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Shin Haba,Kazuo Hara,Nobumasa Mizuno,Takamichi Kuwahara,Nozomi Okuno,Akira Miyano,Daiki Fumihara,Moaz Elshair 대한소화기내시경학회 2022 Clinical Endoscopy Vol.55 No.3
Endoscopic ultrasound (EUS)-guided hepaticogastrostomy (HGS) is widely performed not only as an alternative to transpapillary biliarydrainage, but also as primary drainage for malignant biliary obstruction. For anatomical reasons, this technique carries an unavoidablerisk of mispuncturing intrahepatic vessels. We report a technique for troubleshooting EUS-guided portal vein coiling to preventbleeding from the intrahepatic portal vein after mispuncture during interventional EUS. EUS-HGS was planned for a 59-year-old malepatient with unresectable pancreatic cancer. The dilated bile duct (lumen diameter, 2.8 mm) was punctured with a 19-gauge needle,and a guidewire was inserted. After bougie dilation, the guidewire was found to be inside the intrahepatic portal vein. Embolizing coilswere placed to prevent bleeding. Embolization coils were successfully inserted under stabilization of the catheter using a double-lumencannula with a guidewire. Following these procedures, the patient was asymptomatic. Computed tomography performed the next dayrevealed no complications.
Forward viewing liner echoendoscopy for therapeutic interventions
Kazuo Hara,Nozomi Okuno,Shin Haba,Takamichi Kuwahara 대한소화기내시경학회 2024 Clinical Endoscopy Vol.57 No.2
Therapeutic endoscopic ultrasonography (EUS) procedures using the forward-viewing convex EUS (FV-EUS) have been reviewed based on the articles reported to date. The earliest reported procedure is the drainage of pancreatic pseudocysts using FV-EUS. However, the study on drainage of pancreatic pseudocysts focused on showing that drainage is possible with FV-EUS rather than leveraging its features. Subsequently, studies describing the characteristics of FV-EUS have been reported. By using FV-EUS in EUS-guided choledochoduodenostomy, double punctures in the gastrointestinal tract can be avoided. In postoperative modified anatomical cases, using the endoscopic function of FV-EUS, procedures such as bile duct drainage from anastomosis, pancreatic duct drainage from the afferent limb, and abscess drainage from the digestive tract have been reported. When a perpendicular puncture to the gastrointestinal tract is required or when there is a need to insert the endoscope deep into the gastrointestinal tract, FV-EUS is considered among the options.
Yasuhiro Kuraishi,Kazuo Hara,Shin Haba,Takamichi Kuwahara,Nozomi Okuno,Takafumi Yanaidani,Sho Ishikawa,Tsukasa Yasuda,Masanori Yamada,Nobumasa Mizuno 대한소화기내시경학회 2023 Clinical Endoscopy Vol.56 No.4
Background/Aims: Post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) is the most common and serious complication of endoscopic retrograde cholangiopancreatography. To prevent this event, a unique precutting method, termed opening window fistulotomy, was performed in patients with a large infundibulum as the primary procedure for biliary cannulation, whereby a suprapapillary laid-down H-shaped incision was made without touching the orifice. This study aimed to assess the safety and feasibility of this novel technique. Methods: One hundred and ten patients were prospectively enrolled in this study. Patients with a papillary roof size ≥10 mm underwent opening window fistulotomy for primary biliary access. In addition, the incidence of complications and success rate of biliary cannulation were evaluated. Results: The median size of the papillary roof was 6 mm (range, 3–20 mm). Opening window fistulotomy was performed in 30 patients (27.3%), none of whom displayed PEP. Duodenal perforation was recorded in one patient (3.3%), which was resolved by conservative treatment. The cannulation rate was high (96.7%, 29/30 patients). The median duration of biliary access was 8 minutes (range, 3–15 minutes). Conclusions: Opening window fistulotomy demonstrated its feasibility for primary biliary access by achieving great safety with no PEP complications and a high success rate for biliary cannulation.
Nozomi Okuno,Kazuo Hara,Nobumasa Mizuno,Shin Haba,Takamichi Kuwahara,Yasuhiro Kuraishi,Daiki Fumihara,Takafumi Yanaidani 대한소화기내시경학회 2023 Clinical Endoscopy Vol.56 No.2
Background/Aims: Endoscopic ultrasound-guided tissue acquisition (EUS-TA) is essential for the diagnosis of pancreatic cancer. The feasibility of comprehensive genomic profiling (CGP) using samples obtained by EUS-TA has been under recent discussion. This study aimed to evaluate the utility of EUS-TA for CGP in a clinical setting. Methods: CGP was attempted in 178 samples obtained from 151 consecutive patients with pancreatic cancer at the Aichi Cancer Center between October 2019 and September 2021. We evaluated the adequacy of the samples for CGP and determined the factors associated with the adequacy of the samples obtained by EUS-TA retrospectively. Results: The overall adequacy for CGP was 65.2% (116/178), which was significantly different among the four sampling methods (EUS-TA vs. surgical specimen vs. percutaneous biopsy vs. duodenal biopsy, 56.0% [61/109] vs. 80.4% [41/51] vs. 76.5% [13/17] vs. 100.0% [1/1], respectively; p=0.022). In a univariate analysis, needle gauge/type was associated with adequacy (22 G fine-needle aspiration vs. 22 G fine-needle biopsy [FNB] vs. 19 G-FNB, 33.3% (5/15) vs. 53.5% (23/43) vs. 72.5% (29/40); p=0.022). The sample adequacy of 19 G-FNB for CGP was 72.5% (29/40), and there was no significant difference between 19 G-FNB and surgical specimens (p=0.375). Conclusions: To obtain adequate samples for CGP with EUS-TA, 19 G-FNB was shown to be the best in clinical practice. However, 19 G-FNB was not still sufficient, so further efforts are required to improve adequacy for CGP.
Endoscopic ultrasound-guided drainage for an abscess cavity
Nozomi Okuno,Kazuo Hara,Nobumasa Mizuno,Shin Haba,Takamichi Kuwahara,Yasuhiro Kuraishi,Takafumi Yanaidani,Sho Ishikawa,Tsukasa Yasuda,Masanori Yamada,Toshitaka Fukui 소화기인터벤션의학회 2022 International journal of gastrointestinal interven Vol.11 No.4
Endoscopic ultrasound (EUS)-guided interventions, including EUS-guided biliary drainage and EUS-guided cystic drainage, are now well developed and in widespread use. Intraperitoneal abscess requires drainage because mortality associated with an undrained abscess is high. Percutaneous or surgical drainage has traditionally been performed, but there have been numerous reports of EUS-guided drainage for intraperitoneal abscesses in recent years. EUS-guided abscess drainage has the advantage of being less invasive and enabling direct access to the cavity via the trans-luminal route as well as clear visualization of interposed vessels using color Doppler ultrasonography. It is necessary to consider the advantages and disadvantages when selecting a drainage method. This article reviews the current status of EUS-guided abscess drainage at three sites: the liver, pelvis, and mediastinum.
( Kazumichi Kawakubo ),( Hiroshi Kawakami ),( Masaki Kuwatani ),( Shin Haba ),( Taiki Kudo ),( Yoko Abe ),( Shuhei Kawahata ),( Manabu Onodera ),( Nobuyuki Ehira ),( Hiroaki Yamato ),( Kazunori Eto ) 대한소화기학회 2014 Gut and Liver Vol.8 No.3
Endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) are essential for diagnosing and treating pancreatobiliary diseases. Single-session EUS and ERCP are considered to be essential in reducing the duration of hospital stays; however, complications are a primary concern. The aim of this study was to evaluate the safety and efficacy of single-session EUS and ERCP. Sixty-eight patients underwent single-session EUS and ERCP at a tertiary referral center between June 2008 and December 2012. We retrospectively reviewed patient data from a prospectively maintained EUS-ERCP database and evaluated the procedural characteristics and complications. Thirty-eight patients (56%) underwent diagnostic EUS, and 30 patients (44%) underwent EUS fine-needle aspiration, which had an overall accuracy of 100%. Sixty patients (89%) underwent therapeutic ERCP, whereas the remaining eight procedures were diagnostic. Thirteen patients underwent biliary stone extraction, and 48 underwent biliary drainage. The median total procedural time was 75 minutes. Complications were observed in seven patients (10%). Six complications were post-ERCP pancreatitis, which were resolved using conservative management. One patient developed Mallory-Weiss syndrome, which required endoscopic hemostasis. No sedation-related cardiopulmonary complications were observed. Single-session EUS and ERCP provided accurate diagnosis and effective management with a minimal complication rate.
Endoscopic ultrasound-guided drainage for an abscess cavity
Nozomi Okuno,Kazuo Hara,Nobumasa Mizuno,Shin Haba,Takamichi Kuwahara,Yasuhiro Kuraishi,Takafumi Yanaidani,Sho Ishikawa,Tsukasa Yasuda,Masanori Yamada,Toshitaka Fukui 소화기인터벤션의학회 2022 Gastrointestinal Intervention Vol.11 No.4
Endoscopic ultrasound (EUS)-guided interventions, including EUS-guided biliary drainage and EUS-guided cystic drainage, are now well developed and in widespread use. Intraperitoneal abscess requires drainage because mortality associated with an undrained abscess is high. Percutaneous or surgical drainage has traditionally been performed, but there have been numerous reports of EUS-guided drainage for intraperitoneal abscesses in recent years. EUS-guided abscess drainage has the advantage of being less invasive and enabling direct access to the cavity via the trans-luminal route as well as clear visualization of interposed vessels using color Doppler ultrasonography. It is necessary to consider the advantages and disadvantages when selecting a drainage method. This article reviews the current status of EUS-guided abscess drainage at three sites: the liver, pelvis, and mediastinum.
Nozomi Okuno,Kazuo Hara,Nobumasa Mizuno,Shin Haba,Takamichi Kuwahara,Hiroki Koda,Masahiro Tajika,Tsutomu Tanaka,Sachiyo Onishi,Keisaku Yamada,Akira Miyano,Daiki Fumihara,Moaz Elshair 대한소화기내시경학회 2021 Clinical Endoscopy Vol.54 No.4
Background/Aims: The Japan Gastroenterological Endoscopy Society (JGES) has published guidelines for gastroenterologicalendoscopy in patients undergoing antithrombotic treatment. These guidelines classify endoscopic ultrasound-guided biliary drainage(EUS-BD) as a high-risk procedure. Nevertheless, the bleeding risk of EUS-BD in patients undergoing antithrombotic therapy isuncertain. Therefore, this study aimed to assess the bleeding risk in patients undergoing antithrombotic therapy. Methods: This single-center retrospective study included 220 consecutive patients who underwent EUS-BD between January 2013and December 2018. We managed the withdrawal and continuation of antithrombotic agents according to the JGES guidelines. Wecompared the bleeding event rates among patients who received and those who did not receive antithrombotic agents. Results: A total of 18 patients (8.1 %) received antithrombotic agents and 202 patients (91.8 %) did not. Three patients experiencedbleeding events, with an overall bleeding event rate of 1.3% (3/220): one patient was in the antithrombotic group (5.5%) and twopatients were in the non-antithrombotic group (0.9%) (p=0.10). All cases were moderate. The sole thromboembolic event (0.4%) wasa cerebral infarction in a patient in the non-antithrombotic group. Conclusions: The rate of EUS-BD-related bleeding events was low. Even in patients receiving antithrombotic therapy, the bleedingevent rates were not significantly different from those in patients not receiving antithrombotic therapy.
Asmaa Bakr,Kazuo Hara,Moaz Elshair,Shin Haba,Takamichi Kuwahara,Nozomi Okuno,Daiki Fumihara,Takafumi Yanaidani,Samy Zaky,Hanaa Omar 대한소화기내시경학회 2023 Clinical Endoscopy Vol.56 No.3
Background/Aims: Endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) using oblique-view EUS in patients with a surgically altered anatomy (SAA) of the upper gastrointestinal tract is limited because of difficult scope insertion due to the disturbed anatomy. This study aimed to investigate the efficiency of forward-view (FV)-EUS in performing FNA in patients with a SAA. Methods: We retrospectively investigated 32 patients with a SAA of the upper gastrointestinal tract who visited Aichi Cancer Center Hospital in Nagoya, Japan, between January 2014 and December 2020. We performed upper gastrointestinal EUS-FNA using FV-EUS combined with fluoroscopic imaging to confirm tumor recurrence or to make a decision before chemotherapy or after a failure of diagnosis by radiology. Results: We successfully performed EUS-FNA in all studied patients (100% technical success), with the specificity, sensitivity, and accuracy of 100%, 87.5%, and 87.8%, respectively, with no complications. Conclusions: EUS-FNA using FV-EUS combined with fluoroscopic imaging is an effective and safe technique for tissue acquisition in patients with a SAA.
Tsukasa Yasuda,Kazuo Hara,Nobumasa Mizuno,Shin Haba,Takamichi Kuwahara,Nozomi Okuno,Yasuhiro Kuraishi,Takafumi Yanaidani,Sho Ishikawa,Masanori Yamada,Toshitaka Fukui 대한소화기내시경학회 2024 Clinical Endoscopy Vol.57 No.2
Background/Aims: Endoscopic ultrasound (EUS)-guided hepaticogastrostomy (EUS-HGS) is useful for patients with biliary cannulation failure or inaccessible papillae. However, it can lead to serious complications such as bile peritonitis in patients with ascites; therefore, development of a safe method to perform EUS-HGS is important. Herein, we evaluated the safety of EUS-HGS with continuous ascitic fluid drainage in patients with ascites. Methods: Patients with moderate or severe ascites who underwent continuous ascites drainage, which was initiated before EUS-HGS and terminated after the procedure at our institution between April 2015 and December 2022, were included in the study. We evaluated the technical and clinical success rates, EUS-HGS-related complications, and feasibility of re-intervention. Results: Ten patients underwent continuous ascites drainage, which was initiated before EUS-HGS and terminated after completion of the procedure. Median duration of ascites drainage before and after EUS-HGS was 2 and 4 days, respectively. Technical success with EUS-HGS was achieved in all 10 patients (100%). Clinical success with EUS-HGS was achieved in 9 of the 10 patients (90%). No endoscopic complications such as bile peritonitis were observed. Conclusions: In patients with ascites, continuous ascites drainage, which is initiated before EUS-HGS and terminated after completion of the procedure, may prevent complications and allow safe performance of EUS-HGS.