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Matsumoto Kazuyuki,Kato Hironari,Morimoto Kosaku,Miyamoto Kazuya,Saragai Yosuke,Kawamoto Hirofumi,Okada Hiroyuki 거트앤리버 소화기연관학회협의회 2023 Gut and Liver Vol.17 No.1
Background/Aims: Bilateral endoscopic drainage with self-expanding metallic stent (SEMS) can be used to effectively manage hilar malignant biliary obstruction. However, the benefits of using a trisegment drainage method remain unknown. Methods: This study retrospectively reviewed the data of 125 patients with Bismuth type IIIa or IV unresectable malignant strictures who underwent bilateral endoscopic drainage using SEMSs at four tertiary centers. The patients were divided into the bilateral and trisegment drainage groups for comparison. The primary endpoint was stent patency and the secondary endpoints were technical success, technical and clinical success of reintervention, and overall survival. Results: The technical success rates of the bilateral and trisegment drainage groups were 95% (34/36) and 90% (80/89) (p=0.41), respectively, with median stent patency durations of 226 and 170 days (p=0.26), respectively. Although the technical success of reintervention was not significantly different between the two groups (p=0.51), the clinical success rate of reintrvention was significantly higher in the trisegment drainage group (73% [11/15] vs 96% [47/49], p=0.009). The median survival times were 324 and 323 days in the bilateral and trisegment drainage groups, respectively (p=0.72). Multivariate Cox hazards model revealed no stent patency-associated factor; however, chemotherapy was associated with longer survival. Conclusions: Although no significant difference was noted with respect to stent patency, significantly higher clinical success rates were achieved with reintervention using the trisegment drainage method than using the bilateral drainage method alone.
Azusa Kawasaki,Kunihiro Tsuji,Noriya Uedo,Takashi Kanesaka,Hideaki Miyamoto,Ryosuke Gushima,Yosuke Minoda,Eikichi Ihara,Ryosuke Amano,Kenshi Yao,Yoshihide Naito,Hiroyuki Aoyagi,Takehiro Iwasaki,Kunihi 대한소화기내시경학회 2023 Clinical Endoscopy Vol.56 No.1
Background/Aims: The etiology of superficial non-ampullary duodenal epithelial tumors (SNADETs) remains unclear. Recent studieshave reported conflicting associations between duodenal tumor development and Helicobacter pylori infection or endoscopic gastricmucosal atrophy. As such, the present study aimed to clarify the relationship between SNADETs and H. pylori infection and/or endoscopicgastric mucosal atrophy. Methods: This retrospective case-control study reviewed data from 177 consecutive patients with SNADETs who underwent endoscopicor surgical resection at seven institutions in Japan over a three-year period. The prevalence of endoscopic gastric mucosal atrophyand the status of H. pylori infection were compared in 531 sex- and age-matched controls selected from screening endoscopies attwo of the seven participating institutions. Results: For H. pylori infection, 85 of 177 (48.0%) patients exhibited SNADETs and 112 of 531 (21.1%) control patients were non-infected(p<0.001). Non-atrophic mucosa (C0 to C1) was observed in 96 of 177 (54.2%) patients with SNADETs and 112 of 531 (21.1%)control patients (p<0.001). Conditional logistic regression analysis revealed that non-atrophic gastric mucosa was an independent riskfactor for SNADETs (odds ratio, 5.10; 95% confidence interval, 2.44–8.40; p<0.001). Conclusions: Non-atrophic gastric mucosa, regardless of H. pylori infection status, was a factor independently associated with SNADETs.