http://chineseinput.net/에서 pinyin(병음)방식으로 중국어를 변환할 수 있습니다.
변환된 중국어를 복사하여 사용하시면 됩니다.
REVIEW : Current status of chemotherapy for the treatment of advanced biliary tract cancer
( Takashi Sasaki ),( Hiroyuki Isayama ),( Yousuke Nakai ),( Kazuhiko Koike ) 대한내과학회 2013 The Korean Journal of Internal Medicine Vol.28 No.5
Chemotherapy is indispensable for the treatment of advanced biliary tract cancer. Recently, reports regarding first-line chemotherapy have increased, and first-line chemotherapy treatment has become gradually more sophisticated. Gemcitabine and cisplatin combination therapy (or gemcitabine and oxaliplatin combination therapy) have become the standard of care for advanced biliary tract cancer. Oral f luoropyrimidines have also been shown to have good antitumor effects. Gemcitabine, platinum compounds, and oral fluoropyrimidines are now considered key drugs for the treatment of advanced biliary tract cancer. Several clinical trials using molecular targeted agents are also ongoing. Combination therapy using cytotoxic agents and molecular-targeted agents has been evaluated widely. However, reports regarding second-line chemotherapy remain limited, and it has not yet been clarified whether second-line chemotherapy can improve the prognosis of advanced biliary tract cancer. Thus, there is an urgent need to establish secondline standard chemotherapy treatment for advanced biliary tract cancer. Several problems exist when assessing the results of previous reports concerning advanced biliary tract cancer. In the present review, the current status of the treatment of advanced biliary tract cancer is summarized, and several associated problems are indicated. These problems should be solved to achieve more sophisticated treatment of advanced biliary tract cancer.
Endoscopic Ultrasound-Guided Biliary Drainage for Unresectable Hilar Malignant Biliary Obstruction
Yousuke Nakai,Hirofumi Kogure,Hiroyuki Isayama,Kazuhiko Koike 대한소화기내시경학회 2019 Clinical Endoscopy Vol.52 No.3
Endoscopic transpapillary biliary drainage is the current standard of care for unresectable hilar malignant biliary obstruction (MBO)and bilateral metal stent placement is shown to have longer patency. However, technical and clinical failure is possible and percutaneoustranshepatic biliary drainage (PTBD) is sometimes necessary. Endoscopic ultrasound-guided biliary drainage (EUS-BD) is increasinglybeing reported as an alternative rescue procedure to PTBD. EUS-BD has a potential advantage of not traversing the biliary strictureand internal drainage can be completed in a single session. Some approaches to bilateral biliary drainage for hilar MBO under EUSguidanceinclude a bridging method, hepaticoduodenostomy, and a combination of EUS-BD and transpapillary biliary drainage. Theaim of this review is to summarize data on EUS-BD for hilar MBO and to clarify its advantages over the conventional approaches suchas endoscopic transpapillary biliary drainage and PTBD.
Current Status of Endoscopic Ultrasound Techniques for Pancreatic Neoplsms
Yousuke Nakai,Naminatsu Takahara,Suguru Mizuno,Hirofumi Kogure,Kazuhiko Koike 대한소화기내시경학회 2019 Clinical Endoscopy Vol.52 No.6
Endoscopic ultrasound (EUS) now plays an important role in the management of pancreatic neoplasms. There are various types of pancreatic neoplasms, from benign to malignant lesions, and the role of EUS ranges from the imaging diagnosis to treatment. EUS is useful for the detection, characterization, and tissue acquisition of pancreatic lesions. Recent advancement of contrast-enhanced harmonic EUS and elastography enables better characterization of pancreatic lesions. In addition to these enhanced EUS imagingtechniques, EUS-guided tissue acquisition is now the standard procedure to establish the pathological diagnosis of pancreatic neoplasms. While these diagnostic roles of EUS have been established, EUS-guided interventions such as ablation and drainage are also increasingly utilized in the management of pancreatic neoplasms. However, most of these EUS-guided interventions are not yet standardized in terms of techniques and devices and thus need further investigations.
( Tsuyoshi Hamada ),( Takeshi Tsujino ),( Hiroyuki Isayama ),( Ryunosuke Hakuta ),( Yukiko Ito ),( Ryo Nakata ),( Kazuhiko Koike ) 대한간학회 2013 Gut and Liver Vol.7 No.2
Percutaneous transhepatic biliary drainage (PTBD) is an established procedure for biliary obstruction. However, duodenobiliary or jejunobiliary reflux of the intestinal contents through a PTBD catheter sometimes causes recurrent catheter obstruction or cholangitis. A 64-year-old female patient with a history of choledochojejunostomy was referred to our department with acute cholangitis due to choledochojejunal anastomotic obstruction. Emergent PTBD was performed, but frequent obstructions of the catheter due to the reflux of intestinal contents complicated the post-PTBD course. We therefore introduced a catheter with an antireflux mechanism to prevent jejunobiliary reflux. A commercially available catheter was modified; side holes were made at 1 cm and 5 to 10 cm (1 cm apart) from the tip of the catheter, and the catheter was ligated with a nylon thread just proximal to the first side hole. Using this novel "antireflux PTBD technique," jejunobiliary reflux was prevented successfully, resulting in a longer patency of the catheter. (Gut Liver 2013;7:255-257)
Endoscopic ultrasound-guided biliary drainage: Complications and their management
Hiroyuki Isayama,Yousuke Nakai,Natsuyo Yamamoto,Saburo Matsubara,Yukiko Ito,Hirfoumi Kogure,Tsuyoshi Hamada,Kazuhiko Koike 소화기인터벤션의학회 2017 Gastrointestinal Intervention Vol.6 No.2
Endoscopic ultrasound-guided biliary drainage (EUS-BD), EUS-guided choledochoduodenostomy (EUS-CDS), and EUS-guided hepaticogastrostomy (EUS-HGS) can effectively palliate obstructive jaundice, but have not been well established yet. The incidence of complications is about 30% in EUS-BD and higher for EUS-HGS. Several complications have been reported such as bleeding, perforation and peritonitis. Bleeding occurs due to puncture of portal vein, hepatic vein and artery, and we should use color Doppler. When a cautery dilator is used for fistula dilation, burn effects may cause delayed bleeding. Endoscopic hemostasis is only effective for anastomotic bleeding and embolization with interventional radiology technique is required for pseudo aneurysm. There are some types of perforation: failed stent placement after puncture or fistula dilation, double puncture during CDS procedure, and stent migration. Peritonitis with perforation requires surgery and can be fatal. Stent migration before mature fistula formation causes severe peritonitis because EUS-BD makes fistula between two unattached organs. Stents with flaps or long covered self-expandable metallic stents (cSEMSs) are effective to prevent migration. Recent development of lumen apposing stents may reduce early migration in EUS-CDS. Peritonitis without migration can be due to 1) leakage of bile juice or gastric/duodenal contents during EUS-BD or 2) leakage along the placed stent. We should make procedure time as short as possible, and cSEMSs reduce bile leak along the stent by occluding the dilated fistula. In summary, we should understand the mechanism of complications and the technique to prevent and manage complications. Development of dedicated devices to increase the success rate and reduce complications is required.
( 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)
Complications Related to Gastric Endoscopic Submucosal Dissection and Their Managements
Itaru Saito,Yosuke Tsuji,Yoshiki Sakaguchi,Keiko Niimi,Satoshi Ono,Shinya Kodashima,Nobutake Yamamichi,Mitsuhiro Fujishiro,Kazuhiko Koike 대한소화기내시경학회 2014 Clinical Endoscopy Vol.47 No.5
Endoscopic submucosal dissection (ESD) for early gastric cancer is a well-established procedure with the advantage of resection in an en bloc fashion, regardless of the size, shape, coexisting ulcer, and location of the lesion. However, gastric ESD is a more difficult and meticulous technique, and also requires a longer procedure time, than conventional endoscopic mucosal resection. These factors naturally increase the risk of various complications. The two most common complications accompanying gastric ESD are bleeding and perforation. These complications are known to occur both intraoperatively and postoperatively. However, there are other rare but serious complications related to gastric ESD, including aspiration pneumonia, stenosis, venous thromboembolism, and air embolism. Endoscopists should have sufficient knowledge about such complications and be prepared to deal with them appropriately, as successful management of complications is necessary for the successful completion of the entire ESD procedure.