The A Allele of the Cholecystokinin Type A Receptor Gene g.420 C > A Polymorphism Improves Growth Traits in Amakusa Daioh Cross Chicken.

Amakusa Daioh cross chickens are F1 hybrids of restored Amakusa Daioh sires and Kyushu Rhode dams. In the present study, the association between a single nucleotide polymorphism (SNP; AB604331, g.420 C>A) in the cholecystokinin type A receptor gene and growth traits in Amakusa Daioh cross chicken were investigated. We used 72 male and 72 female birds that had hatched on the same day, were raised in the same chicken house, and were fed the same diet ad libitum from day 0 to 17 weeks (wks) of age. Body weight was recorded at weekly intervals and average daily gain of each week interval was calculated from body weight data. Birds were sacrificed at 17 wks and carcass traits were recorded. SNP genotyping was carried out using the mismatch amplification mutation assay. Associations between the SNP and growth traits were analyzed by a generalized linear model. Body weight from 6 to 17 wks was higher in birds with the A allele than in birds with the C allele, although significant differences in average daily gain traits between birds with A and C alleles were not detected during most of the duration of the experiment. Carcass data showed that birds with the A allele had heavier wings and a smaller proportion of the gizzard than those with the C allele. The g.420 C>A SNP will be useful as a selection marker for parent stock lines to increase the growth performance of Amakusa Daioh cross chickens.

Persistent reflux symptoms cause anxiety, depression, and mental health and sleep disorders in gastroesophageal reflux disease patients.

Some patients with gastroesophageal reflux disease experience persistent reflux symptoms despite proton pump inhibitor therapy. These symptoms reduce their health-related quality of life. Our aims were to evaluate the relationship between proton pump inhibitor efficacy and health-related quality of life and to evaluate predictive factors affecting treatment response in Japanese patients. Using the gastroesophageal reflux disease questionnaire, 145 gastroesophageal reflux disease patients undergoing proton pump inhibitor therapy were evaluated and classified as responders or partial-responders. Their health-related quality of life was then evaluated using the 8-item Short Form Health Survey, the Pittsburgh Sleep Quality Index, and the Hospital Anxiety and Depression Scale questionnaires. Sixty-nine patients (47.6%) were partial responders. These patients had significantly lower scores than responders in 5/8 subscales and in the mental health component summary of the 8-item Short Form Health Survey. Partial responders had significantly higher Pittsburgh Sleep Quality Index and Hospital Anxiety and Depression Scale scores, including anxiety and depression scores, than those of responders. Non-erosive reflux disease and double proton pump inhibitor doses were predictive factors of partial responders. Persistent reflux symptoms, despite proton pump inhibitor therapy, caused mental health disorders, sleep disorders, and psychological distress in Japanese gastroesophageal reflux disease patients.

Endoscopic retrograde cholangiopancreatography-related adverse events in patients with type 1 autoimmune pancreatitis.

BACKGROUND: Endoscopic retrograde cholangiopancreatography (ERCP) is frequently performed for the diagnosis and treatment of type 1 autoimmune pancreatitis (AIP). However, the prevalence of ERCP-related adverse events in patients with type 1 AIP has not been evaluated. We aimed to clarify the feasibility of ERCP in patients with type 1 AIP. METHODS: We retrospectively reviewed 82 consecutive ERCP procedures performed in patients with type 1 AIP from 2004 to 2014 in one university hospital and three tertiary-care referral centers. One hundred four ERCP procedures in chronic pancreatitis and 1123 in non-AIP cohort were enrolled as control groups. We compared the incidence of post-ERCP pancreatitis (PEP) between type 1 AIP and control groups. We evaluated the incidence of ERCP-related adverse events and various predictive factors for hyperamylasemia after ERCP. RESULTS: Pancreatography and cholangiography by ERCP were obtained in 78 (95.1%) and 76 (92.7%) patients, respectively. The incidence of PEP, cholangitis, and bleeding was 1.2% (1/82), 0%, and 1.2%, respectively. PEP occurred in type 1 AIP patient with diffuse parenchymal imaging, and the severity was mild. The incidences of PEP were 2.9% (3/104) and 5.4% (61/1123) in chronic pancreatitis and normal cohort, respectively. The incidence of PEP was slightly lower in type 1 AIP than non-AIP cohort (1.2% vs 5.8%, p = 0.119). There were no significant predictive factors for hyperamylasemia after ERCP in type 1 AIP. CONCLUSIONS: The incidence of ERCP-related adverse events is low in patients with type 1 AIP. ERCP-related procedures are feasible in the diagnosis and treatment of AIP.

Photochromic phenoxyl-imidazolyl radical complexes with decoloration rates from tens of nanoseconds to seconds.

We report a novel photochromic molecular system, phenoxyl-imidazolyl radical complex (PIC), in which both a phenoxyl radical site and an imidazolyl radical site are reversibly and simultaneously generated upon UV light irradiation. PIC consists of the three parts: an aromatic linker, a diarylimidazole moiety, and a 4H-cyclohexadienone ring. Upon UV light irradiation, the C-N bond between the 4H-cyclohexadienone ring and the imidazole ring in the colorless closed-ring isomer of PIC undergoes a homolytic cleavage, leading to the formation of the transient colored open-ring isomer. Based on the substituents on the imidazoyl/4H-cyclohexadienone rings and the nature of the aromatic linker, the half-life of the colored open-ring isomer can be varied between tens of nanoseconds and seconds. PIC derivatives containing a 1,2-phenylene linker exhibit high fatigue resistance toward repeated photochromic reactions. Analysis using laser flash photolysis reveals that the absorption spectra of the open-ring isomers are not readily rationalized by a straightforward superposition of the spectra of the two component radical fragments and the photogenerated radicals are electronically coupled through the aromatic linker. Furthermore, the open-ring isomer can be treated as a hybrid of the pure open-shell biradical and closed-shell quinoid resonance structures.

8-mm versus 10-mm diameter self-expandable metallic stent in bilateral endoscopic stent-in-stent deployment for malignant hilar biliary obstruction.

BACKGROUND: We aimed to clarify the clinical benefits of using 8-mm versus 10-mm diameter self-expandable metallic stent (SEMS) in bilateral endoscopic stent-in-stent (SIS) deployment for malignant hilar biliary obstruction (MHBO). METHODS: A total of 72 consecutive patients with MHBO treated by endoscopic bilateral SIS deployment were enrolled. The 8-mm and 10-mm diameter SEMSs were used in 37 patients (8-mm group) and 35 patients (10-mm group), respectively. We retrospectively compared technical success, functional success, complications, successful re-intervention, time to recurrent biliary obstruction (RBO) and survival time between two groups. RESULTS: There were no significant inter-group differences in terms of technical success (8-mm vs. 10-mm group, both 100%), functional success (96% vs. 100%), early (5% vs. 9%) and late (19% vs. 14%) complications other than RBO, and successful endoscopic re-intervention (94% vs. 100%), respectively. Time to RBO (median: 198 days vs. 222 days; log-rank, P = 0.440) and survival time (median: 186 days vs. 235 days; log-rank, P = 0.883) did not differ significantly between the two groups. However, the success rate of endoscopic bilateral revisionary stent insertion for RBO was significantly higher in the 10-mm compared to the 8-mm group (68% vs. 31%; P = 0.044). CONCLUSIONS: The 10-mm diameter SEMS is more suitable with regard to endoscopic re-intervention.

Comparison study of immunohistochemical staining for the diagnosis of type 1 autoimmune pancreatitis.

BACKGROUND: Various methods to evaluate immunohistochemical staining (IHC) for the diagnosis of type 1 autoimmune pancreatitis (AIP) have been proposed. Our goal was to determine the most useful IHC method for the diagnosis of AIP. METHODS: Specimens of AIP (18 patients), chronic pancreatitis (CP, 24 patients), and pancreatic ductal adenocarcinoma (PDA, 45 patients) were evaluated with IHC for immunoglobulin G (IgG), IgG1, IgG4, and CD138 (syndecan-1). The number of IHC-positive cells was counted in 3, 5, and 10 different high-power fields (HPFs) by selecting fields with the most numerous positive cells (hotspot) or by randomly selecting fields in the affected areas (random). We evaluated the mean number of IgG4-positive plasma cells (IgG4+)/HPF (mean IgG4+), the number of fields with >10 and >50 IgG4+ (NOF >10 and NOF >50 IgG4+), the ratio of IgG4+/IgG+, IgG4+/IgG1+, and IgG4+/CD138+. RESULTS: Analysis with receiver operator characteristic curves revealed that accurate and practical parameters in 3 HPFs were mean IgG4+ with the hotspot method (sensitivity, 88.9; specificity, 92.8 %), mean IgG4+ with the random method (100, 95.7 %), and NOF >10 IgG4+ with the random method (94.4, 97.1 %). These results were as accurate as results from 5 HPFs to 10 HPFs. The combination of mean IgG4+ and IgG4+/IgG+ did not provide more accurate diagnosis for AIP than a single criterion itself. CONCLUSIONS: Mean IgG4+ or NOF >10 IgG4+ with the random method in 3 HPFs was a useful and simple diagnostic method for AIP. The combined criteria of mean IgG4+ and IgG4+/IgG+ might not be required for accurate diagnosis of AIP.

Pentaarylbiimidazole, PABI: an easily synthesized fast photochromic molecule with superior durability.

We report a new type of fast photochromic imidazole dimer, pentaarylbiimidazole (PABI), which shows a few µs fast photochromism with high fatigue resistance against light irradiation. PABI has an unusual spiroconjugated imidazoisoindole skeleton and its derivatives can be prepared by simple synthetic procedures.

A comparison of the diagnostic efficacy in type 1 autoimmune pancreatitis based on biopsy specimens from various organs.

BACKGROUND: Comprehensive immunostaining evaluation of the biopsy specimens from various organs with type 1 autoimmune pancreatitis (AIP) has not been elucidated. Our aim was to clarify which of these biopsy specimens and counting method could be a useful tool for supporting the diagnosis of AIP. METHODS: We retrospectively evaluated biopsy specimens from pancreas (n = 19), stomach (n = 28), duodenum (n = 27), duodenal papilla (n = 25), colon (n = 19), liver (n = 11), bile duct (n = 24), and minor salivary gland (n = 13) in 36 patients with AIP. Positive IgG4 immunostaining (>10 plasma cells/high-power field [HPF]) and positive IgG4/IgG ratio (>40%) of biopsy specimens from 8 sites of 6 organs in one HPF and an average from 3 HPFs were compared between AIP and controls. RESULTS: The sensitivity of IgG4 immunostaining for AIP in one HPF were 16% in pancreas, 14% in stomach, 15% in duodenum, 52% in duodenal papilla, 11% in colon, 27% in liver, 21% in bile duct and 8% in minor salivary gland, respectively. The positive IgG4 immunostaining of the duodenal papilla in one HPF showed the highest sensitivity (52%) and accuracy (73%) among the 8 sites. It also showed the highest sensitivity among 4 different counting methods (IgG4 immunostaining in one HPF and 3 HPFs, both IgG4 immunostaining and IgG/IgG4 ratio in one HPF and 3 HPFs), but there were no significant differences with respect to specificity and accuracy. CONCLUSIONS: IgG4 immunostaining of swollen duodenal papilla with more than 10 IgG4-positive plasma cells in at least one HPF is useful for supporting the diagnosis of AIP.

Incidence of potential rabies exposure among Japanese expatriates and travelers in Thailand.

BACKGROUND: Rabies has become a forgotten and neglected disease in Japan. In 2006, there was a slight increase in social awareness of rabies when Japan had two reported cases of human rabies, originating in the Philippines. Although the number of Japanese either traveling or living in other Asian countries has been increasing, the exact risk of this population contracting rabies is unknown. Thus, this study utilized a questionnaire to investigate the incidence of rabies exposure, as well as the knowledge, attitude, and practice toward rabies prevention among Japanese expatriates and travelers in Thailand. METHODS: Japanese travelers and expatriates were asked questions related to knowledge, attitude, practice toward rabies risk, and experiences of potential rabies exposure such as animal bites, licks, and scratches. Questionnaires were either completed at the Bangkok Suvarnabhumi International Airport and other tourist areas or distributed within Japanese associations in Thailand. RESULTS: A total of 1,208 questionnaires from Japanese expatriates and 590 from Japanese travelers were collected and analyzed. We found high incidence rates of potential exposure events among these populations. In particular, Japanese travelers had the highest incidence rate compared to previous studies of international travelers in Thailand. While expatriates' incidence rates of animal bites, licks, and scratches were 1.7, 6.9, and 1.8/1,000 person-months, travelers have much higher incidence rates of 43.1, 136.1, and 33.0/1,000 person-months. Generally, travelers, compared to expatriates, tended to have less accurate knowledge and less often had the pre-exposure prophylaxis vaccination. Moreover, survey answers indicated that 55.0% of expatriates and 88.9% of travelers who were bitten would not seek proper treatment. CONCLUSIONS: Since rabies is a preventable disease as long as one has the appropriate knowledge, attitude, and practice, it is essential to promote prevention activities for the Japanese population in Thailand to avert serious consequences of this disease.

Efficacy of pancreatic stenting prior to extracorporeal shock wave lithotripsy for pancreatic stones.

BACKGROUND: Extracorporeal shock wave lithotripsy is the first-line therapy for large pancreatic duct stones; however, it requires a long duration of therapy. AIMS: To clarify the effect of pancreatic stenting prior to extracorporeal shock wave lithotripsy on shortening the duration of therapy and reducing complications. METHODS: We retrospectively compared 45 patients who underwent pancreatic stenting prior to extracorporeal shock wave lithotripsy (stenting group) and 35 patients who did not undergo stenting prior to extracorporeal shock wave lithotripsy (non-stenting group) with regard to the cumulative number of shock waves required for stone fragmentation (stone size <3mm) and the rate of complications. RESULTS: The stenting group was associated with a significantly lower cumulative number of shock waves in univariate analysis (log-rank, p=0.046) and multivariate Cox proportional hazard analysis (hazard ratio, 1.88; 95% confidence interval, 1.13-3.14; p=0.015) than the non-stenting group. The frequency of pancreatitis tends to be lower in the stenting group than the non-stenting group (2.2% [1/45] vs 11.4% [4/35]; p=0.162). CONCLUSIONS: Pancreatic stenting prior to extracorporeal shock wave lithotripsy reduced the cumulative number of shock waves required for pancreatic stone fragmentation, and could be useful to shorten the duration of therapy.

Histiocytic sarcoma of the bile duct.

An 80-year-old man was admitted with anorexia, a high fever and general icterus. Laboratory examinations revealed remarkable inflammation and elevation of liver/biliary enzymes. Computed tomography (CT) showed a high-density lesion in the bile duct, and endoscopic retrograde cholangiopancreatography (ERCP) disclosed an oval filling defect mimicking choledocholithiasis. Plastic stents were inserted to treat the acute cholangitis; however, the patient's symptoms recurred. An erythematous hypervascular mass obtained with a balloon catheter contained numerous pleomorphic histiocytic cells with eosinophilic cytoplasm, remarkable anisonucleosis and occasional mitoses. A diagnosis of histiocytic sarcoma (HS) was made based on the results of intensive immunohistochemistry. Monoclonal rearrangement of the IGH and TCRG genes, IGH split and IGH/BCL2 fusion was negative, although polysomy 8, 14, and 18 was detected. The patient was treated conservatively and died of the disease 20 months after the initial diagnosis. To the best of our knowledge, this is the first case of bile duct HS. This case, which involved numerical alterations of chromosomes, presented with CT and ERCP findings similar to those of choledocholithiasis.

Remarkable solvatochromic color change via proton tautomerism of a phenol-linked imidazole derivative.

A unique solvatochromic 2-phenyl-4,5-diarylimidazole derivative linked with a phenol moiety and a p-quinonemethide moiety at the 4- and 5-positions of a imidazole ring, which shows remarkable color change via proton tautomerism, was synthesized and the mechanism of the solvatochromic color change was investigated. The yellow-colored OH tautomeric form (1_OH) exists as a dominant species in nonpolar solvents, whereas the blue-colored NH tautomeric form (1_NH) is stabilized in polar solvents. The molecular structures of these tautomers were determined by X-ray crystallographic analysis. The p-quinonemethide moiety and the imidazole ring of 1_OH are coplanar to one another and possess a planar quinoidal structure. On the other hand, 1_NH has a nonplanar twisted quinoidal structure causing large bathochromic shift in the visible absorption spectrum. Moreover, the X-ray crystallographic analysis and the DFT calculations support the closed-shell singlet character of 1_OH. In contrast 1_NH possesses partial single bond character that leads to the open-shell singlet biradical character and the decrease in the singlet-triplet energy gap. The twisting of the π-conjugated electron system induced by the proton tautomerization was found to be the origin of the open-shell biradical character of 1_NH and the enhanced solvatochromic color change.

Histological evaluation of obliterative phlebitis for the diagnosis of autoimmune pancreatitis.

BACKGROUND: Obliterative phlebitis is a useful pathological finding for the diagnosis of lymphoplasmacytic sclerosing pancreatitis (LPSP), or type 1 autoimmune pancreatitis. The present study evaluated histological findings of obliterative phlebitis, including the significance of adding Elastica van Gieson stain (EVG) in comparison with other pancreatic conditions. METHODS: Specimens of LPSP (n = 18), chronic pancreatitis (CP; n = 24), and pancreatic ductal adenocarcinoma (PDA; n = 45) were enrolled. Obliterative venous lesions (OVLs), defined as the presence of inflammatory cells and/or fibrosis inside the tunica adventitia, were counted and compared between hematoxylin and eosin stain (H&E) and EVG. OVLs were classified into three types: OVL-1, lymphoplasmacytic infiltration and fibrosis against a loose textured background; OVL-2, dense fibrosis with minimal or no lymphoplasmacytic infiltration; and OVL-3, densely packed lymphoplasmacytic infiltration without fibrosis. OVL type and OVL size were compared between disease groups. RESULTS: OVL counts in LPSP, CP, and PDA were significantly higher with EVG than with H&E (p < 0.001). OVL-1 was most common in LPSP (H&E 92.4 %, EVG 79.8 %), and was identified in almost all cases of LPSP, but was less common in CP and PDA. Maximum diameter and OVL count in 1 cm(2) of OVL-1 were high for LPSP. Maximum diameter of OVL-1 ≥150 µm was observed in 17 LPSP, 0 CP, and 1 PDA cases (sensitivity 94.4 %, specificity 98.6 %). CONCLUSIONS: Additional EVG is useful for excluding conditions mimicking OVL-1 or detecting OVL in small specimens. The presence of OVL-1 with diameter ≥150 µm is highly diagnostic for LPSP.

Feasibility of endoscopic retrograde cholangiopancreatography-related procedures in hemodialysis patients.

BACKGROUND AND AIM: The opportunities of endoscopic retrograde cholangiopancreatography (ERCP)-related procedure for hemodialysis (HD) patients have been increasing recently. However, the complication rate of ERCPs in HD patients has not been evaluated sufficiently. We aimed to clarify the feasibility of ERCPs in HD patients. METHODS: We retrospectively reviewed 76 consecutive ERCPs for HD patients between January 2005 and December 2012 in one university hospital and three tertiary-care referral centers. Endoscopic sphincterotomy (EST) was performed in 21 HD patients. We evaluated the incidence and risk factors for complications of all ERCPs and EST in HD patients. RESULTS: The incidence of pancreatitis, cholangitis, and cardiopulmonary complications for ERCPs in HD patients was 7.9% (6/76), 1.3% (1/76), and 1.3% (1/76), respectively. The mortality rate was 2.6% (2/76), and it occurred after acute pancreatitis in one patient and pneumonia in the other patient. The incidence of hemorrhage and pancreatitis with EST was 19% (4/21) and 4.8% (1/21), respectively. The duration of HD was significantly longer in the patients with hemorrhage after EST than without (19.5 vs 6 years; P = 0.029). CONCLUSIONS: ERCP is feasible in HD patients. However, EST is not advisable because of the high hemorrhage rate, particularly for patients with a long duration of HD.

Feasibility of one-step endoscopic metal stenting for distal malignant biliary obstruction.

BACKGROUND: We aimed to clarify the clinical usefulness of one-step self-expandable metal stent (SEMS) placement for distal malignant biliary obstruction by comparing with two-step SEMS placement. METHODS: We retrospectively compared early complications, bilirubin level decreasing rate, and period of hospitalization between 40 patients with one-step SEMS and 52 patients with two-step SEMS. We also evaluated the complications in patients with two-step SEMS by classifying them into first drainage (ERBD or ENBD) and second drainage (SEMS). RESULTS: The total incidence of early complications was significantly higher in patients with one-step SEMS than the second drainage of two-step SEMS (42.5% [17/40] vs. 13.5% [7/52]; P = 0.004). However, there was no significant difference in the early complications between one-step SEMS and two-step SEMS (total of first and second drainage) (42.5% [17/40] vs. 36.5% [19/52]; P = 0.561). The period required to reach the bilirubin level (<3 mg/dL) after initial drainage was significantly shorter in one-step SEMS than in two-step SEMS (5.7 vs. 10.1 days; P = 0.025). Similar results were observed in the period of hospitalization for patients without chemotherapy (22.2 vs. 37.3 days; P = 0.004). CONCLUSIONS: One-step SEMS placement is the alternative option of drainage method for distal malignant biliary obstruction.

Occlusion culling for computer generated hologram based on ray-wavefront conversion.

We propose a new method for occlusion culling in the computation of a hologram based on the mutual conversion between light-rays and wavefront. Since the occlusion culling is performed with light-ray information, conventional rendering techniques such as ray-tracing or image-based rendering can be employed. On the other hand, the wavefront is derived for the calculation of light propagation, the hologram of 3-D objects can be obtained in high accuracy. In the numerical experiment, we demonstrate that our approach can reproduce a high-resolution image for deep 3-D scene with correct occlusion effect between plural objects.

Clinical evaluation of international consensus diagnostic criteria for type 1 autoimmune pancreatitis in comparison with Japanese diagnostic criteria 2011.

OBJECTIVES: The objective of this study was to evaluate the International Consensus Diagnostic Criteria (ICDC) for type 1 autoimmune pancreatitis (AIP) in comparison with the Japanese criteria 2011 (JPS2011). METHODS: We retrospectively investigated the usefulness of ICDC in comparison with JPS2011 in 64 patients with AIP and 90 patients with pancreatic cancer. RESULTS: The sensitivity and specificity of ICDC for AIP were 98.4% (63/64) and 100% (90/90), respectively. The sensitivities and specificities of ductal imaging, serology, other organ involvement, and pancreatic histology were 74.1%, 89.1%, 53.1%, and 26.1% and 94.7%, 94.5%, 100%, and 100%, respectively. On the other hand, the sensitivities and specificities of JPS2011 for AIP were 84.4% (54/64) and 100% (90/90), respectively. The condition of all the 10 patients who were deniable or possible under the JPS2011 could be diagnosed as definitive AIP under the ICDC. The sensitivities and specificities of Japanese criteria 2006, Asian Diagnostic Criteria, and HISORt criteria were 80.6%, 84.4%, and 92.2% and 95.8%, 87.8%, and 100%, respectively. CONCLUSIONS: The sensitivity and specificity of ICDC are higher than those of previous criteria. The JPS2011 is easy to handle for general practice, and specificity is very high. However, the sensitivity of JPS2011 is lower than that of ICDC, and improvement of sensitivity is to be hoped in the future.

Predictive factors for pancreatitis and cholecystitis in endoscopic covered metal stenting for distal malignant biliary obstruction.

BACKGROUND AND AIM: Pancreatitis and cholecystitis are major complications after self-expandable metal stent (SEMS) placement in distal malignant biliary obstruction. We aimed to clarify predictive factors for pancreatitis and cholecystitis after covered SEMS placement. METHODS: We retrospectively reviewed 74 consecutive patients with distal malignant biliary obstruction who underwent initial endoscopic drainage using covered SEMS. Predictive factors for pancreatitis and cholecystitis were evaluated in the 74 patients described above and in 66 patients who had not undergone cholecystectomy. RESULTS: The incidences of pancreatitis and cholecystitis were 10.8% (8/74) and 6.1% (4/66), respectively. Univariate analysis revealed that non-pancreatic cancer (P = 0.018) and contrast injection into the pancreatic duct (P = 0.030) were significant predictive factors for pancreatitis. Multivariate analysis revealed that non-pancreatic cancer (odds ratio [OR], 4.21; 95% confidence interval [CI], 1.63-14.18; P = 0.007) and contrast injection into the pancreatic duct (OR, 3.34; 95% CI, 1.33-9.60; P = 0.016) were significant independent predictive factors for pancreatitis. On the other hand, univariate and multivariate analyses revealed that tumor involvement to the orifice of the cystic duct (OCD) was a significant independent predictive factor for cholecystitis (OR, 5.85; 95% CI, 1.91-27.74; P = 0.005). CONCLUSIONS: Non-pancreatic cancer and contrast injection into the pancreatic duct were predictive factors for pancreatitis, and tumor involvement to the OCD was a positive predictive factor for cholecystitis after endoscopic covered SEMS placement for distal malignant biliary obstruction.