研究者詳細 - 寺井　崇二

論文 - 寺井　崇二

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Evidence-based clinical practice guidelines for liver cirrhosis 2020. 国際誌

Hitoshi Yoshiji, Sumiko Nagoshi, Takemi Akahane, Yoshinari Asaoka, Yoshiyuki Ueno, Koji Ogawa, Takumi Kawaguchi, Masayuki Kurosaki, Isao Sakaida, Masahito Shimizu, Makiko Taniai, Shuji Terai, Hiroki Nishikawa, Yoichi Hiasa, Hisashi Hidaka, Hiroto Miwa, Kazuaki Chayama, Nobuyuki Enomoto, Tooru Shimosegawa, Tetsuo Takehara, Kazuhiko Koike

Hepatology research : the official journal of the Japan Society of Hepatology 51 ( 7 ) 725 - 749 2021年7月

記述言語：英語掲載種別：研究論文（学術雑誌）

The first edition of the clinical practice guidelines for liver cirrhosis was published in 2010, and the second edition was published in 2015 by the Japanese Society of Gastroenterology (JSGE). The revised third edition was recently published in 2020. This version has become a joint guideline by the JSGE and the Japanese Society of Hepatology (JSH). In addition to the clinical questions (CQs), background questions (BQs) are new items for basic clinical knowledge, and future research questions (FRQs) are newly added clinically important items. Concerning the clinical treatment of liver cirrhosis, new findings have been reported over the past 5 years since the second edition. In this revision, we decided to match the international standards as much as possible by referring to the latest international guidelines. Newly developed agents for various complications have also made great progress. In comparison with the latest global guidelines, such as the European Association for the Study of the Liver (EASL) and American Association for the Study of Liver Diseases (AASLD), we are introducing data based on the evidence for clinical practice in Japan. The flowchart for nutrition therapy was reviewed to be useful for daily medical care by referring to overseas guidelines. We also explain several clinically important items that have recently received focus and were not mentioned in the last editions. This digest version describes the issues related to the management of liver cirrhosis and several complications in clinical practice. The content begins with a diagnostic algorithm, the revised flowchart for nutritional therapy, and refracted ascites, which are of great importance to patients with cirrhosis. In addition to the updated antiviral therapy for hepatitis B and C liver cirrhosis, the latest treatments for non-viral cirrhosis, such as alcoholic steatohepatitis/non-alcoholic steatohepatitis (ASH/NASH) and autoimmune-related cirrhosis, are also described. It also covers the latest evidence regarding the diagnosis and treatment of liver cirrhosis complications, namely gastrointestinal bleeding, ascites, hepatorenal syndrome and acute kidney injury, hepatic encephalopathy, portal thrombus, sarcopenia, muscle cramp, thrombocytopenia, pruritus, hepatopulmonary syndrome, portopulmonary hypertension, and vitamin D deficiency, including BQ, CQ and FRQ. Finally, this guideline covers prognosis prediction and liver transplantation, especially focusing on several new findings since the last version. Since this revision is a joint guideline by both societies, the same content is published simultaneously in the official English journal of JSGE and JSH.

DOI： 10.1111/hepr.13678

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Impact of continuous positive airway pressure therapy for nonalcoholic fatty liver disease in patients with obstructive sleep apnea. 国際誌

Haruka Hirono, Kazuhiko Watanabe, Katsuhiko Hasegawa, Masaki Kohno, Shuji Terai, Shogo Ohkoshi

World journal of clinical cases 9 ( 19 ) 5112 - 5125 2021年7月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: Obstructive sleep apnea (OSA) has been suggested as an independent risk factor for nonalcoholic fatty liver disease (NAFLD), and continuous positive airway pressure (CPAP) is the first-line therapy for OSA. AIM: To clarify the efficacy of effective CPAP therapy on NAFLD of OSA patients by serum markers and transient elastography (TE) using FibroScan® (Echosens, Paris, France). METHODS: We prospectively enrolled 123 consecutive patients with OSA who met the indications for CPAP. Liver fibrosis and steatosis were assessed using TE. Before and after 6 mo of CPAP therapy, serum markers and TE were assessed for all patients. The mean usage rate of CPAP therapy for 6 mo was arbitrarily calculated in each patient and expressed as "mean compliance index" (m-CI). RESULTS: In 50 OSA patients with NAFLD, both aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels were significantly decreased after 6 mo of CPAP therapy. Univariate analysis showed that decreased body weight (BW), decreased body mass index (BMI), decreased AST level, decreased hemoglobin A1c, and high m-CI were significantly related with improved ALT level. In multivariate regression model adjusted for quantities of BW change during 6 mo of CPAP therapy, high m-CI tended to improve ALT level (P = 0.051). All 17 OSA patients with NAFLD, high m-CI and no BMI changes showed significant improvements in AST and ALT levels. Meanwhile, no significant changes in TE data or serum fibrosis markers were seen. CONCLUSION: Some NAFLD could be associated with chronic intermittent hypoxia due to OSA independent of BW changes. In those cases, adequate reoxygenation from effective CPAP therapy may improve NAFLD.

DOI： 10.12998/wjcc.v9.i19.5112

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Biliary Obstruction Caused by B-Cell Lymphoma Associated With IgG4-Related Disease. 国際誌

Kazuya Ogawa, Hiroki Sato, Satoshi Ikarashi, Kazunao Hayashi, Shuji Terai

The American journal of gastroenterology 2021年7月

Tuberculous Spondylitis in a Woman without Pulmonary Lesions.

Shinichi Morita, Toshinori Takada, Kazumasa Ohashi, Shuji Terai

Internal medicine (Tokyo, Japan) 60 ( 13 ) 2157 - 2158 2021年7月

当院における腹腔鏡・内視鏡合同手術(LECS)の現状と課題

加納陽介, 羽入隆晃, 佐藤裕樹, 水野研一, 市川寛, 石川卓, 宗岡悠介, 茂木大輔, 須藤翔, 小柳英人, 三浦宏平, 滝沢一泰, 中野雅人, 島田能史, 永橋昌幸, 坂田純, 寺井崇二, 若井俊文

ENDOSCOPIC FORUM for digestive disease 37 ( 1 ) 36 - 36 2021年7月

Rapid decline in visceral adipose tissue over 1 month is associated with poor prognosis in patients with unresectable pancreatic cancer. 国際誌

Oki Nakano, Hirokazu Kawai, Takamasa Kobayashi, Junji Kohisa, Satoshi Ikarashi, Kazunao Hayashi, Junji Yokoyama, Shuji Terai

Cancer medicine 10 ( 13 ) 4291 - 4301 2021年7月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: Involuntary weight loss related to cachexia is common in patients with advanced cancer, but the association between body composition changes and survival is still unclear in pancreatic cancer. METHODS: We retrospectively reviewed the clinical outcomes of 55 patients with advanced pancreatic cancer undergoing palliative therapy or best supportive care (BSC). The skeletal muscle index (SMI), visceral adipose tissue index (VATI), subcutaneous adipose tissue index (SATI), and visceral to subcutaneous adipose tissue area ratio (VSR) were calculated based on the cross-sectional area on two sets of computed tomography images obtained at cancer diagnosis and 1 month later before treatment. The prognostic value of body composition indexes at diagnosis and the changes in those indexes over 1 month was then evaluated. RESULTS: In total, 45 patients (81.8%) received chemotherapy, chemoradiation, or radiation therapy, whereas the remaining patients underwent BSC. There were 27 patients (49.1%) who had low SMI at cancer diagnosis. Univariate analysis showed no significant associations between the baseline body composition indexes including SMI, VATI, SATI, and VSR and survival. Meanwhile, male sex (HR, 2.79; 95% CI, 1.16-6.71, p = 0.022) and higher decrease in VATI over 1 month (HR, 2.41; 95% CI, 1.13-5.13, p = 0.023) were identified as independent risk factors for mortality in multivariate analysis. CONCLUSION: Rapid decline in VAT over 1 month is closely associated with poorer survival in unresectable advanced pancreatic cancer. A short-term assessment of body composition changes may be a rational approach to predict prognosis in these patients.

DOI： 10.1002/cam4.3964

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Rapid Onset of Weight Gain and Liver Dysfunction Successfully Treated With Nutrition and Exercise. 国際誌

Hiroteru Kamimura, Masakazu Sano, Takanori Tsujimura, Yasunaga Takeda, Yuko Komoro, Junji Yokoyama, Shuji Terai

Cureus 13 ( 7 ) e16530 2021年7月

記述言語：英語

Physical inactivity is one of the causes of most metabolic syndromes. The incidence of metabolic syndrome is expected to increase in the near future because of the reduced opportunities for exercise caused by COVID-19. Non-alcoholic fatty liver disease (NAFLD) is currently the most common cause of chronic liver disease. Changes in diet and lifestyle have led to a dramatic increase in the prevalence of NAFLD in the world. NAFLD is characterized by excessive triglyceride (TG) accumulation in the hepatocytes due to both increased inflow of free fatty acids and de novo hepatic lipogenesis. Thus far, no study quantitatively assessed the liver fat deposition after a rapid decline in physical activity. Herein, we describe a case of a 17-year-old Japanese boy with severe fat infiltration of the liver, due to a rapid decline in physical activity, treated at our facility. Our rehabilitation and nutritional support teams administered appropriate exercise and nutrition support to reduce weight and improve liver dysfunction. Our findings support dietary changes and exercise therapy to manage such cases.

DOI： 10.7759/cureus.16530

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高齢者消化器がん化学療法〜高齢者のがん治療を安全・効果的に遂行するための取り組み高齢肝細胞癌症例における分子標的治療薬の生存期間延長効果と予測因子の検討

横尾健, 酒井規裕, 渡邉雄介, 荒生祥尚, 木村成宏, 阿部寛幸, 薛徹, 上村博輝, 坂牧僚, 上村顕也, 土屋淳紀, 寺井崇二

日本高齢消化器病学会誌 24 ( 1 ) 115 - 115 2021年7月

被包化膵壊死への真菌感染による敗血症性ショックをきたした一例

山田麻理奈[大越], 上村顕也, 石川夏生, 小関洋平, 田中裕登, 水澤健, 佐藤裕樹, 五十嵐聡, 林和直, 坂牧僚, 横山純二, 寺井崇二

ENDOSCOPIC FORUM for digestive disease 37 ( 1 ) 30 - 30 2021年7月

自己免疫性膵炎と膵癌との鑑別の現状と課題

小川光平, 林和直, 五十嵐聡, 寺井崇二

ENDOSCOPIC FORUM for digestive disease 37 ( 1 ) 32 - 32 2021年7月

Shrinkage of a Submucosal Tumor in the Rectum. 国際誌

Takamasa Kobayashi, Manabu Takeuchi, Shuji Terai

Journal of gastrointestinal and liver diseases : JGLD 30 ( 2 ) 183 - 184 2021年6月

Severe steatosis and mild colitis are important for the early occurrence of hepatocellular carcinoma. 国際誌

Takeki Sato, Atsunori Tsuchiya, Takashi Owaki, Masaru Kumagai, Satoko Motegi, Takahiro Iwasawa, Shunsuke Nojiri, Masahiro Ogawa, Suguru Takeuchi, Yusuke Watanabe, Yuzo Kawata, Hiroteru Kamimura, Shuji Terai

Biochemical and biophysical research communications 566 36 - 44 2021年6月

記述言語：英語掲載種別：研究論文（学術雑誌）

The number of patients with non-alcoholic steatohepatitis (NASH) and inflammatory bowel disease (IBD) is increasing. This study elucidates the effect of both NASH and IBD on hepatocellular carcinoma (HCC) using a mouse model combining NASH and IBD. The melanocortin 4 receptor-deficient (Mc4r-KO) mice were divided into four groups with or without a high-fat diet (HFD) and with or without dextran sulfate sodium (DSS) to induce colitis, and the differences in liver damage and occurrence of HCC were analyzed. In the HFD + DSS group, the body weight, liver weight/body weight ratio, and serum levels of albumin and alanine aminotransferase were significantly lower than those in the HFD group. We further found that steatosis was significantly lower and lobular inflammation was significantly higher in the HFD + DSS group than those in the HFD group, and that individual steatosis and lobular inflammation state in the HFD + DSS mice varied. We detected HCC only in the HFD + DSS group, and mice with severe steatosis and mild colitis were found to be at high risk of HCC. Presently, the prediction of HCC is very difficult. In some cases, severe colitis reverses the fat accumulation due to appetite loss. Our findings clearly showed that severe steatohepatitis and mild colitis are simultaneously essential for the occurrence of HCC in patients with NASH and IBD.

DOI： 10.1016/j.bbrc.2021.05.097

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Effect of Lenvatinib on a Hepatocellular Carcinoma with Fibroblast Growth Factor Receptor 4 Expression: A Case Report and Review of the Literature.

Osamu Shibata, Kenya Kamimura, Masayoshi Ko, Norihiro Sakai, Hiroyuki Abe, Shinichi Morita, Takeshi Mizusawa, Hiroki Sato, Akira Sakamaki, Shuji Terai

Internal medicine (Tokyo, Japan) 60 ( 11 ) 1709 - 1715 2021年6月

記述言語：英語掲載種別：研究論文（学術雑誌）

Basic and clinical research have shown that the expression of molecules involved in the hepatocellular carcinoma (HCC) cell signaling pathway is related to the sensitivity to molecular-targeted agents. We herein report a case of HCC that was effectively treated with lenvatinib after a poor response to sorafenib. The tumor showed a high expression of fibroblast growth factor receptor 4, which is reportedly related to the sensitivity to lenvatinib in vitro. The information obtained from this case and from our literature review highlights the importance of assessing the expression of the molecules involved in tumors for effective precision medicine.

DOI： 10.2169/internalmedicine.6580-20

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A case of Helicobacter pylori -negative early gastric adenocarcinoma with gastrointestinal phenotype. 国際誌

Masafumi Takatsuna, Rie Azumi, Takeshi Mizusawa, Hiroki Sato, Ken-Ichi Mizuno, Takashi Kato, Junji Yokoyama, Yoichi Ajioka, Shuji Terai

Endoscopy international open 9 ( 6 ) E863-E866 2021年6月

記述言語：英語掲載種別：研究論文（学術雑誌）

A 40-year-old man with slightly depressed (0-IIc) type gastric cancer of the pyloric anterior gastric area underwent pre-operative screening for tetralogy of Fallot and endoscopic submucosal dissection (ESD) and was tested for Helicobacter pylori antigens and antibodies. Both tests were negative. He did not have a history of eradication. Pathological diagnosis of ESD showed a well-differentiated adenocarcinoma. The tumor was CD10-positive, MUC5AC-negative, and MUC6-confocal positive; it showed differentiation with gastrointestinal phenotype. Moreover, the tumor cells were lysozyme-positive, resembling Paneth cells. Mucosal glands exhibited intestinal metaplasia on the anal side of the tumor lesion. On the oral side of the tumor, metaplasia was non-existent, with normal pyloric glands present in the mucosal layer. The patient was not infected with H. pylori ; however, intestinal metaplasia existed around the early gastric cancer. This suggested that the intestinal metaplasia occurred due to bile reflux, and the gastric neoplasia arose with the metaplasia without an H. pylori infection. This case may potentially help explain gastric cancer development in the absence of H. pylori infection.

DOI： 10.1055/a-1396-3854

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Transoral surgery for superficial head and neck cancer: National Multi-Center Survey in Japan. 国際誌

Chikatoshi Katada, Manabu Muto, Satoshi Fujii, Tetsuji Yokoyama, Tomonori Yano, Akihito Watanabe, Toshiro Iizuka, Shigetaka Yoshinaga, Ichiro Tateya, Hiroki Mitani, Yuichi Shimizu, Akiko Takahashi, Tomoyuki Kamijo, Noboru Hanaoka, Makoto Abe, Akihiro Shiotani, Koichi Kano, Yukinori Asada, Tamotsu Matsuhashi, Hirohito Umeno, Kenji Okami, Kenichi Goda, Shinichiro Hori, Yoichiro Ono, Shuji Terai, Yasuaki Nagami, Kenichi Takemura, Kenro Kawada, Mizuo Ando, Naoto Shimeno, Akihito Arai, Yasutoshi Sakamoto, Masaaki Ichinoe, Tetsuo Nemoto, Masahiro Fujita, Hidenobu Watanabe, Tadakazu Shimoda, Atsushi Ochiai, Takakuni Kato, Ryuichi Hayashi

Cancer medicine 10 ( 12 ) 3848 - 3861 2021年6月

記述言語：英語掲載種別：研究論文（学術雑誌）

Head and neck cancers, especially in hypopharynx and oropharynx, are often detected at advanced stage with poor prognosis. Narrow band imaging enables detection of superficial cancers and transoral surgery is performed with curative intent. However, pathological evaluation and real-world safety and clinical outcomes have not been clearly understood. The aim of this nationwide multicenter study was to investigate the safety and efficacy of transoral surgery for superficial head and neck cancer. We collected the patients with superficial head and neck squamous cell carcinoma who were treated by transoral surgery from 27 hospitals in Japan. Central pathology review was undertaken on all of the resected specimens. The primary objective was effectiveness of transoral surgery, and the secondary objective was safety including incidence and severity of adverse events. Among the 568 patients, a total of 662 lesions were primarily treated by 575 sessions of transoral surgery. The median tumor diameter was 12 mm (range 1-75) endoscopically. Among the lesions, 57.4% were diagnosed as squamous cell carcinoma in situ. The median procedure time was 48 minutes (range 2-357). Adverse events occurred in 12.7%. Life-threatening complications occurred in 0.5%, but there were no treatment-related deaths. During a median follow-up period of 46.1 months (range 1-113), the 3-year overall survival rate, relapse-free survival rate, cause-specific survival rate, and larynx-preservation survival rate were 88.1%, 84.4%, 99.6%, and 87.5%, respectively. Transoral surgery for superficial head and neck cancer offers effective minimally invasive treatment. Clinical trials registry number: UMIN000008276.

DOI： 10.1002/cam4.3927

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併存する疾患のあることが多い高齢者における上部消化管疾患のマネージメント地域病院における消化器サルコペニア疾患診療の有用性

上村博輝, 小島雄一, 高橋一也, 高綱将史, 平野正明, 政二文明, 藤田一, 辻村恭憲, 小林太一, 寺井崇二

日本消化器病学会甲信越支部例会抄録集 68回 52 - 52 2021年6月

感染性被包化と壊死門脈瘻を伴う膵仮性嚢胞の一例(A case of pancreatic pseudocyst-portal vein fistula with infected walled off necrosis)

前田悠一郎, 林和直, 戸田遼, 若林拓哉, 木村究, 水戸將貴, 小島雄一, 小川光平, 荒生祥尚, 木村成宏, 五十嵐聡, 土屋淳紀, 徳永麻美, 佐藤知巳, 寺井崇二

日本消化器病学会甲信越支部例会抄録集 68回 35 - 35 2021年6月

Effectiveness of EUS-Guided Fine-Needle Biopsy versus EUS-Guided Fine-Needle Aspiration: A Retrospective Analysis. 国際誌

Naosuke Kuraoka, Satoru Hashimoto, Shigeru Matsui, Shuji Terai

Diagnostics (Basel, Switzerland) 11 ( 6 ) 2021年5月

記述言語：英語掲載種別：研究論文（学術雑誌）

Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) for pancreatic tumors and subepithelial lesions (SEL) of the gastrointestinal tract are effective for histological diagnosis. There are also reports that tissue sampling is possible with a smaller number of punctures by EUS-guided fine-needle biopsy (EUS-FNB). In this study, we retrospectively compared the diagnostic abilities of EUS-FNA and EUS-FNB. We examined 130 patients who underwent EUS-FNA/EUS-FNB for pancreatic tumors and SEL from July 2018 to January 2021. None of the cases underwent rapid on-site evaluation. There were 94 and 36 cases in the EUS-FNA and EUS-FNB groups, respectively. The median tumor size in the EUS-FNB group was 30 mm, which was significantly larger than the EUS-FNA group (p = 0.02). In addition, transgastric puncture was significantly more common in the EUS-FNB group (p = 0.01). The EUS-FNA and EUS-FNB groups had a sensitivity of 82.9% and 91.7% and an accuracy rate of 85.1% and 91.7%, respectively. However, both procedures had a comparable diagnostic ability.

DOI： 10.3390/diagnostics11060965

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Long-term survival of 11 years with multidisciplinary therapy for hepatocellular carcinoma metastasis to the ovary and peritoneum: a case report.

Satoko Motegi, Takeshi Yokoo, Ryosuke Nozawa, Rie Azumi, Yuzo Kawata, Kohei Ogawa, Toru Setsu, Ken-Ichi Mizuno, Koji Nishino, Hajime Umezu, Hirokazu Kawai, Takeshi Suda, Shuji Terai

Clinical journal of gastroenterology 14 ( 4 ) 1211 - 1220 2021年5月

記述言語：英語掲載種別：研究論文（学術雑誌）

We herein report a rare case of HCC metastases to the ovary and peritoneum in a 61-year-old female patient who has achieved 11-year survival with multidisciplinary therapy. The patient was diagnosed with HCC during balloon angioplasty performed for Budd-Chiari syndrome in 1994 and underwent partial hepatectomy twice. Five years after the second hepatectomy, allochronic recurrence of a single nodule detected in S8 was treated by radiofrequency ablation, followed by percutaneous ethanol injection therapy and stereotactic body radiotherapy. However, her α-fetoprotein level rose to 1862 ng/mL within one year and computed tomography revealed a large pelvic tumor suggesting HCC metastasis to the ovary. The subsequent laparotomy revealed one 11-cm left ovarian tumor, one small right ovarian nodule, and numerous peritoneal nodules. Bilateral salpingo-oophorectomy and peritoneal resection of as many nodules as possible were performed. Combination therapy with intravenous 5-fluorouracil plus cisplatin and ramucirumab monotherapy effectively suppressed tumor progression with maintenance of hepatic functional reserve, and she has achieved long-term survival of 11 years, illustrating that multidisciplinary therapy with favorable hepatic functional reserve maintenance can contribute to long-term survival in HCC with extrahepatic spread.

DOI： 10.1007/s12328-021-01434-2

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Endoscopic retrieval of multiple sewing needles by using the tip of a magnetic tube. 国際誌

Shinichi Morita, Kazuyoshi Yagi, Takahiro Hoshi, Satoshi Abe, Shuji Terai

VideoGIE : an official video journal of the American Society for Gastrointestinal Endoscopy 6 ( 5 ) 228 - 230 2021年5月

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