Publications (82)168.92 Total impact
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Article: Therapeutic endoscopic retrograde cholangiography using a single-balloon enteroscope in patients with Roux-en-Y anastomosis.
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ABSTRACT: BACKGROUND: The aim of the present study was to evaluate the usefulness of a single-balloon enteroscope (SBE) including a newly developed short SBE (SIF-Y0004) for therapeutic endoscopic retrograde cholangiography (ERC) in patients with Roux-en-Y (R-Y) anastomosis. PATIENTS AND METHODS: Therapeutic ERC using a SBE was attempted in 19 cases (41 procedures) with R-Y anastomosis after gastrectomy. A standard SBE (working length of 200 cm, working channel of 2.8 mm) was used in 11 cases (Group L), and a short SBE (working length of 152 cm, working channel of 3.2 mm) was used in eight cases (Group S). RESULTS: Insertion of the scope up to the major papilla was achieved in 79% (15/19) of cases. Average insertion time was 37.0 ± 13.8 min (range, 19-62 min). Bile duct cannulation rate was 79% (11/14) after exclusion of the initial case in which scope exchange was unsuccessful. Average procedure time was78.8 ± 26.9 min (18-119 min). The scheduled therapeutic procedure was completed in 67% (10/15) of the cases (53% [10/19] on an intention-to-treat basis). Cardiorespiratory suppression due to sedative agents resulting in scope withdrawal developed in one procedure (2.4%; 1/41). Although there was no significant difference in therapeutic results between the two groups, the number of procedures was smaller (1.8 ± 1.3 vs 3.6 ± 3.1; P = 0.286) in Group S than in Group L. CONCLUSIONS: Therapeutic ERC using a SBE for patients with R-Y anastomosis is considered to be safe and effective. A short SBE appears to be promising for further improvement in therapeutic results.Digestive Endoscopy 01/2013; · 1.19 Impact Factor -
Article: Patent choledochoduodenal fistula created by endosonography-guided biliary drainage after migration of a metallic stent.
Digestive Endoscopy 01/2013; 25(1):84-5. · 1.19 Impact Factor -
Article: Metallic stent deployment in endosonography-guided biliary drainage: Long-term follow-up results in patients with bilio-enteric anastomosis.
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ABSTRACT: Background and Aim: Although reports on endosonography-guided biliary drainage (ESBD) have been increasing, only a few reports on deployment of a self-expandable metal stents (SEMS) have been reported. The aim of the present study was to evaluate the safety and efficacy of SEMS deployment in ESBD. Methods: Of 42 patients who underwent ESBD during the period from January 2007 to August 2011, 21 patients with unresectable malignant biliary obstruction in whom SEMS deployment had been attempted were included. In the first session, a plastic stent or SEMS was placed in a bilio-enteric anastomosis (BEA) method. SEMS was deployed with the one-step technique or with replacement of a plastic stent with a SEMS in the second session. The technical success, early and late complications, and stent patency of SEMS were evaluated. Results: One-step SEMS deployment was attempted in seven patients, and SEMS was deployed with stent exchange in 14. SEMS deployment was successful in all patients without any complications. Finally, SEMS was placed in a BEA method in 16 patients (extrahepatic bile duct, 13; intrahepatic bile duct, three), and with antegrade deployment in five. Late complications occurred in three patients who underwent deployment of SEMS in a BEA method (stent obstruction in two and reflux cholangitis in one). The mean stent patency period was 433 days. Conclusions: As SEMS deployment in ESBD is safe and provides long stent patency, a SEMS seems to be the stent of choice in ESBD for patients with unresectable malignant biliary obstruction in whom long survival is expected.Digestive Endoscopy 11/2012; 24(6):457-61. · 1.19 Impact Factor -
Article: Endoscopic papillectomy as a method of total biopsy for possible early ampullary cancer.
Digestive Endoscopy 07/2012; 24(4):291. · 1.19 Impact Factor -
Article: High b-value diffusion-weighted magnetic resonance imaging for gallbladder lesions: differentiation between benignity and malignancy.
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ABSTRACT: BACKGROUND: Recently, the clinical application of diffusion-weighted magnetic resonance imaging (DWI) has been expanding to abdominal organs. However, only a few studies on gallbladder diseases have been published. The aim of this study was to evaluate the usefulness and limitations of high b-value DWI for gallbladder diseases. METHODS: A total of 153 patients (mean age 60 ± 15 years, 78 males) who had undergone DWI for evaluating gallbladder wall thickening or polypoid lesions were included in this study. Of these 153 patients, 36 had gallbladder cancer and 117 had benign gallbladder diseases (67 chronic cholecystitis, 44 adenomyomatosis, four cholesterol polyp, one gallbladder adenoma, and one xanthogranulomatous cholecystitis). We evaluated the positive signal rate with DWI and the apparent diffusion coefficient (ADC) value of each disease. RESULTS: The positive signal rate with DWI was significantly higher in gallbladder cancer (78 %) than in benign gallbladder diseases (22 %) (p < 0.001). The mean ADC value of gallbladder cancer was (1.83 ± 0.69) × 10(-3) mm(2)/s and that of benign gallbladder diseases was (2.60 ± 0.54) × 10(-3) mm(2)/s (p < 0.001). Benign gallbladder diseases with acute cholecystitis or a history of that had a higher positive signal rate with DWI (p < 0.001) and a lower ADC value (p = 0.018) than those without such conditions. CONCLUSION: DWI can contribute to the improvement of the diagnostic capability for gallbladder wall thickening or polypoid lesions by compensating for weaknesses of other modalities by its many advantages, although cases with acute cholecystitis or such history sometimes show false-positive on DWI.Journal of Gastroenterology 05/2012; · 4.16 Impact Factor -
Article: Endoscopic treatment for biliary stricture secondary to chronic pancreatitis.
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ABSTRACT: The causes of benign biliary stricture include chronic pancreatitis, primary/immunoglobulin G4-related sclerosing cholangitis and complications of surgical procedures. Biliary stricture due to fibrosis as a result of inflammation is sometimes encountered in patients with chronic pancreatitis. Frey's procedure, which can provide pancreatic duct drainage with decompression of biliary stricture, can be an initial treatment for chronic pancreatitis with pancreatic and bile duct strictures with upstream dilation. When patients are high-risk surgical candidates or hesitate to undergo surgery, endoscopic treatment appears to be a potential second-line therapy. Placement of multiple plastic stents is currently considered to be the best choice as endoscopic treatment for biliary stricture due to chronic pancreatitis. Temporary placement with a fully covered metal stent has become an attractive option due to the lesser number of endoscopic retrograde cholangiopancreatography (ERCP) sessions and its large diameter. Further clinical trials comparing multiple placement of plastic stents with placement of a covered metal stent for biliary stricture secondary to chronic pancreatitis are awaited.Digestive Endoscopy 05/2012; 24 Suppl 1:17-21. · 1.19 Impact Factor -
Article: Prospective randomized controlled study comparing cell block method and conventional smear method for pancreatic juice cytology.
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ABSTRACT: To elucidate the diagnostic efficacy of the cell block (CB) method by comparing it with that of conventional smear cytology for pancreatic juice obtained by endoscopic retrograde cholangiopancreatography (ERCP) in a randomized controlled trial fashion. A total of 170 patients with pancreatic lesions suspicious of being malignant who underwent pancreatic juice collection without giving secretin under ERCP were enrolled in this study. After sampling, the pancreatic juice was randomized to the CB method (n = 85) or to smear cytology (n = 85). CB sections were subjected to hematoxylin-eosin, periodic acid Schiff-Alcian blue, and immunohistochemical stains. Both Papanicolaou stain and Giemsa stain were used for smear cytology. The final diagnosis was malignancy in 54 patients: pancreatic cancer, 45; intraductal papillary-mucinous carcinoma, six; and endocrine tumor, three. The number of patients with a cytological borderline malignancy in the CB group (3.5%) was significantly smaller than that in the smear group (27.1%) (P < 0.001). The diagnostic accuracy of the CB method and that of smear cytology were 76.5% (65/85) and 74.1% (63/85), respectively (P = 0.72), and their respective sensitivities were 50% (14/28) and 38.5% (10/26) (P = 0.39). The sensitivity of the CB method (88.9%) was better than that of smear cytology (42.9%) for invasive ductal carcinoma in the pancreas head (P = 0.048). The CB method using immunostaining for pancreatic juice cytology showed a much lower rate of equivocal borderline malignancy and a tendency for a higher diagnostic yield compared with smear cytology. Its diagnostic sensitivity, however, was not satisfactory except for pancreatic-head cancer.Digestive Endoscopy 05/2012; 24(3):168-74. · 1.19 Impact Factor -
Article: Temporary endosonography-guided biliary drainage for transesophageal placement of a metal stent in recurrent cholangiocarcinoma.
Digestive Endoscopy 05/2012; 24(3):191. · 1.19 Impact Factor -
Article: Autoimmune pancreatitis: with special reference to a localized variant
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ABSTRACT: In 2006, the Japan Pancreas Society revised the diagnostic criteria for autoimmune pancreatitis (AIP) so as to more clearly define its morphological, pathological, and immunological features, as follows: (1) diffuse or segmental narrowing of the main pancreatic duct with an irregular wall and diffuse or localized enlargement of the pancreas recognized by imaging studies; (2) high serum gamma globulin, IgG, or IgG4 levels, or the presence of autoantibodies; and (3) marked interlobular fibrosis and prominent infiltration of lymphocytes and plasma cells in the periductal area, occasionally with lymphoid follicles in the pancreas. Establishing a diagnosis of AIP has become easier with knowledge of its immunological abnormalities, including serum IgG4 levels. However, the localized form of AIP sometimes mimics pancreatic cancer. The rate of focal mass formation in patients with AIP is reportedly 24%–43%; however, there have been few reports on the histological findings of localized AIP, in contrast to mass-forming pancreatitis (MFP). Our review of patients who had undergone resection due to a preoperative diagnosis of MFP with possible cancer revealed 72% to be patients with localized AIP. For the discrimination of these conditions, it is important to recognize the characteristic ultrasonographic findings of AIP, i.e., (1) diffuse or localized enlargement and hypoechogenicity of the pancreas; (2) rarity of calcification, cystic lesions, and peripancreatic fluid collection; (3) thickened layer structure of the bile duct wall; (4) iso/hypervascularity in the swollen portion of the pancreas; (5) attenuation of pancreatic swelling and bile duct wall thickening after steroid therapy; and (6) multiple hypoechoic masses in various organs, including the pancreas. Contrast-enhanced endoscopic ultrasonography is potentially a useful tool in the differential diagnosis and for assessment of the efficacy of steroid therapy by enabling evaluation of the vascularity of the lesions. Along with the presence of IgG4-positive plasma cells, verification of obliterative phlebitis is highly specific for the histological diagnosis of AIP.Journal of Medical Ultrasonics 04/2012; 35(2):41-50. · 0.33 Impact Factor -
Article: [Pancreatic tumor: progress in diagnosis and treatment. Topics: I. Pancreatic carcinoma; 3. Differential diagnosis of pancreatic cancer].
Nihon Naika Gakkai Zasshi 01/2012; 101(1):17-28. -
Article: [Endoscopic approach to IPMN].
Nippon Shokakibyo Gakkai zasshi The Japanese journal of gastro-enterology 01/2012; 109(2):190-7. -
Article: Impact of technical modification of endoscopic papillectomy for ampullary neoplasm on the occurrence of complications.
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ABSTRACT: To evaluate the usefulness of a modified technique of endoscopic papillectomy (EP) for lessening the occurrence of complications. Indications for EP were adenoma or well-differentiated adenocarcinoma confined to the papilla of Vater (T1) without tumor spread into the bile/pancreatic duct. Sixteen patients underwent the modified technique, which consists of resection with the Endocut mode, followed by biliary/pancreatic sphincterotomy and stenting (Group A). Twelve patients who had undergone EP, using a cutting current, followed by pancreatic duct stenting were included as control (Group B). The frequency of complications and clinical outcomes were retrospectively compared between the two groups. Sixteen patients had adenoma, and 12 had adenocarcinoma. Early complications occurred in 36% of all patients (hemorrhage, 7; cholangitis, 3; perforation, 2; cholecystitis, 1). The frequency of early complications in Group A was significantly lower than that in Group B (6% vs 75%, odds ratio [OR] 0.022, 95% confidence interval [CI], 0.0020-0.25). Late complications occurred in 18% of the patients (bile duct stone, 3; hemorrhage, 1; pancreatitis, 1). There was no significant difference in the late complication rate between Group A and Group B (19% vs 17%). Local recurrences were found in 14% of the patients, without a significant difference between Group A and Group B (19% vs 8%) during a mean follow-up period. All recurrent tumors were successfully treated with argon plasma coagulation. The modified technique of EP for ampullary neoplasm contributed to lessening the occurrence of early complications. However, further refinement of this technique is necessary for improving the clinical outcome.Digestive Endoscopy 01/2012; 24(1):30-5. · 1.19 Impact Factor -
Article: Undifferentiated carcinoma of the pancreas involving intraductal pedunculated polypoid growth.
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ABSTRACT: We herein report a case of pancreatic undifferentiated carcinoma involving intraductal pedunculated polypoid growth. Duodenoscopy disclosed a congested polypoid mass protruding from the orifice of the papilla of Vater. Endoscopic retrograde pancreatography (ERP) showed a polypoid lesion in Wirsung's duct and Santorini's duct. Pancreatic juice cytology using the cell block method revealed the presence of undifferentiated carcinoma. No extraductal invasion was detected on endoscopic ultrasonography and or intraductal ultrasonography. The patient therefore underwent pancreaticoduodenectomy. A histological examination revealed an intraductal polypoid tumor with a thin stalk without extraductal invasion. The tumor was composed of an abundant mixture of pleomorphic cells, spindle cells, giant cells, and a small amount of adenocarcinoma.Internal Medicine 01/2012; 51(24):3373-7. · 0.94 Impact Factor -
Article: Visualization of pancreatic juice movement using unenhanced MR imaging with spin labeling: preliminary results in normal and pathophysiologic conditions.
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ABSTRACT: To visualize the movement of pancreatic juice noninvasively by using an unenhanced magnetic resonance (MR) imaging technique. Institutional review board approval and informed consent were obtained for this study. A flow-out technique of time-spatial labeling inversion pulse (SLIP) technique was applied using both nonselective and selective inversion pulses to label, or tag, pancreatic juice to move out of the region. Ten normal (eight men, two women; age range, 22-61 years; mean age, 35 years) and two pathologic conditions were examined on a commercially available 1.5 Tesla MR imager with quadrature-detected phased-array coils. All images were evaluated by two radiologists to assess depiction of the pancreatic juice movement or pancreatic juice reflux as compared to the pancreatic duct or the common bile duct on MRCP obtained before time-SLIP examination. The tagged pancreatic juice was satisfactory visualized after applying the pulse labeling. Noninvasive visualization of pancreatic juice movement, including normal pancreatic juice movement and reflux from the main pancreatic duct into the common bile duct, was possible by using the unenhanced time-SLIP technique. Noninvasive visualization of pancreatic juice movement is possible by using the unenhanced MR imaging time-SLIP technique.Journal of Magnetic Resonance Imaging 12/2011; 35(5):1119-24. · 2.70 Impact Factor -
Article: Localized autoimmune pancreatitis, 9 mm in size, without strictures of the main pancreatic duct.
Gastrointestinal endoscopy 07/2011; 75(4):920-2. · 6.71 Impact Factor -
Article: Ampullary cancer with pancreas divisum treated by endoscopic partial papillectomy: a case report.
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ABSTRACT: We herein report a case of ampullary cancer associated with pancreas divisum. Duodenoscopy revealed a tumor at the ampulla of Vater with a normal ampullary orifice. Intraductal ultrasonography showed a hypoechoic mass limited to the ampulla of Vater. ERCP showed an arborizing ventral pancreatic duct without connection to the dorsal duct. Endoscopic snare resection of the tumor was performed following biliary stenting. Histological examination revealed well-differentiated tubular adenocarcinoma limited to the ampulla of Vater. Endoscopic papillectomy with the assistance of a biliary stent is useful in cases of ampullary neoplasm with a normal ampullary orifice in order to avoid ductal injury.Journal of gastrointestinal and liver diseases: JGLD 06/2011; 20(2):205-7. · 1.81 Impact Factor -
Article: Endosonography-guided biliary drainage with one-step placement of a newly designed fully covered metal stent for malignant biliary obstruction.
Digestive Endoscopy 04/2011; 23(2):207. · 1.19 Impact Factor -
Article: Intraductal ultrasonography in the diagnosis of bile duct stones: when and whom?
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ABSTRACT: Biliary intraductal ultrasonography (IDUS) is highly sensitive in visualizing bile duct stones (BDS). Indications for IDUS, however, in cases of suspected BDS have not yet been established. The aim of the present study was to elucidate adequate indications for IDUS in cases that undergo endoscopic retrograde cholangiopancreatography (ERCP) due to suspected BDS. A total of 213 patients who were suspected of having BDS were included in this retrospective study. The patients were divided into two groups: Group A in which BDS was visualized by ERCP; and Group B in which BDS was demonstrated only by IDUS. Comparison between the groups was carried out. ERCP successfully visualized BDS in 166 patients. Forty-seven patients underwent IDUS, which revealed BDS and biliary sludge in 12 and eight patients, respectively. The diameter of the largest stone was 13 ± 6 mm in Group A and 5 ± 1 mm in Group B (P < 0.001). The sensitivity, specificity, and accuracy of ERCP in the diagnosis of BDS were 93%, 100%, and 94%, respectively. The sensitivity was influenced by the size of BDS: 100% in cases of stones ≥ 8 mm in size, but 74% in those with stones < 8 mm. In cases with stones < 8 mm, the sensitivity was significantly affected by the bile duct diameter (≥ 12 mm vs < 12 mm, P < 0.05). Conclusion: When ERCP fails to visualize stones in patients with suspected BDS, IDUS is recommended, especially in those with a bile duct ≥ 12 mm in diameter.Digestive Endoscopy 04/2011; 23(2):173-5. · 1.19 Impact Factor -
Article: [A case of mucinous cystadenoma of the pancreas resected after a 10-year follow-up].
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ABSTRACT: A 40-year-old woman was hospitalized because of acute pancreatitis. CT showed a monolocular cyst thought to be a pseudocyst. The patient was followed as an outpatient. The size of the cyst decreased 6 years later. Ultrasonography 10 years later demonstrated an enlarged cyst with a cyst-in-cyst formation. A tendency to increase in size and the irregular wall thickening indicated that the cyst was a malignant mucinous cystic neoplasm (MCN) and distal pancreatectomy was performed. The tumor was diagnosed histologically as a mucinous cystadenoma. A case of MCN resected after long-term follow-up is extremely rare. The present case is thought to be important for elucidation of the natural history of MCNs.Nippon Shokakibyo Gakkai zasshi The Japanese journal of gastro-enterology 01/2011; 108(7):1280-7. -
Article: [A case of ampullary cancer with pancreas divisum treated by endoscopic papillectomy].
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ABSTRACT: A 60's man underwent a medical check-up and esophagogastroduodenoscopy revealed an exposed-type tumor at the ampulla of Vater. Endoscopic ultrasonography and intraductal ultrasonography showed a hypoechoic mass limited to the ampulla of Vater. Endoscopic retrograde cholangiopancreatography (ERCP) revealed a slightly dilated ventral pancreatic duct not connected to the dorsal duct. Endoscopic papillectomy was performed without pancreatic stent placement and his postprocedural course was uneventful. The specimen was histologically diagnosed as well-differentiated adenocarcinoma limited to the mucosa of the ampulla of Vater. Endoscopic papillectomy without pancreatic stent placement can be performed without a risk of post-ERCP pancreatitis for ampullary tumor limited to the mucosa of the ampulla of Vater associated with pancreas divisum.Nippon Shokakibyo Gakkai zasshi The Japanese journal of gastro-enterology 01/2011; 108(9):1546-53.
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2003–2013
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Sendai City Hospital
Sendai, Kagoshima-ken, Japan
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