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Masafumi Watanabe,Kosuke Okuwaki,Jun Woo,Mitsuhiro Kida,Hiroshi Imaizumi,Tomohisa Iwai,Hiroshi Yamauchi,Toru Kaneko,Rikiya Hasegawa,Takahiro Kurosu,Naoki Minato,Hiroki Haradome,Wasaburo Koizumi 대한소화기내시경학회 2021 Clinical Endoscopy Vol.54 No.4
Background/Aims: Cholecystitis can occur after the placement of covered self-expandable metallic stents for distal malignant biliaryobstructions. We aimed to identify risk factors for cholecystitis following covered self-expandable metallic stent placement. Methods: We investigated risk factors related to cholecystitis following covered self-expandable metallic stent placement in 118patients with distal malignant biliary obstructions between January 1, 2015 and April 30, 2019. Endoscopic assessments and tumorinvasion to the arteries feeding the gallbladder were determined by a pancreaticobiliary endoscopist and a radiologist, respectively. Results: The median patient age was 72 years (men, 61.0%). The flow of the contrast agent into the gallbladder and tumorinvolvement in the orifice of the cystic duct were observed in 35 (29.7%) and 35 (29.7%) patients, respectively. During theobservation period (median, 179 days), cholecystitis occurred in 18 (15.3%) patients. Multivariate analysis revealed the flow ofthe contrast agent into the gallbladder (p=0.023) and tumor involvement in the orifice of the cystic duct (p=0.005) as significantindependent risk factors associated with cholecystitis. Conclusions: The flow of the contrast agent into the gallbladder and tumor involvement in the orifice of the cystic duct are potentialindependent risk factors for cholecystitis following the placement of covered self-expandable metallic stents. A follow-up prospectivestudy is warranted to validate their influence.
Yusuke Mizuuchi,Yoshitaka Tanabe,Masafumi Sada,Koji Tamura,Kinuko Nagayoshi,Shuntaro Nagai,Yusuke Watanabe,Sadafumi Tamiya,Kohei Nakata,Kenoki Ohuchida,Toru Nakano,Masafumi Nakamura 대한대장항문학회 2022 Annals of Coloproctolgy Vol.38 No.5
Purpose: Preoperative sarcopenia worsens postoperative outcomes in various cancer types including colorectal cancer. However, we often experienced postoperative anastomotic leakage in muscular male patients such as Judo players, especially in rectal cancer surgery with lower anastomosis. It is controversial whether the whole skeletal muscle mass impacts the potential for anastomotic failure in male rectal cancer patients. Thus, the purpose of this study was to clarify whether skeletal muscle mass impacts anastomotic leakage in rectal cancer in men. Methods: We reviewed the medical charts of male patients suffering from rectal cancer who underwent colo-procto anastomosis below the peritoneal reflection without a protective diverting stoma. We measured the psoas muscle area and calculated the psoas muscle index. Results: One hundred ninety-seven male rectal cancer patients were enrolled in this study. The psoas muscle index was significantly higher in patients with anastomotic leakage (P<0.001). Receiver operating characteristic curve determined the optimal cut-off value of the psoas muscle index for predicting anastomotic leakage as 812.67 cm2/m2 (sensitivity of 60% and specificity of 74.3%). Multivariate analysis revealed that high psoas muscle index (risk ratio [RR], 3.933; P<0.001; 95% confidence interval [CI], 1.917–8.070) and super low anastomosis (RR, 2.792; P=0.015; 95% CI, 1.221–6.384) were independent predictive factors of anastomotic leakage. Conclusion: This study showed that male rectal cancer patients with a large psoas muscle mass who underwent lower anastomosis had a higher rate of postoperative anastomotic leakage.
Seigo Nakatani,Kosuke Okuwaki,Masafumi Watanabe,Hiroshi Imaizumi,Tomohisa Iwai,Takaaki Matsumoto,Rikiya Hasegawa,Hironori Masutani,Takahiro Kurosu,Akihiro Tamaki,Junro Ishizaki,Ayana Ishizaki,Mitsuhir 대한소화기내시경학회 2024 Clinical Endoscopy Vol.57 No.1
Background/Aims: In stereomicroscopic sample isolation processing, the cutoff value (≥4 mm) of stereomicroscopically visible white cores indicates high diagnostic sensitivity. We aimed to evaluate endoscopic ultrasound-guided tissue acquisition (EUS-TA) using a simplified stereomicroscopic on-site evaluation of upper gastrointestinal subepithelial lesions (SELs). Methods: In this multicenter prospective trial, we performed EUS-TA using a 22-gauge Franseen needle in 34 participants with SELs derived from the upper gastrointestinal muscularis propria, requiring pathological diagnosis. The presence of stereomicroscopically visible white core (SVWC) in each specimen was assessed using stereomicroscopic on-site evaluation. The primary outcome was EUS-TA’s diagnostic sensitivity with stereomicroscopic on-site evaluation based on the SVWC cutoff value (≥4 mm) for malignant upper gastrointestinal SELs. Results: The total number of punctures was 68; 61 specimens (89.7%) contained stereomicroscopically visible white cores ≥4 mm in size. The final diagnoses were gastrointestinal stromal tumor, leiomyoma, and schwannoma in 76.5%, 14.7%, and 8.8% of the cases, respectively. The sensitivity of EUS-TA with stereomicroscopic on-site evaluation based on the SVWC cutoff value for malignant SELs was 100%. The per-lesion accuracy of histological diagnosis reached the highest level (100%) at the second puncture. Conclusions: Stereomicroscopic on-site evaluation showed high diagnostic sensitivity and could be a new method for diagnosing upper gastrointestinal SELs using EUS-TA.
Motoyasu Kan,Yusuke Hashimoto,Taro Shibuki,Gen Kimura,Kumiko Umemoto,Kazuo Watanabe,Mitsuhito Sasaki,Hideaki Takahashi,Hiroshi Imaoka,Izumi Ohno,Shuichi Mitsunaga,Masafumi Ikeda 소화기인터벤션의학회 2019 Gastrointestinal Intervention Vol.8 No.2
Background: In patients with distal malignant biliary obstruction, it is a challenge to manage acute cholecystitis secondary to cystic duct obstruc-tion associated with tumor progression or stent compression. Percutaneous transhepatic gallbladder drainage (PTGBD) has been used as the treatment option of choice, because of its ease of performance and safety, but because of the use of an external drainage tube, some patients experience a de-creased quality of life. We report the technical success and clinical success of conversion from PTGBD to endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) for the treatment of acute cholecystitis in patients with unresectable malignant biliary obstruction.Methods: We included the patients with cholecystitis secondary to unresectable malignant biliary obstruction who underwent conversion from PT-GBD to EUS-GBD in the study. After PTGBD for the treatment of acute cholecystitis, we performed EUS-GBD and a plastic stent or a self-expandable metal stent (SEMS) was placed for fistulostomy.Results: Fourteen patients (median age, 69 years; 9 males and 5 females) underwent conversion to EUS-GBD after clinical improvement of cholecys-titis by PTGBD. The technical success rate of the conversion from PTGBD to EUS-GBD was 100% (14/14). EUS-GBD was performed in a median of 9.5 days (range, 3–51 days) after PTGBD procedure, using mainly a plastic stent (13 patients) and a covered SEMS in one patient. The early (within 24 hours) adverse events rate was 14.3% (2/14), and the late (after 24 hours) adverse events rate was 7.1% (1/14). The rate of recurrence of cholecystitis was 28.6% (4/14). These patients underwent endoscopic re-intervention and there were no cases of further recurrence of cholecystitis. Conclusion: Conversion of PTGBD to EUS-GBD demonstrated a feasible and safe technique for acute cholecystitis in non-surgical candidates with malignant biliary obstruction.
Motoyasu Kan,Yusuke Hashimoto,Taro Shibuki,Gen Kimura,Kumiko Umemoto,Kazuo Watanabe,Mitsuhito Sasaki,Hideaki Takahashi,Hiroshi Imaoka,Izumi Ohno,Shuichi Mitsunaga,Masafumi Ikeda 소화기인터벤션의학회 2019 International journal of gastrointestinal interven Vol.8 No.2
Background: In patients with distal malignant biliary obstruction, it is a challenge to manage acute cholecystitis secondary to cystic duct obstruc-tion associated with tumor progression or stent compression. Percutaneous transhepatic gallbladder drainage (PTGBD) has been used as the treatment option of choice, because of its ease of performance and safety, but because of the use of an external drainage tube, some patients experience a de-creased quality of life. We report the technical success and clinical success of conversion from PTGBD to endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) for the treatment of acute cholecystitis in patients with unresectable malignant biliary obstruction.Methods: We included the patients with cholecystitis secondary to unresectable malignant biliary obstruction who underwent conversion from PT-GBD to EUS-GBD in the study. After PTGBD for the treatment of acute cholecystitis, we performed EUS-GBD and a plastic stent or a self-expandable metal stent (SEMS) was placed for fistulostomy.Results: Fourteen patients (median age, 69 years; 9 males and 5 females) underwent conversion to EUS-GBD after clinical improvement of cholecys-titis by PTGBD. The technical success rate of the conversion from PTGBD to EUS-GBD was 100% (14/14). EUS-GBD was performed in a median of 9.5 days (range, 3–51 days) after PTGBD procedure, using mainly a plastic stent (13 patients) and a covered SEMS in one patient. The early (within 24 hours) adverse events rate was 14.3% (2/14), and the late (after 24 hours) adverse events rate was 7.1% (1/14). The rate of recurrence of cholecystitis was 28.6% (4/14). These patients underwent endoscopic re-intervention and there were no cases of further recurrence of cholecystitis. Conclusion: Conversion of PTGBD to EUS-GBD demonstrated a feasible and safe technique for acute cholecystitis in non-surgical candidates with malignant biliary obstruction.
Satomi Seki,Naoko Kato,Naomi Ito,Koichiro Kinugawa,Minoru Ono,Noboru Motomura,Atsushi Yao,Masafumi Watanabe,Yasushi Imai,Norihiko Takeda,Masashi Inoue,Masaru Hatano,Keiko Kazuma 한국간호과학회 2010 Asian Nursing Research Vol.4 No.2
Purpose The aim of this study was to evaluate the validity and reliability of the Seattle Angina Questionnaire, Japanese version (SAQ-J) as a disease-specific health outcome scale in patients with coronary artery disease. Methods Patients with coronary artery disease were recruited from a university hospital in Tokyo. The patients completed self-administered questionnaires, and medical information was obtained from the subjects’medical records. Face validity, concurrent validity evaluated using Short Form 36 (SF-36), known group differences, internal consistency, and test-retest reliability were statistically analyzed. Results A total of 354 patients gave informed consent, and 331 of them responded (93.5%). The concurrent validity was mostly supported by the pattern of association between SAQ-J and SF-36. The patients without chest symptoms showed significantly higher SAQ-J scores than did the patients with chest symptoms in 4 domains. Cronbach’s alpha ranged from .51 to .96, meaning that internal consistency was confirmed to a certain extent. The intraclass correlation coefficient of most domains was higher than the recommended value of 0.70. The weighted kappa ranged from .24 to .57, and it was greater than .4 for 14 of the 19 items. Conclusions The SAQ-J could be a valid and reliable disease-specific scale in some part for measuring health outcomes in patients with coronary artery disease, and requires cautious use. [Asian Nursing Research 2010;4(2):57–63]