Search

Objectives: We aimed to clarify the clinical utility of measuring serum pancreatic enzymes after endoscopic retrograde cholangiopancreatography (ERCP) for the purpose of predicting post‐ERCP pancreatitis (PEP) by a meta‐analysis of diagnostic test accuracy studies. Methods: Studies on the prediction accuracy of PEP by serum amylase or lipase measured at 2, 3, and 4 h after ERCP were collected. A literature search was performed in PubMed and the Cochrane Library database for studies published between January 1980 and March 2023. The quality of individual studies was evaluated using the Quality Assessment of Diagnostic Accuracy Studies‐2. Data were analyzed using Meta‐DiSc 2.0 software. Results: We searched the databases and identified 20 observational studies (12,313 participants). PEPs were defined according to criteria by Cotton or modified Cotton, revised Atlanta criteria, or the Japanese criteria. Meta‐analysis of eight studies (4389 participants) showed a pooled sensitivity of 71.1% (95% confidence interval [CI] 56.1–82.5) and pooled specificity of 91.2% (95% CI 85.9–94.6) for the serum amylase cut‐off value at 3 times the upper limit of normal (ULN). Another meta‐analysis of five studies (1970 participants) showed a pooled sensitivity of 85.8% (95% CI 61.9–95.7) and pooled specificity of 85.3% (95% CI 81.9–88.1) for the serum lipase cut‐off value at 3 times ULN. Conclusion: Despite a high risk of bias due to various reference standards, this updated meta‐analysis and the utility assessment by a decision tree showed the utility of serum amylase or lipase levels more than 3 times ULN measured 2–4 h after ERCP for predicting PEP. [ABSTRACT FROM AUTHOR]

Watch a video of this article. [ABSTRACT FROM AUTHOR]

Background/Purpose: We developed EUS‐guided double‐balloon occluded gastrojejunostomy (EPASS) for gastric drainage tract obstruction. The success of EPASS depends on the proximity of the stomach and the gastrointestinal (GI) tract near the ligament of Treitz. The aim of this study is to clarify the GI anatomy near the ligament of Treitz. Methods: One thousand and sixteen cases imaged upper GI radiography using barium were retrospectively evaluated. Morphologically, the GI tract running near the ligament of Treitz was divided in three types: Type I: The 4th portion of the duodenum (D4) approaches the stomach; Type II: D4 does not approach the stomach; Type III: D4 forms a loop to the jejunum. The minimum distance between the stomach and the GI tract near the ligament of Treitz was measured. Results: Based on the morphological classification, 74.6% in the study group was classified in Type I, 22.0% in Type II, and 3.3% in Type III, respectively. The median minimum distance in Type II/III group were significantly longer, compared with the Type I (P <.01). Conclusions: The GI anatomy near the ligament of Treitz was clarified using upper GI radiography. It is divided into three patterns, and one‐fourth of cases may have difficulty in EUS‐guided gastrojejunostomy. [ABSTRACT FROM AUTHOR]

Background and Aim: While encouraging data of endoscopic ultrasound (EUS)‐guided fine‐needle biopsy (EUS‐FNB) using a 22‐gauge Franseen needle have been reported, large‐scale data of per pass and quantitative analyses are still lacking. Methods: This was a multicenter prospective study of EUS‐FNB using the 22‐gauge Franseen needle for a pancreatic solid lesion. Cytological and histological analyses per pass were evaluated and semi‐quantitative analyses were performed on core tissue and blood contamination. Primary end‐point was diagnostic accuracy per session. Prognostic factors were analyzed for diagnostic accuracy, sensitivity, core tissue, and blood contamination. Results: A total of 629 passes were performed in 244 cases at 14 centers between 2018 and 2019. The median tumor size was 29 mm, and the puncture was transduodenal in 43%. The median pass number was 2. Diagnostic accuracy per session, at a first pass, and per pass were 93%, 90%, and 88%. In 198 cases with pancreatic cancer, diagnostic sensitivity per session, at a first pass, and per pass were 94%, 89%, and 89%. The rates of core tissue score of 4 and blood contamination score of 3 were 50% and 47%. The adverse event rate was 1.6%. In the multivariate analysis, tumor size ≤20 mm (odds ratio [OR] of 0.46, P = 0.03), transduodenal puncture (OR of 0.53, P = 0.04), and suction (OR of 0.16, P = 0.01) were associated with lower diagnostic accuracy. Conclusions: The EUS‐FNB using the 22‐gauge Franseen needle for pancreatic solid lesions showed high per pass and overall diagnostic accuracy. [ABSTRACT FROM AUTHOR]

Background/Purpose: This study investigated whether measuring pancreatic blood volume (PBV) on whole pancreatic perfusion computed tomography (P‐CT) can predict the progression of walled‐off necrosis (WON) in patients with acute pancreatitis (AP). Methods: A single‐center, retrospective cohort study was conducted between December 2015 and December 2016. The participants were divided into two groups: 14 patients with WON and 15 patients without WON. PBV was measured within 72 hours after the diagnosis of AP, and the final diagnosis of WON was made by contrast‐enhanced CT (CE‐CT) or endoscopic ultrasonography (EUS) 4 weeks after the onset of AP. Results: The minimum CT value did not differ significantly between the two groups. On the other hand, the minimum PBV was significantly lower in the WON group than in the without WON group (1.4 (0.9–9.9) vs 19.8 (8.2–21.7) mL/100 mL, respectively; P =.02). The cutoff value of the minimum PBV for WON was 16.5 mL/100 mL (sensitivity 100%, specificity 67%, AUC 0.85; P =.001). Conclusions: Whole pancreatic P‐CT can evaluate pancreatic ischemia visually and quantitatively. The minimum PBV measurement on whole pancreatic P‐CT within 72 hours after the diagnosis of AP contributes to the prediction of progression of WON. [ABSTRACT FROM AUTHOR]

A 15‐year‐old boy was referred to our hospital with elevated hepatobiliary enzyme levels and jaundice. Magnetic resonance cholangiopancreatography performed at the previous medical facility revealed a stricture of the intrahepatic and extrahepatic bile duct. Computed tomography showed dilatation and wall thickness of the intrahepatic bile ducts. Primary sclerosing cholangitis or cholangiocarcinoma was suspected. Endoscopic retrograde cholangiopancreatography (ERCP) showed stricture in the intrahepatic and extrahepatic bile duct. On admission, the eosinophil count in the peripheral blood was normal; however, rapid hypereosinophilia in the peripheral blood was observed after admission, leading us to suspect eosinophilic cholangitis (EC). A bile duct biopsy showed inflammatory cells and eosinophil infiltration during a second ERCP. The patient was diagnosed with EC based on histopathology. [ABSTRACT FROM AUTHOR]

Abstract: Background and Aim: Endoscopic nasobiliary drainage (ENBD) is often recommended in preoperative biliary drainage (PBD) for hilar malignant biliary obstruction (MBO), but endoscopic biliary stent (EBS) is also used in the clinical practice. We conducted this large‐scale multicenter study to compare ENBD and EBS in this setting. Methods: A total of 374 cases undergoing PBD including 281 ENBD and 76 EBS for hilar MBO in 29 centers were retrospectively studied. Results: Extrahepatic cholangiocarcinoma (ECC) accounted for 69.8% and Bismuth–Corlette classification was III or more in 58.8% of the study population. Endoscopic PBD was technically successful in 94.6%, and adverse event rate was 21.9%. The rate of post‐endoscopic retrograde cholangiopancreatography pancreatitis was 16.0%, and non‐endoscopic sphincterotomy was the only risk factor (odds ratio [OR] 2.51). Preoperative re‐intervention was performed in 61.5%: planned re‐interventions in 48.4% and unplanned re‐interventions in 31.0%. Percutaneous transhepatic biliary drainage was placed in 6.4% at the time of surgery. The risk factors for unplanned procedures were ECC (OR 2.64) and total bilirubin ≥ 10 mg/dL (OR 2.18). In surgically resected cases, prognostic factors were ECC (hazard ratio [HR] 0.57), predraiange magnetic resonance cholangiopancreatography (HR 1.62) and unplanned re‐interventions (HR 1.81). EBS was not associated with increased adverse events, unplanned re‐interventions, or a poor prognosis. Conclusions: Our retrospective analysis did not demonstrate the advantage of ENBD over EBS as the initial PBD for resectable hilar MBO. Although the technical success rate of endoscopic PBD was high, its re‐intervention rate was not negligible, and unplanned re‐intervention was associated with a poor prognosis in resected hilar MBO. [ABSTRACT FROM AUTHOR]

This study was undertaken to examine the relationship between malignant tumor tissue and nerve fibers using a transplantation model and nerve fiber strains. Most of the neural tissue, as well as the other host tissues, showed severe degenerative changes as the transplanted tumor grew. Furthermore, the degenerative changes were chiefly confined to the area anterior to the tumor. These changes were probably provoked chiefly by the compressive effects of the rapidly enlarging transplant. The results could possibly explain clinical symptoms such as paralysis or disturbances in the movement of the tongue observed occasionally in some patients with lingual carcinomas. [ABSTRACT FROM AUTHOR]