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Brachiocephalic to left brachial vein thrombotic vasculitis accompanying mediastinal pancreatic fistula:A case report

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World Journal of Clinical Cases 2022年第32期10卷 11882-11888页

作者： Reiji Kokubo Daisuke Yunaiyama Yu Tajima Natsumi Kugai Mitsuru Okubo Kazuhiro Saito Takayoshi Tsuchiya takao itoi Department of Radiology Tokyo Medical UniversityTokyo 160-0023Japan Department of Gastroenterology and Hepatology Tokyo Medical UniversityTokyo 160-0023Japan

BACKGROUND Pancreatitis is a severe inflammatory pancreatic disease commonly due to bile duct stones or excessive alcohol usage,with clinical manifestations of abdominal pain,nausea,fever,and fluid collections.Healthy persons with less symptomatic pancreatitis are quite rare.Herein,we report a case of a patient with an undetermined onset of pancreatitis mimicking left arm cellulitis due to thrombotic vasculitis of the brachiocephalic vein.CASE SUMMARY A 50-year-old woman visited our hospital for tenderness in the left arm over several recent days.She was diagnosed with cellulitis on the left arm due to left elbow tenderness.Intravenous antibiotics administration did not improve symptoms and laboratory data worsened;thus,chest and abdominal computed tomography(CT)was performed.CT demonstrated pancreatitis with pseudocyst around the pancreas extending to the mediastinum.Thrombotic vasculitis of the brachiocephalic to left brachial vein was observed,which could be the cause of left elbow pain.A pancreatic fistula was found in the head of the pancreas by endoscopic retrograde cholangiopancreatography,so a pancreatic cyst drainage tube via the duodenum was placed in the pseudocyst.Cyst content culture was positive for Escherichia coli infection.Clinical symptoms,imaging findings,and inflammatory reactions resolved gradually after starting therapeutic intervention.The mediastinal pancreatic pseudocysts shrunk,and the venous thrombi remained but shrunk.CONCLUSION The case of a patient with pancreatitis with an undetermined onset that mimics left arm cellulitis is reported.Deep vein thrombosis should be kept in mind when treating patients with severe inflammatory disease.

关键词： Pancreatic fistula Thrombotic vasculitis Pancreatitis Computed tomography Case report

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Effectiveness of narrow-band imaging magnification for invasion depth in early colorectal cancer

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World Journal of Gastroenterology 2010年第14期16卷 1727-1734页

作者： Masakatsu Fukuzawa Yutaka Saito Takahisa Matsuda Toshio Uraoka takao itoi Fuminori Moriyasu Division of Endoscopy National Cancer Center Hospital Tokyo 1040045 Japan Division of Gastroenterology and Hepatology Tokyo Medical University Tokyo 1600023 Japan Department of Endoscopy Okayama University Hospital Okayama 7008558 Japan Microvasculature

AIM: To evaluate the surface microvascular patterns of early colorectal cancer (ECC) using narrow-band imaging (NBI) with magnification and its effectiveness for invasion depth diagnosis. METHODS: We studied 112 ECC lesions [mucosal/ submucosal superficial (m/sm-s), 69; sm-deep (sm-d), 43] ≥ 10 mm that subsequently underwent endoscopic or surgical treatment at our hospital. We compared microvascular architecture revealed by NBI with magnification to histological findings and then to magnifi- cation colonoscopy pit pattern diagnosis. RESULTS: Univariate analysis indicated vessel density: non-dense (P < 0.0001); vessel regularity: negative (P < 0.0001); caliber regularity: negative (P < 0.0001); vessel length: short (P < 0.0001); and vessel meandering: positive (P = 0.002) occurred significantly more often with sm-d invasion than m/sm-s invasion. Multivariate analysis showed sm-d invasion was independently associated with vessel density: non-dense[odds ratio (OR) = 402.5, 95% confidence interval (CI): 12.4-13 133.1] and vessel regularity: negative (OR = 15.9, 95% CI: 1.2-219.1). Both of these findings when combined were an indicator of sm-d invasion with sensitivity, specificity and accuracy of 81.4%, 100% and 92.9%, respectively. Pit pattern diagnosis sensitivity, specificity and accuracy, meanwhile, were 86.0%, 98.6% and 93.8%, respectively, thus, the NBI with magnification findings of non-dense vessel density and negative vessel regularity when combined together were comparable to pit pattern diagnosis. CONCLUSION: Non-dense vessel density and/or negative vessel regularity observed by NBI with magnification could be indicators of ECC sm-d invasion.

关键词： Colorectal neoplasms Narrow-band imaging Microvasculature

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Assessment of the validity of the clinical pathway for colon endoscopic submucosal dissection

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World Journal of Gastroenterology 2012年第28期18卷 3721-3726页

作者： Takaya Aoki Takeshi Nakajima Yutaka Saito Takahisa Matsuda Taku Sakamoto takao itoi Yassir Khiyar Fuminori Moriyasu Endoscopy Division National Cancer Center Hospital Tokyo 104-0045 Japan Department of Gastroenterology and Hepatology Tokyo Medical University Tokyo 160-0023 Japan

AIM: To determine the effective hospitalization period as the clinical pathway to prepare patients for endoscopic submucosal dissection (ESD). METHODS: This is a retrospective observational study which included 189 patients consecutively treated by ESD at the National Cancer Center Hospital from May 2007 to March 2009. Patients were divided into 2 groups; patients in group A were discharged in 5 d and patients in group B included those who stayed longer than 5 d. The following data were collected for both groups: mean hospitalization period, tumor site, median tumor size, post-ESD rectal bleeding requiring urgent endoscopy, perforation during or after ESD, abdominal pain, fever above 38 ℃, and blood test results positive for inflammatory markers before and after ESD. Each parameter was compared after data collection. RESULTS: A total of 83% (156/189) of all patients could be discharged from the hospital on day 3 postESD. Complications were observed in 12.1% (23/189) of patients. Perforation occurred in 3.7% (7/189) of patients. All the perforations occurred during the ESD procedure and they were managed with endoscopic clipping. The incidence of post-operative bleeding was 2.6% (5/189); all the cases involved rectal bleeding. We divided the subjects into 2 groups: tumor diameter ≥ 4 cm and < 4 cm; there was no significant difference between the 2 groups (P = 0.93, χ 2 test with Yates correction). The incidence of abdominal pain was 3.7% (7/189). All the cases occurred on the day of the procedure or the next day. The median white blood cell count was 6800 ± 2280 (cells/μL; ± SD) for group A, and 7700 ± 2775 (cells/μL; ± SD) for group B, showing a statistically significant difference (P = 0.023, t-test). The mean C-reactive protein values the day after ESD were 0.4 ± 1.3 mg/dL and 0.5 ± 1.3 mg/dL for groups A and B, respectively, with no significant difference between the 2 groups (P = 0.54, t -test). CONCLUSION: One-day admission is sufficient in the absence of complications during ESD or early postoperative bleed

关键词：层剥离膜下临床内窥镜评估结肠 C-反应蛋白 ESD

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Computed tomography virtual endoscopy with angiographic imaging for the treatment of type Ⅳ-A choledochal cyst

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World Journal of Gastroenterology 2012年第28期18卷 3761-3764页

作者： Akihiko Tsuchida Yuichi Nagakawa Kazuhiko Kasuya Bunso Kyo Takahisa Ikeda Yoshiaki Suzuki Tatsuya Aoki takao itoi Third Department of Surgery Tokyo Medical University Tokyo 160-0023 Japan Fourth Department of Internal Medicine Tokyo Medical University Tokyo 160-0023 Japan

Type Ⅳ-A choledochal cysts (CCs) are a congenital biliary anomaly which involve dilatation of the extrahepatic and intrahepatic bile ducts. We present the case of a 30-year-old woman with type Ⅳ-A CC, on whom threedimensional computed tomography (3D CT) and virtual endoscopy were performed. 3D CT revealed partial dilatation in the posterior branch of the intrahepatic bile duct and a relative stricture between it and the extrahepatic bile duct. Virtual endoscopy showed that this stricture was membrane-like and separated from the surrounding blood vessels. Based on these image findings, complete cyst resection, bile duct plasty for the stricture, and hepaticojejunostomy were safely performed. To the best of our knowledge, there are no reports of imaging by virtual endoscopy of the biliary tract which show the surrounding blood vessels running along the bile duct.

关键词：虚拟内窥镜血管造影三维CT 仿真囊肿计算机断层扫描 Ⅱ型治疗

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Transpapillary incision of refractory circumscript pancreatic duct stricture using wire-guided snare forceps

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World Journal of Gastroenterology 2010年第12期16卷 1541-1544页

作者： takao itoi Atsushi Sofuni Fumihide Itokawa Toshio Kurihara Takayoshi Tsuchiya Kentaro Ishii Shujiro Tsuji Nobuhito Ikeuchi Fuminori Moriyasu Department of Gastroenterology and Hepatology Tokyo Medical University

Endoscopic therapy of pancreatic duct(PD)strictures using balloon dilation and pancreatic duct stent(PS) placement has been reported to improve the severity of abdominal pain in selected patients with chronic pancreatitis(CP).However,some strictures are refractory and require frequent PS exchange to control symptoms.We describe two cases of successful endoscopic PD incision for difficult PD stricture using a wireguided snare.The snare is partially opened within the strictured pancreatic duct while applying current,thus incising the duct.Although both cases were successful without complications we do not advocate that this method be used routinely because of the potential for severe complications,e.***.bleeding,ductal perforation or pancreatic parenchymal damage.In order to prevent these complications,we developed a wire-guided technique under fluoroscopic control.We think this procedure may be useful in patients with short,straight PD strictures.Although further study is required,this approach may have potential for selected patients with refractory PD strictures due to CP.

关键词： Chronic pancreatitis Pancreatic duct stricture Pancreatic duct incision

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Endoscopic removal and trimming of distal self-expandable metallic biliary stents

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World Journal of Gastroenterology 2011年第21期17卷 2652-2657页

作者： Kentaro Ishii takao itoi Atsushi Sofuni Fumihide Itokawa Takayoshi Tsuchiya Toshio Kurihara Shujiro Tsuji Nobuhito Ikeuchi Junko Umeda Fuminori Moriyasu Akihiko Tsuchida Department of Gastroenterology and Hepatology Tokyo Medical University Third Department of Surgery Tokyo Medical University

AIM:To evaluate the efficacy and safety of endoscopic removal and trimming of self-expandable metallic stents(SEMS).METHODS:All SEMS had been placed for distal biliary strictures.Twenty-seven endoscopic procedures were performed in 19 patients in whom SEMS(one uncovered and 18 covered) removal had been attempted,and 8 patients in whom stent trimming using argon plasma coagulation(APC) had been attempted at Tokyo Medical University Hospital.The APC settings were:voltage 60-80 W and gas flow at 1.5 L/min.RESULTS:The mean stent indwelling period for all patients in whom stent removal had been attempted was 113.7 ± 77.6 d(range,8-280 d).Of the 19 patients in whom removal of the SEMS had been attempted,the procedure was successful in 14(73.7%) without procedure-related adverse events.The indwelling period in the stent removable group was shorter than that in the unremovable group(94.9 ± 71.5 d vs 166.2 ± 76.2 d,P = 0.08).Stent trimming was successful for all patients with one minor adverse event consisting of self-limited hemorrhage.Trimming time ranged from 11 to 16 min.CONCLUSION:Although further investigations on larger numbers of cases are necessary to accumulate evidence,the present data suggested that stent removal and stent trimming is feasible and effective for stent-related complications.

关键词：金属支架修剪时间内镜远端胆道清除 SEMS 支架拆除

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Prognosis of cancer with branch duct type IPMN of the pancreas

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World Journal of Gastroenterology 2010年第15期16卷 1890-1895页

作者： Nobuhito Ikeuchi takao itoi Atsushi Sofuni Fumihide Itokawa Takayoshi Tsuchiya Toshio Kurihara Kentaro Ishii Shujiro Tsuji Junko Umeda Fuminori Moriyasu Akihiko Tsuchida Kazuhiko Kasuya Department of Gastroenterology and Hepatology Tokyo Medical University Department of Surgery Tokyo Medical University

AIM:To examine the coexistence of metachronous and synchronous cancer in branch duct intraductal papillary mucinous neoplasms of the pancreas (IPMN).METHODS: We reviewed the records of 145 patients with branch duct IPMN between January 1991 and April 2008 and assessed the relationship between IPMN and intraor extra-pancreatic carcinoma and the outcome of IPMN.RESULTS: The mean observation period was 55.9 ± 45.3 mo. Among the 145 patients, the frequency of extra-pancreatic cancer was 29.0%. The frequency of gastric cancer, colon cancer, breast cancer, and pan-creatic cancer were 25.5%, 15.7%, 13.7%, and 9.8%, respectively. Twenty (13.8%) of the patients died. The cause of death was extra-pancreatic carcinoma in 40%,pancreatic cancer in 25%, IPMN per se in 20%, and benign disease in 15% of the patients.CONCLUSION: The prognosis for IPMN depends not on the IPMN per se, but on the presence of intraor extra-pancreatic cancer.

关键词： Intraductal papillary mucinous neoplasms of the pancreas Long-term follow-up Extra-pancreatic cancer Pancreatic cancer Prognosis

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Endoscopic diagnosis of pancreaticobiliary maljunction

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World Journal of Gastrointestinal Endoscopy 2011年第1期3卷 1-5页

作者： Terumi Kamisawa Kensuke Takuma Fumihide Itokawa takao itoi Department of Internal Medicine Tokyo Metropolitan Komagome Hospital Department of Gastroenterology Tokyo Medical University

Pancreaticobiliary maljunction (PBM) is a congenital anomaly defined as a junction of the pancreatic and bile ducts located outside the duodenal wall, usually forming a markedly long common channel. As the action of the sphincter of Oddi does not functionally affect the junction in PBM patients, continuous pancreatobiliary reflux occurs, resulting in a high incidence of biliary cancer. PBM can be divided into PBM with biliary dilatation (congenital choledochal cyst) and PBM without biliary dilatation (maximal diameter of the bile duct ≤ 10 mm). The treatment of choice for PBM is prophylactic surgery before malignant changes can take place. Endoscopic retrograde cholangiopancreatography (ERC P) is the most effective examination method for close obs ervation of the pattern of the junction site. When the communication between the pancreatic and bile ducts is maintained, despite contraction of the sphi ncter on ERCP, PBM is diagnosed. In these pat ients, levels of pancreatic enzymes in the bile are gene rally elevated, due to continuous pancreatobiliary reflux via a long common channel. Magnetic resonance cholangiopancreatography and 3D-computed tomography can diagnose PBM, based on findings of an anomalous union between the common bile duct and the pancreatic duct, in addition to a long common channel. Endoscopic ultrasonography and intraductal ultra sonography can demonstrate the junction outside the duodenal wall, and are useful for the diagnosis of asso ciated biliary cancer. Gallbladder wall thickness on ultra so nography can be a screening test for PBM.

关键词： Pancreaticobiliary maljunction Pancreatobiliary reflux Congenital choledochal cyst Endoscopic retrograde cholangiopancreatography Endoscopic ultrasonography Magnetic resonance cholangiopancreatography

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Carcinogenesis and chemoprevention of biliary tract cancer in pancreaticobiliary maljunction

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World Journal of Gastrointestinal Oncology 2010年第3期2卷 130-135页

作者： Akihiko Tsuchida takao itoi the third Department of Surgery Tokyo Medical University the fourth Department of Internal Medicine Tokyo Medical University

Pancreaticobiliary maljunction (PBM) is a high risk factor for biliary tract cancer. In PBM, since the pancreatic duct and bile duct converge outside the duodenal wall beyond the influence of the sphincter of Oddi, pancreatic juice and bile are constantly mixed, producing a variety of harmful substances. Because of this, the biliary mucosa is repeatedly damaged and repaired, which causes an acceleration of cell proliferative activity and multiple gene mutations. Histological changes such as hyperplasia, metaplasia, and dysplasia ultimately result in a high incidence of carcinogenesis. In a nationwide survey by the Japanese Study Group on PBM, coexisting biliary tract cancer was detected in 278 of the 1627 registered cases of PBM (17.1%). Of these cases, in those with dilatation of the extrahepatic bile duct, cancer was often detected not only in the gallbladder but also in the bile ducts. More than 90% of cancer cases without dilatation of the extrahepatic bile duct develop in the gallbladder. Standard treatment for PBM is a cholecystectomy and resection of the extrahepatic bile duct. However, cholecystectomy alone is performed at nearly half of institutions in Japan. Conversely, reports of carcinogenesis in the remnant bile duct or pancreas after diversion surgery are steadily increasing. One of the causes for this is believed to be an accumulation of gene mutations which were present before surgery. Anticancer drugs are ineffective in preventing such carcinogenesis following surgery, thus the postoperative administration of chemopreventive agents may be necessary.

关键词： Chemoprevention Gallbladder cancer Bile duct cancer Carcinogenesis Pancreaticobiliary maljunction

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IDUS for Biliary and Pancreatic Duct Lesions

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中国消化内镜 2008年第9期2卷 21-22页

作者： takao itoi Department of Gastroenterology and Hepatology Tokyo Medical University

In the recent decade, wire-guided intraductal US (IDUS), which can be passed through the working channel of standard duodenoscopes to provide high-frequency ultrasound images, has been developed as a

关键词：胆胰胆管病变治疗方法消化系统

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