研究者詳細 - 堀部　昌靖

堀部　昌靖（ホリベ　マサヤス）

Horibe, Masayasu

写真a

所属（所属キャンパス）: 医学部内科学教室（消化器）（信濃町）

職名: 専任講師（有期）

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Discordant risk factors between pancreatic neuroendocrine neoplasms and pancreatic ductal adenocarcinoma

Chandra S., Halfdanarson T.R., Carlson E.E., Rabe K.G., Mahipal A., Majumder S., Bamlet W.R., Horibe M., Tella S.H., Shariq O., Carr R.M., Cleary S.P., Oberg A.L., Antwi S.O.

Endocrine Related Cancer 32 （ 4 ） 2025年04月

ISSN 13510088

　概要を見る

Pancreatic neuroendocrine neoplasm (panNEN) is a rare malignancy and the second most common type of pancreatic cancer after pancreatic ductal adenocarcinoma (PDAC), but its etiology is poorly understood. We investigated whether the risk factors of panNEN are concordant with those known for PDAC. We performed the largest case-control study to date on panNENs, comprising 927 sporadic nonfunctional panNEN cases and 1807 frequency-matched controls, using data from the Mayo Clinic Biospecimen Resource for Pancreas Research. We assessed associations for obesity, first-degree family history of pancreatic cancer, cigarette smoking, overall type II diabetes mellitus (T2DM), new-onset T2DM (<1 year before panNEN diagnosis), longstanding T2DM (≥5 years), alcohol intake and aspirin use. Multivariable logistic regression was used to calculate odds ratios and 95% confidence intervals (CIs). Our results show that overall T2DM (OR = 1.71, 95% CI: 1.37–2.14) and new-onset T2DM (OR = 2.65, 95% CI: 1.92–3.69) are associated with higher odds of panNEN, but not longstanding T2DM (OR = 1.29, 95% CI: 0.94–1.75). A non-significant elevated odds of panNEN was observed among participants with a positive family history of pancreatic cancer (OR = 1.44, 95% CI: 0.96–2.14). Alcohol use was inversely related to panNEN (OR = 0.52, 95% CI: 0.42–0.66, ever-vs-never). No association was observed for smoking, obesity or aspirin use. These findings indicate that overall T2DM and new-onset T2DM are associated with higher odds of panNEN. Unlike PDAC, alcohol use was inversely related to panNEN, and we found no associations for cigarette smoking, obesity or aspirin use. These results indicate differences in the risk factor profiles of panNEN and PDAC.
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Feasibility of endoscopic submucosal dissection including papilla (with video)

Yahagi N., Takatori Y., Sasaki M., Imura Y., Murata S., Sato T., Minezaki D., Hayakawa T., Nakajima Y., Okada H., Sakurai H., Tojo A., Iwata K., Miyazaki K., Kayashima A., Masunaga T., Mizutani M., Akimoto T., Seino T., Kawasaki S., Horibe M., Fukuhara S., Matsuura N., Sujino T., Nakayama A., Takabayashi K., Iwasaki E., Kato M.

Digestive Endoscopy 37 （ 4 ） 402 - 410 2025年04月

ISSN 09155635

　概要を見る

Objectives: Endoscopic papillectomy (EP) is a low-invasive treatment for duodenal tumors including papilla. The limit of lesion size and local recurrence have been issues in EP. We developed endoscopic submucosal dissection (ESD) for the duodenal tumors including papilla (ESDIP: ESD including papilla) to overcome the problems. The aim of this study was to evaluate the feasibility of ESDIP. Methods: We included the patients who underwent ESDIP from August 2010 to January 2024 in this study. We evaluated the retrospective characteristics of patients and lesions, clinical results of ESDIP and of endoscopic retrograde cholangiopancreatography (ERCP) as prevention for delayed adverse events, and pathological findings. We also calculated the cumulative recurrence rate and overall survival rate at 12 months after ESDIP. Results: Fifty-four patients were included in this study. The mean lesion size was 39 mm. The third-quarter cases revealed a less than half-circumferential lesion, and the one case with a full-circumferential lesion. Resection was accomplished in 96% (n = 52), and also the en-bloc resection rate was 96%. Of the cases in accomplished resection, 98% of patients were intubated with a pancreaticobiliary drainage tube by ERCP. Intraprocedural perforation occurred in eight cases. Delayed bleeding occurred in 10 cases. Delayed perforation was seen only in one case. The incidence of post-ERCP pancreatitis was 25%. Cumulative local recurrence rate and the overall survival rate were 15% and 96%, respectively. Conclusion: ESDIP may be feasible for duodenal tumors including papilla, and is a potential alternative option to avoid pancreaticoduodenectomy.
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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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Bodyweight-Adjusted Nonsteroidal Anti-inflammatory Drugs Dose in the Prevention of Post-endoscopic Retrograde Cholangiopancreatography Pancreatitis

Kayashima A., Horibe M., Iwasaki E., Bazerbachi F., Kawasaki S., Kanai T.

Pancreas 54 （ 3 ） e188 - e193 2025年03月

ISSN 08853177

　概要を見る

Objectives: Although rectal nonsteroidal anti-inflammatory drugs (NSAIDs) reduce the incidence of postendoscopic retrograde cholangiopancreatography pancreatitis (PEP), their optimal dosage is unknown. Given possible interindividual variability in the pharmacodynamics of NSAIDs, we hypothesized that the dose required to achieve adequate PEP prophylaxis varies with body weight. Materials and Methods: We conducted an analysis using single-center, prospective, observational cohort study data. The primary outcome was PEP incidence by NSAID dosage per body weight (mg/kg). Patients meeting the inclusion criteria were classified into 3 groups. Results: We included 891 patients, with 400, 454, and 37 patients in the control group with no NSAID therapy, the NSAID <1.0 mg/kg group, and the NSAID ≥1.0 mg/kg group, respectively. In the adjusted cohort, the odds ratio of PEP was 0.18 (95% confidence interval: 0.041–0.79; P = 0.023) for NSAID ≥1.0 mg/kg and 1.3 (95% confidence interval: 0.76–2.3; P = 0.31) for NSAID <1.0 mg/kg compared to the control group without NSAID. Conclusions: PEP was not prevented by NSAID dosages below 1.0 mg/ kg body weight whereas a dosage above 1.0 mg/kg body weight had a significant prophylactic effect. An NSAID dosage adjusted to body weight may be necessary to achieve an adequate prophylactic effect against PEP.
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Capnographic monitoring using a novel mainstream system during endoscopic ultrasound and endoscopic retrograde cholangiopancreatography: A prospective randomized controlled trial

Takimoto Y., Iwasaki E., Horibe M., Fukuhara S., Minami K., Kawasaki S., Masaoka T., Ogata H., Bazerbachi F., Kanai T.

Journal of Hepato Biliary Pancreatic Sciences 32 （ 3 ） 254 - 263 2025年03月

ISSN 18686974

　概要を見る

Background/Purpose: Insufficient studies exist on capnography efficacy during endoscopic ultrasound or endoscopic retrograde cholangiopancreatography, and no definitive conclusions have been drawn. To evaluate the feasibility and efficacy of a novel mainstream capnography using an over-the-biteblock end-tidal CO<inf>2</inf> (EtCO<inf>2</inf>) detector in decreasing the risk of hypoxemia during endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP). Methods: Patients undergoing EUS or ERCP with conscious sedation at a single Japanese center were randomized to a control or a novel capnography monitored (intervention) group in a 1:1 ratio. Hypoxemia correction maneuvers were pursued if the oxygen saturation decreased to <92% in the control or intervention group and if a 15-s suspension of EtCO<inf>2</inf> wave occurred in the intervention group. The primary outcome was the incidence of hypoxemic events, defined as oxygen saturation <90%, during the procedures. Secondary outcomes included technical feasibility of EUS and ERCP with the use of this novel over-the-biteblock monitor. Results: In total, 250 patients were enrolled without dropouts or missing data (control group: 125; capnography group: 125). There was no significant difference in the incidence of hypoxemia between the control and capnography groups (29.6% [37/125] vs. 26.4% [33/125]; p =.573). The estimated odds ratio was 0.925 (95% confidence interval: 0.708–1.208). The EtCO<inf>2</inf> concentration was successfully captured without impeding endoscopic maneuvers from the beginning to the end of the procedure in all patients. Conclusions: Although the novel mainstream capnography with an over-the-biteblock EtCO<inf>2</inf> detector captures the EtCO<inf>2</inf> concentration in EUS or ERCP under conscious sedation, it does not lead to the prevention of hypoxemia.
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