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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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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 resection of carcinoid of the minor duodenalpapilla

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World Journal of Gastroenterology 2007年第27期13卷 3763-3764页

作者： Takao Itoi Atsushi Sofuni Fumihide Itokawa takayoshi tsuchiya Toshio Kurihara Fuminori Moriyasu Department of Gastroenterology and Hepatology Tokyo Medical University Tokyo Japan

We encountered a 65-year-old man with a carcinoid tumor of the minor duodenal papilla. Since he had liver cirrhosis and completely refused surgery, we performed an endoscopic snare papillectomy. The papillectomy was performed successfully without procedure-related complication. The specimens revealed a carcinoid tumor showing that the margin of the tumor was positive. One week later, upper GI endoscopy was performed and the biopsy specimens obtained from base of ulcer showed no neoplastic cells. We performed a duodenoscopy and CT 3, 6 and 18 mo later, and there was no macroscopic or microscopic evidence of tumor recurrence after more than 4 years.

关键词：内窥镜检查乳头切除手术良性肿瘤较小十二指肠溃疡小脓包肿瘤复发

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Evaluation of novel slim biopsy forceps for diagnosis of biliary strictures: Single-institutional study of consecutive 360 cases(with video)

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World Journal of Gastroenterology 2017年第35期23卷 6429-6436页

作者： Kenjiro Yamamoto takayoshi tsuchiya Takao Itoi Shujiro Tsuji Reina Tanaka Ryosuke Tonozuka Mitsuyoshi Honjo Shuntaro Mukai Kentaro Kamada Mitsuru Fujita Yasutsugu Asai Yukitoshi Matsunami Yuichi Nagakawa Hiroshi Yamaguchi Atsushi Sofuni Department of Gastroenterology and Hepatology Tokyo Medical University Third Department of Surgery Tokyo Medical University Department of Pathology Tokyo Medical University

AIM To evaluate the feasibility and reliability of endoscopic transpapillary bile duct biopsy for the diagnosis of biliary strictures.METHODS A total of 360 patients(241 men) who underwent endoscopic retrograde cholangiopancreatography for biliary strictures with biopsy from April 2012 to March 2016 at Tokyo Medical University Hospital were retrospectively reviewed. This study was approved by our Institutional Review Board(No. 3516). Informed consent was obtained from all individual participants included in this study. The biopsy specimens were obtained using a novel slim biopsy forceps(Radial Jaw 4P, Boston Scientific, Boston, MA, United States).RESULTS The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 69.6%, 100%, 100%, 59.1%, and 78.8%, respectively. The sensitivity was 75.6% in bile duct cancer, 64% in pancreatic cancer, 61.1% in gallbladder cancer, and 57.1% in metastasis. In bile duct cancer, a lower sensitivity was observed for perihilar bile duct stricture(68.7%) than for distal bile duct stricture(83.1%). In terms of the stricture lengths of pancreatic cancer, gallbladder cancer, and metastasis, a longer stenosis resulted in a better sensitivity. In particular, there was a significant difference between pancreatic cancer and gallbladder cancer(P < 0.05). One major complication was perforation of the extrahepatic bile duct with bile leakage. CONCLUSION Endoscopic transpapillary biopsy alone using novel slim biopsy forceps is feasible and reliable, but restrictive. Biopsy should be performed in consideration of the stricture level, stricture length, and cancer type.

关键词： Endoscopic transpapillary biopsy Biopsy forceps Biliary stricture Bile duct cancer Endoscopic retrograde cholangiography

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Endoscopic ultrasound-guided choledochoduodenostomy in patients with failed endoscopic retrograde cholangiopancreatography

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World Journal of Gastroenterology 2008年第39期14卷 6078-6082页

作者： Takao Itoi Fumihide Itokawa Atsushi Sofuni Toshio Kurihara takayoshi tsuchiya Kentaro Ishii Shujiro Tsuji Nobuhito Ikeuchi Fuminori Moriyasu Department of Gastroenterology and Hepatology Tokyo Medical University HospitalTokyo 160-0023Japan

Endoscopic ultrasonography (EUS)-guided biliary drainage was performed for treatment of patients who have obstructive jaundice in cases of failed endoscopic retrograde cholangiopancreatography (ERCP). In the present study,we introduced the feasibility and outcome of EUS-guided choledochoduodenostomy in four patients who failed in ERCP. We performed the procedure in 2 papilla of Vater,including one resectable case,and 2 cases of cancer of the head of pancreas. Using a curved linear array echoendoscope,a 19 G needle or a needle knife was punctured transduodenally into the bile duct under EUS visualization. Using a biliary catheter for dilation,or papillary balloon dilator,a 7-Fr plastic stent was inserted through the choledochoduodenostomy site into the extrahepatic bile duct. In 3 (75%) of 4 cases,an indwelling plastic stent was placed,and in one case in which the stent could not be advanced into the bile duct,a naso-biliary drainage tube was placed instead. In all cases,the obstructive jaundice rapidly improved after the procedure. Focal peritonitis and bleeding not requiring blood transfusion was seen in one case. In this case,pancreatoduodenectomy was performed and the surgical findings revealed severe adhesion around the choledochoduodenostomy site. Although further studies and development of devices are mandatory,EUS-guided choledochoduodenostomy appears to be an effective alternative to ERCP in selected cases.

关键词：内窥镜超声检查法胆囊疾病病理机制

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Usefulness of contrast-enhanced ultrasonography in determining treatment efficacy and outcome after pancreatic cancer chemotherapy

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World Journal of Gastroenterology 2008年第47期14卷 7183-7191页

作者： Atsushi Sofuni Takao Itoi Fumihide Itokawa takayoshi tsuchiya Toshio Kurihara Kentaro Ishii Syujiro Tsuji Nobuhito Ikeuchi Fuminori Moriyasu Department of Gastroenterology and Hepatology Tokyo Medical UniversityTokyo 160-0023Japan

AIM:To investigate if contrast-enhanced ultrasonography(CE-US) is useful for determining treatment efficacy and outcome in the early stages of pancreatic cancer chemotherapy by assessing changes in intratumor hemodynamics using CE-US with a contrast agent.METHODS:The subjects were 34 patients with unresectable advanced pancreatic cancer treated by chemotherapy.CE-US was assessed after every treatment(course) completion under the same conditions,and patients were divided into two groups according to the intratumor enhancement pattern:Vascular rich(R) group and vascular poor(P) group.RESULTS:After the second course of treatment,R group in intratumor hemodynamics had 18 patients,and P group had 16 patients.The reduction rates of serum CA19-9 level after chemotherapy which decreased to half or less of the baseline level were 2/15(0.1%) in P group,but 11/16(69%) in R group(P = 0.006).When the mean number of courses of chemotherapy and outcome were compared,P group had a mean number of courses of 4.9(R group,10.2) and mean survival time(MST) of 246 d(R group,402 d),showing that outcome was significantly better in R group(P=0.006).CONCLUSION:CE-US revealed that the change in intratumor blood flow correlated with both serum CA19-9 level and outcome.Patients with serum CA19-9 that decreased to less than half the baseline level,and patients with an abundant intratumor blood flow,had a significantly better outcome.Thus,CE-US is potentially useful for evaluating treatment efficacy and outcome in the early stages of pancreatic cancer chemotherapy.

关键词：胰腺癌化学疗法超声波扫描术疗效

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Real-time virtual sonography visualization and its clinical application in biliopancreatic disease

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World Journal of Gastroenterology 2013年第42期19卷 7419-7425页

作者： Atsushi Sofuni Takao Itoi Fumihide Itokawa takayoshi tsuchiya Toshio Kurihara Kentaro Ishii Syujiro Tsuji Nobuhito Ikeuchi Reina Tanaka Junko Umeda Ryosuke Tonozuka Mitsuyoshi Honjo Shuntaro Mukai Fuminori Moriyasu Department of Gastroenterology and Hepatology Tokyo Medical UniversityTokyo 160-0023Japan

AIM:To evaluate the usefulness of real-time virtual sonography(RVS)in biliary and pancreatic diseases.METHODS:This study included 15 patients with biliary and pancreatic diseases.RVS can be used to observe an ultrasound image in real time by merging the ultrasound image with a multiplanar reconstruction computed tomography(CT)image,using pre-scanned CT volume data.The ultrasound used was EUB-8500with a convex probe EUP-C514.The RVS images were evaluated based on 3 levels,namely,excellent,good and poor,by the displacement in position.RESULTS:By combining the objectivity of CT with free scanning using RVS,it was possible to easily interpret the relationship between lesions and the surrounding organs as well as the position of vascular structures.The resulting evaluation levels of the RVS images were12 excellent(pancreatic cancer,bile duct cancer,cholecystolithiasis and cholangiocellular carcinoma)and 3 good(pancreatic cancer and gallbladder cancer).Compared with conventional B-mode ultrasonography and CT,RVS images achieved a rate of 80%superior visualization and 20%better visualization.CONCLUSION:RVS has potential usefulness in objective visualization and diagnosis in the field of biliary and pancreatic diseases.

关键词： Biliary and pancreatic disease Computed tomography-multiplanar reconstruction image Navigation Real-time ultrasound image Real-time virtual sonography

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Safety trial of high-intensity focused ultrasound therapy for pancreatic cancer

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World Journal of Gastroenterology 2014年第28期20卷 9570-9577页

作者： Atsushi Sofuni Fuminori Moriyasu Takatomo Sano Fumihide Itokawa takayoshi tsuchiya Toshio Kurihara Kentaro Ishii Syujiro Tsuji Nobuhito Ikeuchi Reina Tanaka Junko Umeda Ryosuke Tonozuka Mitsuyoshi Honjo Shuntaro Mukai Mitsuru Fujita Takao Itoi Department of Gastroenterology and Hepatology Tokyo Medical University

AIM:To evaluate the safety and clinical application of high-intensity focused ultrasound(HIFU)therapy for unresectable pancreatic cancer(PC).METHODS:Thirty PC patients(16 cases in stage III and 14 cases in stage IV)with visualized pancreatic tumors were admitted for HIFU therapy as an optional local therapy in addition to systemic chemotherapy or chemoradiotherapy.Informed consent was obtained.This study began at the end of 2008 and was approved by the ethics committee of our hospital[Institutional Review Board(IRB):890].The HIFU device used was the FEP-BY02(Yuande Bio-Medical Engineering,Beijing,China).RESULTS:The mean tumor size after HIFU therapy changed to 30.9±1.7 mm from 31.7±1.7 mm at pre-therapy.There were no significant changes in tumor size,mean number of treatment sessions(2.7±0.1 mm),or mean total treatment time(2.4±0.1 h).The rate of symptom relief effect was 66.7%.The effectiveness of primary lesion treatment was as follows:complete response,0;partial response,4;stable disease,22;progressive disease,4.Treatment after HIFU therapy included 2 operations,24 chemotherapy treatments,and 4 best supportive care treatments.Adverse events occurred in 10%of cases,namely pseudocyst formation in 2 cases and mild pancreatitis development in 1.However,no severe adverse events occurred in this study.CONCLUSION:We suggest that HIFU therapy is safe and has the potential to be a new method of combination therapy for PC.

关键词： High-intensity focused ultrasound Pancreatic cance

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