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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.
Kunihiro Oyama,Masato Kanzaki,Mitsuko Kondo,Hideyuki Maeda,Kei Sakamoto,Tamami Isaka,Jun Tamaoki,Takamasa Onuki 대한흉부외과학회 2017 Journal of Chest Surgery (J Chest Surg) Vol.50 No.3
Background: To improve postoperative outcomes associated with interstitial pneumonia (IP) in patients with lung c ancer, t he m anagement of t he p ostoperative a cute e xacerbation of I P (PAEIP) was investigated. Methods: Patients with primary lung cancer were considered to be at risk for PAEIP (possible PAEIP) based on a preoperative evaluation. The early phase of this study was from January 2001 to December 2008, and the late phase was from January 2009 to December 2014. In the early phase, chest computed tomography (CT) was performed for patients for whom PAEIP was suspected based on their symptoms, whereas in the late p hase, chest CT w as r outinely p erformed w ithin a few days p ostoperatively. The n umbers o f possible PAEIP cases, actual PAEIP cases, and deaths within 90 days due to PAEIP were compared between both phases. Results: In the early and late phases, surgery was performed in 712 and 617 patients, 31 and 72 possible PAEIP cases were observed, nine and 12 actual PAEIP cases occurred, and the mean interval from the detection of PAEIP to starting treatment was 7.3±2.3 and 5.0±1.8 days, respectively. Five patients died in the early phase, and one patient died in the late phase. Significantly fewer PAEIP-related deaths were observed in the late phase (p<0.05). Conclusion: Identifying patients at risk for PAEIP by routine postoperative CT examinations led to the early diagnosis and treatment of PAEIP, resulting in the reduction of PAEIP-related mortality.
Clinical Efficacy of Endocytoscopy for Gastrointestinal Endoscopy
Masashi Misawa,Shin-ei Kudo,Yuki Takashina,Yoshika Akimoto,Yasuharu Maeda,Yuichi Mori,Toyoki Kudo,Kunihiko Wakamura,Hideyuki Miyachi,Fumio Ishida,Haruhiro Inoue 대한소화기내시경학회 2021 Clinical Endoscopy Vol.54 No.4
Endocytoscopy (EC) is a contact-type optical endoscope that allows in vivo cellular observation during gastrointestinal endoscopyand is now commercially available not only in Japan but also in Asian, European Union, and Middle Eastern countries. EC helpsconduct a highly accurate pathological prediction without biopsy. Initially, EC was reported to be effective for esophageal diseases. Subsequently, its efficacy for stomach and colorectal diseases has been reported. In this narrative review, we searched for clinicalstudies that investigated the efficacy of EC. EC seems to accurately diagnose gastrointestinal diseases without biopsy. Most of thestudies aimed to clarify the relationship between endocytoscopic findings of gastrointestinal neoplasia and pathological diagnosis. Some studies have investigated non-epithelial lesions or diseases, such as inflammatory bowel disease or infectious diseases. However, there are few high-level pieces of evidence, such as randomized trials; thus, further studies are needed.
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.
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.