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- 저자 : Tadashi Iida (검색결과 2 건)
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Impact of sarcopenia on biliary drainage during neoadjuvant therapy for pancreatic cancer
Kunio Kataoka,Eizaburo Ohno,Takuya Ishikawa,Kentaro Yamao,Yasuyuki Mizutani,Tadashi Iida,Hideki Takami,Osamu Maeda,Junpei Yamaguchi,Yukihiro Yokoyama,Tomoki Ebata,Yasuhiro Kodera,Hiroki Kawashima 대한소화기내시경학회 2024 Clinical Endoscopy Vol.57 No.1
Background/Aims: Since the usefulness of neoadjuvant chemo(radiation) therapy (NAT) for pancreatic cancer has been demonstrated, recurrent biliary obstruction (RBO) in patients with pancreatic cancer with a fully covered self-expandable metal stent (FCSEMS) during NAT is expected to increase. This study investigated the impact of sarcopenia on RBO in this setting. Methods: Patients were divided into normal and low skeletal muscle index (SMI) groups and retrospectively analyzed. Patient characteristics, overall survival, time to RBO (TRBO), stent-related adverse events, and postoperative complications were compared between the two groups. A Cox proportional hazard model was used to identify the risk factors for short TRBO. Results: A few significant differences were observed in patient characteristics, overall survival, stent-related adverse events, and postoperative complications between 38 patients in the normal SMI group and 17 in the low SMI group. The median TRBO was not reached in the normal SMI group and was 112 days in the low SMI group (p=0.004). In multivariate analysis, low SMI was the only risk factor for short TRBO, with a hazard ratio of 5.707 (95% confidence interval, 1.148–28.381; p=0.033). Conclusions: Sarcopenia was identified as an independent risk factor for RBO in patients with pancreatic cancer with FCSEMS during NAT.
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Tomoyuki Hayashi,Yoshiro Asahina,Yasuhito Takeda,Masaki Miyazawa,Hajime Takatori,Hidenori Kido,Jun Seishima,Noriho Iida,Kazuya Kitamura,Takeshi Terashima,Sakae Miyagi,Tadashi Toyama,Eishiro Mizukoshi 대한소화기내시경학회 2023 Clinical Endoscopy Vol.56 No.5
Background/Aims: The necessity for pharyngeal anesthesia during upper gastrointestinal endoscopy is controversial. This study aimedto compare the observation ability with and without pharyngeal anesthesia under midazolam sedation. Methods: This prospective, single-blinded, randomized study included 500 patients who underwent transoral upper gastrointestinalendoscopy under intravenous midazolam sedation. Patients were randomly allocated to pharyngeal anesthesia: PA+ or PA– groups (250patients/group). The endoscopists obtained 10 images of the oropharynx and hypopharynx. The primary outcome was the non-inferiorityof the PA- group in terms of the pharyngeal observation success rate. Results: The pharyngeal observation success rates in the pharyngeal anesthesia with and without (PA+ and PA–) groups were 84.0%and 72.0%, respectively. The PA– group was inferior (p=0.707, non-inferiority) to the PA+ group in terms of observable parts (8.33 vs. 8.86, p=0.006), time (67.2 vs. 58.2 seconds, p=0.001), and pain (1.21±2.37 vs. 0.68±1.78, p=0.004, 0–10 point visual analog scale). Suitablequality images of the posterior wall of the oropharynx, vocal fold, and pyriform sinus were inferior in the PA– group. Subgroupanalysis showed a higher sedation level (Ramsay score ≥5) with almost no differences in the pharyngeal observation success rate betweenthe groups. Conclusions: Non-pharyngeal anesthesia showed no non-inferiority in pharyngeal observation ability. Pharyngeal anesthesia may improvepharyngeal observation ability in the hypopharynx and reduce pain. However, deeper anesthesia may reduce this difference.
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