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| 1 | Treatment of hepatocellular carcinoma accompanied by portal vein tumor thrombus显示文摘The prognosis of patients with hepatocellular carcinoma (HCC) accompanied by portal vein tumor thrombus (PVTT) is generally poor if left untreated: a median survival time of 2.7-4.0 mo has been reported. Furthermore, while transcatheter arterial chemoembolization (TACE) has been shown to be safe in selected patients, the median survival time with this treatment is still only 3.8-9.5 mo. Systemic single-agent chemotherapy for HCC with PVTT has failed to improve the prognosis, and the response rates have been less than 20%. While regional chemotherapy with low-dose cisplatin and 5-fluorouracil or interferon and 5-fluorouracil via hepatic arterial infusion has increased the response rate, the median survival time has not exceeded 12 (range 4.5-11.8) mo. Combined treatment consisting of radiation for PVTT and TACE for liver tumor has achieved a high response rate, but the median survival rates have still been only 3.8-10.7 mo. With hepatic resection as monotherapy, the 5-year survival rate and median survival time were reportedly 4%-28.5% and 6-14 mo. The most promising results were reported for combined treatments consisting of hepatectomy and TACE, chemotherapy, or internal radiation. The reported 5-year survival rates and median survival times were 42% and 31 mo for TACE followed by hepatectomy; 36.3% and 22.1 mo for hepatectomy followed by hepatic arterial infusion chemotherapy; and 56% for chemotherapy or internal radiation followed by hepatectomy. | Masami Minagawa Masatoshi Makuuchi | 2006 | World Journal of Gastroenterology2006，12，47： | 74 |
| 2 | Current surgical treatment for bile duct cancer显示文摘Since extrahepatic bile duct cancer is difficult to diagnose and to cure,a safe and radical surgical strategy is needed.In this review,the modes of infiltration and spread of extrahepatic bile duct cancer and surgical strategy are discussed.Extended hemihepatectomy,with or without pancreatoduodenectomy(PD),plus extrahepatic bile duct resection and regional lymphadenectomy has recently been recognized as the standard curative treatment for hilar bile duct cancer.On the other hand,PD is the choice of treatment for middle and distal bile duct cancer.Major hepatectomy concomitant with PD(hepatopancreatoduodenectomy)has been applied to selected patients with widespread tumors.Preoperative biliary drainage(BD)followed by portal vein embolization(PVE)enables major hepatectomy in patients with hilar bile duct cancer without mortality.BD should be performed considering the surgical procedure,especially,in patients with separated intrahepatic bile ducts caused by hilar bile duct cancer.Right or left trisectoriectomy are indicated according to the tumor spread and biliary anatomy.As a result,extended radical resection offers a chance for cure of hilar bile duct cancer with improved resectability,curability,and a 5-year survival rate of 40%.A 5-year survival rate has ranged from 24% to 39% after PD for middle and distal bile duct cancer. | Yasuji Seyama Masatoshi Makuuchi | 2007 | World Journal of Gastroenterology2007，13，10： | 74 |
| 3 | Diagnosis of subepithelial tumors in the upper gastrointestinal tract by endoscopic ultrasonography显示文摘Endoscopic ultrasonography(EUS) is the most accurate procedure for detecting and diagnosing subepithelial tumors,due to its higher sensitivity and specificity than other imaging modalities.EUS can characterize lesions by providing information on echogenic origin,size,borders,homogeneity,and the presence of echogenic or anechoic foci.Linear echoendoscopes,and recently also electronic radial echoendoscopes,can be used with color Doppler or power Doppler to assess the vascular signals from subepithelial masses,and thus permit the differentiation of vascular structures from cysts,as well as the assessment of the tumor blood supply.However,the diagnostic accuracy of EUS imaging alone has been shown to be low in subepithelial lesions with 3rd and 4th layers.It is also difficult to differentiate exactly between benign and malignant tumors and to gain an accurate picture of histology using EUS.On the other hands,EUS guided fine needle aspiration(EUS-FNA) can provide samples for cytologic or histologic analysis.Hypoechoic lesions of the 3rd and the 4th EUS layers,more than in 1 cm diameter are recommended,and histologic confirmation using endoscopic submucosal resection or EUSFNA should be obtained when possible.Therefore,EUSFNA plays an important role in the clinical management of subepithelial tumors.Furthermore improvements in endoscopic technology are expected to be more useful modalities in differential diagnosis and discrimination between benign and malignant subepithelial | Hiroki Sakamoto Masayuki Kitano Masatoshi Kudo | 2010 | World Journal of Radiology2010，2，8： | 40 |
| 4 | Radiofrequency ablation of hepatocellular carcinoma:Current status显示文摘Ablation therapy is one of the best curative treatment options for malignant liver tumors,and can be an alternative to resection.Radiofrequency ablation(RFA) of primary and secondary liver cancers can be performed safely using percutaneous,laparoscopic,or open surgical techniques,and RFA has markedly changed the treatment strategy for small hepatocellular carcinoma(HCC).Percutaneous RFA can achieve the same overall and disease-free survival as surgical resection for patients with small HCC.The use of a laparoscopic or open approach allows repeated placements of RFA electrodes at multiple sites to ablate larger tumors.RFA combined with transcatheter arterial chemoembolization will make the treatment of larger tumors a clinically viable treatment alternative.However,an accurate evaluation of treatment response is very important to secure successful RFA therapy.Since a sufficient safety margin(at least 0.5 cm) can prevent local tumor recurrences,an accurate evaluation of treatment response is very important to secure successful RFA therapy.To minimize complications of RFA,clinicians should be familiar with the imaging features of each type of complication.Appropriate management of complications is essential for successful RFA treatment. | Yasunori Minami Masatoshi Kudo | 2010 | World Journal of Radiology2010，2，11： | 40 |
| 5 | Targeted and immune therapies for hepatocellular carcinoma:Predictions for 2019 and beyond显示文摘Systemic therapy for hepatocellular carcinoma(HCC) has markedly advanced since the survival benefit of a molecular targeted agent, sorafenib, were demonstrated in the SHARP and Asia Pacific trials in 2007. Treatment options for patients with advanced HCC increased by sorafenib, and long-term survival for patients with advanced stage HCC has become possible to some extent. However,development of a more potent first-line novel molecular targeted agent replacing sorafenib and a potent second-line agent after disease progression on or intolerant to sorafenib has been warranted because sorafenib lacks tumor shrinking/necrotizing effects and induces relatively severe adverse events such as hand foot skin reaction. Many agents in the 1 st line and 2 nd line setting were attempted to develop between 2007 and 2016, but all of these clinical trials failed.On the other hand, clinical trials of 4 agents(regorafenib, lenvatinib,cabozantinib, and ramucirumab) succeeded in succession in 2017 and 2018, and their use in clinical practice is possible(regorafenib and lenvatinib) or underway(cabozantinib and ramucirumab). Furthermore, all of 5 clinical trials of combination therapy with transcatheter chemoembolization(TACE) plus a molecular targeted agent failed to date, however, the combination of TACE and sorafenib(TACTICS trials) was reported to be successful and presented at ASCO in 2018. Phase 3 clinical trials of immune checkpoint inhibitors and a combination therapy of immune checkpoint inhibitors and molecular targeted agents are also ongoing, which suggests treatment paradigm of HCC in all stages from early,intermediate and advanced stage, is expected to be changed drastically in the very near future. | Masatoshi Kudo | 2019 | World Journal of Gastroenterology2019，25，7： | 33 |
| 6 | Therapeutic response assessment of RFA for HCC:Contrast-enhanced US,CT and MRI显示文摘Radiofrequency ablation(RFA)is commonly applied for the treatment of hepatocellular carcinoma(HCC)because of the facile procedure,and the safety and effectiveness for the treatment of this type of tumor.On the other hand,it is believed that HCC cells should spread predominantly through the blood flow of the portal vein,which could lead to the formation of intrahepatic micrometastases.Therefore,monitoring tumor response after the treatment is quite important and accurate assessment of treatment response is critical to obtain the most favorable outcome after the RFA.Indeed,several reports suggested that even small HCCs of≤3 cm in diameter might carry intrahepatic micrometastases and/or microvascular invasion.From this point of view,for preventing local recurrences,RFA should be performed ablating a main tumor as well as its surrounding non-tumorous liver tissue where micrometastases and microvascular invasion might exist.Recent advancement of imaging modalities such as contrast-enhanced ultrasonic,computed tomography,and magnetic resonance imaging are playing an important role on assessing the therapeutic effects of RFA.The local recurrence rate tends to be low in HCC patients who were proven to have adequate ablation margin after RFA;namely,not only disappearance of vascular enhancement of main tumor,but also an adequate ablation margin.Therefore,contrast enhancement gives important findings for the diagnosis of recurrent HCCs on each imaging.However,hyperemia of non-tumorous liver surrounding the ablated lesion,which could be attributed to an inflammation after RFA,may well obscure the findings of local recurrence of HCCs after RFA.Therefore,we need to carefully address to these imaging findings given the fact that diagnostic difficulties of local recurrence of HCC.Here,we give an overview of the current status of the imaging assessment of HCC response to RFA. | Yasunori Minami Naoshi Nishida Masatoshi Kudo | 2014 | World Journal of Gastroenterology2014，20，15： | 26 |
| 7 | Transarterial chemoembolization for hepatocellular carcinoma: A review of techniques显示文摘Hepatocellular carcinoma(HCC)is one of the most common malignant diseases worldwide.While curative therapies,including resection,liver transplantation,and percutaneous ablation(percutaneous ethanol injection and radiofrequency ablation),are applicable for only a portion of the HCC population,transcatheter arterial chemoembolization(TACE)has been recognized as an effective palliative treatment option for patients with advanced HCC.TACE is also used even for single HCCs in which it is difficult to perform surgical resection or locoregional treatment due to systemic co-morbidities or anatomical problems.TACE has become widely adopted in the treatment of HCC.By using computed tomography-angiography,TACE is capable of performing diagnosis and treatment at the same time.Furthermore,TACE plays an important role in the multidisciplinary treatment for HCC when combined with other treatment.In this review,we first discuss the history of TACE,and then review the previous findings about techniques of achieving a locoregional treatment effect(liver infarction treatment,e.g.,ultra-selective TACE,balloon-occluded TACE),and the use of TACE as a drugdelivery system for anti-cancer agents(palliative,e.g.,platinum complex agents,drug-eluting beads)for multiple lesions. | Norihiro Imai Masatoshi Ishigami Yoji Ishizu Teiji Kuzuya Takashi Honda Kazuhiko Hayashi Yoshiki Hirooka Hidemi Goto | 2014 | World Journal of Hepatology2014，6，12： | 24 |
| 8 | Comparing mass screening techniques for gastric cancer in Japan显示文摘瞄准:讨论为胃的癌症屏蔽的内视镜的质量的功效。方法:在这研究使用的数据是从 2002 ~ 2004 在 Niigata 城市里为胃的癌症屏蔽程序的质量的结果。参加者的数字在 2002 是 35,089, 34,557 在 2003 和 36,600 在 2004。发现比率在内视镜的文件和组织检查所见的双检查以后指了胃的癌症的最后的诊断。识别胃的癌症的一个盒子的费用为每个屏蔽节目和另外的仔细的检查基于全部的开销被计算。结果:从有内视镜检查法的单个屏蔽节目的分析,有X光检查( ISX )的单个屏蔽节目和有在胃的癌症的发现比率的参考的荧光屏图象摄影( MSP )的集体屏蔽节目,内视镜的检查是为检测早胃的癌症的最好,发现比率在 2004 是0.87%,约 2.7 和 4.6 ISX 和 MSP 组比那些高预定。另外,这个新奇方法是关于识别胃的癌症的一个盒子的费用的最便宜的工具,它被估计是在 2004 的 1,608,000 日本日元。结论:内视镜的集体屏蔽是一个有希望的方法并且如果,能有效地被使用有技能的 endoscopists 的一个足够的数字对职员变得可得到系统并且如果城市办公室支持它。 | Atsushi Tashiro Masatoshi Sano Koichi Kinameri Kazutaka Fujita Yutaka Takeuchi | 2006 | World Journal of Gastroenterology2006，12，30： | 23 |
| 9 | Artificial and bioartificial liver support:A review of perfusion treatment for hepatic failure patients显示文摘Liver transplantation and blood purification therapy,including plasmapheresis,hemodiafiltration,and bioartificial liver support,are the available treatments for patients with severe hepatic failure.Bioartificial liver support,in which living liver tissue is used to support hepatic function,has been anticipated as an effective treatment for hepatic failure.The two mainstream systems developed for bioartificial liver support are extracorporeal whole liver perfusion(ECLP)and bioreactor systems.Comparing various types of bioartificial liver in view of function,safety,and operability,we concluded that the best efficacy can be provided by the ECLP system.Moreover,in our subsequent experiments comparing ECLP and apheresis therapy,ECLP offers more ammonia metabolism than HD and HF.In addition,ECLP can compensate amino acid imbalance and can secret bile.A controversial point with ECLP is the procedure is labor intensive,resulting in high costs.However,ECLP has the potential to reduce elevated serum ammonia levels of hepatic coma patients in a short duration.When these problems are solved,bioartificial liver support,especially ECLP,can be adopted as an option in ordinary clinical therapy to treat patients with hepatic failure. | Katsutoshi Naruse Masatoshi Makuuchi | 2007 | World Journal of Gastroenterology2007，13，10： | 23 |
| 10 | Review of dynamic contrast-enhanced ultrasound guidance in ablation therapy for hepatocellular carcinoma显示文摘Local ablative techniques-percutaneous ethanol injection, microwave coagulation therapy and radiofrequency ablation (RFA)-have been developed to treat unresectable hepatocellular carcinoma (HCC). The success rate of percutaneous ablation therapy for HCC depends on correct targeting of the tumor via an imaging technique. However, probe insertion often is not completely accurate for small HCC nodules, which are poorly def ined on conventional B-mode ultrasound (US) alone. Thus, multiple sessions of ablation therapy are frequently required in diffi cult cases. By means of two breakthroughs in US technology, harmonic imaging and the development of second-generation contrast agents, dynamic contrast-enhanced harmonic US imaging with an intravenous contrast agent can depict tumor vascularity sensitively and accurately, and is able to evaluate small hypervascular HCCs even when B-mode US cannot adequately characterize the tumors. Therefore, dynamic contrast-enhanced US can facilitate RFA electrode placement in hypervascular HCC, which is poorly depicted by B-mode US. The use of dynamic contrast-enhanced US guidance in ablation therapy for liver cancer is an effi cient approach. Here, we present an overview of the current status of dynamic contrast-enhanced US-guided ablation therapy, and summarize the current indications and outcomes of reported clinical use in comparison with that of other modalities. | Yasunori Minami Masatoshi Kudo | 2011 | World Journal of Gastroenterology2011，17，45： | 23 |
| 11 | Precision surgery for primary liver cancer显示文摘Liver resection remains the best curative option for primary liver cancer, such as hepatocellular carcinoma(HCC) and intrahepatic cholangiocarcinoma.In particular, in liver resection for HCC, anatomical resection of the tumor-bearing segments is highly recommended to eradicate the intrahepatic metastases spreading through portal venous branches.Anatomical liver resection,including anatomical segmentectomy and subsegmentectomy using the dye-injection method, is technically demanding and requires experience for completion of a precise procedure.The recent development of imaging studies and new computer technologies has allowed for the preoperative design of the operative procedure, intraoperative navigation, and postoperative quality evaluation of the anatomical liver resection.Although these new technologies are related to the progress of artificial intelligence, the actual operative procedure is still performed as human-hand work.A precise anatomical liver resection still requires meticulous exposure of the boundary of hepatic venous tributaries with deep knowledge of liver anatomy and utilization of intraoperative ultrasonography. | Takeshi Takamoto Masatoshi Makuuchi | 2019 | Cancer Biology & Medicine2019，16，3： | 23 |
| 12 | Systematic review of anastomotic complications of esophagojejunostomy after laparoscopic total gastrectomy显示文摘AIM: To investigate the anastomotic complications ofesophagojejunostomy(EJS) after laparoscopic total gastrectomy(LTG), we reviewed retrospective studies.METHODS: A literature search was conducted in Pub Med for studies published from January 1, 1994 through January 31, 2015. The search terms included 'laparoscopic,' 'total gastrectomy,' and 'gastric cancer.' First, we selected 16 non-randomized controlled trials(RCTs) comparing LTG with open total gastrectomy(OTG) and conducted an updated meta-analysis of anastomotic complications after total gastrectomy. The Newcastle-Ottawa scoring system(NOS) was used to assess the quality of the non-RCTs included in this study. Next, we reviewed anastomotic complications in 46 case studies of LTG to compare the various procedures for EJS. RESULTS: The overall incidence of anastomotic leakage associated with EJS was 3.0%(30 of 984 patients) among LTG procedures and 2.1%(31 of 1500 patients) among OTG procedures in the 16 non-RCTs. The incidence of anastomotic leakage did not differ significantly between LTG and OTG(odds OR = 1.42, 95%CI: 0.86-2.33, P = 0.17, I2 = 0%). Anastomotic stenosis related to EJS was reported in 72(2.9%) of 2484 patients, and the incidence was 3.2% among LTG procedures and 2.7% among OTG procedures. The incidence of anastomotic stenosis related to EJS was slightly, but not significantly, higher in LTG than in OTG(OR = 1.55, 95%CI: 0.94-2.54, P = 0.08, I2 = 0%). The various procedures for LTG were classified into six categories in the review of case studies of LTG. The incidence of EJS leakage was similar(1.1% to 3.2%), although the incidence of EJS stenosis was relatively high when the Or VilTM device was used(8.8%) compared with other procedures(1.0% to 3.6%).CONCLUSION:The incidence of anastomotic complications associated with EJS was not different between LTG and OTG. Anastomotic stenosis was relatively common when the Or VilTM device was used. | Mikito Inokuchi Sho Otsuki Yoshitaka Fujimori Yuya Sato Masatoshi Nakagawa Kazuyuki Kojima | 2015 | World Journal of Gastroenterology2015，21，32： | 23 |
| 13 | Removal of diminutive colorectal polyps: A prospective randomized clinical trial between cold snare polypectomy and hot forceps biopsy显示文摘AIM To compare the efficacy and safety of cold snare polypectomy(CSP) and hot forceps biopsy(HFB) for diminutive colorectal polyps.METHODS This prospective, randomized single-center clinical trial included consecutive patients ≥ 20 years of age with diminutive colorectal polyps 3-5 mm from December 2014 to October 2015. The primary outcome measures were en-bloc resection(endoscopic evaluation) and complete resection rates(pathological evaluation). The secondary outcome measures were the immediate bleeding or immediate perforation rate after polypectomy, delayed bleeding or delayed perforation rate after polypectomy, use of clipping for bleeding or perforation, and polyp retrieval rate. Prophylactic clipping after polyp removal wasn't routinely performed.RESULTS Two hundred eight patients were randomized into the CSP(102), HFB(106) and 283 polyps were evaluated(CSP: 148, HFB: 135). The en-bloc resection rate was significantly higher with CSP than with HFB [99.3%(147/148) vs 80.0%(108/135), P < 0.0001]. The complete resection rate was significantly higher with CSP than with HFB [80.4%(119/148) vs 47.4%(64/135), P < 0.0001]. The immediate bleeding rate was similar between the groups [8.6%(13/148) vs 8.1%(11/135), P = 1.000], and endoscopic hemostasis with hemoclips was successful in all cases. No cases of perforation or delayed bleeding occurred. The rate of severe tissue injury to the pathological specimen was higher HFB than CSP [52.6%(71/135) vs 1.3%(2/148), P < 0.0001]. Polyp retrieval failure was encountered CSP(7), HFB(2).CONCLUSION CSP is more effective than HFB for resecting diminutive polyps. Further long-term follow-up study is required. | Yoriaki Komeda Hiroshi Kashida Toshiharu Sakurai George Tribonias Kazuki Okamoto Masashi Kono Mitsunari Yamada Teppei Adachi Hiromasa Mine Tomoyuki Nagai Yutaka Asakuma Satoru Hagiwara Shigenaga Matsui Tomohiro Watanabe Masayuki Kitano Takaaki Chikugo Yasutaka Chiba Masatoshi Kudo | 2017 | World Journal of Gastroenterology2017，23，2： | 20 |
| 14 | Urgent endoscopic ultrasound-guided choledochoduodenostomy for acute obstructive suppurative cholangitis-induced sepsis显示文摘Acute obstructive suppurative cholangitis(AOSC) due to biliary lithiasis is a life-threatening condition that requires urgent biliary decompression. Although endoscopic retrograde cholangiopancreatography(ERCP) with stent placement is the current gold standard for biliary decompression, it can sometimes be difficult because of failed biliary cannulation. In this retrospective case series, we describe three cases of successful biliary drainage with recovery from septic shock after urgent endoscopic ultrasound-guided choledochoduodenostomy(EUS-CDS) was performed for AOSC due to biliary lithiasis. In all three cases, technical success in inserting the stents was achieved and the patients completely recovered from AOSC with sepsis in a few days after EUS-CDS. There were no procedure-related complications. When initial ERCP fails, EUS-CDS can be an effective life-saving endoscopic biliary decompression procedure that shortens the procedure time and prevents post-ERCP pancreatitis, particularly in patients with AOSC-induced sepsis. | Kosuke Minaga Masayuki Kitano Hajime Imai Kentaro Yamao Ken Kamata Takeshi Miyata Shunsuke Omoto Kumpei Kadosaka Tomoe Yoshikawa Masatoshi Kudo | 2016 | World Journal of Gastroenterology2016，22，16： | 18 |
| 15 | Impact of endoscopic screening on mortality reduction from gastric cancer显示文摘AIM:To investigate mortality reduction from gastric cancer based on the results of endoscopic screening.METHODS:The study population consisted of participants of gastric cancer screening by endoscopy,regular radiography,and photofluorography at Niigata city in 2005.The observed numbers of cumulative deaths from gastric cancers and other cancers were accumulated by linkage with the Niigata Prefectural Cancer Registry.The standardized mortality ratio(SMR)of gastric cancer and other cancer deaths in each screening group was calculated by applying the mortality rate of the reference population.RESULTS:Based on the results calculated from the mortality rate of the population of Niigata city,the SMRs of gastric cancer death were 0.43(95%CI:0.30-0.57)for the endoscopic screening group,0.68(95%CI:0.55-0.79)for the regular radiographic screening group,and 0.85(95%CI:0.71-0.94)for the photofluorography screening group.The mortality reduction from gastric cancer was higher in the endoscopic screening group than in the regular radiographic screening group despite the nearly equal mortality rates of all cancers except gastric cancer.CONCLUSION:The 57%mortality reduction from gastric cancer might indicate the effectiveness of endoscopic screening for gastric cancer.Further studies and prudent interpretation of results are needed. | Chisato Hamashima Kazuei Ogoshi Rintarou Narisawa Tomoki Kishi Toshiyuki Kato Kazutaka Fujita Masatoshi Sano Satoshi Tsukioka | 2015 | World Journal of Gastroenterology2015，21，8： | 16 |
| 16 | Long-term outcome of percutaneous ethanol injection therapy for minimum-sized hepatocellular carcinoma显示文摘AIM: To evaluate long-term follow-up of minimum-sized hepatocellular carcinoma (HCC) treated with percutaneous ethanol injection (PEI). METHODS: PEI was applied to 42 lesions in 31 patients (23 male and eight female) with HCC < 15 mm in diameter, over the past 15 years. RESULTS: Overall survival rate was 74.1% at 3 years, 49.9% at 5 years, 27.2% at 7 years and 14.5% at 10 years. These results are superior to, or at least the same as those for hepatic resection and radiofrequency ablation. Survival was affected only by liver function, but not by sex, age, etiology of Hepatitis B virus or Hepatitis C virus, α-fetoprotein levels, arterial and portal blood flow, histological characteristics, and tumor multiplicity or size. Patients in Child-Pugh class A and B had 5-, 7- and 10-years survival rates of 76.0%, 42.2% and 15.8%, and 17.1%, 8.6% and 0%, respectively (P = 0.025). CONCLUSION: Treatment with PEI is best indicated for patients with HCC < 15 mm in Child-Pugh class A. | Miyuki Taniguchi Soo Ryang Kim Susumu Imoto Hirotsugu Ikawa Kenji Ando Keiji Mita Shuichi Fuki Noriko Sasase Toshiyuki Matsuoka Masatoshi Kudo Yoshitake Hayashi | 2008 | World Journal of Gastroenterology2008，14，13： | 16 |
| 17 | Endoscopic ultrasound-guided gallbladder drainage for acute cholecystitis: Long-term outcomes after removal of a self-expandable metal stent显示文摘AIM To assess the long-term outcomes of this procedure after removal of self-expandable metal stent(SEMS). The efficacy and safety of endoscopic ultrasoundguided gallbladder drainage(EUS-GBD) with SEMS were also assessed.METHODS Between January 2010 and April 2015, 12 patients with acute calculous cholecystitis, who were deemed unsuitable for cholecystectomy, underwent EUSGBD with a SEMS. EUS-GBD was performed under the guidance of EUS and fluoroscopy, by puncturing the gallbladder with a needle, inserting a guidewire, dilating the puncture hole, and placing a SEMS. TheSEMS was removed and/or replaced with a 7-Fr plastic pigtail stent after cholecystitis improved. The technical and clinical success rates, adverse event rate, and recurrence rate were all measured.RESULTS The rates of technical success, clinical success, and adverse events were 100%, 100%, and 0%, respectively. After cholecystitis improved, the SEMS was removed without replacement in eight patients, whereas it was replaced with a 7-Fr pigtail stent in four patients. Recurrence was seen in one patient(8.3%) who did not receive a replacement pigtail stent. The median follow-up period after EUS-GBD was 304 d(78-1492).CONCLUSION EUS-GBD with a SEMS is a possible alternative treatment for acute cholecystitis. Long-term outcomes after removal of the SEMS were excellent. Removal of the SEMS at 4-wk after SEMS placement and improvement of symptoms might avoid migration of the stent and recurrence of cholecystitis due to food impaction. | Ken Kamata Mamoru Takenaka Masayuki Kitano Shunsuke Omoto Takeshi Miyata Kosuke Minaga Kentaro Yamao Hajime Imai Toshiharu Sakurai Tomohiro Watanabe Naoshi Nishida Masatoshi Kudo | 2017 | World Journal of Gastroenterology2017，23，4： | 15 |
| 18 | Efficacy of treatment with rebamipide for endoscopic submucosal dissection-induced ulcers显示文摘AIM:To prospectively compare the healing rates of endoscopic submucosal dissection(ESD)-induced ulcers treated with either a proton-pump inhibitor(PPI)or rebamipide.METHODS:We examined 90 patients with early gastric cancer who had undergone ESD.All patients were administered an intravenous infusion of the PPI lansoprazole(20 mg)every 12 h for 2 d,followed by oral administration of lansoprazole(30 mg/d,5 d).After7-d treatment,the patients were randomly assigned to 2 groups and received either lansoprazole(30 mg/d orally,n=45;PPI group)or rebamipide(300 mg orally,three times a day;n=45;rebamipide group).At 4and 8 wk after ESD,the ulcer outcomes in the 2 groups were compared.RESULTS:No significant differences were noted in patient age,underlying disease,tumor location,Helicobacter pylori infection rate,or ESD-induced ulcersize between the 2 groups.At both 4 and 8 wk,the healing rates of ESD-induced ulcers were similar in the PPI-treated and the rebamipide-treated patients(4 wk:PPI,27.2%;rebamipide,33.3%;P=0.5341;8 wk:PPI,90.9%;rebamipide,93.3%;P=0.6710).At 8 wk,the rates of granulation lesions following ulcer healing were significantly higher in the PPI-treated group(13.6%)than in the rebamipide-treated group(0.0%;P=0.0103).Ulcer-related symptoms were similar in the2 treatment groups at 8 wk.The medication cost of 8-wk treatment with the PPI was 10945 yen vs 4889 yen for rebamipide.No ulcer bleeding or complications due to the drugs were observed in either treatment group.CONCLUSION:The healing rate of ESD-induced ulcers was similar with rebamipide or PPI treatment;however,rebamipide treatment is more cost-effective and prevents granulation lesions following ulcer healing. | Masaki Takayama Shigenaga Matsui Masanori Kawasaki Yutaka Asakuma Toshiharu Sakurai Hiroshi Kashida Masatoshi Kudo | 2013 | World Journal of Gastroenterology2013，19，34： | 15 |
| 19 | Radiation therapy for portal venous invasion by hepatocellular carcinoma显示文摘AIM: To clarify the efficacy and safety of three-dimensional conformal radiotherapy (3-D CRT) for this disease and to specify patient subgroups suitable for this treatment.METHODS: Fifty-two patients with HCC received PVI-targeted radiation therapy from January 1995 through December 2003. Portal venous invasion (PVI) was found in the second or lower order branches of the portal vein in 6 patients, in the first branch in 24 patients and in the main trunk in 22 patients. Child classifications of liver function before radiation therapy were A, B, and C for 19, 24 and 2 patients, respectively. All patients received three-dimensional conformal radiotherapy with a total dose ranging from 39 to 60 Gy (57.0 Gy in average).RESULTS: Overall survival rates at 1, 2, 3, 4, and 5 years were 45.1%, 25.3%, 15.2%, 10.1%, and 5.1%, respectively. Univariate analysis revealed that Child status, the number of tumor foci, tumor type,transcatheter arterial embolization (TAE) after radiation therapy were statistically significant prognostic factors.Multivariate analysis showed that the number of tumor foci and TAE after radiation therapy were statistically significant.CONCLUSION: The results of this study strongly suggest the efficacy of 3-D CRT as treatment for PVI in HCC. 3-D CRT is recommended in combination with postradiation TAE for PVI of HCC with 5 tumor foci or less in the liver and with Child A liver function. | Keiichi Nakagawa Hideomi Yamashita Kenshiro Shiraishi Naoki Nakamura Masao Tago Hiroshi Igaki Yoshio Hosoi Shuichiro Shiina Masao Omata Masatoshi Makuuchi Kuni Ohtomo | 2005 | World Journal of Gastroenterology2005，11，46： | 14 |
| 20 | Can the biliary enhancement of Gd-EOB-DTPA predict the degree of liver function?显示文摘BACKGROUND: Excretion of gadolinium-ethoxybenzyl-diethyl- enetriamine pentaacetic acid (Gd-EOB-DTPA) in the bile may be related to liver function, because of elimination from the liver after preferential uptake by hepatocytes. The purpose of this study was to investigate the relation between liver and biliary enhancement in patients with or without liver dysfunction, and to compare the tumor-to-liver contrast in these patients. METHODS: Forty patients [group 1: normal liver and Child Pugh class A in 20 patients, group 2: Child-Pugh class B in 18 patients and Child-Pugh C in 2] were evaluated. All patients underwent MR imaging of the liver using a 1.5-Tesla system. T1 weighted 3D images were obtained at 5, 10, 15 and 20 minutes after Gd-EOB-DTPA injection. The relation between group 3 (total bilirubin <1.8 mg/dL) and group 4 (total bilirubin ≥1.8 mg/dL) was investigated at 20 minutes. Liver and biliary signals were measured, and compared between groups 1 and 2 or groups 3 and 4. Tumor-to-liver ratio was also evaluated between groups 1 and 2. Scheffé's post-hoc test after two-way repeated measures ANOVA and Pearson's correlation test were used for statistical analysis. RESULTS: Liver enhancement showed significant difference at all time points between groups 1 and 2. Biliary enhancement did not show a significant difference between groups 1 and 2 at 5 minutes, but did at 10, 15 and 20 minutes. At 20 minutes significant differences between groups 3 and 4 were seen for liver and biliary enhancement. At all time points, liver enhancement correlated with biliary enhancement in both groups. At 5 minutes and 20 minutes, statistical differences between groups 1 and 2 were seen for tumor-to-liver ratio.CONCLUSIONS: The degree of biliary enhancement has a close correlation to that of liver enhancement. It is especially important that insufficient liver enhancement causes lower tumor-to-liver contrast in the hepatobiliary phase of Gd-EOB- DTPA. | Masahiro Okada Kazunari Ishii Kazushi Numata Tomoko Hyodo Seishi Kumano Masayuki Kitano Masatoshi Kudo Takamichi Murakami | 2012 | Hepatobiliary & Pancreatic Diseases International2012，11，3： | 13 |
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