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( Taku Tabata ),( Terumi Kamisawa ),( Seiichi Hara ),( Sawako Kuruma ),( Kazuro Chiba ),( Go Kuwata ),( Takashi Fujiwara ),( Hideto Egashira ),( Koichi Koizumi ),( Junko Fujiwara ),( Takeo Arakawa ),( 대한간학회 2013 Gut and Liver Vol.7 No.2
Background/Aims: Few studies have differentiated immunoglobulin G (IgG) 4-related sclerosing cholangitis (IgG4-SC) from hilar cholangiocarcinoma (CC). Thus, we sought to investigate useful features for differentiating IgG4-SC from hilar CC. Methods: We retrospectively compared clinical, serological, imaging, and histological features of six patients with IgG4-SC and 42 patients with hilar CC. Results: In patients with hilar CC, obstructive jaundice was more frequent (p<0.01), serum total bilirubin levels were significantly higher (p<0.05), serum CA19-9 levels were significantly higher (p<0.01), and serum duke pancreatic monoclonal antigen type 2 levels were frequently elevated (p<0.05). However, in patients with IgG4-SC, the serum IgG (p<0.05) and IgG4 (p<0.01) levels were significantly higher and frequently elevated. The pancreas was enlarged in all IgG4-SC patients but only in 17% of hilar CC patients (p<0.01). Salivary and/or lacrimal gland swelling was detected in only 50% of IgG4-SC patients (p<0.01). Endoscopic retrograde cholangiography revealed that the hilar or hepatic duct was completely obstructed in 83% of hilar CC patients (p<0.01). Lower bile duct stenosis, apart from hilar bile duct stenosis, was more frequent in IgG4-SC patients (p<0.01). Bile duct wall thickening in areas without stenosis was more frequent in IgG4-SC patients (p<0.01). Conclusions: An integrated diagnostic approach based on clinical, serological, imaging, and histological findings is necessary to differentiate IgG4-SC from hilar CC. (Gut Liver 2013;7:234-238)
Naoki Okano,Yoshinori Igarashi,Seiichi Hara,Kensuke Takuma,Itaru Kamata,Yui Kishimoto,Takahiko Mimura,Ken Ito,Yasukiyo Sumino 대한소화기내시경학회 2014 Clinical Endoscopy Vol.47 No.2
Background/Aims: In recent years, endoscopic snare papillectomy has been performed to treat tumors of the ampulla of Vater. Thisprocedure requires accurate preoperative evaluation. In this study, we diagnosed the focal extension of such tumors by using endoscopicultrasonography (EUS) and intraductal ultrasonography (IDUS), and examined the indications for endoscopic snare papillectomy. Methods: The subjects were 48 patients with a papillary tumor (13 patients, surgical resection; 35 patients, endoscopic snare papillectomy)who were evaluated preoperatively with EUS and IDUS. The tumor-node-metastasis classification was used for the endosonographicevaluation and pathological diagnosis of these tumors. Results: The diagnostic accuracy of EUS was 97% for diagnosing adenomas and pTis tumors, 73% for pT1 tumors, 50% for pT2 tumors,and 50% for pT3–4 tumors, for an overall accuracy of 85% for T-staging. The diagnostic accuracy of IDUS was 94% for adenomasand pTis tumors, 73% for pT1 tumors, 50% for pT2 tumors, and 100% for pT3–4 tumors, for an overall accuracy of 80% for T-staging. Conclusions: EUS and IDUS are highly capable of evaluating tumors of the ampulla of Vater preoperatively. However, these techniquesare not sufficient for evaluating the focal extension of carcinomas preoperatively. Currently, endoscopic snare papillectomy is adequatefor treating adenomas and pTis tumors.
( Yuji Miyamoto ),( Terumi Kamisawa ),( Taku Tabata ),( Seiichi Hara ),( Sawako Kuruma ),( Kazuro Chiba ),( Yoshihiko Inaba ),( Go Kuwata ),( Takashi Fujiwara ),( Hideto Egashira ),( Koichi Koizumi ) The Editorial Office of Gut and Liver 2012 Gut and Liver Vol.6 No.4
Background/Aims: Autoimmune pancreatitis (AIP) is frequently associated with diabetes mellitus (DM). This study evaluated the effect of steroid therapy on the course of DM in AIP. Methods: Glucose tolerance was examined in 69 patients with AIP. DM onset was classified as either a simultaneous onset with AIP or an exacerbation of pre-existing DM. Based on the changes in the HbA1c levels and insulin dose, the responses of DM to steroids were classified as improved, no change, or worsened. Results: Thirty (46%) patients were diagnosed as having DM (simultaneous onset, n=17; pre-existing, n=13). Three months after starting the steroid treatment, the DM improved in 13 (54%) of 24 DM patients. The DM improved in 55%, had no change in 36%, and worsened in 9% of the 11 simultaneous onset DM patients, and it improved in 54%, had no change in 31%, and worsened in 15% of the 13 pre-existing DM patients. At approximately 3 years after starting the steroid treatment, the DM improved in 10 (63%) of 16 patients. The pancreatic exocrine function improved in parallel with the changes in the DM in seven patients. Conclusions: Because approximately 60% of DM associated with AIP is responsive to steroids in the short- and long-terms, marked DM associated with AIP appears to be an indication for steroid therapy. (Gut Liver 2012;6:501-504)
( Sawako Kuruma ),( Terumi Kamisawa ),( Taku Tabata ),( Seiichi Hara ),( Takashi Fujiwara ),( Go Kuwata ),( Hideto Egarashira ),( Koichi Koizumi ),( Keigo Setoguchi ),( Junko Fujiwara ),( Takeo Arakaw 대한소화기학회 2013 Gut and Liver Vol.7 No.1
Background/Aims: The objective of this study was to compare the clinical characteristics of patients with autoimmune pancreatitis (AIP) with or without Mikulicz`s disease (MD) and with MD alone. Methods: We investigated the clinical findings in 15 AIP patients with MD (group A+M), 49 AIP only patients (group A), and 14 MD only patients (group M). Results: The male-female ratio was significantly higher in group A+M (73%, p<0.05) and group A (78%, p<0.01) than group M (21%). Serum immunoglobulin G (IgG) levels were significantly higher in group A+M than in group A (p<0.01) and group M (p<0.05). Serum IgG4 levels were significantly higher in group A+M than in group A (p<0.01). Other organ involvement was observed in 73% (11/15) of patients in group A+M. The number of patients with diabetes mellitus was significantly higher in group A+M (66%, p<0.01) and group A (51%, p<0.05) than in group M (7%). All of the patients responded well to steroid therapy, but the relapse rate in group A+M (33%) was significantly higher than that in group A (3%, p<0.01). Salivary gland function was impaired in all groups compared with the control group, but the degree of dysfunction was less in group A compared with group A+M and group M. Conclusions: The relapse rate of AIP in MD patients was significantly higher than that of AIP in patients without MD. (Gut Liver 2013;7:96-99)
Yui Kishimoto,Naoki Okano,Ken Ito,Kensuke Takuma,Seiichi Hara,Susumu Iwasaki,Kensuke Yoshimoto,Yuto Yamada,Koji Watanabe,Yusuke Kimura,Hiroki Nakagawa,Yoshinori Igarashi 대한소화기내시경학회 2022 Clinical Endoscopy Vol.55 No.2
Background/Aims: Endoscopic evaluation of intraductal papillary mucinous neoplasms (IPMNs) is useful in determining whetherthe lesions are benign or malignant. This study aimed to examine the usefulness of peroral pancreatoscopy (POPS) in determiningthe prognosis of IPMNs. Methods: POPS with videoscopy was performed using the mother–baby scope technique. After surgery, computed tomography/magnetic resonance cholangiopancreatography or ultrasonography and blood tests were performed every 6 months during thefollow-up. Results: A total of 39 patients with main pancreatic duct (MPD)–type IPMNs underwent POPS using a videoscope, and theprotrusions in the MPD were observed in 36 patients. The sensitivity and specificity of cytology/biopsy performed at the time ofPOPS were 85% and 87.5%, respectively. Of 19 patients who underwent surgery, 18 (95%) patients had negative surgical margins and1 (5%) patient had a positive margin. Conclusions: In IPMNs with dilatation of the MPD, POPS is considered effective if the lesions can be directly observed. Thediagnosis of benign and malignant lesions is possible depending on the degree of lesion elevation. However, in some cases, slightlyelevated lesions may increase in size during the follow-up or multiple lesions may be simultaneously present; therefore, carefulfollow-up is necessary.
Original Article : Ulcerative Colitis and Immunoglobulin G4
( Go Kuwata ),( Terumi Kamisawa ),( Koichi Koizumi ),( Taku Tabata ),( Seiichi Hara ),( Sawako Kuruma ),( Takashi Fujiwara ),( Kazuro Chiba ),( Hideto Egashira ),( Junko Fujiwara ),( Takeo Arakawa ),( The Editorial Office of Gut and Liver 2014 Gut and Liver Vol.8 No.1
Background/Aims: Ulcerative colitis (UC) is sometimes associated with autoimmune pancreatitis (AIP). Infiltration of immunoglobulin G4 (IgG4)-positive plasma cells is sometimes detected in the colonic mucosa of AIP or UC patients. This study aimed to clarify the relation between UC and IgG4. Methods: Associations with UC were reviewed in 85 AIP patients. IgG4 immunostaining was performed on biopsy specimens from the colonic mucosa of 14 AIP and 32 UC patients. Results: UC was confirmed in two cases (type 1 AIP, n=1, suspected type 2 AIP, n=1). Abundant infiltration of IgG4-positive plasma cells in the colonic mucosa was detected in the case of suspected type 2 AIP with UC and two cases of type 1 AIP without colitis. Abundant infiltration of IgG4-positive plasma cells was detected in 10 UC cases (IgG4-present, 31%). Although 72% of IgG4-absent UC patients showed mild disease activity, 70% of IgG4-present patients showed moderate to severe disease activity (p<0.05). Conclusions: UC is sometimes associated with AIP, but it seems that UC is not a manifestation of IgG4-related disease. Infiltration of IgG4-positive plasma cells is sometimes detectable in the colonic mucosa of UC patients and is associated with disease activity. (Gut Liver 2014,8:29-34)
Ito Ken,Okano Naoki,Takuma Kensuke,Iwasaki Susumu,Watanabe Koji,Kimura Yusuke,Yamada Yuto,Yoshimoto Kensuke,Hara Seiichi,Kishimoto Yui,Matsuda Takahisa,Igarashi Yoshinori 거트앤리버 소화기연관학회협의회 2023 Gut and Liver Vol.17 No.4
Background/Aims: Many Japanese institutions use electromagnetic extracorporeal shock wave lithotripsy (ESWL) systems for treating pancreatic duct stones. However, there are no reports on direct comparisons between recent electromagnetic lithotripters. This study aimed to verify whether the new electromagnetic lithotripter can improve the efficiency of pancreatic stone fragmentation, and to clarify the role of combined endoscopic treatment on the clearance of pancreatic duct stones. Methods: We retrospectively identified 208 patients with pancreatolithiasis who underwent endoscopic adjunctive treatment after pancreatic ESWL at a single Japanese center over a 17-year period. We evaluated the outcome data of this procedure performed with SLX-F2 (last 2 years; group A) and Lithostar/Lithoskop (first 15 years; group B), as well as additional endoscopic treatments for pancreatolithiasis. We also performed logistic regression analysis to detect various factors associated with the procedure. Results: For pancreatic head stones, ESWL disintegration was achieved in 93.7% of group A patients and 69.0% of group B patients (p=0.004), and adjunctive endoscopic treatment removed stones in 96.8% of group A patients and 73.0% of group B patients (p=0.003). Multivariate analysis revealed that lithotripter type (odds ratio, 6.99; 95% confidence interval, 1.56 to 31.33; p<0.01) and main pancreatic duct stricture (odds ratio, 2.87; 95% confidence interval, 1.27 to 6.45; p<0.01) were significant factors for ESWL fragmentation. Conclusions: The SLX F2 showed high performance in fragmenting the pancreatic duct stones. In addition, endoscopic adjunctive treatment improved the overall success rate of the procedure. The improved ESWL lithotripter has many advantages for patients undergoing pancreatic lithotripsy treatment.
Naoki Okano,Yoshinori Igarashi,Ken Ito,Saori Mizutani,Hiroki Nakagawa,Kouji Watanabe,Yuuto Yamada,Kensuke Yoshimoto,Yuusuke Kimura,Susumu Iwasaki,Kensuke Takuma,Seiichi Hara,Yuui Kishimoto 대한소화기내시경학회 2021 Clinical Endoscopy Vol.54 No.5
Background/Aims: Bleeding is a complication of endoscopic snare papillectomy for ampullary tumors. This study aimed toinvestigate the clinical efficacy of hypertonic saline-epinephrine (HSE) local injection before endoscopic papillectomy for preventionof bleeding. Methods: We retrospectively reviewed the data of 107 consecutive patients with ampullary tumors who underwent endoscopicpapillectomy. The rates of en bloc resection, pathological resection margins, and prevention of immediate or delayed bleeding in thesimple snaring resection group (Group A) and the HSE injection group (Group B) were compared. Results: A total of 44 and 63 patients were enrolled in Groups A and B, respectively. The total complete resection rate was 89.7%(96/107); the clinical complete resection rates in Group A and Group B were 86.3% (38/44) and 92.1% (58/63), respectively (p=0.354). Post-papillectomy bleeding occurred in 22 patients. In Groups A and B, the immediate bleeding rates were 20.5% (9/44) and 4.8%(3/63), respectively (p=0.0255), while the delayed bleeding rates were 7% (3/44) and 11% (7/63), respectively (p=0.52). The rates ofpositive horizontal and vertical pathological margin in both groups were 27% and 16%, respectively. Conclusions: HSE local injection was effective in preventing immediate bleeding and was useful for safely performing endoscopicpapillectomy for ampullary tumors.