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Yoshihide Kanno,Shinsuke Koshita,Takahisa Ogawa,Hiroaki Kusunose,Kaori Masu,Toshitaka Sakai,Keisuke Yonamine,Yujiro Kawakami,Yuki Fujii,Kazuaki Miyamoto,Toji Murabayashi,Fumisato Kozakai,Jun Horaguchi 대한소화기내시경학회 2019 Clinical Endoscopy Vol.52 No.6
Background/Aims: In this study, we aimed to evaluate the predictive value of localized stenosis of the main pancreatic duct (MPD) forearly detection of pancreatic cancer. Methods: Among 689 patients who underwent endoscopic retrograde pancreatography from January 2008 to September 2018, 19patients with MPD findings were enrolled. These patients showed findings for indicating suspicious pancreatic cancer at an early stage(FiCE); FiCE was defined as a single, localized stenosis in the MPD without a detectable mass (using any other imaging methods) andwithout other pancreatic diseases, such as definite chronic pancreatitis, intraductal papillary mucinous neoplasm, and autoimmunepancreatitis. Final diagnoses were established by examining resected specimens or through follow-up examinations after an interval of>5 years. Results: Among 19 patients with FiCE, 11 underwent surgical resection and 8 were evaluated after a >5-year observation period. Thefinal diagnosis of the MPD stenosis was judged to be pancreatic cancer in 9 patients (47%), including 3 with intraepithelial cancer, andto be a non-neoplastic change in 10. The sensitivity, specificity, and accuracy of preoperative pancreatic juice cytology were 75%, 100%,and 88%, respectively. Conclusions: The predictive value of FiCE for pancreatic cancer prevalence was 47%. Histological confirmation with pancreatic juicecytology is necessary before surgical resection.
Yoshihide Kanno,Kei Ito,Shinsuke Koshita,Takahisa Ogawa,Hiroaki Kusunose,Kaori Masu,Toshitaka Sakai,Toji Murabayashi,Sho Hasegawa,Fumisato Kozakai,Yujiro Kawakami,Yuki Fujii,Yutaka Noda 대한소화기내시경학회 2018 Clinical Endoscopy Vol.51 No.3
Background/Aims: Although both radial- and convex-arrayed endoscopic ultrasonography (EUS) scopes are widely used forobservational EUS examinations, there have been few comparative studies on their power of visualization. The aim of this study was toevaluate the capability of these EUS scopes for observation of the pancreatobiliary junction. Methods: The rate of successful visualization of the pancreatobiliary junction was retrospectively compared between a radial-arrayedand a convex-arrayed echoendoscope, from a prospectively maintained database. Study periods were defined as January 2010 toDecember 2012 for the radial group, and February 2015 to October 2016 for the convex group because the respective scope wasmainly used during those periods. Results: During the study period, 1,660 cases with radial EUS and 1,984 cases with convex EUS were recruited. The success rates ofobservation of the pancreatobiliary junction were 80.0% and 89.5%, respectively (p<0.0001). Conclusions: The capability of visualization of the pancreatobiliary junction in observational EUS was found to be better with aconvex-arrayed than with a radial-arrayed echoendoscope
Sho Hasegawa,Shinsuke Koshita,Yoshihide Kanno,Takahisa Ogawa,Toshitaka Sakai,Hiroaki Kusunose,Kensuke Kubota,Atsushi Nakajima,Yutaka Noda,Kei Ito 대한소화기내시경학회 2021 Clinical Endoscopy Vol.54 No.6
Background/Aims: The use of endoscopic intervention (EI) for acute biliary pancreatitis (ABP) remains controversial because theseverity of biliary obstruction/cholangitis/pancreatitis is not reflected in the indications for early EI (EEI). Methods: A total of 148 patients with ABP were included to investigate 1) the differences in the rate of worsening cholangitis/pancreatitis between the EEI group and the early conservative management (ECM) group, especially for each severity of cholangitis/pancreatitis, and 2) the diagnostic ability of imaging studies, including endoscopic ultrasound (EUS), to detect common bile ductstones (CBDSs) in the ECM group. Results: No differences were observed in the rate of worsening cholangitis between the EEI and ECM groups, regardless of theseverity of cholangitis and/or the existence of impacted CBDSs. Among patients without impacted CBDSs and moderate/severecholangitis, worsening pancreatitis was significantly more frequent in the EEI group (18% vs. 4%, p=0.048). In patients in the ECMgroup, the sensitivity and specificity for detecting CBDSs were 73% and 98%, respectively, for EUS, whereas the values were 13% and92%, respectively, for magnetic resonance cholangiopancreatography. Conclusions: EEI should be avoided in the absence of moderate/severe cholangitis and/or impacted CBDSs because of the high rateof worsening pancreatitis. EUS can contribute to the accurate detection of residual CBDSs, for the determination of the need forelective EI.
Keisuke Yonamine,Shinsuke Koshita,Yoshihide Kanno,Takahisa Ogawa,Hiroaki Kusunose,Toshitaka Sakai,Kazuaki Miyamoto,Fumisato Kozakai,Hideyuki Anan,Haruka Okano,Masaya Oikawa,Takashi Tsuchiya,Takashi Sa 대한소화기내시경학회 2023 Clinical Endoscopy Vol.56 No.4
Background/Aims: We aimed to investigate (1) promising clinical findings for the recognition of focal type autoimmune pancreatitis (FAIP) and (2) the impact of endoscopic ultrasound (EUS)-guided tissue acquisition (EUS-TA) on the diagnosis of FAIP. Methods: Twenty-three patients with FAIP were involved in this study, and 44 patients with resected pancreatic ductal adenocarcinoma (PDAC) were included in the control group. Results: (1) Multivariate analysis revealed that homogeneous delayed enhancement on contrast-enhanced computed tomography was a significant factor indicative of FAIP compared to PDAC (90% vs. 7%, p=0.015). (2) For 13 of 17 FAIP patients (76.5%) who underwent EUS-TA, EUS-TA aided the diagnostic confirmation of AIPs, and only one patient (5.9%) was found to have AIP after surgery. On the other hand, of the six patients who did not undergo EUS-TA, three (50.0%) underwent surgery for pancreatic lesions. Conclusions: Homogeneous delayed enhancement on contrast-enhanced computed tomography was the most useful clinical factor for discriminating FAIPs from PDACs. EUS-TA is mandatory for diagnostic confirmation of FAIP lesions and can contribute to a reduction in the rate of unnecessary surgery for patients with FAIP.
Hiroaki Kusunose,Shinsuke Koshita,Yoshihide Kanno,Takahisa Ogawa,Toshitaka Sakai,Keisuke Yonamine,Kazuaki Miyamoto,Fumisato Kozakai,Hideyuki Anan,Kazuki Endo,Haruka Okano,Masaya Oikawa,Takashi Tsuchiy 대한소화기내시경학회 2023 Clinical Endoscopy Vol.56 No.3
Background/Aims: This study aimed to clarify the efficacy and safety of pancreatic duct lavage cytology combined with a cell-block method (PLC-CB) for possible pancreatic ductal adenocarcinomas (PDACs). Methods: This study included 41 patients with suspected PDACs who underwent PLC-CB mainly because they were unfit for undergoing endoscopic ultrasonography-guided fine needle aspiration. A 6-Fr double lumen catheter was mainly used to perform PLC-CB. Final diagnoses were obtained from the findings of resected specimens or clinical outcomes during surveillance after PLC-CB. Results: Histocytological evaluations using PLC-CB were performed in 87.8% (36/41) of the patients. For 31 of the 36 patients, final diagnoses (invasive PDAC, 12; pancreatic carcinoma in situ, 5; benignancy, 14) were made, and the remaining five patients were excluded due to lack of surveillance periods after PLC-CB. For 31 patients, the sensitivity, specificity, and accuracy of PLC-CB for detecting malignancy were 94.1%, 100%, and 96.8%, respectively. In addition, they were 87.5%, 100%, and 94.1%, respectively, in 17 patients without pancreatic masses detectable using endoscopic ultrasonography. Four patients developed postprocedural pancreatitis, which improved with conservative therapy. Conclusions: PLC-CB has an excellent ability to detect malignancies in patients with possible PDACs, including pancreatic carcinoma in situ.
Clinical and MRI Characteristics of Uterine Cervical Adenocarcinoma: Its Variants and Mimics
Tsukasa Saida,Akiko Sakata,Yumiko Oishi Tanaka,Hiroyuki Ochi,Toshitaka Ishiguro,Masafumi Sakai,Hiroaki Takahashi,Toyomi Satoh,Manabu Minami 대한영상의학회 2019 Korean Journal of Radiology Vol.20 No.3
Adenocarcinoma currently accounts for 10–25% of all uterine cervical carcinomas and has a variety of histopathological subtypes. Among them, mucinous carcinoma gastric type is not associated with high-risk human papillomavirus (HPV) infection and a poor prognosis, while villoglandular carcinoma has an association with high-risk HPV infection and a good prognosis. They show relatively characteristic imaging findings which can be suggested by magnetic resonance imaging (MRI), though the former is sometimes difficult to be distinguished from lobular endocervical glandular hyperplasia. Various kinds of other tumors including squamous cell carcinoma should be also differentiated on MRI, while it is currently difficult to distinguish them on MRI, and HPV screening and pathological confirmation are usually necessary for definite diagnosis and further patient management.
Yoshihide Kanno,Shinsuke Koshita,Takahisa Ogawa,Hiroaki Kusunose,Kaori Masu,Toshitaka Sakai,Keisuke Yonamine,Kazuaki Miyamoto,Toji Murabayashi,Fumisato Kozakai,Jun Horaguchi,Yutaka Noda,Kei Ito 대한소화기내시경학회 2020 Clinical Endoscopy Vol.53 No.6
Background/Aims: The aim of this study was to evaluate outcomes of inside plastic stents (iPSs) versus those of metal stents (MSs) for treating unresectable perihilar malignant obstructions. Methods: For all patients who underwent endoscopic suprapapillary placement of iPS(s) or MS(s) as the first permanent biliary drainage for unresectable malignant perihilar obstructions between January 2014 and August 2019, clinical outcomes using iPSs (n=20) and MSs (n=85), including clinical efficacy, adverse events, and time to recurrence of biliary obstruction (RBO), were retrospectively evaluated. Results: There were no differences in clinical effectiveness (95% for the iPS group vs. 92% for the MS group, p=1.00). Procedure-related adverse events, including pancreatitis, acute cholangitis, acute cholecystitis, and death, were observed for 8% of the MS group, although no patient in the iPS group developed such adverse events. The median time to RBO was 561 days (95% confidence interval, 0–1,186 days) for iPSs and 209 days (127–291 days) for MSs, showing a significant difference (p=0.008). Conclusions: Time to RBO after iPS placement was significantly longer than that after MS placement. IPSs, which are removable, unlike MSs, were an acceptable option.
Yuki Fujii,Yoshihide Kanno,Shinsuke Koshita,Takahisa Ogawa,Hiroaki Kusunose,Kaori Masu,Toshitaka Sakai,Keisuke Yonamine,Yujiro Kawakami,Toji Murabayashi,Fumisato Kozakai,Yutaka Noda,Hiroyuki Okada,Kei 대한소화기내시경학회 2019 Clinical Endoscopy Vol.52 No.2
Background/Aims: This study aimed to identify the predictive factors for inaccurate endoscopic ultrasound-guided fine needleaspiration (EUS-FNA) diagnosis of swollen lymph nodes without rapid on-site cytopathological evaluation. Methods: Eighty-three consecutive patients who underwent EUS-FNA for abdominal or mediastinal lymph nodes from January2008 to June 2017 were included from a prospectively maintained EUS-FNA database and retrospectively reviewed. The sensitivity,specificity, and accuracy of EUS-FNA for the detection of neoplastic diseases were calculated. Candidate factors for inaccurate diagnosis(lymph node size and location, needle type, puncture route, number of passes, and causative disease) were evaluated by comparisonbetween accurately diagnosed cases and others. Results: The final diagnosis of the punctured lymph node was classified as neoplastic (65 cases: a metastatic lymph node, malignantlymphoma, or Crow-Fukase syndrome) or non-neoplastic (18 cases: a reactive node or amyloidosis). The sensitivity, specificity, andaccuracy were 83%, 94%, and 86%, respectively. On multivariate analyses, small size of the lymph node was the sole predictive factor forinaccurate EUS-FNA diagnosis with a significant difference (odds ratios, 19.8; 95% confidence intervals, 3.15–124; p=0.0015). Conclusions: The lymph node size of <16 mm was the only independent factor associated with inaccurate EUS-FNA diagnosis ofswollen lymph nodes.
Yoshihide Kanno,Tetsuya Ohira,Yoshihiro Harada,Shinsuke Koshita,Takahisa Ogawa,Hiroaki Kusunose,Yoshiki Koike,Taku Yamagata,Toshitaka Sakai,Kaori Masu,Keisuke Yonamine,Kazuaki Miyamoto,Megumi Tanaka,T 대한소화기내시경학회 2021 Clinical Endoscopy Vol.54 No.3
Background/Aims: The aim of this study was to evaluate the safety of sedation with propofol as an alternative to benzodiazepinedrugs in outpatient endoscopy. Methods: In this prospective study, examinees who underwent outpatient endoscopy under propofol sedation and submitted a nextdayquestionnaire with providing informed consent were evaluated. Periprocedural acute responses, late adverse events within 24hours, and examinee satisfaction were evaluated. Results: Among the 4,122 patients who received propofol in the 17,978 outpatient-based endoscopic examinations performedbetween November 2016 and March 2018, 2,305 eligible examinees (esophagogastroduodenoscopy for 1,340, endoscopicultrasonography for 945, and total colonoscopy for 20) were enrolled, and their responses to a questionnaire were analyzed. Themean propofol dose was 69.6±24.4 mg (range, 20–200 mg). Diazepam, midazolam, and/or pentazocine in combination withpropofol was administered to 146 examinees. Mild oxygen desaturation was observed in 59 examinees (2.6%); and mild bradycardia,in 2 (0.09%). Other severe reactions or late events did not occur. After eliminating 181 invalid responses, 97.7% (2,065/2,124) of thepatients desired propofol sedation in future examinations. Conclusions: Propofol sedation was found to be safe-without severe adverse events or accidents-for outpatient endoscopy on thebasis of the patients’ next-day self-evaluation. Given the high satisfaction level, propofol sedation might be an ideal tool for painlessendoscopic screening.
Fumisato Kozakai,Yoshihide Kanno,Kei Ito,Shinsuke Koshita,Takahisa Ogawa,Hiroaki Kusunose,Kaori Masu,Toshitaka Sakai,Toji Murabayashi,Keisuke Yonamine,Yujiro Kawakami,Yuki Fujii,Kazuaki Miyamoto,Yutak 대한소화기내시경학회 2019 Clinical Endoscopy Vol.52 No.3
Background/Aims: It is often diffcult to manage acute cholecystitis after metal stent (MS) placement in unresectable malignant biliarystrictures. The aim of this study was to evaluate the feasibility of endoscopic ultrasonography-guided gallbladder drainage (EUS-GBD)for acute cholecystitis. Methods: The clinical outcomes of 10 patients who underwent EUS-GBD for acute cholecystitis after MS placement between January2011 and August 2018 were retrospectively evaluated. The procedural outcomes of percutaneous transhepatic gallbladder drainage(PTGBD) with tube placement (n=11 cases) and aspiration (PTGBA) (n=27 cases) during the study period were evaluated as a reference. Results: The technical success and clinical effectiveness rates of EUS-GBD were 90% (9/10) and 89% (8/9), respectively. Severe bileleakage that required surgical treatment occurred in one case. Acute cholecystitis recurred after stent dislocation in 38% (3/8) of thecases. Both PTGBD and PTGBA were technically successful in all cases without severe adverse events and clinically effective in 91% and63% of the cases, respectively. Conclusions: EUS-GBD after MS placement was a feasible option for treating acute cholecystitis. However, it was a rescue techniquefollowing the established percutaneous intervention in the current setting because of the immature technical methodology, includingdedicated devices, which need further development.