Assessment of Factors Affecting the Usefulness and Diagnostic Yield of Core Biopsy Needles with a Side Hole in Endoscopic Ultrasound-Guided Fine-Needle Aspiration

( Tadahisa Inoue ),( Fumihiro Okumura ),( Takashi Mizushima ),( Hirotada Nishie ),( Hiroyasu Iwasaki ),( Kaiki Anbe ),( Takanori Ozeki ),( Kenta Kachi ),( Shigeki Fukusada ),( Yuta Suzuki ),( Hitoshi 대한소화기기능성질환·운동학회 2016 Gut and Liver Vol.10 No.1

Background/Aims: A barbed puncture needle with a side hole was recently developed to improve sample quality and quantity in endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA). In this study, we retrospectively assessed the usefulness of this puncture needle. Methods: Factors affecting diagnostic yield, safety, and diagnostic accuracy were investigated in 76 patients who consecutively underwent EUS-FNA for neoplastic lesions at our hospital between January and December 2013. Results: The procedure was successful in all cases; the rates of sample collection and determination of the correct diagnosis were 92.1% and 89.5%, respectively. The mean number of needle passes required for diagnosis was 1.1. Complications included mild intraluminal bleeding in two patients (2.6%). Multivariate analysis revealed that lesion size (≤20 mm) was significantly associated with a decreased chance of determining the correct diagnosis. Conclusions: Core biopsy needles with a side hole are safe and provide a satisfactory diagnostic yield. However, the side hole may potentially reduce the rate of making the correct diagnosis in small lesions. (Gut Liver 2016;10:51-57)

Which is better for unresectable malignant hilar biliary obstruction: Side-by-side versus stent-in-stent?

Itaru Naitoh,Tadahisa Inoue,Kazuki Hayashi 소화기인터벤션의학회 2018 Gastrointestinal Intervention Vol.7 No.2

Biliary drainage is required for the management of unresectable malignant hilar biliary obstruction (UMHBO), and endoscopic transpapillary drainage is the first-line therapy because it is less invasive. Self-expandable metallic stents (SEMSs) are superior to plastic stents because they have longer stent patency and are more cost-effective. Endoscopic bilateral SEMS placement is technically challenging compared to unilateral placement. However, recent developments in devices and techniques have facilitated bilateral SEMS placement. There are two methods for bilateral hilar SEMS placement for UMHBO: side-by-side (SBS) and stent-in-stent (SIS). Sequential SBS was commonly conducted for bilateral hilar SEMS placement. In a new and thinner delivery system that was developed for SEM placement, two SEMSs could be simultaneously inserted and deployed through the working channel. This new bilateral stenting method enabled us to accomplish simultaneous SBS placement, which increased the success rate of SBS. Insertion of the guidewire and delivery of the second SEMS through the mesh of the first SEMS is challenging in SIS. Newly designed or modified SEMSs that are suitable for SIS have been developed to overcome this challenge, and these SEMSs have facilitated SIS. Uncovered SEMS has been commonly used for hilar SEMS placement, but covered SEMS (CSEMS) is another option for hilar SEMS placement, because CSEMS prevents tumor ingrowth and allows for removal of the stent for re-intervention. Therefore, CSEMS can be used for bilateral SEMS placement in SBS. There are many methods and kinds of SEMS available for bilateral SEMS placement. However, due to lack of evidence, there is no consensus on whether SBS or SIS is optimal for bilateral hilar SEMS placement. In this review, we compared various outcomes between SBS and SIS from previous studies, to clarify which method is better for bilateral SEMS placement for UMHBO.

Practical Experiences of Unsuccessful Hemostasis with Covered Self-Expandable Metal Stent Placement for Post-Endoscopic Sphincterotomy Bleeding

Michihiro Yoshida,Tadahisa Inoue,Itaru Naitoh,Kazuki Hayashi,Yasuki Hori,Makoto Natsume,Naoki Atsuta,Hiromi Kataoka 대한소화기내시경학회 2022 Clinical Endoscopy Vol.55 No.1

We reviewed 7 patients with unsuccessful endoscopic hemostasis using covered self-expandable metal stent (CSEMS) placementfor post-endoscopic sphincterotomy (ES) bleeding. ES with a medium incision was performed in 6 and with a large incision in 1patient. All but 1 of them (86%) showed delayed bleeding, warranting second endoscopic therapies followed by CSEMS placement1–5 days after the initial ES. Subsequent CSEMS placement did not achieve complete hemostasis in any of the patients. Lateral-sideincision lines (3 or 9 o’clock) had more frequent bleeding points (71%) than oral-side incision lines (11–12 o’clock; 29%). Additionalendoscopic hemostatic procedures with hemostatic forceps, hypertonic saline epinephrine, or hemoclip achieved excellenthemostasis, resulting in complete hemostasis in all patients. These experiences provide an alert: CSEMS placement is not an ultimatetreatment for post-ES bleeding, despite its effectiveness. The lateral-side of the incision line, as well as the oral-most side, should becarefully examined for bleeding points, even after the CSEMS placement.

Which is better for unresectable malignant hilar biliary obstruction: Side-by-side versus stent-in-stent?

Itaru Naitoh,Tadahisa Inoue,Kazuki Hayashi 소화기인터벤션의학회 2018 International journal of gastrointestinal interven Vol.7 No.2

Biliary drainage is required for the management of unresectable malignant hilar biliary obstruction (UMHBO), and endoscopic transpapillary drainage is the first-line therapy because it is less invasive. Self-expandable metallic stents (SEMSs) are superior to plastic stents because they have longer stent patency and are more cost-effective. Endoscopic bilateral SEMS placement is technically challenging compared to unilateral placement. However, recent developments in devices and techniques have facilitated bilateral SEMS placement. There are two methods for bilateral hilar SEMS placement for UMHBO: side-by-side (SBS) and stent-in-stent (SIS). Sequential SBS was commonly conducted for bilateral hilar SEMS placement. In a new and thinner delivery system that was developed for SEM placement, two SEMSs could be simultaneously inserted and deployed through the working channel. This new bilateral stenting method enabled us to accomplish simultaneous SBS placement, which increased the success rate of SBS. Insertion of the guidewire and delivery of the second SEMS through the mesh of the first SEMS is challenging in SIS. Newly designed or modified SEMSs that are suitable for SIS have been developed to overcome this challenge, and these SEMSs have facilitated SIS. Uncovered SEMS has been commonly used for hilar SEMS placement, but covered SEMS (CSEMS) is another option for hilar SEMS placement, because CSEMS prevents tumor ingrowth and allows for removal of the stent for re-intervention. Therefore, CSEMS can be used for bilateral SEMS placement in SBS. There are many methods and kinds of SEMS available for bilateral SEMS placement. However, due to lack of evidence, there is no consensus on whether SBS or SIS is optimal for bilateral hilar SEMS placement. In this review, we compared various outcomes between SBS and SIS from previous studies, to clarify which method is better for bilateral SEMS placement for UMHBO.

Optimal endoscopic drainage strategy for unresectable malignant hilar biliary obstruction

Itaru Naitoh,Tadahisa Inoue 대한소화기내시경학회 2023 Clinical Endoscopy Vol.56 No.2

Endoscopic biliary drainage strategies for managing unresectable malignant hilar biliary obstruction differ in terms of stent type, drainage area, and deployment method. However, the optimal endoscopic drainage strategy remains unclear. Uncovered self-expandable metal stents (SEMS) are the preferred type because of their higher functional success rate, longer time to recurrent biliary obstruction (RBO), and fewer cases of reintervention than plastic stents (PS). Other PS subtypes and covered SEMS, which feature a longer time to RBO than PS, can be removed during reintervention for RBO. Bilateral SEMS placement is associated with a longer time to RBO and a longer survival time than unilateral SEMS placement. Unilateral drainage is acceptable if a drainage volume of greater than 50% of the total liver volume can be achieved. In terms of deployment method, no differences were observed in clinical outcomes between side-by-side (SBS) and stent-in-stent deployment. Simultaneous SBS boasts a shorter procedure time and higher technical success rate than sequential SBS. This review of previous studies aimed to clarify the optimal endoscopic biliary drainage strategy for unresectable malignant hilar biliary obstruction.