K Ikeda

The Jikei University School of Medicine, Edo, Tokyo, Japan

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Publications (13)43.98 Total impact

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    ABSTRACT: A novel multibending backward-oblique viewing duodenoscope was developed to overcome the difficult technical aspect of deep cannulation into the bile duct during endoscopic retrograde cholangiopancreatography (ERCP). The aim of the present study was to evaluate the initial experience of a novel multibending backward-oblique viewing duodenoscope (M-D scope) for ERCP. This was a retrospective review of 23 patients with native papilla who received biliary ERCP with the M-D scope between April and December 2010. The procedures were performed by two well-experienced endoscopists. In all patients, biliary cannulation and therapeutic procedure were successfully completed. In two patients with Billroth I gastrectomy, ERCP were initially attempted with a conventional single-bending duodenoscope, but biliary cannulations were unsuccessful. However, with the use of the M-D scope, biliary cannulation and therapeutic procedures were successfully completed. A novel multibending backward-oblique viewing duodenoscope is safe and feasible for therapeutic and diagnostic ERCP.
    No preview · Article · Nov 2011 · Endoscopy

  • No preview · Article · Mar 2011 · Endoscopy

  • No preview · Article · Dec 2010 · Endoskopie heute
  • H. Tajiri · S. Kitano · K. Sumiyama · K. Ikeda · K. Yasuda
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    ABSTRACT: In the early animal experimental stage when the new concept of NOTES (Natural Orifice Translumenal Endoscopic Surgery) appeared, fierce competition occurred in device development, but now, in the clinical application stage, we face various problems. To ensure safe clinical use, hybrid NOTES was devised. On the other hand, a trend for more minimally invasive rigid endoscopic surgery, such as single-port surgery, is spreading, which takes advantage of the characteristics of NOTES. Since technologies have been developed which bridge the gap with NOTES, such as closure of iatrogenic gastrointestinal perforation, endoscopic full-thickness resection, cellular and molecular imaging of the muscularis propria in the submucosa and peroral endoscopic myotomy, minimally invasive surgery and development of peripheral devices, triggered by NOTES, are considered to have led to new developments not only in the field of surgery, but also in the field of internal medicine. Closer cooperation between physicians and surgeons is important to further advance the common dream of more minimally invasive surgery, without adhering to the word and concept of "NOTES." To keep up with Europe and the US in this field, it would be desirable to establish strong research systems in Japan by promoting industry-university- government cooperative research and close cooperation between medicine and engineering.
    No preview · Article · Dec 2010 · Gastroenterological Endoscopy
  • H. Imazu · K. Ikeda · H. Kakutani · H. Tajiri

    No preview · Article · Sep 2010 · Journal of Gastroenterology and Hepatology
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    ABSTRACT: A randomized in vivo animal study previously demonstrated that topical injection of mesna solution (sodium-2-mercaptoethanesulfonate) chemically softened submucosal connective tissues and facilitated mechanical dissection of the submucosal tissue plane. The present study evaluated the technical feasibility and safety of chemically assisted endoscopic submucosal dissection (CA-ESD) using mesna in 20 consecutive patients who underwent endoscopic excision of gastric neoplasm. Following the margination of the lesion with a mucosal circumcision, 4 - 12 mL of 10 % mesna solution was injected into the submucosal layer. Mechanical submucosal dissection was then performed by bluntly cleaving the chemically treated submucosal layer with the tip of a cap-fitted gastroscope. The use of cautery was restricted to prophylactic hemostasis, dissection of the coagulated vessels and persistent submucosal tissues, and the final snare resection. Post-therapeutic ulceration repair and adverse events were followed up during a 1-week hospitalization and by repeat endoscopies at 1 day, 1 week, and 1 month after the procedure. Sixteen gastric cancers and four adenomas were treated in this study. The sampled tissue measured 38.25 +/- 14.53 mm, with an en bloc resection rate of 100 %. Mean operation time was 21.17 +/- 11.6 minutes. The time spent using cautery was limited to 26.1 % of the total submucosal dissection time. Ulcerations healed normally without complications. This preliminary study demonstrates that submucosal injection of mesna facilitates and expedites mechanical submucosal dissection. The major limitations in this study include the single-arm study design and a small patient population.
    No preview · Article · Aug 2010 · Endoscopy
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    ABSTRACT: Video capsule endoscopy has been established in diagnosis of small-bowel disease and has been evaluated for esophageal pathology and recently for colorectal diagnostics. Gastric capsule endoscopy has not hitherto been feasible due to the stomach's large surface area and volume. We present the first application of a magnetically navigated capsule in the human stomach. 29 volunteers and 24 patients (men 42, women 11; mean age 47.5 years) were included in a feasibility study. Low-level magnetic fields were used to maneuver the double-sensor video capsule within the human stomach with an air-water interface provided by ingestion of 1300 ml water within 1 hour before examination. Visualization of all parts of the stomach was attempted; time for visualization was recorded, and a subjective assessment of completeness of visualization was documented. There was technical failure in one individual; thus technical success rate was 98 %. In the 52 remaining cases, examiners assessed that the antrum, body, fundus, and cardia were fully visualized in 98 %, 96 %, 73 % and 75 %, respectively. Mean duration of examinations was 30 minutes (range 8 - 50), with a longer time (mean 37 minutes) for volunteers for study reasons. In total, 30 findings were identified: 14 were detected by both gastroscopy and capsule, 10 lesions were identified by guided capsule examination only, 6 by gastroscopy only. No significant capsule-related adverse events occurred. Magnetically navigated video capsule endoscopy appears to be feasible and sufficiently accurate for gastric examination. It may permit endoscopic examinations that are more patient-friendly and without sedation. Comparative studies are under way.
    No preview · Article · Jul 2010 · Endoscopy
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    ABSTRACT: Hot saline may be potentially useful for inducing necrosis of pancreatic tissue. However, the local and systemic effects are largely unknown. This pilot study aimed to evaluate the feasibility and safety of EUS-guided injection of hot saline into the pancreas in the porcine model. Boiling hot saline was injected into the tail of normal porcine pancreas under EUS guidance in six pigs via a transgastric approach. Three pigs were killed 4 hours later to study the acute effect of the hot saline injection (acute study). The remaining three pigs were killed after 7 days of clinical observation (survival study). Injection of 5 mL, 2 mL and 1 mL of hot saline produced localized necrosis (7 - 10 mm) of pancreatic tissue in the acute study. However, there was pooling of hot saline on the surface of the pancreas when 5mL was injected. On the basis of the results of the acute study, the volume of hot saline injected in the survival study was 1 mL. One milliliter of hot saline produced localized or sporadic necrosis of pancreatic tissue without any signs of pancreatitis in all three pigs in the survival study; hot saline was observed to pool on the pancreatic surface of one pig. There was no histological evidence of necrosis in the pancreatic tissue adjacent to the pooled hot saline in either the acute or the survival study. EUS-guided hot saline injection of pancreatic tissue in the porcine model was technically successful and led to localized necrosis of pancreatic tissue without any sign of pancreatitis.
    No preview · Article · Aug 2009 · Endoscopy
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    ABSTRACT: : Balloon-occluded retrograde transvenous obliteration (B-RTO) has emerged as an effective, minimally invasive treatment for fundal varices. B-RTO requires a spontaneously developed gastrorenal shunt as a pathway for the balloon catheter to reach the fundal varices. We used a curved linear-array (CLA) echo endoscope in patients with fundal varices to identify gastrorenal shunts, and compared the detection rate with the gold standard, contrast-enhanced computed tomography (CECT). A total of 40 patients with fundal varices were examined with both CLA echo endoscopy and CECT. The CECT images were retrospectively and independently evaluated by two gastroenterologists who were unaware of the clinical details, including the results of the CLA echo endoscopy. CLA echo endoscopy identified gastrorenal shunts in 26/40 patients with fundal varices. It visualized the shunt in a longitudinal direction and provided images of the connections of the shunt at both ends, the fundal varices and the left renal vein/branch of the inferior adrenal vein. The kappa index for CLA echo endoscopy and CECT for the identification of gastrorenal shunt was 0.9 (95 % CI, 0.6 to 1.0). When the cutoff point for the diameter of the gastrorenal shunt detected by the CLA echo endoscope was set at equal to or greater than 5 mm, the kappa index was 1.0 (95 % CI, 0.7 to 1.0). These results suggest that CLA echo endoscopy can successfully identify gastrorenal shunt and provide detailed morphological information. It also efficiently identifies patients suitable for B-RTO, particularly in cases of acute bleeding. It also has considerable potential for providing detailed information with regard to the treatment of gastric varices.
    No preview · Article · Sep 2004 · Endoscopy
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    ABSTRACT: Endoscopic variceal ligation (EVL) is an alternative to sclerotherapy for the treatment of esophageal varices, but is associated with higher rates of recurrence and subsequent bleeding than sclerotherapy. To prevent recurrence of varices after EVL, we have developed a low-dose diode laser therapy combined with the injection of indocyanine green, which allows enhanced tissue absorption of the laser beam selectively around varices. In this study we investigated the efficacy and safety of this technique. Eight patients with F2 or F3 esophageal varices were enrolled. At 1 week after EVL, indocyanine green solution (1 mg/ml) was injected submucosally around the remaining varices. A diode laser (power 10 watts) was applied to the surface from the esophagogastric junction to 5 cm above it. The spot size was kept to 5 mm in diameter. Laser irradiation was performed safely, without bleeding from the varices, or perforation. There were no major complications. Endoscopy 1 month later showed F0 forms in seven patients, F1 in one patient, and no red color sign in any patient. No recurrence of varices has been observed in any of the patients during the follow-up period of at least 12 months. This technique may provide a simple, safe and effective procedure, as an additional treatment to EVL, for the prevention of recurrence of esophageal varices.
    No preview · Article · Nov 2001 · Endoscopy
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    ABSTRACT: The time to recurrence of esophageal varices may vary greatly between patients even after the same endoscopic therapy. To clarify the factors which contribute to recurrence after endoscopic treatment, the hemodynamics and morphology of the left gastric vein (LGV) were investigated using color Doppler endoscopic ultrasonography (EUS). A total of 31 patients with high-risk esophageal varices underwent color Doppler-EUS before receiving endoscopic variceal ligation and endoscopic injection sclerotherapy combined therapy. Endoscopic examination was performed every 3 months after the treatment to evaluate recurrence of varices. A total of 18 patients responded to the therapy, while 13 patients did not respond, and had recurrence within 12 months. The hepatofugal flow velocity in the LGV trunk was significantly lower in the responders (9.9 vs. 13.9 cm/sec; P = 0.02). The branch pattern of the LGV was categorized into three groups: anterior branch dominant, posterior branch dominant, and no-dominant type. The incidence of the anterior branch dominant type was significantly less in responders (17 vs. 70 %; P = 0.01). There was no significant difference in the LGV trunk diameter and the size of the paraesophageal vein between the two groups. Risk factors for recurrence can be analyzed in detail using color Doppler-EUS. Further investigation using color Doppler-EUS may enable us to select the optimal way to treat esophageal varices to prevent recurrence.
    No preview · Article · Nov 2001 · Endoscopy
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    ABSTRACT: We investigated the hemodynamics in 30 cases (untreated group) with esophageal varices before EVL, AS EIS combined therapy and in 18 cases with long-term obserbation after therapy (long-term follow-up group), using color-Doppler endoscopic ultrasonography (CD-EUS). 1. Flow direction of left gastric vein (LGV) was hepatofugal in most cases of both groups, and its velosity was not significantly different. 2. In long-term followed-up group, poterior branch dominant type (type PD) was more increased in the branch patterns of LGV. 3. The size of the paraesophageal veins was significantly larger. 4. Detection rate of enlarged perforating vein (EPV) was significantly lower, as compared with untreated group. It is suggested that the reccurence prognosis may improve because posterior branch and paraesophageal veins may develop after long-term follow up and function as an extravariceal shunt, while anterior branch and EPV may disappear. These findings are important for the reccurence factor after topical treatments of esophageal varices.
    No preview · Article · Jul 1999
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    ABSTRACT: We developed ICG dye enhanced diode laser photosclerotherapy as preventive treatment for bleeding esophageal varices. Submucosal injection of wave length-specific dye (ICG: indocyanine green) could provide enhanced diode laser beam absorption selectively in the submucosal tissues around esophageal varices. First of all, we clarified the efficacy and safety of this new technique experimentally using dog's esophagus and then applied it in 6 cases of esophageal varices. In the experimental study, thermal injuries in the mucosa and submucosa were selectively induced without surface defects during irradiation. A month follow up endoscopy showed degenerated mucosa and submucosa to be replaced with fibrosis while no changes were observed in the muscle layer. Based on these findings, we therefore, applied this technique in 6 patients of esophageal varices after EVL treatment. Complete eradication was archieved within 2 weeks in all cases. A mild stenosis was seen in 2 patients, which was easily treated by balloon dilatation. It is concluded that ICG dye enhanced diode laser photosclerotherapy would be useful as a simple, safe and effective alternative to prevent bleeding from esophageal varices.
    No preview · Article · Nov 1998 · Gastroenterological Endoscopy

Publication Stats

143 Citations
43.98 Total Impact Points


  • 2004-2011
    • The Jikei University School of Medicine
      • Department of Endoscopy
      Edo, Tokyo, Japan
  • 2001
    • Medical University of South Carolina
      • Digestive Disease Center
      Charleston, South Carolina, United States