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Matsunami Y, Itoi T, Tsuchiya T, Ishii K, Tanaka R, Tonozuka R, Mukai S, Nagai K, Yamamoto K, Asai Y, Kurosawa T, Kojima H, Minami H, Homma T, Joyama E, Sofuni A. Objective evaluation of the resistance forces of 22-gauge EUS-FNA and fine-needle biopsy needles. Endosc Ultrasound 2023; 12:251-258. [PMID: 37148137 PMCID: PMC10237597 DOI: 10.4103/eus-d-22-00059] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 11/06/2022] [Indexed: 05/07/2023] Open
Abstract
Background and Objectives EUS-guided tissue acquisition is routinely performed for the diagnosis of gastrointestinal tract and adjacent organ lesions. Recently, various types of needles have been developed. However, how the shape of the needle tip and echoendoscope tip angle affect puncturability, has not been clarified. The aim of this experimental study was to compare the puncturability of several 22-gauge EUS-FNA and EUS-guided fine-needle biopsy (EUS-FNB) needles, and to evaluate the effects of the needle tip shape and echoendoscope tip angle on tissue puncturability. Materials and Methods The following six major FNA and FNB needles were evaluated: SonoTip® ProControl, EZ Shot 3 Plus, Expect™ Standard Handle, SonoTip® TopGain, Acquire™, and SharkCore™. The mean maximum resistance force against needle advancement was evaluated and compared under several conditions using an echoendoscope. Results The mean maximum resistance force of the needle alone was higher for the FNB needles than for the FNA needles. The mean maximum resistance force of the needle in the echoendoscope with free angle demonstrated that the resistance forces were between 2.10 and 2.34 Newton (N). The mean maximum resistance force increased upon increases in angle of the tip of echoendoscope, particularly in the FNA needles. Among the FNB needles, SharkCore™ had the lowest resistance force (2.23 N). The mean maximum resistance force of the needle alone, the needle in the echoendoscope with free angle, and the needle in the echoendoscope with full-up angle for SonoTip® TopGain were all similar to that of Acquire™. Conclusion SonoTip® TopGain had similar puncturability to Acquire™ in all tested situations. Regarding the puncturability, SharkCore™ is most suitable for insertion into target lesions, when tight echoendoscope tip angle is necessary.
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Tonozuka R, Itoi T, Nagai K, Sofuni A, Tsuchiya T, Ishii K, Tanaka R, Mukai S, Minami H, Yamamoto K. A novel peroral digital cholangioscope with a large accessory channel: An experimental study. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2023; 30:401-407. [PMID: 36043228 DOI: 10.1002/jhbp.1231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 07/27/2022] [Accepted: 08/07/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND/PURPOSE A peroral cholangioscope (POCS) can allow direct visualization of the biliary mucosa and its use is becoming more widespread due to improvements in functionality, image quality, and operability, as well as the development of related devices. Recently, a novel mother-baby peroral cholangioscope (nMB-POCS) with a large (2-mm) accessory channel has been developed. In this study, we evaluated the feasibility of this novel POCS in a dry simulation and animal model. METHODS We evaluated the ease of insertion and maneuverability of the nMB-POCS, the image quality, and the passage of the devices into the accessory channel and into the common bile duct in a dry and live porcine model. RESULTS In both models, the nMB-POCS could be easily inserted into the duodenoscope and into the distal bile duct and hilum. The image quality was good, and it was possible to observe the surface structure and the vascular network of the bile duct mucosa in detail. CONCLUSIONS The nMB-POCS with its larger accessory channel is expected to improve the efficiency of diagnosis and treatment, and reduce the procedure time. Clinical studies in patients are warranted.
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Mukai S, Itoi T, Tsuchiya T, Ishii K, Tanaka R, Tonozuka R, Sofuni A. Urgent and emergency endoscopic retrograde cholangiopancreatography for gallstone-induced acute cholangitis and pancreatitis. Dig Endosc 2023; 35:47-57. [PMID: 35702927 DOI: 10.1111/den.14379] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 06/13/2022] [Indexed: 01/17/2023]
Abstract
Urgent or emergency endoscopic retrograde cholangiopancreatography (ERCP) is indicated for gallstone-induced acute cholangitis and pancreatitis. The technique and optimal timing of ERCP depend on the disease state, its severity, anatomy, patient background, and the institutional situation. Endoscopic transpapillary biliary drainage within 24 h is recommended for moderate to severe acute cholangitis. The clinical outcomes of biliary drainage with nasobiliary drainage tube placement and plastic stent placement are comparable, and the choice is made on a case-by-case basis considering the advantages and disadvantages of each. The addition of endoscopic sphincterotomy (EST) is basically not necessary when performing drainage alone, but single-session stone removal following EST is acceptable in mild to moderate cholangitis cases without antithrombotic therapy or coagulopathy. For gallstone pancreatitis, early ERCP/EST are recommended in cases with impacted gallstones in the papilla. In some cases of gallstone pancreatitis, a gallstone impacted in the papilla has already spontaneously passed into the duodenum, and early ERCP/EST lacks efficacy in such cases, with unfavorable findings of cholangitis or cholestasis. If it is difficult to diagnose the presence of gallstones impacted in the papilla on imaging, endoscopic ultrasonography can be useful in determining the indication for ERCP.
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Mukai S, Itoi T, Kojima H. Over-the-scope clip closure of a pancreaticocolonic fistula with walled-off necrosis after necrotizing pancreatitis using a rendezvous technique. Dig Endosc 2023; 35:e24-e25. [PMID: 36437606 DOI: 10.1111/den.14469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 11/08/2022] [Indexed: 11/29/2022]
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Mukai S, Itoi T, Tsuchiya T, Ishii K, Tonozuka R, Nagakawa Y, Kozono S, Takishita C, Osakabe H, Sofuni A. Clinical feasibility of endoscopic ultrasound-guided biliary drainage for preoperative management of malignant biliary obstruction (with videos). JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2022. [PMID: 36458423 DOI: 10.1002/jhbp.1292] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 11/18/2022] [Accepted: 11/26/2022] [Indexed: 12/04/2022]
Abstract
BACKGROUND/PURPOSE EUS-guided biliary drainage (EUS-BD) has recently been reported to be a useful salvage technique after ERCP fail. However, data on EUS-BD used for preoperative biliary drainage (PBD) are limited. The aim of this study was to verify the clinical feasibility of EUS-BD for PBD. METHODS PBD was performed for malignant biliary obstruction in 318 patients at our institution between July 2014 and April 2022. Fifteen (4.7%) of these patients underwent surgical resection after preoperative EUS-BD (HGS 13; HDS 1; AGS with HGS 1) and were retrospectively analyzed. RESULTS The stent was successfully placed in all 15 cases with a median procedure time of 15 min (technical success rate 100%). The median total bilirubin value decreased significantly from 3.7 before drainage to 0.9 after surgery (p < .001) and cholangitis was well managed (clinical success rate 100%). Surgery was performed at a median of 22 days after drainage, and there were no stent-related adverse events or recurrences of biliary obstruction. Severe surgery-related adverse events occurred in three cases, but none were associated with EUS-BD. The stent was removed during surgery in 12 cases. CONCLUSIONS EUS-BD can be a feasible and safe alternative method of PBD for malignant biliary obstruction after ERCP fail.
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Yamamoto K, Tsuchiya T, Tonozuka R, Mukai S, Kojima H, Hirakawa N, Itoi T. Successful biliary cannulation using the hybrid endoscopic ultrasound-guided rendezvous technique for bile duct stenosis after endoscopic papillectomy. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2022; 29:e119-e121. [PMID: 35593895 DOI: 10.1002/jhbp.1185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 03/28/2022] [Accepted: 04/05/2022] [Indexed: 12/24/2022]
Abstract
Management of papillary stenosis after endoscopic papillectomy is technically challenging. Yamamoto et al. report a case of successful biliary cannulation for bile duct stenosis after endoscopic papillectomy using the "guidewire placed in the scope" technique, which is a hybrid procedure that combines the advantages of conventional endoscopic ultrasound-guided rendezvous techniques.
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Yamamoto K, Mukai S, Tonozuka R, Asai Y, Matsunami Y, Hirakawa N, Itoi T. A novel self‐assembling hemostatic agent as an effective therapeutic tool for intracavitary bleeding from peripancreatic fluid collection after endoscopic ultrasonography‐guided drainage using a lumen‐apposing metal stent. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2022. [DOI: 10.1002/jhbp.1254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 08/24/2022] [Accepted: 09/16/2022] [Indexed: 11/05/2022]
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Tokutome M, Matsukawa R, Noma A, Kisanuki H, Nakashima H, Watanabe T, Sakemi T, Okabe K, Okahara A, Kawai S, Matsuura H, Masuda S, Mukai S. Aggressive combined pharmacotherapy for heart failure reduces new onset atrial fibrillation. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Backgrounds
Heart failure (HF) is a risk factor for new onset atrial fibrillation (AF), and the new onset AF is associated with a worse prognosis in HF patients. It has been reported that renin-angiotensin system inhibitor (RASi), β-blocker and mineral-corticoid receptor antagonist (MRA) prevent the new onset AF in HF patients. However, the effect of combined pharmacotherapy including angiotensin receptor neprilysin inhibitor (ARNI) and sodium glucose co-transporter 2 inhibitor (SGLT2i) on AF is unknown. We investigated the impact of contemporary regimen of combined pharmacotherapy for HF (RASi/ARNI+β-blocker+MRA+SGLT2i) on new onset AF.
Methods and results
We retrospectively studied rEF and mrEF patients without AF admitted to our hospital due to decompensated HF between 2015 and 2021 (n=366). Long-term (The mean follow-up was 635±421 days) incidence of new onset AF was investigated with regard to medical therapies. Patients were divided into 2 groups; patients with ≤2 HF drugs (n=181) and patients with ≥3 HF drugs (n=185). Patients with ≤2 HF drugs group were older (77.3 vs 67.0 years old, P<0.001), had a poorer renal function (Cre: 1.66 vs 1.09 mg/dl, P<0.001), and had a higher rate of ischemic heart disease (52 vs 38%, P=0.009), whereas left ventricular systolic function was better (EF: 31.9 vs 27.3%, P<0.001). There were 19 (10.5%) new onsets AF in the ≤2 HF drugs group, whereas only 7 (3.8%) had new onsets AF in the ≥3 HF drugs group (HR 0.36, 95% CI 0.15–0.85, P=0.01). All-cause death and hospitalization for HF were fewer in the ≥3 HF drugs group. A multivariate analysis revealed that ≥3 HF drugs use was an independent negative predictor of new onset AF (HR 0.37, 95% CI 0.15–0.93, P=0.03). Even after a propensity score matching of the clinical variables, the incidence of new onset AF was consistently fewer in the ≥3 HF drugs group (HR 0.36, 95% CI 0.13–0.99, P=0.04). Finally, patients with new onset AF had a higher rate of hospitalization for HF in the studied population (HR 9.68, 95% CI 5.67–16.5, P<0.01).
Conclusion
Aggressive combined pharmacotherapy for HF may be associated with fewer new onset AF in patients with HF.
Funding Acknowledgement
Type of funding sources: None.
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Mukai S, Itoi T. Expanding minimally invasive treatment approaches for refractory large walled-off necrosis after necrotizing pancreatitis. Dig Endosc 2022; 34:1253-1254. [PMID: 35855636 DOI: 10.1111/den.14380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 06/15/2022] [Indexed: 02/08/2023]
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Mukai S, Itoi T, Matsunami Y. Hybrid lithotripsy with endoscopic ultrasound-guided antegrade intervention and balloon enteroscopy-assisted endoscopic retrograde cholangiopancreatography for stacked bile duct stones. Dig Endosc 2022; 34:e92-e93. [PMID: 35483650 DOI: 10.1111/den.14296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/26/2022] [Accepted: 03/06/2022] [Indexed: 02/08/2023]
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Honda H, Yamamoto K, Sofuni A, Sugimoto K, Furuichi Y, Tsuchiya T, Ishii K, Tanaka R, Tonozuka R, Mukai S, Nagai K, Asai Y, Matsunami Y, Kurosawa T, Kojima H, Homma T, Minami H, Nakatsubo R, Hirakawa N, Matsubayashi J, Itoi T. Two Cases of Hemorrhagic Ampullary Lesions Successfully Treated by Endoscopic Papillectomy. Intern Med 2022; 61:1843-1848. [PMID: 34866100 PMCID: PMC9259823 DOI: 10.2169/internalmedicine.8294-21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
We herein report two cases of hemorrhagic ampullary lesions in which endoscopic papillotomy was performed to control bleeding and resulted in successful treatment. Both patients were pathologically diagnosed with an underlying pathology characterized by inflammatory cell infiltration and capillary proliferation. They also had disposing factors for bleeding, such as antithrombotic therapy and idiopathic thrombocytopenic purpura. Endoscopic treatment was selected because the risk of surgical resection was high due to the patients' hemorrhagic condition. Both patients were successfully treated without any serious adverse events and had an uneventful postoperative course with no relapse of bleeding.
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Yamamoto K, Sofuni A, Mukai S, Matsunami Y, Kojima H, Hirakawa N, Itoi T. Use of a novel self-assembling hemostatic gel as a complementary therapeutic tool for endoscopic sphincterotomy-related bleeding. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2022; 29:e81-e83. [PMID: 35561096 DOI: 10.1002/jhbp.1166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 02/25/2022] [Accepted: 04/02/2022] [Indexed: 11/07/2022]
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Sofuni A, Asai Y, Mukai S, Yamamoto K, Itoi T. High-intensity focused ultrasound therapy for pancreatic cancer. J Med Ultrason (2001) 2022:10.1007/s10396-022-01208-4. [PMID: 35551555 DOI: 10.1007/s10396-022-01208-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 03/01/2022] [Indexed: 11/28/2022]
Abstract
Pancreatic cancer (PC) has one of the poorest prognoses among solid cancers, and its incidence has increased recently. Satisfactory outcomes are not achieved with current therapies; thus, novel treatments are urgently needed. High-intensity focused ultrasound (HIFU) is a novel therapy for ablating tissue from the outside of the body by focusing ultrasonic waves from multiple sources on the tumor. In this therapy, only the focal area is heated to 80-100 ºC, which causes coagulative necrosis of the tissue, with hardly any impact on the tissue outside the focal area. Although HIFU is a minimally invasive treatment and is expected to be useful, it is not yet generally known. Here, we discuss the usefulness of HIFU treatment for un-resectable advanced PC using the results of previous research, meta-analyses, and systematic reviews on its efficacy and safety. HIFU therapy for un-resectable PC is useful for its anti-tumor effect and pain relief, and is expected to prolong survival time and improve quality of life. Although HIFU for PC has several limitations and further study is needed, this technique can be safely performed on un-resectable advanced PC. In future, HIFU could be utilized as a minimally invasive treatment strategy for PC patients with a poor prognosis.
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Takada T, Isaji S, Mayumi T, Yoshida M, Takeyama Y, Itoi T, Sano K, Iizawa Y, Masamune A, Hirota M, Okamoto K, Inoue D, Kitamura N, Mori Y, Mukai S, Kiriyama S, Shirai K, Tsuchiya A, Higuchi R, Hirashita T. JPN clinical practice guidelines 2021 with easy-to-understand explanations for the management of acute pancreatitis. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2022; 29:1057-1083. [PMID: 35388634 DOI: 10.1002/jhbp.1146] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 02/02/2022] [Accepted: 02/08/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND In preparing the Japanese (JPN) guidelines for the management of acute pancreatitis 2021, the committee focused the issues raised by the results of nationwide epidemiological survey in 2016 in Japan METHOD: In addition to a systematic search using the previous JPN guidelines, papers published from January 2014 to September 2019 were searched for the contents to be covered by the guidelines based on the concept of GRADE system. RESULTS Thirty-six clinical questions (CQ) were prepared in 15 subject areas. Base on the facts that patients diagnosed with severe disease by both Japanese prognostic factor score and contrast-enhanced CT grade had a high fatality rate and that little prognosis improvement after 2 weeks of disease onset was not obtained, we emphasized the importance of Pancreatitis Bundles, which was shown to be effective in improving prognosis, and the CQ sections for local pancreatic complications had been expanded to ensure adoption of a step-up approach. Furthermore, on the facts that enteral nutrition for severe acute pancreatitis was not started early within 48 hours of admission and that unnecessary prophylactic antibiotics was used in almost all cases, we emphasized early enteral nutrition in small amounts even if gastric feeding is used and no prophylactic antibiotics in mild pancreatitis. CONCLUSION All the members of the committee have put a lot of effort into preparing the extensively revised guidelines in the hope that more people will have a common understanding and that better medical care will be spread.
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Yamamoto K, Itoi T, Nagata N, Sofuni A, Tsuchiya T, Ishii K, Tanaka R, Tonozuka R, Mukai S, Nagai K, Asai Y, Matsunami Y, Matsubayashi J, Nagakawa Y. Optimal mode and power output of electrosurgical units for endoscopic papillectomy based on animal experiments and a preliminary clinical study (with videos). Gastrointest Endosc 2022; 95:760-776. [PMID: 34678300 DOI: 10.1016/j.gie.2021.10.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 10/12/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS The optimal electrosurgical unit (ESU) settings for endoscopic papillectomy (EP) have not been investigated. We conducted animal experiments to determine the optimal endoCUT settings with VIO (Erbe, Tübingen, Germany) ESUs and then conducted a small clinical study. METHODS Dedicated animal experimental models were created. To investigate the incision force, chicken meat was resected with a snare whose handle was a hung weight. To investigate the coagulation effect, a surgical needle electrode was inserted into a pig liver and energized, and to determine changes over time in the coagulation status, simulated EP was performed using a living pig. These experiments were performed using the knife-setting or snare-setting endoCUT modes and various effect, duration, and interval settings and compared with results for ICC (Erbe) ESUs. Based on the results, we performed EP in a small number of patients. RESULTS The main factor affecting the incision force was duration. The coagulation effect was related to not only effect but also duration. In the endoCUT mode, knife-setting produced a higher incision force and lower coagulation effect. The nondischarge coagulation effect may cause deep ulceration. Based on the animal experiments, we concluded the ideal ESU setting for EP, "VIO EP mode," is knife-setting with high duration, lowest effect, and low interval settings. In the clinical study, there were no significant adverse events such as bleeding, pancreatitis, or perforation. CONCLUSIONS "VIO EP mode" seems to afford optimal papillectomy. Larger scale clinical studies are needed to accumulate further data and make clinical comparisons with the ICC ESU.
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Yamamoto K, Tsuchiya T, Tonozuka R, Mukai S, Kojima H, Hirakawa N, Itoi T. Endoscopic ultrasound-guided gastrojejunostomy for malignant afferent loop syndrome with hemorrhage in a patient with recurrent peritoneal dissemination. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2022; 29:e65-e67. [PMID: 35322941 DOI: 10.1002/jhbp.1132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 01/26/2022] [Accepted: 01/28/2022] [Indexed: 11/09/2022]
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Nagai K, Itoi T, Mukai S, Tsuchiya T, Ishii K, Tonozuka R, Matsunami Y, Nakatsubo R, Joyama E, Sofuni A. Single-session Endoscopic Ultrasound-guided Hepaticogastrostomy and Pancreatic Duct Drainage for Concomitant Biliary and Pancreatic Duct Stones in a Patient with a Surgically Altered Anatomy. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2022; 29:e57-e58. [PMID: 35302713 DOI: 10.1002/jhbp.1137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 01/13/2022] [Accepted: 01/19/2022] [Indexed: 11/09/2022]
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Mukai S, Itoi T. Towards establishment of an endoscopic treatment strategy for pancreatic fluid collection in the era of the lumen-apposing metal stent. Dig Endosc 2022; 34:459-461. [PMID: 34528286 DOI: 10.1111/den.14125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Tonozuka R, Mukai S, Itoi T. Long-term precautions after endoscopic ultrasound-guided transmural drainage for pancreatic fluid collection. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2022; 29:e39-e40. [PMID: 35038789 DOI: 10.1002/jhbp.1115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 11/25/2021] [Accepted: 12/14/2021] [Indexed: 11/06/2022]
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Mukai S, Itoi T, Tsuchiya T, Ishii K, Tanaka R, Tonozuka R, Furuichi Y, Joyama E, Miyazawa H, Sofuni A. Experimental study of a physician-controlled electrocautery-enhanced delivery system incorporating a newly developed lumen-apposing metal stent for interventional endoscopic ultrasound (with videos). JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2022; 29:817-824. [PMID: 35030302 DOI: 10.1002/jhbp.1113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 12/09/2021] [Accepted: 12/16/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND/PURPOSE Although the lumen-apposing metal stent (LAMS) is useful for interventional endoscopic ultrasound (EUS) procedures, there has been some concern about the potential for stent-induced adverse events because of the high lumen-apposing force. A newly designed LAMS with less lumen-apposing force has been developed for use with a physician-controlled electrocautery-enhanced delivery system. The aim of this animal study was to evaluate the feasibility of performing interventional EUS using this newly designed LAMS system. METHODS EUS-guided cystogastrostomy was performed using the novel LAMS 3 times in a wet simulation model. EUS-guided gastroenterostomy and EUS-guided gallbladder drainage were then performed using the system in 4 pigs. RESULTS The LAMS was successfully placed in all 3 EUS-guided cystogastrostomy procedures using the wet simulation model and in all 4 EUS-guided gastroenterostomy and gallbladder drainage procedures in the animal model. In the 3 weeks following the procedure, eating behavior was normal in all animals and there were no adverse events. The stents remained patent during this time and were removed without difficulty. The fistula was mature in all cases and a standard upper gastrointestinal endoscope was easily advanced via the fistula to observe the afferent and efferent loops or the lumen of the gallbladder. Necropsy confirmed complete adhesion between the stomach and the wall of the jejunum or gallbladder. CONCLUSIONS Our study findings demonstrate the feasibility of this new LAMS system and its potential clinical value for interventional EUS.
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Yamamoto K, Itoi T, Tsuchiya T, Tonozuka R, Mukai S, Kojima H, Sugimoto K. Intraductal radiofrequency ablation therapy for eradication of intraductal residual lesions after endoscopic papillectomy for ampullary adenoma. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2022; 29:e112-e115. [PMID: 34995406 DOI: 10.1002/jhbp.1108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 11/26/2021] [Accepted: 12/16/2021] [Indexed: 11/09/2022]
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Mukai S, Itoi T. [Up-to-date on the treatment of local complications after acute pancreatitis]. NIHON SHOKAKIBYO GAKKAI ZASSHI = THE JAPANESE JOURNAL OF GASTRO-ENTEROLOGY 2022; 119:721-732. [PMID: 35944990 DOI: 10.11405/nisshoshi.119.721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
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Nagai K, Sofuni A, Tsuchiya T, Kono S, Ishii K, Tanaka R, Tonozuka R, Mukai S, Yamamoto K, Matsunami Y, Asai Y, Kurosawa T, Kojima H, Yamaguchi H, Nagao T, Itoi T. Efficacy of the Franseen needle for diagnosing gastrointestinal submucosal lesions including small tumors. Endosc Ultrasound 2021; 10:424-430. [PMID: 34975040 PMCID: PMC8785670 DOI: 10.4103/eus-d-21-00035] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background and Objectives: Several studies have demonstrated that EUS-guided fine-needle biopsy (EUS-FNB) is useful for diagnosing gastrointestinal subepithelial lesions (GI SELs). However, there is limited evidence regarding the use of Franseen needles during EUS-FNB for patients with GI SELs. In addition, the optimal approach for diagnosing small SELs is unclear. This study aimed to evaluate whether EUS-FNB using a Franseen needle was effective for diagnosing GI SELs, including small lesions. Methods: Between January 2013 and January 2020, 150 consecutive patients with GI SELs underwent EUS-FNA/FNB to achieve a histological diagnosis. Eighty-six consecutive patients who underwent EUS-FNB using a Franseen needle were compared to 64 patients who underwent EUS-FNA using a conventional needle. Results: The diagnostic yield was significantly higher using a Franseen needle than using a conventional needle (85% vs. 75%, P = 0.006). Furthermore, in cases with SELs that were <20 mm, the diagnostic yield was significantly higher using a Franseen needle than using a conventional needle (81% vs. 45%; P = 0.003). Multivariate analysis revealed that obtaining a sufficient diagnostic sample was independently predicted by Franseen needle use (adjusted odds ratio: 2.8, 95% confidence interval: 1.2–6.3; P = 0.01) and tumor size of >20 mm (adjusted odds ratio: 3.4, 95% confidence interval: 1.4–8.2; P = 0.006). Conclusion: Even when attempting to diagnose small GI SELs, EUS-FNB using a Franseen needle appears to provide a more efficient acquisition of true histological core tissue than using a conventional needle.
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Shionoya K, Tonozuka R, Itoi T, Sofuni A, Tsuchiya T, Ishii K, Tanaka R, Mukai S, Nagai K, Yamamoto K, Nakamura I. Severe Acute Cholangitis and Bacteremia Due to Campylobacter jejuni: A Case Report and Review of the Literature. Intern Med 2021; 60:3737-3741. [PMID: 34024858 PMCID: PMC8710384 DOI: 10.2169/internalmedicine.7380-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Campylobacter jejuni is common cause of enteritis, but biliary infection rarely reported. An 82-year-old woman with pancreatic head cancer underwent endoscopic biliary drainage for malignant biliary obstruction. She was subsequently admitted for management of diarrhea. C. jejuni was identified in stool culture. Her symptoms resolved temporarily without antibiotics but flared up with a fever a few days later. She was diagnosed with acute cholangitis and bacteremia with C. jejuni. Endoscopic biliary drainage and antimicrobial administration improved her symptoms. As complications of C. jejuni diarrhea are rare, antibiotics are not necessarily indicated but sometimes are needed to prevent complications.
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Yamamoto K, Itoi T, Iwasaki E, Tsuchiya T, Ishii K, Tonozuka R, Mukai S, Nagai K, Kitagawa Y. Endoscopic papillectomy for tumors of the minor duodenal papilla: A case series of six patients and literature review. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2021; 29:1142-1150. [PMID: 34826213 DOI: 10.1002/jhbp.1084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 09/24/2021] [Accepted: 10/28/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND/PURPOSE Various tumors of the minor duodenal papilla have been reported, most of which are treated by laparotomy. Although early-stage tumors of the major papilla are increasingly being treated by endoscopic resection with relative ease and low invasiveness, there are only a few reports on endoscopic resection of tumors in the minor papilla. METHODS Six patients with tumors in the minor papilla were treated by endoscopic papillectomy (EP), and their clinical and histopathological data were analyzed retrospectively. RESULTS The final pathological diagnoses were carcinoma in adenoma in two patients and adenoma, neuroendocrine neoplasm (G1), hyperplastic lesion, and no neoplastic lesion (disappearance of adenoma after biopsy) in one patient each. En bloc resection was performed in five patients and piecemeal resection in one patient. There were no procedure-related adverse events, such as bleeding, pancreatitis, or perforation. There was one case with a residual lesion, which was treated by ablation therapy, and no recurrences during a mean follow-up of 12 ± 10.33 months (maximum, 28 months) from the date of EP. CONCLUSIONS Endoscopic papillectomy appears to be an effective minimally invasive treatment for ampullary tumors of the minor duodenal papilla.
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