Nippon Shokakibyo Gakkai Zasshi
Online ISSN : 1349-7693
Print ISSN : 0446-6586
Volume 117, Issue 9
Displaying 1-10 of 10 articles from this issue
Monthly report (General review article); Acute liver failure -up to date-
Monthly report (Review article); Acute liver failure -up to date-
Original article
  • Satoru SEKOGUCHI, Hitomi HIROSE, Kanami IKEDA, Satoki YAMANE, Seiko HA ...
    2020 Volume 117 Issue 9 Pages 779-787
    Published: September 10, 2020
    Released on J-STAGE: September 10, 2020
    JOURNAL FREE ACCESS

    Gastroenterologists working in hospitals that have adopted the chief physician system are often required to work overtime during the night and on holidays treating critically ill patients and ordering emergency tests. To help alleviate the attending physician's duties, our hospital initiated an on-call system in October 2019 to replace the existing system. Changes in overtime hours worked and business stress before and after the introduction of the on-call system were verified. After the introduction of the on-call system, both overtime hours and the number of holidays worked decreased and work stress was reduced. We report that the on-call system is a suitable alternative to the attending physician system because it increases the work efficiency and satisfaction of attending physicians.

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  • Kiyonori KUSUMOTO, Yoshitaka NAKAI, Yoshio ITOKAWA, Kentaro AOKI, Masa ...
    2020 Volume 117 Issue 9 Pages 788-795
    Published: September 10, 2020
    Released on J-STAGE: September 10, 2020
    JOURNAL FREE ACCESS

    Objective : The aim of this study was to determine if the difference in serum amylase levels prior to, and two hours following, an endoscopic retrograde cholangiopancreatography (ERCP), or the ratio of the two-hour post-ERCP amylase level to the pre-ERCP amylase level was a better predictor of post-ERCP pancreatitis (PEP). Methods : This was a retrospective, single-center study of consecutive patients, who underwent ERCP between April 2015 and August 2018. Serum amylase was measured before and two hours following ERCP. We compared the difference and the ratio of the two levels in predicting PEP using a receiver operating characteristic (ROC) curve analysis. Results : A total of 1029 patients underwent ERCP, with PEP occurring in 118 (11.5%). Multivariate analysis revealed that an elevated two-hour post-ERCP serum amylase level was a significant predictor of PEP. ROC analysis of the difference and the ratio of the two levels found good performance for both parameters, with an area under the curve (AUC) of 0.861 (95% confidence interval [CI], 0.823-0.900) and 0.847 (95% CI, 0.809-0.886), respectively. The difference between the values was a significantly more effective predictor of PEP, based on the AUC analysis (P = 0.011). Conclusion : The difference between pre and two-hour post-ERCP amylase levels is a better predictor of PEP than the ratio of the two.

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Case report
  • Ryohei ANDO, Chiaki SATOH, Toshiaki FUKUTOMI, Hiroshi OKAMOTO, Kai TAK ...
    2020 Volume 117 Issue 9 Pages 796-801
    Published: September 10, 2020
    Released on J-STAGE: September 10, 2020
    JOURNAL FREE ACCESS

    The patient was a male in his 70s with a history of distal gastrectomy and Billroth-I reconstruction. He was suspected of having esophageal achalasia and was started on calcium blockers in X-2 year. The symptoms worsened, and he presented to our hospital in X year. We diagnosed esophageal achalasia (Chicago classification ver. 3.0;type I), and conducted per-oral endoscopic myotomy (POEM). His postoperative course was uneventful with no postoperative symptoms. In cases of esophageal achalasia following distal gastrectomy, it is important to consider adhesions, mobility of the remaining stomach, and preservation of the short gastric artery and vein. Since the Heller-Dor operation can be difficult, POEM may be a reasonable alternative in these cases.

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  • Daiki ABE, Daisuke ASAOKA, Atsushi IKEDA, Noboru YATAGAI, Yoichi AKAZA ...
    2020 Volume 117 Issue 9 Pages 802-810
    Published: September 10, 2020
    Released on J-STAGE: September 10, 2020
    JOURNAL FREE ACCESS

    While hospitalized due to severe aortic stenosis, an 84-year-old woman developed repeated bleeding from angiodysplasia in the stomach leading to a diagnosis of Heyde syndrome. Following transcatheter aortic valve implantation (TAVI), there was no recurrence of bleeding from the angiodysplasia, and the decrease in von Willebrand factor levels that caused Heyde syndrome also improved. It was felt that the TAVI was able to prevent the recurrence of gastrointestinal bleeding due to angiodysplasia in Heyde syndrome.

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  • Yuki NISHIWAKI, Takeshi BABA, Saori MIZUTANI, Satoko YOKOYAMA, Aya HOJ ...
    2020 Volume 117 Issue 9 Pages 811-818
    Published: September 10, 2020
    Released on J-STAGE: September 10, 2020
    JOURNAL FREE ACCESS

    Vascular complications from a liver abscess are rare but life-threatening. Herein, we report the case of a man in his 40s with a pyogenic hepatic abscess complicated by an inferior vena caval thrombus extending to the right atrium. His presenting complaint was a high fever. Blood tests revealed elevated inflammatory markers and liver enzymes. An abdominal CT demonstrated a 10cm abscess in the right hepatic lobe. A blood culture grew Streptococcus intermedius, which was sensitive to ampicillin sulbactam. He was diagnosed with a pyogenic liver abscess and treated with metronidazole and ampicillin sulbactam. Three days following admission, an abdominal CT scan revealed the thrombus extending from the liver abscess into the right atrium. He underwent thrombectomy and received antibiotic therapy. Postoperatively, abdominal ultrasound revealed a significant decrease in the size of the hepatic abscess. The patient was discharged in good condition on the 46th day of hospitalization. When encountering a hepatic abscess, it is important to consider that it may be associated with a thrombus extending from the inferior vena cava into right atrium.

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