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| 1 | Endoscopic diagnosis of pancreaticobiliary maljunction显示文摘Pancreaticobiliary maljunction (PBM) is a congenital anomaly defined as a junction of the pancreatic and bile ducts located outside the duodenal wall, usually forming a markedly long common channel. As the action of the sphincter of Oddi does not functionally affect the junction in PBM patients, continuous pancreatobiliary reflux occurs, resulting in a high incidence of biliary cancer. PBM can be divided into PBM with biliary dilatation (congenital choledochal cyst) and PBM without biliary dilatation (maximal diameter of the bile duct ≤ 10 mm). The treatment of choice for PBM is prophylactic surgery before malignant changes can take place. Endoscopic retrograde cholangiopancreatography (ERC P) is the most effective examination method for close obs ervation of the pattern of the junction site. When the communication between the pancreatic and bile ducts is maintained, despite contraction of the sphi ncter on ERCP, PBM is diagnosed. In these pat ients, levels of pancreatic enzymes in the bile are gene rally elevated, due to continuous pancreatobiliary reflux via a long common channel. Magnetic resonance cholangiopancreatography and 3D-computed tomography can diagnose PBM, based on findings of an anomalous union between the common bile duct and the pancreatic duct, in addition to a long common channel. Endoscopic ultrasonography and intraductal ultra sonography can demonstrate the junction outside the duodenal wall, and are useful for the diagnosis of asso ciated biliary cancer. Gallbladder wall thickness on ultra so nography can be a screening test for PBM. | Terumi Kamisawa Kensuke Takuma Fumihide Itokawa Takao Itoi | 2011 | World Journal of Gastrointestinal Endoscopy2011，3，1： | 25 |
| 2 | Strategy to differentiate autoimmune pancreatitis from pancreas cancer显示文摘Autoimmune pancreatitis (AIP) is a newly described entity of pancreatitis in which the pathogenesis appears to involve autoimmune mechanisms. Based on histological and immunohistochemical examinations of various organs of AIP patients, AIP appears to be a pancreatic lesion reflecting a systemic 'IgG4-related sclerosing disease'. Clinically, AIP patients and patients with pancreatic cancer share many features, such as preponderance of elderly males, frequent initial symptom of painless jaundice, development of new-onset diabetes mellitus, and elevated levels of serum tumor markers. It is of uppermost importance not to misdiagnose AIP as pancreatic cancer. Since there is currently no diagnostic serological marker for AIP, and approach to the pancreas for histological examination is generally difficult, AIP is diagnosed using a combination of clinical, serological, morphological, and histopathological features. Findings suggesting AIP rather than pancreatic cancer include:fluctuating obstructive jaundice; elevated serum IgG4 levels; diffuse enlargement of the pancreas; delayed en- hancement of the enlarged pancreas and presence of a capsule-like rim on dynamic computed tomography; low apparent diffusion coefficient values on diffusion-weighted magnetic resonance image; irregular narrowing of the main pancreatic duct on endoscopic retrograde cholangiopancreatography; less upstream dilatation of the main pancreatic duct on magnetic resonance cholangiopancreatography, presence of other organ involvement such as bilateral salivary gland swelling, retroperitoneal fibrosis and hilar or intrahepatic sclerosing cholangitis; negative work-up for malignancy including endoscopic ultrasound-guided fine needle aspiration; and steroid responsiveness. Since AIP responds dramatically to steroid therapy, accurate diagnosis of AIP can avoid unnecessary laparotomy or pancreatic resection. | Kensuke Takuma Terumi Kamisawa Rajesh Gopalakrishna Seiichi Hara Taku Tabata Yoshihiko Inaba Naoto Egawa Yoshinori Igarashi | 2012 | World Journal of Gastroenterology2012，18，10： | 20 |
| 3 | Importance of early diagnosis of pancreaticobiliary maljunction without biliary dilatation显示文摘AIM:To clarify the strategy for early diagnosis of pancreaticobiliary maljunction(PBM) without biliary dilatation and to pathologically examine gallbladder before cancer develops.METHODS:The anatomy of the union of the pancreatic and bile ducts was assessed by using endoscopic retrograde cholangiopancreatography(ERCP).Patients with a long common channel in which communication between the pancreatic and bile ducts was maintained even during sphincter contraction were diagnosed as having PBM.Of these,patients in which the maximal diameter of the bile duct was less than 10 mm were diagnosed with PBM without biliary dilatation.The process of diagnosing 54 patients with PBM without biliary dilatation was retrospectively investigated.Histopathological analysis of resected gallbladder specimens from 8 patients with PBM without biliary dilatation or cancer was conducted.RESULTS:Thirty-six PBM patients without biliary dilatation were diagnosed with gallbladder cancer after showing clinical symptoms such as abdominal or back pain(n = 16) or jaundice(n = 12).Radical surgery for gallbladder cancer was only possible in 11 patients(31%) and only 4 patients(11%) survived for 5 years.Eight patients were suspected as having PBM without biliary dilatation from the finding of gallbladder wall thickening on ultrasound and the diagnosis was confirmed by ERCP and/or magnetic resonance cholangiopancreatography(MRCP).The median age of these 8 patients was younger by a decade than PBM patients with gallbladder cancer.All 8 patients underwent prophylactic cholecystectomy and bile duct cancer has not occurred.Wall thickness and mucosal height of the 8 resected gallbladders were significantly greater than controls,and hyperplastic changes,hypertrophic muscular layer,subserosal fibrosis,and adenomyomatosis were detected in 7(88%),5(63%),7(88%) and 5(63%) patients,respectively.Ki-67 labeling index was high and K-ras mutation was detected in 3 of 6 patients.CONCLUSION:To detect PBM without biliary dilatation before onset of gallbladder cancer,we should perform MRCP for individuals showing increased gallbladder wall thickness on ultrasound. | Kensuke Takuma Terumi Kamisawa Taku Tabata Seiichi Hara Sawako Kuruma Yoshihiko Inaba Masanao Kurata Goro Honda Koji Tsuruta Shin-ichiro Horiguchi Yoshinori Igarashi | 2012 | World Journal of Gastroenterology2012，18，26： | 13 |
| 4 | Sclerosing cholangitis associated with autoimmune pancreatitis differs from primary sclerosing cholangitis显示文摘AIM:To clarify the characteristic features of biliary le-sions in patients with autoimmune pancreatitis(AIP) and compare them with those of primary sclerosing cholangitis(PSC) .METHODS:The clinicopathological characteristics of 34 patients with sclerosing cholangitis(SC) associated with AIP were compared with those of 4 patients with PSC.RESULTS:SC with AIP occurred predominantly in el-derly men.Obstructive jaundice was the most frequent initial symptom in SC with AIP.Only SC patients with AIP had elevated serum IgG4 levels,and sclerosing diseases were more frequent in these patients.SC pa-tients with AIP responded well to steroid therapy.Seg-mental stenosis of the lower bile duct was observed only in SC patients with AIP,but a beaded and pruned-tree appearance was detected only in PSC patients.Dense infi ltration of IgG4-positive plasma cells was de-tected in the bile duct wall and the periportal area,as well as in the pancreas,of SC patients with AIP.CONCLUSION:SC with AIP is distinctly different from PSC.The two diseases can be discriminated based on cholangiopancreatographic findings and serum IgG4 levels. | Terumi Kamisawa Kensuke Takuma Hajime Anjiki Naoto Egawa Masanao Kurata Goro Honda Kouji Tsuruta | 2009 | World Journal of Gastroenterology2009，15，19： | 9 |
| 5 | Utility of pancreatography for diagnosing autoimmune pancreatitis显示文摘AIM: To identify pancreatographic findings that facilitate differentiating between autoimmune pancreatitis (AIP) and pancreatic cancer (PC) on endoscopic retrograde cholangiopancreatography (ERCP) and magnetic resonance cholangiopancreatography (MRCP). METHODS: ERCP findings of 48 AIP and 143 PC patients were compared. Diagnostic accuracies for AIP by ERCP and MRCP were compared in 30 AIP patients. RESULTS: The following ERCP findings suggested a diagnosis of AIP rather than PC. Obstruction of the main pancreatic duct (MPD) was more frequently detected in PC (P < 0.001). Skipped MPD lesions were detected only in AIP (P < 0.001). Side branch derivation from the narrowed MPD was more frequent in AIP (P < 0.001). The narrowed MPD was longer in AIP (P < 0.001), and a narrowed MPD longer than 3 cm was more frequent in AIP (P < 0.001). Maximal diameter of the upstream MPD was smaller in AIP (P < 0.001), and upstream dilatation of the MPD less than 5 mm was more frequent in AIP (P < 0.001). Stenosis of the lower bile duct was smooth in 87% of AIP and irregular in 65% of PC patients (P < 0.001). Stenosis of the intrahepatic or hilar bile duct was detected only in AIP (P = 0.001). On MRCP, diffuse narrowing of the MPD on ERCP was shown as a skipped non-visualized lesion in 50% and faint visualization in 19%, but segmental narrowing of the MPD was visualized faintly in only 14%. CONCLUSION: Several ERCP findings are useful for differentiating AIP from PC. Although MRCP cannot replace ERCP for the diagnostic evaluation of AIP, some MRCP findings support the diagnosis of AIP. | Kensuke Takuma Terumi Kamisawa Taku Tabata Yoshihiko Inaba Naoto Egawa Yoshinori Igarashi | 2011 | World Journal of Gastroenterology2011，17，18： | 6 |
| 6 | Differences between diffuse and focal autoimmune pancreatitis显示文摘AIM:To investigate differences in clinical features between diffuse-and focal-type autoimmune pancreatitis(AIP).METHODS:Based on radiological findings by computed tomography and/or magnetic resonance imaging,we divided 67 AIP patients into diffuse type(D type) and focal type(F type).We further divided F type into head type(H type) and body and/or tail type(B/T type) according to the location of enlargement.Finally,we classified the 67 AIP patients into three groups:D type,H type and B/T type.We compared the three types of AIP in terms of clinical,laboratory,radiological,functional and histological findings and clinical course.RESULTS:There were 34 patients with D-type,19 with H-type and 14 with B/T-type AIP.Although obstructive jaundice was frequently detected in D-typepatients(88%) and H-type patients(68%),no B/T-type patients showed jaundice as an initial symptom(P < 0.001).There were no differences in frequency of abdominal pain,but acute pancreatitis was associated more frequently in B/T-type patients(36%) than in D-type patients(3%)(P = 0.017).Serum immunoglobulin G(IgG)4 levels were significantly higher in D-type patients(median 309 mg/dL) than in B/T-type patients(133.5 mg/dL)(P = 0.042).Serum amylase levels in B/T-type patients(median:114 IU/L) were significantly greater than in H-type patients(72 IU/L)(P = 0.049).Lymphoplasmacytic sclerosing pancreatitis(LPSP) was histologically confirmed in 6 D-type,7 H-type and 4 B/T-type patients;idiopathic duct-centric pancreatitis was observed in no patients.Marked fibrosis and abundant infiltration of CD20-positive B lymphocytes with few IgG4-positive plasma cells were detected in 2 B/T-type patients.Steroid therapy was effective in all 50 patients(31 D type,13 H type and 6 B/T type).Although AIP relapsed during tapering or after stopping steroids in 3 D-type and 3 H-type patients,no patients relapsed in B/T type.During follow-up,radiological features of 6 B/T-type patients were not changed and 1 B/T-type patient improved naturally.CONCLUSION:Clinical features of H-type AIP were similar to those of D-type,but B/T-type differed from D and H types.B/T-type may involve diseases other than LPSP. | Taku Tabata Terumi Kamisawa Kensuke Takuma Seiichi Hara Sawako Kuruma Yoshihiko Inaba | 2012 | World Journal of Gastroenterology2012，18，17： | 6 |
| 7 | High Th1/Th2 ratio in patients with multiple myeloma显示文摘 | Hatsue Ogawara Hiroshi Handa Tohru Yamazaki Takuma Toda Kensuke Yoshida Natsumi Nishimoto Wedad Hamdi Saleh Al-ma’Quol Yoriaki Kaneko Takafumi Matsushima Norifumi Tsukamoto Yoshihisa Nojima Morio Matsumoto Morio Sawamura Hirokazu Murakami | 2004 | Leukemia Research2004，，2： | 3 |
| 8 | Clinical implications of accessory pancreatic duct显示文摘The accessory pancreatic duct (APD) is the main drainage duct of the dorsal pancreatic bud in the embryo,entering the duodenum at the minor duodenal papilla (MIP).With the growth,the duct of the dorsal bud undergoes varying degrees of atrophy at the duodenal end.Patency of the APD in 291 control cases was 43% as determined by dye-injection endoscopic retrograde pancreatography.Patency of the APD in 46 patients with acute pancreatitis was only 17%,which was significantly lower than in control cases (P < 0.01).The terminal shape of the APD was correlated with APD patency.Based on the data about correlation between the terminal shape of the APD and its patency,the estimated APD patency in 167 patients with acute pancreatitis was 21%,which was signif icantly lower than in control cases (P < 0.01).A patent APD may function as a second drainage system for the main pancreatic duct to reduce the pressure in the main pancreatic duct and prevent acute pancreatitis.Pancreatographic f indings of 91 patients with pancreaticobiliary maljunction (PBM) were divided into a normal duct group (80 patients) and a dorsal pancreatic duct (DPD) dominant group (11 patients).While 48 patients (60%) with biliary carcinoma (gallbladder carcinoma,n=42;bile duct carcinoma,n=6) were identified in PBM with a normal pancreatic duct system,only two cases of gallbladder carcinoma (18%) occurred in DPD-dominant patients (P < 0.05).Concentration of amylase in the bile of DPD dominance was signifi cantly lower than that of normal pancreatic duct system (75 403.5 ± 82 015.4 IU/L vs 278 157.0 ± 207 395.0 IU/L,P < 0.05).In PBM with DPD dominance,most pancreatic juice in the upper DPD is drained into the duodenum via the MIP,and reflux of pancreatic juice to the biliary tract might be reduced,resulting in less frequency of associated biliary carcinoma. | Terumi Kamisawa Kensuke Takuma Taku Tabata Naoto Egawa | 2010 | World Journal of Gastroenterology2010，16，36： | 2 |
| 9 | Comparison between the location and the histomorphological/immunohistochemical characteristics of noninvasive neoplasms of the ampulla of Vater显示文摘 | Yoshiro Yamamoto Tetsuo Nemoto Yoichiro Okubo Yasuhiro Nihonyanagi Takao Ishiwatari Kensuke Takuma Naobumi Tochigi Naoki Okano Megumi Wakayama Yoshinori Igarashi Kazutoshi Shibuya | 2014 | Human Pathology2014，，9： | 1 |
| 10 | Short-term and long-term outcomes of autoimmune pancreatitis显示文摘 | Kensuke Takuma Terumi Kamisawa Taku Tabata Yoshihiko Inaba Naoto Egawa Yoshinori Igarashi | 2011 | European Journal of Gastroenterology & Hepatology2011，，2： | 1 |
| 11 | Adenosquamous carcinoma of the pancreas associated with humoral hypercalcemia of malignancy (HHM)显示文摘 | Noritoshi Kobayashi Takuma Higurashi Hiroshi Iida Hironori Mawatari Hiroki Endo Yuichi Nozaki Ayako Tomimoto Kyoko Yoneda Tomoyuki Akiyama Koji Fujita Hirokazu Takahashi Masato Yoneda Masahiko Inamori Yasunobu Abe Hiroyuki Kirikoshi Kensuke Kubota Satoru | 2008 | Journal of Hepato-Biliary-Pancreatic Surgery2008，，5： | 1 |
| 12 | Utility of combining assessment of right ventricular function and right atrial remodeling as a prognostic factor for patients with pulmonary hypertension显示文摘 | Yuko Fukuda Hidekazu Tanaka Yoshiki Motoji Keiko Ryo Takuma Sawa Junichi Imanishi Tatsuya Miyoshi Yasuhide Mochizuki Kazuhiro Tatsumi Kensuke Matsumoto Toshiro Shinke Noriaki Emoto Ken-ichi Hirata | 2014 | The International Journal of Cardiovascular Imaging2014，，7： | 1 |
| 13 | Short-term anti long-term outcomes of autoimmune panereatitis 显示文摘 | Kensuke Takuma Terumi Kamisawa Taku Tabata el al | 2011 | Euro J Gastroentero Hepatol2011，23，1： | 1 |
| 14 | Right Ventricular Function and Right-Heart Echocardiographic Response to Therapy Predict Long-term Outcome in Patients With Pulmonary Hypertension显示文摘 | Hiroyuki Sano Hidekazu Tanaka Yoshiki Motoji Yuko Fukuda Takuma Sawa Yasuhide Mochizuki Keiko Ryo Kensuke Matsumoto Noriaki Emoto Ken-ichi Hirata | 2015 | Canadian Journal of Cardiology2015，，4： | 1 |
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