Comparison of tube-assisted mapping biopsy with digital single-operator peroral cholangioscopy for preoperative evaluation of biliary tract cancer

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.

Rotatable sphincterotome as a rescue device for endoscopic retrograde cholangiopancreatography cannulation: a single-center experience

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.

Comparison of Endoscopic Ultrasound-Guided Tissue Acquisition Using a 20-Gauge Menghini Needle with a Lateral Forward Bevel and a 22-Gauge Franseen Needle: A Single-Center Large Cohort Study

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.

Risk factors for recurrent stenosis after balloon dilation for benign hepaticojejunostomy anastomotic stricture

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.

A Study on Automation of Network Maintenance in Telecom Carriers for Zero-Touch Operations

Aiko OI,Ryosuke SATO,Yuichi SUTO,Kosuke SAKATA,Motomu NAKAJIMA,Tsuyoshi FURUKAWA 한국통신학회 2020 한국통신학회 APNOMS Vol.2020 No.09

In recent years, there are many work efficiency efforts in particular automation of business processes in various industry. The same trend applies to the network operations of telecommunication carriers; however, although automation of service fulfillment, such as developing network services, is progressing, automation of service assurance such as responding to network failure has not progressed. Currently, network maintenance personnel have independently developed tools for automation of network maintenance (such as troubleshooting) process partially and they are manually performing maintenance tasks by coordinating multiple groups of tools. However, in view of the future decrease in the working population, work efficiency must be further improved. Following this situation, this article focuses on further automation of network maintenance process, by developing technologies to orchestrate existing automation tools. In this paper, handling network failures among network maintenance work is targeted, the challenges and the requirements for expansion in the range of automation is discussed, after discussing current automation of network maintenance at telecom carriers in the real world. After that an implementation method that satisfies these requirements using our orchestrator and OSS products is proposed and evaluated. By defining a workflow of network maintenance that makes each process reusable, it becomes easy to create new workflow and update the one, and furthermore it was found that by reviewing how to code the workflow, it was possible to significantly improve processing performance.