Nakamura Kazuhiko

順行性ダブルバルーン小腸内視鏡検査後の高酵素血症の予防目的のウリナスタチンに関する、前向き、無作為化、二重盲検、プラセボ対照試験(Prospective, randomized, double-blind, placebo-controlled trial of ulinastatin for prevention of hyperenzymemia after double balloon endoscopy via the antegrade approach)

Double balloon endoscopy (DBE) allows the entire small intestine to be viewed using a combination of antegrade and retrograde approaches. Acute pancreatitis is a serious complication of antegrade DBE with no effective prophylactic treatment currently available. Ulinastatin has been shown to be effective for the prevention of pancreatitis following endoscopic retrograde cholangiopancreatography. We therefore assessed the efficacy of ulinastatin for hyperenzymemia after antegrade DBE.

把持型鋏鉗子を用いた内視鏡的ネクロセクトミーによる治療が奏効した広範囲の隔壁膵壊死(Large area of walled-off pancreatic necrosis successfully treated by endoscopic necrosectomy using a grasping-type scissors forceps)

Endoscopic necrosectomy (EN) for walled‐off pancreatic necrosis (WOPN) is less invasive than surgical treatment and has become the first choice for pancreatic abscess. EN is usually carried out with several devices including snares, baskets, and grasping forceps. Occasionally, we have encountered cases in which EN has not been satisfactorily carried out, and there is pressure for further innovation in EN. Here, we describe a case of a large area of WOPN that was successfully treated by EN with endoscopic submucosal dissection and associated techniques, which facilitated removal of necrotic tissues. A 60‐year‐old man was referred to our hospital for WOPN as a complication of necrotizing pancreatitis. As a result of his complicating conditions including ischemic heart disease, uncontrollable arrhythmia, chronic renalfailure, and persistent pleural effusion, he was deemed a poor surgical candidate. Although EN with conventional devices was carried out for five sessions, we could not remove the dense and massive necrotic tissues. At the sixth EN session, the Clutch Cutter device (Fujifilm, Tokyo, Japan) was used to remove the necrotic tissues, without major complications. This is believed to be the first report of EN using the Clutch Cutter for successful treatment of WOPN.

13C-オクタン酸呼吸試験による、糖尿病患者の胃排出 胃運動性におけるインスリンの役割(Gastric emptying in diabetic patients by the 13C-octanoic acid breath test: role of insulin in gastric motility)

BackgroundImpairment of gastric emptying is well recognized in patients with diabetes mellitus (DM), especially long-standing insulin-dependent diabetes mellitus (IDDM). The aim of this study was to evaluate the cause of delayed gastric emptying in DM patients.MethodsIn 16 controls, 16 non-insulin-dependent diabetes mellitus (NIDDM) patients and 23 IDDM patients, gastric emptying was studied using the 13C octanoic acid breath test. Breath samples were taken before a test meal labeled with 100 mg of 13C octanoic acid, and at 15-min intervals over a 300-min period postprandially.ResultsIn all DM patients, the gastric emptying coefficient was lower than that in the controls (P < 0.05), and lag time and half-emptying time were significantly longer (P < 0.05). Both NIDDM and IDDM patients showed delayed 13CO2 excretion compared with the controls, but IDDM patients showed more delayed gastric emptying than NIDDM patients (P < 0.05). There were no significant differences in sex, HbA1c level, or the rate of neuropathy between the two groups.ConclusionsIDDM patients showed delayed gastric emptying compared with NIDDM patients, and the 13C octanoic acid breath test is useful for evaluating DM patients with delayed gastric emptying.

ワイヤー誘導トリプルルーメン針尖刀を用いた膵周囲炎症液貯留の内視鏡的超音波誘導経壁ドレナージ(ENDOSCOPIC ULTRASOUND-GUIDED TRANSMURAL DRAINAGE OF INFLAMMATORY PERIPANCREATIC FLUID COLLECTIONS WITH A WIRE-GUIDED TRIPLE-LUMEN NEEDLE KNIFE)

Dear Editor Endoscopic ultrasound (EUS)-guided transmural drainage is an alternative to surgical or percutaneous drainage of inflammatory peripancreatic fluid collections (PFC). However, there is still a lack of consensus on the techniques of EUS-guided transmural drainage. Traditionally, Japanese endosonographers tend to use a Soehendra biliary catheter (Cook Endoscopy, Winston-Salem, NC, USA) to dilate a puncture tract following a 19-gauge needle puncture and a guidewire placement. We used a wire-guided triple-lumen needle knife to dilate the puncture tract. From May 2007 to December 2009, a total of consecutive 18 patients were treated with EUS-guided transmural drainage of PFC using a wire-guided needle knife. PFC types were pseudocyst in seven patients, abscess in nine, and necrosis in two.The puncture tract was dilated with a wire-guided needle knife (RX needle knife sphincterotome; Boston Scientific, Natick, MA, USA; Fig. 1) over the guidewire following a 19-gauge needle puncture and a 0.035-inch guidewire placement. The needle was adjusted to 1–2 mm to avoid extra injury by diathermy when it entered the cyst wall (Fig. 2). Diathermy was carried out by coagulation current (forced coagulation mode, 30 W) with a high-frequency generator (ICC 200; ERBE Elektromedizin, Tübingen, Germany) until the needle knife passed through the cyst wall easily. The opening was dilated by a 10-mm, wire-guided, biliary dilatation catheter. A double pig-tail stent and/or a nasobiliary drainage tube was placed in all the patients. Complications occurred in four patients (22.2%), perforation in two, and secondary infection in two. No tight adhesion between the gastric and cyst walls was demonstrated by surgical findings in perforation cases. The advantage of our method is that puncture tract dilatation can be carried out even when the PFC has a hard fibrotic wall.