研究者業績
基本情報
- 所属
- 藤田医科大学 医学部 医学科 先端光学診療学講座
- 学位
- 博士(医学）
- J-GLOBAL ID
- 200901011108502975
- researchmap会員ID
- 6000005568
患者さんの立場にたって、安全かつ最高の医療を提供できるよう努力します。
研究キーワード
8研究分野
1委員歴
28-
2024年2月 - 現在
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2023年2月 - 現在
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2022年9月 - 現在
受賞
4-
2022年10月
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2019年10月
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2015年10月
論文
270-
The Journal of dermatology 2024年9月30日 査読有り
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JAMA 2024年7月22日 査読有りImportance The clinical effects of risankizumab (a monoclonal antibody that selectively targets the p19 subunit of IL-23) for the treatment of ulcerative colitis are unknown. Objective To evaluate the efficacy and safety of risankizumab when administered as an induction and a maintenance therapy for patients with ulcerative colitis. Design, Setting, and Participants Two phase 3 randomized clinical trials were conducted. The induction trial was conducted at 261 clinical centers (in 41 countries) and enrolled 977 patients from November 5, 2020, to August 4, 2022 (final follow-up on May 16, 2023). The maintenance trial was conducted at 238 clinical centers (in 37 countries) and enrolled 754 patients from August 28, 2018, to March 30, 2022 (final follow-up on April 11, 2023). Eligible patients had moderately to severely active ulcerative colitis; a history of intolerance or inadequate response to 1 or more conventional therapies, advanced therapies, or both types of therapies; and no prior exposure to risankizumab. Interventions For the induction trial, patients were randomized 2:1 to receive 1200 mg of risankizumab or placebo administered intravenously at weeks 0, 4, and 8. For the maintenance trial, patients with a clinical response (determined using the adapted Mayo score) after intravenous treatment with risankizumab were randomized 1:1:1 to receive subcutaneous treatment with 180 mg or 360 mg of risankizumab or placebo (no longer receiving risankizumab) every 8 weeks for 52 weeks. Main Outcomes and Measures The primary outcome was clinical remission (stool frequency score ≤1 and not greater than baseline, rectal bleeding score of 0, and endoscopic subscore ≤1 without friability) at week 12 for the induction trial and at week 52 for the maintenance trial. Results Among the 975 patients analyzed in the induction trial (aged 42.1 [SD, 13.8] years; 586/973 [60.1%] were male; and 677 [69.6%] were White), the clinical remission rates at week 12 were 132/650 (20.3%) for 1200 mg of risankizumab and 20/325 (6.2%) for placebo (adjusted between-group difference, 14.0% [95% CI, 10.0%-18.0%], P < .001). Among the 548 patients analyzed in the maintenance trial (aged 40.9 [SD, 14.0] years; 313 [57.1%] were male; and 407 [74.3%] were White), the clinical remission rates at week 52 were 72/179 (40.2%) for 180 mg of risankizumab, 70/186 (37.6%) for 360 mg of risankizumab, and 46/183 (25.1%) for placebo (adjusted between-group difference for 180 mg of risankizumab vs placebo, 16.3% [97.5% CI, 6.1%-26.6%], P < .001; adjusted between-group difference for 360 mg of risankizumab vs placebo, 14.2% [97.5% CI, 4.0%-24.5%], P = .002). No adverse event signals were detected in the treatment groups. Conclusion and Relevance Compared with placebo, risankizumab improved clinical remission rates in an induction trial and in a maintenance trial for patients with moderately to severely active ulcerative colitis. Further study is needed to identify benefits beyond the 52-week follow-up. Trial Registration ClinicalTrials.gov Identifiers: NCT03398148 and NCT03398135
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Journal of gastrointestinal and liver diseases : JGLD 33(2) 164-169 2024年6月29日 査読有りBACKGROUND AND AIMS: Early gastric cancers (EGCs) after Helicobacter pylori (H. pylori) eradication often appear as reddish depressed lesions (RDLs); the same features are also appeared in benign stomachs after eradication. We compared clinic-pathological and endoscopic features of benign and neoplastic RDLs after H. pylori eradication. METHODS: 228 neoplastic RDLs after H. pylori eradication were studied. All lesions were divided into neoplastic RDLs (differentiated carcinoma or adenoma, n=114) and benign RDLs (n=114) according to the histology. Clinical and pathological characteristics were compared in neoplastic and benign groups. Endoscopic diagnostic yields using the white light (WL) endoscopy, chromoendoscopy (CE) using indigo carmine dye and the magnifying endoscopy with narrow-band imaging (ME-NBI) were also evaluated in relation to the pathological diagnosis. RESULTS: Size of neoplastic RDLs was larger than that of benign RDLs (p<0.01). Sensitivity, specificity and accuracy for predicting pathological types of RDLs was 70.1%, 52.6% and 61.4% for the WL, 65.8%, 63.1% and 65.4% for the CE, while the ME-NBI scored better with the 88.6%, 88.6%, 99.1% and 93.9% of sensitivity, specificity and accuracy. The accuracy of the ME-NBI was 99.9% (113/114) in the benign RDLs and 89.4% (101/114) for the neoplastic RDLs. Undiagnosed neoplastic RDLs using the ME-NBI were associated with more differentiated tumors such as adenoma and well-differentiated adenocarcinoma (tub1) and the presence of an unclear demarcation line. CONCLUSIONS: ME-NBI is useful to diagnose RDLs after H. pylori eradiation, while some of neoplastic lesions are difficult to diagnose using the ME-NBI.
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Journal of gastroenterology 59(5) 376-388 2024年5月 査読有りBACKGROUND: The clinicopathological features and prognosis of primary small bowel adenocarcinoma (PSBA), excluding duodenal cancer, remain undetermined due to its rarity in Japan. METHODS: We analyzed 354 patients with 358 PSBAs, between January 2008 and December 2017, at 44 institutions affiliated with the Japanese Society for Cancer of the Colon and Rectum. RESULTS: The median age was 67 years (218 males, 61.6%). The average tumor size was 49.9 (7-100) mm. PSBA sites consisted of jejunum (66.2%) and ileum (30.4%). A total of 219 patients (61.9%) underwent diagnostic small bowel endoscopy, including single-balloon endoscopy, double-balloon endoscopy, and capsule endoscopy before treatment. Nineteen patients (5.4%) had Lynch syndrome, and 272 patients (76.8%) had symptoms at the initial diagnosis. The rates for stages 0, I, II, III, and IV were 5.4%, 2.5%, 27.1%, 26.0%, and 35.6%, respectively. The 5-year overall survival rates at each stage were 92.3%, 60.0%, 75.9%, 61.4%, and 25.5%, respectively, and the 5-year disease-specific survival (DSS) rates were 100%, 75.0%, 84.1%, 59.3%, and 25.6%, respectively. Patients with the PSBA located in the jejunum, with symptoms at the initial diagnosis or advanced clinical stage had a worse prognosis. However, multivariate analysis using Cox-hazard model revealed that clinical stage was the only significant predictor of DSS for patients with PSBA. CONCLUSIONS: Of the patients with PSBA, 76.8% had symptoms at the initial diagnosis, which were often detected at an advanced stage. Detection during the early stages of PSBA is important to ensure a good prognosis.
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日本消化器病学会雑誌 121(臨増総会) A190-A190 2024年3月
MISC
1258-
Pancreas 38(1) 17-22 2009年1月 査読有りObjectives: We investigated the feasibility of using real-time tissue elastography (EG) with transcutaneous ultrasonography (EG-US) for pancreatic diseases. Methods: A preliminary study (phase I) and a prospective (phase II) study were conducted. Phase I: subjects were 10 volunteers, 5 with cancer, 2 with endocrine tumor, 5 with chronic pancreatitis, 14 with intraductal papillary-mucinous neoplasm. To determine the characteristic EG images (diagnostic criteria for phase II), B-mode images were compared with EG images and histopathologic. findings. Phase II: 53 consecutive patients were enrolled. The visualization rate by EG-US in lesions visualized by B mode was assessed, and the correct diagnosis rate by B mode alone (B diagnosis) or in combination with EG-US was evaluated. Results: Phase I: normal parenchyma was a homogeneous color. In cancer, EG-US showed a markedly hard area with soft spots inside. Endocrine tumor was uniform and soft comparable to parenchyma. Chronic pancreatitis showed a mixture of various colors. Phase II: we identified 77.4% (41/53) of the lesions and observed 60.0% (15/25) of the cancers, 100% (3/3) of the endocrine tumor, 92.0% (23/25) of the cases of chronic pancreatitis cases on EG-US. The B-diagnosis rates ranged from about 70% to 80%. The diagnosis rates of the combination were more than 90% of lesions of each type. Conclusions: The EG-US is feasible in the diagnosis of pancreatic diseases.
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Gastrointestinal endoscopy 69(1) 84-93 2009年1月 査読有りBackground: Small-bowel obstruction (SBO) sometimes remains undiagnosed and untreatable without surgery. Objective: To evaluate the diagnostic yields of SBO between double-balloon endoscopy (DBE) and fluoroscopic enteroclysis (FE), and the Outcome of enteroscopic treatment. Design: Single-center, retrospective, and prospective study Setting: Tertiary-referral hospital. Patients: Between June 2003 and July 2007, 66 consecutive patients with SBO were enrolled, investigated, and treated. Main Outcome Measurements: A comparison of diagnostic yields between DBE and FE, and the prognosis after enteroscopic balloon dilation. Results: The diagnostic yield of DBE for SBO (95%) was higher than that of FE (71%) in 59 patients who underwent both examinations (P = .004). The first treatment included 27 Surgical, 25 enteroscopic, and 14 conservative therapies. Of 47 enteroscopic balloon dilation procedures in 22 patients, 45 (96%) were successful. Of 16 patients with Crohn's disease, 11 (69%) remained asymptomatic over the postdilation follow-up period but 5 relapsed: 2 recovered by repeated dilations, but 3 required surgery Of 6 patients who had diseases other than Crohn's disease, 4 (67%) remained asymptomatic but 2 relapsed: one with remission of metastasis recovered by repeated dilations, and one with ischemic enteritis required Surgery. Anastomotic stricture was an independent marker of the symptom-free outcome (hazard ratio 0.037-0.084, P = .037). Two acute pancreatitis, one perforation, and one exacerbation of SBO complications occurred. Limitations: Small sample size and participation bias. Conclusions: DBE was useful for the diagnosis of SBO. Balloon dilation is considered an alternative to surgery in patients with fibrotic strictures both related and unrelated to Crohn's disease. (Gastrointest Endosc 2009-69:84-93.)
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Digestion 79(1) 23-9 2009年 査読有りBackground/Aims: Matrix metalloproteinases (MMPs) are endopeptidases which perform important functions in extracellular matrix remodeling, cell proliferation, and inflammatory processes. Here, we compared MMP-3 levels with those of tissue inhibitor of metalloproteinases (TIMP)-1 and several inflammatory cytokines in gastric ulcer (GU) patients. Methods: This study enrolled 50 patients with GU and 6 with functional dyspepsia (FD). Samples of gastric mucosa from the antrum and the ulcer site were harvested from GU patients and of antral mucosa alone from FD patients during upper gastrointestinal endoscopy. Mucosal biopsy tissues were cultured for 24 h, and the culture supernatant was measured for levels of MMP-3, TIMP-1, IL-1 beta, IL-6, and IL-8. Results: All GU patients were positive for Helicobacter pylori, while all FD patients were negative. Antral levels of TIMP-1, IL-1 beta, IL-6, and IL-8 were significantly higher in GU than FD patients. Further, MMP-3 levels were significantly higher in GU patients at the ulcer site than in the antrum, and had a significantly positive correlation with TIMP-1, IL-1 beta, IL-6, and IL-8. Conclusion: MMP-3 levels were significantly higher at the ulcer site than in the antrum, suggesting that MMP-3 may perform an important function in gastric ulcer healing. Copyright (c) 2009 S. Karger AG, Basel
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Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society 21(1) 29-33 2009年1月 査読有りThe aim of the present study was to use video capsule endoscopy (VCE) to objectively evaluate bowel movements in patients with irritable bowel syndrome (IBS) compared with healthy volunteers. Subjects were nine healthy volunteers (group A) and five IBS patients (group B) whose VCE reached the cecum within the examination time. As the darkest component in an image of VCE is the lumen, we regarded real movements of the intestine observed in the images as the changes of luminal movement, and analyzed them. We trimmed the luminal edge, counted pixels in the lumen and the low brightness area (LBA), of all VCE images and compared them between the groups. There was no difference in the frequency observed in the LBA corresponding to the luminal area between the groups. As for the average volume of the LBA found in an image, it was 1702 pixels in healthy persons versus 305 in IBS patients (P = 0.21) and in healthy persons it tends to be larger. We drew a graph of LBA by time-course. A periodic change in the volume of LBA was found in eight of nine (88.9%) healthy persons over time, but in only two of five (40.0%) IBS patients (P = 0.62). Using endoscopy, a difference in the bowel movement between groups A and B could be evaluated objectively. The present study presents the possibility of a new technique to evaluate functional bowel disorders objectively using an endoscopic procedure.
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Digestion 80(4) 260-6 2009年 査読有りBackground and Aims: Little information is available regarding the prevention and treatment of small intestinal mucosal injuries caused by non-steroidal anti-inflammatory drugs (NSAIDs). We planned a pilot study to investigate the protective effects of geranylgeranylacetone (GGA) against NSAID-induced small intestinal injuries using video capsule endoscopy (VCE). Subjects and Methods: Ten healthy male volunteers took oral GGA 300 mg/day (regimen A) or placebo (regimen B) in addition to diclofenac 75 mg/day + rabeprazole 20 mg/day for 7 days. We conducted a cross-over trial of regimens A and B with a 2-week washout period. All subjects underwent VCE before and after each administration period, and were evaluated for NSAID-induced gastric and small intestinal mucosal lesions. Results: The number of mucosal lesions (erosions, ulcers and a red spot with possible bleeding) detected in both stomach and small bowel changed between prior to and immediately after administration period, with significantly fewer lesions for regimen A after administration period (mean +/- SD A: B = 2.6 +/- 3.2:9.5 +/- 8.5; p = 0.027). Conclusions: Combination therapy with GGA and rabeprazole reduced the incidence of gastroenteropathy induced by 1-week administration of diclofenac. Our findings suggest this therapy as a candidate for protecting patients on long-term NSAID therapy. Copyright (C) 2009 S. Karger AG, Basel
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INTESTINE 13(5) 491-498 2009年
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臨床消化器内科 24(1) 101-106 2009年
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消化器内視鏡 21(6) 958-963 2009年未熟樹状細胞は、アポトーシスを生じた腫瘍細胞を取り込んだ後、クロスプレゼンテーションにより、抗原特異的なT細胞を誘導し、腫瘍抑制性免疫環境を提供する。筆者らは切除不能局所進行膵癌に対する一次治療として、ジェムシタビンによる治療で、腫瘍にアポトーシスを惹起させた後、超音波内視鏡ガイド下に未熟樹状細胞を腫瘍に局注する第1相臨床試験を行い、安全性と有効性を確認し得た。本稿ではその概要につき報告した。(著者抄録)
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消化器の臨床 12(3) 305-309 2009年NSAIDや抗凝血薬の長期内服患者においては消化管出血のリスクが非常に高く、その後のフォローアップが重要なテーマとなる。原因薬剤の休薬を考えると同時に、胃出血の二次予防にはプロトンポンプインヒビダー(PPI)が勧められる。下部消化管出血患者においてはその二次予防に明確な指針はないが、抗凝血薬の場合は小腸血管性病変のチェックを定期的にすること、NSAIDに対してはその同時内服による予防として胃粘膜防御因子製剤やPPIでの研究が試みられている。(著者抄録)
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消化器科 48(2) 166-171 2009年小腸用カプセル内視鏡(VCE)を施行した131症例を対象に、VCEによる大腸画像を撮影し、VCE以前に施行していた大腸スコープ所見と比較して得られる特徴について検討した。対象のVCE検査の契機は、原因不明の消化管出血;87例・小腸腫瘍検査;21例・慢性下痢症又は腹痛;13例・蛋白漏出性胃腸症;9例・クローン病疑い;1例であった。VCEが予定された131例中10例ではポリエチレングリコール/電解質洗浄溶液(PEG)で、10例ではクエン酸マグネシウム(MgC)68gを含む水1.8Lで前処理を受けており、残る111例は絶食のみを行った。当日患者はレコーダーを朝8時に接続されたVCEを嚥下し、2時間後に水分、4時間後に食事が許可され、レコーダーは9時間後に取り外され、VCE所見は経験のある内視鏡専門医2名によって評価された。被検者は絶食群・PEG群・MgC群の3群に分けられ、各群の性・年齢・体重と腹部手術の既往歴には有意差は認めなかった。その結果、VCEの消化管通過はPEG群で平均胃通過時間(GTT)は他群より長く、大腸への検査時間到達率はPEG群で低く、その理由は下部回腸の大量の洗浄液貯留と考えられた。GTTと小腸通過時間(SBTT)は3群間で有意差を認めず、検査時間内のVCEの体外排出は全体で5.3%、絶食群で5.4%、前処理群で5.0%であった。本研究において腸洗浄は大腸を通して迅速な通過には大きな効果を及ぼさず、VCEが終了した時点の大腸の部位は上行又は横行結腸が多く、癌と炎症性腸疾患のスクリーニングに不可欠な直腸・S状結腸部へのアクセスは僅かに6.9%(9/131例)であった。
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胆と膵 30(7) 715-721 2009年病変の悪性度とその組織の硬さには相関があり、一般に、悪性腫瘍は良性腫瘍に比して硬いと考えられており、組織性状診断としてその硬度を検討することは有意義である。Real-time tissue elastographyを用いたUS、EUS診断では、対象病変の硬度からみたパターン分析や定量性を加味したSR(strain ratio)の評価が診断に有用であると思われる。Real-time tissue elastographyで表現される内容としては、対象領域内の硬度分布の性状もきわめて重要な情報であり、解析ソフトを使用することでその定量評価が可能である。(著者抄録)
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胆と膵 30(8) 849-853 2009年当科における胆管狭窄病変診断に対する経乳頭的胆管生検の現状について良性胆管狭窄の診断という点に重点をおいてretrospectiveに検討した。対象は質的診断目的に経乳頭的胆管生検を施行した胆管狭窄病変61例。胆管造影像診断と生検診断を手術標本、経過観察(6ヵ月以上)によって得られた最終診断と比較検討した。生検目的の内視鏡的逆行性胆管造影は61例に対し72回施行、総生検個数は174材(1〜18材、平均2.9材)であった。生検した症例の最終診断は悪性胆管狭窄34例、良性胆管狭窄27例であった。胆管造影像にて良性胆管狭窄と考えられた20例中5例が生検結果で悪性と診断された。悪性胆管狭窄診断に対する経乳頭的胆管生検の感度は76.5%、特異度は100%であった。生検にて診断のついた悪性胆管狭窄26例中25例は3材目までに採取された組織にて悪性と診断され、4材以上生検しても良性の診断であった8例はすべて良性狭窄であった。良性胆管狭窄を良性と診断するためには4材以上の生検組織の採取が必要であると考えられた。(著者抄録)
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胆と膵 30(臨増特大) 1257-1261 2009年切除不能局所進行膵癌に対する超音波内視鏡ガイド下未熟樹状細胞局注療法の実際について述べた。超音波内視鏡にて腫瘍を描出し、カラードプラ断層法を用いて穿刺ルートに介在血管が存在しないことを確認する。確認の際にはカラードプラ断層法での観察下で、実際に穿刺針を消化管壁に押しつけて確認することが重要である。穿刺針が直進すると仮定した場合の穿刺可能距離を測定し、測定距離の範囲内で穿刺を行う。術者は穿刺針の先端部位を常に確認しながら、助手が未熟樹状細胞を注入する。(著者抄録)
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消化器内視鏡 21(11) 1702-1708 2009年胃粘膜下腫瘍の質的診断について、EUSは有用な検査手技となる。精度の高い画像診断を行うためには、良好なEUS画像を得る必要がある。そのため、EUS検査を実際に行う際のコツと注意点について説明した。また、得られたEUS画像に対しては、消化管壁層構造のなかにおける病変が発生した位置、エコー輝度や内部エコーの性状から鑑別診断を行うことになる。EUSで得られる胃粘膜下腫瘍の画像所見は、病理組織像と近似しており、鑑別診断を的確に行うためには、対象病変の病理組織所見を理解することも必要である。代表的な胃粘膜下腫瘍について、EUS画像所見の特徴と実際の症例を呈示した。(著者抄録)
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European journal of gastroenterology & hepatology 20(12) 1144-50 2008年12月 査読有りBackground Helicobacter pylori infection induces a biased T helper type 1 (Th1) response that produces IFN-gamma and Fas ligand (FasL). Th1 cytokines are associated with apoptosis in the gastric epithelial cells. Aim We aimed to define the role of the recently cloned IL-18, a IFN-gamma inducing factor, in gastric mucosal injury induced by H. pylori infection. Methods Twenty-seven gastric ulcer (GU) patients and 20 functional dyspepsia (FD) patients were enrolled in this study. Mucosal biopsy samples were obtained from the gastric antrum and GU site during endoscopy. Samples were used for histological examination, H. pylori culture and in-situ stimulation for 48 h in the presence of 10 mu g/ml phytohemagglutinin-P. IL-18, IFN-gamma, and soluble FasL (sFasL) levels in culture supernatants were assayed by the enzyme-linked immunosorbent assay method. IL-18, IL-1 beta-converting enzyme (ICE) and caspase-3 were evaluated by western blotting in gastric cancer cell lines (MKN45) cocultured with H. pylori. Results All 27 GU patients and ten out of 20 FD patients were found to be H. pylori-positive, whereas ten FD patients were H. pylori-negative. Antral mucosal tissues from H. py/ork-positive FD patients contained (P < 0.01) higher levels of IL-18, IFN-gamma, and sFasL than those from uninfected FD patients. IL-18, IFN-gamma, and sFasL levels at the ulcer site were significantly (P < 0.01) higher than those at distant sites in the antrum. A significant relationship was seen between IL-18 and IFN-gamma levels at the ulcer site (r = 0.7, P < 0.01). H. pylori eradication led to a significant decrease in the levels of IL-18, IFN-gamma, and sFasL at the ulcer site. Western blotting showed that IL-18, ICE, and caspase-3 were activated in gastric cancer cell lines cocultured with H. pylori. Conclusion This study suggests that H. pylori infection enhanced mucosal injury by stimulating a Th1 response, which was mediated by IL-18 upregulation as well as activation of ICE and caspase-3. Eur J Gastroenterol Hepatol 20:1144-1150 (C) 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins.
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Journal of gastroenterology and hepatology 23 Suppl 2(Suppl 2) S193-7-S197 2008年12月 査読有りThe chronic inflammatory process in patients with Crohn's disease (CD) may affect any part of the gastrointestinal (GI) tract. The pathogenesis of CD involves immunological abnormalities, including deficient or excessive expression of cytokines. We examined Helicobacter pylori infection status, endoscopic and histopathological findings, and cytokine production in the duodenum of CD patients in comparison with controls. Thirty-eight CD patients underwent diagnostic upper GI endoscopy. Twelve age- and sex-matched health checkup examinees were used as controls. H. pylori infection status was assessed by the (13)C-urea breath test. At the time of endoscopy, two biopsy specimens each were obtained from the second portion of the duodenum, one for hematoxylin-eosin staining and immunohistochemical analysis with anti-CD68 antibody, and one for in vitro organ culture. Interleukin (IL)-6 and -8 levels were measured in organ culture supernatant by enzyme-linked immunosorbent assay. H. pylori infection was significantly (P < 0.05) more frequent in controls (42%) than in CD patients (8%). In the duodenum, erosions or ulcers were more frequent in CD patients (53%) than in controls (8%). Mononuclear cell infiltration in the duodenum was more severe in CD patients than in controls and IL-6 production was higher, whereas IL-8 production showed no significant difference. CD68+ cells in the duodenum were more prominent in CD patients than in controls. H. pylori infection is unlikely in CD patients, but they show immunological abnormalities in the duodenum, possibly from innate immune responses.
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Journal of gastroenterology and hepatology 23 Suppl 2(Suppl 2) S286-90-S290 2008年12月 査読有りConfocal endomicroscopy is a new technology that provides microscopic images of cellular morphology in the gastrointestinal tract in vivo. In particular, confocal microendoscopy allows histological diagnosis during the endoscopic examination. We examined patients with ulcerative colitis (UC) using confocal endoscopy and investigated the features of confocal endomicroscopic images of inflamed and non-inflamed rectal mucosa. Seventeen patients with UC, 12 in the active phase and 5 in the non-active phase, and 14 non-UC control patients who had colon polyps or colon cancer underwent colonoscopy, during which fluorescence images of the rectal mucosa were obtained with confocal endomicroscopy. Histological findings of rectal biopsy specimens were compared with the microendoscopic images. Confocal microendoscopy allowed observation of cellular and subcellular structures. The crypts of normal colonic mucosa were small, round and regularly arranged, and the crypt lumens of the colonic glands were small and round. The crypts of colonic mucosa in non-active UC were small, round and slightly irregular in arrangement and the crypt lumens of the colonic glands were small and round. Inflammatory cells and capillaries were visible in the lamina propria. The crypts of colonic mucosa in active UC were large, variously shaped and irregular in arrangement. The crypt lumens of the colonic glands were large and the crypt structure could not be recognized in some areas. Numerous inflammatory cells and capillaries were visible in the lamina propria. Images taken with the confocal microendoscope provided information that was equivalent to conventional histology, and improve our understanding of the differences in rectal tissues (crypts, capillaries and inflammatory cells) between normal controls and active and non-active UC patients during ongoing endoscopy.
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肝胆膵画像 10(6) 505-510 2008年11月早期膵癌を診断するために最低限必要なことは,何らかの異常所見(症状,血液検査,画像所見など)を有する患者に対する見逃し例を最小限にすることである.外来での体外式超音波検査と超音波内視鏡検査の同時実施は現時点では最も有効な方法であると考えているが,その精度が術者依存であることが問題である.現状では,異常所見を有する患者に対し,体外式超音波検査,超音波内視鏡検査,MDCTの3種類の検査を外来で実施し,より確実な拾い上げを目指すのが現実的であると考えている.(著者抄録)
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Hepato-Gastroenterology 55(88) 2087-2090 2008年11月 査読有りA 73-year-old woman presented with massive bloody stools while undergoing hospitalization for multiple myeloma. Colonoscopy and transrectal double-balloon enteroscopy revealed multiple punched-out ulcers throughout the entire colon and in the distal ileum. Cytomegalovirus was detected in the biopsy specimens of both the colonic and ileal mucosa and in the peripheral blood, which lead the diagnosis of CMV enterocolitis. The patient's gastrointestinal bleeding was temporarily improved by the administration of ganciclovir, though she died thereafter due to progression of the primary disease. We herein report the effectiveness of transrectal double-balloon enteroscopy for the diagnosis of cytomegolo-virus enterocolitis. © H.G.E. Update Medical Publishing S.A., Athens-Stuttgart.
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HEPATO-GASTROENTEROLOGY 55(88) 2277-2281 2008年11月 査読有りBackground/Aims: To better understand the carcinogenesis pathway in gastric cancer, we investigated the relationship between mucin phenotype and clinicopathologic features. Methodology: The study was conducted in 203 consecutive patients with newly diagnosed gastric cancer. Sections from representative paraffin blocks of each case were immunostained with human gastric mucin, MUC2, CD10, and paradoxical concanavalin A class III. Gastric cancers were divided into three phenotypes; gastric phenotype (G-type), intestinal phenotype (I-type), and the Null phenotype (N-type). Surrounding non-cancerous mucosa was also phenotyped as G- or I-type. Results: In G-type surrounding non-cancerous mucosa, I-type cancers were more frequent among the differentiated type gastric cancers whereas G-type cancers were more frequent among the undifferentiated type gastric cancers (p=0.004). As for surrounding non-cancerous mucosa, the G-type mucosa was more frequently seen than the I-type mucosa in incomplete intestinal metaplasia (p < 0.001). I-type gastric cancers were more frequent in non-cancerous surrounding mucosa with incomplete intestinal metaplasia, and G-type cancers were more frequent in non-cancerous surrounding mucosa with no intestinal metaplasia (p=0.03). Conclusions: G-type gastric cancers may develop in G-type gastric mucosa with incomplete intestinal metaplasia and progress to the G-type undifferentiated carcinomas or the I-type differentiated carcinomas.
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日本消化吸収学会総会プログラム・講演抄録集 39回 146-146 2008年10月
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治療学 42(9) 1045-1049 2008年9月クローン病の腸管狭窄に対しては従来、外科的に腸管切除術や狭窄形成術が行われ、しばしば頻回の手術が必要であった。近年ダブルバルーン小腸内視鏡(DBE)の登場により深部小腸の観察のみならず、狭窄部に対する内視鏡下バルーン拡張術が可能となった。本稿では、症例を提示しDBEによるクローン病の狭窄に対する内視鏡的拡張術の有効性について述べる。(著者抄録)
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日本消化器病学会雑誌 105(臨増大会) A785-A785 2008年9月
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Cancer science 99(9) 1769-73 2008年9月 査読有りGastric mucosa-associated lymphoid tissue (MALT) lymphoma is a distinct low-grade lymphoma that often regresses upon Helicobacter pylori eradication. It was reported that the chemokine receptor CXCR3 is expressed not only on activated T cells, but also on MALT lymphoma cells, and that CXCR3-positive B lymphocytes migrate or home to the MALT of MALT lymphoma. In the present study, we aimed to elucidate the correlation between CXCR3 expression and the clinicopathological features of gastric MALT lymphoma, and to determine whether CXCR3 expression was predictive of responsiveness to H. pylori eradication. Sixty-seven patients with gastric MALT lymphoma in a single-center study were treated with H. pylori eradication therapy. We evaluated the correlation of CXCR3 expression with response to H. pylori eradication therapy by logistic regression stratified according to potential confounders. Immunohistochemical analysis revealed that 28 of 67 cases (42%) were positive for CXCR3 expression. CXCR3 expression was significantly more prevalent in those without H. pylori infection, advanced-stage disease, and in those with API2-MALT1 fusion. In overall analysis, those with CXCR3 expression showed a significantly increased risk of non-responsiveness to H. pylori eradication therapy (odds ratio = 28.6; 95% confidence interval 5.70-143.4) compared to those without CXCR3 expression. This higher risk was observed consistently regardless of sex, API2-MALT1 fusion, H. pylori infection, or clinical stage. We showed that CXCR3 expression was an independent predictive factor for non-responsiveness to H. pylori eradication therapy in patients with gastric MALT lymphoma.
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AMERICAN JOURNAL OF GASTROENTEROLOGY 103(8) 2149-2150 2008年8月 査読有り
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PANCREAS 37(1) 113-113 2008年7月
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胃と腸 43(7) 1031-1038 2008年6月濾胞性リンパ腫(FL)は原則的に節性リンパ腫で,消化管,皮膚発生例を除けば節外性臓器原発例はまれである.FLは胚中心構成B細胞由来のリンパ腫で,少なくとも1つの腫瘍性濾胞様構造が形成されているものをいう.本腫瘍の発生にはt(14;18)(q32;q21)転座およびこれに基づくBCL2遺伝子の再構成,さらにBCL2蛋白質の過剰発現が重要である.また,いくつかの付加的異常がFLの高度悪性転化に関与するとされている.近年,マイクロアレイ解析により,FLの予後は,腫瘍細胞そのものだけでなく,周辺細胞によって形成される微小環境によっても規定されうることが解明されつつある.(著者抄録)
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GASTROINTESTINAL ENDOSCOPY 67(5) AB201-AB201 2008年4月
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GASTROINTESTINAL ENDOSCOPY 67(5) AB214-AB214 2008年4月
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GASTROINTESTINAL ENDOSCOPY 67(5) AB183-AB183 2008年4月
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GASTROINTESTINAL ENDOSCOPY 67(5) AB317-AB317 2008年4月
書籍等出版物
46講演・口頭発表等
430-
JDDW2024 第108回日本消化器内視鏡学会 2024年11月1日
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第62回日本小腸学会学術集会 2024年10月19日
担当経験のある科目(授業)
7所属学協会
12共同研究・競争的資金等の研究課題
31-
日本学術振興会 科学研究費助成事業 2022年4月 - 2025年3月
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日本学術振興会 科学研究費助成事業 基盤研究(C) 2022年4月 - 2025年3月
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厚生労働省 先進医療B 2021年2月 - 2024年6月
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国立研究開発法人日本医療研究開発機構（AMED) 令和6年度 医療機器等研究成果展開事業（開発実践タイプ） 2024年6月
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国立研究開発法人日本医療研究開発機構（AMED) 令和３年度難治性疾患実用化研究事業 2021年5月 - 2024年3月