記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：日本臨床生理学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Although a new potassium-competitive acid blocker (P-CAB) vonoprazan has been developed in Japan, no data are available regarding long-term vonoprazan or vonoprazan and acotiamide combination treatment in patients with functional dyspepsia (FD). METHODOLOGY: A total of 73 consecutive patients with FD diagnosed according to the Rome III classification were enrolled. Forty-two patients with FD were treated with vonoprazan monotherapy and thirty-one patients with FD were treated with vonoprazan and acotiamide combination therapy for 24 weeks. The levels of five pancreatic enzymes were measured, and the overall treatment efficacy (OTE) was defined as the ratio of FD patients with improved or unchanged in all items of GSRS and FD symptom scores after the treatment. RESULTS: Treatment with vonoprazan monotherapy and vonoprazan and acotiamide combination therapy significantly improved FD symptoms. There were no significant differences in OTE between patients treated with vonoprazan monotherapy (42.9%) and those treated with vonoprazan and acotiamide combination therapy (52%). There were no significant differences in duodenal eosinophilic infiltration between the improved and unimproved groups treated with vonoprazan alone and vonoprazan and acotiamide combination therapy, respectively. In contrast, there was a significant difference (P = 0.004) in the ratio of pancreatic enzyme abnormalities between the improved and unimproved patients treated with vonoprazan monotherapy and those treated with vonoprazan and acotiamide combination therapy. CONCLUSIONS: Long-term vonoprazan alone or vonoprazan and acotiamide combination therapy significantly improved each FD symptom. The OTE in patients treated with vonoprazan alone or vonoprazan and acotiamide combination therapy was only 50%. Long-term vonoprazan and acotiamide combination therapy may differentiate patients with pancreatic enzyme abnormalities from those with FD.

DOI： 10.7759/cureus.70371

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

AIMS: During intraoperative bleeding in endoscopic submucosal dissection (ESD), switching to spray coagulation may be beneficial compared with the continuous use of swift coagulation and can reduce the need for hemostatic forceps. We retrospectively assessed the effectiveness of spray modes on intraoperative bleeding during gastric ESD. METHODS AND RESULTS: A total of 316 bleeding events (156 in the Swift group and 160 in the Spray group) were consecutively recorded. In the Swift group, hemostasis was performed using the swift mode with a retracted tip of the needle-type knife, followed by the hemostatic forceps. In the Spray group, bleeding was treated in a stepwise manner: the swift mode, the spray mode, and the hemostatic forceps. All bleeding events were assigned to one of two groups by an endoscopist who retrospectively reviewed the videos. We compared the use of hemostatic forceps, the total hemostatic time, and the cumulative hemostasis rate between the two groups.The use of hemostatic forceps was significantly lower in the Spray group than in the Swift group (32.7% vs. 13.8%, P < 0.001). There was no significant difference in the total hemostatic time (Swift group, 20 s.; Spray group, 16 s.; P = 0.42), whereas the cumulative hemostasis rate with the knife was significantly higher in the Spray group (P = 0.007). CONCLUSION: The results suggested that spray coagulation from the tip of the needle-type knife could reduce the use of hemostatic forceps. In gastric ESD, spray coagulation may facilitate the hemostasis of intraoperative bleeding.

DOI： 10.1002/jgh3.70002

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Endoscopic hand suturing (EHS) was first developed to firmly close a mucosal defect following endoscopic submucosal dissection and has the potential for expanded applications. This study aimed to investigate the feasibility and safety of EHS in various clinical settings. In this single-center pilot study, 15 patients who had diseases with potential indications for EHS were prospectively recruited. Technical success, clinical success after the procedure, and severe EHS-related adverse events (AEs) were evaluated. EHS was applied for defect closure after gastric subepithelial lesion removal under laparoscopic observation (n = 9), defect closure after rectal endoscopic full-thickness resection (EFTR) (n = 2), defect closure after thoracoscopy-assisted esophageal EFTR (n = 1), mucosal closure for gastric ulcer bleeding (n = 1), mucosal closure after peroral endoscopic myotomy (POEM) (n = 1), and postoperative anastomotic leak (n = 1). EHS was completed without severe AEs and the clinical courses were also favorable in 13 patients (87%). The median suturing time was 61 minutes. In patients with POEM and anastomotic leak, EHS was discontinued because of the narrow lumen. In conclusion, EHS appears feasible and safe in situations.

DOI： 10.1055/a-2284-9492

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記述言語：英語  

[This corrects the article DOI: 10.1055/a-2284-9492.].

DOI： 10.1055/a-2302-6845

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE: Mucosal incision-assisted biopsy (MIAB) has been introduced as an alternative to endoscopic ultrasound-guided fine needle aspiration for tissue sampling of subepithelial lesions. However, there have been few reports on MIAB, and the evidence is lacking, particularly in small lesions. In this case series, we investigated the technical outcomes and postprocedural influences of MIAB for gastric subepithelial lesions 10 mm or greater in size. METHODS: We retrospectively reviewed cases with the intraluminal growth type of possible gastrointestinal stromal tumors, in which MIAB was performed at a single institution between October 2020 and August 2022. Technical success, adverse events, and clinical courses following the procedure were evaluated. RESULTS: In 48 MIAB cases with a median tumor diameter of 16 mm, the success rate of tissue sampling and the diagnostic rate were 96% and 92%, respectively. Two biopsies were considered sufficient for making the definitive diagnosis. Postoperative bleeding occurred in one case (2%). In 24 cases, surgery has performed a median of two months after MIAB, and no unfavorable findings caused by MIAB were seen intraoperatively. Finally, 23 cases were histologically diagnosed as gastrointestinal stromal tumors, and no patients who underwent MIAB experienced recurrence or metastasis during a median observation period of 13 months. CONCLUSIONS: The data indicated that MIAB appears feasible, safe, and useful for histological diagnosis of gastric intraluminal growth types of possible gastrointestinal stromal tumors, even those of a small size. Postprocedural clinical effects were considered negligible.

DOI： 10.1002/deo2.264

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Tumor size impacts the technical difficulty and histological curability of colorectal endoscopic submucosal dissection (ESD); however, the preoperative evaluation of tumor size is often different from histological assessment. Analyzing influential factors on failure to obtain an accurate tumor size evaluation could help prepare optimal conditions for safer and more reliable ESD. AIM: To investigate the tumor size discrepancy between endoscopic and pathological evaluations and the influencing factors. METHODS: This was a retrospective study conducted at a single institution. A total of 377 lesions removed by colorectal ESD at our hospital between April 2018 and March 2022 were collected. We first assessed the difference in size with an absolute percentage of the scaling discrepancy. Subsequently, we compared the clinicopathological characteristics of the correct scaling group (> -33% and < 33%) with that of the incorrect scaling group (< -33% or > 33%), which was further subdivided into the underscaling group (-33% or less of the discrepancy) and overscaling group (33% or more of the discrepancy), respectively. As secondary outcome measures, parameters on size estimation were compared between the underscaling and correct scaling groups, as well as between the overscaling and correct scaling groups. Finally, multivariate analysis was performed in terms of the following relevant parameters on size estimation: Pathological size, location, and possible influential factors (P < 0.1) in the univariate analysis. RESULTS: The mean of absolute percentage in the scaling discordance was 21%, and 91 lesions were considered to be incorrectly estimated in size. The incorrect scaling was significantly remarkable in larger lesions (40 mm vs 28 mm; P < 0.001) and less experience (P < 0.001), and these two factors were influential on the underscaling (75 lesions; P < 0.001). Conversely, compared with the correct scaling group, 16 lesions in the overscaling group were significantly small (20 mm vs 28 mm; P < 0.001), and the small lesion size was influential on the overscaling (P = 0.002). CONCLUSION: Lesions indicated for colorectal ESD tended to be underestimated in large tumors, but overestimated in small ones. This discrepancy appears worth understanding for optimal procedural preparation.

DOI： 10.4253/wjge.v16.i3.136

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND AND AIMS: An increasing number of patients are undergoing gastric endoscopic submucosal dissection (ESD) with active prescriptions of direct oral anticoagulants (DOACs). Only a few reports have described the effects of DOAC intake on postoperative bleeding. We aimed to investigate the bleeding risk associated with DOACs after gastric ESD. METHODS: Clinical studies published up to April 2022 showing bleeding rates after gastric ESD in patients taking DOACs were identified using electronic searches. The primary outcome was the rate of bleeding after gastric ESD in patients receiving DOACs compared to those not receiving antithrombotic therapy. In this meta-analysis, odds ratios (ORs) were calculated and pooled using a random effects model. The secondary outcome was the difference in the bleeding rate between patients treated with DOACs and those treated with warfarin and antiplatelet drugs. RESULTS: Seven studies were included in this meta-analysis. The pooled analysis showed that DOACs had a higher bleeding rate than non-thrombotic therapy (17.0% vs. 3.4%; OR 5.72; 95% confidence interval [CI], 4.33-7.54; I2 = 0%). The bleeding risk associated with DOAC administration was similar to that associated with warfarin (17.0% vs. 20.0%; OR 0.83; 95% CI 0.59-1.18; I2 = 0%), whereas it was higher than that associated with antiplatelet administration (16.9% vs. 11.0%; OR 1.63; 95% CI 1.14-2.34; I2 = 8%). CONCLUSIONS: This meta-analysis reveals that the bleeding risk of DOACs is higher than that of non-antithrombotics and antiplatelets, whereas it is comparable to that of warfarin. Gastric ESD in patients on anticoagulants requires careful postoperative management.

DOI： 10.1007/s10620-024-08271-6

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Subclinical stricture after esophageal endoscopic submucosal dissection (ESD) makes the detection and re-ESD of metachronous lesions difficult. This study aimed to investigate the effectiveness of prophylactic steroid use after esophageal ESD for mucosal defects with a circumference less than 75% for the prevention of symptomatic and asymptomatic stricture. METHODS: In 80 retrospectively enrolled patients, we collected paired endoscopic images of a mucosal defects immediately after resection and a scar thereafter. After calculating circumference by image analysis software, all patients were classified into three groups in reference to mucosal defect circumference (MDC; ≤ 50%, 50-75%, ≥ 75%). Frequency of steroid use and symptomatic stricture were compared, and in < 75% MDC patients, a degree of asymptomatic stricture with or without steroid was compared by calculating a scar contraction rate (SCR). RESULTS: In the ≤ 50% (43 patients), 50-75% (27 patients) and ≥ 75% (10 patients) MDC groups, steroids were used in 12%, 59% and 100%, respectively, and symptomatic stricture occurred in 0%, 7% and 40%, respectively. In < 75% MDC patients, SCR in the steroid cohort was significantly lower than that in the nonsteroid cohort (42% vs. 65%, p = 0.002). No steroid-related adverse events occurred. CONCLUSION: Steroid use even for mucosal defects with < 75% circumference appears effective for the reduction of the risk on both symptomatic and asymptomatic stricture after esophageal ESD.

DOI： 10.1007/s00464-023-09988-7

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記述言語：英語  

A 78-year-old man was admitted to our hospital with a tarry stool. Esophagogastroduodenoscopy identified tiny oozing on the greater curvature at the antrum. Despite repeated endoscopic hemostasis by coagulation and clipping, rebleeding occurred. On the third rebleeding, we performed endoscopic hand suturing to completely close the ulcer surface. Biopsy showing massive infiltration of eosinophils at the ulcer edge indicated eosinophilic gastritis. After the endoscopic closure by endoscopic hand suturing, the patient had no symptoms of bleeding thereafter and was discharged 19 days after the procedure by taking oral prednisolone. The patient remained well and was continuously treated with a small dose of steroids in outpatient. This is the first case report of the successful application of endoscopic hand suturing to a refractory hemorrhagic ulcer. Further accumulation of clinical experiences is desired to confirm the usefulness of this technique for the prevention of refractory ulcer bleeding.

DOI： 10.1002/deo2.207

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掲載種別：研究論文（学術雑誌）  

A 56-year-old male was referred by his dentist with noticeable worsening of vitiligo of the tongue, which had been diagnosed as oral leukoplakia 3 years earlier and had been monitored at the dental clinic. The patient had no signifi cant medical history. He had a continuous smoking habit of more than 36 years but did not consume alcohol. Examination confi rmed oral leukoplakia, with an uneven and rough surface, and a white papillary mass was noted within the area of leukoplakia on the right edge of the tongue (Figure 1). No lymph node swelling in the neck was noted. Biopsy of the lesion confi rmed it to be squamous cell carcinoma. Computed tomography, magnetic resonance imaging, and ultrasonography showed that the mass was confi ned to the surface of the tongue.

DOI： 10.3949/ccjm.90a.22044

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

INTRODUCTION: Endoscopic suturing of a mucosal defect is expected to prevent postoperative bleeding after endoscopic submucosal dissection (ESD). Endoscopic suturing causes mucosal deformity, which may interfere with endoscopic surveillance thereafter. We retrospectively investigated long-term chronological changes in mucosal suturing by endoscopic suturing. METHODS: Forty-three patients who underwent endoscopic hand suturing (EHS) after gastric ESD at three institutions were enrolled. First, our hypothesis that the suturing sites healed via inflammation, disappearance of mucosal inversion, and flattening was validated. Subsequently, the duration required to reach each healing step was evaluated. RESULTS: A total of 137 follow-up endoscopies were assessed, in which all cases showed the hypothesized chronological course on the suturing sites. The 95th percentiles of the duration when showing the disappearance of the inflammatory change and the inverted change were 63 days and 15.5 months after the procedure, respectively. DISCUSSION/CONCLUSION: The data show that the mucosal deformity induced by EHS disappeared within 16 months. Endoscopic suturing is thus considered to have a negligible effect on endoscopic surveillance following the procedure.

DOI： 10.1159/000527350

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1055/a-1884-0065

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掲載種別：研究論文（学術雑誌）  

DOI： 10.1093/omcr/omac117

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掲載種別：研究論文（学術雑誌）  

DOI： 10.1016/j.ejim.2022.08.006

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掲載種別：研究論文（学術雑誌）  

DOI： 10.1093/omcr/omac100

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DOI： 10.1093/omcr/omac102

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掲載種別：研究論文（学術雑誌）  

Objective: Standard prophylactic or therapeutic treatments for oral mucositis (OM), a common adverse event of chemotherapy, have not been established. Therefore, we compared the efficacy of several potential drugs administered topically in a rat anticancer agent-induced OM model (ROMM). Methods: Ten-week-old, female Sprague–Dawley rats (n = 196) were used to develop the ROMM; they were divided into seven groups—CT, SAS, TA, RM, SF, PZ, and TJ-14, which received distilled water (control), sodium azulene sulfonate hydrate, tranexamic acid, rebamipide, sucralfate hydrate, polaprezinc, and hangeshashinto, respectively. Body weight, OM grade, histopathology score, and intraoral bacterial count were determined at 6, 9, 11, and 16 days after inducing OM. Results: The body weight of each rat temporarily reduced in all groups. Nevertheless, the TJ-14 group showed a higher body weight than the CT group (p < 0.05) on day 16. The mean OM grade and histopathology score improved with time in the CT group. On days 11 and 16, the OM grade and histopathology score were lower in all drug groups than in the CT group, with a significant difference in the TJ-14 group (p = 0.0281 and 0.0035, respectively). On day 11, the PZ and TJ-14 groups presented lower intraoral bacterial counts than the CT group. On day 16, the RM, SF, PZ, and TJ-14 groups presented lower bacterial counts than the CT group (p < 0.01). Conclusion: TJ-14, followed by PZ, has the greatest efficacy against chemotherapy-induced OM. Therefore, TJ-14 mouthwash is a potential supportive treatment during chemotherapy.

DOI： 10.1016/j.ajoms.2021.11.010

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掲載種別：研究論文（学術雑誌）  

DOI： 10.1016/j.cgh.2021.10.025

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Endocytoscopy (ECS) aids early gastric cancer (EGC) diagnosis by visualization of cells. However, it is difficult for non-experts to accurately diagnose EGC using ECS. In this study, we developed and evaluated a convolutional neural network (CNN)-based system for ECS-aided EGC diagnosis. METHODS: We constructed a CNN based on a residual neural network with a training dataset comprising 906 images from 61 EGC cases and 717 images from 65 noncancerous gastric mucosa (NGM) cases. To evaluate diagnostic ability, we used an independent test dataset comprising 313 images from 39 EGC cases and 235 images from 33 NGM cases. The test dataset was further evaluated by three endoscopists, and their findings were compared with CNN-based results. RESULTS: The trained CNN required 7.0 s to analyze the test dataset. The area under the curve of the total ECS images was 0.93. The CNN produced 18 false positives from 7 NGM lesions and 74 false negatives from 28 EGC lesions. In the per-image analysis, the accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 83.2%, 76.4%, 92.3%, 93.0%, and 74.6%, respectively, with the CNN and 76.8%, 73.4%, 81.3%, 83.9%, and 69.6%, respectively, for the endoscopist-derived values. The CNN-based findings had significantly higher specificity than the findings determined by all endoscopists. In the per-lesion analysis, the accuracy, sensitivity, specificity, PPV, and NPV of the CNN-based findings were 86.1%, 82.1%, 90.9%, 91.4%, and 81.1%, respectively, and those of the results calculated by the endoscopists were 82.4%, 79.5%, 85.9%, 86.9%, and 78.0%, respectively. CONCLUSIONS: Compared with three endoscopists, our CNN for ECS demonstrated higher specificity for EGC diagnosis. Using the CNN in ECS-based EGC diagnosis may improve the diagnostic performance of endoscopists.

DOI： 10.1186/s12876-022-02312-y

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: It is unclear whether prophylactic endoscopic closure after colorectal endoscopic submucosal dissection (ESD) reduces the risk of postoperative adverse events due to variability in lesion characteristics. Therefore, we conducted a retrospective study using propensity score matching to evaluate the efficacy of prophylactic clip closure in preventing postoperative adverse events after colorectal ESD. METHODS: This single-center retrospective cohort study included 219 colorectal neoplasms which were removed by ESD. The patients were allocated into the closure and non-closure groups, which were compared before and after propensity-score matching. Post-ESD adverse events including major and minor bleeding and delayed perforation were compared between the two groups. RESULTS: In this present study, 97 and 122 lesions were allocated to the closure and non-closure groups, respectively, and propensity score matching created 61 matched pairs. The rate of adverse events was significantly lower in the closure group than in the non-closure group (8% vs. 28%, P = 0.008). Delayed perforation occurred in two patients in the non-closure group, whereas no patient in the closure group developed delayed perforation. In contrast, there were no significant differences in other postoperative events including the rate of abdominal pain; fever, white blood cell count, and C-reactive protein; and appetite loss between the two groups. CONCLUSIONS: Propensity score matching analysis demonstrated that prophylactic closure was associated with a significantly reduced rate of adverse events after colorectal ESD. When technically feasible, mucosal defect closure after colorectal ESD may result in a favorable postoperative course.

DOI： 10.1186/s12876-022-02259-0

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掲載種別：研究論文（学術雑誌）  

Glandular odontogenic cyst, which was first reported in 1988, is an extremely rare lesion that was classified as a developmental odontogenic epithelial cyst by the World Health Organization in 1992 and in 2017. Here, we report two patients with glandular odontogenic cysts who presented at our clinic with the chief complaint of swelling of the mandible. Case 1 was 44-year-old female patient and case 2 was a 34-year-old male patient. Orthopantomography and computed tomography revealed a well-defined unilocular radiolucent lesions. The buccal cortical bone showed expanding and thinning. The mandibular canal was located below the lesion. After the biopsy, complete enucleation with the removal of the cystic lining and curettage were performed. Based on the results of histopathological examinations, both cases were diagnosed as glandular odontogenic cyst. Both patient's postoperative courses were uneventful during three years (case 1) and six months (case 2) post-treatment follow-up period.

DOI： 10.1016/j.ajoms.2021.09.003

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND AND AIMS: Surgery is recommended in early gastric cancer (EGC) after noncurative endoscopic submucosal dissection (ESD), although observation can be an alternative. We aimed to develop a tailor-made treatment strategy for noncurative EGCs by comparing the lymph node metastasis risk (LNMR) and the surgical risk. METHODS: We retrospectively identified 485 patients with differentiated-type, noncurative EGCs removed by ESD and classified them into two groups: a surgery-preferable group and an observation-preferable group, according to the clinical courses. Subsequently, LNMR and surgery-related death risk were assessed using a published scoring system and a risk calculator for gastrectomy, respectively. Finally, we investigated the optimal cutoff value of the risk difference (LNMR minus surgery-related death risk) to efficiently allocate these cases into either of two groups, surgery-preferable or observation-preferable. RESULTS: In 485 patients (surgery in 322, observation in 163), 57 and 428 patients were classified into the surgery-preferable group and the observation-preferable group, respectively. The optimal cutoff value of the risk difference (LNMR minus surgery-related death risk) to allocate the cases to the two preferable groups was 7.85 with the highest area under the curve (0.689). When cases with >7.85 LNMR over the surgery-related death risk were allocated into the surgery-preferable group and vice versa, the discriminability was 73.2%, which was sufficiently higher than that in the clinical decision (44.5%). CONCLUSION: Personalized comparison of LNMR and surgery-related death risk is helpful to provide a favorable treatment option for each patient with EGCs after noncurative ESD.

DOI： 10.1159/000523972

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記述言語：英語  

Esophageal submucosal hematoma is a rare disease mainly caused by mechanical stimulation to the esophageal wall. We reported a case of esophageal submucosal hematoma after transesophageal echocardiography (TEE) which was performed during cardiovascular surgery. The stimuli of TEE insertion under general anesthesia and the perioperative use of multiple antithrombotic agents were considered as a possible cause. This is the first report of esophageal submucosal hematoma related to TEE, and endoscopic ultrasonography should be carefully performed in patients, particularly at bleeding tendency and without consciousness.

DOI： 10.1159/000525036

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掲載種別：研究論文（学術雑誌）  

A 55-year-old woman presented 1 hour after noticing tongue discomfort while eating. On self-examination, she had noticed a rapidly expanding dark purple mass. She had experienced similar episodes previously, but in each case, the mass had ruptured in a day or 2 and healed within a week.

DOI： 10.3949/ccjm.89a.22040

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND AND AIMS: Noninvasive, imaging diagnosis of gastrointestinal mesenchymal tumors (GIMTs) is still difficult. This study aimed to develop a novel diagnostic method of GIMTs via endoscopic ultrasonography (EUS) using circularity. METHODS: In a derivation series, we retrospectively collected 50 GIMTs 2-5 cm in diameter of two institutions. After selecting one EUS still image showing the maximal area per lesion, two endoscopists who were blind to the histological diagnosis assessed circularity, a surrogate indicator of roundness (range, 0-1; 1 = a true circle), with an image-analyzing software. Median circularity of three types of GIMT was compared, and the cutoff value to differentiate a group from other groups was presented by drawing a receiver operating characteristic curve. Subsequently, we assessed the diagnostic ability of circularity in 91 GIMTs which were retrospectively collected from the other two institutions by using the optimal cutoff value presented in the derivation series. RESULTS: The circularity in leiomyomas indicated 0.70 and was significantly lower than that of gastrointestinal stromal tumors (0.89), schwannomas (0.90), and their combined group. When leiomyomas were diagnosed as the circularity of <0.8305, which was presented as the optimal cutoff value, the diagnostic accuracy, sensitivity, and specificity in the validation series were 73.6%, 80.0%, and 72.4%, respectively. CONCLUSION: The data demonstrated that leiomyomas significantly exhibited more distortion than other GIMTs. That implies that the difference in shape, which is objectively determined as circularity, is useful to noninvasively discriminate leiomyomas from other GIMTs.

DOI： 10.1159/000523881

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Prevention of postoperative anastomotic leakage in rectal surgery is still required. This study investigated the feasibility of endoscopic hand suturing (EHS) on rectal anastomosis ex vivo. By using isolated porcine colon, we prepared ten anastomoses 6-10 cm from the virtual anus. Then, we sutured anastomoses intraluminally by EHS, which involved a continuous suturing method in 5 cases and a nodule suturing method with extra corporeal ligation in 5 cases. Completeness of suturing, number of stitches, procedure time and presence of stenosis were investigated. Furthermore, the degree of stenosis was compared between the two suturing methods. In all cases, EHS were successfully completed. The median number of stitches and procedure time was 8 and 5.8 min, respectively. Stenosis was created in all continuous suturing cases whereas none was seen in nodule suturing cases. The shortening rate was significantly greater in the continuous suturing method than in the nodule suturing method. Intraluminal reinforcement of rectal anastomosis by EHS using nodule suturing with extra corporeal ligation is feasible without stenosis, which may be helpful as a countermeasure against possible postoperative anastomotic leakage in rectal surgery.

DOI： 10.1038/s41598-021-01396-y

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掲載種別：研究論文（学術雑誌）  

Background/Aim: Phosphodiesterase 5 (PDE5) holds clinical relevance in several pathological states, including lung, breast, and prostate cancer. In this study, we examined PDE5 expression in oral squamous cell carcinoma (OSCC)-derived cell lines and tissues, and the anti-Tumour effect of PDE5 inhibitor, sildenafil citrate (SC). Materials and Methods: Cell proliferation, cell invasion, and gap closure assays were performed in six OSCC-derived cell lines upon treatment with varying concentrations of SC. PDE5 expression was determined in primary OSCC tissues by western blotting and immunohistochemistry. Results: Elevated PDE5 expression was observed in all cell lines. A concentration-dependent decrease in cell viability, invasion rate, and migration was observed after SC treatment. A significant correlation (p=0.05) was observed between elevated PDE5 expression and lymphatic infiltration in OSCC tissues. Conclusion: PDE5 plays an important role in carcinogenesis of OSCC, and the specific inhibition of PDE5 may be an effective chemotherapeutic strategy.

DOI： 10.21873/ANTICANRES.15005

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掲載種別：研究論文（学術雑誌）  

Fractures of the zygomatic arch may be treated with a variety of techniques. The disadvantages of these methods include the difficulty of reaching the fracture site via the intraoral approach and the high level of surgical invasiveness associated with the extraoral approach. This is a case report. A 20-year-old man was banged on the face. He presented at our department complaining of a change in facial shape and difficulty in mouth opening. Modified towel clip method was used to treat the zygomatic fracture which was classified into Yamamoto Class II type, and successful reduction was achieved. We believe that this method is very effective from the standpoint of minimum invasiveness and simplicity.

DOI： 10.1002/osi2.1090

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掲載種別：研究論文（学術雑誌）  

Heat shock protein 90 (HSP90) expression is upregulated in numerous types of cancer. However, its role as a candidate for molecular targeted therapy in oral squamous cell carcinoma (OSCC) cells is poorly understood. In the present study, a common upstream search was performed using molecular network analysis software for proteins with expression abnormalities that were found in a proteomic analysis of six OSCC cell lines. HSP90 was identified as a target protein. In clinical samples, high frequencies of HSP90-high expression were detected via immunohistochemistry (26/58; 45%). Furthermore, the HSP90 expression status was associated with cervical lymph node metastasis (P=0.015). Furthermore, the potential of HSP90 as a candidate for molecular targeted therapy in OSCC cells was investigated using the HSP90 inhibitors 17-dimethylaminoethylamino-17-demethoxygeldanamycin (17-DMAG) and ganetespib. KON cells, which strongly express HSP90, were treated with the HSP90 inhibitors. The numbers of living cells in the 17-DMAG and ganetespib-treated groups were lower than those in the non-treated group. The cells treated with the inhibitors demonstrated reduced cell viability and migration, and this was associated with markedly decreased levels of the HSP90 target proteins EGFR, phospho-EGFR, phospho-MEK and phospho-MAPK in the treated groups compared with the non-treated group. To the best of our knowledge, this was the first study to investigate the effects of 17-DMAG and ganetespib on OSCC cells. The present results indicated the potential of HSP90 as a useful candidate for molecular targeted therapy in OSCC. However, additional studies with larger sample sizes are required to confirm these findings.

DOI： 10.3892/or.2020.7873

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掲載種別：研究論文（学術雑誌）  

An ameloblastic fibroma (AF) is a proliferative mixed tumor which includes components of both odontogenic epithelium and mesenchymal tissue. It is a relatively rare neoplasm, accounting for approximately only 1.5–4.5% of odontogenic tumors. This case report describes an AF that occurred in the mandibular anterior tooth region in a 9-year-old girl who presented with the chief complaint of swelling in the left mandibular anterior tooth region. Intraoral examination revealed a swelling along the labial gingiva, extending from the left mandibular lateral incisor region to the left mandibular canine. Upon palpation, the swelling appeared to comprise a hard tissue. Computed tomography revealed a supernumerary impacted tooth; soft tissue density in the bone surrounding the region extending from the left mandibular lateral incisor to the left mandibular canine; labial bone expansion; and thinning of the labial cortical bone. A biopsy was performed under local anesthesia and the lesion subsequently diagnosed as an AF. Tumor resection and extraction of the supernumerary impacted tooth were carried out under general anesthesia. At 2 years postoperatively the prognosis is good. Although relapse with an AF is rarer than that with an ameloblastoma, strict follow-up is required, as malignant transformation to an ameloblastic fibrosarcoma has been reported in relapsed cases.

DOI： 10.2209/tdcpublication.2020-0031

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

With advancements in the development of flexible endoscopes and endoscopic devices and the increased demand for minimally invasive treatments, the indications of therapeutic endoscopy have been expanded. Methods of endoscopic treatment used for tissue removal, hemostasis, and dilatation are as follows. Endoscopic submucosal dissection (ESD) is considered the gold standard curative method for removal of gastrointestinal node-negative neoplasms, regardless of their size or the presence of ulcer formation. Laparoscopic endoscopic cooperative surgery (LECS), which incorporates ESD, was introduced for removal of lesions in deeper layers. Another technique is endoscopic full-thickness resection, which is challenging without the assistance of laparoscopy. In terms of hemostasis, management of iatrogenic bleeding after endoscopic treatment is an important issue. Shielding methods and suturing techniques have been introduced for large mucosal defects after ESD, and their efficacy has been investigated clinically. Peroral endoscopic myotomy (POEM) is a new alternative surgical approach for minimally invasive treatment of esophageal achalasia. Furthermore, endoscopic fundoplication after POEM was devised to prevent post-POEM gastroesophageal reflux disease. Many endoscopic treatments, including ESD, LECS, and POEM, have been introduced in Japan. With the aging of the population, more attention will be directed toward therapeutic endoscopy for elderly patients, because it is less invasive. Development of endoscopic treatments with expanded indications is expected.

DOI： 10.1272/jnms.JNMS.2021_88-109

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掲載種別：研究論文（学術雑誌）  

Aim. There are several techniques for the treatment of mandibular condylar fractures. This is the first report of the high submandibular anteroparotid approach for open reduction and internal fixation of condylar fracture. Materials and Methods. A 41-year-old woman fell indoors and injured her face. She was referred to our department for detailed examination and treatment of a suspected mandibular fracture. X-ray and computed tomography showed a right mandibular condylar base fracture and lateral dislocation of the fracture fragment. Open reduction and internal fixation procedures were performed for a right mandibular condylar fracture under general anesthesia. The mandibular ramus was reached by approaching from the inferior margin of the mandible, delaminating the masseter fascia posteriorly, and bypassing the anterior margin of the parotid gland. Once the fractured bone was reached, reduction and fixation were performed. Results. We have achieved good results by the high submandibular anteroparotid approach, which is minimally invasive and simple, to reduce and fix condylar fractures. With this approach, no facial artery or retromandibular vein was encountered, and the mental stress for the surgeon was minimal. Postoperative wound infection, parotid gland complications such as parotitis and salivary fistula, facial nerve dysfunction such as facial paralysis, and esthetic disorders such as scarring were not observed. Conclusions. Although it is necessary to examine more cases in the future, the high submandibular anteroparotid approach may be useful as a new approach for open reduction and internal fixation of condylar fractures.

DOI： 10.1155/2021/5542570

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Gastrointestinal muscular sampling is useful in the histological assessment of functional gastrointestinal disorders. We devised a new sampling method to obtain a large volume of muscle tissues and then investigated the feasibility and safety of endoscopic muscular resection with a ligation device in an in vivo porcine model. METHODS: After establishing a submucosal tunnel, a rubber band was placed on the muscle tissue by sucking the exposed muscle layer. Thereafter, the established pseudopolyp was removed using an electrocautery snare, and the entry site of the submucosal tunnel was closed endoscopically. This procedure was performed at three sites in the esophagus and stomach of two pigs. The technical success, histology, and survival rate on postoperative day 7 were examined postoperatively. RESULTS: We successfully completed the mentioned procedure in 11 of the 12 sites (92%), without the occurrence of severe adverse events. The median diameters of obtained tissues from the esophagus and stomach, respectively, were 5 mm and 10 mm. Histologically, both the inner and outer muscle layers were included in all specimens. The postprocedural course was found uneventful in both pigs during the observatory period. CONCLUSIONS: Endoscopic muscular resection using a ligation device enabled us to obtain large and thick muscle tissue samples. This approach may facilitate more precise histological assessments of functional gastrointestinal disorders.

DOI： 10.1272/jnms.JNMS.2021_88-602

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Immune checkpoint inhibitors (ICIs) can induce immune-related adverse events (irAEs) including thyroid dysfunction. There are only a few reports on Graves' disease induced by ICIs. We report a case of new-onset Graves' disease after the initiation of nivolumab therapy in a patient receiving gastric cancer treatment. CASE PRESENTATION: The patient was a 66-year-old Japanese man, who was administered nivolumab (240 mg every 3 weeks) as a third-line therapy for stage IVb gastric cancer. His thyroid function was normal before the initiation of nivolumab therapy. However, he developed thyrotoxicosis before the third administration of nivolumab. Elevated, bilateral, and diffuse uptake of radioactive tracer was observed in the 99mTc-pertechnetate scintigraphy. Furthermore, the thyroid-stimulating hormone receptor antibody (TRAb) and thyroid-stimulating antibody (TSAb) test results, which were negative before the first administration of nivolumab, were positive after starting the therapy. The patient was diagnosed with Graves' disease, and the treatment with methimazole and potassium iodide restored thyroid function. CONCLUSIONS: This is the first complete report of a case of new-onset Graves' disease after starting nivolumab therapy, confirmed by diffusely increased thyroid uptake in scintigraphy and the positive conversion of antibodies against thyroid-stimulating hormone receptor. It is important to perform thyroid scintigraphy and ultrasonography to accurately diagnose and treat ICI-induced thyrotoxicosis, because there are various cases in which Graves' disease is developed with negative and positive TRAb titres.

DOI： 10.1186/s12902-020-00613-5

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) is a hepatic manifestation of metabolic syndrome. Within the spectrum of NAFLD, non-alcoholic steatohepatitis (NASH) in combination with hepatic inflammation and fibrosis can lead to liver cirrhosis and hepatocellular carcinoma. Dysbiosis was reported to contribute to NASH pathogenesis. This study aimed to determine the effects of fructo-oligosaccharides (FOS) on steatohepatitis and visceral adiposity in an obese mouse model of NASH. METHODS: Twelve newborn C57BL/6 J male mice were subcutaneously injected with monosodium glutamate (MSG) to induce obesity on a conventional diet. Six mice were also administered 5% FOS via drinking water from 10 weeks of age. At 18 weeks, histological characteristics of the liver and epididymal fat were compared between the groups. Hepatic mRNA expression of lipid metabolism enzymes and SCFA in feces and sera were measured. RESULTS: Hepatic steatosis, inflammatory cell infiltration, and hepatocyte ballooning in the liver and increased hepatic mRNA expression of fatty acid synthase and glycerol-3-phosphate acyltransferase were observed in the MSG-treated mice. FOS treatment improved the liver pathology and blunted the increases in the mRNA expression levels of lipid metabolism enzymes. In addition, FOS inhibited adipocyte enlargement and formation of crown-like structures and reduced the M1 macrophage frequency in the epididymal fat of the MSG mice (39.4% ± 3.0% vs. 22.8% ± 0.7%; P = 0.001). FOS increased not only the fecal concentrations of n-butyric acid (0.04 ± 0.01 vs. 0.38 ± 0.14 mg/g, P = 0.02), propionic acid (0.09 ± 0.03 vs. 0.42 ± 0.16 mg/g, P = 0.02), and acetic acid (0.65 ± 0.16 vs. 1.48 ± 0.29 mg/g, P = 0.03) but also the serum concentration of propionic acid (3.9 ± 0.5 vs. 8.2 ± 0.5 μmol/L, P = 0.001). CONCLUSIONS: FOS ameliorates steatohepatitis, visceral adiposity, and chronic inflammation by increasing SCFA production.

DOI： 10.1186/s12876-020-01194-2

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記述言語：日本語   出版者・発行元：(一社)日本消化管学会  

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掲載種別：研究論文（学術雑誌）  

An extremely rare case of fibrolipoma in the hard palate is presented and discussed with reference to the literature. An 85-year-old woman visited the Tokyo Dental College Chiba hospital in September 2016 with the chief complaint of a mass in the hard palate. The patient had first become aware of this mass several years earlier. An examination at another hospital in June 2009 resulted in a clinical diagnosis of lipoma. Regular examinations followed every 6 months until September 2014, at which time she stopped attending these appointments because there was no change. In August 2016, however, the patient realized that the tumor was increasing in size. Although there was no pain, awareness of a foreign body in the oral cavity when eating or talking was increasing, so she decided to visit our clinic for detailed examination and treatment. At this point, the mass extended from the center to the left side of the hard palate. It measured 15 mm along the major axis, and had a clear border; nearly spherical, its surface was smooth and glossy, and was of a slightly yellowish color. The mass was painless, elastic, and soft. Computed tomography and magnetic resonance imaging revealed a tumorous lesion. Based on a clinical diagnosis of lipoma, it was subsequently excised under general anesthesia in January 2017. The tumor lay under the palatal mucosa, extending from the center to the left side of the hard palate. It was surrounded by a single-layered membranous structure, and had not adhered to the surrounding tissues. Healthy palatal mucosa and periosteum were also removed en bloc with the tumor within a safety margin of approximately 5 mm. No pressure absorption of palatine bone was seen. Histopathologically, proliferation of mature adipose tissue was observed. This was surrounded by a thin, single-layer membrane within the subepithelial connective tissue, which was covered by stratified squamous epithelium. Proliferation of fibrotic connective tissue was seen between the adipocytes. The final diagnosis was fibrolipoma. To date, at 18 months postoperatively, no recurrence has been observed and progress has been satisfactory.

DOI： 10.2209/tdcpublication.2019-0010

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掲載種別：研究論文（学術雑誌）  

A Stafne bone defect from the mandibular anterior to the premolar region is an extremely rare case. A case of a Stafne bone defect extending from the mandibular anterior to the premolar region was presented. Computed tomography (CT) and magnetic resonance imaging (MRI) suggested that salivary gland tissue connected to the sublingual glands was involved in the formation of the cavity. The patient was a 68-year-old man who was examined at our hospital's emergency outpatient department after a traffic accident. He was referred to our department for the treatment of contusions of the lips and oral cavity. A bone defect in the lingual side of the mandible from the right anterior to the right premolar region was incidentally detected on CT. CT showed a rounded cavity in the lingual side of the mandible that had a lingual opening, was monocystic, and had a cortical margin. The margin of the cavity was relatively dull and regular. MRI showed that the tissue filling the cavity in the lingual side of the mandible had similar signal intensity as the sublingual glands and was contiguous with the normal sublingual glands. Based on these findings, the bone defect was diagnosed as a Stafne bone defect filled with salivary gland tissue connected to the sublingual gland tissue.

DOI： 10.1155/2020/8851174

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掲載種別：研究論文（学術雑誌）  

Purpose: Hangeshashinto (TJ-14), a Kampo medicine comprising seven types of herbs, has been used in Japan to alleviate the side effects associated with anticancer drug treatments. However, the pharmacological effects of this medicine currently remain unclear. The present study aimed to demonstrate the efficacy of TJ-14 against anticancer drug-induced stomatitis, the pain associated with which may have a negative impact on mastication and swallowing. Methods: Mucositis was induced in Sprague-Dawley rats by cancer chemotherapy. Changes in body weight, stomatitis grades, histopathological scores, and oral bacterial counts were examined among TJ-14-treated, saline-treated, and Control (no treatment) rats. In vitro studies, including cell proliferation and wound healing assays, using epidermal keratinocyte and fibroblast cell lines were conducted. Results: The local application of TJ-14 exerted strong antibacterial effects and attenuated oral chemotherapy-induced stomatitis in rats. TJ-14 also increased the viability and invasion of epidermal keratinocytes and fibroblasts. Conclusion: The present results demonstrated the potential of TJ-14 to attenuate chemotherapy-induced stomatitis.

DOI： 10.2147/CMAR.S238306

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掲載種別：研究論文（学術雑誌）  

No effective, reliable treatment for stomatitis associated with cancer therapy has been established. This study focused on the its effectiveness of ozone nano-bubble water (ONBW) for the treatment of chemotherapy-induced stomatitis. Oral mucositis was induced in 14-week-old male Sprague-Dawley rats (N = 21). The animals were randomly divided into 3 groups: 7 without treatment (control); 7 treated with physiological salt solution (saline); and 7 treated with ONBW. Animals were weighed on Days 7, 9, 11, and 16. Stomatitis grade evaluation and bacterial count measurements were performed before rinsing in all animals 3, 5, and 10 days after acetic acid irritation (Days 9, 11, and 17 respectively). Weight loss after stomatitis creation was observed in all groups, with significant differences between the control and ONBW groups and between the saline and ONBW groups on Day 16. The stomatitis grade did not worsen during the experimental period in any group, with the lowest grades in the ONBW group on Days 11 and 16. Significant differences were identified between the control and ONBW groups and between the saline and ONBW groups on Days 11 and 16. Oral bacterial counts tended to decrease over time in all three groups, with the greatest decrease in the ONBW group, followed by the saline group. The decrease in the bacterial count was steepest in the ONBW group. Rinsing out the oral cavity with ONBW decreased bacterial counts and encouraged the healing of oral chemotherapy-induced stomatitis. ONBW may be an effective treatment for chemotherapy-induced stomatitis.

DOI： 10.1016/j.bbrep.2019.100697

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掲載種別：研究論文（学術雑誌）  

First bite syndrome (FBS)is characterized by sharp pain in the parotid region at the first bite of a meal which gradually decreases as mastication continues, and is thought to be caused by sympathetic nerve damage. When FBS occurs with no history suggestive of nerve damage, it is classified as idiopathic. A case of idiopathic FBS that was treated effectively with Rikkosan is presented. The patient was an 81-year-old woman who developed sharp pain in the left parotid region with the first bite of every meal in November 2015. With no specific findings, the initial diagnosis was trigeminal neuralgia, but carbamazepine was ineffective. In February 2016, temporomandibular disorder was diagnosed as the cause of masticatory muscle pain and was treated with splinting and loxoprofen sodium, but this was also ineffective. In June 2016, a panoramic radiograph, plain craniocervical magnetic resonance imaging, and blood tests were all negative. Idiopathic FBS was diagnosed and treated by gargling and swallowing Rikkosan before meals and eating bitter or sweet foods first, followed by salty or sour foods. The FBS improved, and after 1 week, she had days with no pain. Rikkosan was discontinued after a month leading to immediate recurrence. The patient was instructed to use half the dose of Rikkosan, which was effective with no side effects. In October 2016, the patient started gargling with Rikkosan. In March 2017, the Rikkosan was discontinued and the dietary strategy was continued with no further recurrence. In this case, idiopathic FBS improved with Rikkosan treatment.

DOI： 10.1016/j.ajoms.2019.03.011

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掲載種別：研究論文（学術雑誌）  

Oral exfoliative cytology is now used by general practitioners in Japan to screen for oral cancer. With conventional cytology, however, the number of cells that can be sampled is small. Moreover, cell deformation and piling of cells when preparing specimens has been reported. The purpose of this study was to compare conventional and liquid based cytology (LBC), which has been employed with increasing frequency in recent years. We believe that identifying potential pitfalls in oral exfoliative cytology will help improve diagnostic accuracy. A total of 153 patients with tongue squamous cell carcinoma who were diagnosed and treated initially at our hospital between January 2000 and December 2010 were included. Of these, 124 underwent conventional cytology, while the remaining 29 underwent LBC. Histopathological and clinical findings were used as criteria. Conventional cytology yielded a positive rate of 54.8% and LBC 79.3%, while values of 28.2% and 13.8% were obtained for a suspected positive rate, respectively. Liquid based cytology yielded a significantly higher percentage of accurate diagnoses and fewer suspected positives (p<0.05) in cases clinically classified as endophytic and those classified as ulcerative in terms of clinical growth pattern. No significant difference was observed between conventional cytology and LBC in cases of an infiltrative growth pattern, however. The present results suggest that LBC is superior to conventional cytology in achieving an accurate diagnosis based on oral exfoliative cytology. The present findings also suggest that exophytic type, and especially leukoderma type clinical growth patterns constitute pitfall cases in oral exfoliative cytology.

DOI： 10.2209/tdcpublication.2018-0015

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記述言語：日本語  

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2021&ichushi_jid=J02312&link_issn=&doc_id=20211105230047&doc_link_id=%2Faq9syokd%2F2021%2F0033s1%2F048%2F0259-0262%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Faq9syokd%2F2021%2F0033s1%2F048%2F0259-0262%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語  

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記述言語：日本語  

早期胃癌ESD非治癒切除症例は「内視鏡的根治度(eCura)C-2症例」と呼ばれ、原則的に追加外科手術が推奨されている。一方、高齢で複数併存疾患を有するいわゆる手術ハイリスク症例では、無治療経過観察も選択肢となる。eCuraC-2症例かつ手術ハイリスクの場合、追加治療方針の決定には病変側因子(病理結果から推測されるリンパ節転移リスク)と患者側因子(年齢や併存疾患から予測される手術リスクおよび非胃癌死を含む生命予後)の両者を考慮する必要がある。現在、病変側因子についてはリンパ節転移リスクを予測するスコアリングシステムが提案され、また患者側因子に関してもさまざまな予後予測指標の有用性や侵襲性の低い術式が模索されている。近い将来、ESD非治癒切除症例における病変側因子と患者側因子の両者を包括的にとらえた、治療方針決定のアルゴリズムの登場が期待される。(著者抄録)

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2021&ichushi_jid=J02312&link_issn=&doc_id=20210802080012&doc_link_id=%2Faq9syokd%2F2021%2F003307%2F013%2F1159-1164%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Faq9syokd%2F2021%2F003307%2F013%2F1159-1164%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語  

H.pylori感染率が低下するなか、自己免疫性胃炎を診断する機会が増加している。自己免疫性胃炎はさまざまな胃病変を合併するが、本邦多施設共同研究によると過形成性ポリープ21.1%、1型神経内分泌腫瘍(NET)11.4%、胃癌9.8%の発生頻度であった。1型NETは大多数が小病変であるが、転移例も少数報告されており、その予後は良好と考えられている。自己免疫性胃炎に伴う胃癌の特徴は、(1)自己免疫性胃炎が高度に進行した悪性貧血を合併することが多い、(2)肉眼型は0-IIa型または0-I型の隆起型が多い、(3)局在はM領域が約半数だがL領域にも一定程度みられる、(4)組織型は分化型腺癌が多数を占め胃型粘液形質が優勢、(5)大多数が早期胃癌で進行胃癌は稀、である。(著者抄録)

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2021&ichushi_jid=J02312&link_issn=&doc_id=20210802080007&doc_link_id=%2Faq9syokd%2F2021%2F003307%2F008%2F1124-1133%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Faq9syokd%2F2021%2F003307%2F008%2F1124-1133%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語  

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記述言語：日本語  

＜文献概要＞はじめに 早期胃癌に対する内視鏡的粘膜下層剥離術(endoscopic submucosal dissection;ESD)は,その低侵襲性により耐術能の低い高齢者に対しても適応しやすい手技として認識されている.しかし,主な偶発症として挙げられる後出血は抗血栓薬の服用が危険因子の一つとされ,抗血栓薬の服用頻度の高い高齢者においては特に留意すべきものである.一方で,抗血栓薬休薬による血栓塞栓症のリスクも看過できず,安易な休薬は極めて重篤な合併症の引き金になりかねない.したがって,抗血栓薬服用者に対する胃ESDにおいては,抗血栓薬を継続することで可能な限り血栓塞栓症のリスクを回避しつつ,後出血のリスクを極力低減することが理想となる.

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記述言語：日本語  

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2020&ichushi_jid=J02312&link_issn=&doc_id=20200928130010&doc_link_id=%2Faq9syokd%2F2020%2F003209%2F011%2F1303-1308%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Faq9syokd%2F2020%2F003209%2F011%2F1303-1308%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語  

食道胃接合部ポリープを「食道胃接合部(食道胃接合部上下2cm)に存在するポリープ」と定義し、病理所見と酸逆流所見(びらん性食道炎、1cm以上のBarrett食道)の有無によって、(1)酸逆流合併円柱上皮型、(2)酸逆流非合併円柱上皮型、(3)酸逆流合併扁平上皮型、(4)酸逆流非合併扁平上皮型、に分類した。食道胃接合部ポリープの約7割が酸逆流所見を合併し、ポリープは酸分泌抑制薬で消失してBarrett食道に置換された。酸逆流合併型は「Barrett食道粘膜由来ポリープ」ともいえる。一方、酸逆流非合併型にはHelicobacter pylori関連過形成性ポリープや乳頭腫(ヒトパピローマウイルス関連)などがあり、酸分泌抑制薬によるポリープ消失は期待できない。Barrett食道腺癌には食道胃接合部ポリープ類似型があるが、食道胃接合部ポリープの癌化例を筆者らは経験していない。食道胃接合部ポリープ類似型癌は酸分泌抑制薬で縮小する症例があり、酸逆流による炎症の関与が推定される。(著者抄録)

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記述言語：日本語  

EUSガイド下腹腔神経節ブロック(EUS-CGN)は、従来行われてきたEUSガイド下腹腔神経叢ブロック(EUS-CPN)よりも高い疼痛緩和効果が期待できる。腹腔神経節の描出はコツさえつかめば容易であり、すべての症例において描出可能である。また、エタノールの注入量はEUS-CPNよりも少量ですむため、偶発症の発生も抑制できる可能性がある。効果的で安全なEUS-CGNを行うための手技の工夫について紹介した。(著者抄録)

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記述言語：日本語  

内視鏡的逆行性膵胆管造影(ERCP)におけるスコープ挿入の基本手技および困難例における対処法について解説した。ERCPで用いる後方斜視鏡は直視下にスコープを進めることができないため、安全かつ速やかに乳頭まで到達するには様々な注意点とコツが必要である。なかでも、挿入に際して最も重要なことは、抵抗を感じたら無理にスコープを押し込まず、スコープをいったん少し引き戻して進行方向を確認してから、再度スコープを進めることである。(著者抄録)

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記述言語：日本語  

癌性疼痛の管理は、近年WHOの除痛ラダーが推奨されている。しかし、種々の理由によりモルヒネを中心とした鎮痛薬による疼痛管理が困難な場合がある。一方、内視鏡技術の進歩により超音波内視鏡下腹腔神経叢ブロック(EUS-guided celiac plexus neurolysis:EUS-CPN)が近年行われるようになり、膵癌をはじめとする上腹部悪性腫瘍に伴う癌性疼痛の緩和治療に用いられている。超音波内視鏡下では、穿刺経路に介在する血管や臓器を避けて対象部位に正確な穿刺が行えるため、従来の方法と比べてはるかに手技の安全性が高い。さらに最近では、EUSによって腹腔神経節を視認できることが確認され、EUS-guided celiac ganglia neurolysis(EUS-CGN)も行われるようになっており、より一層の疼痛緩和効果が期待されている。(著者抄録)

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記述言語：日本語  

総胆管結石はバスケットやバルーンカテーテルを用いた内視鏡的結石除去術によりほとんどの症例で治療完遂可能であるが、2cmを超えるような大結石に対しては内視鏡的機械的砕石術(endoscopic mechanical lithotripsy:EML)を適宜併用した処置を行う必要がある。EML砕石具のシースは乳頭への挿入が他のデバイスと比べて難しく、軸合わせを意識した丁寧な挿入を心がけないと思わぬ偶発症を招く可能性がある。最近では新しい経口胆道鏡や、電気水圧衝撃波結石破砕装置(EHL)が相次いで発売されてきており、大結石に対する治療選択肢の幅が増えてきている。(著者抄録)

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記述言語：日本語  

古典的な胆管カニュレーションの方法は、造影剤を充填したカニューラの先端で胆管口を探ったのち、造影剤の注入によって胆管挿管の成否を確認する方法である。しかし、欧米では以前から十二指腸乳頭において見上げのポジションをとりやすいパピロトームを好んで使用する施設が多くあり、また最近ではガイドワイヤーを先行させて胆管を探るwire-guided cannulationが標準的な手技として定着している。また、胆管カニュレーション困難例については、従来、プレカット法が一般的に行われてきたが、国内では膵管ガイドワイヤー法/ダブルガイドワイヤー法も広く行われており、最近ではEUSを用いて胆管穿刺を行い、そこからガイドワイヤーを乳頭に出し、このガイドワイヤーを利用して胆管カニュレーションを行うEUSランデブー法の有用性が国内外から報告されている。(著者抄録)

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記述言語：日本語  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：日本消化器病学会-関東支部  

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記述言語：日本語   出版者・発行元：(NPO)日本高齢消化器病学会  

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記述言語：日本語   出版者・発行元：(NPO)日本高齢消化器病学会  

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記述言語：日本語   出版者・発行元：(一社)日本膵臓学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会-関東支部  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会-関東支部  

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2023&ichushi_jid=J04260&link_issn=&doc_id=20230526360017&doc_link_id=%2Fcw1nimed%2F2023%2F001902%2F019%2F0178-0190%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fcw1nimed%2F2023%2F001902%2F019%2F0178-0190%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：日本消化器病学会-関東支部  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：日本消化器病学会-関東支部  

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記述言語：日本語   出版者・発行元：(一社)日本消化管学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化管学会  

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記述言語：日本語   出版者・発行元：(一社)日本総合健診医学会  

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2023&ichushi_jid=J03750&link_issn=&doc_id=20230116240016&doc_link_id=10.7143%2Fjhep.50.97&url=https%3A%2F%2Fdoi.org%2F10.7143%2Fjhep.50.97&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

記述言語：日本語   出版者・発行元：(一社)日本消化管学会  

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記述言語：日本語   出版者・発行元：日本消化器病学会-関東支部  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：日本臨床生理学会  

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記述言語：日本語   出版者・発行元：日本消化器病学会-関東支部  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会-関東支部  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会-関東支部  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：日本消化器病学会-関東支部  

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記述言語：日本語   出版者・発行元：(一社)日本消化管学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化管学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化管学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：(NPO)日本食道学会  

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記述言語：日本語   出版者・発行元：(NPO)日本食道学会  

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記述言語：日本語   出版者・発行元：(NPO)日本食道学会  

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記述言語：日本語   出版者・発行元：(NPO)日本食道学会  

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記述言語：日本語   出版者・発行元：(株)東京医学社  

内視鏡診療における鎮静の使用頻度は年々上昇しており、外来内視鏡においても例外ではない。これまでの全国調査で、前処置においては鎮静・鎮痛薬に関連する偶発症が最も多いことがわかっている。そうした背景をふまえ2013年に「内視鏡診療における鎮静に関するガイドライン」が作成され、それから7年後の2020年には第2版が作成されるに至った。このガイドラインにおいて、安全に内視鏡検査・治療を遂行するための標準的な指針が示されている。鎮静下内視鏡では中等度の鎮静が至適とされるが、検査数や安全性が求められる外来内視鏡においては、鎮静深度を浅めに設定する必要がある。この微妙な調整を行うためには使用する薬剤のそれぞれの特徴を理解し、患者背景に応じた薬剤の選択など、より細かなマネジメントが求められる。鎮静の安心・安全な運用のために、個々の患者の希望、年齢、合併症、社会的状況、施設の事情によって柔軟に対応する必要がある。(著者抄録)

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2021&ichushi_jid=J02312&link_issn=&doc_id=20210624130003&doc_link_id=%2Faq9syokd%2F2021%2F003306%2F004%2F0963-0971%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Faq9syokd%2F2021%2F003306%2F004%2F0963-0971%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会-関東支部  

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記述言語：日本語   出版者・発行元：(株)医学書院  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：(株)東京医学社  

緊急内視鏡は、通常の内視鏡とは異なり「急性症状の改善を目的とした内視鏡検査および治療」と定義されている。対象はすでに症状を有し、時に重篤化しつつある。あるいはすでに重篤な症状を呈している患者となることから、その周術期管理もより厳格に行う必要がある。適応について迅速かつ十分に検討し、遅滞なく内視鏡の準備とスタッフの確保を行ったうえで、厳重なモニタリングのもと内視鏡を行う。診断を行いつつ処置の適応と方法を決定し、すかさず適切な処置へと移行する。目的が達成できた時点でただちに検査を終了し、慎重に術後管理を行う。特に高齢者、重篤な併存疾患を有する患者、抗血栓薬服用者はハイリスクと考えられるため、医療安全を考慮しつつ、個々の症例の状態に応じて安全性を最優先とした処置を心がける。緊急内視鏡は低侵襲できわめて効果的なアウトカムを生むことができる手段であることから、今後もそのニーズはますます高くなると予想される。内視鏡医として緊急内視鏡の性質を十分に理解し、その手技に習熟しておくことが肝要である。(著者抄録)

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2021&ichushi_jid=J02312&link_issn=&doc_id=20210426120002&doc_link_id=%2Faq9syokd%2F2021%2F003304%2F002%2F0671-0678%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Faq9syokd%2F2021%2F003304%2F002%2F0671-0678%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：(一社)日本消化管学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化管学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化管学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化管学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化管学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会-関東支部  

目的:当院では食道運動機能障害に対して2018年10月よりPOEMを開始した。今回、その短期成績を検討した。方法:2019年12月までに施行したPOEM16症例を対象とし、対象疾患、施行時間、筋層切開長、術後入院日数、合併症、POEM前後の食道内圧検査所見及び治療効果について後方視的に解析した。結果:原疾患は食道アカラシア(EA)12例、jackhammer esophagus(JE)3例、esophagogastric junction outlet obstruction(EGJOO)1例であった。施行時間は91.0(65-196)分、筋層切開長は8.0(5-21)cmであり、術後の入院日数は3.0(2-5)日間であった。重篤な有害事象は認めなかった。Eckardt scoreは中央値5.5→1.5と有意に改善し(p値=0.005)、F scaleも中央値21.0→11.0と改善を認めた(p値=0.004)、術後2ヵ月に食道内圧検査を施行した13例中、EA9例とEGJOO1例でIRPが中央値29.6→10.1mmHgに低下(p値<0.005)、JE3例ではDCIが中央値8831.4→849.2mmHg/s/cmと低下した。結語:当院においてもPOEMを安全に導入し、良好な成績を示すことができた。今後さらなる症例の蓄積と長期成績についての検討が必要である。(著者抄録)

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2020&ichushi_jid=J04450&link_issn=&doc_id=20201225120001&doc_link_id=%2Fdw9poden%2F2020%2F009701%2F014%2F0024-0027%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fdw9poden%2F2020%2F009701%2F014%2F0024-0027%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会-関東支部  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会-関東支部  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会-関東支部  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会-関東支部  

症例は63歳男性で、肺扁平上皮癌に対しペムブロリズマブを計31コース施行し部分奏功を維持していたが、開始から23ヵ月後より下痢を認め、32コース目を中止し入院した。入院時検査所見で軽度炎症反応上昇を認め、下部消化管内視鏡検査および病理組織所見で潰瘍性大腸炎に類似する所見を認めたことから、ペムブロリズマブによる免疫関連副作用(irAE)大腸炎と診断した。プレドニゾロンにより症状は軽快したが、漸減中に誤嚥性肺炎を合併し抗菌薬加療を行った。第70病日に偽膜性腸炎とCMV腸炎を同時合併し、メトロニダゾールおよびガンシクロビルにより症状改善を認めた。第105病日にirAE大腸炎を再燃したが軽症であり、メサラジンによる維持治療で半年経過している。

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2020&ichushi_jid=J04450&link_issn=&doc_id=20201225120035&doc_link_id=%2Fdw9poden%2F2020%2F009701%2F048%2F0130-0132%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fdw9poden%2F2020%2F009701%2F048%2F0130-0132%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会-関東支部  

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記述言語：日本語   出版者・発行元：日本消化器病学会-関東支部  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：(一社)日本大腸肛門病学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会-関東支部  

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記述言語：日本語   出版者・発行元：日本消化器病学会-関東支部  

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記述言語：日本語   出版者・発行元：(一社)日本内分泌学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化管学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会-関東支部  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会-関東支部  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：日本消化器病学会-関東支部  

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記述言語：日本語   出版者・発行元：日本消化器病学会-関東支部  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：(公社)神奈川県医師会  

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記述言語：日本語   出版者・発行元：日本内科学会-関東地方会  

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記述言語：日本語   出版者・発行元：日本内科学会-関東地方会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会-関東支部  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会-関東支部  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会-関東支部  

症例は71歳、女性。Vogt-小柳-原田病に対して当院眼科にてステロイド内服加療中であったが、腹痛、嘔吐、下痢、発熱が出現したため当科を受診した。感染性腸炎と診断し、絶食・補液・抗菌薬投与で加療を開始したところ、症状は数日で改善し、炎症反応もおさまったため抗菌薬投与を終了した。しかし、食事再開後に炎症が再燃し、CTにて骨盤内に膿瘍形成を認めた。抗菌薬投与を再開したが、膿瘍が消失せず症状も遷延したため、超音波内視鏡下経直腸膿瘍ドレナージを施行した。術中・術後偶発症はなく、症状・炎症反応は改善し、CTでも膿瘍の縮小が確認できた。骨盤内膿瘍に対する超音波内視鏡下経直腸膿瘍ドレナージは比較的低侵襲で有効な治療法と考えられる。しかし本邦では施行例が少なく、手技の標準化のためには、今後さらなる症例の蓄積と検討が必要である。(著者抄録)

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2017&ichushi_jid=J04450&link_issn=&doc_id=20170621140005&doc_link_id=%2Fdw9poden%2F2017%2F009001%2F017%2F0062-0066%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fdw9poden%2F2017%2F009001%2F017%2F0062-0066%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会  

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記述言語：日本語   出版者・発行元：(公社)神奈川県医師会  

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記述言語：日本語   出版者・発行元：(公社)神奈川県医師会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会-関東支部  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会-関東支部  

ERCP時の鎮痙薬としてl-menthol製剤を投与した359例を対象に、他の鎮痙薬を用いない手技完遂率、腸蠕動の程度、全処置時間、術中・術後の偶発症について検討した。その結果、他の鎮痙剤を用いない手技完遂率は90.5%で、鎮痙剤の追加の有無にかかわらず、手技を完遂できなかった症例は4.5%であった。鎮痙剤の追加を必要とした症例は34例(9.5%)であった。スコープ挿入からの総検査時間は中央値23分(2～102分)であった。l-menthol単独での腸蠕動は、grade別に各々none/mild/moderate/severeが27.9%/51.0%/15.3%/5.8%であった。偶発症は5%に認め、ERCP後膵炎が2.5%(重症0.5%)と最多であった。その他として、胆管穿孔を0.5%、十二指腸穿孔を0.2%、出血を0.2%、その他を1.6%に認めた。偶発症による死亡例、外科手術例はなかった。以上、l-menthol製剤はERCP時の鎮痙薬として有用であると考えられた。

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2016&ichushi_jid=J04450&link_issn=&doc_id=20170112130009&doc_link_id=10.11641%2Fpde.89.1_70&url=https%3A%2F%2Fdoi.org%2F10.11641%2Fpde.89.1_70&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif