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Techniques for percutaneous transesophageal gastrotubing
Yozo Sato,Shohei Chatani,Takaaki Hasegawa,Shinichi Murata,Yoshitaka Inaba 소화기인터벤션의학회 2021 Gastrointestinal Intervention Vol.10 No.2
Percutaneous transesophageal gastrotubing (PTEG) procedure was developed in Japan as an alternative access route into the gastrointestinal tract, and it has been performed for patients in whom percutaneous endoscopic gastrostomy would be technically difficult to place or is contraindicated, such as in a prior gastrectomy and massive ascites. In the PTEG procedure, an indwelling tube is inserted through the cervical esophagus, which gives the patient a slight discomfort after the tube placement. Therefore, PTEG is performed not only for enteral feeding, but also for bowel decompression as a palliative care in patients with malignant gastrointestinal obstruction. Recently, several reports of PTEG from countries outside Japan indicated a high technical success rate without major complications. Furthermore, the usefulness of PTEG for bowel decompression as a palliative care was reported in prospective studies. In fact, PTEG is a technically feasible and safe procedure worldwide.
Yozo Sato,Shohei Chatani,Takaaki Hasegawa,Shinichi Murata,Takamichi Kuwahara,Kazuo Hara,Yasuhiro Shimizu,Yoshitaka Inaba 소화기인터벤션의학회 2021 International journal of gastrointestinal interven Vol.10 No.1
Background: Malignant afferent loop syndrome occurs after biliary reconstruction and is difficult to treat because of the complicated anatomical changes. The aim of this study was to investigate the safety and efficacy of percutaneous metallic stent placement for malignant afferent loop syndrome via the blind end of the jejunal limb after biliary reconstruction. Methods: Percutaneous metallic stent placement via the jejunal limb was performed in five male patients (median age, 68 years; range, 51–88 years) with malignant afferent loop syndrome following pancreatoduodenectomy or bile duct resection with reconstruction at our institute from June 2009 to April 2019. Reconstruction was performed using a modified Child’s method or the Roux-en-Y method, and blind end of the jejunal limb was surgically fixed to the abdominal wall. Percutaneous drainage of the afferent loop was performed via the blind end of the jejunal limb. Subsequently, percutaneous metallic stent placement was performed via the same route. Technical success, clinical success, and complications were retrospectively evaluated. Results: Percutaneous metallic stent placement via the blind end of the jejunal limb was successfully achieved in all six procedures. Additional metallic stent placement was performed due to tumor ingrowth in a patient. Drainage catheters were removed from three patients, clamped in one, and could not be removed in one. Clinical success was achieved in four patients (80%) without major complications. Conclusion: Percutaneous metallic stent placement for malignant afferent loop syndrome via the blind end of the jejunal limb after biliary reconstruction could be a safe and effective procedure.
Yozo Sato,Shohei Chatani,Takaaki Hasegawa,Shinichi Murata,Takamichi Kuwahara,Kazuo Hara,Yasuhiro Shimizu,Yoshitaka Inaba 소화기인터벤션의학회 2021 Gastrointestinal Intervention Vol.10 No.1
Background: Malignant afferent loop syndrome occurs after biliary reconstruction and is difficult to treat because of the complicated anatomical changes. The aim of this study was to investigate the safety and efficacy of percutaneous metallic stent placement for malignant afferent loop syndrome via the blind end of the jejunal limb after biliary reconstruction. Methods: Percutaneous metallic stent placement via the jejunal limb was performed in five male patients (median age, 68 years; range, 51–88 years) with malignant afferent loop syndrome following pancreatoduodenectomy or bile duct resection with reconstruction at our institute from June 2009 to April 2019. Reconstruction was performed using a modified Child’s method or the Roux-en-Y method, and blind end of the jejunal limb was surgically fixed to the abdominal wall. Percutaneous drainage of the afferent loop was performed via the blind end of the jejunal limb. Subsequently, percutaneous metallic stent placement was performed via the same route. Technical success, clinical success, and complications were retrospectively evaluated. Results: Percutaneous metallic stent placement via the blind end of the jejunal limb was successfully achieved in all six procedures. Additional metallic stent placement was performed due to tumor ingrowth in a patient. Drainage catheters were removed from three patients, clamped in one, and could not be removed in one. Clinical success was achieved in four patients (80%) without major complications. Conclusion: Percutaneous metallic stent placement for malignant afferent loop syndrome via the blind end of the jejunal limb after biliary reconstruction could be a safe and effective procedure.
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.
Yozo Sato,Kazuo Hara,Nozomi Okuno,Shinichi Murata,Takaaki Hasegawa,Hiroyuki Morinaga,Yuki Kimbara,Yugo Imai,Hidekazu Yamaura,Yoshitaka Inaba 소화기인터벤션의학회 2020 Gastrointestinal Intervention 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.
Techniques for percutaneous transesophageal gastrotubing
Yozo Sato,Shohei Chatani,Takaaki Hasegawa,Shinichi Murata,Yoshitaka Inaba 소화기인터벤션의학회 2021 International journal of gastrointestinal interven Vol.10 No.2
Percutaneous transesophageal gastrotubing (PTEG) procedure was developed in Japan as an alternative access route into the gastrointestinal tract, and it has been performed for patients in whom percutaneous endoscopic gastrostomy would be technically difficult to place or is contraindicated, such as in a prior gastrectomy and massive ascites. In the PTEG procedure, an indwelling tube is inserted through the cervical esophagus, which gives the patient a slight discomfort after the tube placement. Therefore, PTEG is performed not only for enteral feeding, but also for bowel decompression as a palliative care in patients with malignant gastrointestinal obstruction. Recently, several reports of PTEG from countries outside Japan indicated a high technical success rate without major complications. Furthermore, the usefulness of PTEG for bowel decompression as a palliative care was reported in prospective studies. In fact, PTEG is a technically feasible and safe procedure worldwide.
Seyoung Han,ShinIchi Esumi,Kazuki Sato,Itaru Nakagawa,Takahito Todoroki 한국물리학회 2018 THE JOURNAL OF THE KOREAN PHYSICAL SOCIETY Vol.73 No.5
Azimuthal anisotropy in high-multiplicity small system collisions is often quantified by the har- monic modulations cn = hcos (n)i in di-hadron azimuthal correlations, with a non- ow baseline subtraction using correlation functions in low-multiplicity events. We present mathematical evalu- ations for three different baseline subtraction methods; i) the template fit method, ii) the reference t method, and iii) the c1 scaling method. We describe conceptual differences among the three methods. These methods are compared and examined using a toy Monte Carlo model with vari- ous realistic cn values implemented in high-multiplicity events. Our results show the reference fit method is more stable than the template fit method because the reference fit does not estimate the ow yield. On the other hand, the template fit method can evaluate the ow effect reasonably, for the case where the ow does not contain c1 factor.
Abnormal B Lymphocyte Activation and Function in Systemic Sclerosis
( Ayumi Yoshizaki ),( Shinichi Sato ) 대한피부과학회 2015 Annals of Dermatology Vol.27 No.1
Systemic sclerosis (SSc) is characterized by tissue fibrosis andautoimmunity. Although the pathogenic relationship betweenautoimmunity and clinical manifestations of SSc remainsunknown, SSc patients display abnormal immune responsesincluding the production of disease-specificautoantibodies. Previous studies have demonstrated that Bcells play a critical role in systemic autoimmunity and diseaseexpression through various functions such as inductionof the activation of other immune cells in addition to autoantibodyproduction. CD19 is a crucial regulator of B cellactivation. Recent studies demonstrated that B cells from SScpatients showed an up-regulated CD19 signaling pathwaythat induced SSc-specific autoantibody production in SScmouse models. CD19 transgenic mice lost tolerance for autoantigenand generated autoantibodies spontaneously. Bcells from SSc patients exhibited an overexpression of CD19that induced SSc-specific autoantibody production in transgenicmice. Moreover, SSc patients displayed intrinsic B cellabnormalities characterized by chronic hyper-reactivity ofmemory B cells, which was possibly due to CD19overexpression. Similarly, B cells from a tight-skin mouse, agenetic model of SSc, showed augmented CD19 signaling. Inbleomycin-induced SSc mouse models, endogenous ligandsfor toll-like receptor 4 induced by bleomycin stimulated Bcells to produce various fibrogenic cytokines and autoantibodies. Remarkably, the loss of CD19 resulted in the inhibitionof B cell hyper-reactivity and autoantibody production,which are associated with improvements in fibrosisand a parallel decrease in fibrogenic cytokine production byB cells. Taken together, the findings suggest that altered B cellfunction may result in tissue fibrosis as well as autoimmunityin SSc. (Ann Dermatol 27(1) 1∼9, 2015)