記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVES: Unresectable ampullary cancer (AC) is a rare disease entity. The risk factors for recurrent biliary obstruction (RBO) following endoscopic biliary stenting (EBS) for unresectable AC remain unknown. In this study we aimed to evaluate the cumulative RBO rate and to identify risk factors for RBO following palliative EBS in patients with unresectable AC. METHODS: This multicenter retrospective observational study enrolled consecutive patients with unresectable AC who had undergone palliative EBS between April 2011 and December 2021. The cumulative rate of and risk factors for RBO following palliative EBS were evaluated via multivariate analysis. RESULTS: The study analysis comprised 107 patients with a median age of 84 years (interquartile range 79-88 years). Plastic stents (PSs) and self-expandable metal stents (SEMSs) were placed in 53 and 54 patients, respectively. Functional success was accomplished in 104 (97.2%) patients. Of these, RBO occurred in 62 (59.6%) patients, with obstruction and complete/partial migration occurring in 47 and 15 patients, respectively. The median time to RBO was 190 days. Multivariate analysis showed that PS was associated with a higher rate of RBO compared to SEMS (hazard ratio [HR] 2.48; P < 0.01) and that the presence of common bile duct stones/sludge immediately after EBS was an independent risk factor for RBO (HR 1.99; P = 0.04). CONCLUSIONS: The use of SEMS compared to PS during EBS reduced the time to RBO in patients with unresectable AC. Common bile duct stones/sludge immediately after EBS was a risk factor for RBO.

DOI： 10.1111/1751-2980.13288

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

A 29-year-old woman was admitted to our hospital for examination of obstructive jaundice and an extrahepatic bile duct lesion. Contrast-enhanced computed tomography revealed a 20 mm cystic lesion with a thin external capsule in the common hepatic duct. Cholangioscopy revealed translucent oval masses with capillary vessels attached to the bile duct walls. The surface was mostly smooth yet partially irregular with redness, suggesting that the masses were epithelial neoplasms. Histological findings of cholangioscopy-guided targeted biopsies of the mass showed subepithelial spindle cell proliferation with no atypical epithelium. The patient underwent an extrahepatic bile duct resection to confirm the pathological diagnosis. Immunohistochemistry of surgical specimens revealed that the spindle cells were positive for estrogen and progesterone receptors. Finally, the cystic lesion with ovarian-like stroma was diagnosed as a mucinous cystic neoplasm with low-grade intraepithelial neoplasia. This is the first report of cholangioscopic imaging of a biliary mucinous cyctic neoplasm. Cholangioscopic imaging can be helpful in the differential diagnosis of biliary neoplasms and in the determination of treatment strategies.

DOI： 10.1002/deo2.349

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Pancreaticobiliary maljunction (PBM) is a known risk factor for biliary tract cancer. However, its association with carcinoma of the papilla of Vater (PVca) remains unknown. We report a case with PVca that was thought to be caused by the hyperplasia-dysplasia-carcinoma sequence, which is considered a mechanism underlying PBM-induced biliary tract cancer. CASE PRESENTATION: A 70-year-old woman presented with white stool and had a history of cholecystectomy for the diagnosis of a non-dilated biliary tract with PBM. Esophagogastroduodenoscopy revealed a tumor in the papilla of Vater, and PVca was histologically proven by biopsy. We finally diagnosed her with PVca concurrent with non-biliary dilated PBM (cT1aN0M0, cStage IA, according to the Union for International Cancer Control, 8th edition), and subsequently performed subtotal stomach-preserving pancreaticoduodenectomy. Pathological findings of the resected specimen revealed no adenomas and dysplastic and hyperplastic mucosae in the common channel slightly upstream of the main tumor, suggesting a PBM related carcinogenic pathway with hyperplasia-dysplasia-carcinoma sequence. Immunostaining revealed positivity for CEA. CK7 positivity, CK20 negativity, and MUC2 negativity indicated that this PVca was of the pancreatobiliary type. Genetic mutations were exclusively detected in tumors and not in normal tissues, and bile ducts from formalin-fixed paraffin-embedded samples included mutated-ERBB2 (Mutant allele frequency, 81.95%). Moreover, of the cell-free deoxyribonucleic acid (cfDNA) extracted from liquid biopsy mutated-ERBB2 was considered the circulating-tumor deoxyribonucleic acid (ctDNA) of this tumor. CONCLUSIONS: Herein, we report the first case of PVca with PBM potentially caused by a "hyperplasia-dysplasia-carcinoma sequence" detected using immunostaining and next-generation sequencing. Careful follow-up is required if pancreaticobiliary reflux persists, considering the possible development of PVca.

DOI： 10.1186/s12957-024-03347-z

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Pancreatic tail cancer (Pt-PC) is generally considered resectable when metastasis is absent, but doubts persist in clinical practice due to the variability in local tumor extent. We conducted a multicenter retrospective study to comprehensively identify prognostic factors associated with Pt-PC after resection. METHODS: We enrolled 100 patients that underwent distal pancreatectomy. The optimal combination of factors influencing relapse-free survival (RFS) was determined using the maximum likelihood method (MLM) and corrected Akaike and Bayesian information criteria (AICc and BIC). Prognostic elements were then validated to predict oncological outcomes. RESULTS: Therapeutic interventions included neoadjuvant treatment in 16 patients and concomitant visceral resection (CVR) in 37 patients; 89 patients achieved R0. Median RFS and OS after surgery were 23.1 and 37.1 months, respectively. AICc/BIC were minimized in the model with ASA-PS (≥2), CA19-9 (≥112 U/mL at baseline, non-normalized postoperatively), need for CVR, 6 pathological items (tumor diameter ≥19.5 mm, histology G1, invasion of the anterior pancreatic border, splenic vein invasion, splenic artery invasion, lymph node metastasis), and completed adjuvant treatment (cAT) for RFS. Regarding the predictive value of these 11 factors, area under the curve was 0.842 for 5-year RFS. Multivariate analysis of these 11 factors showed that predictors of RFS include CVR (hazard ratio, 2.13; 95 % confidence interval, 1.08-4.19; p = 0.028) and cAT (0.38, 0.19-0.76; p = 0.006). CONCLUSIONS: The MLM identified certain Pt-PC cases warranting consideration beyond resectable during clinical management. Particular attention should be paid to conditions requiring CVR, even though immortal time bias remains unresolved with adjuvant treatment.

DOI： 10.1016/j.pan.2023.12.004

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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-2177-3793

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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-1981-6880

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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: The efficacy of the suprapapillary placement of inside plastic stents (iPSs) for unresectable malignant hilar biliary obstructions (MHOs) is unknown compared with that of uncovered inside metal stents (iMSs). This randomized controlled trial was designed to evaluate the outcomes of endoscopic placement of these stents for unresectable MHOs. METHODS: This open-label, randomized study was conducted at 12 Japanese institutions. The enrolled patients with unresectable MHOs were allocated to iPS and iMS groups. The primary outcome was defined as the time to recurrent biliary obstruction in patients for whom the intervention was both technically and clinically successful. RESULTS: Among 87 enrollments, 38 patients in the iPS group and 46 patients in the iMS group were analyzed. Technical success rates were 100% (38 of 38) and 96.6% (44 of 46), respectively (P = 1.00). After transferring 1 unsuccessful iMS-group patient to the iPS group (since iPSs were deployed), the clinical success rates were 90.0% (35 of 39) for the iPS group and 88.9% (40 of 45) for the iMS group from a per-protocol analysis (P = 1.00). Among the patients with clinical success, the median times to recurrent biliary obstruction were 250 (95% confidence interval, 85-415) and 361 (95% confidence interval, 107-615) days (log-rank test, P = .34). No differences were detected in rates of adverse events. CONCLUSIONS: This Phase II randomized trial did not show any statistically significant difference in stent patency between suprapapillary plastic versus metal stents. Considering the potential advantages of plastic stents for malignant hilar obstruction, these findings suggest that suprapapillary plastic stents could be a viable alternative to metal stents for this condition.

DOI： 10.1016/j.gie.2023.03.007

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Patients with various cancers benefit from immune checkpoint inhibitors. However, immune checkpoint inhibitor-induced adverse events have also been reported, such as colitis. Prednisolone is the first-line treatment for immune-related adverse events, but second-line therapy for patients refractory to steroids has not been established. Furthermore, the inflammatory cytokine expression pattern in the intestinal mucosa of patients with steroid-refractory immune-related colitis remains unclear. We present the case of a 48-year-old man diagnosed with immune-related colitis and pancreatitis induced by pembrolizumab for advanced lung cancer. First, we administered 50 mg/day of prednisolone, and the patient's abdominal symptoms improved. However, the pancreatic enzyme levels did not return to normal. Furthermore, the patient's diarrhea worsened and hematochezia appeared at a 40 mg/day prednisolone dose. A mucosal cytokine analysis identified a low interleukin-10 messenger RNA level, which has been associated with a poor response to prednisolone. Thus, we administered 5 mg/kg of infliximab; the patient's diarrhea and hematochezia immediately improved, and the pancreatic enzyme levels returned to normal. Infliximab was administered three times every 2 weeks. After, the patient's colitis and pancreatitis did not recur. To our knowledge, this is the first report demonstrating the effectiveness of infliximab for immune-related colitis and pancreatitis.

DOI： 10.1007/s12328-022-01731-4

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Immunoglobulin G4-related disease (IgG4-RD) is a systemic inflammatory disease characterized by the infiltration of IgG4-positive plasma cells and fibrosis in organs throughout the body. IgG4-RD involvement in the gastrointestinal (GI) tract (IgG4-related GI disease; IgG4-GID) is rare, and the disease concept remains unclear. Generally, IgG4-GID has been reported with morphological changes, including ulcers, strictures, and submucosal tumors. Here, we report a case of IgG4-GID with persistent diarrhea and abdominal pain in which typical endoscopic findings were absent. This case suggests the unidentified clinical features of IgG4-GID.

DOI： 10.1016/j.gastha.2023.07.009

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Eosinophilic cholangiopathy (EC) presents with thickening and stenosis of the bile duct wall that is histologically characterized by eosinophil infiltration. The diagnosis is often difficult. We herein report a patient who had been followed up with a diagnosis of primary sclerosing cholangitis but had a final diagnosis of EC based on eosinophilia, histological findings of bile duct and liver biopsy specimens, and a review of a previous surgical specimen of the gallbladder. Antigen tests, isolation from her house, and accidental re-exposure to the antigen revealed that the causative antigen was the mite Dermatophagoides pteronyssinus.

DOI： 10.2169/internalmedicine.8323-21

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Intrahepatic mucinous cholangiocarcinoma (IHMC) is rare and behaves notoriously; however, the details of the clinicopathological characteristics of IHMC remain unknown. A 70-year-old man was admitted for examination of the hepatic mass in the S1 segment. He underwent extended left hepatic lobectomy. Histopathological evaluation demonstrated mixed papillary carcinoma that comprised well to moderately differentiated tubular adenocarcinoma and signet-ring cell carcinoma with large amounts of mucus lakes. Tumor was relapsed 9 months after surgery. Although he received chemotherapy with the combination of gemcitabine and cisplatin, he had renal failure and discontinued the chemotherapy. He received palliative radiotherapy for metastasis in the cervical spine. Then, the patient treated with S-1, however, he died 16 months after the initial diagnosis. The autopsy findings showed multiple nodules in the lungs, pleura, kidneys, adrenal glands, stomach, pancreas, and lymph nodes. Histological examination revealed that all nodules were IHMC. Next-generation sequencing revealed that somatic mutations in ADGRB3, TAF1L and EPHA3 may affect carcinogenesis, and those in TAF1, EPHA3, PIK3C2B, FN1, ERBB3, BRIP1, SYNE1 and TGFBR2 may affect metastasis. Molecular carcinogenesis of IHMC may be distinct from that of ordinary cholangiocarcinoma. Further studies are needed to elucidate the genetic mutations and their functions in IHMC.

DOI： 10.1007/s12328-022-01649-x

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Remitting seronegative symmetrical synovitis with pitting edema (RS3PE) syndrome is characterized by bilateral synovitis and marked pitting edema of the hands and/or feet. Despite the unknown etiology of RS3PE, several reports have described the putative association of this disease with malignant tumors. We herein report the findings of a 76-year-old man with RS3PE syndrome who developed hepatocellular carcinoma 3 years after achieving clinical remission of RS3PE using corticosteroid treatment; high vascular endothelial growth factor and tumor necrosis factor-alpha levels were considered to have contributed to carcinogenesis in this patient. The sequence of clinical events in this case strongly suggests that careful follow-up, even after clinical remission, is necessary for patients with RS3PE syndrome whose malignancy is not confirmed at diagnosis.

DOI： 10.31662/jmaj.2022-0066

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Thus far, there have been limited case reports on immunoglobulin G4-related autoimmune hepatitis (IgG4-AIH), and its clinical features have not been elucidated. We herein report a rare case of IgG4-AIH simultaneously concomitant with autoimmune pancreatitis (AIP). A 73-year-old female was admitted to our hospital for further investigation of elevated levels of liver transaminase and pancreatic enzymes. Her serological tests showed a high antinuclear antibody titer, and elevated IgG and IgG4 levels. Liver biopsy revealed interface hepatitis and bridging necrosis with IgG4-positive lymphoplasmacytic infiltration in the portal area. Moreover, contrast-enhanced computed tomography (CECT) showed pancreatic tail enlargement, and magnetic resonance cholangiopancreatography showed skipped narrowing of the main pancreatic duct in the pancreatic tail. Endoscopic ultrasonography-fine needle aspiration specimens showed no malignant cells. Based on these results, we diagnosed her with IgG4-AIH simultaneously concomitant with probable type 1 AIP. She was started on prednisolone (PSL) at 35 mg/d, and her symptoms and liver transaminase levels improved. One month after starting treatment, CECT showed improvement of pancreatic tail enlargement. She is maintained on 5 mg PSL/d and has been in remission for two years.

DOI： 10.1007/s12328-021-01509-0

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

RATIONALE: Mixed neuroendocrine non-neuroendocrine neoplasm (MiNEN) is a rare tumor. MiNEN of the gallbladder (GB) with pancreaticobiliary maljunction (PMJ) is extremely rare. The origin of MiNEN of the GB remains unknown; the biliary tract normally lacks neuroendocrine cells. MiNEN of the GB has a poor prognosis; because of its rarity, no treatment or management guidelines have been established yet. PATIENT CONCERNS: A 47-year-old male presenting with right hypochondrial pain and malaise for 3 months was referred to our hospital for further management. DIAGNOSIS: The neuron-specific enolase level was increased. Contrast-enhanced computed tomography revealed a mass of 70 mm in size with unclear boundaries in the liver. The GB was surrounded by this mass, narrowing the lumen of the GB. Many swollen lymph nodes were observed in the hepatoduodenal ligament. Endoscopic retrograde cholangiopancreatography revealed a PMJ with a non-dilated biliary duct. A percutaneous biopsy was performed on the liver mass, and the pathological findings were neuroendocrine carcinoma (NEC) (small cell type). We diagnosed a NEC of the GB, T3N1M0, stage IIIB (Union for International Cancer Control, 7th edition). INTERVENTIONS: Because of advanced lymph node metastasis, we considered this tumor difficult to cure solely by surgical intervention. After initial chemotherapy consisting of cisplatin and irinotecan, a marked reduction in both tumor and lymph node sizes enabled conversion surgery. The pathological diagnosis of the resected tumor was MiNEN consisting of NEC and adenocarcinoma. The primary lesion was the adenocarcinoma occupying the luminal side of the GB. As a postsurgical treatment, the patient received additional irradiation therapy to the common hepatic duct and liver stump because of positive surgical margins. OUTCOMES: At 13 months postoperatively, computed tomography findings revealed the appearance of a hypervascular liver tumor, and laboratory data showed increased serum neuron-specific enolase levels. Chemotherapy was unsuccessful, leading to the death of the patient 36 months from the date of diagnosis. LESSONS: There are several reports on the development of MiNEN of the GB. In our case, a PMJ-related adenocarcinoma of the GB transdifferentiated into NEC. Further accumulation of cases is necessary to establish a treatment strategy for MiNEN of the GB.

DOI： 10.1097/MD.0000000000027336

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

The effectiveness of azathioprine (AZA) in preventing relapse and maintaining autoimmune pancreatitis (AIP) remission has been reported; however, most of these studies are case series with no randomized control trials available in the literature. Therefore, this study performed a systematic review and meta-analysis of the existing literature on this subject to determine the clinical efficacy of AZA as maintenance therapy for AIP patients. A systematic search was performed to identify studies on the clinical efficacy of AZA as maintenance therapy in AIP patients. The crude multiple relapse rate was estimated to assess the ability of AZA to control relapses in AIP. Pooled estimates were obtained using a random-effects model with the DerSimonian-Laird method. We identified AIP patients who did not respond to initial steroid treatment, experienced steroid weaning failure, or those who relapsed during remission as refractory cases. After reviewing the studies, ten articles fulfilled the inclusion criteria and were selected for meta-analysis. Of all 4504 patients, 3534 patients were treated with steroids, and 346 patients were treated with AZA for relapsed AIP. In this meta-analysis, 14/73 (19.2%) patients receiving AZA for refractory AIP relapsed. Meanwhile, 14/47 (29.8%) patients without AZA experienced relapse. The integrated odds ratio for relapse risk in patients receiving AZA was estimated to be 0.52 (p = 0.15). This systematic review and meta-analysis demonstrated the efficacy of AZA in preventing relapse of AIP, which supports the use of AZA as a maintenance treatment in patients with AIP who relapse upon withdrawal of steroid therapy.

DOI： 10.1007/s00535-021-01817-9

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

We demonstrate a case, in which endoscopic ultrasonography-guided fine-needle biopsy (EUS-FNB) was useful for determining the diagnosis of lesions of retroperitoneal fibrosis. In our case, accessing the retroperitoneal lesions by conventional percutaneous biopsy procedures was not feasible due to the difficulty of avoiding the inferior vena cava and ureter. We believe that our case demonstrates a unique approach for performing histological analysis in a challenging case.

DOI： 10.1002/jgh3.12431

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

A 60-year-old man was admitted for investigation of a mediastinal cystic lesion. During endoscopic retrograde pancreatography, the contrast medium leaked from the head of the main pancreatic duct, and the cystic fluid collected with endoscopic ultrasonography (EUS) -guided aspiration showed high levels of pancreatic enzymes. Therefore, we diagnosed mediastinal pancreatic pseudocyst. The pseudocyst shrank as a result of EUS-guided drainage, and an endoscopic nasopancreatic drainage tube was then placed to close the fistula of the pancreatic duct. This case suggests that endoscopic procedures could be useful for the diagnosis and treatment of mediastinal pancreatic pseudocyst. We review 48 case reports of mediastinal pancreatic pseudocyst and discuss the usefulness of endoscopic procedures for diagnosis and treatment.

DOI： 10.11405/nisshoshi.118.578

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Arteriovenous malformation (AVM) is defined as a disease that causes blood flow abnormality due to anastomoses of the arteries and veins. AVM can occur in any gastrointestinal tract, but pancreatic AVM (P-AVM) is very rare. Previous reports demonstrated that contrast-enhanced CT (CECT) typically showed abnormal vascular network in pancreas. We present a 58-year old man with a history of acute pancreatitis. He was referred to our hospital for examination of pancreatic mass. CECT showed a round-shaped hypervascular lesion with a diameter of 8 mm in the head of the pancreas. Selective angiography showed vascular network and early visualization of superior mesenteric vein. We finally diagnosed this case as P-AVM. He underwent duodenum preserving pancreatic head resection. Histological findings confirmed the preoperative diagnosis of P-AVM.

DOI： 10.1002/jgh3.12343

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: To elucidate predictive factors for malignant main duct type IPMN (MD-IPMN). METHODS: All 29 subjects had mural nodules (MNs) in the main pancreatic duct (MPD) on preoperative endoscopic ultrasonography and underwent surgery (19, malignant; 10, benign). Possible predictive factors for malignancy such as background, imaging, and histological factors including histological subtype (HS), were evaluated. RESULTS: Multivariate analysis revealed an MPD diameter of ≥12 mm (p = 0.042) and non-gastric type (p = 0.001) to be the statistically significant predictive factors for malignancy. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy to detect malignancy by using "an MPD diameter of ≥12 mm and/or non-gastric type" were 95%, 70%, 86%, 88%, and 86%, respectively. In 7 subjects in whom HS was preoperatively evaluated using pancreatic specimens obtained before surgery, the agreement rate of the preoperative HS with definitive HS evaluated using resected specimens was 86%. CONCLUSIONS: For MD-IPMNs with MNs, "an MPD diameter of ≥12 mm and/or non-gastric type" are indicated for surgery. On the other hand, careful surveillance without immediate pancreatic surgery may be an option for MD-IPMNs showing both an MPD diameter of <12 mm and gastric type.

DOI： 10.1016/j.pan.2019.01.005

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

RATIONALE: Immunoglobulin (Ig) G4-related disease (IgG4-RD) is a chronic inflammatory disorder characterized by high levels of serum IgG4, swollen organs with fibrosis and abundant infiltration of IgG4-positive plasmacytes. PATIENT CONCERNS: An 82-year-old male visited our hospital for an evaluation of a pancreatic enlargement and a bilateral submandibular adenopathy. Further investigation revealed elevation of serum IgG4 and bilateral lacrimal submandibular adenopathy. We diagnosed him with IgG4-related disease (IgG4-RD) and started administration of corticosteroid (CS) therapy. Both pancreatic enlargement and adenopathy rapidly improved; however, there was a new occurrence of diffuse wall thickening of the gallbladder during CS treatment. DIAGNOSIS: Radiological examination revealed diffuse wall thickening of the gallbladder, and its inner layer was smooth and homogenous. These findings suggested an inflammatory change, but the possibility of malignancy could not be excluded. INTERVENTIONS: The patient underwent laparoscopic cholecystectomy for a pathological diagnosis. OUTCOMES: Histological examination revealed a transmural infiltration of IgG4 positive plasma cells and dense fibrosis. The patient was pathologically diagnosed with IgG4 related cholecystitis presenting as an ectopic relapse. LESSONS: There are 2 major types of IgG4-related cholecystitis, a diffuse wall thickening type and a mass formation type. It is sometimes difficult to differentiate IgG4-related cholecystitis with gallbladder cancer.Corticosteroid (CS) is effective for induction of remission; however, we sometimes encounter disease relapse after reduction of CS dose. We should be mindful that some patients may relapse with new organ involvements even if the primary site and serum IgG4 level are well controlled.

DOI： 10.1097/MD.0000000000013868

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

A 62-year-old man with a chief complaint of dysphagia visited our hospital. Enhanced computed tomography showed the tumor near the duodenal wall and lymphadenopathy in the left supraclavicular fossa and para-aortic lymph node. Upper gastrointestinal endoscopy showed an ulcer accompanied with a fistula in the anterior wall of duodenal bulb, suggesting that the tumor penetrated into duodenal wall. Biopsy from the lymph node in the left supraclavicular fossa indicated diffuse large B-cell lymphoma. Although chemotherapy was planned, massive arterial bleeding occurred from the part of duodenal penetration. Endoscopic hemostasis was unsuccessfully performed. Therefore, we performed transcathether arterial embolization for hemostasis. After the procedure, the patient received six cycles of chemotherapy, and he achieved complete response. He has been alive 5 years without recurrence. There were many cases of gastrointestinal bleeding from primary gastrointestinal lymphomas, while there were few cases with nodal involvement by malignant lymphoma resulting in bleeding from gastrointestinal tract. We herein report a case of duodenal bleeding by nodal involvement of diffuse large B-cell lymphoma with review of literature.

DOI： 10.1007/s12328-018-0827-7

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Objective Patients with perihilar malignancy often develop recurrence of infectious cholangitis, which makes further transpapillary intervention extremely difficult. As endoscopic ultrasound (EUS)-guided biliary drainage (EUS-BD) of an intrahepatic bile duct is a possible option for additional intervention, the aim of this study was to estimate the feasibility of such intervention. Methods and Patients Patients who had undergone EUS-BD after further transpapillary intervention was deemed impossible or ineffective were investigated in this study. Those who had not received previous interventions via the papilla were excluded. Procedure-related adverse events, clinical efficacy, and time to recurrence of jaundice or infectious cholangitis transthyretin (TTR) were evaluated. Results Seven patients were eligible for the study between 2007 and 2016 (7 men; mean age, 77 years; 4 with perihilar cholangiocarcinoma and 3 with intrahepatic cholangiocarcinoma). No procedure-related adverse events were observed. EUS-BD was clinically effective and enabled hospital discharge in 4 patients (57%). The TTR in these 4 clinically effective patients was 43, 105, 118, and 147 days after the procedure (median, 112 days). Conclusion EUS-BD was found to be safe and often effective in patients in whom additional transpapillary intervention had become difficult, although its efficacy was limited to a short period.

DOI： 10.2169/internalmedicine.9001-17

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

AIM: To evaluate the efficacy of a newly developed dilator for endoscopic ultrasound (EUS)-guided drainage (ES Dilator). METHODS: Fourteen consecutive patients who had undergone EUS-guided choledochoduodenostomy (EUS-CDS) with the ES Dilator were identified from a prospectively maintained database and enrolled in the study group. Fourteen other patients who had undergone EUS-CDS without the dilator just prior to its introduction were analyzed as the control group. A historical cohort study was carried out comparing the two groups. The main outcome measurement was the procedure time. The technical success rate and early AE rate were also compared between the two groups. RESULTS: There were no significant differences in age, sex and etiology of biliary obstruction. The utilization rate of a plastic stent was higher in the control group (36% vs 0%). The technical success rate was 100% in both groups. The mean procedure time was significantly shorter in the study group than in the control group (27 ± 7 min vs 44 ± 26 min, P = 0.026). Additionally, there were no patients who required more than 40 min for the procedure in the study group. Early adverse events occurred in 29% (4/14) of the control group whereas none in the study group. The adverse events in all 4 patients was bile peritonitis, including pan-peritonitis in one patient. All patients recovered with conservative treatment by medication. CONCLUSION: The newly developed dilator was found to be useful for shortening procedure time and would prevent adverse events related to bile leakage in EUS-CDS.

DOI： 10.4253/wjge.v9.i7.304

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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: The aim of this study was to elucidate the efficacy of pancreatic juice cytology with the cell-block method (CB-PJC) for the determination of surgery in patients with branch duct intraductal papillary mucinous neoplasm (BD-IPMN). METHODS: In 138 patients with BD-IPMN from whom pancreatic juice was collected under ERCP for CB-PJC, we retrospectively evaluated the following: (1) the rate of successfully evaluated CB-PJC; (2) the ability of CB-PJC to diagnose malignancy and to identify pathologic subtypes in resected BD-IPMNs; (3) the rate of development into invasive cancer and progression of BD-IPMNs in patients with BD-IPMNs diagnosed as benignancy by CB-PJC; and (4) post-ERCP adverse events. RESULTS: (1) The success rate of CB-PJC was 89.9%. (2) The sensitivity and specificity of CB-PJC for preoperative diagnosis of malignancy were 50% and 100%, respectively, with only hematoxylin and eosin staining, whereas they were 79% and 100%, respectively, by adding immunohistologic staining. The agreement rate of the preoperative subtypes by CB-PJC with the subtypes of resected specimens was 93%. (3) The onset of invasive cancer was not detected at all on imaging studies, whereas the progression of IPMN was detected in 14 patients. Multivariate analysis revealed the risk factor of progression to be non-gastric type. The cumulative 5-year progression rate in this group was 89%. (4) Post-ERCP pancreatitis developed in 13 patients (7.7%). CONCLUSIONS: The diagnostic efficacy of preoperative CB-PJC for malignant BD-IPMN was excellent. The results may suggest the feasibility of applying preoperative subtyping by CB-PJC for decisions as to whether surgery is indicated.

DOI： 10.1016/j.gie.2016.10.017

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

An 88-year-old man who had been suffering from repetitive fever and abdominal pain every few months for several years was diagnosed with localized acute cholangitis and referred to our center. Various examinations, including computed tomography (CT) and endoscopic ultrasonography (EUS), revealed that the accessary hepatic duct was obstructed by clips used during laparoscopic cholecystectomy performed 7 years previously. It was not possible to approach the completely isolated duct via the transpapillary route. After obtaining fully informed consent, EUS-guided drainage of the occluded duct through the duodenal wall was performed with a self-expanding metal stent. No adverse events related to the procedure were observed, and his symptoms disappeared by the next day. EUS-guided drainage represents a therapeutic option in patients with an accessory hepatic duct, which is iatrogenically isolated by surgical clips.

DOI： 10.11405/nisshoshi.114.683

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

We herein report a 68-year-old man with branch duct intraductal papillary mucinous neoplasms of the pancreas (BD-IPMNs) involving type 1 localized autoimmune pancreatitis (AIP) with normal serum IgG4 levels. Although he was referred to our medical center due to suspicion of pancreatic cancer concomitant with BD-IPMNs, endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) revealed a mass suspected of being pancreatic cancer to be type 1 AIP. Steroid administration notably reduced the mass. Although the clinical diagnosis of pancreatic masses in patients with IPMN can be occasionally challenging, performing a pathological examination by EUS-FNA may prevent unnecessary pancreatic surgery in cases of possible AIP.

DOI： 10.2169/internalmedicine.56.8017

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

A 58-year-old woman with a three-year progressive history of chronic arthritis, had become disabled due to general malaise and fever. Her laboratory data revealed hyperuricemia and elevated levels of C-reactive protein. Neither rheumatoid factor nor anti-citrullinated peptide antibodies were present. We diagnosed her with tophaceous gout with uric crystalline revealed by the arthrocentesis of the elbow. (99m)Tc scintigraphy also disclosed a significant uptake in the cervical spine. The CT of the patient's cervical spine revealed significant bone erosion and destruction. We diagnosed the cervical involvement of gout based on the exclusion of infections and sarcoidosis. Rheumatologists should be aware of this rare association.

PubMed

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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  

医中誌

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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  

医中誌

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記述言語：英語   出版者・発行元：(一社)日本消化器内視鏡学会  

医中誌

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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-北海道支部  

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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-北海道支部  

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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-北海道支部  

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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-北海道支部  

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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-北海道支部  

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記述言語：日本語   出版者・発行元：(一社)日本内科学会  

医中誌

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本内科学会  

医中誌

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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  

医中誌

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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  

医中誌

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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  

医中誌

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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  

医中誌

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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  

医中誌

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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  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本臨床免疫学会  

医中誌

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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-北海道支部  

医中誌

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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-北海道支部  

医中誌

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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  

医中誌

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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  

医中誌

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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  

医中誌

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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  

医中誌

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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  

医中誌

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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  

医中誌

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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  

医中誌

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記述言語：日本語   出版者・発行元：(公社)日本超音波医学会  

医中誌

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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-北海道支部  

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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-北海道支部  

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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-北海道支部  

医中誌

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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-北海道支部  

医中誌

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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  

医中誌

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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  

医中誌

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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-北海道支部  

医中誌

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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-北海道支部  

医中誌

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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-北海道支部  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本内科学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本内科学会  

医中誌

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記述言語：英語   出版者・発行元：(一社)日本癌治療学会  

医中誌

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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-北海道支部  

医中誌

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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-北海道支部  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本胆道学会  

医中誌

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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-北海道支部  

医中誌

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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-北海道支部  

医中誌

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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  

医中誌

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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  

医中誌

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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  

医中誌

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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-北海道支部  

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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-北海道支部  

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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-北海道支部  

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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-北海道支部  

医中誌

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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-北海道支部  

医中誌

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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-北海道支部  

医中誌

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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-北海道支部  

医中誌

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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-北海道支部  

医中誌

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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  

医中誌

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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  

医中誌

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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  

医中誌

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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  

医中誌

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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-北海道支部  

医中誌

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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-北海道支部  

医中誌

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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-北海道支部  

医中誌

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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-北海道支部  

医中誌

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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-北海道支部  

医中誌

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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-北海道支部  

医中誌

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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-北海道支部  

医中誌

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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-北海道支部  

医中誌

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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  

医中誌

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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  

その他リンク:： https://search.jamas.or.jp/default/link?pub_year=2021&ichushi_jid=J01118&link_issn=&doc_id=20210617370011&doc_link_id=1390851264574879232&url=https%3A%2F%2Fcir.nii.ac.jp%2Fcrid%2F1390851264574879232&type=CiNii&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00003_3.gif

医中誌

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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-北海道支部  

医中誌

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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-北海道支部  

医中誌

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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-北海道支部  

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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-北海道支部  

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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-北海道支部  

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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-北海道支部  

医中誌

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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  

医中誌

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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  

医中誌

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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  

医中誌

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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  

医中誌

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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  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本癌治療学会  

医中誌

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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  

医中誌

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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-北海道支部  

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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-北海道支部  

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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-北海道支部  

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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-北海道支部  

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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-北海道支部  

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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-北海道支部  

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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-北海道支部  

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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-北海道支部  

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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-北海道支部  

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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-北海道支部  

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記述言語：日本語   出版者・発行元：(一社)日本胆道学会  

医中誌

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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  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本胆道学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本胆道学会  

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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)日本膵臓学会  

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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)日本膵臓学会  

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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-北海道支部  

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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-北海道支部  

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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-北海道支部  

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記述言語：英語   出版者・発行元：(一社)日本癌治療学会  

医中誌

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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-北海道支部  

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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-北海道支部  

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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-北海道支部  

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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)日本膵臓学会  

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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-北海道支部  

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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-北海道支部  

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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  

医中誌

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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  

医中誌

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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  

医中誌

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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  

医中誌

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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  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本門脈圧亢進症学会  

医中誌

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記述言語：日本語   出版者・発行元：医学図書出版(株)  

医中誌

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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  

医中誌

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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  

医中誌

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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  

その他リンク:： https://search.jamas.or.jp/default/link?pub_year=2017&ichushi_jid=J01118&link_issn=&doc_id=20170418100008&doc_link_id=1390001206402746752&url=https%3A%2F%2Fcir.nii.ac.jp%2Fcrid%2F1390001206402746752&type=CiNii&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00003_3.gif

医中誌

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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  

医中誌

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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  

医中誌

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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  

医中誌

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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  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本胆道学会  

その他リンク:： https://search.jamas.or.jp/default/link?pub_year=2017&ichushi_jid=J02149&link_issn=&doc_id=20170411180003&doc_link_id=%2Fdw1tando%2F2017%2F003101%2F014%2F0062-0068%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fdw1tando%2F2017%2F003101%2F014%2F0062-0068%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

医中誌

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記述言語：日本語   出版者・発行元：医学図書出版(株)  

医中誌

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記述言語：日本語   出版者・発行元：医学図書出版(株)  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本胆道学会  

医中誌

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記述言語：日本語   出版者・発行元：医学図書出版(株)  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本胆道学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本胆道学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本胆道学会  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本病理学会  

医中誌

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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  

医中誌

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記述言語：日本語   出版者・発行元：(一社)日本内科学会  

医中誌

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記述言語：日本語   出版者・発行元：(株)医学書院  

その他リンク:： https://search.jamas.or.jp/default/link?pub_year=2016&ichushi_jid=J01539&link_issn=&doc_id=20160119390008&doc_link_id=10.11477%2Fmf.1407211042&url=https%3A%2F%2Fdoi.org%2F10.11477%2Fmf.1407211042&type=%E5%8C%BB%E6%9B%B8.jp_%E3%82%AA%E3%83%BC%E3%83%AB%E3%82%A2%E3%82%AF%E3%82%BB%E3%82%B9&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

医中誌

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記述言語：日本語   出版者・発行元：(株)アークメディア  

医中誌

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記述言語：日本語   出版者・発行元：函館五稜郭病院  

医中誌

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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  

医中誌

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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  

医中誌

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記述言語：日本語   出版者・発行元：道南医学会  

医中誌

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記述言語：日本語   出版者・発行元：道南医学会  

医中誌

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記述言語：日本語   出版者・発行元：道南医学会  

医中誌

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記述言語：日本語   出版者・発行元：道南医学会  

医中誌

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記述言語：日本語   出版者・発行元：道南医学会  

医中誌

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記述言語：日本語   出版者・発行元：函館五稜郭病院  

医中誌

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記述言語：日本語   出版者・発行元：道南医学会  

医中誌

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記述言語：日本語   出版者・発行元：道南医学会  

医中誌

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記述言語：日本語   出版者・発行元：道南医学会  

医中誌

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記述言語：日本語   出版者・発行元：道南医学会  

医中誌

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記述言語：日本語   出版者・発行元：道南医学会  

医中誌

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記述言語：日本語   出版者・発行元：市立室蘭総合病院  

その他リンク:： https://search.jamas.or.jp/default/link?pub_year=2011&ichushi_jid=J00552&link_issn=&doc_id=20120110370001&doc_link_id=%2Fer8muran%2F2011%2F003601%2F002%2F0005-0009%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fer8muran%2F2011%2F003601%2F002%2F0005-0009%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

医中誌

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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  

医中誌

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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  

医中誌

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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  

医中誌

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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  

医中誌

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記述言語：日本語   出版者・発行元：市立室蘭総合病院  

医中誌

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記述言語：日本語   出版者・発行元：市立室蘭総合病院  

その他リンク:： https://search.jamas.or.jp/default/link?pub_year=2010&ichushi_jid=J00552&link_issn=&doc_id=20101221390001&doc_link_id=%2Fer8muran%2F2010%2F003501%2F002%2F0005-0009%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fer8muran%2F2010%2F003501%2F002%2F0005-0009%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

医中誌

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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  

医中誌

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