Hiroki Yuhara

Recombinant human soluble thrombomodulin in severe sepsis: a systematic review and meta‐analysis

Although recombinant human soluble thrombomodulin (rhTM) is a widely used novel anticoagulant agent for disseminated intravascular coagulation (DIC) in Japan, its clinical efficacy in sepsis‐induced DIC has not been demonstrated convincingly.

Meta‐analysis: the risk of venous thromboembolism in patients with inflammatory bowel disease

Inflammatory bowel disease (IBD), which includes Crohns disease (CD) and ulcerative colitis (UC), is a systemic disorder that predominantly affects the bowels but is also associated with venous thromboembolism (VTE).

Efficacy and safety of anticoagulant therapy in three specific populations with sepsis: a meta‐analysis of randomized controlled trials

Essentials Most anticoagulant therapy has failed to demonstrate a survival benefit in the overall sepsis population. We conducted separate meta‐analyses of anticoagulant therapy in three different populations. Survival benefit was observed only in the septic disseminated intravascular coagulation (DIC) population. Further randomized controlled trials should focus on specific populations with septic DIC.

Smoking and risk for acute pancreatitis: a systematic review and meta-analysis.

Abstract We aimed to better understand the relationship between smoking and a risk for acute pancreatitis (AP) in existing observational studies. We identified studies by searching the PubMed, Scopus, and Web of Science databases (from inception through August 31, 2013) and by searching bibliographies of relevant articles. Summary relative risks (RRs) with 95% confidence intervals (CIs) were calculated with fixed-effects and random-effects models. A total of 5 studies met inclusion criteria for analysis. Both current smoking (summary RR, 1.74; 95% CI, 1.39–2.17; n = 5 studies) and former smoking (summary RR, 1.32; 95% CI, 1.03–1.71; n = 4 studies) were associated with an increased risk for AP. The positive association of current smoking and risk for AP remained when we limited the meta-analysis to studies that controlled for alcohol intake and body mass index (summary RR, 1.76; 95% CI, 1.31–2.36; n = 4 studies). Both current and former smoking are associated with increased risk for AP. Further investigations, both epidemiological and mechanistic, are needed to establish the extent to which the association can be explained by a causal link and whether smoking cessation can prevent the occurrence and development of AP.

Irsogladine maleate and rabeprazole in non-erosive reflux disease: A double-blind, placebo-controlled study.

AIM To evaluate the efficacy of adding irsogladine maleate (IM) to proton-pump inhibitor (PPI) therapy in non-erosive reflux disease (NERD) treatment. METHODS One hundred patients with NERD were recruited and randomized to receive rabeprazole plus IM (group I) or rabeprazole plus placebo (group P). The efficacy of the treatment was assessed using the Frequency Scale for the Symptoms of Gastroesophageal Reflux Disease (FSSG) and the short form (SF)-36 quality of life questionnaires after four weeks of treatment. We also assessed whether patients with NERD with minimal changes (grade M) had different responses to the therapies compared with patients who did not have minimal changes (grade N). RESULTS Group I and group P showed significant improvements in their FSSG scores after the treatment (from 17.9 ± 7.9 to 9.0 ± 7.6, and from 17.7 ± 7.3 to 11.2 ± 7.9, respectively, P = 0.0001), but there was no statistically significant difference between the FSSG scores in group I and those in group P. Subgroup analysis showed that significant improvements in the FSSG scores occurred in the patients in group I who had NERD grade N (modified Los Angeles classification) (7.8 ± 7.4 vs 12.5 ± 9.8, P = 0.041). The SF-36 scores for patients with NERD grade N who had received IM and rabeprazole were significantly improved in relation to their vitality and mental health scores. CONCLUSION The addition of IM to rabeprazole significantly improves gastroesophageal reflux disease symptoms and the quality of the lives of patients with NERD grade N.

Strategy of Endoscopic Pancreatic Duct Drainage for Recurrent Chronic Pancreatitis

Background: Methods of pancreatic duct (PD) drainage for recurrent chronic pancreatitis (CP) include endoscopic drainage combined with ESWL and surgical drainage. Although the endoscopic drainage has become widespread as this method is minimally invasive, there are cases in which stent removal is difficult. We retrospectively examined the current status of endoscopic drainage for recurrent CP at our hospital. Methods: This study included 66 patients with recurrent CP (57 men and 9 women with a mean age of 59 ± 14 years, including 58 patients with alcoholic CP) who underwent endoscopic drainage between April 2006 and April 2012. Based on the initial images of PD, the patients were classified into the following types to compare their backgrounds and treatment processes: pancreatolithiasis (Stone) type (7 patients), PD stenosis (Stenosis) type (18), and Stone+Stenosis type (41). Moreover, patients with PD stent were divided into the following groups to compare their backgrounds and treatment processes: stent-removed groupand stent-maintained group in which the stent could not be removed. Results: The procedure was successful in 61 patients (92%). Complete pain relief without analgesics was achieved in 60 patients (91%). The early complications were post-ERCP pancreatitis in 11 patients (2.7%, all mild in severity), and hemorrhage, basket impaction, and rupture of the pancreatic duct in 1 patient (0.5%) each. The late complications were pancreatic ductitis (0.7%), stent displacement (0.5%), stent migration (1.5%), and tear during removal of stent (1%). In Stone type patients, the mean number of procedural sessions and the number of patients who required at least 1 year of treatment were significantly smaller thanin those withPD stenosis (Stenosis type or Stone+Stenosis type) (P=0.0133 and P=0.0043, respectively). Patients with Stenosis type had a significantly smaller mean number of procedural sessions (P=0.0423) and a significantly lower incidence of complications (P=0.0366) than those with Stone+Stenosis type. Comparison between the stent-removed and stent-maintained groups revealed no significant differences in the mean number of procedural sessions, the number of patients with implantation of a stent with a diameter (thicker than 8.5-Fr), or the incidence of complications. In the stent-removed group, the number of patients who required at least 1 year of treatment was significantly smaller (P=0.0285). Conclusions: In the short term, endoscopic stenting combined with ESWL was effective for pain relief, was associated with a low incidence of complications, and could be performed safely and effectively. For Stonetype recurrent CP, endoscopic therapy is highly effective and useful. On the other hand, from the long-term perspective, there are cases, especially among those with the Stone+Stenosis type, in which stent removal is difficult. Thus, surgical drainage should also be considered.

Mo1109 Antithrombotic Agents and Bleeding Risk After Endoscopic Submucosal Dissection in Patients With Gastric Neoplasms: A Meta-Analysis

Cost-Effectiveness Analysis of Radiofrequency Ablation for Barretts Esophagus With Low-Grade Dysplasia: Results From a Randomized Controlled Trial (SURF) Kai Yi N. Phoa, Wilda Rosmolen, Bas L. Weusten, Raf Bisschops, Erik J. Schoon, Krish Ragunath, Grant Fullarton, Massimiliano di Pietro, Narayanasamy Ravi, Mike Visser, Johan Offerhaus, Cees A. Seldenrijk, Sybren L. Meijer, Fiebo T. Ten Kate, Jan Tijssen, Marcel G. Dijkgraaf, Jacques J. Bergman