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( Kazumichi Kawakubo ),( Hiroyuki Isayama ),( Yousuke Nakai ),( Naoki Sasahira ),( Hirofumi Kogure ),( Takashi Sasaki ),( Kenji Hirano ),( Minoru Tada ),( Kazuhiko Koike ) The Editorial Office of Gut and Liver 2012 Gut and Liver Vol.6 No.3
Patients with pancreatic cancer frequently suffer from both biliary and duodenal obstruction. For such patients, both bili-ary and duodenal self-expandable metal stent placement is necessary to palliate their symptoms, but it was difficult to cross two metal stents. Recently, endoscopic ultrasonogra-phy-guided choledochoduodenostomy (EUS-CDS) was report-ed to be effective for patients with an inaccessible papilla. We report two cases of pancreatic cancer with both biliary and duodenal obstructions treated successfully with simul-taneous duodenal metal stent placement and EUS-CDS. The first case was a 74-year-old man with pancreatic cancer. Duodenoscopy revealed that papilla had been invaded with tumor and duodenography showed severe stenosis in the horizontal portion. After a duodenal uncovered metal stent was placed across the duodenal stricture, EUS-CDS was per-formed. The second case was a 63-year-old man who previ-ously had a covered metal stent placed for malignant biliary obstruction. After removing the previously placed metal stent, EUS-CDS was performed. Then, a duodenal covered metal stent was placed across the duodenal stenosis. Both patients could tolerate a regular diet and did not suffer from stent occlusion. EUS-CDS combined with duodenal metal stent placement may be an ideal treatment strategy in pa-tients with pancreatic cancer with both duodenal and biliary malignant obstruction. (Gut Liver 2012;6:399-402)
Total Cholesterol Level for Assessing Pancreatic Insufficiency Due to Chronic Pancreatitis
( Kenji Hirano ),( Tomotaka Saito ),( Suguru Mizuno ),( Minoru Tada ),( Naoki Sasahira ),( Hiroyuki Isayama ),( Miho Matsukawa ),( Gyotane Umefune ),( Dai Akiyama ),( Kei Saito ),( Shuhei Kawahata ),( 대한소화기학회 2014 Gut and Liver Vol.8 No.5
Background/Aims: To determine the nutritional markers important for assessing the degree of pancreatic insufficiency due to chronic pancreatitis in routine clinical practice. Methods: A total of 137 patients with chronic pancreatitis were followed up for more than 1 year. They were divided into two groups: a pancreatic diabetes mellitus (DM) group, consisting of 47 patients undergoing medical treatment for DM of pancreatic origin, and a nonpancreatic DM group, consisting of 90 other patients (including 86 patients without DM). Serum albumin, prealbumin, total cholesterol, cholinesterase, magnesium, and hemoglobin were compared between the two groups. Results: The total cholesterol was significantly lower in the pancreatic than the nonpancreatic DM group (164 mg/dL vs 183 mg/dL, respectively; p=0.0028). Cholinesterase was significantly lower in the former group (263 U/L vs 291 U/L, respectively; p=0.016). Among the 37 patients with nonalcoholic pancreatitis, there was no difference in the cholinesterase levels between the pancreatic and nonpancreatic (296 U/L vs 304 U/L, respectively; p=0.752) DM groups, although cholesterol levels remained lower in the former (165 mg/dL vs 187 mg/dL, respectively; p=0.052). Conclusions: Cholinesterase levels are possibly affected by concomitant alcoholic liver injury. The total cholesterol level should be considered when assessing pancreatic insufficiency due to chronic pancreatitis. (Gut Liver 2014;8:563-568)
Wataru Yamagata,Toshio Fujisawa,Takashi Sasaki,Rei Ishibashi,Tomotaka Saito,Shuntaro Yoshida,Shizuka No,Kouta Inoue,Yousuke Nakai,Naoki Sasahira,Hiroyuki Isayama 대한소화기내시경학회 2023 Clinical Endoscopy Vol.56 No.5
Background/Aims: Mechanical properties (MPs) and axial and radial force (AF and RF) may influence the efficacy and complicationsof self-expandable metallic stent (SEMS) placement. We measured the MPs of various SEMSs and examined their influence on theSEMS clinical ability. Methods: We evaluated the MPs of 29 types of 10-mm SEMSs. RF was measured using a conventional measurement device. AF wasmeasured using the conventional and new methods, and the correlation between the methods was evaluated. Results: A high correlation in AFs was observed, as measured by the new and conventional manual methods. AF and RF scatterplotsdivided the SEMSs into three subgroups according to structure: hook-and-cross-type (low AF and RF), cross-type (high AF and lowRF), and laser-cut-type (intermediate AF and high RF). The hook-and-cross-type had the largest axial force zero border (>20°), followedby the laser-cut and cross types. Conclusions: MPs were related to stent structure. Hook-and-cross-type SEMSs had a low AF and high axial force zero border and wereconsidered safest because they caused minimal stress on the biliary wall. However, the increase in RF must be overcome.
Takafumi Mie,Takashi Sasaki,Ryo Kanata,Takaaki Furukawa,Tsuyoshi Takeda,Akiyoshi Kasuga,Masato Matsuyama,Masato Ozaka,Naoki Sasahira 대한소화기내시경학회 2021 Clinical Endoscopy Vol.54 No.5
Background/Aims: Several fine-needle biopsy (FNB) needles are available for endoscopic ultrasound (EUS)-guided tissueacquisition. However, there is disagreement on which type of needle has the best diagnostic yield. The aim of this study was tocompare the performance and safety of two commonly used EUS-FNB needles. Methods: We retrospectively analyzed consecutive patients who underwent EUS-FNB between June 2016 and March 2020 in ourhospital. Two types of needles were evaluated: a 20-gauge Menghini needle with a lateral forward bevel and a 22-gauge Franseenneedle. Rapid on-site evaluation was performed in all the cases. A multivariate analysis was performed to clarify the negativepredictive factors for obtaining a histological diagnosis. Propensity score matching was performed to compare the diagnostic yieldsof these two needles. Results: We analyzed 666 patients and 690 lesions. The overall diagnostic rate of histology alone was 88.8%, and the overall adverseevent rate was 1.5%. Transduodenal access and small lesions (≤2 cm) were identified as negative predictive factors for obtaining ahistological diagnosis. After propensity score matching, 482 lesions were analyzed. The diagnostic accuracy rates of histology in theM and F needle groups were 89.2% and 88.8%, respectively (p=1.00). Conclusions: Both the needles showed high diagnostic yield, and no significant difference in performance was observed between thetwo.
Tsuyoshi Takeda,Takashi Sasaki,Takafumi Mie,Takeshi Okamoto,Chinatsu Mori,Takaaki Furukawa,Yuto Yamada,Akiyoshi Kasuga,Masato Matsuyama,Masato Ozaka,Naoki Sasahira 대한소화기내시경학회 2022 Clinical Endoscopy Vol.55 No.4
Background/Aims: Digital single-operator cholangioscopy (DSOC)-guided mapping biopsy (DMB) and tube-assisted mapping biopsy(TMB) are two techniques used for preoperative evaluation of biliary tract cancer (BTC). However, data regarding the diagnostic performanceof these techniques are limited. Methods: We retrospectively examined consecutive patients with BTC who underwent either technique at our institution between2018 and 2020. We evaluated the technical success rate, adequate tissue acquisition rate, and diagnostic performance of these techniquesfor the evaluation of lateral spread of BTC. Results: A total of 54 patients were included in the study. The technical success rate of reaching the target sites was 95% for DMB and100% for TMB. The adequate tissue acquisition rate was 61% for DMB and 69% for TMB. The adequate tissue acquisition rate was low,especially for target sites beyond the secondary biliary radicles. The sensitivity of DMB alone was 39%, which improved to 65% whencombined with visual impression. Experts demonstrated a higher negative predictive value and diagnostic accuracy with respect toboth DSOC visual impression and DMB for the evaluation of lateral spread of BTC compared to trainees. Conclusions: Adequate tissue acquisition rates were similar between the two techniques. Since DMB requires expertise, TMB may bean acceptable option when DSOC is unavailable or when DSOC expertise is limited.
Takeshi Okamoto,Takashi Sasaki,Tsuyoshi Takeda,Takafumi Mie,Chinatsu Mori,Takaaki Furukawa,Yuto Yamada,Akiyoshi Kasuga,Masato Matsuyama,Masato Ozaka,Naoki Sasahira 대한소화기내시경학회 2024 Clinical Endoscopy Vol.57 No.1
Background/Aims: Selective bile duct or pancreatic duct cannulation remains a significant initial hurdle in endoscopic retrograde cholangiopancreatography (ERCP) despite advances in endoscopy and accessories. This study evaluated our experience with a rotatable sphincterotome in cases of difficult cannulation. Methods: We retrospectively reviewed ERCP cases using TRUEtome, a rotatable sphincterotome, as a rescue device for cannulation at a cancer institute in Japan from October 2014 to December 2021. Results: TRUEtome was used in 88 patients. Duodenoscopes were used for 51 patients, while single-balloon enteroscopes (SBE) were used for 37 patients. TRUEtome was used for biliary and pancreatic duct cannulation (84.1%), intrahepatic bile duct selection (12.5%), and strictures of the afferent limb (3.4%). Cannulation success rates were similar in the duodenoscope and SBE groups (86.3% vs. 75.7%, p=0.213). TRUEtome was more commonly used in cases with steep cannulation angles in the duodenoscope group and in cases requiring cannulation in different directions in the SBE group. There were no significant differences in adverse events between the two groups. Conclusions: The cannulation sphincterotome was useful for difficult cannulations in both unaltered and surgically altered anatomies. It may be an option to consider before high-risk procedures such as precut and endoscopic ultrasound-guided rendezvous techniques.
Takafumi Mie,Takashi Sasaki,Takeshi Okamoto,Tsuyoshi Takeda,Chinatsu Mori,Yuto Yamada,Takaaki Furukawa,Akiyoshi Kasuga,Masato Matsuyama,Masato Ozaka,Naoki Sasahira 대한소화기내시경학회 2024 Clinical Endoscopy Vol.57 No.2
Background/Aims: Hepaticojejunostomy anastomotic stricture (HJAS) is a feared adverse event associated with hepatopancreatobiliary surgery. Although balloon dilation for benign HJAS during endoscopic retrograde cholangiopancreatography with balloon-assisted enteroscopy has been reported to be useful, the treatment strategy remains controversial. Therefore, we evaluated the outcomes and risk factors of recurrent stenosis after balloon dilation alone for benign HJAS. Methods: We retrospectively analyzed consecutive patients who underwent balloon-assisted enteroscopy-endoscopic retrograde cholangiopancreatography for benign HJAS at our institution between July 2014 and December 2020. Results: Forty-six patients were included, 16 of whom had recurrent HJAS after balloon dilation. The patency rates at 1 and 2 years after balloon dilation were 76.8% and 64.2%, respectively. Presence of a residual balloon notch during balloon dilation was an independent predictor of recurrence (hazard ratio, 2.80; 95% confidence interval, 1.01–7.78; p=0.048), whereas HJAS within postoperative 1 year tended to be associated with recurrence (hazard ratio, 2.43; 95% confidence interval, 0.85–6.89; p=0.096). The patency rates in patients without a residual balloon notch were 82.1% and 73.1% after 1 and 2 years, respectively. Conclusions: Balloon dilation alone may be a viable option for patients with benign HJAS without residual balloon notches on fluoroscopy.