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 radio...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.展开更多
AIM： To study the amino acid substitutions in the carboxy （C）-terminal part of E2 protein and in the interferon （IFN） sensitivity determining region （ISDR） and their correlation with response to IFN and viral l...AIM： To study the amino acid substitutions in the carboxy （C）-terminal part of E2 protein and in the interferon （IFN） sensitivity determining region （ISDR） and their correlation with response to IFN and viral load in 85 hepatitis C virus （HCV）-lb-infected patients treated with IFN. METHODS： The C-terminal part of E2 （codons 617-711） including PKR/eIF2α phosphorylation homology domain （PePHD） and ISDR was sequenced in 85 HCV-1b-infected patients treated by IFN monotherapy. RESULTS： The amino acid substitutions in PePHD detected only in 4 of 85 patients were not correlated either with response to iFN or with viral load. The presence of substitutions in a N-terminal variable region （codons 617-641） in the C-terminal part of E2 was significantly correlated with both small viral load （33.9% vs 13.8%, P = 0.0394） and sustained response to iFN （25.0% vs 6.9 %, P = 0.0429）. Four or more substitutions in ISDR were significantly correlated with both small viral load （78.6% vs 16.2%, P 〈 0.0001） and sustained response to iFN （85.7% vs 2.9%, P 〈 0.0001）. In multivariate analysis, ISDR in nonstructural （NS） 5A （OR = 0.39, P 〈 0.0001） and N-terminal variable region （OR = 0.51, P = 0.039） was selected as the independentpredictors for small viral load, and ISDR （OR = 39.0, P 〈 0.0001） was selected as the only independent predictor for sustained response. CONCLUSION： The N-terminal variable region in the C-terminal part of E2 correlates with both response to IFN monotherapy and viral load and is one of the factors independently associated with a small viral load.展开更多
BACKGROUND Double-balloon endoscopic retrograde cholangiography (DB-ERC) is widely performed for biliary diseases after reconstruction in gastrointestinal surgery,but there are few reports on DB-ERC after hepatectomy ...BACKGROUND Double-balloon endoscopic retrograde cholangiography (DB-ERC) is widely performed for biliary diseases after reconstruction in gastrointestinal surgery,but there are few reports on DB-ERC after hepatectomy or living donor liver transplantation (LDLT).AIM To examine the success rates and safety of DB-ERC after hepatectomy or LDLT METHODS The study was performed retrospectively in 26 patients (45 procedures) who underwent hepatectomy or LDLT (liver operation:LO group) and 40 control patients (59 procedures) who underwent pancreatoduodenectomy (control group).The technical success (endoscope reaching the choledochojejunostomy site),diagnostic success (performance of cholangiography),therapeutic success(completed interventions) and overall success rates,insertion and procedure(completion of DB-ERC) time,and adverse events were compared between these groups.RESULTS There were no significant differences between LO and control groups in the technical [93.3%(42/45) vs 96.6%(57/59),P=0.439],diagnostic [83.3%(35/42) vs83.6%(46/55),P=0.968],therapeutic [97.0%(32/33) vs 97.7%(43/44),P=0.836],and overall [75.6%(34/45) vs 79.7%(47/59),P=0.617] success rates.The median insertion time (22 vs 14 min,P <0.001) and procedure time (43.5 vs 30 min,P=0.033) were significantly longer in the LO group.The incidence of adverse events showed no significant difference [11.1%(5/45) vs 6.8%(4/59),P=0.670].CONCLUSION DB-ERC after liver operation is safe and useful but longer time is required,so should be performed with particular care.展开更多
AIMTo investigate factors, including psychosocial factors, associated with alcoholic use relapse after liver transplantation (LT) for alcoholic liver disease (ALD).METHODSThe clinical records of 102 patients with ALD ...AIMTo investigate factors, including psychosocial factors, associated with alcoholic use relapse after liver transplantation (LT) for alcoholic liver disease (ALD).METHODSThe clinical records of 102 patients with ALD who were referred to Nagoya University Hospital for LT between May 2003 and March 2015 were retrospectively evaluated. History of alcohol intake was obtained from their clinical records and scored according to the High-Risk Alcoholism Relapse scale, which includes duration of heavy drinking, types and amount of alcohol usually consumed, and previous inpatient treatment history for alcoholism. All patients were assessed for eligibility for LT according to comprehensive criteria, including Child-Pugh score, Model for End-Stage Liver Disease score, and psychosocial criteria.RESULTSOf the 102 patients with ALD referred for LT, seven (6.9%) underwent LT. One (14.3%) of these seven patients returned to heavy drinking, but that patient was able to successfully quit drinking following an immediate intervention, consisting of psychotherapeutic education and supportive psychotherapy, by a psychiatrist. A comparison between the transplantation/registration (T/R) group, consisting of the seven patients who underwent LT and 10 patients listed for deceased donor LT, and 50 patients who did not undergo LT and were not listed for deceased donor LT (non-T/R group), showed statistically significant differences in duration of abstinence period (P < 0.01), duration of heavy drinking (P < 0.05), adherence to medical treatment (P < 0.01), and declaration of abstinence (P < 0.05).CONCLUSIONPatients with ALD referred for LT require comprehensive evaluation, including evaluation of psychosocial criteria, to prevent alcoholic recidivism.展开更多
A few decades ago,liver transplantation in patients with chronic hepatitis B virus(HBV) infection was considered a relative contraindication because of the high rate of graft infections and poor prognosis. Since then,...A few decades ago,liver transplantation in patients with chronic hepatitis B virus(HBV) infection was considered a relative contraindication because of the high rate of graft infections and poor prognosis. Since then,remarkable progress was introduced by using nucleos(t)ide analogues and/or hepatitis B immunoglobulin(HBIg) and liver transplantation for HBV-related disease is now becoming one of the good indication. However,high cost burden is the main problem for this combination prophylaxis for a long time use,and this issue should be emerged to be resolved. In this review,we show the progress of post antiHBV strategies showing the history from introduction of HBIg and nucleos(t)ide analogues to recent new strategies with hepatitis B vaccine or saving or stopping protocols of HBIg,and clarify and discuss how to do for further improvement of prevention strategies with better quality.展开更多
In the early 2000s,the main stream of endoscopic ultrasonography(EUS)changed from a mechanical scanning method to electronic radial or linear scanning methods.Subsequently,useful applications in trans-abdominal ultras...In the early 2000s,the main stream of endoscopic ultrasonography(EUS)changed from a mechanical scanning method to electronic radial or linear scanning methods.Subsequently,useful applications in trans-abdominal ultrasonography came within reach of EUS.In particular,contrast-enhanced EUS(CE-EUS)and EUS-elastography became cutting-edge diagnostic modalities for pancreatic disorders.Each type of pancreatic disorder has characteristic hemodynamics.CE-EUS uses color Doppler flow imaging and harmonic imaging to classify pancreatic lesions.EUS-elastography can assess tissue hardness by measuring its elasticity.This parameter appears to correlate with the malignant potential of the lesions.Tissue elasticity studies can provide information on both its pattern and distribution.The former is the conventional method of morphological diagnosis,but it is restricted to observations made in a region of interest(ROI).The latter is an unbiased analysis that can be performed by image analysis software and is theoretically constant,regardless of the ROI.Though EUSfine needle aspiration(FNA)is also a very useful diagnostic tool,there are several limitations.Diagnostic EUS-FNA of pancreatic cystic lesions has marginal utility mainly due to low sensitivity.Therefore,in particular,endoscopists should keep this limitation in mind.展开更多
BACKGROUND It is unclear whether the Japan Narrow-Band Imaging Expert Team(JNET)classification and pit pattern classification are applicable for diagnosing neoplastic lesions in patients with ulcerative colitis(UC).AI...BACKGROUND It is unclear whether the Japan Narrow-Band Imaging Expert Team(JNET)classification and pit pattern classification are applicable for diagnosing neoplastic lesions in patients with ulcerative colitis(UC).AIM To clarify the diagnostic performance of these classifications for neoplastic lesions in patients with UC.METHODS This study was conducted as a single-center,retrospective case-control study.Twenty-one lesions in 19 patients with UC-associated neoplasms(UCAN)and 23 lesions in 22 UC patients with sporadic neoplasms(SN),evaluated by magnifying image-enhanced endoscopy,were retrospectively and separately assessed by six endoscopists(three experts,three non-experts),using the JNET and pit pattern classifications.The results were compared with the pathological diagnoses to evaluate the diagnostic performance.Inter-and intra-observer agreements were calculated.RESULTS In this study,JNET type 2 A and pit pattern typeⅢ/Ⅳwere used as indicators of low-grade dysplasia,JNET type 2 B and pit pattern typeⅥlow irregularity were used as indicators of highgrade dysplasia to shallow submucosal invasive carcinoma,JNET type 3 and pit pattern typeⅥhigh irregularity/VN were used as indicators of deep submucosal invasive carcinoma.In the UCAN group,JNET type 2 A and pit pattern typeⅢ/Ⅳhad a low positive predictive value(PPV;50.0%and 40.0%,respectively);however,they had a high negative predictive value(NPV;94.7%and 100%,respectively).Conversely,in the SN group,JNET type 2 A and pit pattern typeⅢ/Ⅳhad a high PPV(100%for both)but a low NPV(63.6%and 77.8%,respectively).In both groups,JNET type 3 and pit pattern typeⅥ-high irregularity/VN showed high specificity.The interobserver agreement of JNET classification and pit pattern classification for UCAN among experts were 0.401 and 0.364,in the same manner for SN,0.666 and 0.597,respectively.The intra-observer agreements of JNET classification and pit pattern classification for UCAN among experts were 0.387,0.454,for SN,0.803 and 0.567,respectively.CONCLUSION The accuracy of endoscopic diagnosis using both classifications was lower for UCAN than for SN.Endoscopic diagnosis of UCAN tended to be underestimated compared with the pathological results.展开更多
BACKGROUND Cold polypectomy(CP)is a simple and safe procedure for polyps less than 10 mm in size;however,there is concern about local recurrence following CP because of unidentified margins of excised specimens and th...BACKGROUND Cold polypectomy(CP)is a simple and safe procedure for polyps less than 10 mm in size;however,there is concern about local recurrence following CP because of unidentified margins of excised specimens and the lack of tumor suppression effect by coagulation.Some clinical trials have evaluated local persistent recurrence;their results suggest that a higher rate of local recurrence has not been documented so far.There were few reports that observed the course over long periods of time after CP in clinical practice.AIM To evaluate the presence of local recurrence following CP and hot polypectomy(HP)using propensity score matching.METHODS We analyzed 275 patients who underwent polypectomy for non-pedunculated colorectal polyps less than 10 mm(959 Lesions)between October 2016 and 2017 and underwent follow-up endoscopy subsequently.We divided them into the CP group(706 Lesions),wherein CP was performed,and the HP group(253 Lesions),wherein HP was performed.Using propensity score matching,we extracted 215 Lesions in each group and evaluated the local recurrence and content of CP in the real clinic and adverse events using medical records.RESULTS After propensity score matching,there were no significant differences in the patients’and their endoscopic background(age,use of antithrombotics,indications,size,morphology,location of polyps,and polypectomy device)between the groups.The mean duration between colorectal polypectomy and the next follow-up colonoscopy was 17.5±7.1(range,6-39)mo in the CP group and 15.7±6.0(range,6-35)mo in the HP group,which was significantly longer in the CP group(P=0.005).The local recurrence rate was 0.93%in the CP group and 0.93%in the HP group,without a significant difference(P=0.688).Additionally,no differences were observed in the macroscopic en bloc resection rate,histopathological complete resection rate,and pathological results between the groups.Adverse events did not occur in either group.CONCLUSION Local recurrence after CP was equivalent to that following HP in clinical practice.CP is useful and safe in the treatment of non-pedunculated polyps of less than 10 mm.展开更多
BACKGROUND Despite the popularity of immune checkpoint inhibitors(ICIs)in the treatment of advanced cancer,patients often develop gastrointestinal(GI)and non-GI immune-related adverse events(irAEs).The clinical charac...BACKGROUND Despite the popularity of immune checkpoint inhibitors(ICIs)in the treatment of advanced cancer,patients often develop gastrointestinal(GI)and non-GI immune-related adverse events(irAEs).The clinical characteristics and survival outcomes of GI-irAEs have not been fully elucidated in previous reports.This necessitates the evaluation of the impact of GI-irAEs on patients receiving ICI treatment.AIM To evaluate the clinical characteristics of GI-irAEs and their impact on survival in patients treated with ICIs.METHODS In this single-center,retrospective,observational study,we reviewed the records of 661 patients who received ICIs for various cancers at Nagoya University Hospital from September 2014 to August 2020.We analyzed the clinical characteristics of patients who received ICI treatment.We also evaluated the correlation between GI-irAE development and prognosis in non-small cell lung cancer(LC)and malignant melanoma(MM).Kaplan-Meier analysis was used to compare the median overall survival(OS).Multivariate Cox proportional hazards models were used to identify prognostic factors.A P value<0.05 was considered statistically significant.RESULTS GI-irAEs occurred in 34 of 605 patients(5.6%)treated with an anti-programmed cell death-1/programmed death-ligand 1(anti-PD-1/PD-L1)antibody alone and in nine of 56 patients(16.1%)treated with an anti-cytotoxic T-lymphocyte antigen 4(CTLA-4)antibody alone or a combination of anti-PD-1 and anti-CTLA-4 antibodies.The cumulative incidence and median daily diarrhea frequency were significantly higher in patients receiving anti-CTLA-4 antibodies(P<0.05).In 130 patients with MM,OS was significantly prolonged in the group that continued ICI treatment despite the development of GI-irAEs compared to the group that did not experience GI-irAEs(P=0.035).In contrast,in 209 patients with non-small cell LC,there was no significant difference in OS between the groups.The multivariate analyses showed that a performance status of 2-3(hazard ratio:2.406;95%confidence interval:1.125–5.147;P=0.024)was an independent predictive factor for OS in patients with MM.CONCLUSION Patients receiving anti-CTLA-4 antibodies develop GI-irAEs more frequently and with higher severity than those receiving anti-PD-1/PD-L1 antibodies.Continuing ICI treatment in patients with MM with GI-irAEs have better OS.展开更多
BACKGROUND Retrograde cholangiopancreatography using double-balloon endoscopic retrograde cholangiography(DBERC)is a valuable technique to treat biliary stone and jejunobiliary anastomotic stenosis in patients with al...BACKGROUND Retrograde cholangiopancreatography using double-balloon endoscopic retrograde cholangiography(DBERC)is a valuable technique to treat biliary stone and jejunobiliary anastomotic stenosis in patients with altered gastrointestinal anatomy.The accurate selection of the route at the anastomosis branch is one of the most important factors in reaching the target in a timely manner.AIM To determine the accuracy of carbon dioxide insufflation enterography(CDE)at the branch for selecting the correct route during DBERC.METHODS We enrolled 52 consecutive patients scheduled for DBERC at our institution from June 2015 to November 2017.Route selection via two methods(visual observation and CDE)was performed in each patient.We determined the correct rate of route selection using CDE.RESULTS Thirty-three patients had a jejunojejunal anastomosis and 19 patients had a gastrojejunal anastomosis.The therapeutic target region was reached in 50 patients.The mean procedure times from the teeth to the target(total insertion time),from the teeth to the branch,and from the branch to the target,and the mean total examination time were 15.2,5.0,8.2,and 60.3 min,respectively.The rate of correct route selection using visual observation and CDE were 36/52(69.2%)and 48/52(92.3%),respectively(P=0.002).The rate of correct route selection using CDE in patients with a jejunojejunal anastomosis was 29/33(87.8%),and the rate in patients with a gastrojejunal anastomosis was 19/19(100%).CONCLUSION CDE is helpful in selecting the route at the branch in the anastomosis for more timely access to the target in patients with altered gastrointestinal anatomy undergoing DBERC.展开更多
Background and Aims:As practice patterns and hepatitis C virus(HCV)genotypes(GT)vary geographically,a global real-world study from both East and West covering all GTs can help inform practice policy toward the 2030 HC...Background and Aims:As practice patterns and hepatitis C virus(HCV)genotypes(GT)vary geographically,a global real-world study from both East and West covering all GTs can help inform practice policy toward the 2030 HCV elimination goal.This study aimed to assess the effectiveness and tolerability of DAA treatment in routine clinical practice in a multinational cohort for patients infected with all HCV GTs,focusing on GT3 and GT6.Methods:We analyzed the sustained virological response(SVR12)of 15,849 chronic hepatitis C patients from 39 Real-World Evidence from the Asia Liver Consortium for HCV clinical sites in Asia Pacific,North America,and Europe between 07/01/2014–07/01/2021.Results:The mean age was 62±13 years,with 49.6%male.The demographic breakdown was 91.1%Asian(52.9%Japanese,25.7%Chinese/Taiwan residents,5.4%Korean,3.3%Malaysian,and 2.9%Vietnamese),6.4%White,1.3%Hispanic/Latino,and 1%Black/African-American.Additionally,34.8%had cirrhosis,8.6%had hepatocellular carcinoma(HCC),and 24.9%were treatment-experienced(20.7%with interferon,4.3%with direct-acting antivirals).The largest group was GT1(10,246[64.6%]),followed by GT2(3,686[23.2%]),GT3(1,151[7.2%]),GT6(457[2.8%]),GT4(47[0.3%]),GT5(1[0.006%]),and untyped GTs(261[1.6%]).The overall SVR12 was 96.9%,with rates over 95%for GT1/2/3/6 but 91.5%for GT4.SVR12 for GT3 was 95.1%overall,98.2%for GT3a,and 94.0%for GT3b.SVR12 was 98.3%overall for GT6,lower for patients with cirrhosis and treatment-experienced(TE)(93.8%)but≥97.5%for tretment-naive patients regardless of cirrhosis status.On multivariable analysis,advanced age,prior treatment failure,cirrhosis,active HCC,and GT3/4 were independent predictors of lower SVR12,while being Asian was a significant predictor of achieving SVR12.Conclusions:In this diverse multinational realworld cohort of patients with various GTs,the overall cure rate was 96.9%,despite large numbers of patients with cirrhosis,HCC,TE,and GT3/6.SVR12 for GT3/6 with cirrhosis and TE was lower but still excellent(>91%).展开更多
Background and Aims:Cloning of ATP7B provided evidence that Wilson's disease is a hepatic copper toxicosis with a variety of extrahepatic complications.Affected siblings with the same genetic background and exposu...Background and Aims:Cloning of ATP7B provided evidence that Wilson's disease is a hepatic copper toxicosis with a variety of extrahepatic complications.Affected siblings with the same genetic background and exposure to similar environmental factors may be a good model for the study of genotype-phenotype correlation.Methods:Twenty-three affected siblings in 11 families were selected from a database.The first phenotypes were determined according to the international proposal.The final types of chronic organ damage were re-evaluated for life-long management.Results:Phenotypes were identical in 5 of the families and different in 6 of the families.The acute hepatic phenotype H1 was found in 3 younger siblings and 1 older sibling.All survived an acute episode of hemolysis with underlying chronic liver disease.One also presented complication with neurological disease.The neurological phenotype N1 with neuropsychiatric symptoms and hepatic disease was found in 2 aged siblings of 1 family,in an older sibling in 3 families and in the oldest sibling in 1 family.Phenotypes in siblings were mainly split by either H1 occurring in random order or age-dependent N1.Types of chronic organ damage were identical in 8 of the families and different in 3 of the families.The same combination of chronic liver disease was found in 6 families and chronic liver disease complicated with neurological disease in 2 families.Split organ damage in siblings was found when an older sibling was complicated by neurological disease.There was no reverse combination of a younger sibling being complicated by neurological disease in any of the families.Conclusion:Phenotype combinations of siblings were mainly modified by externally-induced hemolytic episodes,while chronic organ damage in siblings was split by age-dependent neurological complications.展开更多
In biology,redox reactions are essential and sometimes harmful,and therefore,iron metabolism is tightly regulated by cuproproteins.Since the state of copper in iron overload syndromes remains unclear,we investigated w...In biology,redox reactions are essential and sometimes harmful,and therefore,iron metabolism is tightly regulated by cuproproteins.Since the state of copper in iron overload syndromes remains unclear,we investigated whether copper metabolism is altered in these syndromes.Eleven patients with iron overload syndromes participated in this study.The clinical diagnoses were aceruloplasminemia (n=2),hemochromatosis (n=5),ferroportin disease (n=2),and receiving excess intravenous iron supplementation (n=2).Liver specimens were analyzed using a light microscope and transmission electron microscope equipped with an X-ray analyzer.In addition to a large amount of iron associated with oxygen and phosphorus,the iron-rich hemosiderins of hepatocytes and Kupffer cells contained small amounts of copper and sulfur,regardless of disease etiology.Two-dimensional imaging clearly showed that cuproproteins were distributed homogenously with iron complexes within hemosiderins.Copper stasis was unlikely in noncirrhotic patients.The enhanced induction of cuproproteins by excess iron may contribute to copper accumulation in hemosiderins.In conclusion,we have demonstrated that copper accumulates in hemosiderins in iron overload conditions,perhaps due to alterations in copper metabolism.展开更多
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.
文摘AIM： To study the amino acid substitutions in the carboxy （C）-terminal part of E2 protein and in the interferon （IFN） sensitivity determining region （ISDR） and their correlation with response to IFN and viral load in 85 hepatitis C virus （HCV）-lb-infected patients treated with IFN. METHODS： The C-terminal part of E2 （codons 617-711） including PKR/eIF2α phosphorylation homology domain （PePHD） and ISDR was sequenced in 85 HCV-1b-infected patients treated by IFN monotherapy. RESULTS： The amino acid substitutions in PePHD detected only in 4 of 85 patients were not correlated either with response to iFN or with viral load. The presence of substitutions in a N-terminal variable region （codons 617-641） in the C-terminal part of E2 was significantly correlated with both small viral load （33.9% vs 13.8%, P = 0.0394） and sustained response to iFN （25.0% vs 6.9 %, P = 0.0429）. Four or more substitutions in ISDR were significantly correlated with both small viral load （78.6% vs 16.2%, P 〈 0.0001） and sustained response to iFN （85.7% vs 2.9%, P 〈 0.0001）. In multivariate analysis, ISDR in nonstructural （NS） 5A （OR = 0.39, P 〈 0.0001） and N-terminal variable region （OR = 0.51, P = 0.039） was selected as the independentpredictors for small viral load, and ISDR （OR = 39.0, P 〈 0.0001） was selected as the only independent predictor for sustained response. CONCLUSION： The N-terminal variable region in the C-terminal part of E2 correlates with both response to IFN monotherapy and viral load and is one of the factors independently associated with a small viral load.
文摘BACKGROUND Double-balloon endoscopic retrograde cholangiography (DB-ERC) is widely performed for biliary diseases after reconstruction in gastrointestinal surgery,but there are few reports on DB-ERC after hepatectomy or living donor liver transplantation (LDLT).AIM To examine the success rates and safety of DB-ERC after hepatectomy or LDLT METHODS The study was performed retrospectively in 26 patients (45 procedures) who underwent hepatectomy or LDLT (liver operation:LO group) and 40 control patients (59 procedures) who underwent pancreatoduodenectomy (control group).The technical success (endoscope reaching the choledochojejunostomy site),diagnostic success (performance of cholangiography),therapeutic success(completed interventions) and overall success rates,insertion and procedure(completion of DB-ERC) time,and adverse events were compared between these groups.RESULTS There were no significant differences between LO and control groups in the technical [93.3%(42/45) vs 96.6%(57/59),P=0.439],diagnostic [83.3%(35/42) vs83.6%(46/55),P=0.968],therapeutic [97.0%(32/33) vs 97.7%(43/44),P=0.836],and overall [75.6%(34/45) vs 79.7%(47/59),P=0.617] success rates.The median insertion time (22 vs 14 min,P <0.001) and procedure time (43.5 vs 30 min,P=0.033) were significantly longer in the LO group.The incidence of adverse events showed no significant difference [11.1%(5/45) vs 6.8%(4/59),P=0.670].CONCLUSION DB-ERC after liver operation is safe and useful but longer time is required,so should be performed with particular care.
文摘AIMTo investigate factors, including psychosocial factors, associated with alcoholic use relapse after liver transplantation (LT) for alcoholic liver disease (ALD).METHODSThe clinical records of 102 patients with ALD who were referred to Nagoya University Hospital for LT between May 2003 and March 2015 were retrospectively evaluated. History of alcohol intake was obtained from their clinical records and scored according to the High-Risk Alcoholism Relapse scale, which includes duration of heavy drinking, types and amount of alcohol usually consumed, and previous inpatient treatment history for alcoholism. All patients were assessed for eligibility for LT according to comprehensive criteria, including Child-Pugh score, Model for End-Stage Liver Disease score, and psychosocial criteria.RESULTSOf the 102 patients with ALD referred for LT, seven (6.9%) underwent LT. One (14.3%) of these seven patients returned to heavy drinking, but that patient was able to successfully quit drinking following an immediate intervention, consisting of psychotherapeutic education and supportive psychotherapy, by a psychiatrist. A comparison between the transplantation/registration (T/R) group, consisting of the seven patients who underwent LT and 10 patients listed for deceased donor LT, and 50 patients who did not undergo LT and were not listed for deceased donor LT (non-T/R group), showed statistically significant differences in duration of abstinence period (P < 0.01), duration of heavy drinking (P < 0.05), adherence to medical treatment (P < 0.01), and declaration of abstinence (P < 0.05).CONCLUSIONPatients with ALD referred for LT require comprehensive evaluation, including evaluation of psychosocial criteria, to prevent alcoholic recidivism.
文摘A few decades ago,liver transplantation in patients with chronic hepatitis B virus(HBV) infection was considered a relative contraindication because of the high rate of graft infections and poor prognosis. Since then,remarkable progress was introduced by using nucleos(t)ide analogues and/or hepatitis B immunoglobulin(HBIg) and liver transplantation for HBV-related disease is now becoming one of the good indication. However,high cost burden is the main problem for this combination prophylaxis for a long time use,and this issue should be emerged to be resolved. In this review,we show the progress of post antiHBV strategies showing the history from introduction of HBIg and nucleos(t)ide analogues to recent new strategies with hepatitis B vaccine or saving or stopping protocols of HBIg,and clarify and discuss how to do for further improvement of prevention strategies with better quality.
文摘In the early 2000s,the main stream of endoscopic ultrasonography(EUS)changed from a mechanical scanning method to electronic radial or linear scanning methods.Subsequently,useful applications in trans-abdominal ultrasonography came within reach of EUS.In particular,contrast-enhanced EUS(CE-EUS)and EUS-elastography became cutting-edge diagnostic modalities for pancreatic disorders.Each type of pancreatic disorder has characteristic hemodynamics.CE-EUS uses color Doppler flow imaging and harmonic imaging to classify pancreatic lesions.EUS-elastography can assess tissue hardness by measuring its elasticity.This parameter appears to correlate with the malignant potential of the lesions.Tissue elasticity studies can provide information on both its pattern and distribution.The former is the conventional method of morphological diagnosis,but it is restricted to observations made in a region of interest(ROI).The latter is an unbiased analysis that can be performed by image analysis software and is theoretically constant,regardless of the ROI.Though EUSfine needle aspiration(FNA)is also a very useful diagnostic tool,there are several limitations.Diagnostic EUS-FNA of pancreatic cystic lesions has marginal utility mainly due to low sensitivity.Therefore,in particular,endoscopists should keep this limitation in mind.
文摘BACKGROUND It is unclear whether the Japan Narrow-Band Imaging Expert Team(JNET)classification and pit pattern classification are applicable for diagnosing neoplastic lesions in patients with ulcerative colitis(UC).AIM To clarify the diagnostic performance of these classifications for neoplastic lesions in patients with UC.METHODS This study was conducted as a single-center,retrospective case-control study.Twenty-one lesions in 19 patients with UC-associated neoplasms(UCAN)and 23 lesions in 22 UC patients with sporadic neoplasms(SN),evaluated by magnifying image-enhanced endoscopy,were retrospectively and separately assessed by six endoscopists(three experts,three non-experts),using the JNET and pit pattern classifications.The results were compared with the pathological diagnoses to evaluate the diagnostic performance.Inter-and intra-observer agreements were calculated.RESULTS In this study,JNET type 2 A and pit pattern typeⅢ/Ⅳwere used as indicators of low-grade dysplasia,JNET type 2 B and pit pattern typeⅥlow irregularity were used as indicators of highgrade dysplasia to shallow submucosal invasive carcinoma,JNET type 3 and pit pattern typeⅥhigh irregularity/VN were used as indicators of deep submucosal invasive carcinoma.In the UCAN group,JNET type 2 A and pit pattern typeⅢ/Ⅳhad a low positive predictive value(PPV;50.0%and 40.0%,respectively);however,they had a high negative predictive value(NPV;94.7%and 100%,respectively).Conversely,in the SN group,JNET type 2 A and pit pattern typeⅢ/Ⅳhad a high PPV(100%for both)but a low NPV(63.6%and 77.8%,respectively).In both groups,JNET type 3 and pit pattern typeⅥ-high irregularity/VN showed high specificity.The interobserver agreement of JNET classification and pit pattern classification for UCAN among experts were 0.401 and 0.364,in the same manner for SN,0.666 and 0.597,respectively.The intra-observer agreements of JNET classification and pit pattern classification for UCAN among experts were 0.387,0.454,for SN,0.803 and 0.567,respectively.CONCLUSION The accuracy of endoscopic diagnosis using both classifications was lower for UCAN than for SN.Endoscopic diagnosis of UCAN tended to be underestimated compared with the pathological results.
基金the Ethical Review Board of the Nagoya University Hospital(2015-0449).
文摘BACKGROUND Cold polypectomy(CP)is a simple and safe procedure for polyps less than 10 mm in size;however,there is concern about local recurrence following CP because of unidentified margins of excised specimens and the lack of tumor suppression effect by coagulation.Some clinical trials have evaluated local persistent recurrence;their results suggest that a higher rate of local recurrence has not been documented so far.There were few reports that observed the course over long periods of time after CP in clinical practice.AIM To evaluate the presence of local recurrence following CP and hot polypectomy(HP)using propensity score matching.METHODS We analyzed 275 patients who underwent polypectomy for non-pedunculated colorectal polyps less than 10 mm(959 Lesions)between October 2016 and 2017 and underwent follow-up endoscopy subsequently.We divided them into the CP group(706 Lesions),wherein CP was performed,and the HP group(253 Lesions),wherein HP was performed.Using propensity score matching,we extracted 215 Lesions in each group and evaluated the local recurrence and content of CP in the real clinic and adverse events using medical records.RESULTS After propensity score matching,there were no significant differences in the patients’and their endoscopic background(age,use of antithrombotics,indications,size,morphology,location of polyps,and polypectomy device)between the groups.The mean duration between colorectal polypectomy and the next follow-up colonoscopy was 17.5±7.1(range,6-39)mo in the CP group and 15.7±6.0(range,6-35)mo in the HP group,which was significantly longer in the CP group(P=0.005).The local recurrence rate was 0.93%in the CP group and 0.93%in the HP group,without a significant difference(P=0.688).Additionally,no differences were observed in the macroscopic en bloc resection rate,histopathological complete resection rate,and pathological results between the groups.Adverse events did not occur in either group.CONCLUSION Local recurrence after CP was equivalent to that following HP in clinical practice.CP is useful and safe in the treatment of non-pedunculated polyps of less than 10 mm.
文摘BACKGROUND Despite the popularity of immune checkpoint inhibitors(ICIs)in the treatment of advanced cancer,patients often develop gastrointestinal(GI)and non-GI immune-related adverse events(irAEs).The clinical characteristics and survival outcomes of GI-irAEs have not been fully elucidated in previous reports.This necessitates the evaluation of the impact of GI-irAEs on patients receiving ICI treatment.AIM To evaluate the clinical characteristics of GI-irAEs and their impact on survival in patients treated with ICIs.METHODS In this single-center,retrospective,observational study,we reviewed the records of 661 patients who received ICIs for various cancers at Nagoya University Hospital from September 2014 to August 2020.We analyzed the clinical characteristics of patients who received ICI treatment.We also evaluated the correlation between GI-irAE development and prognosis in non-small cell lung cancer(LC)and malignant melanoma(MM).Kaplan-Meier analysis was used to compare the median overall survival(OS).Multivariate Cox proportional hazards models were used to identify prognostic factors.A P value<0.05 was considered statistically significant.RESULTS GI-irAEs occurred in 34 of 605 patients(5.6%)treated with an anti-programmed cell death-1/programmed death-ligand 1(anti-PD-1/PD-L1)antibody alone and in nine of 56 patients(16.1%)treated with an anti-cytotoxic T-lymphocyte antigen 4(CTLA-4)antibody alone or a combination of anti-PD-1 and anti-CTLA-4 antibodies.The cumulative incidence and median daily diarrhea frequency were significantly higher in patients receiving anti-CTLA-4 antibodies(P<0.05).In 130 patients with MM,OS was significantly prolonged in the group that continued ICI treatment despite the development of GI-irAEs compared to the group that did not experience GI-irAEs(P=0.035).In contrast,in 209 patients with non-small cell LC,there was no significant difference in OS between the groups.The multivariate analyses showed that a performance status of 2-3(hazard ratio:2.406;95%confidence interval:1.125–5.147;P=0.024)was an independent predictive factor for OS in patients with MM.CONCLUSION Patients receiving anti-CTLA-4 antibodies develop GI-irAEs more frequently and with higher severity than those receiving anti-PD-1/PD-L1 antibodies.Continuing ICI treatment in patients with MM with GI-irAEs have better OS.
文摘BACKGROUND Retrograde cholangiopancreatography using double-balloon endoscopic retrograde cholangiography(DBERC)is a valuable technique to treat biliary stone and jejunobiliary anastomotic stenosis in patients with altered gastrointestinal anatomy.The accurate selection of the route at the anastomosis branch is one of the most important factors in reaching the target in a timely manner.AIM To determine the accuracy of carbon dioxide insufflation enterography(CDE)at the branch for selecting the correct route during DBERC.METHODS We enrolled 52 consecutive patients scheduled for DBERC at our institution from June 2015 to November 2017.Route selection via two methods(visual observation and CDE)was performed in each patient.We determined the correct rate of route selection using CDE.RESULTS Thirty-three patients had a jejunojejunal anastomosis and 19 patients had a gastrojejunal anastomosis.The therapeutic target region was reached in 50 patients.The mean procedure times from the teeth to the target(total insertion time),from the teeth to the branch,and from the branch to the target,and the mean total examination time were 15.2,5.0,8.2,and 60.3 min,respectively.The rate of correct route selection using visual observation and CDE were 36/52(69.2%)and 48/52(92.3%),respectively(P=0.002).The rate of correct route selection using CDE in patients with a jejunojejunal anastomosis was 29/33(87.8%),and the rate in patients with a gastrojejunal anastomosis was 19/19(100%).CONCLUSION CDE is helpful in selecting the route at the branch in the anastomosis for more timely access to the target in patients with altered gastrointestinal anatomy undergoing DBERC.
基金partially supported by an investigator-initiated research grant(IN-US-334-4309)from Gilead Sciences to Stanford University.
文摘Background and Aims:As practice patterns and hepatitis C virus(HCV)genotypes(GT)vary geographically,a global real-world study from both East and West covering all GTs can help inform practice policy toward the 2030 HCV elimination goal.This study aimed to assess the effectiveness and tolerability of DAA treatment in routine clinical practice in a multinational cohort for patients infected with all HCV GTs,focusing on GT3 and GT6.Methods:We analyzed the sustained virological response(SVR12)of 15,849 chronic hepatitis C patients from 39 Real-World Evidence from the Asia Liver Consortium for HCV clinical sites in Asia Pacific,North America,and Europe between 07/01/2014–07/01/2021.Results:The mean age was 62±13 years,with 49.6%male.The demographic breakdown was 91.1%Asian(52.9%Japanese,25.7%Chinese/Taiwan residents,5.4%Korean,3.3%Malaysian,and 2.9%Vietnamese),6.4%White,1.3%Hispanic/Latino,and 1%Black/African-American.Additionally,34.8%had cirrhosis,8.6%had hepatocellular carcinoma(HCC),and 24.9%were treatment-experienced(20.7%with interferon,4.3%with direct-acting antivirals).The largest group was GT1(10,246[64.6%]),followed by GT2(3,686[23.2%]),GT3(1,151[7.2%]),GT6(457[2.8%]),GT4(47[0.3%]),GT5(1[0.006%]),and untyped GTs(261[1.6%]).The overall SVR12 was 96.9%,with rates over 95%for GT1/2/3/6 but 91.5%for GT4.SVR12 for GT3 was 95.1%overall,98.2%for GT3a,and 94.0%for GT3b.SVR12 was 98.3%overall for GT6,lower for patients with cirrhosis and treatment-experienced(TE)(93.8%)but≥97.5%for tretment-naive patients regardless of cirrhosis status.On multivariable analysis,advanced age,prior treatment failure,cirrhosis,active HCC,and GT3/4 were independent predictors of lower SVR12,while being Asian was a significant predictor of achieving SVR12.Conclusions:In this diverse multinational realworld cohort of patients with various GTs,the overall cure rate was 96.9%,despite large numbers of patients with cirrhosis,HCC,TE,and GT3/6.SVR12 for GT3/6 with cirrhosis and TE was lower but still excellent(>91%).
文摘Background and Aims:Cloning of ATP7B provided evidence that Wilson's disease is a hepatic copper toxicosis with a variety of extrahepatic complications.Affected siblings with the same genetic background and exposure to similar environmental factors may be a good model for the study of genotype-phenotype correlation.Methods:Twenty-three affected siblings in 11 families were selected from a database.The first phenotypes were determined according to the international proposal.The final types of chronic organ damage were re-evaluated for life-long management.Results:Phenotypes were identical in 5 of the families and different in 6 of the families.The acute hepatic phenotype H1 was found in 3 younger siblings and 1 older sibling.All survived an acute episode of hemolysis with underlying chronic liver disease.One also presented complication with neurological disease.The neurological phenotype N1 with neuropsychiatric symptoms and hepatic disease was found in 2 aged siblings of 1 family,in an older sibling in 3 families and in the oldest sibling in 1 family.Phenotypes in siblings were mainly split by either H1 occurring in random order or age-dependent N1.Types of chronic organ damage were identical in 8 of the families and different in 3 of the families.The same combination of chronic liver disease was found in 6 families and chronic liver disease complicated with neurological disease in 2 families.Split organ damage in siblings was found when an older sibling was complicated by neurological disease.There was no reverse combination of a younger sibling being complicated by neurological disease in any of the families.Conclusion:Phenotype combinations of siblings were mainly modified by externally-induced hemolytic episodes,while chronic organ damage in siblings was split by age-dependent neurological complications.
文摘In biology,redox reactions are essential and sometimes harmful,and therefore,iron metabolism is tightly regulated by cuproproteins.Since the state of copper in iron overload syndromes remains unclear,we investigated whether copper metabolism is altered in these syndromes.Eleven patients with iron overload syndromes participated in this study.The clinical diagnoses were aceruloplasminemia (n=2),hemochromatosis (n=5),ferroportin disease (n=2),and receiving excess intravenous iron supplementation (n=2).Liver specimens were analyzed using a light microscope and transmission electron microscope equipped with an X-ray analyzer.In addition to a large amount of iron associated with oxygen and phosphorus,the iron-rich hemosiderins of hepatocytes and Kupffer cells contained small amounts of copper and sulfur,regardless of disease etiology.Two-dimensional imaging clearly showed that cuproproteins were distributed homogenously with iron complexes within hemosiderins.Copper stasis was unlikely in noncirrhotic patients.The enhanced induction of cuproproteins by excess iron may contribute to copper accumulation in hemosiderins.In conclusion,we have demonstrated that copper accumulates in hemosiderins in iron overload conditions,perhaps due to alterations in copper metabolism.
