Takahiro Beppu

Adverse reactions to azathioprine cannot be predicted by thiopurine S-methyltransferase genotype in Japanese patients with inflammatory bowel disease

Background and Aims:  Azathioprine (AZA) is associated with a high frequency of adverse reactions. We examined polymorphism of the thiopurine S‐methyltransferase (TPMT) gene to determine whether the TPMT genotype would be a predictive marker for the development of adverse reactions to AZA.

ENDOSCOPIC BALLOON DILATATION USING DOUBLE‐BALLOON ENDOSCOPY IS A USEFUL AND SAFE TREATMENT FOR SMALL INTESTINAL STRICTURES IN CROHN'S DISEASE

Background:  Endoscopic balloon dilatation (EBD) is a therapeutic option for intestinal strictures of Crohns disease (CD). Double‐balloon endoscopy (DBE) enables EBD to be performed even for deep‐situated strictures of the small intestine. The aim of this study was to clarify the efficacy and safety of EBD using DBE for small bowel strictures in patients with CD.

Long-term outcome of endoscopic balloon dilation for small bowel strictures in patients with Crohn's disease.

Endoscopic balloon dilation (EBD) is an alternative to surgery for small bowel strictures of patients with Crohns disease (CD). However, little is known about the long‐term efficacy of EBD. The aim of the present study was to clarify the long‐term outcome of EBD for small bowel strictures in patients with CD.

Carbon dioxide insufflation compared with air insufflation in double-balloon enteroscopy: a prospective, randomized, double-blind trial

BACKGROUND Few studies have evaluated the degree of pain, the amount of retained gas, and the safety of carbon dioxide (CO(2)) insufflation in patients undergoing double-balloon enteroscopy (DBE). OBJECTIVE To clarify the usefulness and safety of CO(2) insufflation during DBE. DESIGN Single-center, prospective, randomized, double-blind, controlled trial. SETTING University hospital. PATIENTS Forty eligible patients with small-bowel disease for whom DBE was indicated were randomized to a CO(2) insufflation (CO(2)) group or an air insufflation (air) group by means of sealed envelopes. INTERVENTION DBE with insufflation of CO(2) or air. MAIN OUTCOME MEASUREMENTS Efficacy evaluation was based on the degree of pain as assessed by use of a visual analog scale (VAS) and the amount of residual gas retention within the small and large bowels on radiography. The safety of CO(2) insufflation was evaluated by arterial blood gas analysis. RESULTS Significantly fewer patients in the CO(2) group had severe pain of ≥ 50 mm on the VAS during DBE than in the air group (P = .02). Significantly less gas was retained in the small bowel just after and at 3 hours after DBE in the CO(2) group than in the air group (P = .003, P = .01, respectively). There was significantly less residual gas retention in the large bowel at 3 hours after DBE in the CO(2) group than in the air group (P = .02). There was no significant difference in pre-DBE and post-DBE partial pressure of oxygen in the blood (PaO(2)) and partial pressure of carbon dioxide in the blood (PaCO(2)) between groups. LIMITATIONS Small sample size. CONCLUSION CO(2) insufflation is a safe and useful procedure when performed during DBE.

Value of concomitant endoscopic balloon dilation for intestinal stricture during long‐term infliximab therapy in patients with crohn's disease

Aim:  We assessed the long‐term outcome of infliximab (IFX) therapy in patients with Crohns disease (CD) and investigated the efficacy of concomitant endoscopic balloon dilation (EBD) for intestinal stricture during treatment.

Mucosal healing of ileal lesions is associated with long-term clinical remission after infliximab maintenance treatment in patients with Crohn's disease.

The aim of the present study was to endoscopically evaluate ileal mucosal healing during maintenance therapy with infliximab in order to investigate the clinical significance of endoscopic examination of ileal lesions in Crohns disease patients.

Efficacy of azathioprine in mild or moderate relapse in Crohn's disease: clinical and endoscopic evaluation.

Aim:  The present study was aimed at evaluating the efficacy of azathioprine (AZA) in patients with active and relapsing Crohns disease (CD) and the usefulness of endoscopy in this evaluation.

Long‐term course of Crohn's disease in Japan: Incidence of complications, cumulative rate of initial surgery, and risk factors at diagnosis for initial surgery

Intestinal complications of stenosis or fistula may occur during the course of Crohns disease (CD), and surgery is performed in a fair number of patients. The risk factors for initial surgery in a Japanese hospital‐based cohort of CD patients were evaluated.

Three-dimensional computed tomography pancreatography of an annular pancreas with special reference to embryogenesis.

Objectives: Several hypotheses have been proposed to explain the embryogenesis of an annular pancreas. Three-dimensional (3D) imaging of the annular pancreas may be useful to elucidate the embryogenesis. The aim of this case report is to clarify the pancreatic ducts in the annular pancreas by 3D computed tomography pancreatography (3D-CTP), stereographically. Methods: Three-dimensional CTP under endoscopic retrograde pancreatography using a balloon catheter was performed with a helical CT scanner. Three-dimensional images of the pancreatic duct were obtained with simple threshold, shaped surface display. Results: Wirsung duct that surrounds the ventral side of the descending portion of the duodenum and Santorini duct that surrounds the dorsal side of the descending portion of the duodenum were reconstructed by 3D-CTP, stereographically, and the presence of an annular pancreas was confirmed. These findings suggest that the formation of the annular pancreas in the current case may be attributable not only to abnormal development of the right lobe of the ventral pancreatic bud, but also to overgrowth of the dorsal pancreatic bud toward the ventral aspect of the duodenum or excessive rotation of the duodenum following fusion of the ventral bud to the dorsal bud. Conclusion: Three-dimensional CTP is expected to contribute usefully toward clarifying the embryogenesis of an annular pancreas.

CLINICAL AND ENDOSCOPIC FEATURES OF AMYLOIDOSIS SECONDARY TO CROHN'S DISEASE: DIAGNOSTIC VALUE OF DUODENAL OBSERVATION AND BIOPSY

Aim:  Recent reports have focused on the development of secondary amyloidosis (AMY) as a complication of Crohns disease (CD). The present study was carried out to investigate the frequency of AMY secondary to CD, its clinical and endoscopic features, and the importance of duodenal biopsy in detecting this disease.