IMaging and issue : Double Penetrated Duodenal Wall during Endoscopic Ultrasound-Guided Choledochoduodenostomy

Hiroshi Kawakami,Masaki Kuwatani,Naoya Sakamoto 대한소화기학회 2016 Gut and Liver Vol.10 No.2

Relative Contribution of Physiological Hydrostatic Pressure and Fluid Shear Stress to Endothelial Monolayer Integrity

Toshiro Ohashi,Yoshiaki Sugaya,Naoya Sakamoto,Masaaki Sato 대한의용생체공학회 2016 Biomedical Engineering Letters (BMEL) Vol.6 No.1

Purpose Vascular endothelial cells (ECs) are continuouslysubjected to mechanical forces such as fluid shear stress,stretching and hydrostatic pressure. The effect of hydrostaticpressure on EC responses has not been fully understoodcompared to that of the other two stimuli. The purpose ofthis study is to assess mechanical responses of ECs to thesemechanical stimuli. Methods Bovine aortic ECs were exposed to hydrostaticpressure of 50, 100, and 150 mmHg and fluid shear stressof 3 Pa in simultaneous or successive fashion. Immunofluorescencestaining of actin filaments and VEcadherin wasthen performed to observe cell morphology and cell-celljunctions, respectively. Results The results showed that ECs subjected to 50, 100,and 150 mmHg for 24 h elongated without predominantorientation and exhibited multilayered structure, whereassimultaneous application of 50 and 100 mmHg and 3 Pa for24 h induced marked elongation and orientation of ECsparallel to the direction of flow maintaining monolayerintegrity. This monolayer integrity was lost in ECs subjectedto 150 mmHg together with 3 Pa. A successive applicationof 100 mmHg for 24 h followed by 100 mmHg and 3 Pa for24 h, indicated that the loss of monolayer integrity due tohydrostatic pressure could not be retrieved by the followingsimultaneous application. Conclusions It can be concluded that physiological shearstress of 3 Pa is dominant to physiological hydrostatic pressureup to 100 mmHg, importantly suggesting the relativecontribution of physiological hydrostatic pressure and fluidshear stress to endothelial monolayer integrity.

Review : Endoscopic Ultrasound-Guided Transluminal Drainage for Peripancreatic Fluid Collections: Where Are We Now?

( Hiroshi Kawakami ),( Takao Itoi ),( Naoya Sakamoto ) The Editorial Office of Gut and Liver 2014 Gut and Liver Vol.8 No.4

Endoscopic drainage for pancreatic and peripancreatic fluid collections (PFCs) has been increasingly used as a minimally invasive alternative to surgical or percutaneous drainage. Recently, endoscopic ultrasound guided transluminal drainage (EUS-TD) has become the standard of care and a safe procedure for nonsurgical PFC treatment. EUS-TD ensures a safe puncture, avoiding intervening blood vessels. Single or multiple plastic stents (combined with a nasocystic catheter) were used for the treatment of PFCs for EUS-TD. More recently, the use of covered self-expandable metallic stents (CSEMSs) has provided a safer and more efficient approach route for internal drainage. We focused our review on the best approach and stent to use in endoscopic drainage for PFCs. We reviewed studies of EUS TD for PFCs based on the original Atlanta Classification, including case reports, case series, and previous review articles. Data on clinical outcomes and adverse events were collected retrospectively. A total of 93 patients underwent EUS-TD of pancreatic pseudocysts using CSEMSs. The treatment success and adverse event rates were 94.6% and 21.1%, respectively. The majority of complications were of mild severity and resolved with conservative therapy. A total of 56 patients underwent EUS-TD using CSEMSs for pancreatic abscesses or infected walled-off necroses. The treatment success and adverse event rates were 87.8% and 9.5%, respectively. EUS-TD can be performed safely and efficiently for PFC treatment. Larger diameter CSEMSs without additional fistula tract dilation for the passage of a standard scope are needed to access and drain for PFCs with solid debris. (Gut Liver 2014;8:341-355)

Preoperative Prognostic Nutritional Index is a significant predictive factor for posthepatectomy bile leakage

Atsushi Nanashima,Masahide Hiyoshi,Naoya Imamura,Koichi Yano,Takeomi Hamada,Kengo Kai,Takahiro Nishida,Yukako Uchise,Risa Sakamoto,Mayu Inomata 한국간담췌외과학회 2021 Annals of hepato-biliary-pancreatic surgery Vol.25 No.4

Backgrounds/Aims: It is known that preoperative nutritional status can influence patient outcomes after hepatectomy. Prognostic Nutritional Index (PNI) is a useful parameter to reflect patient outcomes undergoing gastro-intestinal surgery. The aim of this study was to retrospectively evaluate relationships of nutritional parameters, demographics, and surgical records with postoperative outcomes in a cohort study. Methods: Curative hepatectomy was performed for 182 patients at the University of Miyazaki between 2015 and 2018. Each preoperative level of albumin, prealbumin, lymphocyte, total cholesterol, or the comprehensively calculated Onodera’s PNI was examined as a nutritional parameter. Results: The mean PNI was 39.6 ± 5.1, with PNI below 40 observed in 91 (50.0%) patients. Nutritional parameters were not different among patients with various liver diseases. Serum albumin or prealbumin level was significantly correlated with each hepatic parameter (p < 0.01). Prealbumin and total cholesterol levels were significantly correlated with postoperative prothrombin activity (p < 0.05). Albumin or prealbumin levels and PNI were significantly lower in patients with posthepatectomy complications, particularly bile leakage in comparison those without such complications (p < 0.05). Multiple logistic analysis showed that albumin level was an independent risk factor for complications after hepatectomy (risk ratio [RR]: 1.33) and that lymphocyte count was an independent risk factor for bile leakage (RR: 1.28) (p < 0.05). The cut-off level of albumin was approximately 3.8 mg/dL and that of lymphocyte count was 1,320/㎣. Conclusions: Preoperative PNI reflected perioperative liver functional status. It was a predictive parameter for postoperative complications, particularly biliary leakage.

Combined use of a two-channel endoscope and a flexible tip catheter for difficult biliary cannulation

Masaki Kuwatani,Yoshimasa Kubota,Shuhei Kawahata,Kimitoshi Kubo,Kazumichi Kawakubo,Hiroshi Kawakami,Naoya Sakamoto 소화기인터벤션의학회 2018 International journal of gastrointestinal interven Vol.7 No.1

A 69-year-old woman with jaundice was referred to our hospital. After a final diagnosis of pancreatic cancer with liver metastasis, we performed transpapillary biliary drainage with a covered self-expandable metal stent (SEMS). Three months later, we also placed an uncovered duodenal stent for duodenal stricture in a side-to-end fashion. Another month later, for biliary SEMS obstruction, we attempted a transpapillary approach. A duodenoscope was advanced and a guidewire was passed through the mesh of the duodenal stent into the bile duct with a flexible tip catheter, but the catheter was not. Thus, we exchanged the duodenoscope for a forward-viewing two-channel endoscope and used the left working channel with a flexible tip catheter. By adjusting the axis, we finally succeeded biliary cannulation and accomplished balloon cleaning for recanalization of the SEMS. This is the first case with successful biliary cannulation by combined use of a two-channel endoscope and a flexible tip catheter.

Brief communication : A Unique Use of a Double-Pigtail Plastic Stent: Correction of Kinking of the Common Bile Duct Due to a Metal Stent

( Masaki Kuwatani ),( Hiroshi Kawakami ),( Yoko Abe ),( Shuhei Kawahata ),( Kazumichi Kawakubo ),( Kimitoshi Kubo ),( Naoya Sakamoto ) The Editorial Office of Gut and Liver 2015 Gut and Liver Vol.9 No.2

A 72-year-old man with jaundice by ampullary adenocarcinoma was treated at our hospital. For biliary decompression, a transpapillary, fully covered, self-expandable metal stent (FCSEMS) was deployed. Four days later, the patient developed acute cholangitis. Endoscopic carbon dioxide cholangiography revealed kinking of the common bile duct above the proximal end of the FCSEMS. A 7-F double-pigtail plastic stent was therefore placed through the FCSEMS to correct the kink, straightening the common bile duct (CBD) and improving cholangitis. This is the first report of a unique use of a double-pigtail plastic stent to correct CBD kinking. The placement of a double-pigtail plastic stent can correct CBD kinking, without requiring replacement or addition of a FCSEMS, and can lead to cost savings. (Gut Liver, 2015;9:251-252)

Bleeding After Gastric Endoscopic Submucosal Dissection Focused on Management of Xa Inhibitors

Ono Shoko,Ieko Masahiro,Tanaka Ikko,Shimoda Yoshihiko,Ono Masayoshi,Yamamoto Keiko,Sakamoto Naoya 대한위암학회 2022 Journal of gastric cancer Vol.22 No.1

Purpose: The use of direct oral Xa inhibitors (DXaIs) to prevent venothrombotic events is increasing. However, gastrointestinal bleeding, including that related to endoscopic resection, is a concern. In this study, we evaluated bleeding and coagulation times during the perioperative period of gastric endoscopic submucosal dissection (ESD). Materials and Methods: Patients who consecutively underwent gastric ESD from August 2016 to December 2018 were analyzed. Bleeding rates were compared among the 3 groups (antiplatelet, DXaIs, and control). DXaI administration was discontinued on the day of the procedure. Prothrombin time (PT), activated partial thromboplastin time, and the ratio of inhibited thrombin generation (RITG), which was based on dilute PT, were determined before and after ESD. Results: During the study period, 265 gastric ESDs were performed in 239 patients, where 23 and 50 patients received DXaIs and antiplatelets, respectively. Delayed bleeding occurred in 17 patients (7.4%) and 21 lesions (7.1%). The bleeding rate in the DXaI group was significantly higher than that in the other groups (30.4%, P<0.01), and the adjusted odds ratio of bleeding was 5.7 (95% confidence interval, 1.4–23.7; P=0.016). In patients using DXaIs, there was a significant (P=0.046) difference in the median RITG between bleeding cases (18.6%) and non-bleeding cases (3.8%). Conclusions: A one-day cessation of DXaIs was related to a high incidence of bleeding after gastric ESD, and monitoring of residual coagulation activity at trough levels might enable the predicted risk of delayed bleeding in patients using DXaIs.

Hepatitis C virus NS5A protein increases hepatic lipid accumulation via induction of activation and expression of PPARgamma

Kim, KyeongJin,Kim, Kook Hwan,Ha, Eunsin,Park, Jin Young,Sakamoto, Naoya,Cheong, JaeHun Elsevier 2009 FEBS letters Vol.583 No.17

<P><B>Abstract</B></P><P>Steatosis is an established risk factor for disease progression in cases of chronic hepatitis C. Recently it was demonstrated that Hepatitis C virus (HCV) core and non-structural (NS) 2 proteins (NS2) induce lipid accumulation in hepatic cells. However, it has yet to be determined whether other HCV proteins are associated with lipid metabolism. The NS5A augmented the transcriptional activity and gene expression of PPARγ. Furthermore, NS5A increased the ability to recruit the transcriptional coactivator PGC-1s to the PPRE with PPARγ, as well as the interaction with PPARγ2 and PGC-1α. Our results indicate that NS5A may exploit multiple strategies that enhance PPARγ-induced lipid accumulation.</P><P><B>Structured summary</B></P><P>MINT-7229685: <I>PPAR gamma 2</I> (uniprotkb:P37231-2) <I>physically interacts</I> (MI:0914) with <I>PGC1 alpha</I> (uniprotkb:Q9UBK2) by <I>pull down</I> (MI:0096)</P><P>MINT-7229712: <I>PPAR gamma 2</I> (uniprotkb:P37231-2) <I>physically interacts</I> (MI:0914) with <I>NS5A</I> (uniprotkb:P26662) by <I>pull down</I> (MI:0096)</P><P>MINT-7229698: <I>PPAR gamma 2</I> (uniprotkb:P37231-2) <I>physically interacts</I> (MI:0914) with <I>PGC1 alpha</I> (uniprotkb:Q9UBK2) by <I>anti tag coimmunoprecipitation</I> (MI:0007)</P><P>MINT-7229731: <I>PPAR gamma 2</I> (uniprotkb:P37231-2) <I>physically interacts</I> (MI:0914) with <I>NS5A</I> (uniprotkb:P26662) by <I>anti tag coimmunoprecipitation</I> (MI:0007)</P>

Combined use of a two-channel endoscope and a flexible tip catheter for difficult biliary cannulation

Masaki Kuwatani,Yoshimasa Kubota,Shuhei Kawahata,Kimitoshi Kubo,Kazumichi Kawakubo,Hiroshi Kawakami,Naoya Sakamoto 소화기인터벤션의학회 2018 Gastrointestinal Intervention Vol.7 No.1

A 69-year-old woman with jaundice was referred to our hospital. After a final diagnosis of pancreatic cancer with liver metastasis, we performed transpapillary biliary drainage with a covered self-expandable metal stent (SEMS). Three months later, we also placed an uncovered duodenal stent for duodenal stricture in a side-to-end fashion. Another month later, for biliary SEMS obstruction, we attempted a transpapillary approach. A duodenoscope was advanced and a guidewire was passed through the mesh of the duodenal stent into the bile duct with a flexible tip catheter, but the catheter was not. Thus, we exchanged the duodenoscope for a forward-viewing two-channel endoscope and used the left working channel with a flexible tip catheter. By adjusting the axis, we finally succeeded biliary cannulation and accomplished balloon cleaning for recanalization of the SEMS. This is the first case with successful biliary cannulation by combined use of a two-channel endoscope and a flexible tip catheter.

Endoscopic balloon dilations for strictures of rectum, ileocecal valve and duodenum in a patient with X-linked inhibitor of apoptosis deficiency: a case report

( Shinsuke Otagiri ),( Takehiko Katsurada ),( Kensuke Sakurai ),( Junichi Sugita ),( Naoya Sakamoto ) 대한장연구학회 2022 Intestinal Research Vol.20 No.2

X-linked inhibitor of apoptosis (XIAP) deficiency is a rare primary immunodeficiency and gastrointestinal (GI) lesions in XIAP deficiency are similar to Crohn’s disease. For patients with Crohn’s disease, endoscopic balloon dilation (EBD) is known to be a standard procedure for intestinal strictures including upper GI tract. However, there are no articles which mention the efficacy of EBDs for the strictures in upper GI tract in patients with XIAP deficiency. Herein, we describe an 18-year-old male with XIAP deficiency in whom EBDs for the rectum, ileocecal valve (ICV), and duodenum were performed. Before hematopoietic stem cell transplantation (HSCT), GI endoscopy revealed strictures of the rectum, ICV and duodenum with active ulcers. Although these ulcers healed after HSCT, the strictures progressed. Therefore, we performed EBDs for the strictures of the rectum, ICV, and duodenum. In contrast studies, we did not find any other strictures in the small intestine. Throughout the patient’s clinical course, no complications of EBD occurred. He started eating after EBDs, but abdominal symptoms did not relapse without any dietary restrictions. Our case suggests that EBD could be an effective and safe procedure for intestinal strictures including upper GI tract after HSCT in patients with XIAP deficiency. (Intest Res 2022;20:274-277)