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Pancreatic stents for the prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis should be inserted up to the pancreatic body or tail

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World Journal of Gastroenterology 2018年第22期24卷 2392-2399页

作者： Mitsuru Sugimoto Tadayuki Takagi Rei Suzuki Naoki Konno Hiroyuki Asama Yuki Sato hiroki irie Ko Watanabe Jun Nakamura Hitomi Kikuchi Yuichi Waragai Mika Takasumi Takuto Hikichi Hiromasa Ohira Department of Gastroenterology School of Medicine Fukushima Medical University Department of Endoscopy Fukushima Medical University Hospital

AIM To investigate the location to which a pancreatic stent should be inserted to prevent post-endoscopic retrograde cholangiopancreatography(ERCP) pancreatitis(PEP).METHODS Over a ten-year period at our hospital, 296 patients underwent their first ERCP procedure and had a pancreatic stent inserted; this study included 147 patients who had ERCP performed primarily for biliary investigation and had a pancreatic stent inserted to prevent PEP. We dividedthese patients into two groups: 131 patients with a stent inserted into the pancreatic head(head group) and 16 patients with a stent inserted up to the pancreatic body or tail(body/tail group). Patient characteristics and ERCP factors were compared between the *** Pancreatic amylase isoenzyme(p-AMY) levels in the head group were significantly higher than those in the body/tail group [138.5(7.0-2086) vs 78.5(5.0-1266.5), P = 0.03] [median(range)]. No cases of PEP were detected in the body/tail group [head group, 12(9.2%)]. Of the risk factors for post-ERCP hyperamylasemia(≥ p-AMY median, 131 IU/L), procedure time ≥ 60 min [odds ratio(OR) 2.65, 95%CI: 1.17-6.02, P = 0.02) and stent insertion into the pancreatic head(OR 3.80, 95%CI: 1.12-12.9, P = 0.03) were identified as independent risk factors by multivariate *** Stent insertion up to the pancreatic body or tail reduces the risk of post-ERCP hyperamylasemia and may reduce the risk of PEP.

关键词： Pancreatic stent Endoscopic retrograde cholangiopancreatography Post-endoscopic retrograde cholangiopancreatography pancreatitis Post-endoscopic retrograde cholangiopancreatography hyperamylasemia Pancreatic body or tail

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Biliary metal stents should be placed near the hilar duct in distal malignant biliary stricture patients

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World Journal of Gastroenterology 2022年第17期28卷 1860-1870页

作者： Mitsuru Sugimoto Tadayuki Takagi Rei Suzuki Naoki Konno Hiroyuki Asama Yuki Sato hiroki irie Yoshinori Okubo Jun Nakamura Mika Takasumi Minami Hashimoto Tsunetaka Kato Ryoichiro Kobashi Takumi Yanagita Takuto Hikichi Hiromasa Ohira Department of Gastroenterology Fukushima Medical UniversityFukushima 9601295Japan Department of Endoscopy Fukushima Medical University HospitalFukushima 9601295Japan

BACKGROUND Endoscopic biliary drainage using a self-expandable metallic stent(SEMS)has been widely performed to treat distal malignant biliary obstruction(DMBO).However,the optimal position of the stent remains *** To determine the ideal position for SEMS *** In total,135 DMBO patients underwent SEMS(uncovered or covered)placement over a ten-year period.A total of 127 patients with biliary obstruction between the junction of the cystic duct and Vater’s papilla were *** SEMS was placed through the upper common bile duct 2 cm from the biliary hilar duct in 83 patients(Hilar group)or near the top of the biliary obstruction in 44 patients(Lower group).Technical and functional success,adverse events,and risk factors for SEMS dysfunction were *** The stent patency period was significantly longer in the Hilar group than in the Lower group(P value<0.01).In multivariate analysis,the only statistically significant risk factor for SEMS dysfunction was being in the Lower group(hazard ratio:9.94,95%confidence interval:2.25–44.0,P<0.01).CONCLUSION A longer patency period was achieved by positioning the SEMS near the biliary hilar duct.

关键词： Endoscopic biliary drainage Malignant biliary obstruction Uncovered self-expandable metallic stent Covered self-expandable metallic stent Biliary hilar duct Patency period

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Can the wet suction technique change the efficacy of endoscopic ultrasound-guided fine-needle aspiration for diagnosing autoimmune pancreatitis type 1? A prospective single-arm study

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World Journal of Clinical Cases 2020年第1期8卷 88-96页

作者： Mitsuru Sugimoto Tadayuki Takagi Rei Suzuki Naoki Konno Hiroyuki Asama Yuki Sato hiroki irie Ko Watanabe Jun Nakamura Hitomi Kikuchi Mika Takasumi Minami Hashimoto Tsunetaka Kato Takuto Hikichi Kenji Notohara Hiromasa Ohira Department of Gastroenterology Fukushima Medical UniversitySchool of MedicineFukushima 960-1295Japan Department of Endoscopy Fukushima Medical University HospitalFukushima 960-1295Japan Department of Anatomic Pathology Kurashiki Central HospitalKurashiki 710-8602Japan

BACKGROUND Other than surgery,endoscopic ultrasound-guided fine-needle aspiration(EUSFNA)is the only procedure for histologically diagnosing autoimmune pancreatitis(AIP).However,adequate specimens are difficult to ***,more adequate specimens were reported to be obtained with EUS-FNA with a wet suction technique(WEST)than with conventional *** To histologically diagnose AIP by EUS-FNA with a *** Eleven patients with possible type 1 AIP between February 2016 and August 2018 underwent EUS-FNA with a WEST(WEST group),with four punctures by 19 or 22 G *** a historical control,23 type 1 AIP patients who underwent no fewer than four punctures with 19 or 22 G needles were enrolled(DRY group).Patient characteristics and histological findings were compared between the two *** Three histopathological factors according to the International Consensus Diagnostic Criteria were significantly greater in the WEST group than the DRY group[lymphoplasmacytic infiltrate without granulocytic infiltration:9(81.8%)vs 6(26.1%),P=0.003,storiform fibrosis:5(45.5%)vs 1(4.3%),P=0.008,abundant(>10 cells/HPF)IgG4-positive cells:7(63.6%)vs 5(21.7%),P=0.026].Level 1 or level 2 histopathological findings were observed more often in the WEST group than in the DRY group[8(72.7%)vs 3(13.0%),P=0.001].CONCLUSION EUS-FNA with a WEST was more successful than standard EUS-FNA in histologically diagnosing AIP.

关键词： Autoimmune pancreatitis Endoscopic ultrasound-guided fine needle aspiration Wet suction technique

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Push vs pull method for endoscopic ultrasound-guided fine needle aspiration of pancreatic head lesions: Propensity score matching analysis

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World Journal of Gastroenterology 2018年第27期24卷 3006-3012页

作者： Mitsuru Sugimoto Tadayuki Takagi Rei Suzuki Naoki Konno Hiroyuki Asama Yuki Sato hiroki irie Ko Watanabe Jun Nakamura Hitomi Kikuchi Yuichi Waragai Mika Takasumi Minami Hashimoto Yuko Hashimoto Takuto Hikichi Hiromasa Ohira Department of Gastroenterology Fukushima Medical UniversitySchool of Medicine Department of Endoscopy Fukushima Medical University Hospital Department of Diagnostic Pathology Fukushima Medical University

AIM To evaluate the efficacy of endoscopic ultrasoundguided fine needle aspiration(EUS-FNA) of pancreatic head cancer when pushing(push method) or pulling the echoendoscope(pull method).METHODS Overall, 566 pancreatic cancer patients had their first EUS-FNA between February 2001 and December 2017. Among them, 201 who underwent EUS-FNA for pancreatic head lesions were included in this study. EUS-FNA was performed by the push method in 85 patients, the pull method in 101 patients and both the push and pull methods in 15 patients. After propensity score matching(age, sex, tumor diameter, and FNA needle), 85 patients each were stratified into the push and pull groups. Patient characteristics and EUSFNA-related factors were compared between the two *** Patient characteristics were not significantly different between the two groups. The distance to lesion was significantly longer in the push group than in the pull group(13.9 ± 4.9 mm vs 7.0 ± 4.9 mm, P < 0.01). The push method was a significant factor influencing the distance to lesion(≥ median 10 mm)(P < 0.01). Additionally, tumor diameter ≥ 25 mm(OR = 1.91, 95%CI: 1.02-3.58, P = 0.043) and the push method(OR = 1.91, 95%CI: 1.03-3.55, P = 0.04) were significant factors contributing to the histological diagnosis of *** The pull method shortened the distance between the endoscope and the lesion and facilitated EUS-FNA of pancreatic head cancer. The push method contributed to the histological diagnosis of pancreatic head cancer using EUS-FNA specimens.

关键词： Endoscopic ultrasound-guided fine needle aspiration Pancreatic head Pancreatic cancer Push method Pull method

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Dysbiosis of the duodenal microbiota as a diagnostic marker for pancreaticobiliary cancer

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World Journal of Gastrointestinal Oncology 2021年第12期13卷 2088-2100页

作者： Mitsuru Sugimoto Kazumichi Abe Tadayuki Takagi Rei Suzuki Naoki Konno Hiroyuki Asama Yuki Sato hiroki irie Ko Watanabe Jun Nakamura Hitomi Kikuchi Mika Takasumi Minami Hashimoto Tsunetaka Kato Ryoichiro Kobashi Takuto Hikichi Hiromasa Ohira Department of Gastroenterology Fukushima Medical University School of MedicineFukushima 960-1295Japan Department of Endoscopy Fukushima Medical University HospitalFukushima 960-1295Japan

BACKGROUND Pancreaticobiliary cancer(PB Ca)is a lethal disease,and a useful diagnostic marker is urgently needed.A correlation between the human microbiota and malignant gastrointestinal diseases was recently *** To investigate the efficacy of the duodenal microbiota for diagnosing PB *** We recruited 22 patients with benign pancreaticobiliary diseases(benign group)and 12 patients with PB Ca(malignant group).The duodenal microbiota of each patient was analyzed by the 16S rDNA terminal restriction fragment length polymorphism *** characteristics,tumor markers,and relative abundances of the duodenal microbiota were compared between the benign and malignant *** Cancer antigen 19-9(CA19-9),Bifidobacterium,Clostridium cluster XVIII,and Prevotella levels differed significantly between the benign and malignant *** cluster XVIII had the greatest area under the receiver operating characteristic curve(AUC)among the four factors with respect to diagnosing PB Ca(cutoff value:3.038%;sensitivity:58.3%;specificity:95.2%;AUC:0.81).The combination of Clostridium cluster XVIII(cutoff value:3.038%)and CA19-9 Levels(cutoff value:18.8 U/mL)showed 91.7%sensitivity and 71.4%specificity for diagnosing PB *** The duodenal microbiota may be useful for PB Ca screening.

关键词： Pancreaticobiliary cancer Diagnostic marker Duodenal microbiota Clostridium cluster XVIII Cancer antigen 19-9

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In vivo direct neuronal conversion as a therapeutic strategy for ischemic stroke

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Neural Regeneration Research 2025年第8期20卷 2309-2310页

作者： Takashi irie Taito Matsuda Department of Stem Cell Biology and Medicine Graduate School of Medical SciencesKyushu UniversityFukuokaJapan Department of Neurology Neurological InstituteGraduate School of Medical SciencesKyushu UniversityFukuokaJapan

Stroke causes neuronal loss,which ultimately results in persistent neurological ***,stroke was the third-leading cause of death and disability combined in all ages in 2019,after neonatal disorders and ischemic heart *** that year,there were 12.2 million incident strokes,101 million prevalent strokes,and 143 million disability-adjusted life-years due to stroke.

关键词： neonatal death therapeutic

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Appropriate number of biliary biopsies and endoscopic retrograde cholangiopancreatography sessions for diagnosing biliary tract cancer

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World Journal of Gastrointestinal Endoscopy 2019年第3期11卷 231-238页

作者： Tadayuki Takagi Mitsuru Sugimoto Rei Suzuki Naoki Konno Hiroyuki Asama Yuki Sato hiroki irie Ko Watanabe Jun Nakamura Hitomi Kikuchi Mika Takasumi Minami Hashimoto Takuto Hikichi Hiromasa Ohira Department of Gastroenterology Fukushima Medical UniversitySchool of MedicineFukushima 960-1247Japan Department of Endoscopy Fukushima Medical University HospitalFukushima 960-1247Japan 不详

BACKGROUND Biliary ductal cancer(BDC) is a lethal disease; however, diagnosing BDC is challenging. Biliary biopsies are performed to pathologically diagnose BDC, but the appropriate parameters for biliary biopsy [number of biliary biopsies, number of endoscopic retrograde cholangiopancreatography(ERCP) sessions, etc.] are *** To clarify what constitutes an adequate method for biliary *** In total, 95 patients who underwent endoscopic biliary biopsy without choledochoscopy and who were pathologically diagnosed with BDC were enrolled in this study. The patients were divided into two groups. Seventy-six patients who were diagnosed by biliary biopsy were defined as the positive group(P group), and nineteen patients who were not diagnosed by biliary biopsy were defined as the negative group(N group). The patient characteristics and ERCP-related procedures were compared between the P and N *** The numbers of ERCP sessions and biliary biopsies were significantly different between the two groups [ERCP sessions(one/two), P group 72/4 vs N group15/4, P value = 0.048; number of biliary biopsies, P group 2(1-6) vs N group 2(1-7), P value = 0.039]. In a multivariate analysis, fewer than 2 ERCP sessions was an independent factor influencing the positivity of the biliary *** This study clarified that ERCP and biliary ductal biopsy should only be performed once. If biliary cancer is not pathologically diagnosed after the first ERCP session, other methods(Endoscopic ultrasonography-guided fine needle aspiration or choledochoscopy-guided biliary ductal biopsy) should be employed.

关键词： Biliary ductal cancer Biliary biopsy Endoscopic retrograde cholangiopancreatography Endoscopic ultrasonography-guided fine needle aspiration Choledochoscopy

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Which scope is appropriate for endoscopic retrograde cholangiopancreatography after Billroth II reconstruction:An esophagogastroduodenoscope or a colonoscope?

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World Journal of Gastrointestinal Endoscopy 2020年第8期12卷 220-230页

作者： Mitsuru Sugimoto Tadayuki Takagi Rei Suzuki Naoki Konno Hiroyuki Asama Yuki Sato hiroki irie Ko Watanabe Jun Nakamura Hitomi Kikuchi Mika Takasumi Minami Hashimoto Tsunetaka Kato TakutoHikichi Hiromasa Ohira Department of Gastroenterology School of MedicineFukushima Medical UniversityFukushima 9601247Japan Department of Endoscopy Fukushima Medical University HospitalFukushima 9601247Japan

BACKGROUND Recently,with the advent of more advanced devices and endoscopic techniques,endoscopic retrograde cholangiopancreatography(ERCP)in Billroth II(B-II)patients has been increasingly ***,the procedures are difficult,and the techniques and strategies have not been *** To reveal the appropriate scope for ERCP in B-II *** Sixty ERCP procedures were performed on B-II patients between June 2005 and May 2018 at Fukushima Medical University Hospital,and in 44 cases,this was the first ERCP procedure performed by esophagogastroduodenoscopy(EGDS)or colonoscopy(CS)after B-II *** cases were divided into two groups:17 cases of ERCP performed by EGDS(EGDS group)and 27 cases of ERCP performed by CS(CS group).The patient characteristics and ERCP procedures were compared between the EGDS and CS *** The procedural time was significantly shorter in the EGDS group than in the CS group[median(range):60(20-100)vs 90(40-128)min,P value<0.01].CS was an independent factor of a longer ERCP procedural time according to the univariate and multivariate analyses(odds ratio:3.97,95%CI:1.05-15.0,P value=0.04).CONCLUSION Compared to CS,EGDS shortened the procedural time of ERCP in B-II patients.

关键词： Endoscopic retrograde cholangiopancreatography Billroth II reconstruction Esophagogastroduodenoscope Colonoscope

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Screening for hilar biliary invasion in ampullary cancer patients

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World Journal of Gastrointestinal Endoscopy 2022年第9期14卷 536-546页

作者： Tadayuki Takagi Mitsuru Sugimoto Rei Suzuki Naoki Konno Hiroyuki Asama Yuki Sato hiroki irie Jun Nakamura Mika Takasumi Minami Hashimoto Tsunetaka Kato Ryoichiro Kobashi Takumi Yanagita Yuko Hashimoto Shigeru Marubashi Takuto Hikichi Hiromasa Ohira Department of Gastroenterology Fukushima Medical UniversityFukushima 960-1295Japan Department of Endoscopy Fukushima Medical University HospitalFukushima 960-1295Japan Department of Pathological Diagnosis Fukushima Medical UniversityFukushima 960-1295Japan Department of Hepato-Biliary-Pancreatic and Transplant Surgery Fukushima Medical UniversityFukushima 960-1295Japan

BACKGROUND The treatment for ampullary cancer is pancreatoduodenectomy or local ***,effective methods for the preoperative investigation of hilar biliary invasion in ampullary cancer patients have not yet been *** To determine the necessity of and an appropriate method for investigating hilar biliary invasion of ampullary *** Among 43 ampullary cancer patients,34 underwent endoscopic treatment(n=9)or surgery(n=25).The use of imaging findings(thickening and enhancement of the bile duct wall on contrast-enhanced computed tomography,irregularity on endoscopic retrograde cholangiography,thickening of the entire bile duct wall on intraductal ultrasonography(IDUS),and partial thickening of the bile duct wall on IDUS)and biliary biopsy results for diagnosing hilar biliary invasion of ampullary cancer was *** Hilar invasion was not observed in every *** the patients who did not undergo biliary stent insertion,the combination of partial thickening of the bile duct wall on IDUS and biliary biopsy results showed the highest accuracy(100%)for diagnosing hilar biliary ***,each imaging method and biliary biopsy yielded some false-positive *** Although some false-positive results were obtained with each method,the combination of partial thickening of the bile duct wall on IDUS and biliary biopsy results was useful for diagnosing hilar biliary invasion of ampullary ***,hilar invasion of ampullary cancer is rare;therefore,the investigation of hilar biliary invasion of ampullary cancer might be unnecessary.

关键词： Ampullary cancer Biliary biopsy Contrast-enhanced CT Hilar biliary invasion Intraductal ultrasonography

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Present state of endoscopic ultrasonography-guided fine needle aspiration for the diagnosis of autoimmune pancreatitis type 1

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World Journal of Meta-Analysis 2019年第5期7卷 218-223页

作者： Mitsuru Sugimoto Tadayuki Takagi Rei Suzuki Naoki Konno Hiroyuki Asama Yuki Sato hiroki irie Ko Watanabe Jun Nakamura Hitomi Kikuchi Mika Takasumi Minami Hashimoto Takuto Hikichi Hiromasa Ohira Department of Gastroenterology Fukushima Medical UniversitySchool of MedicineFukushima 960-1247Japan Department of Endoscopy Fukushima Medical University HospitalFukushima 960-1247Japan

Autoimmune pancreatitis(AIP)is defined as pancreatitis caused by irregular narrowing of the pancreatic duct accompanied by pancreatic swelling,fibrosis and lymphocyte infiltration,events that are related to autoimmune *** 2010 International Consensus Diagnostic Criteria for AIP defined pancreatitis as“type 1”when increased levels of serum IgG4 were present and other organs were involved;lymphoplasmacytic sclerosing pancreatitis was the main histological *** from surgery,endoscopic ultrasonographyguided fine needle aspiration(EUS-FNA)is the only method for the histological diagnosis of AIP;however,this method is *** use of larger-diameter FNA needles and trucut biopsy did not improve the diagnostic performance of EUS-FNA,but it has improved *** this review,we look back at past efforts to improve the diagnostic performance of EUS-FNA and reveal the present state of EUS-FNA for the histological diagnosis of AIP type 1.

关键词： Autoimmune pancreatitis type 1 Endoscopic ultrasonography-guided fine needle aspiration IgG4-related disease Lymphoplasmacytic sclerosing pancreatitis

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