研究者総覧

菅野 敦 (カンノ アツシ)

  • 光学医療センター 内視鏡部 講師
メールアドレス: atsushihjichi.ac.jp
Last Updated :2021/12/04

研究者情報

ホームページURL

J-Global ID

研究キーワード

  • 胆道・膵疾患の内視鏡治療 自己免疫性膵炎 膵管内乳頭粘液性腫瘍   

研究分野

  • ライフサイエンス / 消化器内科学 / 胆道・膵臓

経歴

  • 2020年04月  自治医科大学内科学講座 消化器内科学部門講師
  • 2017年04月 - 2020年03月  東北大学病院消化器内科講師
  • 2009年04月 - 2017年03月  東北大学病院消化器内科助教
  • 2008年04月 - 2009年03月  東北大学病院消化器内科医員
  • 2004年04月 - 2008年03月  東北大学大学院医学系研究科消化器病態学分野大学院生
  • 2003年04月 - 2004年03月  宮城県立がんセンター消化器内科
  • 1999年04月 - 2003年03月  公立米谷病院 (現 登米市立米谷病院)内科
  • 1997年04月 - 1999年03月  公立佐沼総合病院(現 登米市民病院)内科
  • 1995年05月 - 1997年03月  国立仙台病院(現 仙台医療センター)研修医

学歴

  •         - 2008年03月   東北大学大学院 医学系研究科 修了   Graduate School of Medicine
  •         - 1995年03月   自治医科大学   医学部 卒業

所属学協会

  • 日本内科学会   日本消化器病学会   日本消化器内視鏡学会   日本膵臓学会   日本超音波医学会   日本胆道学会(2010/04- 評議員)   

研究活動情報

論文

  • 池田 恵理子, 牛尾 純, 安藤 梢, 谷川 雅彦, 坂口 美織, 三輪田 哲郎, 長井 洋樹, 多田 大和, 横山 健介, 菅野 敦, 森嶋 計, 笹沼 英紀, 玉田 喜一, 佐田 尚宏, 福嶋 敬宜
    胆と膵 42 5 393 - 400 医学図書出版(株) 2021年05月 
    胆膵領域に発生する腫瘍は、しばしば画像診断に難渋する。画像診断精度を向上させるためには、術前画像で異常所見を拾い上げる所見のための根拠を病理組織学的に検証していくことが重要である。当施設では、詳細な術前画像と病理像の対比のために、臨床医と病理医が協力して「検体造影検査」に加え「術後検体超音波検査」を行っている。とくに、「術後検体超音波検査」は、簡便で、病理像・画像対比に適した病理組織標本を作ることができ、画像所見へのフィードバックや診療科横断的なコミュニケーションツールとしても有意義な検査である。(著者抄録)
  • 池田 恵理子, 牛尾 純, 安藤 梢, 谷川 雅彦, 坂口 美織, 三輪田 哲郎, 長井 洋樹, 多田 大和, 横山 健介, 菅野 敦, 森嶋 計, 笹沼 英紀, 玉田 喜一, 佐田 尚宏, 福嶋 敬宜
    胆と膵 42 5 393 - 400 医学図書出版(株) 2021年05月 
    胆膵領域に発生する腫瘍は、しばしば画像診断に難渋する。画像診断精度を向上させるためには、術前画像で異常所見を拾い上げる所見のための根拠を病理組織学的に検証していくことが重要である。当施設では、詳細な術前画像と病理像の対比のために、臨床医と病理医が協力して「検体造影検査」に加え「術後検体超音波検査」を行っている。とくに、「術後検体超音波検査」は、簡便で、病理像・画像対比に適した病理組織標本を作ることができ、画像所見へのフィードバックや診療科横断的なコミュニケーションツールとしても有意義な検査である。(著者抄録)
  • 【これだけは知っておきたい胆膵疾患の診断・治療up-to-date】膵癌早期発見・診断はどこまで進歩したか?
    安藤 梢, 菅野 敦, 池田 恵理子, 三輪田 哲郎, 長井 洋樹, 川崎 佑輝, 多田 大和, 横山 健介, 沼尾 規且, 牛尾 純, 福嶋 敬宜, 玉田 喜一, 山本 博徳
    消化器クリニカルアップデート 2 2 203 - 208 医学図書出版(株) 2021年04月 
    膵癌は予後不良な悪性腫瘍であり、膵癌の予後を改善するためには、早期診断が極めて重要である。近年、膵癌のリスク因子や、早期に診断された膵癌の臨床的な特徴、画像の特徴などが報告されるようになり、リスク因子を有する症例の集積や経過観察の方法などが注目されている。本稿では、膵癌早期診断における活動の現状について概説する。(著者抄録)
  • Masahiro Iseki, Masamichi Mizuma, Yasutaka Aoki, Shuichi Aoki, Tatsuo Hata, Tatsuyuki Takadate, Kei Kawaguchi, Kunihiro Masuda, Masaharu Ishida, Hideo Ohtsuka, Kei Nakagawa, Hiroki Hayashi, Takanori Morikawa, Takashi Kamei, Kiyoshi Kume, Atsushi Kanno, Atsushi Masamune, Yuko Omori, Yusuke Ono, Yusuke Mizukami, Toru Furukawa, Michiaki Unno
    Clinical journal of gastroenterology 14 2 668 - 677 2021年04月 
    An 83-year-old man without specific symptoms was referred to our hospital for further evaluation and treatment of apparent double primary tumors of the cystic duct and common bile duct. Computed tomography showed contrast-enhanced solid tumors in the cystic duct and common bile duct. Magnetic resonance imaging showed that the bile duct tumor was isointense on T1-weighted images and had low intensity on T2-weighted images. In addition, the bile duct tumor showed high intensity on diffusion-weighted images. Endoscopic ultrasonography revealed the tumor of the common bile duct and endoscopic retrograde cholangiopancreatography demonstrated a filling defect in the bile duct. The cystic duct was not identified on endoscopic ultrasonography or endoscopic retrograde cholangiopancreatography. Transpapillary biopsy of the bile duct tumor showed adenocarcinoma. The patient was diagnosed with double primary tumors of the cystic duct and the common bile duct and underwent subtotal stomach-preserving pancreaticoduodenectomy. Microscopic examination with molecular profiling of the tumors revealed a high-grade noninvasive intracholecystic papillary neoplasm of the cystic duct extending into the common bile duct and forming a tubulopapillary neoplasm with invasion of the common bile duct.
  • Jun Ushio, Atsushi Kanno, Eriko Ikeda, Kozue Ando, Hiroki Nagai, Tetsurou Miwata, Yuki Kawasaki, Yamato Tada, Kensuke Yokoyama, Norikatsu Numao, Kiichi Tamada, Alan Kawarai Lefor, Hironori Yamamoto
    Diagnostics (Basel, Switzerland) 11 3 2021年03月 
    The number of new cases of pancreatic ductal adenocarcinoma is increasing with a cumulative total of 495,773 cases worldwide, making it the fourteenth most common malignancy. However, it accounts for 466,003 deaths per year and is the seventh leading cause of cancer deaths. Regional differences in the number of patients with pancreatic ductal adenocarcinoma appear to reflect differences in medical care, as well as racial differences. Compared to the prevalence of other organ cancers in Japan, pancreatic ductal adenocarcinoma ranks seventh based on the number of patients, eighth based on morbidity, and fourth based on the number of deaths, with a continuing increase in the mortality rate. Risk factors for developing pancreatic ductal adenocarcinoma include family history, genetic disorders, diabetes, chronic pancreatitis, and intraductal papillary mucinous neoplasms. An issue that hinders improvement in the prognosis of patients with pancreatic ductal adenocarcinoma is the development of a strategy to identify patients with these risk factors to facilitate detection of the disease at a stage when intervention will improve survival.
  • Shunsuke Omoto, Masayuki Kitano, Mitsuharu Fukasawa, Reiko Ashida, Hironari Kato, Hideyuki Shiomi, Kazuya Sugimori, Atsushi Kanno, Yasutaka Chiba, Shinichi Takano, Naoki Yamamoto, Takeshi Ezaki, Haruo Miwa, Akitaka Yokomura, Masato Hoshikawa, Takamitsu Tanaka, Masatoshi Kudo
    Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society 2021年02月 
    OBJECTIVES: This prospective multicenter study aimed to assess and compare the accuracy of tissue harmonic endoscopic ultrasonography (TH-EUS) and contrast-enhanced harmonic endoscopic ultrasonography (CH-EUS) for differentiating pancreatic carcinoma from other pancreatic tumors. METHODS: Consecutive patients with solid pancreatic tumors were prospectively enrolled between August 2013 and December 2014. To assess the accuracy of TH-EUS and CH-EUS, we compared four parameters of TH-EUS (fuzzy edge, irregular periphery, hypoechogenicity, and heterogeneous internal echogenicity) and four parameters of CH-EUS (hypoenhancement and heterogeneous enhancement in the early and late phases, respectively) to investigate which parameter of each method was most suitable to diagnose pancreatic carcinomas. Interobserver agreement and the diagnostic ability of pancreatic carcinoma using TH-EUS and CH-EUS were assessed and compared. RESULTS: A total of 204 patients were enrolled. For the diagnosis of pancreatic carcinoma, interobserver agreement by experts and nonexperts was 0.33-0.50 and 0.35-0.50 for TH-EUS, respectively, and 0.72-0.74 and 0.20-0.54 for CH-EUS, respectively. Irregular periphery was the most accurate diagnostic parameter among TH-EUS findings for differentiating pancreatic carcinomas, with sensitivity, specificity, and accuracy of 95.0%, 42.9%, and 78.9%, respectively. Late phase hypoenhancement was the most accurate diagnostic parameter among CH-EUS findings for differentiating pancreatic carcinomas, with sensitivity, specificity, and accuracy of 90.8%, 74.6%, and 85.8%, respectively. The accuracy of CH-EUS (late phase hypoenhancement) for diagnosis of pancreatic carcinoma was significantly higher than that of TH-EUS (irregular periphery) (p < 0.001). CONCLUSION: In comparison with TH-EUS, CH-EUS increased the diagnostic ability and reproducibility for the diagnosis of pancreatic carcinoma. UMIN (000011124).
  • Kei Saito, Yousuke Nakai, Hiroyuki Isayama, Ryuichi Yamamoto, Kazumichi Kawakubo, Yuzo Kodama, Akio Katanuma, Atsushi Kanno, Masahiro Itonaga, Kazuhiko Koike
    Gut and liver 15 1 135 - 141 2021年01月 [査読有り][通常論文]
     
    Background/Aims: The aim of this study was to evaluate the safety and efficacy of partially covered self-expandable metallic stents (PCSEMS) in patients undergoing neoadjuvant chemo(radio) therapy (NAC) for pancreatic cancer (PC). Methods: This was a prospective multicenter study to evaluate the safety and efficacy of PCSEMS in patients receiving NAC for resectable and borderline resectable PC. The primary endpoint was the rate of recurrent biliary obstruction (RBO). Results: Twenty-six patients with PC (three with resectable PC and 23 with borderline resectable PC) who underwent NAC at seven Japanese centers were included in the analysis. Both the technical and functional success rates of PCSEMS placement were 100%. Early stent-related complications were observed in three patients (11.5%): mild pancreatitis (n=2) and mild liver abscess (n=1). The median time to surgery or palliation was 4.0 months. Surgical resection was eventually performed in 73.1% of patients, and stent removal during surgery was successful in all patients. RBO was observed in nine patients (34.6%): seven with stent occlusion, one with kinking and one with migration. The RBO rates in resected cases and nonresected cases were 36.8% and 28.6%, respectively. Conclusions: Biliary drainage by PCSEMS was safe and feasible in patients undergoing NAC for resectable and borderline resectable PC.
  • Kensuke Yokoyama, Atsushi Kanno, Jun Ushio, Kiichi Tamada, Hironori Yamamoto
    VideoGIE : an official video journal of the American Society for Gastrointestinal Endoscopy 6 1 32 - 34 2021年01月
  • Atsushi Kanno, Alan Kawarai Lefor
    Journal of medical ultrasonics (2001) 48 1 1 - 2 2021年01月
  • Atsushi Kanno, Alan Kawarai Lefor, Hironori Yamamoto
    Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society 2020年12月
  • Atsushi Kanno, Ichiro Yasuda, Atsushi Irisawa, Kazuo Hara, Reiko Ashida, Takuji Iwashita, Mamoru Takenaka, Akio Katanuma, Tetsuya Takikawa, Kensuke Kubota, Hironari Kato, Yousuke Nakai, Shomei Ryozawa, Masayuki Kitano, Hiroyuki Isayama, Hideki Kamada, Yoshinobu Okabe, Keiji Hanada, Koushiro Ohtsubo, Shinpei Doi, Hiroyuki Hisai, Goro Shibukawa, Hiroo Imazu, Atsushi Masamune
    Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society 2020年12月 
    BACKGROUND AND AIMS: Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is used for the histopathological diagnosis of any type of gastrointestinal disease. Few adverse events are experienced with this procedure; however, the actual rate of adverse events remains unclear. This study aimed to clarify the current status of cases that experienced adverse events related to the EUS-FNA procedure used for histopathologic diagnoses. METHODS: A retrospective analysis of cases with EUS-FNA-related adverse events in Japanese tertiary centers was conducted by assessing the following clinical data: basic case information, FNA technique, type of procedural adverse events, and prognosis. RESULTS: Of the 13,566 EUS-FNA cases overall, the total number of cases in which adverse events related to EUS-FNA occurred was 234. The incidence of EUS-FNA-related adverse events was ~1.7%. Bleeding and pancreatitis cases accounted for ~49.1% and 26.5% of all adverse events, respectively. Bleeding was the most common adverse event with only seven cases requiring blood transfusion. In cases with neuroendocrine tumors, pancreatitis was the most frequent adverse event. Needle tract seeding because of EUS-FNA was observed during the follow-up period in only ~0.1% of cases with pancreatic cancer. There was no mortality because of adverse events caused by EUS-FNA. CONCLUSIONS: This study revealed that the adverse events-related EUS-FNA for histopathologic diagnoses were not severe conditions, and had low incidence.
  • Atsushi Kanno, Eriko Ikeda, Kozue Ando, Hiroki Nagai, Tetsuro Miwata, Yuki Kawasaki, Yamato Tada, Kensuke Yokoyama, Norikatsu Numao, Jun Ushio, Kiichi Tamada, Alan Kawarai Lefor, Hironori Yamamoto
    Diagnostics (Basel, Switzerland) 10 12 2020年11月 
    Autoimmune pancreatitis (AIP) is characterized by enlargement of the pancreas and irregular narrowing of the main pancreatic duct. It is often associated with IgG4-related sclerosing cholangitis (IgG4-SC), in which the bile duct narrows. Although characteristic irregular narrowing of the pancreatic duct caused by endoscopic retrograde cholangiopancreatography is noted in AIP, it is difficult to differentiate between localized AIP and pancreatic carcinoma based on imaging of the pancreatic duct. While stenosis of the bile duct in IgG4-SC is characterized by longer-length stenosis than in cholangiocarcinoma, differentiation based on bile duct imaging alone is challenging. Endoscopic ultrasound (EUS) can characterize hypoechoic enlargement of the pancreas or bile duct wall thickening in AIP and IgG4-SC, and diagnosis using elastography and contrast-enhanced EUS are being evaluated. The utility of EUS-guided fine needle aspiration for the histological diagnosis of AIP has been reported and is expected to improve diagnostic performance for AIP. Findings in the bile duct wall from endoscopic retrograde cholangiopancreatography followed by intraductal ultrasonography are useful in differentiating IgG4-SC from cholangiocarcinoma. Diagnoses based on endoscopic ultrasonography play a central role in the diagnosis of AIP.
  • 大塚 英郎, 青木 泰孝, 畠 達夫, 益田 邦洋, 水間 正道, 中川 圭, 森川 孝則, 菅野 敦, 正宗 淳, 大森 優子, 古川 徹, 海野 倫明
    胆道 34 4 772 - 780 日本胆道学会 2020年10月 
    症例は29歳男性.心窩部痛を主訴に近医受診し,血液生化学検査で肝胆道系酵素値の上昇と黄疸を認めた.造影CTで肝内胆管の拡張と肝門部胆管に腫瘍性病変を認めるとともに,MRCPで膵・胆管合流異常を認めた.腫瘍より乳頭側の胆管に拡張を認めず,非拡張型膵・胆管合流異常に合併した肝門部胆管癌(BismuthII)と診断し,肝拡大左葉切除・尾状葉切除・肝外胆管切除術を施行した.切除標本で肝門部に結節浸潤型の病変を認め,病理組織学的検討より浸潤癌部に連続する乳頭側の胆管上皮にbiliary intraepithelial neoplasia(BilIN)病変を認めた.非拡張型の膵・胆管合流異常では,胆嚢癌が高率に発症するとされるが,胆管癌の発症は多くない.本症例は30歳未満と若年発症した胆管癌症例であるが,職業性胆管癌の可能性は示唆されず,その発癌に膵・胆管合流異常が深く関与していたと考えられる.(著者抄録)
  • Hiroki Tanaka, Susumu Hijioka, Waki Hosoda, Makoto Ueno, Noritoshi Kobayashi, Masafumi Ikeda, Tetsuhide Ito, Yuzo Kodama, Chigusa Morizane, Kenji Notohara, Hiroki Taguchi, Masayuki Kitano, Izumi Komoto, Akihito Tsuji, Syunpei Hashigo, Atsushi Kanno, Katsuyuki Miyabe, Tadayuki Takagi, Hiroshi Ishii, Yasushi Kojima, Hideyuki Yoshitomi, Hiroaki Yanagimoto, Junji Furuse, Nobumasa Mizuno
    Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.] 20 7 1421 - 1427 2020年10月 
    BACKGROUND/OBJECTIVES: Pancreatic neuroendocrine carcinoma (PanNEC)-G3 often presents along with genetic abnormalities such as KRAS, RB1, and TP53 mutations. However, the association between these genetic findings and response to chemotherapy and prognosis has not been clarified. This study aimed to clarify the clinicopathological features of PanNEC-G3. METHODS: We performed a subgroup analysis of the Japanese PanNEN-G3 study (multicenter, retrospective study), which revealed that Rb loss and KRAS mutation were predictors of the response to platinum-based regimen in PanNEN-G3. We re-classified WHO grades of PanNENs using the 2017 WHO classification and then analyzed the clinicopathological features and prognostic factors in 49 patients with PanNEC-G3. RESULTS: The rates of Rb loss and KRAS mutation in PanNEC-G3 were 54.5% and 48.7%, respectively. Patients with Rb loss and/or KRAS mutation showed a higher response rate to first-line platinum-based regimen than those without Rb loss or KRAS mutation (object response rate 70.0% vs 33.3%, odds ratio 9.22; 95% CI 1.26-67.3, P = 0.029), but tended to have shorter overall survival rates than those without Rb loss or KRAS mutation (median 239 vs 473 days, hazard ratio 2.11; 95% CI 0.92-4.86, P = 0.077). CONCLUSIONS: Patients with PanNEC-G3 have varied clinical outcomes for platinum-based regimen. When grouped based on Rb loss and KRAS mutation, there seemed to be two groups with distinct prognoses and responses to the platinum-based regimen. PanNEC-G3 could, therefore, be classified into two distinct groups based on immunohistochemical and genetic findings.
  • Kenji Notohara, Terumi Kamisawa, Noriyoshi Fukushima, Toru Furukawa, Takuma Tajiri, Hiroshi Yamaguchi, Shinichi Aishima, Yuki Fukumura, Kenichi Hirabayashi, Eisuke Iwasaki, Atsushi Kanno, Satomi Kasashima, Atsuhiro Kawashima, Motohiro Kojima, Kensuke Kubota, Yasuhiro Kuraishi, Tomoko Mitsuhashi, Yoshiki Naito, Itaru Naitoh, Hiroshi Nakase, Takayoshi Nishino, Nobuyuki Ohike, Junichi Sakagami, Kyoko Shimizu, Masahiro Shiokawa, Takeshi Uehara, Tsukasa Ikeura, Shigeyuki Kawa, Kazuichi Okazaki
    Pathology international 70 10 699 - 711 2020年10月 [査読有り][通常論文]
     
    The biopsy-based diagnosis of autoimmune pancreatitis (AIP) is difficult but is becoming imperative for pathologists due to the increased amount of endoscopic ultrasound-guided biopsy tissue. To cope with this challenge, we propose guidance for the biopsy diagnosis of type 1 AIP. This guidance is for pathologists and comprises three main parts. The first part includes basic issues on tissue acquisition, staining, and final diagnosis, and is intended for gastroenterologists as well. The second part is a practical guide for diagnosing type 1 AIP based on the AIP clinical diagnostic criteria 2018. Inconsistent histological findings, tips for evaluating IgG4 immunostaining and key histological features including the ductal lesion and others are explained. Storiform fibrosis and obliterative phlebitis are diagnostic hallmarks but are sometimes equivocal. Storiform fibrosis is defined as spindle-shaped cells, inflammatory cells and fine collagen fibers forming a flowing arrangement. Obliterative phlebitis is defined as fibrous venous obliteration with inflammatory cells. Examples of each are provided. The third part describes the differentiation of AIP from pancreatic ductal adenocarcinoma (PDAC), focusing on histological features of acinar-ductal metaplasia in AIP, which is an important mimicker of PDAC. This guidance will help standardize pathology reports of pancreatic biopsies for diagnosing type 1 AIP.
  • Masayuki Kitano, Thomas M Gress, Pramod K Garg, Takao Itoi, Atsushi Irisawa, Hiroyuki Isayama, Atsushi Kanno, Kei Takase, Michael Levy, Ichiro Yasuda, Phillipe Lévy, Shuiji Isaji, Carlos Fernandez-Del Castillo, Asbjørn M Drewes, Andrea R G Sheel, John P Neoptolemos, Tooru Shimosegawa, Marja Boermeester, C Mel Wilcox, David C Whitcomb
    Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.] 20 6 1045 - 1055 2020年09月 [査読有り][通常論文]
     
    BACKGROUND/OBJECTIVES: This paper is part of the international consensus guidelines on chronic pancreatitis, presenting for interventional endoscopy. METHODS: An international working group with experts on interventional endoscopy evaluated 26 statements generated from evidence on 9 clinically relevant questions. The Grading of Recommendations Assessment, Development, and Evaluation approach was used to evaluate the level of evidence. To determine the level of agreement, a nine-point Likert scale was used for voting on the statements. RESULTS: Strong consensus was obtained for 15 statements relating to nine questions including the recommendation that endoscopic intervention should be offered to patients with persistent severe pain but not to those without pain. Endoscopic decompression of the pancreatic duct could be used for immediate pain relief, and then offered surgery if this fails or needs repeated endoscopy. Endoscopic drainage is preferred for portal-splenic vein thrombosis and pancreatic fistula. A plastic stent should be placed and replaced 2-3 months later after insertion. Endoscopic extraction is indicated for stone fragments remaining after ESWL. Interventional treatment should be performed for symptomatic/complicated pancreatic pseudocysts. Endoscopic treatment is recommended for bile duct obstruction and afterwards surgery if this fails or needs repeated endoscopy. Surgery may be offered if there is significant calcification and/or mass of the pancreatic head. Percutaneous endovascular treatment is preferred for hemosuccus pancreaticus. Surgical treatment is recommended for duodenal stenosis due to chronic pancreatitis. CONCLUSIONS: This international expert consensus guideline provides evidenced-based statements concerning indications and key aspects for interventional endoscopy in the management of patients with chronic pancreatitis.
  • Tatsuo Hata, Masamichi Mizuma, Fuyuhiko Motoi, Masaharu Ishida, Takanori Morikawa, Kei Nakagawa, Hiroki Hayashi, Atsushi Kanno, Atsushi Masamune, Takashi Kamei, Takeshi Naitoh, Toru Furukawa, Michiaki Unno
    Surgery today 50 9 1039 - 1048 2020年09月 [査読有り][通常論文]
     
    PURPOSE: To clarify the usefulness of cancer-related inflammation, hypermetabolism, and subsequent host malnutrition biomarkers for predicting the histological grades of intraductal papillary mucinous neoplasms of the pancreas (IPMNs). METHODS: The systemic immune-inflammation index (SII), prognostic nutritional index (PNI), and maximum standardized uptake value (SUVmax) on fluorodeoxyglucose-positron emission tomography were compared across 171 resected IPMN cases of different histological grades. The diagnostic performance of each marker and of their combinations for predicting IPMN with high-grade dysplasia (HGD)/associated invasive carcinoma (INV) was also tested. RESULTS: Of the 171 IPMNs, the IPMN cases with HGD showed significantly higher values of SII (median 406 vs. 340; P = 0.041) and SUVmax (median 2.5 vs. 2.0; P = 0.001) than those with low-grade dysplasia (LGD). On a multivariate analysis, the SII and SUVmax were both independent markers for predicting HGD/INV. A combination analysis including the tumor- and host-derived markers in combination with imaging findings showed an improved diagnostic performance (area under the curve 0.824; sensitivity 75.9%; specificity 80.0%). CONCLUSIONS: The combination of multiple markers of host-derived inflammation and tumor-derived focal hypermetabolism can serve as a predictor for the presence of HGD/INV.
  • 当院でのEUS-FNAにおける偶発症の検討
    滝川 哲也, 菅野 敦, 池田 美緒, 佐野 貴紀, 松本 諒太郎, 田中 裕, 鍋島 立秀, 本郷 星仁, 三浦 晋, 濱田 晋, 粂 潔, 菊田 和宏, 正宗 淳
    Gastroenterological Endoscopy 62 Suppl.1 1236 - 1236 (一社)日本消化器内視鏡学会 2020年08月
  • 肝門部悪性胆管狭窄に留置されたinside stent抜去困難例の検討
    三浦 晋, 菅野 敦, 正宗 淳
    Gastroenterological Endoscopy 62 Suppl.1 1305 - 1305 (一社)日本消化器内視鏡学会 2020年08月
  • 菅野 敦, 三浦 晋, 滝川 哲也, 粂 潔, 正宗 淳
    臨床消化器内科 35 9 1067 - 1074 (株)日本メディカルセンター 2020年08月
  • 菅野 敦, 三浦 晋, 滝川 哲也, 粂 潔, 正宗 淳
    臨床消化器内科 35 9 1067 - 1074 (株)日本メディカルセンター 2020年08月
  • 当院でのEUS-FNAにおける偶発症の検討
    滝川 哲也, 菅野 敦, 池田 美緒, 佐野 貴紀, 松本 諒太郎, 田中 裕, 鍋島 立秀, 本郷 星仁, 三浦 晋, 濱田 晋, 粂 潔, 菊田 和宏, 正宗 淳
    Gastroenterological Endoscopy 62 Suppl.1 1236 - 1236 (一社)日本消化器内視鏡学会 2020年08月
  • 肝門部悪性胆管狭窄に留置されたinside stent抜去困難例の検討
    三浦 晋, 菅野 敦, 正宗 淳
    Gastroenterological Endoscopy 62 Suppl.1 1305 - 1305 (一社)日本消化器内視鏡学会 2020年08月
  • 三浦 晋, 菅野 敦, 正宗 淳
    日本消化器病学会雑誌 117 臨増総会 A204 - A204 (一財)日本消化器病学会 2020年07月
  • 急性膵炎に対する局所合併症治療 内視鏡的ネクロセクトミー後のWONの再発要因について
    粂 潔, 菅野 敦, 池田 未緒, 佐野 貴紀, 松本 諒太郎, 田中 裕, 鍋島 立秀, 本郷 星仁, 滝川 哲也, 三浦 晋, 濱田 晋, 菊田 和宏, 海野 倫明, 正宗 淳
    膵臓 35 3 A208 - A208 (一社)日本膵臓学会 2020年07月
  • Atsushi Irisawa, Takahisa Furuta, Takayuki Matsumoto, Takashi Kawai, Tomoki Inaba, Atsushi Kanno, Akio Katanuma, Yoshiro Kawahara, Koji Matsuda, Kazuhiro Mizukami, Takao Otsuka, Ichiro Yasuda, Shinji Tanaka, Kazuma Fujimoto, Shinsaku Fukuda, Hiroyasu Iishi, Yoshinori Igarashi, Kazuo Inui, Toshiharu Ueki, Haruhiko Ogata, Mototsugu Kato, Akiko Shiotani, Kazuhide Higuchi, Naotaka Fujita, Kazunari Murakami, Hironori Yamamoto, Tohru Ito, Kazuichi Okazaki, Yuko Kitagawa, Tetsuya Mine, Hisao Tajiri, Haruhiro Inoue
    Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society 32 5 648 - 650 2020年07月 [査読有り][通常論文]
     
    All gastrointestinal endoscopic procedures have a high risk of aerosol contamination of the coronavirus disease 2019 (COVID-19) to endoscopists, nurses, and healthcare assistants. Given the current pandemic situation of COVID-19, the Japan Gastroenterological Endoscopy Society issued the recommendation for gastrointestinal (GI) endoscopy based on the status of COVID-19 as of April 9, 2020, in Japan: (i) indications for GI endoscopy in the pandemic of COVID-19; (ii) practical protective equipment for medical personnel depending on the risk for COVID-19; (iii) preprocedural management, such as pharyngeal local anesthesia using lidocaine spray which has a potential to generate the aerosols; (iv) ideal settings of the endoscopy room including the numbers of the staff and the patients; (v) postprocedural management, such as undressing and follow-up of the patients, as well as the involved staff, were documented to fit the practical scenarios in GI endoscopy, with the available data in Japan and the world. We believe that certain measures will prevent further spread of COVID-19.
  • Takahisa Furuta, Atsushi Irisawa, Takayuki Matsumoto, Takashi Kawai, Tomoki Inaba, Atsushi Kanno, Akio Katanuma, Yoshiro Kawahara, Koji Matsuda, Kazuhiro Mizukami, Takao Otsuka, Ichiro Yasuda, Mitsuhiro Fujishiro, Shinji Tanaka, Kazuma Fujimoto, Shinsaku Fukuda, Hiroyasu Iishi, Yoshinori Igarashi, Kazuo Inui, Toshiharu Ueki, Haruhiko Ogata, Mototsugu Kato, Akiko Shiotani, Kazuhide Higuchi, Naotaka Fujita, Kazunari Murakami, Hironori Yamamoto, Tohru Ito, Kazuichi Okazaki, Yuko Kitagawa, Tetsuya Mine, Hisao Tajiri, Haruhiro Inoue
    Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society 32 5 651 - 657 2020年07月 [査読有り][通常論文]
     
    Some situations may require endoscopy during the COVID-19 (Coronavirus Disease 2019) pandemic. Here, we describe the necessary precautions in the form of clinical questions and answers (Q&A) regarding the safe deployment of gastrointestinal endoscopy in such situations while protecting endoscopy staff and patients from infection. Non-urgent endoscopy should be postponed. The risk of infection in patients should be evaluated in advance by questionnaire and body temperature. The health of staff must be checked every day. Decisions to employ endoscopy should be based on the institutional conditions and aims of endoscopy. All endoscopic staff need to wear appropriate personal protective equipment (PPE). The endoscope and other devices should be cleaned and disinfected after procedures in accordance with the relevant guidelines. Optimal management of the endoscopy unit is required. Endoscopy for infected patients or those with suspected infection demands exceptional caution. When a patient who undergoes endoscopy is later found to have COVID-19, the members of staff involved are considered exposed to the virus and must not work for at least 14 days if their PPE is considered insufficient. When PPE resources are limited, some equipment may be used continuously throughout a shift as long as it is not contaminated. Details of the aforementioned protective measures are described.
  • Kenji Notohara, Terumi Kamisawa, Atsushi Kanno, Itaru Naitoh, Eisuke Iwasaki, Kyoko Shimizu, Yasuhiro Kuraishi, Masayo Motoya, Yuzo Kodama, Satomi Kasashima, Takayoshi Nishino, Kensuke Kubota, Junichi Sakagami, Tsukasa Ikeura, Shigeyuki Kawa, Kazuichi Okazaki
    Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.] 20 5 834 - 843 2020年07月 [査読有り][通常論文]
     
    OBJECTIVES: We examined the efficacy and limitations of acquiring large specimens by endoscopic ultrasound-guided fine needle biopsy (EUS-FNB) for diagnosing type 1 autoimmune pancreatitis (AIP). METHODS: Patients from 12 institutions with non-neoplastic diseases or pancreatic ductal adenocarcinoma (PDAC) with large EUS-FNB specimens were investigated. Slides stained with hematoxylin-eosin, elastic, IgG4, and IgG stains were evaluated. The IgG4- and IgG-positive cell numbers were counted in three foci. The diagnoses were based on the Japan Pancreas Society 2011 (JPS 2011) criteria and the International Consensus Diagnostic Criteria (ICDC). RESULTS: We analyzed 85 non-neoplastic (definite type 1 AIP in 73/85 based on the ICDC) cases and 64 PDAC cases. IgG4-positive cells were numerous (>10 in 85.9%), and the IgG4/IgG ratios were high (>40% in 81.2%). Plasma cell crushing by an artifact caused unsuccessful immunostaining, notably in smaller samples. Tissue lengths were an important factor for the presence of storiform fibrosis and obliterative phlebitis, but storiform fibrosis was equivocal even in large tissues. A definite or possible histological diagnosis was achieved in 45.9% (39/85) and 41.2% (35/85), respectively, and contributed to the definite final diagnosis of type 1 AIP in 33.3% (ICDC) and 55.6% (JPS 2011) in cases with segmental/focal lesions. In the PDAC group, >10 IgG4-positive cells was rare (2/58), but elastic stains revealed fibrous venous occlusions in 10.3% (6/58). CONCLUSIONS: EUS-FNB with large tissue amounts was useful for diagnosing type 1 AIP, notably by facilitating successful IgG4 immunostaining, but definite diagnosis may not be achieved even in cases with large specimens.
  • Ryotaro Matsumoto, Shin Miura, Atsushi Kanno, Mio Ikeda, Takanori Sano, Yu Tanaka, Tatsuhide Nabeshima, Seiji Hongou, Tetsuya Takikawa, Shin Hamada, Kiyoshi Kume, Kazuhiro Kikuta, Atsushi Masamune
    Internal medicine (Tokyo, Japan) 59 7 945 - 950 2020年04月 [査読有り][通常論文]
     
    A 58-year-old man was referred for obstructive jaundice. Imaging modalities revealed the presence of multiple pancreatic tumors and the stenosis of the middle common bile duct due to a hypoenhanced localized tumor. The multiple pancreatic tumors were histopathologically diagnosed as autoimmune pancreatitis by endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA). To differentiate between IgG4-related sclerosing cholangitis (IgG4-SC) and cholangiocarcinoma, we diagnosed the biliary tumor as IgG4-SC by EUS-FNA because of insufficient pathological materials obtained in a transpapillary manner. We herein report a case of IgG4-SC diagnosed by EUS-FNA.
  • Shingo Yoshimachi, Hideo Ohtsuka, Takeshi Aoki, Takayuki Miura, Kyohei Ariake, Kunihiro Masuda, Masaharu Ishida, Masamichi Mizuma, Hiroki Hayashi, Kei Nakagawa, Takanori Morikawa, Fuyuhiko Motoi, Atsushi Kanno, Atsushi Masamune, Fumiyoshi Fujishima, Hironobu Sasano, Takashi Kamei, Takeshi Naitoh, Michiaki Unno
    Clinical journal of gastroenterology 13 1 37 - 45 2020年02月 [査読有り][通常論文]
     
    Mixed adenoneuroendocrine carcinoma (MANEC) is defined as a tumor composed of both adenocarcinoma and neuroendocrine components. Here, we report the case of a 75-year-old woman with ampullary MANEC. She visited a physician with the chief complaint of dark urine and was diagnosed with advanced jaundice. Subsequently, she was referred to our hospital. Contrast-enhanced computed tomography scan revealed a neoplastic lesion measuring approximately 2 cm with a contrast effect at the duodenal papilla. Upper endoscopy showed a non-exposed tumor at the duodenal papilla. After biliary drainage, a subtotal stomach-preserving pancreaticoduodenectomy was performed. Histopathological examination revealed that the tumor components were composed of circular-to-oval atypical cells admixed with tubular adenocarcinoma tissue. These atypical cells were immunohistochemically positive for synaptophysin and diagnosed as neuroendocrine carcinoma with a Ki-67 labeling index of 63%. The patient was diagnosed with MANEC with a neuroendocrine carcinoma component of approximately 40%. The neuroendocrine carcinoma component had metastasized to the posterior pancreatic lymph nodes. Despite starting adjuvant chemotherapy with S-1, computed tomography revealed the presence of multiple liver metastases within 4 months after surgery. MANEC with neuroendocrine carcinoma is well known to have an extremely poor prognosis. Therefore, establishing a multidisciplinary therapy including chemotherapy is crucial.
  • Shin Miura, Atsushi Kanno, Koji Fukase, Yu Tanaka, Ryotaro Matsumoto, Tatsuhide Nabeshima, Seiji Hongou, Tetsuya Takikawa, Shin Hamada, Kiyoshi Kume, Kazuhiro Kikuta, Kei Nakagawa, Michiaki Unno, Atsushi Masamune
    Surgical endoscopy 34 2 667 - 674 2020年02月 [査読有り][通常論文]
     
    BACKGROUND: In patients with malignant perihilar biliary strictures, preoperative biliary drainage (PBD) of the hepatic lobe to be resected may decrease the liver volume of the future liver remnant (FLR) after percutaneous transhepatic portal vein embolization (PVE). However, evidence of its application is insufficient. This study aimed to clarify the effects of PBD on liver hypertrophy after PVE. METHODS: Between January 2008 and December 2017, 169 patients with malignant perihilar biliary strictures underwent major hepatectomy or palliative surgery at our hospital. Of these, 76 patients who underwent PVE were categorized into two groups: group A (n = 29) who received unilateral PBD of the FLR and group B (n = 47) who received bilateral PBD, including that of the hepatic lobe to be resected. FLR ratios after PVE and liver hypertrophy ratios were retrospectively compared in both groups. RESULTS: Group B exhibited significantly severe biliary stenosis (p = 0.0038) and high serum bilirubin before biliary drainage (p = 0.0037). After PVE, the total liver volumes were 1287 ± 260 ml and 1340 ± 257 ml (p = 0.39), respectively. FLR volumes were 555 ± 135 and 577 ± 113 ml (p = 0.45), respectively. FLR ratios were 43.4 ± 8.2% and 43.4 ± 6.4%, respectively (p = 0.98). Liver hypertrophy ratios were 124.2 ± 17.7% and 129.2 ± 20.9%, respectively (p = 0.28). In addition, an examination which excluded patients with Bismuth type I obtained similar result. CONCLUSIONS: PBD of the hepatic lobe to be resected did not decrease the FLR ratios and hypertrophy ratios. Thus, in patients with poor biliary drainage, additional PBD of the target lobe is acceptable.
  • 低侵襲検査・治療(肝胆膵) 超音波内視鏡下穿刺吸引法の施行困難例についての検討
    粂 潔, 菅野 敦, 三浦 晋, 滝川 哲也, 正宗 淳
    日本消化器病学会東北支部例会プログラム・抄録集 208回 85 - 85 日本消化器病学会-東北支部 2020年01月
  • 抗HIV療法中に自己免疫性膵炎を発症した慢性膵炎の1例
    池田 未緒, 三浦 晋, 佐野 貴紀, 田中 裕, 松本 諒太郎, 鍋島 立秀, 本郷 星仁, 滝川 哲也, 菊田 和宏, 濱田 晋, 粂 潔, 菅野 敦, 正宗 淳
    日本消化器病学会東北支部例会プログラム・抄録集 208回 116 - 116 日本消化器病学会-東北支部 2020年01月
  • Seiko Hirono, Yasuhiro Shimizu, Takao Ohtsuka, Toshifumi Kin, Kazuo Hara, Atsushi Kanno, Shinsuke Koshita, Keiji Hanada, Masayuki Kitano, Hiroyuki Inoue, Takao Itoi, Toshiharu Ueki, Toshio Shimokawa, Susumu Hijioka, Akio Yanagisawa, Masafumi Nakamura, Kazuichi Okazaki, Hiroki Yamaue
    Journal of gastroenterology 55 1 86 - 99 2020年01月 [査読有り][通常論文]
     
    BACKGROUND: Although there are numerous reports focusing on surgical indication for intraductal papillary mucinous neoplasm (IPMN), the recurrence patterns following surgery are less widely reported. To ascertain optimal treatment and postoperative surveillance for IPMN patients, we analyzed patterns and risk factors for recurrence after surgery for IPMN. METHODS: This study is a retrospective, multi-institutional, observational study, including 1074 patients undergoing surgery for IPMN at 11 academic institutions. We analyzed the risk factors for recurrence after classifying postoperative recurrences into metachronous high-risk lesions (malignant progression of IPMN and/or metachronous pancreatic ductal adenocarcinoma) in the remnant pancreas and extra-pancreatic recurrence. RESULTS: Of 1074 patients undergoing surgery for IPMN, 155 patients (14.4%) developed postoperative recurrence. We found that 34.3% of 70 high-risk lesions in the remnant pancreas occurred over 5 years after surgery, and survival of 36 patients undergoing second operation for high-risk lesions was better than that of 34 patients who did not (P = 0.04). We found four independent risk factors for metachronous high-risk lesions in remnant pancreas: symptoms [P = 0.005, hazard ratio (HR) 1.988], location of pancreatic body/tail (P < 0.001, HR 3.876), main duct size ≥ 10 mm (P = 0.021, HR 1.900), and high-grade dysplasia/invasive intraductal papillary mucinous carcinoma (IPMC) (P < 0.001, HR 3.204). Although six patients (0.7%) with low- or high-grade dysplasia IPMN developed extra-pancreatic recurrence, invasive IPMC was the strongest risk factor for extra-pancreatic recurrence (P < 0.001, HR 39.667). CONCLUSION: We suggest that life-time continuous surveillance might be necessary for IPMN patients. Second surgery for metachronous high-risk lesions in remnant pancreas should be considered to improve survival.
  • Masamune A, Kikuta K, Hamada S, Tsuji I, Takeyama Y, Shimosegawa T, Okazaki K, Collaborators. Collaborators, Kanno A, Sano T, Uchida K, Ikeura T, Fujimori N, Nakai Y, Kamisawa T, Kubota K, Motoya M, Shimizu K, Ushijima T, Fukasawa M, Naitoh I, Ueno M, Okuwaki K, Uza N, Asada M, Mukai T, Kudo Y, Uetsuki K, Mitoro A, Watanabe H, Terai S, Hayashi K, Imamura Y, Haba S, Hara K, Fujisawa T, Iwasaki E, Okumura F, Kawaji Y, Kitano M, Nishino T, Nagahama M, Hirano A, Aruga Y, Yamamoto S, Inui K, Kubota Y, Takahashi K, Sakagami J, Kobayashi T, Miraki T, Watanabe T, Sato H, Takeda Y, Satoh M, Kobashigawa K, Chiba M, Tamura T, Sawada N, Mizukami K, Sekine M, Unno J, Ishizawa T, Funayama H, Hatayama K, Miyakawa H, Sakai T, Kuwatani M, Toki M, To
    Journal of Gastroenterology 55 4 462 - 470 2019年12月 [査読有り][通常論文]
     
    © 2019, Japanese Society of Gastroenterology. Background: To further clarify the clinico-epidemiological features of autoimmune pancreatitis (AIP) in Japan, we conducted the fourth nationwide epidemiological survey. Methods: This study consisted of two stage surveys; the number of AIP patients was estimated by the first survey and their clinical features were assessed by the second survey. We surveyed the AIP patients who had visited hospitals in 2016. Results: The estimated number of AIP patients in 2016 was 13,436, with an overall prevalence rate of 10.1 per 100,000 persons. The estimated number of newly diagnosed patients was 3984, with an annual incidence rate of 3.1 per 100,000 persons. Compared to the 2011 survey, both numbers more than doubled. We obtained detailed clinical information of 1474 AIP patients. The male-to-female sex ratio was 2.94, the mean age was 68.1, and mean age at diagnosis was 64.8. At diagnosis, 63% patients were symptomatic and nearly half of them presented jaundice. Pancreatic cysts were found in 9% of the patients and calcifications in 6%. Histopathological examination was performed in 64%, mainly by endoscopic ultrasonography-guided fine needle aspiration. Extra-pancreatic lesions were detected in 60% of the patients. Eighty-four % patients received the initial steroid therapy, and 85% received maintenance steroid therapy. Kaplan–Meier analysis revealed that the relapsed survival was 14% at 3 years, 25% at 5 years, 40% at 10 years, and 50% at 15 years. Mortality was favorable, but pancreatic cancer accounted for death in one quarter of fatal cases. Conclusion: We clarified the current status of AIP in Japan.
  • 膵癌の長期予後に術後合併症が及ぼす影響
    水間 正道, 元井 冬彦, 林 洋毅, 畠 達夫, 伊関 雅裕, 高舘 達之, 有明 恭平, 川口 桂, 益田 邦洋, 石田 晶玄, 大塚 英郎, 中川 圭, 森川 孝則, 内藤 剛, 亀井 尚, 菅野 敦, 正宗 淳, 海野 倫明
    日本消化器外科学会雑誌 52 Suppl.2 247 - 247 (一社)日本消化器外科学会 2019年11月
  • 膵癌の長期予後に術後合併症が及ぼす影響
    水間 正道, 元井 冬彦, 林 洋毅, 畠 達夫, 伊関 雅裕, 高舘 達之, 有明 恭平, 川口 桂, 益田 邦洋, 石田 晶玄, 大塚 英郎, 中川 圭, 森川 孝則, 内藤 剛, 亀井 尚, 菅野 敦, 正宗 淳, 海野 倫明
    日本消化器外科学会雑誌 52 Suppl.2 247 - 247 (一社)日本消化器外科学会 2019年11月
  • 青木 泰孝, 伊関 雅裕, 高舘 達之, 益田 邦洋, 水間 正道, 大塚 英郎, 中川 圭, 林 洋毅, 森川 孝則, 元井 冬彦, 内藤 剛, 菅野 敦, 正宗 淳, 古川 徹, 海野 倫明
    胆道 33 3 658 - 658 日本胆道学会 2019年10月
  • 当院における術後再建腸管総胆管結石症例に対する内視鏡治療の現状
    滝川 哲也, 菅野 敦, 正宗 淳
    胆道 33 3 639 - 639 日本胆道学会 2019年10月
  • 安全に胆道癌拡大肝切除を行うための術前・術後管理 術前胆管ドレナージによる残肝機能への影響 99mTc-GSAシンチグラフィを用いた機能解析
    三浦 晋, 菅野 敦, 正宗 淳
    胆道 33 3 438 - 438 日本胆道学会 2019年10月
  • 膵胆管合流異常を伴う胆嚢Mixed adenoneuroendcrine carcinomaの1例
    佐野 貴紀, 菅野 敦, 田中 裕, 松本 諒太郎, 鍋島 立秀, 滝川 哲也, 三浦 晋, 林 洋毅, 益田 邦洋, 海野 倫明, 藤島 史喜, 古川 徹, 正宗 敦
    胆道 33 3 673 - 673 日本胆道学会 2019年10月
  • 膵癌/胆道癌における早期診断の進歩 肝門部領域胆管癌Stage 0-I期の臨床・病理学的特徴
    三浦 晋, 菅野 敦, 正宗 淳
    Gastroenterological Endoscopy 61 Suppl.2 1999 - 1999 (一社)日本消化器内視鏡学会 2019年10月
  • 佐野 貴紀, 菅野 敦, 田中 裕, 松本 諒太郎, 鍋島 立秀, 滝川 哲也, 三浦 晋, 森川 孝則, 海野 倫明, 藤島 史喜, 古川 徹, 正宗 淳
    胆道 33 4 744 - 751 日本胆道学会 2019年10月 [査読無し][通常論文]
     
    症例は71歳女性。20XX年Y月上腹部痛を主訴に近医を受診、腹部CT検査にて胆嚢内に腫瘍を認め、当院紹介となった。血液検査ではγ-GTの軽度上昇、腫瘍マーカーではAFP、AFP-L3%の上昇を認めた。腹部超音波検査では胆嚢内腔を充満する腫瘤を認め、造影CT、MRIでは造影早期から濃染された。画像診断から胆嚢癌を強く疑い、胆嚢胆管切除及び肝S4a+S5切除術を施行した。切除標本で胆嚢内腔を占拠する70×50×45mm大の塊状型の腫瘍を認めた。病理学的検査では、AFPとhepatocyte parafine-1、Arginaseが陽性を示す肝細胞癌に類似した組織と、充実胞巣や腺管構造を形成しながら浸潤性に増殖する通常の腺癌成分の2つの異なる組織が混在していた。以上の結果より、胆嚢原発肝様腺癌と診断した。(著者抄録)
  • Atsushi Masamune, Tatsuhide Nabeshima, Kazuhiro Kikuta, Shin Hamada, Eriko Nakano, Kiyoshi Kume, Atsushi Kanno, Ai Sato, Yuichi Tachibana, Osamu Inatomi, Satoshi Yamamoto, Tsukasa Ikeura, Seiji Futagami, Masashi Taguchi, Keiji Hanada, Kyoko Shimizu, Masanobu Kageoka, Tomotaka Saito, Takaaki Eguchi, Kensuke Kubota, Mamoru Takenaka, Atsushi Mima, Atsushi Irisawa, Tetsuhide Ito, Akira Andoh, Kazuo Inui, Yoshifumi Takeyama, Hiroki Yamaue, Kazuichi Okazaki, Tooru Shimosegawa
    Journal of gastroenterology 54 10 928 - 935 2019年10月 [査読有り][通常論文]
     
    BACKGROUND: Chronic pancreatitis (CP) is a fibro-inflammatory disease of the pancreas. Early diagnosis and intervention, before CP becomes established and irreversible, are essential to improve the long-term outcomes. The world's first diagnostic criteria for early CP were proposed in Japan in 2009, but their clinical utility remains elusive. This study aimed to clarify whether patients with early CP progress to definite CP. METHODS: This is a multicenter, prospective study. Patients diagnosed as having early CP according to the Japanese diagnostic criteria were prospectively followed for 2 years. Clinical profiles including symptoms, drinking and smoking status, laboratory data, imaging findings and treatments were analyzed. RESULTS: Among the 83 patients who completed the 2-year follow-up period, four (4.8%) patients progressed to definite CP. The diagnosis of 48 (57.8%) patients was unchanged, and that of 31 (37.3%) patients was downgraded. All the four progressive patients were male, alcohol-related, smokers (3 current and 1 ever), and continued drinking. Comparison of the clinical profiles between the progression group (n = 4) and non-progression group (n = 79) revealed that etiology (alcohol-related), smoking status and presence of acute pancreatitis episodes were associated with the progression to definite CP. CONCLUSIONS: The Japanese diagnostic criteria could identify some patients before the progression to definite CP, while the majority of the patients did not progress. TRIAL REGISTRATION NUMBER: UMIN000015992.
  • 短期間で形態変化を認めた膵腺房細胞癌の1例
    池田 未緒, 三浦 晋, 佐野 貴紀, 田中 裕, 松本 諒太郎, 鍋島 立秀, 本郷 星仁, 滝川 哲也, 菊田 和宏, 濱田 晋, 粂 潔, 菅野 敦, 畠 達夫, 元井 冬彦, 海野 倫明, 大森 優子, 古川 徹, 正宗 淳
    日本消化器病学会東北支部例会プログラム・抄録集 207回 50 - 50 日本消化器病学会-東北支部 2019年07月
  • 術後に挿入され迷入した膵管ステントを内視鏡的に回収し得た1例
    佐野 貴紀, 菅野 敦, 池田 未緒, 田中 裕, 松本 諒太郎, 鍋島 立秀, 本郷 星仁, 滝川 哲也, 三浦 晋, 濱田 晋, 菊田 和宏, 粂 潔, 正宗 淳
    日本消化器病学会東北支部例会プログラム・抄録集 207回 51 - 51 日本消化器病学会-東北支部 2019年07月
  • 水間 正道, 畠 達夫, 伊関 雅裕, 高舘 達之, 有明 恭平, 川口 桂, 益田 邦洋, 青木 豪, 石田 晶玄, 大塚 英郎, 中川 圭, 林 洋毅, 森川 孝則, 元井 冬彦, 内藤 剛, 亀井 尚, 菅野 敦, 正宗 淳, 海野 倫明
    膵臓 34 3 A275 - A275 (一社)日本膵臓学会 2019年06月
  • 当科における膵石症治療の現状と課題
    菊田 和宏, 菅野 敦, 正宗 淳
    Gastroenterological Endoscopy 61 Suppl.1 693 - 693 (一社)日本消化器内視鏡学会 2019年05月
  • 悪性肝門部胆管狭窄の前医の胆管ドレナージの影響
    三浦 晋, 菅野 敦, 正宗 淳
    Gastroenterological Endoscopy 61 Suppl.1 862 - 862 (一社)日本消化器内視鏡学会 2019年05月
  • 治療困難胆管結石に対するESWLとEHLに有用性についての検討
    滝川 哲也, 菅野 敦, 正宗 淳, 田中 裕, 松本 諒太郎, 鍋島 立秀, 本郷 星仁, 三浦 晋, 濱田 晋, 粂 潔, 菊田 和宏
    Gastroenterological Endoscopy 61 Suppl.1 998 - 998 (一社)日本消化器内視鏡学会 2019年05月
  • Kanno A, Masamune A, Hanada K, Kikuyama M, Kitano M
    Diagnostics (Basel, Switzerland) 9 1 2019年02月 [査読有り][通常論文]
     
    Pancreatic ductal adenocarcinoma (PDAC) is a lethal disease. PDAC is the fourth leading cause of death in the United States and Japan based on epidemiological data. Early detection of PDAC is very important to improve the prognosis of PDAC. Early detection of pancreatic ductal adenocarcinoma (PDAC) requires further examination after selecting cases with risk factors for the condition, such as family history, hereditary pancreatic carcinoma syndrome, intraductal papillary mucinous neoplasms, or chronic pancreatitis. The Japan Study Group on the Early Detection of Pancreatic Cancer has investigated and clarified the clinicopathological features for the early diagnosis of PDAC. In Japan, an algorithm for the early diagnosis of PDAC, which utilized the cooperation of local clinics and regional general hospitals, has been a breakthrough in the detection of early-stage PDAC. Further approaches for the early diagnosis of PDAC are warranted.
  • 神澤輝実, 中沢貴宏, 田妻 進, 全 陽, 田中 篤, 大原弘隆, 村木 崇, 乾 和郎, 井上 大, 西野隆義, 内藤 格, 糸井隆夫, 能登原憲司, 菅野 敦, 窪田賢輔, 平野賢二, 伊佐山浩通, 清水京子, 露口利夫, 下瀬川徹, 川 茂幸, 千葉 勉, 岡崎和一, 滝川 一, 木村 理, 海野倫明, 吉田雅博
    胆道 33 2 169 - 210 日本胆道学会 2019年 [査読有り][通常論文]
     
    IgG4関連硬化性胆管炎は、高率に自己免疫性膵炎を合併する胆管炎で、現在はIgG4関連疾患の胆管病変と考えられている。IgG4関連硬化性胆管炎臨床診断基準が2012年に策定されたが、原発性硬化性胆管炎や胆管癌との鑑別はしばしば困難である。ほとんどの関連文献のエビデンスレベルは低いため(C以下)、コンセンサスに基づくガイドラインを作成した。本ガイドラインの作成組織として、ガイドライン作成委員会、modified Delphi法による専門家委員会と評価委員会の3つの委員会を設けた。診断と治療に関する18個のクリニカルクエスチョンと各クリニカルステートメントを作成した。各ステートメントの推奨度は、modified Delphi法により決定した。本ガイドラインでは、IgG4関連硬化性胆管炎の正確な診断法と安全で適切な治療法を解説した。(著者抄録)
  • Kanno A, Masamune A
    Nihon Shokakibyo Gakkai zasshi = The Japanese journal of gastro-enterology 116 4 286 - 295 2019年 [査読有り][通常論文]
  • Tsukasa Yoshida, Susumu Hijioka, Waki Hosoda, Makoto Ueno, Masayuki Furukawa, Noritoshi Kobayashi, Masafumi Ikeda, Tetsuhide Ito, Yuzo Kodama, Chigusa Morizane, Kenji Notohara, Hiroki Taguchi, Masayuki Kitano, Kei Yane, Yoshiaki Tsuchiya, Izumi Komoto, Hiroki Tanaka, Akihito Tsuji, Syunpei Hashigo, Tetsuya Mine, Atsushi Kanno, Go Murohisa, Katsuyuki Miyabe, Tadayuki Takagi, Nobutaka Matayoshi, Masafumi Sakaguchi, Hiroshi Ishii, Yasushi Kojima, Keitaro Matsuo, Hideyuki Yoshitomi, Shoji Nakamori, Hiroaki Yanagimoto, Yasushi Yatabe, Junji Furuse, Nobumasa Mizuno
    Annals of Surgical Oncology 26 5 1385 - 1393 2019年 [査読有り][通常論文]
     
    © 2019, Society of Surgical Oncology. Background: The role of surgery in pancreatic neuroendocrine neoplasm grade 3 (pNEN-G3) treatment remains unclear. We aimed to clarify the role of surgery for pNEN-G3, which has recently been reclassified as pancreatic neuroendocrine tumor-G3 (pNET-G3) and pancreatic neuroendocrine carcinoma-G3 (pNEC-G3), with and without metastases, respectively. Methods: We analyzed a subgroup of patients from the Japanese pancreatic NEC study, a Japanese multicenter case-series study of pNEN-G3. Pathologists subclassified 67 patients as having pNET-G3 or pNEC-G3 based on morphological features. We compared the overall survival (OS) rates among patients who were grouped according to whether they had undergone tumor-targeted surgery for tumors without (SwoM) or with (SwM) metastases, or non-surgical procedures (NS). Results: Data from 21 patients with pNET-G3 (SwoM, n = 6; SwM, n = 5; NS, n = 10) and 46 patients with pNEC-G3 (SwoM, n = 8; SwM, n = 5; NS, n = 33) were analyzed. OS of patients with pNET-G3 was significantly longer after SwoM and SwM than with NS (p = 0.018 and p = 0.022). In contrast, OS did not significantly differ between either SwoM or SwM and NS (p = 0.093 and p = 0.489) among patients with pNEC-G3. Conclusion: The role of surgery should be considered separately for pNET-G3 and pNEC-G3. Although SwoM and SwM can be considered for pNET-G3, caution is advised before considering SwM and SwoM for pNEC-G3.
  • Terumi Kamisawa, Takahiro Nakazawa, Susumu Tazuma, Yoh Zen, Atsushi Tanaka, Hirotaka Ohara, Takashi Muraki, Kazuo Inui, Dai Inoue, Takayoshi Nishino, Itaru Naitoh, Takao Itoi, Kenji Notohara, Atsushi Kanno, Kensuke Kubota, Kenji Hirano, Hiroyuki Isayama, Kyoko Shimizu, Toshio Tsuyuguchi, Tooru Shimosegawa, Shigeyuki Kawa, Tsutomu Chiba, Kazuichi Okazaki, Hajime Takikawa, Wataru Kimura, Michiaki Unno, Masahiro Yoshida
    Journal of hepato-biliary-pancreatic sciences 26 1 9 - 42 2019年01月 [査読有り][通常論文]
     
    IgG4-related sclerosing cholangitis (IgG4-SC) is a distinct type of cholangitis frequently associated with autoimmune pancreatitis and currently recognized as a biliary manifestation of IgG4-related disease. Although clinical diagnostic criteria of IgG4-SC were established in 2012, differential diagnosis from primary sclerosing cholangitis and cholangiocarcinoma is sometimes difficult. Furthermore, no practical guidelines for IgG4-SC are available. Because the evidence level of most articles retrieved through searching the PubMed, Cochrane Library, and Igaku Chuo Zasshi databases was below C based on the systematic review evaluation system of clinical practice guidelines MINDS 2014, we developed consensus guidelines using the modified Delphi approach. Three committees (a guideline creating committee, an expert panelist committee for rating statements according to the modified Delphi method, and an evaluating committee) were organized. Eighteen clinical questions (CQs) with clinical statements were developed regarding diagnosis (14 CQs) and treatment (4 CQs). Recommendation levels for clinical statements were set using the modified Delphi approach. The guidelines explain methods for accurate diagnosis, and safe and appropriate treatment of IgG4-SC.
  • Tatsuo Hata, Masamichi Mizuma, Fuyuhiko Motoi, Masaharu Ishida, Takanori Morikawa, Tatsuyuki Takadate, Kei Nakagawa, Hiroki Hayashi, Atsushi Kanno, Atsushi Masamune, Takashi Kamei, Toru Furukawa, Takeshi Naitoh, Michiaki Unno
    Pancreas 48 1 99 - 106 2019年01月 [査読有り][通常論文]
     
    OBJECTIVES: The aim of this study was to evaluate the diagnostic and prognostic impact of systemic inflammatory markers for IPMN with high-grade dysplasia (HGD)/invasive carcinoma. METHODS: Neutrophil-to-lymphocyte ratio (NLR), derived NLR, platelet-to-lymphocyte ratio, and C-reactive protein-to-albumin ratio were compared across the different histological grades of 205 IPMN cases. We also tested the diagnostic performance for IPMN with HGD/invasive carcinoma. RESULTS: The median (interquartile range) preoperative NLR was higher in IPMN with HGD/invasive carcinoma (2.03 [1.48-2.93]) than IPMN with low-grade dysplasia (1.74 [1.42-2.24], P = 0.0137). The C-reactive protein-to-albumin ratio and derived NLR values were also significant higher in cases with HGD/invasive carcinoma. A combination assay of NLR, carcinoembryonic antigen, and carbohydrate antigen 19-9 revealed a 58.8% sensitivity and 76.8% specificity. Among the cases with worrisome features, the high NLR values increased the positive predictive value (68.8%) compared with low values (31.8%). In IPMN cases with the associated invasive carcinoma, high NLR values showed association with the deeper vertical invasion and shorter survival periods. CONCLUSIONS: Preoperative NLR, combined with tumor markers and image findings, can be a useful predictive marker for the presence of HGD/invasive carcinoma in IPMNs. Preoperative NLR also predicts the long-term outcomes in IPMN cases with invasive carcinoma.
  • Ito T, Kawa S, Matsumoto A, Kubota K, Kamisawa T, Okazaki K, Hirano K, Hirooka Y, Uchida K, Masuda A, Ohara H, Shimizu K, Arakura N, Masamune A, Kanno A, Sakagami J, Itoi T, Ito T, Ueki T, Nishino T, Inui K, Mizuno N, Yoshida H, Sugiyama M, Iwasaki E, Irisawa A, Shimosegawa T, Chiba T
    Pancreas 48 1 49 - 54 2019年01月 [査読有り][通常論文]
     
    OBJECTIVE: Autoimmune pancreatitis (AIP) has the potential to transform into chronic pancreatitis with pancreatic stone involvement. This retrospective investigation sought to clarify the risk factors for stone formation in type 1 AIP. METHODS: Questionnaires on patients with type 1 AIP were sent to 22 high-volume medical centers across Japan to compare the clinical features of patients with and without pancreatic stone formation. RESULTS: Of the completed records on 624 type 1 AIP patients, 31 (5%) had experienced pancreatic stones. Median follow-up duration was 1853 days. Bentiromide test values at diagnosis were significantly lower, and hemoglobin A1c values after corticosteroid treatment were significantly higher in patients with pancreatic stones. Imaging results disclosed that pancreatic atrophy and hilar or intrahepatic bile duct stenosis were significantly more frequent in patients with pancreatic stone formation. Pancreatic head swelling tended to be more frequent in this group as well. On the other hand, a shorter follow-up period was associated with the nonformation of pancreatic stones. CONCLUSIONS: The increased frequency of pancreatic head swelling in type 1 AIP patients exhibiting pancreatic stones indicated a propensity for pancreatic juice stasis with subsequent stone development and pancreatic dysfunction occurring over longer periods of disease duration.
  • 後期高齢者膵癌における外科治療の特徴と術前治療の有用性
    水間 正道, 元井 冬彦, 畠 達夫, 伊関 雅裕, 高舘 達之, 有明 恭平, 益田 邦洋, 石田 晶玄, 深瀬 耕二, 大塚 英郎, 中川 圭, 林 洋毅, 森川 孝則, 内藤 剛, 亀井 尚, 菅野 敦, 正宗 淳, 海野 倫明
    日本消化器外科学会雑誌 51 Suppl.2 376 - 376 (一社)日本消化器外科学会 2018年11月
  • Shimizu Y, Hijioka S, Hirono S, Kin T, Ohtsuka T, Kanno A, Koshita S, Hanada K, Kitano M, Inoue H, Itoi T, Ueki T, Matsuo K, Yanagisawa A, Yamaue H, Sugiyama M, Okazaki K
    Annals of surgery 272 1 155 - 162 2018年11月 [査読有り][通常論文]
     
    OBJECTIVE: To create a simple, objective model to predict the presence of malignancy in patients with intraductal papillary mucinous neoplasm (IPMN), which can be easily applied in daily practice and, importantly, adopted for any lesion types. BACKGROUND: No predictive model for malignant IPMN has been widely applied in clinical practice. METHODS: The clinical details of 466 patients with IPMN who underwent pancreatic resection at 3 hospitals were retrospectively analyzed for model development. Then, the model was validated in 664 surgically resected patients at 8 hospitals in Japan.In the preoperative examination, endoscopic ultrasonography (EUS) was considered to be essential to observe mural nodules in both the model development and external validation sets. Malignant IPMNs were defined as those with high-grade dysplasia and associated invasive carcinoma. RESULTS: Of the 466 patients, 258 (55%) had malignant IPMNs (158 high-grade dysplasia, 100 invasive carcinoma), and 208 (45%) had benign IPMNs. Logistic regression analysis resulted in 3 variables (mural nodule size, main pancreatic duct diameter, and cyst size) being selected to construct the model. The area under the receiver operating characteristic curve (AUC) for the model was 0.763. In external validation sets, the pathological diagnosis was malignant and benign IPMN in 351 (53%) and 313 (47%) cases, respectively. For the external validation, the malignancy prediction ability of the model corresponded to an AUC of 0.725. CONCLUSION: This predictive model provides important information for physicians and patients in assessing an individual's risk for malignancy and may help to identify patients who need surgery.
  • Hiroyuki Isayama, Susumu Tazuma, Norihiro Kokudo, Atsushi Tanaka, Toshio Tsuyuguchi, Takahiro Nakazawa, Kenji Notohara, Suguru Mizuno, Nobuhisa Akamatsu, Masahiro Serikawa, Itaru Naitoh, Yoshiki Hirooka, Toshifumi Wakai, Takao Itoi, Tomoki Ebata, Shinji Okaniwa, Terumi Kamisawa, Hiroki Kawashima, Atsushi Kanno, Keiichi Kubota, Masami Tabata, Michiaki Unno, Hajime Takikawa
    Journal of gastroenterology 53 9 1006 - 1034 2018年09月 [査読有り][通常論文]
     
    BACKGROUND: Primary sclerosing cholangitis (PSC) is relatively rare disease and pathogenesis and methods of treatments were still not established. Then, we had conducted the making clinical guidelines to manage patients with PSC based on the literature review and expert opinions. These clinical guidelines were made for the medical doctors on the management of PSC, except child case of PSC. METHODS: We had employed modified Delphi method. The production committee decided guidelines, strength of recommendations and evidence level after reviewed literatures systematically, and The Expert panel evaluated those. The Scientific Committee of the Japan Biliary Association (JBA) evaluated revised guidelines, and the Public comments were collected on web site of JBA. RESULTS: We had made 16 guidelines about epidemiology/pathophysiology, diagnostics, therapy and prognosis. Also, we had made both diagnostic and therapeutic flow chart. CONCLUSIONS: We hope that these guidelines will contribute to the improvement and development of the medical care of PSC.
  • Hanzawa T, Matsunaga T, Koike T, Kanno A, Masamune A, Iijima K, Shimosegawa T, Haga Y
    Minimally invasive therapy & allied technologies : MITAT : official journal of the Society for Minimally Invasive Therapy 27 4 226 - 232 2018年08月 [査読有り][通常論文]
  • Yoshida N, Kanno A, Masamune A, Nabeshima T, Hongo S, Miura S, Takikawa T, Hamada S, Kikuta K, Kume K, Ueno M, Shimosegawa T
    Internal medicine (Tokyo, Japan) 57 24 3529 - 3535 2018年08月 [査読有り][通常論文]
     
    A 79-year-old woman was referred for pancreatic tail cancer with multiple liver metastases. The pancreatic tail tumor was diagnosed as acinar cell carcinoma (ACC) histologically by endoscopic ultrasound-guided fine-needle aspiration. Because of multiple liver metastases, S-1 chemotherapy was administered, resulting in a partial response to chemotherapy one year later. After approximately three years, liver atrophy and esophageal varices developed. We suspected S-1 as the cause of the liver cirrhosis. S-1 cessation minimized ascites and improved the esophageal varices. Although S-1 can potentially treat ACC, we should be watchful for liver cirrhosis caused by its long-term administration.
  • Kensuke Kubota, Terumi Kamisawa, Kenji Hirano, Yoshiki Hirooka, Kazushige Uchida, Tsukasa Ikeura, Hideyuki Shiomi, Hirotaka Ohara, Kyoko Shimizu, Norikazu Arakura, Atsushi Kanno, Junichi Sakagami, Takao Itoi, Tetsuhide Ito, Toshiharu Ueki, Takayoshi Nishino, Kazuo Inui, Nobumasa Mizuno, Hitoshi Yoshida, Masanori Sugiyama, Eisuke Iwasaki, Atsushi Irisawa, Kazuichi Okazaki, Shigeyuki Kawa, Toru Shimosegawa, Yoshifumi Takeyama, Tsutomu Chiba
    Journal of Hepato-Biliary-Pancreatic Sciences 25 4 223 - 230 2018年04月 [査読有り][通常論文]
     
    Background: Sporadic autoimmune pancreatitis (AIP) cases showing remission without steroid treatment have been reported, however, the clinical course of these patients has not been clarified. This study sought to clarify the clinical course in AIP patients with hesitation for steroid treatment. Methods: We collected clinical data for AIP patients from high-volume centers in Japan. Data for AIP patients with and those without steroid treatment (steroid treatment vs. wait and see policy or W& S) were then compared. The primary point was the relapse-free survival rate (RFS) in patients with and those without steroid treatment, as determined using Kaplan–Meier curve. The secondary point was the identification of predictors of remission and risks of relapse in AIP patients without steroid treatment. Results: There were 510 AIP patients in the steroid treatment group and 97 patients in the W& S group. Overall, 55.7% (54/97) of type 1 AIP patients in the W& S group experienced transient remission without steroid treatment. The W& S group had a significantly higher patient age and significantly lower incidences of jaundice, diffuse pancreas swelling, proximal-type sclerosing cholangitis, and stent placement and a lower remission rate than the steroid treatment group (each P <  0.05). The RFS reached a plateau at 10 years in both the W& S group (50%) and steroid treatment group (52.9%). As for the RFS (W& S vs. group with steroid), 89.4% vs. 74.4% within 3 years, 81.8% vs. 65.3% within 5 years, and 50% vs. 52.9% within 10 years (log-rank, P = 0.064). Female gender (OR 0.340, P = 0.027) and stent placement for jaundice (OR 4.552, P = 0.008) were identified as predictors of transient remission in the W& S group. New-onset diabetes mellitus (OR 8.333, P = 0.012) and the presence of extensive multi-organ involvement (OR 35, P = 0.006) were identified as risks of relapse in the W& S group. Conclusion: Some type 1 AIP patients without steroid treatment experience transient remission. These cases tend to have lower disease activities than AIP patients receiving steroids. Female gender and stent placement for jaundice may be predictors of transient remission among patients not receiving steroid treatment, however, relapses can occur in these patients with new-onset diabetes mellitus and the presence of extensive multi-organ involvement. Therefore, steroid treatment is still imperative for these patients.
  • Yuuri Hatsuzawa, Masamichi Mizuma, Fuyuhiko Motoi, Tatsuo Hata, Masahiro Iseki, Tatsuyuki Takadate, Hideo Ohtsuka, Naoaki Sakata, Takanori Morikawa, Kei Nakagawa, Hiroki Hayashi, Takeshi Naitoh, Atsushi Kanno, Tooru Shimosegawa, Michiaki Unno
    Gan to kagaku ryoho. Cancer & chemotherapy 45 2 347 - 349 2018年02月 [査読有り][通常論文]
     
    Here we report a case of pancreatic cancer(PC)with peritoneal dissemination, underwent conversion surgery following chemotherapy for 2 years. A5 5-year-old woman was referred to our hospital for treatment of PC. Abdominal CT scan revealed 3.0 cm of a pancreatic head tumor with abutment of the portal vein and the hepatic artery, classified as borderline resectable. Staging laparoscopy(SL)showed positive peritoneal cytology(CY). Gemcitabine(Gem)plus S-1 therapy(GS) was performed. Ten months after initial GS, SL revealed the disseminated nodule and positive CY. The regimen was changed to Gem plus nab-paclitaxel therapy(Gem plus nab-PTX). Since right ovarian tumor was detected by CT scan 6 months after initial Gem plus nab-PTX, laparoscopic oophorectomy was performed. Histological findings showed positive CY and ovarian metastasis of PC. Afterward, Gem plus nab-PTX has been continued for 8 months. Since SL after 2 years from initial chemotherapy showed negative CY and no metastatic lesion, pancreaticoduodenectomy with portal vein resection was performed as conversion surgery. According to General Rules for the Study of Pancreatic Cancer the 7th edition by Japan Pancreas Society, histological findings showed ypT3, ypN0, R0, and Grade 1b of histological effect. The patient is alive without recurrence 6 months after the resection.
  • Tatsuhide Nabeshima, Atsushi Kanno, Atsushi Masamune, Hiroki Hayashi, Seiji Hongo, Naoki Yoshida, Eriko Nakano, Shin Miura, Shin Hamada, Kazuhiro Kikuta, Kiyoshi Kume, Morihisa Hirota, Michiaki Unno, Tooru Shimosegawa
    Internal Medicine 57 3 357 - 362 2018年 [査読有り][通常論文]
     
    Pancreaticojejunostomy stricture (PJS) is a late complication of pancreaticoduodenectomy. The endoscopic treatment of PJS is very challenging due to the difficulty of locating the small anastomotic site and passing the stricture using a guidewire. We herein report two cases of severe PJS. These patients could not be treated using only double-balloon endoscopy or endoscopic ultrasound-guided puncture of the main pancreatic duct because of severe stenosis at the anastomotic site. However, we could treat them by the rendezvous technique using the rigid part of the guidewire to penetrate PJS. This method was useful and safe for treating severe PJS.
  • Atsushi Kanno, for the Japan Study Group on the Early Detection of Pancreatic Cancer (JEDPAC), Atsushi Masamune, Keiji Hanada, Hiroyuki Maguchi, Yasuhiro Shimizu, Toshiharu Ueki, Osamu Hasebe, Takao Ohtsuka, Masafumi Nakamura, Mamoru Takenaka, Masayuki Kitano, Masataka Kikuyama, Toshifumi Gabata, Koji Yoshida, Tamito Sasaki, Masahiro Serikawa, Toru Furukawa, Akio Yanagisawa, Tooru Shimosegawa
    Pancreatology 18 1 61 - 67 2018年01月 [査読有り][通常論文]
     
    Background/Objectives: The diagnosis of early-stage pancreatic ductal adenocarcinoma (PDAC) is still challenging. We conducted a multicenter study to clarify the clinical features of early-stage PDAC in Japan. Methods: We collected patients with stage 0 and stage I PDAC according to the sixth edition of the Japanese Classification of Pancreatic Carcinoma. We retrospectively analyzed the clinical profiles including opportunities for medical examination, imaging modalities and findings, methods of cytological diagnosis, and prognosis according to the stages at diagnosis. Results: Two hundred cases with Stage 0 and stage I PDAC were reported from 14 institutions, which accounted for approximately 0.7% and 3% of all PDAC cases, respectively. Overall, 20% of the early-stage PDAC cases were symptomatic. Indirect imaging findings such as dilatation of the main pancreatic duct were useful to detect early-stage PDAC. In particular, local fatty changes may be specific to early-stage PDAC. For preoperative pathologic diagnosis, cytology during endoscopic retrograde cholangiopancreatography was more commonly applied than endoscopic ultrasound fine-needle aspiration. Although the overall prognosis was favorable, new PDAC lesions developed in the remnant pancreas in 11.5% cases. Conclusions: This multicenter study revealed several key points concerning the diagnosis and management of early-stage PDAC, including screening of asymptomatic cases, importance of indirect imaging findings, application of cytology during endoscopic retrograde cholangiopancreatography, and the risk of carcinogenesis in the remnant pancreas.
  • Olca Basturk, Michael F. Berger, Hiroshi Yamaguchi, Volkan Adsay, Gokce Askan, Umesh K. Bhanot, Ahmet Zehir, Fatima Carneiro, Seung-Mo Hong, Giuseppe Zamboni, Esra Dikoglu, Vaidehi Jobanputra, Kazimierz O. Wrzeszczynski, Serdar Balci, Peter Allen, Naoki Ikari, Shoko Takeuchi, Hiroyuki Akagawa, Atsushi Kanno, Tooru Shimosegawa, Takanori Morikawa, Fuyuhiko Motoi, Michiaki Unno, Ryota Higuchi, Masakazu Yamamoto, Kyoko Shimizu, Toru Furukawa, David S. Klimstra
    MODERN PATHOLOGY 30 12 1760 - 1772 2017年12月 [査読有り][通常論文]
     
    Intraductal tubulopapillary neoplasm is a relatively recently described member of the pancreatic intraductal neoplasm family. The more common member of this family, intraductal papillary mucinous neoplasm, often carries genetic alterations typical of pancreatic infiltrating ductal adenocarcinoma (KRAS, TP53, and CDKN2A) but additionally has mutations in GNAS and RNF43 genes. However, the genetic characteristics of intraductal tubulopapillary neoplasm have not been well characterized. Twenty-two intraductal tubulopapillary neoplasms were analyzed by either targeted next-generation sequencing, which enabled the identification of sequence mutations, copy number alterations, and selected structural rearrangements involving all targeted (>= 300) genes, or whole-exome sequencing. Three of these intraductal tubulopapillary neoplasms were also subjected to whole-genome sequencing. All intraductal tubulopapillary neoplasms revealed the characteristic histologic (cellular intraductal nodules of back-to-back tubular glands lined by predominantly cuboidal cells with atypical nuclei and no obvious intracellular mucin) and immunohistochemical (immunolabeled with MUC1 and MUC6 but were negative for MUC2 and MUC5AC) features. By genomic analyses, there was loss of CDKN2A in 5/20 (25%) of these cases. However, the majority of the previously reported intraductal papillary mucinous neoplasm-related alterations were absent. Moreover, in contrast to most ductal neoplasms of the pancreas, MAP-kinase pathway was not involved. In fact, 2/22 (9%) of intraductal tubulopapillary neoplasms did not reveal any mutations in the tested genes. However, certain chromatin remodeling genes (MLL1, MLL2, MLL3, BAP1, PBRM1, EED, and ATRX) were found to be mutated in 7/22 (32%) of intraductal tubulopapillary neoplasms and 27% harbored phosphatidylinositol 3-kinase (PI3K) pathway (PIK3CA, PIK3CB, INPP4A, and PTEN) mutations. In addition, 4/ 18 (18%) of intraductal tubulopapillary neoplasms had FGFR2 fusions (FGFR2-CEP55, FGFR2-SASS6, DISP1-FGFR2, FGFR2-TXLNA, and FGFR2-VCL) and 1/18 (5.5%) had STRN-ALK fusion. Intraductal tubulopapillary neoplasm is a distinct clinicopathologic entity in the pancreas. Although its intraductal nature and some clinicopathologic features resemble those of intraductal papillary mucinous neoplasm, our results suggest that intraductal tubulopapillary neoplasm has distinguishing genetic characteristics. Some of these mutated genes are potentially targetable. Future functional studies will be needed to determine the consequences of these gene alterations.
  • Kyakumoto Y, Takadate T, Mizuma M, Hata T, Iseki M, Ohtsuka H, Sakata N, Nakagawa K, Morikawa T, Hayashi H, Motoi F, Naitoh T, Kanno A, Shimosegawa T, Unno M
    Gan to kagaku ryoho. Cancer & chemotherapy 44 12 1880 - 1882 2017年11月 [査読有り][通常論文]
  • Tetsuya Mine, Toshio Morizane, Yoshiaki Kawaguchi, Ryukichi Akashi, Keiji Hanada, Tetsuhide Ito, Atsushi Kanno, Mitsuhiro Kida, Hiroyuki Miyagawa, Taketo Yamaguchi, Toshihiko Mayumi, Yoshifumi Takeyama, Tooru Shimosegawa
    JOURNAL OF GASTROENTEROLOGY 52 9 1013 - 1022 2017年09月 [査読有り][通常論文]
     
    Background Endoscopic retrograde cholangiopancreatography (ERPC) is used for the diagnosis and treatment of pancreatic and biliary diseases. Post-ERCP pancreatitis (PEP) is a complication which needs special care and clinical practice guideline for this morbidity is also needed. Methods The key clinical issues of diagnosis and treatment of PEP were listed and checked, and then the clinical questions were formulated. PubMed (MEDLINE) and Ichushi-web (Japanese medical literature) were used as databases. For the study of diagnostic test accuracy, items similar to QUADAS-2, i.e., random selection from a population to which the diagnostic test is applied, blinding of index tests and reference tests, completeness of reference standard, completeness of test implementations, the same timing of tests, and missing data were assessed as well as the indirectness of the study subjects, index tests, reference standard, and outcomes. Grading of recommendations was determined as strong or weak. In clinical practice, the judgment of attending doctors should be more important than recommendations described in clinical practice guidelines. Gastroenterologists are the target users of this clinical practice guideline. General practitioners or general citizens are not supposed to use this guideline. The guideline committee has decided to include wide clinical issues such as etiological information, techniques of ERCP, the diagnosis, treatments, and monitoring of PEP in this guideline. Results In this concise report, we described ten clinical questions, recommendations, and explanations pertaining to risk factors, diagnosis, prognostic factors, treatments, and preventive interventions in the medical practice for PEP. Conclusion We reported here the essence of the clinical practice guideline for PEP.
  • Kensuke Kubota, Terumi Kamisawa, Kazuichi Okazaki, Shigeyuki Kawa, Kenji Hirano, Yoshiki Hirooka, Kazushige Uchida, Hideyuki Shiomi, Hirotaka Ohara, Kyoko Shimizu, Norikazu Arakura, Atsushi Kanno, Junichi Sakagami, Takao Itoi, Tetsuhide Ito, Toshiharu Ueki, Takayoshi Nishino, Kazuo Inui, Nobumasa Mizuno, Hitoshi Yoshida, Masanori Sugiyama, Eisuke Iwasaki, Atshishi Irisawa, Toru Shimosegawa, Yoshifumi Takeyama, Tsutomu Chiba
    JOURNAL OF GASTROENTEROLOGY 52 8 955 - 964 2017年08月 [査読有り][通常論文]
     
    The effect of maintenance steroid treatment (MST) in reducing the risk of relapse in patients with autoimmune pancreatitis (AIP) remains under debate. The aim of this study was to validate the effect of MST on AIP administered in accordance with the 2010 Japanese consensus guidelines. The clinical data of patients with (n = 510) from 22 high-volume centers in Japan were studied. The primary endpoints were the relapse rates (RRs) in patients administered MST versus those not administered MST. The secondary endpoints were the optimal dose and duration of MST in terms of steroid toxicity and the predictors of relapse. The RRs were 10.0% within 1 year, 25.8% within 3 years and 35.1% within 5 years. The RR in the steroid therapy group reached a plateau at 42.7% at 7 years. In terms of the optimal dosage, the overall RR in the MST 5 mg/day group was 26.1%, which was significantly lower than that in the group which had discontinued steroid therapy (45.2%; p = 0.023) or was receiving MST at 2.5 mg/day (43.4%, p = 0.001). The RRs in the group receiving MST at >= 5 mg/day versus the patient group receiving MST at < 5 mg/day were 10.6 vs. 10.3% within 1 year, 23.5 vs. 32.9% within 3 years and 32.2 vs. 41.3% within 5 years, respectively (log-rank, p = 0.028). The best cutoff value of the total steroid dose for serious steroid toxicity was 6405 mg, with a moderate accuracy of 0.717 determined using the area under the curve. Presence of diffuse pancreatic swelling [odds ratio OR) 1.745; p = 0.008) and MST at > 5 mg/day were identified as predictors of relapse (OR 0.483; p = 0.001). The RR could continue to increase for 7 years even under MST. Based on our analysis of the side effects of steroid therapy, MST at 5 mg/day for 2 (total 4625 mg) to 3 (total 6425 mg) years might be a rational and safe therapeutic strategy in terms of keeping the RR to < 30% while avoiding potential steroid toxicity.
  • Atsushi Masamune, Kazuhiro Kikuta, Tatsuhide Nabeshima, Eriko Nakano, Morihisa Hirota, Atsushi Kanno, Kiyoshi Kume, Shin Hamada, Tetsuhide Ito, Motokazu Fujita, Atsushi Irisawa, Masanori Nakashima, Keiji Hanada, Takaaki Eguchi, Ryusuke Kato, Osamu Inatomi, Akio Shirane, Yoshifumi Takeyama, Ichiro Tsuji, Tooru Shimosegawa
    JOURNAL OF GASTROENTEROLOGY 52 8 992 - 1000 2017年08月 [査読有り][通常論文]
     
    The world's first diagnostic criteria for early CP were proposed in 2009 in Japan. This study aimed to clarify the clinico-epidemiological features of early CP in Japan. Patients with early CP who were diagnosed according to the diagnostic criteria for early CP and had visited the selected hospitals in 2011 were surveyed. The study consisted of two-stage surveys: the number of patients with early CP was estimated by the first questionnaire and their clinical features were assessed by the second questionnaire. The estimated number of early CP patients was 5410 (95% confidence interval 3675-6945), with an overall prevalence of 4.2 per 100,000 persons. The number of patients who were newly diagnosed with early CP was estimated to be 1330 (95% confidence interval 1058-1602), with an annual incidence of 1.0 per 100,000 persons. Detailed clinical information was obtained in 151 patients in the second survey. The male-to-female sex ratio was 1.32:1. The mean age was 60.4 and the mean age at disease onset was 55.4. Idiopathic (47.7%) and alcoholic (45.0%) were the two most common etiologies. Proportions of female and idiopathic cases were higher in early CP than in definite CP. Hyperechoic foci without shadowing and stranding were the most common findings on endoscopic ultrasonography. The clinical profiles of early CP patients who showed lobularity with honeycombing on endoscopic ultrasonography or previous episodes of acute pancreatitis were similar to those of definite CP patients. We clarified the current status of early CP in Japan.
  • Susumu Hijioka, Waki Hosoda, Keitaro Matsuo, Makoto Ueno, Masayuki Furukawa, Hideyuki Yoshitomi, Noritoshi Kobayashi, Masafumi Ikeda, Tetsuhide Ito, Shoji Nakamori, Hiroshi Ishii, Yuzo Kodama, Chigusa Morizane, Takuji Okusaka, Hiroaki Yanagimoto, Kenji Notohara, Hiroki Taguchi, Masayuki Kitano, Kei Yane, Hiroyuki Maguchi, Yoshiaki Tsuchiya, Izumi Komoto, Hiroki Tanaka, Akihito Tsuji, Syunpei Hashigo, Yoshiaki Kawaguchi, Tetsuya Mine, Atsushi Kanno, Go Murohisa, Katsuyuki Miyabe, Tadayuki Takagi, Nobutaka Matayoshi, Tsukasa Yoshida, Kazuo Hara, Masayuki Imamura, Junji Furuse, Yasushi Yatabe, Nobumasa Mizuno
    CLINICAL CANCER RESEARCH 23 16 4625 - 4632 2017年08月 [査読有り][通常論文]
     
    Purpose: Patients with pancreatic neuroendocrine neoplasm grade-3 (PanNEN-G3) show variable responses to platinumbased chemotherapy. Recent studies indicated that PanNEN-G3 includes well-differentiated neuroendocrine tumor with G3 (NET-G3). Here, we examined the clinicopathologic and molecular features of PanNEN-G3 and assessed the responsiveness to chemotherapy and survival. Experimental Design: A total of 100 patients with PanNEN-G3 were collected from 31 institutions, and after central review characteristics of each histologic subtype [NET-G3 vs. pancreatic neuroendocrine carcinoma (NEC-G3)] were analyzed, including clinical, radiological, and molecular features. Factors that correlate with response to chemotherapy and survival were assessed. Results: Seventy patients analyzed included 21 NETs-G3 (30%) and 49 NECs-G3 (70%). NET-G3 showed lower Ki67labeling index (LI; median 28.5%), no abnormal Rb expression (0%), and no mutated KRAS (0%), whereas NEC-G3 showed higher Ki67-LI (median 80.0%), Rb loss (54.5%), and KRAS mutations (48.7%). Chemotherapy response rate (RR), platinum-based chemotherapy RR, and prognosis differed significantly between NET-G3 and NEC-G3. Chemotherapeutic outcomes were worse in NET-G3 (P < 0.001). When we stratified PanNEN-G3 with Rb and KRAS, PanNENs-G3 with Rb loss and those with mutated KRAS showed significantly higher RRs to platinum-based chemotherapy than those without (Rb loss, 80% vs. normal Rb, 24%, P = 0.006; mutated KRAS, 77% versus wild type, 23%, P = 0.023). Rb was a predictive marker of response to platinum-based chemotherapy even in NEC-G3 (P = 0.035). Conclusions: NET-G3 and NEC-G3 showed distinct clinicopathologic characteristics. Notably, NET-G3 does not respond to platinum-based chemotherapy. Rb and KRAS are promising predictors of response to platinum-based chemotherapy for PanNEN-G3, and Rb for NEC-G3. (C) 2017 AACR.
  • Atsushi Masamune, Isao Nishimori, Kazuhiro Kikuta, Ichiro Tsuji, Nobumasa Mizuno, Tatsuo Iiyama, Atsushi Kanno, Yuichi Tachibana, Tetsuhide Ito, Terumi Kamisawa, Kazushige Uchida, Hideaki Hamano, Hiroaki Yasuda, Junichi Sakagami, Akira Mitoro, Masashi Taguchi, Yasuyuki Kihara, Hiroyuki Sugimoto, Yoshiki Hirooka, Satoshi Yamamoto, Kazuo Inui, Osamu Inatomi, Akira Andoh, Kazuyuki Nakahara, Hiroyuki Miyakawa, Shin Hamada, Shigeyuki Kawa, Kazuichi Okazaki, Tooru Shimosegawa
    GUT 66 3 487 - 494 2017年03月 [査読有り][通常論文]
     
    Objective Corticosteroid has been established as the standard therapy for autoimmune pancreatitis (AIP), but the requirement for maintenance corticosteroid therapy is controversial. We conducted a randomised controlled trial to clarify the efficacy of maintenance corticosteroid therapy in patients with AIP. Design We conducted a multicentre, tertiary setting, randomised controlled trial. After the induction of remission with the initial oral prednisolone (PSL) treatment, maintenance therapy with PSL at 5-7.5 mg/day was continued for 3 years or withdrawn at 26 weeks. The primary endpoint was relapse-free survival over 3 years and the secondary endpoint was serious corticosteroid-related complications. All analyses were performed on an intention-to-treat basis. Results Between April 2009 and March 2012, 49 patients with AIP were randomly assigned to the maintenance therapy group (n=30) or the cessation group (n=19). Baseline characteristics were not different between the two groups. Relapses occurred within 3 years in 11 out of 19 (57.9%) patients assigned to the cessation group, and in 7 of 30 (23.3%) patients in the maintenance therapy group. The relapse rate over 3 years was significantly lower in the maintenance therapy group than that in the cessation group (p=0.011). The relapse-free survival was significantly longer in the maintenance therapy group than that in the cessation group (p=0.007). No serious corticosteroid-related complications requiring discontinuation of PSL were observed. Conclusions Maintenance corticosteroid therapy for 3 years may decrease relapses in patients with AIP compared with those who discontinued the therapy at 26 weeks.
  • Atsushi Kanno, Atsushi Masamune, Fumiyoshi Fujishima, Takuji Iwashita, Yuzo Kodama, Akio Katanuma, Hirotaka Ohara, Masayuki Kitano, Hiroyuki Inoue, Takao Itoi, Nobumasa Mizuno, Hiroyuki Miyakawa, Rintaro Mikata, Atsushi Irisawa, Satoko Sato, Kenji Notohara, Tooru Shimosegawa
    GASTROINTESTINAL ENDOSCOPY 84 5 797 - + 2016年11月 [査読有り][通常論文]
     
    Background and Aims: Histopathologic examination is critical for diagnosing autoimmune pancreatitis (AIP). However, specimens obtained using EUS-guided FNA (EUS-FNA) are not recommended for histopathologic diagnosis because of inadequate sample size volume. We evaluated EUS-FNA efficacy for AIP diagnosis using a 22G needle. Methods: Seventy-eight patients exhibiting the imaging characteristics indicative of AIP in the pancreatic parenchyma and pancreatic duct underwent EUS-FNA with a 22 G needle at 12 institutions between February 2013 and March 2014. Samples were evaluated for tissue sampling conditions, CD38- and IgG4-positive plasma cell counts, storiform fibrosis (SF), and obliterative phlebitis (OP). Results: Tissue specimens containing > 10, 5 to 10, and 1 to 4 high-power fields (HPFs) were obtained from 29 (37.2%), 18 (23.1%), and 15 (19.2%) of 78 patients, respectively. The mean +/- standard deviation (SD) CD38-and IgG4-positive plasma cell counts were 23.2 +/- 18.8/HPF and 5.1 +/- 6.7/HPF, respectively. SF was detected in 49 of 78 patients (62.8%) and OP in 38 of 78 patients (48.7%). According to the International Consensus Diagnostic Criteria (ICDC), histopathologic levels corresponded to level 1 in 32, level 2 in 13, and unclassifiable in 17 patients. Hence, 45 of 78 patients (57.7%) could be diagnosed with lymphoplasmacytic sclerosing pancreatitis according to ICDC. Conclusions: Pancreatic tissues with at least 1 HPF were obtained by EUS-FNA from approximately 80% of patients, and nearly 60% of patients were diagnosed with ICDC level 2 or higher. Our findings indicate that EUS-FNA with a 22G needle may be useful for the histopathologic diagnosis of AIP.
  • Miura S, Kanno A, Masamune A
    Endoscopy 48 11 1049 - 1050 2016年11月 [査読有り][通常論文]
  • Kyakumoto Y, Mizuma M, Abe T, Takadate T, Fukase K, Otsuka H, Sakata N, Nakagawa K, Morikawa T, Hayashi H, Naitoh T, Motoi F, Kanno A, Shimosegawa T, Unno M
    Gan to kagaku ryoho. Cancer & chemotherapy 43 12 1966 - 1968 2016年11月 [査読有り][通常論文]
  • Miura Shin, Kanno Atsushi, Masamune Atushi, Hongou Seiji, Yoshida Naoki, Nakano Eriko, Hamada Shin, Kume Kiyoshi, Kikuta Kazuhiro, Hirota Morihisa, Shimosegawa Tooru
    膵臓 31 3 441 - 442 2016年07月
  • Nakano Eriko, Kanno Atsushi, Masamune Atsushi, Yoshida Naoki, Hongo Seiji, Miura Shin, Hamada Shin, Kume Kiyoshi, Kikuta Kazuhiro, Hirota Morihisa, Morikawa Takanori, Fukase Koji, Unno Michiaki, Fujishima Fumiyoshi, Shimosegawa Tooru
    膵臓 31 3 557 - 558 2016年07月
  • Yoshida Naoki, Kanno Atsushi, Masamune Atsushi, Hongo Seiji, Nakano Eriko, Miura Shin, Hamada Shin, Kikuta Kazuhiro, Kume Kiyoshi, Hirota Morihisa, Ueno Msamichi, Shimosegawa Tooru
    膵臓 31 3 620 - 620 2016年07月
  • Shin Miura, Atsushi Kanno, Atsushi Masamune, Shin Hamada, Seiji Hongou, Naoki Yoshida, Eriko Nakano, Tetsuya Takikawa, Kiyoshi Kume, Kazuhiro Kikuta, Morihisa Hirota, Hiroshi Yoshida, Yu Katayose, Michiaki Unno, Tooru Shimosegawa
    ENDOSCOPY 48 6 536 - 545 2016年06月 [査読有り][通常論文]
     
    Background and study aim: Self-expandable metallic stents (SEMSs) are used for palliation in patients with malignant perihilar biliary strictures. However, recurrent biliary obstruction occasionally causes cholangitis and jaundice. This study aimed to identify risk factors for recurrent biliary obstruction in such patients. Methods: Data from consecutive patients with malignant perihilar biliary strictures treated with endoscopic placement of SEMSs between 2007 and 2014 in Tohoku University Hospital were retrospectively reviewed. Risk factors for recurrent biliary obstruction were calculated using the Cox proportional hazards models (with hazard ratios [HRs] and 95% confidence interval [95 %CIs]), and SEMS patency period was examined using the Kaplan - Meier method. SEMS patency was defined as the period between SEMS insertion and the development of recurrent biliary obstruction. Results: 104 patients were included. Median survival time was 281 days; and 85 patients died during a median follow-up period of 320 days. Recurrent biliary obstruction occurred in 35 patients. Median SEMS patency period was 549 days. Multivariable analyses showed that: compared with bile duct carcinoma, gallbladder carcinoma was associated with shorter SEMS patency (HR 8.18, 95% CI 2.41-26.83); patency of left-sided SEMS was inferior to that of bilateral (HR 0.5, 95% CI 0.32-0.93) and right-sided SEMS (HR 0.1, 95% CI 0.02-0.65). Cholangitis before SEMS placement increased the risk of recurrent biliary obstruction (HR 11.44; 95% CI 4.48-32.35) and reduced the SEMS patency period (746 vs. 210 days). Conclusion: Gallbladder carcinoma, left-sided stent placement, and cholangitis before SEMS placement are risk factors for recurrent biliary obstruction after SEMS placement.
  • Kazuaki Tokodai, Naoki Kawagishi, Shigehito Miyagi, Chikashi Nakanishi, Yasuyuki Hara, Atsushi Fujio, Toshiaki Kashiwadate, Atsushi Kanno, Hitoshi Goto, Takashi Kamei, Noriaki Ohuchi
    PEDIATRIC TRANSPLANTATION 20 2 316 - 320 2016年03月 [査読有り][通常論文]
     
    BAS is a potentially life-threatening complication of LDLT. The aim of this study was to report on the indications and outcomes of an endoscopic approach under laparotomy being used in our institution to treat BAS after LDLT, using hepaticojejunostomy, for a small case series. Eighty-three patients underwent an LDLT in our institution between 1991 and 2014. Retrospective chart review indicated that 10 of these patients developed BAS and were included in our analysis. The endoscopic approach under laparotomy was used in three patients who developed BAS 10 yr or more after their LDLT and in whom a percutaneous transhepatic approach and an endoscopic approach had failed. The course of recovery post-operatively was unremarkable for two of the three patients who underwent the endoscopic approach under laparotomy. One patient required follow-up laparotomy to treat a perforation of the bowel causing acute peritonitis. At follow-up one yr post-operatively, the stent tube was removed in two patients who recovered fully. The other patient had full recovery with the stent remaining in situ. The endoscopic approach under laparotomy could be a safe and promising option in the treatment of BAS to avoid surgical re-anastomosis.
  • Tetsuya Takikawa, Atsushi Kanno, Atsushi Masamune, Seiji Hongo, Naoki Yoshida, Eriko Nakano, Shin Miura, Shin Hamada, Kiyoshi Kume, Kazuhiro Kikuta, Morihisa Hirota, Tooru Shimosegawa
    INTERNAL MEDICINE 55 9 1097 - 1102 2016年 [査読有り][通常論文]
     
    A 32-year-old woman was referred due to abdominal pain and elevated liver enzymes. Computed tomography and magnetic resonance imaging showed ectopic opening of the common bile duct (CBD) into the duodenal bulb. Esophagogastroduodenoscopy showed a hemispheric bulge in the duodenal bulb. Endoscopic retrograde cholangiopancreatography (ERCP) revealed the bulge to be cystic dilatation of the CBD. ERCP also showed no communication between the ventral and dorsal pancreatic ducts. We diagnosed the patient with ectopic opening of the CBD accompanied by choledochocele and pancreas divisum. Endoscopic incision was performed for the treatment of the choledochocele. The patient's symptoms and elevated liver enzymes improved after treatment.
  • Kenji Notohara, Isao Nishimori, Nobumasa Mizuno, Kazuichi Okazaki, Tetsuhide Ito, Shigeyuki Kawa, Shinichi Egawa, Yasuyuki Kihara, Atsushi Kanno, Atsushi Masamune, Tooru Shimosegawa
    PANCREAS 44 7 1072 - 1077 2015年10月 [査読有り][通常論文]
     
    Objective The aim of the study was to clarify clinicopathological features of type 2 autoimmune pancreatitis (AIP) in Japan; a multicenter survey was carried out. Methods The first screening collected patients with pancreatitis whose pancreatic tissue samples were available and who fulfilled at least 1 of the following 3 criteria as possible type 2 AIP: (1) histological presence of granulocytic epithelial lesion, (2) age of 50 years or younger, and (3) association of ulcerative colitis, Sjogren syndrome, and/or primary biliary cirrhosis. Patients with histologically confirmed type 1 AIP were also collected as a control. Clinical information was gathered by questionnaire. Results A histological re-evaluation identified 8 patients with type 2 AIP and 20 with type 1 AIP. Three of the latter had intralobular neutrophilic infiltration. Factors more frequent in type 2 included age younger than 40 years, abdominal pain, and elevation of serum amylase and lipase, whereas patients with type 1 more frequently showed jaundice, elevated serum IgG and IgG4, presence of autoantibodies, association of IgG4-related disease, sclerosing cholangitis and diabetes mellitus, and imaging findings of intrapancreatic biliary stenosis and extrapancreatic biliary dilatation. Conclusions The clinical features of type 2 AIP in Japan were similar to those of western countries. Intralobular neutrophilic infiltration in type 1 is a potential pitfall, especially in the biopsy-based diagnosis.
  • Eriko Nakano, Atsushi Kanno, Atsushi Masamune, Naoki Yoshida, Seiji Hongo, Shin Miura, Tetsuya Takikawa, Shin Hamada, Kiyoshi Kume, Kazuhiro Kikuta, Morihisa Hirota, Keisuke Nakayama, Fumiyoshi Fujishima, Tooru Shimosegawa
    WORLD JOURNAL OF GASTROENTEROLOGY 21 33 9808 - 9816 2015年09月 [査読有り][通常論文]
     
    A 50-year-old male was referred to our hospital for the evaluation of hyperproteinemia. Fluorodeoxyglucose positron emission tomography revealed high fluorodeoxyglucose uptake in the pancreas, bilateral lacrimal glands, submandibular glands, parotid glands, bilateral pulmonary hilar lymph nodes, and kidneys. Laboratory data showed an elevation of hepatobiliary enzymes, renal dysfunction, and remarkably high immunoglobulin (Ig) G levels, without elevated serum IgG4. Abdominal computed tomography revealed swelling of the pancreatic head and bilateral kidneys. Endoscopic retrograde cholangiopancreatography showed an irregular narrowing of the main pancreatic duct in the pancreatic head and stricture of the lower common bile duct. Histological examination by endoscopic ultrasonography-guided fine-needle aspiration revealed findings of lymphoplasmacytic sclerosing pancreatitis without IgG4-positive plasma cells. Abnormal laboratory values and the swelling of several organs were improved by the treatment with steroids. The patient was diagnosed as having type 1 autoimmune pancreatitis (AIP) based on the International Consensus Diagnostic Criteria. Therefore, we encountered a case of compatible type 1 AIP without elevated levels of serum IgG4 or IgG4-positive plasma cells. This case suggests that AIP phenotypes are not always associated with IgG4.
  • Shigeyuki Kawa, Kazuichi Okazaki, Kenji Notohara, Mamoru Watanabe, Tooru Shimosegawa, Toshiharu Ueki, Toshiyuki Matsui, Atsushi Kanno, Takayuki Watanabe, Kazushige Uchida, Masashi Taguchi, Hisato Igarashi, Tetsuhide Ito, Hiroaki Igarashi, Takeshi Kawanobe, Hideki Iijima, Yutaka Kohgo, Takahiro Ito, Reiko Kunisaki, Masakazu Nagahori, Takao Itoi, Mitsuyoshi Honjo, Junichi Sakagami, Hiroaki Yasuda, Katsuyoshi Hatakeyama, Tsuneo Iiai, Yoshiki Hirooka, Hajime Sumi, Kenji Watanabe, Makoto Sasaki, Akira Ando, Osamu Inatomi, Fukunori Kinjo, Atsushi Iraha, Naotaka Fujita, Kaori Mas, Takashi Kagaya, Hiroyuki Miyakawa, Keiya Okamura, Toshifumi Hibi, Yuji Nakamura, Katsuyuki Fukuda, Tsukasa Ikeura, Takuya Ishikawa, Fumiaki Ueno, Akihiko Satoh, Masato Uemura, Hirohito Tsubouchi, Keita Funakawa, Masahiro Iizuka, Atsushi Yoden, Kensuke Kubota, Yuji Funayama, Takaaki Eguchi, Yoh Ishiguro, Natsumi Uehara, Norikazu Arakura, Terumi Kamisawa, Isao Nishimori, Hirotaka Ohara, Nobumasa Mizuno, Kenji Hirano, Atsushi Masamune, Kazuhiro Kikuta, Study Group for Pancreatitis Complicated with Inflammatory Bowel Disease organized by The Research
    Journal of Gastroenterology 50 7 805 - 815 2015年07月 
    © 2014, Springer Japan. Background: Two types of autoimmune pancreatitis (AIP) have been reported, lymphoplasmacytic sclerosing pancreatitis and idiopathic duct-centric chronic pancreatitis (IDCP), which are now recognized as type 1 and type 2 AIP, respectively. Since the clinical features of type 2 AIP have not been fully elucidated and this condition is frequently accompanied by inflammatory bowel disease (IBD), we performed a nationwide survey of patients with AIP complicated with IBD to precisely characterize this disease entity. Methods: We collected 138 cases of pancreatitis with complicating IBD from affiliated institutes specializing in AIP or IBD, and comparative study between the IDCP groups and type 1 AIP was performed. Results: Histological examination revealed 15 AIP cases to be IDCP of institutional diagnosis, among which 11 cases were upgraded to IDCP of central diagnosis by an expert pathologist. The IDCP group exhibited younger onset age, no gender bias, frequent abdominal pain, and normal IgG4 value, similar to those of type 2 AIP reported previously. We also witnessed a lower prevalence of jaundice in type 2 AIP than in type 1 AIP that corresponded to imaging findings of less frequent pancreatic head swelling and scarce bile duct stenosis. Conclusions: A characteristic feature of type 2 AIP compared with type 1 AIP is a low frequency of obstructive jaundice that is related to rare lower bile duct stricture due to lower prevalence of pancreatic head swelling. Contrary to type 1 AIP, lower bile duct stricture in this condition has no apparent relation to sclerosing cholangitis.
  • Shin Miura, Atsushi Kanno, Atsushi Masamune, Shin Hamada, Tetsuya Takikawa, Eriko Nakano, Naoki Yoshida, Seiji Hongo, Kazuhiro Kikuta, Kiyoshi Kume, Morihisa Hirota, Hiroshi Yoshida, Yu Katayose, Michiaki Uuno, Tooru Shimosegawa
    SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES 29 7 1862 - 1870 2015年07月 [査読有り][通常論文]
     
    Single preoperative biliary drainage for malignant perihilar biliary stricture occasionally fails to control jaundice and cholangitis. Multiple biliary drainage is required in such cases, but their clinical background is unclear. We determined the clinical characteristics associated with the requirement for multiple biliary drainage. The consecutive 122 patients with malignant perihilar biliary stricture were enrolled in a single-center retrospective study. Preoperative biliary drainage was initially performed on the future remnant hepatic lobe. Additional drainage was performed if jaundice failed to improve or cholangitis developed in undrained hepatic lobes. Detailed clinical characteristics and the number of preoperative biliary drainage procedures required before operation were analyzed. Thirty-one patients (25.4 %) initially underwent multiple biliary drainage. However, 69 (56.7 %) required multiple biliary drainage by the time of the operation. In the univariate analysis, the initial serum bilirubin level, cholangitis, percutaneous portal vein embolization, history of inserted endoscopic biliary stenting, length of preoperative period, operative procedure, and Bismuth classification were significant factors. In the multivariate analysis using these factors, Bismuth classification was independently associated with the requirement for multiple biliary drainage. The number of patients who required multiple biliary drainage was higher in those with Bismuth-II (91.9 %), Bismuth-IIIa (65.7 %), and Bismuth-IV (92.9 %) than in those with Bismuth-I (22.2 %) and Bismuth-IIIb (18.2 %). Patients with Bismuth-II, Bismuth-IIIa, and Bismuth-IV are at higher risk for multiple biliary drainage. A strategy based on the Bismuth classification for performing preoperative biliary drainage is important for patients with malignant perihilar biliary stricture.
  • Atsushi Kanno, Atsushi Masamune, Kazuichi Okazaki, Terumi Kamisawa, Shigeyuki Kawa, Isao Nishimori, Ichiro Tsuji, Tooru Shimosegawa
    PANCREAS 44 4 535 - 539 2015年05月 [査読有り][通常論文]
     
    Objectives: To clarify the clinicoepidemiological features of autoimmune pancreatitis (AIP) in Japan, a nationwide epidemiological survey was conducted. Methods: Patients with AIP who had visited selected hospitals in 2011 were surveyed. Autoimmune pancreatitis was diagnosed according to the revised clinical diagnostic criteria for AIP (Japan Pancreas Society 2011). The study consisted of 2 stage surveys; the number of patients with AIP was estimated by the first questionnaire, and their clinical features were assessed by the second questionnaire. Results: The estimated total number of AIP patients in 2011 was 5745 (95% confidence interval, 5325-6164), with an overall prevalence rate of 4.6 per 100,000 population. The number of patients who were newly diagnosed as AIP was estimated to be 1808 (95% confidence interval, 1597-2018), with an annual incidence rate of 1.4 per 100,000 population. The sex ratio (male to female) was 3.2, and the mean age was 66.3 (11.5). Among the 936 patients whose detailed clinical information was obtained, 86.4% of the patients presented high serum immunoglobulin G4 levels (>= 135 mg/dL), and 82.3% received steroid therapy. Conclusions: The data represent the current clinical features of AIP in Japan.
  • Shin Hamada, Atsushi Masamune, Atsushi Kanno, Tooru Shimosegawa
    DIGESTION 91 4 263 - 271 2015年 [査読有り][通常論文]
     
    Background/Aims: Autoimmune pancreatitis (AIP) is a rare disease that has recently emerged as a unique type of pancreatitis with a presumed autoimmune etiology. MicroRNA (miRNA) is a small non-coding RNA that targets multiple mRNAs. miRNAs might exist in serum in a stabilized form, suggesting its potential application as a biomarker. We here examined the miRNA expression profile in the serum of patients with AIP. Methods: miRNAs were prepared from serum samples of patients with various pancreatic diseases (AIP (n = 3, each before and after the steroid therapy), chronic pancreatitis (n = 5), pancreatic cancer (n = 5)) or healthy controls (n = 5). A human miRNA Oligo chip containing approximately 2,000 miRNAs was used to identify differentially expressed miRNAs. Ingenuity Pathway Analysis (IPA) was used for the integrated analysis of altered miRNAs. Results: Microarray analysis identified miRNAs highly expressed in the serum of patients with AIP: 13 miRNAs vs. CP, 204 miRNAs vs. pancreatic cancer, and 19 miRNAs vs. healthy controls. miR-150-5p was commonly upregulated in AIP compared to the other samples. IPA revealed the most biological processes affected by the steroid therapy including cellular development, cellular growth, and cell movement. Conclusion: Our results identified that miRNAs were differentially expressed in the serum of AIP patients. (C) 2015 S. Karger AG, Basel
  • A. Kanno, A. Masamune, T. Shimosegawa
    Autoimmune Pancreatitis 45 - 52 2015年01月 [査読有り][通常論文]
     
    Autoimmune pancreatitis (AIP) is a relatively rare disease that has recently emerged as a unique type of pancreatitis with a presumed autoimmune etiology. Sarles et al. [1] first reported a form of idiopathic chronic pancreatitis which might be caused by an autoimmune mechanism in 1961. It is uncertain whether the pancreatitis they reported coincides with AIP as we currently understand it. In 1991, Kawaguchi et al. [2] reported two cases of unusual inflammatory disease, involving the pancreas and biliary tract that were resected on suspicion of pancreatic cancer, and described the histology as lymphoplasmacytic sclerosing pancreatitis (LPSP). In 1992, Toki et al. [3] reported four cases with an unusual type of chronic pancreatitis showing diffuse, irregular narrowing of the entire main pancreatic duct (MPD) on endoscopic retrograde pancreatography (ERP) scans. This type of pancreatitis was described in the marginal notes of the newly established the JPS criteria for chronic pancreatitis in 1995 as “duct-narrowing chronic pancreatitis,” a chronic inflammation of the pancreas which may not fulfill the criteria of chronic pancreatitis [4]. In 1995, Yoshida et al. [5] proposed AIP as a diagnostic entity. They summarized the clinical features as follows: increased serum γ-globulin or immunoglobulin (Ig)G levels and the presence of autoantibodies diffuse irregular narrowing of MPD and enlargement of the pancreas occasional association with stenosis of the lower bile duct and other autoimmune diseases mild symptoms, usually without acute attacks of pancreatitis effectiveness of steroid therapy and histological findings of LPSP [5, 6]. Thereafter, AIP has been extensively reported worldwide including from Japan, Korea, Europe, and the USA. In this chapter, we will describe the diagnostic criteria of AIP, mainly focusing on the International Consensus Diagnostic Criteria (ICDC) [7] and those proposed by the JPS [8–10].
  • A. Kanno, A. Masamune, T. Shimosegawa
    Autoimmune Pancreatitis 9 - 14 2015年01月 [査読有り][通常論文]
     
    Autoimmune pancreatitis (AIP) is a rare disease that has recently emerged as a unique type of pancreatitis with a presumed autoimmune etiology. In 1995, Yoshida et al. [1] proposed AIP as a diagnostic entity. They summarized the clinical features of AIP as follows: increased serum γ-globulin or immunoglobulin (Ig)G levels and the presence of autoantibodies diffuse irregular narrowing of the main pancreatic duct (MPD) and enlargement of the pancreas occasional association with stenosis of the lower bile duct and other autoimmune diseases mild symptoms, usually without acute attacks of pancreatitis effectiveness of steroid therapy and histological findings of lymphoplasmacytic sclerosing pancreatitis (LPSP) [1, 2]. Thereafter, AIP has been extensively reported worldwide including from Japan, Korea, Europe, and the United States. Because AIP is a relatively new clinical entity and the diagnostic criteria are being established, the epidemiology of AIP is not fully known. In Japan, the Research Committee of Intractable Pancreatic Disease provided by the Ministry of Health, Labour, and Welfare of Japan (RCIPD) has conducted three nationwide epidemiological surveys of AIP according to the diagnostic criteria used at that time. We here describe the epidemiology of AIP, mainly focusing on the results of nationwide surveys in Japan [3, 4].
  • Morihisa Hirota, Tooru Shimosegawa, Atsushi Masamune, Kazuhiro Kikuta, Kiyoshi Kume, Shin Hamada, Atsushi Kanno, Kenji Kimura, Ichiro Tsuji, Shinichi Kuriyama
    PANCREATOLOGY 14 6 490 - 496 2014年11月 [査読有り][通常論文]
     
    Objectives: A nationwide survey was conducted to clarify the epidemiological features of patients with chronic pancreatitis (CP) in Japan. Methods: In the first survey, both the prevalence and the incidence of CP in 2011 were estimated. In the second survey, the clinicoepidemiological features of the patients were clarified by mailed questionnaires. Patients were diagnosed by the Japanese diagnostic criteria for chronic pancreatitis 2009. Results: The estimated annual prevalence and incidence of CP in 2011 were 52.4/100,000 and 14.0/100,000, respectively. The sex ratio (male/female) of patients was 4.6, with a mean age of 62.3 years. Alcoholic (67.5%) was the most common and idiopathic (20.0%) was the second most common cause of CP. Comorbidity with diabetes mellitus (DM) and pancreatic calcifications (PC) occurred more frequent in ever smokers independently of their drinking status. Among patients without drinking habit, the incidences of DM and PC were significantly higher in ever smokers than in never smokers. The multiple logistic regression analysis revealed smoking was an independent factor of DM and PC in CP patients: DM, Odds ratio (OR) 1.644, 95% confidence interval (CI) 1.202 to 2.247 (P = 0.002): PC, OR 2.010, 95% CI 1.458 to 2.773 (P < 0.001). On the other hand, smoking was not identified as an independent factor for the appearance of abdominal pain by this analysis. Conclusion: The prevalence of Japanese patients with CP has been increasing. Smoking was identified as an independent factor related to DM and PC in Japanese CP patients. Copyright (C) 2014, IAP and EPC. Published by Elsevier India, a division of Reed Elsevier India Pvt. Ltd. All rights reserved.
  • Unno, Jun Kanno, Atsushi Masamune, Atsushi Kasajima, Atsuko Fujishima, Fumiyoshi Ishida, Kazuyuki Hamada, Shin Kume, Kiyoshi Kikuta, Kazuhiro Hirota, Morihisa Motoi, Fuyuhiko Unno, Michiaki Shimosegawa, Tooru
    Scand J Gastroenterol 49 11 1 - 8 2014年09月 [査読有り][通常論文]
     
    BACKGROUND: We assessed the controversial topic of using 22-gauge needles in endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) for the diagnosis and evaluation of Ki67 labeling indices (Ki67LI) of pancreatic neuroendocrine tumors (pNET). METHODS: Thirty-eight patients with pNET who underwent EUS-FNA between January 1, 2008 and December 31, 2012 were enrolled in this study. When available, the Ki67LI and WHO classifications obtained by EUS-FNA and surgical resection were compared. RESULTS: EUS-FNA with a 22-gauge needle acquired sufficient histological sample to correctly diagnose pNET in 35 cases (92.1%). Both EUS-FNA and surgical histological specimens were available for 19 cases, and grading classes of the 2 procedures were consistent in 17 cases (89.5%) according to the WHO classification based on the Ki67LI. Tumor size was associated with a difference in the Ki67LI between the 2 procedures, although the Ki67LI was almost completely consistent for tumors less than 18 mm in size. CONCLUSIONS: EUS-FNA with a 22-gauge needle is a safe and highly accurate technique for the diagnosis of pNET. There was a clear correlation between the Ki67LI of histological specimens acquired by EUS-FNA and surgery. EUS-FNA with a 22-gauge needle is useful to predict the WHO classification of pNET.
  • Terumi Kamisawa, Hirotaka Ohara, Myung Hwan Kim, Atsushi Kanno, Kazuichi Okazaki, Naotaka Fujita
    DIGESTIVE ENDOSCOPY 26 5 627 - 635 2014年09月 [査読有り][通常論文]
     
    Autoimmune pancreatitis (AIP) must be differentiated from pancreatic carcinoma, and immunoglobulin (Ig)G4-related sclerosing cholangitis (SC) from cholangiocarcinoma and primary sclerosing cholangitis (PSC). Pancreatographic findings such as a long narrowing of the main pancreatic duct, lack of upstream dilatation, skipped narrowed lesions, and side branches arising from the narrowed portion suggest AIP rather than pancreatic carcinoma. Cholangiographic findings for PSC, including band-like stricture, beaded or pruned-tree appearance, or diverticulum-like out-pouching are rarely observed in IgG4-SC patients, whereas dilatation after a long stricture of the bile duct is common in IgG4-SC. Transpapillary biopsy for bile duct stricture is useful to rule out cholangiocarcinoma and to support the diagnosis of IgG4-SC with IgG4-immunostaining. IgG4-immunostaining of biopsy specimens from the major papilla advances a diagnosis of AIP. Contrast-enhanced endoscopic ultrasonography (EUS) and EUS elastography have the potential to predict the histological nature of the lesions. Intraductal ultrasonographic finding of wall thickening in the non-stenotic bile duct on cholangiography is useful for distinguishing IgG4-SC from cholangiocarcinoma. Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is widely used to exclude pancreatic carcinoma. To obtain adequate tissue samples for the histological diagnosis of AIP, EUS-Tru-cut biopsy or EUS-FNA using a 19-gauge needle is recommended, but EUS-FNA with a 22-gauge needle can also provide sufficient histological samples with careful sample processing after collection and rapid motion of the FNA needles within the pancreas. Validation of endoscopic imaging criteria and new techniques or devices to increase the diagnostic yield of endoscopic tissue sampling should be developed.
  • Kanno, Atsushi Masamune, Atsushi Shimosegawa, Tooru
    Dig Endosc 27 2 250 - 258 2014年08月 [査読有り][通常論文]
  • Shigeyuki Kawa, Kazuichi Okazaki, Terumi Kamisawa, Keishi Kubo, Hirotaka Ohara, Osamu Hasebe, Yasunari Fujinaga, Atsushi Irisawa, Kenji Notohara, Tetsuhide Ito, Kazuo Inui, Hiroyuki Irie, Takayoshi Nishino, Isao Nishimori, Shigeki Tanaka, Toshimasa Nishiyama, Koichi Suda, Keiko Shiratori, Masao Tanaka, Tooru Shimosegawa
    JOURNAL OF GASTROENTEROLOGY 49 5 765 - 784 2014年05月 [査読有り][通常論文]
  • Kazuichi Okazaki, Shigeyuki Kawa, Terumi Kamisawa, Tetsuhide Ito, Kazuo Inui, Hiroyuki Irie, Takayoshi Nishino, Kenji Notohara, Isao Nishimori, Shigeki Tanaka, Toshimasa Nishiyama, Koichi Suda, Keiko Shiratori, Masao Tanaka, Tooru Shimosegawa
    JOURNAL OF GASTROENTEROLOGY 49 4 567 - 588 2014年04月 [査読有り][通常論文]
     
    In response to the proposal of the international consensus diagnostic criteria (ICDC) for autoimmune pancreatitis (AIP) and the Japanese diagnostic criteria in 2011, the 2009 Japanese consensus guidelines for managing AIP required revision. Three committees [the professional committee for making clinical questions (CQs) and statements by Japanese specialists, the expert panelist committee for rating statements by the modified Delphi method, and the evaluating committee by moderators] were organized. Fifteen specialists for AIP extracted the specific clinical statements from 1,843 articles published between 1963 and 2012 (obtained from Pub Med and a secondary database, and developed the CQs and statements. The expert panel individually rated the clinical statements using a modified Delphi approach, in which a clinical statement receiving a median score greater than seven on a nine-point scale from the panel was regarded as valid. The professional committee created 13 CQs and statements for the current concept and diagnosis of AIP, 6 for extra-pancreatic lesions, 6 for differential diagnosis, and 11 for treatment. After evaluation by the moderators, amendments to the Japanese consensus guidelines for AIP have been proposed for 2013.
  • 【消化管術後例における胆膵治療内視鏡】 Billroth II再建における汎用スコープによる内視鏡治療
    菅野 敦, 正宗, 淳, 下瀬川
    胆と膵 35 2 113 - 120 2014年02月 [査読無し][招待有り]
  • Atsushi Kanno, Atsushi Masamune, Shin Hamada, Kazuhiro Kikuta, Kiyoshi Kume, Morihisa Hirota, Kentaro Shima, Takaho Okada, Fuyuhiko Motoi, Fumiyoshi Fujishima, Kazuyuki Ishida, Michiaki Unno, Tooru Shimosegawa
    INTERNAL MEDICINE 53 22 2589 - 2593 2014年 [査読有り][通常論文]
     
    A 55-year-old man was referred to our hospital for a further examination of a pancreatic cystic tumor with a solid component exhibiting vascularity. A few days later, the patient was admitted with a complaint of sudden severe epigastric pain. Enhanced CT showed the loss of vascularity in the tumor. In particular, contrastenhanced endoscopic ultrasonography (EUS) clearly demonstrated the disappearance of the blood flow, and a histological examination revealed acinar cell carcinoma with central necrosis. To our knowledge, this is the first case in the literature of acinar cell carcinoma associated with the sudden disappearance of vascularity. In this case, contrast-enhanced harmonic EUS was especially useful for assessing the degree of vascularity.
  • 【PSC・IgG4-SC】 PSC・IgG4-SC治療 IgG4-SCの治療の現状
    菅野 敦, 正宗, 淳, 下瀬川
    肝・胆・膵 68 1 69 - 75 2014年01月 [査読無し][招待有り]
  • 岡崎 和一, 川, 茂幸, 神澤, 輝実, 伊藤, 鉄英, 乾, 和郎, 入江, 裕之, 西野, 隆義, 能登原, 憲司, 久保, 惠嗣, 大原, 弘隆, 入澤, 篤志, 藤永, 康成, 長谷部, 修, 西森, 功, 田中, 滋城, 下瀬川, 徹, 田中, 雅夫, 白鳥, 敬子, 須田, 耕一, 西山, 利正, 内田, 一茂, 菅野, 敦, 窪田, 賢輔, 洪 繁, 阪上, 順一, 清水, 京子, 杉山, 政則, 多田, 稔, 中沢, 貴宏, 西野, 博一, 浜野, 英明, 廣岡, 芳樹, 平野, 賢二, 正宗, 淳, 増田, 充弘, 水野, 伸匡, 山口, 幸二, 吉田 仁, 日本膵臓学会, 厚生労働省難治性膵疾患に関する調査研究班
    膵臓 28 6 717 - 783 2013年12月 [査読有り][通常論文]
  • 菅野 敦, 正宗, 淳, 藤島, 史喜, 石田, 和之, 入澤, 篤志, 下瀬川 徹
    Gastroenterological Endoscopy 55 12 3795 - 3807 (一社)日本消化器内視鏡学会 2013年12月 [査読無し][招待有り]
     
    1995年に疾患概念が提唱されてから、自己免疫性膵炎(AIP)に関する様々な知見が積み重ねられた。現在、AIPは、主に国際コンセンサス診断基準(ICDC)に基づき診断される。ICDCは、組織学的診断を重要視しているが、EUS-FNAにより採取された組織は対象とされていない。近年、EUS-FNAを用いて採取した組織を用いたAIP診断の報告が散見される。本稿では、EUS-FNAを用いてAIPの組織を採取し診断する要点につき概説する。本稿で紹介した手技が普及し、AIPの診断と研究がさらに発展することを期待したい。(著者抄録)
  • 【IPMN/MCN診療の転換期-日本の成績が示すものは-】 IPMN 臨床病型分類と治療方針 分枝型の画像診断による悪性度診断 High-risk stigmataとworrisome featureが設定された。これまでのデータからみてその有用性は?
    菅野 敦, 正宗, 淳, 下瀬川
    肝・胆・膵 67 5 657 - 665 2013年11月 [査読無し][招待有り]
  • 中野 絵里子, 菅野, 敦, 正宗, 淳, 三浦, 晋, 滝川, 哲也, 有賀, 啓之, 海野, 純, 濱田, 晋, 粂 潔, 菊田, 和宏, 廣田, 衛久, 坂田, 直昭, 元井, 冬彦, 江川, 新一, 海野, 倫明, 藤島, 史喜, 石田, 和之, 下瀬川 徹
    膵臓 28 5 627 - 635 日本膵臓学会 2013年10月 [査読有り][通常論文]
     
    症例は68歳男性。早期胃癌に対する加療時に施行したスクリーニング目的のCTにて、膵尾部に遅延濃染を呈する30mm大の腫瘤を認めた。血清IgG4値が258mg/dlと高値であり自己免疫性膵炎(AIP)も疑われたが、EUS-FNAにて腺癌の組織像を認め、膵尾部癌の診断で膵体尾部切除術を施行した。病理組織学的所見では、膵癌組織に加えて周囲に著明な線維化とリンパ球形質細胞浸潤を認めた。あわせて閉塞性静脈炎と著明なIgG4陽性形質細胞浸潤というAIPに類似した組織像も認めた。術後、血清IgG4値は144mg/dlに低下した。近年、AIPに膵癌を合併した症例や、AIPに類似した間質所見を呈する膵癌症例の報告がある。膵腫瘍の鑑別には、臨床像とあわせてEUS-FNAを用いた病理組織学的診断が有用と考えられた。(著者抄録)
  • 【IgG4と肝胆膵】 既知の肝胆膵疾患との関連性 PSCとIgG4硬化性胆管炎
    菅野 敦, 正宗, 淳, 下瀬川
    肝・胆・膵 67 3 389 - 397 2013年09月 [査読無し][招待有り]
  • 【自己免疫性膵炎の最前線】 本邦における自己免疫性膵炎の疫学
    菅野 敦, 正宗, 淳, 下瀬川
    胆と膵 34 9 681 - 685 2013年09月 [査読無し][招待有り]
  • Tetsuya Takikawa, Atsushi Kanno, Atsushi Masamune, Shin Hamada, Eriko Nakano, Shin Miura, Hiroyuki Ariga, Jun Unno, Kiyoshi Kume, Kazuhiro Kikuta, Morihisa Hirota, Hiroshi Yoshida, Yu Katayose, Michiaki Unno, Tooru Shimosegawa
    World Journal of Gastroenterology 19 31 5182 - 5186 2013年08月 [査読有り][通常論文]
     
    The patient was a 30-year-old female who had undergone excision of the extrahepatic bile duct and Rouxen- Y hepaticojejunostomy for congenital biliary dilatation at the age of 7. Thereafter, she suffered from recurrent acute pancreatitis due to pancreaticobiliary maljunction and received subtotal stomach-preserving pancreaticoduodenectomy. She developed a pancreatic fistula and an intra-abdominal abscess after the operation. These complications were improved by percutaneous abscess drainage and antibiotic therapy. However, upper abdominal discomfort and the elevation of serum pancreatic enzymes persisted due to stenosis from the pancreaticojejunostomy. Because we could not accomplish dilation of the stenosis by endoscopic retrograde cholangiopancreatography, we tried an endoscopic ultrasonography (EUS) guided rendezvous technique for pancreatic duct drainage. After transgastric puncture of the pancreatic duct using an EUS-fine needle aspiration needle, the guidewire was inserted into the pancreatic duct and finally reached to the jejunum through the stenotic anastomosis. We changed the echoendoscope to an oblique-viewing endoscope, then grasped the guidewire and withdrew it through the scope. The stenosis of the pancreaticojejunostomy was dilated up to 4 mm, and a pancreatic stent was put in place. Though the pancreatic stent was removed after three months, the patient remained symptomfree. Pancreatic duct drainage using an EUS-guided rendezvous technique was useful for the treatment of a stenotic pancreaticojejunostomy after pancreaticoduodenectomy. © 2013 Baishideng. All rights reserved.
  • 菅野 敦, 正宗, 淳 林, 洋毅, 海野, 倫明, 下瀬川 徹
    日本消化器病学会雑誌 110 8 1400 - 1407 2013年08月 [査読有り][招待有り]
  • Hirotaka Ohara, Takahiro Nakazawa, Shigeyuki Kawa, Terumi Kamisawa, Tooru Shimosegawa, Kazushige Uchida, Kenji Hirano, Takayoshi Nishino, Hideaki Hamano, Atsushi Kanno, Kenji Notohara, Osamu Hasebe, Takashi Muraki, Etsuji Ishida, Itaru Naitoh, Kazuichi Okazaki
    JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY 28 7 1247 - 1251 2013年07月 [査読有り][通常論文]
     
    Background and Aim IgG4-related sclerosing cholangitis (IgG4-SC) must be precisely distinguished from primary sclerosing cholangitis and cholangiocarcinoma (CC) because the treatments are completely different. However, the pathological diagnosis of IgG4-SC is difficult. Therefore, highly specific non-invasive criteria such as serum IgG4 should be established. This study established a cut-off for serum IgG4 to differentiate IgG4-SC from respective controls using serum IgG4 levels measured in Japanese centers. Methods A total of 344 IgG4-SC patients were enrolled in this study. As controls, 245, 110, and 149 patients with pancreatic cancer, primary sclerosing cholangitis, and CC, respectively, were enrolled. IgG4-SC patients were classified into three groups: type 1 (stenosis only in the lower part of the common bile duct), type 2 (stenosis diffusely distributed throughout the intrahepatic and extrahepatic bile ducts), and types 3 and 4 (stenosis in the hilar hepatic region) with 246, 56, and 42 patients, respectively. Serum IgG4 levels were compared, and the cut-offs were established. Results The cut-off obtained from receiver operator characteristic curves showed similar sensitivity and specificity to that of 135mg/dL when all IgG4-SC and controls were compared. However, a new cut-off value was established when subgroups of IgG4-SC and controls were compared. A cut-off of 182mg/dL can increase the specificity to 96.6% (4.7% increase) for distinguishing types 3 and 4 IgG4-SC from CC. A cut-off of 207mg/dL might be useful for completely distinguishing types 3 and 4 IgG4-SC from all CC. Conclusions Serum IgG4 is useful for the differential diagnosis of IgG4-SC and controls.
  • 菅野 敦, 中野 絵里子, 滝川 哲也, 三浦 晋, 有賀 啓之, 海野 純, 濱田 晋, 粂 潔, 菊田 和宏, 廣田 衛久, 正宗 淳, 下瀬川 徹, 乙供 茂, 元井 冬彦, 海野 倫明, 笠島 敦子, 藤島 史善, 古川 徹
    膵臓 28 3 495 - 495 日本膵臓学会 2013年06月
  • 三浦 晋, 菅野 敦, 中野 絵里子, 滝川 哲也, 有賀 啓之, 濱田 晋, 海野 純, 粂 潔, 菊田 和宏, 廣田 衛久, 正宗 淳, 元井 冬彦, 海野 倫明, 藤島 史喜, 下瀬川 徹
    膵臓 28 3 495 - 495 日本膵臓学会 2013年06月
  • 中野 絵里子, 菅野 敦, 滝川 哲也, 三浦 晋, 有賀 啓之, 海野 純, 濱田 晋, 粂 潔, 菊田 和宏, 廣田 衛久, 正宗 淳, 中山 恵輔, 藤島 史喜, 下瀬川 徹
    膵臓 28 3 522 - 522 日本膵臓学会 2013年06月
  • 化学放射線療法(CRT)と化学療法(GS療法)が奏効して切除し得た進行膵体部癌の一例
    高橋 弥生, 森川, 孝則, 元井, 冬彦, 川口, 圭, 薮内, 伸一, 青木, 豪, 坂田, 直昭, 深瀬, 耕二, 水間, 正道, 乙供, 茂, 大塚, 英郎, 中川, 圭 林, 洋毅, 岡田, 恭穂, 吉田, 寛, 内藤, 剛, 片寄, 友, 江川, 新一, 菅野, 敦, 海野 倫明
    膵臓 28 3 512 - 512 2013年06月 [査読有り][通常論文]
  • 通常型膵癌切除例における実5年生存者20例の検討
    吉松 軍平, 元井, 冬彦, 坂田, 直昭, 川口, 桂, 青木, 豪, 藪内, 伸一, 深瀬, 耕二, 水間, 正道, 大塚, 英郎, 中川, 圭, 林, 洋毅, 岡田, 恭穂, 森川, 孝則, 吉田, 寛, 内藤, 剛, 片寄, 友, 江川, 新一, 菅野, 敦, 下瀬川, 徹, 海野 倫明
    膵臓 28 3 457 - 457 2013年06月 [査読有り][通常論文]
  • Shin Hamada, Kennichi Satoh, Shin Miura, Morihisa Hirota, Atsushi Kanno, Atsushi Masamune, Kazuhiro Kikuta, Kiyoshi Kume, Jun Unno, Shinichi Egawa, Fuyuhiko Motoi, Michiaki Unno, Tooru Shimosegawa
    Journal of Cellular Physiology 228 6 1255 - 1263 2013年06月 [査読有り][通常論文]
     
    Invasive ductal adenocarcinoma (IDA) of the pancreas manifests poor prognosis due to the early invasion and distant metastasis. In contrast, intraductal papillary mucinous adenoma or carcinoma (IPMA or IPMC) reveals better clinical outcomes. Various molecular mechanisms contribute to these differences but entire picture is still unclear. Recent researches emphasized the important role of miRNA in biological processes including cancer invasion and metastasis. We previously described that miR-126 is down-regulated in IDA compared with IPMA or IPMC, and miR-126 regulates the expression of invasion related molecule disintegrin and metalloproteinase domain-containing protein 9 (ADAM9). Assessing the difference of miRNA expression profiles of IDA, IPMA, and IPMC, we newly identified miR-197 as an up-regulated miRNA specifically in IDA. Expression of miR-197 in pancreatic cancer cells resulted in the induction of epithelial-mesenchymal transition (EMT) along with the down-regulation of p120 catenin which is a putative target of miR-197. Direct interaction between miR-197 and p120 catenin mRNA sequence was confirmed by 3′UTR assay, and knockdown of p120 catenin recapitulated EMT induction in pancreatic cancer cells. In situ hybridization of miR-197 and immunohistochemistry of p120 catenin showed mutually exclusive patterns suggesting pivotal role of miR-197 in the regulation of p120 catenin. This miR-197/p120 catenin axis could be a novel therapeutic target. © 2012 Wiley Periodicals, Inc.
  • 【膵臓と胆嚢・胆管疾患の診断と治療:アップデート】 各論 慢性膵炎の診断と治療
    菅野 敦, 正宗, 淳, 下瀬川
    診断と治療 101 5 703 - 710 2013年05月 [査読無し][招待有り]
  • Okada T, Motoi F, Kanno A, Masamune A, Ishida K, Fujishima F, Rikiyama T, Katayose Y, Egawa S, Shimosegawa T, Unno M
    Clinical journal of gastroenterology 6 2 164 - 168 2013年04月 [査読有り][通常論文]
  • Atsushi Masamune, Noriaki Suzuki, Kazuhiro Kikuta, Hiroyuki Ariga, Shintaro Hayashi, Tetsuya Takikawa, Kiyoshi Kume, Shin Hamada, Morihisa Hirota, Atsushi Kanno, Shinichi Egawa, Michiaki Unno, Tooru Shimosegawa
    PANCREAS 42 2 308 - 316 2013年03月 [査読有り][通常論文]
     
    Objectives: Pancreatic stellate cells (PSCs) play a pivotal role in pancreatic fibrosis associated with chronic pancreatitis and pancreatic cancer. Connexins (Cxs) allow direct intercellular communications as components of gap junction but also play important roles in the regulation of cell proliferation, cell differentiation, and tissue development. We here examined the expression of Cxs and Cx-mediated regulation of cell functions in PSCs. Methods: Human PSCs were isolated from patients undergoing operation for chronic pancreatitis or pancreatic cancer. The expression of Cxs was examined by reverse transcription polymerase chain reaction, Western blotting, and immunofluorescent staining. The roles of Cxs in PSC functions were examined by using carbenoxolone, a broad-spectrum Cx inhibitor, and small interfering RNA for Cx43. Results: Human activated PSCs expressed a variety of Cxs including Cx43 both in vitro and in vivo. Carbenoxolone inhibited platelet-derived growth factor-BB-induced proliferation and migration, and type I collagen expression in PSCs. In addition, carbenoxolone inhibited the activation of quiescent PSCs to a myofibroblastlike phenotype. Decreased Cx43 expression by small interfering RNA resulted in decreased proliferation and type I collagen expression. Conclusions: Pancreatic stellate cells expressed a variety of Cxs. Connexins, especially Cx43, might regulate the cell functions and activation of PSCs.
  • 【とことん知りたいERCPの手技のコツ もう迷わない!後方斜視鏡の挿入から、乳頭の観察、深部挿管まで】 乳頭観察法 乳頭が見つからない場合は、どうしたらよいですか?
    菅野 敦, 下瀬川
    消化器内視鏡レクチャー 1 3 461 - 467 2013年01月 [査読無し][招待有り]
  • I. Yasuda, M. Nakashima, T. Iwai, H. Isayama, T. Itoi, H. Hisai, H. Inoue, H. Kato, A. Kanno, K. Kubota, A. Irisawa, H. Igarashi, Y. Okabe, M. Kitano, H. Kawakami, T. Hayashi, T. Mukai, N. Sata, M. Kida, T. Shimosegawa
    Endoscopy 45 8 627 - 634 2013年 [査読有り][通常論文]
     
    Background and study aims: Only a few large cohort studies have evaluated the efficacy and safety of endoscopic necrosectomy for infected walled-off pancreatic necrosis (WOPN). Therefore, a multicenter, large cohort study was conducted to evaluate the efficacy and safety of endoscopic necrosectomy and to examine the procedural details and follow-up after successful endoscopic necrosectomy. Patients and methods: A retrospective review was conducted in 16 leading Japanese institutions for patients who underwent endoscopic necrosectomy for infected WOPN between August 2005 and July 2011. The follow-up data were also reviewed to determine the long-term outcomes of the procedures. Results: Of 57 patients, 43 (75 %) experienced successful resolution after a median of 5 sessions of endoscopic necrosectomy and 21 days of treatment. Complications occurred in 19 patients (33 %) during the treatment period. Six patients died (11 %): two due to multiple organ failure and one patient each from air embolism, splenic aneurysm, hemorrhage from a Mallory - Weiss tear, and an unknown cause. Of 43 patients with successful endoscopic necrosectomy, recurrent cavity formation was observed in three patients during a median follow-up period of 27 months. Conclusions: Endoscopic necrosectomy can be an effective technique for infected WOPN and requires a relatively short treatment period. However, serious complications can arise, including death. Therefore, patients should be carefully selected, and knowledgeable, skilled, and experienced operators should perform the procedure. Further research into safer technologies is required in order to reduce the associated morbidity and mortality. © Georg Thieme Verlag KG Stuttgart · New York.
  • Tatsuo Hata, Naoaki Sakata, Takeshi Aoki, Hiroshi Yoshida, Atsushi Kanno, Fumiyoshi Fujishima, Fuyuhiko Motoi, Atsushi Masamune, Tooru Shimosegawa, Michiaki Unno
    Case reports in gastroenterology 7 3 442 - 8 2013年 [査読有り][通常論文]
     
    A 50-year-old woman had undergone left nephrectomy for renal cell carcinoma 13 years previously. Ten years later, a solitary metastatic tumor had been detected in the pancreatic tail and she had undergone subsequent resection of the pancreatic tail and spleen. Three years after surgery, she was admitted to our hospital for severe anemia resulting from gastrointestinal tract bleeding. Esophagogastroduodenoscopy revealed a 3-cm solid tumor at the oral side of the papilla of Vater. Histology of the bioptic duodenal tissue revealed inflammatory granulation without malignancy. Computed tomography showed a well-contrasted hypervascular tumor in the descending portion of the duodenum. We diagnosed the patient with metachronous duodenal metastasis of renal cell carcinoma and performed a pancreaticoduodenectomy. An ulcerated polypoid mass was detected at the oral side of the papilla of Vater. Histology revealed clear cell carcinoma coated by granulation tissue across the surface of the tumor. Immunohistology demonstrated that the cells were positive for vimentin, CD10 and epithelial membrane antigen and negative for CK7. After a repeated pancreatectomy, the patient had no symptoms of gastrointestinal bleeding and maintained good glucose tolerance without insulin therapy because the remnant pancreas functioned well. In conclusion, for the diagnosis of patients who have previously undergone nephrectomy and present with gastrointestinal bleeding, the possibility of metastasis to the gastrointestinal tract, including the duodenum, should be considered. With respect to surgical treatment, the pancreas should be minimally resected to maintain a free surgical margin during the first surgery taking into account further metachronous metastasis to the duodenum and pancreas.
  • Shin Miura, Kiyoshi Kume, Shin Hamada, Atsushi Kanno, Jun Unno, Kazuhiro Kikuta, Morihisa Hirota, Atsushi Masamune, Tooru Shimosegawa
    Nihon Naika Gakkai zasshi. The Journal of the Japanese Society of Internal Medicine 101 12 3510 - 2 2012年12月
  • 三浦 晋, 粂, 潔, 濱田, 晋, 菅野, 敦, 海野, 純, 菊田, 和宏, 廣田, 衛久, 正宗, 淳, 下瀬川
    日本内科学会雑誌 101 12 3510 - 3512 2012年12月 [査読有り][通常論文]
  • 【再びIPMNの切除適応を考える】 各種画像による分枝型IPMNの診断能
    菅野 敦, 下瀬川
    胆と膵 33 11 1141 - 1149 2012年11月 [査読無し][招待有り]
  • Morihisa Hirota, Tooru Shimosegawa, Atsushi Kanno, Kazuhiro Kikuta, Kiyoshi Kume, Shin Hamada, Jun Unno, Atsushi Masamune
    TOHOKU JOURNAL OF EXPERIMENTAL MEDICINE 228 3 173 - 180 2012年11月 [査読有り][通常論文]
     
    Chronic pancreatitis (CF) has been considered an intractable inflammatory disease that is progressive and irreversible after definite structural changes appear in the pancreas. The Japanese diagnostic criteria for CF were revised in 2009. One of the reasons for this revision was to define a diagnostic criterion for the early phase of CF (early CF) to improve a patient's clinical outcome, because the disease progression might be reversed in this phase by a therapeutic intervention. However, the clinical features and outcome of early CP remain largely unknown, and the diagnostic reliability of early CP needs to be verified. Here, we show two patients who met the diagnostic criteria of early CF and then progressed to the advanced, late phase of CF (definite CP). A 64-year-old man with recurrent acute pancreatitis was diagnosed as early CF and later progressed to definite CF with multiple pancreatic calcifications at the age of 69. The etiology of CF in this patient was thought to be idiopathic. The other patient was a 57-year-old man with alcohol abuse (ethanol consumption > 120 g/day). He was diagnosed as early CF and then rapidly progressed to definite CP without any acute attack. He could not remain abstinent after the diagnosis of early CP. In the present report, we retrospectively demonstrated distinct clinical features of the two patients, both of whom were diagnosed as early CF first and then progressed to definite CP. Thus, our findings support the disease concept of early CF and also suggest the validity of the revised Japanese criteria for the diagnosis of early CP.
  • Kiyoshi Kume, Atsushi Masamune, Hiroyuki Ariga, Shintaro Hayashi, Tetsuya Takikawa, Shin Miura, Noriaki Suzuki, Kazuhiro Kikuta, Shin Hamada, Morihisa Hirota, Atsushi Kanno, Tooru Shimosegawa
    JOURNAL OF GASTROENTEROLOGY 47 11 1267 - 1274 2012年11月 [査読有り][通常論文]
     
    The serine protease inhibitor Kazal type 1 (SPINK1), also known as pancreatic secretory trypsin inhibitor (PSTI), is a peptide secreted by pancreatic acinar cells. Genetic studies have shown an association between SPINK1 gene variants and chronic pancreatitis or recurrent acute pancreatitis. The aim of this study was to clarify whether the SPINK1 variants affect the level of serum PSTI. One hundred sixty-three patients with chronic pancreatitis or recurrent acute pancreatitis and 73 healthy controls were recruited. Serum PSTI concentrations were determined with a commercial radioimmunoassay kit. Ten patients with the p.N34S variant, 7 with the IVS3+2T > C variant, two with both the p.N34S and the IVS3+2T > C variants, and one with the novel missense p.P45S variant in the SPINK1 gene were identified. The serum PSTI level in patients with no SPINK1 variants was 14.3 +/- A 9.6 ng/ml (mean +/- A SD), and that in healthy controls was 10.7 +/- A 2.2 ng/ml. The PSTI level in patients carrying the IVS3+2T > C variant (5.1 +/- A 3.4 ng/ml), but not in those with the p.N34S variant (8.9 +/- A 3.5 ng/ml), was significantly lower than that in the patients without the SPINK1 variants and the healthy controls. The serum PSTI level in the patient with the p.P45S variant was 4.9 ng/ml. Low levels of serum PSTI (< 6.0 ng/ml) showed sensitivity of 80 %, specificity of 97 %, and accuracy of 96 % in the differentiation of IVS3+2T > C and p.P45S carriers from non-carriers. Serum PSTI levels were decreased in patients with the IVS3+2T > C and p.P45S variants of the SPINK1 gene.
  • Utaroh Motosugi, Hiroshi Yamaguchi, Toru Furukawa, Tomoaki Ichikawa, Takashi Hatori, Izumi Fujita, Masakazu Yamamoto, Fuyuhiko Motoi, Atsushi Kanno, Tomoo Watanabe, Naoto Koike, Isamu Koyama, Junya Kobayashi, Michio Shimizu
    JOURNAL OF COMPUTER ASSISTED TOMOGRAPHY 36 6 710 - 717 2012年11月 [査読有り][通常論文]
     
    Objective: The objective of this study was to describe the imaging findings for intraductal tubulopapillary neoplasms of the pancreas. Methods: Eleven pancreatic tumors pathologically confirmed as intraductal tubulopapillary neoplasm were retrospectively collected. The dynamic contrast-enhanced computed tomography (CT), magnetic resonance (MR) imaging including MR cholangiopancreatography (MRCP), ultrasound, and endoscopic retrograde cholangiopancreatography (ERCP) results were reviewed. The 2-tone duct sign and cork-of-wine-bottle sign were reviewed as indicators of intraductal tumor growth on CT/MR and MRCP/ERCP images, respectively. Results: A 2-tone duct sign was noted on the dynamic CT images (7/10, 70%) and on the MR imaging (5/8, 63%). The distal main pancreatic duct was dilated in all the patients except one, who had a branch duct lesion. A cork-of-wine-bottle sign was observed on the MRCP image (3/8, 38%) and on the ERCP image (3/6, 50%). Conclusions: Intraductal tubulopapillary neoplasms are rare tumors showing characteristic imaging findings such as the 2-tone duct sign and the cork-of-wine-bottle sign that represent their intraductal growth.
  • Morihisa Hirota, Kennichi Satoh, Kazuhiro Kikuta, Atsushi Masamune, Kiyoshi Kume, Shin Hamada, Akihiko Satoh, Atsushi Kanno, Jun Unno, Hiromichi Ito, Hiroyuki Ariga, Tooru Shimosegawa
    PANCREAS 41 7 1099 - 1104 2012年10月 [査読有り][通常論文]
     
    Objectives: The usefulness of early severity assessment of acute pancreatitis (AP) by contrast-enhanced computed tomography (CECT) was investigated. Methods: Data were obtained from a 2007 nationwide survey in Japan. Clinical data of 983 patients with AP were analyzed. All were examined by CECT on the day of admission. Results: Early findings of CECT demonstrated that low enhanced pancreatic parenchyma (LEPP) was associated with the incidence of organ failure (OF), multiple OF, and infectious complications as well as mortality (P < 0.0001). Next, patients were further divided into 4 groups according to the CECT findings, which focused on the LEPP and peripancreatic collections (PPCs). The LEPP/PPC (+/+) group was characterized as high morbidity and high mortality. The incidence of OF (28.2%), multiple OF (15.5%), and mortality (11.4%) in patients assigned to the (+/+) group was significantly higher than in those assigned to the other groups. The incidence of infectious complications was significantly higher in patients assigned to the (+/+) group (16.7%), the (+/-) group (9.0%), and the (-/+) group (7.0%) than those assigned to the (-/-) group (1.8%). Conclusions: The detection of LEPP and PPC was a useful CECT finding for the early assessment of the severity of AP.
  • Atsushi Kanno, Kazuyuki Ishida, Shin Hamada, Fumiyoshi Fujishima, Jun Unno, Kiyoshi Kume, Kazuhiro Kikuta, Morihisa Hirota, Atsushi Masamune, Kennichi Satoh, Kenji Notohara, Tooru Shimosegawa
    GASTROINTESTINAL ENDOSCOPY 76 3 594 - 602 2012年09月 [査読有り][通常論文]
     
    Background: It is controversial whether EUS-guided FNA by using 22-gauge (G) needles is useful for the diagnosis or evaluation of autoimmune pancreatitis (AIP). Objective: To evaluate the usefulness of EUS-FNA by 22-G needles for the histopathological diagnosis of AIP. Design: A retrospective study. Setting: Single academic center. Patients: A total of 273 patients, including 25 with AIP, underwent EUS-FNA and histological examinations. Results: EUS-FNA by using 22-G needles provided adequate tissue samples for histopathological evaluation because more than 10 high-power fields were available for evaluation in 20 of 25 patients (80%). The mean immunoglobulin G4-positive plasma cell count was 13.7/high-power field. Obliterative phlebitis was observed in 10 of 25 patients (40%). In the context of the International Consensus Diagnostic Criteria for AIP, 14 and 6 of 25 patients were judged to have level 1 (positive for 3 or 4 items) and level 2 (positive for 2 items) histological findings, respectively, meaning that 20 of 25 patients were suggested to have lymphoplasmacytic sclerosing pancreatitis based on the International Consensus Diagnostic Criteria. The diagnosis in 1 patient was type 2 AIP because a granulocytic epithelial lesion was identified in this patient. Limitations: A retrospective study with a small number of patients. Conclusions: The results of this study suggest that EUS-FNA by using 22-G needles provides tissue samples adequate for histopathological evaluation and greatly contributes to the histological diagnosis of AIP. (Gastrointest Endosc 2012;76:594-602.)
  • Hirotaka Ohara, Kazuichi Okazaki, Hirohito Tsubouchi, Kazuo Inui, Shigeyuki Kawa, Terumi Kamisawa, Susumu Tazuma, Kazushige Uchida, Kenji Hirano, Hitoshi Yoshida, Takayoshi Nishino, Shigeru B. H. Ko, Nobumasa Mizuno, Hideaki Hamano, Atsushi Kanno, Kenji Notohara, Osamu Hasebe, Takahiro Nakazawa, Yasuni Nakanuma, Hajime Takikawa
    JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 19 5 536 - 542 2012年09月 [査読有り][通常論文]
     
    Background IgG4-sclerosing cholangitis (IgG4-SC) patients have an increased level of serum IgG4, dense infiltration of IgG4-positive plasma cells with extensive fibrosis in the bile duct wall, and a good response to steroid therapy. However, it is not easy to distinguish IgG4-SC from primary sclerosing cholangitis, pancreatic cancer, and cholangiocarcinoma on the basis of cholangiographic findings alone because various cholangiographic features of IgG4-SC are similar to those of the above progressive or malignant diseases. Methods The Research Committee of IgG4-related Diseases and the Research Committee of Intractable Diseases of Liver and Biliary Tract in association with the Ministry of Health, Labor and Welfare, Japan and the Japan Biliary Association have set up a working group consisting of researchers specializing in IgG4-SC, and established the new clinical diagnostic criteria of IgG4-SC 2012. Results The diagnosis of IgG4-SC is based on the combination of the following 4 criteria: (1) characteristic biliary imaging findings, (2) elevation of serum IgG4 concentrations, (3) the coexistence of IgG4-related diseases except those of the biliary tract, and (4) characteristic histopathological features. Furthermore, the effectiveness of steroid therapy is an optional extra diagnostic criterion to confirm accurate diagnosis of IgG4-SC. Conclusion These diagnostic criteria for IgG4-SC are useful in practice for general physicians and other nonspecialists.
  • 廣田 衛久, 津田, 雅視, 辻, 喜久, 菅野, 敦, 菊田, 和宏, 粂, 潔, 濱田, 晋, 海野, 純, 有賀, 宏之, 滝川, 哲也 林, 晋太郎, 三浦, 晋, 千葉, 勉, 正宗, 淳, 下瀬川
    膵臓 27 4 601 - 607 日本膵臓学会 2012年08月 [査読有り][通常論文]
     
    自己免疫性膵炎(AIP)は膵癌(PC)との鑑別が臨床上の問題である。本研究では、Perfusion CTによる膵血流解析が両者の鑑別に有用であるかを検討した。AIP12症例(全例type1)とPC22症例にPerfusion CTを施行し、single-compartment kinetic model法を用いて画像解析を行い、3つのパラメータを用いて両者を比較した。FV値はAIPで平均81.3/分に対しPCでは平均19.3/分と有意に低値(p=0.0005)、VD値はAIPが28.8に対しPCでは93.6と有意に高値(p=0.0084)、R2値はAIPが0.659に対しPCでは0.250と有意に低値(p<0.0001)であった。また、カラーマップ画像も鑑別に有用であった。本研究は、AIPとPCの鑑別におけるPerfusion CTの有用性を示す最初の報告である。(著者抄録)
  • 海野 純, 廣田, 衛久, 正宗, 淳, 菅野, 敦, 菊田, 和宏, 粂, 潔, 濱田, 晋, 有賀, 啓之, 下瀬川 徹
    膵臓 27 4 593 - 600 日本膵臓学会 2012年08月 [査読有り][通常論文]
     
    慢性膵炎に対する内視鏡的治療の意義を栄養改善の観点から検討した。12ヵ月以上の内視鏡的治療を要した19例を対象とし、栄養状態の評価指標としてBMI、血清アルブミン(Alb)、総リンパ球数(Lym)、小野寺のPrognostic Nutritional Index(PNI)、総コレステロールの経時的変化をレトロスペクティブに解析した。治療開始後、腹痛発作がなかった12例では各栄養指標は有意に改善したが、腹痛発作が1回以上発生した7例では改善がみられなかった。Alb、Lym、PNIは治療後1〜3ヵ月の期間に有意な改善を示し、BMIについては7〜9ヵ月で有意な増加を認めた。内視鏡治療によって、腹痛発作を完全に防止できれば栄養指標の改善効果が得られ、その効果は10ヵ月以内に達成された。外科治療に先行する短期間の内視鏡治療は栄養障害の改善という見地からも有効な治療ストラテジーとなり得る。(著者抄録)
  • Atsushi Kanno, Isao Nishimori, Atsushi Masamune, Kazuhiro Kikuta, Morihisa Hirota, Shinichi Kuriyama, Ichiro Tsuji, Tooru Shimosegawa
    PANCREAS 41 6 835 - 839 2012年08月 [査読有り][通常論文]
     
    Objectives: To clarify the clinicoepidemiological features of autoimmune pancreatitis (AIP) in Japan, the nationwide survey was conducted. Methods: Patients with AIP who had visited the selected hospitals in 2007 were surveyed. Autoimmune pancreatitis was diagnosed according to the Japanese clinical diagnostic criteria 2006. The study consisted of 2-stage surveys: the number of patients with AIP was estimated by the first questionnaire and their clinical features were assessed by the second questionnaire. Results: The estimated total number of AIP patients in 2007 was 2790 (95% confidence interval, 2540-3040), with an overall prevalence rate of 2.2 per 100,000 populations. The number of patients, who were newly diagnosed as AIP, was estimated to be 1120 (95% confidence interval, 1000-1240), with an annual incidence rate of 0.9 per 100,000 populations. Sex ratio (male to female) was 3.7, and the mean (SD) age was 63.0 (11.4) years. Among the 546 patients whose clinical information was obtained, 87.6% of the patients presented high serum immunoglobulin G4 levels (>= 135 mg/dL), and 83% received steroid therapy. Conclusions: The data represent the current clinical features of AIP in Japan. From the results, most AIP patients in Japan can be categorized to type 1 AIP according to the recent classification of AIP.
  • 【肝胆膵のチューブ管理を極める!異常の緊急度がわかる・異常発見時の対応がわかる】 ENPDチューブ
    菅野 敦, 下瀬川
    消化器外科Nursing 17 7 724 - 728 2012年07月 [査読無し][招待有り]
  • Atsushi Kanno, Atsushi Masamune, Morihisa Hirota, Kazuhiro Kikuta, Tooru Shimosegawa
    DIGESTIVE ENDOSCOPY 24 43 - 48 2012年05月 [査読有り][通常論文]
     
    The patient was a 73 year old man for whom surgery under general anesthesia was difficult to perform because of pulmonary emphysema. In April 2003, he visited our hospital complaining of epigastralgia and dorsal pain, and was admitted under a diagnosis of acute exacerbation of chronic pancreatitis. In 2005, acute cholangitis concomitantly developed with acute exacerbation of chronic pancreatitis, for which a plastic stent was placed in the common bile duct. Cholangitis repeatedly developed every 23 months thereafter, and admission was required each time to exchange the stent. Surgery was considered but not applicable because of his poor respiratory function, and a partially covered self-expandable metallic stent was inevitably placed in the bile duct. Ten months later, an aberration of the metallic stent in the bile duct occurred, but it was dealt with by placing an additional metallic stent, and no cholangitis or pancreatitis developed until the patient died of respiratory insufficiency 3 years later. Placement of a covered self-expandable metallic stent might be an option for the treatment of benign biliary stricture, especially in patients at high risk from surgery.
  • 海野 純, 廣田, 衛久, 正宗, 淳, 菅野, 敦, 菊田, 和宏, 粂, 潔, 濱田, 晋, 有賀, 啓之, 下瀬川 徹
    胆と膵 33 4 345 - 350 医学図書出版(株) 2012年04月 [査読無し][招待有り]
     
    慢性膵炎の疼痛に対して、外科治療に先行して内科治療を行うことが一般的である。膵管ステントなどによる内視鏡的治療は、疼痛や膵液流出障害を軽減することで栄養障害を改善し、たとえ後に外科手術へ移行するような難治症例であっても、一定のメリットを患者にもたらすことが期待できる。このような観点から、内視鏡的治療の難治症例を対象に栄養状態の変化を検討した。内視鏡的治療開始後、腹痛などのイベント発生のなかったグループでは、血清アルブミン、総リンパ球数、BMIなどの栄養状態の指標は有意に改善したが、イベントが1回以上発生したグループでは改善がみられなかった。BMIは内視鏡的治療開始後7〜9ヵ月で有意な増加を認めた。すなわち、10ヵ月程度の短期内科治療によって栄養障害の改善効果が得られ、たとえ手術に移行した場合でも、合併症発生率の低減などのメリットを得られる可能性が考えられた。(著者抄録)
  • 国際的コンセンサス診断基準に基づく22ゲージ針を用いたEUS-FNAによる自己免疫性膵炎の診断(The diagnosis of autoimmune pancreatitis by EUS-FNA using 22-gauge needle based on the international consensus diagnostic criteria)
    Kanno Atsushi, Ishida Kazuyuki, Hamada Shin, Unno Jun, Kume Kiyoshi, Kikuta Kazuhiro, Hirota Morihisa, Masamune Atsushi, Satoh Kennichi, Notohara Kenji, Shimosegawa Tooru
    Gastroenterological Endoscopy 54 Suppl.1 1144 - 1144 2012年04月
  • IgG4関連硬化性胆管炎臨床診断基準2012
    岡崎 和一, 川, 茂幸, 乾, 和郎, 神澤, 輝実, 田妻, 進, 内田, 一茂, 平野, 賢二, 吉田, 仁, 西野, 隆義, 洪 繁, 水野, 伸匡, 濱野, 英明, 菅野, 敦, 能登原, 憲司, 長谷部, 修, 中沢, 貴宏, 中沼, 安二, 滝川, 一, 坪内, 博仁, 大原, 弘隆, 厚生労働省I, 関連全身硬化性疾患の診断法の確立と治療方法の開発に関する研究班
    胆道 26 1 59 - 63 2012年03月 [査読有り][通常論文]
  • 岡崎 和一, 下瀬川, 徹, 伊藤, 鉄英, 乾, 和郎, 内田, 一茂, 大原, 弘隆, 神澤, 輝実, 川, 茂幸, 清水, 京子, 多田, 稔, 西野, 博一, 西森, 功, 廣岡, 芳樹, 水野, 伸匡, 山口, 武人, 杉山, 政則, 山口, 幸二, 能登原, 憲司, 諸星, 利男, 入澤, 篤志, 大原, 弘隆, 洪, 繁, 菅野, 敦, 須田, 耕一, 西野, 隆義, 平野, 賢二, 吉田, 仁, 浜野, 英明, 日本膵臓学会, 厚生労働省難治性膵疾患に関する調査研究班
    膵臓 27 1 17 - 25 2012年02月 [査読有り][通常論文]
  • Shin Hamada, Kennichi Satoh, Morihisa Hirota, Atsushi Kanno, Jun Umino, Hiromichi Ito, Atsushi Masamune, Kazuhiro Kikuta, Kiyoshi Kume, Tooru Shimosegawa
    JOURNAL OF CELLULAR PHYSIOLOGY 227 2 729 - 738 2012年02月 [査読有り][通常論文]
     
    Pancreatic cancer is one of the life-threatening cancers due to the difficulty in the curative surgery and resistance against conventional therapeutic strategies. Recent studies indicated that cancer stem cells, which exist as a small number of cells within the entire cancer tissue, contribute to the disease progression. Cancer stem cells reveal resistance against conventional chemotherapy, which is derived from the high-expression of multiple transporter genes. Our previous study demonstrated the aggravating role of the homeobox gene MSX2 as an inducer of epithelial-mesenchymal transition, and MSX2 turned out to correlate with the chemoresistance in the current study. Comprehensive analysis of the MSX2-target gene has identified ABCG2 as the responsible gene. Since previous studies reported the pivotal role of ABCG2 as a determining factor of cancer stem cells, the detailed regulatory mechanism of ABCG2 expression by MSX2 was investigated. As a result, the MSX2 expression level in each cell line well correlated with the ABCG2 expression level, and alteration of the MSX2 expression level by over-expression or siRNA-based knockdown affected the ABCG2 expression accordingly. Finally, we identified the functional cooperation of MSX2 and SP1 in the transcriptional regulation of ABCG2 via the SP1 binding elements within the ABCG2 promoter. These findings clarified the intriguing regulatory mechanism of the cancer stem cell-related gene, and will delineate a novel therapeutic target in pancreatic cancer. J. Cell. Physiol. (C) 2011 Wiley Periodicals, Inc.
  • 【明らかにされた自己免疫性膵炎および周辺疾患】 AIPおよびその周辺疾患に関連する生化学・画像診断up to date EUS-FNAによる自己免疫性膵炎の診断能の検討
    菅野 敦, 濱田, 晋, 石田, 和之, 能登原, 憲司, 下瀬川 徹
    肝・胆・膵 64 1 45 - 51 2012年01月 [査読無し][招待有り]
  • Terumi Kamisawa, Taku Tabata, Seiichi Hara, Sawako Kuruma, Kazuro Chiba, Atsushi Kanno, Atsushi Masamune, Tooru Shimosegawa
    FRONTIERS IN PHYSIOLOGY 3 374 - 374 2012年 [査読有り][通常論文]
     
    It is now clear that are two histological types (Type-1 and Type-2) of autoimmune pancreatitis (AIP). The histological pattern of Type-1 AIP or traditional AIP is called lymphoplasmacytic sclerosing pancreatitis (LPSP). The histological pattern of Type-2 AIR is characterized by neutrophilic infiltration in the epithelium of the pancreatic duct. In general, Type-2 AIR patients are younger, may not have a male preponderance, and rarely show elevation of serum IgG4 compared with Type-1 AIP patients. Unlike Type-1 AIP patients, Type-2 AIP patients rarely have associated sclerosing diseases, but they are more likely to have acute pancreatitis and ulcerative colitis. Although Type-2 AIP is sometimes observed in the USA and Europe, most AIP cases in Japan and Korea are Type-1. The international consensus diagnostic criteria for AIP comprise 5 cardinal features, and combinations of one or more of these features provide the basis for diagnoses of both Type-1 and Type-2 AIP Due to the fact that steroid therapy is clinically, morphologically, and serologically effective in AIP patients, it is the standard therapy for AIP The indications for steroid therapy in AIP include symptoms such as obstructive jaundice and the presence of symptomatic extrapancreatic lesions. Oral prednisolone (0.6 mg/kg/day) is administered for 2-4 weeks and gradually tapered to a maintenance dose of 2.5-5 mg/day over a period of 2-3 months. Maintenance therapy by low-dose prednisolone is usually performed for 1-3 years to prevent relapse of AIP
  • Shin Hamada, Kennichi Satoh, Wataru Fujibuchi, Morihisa Hirota, Atsushi Kanno, Jun Unno, Atsushi Masamune, Kazuhiro Kikuta, Kiyoshi Kume, Tooru Shimosegawa
    MOLECULAR CANCER RESEARCH 10 1 3 - 10 2012年01月 [査読有り][通常論文]
     
    The epithelial-mesenchymal transition (EMT) is a critical step for pancreatic cancer cells as an entry of metastatic disease. Wide variety of cytokines and signaling pathways are involved in this complex process while the entire picture is still cryptic. Recently, miRNA was found to regulate cellular function including EMT by targeting multiple mRNAs. We conducted comprehensive analysis of miRNA expression profiles in invasive ductal adenocarcinoma (IDA), intraductal papillary mucinous adenoma, intraductal papillary mucinous carcinoma, and human pancreatic cancer cell line to elucidate essential miRNAs which regulate invasive growth of pancreatic cancer cells. Along with higher expression of miR-21 which has been shown to be highly expressed in IDA, reduced expression of miR-126 in IDA and pancreatic cancer cell line was detected. The miR-126 was found to target ADAM9 (disintegrin and metalloproteinase domain-containing protein 9) which is highly expressed in pancreatic cancer. The direct interaction between miR-126 and ADAM9 mRNA was confirmed by 30 untranslated region assay. Reexpression of miR-126 and siRNA-based knockdown of ADAM9 in pancreatic cancer cells resulted in reduced cellular migration, invasion, and induction of epithelial marker E-cadherin. We showed for the first time that the miR-126/ADAM9 axis plays essential role in the inhibition of invasive growth of pancreatic cancer cells. Mol Cancer Res; 10(1); 3-10. (C) 2011 AACR.
  • Hiroshi Yamaguchi, Yuko Kuboki, Takashi Hatori, Masakazu Yamamoto, Keiko Shiratori, Shunji Kawamura, Makio Kobayashi, Michio Shimizu, Shinichi Ban, Isamu Koyama, Morihiro Higashi, Nobuhiro Shin, Kazuyuki Ishida, Takanori Morikawa, Fuyuhiko Motoi, Michiaki Unno, Atsushi Kanno, Kennichi Satoh, Tooru Shimosegawa, Hideki Orikasa, Tomoo Watanabe, Kazuhiko Nishimura, Youji Harada, Toru Furukawa
    AMERICAN JOURNAL OF SURGICAL PATHOLOGY 35 12 1812 - 1817 2011年12月 [査読有り][通常論文]
     
    Intraductal tubulopapillary neoplasm (ITPN) is a recently recognized rare variant of intraductal neoplasms of the pancreas. Molecular aberrations underlying the neoplasm remain unknown. We investigated somatic mutations in PIK3CA, PTEN, AKT1, KRAS, and BRAF. We also investigated aberrant expressions of phosphorylated AKT, phosphatase and tensin homolog (PTEN), tumor protein 53 (TP53), SMAD4, and CTNNB1 in 11 cases of ITPNs and compared these data with those of 50 cases of intraductal papillary mucinous neoplasm (IPMN), another distinct variant of pancreatic intraductal neoplasms. Mutations in PIK3CA were found in 3 of 11 ITPNs but not in IPMNs (P = 0.005; Fisher exact test). In contrast, mutations in KRAS were found in none of the ITPNs but were found in 26 of the 50 IPMNs (P = 0.001; Fisher exact test). PIK3CA mutations were associated with strong expression of phosphorylated AKT (P < 0.001; the Mann-Whitney U test). Moreover, the expression of phosphorylated AKT was apparent in most ITPNs but only in a few IPMNs (P < 0.001; the Mann-Whitney U test). Aberrant expressions of TP53, SMAD4, and CTNNB1 were not statistically different between these neoplasms. Mutations in PIK3CA and the expression of phosphorylated AKT were not associated with age, sex, tissue invasion, and patients' prognosis in ITPNs. These results indicate that activation of the phosphatidylinositol 3-kinase pathway may play a crucial role in ITPNs but not in IPMNs. In contrast, the mutation in KRAS seems to play a major role in IPMNs but not in ITPNs. The activated phosphatidylinositol 3-kinase pathway may be a potential target for molecular diagnosis and therapy of ITPNs.
  • Morihisa Hirota, Masashi Tsuda, Yoshihisa Tsuji, Atsushi Kanno, Kazuhiro Kikuta, Kiyoshi Kume, Shin Hamada, Jun Unno, Hiromichi Ito, Hiroyuki Ariga, Tsutomu Chiba, Atsushi Masamune, Kennichi Satoh, Tooru Shimosegawa
    PANCREAS 40 8 1295 - 1301 2011年11月 [査読有り][通常論文]
     
    Objectives: The aim of this study was to clarify the pancreatic blood perfusion in patients with autoimmune pancreatitis (AIP) and the changes after steroid treatment. Methods: Perfusion computed tomography was performed in 11 patients with AIP and 12 control subjects. Pancreatic volumetric blood flow (F(V)), volume of distribution (V(D)), and blood transit time (T) were determined from a single-compartment kinetic model. Nine patients with AIP were reexamined by perfusion computed tomography after corticosteroid administration. Results: The pancreatic F(V) values of the 11 patients with AIP (82.7/min) were significantly lower than those of control subjects (163.5/min, P = 0.0006). On the other hand, the pancreatic V(D) and (T) values were not significantly different between AIP and normal. After steroid treatment, the F(V) values of 9 reexamined patients with AIP (76.2/min) were significantly elevated (109.8/min, P = 0.0391). However, the changes of the values after the treatment differed in degree among individuals. The values of 4 patients were dramatically elevated to greater than 100/min, whereas those of 4 other patients did not improve well. The value of the remaining patient whose initial FV value was normal (168.09/min) did not change after the treatment. Conclusions: Pancreatic volumetric perfusion was attenuated in AIP patients. The perfusion was improved after the steroid treatment.
  • Yu Katayose, Toshiki Rikiyama, Fuyuhiko Motoi, Kuniharu Yamamoto, Hiroshi Yoshida, Takanori Morikawa, Hiroki Hayashi, Atsushi Kanno, Morihisa Hirota, Kennichi Satoh, Hisanori Ariga, Masaki Suzuki, Motoki Ohyauchi, Yutaka Kondo, Shinichi Ikeya, Yoshihiro Ogawa, Tooru Shimosegawa, Shinichi Egawa, Michiaki Unno
    HEPATO-GASTROENTEROLOGY 58 112 1866 - 1872 2011年11月 [査読有り][通常論文]
     
    Background/Aims: The feasibility of neoadjuvant chemoradiation therapy for cholangiocarcinoma, followed by conventional resection, has not been determined yet. Here, a phase I study of neoadjuvant chemoradiation therapy, named NACRAC, was performed to determine the maximum tolerated dose (MTD) and the recommended dose (RD) of gemcitabine when combined with external beam radiation therapy for resectable cholangiocarcinoma. Methodology: From August 2007 to June 2008, 12 patients provided informed consent. Preoperative radiation was administered in 1.8Gy daily fractions up to a total dose of 45Gy. Gemcitabine was administered at day land 8 every three weeks. The initial dose of gemcitabine was started from 400mg/m2(.) Results: One patient was not able to start treatment because of bleeding caused by a duodenal ulcer and cholangitis. At 800mg/m(2) of gemcitabine, one patient out of three failed to complete the treatment because of Grade 3 hematological toxicity. In another three cases of 800mg/m(2), the second case could not complete the treatment because of cholangitis. Then, 600mg/m(2) was determined to be the MTD, and the RD dose decided as 600mg/m(2). Conclusions: The RD of gemcitabine in NACRAC study was determined to be 600mg/m(2). NACRAC study should proceed to a phase II trial to evaluate the effectiveness.
  • Evangelos Kalaitzakis, Michael Levy, Terumi Kamisawa, Gavin J. Johnson, Todd H. Baron, Mark D. Topazian, Naoki Takahashi, Atsushi Kanno, Kazuichi Okazaki, Naoto Egawa, Kazushige Uchida, Kashif Sheikh, Zahir Amin, Tooru Shimosegawa, Neomal S. Sandanayake, Nicholas I. Church, Michael H. Chapman, Stephen P. Pereira, Suresh Chari, George J. M. Webster
    CLINICAL GASTROENTEROLOGY AND HEPATOLOGY 9 9 800 - U120 2011年09月 [査読有り][通常論文]
     
    BACKGROUND & AIMS: Distinction of immunoglobulin G4-associated cholangitis (IAC) from primary sclerosing cholangitis (PSC) or cholangiocarcinoma is challenging. We aimed to assess the performance characteristics of endoscopic retrograde cholangiography (ERC) for the diagnosis of IAC. METHODS: Seventeen physicians from centers in the United States, Japan, and the United Kingdom, unaware of clinical data, reviewed 40 preselected ERCs of patients with IAC (n = 20), PSC (n = 10), and cholangiocarcinoma (n = 10). The performance characteristics of ERC for IAC diagnosis as well as the kappa statistic for intraobserver and interobserver agreement were calculated. RESULTS: The overall specificity, sensitivity, and interobserver agreement for the diagnosis of IAC were 88%, 45%, and 0.18, respectively. Reviewer origin, specialty, or years of experience had no statistically significant effect on reporting success. The overall intraobserver agreement was fair (0.74). The operating characteristics of different ERC features for the diagnosis of IAC were poor. CONCLUSIONS: Despite high specificity of ERC for diagnosing IAC, sensitivity is poor, suggesting that many patients with IAC may be misdiagnosed with PSC or cholangiocarcinoma. Additional diagnostic strategies are likely to be vital in distinguishing these diseases.
  • 【胆膵系超音波検査の基礎知識2011】 膵疾患における造影ハーモニックEUSの手技の実際と画像
    菅野敦, 下瀬川徹
    胆と膵 32 8 747 - 755 2011年08月 [査読無し][招待有り]
  • Morihisa Hirota, Tohru Asakura, Atsushi Kanno, Kazuhiro Kikuta, Kiyoshi Kume, Shin Hamada, Jun Unno, Hiromichi Ito, Hiroyuki Ariga, Atsushi Masamune, Kennichi Satoh, Fuyuhiko Motoi, Shinichi Egawa, Michiaki Unno, Tooru Shimosegawa
    PANCREAS 40 6 946 - 950 2011年08月 [査読有り][通常論文]
     
    Objectives: The aim of this study was to compare the benefits between endoscopic drainage and surgical drainage of the pancreatic duct for patients with chronic calcified pancreatitis. Methods: A total of 68 patients were classified into endoscopic (n = 34) or surgical (n = 34) treatment groups. Patients receiving endoscopic treatment were further divided into 2 subgroups: a short-period group, patients who could discontinue serial pancreatic stenting within 1 year (n = 19); and a long-period group, patients who needed pancreatic drainage by serial endoscopic stenting for more than 1 year (n = 15). The medical records of these patients were retrospectively analyzed. Results: Hospital stays, frequency of hospitalizations, and medical expense were similar between the short-period endoscopic treatment group and surgery group. On the other hand, patients in the long-period endoscopic treatment group required significantly longer hospital stays, more frequent hospitalizations, and had higher medical expenses than the short-period endoscopic treatment group as well as than the surgery group. Conclusions: Patients who underwent serial endoscopic stenting for more than 1 year showed no benefit compared with surgical treatment in terms of the frequency of hospital stays and medical costs.
  • Kentaro Takanami, Takayuki Yamada, Masashi Tsuda, Kei Takase, Kazuyuki Ishida, Yasuhiro Nakamura, Atsushi Kanno, Tooru Shimosegawa, Michiaki Unno, Shoki Takahashi
    ABDOMINAL IMAGING 36 4 447 - 456 2011年08月 [査読有り][通常論文]
     
    Mucin-producing intraductal papillary neoplasm (adenocarcinoma/adenoma) in the bile duct is becoming recognized as a specific type of neoplasm. Since, it bears a striking similarity to intraductal papillary mucinous neoplasms of the pancreas with regard to its histopathologic features, the term "intraductal papillary mucinous neoplasms of the bile duct" (IPMN-B) is frequently used, although no definite terminology or definition has been decided by World Health Organization. This neoplasm lacks ovarian-like stroma and communicates with the bile ducts, unlike biliary mucinous cystic neoplasm (MCN). On the other hand, malignant IPMN-B is categorized as an intraductal-growth type of intrahepatic cholangiocarcinoma (ICC). In comparison to other types of ICC, such as the mass-forming type and periductal-infiltrating type that have poor resectability and an unfavorable prognosis, malignant IPMN-B can be resected and demonstrates a more favorable prognosis. Meanwhile, unlike biliary MCN that is usually confined in a closed cyst, IPMN-B can spread along the mucosal surface of the bile ducts, and it should be widely resected. Therefore, multimodality assessment is needed to ensure the correct diagnosis of IPMN-B. We herein review the imaging findings of IPMN-B with pathologic correlation.
  • 【膵IPMNの手術適応の見直し】 分枝型IPMNの治療方針
    菅野敦, 下瀬川徹
    消化器内科 52 6 634 - 639 2011年06月 [査読無し][招待有り]
  • 超音波内視鏡下穿刺吸引生検法(EUS-FNA)が診断及び治療方針決定に有用であった膵内分泌腫瘍の1例
    伊藤 広通, 菅野, 敦, 石田, 和之, 下瀬川 徹
    クリニシアン 58 6 715 - 719 2011年06月 [査読無し][招待有り]
  • Hiromichi Ito, Kennichi Satoh, Shin Hamada, Morihisa Hirota, Atsushi Kanno, Kazuyuki Ishida, Jun Unno, Atsushi Masamune, Yu Katayose, Michiaki Unno, Tooru Shimosegawa
    ANTICANCER RESEARCH 31 3 1011 - 1017 2011年03月 [査読有り][通常論文]
     
    Background: To distinguish cholangiocarcinoma from inflammatory disease remains difficult when stricture is present in the bile duct. Endoscopic brushing cytology is a convenient method for stricture in the bile duct, however, the diagnostic sensitivity of this method for malignancy is reported to be low (< 60%). Msh homeobox 2 is frequently expressed in carcinoma cells of epithelial origin but not in normal tissues. Aim: To assess whether MSX2 expression level in brushing samples allows differentiation of malignant from benign bile duct stricture. Patients and Methods: Cytological brushing specimens were obtained from strictures of the bile duct during endoscopic retrograde cholangiopancreaticography (ERCP) in 71 patients. The brushing fluid was subjected to cytological diagnosis and RNA extraction. The expression level of MSX2 was evaluated by one-step real-time RT-PCR. Results: MSX2 expression levels were significantly higher in malignant than in benign bile duct stricture (p=0.004). The sensitivity and specificity for cholangiocarcinoma of cytology and MSX2 expression in strictures of the bile duct were: 55.3% and 100%, and 72.3% and 58.3%, respectively. Conclusion: The sensitivity of MSX2 expression level for cholangiocarcinoma was much higher than that of cytology. This suggests that the evaluation of MSX2 level in ERCP brushing samples would be a useful tool to distinguish malignant from benign bile duct stricture.
  • Kei Ito, Naotaka Fujita, Atsushi Kanno, Hiroyuki Matsubayashi, Shinji Okaniwa, Kazunari Nakahara, Kazuya Suzuki, Rhoichi Enohara
    INTERNAL MEDICINE 50 24 2927 - 2932 2011年 [査読有り][通常論文]
     
    Background and Aim Pancreatitis remains a serious complication after endoscopic retrograde cholangiopancreatography (ERCP). The efficacy of prophylactic pancreatic duct stent placement to prevent post-ERCP pancreatitis in patients at high risk has been established in several randomized controlled trials. The aim of this study was to investigate the frequency and risk factors of post-ERCP pancreatitis in patients who had undergone prophylactic pancreatic duct stenting. Patients and Methods Between July 2002 and January 2010, ERCP-related procedures were performed in 9192 cases of pancreatobiliary diseases at seven institutions. Among them, 414 patients (246 men, 168 women; mean age, 68 yr; age range, 22-91 yr) at high risk of post-ERCP pancreatitis who had undergone prophylactic pancreatic duct stenting were included in this study. The stent used in the present study was a 5-Fr stent with a single duodenal pigtail, which is made of soft polyethylene and has no flange (Pit-stent: Cathex, Co., Ltd., Tokyo, Japan). The pancreatic duct stent was placed via the channel of the duodenoscope over a guidewire with the assistance of fluoroscopy at the end of the procedure. The frequency and risk factors of post-ERCP pancreatitis were investigated. Post-ERCP pancreatitis was defined based on the consensus criteria. Results Therapeutic ERCP was performed in 52% of the patients. Indications for prophylactic pancreatic duct stenting were as follows: difficult cannulation of the bile duct, 192; pancreatic duct cytology/biopsy, 95; precut sphincterotomy, 40; pancreatic sphincterotomy, 29; female gender, 28; papillectomy, 25; sphincter of Oddi dysfunction, 12; history of pancreatitis, 10. Hyperamylasemia at 18-24 h after ERCP was observed in 64% (267 patients) of the patients. Pancreatitis occurred in 9.9% (41 patients: mild, 37; moderate, 2; severe, 2). Univariate analysis revealed intraductal papillary mucinous neoplasm (IPMN) of the pancreas to be the only significant risk factor for pancreatitis (OR 2.9, 95% CI 1.2, 7.1). Multivariate analysis also showed IPMN to be the only risk factor for pancreatitis (OR 3.1, 95% CI 1.2, 7.8). The mean diameter of the pancreatic head duct in patients with IPMN who developed post-ERCP pancreatitis was significantly smaller than that in those who did not develop pancreatitis (3.0 +/- 1 mm vs 4.7 +/- 2.6 mm, p=0.0037). Conclusion Post-ERCP pancreatitis developed in 9.9% of the patients at high risk who had undergone prophylactic pancreatic duct stenting. Since the majority of cases of post-ERCP pancreatitis were mild, pancreatic duct stenting may contribute to lessening the severity of pancreatitis. The present results suggest that IPMN without a dilated pancreatic head duct is a possible risk factor for post-ERCP pancreatitis after prophylactic pancreatic duct stenting.
  • Atsushi Kanno, Kennichi Satoh, Shin Hamada, Morihisa Hirota, Atsushi Masamune, Fuyuhiko Motoi, Shinichi Egawa, Michiaki Unno, Kazuyuki Ishida, Kenji Kimura, Taro Shuin, Tooru Shimosegawa
    INTERNAL MEDICINE 50 12 1293 - 1298 2011年 [査読有り][通常論文]
     
    We describe here a case of von Hippel-Lindau (VHL) disease with a serous cystic neoplasm of the whole pancreas. The patient was a 35-year-old woman suffering from a palpable abdominal tumor. She had a history of hemangioblastomas of the cerebellum. CT revealed large solid tumors in the pancreatic head and body, and multiple cystic lesions in the whole pancreas as well as a right renal tumor. When endoscopic retrograde cholangiopancreatography (ERCP) was performed, bleeding from the duodenal papilla was detected. Since she had some distinguishing clinical features, the diagnosis of VHL disease was made. The preoperative diagnosis of the pancreatic lesion was serous cystic neoplasms with hemosuccus pancreaticus and total pancreatectomy was performed. Histological examination of the specimen revealed serous cystic neoplasms which occupied the entire pancreas. VHL cases operated on for serous cystic neoplasms of the entire pancreas are very rare.
  • Shin Hamada, Kennichi Satoh, Morihisa Hirota, Atsushi Kanno, Kazuyuki Ishida, Jun Umino, Hiromichi Ito, Kazuhiro Kikuta, Kiyoshi Kume, Atsushi Masamune, Yu Katayose, Michiaki Unno, Tooru Shimosegawa
    CANCER SCIENCE 102 1 150 - 156 2011年01月 [査読有り][通常論文]
     
    The incidence and mortality of cholangiocarcinoma are increasing despite improvements in the diagnostic method. Since the sensitivity of brushing cytology for cholangiocarcinoma is not satisfactory, a novel diagnostic marker needs to be established. A recent report has suggested upregulation of the calcium-binding protein S100P in cholangiocarcinoma. The expression status of S100P in normal bile duct and cholangiocarcinoma tissues was assessed by immunohistochemistry. The expression levels of S100P mRNA in the brushing cytology samples during endoscopic retrograde cholangiopancreatography (ERCP) from benign biliary strictures and cholangiocarcinoma were assessed by real-time reverse transcription-polymerase chain reaction (RT-PCR). The sensitivity and specificity of each diagnostic strategy was compared. S100P was frequently expressed in the cholangiocarcinoma tissues, but not in the normal bile duct. The brushing cytology samples from the cholangiocarcinoma cases revealed higher expression levels of S100P compared with the benign biliary strictures. The relative expression level of S100P could determine the cholangiocarcinoma at higher sensitivity than classical cytology, and the combination of the S100P expression level and cytology yielded a sensitivity of 90.0%, with a specificity of 92.0%. Calcium-binding protein S100P is a novel marker of cholangiocarcinoma. Detecting the S100P expression levels in brushing cytology samples has a diagnostic value, which will be helpful for better diagnosis of cholangiocarcinoma. (Cancer Sci 2011; 102: 150-156).
  • Kennichi Satoh, Shin Hamada, Atsushi Kanno, Kazuyuki Ishida, Hiromichi Ito, Morihisa Hirota, Atsushi Masamune, Shinichi Egawa, Michiaki Unno, Tooru Shimosegawa
    CANCER SCIENCE 102 1 157 - 161 2011年01月 [査読有り][通常論文]
     
    It is difficult to distinguish pancreatic ductal adenocarcinoma (PDAC) from chronic pancreatitis (CP) when stricture is present in the pancreatic duct. Endoscopic brushing cytology is a convenient method for investigating strictures in the pancreatic duct, however, the diagnostic sensitivity of this method for PDAC is reported to be low (40-70%). Recently, we revealed that MSX2 is frequently expressed in PDAC cells but not in normal cultured pancreatic duct or stellate cells. Thus, we analyzed MSX2 expression levels in brushing samples to examine whether this would differentiate PDAC from CP. Cytologic brushing specimens were obtained from pancreatic duct strictures during endoscopic retrograde cholangiopancreaticography in 82 patients. The brushing fluid was subjected to cytological diagnosis and RNA extraction. The expression level of MSX2 was evaluated by one-step real-time RT-PCR. MSX2 expression levels were significantly higher in PDAC than in CP (P = 0.0000007), and the expression level was associated with positive cytology (P = 0.013). The sensitivity, specificity, and diagnostic accuracy for PDAC of cytology and MSX2 expression in ductal strictures were: 47.4%, 100%, and 63.4%, and 73.7%, 84.0%, and 79.3%, respectively. The sensitivity and accuracy of MSX2 expression levels for diagnosis were much higher than those of cytology. This suggests that the evaluation of MSX2 levels in endoscopic retrograde cholangiopancreaticography brushing samples would be useful for distinguishing PDAC from CP. (Cancer Sci 2011; 102: 157-161).
  • 菅野敦, 大学院消化器病態学分野, 佐藤賢一, 廣田衛久, 正宗淳, 高舘達之, 力山敏樹, 海野倫明, 石田和之, 下瀬川徹
    胆道 24 5 714 - 722 日本胆道学会 2010年12月 [査読有り][通常論文]
     
    下部胆管に発生した腺内分泌細胞癌の1例を報告する。症例は62歳、男性。全身倦怠感と皮膚黄染を主訴に来院した。入院時の血液検査所見は肝胆道系酵素の上昇を認めた。腹部CTでは下部胆管に造影効果のある腫瘍を認め、そこから肝側の胆管は拡張していた。ERCPでは、下部胆管に腫瘤影と一致した偏側性の欠損像を認めた。経乳頭的に生検を施行した結果、腺内分泌細胞癌の診断であった。遠隔転移を認めず、膵頭十二指腸切除術を施行した。術後gemcitabineの補助化学療法を施行したが、術後3ヵ月で多発性の肝転移が認められ、術後5ヵ月で永眠された。胆管原発の腺内分泌細胞癌は極めて稀であり、また術前の生検にて腺内分泌細胞癌と診断し得た症例の報告はなく貴重と考えられた。(著者抄録)
  • Morihisa Hirota, Tooru Asakura, Atsushi Kanno, Tooru Shimosegawa
    JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 17 6 770 - 775 2010年11月 [査読有り][通常論文]
     
    Endoscopic treatment associated with or without extracorporeal shock wave lithotripsy (ESWL) for chronic pancreatitis has been employed for about 20 years. Although two randomized control trials have revealed the greater effectiveness of surgery as compared to endoscopic treatment for chronic pancreatitis, a considerable number of patients have successfully obtained complete and long-term relief from pain by the less invasive endoscopic treatment. In this review, we discuss the indications, techniques and results of endoscopic treatment and ESWL for painful chronic pancreatitis. We also discuss the characteristic clinical features that are predictive of a good response to endoscopic treatment and ESWL.
  • Morihisa Hirota, Tooru Asakura, Atsushi Kanno, Tooru Shimosegawa
    JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 17 6 770 - 775 2010年11月 [査読有り][通常論文]
     
    Endoscopic treatment associated with or without extracorporeal shock wave lithotripsy (ESWL) for chronic pancreatitis has been employed for about 20 years. Although two randomized control trials have revealed the greater effectiveness of surgery as compared to endoscopic treatment for chronic pancreatitis, a considerable number of patients have successfully obtained complete and long-term relief from pain by the less invasive endoscopic treatment. In this review, we discuss the indications, techniques and results of endoscopic treatment and ESWL for painful chronic pancreatitis. We also discuss the characteristic clinical features that are predictive of a good response to endoscopic treatment and ESWL.
  • Atsushi Masamune, Takashi Watanabe, Kazuhiro Kikuta, Kennichi Satoh, Atsushi Kanno, Tooru Shimosegawa
    AMERICAN JOURNAL OF PHYSIOLOGY-GASTROINTESTINAL AND LIVER PHYSIOLOGY 299 4 G821 - G832 2010年10月 [査読有り][通常論文]
     
    Activated pancreatic stellate cells (PSCs) play a pivotal role in pancreatic fibrosis in chronic pancreatitis and pancreatic cancer. Recent studies have suggested a role of IL-33, a newly identified IL-1 family member, in fibrosis. We here examined the expression of IL-33 and the IL-33-mediated regulation of cell functions in PSCs. PSCs were isolated from human and rat pancreas tissues. The expression of IL-33 was examined by Western blotting, PCR, ELISA, and immunostaining. The roles of IL-33 in the regulation of PSC functions were examined by using recombinant IL-33 and small interfering RNA. Activated PSCs expressed IL-33 in the nucleus, and the expression was increased by IL-1 beta, TNF-alpha, PDGF-BB, and IFN-gamma, but not TGF-beta 1. Nuclear IL-33 expression was also observed in the pancreatic acinar and ductal cells. IL-1 beta induced IL-33 expression mainly through the activation of NF-kappa B and ERK pathways and partially through that of p38 MAP kinase, whereas PDGF-BB induced IL-33 expression mainly through the activation of ERK pathway. PSCs expressed soluble ST2, ST2L, and IL-1RAcP, but the expression level of ST2L was relatively low. Recombinant IL-33 did not stimulate key cell functions of PSCs. Decreased IL-33 expression by small interfering RNA resulted in decreased proliferation in response to PDGF-BB. In conclusion, activated PSCs expressed IL-33 in the nucleus. IL-33 might regulate the PDGF-induced proliferation in PSCs.
  • 三浦 孝之, 元井, 冬彦, 伊藤, 啓, 伊藤, 広通, 菅野, 敦, 佐藤, 賢一, 赤田, 昌紀, 力山, 敏樹, 片寄, 友, 江川, 新一, 下瀬川, 徹, 海野 倫明
    日本消化器病学会雑誌 107 10 1669 - 1675 (一財)日本消化器病学会 2010年10月 [査読有り][通常論文]
     
    50歳男性、乳頭部癌に対し幽門輪温存膵頭十二指腸切除術(膵胃吻合)を施行され、6年後膵胃吻合部狭窄にともなう慢性膵炎、膵石症を併発した。超音波内視鏡下に膵管ステントを留置し症状が改善するも、9ヵ月後膵炎が頻回に再燃したため当科にて膵管空腸側々吻合(膵管ドレナージ術)を施行した。膵管空腸側々吻合術は膵頭切除後の慢性膵炎に対して有効で安全に施行し得、残膵機能温存の観点からも推奨される術式だと考えられた。(著者抄録)
  • 自己免疫性膵炎の治療と予後 自己免疫性膵炎の再燃に関する検討
    菅野 敦, 佐藤 賢一, 下瀬川 徹
    日本消化器病学会雑誌 107 臨増大会 A580 - A580 (一財)日本消化器病学会 2010年09月
  • Atsushi Kanno, Kennichi Satoh, Morihisa Hirota, Shin Hamada, Jun Umino, Hiromichi Itoh, Atsushi Masamune, Tohru Asakura, Tooru Shimosegawa
    JOURNAL OF GASTROENTEROLOGY 45 9 952 - 959 2010年09月 [査読有り][通常論文]
     
    Background Patients with branch duct type intraductal papillary mucinous neoplasm (BD-IPMN) without invasion usually show favorable prognosis. However, the prognosis becomes poor when the IPMN lesions give rise to invasive carcinoma cells. In addition, recent studies have revealed that BD-IPMN is frequently complicated by common type pancreatic ductal carcinoma. Thus, the prognosis of BD-IPMN depends on the occurrence of these two types of invasive carcinoma. However, little is known about the risk factors for the development of these invasive carcinomas in BD-IPMN. This study aims to identify the factors which predict the development of invasive carcinoma in BD-IPMN. Methods Invasive pancreatic carcinoma associating with BD-IPMN was classified as invasive IPMN group (invasive carcinoma derived directly from IPMN lesions) and concomitant group (common type of invasive carcinoma concomitant with BD-IPMN). The relation between the incidence of each type of invasive carcinoma in BD-IPMN and the clinicopathological parameters was retrospectively analyzed. Results There were 12 patients with invasive IPMN and 7 patients with concomitant cancer in 159 patients with BD-IPMN. Diameter of dilated branch (P < 0.001) or main pancreatic duct (MPD) (P = 0.001), size of mural nodule (P < 0.001), serum CEA level (P < 0.001) and serum CA19-9 level (P < 0.001) were factors associated significantly with invasive IPMN by univariate analysis. Among these factors, mural nodule with size larger than 6.5 mm [odds ratio 14.86 (95% CI 1.37-60.45); P = 0.02] and serum carcinoembryonic antigen (CEA) level over 5 ng/ml [odds ratio 6.91 (95% CI 1.17-54.13); P = 0.03] were found to be the factors independently associated with invasive IPMN. On the other hand, both univariate and multivariate analyses revealed that elevated carbohydrate antigen 19-9 (CA 19-9) levels were associated with the occurrence of concomitant ductal carcinoma in BD-IPMN [odds ratio 10.31 (95% CI 1.77-81.51); P = 0.01]. Conclusions Our results suggested that careful imaging study of the entire pancreas in addition to tumor lesions and measurement of serum CEA and CA19-9 would be required to find out the development of the two types of invasive carcinoma in BD-IPMN.
  • Hirota, Morihisa Asakura, Tooru Kanno, Atsushi Satoh, Kennichi Masamune, Atsushi Kikuta, Kazuhiro Kume, Kiyoshi Hamada, Shin Umino, Jun Takagi, Yasuhiko Watanabe, Takashi Itoh, Hiromichi Shimosegawa, Tooru
    Pancreas 39 5 695 - 695 2010年07月 [査読有り][通常論文]
  • Kennichi Satoh, Shin Hamada, Atsushi Kanno, Morihisa Hirota, Jun Umino, Hiromichi Ito, Atsushi Masamune, Shinichi Egawa, Michiaki Unno, Tooru Shimosegawa
    JOURNAL OF GASTROENTEROLOGY 45 7 763 - 770 2010年07月 [査読有り][通常論文]
     
    To distinguish malignant from benign branch duct (BD)-intraductal papillary mucinous neoplasm (IPMN) still remains difficult. Recently, we revealed that MSX2 was frequently expressed in pancreatic cancer and its expression was correlated with aggressive behavior of the cancer. The aim of this study was to assess the involvement of MSX2 in IPMN development and whether its expression would differentiate malignant from benign IPMN. Seventeen microdissected lesions and 45 IPMN tissues were used for quantitative real-time reverse-transcription polymerase chain reaction (RT-PCR) and immunohistochemistry, respectively. The role of MSX2 in the pancreatic duct cell was assessed by the induced expression of MSX2 in a normal human pancreatic duct epithelial cell line (HPDE). Malignant IPMN expressed significantly higher levels of MSX2 mRNA than benign IPMN lesions. MSX2 protein expression was frequently found in borderline and malignant lesions (20/29, 68.9%), while its expression was seen in only one of 16 benign IPMN tissues. Univariate analysis showed that nodules of 6 mm or more and MSX2 expression were significantly correlated with the malignancy of BD-IPMN (P = 0.022 and 0.0026, respectively), and multivariate analysis revealed that only MSX2 expression was identified as an independent factor to predict malignant BD-IPMN. HPDE cells expressing MSX2 showed increased cellular proliferation compared to control cells. Based on our results, MSX2 plays a pivotal role in the development of IPMN through growth stimulation of tumor cells, and its expression was identified as an independent predictive factor for malignancy of BD-IPMN.
  • 国際診療ガイドラインを踏まえたIPMNの内視鏡診断の現状と問題点 IPMN手術適応症例の再検討 EUS、CT、PETの比較
    菅野 敦, 佐藤 賢一, 下瀬川 徹
    Gastroenterological Endoscopy 52 Suppl.1 914 - 914 (一社)日本消化器内視鏡学会 2010年04月
  • 粂 潔, 正宗, 淳, 菅野, 敦, 伊藤, 広通, 渡辺, 崇, 濱田, 晋, 菊田, 和宏, 廣田, 衛久, 佐藤, 賢一, 朝倉, 徹, 下瀬川
    肝胆膵画像 12 2 215 - 222 (株)医学書院 2010年03月 [査読有り][通常論文]
     
    慢性膵炎患者における膵癌発生の相対的危険度は4〜8といわれている.なかでも遺伝性膵炎や熱帯性膵炎では膵癌発生が極めて高率であるとされ,遺伝性膵炎では膵癌発症率が標準人口と比べて約50〜60倍である.大結石型の膵石で高度な膵管拡張を示す症例は,膵癌合併の危険性がより高いと考えられる.当科で経験した膵癌を合併した慢性膵炎症例について遺伝子解析を行った結果,熱帯性膵炎や若年性膵炎と関連がある膵分泌性トリプシンインヒビター(SPINK1)遺伝子変異を8例中3例に同定した.膵癌の高危険群を同定できれば,症状の出現前から膵に注目した検査が行われ,早期診断の可能性が高くなると考えられる.(著者抄録)
  • 膵IPMNの手術適応の見直し 分枝型IPMNの手術適応の再検討
    菅野 敦, 佐藤 賢一, 下瀬川 徹
    日本消化器病学会雑誌 107 臨増総会 A114 - A114 (一財)日本消化器病学会 2010年03月
  • 自己免疫性膵炎をめぐる新たな展開 IgG4陰性自己免疫性膵炎の診断基準における位置づけ
    菅野 敦, 佐藤 賢一, 下瀬川 徹
    日本消化器病学会雑誌 107 臨増総会 A187 - A187 (一財)日本消化器病学会 2010年03月
  • Atsushi Kanno, Kennichi Satoh, Morihisa Hirota, Shin Hamada, Jun Umino, Hiromichi Itoh, Atsushi Masamune, Shinichi Egawa, Fuyuhiko Motoi, Michiaki Unno, Kazuyuki Ishida, Tooru Shimosegawa
    WORLD JOURNAL OF GASTROINTESTINAL ONCOLOGY 2 2 121 - 124 2010年02月 [査読有り][通常論文]
     
    Granular cell tumors, also called Abrikossof's tumors, were originally described by Abrikossof A in 1926. The first case of a pancreatic granular cell tumor was described in 1975 and only 6 cases have been reported. We describe a case of granular cell tumor in the pancreas showing pancreatic duct obstruction. Because imaging studies showed findings compatible with those of pancreatic carcinoma, the patient underwent distal pancreatectomy. Histological examination showed that the tumor consisted of a nested growth of large tumor cells with ample granular cytoplasm and small round nuclei. The tumor cells expressed S-100 protein and were stained with neuron-specific enolase and periodic acid-Schiff, but were negative for desmin, vimentin, and cytokeratin. The resected tumor was diagnosed as a granular cell tumor. To our knowledge, this is the seventh case of Granular cell tumor of the pancreas to be reported. (C) 2010 Baishideng. All rights reserved.
  • Atsushi Masamune, Kiyoshi Kume, Kazuhiro Kikuta, Takashi Watanabe, Morihisa Hirota, Kennichi Satoh, Atsushi Kanno, Noriaki Suzuki, Yoichi Kakuta, Tooru Shimosegawa
    JOURNAL OF GASTROENTEROLOGY 45 2 225 - 233 2010年02月 [査読有り][通常論文]
     
    This study aimed to clarify the association of the promoter variants in the CD14 gene with pancreatic diseases in Japan. Three hundred forty-six unrelated patients with acute pancreatitis (AP) (107 with severe and 239 with mild), 263 patients with chronic pancreatitis (CP), 264 patients with pancreatic neoplasm, and 319 healthy controls were genotyped for the single nucleotide polymorphisms at positions -260 and -651 from the AUG start codon in the CD14 gene by polymerase chain reaction-restriction enzyme digestion. The allele and genotype frequencies of the -260C/T and -651C/T polymorphisms did not differ between controls and patients with AP. In subgroup analyses, patients with severe AP had more -651C allele than controls [P = 0.005; odds ratio (OR) 1.71; 95% confidence interval (CI) = 1.18-2.49] or patients with mild AP (P = 0.001; OR 1.95; 95% CI = 1.33-2.85). Genotype -651CC was more common (P = 0.001 vs. controls and P = 0.001 vs. mild AP), and -651CT was less (P = 0.009 vs. controls and P = 0.007 vs. mild AP) in patients with severe AP than in healthy controls or patients with mild AP. The frequencies of pseudocyst development and requirement of surgery were higher in AP patients with -651CC than in those without this genotype. The -260C/T polymorphism was not associated with the severity of AP. The allele and genotype frequencies of both polymorphisms did not differ between controls and patients with CP or pancreatic neoplasm. -651C/T promoter polymorphism in the CD14 gene was associated with severity of AP in Japan.
  • 廣田衛久, 朝倉徹, 菅野敦, 佐藤賢一, 正宗淳, 菊田和宏, 粂潔, 濱田晋, 渡辺崇, 伊藤広通, 下瀬川徹
    胆と膵 30 11 1389 - 1393 医学図書出版(株) 2009年11月 [査読有り][通常論文]
     
    慢性膵炎の疼痛に対する治療の手順として内科治療を第一選択として先行し、内科治療難渋例に対し手術を行うことが一般的である。しかし、膵管ステント交換等で入退院を繰り返さざるを得ない場合、どの時点で外科治療へ移行するべきか具体的な指針は示されていない。入院回数や費用などの患者負担に着目して内科治療群34症例と外科治療群34症例の比較を行ったところ、入院経費に有意差は無かったが、内科治療群は年間入院回数が有意に多かった。次に、内科治療群を膵管ステントの交換を繰り返しながら1年以上留置した群と膵管ステントが1年未満で不要になった群に分けて比較した所、前者は後者および外科治療群に比べ急性膵炎などのイベント発生率、入院回数、入院費用ともに成績が劣っていた。膵管ステントを継続的に1年以上留置することは患者の利益にならない。膵管ステントを継続しなければならない症例は、1年を目処に手術を考慮するべきである。(著者抄録)
  • Atsushi Masamune, Takashi Watanabe, Kazuhiro Kikuta, Tooru Shimosegawa
    Clinical Gastroenterology and Hepatology 7 11 S48 - S54 2009年11月 [査読有り][通常論文]
     
    Over a decade, there is accumulating evidence that activated pancreatic stellate cells (PSCs) play a pivotal role in the development of pancreatic fibrosis. In response to pancreatic injury or inflammation, quiescent PSCs are transformed (activated) to myofibroblast-like cells, which express α-smooth muscle actin. Activated PSCs proliferate, migrate, produce extracellular matrix components, such as type I collagen, and express cytokines and chemokines. Recent studies have suggested novel roles of PSCs in local immune functions and angiogenesis in the pancreas. If the pancreatic inflammation and injury are sustained or repeated, PSC activation is perpetuated, leading to the development of pancreatic fibrosis. In this context, pancreatic fibrosis can be defined as pathologic changes of extracellular matrix composition in both quantity and quality, resulting from perpetuated activation of PSCs. Because PSCs are very similar to hepatic stellate cells, PSC research should develop in directions more relevant to the pathophysiology of the pancreas, for example, issues related to trypsin, non-oxidative alcohol metabolites, and pancreatic cancer. Indeed, in addition to their roles in chronic pancreatitis, it has been increasingly recognized that PSCs contribute to the progression of pancreatic cancer. Very recently, contribution of bone marrow-derived cells to PSCs was reported. Further elucidation of the roles of PSCs in pancreatic fibrosis should promote development of rational approaches for the treatment of chronic pancreatitis and pancreatic cancer. © 2009 AGA Institute.
  • T. Kamisawa, T. Shimosegawa, K. Okazaki, T. Nishino, H. Watanabe, A. Kanno, F. Okumura, T. Nishikawa, K. Kobayashi, T. Ichiya, H. Takatori, K. Yamakita, K. Kubota, H. Hamano, K. Okamura, K. Hirano, T. Ito, S. B. H. Ko, M. Omata
    GUT 58 11 1504 - 1507 2009年11月 [査読有り][通常論文]
     
    Objective: To establish an appropriate steroid treatment regimen for autoimmune pancreatitis (AIP). Methods: A retrospective survey of AIP treatment was conducted in 17 centres in Japan. The main outcome measures were rate of remission and relapse. Results: Of 563 patients with AIP, 459 (82%) received steroid treatment. The remission rate of steroid-treated AIP was 98%, which was significantly higher than that of patients without steroid treatment (74%, 77/104; p < 0.001). Steroid treatment was given for obstructive jaundice (60%), abdominal pain (11%), associated extrapancreatic lesions except the biliary duct (11%), and diffuse enlargement of the pancreas (10%). There was no relationship between the period necessary to achieve remission and the initial dose (30 mg/day vs 40 mg/day) of prednisolone. Maintenance steroid treatment was given in 377 (82%) of 459 steroid-treated patients, and steroid treatment was stopped in 104 patients. The relapse rate of patients with AIP on maintenance treatment was 23% (63/273), which was significantly lower than that of patients who stopped maintenance treatment (34%, 35/104; p=0.048). From the start of steroid treatment, 56% (55/99) relapsed within 1 year and 92% (91/99) relapsed within 3 years. Of the 89 relapsed patients, 83 (93%) received steroid re-treatment, and steroid re-treatment was effective in 97% of them. Conclusions: The major indication for steroid treatment in AIP is the presence of symptoms. An initial prednisolone dose of 0.6 mg/kg/day, is recommend, which is then reduced to a maintenance dose over a period of 3-6 months. Maintenance treatment with lowdose steroid reduces but dose not eliminate relapses.
  • 【胆道癌における進展度診断の新展開】
    海野倫明, 菅野敦, 力山敏樹, 片寄友, 江川新一, 下瀬川徹
    癌の臨床 55 7 487 - 491 2009年10月 [査読有り][通常論文]
  • Jun Unno, Kennichi Satoh, Morihisa Hirota, Atsushi Kanno, Shin Hamada, Hiromichi Ito, Atsushi Masamune, Nobukazu Tsukamoto, Fuyuhiko Motoi, Shinichi Egawa, Michiaki Unno, Akira Horii, Tooru Shimosegawa
    INTERNATIONAL JOURNAL OF ONCOLOGY 35 4 813 - 821 2009年10月 [査読有り][通常論文]
     
    LIV-1 is a downstream target of STAT3 and is essential for the nuclear localization of Snail, a master regulator of epithelial to mesenchymal transition (EMT). Little is known about the association of LIV-1 with pancreatic carcinoma development, therefore, expression of LIV-1 mRNA was analyzed by real-time reverse transcriptase polymerase chain reaction (RT-PCR) in 9 cultured cell lines (8 carcinoma and I normal duct cell lines) and 24 pancreatic tissues (12 carcinoma and 12 normal tissues). Localization of this gene product was investigated by immunohistochemistry in 72 pancreatic carcinoma and the relation between its expression and clinicopathological findings was examined. To assess the function of LIV-1 in pancreatic carcinoma cells, stable siRNA expressing Panc-1 cells were generated. Higher expression of LIV-1 mRNA was found in both pancreatic carcinoma cell lines and pancreatic carcinoma tissues compared to normal duct cell line and histologically normal tissues, respectively. Immunohistochemical analysis revealed that LIV-1 expression was frequently found in 76.4% of pancreatic carcinoma tissues and its expression level was associated with tumor size and lymphatic infiltration. Down-regulated LIV-1 cells showed significant inhibition of anchorage-dependent or -independent proliferation and cell motility in vitro and reduction of tumor growth and metastasis in vivo. Furthermore, nuclear expression of Snail was decreased and E-cadherin expression was restored in LIV-1 siRNA expressing pancreatic carcinoma cells. These findings indicate that LIV-1 may be involved in acquisition of the aggressive phenotype of human pancreatic carcinoma cells through the induction of epithelial to mesenchymal transition.
  • 菅野敦, 佐藤賢一, 廣田衛久, 正宗淳, 片寄友, 海野倫明, 石田和之, 全陽, 下瀬川徹
    胆道 23 4 677 - 683 日本胆道学会 2009年10月 [査読有り][通常論文]
     
    症例は64歳・男性。検診にて肝左葉に腫瘤を指摘され、精査目的に当科を紹介された。腹部超音波検査、CT、MRIで肝S2に類円形の嚢胞内に増殖する乳頭状腫瘤を認めた。MRCPでは嚢胞はB2からの連続性が推測されたが、ERCPでは胆管と嚢胞の交通は確認できなかった。肝左葉切除を施行したところ、嚢胞内に少量の粘液と、充実性に発育する腫瘍を認めた。腫瘍は、卵巣様間質を認めず、pancreatobiliary typeの高分化型乳頭腺癌であった。中枢側の正常胆管と交通を示唆する部位を認め、また腫瘍より末梢の胆管の存在を認めなかった。以上から、末梢胆管に発生した胆管内乳頭状腫瘍(intraductal papillary neoplasm of the bile duct:IPNB)と診断した。IPNBは、症例数が少なく臨床的特徴が不明である。本症例は類円形の形態を呈した貴重な一例と考えられた。(著者抄録)
  • 膵管内乳頭粘液腫瘍(IPMN)の手術適応と切離線を決定する検査法
    菅野 敦, 佐藤 賢一, 下瀬川 徹
    Gastroenterological Endoscopy 51 Suppl.2 2293 - 2293 (一社)日本消化器内視鏡学会 2009年09月
  • 自己免疫性膵炎関連疾患の病因病態 IgG4陰性自己免疫性膵炎の臨床的背景の検討
    菅野 敦, 佐藤 賢一, 下瀬川 徹
    日本消化器病学会雑誌 106 臨増大会 A740 - A740 (一財)日本消化器病学会 2009年09月
  • 菅野 敦, 佐藤 賢一, 廣田 衛久, 下瀬川 徹, 力山 敏樹, 海野 倫明, 石田 和之
    胆道 23 3 518 - 518 日本胆道学会 2009年08月
  • Hiroshi Yamaguchi, Michio Shimizu, Shinichi Ban, Isamu Koyama, Takashi Hatori, Izumi Fujita, Masaka Yamamoto, Shunji Kawamura, Makio Kobayashi, Kazuyuki Ishida, Takanori Morikawa, Fuyuhiko Motoi, Michiaki Unno, Atsushi Kanno, Kennichi Satoh, Tooru Shimosegawa, Hideki Orikasa, Tomoo Watanabe, Kazuhiko Nishimura, Yoshiro Ebihara, Naoto Koike, Toru Furukawa
    AMERICAN JOURNAL OF SURGICAL PATHOLOGY 33 8 1164 - 1172 2009年08月 [査読有り][通常論文]
     
    We have encountered cases of unusual intraductal pancreatic neoplasms with predominant tubulopapillary growth. We collected data on 10 similar cases of "intraductal tubulopapillary neoplasms (ITPNs)" and analyzed their clinicopathologic and molecular features. Tumor specimens were obtained from 5 men and 5 women with a mean age of 58 years. ITPNs were solid and nodular tumors obstructing dilated pancreatic ducts and did not contain any visible mucin. The tumor cells formed tubulopapillae and contained little cytoplasmic mucin. The tumors exhibited uniform high-grade atypia. Necrotic foci were frequently observed, and invasion was observed in some cases. The ITPNs were immunohistochemically positive for cytokeratin 7 and/or cytokeratin 19 and negative for trypsin, MUC2, MUC5AC, and fascin. Molecular studies revealed abnormal expressions of TP53 and SMAD4 in 1 case, but aberrant expression of P-catenin was not observed. No mutations in KRAS and BRAF were observed in the 8 cases that were examined. Eight patients are alive without recurrence, I patient died of liver metastases, and I patient is alive but had a recurrence and underwent additional pancreatectomy. The mitotic count and Ki-67 labeling index were significantly associated with invasion. All the features of ITPN were distinct from those of other known intraductal pancreatic neoplasms, including pancreatic intraepithelial neoplasia, intraductal papillary mucinous neoplasm, and the intraductal variant of acinar cell carcinoma. Intraductal tubular carcinomas showed several features that were similar to, those of ITPN, except for the tubulopapillary growth pattern. In conclusion, ITPNs can be considered to represent a new disease entity encompassing intraductal tubular carcinoma as a morphologic variant.
  • 佐藤 賢一, 濱田 晋, 菅野 敦, 廣田 衛久, 伊藤 広通, 下瀬川 徹
    膵臓 24 3 289 - 289 日本膵臓学会 2009年06月
  • 濱田 晋, 佐藤 賢一, 廣田 衛久, 菅野 敦, 海野 純, 伊藤 広通, 下瀬川 徹
    膵臓 24 3 376 - 376 日本膵臓学会 2009年06月
  • Tooru Shimosegawa, Atsushi Kanno
    JOURNAL OF GASTROENTEROLOGY 44 6 503 - 517 2009年06月 [査読有り][通常論文]
     
    Since the rediscovery and definition of autoimmune pancreatitis (AIP) by Yoshida et al. in 1995, the disease has been attracting attention because of its unique clinical features and practical issues. This disease shows very impressive imaging findings, serological changes, and characteristic histopathology. It occurs most commonly in elderly males with painless jaundice or mild abdominal pain; resemblance in imaging findings between AIP and pancreatobiliary cancers poses an important practical issue of differentiation. With increasing recognition of AIP and accumulation of cases, another important feature of this disease has been revealed, i.e., association of extrapancreatic organ involvements. Initially misunderstood because it can be accompanied by other autoimmune disorders, such as Sjogren's syndrome or primary sclerosing cholangitis (PSC), AIP is now known to be associated with unique types of sialadenitis and cholangitis distinct from Sjogren's syndrome or PSC. Now the concept of "IgG4-related sclerosing disease" has become widely accepted and the list of organs involved continues to increase. With worldwide recognition, an emerging issue is the clinical definition of other possible types of autoimmune-related pancreatitis called "idiopathic duct-centric chronic pancreatitis (IDCP)" and "AIP with granulocyte epithelial lesion (GEL)" and their relation to AIP with lymphoplasmacytic sclerosing pancreatitis (LPSP). The time has arrived to establish clinical diagnostic criteria of AIP based on international consensus and to discuss regional and racial differences in the clinicopathological features of AIP. Consensus guidelines are also required for the ideal use of steroids in the treatment of AIP to suppress recurrence efficiently with minimal side effects. There are many issues to be settled in AIP; international collaboration of experts in the pancreas field is necessary to clarify the entire picture of this unique and important disease.
  • 膵癌の診断と治療の新展開 膵管擦過細胞におけるMSX2、S100P発現量解析による膵癌診断への応用
    佐藤 賢一, 菅野 敦, 下瀬川 徹
    Gastroenterological Endoscopy 51 Suppl.1 686 - 686 (一社)日本消化器内視鏡学会 2009年04月
  • 菅野敦, 佐藤賢一, 下瀬川徹
    胆と膵 30 3 245 - 249 医学図書出版(株) 2009年03月 [査読有り][招待有り]
     
    分枝型IPMNの手術適応基準を検討するため、分枝型IPMN159例を対象とし、さらに手術例45例と経過観察例114例に分けて、後ろ向きに調査した。経過観察例114例を対象に、国際診療ガイドラインの手術適応である拡張分枝膵管径30mmより大きい群とそれ未満で分け、予後に関してKaplan-Meier法によって比較したところ有意差を認めなかった(p=0.35)。次に分枝型IPMNの手術例45例からROC曲線を用いて良悪性を規定する因子として結節隆起高6mmを導きだし、結節隆起高6mmで経過観察例を分け、予後を比較したところ有意差を認めなかった(p=0.15)。さらに、経過観察例の結節隆起高を6mmから1mmずつ高く設定してそれより高い群と低い群の2群に分けて予後を比較したところ、9mmより高い群と低い群で有意差(p<0.05)が認められ、死亡例の死因はすべてIPMN由来浸潤癌であった。また、手術例の結節隆起高を調べると、9mmより大きい例はすべて悪性であった。以上から、確実に悪性と判定出来る結節隆起高9mmより大きい群を最初に手術適応とすることは、予後の観点からも妥当と考えられた。(著者抄録)
  • IgG4関連硬化性疾患 膵病変と膵外病変をめぐって 膵外病変からみた自己免疫性膵炎
    菅野 敦, 佐藤 賢一, 下瀬川 徹
    日本消化器病学会雑誌 106 臨増総会 A138 - A138 (一財)日本消化器病学会 2009年03月
  • 廣田 衛久, 朝倉, 徹, 菅野, 敦, 佐藤, 賢一, 正宗, 淳, 菊田, 和宏, 粂, 潔, 濱田, 晋, 海野, 純, 高木, 康彦, 渡辺, 崇, 伊藤, 広通, 下瀬川 徹
    膵臓 24 1 79 - 83 日本膵臓学会 2009年02月 [査読無し][招待有り]
     
    慢性石灰化膵炎に対する膵管ステントを用いた内視鏡治療の限界を検討するために、内科的治療を行いあるいは継続し1年以上経過観察した内科的治療群30症例と、外科的治療を行い1年以上経過観察した外科的治療群17症例を社会的要因に注目して比較した。治療後の膵炎再発など入院が必要なイベントの発生率は両群間で差を認めなかったが、入院回数、日数は有意に内科的治療群が多かった。総入院費は両群間で有意な差が無かった。次に、膵管ステント総留置期間で内科的治療群を1年未満17症例と1年以上13症例の2群に分けて、外科治療群とそれぞれ比較した。1年未満群は、イベント発生率は外科的治療群の約半数であったが、入院回数、日数、総入院費では外科的治療群と差を認めなかった。1年以上群では検討した項目全てで外科治療群に劣っていた。膵管ステントを1年以上長期間継続して留置することは社会的見地より患者の利益とはならない。(著者抄録)
  • Shin Hamada, Kennichi Satoh, Morihisa Hirota, Wataru Fujibuchi, Atsushi Kanno, Jun Umino, Hiromichi Ito, Akihiko Satoh, Kazuhiro Kikuta, Kiyoshi Kume, Atsushi Masamune, Tooru Shimosegawa
    CANCER SCIENCE 100 1 103 - 110 2009年01月 [査読有り][通常論文]
     
    We previously reported that bone morphogenetic protein (BMP)-4 induces epithelial-mesenchymal transition in a pancreatic cancer cell line. To further investigate the detailed molecular mechanism of BMP action in pancreatic cancer, we carried out comprehensive microarray analysis in Panc-1 cells. The microarray analysis elucidated novel BMP target genes, and among them, the calcium-binding protein S100P was identified as an upregulated gene. S100P induction by BMP4 was confirmed by real-time reverse transcription-polymerase chain reaction and western blot analysis in Panc-1 and HPDE cells. Short interfering RNA-based knockdown of S100P expression sufficiently repressed BMP4-induced cell migration in Panc-1 cells. Because Panc-1 and HPDE cells express wild-type Smad4, we hypothesized that Smad4 might be indispensable for S100P induction by BMP4. S100P induction by BMP4 was not observed in the Smad4-null cell line BxPC3, and was sufficiently attenuated in short interfering RNA-based Smad4-knockdown Panc-1 cells. Interestingly, detailed promoter analysis revealed that upregulation of S100P by BMP4 was independent of the Smad-binding element, indicating that an additional unknown downstream factor of the Smad4-dependent pathway is necessary for this induction. These findings are the first of their kind, and this Smad4-dependent regulation of S100P by BMP signaling might explain the migratory mechanism of cancer cells, which is still unknown. (Cancer Sci 2009; 100: 103-110).
  • Tooru Shimosegawa, Atsushi Kanno
    Journal of Gastroenterology 44 6 503 - 517 2009年 [査読有り][通常論文]
     
    Since the rediscovery and definition of autoimmune pancreatitis (AIP) by Yoshida et al. in 1995, the disease has been attracting attention because of its unique clinical features and practical issues. This disease shows very impressive imaging findings, serological changes, and characteristic histopathology. It occurs most commonly in elderly males with painless jaundice or mild abdominal pain resemblance in imaging findings between AIP and pancreatobiliary cancers poses an important practical issue of differentiation. With increasing recognition of AIP and accumulation of cases, another important feature of this disease has been revealed, i.e., association of extrapancreatic organ involvements. Initially misunderstood because it can be accompanied by other autoimmune disorders, such as Sjögren's syndrome or primary sclerosing cholangitis (PSC), AIP is now known to be associated with unique types of sialadenitis and cholangitis distinct from Sjögren's syndrome or PSC. Now the concept of "IgG4-related sclerosing disease" has become widely accepted and the list of organs involved continues to increase. With worldwide recognition, an emerging issue is the clinical definition of other possible types of autoimmune-related pancreatitis called "idiopathic duct-centric chronic pancreatitis (IDCP)" and "AIP with granulocyte epithelial lesion (GEL)" and their relation to AIP with lymphoplasmacytic sclerosing pancreatitis (LPSP). The time has arrived to establish clinical diagnostic criteria of AIP based on international consensus and to discuss regional and racial differences in the clinicopathological features of AIP. Consensus guidelines are also required for the ideal use of steroids in the treatment of AIP to suppress recurrence efficiently with minimal side effects. There are many issues to be settled in AIP international collaboration of experts in the pancreas field is necessary to clarify the entire picture of this unique and important disease. © Springer 2009.
  • 【症例からみた「消化器病」の診断と治療の進め方】 膵胆道疾患 膵癌との鑑別診断に苦慮した自己免疫性膵炎
    菅野 敦, 佐藤, 賢一, 下瀬川 徹
    月刊レジデント 1 9 64 - 73 (株)医学出版 2008年12月 [査読無し][招待有り]
  • 自己免疫性膵炎・胆管炎診療に果たす内視鏡の役割り 自己免疫性膵炎と膵癌の鑑別 ERCP、EUS、IDUSの重要性
    菅野 敦, 佐藤 賢一, 下瀬川 徹
    Gastroenterological Endoscopy 50 Suppl.2 2205 - 2205 (一社)日本消化器内視鏡学会 2008年09月
  • 自己免疫性膵炎の診断・治療 ステロイド投与の意義 自己免疫性膵炎の再発からみたステロイド投与の有用性の検討
    菅野 敦, 佐藤 賢一, 下瀬川 徹
    日本消化器病学会雑誌 105 臨増大会 A488 - A488 (一財)日本消化器病学会 2008年09月
  • 菅野敦, 佐藤賢一, 正宗淳, 佐藤晃彦, 廣田衛久, 菊田和弘, 粂潔, 濱田晋, 海野純, 高木康彦, 渡辺崇, 伊藤広通, 下瀬川徹, 片寄友, 海野倫明, 石田和之
    胆道 22 3 470 - 470 日本胆道学会 2008年08月 [査読有り][通常論文]
  • 菅野 敦, 佐藤, 賢一, 下瀬川 徹
    内科 101 6 1661 - 1664 (株)南江堂 2008年06月 [査読無し][招待有り]
  • 菅野 敦, 佐藤 賢一, 伊藤 広通, 渡辺 崇, 海野 純, 高木 康彦, 木村 洋, 濱田 晋, 菊田 和宏, 粂 潔, 廣田 衛久, 佐藤 晃彦, 正宗 淳, 朝倉 徹, 下瀬川 徹, 元井 冬彦, 江川 新一, 海野 倫明
    膵臓 23 3 464 - 464 日本膵臓学会 2008年06月
  • 菅野 敦, 佐藤 賢一, 下瀬川 徹
    膵臓 23 3 281 - 281 日本膵臓学会 2008年06月
  • Atsushi Kanno, Kennichi Satoh, Atsushi Masamune, Morihisa Hirota, Kenji Kimura, Jun Umino, Shin Hamada, Akihiko Satoh, Shinichi Egawa, Fuyuhiko Motoi, Michiaki Unno, Tooru Shimosegawa
    INTERNATIONAL JOURNAL OF CANCER 122 12 2707 - 2718 2008年06月 [査読有り][通常論文]
     
    Periostin is a secretory protein that has been suggested to function as a cell adhesion molecule and promote the invasiveness or growth rate of tumors. However, little is known about the association of its expression and epithelial to mesenchymal transition (EMT), which is considered to play a crucial role in cancer cell metastasis. Thus, the authors investigated whether periostin could be involved in the process of EMT and the role of this gene in pancreatic cancer development. The expression of periostin was observed mainly in stromal cells but very little in cancer cells by immunohistochemistry and real-time RT-PCR. In vitro, pancreatic stellate cells (PSCs) exhibited a much higher basal expression of periostin compared with cancer cells. Periostin secreted in the supernatant from 293T cells that expressed periostin (approximately 150 ng/ml) inhibited the migration of pancreatic cancer cells. Coculture assay revealed that periostin expression in PSC was induced by pancreatic cancer cells. To assess the direct role of periostin in pancreatic cancer cells, the authors generated pancreatic cancer cell lines that stably express periostin. The induced expression of periostin (to 150 ng/ml) altered the morphology of cancer cells, changing them from mesenchymal to epithelial phenotypes with the induction of epithelial markers and a reduction of mesenchymal markers, and showed reduced cell migration in vitro and formed smaller tumors as well as suppressed metastasis in vivo. On the other hand, high concentration of recombinant periostin (1 mu g/ml) promoted cell migration with AKT activation. The findings suggest that periostin has biphasic effect on the development of pancreatic cancer. (C) 2008 Wiley-Liss, Inc.
  • Kennichi Satoh, Atsushi Kanno, Shin Hamada, Morihisa Hirota, Jun Umino, Atsushi Masamune, Shinichi Egawa, Fuyuhiko Motoi, Michiaki Unno, Tooru Shimosegawa
    ONCOLOGY REPORTS 19 5 1185 - 1190 2008年05月 [査読有り][通常論文]
     
    Sonic hedgehog (SHH) is frequently expressed in pre-cancerous lesions and carcinoma of the pancreas. A recent study revealed that its expression was higher in the intraductal papillary mucinous neoplasm (IPMN) of the pancreas than in the pancreatic carcinoma. However, the correlation between its signaling pathway and turnorigenesis of IPMN has not yet been well documented. We investigated the expression of mRNA and protein of SHH as well as its downstream transcription factor Gli1 in 19 microdissected lesions from 15 cases and in 75 lesions from 33 cases of the IPMN by one-step quantitative real-time reverse transcription-polymerase chain reaction and immunohistochemistry, respectively. SHH and Gli1 mRNAs were detected in all the examined lesions and 8 out of 19 lesions in IPMNs, respectively. SHH and Gli1 mRNAs were likely to be up-regulated from the adenoma and from borderline to carcinoma cells, respectively. Immunohistochemical analysis also reported that SHH and Gli1 expression was correlated with the grade of cell atypia. These findings suggested that HH signaling was activated in IPMNs and contributed to tumorigenesis in these types of neoplasms.
  • Kennichi Satoh, Shin Hamada, Kenji Kimura, Atsushi Kanno, Morihisa Hirota, Jun Umino, Wataru Fujibuchi, Atsushi Masamune, Naoki Tanaka, Koh Miura, Shinichi Egawa, Fuyuhiko Motoi, Michiaki Unno, Barbara K. Vonderhaar, Tooru Shimosegawa
    AMERICAN JOURNAL OF PATHOLOGY 172 4 926 - 939 2008年04月 [査読有り][通常論文]
     
    MSX2 is thought to be a regulator of organ development and a downstream target of the ras signaling pathway; however, little is known about the role of MSX2 in the development of pancreatic cancers, most of which harbor a K-ras gene mutation. Therefore, we examined whether the presence of MSX2 correlates with the malignant behavior of pancreatic cancer cells. BxPC3 pancreatic cancer cells that stably overexpress MSX2 showed a flattened and scattered morphology accompanied by a change in localization of E-cadherin and beta-catenin from membrane to cytoplasm. Cell proliferation rate, cell migration, and anchorage-independent cell growth were enhanced in MSX2-expressing cells. Injection of MSX2-expressing cells into the pancreas of nude mice resulted in a significant increase in liver metastases and peritoneal disseminations compared with injection of control cells. Microarray analysis revealed a significant induction of Twist 1 expression in cells that express MSX2. When MSX2 was inactivated in pancreatic cancer cells following transfection with an MSX2-specific small interfering RNA, Twist 1 was down-regulated. Immunohistochemistry of human pancreatic carcinoma tissue revealed that MSX2 was frequently expressed in cancer cells, and that increased expression of MSX2 significantly correlated with higher tumor grade, vascular invasion, and Twist I expression. These data indicate that MSX2 plays a crucial role in pancreatic cancer development by inducing changes consistent with epithelial to mesenchymal transition through enhanced expression of Twist 1.
  • 【IPMNの長期経過と予後】 組織学的悪性度と予後を反映させるための分枝型IPMNの治療方針
    菅野 敦, 佐藤, 賢一, 下瀬川 徹
    消化器科 46 3 328 - 334 (有)科学評論社 2008年03月 [査読無し][招待有り]
     
    1995年1月〜2007年3月の膵管内乳頭状粘液腫瘍(IPMN)患者156例(男96例、女60例、平均年齢68.2±8.6歳)を対象に生命予後と適切な手術適応を検討した。分枝型149例、主膵型7例で平均観察期間は1637±127日、手術例は41例(悪性22例、良性19例)であった。この中で、分枝型IPMNを手術例41例と経過観察例115例に分け、後向きに調査した。(1)分枝型IPMNの国際診療ガイドラインの治療方針が予後を反映しているかどうかを調べるため、超音波内視鏡(EUS)で経過観察可能であった84例を対象に、結節のある拡張分枝30mm以上で手術適応、以下で非適応として予後を比較した。結果、有意差は認めず予後を反映していなかった。(2)良悪性を規定する因子を決定するため、分枝型IPMN手術例41例を対象に拡張分枝膵管径、壁在結節径、主膵管径をROC曲線を用いて最も高い正診率を示す値を出し、良性悪性群間で比較した。この値が経過観察例の予後を反映するかを調べた。その結果、拡張分枝膵管径は良悪性群間に有意差を認めたがcut off値32mmで分けた正診率は64%と低く、主膵管径でも良悪性群間に有意差を認めたがcut off値6mmで分けた正診率は55%と低値であった。結節隆起高も良悪性間に有意差を認め、cut off値6mmで分けた正診率は77%と最も高かった。(3)経過観察例の予後をもとに、手術例の結節隆起高から最も予後を反映する値を導き出し、経過観察例の予後を比較した。結果、結節隆起高6mmで経過観察例を分けた予後比較では有意差は認めなかったが、9mmより大きい群と小さい群で予後に有意差を認め、手術例の結節隆起高では9mm以上例は全て悪性であった。以上より確実に悪性である結節隆起高9mm以上を最初に手術適応とすることは予後の観点から妥当と考えられた。
  • ヒト膵癌細胞株におけるBone morphogenetic protein 4によるEMT誘導経路の検討
    濱田 晋, 佐藤 賢一, 廣田 衛久, 菅野 敦, 海野 純, 伊藤 広通, 下瀬川 徹
    日本消化器病学会雑誌 105 臨増総会 A193 - A193 (一財)日本消化器病学会 2008年03月
  • 佐藤 賢一, 木村, 憲治, 菅野, 敦, 濱田, 晋, 廣田, 衛久, 下瀬川 徹
    膵臓 23 1 46 - 53 日本膵臓学会 2008年02月 [査読有り][招待有り]
     
    膵癌早期発見のためには膵発癌機構を解明することが不可欠である。そのためには、遺伝子解析も作成法も容易である動物モデルの開発が必要と考えられる。我々は化学発癌物質DMBA投与によってマウス膵発癌モデルを作成し、それがヒト膵癌研究に応用できるか否かを検討した。DMBA処理2週後からマウス膵にtubular complexが観察され、1ヵ月でPanIN類似病変、2ヵ月後3ヵ月後にかけて癌病変の形成が認められた。癌は肉腫様形態を呈したがcytokeratin陽性、vimentin,chymotrypsin陰性で膵管由来の癌と考えられた。過形成病変および癌病変において、ヒト膵癌同様、悪性度の進行に伴って、smad4発現の消失、cyclin D1,p53発現の増強、Notchシグナルの活性化が認められた。しかし、ヒトで最も初期にまた最も高頻度に異常の認められるK-ras遺伝子の変異は確認されなかった。これらの事から、本マウスモデルは、多くのヒト膵癌とは初期の発癌過程は異なるが進展過程に関与する遺伝子異常には類似性がみられ、ヒトにおける発癌過程の後期から癌進展過程の研究に適用できる可能性が示唆された。(著者抄録)
  • Toshiaki Suzuki, Y. Hattori, Takashi Katagiri, Hiroki Mitsuoka, Atsushi Kanno, Kennichi Satoh, Toru Asakura, Toru Shimosegawa, Hidetoshi Sato
    Progress in Biomedical Optics and Imaging - Proceedings of SPIE 6853 2008年 [査読有り][通常論文]
     
    Living pancreatic cancer tissues grown subcutaneously in nude mice are studied by in vivo microscope Raman spectroscopy. Comparing the spectra of living pancreatic cancer tissue to that of the dead same tissue, it is found that they are different each other. In the subtraction spectrum, Raman bands observed at 937, 1251, 1447 and 1671 cm-1 are appeared in negative direction and those observed at 966 and 1045 cm-1 are appeared in positive direction. The results strongly suggest that the spectral changes reflect the protein conformational changes in the tumor tissue with death of the host animal. The present result demonstrates the importance of in vivo, real time studies of biomedical tissues using Raman spectroscopy.
  • Shin Hamada, Kennichi Satoh, Morihisa Hirota, Kenji Kimura, Atsushi Kanno, Atsushi Masamune, Tooru Shimosegawa
    JOURNAL OF CELLULAR PHYSIOLOGY 213 3 768 - 774 2007年12月 [査読有り][通常論文]
     
    In our study, we found that bone morphogeretic protein 4 (BMP4) has a novel effect as an inducer of epithelial-mesenchymal transition (EMT) on Panc-I cells, a human pancreatic carcinoma cell line. BMP4-treated Panc-I cells showed loose cell contacts and a scattered, fibroblast-like appearance along with E-cadherin clownregulation, Vimentin upregulation and enhanced cell migration, which are characteristic of EMT. BMP4 treatment also induced homeobox gene MSX2 expression, which we previously showed to be associated with EMT in pancreatic carcinoma cells. BMP4 treatment activated the Smad signaling pathway, and extracellular signal-related kinase (ERK) and p38 mitogen-activated kinase (MAPK) pathways in these cells. MSX2 was markedly induced by BMP4 through the ERK and p38 MAPK pathways in collaboration with the Smad signaling pathway. The repression of E-cadherin, induction of Vimentin and enhanced cell migration disappeared when siRNA-based MSX2 downregulated pancreatic cancer cells were treated with BMP4. These findings indicate that BMP4 may be involved in pancreatic carcinoma development through the promotion of EMT and that MSX2 is indispensable to this process.
  • 【知っておくべき胆嚢癌の診療方針】 診断 胆嚢癌の術前進展度診断法における最近の進歩
    吉田 寛, 片寄, 友, 力山, 敏樹, 朝倉, 徹, 菅野, 敦, 江川, 新一, 海野 倫明
    外科 69 11 1248 - 1254 2007年11月 [査読無し][招待有り]
  • 膵IPMNの診療アルゴリズム 結節径を重要視したIPMN診療アルゴリズム
    菅野 敦, 佐藤 賢一, 下瀬川 徹
    日本消化器病学会雑誌 104 臨増大会 A491 - A491 (一財)日本消化器病学会 2007年09月
  • ヒト膵癌細胞においてSmad4機能の喪失はE-カドヘリンの発現低下により細胞移動を促進する(Loss of Smad4 function promotes cell migration with reduced expression of E-cadherin in human pancreatic cancer cells)
    廣田 衛久, 佐藤 賢一, 濱田 晋, 菅野 敦, 海野 純, 伊藤 広通, 下瀬川 徹
    日本癌学会総会記事 66回 442 - 442 2007年08月
  • 消化器疾患のX線診断 胆膵疾患 CT診断
    菅野 敦, 朝倉, 徹, 下瀬川
    綜合臨床 56 7 2386 - 2392 2007年07月 [査読無し][招待有り]
  • 菅野 敦, 佐藤 賢一, 下瀬川 徹
    膵臓 22 3 269 - 269 日本膵臓学会 2007年05月
  • 佐藤 賢一, 菅野 敦, 廣田 衛久, 木村 憲治, 下瀬川 徹
    膵臓 22 3 284 - 284 日本膵臓学会 2007年05月
  • 廣田 衛久, 佐藤 賢一, 菅野 敦, 朝倉 徹, 下瀬川 徹
    膵臓 22 3 289 - 289 日本膵臓学会 2007年05月
  • 佐藤 賢一, 海野 純, 菅野 敦, 廣田 衛久, 下瀬川 徹
    膵臓 22 3 298 - 298 日本膵臓学会 2007年05月
  • 菅野 敦, 佐藤 賢一, 下瀬川 徹
    日本消化器病学会雑誌 104 臨増総会 A52 - A52 (一財)日本消化器病学会 2007年03月
  • Kenji Kimura, Kennichi Satoh, Atsushi Kanno, Shin Hamada, Morihisa Hirota, Mareyuki Endoh, Atsushi Masamune, Tooru Shimosegawa
    CANCER SCIENCE 98 2 155 - 162 2007年02月 [査読有り][通常論文]
     
    To establish pancreatic cancer in mice, dimethylbenzanthracene (DMBA) was administered into mice pancreata. The formation of tubular complex lesions was found in the pancreatic sections from 2 weeks after DMBA treatment. Abnormal tubular complex formations with ductal metaplasia were found from 1 month after the administration. By 3 months after DMBA injection into the pancreas, 6 of 10 mice showed visually recognizable tumors with precursor lesions of various types of cell atypia. In contrast, there were no visually or histologically detectable tumors in the placebo-treated animals. The expression profiles of smad 4, cyclin D1 and p53 in the DMBA-induced tumors were similar to those of human pancreatic cancer, suggesting that this would be a useful mouse model for studying the morphological and molecular mechanisms involved in pancreatic carcinogenesis. Immunohistochemical study using specific antibodies revealed that Notch-1 and Hes-1 were expressed in lesions ranging from tubular complexes to carcinoma in these chemically induced pancreatic tumors. Semiquantitative reverse transcription-polymerase chain reaction with microdissection demonstrated that Notch-1 expression was continuous from precursor lesions to carcinoma cells, whereas Pdx-1 expression was attenuated in carcinoma cells compared to precursor lesions. In addition, inhibition of the Notch signaling pathway by the gamma-secretase inhibitor N-(N-[3,5-difluorophenacetyl]-L-alanyl)-S-phenylglycine t-butyl ester reduced pancreatic cancer cell growth. Therefore, Notch signaling is required to form the tubular complexes and its continuous activation might lead to the transition from tubular complexes to premalignant or malignant lesions and carcinoma cell development in the pancreas.
  • Atsushi Kanno, Kennichi Satoh, Kenji Kimura, Morihisa Hirota, Jun Umino, Atsushi Masamune, Akihiko Satoh, Tohru Asakura, Shinichi Egawa, Makoto Sunamura, Mareyuki Endoh, Tooru Shimosegawa
    PANCREAS 33 4 391 - 396 2006年11月 [査読有り][通常論文]
     
    Objective: Intraductal papillary mucinous neoplasms (IPMNs) of the pancreas show heterogeneous proliferations with latent malignancy. Mucins (MUC) are high-molecular-weight glycoproteins, with an aberrant expression profile in various malignancies. Recently, MUC4 and MUC5AC expressions have been demonstrated to correlate with the unfavorable and the favorable prognosis of pancreatic duct cell carcinoma, respectively. However, little is known about these mucin expressions in IPMNs. Methods: To clarify the role of MUC4 and MUC5AC expressions in IPMNs, the expression profiles of MUC4 and MUC5AC were investigated in 50 lesions from 17 specimens with 16 IPMNs by immunohistochemistry, using each of their specific antibodies. Results: The expression of MUC4 was found in the lesions ranging from adenoma to cancer lesions of IPMNs, whereas it was undetectable in normal and hyperplastic lesions. Frequent expression of MUC4 is found in the higher grade of IPMNs (borderline and cancer lesions; 16/18 lesions, 94%). The differences were independently significant (P < 0.001) when the cutoff point was set between adenoma and borderline IPMNs. Similarly, frequent expression of MUC5AC was detected in the lesions from adenoma to cancer of IPMNs (32/34, 94%), whereas no intense expression was detected in normal or hyperplastic lesions. The significant difference was found when the cutoff point was set between hyperplasia and adenoma of IPMNs (P < 0.001). Conclusions: These results indicated that the expressions of MUC4 and MUC5AC are potential markers to distinguish adenoma or above malignant lesions of IPMNs from lesser malignant ones, respectively.
  • 自己免疫性膵炎の新局面 AIPのIgG4値による臨床像の違い、および膵癌との鑑別
    菅野 敦, 佐藤 賢一, 下瀬川 徹
    日本消化器病学会雑誌 103 臨増大会 A677 - A677 (一財)日本消化器病学会 2006年09月
  • ヒト膵癌における亜鉛輸送体蛋白LIV-1の役割
    海野 純, 佐藤 賢一, 廣田 衛久, 菅野 敦, 下瀬川 徹
    日本消化器病学会雑誌 103 臨増大会 A981 - A981 (一財)日本消化器病学会 2006年09月
  • 佐藤 賢一, 菅野 敦, 木村 憲治, 下瀬川 徹
    膵臓 21 3 201 - 201 日本膵臓学会 2006年06月
  • Atsushi Kanno, Kennichi Satoh, Kenji Kimura, Atsushi Masamune, Tohru Asakura, Shinichi Egawa, Makoto Sunamura, Mika Watanabe, Tooru Shimosegawa
    PANCREAS 32 4 422 - 425 2006年05月 [査読有り][通常論文]
     
    Pancreatic arteriovenous malformation (AVM) is a relatively rare disease. Based on our literature search, 51 cases of pancreatic AVM have been reported since 1968. The gastrointestinal bleeding is the most common presenting symptom (24/51 cases [47%]). There were only 6 cases of pancreatitis in these cases. We describe 2 cases of acute pancretitis with pancreatic AVM. The patients who were diagnosed with acute pancreatitis were admitted to our hospital. Pancreatitis was considered to be caused by pancreatic AVM by some modalities of diagnostic imaging. The respective pancreatic AVM lesions of patients were resected to prevent the recurrence of pancreatitis. They are asymptomatic after the surgery. Pancreatic AVM is thought to be the one of the reasons for acute pancreatitis.
  • 菅野 敦, 佐藤, 賢一, 下瀬川 徹
    胆と膵 27 3 163 - 170 医学図書出版(株) 2006年03月 [査読無し][招待有り]
     
    膵管内乳頭粘液腫瘍(IPMN)の手術適応をめぐって,画像診断を駆使した報告を多数認めるが,いまだに統一した見解はない.IPMNは異型度が進行するにつれ,遺伝子発現のパターンが変化することが推測されている.著者等は,IPMNの異型度別におけるMUC4,MUC5AC,sonic hedgehog,Smad4の発現を免疫染色にて検討した.その結果, 1)MUC4は癌との境界病変以上での発現, 2)MUC5ACは腺腫以上での発現, 3)shhは腺腫以上での発現を認めた.一方Smad4は合併膵癌では発現を認めず,浸潤癌で発現が消失していた.またIPM-C症例の膵液からRNAを採取しRT-PCRを施行したところ,MUC4,MUC5ACの発現を確認でき,免疫染色でも発現を認めた.すなわち膵液のRNAからIPMNの異型度を診断できる可能性が示唆された(著者抄録)
  • 膵癌細胞におけるBMP signalのepithelial-mesenchymal transition(EMT)への関与とその機序
    佐藤 賢一, 濱田 晋, 菅野 敦, 廣田 衛久, 海野 純, 下瀬川 徹
    日本消化器病学会雑誌 103 臨増総会 A150 - A150 (一財)日本消化器病学会 2006年03月
  • Sonic hedgehogシグナルの膵癌とIPMNの進展に対する検討
    菅野 敦, 佐藤 賢一, 濱田 晋, 廣田 衛久, 海野 純, 下瀬川 徹
    日本消化器病学会雑誌 103 臨増総会 A150 - A150 (一財)日本消化器病学会 2006年03月
  • A Kanno, K Satoh, K Kimura, A Masamune, T Asakura, M Unno, S Matsuno, T Moriya, T Shimosegawa
    PANCREAS 31 4 420 - 423 2005年11月 [査読有り][通常論文]
     
    We report a case of autoimmune pancreatitis (AIP) with hepatic inflammatory pseudotumor (IP). The patient was clinically diagnosed as having multiple metastatic tumors originated from cholangiocellular carcinoma as well as autoimmune pancreatitis and underwent left lobectomy of the liver. Histological examination showed a diffuse or dense lymphoplasmacytic infiltration with obliterating phlebitis but an absence of neoplastic proliferation both in the liver tumor and in the biopsy specimen of the pancreas. Abundant IgG4-positive plasma cells were seen in the lesions. This is the first case report that shows a simultaneous occurrence of hepatic IP and AIP, suggesting that these lesions appeared on the background of the recently proposed entity of IgG4-related systemic disease.
  • Shin Hamada, Kennichi Satoh, Kenji Kimura, Atsushi Kanno, Atsushi Masamune, Tooru Shimosegawa
    WORLD JOURNAL OF GASTROENTEROLOGY 11 43 6867 - 6870 2005年11月 [査読有り][通常論文]
     
    AIM: To evaluate the effect of MSX2 on gemcitabine-induced caspase-3 activation in pancreatic cancer cell line Panc-1. METHODS: Using V5-tagged MSX2 expression vector, stable transfectant of MSX2 was generated from Panc-1 cells (Px14 cells). Cell viability under gemcitabine administration was determined by MTT assay relative to control cell line (empty-vector transfected Panc-1 cells; P-3EV cells). Hoechst staining was used for the detection of apoptotic cell. Activation of caspase-3 was assessed using Western blotting analysis and direct measurement of caspase-3 specific activities. RESULTS: MSX2 overexpression in Panc-1 cells resulted in decreased gemcitabine-induced caspase-3 activation and increased cell viability under gemcitabine treatment in Px14 cells. CONCLUSION: MSX2 exerts repressive effects on gemcitabine-induced apoptotic pathway. This novel apoptosis-regulating function of MSX2 may provide a new therapeutic target for pancreatic cancer. (C) 2005 The WJG Press and Elsevier Inc. All rights reserved.
  • 【自己免疫性膵炎】 自己免疫性膵炎の診断基準と非合致例
    菅野 敦, 佐藤, 賢一, 朝倉 徹, 鹿志村, 純也, 下瀬川 徹
    消化器科 41 3 250 - 256 (有)科学評論社 2005年09月 [査読無し][招待有り]
     
    当科において自己免疫性膵炎(AIP)と考えられた14例のうち,日本膵臓学会の臨床診断基準に合致したのは7例(男6例・女1例,44〜78歳:A群),非合致は7例(男6例・女1例,55〜86歳:B群)であった.診断基準の必須項目である「膵管狭窄1/3以上」を満たさなかったのはB群のうち4例で,これらはIgG4高値を診断の根拠とした.うち1例は膵腫大も認めず,胆管病変が中心であった.診断基準で示された血液検査6項目の陽性率をみると,全体的に陽性率は高くなく,最も高かったのは必須項目ではない「IgG4 135mg/dl以上」であった.γグロブリン高値またはIgG高値を認めず,IgG4高値を認めた症例が3例あり,これらはIgG4の上昇の程度が軽度で,高IgG血症の基準を満たしていなかった.すなわち,高γグロブリン血症および高IgG血症はIgG4の上昇を反映しているものと考えられ,IgG4高値がAIPの診断に重要であることが示唆された
  • MSX2の発現は膵癌細胞株Panc-1のGemcitabineに対する感受性を低下させる
    佐藤 賢一, 濱田 晋, 菅野 敦, 下瀬川 徹
    日本消化器病学会雑誌 102 臨増大会 A850 - A850 (一財)日本消化器病学会 2005年09月
  • 膵AVMの2例
    菅野 敦, 佐藤 賢一, 朝倉 徹, 木村 憲治, 正宗 淳, 下瀬川 徹, 元井 冬彦, 江川 新一, 砂村 真琴
    日本消化器病学会雑誌 102 臨増大会 A855 - A855 (一財)日本消化器病学会 2005年09月
  • IPMNの悪性度に関与する遺伝子発現の検討
    菅野 敦, 佐藤 賢一, 木村 憲治, 朝倉 徹, 下瀬川 徹
    膵臓 20 3 283 - 283 日本膵臓学会 2005年06月
  • 菅野 敦, 鈴木, 雅貴, 小野寺, 博義, 鈴木, 真一, 萱場, 佳郎, 佐々木, 明徳, 加賀谷, 浩文, 野口, 哲也, 菊地, 徹, 三国, 潤一, 角川, 陽一郎, 藤谷, 恒明, 立野, 紘雄, 佐藤 郁郎
    日本消化器病学会雑誌 102 5 612 - 618 2005年05月 [査読無し][招待有り]
  • 【原発性硬化性胆管炎(PSC)の診療をめぐって】 PSCと自己免疫性膵炎
    菅野 敦, 朝倉, 徹, 下瀬川
    胆と膵 26 4 373 - 377 2005年04月 [査読無し][招待有り]
  • 膵癌細胞におけるBMP4のepithelial-mesenchymal transition(EMT)への関与とその機序の検討
    佐藤 賢一, 濱田 晋, 木村 憲治, 菅野 敦, 下瀬川 徹
    日本消化器病学会雑誌 102 臨増総会 A248 - A248 (一財)日本消化器病学会 2005年03月
  • 自己免疫性膵炎に合併した炎症性肝偽腫瘍の一例
    菅野 敦, 朝倉 徹, 佐藤 賢一, 正宗 淳, 木村 憲治, 菊田 和宏, 佐藤 真広, 粂 潔, 鈴木 範明, 下瀬川 徹, 海野 倫明, 松野 正紀
    日本消化器病学会雑誌 102 臨増総会 A349 - A349 (一財)日本消化器病学会 2005年03月
  • 菅野 敦, 朝倉, 徹, 山際, 哲也, 石田, 晶玄, 砂村, 眞琴, 江川, 新一, 下瀬川 徹
    消化器画像 7 1 45 - 51 2005年01月 [査読無し][招待有り]
  • 正宗 淳, 朝倉, 徹, 菅野, 敦, 下瀬川 徹
    消化器画像 6 6 759 - 769 2004年11月 [査読無し][通常論文]
  • 菅野 敦, 菅野, 潤子, 高橋 健一
    Gastroenterological Endoscopy 44 10 1856 - 1861 2002年 [査読有り][通常論文]
     
    We experienced a case of detorsion of cecal volvulus by colonoscopic maneuver. An 83-years-old man who was confined to bed for cerebral infarction was admitted to our hospital complaing of abdominal distension and abdominal pain. Suspecting ileus of the colon, we performed a colonoscopy, we found the torsion of the cecum. Colonoscopic detorsion was successful. This is the first reported case of colonoscopic detorsion of cecal volvulus in Japanese literature. © 2002, Japan Gastroenterological Endoscopy Society. All rights reserved.

書籍

  • The PANCREAS
    Tooru Shimosegawa Morihisa Hirota, Atsushi Kanno (担当:共著範囲:Clinical Manifestation of Type 1 Autoimmune Pancreatitis)
    Wiley Blackwell 2018年
  • IgG4 related sclerosing cholangitis
    菅野 敦 (担当:共著範囲:Imaging:ERCP)
    Springer 2018年
  • 新膵臓病学
    菅野 敦 (担当:共著範囲:膵疾患の疫学 A 炎症 3.自己免疫性膵炎)
    南江堂 2017年
  • Autoimmune pancreatitis.
    菅野 敦 (範囲:Epidemiology and Pathology. 2. Epidemiology of Autoimmune pancreatitis.)
    Springer 2015年
  • 増刊 レジデントノート 消化器診療の疑問 これで納得!
    菅野 敦 (範囲:急性膵炎で入院した患者に対する初期治療の戦略がよくわかりません。アルコール性・胆石性の対処法は?)
    2013年
  • 症状・画像から見抜く!膵胆道系の鑑別診断 疾患の見極め方と治療のポイント
    菅野 敦 (担当:共著範囲:急性膵炎に対する薬物・栄養療法の実際)
    2011年

講演・口頭発表等

  • 自己免疫性膵炎の病理組織学的診断におけるフランシーン形状FNA針の有用性  [通常講演]
    菅野 敦
    第105回日本消化器病学会総会 2019年05月 シンポジウム・ワークショップパネル(公募)
  • 腸炎合併膵炎と1型自己免疫性膵炎の臨床像の比較  [通常講演]
    菅野 敦
    JDDW 2018 第60回日本消化器病学会大会 2018年11月 シンポジウム・ワークショップパネル(公募)
  • EUS-FNAによる自己免疫性膵炎の病理組織学的検討  [通常講演]
    菅野 敦
    第49回日本膵臓学会 2018年08月 シンポジウム・ワークショップパネル(公募)
  • A nationwide epidemiological survey of autoimmune pancreatitis in Japan.  [通常講演]
    菅野 敦
    International Pancreas Research Forum 2017 2017年10月 シンポジウム・ワークショップパネル(指名)
  • 当科における1型自己免疫性膵炎107例の臨床経過  [通常講演]
    菅野 敦
    第48回日本膵臓学会大会 2017年07月 シンポジウム・ワークショップパネル(公募)
  • 膵癌早期診断の現状 -膵癌早期診断研究会における多施設研究の結果をもとに-  [通常講演]
    菅野 敦
    第48回日本膵臓学会大会 2017年07月 シンポジウム・ワークショップパネル(公募)
  • 自己免疫性膵炎の超音波内視鏡像における慢性膵炎様変化の臨床的意義.  [招待講演]
    菅野 敦
    第90回日本超音波医学会学術集会 2017年05月 シンポジウム・ワークショップパネル(指名)
  • 肝門部領域胆管癌における術前ドレナージの検討  [通常講演]
    菅野 敦
    第52回日本胆道学会学術集会 2016年09月 シンポジウム・ワークショップパネル(公募)
  • Challenges in early detection of pancreastic cancer.  [通常講演]
    菅野 敦
    The joint meeting of 47th JPS/ 20th IAP/ 6th AOPA JPS symposium 2016年08月 シンポジウム・ワークショップパネル(指名)
  • 超音波内視鏡による膵神経内分泌腫瘍の診断  [通常講演]
    菅野 敦
    第3回日本神経内分泌腫瘍研究会学術集会 2015年09月 シンポジウム・ワークショップパネル(指名)
  • 当科における自己免疫性膵炎の現状  [通常講演]
    菅野 敦
    第46回日本膵臓学会大会 2015年06月 シンポジウム・ワークショップパネル(公募)
  • IgG4関連胆膵疾患における内視鏡の役割  [通常講演]
    菅野 敦
    第89回日本消化器内視鏡学会総会 2015年05月 シンポジウム・ワークショップパネル(公募)
  • 術後腸管に対するERCP-症例に応じたスコープ選択-  [通常講演]
    菅野 敦
    第101回日本消化器病学会総会 2015年04月 シンポジウム・ワークショップパネル(指名)
  • A nationwide epidemiological survey of autoimmune pancreatitis in Japan.  [通常講演]
    菅野 敦
    第45回日本膵臓学会大会 2014年07月 シンポジウム・ワークショップパネル(指名)
  • Autoimmune pancreatitis in Asian countries and its Diagnostic Guideline  [通常講演]
    第45回日本膵臓学会 2014年07月 シンポジウム・ワークショップパネル(公募) 小倉
  • The usefulness of endoscopic ultrasound-guided fine-needle aspiration for the diagnosis of pancreatic neuroendocrine tumors based on the World Health Organization classification  [通常講演]
    DDW2014 2014年05月 ポスター発表 アメリカ合衆国
  • AIP-概念、診断、治療のUpdate-  [通常講演]
    第100回日本消化器病学会総会 2014年04月 シンポジウム・ワークショップパネル(公募)
  • IgG4-related disease and endoscopy  [通常講演]
    JDDW2013 2013年10月 シンポジウム・ワークショップパネル(公募)
  • 中下部胆管癌における造影ハーモニック超音波内視鏡の有用性  [通常講演]
    49回日本胆道学会学術集会 2013年09月 口頭発表(一般) 千葉
  • 自己免疫性膵炎  [通常講演]
    第44回日本膵臓学会学術集会 2013年07月 シンポジウム・ワークショップパネル(公募) 仙台
  • Interventional EUSの進歩  [通常講演]
    第85回日本消化器内視鏡学会総会 2013年05月 シンポジウム・ワークショップパネル(公募) 京都
  • 消化器領域におけるIgG4関連疾患の診断と治療  [通常講演]
    第99回日本消化器病学会総会 2013年04月 シンポジウム・ワークショップパネル(公募)
  • 自己免疫性膵炎の各診断基準の比較  [通常講演]
    JDDW2012 2012年10月 ポスター発表
  • 硬化性胆管炎をめぐる諸問題  [通常講演]
    第48回日本胆道学会学術集会 2012年09月 シンポジウム・ワークショップパネル(公募) 東京
  • IPMNの良悪性診断  [通常講演]
    第43回日本膵臓学会 2012年06月 口頭発表(一般) 山形
  • 胆膵疾患における造影ハーモニック超音波内視鏡の有用性と限界  [通常講演]
    85回日本超音波医学会学術集会 2012年05月 口頭発表(一般)
  • IPMNの診断・治療における内視鏡の役割  [通常講演]
    第83回日本消化器内視鏡学会総会 2012年05月 シンポジウム・ワークショップパネル(公募)
  • ICDCに基づいた自己免疫性膵炎の診断  [通常講演]
    日本消化器病学会総会 2012年04月 シンポジウム・ワークショップパネル(公募)
  • Diagnosis of IPMNs  [通常講演]
    日本消化器病学会総会 2012年04月 シンポジウム・ワークショップパネル(公募)
  • IgG4関連疾患の概念と診断  [通常講演]
    菅野 敦, 下瀬川 徹
    JDDW2011 2011年10月 シンポジウム・ワークショップパネル(公募) 日本国
  • Autoimmune pancreatitis-Current treatment strategy of AIP in Japan-  [通常講演]
    Atsushi Kanno, Tooru Shimosegawa
    APDW 2011年10月 シンポジウム・ワークショップパネル(公募) シンガポール
  • Autoimmune pancreatitis -Management Update-  [通常講演]
    Atsushi Kanno, Tooru Shimosegawa
    APDW 2011年10月 口頭発表(招待・特別) シンガポール
  • 肝門部悪性胆道狭窄に対する内視鏡的ドレナージの検討  [通常講演]
    菅野 敦, 林洋毅, 吉田寛, 力山敏樹, 片寄友, 海野倫明, 下瀬川徹
    日本胆道学会 2011年09月 口頭発表(一般) 日本国
  • EUS-FNAによる病理組織学的検討  [通常講演]
    菅野 敦, 下瀬川徹, 石田和之
    日本消化器内視鏡学会 2011年08月 シンポジウム・ワークショップパネル(公募) 日本国
  • 胆膵疾患における造影ハーモニック超音波内視鏡の有用性  [通常講演]
    菅野 敦, 下瀬川徹
    日本超音波医学会 2011年05月 シンポジウム・ワークショップパネル(公募) 日本国
  • 自己免疫性膵炎の再燃に関する検討  [通常講演]
    菅野敦, 消化器内科, 佐藤賢一, 下瀬川徹
    jddw2010 2010年10月 シンポジウム・ワークショップパネル(公募) 日本国
  • 自己免疫性膵炎におけるIgG4関連硬化性胆管炎の臨床的意義  [通常講演]
    菅野敦, 消化器内科, 佐藤賢一, 下瀬川徹
    日本胆道学会総会 2010年09月 シンポジウム・ワークショップパネル(公募) 日本国
  • IPMN手術適応症例の再検討 EUS、CT、PETの比較  [通常講演]
    菅野敦, 消化器内科, 佐藤賢一, 下瀬川徹
    日本消化器内視鏡学会総会 2010年05月 シンポジウム・ワークショップパネル(公募) 日本国
  • 分枝型IPMNの手術適応の再検討  [通常講演]
    菅野敦, 消化器内科, 佐藤賢一, 下瀬川徹
    日本消化器病学会総会 2010年04月 シンポジウム・ワークショップパネル(公募) 日本国
  • IgG4陰性自己免疫性膵炎の臨床的背景の検討  [通常講演]
    菅野敦, 佐藤賢一, 下瀬川徹
    JDDW2009 2009年10月 シンポジウム・ワークショップパネル(公募) 日本国
  • 膵管内乳頭粘液腫瘍(IPMN)の手術適応と切離線を決定するための検査法  [通常講演]
    菅野敦, 佐藤賢一, 下瀬川徹
    JDDW2009 2009年10月 ポスター発表 日本国
  • 下部胆管に発生した腺内分泌細胞癌の一例  [通常講演]
    菅野敦, 佐藤賢一, 正宗淳, 廣田衛久, 菊田和弘, 粂潔, 濱田晋, 渡辺崇, 伊藤広通, 下瀬川徹, 高舘達之, 力山敏樹, 海野倫明, 石田和之
    第45回日本胆道学会 2009年09月 ポスター発表 日本国
  • 当科における自己免疫性膵炎診断基準2006の検討  [通常講演]
    菅野敦, 佐藤賢一, 下瀬川徹
    第40回日本膵臓学会大会 2009年07月 シンポジウム・ワークショップパネル(公募) 日本国
  • 膵癌と自己免疫性膵炎の鑑別診断におけるソナゾイドの使用経験  [通常講演]
    菅野敦, 佐藤賢一, 下瀬川徹
    第82回 日本超音波医学会 2009年05月 口頭発表(一般) 日本国
  • 膵外病変からみた自己免疫性膵炎  [通常講演]
    菅野敦, 佐藤賢一, 下瀬川徹
    第95回日本消化器病学会総会 2009年05月 シンポジウム・ワークショップパネル(公募) 日本国

MISC

  • 【胆道ドレナージを極める】経皮的アプローチ 肝門部領域胆管狭窄に対するPTBDの活用法
    牛尾 純, 玉田 喜一, 池田 恵理子, 三輪田 哲郎, 長井 洋樹, 横山 健介, 沼尾 規且, 菅野 敦, 山本 博徳 消化器内視鏡 33 (3) 602 -607 2021年03月
  • 岡崎 和一, 川 茂幸, 神澤 輝実, 池浦 司, 糸井 隆夫, 伊藤 鉄英, 乾 和郎, 入澤 篤志, 内田 一茂, 大原 弘隆, 窪田 賢輔, 児玉 裕三, 清水 京子, 殿塚 亮祐, 中沢 貴宏, 西野 隆義, 能登原 憲司, 藤永 康成, 正宗 淳, 山本 洋, 渡辺 貴之, 下瀬川 徹, 白鳥 敬子, 川野 充弘, 西山 利正, 竹山 宜典, 井上 大, 入江 裕之, 岩崎 栄典, 植木 敏晴, 上原 剛, 菅野 敦, 洪 繁, 阪上 順一, 新倉 則和, 多田 稔, 濱野 英明, 平野 賢二, 廣岡 芳樹, 増田 充弘, 水野 伸匡, 吉田 仁, 日本膵臓学会・厚生労働省IgG4関連疾患の診断基準並びに治療指針を目指す研究班, 自己免疫性膵炎診療ガイドライン2020改訂委員会 膵臓 35 (6) 465 -550 2020年12月
  • 【進化するEUS】ラジアル走査式EUSの標準的描出法
    安田 一朗, 糸井 隆夫, 潟沼 朗生, 菅野 敦, 花田 敬士, 木田 光広, 安田 健治朗, ラジアル走査式超音波内視鏡描出法標準化検討部会 消化器内視鏡 32 (11) 1688 -1691 2020年11月
  • 大塚 英郎, 青木 泰孝, 畠 達夫, 益田 邦洋, 水間 正道, 中川 圭, 森川 孝則, 菅野 敦, 正宗 淳, 大森 優子, 古川 徹, 海野 倫明 胆道 34 (4) 772 -780 2020年10月 
    症例は29歳男性.心窩部痛を主訴に近医受診し,血液生化学検査で肝胆道系酵素値の上昇と黄疸を認めた.造影CTで肝内胆管の拡張と肝門部胆管に腫瘍性病変を認めるとともに,MRCPで膵・胆管合流異常を認めた.腫瘍より乳頭側の胆管に拡張を認めず,非拡張型膵・胆管合流異常に合併した肝門部胆管癌(BismuthII)と診断し,肝拡大左葉切除・尾状葉切除・肝外胆管切除術を施行した.切除標本で肝門部に結節浸潤型の病変を認め,病理組織学的検討より浸潤癌部に連続する乳頭側の胆管上皮にbiliary intraepithelial neoplasia(BilIN)病変を認めた.非拡張型の膵・胆管合流異常では,胆嚢癌が高率に発症するとされるが,胆管癌の発症は多くない.本症例は30歳未満と若年発症した胆管癌症例であるが,職業性胆管癌の可能性は示唆されず,その発癌に膵・胆管合流異常が深く関与していたと考えられる.(著者抄録)
  • 治療法の再整理とアップデートのために 専門家による私の治療 自己免疫性膵炎
    菅野 敦, 正宗 淳 日本医事新報 (5015) 45 -46 2020年06月 [査読無し][通常論文]
  • 【消化器領域におけるIgG4関連疾患】自己免疫性膵炎の疫学
    菊田 和宏, 菅野 敦, 正宗 淳 消化器内科 2 (4) 15 -19 2020年04月 [査読無し][通常論文]
     
    日本では、これまで4回にわたり自己免疫性膵炎の全国疫学調査が行われている。2002年、2007年、2011年、2016年の1年間に受療した自己免疫性膵炎患者はそれぞれ1,700人、2,790人、5,745人、13,436人と推計されており、増加傾向にある。最新の2016年の全国調査によれば、有病患者数は10.1人/人口10万人、罹患率3.1人/人口10万人/年と推計されている。男女比は2.94:1で、平均年齢は68.1歳であった。診断時年齢は64.8歳であった。日本で多く報告されている自己免疫性膵炎はIgG4関連疾患の膵病変であり、病理組織学的にはlymphoplasmacytic sclerosing pancreatitis(LPSP)を呈する(1型自己免疫性膵炎)。一方、国際調査によれば、アジアに比べ欧米では病理組織学的に好中球上皮病変を特徴とする2型自己免疫性膵炎の頻度が高い。1型に比べ、2型は診断時年齢が若く、膵炎や腹痛を呈することが多く、炎症性腸疾患を合併することが多い。1型、2型のいずれもステロイド治療への反応性は良好であるが、1型は2型に比べ再燃率が高い。(著者抄録)
  • 【膵癌をめぐる最近の話題】膵癌早期発見のストラテジー
    菅野 敦, 佐野 貴紀, 池田 未緒, 田中 裕, 松本 諒太郎, 鍋島 立秀, 本郷 星仁, 三浦 晋, 滝川 哲也, 濱田 晋, 粂 潔, 菊田 和宏, 正宗 淳 消化器・肝臓内科 7 (3) 197 -203 2020年03月 [査読無し][通常論文]
  • 【肝膵内視鏡治療におけるトラブルシューティング】ERCP関連治療における偶発症予防とトラブルシューティング ERCP後膵炎の予防と対策 こうすれば重症化しない
    滝川 哲也, 菅野 敦, 三浦 晋, 濱田 晋, 粂 潔, 菊田 和宏, 正宗 淳 消化器内視鏡 32 (3) 324 -327 2020年03月 [査読無し][通常論文]
  • 【EUSの現状と将来】治療 膵仮性嚢胞・WONドレナージ
    粂 潔, 菅野 敦, 正宗 淳 肝・胆・膵 80 (3) 489 -494 2020年03月 [査読無し][通常論文]
  • 【膵癌をめぐる最近の話題】膵癌早期発見のストラテジー
    菅野 敦, 佐野 貴紀, 池田 未緒, 田中 裕, 松本 諒太郎, 鍋島 立秀, 本郷 星仁, 三浦 晋, 滝川 哲也, 濱田 晋, 粂 潔, 菊田 和宏, 正宗 淳 消化器・肝臓内科 7 (3) 197 -203 2020年03月 [査読無し][通常論文]
  • 北野 雅之, 糸井 隆夫, 高山 敬子, 鎌田 研, 菅野 敦, 高岡 亮, 芹川 正浩, 川井 学, 高折 恭一, 花田 敬士 膵臓 35 (1) 47 -51 2020年02月 [査読無し][通常論文]
     
    膵癌診療ガイドラインが2019年7月に改訂された。疾患概念・診断法部門では、2016年版と比較して、一部を変更したうえで新設クリニカルクエスチョン(CQ)7項目、1コラムを追加し、合計14項目のCQおよび2つのコラムが作成された。「疾患概念」と、「診断法」の一部のCQは総論のなかで紹介することとなった。一方で、診断ストラテジーをより詳細に述べるために、「診断法」を「存在・確定診断」、「病期・切除可能性診断」に大別したうえで、ぞれぞれの画像検査に関するCQを作成し、特徴・位置付けを明瞭化した。特に、PET検査は、存在・確定診断には行わないことを提案するが、病期・切除可能性診断には行うことを提案することとなった。病理診断法についても、EUS-FNAおよびERCPに関するCQを追加し、それぞれの使い分けの指針を示すこととした。また、病診連携を生かした膵癌早期診断に関するコラムを記載した。(著者抄録)
  • 上坂 克彦, 江口 英利, 菅野 敦, 中村 聡明, 中郡 聡夫 膵臓 35 (1) 58 -62 2020年02月 [査読無し][通常論文]
     
    『膵癌診療ガイドライン2019年版』では補助療法のCQが4つ設定された。「切除可能膵癌の治療法」内にRA1 術前補助療法、RA2 術後補助化学放射線療法、RA3 術後補助化学療法のCQが設定され、術中放射線療法のCQは総論に移った。また「切除可能境界膵癌の治療法」内にB3 術後補助化学療法のCQが新設された。RA1 術前補助療法については、冊子版では「行うべきか否かは明らかではない」とされたが、その後のエビデンスの追加により、「ゲムシタビン塩酸塩+S-1併用療法を行うことを提案する」と改訂された。RA2は2016年版と変更なく、RA3では新たなエビデンスに基づき「ゲムシタビン塩酸塩+カペシタビン併用療法およびmodified FOLFIRINOX療法を行うことを提案する」ことが追記された。B3には高いエビデンスはないが、改訂委員の賛成により「術後補助化学療法を行うことを提案する」旨記載された。(著者抄録)
  • 三浦孝之, 中川圭, 林洋毅, 森川孝則, 菅野敦, 大森優子, 古川徹, 元井冬彦, 内藤剛, 亀井尚, 海野倫明 日本消化器画像診断研究会プログラム・抄録集 72nd 2020年
  • Mio Ikeda, Shin Miura, Atsushi Kanno, Takanori Sano, Ryotaro Matsumoto, Yu Tanaka, Tatsuhide Nabeshima, Seiji Hongo, Tetsuya Takikawa, Shin Hamada, Kiyoshi Kume, Kazuhiro Kikuta, Atsushi Masanume JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY 34 809 -809 2019年12月
  • Shin Miura, Atsushi Kanno, Mio Ikeda, Takanori Sano, Yu Tanaka, Ryotaro Matsumoto, Tatsuhide Nabeshima, Seiji Hongou, Tetsuya Takikawa, Shin Hamada, Kiyoshi Kume, Kazuhiro Kikuta, Ashushi Masamune JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY 34 112 -112 2019年12月
  • Tetusya Takikawa, Atsushi Kanno, Yu Tanaka, Ryoutaro Matsumoto, Tatsuhide Nabeshima, Seiji Hongo, Shin Miura, Shin Hamada, Kiyoshi Kume, Kazuhiro Kikuta, Atsushi Masamune JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY 34 297 -297 2019年12月
  • 菅野 敦, 田中 裕, 松本 諒太郎, 鍋島 立秀, 本郷 星仁, 三浦 晋, 滝川 哲也, 濱田 晋, 粂 潔, 菊田 和宏, 正宗 淳 胆と膵 40 (11) 971 -975 2019年11月 [査読無し][通常論文]
     
    膵癌診療ガイドラインの改訂に伴い、膵癌の術前補助化学療法(neoadjuvant chemotherapy:NAC)症例の増加が予想される。NACを行うためには、施行前に組織学的な確定診断が必要となる。超音波内視鏡下穿刺吸引法(endoscopic ultrasonography-fine needle aspiration:EUS-FNA)は、高い診断能を有することから広く用いられているが、NAC症例に対する安全性や有効性に関する検討は不十分である。今後、症例ごとの詳細な検討を積み重ねることにより、EUS-FNAの是非について明らかにする必要がある。(著者抄録)
  • 菅野 敦, 三浦 晋, 菊田 和宏, 粂 潔, 正宗 淳 消化器内視鏡 31 (11) 1719 -1722 2019年11月 [査読無し][通常論文]
  • 安全に胆道癌拡大肝切除を行うための術前・術後管理 術前胆管ドレナージによる残肝機能への影響 99mTc-GSAシンチグラフィを用いた機能解析
    三浦 晋, 菅野 敦, 正宗 淳 胆道 33 (3) 438 -438 2019年10月 [査読無し][通常論文]
  • MCN疑い病変の取扱い-経過観察可能な病変はあるか? Mucinous cystic neoplasmsの術前診断能と良悪性診断に関する検討
    三浦 晋, 菅野 敦, 松本 裕, 松本 遼太郎, 本郷 星仁, 滝川 哲也, 濱田 晋, 菊田 和宏, 粂 潔, 元井 冬彦, 海野 倫明, 正宗 淳 膵臓 34 (3) A78 -A78 2019年06月 [査読無し][通常論文]
  • 膵がん患者のサポーティブケア 当科における膵癌患者に対する栄養アセスメントの現況
    菊田 和宏, 菅野 敦, 粂 潔, 濱田 晋, 三浦 晋, 滝川 哲也, 本郷 星仁, 鍋島 立秀, 田中 裕, 松本 諒太郎, 正宗 淳 膵臓 34 (3) A43 -A43 2019年06月 [査読無し][通常論文]
  • MCN疑い病変の取扱い-経過観察可能な病変はあるか? Mucinous cystic neoplasmsの術前診断能と良悪性診断に関する検討
    三浦 晋, 菅野 敦, 松本 裕, 松本 遼太郎, 本郷 星仁, 滝川 哲也, 濱田 晋, 菊田 和宏, 粂 潔, 元井 冬彦, 海野 倫明, 正宗 淳 膵臓 34 (3) A78 -A78 2019年06月 [査読無し][通常論文]
  • 術前生検で腺腫と診断された十二指腸乳頭部癌症例の特徴について
    粂 潔, 菅野 敦, 正宗 淳 Gastroenterological Endoscopy 61 (Suppl.1) 924 -924 2019年05月 [査読無し][通常論文]
  • 【自己免疫性膵炎 最近の進歩】 自己免疫性膵炎の診断 画像診断とEUS-FNAを用いた病理組織学的診断
    菅野 敦, 正宗 淳 日本消化器病学会雑誌 116 (4) 286 -295 2019年04月 [査読無し][通常論文]
     
    長年の研究と多数例の経験から自己免疫性膵炎(autoimmune pancreatitis;AIP)の診断能が向上した。特に、画像診断における進歩はめざましく、腹部超音波検査、CT、MRI、FDG-PET、超音波内視鏡(endoscopic ultrasonography;EUS)、内視鏡的逆行性胆管膵管造影(endoscopic retrograde cholangio-pancreatography;ERCP)などを用いたAIPの診断に関する報告が多数認められる。超音波内視鏡下穿刺吸引法(EUS-fine needle aspiration;EUS-FNA)による病理組織学的診断の精度も向上しつつある。これらの進歩を踏まえ、わが国のAIP臨床診断基準が2018年に改訂され、さらなる診断能の向上が期待される。(著者抄録)
  • 三浦 晋, 菅野 敦, 正宗 淳 日本消化器病学会雑誌 116 (臨増総会) A219 -A219 2019年03月 [査読無し][通常論文]
  • 【消化器癌の危険因子・予防対策】 膵癌と危険因子
    滝川 哲也, 大学院医学系研究科消化器病態学分野, 濱田 晋, 菊田 和宏, 松本 諒太郎, 田中 裕, 鍋島 立秀, 本郷 星仁, 三浦 晋, 粂 潔, 菅野 敦, 正宗 淳 消化器・肝臓内科 5 (2) 207 -214 2019年03月 [査読無し][通常論文]
  • 【自己免疫性膵炎2019】 AIPの実態 自己免疫性膵炎の疫学 全国調査の歴史を振り返りながら
    正宗 淳, 大学院医学系研究科消化器病態学分野, 菊田 和宏, 濱田 晋, 菅野 敦, 鍋島 立秀 肝・胆・膵 78 (2) 165 -170 2019年02月 [査読無し][招待有り]
  • 【自己免疫性膵炎2019】 AIPの治療と予後 ステロイド抵抗例の治療 免疫調節薬の現状と使用経験
    菅野 敦, 大学院医学系研究科消化器病態学分野, 田中 裕, 松本 諒太郎, 鍋島 立秀, 本郷 星仁, 三浦 晋, 滝川 哲也, 濱田 晋, 粂 潔, 菊田 和宏, 正宗 淳 肝・胆・膵 78 (2) 261 -267 2019年02月 [査読無し][招待有り]
  • 水間正道, 元井冬彦, 林洋毅, 畠達夫, 伊関雅裕, 高舘達之, 有明恭平, 川口桂, 益田邦洋, 石田晶玄, 大塚英郎, 中川圭, 森川孝則, 内藤剛, 亀井尚, 菅野敦, 正宗淳, 海野倫明 日本消化器外科学会雑誌(Web) 52 (Supplement2) 2019年
  • 【膵神経内分泌腫瘍-診断と治療のパラダイムシフト-】 膵神経内分泌腫瘍 最近の進歩、今後の展望
    全 陽, 病理診断科, 工藤 篤, 菅野 敦, 池田 公史 肝・胆・膵 78 (1) 115 -132 2019年01月 [査読無し][招待有り]
  • 竹山 宜典, 部外科, 岡崎 和一, 新倉 則和, 池浦 司, 糸井 隆夫, 伊藤 鉄英, 乾 和郎, 井上 大, 入江 裕之, 入澤 篤志, 岩崎 栄典, 植木 敏晴, 上原 剛, 内田 一茂, 大原 弘隆, 神澤 輝実, 川 茂幸, 菅野 敦, 窪田 賢輔, 洪 繁, 児玉 裕三, 阪上 順一, 清水 京子, 全 陽, 多田 稔, 中沢 貴宏, 西野 隆義, 能登原 憲司, 浜野 英明, 平野 賢二, 廣岡 芳樹, 正宗 淳, 増田 充弘, 水野 伸匡, 吉田 仁, 井戸 章雄, 下瀬川 徹, 妹尾 浩, 滝川 一, 千葉 勉, 仲瀬 裕志, 伊佐山 浩通, 伊藤 哲也, 梅村 武司, 太田 正穂, 鎌田 研, 河邉 顕, 菅野 敦, 木村 理, 栗山 勝利, 小山 貴, 塩川 雅広, 田妻 進, 田中 篤, 玉木 長良, 露口 利夫, 内藤 格, 仲野 俊成, 濱田 晋, 藤永 康成, 村木 崇, 本谷 雅代, 渡邉 貴之, 渡邉 智裕, 日本膵臓学会, 厚生労働科学研究費補助金, 難治性疾患等政策研究事業, 「IgG, 関連疾患の診断基準並びに治療指針の確立を目指す研究, 班, 自己免疫性膵炎臨床診断, 改訂合同委員会, 日本膵臓学会膵炎調査研究委員会 膵臓 33 (6) 902 -913 2018年12月 [査読有り][通常論文]
     
    自己免疫性膵炎臨床診断基準2011では、限局性膵腫大例の診断にはendoscopic retrograde pancreatography(ERP)は必須である。ERPは昨今施行されることが少なくなり、限局性膵腫大例をmagnetic resonance cholangiopancreatography所見や超音波内視鏡下穿刺吸引法による癌の否定所見などにより、ERPなしでも診断できるプロセスを策定することが、厚生労働科学研究費補助金(難治性疾患等政策研究事業)「IgG4関連疾患の診断基準並びに治療指針の確立を目指す研究」班より提案された。同消化器疾患分科会で自己免疫性膵炎臨床診断基準2011改訂案を作成し、日本膵臓学会自己免疫性膵炎分科会との合同会議、公聴会にて審議し、決定された最終案に対してパブリックコメントを求めた後、合同会議最終版を自己免疫性膵炎臨床診断基準2018公表版とした。(著者抄録)
  • 鍋島 立秀, 学, 大学院消化器病態学分野, 菅野 敦, 正宗 淳, 益田 邦洋, 三浦 晋, 滝川 哲也, 森川 孝則, 藤島 史喜, 海野 倫明, 古川 徹, 下瀬川 徹 胆道 32 (5) 868 -875 2018年12月 [査読有り][通常論文]
     
    症例は60歳代男性。1年前に左腎細胞癌のため左腎摘出術が施行された。同時期に認められていた胆嚢ポリープが徐々に増大傾向を示したため、精査目的に当科を紹介された。造影CTでは胆嚢底部に長径12mmの多血性の隆起性病変を認めた。EUSでは腫瘤は亜有茎性で、強い造影効果を認めた。臨床経過と画像所見より胆嚢癌または腎細胞癌の胆嚢転移を疑い胆嚢摘出術を施行した。最終病理診断は腎細胞癌の胆嚢転移であった。転移性胆嚢腫瘍は稀な腫瘍である。医中誌・PubMedにおいて転移性胆嚢腫瘍で検索したところ165例の報告を認めた。原発巣は腎細胞癌58例(35.1%)、悪性黒色腫45例(27.1%)、胃癌・乳癌は各15例(9.1%)であった。腎細胞癌・悪性黒色腫の胆嚢転移では隆起性病変の形態を、胃癌・乳癌では壁肥厚性病変の形態をとる症例が多かった。転移性胆嚢腫瘍は原発巣によって特徴的な形態を呈する可能性が示唆された。(著者抄録)
  • 膵神経内分泌腫瘍の治療戦略 機能性PNENにおけるSASI testの有用性についての検討
    滝川 哲也, 菅野 敦, 正宗 淳 日本消化器病学会雑誌 115 (臨増大会) A638 -A638 2018年10月 [査読無し][通常論文]
  • 胆膵領域におけるIgG4関連疾患の研究と診療の進歩 腸炎合併膵炎と1型自己免疫性膵炎の臨床像の比較
    菅野 敦, 正宗 淳 日本消化器病学会雑誌 115 (臨増大会) A662 -A662 2018年10月 [査読無し][通常論文]
  • 【胆膵疾患内視鏡アトラス】 膵臓 嚢胞性 非腫瘍性嚢胞 仮性嚢胞、貯留嚢胞
    菅野 敦, 正宗 淳 消化器内視鏡 30 (増刊) 82 -85 2018年10月 [査読無し][通常論文]
  • 画像を診る 鑑別診断のポイント IgG4関連硬化性胆管炎
    粂 潔, 菅野 敦, 宗正 淳 消化器の臨床 21 (3) 197 -199 2018年08月 [査読無し][通常論文]
  • 肝外発生胆管内乳頭状腫瘍(IPNB)の臨床病理学的特徴
    水間 正道, 青木 泰孝, 青木 豪, 深瀬 耕二, 大塚 英郎, 中川 圭, 林 洋毅, 森川 孝則, 元井 冬彦, 内藤 剛, 亀井 尚, 菅野 敦, 正宗 淳, 古川 徹, 海野 倫明 胆道 32 (3) 620 -620 2018年08月 [査読無し][通常論文]
  • 画像を診る 鑑別診断のポイント IgG4関連硬化性胆管炎
    粂 潔, 菅野 敦, 宗正 淳 消化器の臨床 21 (3) 197 -199 2018年08月 [査読無し][通常論文]
  • 自己免疫性膵炎の内視鏡診断と治療の最前線
    菅野 敦, 正宗 淳, 下瀬川 徹 Gastroenterological Endoscopy 60 (7) 1295 -1308 2018年07月 [査読無し][通常論文]
     
    自己免疫性膵炎(AIP)は、膵腫大と主膵管の不整狭細像を特徴とし、しばしば胆管が狭窄するIgG4関連硬化性胆管炎(IgG4-SC)を合併する。内視鏡的逆行性胆管膵管造影(ERCP)による膵管の不整狭細像はAIPに特徴的であるが、限局性のAIPと膵癌を膵管像から鑑別することは難しい。IgG4-SCにおける胆管狭窄は、胆管癌と比較して狭窄長が長いといった特徴を有するが、胆管像のみによる鑑別は困難である。ERCPに引き続いて行われる管腔内超音波検査による胆管壁の所見は、IgG4-SCと胆管癌の鑑別に有用とされている。超音波内視鏡検査(EUS)は、膵臓の低エコー腫大やIgG4-SCの胆管壁肥厚を描出可能で、Elastographyや造影EUSなどを用いた診断も試みられている。EUSガイド下穿刺吸引法を用いたAIPの組織学的診断の有用性も報告されており、AIPの診断能向上が期待される。AIPの治療は、ステロイドを用いた寛解導入ならびに維持療法が基本であるが、閉塞性黄疸時の胆道ドレナージや膵石治療の適応、さらに再燃時に用いられる免疫調節薬の使用法などについて更なる検討が必要である。(著者抄録)
  • 自己免疫性膵炎の内視鏡診断と治療の最前線
    菅野 敦, 正宗 淳, 下瀬川 徹 Gastroenterological Endoscopy 60 (7) 1295 -1308 2018年07月 [査読無し][通常論文]
     
    自己免疫性膵炎(AIP)は、膵腫大と主膵管の不整狭細像を特徴とし、しばしば胆管が狭窄するIgG4関連硬化性胆管炎(IgG4-SC)を合併する。内視鏡的逆行性胆管膵管造影(ERCP)による膵管の不整狭細像はAIPに特徴的であるが、限局性のAIPと膵癌を膵管像から鑑別することは難しい。IgG4-SCにおける胆管狭窄は、胆管癌と比較して狭窄長が長いといった特徴を有するが、胆管像のみによる鑑別は困難である。ERCPに引き続いて行われる管腔内超音波検査による胆管壁の所見は、IgG4-SCと胆管癌の鑑別に有用とされている。超音波内視鏡検査(EUS)は、膵臓の低エコー腫大やIgG4-SCの胆管壁肥厚を描出可能で、Elastographyや造影EUSなどを用いた診断も試みられている。EUSガイド下穿刺吸引法を用いたAIPの組織学的診断の有用性も報告されており、AIPの診断能向上が期待される。AIPの治療は、ステロイドを用いた寛解導入ならびに維持療法が基本であるが、閉塞性黄疸時の胆道ドレナージや膵石治療の適応、さらに再燃時に用いられる免疫調節薬の使用法などについて更なる検討が必要である。(著者抄録)
  • 滝川 哲也, 本郷 星仁, 鍋島 立秀, 三浦 晋, 濱田 晋, 粂 潔, 菊田 和宏, 菅野 敦, 正宗 淳 肝・胆・膵 76 (6) 1137 -1145 2018年06月 [査読無し][通常論文]
  • 膵癌における術前治療と効果判定-画像・病理診断と腫瘍マーカーを中心に- 膵癌術前治療における組織効果と画像・腫瘍マーカーの変化との関係
    水間 正道, 元井 冬彦, 畠 達夫, 伊関 雅裕, 有明 恭平, 高舘 達之, 益田 邦洋, 青木 豪, 石田 晶玄, 深瀬 耕二, 大塚 英郎, 森川 孝則, 中川 圭, 林 洋毅, 内藤 剛, 亀井 尚, 菅野 敦, 正宗 淳, 古川 徹, 海野 倫明 膵臓 33 (3) 355 -355 2018年05月 [査読無し][通常論文]
  • 自己免疫性膵炎の診断と治療-基礎から応用まで- EUS-FNAによる自己免疫性膵炎の病理組織学的検討
    菅野 敦, 正宗 淳 膵臓 33 (3) 328 -328 2018年05月 [査読無し][通常論文]
  • 非切除肝門部悪性胆道狭窄に対する内視鏡的胆道ドレナージ Self-expandable metallic stentとinside stentの治療成績
    三浦 晋, 菅野 敦, 正宗 淳 Gastroenterological Endoscopy 60 (Suppl.1) 733 -733 2018年04月 [査読無し][通常論文]
  • 非切除肝門部悪性胆道狭窄に対する内視鏡的胆道ドレナージ Self-expandable metallic stentとinside stentの治療成績
    三浦 晋, 菅野 敦, 正宗 淳 Gastroenterological Endoscopy 60 (Suppl.1) 733 -733 2018年04月 [査読無し][通常論文]
  • 菅野 敦, 正宗 淳, 鍋島 立秀, 本郷 星仁, 滝川 哲也, 三浦 晋, 濱田 晋, 菊田 和宏, 粂 潔, 下瀬川 徹, 海野 倫明 胆と膵 39 (3) 217 -227 2018年03月 [査読無し][通常論文]
     
    超音波内視鏡(endoscopic ultrasonography:EUS)は、胆嚢を詳細に観察することができる画像診断のmodalityであり、先端プローブの形状や超音波の特性を理解して診断を行う必要がある。EUSは、胆嚢病変の診断や胆嚢癌の進展度診断に有用である。近年EUS-fine needle aspiration(FNA)を用いた胆嚢癌の病理組織学的診断の報告も散見される。EUSを使いこなすことが胆嚢病変の診断に重要である。(著者抄録)
  • 2年間の化学療法でDown-Stagingし根治切除を施行した腹膜転移を伴う膵頭部癌の1例
    初沢 悠人, 水間 正道, 元井 冬彦, 畠 達夫, 伊関 雅裕, 高舘 達之, 大塚 英郎, 坂田 直昭, 森川 孝則, 中川 圭, 林 洋毅, 内藤 剛, 菅野 敦, 下瀬川 徹, 海野 倫明 癌と化学療法 45 (2) 347 -349 2018年02月 [査読無し][通常論文]
     
    腹膜転移を伴う膵頭部癌に対して2年間の化学療法後にdown-stagingが得られ根治切除し得た症例を経験した。症例は55歳、女性。腹部CTで膵頭部に径3.0cmの腫瘤を認め、総肝動脈に接触する切除可能境界膵癌に対して審査腹腔鏡(SL)を施行したところ、腹腔洗浄細胞診が陽性(CY1)であった。gemcitabine(Gem)+S-1併用療法(GS)を開始し、10ヵ月後のSLで右下腹部に播種結節を認め、CY1であったことからGem+nab-paclitaxel療法(Gem+nab-PTX)に変更した。6ヵ月後のCTで右卵巣に腫瘍を認め診断的腹腔鏡下右卵巣摘出術を施行し、組織学的に卵巣への転移と診断され、CY1であった。Gem+nab-PTXを継続し、GS開始から2年時のSLで、CYは陰性化し新規遠隔転移もないことから、亜全胃温存膵頭十二指腸切除術、門脈合併切除再建術を施行した。膵癌取扱い規約第7版に基づき組織学的にypT3、ypN0、cM1、Stage IV、R0切除、組織学的治療効果はGrade 1bと診断された。術後6ヵ月無再発生存中である。(著者抄録)
  • 滝川 哲也, 正宗 淳, 菊田 和宏, 菅野 敦, 下瀬川 徹 臨床消化器内科 33 (2) 211 -217 2018年01月 [査読無し][通常論文]
     
    Yoshidaらにより自己免疫性膵炎(AIP)の疾患概念が提唱されてから約20年が経過し,初期治療に関して多くの検討がなされてきた.初期治療の第一選択はステロイドであり,閉塞性黄疸合併例や持続する腹痛例など臨床的に問題となる症状や徴候を有する症例が積極的な治療適応となる.多くの症例でステロイド治療が著効するが経過とともに再燃をきたす症例も多いため,本邦ではステロイド開始後に漸減を行い,再燃抑制のためステロイドの維持療法が推奨されている.維持療法の期間は3年が目安とされており,3年を経過した後は副作用の観点から個々の症例に応じてステロイドの中止を検討する.(著者抄録)
  • 腹膜転移を有する膵頭部癌に対してAdjuvant Surgeryを企図し切除し得た1例
    客本 ゆき恵, 高舘 達之, 水間 正道, 畠 達夫, 伊関 雅裕, 大塚 英郎, 坂田 直昭, 中川 圭, 森川 孝則, 林 洋毅, 元井 冬彦, 内藤 剛, 菅野 敦, 下瀬川 徹, 海野 倫明 癌と化学療法 44 (12) 1880 -1882 2017年11月 [査読無し][通常論文]
     
    症例は66歳、男性。検診で主膵管拡張を指摘され精査でCA19-9上昇と胆管狭窄も認めたが、確定診断が得られず当院紹介となった。悪性疾患が否定できないため切除目的に開腹し、術中所見で膵頭部に低エコー域と空腸間膜に8mm大の腺癌の播種結節を認め、腹膜転移を伴う膵頭部癌と診断した。胆管空腸吻合術を施行後、adjuvant surgeryを企図し、化学療法gemcitabine+nab-paclitaxelを5コース施行した。治療効果は画像上response evaluaton criteria in solid tumor(RECIST)でstable disease(SD)だが、腫瘍マーカーは正常化した。初回手術から6ヵ月後に亜全胃温存膵頭十二指腸切除術を施行した。組織学的には膵頭部に癌細胞の残存を少量認め、膵癌取扱い規約第7版に基づきypT3、ypN1、pM1(PER)、Stage IV、R0切除、組織学的治療効果Grade 3の診断であった。術後8ヵ月、無再発生存中である。adjuvant surgeryは、腹膜転移を伴う膵癌に対しても治療選択肢の一つとなる可能性が示唆された。(著者抄録)
  • 菅野 敦, 正宗 淳, 鍋島 立秀, 本郷 星仁, 中野 絵里子, 滝川 哲也, 三浦 晋, 濱田 晋, 菊田 和宏, 粂 潔, 下瀬川 徹 胆と膵 38 (臨増特大) 973 -981 2017年10月 [査読無し][通常論文]
     
    超音波内視鏡下穿刺吸引法(endoscopic ultrasound-guided fine needle aspiration:EUS-FNA)には、さまざまな穿刺針や穿刺方法があり、おのおのの特徴をよく理解したうえで施行する必要がある。十分な組織採取量が得られることから、穿刺針はフランシーン形状のものを用いることが多い。穿刺法は、knocking the door法で行い、吸引は凝血塊の混入を防ぐためslow-pull法を用いている。病理検体の処理は正確な病理診断を行ううえで鍵となるため、病理部と密な連携をとることが求められる。(著者抄録)
  • 菅野 敦, 正宗 淳, 鍋島 立秀, 本郷 星仁, 中野 絵里子, 滝川 哲也, 三浦 晋, 濱田 晋, 菊田 和宏, 粂 潔, 下瀬川 徹 肝・胆・膵 75 (3) 589 -594 2017年09月 [査読無し][通常論文]
  • 客本 ゆき恵, 水間 正道, 石田 晶玄, 橘 知睦, 伊関 雅裕, 高舘 達之, 阿部 友哉, 大塚 英郎, 坂田 直昭, 森川 孝則, 中川 圭, 林 洋毅, 元井 冬彦, 内藤 剛, 佐藤 聡子, 藤島 史喜, 菅野 敦, 下瀬川 徹, 海野 倫明 膵臓 32 (4) 767 -774 2017年08月 [査読無し][通常論文]
     
    症例は52歳女性。糖尿病の既往あり。急激な腹痛を主訴に前医受診し、画像検査で膵嚢胞破裂が疑われ当院に紹介された。CTで膵体尾部に径10cmの嚢胞性病変と、周囲に血性を示唆する腹水を認めた。前医MRIで嚢胞はCyst in cyst様であり膵粘液性嚢胞腫瘍(MCN)の破裂が疑われた。超音波内視鏡検査では膵体尾部に多量の凝血塊を内部に含む多房性嚢胞を認め、出血性膵嚢胞性腫瘍と診断された。保存的に止血され、発症2ヵ月後に膵体尾部切除術を施行した。組織学的に嚢胞壁は粘液胞体を有する低異型高円柱細胞から成り、卵巣様間質を認めMCN、intermediate-grade dysplasiaと診断された。嚢胞内容液は褐色で、嚢胞壁下には炎症性細胞とヘモジデリン貪食細胞を認め、陳旧性出血が示唆された。術後1年、再発なく経過している。MCNの自然破裂はまれであり、本邦報告例についての考察を加え報告する。(著者抄録)
  • 膵癌の胆道ドレナージ 【カバー型金属ステントにより長期開存が可能に】
    北野 雅之, 菅野 敦 日本医事新報 (4861) 54 -55 2017年06月 [査読無し][通常論文]
  • 自己免疫性膵炎の治療における注意点 ステロイドの長期投与による副作用などに注意
    菅野 敦, 川嶋 啓揮 日本医事新報 (4854) 57 -58 2017年05月 [査読無し][通常論文]
  • 菅野 敦, 正宗 淳, 鍋島 立秀, 吉田 直樹, 本郷 星仁, 中野 絵里子, 三浦 晋, 濱田 晋, 菊田 和宏, 粂 潔, 廣田 衛久, 下瀬川 徹 消化器内視鏡 29 (5) 946 -951 2017年05月 [査読無し][通常論文]
     
    内視鏡的逆行性膵胆管造影(ERCP)は胆膵疾患の診断や治療に欠かせない手技であるが、偶発症として膵炎の危険性を常に念頭におく必要がある。ERCP後膵炎発症の危険因子として、若年者、女性、Oddi括約筋機能不全疑い、ERCP後膵炎の既往、再発性膵炎などがあげられている。その予防法は、予防的膵管ステント留置やwire-guided cannulationなど内視鏡手技に関連するものと、非ステロイド性抗炎症薬(NSAIDs)やニトログリセリン製剤などの薬物療法に大別される。輸液療法によるERCP後膵炎予防効果についても報告されている。ERCP後膵炎の発症を可能な限り予防するとともに、迅速な診断と対応が必要である。(著者抄録)
  • 自己免疫性膵炎に対する診療の現状と長期予後 当科における1型自己免疫液性膵炎107例の臨床経過
    菅野 敦, 正宗 淳, 下瀬川 徹 膵臓 32 (3) 353 -353 2017年05月 [査読無し][通常論文]
  • 男性に発生した粘液性嚢胞性腫瘍(MCN)の1例
    高舘 達之, 水間 正道, 伊関 雅裕, 有明 恭平, 前田 晋平, 益田 邦洋, 石田 晶玄, 深瀬 耕二, 大塚 英郎, 坂田 直昭, 中川 圭, 林 洋毅, 森川 孝則, 内藤 剛, 元井 冬彦, 菅野 敦, 下瀬川 徹, 海野 倫明 膵臓 32 (3) 634 -634 2017年05月 [査読無し][通常論文]
  • 慢性膵炎診断における超音波の役割 自己免疫性膵炎の超音波内視鏡像における慢性膵炎様変化の臨床的意義
    菅野 敦, 正宗 淳, 下瀬川 徹 超音波医学 44 (Suppl.) S242 -S242 2017年04月 [査読無し][通常論文]
  • 当院における膵粘液性嚢胞腫瘍(MCN)症例の検討
    鍋島 立秀, 菅野 敦, 正宗 淳, 本郷 星仁, 吉田 直樹, 中野 絵里子, 三浦 晋, 濱田 晋, 粂 潔, 菊田 和宏, 廣田 衛久, 元井 冬彦, 海野 倫明, 藤島 史喜, 下瀬川 徹 日本消化器病学会雑誌 114 (臨増総会) A283 -A283 2017年03月 [査読無し][通常論文]
  • 菅野 敦, 正宗 淳, 花田 敬士, 真口 宏介, 清水 泰博, 植木 敏晴, 長谷部 修, 大塚 隆生, 中村 雅史, 竹中 完, 北野 雅之, 菊山 正隆, 蒲田 敏文, 吉田 浩司, 佐々木 民人, 芹川 正浩, 古川 徹, 柳澤 昭夫, 下瀬川 徹 膵臓 32 (1) 16 -22 2017年02月 [査読無し][通常論文]
     
    膵癌早期診断研究会が主導して行った。早期診断された膵癌の実態調査について報告する。40例のStage 0膵癌と119例のStage I膵癌が集積された。膵癌全体に占めるStage 0膵癌とStage I膵癌の割合は約2%であり、Stage 0膵癌は0.6%であった。症状を認めたために医療機関を受診した症例は38例(23.9%)と少なかったのに対して、検診にて異常を指摘され受診した症例は27例(17.0%)、他疾患の経過観察中に異常を指摘された症例は85例(53.5%)と無症状で医療機関を受診した症例が多かった。検診にて異常を指摘された27例中、膵管拡張を指摘された症例が19例と画像における副所見の指摘から精査を行った症例が多かった。術前の病理診断では、超音波内視鏡下穿刺吸引法を用いた症例(30.8%)と比較して、内視鏡的逆行性胆管膵管造影下にて病理検体を採取した症例(77.8%)が多かった。予後は良好であったが、14.5%の症例で術後の残膵に膵癌が新たに発生した。今回の調査が、膵癌の早期発見ならびに予後改善に寄与をすることが期待される。(著者抄録)
  • 菅野敦, 菅野敦, 正宗淳, 花田敬士, 花田敬士, 真口宏介, 真口宏介, 清水泰博, 清水泰博, 植木敏晴, 植木敏晴, 長谷部修, 長谷部修, 大塚隆生, 大塚隆生, 中村雅史, 竹中完, 竹中完, 北野雅之, 北野雅之, 菊山正隆, 菊山正隆, 蒲田敏文, 蒲田敏文, 吉田浩司, 吉田浩司, 佐々木民人, 佐々木民人, 芹川正浩, 芹川正浩, 古川徹, 古川徹, 柳澤昭夫, 柳澤昭夫, 下瀬川徹 膵臓 32 (1) 2017年
  • 岡崎和一, 岡崎和一, 下瀬川徹, 神澤輝実, 川茂幸, 井戸章雄, 滝川一, 能登原憲司, 岩崎栄典, 児玉裕三, 乾和郎, 全陽, 田中篤, 中沼安二, 窪田賢輔, 吉田仁, 太田正穂, 正宗淳, 伊藤鉄英, 中沢貴宏, 西野隆義, 浜野英明, 清水京子, 藤永康成, 内田一茂, 洪繁, 平野賢二, 水野伸匡, 塩見英之, 菅野敦, 濱田晋, 塩川雅広, 栗山勝利 IgG4関連疾患の診断基準並びに治療指針の確立を目指した研究 平成28年度 総括・分担研究報告書(Web) 2017年
  • 【胆膵内視鏡自由自在〜基本手技を学び応用力をつける集中講座〜】 ERCP関連手技編 トラブルシューティング ERCP後膵炎への対処と予防
    川口 義明, 明石 隆吉, 伊藤 鉄英, 木田 光広, 菅野 敦, 花田 敬士, 宮川 宏之, 森實 敏夫, 山口 武人, 竹山 宜典, 真弓 俊彦, 下瀬川 徹, 峯 徹哉 胆と膵 37 (臨増特大) 1295 -1300 2016年11月 [査読無し][通常論文]
     
    ERCPは胆膵疾患の診断・治療において必要欠くべからざるものであるが、問題点としてERCP後膵炎があげられる。ときに重症化して死亡事故に至るケースもあり、胆膵内視鏡医としては回避しなければならないものである。2015年厚労省難治性膵疾患研究班・日本膵臓学会からERCP後膵炎ガイドラインが発表された。重要なポイントとして、ERCPの適応があるかどうかの判断、ERCP後膵炎発症機序の理解、ERCP後膵炎危険因子の把握、患者へのインフォームドコンセント、ERCP後膵炎の早期診断と治療法、そしてERCP後膵炎の予防があげられる。とくにERCP後膵炎の予防法としては、術前の薬剤投与による予防、自然脱落型膵管ステント留置、WGC法による胆管挿管があり、これらの十分な理解と習得が望まれる。(著者抄録)
  • 菅野 敦, 正宗 淳, 中野 絵里子, 鍋島 立秀, 吉田 直樹, 本郷 星仁, 三浦 晋, 濱田 晋, 菊田 和宏, 粂 潔, 廣田 衛久, 下瀬川 徹 胆と膵 37 (臨増特大) 1333 -1337 2016年11月 [査読無し][通常論文]
     
    症状を有する膵管狭窄症例は、内視鏡的治療の適応となることが多い。膵管狭窄はさまざまな原因で起こりうるが、治療を行ううえで、その原因を正しく診断することがもっとも重要である。膵管狭窄の内視鏡的治療は、ガイドワイヤーによる狭窄部の突破、狭窄部の拡張、ステント挿入などのいくつかの段階を要する。膵管狭窄に対する安易な内視鏡治療は、膵管損傷などの重篤な偶発症を招くため、多くの症例を経験する必要がある。(著者抄録)
  • 肝動脈走行破格と術前治療により腹腔動脈合併膵頭十二指腸切除で切除し得た膵癌の1例
    客本 ゆき恵, 水間 正道, 阿部 友哉, 高舘 達之, 深瀬 耕二, 大塚 英郎, 坂田 直昭, 中川 圭, 森川 孝則, 林 洋毅, 内藤 剛, 元井 冬彦, 菅野 敦, 下瀬川 徹, 海野 倫明 癌と化学療法 43 (12) 1966 -1968 2016年11月 [査読無し][通常論文]
     
    症例は70歳、女性。糖尿病悪化を契機に施行した腹部超音波検査で膵体頭部に腫瘤を認め、精査にて膵癌と診断された。造影CTで膵体頭部に径2.5cmの腫瘤を認めた。総肝動脈から脾動脈起始部にかけて全周性の接触と腹腔動脈から左胃動脈にかけて半周以下の接触を認め、門脈浸潤も疑われた。肝動脈に破格があり、上腸間膜動脈から分岐する右肝動脈と左胃動脈から分岐する左肝動脈を認めた。明らかな遠隔転移は認めず、動脈因子によるborderline resectable膵体頭部癌と診断した。術前化学放射線療法後、亜全胃温存膵頭十二指腸切除・左胃動脈温存腹腔動脈切除・門脈合併切除を施行し、R0切除が得られた。膵癌に対する再建を要する主要動脈合併切除の意義は不明であるが、走行破格によっては総肝動脈の再建を要せず安全に切除できる場合もあり、術前の詳細な血管走行の把握とそれに応じた術式検討が重要である。(著者抄録)
  • 菅野 敦, 正宗 淳, 鍋島 立秀, 吉田 直樹, 本郷 星仁, 中野 絵里子, 三浦 晋, 濱田 晋, 菊田 和宏, 粂 潔, 廣田 衛久, 下瀬川 徹 消化器内視鏡 28 (10) 1593 -1599 2016年10月 [査読無し][通常論文]
     
    超音波内視鏡下穿刺吸引法(EUS-FNA)には、さまざまな穿刺針や穿刺方法があり、各々の特徴を理解したうえで施行する必要がある。また、病理検体処理の方法は病理診断能を左右する重要な過程であり、内視鏡医と病理部門が密な連携をとって、各施設における最適な方法を行うことが重要である。(著者抄録)
  • 峯 徹哉, 明石 隆吉, 川口 義明, 木田 光弘, 伊藤 鉄英, 花田 敬士, 山口 武人, 宮川 宏之, 菅野 敦, 森實 敏夫, 竹山 宜典, 下瀬川 徹 臨床消化器内科 31 (5) 579 -584 2016年04月 [査読無し][通常論文]
     
    ERCPについては偶発症の問題,おもにERCP後膵炎の問題が現在もクローズアップされており,またMRCPの一般化により最近,症例数は減少傾向にあるといわれている.確かにMRCPで診断でき内視鏡的治療を行わない症例にはERCPは行われなくなっている.しかし,ERCP関連手技の応用や普及により,ERCPは今後も胆膵領域にとって重要な手技であることに変わりはないと思われる.ではどうすればよいのか.これについてはERCP後膵炎の診断基準を見直し,より早く治療を行い救命することと同時に,いかに重症のERCP後膵炎を生じさせないか,その予防法を検討する必要がある.(著者抄録)
  • 志村 充広, 水間 正道, 岡田 恭穂, 片桐 宗利, 坂田 直昭, 中川 圭, 林 洋毅, 森川 孝則, 元井 冬彦, 内藤 剛, 江川 新一, 藤島 史喜, 菅野 敦, 廣田 衛久, 正宗 淳, 下瀬川 徹, 海野 倫明 膵臓 31 (1) 93 -100 2016年02月 [査読無し][通常論文]
     
    症例は58歳女性。父が膵癌の家族歴がある。2008年11月に背部痛で発症し、当院で精査を施行。膵鉤部と体尾部に複数の分枝型膵管内乳頭粘液性腫瘍(IPMN)に併存する膵体部の通常型膵癌に対し、2009年4月に膵体尾部切除術を施行した。組織学的には分枝型IPMNに併存した高分化型管状腺癌(tub1)であり、膵癌取扱い規約では、T3N0M0、Stage III、R0であった。膵断端近傍にPanIN1A-1B相当の所見を認めた。術後37ヵ月からCA19-9の上昇を認め、精査で異時性発生膵癌あるいは残膵再発と診断し初回手術から46ヵ月後に残膵全摘術・門脈合併切除術を施行。組織学的に膵鉤部IPMNとの連続性は認めず、初回手術と同様にtub1と診断されたが、組織像がやや異なることや時間経過等から異時性発生と診断された。IPMNに併存し異時性多中心性に発生した膵癌に関して文献的考察を加え報告する。(著者抄録)
  • 胆・膵 胆道 悪性肝門部胆管狭窄に対する胆道ドレナージ
    菅野 敦, 正宗 淳, 三浦 晋, 下瀬川 徹 Annual Review消化器 2016 205 -211 2016年01月 [査読無し][通常論文]
     
    悪性肝門部胆管狭窄の胆道ドレナージには,最初にCTなどを用いて原因疾患を診断し治療方針を決める必要がある.手術を行う場合には,広範囲肝切除を必要とし,内視鏡的経鼻胆道ドレナージ(Endoscopic nasobiliary drainage:ENBD)を用いた残存予定肝側への片葉ドレナージを行うことが基本である.しかし,ドレナージされる肝容積が少ない場合には,複数本のENBDが必要となる.非切除悪性肝門部胆管狭窄症例に対する胆管ドレナージは,uncovered self expandable metallic stentが推奨されているが,その留置形態は決まっていない.開存期間が長く,閉塞時の対応が容易なステントの開発が期待される.(著者抄録)
  • 菅野 敦, 正宗 淳, 三浦 晋, 吉田 直樹, 本郷 星仁, 中野 絵里子, 濱田 晋, 菊田 和宏, 粂 潔, 廣田 衛久, 下瀬川 徹, 深瀬 耕二, 海野 倫明 胆と膵 37 (1) 37 -44 2016年01月 [査読無し][通常論文]
     
    胆道癌取扱い規約が改訂され、UICC分類に則って肝門部領域胆管癌が新たに定義された。肝門部領域胆管癌は手術を中心に考えられた定義であり、広範囲肝切除を中心に術式が立案される。超音波内視鏡(endoscopic ultrasonograpy:EUS)と管腔内超音波検査(intraductal ultrasonography:IDUS)は、胆管癌の進展度診断に必須の検査であるが、今回の定義変更により、術前診断におけるEUSとIDUSの役割がさらに重要になった。(著者抄録)
  • 正宗淳, 岡崎和一, 安藤朗, 伊藤鉄英, 伊佐山浩通, 糸井隆夫, 乾和郎, 入澤篤志, 大原弘隆, 神澤輝実, 川茂幸, 菅野敦, 北野雅之, 木原康之, 児玉裕三, 阪上順一, 清水京子, 田口雅史, 能登原憲司, 花田敬士, 廣岡芳樹, 下瀬川徹, 菊田和宏, 竹山宜典 難治性膵疾患に関する調査研究 平成27年度 総括・分担研究報告書 2016年
  • 岡崎和一, 下瀬川徹, 神澤輝実, 川茂幸, 井戸章雄, 滝川一, 能登原憲司, 岩崎栄典, 児玉裕三, 乾和郎, 全陽, 田中篤, 中沼安二, 窪田賢輔, 吉田仁, 太田正穂, 正宗淳, 伊藤鉄英, 中沢貴宏, 西野隆義, 浜野英明, 浜野英明, 清水京子, 藤永康成, 内田一茂, 洪繁, 平野賢二, 水野伸匡, 塩見英之, 菅野敦, 濱田晋, 塩川雅広, 栗山勝利 IgG4関連疾患の診断基準並びに治療指針の確立を目指した研究 平成27年度 総括・分担研究報告書 2016年
  • 膵原発Mixed acinar-endocrine carcinoma(MAEC)の1例
    中野 絵里子, 菅野 敦, 正宗 淳, 本郷 星仁, 吉田 直樹, 三浦 晋, 濱田 晋, 粂 潔, 菊田 和宏, 廣田 衛久, 下瀬川 徹, 深瀬 耕二, 元井 冬彦, 海野 倫明, 笠島 敦子 東北医学雑誌 127 (2) 186 -187 2015年12月 [査読無し][通常論文]
  • 術前治療施行膵癌切除後3年の残膵再発に対し根治切除を施行した1例
    客本 ゆき恵, 水間 正道, 益田 邦洋, 有明 恭平, 前田 晋平, 川口 桂, 岡田 良, 石田 晶玄, 深瀬 耕二, 大塚 英郎, 坂田 直昭, 中川 圭, 森川 孝則, 林 洋毅, 内藤 剛, 元井 冬彦, 海野 倫明, 菅野 敦, 下瀬川 徹 東北医学雑誌 127 (2) 192 -193 2015年12月 [査読無し][通常論文]
  • 菅野 敦, 正宗 淳, 吉田 直樹, 本郷 星仁, 中野 絵里子, 三浦 晋, 濱田 晋, 菊田 和宏, 粂 潔, 廣田 衛久, 下瀬川 徹 最新医学 70 (10) 1955 -1965 2015年10月 [査読無し][通常論文]
     
    消化管や膵臓に発生する神経内分泌腫瘍(NEN)の報告数が増加している.2010年に,細胞分裂所見とKi67標識率に基づいて分類される新しいNENのWHO病理分類が公表された.超音波内視鏡下穿刺吸引法(EUS-FNA)を用いた膵NEN(PNEN)の診断における有用性が報告され,組織学的診断のみならず,悪性度診断にも応用されている.EUS-FNAを用いてPNENの診断を行うためには十分な組織量が必要であり,穿刺方法や検体処理法を工夫する必要がある.(著者抄録)
  • 菅野 敦, 正宗 淳, 吉田 直樹, 本郷 星仁, 中野 絵里子, 三浦 晋, 濱田 晋, 菊田 和宏, 粂 潔, 廣田 衛久, 下瀬川 徹 肝臓クリニカルアップデート 1 (2) 215 -222 2015年10月 [査読無し][通常論文]
  • 菅野 敦, 正宗 淳, 吉田 直樹, 本郷 星仁, 中野 絵里子, 三浦 晋, 濱田 晋, 菊田 和宏, 粂 潔, 廣田 衛久, 下瀬川 徹 胆と膵 36 (臨増特大) 947 -954 2015年10月 [査読無し][通常論文]
     
    内視鏡的逆行性胆管膵管造影(Endoscopic retrograde cholangio-pancreatography:ERCP)下細胞診および生検は、膵・胆道疾患の診断上必要であり、胆道腫瘍の良悪性診断や水平方向進展診断の他、膵上皮内癌や膵管内乳頭粘液性腫瘍の診断を行ううえで重要な役割を担っている。さまざまなデバイスの特徴を理解し、安全かつ効率的に膵・胆道疾患の病理組織学的診断を行うことが重要である。(著者抄録)
  • 峯 徹哉, 明石 隆吉, 伊藤 鉄英, 川口 義明, 菅野 敦, 木田 光広, 花田 敬士, 宮川 宏之, 山口 武人, 森實 敏夫, 下瀬川 徹, 竹山 宜典, 真弓 俊彦, 厚生労働省難治性膵疾患調査研究班, 厚生労働省難治性膵疾患調査研究班, 日本膵臓学会 膵臓 30 (4) 541 -584 2015年08月 [査読無し][通常論文]
  • 菅野 敦, 正宗 淳, 吉田 直樹, 本郷 星仁, 中野 絵里子, 三浦 晋, 滝川 哲也, 濱田 晋, 菊田 和宏, 粂 潔, 廣田 衛久, 下瀬川 徹 胆と膵 36 (7) 691 -698 2015年07月 [査読無し][通常論文]
     
    電子型超音波内視鏡や超音波造影剤の進歩により、造影超音波内視鏡検査が可能になり、組織内の血流をリアルタイムに観察することができるようになった。造影ハーモニック超音波内視鏡は、詳細な血流の観察のみならず、定量的な血流解析による膵腫瘍診断への応用が期待されている。また、超音波内視鏡下穿刺吸引細胞診・組織診(endoscopic ultrasonography-fine needle aspiration:EUS-FNA)が普及したが、穿刺による播種の問題は解決しておらず、より侵襲の少ない造影超音波内視鏡による膵腫瘍の鑑別診断への応用が期待される。(著者抄録)
  • 内視鏡的手技 膵疾患に対するInterventional Endoscopy 壊死性膵炎後の膵局所合併症に対する内視鏡的ネクロセクトミーの当科における現況
    粂 潔, 菅野 敦, 正宗 淳, 下瀬川 徹 膵臓 30 (3) 287 -287 2015年05月 [査読無し][通常論文]
  • IgG4関連膵胆管病変における内視鏡の役割 22G針を用いたEUS-FNAによる自己免疫性膵炎の病理組織学的検討 多施設共同観察研究
    菅野 敦, 正宗 淳, 下瀬川 徹 Gastroenterological Endoscopy 57 (Suppl.1) 707 -707 2015年04月 [査読無し][通常論文]
  • 【膵癌・胆道癌-基礎と臨床の最新研究動向-】 膵癌 上皮性腫瘍 通常型膵癌 治療 集学的治療 内視鏡的ステント(胆道、十二指腸)
    菅野 敦, 正宗 淳, 下瀬川 徹 日本臨床 73 (増刊3 膵癌・胆道癌) 168 -172 2015年03月 [査読無し][通常論文]
  • 【膵癌・胆道癌-基礎と臨床の最新研究動向-】 膵癌 上皮性腫瘍 転移性膵腫瘍
    菅野 敦, 正宗 淳, 下瀬川 徹 日本臨床 73 (増刊3 膵癌・胆道癌) 371 -375 2015年03月 [査読無し][通常論文]
  • 【膵癌・胆道癌-基礎と臨床の最新研究動向-】 胆道癌 腺癌 乳頭部癌 症状・所見・血液検査
    菅野 敦, 正宗 淳, 下瀬川 徹 日本臨床 73 (増刊3 膵癌・胆道癌) 707 -710 2015年03月 [査読無し][通常論文]
  • 【膵癌・胆道癌-基礎と臨床の最新研究動向-】 胆道癌 腺癌 乳頭部癌 治療 集学的治療(内視鏡ステント・胆道、十二指腸)
    菅野 敦, 正宗 淳, 下瀬川 徹 日本臨床 73 (増刊3 膵癌・胆道癌) 741 -744 2015年03月 [査読無し][通常論文]
  • 海野 倫明, 吉田 寛, 菅野 敦, 藤島 史喜 胆道 29 (1) 163 -166 2015年03月 [査読無し][通常論文]
  • 術後腸管に対するERCP 症例に応じたスコープ選択
    菅野 敦, 正宗 淳, 下瀬川 徹 日本消化器病学会雑誌 112 (臨増総会) A273 -A273 2015年03月 [査読無し][通常論文]
  • 【自己免疫性膵炎20年の軌跡】 AIPの実態 わが国における実態 2011年全国疫学調査の結果を中心に
    正宗 淳, 菅野 敦, 下瀬川 徹 肝・胆・膵 70 (2) 185 -192 2015年02月 [査読無し][通常論文]
  • 菅野 敦, 正宗 淳, 下瀬川 徹 膵臓 30 (1) 54 -61 2015年02月 [査読無し][通常論文]
     
    Yoshidaらにより疾患概念として自己免疫性膵炎(Autoimmune pancreatitis:AIP)が提唱されてから約20年が経過するが、その全体像については未だ不明な点が少なくない。我が国では厚生労働省の「難治性膵疾患に関する調査研究班」により、全国疫学調査がこれまでに3回行われている。最新の2011年の受療患者を対象として行われた第3回AIP全国調査では、年間推計受療者数は5,745人(95%信頼区間:5,325〜6,164人)、有病率は人口10万人あたり4.6人、罹患率は人口10万人あたり1.4人であった。2次調査により、大部分の症例において血清IgG4が高値であることや、8割以上にステロイド治療が行われているなど、我が国におけるAIP診療の実態が明らかとなった。全国調査から得られたAIPの全体像をもとに、AIPの診断、治療、研究に関して今後さらなる展開が期待される。(著者抄録)
  • 【最新肝癌学-基礎と臨床の最新研究動向-】 肝癌の危険因子と発癌機序 非B非C肝癌 非B非C肝癌の危険因子と発癌機序 自己免疫性肝疾患 原発性硬化性胆管炎
    菅野 敦, 正宗 淳, 下瀬川 徹 日本臨床 73 (増刊1 最新肝癌学) 130 -133 2015年01月 [査読無し][通常論文]
  • 奥坂 拓志, 福冨 晃, 木原 康之, 伊藤 鉄英, 古瀬 純司, 大東 弘明, 中郡 聡夫, 菅野 敦, 上坂 克彦, 中村 聡明, 山口 幸二 膵臓 29 (6) 892 -897 2014年12月 [査読無し][通常論文]
     
    膵癌診療ガイドラインは2013年に4年ぶりの改訂版が出版された。切除可能例に対する化学療法(補助療法)に関しては、JASPAC-01試験の結果をうけてS-1単独療法が推奨され、切除不能例に対する化学療法に関しては、PA.3試験の結果をうけてゲムシタビン塩酸塩+エルロチニブ併用療法が、GEST試験の結果をうけてS-1単独療法が、推奨に追加された。また切除不能例に関しては2014年にも改訂が行われ、PRODIGE 4/ACCORD 11試験の結果に基づきFOLFIRINOX療法の推奨が追加された。膵癌に対する化学療法は今後も有効な治療の開発が続くと予想されており、患者の予後のさらなる改善に寄与することが期待されている。(著者抄録)
  • 【AIPの概念・診断・治療】 自己免疫性膵炎の疫学調査
    菅野 敦, 正宗 淳, 下瀬川 徹 消化器内科 59 (5) 456 -461 2014年11月 [査読無し][通常論文]
  • 下瀬川 徹, 糸井 隆夫, 佐田 尚宏, 祖父尼 淳, 向井 俊太郎, 乾 和郎, 白鳥 敬子, 廣岡 芳樹, 入澤 篤志, 菅野 敦, 五十嵐 良典, 北野 雅之, 兼田 裕司, 伊佐地 秀司, 武田 和憲, 竹山 宜典, 真弓 俊彦, 木原 康之, 桐山 勢生, 安田 一朗, 厚生労働省科学研究費補助金難治性疾患克服研究事業難治性膵疾患に関する調査研究班 膵臓 29 (5) 777 -818 2014年10月 [査読無し][通常論文]
  • 分枝型膵IPMNの診断・悪性度の評価における内視鏡の役割 分枝型IPMNの壁在結節隆起高増大に影響を与える臨床的背景因子の検討
    三浦 晋, 菅野 敦, 下瀬川 徹 Gastroenterological Endoscopy 56 (Suppl.1) 889 -889 2014年04月 [査読無し][通常論文]
  • AIP 概念、診断、治療のUpdate 自己免疫性膵炎の疫学調査
    菅野 敦, 正宗 淳, 下瀬川 徹 日本消化器病学会雑誌 111 (臨増総会) A149 -A149 2014年03月 [査読無し][通常論文]
  • 胆道癌の胆管ドレナージの標準化 手術症例と非手術症例 肝門部悪性胆道狭窄における術前期間における胆管炎発症の検討
    三浦 晋, 菅野 敦, 下瀬川 徹 日本消化器病学会雑誌 110 (臨増大会) A783 -A783 2013年09月 [査読無し][通常論文]
  • MiR-365によるゲムシタビン耐性誘導機構の検討
    濱田 晋, 佐藤 賢一, 正宗 淳, 菅野 敦, 菊田 和宏, 粂 潔, 廣田 衛久, 下瀬川 徹 日本消化器病学会雑誌 110 (臨増大会) A852 -A852 2013年09月 [査読無し][通常論文]
  • 【消化器診療の疑問、これで納得!外来・病棟・当直での初期対応や鑑別診断から検査・画像・薬物治療まで、よくある悩みに答えます】 (第2章)こんなとき病棟で役立つ!消化器症状へのアプローチ 急性膵炎で入院した患者に対する初期治療の戦略がよくわかりません。アルコール性・胆石性の対処法は? 動注、CHDFなどの適応なども教えてください
    菅野 敦, 正宗, 淳, 下瀬川 レジデントノート 15 (8) 1442 -1449 2013年08月 [査読無し][通常論文]
     
    <Point>・当初は軽症でも重症化することが少なくないため、頻回に重症度判定を行うことが重要である・初期治療で最も重要な治療は大量輸液である・自施設の治療能力を見極め、重症例や重症化の可能性があると判断した場合はすみやかに高次医療施設へ搬送する・重症急性膵炎と診断した場合には、すみやかに公費申請を行うよう(患者)家族に説明する(著者抄録)
  • 水間正道, 元井冬彦, 岡田恭穂, 中川圭, 林洋毅, 森川孝則, 乙供茂, 坂田直昭, 大塚英郎, 深瀬耕二, 藪内伸一, 青木豪, 川口桂, 吉田寛, 内藤剛, 片寄友, 江川新一, 菅野敦, 下瀬川徹, 海野倫明 すい臓 28 (3) 392 2013年06月 [査読無し][通常論文]
  • 大腸癌膵転移への外科的切除の意義
    佐藤 好宏, 深瀬 耕二, 青木 豪, 水間 正道, 坂田 直昭, 乙供 茂, 大塚 英郎, 岡田 恭穂, 中川 圭, 森川 孝則, 林 洋毅, 吉田 寛, 元井 冬彦, 内藤 剛, 片寄 友, 柴田 近, 菅野 敦, 正宗 淳, 下瀬川 徹, 海野 倫明 膵臓 28 (3) 443 -443 2013年06月 [査読無し][通常論文]
  • Shin Hamada, Kennichi Satoh, Atsushi Masamune, Atsushi Kanno, Kazuhiro Kikuta, Kiyoshi Kume, Jun Unno, Morihisa Hirota, Tooru Shimosegawa GASTROENTEROLOGY 144 (5) S68 -S68 2013年05月 
    0
  • 坂田直昭, 後藤昌史, 元井冬彦, 林洋毅, 中川圭, 水間正道, 山谷英之, 長谷川豊, 澤田正二郎, 吉松軍平, 伊藤経夫, 菅野敦, 廣田衛久, 石垣泰, 力山敏樹, 江川新一, 片桐秀樹, 下瀬川徹, 里見進, 海野倫明 日本消化器病学会雑誌 109 A765 2012年09月 [査読無し][通常論文]
  • miR-197は膵癌細胞のEMT誘導因子であり、p120 catenin発現を制御する
    濱田 晋, 佐藤 賢一, 三浦 晋, 廣田 衛久, 菅野 敦, 正宗 淳, 菊田 和宏, 粂 潔, 海野 純, 江川 新一, 元井 冬彦, 海野 倫明, 下瀬川 徹 日本消化器病学会雑誌 109 (臨増大会) A741 -A741 2012年09月 [査読無し][通常論文]
  • 早期慢性膵炎の臨床像 早期から確診に進行した2症例の比較
    廣田 衛久, 下瀬川 徹, 菅野 敦, 粂 潔, 菊田 和宏, 濱田 晋, 海野 純, 正宗 淳 日本消化器病学会雑誌 109 (臨増大会) A762 -A762 2012年09月 [査読無し][通常論文]
  • 自己免疫性膵炎の合併が疑われた通常型膵癌の1例
    菅野 敦, 滝川 哲也, 三浦 晋, 有賀 啓之, 海野 純, 濱田 晋, 粂 潔, 菊田 和宏, 廣田 衛久, 正宗 淳, 坂田 直昭, 元井 冬彦, 海野 倫明, 石田 和之, 下瀬川 徹 Gastroenterological Endoscopy 54 (Suppl.2) 2826 -2826 2012年09月 [査読無し][通常論文]
  • 内視鏡的膵管ドレナージ術が有効であった、膵性胸水の一例
    三浦 晋, 菅野 敦, 濱田 晋, 滝川 哲也, 林 晋太郎, 鈴木 範明, 海野 純, 粂 潔, 有賀 啓之, 菊田 和宏, 廣田 衛久, 正宗 淳, 下瀬川 徹 Gastroenterological Endoscopy 54 (Suppl.1) 1214 -1214 2012年04月 [査読無し][通常論文]
  • 主膵管型IPMN oncocytic typeの1例
    林 晋太郎, 海野 純, 三浦 晋, 滝川 哲也, 有賀 啓之, 鈴木 範明, 濱田 晋, 粂 潔, 菅野 敦, 廣田 衛久, 正宗 淳, 下瀬川 徹, 元井 冬彦, 江川 新一, 海野 倫明, 石田 和之 東北医学雑誌 123 (2) 216 -216 2011年12月 [査読無し][通常論文]
  • 高野成尚, 林洋毅, 吉田寛, 乙供茂, 中川圭, 石田和之, 元井冬彦, 力山敏樹, 片寄友, 江川新一, 菅野敦, 佐藤賢一, 下瀬川徹, 海野倫明 胆道 24 (3) 463 2010年08月 [査読無し][通常論文]
  • Atsushi Masamune, Tooru Shimosegawa Journal of Gastroenterology 44 (4) 249 -260 2009年 [査読無し][通常論文]
     
    Pancreatic fibrosis is a characteristic feature of chronic pancreatitis and of desmoplastic reaction associated with pancreatic cancer. For over a decade, there has been accumulating evidence that activated pancreatic stellate cells (PSCs) play a pivotal role in the development of pancreatic fibrosis in these pathological settings. In response to pancreatic injury or inflammation, quiescent PSCs undergo morphological and functional changes to become myofibroblast-like cells, which express α-smooth muscle actin (α-SMA). Activated PSCs actively proliferate, migrate, produce extracellular matrix (ECM) components, such as type I collagen, and express cytokines and chemokines. In addition, PSCs might play roles in local immune functions and angiogenesis in the pancreas. Following the initiation of activation, if the inflammation and injury are sustained or repeated, PSCs activation is perpetuated, leading to the development of pancreatic fibrosis. From this point of view, pancreatic fibrosis can be defined as pathological changes of ECM composition in the pancreas both in quantity and quality, resulting from perpetuated activation of PSCs. Because the activation and cell functions in PSCs are regulated by the dynamic but coordinated activation of intracellular signaling pathways, identification of signaling molecules that play a crucial role in PSCs activation is important for the development of anti-fibrosis therapy. Recent studies have identified key mediators of stimulatory and inhibitory signals. Signaling molecules, such as peroxisome proliferator-activated receptor-α (PPAR-α), Rho/Rho kinase, nuclear factor-κB (NF-κB), mitogen-activated protein (MAP) kinases, phosphatidylinositol 3 kinase (PI3K), Sma- and Mad-related proteins, and reactive oxygen species (ROS) might be candidates for the development of anti-fibrosis therapy targeting PSCs. © Springer 2009.
  • 膵癌細胞Panc-1においてSmad4機能欠損はEMTを抑制し転移能を低下させる (日本癌学会総会記事)
    廣田衛久, 佐藤賢一, 濱田晋, 菅野敦, 海野純, 伊藤広通, 下瀬川徹 日本癌学会総会記事 67 199 2008年 [査読無し][通常論文]
  • 菅野 敦, 佐藤 賢一, 木村 憲治, 廣田 衛久, 海野 純, 正宗 淳, 佐藤 晃彦, 朝倉 徹, 江川 新一, 砂村 真琴, 遠藤 希之, 下瀬川 徹 膵臓 = The Journal of Japan Pancreas Society 22 (2) 156 -157 2007年04月 [査読無し][通常論文]

共同研究・競争的資金等の研究課題

  • 膵腺房細胞癌の実態調査
    日本膵臓学会:プロジェクト研究
    研究期間 : 2020年12月 -2022年12月
  • 膵上皮内癌周囲の膵腺房細胞萎縮に着目した膵癌早期診断の基礎的研究
    日本学術振興協会:科研費 基盤研究(C)(一般)
    研究期間 : 2018年04月 -2021年03月 
    代表者 : 菅野 敦
  • 臨床検体から導き出す膵癌幹細胞関連 miRNAを用いた膵癌治療の確立
    日本学術振興協会:科研費 基盤研究(C)(一般)
    研究期間 : 2013年04月 -2015年03月 
    代表者 : 菅野 敦
  • 膵管上皮細胞の上皮間様相互作用における遺伝子変化
    日本学術振興会:科研費 若手研究B
    研究期間 : 2009年04月 -2011年03月 
    代表者 : 菅野 敦

委員歴

  • 2020年07月 - 現在   日本超音波医学会和文誌   編集委員会 委員
  • 2020年04月 - 現在   日本超音波医学会   編集委員会 査読委員
  • 2020年04月 - 現在   日本消化器内視鏡学会   Digestive Endoscopy(英文誌)associate editor
  • 2019年07月 - 現在   日本膵臓学会   評議員
  • 2018年04月 - 現在   日本消化器病学会   ガイドライン作成委員会慢性膵炎作成委員会委員
  • 2018年04月 - 現在   日本消化器病学会   難治癌対策委員会 委員
  • 2018年 - 現在   日本消化器内視鏡学会   和文誌編集委員会査読委員
  • 2018年 - 現在   日本消化器内視鏡学会   医療安全委員会 委員
  • 2017年 - 現在   日本消化器内視鏡学会   学術評議員
  • 2017年 - 現在   日本消化器病学会   学会評議委員
  • 2014年04月 - 現在   日本膵臓学会   自己免疫性膵炎委員会
  • 2010年04月 - 現在   日本胆道学会   評議員
  • 2010年 - 現在   日本膵臓学会   膵癌診療ガイドライン改訂委員会 委員
  • 2017年 - 2020年10月   日本膵臓学会   嚢胞性膵腫瘍委員会 委員

社会貢献活動

  • すい臓がんのお話し-内科から-
    期間 : 2018年08月26日
    役割 : パネリスト
    主催者・発行元 : NPO法人 NEXTSURG
    イベント・番組・新聞雑誌名 : NEXTSURG市民公開講座
  • 膵腫瘍の診断と内視鏡治療
    期間 : 2014年07月27日
    役割 : パネリスト
    主催者・発行元 : 第44回 日本膵臓学会
    イベント・番組・新聞雑誌名 : 市民公開講座


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