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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.
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.
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.
Interventional management for postoperative arterial bleeding in gastrointestinal surgery
Yozo Sato,Kiyoshi Matsueda,Marie Osawa,Yoshitaka Inaba,Yu Takahashi,Yosuke Inoue,Atsushi Oba,Yosuke Fukunaga,Yasuhiro Shimizu 소화기인터벤션의학회 2022 International journal of gastrointestinal interven Vol.11 No.4
Postoperative arterial bleeding after gastrointestinal surgery is a potentially fatal complication. Transcatheter arterial embolization is considered the first-line treatment because of efficacy and less invasiveness despite the risk of organ infarction. With the recent advances in endovascular devices, stent-graft placement, which can preserve arterial flow, has been an alternative treatment option in patients with extrahepatic artery hemorrhage. Moreover, clinical outcomes of stent-graft placement for pseudoaneurysms in relative long term have been reported recently. Herein, we review the techniques and clinical outcomes for interventional management for postoperative arterial bleeding.
Yozo Sato,Shigeru Matsushima,Yoshitaka Inaba,Tsuyoshi Sano,Hidekazu Yamaura,Mina Kato,Yasuhiro Shimizu,Yoshiki Senda,Tsuneo Ishiguchi 대한영상의학회 2015 Korean Journal of Radiology Vol.16 No.3
To retrospectively evaluate relative enhancement (RE) in the hepatobiliary phase of gadoxetic acid disodium-enhanced magnetic resonance (MR) imaging as a preoperative estimation of future remnant liver (FRL) function in a patients who underwent portal vein embolization (PVE). In 53 patients, the correlation between the indocyanine green clearance (ICG-K) and RE imaging was analyzed before hepatectomy (first analysis). Twenty-three of the 53 patients underwent PVE followed by a repeat RE imaging and ICG test before an extended hepatectomy and their results were further analyzed (second analysis). Whole liver function and FRL function were calculated on the MR imaging as follows: RE x total liver volume (RE Index) and FRL-RE x FRL volume (Rem RE Index), respectively. Regarding clinical outcome, posthepatectomy liver failure (PHLF) was evaluated in patients undergoing PVE. Indocyanine green clearance correlated with the RE Index (r = 0.365, p = 0.007), and ICG-K of FRL (ICG-Krem) strongly correlated with the Rem RE Index (r = 0.738, p < 0.001) in the first analysis. Both the ICG-Krem and the Rem RE Index were significantly correlated after PVE (r = 0.508, p = 0.013) at the second analysis. The rate of improvement of the Rem RE Index from before PVE to after PVE was significantly higher than that of ICG-Krem (p = 0.014). Patients with PHLF had a significantly lower Rem RE Index than patients without PHLF (p = 0.023). Relative enhancement imaging can be used to estimate FRL function after PVE.
Interventional management for postoperative arterial bleeding in gastrointestinal surgery
Yozo Sato,Kiyoshi Matsueda,Marie Osawa,Yoshitaka Inaba,Yu Takahashi,Yosuke Inoue,Atsushi Oba,Yosuke Fukunaga,Yasuhiro Shimizu 소화기인터벤션의학회 2022 Gastrointestinal Intervention Vol.11 No.4
Postoperative arterial bleeding after gastrointestinal surgery is a potentially fatal complication. Transcatheter arterial embolization is considered the first-line treatment because of efficacy and less invasiveness despite the risk of organ infarction. With the recent advances in endovascular devices, stent-graft placement, which can preserve arterial flow, has been an alternative treatment option in patients with extrahepatic artery hemorrhage. Moreover, clinical outcomes of stent-graft placement for pseudoaneurysms in relative long term have been reported recently. Herein, we review the techniques and clinical outcomes for interventional management for postoperative arterial bleeding.
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.
Shohei Chatani,Yozo Sato,Nozomi Okuno,Takaaki Hasegawa,Shinichi Murata,Hidekazu Yamaura,Kazuo Hara,Yasuhiro Shimizu,Yoshitaka Inaba 소화기인터벤션의학회 2021 International journal of gastrointestinal interven Vol.10 No.2
Left-sided portal hypertension following pancreaticoduodenectomy (PD) with portal vein resection and splenic vein ligation may cause ectopic variceal formation, potentially resulting in life-threatening bleeding. We report of a 79-year-old male suffering from severe anemia and melena after PD. Emergency endoscopy and contrast-enhanced computed tomography (CECT) revealed ectopic varices at the anastomosis site of pancreaticojejunostomy. An interventional radiology approach was preferred over surgical and endoscopic treatment because of the poor general condition and altered anatomy. In the first procedure, percutaneous transhepatic retrograde obliteration was performed using the coaxial double balloon-occlusion technique. Although hemostasis was obtained, re-bleeding occurred two months later. CECT revealed the development of another collateral pathway and the recurrence of varices. Insufficient embolization of the afferent vein was considered the cause of recurrence. Therefore, a percutaneous transsplenic approach was used, and complete embolization of varices was achieved. When transhepatic retrograde obliteration is not effective, transsplenic antegrade obliteration can be a useful therapeutic option.