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| 1 | Crowned dens syndrome developed after an endoscopic retrograde cholangiopancreatography procedure显示文摘We present a unique case of crowned dens syndrome(CDS) that developed after endoscopic retrograde cholangiopancreatography(ERCP) in a patient who presented with fever and neck pain. Administration of non-steroidal anti-inflammatory drugs was extremely effective for relieving fever and neck pain, and in the improvement of inflammatory markers. To the best of our knowledge, this is the first case report of CDS caused by an ERCP procedure. In a patient with fever and neck pain after an ERCP procedure, CDS should be considered in the differential diagnosis. | Hiroyasu Nakano Kazunari Nakahara Yosuke Michikawa Keigo Suetani Ryo Morita Nobuyuki Matsumoto Fumio Itoh | 2016 | World Journal of Gastroenterology2016，22，39： | 5 |
| 2 | Need for pancreatic stenting after sphincterotomy in patients with difficult cannulation显示文摘AIM:To investigate the need for pancreatic stenting after endoscopic sphincterotomy(EST)in patients with difficult biliary cannulation.METHODS:Between April 2008 and August 2013,2136 patients underwent endoscopic retrograde cholangiopancreatography(ERCP)-related procedures.Among them,55 patients with difficult biliary cannulation who underwent EST after bile duct cannulation using the pancreatic duct guidewire placement method(P-GW)were divided into two groups:a stent group(n=24;pancreatic stent placed)and a no-stent group(n=31;no pancreatic stenting).We retrospectively compared the two groups to examine the need for pancreatic stenting to prevent post-ERCP pancreatitis(PEP)in patients undergoing EST after biliary cannulation by P-GW.RESULTS:No differences in patient characteristics or endoscopic procedures were observed between the two groups.The incidence of PEP was 4.2%(1/24)and29.0%(9/31)in the Stent and no-stent groups,respectively,with the no-stent group having a significantly higher incidence(P=0.031).The PEP severity was mild for all the patients in the stent group.In contrast,8 had mild PEP and 1 had moderate PEP in the no-stent group.The mean serum amylase levels(means±SD)3 h after ERCP(183.1±136.7 vs 463.6±510.4 IU/L,P=0.006)and on the day after ERCP(209.5±208.7vs 684.4±759.3 IU/L,P=0.002)were significantly higher in the no-stent group.A multivariate analysis identified the absence of pancreatic stenting(P=0.045;odds ratio,9.7;95%CI:1.1-90)as a significant risk factor for PEP.CONCLUSION:In patients with difficult cannulation in whom the bile duct is cannulated using P-GW,a pancreatic stent should be placed even if EST has been performed. | Kazunari Nakahara Chiaki Okuse Keigo Suetani Yosuke Michikawa Shinjiro Kobayashi Takehito Otsubo Fumio Itoh | 2014 | World Journal of Gastroenterology2014，20，26： | 4 |
| 3 | Thrombomodulin in the management of acute cholangitisinduced disseminated intravascular coagulation显示文摘AIM: To evaluate the need for thrombomodulin(r TM) therapy for disseminated intravascular coagulation(DIC) in patients with acute cholangitis(AC)-induced DIC. METHODS: Sixty-six patients who were diagnosedwith AC-induced DIC and who were treated at our hospital were enrolled in this study. The diagnoses of AC and DIC were made based on the 2013 Tokyo Guidelines and the DIC diagnostic criteria as defined by the Japanese Association for Acute Medicine, respectively. Thirty consecutive patients who were treated with r TM between April 2010 and September 2013(r TM group) were compared to 36 patients who were treated without r TM(before the introduction of r TM therapy at our hospital) between January 2005 and January 2010(control group). The two groups were compared in terms of patient characteristics at the time of DIC diagnosis(including age, sex, primary disease, severity of cholangitis, DIC score, biliary drainage, and anti-DIC drugs), the DIC resolution rate, DIC score, the systemic inflammatory response syndrome(SIRS) score, hematological values, and outcomes. Using logistic regression analysis based on multivariate analyses, we also examined factors that contributed to persistent DIC. RESULTS: There were no differences between the r TM group and the control group in terms of the patients' backgrounds other than administration. DIC resolution rates on day 9 were higher in the r TM group than in the control group(83.3% vs 52.8%, P < 0.01). The mean DIC scores on day 7 were lower in the r TM group than in the control group(2.1 ± 2.1 vs 3.5 ± 2.3, P = 0.02). The mean SIRS scores on day 3 were significantly lower in the r TM group than in the control group(1.1 ± 1.1 vs 1.8 ± 1.1, P = 0.03). Mortality on day 28 was 13.3% in the r TM group and 27.8% in the control group; these rates were not significantly different(P = 0.26). Multivariate analysis identified only the absence of biliary drainage as significantly associated with persistent DIC(P < 0.01, OR = 12, 95%CI: 2.3-60). Although the difference did not reach statistical significance, primary diseases(malignancies)(P = 0.055, OR = 3.9, 95%CI: 0.97-16) and the non-use of r TM had a tendency to be associated with persistent DIC(P = 0.08, OR = 4.3, 95%CI: 0.84-22).CONCLUSION: The add-on effects of r TM are anticipated in the treatment of AC-induced DIC, although biliary drainage for AC remains crucial. | Keigo Suetani Chiaki Okuse Kazunari Nakahara Yosuke Michikawa Yohei Noguchi Midori Suzuki Ryo Morita Nozomi Sato Masaki Kato Fumio Itoh | 2015 | World Journal of Gastroenterology2015，21，2： | 4 |
| 4 | Covered Metal Stenting for Malignant Lower Biliary Stricture with Pancreatic Duct Obstruction: Is Endoscopic Sphincterotomy Needed?显示文摘 | Kazunari Nakahara Chiaki Okuse Keigo Suetani Yosuke Michikawa Shinjiro Kobayashi Takehito Otsubo Fumio Itoh Peter V. Draganov | 2013 | Gastroenterology Research and Practice2013，，： | 1 |
| 5 | Enteral metallic stenting by balloon enteroscopy for obstruction of surgically reconstructed intestine显示文摘We present three cases of self-expandable metallic stent(SEMS) placement using a balloon enteroscope(BE) and its overtube(OT) for malignant obstruction of surgically reconstructed intestine. A BE is effective for the insertion of an endoscope into the deep bowel. However, SEMS placement is impossible through the working channel, because the working channel of BE is too small and too long for the stent device. Therefore, we used a technique in which the BE is inserted as far as the stenotic area; thereafter, the BE is removed, leaving only the OT, and then the stent is placed by inserting the stent device through the OT. In the present three cases, a modification of this technique resulted in the successful placement of the SEMS for obstruction of surgically reconstructed intestine, and the procedures were performed without serious complications. We consider that the present procedure is extremely effective as a palliative treatment for distal bowel stenosis, such as in the surgically reconstructed intestine. | Kazunari Nakahara Chiaki Okuse Nobuyuki Matsumoto Keigo Suetani Ryo Morita Yosuke Michikawa Shun-ichiro Ozawa Kosuke Hosoya Shinjiro Kobayashi Takehito Otsubo Fumio Itoh | 2015 | World Journal of Gastroenterology2015，21，24： | 1 |
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