研究者詳細 - 辻　喜久

論文 - 辻　喜久

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上野真行, 辻喜久, 宇座徳光, 妹尾浩

胆膵の病態生理 ( 日本胆膵病態・生理研究会 ) 38 ( 1 ) 1 - 6 2022年06月 [査読有り]

膵疾患患者は一般人口よりもサルコペニアの有病率が高い。外分泌機能障害や食事摂取量の低下がその一因と考えられる。膵癌領域ではサルコペニアが予後や術後合併症リスクと関連することが明らかになった。サルコペニアの定義と評価方法を概説した。膵癌と骨格筋量との関連を切除例と非切除例に分けて示した。急性膵炎は骨格筋量喪失の原因となる可能性があり、再発を繰り返して慢性膵炎に移行する例では骨格筋量の維持が重要である。

J-GLOBAL

Blue Foreign Body in the Esophagus.

Ryosuke Tomiyama, Tomoko Ichiki, Yoshihisa Tsuji

Gastroenterology 162 ( 7 ) e14-e15 2022年06月 [査読有り] [国際誌]

DOI PubMed

Two Types of Immune Checkpoint Inhibitor-related Pancreatitis.

Tomoko Ichiki, Yasuki Hori, Yoshihisa Tsuji

Internal medicine (Tokyo, Japan) 61 ( 10 ) 1477 - 1478 2022年05月 [査読有り] [国内誌]

DOI PubMed

Estimated tumor blood flow as a predictive imaging indicator of therapeutic response in pancreatic ductal adenocarcinoma: use of three-phase contrast-enhanced computed tomography.

Hiromitsu Maehira, Yoshihisa Tsuji, Hiroya Iida, Haruki Mori, Nobuhito Nitta, Takeru Maekawa, Sachiko Kaida, Toru Miyake, Masaji Tani

International journal of clinical oncology 27 ( 2 ) 373 - 382 2022年02月 [査読有り] [国内誌]

BACKGROUND: Preoperative chemotherapy or chemoradiotherapy is a common strategy for treating pancreatic ductal adenocarcinoma (PDAC). This study aimed to assess the association between the therapeutic response in PDAC and tumor blood circulation. METHODS: The medical records of patients who underwent chemotherapy or chemoradiotherapy prior to pancreatectomy for PDAC were reviewed. Of these, patient data that included three-phase contrast-enhanced computed tomography (CECT) findings before treatments were used in this study. We evaluated the estimated tumor blood flow (eTBF) using CECT. According to the therapeutic histopathological response defined by the Evans classification, patients were divided into poor (grade I/IIa) and good (grade IIb/III/IV) responder groups. The variables, including eTBF, were compared between the two groups. RESULTS: Thirty patients were enrolled in this study. Of these, 13 (43.3%) (grade IIB/III/IV: 8/4/1 patients) were categorized into the good responder group and 17 patients (56.7%) (grade I/IIA: 4/13 patients) were categorized into the poor responder group. eTBF was significantly higher in the good responder group (0.39 s-1 vs. 0.32 s-1, p = 0.007). An eTBF ≥ 0.36 s-1 was found to be an independent predictive factor for the destruction of over 50% of tumor cells (p = 0.036; odds ratio, 9.71; 95% confidence interval, 1.16-81.30). CONCLUSIONS: eTBF can be used to predict the therapeutic histopathological response in PDAC prior to treatment.

DOI PubMed

Larger Volume and Higher Fat Content of the Pancreatic Head Are Predictive Factors for Postendoscopic Retrograde Cholangiopancreatography Pancreatitis.

SHINTANI, Shuhei, INATOMI, Osamu, BAMBA, Shigeki, TAKEDA, Yoshiya, FUJIMOTO, Takehide, OTA, Shinichi, TSUJI, Yoshihisa, KUTSUMI, Hiromu, WATANABE, Yoshiyuki, ANDOH, Akira, 新谷, 修平, 稲富, 理, 馬場, 重樹, 竹田, 善哉, 藤本, 剛英, 大田, 信一, 辻, 喜久, 久津見, 弘, 渡邉, 嘉之, 安藤, 朗

Pancreas ( Lippincott Williams and Wilkins ) 51 ( 1 ) 28 - 34 2022年01月 [査読有り] [国際誌]

type:Journal Article Objectives:Acute pancreatitis is the most critical complication of endoscopic retrograde cholangiopancreatography (ERCP). In this study, we investigated the association between the volume/fat content of the pancreatic head and the incidence of post-ERCP pancreatitis (PEP). Methods:We retrospectively enrolled 157 patients who underwent ERCP. The volume and fat content of the pancreas were calculated by multislice computed tomographic imaging by using a volume analyzer. Multivariate analysis was performed to identify risk factors for PEP. Results:The mean volumes of the whole pancreas and pancreatic head were significantly larger, and the fat content of the pancreatic head was significantly higher in the PEP group (P < 0.01). There were no significant differences in the mean volume and fat content of the pancreatic body and tail in the PEP group. Multivariate analysis revealed that the pancreatic guidewire placement (odds ratio [OR], 12.4; P < 0.01), pancreatic head volume (OR, 5.3; P < 0.01), and the pancreatic head fat content (OR, 4.8; P < 0.01) were independent risk factors for PEP. Conclusions:The pancreatic head volume and fat content were independent predicting factors of PEP. Quantitative assessment of the pancreas may contribute to the prediction of PEP onset.

DOI PubMed

感染性walled-off necrosisの上腸間膜静脈内への穿破に対し、保存的治療で救命しえた1例

上西陽介, 上野真行, 辻喜久, 上山伸也, 小山貴, 池田有希, 戸川文子, 羽田綾子, 眞野俊史, 石田悦嗣, 山本博, 水野元夫

日本病院総合診療医学会雑誌 ( (一社)日本病院総合診療医学会 ) 18 ( 1 ) 20 - 27 2022年01月 [査読有り]

症例は67歳,男性。アルコール性慢性膵炎とwalled-off necrosis(WON)の既往があり,発熱と腹痛,尿量減少を主訴に近医を受診した。血液検査とCTで慢性膵炎の急性増悪と診断され入院した。当初は軽症であったが徐々に全身状態が悪化し,重症急性膵炎の基準を満たした為当院に搬入された。敗血症性ショック,播種性血管内凝固を伴い,特徴的なCT所見と持続性の菌血症をきたしていた事から,感染性WONが上腸間膜静脈に穿破したと考えた。循環動態が不安定で高度の凝固障害を伴い,ドレナージやネクロセクトミーは実施困難であった。感染性心内膜炎の治療指針に準じ,6週間の抗菌薬2剤併用療法と抗凝固療法を行い良好な転機が得られた。感染性WONの血管内穿破に対して侵襲的な治療が困難な際,これらの治療が有効な可能性が示された。総合診療医にとって,重症度評価の反復と円滑な病院連携の重要性を実感する一例であった。(著者抄録)

DOI

消化器内視鏡診療における医学教育の重要性

辻喜久

Gastroenterological Endoscopy ( (一社)日本消化器内視鏡学会 ) 64 ( 1 ) 7 - 18 2022年01月 [査読有り]

本邦における大学教育や医学教育の改革の重要性が注目されている.米国や英国といった諸外国での高等教育改革の細部を見ると,良い医師を育てよう,良い研究者を育てようという理念を見て取ることができる.こうした理念は教育の研究を推進させ,新しい用語や概念を生み出した.本邦では,第三者による各大学の教育の質評価が進んでいるが,これを表面的に乗り切るために用語や概念を形だけ新しくするものがいるとすれば大変残念である.これでは真の成長にはつながらない.そこで,本稿では,そういった改革に伴い欧米で発展した教育に関するいくつかの重要な用語の背景を整理し,今後,消化器内視鏡教育のデザインをされる諸先生方にその重要性を広く紹介することを目的とした.(著者抄録)

DOI CiNii

Impaired tryptophan metabolism in the gastrointestinal tract of patients with critical coronavirus disease 2019.

Yoshihiro Yokoyama, Tomoko Ichiki, Tsukasa Yamakawa, Yoshihisa Tsuji, Koji Kuronuma, Satoshi Takahashi, Eichi Narimatsu, Hiroshi Nakase

Frontiers in medicine 9 941422 - 941422 2022年 [査読有り] [国際誌]

INTRODUCTION: Coronavirus disease 2019 (COVID-19) is still causing a global pandemic. But the mechanism of COVID-19 severity is not well elucidated. MATERIALS AND METHODS: We conducted two single-center observational studies of patients with COVID-19. In the first study, the enrolled patients were distinguished based on critical vs. non-critical COVID-19. We collected blood samples from the patients at admission to measure markers related to inflammation and thrombosis and stool samples to analyze the fecal microbiome, metabolome, and calprotectin level. In the second study, we collected ileum and colon tissue samples from patients with critical COVID-19 who required colonoscopy due to severe gastrointestinal symptoms and analyzed mucosal gene expression. RESULTS: A total of 19 blood samples and 10 stool samples were collected. Interleukin (IL)-6 was the only serum inflammatory marker with significantly higher levels in the critical group than in the non-critical group. The fecal calprotectin level in the critical group was significantly higher than that in the non-critical group (P = 0.03), regardless of the presence of gastrointestinal symptoms. Stool metabolomic analysis showed that the level of indole-3-propionic acid, a ligand for aryl hydrocarbon receptor (AhR), was markedly decreased in the critical group compared to that in the non-critical group (P = 0.01). The expression of genes involved in tryptophan metabolism, including ACE2, AHR, CARD9, and IL22, was downregulated in the ileum of critical COVID-19 patients who required a colonoscopy. DISCUSSION: Critical COVID-19 patients have gastrointestinal inflammation potentially caused by impaired tryptophan metabolism in the small intestine due to decreased expression of genes involved in tryptophan metabolism.

DOI PubMed

感染性walled-off necrosisの上腸間膜静脈内への穿破に対し,保存的治療で救命しえた1例

上西陽介, 上野真行, 上野真行, 辻喜久, 上山伸也, 小山貴, 池田有希, 戸川文子, 羽田綾子, 眞野俊史, 石田悦嗣, 山本博, 水野元夫

日本病院総合診療医学会雑誌(Web) 18 ( 1 ) 2022年 [査読有り]

J-GLOBAL

消化器内視鏡診療における医学教育の重要性

辻喜久, 辻喜久

Gastroenterological Endoscopy (Web) 64 ( 1 ) 2022年 [査読有り]

J-GLOBAL

改定Atlanta分類と本邦ガイドラインを組み合わせた急性壊死性貯留の新診断基準の有用性検討

江口考明, 辻喜久, 児玉裕三

日本消化器病学会雑誌(Web) 119 2022年 [査読有り]

J-GLOBAL

急性膵炎におけるDICとトロンボモジュリン製剤早期投与による有効性の検討

江口考明, 辻喜久, 岡田明彦

日本腹部救急医学会雑誌 42 ( 2 ) 2022年 [査読有り]

J-GLOBAL

急性膵炎に対するトロンボモジュリンアルファの早期投与による膵血流改善への有用性検討

江口考明, 辻喜久, 岡田明彦

日本外科感染症学会雑誌(Web) 19 ( 1 ) 2022年 [査読有り]

J-GLOBAL

Fatal Immune Checkpoint Inhibitor-related Pancreatitis.

Masayuki Ueno, Yoshihisa Tsuji, Toshihide Yokoyama, Takashi Koyama, Yosuke Uenishi, Etsuji Ishida, Motowo Mizuno

Internal medicine (Tokyo, Japan) 60 ( 24 ) 3905 - 3911 2021年12月 [査読有り] [国内誌]

We herein report a case of fatal pancreatitis induced by an immune checkpoint inhibitor. A 62-year-old man with cancer of unknown primary was treated with pembrolizumab. After 12 cycles, immune-related pneumonitis developed and was treated with prednisolone. Three months later, pancreatitis developed, which was successfully treated with hydration and protease inhibitors. Eight months later, another attack of pancreatitis occurred, which did not respond to therapy, including high-dose corticosteroids, and he eventually died. This is the first report describing fatal immune checkpoint inhibitor-related pancreatitis. Despite the rarity of this complication, attention should be paid to its potential severity and treatment.

DOI PubMed

Utility and safety of a new uneven double-lumen sphincterotome in cases of difficult biliary cannulation.

SHINTANI, Shuhei, INATOMI, Osamu, TAKEDA, Yoshiya, MATSUMOTO, Hiroshi, FUJIMOTO, Takehide, TSUJI, Yoshihisa, KUTSUMI, Hiromu, ANDOH, Akira, 新谷, 修平, 稲富, 理, 竹田, 善哉, 松本, 寛史, 藤本, 剛英, 辻, 喜久, 久津見, 弘, 安藤, 朗

BMC Gastroenterology ( BioMed Central Ltd ) 21 ( 1 ) 102 - 102 2021年12月 [査読有り] [国際誌]

type:Journal Article Background:We investigated the utility and safety of a new uneven double-lumen sphincterotome in biliary cannulation in comparison with the conventional pancreatic guidewire (PGW) method. Methods:We retrospectively evaluated 119 patients who required PGW placement because of difficult biliary cannulation. Endoscopic retrograde cholangiopancreatography (ERCP) was performed using a conventional ERCP catheter or a new uneven double-lumen sphincterotome. The success rate of bile duct cannulation, the operation time of bile duct cannulation, and the incidence of post-ERCP pancreatitis (PEP) were evaluated. Results:Forty-four patients were treated with a new double-lumen sphincterotome (the new sphincterotome group) and 75 patients underwent conventional PGW placement (the conventional group). The success rate of bile duct cannulation was 39/44 (88.6%) in the new sphincterotome group and 63/75 (84.0%) in the conventional group (not significant). The total biliary cannulation time (from the reach to the papilla to the finish of biliary cannulation) was 16.0 (6.5-78) min in the new sphincterotome group and 26.0 (5-80) min in the conventional group (P < 0.01). The time from PGW placement to bile duct cannulation was 3.5 (0.3-57) min in the magictome group and 12.0 (1-65) min in the conventional group (P < 0.01). Hyperamylasemia was observed in 13/44 (29.5%) and 17/75 (22.7%), respectively (not significant). Five of 44 (11.3%) of the new sphincterotome group and 14/75 (18.7%) of the conventional group were diagnosed with PEP (not significant). Conclusion:A new double-lumen sphincterotome allows selective bile duct cannulation to be performed in a shorter time than the conventional PGW method. source:http://www.ncbi.nlm.nih.gov/pmc/articles/pmc7934518/

DOI PubMed CiNii

The clinical efficacy of azathioprine as maintenance treatment for autoimmune pancreatitis: a systematic review and meta-analysis.

Yoshiharu Masaki, Hiroshi Nakase, Yoshihisa Tsuji, Masanori Nojima, Kyoko Shimizu, Nobumasa Mizuno, Tsukasa Ikeura, Kazushige Uchida, Akio Ido, Yuzo Kodama, Hiroshi Seno, Kazuichi Okazaki, Seiji Nakamura, Atsushi Masamune

Journal of gastroenterology 56 ( 10 ) 869 - 880 2021年10月 [国内誌]

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 PubMed

急性膵炎臨床におけるガイドラインの国際比較

辻喜久, 佐藤健太

膵臓 ( 一般社団法人日本膵臓学会 ) 36 ( 4 ) 226 - 232 2021年08月

近年，急性膵炎の治療に関するガイドラインが各国から発表されている．そこで本稿では，①最近10年以内（2010～2020年）に発行されたもの，②英語で書かれているもの，③国内外の医学会・学会が発行したもの，④GRADEシステムを採用しているもの，以上①～④にて収集された8つのガイドラインでの推奨度とエビデンス評価の相同に関して比較検討した．7つの主要項目に分けられた31の項目について，27の項目については概ね一致したが，4つの項目で不一致が認められた．しかし，詳細に記述を確認すると一概に不一致と言い切れない部分もあった．推奨が分かれる一つの原因は十分なエビデンスがないことであり，実際に項目内でもエビデンスの質の評価が大きく分かれていることが見て取れた．以上から，今後，新しい精度の高いエビデンスが蓄積されるにつれ，ある程度推奨度も統一されていくと考えられた．

DOI CiNii

Reducing the risk of developing walled-off necrosis in patients with acute necrotic collection using recombinant human soluble thrombomodulin.

Takaaki Eguchi, Yoshihisa Tsuji, Akihiko Okada, Dai Inoue, Hironobu Tokumasu, Kosuke Iwane, Yoshitaka Nakai, Toshihiro Kusaka, Yoshito Uenoyama, Koichi Fujita, Masataka Yokode, Yukimasa Yamashita, Yugo Sawai, Masanori Asada, Takao Mikami, Chiharu Kawanami, Yasushi Kudo, Shujiro Yazumi, Tsuyoshi Sanuki, Arata Sakai, Toshihiro Morita, Yojiro Sakuma, Norimitsu Uza, Yutaka Takada, Toshinao Itani, Katsutoshi Kuriyama, Kazuyoshi Matsumura, Kazuki Ikeda, Hitoshi Someda, Eiji Funatsu, Shinji Katsushima, Yuzo Kodama, Hiroshi Seno

Journal of hepato-biliary-pancreatic sciences 28 ( 9 ) 788 - 797 2021年06月 [国内誌]

BACKGROUND/PURPOSE: The purpose of the present study was to investigate the possibility of reducing clinical impacts of acute necrotic collection (ANC) on patients with acute pancreatitis (AP) using recombinant human soluble thrombomodulin (rTM). METHODS: In this retrospective multicenter study, 233 consecutive AP patients with ANC and acute peripancreatic fluid collection (APFC) from 2012 to 2016 were enrolled. To assess clinical impacts of ANC, severity on admission (JPN score, JPN CT grade, and Modified CT severity index), development of walled-off necrosis (WON), imaging costs for follow-up, and mortality were recorded. Finally, we investigated whether rTM could reduce the clinical impacts, adjusting the severity using propensity analysis with Inverse probability of treatment weighting. RESULTS: Patients with ANC developed WON with higher ratio than APFC (58/98 [59.2%] vs 20/135 [14.8%], OR = 8.3, P < .01]. Severity on admission and imaging costs for follow-up in ANC patients were significantly higher than those in APFC (P < .01). However, regarding mortality, there was no significant difference between patients with ANC and APFC (P = .41). Adjusting severity, it was revealed that rTM administration significantly reduced the risk of ANC developed WON (OR = 0.23, P = .01). CONCLUSIONS: While ANC had a higher clinical impact than that of APFC, we found that early administration of rTM may reduce the impact.

DOI PubMed

Diagnosing Biliary Strictures: Distinguishing IgG4-Related Sclerosing Cholangitis From Cholangiocarcinoma and Primary Sclerosing Cholangitis.

Yasuki Hori, Suresh T Chari, Yoshihisa Tsuji, Naoki Takahashi, Dai Inoue, Phil A Hart, Takeshi Uehara, Masayasu Horibe, Satoshi Yamamoto, Akira Satou, Lizhi Zhang, Kenji Notohara, Itaru Naitoh, Takahiro Nakazawa

Mayo Clinic proceedings. Innovations, quality & outcomes 5 ( 3 ) 535 - 541 2021年06月 [国際誌]

Biliary strictures caused by inflammation or fibrosis lead to jaundice and cholangitis which often make it difficult to distinguish malignant strictures. In cases when malignancy cannot be excluded, surgery is often performed. The concept of immunoglobulin G4 (IgG4)-related sclerosing cholangitis (SC) as a benign biliary stricture was recently proposed. The high prevalence of the disease in Asian countries has resulted in multiple diagnostic and treatment guidelines; however, there is need to formulate a standardized diagnostic strategy among various countries considering the utility, invasiveness, and cost-effectiveness. We evaluated accuracies of various diagnostic modalities for biliary strictures comparing pathology in the Delphi meetings which were held in Rochester, MN. The diagnostic utility for each modality was graded according to the experts, including gastroenterologists, endoscopists, radiologists, and pathologists from the United States and Japan. Diagnostic utility of 10 modalities, including serum IgG4 level, noninvasive imaging, endoscopic ultrasound, endoscopic retrograde cholangiopancreatography-related diagnostic procedures were advocated and the reasons were specified. Serum IgG4 level, noninvasive imaging, diagnostic endoscopic ultrasound and intraductal ultrasonography under endoscopic retrograde cholangiopancreatography were recognized as useful modalities for the diagnosis. The information in this article will aid in the diagnosis of biliary strictures particularly for distinguishing IgG4-SC from cholangiocarcinoma and/or primary SC.

DOI PubMed

一般内科における入院患者の入院日数の延長に関するリスクの検討

若林崇雄, 山本武志, 相馬仁, 辻喜久, 山本和利

日本病院総合診療医学会雑誌 ( 一般社団法人日本病院総合診療医学会 ) 17 ( 3 ) 274 - 281 2021年05月

【目的】一般内科における患者の入院日数の延長に関連する因子を検討する。【方法】2016 年 4 月 1 日から 2017 年 3 月 31 日まで 200 床規模のA病院総合診療科に即日入院した患者 289 名を対象とした。入院期間に影響を及ぼす要因として 12 項目の説明変数を選定し，比例Coxハザード分析を用いて入院日数の延長と関連する因子を検討した。【結果】在院日数の中央値は 10 日だった。入院前の住居と退院先の相違（ハザード比（HR）2.25，95％信頼区間（95％ CI）；1.35-3.75）であり，次いでBMI低値（HR 1.70，95％ CI；1.18-2.45），要介護（HR 1.56，95％ CI；1.07-2.27），ポリファーマシー（HR 1.48，95％ CI；1.08-2.04）が入院日数の延長と正の相関を示した。【結論】入院日数の延長と関連する因子が示唆された。今後は本検討を基に多施設前向き研究で妥当性を確保する必要がある。

DOI

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