研究者詳細 - 寺井　崇二

論文 - 寺井　崇二

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Risk of delayed bleeding after hot snare polypectomy and endoscopic mucosal resection in the colorectum with continuation of anticoagulants. 国際誌

Takamasa Kobayashi, Manabu Takeuchi, Yuki Hojo, Yui Ishii, Youhei Koseki, Yoko Kobayashi, Motoi Azumi, Yuji Kobayashi, Junji Kohisa, Seiichi Yoshikawa, Shuji Terai

Journal of gastrointestinal oncology 12 ( 4 ) 1518 - 1530 2021年8月

記述言語：英語掲載種別：研究論文（学術雑誌）

Background: Current guidelines recommend the temporary discontinuation of anticoagulants before colonoscopic polypectomy, but the effect of this practice on reducing the risk of delayed bleeding after hot snare polypectomy (HSP) and endoscopic mucosal resection (EMR) remains unclear. Our aim was to assess the impact of anticoagulants on the risk of colorectal delayed bleeding after HSP and EMR, and evaluate the necessity of drug withdrawal. Methods: We reviewed the clinical data of patients with colorectal polyps using antithrombotic drugs who underwent HSP and/or EMR between January 2016 and September 2020 at Nagaoka Red Cross Hospital. After excluding antiplatelet users, patients were classified into those who continued anticoagulants [continuation group: 50 patients (93 lesions)] and those who discontinued anticoagulants [discontinuation group: 87 patients (190 lesions)]. Results: Delayed bleeding occurred in 12 lesions, and there was no significant difference in the incidence rates between the continuation and the discontinuation groups (3.2% vs. 4.7%; P=0.756). Logistic regression analysis showed that continued use of anticoagulants was not a significant risk factor for delayed bleeding compared to anticoagulant discontinuation (odds ratio, 0.670; 95% CI, 0.177-2.537; P=0.556). There was no significant difference in the incidence rate and risk of delayed bleeding, regardless of the length of the anticoagulant withdrawal period. Conclusions: Continued use of anticoagulants, compared to their discontinuation, did not increase the risk of colorectal delayed bleeding after HSP and EMR. Our results suggest that current guideline recommendations for anticoagulant withdrawal before colonoscopic polypectomy may be reconsidered. Trial Registration: UMIN000040449.

DOI： 10.21037/jgo-21-3

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The promise of radiotherapy for hepatocellular carcinoma. 国際誌

Kenya Kamimura, Shuji Terai

Hepatology research : the official journal of the Japan Society of Hepatology 51 ( 8 ) 837 - 838 2021年8月

Pyloric-gland metaplasia may be an origin of cancer and intestinal metaplasia with possible CDX2 expression. 国際誌

Kazuyoshi Yagi, Atsunori Tsuchiya, Satoru Hashimoto, Taisuke Kato, Osamu Onodera, Shuji Terai

Gastroenterology report 9 ( 4 ) 370 - 373 2021年8月

門脈圧亢進症と臓器相関心、肝、肺、腎、脾当院における心不全に伴う肝臓への影響(Cardiac Hepatopathy)の解析

上村博輝, 寺井崇二, 猪又孝文, 三井田秀, 山崎文紗子, 柏村健, 藤木信也, 渡邊雄介, 荒生祥尚, 木村成宏, 阿部寛幸, 薛徹, 坂牧僚, 横尾健

日本門脈圧亢進症学会雑誌 27 ( 3 ) 109 - 109 2021年8月

急性膵炎後の膵仮性嚢胞門脈瘻による広範な門脈血栓症を発症した2例

木村成宏, 林和直, 土屋淳紀, 寺井崇二

日本門脈圧亢進症学会雑誌 27 ( 3 ) 147 - 147 2021年8月

門脈圧亢進症を伴う肝硬変に対する薬物療法の進歩〜QOL、予後の改善を目指して〜肝硬変に伴うサルコペニアに対する難吸収性抗菌薬の有用性についての検討

坂牧僚, 土屋淳紀, 寺井崇二

日本門脈圧亢進症学会雑誌 27 ( 3 ) 106 - 106 2021年8月

潜在性肝性脳症は水素型SIBOに関連し、その治療にはリファキシミンが有効である

坂牧僚, 横山邦彦, 高橋一也, 成瀬匠, 冨永顕太郎, 佐藤裕樹, 上村顕也, 横山純二, 寺井崇二

日本門脈圧亢進症学会雑誌 27 ( 3 ) 176 - 176 2021年8月

BRTO中に出血を来し、NBCAによるEISを併用し治療を完遂した十二指腸静脈瘤の1例

前田悠一郎, 荒生祥尚, 小島雄一, 川田雄三, 渡邉雄介, 薛徹, 阿部寛幸, 坂牧僚, 上村博輝, 横尾健, 土屋淳紀, 上村顕也, 横山純二, 寺井崇二

日本門脈圧亢進症学会雑誌 27 ( 3 ) 134 - 134 2021年8月

Suppression of Noncoding RNAs as Shared Early Genetic Events in Multistep Hepatocarcinogenesis. 国際誌

Takeshi Suda, Seiichi Yoshikawa, Tsutomu Kanefuji, Satoshi Abe, Takahiro Hoshi, Shinichi Morita, Kazuyoshi Yagi, Shuji Terai

Hepatology (Baltimore, Md.) 2021年7月

A genome-wide association study identifying SVEP1 variant as a predictor of response to tolvaptan for cirrhotic ascites. 国際誌

Hideto Kawaratani, Hiromi Sawai, Masaya Onishi, Tomomi Kogiso, Noritomo Shimada, Haruki Uojima, Tomoaki Nakajima, Naoki Matsumoto, Kenichi Ikejima, Toru Ishikawa, Shuji Terai, Hiroyuki Motoyama, Atsumasa Komori, Noboru Hirashima, Satoru Saito, Yuichiro Eguchi, Masanori Nojima, Yosuke Kawai, Masakuni Tateyama, Hitoshi Yoshiji, Yasuhito Tanaka

Liver international : official journal of the International Association for the Study of the Liver 41 ( 12 ) 2944 - 2953 2021年7月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND & AIMS: Tolvaptan, vasopressin V2-receptor antagonist, has been used for patients with difficult-to-treat ascites in Japan. In this study, we conducted a genome-wide association study (GWAS) in the Japanese population to identify genetic variants associated with tolvaptan's efficacy for patients with hepatic ascites. METHODS: From 2014 through 2018, genomic DNA samples were obtained from 550 patients who were treated with tolvaptan. Of those, 80 cases (non-responder; increase of body weight [BW]) and 333 controls (responder; >1.5 kg decrease of BW) were included in the GWAS and replication study. RESULTS: Genome-wide association study showed 5 candidate SNPs around the miR818, KIAA1109, and SVEP1 genes. After validation and performing a replication study, an SNP (rs2991364) located in the SVEP1 gene was found to have a significant genome-wide association (OR = 3.55, P = 2.01 × 10-8 ). Multivariate analyses showed that serum sodium (Na), blood urea nitrogen (BUN) and SVEP1 SNP were significantly associated with the response (OR = 0.92, P = .003; OR = 1.02, P = .02 and OR = 3.98, P = .000008, respectively). Based on a prediction model of logistic regression analysis in a population with the rs2991364 risk allele, the failure probability (=exp (score: 22.234 + BUN*0.077 + Na*-0.179) (1 + exp (score)) was determined for the detection of non-responders. Assuming a cutoff of failure probability at 38.6%, sensitivity was 84.4%, specificity was 70% and AUC was 0.774. CONCLUSION: SVEP1 rs2991364 was identified as the specific SNP for the tolvaptan response. The prediction score (>38.6%) can identify tolvaptan non-responders and help to avoid a lengthy period of futile treatment.

DOI： 10.1111/liv.15022

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Evidence-based clinical practice guidelines for Liver Cirrhosis 2020.

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

Journal of gastroenterology 56 ( 7 ) 593 - 619 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 Japan 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： 10.1007/s00535-021-01788-x

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

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

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