Characteristic Findings of Endoscopic Retrograde Cholangiopancreatography in Autoimmune Pancreatitis

( Susumu Iwasaki ),( Terumi Kamisawa ),( Satomi Koizumi ),( Kazuro Chiba ),( Taku Tabata ),( Sawako Kuruma ),( Go Kuwata ),( Takashi Fujiwara ),( Koichi Koizumi ),( Takeo Arakawa ),( Kumiko Momma ),( 대한소화기학회 2015 Gut and Liver Vol.9 No.1

Background/Aims: Diffuse or segmental irregular narrowing of the main pancreatic duct (MPD), as observed by endoscopic retrograde cholangiopancreatography (ERCP), is a characteristic feature of autoimmune pancreatitis (AIP). Methods: ERCP findings were retrospectively examined in 40 patients with AIP in whom irregular narrowing of the MPD was detected near the orifice. The MPD opening sign was defined as the MPD within 1.5 cm from the orifice being maintained. The distal common bile duct (CBD) sign was defined as the distal CBD within 1.5 cm from the orifice being maintained. Endoscopic findings of a swollen major papilla and histological findings of specimens obtained from the major papilla were examined in 26 and 21 patients, respectively. Results: The MPD opening sign was detected in 26 of the 40 patients (65%). The distal CBD sign was detected in 25 of the 32 patients (78%), which showed stenosis of the lower bile duct. The patients who showed the MPD opening sign frequently showed the distal CBD sign (p=0.018). Lymphoplasmacytic infiltration, but not dense fibrosis, was histologically detected in biopsy specimens obtained from the major papilla. Conclusions: On ERCP, the MPD and CBD adjacent to the major papilla are frequently maintained in patients with AIP involving the pancreatic head. These signs are useful for diagnosing AIP on ERCP. (Gut Liver 2015;9:113-117)

Optimal Timing to Assess Drain Amylase Concentration after Elective Gastrectomy

Wakahara, Tomoyuki,Kanemitsu, Kiyonori,Miura, Susumu,Tsuchida, Shinobu,Iwasaki, Takeshi,Sasako, Mitsuru The Korean Gastric Cancer Association 2021 Journal of gastric cancer Vol.21 No.1

Purpose: While the amylase concentration of the drainage fluid (dAmy) has been reported to be a predictor of postoperative pancreas-related complications (PPRC), the optimal timing for its measurement has not been fully investigated. Materials and Methods: The clinicopathological data of 387 patients who underwent elective gastrectomy for gastric cancer were reviewed. Laboratory data, including dAmy on postoperative days 1 (dAmy1) and 3 (dAmy3), and serum C-reactive protein (sCRP) concentrations on postoperative days 1 (sCRP1) and 3 (sCRP3) were compared between patients with PPRC and without PPRC. Results: Nineteen of the 387 patients (4.9%) developed PPRC. The optimal cutoff values of dAmy1, dAmy3, sCRP1, and sCRP3 were 1514 IU/L, 761 IU/L, 8.32 mg/dL, and 15.15 mg/dL, respectively. The area under the curve of dAmy1 was greater than that of dAmy3 (0.915 vs. 0.826), and that of sCRP3 was greater than that of sCRP1 (0.820 vs. 0.659). In the multivariate analysis, dAmy1 (P<0.001) and sCRP3 (P=0.004) were significant predictors of PPRC, while dAmy3 (P=0.069) and sCRP1 (P=0.831) were not. Thirteen (41.9%) of 31 patients with both dAmy1 ≥1,545 IU/L and sCRP3 ≥15.15 mg/dL had PPRC ≥Clavien-Dindo II. In contrast, among 260 patients with both dAmy1 <1,545 IU/L and sCRP3 <15.15 mg/dL, none developed PPRC. Conclusions: dAmy1 was more useful than dAmy3 in predicting PPRC. The combination of dAmy1 and sCRP3 may be a useful criterion for the removal of drains on postoperative day 3.

Are Newer Extracorporeal Shock Wave Lithotripsy Models Truly Improving Pancreatolithiasis Lithotripsy Performance? A Japanese Single-Center Study Using Endoscopic Adjunctive Treatment

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.

Organ Correlation in IgG4-Related Diseases

Satomi Koizumi,Terumi Kamisawa,Sawako Kuruma,Taku Tabata,Kazuro Chiba,Susumu Iwasaki,Go Kuwata,Takashi Fujiwara,Junko Fujiwara,Takeo Arakawa,Koichi Koizumi,Kumiko Momma 대한의학회 2015 Journal of Korean medical science Vol.30 No.6

IgG4-related disease (IgG4-RD) is a potentially multiorgan disorder. In this study, clinical and serological features from 132 IgG4-RD patients were compared about organ correlations. Underlying pathologies comprised autoimmune pancreatitis (AIP) in 85 cases, IgG4-related sclerosing cholangitis (IgG4-SC) in 12, IgG4-related sialadenitis (IgG4-SIA) in 56, IgG4-related dacryoadenitis (IgG4-DAC) in 38, IgG4-related lymphadenopathy (IgG4- LYM) in 20, IgG4-related retroperitoneal fibrosis (IgG4-RF) in 19, IgG4-related kidney disease (IgG4-KD) in 6, IgG4-related pseudotumor (IgG4-PT) in 3. Sixty-five patients (49%) had multiple IgG4-RD (two affected organs in 36 patients, three in 19, four in 8, five in 1, and six in 1). Serum IgG4 levels were significantly higher with multiple lesions than with a single lesion (P < 0.001). The proportion of association with other IgG4-RD was 42% in AIP, the lowest of all IgG4-RDs. Serum IgG4 level was lower in AIP than in other IgG4-RDs. Frequently associated IgG4-RDs were SIA (25%) and DAC (12%) for AIP; AIP (75%) for IgG4-SC; DAC (57%), AIP (38%) and LYM (27%) for IgG4-SIA; AIP (26%) and LYM (26%) for IgG4-DAC; SIA (75%), DAC (50%) and AIP (45%) for IgG4-LYM; SIA (58%), AIP (42%) and LYM (32%) for IgG4-RF; AIP (100%) and SIA (67%) for IgG4-KID; and DAC (67%) and SIA (67%) for IgG4-PT. Most associated IgG4-RD lesions were diagnosed simultaneously, but IgG4-SIA and IgG4-DAC were sometimes identified before other lesions. About half of IgG4-RD patients had multiple IgG4-RD lesions, and some associations were seen between specific organs.

Peroral Pancreatoscopy with Videoscopy and Narrow-Band Imaging in Intraductal Papillary Mucinous Neoplasms with Dilatation of the Main Pancreatic Duct

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.

RecA requires two molecules of Mg ²⁺ ions for its optimal strand exchange activity <i>in vitro</i>

Kim, Raeyeong,Kanamaru, Shuji,Mikawa, Tsutomu,Pré,vost, Chantal,Ishii, Kentaro,Ito, Kentaro,Uchiyama, Susumu,Oda, Masayuki,Iwasaki, Hiroshi,Kim, Seog K,Takahashi, Masayuki Oxford University Press 2018 Nucleic acids research Vol.46 No.5

<P><B>Abstract</B></P><P>Mg<SUP>2+</SUP> ion stimulates the DNA strand exchange reaction catalyzed by RecA, a key step in homologous recombination. To elucidate the molecular mechanisms underlying the role of Mg<SUP>2+</SUP> and the strand exchange reaction itself, we investigated the interaction of RecA with Mg<SUP>2+</SUP> and sought to determine which step of the reaction is affected. Thermal stability, intrinsic fluorescence, and native mass spectrometric analyses of RecA revealed that RecA binds at least two Mg<SUP>2+</SUP> ions with K<SUB>D</SUB> ≈ 2 mM and 5 mM. Deletion of the C-terminal acidic tail of RecA made its thermal stability and fluorescence characteristics insensitive to Mg<SUP>2+</SUP> and similar to those of full-length RecA in the presence of saturating Mg<SUP>2+</SUP>. These observations, together with the results of a molecular dynamics simulation, support the idea that the acidic tail hampers the strand exchange reaction by interacting with other parts of RecA, and that binding of Mg<SUP>2+</SUP> to the tail prevents these interactions and releases RecA from inhibition. We observed that binding of the first Mg<SUP>2+</SUP> stimulated joint molecule formation, whereas binding of the second stimulated progression of the reaction. Thus, RecA is actively involved in the strand exchange step as well as bringing the two DNAs close to each other.</P>

Efficacy of Hypertonic Saline-Epinephrine Local Injection Around the Anal Side before Endoscopic Papillectomy for Ampullary Tumors

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.