Takashi Adachi

Nagoya University, Nagoya, Aichi, Japan

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Publications (7)30.51 Total impact

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    ABSTRACT: New InsightsSESSION TYPE: Original Investigation SlidePRESENTED ON: Sunday, October 27, 2013 at 04:15 PM - 05:15 PMPURPOSE: The purpose of this study was to compare the tolerance, efficacy and safety of EBUS-TBNA versus EUS-B-FNA for the diagnosis of hilar/mediastinal/parenchymal lesions which can be accessible through both the trachea/bronchus and esophagus.METHODS: One hundred ten patients who had hilar/mediastinal/parenchymal lesions adjacent to both the trachea/bronchus and esophagus were enrolled in this study and randomized to undergo EBUS-TBNA or EUS-B-FNA under local anesthesia with lidocaine and conscious sedation with intravenous midazolam. Patients quantified tolerance and operators charted the quality of examination using a 100-mm visual analogue scale (VAS).RESULTS: The specific diagnosis was made in 50 of 55 patients (91%) in the EBUS-TBNA group and in 48 of 55 patients (87%) in the EUS-B-FNA group. EUS-B-FNA was associated with shorter duration of the procedure (mean 16 min vs 12 min, p < 0.001), lower doses of midazolam (mean 4.3 vs 4 mg, p = 0.047) and lidocaine (mean 306 vs 189 mg, p < 0.001), less frequent oxygen desaturations (23/55 vs 2/55, p < 0.001), lower scores of cough (p = 0.04), pain (p = 0.03), dyspnea (p = 0.02) according to the patient's VAS, and higher operator's satisfaction according to the operator's VAS (p = 0.001), compared with EBUS-TBNA. There was no significant difference in patient's comfort, satisfaction, vomiting and willingness to have a repeat procedure, according to the patient's VAS. Mediastinal abscess occurred in 1 of the EBUS-TBNA group and 2 of the EUS-B-FNA group.CONCLUSIONS: Both EBUS-TBNA and EUS-B-FNA provide high accuracy with good tolerance, though the occurrence of infectious complications should be monitored carefully. EUS-B-FNA has the advantage of less frequent respiratory symptoms or oxygen desaturations during the procedure.CLINICAL IMPLICATIONS: EUS-B-FNA may be a useful alternative to EBUS-TBNA in the diagnosis of lesions located adjacent to both the trachea/bronchus and esophagus.DISCLOSURE: The following authors have nothing to disclose: Masahide Oki, Hideo Saka, Chiyoe Kitagawa, Yoshihito Kogure, Misaki Ryuge, Saori Oka, Takashi Adachi, Rie Tsuboi, Masashi Nakahata, Kazumi Hori, Masahiko AndoNo Product/Research Disclosure Information.
    Chest 10/2013; 144(4_MeetingAbstracts):822A. · 7.13 Impact Factor
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    ABSTRACT: Background: Although rapid on-site cytologic evaluation (ROSE) is widely used during endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), its role remains unclear. Objectives: The purpose of the present study was to evaluate the efficacy of ROSE during EBUS-TBNA in the diagnosis of lung cancer. Methods: One hundred and twenty patients highly suspected of having lung cancer who had hilar/mediastinal lymphadenopathy or a tumor adjacent to the central airway were enrolled in this study and randomized to undergo EBUS-TBNA with or without ROSE. Results: Twelve patients with visible endobronchial lesions were excluded in the analysis. Thus, a total of 108 patients (55 in the ROSE group, 53 in the non-ROSE group) were analyzed. Additional procedures including EBUS-TBNA for lesions other than the main target lesion and/or transbronchial biopsy in the same setting were performed in 11% of patients in the ROSE group and 57% in the non-ROSE group (p < 0.001). Mean puncture number was significantly lower in the ROSE group (2.2 vs. 3.1 punctures, p < 0.001), and mean bronchoscopy time was similar between both groups (22.3 vs. 22.1 min, p = 0.95). The sensitivity and accuracy for diagnosing lung cancer were 88 and 89% in the ROSE group, and 86 and 89% in the non-ROSE group, respectively. No complications were associated with the procedures. Conclusions: ROSE during EBUS-TBNA is associated with a significantly lower need for additional bronchoscopic procedures and puncture number.
    Respiration 04/2013; · 2.92 Impact Factor
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    ABSTRACT: Background: Several studies have reported that specimens from mediastinal lesions located adjacent to the esophagus can be sampled using an ultrasound bronchoscope instead of an ultrasound endoscope. Objectives: The aim of this study was to evaluate the diagnostic utility of transesophageal bronchoscopic ultrasound-guided fine needle aspiration using an ultrasound bronchoscope in patients with stage I/II sarcoidosis. Methods: Thirty-three patients suspected of having stage I/II sarcoidosis were included in this prospective study. Needle aspiration through the esophagus using an ultrasound bronchoscope was performed for hilar and/or mediastinal lymph nodes. The final diagnosis of sarcoidosis was based on clinicoradiological compatibility and pathological findings. Results: A total of 62 lymph nodes with a mean shortest diameter of 13.6 mm were examined. Of the 33 patients enrolled, 29 were given a final diagnosis of sarcoidosis. Four of the residual patients had other diseases (1 lung cancer, 1 tuberculosis, 2 non-specific lymphadenitis). Transesophageal bronchoscopic ultrasound-guided fine needle aspiration showed noncaseating epithelioid cell granulomas in 25 of 29 patients (86%; 95% confidence interval 73-100) with the final diagnosis of sarcoidosis. No complications were observed. Conclusions: Transesophageal bronchoscopic ultrasound-guided fine needle aspiration is feasible, safe and accurate for the diagnosis of stage I/II sarcoidosis.
    Respiration 12/2012; · 2.92 Impact Factor
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    ABSTRACT: SESSION TYPE: Therapeutic BronchoscopyPRESENTED ON: Sunday, October 21, 2012 at 01:15 PM - 02:45 PMPURPOSE: The purpose of this study was to evaluate the feasibility, efficacy, and safety of a novel silicone stent designed for treating airway stenosis around the carina between the bronchus to the right upper lobe and bronchus intermedius (primary right carina).METHODS: We recruited 16 patients for whom we suspected stenosis around the primary right carina. Of the 16 patients, 10 met inclusion criteria for inserting the study stent. All stenting procedures were performed with a flexible and rigid bronchoscope under general anesthesia.RESULTS: The study stent could be placed on the primary right carina in all 10 patients. Five patients underwent stenting using only the study stent, and the other 5 underwent stenting with the study stent on the primary right carina and a silicone Y-stent on the main carina. The dyspnea index improved in 8 of 10 patients, including one mechanically-ventilated patient. Early complications occurred in 3 patients (temporary pneumonia in 2 and retention of secretions in 1), and a late complication occurred in 1 patient (granuloma formation).CONCLUSIONS: Stent placement with our novel silicone stent designed to fit on the primary right carina is feasible, effective and acceptably safe.CLINICAL IMPLICATIONS: Stenting with the novel silicone stent is promising for treating airway stenosis around the primary right carina.DISCLOSURE: The following authors have nothing to disclose: Masahide Oki, Hideo Saka, Chiyoe Kotagawa, Yoshihito Kogure, Misaki Ryuge, Takashi Adachi, Saori Oka, Rie TsuboiThe prototype bifurcated silicone stents (total 10 stents) were provided to the authors by Novatech, La Ciotat, France. This stent is now available in the market in Europe.Nagoya Medical Center, Nagoya, Japan.
    Chest 10/2012; 142(4_MeetingAbstracts):862A. · 7.13 Impact Factor
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    ABSTRACT: No abstract available.
    Respiration 05/2012; 84(1):69. · 2.92 Impact Factor
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    ABSTRACT: In endobronchial ultrasound-guided transbronchial biopsy (EBUS-TBB), techniques using a thin bronchoscope or a guide sheath have been proposed for accurate biopsy instrument reinsertion into the bronchial route indicated by a radial ultrasonic probe. The purpose of this study was to compare the diagnostic yields of these techniques for peripheral pulmonary lesions. Patients with suspected peripheral pulmonary lesions were included in this prospective, randomized, noninferiority study and assigned to undergo EBUS-TBB under fluoroscopic guidance using a prototype 3.4-mm thin bronchoscope or a 4.0-mm bronchoscope with a guide sheath. A total of 205 patients were enrolled and randomized, of whom 203 patients (101 thin bronchoscopic method; 102 guide sheath method) were included in the analysis. Diagnostic histologic specimens were obtained in 65% (41% for benign and 75% for malignant lesions) of the thin bronchoscopy group and 62% (25% for benign and 71% for malignant lesions) of the guide sheath group. Diagnostic performance of the thin bronchoscopic method was confirmed to be noninferior to the guide sheath method (difference in diagnostic yields, 3.6%; 90% confidence interval, -7.5 to 14.7%). Mean procedure time was significantly shorter in the thin bronchoscopy group than the guide sheath group (27 versus 33 minutes; p = 0.002). Complications including pneumothorax, moderate bleeding, and pneumonia occurred in 5% and 2% in the respective groups (p = 0.28). EBUS-TBB using the thin bronchoscope was noninferior to the guide sheath method for the diagnosis of peripheral pulmonary lesions and was associated with shorter procedural time.
    Journal of thoracic oncology: official publication of the International Association for the Study of Lung Cancer 12/2011; 7(3):535-41. · 4.55 Impact Factor
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    ABSTRACT: The silicone stent has been widely used to re-establish airway patency for patients with airway stenosis. The ideal shape of the stent should be well adapted to the tracheobronchial anatomic structures, and its optimal length should cover the entire inner wall of the stenotic airway. Although the silicone Y-stent was developed as a dedicated prosthesis for main carinal stenosis, we often encounter patients with tracheobronchial stenosis that cannot be treated by a single silicone Y-stent. The present study reports 2 cases of malignant disease who underwent double Y-stent placement on the involved carina between the right upper lobe bronchus and the bronchus intermedius as well as on the involved main carina as a unit. The procedure provided successful palliation.
    Respiration 05/2009; 79(3):245-9. · 2.92 Impact Factor

Publication Stats

18 Citations
30.51 Total Impact Points

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Institutions

  • 2013
    • Nagoya University
      • Center for Advanced Medicine and Clinical Research
      Nagoya, Aichi, Japan
  • 2009–2012
    • National Hospital Organization Nagoya Medical Center
      • Department of Respiratory Medicine
      Nagoya, Aichi, Japan