscopy 2022/11
  • 術後再建腸管例に対する受動彎曲機能付大腸内視鏡を用いた胆道および胆管結石処置の有用性
    加藤 新, 甲谷 理紗子, 村井 太一, 板谷 一史, 池 祐太, 出水 孝章, 遠藤 文菜, 小野 雄司, 中村 路夫, 西川 秀司, 桑谷 将城
    Gastroenterological Endoscopy (一社)日本消化器内視鏡学会 64 (Suppl.2) 2141 - 2141 0387-1207 2022/10
  • 術後再建腸管に対する受動彎曲機能付大腸内視鏡を用いたERCPの有用性
    加藤 新, 野村 朝子, 松村 まり子, 村井 太一, 板谷 一史, 小池 祐太, 出水 孝章, 遠藤 文菜, 小野 雄司, 中村 路夫, 西川 秀司, 桑谷 将城
    日本消化器病学会北海道支部例会・日本消化器内視鏡学会北海道支部例会プログラム・抄録集 日本消化器病学会-北海道支部 131回・125回 41 - 41 2022/09
  • 内科・外科による消化器病共同診療の現況と展望 当科における切除可能境界膵癌に対する術前治療の現状
    原田 一顕, 中村 赳晶, 渡辺 亮介, 山村 貴洋, 川本 泰之, 結城 敏志, 桑谷 将城, 田口 大志, 加藤 徳雄, 浅野 賢道, 中村 透, 平野 聡, 小松 嘉人, 坂本 直哉
    日本消化器病学会北海道支部例会・日本消化器内視鏡学会北海道支部例会プログラム・抄録集 日本消化器病学会-北海道支部 131回・125回 28 - 28 2022/09
  • Ryo Sugiura, Hideaki Nakamura, Shoichi Horita, Takashi Meguro, Kiyotaka Sasaki, Hidetoshi Kagaya, Tatsuya Yoshida, Hironori Aoki, Takayuki Morita, Miyoshi Fujita, Eiji Tamoto, Masayuki Fukushima, Yoshitomo Ashitate, Takashi Ueno, Akio Tsutaho, Masaki Kuwatani, Naoya Sakamoto
    Surgical Endoscopy 36 (9) 6535 - 6542 0930-2794 2022/09
  • Shintaro Nakano, Yasuyuki Kawamoto, Yoshito Komatsu, Rika Saito, Ken Ito, Takahiro Yamamura, Kazuaki Harada, Satoshi Yuki, Kazumichi Kawakubo, Ryo Sugiura, Shin Kato, Koji Hirata, Hajime Hirata, Masahito Nakajima, Ryutaro Furukawa, Yunosuke Takishin, Kousuke Nagai, Isao Yokota, Keisuke H. Ota, Shinji Nakaoka, Masaki Kuwatani, Naoya Sakamoto
    Pancreas Publish Ahead of Print (4) 351 - 357 0885-3177 2022/06/13
  • Masayuki Kitano, Makoto Yoshida, Reiko Ashida, Emiri Kita, Akio Katanuma, Takao Itoi, Rintaro Mikata, Kenichiro Nishikawa, Hiroyuki Matsubayashi, Yukiko Takayama, Hironari Kato, Mamoru Takenaka, Toru Ueki, Yohei Kawashima, Yousuke Nakai, Shinichi Hashimoto, Minoru Shigekawa, Hiroko Nebiki, Hidetaka Tsumura, Yosinobu Okabe, Shomei Ryozawa, Yoshiyuki Harada, Akira Mitoro, Tamito Sasaki, Hiroaki Yasuda, Natsuki Miura, Tetsuya Ikemoto, Eisuke Ozawa, Kazuhiko Shioji, Atsushi Yamaguchi, Toru Okuzono, Ichiro Moriyama, Hiroyuki Hisai, Koichi Fujita, Takuma Goto, Nakao Shirahata, Yoshinori Iwata, Yoshihiro Okabe, Kazuo Hara, Yusuke Hashimoto, Masaki Kuwatani, Hiroyuki Isayama, Nao Fujimori, Atsushi Masamune, Keiichi Hatamaru, Toshio Shimokawa, Kazuichi Okazaki, Yoshifumi Takeyama, Hiroki Yamaue
    Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society 2022/05/03 
    OBJECTIVES: Endoscopic ultrasound-guided tissue acquisition (EUS-TA) plays a crucial role in the diagnosis of pancreatic tumors. The present study aimed to investigate the current status of needle tract seeding (NTS) after EUS-TA of pancreatic tumors based on a nationwide survey in Japan. METHODS: Patients who underwent surgical resection of primary pancreatic tumors after EUS-TA performed between April 2010 and March 2018 were surveyed. The incidence rates of NTS were determined, and compared in patients with pancreatic ductal adenocarcinomas (PDACs) and other tumors, and in patients who underwent transgastric and transduodenal EUS-TA of PDACs. The detailed features and prognosis of patients with NTS were also assessed. RESULTS: A total of 12,109 patients underwent surgical resection of primary pancreatic tumors after EUS-TA. The overall incidence rate of NTS was 0.330%, and the NTS rate was significantly higher in patients with PDAC than in those with other tumors (0.409% vs. 0.071%, P=0.004). NTS was observed in 0.857% of patients who underwent transgastric EUS-TA, but in none of those who underwent transduodenal EUS-TA. Of the patients with NTS of PDACs, the median time from EUS-TA to occurrence of NTS and median patient survival were 19.3 and 44.7 months, respectively, with 97.4% of NTS located in the gastric wall and 65.8% of NTS resected. The patient survival was significantly longer in patients who underwent NTS resection than in those without NTS resection (P=0.037). CONCLUSIONS: NTS appeared only after transgastric not after transduodenal EUS-TA. Careful follow-up provides an opportunity to remove localized NTS lesions by gastrectomy.
  • Masaki Kuwatani, Kazumichi Kawakubo, Naoya Sakamoto
    Diagnostics (Basel, Switzerland) 12 (4) 2022/04/05 
    The undesired prognosis of biliary tract cancer is mainly attributed to the difficult detection of cancer lesions, including intraepithelial neoplasia and no standard examination for screening. In addition, pathological diagnosis of biliary stricture, whether it is malignant or benign, is not so easy, because of difficult optimal sampling by forceps biopsy and brush cytology, although various devices and methods for pathological diagnosis have been reported. Furthermore, we have to be careful about post-endoscopic retrograde cholangiography pancreatitis when we approach the biliary tract lesion via a transpapillary route. In order to improve the diagnostic accuracy, there have been several studies that indicate the feasibility and efficacy of genomic analysis for accurate diagnosis of biliary tract cancer by using pathological specimens, including endoscopic ultrasound-guided fine-needle aspiration/biopsy (EUS-FNA/FNB) samples. For efficient and precision medicine for patients with biliary tract cancer, future diagnosis and treatment should also be based on molecular and genetic analyses. In this article, we review and summarize the past knowledge and cutting edge of genomic testing for biliary tract cancer, using EUS-FNA/FNB specimens, and indicate some ingenuities in sample processing to promote effective clinical practice and future perspectives.
  • 個別化医療を見据えた消化器診療の現状 超音波内視鏡下穿刺吸引法で得られた検体を用いた膵腫瘍内細菌叢の検討
    中野 真太郎, 川本 泰之, 小松 嘉人, 伊藤 憲, 原田 一顕, 結城 敏志, 川久保 和道, 杉浦 諒, 加藤 新, 平田 幸司, 平田 甫, 中島 正人, 古川 龍太郎, 滝新 悠之介, 永井 孝輔, 横田 勲, 太田 圭祐, 中岡 慎治, 桑谷 将城, 坂本 直哉
    日本消化器病学会北海道支部例会・日本消化器内視鏡学会北海道支部例会プログラム・抄録集 日本消化器病学会-北海道支部 130回・124回 36 - 36 2022/03
  • Ryo Sugiura, Masaki Kuwatani, Tsuyoshi Hayashi, Makoto Yoshida, Hideyuki Ihara, Hiroaki Yamato, Manabu Onodera, Akio Katanuma
    Digestion 103 (3) 205 - 216 0012-2823 2022 
    <b><i>Introduction:</i></b> Preoperative endoscopic biliary drainage (PEBD) for malignant hilar biliary obstruction (MHBO) is widely accepted. Recent PEBD consists of endoscopic nasobiliary drainage (ENBD), conventional endoscopic biliary stenting (CEBS) with plastic stents across the papilla, and endoscopic biliary inside stenting (EBIS) with plastic stents above the papilla, while ENBD is the primary procedure in Asian countries. Thus, we aimed to compare the efficacy of ENBD with those of CEBS and EBIS as a means of PEBD for MHBO. <b><i>Methods:</i></b> We retrospectively identified patients with MHBO who underwent upfront surgery between January 2011 and December 2018 in a multicenter setting. The outcome measures were cumulative dysfunction of PEBD, risk factors for PEBD dysfunction, and adverse events. <b><i>Results:</i></b> We analyzed a total of 219 patients, comprising 163 males (74.4%); mean age, 69.7 (±7.6) years; Bismuth-Corlette (BC) classification I, II, IIIa, IIIb, and IV in 68, 49, 43, 30, and 29 patients, respectively; and diagnosis of hilar cholangiocarcinoma and gallbladder cancer in 188 and 31 patients, respectively. PEBD procedures were performed in 160 patients with ENBD, 31 patients with CEBS, and 28 patients with EBIS. PEBD dysfunction occurred in 58 patients (26.5%), and the cumulative dysfunction rates were not significantly different among PEBD methods (<i>p</i> = 0.60). Multivariate analysis showed that BC-IV was significantly associated with the occurrence of PEBD dysfunction (hazard ratio = 2.10, <i>p</i> = 0.02). The adverse event rates were not significantly different among PEBD groups (<i>p</i> = 0.70). <b><i>Conclusion:</i></b> ENBD as a means of PEBD for MHBO is comparable with CEBS and EBIS in rates of dysfunction and adverse events.
  • 再発胆道癌に対する積極的外科切除の成績
    野路 武寛, 松井 あや, 田中 公貴, 中西 喜嗣, 渡邉 祐介, 浅野 賢道, 海老原 裕磨, 倉島 庸, 中村 透, 村上 壮一, 土川 貴裕, 岡村 圭佑, 七戸 俊明, 川本 泰之, 桑谷 将城, 平野 聡
    日本消化器外科学会雑誌 (一社)日本消化器外科学会 54 (Suppl.2) 155 - 155 0386-9768 2021/11
  • 再発胆道癌に対する積極的外科切除の成績
    野路 武寛, 松井 あや, 田中 公貴, 中西 喜嗣, 渡邉 祐介, 浅野 賢道, 海老原 裕磨, 倉島 庸, 中村 透, 村上 壮一, 土川 貴裕, 岡村 圭佑, 七戸 俊明, 川本 泰之, 桑谷 将城, 平野 聡
    日本消化器外科学会雑誌 (一社)日本消化器外科学会 54 (Suppl.2) 155 - 155 0386-9768 2021/11
  • Shin Kato, Masaki Kuwatani
    Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association 2021/10/12
  • Masaki Kuwatani, Naoya Sakamoto
    Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society 2021/09/29
  • Shin Kato, Masaki Kuwatani
    Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association 2021/09/20
  • Kosuke Nagai, Masaki Kuwatani, Yunosuke Takishin, Ryutaro Furukawa, Hajime Hirata, Kazumichi Kawakubo, Tomoko Mitsuhashi, Naoya Sakamoto
    Endoscopic ultrasound 2021/09/03
  • Masaki Kuwatani, Naoya Sakamoto
    Internal medicine (Tokyo, Japan) 60 (16) 2523 - 2524 2021/08/15
  • Shin Kato, Masaki Kuwatani, Manabu Onodera, Taiki Kudo, Itsuki Sano, Akio Katanuma, Minoru Uebayashi, Kazunori Eto, Mitsuharu Fukasawa, Shunpei Hashigo, Takuji Iwashita, Makoto Yoshida, Yoko Taya, Hiroshi Kawakami, Hironari Kato, Yousuke Nakai, Kasen Kobashigawa, Shuhei Kawahata, Susumu Shinoura, Kei Ito, Kimitoshi Kubo, Hiroaki Yamato, Kazuo Hara, Iruru Maetani, Tsuyoshi Mukai, Goro Shibukawa, Takao Itoi
    Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association 20 (6) 1394 - 1403 2021/08/12 
    BACKGROUND AND AIMS: The efficacy of endoscopic sphincterotomy before endoscopic transpapillary biliary drainage in preventing post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) has not been established. The aim of this study was to evaluate the effect of performing endoscopic sphincterotomy before biliary stent/tube placement on the occurrence of PEP. METHODS: Three-hundred seventy patients with biliary stricture requiring endoscopic biliary stenting were enrolled and randomly allocated to the endoscopic sphincterotomy group (ES group, n = 185) or non-endoscopic sphincterotomy group (non-ES group, n = 185). All participants were followed up for 30 days after the procedure. The data and occurrence of adverse events were prospectively collected. The primary outcome measure of this study was the incidence of PEP within 2 days of initial transpapillary biliary drainage. Secondary outcome measures were the incidence of other adverse events related to biliary stent/tube placement. RESULTS: PEP occurred in 36 (20.6%) patients in the non-ES group and in 7 (3.9%) patients in the ES group (P < .001). The difference in the incidence of PEP between the two groups in the per-protocol population was 16.7% (95% confidence interval, 10.1%-23.3%), which was not within the noninferiority margin of 6%. Except for bleeding, the incidences of other adverse events were not significantly different between the groups. CONCLUSION: ES before endoscopic biliary stenting could have the preventive effect on the occurrence of PEP in patients with biliary stricture.; University Hospital Medical Information Network Number, UMIN000025727.
  • 平田 甫, 桑谷 将城, 永井 孝輔, 瀧新 悠之介, 古川 龍太郎, 坂本 直哉, 浅野 賢道, 平野 聡, 三橋 智子
    膵臓 (一社)日本膵臓学会 36 (3) A257 - A257 0913-0071 2021/08
  • Hajime Hirata, Masaki Kuwatani, Daisuke Abo
    Journal of hepato-biliary-pancreatic sciences 28 (8) e38-e39  2021/08 
    Highlight Hirata and colleagues report on a difficult case of biliary strictures and extensive bile leak near the hepatic hilum after hepatectomy for metastatic cancer. Treatment with sharp recanalization and the rendezvous technique was effective to establish bridging between the common bile duct and intrahepatic bile duct in this case.
  • Masaki Kuwatani, Naoya Sakamoto
    Diagnostics (Basel, Switzerland) 11 (8) 2021/07/28 
    Since autoimmune pancreatitis (AIP) was established as a new disease entity, sclerosing change with abundant immunoglobulin-4 (IgG4)-positive plasma cells, storiform fibrosis, and obliterative phlebitis are main pathological features in IgG4-related diseases. Regarding IgG4-related sclerosing cholecystitis (IgG4-CC), which is occasionally associated with AIP cases and is rarely isolated, there are no diagnostic criteria and insufficient perceptions of the image findings. Although there have been some reports on IgG4-CC, differentiation between IgG4-CC and gallbladder cancer is very difficult in some cases with a localized lesion. In this review, we especially focused on image findings of IgG4-CC and summarized its image features for diagnostic assistance. The ultrasonography and CT findings of IgG4-CC could be classified into diffuse and localized types. Based on these findings, the presence of wall thickening with an intact or smooth mucosal layer, followed by a homogenously thickened outer layer, would be a helpful morphological finding to distinguish IgG4-CC from gallbladder cancer.
  • Kazuyuki Matsumoto, Hironari Kato, Masayuki Kitano, Kazuo Hara, Masaki Kuwatani, Reiko Ashida, Mamoru Takenaka, Tatsuhiro Yamazaki, Jun Sakurai, Michihiro Yoshida, Hiroyuki Okada
    BMJ open 11 (7) e046505  2021/07/12 
    INTRODUCTION: The management of small pancreatic neuroendocrine neoplasms (PNENs) remains controversial. The standard treatment for PNENs is surgical resection; however, invasiveness of surgical procedure remains higher and the incidence of postoperative adverse events is still high. Recently, the efficacy and safety of endoscopic ultrasonography (EUS)-guided ethanol injection for small PNENs has been preliminarily demonstrated. Thus, a multicentre prospective study is being conducted to evaluate the efficacy and safety of EUS-guided ethanol injection therapy for small PNENs. METHODS AND ANALYSIS: The major eligibility criteria are the presence of pathologically diagnosed grade (G) 1 tumour, a tumour size of ≤15 mm and non-functional PNEN or insulinoma. For treatment, we will use a 25-gauge needle and pure ethanol. Contrast-enhanced CT (CE-CT) will be performed on postoperative day 3-5, and if enhanced areas of the tumour are still apparent, an additional session is scheduled during the same hospitalisation period. We set the total amount of ethanol per session to 2 mL. To evaluate the efficacy and safety, CE-CT will be performed at 1 and 6 months after treatment. The primary endpoint is the percentage of subjects who achieved all of the following evaluated points. Efficacy will be evaluated based on the achievement of complete ablation (defined as no enhanced area within the tumour on CE-CT) at 1 and 6 months. Safety will be evaluated based on the avoidance of severe adverse events within 1 month after treatment, continuing severe pancreatic fistula at 1 month after treatment and the incidence and/or exacerbation of diabetes mellitus at 6 months after treatment. ETHICS AND DISSEMINATION: This protocol has been approved by Okayama University Certified Review Board (approval number. CRB19-007). The results will be submitted to peer-reviewed journals and will be presented at international conferences. TRIAL REGISTRATION NUMBER: jRCTs061200016.
  • Masaki Kuwatani, Kazumichi Kawakubo, Kazuya Sugimori, Hiroyuki Inoue, Hideki Kamada, Hirotoshi Ishiwatari, Shin Kato, Takuji Iwashita, Makoto Yoshida, Shinichi Hashimoto, Masahiro Itonaga, Yusuke Mizukami, Yusuke Nomura, Akio Katanuma, Naoya Sakamoto
    BMJ open 11 (7) e045698  2021/07/08 
    INTRODUCTION: Neoadjuvant chemotherapy or neoadjuvant chemoradiotherapy (NAC/NACRT) for resectable/borderline resectable pancreatic cancers was recently performed to improve clinical outcomes and led to good results, although it remains controversial whether NAC/NACRT is beneficial for resectable pancreatic cancer. A few recent studies revealed longer patency and lower cost related to the stent occlusion of a metal stent than those of a plastic stent during NAC/NACRT. It also remains controversial which type of self-expandable metal stent (SEMS) is the most suitable for patients with resectable/borderline resectable pancreatic cancer during NAC/NACRT: an uncovered SEMS (USEMS), a fully covered SEMS (FCSEMS) or a partially covered SEMS (PCSEMS). So far, two randomised controlled trials indicated that a USEMS and an FCSEMS were similar in preoperative stent dysfunction and adverse event rate. Thus, we aimed to verify the non-inferiority of a PCSEMS to a USEMS in this multicentre randomised controlled trial. METHODS AND ANALYSIS: We designed a multicentre randomised controlled trial, for which we will recruit 100 patients with resectable/borderline resectable pancreatic cancer and distal biliary obstruction scheduled for NAC/NACRT from 13 high-volume institutions. Patients will be randomly allocated to the PCSEMS group or USEMS group. The primary outcome measure is the preoperative biliary event rate. Data will be analysed after completion of the study. We will calculate the 95% CIs of the incidence of preoperative biliary events in each group and analyse whether the difference between them is within the non-inferiority margin (10%). ETHICS AND DISSEMINATION: This study has been approved by the institutional review board of Hokkaido University Hospital. The results will be submitted for presentation at an international medical conference and published in a peer-reviewed journal. TRIAL REGISTRATION NUMBER: UMIN000041737; jRCT1012200002.
  • Masaki Kuwatani, Kazumichi Kawakubo, Naoya Sakamoto
    Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society 2021/05/04 
    Endoscopic biliary decompression is a minimally invasive procedure for cholestasis since the first endoscopic retrograde cholangiopancreatography-guided biliary stenting performed by Soehendra and Reynders-Frederix. Among the endoscopic biliary decompression, endoscopic transpapillary biliary stenting (EBS), is a mainstream choice and presently has two methods of placement: stenting above the sphincter of Oddi (SO) (suprapapillary) and stenting across the SO (transpapillary). Stent patency is the most important concern for patients, endoscopists and physicians because it can affect both the life prognosis and treatment schedule of patients. Biliary stent occlusion can occur because of several factors. Among them, direct food impaction, biofilm formation, and sludge formation play important roles and are presumed to be theoretically overcome by EBS above the SO. Thus, EBS above the SO is expected to result in a longer patency than EBS across the SO. In the literature, there have been six comparative studies on EBS for distal biliary obstruction in which the stent was placed above or across the SO, including two randomized controlled trials (RCTs) with negative results of stenting above the SO. With respect to EBS for hilar biliary obstruction, there have been no RCTs, whereas four retrospective comparative studies with negative results and four retrospective comparative studies showing positive results of stenting above the SO have been reported. In this review, we focused on EBS above and across the SO, and summarized the positive and negative results of the two types of stenting to promote effective clinical practice and to provide a basis for future studies.
  • 野路 武寛, 松井 あや, 桑谷 将城, 大場 光信, 三橋 智子, 平野 聡
    胆道 (一社)日本胆道学会 35 (2) 230 - 236 0914-0077 2021/05
  • Noji Takehiro, Matsui Aya, Kuwatani Masaki, Ohba Mitsunobu, Mitsuhashi Tomoko, Hirano Satoshi
    Tando 日本胆道学会 35 (2) 230 - 236 0914-0077 2021/05
  • Yunosuke Takishin, Masaki Kuwatani, Naoya Sakamoto
    Endoscopy 2021/04/28
  • Masaki Kuwatani, Naoya Sakamoto
    JMA journal 4 (2) 176 - 177 2021/04/15
  • Masaki Kuwatani, Kosuke Nagai, Yunosuke Takishin, Ryutaro Furukawa, Hajime Hirata, Kazumichi Kawakubo, Naoya Sakamoto
    Endoscopy 2021/03/30
  • Shin Kato, Masaki Kuwatani, Kazumichi Kawakubo, Ryutaro Furukawa, Koji Hirata, Yunosuke Takishin, Hajime Hirata, Naoya Sakamoto
    Scandinavian journal of gastroenterology 56 (3) 1 - 4 2021/02/09 
    The placement of additional stents in patients with hilar malignant biliary obstruction can be challenging when a metal stent already exists because occasionally, the catheter and delivery system of the additional stent cannot pass through the mesh of the formerly placed stent. We studied ten consecutive patients with hilar malignant biliary obstruction who underwent mesh dilation using a novel ultra-sharp dilation device (ES dilator) to assess the efficacy and safety of the ES dilator for mesh dilation. Mesh dilation using the ES dilator was successful in eight patients (8/10; 80.0%), which was the same rate as that of patients with pre-dilation using a Soehendra biliary dilation catheter (4/5, 80.0%) and patients without pre-dilation (4/5, 80.0%). In the two patients with dilation failure, the angle of the hilar bile duct branch was too steep to permit the passage of a stiff dilation device. Nonetheless, stent placement was uncomplicated in all mesh-dilated patients (8/8, 100.0%), and no adverse events related to the ES dilator were observed. The efficacy of an ultra-sharp dilation device appears promising for metallic stent mesh dilation, especially in patients where conventional methods are unsuccessful. However, additional data are necessary to confirm our findings.
  • Hajime Hirata, Masaki Kuwatani, Kohei Nakajima, Yuki Kodama, Yasuo Yoshikawa, Mikako Ogawa, Naoya Sakamoto
    Cancer science 112 (2) 828 - 838 2021/02 
    Near-infrared photoimmunotherapy (NIR-PIT) is a novel therapy for cancers that uses NIR light and antibody-photosensitizer (IR700) conjugates. However, it is difficult to deliver NIR light into the bile duct for cholangiocarcinoma (CCA) from the conventional extracorporeal apparatus. Thus, in this study, we developed a dedicated catheter with light emitting diodes (LEDs) that supersedes conventional external irradiation devices; we investigated the therapeutic effect of NIR-PIT for CCA using the novel catheter. The new catheter was designed to be placed in the bile duct and a temperature sensor was attached to the tip of the catheter to avoid thermal burn. An anti-epidermal growth factor receptor (EGFR) antibody, Panitumumab-IR700 conjugate or anti-human epidermal growth factor receptor type 2 (HER2) antibody, Trastuzumab-IR700 conjugate, was used with EGFR- or HER2-expressing cell lines, respectively. The in vitro efficacy of NIR-PIT was confirmed in cultured cells; the capability of the new catheter for NIR-PIT was then tested in a mouse tumor model. NIR-PIT via the developed catheter treated CCA xenografts in mice. NIR-PIT had an effect in Panitumumab-IR700 conjugate- and Trastuzumab-IR700 conjugate-treated CCA cells that depended on the receptor expression level. Tumor growth was significantly suppressed in mice treated with NIR-PIT using the novel catheter compared with controls (P < .01). NIR-PIT was an effective treatment for EGFR- and HER2-expressing CCA cells, and the novel catheter with mounted LEDs was useful for NIR-PIT of CCA.
  • Masaki Kuwatani, Masafumi Imamura, Tsuyoshi Hayashi, Makoto Yoshida, Yasutoshi Kimura, Toshimichi Asano, Toru Nakamura, Masayo Motoya, Makoto Yoshida, Takehiro Noji, Keisuke Okamura, Kuniyuki Takahashi, Akio Katanuma, Satoshi Hirano
    Langenbeck's archives of surgery 406 (3) 743 - 751 2021/01/03 
    PURPOSE: Postoperative pancreatic fistula (POPF) after pancreatectomy is one of the severe postoperative adverse events. We aimed to clarify the outcomes of a strategy for POPF after left-sided pancreatectomy with one-step endoscopic ultrasonography-guided drainage (EUSD) and percutaneous drainage (PCD) based on the wall status of collected fluid. METHODS: From January 2012 to September 2017, 90 of 336 patients developed grade B/C POPF and were retrospectively analyzed. Primary outcome measures were the technical and clinical success and resolution rates. Secondary outcome measures were time from surgery to intervention, and time from intervention to discharge/resolution or stent/tube removal and adverse events. RESULTS: Seventeen patients underwent EUSD and 73 patients underwent PCD for POPF. The technical success rates were 100% in both the EUSD and PCD groups. The clinical success and resolution rates in the EUSD group were 100%, while those in the PCD group were 98.6%. The time from surgery to intervention was significantly longer in the EUSD group than in the PCD group (20 vs. 11 days, p < 0.001). The time from intervention to discharge/resolution was significantly shorter in the EUSD group than in the PCD group (11 vs. 22 days, p < 0.001/10 vs. 20 days, p < 0.001). The time from intervention to stent/tube removal was significantly shorter in the PCD group than in the EUSD group (20.5 vs. 873 days, p < 0.001). Adverse event rates were similar in the two groups (11.8% vs. 5.5%). CONCLUSION: A drainage strategy for POPF based on the wall status of collected fluid is appropriate.
  • Tetsuhiro Okada, Yusuke Mizukami, Yusuke Ono, Hiroki Sato, Akihiro Hayashi, Hidemasa Kawabata, Kazuya Koizumi, Sakue Masuda, Shinichi Teshima, Kuniyuki Takahashi, Akio Katanuma, Yuko Omori, Hirotoshi Iwano, Masataka Yamada, Tomoki Yokochi, Shingo Asahara, Kazumichi Kawakubo, Masaki Kuwatani, Naoya Sakamoto, Katsuro Enomoto, Takuma Goto, Junpei Sasajima, Mikihiro Fujiya, Jun Ueda, Seiji Matsumoto, Kenzui Taniue, Ayumu Sugitani, Hidenori Karasaki, Toshikatsu Okumura
    Journal of gastroenterology 55 (12) 1183 - 1193 2020/12 
    BACKGROUND: Cell-free DNA (cfDNA) shed from tumors into the circulation offers a tool for cancer detection. Here, we evaluated the feasibility of cfDNA measurement and utility of digital PCR (dPCR)-based assays, which reduce subsampling error, for diagnosing pancreatic ductal adenocarcinoma (PDA) and surveillance of intraductal papillary mucinous neoplasm (IPMN). METHODS: We collected plasma from seven institutions for cfDNA measurements. Hot-spot mutations in KRAS and GNAS in the cfDNA from patients with PDA (n = 96), undergoing surveillance for IPMN (n = 112), and normal controls (n = 76) were evaluated using pre-amplification dPCR. RESULTS: Upon Qubit measurement and copy number assessment of hemoglobin-subunit (HBB) and mitochondrially encoded NADH:ubiquinone oxidoreductase core subunit 1 (MT-ND1) in plasma cfDNA, HBB offered the best resolution between patients with PDA relative to healthy subjects [area under the curve (AUC) 0.862], whereas MT-ND1 revealed significant differences between IPMN and controls (AUC 0.851). DPCR utilizing pre-amplification cfDNA afforded accurate tumor-derived mutant KRAS detection in plasma in resectable PDA (AUC 0.861-0.876) and improved post-resection recurrence prediction [hazard ratio (HR) 3.179, 95% confidence interval (CI) 1.025-9.859] over that for the marker CA19-9 (HR 1.464; 95% CI 0.674-3.181). Capturing KRAS and GNAS could also provide genetic evidence in patients with IPMN-associated PDA and undergoing pancreatic surveillance. CONCLUSIONS: Plasma cfDNA quantification by distinct measurements is useful to predict tumor burden. Through appropriate methods, dPCR-mediated mutation detection in patients with localized PDA and IPMN likely to progress to invasive carcinoma is feasible and complements conventional biomarkers.
  • Hajime Hirata, Masaki Kuwatani, Tomoko Mitsuhashi
    Journal of hepato-biliary-pancreatic sciences 2020/11/11
  • Takehiro Noji, Minoru Nagayama, Koji Imai, Yasuyuki Kawamoto, Masaki Kuwatani, Masafumi Imamura, Keikuke Okamura, Yastoshi Kimura, Satoshi Hirano
    Surgery today 50 (11) 1409 - 1417 2020/11 
    PURPOSE: Few studies have focused on conversion surgery for biliary malignancy; thus, it is not clear if this treatment modality can extend the survival of patients with unresectable biliary malignancy. We conducted a multicenter retrospective cohort study to evaluate the surgical outcomes of conversion surgery in this setting and analyze long-term survival. METHODS: We collected clinical data retrospectively on patients who underwent conversion surgery for biliary malignancy. RESULTS: Twenty-four patients met our inclusion criteria. Preoperative chemotherapy regimens or chemoradiation therapy regimens were administered based on the institutional criteria, and surgical procedures were chosen based on tumor location. Morbidity occurred in 16 patients (66.7%), and 1 patient died of liver failure after surgery. The overall 5-year survival rate following initial therapy was 43.2%, and the median survival time was 57.4 months. The corresponding values following surgery were 38.2% and 34.3 months, respectively. The 5-year survival rate of the 24 patients who received both chemotherapy and surgery was significantly better than that of 110 patients treated with chemotherapy only (p < 0.001). CONCLUSION: Conversion surgery for initially unresectable biliary malignancies may be feasible and achieve long-term survival for selected patients.
  • Masaki Kuwatani, Naoya Sakamoto
    Internal medicine (Tokyo, Japan) 60 (6) 825 - 826 2020/10/14
  • 主膵管多発狭窄を呈した膵管上皮内病変の1例
    佐々木 貴志, 桑谷 将城, 三橋 智子, 浅野 賢道, 中村 透, 平野 聡, 坂本 直哉
    日本消化器病学会北海道支部例会・日本消化器内視鏡学会北海道支部例会プログラム・抄録集 日本消化器病学会-北海道支部 127回・121回 68 - 68 2020/10
  • 超音波内視鏡下瘻孔形成術における先端鋭拡張専用カテーテルと通電拡張カテーテルの有用性の比較
    加藤 新, 桑谷 将城, 平田 甫, 瀧新 悠之介, 平田 幸司, 古川 龍太郎, 坂本 直哉
    Gastroenterological Endoscopy (一社)日本消化器内視鏡学会 62 (Suppl.2) 2172 - 2172 0387-1207 2020/10
  • 滝新 悠之介, 桑谷 将城, 坂本 直哉, 古川 龍太郎, 平田 甫, 平田 幸司, 加藤 新
    胆道 34 (3) 452 - 452 0914-0077 2020/08
  • 古川 龍太郎, 桑谷 将城, 三橋 智子, 平田 甫, 瀧新 悠之介, 平田 幸司, 加藤 新, 平野 聡, 坂本 直哉
    胆道 日本胆道学会 34 (3) 528 - 528 0914-0077 2020/08
  • 肝門部金属ステント留置困難例でのESダイレーターを用いたトラブルシューティング
    加藤 新, 桑谷 将城, 坂本 直哉, 平田 甫, 瀧新 悠之介, 平田 幸司, 古川 龍太郎
    Gastroenterological Endoscopy (一社)日本消化器内視鏡学会 62 (Suppl.1) 1234 - 1234 0387-1207 2020/08
  • 膵周囲液体貯留に対する超音波内視鏡下ドレナージの有効性と安全性
    古川 龍太郎, 桑谷 将城, 坂本 直哉, 平田 甫, 瀧新 悠之介, 平田 幸司, 加藤 新
    Gastroenterological Endoscopy 62 (Suppl.1) 1312 - 1312 0387-1207 2020/08
  • 加藤 新, 桑谷 将城, 平田 甫, 瀧新 悠之介, 平田 幸司, 古川 龍太郎, 坂本 直哉
    膵臓 (一社)日本膵臓学会 35 (3) A326 - A326 0913-0071 2020/07
  • 瀧新 悠之介, 桑谷 将城, 古川 龍太郎, 平田 甫, 平田 幸司, 加藤 新, 坂本 直哉
    日本消化器病学会雑誌 (一財)日本消化器病学会 117 (臨増総会) A297 - A297 0446-6586 2020/07
  • Kei Yane, Masaki Kuwatani, Makoto Yoshida, Takuma Goto, Ryusuke Matsumoto, Hideyuki Ihara, Toshinori Okuda, Yoko Taya, Nobuyuki Ehira, Taiki Kudo, Takeya Adachi, Kazunori Eto, Manabu Onodera, Itsuki Sano, Masanori Nojima, Akio Katanuma
    Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society 32 (5) 801 - 811 2020/07 
    BACKGROUND AND AIMS: Needle tract seeding after preoperative endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) for pancreatic body and tail cancer has been reported. This study aimed to investigate the long-term outcomes, including the needle tract seeding ratio, of patients undergoing distal pancreatectomy for pancreatic body and tail cancer diagnosed preoperatively by EUS-FNA. METHODS: This retrospective, observational cohort study assessed patients from three university hospitals and 11 tertiary referral centers. All patients who underwent distal pancreatectomy for invasive cancer of the pancreatic body and tail between January 2006 and December 2015 were identified and reviewed. Needle tract seeding rate, recurrence-free survival (RFS), and overall survival (OS) were evaluated. RESULTS: Of the 301 total patients analyzed, 176 underwent preoperative EUS-FNA (EUS-FNA group) and 125 did not (non-EUS-FNA group). The median follow-up periods of the EUS-FNA group and non-EUS-FNA group were 32.8 and 30.1 months. Six patients (3.4%) in the EUS-FNA group were diagnosed as having needle tract seeding. The 5-year cumulative needle tract seeding rate estimated using Fine and Gray's method was 3.8% (95% CI 1.6-7.8%). The median RFS or OS was not significantly different between the EUS-FNA group and the non-EUS-FNA group (23.7 vs 16.9 months: P = 0.205; 48.0 vs 43.9 months: P = 0.392). CONCLUSION: Although preoperative EUS-FNA for pancreatic body and tail cancer has no negative effect on RFS or OS, needle tract seeding after EUS-FNA was observed to have a non-negligible rate. (UMIN000030719).
  • Ryo Sugiura, Masaki Kuwatani, Shin Kato, Kazumichi Kawakubo, Hirofumi Kamachi, Akinobu Taketomi, Takehiro Noji, Keisuke Okamura, Satoshi Hirano, Naoya Sakamoto
    Journal of hepato-biliary-pancreatic sciences 27 (11) 851 - 859 2020/06/07 [Refereed][Not invited]
     
    BACKGROUND: Few studies have focused on the risk factors for dysfunction of endoscopic biliary drainage (EBD) in preoperative patients with malignant hilar biliary obstruction (MHBO). METHODS: We searched the database between February 2011 and December 2018 and identified patients with MHBO who underwent radical operation. The rate of dysfunction of the initial EBD, risk factors for dysfunction of the initial EBD and survival after surgery were retrospectively evaluated. RESULTS: We analyzed a total of 131 patients [95 males (72.5%); mean age, 69.5(±7.3) years; Bismuth-Corlette classification (BC) I/II/IIIa/IIIb/IV, 50/26/22/17/16; hilar cholangiocarcinoma/gall bladder cancer, 115/16]. Dysfunction of the initial EBD occurred in 28patients (21.4%). The cumulative incidences of dysfunction of the initial EBD in all patients were 18.4%, 38.2% and 47.0% at 30, 60 and 90days, respectively (Kaplan-Meier method). The rate of dysfunction of the initial EBD increased in patients with BC-IV (P=0.03). Multivariate analysis showed that BC-IV and pre-EBD cholangitis were significantly associated with the occurrence of dysfunction of the initial EBD. Survival rates were not significantly different according to the initial biliary drainage methods and presence/absence of the initial EBD dysfunction. CONCLUSIONS: Dysfunction of the initial EBD frequently occurs in patients with the BC-IV and those with pre-EBD cholangitis.
  • Koji Hirata, Masaki Kuwatani, Hajime Hirata, Ryo Sugiura, Shin Kato, Naoya Sakamoto
    Clinical journal of gastroenterology 13 (3) 455 - 458 2020/06 
    A covered self-expandable metal stent is an efficient and established tool for solution of biliary obstruction. The use of multiple fully covered self-expandable metal stents (SEMSs) for distal malignant biliary obstruction has never been reported. The first case, a 33-year-old female with pancreatic head cancer had low bifurcation of the hepatic ducts and developed obstructive cholangitis by the first single SEMS. The second case, a-59-year-old female with pancreatic head cancer repeatedly underwent biliary decompression by a single SEMS (10-mm, 12-mm), because placed SEMSs were repeatedly dislocated. For solving these problems, we performed side-by-side placement of covered self-expandable metal stents. Finally, side-by-side placement of SEMSs across the papilla for distal malignant biliary obstruction was feasible and available for the two cases.
  • Koji Hirata, Masaki Kuwatani, Naoya Sakamoto
    Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society 32 (4) e73-e74  2020/05
  • Shin Kato, Masaki Kuwatani, Tsuyoshi Hayashi, Kazunori Eto, Michihiro Ono, Nobuyuki Ehira, Hiroaki Yamato, Itsuki Sano, Yoko Taya, Manabu Onodera, Kimitoshi Kubo, Hideyuki Ihara, Hajime Yamazaki, Naoya Sakamoto
    Scandinavian journal of gastroenterology 55 (4) 503 - 508 2020/04/10 [Refereed][Not invited]
     
    Background: The incidence of post-ERCP pancreatitis (PEP) has been reported to be significantly higher in patients without main pancreatic duct (MPD) obstruction who undergo transpapillary biliary metal stent (MS) placement than in those with ordinary ERCP setting.Objective: To evaluate the benefit of endoscopic sphincterotomy (ES) prior to MS placement in preventing PEP in patients with distal malignant biliary obstruction (MBO) without MPD obstruction.Materials and methods: In total, 160 patients who underwent initial MS placement for MBO were enrolled. Eighty-two patients underwent ES immediately prior to MS placement, whereas 78 underwent MS placement without ES. An inverse probability of treatment weighting method was adopted to adjust the differences of the patients' characteristics. The primary outcome was the incidence of PEP. The secondary outcomes included the incidence of other adverse events (bleeding, cholangitis, perforation and stent dislocation) and time to recurrent biliary obstruction.Results: The incidence of PEP was 26.8% in the ES and 23.1% in the non-ES (unadjusted odds ratio [OR] [95%CI]: 1.22, [0.60-2.51], adjusted OR [95%CI]: 1.23, [0.53-2.81], p = .63). Logistic-regression analysis revealed no factors that could be attributed to the occurrence of PEP. The incidence of other adverse events was not different between the groups. The median time to recurrent biliary obstruction was 131 (2-465) days and 200 (4-864) days in the ES and non-ES, respectively (p = .215).Conclusions: ES prior to MS placement for patients with distal MBO without MPD obstruction does not reduce the incidence of PEP.
  • Masaki Kuwatani, Toru Nakamura, Tsuyoshi Hayashi, Yasutoshi Kimura, Michihiro Ono, Masayo Motoya, Koji Imai, Keisuke Yamakita, Takuma Goto, Kuniyuki Takahashi, Hiroyuki Maguchi, Satoshi Hirano
    Gut and liver 14 (2) 269 - 273 2020/03/15 
    Neoadjuvant chemotherapy/neoadjuvant chemoradiotherapy (NAC/NACRT) can be performed in patients with pancreatic cancer to improve survival. We aimed to clarify the clinical outcomes of biliary drainage with a metal stent (MS) or a plastic stent (PS) during NAC/NACRT. Between October 2013 and April 2016, 96 patients with pancreatic cancer were registered for NAC/NACRT. Of these, 29 patients who underwent biliary drainage with MS or PS before NAC/NACRT and a subsequent pancreatoduodenectomy were retrospectively analyzed with regard to patient characteristics, preoperative recurrent biliary obstruction rate, NAC/NACRT delay or discontinuation rate, and operative characteristics. The median age of the patients was 67 years. NAC and NACRT were performed in 14 and 15 patients, respectively, and MS and PS were used in 17 and 12 patients, respectively. Recurrent biliary obstruction occurred in 6% and 83% of the patients in the MS and PS groups, respectively (p<0.001). NAC/NACRT delay was observed in 35% and 50% of the patients in the MS and PS groups, respectively (p=0.680). NAC/NACRT discontinuation was observed in 12% and 17% of the patients in the MS and PS groups, respectively (p=1.000). The operative time in the MS group tended to be longer than that in the PS group (625 minutes vs 497 minutes, p=0.051), and the operative blood loss volumes and postoperative adverse event rates were not different between the two groups. MS was better than PS from the viewpoint of preventing recurrent biliary obstruction, although MS was similar to PS with regards to perioperative outcomes.
  • 消化器がん内視鏡診断・治療の最前線 胆嚢癌に対する術前胆道ドレナージ 肝門部領域胆管癌との比較検討
    平田 幸司, 桑谷 将城, 加藤 新, 坂本 直哉
    日本消化器病学会北海道支部例会プログラム・抄録集 日本消化器病学会-北海道支部 126回 35 - 35 2020/03
  • 悪性胆道狭窄に対するトリプルルーメンカテーテルの有用性
    平田 甫, 桑谷 将城, 瀧新 悠之介, 古川 龍太郎, 平田 幸司, 加藤 新, 坂本 直哉
    日本消化器病学会北海道支部例会プログラム・抄録集 日本消化器病学会-北海道支部 126回 43 - 43 2020/03
  • 桑谷 将城, 川久保 和道, 加藤 新, 平田 幸司, 平田 甫, 坂本 直哉
    肝胆膵 (株)アークメディア 80 (3) 471 - 479 0389-4991 2020/03
  • 桑谷 将城, 加藤 新, 平田 幸司, 平田 甫, 坂本 直哉
    肝胆膵 (株)アークメディア 80 (2) 265 - 269 0389-4991 2020/02
  • Atsushi Masamune, Kazuhiro Kikuta, Kiyoshi Kume, Shin Hamada, Ichiro Tsuji, Yoshifumi Takeyama, Tooru Shimosegawa, Kazuichi Okazaki, Shin Miura, Tetsuya Takikawa, Seiji Hongo, Eriko Nakano, Tatsuhide Nabeshima, Ryotaro Matsumoto, Yu Tanaka, Masayuki Ueno, Tsuyoshi Mukai, Masataka Matsumoto, Yasushi Kudo, Shunjiro Azuma, Kosuke Okuwaki, Satoshi Yamamoto, Kazuo Inui, Kasen Kobashigawa, Jun Unno, Nao Fujimori, Katsuya Kitamura, H. iroyuki Miyakawa, Kuniyuki Takahashi, Tsukasa Ikeura, Mamoru Takenaka, Mitsuharu Fukasawa, Hiroyuki Funayama, Akira Mitoro, Tadayuki Takagi, Masanari Sekine, Kanetoshi Suwa, Junichi Sakagami, Masaharu Ishida, Masayuki Ohtsuka, S. hingo Kagawa, Takashi Muraki, Takayuki Watanabe, Takashi Watanabe, Katsunori Yamamoto, T. omohiro Masaka, Masatsugu Nagahama, Ai Sato, Yukio Aruga, Yousuke Nakai, Eisuke Iwasaki, T. akao Itoi, Yuki Kawaji, Masayuki Kitano, Kazuhiro Mizukami, Susumu Iwasaki, Masashi Mori, Naoya Kaneko, Yuzo Kodama, Hiroko Sato, Naoki Yoshida, Katsuko Hatayama, Takashi Kobayashi, Atsuyuki Hirano, Miyuki Kaino, Toshio Fujisawa, Tomoyuki Ushijima, Mitsuru Chiba, K. yoko Shimizu, Hirotaka Ota, Masao Toki, Takao Nishikawa, Yu Yoshida, Kei Tanaka, Kota Uetsuki, Daisuke Motoya, Shinichiro Muro, Hiroyuki Watanabe, Yoshiki Imamura, Tetsuya Ishizawa, Terumi Kamisawa, M. io Tsuruoka, Kazunao Hayashi, Shuji Terai, K. unio Iwatsuka, Keisuke Iwata, Motoyuki Yoshida, T. omofumi Takagi, Manabu Goto, Noriko Oza, Y. asuhito Takeda, Hideki Hagiwara, Toshihiro Tadano, Toshitaka Sakai, Kimi Sumimoto, Nauro Nishimura, Atsushi Irisawa, Masaki Kuwatani, Nakao Shirahata, Masahiro Satoh
    Journal of Gastroenterology 0944-1174 2020 
    © 2020, Japanese Society of Gastroenterology. Objectives: To provide updated clinico-epidemiological information on chronic pancreatitis (CP) in Japan. Methods: We conducted a two-stage nationwide epidemiological survey; the number of CP patients was estimated in the first-stage survey, and their clinical features were examined in the second-stage survey. We surveyed patients with CP who had visited hospitals in 2016 and were diagnosed according to the Japanese diagnostic criteria 2009 (DC2009). Furthermore, we validated the new Japanese diagnostic criteria (DC2019) in patients with early CP diagnosed according to DC2009. Results: The number of patients with definite/probable CP in 2016 was 56,520 (prevalence, 44.5 per 100,000 persons), and that of early CP was 4470 (prevalence, 3.5 per 100,000 persons). We obtained detailed clinical information of 2150 patients with definite/probable CP and 249 patients with early CP. Compared with the early CP cases, the definite/probable CP cases had higher proportions of male (4.8 vs. 1.3), alcohol-related etiology (72.0% vs. 45.8%), smoking history (69.6% vs. 41.0%), diabetes mellitus (42.3% vs. 19.3%), and past history of acute pancreatitis (AP) (50.4% vs. 22.1%). Among the patients with early CP diagnosed according to DC2009, 93 (37.3%) were diagnosed with early CP according to DC2019, but the diagnosis of the remaining 156 (62.7%) patients was downgraded. Alcohol-related etiology, smoking history, early disease onset, and past history of AP were associated with the maintenance of early CP diagnosis in DC2019. Conclusion: We clarified the current status of CP in Japan. Further validation studies are warranted to clarify the diagnostic utility of DC2019.
  • Masamune A, Kikuta K, Hamada S, Tsuji I, Takeyama Y, Shimosegawa T, Okazaki K, Collaborators. Collaborators, Kanno A, Sano T, Uchida K, Ikeura T, Fujimori N, Nakai Y, Kamisawa T, Kubota K, Motoya M, Shimizu K, Ushijima T, Fukasawa M, Naitoh I, Ueno M, Okuwaki K, Uza N, Asada M, Mukai T, Kudo Y, Uetsuki K, Mitoro A, Watanabe H, Terai S, Hayashi K, Imamura Y, Haba S, Hara K, Fujisawa T, Iwasaki E, Okumura F, Kawaji Y, Kitano M, Nishino T, Nagahama M, Hirano A, Aruga Y, Yamamoto S, Inui K, Kubota Y, Takahashi K, Sakagami J, Kobayashi T, Miraki T, Watanabe T, Sato H, Takeda Y, Satoh M, Kobashigawa K, Chiba M, Tamura T, Sawada N, Mizukami K, Sekine M, Unno J, Ishizawa T, Funayama H, Hatayama K, Miyakawa H, Sakai T, Kuwatani M, Toki M, To
    Journal of Gastroenterology 55 (4) 462 - 470 0944-1174 2019/12 [Refereed][Not invited]
     
    © 2019, Japanese Society of Gastroenterology. Background: To further clarify the clinico-epidemiological features of autoimmune pancreatitis (AIP) in Japan, we conducted the fourth nationwide epidemiological survey. Methods: This study consisted of two stage surveys; the number of AIP patients was estimated by the first survey and their clinical features were assessed by the second survey. We surveyed the AIP patients who had visited hospitals in 2016. Results: The estimated number of AIP patients in 2016 was 13,436, with an overall prevalence rate of 10.1 per 100,000 persons. The estimated number of newly diagnosed patients was 3984, with an annual incidence rate of 3.1 per 100,000 persons. Compared to the 2011 survey, both numbers more than doubled. We obtained detailed clinical information of 1474 AIP patients. The male-to-female sex ratio was 2.94, the mean age was 68.1, and mean age at diagnosis was 64.8. At diagnosis, 63% patients were symptomatic and nearly half of them presented jaundice. Pancreatic cysts were found in 9% of the patients and calcifications in 6%. Histopathological examination was performed in 64%, mainly by endoscopic ultrasonography-guided fine needle aspiration. Extra-pancreatic lesions were detected in 60% of the patients. Eighty-four % patients received the initial steroid therapy, and 85% received maintenance steroid therapy. Kaplan–Meier analysis revealed that the relapsed survival was 14% at 3 years, 25% at 5 years, 40% at 10 years, and 50% at 15 years. Mortality was favorable, but pancreatic cancer accounted for death in one quarter of fatal cases. Conclusion: We clarified the current status of AIP in Japan.
  • 桑谷 将城, 川久保 和道, 加藤 新, 平田 幸司, 平田 甫, 坂本 直哉
    肝胆膵 (株)アークメディア 79 (4) 705 - 711 0389-4991 2019/10
  • 杉浦 諒, 桑谷 将城, 平田 甫, 中島 正人, 平田 幸司, 加藤 新, 坂本 直哉
    胆道 日本胆道学会 33 (3) 493 - 493 0914-0077 2019/10
  • 平田 甫, 桑谷 将城, 中島 正人, 平田 幸司, 杉浦 諒, 加藤 新, 坂本 直哉, 浅野 賢道, 平野 聡
    胆道 日本胆道学会 33 (3) 548 - 548 0914-0077 2019/10
  • 加藤 新, 桑谷 将城, 平田 甫, 滝新 悠之介, 平田 幸司, 古川 龍太郎, 坂本 直哉
    胆道 日本胆道学会 33 (3) 603 - 603 0914-0077 2019/10
  • さあ、どうする?治療内視鏡におけるトラブルシューティング(胆膵編) 胆管金属ステント留置後reintervention困難例におけるESダイレーターの有用性
    加藤 新, 桑谷 将城, 坂本 直哉
    Gastroenterological Endoscopy (一社)日本消化器内視鏡学会 61 (Suppl.2) 2054 - 2054 0387-1207 2019/10
  • Ryo Sugiura, Masaki Kuwatani, Mutsumi Nishida, Koji Hirata, Itsuki Sano, Shin Kato, Kazumichi Kawakubo, Masato Nakai, Takuya Sho, Goki Suda, Kenichi Morikawa, Koji Ogawa, Naoya Sakamoto
    Ultrasound in Medicine & Biology 0301-5629 2019/10 [Refereed][Not invited]
  • 膵胆管合流異常症における画像所見の検討
    古川 龍太郎, 桑谷 将城, 平田 甫, 滝新 悠之介, 平田 幸司, 加藤 新, 岡村 圭佑, 平野 聡, 坂本 直哉
    日本消化器病学会北海道支部例会プログラム・抄録集 日本消化器病学会-北海道支部 125回 34 - 34 2019/09
  • 胆管空腸吻合部狭窄に対するバルーン内視鏡治療の臨床成績
    平田 甫, 桑谷 将城, 瀧新 悠之介, 古川 龍太郎, 平田 幸司, 加藤 新, 坂本 直哉
    日本消化器病学会北海道支部例会プログラム・抄録集 日本消化器病学会-北海道支部 125回 35 - 35 2019/09
  • 胆嚢原発神経内分泌腫瘍の4症例
    滝新 悠之介, 桑谷 将城, 古川 龍太郎, 平田 甫, 平田 幸司, 加藤 新, 坂本 直哉, 岡村 圭祐, 平野 聡, 三橋 智子
    日本消化器病学会北海道支部例会プログラム・抄録集 日本消化器病学会-北海道支部 125回 37 - 37 2019/09
  • Yasutoshi Kimura, Toru Nakamura, Tsuyoshi Hayashi, Masaki Kuwatani, Masayo Motoya, Makoto Yoshida, Masafumi Imamura, Minoru Nagayama, Hiroshi Yamaguchi, Keisuke Yamakita, Takuma Goto, Yusuke Sakuhara, Kuniyuki Takahashi, Hiroyuki Maguchi, Satoshi Hirano, Ichiro Takemasa
    Annals of gastroenterological surgery 3 (5) 523 - 533 2019/09 
    Background and Aim: Effective multidisciplinary approaches for unresectable pancreatic cancer (UR-PC) that include modern chemotherapeutic regimens and subsequent conversion surgery (CS) are being developed. The aim of this study was to evaluate outcomes of patients clinically diagnosed with UR-PC, focusing on the efficacy of CS. Methods: Patients ineligible for two multicenter phase II studies conducted by the Hokkaido Pancreatic Cancer Study Group (HOPS) were recruited. Sequential treatment regimens, conversion to radical surgery, and overall survival (OS) were analyzed by multidetector computed tomography (MDCT)-based UR factors. Univariate and multivariate analyses were performed to identify predictors of OS. Results: Sixty-six of 247 intended recruits for HOPS studies from October 2013 to April 2016 were included. Unresectability was due to locally advanced (LA) disease and metastasis (M) in 42 and 24 patients, respectively. Induction therapy began with chemotherapy (CT) and chemoradiotherapy (CRT) in 44 and 17 patients, respectively, of whom 23 received modern CT regimens. Radical surgery was completed in 12 (LA, 10; M, two) with a median treatment interval of 10.3 months (range, 2-32). Eleven patients (91.6%) achieved pathological R0 resection. Median OS was significantly longer in patients who underwent CS than those who did not (44.1 vs 14.5 months, P < 0.0001). CS was an independent predictor of OS (hazard ratio, 0.078; 95% confident interval, 0.017-0.348; P = 0.001). Conclusion: Conversion surgery after a favorable response to sequential treatment might prolong survival in patients with UR-PC. Precise diagnosis on MDCT followed by sequential multimodal anticancer treatment is essential.
  • Sugiura R, Kuwatani M, Hirata K, Sano I, Kato S, Kawakubo K, Sakamoto N
    Digestive diseases and sciences 64 (7) 2006 - 2013 0163-2116 2019/07 [Refereed][Not invited]
     
    BACKGROUND: Endoscopic ultrasonography-guided fine-needle aspiration (EUS-FNA) has high diagnostic accuracy for pancreatic diseases. However, the effect of mass size on diagnostic accuracy has yet to be determined, especially for small pancreatic lesions. We aimed to determine the effect of pancreatic mass size on the diagnostic yield of EUS-FNA. METHODS: We searched the database in Hokkaido University Hospital between May 2008 and December 2016 and identified solid pancreatic lesions examined by EUS-FNA. All lesions were stratified into five groups based on mass sizes: groups A (< 10 mm), B (10-20 mm), C (20-30 mm), D (30-40 mm) and E (≥ 40 mm). The sensitivity, specificity, diagnostic accuracy and adverse event rate were retrospectively evaluated. RESULTS: We analyzed a total of 788 solid pancreatic lesions in 761 patients. The patients included 440 males (57.8%) with a mean age of 65.7 years. The sensitivities in groups A (n = 36), B (n = 223), C (n = 304), D (n = 147) and E (n = 78) were 89.3%, 95.0%, 97.4%, 98.5% and 98.7%, respectively, and they significantly increased as the mass size increased (P < 0.01, chi-squared test for trend). The diagnostic accuracies were 91.7%, 96.4%, 97.7%, 98.6% and 98.7%, respectively, and they also significantly increased as the mass size increased (P = 0.03). Multivariate analysis showed that pancreatic mass size was associated with diagnostic accuracy. The adverse event rates were not significantly different among the five groups. CONCLUSIONS: The sensitivities and diagnostic accuracies of EUS-FNA for solid pancreatic lesions are higher for lesions ≥ 10 mm in size, and they are strongly correlated with mass size.
  • Kato S, Kuwatani M, Kawakubo K, Sugiura R, Hirata K, Nakajima M, Hirata H, Kawakami H, Sakamoto N
    Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society 31 (4) 448 - 452 0915-5635 2019/07 [Refereed][Not invited]
     
    Endoscopic dilation for severe benign biliary stricture using mechanical dilation devices is occasionally ineffective. Hence, diathermic dilation has recently been gaining attention as a salvage procedure. We evaluated the short- and long-term outcomes of diathermic dilation for severe benign biliary stricture that could not be dilated using conventional mechanical dilation. Thirteen consecutive cases with severe benign biliary stricture that underwent diathermic dilation using 6-Fr electrocautery dilator were enrolled. Short- and long-term outcomes were analyzed. Diathermic dilation was successful in 13 cases (100%), whereas stent was successfully placed in 12 cases (92.3%). Adverse events occurred in two cases (15.4%): mild hemobilia and cholangitis. Recurrence of bile duct stricture was observed in five out of 12 cases (41. 7%) in the 1115-day median follow-up period. Finally, eight cases achieved stent-free state (61.5%) and have remained stent-free without any episode of cholangitis and abnormal liver function test. Diathermic dilation using 6-Fr electrocautery dilator is a promising salvage procedure for severe benign biliary stricture when the conventional dilation technique has been ineffective.
  • 岡田 哲弘, 水上 裕輔, 河本 徹, 林 明宏, 佐藤 裕基, 河端 秀賢, 後藤 拓磨, 笹島 順平, 小泉 一也, 高橋 邦幸, 岩野 博俊, 浅原 新吾, 桑谷 将城, 唐崎 秀則, 奥村 利勝
    膵臓 日本膵臓学会 34 (3) A106 - A107 0913-0071 2019/06
  • Masaki Kuwatani, Hiroshi Kawakami, Yoshimasa Kubota, Kazumichi Kawakubo, Yoichi M Ito, Shinji Togo, Takaaki Ikeda, Ken Kusama, Yuka Kobayashi, Teizo Murata, Naoya Sakamoto
    Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.] 19 (4) 569 - 577 1424-3903 2019/06 [Refereed][Not invited]
     
    BACKGROUND: Fucosylated haptoglobin detected by Pholiota squarrosa lectin (PhoSL) that had specificity for fucose α1-6 was reported as an effective biomarker for several gastrointestinal diseases. The aim of this study was to verify Fucosylated haptoglobin detected by Pholiota squarrosa lectin (PhoSL-HP) as a pancreatic cancer (PC) marker using a new method of PhoSL-ELISA. METHODS: PhoSL-HP in sera from 98 PC patients and 158 non-PC samples including 32 intraductal papillary mucinous neoplasm (IPMN) patients, 21 chronic pancreatitis (CP) patients and 105 non-pancreatic disease controls (NPDC) were measured. We compared sensitivities, specificities and areas under the curves (AUC) of PhoSL-HP, CA19-9 and CEA as single markers. We also evaluated PhoSL-HP as combination marker by comparing AUC of CA19-9 combined with PhoSL-HP or CEA. RESULTS: The sensitivities of PhoSL-HP, CA19-9 and CEA for PC were 58%, 76% and 42%, respectively. Although the specificity of PhoSL-HP for NPDC was inferior to both of CA19-9 and CEA, that for pancreatic diseases was higher than both of CA19-9 and CEA. Combined CA19-9 with PhoSL-HP, the AUC was significantly higher at 0.880 than single use of CA19-9 at 0.825 in case of distinguishing PC from other pancreatic diseases. In contrast, the AUC of CA19-9 was not elevated significantly when combined with CEA. CONCLUSION: PhoSL-HP would be a useful marker for PC and have sufficient complementarity for CA19-9.
  • 主膵管閉塞を伴わない悪性胆管狭窄に対する金属ステント留置時の乳頭括約筋切開の必要性 多施設共同傾向スコア解析研究
    加藤 新, 桑谷 将城, 江藤 和範, 小野 道洋, 大和 弘明, 江平 宣起, 佐野 逸紀, 庵原 秀之, 久保 公利, 坂本 直哉
    Gastroenterological Endoscopy (一社)日本消化器内視鏡学会 61 (Suppl.1) 864 - 864 0387-1207 2019/05
  • 内視鏡的乳頭括約筋切開術による出血に対する治療法
    平田 甫, 桑谷 将城, 坂本 直哉, 中島 正人, 平田 幸司, 杉浦 諒, 加藤 新
    Gastroenterological Endoscopy (一社)日本消化器内視鏡学会 61 (Suppl.1) 922 - 922 0387-1207 2019/05
  • Sugiura R, Kuwatani M, Hirata K, Kato S, Kawamoto Y, Kawakubo K, Mitsuhashi T, Asano T, Hirano S, Sakamoto N
    Endoscopic ultrasound 8 (3) 213 - 214 2303-9027 2019/05 [Refereed][Not invited]
  • 平田 幸司, 桑谷 将城, 坂本 直哉
    日本消化器病学会雑誌 (一財)日本消化器病学会 116 (臨増総会) A74 - A74 0446-6586 2019/03
  • 胆道病変に対する超音波内視鏡下穿刺吸引法の臨床成績
    平田 甫, 桑谷 将城, 中島 正人, 平田 幸司, 杉浦 諒, 加藤 新, 坂本 直哉
    日本消化器病学会北海道支部例会プログラム・抄録集 日本消化器病学会-北海道支部 124回 66 - 66 2019/03
  • Ryo Sugiura, Masaki Kuwatani, Naoya Sakamoto
    Digestive Endoscopy 31 (2) e48 - e49 0915-5635 2019/03 [Refereed][Not invited]
  • Sano I, Katanuma A, Kuwatani M, Kawakami H, Kato H, Itoi T, Ono M, Irisawa A, Okabe Y, Iwashita T, Yasuda I, Ryozawa S, Kaino S, Sakamoto N
    Journal of gastroenterology and hepatology 34 (3) 612 - 619 0815-9319 2019/03 [Refereed][Not invited]
     
    BACKGROUND AND AIM: Data on long-term outcomes after therapeutic endoscopic retrograde cholangiopancreatography (ERCP) using balloon-assisted enteroscopy (BAE) for choledochojejunal anastomotic stenosis (CJS) or pancreaticojejunal anastomotic stenosis (PJS) remain limited. We retrospectively assessed the long-term results of patients who achieved clinical success using BAE for CJS and PJS. METHODS: Patients who achieved technical and clinical success for CJS or PJS by BAE-ERCP and were followed up for more than 6 months after the initial BAE-ERCP therapy were retrospectively identified at 11 Japanese institutions. The primary end-point was CJS or PJS recurrence rates. The secondary end-points were initial therapy details, initial therapy complications, and CJS or PJS recurrence treatment details. We also evaluated restenosis-associated factors. RESULTS: From September 2008 to December 2015, 67 patients (CJS, 61; PJS, six) were included. The overall CJS and PJS recurrence rates were 34.4% and 33.3%, respectively. The 1-year CJS recurrence rate was 18.5% (95% confidence interval, 10.7-31.0). Of all the patients, 88.1% underwent balloon dilation at the anastomotic stenosis site; stent placement was performed in 15 of 67 patients (22.4%). The complication rate was 8.2% in CJS and 0% in PJS. In patients who underwent balloon dilation, "remaining waist" was significantly associated with CJS recurrence after anastomotic balloon dilation (P = 0.001). CONCLUSIONS: The long-term outcomes of BAE-ERCP were comparable with those of percutaneous transhepatic treatment or surgical re-anastomosis.
  • Kawakubo K, Kuwatani M, Kato S, Sakamoto N
    Gastrointestinal endoscopy 89 (3) 650 - 651 0016-5107 2019/03 [Refereed][Not invited]
  • Sugiura R, Kuwatani M, Yane K, Taya Y, Ihara H, Onodera M, Eto K, Sano I, Kudo T, Mitsuhashi T, Katanuma A, Sakamoto N, Hokkaido Interventional EUS, ERCP study, HONEST) group
    Endoscopic ultrasound 2303-9027 2019/03 [Refereed][Not invited]
  • Hirata K, Kuwatani M, Suda G, Ishikawa M, Sugiura R, Kato S, Kawakubo K, Sakamoto N
    Clinical and translational gastroenterology 10 (3) e00022  2019/03 [Refereed][Not invited]
     
    OBJECTIVES: Biliary tract cancer (BTC) is an aggressive malignant tumor, and biomarker-based clinical trials for this cancer are currently ongoing. Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is a safe procedure and enables pathological diagnoses; however, it is uncertain whether a tiny tumor sample of BTC obtained through EUS-FNA can be analyzed for diverse genetic alterations in the development and tolerance of BTC. Thus, we aimed to verify the feasibility of genetic analyses with EUS-FNA samples of BTC. METHODS: Targeted amplicon sequencing using a cancer gene panel with 50 genes was performed with tissue samples of 21 BTC patients obtained through EUS-FNA with a novel rapid on-site process compared with paired peripheral blood samples. RESULTS: Pathogenic gene alterations were successfully identified in 20 out of 21 patients (95.2%) with EUS-FNA specimens of BTC, which included 19 adenocarcinomas and 2 adenosquamous carcinomas. Eighty single nucleotide variants and 8 indels in 39 genes were identified in total, and 28 pathogenic alterations in 14 genes were identified (average, 1.4 alterations per patient). The most common alterations were TP53, KRAS, and CDKN2A in gallbladder carcinoma; TP53, KRAS, PIK3CA, and BRAF in intrahepatic cholangiocarcinoma; and TP53 and SMAD4 in extrahepatic cholangiocarcinoma. Actionable gene alterations (BRAF, NRAS, PIK3CA, and IDH1) were identified in 7 out of 21 patients. CONCLUSIONS: A novel approach in genetic analysis using targeted amplicon sequencing with BTC specimens obtained through EUS-FNA was feasible and enabled us to identify genomic alterations.
  • 出口 貴祥, 丸川 活司, 高桑 恵美, 安孫子 光春, 清水 知浩, 恩田 千景, 宮越 里絵, 渡部 涼子, 岡田 宏美, 中 智昭, 加藤 新, 桑谷 将城, 三橋 智子, 松野 吉宏
    北海道臨床細胞学会会報 北海道臨床細胞学会 27 21 - 26 2189-2342 2018/11 
    超音波内視鏡下穿刺吸引法(Endoscopic Ultrasound-Fine Needle Aspiration、以下EUSFNA)は、胃や十二指腸腔から病変を穿刺し細胞や組織を採取することにより病理学的検索を可能とする手法である。膵、胃粘膜下などの腫瘍を対象として普及している手法であるが、現在では傍大動脈領域や副腎などの組織・細胞採取のアプローチが難しい後腹膜領域に発生する腫瘍に対しても施行される。症例は60歳台・男性。高血圧、高尿酸血症、高脂血症により前医通院中に肝機能障害を指摘され、その際のCTにて後腹膜腫瘍を認め、当院を紹介受診した。血液検査にてAFPやノルアドレナリン等の上昇がみられ、画像検査では胚細胞腫瘍、神経鞘腫、褐色細胞腫などが鑑別疾患に挙がったことから、さらなる精査目的のため、EUS-FNAが施行された。EUS-FNA細胞診標本では、壊死物質を背景に結合性の緩い乳頭状細胞集塊を認め、低分化な癌腫を疑ったが、同時に採取された生検検体の組織所見を併せ、推定診断を胚細胞腫瘍とした。後日、腫瘍摘出術が施行され、腫瘍内に卵黄嚢腫瘍と成熟軟骨が観察され、胚細胞腫瘍と病理診断された。EUS-FNA細胞診標本に出現した細胞像のみで胚細胞腫瘍を推定することは困難であったが、AFPなどの検査所見と出現細胞の形態的特徴から胚細胞腫瘍も鑑別に挙げることが可能と思われた。(著者抄録)
  • Kawakubo K, Kuwatani M, Sakamoto N
    Gastrointestinal endoscopy 88 (5) 884  0016-5107 2018/11 [Refereed][Not invited]
  • Interventional EUSのトラブルシューティング 超音波内視鏡下胆管消化管吻合術における瘻孔拡張の実際とトラブルシューティング
    平田 幸司, 桑谷 将城, 坂本 直哉
    Gastroenterological Endoscopy (一社)日本消化器内視鏡学会 60 (Suppl.2) 2048 - 2048 0387-1207 2018/10
  • Interventional EUSのトラブルシューティング 超音波内視鏡下胆管消化管吻合術における瘻孔拡張の実際とドラブルシューティング
    平田 幸司, 桑谷 将城, 坂本 直哉
    日本消化器病学会雑誌 (一財)日本消化器病学会 115 (臨増大会) A680 - A680 0446-6586 2018/10
  • Innovative therapeutic endoscopy良性胆管・膵管狭窄に対する内視鏡治療 良性胆管・膵管狭窄に対する経乳頭的通電拡張術の効果
    加藤 新, 桑谷 将城, 坂本 直哉
    Gastroenterological Endoscopy (一社)日本消化器内視鏡学会 60 (Suppl.2) 2013 - 2013 0387-1207 2018/10
  • 良性胆管・膵管狭窄に対する内視鏡治療 良性胆管・膵管狭窄に対する経乳頭的通電拡張術の効果
    加藤 新, 桑谷 将城, 坂本 直哉
    日本消化器病学会雑誌 (一財)日本消化器病学会 115 (臨増大会) A633 - A633 0446-6586 2018/10
  • Kuwatani M, Kato S, Sakamoto N
    Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society 31 (1) e18 - e19 0915-5635 2018/10 [Refereed][Not invited]
  • Kawakubo K, Kuwatani M, Sakamoto N
    Gastrointestinal endoscopy 88 (3) 573  0016-5107 2018/09 [Refereed][Not invited]
  • 平田 幸司, 桑谷 将城, 平田 甫
    胆道 (一社)日本胆道学会 32 (3) 408 - 408 0914-0077 2018/08
  • S. Kato, M. Kuwatani, K. Kawakubo, R. Sugiura, K. Hirata, S. Tanikawa, T. Mitsuhashi, S. Shiratori, N. Sakamoto
    Journal of Gastroenterology and Hepatology (Australia) 33 (7) 1310  1440-1746 2018/07/01 [Refereed][Not invited]
  • Ryo Sugiura, Masaki Kuwatani, Kazumichi Kawakubo, Itsuki Sano, Shin Kato, Tomoyuki Endo, Naoya Sakamoto
    Clinical Journal of Gastroenterology 11 (3) 188 - 192 1865-7265 2018/06/01 [Refereed][Not invited]
     
    Endoscopic sphincterotomy (ES) is a standard procedure for bile duct stone removal. However, the safety of ES in patients with hemophilia remains unknown. We treated a 46-year-old man who had choledocholithiasis and severe hemophilia A with high-responding inhibitors during immune tolerance induction therapy. Since coagulation factor VIII inhibitors neutralize and inactivate endogenous and exogenous factor VIII, bleeding risk is higher in hemophilia A patients with inhibitors than in those without inhibitors. With adequate pre- and post-procedure monitoring of the clotting factor and supplemented clotting factor, the patient could safely undergo ES without bleeding complications. ES can be also an effective and safe first-line therapy for choledocholithiasis in patients with hemophilia and inhibitors under the condition of appropriate management.
  • Kazumichi Kawakubo, Kei Yane, Kazunori Eto, Hirotoshi Ishiwatari, Nobuyuki Ehira, Shin Haba, Ryusuke Matsumoto, Keisuke Shinada, Hiroaki Yamato, Taiki Kudo, Manabu Onodera, Toshinori Okuda, Yoko Taya-Abe, Shuhei Kawahata, Kimitoshi Kubo, Yoshimasa Kubota, Masaki Kuwatani, Hiroshi Kawakami, Akio Katanuma, Michihiro Ono, Tsuyoshi Hayashi, Minoru Uebayashi, Naoya Sakamoto
    Gut and Liver 12 (3) 353 - 359 2005-1212 2018/05/01 [Refereed][Not invited]
     
    Background/Aims: Although the risk of bleeding after endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is low, the safety of EUS-FNA in patients prescribed antithrombotic agents is unclear. Therefore, this study evaluated the incidence of bleeding after EUS-FNA in those patients. Methods: Between September 2012 and September 2015, patients who were prescribed antithrombotic agents underwent EUS-FNA at 13 institutions in Japan were prospectively enrolled in the study. The antithrombotic agents were managed according to the guidelines of the Japanese Gastrointestinal Endoscopy Society. The rate of bleeding events, thromboembolic events and other complications within 2 weeks after EUS-FNA were analyzed. Results: Of the 2,629 patients who underwent EUS-FNA during the study period, 85 (62 males median age, 74 years) patients were included in this stduy. Two patients (2.4% 95% confidence interval [CI], 0.6% to 8.3%) experienced bleeding events. One patient required surgical intervention for hemothorax 5 hours after EUS-FNA, and the other experienced melena 8 days after EUS-FNA and required red blood cell transfusions. No thromboembolic events occurred (0% 95% CI, 0.0% to 4.4%). Three patients (3.5% 95% CI, 1.2% to 10.0%) experienced peri-puncture abscess formation. Conclusions: The rate of bleeding after EUS-FNA in patients prescribed antithrombotic agents might be considerable.
  • Hirata K, Kuwatani M, Mitsuhashi T, Sugiura R, Kato S, Kawakubo K, Yamada T, Asano T, Hirano S, Sakamoto N
    Endoscopic ultrasound 8 (2) 129 - 130 2303-9027 2018/05 [Refereed][Not invited]
  • Masaki Kuwatani, Yoshimasa Kubota, Shuhei Kawahata, Kimitoshi Kubo, Kazumichi Kawakubo, Hiroshi Kawakami, Naoya Sakamoto
    International Journal of Gastrointestinal Intervention 7 (1) 34 - 35 2018/04/30 [Refereed][Not invited]
  • 遠位胆管金属ステント閉塞への対処 double stentingとpigtail stentによる工夫
    平田 幸司, 桑谷 将城, 杉浦 諒, 加藤 新, 川久保 和道, 坂本 直哉
    Gastroenterological Endoscopy (一社)日本消化器内視鏡学会 60 (Suppl.1) 742 - 742 0387-1207 2018/04
  • 胆管ステントの現況と将来 悪性胆道狭窄に対するメタリックステント留置時の乳頭括約筋切開術付加は、ERCP後膵炎の発症を抑制するか
    加藤 新, 桑谷 将城, 坂本 直哉
    Gastroenterological Endoscopy (一社)日本消化器内視鏡学会 60 (Suppl.1) 612 - 612 0387-1207 2018/04
  • Tsuyoshi Hamada, Yousuke Nakai, James Y. Lau, Jong Ho Moon, Tsuyoshi Hayashi, Ichiro Yasuda, Bing Hu, Dong-Wan Seo, Hiroshi Kawakami, Masaki Kuwatani, Akio Katanuma, Masayuki Kitano, Shomei Ryozawa, Keiji Hanada, Takuji Iwashita, Yukiko Ito, Hiroshi Yagioka, Osamu Togawa, Iruru Maetani, Hiroyuki Isayama
    Scandinavian Journal of Gastroenterology 53 (1) 46 - 55 1502-7708 2018/01/02 [Refereed][Not invited]
     
    Objective: Endoscopic transpapillary or endoscopic ultrasound (EUS)-guided stent placement is used for nonresectable distal malignant biliary obstruction. We conducted a retrospective study to evaluate endoscopic biliary drainage in patients with duodenal obstruction. Methods: We included consecutive patients who underwent endoscopic biliary drainage combined with a duodenal stent at 16 referral centers in four Asian countries. The primary outcome was time to recurrent biliary obstruction (TRBO). We assessed TRBO according to the sequence of biliary and duodenal obstruction (group 1/2/3, biliary obstruction first/concurrent/duodenal obstruction first, respectively) or the location of duodenal obstruction (type I/II/III, proximal to/affecting/distal to the ampulla, respectively). We also evaluated functional success and adverse events. Results: We included 110 patients (group1/2/3, 67/29/14 patients type I/II/III, 45/46/19 patients endoscopic retrograde cholangiopancreatography [ERCP]/EUS-guided choledocoduodenostomy/EUS-guided hepaticogastrostomy, 90/10/10 patients, respectively). The median TRBO of all cases was 450 days (interquartile range, 212–666 days) and functional success was achieved in 105 cases (95%). The TRBO did not differ significantly by the timing or location of duodenal obstruction (p =.30 and.79, respectively). The TRBO of metal stents (n = 96) tended to be longer compared with plastic stents (n = 14, p =.083). Compared with ERCP, EUS-guided biliary drainage was associated with a higher rate of adverse events. Conclusion: Transpapillary or transmural endoscopic biliary drainage with a duodenal stent was effective, irrespective of the timing or location of duodenal obstruction. A prospective study is required considering the tradeoff of technical success rate, stent patency, and adverse events (ClinicalTrials.gov number, NCT02376907).
  • Sugiura R, Ohnishi S, Ohara M, Ishikawa M, Miyamoto S, Onishi R, Yamamoto K, Kawakubo K, Kuwatani M, Sakamoto N
    American journal of translational research 10 (7) 2102 - 2114 1943-8141 2018 [Refereed][Not invited]
     
    Mesenchymal stem cells (MSCs) represent a valuable cell source in regenerative medicine, and large numbers of MSCs can be isolated from the amnion noninvasively. Sclerosing cholangitis is a chronic cholestatic disease and characterized by progressive biliary destruction leading to cirrhosis. Many factors are involved in the development of sclerosing cholangitis; however, effective medical therapy is not established. We investigated the effects of human amnion-derived MSCs (hAMSCs) and conditioned medium (CM) obtained from hAMSC cultures in rats with sclerosing cholangitis. Sclerosing cholangitis was induced via the intragastric administration of 100 mg/kg alpha-naphthylisothiocyanate (ANIT) twice weekly for 4 weeks. One million hAMSCs or 200 mu L of CM were intravenously administered on days 15 and 22. Rats were sacrificed on day 29 and evaluated via histological, immunohistochemical, and mRNA expression analyses. hAMSC transplantation and CM administration significantly improved the histological score. In addition, these two interventions significantly improved biliary hyperplasia, peribiliary fibrosis, and inflammation in Glisson's sheath. Accordingly, CK19, MMP-9, and TNF-alpha, and MCP-1 expression in the liver was also decreased by hAMSC and CM administration. In conclusion, hAMSC and CM administration ameliorated biliary hyperplasia, peribiliary fibrosis, and inflammation in a rat model of sclerosing cholangitis. hAMSCs and CM may represent new modalities for treating sclerosing cholangitis.
  • Hontani K, Tsuchikawa T, Hiwasa T, Nakamura T, Ueno T, Kushibiki T, Takahashi M, Inoko K, Takano H, Takeuchi S, Dosaka-Akita H, Kuwatani M, Sakamoto N, Hatanaka Y, Mitsuhashi T, Shimada H, Shichinohe T, Hirano S
    Oncotarget 8 (63) 106206 - 106221 2017/12 [Refereed][Not invited]
     
    Pancreatic neuroendocrine tumors (pNETs) are relatively rare heterogenous tumors, comprising only 1-2% of all pancreatic neoplasms. The majority of pNETs are non-functional tumors (NF-pNETs) that do not produce hormones, and as such, do not cause any hormone-related symptoms. As a result, these tumors are often diagnosed at an advanced stage because patients do not present with specific symptoms. Although tumor markers are used to help diagnosis and predict some types of cancers, chromogranin A, a widely used tumor marker of pNETs, has significant limitations. To identify novel NF-pNET-associated antigens, we performed serological identification of antigens by recombinant cDNA expression cloning (SEREX) and identified five tumor antigens (phosphatase and tensin homolog, EP300-interacting inhibitor of differentiation 3 [EID3], EH domain-containing protein 1, galactoside-binding soluble 9, and BRCA1-associated protein). Further analysis using the AlphaLISA® immunoassay to compare serum antibody levels revealed that antibody levels against the EID3 antigen was significantly higher in the patient group than in the healthy donor group (n = 25, both groups). In addition, higher serum anti-EID3 antibody levels in NF-pNET patients correlated with shorter disease-free survival. The AUC calculated by ROC analysis was 0.784 with moderate diagnostic accuracy. In conclusion, serum anti-EID3 antibody levels may be useful as a tumor marker for prediction of tumor recurrence in NF-pNETs.
  • 腰塚 靖之, 川村 典生, 渡辺 正明, 後藤 了一, 太田 稔, 川久保 和道, 桑谷 将城, 山下 健一郎, 武冨 紹信, 蒲池 浩文, 神山 俊哉, 嶋村 剛
    移植 (一社)日本移植学会 52 (4-5) 454 - 455 0578-7947 2017/11
  • 杉浦 諒, 桑谷 将城, 佐野 逸紀, 加藤 新, 川久保 和道, 坂本 直哉
    胆道 (一社)日本胆道学会 31 (3) 566 - 566 0914-0077 2017/08
  • Yasunobu Arima, Takuto Ohki, Naoki Nishikawa, Kotaro Higuchi, Mitsutoshi Ota, Yuki Tanaka, Junko Nio-Kobayashi, Mohamed Elfeky, Ryota Sakai, Yuki Mori, Tadafumi Kawamoto, Andrea Stofkova, Yukihiro Sakashita, Yuji Morimoto, Masaki Kuwatani, Toshihihiko Iwanaga, Yoshichika Yoshioka, Naoya Sakamoto, Akihiko Yoshimura, Mitsuyoshi Takiguchi, Saburo Sakoda, Marco Prinz, Daisuke Kamimura, Masaaki Murakami
    ELIFE 6 2050-084X 2017/08 [Refereed][Not invited]
     
    Impact of stress on diseases including gastrointestinal failure is well-known, but molecular mechanism is not understood. Here we show underlying molecular mechanism using EAE mice. Under stress conditions, EAE caused severe gastrointestinal failure with high-mortality. Mechanistically, autoreactive-pathogenic CD4+ T cells accumulated at specific vessels of boundary area of third-ventricle, thalamus, and dentate-gyrus to establish brain micro-inflammation via stress gateway reflex. Importantly, induction of brain micro-inflammation at specific vessels by cytokine injection was sufficient to establish fatal gastrointestinal failure. Resulting micro-inflammation activated new neural pathway including neurons in paraventricular-nucleus, dorsomedial-nucleus-ofhypothalamus, and also vagal neurons to cause fatal gastrointestinal failure. Suppression of the brain micro-inflammation or blockage of these neural pathways inhibited the gastrointestinal failure. These results demonstrate direct link between brain micro-inflammation and fatal gastrointestinal disease via establishment of a new neural pathway under stress. They further suggest that brain micro-inflammation around specific vessels could be switch to activate new neural pathway(s) to regulate organ homeostasis.
  • Kawakubo K, Kuwatani M, Kato S, Sugiura R, Sano I, Sakamoto N
    Endoscopic ultrasound 2303-9027 2017/08 [Refereed][Not invited]
  • Shin Kato, Masaki Kuwatani, Ryo Sugiura, Itsuki Sano, Kazumichi Kawakubo, Kota Ono, Naoya Sakamotol
    BMJ OPEN 7 (8) e017160  2044-6055 2017/08 [Refereed][Not invited]
     
    Introduction The effect of endoscopic sphincterotomy prior to endoscopic biliary stenting to prevent post-endoscopic retrograde cholangiopancreatography pancreatitis remains to be fully elucidated. The aim of this study is to prospectively evaluate the non-inferiority of non-endoscopic sphincterotomy prior to stenting for naive major duodenal papilla compared with endoscopic sphincterotomy prior to stenting in patients with biliary stricture. Methods and analysis We designed a multicentre randomised controlled trial, for which we will recruit 370 patients with biliary stricture requiring endoscopic biliary stenting from 26 high-volume institutions in Japan. Patients will be randomly allocated to the endoscopic sphincterotomy group or the non-endoscopic sphincterotomy group. The main outcome measure is the incidence of pancreatitis within 2 days of initial transpapillary biliary drainage. Data will be analysed on completion of the study. We will calculate the 95% confidence intervals (CIs) of the incidence of pancreatitis in each group and analyse weather the difference in both groups with 95% CIs is within the non-inferiority margin (6%) using the Wald method. Ethics and dissemination This study has been approved by the institutional review board of Hokkaido University Hospital (IRB:016-0181). Results will be submitted for presentation at an international medical conference and published in a peer-reviewed journal.
  • Kawakubo K, Ohnishi S, Kuwatani M, Sakamoto N
    Journal of gastroenterology 53 (1) 1 - 5 0944-1174 2017/06 [Refereed][Not invited]
  • Muranaka T, Kuwatani M, Komatsu Y, Sawada K, Nakatsumi H, Kawamoto Y, Yuki S, Kubota Y, Kubo K, Kawahata S, Kawakubo K, Kawakami H, Sakamoto N
    Journal of gastrointestinal oncology 8 (3) 566 - 571 2078-6891 2017/06 [Refereed][Not invited]
     
    BACKGROUND: Irinotecan, oxaliplatin and leucovorin-modulated fluorouracil (FOLFIRINOX) and the combination regimen of gemcitabine and nanoparticle albumin-bound paclitaxel (GnP) (nab-PTX) improve the prognosis of patients with metastatic pancreatic cancer. However, no study has compared the efficacy of the two regimens. We compared retrospectively the efficacy and safety of the two regimens in patients with unresectable pancreatic cancer. METHODS: Thirty-eight patients with unresectable locally advanced or metastatic pancreatic cancer received FOLFIRINOX or GnP as first-line chemotherapy between December 2013 and September 2015. In the FOLFIRINOX group, patients received 85 mg/m2 oxaliplatin followed by 180 mg/m2 irinotecan and 200 mg/m2 L-leucovorin, and by 400 mg/m2 fluorouracil as a bolus and 2,400 mg/m2 fluorouracil as a 46-h continuous infusion every 14 days. In the GnP group, patients received 125 mg/m2 nab-PTX followed by 1 g/m2, and gemcitabine on days 1, 8 and 15, repeated every 28 days. RESULTS: Response rate was 6.3% in the FOLFIRINOX group and 40.9% in the GnP group (P=0.025). Median progression-free survival (PFS) was 3.7 months [95% confidence interval (CI), 3.0-4.5] in the FOLFIRINOX group and 6.5 months (95% CI, 6.2-6.9 months) in the GnP group (P=0.031). Drug toxicity in the GnP group was less than in the FOLFIRINOX group. CONCLUSIONS: Efficacy and safety of GnP compare favorably to those of FOLFIRINOX in patients with pancreatic cancer. Additional prospective trials are warranted.
  • Tsuyoshi Hamada, Yousuke Nakai, James Y. Lau, Jong Ho Moon, Bing Hu, Dong Wan Seo, Rungsun Rerknimitr, Christopher Khor, Hsiu-Po Wang, Thawee Ratanachu-ek, Sundeep Lakhtakia, Tiing Leong Ang, Ryan Ponnudurai, Iruru Maetani, Tsuyoshi Hayashi, Ichiro Yasuda, Takuji Iwashita, Hiroshi Kawakami, Masaki Kuwatani, Akio Katanuma, Masayuki Kitano, Shomei Ryozawa, Keiji Hanada, Yukiko Ito, Hiroshi Yagioka, Osamu Togawa, Atsushi Irisawa, Takao Itoi, Hiroyuki Isayama, Kazuhiko Koike
    GASTROINTESTINAL ENDOSCOPY 85 (5) AB621 - AB621 0016-5107 2017/05 [Refereed][Not invited]
  • 高度悪性胆道狭窄に対する経乳頭的通電拡張術の有効性と諸問題
    加藤 新, 桑谷 将城, 杉浦 諒, 佐野 逸紀, 川久保 和道, 坂本 直哉
    Gastroenterological Endoscopy (一社)日本消化器内視鏡学会 59 (Suppl.1) 993 - 993 0387-1207 2017/04
  • Kazumichi Kawakubo, Masaki Kuwatani, Naoya Sakamoto
    GASTROINTESTINAL ENDOSCOPY 85 (3) 690 - 690 0016-5107 2017/03 [Refereed][Not invited]
  • Ryo Sugiura, Hiroshi Kawakami, Nobuyuki Ehira, Ichiro Iwanaga, Minoru Uebayashi, Masaki Kuwatani, Naoya Sakamoto
    ENDOSCOPY 49 (S 01) E42 - E45 0013-726X 2017/02 [Refereed][Not invited]
  • Kawakami H, Kawakubo K, Kubota Y, Kuwatani M, Sakamoto N
    Endoscopy 48 (7) 687  0013-726X 2016/07 [Refereed][Not invited]
  • Kawakami H, Kawakubo K, Kubota Y, Kuwatani M, Sakamoto N
    Endoscopy 48 (7) 689  0013-726X 2016/07 [Refereed][Not invited]
  • Kawakubo K, Ohnishi S, Hatanaka Y, Hatanaka KC, Hosono H, Kubota Y, Kamiya M, Kuwatani M, Kawakami H, Urano Y, Sakamoto N
    Molecular imaging and biology : MIB : the official publication of the Academy of Molecular Imaging Springer 18 (3) 463 - 471 1536-1632 2016/06 [Refereed][Not invited]
     
    Purpose: Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is the most reliable method for the histological diagnosis of pancreatic tumors. Rapid on-site fluorescence-guided histological diagnosis was evaluated by topically applying an enzymatically activatable probe onto the EUS-FNA samples; the probe fluoresces in the presence of γ-glutamyltranspeptidase (GGT). Procedures: We evaluated GGT expression in pancreatic cancer cell lines in vitro. EUS-FNA was performed in 10 pancreatic tumors. After topical application of the probe, signal intensity was measured using a fluorescence imaging system for 13 min. Results: GGT was expressed in Panc-1, AsPC-1, and AR42J, but not in KP4 cells. In samples from six cases, several regions of the specimens fluoresced and contained adequate tissue for pathological diagnosis. The remaining four non-fluorescent samples contained very small amounts of carcinoma, normal epithelial cells, or no epithelial cells. The signal intensity at 5 min was 25.5 ± 7.7 and 7.7 ± 0.5 in fluorescent and non-fluorescent regions, respectively (p < 0.05). Conclusions: Application of enzymatically activatable probe onto EUS-FNA samples would be feasible for the rapid evaluation of tissues suitable for histological diagnosis.
  • Kawakubo K, Ohnishi S, Fujita H, Kuwatani M, Onishi R, Masamune A, Takeda H, Sakamoto N
    Pancreas 45 (5) 707 - 713 0885-3177 2016/05 [Refereed][Not invited]
     
    Objectives: Mesenchymal stem cells (MSCs) are a valuable cell source in regenerative medicine and can be isolated from fetal membranes (FMs), particularly amniotic membranes. We investigated the effect of rat FM-derived MSCs (rFM-MSCs) and human amnion-derived MSCs (hAMSCs) on the inflammatory reaction in vitro and therapeutic effects in rats with acute and chronic pancreatitis.Methods: Effect of rFM-MSCs or hAMSC-conditioned medium was investigated in vitro. Acute pancreatitis was induced by intraductal injection of 4% taurocholate, and rFM-MSCs were transplanted intravenously. Chronic pancreatitis was induced by intravenous injection of 5 mg/kg dibutyltin dichloride, and hAMSCs were transplanted intravenously.Results: The inflammatory reaction of macrophages induced by lipopolysaccharide and trypsin was significantly suppressed by rFM-MSC coculture. Pancreatic acinar cell injury induced by cerulein was significantly ameliorated by hAMSC-conditioned medium. Pancreatic stellate cell activation induced by tumor necrosis factor-a was significantly decreased by hAMSC-conditioned medium. Transplantation of rFM-MSCs significantly reduced the histological score and infiltration of CD68-positive macrophages in the rat pancreas. The hAMSC transplantation significantly decreased the expression of MCP-1 and attenuated the downregulation of amylase expression in the pancreas.Conclusions: Transplantation of FM-MSCs and AMSCs suppressed the inflammatory reaction of acute and chronic pancreatitis in rats.
  • Kawakubo K, Kawakami H, Kuwatani M, Haba S, Kudo T, Taya YA, Kawahata S, Kubota Y, Kubo K, Eto K, Ehira N, Yamato H, Onodera M, Sakamoto N
    World journal of gastrointestinal endoscopy 8 (9) 385 - 390 2016/05 [Refereed][Not invited]
  • Masaki Kuwatani, Yasuyuki Kawamoto, Toru Nakamura
    CLINICAL GASTROENTEROLOGY AND HEPATOLOGY 14 (5) XXIX - XXX 1542-3565 2016/05 [Refereed][Not invited]
  • Kawakami H, Kubota Y, Kawahata S, Kubo K, Kawakubo K, Kuwatani M, Sakamoto N
    Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society 28 Suppl 1 77 - 95 0915-5635 2016/04 [Refereed][Not invited]
  • Kawakami H, Kuwatani M, Sakamoto N
    Gut and liver 10 (2) 318 - 319 1976-2283 2016/03 [Refereed][Not invited]
  • Kawakubo K, Kawakami H, Kuwatani M, Kubota Y, Kawahata S, Kubo K, Sakamoto N
    Endoscopy 48 (2) 164 - 169 0013-726X 2016/02 [Refereed][Not invited]
  • Yoko Abe, Hiroshi Kawakami, Koji Oba, Tsuyoshi Hayashi, Ichiro Yasuda, Tsuyoshi Mukai, Hiroyuki Isayama, Hirotoshi Ishiwatari, Shinpei Doi, Masanori Nakashima, Natsuyo Yamamoto, Masaki Kuwatani, Tomoko Mitsuhashi, Tadashi Hasegawa, Yoshinobu Hirose, Tetsuya Yamada, Mariko Tanaka, Naoya Sakamoto
    Gastrointestinal endoscopy 82 (5) 837 - 844 0016-5107 2015/11 [Refereed][Not invited]
     
    BACKGROUND: EUS-guided FNA (EUS-FNA) has become the most efficacious way to obtain specimens from a solid lesion adjacent to the GI tract. Previous reports regarding the use of a stylet during EUS-FNA were all based on cytological diagnosis and have showed no significant superiority in terms of diagnostic yield. OBJECTIVE: To clarify the noninferiority of EUS-FNA without a stylet (S-) compared with EUS-FNA with a stylet (S+) on histological assessment. DESIGN: A prospective, single-blind, randomized, controlled crossover study. SETTING: Five tertiary referral centers in Japan. PATIENTS: Patients referred for EUS-FNA of a solid lesion. INTERVENTION: EUS-FNA S+ and S- in a total of 4 alternate passes with randomization to S+ first or S- first. MAIN OUTCOME MEASUREMENTS: The primary endpoint was the acquisition rate of an appropriate and sufficient specimen for histological assessment. The secondary endpoints were cellularity, contamination, bloodiness, diagnostic ability, and diagnostic accuracy. RESULTS: We enrolled 107 patients (110 lesions) and analyzed 220 specimens each in the S+ and S- groups. The acquisition rate of appropriate and sufficient specimens in the S+ group was 121 of 220 (55.0%) and 122 of 220 (55.5%) in the S- group. The difference in the acquisition rate of the specimen (S- minus S+) based on the generalized estimating equation was 0.42% (95% confidence interval, -6.72% to 7.56%), which was less than 10% of the prespecified noninferiority margin of this study. With regard to cellularity, contamination, bloodiness score, diagnostic ability, and diagnostic accuracy, there were no significant differences between both groups. There were no dropouts in the study. LIMITATIONS: A variety of target lesions, multiple pathologists, lack of an assessment of intraobserver and interobserver variability, and a single-blind study for the pathologists. CONCLUSION: EUS-FNA S- is noninferior to EUS-FNA S+ on histological assessment. ( CLINICAL TRIAL REGISTRATION NUMBER: UMIN000008695.).
  • 閉塞性黄疸患者における胆道ドレナージ術前後の肝硬度の変化
    久保 公利, 河上 洋, 桑谷 将城, 川久保 和道, 阿部 容子, 川畑 修平, 坂本 直哉, 作原 佑介, 白土 博樹, 工藤 悠輔, 西田 睦
    日本消化器病学会雑誌 (一財)日本消化器病学会 112 (臨増大会) A855 - A855 0446-6586 2015/09
  • Kawakubo Kazumichi, Kawakami Hiroshi, Kuwatani Masaki, Haba Shin, Kawahata Shuhei, Abe Yoko, Kubota Yoshimasa, Kubo Kimitoshi, Isayama Hiroyuki, Sakamoto Naoya
    WORLD JOURNAL OF GASTROENTEROLOGY 21 (32) 9494 - 9502 1007-9327 2015/08/28 [Refereed][Not invited]
     
    Interventional endoscopic ultrasonography (EUS) based on EUS-guided fine-needle aspiration has rapidly spread as a minimally invasive procedure. Especially in patients with failed endoscopic retrograde cholangiopancreatography, EUS-guided biliary intervention is reported to be useful as salvage therapy. EUS-guided biliary interventions are carried out using three techniques: EUS-guided bilioenteric anastomosis, EUS-guided rendezvous procedure, and EUS-guided antegrade treatment. Although interventional EUS is not yet a standardized procedure, there have been recent advances in this field that address various biliary diseases. Here, we summarize the indications, techniques, clinical results of previous studies, and future perspectives.
  • Hiroshi Kawakami, Masaki Kuwatani, Shuhei Kawahata
    JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 22 (7) 571 - 572 1868-6974 2015/07 [Refereed][Not invited]
  • Kawakubo Kazumichi, Ohnishi Shunsuke, Urano Yasuteru, Hatanaka Yutaka, Hatanaka Kanako C, Kawakami Hiroshi, Kuwatani Masaki, Kawahata Shuhei, Abe Yoko, Kubota Yoshimasa, Kubo Kimitoshi, Sakamoto Naoya
    GASTROINTESTINAL ENDOSCOPY 81 (5) AB536 - AB537 0016-5107 2015/05 [Refereed][Not invited]
  • Kawakubo K, Hata H, Kawakami H, Kuwatani M, Kawahata S, Kubo K, Imafuku K, Kitamura S, Sakamoto N
    Case reports in oncology Karger 8 (2) 356 - 358 1662-6575 2015/05 [Refereed][Not invited]
     
    Pazopanib is an oral angiogenesis inhibitor targeting vascular endothelial growth factor receptors, platelet-derived growth factor receptors, and c-Kit approved for the treatment of renal cell carcinoma and soft tissue sarcoma. Nonselective kinase inhibitors, such as sunitinib and sorafenib, are known to be associated with acute pancreatitis. There are few case reports of severe acute pancreatitis induced by pazopanib treatment. We present a case of severe acute pancreatitis caused by pazopanib treatment for cutaneous angiosarcoma. The patient was an 82-year-old female diagnosed with cutaneous angiosarcoma. She had been refractory to docetaxel treatment and began pazopanib therapy. Three months after pazopanib treatment, CT imaging of the abdomen showed the swelling of the pancreas and surrounding soft tissue inflammation without abdominal pain. After she continued pazopanib treatment for 2 months, she presented with nausea and appetite loss. Abdominal CT showed the worsening of the surrounding soft tissue inflammation of the pancreas. Serum amylase and lipase levels were 296 and 177 IU/l, respectively. She was diagnosed with acute pancreatitis induced by pazopanib treatment and was managed conservatively with discontinuation of pazopanib, but the symptoms did not improve. Subsequently, an abdominal CT scan demonstrated the appearance of a pancreatic pseudocyst. She underwent endoscopic ultrasound-guided pseudocyst drainage using a flared-end fully covered self-expandable metallic stent. Then, the symptoms resolved without recurrence. Due to the remarkable progress of molecular targeted therapy, the oncologist should know that acute pancreatitis was recognized as a potential adverse event of pazopanib treatment and could proceed to severe acute pancreatitis.
  • Kawakami H, Itoi T, Kuwatani M, Kawakubo K, Kubota Y, Sakamoto N
    Journal of hepato-biliary-pancreatic sciences 22 (4) E12 - 21 1868-6974 2015/04 [Refereed][Not invited]
     
    Unresectable malignant hilar biliary obstruction (MHBO) occurs in various diseases, such as cholangiocarcinoma, gallbladder carcinoma, hepatocellular carcinoma, pancreatic cancer, and lymph node metastasis of the hilum of the liver. The majority of patients with advanced MHBO are not candidates for surgical resection because of the tumor location in the hepatic hilum and adjacent areas, advanced tumor stage, or comorbidities. Therefore, these patients often have a poor prognosis in terms of survival and quality of life. Most of these patients will require non-surgical, palliative biliary drainage. To date, various biliary drainage techniques for unresectable MHBO (UMHBO) have been reported. Of these techniques, endoscopic biliary drainage is currently considered to be the most safe and minimally invasive procedure. However, endoscopic biliary drainage for UMHBO is still not standardized regarding the optimal stent, drainage area, stenting method, and reintervention technique. Recently, towards standardization of this technique for UMHBO, clinical research and trials including randomized controlled trials have been performed. In this article, we reviewed the most important issues regarding endoscopic biliary drainage for UMHBO, focusing on prospective studies. We also described in detail the techniques and future perspectives of endoscopic biliary drainage in patients with UMHBO.
  • Kawakubo K, Kawakami H, Kuwatani M, Sakamoto N
    Radiology 274 (3) 939  0033-8419 2015/03 [Refereed][Not invited]
  • Kawakami H, Kuwatani M, Sakamoto N
    Nihon rinsho. Japanese journal of clinical medicine 73 Suppl 3 595 - 600 0047-1852 2015/03 [Refereed][Not invited]
  • Masaki Kuwatani, Hiroshi Kawakami, Yoka Abe, Shuhei Kawahata, Kazumichi Kawakubo, Kimitoshi Kubo, Naoya Sakamoto
    GUT AND LIVER 9 (2) 251 - 252 1976-2283 2015/03 [Refereed][Not invited]
     
    A 72-year-old man with jaundice by ampullary adenocarcinonria was treated at our hospital. For biliary decompression, a transpapillary, fully covered, self-expandable metal stent (FCSEMS) was deployed. Four days later, the patient developed acute. cholangitis. Endoscopic carbon dioxide cholangiography revealed kinking of the common bile duct above the proximal end of the FCSEMS. A 7-F double-pigtail plastic stent was therefore placed through the FCSEMS to correct the kink, straightening the common bile duct (CBD) and improving cholangitis. This is the first report of a unique use of a double-pigtail plastic stent to correct CBD kinking. The placement of a double-pigtail plastic stent can correct CBD kinking, without requiring replacement or addition of a FCSEMS, and can lead to cost savings.
  • Kawakubo K, Kawakami H, Kuwatani M, Kudo T, Abe Y, Kawahata S, Kubo K, Kubota Y, Sakamoto N
    Journal of hepato-biliary-pancreatic sciences [The Japanese Society of Hepato-Biliary-Pancreatic Surgery, The Asian-Pacific Hepato-Pancreato-Biliary Association, The Japan Biliary Association] [編] 22 (2) 151 - 155 1868-6974 2015/02 [Refereed][Not invited]
  • Kubota Y, Kawakami H, Natsuizaka M, Kawakubo K, Marukawa K, Kudo T, Abe Y, Kubo K, Kuwatani M, Hatanaka Y, Mitsuhashi T, Matsuno Y, Sakamoto N
    Journal of gastroenterology Springer 50 (2) 203 - 210 0944-1174 2015/02 [Refereed][Not invited]
     
    Solid-pseudopapillary neoplasm (SPN), a rare neoplasm of the pancreas, frequently harbors mutations in exon 3 of the cadherin-associated protein beta 1 (CTNNB1) gene. Here, we analyzed SPN tissue for CTNNB1 mutations by deep sequencing using next-generation sequencing (NGS). Tissue samples from 7 SPNs and 31 other pancreatic lesions (16 pancreatic ductal adenocarcinomas (PDAC), 11 pancreatic neuroendocrine tumors (PNET), 1 acinar cell carcinoma, 1 autoimmune pancreatitis lesion, and 2 focal pancreatitis lesions) were analyzed by NGS for mutations in exon 3 of CTNNB1. A single-base-pair missense mutations in exon 3 of CTNNB1 was observed in all 7 SPNs and in 1 of 11 PNET samples. However, mutations were not observed in the tissue samples of any of the 16 PDAC or other four pancreatic disease cases. The variant frequency of CTNNB1 ranged from 5.4 to 48.8 %. Mutational analysis of CTNNB1 by NGS is feasible and was achieved using SPN samples obtained by endoscopic ultrasound-guided fine needle aspiration.
  • 閉塞性黄疸患者における胆道ドレナージ後の肝硬度の変化
    久保 公利, 河上 洋, 桑谷 将城, 川久保 和道, 阿部 容子, 川畑 修平, 坂本 直哉, 作原 佑介, 白土 博樹, 西田 睦
    超音波医学 (公社)日本超音波医学会 42 (1) 89 - 89 1346-1176 2015/01
  • KUBO Kimitoshi, KAWAKAMI Hiroshi, KUWATANI Masaki, MITSUHASHI Tomoko, KAWAKUBO Kazumichi, KAWAHATA Shuhei, KUBOTA Yoshimasa, SAKAMOTO Naoya
    Suizo Japan Pancreas Society 30 (5) 679 - 688 0913-0071 2015 [Not refereed]
     
    A 69-year-old female with fever, a pancreatic mass and portal vein thrombosis was referred to our hospital. Blood culture test was positive for Escherichia coli. Abdominal contrast-enhanced CT revealed a heterogeneously enhanced oval mass in the head of the pancreas with a size of 16×14mm, and a non-enhanced nodule in the portal vein, which was adjacent to a cystic lesion in the body of the pancreas. Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) of the mass in the head of the pancreas indicated adenocarcinoma. On the diagnosis of pancreatic cancer with infectious pseudocyst and portal vein thrombosis, she underwent subtotal stomach-preserving pancreaticoduodenectomy and partial round resection of the portal vein. Histopathological findings of the resected specimen revealed pancreatic head cancer followed by pancreatitis which caused the pancreatic pseudocyst. Infection of the pancreatic pseudocyst would lead to the communication between the cyst and the portal vein. This is the first case with pancreatic cancer with infectious pancreatic pseudocyst communicating to the portal vein.
  • Kawakami Hiroshi, Kuwatani Masaki, Kawakubo Kazumichi, Kawahata Shuhei, Kubota Yoshimasa, Sakamoto Naoya
    J.J.B.A Japan Biliary Association 29 (4) 752 - 761 0914-0077 2015 
    Nearly 50 years have passed since the first report of endoscopic retrograde cholangiography. Ever since, endoscopic retrograde cholangiopancreatography (ERCP) have been a basic procedure for practice in pancreatico-biliary diseases. Of the various procedures of ERCP, selective biliary cannulation is the most basic and important technique. Various cannulation techniques have been reported with the development of endoscopes and devices. However, there still does not exist the perfect technique that enables selective biliary cannulation for whichever cases. Although contrast medium injection cannulation technique is important, wire-guided cannulation technique has been extended and is now widely performed since early 2000s in the US and Europe. We should use various techniques to achieve safe, accurate and effective bile duct cannulation with a shorter procedure time and reduced complications. Nowadays, recent development of bile duct cannulation, especially transpapillary approach, is discussed in this report.
  • Kawakami H, Kuwatani M, Abe Y, Kubota Y, Kawakubo K, Kubo K, Kawahata S, Sakamoto N
    Endoscopy 47 Suppl 1 E43 - 4 0013-726X 2015 [Refereed][Not invited]
  • Kawakubo K, Kawakami H, Toyokawa Y, Otani K, Kuwatani M, Abe Y, Kawahata S, Kubo K, Kubota Y, Sakamoto N
    Journal of hepato-biliary-pancreatic sciences 22 (1) 79 - 85 1868-6974 2015/01 [Refereed][Not invited]
  • Kawakami H, Kuwatani M, Abe Y, Kubota Y, Kawakubo K, Kubo K, Kawahata S, Sakamoto N
    Endoscopy 47 Suppl 1 UCTN E43 - 4 0013-726X 2015 [Refereed][Not invited]
  • Kawakami H, Kuwatani M, Kubo K, Kubota Y, Kawakubo K, Abe Y, Kawahata S, Homma N, Hida Y, Sakamoto N
    Endoscopy 47 Suppl 1 UCTN E69 - 70 0013-726X 2015 [Refereed][Not invited]
  • Kawakami H, Kuwatani M, Abe Y, Kawahata S, Kawakubo K, Kubo K, Sakamoto N
    Endoscopy 47 Suppl 1 UCTN E217 - 8 0013-726X 2015 [Refereed][Not invited]
  • Kawakami H, Kuwatani M, Kawahata S, Kubota Y, Kubo K, Kawakubo K, Sakamoto N
    Endoscopy 47 Suppl 1 UCTN E265 - 6 0013-726X 2015 [Refereed][Not invited]
  • Kawakami H, Kuwatani M, Kubota Y, Kawahata S, Kubo K, Kawakubo K, Sakamoto N
    Endoscopy 47 Suppl 1 UCTN E340 - 1 0013-726X 2015 [Refereed][Not invited]
  • Kawakami H, Kuwatani M, Kawakubo K, Kubota Y, Kawahata S, Kubo K, Sakamoto N
    Endoscopy 47 Suppl 1 UCTN E346 - 7 0013-726X 2015 [Refereed][Not invited]
  • Masaki Kuwatani, Hiroshi Kawakami, Yoh Zen, Kazumichi Kawakubo, Taiki Kudo, Yoko Abe, Kimitoshi Kubo, Naoya Sakamoto
    HEPATO-GASTROENTEROLOGY 61 (135) 1852 - 1856 0172-6390 2014/10 [Refereed][Not invited]
     
    Background/Aims: IgG4-related sclerosing cholangitis (IgG4-SC) is a newly established entity The purpose of this study was to investigate the differences in intraductal ultrasonography (IDUS) findings between IgG4-SC and bile duct (BD) cancer (BDC) as well as the relationship among BD wall thickness, serological and pathological findings in IgG4-SC. Methodology: Based on the diagnostic criteria of IgG4-SC, we reviewed patients in our hospital between April 2005 and June 2013, and analyzed the data obtained from 32 patients with IgG4-SC and 40 patients with BDC. Results: Regarding IDUS findings, significantly more cases in BDC indicated rigid/papillary inner margin than in IgG4-SC, while biopsy was more efficient. There were no significant correlations between BD wall thickness and serum I IgG/IgG4 levels or the number of IgG4-positive cells of the BD specimens. All the IgG4-SC patients without steroid treatment revealed discordant results in the shifts of IgG, IgG4 and BD wall thickness between the 1st and 2nd examinations, while all patients with steroid had completely concordant results of the shifts. Conclusions: IDUS findings alone are insufficient for differ entiation between IgG4-SC and BDC. BD wall thickness, serum IgG and IgG4 proportionally shift and reflect the effect of steroid on IgG4-SC after steroid treatment, not before it.
  • Masaki Kuwatani, Hiroshi Kawakami, Tsuyoshi Hayashi, Kazunori Eto, Hiroaki Yamato, Manabu Onodera, Hirohito Naruse, Koji Oba
    Endoscopic ultrasound 3 (3) 167 - 73 2014/07 [Refereed][Not invited]
     
    BACKGROUND AND OBJECTIVE: Antispasmodic drugs (ADs) have been used to reduce examination time or improve the quality of gastrointestinal endoscopy, although the practice is controversial. No evidence about the efficacy of AD for endoscopic ultrasonography/EUS-guided fine-needle aspiration (EUS/EUS-FNA) is available. This study was aimed to evaluate the efficacy of AD in EUS/EUS-FNA. PATIENTS AND METHODS: A total of 400 patients with pancreaticobiliary, peripancreatic, or peribiliary disease or disorder undergoing EUS/EUS-FNA were prospectively and evenly randomized to undergo EUS/EUS-FNA with AD (w-AD) or without AD (w/o-AD). The primary endpoint was total EUS/EUS-FNA examination time. The secondary endpoints were visual analogue scale (VAS) scores of endoscopists (patient body motion, gastrointestinal peristalsis, and accomplishment of the purpose) and patients (pain, discomfort, and willingness to undergo re-examination), vital sign changes, adverse events, and sedative dose. RESULTS: Two hundred patients in the w-AD group and 197 patients in the w/o-AD group were ultimately analyzed. The total examination time was similar between the groups (2299 ± 937 vs. 2259 ± 1019 s). The difference in total examination time from w/o-AD group to w-AD group was -40 s (95% confidence interval, -234-153 s), which was within the noninferiority margin. No statistical differences were observed in endoscopist and patient VAS scores, changes in vital signs, adverse events, or total sedative dose other than fentanyl between the groups. CONCLUSION: EUS/EUS-FNA can be effectively and safely performed w/o-AD. Further, randomized controlled trials on EUS/EUS-FNA in various disease entities may be required to confirm the results of this study (UMIN000008047).
  • Kazumichi Kawakubo, Hiroshi Kawakami, Masaki Kuwatani, Shin Haba, Taiki Kudo, Yoko Abe, Shuhei Kawahata, Manabu Onodera, Nobuyuki Ehira, Hiroaki Yamato, Kazunori Eto, Naoya Sakamoto
    GUT AND LIVER 8 (3) 329 - 332 1976-2283 2014/05 [Refereed][Not invited]
     
    Endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) are essential for diagnosing and treating pancreatobiliary diseases. Single-session EUS and ERCP are considered to be essential in reducing the duration of hospital stays; however, complications are a primary concern. The aim of this study was to evaluate the safety and efficacy of single-session EUS and ERCP. Sixty-eight patients underwent single-session EUS and ERCP at a tertiary referral center between June 2008 and December 2012. We retrospectively reviewed patient data from a prospectively maintained EUS-ERCP database and evaluated the procedural characteristics and complications. Thirty-eight patients (56%) underwent diagnostic EUS, and 30 patients (44%) underwent EUS fine-needle aspiration, which had an overall accuracy of 100%. Sixty patients (89%) underwent therapeutic ERCP, whereas the remaining eight procedures were diagnostic. Thirteen patients underwent biliary stone extraction, and 48 underwent biliary drainage. The median total procedural time was 75 minutes. Complications were observed in seven patients (10%). Six complications were post-ERCP pancreatitis,,which were resolved using conservative management. One patient developed Mallory-Weiss syndrome, which required endoscopic hemostasis. No sedation-related cardiopulmonary complications were observed. Single-session EUS and ERCP provided accurate diagnosis and effective management with a minimal complication rate.
  • Kawakubo K, Isayama H, Kato H, Itoi T, Kawakami H, Hanada K, Ishiwatari H, Yasuda I, Kawamoto H, Itokawa F, Kuwatani M, Iiboshi T, Hayashi T, Doi S, Nakai Y
    Journal of hepato-biliary-pancreatic sciences 21 (5) 328 - 334 1868-6974 2014/05 [Refereed][Not invited]
     
    BACKGROUND: Endoscopic ultrasound-guided biliary drainage (EUS-BD) is considered to be an effective salvage procedure for failed endoscopic retrograde cholangiopancreatography in patients with unresectable malignant biliary obstruction. The aim of this retrospective study was to evaluate the efficacy and feasibility of EUS-BD. METHODS: From November 2006 to May 2012, a total of 64 patients who underwent EUS-BD (44 EUS-guided choledochoduodenostomy [EUS-CDS] and 20 EUS-guided hepaticogastrostomy [EUS-HGS]) at seven tertiary-care referral centers in Japan were included. The primary outcome was the technical success rate, and the secondary outcomes were the incidence of complications, stent dysfunction rate, time to stent dysfunction, and overall survival. RESULTS: The technical success rate for both EUS-CDS and EUS-HGS was 95%. The reasons for technical failure were two failed dilations of the anastomosis in EUS-CDS and one puncture failure in EUS-HGS. The stent dysfunction rate and 3-month dysfunction-free patency rate were 21% and 80% for EUS-CDS and 32% and 51% for EUS-HGS. There were 12 (six in EUS-CDS and six in EUS-HGS) procedure-related complications (19%): five cases of bile leakage (3/2), three stent misplacements (1/2), one pneumoperitoneum (1/0), two cases of bleeding (1/1), one perforation (1/0), and one biloma (0/1). Bile leakage was more frequently observed in patients who underwent plastic stent placement (11%) than in those with covered metal stents (4%). CONCLUSIONS: This Japanese multicenter study revealed a high success rate in EUS-BD. However, the complication rate was as high as that in previous series. Covered metal stents may be useful to reduce bile leakage in EUS-BD.
  • Kudo T, Kawakami H, Kuwatani M, Eto K, Kawahata S, Abe Y, Onodera M, Ehira N, Yamato H, Haba S, Kawakubo K, Sakamoto N
    World journal of gastroenterology 20 (13) 3620 - 3627 1007-9327 2014/04 [Refereed][Not invited]
  • Kawakubo K, Kawakami H, Kuwatani M, Sakamoto N
    The American journal of gastroenterology 109 (3) 446 - 447 0002-9270 2014/03 [Refereed][Not invited]
  • 桑谷 将城, 河上 洋, 川久保 和道, 工藤 大樹, 阿部 容子, 羽場 真, 田中 栄一, 平野 聡, 三橋 智子, 坂本 直哉
    胆道 日本胆道学会 28 (1) 73 - 80 0914-0077 2014/03 [Not refereed][Not invited]
     
    症例は71歳、男性。近医における腹部超音波検査で2年前より指摘されていた胆嚢底部の腫瘤性病変の増大がみられたため、精査目的に当科に紹介となった。各種画像診断により、腫瘤性病変は約20mm大であり、辺縁はほぼ平滑で、内部には脂肪成分が含まれていることが明らかとなった。良性病変も示唆されたが、表面に不整な顆粒状粘膜を伴い、増大傾向にある亜有茎性の腫瘤性病変であり、漿膜側に腫瘤内部への引きつれを伴うことから、胆嚢癌を第一に考え、胆嚢摘出術を施行した。腫瘍内部には脂肪組織と石灰化成分を含有し、腫瘍中心の不整な癌性腺管の周囲には著明な線維化と毛細血管の増生やフィブリンの析出がみられた。胆嚢底部には、炎症性変化に伴う漿膜下脂肪織の引きつれがみられ、その結果、腫瘍内部に脂肪組織を含有したものと考えられた。脂肪組織および石灰化成分を含有する胆嚢癌は非常にまれであり、術前の診断を困難にする要因であった。(著者抄録)
  • Kawakami H, Kuwatani M, Kawakubo K, Eto K, Haba S, Kudo T, Abe Y, Kawahata S, Sakamoto N
    Gastrointestinal endoscopy Mosby-elsevier 79 (2) 338 - 343 0016-5107 2014/02 [Refereed][Not invited]
  • Kawakami Hiroshi, Isayama Hiroyuki, Maguchi Hiroyuki, Kuwatani Masaki, Kawakubo Kazumichi, Kudo Taiki, Abe Yoko, Kawahata Shuhei, Kubo Kimitoshi, Koike Kazuhiko, Sakamoto Naoya
    ENDOSCOPY 46 (2) 163 - 163 0013-726X 2014/02 [Refereed][Not invited]
  • Hiroshi Kawakami, Masaki Kuwatani, Kazumichi Kawakubo, Taiki Kudo, Yoko Abe, Kimitoshi Kubo, Naoya Sakamoto
    ENDOSCOPY 46 E58 - E59 0013-726X 2014/01 [Refereed][Not invited]
  • Hiroshi Kawakami, Masaki Kuwatani, Kazumichi Kawakubo, Yoshimasa Kubota, Yoko Abe, Shuhei Kawahata, Kimitoshi Kubo, Naoya Sakamoto
    ENDOSCOPY 46 E517 - E518 0013-726X 2014 [Refereed][Not invited]
  • Kawakami H, Kuwatani M, Kawakubo K, Kudo T, Abe Y, Kubo K, Kubota Y, Sakamoto N
    Endoscopy 46 Suppl 1 UCTN E406 - 7 0013-726X 2014 [Refereed][Not invited]
  • Kawakami H, Okamoto M, Kuwatani M, Kubota Y, Kawakubo K, Abe Y, Kawahata S, Kubo K, Sakamoto N
    Endoscopy 46 Suppl 1 UCTN E566 - 7 0013-726X 2014 [Refereed][Not invited]
  • Kawakami H, Kawakubo K, Kuwatani M, Kubota Y, Abe Y, Kawahata S, Kubo K, Sakamoto N
    Endoscopy Georg Thieme Verlag 46 Suppl 1 UCTN (1) E982 - 3 0013-726X 2014 [Refereed][Not invited]
  • Kawakami H, Kuwatani M, Sakamoto N
    Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society 26 (1) 121 - 122 0915-5635 2014/01 [Refereed][Not invited]
  • Kawakami H, Kuwatani M, Kawakubo K, Kudo T, Abe Y, Kubo K, Kubota Y, Sakamoto N
    Endoscopy 46 Suppl 1 UCTN E328 - 9 0013-726X 2014 [Refereed][Not invited]
  • Kawakami H, Kuwatani M, Sakamoto N
    Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society 25 (4) 466  0915-5635 2013/07 [Refereed][Not invited]
  • Yamamoto Natsuyo, Isayama Hiroyuki, Kawakami Hiroshi, Sasahira Naoki, Hamada Tsuyoshi, Ito Yukiko, Takahara Naminatsu, Uchino Rie, Miyabayashi Koji, Mizuno Suguru, Kogure Hirofumi, Sasaki Takashi, Nakai Yousuke, Kuwatani Masaki, Hirano Kenji, Tada Minoru, Koike Kazuhiko
    GASTROINTESTINAL ENDOSCOPY 77 (5) 809 - 814 0016-5107 2013/05 [Refereed][Not invited]
     
    BACKGROUND: Endoscopic transluminal treatment of pancreatic fluid collections (PFC) has been reported as an effective alternative approach to surgical treatment. A wide, short stent with an anti-migration system has been developed. OBJECTIVE: To evaluate a newly developed, fully covered, self-expandable metal stent (FCSEMS) customized for cystogastrostomy. DESIGN: Retrospective case series. SETTING: Tertiary-care academic medical centers and affiliated hospitals. PATIENTS: Nine patients who underwent endoscopic treatment of PFCs (5 with pseudocysts and 4 with walled-off pancreatic necrosis). INTERVENTION: Stent deployment after endoscopic US-guided puncture. Irrigation and necrosectomy were performed at the discretion of the endoscopist. MAIN OUTCOME MEASUREMENTS: Technical and clinical success rate, complications, and removability. RESULTS: The FCSEMS was inserted successfully in all cases (9/9, 100%). Clinical success was achieved in 7 of 9 cases (77.8%). No early complications associated with the procedure were observed. Late complications were observed in 2 cases (bleeding and asymptomatic migration). The FCSEMS was removed without any complications in all 6 cases where it was attempted after the procedure had been completed (100%). LIMITATIONS: This was a retrospective evaluation of a small number of cases. The FCSEMS was always inserted via the transgastric route. Follow-up duration was short. CONCLUSION: The endoscopic approach that uses this new FCSEMS is feasible for the treatment of PFCs. However, further evaluation is required.
  • Kawakami H, Kuwatani M, Sakamoto N
    Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society Wiley-Blackwell 25 (3) 339 - 340 0915-5635 2013/05 [Refereed][Not invited]
  • Kawakami H, Kuwatani M, Sakamoto N
    Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society Wiley-Blackwell 25 (3) 343 - 344 0915-5635 2013/05 [Refereed][Not invited]
  • K Eto, H Kawakami, M Kuwatani, T Kudo, Y Abe, S Kawahata, A Takasawa, M Fukuoka, Y Matsuno, M Asaka, N Sakamoto
    British journal of cancer 108 (7) 1488 - 94 2013/04/16 
    BACKGROUND: Pancreatic ductal carcinoma (PDC) is one of the most lethal human carcinomas. Expression patterns of some genes may predict gemcitabine (GEM) treatment efficacy. We examined predictive indicators of survival in GEM-treated patients by quantifying the expression of several genes in pre-treatment endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) samples from patients with PDC. METHODS: The expressions of human equilibrative nucleoside transporter 1 (hENT1), deoxycitidine kinase, ribonucleoside reductase 1, ribonucleoside reductase 2 and Notch3 in EUS-FNA tissue samples from 71 patients with unresectable PDC were quantified using real-time reverse transcription-polymerase chain reactions and examined for correlations with GEM sensitivity. RESULTS: The log-rank test detected no significant differences in overall survival between GEM-treated patients with low and high mRNA levels of all genes examined. However, low Notch3 mRNA expression was significantly associated with longer overall survival in a multivariate analysis for survival (P=0.0094). High hENT1 expression level was significantly associated with a longer time to progression (P=0.039). Interaction tests for GEM administration and hENT1 or Notch3 mRNA expression were statistically significant (P=0.0054 and 0.0047, respectively). CONCLUSION: hENT1 and Notch3 mRNA expressions in EUS-FNA specimens were the key predictive biomarkers of GEM effect and GEM sensitivity in patients with unresectable PDC.
  • Takao Itoi, Terumi Kamisawa, Yoshinori Igarashi, Hiroshi Kawakami, Ichiro Yasuda, Fumihide Itokawa, Yuui Kishimoto, Masaki Kuwatani, Shinpei Doi, Seiichi Hara, Fuminori Moriyasu, Todd H. Baron
    JOURNAL OF GASTROENTEROLOGY 48 (4) 504 - 514 0944-1174 2013/04 [Refereed][Not invited]
     
    The cholangioscopic features of IgG4-related sclerosing cholangitis (IgG4-SC) remain undefined. The aim of this study was to clarify these endoscopic features using peroral video cholangioscopy (PVCS) in IgG4-SC patients. PVCS was performed in 33 patients: IgG4-SC (n = 13); primary sclerosing cholangitis (PSC; n = 5); and cholangiocarcinoma (n = 15), which included hilar cholangiocarcinoma (HCCA; n = 5) and distal cholangiocarcinoma (DCCA; n = 10). The most frequent findings on PVCS in the IgG4-SC patients were dilated (62 %) and tortuous (69 %) vessels, and absence of partially enlarged vessels. The incidence of dilated and tortuous vessels was significantly higher in IgG4-SC patients than in PSC patients (p = 0.015). Scarring and pseudodiverticula were found significantly more often in PSC patients than in IgG4-SC patients (p = 0.001 and p = 0.0007, respectively). The incidence of partially enlarged vessels was significantly higher in DCCA patients than in IgG4-SC patients (p = 0.004). In contrast, the incidence of dilated vessels was significantly higher in IgG4-SC patients than in HCCA patients (p = 0.015). PVCS performed after corticosteroid therapy showed resolution of bile duct stenosis and dilated, tortuous, or partially enlarged vessels, as well as resolution of friability in all patients with IgG4-SC. Cholangioscopy was useful in differentiating IgG4-SC from PSC. In addition, monitoring the patterns of proliferative vessels on PVCS may be useful to differentiate IgG4-SC from cholangiocarcinoma.
  • Kuwatani M, Kawakami H, Sakamoto N
    Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society 25 (2) 205  0915-5635 2013/03 [Refereed][Not invited]
  • Kawakami Hiroshi, Isayama Hiroyuki, Maguchi Hiroyuki, Kuwatani Masaki, Nakai Yousuke, Kawakubo Kazumichi, Haba Shin, Kudo Taiki, Abe Yoko, Koike Kazuhiko, Sakamoto Naoya
    GASTROINTESTINAL ENDOSCOPY 76 (4) 920 - 921 0016-5107 2012/10 [Refereed][Not invited]
  • Hiroshi Kawakami, Masaki Kuwatani, Kazunori Eto, Taiki Kudo, Eiichi Tanaka, Satoshi Hirano
    WORLD JOURNAL OF SURGERY 36 (9) 2265 - 2266 0364-2313 2012/09 [Refereed][Not invited]
  • Kawakami Hiroshi, Isayama Hiroyuki, Kuwatani Masaki, Eto Kazunori, Kudo Taiki, Abe Yoko, Kawahata Shuhei, Nakai Yousuke, Sasahira Naoki, Koike Kazuhiko, Kato Mototsugu
    GASTROINTESTINAL ENDOSCOPY 76 (1) 223  0016-5107 2012/07 [Refereed][Not invited]
  • Manabu Onodera, Hiroshi Kawakami, Masaki Kuwatani, Taiki Kudo, Shin Haba, Yoko Abe, Shuhei Kawahata, Kazunori Eto, Yuya Nasu, Eiichi Tanaka, Satoshi Hirano, Masahiro Asaka
    SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES 26 (6) 1710 - 1717 0930-2794 2012/06 [Refereed][Not invited]
     
    Background Endoscopic ultrasound (EUS)-guided drainage is widely used to manage pancreatic pseudocysts. Several studies have reported the use of EUS-guided drainage for pancreatic fistula and stasis of pancreatic juice caused by stricture of the pancreatic duct after pancreatic resection. Methods At the authors' hospital, 262 patients underwent surgery involving pancreatic resection from April 2005 to March 2010. In 90 of these patients (34%), a grade B or C postoperative pancreatic fistula developed that required additional treatment. The authors performed EUS-guided transmural drainage (EUS-TD) for six patients (2.1%) with a pancreatic fistula or dilation of the main pancreatic duct visible by EUS. Percutaneous drainage was provided for 18 patients (6.8%). The success rates for EUS-TD and percutaneous drainage were compared in a retrospective analysis. Results In all six cases, EUS-TD was performed successfully without complications. Five of the six patients were successfully treated with only one trial of EUS-TD. The final technical success rate was 100% for both EUS-TD and percutaneous drainage. Both the short- and long-term clinical success rates for EUS-TD were 100% and those for percutaneous drainage were 61.1 and 83%, respectively. The differences in these rates were not significant (short-term success, P = 0.091 vs. long-term success, P = 0.403). However, the time to clinical success was significantly shorter with EUS-TD (5.8 days) than with percutaneous drainage (30.4 days; P = 0.0013) in the current series. Conclusions The EUS-TD approach appears to be a safe and technically feasible alternative to percutaneous drainage and may be considered as first-line therapy for pancreatic fistulas visible by EUS.
  • Hiroshi Kawakami, Masaki Kuwatani, Kazunori Eto, Taiki Kudo, Masahiro Asaka
    DIGESTIVE ENDOSCOPY 24 49 - 54 0915-5635 2012/05 [Refereed][Not invited]
     
    Compared with surgery, endoscopic treatment is safe and highly effective for a postoperative hilar benign bile duct stricture (BDS). However, the long-term outcome of conventional placement of a single biliary stent for hilar benign BDS is generally poor. Although the placement of multiple biliary stents is preferred, multiple stenting in a BDS is difficult. Alternatively, single or multiple stent placement above the papilla (inside stent) or fully-covered self-expandable metallic stents (SEMS) are feasible approaches for benign BDS. Nevertheless, controversy remains regarding whether and how to perform endoscopic biliary drainage for a hilar benign BDS. In patients with hilar benign BDS, endoscopic biliary drainage can be performed by placing conventional plastic stents across the papilla, plastic stents above the papilla or fully-covered SEMS. Individualized treatment should be considered. We report the placement of a fully-covered SEMS for a hilar benign biliary stricture after extended left hepatectomy.
  • Masaki Kuwatani, Hiroshi Kawakami, Mototsugu Kato
    INTERNAL MEDICINE 51 (10) 1285 - 1285 0918-2918 2012 [Refereed][Not invited]
  • Masaki Kuwatani, Hiroshi Kawakami, Tsuyoshi Hayashi, Hirotoshi Ishiwatari, Taiki Kudo, Hiroaki Yamato, Nobuyuki Ehira, Shin Haba, Kazunori Eto, Mototsugu Kato, Masahiro Asaka
    SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES 25 (12) 3784 - 3790 0930-2794 2011/12 [Refereed][Not invited]
     
    Endoscopic retrograde cholangiopancreatography (ERCP) and related procedures can cause abdominal pain and discomfort. Two clinical trials have indicated, using the visual analogue scale (VAS) score, that CO(2) insufflation during ERCP ameliorates the suffering of patients without complications, compared with air insufflation. However, differences in patient suffering between CO(2) and air insufflation after ERCP under deep conscious sedation have not been reported. We focused on the gas volume score (GVS) as an objective indicator of gas volume, and designed a multicenter, prospective, double-blind, randomized, controlled study with CO(2) and air insufflation during ERCP. Between March 2010 and August 2010, 80 patients who required ERCP were enrolled and evenly randomized to receive CO(2) insufflation (CO(2) group) or air insufflation (air group). ERCP and related procedures were performed under deep conscious sedation with fentanyl citrate or pethidine and midazolam or diazepam. The GVS was evaluated as the primary endpoint in addition to the VAS score as the secondary endpoint. The GVS after ERCP and related procedures in the CO(2) group was significantly lower than that in the air group (0.14 +/- A 0.06 vs. 0.31 +/- A 0.11, P < 0.01), as well as the rate of increase in GVS ([GVS after - GVS before]/[GVS before ERCP and related procedures] x 100) (3.8 +/- A 5.9 vs. 21 +/- A 11.1%, P < 0.01). VAS scores 3 and 24 h after ERCP and related procedures were comparable between the CO(2) and air groups for abdominal pain, abdominal distension, and nausea. Additionally, VAS scores were not correlated with the GVS. CO(2) insufflation during ERCP reduces GVS (bowel gas volume) but not the VAS score of suffering compared with air insufflation. Deep and sufficient sedation during ERCP and related procedures is important for the palliation of patients' pain and discomfort.
  • Hiroshi Kawakami, Satoshi Kondo, Masaki Kuwatani, Hiroaki Yamato, Nobuyuki Ehira, Taiki Kudo, Kazunori Eto, Shin Haba, Joe Matsumoto, Kentaro Kato, Takahiro Tsuchikawa, Eiichi Tanaka, Satoshi Hirano, Masahiro Asaka
    JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 18 (5) 630 - 635 1868-6974 2011/09 [Refereed][Not invited]
     
    The controversy over whether and how to perform preoperative biliary drainage (PBD) in patients with hilar cholangiocarcinoma (HCA) remains unsettled. Arguments against PBD before pancreatoduodenectomy have recently been gaining momentum. However, the complication-related mortality rate is as high as 10% for patients with HCA who have undergone major liver resection, and liver failure is a major cause of postoperative death. This suggests the need for PBD to treat jaundice in HCA patients scheduled for major surgical resection of the liver and that major surgery should be performed only after the recovery of hepatic function. No definite criteria or guidelines outlining indications for PBD are currently available. In patients with HCA, PBD may be performed by either percutaneous transhepatic biliary drainage (PTBD) or endoscopic biliary drainage (EBD). No consensus, however, has been reached regarding which drainage method is more appropriate. No reported study has compared the effectiveness of PTBD, endoscopic biliary stenting (EBS), and endoscopic nasobiliary drainage (ENBD) in patients with HCA. This review summarizes the results of our study comparing the three methods and outlines the preoperative endoscopic management of segmental cholangitis (SC) in HCA patients undergoing PBD.
  • Taiki Kudo, Hiroshi Kawakami, Masaki Kuwatani, Nobuyuki Ehira, Hiroaki Yamato, Kazunori Eto, Kanako Kubota, Masahiro Asaka
    WORLD JOURNAL OF GASTROENTEROLOGY 17 (29) 3459 - 3464 1007-9327 2011/08 [Refereed][Not invited]
     
    Schwannomas are peripheral nerve tumors that are typically solitary and benign. Their diagnosis is largely based on surgically resected specimens. Recently, a number of case reports have indicated that retroperitoneal schwannomas could be diagnosed with endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA). We report the diagnosis of three cases of schwannoma using EUS-FNA. Subjects were two males and one female, ages 22, 40, and 46 years, respectively, all of whom were symptom-free. Imaging findings showed well-circumscribed round tumors. However, as the tumors could not be diagnosed using these findings alone, EUS-FNA was performed. Hematoxylin-eosin staining of the resulting tissue fragments revealed bland spindle cells with nuclear palisading. There was no disparity in nuclear sizes. Immunostaining revealed S-100 protein positivity and all cases were diagnosed as schwannomas. Ki-67 indexes were 3%-15%, 2%-3%, and 3%, respectively. No case showed any signs of malignancy. As most schwannomas are benign tumors and seldom become malignant, we observed these patients without therapy. All tumors demonstrated no enlargement and no change in characteristics. Schwannomas are almost always benign and can be observed following diagnosis by EUS-FNA. (C) 2011 Baishideng. All rights reserved.
  • Yasuhiro Ohshima, Ichiro Yasuda, Hiroshi Kawakami, Masaki Kuwatani, Tsuyoshi Mukai, Takuji Iwashita, Shinpei Doi, Masanori Nakashima, Yoshinobu Hirose, Masahiro Asaka, Hisataka Moriwaki
    JOURNAL OF GASTROENTEROLOGY 46 (7) 921 - 928 0944-1174 2011/07 [Refereed][Not invited]
     
    Endoscopic transpapillary brush cytology and forceps biopsy are widely used for the pathological diagnosis of suspected malignant biliary strictures (MBS). However, the sensitivity of these methods remains insufficient, and it can be difficult to confirm the diagnosis. We aimed to evaluate the diagnostic ability of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) and the impact of this technique on clinical management in patients with suspected MBS where endoscopic brush cytology and biopsy yielded negative results. This study included 225 consecutive patients with suspected MBS, who underwent endoscopic brush cytology and biopsy at our institutions. Negative results were obtained for these pathological tests in 75 patients, and EUS-FNA was performed in 22 of these patients. We retrospectively compared the EUS-FNA results with the final diagnosis and examined the influence of the EUS-FNA diagnosis on treatment selection. FNA specimens were successfully obtained in all patients, and the pathological results confirmed malignancy in 16 cases and predicted that the other 6 cases were benign. Of the 6 cases that were suspected to be benign, 3 patients were diagnosed with xanthogranulomatous cholecystitis by surgical pathology, and the remaining 3 patients were diagnosed with benign diseases at a follow-up after 12-18 months. Thus, the EUS-FNA-based diagnosis was proven correct for all the patients. In addition, the treatment strategy was altered as a result of the EUS-FNA results in the above 6 patients (27%). EUS-FNA is a sensitive and safe diagnostic modality for patients with suspected MBS and can be an additional option in cases where endoscopic brush cytology and biopsy have produced negative results.
  • H. Kawakami, M. Kuwatani, T. Kudo, N. Ehira, H. Yamato, M. Asaka
    ENDOSCOPY 43 E98 - E99 0013-726X 2011/03 [Refereed][Not invited]
  • Hiroshi Kawakami, Masaki Kuwatani, Manabu Onodera, Shin Haba, Kazunori Eto, Nobuyuki Ehira, Hiroaki Yamato, Taiki Kudo, Eiichi Tanaka, Satoshi Hirano, Satoshi Kondo, Masahiro Asaka
    JOURNAL OF GASTROENTEROLOGY 46 (2) 242 - 248 0944-1174 2011/02 [Refereed][Not invited]
     
    Controversy exists over the preferred technique of preoperative biliary drainage (PBD) in patients with hilar cholangiocarcinoma (HCA). The goal of this retrospective study was to identify the preferred technique of PBD for HCA. A total of 128 consecutive patients with HCA diagnosed between September 1999 and December 2009 who underwent PBD were included in this study. The study compared outcomes of endoscopic nasobiliary drainage (ENBD), endoscopic biliary stenting (EBS), and percutaneous transhepatic biliary drainage (PTBD) in patients with HCA. There were no significant differences in preoperative laboratory data, rates of major hepatectomy, or decompression periods among the 3 groups. Complications were significantly more frequent in the EBS group compared with either the ENBD or PTBD group (p < 0.05). Drainage tube occlusion with cholangitis was significantly more common in the EBS group compared with either the ENBD or PTBD group (p < 0.0001). Patients in the PTBD group experienced serious complications including vascular injury (8%) and cancer dissemination (4%). Patients in the ENBD and EBS groups had mild post-endoscopic retrograde cholangiopancreatography pancreatitis (5%). Conversion procedures were significantly more common in the EBS group compared with the ENBD and PTBD groups (p < 0.05). There was no significant difference in postsurgical morbidity or mortality among the 3 groups. Drainage tube occlusion with cholangitis was a frequent complication associated with EBS. PTBD was associated with serious complications such as vascular injury and cancer dissemination. ENBD was found to be the most suitable method for initial PBD management in patients with HCA.
  • Hiroshi Kawakami, Yoh Zen, Masaki Kuwatani, Kazunori Eto, Shin Haba, Hiroaki Yamato, Keisuke Shinada, Kanako Kubota, Masahiro Asaka
    JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY 25 (10) 1648 - 1655 0815-9319 2010/10 [Refereed][Not invited]
     
    Background and Aim: Autoimmune pancreatitis is commonly associated with immunoglobulin (Ig) G4-related sclerosing cholangitis (IgG4-SC). The discrimination between IgG4-SC and pancreatobiliary malignancies or primary sclerosing cholangitis (PSC) is now an important issue. The present study was carried out to examine the usefulness of endoscopic biopsies from Vater's ampulla and the bile duct to diagnose IgG4-SC. Methods: The present study included 29 IgG4-SC patients (26 with both pancreatitis and cholangitis, and 3 with cholangitis only), 6 PSC patients, and 27 pancreatobiliary carcinoma patients. All patients underwent endoscopic biopsies from Vater's ampulla and the common bile duct. Biopsied specimens were histologically examined using immunostaining for IgG4. Results: For the ampullary and bile duct biopsies, the IgG4-SC samples had a significantly greater number of IgG4-positive plasma cells than the PSC or pancreatobiliary carcinoma specimens. In addition, bile duct biopsies from five patients (17%) with IgG4-SC showed diffuse inflammatory cell infiltration with irregular fibrosis corresponding to the histological features of lymphoplasmacytic sclerosing pancreatocholangitis. Based on the threshold of 10 IgG4-positive plasma cells per high power field, the diagnostic rates of the ampullar and bile duct biopsies were both 52% (15/29 cases). Twenty-one patients (72%) had more than 10 IgG4-positive plasma cells in at least one biopsy. The bile duct biopsy was significantly valuable for IgG4-SC patients with swelling of the pancreatic head. Conclusion: The present study suggested that ampullar and bile duct biopsies are useful for diagnosing IgG4-SC.
  • Hiroshi Kawakami, Masaki Kuwatani, Manabu Onodera, Shin Haba, Masahiro Asaka
    DIGESTIVE ENDOSCOPY 22 S107 - S110 0915-5635 2010/07 [Refereed][Not invited]
     
    Endoscopic treatment is highly effective for extracting common bile duct (CBD) stones and is the most common therapeutic method for CBD stones. For patients with CBD stones, the treatment goal is to completely clear the biliary duct. In general, the successful extraction rate using a basket and/or balloon catheter is as high as 90%. However, stones that are resistant to conventional endoscopic treatment procedures can be both challenging and time-consuming to treat; and successful treatment can require a combination of techniques, including mechanical lithotripsy or extracorporeal shock-wave lithotripsy. We performed needle knife sphincterotomy and attempted to remove a CBD stone using biopsy forceps and alligator grasping forceps without a lithotripter in a patient with a large impacted stone at Vater's ampulla. After attempting several techniques, the stone was successfully removed with balloon extraction.
  • Masaki Kuwatani, Hiroshi Kawakami, Yosuke Yamada
    Clinical Gastroenterology and Hepatology 8 (5) e52 - e53 1542-3565 2010/05 [Refereed][Not invited]
  • H. Kawakami, M. Kuwatani, K. Etoh, S. Haba, H. Yamato, K. Shinada, Y. Nakanishi, E. Tanaka, S. Hirano, S. Kondo, K. Kubota, M. Asaka
    ENDOSCOPY 41 (11) 959 - 964 0013-726X 2009/11 [Refereed][Not invited]
     
    Background and study aims: Localized-type bile duct carcinoma (LBDC) is often accompanied by extensive intraepithelial tumor spread (ITS) of 2 cm or more, which makes radical resection more difficult. This retrospective case review compares the diagnostic accuracy of endoscopic retrograde cholangiography (ERC) and peroral cholangioscopy (POCS) to detect ITS beyond the visible LBDC. Patients and methods: Forty-four consecutive patients with LBDC diagnosed between April 2004 and October 2008 who underwent radical resection with histopathological analysis were included in this study. Extensive ITS was found histopathologically in one-third of the cases (32%). The outcome parameters were the presence or absence of extensive ITS and the extent of extensive ITS proximal and distal to the main tumor. Results: In six cases it was not possible to pass the cholangioscope through the tumor sites. ERC correctly identified the presence of extensive ITS in 11/14 cases and did not yield any false-positive results. The three cases in which ERC was negative were all correctly identified by POCS plus biopsy since the cholangioscope could be passed in all three cases. The extent of extensive ITS was correctly diagnosed by ERC alone, ERC with POCS, and ERC with POCS plus mapping biopsy in 22%, 77%, and 100% of cases, respectively. Conclusions: The presence of extensive ITS was correctly detected in 80% of cases by ERC alone. POCS with mapping biopsy provided perfect diagnostic accuracy not only of the presence or absence but also of the extent of extensive ITS. However, POCS has the limitation that the cholangioscope cannot be passed through the tumor sites in approximately 15% of cases.
  • ETO Kazunori, KAWAKAMI Hiroshi, KUWATANI Masaki, HABA Shin, HIRANO Satoshi, KONDO Satoshi, KUBOTA Kanako, MATUNO Yoshihiro, HIRAYAMA Atushi, GOTOUDA Yuuko, ASAKA Masahiro
    Suizo 24 (4) 537 - 547 0913-0071 2009/08/25 [Not refereed][Not invited]
  • HABA Shin, KAWAKAMI Hiroshi, KUWATANI Masaki, ETO Kazunori, KONDO Satoshi, ASAKA Masahiro
    Tando 日本胆道学会 23 (2) 181 - 187 0914-0077 2009/05/31 
    The patient was a 75-year-old woman who was referred to our hospital for detailed examination of liver dysfunction. Abdominal CT and EUS revealed a mass lesion in the distal bile duct, while ERC showed a filling defect. The patient was preoperatively diagnosed with papillary distal bile duct carcinoma, and surgical resection was performed. Macroscopic findings for the resected specimen included a papillary tumor presenting with redness in the distal bile duct. Histologically, mildly atypical gland and hyperplasia of muscle fibers and fibrous tissue were observed. Based on these findings, a final diagnosis of adenomyomatous hyperplasia was made. Benign tumors rarely occur in the bile duct, and among them, adenomyomatous hyperplasia is particularly rare. As no characteristic findings on diagnostic imaging have been elucidated for this disease, accurate preoperative diagnosis is currently difficult. Detailed investigation through accumulation of cases is necessary in the future.
  • Sonazoid造影下超音波検査が有用であった膵・胆道腫瘤性病変
    桑谷 将城, 河上 洋, 西田 睦, 江藤 和範, 羽場 真, 小野寺 祐也, 浅香 正博
    日本消化器病学会雑誌 (一財)日本消化器病学会 106 (臨増総会) A385 - A385 0446-6586 2009/03
  • Hiroaki Yamato, Hiroshi Kawakami, Masaki Kuwatani, Keisuke Shinada, Satoshi Kondo, Kanako Kubota, Masahiro Asaka
    INTERNAL MEDICINE 48 (3) 143 - 150 0918-2918 2009 [Refereed][Not invited]
     
    Pancreatic carcinoma associated with portal vein tumor thrombus (PVTT) is rare. Here, we report three cases of resected pancreatic carcinoma associated with PVTT. In all three cases, preoperative images obtained using computed tomography and endoscopic ultrasonography revealed a tumor thrombus in the portal vein, which was connected to an irregular mass in the pancreas. All cases underwent surgical resection of the primary lesion and the PVTT. The pathological diagnoses of the tumors were two cases of tubular adenocarcinoma and one case of nonfunctioning endocrine carcinoma. We also retrospectively examined other patients who underwent surgical excision with portal vein resection.
  • Masaki Kuwatani, Hiroshi Kawakami, Kazunori Eto, Shin Haba, Tohru Shiga, Nagara Tamaki, Masahiro Asaka
    INTERNAL MEDICINE 48 (11) 867 - 875 0918-2918 2009 [Refereed][Not invited]
     
    Objective It has recently been reported that (18)F-fluorodeoxyglucose positron emission tomography (FDG-PET) is useful for estimation of the chemotherapy effect. Thus, we examined the value of FDG-PET in assessing the efficacy of chemotherapy in advanced pancreatic cancer, and compared this modality with tumor markers (TMs) and CT. Patients and Methods Nineteen patients with unresectable pancreatic adenocarcinoma were enrolled. All patients received chemotherapy with gemcitabine and S-1, an oral derivative of 5-fluorouracil, and underwent FDG-PET, CT, and serological examination for TMs before and after chemotherapy. Results Standardized uptake value in FDG-PET before treatment and survival time were not correlated. A good prognosis was seen after 1 course of chemotherapy in patients whose tumors were in partial or complete remission as assessed by FDG-PET [ median of survival time (MST), 12.5 months] or TMs ( MST, 13.5 months), but not in CT responders ( MST, 10.3 months). Furthermore, patient prognosis correlated with PET and TM assessment of the best tumor response through all courses. Namely, both PET and TM were useful for the prediction of survival or chemotherapy sensitivity of the patients. Conclusion FDG-PET and TMs can each play an adjunct role to CT for estimating the effect of chemotherapy and predicting survival by distinguishing between responders and non-responders among patients with advanced pancreatic cancer.
  • Kuwatani M, Kawakami H, Asaka M, Marukawa K, Matsuno Y, Hosaka M
    Diagnostic cytopathology 36 (11) 840 - 842 8755-1039 2008/11 [Refereed][Not invited]
  • 河上 洋, 桑谷 将城, 大和 弘明, 品田 恵佐, 江藤 和範, 羽場 真, 中西 喜嗣, 近藤 哲, 浅香 正博
    肝胆膵画像 (株)医学書院 10 (5) 393 - 397 1882-5087 2008/09 
    胆管癌の治癒する唯一の方法は外科的切除であり,局所進展度・範囲の正確な診断,およびそれに基づいた適切な手術術式の選択が重要となる.進展範囲診断のなかでも,胆管粘膜表層拡大進展の診断は重要である.結節膨張型や乳頭膨張型を呈する限局型胆管癌では胆管粘膜表層拡大進展が1/3程度の症例にみられ,胆道鏡による観察が必要となる.本稿では,胆管癌に対する経口胆道鏡検査(peroral cholangioscopy:POCS)の胆管粘膜表層拡大進展の診断における意義と限界について述べた.当科では,2008年2月までに胆管粘膜表層拡大進展の可能性がある限局型胆管癌38例に対してPOCSを施行した.腫瘍による高度狭窄を通過できたのは33例であり,このうち胆管粘膜表層拡大進展の有無についての存在診断は全例で可能であった.範囲診断は67%で可能であった.表層拡大進展は不整な小顆粒状粘膜やイクラ状粘膜として観察された.POCSで胆管粘膜表層拡大進展の範囲診断が困難であった例は切除標本肉眼所見においても異常の指摘が困難であり,病理組織学的には1層の平坦な癌上皮から成っていた.POCSの高画質画像によって胆管粘膜表層拡大進展の診断が可能である一方,約30%の症例では1層の平坦な癌上皮のため範囲診断が不可能であった.現時点では,粘膜表層拡大進展を呈する限局型胆管癌は診断の限界をふまえたうえでの治療方針の決定が必要である.今後さらなる機器の改良・開発が望まれる.(著者抄録)
  • 肝移植後膵液瘻による合併症に対し複合的IVRが奏功した1例
    長谷川 悠, 阿保 大介, 佐原 祐介, 白土 博樹, 清水 匡, 嶋村 剛, 古川 博之, 桑谷 将城, 河上 洋
    IVR: Interventional Radiology (一社)日本インターベンショナルラジオロジー学会 23 (3) 316 - 316 1340-4520 2008/07
  • Masaki Kuwatani, Hiroshi Kawakami, Hiroaki Yamato, Keisuke Shinada, Eiichi Tanaka, Satoshi Hirano, Satoshi Kondoh, Tomoo Itoh, Masahiro Asaka
    Japanese Journal of Gastroenterology 105 (7) 1061 - 1069 0446-6586 2008 [Refereed][Not invited]
     
    We had three cases of pancreatic groove carcinoma. All cases developed obstructive jaundice. Duodenoscopy showed stenosis of the second portion of the duodenum in every case. Thus, endoscopic bile duct drainage could not be performed in two cases. CT revealed a mass between the duodenum and head of the pancreas, which was not well-defined by contrast-enhancement. Endoscopic ultrasonograghy revealed a hypoechoic mass which was adjacent to the common bile duct and duodenum in the pancreas head in all cases. Therefore, we could diagnose pancreatic groove carcinoma.
  • Kawakami H, Kuwatani M, Shinada K, Yamato H, Hirano S, Kondo S, Yonemori A, Itoh T, Matsuno Y, Asaka M
    Internal medicine (Tokyo, Japan) 一般社団法人 日本内科学会 47 (7) 603 - 608 0918-2918 2008 [Refereed][Not invited]
     
    Autoimmune pancreatitis (AIP) is a new category of pancreatic diseases. AIP associated with pseudocysts is rare; only 8 cases have been reported in the literature. A 63-year-old man was admitted to our department because of upper left abdominal pain and back pain. Various imaging studies demonstrated swelling of the tail of the pancreas with hemorrhagic pseudocysts. The patient underwent a surgical operation. A pancreatogram of the specimen revealed total occlusion of the main pancreatic duct in the tail of the pancreas. Histopathological examination revealed that it was AIP with hemorrhagic pseudocysts.
  • Kawakami H, Kuwatani M, Yamato H, Shinada K, Hirano S, Kondo S, Yonemori A, Matsuno Y, Asaka M
    Internal medicine (Tokyo, Japan) The Japanese Society of Internal Medicine 47 (22) 1967 - 1970 0918-2918 2008 [Refereed][Not invited]
     
    A 68-year-old woman with a history of renal cell carcinoma (RCC) resected curatively 12 years previously was admitted to our department for scrutiny of pancreatic tumors. Various imaging studies demonstrated heterogeneously well-enhanced masses in the head and tail of the pancreas. The well-enhanced mass in the head of the pancreas was connected with the tumor thrombus in the portal vein. To differentially diagnose the multiple pancreatic lesions, we performed endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS-FNAB). Histopathologic findings of the EUS-FNAB specimens were similar to those of the renal clear cell carcinoma previously resected. The patient underwent a surgical operation with segmental resection of the portal vein with the preoperative diagnosis of RCC metastasis to the pancreas with intraportal growth. Histopathological examination of the resected specimen revealed that the masses in the pancreas were multiple pancreatic metastases with intraportal tumor thrombus of RCC. The pancreas is a rare target for metastasis. This is a rare case of pancreatic metastasis from RCC with intraportal extension, and is the first preoperatively definitely diagnosed case using EUS-FNAB.
  • Hiroshi Kawakami, Masaki Kuwatani, Manabu Onodera, Masahiro Asaka, Satoshi Hirano, Satoshi Kondo
    GASTROINTESTINAL ENDOSCOPY 66 (6) 1231 - 1232 0016-5107 2007/12 [Refereed][Not invited]
  • 小野寺 学, 河上 洋, 桑谷 将城, 上林 実, 平野 聡, 近藤 哲, 中西 喜嗣, 伊藤 智雄, 浅香 正博
    胆道 日本胆道学会 21 (4) 527 - 533 0914-0077 2007/10 
    73歳男性。患者は近医にて血清19-9値の上昇、腹部CT上の肝腫瘤性病変を指摘され、著者らの施設へ紹介となった。入院時、肝・胆道系酵素の上昇を認め、腹部CT・MRCP・IDUS・内視鏡的逆行性胆管造影検査にて左肝内胆管癌と上中部胆管癌の重複癌が疑われた。肝左葉尾状葉切除、肝外胆管合併切除、門脈楔状切除、右肝動脈切除、再建術を行なった結果、病理組織学的に本症例は肝外胆管まで広範囲に粘膜下壁内進展した胆管浸潤型肝内胆管癌と最終的に診断された。術後は経過良好で、現在、1年2ヵ月経過で無再発生存中である。
  • Hiroshi Kawakami, Masaki Kuwatani, Manabu Onodera, Satoshi Hirano, Satoshi Kondo, Yoshitsugu Nakanishi, Tomoo Itoh, Masahiro Asaka
    JOURNAL OF GASTROENTEROLOGY 42 (8) 694 - 697 0944-1174 2007/08 [Refereed][Not invited]
     
    Acinar cell carcinoma of the pancreatobiliary system is a relatively rare malignant neoplasm arising usually in the pancreatic parenchyma. We experienced a 68-year-old woman who presented with obstructive jaundice due to an ampullary mass 1.0cm in diameter, detected by abdominal computed tomography and endoscopic examination. The patient underwent a curative surgical operation, and histopathological examination revealed that the tumor was confined to the ampulla of Vater with no continuity to the pancreatic parenchyma. The tumor cells showed acinar or tubular arrangement with eosinophilic to basophilic granular cytoplasm, findings identical to those of acinar cell carcinoma of the pancreas. Immunohistochemically, the tumor cells were positive for lipase. From these findings, we concluded that the tumor was primary acinar cell carcinoma arising in the ampulla of Vater, probably originating from heterotopic pancreatic tissue. This is the first reported case of primary acinar cell carcinoma in the ampulla of Vater.
  • 河上 洋, 桑谷 将城, 藤谷 好弘, 上林 実, 小西 康平, 牧山 裕顯, 橋野 聡, 久保田 佳奈子, 伊藤 智雄, 浅香 正博
    日本消化器病学会雑誌 (一財)日本消化器病学会 104 (2) 233 - 238 0446-6586 2007/02 
    症例は56歳、男性。膵体尾部と肝腫瘤性病変の精査加療目的に当科入院。入院時より好中球数増多がみられ、血清中G-CSFが高値を示した。肝生検により膵癌肝転移と診断し、全身化学療法を施行した。加療によっても検査所見に改善はみられず、治療開始4ヵ月後に永眠した。剖検の結果、低分化型管状腺癌で、免疫組織学的にG-CSF産生膵管癌と最終診断した。極めてまれな疾患であり、若干の文献的考察を加えて報告する。(著者抄録)
  • Kawakami H, Kuwatani M, Fujiya Y, Uebayashi M, Konishi K, Makiyama H, Hashino S, Kubota K, Itoh T, Asaka M
    Nihon Shokakibyo Gakkai zasshi = The Japanese journal of gastro-enterology 2 104 (2) 233 - 238 0446-6586 2007/02 [Refereed][Not invited]
     
    We report a case of pancreatic ductal adenocarcinoma producing granulocyte-colony stimulating factor (G-CSF). A 56-year-old Japanese man was admitted to our hospital with back pain and high fever. An abdominal CT scan revealed masses in the pancreatic body to the tail, and both lobes of the liver. A biopsy specimen of the hepatic tumor demonstrated metastatic poorly differentiated adenocarcinoma. We administered oral S-1 in combination with gemcitabine. However, his general condition gradually worsened, and a high serum level of G-CSF persisted. He died 135 days after admission. The diagnosis of autopsy was pancreatic ductal adenocarcinoma. Immunohistochemical staining showed the presence of G-CSF in tumor cells. The final diagnosis was G-CSF-producing pancreatic carcinoma.
  • Masaki Kuwatani, Hiroshi Kawakami, Hiroaki Makiyama, Manabu Onodera, Kakuya Matsumoto, Gakuyo Karasawa, Masahiro Asaka
    INTERNAL MEDICINE 46 (18) 1557 - 1564 0918-2918 2007 [Refereed][Not invited]
     
    A 58-year-old male had been diagnosed as having autoimmune pancreatitis (AIP) from the results of serological examinations and image findings. He was treated with prednisolone (PSL) for 3.5 months. Fifteen months later, follow-up CT revealed the main pancreatic duct (MPD) dilatation in the pancreas body to tail and right hydronephrosis caused by complicated retroperitoneal mass. We diagnosed him as having recurrent AIP with retroperitoneal fibrosis, and restarted PSL treatment. After one month, Examinations indicated amelioration of the MPD dilatation and right hydronephrosis, but not the right renal failure. This case indicates the importance of maintenance of PSL treatment.
  • Hiroshi Kawakami, Masaki Kuwatani, Satoshi Hirano, Satoshi Kondo, Yoshitsugu Nakanishi, Tomoo Itoh, Masahiro Asaka
    INTERNAL MEDICINE 46 (6) 273 - 277 0918-2918 2007 [Refereed][Not invited]
     
    Pancreatic endocrine tumors are rare tumors classified into "functioning" and "nonfunctioning" tumors. A 68-year-old man was admitted to our hospital with the chief compliant of abdominal pain. Various imaging studies demonstrated a mass in the head of the pancreas with intraductal growth into the main pancreatic duct and an intraportal mass. The patient underwent a curative surgical operation. Histopathological examination revealed that it was nonfunctioning endocrine carcinoma of the pancreas. This is the first reported case of a pancreatic endocrine tumor with intraductal growth into the main pancreatic duct and tumor thrombus within the portal vein.
  • Hiroshi Kawakami, Masaki Kuwatani, Manabu Onodera, Satoshi Hirano, Satoshi Kondo, Yoshitsugu Nakanishi, Tomoo Itoh, Masahiro Asaka
    INTERNAL MEDICINE 46 (15) 1191 - 1195 0918-2918 2007 [Refereed][Not invited]
     
    Hepatolithiasis associated with cholangiocellular carcinoma is occasionally a calcium bilirubinate stone. Primary cholesterol hepatolithiasis associated with cholangiocellular carcinoma is rare; only 6 cases have been reported in the literature. A 55-year-old man was admitted to our hospital because of an elevated level of carbohydrate antigen 19-9. Various imaging studies demonstrated a mass in the segment VII of the liver. The patient underwent a curative surgical operation. Histopathological examination revealed that it was cholangiocellular carcinoma located in the periphery of the liver. A cholesterol stone was present, encircled by the cholangiocellular carcinoma. Minor inflammatory changes were observed around the stone.
  • 門脈内腫瘍栓および膵管内腫瘍進展を伴った悪性膵内分泌腫瘍の1例
    桑谷 将城, 河上 洋, 斉藤 克憲, 平野 聡, 近藤 哲, 中西 喜嗣, 伊藤 智雄, 浅香 正博
    日本消化器病学会雑誌 (一財)日本消化器病学会 103 (臨増大会) A1009 - A1009 0446-6586 2006/09
  • Masaki Kuwatani, Yoshinori Ikarashi, Akira Iizuka, Chihiro Kawakami, Gary Quinn, Yuji Heike, Mitsuzi Yoshida, Masahiro Asaka, Yoichi Takaue, Hiro Wakasugi
    IMMUNOLOGY LETTERS 106 (1) 82 - 90 0165-2478 2006/07 [Refereed][Not invited]
     
    Mouse natural killer T cells with an invariant V alpha 14-J alpha 18 TCR rearrangement (V alpha 14i NKT cells) are able to regulate immune responses through rapid and large amounts of Th1 and Th2 cytokine production. It has been reported that in vivo administration of the Va14i NKT cell ligand, a-galactosylceramide (alpha-Ga1Cer) significantly reduced morbidity and mortality of acute graft-versus-host disease (GVHD) in mice. In this study, we examined whether adoptive transfer of in vitro-expanded Va14i NKT cells using a-GalCer and IL-2 could modulate acute GVHD in the transplantation of spleen cells of C57BL/6 mice into (B6 x DBA/2) F-1 mice. We found that the adoptive transfer of cultured spleen cells with a combination of alpha-GalCer and IL-2, which contained many V alpha 14i NKT cells, modulated acute GVHD by exhibiting long-term mixed chimerism and reducing liver damage. Subsequently, the transfer of V alpha 14i NKT cells purified from spleen cells cultured with a-Ga1Cer and IL-2 also inhibited acute GVHD. This inhibition of acute GVHD by V alpha 14i NKT cells was blocked by anti-IL-4 but not by anti-IFN-gamma monoclonal antibody. Therefore, the inhibition was dependent on IL-4 production by V alpha 14i NKT cells. Our findings highlight the therapeutic potential of in vitro-expanded V alpha 14i NKT cells for the prevention of acute GVHD after allogeneic hematopoietic stem cell transplantation. (c) 2006 Elsevier B.V All rights reserved.
  • M Kuwatani, Y Ikarashi, S Mineishi, M Asaka, H Wakasugi
    TRANSPLANTATION 80 (9) 1145 - 1152 0041-1337 2005/11 [Refereed][Not invited]
     
    Background. Animal allogeneic bone marrow transplantation (BMT) models with nonmyeloablative conditioning regimens have so far required irradiation or antibodies in addition to immunosuppressive drugs for engraftment. Moreover, although it is known that the balance between donor T-cell number and the dose of immunosuppressive drugs would be critical for engraftment, it has not been experimentally clarified in a nonmyeloablative regimen. Methods. We used C57BL/6 mice as donors and DBA/2 mice as recipients with a nonmyeloablative regimen including fludarabine (Flu) and cyclophosphamide (CPA) without irradiation or antibodies. To determine the adequate doses, we injected recipients with various doses of Flu and CPA, and 2 X 107 bone marrow cells (BMC) and 5 X 107 splenocytes (SC). Furthermore, using T-cell-depleted BMC and enriched T cells, we investigated the balance between donor T-cell number and the dose of Flu. Results. Doses of Flu at 150 mg/kg/dayx6 and CPA at 150 mg/kg/dayx2 were most appropriate for engraftment with low mortality. All mice appropriately pretreated and transplanted with both BMC and SC exhibited complete donor chimeras. Donor cell engraftment was not enhanced by any increase of BMC transplanted, and dose escalation of donor T cells but not BMC led to the reduction of Flu dose required for engraftment of donor cells. Conclusions. We have established a murine nonmyeloablative BMT model in a fully MHC-mis matched combination for donor cell engraftment with complete donor chimerism. Simultaneously, we have quantitatively demonstrated that the balance between donor T-cell number and the dose of immunosuppressive drugs is critical or stable engraftment.

Books etc

  • 膵切除後膵液瘻に対する内視鏡治療
    桑谷将城 (Joint work消化器・肝臓内科)
    科学評論社 2017/12
  • 胆膵疾患に対する内視鏡診断・治療の最前線
    桑谷将城 (Joint work北海道医報)
    北海道医師会 2016/05 8-12
  • 乳頭型肝外胆管癌、乳頭浸潤型肝外胆管癌
    桑谷将城 (Joint work別冊肝・胆道系症候群III)
    日本臨床 2011/02

Conference Activities & Talks

  • 悪性肝門部胆管閉塞に対する術前内視鏡的胆道ドレナージの機能不全リスクの検討  [Not invited]
    杉浦諒, 桑谷将城, 坂本直哉
    第58回日本胆道学会学術集会  2022/10
  • 膵癌に対するrBC2LCN-IR700複合体を利用した近赤外線光免疫治療の基礎的検討
    平田 甫, 桑谷 将城, 坂本 直哉
    第108回日本消化器病学会総会  2022/04
  • 自己免疫性肝胆膵疾患の新展開 IgG4関連疾患に随伴する胆嚢病変の臨床的検討  [Not invited]
    滝新 悠之介, 桑谷 将城, 坂本 直哉
    第108回日本消化器病学会総会  2022/04
  • 膵周囲液体貯留に対する経消化管的超音波内視鏡下ドレナージの臨床成績
    永井 孝輔, 桑谷 将城, 坂本 直哉
    JDDW 2021  2021/11
  • 初期画像検査陰性の総胆管結石の診断における超音波内視鏡の有用性の検討 多施設共同非ランダム化非盲検探索的臨床試験  [Not invited]
    羽場 真, 桑谷 将城, 潟沼 朗生, Hokkaido Interventional EUS, ERCP study group
    第57回日本胆道学会学術集会  2021/10
  • リアルワールドエビデンスを支援する「バイオマーカー迅速検証プラットフォーム」について
    加城 歩, 小西 宏, 野村 由美子, 久津見 弘, 島田 英昭, 中森 正二, 坪内 博仁, 岩下 祐司, 井戸 章雄, 田ノ上 史郎, 藤田 浩, 坂本 直哉, 桑谷 将城, 野呂 林太郎, 大槻 純男, 奈良 聡, 柴原 孝彦, 高野 正行, 菊池 正二郎, 加藤 真吾, 鵜澤 成一, 落合 大樹, 土田 明彦, 小畑 大輔, 桶谷 薫, 江原 亮子, 武内 恵子, 長島 健悟, 本田 一文
    第41回日本分子腫瘍マーカー研究会  2021/09
  • 超音波内視鏡下胆道ドレナージにおける拡張手技 通電法と非通電法の比較検討
    永井 孝輔, 桑谷 将城, 坂本 直哉
    第101回 日本消化器内視鏡学会総会  2021/05
  • IgG4関連硬化性胆管炎におけるステロイド治療後の再燃因子の検討
    滝新 悠之介, 桑谷 将城, 坂本 直哉
    第107回日本消化器病学会総会  2021/04
  • 新規LEDカテーテルを使用した胆管癌に対する光免疫治療効果の検証  [Not invited]
    平田 甫, 桑谷 将城, 中島 孝平, 小川 美香子, 坂本 直哉
    第79回日本癌学会総会  2020/10
  • 超音波内視鏡下穿刺生検検体による胆道癌遺伝子解析
    平田 幸司, 桑谷 将城, 坂本 直哉
    第105回日本消化器病学会総会  2019/05
  • 北海道多施設共同研究における膵癌術前化学(放射線)療法中の胆道ドレナージの臨床成績 metal stent vs.plastic stent  [Not invited]
    桑谷 将城, 中村 透, 林 毅, 木村 康利, 小野 道洋, 本谷 雅代, 山北 圭介, 後藤 拓磨, 高橋 邦幸, 真口 宏介, 平野 聡, 坂本 直哉
    胆道  2017/08
  • 胆管ドレナージにおける超音波内視鏡下胆管十二指腸吻合術の適応と限界  [Not invited]
    桑谷 将城, 河上 洋, 川久保 和道, 坂本 直哉
    Gastroenterological Endoscopy  2016/10
  • 胆道疾患に対する超音波内視鏡の有用性 超音波内視鏡下胆管十二指腸吻合術による胆管ドレナージの適応と限界  [Not invited]
    桑谷 将城, 河上 洋, 川久保 和道
    胆道  2016/08
  • 胆膵におけるInterventional EUS 超音波内視鏡下瘻孔形成術 偶発症とその対策 胆管ドレナージ法としての超音波内視鏡下瘻孔形成術の功罪の検証  [Not invited]
    桑谷 将城, 河上 洋, 坂本 直哉
    Gastroenterological Endoscopy  2016/04
  • 胆膵内視鏡検査・治療のトラブルシューティング 超音波内視鏡ガイド下胆管ドレナージにおけるトラブルとその対処法  [Not invited]
    桑谷 将城, 河上 洋, 坂本 直哉
    Gastroenterological Endoscopy  2015/09
  • 胆道内視鏡診断・治療の進歩(バルーン内視鏡を含めて) 超音波内視鏡ガイド下胆管アプローチおよび処置における偶発症とその対策  [Not invited]
    桑谷 将城, 河上 洋, 坂本 直哉
    胆道  2015/08
  • PSCとIgG4-SC わが国の現状と最適治療を目指して IgG4関連硬化性胆管炎に対するステロイド治療の功罪  [Not invited]
    桑谷 将城, 河上 洋, 坂本 直哉
    日本消化器病学会雑誌  2015/03
  • 胆管結石治療困難例への戦略 内視鏡的胆管結石治療困難例に対する効率的な治療 EUS-guided stone therapy  [Not invited]
    桑谷 将城, 河上 洋, 川久保 和道
    Gastroenterological Endoscopy  2014/09
  • 気遣いの内視鏡 超音波内視鏡検査における鎮痙剤の役割 鎮痙剤の有無に関する多施設共同前向き無作為化比較試験  [Not invited]
    桑谷 将城, 林 毅, 河上 洋
    Gastroenterological Endoscopy  2014/04
  • 膵内分泌腫瘍におけるEUS-FNAの有用性と限界 外科的切除標本との比較検討  [Not invited]
    桑谷 将城, 河上 洋, 川久保 和道, 羽場 真, 工藤 大樹, 阿部 容子, 坂本 直哉
    膵臓  2013/06

MISC

  • 川久保 和道, 桒谷 将城, 杉浦 諒, 永井 孝輔, 岸 法磨, 米村 洋輝, 野澤 俊一郎, 坂本 直哉  映像情報medical : a monthly journal of medical imaging and information  55-  (2)  12  -16  2023/02
  • 桒谷 将城, 岸 法磨, 永井 孝輔, 川久保 和道, 坂本 直哉  内科 = Internal medicine : 臨床雑誌  130-  (1)  41  -46  2022/07/01
  • Kuwatani Masaki, Takishin Yunosuke, Mitsuhashi Tomoko, Sakamoto Naoya  Tando  36-  (1)  82  -90  2022/03/31
  • Kashiro Ayumi, Konishi Hiroshi, Nomura Yumiko, Kutsumi Hiromu, Shimada Hideaki, Nakamori Syoji, Tsubouchi Hirohito, Iwashita Yuji, Ido Akio, Tanoue Shiro, Fujita Hiroshi, Sakamoto Naoya, Kuwatani Masaki, Noro Rintaro, Ohtsuki Sumio, Nara Satoshi, Shibahara Takahiko, Takano Masayuki, Kikuchi Shojiro, Kato Shingo, Uzawa Narikazu, Ochiai Hiroki, Tsuchida Akihiko, Obata Daisuke, Oketani Kaoru, Ehara Sakiko, Takeuchi Keiko, Nagashima Kengo, Honda Kazufumi  Japan Journal of Molecular Tumor Marker Research  37-  49  -50  2022
  • リアルワールドエビデンスを支援する「バイオマーカー迅速検証プラットフォーム」について
    加城 歩, 小西 宏, 野村 由美子, 久津見 弘, 島田 英昭, 中森 正二, 坪内 博仁, 岩下 祐司, 井戸 章雄, 田ノ上 史郎, 藤田 浩, 坂本 直哉, 桑谷 将城, 野呂 林太郎, 大槻 純男, 奈良 聡, 柴原 孝彦, 高野 正行, 菊池 正二郎, 加藤 真吾, 鵜澤 成一, 落合 大樹, 土田 明彦, 小畑 大輔, 桶谷 薫, 江原 亮子, 武内 恵子, 長島 健悟, 本田 一文  日本分子腫瘍マーカー研究会プログラム・講演抄録  41回-  86  -87  2021/09
  • 桒谷 将城, 永井 孝輔, 平田 甫, 瀧新 悠之介, 古川 龍太郎, 川久保 和道, 坂本 直哉, 平野 聡  外科 = Surgery : 臨床雑誌  83-  (8)  917  -927  2021/07
  • 桒谷 将城, 永井 孝輔, 平田 甫, 瀧新 悠之介, 古川 龍太郎, 川久保 和道, 坂本 直哉, 平野 聡  外科  83-  (8)  917  -927  2021/07/01
  • 野路 武寛, 永山 稔, 今井 浩二, 川本 泰之, 桒谷 将城, 今村 将史, 岡村 圭佑, 木村 康利, 平野 聡  北海道外科雑誌 = The Hokkaido journal of surgery / 北海道外科雑誌編集委員会 編  66-  (1)  42  -46  2021/06
  • 野路武寛, 松井あや, 田中公貴, 中西喜嗣, 渡邉祐介, 浅野賢道, 海老原裕磨, 倉島庸, 中村透, 村上壮一, 土川貴裕, 岡村圭佑, 七戸俊明, 川本泰之, 桑谷将城, 平野聡  日本消化器外科学会雑誌(Web)  54-  (Supplement2)  2021
  • 桒谷 将城, 川久保 和道, 坂本 直哉  消化器・肝臓内科 = Gastroenterology & hepatology / 消化器・肝臓内科編集委員会 編  9-  (1)  99  -103  2021/01
  • YANE Kei, KUWATANI Masaki, YOSHIDA Makoto, GOTO Takuma, MATSUMOTO Ryusuke, IHARA Hideyuki, OKUDA Toshinori, TAYA Yoko, EHIRA Nobuyuki, KUDO Taiki, ADACHI Takeya, ETO Kazunori, ONODERA Manabu, SANO Itsuki, NOJIMA Masanori, KATANUMA Akio  GASTROENTEROLOGICAL ENDOSCOPY  63-  (1)  104  -116  2021  
    Background and aims: Needle tract seeding after preoperative endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) for pancreatic body and tail cancer has been reported. This study aimed to investigate the long-term outcomes, including the needle tract seeding ratio, of patients undergoing distal pancreatectomy for pancreatic body and tail cancer diagnosed preoperatively by EUS-FNA. Methods: This retrospective, observational cohort study assessed patients from three university hospitals and 11 tertiary referral centers. All patients who underwent distal pancreatectomy for invasive cancer of the pancreatic body and tail between January 2006 and December 2015 were identified and reviewed. Needle tract seeding rate, recurrence-free survival (RFS), and overall survival (OS) were evaluated. Results: Of the 301 total patients analyzed, 176 underwent preoperative EUS-FNA (EUS-FNA group) and 125 did not (non- EUS-FNA group). The median follow-up periods of the EUS-FNA group and non-EUS-FNA group were 32.8 and 30.1 months. Six patients (3.4%) in the EUS-FNA group were diagnosed as having needle tract seeding. The 5-year cumulative needle tract seeding rate estimated using Fine and Gray’s method was 3.8% (95% CI 1.6-7.8%). The median RFS or OS was not significantly different between the EUS-FNA group and the non-EUS-FNA group (23.7 vs 16.9 months: P=0.205; 48.0 vs 43.9 months: P=0.392). Conclusion: Although preoperative EUS-FNA for pancreatic body and tail cancer has no negative effect on RFS or OS, needle tract seeding after EUS-FNA was observed to have a non-negligible rate. (UMIN000030719)
  • 桑谷将城, 桑谷将城, 永井孝輔, 平田甫, 瀧新悠之介, 古川龍太郎, 川久保和道, 坂本直哉  臨床消化器内科  36-  (9)  1215  -1221  2021
  • 桑谷将城, 永井孝輔, 平田甫, 瀧新悠之介, 古川龍太郎, 川久保和道, 坂本直哉  消化器内視鏡  33-  (3)  2021
  • 桑谷将城, 桑谷将城, 永井孝輔, 平田甫, 瀧新悠之介, 古川龍太郎, 川久保和道, 坂本直哉  胆と膵  42-  (7)  2021
  • 桑谷将城  日本臨床  2021
  • Tetsuhiro Okada, Yusuke Mizukami, Kazuya Koizumi, Kuniyuki Takahashi, Hirotoshi Iwano, Shingo Asahara, Masaki Kuwatani, Toru Kawamoto, Hiroki Sato, Akihiro Hayashi, Hidemasa Kawabata, Takuma Goto, Junpei Sasajima, Mikihiro Fujiya, Yusuke Ono, Hidenori Karasaki, Toshikatsu Okumura  GASTROENTEROLOGY  158-  (6)  S863  -S863  2020/05  
    0
  • Masaki Kuwatani, Masaki Kuwatani, Naoya Sakamoto  Endoscopic Ultrasound  9-  (3)  151  -153  2020/05
  • 血漿遊離核酸を用いた膵腫瘍診断
    岡田 哲弘, 水上 裕輔, 河本 徹, 林 明宏, 佐藤 裕基, 河端 秀賢, 後藤 拓磨, 笹島 順平, 小泉 一也, 高橋 邦幸, 岩野 博俊, 浅原 新吾, 桑谷 将城, 唐崎 秀則, 奥村 利勝  膵臓  34-  (3)  A106  -A107  2019/06  [Not refereed][Not invited]
  • 岡田哲弘, 岡田哲弘, 水上裕輔, 水上裕輔, 河本徹, 林明宏, 佐藤裕基, 河端秀賢, 後藤拓磨, 笹島順平, 小泉一也, 高橋邦幸, 岩野博俊, 浅原新吾, 桑谷将城, 唐崎秀則, 奥村利勝  膵臓(Web)  34-  (3)  2019
  • 川久保 和道, 桑谷 将城, 杉浦 諒, 加藤 新, 平田 幸司, 平田 甫, 中島 正人, 坂本 直哉  胆と膵  39-  (臨増特大)  1117  -1121  2018/11  [Not refereed][Not invited]
     
    EUSランデブー法(EUS-rendezvous method:EUS-RV)は、超音波内視鏡下に直視下で胆管を穿刺し、ガイドワイヤーを胆管内から十二指腸へ誘導し、そのガイドワイヤーを頼りにして、ERCP関連処置を行うものである。確実なbiliary accessが得られる一方、さまざまなアプローチルートがあり、その後のガイドワイヤー操作や、胆管挿管の方法など、習熟すべきことが多数ある。また、EUS-RVに伴う重篤な偶発症もあるため、EUS-RVの適応を再度確認するとともに、他のbiliary access方法も考慮しつつ、EUS-RVによるbiliary accessを行うべきである。(著者抄録)
  • 出口 貴祥, 丸川 活司, 高桑 恵美, 安孫子 光春, 清水 知浩, 恩田 千景, 宮越 里絵, 渡部 涼子, 岡田 宏美, 中 智昭, 加藤 新, 桑谷 将城, 三橋 智子, 松野 吉宏  北海道臨床細胞学会会報  27-  21  -26  2018/11  [Not refereed][Not invited]
  • 川久保 和道, 桑谷 将城, 杉浦 諒, 加藤 新, 平田 幸司, 坂本 直哉  消化器内視鏡  30-  (10)  1474  -1479  2018/10  [Not refereed][Not invited]
     
    超音波内視鏡ガイド下穿刺吸引法(EUS-FNA)やinterventional EUSは、出血高危険度手技である。抗血栓薬服用中の患者においては、出血性偶発症の頻度が上昇する可能性があり、適切な休薬方法をとる必要がある。EUS-FNAの出血性偶発症の頻度は0.5%程度であり重篤なものも少ない。したがって、安易に抗血栓薬を休薬するのではなく、「止めない覚悟」で臨むことも必要である。超音波内視鏡(EUS)ガイド下胆道ドレナージ術は、出血性偶発症の頻度は4%程度で、重篤なものも少なくない。つまり、抗血栓薬はガイドラインに従って必要最低限の休薬を行う、「止める勇気」が必要である。EUSガイド下膵周囲液体貯留ドレナージ術、さらに内視鏡的ネクロセクトミーでの出血性偶発症の頻度は18%と非常に高いものである。抗血栓薬については、ガイドラインに従った休薬を行うことは当然であるが、「止めない覚悟」は必要でなく、適切な休薬方法をとるべきである。それぞれの手技において出血性偶発症の頻度を下げる明確な方法はなく、抗血栓薬服用中患者においては、細心の注意を払って施行するべきである。(著者抄録)
  • 超音波検査を用いた肝予備能評価の検討
    杉浦 諒, 桑谷 将城, 西田 睦, 平田 幸司, 加藤 新, 川久保 和道, 坂本 直哉  超音波医学  45-  (Suppl.)  S688  -S688  2018/04  [Not refereed][Not invited]
  • 胆管ステントの現況と将来 悪性胆道狭窄に対するメタリックステント留置時の乳頭括約筋切開術付加は、ERCP後膵炎の発症を抑制するか
    加藤 新, 桑谷 将城, 坂本 直哉  Gastroenterological Endoscopy  60-  (Suppl.1)  612  -612  2018/04  [Not refereed][Not invited]
  • 超音波内視鏡ガイド下治療の現状と問題点 膵周囲液体貯留に対する超音波内視鏡下ドレナージの現状と問題点
    加藤 新, 桑谷 将城, 坂本 直哉  日本消化器病学会雑誌  115-  (臨増総会)  A69  -A69  2018/04  [Not refereed][Not invited]
  • 肝門部領域胆管癌の胆管水平方向進展診断における経乳頭的鉗子生検の診断能
    杉浦 諒, 桑谷 将城, 平田 幸司, 加藤 新, 川久保 和道, 坂本 直哉  日本消化器病学会雑誌  115-  (臨増総会)  A301  -A301  2018/04  [Not refereed][Not invited]
  • 桑谷 将城, 川久保 和道, 加藤 新, 杉浦 諒, 平田 幸司, 平野 聡, 坂本 直哉  消化器・肝臓内科  2-  (6)  625  -631  2017/12  [Not refereed][Not invited]
  • K. Kawakubo, M. Kuwatani, T. Shimamura, K. Yamashita, R. Goto, M. Watanabe, Y. Koshizuka, N. Kawamura, D. Iwami, K. Hotta, I. Sano, R. Sugiura, S. Kato, N. Shinohara, A. Taketomi, N. Sakamoto  JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY  32-  (11)  1791  -1791  2017/11  [Not refereed][Not invited]
  • 中西 喜嗣, 岡村 圭祐, 土川 貴裕, 中村 透, 村上 壮一, 倉島 庸, 海老原 裕磨, 野路 武寛, 浅野 賢道, 田中 公貴, 七戸 俊明, 平野 聡, 桑谷 将城, 平田 幸司  胆と膵  38-  (10)  1233  -1236  2017/10  [Not refereed][Not invited]
     
    急性胆嚢炎に1〜1.5%ほど胆嚢癌が併発しているとされる。とくに、60歳以上の急性胆嚢炎患者には胆嚢癌の併発率が高くなる。急性胆嚢炎診断時の腹部US検査は胆嚢癌の併発を念頭に置いて施行する必要がある。胆嚢癌を疑う症例に関しては、炎症の鎮静化の後にダイナミックCT、EUSなどの検査を追加し、胆嚢癌の存在を確認する。胆嚢癌の併発を疑う患者においては、PTGBD(経皮経肝胆嚢ドレナージ)は播種の危険があるので原則禁忌であり、胆嚢ドレナージが必要な症例に対してはENGBD(内視鏡的経鼻経胆嚢管胆嚢ドレナージ)を考慮する。手術に関しては、胆嚢癌の併発を疑う症例については、炎症鎮静化後、通常の胆嚢癌に対する手術を行う。術前早期癌と考えられる症例に関しては、開腹胆嚢摘出術を行い、胆嚢管断端を術中迅速病理に提出し陰性を確認する。術後深達度が漿膜下層以深と判明した症例に対しては追加切除を考慮する。(著者抄録)
  • 川久保 和道, 桑谷 将城, 加藤 新, 杉浦 諒, 平田 幸司, 坂本 直哉  消化器・肝臓内科  2-  (3)  274  -281  2017/09  [Not refereed][Not invited]
  • 北海道多施設共同研究における膵癌術前化学(放射線)療法中の胆道ドレナージの臨床成績 metal stent vs.plastic stent
    桑谷 将城, 中村 透, 林 毅, 木村 康利, 小野 道洋, 本谷 雅代, 山北 圭介, 後藤 拓磨, 高橋 邦幸, 真口 宏介, 平野 聡, 坂本 直哉  胆道  31-  (3)  567  -567  2017/08  [Not refereed][Not invited]
  • 腰塚靖之, 川村典生, 渡辺正明, 後藤了一, 川久保和道, 桑谷将城, 山下健一郎, 蒲池浩文, 神山俊哉, 武冨紹信, 嶋村剛  日本移植学会総会プログラム抄録集  53rd-  (総会臨時)  378  -378  2017/08  [Not refereed][Not invited]
  • Kawamoto Yasuyuki, Yuki Satoshi, Yagisawa Masataka, Muranaka Tetsuhito, Harada Kazuaki, Nakatsumi Hiroshi, Kawakubo Kazumichi, Kuwatani Masaki, Sakamoto Naoya, Komatsu Yoshito  ANNALS OF ONCOLOGY  28-  2017/06  [Not refereed][Not invited]
  • Shin Kato, Masaki Kuwatani, Ryo Sugiura, Itsuki Sano, Kazumichi Kawakubo, Naoya Sakamoto  GASTROINTESTINAL ENDOSCOPY  85-  (5)  AB631  -AB632  2017/05  [Not refereed][Not invited]
  • Itsuki Sano, Akio Katanuma, Masaki Kuwatani, Hiroshi Kawakami, Hironari Kato, Takao Itoi, Michihiro Ono, Atsushi Irisawa, Yoshinobu Okabe, Takuji Iwashita, Ichiro Yasuda, Shomei Ryozawa, Seiji Kaino, Naoya Sakamoto  GASTROINTESTINAL ENDOSCOPY  85-  (5)  AB228  -AB229  2017/05  [Not refereed][Not invited]
  • Kazumichi Kawakubo, Masaki Kuwatani, Itsuki Sano, Ryo Sugiura, Shin Kato, Naoya Sakamoto  GASTROINTESTINAL ENDOSCOPY  85-  (5)  AB617  -AB617  2017/05  [Not refereed][Not invited]
  • 北海道内多施設共同研究における切除不能・局所進行膵癌の治療成績
    木村 康利, 中村 透, 林 毅, 桑谷 将城, 本谷 雅代, 小野 道洋, 山北 圭介, 後藤 拓磨, 高橋 邦幸, 真口 宏介, 平野 聡, 竹政 伊知朗, 北海道膵癌研究グループ, Hokkaido, Pancreatic Cancer, Study Group, HOPS  膵臓  32-  (3)  537  -537  2017/05  [Not refereed][Not invited]
  • 川久保 和道, 多田 稔, 桑谷 将城, 佐野 逸紀, 杉浦 諒, 加藤 新, 坂本 直哉  肝・胆・膵  74-  (4)  597  -600  2017/04  [Not refereed][Not invited]
  • I. Sano, M. Kuwatani, R. Sugiura, S. Kato, K. Kawakubo, T. Ueno, Y. Nakanishi, T. Mitsuhashi, H. Hirata, S. Haba, S. Hirano, N. Sakamoto  JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY  32-  (1)  11  -11  2017/01  [Not refereed][Not invited]
  • 川本泰之, 川本泰之, 結城敏志, 八木澤允貴, 八木澤允貴, 村中徹人, 村中徹人, 原田一顕, 原田一顕, 中積宏之, 中積宏之, 川久保和道, 桑谷将城, 小松嘉人, 坂本直哉  日本臨床腫瘍学会学術集会(CD-ROM)  15th-  ROMBUNNO.P1‐107  2017  [Not refereed][Not invited]
  • Shin Kato, Masaki Kuwatani, Ryo Sugiura, Itsuki Sano, Kazumichi Kawakubo, Naoya Sakamoto, Yoshitsugu Nakanishi, Satoshi Hirano, Takashi Ueno, Tomoko Mitsuhashi  JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY  31-  231  -231  2016/11  [Not refereed][Not invited]
  • Kimitoshi Kubo, Hiroshi Kawakami, Hiroshi Kawakami, Masaki Kuwatani, Mutsumi Nishida, Kazumichi Kawakubo, Shuhei Kawahata, Yoko Taya, Yoshimasa Kubota, Yoshimasa Kubota, Toraji Amano, Hiroki Shirato, Naoya Sakamoto  BMC Gastroenterology  16-  (1)  116  -116  2016/09/20  [Not refereed][Not invited]
     
    © 2016 The Author(s). Unfortunately, after publication of this article [1], it was noticed that the title was captured incorrectly during the production process. The words, "a prospective cohort study" were erroneously added twice. The corrected title can be seen above.
  • Hiroyuki Isayama, Yousuke Nakai, Rungsun Rerknimitr, Christopher Khor, James Lau, Hsiu-Po Wang, Dong Wan Seo, Thawee Ratanachu-Ek, Sundeep Lakhtakia, Tiing Leong Ang, Shomei Ryozawa, Tsuyoshi Hayashi, Hiroshi Kawakami, Natusyo Yamamoto, Takuji Iwashita, Fumihide Itokawa, Masaki Kuwatani, Masayuki Kitano, Keiji Hanada, Hirofumi Kogure, Tsuyoshi Hamada, Ryan Ponnudurai, Jong Ho Moon, Takao Itoi, Ichiro Yasuda, Atsushi Irisawa, Iruru Maetani  Journal of gastroenterology and hepatology  31-  (9)  1555  -65  2016/09  
    Walled-off necrosis (WON) is a new term for encapsulated necrotic tissue after severe acute pancreatitis. Various terminologies such as pseudocyst, necroma, pancreatic abscess, and infected necrosis were previously used in the literature, resulting in confusion. The current and past terminologies must be reconciled to meaningfully interpret past data. Recently, endoscopic necrosectomy was introduced as a treatment option and is now preferred over surgical necrosectomy when the expertise is available. However, high-quality evidence is still lacking, and there is no standard management strategy for WON. The consensus meeting aimed to clarify the diagnostic criteria for WON and the role of endoscopic interventions in its management. In the Consensus Conference, 27 experts from eight Asian countries took an active role and examined key clinical aspects of WON diagnosis and endoscopic management. Statements were crafted based on literature review and expert opinion, employing the modified Delphi method. All statements were substantiated by the level of evidence and the strength of the recommendation. We created 27 consensus statements for WON diagnosis and management, including details of endoscopic procedures. When there was not enough solid evidence to support the statements, this was clearly acknowledged to facilitate future research. Proposed management strategies were formulated and are illustrated using flow charts. These recommendations, which are based on the best current scientific evidence and expert opinion, will be useful for guiding endoscopic management of WON. Part 2 of this statement focused on the endoscopic management of WON.
  • Hiroyuki Isayama, Yousuke Nakai, Rungsun Rerknimitr, Christopher Khor, James Lau, Hsiu-Po Wang, Dong Wan Seo, Thawee Ratanachu-Ek, Sundeep Lakhtakia, Tiing Leong Ang, Shomei Ryozawa, Tsuyoshi Hayashi, Hiroshi Kawakami, Natusyo Yamamoto, Takuji Iwashita, Fumihide Itokawa, Masaki Kuwatani, Masayuki Kitano, Keiji Hanada, Hirofumi Kogure, Tsuyoshi Hamada, Ryan Ponnudurai, Jong Ho Moon, Takao Itoi, Ichiro Yasuda, Atsushi Irisawa, Iruru Maetani  Journal of gastroenterology and hepatology  31-  (9)  1546  -54  2016/09  
    Walled-off necrosis (WON) is a relatively new term for encapsulated necrotic tissue after severe acute pancreatitis. Various terminologies such as pseudocyst, necroma, pancreatic abscess, and infected necrosis were previously used in the literature, resulting in confusion. The current and past terminologies must be reconciled to meaningfully interpret past data. Recently, endoscopic necrosectomy was introduced as a treatment option and is now preferred over surgical necrosectomy when the expertise is available. However, high-quality evidence is still lacking, and there is no standard management strategy for WON. The consensus meeting aimed to clarify the diagnostic criteria for WON and the role of endoscopic interventions in its management. In the Consensus Conference, 27 experts from eight Asian countries took an active role and examined key clinical aspects of WON diagnosis and endoscopic management. Statements were crafted based on literature review and expert opinion, employing the modified Delphi method. All statements were substantiated by the level of evidence and the strength of the recommendation. We created 27 consensus statements for WON diagnosis and management, including details of endoscopic procedures. When there was not enough solid evidence to support the statements, this was clearly acknowledged to facilitate future research. Proposed management strategies were formulated and are illustrated using flow charts. These recommendations, which are based on the best current scientific evidence and expert opinion, will be useful for guiding endoscopic management of WON. Part 1 of this statement focused on the epidemiology, diagnosis, and timing of intervention.
  • Kimitoshi Kubo, Hiroshi Kawakami, Hiroshi Kawakami, Masaki Kuwatani, Mutsumi Nishida, Kazumichi Kawakubo, Shuhei Kawahata, Yoko Taya, Yoshimasa Kubota, Yoshimasa Kubota, Toraji Amano, Hiroki Shirato, Naoya Sakamoto  BMC Gastroenterology  16-  (1)  2016/07/08  [Not refereed][Not invited]
     
    © 2016 The Author(s). Background: Obstructive jaundice has been reported to influence liver elasticity, independent of liver fibrosis. The aim of our prospective study was to evaluate the changes in liver elasticity, before and after biliary drainage, in patients with obstructive jaundice, and to evaluate the correlation between elasticity measures and serum markers of liver fibrosis. Methods: This is a prospective cohort study of 20 patients with obstructive jaundice. Liver elasticity was assessed by Transient Elastography (TE) and Virtual Touch™ Quantification (VTQ). Serum total bilirubin (T-Bil) level was measured before biliary drainage (Day 0), with measures repeated at 2 days (Day 2) and 7 days (Day 7) after biliary drainage. Serum levels of the following markers of liver fibrosis were also obtained on Day 0 and Day 7: hyaluronic acid (HA), procollagen-III-peptide (P-III-P). Results: T-Bil, TE, and VTQ for the left (VTQ-L) and right (VTQ-R) lobes of the liver were all elevated before biliary drainage, with respective levels, measured at Day 0, of 11.9 ± 1.5 mg/dl, 12.1 ± 0.9 kPa, 2.23 ± 0.10 m/s, and 1.85 ± 0.10 m/s. All values decreased on Day 7 after drainage: T-Bil, 4.7 ± 1.0 mg/dl (P < 0.001); TE, 7.6 ± 0.6 kPa (P < 0.001); VTQ-L, 1.53 ± 0.08 m/s (P < 0.001); and VTQ-R, 1.30 ± 0.05 m/s (P < 0.001). Similar changes were observed in serum markers of liver fibrosis. Liver elasticity measures correlated with serum levels of T-Bil, P-III-P, and HA (r = 0.35-0.67, P < 0.001). Conclusions: This study confirmed decreases in liver elasticity, measured by TE and VTQ, after biliary drainage. Measures of liver elasticity correlated to levels of T-Bil and serum markers of liver fibrosis. (UMIN ID: UMIN00001284313). Trial registration: Registration number: University Hospital Medical Information Network (UMIN) Clinical Trials Registry (UMIN ID: UMIN00001284313); Registration date: 2014-01-14.
  • Kimitoshi Kubo, Hiroshi Kawakami, Masaki Kuwatani, Tomoko Mitsuhashi, Kazumichi Kawakubo, Shuhei Kawahata, Yoshimasa Kubota, Naoya Sakamoto  PANCREAS  45-  (6)  925  -926  2016/07  [Not refereed][Not invited]
  • Masaki Kuwatani, Hiroshi Kawakami, Kazumichi Kawakubo, Shuhei Kawahata, Kimitoshi Kubo, Yoshimasa Kubota, Naoya Sakamoto  GASTROINTESTINAL ENDOSCOPY  83-  (5)  AB355  -AB355  2016/05  [Not refereed][Not invited]
  • Kazumichi Kawakubo, Kei Yane, Kazunori Eto, Hirotoshi Ishiwatari, Nobuyuki Ehira, Shin Haba, Ryusuke Matsumoto, Keisuke Shinada, Hiroaki Yamato, Taiki Kudo, Manabu Onodera, Toshinori Okuda, Yoko Taya, Shuhei Kawahata, Kimitoshi Kubo, Yoshimasa Kubota, Masaki Kuwatani, Hiroshi Kawakami, Akio Katanuma, Michihiro Ono, Tsuyoshi Hayashi, Minoru Uebayashi, Naoya Sakamoto  GASTROINTESTINAL ENDOSCOPY  83-  (5)  AB208  -AB208  2016/05  [Not refereed][Not invited]
  • Kubo Kimitoshi, Kawakami Hiroshi, Kubota Yoshimasa, Kawahata Shuhei, Kawakubo Kazumichi, Kuwatani Masaki, Ueno Takashi, Mitsuhashi Tomoko, Sakamoto Naoya  Tando  30-  (4)  723  -730  2016  
    A 60-year-old male with a tumor of the gallbladder that was detected by screening ultrasonography (US) was referred to our hospital for workup. US revealed a pedunculated polyp at the fundus of gallbladder and diffuse thickened wall of the gallbladder. We followed it on the diagnosis of cholesterol polyp and cholesterosis. During the follow-up period, the polyp tended to enlarge and change morphologically. Since adenoma or gallbladder carcinoma in situ could be considered as a diagnosis of the polyp based on various images, a laparoscopic cholecystectomy was carried out. Resected specimen revealed a light yellowish pedunculated polyp at the fundus of gallbladder and cholesterosis. Histologically, it was covered with a simple epithelium with low-grade atypia and was composed of mucinous edematous stroma with few infiltration of foamy cells in lamina propria, and finally diagnosed as a fibrous polyp. This is a rare case with a fibrous polyp of the gallbladder and has been suspected to change from a cholesterol polyp.
  • Kazumichi Kawakubo, Hiroshi Kawakami, Masaki Kuwatani, Shin Haba, Taiki Kudo, Yoko Abe, Shuhei Kawahata, Yoshimasa Kubota, Kimitoshi Kubo, Kazunori Eto, Nobuyuki Ehira, Hiroaki Yamato, Naoya Sakamoto  JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY  30-  235  -235  2015/12  [Not refereed][Not invited]
  • 【難治な胆道良性疾患の対処法を考える】 良性胆道疾患別の診断と治療(各論) 虚血性胆管炎
    Zen Yoh, 河上洋, 桑谷将城, 三橋智子, 坂本直哉  肝・胆・膵  71-  (3号)  481  -487  2015/09  [Not refereed][Invited]
  • Yoshimasa Kubota, Hiroshi Kawakami, Mitsuteru Natsuizaka, Masaki Kuwatani, Kazumichi Kawakubo, Yoko Abe, Shuhei Kawahata, Kimitoshi Kubo, Naoya Sakamoto  GASTROENTEROLOGY  148-  (4)  S941  -S941  2015/04  [Not refereed][Not invited]
  • Masaki Kuwatani, Hiroshi Kawakami, Kazumichi Kawakubo, Shuhei Kawahata, Kimitoshi Kubo, Yoko Abe, Naoya Sakamoto  GASTROENTEROLOGY  148-  (4)  S292  -S293  2015/04  [Not refereed][Not invited]
  • K. Kawakubo, H. Kawakami, M. Kuwatani, N. Sakamoto  JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY  30-  (4)  655  -655  2015/04  [Not refereed][Not invited]
  • KUBO Kimitoshi, ONODERA Manabu, SOGABE Susumu, ODA Hisashi, MIYAGISHIMA Takuto, TAKAHASHI Tatsurou, KUWATANI Masaki  GASTROENTEROLOGICAL ENDOSCOPY  57-  (7)  1467  -1476  2015  
    [Background and aim] Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) of mediastinal lesions has been reported as an available method for diagnosis in the last two decades, while transbronchial lung biopsy (TBLB) has been performed for diagnosis of lung cancer. We aimed to investigate the efficacy of EUS-FNA of a mediastinal lesion and the contribution of EUS-FNA to the diagnosis of lung cancer with TBLB. [Method] Between May 2010 and March 2012, we performed EUS-FNA on a total of 102 lesions (mediastinal lesion, 52 ; pancreatic lesion, 40 ; others, 10). Among them, we retrospectively analyzed the results of EUS-FNA of the 52 mediastinal lesions with the results of TBLB. [Results] The diagnostic rate by EUS-FNA in the 52 lesions was 100% (52/52). The final diagnoses were metastasis of lung cancer to a lymph node, 29 ; metastasis of gastrointestinal or prostate cancer to a lymph node, 3 ; sarcoidosis, 4 ; malignant lymphoma, 2 ; and inflammatory or non-specific lymphadenopathy, 14. The acquisition rates of evaluable cells and tissues obtained by EUS-FNA were 100% (52/52) and 98% (51/52), respectively. Among the 29 patients with lung cancer, the diagnostic accuracy of TBLB was 36% (9/25), and that of both EUS-FNA and TBLB was increased to 100%. [Conclusion] EUS-FNA is effective for diagnosis of a mediastinal lesion. Especially for diagnosis of lung cancer, EUS-FNA plays a complementary role to TBLB.
  • 河上 洋, 桒谷 将城, 川久保 和道  臨床外科 = Journal of clinical surgery  70-  (1)  6  -11  2015/01
  • 川久保 和道, 河上 洋, 桑谷 将城  映像情報medical  46-  (9)  833  -839,790-792  2014/09
  • EGFR阻害剤を用いた食道扁平上皮癌幹細胞を標的とした新規治療法の開発(EGFR inhibitors suppress EMT and diminish cancer stem-like cells in esophageal squamous cell carcinoma)
    佐藤 史幸, 夏井坂 光輝, 大橋 真也, 賀川 真吾, 桑谷 将城, 河上 洋, 大西 俊介, 小松 嘉人, 加藤 元嗣, 坂本 直哉  日本癌学会総会記事  73回-  J  -1034  2014/09  [Not refereed][Not invited]
  • Yoshimasa Kubota, Hiroshi Kawakami, Mitsuteru Natsuizaka, Kazumichi Kawakubo, Katsuji Marukawa, Taiki Kudo, Yoko Abe, Kimitoshi Kubo, Masaki Kuwatani, Yutaka Hatanaka, Tomoko Mitsuhashi, Yoshihiro Matsuno, Naoya Sakamoto  GASTROENTEROLOGY  146-  (5)  S871  -S871  2014/05  [Not refereed][Not invited]
  • 河上 洋, 桒谷 将城, 川久保 和道  消化器内科  58-  (4)  535  -542  2014/04
  • Hiroshi Kawakami, Daisuke Abo, Kazumichi Kawakubo, Masaki Kuwatani, Yuki Yoshino, Yoshimasa Kubota, Yoko Abe, Shuhei Kawahata, Kimitoshi Kubo, Yusuke Sakuhara, Hiroki Shirato, Naoya Sakamoto  Endoscopy  46-  E460-1  2014/01/01  [Not refereed][Not invited]
  • K. Kawakubo, H. Kawakami, M. Kuwatani, S. Haba, T. Kudo, Y. Abe, N. Sakamoto  ENDOSCOPY  45-  E89  -E90  2013/12  [Not refereed][Not invited]
  • 食道扁平上皮癌におけるTGF-βおよびNotch1による癌幹細胞維持機構(TGF-β changes a switch of Notch1-mediated signaling to maintain tumor-initiating cells in esophageal SCC(ESCC))
    夏井坂 光輝, 大橋 真也, 長沼 誠二, 大西 俊介, 桑谷 将城, 河上 洋, 中馬 誠, 小松 嘉人, 加藤 元嗣, 坂本 直哉  日本癌学会総会記事  72回-  137  -137  2013/10  [Not refereed][Not invited]
  • 河上 洋, 桑谷 将城, 川久保 和道, 羽場 真, 工藤 大樹, 阿部 容子, 川畑 修平, 田中 栄一, 平野 聡, 浅香 正博, 坂本 直哉  北海道醫學雜誌 = Acta medica Hokkaidonensia  88-  (2)  90  -90  2013/04/01
  • 羽場 真, 河上 洋, 桒谷 将城  膵・胆道癌frontier  3-  (1)  14  -17  2013/03
  • Kazumichi Kawakubo, Hiroshi Kawakami, Masaki Kuwatani, Yoko Abe, Taiki Kudo, Shin Haba, Naoya Sakamoto  JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY  27-  77  -77  2012/12  [Not refereed][Not invited]
  • 【胆膵ステントの新しい潮流-開発コンセプトとステント選択を学ぶ-】 EUS-guided hepaticogastrostomy(EUS-HGS)におけるcovered metallic stent 専用ステントの開発コンセプト
    川久保 和道, 河上 洋, 桑谷 将城, 羽場 真, 工藤 大樹, 阿部 容子, 伊佐山 浩通, 小池 和彦, 坂本 直哉  胆と膵  33-  (10)  865  -868  2012/10  [Not refereed][Not invited]
     
    超音波内視鏡下胆管胃吻合術(endoscopic ultrasound-guided hepaticogastrostsomy:EUS-HGS)は、悪性胆管狭窄による閉塞性黄疸に対しての有効性が報告されている。しかし、本邦では専用のステントがまだ使用できないのが現状である。EUS-HGS専用ステントとして求められることは、(1)ショートニングが少ない、(2)肝内胆管側ではカバーがなく、腹腔を通過するところにカバーがある、(3)アンカー機能、(4)レントゲン不透過マーカー、などである。現在、ヨーロッパでは、EUS-HGS専用としてGioBorステントが市販されているが、手技の普及のためには、さらなるステントの開発が必要と考える。(著者抄録)
  • Hiroshi Kawakami, Masaki Kuwatani, Eiichi Tanaka, Satoshi Hirano  JOURNAL OF GASTROENTEROLOGY  47-  (1)  90  -91  2012/01  [Not refereed][Not invited]
  • 河上 洋, 近藤 哲, 桑谷 将城  内科  107-  (3)  432  -436  2011/03
  • 阿保大介, 森谷亮, 長谷川悠, 作原祐介, 白土博樹, 寺江聡, 清水匡, 桑谷将城, 河上洋, 田中栄一, 平野聡, 近藤哲  IVR  25-  (4)  557  -557  2010/10/01  [Not refereed][Not invited]
  • Kazunori Eto, Hiroshi Kawakami, Masaki Kuwatani, Shin Haba, Satoshi Hirano, Satoshi Kondo, Kanako Kubota, Yoshihiro Matuno, Atushi Hirayama, Yuuko Gotouda, Masahiro Asaka  PANCREAS  39-  (5)  699  -700  2010/07  [Not refereed][Not invited]
  • 河上 洋, 桑谷 将城, 小野寺 学  Gastroenterology  50-  (2)  175  -179  2010/02
  • Masaki Kuwatani, Hiroshi Kawakami, Shin Haba, Kazunori Eto, Manabu Onodera, Masahiro Asaka  INTERNAL MEDICINE  49-  (6)  627  -628  2010  [Not refereed][Not invited]
  • Hiroshi Kawakami, Kazunori Eto, Masaki Kuwatani, Masahiro Asaka  INTERNAL MEDICINE  49-  (21)  2359  -2360  2010  [Not refereed][Not invited]
  • Hiroshi Kawakami, Minoru Uebayashi, Kohei Konishi, Masaki Kuwatani, Keisuke Shinada, Hiroaki Yamato, Masahiro Asaka  GASTROINTESTINAL ENDOSCOPY  67-  (7)  1170  -1171  2008/06  [Not refereed][Not invited]
  • 桑谷将城, 河上洋, 大和弘明, 品田恵佐, 田中栄一, 平野聡, 近藤哲, 伊藤智雄, 浅香正博  日本消化器病学会雑誌  105-  (7)  1061  -1069  2008  [Not refereed][Not invited]
  • KUWATANI Masaki, KAWAKAMI Hiroshi, ONODERA Manabu, HIRANO Satoshi, KONDO Satoshi, ITOH Tomoo, KOSHIYAMA Tatsumi, KAWAKAMI Ayae, ASAKA Masahiro  Gastroenterol Endosc  49-  (5)  1303  -1309  2007  [Not refereed][Not invited]
  • Masaki Kuwatani, Yoshinori Ikarashi, Shin Mineishi, Masahiro Asaka, Hiro Wakasugi  TRANSPLANTATION  81-  (9)  1357  -1358  2006/05  [Not refereed][Not invited]

Awards & Honors

  • 2024/02 Japan Gastroenterological Endoscopy Society Digestive Endoscopy Best Reviewers Award 2023
  • 2023/06 Japanese Society of Hepato-Biliary-Pancreatic Surgery Journal of Hepato-Biliary-Pancreatic Sciences Best Reviewer Award 2022
  • 2023/03 Japan Gastroenterological Endoscopy Society DEN Open: Best Reviewers Award 2022
  • 2023/02 Japan Gastroenterological Endoscopy Society Digestive Endoscopy Best Reviewers Award 2022
  • 2023/01 内視鏡医学研究振興財団 2022年度研究助成B
     抗体と低分子化合物を用いて膵癌細胞と癌関連線維芽細胞を標的とした内視鏡的二重光免疫療法の開発
  • 2022/06 Japanese Society of Hepato-Biliary-Pancreatic Surgery Journal of Hepato-Biliary-Pancreatic Sciences Best Reviewers Award 2021
  • 2020/01 内視鏡医学研究振興財団 2019年度研究助成B
     胆管癌に対する光感受性色素複合体を用いた内視鏡的光線免疫療法の開発
  • 2019/03 Japan Gastroenterological Endoscopy Society Digestive Endoscopy Best Reviewers Award 2018
  • 2011/01 内視鏡医学研究振興財団 2010年度研究助成B
     内視鏡的逆行性胆管膵管造影 (ERCP) の苦痛低減のためのCO2送気法の有用性に関する多施設共同無作為化二重盲検比較試験
  • 2008/09 秋山記念生命科学振興財団 研究助成（一般）
     骨髄移植後GVHDに対する胎児付属物由来間葉系幹細胞の効果

Research Grants & Projects

  • 日本学術振興会：科学研究費助成事業 基盤研究(C)
    Date (from‐to) : 2023/04 -2026/03 
    Author : 桑谷 将城, 中島孝平, 川久保和道
  • 日本学術振興会：科学研究費助成事業
    Date (from‐to) : 2022/08 -2024/03 
    Author : 杉浦諒, 桑谷将城, 川久保和道, 川本泰之
     
    胆道癌は，根治切除割合は低く，緩和的化学療法も十分でないことから難治性悪性腫瘍の一つとされる．近年，細菌叢（マイクロバイオーム）と様々な疾患との関連が明らかになっているが，胆道癌においては免疫チェックポイント阻害薬の効果，治療抵抗性と糞便内マイクロバイオームとの関連性が報告されているのみである．胆道癌腫瘍内および胆汁中マイクロバイオームと殺細胞性抗癌剤や免疫チェックポイント阻害薬への抵抗性，予後への関与について検討した研究はない．したがって，本研究では胆道癌患者から得られた腫瘍生検検体および胆汁中のマイクロバイオームと化学療法（殺細胞性抗癌剤，あるいは殺細胞性抗癌剤+免疫チェックポイント阻害薬）への抵抗性や予後との関連を明らかにすることを目的とする．それらの関連性が明らかになることで，治療薬剤の選択や，マイクロバイオームに関連した新薬創薬標的の探索研究へ繋げられる可能性がある． 本研究では，目標症例数を40例とし，当該施設での倫理審査を得て，2023年2月から検体収集を開始した．腫瘍内細菌の由来を検討するため，内視鏡的逆行性胆管膵管造影検査（ERCP）に続いて行われる鉗子生検によって得られる生検検体と胆汁を収集している．2023年3月31日までで仮登録を含めて5例の検体収集をおこなっており，引き続き検体採取を行っている． 今後，検体が揃い次第，順次，16S rRNA領域を次世代シーケンサーと菌叢解析ツールを用いて解析し，検体内に棲息するマイクロバイオームを網羅的に同定する。また，診療録から得られる、対象者の基本情報、血液検査所見、画像検査所見、治療情報・アウトカム（無増悪生存期間，全生存期間）等との関連を検討する．
  • 膵外分泌機能を評価する血液バイオマーカーを用いた膵がんリスク疾患・早期膵がんの診断法の臨床開発
    国立研究開発法人日本医療研究開発機構（AMED）：革新的がん医療実用化研究事業
    Date (from‐to) : 2021/04 -2024/03 
    Author : 本田一文, 小西宏, 井戸章雄, 坪内博仁, 桑谷将城, 小畑大輔, 長島健悟, 吉田寛, 岩切勝彦, 宮本美津子
  • Japan Society for the Promotion of Science：Grants-in-Aid for Scientific Research Grant-in-Aid for Young Scientists (B)
    Date (from‐to) : 2015/04 -2017/03 
    Author : Kawakubo Kazumichi, MITSUHASHI Tomoko, MIZUKAMI Yusuke, ONO Yusuke, KUWATANI Masaki
     
    Endoscopic ultrasonography-guided through-the-needle cyst wall biopsy (EUS-TNCB) was performed in two patients. A 71-year-old female had 32mm cystic lesion in the head of the pancreas. EUS-TNCB revealed fragmented epithelial cells with small nucleus with interstitial fibrotic tissue. A 48-year-old male had 20mm cystic lesion in the body of the pancreas. EUS-TNCB revealed no epithelial cells but interstitial fibrotic tissue. Gene mutation analysis by next-generation sequencer could not detect any mutation in both samples.
  • Japan Society for the Promotion of Science：Grants-in-Aid for Scientific Research Grant-in-Aid for Young Scientists (B)
    Date (from‐to) : 2012 -2014 
    Author : KUWATANI Masaki, KAWAKUBO Kazumichi, OHNISHI Shunsuke
     
    Objectives: We investigated the effect of rat FM-derived mesenchymal stem cells (FM-MSCs) and human amnion-derived MSCs (AMSCs) on the therapeutic effects in rats with acute and chronic pancreatitis. Methods: Acute pancreatitis was induced by intraductal injection of taurocholate, and rat FM-MSCs were transplanted intravenously. Chronic pancreatitis was induced by intravenous injection of 5 mg/kg dibutyltin dichloride, and human AMSCs were transplanted intravenously. Results: Transplantation of rat FM-MSCs significantly reduced the histological score and infiltration of CD68-positive macrophages in the rat pancreas. Human AMSC transplantation significantly decreased the expression of MCP-1 and attenuated the downregulation of amylase expression in the pancreas. Conclusions: Transplantation of FM-MSCs and AMSCs suppressed the inflammatory reaction of acute and chronic pancreatitis in rats.

Educational Activities

Teaching Experience

  • Master's Thesis Research in Medical Sciences
    開講年度 : 2021
    課程区分 : 修士課程
    開講学部 : 医学院
    キーワード : 肝炎ウイルス、癌ゲノミクス、H.pylori、食道癌 Hepatitis viruses、Cancer genomics、H.pylori、Esophageal cancer
  • Basic Principles of Medicine
    開講年度 : 2021
    課程区分 : 修士課程
    開講学部 : 医学院
    キーワード : 肝炎ウイルス、癌ゲノミクス、H.pylori、分子標的療法 Hepatitis viruses、Cancer genomics、H.pylori、Molecular targeting therapies
  • Principles of Medicine
    開講年度 : 2021
    課程区分 : 博士後期課程
    開講学部 : 医学院
    キーワード : 肝炎ウイルス、癌ゲノミクス、H.pylori、食道癌、膵癌、炎症性腸疾患
  • Dissertation Research in Medical Sciences
    開講年度 : 2021
    課程区分 : 博士後期課程
    開講学部 : 医学院
    キーワード : 肝炎ウイルス、癌ゲノミクス、H.pylori、分子標的療法、がんプロフェッショナル
  • Dissertation Research in Clinical Medicine
    開講年度 : 2021
    課程区分 : 博士後期課程
    開講学部 : 医学院
    キーワード : 肝炎ウイルス、癌ゲノミクス、H.pylori、食道癌、膵癌、炎症性腸疾患

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