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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.
Yousuke Nakai,Tatsuya Sato,Ryunosuke Hakuta,Kazunaga Ishigaki,Kei Saito,Tomotaka Saito,Naminatsu Takahara,Tsuyoshi Hamada,Suguru Mizuno,Hirofumi Kogure,Minoru Tada,Hiroyuki Isayama,Kazuhiko Koike 거트앤리버 소화기연관학회협의회 2020 Gut and Liver Vol.14 No.3
Endoscopic management of bile duct stones is now the standard of care, but challenges remain with difficult bile duct stones. There are some known factors associated with technically difficult bile duct stones, such as large size and surgically altered anatomy. Endoscopic mechanical lithotripsy is now the standard technique used to remove large bile duct stones, but the efficacy of endoscopic papillary large balloon dilatation (EPLBD) and cholangioscopy with intraductal lithotripsy has been increasingly reported. In patients with surgically altered anatomy, biliary access before stone removal can be technically difficult. Endotherapy using two new endoscopes is now utilized in clinical practice: enteroscopy-assisted endoscopic retrograde cholangiopancreatography and endoscopic ultrasound-guided antegrade treatment. These new approaches can be combined with EPLBD and/or cholangioscopy to remove large bile duct stones from patients with surgically altered anatomy. Since various endoscopic procedures are now available, endoscopists should learn the indications, advantages and disadvantages of each technique for better management of bile duct stones.
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.
Technical tips for endoscopic ultrasound-guided pancreatic duct access and drainage
Yousuke Nakai 소화기인터벤션의학회 2020 International journal of gastrointestinal interven Vol.9 No.4
Endoscopic ultrasound (EUS)-guided pancreatic duct access and drainage can be achieved by EUS-guided rendezvous (EUS-RV) or EUS-guided pancreatic duct drainage (EUS-PD) by transmural stent placement. Although the procedure is utilized for further complex treatment such as intraductal lithotripsy in obstructive pancreatic duct stones, the procedure is technically difficult compared to other EUS-guided interventions. Recently, some devices are developed for EUS-guided pancreatic duct intervention. In this review, technical tips are reviewed in a step-by-step fashion from puncture, guidewire insertion, tract dilation to drainage. Given the advantage of EUS-guided approach, treatment algorithm of endotherapy for pancreatic indications should be further established especially in cases with surgically altered anatomy.
A Meta-Analysis of Slow Pull versus Suction for Endoscopic Ultrasound-Guided Tissue Acquisition
( Yousuke Nakai ),( Tsuyoshi Hamada ),( Ryunosuke Hakuta ),( Tatsuya Sato ),( Kazunaga Ishigaki ),( Kei Saito ),( Tomotaka Saito ),( Naminatsu Takahara ),( Suguru Mizuno ),( Hirofumi Kogure ),( Kazuhi 대한소화기기능성질환·운동학회(구 대한소화관운동학회) 2021 Gut and Liver Vol.15 No.4
Background/Aims: Endoscopic ultrasound (EUS)-guided tissue acquisition is widely utilized as a diagnostic modality for intra-abdominal masses, but there remains debate regarding which suction technique, slow pull (SP) or conventional suction (CS), is better. A meta-analysis of reported studies was conducted to compare the diagnostic yields of SP and CS during EUS-guided tissue acquisition. Methods: We conducted a systematic electronic search using MEDLINE/PubMed, Web of Science, and the Cochrane Central Register of Controlled Trials to identify clinical studies comparing SP and CS. We meta-analyzed accuracy, sensitivity, blood contamination and cellularity using the random-effects model. Results: A total of 17 studies (seven randomized controlled trials, four prospective studies, and six retrospective studies) with 1,616 cases were included in the analysis. Compared to CS, there was a trend toward better accuracy (odds ratio [OR], 1.48; 95% confidence interval [CI], 0.97 to 2.27; p=0.07) and sensitivity (OR, 1.67; 95% CI, 0.95 to 2.93; p=0.08) with SP and a significantly lower rate of blood contamination (OR, 0.48; 95% CI, 0.33 to 0.69; p<0.01). However, there was no significant difference in cellularity between SP and CS, with an OR of 1.28 (95% CI, 0.68 to 2.40; p=0.45). When the use of a 25-gauge needle was analyzed, the accuracy and sensitivity of SP were significantly better than those of CS, with ORs of 4.81 (95% CI, 1.99 to 11.62; p<0.01) and 4.69 (95% CI, 1.93 to 11.40; p<0.01), respectively. Conclusions: Compared to CS, SP appears to provide better accuracy and sensitivity in EUSguided tissue acquisition, especially when a 25-gauge needle is used. (Gut Liver 2021;15:625- 633)
Development of a Compact Dose Verification System Using a Fluorescent Screen for Carbon-Ion Therapy
Yousuke Hara,Takuji Furukawa,Kota Mizushima,Naoya Saotome,Yuichi Saraya,Ryohei Tansho,Toshiyuki Shirai,Koji Noda 한국물리학회 2016 THE JOURNAL OF THE KOREAN PHYSICAL SOCIETY Vol.69 No.6
For quality assurance (QA) of therapeutic ion beams, a QA tool having high spatial resolution and quick verification is required. An imaging system with a fluorescent screen is suitable for the QA procedure. We developed a compact and quick verification system (NQA-SCN) using a fluorescent screen with a charge-coupled device (CCD) camera for the sake of two-dimensional dosimetry. The NQA-SCN can be attached to the irradiation port and the water column. Several types of corrections were applied to the raw image obtained by using the NQA-SCN. Our goal is to use the NQA-SCN for three-dimensional dose verification. However, in carbon-ion therapy, the fluorescent light is decreased by the quenching effect due to the increased linear energy transfer (LET) in the Bragg peak. For three-dimensional dose verification, as a first approach, we investigated the quenching effect of a carbon-ion beam in water. Also, to evaluate the performance of NQA-SCN, we carried out experiments concerning QA procedures.