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Dai Akiyama Tsuyoshi Hamada Hiroyuki Isayama Yousuke Nakai Takeshi Tsujino Gyotane Umefune Naminatsu Takahara Dai Mohri Hirofumi Kogure Saburo Matsubara Yukiko Ito Natsuyo Yamamoto Naoki Sasahira Minoru Tada Kazuhiko Koike 《Saudi Journal Of Gastroenterology》2015,21(4):213-219
Background/Aims:
Endoscopic papillary balloon dilation (EPBD) is a possible alternative to endoscopic sphincterotomy (EST) for common bile duct (CBD) stones. To date, 10- and 8-mm EPBD have not been fully compared.Patients and Methods:
Patients who underwent EPBD for CBD stones at two Japanese tertiary care centers between May 1994 and January 2014 were identified. Matched pairs with 10- and 8-mm EPBD were generated. Short- and long-term outcomes were compared between the two groups.Results:
A total of 869 patients were identified (61 and 808 patients for 10- and 8-mm EPBD, respectively), and 61 well-balanced pairs were generated. The rate of complete stone removal within a single session was higher in the 10-mm EPBD group than in the 8-mm EPBD group (69% vs. 44%, P < 0.001), and use of lithotripsy was less frequent in the 10-mm EPBD group (23% vs. 56%, P < 0.001). The rates of post-ERCP pancreatitis were similar between the 10- and 8-mm EPBD groups (11% vs. 8%). Cumulative biliary complication-free rates were not statistically different between the two groups: 88% [95% confidence interval (CI): 79–97%] and 94% (95% CI: 88–100%) at 1 year and 69% (95% CI: 56–85%) and 80% (95% CI: 69–93%) at 2 years in the 10- and 8-mm EPBD groups, respectively. In the 10-mm EPBD group, ascending cholangitis was not observed, and pneumobilia was found in 5% of cases during the follow-up period.Conclusions:
EPBD using a 10-mm balloon for CBD stones is safe and more effective than 8-mm EPBD. The sphincter function is highly preserved after 10-mm EPBD. 相似文献2.
Indications for endoscopic ultrasonography (EUS)‐guided biliary intervention: Does EUS always come after failed endoscopic retrograde cholangiopancreatography?
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Gyotane?Umefune Hirofumi?Kogure Tsuyoshi?Hamada Hiroyuki?IsayamaEmail author Kazunaga?Ishigaki Kaoru?Takagi Dai?Akiyama Takeo?Watanabe Naminatsu?Takahara Suguru?Mizuno Saburo?Matsubara Natsuyo?Yamamoto Yousuke?Nakai Minoru?Tada Kazuhiko?Koike 《Journal of gastroenterology》2017,52(6):734-745
Background
Procalcitonin is being increasingly used to diagnose and grade acute systemic bacterial infection at an early stage of disease onset. The aim of this prospective study was to evaluate the usefulness of procalcitonin for severity grading of acute cholangitis on patient admission.Methods
Patients with acute cholangitis were prospectively enrolled. The severity of acute cholangitis was graded on the basis of the 2013 Tokyo guidelines (Japanese Society of Hepato-Biliary-Pancreatic Surgery, 2013). We compared the ability of procalcitonin level on admission to predict moderate/severe (vs mild) or severe (vs mild/moderate) acute cholangitis with the abilities of white blood cell (WBC) count and C-reactive protein (CRP) level.Results
Two hundred thirteen patients were analyzed, and the severity of acute cholangitis was graded as mild, moderate, and severe in 108, 76, and 29 patients respectively. Procalcitonin level, WBC count, and CRP level all increased significantly according to the severity. In the receiver operating characteristic analyses, the area under the curve for procalcitonin for severe acute cholangitis was 0.90 [95% confidence interval (CI) 0.85–0.96] and was significantly greater than that for WBC (0.62; 95% CI 0.48–0.76) and that for CRP (0.70; 95% CI 0.60–0.80). The optimal cutoff value for procalcitonin for prediction of severe acute cholangitis was 2.2 ng/mL (sensitivity 0.97; specificity 0.73; accuracy 0.77). The areas under the curve for procalcitonin, WBC, and CRP for moderate/severe acute cholangitis were not significantly different.Conclusions
Procalcitonin predicted severe acute cholangitis better than conventional biomarkers. Severe cases for which urgent biliary drainage is indicated might be identified on admission on the basis of the cutoff values for procalcitonin suggested in this study.4.
Kenji Hirano Tomotaka Saito Suguru Mizuno Minoru Tada Naoki Sasahira Hiroyuki Isayama Miho Matsukawa Gyotane Umefune Dai Akiyama Kei Saito Shuhei Kawahata Naminatsu Takahara Rie Uchino Tsuyoshi Hamada Koji Miyabayashi Dai Mohri Takashi Sasaki Hirofumi Kogure Natsuyo Yamamoto Yosuke Nakai Kazuhiko Koike 《Gut and liver》2014,8(5):563-568
Background/Aims
To determine the nutritional markers important for assessing the degree of pancreatic insufficiency due to chronic pancreatitis in routine clinical practice.Methods
A total of 137 patients with chronic pancreatitis were followed up for more than 1 year. They were divided into two groups: a pancreatic diabetes mellitus (DM) group, consisting of 47 patients undergoing medical treatment for DM of pancreatic origin, and a nonpancreatic DM group, consisting of 90 other patients (including 86 patients without DM). Serum albumin, prealbumin, total cholesterol, cholinesterase, magnesium, and hemoglobin were compared between the two groups.Results
The total cholesterol was significantly lower in the pancreatic than the nonpancreatic DM group (164 mg/dL vs 183 mg/dL, respectively; p=0.0028). Cholinesterase was significantly lower in the former group (263 U/L vs 291 U/L, respectively; p=0.016). Among the 37 patients with nonalcoholic pancreatitis, there was no difference in the cholinesterase levels between the pancreatic and nonpancreatic (296 U/L vs 304 U/L, respectively; p=0.752) DM groups, although cholesterol levels remained lower in the former (165 mg/dL vs 187 mg/dL, respectively; p=0.052).Conclusions
Cholinesterase levels are possibly affected by concomitant alcoholic liver injury. The total cholesterol level should be considered when assessing pancreatic insufficiency due to chronic pancreatitis. 相似文献
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