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World Journal of Gastroenterology 2016年第16期22卷 4264-4269页

作者： Kosuke Minaga Masayuki Kitano Hajime Imai Kentaro Yamao Ken Kamata Takeshi Miyata Shunsuke Omoto kumpei kadosaka Tomoe Yoshikawa Masatoshi Kudo Department of Gastroenterology and Hepatology Kinki University Faculty of Medicine

Acute obstructive suppurative cholangitis(AOSC) due to biliary lithiasis is a life-threatening condition that requires urgent biliary decompression. Although endoscopic retrograde cholangiopancreatography(ERCP) with stent placement is the current gold standard for biliary decompression, it can sometimes be difficult because of failed biliary cannulation. In this retrospective case series, we describe three cases of successful biliary drainage with recovery from septic shock after urgent endoscopic ultrasound-guided choledochoduodenostomy(EUS-CDS) was performed for AOSC due to biliary lithiasis. In all three cases, technical success in inserting the stents was achieved and the patients completely recovered from AOSC with sepsis in a few days after EUS-CDS. There were no procedure-related complications. When initial ERCP fails, EUS-CDS can be an effective life-saving endoscopic biliary decompression procedure that shortens the procedure time and prevents post-ERCP pancreatitis, particularly in patients with AOSC-induced sepsis.

关键词： Endoscopic ultrasound-guided biliary drainage Choledochoduodenostomy Acute obstructive suppurative c

Modified single transluminal gateway transcystic multiple drainage technique for a huge infected walled-off pancreatic necrosis: A case report

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World Journal of Gastroenterology 2016年第21期22卷 5132-5136页

作者： Kosuke Minaga Masayuki Kitano Hajime Imai Kentaro Yamao Ken Kamata Takeshi Miyata Tomohiko Matsuda Shunsuke Omoto kumpei kadosaka Tomoe Yoshikawa Masatoshi Kudo Department of Gastroenterology and Hepatology Kinki University Faculty of Medicine

We report a successful endoscopic ultrasonographyguided drainage of a huge infected multilocular walledoff necrosis(WON) that was treated by a modified single transluminal gateway transcystic multiple drainage(SGTMD) technique. After placing a widecaliber fully covered metal stent, follow-up computed tomography revealed an undrained subcavity of WON. A large fistula that was created by the wide-caliber metal stent enabled the insertion of a forward-viewing upper endoscope directly into the main cavity, and the narrow connection route within the main cavity to the subcavity was identified with a direct view, leading to the successful drainage of the subcavity. This modified SGTMD technique appears to be useful for seeking connection routes between subcavities of WON in some cases.

关键词： Endoscopic ultrasonography Infected pancreatic necrosis Walled-off necrosis Endoscopic ultrasonograp

Evaluation of anti-migration properties of biliary covered self-expandable metal stents

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World Journal of Gastroenterology 2016年第30期22卷 6917-6924页

作者： Kosuke Minaga Masayuki Kitano Hajime Imai Yogesh Harwani Kentaro Yamao Ken Kamata Takeshi Miyata Shunsuke Omoto kumpei kadosaka Toshiharu Sakurai Naoshi Nishida Masatoshi Kudo Department of Gastroenterology and Hepatology Kindai University Faculty of Medicine

AIM: To assess anti-migration potential of six biliary covered self-expandable metal stents(C-SEMSs) by using a newly designed phantom model. METHODS: In the phantom model, the stent was placed in differently sized holes in a silicone wall and retracted with a retraction robot. Resistance force to migration(RFM) was measured by a force gauge on the stent end. Radial force(RF) was measured with a RF measurement machine. Measured flare structure variables were the outer diameter, height, and taper angle of the flare(ODF, HF, and TAF, respectively). Correlations between RFM and RF or flare variables were analyzed using a linear correlated ***: Out of the six stents, five stents were braided, the other was laser-cut. The RF and RFM of each stent were expressed as the average of five replicate measurements. For all six stents, RFM and RF decreased as the hole diameter increased. For all six stents, RFM and RF correlated strongly when the stent had not fully expanded. This correlation was not observed in the five braided stents excluding the laser cut stent. For all six stents, there was a strong correlation between RFM and TAF when the stent fully expanded. For the five braided stents, RFM after full stent expansion correlated strongly with all three stent flare structure variables(ODF, HF, and TAF). The laser-cut C-SEMS had higher RFMs than the braided C-SEMSs regardless of expansion ***: RF was an important anti-migration property when the C-SEMS did not fully expand. Once fully expanded, stent flare structure variables plays an important role in anti-migration.

关键词： biliary stricture Self-expandable metal stent Radial force Resistance force to migration Antimigrati

Contrast-enhanced harmonic endoscopic ultrasonography for assessment of lymph node metastases in pancreatobiliary carcinoma

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World Journal of Gastroenterology 2016年第12期22卷 3381-3391页

作者： Takeshi Miyata Masayuki Kitano Shunsuke Omoto kumpei kadosaka Ken Kamata Hajime Imai Hiroki Sakamoto Naoshi Nisida Yogesh Harwani Takamichi Murakami Yoshifumi Takeyama Yasutaka Chiba Masatoshi Kudo Department of Gastroenterology and Hepatology Kinki University Faculty of Medicine Department of Radiology Kinki University Faculty of Medicine Department of Surgery Kinki University Faculty of Medicine Division of Biostatistics Clinical Research Center Kinki University Faculty of Medicine

AIM: To assess the usefulness of contrast-enhanced harmonic endoscopic ultrasonography(CH-EUS) for lymph node metastasis in pancreatobiliary ***: All patients suspected of pancreatobiliary carcinoma with visible lymph nodes after standard EUS between June, 2009 and January, 2012 were *** the primary analysis, patients with successful EUSfine needle aspiration(FNA) were included. The lymph nodes were assessed by several standard EUS variables(short and long axis lengths, shape, edge characteristic and echogenicity), color Doppler EUS variable [central intranodal blood vessel(CIV) presence] and CH-EUS variable(heterogeneous/homogeneous enhancement patterns). The diagnostic accuracy relative to EUSFNA was calculated. In the second analysis, N-stage diagnostic accuracy of CH-EUS was compared with EUS-FNA in patients who underwent surgical ***: One hundred and nine patients(143 lymph nodes) fulfilled the criteria. The short axis cutoff ≥ 13 mm predicted malignancy with a sensitivity and specificity of 72% and 85%, respectively. These values were 72% and 63% for the long axis cut-off ≥ 20 mm, 62% and 75% for the round shape variable, 81% and 30% for the sharp edge variable, 66% and 61% for the hypoechogenicity variable, 70% and 72% for the CIV-absent variable, and 83% and 91% for the heterogeneous CH-EUS-enhancement variable, respectively. CH-EUS was more accurate than standard and color Doppler EUS, except the short axis cut-off. Notably, three patients excluded because of EUS-FNA failure were correctly N-staged by ***: CH-EUS complements standard and color Doppler EUS and EUS-FNA for assessment of lymph node metastases.

关键词： Contrast-enhanced harmonic endoscopic ultrasonography Sensitivity and specificity Lymph node Pancrea