慶應義塾研究者情報データベース

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• Distinct phenotype of primary sclerosing cholangitis-associated inflammatory bowel disease

  Okada H., Sugimoto S., Kayashima A., Mikami Y., Kanai T., Nakamoto N., Ueno M., Tabuchi T., Suzuki S., Kaieda Y., Mizushima I., Sunaga S., Usui S., Ojiro K., Taniki N., Kasuga R., Nakadai Y., Kiyohara H., Yoshimatsu Y.

  Journal of Gastroenterology 61 （ 7 ） 863 - 879 2026年07月

  ISSN  09441174

  　概要を見る

  Primary sclerosing cholangitis (PSC) is frequently accompanied by colitis with clinicopathologic features that differ from conventional inflammatory bowel disease (IBD). Accumulating evidence indicates that PSC-associated IBD (PSC-IBD) often presents as extensive colitis with a right-sided predominant distribution and characteristic endoscopic features, such as rectal sparing and backwash ileitis. Beyond endoscopic appearance, PSC-IBD also appears to have distinct biological underpinnings, including shared genetic susceptibility, dysregulated bile acid signaling, altered gut microbial communities, and immune crosstalk along the gut–liver axis. These mechanisms may contribute not only to intestinal inflammation but also to PSC-related clinical outcomes. From a long-term perspective, patients with PSC and colitis are consistently classified as a high-risk group for colorectal neoplasia, warranting early and intensive colonoscopic surveillance. In parallel, surveillance for hepatobiliary malignancies remains central in PSC care, although risk stratification continues to evolve. Therapeutic management generally follows established IBD algorithms, yet the extent to which colitis-directed therapies modify PSC outcomes remains uncertain, with heterogeneous findings across cohorts and endpoints. In this review, we summarize current knowledge on the clinical phenotype, mechanistic framework, and outcome-driven management of PSC-IBD, and highlight future directions toward precision surveillance and mechanism-based interventions targeting bile acid–microbiota–immune interactions.

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• Clinical outcomes of endoscopic papillectomy for ampullary adenoma and adenocarcinoma: a multicenter retrospective study in Japan

  Iwasaki E., Kawashima H., Takada Y., Hara K., Iwai T., Okano N., Kubota K., Yamao T., Yamamoto K., Shiomi H., Ikezawa K., Ushio J., Kato H., Fujimori N., Katanuma A., Ozawa E., Takahara N., Nakahara K., Ueki T., Hashimoto S., Ryozawa S., Isayama H., Irisawa A., Inui K., Fujita N., Kayashima A., Horibe M., Bazerbachi F., Itoi T., Okuno N., Hasegawa R., Igarashi Y., Abe S., Takada R., Yokoyama K., Fujii Y., Matsumoto K., Ishii T., Komatsu N., Nakai Y., Nagayama R., Hinokuchi M., Tanisaka Y., Fujisawa T., Hoshi K.

  Gastrointestinal Endoscopy 103 （ 5 ） 1016 - 1027.e5 2026年05月

  ISSN  00165107

  　概要を見る

  Background and Aims Endoscopic papillectomy (EP) is a minimally invasive treatment for ampullary epithelial tumors. However, clinical outcomes and predictors of recurrence remain unclear. Methods We conducted a multicenter, retrospective cohort study at 22 tertiary centers in Japan, including patients who underwent EP between January 2009 and December 2020. The primary outcome was cumulative recurrence in patients with histologically confirmed adenoma or adenocarcinoma. Recurrence predictors were evaluated using Cox proportional hazards model. Results Of 875 patients, 798 had confirmed ampullary epithelial tumor, and 776 were included in the long-term outcome analysis. The 3-year cumulative recurrence rate was 20%. Indeterminate (Rx) and positive (R1) resection margins were independently associated with higher recurrence compared with negative margins (R0), with hazard ratios of 2.30 (95% CI, 1.44-3.68) and 2.95 (95% CI, 1.85-4.71), respectively. R0 resection was achieved in 52.1% (416/798) of patients, with a 3-year cumulative recurrence rate of 11% (95% CI, 7.6%-15%). Conclusions Recurrence after EP for ampullary epithelial tumors is common, even after R0 resection. These findings highlight the need for long-term surveillance following EP.

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• A case of IgA vasculitis developing in a patient with Crohn’s disease treated with adalimumab

  Yamamoto H., Wakisaka Y., Aoki Y., Kayashima A., Matsunaga T., Watanabe K., Fukuhara S.

  Clinical Journal of Gastroenterology 19 （ 2 ） 462 - 465 2026年04月

  ISSN  18657257

  　概要を見る

  This study aimed to investigate a suggestive case of IgA vasculitis that developed following acute tonsillitis in a patient with Crohn’s disease treated with adalimumab. IgA vasculitis and Crohn’s disease can both cause abdominal pain, joint pain, and erythema, making an early diagnosis difficult. When they occur together, it can be challenging to determine which is the primary condition. Due to similar symptoms, a careful assessment and thorough understanding of each disease’s characteristics are essential for an accurate diagnosis and proper management. In this case, the overlapping of immunological events due to anti-tumor necrosis factor-ɑ (TNF-ɑ) agents and infection, in addition to pre-existing immune abnormalities, may be contributing factors to the development of IgA vasculitis. Based on this experience, we suggest that patients with inflammatory bowel disease receiving anti-TNF-ɑ agents should be monitored not only for the relapse of their underlying disease but also for the development of IgA vasculitis following tonsillitis.

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• Recombinant Human Soluble Thrombomodulin and In-Hospital Mortality in Acute Pancreatitis With Disseminated Intravascular Coagulation: A Japanese Nationwide Study

  Okada H., Horibe M., Sasabuchi Y., Bazerbachi F., Kayashima A., Sato T., Kimura Y., Matsui H., Iwasaki E., Fushimi K., Yasunaga H., Kanai T.

  Critical Care Medicine 54 （ 3 ） 474 - 483 2026年03月

  ISSN  00903493

  　概要を見る

  Objective: – Acute pancreatitis (AP) complicated by disseminated intravascular coagulation (DIC) is associated with high mortality. Although recombinant human soluble thrombomodulin (rTM) is commonly used in clinical practice, its association with outcomes in AP has not been established. Design: – A nationwide, propensity score-matched, retrospective cohort study. Setting: – The Japanese Diagnosis Procedure Combination national inpatient database. Patients: – Adult patients hospitalized with AP and DIC between July 2010 and March 2022, who survived at least 3 days. Patients were divided into those receiving rTM within three days of admission and those who did not. Propensity score matching compared in-hospital mortality. Interventions: – None. Measurements and Main Results: – The analysis included 10, 238 patients with AP and DIC, of whom 2, 001 (19.5%) received rTM and 8, 237 (80.5%) did not. Propensity score matching yielded 1, 868 well-balanced pairs. In-hospital mortality was lower in the rTM group (15.5% [290/1, 868]) compared with the non-rTM group (19.7% [368/1, 868]; risk difference: –4.2%, 95% CI, –6.6% to –1.7%; risk ratio: 0.79, 95% CI, 0.69 to 0.91). Conclusions: – Administration of rTM in patients with AP complicated by DIC was associated with lower in-hospital mortality.

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• Evaluation of a novel contrast-enhanced fluoroscopy protocol for endoscopic retrograde cholangiopancreatography in a phantom model (with video)

  Hayakawa T., Horibe M., Iwasaki E., Bazerbachi F., Suno Y., Sato T., Okada H., Nakajima Y., Mizukami Y., Kayashima A., Seino T., Kawasaki S., Kanai T.

  Den Open 5 （ 1 ）  2025年04月

  　概要を見る

  Objectives: This study evaluated a novel contrast-enhanced (CE) fluoroscopy protocol for endoscopic retrograde cholangiopancreatography, which optimizes image processing to enhance contrast of devices and contrast media. We compared the CE protocol with the conventional standard protocol to assess its potential for reducing radiation exposure while improving image visibility. Methods: The study utilized a multidirectional fluoroscopy unit and phantoms to evaluate the new CE protocol against the conventional protocol. Comparisons included radiation dose rates, spatial resolution, and concentration resolution under various fluoroscopic conditions. The investigation aimed to determine if the CE protocol offered improved visibility while potentially reducing radiation exposure. Results: Three CE protocol modes (LOW-7.5 fps, MID-3.75 fps, and LOW-3.75 fps) achieved lower dose rates than the standard MID-7.5 fps mode commonly used in clinical practice. Dynamic spatial resolution was significantly superior in all three CE modes compared to the standard protocol (p < 0.0167). Static spatial resolution did not differ significantly between protocols. Only the CE MID-3.75 fps mode showed superior concentration resolution compared to the standard protocol (p < 0.00833). Conclusions: The novel CE fluoroscopy protocol provides superior dynamic spatial resolution in endoscopic retrograde cholangiopancreatopgraphy while reducing radiation exposure, potentially enhancing procedure guidance and safety for both patients and clinicians.

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• Non-interventional management of asymptomatic diminutive choledocholithiasis versus endoscopic extraction in consecutive patients (審査報告)

  茅島, 敦人

  （慶應義塾大学大学院医学研究科）  2023年

• Non-interventional management of asymptomatic diminutive choledocholithiasis versus endoscopic extraction in consecutive patients (要約)

  茅島, 敦人

  （慶應義塾大学大学院医学研究科）  2023年

• Non-interventional management of asymptomatic diminutive choledocholithiasis versus endoscopic extraction in consecutive patients (要旨)

  茅島, 敦人

  （慶應義塾大学大学院医学研究科）  2023年

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• The Role of Stone Size in Risk Stratification for Intervention in Asymptomatic Choledocholithiasis

  Kayashima A., Horibe M., Bazerbachi F., Iwasaki E.

  Digestive Diseases and Sciences 69 （ 8 ） 3085 - 3086 2024年08月

  ISSN  01632116

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• Successful transpapillary removal of a migrated percutaneous transhepatic biliary drainage tube with a digital peroral cholangioscope

  Kayashima A., Iwasaki E., Kanai T.

  Digestive Endoscopy 34 （ 1 ） e3 - e4 2022年01月

  ISSN  09155635

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