124 results on '"Shunsuke Omoto"'
Search Results
2. Low‐dose gemcitabine plus nab‐paclitaxel versus standard‐dose gemcitabine plus nab‐paclitaxel in elderly patients with metastatic pancreatic cancer: A randomized Phase II trial
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Ken Kamata, Hajime Imai, Hisakazu Matsumoto, Yukitaka Yamashita, Takao Kato, Katsuhisa Nishi, Shunsuke Omoto, Kosuke Minaga, Kentaro Yamao, Tomoko Hyodo, Sung‐Woon Im, Akane Hara, Tomoe Yoshikawa, Rei Ishikawa, Ayana Okamoto, Tomohiro Yamazaki, Atsushi Nakai, Kazuomi Ueshima, Yasutaka Chiba, Mamoru Takenaka, Tomohiro Watanabe, Masayuki Kitano, and Masatoshi Kudo
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chemotherapy ,elderly ,gemcitabine ,nab‐paclitaxel ,pancreatic cancer ,Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Abstract Background and Aim A multicenter, open‐label randomized Phase II trial was conducted to determine whether low‐dose gemcitabine plus nab‐paclitaxel (GnP) could improve tolerability and show equivalent efficacy to the standard‐dose GnP for elderly patients with metastatic pancreatic cancer. Methods Consecutive patients aged ≥65 years with metastatic pancreatic cancer who presented at one of four Japanese referral centers between November 2016 and January 2021 were enrolled. The 60 patients were randomly assigned to low‐ or standard‐dose groups with a 1:1 ratio. Patients in the low‐dose GnP group received gemcitabine at a dose of 250 mg/m2 and nab‐paclitaxel at 125 mg/m2. Results Low‐dose GnP significantly decreased the rate of cases requiring dose reduction (16.7% vs 63.3%). The response rate (36.7% vs 33.3%) and progression‐free survival (7.3 vs 8 months) were comparable between the low‐ and standard‐dose groups as determined by independent review. The difference in the median overall survival between the two groups was not significant (7.9 vs 12 months). The proportion of patients with hematologic and non‐hematologic treatment‐related adverse events was comparable between the two groups. Conclusion Low‐dose GnP had an equivalent efficacy to conventional therapy; however, it did not reduce adverse events.
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- 2023
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3. Serum leucine‐rich alpha‐2 glycoprotein in monitoring disease activity and intestinal mucosal healing for biotherapy‐naïve cases with ulcerative colitis
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Masashi Kono, Yoriaki Komeda, George Tribonias, Saki Yoshida, Kenji Nomura, Kohei Handa, Tomoyuki Nagai, Satoru Hagiwara, Shunsuke Omoto, Mamoru Takenaka, Naoshi Nishida, Naoko Tsuji, Hiroshi Kashida, and Masatoshi Kudo
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biotherapy‐naïve ,leucine‐rich alpha‐2 glycoprotein ,ulcerative colitis ,Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Abstract Background and Aim Serum leucine‐rich alpha‐2 glycoprotein level has been reported to be a useful biomarker in assessing mucosal healing in patients undergoing biotherapy, where mucosal lesions caused by ulcerative colitis are difficult to assess endoscopically. However, no such reports have been reported in biotherapy‐naïve cases. Methods Sixty‐eight patients with ulcerative colitis (UC) who were biotherapy‐naïve at Kindai University Hospital between October 2021 and October 2022 were enrolled. We prospectively examined the correlation between leucine‐rich alpha‐2 glycoprotein (LRG), C‐reactive protein (CRP), erythrocyte sedimentation rate (ESR), and Geboes scores with clinical endoscopic activity using the Mayo endoscopic subscore (MES). Results Mucosal healing was achieved in 39 (57%) patients. Univariate analysis revealed that the factors associated with mucosal healing were LRG (P = 0.0024), CRP (P = 0.1078), ESR (P = 0.0372), and Geboes scores (P = 0.0075). Logistic regression analysis identified LRG and Geboes scores as independent factors associated with mucosal healing assessed using MES (P = 0.0431 for LRG and P = 0.0166 for Geboes scores). Conclusion LRG was found to be the easiest marker to monitor disease activity and mucosal inflammation in UC patients with biotherapy‐naïve cases, with a performance equivalent to that of Geboes scores.
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- 2023
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4. Occupational radiation exposure to the lens of the eyes and its protection during endoscopic retrograde cholangiopancreatography
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Kenji Ikezawa, Shiro Hayashi, Mamoru Takenaka, Takayuki Yakushijin, Koji Nagaike, Ryoji Takada, Takuo Yamai, Kengo Matsumoto, Masashi Yamamoto, Shunsuke Omoto, Kosuke Minaga, Shuji Ishii, Takeshi Shimizu, Kengo Nagai, Makoto Hosono, and Tsutomu Nishida
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Medicine ,Science - Abstract
Abstract This study aimed to examine occupational radiation exposure to the lens of the eyes during endoscopic retrograde cholangiopancreatography (ERCP). In this multicenter, prospective, observational cohort study, we collected data regarding occupational radiation exposure to the lens of the eyes during ERCP. We measured radiation exposure of patients and examined its correlation with occupational exposure. In dosimetrically-measured ERCPs (n = 631), the median air kerma at the patient entrance reference point, air kerma-area product, and fluoroscopy time were 49.6 mGy, 13.5 Gycm2, and 10.9 min, respectively. The median estimated annual radiation dose to the lens of the eyes was 3.7, 2.2, and 2.4 mSv for operators, assistants, and nurses, respectively. Glass badge over lead aprons and eye dosimeter results were similar in operators but differed in assistants and nurses. A strong correlation was shown between eye dosimeter measurements and patients' radiation exposure. The shielding rates of the lead glasses were 44.6%, 66.3%, and 51.7% for operators, assistants, and nurses, respectively. This study revealed the actual occupational exposure dose for the lens of the eyes during ERCP and the efficacy of lead glass. Values of radiation exposure to patients can help estimate exposure to the lens of the eyes of medical staff.
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- 2023
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5. Real-World Data on Short-Term and Long-Term Treatment Results of Ustekinumab in Patients with Steroid-Resistant/Dependent Ulcerative Colitis
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Yoriaki Komeda, George Tribonias, Masashi Kono, Kohei Handa, Shunsuke Omoto, Mamoru Takenaka, Satoru Hagiwara, Naoko Tsuji, Naoshi Nishida, Hiroshi Kashida, and Masatoshi Kudo
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Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Introduction: Ustekinumab is an IgG1 kappa monoclonal antibody directed against the common p40 subunit of interleukin-12 and interleukin-23, which activate Th1- and Th17-mediated immune responses, respectively. It has proven efficacy for the treatment of moderate to severe ulcerative colitis (UC) in the UNIFI Phase III clinical trial; however, data on its efficacy in the real world is limited. In this study, we aimed to assess the real-world efficacy of ustekinumab. Methods: This observational study included 30 patients with UC who received ustekinumab from April 2020 to April 2022. We examined demographic information, disease type and activity (Mayo score, partial Mayo score [PMS]), use of biologics, concomitant use of predonisolone (PSL), 8-week ustekinumab clinical response rate, remission induction rate, 44- and 152-week remission maintenance rate, continuation rate, and 44-week steroid-free remission rate. The primary outcomes were the short- and long-term efficacy of ustekinumab. Results: Included patients (53% women; mean age: 41.2 years [16–80 years]) had an average disease duration of 86 weeks. Mayo’s score (median) was 7.4 and the PMS was 5.4. Two (7%), 24 (80%), and four (13%) patients had a Mayo endoscopic sub-score (MES) of MES1, MES2, and MES3, respectively. The median serum CRP was 1.0 mg/dL. Five patients had no history of biotherapy (naive), while 8 and 17 had a history of one and two or more biologic agents, respectively. Eight patients were PSL-resistant and 22 were PSL-dependent. The 8-week clinical response rate was 73%, and the clinical remission induction rate was 70%. The remission maintenance rates at 44 and 152 weeks were 67% and 63%, respectively. The ustekinumab retention rate was 67% (86-week mean follow-up period). Regarding biologic failure cases, the clinical response rate in the failure group with up to one biologic agent (including naive cases) was 84.6%, which was higher than the 58.0% rate in the failure group with two or more biologic agents (p=0.06). Steroid-free remission rates at 44 and 152 weeks were 63% each. In the logistic regression analysis parameters for discontinuation of ustekinumab, only PMS remained significant after multivariate analysis (p=0.018). Conclusion: Our study showed short-term and long-term ustekinumab effectiveness, especially with comparative low disease activity.
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- 2023
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6. Bispectral index-guided propofol sedation during endoscopic ultrasonography
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Ayana Okamoto, Ken Kamata, Takeshi Miyata, Tomoe Yoshikawa, Rei Ishikawa, Tomohiro Yamazaki, Atsushi Nakai, Shunsuke Omoto, Kosuke Minaga, Kentaro Yamao, Mamoru Takenaka, Yasutaka Chiba, Toshiharu Sakurai, Naoshi Nishida, Masayuki Kitano, and Masatoshi Kudo
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consciousness monitors ,intravenous anesthesia ,endosonography ,midazolam ,propofol ,Internal medicine ,RC31-1245 ,Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Background/Aims Bispectral index (BIS) monitors process and display electroencephalographic data are used to assess the depth of anesthesia. This study retrospectively evaluated the usefulness of BIS monitoring during endoscopic ultrasonography (EUS). Methods This study included 725 consecutive patients who underwent EUS under sedation with propofol. BIS monitoring was used in 364 patients and was not used in 361. The following parameters were evaluated: (1) median dose of propofol; (2) respiratory and circulatory depression; (3) occurrence of body movements; (4) awakening score >8 at the time; and (5) awakening score 2 hours after leaving the endoscopy room. Results The BIS group received a significantly lower median dose of propofol than the non-BIS group (159.2 mg vs. 167.5 mg; p=0.015) in all age groups. For patients aged ≥75 years, the reduction in heart rate was significantly lower in the BIS group than in the non-BIS group (1.2% vs. 9.1%; p=0.023). Moreover, the occurrence of body movements was markedly lower in the BIS group than in the non-BIS group (8.5% vs. 39.4%; p
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- 2022
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7. A novel and effective EUS training program that enables visualization of the learning curve: Educational Program of Kindai system (EPOK)
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Shunsuke Omoto, MD, PhD, Mamoru Takenaka, MD, PhD, Fauze Maluf-Filho, MD, PhD, and Masatoshi Kudo, MD, PhD
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Diseases of the digestive system. Gastroenterology ,RC799-869 - Published
- 2022
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8. Successful endoscopic submucosal dissection of colorectal lipoma with an overlying adenoma
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Akito Furuta, Shunsuke Omoto, Taro Inoue, Mitsuru Yanai, Hideo Iwabe, Hiroshi Takihara, Kohei Ishibashi, Hironori Tanaka, Ko Matsuura, Shunsuke Ogata, Akitaka Yokomura, Masato Hoshikawa, Michihito Kono, Takasi Koriyama, Tomohiko Tazawa, Eri Tsuyuguchi, Yasuo Yamasaki, Shun Esumi, Yoshimasa Tsuruta, Takahiro Shishimoto, Masaki Yamamoto, and Wataru Ono
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endoscopic submucosal dissection ,lipoma ,lipoma with an overlying adenoma ,Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Abstract We report the case of a 65‐year‐old woman whose colonoscopy revealed a soft submucosal tumor approximately 7 cm in diameter in the ascending colon with an overlying flat lesion. The tumor was diagnosed as a lipoma with an overlying adenoma. Endoscopic submucosal dissection (ESD) was performed. Pathological examination revealed that the epithelium was a low‐grade tubulovillous adenoma, while the submucosal yellow tumor was a lipoma. ESD appears to be a safe and effective treatment for colorectal lipomas overlying lipomas with colorectal adenomas.
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- 2023
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9. Comparison of endoscopic ultrasonography with and without contrast enhancement for characterization of pancreatic tumors: a meta-analysis
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Yasunobu Yamashita, Toshio Shimokawa, Reiko Ashida, Bertrand Napoléon, Andrea Lisotti, Pietro Fusaroli, Rodica Gincul, Christoph F. Dietrich, Shunsuke Omoto, and Masayuki Kitano
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Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Background and study aims Endoscopic ultrasonography (EUS) is a reliable and efficient modality for detecting pancreatic tumors; however, plain EUS (P-EUS) is limited with respect to characterization of pancreatic tumors. Recently, the use of contrast-enhanced harmonic EUS (CH-EUS) has increased, and its utility for characterization of pancreatic tumors has been reported. This meta-analysis compares the diagnostic ability of P-EUS with that of CH-EUS for characterization of pancreatic tumors. Methods A systematic meta-analysis of all potentially relevant articles in PubMed, the Cochrane library, and Google Scholar databases was performed. Fixed effects or random effects models were used to investigate pooled sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio, with 95 % confidence intervals (CIs). Results This meta-analysis included 719 patients who underwent CH-EUS and 723 who underwent P-EUS, from six eligible studies. The pooled estimates of sensitivity, specificity, and diagnostic odds ratio were 93 % (95 % CI, 0.90–0.95), 80 % (95 % CI, 0.75–0.85), and 57.9 (95 % CI, 25.9–130), respectively, for CH-EUS, and 86 % (95 % CI, 0.82–0.89), 59 % (95 % CI, 0.52–0.65), and 8.3 (95 % CI, 2.8–24.5) for P-EUS. The areas under the summary receiver operating characteristics curves for CH-EUS and P-EUS were 0.96 and 0.80, respectively. The diagnostic odds ratio for pancreatic cancer was 2.98 times higher on CH-EUS than on P-EUS (P = 0.03). Funnel plots demonstrated no publication bias. Conclusions This meta-analysis demonstrates that CH-EUS has higher diagnostic accuracy for pancreatic cancer than P-EUS, and is thus a valuable tool for characterization of pancreatic tumors.
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- 2022
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10. Analysis of Progression Time in Pancreatic Cancer including Carcinoma In Situ Based on Magnetic Resonance Cholangiopancreatography Findings
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Kentaro Yamao, Masakatsu Tsurusaki, Kota Takashima, Hidekazu Tanaka, Akihiro Yoshida, Ayana Okamoto, Tomohiro Yamazaki, Shunsuke Omoto, Ken Kamata, Kosuke Minaga, Mamoru Takenaka, Takaaki Chikugo, Yasutaka Chiba, Tomohiro Watanabe, and Masatoshi Kudo
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carcinoma in situ ,computed tomography ,early diagnosis ,magnetic resonance cholangiopancreatography ,natural history ,pancreatic carcinoma ,Medicine (General) ,R5-920 - Abstract
Background: Pancreatic cancer (PC) exhibits extremely rapid growth; however, it remains largely unknown whether the early stages of PC also exhibit rapid growth speed equivalent to advanced PC. This study aimed to investigate the natural history of early PCs through retrospectively assessing pre-diagnostic images. Methods: We examined the data of nine patients, including three patients with carcinoma in situ (CIS), who had undergone magnetic resonance cholangiopancreatography (MRCP) to detect solitary main pancreatic duct (MPD) stenosis >1 year before definitive PC diagnosis. We retrospectively analyzed the time to diagnosis and first-time tumor detection from the estimated time point of first-time MPD stenosis detection without tumor lesion. Results: The median tumor size at diagnosis and the first-time tumor detection size were 14 and 7.5 mm, respectively. The median time to diagnosis and first-time tumor detection were 26 and 49 months, respectively. Conclusions: No studies have investigated the PC history, especially that of early PCs, including CIS, based on the initial detection of MPD stenosis using MRCP. Assessment of a small number of patients showed that the time to progression can take several years in the early PC stages. Understanding this natural history is very important in the clinical setting.
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- 2021
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11. Endoscopic Ultrasound Fine-Needle Biopsy May Contribute to the Diagnosis of Malignant Lymph Nodes
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Mamoru Takenaka, Shunsuke Omoto, and Masatoshi Kudo
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Internal medicine ,RC31-1245 ,Diseases of the digestive system. Gastroenterology ,RC799-869 - Published
- 2020
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12. New endoscopic ultrasonography techniques for pancreaticobiliary diseases
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Ken Kamata, Masayuki Kitano, Shunsuke Omoto, Kumpei Kadosaka, Takeshi Miyata, Kosuke Minaga, Kentaro Yamao, Hajime Imai, and Masatoshi Kudo
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Endosonography ,Endoscopic ultrasound-guided fine needle aspiration ,Elasticity imaging techniques ,Biliary tract ,Pancreas ,Sonazoid ,Medical technology ,R855-855.5 - Abstract
Endoscopic ultrasonography (EUS) is widely used to evaluate pancreaticobiliary diseases, especially pancreatic masses. EUS has a good ability to detect pancreatic masses, but it is not sufficient for the differential diagnosis of various types of lesions. In order to address the limitations of EUS, new techniques have been developed to improve the characterization of the lesions detected by EUS. EUS-guided fine needle aspiration (EUS-FNA) has been used for diagnosing pancreatic tumors. In order to improve the histological diagnostic yield, a EUS-FNA needle with a core trap has recently been developed. Contrast-enhanced harmonic EUS is a new imaging modality that uses an ultrasonographic contrast agent to visualize blood flow in fine vessels. This technique is useful in the diagnosis of pancreatic solid lesions and in confirming the presence of vascularity in mural nodules for cystic lesions. EUS elastography analyzes several different variables to measure tissue elasticity, color patterns, and strain ratio, using analytical techniques such as hue-histogram analysis, and artificial neural networks, which are useful for the diagnosis of chronic pancreatitis and pancreatic cancer.
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- 2016
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13. Partial Pancreatic Parenchymal Atrophy Is a New Specific Finding to Diagnose Small Pancreatic Cancer (≤10 mm) Including Carcinoma in Situ: Comparison with Localized Benign Main Pancreatic Duct Stenosis Patients
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Kentaro Yamao, Mamoru Takenaka, Rei Ishikawa, Ayana Okamoto, Tomohiro Yamazaki, Atsushi Nakai, Shunsuke Omoto, Ken Kamata, Kosuke Minaga, Ippei Matsumoto, Yoshifumi Takeyama, Isao Numoto, Masakatsu Tsurusaki, Takaaki Chikugo, Yasutaka Chiba, Tomohiro Watanabe, and Masatoshi Kudo
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carcinoma in situ ,computed tomography ,early diagnosis ,pancreatic parenchymal atrophy ,small pancreatic cancer ,Medicine (General) ,R5-920 - Abstract
Background: This study aimed to evaluate and identify the specific CT findings by focusing on abnormalities in the main pancreatic duct (MPD) and pancreatic parenchyma in patients with small pancreatic cancer (PC) including carcinoma in situ (CIS). Methods: Nine CT findings indicating abnormalities of MPD and pancreatic parenchyma were selected as candidate findings for the presence of small PC ≤ 10 mm. The proportions of patients positive for each finding were compared between small PC and benign MPD stenosis groups. Interobserver agreement between two independent image reviewers was evaluated using kappa statistics. Results: The final analysis included 24 patients with small PC (including 11 CIS patients) and 28 patients with benign MPD stenosis. The proportion of patients exhibiting partial pancreatic parenchymal atrophy (PPA) corresponding to the distribution of MPD stenosis (45.8% vs. 7.1%, p < 0.01), upstream PPA arising from the site of MPD stenosis (33.3% vs. 3.6%, p = 0.01), and MPD abrupt stenosis (45.8% vs. 14.3%, p = 0.03) was significantly higher in the small PC group than in the benign MPD stenosis group. Conclusions: The presence of partial PPA, upstream PPA, and MPD abrupt stenosis on a CT image was highly suggestive of the presence of small PCs including CIS.
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- 2020
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14. Predictors of pain response in patients undergoing endoscopic ultrasound-guided neurolysis for abdominal pain caused by pancreatic cancer
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Kosuke Minaga, Masayuki Kitano, Hiroki Sakamoto, Takeshi Miyata, Hajime Imai, Kentaro Yamao, Ken Kamata, Shunsuke Omoto, Kumpei Kadosaka, Toshiharu Sakurai, Naoshi Nishida, Yasutaka Chiba, and Masatoshi Kudo
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Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Background: Interventional endoscopic ultrasound (EUS)-guided procedures such as EUS-guided celiac ganglia neurolysis (EUS-CGN) and EUS-guided broad plexus neurolysis (EUS-BPN) were developed to treat abdominal cancer-associated pain; however, these procedures are not always effective. The aim of this study was to explore predictors of pain response in EUS-guided neurolysis for pancreatic cancer-associated pain. Methods: This was a retrospective analysis of prospectively collected data of 112 consecutive patients who underwent EUS-BPN in our institution. EUS-CGN was added in cases of visible celiac ganglia. The neurolytic-spread area was divided into six sections and evaluated by post-procedural computed tomography scanning. Pain intensity was assessed using a visual analog scale (VAS), and a decrease in VAS scores by ⩾3 points after neurolysis was considered a good pain response. Univariable and multivariable logistic regression analyses were performed to explore predictors of pain response at 1 and 4 weeks, and complications. Results: A good pain response was obtained in 77.7% and 67.9% of patients at 1 and 4 weeks, respectively. In the multivariable analysis of these patients, the combination method (EUS-BPN plus CGN) was a significant positive predictive factor at 1 week (odds ratio = 3.69, p = 0.017) and 4 weeks (odds ratio = 6.37, p = 0.043). The numbers of neurolytic/contrast spread areas (mean ± SD) were 4.98 ± 1.08 and 4.15 ± 1.12 in patients treated with the combination method and single method, respectively ( p < 0.001). There was no significant predictor of complications. Conclusions: EUS-BPN in combination with EUS-CGN was a predictor of a good pain response in EUS-guided neurolysis for pancreatic cancer-related pain. The larger number of neurolytic/contrast spread areas may lead to better outcomes in patients receiving combination treatment.
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- 2016
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15. Familial Adenomatous Polyposis with Atypical Clinical Morphology and Genetic Variants.
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Yoriaki Komeda, Hideki Ishikawa, Teruhiko Yoshida, Mineko Ushiama, Saki Yoshida, Kenji Nomura, Masashi Kono, Shunsuke Omoto, Mamoru Takenaka, Satoru Hagiwara, Hiroshi Kashida, and Masatoshi Kudo
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- 2024
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16. 重症急性膵炎に対する予防的抗菌薬使用の現況 第49回日本救急医学会総会・学術集会より(Current status of prophylactic antimicrobial use for severe acute pancreatitis: in the 49th Annual Meeting of the Japanese Association for Acute Medicine)
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土谷 飛鳥 (Asuka Tsuchiya), 平下 禎二郎 (Teijiro Hirashita), 堀部 昌靖 (Masayasu Horibe), 大本 俊介 (Shunsuke Omoto), 松田 直之 (Naoyuki Matsuda), and 真弓 俊彦 (Toshihiko Mayumi)
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- 2022
17. The 'echo-free space' technique: a safe and reliable method for endoscopic ultrasound scope insertion
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Shunsuke Omoto, Mamoru Takenaka, Tomohiro Fukunaga, Kota Takashima, Yoriaki Komeda, Seok Jeong, and Masatoshi Kudo
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Gastroenterology - Published
- 2023
18. EUS-guided drainage of the gallbladder using a novel 0.018-inch guidewire for preventing bile leakage (with video)
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Mamoru Takenaka, Shunsuke Omoto, and Masatoshi Kudo
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Hepatology ,Gastroenterology ,Radiology, Nuclear Medicine and imaging - Published
- 2022
19. Utility of contrast-enhanced harmonic endoscopic ultrasonography for T-staging of patients with extrahepatic bile duct cancer
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Ayana Okamoto, Mamoru Takenaka, Hidekazu Tanaka, Kosuke Minaga, Rei Ishikawa, Takaaki Chikugo, Masatoshi Kudo, Shunsuke Omoto, Ken Kamata, Kentaro Yamao, Yasutaka Chiba, Takuya Nakai, Yasuo Otsuka, Tomohiro Yamazaki, Akane Hara, Ippei Matsumoto, Tomohiro Watanabe, Tomoko Hyodo, Yoshifumi Takeyama, Atsushi Nakai, and Tomoe Yoshikawa
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medicine.medical_specialty ,Inferior vena cava ,Endosonography ,Bile duct cancer ,Bile Ducts, Extrahepatic ,Internal medicine ,medicine ,Humans ,Superior mesenteric vein ,Pancreas ,Neoplasm Staging ,Retrospective Studies ,business.industry ,Gallbladder ,Cancer ,Hepatology ,medicine.disease ,digestive system diseases ,medicine.anatomical_structure ,Bile Duct Neoplasms ,medicine.vein ,Duodenum ,Surgery ,Radiology ,business - Abstract
The value of contrast-enhanced harmonic endoscopic ultrasonography (CH-EUS) for T-staging in patients with extrahepatic bile duct cancer was evaluated. This single-center, retrospective study included consecutive patients with extrahepatic bile duct cancer who underwent surgical resection after preoperative EUS, CH-EUS, and contrast-enhanced CT (CE-CT) examinations between June 2014 and August 2017. The capacity of these modalities for T-staging of extrahepatic bile duct cancer was evaluated by assessing invasion beyond the biliary wall into the surrounding tissue, gallbladder, liver, pancreas, duodenum, portal vein system (portal vein and/or superior mesenteric vein), inferior vena cava, and hepatic arteries (proper hepatic artery, right. and/or left. hepatic artery). Blind reading of EUS, CH-EUS, and CE-CT images was performed by two expert reviewers each. 38 patients were eligible for analysis, of which eight had perihilar bile duct cancer and 30 had distal bile duct cancer. Postoperative T-staging was T1 in 6, T2 in 16, and T3 in 16 cases. CH-EUS was superior to CE-CT for diagnosing invasion beyond the biliary wall into surrounding tissue (92.1% vs. 45.9%, P = 0.0002); the ability to detect invasion to other organs did not differ significantly between the two modalities. The accuracy of CH-EUS for T-staging of tumors was better than that of CE-CT (73.7% vs. 39.5%, P = 0.0059). CH-EUS tended to have a better accuracy than EUS for the diagnosis of invasion beyond the biliary wall into the surrounding tissue (92.1% vs. 78.9%, P = 0.074) and T-staging (73.7% vs. 60.5%, P = 0.074). CH-EUS is useful for T-staging of extra hepatic bile duct cancer, especially in terms of invasion beyond the biliary wall into the surrounding tissue.
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- 2021
20. The 'straighten pigtail' technique for selective replacement of a pigtail plastic stent
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Mamoru Takenaka, Tomohiro Fukunaga, Akihiro Yoshida, Shunsuke Omoto, and Masatoshi Kudo
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Gastroenterology - Published
- 2022
21. Prospective multicenter evaluation of moving cell metallic stents in endoscopic multiple stent deployment for hepatic hilar obstruction
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Takeshi Ogura, Mamoru Takenaka, Takuya Ikegawa, Kazuya Ueshima, Junichi Kawai, Atsushi Nakai, Akitoshi Hakoda, Saori Ueno, Jun Matsuno, Kazuhide Higuchi, Atsushi Okuda, Shunsuke Omoto, Kousuke Minaga, and Hideyuki Shiomi
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medicine.medical_specialty ,medicine.medical_treatment ,Technical success ,Self Expandable Metallic Stents ,law.invention ,Randomized controlled trial ,law ,Stent deployment ,medicine ,Humans ,Prospective Studies ,Retrospective Studies ,Cholestasis ,Endoscopic retrograde cholangiopancreatography ,Hepatology ,medicine.diagnostic_test ,business.industry ,Liver Diseases ,Stent ,Surgery ,Treatment Outcome ,Bile Duct Neoplasms ,Biliary tract ,Stents ,Delivery system ,business ,Single session - Abstract
Background and aim Bilateral stent deployment for malignant biliary obstruction (MHBO) can be achieved using side-by-side (SBS) or stent-in-stent (SIS) procedures. Compared with SBS techniques, the procedural steps of SIS are technically complex due to the necessity of introducing the delivery system into a contralateral biliary tract through the mesh of the SEMS. To overcome this issue, a novel uncovered SEMS, the HILZO Moving Cell Stent (MCS) has been released. The present study examined the technical feasibility of treating MHBO using bilateral deployment of this novel stent without dilating the mesh of the first stent to achieve insertion of the second stent within a single session, using a prospective, multicenter setting. Method The primary outcome in the present study was the technical success rate. Technical success was defined as deployment of bilateral MCSs into two or more biliary tracts using SIS without a dilation device in a single-session. Results A total of 27 patients with complications of MHBO were enrolled in this study. Bilateral SIS using two MCS was successfully performed in 23 patients without using dilation devices among 27 patients (initial technical success rate; 85.2%). Median time to recurrent biliary obstruction (TRBO) was 271 days. Stent dysfunction was observed in 12 patients (44.4%), and re-intervention was successfully performed in all patients without one patient who instead received best supportive care. Conclusions The SIS technique using MCS without dilation of the mesh may be technically feasible and safe. In addition, this may be useful for re-intervention. Further comparative randomized trials are needed.
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- 2021
22. Clinical impact of recombinant thrombomodulin administration on disseminated intravascular coagulation due to severe acute cholangitis (Recover‐AC study)
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Kei Ito, Shinsuke Koshita, Megumi Takagi, Shunsuke Omoto, Seitaro Ikeoka, Kazunari Nakahara, Masayuki Kitano, Takaaki Eguchi, Junya Sato, Mitsuhito Koizumi, Kazuhide Higuchi, Masahiro Itonaga, Akitoshi Hakoda, Kanno Yoshihide, Yousuke Michikawa, Mamoru Takenaka, Taira Kuroda, Ryo Morita, Akihiko Okada, and Takeshi Ogura
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Disseminated intravascular coagulation ,medicine.medical_specialty ,Endoscopic retrograde cholangiopancreatography ,Multivariate analysis ,Hepatology ,APACHE II ,medicine.diagnostic_test ,business.industry ,030204 cardiovascular system & hematology ,Thrombomodulin ,medicine.disease ,Gastroenterology ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Propensity score matching ,Etiology ,Medicine ,030211 gastroenterology & hepatology ,Surgery ,business ,Survival rate - Abstract
BACKGROUND AND AIM Recombinant thrombomodulin (rhTM) is potentially effective in the treatment of disseminated intravascular coagulation (DIC). Several studies related to drugs for the treatment of acute cholangitis have shown negative results in improvement of overall survival (OS) with rhTM. The aim of this multicenter study was to evaluate the clinical effectiveness of rhTM in patients with acute cholangitis and sepsis-induced DIC who underwent biliary drainage. METHODS A total of 284 consecutive patients, who were complicated with sepsis-induced DIC due to severe acute cholangitis, were included (rhTM group, n = 173; non-rhTM, n = 111) in this study. The primary outcome was the DIC resolution rate at 7 days after starting treatment. The 28-day survival rate was secondarily evaluated. RESULTS DIC scores in the rhTM group improved significantly compared with the non-rhTM group on day 7 (P = .020). According to multivariate analysis, etiology of cholangitis (malignant, HR 2.28), rhTM (non-administration, HR 4.13), and DIC score (≥5, HR 2.46) were significant factors associated with failed DIC resolution on day 7. Propensity score matching created 103 matched pairs. Survival rate at day 28 was significantly higher in rhTM group (94.3%) compared with non-rhTM group (82.6%; P = .048) after propensity score matching. rhTM (non-administration, HR 2.870), DIC score (≥5, HR 2.751), and APACHE II score (≥20, HR 9.310) were significant factors associated with decreasing survival rate at day 28. CONCLUSION In conclusion, rhTM seemed to improve patient survival, but future studies should only include patients with benign or malignant disease and should be performed according to APACHE II scores.
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- 2021
23. The usefulness of texture and color-enhanced imaging for balloon endoscopy–assisted ERCP for hepatic-jejunal anastomotic stenosis
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Mamoru, Takenaka, Shunsuke, Omoto, Tomohiro, Fukunaga, and Masatoshi, Kudo
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Gastroenterology ,Radiology, Nuclear Medicine and imaging - Published
- 2023
24. Utility of contrast-enhanced harmonic EUS for diagnosis of portal vein invasion by pancreatic cancer
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Ken Kamata, Atsushi Nakai, Tomoko Hyodo, Takaaki Chikugo, Akane Hara, Yasuo Otsuka, Hidekazu Tanaka, Tomoe Yoshikawa, Rei Ishikawa, Ayana Okamoto, Tomohiro Yamazaki, Shunsuke Omoto, Kosuke Minaga, Kentaro Yamao, Mamoru Takenaka, Yasutaka Chiba, Tomohiro Watanabe, Ippei Matsumoto, Yoshifumi Takeyama, and Masatoshi Kudo
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Hepatology ,Gastroenterology ,Radiology, Nuclear Medicine and imaging - Abstract
The value of contrast-enhanced harmonic EUS (CH-EUS) for diagnosis of portal vein invasion in patients with pancreatic cancer was evaluated.This single-center, retrospective study included consecutive patients with pancreatic cancer who underwent both surgical resection after preoperative EUS, CH-EUS, and contrast-enhanced computed tomography (CE-CT) examinations between April 2015 and August 2017. CH-EUS evaluation was performed during the late phase. Portal vein invasion on EUS and CH-EUS was defined as no continuity in the line of the vessel wall. Definition of portal vein invasion on CE-CT was based on the Loyer's criteria. The accuracy of three modalities for diagnosis of invasion into the portal vein was compared using the McNemar's test.Eighty-eight patients (mean age: 71.0 years, ratio of male to female: 48:40) were eligible. Postoperative pathological results were as follows: seven cases of portal vein invasion; 81 cases without. Diagnostic accuracy of EUS, CH-EUS, and CE-CT for diagnosing invasion into the portal vein was 72.7%, 93.2%, and 81.8%, respectively. The differences between CH-EUS and CE-CT (P = 0.0094) and CH-EUS and EUS (P = 0.0022) were significant. EUS and CE-CT were comparable.CH-EUS is useful for diagnosis of portal vein invasion by pancreatic cancer.
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- 2022
25. Tissue harmonic versus contrast‐enhanced harmonic endoscopic ultrasonography for the diagnosis of pancreatic tumors: Prospective multicenter study
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Hironari Kato, Yasutaka Chiba, Hideyuki Shiomi, Masatoshi Kudo, Naoki Yamamoto, Shinichi Takano, Shunsuke Omoto, Masato Hoshikawa, Kazuya Sugimori, Haruo Miwa, Takamitsu Tanaka, Masayuki Kitano, Takeshi Ezaki, Atsushi Kanno, Akitaka Yokomura, Reiko Ashida, and Mitsuharu Fukasawa
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medicine.medical_specialty ,business.industry ,Gastroenterology ,Contrast Media ,Reproducibility of Results ,Echogenicity ,Endoscopic ultrasonography ,Sensitivity and Specificity ,digestive system diseases ,Endosonography ,Pancreatic Neoplasms ,Multicenter study ,Late phase ,Humans ,Medicine ,Radiology, Nuclear Medicine and imaging ,Prospective Studies ,Pancreatic carcinoma ,Radiology ,business - Abstract
OBJECTIVES This prospective multicenter study aimed to assess and compare the accuracy of tissue harmonic endoscopic ultrasonography (TH-EUS) and contrast-enhanced harmonic endoscopic ultrasonography (CH-EUS) for differentiating pancreatic carcinoma from other pancreatic tumors. METHODS Consecutive patients with solid pancreatic tumors were prospectively enrolled between August 2013 and December 2014. To assess the accuracy of TH-EUS and CH-EUS, we compared four parameters of TH-EUS (fuzzy edge, irregular periphery, hypoechogenicity, and heterogeneous internal echogenicity) and four parameters of CH-EUS (hypoenhancement and heterogeneous enhancement in the early and late phases, respectively) to investigate which parameter of each method was most suitable to diagnose pancreatic carcinomas. Interobserver agreement and the diagnostic ability of pancreatic carcinoma using TH-EUS and CH-EUS were assessed and compared. RESULTS A total of 204 patients were enrolled. For the diagnosis of pancreatic carcinoma, interobserver agreement by experts and nonexperts was 0.33-0.50 and 0.35-0.50 for TH-EUS, respectively, and 0.72-0.74 and 0.20-0.54 for CH-EUS, respectively. Irregular periphery was the most accurate diagnostic parameter among TH-EUS findings for differentiating pancreatic carcinomas, with sensitivity, specificity, and accuracy of 95.0%, 42.9%, and 78.9%, respectively. Late phase hypoenhancement was the most accurate diagnostic parameter among CH-EUS findings for differentiating pancreatic carcinomas, with sensitivity, specificity, and accuracy of 90.8%, 74.6%, and 85.8%, respectively. The accuracy of CH-EUS (late phase hypoenhancement) for diagnosis of pancreatic carcinoma was significantly higher than that of TH-EUS (irregular periphery) (p
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- 2021
26. Improved detection of liver metastasis using Kupffer-phase imaging in contrast-enhanced harmonic EUS in patients with pancreatic cancer (with video)
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Shunsuke Omoto, Mamoru Takenaka, Masayuki Kitano, Ippei Matsumoto, Masatoshi Kudo, Takaaki Chikugo, Atsushi Nakai, Kosuke Minaga, Masakatsu Tsurusaki, Ken Kamata, Kentaro Yamao, Yasutaka Chiba, and Tomohiro Watanabe
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medicine.medical_specialty ,Perfluorobutane ,business.industry ,Gastroenterology ,medicine.disease ,digestive system diseases ,Patient management ,Metastasis ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,chemistry ,Interquartile range ,030220 oncology & carcinogenesis ,Pancreatic cancer ,Phase imaging ,medicine ,030211 gastroenterology & hepatology ,Radiology, Nuclear Medicine and imaging ,In patient ,Radiology ,Stage (cooking) ,business - Abstract
Background and Aims Kupffer-phase imaging visualized by perfluorobutane (Sonazoid) distribution into normal liver tissues upon phagocytosis by Kupffer cells potentially aids in improving detection of liver metastasis compared with fundamental B-mode EUS (FB-EUS). However, the diagnostic performance of Kupffer-phase imaging in contrast-enhanced harmonic EUS (CH-EUS) remains unclear. Hence, this study aimed to evaluate the usefulness of CH-EUS-based Kupffer-phase imaging for diagnosing liver metastasis from pancreatic cancer. Methods We retrospectively analyzed consecutive patients with pancreatic cancer who underwent contrast-enhanced CT (CE-CT) and FB-EUS, followed by CH-EUS, from 2011 to 2017. The diagnostic ability of CH-EUS against that of CE-CT and FB-EUS for metastasis in the left liver lobe was compared. Subsequently, the influences of CH-EUS on the determination of clinical stage and patient management for pancreatic cancer were assessed. Results We enrolled 426 patients with pancreatic cancer. Metastasis in the left liver lobe was present in 27.2% of patients. The diagnostic accuracy of CE-CT, FB-EUS, and CH-EUS was 90.6%, 93.4%, and 98.4%, respectively. The sensitivity and diagnostic accuracy of CH-EUS for metastasis in the left liver lobe were significantly higher than those of FB-EUS or CE-CT. The sensitivity of CH-EUS for detecting small liver metastasis ( Conclusions CH-EUS-based Kupffer-phase imaging increased the detectability of metastasis in the left liver lobe. This technique could be a reliable pretreatment imaging modality for clinical decision-making in patients with pancreatic cancer.
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- 2021
27. 重症急性膵炎に対する予防的抗菌薬使用の現況 第49回日本救急医学会総会・学術集会より(Current status of prophylactic antimicrobial use for severe acute pancreatitis: in the 49th Annual Meeting of the Japanese Association for Acute Medicine)
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(Asuka Tsuchiya), 土谷 飛鳥, primary, (Teijiro Hirashita), 平下 禎二郎, additional, (Masayasu Horibe), 堀部 昌靖, additional, (Shunsuke Omoto), 大本 俊介, additional, (Naoyuki Matsuda), 松田 直之, additional, and (Toshihiko Mayumi), 真弓 俊彦, additional
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- 2022
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28. Utility of contrast‐enhanced harmonic endoscopic ultrasonography for predicting the prognosis of pancreatic neuroendocrine neoplasms
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Masatoshi Kudo, Tomohiro Yamazaki, Yasunori Minami, Shunsuke Omoto, Yuko Matsukubo, Tomoko Hyodo, Mamoru Takenaka, Ippei Matsumoto, Atsushi Nakai, Kentaro Yamao, Hidekazu Tanaka, Kosuke Minaga, Akane Hara, Yasutaka Chiba, Yoshifumfi Takeyama, Tomohiro Watanabe, Ayana Okamoto, Rei Ishikawa, Ken Kamata, and Takaaki Chikugo
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medicine.medical_specialty ,Poor prognosis ,Contrast Media ,Endoscopic ultrasonography ,Malignancy ,Endosonography ,03 medical and health sciences ,0302 clinical medicine ,Fibrosis ,Humans ,Medicine ,Radiology, Nuclear Medicine and imaging ,Pathological ,Retrospective Studies ,medicine.diagnostic_test ,business.industry ,Gastroenterology ,Retrospective cohort study ,Prognosis ,medicine.disease ,Predictive value ,digestive system diseases ,Pancreatic Neoplasms ,Neuroendocrine Tumors ,Fine-needle aspiration ,030220 oncology & carcinogenesis ,030211 gastroenterology & hepatology ,Radiology ,business - Abstract
BACKGROUND AND AIMS Pancreatic neuroendocrine neoplasms (PanNENs), including Grade 1 (G1) or G2 tumors, can have a poor prognosis. This study investigated the value of contrast-enhanced harmonic endoscopic ultrasonography (CH-EUS) for predicting the prognosis of PanNENs. METHODS This single-center, retrospective study included 47 consecutive patients who underwent CH-EUS and were diagnosed with PanNEN by surgical resection or EUS-guided fine needle aspiration between December 2011 and February 2016. Patients were divided into aggressive and non-aggressive groups according to the degree of clinical malignancy. CH-EUS was assessed regarding its capacity for diagnosing aggressive PanNEN, the correspondence between contrast patterns and pathological features, and its ability to predict the prognosis of PanNEN. RESULTS There were 19 cases of aggressive PanNEN and 28 cases of non-aggressive PanNEN. The aggressive group included three G1, four G2, three G3 tumors, three mixed neuroendocrine non-neuroendocrine neoplasms, and six neuroendocrine carcinomas. CH-EUS was superior to contrast-enhanced computed tomography for the diagnosis of aggressive PanNEN (P
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- 2020
29. Identification of serum IFN-α and IL-33 as novel biomarkers for type 1 autoimmune pancreatitis and IgG4-related disease
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Kentaro Yamao, Akane Hara, Yasutaka Chiba, Shunsuke Omoto, Mamoru Takenaka, Tomohiro Watanabe, Tomoe Yoshikawa, Atsushi Nakai, Ken Kamata, Yasuo Otsuka, Ikue Sekai, Masatoshi Kudo, and Kosuke Minaga
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0301 basic medicine ,Male ,medicine.medical_specialty ,Autoimmune diseases ,Autoimmune Pancreatitis ,Prednisolone ,Anti-Inflammatory Agents ,lcsh:Medicine ,Gastroenterology ,Article ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,parasitic diseases ,medicine ,Humans ,skin and connective tissue diseases ,lcsh:Science ,Autoimmune pancreatitis ,Aged ,Autoimmune disease ,Multidisciplinary ,integumentary system ,business.industry ,fungi ,lcsh:R ,Interferon-alpha ,medicine.disease ,Interleukin-33 ,Interleukin 33 ,Immunoglobulin Isotypes ,030104 developmental biology ,medicine.anatomical_structure ,Pancreatitis ,ROC Curve ,Biomarker (medicine) ,030211 gastroenterology & hepatology ,IgG4-related disease ,Female ,lcsh:Q ,Immunoglobulin G4-Related Disease ,Pancreas ,business ,Biomarkers ,medicine.drug - Abstract
IgG4-related disease (IgG4-RD) is a multi-organ autoimmune disease characterized by elevated serum IgG4 concentration. Although serum IgG4 concentration is widely used as a biomarker for IgG4-RD and type 1 autoimmune pancreatitis (AIP), a pancreatic manifestation of IgG4-RD, a significant number of patients have normal serum IgG4 levels, even in the active phase of the disease. Recently, we reported that the development of experimental AIP and human type 1 AIP is associated with increased expression of IFN-α and IL-33 in the pancreas. In this study, we assessed the utility of serum IFN-α and IL-33 levels as biomarkers for type 1 AIP and IgG4-RD. Serum IFN-α and IL-33 concentrations in patients who met the diagnostic criteria for definite type 1 AIP and/or IgG4-RD were significantly higher than in those with chronic pancreatitis or in healthy controls. Strong correlations between serum IFN-α, IL-33, and IgG4 concentrations were observed. Diagnostic performance of serum IFN-α and IL-33 concentrations as markers of type 1 AIP and/or IgG4-RD was comparable to that of serum IgG4 concentration, as calculated by the receiver operating characteristic curve analysis. Induction of remission by prednisolone treatment markedly decreased the serum concentration of these cytokines. We conclude that serum IFN-α and IL-33 concentrations can be useful as biomarkers for type 1 AIP and IgG4-RD.
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- 2020
30. Endosonography-guided gallbladder drainage versus percutaneous cholecystostomy in very high-risk surgical patients with acute cholecystitis: an international randomised multicentre controlled superiority trial (DRAC 1)
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Takao Itoi, Philip Wai Yan Chiu, James Y.W. Lau, Shunsuke Omoto, Shannon M. Chan, Ka Tak Wong, Masayuki Kitano, Chi-Ho Leung, Manuel Perez-Miranda, Enders K.W. Ng, Anthony Yuen Bun Teoh, Takeshi Ogura, Carlos de la Serna-Higuera, Takayoshi Tsuichiya, and Raúl Torres-Yuste
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Male ,Endoscopic ultrasound ,medicine.medical_specialty ,medicine.medical_treatment ,Cholecystitis, Acute ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Superiority Trial ,Randomized controlled trial ,law ,medicine ,Acute cholecystitis ,Humans ,Adverse effect ,Cholecystostomy ,Ultrasonography, Interventional ,Aged ,Aged, 80 and over ,medicine.diagnostic_test ,business.industry ,Gallbladder ,Gastroenterology ,medicine.disease ,Surgery ,Treatment Outcome ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Cholecystitis ,Drainage ,Female ,030211 gastroenterology & hepatology ,Cholecystectomy ,business - Abstract
ObjectiveThe optimal management of acute cholecystitis in patients at very high risk for cholecystectomy is uncertain. The aim of the current study was to compare endoscopic ultrasound (EUS)-guided gallbladder drainage (EUS-GBD) to percutaneous cholecystostomy (PT-GBD) as a definitive treatment in these patients under a randomised controlled trial.DesignConsecutive patients suffering from acute calculous cholecystitis but were at very high-risk for cholecystectomy were recruited. The primary outcome was the 1-year adverse events rate. Secondary outcomes include technical and clinical success, 30-day adverse events, pain scores, unplanned readmissions, re-interventions and mortalities.ResultsBetween August 2014 to February 2018, 80 patients were recruited. EUS-GBD significantly reduced 1 year adverse events (10 (25.6%) vs 31 (77.5%), pConclusionEUS-GBD improved outcomes as compared to PT-GBD in those patients that not candidates for cholecystectomy. EUS-GBD should be the procedure of choice provided that the expertise is available after a multi-disciplinary meeting. Further studies are required to determine the long-term efficacy.Trial registration numberNCT02212717
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- 2020
31. Clinical utility of treatment method conversion during single-session endoscopic ultrasound-guided biliary drainage
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Rei Ishikawa, Shunsuke Omoto, Ayana Okamoto, Tomoe Yoshikawa, Kentaro Yamao, Mamoru Takenaka, Tomohiro Yamazaki, Atsushi Nakai, Yasutaka Chiba, Masatoshi Kudo, Tomohiro Watanabe, Ken Kamata, and Kosuke Minaga
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Endoscopic ultrasound ,Adult ,Male ,medicine.medical_specialty ,Gallstones ,Biliary drainage ,Endosonography ,03 medical and health sciences ,0302 clinical medicine ,Retrospective Study ,Stomach Neoplasms ,Biliary obstruction ,Medicine ,Endoscopic ultrasound-guided biliary drainage ,Humans ,Aged ,Retrospective Studies ,Ultrasonography ,Aged, 80 and over ,Cholestasis ,medicine.diagnostic_test ,business.industry ,Interventional endoscopic ultrasound ,Gastroenterology ,Treatment method ,Endoscopy ,General Medicine ,Middle Aged ,digestive system diseases ,Pancreatic Neoplasms ,Treatment Outcome ,Bile Duct Neoplasms ,030220 oncology & carcinogenesis ,Colonic Neoplasms ,Drainage ,030211 gastroenterology & hepatology ,Female ,Radiology ,Bile Ducts ,business ,Single session ,Algorithms - Abstract
BACKGROUND Although several techniques for endoscopic ultrasound-guided biliary drainage (EUS-BD) are available at present, an optimal treatment algorithm of EUS-BD has not yet been established. AIM To evaluate the clinical utility of treatment method conversion during single endoscopic sessions for difficult cases in initially planned EUS-BD. METHODS This was a single-center retrospective analysis using a prospectively accumulated database. Patients with biliary obstruction undergoing EUS-BD between May 2008 and April 2016 were included. The primary outcome was to evaluate the improvement in EUS-BD success rates by converting the treatment methods during a single endoscopic session. Secondary outcomes were clarification of the factors leading to the conversion from the initial EUS-BD and the assessment of efficacy and safety of the conversion as judged by technical success, clinical success, and adverse events (AEs). RESULTS A total of 208 patients underwent EUS-BD during the study period. For 18.8% (39/208) of the patients, the treatment methods were converted to another EUS-BD technique from the initial plan. Biliary obstruction was caused by pancreatobiliary malignancies, other malignant lesions, biliary stones, and other benign lesions in 22, 11, 4, and 2 patients, respectively. The reasons for the difficulty with the initial EUS-BD were classified into the following 3 procedures: Target puncture (n = 13), guidewire manipulation (n = 18), and puncture tract dilation (n = 8). Technical success was achieved in 97.4% (38/39) of the cases and clinical success was achieved in 89.5% of patients (34/38). AEs occurred in 10.3% of patients, including bile leakage (n = 2), bleeding (n = 1), and cholecystitis (n = 1). The puncture target and drainage technique were altered in subsequent EUS-BD procedures in 25 and 14 patients, respectively. The final technical success rate with 95%CI for all 208 cases was 97.1% (95%CI: 93.8%-98.9%), while that of the initially planned EUS-BD was 78.8% (95%CI: 72.6%-84.2%). CONCLUSION Among multi-step procedures in EUS-BD, guidewire manipulation appeared to be the most technically challenging. When initially planned EUS-BD is technically difficult, treatment method conversion in a single endoscopic session may result in successful EUS-BD without leading to severe AEs.
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- 2020
32. Value of artificial intelligence with novel tumor tracking technology in the diagnosis of gastric submucosal tumors by contrast-enhanced harmonic endoscopic ultrasonography
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Hidekazu Tanaka, Ken Kamata, Rika Ishihara, Hisashi Handa, Yasuo Otsuka, Akihiro Yoshida, Tomoe Yoshikawa, Rei Ishikawa, Ayana Okamoto, Tomohiro Yamazaki, Atsushi Nakai, Shunsuke Omoto, Kosuke Minaga, Kentaro Yamao, Mamoru Takenaka, Tomohiro Watanabe, Naoshi Nishida, and Masatoshi Kudo
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Technology ,Hepatology ,Leiomyoma ,Artificial Intelligence ,Gastrointestinal Stromal Tumors ,Stomach Neoplasms ,Gastroenterology ,Humans ,Endosonography ,Retrospective Studies - Abstract
Contrast-enhanced harmonic endoscopic ultrasonography (CH-EUS) is useful for the diagnosis of lesions inside and outside the digestive tract. This study evaluated the value of artificial intelligence (AI) in the diagnosis of gastric submucosal tumors by CH-EUS.This retrospective study included 53 patients with gastrointestinal stromal tumors (GISTs) and leiomyomas, all of whom underwent CH-EUS between June 2015 and February 2020. A novel technology, SiamMask, was used to track and trim the lesions in CH-EUS videos. CH-EUS was evaluated by AI using deep learning involving a residual neural network and leave-one-out cross-validation. The diagnostic accuracy of AI in discriminating between GISTs and leiomyomas was assessed and compared with that of blind reading by two expert endosonographers.Of the 53 patients, 42 had GISTs and 11 had leiomyomas. Mean tumor size was 26.4 mm. The consistency rate of the segment range of the tumor image extracted by SiamMask and marked by the endosonographer was 96% with a Dice coefficient. The sensitivity, specificity, and accuracy of AI in diagnosing GIST were 90.5%, 90.9%, and 90.6%, respectively, whereas those of blind reading were 90.5%, 81.8%, and 88.7%, respectively (P = 0.683). The κ coefficient between the two reviewers was 0.713.The diagnostic ability of CH-EUS results evaluated by AI to distinguish between GISTs and leiomyomas was comparable with that of blind reading by expert endosonographers.
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- 2021
33. Analysis of Progression Time in Pancreatic Cancer including Carcinoma In Situ Based on Magnetic Resonance Cholangiopancreatography Findings
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Masatoshi Kudo, Akihiro Yoshida, Ken Kamata, Mamoru Takenaka, Masakatsu Tsurusaki, Takaaki Chikugo, Ayana Okamoto, Kosuke Minaga, Tomohiro Yamazaki, Hidekazu Tanaka, Kota Takashima, Shunsuke Omoto, Yasutaka Chiba, Tomohiro Watanabe, and Kentaro Yamao
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Medicine (General) ,medicine.medical_specialty ,Clinical Biochemistry ,Article ,Lesion ,R5-920 ,Pancreatic cancer ,medicine ,Growth speed ,Pancreatic duct ,Magnetic resonance cholangiopancreatography ,Tumor size ,medicine.diagnostic_test ,pancreatic carcinoma ,business.industry ,Carcinoma in situ ,carcinoma in situ ,computed tomography ,medicine.disease ,Stenosis ,medicine.anatomical_structure ,magnetic resonance cholangiopancreatography ,natural history ,Radiology ,medicine.symptom ,business ,early diagnosis - Abstract
Background: Pancreatic cancer (PC) exhibits extremely rapid growth, however, it remains largely unknown whether the early stages of PC also exhibit rapid growth speed equivalent to advanced PC. This study aimed to investigate the natural history of early PCs through retrospectively assessing pre-diagnostic images. Methods: We examined the data of nine patients, including three patients with carcinoma in situ (CIS), who had undergone magnetic resonance cholangiopancreatography (MRCP) to detect solitary main pancreatic duct (MPD) stenosis >, 1 year before definitive PC diagnosis. We retrospectively analyzed the time to diagnosis and first-time tumor detection from the estimated time point of first-time MPD stenosis detection without tumor lesion. Results: The median tumor size at diagnosis and the first-time tumor detection size were 14 and 7.5 mm, respectively. The median time to diagnosis and first-time tumor detection were 26 and 49 months, respectively. Conclusions: No studies have investigated the PC history, especially that of early PCs, including CIS, based on the initial detection of MPD stenosis using MRCP. Assessment of a small number of patients showed that the time to progression can take several years in the early PC stages. Understanding this natural history is very important in the clinical setting.
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- 2021
34. Usefulness of the Novel Snare-over-the-Guidewire Method for Transpapillary Plastic Stent Replacement (with Video)
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Atsushi Nakai, Ken Kamata, Akihiro Yoshida, Mamoru Takenaka, Shunsuke Omoto, Yoriaki Komeda, Kota Takashima, Tomohiro Yamazaki, Hidekazu Tanaka, Ayana Okamoto, Masatoshi Kudo, Kosuke Minaga, Naoshi Nishida, and Kentaro Yamao
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medicine.medical_specialty ,Lumen (anatomy) ,snare-over-the-guidewire ,Article ,03 medical and health sciences ,0302 clinical medicine ,re-intervention ,medicine ,Bile duct stenosis ,Plastic stent ,cardiovascular diseases ,Replacement method ,Biliary drainage ,Access route ,business.industry ,General Medicine ,equipment and supplies ,eye diseases ,Surgery ,stomatognathic diseases ,surgical procedures, operative ,Biliary tract ,plastic stent ,030220 oncology & carcinogenesis ,Biliary stenosis ,Medicine ,030211 gastroenterology & hepatology ,business - Abstract
Unsuccessful stent replacement in transpapillary biliary drainage with plastic stents (PSs) has a significant impact on patient prognosis, thus, a safe and reliable replacement method is required. We aimed to compare the snare-over-the-guidewire (SOG) method, wherein the PS lumen is used as an access route to the biliary tract and the PS is removed with a snare inserted via the inserted guidewire, with the conventional side-of-stent (SOS) method, wherein the biliary approach is performed from the side of the PS. This retrospective single-center study included 244 consecutive patients who underwent biliary PS replacement between January 2018 and July 2020. The procedural success rates were compared between the two methods. A predictive analysis of unsuccessful PS replacement was also performed. The procedural success rate in the SOG group was significantly higher than that in the SOS group (p = 0.026). In the proximal biliary stenosis lesion, the same trend was observed (p = 0.025). Multivariate analysis also showed that the SOS method (p = 0.0038), the presence of proximal biliary stenosis (p <, 0.0001), and parapapillary diverticulum (p = 0.0007) were predictors of unsuccessful PS replacement. The SOG method may be useful for biliary PS replacement, especially in cases of proximal hilar bile duct stenosis.
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- 2021
35. Comparison of radiation exposure between endoscopic ultrasound-guided drainage and transpapillary drainage by endoscopic retrograde cholangiopancreatography for pancreatobiliary diseases
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Kentaro Yamao, Mamoru Takenaka, Ken Kamata, Masatoshi Kudo, Ayana Okamoto, Tsutomu Nishida, Rei Ishikawa, Tomohiro Yamazaki, Shiro Hayashi, Shunsuke Omoto, Makoto Hosono, Madan M. Rehani, Atsushi Nakai, Kosuke Minaga, and Yasutaka Chiba
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Endoscopic ultrasound ,medicine.medical_treatment ,Endosonography ,Cohort Studies ,Kerma ,medicine ,Fluoroscopy ,Humans ,Radiology, Nuclear Medicine and imaging ,Drainage ,Ultrasonography, Interventional ,Retrospective Studies ,Cholangiopancreatography, Endoscopic Retrograde ,Endoscopic retrograde cholangiopancreatography ,Cholestasis ,medicine.diagnostic_test ,business.industry ,Gastroenterology ,Interventional ultrasonography ,Radiation Exposure ,digestive system diseases ,Radiation exposure ,Nuclear medicine ,business ,Cohort study - Abstract
Objectives The transpapillary drainage by endoscopic retrograde cholangiopancreatography (ERCP-D) cannot be performed without fluoroscopy, and there are many situations in which fluoroscopy is required even in endoscopic ultrasound-guided drainage (EUS-D). Previous studies have compared the efficacy, but not the radiation exposure of EUS-D and ERCP-D. While radiation exposure in ERCP-D has been previously evaluated, there is a paucity of information regarding radiation doses in EUS-D. This study aimed to assess radiation exposure in EUS-D compared with that in ERCP-D. Methods This retrospective single-center cohort study included consecutive patients who underwent EUS-D and ERCP-D between October 2017 and March 2019. The air kerma (AK: mGy), kerma-area product (KAP: Gycm2 ), fluoroscopy time (FT: min), and procedure time (PT: min) were assessed. The invasive probability weighting method was used to qualify the comparisons. Results We enrolled 372 and 105 patients who underwent ERCP-D and EUS-D, respectively. The mean AK, KAP, and FT in the EUS-D group were higher by 53%, 28%, and 27%, respectively, than those in the ERCP-D group, whereas PT was shorter by approximately 11% (AK; 135.0 vs. 88.4, KAP; 28.1 vs. 21.9, FT; 20.4 vs. 16.0, PT; 38.7 vs. 43.5). The sub-analysis limited to biliary drainage cases showed the same trend (AK; 128.3 vs. 90.9, KAP; 27.0 vs. 22.2, FT; 16.4 vs. 16.1, PT; 32.5 vs. 44.4). Conclusions This is the first study to assess radiation exposure in EUS-D compared with that in ERCP-D. Radiation exposure was significantly higher in EUS-D than in ERCP-D, despite the shorter procedure time.
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- 2021
36. Comparison of endoscopic ultrasonography with and without contrast enhancement for characterization of pancreatic tumors: a meta-analysis
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Yasunobu Yamashita, Toshio Shimokawa, Reiko Ashida, Bertrand Napoléon, Andrea Lisotti, Pietro Fusaroli, Rodica Gincul, Christoph F. Dietrich, Shunsuke Omoto, and Masayuki Kitano
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Pharmacology (medical) ,digestive system diseases - Abstract
Background and study aims Endoscopic ultrasonography (EUS) is a reliable and efficient modality for detecting pancreatic tumors; however, plain EUS (P-EUS) is limited with respect to characterization of pancreatic tumors. Recently, the use of contrast-enhanced harmonic EUS (CH-EUS) has increased, and its utility for characterization of pancreatic tumors has been reported. This meta-analysis compares the diagnostic ability of P-EUS with that of CH-EUS for characterization of pancreatic tumors. Methods A systematic meta-analysis of all potentially relevant articles in PubMed, the Cochrane library, and Google Scholar databases was performed. Fixed effects or random effects models were used to investigate pooled sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio, with 95 % confidence intervals (CIs). Results This meta-analysis included 719 patients who underwent CH-EUS and 723 who underwent P-EUS, from six eligible studies. The pooled estimates of sensitivity, specificity, and diagnostic odds ratio were 93 % (95 % CI, 0.90–0.95), 80 % (95 % CI, 0.75–0.85), and 57.9 (95 % CI, 25.9–130), respectively, for CH-EUS, and 86 % (95 % CI, 0.82–0.89), 59 % (95 % CI, 0.52–0.65), and 8.3 (95 % CI, 2.8–24.5) for P-EUS. The areas under the summary receiver operating characteristics curves for CH-EUS and P-EUS were 0.96 and 0.80, respectively. The diagnostic odds ratio for pancreatic cancer was 2.98 times higher on CH-EUS than on P-EUS (P = 0.03). Funnel plots demonstrated no publication bias. Conclusions This meta-analysis demonstrates that CH-EUS has higher diagnostic accuracy for pancreatic cancer than P-EUS, and is thus a valuable tool for characterization of pancreatic tumors.
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- 2021
37. Contrast-enhanced harmonic endoscopic ultrasonography for evaluating the response to chemotherapy in pancreatic cancer
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Mamoru Takenaka, Rei Ishikawa, Tomoe Yoshikawa, Ayana Okamoto, Ken Kamata, Tomohiro Yamazaki, Shunsuke Omoto, Hidekazu Tanaka, Kosuke Minaga, Masatoshi Kudo, Naoshi Nishida, Toshiharu Sakurai, Masayuki Kitano, Yasutaka Chiba, Tomohiro Watanabe, Atsushi Nakai, and Kentaro Yamao
- Subjects
Adult ,Male ,medicine.medical_specialty ,CA-19-9 Antigen ,medicine.medical_treatment ,Computed tomography ,Kaplan-Meier Estimate ,Endoscopic ultrasonography ,Endosonography ,03 medical and health sciences ,0302 clinical medicine ,Pancreatic cancer ,Mean Survival Time ,medicine ,Humans ,Pancreas ,Aged ,Retrospective Studies ,Aged, 80 and over ,Chemotherapy ,Hepatology ,medicine.diagnostic_test ,business.industry ,Incidence (epidemiology) ,Gastroenterology ,Middle Aged ,Prognosis ,medicine.disease ,digestive system diseases ,Pancreatic Neoplasms ,Treatment Outcome ,030220 oncology & carcinogenesis ,Female ,030211 gastroenterology & hepatology ,Radiology ,Tomography, X-Ray Computed ,business ,Carbohydrate antigen - Abstract
Background and aims Contrast-enhanced harmonic endoscopic ultrasonography (CH-EUS) is used for the diagnosis of pancreatic cancer (PC). Here, we examined the usefulness of CH-EUS for evaluating therapeutic responses in PC. Methods The study included 23 patients with PC who received chemotherapy. Patients underwent contrast-enhanced computed tomography (CE-CT) and CH-EUS before chemotherapy and at the time of evaluation of the therapeutic response. Patients with a ≧50% reduction in serum carbohydrate antigen 19–9 levels after chemotherapy were defined as “super responders”. The incidence of an avascular area in the tumor on CH-EUS after chemotherapy was compared between “super responders” and non-super responders. Results Nine patients were included in the “super responders” group.Tumor reduction rates did not differ significantly between CE-CT and CH-EUS in the “super responders”. The appearance of an avascular area was detected in 7 of 9 super responders (77.8%) and in 4 of 14 non-super responders (28.6%), and the difference was significant (P = 0.036). The mean survival time of patients with an avascular area after chemotherapy was longer than that of without an avascular area. Conclusions Detection of avascular areas by CH-EUS after chemotherapy may predict long-term survival of patients with PC.
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- 2019
38. Clinical Safety and Efficacy of Secondary Prophylactic Pegylated G-CSF in Advanced Pancreatic Cancer Patients Treated with mFOLFIRINOX: A Single-center Retrospective Study
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Ken Kamata, Tomohiro Yamazaki, Ayana Okamoto, Shunsuke Omoto, Toshiharu Sakurai, Rei Ishikawa, Atsushi Nakai, Mamoru Takenaka, Yasutaka Chiba, Tomohiro Watanabe, Satoru Hagiwara, Kosuke Minaga, Kentaro Yamao, Masatoshi Kudo, Tomoe Yoshikawa, and Naoshi Nishida
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medicine.medical_specialty ,Chemotherapy ,Combination therapy ,business.industry ,FOLFIRINOX ,medicine.medical_treatment ,pancreatic cancer ,Retrospective cohort study ,General Medicine ,Neutropenia ,medicine.disease ,Single Center ,Gastroenterology ,pegylated G-CSF ,mFOLFIRINOX ,Internal medicine ,Pancreatic cancer ,Internal Medicine ,medicine ,Original Article ,business ,Febrile neutropenia - Abstract
Objective Although modified FOLFIRINOX (mFOLFIRINOX, mFFX) is widely used for patients with advanced pancreatic ductal adenocarcinoma (PDAC), maintenance of the standard dose intensity is often difficult due to the high incidence of neutropenic events. Pegylated granulocyte colony-stimulating factor (G-CSF) (Peg G) is a long-lasting G-CSF agent that is applicable for prophylaxis against neutropenic complications. The aim of this study was to assess the clinical safety and efficacy of mFFX combined with secondary prophylaxis using Peg G in advanced PDAC patients. Methods Advanced PDAC patients who had received more than two cycles of mFFX were analyzed. The clinical safety and efficacy were compared between patients in the Peg G group and those in the non-Peg G group in a retrospective manner. Results Among 45 patients treated with mFFX, 28 exhibited grade 3-4 neutropenia or febrile neutropenia. Among these 28 patients, 4 who received only 1 or 2 mFFX cycles were excluded from this study. Finally, 11 patients in the Peg G group and 13 in the non-Peg G group were enrolled. The combination therapy with Peg G and mFFX markedly prolonged the progression-free survival compared with the non-Peg G group, and its effects were associated with a reduced incidence of neutropenic events as well as lower rates of dosage reduction, delayed chemotherapy due to neutropenic events and altered blood cell counts after chemotherapy. Conclusion The scheduled administration of secondary prophylactic Peg G prolonged the progression-free survival in patients treated with mFFX. The combination therapy of Peg G and mFFX may be recommended in patients who exhibit grade 3-4 neutropenic events after prior mFFX cycles.
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- 2019
39. Neurilemmoma Mimicking a Multilocular Cystic Lesion of the Liver
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Takaaki Chikugo, Akihiro Yoshida, Kosuke Minaga, Takeshi Miyata, Mamoru Takenaka, Hajime Imai, Masatoshi Kudo, Ippei Matsumoto, Kentaro Yamao, Ken Kamata, Shunsuke Omoto, Y. Takeyama, and Atsushi Nakai
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Male ,medicine.medical_specialty ,Case Report ,Abdominal cavity ,Malignancy ,030218 nuclear medicine & medical imaging ,Diagnosis, Differential ,Lesion ,03 medical and health sciences ,Cystic lesion ,0302 clinical medicine ,Internal Medicine ,medicine ,Humans ,right hepatic artery ,Aged, 80 and over ,Porta hepatis ,Neurilemoma ,multiple liver cyst ,porta hepatis ,business.industry ,Liver Neoplasms ,General Medicine ,neurilemmoma ,medicine.disease ,medicine.anatomical_structure ,Liver lesion ,030211 gastroenterology & hepatology ,Radiology ,Differential diagnosis ,medicine.symptom ,business - Abstract
Neurilemmomas are benign tumors arising from the sheaths of peripheral nerves. They appear rarely in the abdominal cavity. We herein report an 80-year-old man with a multilocular cystic neurilemmoma mimicking a liver lesion. Preoperative images showed a lesion in the porta hepatis. Although a preoperative diagnosis was difficult, surgery was undertaken because of the possibility of malignancy. Histologically, the tumor consisted of spindle-shaped cells with positivity for S-100 protein. The final diagnosis was a neurilemmoma. Porta hepatic neurilemmomas are rare. When we encounter a multilocular cystic lesion of the liver, neurilemmoma should be considered in the differential diagnosis.
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- 2018
40. Urgent endoscopic ultrasound-guided choledochoduodenostomy for adenocarcinoma of the ampulla of Vater with scirrhous invasion
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Takamitsu Tanaka, Shunsuke Omoto, and Mamoru Takenaka
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Endoscopic ultrasound ,medicine.medical_specialty ,Ampulla of Vater ,medicine.diagnostic_test ,business.industry ,Common Bile Duct Neoplasms ,Gastroenterology ,Adenocarcinoma ,medicine.disease ,medicine.anatomical_structure ,Choledochostomy ,Medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Radiology ,business ,Ultrasonography, Interventional - Published
- 2020
41. Comparison of Radiation Exposure between Endoscopic Ultrasound-Guided Hepaticogastrostomy and Hepaticogastrostomy with Antegrade Stenting
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Mamoru Takenaka, Madan M. Rehani, Makoto Hosono, Tomohiro Yamazaki, Shunsuke Omoto, Kosuke Minaga, Ken Kamata, Kentaro Yamao, Shiro Hayashi, Tsutomu Nishida, and Masatoshi Kudo
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fluoroscopy ,ultrasound-guided hepaticogastrostomy ,radiation exposure ,General Medicine ,digestive system diseases - Abstract
Fluoroscopy forms an essential part of endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) and hepaticogastrostomy with antegrade stenting (EUS-HGAS). To date, no study has assessed and compared radiation exposure between EUS-HGS and EUS-HGAS. This study aimed to compare the radiation exposure parameters between EUS-HGS and EUS-HGAS. This retrospective single-center cohort study included consecutive patients who underwent EUS-HGS or EUS-HGAS from October 2017 to March 2019. The air kerma (AK: mGy), kerma–area product (KAP: Gycm2), fluoroscopy time (FT: min), and procedure time (PT: min) were assessed and compared between the two procedures. Altogether, 45 and 24 patients underwent EUS-HGS and EUS-HGAS, respectively. The median AK, KAP, FT, and PT were higher in the EUS-HGAS group than in the EUS-HGS group. A comparison revealed no difference in the technical success rate, complications rate, adverse event occurrence rate, and re-intervention rate between both procedures. This is the first report in which radiation exposure was used as a comparative parameter between EUS-HGS and EUS-HGAS. This study revealed that radiation exposure is significantly higher in EUS-HGAS than in EUS-HGS. Increased awareness on radiation exposure is warranted among gastroenterologists so that they choose the procedure with lower radiation exposure in cases where both procedures are indicated.
- Published
- 2022
42. Partial Pancreatic Parenchymal Atrophy Is a New Specific Finding to Diagnose Small Pancreatic Cancer (≤10 mm) Including Carcinoma in Situ: Comparison with Localized Benign Main Pancreatic Duct Stenosis Patients
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Ken Kamata, Ayana Okamoto, Kosuke Minaga, Yoshifumi Takeyama, Tomohiro Yamazaki, Masakatsu Tsurusaki, Mamoru Takenaka, Takaaki Chikugo, Rei Ishikawa, Isao Numoto, Kentaro Yamao, Yasutaka Chiba, Ippei Matsumoto, Tomohiro Watanabe, Atsushi Nakai, Shunsuke Omoto, and Masatoshi Kudo
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medicine.medical_specialty ,Clinical Biochemistry ,pancreatic parenchymal atrophy ,Gastroenterology ,Article ,03 medical and health sciences ,0302 clinical medicine ,Atrophy ,Internal medicine ,Pancreatic cancer ,hemic and lymphatic diseases ,Parenchyma ,Medicine ,In patient ,Pancreatic duct ,lcsh:R5-920 ,business.industry ,Carcinoma in situ ,small pancreatic cancer ,carcinoma in situ ,computed tomography ,early diagnosis ,medicine.disease ,Pancreatic Duct Stenosis ,Stenosis ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,030211 gastroenterology & hepatology ,lcsh:Medicine (General) ,business - Abstract
Background: This study aimed to evaluate and identify the specific CT findings by focusing on abnormalities in the main pancreatic duct (MPD) and pancreatic parenchyma in patients with small pancreatic cancer (PC) including carcinoma in situ (CIS). Methods: Nine CT findings indicating abnormalities of MPD and pancreatic parenchyma were selected as candidate findings for the presence of small PC ≤ 10 mm. The proportions of patients positive for each finding were compared between small PC and benign MPD stenosis groups. Interobserver agreement between two independent image reviewers was evaluated using kappa statistics. Results: The final analysis included 24 patients with small PC (including 11 CIS patients) and 28 patients with benign MPD stenosis. The proportion of patients exhibiting partial pancreatic parenchymal atrophy (PPA) corresponding to the distribution of MPD stenosis (45.8% vs. 7.1%, p < 0.01), upstream PPA arising from the site of MPD stenosis (33.3% vs. 3.6%, p = 0.01), and MPD abrupt stenosis (45.8% vs. 14.3%, p = 0.03) was significantly higher in the small PC group than in the benign MPD stenosis group. Conclusions: The presence of partial PPA, upstream PPA, and MPD abrupt stenosis on a CT image was highly suggestive of the presence of small PCs including CIS.
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- 2020
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43. Do Endoscopic Ultrasound-Guided Transluminal Procedures Involve High Radiation Exposure?
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Tomohiro Yamazaki, Takamitsu Tanaka, Akihiro Yoshida, Rei Ishikawa, Shiro Hayashi, Yasutaka Chiba, Mamoru Takenaka, Tomoe Yoshikawa, Hidekazu Tanaka, Makoto Hosono, Madan M. Rehani, Ayana Okamoto, Atsushi Nakai, Ken Kamata, Shunsuke Omoto, Kosuke Minaga, Kentaro Yamao, Tsutomu Nishida, Masatoshi Kudo, and Yasuo Otsuka
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Endoscopic ultrasound ,medicine.medical_specialty ,Endoscopic retrograde cholangiopancreatography ,medicine.diagnostic_test ,business.industry ,General surgery ,Ultrasound ,Institutional review board ,digestive system diseases ,Radiation exposure ,Kerma ,Medicine ,Fluoroscopy ,business ,Cohort study - Abstract
Background: The ultrasound-based imaging procedures are known to be safer than those based on X-ray fluoroscopy as they do not involve ionising radiation. There is a natural tendency to look for ultrasound guidance wherever clinical needs can be met. While radiation exposure in endoscopic retrograde cholangiopancreatography (ERCP) has been evaluated, there is paucity of information on radiation doses in endoscopic ultrasound-guided transluminal drainage (EUS-D), which also utilises fluoroscopy in addition to ultrasound. In our study, we compared radiation exposures in EUS-D and ERCP. Methods: This retrospective, single-centre cohort study included consecutive EUS-D and ERCP performed between October 2017 and March 2019. The air kerma (Ka,r: mGy), kerma-area product (PKA: mGycm2), fluoroscopy time (FT: min), and procedure time (PT: min) were noted. The invasive probability weighting method was used to qualify comparison. Findings: In total 918 ERCPs and 105 EUS-Ds were enrolled. The median Ka,r, PKA, and FT in the EUS-D group were higher by 65%, 40%, and 40%, respectively, than those in the ERCP group, whereas PT was shorter by approximately 15% (Ka,r; 135·2 vs 82·5, PKA; 28275·0 vs 20399·9, FT; 20·4 vs 14·7, PT; 38·7 vs 45·2). Interpretation: This is the first report to assess radiation exposure in EUS-D and compare it with that in ERCP, which unexpectedly found that radiation exposure parameters were significantly higher in EUS-D than in ERCP, despite the shorter PT. This finding is of significance for future design of the equipment and for selection strategy for the procedure. Knowledge of these findings would raise awareness among endoscopists to minimise radiation risks to patients and staff. Funding Statement: There was no funding support for this study. Declaration of Interests: All authors had no conflicts of interest with other people or organisations. Ethics Approval Statement: The study protocol was approved by the Institutional Review Board of Kindai University (IRB No. R02-121). The study was conducted according to the provisions of the Declaration of Helsinki as revised in Fortleza, Brazil, in 2013.
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- 2020
44. [Current status of radiation exposure to crystalline lens in ERCP (endoscopic retrograde cholangiopancreatography)]
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Mamoru, Takenaka, Makoto, Hosono, Atsushi, Nakai, Shunsuke, Omoto, Kosuke, Minaga, Ken, Kamata, Kentaro, Yamao, Shiro, Hayashi, Tsutomu, Nishida, and Masatoshi, Kudo
- Published
- 2019
45. Value of additional endoscopic ultrasonography for surveillance after surgical removal of intraductal papillary mucinous neoplasms
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Masayuki Kitano, Ken Kamata, Yasutaka Chiba, Hajime Imai, Shunsuke Omoto, Takeshi Miyata, Takaaki Chikugo, Toshiharu Sakurai, Tomohiro Watanabe, Mamoru Takenaka, Yoshifumi Takeyama, Ippei Matsumoto, Kosuke Minaga, Masatoshi Kudo, Naoshi Nishida, Kentaro Yamao, Hidekazu Tanaka, and Atsushi Nakai
- Subjects
Male ,medicine.medical_specialty ,Pancreatic ductal adenocarcinoma ,endocrine system diseases ,Aftercare ,Contrast Media ,Endoscopic ultrasonography ,Endosonography ,03 medical and health sciences ,0302 clinical medicine ,Surgical removal ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Pancreas ,Aged ,Retrospective Studies ,Pancreatic duct ,Mural Nodule ,Intraductal papillary mucinous neoplasm ,business.industry ,Gastroenterology ,Middle Aged ,medicine.disease ,Adenocarcinoma, Mucinous ,digestive system diseases ,Tumor recurrence ,Pancreatic Neoplasms ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Remnant pancreas ,Female ,030211 gastroenterology & hepatology ,Radiology ,Neoplasm Recurrence, Local ,Tomography, X-Ray Computed ,business ,Precancerous Conditions ,Carcinoma, Pancreatic Ductal ,Follow-Up Studies - Abstract
Background and aim This study evaluated the utility of endoscopic ultrasonography (EUS) combined with contrast-enhanced harmonic EUS (CH-EUS) for surveillance of the remnant pancreas after surgery for intraductal papillary mucinous neoplasm (IPMN). Methods This was a single-center, retrospective, descriptive study. A total of 134 consecutive patients who underwent surgical resection for IPMN between April 2009 and March 2015 were evaluated. Rates of recurrence and development of IPMN-concomitant pancreatic ductal adenocarcinoma (PDAC) during follow up were assessed. Clinical findings of patients with recurrence or development of PDAC were also evaluated. Results Of 134 resected IPMN 56 (41.8%) and 78 (58.2%) were classified as benign and malignant, respectively. Patients were followed up for a median of 29 months, 33 (24.6%) by both contrast-enhanced computed tomography (CE-CT) and EUS, and 101 (75.4%) by computed tomography (CT) alone. Thirteen patients (9.7%) showed tumor recurrence, five with intra-pancreatic recurrence and eight with extra-pancreatic metastases. An enhancing mural nodule within the dilated main pancreatic duct was successfully detected by EUS in one patient, but not by CE-CT. Two patients developed IPMN-concomitant PDAC during follow up. EUS combined with CH-EUS successfully detected small IPMN-concomitant PDAC in two patients, whereas these lesions were not detected by CT. CH-EUS was useful for better visualization of the margins of IPMN-concomitant PDAC in one of these two patients. Conclusion Endoscopic ultrasonography combined with CH-EUS may improve follow up of patients with resected IPMN.
- Published
- 2018
46. Papillary Neoplasm in a Common Channel in Patients with Pancreaticobiliary Maljunction
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Takaaki Murase, Masataka Matsumoto, Kohei Kawaguchi, Shumpei Satoi, Keiko Kamei, Takuya Nakai, Mamoru Takenaka, Yusuke Makutani, Ippei Matsumoto, Shunsuke Omoto, Masatoshi Kudo, Yoshifumi Takeyama, and Takaaki Chikugo
- Subjects
medicine.medical_specialty ,Pancreaticobiliary maljunction ,business.industry ,Papillary Neoplasm ,Gastroenterology ,medicine ,Surgery ,In patient ,Channel (broadcasting) ,Radiology ,business - Published
- 2018
47. Impact of avascular areas, as measured by contrast-enhanced harmonic EUS, on the accuracy of FNA for pancreatic adenocarcinoma
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Hajime Imai, Takaaki Chikugo, Takeshi Miyata, Ken Kamata, Yasutaka Chiba, Kosuke Minaga, Masatoshi Kudo, Toshiharu Sakurai, Kentaro Yamao, Shunsuke Omoto, Naoshi Nishida, Mamoru Takenaka, Yoshifumi Takeyama, and Ippei Matsumoto
- Subjects
Adult ,Male ,Endoscopic ultrasound ,medicine.medical_specialty ,Contrast Media ,Adenocarcinoma ,Sensitivity and Specificity ,03 medical and health sciences ,0302 clinical medicine ,Cytology ,Retrospective analysis ,Humans ,Medicine ,Radiology, Nuclear Medicine and imaging ,skin and connective tissue diseases ,Endoscopic Ultrasound-Guided Fine Needle Aspiration ,Aged ,Retrospective Studies ,Aged, 80 and over ,Endoscopic retrograde cholangiopancreatography ,medicine.diagnostic_test ,business.industry ,Gastroenterology ,Histology ,Retrospective cohort study ,Middle Aged ,medicine.disease ,University hospital ,digestive system diseases ,Pancreatic Neoplasms ,body regions ,surgical procedures, operative ,030220 oncology & carcinogenesis ,Female ,030211 gastroenterology & hepatology ,Radiology ,business - Abstract
Background and Aims EUS-guided FNA (EUS-FNA) is used for the diagnosis of pancreatic adenocarcinoma, but sometimes the method results in a false negative. Occasionally, an avascular area may be observed within the pancreatic adenocarcinoma tumor during contrast-enhanced harmonic EUS (CH-EUS). The aim of this study was to evaluate whether the diagnostic sensitivity of EUS-FNA for pancreatic adenocarcinoma was affected by the presence of avascularity on CH-EUS. Methods Two hundred ninety-two patients with pancreatic adenocarcinoma who presented at Kindai University Hospital for EUS-FNA and CH-EUS between June 2009 and August 2013 were retrospectively evaluated. This was a single-center retrospective analysis of prospectively collected data held in a registry. The overall sensitivity of EUS-FNA for the diagnosis of pancreatic adenocarcinoma was calculated. The sensitivities of cytology, histology, and the combination of cytology and histology were also evaluated. These variables were individually evaluated according to the presence or absence of an avascular area on CH-EUS to assess whether the diagnostic sensitivity of EUS-FNA for pancreatic adenocarcinoma was related to the presence of an avascular area within the tumors. Results The overall sensitivity of EUS-FNA was 90.8% (265/292). The sensitivities of EUS-FNA for lesions with and without an avascular area were 72.9% (35/48) and 94.3% (230/244), respectively, with the difference being statistically significant ( P Conclusions EUS-FNA has lower sensitivity for pancreatic adenocarcinoma with avascular areas on CH-EUS.
- Published
- 2018
48. Diagnostic Value of EUS-Guided Fine-Needle Aspiration Biopsy for Gastric Linitis Plastica with Negative Endoscopic Biopsy
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Ken Kamata, Ryutaro Takada, Yasuo Otsuka, Mamoru Takenaka, Kentaro Yamao, Hajime Honjo, Akane Hara, Masatoshi Kudo, Shunsuke Omoto, Satoru Hagiwara, Shigenaga Matsui, Kosuke Minaga, Tomohiro Watanabe, and Takaaki Chikugo
- Subjects
Endoscopic ultrasound ,medicine.medical_specialty ,Linitis plastica ,Malignancy ,Article ,Biopsy ,medicine ,gastric linitis plastica ,biopsy ,fine-needle aspiration ,Adverse effect ,Prospective cohort study ,Pathological ,medicine.diagnostic_test ,business.industry ,gastric cancer ,digestive, oral, and skin physiology ,General Medicine ,medicine.disease ,digestive system diseases ,linitis plastica ,Fine-needle aspiration ,endoscopic ultrasound ,Medicine ,Radiology ,business - Abstract
Due to the tendency of gastric linitis plastica (GLP) to cause extensive submucosal infiltration, a superficial endoscopic biopsy sometimes yields no evidence of malignancy, hindering definite diagnosis. The present study was a single-center retrospective analysis of 54 consecutive patients diagnosed with GLP between 2016 and 2020 to evaluate EUS-guided fine-needle aspiration (EUS-FNA) biopsy outcomes in patients with negative endoscopic biopsy findings. A pathological GLP diagnosis was achieved by endoscopic biopsy in 40 patients (74.1%). EUS-FNA biopsy with a 22-gauge needle was performed in 13 of the remaining 14 patients, and GLP diagnosis was confirmed in 10 patients, with a median of three needle passes. The remaining four patients were laparoscopically diagnosed with GLP. The diagnostic ability of EUS-FNA biopsy for GLP was 76.9%, and EUS-FNA biopsy contributed to GLP diagnosis in 18.5% (10/54) of all cases. None of the 13 patients exhibited EUS-FNA biopsy-related adverse events. Univariable and multivariable analyses revealed an absence of superficial ulcerations as a predictor of false-negative endoscopic biopsy findings in patients with GLP. These results suggest EUS-FNA biopsy as a minimally invasive and safe alternative diagnostic modality for GLP in cases where conventional endoscopic biopsy fails to verify malignancy, although prospective studies with larger cohorts are warranted to confirm these findings.
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- 2021
49. Contrast-enhanced harmonic endoscopic ultrasonography for differential diagnosis of submucosal tumors of the upper gastrointestinal tract
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Masayuki Kitano, Hajime Imai, Mamoru Takenaka, Takushi Yasuda, Takaaki Chikugo, Toshiharu Sakurai, Haruhiko Imamoto, Pietro Fusaroli, Ken Kamata, Kosuke Minaga, Naoshi Nishida, Andrea Lisotti, Takeshi Miyata, Masatoshi Kudo, Yasutaka Chiba, Tomohiro Watanabe, Shunsuke Omoto, and Kentaro Yamao
- Subjects
Endoscopic ultrasound ,medicine.medical_specialty ,Contrast enhancement ,Hepatology ,medicine.diagnostic_test ,business.industry ,Stomach ,Gastroenterology ,Endoscopic ultrasonography ,medicine.disease ,digestive system diseases ,Glomus tumor ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Ectopic pancreas ,Internal medicine ,medicine ,Upper gastrointestinal ,030211 gastroenterology & hepatology ,Radiology ,Differential diagnosis ,business - Abstract
Background and Aim The study aims to evaluate contrast-enhanced harmonic endoscopic ultrasonography (CH-EUS) for the differential diagnosis of submucosal tumors (SMT) of the upper gastrointestinal tract. Methods Between June 2008 and May 2015, 157 consecutive patients with submucosal lesions of the upper gastrointestinal tract were evaluated by CH-EUS. This was a single-center retrospective analysis of prospectively collected data in a registry. The data from 73 patients who later underwent surgical resection were analyzed in this study. Surgical specimens served as the final diagnoses. The two CH-EUS variables of blood flow (hyper-enhancement vs hypo-enhancement) and homogeneity of enhancement pattern were evaluated. Results The final diagnoses were 58 gastrointestinal stromal tumors (GISTs) and 15 benign SMTs (two lipomas, five leiomyomas, five schwannomas, two glomus tumors, and one ectopic pancreas). On CH-EUS, 49 of 58 (84.5%) GISTs presented with hyper-enhancement, whereas 4 of 15 (26.7%) benign SMTs showed hyper-enhancement; 21 of 58 (36.2%) GISTs showed inhomogeneous contrast enhancement, while only 2 of 15 (13.3%) benign SMTs demonstrated inhomogeneous contrast enhancement. If hyper-enhancement was considered to indicate GISTs, the sensitivity, specificity, and accuracy were 84.5%, 73.3%, and 82.2%, respectively. If inhomogeneous enhancement was considered to indicate GISTs, the sensitivity, specificity, and accuracy were 36.2%, 86.7%, and 46.6%, respectively. In lesions of less than 2 cm, hyper-enhancement was a more sensitive indicator of GISTs than inhomogeneous enhancement. Conclusions Hyper-enhancement and inhomogeneous enhancement were found to be a characteristic of GISTs. CH-EUS was useful for discrimination of benign SMTs from GISTs.
- Published
- 2017
50. Early diagnosis of pancreatic cancer by EUS
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Ken Kamata, Hajime Imai, Shunsuke Omoto, Kentaro Yamao, Mamoru Takenaka, Masayuki Kitano, Kosuke Minaga, Masatoshi Kudo, and Takeshi Miyata
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Oncology ,03 medical and health sciences ,medicine.medical_specialty ,0302 clinical medicine ,business.industry ,030220 oncology & carcinogenesis ,Internal medicine ,Pancreatic cancer ,Medicine ,030211 gastroenterology & hepatology ,business ,medicine.disease - Published
- 2017
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