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To investigate the usefulness of endoscopic ultra-sound-guided fine needle aspiration (EUS-FNA) in the differentiation of autoimmune pancreatitis (AIP).We retrospectively reviewed 47 of 56 AIP patients who underwent EUS-FNA and met the Asian diagnostic criteria. On 47 EUS-FNA specimens, we evaluated the presence of adequate material and characteristic features of lymphoplasmacytic sclerosing pancreatitis (LPSP) and idiopathic duct-centric pancreatitis (IDCP) mentioned in the International Consensus Diagnostic Criteria and examined if these findings make a contribution to the differential diagnosis of type 1 and type 2 AIP. A disposable 22-gauge needle was used for EUS-FNA.Adequate specimens including pancreatic tissue for differentiating AIP from cancer were obtained from 43 of 47 patients who underwent EUS-FNA. EUS-FNA was performed from the pancreatic head in 21 cases, which is known to be technically difficult when performed by core biopsy; there was no significant difference in the results compared with pancreatic body-tail. Nine of 47 patients met level 1 findings of LPSP and 5 patients met level 2 findings of LPSP. No one met level 1 findings of IDCP, but 3 patients met level 2 findings of IDCP. Of 10 seronegative cases, 2 cases were diagnosed with "definitive type 1 AIP", and 3 cases were diagnosed with "probable type 2 AIP" when considering both the level 2 histological findings and response to steroids.EUS-FNA is useful in the differentiation of type 1 and type 2 AIP, particularly in seronegative cases.

The average doses of midazolam, meperidine, fentanyl, and diphenhydramine used for conscious sedation were 6 mg, 68 mg, 127 mcg, and 44 mg, respectively. The EUS team included an endosonographer and two R.N’s. Three (3/479, 0.63%) complications (1 bleeding, 1 micro-perforation and 1 pancreatitis, no mortality) were encountered, which required ED evaluation; only 2 patients were hospitalized for an average 5-day length of stay. In 3 patients, reversal agents were used for over-sedation; 2 patients could not be sedated and required rescheduling of procedure with deep sedation. Conclusion: Our experience, which was the largest yet reported in this area, showed that: 1) EUS could be performed safely in AECs by specialty-trained endoscopists, and 2) conscious sedation with benzodiazepine/narcotic combination could be administered safely in this setting when patients had ASA status 3 or lower.

Mo1514 Relationship Between NBI-ME Images and Mucin Phenotypes of Early Gastric Cancer Hidezumi Tatematsu, Ryoji Miyahara, Kohei Funasaka, Kakunori Banno, Keiichi Sakamaki, Masanao Nakamura, Hiroki Kawashima, Akihiro Itoh, Naoki Ohmiya, Yoshiki Hirooka, Osamu Watanabe, Osamu Maeda, Takafumi Ando, Hidemi Goto Nagoya University graduate School of Medicine, Nagoya, Japan; Department of endoscopy, Nagoya University Hospital, Nagoya, Japan Background: In Japan, Narrow-band imaging with magnifying endoscope(NBIME) is widely used to diagnose of gastric cancers and determine of its extent. However because of its complicated surrounding mucosa and mucin phenotype, there is no comparable classification equivalent to Kudo’s Pit Pattern Classification in the colon. Biological and clinical behavior of gastric type adenocarcinoma has been suspected of being highly malignant. We hope that the several patterns of NBI-ME images could be clearly classified based on mucin phenotype. Aims: The aim of this study is to clarify the correlation between NBIME images and mucin phenotype. Material and Methods: We examined 147 early gastric cancers (122 differentiated type and 25 undifferentiated type) at our hospital between June 2006 and May 2010. NBI-ME images were divided into the elevated type or dpressed type, and then classified based on micromucosal patterns (granular, villous, unclear) and microvascular patterns (chain loop, spiral, fine network, corkscrew, unclassified). Finally micromucosal patterns were combined with microvascular patterns and assessed. Cases were also divided into four mucin phenotypes according to the expression of mucin immunohistochemical staining (using monoclonal antibodies against MAC5AC, MUC6, MUC2, CD10); gastric mucin phenotype (G-type),intestinal mucin phenotype(I-type), mix gastric and intestinal phenotype (M-type),and Null phenotype(N-type). NBI-ME classification was compared with histological findings and mucin phenotype. Results: Among the differentiated type adenocarcinoma, G-type, I-type, M-type, N-type were observed in 21.3%, 32.0%, 45.1%, and 1.6%, respectively. In undifferentiated type adenocarcinoma, G-type, I-type, M-type, N-type were observed in 48%, 8%, 44%, and 0%, respectively. Sensitivity for “granular chain loop pattern”obtained by NBI-ME were 81.4% (35/43) at early differentiated gastric adenocarcinoma with G-type. In undifferentiated depressed type adenocarcinoma lesions,corkscrew pattern was observed in 81.3% (13/16), all lesions had component of G-type, and 8 of them showed organoid differentiation. Conclusions: NBI-ME image that show“granular chain loop pattern”may be able to predict the G-type.

patients and EGD in 23/30 (76.67%) patients. Regarding the number of lesions, CE could detect 14 additional lesions other than gastritis, the same number of lesions found by EGD that includes: 1 angyodisplasia, 2 adenomatous polyps, 6 gastric ulcers (being 1 an early gastric cancer), 3 intestinal metaplasia. Helicobacter pylori was present in 14/30 patients (46.66%) Biopsy from EGD revealed gastritis in 26/30 patients, being 25/26 active atrophic chronic gastritis and 1/26 active non atrophic chronic gastritis.Finally in this study the sensitivity and specificity of CE to detect gastritis was 88% and 66% respectively. Conclusion: In spite of the limitations of this study (number of patients and one tip CE), CE has a good sensitivity compared to EGD for the detection of gastritis and gastric lesions. CE could be a screening method to decide which patients should be submitted to Endoscopy with biopsy. In the future this indication could diminish the number of EGDs performed per year as well as the price of CE, which could have a good economic impact.

tion. Methods: Twenty two kidney transplant candidates, of average age of 50 years (range 25-64), on maintenance hemodialysis, were treated with peginterferon alpha-2a before enlistment for kidney transplantation, 18/22 were after kidney graft failure. 12/22 underwent graft nephrectomy before treatment, 6 patients were treated with retained nonfunctional allograft. All patient were infected with genotype 1b, pretreatment HCV RNA ranged from 120 IU/mL to 3,5 millions IU/mL. Peginterferon alpha-2a was administered once weekly (180 μg), anticipated duration of treatment was 48 weeks with follow-up period of 24 weeks. In 9 patients with hemoglobin concentration above 9,0 g/dL, ribavirin 200 mg twice a week was added. Results: Sustained virological response (SVR) was achieved in 16/22 (72,7%) patients. Four patients were nonresponders and 2 patients relapsed. In 9 patients, antiviral treatment was stopped prematurely at a median of 22 weeks (range 14-32) due to adverse events or lack of efficacy (4 nonresponders, 3 anemia, 2 retained graft rejection). 2/6 patients with retained kidney allograft (12 and 11 months after graft failure) presented with fever, anemia and abdominal pain in 14th and 20th week of therapy. Physical examination, radiographic and laboratory findings confirmed nonfunctional graft rejection. Peginterferon alpha-2a treatment was prematurely discontinued and both patients underwent graftectomy. Histologic findings in both grafts prooved acute rejection type III. Although the treatment was discontinued prematurely, both patients achieved SVR. Four patients with retained kidney more than 12 months after graft failure had no symptoms of graft rejection. Conclusion: Antiviral treatment of chronic hepatitis C in kidney transplant candidates with peginterferon alpha-2a and reduced dose of ribavirin is highly effective. In patients with retained kidney allograft, the treatment should be started more than 12 months after graft failure. In early treated patients, graftectomy is recommended. Supported by grant IKEM MZ0 00023001.

(Backgrounds)To detect significant fibrosis in chronic hepatitis is important to determine the timing of treatment intervention. Liver biopsy is still a gold standard until now, though it is quite invasive. In this study, we evaluate the utility of some laboratory tests and indeces that are related to liver fibrosis and found new formulas that is considered to be more effective than previously reported indeces and proposed as one of the noninvasive and easy diagnostic tool. (Patients and Methods) 95 patients with chronic hepatitis who have also done liver biopsy were included in this study. We evaluated the relationship between significant fibrosis (Metavir score≧2) and age, sex, serum AST, ALT, γGTP, hyaruronan, Procollagen-III-peptide (P-III-P), type IV collagen, platelet counts (Plt) as single serum marker, and AST/ALT ratio (AAR), AP index, and AST to platelet ratio index (APRI) as fibrosis indeces. In univariate analysis, Students' t-test was applied in continuous values and Chi-square test was applied in categorical values. In multivariate analysis, logistic regression analysis was done. P

Tumors of the minor papilla of the duodenum are quite rare. We successfully and safely treated an 18-mm adenoma of the minor papilla associated with pancreas divisum using endoscopic papillectomy. A 64-year-old man was admitted to our hospital for treatment of an asymptomatic mass in the minor papilla detected by upper gastrointestinal endoscopy. Endscopic analysis showed an 18-mm, whitish, sessile mass, located in the duodenum proximal to a normal-appearing major papilla. Endoscopic retrograde pancreatography did not reveal the pancreatic duct. Magnetic resonance cholangiopancreatography showed a lack of the ventral pancreatic duct. We suspected this case was associated with pancreatic divisum; therefore, we performed endoscopic papillectomy of the minor papilla tumor. Subsequently, endoscopic pancreatic stent placement in the minor papilla was done to prevent drainage disturbance. The patient has been asymptomatic without recurrence of tumor or stenosis of the Santorini orifice upon endoscopic examination for the past 2 years.

膵疾患診断における超音波内視鏡（EUS）の有用性は既に確立されており，必須の検査法であるといえる．基本となるB-mode画像において，電子走査方式EUSはメカニカルラジアル走査方式に比して同等以上の画質が得られることが証明されたことで，EUSの主流がメカニカルラジアル走査方式から電子走査方式（電子ラジアル型，電子コンベックス型）に変化することは必然的なものとなる．電子走査方式になることで，ティッシュハーモニックイメージング法，カラードプラ断層法·パワードプラ断層法，造影ハーモニックイメージング法，三次元画像，real time tissue elastography®などすでに体外式超音波検査（US）では広く臨床応用されている技術がEUSで行えるようになった．このように多方面からのtissue characterizationが可能になったことは膵疾患診断に関する有用性がさらに向上したことを意味する．今後はさらに症例を蓄積し明確な臨床的有用性を証明してゆく必要がある．本稿では，電子走査型EUSで可能になった種々の画像診断法に関して概説する．

13503 Background: Dendritic cells (DCs) play a pivotal role in T cell-mediated immunity. Usually, mature DCs were cultured using resected tumor tissue, but for inoperable cases, this method is impractical. The injection of immature DCs into the tumor after appropriate chemotherapy is reasonable, if DCs come to maturity capturing the specific cancer antigen . The aim of this study is to assess the toxicity and efficacy of combined treatment with immunotherapy and chemotherapy for locally advanced pancreatic carcinoma. Methods: Five patients with pathologically confirmed pancreatic ductal carcinoma using EUS-FNA were enrolled, median age 56 years (range, 46–70 years). All cases without distant metastasis were diagnosed as surgically unresectable . Patients underwent leukapheresis, immature DCs were prepared from peripheral blood by a culture with granulocyte macrophage colony-stimulating factor and interleukin 4. Lymphokine-activated killer (LAK) were also prepared from peripheral blood. Immature DCs were injected biweekly in the mass by endoscopic ultrasound-guided fine needle injection (EUS-FNI), LAK were administered intravenously. Patients received the treatment of gemcitabine 1000 mg / m2 by intravenous injection 3 days before the immunotherapy. One course with 6 times combined therapy was continued until the judgment of progressive diseases (PD) was given. The toxicity and efficacy of this treatment were assessed. We also assessed whether tumor associated antigen (TAA)-specific IFN-?producing cells increase after treatment. Results: Hematological toxicity occurred in one case, leucopenia of grade 2. No severe toxicities of grade 3 to 4 occurred. One had a partial response (PR), stable disease (SD) was observed in 2 patients for more than 6 months (long-term SD). PR patient could undergo curative operation after this therapy. The number of TAA-specific IFN-?producing cells in PR patient increased 12-fold higher than that seen before treatments. Conclusions: These results support the safety and efficacy of combined treatment with immunotherapy and chemotherapy for locally advanced pancreatic ductal carcinoma. This treatment may be a useful for the treatment of pancreatic ductal carcinoma. No significant financial relationships to disclose.