Forward viewing liner echoendoscopy for therapeutic interventions

Kazuo Hara,Nozomi Okuno,Shin Haba,Takamichi Kuwahara 대한소화기내시경학회 2024 Clinical Endoscopy Vol.57 No.2

Therapeutic endoscopic ultrasonography (EUS) procedures using the forward-viewing convex EUS (FV-EUS) have been reviewed based on the articles reported to date. The earliest reported procedure is the drainage of pancreatic pseudocysts using FV-EUS. However, the study on drainage of pancreatic pseudocysts focused on showing that drainage is possible with FV-EUS rather than leveraging its features. Subsequently, studies describing the characteristics of FV-EUS have been reported. By using FV-EUS in EUS-guided choledochoduodenostomy, double punctures in the gastrointestinal tract can be avoided. In postoperative modified anatomical cases, using the endoscopic function of FV-EUS, procedures such as bile duct drainage from anastomosis, pancreatic duct drainage from the afferent limb, and abscess drainage from the digestive tract have been reported. When a perpendicular puncture to the gastrointestinal tract is required or when there is a need to insert the endoscope deep into the gastrointestinal tract, FV-EUS is considered among the options.

Mesoscale Ensemble Prediction Approaches for High Impact Weather Phenomena

Kazuo Saito,Hiromu Seko,Masahiro Hara,Munehiko Yamaguchi,Masayuki Kyouda 한국기상학회 2006 한국기상학회 학술대회 논문집 Vol.2006 No.-

Endoscopic necrosectomy through a self-expandable metallic stent placed percutaneously for walled-off pancreatic necrosis

Yozo Sato,Kazuo Hara,Nozomi Okuno,Shinichi Murata,Takaaki Hasegawa,Hiroyuki Morinaga,Yuki Kimbara,Yugo Imai,Hidekazu Yamaura,Yoshitaka Inaba 소화기인터벤션의학회 2020 International journal of gastrointestinal interven Vol.9 No.3

Walled-off pancreatic necrosis (WOPN) is defined as encapsulated necrotic tissue after severe acute pancreatitis. Treatment strategies for WOPN can be challenging. Although open surgical necrosectomy is the standard treatment for WOPN, it is associated with high rates of morbidity and mortality. Endoscopic necrosectomy, introduced recently, is a treatment option that produces lower rates of morbidity than does open surgery. We report a case of severe WOPN that could not be treated with the usual procedures. Although endoscopic necrosectomy of the left subphrenic and prepancreatic spaces was technically impossible, these spaces could be percutaneously drained. Finally, sufficient drainage of these spaces was achieved with endoscopic necrosectomy through the internal lumen of the self-expandable metallic stent placed percutaneously. This procedure was performed by an endoscopist and an interventional radiologist, and the multidisciplinary approach was useful.

Infectious peritonitis after endoscopic ultrasound-guided biliary drainage in a patient with ascites

Nozomi Okuno,Kazuo Hara,Nobumasa Mizuno,Takamichi Kuwahara,Hiromichi Iwaya,Masahiro Tajika,Tsutomu Tanaka,Makoto Ishihara,Yutaka Hirayama,Sachiyo Onishi,Kazuhiro Toriyama,Ayako Ito,Naosuke Kuraoka,Shi 소화기인터벤션의학회 2018 International journal of gastrointestinal interven Vol.7 No.1

Summary of Event Bacterial, mycotic peritonitis and Candida fungemia developed in a patient with moderate ascites who had undergone endoscopic ultrasound-guided biliary drainage (EUS-BD). Antibiotics and antifungal agent were administered and ascites drainage was performed. Although the infection improved, the patient’s general condition gradually deteriorated due to aggravation of the primary cancer and he died. Teaching Point This is the first report to describe infectious peritonitis after EUS-BD. Ascites carries the potential risk of severe complications. As such, in patients with ascites, endoscopic retrograde cholangiopancreatography (ERCP) is typically preferred over EUS-BD or percutaneous drainage to prevent bile leakage. However, ERCP may not be possible in some patients with tumor invasion of the duodenum or with surgically altered anatomy. Thus, in patients with ascites who require EUS-BD, we recommend inserting the drainage tube percutaneously and draining the ascites before and after the intervention in order to prevent severe infection. Summary of Event Bacterial, mycotic peritonitis and Candida fungemia developed in a patient with moderate ascites who had undergone endoscopic ultrasound-guided biliary drainage (EUS-BD). Antibiotics and antifungal agent were administered and ascites drainage was performed. Although the infection improved, the patient’s general condition gradually deteriorated due to aggravation of the primary cancer and he died. Teaching Point This is the first report to describe infectious peritonitis after EUS-BD. Ascites carries the potential risk of severe complications. As such, in patients with ascites, endoscopic retrograde cholangiopancreatography (ERCP) is typically preferred over EUS-BD or percutaneous drainage to prevent bile leakage. However, ERCP may not be possible in some patients with tumor invasion of the duodenum or with surgically altered anatomy. Thus, in patients with ascites who require EUS-BD, we recommend inserting the drainage tube percutaneously and draining the ascites before and after the intervention in order to prevent severe infection.

Endoscopic ultrasound-guided portal vein coiling: troubleshooting interventional endoscopic ultrasonography

Shin Haba,Kazuo Hara,Nobumasa Mizuno,Takamichi Kuwahara,Nozomi Okuno,Akira Miyano,Daiki Fumihara,Moaz Elshair 대한소화기내시경학회 2022 Clinical Endoscopy Vol.55 No.3

Endoscopic ultrasound (EUS)-guided hepaticogastrostomy (HGS) is widely performed not only as an alternative to transpapillary biliarydrainage, but also as primary drainage for malignant biliary obstruction. For anatomical reasons, this technique carries an unavoidablerisk of mispuncturing intrahepatic vessels. We report a technique for troubleshooting EUS-guided portal vein coiling to preventbleeding from the intrahepatic portal vein after mispuncture during interventional EUS. EUS-HGS was planned for a 59-year-old malepatient with unresectable pancreatic cancer. The dilated bile duct (lumen diameter, 2.8 mm) was punctured with a 19-gauge needle,and a guidewire was inserted. After bougie dilation, the guidewire was found to be inside the intrahepatic portal vein. Embolizing coilswere placed to prevent bleeding. Embolization coils were successfully inserted under stabilization of the catheter using a double-lumencannula with a guidewire. Following these procedures, the patient was asymptomatic. Computed tomography performed the next dayrevealed no complications.

Utility of forward-view endoscopic ultrasound in fine-needle aspiration in patients with a surgically altered upper gastrointestinal anatomy

Asmaa Bakr,Kazuo Hara,Moaz Elshair,Shin Haba,Takamichi Kuwahara,Nozomi Okuno,Daiki Fumihara,Takafumi Yanaidani,Samy Zaky,Hanaa Omar 대한소화기내시경학회 2023 Clinical Endoscopy Vol.56 No.3

Background/Aims: Endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) using oblique-view EUS in patients with a surgically altered anatomy (SAA) of the upper gastrointestinal tract is limited because of difficult scope insertion due to the disturbed anatomy. This study aimed to investigate the efficiency of forward-view (FV)-EUS in performing FNA in patients with a SAA. Methods: We retrospectively investigated 32 patients with a SAA of the upper gastrointestinal tract who visited Aichi Cancer Center Hospital in Nagoya, Japan, between January 2014 and December 2020. We performed upper gastrointestinal EUS-FNA using FV-EUS combined with fluoroscopic imaging to confirm tumor recurrence or to make a decision before chemotherapy or after a failure of diagnosis by radiology. Results: We successfully performed EUS-FNA in all studied patients (100% technical success), with the specificity, sensitivity, and accuracy of 100%, 87.5%, and 87.8%, respectively, with no complications. Conclusions: EUS-FNA using FV-EUS combined with fluoroscopic imaging is an effective and safe technique for tissue acquisition in patients with a SAA.

Safety and feasibility of opening window fistulotomy as a new precutting technique for primary biliary access in endoscopic retrograde cholangiopancreatography

Yasuhiro Kuraishi,Kazuo Hara,Shin Haba,Takamichi Kuwahara,Nozomi Okuno,Takafumi Yanaidani,Sho Ishikawa,Tsukasa Yasuda,Masanori Yamada,Nobumasa Mizuno 대한소화기내시경학회 2023 Clinical Endoscopy Vol.56 No.4

Background/Aims: Post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) is the most common and serious complication of endoscopic retrograde cholangiopancreatography. To prevent this event, a unique precutting method, termed opening window fistulotomy, was performed in patients with a large infundibulum as the primary procedure for biliary cannulation, whereby a suprapapillary laid-down H-shaped incision was made without touching the orifice. This study aimed to assess the safety and feasibility of this novel technique. Methods: One hundred and ten patients were prospectively enrolled in this study. Patients with a papillary roof size ≥10 mm underwent opening window fistulotomy for primary biliary access. In addition, the incidence of complications and success rate of biliary cannulation were evaluated. Results: The median size of the papillary roof was 6 mm (range, 3–20 mm). Opening window fistulotomy was performed in 30 patients (27.3%), none of whom displayed PEP. Duodenal perforation was recorded in one patient (3.3%), which was resolved by conservative treatment. The cannulation rate was high (96.7%, 29/30 patients). The median duration of biliary access was 8 minutes (range, 3–15 minutes). Conclusions: Opening window fistulotomy demonstrated its feasibility for primary biliary access by achieving great safety with no PEP complications and a high success rate for biliary cannulation.

Endoscopic ultrasound-guided drainage for an abscess cavity

Nozomi Okuno,Kazuo Hara,Nobumasa Mizuno,Shin Haba,Takamichi Kuwahara,Yasuhiro Kuraishi,Takafumi Yanaidani,Sho Ishikawa,Tsukasa Yasuda,Masanori Yamada,Toshitaka Fukui 소화기인터벤션의학회 2022 International journal of gastrointestinal interven Vol.11 No.4

Endoscopic ultrasound (EUS)-guided interventions, including EUS-guided biliary drainage and EUS-guided cystic drainage, are now well developed and in widespread use. Intraperitoneal abscess requires drainage because mortality associated with an undrained abscess is high. Percutaneous or surgical drainage has traditionally been performed, but there have been numerous reports of EUS-guided drainage for intraperitoneal abscesses in recent years. EUS-guided abscess drainage has the advantage of being less invasive and enabling direct access to the cavity via the trans-luminal route as well as clear visualization of interposed vessels using color Doppler ultrasonography. It is necessary to consider the advantages and disadvantages when selecting a drainage method. This article reviews the current status of EUS-guided abscess drainage at three sites: the liver, pelvis, and mediastinum.

Clinical utility of endoscopic ultrasound-guided tissue acquisition for comprehensive genomic profiling of pancreatic cancer

Nozomi Okuno,Kazuo Hara,Nobumasa Mizuno,Shin Haba,Takamichi Kuwahara,Yasuhiro Kuraishi,Daiki Fumihara,Takafumi Yanaidani 대한소화기내시경학회 2023 Clinical Endoscopy Vol.56 No.2

Background/Aims: Endoscopic ultrasound-guided tissue acquisition (EUS-TA) is essential for the diagnosis of pancreatic cancer. The feasibility of comprehensive genomic profiling (CGP) using samples obtained by EUS-TA has been under recent discussion. This study aimed to evaluate the utility of EUS-TA for CGP in a clinical setting. Methods: CGP was attempted in 178 samples obtained from 151 consecutive patients with pancreatic cancer at the Aichi Cancer Center between October 2019 and September 2021. We evaluated the adequacy of the samples for CGP and determined the factors associated with the adequacy of the samples obtained by EUS-TA retrospectively. Results: The overall adequacy for CGP was 65.2% (116/178), which was significantly different among the four sampling methods (EUS-TA vs. surgical specimen vs. percutaneous biopsy vs. duodenal biopsy, 56.0% [61/109] vs. 80.4% [41/51] vs. 76.5% [13/17] vs. 100.0% [1/1], respectively; p=0.022). In a univariate analysis, needle gauge/type was associated with adequacy (22 G fine-needle aspiration vs. 22 G fine-needle biopsy [FNB] vs. 19 G-FNB, 33.3% (5/15) vs. 53.5% (23/43) vs. 72.5% (29/40); p=0.022). The sample adequacy of 19 G-FNB for CGP was 72.5% (29/40), and there was no significant difference between 19 G-FNB and surgical specimens (p=0.375). Conclusions: To obtain adequate samples for CGP with EUS-TA, 19 G-FNB was shown to be the best in clinical practice. However, 19 G-FNB was not still sufficient, so further efforts are required to improve adequacy for CGP.

Review : EUS-Guided Biliary Drainage

( Kenji Yamao ),( Kazuo Hara ),( Nobumasa Mizuno ),( Akira Sawaki ),( Susumu Hijioka ),( Yasumasa Niwa ),( Masahiro Tajika ),( Hiroki Kawai ),( Shinya Kondo ),( Yasuhiro Shimizu ),( Vikram Bhatia ) The Editorial Office of Gut and Liver 2010 Gut and Liver Vol.4 No.s1

Endoscopic ultrasonography (EUS) combines endoscopy and intraluminal ultrasonography, and allows imaging with a high-frequency transducer over a short distance to generate high-resolution ultrasonographic images. EUS is now a widely accepted modality for diagnosing pancreatobiliary diseases. EUS-guided fineneedle aspiration (EUS-FNA) using a curved linear- array echoendoscope was initially described more than 20 years ago, and since then many researchers have expanded its indications to sample diverse lesions and have also used it for various therapeutic purposes. EUS-guided biliary drainage (EUS-BD) is one of the therapeutic procedures that has been developed using a curved linear-array echoendoscope. Technically, EUS-BD includes rendezvous techniques via transesophageal, transgastric, and transduodenal routes, EUS-guided choledochoduodenostomy (EUS-CDS), and EUS-guided hepaticogastrostomy (EUS-HGS). Published data have demonstrated a high success rate, albeit with a comparatively high rate of nonfatal complications for EUS-CDS and EUS-HGS, and a comparatively low success rate with a low complication rate for the rendezvous technique. At present, these procedures represent an alternative to surgery or percutaneous transhepatic biliary drainage (PTBD) for patients with obstructive jaundice when endoscopic biliary drainage (EBD) has failed. However, these procedures should be performed in centers with extensive experience in linear EUS and therapeutic biliary ERCP. Large prospective studies are needed in the near future to establish standardized EUS-BD procedures as well as to perform controlled comparative trials between EUS-BD and PTBD, between rendezvous techniques and direct-access techniques (EUS-CDS and EUS-HGS), and between EBD and EUS-BD. (Gut Liver 2010;4(Suppl. 1):S67-75)