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A Rare Case of a White-Furred Ileocecal Valve
Shinya Taki,Takao Maekita,Masayuki Kitano 대한소화기내시경학회 2021 Clinical Endoscopy Vol.54 No.4
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Shinya Taki,Takao Maekita,Mayumi Sakata,Kazuhiro Fukatsu,Yoshimasa Maeda,Mikitaka Iguchi,Hidefumi Ito,Masayuki Kitano 대한소화기내시경학회 2019 Clinical Endoscopy Vol.52 No.6
Continuous duodenal levodopa/carbidopa intestinal gel delivery by a gastrostomy infusion system improves control of Parkinson’sdisease. The overall complication rates of percutaneous endoscopic gastrojejunostomy were reported to be 41% and 59% for immediateand delayed adverse events, respectively. A 72-year-old woman underwent percutaneous endoscopic gastrojejunostomy using thedelivery system noted above. Abdominal pain and vomiting occurred 3 months later. Esophagogastroduodenoscopy showed alongitudinal ulcer extending from the lower gastric body to the ileum end, with small intestinal telescoping. Colonoscopy showed alarge bezoar of food residue that was attached around the tip of the tube, reaching the ascending colon, which may have acted as ananchor. Thus, the gastric antrum and small intestine were shortened with telescoping. This complication was resolved by crushing thebezoar with forceps during colonoscopy and can be prevented by consuming a fiber-free diet and periodic exchanges of the tube usingesophagogastroduodenoscopy.
Hideyuki Tamai,Naoki Shingaki,Yoshiyuki Mori,Kosaku Moribata,Akira Kawashima,Yoshimasa Maeda,Toru Niwa,Hisanobu Deguchi,Izumi Inoue,Takao Maekita,Mikitaka Iguchi,Jun Kato,Masao Ichinose 거트앤리버 소화기연관학회협의회 2016 Gut and Liver Vol.10 No.4
Background/Aims: This study aimed to predict sustained viral response (SVR) to low-dose pegylated interferon (PEGIFN) plus ribavirin of elderly and/or cirrhotic patients with genotype 2 hepatitis C virus (HCV) using viral response within 2 weeks. Methods: Low-dose PEG-IFN-α-2b plus ribavirin was administered to 50 elderly and/or cirrhotic patients with genotype 2 HCV for 24 weeks. The dynamics of HCV RNA and HCV core antigen levels within 2 weeks were measured. Results: The patients’ median age was 66 years. There were 21 male and 29 female patients. The median baseline HCV RNA level was 5.7 log IU/mL. Rapid viral response was achieved in 17 patients (34%), SVR in 28 (56%), and two (4%) discontinued treatment. Univariate analysis of factors contributing to SVR showed significant differences for sex, baseline virus level, and response within 4 weeks. When 40 fmol/L was set as the cutoff value for the core antigen level at 1 week, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for predicting SVR were 93%, 75%, 84%, 88%, and 85%, respectively. Conclusions: Low-dose PEG-IFN plus ribavirin was a safe and costeffective treatment for elderly and/or cirrhotic patients with genotype 2 HCV, and the viral response within 2 weeks was a useful predictor of SVR.
Yasunobu Yamashita,Kensuke Tanioka,Yuki Kawaji,Takashi Tamura,Junya Nuta,Keiichi Hatamaru,Masahiro Itonaga,Takeichi Yoshida,Yoshiyuki Ida,Takao Maekita,Mikitaka Iguchi,Masayuki Kitano 거트앤리버 소화기연관학회협의회 2020 Gut and Liver Vol.14 No.5
Background/Aims: Rosemont classification (RC) with endoscopic ultrasonography (EUS) is important for diagnosing chronic pancreatitis (CP) but is based only on subjective judgement. EUS shear wave measurement (EUS-SWM) is a precise modality based on objective judgment, but its usefulness has not been extensively studied yet. This study evaluated the utility of EUS-SWM for diagnosing CP and estimating CP severity by determining the presence of endocrine dysfunction along with diabetes mellitus (DM). Methods: Between June 2018 and December 2018, 52 patients who underwent EUS and EUS-SWM were classified into two groups according to RC: non-CP (indeterminate CP and normal) and CP (consistent and suggestive of CP). The EUSSWM value by shear wave velocity was evaluated with a median value. The EUS-SWM value was compared with RC and the number of EUS features. The diagnostic accuracy and cutoff value of EUS-SWM for CP and DM and its sensitivity and specificity were calculated. Results: The EUS-SWM value significantly positively correlated with the RC and the number of EUS features. The EUS-SWM values that were consistent and suggestive of CP were significantly higher than that of normal. The area under the receiver operating characteristic (AUROC) curve for the diagnostic accuracy of EUS-SWM for CP was 0.97. The cutoff value of 2.19 had 100% sensitivity and 94% specificity. For endocrine dysfunction in CP, the AUROC was 0.75. The cutoff value of 2.78 had 70% sensitivity and 56% specificity. Conclusions: EUS-SWM provides an objective assessment and can be an alternative diagnostic tool for diagnosing CP. EUS-SWM may also be useful for predicting the presence of endocrine dysfunction.
The Real-World Safety and Efficacy of Daclatasvir and Asunaprevir for Elderly Patients
( Shinya Taki ),( Hideyuki Tamai ),( Yoshiyuki Ida ),( Naoki Shingaki ),( Akira Kawashima ),( Ryo Shimizu ),( Kosaku Moribata ),( Takao Maekita ),( Mikitaka Iguchi ),( Jun Kato ),( Taisei Nakao ),( Ma 대한간학회 2018 Gut and Liver Vol.12 No.1
Background/Aims: Although daclatasvir with asunaprevir was approved in Japan for interferon ineligible or intolerant patients, patients aged ≥75 years were excluded in the phase III trial. The present study aimed to evaluate the safety and efficacy of this therapy for elderly patients aged ≥75 years and to clarify whether an extremely high sustained virological response (SVR) rate can be achieved, even in a real-world setting when patients with resistance-associated substitutions (RASs) to nonstructural protein 5A (NS5A) inhibitors or prior simeprevir failure are excluded. Methods: Daclatasvir (60 mg) and asunaprevir (100 mg) were orally administered daily for 24 weeks. Patients without pre-existing NS5A RASs and simeprevir failure were enrolled in this study. Results: Overall, 110 patients were treated. The median age was 73 years old. The SVR rates of total patients, those aged ≥75 years, and those aged <75 years were 97% (107/110), 98% (46/47), and 97% (61/63), respectively. The treatment of two patients (2%) was discontinued because of adverse events. Conclusions: Daclatasvir with asunaprevir was a safe treatment, even in patients aged ≥75 years. When patients without pre-existing NS5A RASs and prior simeprevir failure were selected, an extremely high SVR rate could be achieved irrespective of age. (Gut Liver 2018;12:86-93)
( Hideyuki Tamai ),( Yoshiyuki Ida ),( Akira Kawashima ),( Naoki Shingaki ),( Ryo Shimizu ),( Kosaku Moribata ),( Tetsushi Nasu ),( Takao Maekita ),( Mikitaka Iguchi ),( Jun Kato ),( Taisei Nakao ),( 대한간학회 2017 Gut and Liver Vol.11 No.4
Background/Aims: The present study aimed to evaluate the safety and efficacy of simeprevir-based triple therapy with reduced doses of pegylated interferon (PEG-IFN) and ribavirin for interferon (IFN) ineligible patients, such as elderly and/or cirrhotic patients, and to elucidate the factors contributing to a sustained virologic response (SVR). Methods: One hundred IFN ineligible patients infected with genotype 1b hepatitis C virus (HCV) were treated. Simeprevir (100 mg) was given orally together with reduced doses of PEG-IFN-α 2a (90 μg), and ribavirin (200 mg less than the recommended dose). Results: The patients` median age was 70 years, and 70 patients were cirrhotic. Three patients (3%) discontinued treatment due to adverse events. The SVR rate was 64%. Factors that significantly contributed to the SVR included the γ-glutamyl transferase and α-fetoprotein levels, interleukin- 28B (IL28B) polymorphism status, and the level and reduction of HCV RNA at weeks 2 and 4. The multivariate analysis showed that the IL28B polymorphism status was the only independent factor that predicted the SVR, with a positive predictive value of 77%. Conclusions: Simeprevir-based triple therapy with reduced doses of PEG-IFN and ribavirin was safe and effective for IFN ineligible patients infected with genotype 1b HCV. IL28B polymorphism status was a useful predictor of the SVR. (Gut Liver 2017;11:551-558)
Yasunobu Yamashita,Kazuki Ueda,Yuki Kawaji,Takashi Tamura,Masahiro Itonaga,Takeichi Yoshida,Hiroki Maeda,Hirohito Magari,Takao Maekita,Mikitaka Iguchi,Hideyuki Tamai,Masao Ichinose,Jun Kato 거트앤리버 소화기연관학회협의회 2016 Gut and Liver Vol.10 No.4
Background/Aims: Transpapillary forceps biopsy is an effective diagnostic technique in patients with biliary stricture. This prospective study aimed to determine the usefulness of the wire-grasping method as a new technique for forceps biopsy. Methods: Consecutive patients with biliary stricture or irregularities of the bile duct wall were randomly allocated to either the direct or wire-grasping method group. In the wiregrasping method, forceps in the duodenum grasps a guidewire placed into the bile duct beforehand, and then, the forceps are pushed through the papilla without endoscopic sphincterotomy. In the direct method, forceps are directly pushed into the bile duct alongside a guide-wire. The primary endpoint was the success rate of obtaining specimens suitable for adequate pathological examination. Results: In total, 32 patients were enrolled, and 28 (14 in each group) were eligible for analysis. The success rate was significantly higher using the wire-grasping method than the direct method (100% vs 50%, p=0.016). Sensitivity and accuracy for the diagnosis of cancer were comparable in patients with the successful procurement of biopsy specimens between the two methods (91% vs 83% and 93% vs 86%, respectively). Conclusions: The wire-grasping method is useful for diagnosing patients with biliary stricture or irregularities of the bile duct wall.
Takashi Tamura,Yasunobu Yamashita,Kazuki Ueda,Yuki Kawaji,Masahiro Itonaga,Shin-ichi Murata,Kaori Yamamoto,Takeichi Yoshida,Hiroki Maeda,Takao Maekita,Mikitaka Iguchi,Hideyuki Tamai,Masao Ichinose,Jun 대한소화기내시경학회 2017 Clinical Endoscopy Vol.50 No.4
Background/Aims: Endoscopic ultrasonography-guided fine-needle aspiration (EUS-FNA) has been used to diagnose gastrointestinal submucosal tumors (SMTs). Although rapid on-site evaluation (ROSE) has been reported to improve the diagnostic accuracy of EUS-FNA for pancreatic lesions, on-site cytopathologists are not routinely available. Given this background, the usefulness of ROSE by endosonographers themselves for pancreatic tumors has also been reported. However, ROSE by endosonographers for diagnosis of SMT has not been reported. The aim of this study was to evaluate the diagnostic accuracy of EUS-FNA with ROSE by endosonographers for SMT, focusing on diagnosis of gastrointestinal stromal tumor (GIST), compared with that of EUS-FNA alone. Methods: Twenty-two consecutive patients who underwent EUS-FNA with ROSE by endosonographers for SMT followed by surgical resection were identified. Ten historical control subjects who underwent EUS-FNA without ROSE were used for comparison. Results: The overall diagnostic accuracy for SMT was significantly higher in cases with than without ROSE (100% vs. 80%, p=0.03). The number of needle passes by FNA with ROSE by endosonographers tended to be fewer, although accuracy was increased (3.3±1.3 vs. 5.9±3.8, p=0.06). Conclusions: ROSE by endosonographers during EUS-FNA for SMT is useful for definitive diagnosis, particularly for GIST.