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Kozakai F, Ogawa T, Sakai T, Koshita S, Kanno Y, Kusunose H, Yonamine K, Miyamoto K, Okano H, Matsuoka Y, Hosokawa K, Sumiya H, Sugita R, Ito K. Plain computed tomography for differentiating neoplastic and non-neoplastic pedunculated gallbladder polyps. Intern Med 2024:2760-23. [PMID: 38569912 DOI: 10.2169/internalmedicine.2760-23] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/05/2024] Open
Abstract
AIMS Surgery is recommended for large pedunculated gallbladder polyps (PGPs), which measure 10 mm or more in size, because they tend to be neoplastic polyps (NPs), such as adenomas and adenocarcinomas. However, after resection, they are often found to be non-neoplastic polyps (non-NPs). This study aimed to evaluate the usefulness of plain CT in distinguishing NPs from non-NPs. METHODS Of the 80 patients who underwent cholecystectomy for PGPs ( 10 mm between January 2008 and February 2021, 46 who underwent plain and contrast-enhanced CT (CE-CT) before resection were included in this study. We retrospectively assessed the polyp detection rate (PDR) using CT and calculated the difference in the CT values between PGPs and the surrounding bile. RESULTS Twenty-one patients had NPs (12 adenomas, 5 carcinomas in adenoma, and 4 adenocarcinomas). The others were non-NPs (24 cholesterol polyps and one hyperplastic polyp). The PDR using plain CT was significantly higher in the NP group than in the non-NP group (38% (8/21) vs. 0% (0/25), p <0.01). The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of NPs were 38%, 100%, 100%, 66%, and 72%, respectively. The difference in the CT values between PGPs and the surrounding bile was significantly larger in the NP group than in the non-NP group (14.12 ± 11.38 HU, 5.04 ± 6.15 HU, p <0.01). CONCLUSIONS PGPs detected using plain CT had a high probability of being NPs. Plain CT is therefore considered to be useful for differentiating NPs from non-NPs.
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Affiliation(s)
- Fumisato Kozakai
- Department of Gastroenterology, Sendai City Medical Center, Japan
| | - Takahisa Ogawa
- Department of Gastroenterology, Sendai City Medical Center, Japan
| | - Toshitaka Sakai
- Department of Gastroenterology, Sendai City Medical Center, Japan
| | - Shinsuke Koshita
- Department of Gastroenterology, Sendai City Medical Center, Japan
| | - Yoshihide Kanno
- Department of Gastroenterology, Sendai City Medical Center, Japan
| | - Hiroaki Kusunose
- Department of Gastroenterology, Sendai City Medical Center, Japan
| | - Keisuke Yonamine
- Department of Gastroenterology, Sendai City Medical Center, Japan
| | - Kazuaki Miyamoto
- Department of Gastroenterology, Sendai City Medical Center, Japan
| | - Haruka Okano
- Department of Gastroenterology, Sendai City Medical Center, Japan
| | - Yuto Matsuoka
- Department of Gastroenterology, Sendai City Medical Center, Japan
| | - Kento Hosokawa
- Department of Gastroenterology, Sendai City Medical Center, Japan
| | - Hidehito Sumiya
- Department of Gastroenterology, Sendai City Medical Center, Japan
| | - Reiji Sugita
- Department of Radiology, Sendai City Medical Center, Japan
| | - Kei Ito
- Department of Gastroenterology, Sendai City Medical Center, Japan
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Nagayama R, Ueki T, Shimizu Y, Hijioka S, Nakamura M, Kitano M, Hara K, Masamune A, Kin T, Hanada K, Koshita S, Yamada R, Takenaka M, Itoi T, Yanagisawa A, Otuka T, Hirono S, Kanno A, Ideno N, Kuwahara T, Shimizu A, Kamata K, Asai Y, Takeyama Y. Is preoperative pancreatic juice cytology useful for determining therapeutic strategies for patients with intraductal papillary mucinous neoplasm of the pancreas? J Hepatobiliary Pancreat Sci 2024; 31:183-192. [PMID: 38084510 DOI: 10.1002/jhbp.1394] [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] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 10/04/2023] [Accepted: 10/11/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND We compared the results of preoperative pancreatic juice cytology (PJC) and final pathological diagnosis after resection in patients who underwent resection of intraductal papillary mucinous neoplasm (IPMN) of the pancreas to determine whether preoperative PJC can help determine therapeutic strategies. METHODS Of 1130 patients who underwent surgical resection IPMN at 11 Japanese tertiary institutions, the study included 852 patients who underwent preoperative PJC guided by endoscopic retrograde cholangiopancreatography (ERCP). RESULTS The accuracy of preoperative PJC for differentiation between cancerous and noncancerous lesions were 55% for IPMN overall; 59% for the branch duct type; 49% for the main pancreatic duct type; 53% for the mixed type, respectively. On classifying IPMN according to the diameters of the mural nodule (MN) and main pancreatic duct (MPD), the corresponding values for diagnostic performance were 40% for type 1 (MN ≥5 mm and MPD ≥ 10 mm); 46% for type 2 (MN ≥5 mm and MPD < 10 mm); 61% for type 3 (MN < 5 mm and MPD ≥ 10 mm); 72% for type 4 (MN < 5 mm and MPD < 10 mm), respectively. CONCLUSIONS PJC in IPMN is not a recommended examination because of its low overall sensitivity and no significant difference in diagnostic performance by type, location, or subclassification. Although the sensitivity is low, the positive predictive value is high, so we suggest that pancreatic juice cytology be performed only in cases where the patient is not sure about surgery.
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Affiliation(s)
- Rintaro Nagayama
- Department of Gastroenterology, Fukuoka University Chikushi Hospital, Fukuoka, Japan
| | - Toshiharu Ueki
- Department of Gastroenterology, Fukuoka University Chikushi Hospital, Fukuoka, Japan
| | - Yasuhiro Shimizu
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Aichi, Japan
| | - Susumu Hijioka
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center, Tokyo, Japan
| | - Masafumi Nakamura
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masayuki Kitano
- Second Department of Internal Medicine, Wakayama Medical University School of Medicine, Wakayama, Japan
| | - Kazuo Hara
- Department of Gastroenterology, Aichi Cancer Center Hospital, Aichi, Japan
| | - Atsushi Masamune
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Toshifumi Kin
- Center for Gastroenterology, Teine-Keijinkai Hospital, Hokkaido, Japan
| | - Keiji Hanada
- Department of Gastroenterology, JA Onomichi General Hospital, Hiroshima, Japan
| | - Shinsuke Koshita
- Department of Gastroenterology, Sendai City Medical Center Sendai Open Hospital, Miyagi, Japan
| | - Reiko Yamada
- Department of Gastroenterology and Hepatology, Mie University Graduate School of Medicine, Mie, Japan
| | - Mamoru Takenaka
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-sayama, Japan
| | - Takao Itoi
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Akio Yanagisawa
- Department of Pathology and Laboratory Medicine, Kyoto First Red Cross Hospital, Kyoto, Japan
| | - Takao Otuka
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Seiko Hirono
- Department of Hepato-Biliary-Pancreatic Surgery, Hyogo College of Medicine, Hyogo, Japan
| | - Atsushi Kanno
- Department of Medicine, Division of Gastroenterology, Jichi Medical University, Tochigi, Japan
| | - Noboru Ideno
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takamichi Kuwahara
- Department of Gastroenterology, Aichi Cancer Center Hospital, Aichi, Japan
| | - Akinori Shimizu
- Department of Gastroenterology, JA Onomichi General Hospital, Hiroshima, Japan
| | - Ken Kamata
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-sayama, Japan
| | - Yasutsugu Asai
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Yoshifumi Takeyama
- Department of Surgery, Kinki University School of Medicine, Osaka-sayama, Japan
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Kanno Y, Okano H, Kozakai F, Koshita S, Ogawa T, Sakai T, Ito K. Lariat preparation using a snare catheter for removal of a pancreaticogastric stent in a rendezvous stent exchange. Endoscopy 2023; 55:E664-E665. [PMID: 37100409 PMCID: PMC10132932 DOI: 10.1055/a-2058-8265] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Affiliation(s)
- Yoshihide Kanno
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Haruka Okano
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Fumisato Kozakai
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Shinsuke Koshita
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Takahisa Ogawa
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Toshitaka Sakai
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Kei Ito
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
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4
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Kawakami Y, Koshita S, Kanno Y, Ogawa T, Kusunose H, Sakai T, Yonamine K, Miyamoto K, Kozakai F, Okada T, Oikawa M, Tsuchiya T, Noda Y, Sawai T, Nakase H, Ito K. Pancreatic ductal adenocarcinomas concomitant with intraductal papillary mucinous neoplasms of the pancreas: A investigation of those clinicopathological features by analyzing 48 patients who underwent surgery for those lesions. Pancreatology 2023; 23:674-681. [PMID: 37604732 DOI: 10.1016/j.pan.2023.07.010] [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: 03/28/2023] [Revised: 07/26/2023] [Accepted: 07/31/2023] [Indexed: 08/23/2023]
Abstract
BACKGROUND Differences between pancreatic ductal adenocarcinomas (PDACs) concomitant with intraductal papillary mucinous neoplasm (IPMN) (C-PDACs), those without IPMN (NC-PDACs) and invasive cancers derived from IPMN (IC-Ds) have not been fully clarified. METHODS Forty-eight patients with C-PDAC were included to investigate the differences in 1) clinicopathological features and 2) post-operative courses among the three invasive cancer groups. RESULTS 1) Characteristics of C-PDACs were mostly similar to those of NC-PDACs; whereas, between C-PDACs and IC-Ds, the rate of mucinous carcinoma (2%/25%, p = 0.003) and pathological stage (IA, 15%/36%, p = 0.033; III, 31%/4%, p = 0.015) significantly differed. Most C-PDACs coexisted with small, multifocal IPMNs without mural nodules. 2) Cumulative 5-year recurrence-free survival (RFS) rate related to extra-pancreatic recurrence was significantly worse in C-PDACs than in IC-Ds (35%/69%, p = 0.008) and was not significantly different between C-PDACs and NC-PDACs (35%/18%). This related to intra-pancreatic recurrence tended to be poor in the order of IC-Ds, C-PDACs, and NC-PDACs (69%/82%/93%). CONCLUSIONS Because characteristics of IPMNs remarkably differed between C-PDACs and IC-Ds, another algorithm specific to the early detection of C-PDACs is necessary. Appropriate post-operative managements according to the two types of recurrences may contribute to the improvement in the prognoses of C-PDACs/IC-Ds.
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Affiliation(s)
- Yujiro Kawakami
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan; Department of Gastroenterology and Hepatology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Shinsuke Koshita
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan.
| | - Yoshihide Kanno
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Takahisa Ogawa
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Hiroaki Kusunose
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Toshitaka Sakai
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Keisuke Yonamine
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Kazuaki Miyamoto
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Fumisato Kozakai
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Takaho Okada
- Department of Surgery, Sendai City Medical Center, Sendai, Japan
| | - Masaya Oikawa
- Department of Surgery, Sendai City Medical Center, Sendai, Japan
| | - Takashi Tsuchiya
- Department of Surgery, Sendai City Medical Center, Sendai, Japan
| | - Yutaka Noda
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan; Department of Pathology, Sendai City Medical Center, Sendai, Japan
| | - Takashi Sawai
- Department of Pathology, Sendai City Medical Center, Sendai, Japan
| | - Hiroshi Nakase
- Department of Gastroenterology and Hepatology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Kei Ito
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
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5
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Kin T, Shimizu Y, Hijioka S, Hara K, Katanuma A, Nakamura M, Yamada R, Itoi T, Ueki T, Masamune A, Hirono S, Koshita S, Hanada K, Kamata K, Yanagisawa A, Takeyama Y. A comparative study between computed tomography and endoscopic ultrasound in the detection of a mural nodule in intraductal papillary mucinous neoplasm -Multicenter observational study in Japan. Pancreatology 2023; 23:550-555. [PMID: 37286439 DOI: 10.1016/j.pan.2023.05.010] [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: 12/20/2022] [Revised: 04/20/2023] [Accepted: 05/22/2023] [Indexed: 06/09/2023]
Abstract
BACKGROUND/OBJECTIVES The detection of malignancy is a major concern in the management of intraductal papillary mucinous neoplasm (IPMN). The height of the mural nodule (MN), estimated using endoscopic ultrasound (EUS) and computed tomography (CT), has been considered crucial for predicting malignant IPMN. Currently, whether surveillance using CT or EUS alone is sufficient for detecting MNs remains unclear. This study aimed to compare the ability of CT and EUS to detect MNs in IPMN. METHODS This multicenter, retrospective observational study was conducted in 11 Japanese tertiary institutions. Patients who underwent surgical resection of IPMN with MN after CT and EUS examinations were eligible to participate. The MN detection rates between CT and EUS were examined. RESULTS Two-hundred-and-forty patients who underwent preoperative EUS and CT had pathologically confirmed MNs. The MN detection rates of EUS and CT were 83% and 53%, respectively (p < 0.001). Additionally, the MN detection rate of EUS was significantly higher than that of CT regardless of morphological type (76% vs. 47% in branch-duct-type IPMN; 90% vs. 54% in mixed IPMN; 98% vs. 56% in main-duct-type IPMN; p < 0.001). Further, pathologically confirmed MNs ≥5 mm were more frequently observed on EUS than on CT (95% vs. 76%, p < 0.001). CONCLUSIONS EUS was superior to CT for the detection of MN in IPMN. EUS surveillance is essential for the detection of MNs.
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Affiliation(s)
- Toshifumi Kin
- Center for Gastroenterology, Teine-Keijinkai Hospital, Sapporo, Japan.
| | - Yasuhiro Shimizu
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Susumu Hijioka
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Kazuo Hara
- Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Akio Katanuma
- Center for Gastroenterology, Teine-Keijinkai Hospital, Sapporo, Japan
| | - Masafumi Nakamura
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Reiko Yamada
- Department of Gastroenterology and Hepatology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Takao Itoi
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Toshiharu Ueki
- Department of Gastroenterology, Fukuoka University Chikushi Hospital, Fukuoka, Japan
| | - Atsushi Masamune
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Seiko Hirono
- Department of Hepato-Biliary-Pancreatic Surgery, Hyogo College of Medicine, Nishinomiya, Japan; Second Department of Surgery, School of Medicine, Wakayama Medical University, Wakayama, Japan
| | - Shinsuke Koshita
- Department of Gastroenterology, Sendai City Medical Center Sendai Open Hospital, Sendai, Japan
| | - Keiji Hanada
- Department of Gastroenterology, JA Onomichi General Hospital, Hiroshima, Japan
| | - Ken Kamata
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osakasayama, Japan
| | - Akio Yanagisawa
- Department of Pathology and Laboratory Medicine, Kyoto First Red Cross Hospital, Kyoto, Japan
| | - Yoshifumi Takeyama
- Department of Surgery, Kindai University Faculty of Medicine, Osakasayama, Japan
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6
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Hozaka Y, Ohtsuka T, Nakamura M, Hijioka S, Unno M, Shimizu Y, Tanabe M, Nagakawa Y, Hatano E, Kawai M, Sano T, Koshita S, Katanuma A, Kita E, Hanada K, Nakai Y, Aoki T, Serikawa M, Okamoto K, Takeyama Y. Feasibility of Surveillance for Mucinous Cystic Neoplasm of the Pancreas: A Multi-Institutional Retrospective Study of 328 Patients by the Japanese Pancreatic Society. Pancreas 2023; 52:e288-e292. [PMID: 37922344 DOI: 10.1097/mpa.0000000000002254] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2023]
Abstract
OBJECTIVE We aimed to elucidate the feasibility of surveillance of patients with mucinous cystic neoplasm (MCN). METHODS We performed a retrospective, multi-institutional study of 328 patients who underwent surgery for MCN at 18 Japanese institutions. Patients with MCN were divided into an immediate surgery group and a surveillance group, which underwent surgery after surveillance. RESULTS The median surveillance period until surgery in the surveillance group was 27 months (range, 7-165 months). Compared with the immediate surgery group, the surveillance group showed smaller tumor diameter (46 vs 50 mm, P = 0.01), more frequent laparoscopic approach (58% vs 37%, P < 0.01), and less frequent malignancy (7% vs 15%, P = 0.03). The new appearance of mural nodules and elevation of serum tumor markers were associated with malignancy in the surveillance group. Two patients in the surveillance group experienced postoperative recurrence, although there was no significant difference in recurrence or disease-free survival between the two groups. In the surveillance group, the 1-, 5-, and 10-year cumulative incidence rates of malignant MCN were 0.8%, 5.6%, and 36.5%, respectively. CONCLUSION As the risk of progression to malignant MCNs increases over the long term, MCNs should be resected rather than subjected to unnecessary surveillance.
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Affiliation(s)
- Yuto Hozaka
- From the Department of Digestive Surgery, Breast and Thyroid Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Takao Ohtsuka
- From the Department of Digestive Surgery, Breast and Thyroid Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Masafumi Nakamura
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Susumu Hijioka
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Michiaki Unno
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yasuhiro Shimizu
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Aichi, Japan
| | - Minoru Tanabe
- Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yuichi Nagakawa
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo, Japan
| | - Etsuro Hatano
- Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Manabu Kawai
- Second Department of Surgery, Wakayama Medical University, Wakayama, Japan
| | - Tsuyoshi Sano
- Division of Gastroenterological Surgery, Department of Surgery, Aichi Medical University, Aichi, Japan
| | - Shinsuke Koshita
- Department of Gastroenterology, Sendai City Medical Center, Miyagi, Japan
| | - Akio Katanuma
- Center for Gastroenterology, Teine Keijinkai Hospital, Hokkaido, Japan
| | - Emiri Kita
- Department of Gastroenterology, Chiba Cancer Center, Chiba, Japan
| | - Keiji Hanada
- Department of Gastroenterology, Onomichi General Hospital, Onomichi, Japan
| | | | - Takeshi Aoki
- Department of Gastroenterological and General Surgery, School of Medicine, Showa University, Tokyo, Japan
| | - Masahiro Serikawa
- Department of Gastroenterology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Kojun Okamoto
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Saitama, Japan
| | - Yoshifumi Takeyama
- Department of Surgery, Kinki University Faculty of Medicine, Osaka, Japan
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Yonamine K, Koshita S, Kanno Y, Ogawa T, Kusunose H, Sakai T, Miyamoto K, Kozakai F, Anan H, Okano H, Oikawa M, Tsuchiya T, Sawai T, Noda Y, Ito K. Diagnostic value of homogenous delayed enhancement in contrast-enhanced computed tomography images and endoscopic ultrasound-guided tissue acquisition for patients with focal autoimmune pancreatitis. Clin Endosc 2023:ce.2022.142. [PMID: 37032116 PMCID: PMC10393566 DOI: 10.5946/ce.2022.142] [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: 05/09/2022] [Accepted: 07/27/2022] [Indexed: 04/11/2023] Open
Abstract
Background/Aims We aimed to investigate (1) promising clinical findings for the recognition of focal type autoimmune pancreatitis (FAIP) and (2) the impact of endoscopic ultrasound (EUS)-guided tissue acquisition (EUS-TA) on the diagnosis of FAIP. Methods Twenty-three patients with FAIP were involved in this study, and 44 patients with resected pancreatic ductal adenocarcinoma (PDAC) were included in the control group. Results (1) Multivariate analysis revealed that homogeneous delayed enhancement on contrast-enhanced computed tomography was a significant factor indicative of FAIP compared to PDAC (90% vs. 7%, p=0.015). (2) For 13 of 17 FAIP patients (76.5%) who underwent EUS-TA, EUS-TA aided the diagnostic confirmation of AIPs, and only one patient (5.9%) was found to have AIP after surgery. On the other hand, of the six patients who did not undergo EUS-TA, three (50.0%) underwent surgery for pancreatic lesions. Conclusions Homogeneous delayed enhancement on contrast-enhanced computed tomography was the most useful clinical factor for discriminating FAIPs from PDACs. EUS-TA is mandatory for diagnostic confirmation of FAIP lesions and can contribute to a reduction in the rate of unnecessary surgery for patients with FAIP.
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Affiliation(s)
- Keisuke Yonamine
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Shinsuke Koshita
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Yoshihide Kanno
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Takahisa Ogawa
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Hiroaki Kusunose
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Toshitaka Sakai
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Kazuaki Miyamoto
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Fumisato Kozakai
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Hideyuki Anan
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Haruka Okano
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Masaya Oikawa
- Department of Gastroenterological Surgery, Sendai City Medical Center, Sendai, Japan
| | - Takashi Tsuchiya
- Department of Gastroenterological Surgery, Sendai City Medical Center, Sendai, Japan
| | - Takashi Sawai
- Department of Pathology, Sendai City Medical Center, Sendai, Japan
| | - Yutaka Noda
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
- Department of Pathology, Sendai City Medical Center, Sendai, Japan
| | - Kei Ito
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
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8
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Kozakai F, Kanno Y, Koshita S, Ogawa T, Kusunose H, Sakai T, Yonamine K, Miyamoto K, Anan H, Okano H, Ito K. Treatment Strategy for Acute Cholecystitis Induced by a Metallic Stent Placed in Malignant Biliary Strictures: Role of Percutaneous Transhepatic Gallbladder Aspiration. Intern Med 2023; 62:673-679. [PMID: 35871591 PMCID: PMC10037011 DOI: 10.2169/internalmedicine.9370-22] [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] [Indexed: 11/06/2022] Open
Abstract
Objective The present study evaluated the strategic role of percutaneous transhepatic gallbladder aspiration (PTGBA) for acute cholecystitis (AC) induced by a metallic stent (MS) placed in a malignant biliary stricture in comparison with percutaneous transhepatic gallbladder drainage (PTGBD). Methods The treatment outcomes for 31 patients who underwent PTGBA as the initial intervention for MS-induced AC were evaluated and compared with those for 12 who underwent PTGBD. Results The technical success rate was 100% for both groups. PTGBA was ineffective for 11 patients, all of whom recovered with additional intervention, whereas PTGBD was effective for all patients except for 1 who died of sepsis (clinical success rate, 65% vs. 90%, p=0.16). Adverse events (AEs) were observed in only 1 case (3%) in the PTGBA group (mild bile peritonitis). Among the clinically effective cases, AC recurred in 20% of the PTGBA group and 33% of the PTGBD group (p=0.72). In the PTGBA group, the clinical success rate was significantly higher for patients without cancer invasion to a feeding artery of the gallbladder than in those with invasion (75% without invasion vs. 29% with invasion; p=0.036). According to the multivariate analysis, this factor was an independent factor for clinical success of PTGBA (odds ratio, 9.27; p=0.040). Conclusion Although the clinical success rate of PTGBA for MS-induced AC was lower than that of PTGBD, PTGBA remains a viable option because of its safety and procedural simplicity, especially for cases without tumor invasion to a feeding artery.
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Affiliation(s)
- Fumisato Kozakai
- Department of Gastroenterology, Sendai City Medical Center, Japan
| | - Yoshihide Kanno
- Department of Gastroenterology, Sendai City Medical Center, Japan
| | - Shinsuke Koshita
- Department of Gastroenterology, Sendai City Medical Center, Japan
| | - Takahisa Ogawa
- Department of Gastroenterology, Sendai City Medical Center, Japan
| | - Hiroaki Kusunose
- Department of Gastroenterology, Sendai City Medical Center, Japan
| | - Toshitaka Sakai
- Department of Gastroenterology, Sendai City Medical Center, Japan
| | - Keisuke Yonamine
- Department of Gastroenterology, Sendai City Medical Center, Japan
| | - Kazuaki Miyamoto
- Department of Gastroenterology, Sendai City Medical Center, Japan
| | - Hideyuki Anan
- Department of Gastroenterology, Sendai City Medical Center, Japan
| | - Haruka Okano
- Department of Gastroenterology, Sendai City Medical Center, Japan
| | - Kei Ito
- Department of Gastroenterology, Sendai City Medical Center, Japan
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9
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Ogura T, Eguchi T, Nakahara K, Kanno Y, Omoto S, Itonaga M, Kuroda T, Hakoda A, Ikeoka S, Takagi M, Okada A, Sato J, Morita R, Michikawa Y, Ito K, Koshita S, Takenaka M, Kitano M, Koizumi M, Higuchi K. Clinical impact of recombinant thrombomodulin administration on disseminated intravascular coagulation due to severe acute cholangitis (Recover-AC study). J Hepatobiliary Pancreat Sci 2023; 30:221-228. [PMID: 34021720 DOI: 10.1002/jhbp.998] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 04/19/2021] [Accepted: 05/01/2021] [Indexed: 12/07/2022]
Abstract
BACKGROUND AND AIM Recombinant thrombomodulin (rhTM) is potentially effective in the treatment of disseminated intravascular coagulation (DIC). Several studies related to drugs for the treatment of acute cholangitis have shown negative results in improvement of overall survival (OS) with rhTM. The aim of this multicenter study was to evaluate the clinical effectiveness of rhTM in patients with acute cholangitis and sepsis-induced DIC who underwent biliary drainage. METHODS A total of 284 consecutive patients, who were complicated with sepsis-induced DIC due to severe acute cholangitis, were included (rhTM group, n = 173; non-rhTM, n = 111) in this study. The primary outcome was the DIC resolution rate at 7 days after starting treatment. The 28-day survival rate was secondarily evaluated. RESULTS DIC scores in the rhTM group improved significantly compared with the non-rhTM group on day 7 (P = .020). According to multivariate analysis, etiology of cholangitis (malignant, HR 2.28), rhTM (non-administration, HR 4.13), and DIC score (≥5, HR 2.46) were significant factors associated with failed DIC resolution on day 7. Propensity score matching created 103 matched pairs. Survival rate at day 28 was significantly higher in rhTM group (94.3%) compared with non-rhTM group (82.6%; P = .048) after propensity score matching. rhTM (non-administration, HR 2.870), DIC score (≥5, HR 2.751), and APACHE II score (≥20, HR 9.310) were significant factors associated with decreasing survival rate at day 28. CONCLUSION In conclusion, rhTM seemed to improve patient survival, but future studies should only include patients with benign or malignant disease and should be performed according to APACHE II scores.
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Affiliation(s)
- Takeshi Ogura
- Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Takaaki Eguchi
- Department of Gastroenterology and Hepatology, Osaka Saiseikai Nakatsu Hospital, Osaka, Japan
| | - Kazunari Nakahara
- Department of Gastroenterology and Hepatology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Yoshihide Kanno
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Shunsuke Omoto
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osakasayama, Japan
| | - Masahiro Itonaga
- Second Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan
| | - Taira Kuroda
- Department of Gastroenterology and Hepatology, Ehime University Graduate School of Medicine, Toon, Japan
| | - Akitoshi Hakoda
- Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - Seitaro Ikeoka
- Department of Gastroenterology and Hepatology, Osaka Saiseikai Nakatsu Hospital, Osaka, Japan
| | - Megumi Takagi
- Department of Gastroenterology and Hepatology, Osaka Saiseikai Nakatsu Hospital, Osaka, Japan
| | - Akihiko Okada
- Department of Gastroenterology and Hepatology, Osaka Saiseikai Nakatsu Hospital, Osaka, Japan
| | - Junya Sato
- Department of Gastroenterology and Hepatology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Ryo Morita
- Department of Gastroenterology and Hepatology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Yousuke Michikawa
- Department of Gastroenterology and Hepatology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Kei Ito
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Shinsuke Koshita
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Mamoru Takenaka
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osakasayama, Japan
| | - Masayuki Kitano
- Second Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan
| | - Mitsuhito Koizumi
- Department of Gastroenterology and Hepatology, Ehime University Graduate School of Medicine, Toon, Japan
| | - Kazuhide Higuchi
- Department of Internal Medicine, Osaka Medical College, Osaka, Japan
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10
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Murabayashi T, Kanno Y, Odaira T, Koshita S, Ogawa T, Kusunose H, Sakai T, Yonamine K, Miyamoto K, Kozakai F, Endo K, Noda Y, Sawai T, Ito K. Mixed neuroendocrine-non-neuroendocrine neoplasm with mucinous adenocarcinoma and amphicrine carcinoma components in the bile duct: an autopsy case. Clin J Gastroenterol 2023; 16:310-316. [PMID: 36689097 DOI: 10.1007/s12328-023-01763-4] [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: 09/03/2020] [Accepted: 10/25/2020] [Indexed: 01/24/2023]
Abstract
We report the first case of bile duct mixed neuroendocrine-non-neuroendocrine neoplasm (MiNEN) that had a mucinous carcinoma component. An 88-year-old man with biliary obstruction was diagnosed as having distal bile duct cancer using imaging examinations and endoscopic biopsy. The patient received the best supportive care without surgical resection for 13 months until death. An autopsy revealed a bulky mass involving the distal bile duct and multiple metastases in intra-abdominal lymph nodes, the liver, and the lungs. The primary cancer was microscopically diagnosed as a MiNEN, which consisted of mucinous adenocarcinoma and large cell-type neuroendocrine carcinoma (NEC) components. Metastatic lesions in the liver and lungs were composed of only NEC with rich extracellular mucin without adenocarcinoma cells. Using electron microscopy and immunohistochemistry, it was proved that all NEC cells in both primary and metastatic lesions had amphicrine features. On the basis of pathological findings, we thought that the MiNEN was initially derived from a mucinous adenocarcinoma that dedifferentiated to amphicrine NEC cells with mucin production.
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Affiliation(s)
- Toji Murabayashi
- Department of Gastroenterology, Sendai City Medical Center, 5-22-1, Tsurugaya, Miyaginoku, Sendai, 983-0824, Japan.
| | - Yoshihide Kanno
- Department of Gastroenterology, Sendai City Medical Center, 5-22-1, Tsurugaya, Miyaginoku, Sendai, 983-0824, Japan
| | - Takashi Odaira
- Department of Gastroenterology, Sendai City Medical Center, 5-22-1, Tsurugaya, Miyaginoku, Sendai, 983-0824, Japan
| | - Shinsuke Koshita
- Department of Gastroenterology, Sendai City Medical Center, 5-22-1, Tsurugaya, Miyaginoku, Sendai, 983-0824, Japan
| | - Takahisa Ogawa
- Department of Gastroenterology, Sendai City Medical Center, 5-22-1, Tsurugaya, Miyaginoku, Sendai, 983-0824, Japan
| | - Hiroaki Kusunose
- Department of Gastroenterology, Sendai City Medical Center, 5-22-1, Tsurugaya, Miyaginoku, Sendai, 983-0824, Japan
| | - Toshitaka Sakai
- Department of Gastroenterology, Sendai City Medical Center, 5-22-1, Tsurugaya, Miyaginoku, Sendai, 983-0824, Japan
| | - Keisuke Yonamine
- Department of Gastroenterology, Sendai City Medical Center, 5-22-1, Tsurugaya, Miyaginoku, Sendai, 983-0824, Japan
| | - Kazuaki Miyamoto
- Department of Gastroenterology, Sendai City Medical Center, 5-22-1, Tsurugaya, Miyaginoku, Sendai, 983-0824, Japan
| | - Fumisato Kozakai
- Department of Gastroenterology, Sendai City Medical Center, 5-22-1, Tsurugaya, Miyaginoku, Sendai, 983-0824, Japan
| | - Kazuki Endo
- Department of Gastroenterology, Sendai City Medical Center, 5-22-1, Tsurugaya, Miyaginoku, Sendai, 983-0824, Japan
| | - Yutaka Noda
- Department of Gastroenterology, Sendai City Medical Center, 5-22-1, Tsurugaya, Miyaginoku, Sendai, 983-0824, Japan.,Department of Pathology, Sendai City Medical Center, 5-22-1, Tsurugaya, Miyaginoku, Sendai, 983-0824, Japan
| | - Takashi Sawai
- Department of Pathology, Sendai City Medical Center, 5-22-1, Tsurugaya, Miyaginoku, Sendai, 983-0824, Japan
| | - Kei Ito
- Department of Gastroenterology, Sendai City Medical Center, 5-22-1, Tsurugaya, Miyaginoku, Sendai, 983-0824, Japan
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11
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Yonamine K, Koshita S, Kanno Y, Ogawa T, Ito K. EUS-guided transluminal drainage for a huge perihepatic biloma covering the right hepatic lobe (with video). Endosc Ultrasound 2022; 12:284-285. [PMID: 36510874 DOI: 10.4103/eus-d-22-00061] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Affiliation(s)
- Keisuke Yonamine
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Shinsuke Koshita
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Yoshiide Kanno
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Takahisa Ogawa
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Kei Ito
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
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12
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Kusunose H, Koshita S, Kanno Y, Ogawa T, Sakai T, Yonamine K, Miyamoto K, Kozakai F, Anan H, Endo K, Okano H, Oikawa M, Tsuchiya T, Sawai T, Noda Y, Ito K. Pancreatic duct lavage cytology combined with a cell-block method for patients with possible pancreatic ductal adenocarcinomas, including pancreatic carcinoma <i>in situ</i>. Clin Endosc 2022. [DOI: 10.5946/ce.2022.021] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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13
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Ogawa T, Kanno Y, Koshita S, Kusunose H, Sakai T, Yonamine K, Miyamoto K, Kozakai F, Okano H, Anan H, Hosokawa K, Ito K. Prospective feasibility study on the efficacy and safety of a novel spiral dilator for endoscopic ultrasound-guided drainage. DEN Open 2022; 3:e170. [PMID: 36262217 PMCID: PMC9576110 DOI: 10.1002/deo2.170] [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] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 09/13/2022] [Accepted: 09/18/2022] [Indexed: 11/05/2022]
Abstract
Objectives A difficult step in endoscopic ultrasound (EUS)‐guided drainage procedures is dilation of the puncture tract before stent deployment. The efficacy and safety of a novel spiral dilator, Tornus ES, for EUS‐guided drainage were investigated in this study. Methods This study was conducted as a prospective, single‐arm, observational study at Sendai City Medical center. Dilation of the puncture tract using a spiral dilator was attempted for all EUS‐guided drainage cases. The primary outcome was the technical success rate which was defined as successful stent placement in the puncture tract. Secondary outcomes were the success rate of dilation using a spiral dilator, procedure time, and adverse events related to the procedures. Results A total of 10 patients were enrolled between January and March 2022. Seven patients underwent EUS‐guided biliary drainage (hepaticogastrostomy for six and hepaticojejunostomy for one), and the remaining three patients underwent EUS‐guided gallbladder drainage. The technical success rate and the success rate of dilation using a spiral dilator were both 100%. The mean procedure time was 27 min. No adverse events related to the procedure occurred in all cases. Conclusions Dilation of the puncture tract using a spiral dilator was effective and safe and might make it easier to perform EUS‐guided drainage.
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Affiliation(s)
- Takahisa Ogawa
- Department of GastroenterologySendai City Medical CenterMiyagiJapan
| | - Yoshihide Kanno
- Department of GastroenterologySendai City Medical CenterMiyagiJapan
| | - Shinsuke Koshita
- Department of GastroenterologySendai City Medical CenterMiyagiJapan
| | - Hiroaki Kusunose
- Department of GastroenterologySendai City Medical CenterMiyagiJapan
| | - Toshitaka Sakai
- Department of GastroenterologySendai City Medical CenterMiyagiJapan
| | - Keisuke Yonamine
- Department of GastroenterologySendai City Medical CenterMiyagiJapan
| | - Kazuaki Miyamoto
- Department of GastroenterologySendai City Medical CenterMiyagiJapan
| | - Fumisato Kozakai
- Department of GastroenterologySendai City Medical CenterMiyagiJapan
| | - Haruka Okano
- Department of GastroenterologySendai City Medical CenterMiyagiJapan
| | - Hideyuki Anan
- Department of GastroenterologySendai City Medical CenterMiyagiJapan
| | - Kento Hosokawa
- Department of GastroenterologySendai City Medical CenterMiyagiJapan
| | - Kei Ito
- Department of GastroenterologySendai City Medical CenterMiyagiJapan
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14
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Okano H, Koshita S, Kanno Y, Ogawa T, Kusunose H, Sakai T, Ito K. Peroral cholangioscopy via an endoscopic ultrasound-guided hepaticojejunostomy route for distal bile duct cancer with Roux-en-Y reconstruction. Endoscopy 2022; 54:E188-E189. [PMID: 33979861 DOI: 10.1055/a-1472-5683] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Haruka Okano
- Public Interest Incorporated Foundation Sendai City Medical Center, Gastroenterology, Sendai, Japan
| | - Shinsuke Koshita
- Public Interest Incorporated Foundation Sendai City Medical Center, Gastroenterology, Sendai, Japan
| | - Yoshihide Kanno
- Public Interest Incorporated Foundation Sendai City Medical Center, Gastroenterology, Sendai, Japan
| | - Takahisa Ogawa
- Public Interest Incorporated Foundation Sendai City Medical Center, Gastroenterology, Sendai, Japan
| | - Hiroaki Kusunose
- Public Interest Incorporated Foundation Sendai City Medical Center, Gastroenterology, Sendai, Japan
| | - Toshitaka Sakai
- Public Interest Incorporated Foundation Sendai City Medical Center, Gastroenterology, Sendai, Japan
| | - Kei Ito
- Public Interest Incorporated Foundation Sendai City Medical Center, Gastroenterology, Sendai, Japan
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15
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Yonamine K, Koshita S, Kanno Y, Ogawa T, Kusunose H, Sakai T, Ito K. Endoscopic ultrasound (EUS)-guided antegrade intervention for a hepaticojejunostomy anastomosis obstruction under peroral cholangioscopy via an EUS-guided hepaticogastrostomy route. Endoscopy 2022; 54:E788-E789. [PMID: 35468628 PMCID: PMC9735294 DOI: 10.1055/a-1810-7068] [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: 12/14/2022]
Affiliation(s)
- Keisuke Yonamine
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Shinsuke Koshita
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Yoshihide Kanno
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Takahisa Ogawa
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Hiroaki Kusunose
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Toshitaka Sakai
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Kei Ito
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
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16
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Shimizu T, Koshita S, Ohira T, Harada Y, Kanno Y, Ogawa T, Yamagata T, Kusunose H, Sakai T, Tsuchiya T, Oikawa M, Noda Y, Sawai T, Ito K. Endoscopic Ultrasonography-guided Fine-needle Aspiration Cytology Combined with a Cell-block Method for Gastrointestinal Subepithelial Lesions. Intern Med 2022; 61:935-942. [PMID: 34511568 PMCID: PMC9038475 DOI: 10.2169/internalmedicine.7889-21] [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 The diagnostic accuracy of an endoscopic ultrasound-guided fine-needle aspiration cytology/biopsy combined with a cell-block method (FNA-CB) for gastrointestinal subepithelial lesions (GI-SELs) has not been fully studied. Methods A total of 109 patients (with 110 GI-SELs) were evaluated to clarify the rate of obtaining evaluable histology specimens using FNA-CB. In addition, we investigated the following: 1) the accuracy for determining the histology, 2) effects of the number of cell clusters obtained via FNA-CB, 3) correlation of the Ki67 labelling index (Ki67LI) of the gastrointestinal stromal tumor (GIST) lesions between FNA-CB and resected specimens, and 4) clinical courses for patients followed up after FNA-CB. Results Of the 110 GI-SELs for which FNA-CB was performed, 95 (86%) were able to be histologically evaluated using the first FNA-CB. For the 70 resected GI-SELs, the accuracy of FNA-CB to determine histology was 96%, remaining at 90% even when only a few cell clusters were obtained. The concordance rate of the risk-grouping of GIST (high-risk, Ki67LI ≥8; low-risk, <8) between FNA-CB and resected specimens was 84%. Of the 29 patients followed up after the first FNA-CB, 12 with benign GI-SELs determined using the first FNA-CB showed no obvious increases in their GI-SEL sizes. Conclusion Since FNA-CB can be used to determine the histology and reproductive activity of GI-SELs accurately, not only preoperative histological confirmation but also reliable information to determine clinical plans, such as follow-up without surgery or neoadjuvant chemotherapy, can be obtained.
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Affiliation(s)
- Takeshi Shimizu
- Department of Gastroenterology, Sendai City Medical Center, Japan
| | - Shinsuke Koshita
- Department of Gastroenterology, Sendai City Medical Center, Japan
| | - Tetsuya Ohira
- Department of Gastroenterology, Sendai City Medical Center, Japan
| | - Yoshihiro Harada
- Department of Gastroenterology, Sendai City Medical Center, Japan
| | - Yoshihide Kanno
- Department of Gastroenterology, Sendai City Medical Center, Japan
| | - Takahisa Ogawa
- Department of Gastroenterology, Sendai City Medical Center, Japan
| | - Taku Yamagata
- Department of Gastroenterology, Sendai City Medical Center, Japan
| | - Hiroaki Kusunose
- Department of Gastroenterology, Sendai City Medical Center, Japan
| | - Toshitaka Sakai
- Department of Gastroenterology, Sendai City Medical Center, Japan
| | | | - Masaya Oikawa
- Department of Surgery, Sendai City Medical Center, Japan
| | - Yutaka Noda
- Department of Gastroenterology, Sendai City Medical Center, Japan
- Department of Pathology, Sendai City Medical Center, Japan
| | - Takashi Sawai
- Department of Pathology, Sendai City Medical Center, Japan
| | - Kei Ito
- Department of Gastroenterology, Sendai City Medical Center, Japan
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17
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Sakai T, Koshita S, Kanno Y, Ogawa T, Kusunose H, Yonamine K, Miyamoto K, Kozakai F, Okano H, Ohira T, Horaguchi J, Oikawa M, Tsuchiya T, Noda Y, Ito K. Early and long-term clinical outcomes of endoscopic interventions for benign pancreatic duct stricture/obstruction-the possibility of additional clinical effects of endoscopic ultrasonography-guided pancreatic drainage. Pancreatology 2022; 22:58-66. [PMID: 34742630 DOI: 10.1016/j.pan.2021.10.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 08/06/2021] [Revised: 10/14/2021] [Accepted: 10/24/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVES For benign pancreatic duct strictures/obstructions (BPDS/O), endoscopic ultrasonography-guided pancreatic drainage (EUS-PD) is performed when endoscopic transpapillary pancreatic drainage (ETPD) fails. We clarified the clinical outcomes for patients with BPDS/O who underwent endoscopic interventions through the era where EUS-PD was available. METHODS Forty-five patients with BPDS/O who underwent ETPD/EUS-PD were included. We retrospectively investigated overall technical and clinical success rates for endoscopic interventions, adverse events, and clinical outcomes after successful endoscopic interventions. RESULTS The technical success rates for ETPD and EUS-PD were 77% (35/45) and 80% (8/10), respectively, and the overall technical success rate using two drainage procedures was 91% (41/45). Among the 41 patients who underwent successful endoscopic procedures, the clinical success rates were 97% for the symptomatic patients (35/36). The rates of procedure-related pancreatitis after ETPD and EUS-PD were 13% and 30%, respectively. After successful endoscopic interventions, the cumulative 3-year rate of developing recurrent symptoms/pancreatitis was calculated to be 27%, and only two patients finally needed surgery. Continuous smoking after endoscopic interventions was shown to be a risk factor for developing recurrent symptoms/pancreatitis. CONCLUSIONS By adding EUS-PD to ETPD, the technical success rate for endoscopic interventions for BPDS/O was more than 90%, and the clinical success rate was nearly 100%. Due to the low rate of surgery after endoscopic interventions, including EUS-PD, for patients with BPDS/O, EUS-PD may contribute to their good clinical courses as a salvage treatment for refractory BPDS/O.
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Affiliation(s)
- Toshitaka Sakai
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan.
| | - Shinsuke Koshita
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Yoshihide Kanno
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Takahisa Ogawa
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Hiroaki Kusunose
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Keisuke Yonamine
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Kazuaki Miyamoto
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Fumisato Kozakai
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Haruka Okano
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Tetsuya Ohira
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | | | - Masaya Oikawa
- Department of Surgery, Sendai City Medical Center, Sendai, Japan
| | - Takashi Tsuchiya
- Department of Surgery, Sendai City Medical Center, Sendai, Japan
| | - Yutaka Noda
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Kei Ito
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
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18
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Kanno Y, Ohira T, Kozakai F, Miyamoto K, Kusunose H, Sakai T, Yonamine K, Okano H, Koshita S, Ogawa T, Shimizu T, Ito K. Accurate endoscopic identification of the afferent limb at the Y anastomosis using the fold disruption sign after gastric resection with Roux-en-Y reconstruction. Dig Endosc 2022; 34:238-243. [PMID: 34516705 DOI: 10.1111/den.14128] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 07/21/2021] [Revised: 08/30/2021] [Accepted: 09/08/2021] [Indexed: 02/08/2023]
Abstract
In patients with Roux-en-Y (RY) reconstruction for gastric resection, the newly defined "fold disruption" (FD) sign can be useful to distinguish the afferent limb from the efferent limb at the Y anastomosis when balloon endoscopy-assisted endoscopic retrograde cholangiopancreatography (BE-ERCP) is performed. The FD sign was defined as endoscopic findings of the internal folds disrupted toward the afferent limb and continued toward the efferent limb at the Y anastomosis. In this prospective observational study, the accuracy of the FD sign was evaluated for those who underwent BE-ERCP after gastric resection with RY reconstruction. Of 28 patients for whom the accuracy could be evaluated among 30 enrolled patients, the afferent limb was identified using the FD sign with 100% accuracy. For the other two patients, the scope could not reach the target lumen due to severe intestinal adhesion in one and reached the target lumen without recognition of the Y anastomosis in the other. There was no patient for whom the FD sign could not be judged for any reason, such as a blurred anastomosis line, unclear folds, sticky discharge and blood coating the surface, when the Y anastomosis was recognized. The FD sign was a highly accurate tool for distinguishing the afferent limb from the efferent limb in patients after gastric resection with RY reconstruction. This study was registered in UMIN (issued ID, UMIN000038326).
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Affiliation(s)
- Yoshihide Kanno
- Department of Gastroenterology, Sendai City Medical Center, Miyagi, Japan
| | - Tetsuya Ohira
- Department of Gastroenterology, Sendai City Medical Center, Miyagi, Japan
| | - Fumisato Kozakai
- Department of Gastroenterology, Sendai City Medical Center, Miyagi, Japan
| | - Kazuaki Miyamoto
- Department of Gastroenterology, Sendai City Medical Center, Miyagi, Japan
| | - Hiroaki Kusunose
- Department of Gastroenterology, Sendai City Medical Center, Miyagi, Japan
| | - Toshitaka Sakai
- Department of Gastroenterology, Sendai City Medical Center, Miyagi, Japan
| | - Keisuke Yonamine
- Department of Gastroenterology, Sendai City Medical Center, Miyagi, Japan
| | - Haruka Okano
- Department of Gastroenterology, Sendai City Medical Center, Miyagi, Japan
| | - Shinsuke Koshita
- Department of Gastroenterology, Sendai City Medical Center, Miyagi, Japan
| | - Takahisa Ogawa
- Department of Gastroenterology, Sendai City Medical Center, Miyagi, Japan
| | - Takeshi Shimizu
- Department of Gastroenterology, Sendai City Medical Center, Miyagi, Japan
| | - Kei Ito
- Department of Gastroenterology, Sendai City Medical Center, Miyagi, Japan
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19
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Yonamine K, Koshita S, Kanno Y, Ogawa T, Kusunose H, Sakai T, Miyamoto K, Kozakai F, Okano H, Okada T, Oikawa M, Tsuchiya T, Sawai T, Noda Y, Ito K. Pancreatic Ductal Adenocarcinoma Concomitant with Main Duct Type Intraductal Papillary Mucinous Neoplasm of the Pancreas: A Case Report. Am J Case Rep 2021; 22:e932565. [PMID: 34473678 PMCID: PMC8422565 DOI: 10.12659/ajcr.932565] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 07/28/2021] [Accepted: 07/12/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Intraductal papillary mucinous neoplasm of the pancreas (IPMN) and pancreatic ductal adenocarcinoma (PDAC) often coexist in the same pancreas. Almost all IPMNs involving PDACs concomitant with IPMN have been shown to be branch duct type IPMNs (BD-IPMNs), and their histological subtypes are gastric type. Therefore, PDACs concomitant with main duct type IPMNs (MD-IPMNs) are considered to be rare. We herein report a rare case preoperatively diagnosed as being a PDAC concomitant with MD-IPMN on the basis of imaging findings and histological findings of pancreatic specimens endoscopically obtained from 2 lesions. CASE REPORT A 67-year-old man was referred to our hospital due to an enlarged pancreas. Using imaging studies, a solid mass was found in the pancreatic head and intraductal papillary masses in the dilated main pancreatic duct of the body and tail with a fistula in the duodenum. On the basis of histological results using specimens endoscopically obtained from each of the 2 lesions, total pancreatectomy was planned due to suspected PDAC concomitant with an MD-IPMN. Finally, resected specimens were used to confirm the presence of a rare case of PDAC concomitant with MD-IPMN. CONCLUSIONS We encountered a rare case of a PDAC concomitant with an MD-IPMN which could be preoperatively diagnosed by using imaging studies and histological specimens endoscopically obtained. In addition to invasive cancers derived from IPMNs, PDACs concomitant with IPMNs can rarely develop in the pancreas involving MD-IPMNs.
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Affiliation(s)
- Keisuke Yonamine
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Miyagi, Japan
| | - Shinsuke Koshita
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Miyagi, Japan
| | - Yoshihide Kanno
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Miyagi, Japan
| | - Takahisa Ogawa
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Miyagi, Japan
| | - Hiroaki Kusunose
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Miyagi, Japan
| | - Toshitaka Sakai
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Miyagi, Japan
| | - Kazuaki Miyamoto
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Miyagi, Japan
| | - Fumisato Kozakai
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Miyagi, Japan
| | - Haruka Okano
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Miyagi, Japan
| | - Takaho Okada
- Department of Gastroenterological Surgery, Sendai City Medical Center, Sendai, Miyagi, Japan
| | - Masaya Oikawa
- Department of Gastroenterological Surgery, Sendai City Medical Center, Sendai, Miyagi, Japan
| | - Takashi Tsuchiya
- Department of Gastroenterological Surgery, Sendai City Medical Center, Sendai, Miyagi, Japan
| | - Takashi Sawai
- Department of Pathology, Sendai City Medical Center, Sendai, Miyagi, Japan
| | - Yutaka Noda
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Miyagi, Japan
- Department of Pathology, Sendai City Medical Center, Sendai, Miyagi, Japan
| | - Kei Ito
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Miyagi, Japan
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20
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Hasegawa S, Koshita S, Kanno Y, Ogawa T, Sakai T, Kusunose H, Kubota K, Nakajima A, Noda Y, Ito K. Endoscopic Interventions for the Early and Remission Phases of Acute Biliary Pancreatitis: What are the More Concrete and Practical Situations for Performing Them? Clin Endosc 2021; 54:888-898. [PMID: 34038997 PMCID: PMC8652157 DOI: 10.5946/ce.2020.271] [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: 10/13/2020] [Accepted: 01/11/2021] [Indexed: 11/14/2022] Open
Abstract
Background/Aims The use of endoscopic intervention (EI) for acute biliary pancreatitis (ABP) remains controversial because the severity of biliary obstruction/cholangitis/pancreatitis is not reflected in the indications for early EI (EEI). Methods A total of 148 patients with ABP were included to investigate 1) the differences in the rate of worsening cholangitis/pancreatitis between the EEI group and the early conservative management (ECM) group, especially for each severity of cholangitis/pancreatitis, and 2) the diagnostic ability of imaging studies, including endoscopic ultrasound (EUS), to detect common bile duct stones (CBDSs) in the ECM group. Results No differences were observed in the rate of worsening cholangitis between the EEI and ECM groups, regardless of the severity of cholangitis and/or the existence of impacted CBDSs. Among patients without impacted CBDSs and moderate/severe cholangitis, worsening pancreatitis was significantly more frequent in the EEI group (18% vs. 4%, p=0.048). In patients in the ECM group, the sensitivity and specificity for detecting CBDSs were 73% and 98%, respectively, for EUS, whereas the values were 13% and 92%, respectively, for magnetic resonance cholangiopancreatography. Conclusions EEI should be avoided in the absence of moderate/severe cholangitis and/or impacted CBDSs because of the high rate of worsening pancreatitis. EUS can contribute to the accurate detection of residual CBDSs, for the determination of the need for elective EI.
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Affiliation(s)
- Sho Hasegawa
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan.,Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama, Japan
| | - Shinsuke Koshita
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Yoshihide Kanno
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Takahisa Ogawa
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Toshitaka Sakai
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Hiroaki Kusunose
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Kensuke Kubota
- Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama, Japan
| | - Atsushi Nakajima
- Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama, Japan
| | - Yutaka Noda
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Kei Ito
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
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21
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Kanno Y, Ohira T, Harada Y, Koshita S, Ogawa T, Kusunose H, Koike Y, Yamagata T, Sakai T, Masu K, Yonamine K, Miyamoto K, Tanaka M, Shimada T, Kozakai F, Endo K, Okano H, Komabayashi D, Shimizu T, Suzuki S, Ito K. Safety and Recipient Satisfaction of Propofol Sedation in Outpatient Endoscopy: A 24-Hour Prospective Investigation Using a Questionnaire Survey. Clin Endosc 2020; 54:340-347. [PMID: 33302328 PMCID: PMC8182244 DOI: 10.5946/ce.2020.138] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 07/06/2020] [Indexed: 12/16/2022] Open
Abstract
Background/Aims The aim of this study was to evaluate the safety of sedation with propofol as an alternative to benzodiazepine drugs in outpatient endoscopy.
Methods In this prospective study, examinees who underwent outpatient endoscopy under propofol sedation and submitted a nextday questionnaire with providing informed consent were evaluated. Periprocedural acute responses, late adverse events within 24 hours, and examinee satisfaction were evaluated.
Results Among the 4,122 patients who received propofol in the 17,978 outpatient-based endoscopic examinations performed between November 2016 and March 2018, 2,305 eligible examinees (esophagogastroduodenoscopy for 1,340, endoscopic ultrasonography for 945, and total colonoscopy for 20) were enrolled, and their responses to a questionnaire were analyzed. The mean propofol dose was 69.6±24.4 mg (range, 20–200 mg). Diazepam, midazolam, and/or pentazocine in combination with propofol was administered to 146 examinees. Mild oxygen desaturation was observed in 59 examinees (2.6%); and mild bradycardia, in 2 (0.09%). Other severe reactions or late events did not occur. After eliminating 181 invalid responses, 97.7% (2,065/2,124) of the patients desired propofol sedation in future examinations.
Conclusions Propofol sedation was found to be safe-without severe adverse events or accidents-for outpatient endoscopy on the basis of the patients’ next-day self-evaluation. Given the high satisfaction level, propofol sedation might be an ideal tool for painless endoscopic screening.
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Affiliation(s)
- Yoshihide Kanno
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Tetsuya Ohira
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Yoshihiro Harada
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Shinsuke Koshita
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Takahisa Ogawa
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Hiroaki Kusunose
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Yoshiki Koike
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Taku Yamagata
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Toshitaka Sakai
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Kaori Masu
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Keisuke Yonamine
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Kazuaki Miyamoto
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Megumi Tanaka
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Tomohiro Shimada
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Fumisato Kozakai
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Kazuki Endo
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Haruka Okano
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Daichi Komabayashi
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Takeshi Shimizu
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Shohei Suzuki
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Kei Ito
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
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22
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Ogawa T, Kanno Y, Koshita S, Masu K, Kusunose H, Sakai T, Yonamine K, Miyamoto K, Murabayashi T, Kozakai F, Endo K, Noda Y, Ito K. Cholangioscopy- versus fluoroscopy-guided transpapillary mapping biopsy for preoperative evaluation of extrahepatic cholangiocarcinoma: a prospective randomized crossover study. Surg Endosc 2020; 35:6481-6488. [PMID: 33141278 DOI: 10.1007/s00464-020-08141-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 05/12/2020] [Accepted: 10/27/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND To evaluate the lateral extent of extrahepatic cholangiocarcinoma, the value of cholangioscopy-guided mapping biopsy (CMB) compared with that of fluoroscopy-guided mapping biopsy (FMB) remains unknown. The aim of this study was to compare these two techniques. METHODS In this prospective, randomized, crossover study, both CMB and FMB techniques were performed for all patients in a randomized order. Target sites for the mapping biopsy were determined based on resection lines of possible surgical procedures. At least two biopsy strokes were attempted at each target site. The primary outcome was the rate of site-based successful biopsies, which was defined as acquisition of epithelium-containing material appropriate for diagnosing benignancy/malignancy from each site, regardless of amount of materials obtained from the same site. RESULTS Between September 2016 and October 2018, 28 patients (16 distal bile duct cancer and 12 perihilar bile duct cancer) were enrolled and divided into two groups of 14 patients: CMB first and FMB first. Although all 118 target sites could be approached using CMB, FMB forceps reached only 71% of them with significantly poor accessibility to the B2/3 confluence. Since several materials were too small and did not contain epithelium, the overall rates of site-based successful biopsies were 78% (92/118) using CMB and 64% (76/118) using FMB (P = 0.031). CONCLUSIONS The rate of site-based successful biopsies using CMB was significantly higher than that using FMB when evaluated using specimens obtained from several biopsy strokes.
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Affiliation(s)
- Takahisa Ogawa
- Department of Gastroenterology, Sendai City Medical Center, 5-22-1, Tsurugaya, Miyagino-ku, Sendai, 983-0824, Japan.
| | - Yoshihide Kanno
- Department of Gastroenterology, Sendai City Medical Center, 5-22-1, Tsurugaya, Miyagino-ku, Sendai, 983-0824, Japan
| | - Shinsuke Koshita
- Department of Gastroenterology, Sendai City Medical Center, 5-22-1, Tsurugaya, Miyagino-ku, Sendai, 983-0824, Japan
| | - Kaori Masu
- Department of Gastroenterology, Sendai City Medical Center, 5-22-1, Tsurugaya, Miyagino-ku, Sendai, 983-0824, Japan
| | - Hiroaki Kusunose
- Department of Gastroenterology, Sendai City Medical Center, 5-22-1, Tsurugaya, Miyagino-ku, Sendai, 983-0824, Japan
| | - Toshitaka Sakai
- Department of Gastroenterology, Sendai City Medical Center, 5-22-1, Tsurugaya, Miyagino-ku, Sendai, 983-0824, Japan
| | - Keisuke Yonamine
- Department of Gastroenterology, Sendai City Medical Center, 5-22-1, Tsurugaya, Miyagino-ku, Sendai, 983-0824, Japan
| | - Kazuaki Miyamoto
- Department of Gastroenterology, Sendai City Medical Center, 5-22-1, Tsurugaya, Miyagino-ku, Sendai, 983-0824, Japan
| | - Toji Murabayashi
- Department of Gastroenterology, Sendai City Medical Center, 5-22-1, Tsurugaya, Miyagino-ku, Sendai, 983-0824, Japan
| | - Fumisato Kozakai
- Department of Gastroenterology, Sendai City Medical Center, 5-22-1, Tsurugaya, Miyagino-ku, Sendai, 983-0824, Japan
| | - Kazuki Endo
- Department of Gastroenterology, Sendai City Medical Center, 5-22-1, Tsurugaya, Miyagino-ku, Sendai, 983-0824, Japan
| | - Yutaka Noda
- Department of Gastroenterology, Sendai City Medical Center, 5-22-1, Tsurugaya, Miyagino-ku, Sendai, 983-0824, Japan
| | - Kei Ito
- Department of Gastroenterology, Sendai City Medical Center, 5-22-1, Tsurugaya, Miyagino-ku, Sendai, 983-0824, Japan
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23
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Kanno Y, Koshita S, Ito K. Response. Gastrointest Endosc 2020; 92:1144. [PMID: 33160502 DOI: 10.1016/j.gie.2020.06.072] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 06/28/2020] [Indexed: 02/08/2023]
Affiliation(s)
- Yoshihide Kanno
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Shinsuke Koshita
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Kei Ito
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
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24
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Kawakami Y, Koshita S, Kanno Y, Ogawa T, Murabayashi T, Nakase H, Ito K. Recanalization of an obstructive pancreaticojejunal anastomosis with direct visualization by using antegrade peroral pancreatoscopy. Endoscopy 2020; 52:E376-E377. [PMID: 32219788 DOI: 10.1055/a-1133-4304] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Yujiro Kawakami
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan.,Department of Gastroenterology and Hepatology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Shinsuke Koshita
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Yoshihide Kanno
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Takahisa Ogawa
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Toji Murabayashi
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Hiroshi Nakase
- Department of Gastroenterology and Hepatology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Kei Ito
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
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25
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Koshita S, Noda Y, Kanno Y, Ogawa T, Masu K, Kusunose H, Sakai T, Murabayashi T, Kozakai F, Yonamine K, Miyamoto K, Endo K, Horaguchi J, Oikawa M, Tsuchiya T, Sawai T, Ito K. Value of repeated cytology for intraductal papillary mucinous neoplasms of the pancreas with high risk potential of malignancy: Is it a promising method for monitoring a malignant transformation? Pancreatology 2020; 20:1164-1174. [PMID: 32800646 DOI: 10.1016/j.pan.2020.05.021] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 05/19/2020] [Accepted: 05/27/2020] [Indexed: 02/08/2023]
Abstract
OBJECTIVES The efficacy of and indications for cytological reexamination to detect malignant changes in branch duct type intraductal papillary mucinous neoplasms (BD-IPMNs) have not been studied in detail. We conducted a retrospective study to evaluate the efficacy and indications of cytological reexamination by using pancreatic juice (repeated cytology) for BD-IPMNs. METHODS Forty-five patients who underwent repeated cytology after a diagnosis of benignancy by using initial cytology were recruited for this study. RESULTS Thirty-eight patients, excluding 7 patients with lack of surveillance period after the final cytology, were classified into Malignancy (n = 13) and Benignancy groups (n = 25) on the bases of the findings from resected specimens or changes in BD-IPMNs after repeated cytology. The sensitivity and specificity to detect malignant changes in BD-IPMNs by using repeated cytology were 62% and 100%, respectively. For the 12 patients with mural nodules (MNs) ≥ 5 mm (67% of them were malignant), the sensitivity was 50%, whereas, for the 26 patients without MNs ≥ 5 mm (19% of them were malignant), it was 80%. In addition, malignant changes in BD-IPMNs after initial cytology occurred in 62% of the patients with changes in the MNs and 27% of the patients with an increase in the cyst size. CONCLUSION Repeated cytology can play a role in the determination for surgery even after a diagnosis of benignancy by using initial cytology, especially for BD-IPMNs without MNs ≥5 mm. In addition, changes in the MNs or cyst size may be appropriate indications for repeated cytology.
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Affiliation(s)
- Shinsuke Koshita
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan.
| | - Yutaka Noda
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan; Department of Pathology, Sendai City Medical Center, Sendai, Japan
| | - Yoshihide Kanno
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Takahisa Ogawa
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Kaori Masu
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Hiroaki Kusunose
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Toshitaka Sakai
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Toji Murabayashi
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Fumisato Kozakai
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Keisuke Yonamine
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Kazuaki Miyamoto
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Kazuki Endo
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Jun Horaguchi
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan; Natori-Chuo-Clinic, Natori, Japan
| | - Masaya Oikawa
- Department of Surgery, Sendai City Medical Center, Sendai, Japan
| | - Takashi Tsuchiya
- Department of Surgery, Sendai City Medical Center, Sendai, Japan
| | - Takashi Sawai
- Department of Pathology, Sendai City Medical Center, Sendai, Japan
| | - Kei Ito
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
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26
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Murabayashi T, Ogawa T, Koshita S, Kanno Y, Kusunose H, Sakai T, Masu K, Yonamine K, Miyamoto K, Kozakai F, Endo K, Noda Y, Ito K. Peroral Cholangioscopy-guided Electrohydraulic Lithotripsy with a SpyGlass DS Versus a Conventional Digital Cholangioscope for Difficult Bile Duct Stones. Intern Med 2020; 59:1925-1930. [PMID: 32389946 PMCID: PMC7492117 DOI: 10.2169/internalmedicine.4463-20] [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] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Objective Recently, a new digital peroral cholangioscopy (POCS) system, the SpyGlass DS (SpyDS), has been used for POCS-guided lithotripsy for difficult bile duct stones (DBDSs). The aim of this retrospective study was to compare the efficacy of SpyDS-guided electrohydraulic lithotripsy (EHL) for DBDS with that of a conventional digital cholangioscope. Methods Seventeen consecutive patients who had undergone POCS-guided EHL for DBDS with the SpyDS between October 2015 and January 2019 were enrolled in this study group (SpyDS group) using a prospectively maintained database. Fifteen other consecutive patients who had undergone POCS-guided EHL with a conventional digital cholangioscope (CHF-B260) just prior to the introduction of the SpyDS between December 2006 and September 2015 were analyzed as a control group (CHF group). The main outcome measurement was the total procedure time to complete stone removal. Results The rate of complete stone removal was 100% for both groups. The mean total procedure time for the SpyDS group was significantly shorter than that for the CHF group (67±30 minutes vs. 107±64 minutes, p=0.038). The mean number of endoscopic sessions for the SpyDS group was significantly lower than that for the CHF group (1.35±0.49 vs. 2.00±0.85, p=0.037). There were no significant differences in the rate of adverse events between the two groups. Conclusion The SpyDS appears useful for decreasing the procedure time and number of endoscopic sessions for complete stone removal in POCS-guided EHL for DBDS compared with a conventional digital cholangioscope.
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Affiliation(s)
- Toji Murabayashi
- Department of Gastroenterology, Sendai City Medical Center, Japan
| | - Takahisa Ogawa
- Department of Gastroenterology, Sendai City Medical Center, Japan
| | - Shinsuke Koshita
- Department of Gastroenterology, Sendai City Medical Center, Japan
| | - Yoshihide Kanno
- Department of Gastroenterology, Sendai City Medical Center, Japan
| | - Hiroaki Kusunose
- Department of Gastroenterology, Sendai City Medical Center, Japan
| | - Toshitaka Sakai
- Department of Gastroenterology, Sendai City Medical Center, Japan
| | - Kaori Masu
- Department of Gastroenterology, Sendai City Medical Center, Japan
| | - Keisuke Yonamine
- Department of Gastroenterology, Sendai City Medical Center, Japan
| | - Kazuaki Miyamoto
- Department of Gastroenterology, Sendai City Medical Center, Japan
| | - Fumisato Kozakai
- Department of Gastroenterology, Sendai City Medical Center, Japan
| | - Kazuki Endo
- Department of Gastroenterology, Sendai City Medical Center, Japan
| | - Yutaka Noda
- Department of Gastroenterology, Sendai City Medical Center, Japan
| | - Kei Ito
- Department of Gastroenterology, Sendai City Medical Center, Japan
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27
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Kanno Y, Koshita S, Masu K, Ogawa T, Kusunose H, Murabayashi T, Sakai T, Kozakai F, Ito K. Efficacy of EUS-guided celiac plexus neurolysis compared with medication alone for unresectable pancreatic cancer in the oxycodone/fentanyl era: a prospective randomized control study. Gastrointest Endosc 2020; 92:120-130. [PMID: 31953188 DOI: 10.1016/j.gie.2020.01.011] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [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: 10/10/2019] [Accepted: 01/02/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS The efficacy of celiac plexus neurolysis (CPN) with EUS guidance (EUS-CPN) has not been confirmed in the era of developed opioids. The aim of this study was to evaluate the efficacy of EUS-CPN for patients with pancreatic cancer-associated pain to compare medication using oxycodone and/or fentanyl with and without EUS-CPN. METHODS In this randomized control study involving patients who underwent EUS-CPN and those who did not, pain, quality of life (QOL), and opioid consumption were compared. Standard medicinal treatment using oxycodone and/or fentanyl was performed for both groups. The primary endpoint was defined as the pain evaluated by using a visual analog scale (VAS) rated from a 0 to 10, 4 weeks after the baseline. RESULTS For 48 registered patients, the outcomes of 24 patients in the EUS-CPN group and 22 patients in the control group were analyzed. EUS-CPN was successfully performed and did not induce severe procedure-related adverse events for all patients in the EUS-CPN group. Although the average pain VAS scores for both groups significantly decreased in comparison with baseline, scores were not statistically different between the groups at week 4 (1.3 ± 1.3 for the EUS-CPN group vs 2.3 ± 2.3 for the control group, P = .10). There was no statistical difference or tendency in favor of EUS-CPN at evaluation points of weeks 1, 2, 8, and 12. Moreover, the average VAS scores for QOL and the average opioid consumption between the groups were not different at all evaluation points. CONCLUSIONS EUS-CPN for patients with pancreatic cancer-associated pain did not appear to improve pain, QOL, or opioid consumption compared with those who did not undergo EUS-CPN and medicated with oxycodone/fentanyl. Although EUS-CPN can be an option, it was not found to have a large enough impact to be routinely performed for all patients with pain. (Clinical trial registration number: UMIN 000037172.).
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Affiliation(s)
- Yoshihide Kanno
- Department of Gastroenterology, Sendai City Medical Center, Miyagi, Japan
| | - Shinsuke Koshita
- Department of Gastroenterology, Sendai City Medical Center, Miyagi, Japan
| | - Kaori Masu
- Department of Gastroenterology, Sendai City Medical Center, Miyagi, Japan
| | - Takahisa Ogawa
- Department of Gastroenterology, Sendai City Medical Center, Miyagi, Japan
| | - Hiroaki Kusunose
- Department of Gastroenterology, Sendai City Medical Center, Miyagi, Japan
| | - Toji Murabayashi
- Department of Gastroenterology, Sendai City Medical Center, Miyagi, Japan
| | - Toshitaka Sakai
- Department of Gastroenterology, Sendai City Medical Center, Miyagi, Japan
| | - Fumisato Kozakai
- Department of Gastroenterology, Sendai City Medical Center, Miyagi, Japan
| | - Kei Ito
- Department of Gastroenterology, Sendai City Medical Center, Miyagi, Japan
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Murabayashi T, Kanno Y, Koshita S, Ogawa T, Kusunose H, Sakai T, Masu K, Yonamine K, Miyamoto K, Kozakai F, Endo K, Noda Y, Ito K. Long-term Outcomes of Endoscopic Papillary Large-balloon Dilation for Common Bile Duct Stones. Intern Med 2020; 59:891-899. [PMID: 31787702 PMCID: PMC7184081 DOI: 10.2169/internalmedicine.3881-19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 12/22/2022] Open
Abstract
Objective Endoscopic papillary large-balloon dilation (EPLBD) for common bile duct (CBD) stone removal has been confirmed to be safe and effective in the short term. The long-term outcomes of EPLBD, which have not been sufficiently evaluated, were therefore investigated in this study. Methods For patients who had undergone endoscopic CBD stone removal with EPLBD between October 2011 and December 2015, follow-up surveys were conducted using a postal survey, telephone interview, or medical record review in August 2017. The main outcome measurement was the recurrence rate of CBD stones after complete stone removal with EPLBD in patients who received follow-up for more than one year. Risk factors for such recurrence were secondarily analyzed. Results Of the 98 patients treated using EPLBD, 93 (95%) were followed up after complete stone removal and analyzed for the long-term outcomes. During the mean follow-up period of 33.7±16.6 months, CBD stones recurred in 16 patients (17%) with a mean interval of 12.7±12.7 months. Univariate analyses showed that a large stone size, multiple stones, a large distal CBD diameter, and a history of cholecystectomy were significant risk factors for stone recurrence (p=0.022, 0.013, 0.001 and 0.035, respectively). The large distal CBD diameter was the only significant risk factor for stone recurrence in a multivariate analysis (hazard ratio, 1.227; p=0.031). Conclusion The long-term outcomes of EPLBD for CBD stones, including the rate of stone recurrence, were found to be acceptable. A large distal CBD diameter was an independent risk factor for stone recurrence.
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Affiliation(s)
- Toji Murabayashi
- Department of Gastroenterology, Sendai City Medical Center, Japan
| | - Yoshihide Kanno
- Department of Gastroenterology, Sendai City Medical Center, Japan
| | - Shinsuke Koshita
- Department of Gastroenterology, Sendai City Medical Center, Japan
| | - Takahisa Ogawa
- Department of Gastroenterology, Sendai City Medical Center, Japan
| | - Hiroaki Kusunose
- Department of Gastroenterology, Sendai City Medical Center, Japan
| | - Toshitaka Sakai
- Department of Gastroenterology, Sendai City Medical Center, Japan
| | - Kaori Masu
- Department of Gastroenterology, Sendai City Medical Center, Japan
| | - Keisuke Yonamine
- Department of Gastroenterology, Sendai City Medical Center, Japan
| | - Kazuaki Miyamoto
- Department of Gastroenterology, Sendai City Medical Center, Japan
| | - Fumisato Kozakai
- Department of Gastroenterology, Sendai City Medical Center, Japan
| | - Kazuki Endo
- Department of Gastroenterology, Sendai City Medical Center, Japan
| | - Yutaka Noda
- Department of Gastroenterology, Sendai City Medical Center, Japan
| | - Kei Ito
- Department of Gastroenterology, Sendai City Medical Center, Japan
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Kanno Y, Koshita S, Ogawa T, Kusunose H, Masu K, Sakai T, Yonamine K, Miyamoto K, Murabayashi T, Kozakai F, Horaguchi J, Noda Y, Ito K. Inside Plastic Stents versus Metal Stents for Treating Unresectable Malignant Perihilar Biliary Obstructions: A Retrospective Comparative Study. Clin Endosc 2020; 53:735-742. [PMID: 32126740 PMCID: PMC7719412 DOI: 10.5946/ce.2020.003] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 01/04/2020] [Indexed: 02/07/2023] Open
Abstract
Background/Aims: The aim of this study was to evaluate outcomes of inside plastic stents (iPSs) versus those of metal stents (MSs) for treating unresectable perihilar malignant obstructions.
Methods: For all patients who underwent endoscopic suprapapillary placement of iPS(s) or MS(s) as the first permanent biliary drainage for unresectable malignant perihilar obstructions between January 2014 and August 2019, clinical outcomes using iPSs (n=20) and MSs (n=85), including clinical efficacy, adverse events, and time to recurrence of biliary obstruction (RBO), were retrospectively evaluated.
Results: There were no differences in clinical effectiveness (95% for the iPS group vs. 92% for the MS group, p=1.00). Procedure-related adverse events, including pancreatitis, acute cholangitis, acute cholecystitis, and death, were observed for 8% of the MS group, although no patient in the iPS group developed such adverse events. The median time to RBO was 561 days (95% confidence interval, 0–1,186 days) for iPSs and 209 days (127–291 days) for MSs, showing a significant difference (p=0.008).
Conclusions: Time to RBO after iPS placement was significantly longer than that after MS placement. IPSs, which are removable, unlike MSs, were an acceptable option.
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Affiliation(s)
- Yoshihide Kanno
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Shinsuke Koshita
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Takahisa Ogawa
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Hiroaki Kusunose
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Kaori Masu
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Toshitaka Sakai
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Keisuke Yonamine
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Kazuaki Miyamoto
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Toji Murabayashi
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Fumisato Kozakai
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Jun Horaguchi
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan.,Natori Chuo Clinic, Sendai, Japan
| | - Yutaka Noda
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Kei Ito
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
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Fujii Y, Koshita S, Kanno Y, Ogawa T, Masu K, Oikawa M, Okada T, Noda Y, Sawai T, Ito K. [Synchronous double primary cancers of a mixed adenoneuroendocrine carcinoma of the distal bile duct and a carcinoma in situ in the perihilar bile duct]. Nihon Shokakibyo Gakkai Zasshi 2020; 117:178-188. [PMID: 32037364 DOI: 10.11405/nisshoshi.117.178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
We report the rare case of a 69-year-old man who underwent resection of a mixed adenoneuroendocrine carcinoma (MANEC) of the distal bile duct and a carcinoma in situ in the perihilar bile duct. The patient was admitted to our hospital for obstructive jaundice. Imaging studies revealed a mass in the distal bile duct, and an abnormal epithelium was detected in the perihilar bile duct using peroral cholangioscopy. Bile cytology and transpapillary biopsy of the tumor revealed adenocarcinoma. We diagnosed this patient with distal cholangiocarcinoma with extensive intraepithelial progression toward the perihilar bile duct and performed a subtotal stomach-preserving pancreaticoduodenectomy and left hepatectomy. According to the histological examination of the resected specimens, we found a MANEC in the distal bile duct and a carcinoma in situ in the perihilar bile duct. Together, they were diagnosed as synchronous double primary cancers due to the lack of pathological transition between them.
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Affiliation(s)
- Yuki Fujii
- Department of Gastroenterology, Sendai City Medical Center
| | | | | | - Takahisa Ogawa
- Department of Gastroenterology, Sendai City Medical Center
| | - Kaori Masu
- Department of Gastroenterology, Sendai City Medical Center
| | - Masaya Oikawa
- Department of Gastroenterological Surgery, Sendai City Medical Center
| | - Takaho Okada
- Department of Gastroenterological Surgery, Sendai City Medical Center
| | - Yutaka Noda
- Department of Gastroenterology, Sendai City Medical Center.,Department of Pathology, Sendai City Medical Center
| | | | - Kei Ito
- Department of Gastroenterology, Sendai City Medical Center
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Kanno Y, Kozakai F, Koshita S, Ogawa T, Kusunose H, Masu K, Sakai T, Murabayashİ T, Ito K. Technical issues stemming from endoscopic-ultrasound-guided gallbladder drainage: A single center experience. Turk J Gastroenterol 2019; 30:1055-1061. [PMID: 31854311 DOI: 10.5152/tjg.2019.181032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND/AIMS This study was conducted to evaluate the outcomes of endoscopic-ultrasound-guided gallbladder drainage (EUS-GBD) using traditional biliary stents without lumen-apposing stents and to determine technical issues. MATERIALS AND METHODS All 18 patients who underwent EUS-GBD at our center between 2012 and 2018 were evaluated. After the clinical outcomes (including technical success, clinical effectiveness, adverse events, and recurrence) were analyzed, technical countermeasures for problems extracted from the analysis were developed. RESULTS The rates of technical success, clinical effectiveness, severe adverse event occurrence, and recurrence of acute cholecystitis were 94% (17/18), 88% (15/17), 6% (1/18, massive bile leakage), and 27% (4/15), respectively. Distal gastrectomy causing scope instability, the non-swollen gallbladder, and double pigtail stent use caused technical difficulties. A fully covered metal stent (fcMS) should be placed in a shallow position so that it does not wedge into the opposite site. When the puncture route involves the gastric wall, the proximal portion of an fcMS located in the stomach can migrate toward the abdominal cavity. CONCLUSION Although the clinical outcomes of EUS-GBD were relatively favorable, several technical issues related specifically to EUS-GBD were observed. Technical countermeasures would improve the outcomes.
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Affiliation(s)
| | | | | | | | | | - Kaori Masu
- Sendai City Medical Center, Sendai, Miyagi, Japan
| | | | | | - Kei Ito
- Sendai City Medical Center, Sendai, Miyagi, Japan
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Kanno Y, Koshita S, Ogawa T, Kusunose H, Masu K, Sakai T, Yonamine K, Kawakami Y, Fujii Y, Miyamoto K, Murabayashi T, Kozakai F, Horaguchi J, Noda Y, Oikawa M, Okada T, Ito K. Predictive Value of Localized Stenosis of the Main Pancreatic Duct for Early Detection of Pancreatic Cancer. Clin Endosc 2019; 52:588-597. [PMID: 31744269 PMCID: PMC6900300 DOI: 10.5946/ce.2019.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 12/21/2018] [Accepted: 03/07/2019] [Indexed: 01/21/2023] Open
Abstract
Background/Aims: In this study, we aimed to evaluate the predictive value of localized stenosis of the main pancreatic duct (MPD) for early detection of pancreatic cancer.
Methods: Among 689 patients who underwent endoscopic retrograde pancreatography from January 2008 to September 2018, 19 patients with MPD findings were enrolled. These patients showed findings for indicating suspicious pancreatic cancer at an early stage (FiCE); FiCE was defined as a single, localized stenosis in the MPD without a detectable mass (using any other imaging methods) and without other pancreatic diseases, such as definite chronic pancreatitis, intraductal papillary mucinous neoplasm, and autoimmune pancreatitis. Final diagnoses were established by examining resected specimens or through follow-up examinations after an interval of >5 years.
Results: Among 19 patients with FiCE, 11 underwent surgical resection and 8 were evaluated after a >5-year observation period. The final diagnosis of the MPD stenosis was judged to be pancreatic cancer in 9 patients (47%), including 3 with intraepithelial cancer, and to be a non-neoplastic change in 10. The sensitivity, specificity, and accuracy of preoperative pancreatic juice cytology were 75%, 100%, and 88%, respectively.
Conclusions: The predictive value of FiCE for pancreatic cancer prevalence was 47%. Histological confirmation with pancreatic juice cytology is necessary before surgical resection.
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Affiliation(s)
- Yoshihide Kanno
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Shinsuke Koshita
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Takahisa Ogawa
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Hiroaki Kusunose
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Kaori Masu
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Toshitaka Sakai
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Keisuke Yonamine
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Yujiro Kawakami
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Yuki Fujii
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Kazuaki Miyamoto
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Toji Murabayashi
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Fumisato Kozakai
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Jun Horaguchi
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan.,Department of Gastroenterology, Natori Chuo Clinic, Sendai, Japan
| | - Yutaka Noda
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Masaya Oikawa
- Department of Gastroenterological Surgery, Sendai City Medical Center, Sendai, Japan
| | - Takaho Okada
- Department of Gastroenterological Surgery, Sendai City Medical Center, Sendai, Japan
| | - Kei Ito
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
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Kawakami Y, Kanno Y, Koshita S, Ogawa T, Kusunose H, Murabayashi T, Ito K. Endoscopic ultrasound-guided hepaticoduodenostomy for an obstructed anterior hepatic branch in a patient with Billroth-II reconstruction. Endoscopy 2019; 51:E221-E222. [PMID: 31039590 DOI: 10.1055/a-0885-9348] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Yujiro Kawakami
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Yoshihide Kanno
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Shinsuke Koshita
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Takahisa Ogawa
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Hiroaki Kusunose
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Toji Murabayashi
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Kei Ito
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
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Kozakai F, Kanno Y, Ito K, Koshita S, Ogawa T, Kusunose H, Masu K, Sakai T, Murabayashi T, Yonamine K, Kawakami Y, Fujii Y, Miyamoto K, Noda Y. Endoscopic Ultrasonography-Guided Gallbladder Drainage as a Treatment Option for Acute Cholecystitis after Metal Stent Placement in Malignant Biliary Strictures. Clin Endosc 2019; 52:262-268. [PMID: 30871312 PMCID: PMC6547349 DOI: 10.5946/ce.2018.183] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 10/16/2018] [Accepted: 01/01/2019] [Indexed: 02/06/2023] Open
Abstract
Background/Aims It is often difficult to manage acute cholecystitis after metal stent (MS) placement in unresectable malignant biliary strictures. The aim of this study was to evaluate the feasibility of endoscopic ultrasonography-guided gallbladder drainage (EUS-GBD) for acute cholecystitis. Methods The clinical outcomes of 10 patients who underwent EUS-GBD for acute cholecystitis after MS placement between January 2011 and August 2018 were retrospectively evaluated. The procedural outcomes of percutaneous transhepatic gallbladder drainage (PTGBD) with tube placement (n=11 cases) and aspiration (PTGBA) (n=27 cases) during the study period were evaluated as a reference. Results The technical success and clinical effectiveness rates of EUS-GBD were 90% (9/10) and 89% (8/9), respectively. Severe bile leakage that required surgical treatment occurred in one case. Acute cholecystitis recurred after stent dislocation in 38% (3/8) of the cases. Both PTGBD and PTGBA were technically successful in all cases without severe adverse events and clinically effective in 91% and 63% of the cases, respectively. Conclusions EUS-GBD after MS placement was a feasible option for treating acute cholecystitis. However, it was a rescue technique following the established percutaneous intervention in the current setting because of the immature technical methodology, including dedicated devices, which need further development.
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Affiliation(s)
- Fumisato Kozakai
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Yoshihide Kanno
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Kei Ito
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Shinsuke Koshita
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Takahisa Ogawa
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Hiroaki Kusunose
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Kaori Masu
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Toshitaka Sakai
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Toji Murabayashi
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Keisuke Yonamine
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Yujiro Kawakami
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Yuki Fujii
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Kazuaki Miyamoto
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Yutaka Noda
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
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Kanno Y, Noda Y, Koshita S, Ogawa T, Masu K, Oikawa M, Okada T, Akazawa N, Sawai T, Ito K. Surgically resected pancreatic metastasis from nasal malignant melanoma: case report and literature review. Clin J Gastroenterol 2019; 12:372-381. [PMID: 30671896 DOI: 10.1007/s12328-019-00936-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 12/20/2018] [Accepted: 01/10/2019] [Indexed: 12/22/2022]
Abstract
A 13-mm mass was observed in the pancreatic head of a 70-year-old woman who had undergone melanoma resection in the nasal cavity 10 years earlier. Endoscopic ultrasonography (EUS) showed that the mass consisted of multiple hypoechoic nodules. EUS-guided fine needle aspiration and pancreatic juice cytologies revealed neoplastic cells positive for HMB45 and melan-A staining with a few melanin granules, indicating the presence of a metastatic malignant melanoma. These additional stainings were evaluated after surgery. In the surgically resected specimen, the mass had multiple nodule-like structures, some of which were brown colored. Immunocytochemistry and electronic microscopy findings confirmed the diagnosis of malignant melanoma. Microscopic findings were similar to the nasal specimen; therefore, the pancreatic lesion was considered to be a metastasis from the nasal cavity.
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Affiliation(s)
- Yoshihide Kanno
- Department of Gastroenterology, Sendai City Medical Center, Tsurugaya 5-22-1, Miyagino-ku, Sendai, Miyagi, Japan.
| | - Yutaka Noda
- Department of Gastroenterology, Sendai City Medical Center, Tsurugaya 5-22-1, Miyagino-ku, Sendai, Miyagi, Japan
| | - Shinsuke Koshita
- Department of Gastroenterology, Sendai City Medical Center, Tsurugaya 5-22-1, Miyagino-ku, Sendai, Miyagi, Japan
| | - Takahisa Ogawa
- Department of Gastroenterology, Sendai City Medical Center, Tsurugaya 5-22-1, Miyagino-ku, Sendai, Miyagi, Japan
| | - Kaori Masu
- Department of Gastroenterology, Sendai City Medical Center, Tsurugaya 5-22-1, Miyagino-ku, Sendai, Miyagi, Japan
| | - Masaya Oikawa
- Department of Gastroenterology, Sendai City Medical Center, Tsurugaya 5-22-1, Miyagino-ku, Sendai, Miyagi, Japan
| | - Takaho Okada
- Department of Gastroenterology, Sendai City Medical Center, Tsurugaya 5-22-1, Miyagino-ku, Sendai, Miyagi, Japan
| | - Naoya Akazawa
- Department of Gastroenterology, Sendai City Medical Center, Tsurugaya 5-22-1, Miyagino-ku, Sendai, Miyagi, Japan
| | - Takashi Sawai
- Department of Gastroenterology, Sendai City Medical Center, Tsurugaya 5-22-1, Miyagino-ku, Sendai, Miyagi, Japan
| | - Kei Ito
- Department of Gastroenterology, Sendai City Medical Center, Tsurugaya 5-22-1, Miyagino-ku, Sendai, Miyagi, Japan
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Murabayashi T, Koshita S, Masu K, Kanno Y, Ogawa T, Okada T, Oikawa M, Noda Y, Sawai T, Ito K. [Detection of small pancreatic cancer during surveillance of the main pancreatic duct stenosis]. Nihon Shokakibyo Gakkai Zasshi 2019; 116:99-108. [PMID: 30626860 DOI: 10.11405/nisshoshi.116.99] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
An 83-year-old man with main pancreatic duct (MPD) stenosis in the pancreatic body had undergone surveillance with semiannual imaging studies for 3 years. During surveillance, magnetic resonance cholangiopancreatography revealed gradual enlargement of a small cyst near the MPD stenosis and contrast-enhanced computed tomography revealed locally progressive atrophic parenchyma in the pancreatic body. On endoscopic retrograde pancreatography, the MPD stenosis was more severe than it had been at diagnosis 3 years earlier. Endoscopic ultrasonography (EUS) showed a 10-mm hypoechoic mass adjacent to the MPD stenosis. The mass was pathologically diagnosed as an adenocarcinoma using EUS-guided fine needle aspiration, and distal pancreatectomy was performed. On histopathological examination, the resected specimen was found to be a moderately differentiated 9-mm invasive ductal carcinoma. Additionally, multiple high-grade pancreatic intraepithelial neoplasms (i.e., carcinoma in situ) were detected in the MPD and branch ducts near the invasive carcinoma.
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Affiliation(s)
| | | | - Kaori Masu
- Department of Gastroenterology, Sendai City Medical Center
| | | | - Takahisa Ogawa
- Department of Gastroenterology, Sendai City Medical Center
| | - Takaho Okada
- Department of Surgery, Sendai City Medical Center
| | | | - Yutaka Noda
- Department of Gastroenterology, Sendai City Medical Center.,Department of Pathology, Sendai City Medical Center
| | | | - Kei Ito
- Department of Gastroenterology, Sendai City Medical Center
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Fujii Y, Kanno Y, Koshita S, Ogawa T, Kusunose H, Masu K, Sakai T, Yonamine K, Kawakami Y, Murabayashi T, Kozakai F, Noda Y, Okada H, Ito K. Predictive Factors for Inaccurate Diagnosis of Swollen Lymph Nodes in Endoscopic Ultrasound-Guided Fine Needle Aspiration. Clin Endosc 2019; 52:152-158. [PMID: 30613067 PMCID: PMC6453856 DOI: 10.5946/ce.2018.125] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 07/13/2018] [Accepted: 10/17/2018] [Indexed: 12/11/2022] Open
Abstract
Background/Aims This study aimed to identify the predictive factors for inaccurate endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) diagnosis of swollen lymph nodes without rapid on-site cytopathological evaluation.
Methods Eighty-three consecutive patients who underwent EUS-FNA for abdominal or mediastinal lymph nodes from January 2008 to June 2017 were included from a prospectively maintained EUS-FNA database and retrospectively reviewed. The sensitivity, specificity, and accuracy of EUS-FNA for the detection of neoplastic diseases were calculated. Candidate factors for inaccurate diagnosis (lymph node size and location, needle type, puncture route, number of passes, and causative disease) were evaluated by comparison between accurately diagnosed cases and others.
Results The final diagnosis of the punctured lymph node was classified as neoplastic (65 cases: a metastatic lymph node, malignant lymphoma, or Crow-Fukase syndrome) or non-neoplastic (18 cases: a reactive node or amyloidosis). The sensitivity, specificity, and accuracy were 83%, 94%, and 86%, respectively. On multivariate analyses, small size of the lymph node was the sole predictive factor for inaccurate EUS-FNA diagnosis with a significant difference (odds ratios, 19.8; 95% confidence intervals, 3.15–124; p=0.0015).
Conclusions The lymph node size of <16 mm was the only independent factor associated with inaccurate EUS-FNA diagnosis of swollen lymph nodes.
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Affiliation(s)
- Yuki Fujii
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama, Japan.,Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama, Japan
| | - Yoshihide Kanno
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama, Japan
| | - Shinsuke Koshita
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama, Japan
| | - Takahisa Ogawa
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama, Japan
| | - Hiroaki Kusunose
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama, Japan
| | - Kaori Masu
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama, Japan
| | - Toshitaka Sakai
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama, Japan
| | - Keisuke Yonamine
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama, Japan
| | - Yujiro Kawakami
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama, Japan
| | - Toji Murabayashi
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama, Japan
| | - Fumisato Kozakai
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama, Japan
| | - Yutaka Noda
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama, Japan
| | - Hiroyuki Okada
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama, Japan
| | - Kei Ito
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama, Japan
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Fujii Y, Koshita S, Ito K. Percutaneous transhepatic cholangioscopy using SpyGlassDS for an anastomotic stenosis after choledochojejunostomy. Dig Endosc 2018; 30:806-807. [PMID: 30079581 DOI: 10.1111/den.13252] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 07/22/2018] [Accepted: 08/02/2018] [Indexed: 12/13/2022]
Affiliation(s)
- Yuki Fujii
- Department of Gastroenterology, Sendai City Medical Center, Miyagi, Japan
| | - Shinsuke Koshita
- Department of Gastroenterology, Sendai City Medical Center, Miyagi, Japan
| | - Kei Ito
- Department of Gastroenterology, Sendai City Medical Center, Miyagi, Japan
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Kanno Y, Koshita S, Ogawa T, Masu K, Kusunose H, Sakai T, Murabayashi T, Haegawa S, Kozakai F, Yonamine K, Kawakami Y, Fujii Y, Horaguchi J, Noda Y, Ito K. Peroral cholangioscopy by SpyGlass DS versus CHF-B260 for evaluation of the lateral spread of extrahepatic cholangiocarcinoma. Endosc Int Open 2018; 6:E1349-E1354. [PMID: 30410956 PMCID: PMC6221821 DOI: 10.1055/a-0743-5283] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 03/08/2018] [Accepted: 07/24/2018] [Indexed: 01/16/2023] Open
Abstract
Background and study aims A newly developed peroral cholangioscopy (POCS) system, SpyGlassDS has high maneuverability. This study aimed to evaluate acceptability of the accuracy of SpyGlassDS accompanied by simultaneous POCS-guided biopsy compared with that of a traditional POCS scope, CHF-B260, to diagnose the lateral extent of extrahepatic cholangiocarcinoma (LEC). Patients and methods Patients who underwent surgical resection after preoperative examinations to diagnose LEC were evaluated. POCS by CHF-B260 was performed if there was discrepancy between preceding fluoroscopy-guided biopsy findings and other examinations between January 2004 and September 2015 (group A, n = 56); and POCS plus POCS-guided mapping biopsy by SpyGlassDS was performed in all surgical candidates between October 2015 and December 2017 (group B, n = 20). The main outcome measure was the accuracy of overall preoperative diagnosis (OPD) of LEC defined based on all examinations, including POCS. Results Accuracy of OPD for the liver side and the ampullary side was 93 % and 100 %, respectively, in group A, and 84 % and 100 %, respectively, in group B ( P = 0.37 for the liver side; P , not available for the ampullary side). Diagnostic accuracy of simple optical evaluation by POCS for the liver side and the ampullary side was 83 % and 100 %, respectively, in group A, and 58 % and 88 %, respectively, in group B ( P = 0.29 for the liver side; P = 0.40 for the ampullary side). Conclusions POCS by SpyGlassDS was found to be acceptable and could be a standard approach for diagnosis of LEC.
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Affiliation(s)
- Yoshihide Kanno
- Sendai City Medical Center – Gastroenterology, Sendai, Japan
| | | | - Takahisa Ogawa
- Sendai City Medical Center – Gastroenterology, Sendai, Japan
| | - Kaori Masu
- Sendai City Medical Center – Gastroenterology, Sendai, Japan
| | | | - Toshitaka Sakai
- Sendai City Medical Center – Gastroenterology, Sendai, Japan
| | | | - Sho Haegawa
- Sendai City Medical Center – Gastroenterology, Sendai, Japan
| | | | | | - Yujiro Kawakami
- Sendai City Medical Center – Gastroenterology, Sendai, Japan
| | - Yuki Fujii
- Sendai City Medical Center – Gastroenterology, Sendai, Japan
| | - Jun Horaguchi
- Sendai City Medical Center – Gastroenterology, Sendai, Japan,Natori Chuo Clinic – Gastroenterology, Natori, Japan
| | - Yutaka Noda
- Sendai City Medical Center – Gastroenterology, Sendai, Japan
| | - Kei Ito
- Sendai City Medical Center – Gastroenterology, Sendai, Japan
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Murabayashi T, Kanno Y, Ito K, Koshita S, Ogawa T, Oikawa M, Noda Y. Correction: Severe peritonitis after successful endoscopic ultrasound-guided gallbladder drainage for acute gangrenous cholecystitis. Endoscopy 2018; 50:C8. [PMID: 30125916 DOI: 10.1055/a-0666-6316] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Toji Murabayashi
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Yoshihide Kanno
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Kei Ito
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Shinsuke Koshita
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Takahisa Ogawa
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Masaya Oikawa
- Department of Surgery, Sendai City Medical Center, Sendai, Japan
| | - Yutaka Noda
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
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Murabayashi T, Kanno Y, Ito K, Koshita S, Ogawa T, Oikawa M, Noda Y. Severe peritonitis after successful endoscopic ultrasound-guided gallbladder drainage for acute gangrenous cholecystitis. Endoscopy 2018; 50:642-643. [PMID: 29631302 DOI: 10.1055/a-0591-2630] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Toji Murabayashi
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Yoshihide Kanno
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Kei Ito
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Shinsuke Koshita
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Takahisa Ogawa
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Masaya Oikawa
- Department of Surgery, Sendai City Medical Center, Sendai, Japan
| | - Yutaka Noda
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
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Sakai T, Koshita S, Ito K, Kanno Y, Ogawa T, Kusunose H, Masu K, Kawakami Y, Fujii Y, Murabayashi T, Hasegawa S, Kozakai F, Noda Y, Oikawa M, Tsuchiya T, Sawai T. Signet-ring Cell Carcinoma Derived from a Main Duct-type Intraductal Papillary Mucinous Neoplasm of the Pancreas: A Case Report with Long-term Follow-up. Intern Med 2018; 57:1093-1099. [PMID: 29269677 PMCID: PMC5938498 DOI: 10.2169/internalmedicine.9743-17] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
We herein report the case of a 74-year-old man who underwent surgery 9 years after his initial visit and who was pathologically diagnosed with signet-ring cell carcinoma (SRCC) derived from a main-duct-type intraductal papillary mucinous neoplasm (MD-IPMN). At the first imaging examination, only a small pancreatic cyst with mild dilation of the main pancreatic duct (MPD) was detected in the pancreatic head. Eventually, MD-IPMN with mural nodules and MPD dilation (30 mm) developed in the pancreatic body, while the pancreatic head cyst remained unchanged. Total pancreatectomy was performed and the MD-IPMN was pathologically diagnosed as SRCC derived from an intestinal-type MD-IPMN.
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Affiliation(s)
- Toshitaka Sakai
- Department of Gastroenterology, Sendai City Medical Center, Japan
| | - Shinsuke Koshita
- Department of Gastroenterology, Sendai City Medical Center, Japan
| | - Kei Ito
- Department of Gastroenterology, Sendai City Medical Center, Japan
| | - Yoshihide Kanno
- Department of Gastroenterology, Sendai City Medical Center, Japan
| | - Takahisa Ogawa
- Department of Gastroenterology, Sendai City Medical Center, Japan
| | - Hiroaki Kusunose
- Department of Gastroenterology, Sendai City Medical Center, Japan
| | - Kaori Masu
- Department of Gastroenterology, Sendai City Medical Center, Japan
| | - Yujiro Kawakami
- Department of Gastroenterology, Sendai City Medical Center, Japan
| | - Yuki Fujii
- Department of Gastroenterology, Sendai City Medical Center, Japan
| | | | - Sho Hasegawa
- Department of Gastroenterology, Sendai City Medical Center, Japan
| | - Fumisato Kozakai
- Department of Gastroenterology, Sendai City Medical Center, Japan
| | - Yutaka Noda
- Department of Gastroenterology, Sendai City Medical Center, Japan
| | - Masaya Oikawa
- Department of Surgery, Sendai City Medical Center, Japan
| | | | - Takashi Sawai
- Department of Pathology, Sendai City Medical Center, Japan
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Ogawa T, Ito K, Koshita S, Kanno Y, Masu K, Kusunose H, Sakai T, Murabayashi T, Hasegawa S, Noda Y. Usefulness of cholangioscopic-guided mapping biopsy using SpyGlass DS for preoperative evaluation of extrahepatic cholangiocarcinoma: a pilot study. Endosc Int Open 2018; 6:E199-E204. [PMID: 29399618 PMCID: PMC5794453 DOI: 10.1055/s-0043-117949] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [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: 02/10/2017] [Accepted: 06/22/2017] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND AND STUDY AIMS Evaluation of longitudinal tumor extent is indispensable for curative surgical treatment of extrahepatic cholangiocarcinoma. The aim of this study was to evaluate the usefulness and feasibility of cholangioscopic-guided mapping biopsy using a newly developed peroral digital cholangioscope, SpyGlass DS (SpyDS), for preoperative evaluation of extrahepatic cholangiocarcinoma. PATIENTS AND METHODS Thirteen patients (mean age, 75 years; male 10, female 3) with extrahepatic cholangiocarcinoma who underwent cholangioscopic-guided mapping biopsy using SpyDS for preoperative evaluation were included in this study. Successful cholangioscopic-guided mapping biopsy was defined as the acquisition of specimens sufficient for histopathological diagnosis. RESULTS The mean number of biopsies was 5 per patient. The overall success rate for cholangioscopic-guided mapping biopsy was 88 % (59/67). The success rate for cholangioscopic-guided mapping biopsy from the confluence of the right and left hepatic ducts was 89 %, that from the B4 confluence was 93 %, that from the confluence of the right anterior and right posterior segmental ducts was 86 %, that from the intrapancreatic common bile duct was 67 %, and that from the main lesion was 100 %. The overall diagnostic accuracy of longitudinal tumor extent at the hepatic side, the duodenal side and overall by cholangioscopic findings and mapping biopsy, was 88 % (7/8), 88 % (7/8) and 88 % (7/8), respectively. Assessment according to location of the main lesion revealed that diagnostic accuracy in the patients with distal bile duct carcinoma was 100 % (5/5) and that in patients with perihilar bile duct carcinoma was 66 % (2/3). Complications after the procedure did not occur in any patients. CONCLUSIONS Cholangioscopic-guided mapping biopsy using SpyDS is thought to be feasible for preoperative evaluation of extrahepatic cholangiocarcinoma.
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Affiliation(s)
- Takahisa Ogawa
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan,Corresponding author Takahisa Ogawa Sendai City Medical Center5-22-1, TsurugayaMiyagino-kuSendai 983-0824, Japan+81-22-252-9431
| | - Kei Ito
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Shinsuke Koshita
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Yoshihide Kanno
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Kaori Masu
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Hiroaki Kusunose
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Toshitaka Sakai
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Toji Murabayashi
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Sho Hasegawa
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Yutaka Noda
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
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Kanno Y, Ito K, Koshita S, Ogawa T, Masu K, Kusunose H, Sakai T, Masaki Y, Murabayashi T, Hasegawa S, Kozakai F, Horaguchi J, Matsuo H, Noda Y. EUS-guided Biliary Drainage for Malignant Perihilar Biliary Strictures after Further Transpapillary Intervention Has Been Judged to Be Impossible or Ineffective. Intern Med 2017; 56:3145-3151. [PMID: 29021470 PMCID: PMC5742384 DOI: 10.2169/internalmedicine.9001-17] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Objective Patients with perihilar malignancy often develop recurrence of infectious cholangitis, which makes further transpapillary intervention extremely difficult. As endoscopic ultrasound (EUS)-guided biliary drainage (EUS-BD) of an intrahepatic bile duct is a possible option for additional intervention, the aim of this study was to estimate the feasibility of such intervention. Methods and Patients Patients who had undergone EUS-BD after further transpapillary intervention was deemed impossible or ineffective were investigated in this study. Those who had not received previous interventions via the papilla were excluded. Procedure-related adverse events, clinical efficacy, and time to recurrence of jaundice or infectious cholangitis transthyretin (TTR) were evaluated. Results Seven patients were eligible for the study between 2007 and 2016 (7 men; mean age, 77 years; 4 with perihilar cholangiocarcinoma and 3 with intrahepatic cholangiocarcinoma). No procedure-related adverse events were observed. EUS-BD was clinically effective and enabled hospital discharge in 4 patients (57%). The TTR in these 4 clinically effective patients was 43, 105, 118, and 147 days after the procedure (median, 112 days). Conclusion EUS-BD was found to be safe and often effective in patients in whom additional transpapillary intervention had become difficult, although its efficacy was limited to a short period.
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Affiliation(s)
| | - Kei Ito
- Sendai City Medical Center, Japan
| | | | | | | | | | | | | | | | | | | | - Jun Horaguchi
- Sendai City Medical Center, Japan
- Natori Chuo Clinic, Japan
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Kozakai F, Kanno Y, Ito K, Koshita S, Ogawa T, Kusunose H, Masu K, Sakai T, Masaki Y, Murabayashi T, Hasegawa S, Noda Y. Endoscopic-ultrasonography-guided biliary drainage for repetitive acute cholangitis of the accessory hepatic duct obstructed by clipping during laparoscopic cholecystectomy. Nihon Shokakibyo Gakkai Zasshi 2017; 114:683-690. [PMID: 28381783 DOI: 10.11405/nisshoshi.114.683] [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] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
An 88-year-old man who had been suffering from repetitive fever and abdominal pain every few months for several years was diagnosed with localized acute cholangitis and referred to our center. Various examinations, including computed tomography (CT) and endoscopic ultrasonography (EUS), revealed that the accessary hepatic duct was obstructed by clips used during laparoscopic cholecystectomy performed 7 years previously. It was not possible to approach the completely isolated duct via the transpapillary route. After obtaining fully informed consent, EUS-guided drainage of the occluded duct through the duodenal wall was performed with a self-expanding metal stent. No adverse events related to the procedure were observed, and his symptoms disappeared by the next day. EUS-guided drainage represents a therapeutic option in patients with an accessory hepatic duct, which is iatrogenically isolated by surgical clips.
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Kanno Y, Ito K, Koshita S, Ogawa T, Kusunose H, Masu K, Sakai T, Murabayashi T, Hasegawa S, Kozakai F, Kawakami Y, Fujii Y, Noda Y. Capability of Radial- and Convex-Arrayed Echoendoscopes for Visualization of the Pancreatobiliary Junction. Clin Endosc 2017; 51:274-278. [PMID: 28942626 PMCID: PMC5997075 DOI: 10.5946/ce.2017.098] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 06/14/2017] [Accepted: 08/20/2017] [Indexed: 01/04/2023] Open
Abstract
Background/Aims Although both radial- and convex-arrayed endoscopic ultrasonography (EUS) scopes are widely used for observational EUS examinations, there have been few comparative studies on their power of visualization. The aim of this study was to evaluate the capability of these EUS scopes for observation of the pancreatobiliary junction. METHODS The rate of successful visualization of the pancreatobiliary junction was retrospectively compared between a radial-arrayed and a convex-arrayed echoendoscope, from a prospectively maintained database. Study periods were defined as January 2010 to December 2012 for the radial group, and February 2015 to October 2016 for the convex group because the respective scope was mainly used during those periods. RESULTS During the study period, 1,660 cases with radial EUS and 1,984 cases with convex EUS were recruited. The success rates of observation of the pancreatobiliary junction were 80.0% and 89.5%, respectively (p<0.0001). Conclusions The capability of visualization of the pancreatobiliary junction in observational EUS was found to be better with a convex-arrayed than with a radial-arrayed echoendoscope.
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Affiliation(s)
| | - Kei Ito
- Sendai City Medical Center, Sendai, Japan
| | | | | | | | - Kaori Masu
- Sendai City Medical Center, Sendai, Japan
| | | | | | | | | | | | - Yuki Fujii
- Sendai City Medical Center, Sendai, Japan
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Kanno Y, Ito K, Koshita S, Ogawa T, Masu K, Kusunose H, Sakai T, Murabayashi T, Hasegawa S, Kozakai F, Noda Y. Soft surface irregularity of malignant perihilar biliary strictures in cholangiography as a risk factor for early dysfunction of multiple metal stents. Dig Liver Dis 2017; 49:1014-1021. [PMID: 28539228 DOI: 10.1016/j.dld.2017.04.018] [Citation(s) in RCA: 2] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 04/18/2017] [Accepted: 04/24/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Multiple metal stents (multi-MS) in the perihilar bile duct often develop dysfunction in an unexpectedly short period. AIMS This study is aimed to identify the risk factors for shorter patency of multi-MS. METHODS Of 97 patients who underwent multi-MS placement, 68 patients were followed-up for >28 days were retrospectively analyzed. Univariate analyses with the log-rank test was performed on 20 factors, including two newly defined classifications of cholangiography: the R classification, which classifies the rough image (localized type [R1] or spreading type [R2]); and the S classification, which classifies the surface texture (soft irregularity [S1], solid irregularity [S2], or smooth [S3]). RESULTS Stent dysfunction occurred in 36 patients (53%) (median time, 209 days). Type S1 was a significant risk factor for short stent patency (median, 100 days in S1 [n=18]; 231 in S2 [n=38]; 356 in S3 [n=12], p<0.0001). On multivariate analysis, type S1 was again the only independent factor among the six factors (HR 4.8, p<0.001). CONCLUSION Soft surface irregularity of the perihilar malignancy in cholangiography was found to be a significant risk factor for a shorter time to dysfunction of multi-MS.
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Affiliation(s)
| | - Kei Ito
- Sendai City Medical Center, Sendai, Miyagi, Japan
| | | | | | - Kaori Masu
- Sendai City Medical Center, Sendai, Miyagi, Japan
| | | | | | | | - Sho Hasegawa
- Sendai City Medical Center, Sendai, Miyagi, Japan
| | | | - Yutaka Noda
- Sendai City Medical Center, Sendai, Miyagi, Japan
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Kanno Y, Ito K, Koshita S, Ogawa T, Masu K, Masaki Y, Noda Y. Efficacy of a newly developed dilator for endoscopic ultrasound-guided biliary drainage. World J Gastrointest Endosc 2017; 9:304-309. [PMID: 28744342 PMCID: PMC5507821 DOI: 10.4253/wjge.v9.i7.304] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [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: 11/08/2016] [Revised: 12/30/2016] [Accepted: 03/24/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To evaluate the efficacy of a newly developed dilator for endoscopic ultrasound (EUS)-guided drainage (ES Dilator).
METHODS Fourteen consecutive patients who had undergone EUS-guided choledochoduodenostomy (EUS-CDS) with the ES Dilator were identified from a prospectively maintained database and enrolled in the study group. Fourteen other patients who had undergone EUS-CDS without the dilator just prior to its introduction were analyzed as the control group. A historical cohort study was carried out comparing the two groups. The main outcome measurement was the procedure time. The technical success rate and early AE rate were also compared between the two groups.
RESULTS There were no significant differences in age, sex and etiology of biliary obstruction. The utilization rate of a plastic stent was higher in the control group (36% vs 0%). The technical success rate was 100% in both groups. The mean procedure time was significantly shorter in the study group than in the control group (27 ± 7 min vs 44 ± 26 min, P = 0.026). Additionally, there were no patients who required more than 40 min for the procedure in the study group. Early adverse events occurred in 29% (4/14) of the control group whereas none in the study group. The adverse events in all 4 patients was bile peritonitis, including pan-peritonitis in one patient. All patients recovered with conservative treatment by medication.
CONCLUSION The newly developed dilator was found to be useful for shortening procedure time and would prevent adverse events related to bile leakage in EUS-CDS.
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Koshita S, Noda Y, Ito K, Kanno Y, Ogawa T, Masu K, Masaki Y, Horaguchi J, Oikawa M, Tsuchiya T, Sawai T, Uzuki M, Fujishima F. Pancreatic juice cytology with immunohistochemistry to detect malignancy and histologic subtypes in patients with branch duct type intraductal papillary mucinous neoplasms of the pancreas. Gastrointest Endosc 2017; 85:1036-1046. [PMID: 27756613 DOI: 10.1016/j.gie.2016.10.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [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: 07/17/2016] [Accepted: 10/05/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS The aim of this study was to elucidate the efficacy of pancreatic juice cytology with the cell-block method (CB-PJC) for the determination of surgery in patients with branch duct intraductal papillary mucinous neoplasm (BD-IPMN). METHODS In 138 patients with BD-IPMN from whom pancreatic juice was collected under ERCP for CB-PJC, we retrospectively evaluated the following: (1) the rate of successfully evaluated CB-PJC; (2) the ability of CB-PJC to diagnose malignancy and to identify pathologic subtypes in resected BD-IPMNs; (3) the rate of development into invasive cancer and progression of BD-IPMNs in patients with BD-IPMNs diagnosed as benignancy by CB-PJC; and (4) post-ERCP adverse events. RESULTS (1) The success rate of CB-PJC was 89.9%. (2) The sensitivity and specificity of CB-PJC for preoperative diagnosis of malignancy were 50% and 100%, respectively, with only hematoxylin and eosin staining, whereas they were 79% and 100%, respectively, by adding immunohistologic staining. The agreement rate of the preoperative subtypes by CB-PJC with the subtypes of resected specimens was 93%. (3) The onset of invasive cancer was not detected at all on imaging studies, whereas the progression of IPMN was detected in 14 patients. Multivariate analysis revealed the risk factor of progression to be non-gastric type. The cumulative 5-year progression rate in this group was 89%. (4) Post-ERCP pancreatitis developed in 13 patients (7.7%). CONCLUSIONS The diagnostic efficacy of preoperative CB-PJC for malignant BD-IPMN was excellent. The results may suggest the feasibility of applying preoperative subtyping by CB-PJC for decisions as to whether surgery is indicated.
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Affiliation(s)
- Shinsuke Koshita
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Yutaka Noda
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan; Department of Pathology, Sendai City Medical Center, Sendai, Japan
| | - Kei Ito
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Yoshihide Kanno
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Takahisa Ogawa
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Kaori Masu
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Yoshiharu Masaki
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Jun Horaguchi
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan; Natori-Chuo-Clinic, Natori, Japan
| | - Masaya Oikawa
- Department of Surgery, Sendai City Medical Center, Sendai, Japan
| | - Takashi Tsuchiya
- Department of Surgery, Sendai City Medical Center, Sendai, Japan
| | - Takashi Sawai
- Department of Pathology, Sendai City Medical Center, Sendai, Japan
| | - Miwa Uzuki
- Department of Nursing, Faculty of Medical Science and Welfare, Tohoku Bunka Gakuen University, Sendai, Japan
| | - Fumiyoshi Fujishima
- Department of Pathology, Tohoku University School of Medicine, Sendai, Japan
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Koshita S, Noda Y, Ito K, Kanno Y, Ogawa T, Masu K, Masaki Y, Kusunose H, Sakai T, Murabayashi T, Hasegawa S, Kozakai F, Horaguchi J, Sawai T. Branch Duct Intraductal Papillary Mucinous Neoplasms of the Pancreas Involving Type 1 Localized Autoimmune Pancreatitis with Normal Serum IgG4 Levels Successfully Diagnosed by Endoscopic Ultrasound-guided Fine-needle Aspiration and Treated without Pancreatic Surgery. Intern Med 2017; 56:1163-1167. [PMID: 28502930 PMCID: PMC5491810 DOI: 10.2169/internalmedicine.56.8017] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
We herein report a 68-year-old man with branch duct intraductal papillary mucinous neoplasms of the pancreas (BD-IPMNs) involving type 1 localized autoimmune pancreatitis (AIP) with normal serum IgG4 levels. Although he was referred to our medical center due to suspicion of pancreatic cancer concomitant with BD-IPMNs, endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) revealed a mass suspected of being pancreatic cancer to be type 1 AIP. Steroid administration notably reduced the mass. Although the clinical diagnosis of pancreatic masses in patients with IPMN can be occasionally challenging, performing a pathological examination by EUS-FNA may prevent unnecessary pancreatic surgery in cases of possible AIP.
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Affiliation(s)
- Shinsuke Koshita
- Department of Gastroenterology, Sendai City Medical Center, Japan
| | - Yutaka Noda
- Department of Gastroenterology, Sendai City Medical Center, Japan
- Department of Pathology, Sendai City Medical Center, Japan
| | - Kei Ito
- Department of Gastroenterology, Sendai City Medical Center, Japan
| | - Yoshihide Kanno
- Department of Gastroenterology, Sendai City Medical Center, Japan
| | - Takahisa Ogawa
- Department of Gastroenterology, Sendai City Medical Center, Japan
| | - Kaori Masu
- Department of Gastroenterology, Sendai City Medical Center, Japan
| | - Yoshiharu Masaki
- Department of Gastroenterology, Sendai City Medical Center, Japan
| | - Hiroaki Kusunose
- Department of Gastroenterology, Sendai City Medical Center, Japan
| | - Toshitaka Sakai
- Department of Gastroenterology, Sendai City Medical Center, Japan
| | - Toji Murabayashi
- Department of Gastroenterology, Sendai City Medical Center, Japan
| | - Sho Hasegawa
- Department of Gastroenterology, Sendai City Medical Center, Japan
| | - Fumisato Kozakai
- Department of Gastroenterology, Sendai City Medical Center, Japan
| | | | - Takashi Sawai
- Department of Pathology, Sendai City Medical Center, Japan
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