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Suzuki K, Aizawa M, Tamazawa K, Ueda K, Wada J, Nakajima Y, Shibukawa G, Ikeda S, Tsunoda S, Togashi K. Relapse of Ulcerative Colitis with Immune Thrombocytopenia and Pyoderma Gangrenosum Subsequent to Receiving COVID-19 Vaccination. Intern Med 2024; 63:665-669. [PMID: 38171870 PMCID: PMC10982002 DOI: 10.2169/internalmedicine.2969-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 11/12/2023] [Indexed: 01/05/2024] Open
Abstract
This case illustrates the complex interactions of the immune responses after vaccination and highlights their potential connections to various autoimmune conditions. A 22-year-old man with quiescent ulcerative colitis (UC) presented with abdominal pain, rectal bleeding, and thrombocytopenia 7 days after receiving the third coronavirus disease 2019 mRNA vaccination. Laboratory data confirmed the diagnosis of immune thrombocytopenia. High-dose intravenous immunoglobulin administration boosted the patient's platelet count. Simultaneously, colonoscopy revealed that his UC had relapsed. Although salazosulfapyridine briefly improved his symptoms, his stool frequency worsened one week later. The patient also developed pyoderma gangrenosum. Subsequent treatment with infliximab notably improved both pyoderma gangrenosum and UC.
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Affiliation(s)
- Kohei Suzuki
- Department of Coloproctology & Gastroenterology, Fukushima Medical University Aizu Medical Center, Japan
| | - Masato Aizawa
- Department of Coloproctology & Gastroenterology, Fukushima Medical University Aizu Medical Center, Japan
| | - Kana Tamazawa
- Department of Coloproctology & Gastroenterology, Fukushima Medical University Aizu Medical Center, Japan
| | - Kenta Ueda
- Department of Coloproctology & Gastroenterology, Fukushima Medical University Aizu Medical Center, Japan
| | - Jun Wada
- Department of Coloproctology & Gastroenterology, Fukushima Medical University Aizu Medical Center, Japan
| | - Yuki Nakajima
- Department of Coloproctology & Gastroenterology, Fukushima Medical University Aizu Medical Center, Japan
| | - Goro Shibukawa
- Department of Coloproctology & Gastroenterology, Fukushima Medical University Aizu Medical Center, Japan
| | - Shohei Ikeda
- Department of Hematology, Fukushima Medical University Aizu Medical Center, Japan
| | - Saburo Tsunoda
- Department of Hematology, Fukushima Medical University Aizu Medical Center, Japan
| | - Kazutomo Togashi
- Department of Coloproctology & Gastroenterology, Fukushima Medical University Aizu Medical Center, Japan
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Sato K, Shibukawa G, Ueda K, Nakajima Y, Togashi K, Ohira H. Percutaneous endoscopic necrosectomy for walled-off necrosis in the retroperitoneal space of the elderly: A case report. World J Clin Cases 2023; 11:5736-5741. [PMID: 37727710 PMCID: PMC10506012 DOI: 10.12998/wjcc.v11.i24.5736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 06/19/2023] [Accepted: 07/21/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND Walled-off necrosis (WON) is a late complication of acute pancreatitis possibly with a fatal outcome. Even for WON spreading to the retroperitoneal space, percutaneous endoscopic necrosectomy (PEN) can be an alternate approach to surgical necrosectomy, particularly for the older individuals or patients with poor condition because of WON. CASE SUMMARY An 88-year-old man was admitted to our hospital with a jaundice. Endoscopic retrograde cholangiopancreatography (ERCP) was performed to improve jaundice; however, post-ERCP pancreatitis developed. The inflammation of pancreatitis spread widely from the right retroperitoneal cavity to the pelvis, and WON was formed 4 wk later. A percutaneous drainage tube was placed into the WON under computed tomography guidance. However, the drainage did not ameliorate clinical symptoms including fever, which assured less invasive necrosectomy. A metallic stent for the upper gastrointestinal (GI) tract was placed from the percutaneous drainage route. An upper GI endoscope was inserted into the inside of the WON through the metallic stent, and the necrotic tissues were bluntly removed with a snare forceps. Ten times of these necrosectomies resulted in the near-complete removal of necrotic tissues. These procedures consequently abated his fever and remarkable improvement in blood tests. CONCLUSION PEN for WON occurring in the retroperitoneal space was safe and effective for very old individuals.
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Affiliation(s)
- Kentaro Sato
- Department of Gastroenterology, Aizu Medical Center Fukushima Medical University, Aizuwakamatsu 969-3492, Fukushima, Japan
| | - Goro Shibukawa
- Department of Gastroenterology, Aizu Medical Center Fukushima Medical University, Aizuwakamatsu 969-3492, Fukushima, Japan
| | - Kenta Ueda
- Department of Gastroenterology, Aizu Medical Center Fukushima Medical University, Aizuwakamatsu 969-3492, Fukushima, Japan
| | - Yuki Nakajima
- Department of Gastroenterology, Aizu Medical Center Fukushima Medical University, Aizuwakamatsu 969-3492, Fukushima, Japan
| | - Kazutomo Togashi
- Department of Gastroenterology, Aizu Medical Center Fukushima Medical University, Aizuwakamatsu 969-3492, Fukushima, Japan
| | - Hiromasa Ohira
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Fukushima, Japan
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Maki T, Irisawa A, Yamamiya A, Tominaga K, Abe Y, Imbe K, Hoshi K, Yamabe A, Igarashi R, Nakajima Y, Sato K, Shibukawa G. Guide Wire Selection (Straight vs. Angled) in Endoscopic Retrograde Cholangiopancreatography Using a Normal Contrast Catheter Performed by a Trainee: A Single-Center Prospective Randomized Controlled Cross-Over Study. J Clin Med 2023; 12:jcm12082917. [PMID: 37109253 PMCID: PMC10143334 DOI: 10.3390/jcm12082917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 03/28/2023] [Accepted: 04/14/2023] [Indexed: 04/29/2023] Open
Abstract
INTRODUCTION Wire-guided cannulation (WGC) during endoscopic retrograde cholangiopancreatography (ERCP) is a selective biliary cannulation technique aimed at improving the successful selective biliary cannulation rate and reducing the rate of post-ERCP pancreatitis (PEP) incidence. This study aimed to evaluate the effectiveness of angled-tip guidewires (AGW) vs. straight-tip guidewires (SGW) for biliary cannulation via WGC by a trainee. METHODS We conducted a prospective, single-center, open-labeled, randomized, and controlled trial. Fifty-seven patients were enrolled in this study and assigned randomly to two groups (Group A to S and Group S to A). In this study, we started selective biliary cannulation via WGC with an AGW or an SGW for 7 min. If cannulation was unsuccessful, the other guidewire was used, and cannulation was continued for another 7 min (cross-over method). RESULTS The selective biliary cannulation success rate over 14 min was significantly higher with an AGW compared with an SGW over 14 min (57.8% vs. 34.3%, p = 0.04) and for the second 7-min segment (36.4% vs. 0%, p = 0.04). No significant difference was found for adverse events such as pancreatitis between the two guidewires. CONCLUSIONS Our results suggest that an AGW is recommended for WGC performed by a trainee.
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Affiliation(s)
- Takumi Maki
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, 21-2 Kawahigashi Aizuwakamatsu, Fukushima 969-3482, Japan
- Department of Internal Medicine, Minamiaizu Prefectural Hospital, 14-1 Nagata Minamiaizu, Fukushima 967-0006, Japan
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, 880 Kitakobayashi Mibu, Tochigi 321-0293, Japan
| | - Atsushi Irisawa
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, 21-2 Kawahigashi Aizuwakamatsu, Fukushima 969-3482, Japan
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, 880 Kitakobayashi Mibu, Tochigi 321-0293, Japan
| | - Akira Yamamiya
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, 880 Kitakobayashi Mibu, Tochigi 321-0293, Japan
| | - Keiichi Tominaga
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, 880 Kitakobayashi Mibu, Tochigi 321-0293, Japan
| | - Yoko Abe
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, 21-2 Kawahigashi Aizuwakamatsu, Fukushima 969-3482, Japan
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, 880 Kitakobayashi Mibu, Tochigi 321-0293, Japan
| | - Koh Imbe
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, 21-2 Kawahigashi Aizuwakamatsu, Fukushima 969-3482, Japan
| | - Koki Hoshi
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, 21-2 Kawahigashi Aizuwakamatsu, Fukushima 969-3482, Japan
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, 880 Kitakobayashi Mibu, Tochigi 321-0293, Japan
| | - Akane Yamabe
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, 21-2 Kawahigashi Aizuwakamatsu, Fukushima 969-3482, Japan
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, 880 Kitakobayashi Mibu, Tochigi 321-0293, Japan
| | - Ryo Igarashi
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, 21-2 Kawahigashi Aizuwakamatsu, Fukushima 969-3482, Japan
| | - Yuki Nakajima
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, 21-2 Kawahigashi Aizuwakamatsu, Fukushima 969-3482, Japan
| | - Kentaro Sato
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, 21-2 Kawahigashi Aizuwakamatsu, Fukushima 969-3482, Japan
| | - Goro Shibukawa
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, 21-2 Kawahigashi Aizuwakamatsu, Fukushima 969-3482, Japan
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Irie H, Suzuki R, Okubo Y, Asama H, Konno N, Noguchi Y, Watanabe K, Shibukawa G, Imamura H, Takagi T, Sugimoto M, Sato Y, Nakamura J, Kato T, Hashimoto M, Yanagita T, Hikichi T, Ohira H. Clinical benefit of subsequent chemotherapy after drug-induced interstitial lung disease in pancreatic cancer patients: a multicenter retrospective study from Japan. BMC Cancer 2023; 23:316. [PMID: 37024781 PMCID: PMC10080831 DOI: 10.1186/s12885-023-10781-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 03/28/2023] [Indexed: 04/08/2023] Open
Abstract
PURPOSE Drug-induced interstitial lung disease (ILD) is not a rare adverse event in the current chemotherapy strategy for pancreatic ductal adenocarcinoma (PDAC). Thus, we aimed to find the optimal management for PDAC patients with a history of ILD induced by a gemcitabine-based regimen. METHODS We conducted a multicenter retrospective study. The primary endpoint was the overall survival (OS) of patients who underwent either S-1 monotherapy or FOLFOX after the onset of ILD. Toxicity data was also analyzed in the 2 groups. RESULTS Twenty-four patients were diagnosed with ILD and 17 patients who received subsequent chemotherapy were enrolled in the study. Among 17 patients who were managed with subsequent chemotherapy after recovering from ILD, we did not observe significant difference in OS between S-1 and FOLFOX (290.0 days vs. undefined, p = 0.39). Relapse of drug-induced ILD was not observed in all cases during the course. Overall, severe adverse events (CTCAE Grade 3 or 4) were observed in 3 patients (23.1%) in S-1 treatment group and 1 patient (25.0%) in FOLFOX treatment group (p = 0.93). CONCLUSIONS S-1 monotherapy and FOLFOX are comparable as the subsequent chemotherapy after gemcitabine-based chemotherapy-induced ILD in unresectable PDAC.
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Affiliation(s)
- Hiroki Irie
- Department of Gastroenterology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Rei Suzuki
- Department of Gastroenterology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan.
| | - Yoshinori Okubo
- Department of Gastroenterology, Fukushima Rosai Hospital, Fukushima, Japan
| | - Hiroyuki Asama
- Department of Gastroenterology, Fukushima Red Cross Hospital, Fukushima, Japan
| | - Naoki Konno
- Department of Gastroenterology, Fukushima Red Cross Hospital, Fukushima, Japan
| | - Yuki Noguchi
- Department of Gastroenterology, Ohta Nishinouchi Hospital, Fukushima, Japan
| | - Ko Watanabe
- Department of Gastroenterology, Ohara General Hospital, Fukushima, Japan
| | - Goro Shibukawa
- Department of Gastroenterology, Fukushima Medical University Aizu Medical Center, Fukushima, Japan
| | - Hidemichi Imamura
- Department of Gastroenterology, Ohta Nishinouchi Hospital, Fukushima, Japan
| | - Tadayuki Takagi
- Department of Gastroenterology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Mitsuru Sugimoto
- Department of Gastroenterology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Yuki Sato
- Department of Gastroenterology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Jun Nakamura
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan
| | - Tsunetaka Kato
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan
| | - Minami Hashimoto
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan
| | - Takumi Yanagita
- Department of Gastroenterology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Takuto Hikichi
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan
| | - Hiromasa Ohira
- Department of Gastroenterology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan
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Takagi T, Sugimoto M, Imamura H, Takahata Y, Nakajima Y, Suzuki R, Konno N, Asama H, Sato Y, Irie H, Nakamura J, Takasumi M, Hashimoto M, Kato T, Kobashi R, Hashimoto Y, Shibukawa G, Marubashi S, Hikichi T, Ohira H. A multicenter comparative study of endoscopic ultrasound-guided fine-needle biopsy using a Franseen needle versus conventional endoscopic ultrasound-guided fine-needle aspiration to evaluate microsatellite instability in patients with unresectable pancreatic cancer. Clin Endosc 2023; 56:107-113. [PMID: 36646425 PMCID: PMC9902688 DOI: 10.5946/ce.2022.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 02/22/2022] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND/AIMS Immune checkpoint blockade has recently been reported to be effective in treating microsatellite instability (MSI)-high tumors. Therefore, sufficient sampling of histological specimens is necessary in cases of unresectable pancreatic cancer (UR-PC). This multicenter study investigated the efficacy of endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) using a Franseen needle for MSI evaluation in patients with UR-PC. METHODS A total of 89 patients with UR-PC who underwent endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) or EUS-FNB using 22-G needles at three hospitals in Japan (2018-2021) were enrolled. Fifty-six of these patients (FNB 23 and FNA 33) were followed up or evaluated for MSI. Patient characteristics, UR-PC data, and procedural outcomes were compared between patients who underwent EUS-FNB and those who underwent EUS-FNA. RESULTS No significant difference in terms of sufficient tissue acquisition for histology was observed between patients who underwent EUS-FNB and those who underwent EUS-FNA. MSI evaluation was possible significantly more with tissue samples obtained using EUS-FNB than with tissue samples obtained using EUS-FNA (82.6% [19/23] vs. 45.5% [15/33], respectively; p<0.01). In the multivariate analysis, EUS-FNB was the only significant factor influencing the possibility of MSI evaluation. CONCLUSION EUS-FNB using a Franseen needle is desirable for ensuring sufficient tissue acquisition for MSI evaluation.
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Affiliation(s)
- Tadayuki Takagi
- Department of Gastroenterology, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Mitsuru Sugimoto
- Department of Gastroenterology, School of Medicine, Fukushima Medical University, Fukushima, Japan,Correspondence: Mitsuru Sugimoto Department of Gastroenterology, School of Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima 960-1295, Japan E-mail:
| | - Hidemichi Imamura
- Department of Gastroenterology, Ohtanishinouchi Hospital, Koriyama, Japan
| | - Yosuke Takahata
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, Aizuwakamatsu, Japan
| | - Yuki Nakajima
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, Aizuwakamatsu, Japan
| | - Rei Suzuki
- Department of Gastroenterology, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Naoki Konno
- Department of Gastroenterology, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Hiroyuki Asama
- Department of Gastroenterology, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Yuki Sato
- Department of Gastroenterology, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Hiroki Irie
- Department of Gastroenterology, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Jun Nakamura
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan
| | - Mika Takasumi
- Department of Gastroenterology, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Minami Hashimoto
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan
| | - Tsunetaka Kato
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan
| | - Ryoichiro Kobashi
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan
| | - Yuko Hashimoto
- Department of Diagnostic Pathology, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Goro Shibukawa
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, Aizuwakamatsu, Japan
| | - Shigeru Marubashi
- Department of Hepato-Biliary-Pancreatic and Transplant Surgery, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Takuto Hikichi
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan
| | - Hiromasa Ohira
- Department of Gastroenterology, School of Medicine, Fukushima Medical University, Fukushima, Japan
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Nakajima Y, Nemoto D, Suzuki K, Sato A, Shibukawa G, Lefor AK, Togashi K. Miniprobe ultrasonography guidance during endoscopic submucosal dissection of an ampullary duodenal lesion. Endoscopy 2022; 55:E92-E93. [PMID: 36216258 PMCID: PMC9829764 DOI: 10.1055/a-1934-9641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Yuki Nakajima
- Department of Coloproctology, Aizu Medical Center, Fukushima Medical University, Fukushima, Japan,Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, Fukushima, Japan
| | - Daiki Nemoto
- Department of Coloproctology, Aizu Medical Center, Fukushima Medical University, Fukushima, Japan
| | - Kohei Suzuki
- Department of Coloproctology, Aizu Medical Center, Fukushima Medical University, Fukushima, Japan
| | - Ai Sato
- Department of Gastroenterology, Nikko Medical Center, Dokkyo Medical University, Mibu, Japan
| | - Goro Shibukawa
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, Fukushima, Japan
| | | | - Kazutomo Togashi
- Department of Coloproctology, Aizu Medical Center, Fukushima Medical University, Fukushima, Japan
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Kato S, Kuwatani M, Onodera M, Kudo T, Sano I, Katanuma A, Uebayashi M, Eto K, Fukasawa M, Hashigo S, Iwashita T, Yoshida M, Taya Y, Kawakami H, Kato H, Nakai Y, Kobashigawa K, Kawahata S, Shinoura S, Ito K, Kubo K, Yamato H, Hara K, Maetani I, Mukai T, Shibukawa G, Itoi T. Risk of Pancreatitis Following Biliary Stenting With/Without Endoscopic Sphincterotomy: A Randomized Controlled Trial. Clin Gastroenterol Hepatol 2022; 20:1394-1403.e1. [PMID: 34391923 DOI: 10.1016/j.cgh.2021.08.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 08/04/2021] [Accepted: 08/04/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND & AIMS The efficacy of endoscopic sphincterotomy (ES) before endoscopic transpapillary biliary drainage in preventing post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) has not been established. The aim of this study was to evaluate the effect of performing ES before biliary stent/tube placement on the occurrence of PEP. METHODS Three hundred seventy patients with biliary stricture requiring endoscopic biliary stenting were enrolled and randomly allocated to the ES group (n = 185) or non-ES group (n = 185). All participants were followed up for 30 days after the procedure. The data and occurrence of adverse events were prospectively collected. The primary outcome measure of this study was the incidence of PEP within 2 days of initial transpapillary biliary drainage. Secondary outcome measures were the incidence of other adverse events related to biliary stent/tube placement. RESULTS PEP occurred in 36 patients (20.6%) in the non-ES group and in 7 patients (3.9%) in the ES group (P < .001). The difference in the incidence of PEP between the 2 groups in the per-protocol population was 16.7% (95% confidence interval, 10.1%-23.3%), which was not within the noninferiority margin of 6%. Except for bleeding, the incidences of other adverse events were not significantly different between the groups. CONCLUSION ES before endoscopic biliary stenting could have the preventive effect on the occurrence of PEP in patients with biliary stricture. University Hospital Medical Information Network Number, UMIN000025727.University Hospital Medical Information Network Clinical Trial Registry URL: https://www.umin.ac.jp/ctr/index.htm.
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Affiliation(s)
- Shin Kato
- Department of Gastroenterology and Hepatology, Hokkaido University Hospital, Sapporo, Japan; Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Masaki Kuwatani
- Department of Gastroenterology and Hepatology, Hokkaido University Hospital, Sapporo, Japan; Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan; Division of Endoscopy, Hokkaido University Hospital, Sapporo, Japan.
| | - Manabu Onodera
- Department of Gastroenterology, NTT Medical Center Sapporo Hospital, Sapporo, Japan
| | - Taiki Kudo
- Department of Gastroenterology, Hakodate Municipal Hospital, Hakodate, Japan
| | - Itsuki Sano
- Department of Gastroenterology, Kushiro Rosai Hospital, Kushiro, Japan
| | - Akio Katanuma
- Center for Gastroenterology, Teine Keijinkai Hospital, Sapporo, Japan
| | - Minoru Uebayashi
- Department of Gastroenterology, Kitami Red Cross Hospital, Kitami, Japan
| | - Kazunori Eto
- Department of Gastroenterology, Tomakomai Municipal Hospital, Tomakomai, Japan
| | - Mitsuharu Fukasawa
- First Department of Internal Medicine, University of Yamanashi, Chuo, Japan
| | - Shunpei Hashigo
- Department of Gastroenterology and Hepatology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Takuji Iwashita
- First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan
| | - Makoto Yoshida
- Department of Medical Oncology, Sapporo Medical University Hospital, Sapporo, Japan
| | - Yoko Taya
- Department of Gastroenterology, NHO Hokkaido Medical Center, Sapporo, Japan
| | - Hiroshi Kawakami
- Department of Gastroenterology, University of Miyazaki Hospital, Miyazaki, Japan
| | - Hironari Kato
- Department of Gastroenterology and Hepatology, Okayama University Hospital, Okayama, Japan
| | - Yousuke Nakai
- Department of Endoscopy and Endoscopic Surgery, The University of Tokyo Hospital, Tokyo, Japan; Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Kasen Kobashigawa
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Department of Gastroenterology, Urasoe General Hospital, Urasoe, Japan
| | - Shuhei Kawahata
- Department of Gastroenterology, Obihiro-Kosei General Hospital, Obihiro, Japan
| | - Susumu Shinoura
- Department of Gastroenterology, Okinawa Prefectural Chubu Hospital, Uruma, Japan
| | - Kei Ito
- Department of Gastroenterology, Sendai Open Hospital, Sendai, Japan
| | - Kimitoshi Kubo
- Department of Gastroenterology, NHO Hakodate Hospital, Hakodate, Japan
| | - Hiroaki Yamato
- Department of Gastroenterology, Iwamizawa Municipal General Hospital, Iwamizawa, Japan
| | - Kazuo Hara
- Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Iruru Maetani
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Tsuyoshi Mukai
- Department of Gastroenterology, Gifu Municipal Hospital, Gifu, Japan
| | - Goro Shibukawa
- Department of Gastroenterology, Fukushima Medical University, Aizu Medical Center, Aizu, Japan
| | - Takao Itoi
- Department of Gastroenterology, Tokyo Medical University Hospital, Tokyo, Japan
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Ogawa T, Ryozawa S, Irisawa A, Masuda A, Tanisaka Y, Fujita A, Mizuide M, Yamabe A, Shibukawa G, Sakai A, Shiomi H, Yoshinaka H, Okabe Y, Arisaka Y, Kutsumi H. A Prospective Multicenter Randomized Feasibility Trial of Double-guidewire Techniques for Difficult Biliary Cannulation Comparing a New Double-guidewire-supported Sphincterotome (MagicTome) to a Conventional Device. Intern Med 2022; 61:291-301. [PMID: 34373374 PMCID: PMC8866775 DOI: 10.2169/internalmedicine.7367-21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objective To evaluate the effectiveness and safety of the double-guidewire technique (DGT) using a new double-guidewire-supported sphincterotome (MagicTome) for patients who required endoscopic retrograde cholangiopancreatography (ERCP) for biliary cannulation. Methods This prospective multicenter randomized feasibility trial involved patients with difficult biliary cannulation at any of the three study sites from June 2017 to October 2018. Patients were assigned to the DGT with MagicTome (MDGT) initially performed group and the conventional DGT (CDGT) initially performed group. The success rates of biliary cannulation by MDGT and CDGT and the ERCP-related complications were evaluated. Results Twenty-eight patients were included in this study. No significant difference was observed in the success rates of first attempts and crossover attempts between the groups (p=0.69 and p=1.00). Furthermore, no significant difference was observed in the success rate of biliary cannulation between MDGT and CDGT (62.5% and 75.0%, respectively; p=0.48). CDGT was successful in two of four patients with malignant biliary obstruction. MDGT was successful in all four patients with malignant biliary obstruction, including the two for whom CDGT was unsuccessful. Post-ERCP pancreatitis occurred in only one MDGT case. Conclusion MDGT is safe for biliary cannulation and can be used in cases where biliary cannulation by CDGT is difficult.
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Affiliation(s)
- Tomoya Ogawa
- Department of Gastroenterology, Saitama Medical University International Medical Center, Japan
| | - Shomei Ryozawa
- Department of Gastroenterology, Saitama Medical University International Medical Center, Japan
| | - Atsushi Irisawa
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, Japan
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, Japan
| | - Atsuhiro Masuda
- Division of Gastroenterology Department of Internal Medicine, Kobe University Graduate School of Medicine, Japan
| | - Yuki Tanisaka
- Department of Gastroenterology, Saitama Medical University International Medical Center, Japan
| | - Akashi Fujita
- Department of Gastroenterology, Saitama Medical University International Medical Center, Japan
| | - Masafumi Mizuide
- Department of Gastroenterology, Saitama Medical University International Medical Center, Japan
| | - Akane Yamabe
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, Japan
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, Japan
| | - Goro Shibukawa
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, Japan
| | - Arata Sakai
- Division of Gastroenterology Department of Internal Medicine, Kobe University Graduate School of Medicine, Japan
| | - Hideyuki Shiomi
- Division of Gastroenterology Department of Internal Medicine, Kobe University Graduate School of Medicine, Japan
| | - Hayato Yoshinaka
- Center for Clinical Research and Advanced Medicine Establishment, Shiga University of Medical Science, Japan
| | - Yoshihiro Okabe
- Department of Gastroenterology, Kakogawa Central City Hospital, Japan
| | | | - Hiromu Kutsumi
- Center for Clinical Research and Advanced Medicine Establishment, Shiga University of Medical Science, Japan
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9
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Arakawa N, Irisawa A, Ishida K, Tsunoda T, Yamaguchi Y, Shibukawa G, Eizuka M, Tokioka S, Wakabayashi H. Clinical Differences in c-Myc Expression in Early-Stage Gastric Neoplasia: A Retrospective Study Based on the WHO Classification. J Clin Med 2022; 11:jcm11030544. [PMID: 35159995 PMCID: PMC8836573 DOI: 10.3390/jcm11030544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/12/2022] [Accepted: 01/20/2022] [Indexed: 02/01/2023] Open
Abstract
c-Myc is an oncogene that is dysregulated in various cancers. Early gastric neoplasia with c-Myc expression has been reported as a more malignant lesion. This study clarifies the differences in c-Myc expression in early gastric neoplasia based on the WHO classification. Samples from 100 patients with differentiated-type early gastric neoplasia, who underwent endoscopic submucosal dissection between March 2020 and January 2021, were stained for c-Myc. One hundred lesions were classified as low-grade dysplasia, high-grade dysplasia, or intramucosal adenocarcinoma. The staining intensity and extent were scored. A hierarchical cluster analysis for a clinicopathological analysis among the groups, the chi-square test, Bonferroni correction, and residual analysis were performed. Subgroup one and two consisted of 39 patients; while subgroup three consisted of 22. Significant differences among various characteristics were observed between these subgroups. The frequency of low-grade dysplasia was significantly higher, while that of high-grade dysplasia was significantly lower in subgroup three. The frequency of intramucosal adenocarcinoma was significantly higher in subgroup one. The c-Myc positivity rate was significantly higher in subgroup one compared with that in subgroup three. c-Myc expression distinctly differed in early gastric neoplasia. c-Myc-negative low-grade dysplasia may be separately categorized from c-Myc-positive low-grade dysplasia, high-grade dysplasia, and intramucosal adenocarcinoma.
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Affiliation(s)
- Noriyuki Arakawa
- Department of Gastroenterology, Takeda General Hospital, Aizuwakamatsu 965-8585, Japan; (T.T.); (S.T.); (H.W.)
- Correspondence: ; Tel.: +81-242-27-5511
| | - Atsushi Irisawa
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, Mibu 321-0293, Japan;
| | - Kazuyuki Ishida
- Department of Pathology, Dokkyo Medical University School of Medicine, Mibu 321-0293, Japan;
| | - Takuya Tsunoda
- Department of Gastroenterology, Takeda General Hospital, Aizuwakamatsu 965-8585, Japan; (T.T.); (S.T.); (H.W.)
| | - Yoshiko Yamaguchi
- Department of Pathology, Takeda General Hospital, Aizuwakamatsu 965-8585, Japan;
| | - Goro Shibukawa
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, Aizuwakamatsu 969-3492, Japan;
| | - Makoto Eizuka
- Department of Molecular Diagnostic Pathology, Iwate Medical University School of Medicine, Iwate 028-3694, Japan;
| | - Shunzo Tokioka
- Department of Gastroenterology, Takeda General Hospital, Aizuwakamatsu 965-8585, Japan; (T.T.); (S.T.); (H.W.)
| | - Hiroto Wakabayashi
- Department of Gastroenterology, Takeda General Hospital, Aizuwakamatsu 965-8585, Japan; (T.T.); (S.T.); (H.W.)
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10
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Kanno A, Yasuda I, Irisawa A, Hara K, Ashida R, Iwashita T, Takenaka M, Katanuma A, Takikawa T, Kubota K, Kato H, Nakai Y, Ryozawa S, Kitano M, Isayama H, Kamada H, Okabe Y, Hanada K, Ohtsubo K, Doi S, Hisai H, Shibukawa G, Imazu H, Masamune A. Adverse events of endoscopic ultrasound-guided fine-needle aspiration for histologic diagnosis in Japanese tertiary centers: Multicenter retrospective study. Dig Endosc 2021; 33:1146-1157. [PMID: 33284491 DOI: 10.1111/den.13912] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 11/27/2020] [Accepted: 12/03/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND AIMS Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is used for the histopathological diagnosis of any type of gastrointestinal disease. Few adverse events are experienced with this procedure; however, the actual rate of adverse events remains unclear. This study aimed to clarify the current status of cases that experienced adverse events related to the EUS-FNA procedure used for histopathologic diagnoses. METHODS A retrospective analysis of cases with EUS-FNA-related adverse events in Japanese tertiary centers was conducted by assessing the following clinical data: basic case information, FNA technique, type of procedural adverse events, and prognosis. RESULTS Of the 13,566 EUS-FNA cases overall, the total number of cases in which adverse events related to EUS-FNA occurred was 234. The incidence of EUS-FNA-related adverse events was ~1.7%. Bleeding and pancreatitis cases accounted for ~49.1% and 26.5% of all adverse events, respectively. Bleeding was the most common adverse event with only seven cases requiring blood transfusion. In cases with neuroendocrine tumors, pancreatitis was the most frequent adverse event. Needle tract seeding because of EUS-FNA was observed during the follow-up period in only ~0.1% of cases with pancreatic cancer. There was no mortality because of adverse events caused by EUS-FNA. CONCLUSIONS This study revealed that the adverse events-related EUS-FNA for histopathologic diagnoses were not severe conditions, and had low incidence.
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Affiliation(s)
- Atsushi Kanno
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Miyagi, Japan.,Department of Medicine, Division of Gastroenterology, Jichi Medical University, Tochigi, Japan
| | - Ichiro Yasuda
- Third Department of Internal Medicine, University of Toyama, Toyama, Japan
| | - Atsushi Irisawa
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, Tochigi, Japan
| | - Kazuo Hara
- Department of Gastroenterology, Aichi Cancer Center Hospital, Aichi, Japan
| | - Reiko Ashida
- Departments of Cancer Survey and Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan.,Second Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan
| | - Takuji Iwashita
- First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan
| | - Mamoru Takenaka
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, Osaka, Japan
| | - Akio Katanuma
- Center for Gastroenterology, Teine Keijinkai Hospital, Hokkaido, Japan
| | - Tetsuya Takikawa
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Kensuke Kubota
- Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Kanagawa, Japan
| | - Hironari Kato
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Yousuke Nakai
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shomei Ryozawa
- Department of Gastroenterology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Masayuki Kitano
- Second Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan
| | - Hiroyuki Isayama
- Department of Gastroenterology, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Hideki Kamada
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Yoshinobu Okabe
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Fukuoka, Japan
| | - Keiji Hanada
- Department of Gastroenterology, JA Onomichi General Hospital, Hiroshima, Japan
| | - Koushiro Ohtsubo
- Division of Medical Oncology, Cancer Research Institute, Kanazawa University, Ishikawa, Japan
| | - Shinpei Doi
- Department of Gastroenterology, Teikyo University Mizonokuchi Hospital, Kanagawa, Japan
| | - Hiroyuki Hisai
- Department of Gastroenterology, Japanese Red Cross Date Hospital, Hokkaido, Japan
| | - Goro Shibukawa
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, Fukushima, Japan
| | - Hiroo Imazu
- Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Atsushi Masamune
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Miyagi, Japan
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11
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Yamabe A, Irisawa A, Bhutani MS, Sato A, Maki T, Takasaki Y, Yoshida Y, Yamamoto S, Shibukawa G. Validity of Endoscopic Ultrasound Findings of Chronic Pancreatitis: Evaluation from the Viewpoint of Disease Risk Factors. Digestion 2021; 102:289-297. [PMID: 31801132 DOI: 10.1159/000504780] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 11/13/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND The diagnosis of chronic pancreatitis (CP) using endoscopic ultrasound (EUS) criteria, referred to as the Rosemont classification (RC), has been widely performed. However, the validity of the RC, which was based on expert opinion, is still controversial. If EUS findings are associated with CP, then they should be associated with risk factors for CP. In this study, to verify the appropriateness of the RC and each EUS finding, we performed a retrospective analysis from the viewpoint of risk factors for CP. SUMMARY Three hundred and forty-four patients were enrolled in this study. Clinical background characteristics that associate with CP were alcohol intake, smoking, history of acute pancreatitis (AP), and age. The correlation between EUS criteria for CP and clinical background was investigated. All EUS findings except the presence of cysts showed significant correlations with one or 2 of the 3 following factors: ethanol (EtOH) intake, smoking status, and history of AP. Results of the univariate and multivariate analyses showed that 3 factors (EtOH intake, smoking, and history of AP) other than age were positively correlated with the RC. Moreover, the risk of progression from normal to consistent CP to indeterminate and suggestive CP was found to increase with increasing EtOH intake. Key Messages: The RC and each EUS finding was validated from the viewpoint of risk factors for CP.
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Affiliation(s)
- Akane Yamabe
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, Tochigi, Japan.,Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, Fukushima, Japan
| | - Atsushi Irisawa
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, Tochigi, Japan, .,Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, Fukushima, Japan,
| | - Manoop S Bhutani
- Department of Gastroenterology, Hepatology and Nutrition-Unit, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ai Sato
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, Tochigi, Japan.,Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, Fukushima, Japan
| | - Takumi Maki
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, Tochigi, Japan
| | - Yusuke Takasaki
- Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan
| | - Yoshitsugu Yoshida
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, Tochigi, Japan
| | - Shogo Yamamoto
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, Tochigi, Japan
| | - Goro Shibukawa
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, Tochigi, Japan
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12
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Irisawa A, Shibukawa G, Hoshi K, Yamabe A, Sato A, Maki T, Yoshida Y, Yamamoto S, Obara K. Endoscopic ultrasound-guided coil deployment with sclerotherapy for isolated gastric varices: Case series of feasibility, safety, and long-term follow-up. Dig Endosc 2020; 32:1100-1104. [PMID: 32147871 DOI: 10.1111/den.13666] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 03/05/2020] [Indexed: 02/08/2023]
Abstract
The purpose of the present study is to report our experience of endoscopic ultrasound-guided coil deployment with sclerotherapy (EUS-CS) for isolated gastric varices (IGV) through a case series. Eight consecutive patients who had risky IGV were prospectively enrolled. EUS-CS was performed according to the following procedures: (i) several coils were first deployed in the IGV under EUS guidance; (ii) contrast medium was subsequently injected without removing the needle; (iii) if the infused contrast medium stayed in the IGV and feeding vein, sclerosant was then injected to obliterate the IGV and feeders. Coil deployment in the IGV was successfully performed in all cases. Sclerosant was injected both into the IGV and feeders in seven patients (87.5%). There was no adverse event during the procedure. During a median follow-up of 57 months, one patient who could not inject the sclerosant into IGV and feeders had an early hemorrhagic recurrence. Our case series showed that EUS-CS could be a feasible and safe procedure for the treatment of IGV.
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Affiliation(s)
- Atsushi Irisawa
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, Tochigi, Japan.,Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, Fukushima, Japan
| | - Goro Shibukawa
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, Fukushima, Japan
| | - Koki Hoshi
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, Tochigi, Japan
| | - Akane Yamabe
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, Tochigi, Japan
| | - Ai Sato
- Department of Gastroenterology, Dokkyo Medical University School of Medicine, Tochigi, Japan.,Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, Fukushima, Japan
| | - Takumi Maki
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, Fukushima, Japan
| | - Yoshitsugu Yoshida
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, Fukushima, Japan
| | - Shogo Yamamoto
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, Fukushima, Japan
| | - Katsutoshi Obara
- Department of Advanced Gastrointestinal Endoscopy, Fukushima Medical University School of Medicine, Fukushima, Japan
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13
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Nakajima Y, Zhu X, Nemoto D, Li Q, Guo Z, Katsuki S, Hayashi Y, Utano K, Aizawa M, Takezawa T, Sagara Y, Shibukawa G, Yamamoto H, Lefor AK, Togashi K. Diagnostic performance of artificial intelligence to identify deeply invasive colorectal cancer on non-magnified plain endoscopic images. Endosc Int Open 2020; 8:E1341-E1348. [PMID: 33015336 PMCID: PMC7508661 DOI: 10.1055/a-1220-6596] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 06/24/2020] [Indexed: 02/07/2023] Open
Abstract
Background and study aims Colorectal cancers (CRC) with deep submucosal invasion (T1b) could be metastatic lesions. However, endoscopic images of T1b CRC resemble those of mucosal CRCs (Tis) or with superficial invasion (T1a). The aim of this study was to develop an automatic computer-aided diagnosis (CAD) system to identify T1b CRC based on plain endoscopic images. Patients and methods In two hospitals, 1839 non-magnified plain endoscopic images from 313 CRCs (Tis 134, T1a 46, T1b 56, beyond T1b 37) with sessile morphology were extracted for training. A CAD system was trained with the data augmented by rotation, saturation, resizing and exposure adjustment. Diagnostic performance was assessed using another dataset including 44 CRCs (Tis 23, T1b 21) from a third hospital. CAD generated a probability level for T1b diagnosis for each image, and > 95 % of probability level was defined as T1b. Lesions with at least one image with a probability level > 0.95 were regarded as T1b. Primary outcome is specificity. Six physicians separately read the same testing dataset. Results Specificity was 87 % (95 % confidence interval: 66-97) for CAD, 100 % (85-100) for Expert 1, 96 % (78-100) for Expert 2, 61 % (39-80) for both gastroenterology trainees, 48 % (27-69) for Novice 1 and 22 % (7-44) for Novice 2. Significant differences were observed between CAD and both novices ( P = 0.013, P = 0.0003). Other diagnostic values of CAD were slightly lower than of the two experts. Conclusions Specificity of CAD was superior to novices and possibly to gastroenterology trainees but slightly inferior to experts.
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Affiliation(s)
- Yuki Nakajima
- Coloproctology & Gastroenterology, Aizu Medical Center, Fukushima Medical University, Japan
| | - Xin Zhu
- Biomedical Information Engineering Lab, the University of Aizu, Japan
| | - Daiki Nemoto
- Coloproctology & Gastroenterology, Aizu Medical Center, Fukushima Medical University, Japan
| | - Qin Li
- Biomedical Information Engineering Lab, the University of Aizu, Japan
| | - Zhe Guo
- Biomedical Information Engineering Lab, the University of Aizu, Japan
| | | | | | - Kenichi Utano
- Coloproctology & Gastroenterology, Aizu Medical Center, Fukushima Medical University, Japan
| | - Masato Aizawa
- Coloproctology & Gastroenterology, Aizu Medical Center, Fukushima Medical University, Japan
| | | | | | - Goro Shibukawa
- Coloproctology & Gastroenterology, Aizu Medical Center, Fukushima Medical University, Japan
| | | | | | - Kazutomo Togashi
- Coloproctology & Gastroenterology, Aizu Medical Center, Fukushima Medical University, Japan
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14
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Maki T, Irisawa A, Notohara K, Shibukawa G, Sato A, Yamabe A, Yoshida Y, Yamamoto S, Soeta N, Saito T. Duodenal Stenosis Due to Carcinoma of the Lower Bile Duct: A Case Report. Clin Med Insights Case Rep 2020; 13:1179547620919453. [PMID: 32425628 PMCID: PMC7218460 DOI: 10.1177/1179547620919453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 03/24/2020] [Indexed: 11/17/2022]
Abstract
An 83-year-old man was referred to our hospital for a detailed evaluation for vomiting. Esophagogastroduodenoscopy and abdominal computed tomography showed duodenal stenosis with wall thickness. Biopsy including endoscopic ultrasound-guided fine-needle aspiration of the thickened wall showed inflammation without malignancy. During the clinical course, wall thickening of the distal bile duct appeared. Biopsy under endoscopic retrograde cholangiography showed papillary adenocarcinoma. Surgery revealed that the tumor had widely invaded the duodenal wall from the outside; therefore, only gastrojejunostomy was performed. It was hypothesized that the cholangiocarcinoma had progressed to the serosal side, disseminated in the peritoneum, infiltrated the duodenal serosa, and caused duodenal stenosis.
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Affiliation(s)
- Takumi Maki
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, Fukushima, Japan
| | - Atsushi Irisawa
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, Fukushima, Japan.,Department of Gastroenterology, Dokkyo Medical University, Mibu, Japan
| | - Kenji Notohara
- Department of Anatomic Pathology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Goro Shibukawa
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, Fukushima, Japan
| | - Ai Sato
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, Fukushima, Japan.,Department of Gastroenterology, Dokkyo Medical University, Mibu, Japan
| | - Akane Yamabe
- Department of Gastroenterology, Dokkyo Medical University, Mibu, Japan
| | - Yoshitsugu Yoshida
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, Fukushima, Japan
| | - Shogo Yamamoto
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, Fukushima, Japan
| | - Nobutoshi Soeta
- Department of Surgery, Aizu Medical Center, Fukushima Medical University, Fukushima, Japan
| | - Takuro Saito
- Department of Surgery, Aizu Medical Center, Fukushima Medical University, Fukushima, Japan
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15
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Shibukawa G, Irisawa A, Sato A, Abe Y, Yamabe A, Arakawa N, Takasaki Y, Maki T, Yoshida Y, Igarashi R, Yamamoto S, Ikeda T, Hojo H. Endoscopic Mucosal Resection Performed Underwater for Nonampullary Duodenal Epithelial Tumor: Evaluation of Feasibility and Safety. Gastroenterol Res Pract 2018; 2018:7490961. [PMID: 30158967 PMCID: PMC6109562 DOI: 10.1155/2018/7490961] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Revised: 05/14/2018] [Accepted: 06/14/2018] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES Recently, opportunities to encounter superficial nonampullary duodenal epithelial tumor (SNADET) have increased. EMR and ESD are performed to treat SNADET. However, the rate of perforation is higher than that of other gastrointestinal lesions, regardless of which method is used. Underwater EMR (UW-EMR) is immersion treatment of SNADET, which has low risk of perforation and can remove lesions safely and completely. In the present study, we retrospectively investigated patients in whom UW-EMR was performed to evaluate the feasibility and safety of UW-EMR for the treatment of SNADET. METHODS The primary endpoint was to evaluate the feasibility of UW-EMR for the treatment of SNADET, and secondary objective was to determine the operation's safety. RESULTS There were 14 participants, with a total of 16 lesions, who underwent UW-EMR between August 2015 and December 2017. Histological heteromorphism revealed that seven patients had low-grade adenoma, seven had high-grade adenoma, and two had adenocarcinoma. En bloc resection was performed in 14 lesions. In two patients, nodular lesions were observed in the scar and biopsy confirmed recurrences. There were no serious adverse events including bleeding or perforation. CONCLUSIONS UW-EMR may be a safe and effective treatment method for SNADET, if its therapeutic indication is adequately considered.
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Affiliation(s)
- Goro Shibukawa
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, Aizuwakamatsu, Japan
| | - Atsushi Irisawa
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, Aizuwakamatsu, Japan
| | - Ai Sato
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, Aizuwakamatsu, Japan
| | - Yoko Abe
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, Aizuwakamatsu, Japan
| | - Akane Yamabe
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, Aizuwakamatsu, Japan
| | - Noriyuki Arakawa
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, Aizuwakamatsu, Japan
| | - Yusuke Takasaki
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, Aizuwakamatsu, Japan
| | - Takumi Maki
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, Aizuwakamatsu, Japan
| | - Yoshitsugu Yoshida
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, Aizuwakamatsu, Japan
| | - Ryo Igarashi
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, Aizuwakamatsu, Japan
| | - Shogo Yamamoto
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, Aizuwakamatsu, Japan
| | - Tsunehiko Ikeda
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, Aizuwakamatsu, Japan
| | - Hiroshi Hojo
- Department of Pathology, Aizu Medical Center, Fukushima Medical University, Aizuwakamatsu, Japan
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16
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Takasaki Y, Irisawa A, Shibukawa G, Sato A, Abe Y, Yamabe A, Arakawa N, Maki T, Yoshida Y, Igarashi R, Yamamoto S, Ikeda T, Soeta N, Saito T, Hojo H. A Case of Obstructive Jaundice Caused by Metastasis of Ovarian Cancer to the Duodenal Major Papilla. Clin Med Insights Case Rep 2018; 11:1179547618791571. [PMID: 30090022 PMCID: PMC6077891 DOI: 10.1177/1179547618791571] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 07/06/2018] [Indexed: 12/29/2022]
Abstract
Ovarian cancer often occurs distant metastasis to the peritoneum, liver, lungs, and lymph nodes. However, there has been no reported case of direct metastasis to the duodenal major papilla. We herein reported 72-year-old woman with history of ovarian cancer surgery 11 years ago presenting with obstructive jaundice. Abdominal CT showed a small mass in the distal bile duct. Forceps biopsy from the small mass was done under endoscopic retrograde cholangiography, and histologic examination revealed adenocarcinoma. Pancreaticoduodenectomy was performed and diagnosed immunohistochemically direct metastasis to the papilla from ovarian cancer. The duodenal major papilla is known to be rich in lymph vessels, and these lymph vessels are considered the likely pathway of metastasis in this case.
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Affiliation(s)
- Yusuke Takasaki
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, Fukushima, Japan.,Department of Gastroenterology, Juntendo University, Tokyo, Japan
| | - Atsushi Irisawa
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, Fukushima, Japan.,Department of Gastroenterology, Juntendo University, Tokyo, Japan.,Department of Gastroenterology, Dokkyo Medical University, Tochigi, Japan
| | - Goro Shibukawa
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, Fukushima, Japan
| | - Ai Sato
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, Fukushima, Japan
| | - Yoko Abe
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, Fukushima, Japan
| | - Akane Yamabe
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, Fukushima, Japan
| | - Noriyuki Arakawa
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, Fukushima, Japan
| | - Takumi Maki
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, Fukushima, Japan
| | - Yoshitsugu Yoshida
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, Fukushima, Japan
| | - Ryo Igarashi
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, Fukushima, Japan
| | - Shogo Yamamoto
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, Fukushima, Japan
| | - Tsunehiko Ikeda
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, Fukushima, Japan
| | - Nobutoshi Soeta
- Department of Surgery, Aizu Medical Center, Fukushima Medical University, Fukushima, Japan
| | - Takuro Saito
- Department of Surgery, Aizu Medical Center, Fukushima Medical University, Fukushima, Japan
| | - Hiroshi Hojo
- Department of Pathology, Aizu Medical Center, Fukushima Medical University, Fukushima, Japan
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17
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Arakawa N, Irisawa A, Shibukawa G, Sato A, Abe Y, Yamabe A, Takasakia Y, Yoshida Y, Maki T, Igarashi R, Yamamoto S, Ikeda T, Hojo H. Simultaneous Gastric Metastasis From Renal Cell Carcinoma: A Case Report and Literature Review. Clin Med Insights Case Rep 2018; 11:1179547618775095. [PMID: 29844708 PMCID: PMC5967158 DOI: 10.1177/1179547618775095] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 04/03/2018] [Indexed: 12/27/2022]
Abstract
While some reports are available regarding metachronous gastric metastasis from renal cell carcinoma after treatment, there are few reports of primary lesion detection based on the diagnosis of a gastric metastatic lesion. The patient in this case was an 80-year-old woman who underwent upper gastrointestinal endoscopy after having developed anorexia 2 months earlier. A submucosal tumor with central umbilication was found in the gastric greater curvature. Endoscopic ultrasonography revealed a solid and hypoechoic mass with hypervascularity on color Doppler imaging that proliferated mainly within the submucosal layer. There was partial exposure of the tumor on the superficial layer. Biopsy was performed, as a neuroendocrine tumor was suspected; however, histopathological findings with immunostaining revealed gastric metastasis from clear renal cell carcinoma. Subsequently, contrast enhanced computed tomography showed right renal cell carcinoma and liver metastasis. Thus, molecularly targeted drug treatment was initiated by the Department of Urology. Our findings indicate that a primary lesion can be identified and prognosis can be assumed based on biopsy of the gastric metastatic lesion. Immunostaining of biopsy samples collected endoscopically could help achieve definite diagnosis.
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Affiliation(s)
- Noriyuki Arakawa
- Department of Gastroenterology, Fukushima Medical University Aizu Medical Center, Aizuwakamatsu, Japan
| | - Atsushi Irisawa
- Department of Gastroenterology, Fukushima Medical University Aizu Medical Center, Aizuwakamatsu, Japan
| | - Goro Shibukawa
- Department of Gastroenterology, Fukushima Medical University Aizu Medical Center, Aizuwakamatsu, Japan
| | - Ai Sato
- Department of Gastroenterology, Fukushima Medical University Aizu Medical Center, Aizuwakamatsu, Japan
| | - Yoko Abe
- Department of Gastroenterology, Fukushima Medical University Aizu Medical Center, Aizuwakamatsu, Japan
| | - Akane Yamabe
- Department of Gastroenterology, Fukushima Medical University Aizu Medical Center, Aizuwakamatsu, Japan
| | - Yusuke Takasakia
- Department of Gastroenterology, Fukushima Medical University Aizu Medical Center, Aizuwakamatsu, Japan
| | - Yoshitsugu Yoshida
- Department of Gastroenterology, Fukushima Medical University Aizu Medical Center, Aizuwakamatsu, Japan
| | - Takumi Maki
- Department of Gastroenterology, Fukushima Medical University Aizu Medical Center, Aizuwakamatsu, Japan
| | - Ryo Igarashi
- Department of Gastroenterology, Fukushima Medical University Aizu Medical Center, Aizuwakamatsu, Japan
| | - Shogo Yamamoto
- Department of Gastroenterology, Fukushima Medical University Aizu Medical Center, Aizuwakamatsu, Japan
| | - Tsunehiko Ikeda
- Department of Gastroenterology, Fukushima Medical University Aizu Medical Center, Aizuwakamatsu, Japan
| | - Hiroshi Hojo
- Department of Pathology, Fukushima Medical University Aizu Medical Center, Aizuwakamatsu, Japan
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18
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Igarashi R, Irisawa A, Shibukawa G, Soeta N, Sato A, Yamabe A, Fujisawa M, Arakawa N, Yoshida Y, Ikeda T, Abe Y, Maki T, Yamamoto S, Oshibe I, Saito T, Hojo H. Case Report of a Small Gastric Neuroendocrine Tumor in a Deep Layer of Submucosa With Diagnosis by Endoscopic Ultrasound-Guided Fine-Needle Aspiration and Treatment With Laparoscopic and Endoscopic Cooperative Surgery. Clin Med Insights Case Rep 2018; 11:1179547617749226. [PMID: 29371789 PMCID: PMC5768268 DOI: 10.1177/1179547617749226] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 09/29/2017] [Indexed: 12/24/2022]
Abstract
Gastric neuroendocrine tumors (GNETs) are rare lesions characterized by enterochromaffin-like cells of the stomach. Optimal management of GNETs has not yet been definitively determined. Endoscopic resection is approximately recommended for small GNETs associated with hypergastrinemia. However, endoscopic resection might present risk of perforation or positive vertical margin because neuroendocrine tumors occur in the deep mucosa, with some invading the submucosa. In this case, a patient with type A chronic atrophic gastritis had a small subepithelial lesion in a deep submucosal layer, and we diagnosed it as GNET using endoscopic ultrasound-guided fine-needle aspiration biopsy using a forward-viewing and curved linear-array echoendoscope. Moreover, our results show that laparoscopic and endoscopic cooperative surgery with regional lymph node dissection is a safe and feasible procedure for GNETs, especially those that cross to the muscularis propria. We suggest this approach as one therapeutic option for GNETs because it safely minimizes resection and is less invasive.
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Affiliation(s)
- Ryo Igarashi
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, Fukushima, Japan
| | - Atsushi Irisawa
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, Fukushima, Japan
| | - Goro Shibukawa
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, Fukushima, Japan
| | - Nobutoshi Soeta
- Department of Surgery, Aizu Medical Center, Fukushima Medical University, Fukushima, Japan
| | - Ai Sato
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, Fukushima, Japan
| | - Akane Yamabe
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, Fukushima, Japan
| | - Mariko Fujisawa
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, Fukushima, Japan
| | - Noriyuki Arakawa
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, Fukushima, Japan
| | - Yoshitsugu Yoshida
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, Fukushima, Japan
| | - Tsunehiko Ikeda
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, Fukushima, Japan
| | - Yoko Abe
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, Fukushima, Japan
| | - Takumi Maki
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, Fukushima, Japan
| | - Shogo Yamamoto
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, Fukushima, Japan
| | - Ikuro Oshibe
- Department of Surgery, Aizu Medical Center, Fukushima Medical University, Fukushima, Japan
| | - Takuro Saito
- Department of Surgery, Aizu Medical Center, Fukushima Medical University, Fukushima, Japan
| | - Hiroshi Hojo
- Department of Pathology, Aizu Medical Center, Fukushima Medical University, Fukushima, Japan
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Yamabe A, Irisawa A, Shibukawa G, Sato A, Fujisawa M, Arakawa N, Yoshida Y, Abe Y, Igarashi R, Maki T, Yamamoto S. Early diagnosis of chronic pancreatitis: understanding the factors associated with the development of chronic pancreatitis. Fukushima J Med Sci 2017; 63:1-7. [PMID: 28450665 DOI: 10.5387/fms.2016-14] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The prognosis of advanced chronic pancreatitis (CP) is poor with the mortality rate approximately two-fold higher than the general population according to a survey of the prognosis of CP. From this standpoint, the concept of early CP was propagated in Japan in 2009 to encourage the medical treatment for the earlier stages of CP. That is, picking up the patients suspicious for early CP and then providing medical treatment for them are very important not only for patients, but also for health care economics. In this review, we described some potential factors associated with the development of CP (alcohol, smoking, past history of acute pancreatitis, aging, gallstone, and gender) that are extremely important to discover patients with early-stage CP.
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Affiliation(s)
| | - Atsushi Irisawa
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University
| | - Goro Shibukawa
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University
| | - Ai Sato
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University
| | - Mariko Fujisawa
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University
| | - Noriyuki Arakawa
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University
| | - Yoshitsugu Yoshida
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University
| | - Yoko Abe
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University
| | - Ryo Igarashi
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University
| | - Takumi Maki
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University
| | - Shogo Yamamoto
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University
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20
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Yamabe A, Irisawa A, Shibukawa G, Sato A, Fujisawa M, Arakawa N, Yoshida Y, Igarashi R, Maki T, Yamamoto S, Ikeda T, Abe Y, Hoshi K. Inflammatory Bile Duct Obstruction during the Healing Stage of Severe Acute Pancreatitis. Intern Med 2017; 56:1037-1040. [PMID: 28458308 PMCID: PMC5478563 DOI: 10.2169/internalmedicine.56.7859] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The patient was a 62-year-old woman with a history of severe acute pancreatitis complicated by walled-off necrosis (WON), who developed obstructive jaundice during the recovery phase from WON. Magnetic resonance cholangiopancreatography (MRCP) and endoscopic retrograde cholangiopancreatography (ERCP) revealed the complete obstruction of the distal bile duct, and endoscopic ultrasonography (EUS) revealed thickening of the duct wall, with a uniform distribution, and a relatively well-preserved layered structure. A cytopathological examination using ERCP showed no malignancy. The underlying etiology of this case may have been the formation of a cicatricial stricture during the resolution of WON, in addition to fibrosis caused by the spreading of inflammation from pancreatitis.
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Affiliation(s)
- Akane Yamabe
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, Japan
| | - Atsushi Irisawa
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, Japan
| | - Goro Shibukawa
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, Japan
| | - Ai Sato
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, Japan
| | - Mariko Fujisawa
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, Japan
| | - Noriyuki Arakawa
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, Japan
| | - Yoshitsugu Yoshida
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, Japan
| | - Ryo Igarashi
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, Japan
| | - Takumi Maki
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, Japan
| | - Shogo Yamamoto
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, Japan
| | - Tsunehiko Ikeda
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, Japan
| | - Yoko Abe
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, Japan
| | - Koki Hoshi
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, Japan
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21
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Sato A, Irisawa A, Bhutani MS, Shibukawa G, Yamabe A, Fujisawa M, Igarashi R, Arakawa N, Yoshida Y, Abe Y, Maki T, Hoshi K, Ohira H. Significance of normal appearance on endoscopic ultrasonography in the diagnosis of early chronic pancreatitis. Endosc Ultrasound 2017; 7:110-118. [PMID: 28685746 PMCID: PMC5914182 DOI: 10.4103/2303-9027.209870] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background and Objectives: The Rosemont classification (RC) was developed as a consensus-based standard for the diagnosis of chronic pancreatitis (CP) by endoscopic ultrasonography (EUS), however, it is more complicated than the conventional scoring system. We have noticed that in the early stages of CP, it is not unusual to observe pancreas with abnormal appearance coexisting with the areas of normal parenchyma. The aim of this study was to investigate the validity of a “normal” pancreas appearance and to evaluate the usefulness of modified diagnostic criteria in comparison to the traditional EUS criteria and the RC. Patients and Methods: One hundred and seventy-seven patients who had undergone both EUS and endoscopic retrograde pancreatography (ERP) within 2 months were enrolled in the study, and patients with pancreatic cancer were excluded from the study. ERP findings were used as the gold standard for the diagnosis of CP. The EUS images obtained were classified according to both the RC and our new modified criteria. The latter includes an additional criterion to the modified traditional criteria: fine-reticular pattern (F-RP) was defined as a normal pancreatic parenchyma. We compared the accuracy between the new modified EUS criteria and the RC. Results: (1) Normal or equivocal findings on ERP were obtained for 132 patients; 113 patients had F-RP on EUS. In contrast, F-RP was found in only 6 out of 45 CP cases on ERP (P < 0.0001). (2) We investigated the diagnostic capability of our new criteria for endoscopic retrograde cholangiopancreatography normal/equivocal pancreas compared to the traditional criteria. In cases where fewer than two points were defined as normal, the incidence of normal pancreas was significantly higher based on the new criteria than on the traditional criteria (P = 0.002). (3) No significant differences were found between the new criteria and the RC across all ERP grades. Conclusion: Our new proposed “normal-added EUS criteria” for diagnosing CP was equivalent to the RC.
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Affiliation(s)
- Ai Sato
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, Tanisawa, Kawahigashi, Aizuwakamatsu, Japan
| | - Atsushi Irisawa
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, Tanisawa, Kawahigashi, Aizuwakamatsu, Japan
| | - Manoop S Bhutani
- Department of Gastroenterology Hepatology and Nutrition, Unit 1466, MD Anderson Cancer Center, University of Texas, Houston, Texas, USA
| | - Goro Shibukawa
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, Tanisawa, Kawahigashi, Aizuwakamatsu, Japan
| | - Akane Yamabe
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, Tanisawa, Kawahigashi, Aizuwakamatsu, Japan
| | - Mariko Fujisawa
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, Tanisawa, Kawahigashi, Aizuwakamatsu, Japan
| | - Ryo Igarashi
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, Tanisawa, Kawahigashi, Aizuwakamatsu, Japan
| | - Noriyuki Arakawa
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, Tanisawa, Kawahigashi, Aizuwakamatsu, Japan
| | - Yoshitsugu Yoshida
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, Tanisawa, Kawahigashi, Aizuwakamatsu, Japan
| | - Yoko Abe
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, Tanisawa, Kawahigashi, Aizuwakamatsu, Japan
| | - Takumi Maki
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, Tanisawa, Kawahigashi, Aizuwakamatsu, Japan
| | - Koki Hoshi
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, Tanisawa, Kawahigashi, Aizuwakamatsu, Japan
| | - Hiromasa Ohira
- Department of Gastroenterology and Rheumatology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, Japan
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22
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Yamabe A, Irisawa A, Wada I, Shibukawa G, Fujisawa M, Sato A, Igarashi R, Maki T, Hoshi K. Application of a silver coating on plastic biliary stents to prevent biofilm formation: an experimental study using electron microscopy. Endosc Int Open 2016; 4:E1090-E1095. [PMID: 27747284 PMCID: PMC5063737 DOI: 10.1055/s-0042-115173] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 07/29/2016] [Indexed: 02/06/2023] Open
Abstract
Background and study aims: Biliary stent dysfunction is mainly caused by biliary sludge that forms as a result of bacterial adherence and subsequent biofilm formation on the inner surface of the stent. Silver ions arewell known to have excellent antimicrobial activity against a wide range of microorganisms. In this study, we designed and constructed silver-coated plastic stent (PS) and investigated whether the silver coating prevented bacterial adherence and biofilm formation through the use of electron microscopy. Material and methods: The polyurethane PS with/without silver coating were prepared in 6-inch segments. The silver-based antimicrobial agents were electrostatically applied onto the stent surface. The stents were then immersed for 5 weeks in infected human bile juice obtained from a patient with cholangitis, and electron microscopy was used to investigate the ability of the modified PS to prevent bacterial adherence and biofilm formation. Results: The bacterial flora did not change before and after immersion of stents in both the group with and without silver coating. Electron microscopic observation revealed meshwork-like structures around the bacteria, characteristic of biofilm-forming bacteria, in all stents from the control group (6/6, 100 %). On the other hand, a limited number of bacteria were observed in all stents in the silver-coated group, and no apparent biofilm formation was observed (0/6, 0 %). Conclusions: The significance of the findings from our study is the ability of silver-coated PS to prevent biofilm formation on the stent surface, which results in the prevention of stent occlusion.
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Affiliation(s)
- Akane Yamabe
- Gastroenterology, Aizu Medical Center, Fukushima Medical University, Aizuwakamatsu, Japan
| | - Atsushi Irisawa
- Gastroenterology, Aizu Medical Center, Fukushima Medical University, Aizuwakamatsu, Japan
| | - Ikuo Wada
- Department of Cell Science, Institute of Biomedical Science, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Goro Shibukawa
- Gastroenterology, Aizu Medical Center, Fukushima Medical University, Aizuwakamatsu, Japan
| | - Mariko Fujisawa
- Gastroenterology, Aizu Medical Center, Fukushima Medical University, Aizuwakamatsu, Japan
| | - Ai Sato
- Gastroenterology, Aizu Medical Center, Fukushima Medical University, Aizuwakamatsu, Japan
| | - Ryo Igarashi
- Gastroenterology, Aizu Medical Center, Fukushima Medical University, Aizuwakamatsu, Japan
| | - Takumi Maki
- Gastroenterology, Aizu Medical Center, Fukushima Medical University, Aizuwakamatsu, Japan
| | - Koki Hoshi
- Gastroenterology, Aizu Medical Center, Fukushima Medical University, Aizuwakamatsu, Japan
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23
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Hoshi K, Irisawa A, Shibukawa G, Yamabe A, Fujisawa M, Igarashi R, Yoshida Y, Abe Y, Imbe K. Validation of a realistic, simple, and inexpensive EUS-FNA training model using isolated porcine stomach. Endosc Int Open 2016; 4:E1004-8. [PMID: 27652292 PMCID: PMC5025348 DOI: 10.1055/s-0042-110094] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Accepted: 06/06/2016] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND AND STUDY AIMS Trainees are required to learn EUS-FNA using a model before working with a patient. The aim of the current study was to validate a new training model developed for EUS-FNA. PATIENTS AND METHODS Several fresh chicken tenderloins were embedded as target lesions in the submucosal layer of an isolated porcine stomach. The stomach was fixed to a plate with nails, and was placed in a tub filled with water. The primary endpoint was feasibility of the newly developed model for EUS-FNA training, evaluated as follows: 1) visualization of the target lesion with blinding for lesion location; 2) penetrability of the needle; 3) sampling rate of macroscopic specimen; and 4) ROSE capability. Secondary endpoints were its durability and utility for multiple EUS-FNA procedures during EUS-FNA training, and the ease and cost of preparing the model. RESULTS Six endoscopists (1 expert, 5 trainees) attempted EUS-FNA procedures using this model. The target lesion could be identified clearly, and EUS-FNA could be performed with realistic resistance felt. In addition, rapid on-site evaluation could be easily achieved. Based on 10 needlings by each endoscopist, adequate specimens for histology could be macroscopically taken with an average 85 % success rate. Visibility and maneuverability were maintained throughout all needlings. Preparation time for this model was less than 30 minutes with a total cost of $ 22. CONCLUSIONS An easy-to-use and inexpensive training model with a realistic feel of needling was created. This model can potentially enable beginners to practice safe and effective EUS-FNA procedures.
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Affiliation(s)
- Koki Hoshi
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, Aizuwakamatsu, Japan
| | - Atsushi Irisawa
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, Aizuwakamatsu, Japan
| | - Goro Shibukawa
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, Aizuwakamatsu, Japan
| | - Akane Yamabe
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, Aizuwakamatsu, Japan
| | - Mariko Fujisawa
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, Aizuwakamatsu, Japan
| | - Ryo Igarashi
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, Aizuwakamatsu, Japan
| | - Yoshitsugu Yoshida
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, Aizuwakamatsu, Japan
| | - Yoko Abe
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, Aizuwakamatsu, Japan
| | - Koh Imbe
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, Aizuwakamatsu, Japan
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24
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Igarashi R, Irisawa A, Shibukawa G, Yamabe A, Fujisawa M, Sato A, Maki T, Arakawa N, Yoshida Y, Yamamoto S, Ikeda T. Eosinophilic esophageal myositis diagnosed by endoscopic ultrasound-guided fine-needle aspiration biopsy: a case report. Clin J Gastroenterol 2016; 9:285-8. [PMID: 27503258 DOI: 10.1007/s12328-016-0678-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 07/29/2016] [Indexed: 12/20/2022]
Abstract
Eosinophilic esophagitis (EoE) is diagnosed by microscopic findings of eosinophilic infiltration into the squamous epithelium. In contrast, another disease concept termed "eosinophilic esophageal myositis (EoEM)" has been proposed, whereby there is eosinophilic infiltration into the muscularis propria instead. A 60-year-old man was referred to our hospital for chest pain, dysphagia, and several episodes of esophageal food impaction. Although EoE was suspected based on clinical features, biopsy specimens showed no mucosal eosinophilic infiltration. Endoscopic ultrasound (EUS) showed thickening of the muscularis propria layer and subsequent EUS-guided fine-needle aspiration biopsy (EUS-FNA) revealed eosinophilic infiltration into the muscularis propria. Although the patient's symptoms gradually improved after steroid administration, complete remission was not achieved after 1 year of treatment. This case may reflect a disorder distinct from typical EoE based on eosinophilic infiltration of the muscularis propria but not the squamous epithelium, and we, therefore, diagnosed it as EoEM using the EUS-FNA findings as reference.
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Affiliation(s)
- Ryo Igarashi
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, 21-2, Maeda, Tanisawa, Kawahigashi, Aizuwakamatsu, 969-3492, Japan.
| | - Atsushi Irisawa
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, 21-2, Maeda, Tanisawa, Kawahigashi, Aizuwakamatsu, 969-3492, Japan
| | - Goro Shibukawa
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, 21-2, Maeda, Tanisawa, Kawahigashi, Aizuwakamatsu, 969-3492, Japan
| | - Akane Yamabe
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, 21-2, Maeda, Tanisawa, Kawahigashi, Aizuwakamatsu, 969-3492, Japan
| | - Mariko Fujisawa
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, 21-2, Maeda, Tanisawa, Kawahigashi, Aizuwakamatsu, 969-3492, Japan
| | - Ai Sato
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, 21-2, Maeda, Tanisawa, Kawahigashi, Aizuwakamatsu, 969-3492, Japan
| | - Takumi Maki
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, 21-2, Maeda, Tanisawa, Kawahigashi, Aizuwakamatsu, 969-3492, Japan
| | - Noriyuki Arakawa
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, 21-2, Maeda, Tanisawa, Kawahigashi, Aizuwakamatsu, 969-3492, Japan
| | - Yoshitsugu Yoshida
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, 21-2, Maeda, Tanisawa, Kawahigashi, Aizuwakamatsu, 969-3492, Japan
| | - Shogo Yamamoto
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, 21-2, Maeda, Tanisawa, Kawahigashi, Aizuwakamatsu, 969-3492, Japan
| | - Tsunehiko Ikeda
- Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, 21-2, Maeda, Tanisawa, Kawahigashi, Aizuwakamatsu, 969-3492, Japan
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Yamabe A, Irisawa A, Notohara K, Shibukawa G, Fujisawa M, Sato A, Yoshida Y, Arakawa N, Ikeda T, Igarashi R, Maki T, Yamamoto S. A case of autoimmune pancreatitis effectively treated with an immunosuppressant (azathioprine). Clin J Gastroenterol 2016; 9:324-8. [PMID: 27450404 DOI: 10.1007/s12328-016-0673-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 07/10/2016] [Indexed: 10/21/2022]
Abstract
The patient was a 42-year-old man who presented at our hospital with obstructive jaundice. Although antinuclear antibody test results were negative, and immunoglobulin G4 (IgG4) was not elevated, endoscopic ultrasound revealed a mixed internal hyperechoic and diffuse hypoechoic pattern, a finding consistent with autoimmune pancreatitis. Endoscopic retrograde cholangiopancreatography further revealed irregular narrowing of the main pancreatic duct and sclerosing cholangitis with distal biliary stricture. In addition, endoscopic ultrasound with fine needle aspiration cytology resulted in a diagnosis of type 1 autoimmune pancreatitis. Oral prednisolone treatment was initiated at 30 mg/day, and the dosage was gradually decreased. However, in accordance with the patient's wishes, maintenance treatment was discontinued once dosage reached 5 mg/day. Despite this, relapse of obstructive jaundice occurred 1 month post discontinuation, and was treated with methyl-prednisolone pulse therapy (500 mg/day) followed by oral prednisolone. However, computed tomography, magnetic resonance imaging, and endoscopic ultrasound did not reveal sufficient improvement after 6 months of treatment. Therefore, an immunosuppressant (azathioprine) was introduced. Subsequent imaging analyses and endoscopic ultrasound fine needle aspiration revealed clear improvements in pathology.
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Affiliation(s)
- Akane Yamabe
- Department of Gastroenterology, Fukushima Medical University Aizu Medical Center, 21-2, Maeda, Tanisawa, Kawahigashi, Aizuwakamatsu, 969-3492, Japan.
| | - Atsushi Irisawa
- Department of Gastroenterology, Fukushima Medical University Aizu Medical Center, 21-2, Maeda, Tanisawa, Kawahigashi, Aizuwakamatsu, 969-3492, Japan
| | - Kenji Notohara
- Department of Pathology, Kurashiki Central Hospital, 1-1-1, Miwa, Kurashiki, 710-8602, Japan
| | - Goro Shibukawa
- Department of Gastroenterology, Fukushima Medical University Aizu Medical Center, 21-2, Maeda, Tanisawa, Kawahigashi, Aizuwakamatsu, 969-3492, Japan
| | - Mariko Fujisawa
- Department of Gastroenterology, Fukushima Medical University Aizu Medical Center, 21-2, Maeda, Tanisawa, Kawahigashi, Aizuwakamatsu, 969-3492, Japan
| | - Ai Sato
- Department of Gastroenterology, Fukushima Medical University Aizu Medical Center, 21-2, Maeda, Tanisawa, Kawahigashi, Aizuwakamatsu, 969-3492, Japan
| | - Yoshitsugu Yoshida
- Department of Gastroenterology, Fukushima Medical University Aizu Medical Center, 21-2, Maeda, Tanisawa, Kawahigashi, Aizuwakamatsu, 969-3492, Japan
| | - Noriyuki Arakawa
- Department of Gastroenterology, Fukushima Medical University Aizu Medical Center, 21-2, Maeda, Tanisawa, Kawahigashi, Aizuwakamatsu, 969-3492, Japan
| | - Tsunehiko Ikeda
- Department of Gastroenterology, Fukushima Medical University Aizu Medical Center, 21-2, Maeda, Tanisawa, Kawahigashi, Aizuwakamatsu, 969-3492, Japan
| | - Ryo Igarashi
- Department of Gastroenterology, Fukushima Medical University Aizu Medical Center, 21-2, Maeda, Tanisawa, Kawahigashi, Aizuwakamatsu, 969-3492, Japan
| | - Takumi Maki
- Department of Gastroenterology, Fukushima Medical University Aizu Medical Center, 21-2, Maeda, Tanisawa, Kawahigashi, Aizuwakamatsu, 969-3492, Japan
| | - Shogo Yamamoto
- Department of Gastroenterology, Fukushima Medical University Aizu Medical Center, 21-2, Maeda, Tanisawa, Kawahigashi, Aizuwakamatsu, 969-3492, Japan
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Yamabe A, Irisawa A, Shibukawa G, Hoshi K, Fujisawa M, Igarashi R, Sato A, Maki T, Hojo H. Rare condition of needle tract seeding after EUS-guided FNA for intraductal papillary mucinous carcinoma. Endosc Int Open 2016; 4:E756-8. [PMID: 27556091 PMCID: PMC4993906 DOI: 10.1055/s-0042-107072] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 04/18/2016] [Indexed: 12/21/2022] Open
Abstract
We report on a 75-year-old man who was admitted due to pancreatic cystic lesion accompanied by a solid mass with liver metastasis. Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) was performed on the solid mass, and pathological findings revealed the lesion to be an adenocarcinoma diagnosed as intraductal papillary mucinous carcinoma (IPMC). Approximately 3 months after, a cystic subepithelial lesion appeared in the posterior gastric wall where the EUS-FNA had been performed. We performed EUS-FNA again, which revealed that the cystic mass was IPMC with pathology similar to the original lesion. This is a rare case demonstrating needle tract seeding of EUS-FNA for IPMC.
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Affiliation(s)
- Akane Yamabe
- Department of Gastroenterology. Fukushima Medical University Aizu Medical Center, Aizuwakamatsu, Japan
| | - Atsushi Irisawa
- Department of Gastroenterology. Fukushima Medical University Aizu Medical Center, Aizuwakamatsu, Japan,Corresponding author Atsushi Irisawa, MD, PhD Department of GastroenterologyFukushima Medical University Aizu Medical Center21-2, Maeda, Tanisawa, KawahigashiAizuwakamatsu 969-3492Japan
| | - Goro Shibukawa
- Department of Gastroenterology. Fukushima Medical University Aizu Medical Center, Aizuwakamatsu, Japan
| | - Koki Hoshi
- Department of Gastroenterology. Fukushima Medical University Aizu Medical Center, Aizuwakamatsu, Japan
| | - Mariko Fujisawa
- Department of Gastroenterology. Fukushima Medical University Aizu Medical Center, Aizuwakamatsu, Japan
| | - Ryo Igarashi
- Department of Gastroenterology. Fukushima Medical University Aizu Medical Center, Aizuwakamatsu, Japan
| | - Ai Sato
- Department of Gastroenterology. Fukushima Medical University Aizu Medical Center, Aizuwakamatsu, Japan
| | - Takumi Maki
- Department of Gastroenterology. Fukushima Medical University Aizu Medical Center, Aizuwakamatsu, Japan
| | - Hiroshi Hojo
- Department of Pathology, Fukushima Medical University Aizu Medical Center, Aizuwakamatsu, Japan
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Yamabe A, Irisawa A, Bhutani MS, Shibukawa G, Fujisawa M, Sato A, Yoshida Y, Arakawa N, Ikeda T, Igarashi R, Maki T, Yamamoto S. Efforts to improve the diagnostic accuracy of endoscopic ultrasound-guided fine-needle aspiration for pancreatic tumors. Endosc Ultrasound 2016; 5:225-32. [PMID: 27503153 PMCID: PMC4989402 DOI: 10.4103/2303-9027.187862] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Accepted: 06/09/2016] [Indexed: 02/06/2023] Open
Abstract
Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is widely used to obtain a definitive diagnosis of pancreatic tumors. Good results have been reported for its diagnostic accuracy, with high sensitivity and specificity of around 90%; however, technological developments and adaptations to improve it still further are currently underway. The endosonographic technique can be improved when several tips and tricks useful to overcome challenges of EUS-FNA are known. This review provides various techniques and equipment for improvement in the diagnostic accuracy in EUS-FNA.
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Affiliation(s)
- Akane Yamabe
- Aizu Medical Center, Fukushima Medical University, Aizuwakamatsu, Japan
| | - Atsushi Irisawa
- Aizu Medical Center, Fukushima Medical University, Aizuwakamatsu, Japan
| | | | - Goro Shibukawa
- Aizu Medical Center, Fukushima Medical University, Aizuwakamatsu, Japan
| | - Mariko Fujisawa
- Aizu Medical Center, Fukushima Medical University, Aizuwakamatsu, Japan
| | - Ai Sato
- Aizu Medical Center, Fukushima Medical University, Aizuwakamatsu, Japan
| | | | - Noriyuki Arakawa
- Aizu Medical Center, Fukushima Medical University, Aizuwakamatsu, Japan
| | - Tsunehiko Ikeda
- Aizu Medical Center, Fukushima Medical University, Aizuwakamatsu, Japan
| | - Ryo Igarashi
- Aizu Medical Center, Fukushima Medical University, Aizuwakamatsu, Japan
| | - Takumi Maki
- Aizu Medical Center, Fukushima Medical University, Aizuwakamatsu, Japan
| | - Shogo Yamamoto
- Aizu Medical Center, Fukushima Medical University, Aizuwakamatsu, Japan
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Irisawa A, Shibukawa G, Hoshi K, Yamabe A, Fujisawa M, Igarashi R, Sato A, Ikeda T, Maki T. [The forefront of therapeutic interventional EUS for pancreatobiliary disease]. Nihon Shokakibyo Gakkai Zasshi 2016; 113:614-24. [PMID: 27052391 DOI: 10.11405/nisshoshi.113.614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Atsushi Irisawa
- Department of Gastroenterology, Fukushima Medical University Aizu Medical Center
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Yamabe A, Irisawa A, Shibukawa G, Hoshi K, Fujisawa M, Igarashi R, Abe Y, Imbe K. An experimental study to assess the best maneuver when using a reverse side-bevel histology needle for EUS-guided fine-needle biopsy. Endosc Int Open 2016; 4:E56-61. [PMID: 26793786 PMCID: PMC4713184 DOI: 10.1055/s-0041-107801] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND AND STUDY AIMS Recently, ProCore™ was developed as an endoscopy ultrasound (EUS)-guided histology needle designed to address several current limitations of EUS-guided fine-needle aspiration (FNA). Nevertheless, tissue yield with the ProCore™ is not consistent. No standard technique has been established. This experimental study was conducted to ascertain the best maneuver when using the ProCore™. PATIENTS AND METHODS We performed fine-needle aspiration and biopsy (FNAB) with a 22-gauge (G) ProCore™ using chicken tenderloin and liver. Six methods were used, with two needle movement techniques (natural speed and whipping back) and three negative pressures (no suction (NS), slow pull (SP), and 10-mL suction). RESULTS In cases using the "natural speed" technique, a significant difference in tissue yield was found with suction pressures in both tenderloin and liver (P < 0.0001, P = 0.0079). In cases using the "whipping back" technique, for the tenderloin, no significant difference in tissue yield was found for NS vs. SP (P = 0.0596), however, a significant difference was found for SP vs. 10-mL suction (P < 0.0001) and for NS vs. 10-mL suction (P < 0.0001). For the liver, a significant difference was found among suction pressures (P = 0.0079). Comparing "natural speed" with "whipping back" using the tenderloin, no significant difference in tissue yield was found with NS and 10 mL of pressure (P = 0.1126, P = 0.0718), but a significant difference was found with SP (P = 0.0028). Regarding the liver, no significant difference was found based upon suction pressure (NS P = 0.1508; SP P = 0.0873; 10 mL P = 0.6667). CONCLUSIONS EUS-FNAB using ProCore™ can be performed with negative pressure with any needling technique. Although ProCore™ has a reverse side-bevel, results in using it with a whipping-back technique were inconclusive.
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Affiliation(s)
- Akane Yamabe
- Department of Gastroenterology, Fukushima Medical University Aizu Medical Center
| | - Atsushi Irisawa
- Department of Gastroenterology, Fukushima Medical University Aizu Medical Center,Corresponding author Atsushi Irisawa Department of GastroenterologyFukushima Medical University Aizu Medical CenterArzuwakamazuJapan
| | - Goro Shibukawa
- Department of Gastroenterology, Fukushima Medical University Aizu Medical Center
| | - Koki Hoshi
- Department of Gastroenterology, Fukushima Medical University Aizu Medical Center
| | - Mariko Fujisawa
- Department of Gastroenterology, Fukushima Medical University Aizu Medical Center
| | - Ryo Igarashi
- Department of Gastroenterology, Fukushima Medical University Aizu Medical Center
| | - Yoko Abe
- Department of Gastroenterology, Fukushima Medical University Aizu Medical Center
| | - Koh Imbe
- Department of Gastroenterology, Fukushima Medical University Aizu Medical Center
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Imamura HI, Irisawa A, Shibukawa G, Takagi T, Hikichi T, Obara K, Ohira H. Echo-endoscopic analysis of variceal hemodynamics in patient with isolated gastric varices. Endosc Ultrasound 2015; 3:238-44. [PMID: 25485272 PMCID: PMC4247532 DOI: 10.4103/2303-9027.144542] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Accepted: 04/29/2014] [Indexed: 02/03/2023] Open
Abstract
Background: It is considered that gastric varices (GVs) which have the large form in endoscopic view should be treated because they are regarded as having high blood flow volume and the risky varices of hemorrhage. However, there is no data of the correlation among the endoscopic view, diameter of GV, and blood flow volume in GV. The aim of this study was to investigate whether GV diameter correlates to blood flow volume or not. In addition, the correlation between the endoscopic findings of GVs, patient status, and blood flow volume was assessed. Materials and Methods: In this study, 24 patients were enrolled. Variceal form and its location were observed using flexible GI endoscopes. Assessment of variceal form and location was according to Japanese society of portal hypertension. Then, the GV diameter (the maximum short axis), the GV flow velocity, and the GV flow volume were measured by echo-endoscope with curved linear array or with electronic radial array. Results: Nineteen of 24 enrolled patients were analyzed. There was strong correlation between the GV diameter and the GV flow volume (rs = 0.85, P < 0.01). No significant difference in the GV diameter and the GV flow volume was found between each location. However, there was no significant difference in the GV diameter between each variceal form. In addition, no significant difference was found among Child–Pugh classifications, and in cases associated with or without hepatocelluer carcinoma. Conclusions: Strong correlation was found between GV diameter and flow volume of GV, regardless of the location. However, since there was no significant difference in the GV diameter between each variceal form in endoscopic view, measuring GV diameter is important to understand its hemodynamics for further treatment.
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Affiliation(s)
- HIdemichi Imamura
- Department of Gastroenterology and Rheumatology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Atsushi Irisawa
- Department of Gastroenterology, Fukushima Medical University Aizu Medical Center, Aizuwakamatsu, Japan
| | - Goro Shibukawa
- Department of Gastroenterology, Fukushima Medical University Aizu Medical Center, Aizuwakamatsu, Japan
| | - Tadayuki Takagi
- Department of Gastroenterology and Rheumatology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Takuto Hikichi
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan
| | - Katsutoshi Obara
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan
| | - Hiromasa Ohira
- Department of Gastroenterology and Rheumatology, Fukushima Medical University School of Medicine, Fukushima, Japan
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31
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Affiliation(s)
- Goro Shibukawa
- Department of Gastroenterology, Fukushima Medical University Aizu Medical Center, Aizuwakamatsu City, Japan
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Yamabe A, Irisawa A, Bhutani MS, Shibukawa G, Abe Y, Saito A, Imbe K, Hoshi K, Igarashi R. Usefulness of endoscopic ultrasound-guided fine-needle aspiration with a forward-viewing and curved linear-array echoendoscope for small gastrointestinal subepithelial lesions. Endosc Int Open 2015; 3:E161-4. [PMID: 26135661 PMCID: PMC4477025 DOI: 10.1055/s-0034-1391671] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 11/11/2014] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND AND STUDY AIMS It is difficult to perform endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) of small gastrointestinal (GI) subepithelial lesions (SELs) approximately 10 mm in diameter. This study was undertaken to evaluate the feasibility, safety, and diagnostic ability of EUS-FNA with a forward-viewing and curved linear-array echoendoscope (FVCLA-ES) that has a cap for small SELs. PATIENTS AND METHODS The study enrolled 8 patients who had small upper GI SELs approximately 10 mm in diameter. To fix the SELs during FNA, a cap device was attached to the scope tip. RESULTS The mean (standard deviation [SD]) diameter of the SELs was 10.6 mm (2.94). Even small lesions were well targeted for FNA when the FVCLA-ES with a cap device was used. The mean (SD) number of passes was 4.6 (1.59). Adequate samples were obtained from 7 patients (87.5 %) - in 6 (75 %) for cytology and in 4 (50 %) for histologic examination with immunohistochemical (IHC) staining. No complication occurred. Gastrointestinal stromal tumor (GIST) in 2 patients and leiomyoma in 2 patients were definitively diagnosed with IHC staining. CONCLUSIONS EUS-FNA with an FVCLA-ES that has a cap device is feasible and safe. This technique is expected to contribute to histologic diagnosis, even in small SELs.
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Affiliation(s)
- Akane Yamabe
- Department of Gastroenterology, Fukushima Medical University, Aizu Medical Center, Aizuwakamatsu, Japan
| | - Atsushi Irisawa
- Department of Gastroenterology, Fukushima Medical University, Aizu Medical Center, Aizuwakamatsu, Japan,Corresponding author Atsushi Irisawa, MD, PhD Department of GastroenterologyFukushima Medical UniversityAizu Medical Center21-2, Maeda, Tanisawa, KawahigashiAizuwakamatsu 969-3492Japan+81-242-75-2568
| | - Manoop S. Bhutani
- Department of Gastroenterology, Hepatology and Nutrition Unit, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Goro Shibukawa
- Department of Gastroenterology, Fukushima Medical University, Aizu Medical Center, Aizuwakamatsu, Japan
| | - Yoko Abe
- Department of Gastroenterology, Fukushima Medical University, Aizu Medical Center, Aizuwakamatsu, Japan
| | - Akiko Saito
- Department of Gastroenterology, Fukushima Medical University, Aizu Medical Center, Aizuwakamatsu, Japan
| | - Koh Imbe
- Department of Gastroenterology, Fukushima Medical University, Aizu Medical Center, Aizuwakamatsu, Japan
| | - Koki Hoshi
- Department of Gastroenterology, Fukushima Medical University, Aizu Medical Center, Aizuwakamatsu, Japan
| | - Ryo Igarashi
- Department of Gastroenterology, Fukushima Medical University, Aizu Medical Center, Aizuwakamatsu, Japan
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Takagi T, Irisawa A, Shibukawa G, Hikichi T, Obara K, Ohira H. Intraductal ultrasonographic anatomy of biliary varices in patients with portal hypertension. Endosc Ultrasound 2015; 4:44-51. [PMID: 25789284 PMCID: PMC4362004 DOI: 10.4103/2303-9027.151346] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2014] [Accepted: 05/10/2014] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The term, portal biliopathy, denotes various biliary abnormalities, such as stenosis and/or dilatation of the bile duct, in patients with portal hypertension. These vascular abnormalities sometimes bring on an obstructive jaundice, but they are not clear which vessels participated in obstructive jaundice. The aim of present study was clear the bile ductal changes in patients with portal hypertension in hopes of establishing a therapeutic strategy for obstructive jaundice caused by biliary varices. MATERIALS AND METHODS Three hundred and thirty-seven patients who underwent intraductal ultrasound (IDUS) during endoscopic retrograde cholangiography for biliary abnormalities were enrolled. Portal biliopathy was analyzed using IDUS. RESULTS Biliary varices were identified in 11 (2.7%) patients. IDUS revealed biliary varices as multiple, hypoechoic features surrounding the bile duct wall. These varices could be categorized into one of two groups according to their location in the sectional image of bile duct: epicholedochal and paracholedochal. Epicholedochal varices were identified in all patients, but paracholedochal varices were observed only in patients with extrahepatic portal obstruction. CONCLUSION IDUS was useful to characterize the anatomy of portal biliopathy in detail.
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Affiliation(s)
- Tadayuki Takagi
- Department of Gastroenterology and Rheumatology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Atsushi Irisawa
- Department of Gastroenterology, Fukushima Medical University Aizu Medical Center, Aizuwakamatsu, Japan
| | - Goro Shibukawa
- Department of Gastroenterology, Fukushima Medical University Aizu Medical Center, Aizuwakamatsu, Japan
| | - Takuto Hikichi
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan
| | - Katsutoshi Obara
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan
| | - Hiromasa Ohira
- Department of Gastroenterology and Rheumatology, Fukushima Medical University School of Medicine, Fukushima, Japan
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Irisawa A, Shibukawa G. [EUS-guided fine-needle aspiration biopsy (EUS-FNA) for pancreatic tumor]. Nihon Rinsho 2015; 73 Suppl 3:88-92. [PMID: 25856991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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35
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Imbe K, Irisawa A, Shibukawa G, Abe Y, Saito A, Hoshi K, Yamabe A, Igarashi R. Idiopathic granulomatous gastritis diagnosed with endoscopic ultrasound-guided fine-needle aspiration: report of a case. Endosc Int Open 2014; 2:E259-61. [PMID: 26135104 PMCID: PMC4423308 DOI: 10.1055/s-0034-1390744] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Accepted: 09/08/2014] [Indexed: 11/17/2022] Open
Abstract
A 71-year-old man in whom a gastric submucosal lesion was found incidentally was referred to our hospital for detailed examination. Esophagastroduodenoscopy showed a submucosal lesion in the body of the stomach. Endoscopic ultrasound revealed a 15-mm hypoechoic round mass with calcifications arising from the muscular layer. Confusing the diagnosis, it resembled a gastrointestinal mesenchymal tumor. Subsequently, endoscopic ultrasound-guided fine-needle aspiration was conducted for definitive diagnosis. Pathologic analysis showed a granuloma. Because this patient had no prior exposure to tuberculosis or Helicobacter pylori infection and had no abnormal laboratory data, this submucosal lesion was diagnosed as idiopathic granulomatous gastritis.
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Affiliation(s)
- Koh Imbe
- Department of Gastroenterology, Fukushima Medical University, Aizu Medical Center, Aizuwakamatsu, Japan
| | - Atsushi Irisawa
- Department of Gastroenterology, Fukushima Medical University, Aizu Medical Center, Aizuwakamatsu, Japan,Corresponding author Atsushi Irisawa, MD, PhD Department of GastroenterologyFukushima Medical UniversityAizu Medical Center21-2, Maeda, Tanisawa, KawahigashiAizuwakamatsu 969-3492Japan+81-242-75-2568
| | - Goro Shibukawa
- Department of Gastroenterology, Fukushima Medical University, Aizu Medical Center, Aizuwakamatsu, Japan
| | - Yoko Abe
- Department of Gastroenterology, Fukushima Medical University, Aizu Medical Center, Aizuwakamatsu, Japan
| | - Akiko Saito
- Department of Gastroenterology, Fukushima Medical University, Aizu Medical Center, Aizuwakamatsu, Japan
| | - Koki Hoshi
- Department of Gastroenterology, Fukushima Medical University, Aizu Medical Center, Aizuwakamatsu, Japan
| | - Akane Yamabe
- Department of Gastroenterology, Fukushima Medical University, Aizu Medical Center, Aizuwakamatsu, Japan
| | - Ryo Igarashi
- Department of Gastroenterology, Fukushima Medical University, Aizu Medical Center, Aizuwakamatsu, Japan
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Irisawa A, Shibukawa G, Takagi T, Abe Y, Saito A, Imbe K, Hoshi K, Yamabe A, Igarashi R. Endoscopic ultrasound-guided immunotherapy. Gastrointestinal Intervention 2014. [DOI: 10.1016/j.gii.2014.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Suzuki R, Irisawa A, Bhutani MS, Hikichi T, Takagi T, Shibukawa G, Sato A, Sato M, Ikeda T, Watanabe K, Nakamura J, Annangi S, Tasaki K, Obara K, Ohira H. An automated spring-loaded needle for endoscopic ultrasound-guided abdominal paracentesis in cancer patients. World J Gastrointest Endosc 2014; 6:55-59. [PMID: 24567793 PMCID: PMC3930891 DOI: 10.4253/wjge.v6.i2.55] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Revised: 12/18/2013] [Accepted: 01/13/2014] [Indexed: 02/05/2023] Open
Abstract
AIM: To evaluate the feasibility of using an automated spring-loaded needle device for endoscopic ultrasound (EUS)-guided abdominal paracentesis (EUS-P) to see if this would make it easier to puncture the mobile and lax gastric wall for EUS-P.
METHODS: The EUS database and electronic medical records at Fukushima Medical University Hospital were searched from January 2001 to April 2011. Patients with a history of cancer and who underwent EUS-P using an automated spring-loaded needle device with a 22-gauge puncture needle were included. The needle was passed through the instrument channel and advanced through the gastrointestinal wall under EUS guidance into the echo-free space in the abdominal cavity and ascitic fluid was collected. The confirmed diagnosis of malignant ascites included positive cytology and results from careful clinical observation for at least 6 mo in patients with negative cytology. The technical success rate, cytology results and complications were evaluated.
RESULTS: We found 11 patients who underwent EUS-P with an automated spring-loaded needle device. In 4 cases, ascites was revealed only with EUS but not in other imaging modalities. EUS-P was done in 7 other cases because there was minimal ascitic fluid and no safe window for percutaneous abdominal aspiration. Ascitic fluid was obtained in all cases by EUS-P. The average amount aspirated was 14.1 mL (range 0.5-38 mL) and that was sent for cytological exam. The etiology of ascitic fluid was benign in 5 patients and malignant in 6. In all cases, ascitic fluid was obtained with the first needle pass. No procedure-related adverse effects occurred.
CONCLUSION: EUS-P with an automated spring-loaded needle device is a feasible and safe method for ascites evaluation.
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Irisawa A, Shibukawa G, Hikichi T, Takagi T, Imamura H, Takahashi Y, Sato A, Sato M, Ikeda T, Suzuki R, Abe Y, Nikaido A, Yamabe A, Ohira H, Obara K. [Interventional EUS for pancreatic pseudocyst and walled-off necrosis]. Nihon Shokakibyo Gakkai Zasshi 2013; 110:575-584. [PMID: 23558121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Atsushi Irisawa
- Department of Gastroenterology, Fukushima Medical University Aizu Medical Center.
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Suzuki R, Irisawa A, Bhutani MS, Takagi T, Ikeda T, Hikichi T, Shibukawa G, Sato M, Watanabe K, Nakamura J, Obara K, Ohira H. Ultrathin endoscope-guided trangastric nasocystic irrigation tube placement to manage paracolic gutter extension of pancreatic necrosis. Gastrointest Endosc 2012; 76:457-9. [PMID: 21963068 DOI: 10.1016/j.gie.2011.07.065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2011] [Accepted: 07/27/2011] [Indexed: 02/08/2023]
Affiliation(s)
- Rei Suzuki
- Department of Gastroenterology and Rheumatology, Fukushima Medical University School of Medicine, Fukushima, Japan
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Watanabe K, Irisawa A, Hikichi T, Takagi T, Shibukawa G, Sato M, Obara K, Ohira H. Acute inflammation occurring in gastric aberrant pancreas followed up by endoscopic ultrasonography. World J Gastrointest Endosc 2012. [PMID: 22816015 DOI: 10.4523/wjge/v4.i7.331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
We describe a case of gastric aberrant pancreas with acute pancreatitis followed up with subsequent endoscopic ultrasound. A 20-year-old woman known to have aberrant pancreas in the stomach was admitted to our hospital because of severe epigastralgia. Laboratory tests showed slight C reactive protein elevation without hyperamylasemia. Esophagogastroduodenoscopy revealed a swollen submucosal lesion (SML) to a greater degree compared with the previous findings. Subsequent endoscopic ultrasonography (EUS) revealed a swollen lesion of 35 mm in diameter. The internal echo-pattern was more hypoechoic than in the previous EUS. The border between the fourth layer (muscularis propria) and the SML was unclear. The anechoic lumen in the mass, considered as the ductal lumen, was dilated. Based on these results, we diagnosed the patient as having acute inflammation, resembling pancreatitis, in the aberrant pancreas.
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Affiliation(s)
- Ko Watanabe
- Ko Watanabe, Tadayuki Takagi, Masaki Sato, Hiromasa Ohira, Division of Medicine, Department of Gastroenterology and Rheumatology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
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Watanabe K, Irisawa A, Hikichi T, Takagi T, Shibukawa G, Sato M, Obara K, Ohira H. Acute inflammation occurring in gastric aberrant pancreas followed up by endoscopic ultrasonography. World J Gastrointest Endosc 2012; 4:331-4. [PMID: 22816015 PMCID: PMC3399013 DOI: 10.4253/wjge.v4.i7.331] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2011] [Revised: 10/25/2011] [Accepted: 07/01/2012] [Indexed: 02/05/2023] Open
Abstract
We describe a case of gastric aberrant pancreas with acute pancreatitis followed up with subsequent endoscopic ultrasound. A 20-year-old woman known to have aberrant pancreas in the stomach was admitted to our hospital because of severe epigastralgia. Laboratory tests showed slight C reactive protein elevation without hyperamylasemia. Esophagogastroduodenoscopy revealed a swollen submucosal lesion (SML) to a greater degree compared with the previous findings. Subsequent endoscopic ultrasonography (EUS) revealed a swollen lesion of 35 mm in diameter. The internal echo-pattern was more hypoechoic than in the previous EUS. The border between the fourth layer (muscularis propria) and the SML was unclear. The anechoic lumen in the mass, considered as the ductal lumen, was dilated. Based on these results, we diagnosed the patient as having acute inflammation, resembling pancreatitis, in the aberrant pancreas.
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Affiliation(s)
- Ko Watanabe
- Ko Watanabe, Tadayuki Takagi, Masaki Sato, Hiromasa Ohira, Division of Medicine, Department of Gastroenterology and Rheumatology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
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Hikichi T, Irisawa A, Takagi T, Shibukawa G, Wakatsuki T, Imamura H, Takahashi Y, Sato A, Sato M, Ikeda T, Suzuki R, Watanabe K, Nakamura J, Ohira H, Obara K. An electronic radial scanning echoendoscope is superior to a mechanical radial scanning echoendoscope in ultrasound image quality for gastrointestinal tract and pancreaticobiliary lesions. Fukushima J Med Sci 2011; 56:99-106. [PMID: 21502709 DOI: 10.5387/fms.56.99] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To objectively compare the electronic radial scanning echoendoscope (ER-ES) with the mechanical radial scanning echoendoscope (MR-ES) in the quality of endoscopic ultrasonography (EUS) images of gastrointestinal tract and pancreaticobiliary lesions. METHODS Studied were 56 patients: 20 with gastric cancer, 20 with gallbladder lesions, and 16 with intraductal papillary-mucinous neoplasms of the pancreas (IPMN). They were subjected to EUS, half of them using the ER-ES, and the other half using the MR-ES. EUS images thus obtained were evaluated concerning four items in patients with gastric cancer and those with gallbladder lesions, and three items in patients with IPMN. Six endosonographers blindly assessed two EUS images per patient on a visual analogue scale. In each of the three groups of patients, the evaluators' median scores for the ER-ES and MR-ES for each item were compared. RESULTS The median scores for the ER-ES were significantly higher than those for the MR-ES in all items in patients with gastric cancer and those with IPMN, and in one item in patients with gallbladder lesions. CONCLUSION The ER-ES is certainly superior to the MR-ES in the quality of EUS images of gastrointestinal tract and pancreaticobiliary lesions.
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Affiliation(s)
- Takuto Hikichi
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan.
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Sato S, Irisawa A, Sato A, Shibukawa G, Suzuki R, Takagi T, Ikeda T, Sato M, Hikichi T, Obara K, Ohira H. Autoimmune neutropenia associated with autoimmune pancreatitis. JOP 2011; 12:407-409. [PMID: 21737905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
CONTEXT We report a rare case of autoimmune neutropenia associated with autoimmune pancreatitis. CASE REPORT A 61-year-old man was referred to our hospital with slight epigastralgia. He had been admitted to another hospital with exacerbation of diabetes and jaundice. Blood tests showed low white blood cell and neutrophil counts (1,800 µL-1 and 3%, respectively), and elevated transaminase, biliary enzyme, amylase and lipase levels. Serum IgG and IgG4 levels were elevated to 2,693 mg/dL and 454 mg/dL, respectively. Abdominal CT showed diffuse pancreatic swelling, and MRCP revealed diffuse narrowing of the main pancreatic duct and dilation of the common bile duct. An additional EUS-FNA was performed in our hospital. Laboratory data, imaging and histopathological findings confirmed the diagnosis of autoimmune pancreatitis. However, the low white blood cell count continued. For additional investigation, a bone marrow examination was performed, indicating a granulocyte maturation disorder. Moreover, anti-neutrophil antibodies were positive. Therefore, a diagnosis of autoimmune neutropenia associated with autoimmune pancreatitis was made. After steroid therapy, the anti-neutrophil antibodies disappeared and the white blood cell count was within the reference limit. No recurrence of disease has been observed since then. CONCLUSION Autoimmune neutropenia, which is positive for anti-neutrophil antibodies, can be associated with autoimmune pancreatitis.
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Affiliation(s)
- Shuzo Sato
- Division of Internal Medicine, Department of Gastroenterology and Rheumatology, Fukushima Medical University School of Medicine, Fukushima, Japan.
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Wakatsuki T, Irisawa A, Terashima M, Shibukawa G, Takagi T, Imamura H, Takahashi Y, Sato A, Sato M, Ikeda T, Suzuki R, Hikichi T, Obara K, Ohira H. ATP assay-guided chemosensitivity testing for gemcitabine with biopsy specimens obtained from unresectable pancreatic cancer using endoscopic ultrasonography-guided fine-needle aspiration. Int J Clin Oncol 2011; 16:387-94. [PMID: 21331767 DOI: 10.1007/s10147-011-0197-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2010] [Accepted: 01/24/2011] [Indexed: 01/30/2023]
Abstract
OBJECTIVES This study evaluates the feasibility of chemosensitivity testing by use of endoscopic ultrasonography-guided fine-needle aspiration (EUS-FNA) samples and determines the optimum cut-off value for gemcitabine. METHODS Thirty-four consecutive patients with unresectable pancreatic cancer were enrolled. Chemosensitivity (treated/control ratio: T/C ratio) was calculated as the quantity of adenosine triphosphate for a tumor treated with gemcitabine as a percentage of that for the control. To identify the cut-off value sufficient to predict 180 days of progression-free survival (PFS), the receiver operating characteristic curve and the corresponding area under the curve (AUC) were calculated. RESULTS The success of this assay was 88.2% (30/34); therefore, 30 patients were assessable and included in the population of analyzable patients.. The response was 6.7%. Median PFS was 96 days and median overall survival was 241 days, respectively. The cut-off value was determined as 74% (AUC, 0.745; p = 0.053; 95% CI 0.485-1.005). According to this cut-off value, we predicted 180 days PFS with a sensitivity and specificity of 71.4 and 91.3%, respectively. When patients were divided into two groups at T/C ratio 74%, a significant difference was found in PFS (median 77 vs. 205 days, p = 0.0036). Moreover, T/C ratio < 74% and decrease of CA19-9 were significant and independent prognostic factors by multivariate analysis. CONCLUSION Chemosensitivity testing by use of EUS-FNA samples in patients with unresectable pancreatic cancer is feasible. This definition emphasizes the possibility of selecting patients for whom favorable results from gemcitabine treatment can be expected.
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Affiliation(s)
- Takeru Wakatsuki
- Department of Gastroenterology and Rheumatology, Fukushima Medical University, School of Medicine, 1 Hikarigaoka, Fukushima, 960-1295, Japan.
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Wakatsuki T, Irisawa A, Terashima M, Takagi T, Shibukawa G, Imamura H, Takahashi Y, Sato A, Sato M, Ohira H, Ohira. Chemosensitivity testing to predict chemosensitivity for gemcitabine, using the biopsy specimens obtained by EUS-FNA from unresectable pancreatic cancer. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e14640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Wakatsuki T, Obara K, Irisawa A, Sakamoto H, Kuwana T, Takiguchi F, Saito A, Shishido H, Hikichi T, Oyama H, Shibukawa G, Takagi T, Yamamoto G, Imamura H, Takahashi Y, Sato A, Sato M, Kasukawa R, Ohira H. Analysis of prognostic factors in patients with gastric varices after endoscopic treatment. Dig Endosc 2009; 21:232-8. [PMID: 19961521 DOI: 10.1111/j.1443-1661.2009.00898.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND The prognostic factors, including gastric variceal bleeding itself, in patients with gastric varices (GV) after endoscopic treatment remain unclear. The aim of this study was to analyze prognostic factors in patients with GV after endoscopic treatment as well as to evaluate safety and efficacy of our endoscopic treatment. PATIENTS AND METHODS This study enrolled 115 patients who underwent endoscopic treatment for GV between October 1988 and December 2003 using cyanoacrylate and 5% ethanolamine oleate. Successful hemostasis, recurrence rates, rebleeding rates, survival rates, complications and prognostic factors after the treatment were retrospectively reviewed. RESULTS Treatment sessions for GV were performed 3.4 +/- 2.5 times. All cases, including 14 emergency cases, were treated successfully. The cumulative recurrence rates at 1, 3 and 5 years after the treatment were 7.0%, 15.6% and 20.0%, respectively, and the cumulative rebleeding rates at 1, 3 and 5 years were 3.5%, 8.7% and 14.8%, respectively. The overall survival rates were 78.3%, 63.7% and 51.5% at 1, 3 and 5 years, respectively. Grade B or C in Child-Pugh classification, emergency or elective cases, and association with hepatocellular carcinoma were identified as significant negative prognostic factors after endoscopic treatment by multivariate analysis. Although several complications were observed, there was no mortality. CONCLUSIONS Grade B or C in Child-Pugh classification, emergency or elective situation, and association with hepatocellular carcinoma are negative prognostic factors after endoscopic treatment.
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Affiliation(s)
- Takeru Wakatsuki
- Department of Internal Medicine 2, Fukushima Medical University School of Medicine, Fukushima Medical University Hospital, Fukushima City, Fukushima, Japan.
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Abstract
For tissue diagnosis in patients with abnormalities of various organs, endoscopic ultrasonography (EUS)-guided fine needle aspiration (EUS-FNA) has emerged as an effective technique. Subsequently, EUS-guided fine needle injection (EUS-FNI) has expanded the clinical utility of EUS. Several applications of EUS-FNI for anti-cancer efforts have included celiac nerve blocking and drug delivery into tumors, such as ablation, chemotherapy, gene therapy, and cytoimplantation. Furthermore, chemosensitivity tests with materials obtained using EUS-FNA are available to produce tailor-made medicines. Demonstrably, EUS-guided intervention has opened new and exciting clinical applications for the management of malignancies.
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Affiliation(s)
- Atsushi Irisawa
- Department of Internal Medicine, Fukushima Medical University School of Medicine, Japan.
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Hikichi T, Irisawa A, Bhutani MS, Takagi T, Shibukawa G, Yamamoto G, Wakatsuki T, Imamura H, Takahashi Y, Sato A, Sato M, Ikeda T, Hashimoto Y, Tasaki K, Watanabe K, Ohira H, Obara K. Endoscopic ultrasound-guided fine-needle aspiration of solid pancreatic masses with rapid on-site cytological evaluation by endosonographers without attendance of cytopathologists. J Gastroenterol 2009; 44:322-8. [PMID: 19274426 DOI: 10.1007/s00535-009-0001-6] [Citation(s) in RCA: 103] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2008] [Accepted: 09/27/2008] [Indexed: 02/06/2023]
Abstract
BACKGROUND Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) with rapid on-site evaluation (ROSE) has been reported to provide a more accurate diagnosis than EUS-FNA without such evaluation. However, even endosonographers can evaluate ROSE regarding sample adequacy. The aim of this study was to evaluate the diagnostic accuracy of EUS-FNA with ROSE by endosonographers compared to ROSE by cytopathologists in patients with solid pancreatic masses. METHODS Between September 2001 and October 2005, of the 73 EUS-FNA procedures with the final diagnoses, 38 procedures after the introduction of ROSE by endosonographers (September 2001-September 2003, period 1), and 35 procedures after the introduction of ROSE by cytopathologists (October 2003-October 2005, period 2) were included. The specimens were stained with Diff-Quik stain and assessed. When the on-site assessors (endosonographers or cytopathologists) indicated that the amounts of cell samples were adequate, the procedure was stopped. RESULTS Results are presented with 95% confidence limits. The average numbers of needle passes were 4.0 +/- 1.6 and 3.4 +/- 1.5 in periods 1 and 2, respectively (P = 0.06). The specimen collection rates were 97.4 and 97.1% in periods 1 and 2, respectively (P = 0.51). Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for malignancy and benign were 92.9, 100, 100, 83.3, and 94.7%, respectively, in period 1, and 93.1, 100, 100, 75.0, and 94.3%, respectively, in period 2 (P = 0.97, P = 1.0, P = 1.0, P = 0.65, P = 0.93, respectively). No complications were seen. CONCLUSIONS For accurate diagnosis, ROSE should be performed during EUS-FNA by the endosonographer, if no cytopathologist is available.
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Affiliation(s)
- Takuto Hikichi
- Department of Internal Medicine II, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, Fukushima, 960-1295, Japan
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Suzuki R, Irisawa A, Hikichi T, Shibukawa G, Takagi T, Wakatsuki T, Imamura H, Takahashi Y, Sato A, Sato M, Ikeda T, Tasaki K, Obara K, Ohira H. Pancreatic lipoma diagnosed using EUS-FNA. A case report. JOP 2009; 10:200-203. [PMID: 19287119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
CONTEXT Pancreatic mesenchymal tumors are rare, accounting for only 1-2% of pancreatic tumors. A pancreatic lipoma is an especially rare condition. This is only the second report of a pancreatic lipoma diagnosed before surgery using endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS-FNA). CASE REPORT A 75-year-old woman with a round low-density lesion which had been detected by CT was referred to our hospital. EUS revealed an oval 49x32 mm homogeneous and almost isoechoic mass (as compared to normal pancreatic parenchyma) in the pancreatic head. Its outer margin was not clearly differentiated from the parenchyma. Although a benign pancreatic lipomatous lesion was deemed most probable from information obtained using CT/MRI, a mass with malignancy such as a liposarcoma could not be ruled out as a differential diagnosis. Therefore, EUS-FNA was performed for a definitive diagnosis. Two passes were performed with on-site pathology. The results obtained from the sample analysis indicated a pancreatic lipoma consisting of mature fat cells with no atypia. CONCLUSION Although imaging modalities are useful for the diagnosis of pancreatic lipomatous lesions, it is sometimes difficult to diagnose lipomatous malignancies mimicking benign lipoma. This case demonstrates the usefulness of EUS-FNA for the differential diagnosis of pancreatic lipomatous lesions.
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Affiliation(s)
- Rei Suzuki
- Department of Internal Medicine II, Fukushima Medical University Hospital, Fukushima, Japan
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Sato M, Irisawa A, Bhutani MS, Schnadig V, Takagi T, Shibukawa G, Wakatsuki T, Imamura H, Takahashi Y, Sato A, Hikichi T, Obara K, Hashimoto Y, Watanabe K, Ohira H. Gastric bronchogenic cyst diagnosed by endosonographically guided fine needle aspiration biopsy. J Clin Ultrasound 2008; 36:237-239. [PMID: 18027836 DOI: 10.1002/jcu.20425] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
We report a case of a gastric bronchogenic cyst diagnosed via endosonographically guided fine-needle aspiration (EUS-FNA) biopsy. A 60-year-old woman was referred to our hospital for an endoscopic ultrasound (EUS) examination because of a gastric subepithelial lesion detected by upper gastrointestinal endoscopy. EUS examination revealed a lesion that appeared to originate from the gastric submucosa but seemed to extend beyond the gastric wall. The latter finding raised concerns that the lesion might represent a cystic neoplasm rather than a simple cyst. Subsequently, EUS-FNA was performed to establish a definitive diagnosis and to guide further management. Cytologic evaluation of aspirated material revealed the presence of benign-appearing ciliated columnar epithelial cells within a mucinous background. Based on imaging and EUS-FNA findings, a diagnosis of gastric bronchogenic cyst was made and surgical resection was avoided.
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Affiliation(s)
- Masaki Sato
- Department of Internal Medicine 2, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima City, 960-1295, Japan
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