Akihiro Miyata

Usefulness of measurement of lens culinaris agglutinin-reactive fraction of α-fetoprotein as a marker of prognosis and recurrence of small hepatocellular carcinoma

Objective:Lens culinaris agglutinin-reactive fraction of α-fetoprotein (AFP-L3%) is a recently described marker of hepatocellular carcinoma (HCC), and its usefulness has been demonstrated in many studies. We evaluated the usefulness of serial measurement of AFP-L3% as a marker of prognosis and recurrence after treatment of small HCC.Methods:AFP-L3% was measured before and after initial treatment in 60 patients with small HCC (maximum diameter ≤2 cm). AFP-L3% was taken as the ratio of AFP-L3 to total AFP and multiplied by 100%, and levels ≥10% were considered positive. Outcomes and recurrence were compared between patients AFP-L3%–negative after initial treatment (Group A, n = 43) and patients who were AFP-L3%–positive after initial treatment (Group B, n = 17).Results:Before treatment, AFP-L3% was positive in 14 (23.3%) of the 60 patients. The cumulative survival rate of Group A was significantly longer (p= 0.0091) than that of Group B. The recurrence rate was significantly higher in Group B (p= 0.0104) than in Group A. When recurrence was limited to intrahepatic metastasis, the recurrence rate was significantly higher in Group B (p= 0.0064). However, the recurrence rate of multicentric occurrence did not differ significantly between Groups A and B.Conclusion:Measurement of AFP-L3% after treatment may be useful for understanding prognosis and recurrence of HCC.

Progressive fibrosis significantly correlates with hepatocellular carcinoma in patients with a sustained virological response

Hepatocellular carcinoma develops even in some patients who achieve a sustained virological response following treatment for hepatitis C virus infection. This study investigated the relationship between changes in fibrosis, as assessed by sequential biopsies, and development of hepatocellular carcinoma in patients who achieved a sustained virological response for hepatitis C virus.

Long-term prognosis of bile duct stones: endoscopic papillary balloon dilatation versus endoscopic sphincterotomy.

Aim:  Endoscopic papillary balloon dilatation (EPBD), which allows preservation of papillary functions, is used as the first‐line therapy in our hospital for common bile duct (CBD) stones to reduce biliary complications. In the present study, we investigated causal factors for CBD stones and compared long‐term prognosis between EPBD and endoscopic sphincterotomy (EST).

Liver stiffness measurement using acoustic radiation force impulse elastography in hepatitis C virus‐infected patients with a sustained virological response

Acoustic radiation force impulse (ARFI) elastography is a non‐invasive method for measuring liver stiffness. However, there are no reports evaluating the value of ARFI elastography for liver fibrosis in chronic hepatitis C patients with a sustained virological response (SVR).

HISTOLOGICAL EVALUATION OF CONNECTIVE TISSUE COMPONENTS IN THE HEALING PROCESS OF HUMAN GASTRIC ULCER

1. The aim of the present study was the evaluation of human gastric ulcer healing and intractability from the viewpoint of connective tissue components.

Morphological and Functional Evaluation of Gastric Ulcer Healing and Recurrence by Endoscopic Ultrasonography

Abstract: The aim of this study was the evaluation of gastric ulcer healing and recurrence, from the viewpoints of morphology and function, by means of endoscopic ultrasonography (EUS). We determined ulcer depth by EUS and quantified ulcer size in EUS images. In addition, we measured the total gastric juice acid content after fasting and the macromolecular glycoprotein weight in antral biopsies. First, we examined 22 patients receiving initial therapy during the active ulcer stage. Fourteen of these patients were reexamined after healing. The ulcer area diminished significantly, as did the total acid content, during the scarring stage. Then, another 22 patients on maintenance therapy were followed for recurrence over a 10 month period. The recurrence rate in UI‐IV ulcers was significantly higher than those in UI‐II or III ulcers. The ulcer area was greater and the macromolecular glycoprotein content lower in patients experiencing recurrence. In conclusion, morphological and functional factors (ulcer depth and ulcer area; total acid content and macromolecular glycoprotein weight), which could be assessed easily and simultaneously using an EUS fiberscope with a biopsy channel, were useful for evaluating gastric ulcer healing and recurrence.

7232 Diagnosis of gastric submucosal tumors by endoscopic ultrasonography (eus); only image vs. eus-guided fine needle aspiration biopsy.

Introduction:Endoscopic ultrasonography-guided fine needle aspiration biopsy (EUS-FNAB) for gastric submucosal tumors (SMTs) is controversial. Although it is generally believed that the EUS diagnosis of SMTs is reliable, and the rate obtained from histological samples from SMTs by EUS-FNAB is admittedly not so high, we are sometimes at a loss whether we should recommend a patient to undergo surgical resection or merely be observed. Therefore, we compared simple EUS diagnosis by experienced EUS doctors and results of EUS-FNAB. Subjects and methods: From March 1994 to May 1999 we performed EUS-FNAB in twenty-three patients with gastric SMT. All SMTs were over 3 cm. We gave five senior EUS doctors 2 EUS images of each SMT, and had them answer questionnaires regarding the diagnosis of SMT and treatment options. These doctors have experienced EUS for over five years. They judged the diagnosis of SMT and surgical resection or follow-up. Initially, we used a radial scanner GF-UM20 (Olympus Optical Co. Ltd.) for diagnosis. EUS-FNAB was performed using Pentax FG-32UA or FG-36UX convex array endosonography. Results: 1. Twenty-three patients with SMT were average 57.7 years old, 14 men and 9 women. SMTs were 14 leiomyomas, 4 leiomyosarcomas, 4 aberrant pancreases, and 1 ectopic gastric gland (mean size 33.4mm). 2. Simple EUS diagnosis was about 50% accurate by EUS senior doctors. 3. Diagnosis in 17 out of 23 SMTs was in accordance among experienced doctors („ 80%). Six of 17 SMTs were misdiagnosed. Of these 6 SMTs we obtained 4 correct diagnoses by EUS-FNAB. The six out-of-accordance cases included 3 aberrant pancreases. 4. Even when the doctors diagnosed leiomyoma, they recommended surgical resection because of a diameter over 50 mm and rapid growth in a short time. Conclusions: 1. FNA was useful for the relatively large solid tumor with cystic structure, for example, leiomyoma, leiomyosarcoma, and aberrant pancreas. 2. However, FNA diagnosis did not influence the choice of surgery or follow-up for tumors over 50 mm in diameter.