Takamitsu Sato

Evaluation of Modified Glasgow Prognostic Score for Pancreatic Cancer: A Retrospective Cohort Study.

Objectives The modified Glasgow prognostic score (mGPS) is known to be useful in determining the prognosis of cancers. However, the utility of mGPS for pancreatic cancer (PC) has been examined based primarily on a surgical series of early-stage cancers. The purpose of this study was to examine the utility of mGPS for PC of all stages using a retrospective cohort design. Methods We conducted a retrospective cohort study using data from a computerized database. A total of 807 patients with pathologically confirmed PC were analyzed (mGPS-0, n = 620; mGPS-1, n = 153; mGPS-2, n = 34). Results Median overall survival (OS) was significantly worse for the mGPS-1 group than for the mGPS-0 group (5.8 vs 15.8 months, respectively) but was comparable between the mGPS-2 and mGPS-1 groups (4.8 vs 5.8 months, respectively). After adjustment, both mGPS-1 and mGPS-2 were independent predictive factors of OS (mGPS-1: hazard ratio, 1.772; 95% confidence interval, 1.417–2.215; mGPS-2: hazard ratio, 2.033; 95% confidence interval, 1.284–3.219). Subgroup analysis showed that OS was significantly worse in the mGPS-1 and mGPS-2 groups than in the mGPS-0 group for all except the following 2 subgroups: localized disease and curative resection. Conclusions The present results show that the mGPS is an independent prognostic factor in patients with PC, especially for advanced-stage disease.

Gastroduodenal stenting with Niti-S stent: long-term benefits and additional stent intervention.

Self‐expandable metallic stents have mainly been used for the palliation of malignant gastric outlet obstruction (GOO). However, their use in long‐term survivors and the feasibility, safety and benefit of additional intervention for stent dysfunction remain controversial. The present study examined the long‐term benefits of endoscopic gastroduodenal stenting.

aPKCλ/ι is a beneficial prognostic marker for pancreatic neoplasms

Pancreatic cancer is a lethal disease. Overall survival is typically 6 months from diagnosis. Determination of prognostic factors in pancreatic cancer that would allow identification of patients who could potentially benefit from aggressive treatment is important. However, until date, there are no established reliable prognostic factors for pancreatic cancer patients. Herein, we propose a beneficial biomarker which is significantly correlated with the prognosis in pancreatic cancer patients. Atypical protein kinase C λ/ι (aPKCλ/ι) is overexpressed and has been implicated in the progression of several cancers. We tested the expression levels of aPKCλ/ι in two types of pancreatic neoplasm, pancreatic ductal adenocarcinoma (PDAC) and intraductal papillary mucinous neoplasms (IPMNs), by immunohistochemistry. Examination of the aPKCλ/ι expression levels in surgically resected specimens of PDCA (n = 115) demonstrated that the expression levels of aPKCλ/ιin PDAC had prognostic implications, independent of the Tumor-Node-Metastasis classification and World Health Organization tumor grade. In the case of IPMNs (n = 46) also, the expression levels of aPKCλ/ιin IPMN were found to be of prognostic importance, independent of the World Health Organization histological grade or morphological type. Interestingly, high expression levels of aPKCλ/ι were significantly correlated with a worse histological grade (p = 0.010) and advanced stage of the tumor (p = 0.0050) in IPMN patients. These findings suggest that high expression levels of aPKCλ/ι could be involved in the malignant transformation of IPMNs. Based on these observations, we propose the expression level of aPKCλ/ι as a prognostic marker common to different types of pancreatic neoplasms.

A Randomized Controlled Trial Evaluating a Low-Volume PEG Solution Plus Ascorbic Acid versus Standard PEG Solution in Bowel Preparation for Colonoscopy

Evaluation of polyethylene glycol electrolyte lavage solution containing ascorbic acid (PEG-ASC) has been controversial in the point of its hyperosmolarity, especially in old population. So we therefore designed the present study to compare the efficacy, acceptability, tolerability, and safety of 1.5 L PEG+ASC and 2 L standard PEG electrolyte solution (PEG-ELS), not only in the general population, but also in patients of advanced age. Randomization was stratified by age (<70 years or 70> years), and hematological and biochemical parameters were compared in each age group, especially with respect to the safety profile of each regimen. As a result, the 1.5-L PEG-ASC regimen had higher patient acceptability than the 2-L PEG-ELS regimen. Tolerability, bowel cleansing, and safety were similar between regimens. However, we demonstrated significant statistical changes in the hematological and biochemical parameters after taking bowel preparation solutions, not only in the PEG+ASC group, but also in the PEG-ELS group. No significant differences in the safety profile were found between subjects aged less than 70 years and those aged 70 years or more; nevertheless, regardless of age, proper hydration is needed throughout the bowel preparation process.

Covered self‐expandable metal stent deployment promises safe neoadjuvant chemoradiation therapy in patients with borderline resectable pancreatic head cancer

Patients with borderline resectable pancreatic head cancer (BRPHC) have been treated with neoadjuvant chemoradiation therapy (NACRT) using metallic stents. The aim of the present study was to evaluate the efficacy and complications of covered self‐expanding metallic stents (CSEMS) during the NACRT and surgical period.

Colocutaneous fistula after percutaneous endoscopic gastrostomy.

In conclusion, we have reported a patient who developed a colocutaneous fistula after the insertion of a PEG. Colocutaneous fistula is a rare but important complication of PEG. Dear Sir, Percutaneous endoscopic gastrostomy (PEG) was first introduced by Gauderer et al. [1] in 1979 for enteral feeding. Since then, PEG has become a widely accepted method because of its safety and convenience. As this procedure becomes more common, however, numerous complications have been described. A 74-year-old man with a cerebral infarction and Parkinson disease had a PEG tube inserted at our hospital. The procedure was uneventful and the PEG functioned normally. Six months after the PEG insertion, he was admitted to our hospital because fecal material was observed in the gastrostomy tube. A gastrografin study revealed that the tube had been mispositioned in the colon ( fig. 1 ). Colocutaneous fistula was diagnosed. Colocutaneous fistula, which is a rare complication of PEG [2] , is thought to be formed during the insertion of the original PEG tube when the colon becomes interposed between the stomach and the abdominal wall. The fistula initially functions normally and can remain asymptomatic for several months. The transverse colon is often tightly compressed but not completely obstructed, enabling feces and flatus to pass. Such colocutaneous fistulas often remain asymptomatic until the tube is exchanged; in the present case, however, the patient exhibited symptoms prior to the replacement of the gastrostomy tube. Published online: June 26, 2007

Familial pancreatic cancer: Concept, management and issues

Familial pancreatic cancer (FPC) is broadly defined as two first-degree-relatives with pancreatic cancer (PC) and accounts for 4%-10% of PC. Several genetic syndromes, including Peutz-Jeghers syndrome, hereditary pancreatitis, hereditary breast-ovarian cancer syndrome (HBOC), Lynch syndrome, and familial adenomatous polyposis (FAP), also have increased risks of PC, but the narrowest definition of FPC excludes these known syndromes. When compared with other familial tumors, proven genetic alterations are limited to a small proportion (< 20%) and the familial aggregation is usually modest. However, an ethnic deviation (Ashkenazi Jewish > Caucasian) and a younger onset are common also in FPC. In European countries, “anticipation” is reported in FPC families, as with other hereditary syndromes; a trend toward younger age and worse prognosis is recognized in the late years. The resected pancreases of FPC kindred often show multiple pancreatic intraepithelial neoplasia (PanIN) foci, with various K-ras mutations, similar to colorectal polyposis seen in the FAP patients. As with HBOC patients, a patient who is a BRCA mutation carrier with unresectable pancreatic cancer (accounting for 0%-19% of FPC patients) demonstrated better outcome following platinum and Poly (ADP-ribose) polymerase inhibitor treatment. Western countries have established FPC registries since the 1990s and several surveillance projects for high-risk individuals are now ongoing to detect early PCs. Improvement in lifestyle habits, including non-smoking, is recommended for individuals at risk. In Japan, the FPC study group was initiated in 2013 and the Japanese FPC registry was established in 2014 by the Japan Pancreas Society.

Lubiprostone improves intestinal permeability in humans, a novel therapy for the leaky gut: A prospective randomized pilot study in healthy volunteers

Background and aims The barrier function of the small intestinal mucosa prevents the introduction of undesired pathogens into the body. Breakdown of this barrier function increases intestinal permeability. This has been proposed to induce not only gastrointestinal diseases, including inflammatory bowel disease and irritable bowel syndrome, but also various other diseases, including allergies, diabetes mellitus, liver diseases, and collagen diseases, which are associated with this so called “leaky gut syndrome.” As such, a method to prevent leaky gut syndrome would have substantial clinical value. However, no drugs have been demonstrated to improve disturbed intestinal permeability in humans to date. Therefore, we investigated whether a drug used to treat chronic constipation, lubiprostone, was effective for this purpose. Methods Healthy male volunteers were treated with lubiprostone (24 μg/day) for 28 days. Intestinal permeability was evaluated by measuring the lactulose-mannitol ratio (LMR) after administration of diclofenac and compared with an untreated group. The examination was conducted three times in total, i.e., at baseline before diclofenac administration and after 14 and 28 days of lubiprostone treatment. Blood endotoxin activity was also evaluated at the same time points. Results The final analysis was conducted on 28 subjects (14 in the lubiprostone group and 14 in the untreated group). The LMR after 28 days of treatment was significantly lower in the lubiprostone group than that in the untreated group (0.017 vs. 0.028, respectively; 95% confidence interval, −0.022–−0.0001; p = 0.049). Blood endotoxin activity exhibited almost no change over time in the lubiprostone and untreated groups and displayed no significant differences at any time point of examination. Conclusions This study is the first to report an improvement in leaky gut using an available drug in humans. The result suggests that lubiprostone may prevent and ameliorate “leaky gut syndrome”. However, a pivotal trial is needed to confirm our finding.

Positioning of nasobiliary tube using magnet-loaded catheters

BACKGROUND AND STUDY AIMS In endoscopic nasobiliary drainage (ENBD), repositioning the catheter from the mouth to the nose is complicated. We devised a method using catheters with magnets and verified its utility and safety. PATIENTS AND METHODS We prospectively enrolled 20 patients undergoing ENBD at Yokohama City University Hospital. RESULTS The procedures were successful in all 20 cases and no case required a change of operators to a senior doctor. The mean time for the procedure was 36.6 seconds. The emetic reflex was induced 0.5 times on average using the magnet method. The mean X-ray exposure time was 29.6 seconds. No complications occurred. CONCLUSIONS The magnet-loaded catheter method for positioning the ENBD catheter before finally leading it through the nose took little time and was performed successfully and safely. Therefore, the magnet method could become the first choice among techniques for ENBD catheter placement.

Protein-losing gastroenteropathy and gastric polyps: successful treatment by Helicobacter pylori eradication.

day, and he was diagnosed as having protein-losing gastroenteropathy. We tried H. pylori eradication therapy for reduction of the polyps. After 1 month, an urea breath test revealed that H. pylori had been eradicated from his stomach. Two months after H. pylori eradication therapy, endoscopic examination showed that the gastric polyps were smaller in size. His body weight increased, and the serum total protein level also increased to 5.8 g/dl and the albumin concentration to 3.8 g/dl. We succeeded in treating protein-losing gastroenteropathy associated with gastric hyperplastic polyps by H. pylori eradication. Dear Sir, Protein-losing gastroenteropathy is a disease associated with excessive loss of plasma protein into the gastrointestinal tract and is caused by a wide variety of disorders. A 71-year-old man was admitted to our hospital for edema and body weight loss. His serum total protein level was 4.2 g/dl, and the albumin concentration was 2.6 g/dl. Endoscopy of the upper gastrointestinal tract showed a lot of reddish pedunculated polyps, measuring 5–20 mm in diameter, in gastric body and antrum ( fig. 1 ). Histological investigation of biopsy specimens revealed hyperplastic changes, and Helicobacter pylori was confirmed. His 1 -antitrypsin clearance was 120 ml/ Published online: May 18, 2007