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Propensity score matching analysis for clinical impact of braided-type versus laser-cut-type covered self-expandable metal stents for endoscopic ultrasound-guided hepaticogastrostomy

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Hepatobiliary & Pancreatic Diseases International 2024年第2期23卷 181-185页

作者： Mitsuki Tomita takeshi ogura Akitoshi Hakoda Saori Ueno Atsushi Okuda Nobu Nishioka Yoshitaro Yamamoto Hiroki Nishikawa 2nd Department of Internal Medicine Osaka Medical and Pharmaceutical UniversityOsakaJapan Endoscopy Center Osaka Medical and Pharmaceutical UniversityOsakaJapan

Background:To prevent stent migration during endoscopic ultrasound-guided hepaticogastrostomy(EUS-HGS),intra-scope channel release technique is important,but is unfamiliar to non-expert hands.The self-expandable metal stent(SEMS)is an additional factor to prevent stent migration.However,no compara-tive studies of laser-cut-type and braided-type during EUS-HGS have been reported.The aim of this study was to compare the distance between the intrahepatic bile duct and stomach wall after EUS-HGS among laser-cut-type and braided-type SEMS.Methods:To evaluate stent anchoring function,we measured the distance between the hepatic parenchyma and stomach wall before EUS-HGS,one day after EUS-HGS,and 7 days after EUS-HGS.Also,propensity score matching was performed to create a propensity score for using laser-cut-type group and braided-type group.Results:A total of 142 patients were enrolled in this study.Among them,24 patients underwent EUS-HGS using a laser-cut-type SEMS,and 118 patients underwent EUS-HGS using a braided-type SEMS.EUS-HGS using the laser-cut-type SEMS was mainly performed by non-expert endoscopists(n=21);EUS-HGS using braided-type SEMS was mainly performed by expert endoscopists(n=98).The distance after 1 day was significantly shorter in the laser-cut-type group than that in the braided-type group[2.00(1.70-3.75)vs.6.90(3.72-11.70)mm,P<0.001].In addition,this distance remained significantly shorter in the laser-cut-type group after 7 days.Although these results were similar after propensity score matching analysis,the distance between hepatic parenchyma and stomach after 7 days was increased by 4 mm compared with the distance after 1 day in the braided-type group.On the other hand,in the laser-cut-type group,the distance after 1 day and 7 days was almost the same.Conclusions:EUS-HGS using a laser-cut-type SEMS may be safe to prevent stent migration,even in non-expert hands.

关键词： Endoscopic ultrasound-guided hepaticogastrostomy Endoscopic ultrasound-guided biliary drainage Endoscopic retrograde cholangiopancreatography

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Endoscopic hemostasis using self-expandable metal stent combinedwith PuraStat® for patient with high risk of post-endoscopicsphincterotomy bleeding (with video)

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Hepatobiliary & Pancreatic Diseases International 2024年第1期23卷 94-96页

作者： takeshi ogura Yuki Uba Masahiro Yamamura Nobu Nishioka Hiroki Nishikawa 2nd Department of Internal Medicine Osaka Medical and Pharmaceutical UniversityOsakaJapan

To the Editor:Endoscopic sphincterotomy(EST)is an established technique for removal of bile duct stones and self-expandable metal stent(SEMS)deployment.However,bleeding can be considered an adverse event after EST,particularly for patients with high risk of bleeding such as those on hemodialysis.Among the various techniques reported for obtaining endoscopic hemostasis[1-3].

关键词： bleeding stasis endoscopic

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Novel re-intervention device for occluded multiple uncovered self-expandable metal stent(with video)

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Hepatobiliary & Pancreatic Diseases International 2023年第4期22卷 434-436页

作者： takeshi ogura Yuki Uba Mitsuki Tomita Kimi Bessho Hiroki Nishikawa 2nd Department of Internal Medicine Osaka Medical and Pharmaceutical University2-7 DaigakuchouTakatsukishiOsaka 569-8686Japan

To the Editor:Obstructive jaundice due to unresectable malignant hilar obstruction can be treated by deployment of bilateral uncovered self-expandable metal stents(UCSEMSs),which enable longer stent patency to be obtained compared with multiple plastic stents[1-3].However,re-intervention is needed if obstructive jaundice occurs after bilateral UCSEMS deployment.During re-intervention procedures,insertion of the stent delivery system across the mesh of a UCSEMS and into the bile duct can be challenging.A novel drill dilator has recently become available in Japan(Tornus ES;Asahi Intecc,Nagoya,Japan)(Fig.1)[4].The tract is easily dilated using a clockwise rotation.We herein describe a successful re-intervention using this device for a patient with occluded bilateral UCSEMSs.

关键词： stent struction Asahi

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Lumen-apposing metal stent deployment for walled-off necrosis using semi-free hand technique from the intestine

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Hepatobiliary & Pancreatic Diseases International 2020年第2期19卷 191-193页

作者： takeshi ogura Nobu Nishioka Kazuhide Higuchi nd Department of Internal Medicine Osaka Medical College2-7 DaigakuchouTakatsukishiOsaka 569-8686Japan

Lumen-apposing metal stent (LAMS) deployment under en- doscopic ultrasonography (EUS) guidance has been used for walled-off necrosis (WON) [1] . Recently, LAMS with electrocautery enhanced delivery system has been developed. One of the advan- tages of this stent is that the stent can be delivered without any dilation devices. However, to prevent stent migration into the in- testinal lumen, it is important that stent delivery system should be inserted within the WON. When the diameter of WON is not large enough to insert stent delivery system, contralateral wall of WON may be injured. To prevent this adverse event, guidewire insertion may be useful after puncturing. In addition, according to the re- cent reports [2–4] , EUS-guided LAMS placement for WON drainage has been performed. We herein described a case of LAMS deploy- ment from the second part of the duodenum using semi-free hand technique.

关键词： enough insertion intestine

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Hemobilia due to hepatocellular carcinoma： cholangioscopicfindings and novel endoscopic hemostasis

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Hepatobiliary & Pancreatic Diseases International 2018年第3期17卷 275-277页

作者： takeshi ogura atsushi okuda kazuhide higuchi second department of internal medicine osaka medical college2-7 DaigakuchouTakatsukishiOsaka 569-8686Japan

To the Editor：Trauma, inflammation, iatrogenic procedures such as liverbiopsy and percutaneous transhepatic biliary drainage （PTBD）, vascularanomalies, coagulopathy status, and malignancy can causehemobilia [1]. Malignant causes of hemobilia include cholangiocarcinoma,pancreatic cancer, gallbladder tumor, and liver metastasis,but rarely hepatocellular carcinoma （HCC）. Here, we describeachieving endoscopic hemostasis for hemobilia caused by HCC,which was visualized using the single-operator, SPY-DS cholangioscope（Boston Scientific, Tokyo, Japan） under endoscopic retrogradecholangiopancreatography （ERCP） guidance. This scope is a dramaticimprovement over the SpyGlass system in that it is easier to insert into the biliary tract due to a tapered tip, a 120° digitalfield-of-view provides favorable visualization, and new injection and suction functions have been added via a two-port adaptor.

关键词： COVERED METALLIC STENT

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Technical tips of endoscopic ultrasound-guided choledochoduodenostomy

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World Journal of Gastroenterology 2015年第3期21卷 820-828页

作者： takeshi ogura Kazuhide Higuchi Second Department of Internal Medicine Osaka Medical CollegeOsaka 569-8686Japan

Endoscopic ultrasound(EUS) is clinically useful not only as a diagnostic tool during EUS-guided fine needle aspiration,but also during interventional EUS.EUS-guided biliary drainage has been developed and performed by experienced endoscopists.EUS-guided choledocoduodenostomy(EUS-CDS) is relatively well established as an alternative biliary drainage method for biliary decompression in patients with biliary obstruction.The reported technical success rate of EUS-CDS ranges from 50% to 100%,and the clinical success rate ranges from 92% to 100%.Further,the over-all technicalsuccess rate was 93%,and clinical success rate was 98%.Based on the currently available literature,the overall adverse event rate for EUS-CDS is 16%.The data on the cumulative technical and clinical success rate for EUS-CDS is promising.However,EUS-CDS can still lead to several problems,so techniques or devices that are more feasible and safe need to be established.EUS-CDS has the potential to become a first-line biliary drainage procedure,although standardizing the technique in multicenter clinical trials and comparisons with endoscopic biliary drainage by randomized clinical trials are still needed.

关键词： Endoscopic ultrasound Endoscopic ultrasoundguided

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Does endoscopic ultrasound-guided biliary drainage really have clinical impact?

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World Journal of Gastroenterology 2015年第4期21卷 1049-1052页

作者： takeshi ogura Kazuhide Higuchi Second Department of Internal Medicine Osaka Medical CollegeOsaka 569-8686Japan

The well established, gold standard method for treatment of obstructive jaundice involves biliary drainage under endoscopic retrograde cholangiopancreatography(ERCP) performed by pancreatobiliary endoscopists. Recently, interventions using endoscopic ultrasound(EUS) have been developed not only for obtaining cytological and histological diagnosis, but also for biliary drainage as alternative method. EUS-guided biliary drainage(EUSBD) was first reported by Giovannini et al. EUS-BD broadly includes EUS-guided rendezvous technique, EUS-guided choledochoduodenostomy, and EUS-guided hepaticogastrostomy. More recently, EUS-guided antegrade stenting and EUS-guided gallbladder drainage have also been reported. many case reports, series, and retrospective studies on EUS-BD have been reported. However, because prospective studies and comparisons between the different biliary drainage methods have not been reported, the technical success, functional success, adverse events, and stent patency with long-term follow up of EUS-BD are still unclear. Therefore, prospective, randomized controlled studies addressing these issues are needed. Despite this, EUSBD undoubtedly is clinically useful as an alternative biliary drainage method. EUS-BD has the potential to be a first-line biliary drainage method instead of ERCP if results of clinical trials are favorable and the technique is simplified.

关键词： Endoscopic ultrasound Endoscopic ultrasoundguided

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Technical tips for endoscopic ultrasound-guided hepaticogastrostomy

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World Journal of Gastroenterology 2016年第15期22卷 3945-3951页

作者： takeshi ogura Kazuhide Higuchi Second Department of Internal Medicine Osaka Medical College

Interventional procedures using endoscopic ultrasound(EUS) have recently been developed. For biliary drainage, EUS-guided trans-luminal drainage has been reported. In this procedure, the transduodenal approach for extrahepatic bile ducts is called EUSguided choledochoduodenostomy, and the transgastric approach for intrahepatic bile ducts is called EUSguided hepaticogastrostomy(EUS-HGS). These procedures have several effects, such as internal drainage and avoiding post-endoscopic retrograde cholangiopancreatography(ERCP) pancreatitis, and they are indicated for an inaccessible ampulla of Vater due to duodenal obstruction or surgical anatomy. EUS-HGS has particularly wide indications and clinical impact as an alternative biliary drainage method. In this procedure, it is necessary to dilate the fistula, and several devices and approaches have been reported. Stent selection is also important. In previous reports, the overall technical success rate was 82%(221/270), the clinical success rate was 97%(218/225), and the overall adverse event rate for EUS-HGS was 23%(62/270). Adverse events of EUS-biliary drainage are still high compared with ERCP or PTCD. EUSHGS should continue to be performed by experienced endoscopists who can use various strategies when adverse events occur.

关键词： Endoscopic ultrasound Endoscopic ultrasound guided hepaticogastrostomy Endoscopic ultrasound guided

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Study on conservation of mural paintings in Tumulus： Numerical analysis of heat behaviors of stone chamber after excavation

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Frontiers of Architectural Research 2012年第4期1卷 375-379页

作者： Yonghui Li Daisuke ogura Shuichi Hokoi takeshi Ishizaki School of Architecture Key Laboratory of Architectural and Urban Heritage Conservation Southeast University Nanjing 210096 China Graduate School of Engineering Kyoto University Kyoto 606-8501 Japan Department of Research Support and Promotion National Research Institute for Cultural Properties Tokyo 110-8713 Japan

In 1972 mural paintings of Takamatsuzuka tumulus were discovered and have been conserved on site for 35 years, but fungi growth on the mural paintings was not suppressed. In 2007 the stone chamber was dismantled and removed to the facility for conservation and restoration. The purposes of our study are to clarify the main cause of the deterioration and to propose a suitable method to prevent the deterioration for preserving them on site. In this paper, we developed the two-dimensional analysis model by considering the actual change of the surrounding mound because of the excavation in 1972, and perform the analysis of heat behavior of Takamatsuzuka tumulus before and after excavation and compare effects of different sun-shading methods on heat behavior of the stone chamber. The main results are as follows：（1） after the excavation, the inside surface temperature distribution of the stone chamber and the amplitude of indoor temperature become larger. （2） Using the sun-shading panel in the area of excavation is an effective method to reduce the average indoor temperature; however, it has no influence on reducing the temperature distribution of the stone chamber and the temperature difference between the inside wall and indoor.

关键词： Effect Excavation Heat transfer Sun-shading Conservation

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Comparative study on pharmacokinetics and toxicity of intravitreal and sub-Tenon injection of triamcinolone acetonide in ocular tissues

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International Journal of Ophthalmology(English edition) 2020年第12期13卷 1864-1871页

作者： Yuko Arie Hiroko Miyai Ayako Suzuki takeshi Okabe Mitsuyo Takashima Mayumi Takata Takashi Kurasawa Masaki Ito Reijiro Arakawa Yuichiro ogura Akira Naito Sagami Research Laboratories Wakamoto Pharmaceutical Corporation Ltd.Kanagawa 2580018Japan Department of Ophthalmology and Visual Science Nagoya City University Graduate School of Medical SciencesNagoya 4678601Japan

AIM:To compare the differences in kinetics,distribution,and toxicity of triamcinolone acetonide(TA)between the injection methods,sub-Tenon and intravitreal injections in rabbit ocular tissues.METHODS:TA was injected into the vitreous or the sub-Tenon in rabbits.For pharmacokinetic study,rabbits were sacrificed periodically and then TA in blood and ocular tissues(retina/choroids,vitreous,and aqueous humor)were measured over 91 d.For toxicological study,clinical signs,slit-lamp microscopic examination,ophthalmological test were performed.The eyeballs and surrounding tissues were collected and fixed with glutaraldehyde-formalin solution,and then paraffin embedded for histological investigation.RESULTS:Higher levels of TA were distributed in the intraocular tissues when injected into the vitreous compared to the sub-Tenon.Conversely,TA level was remarkably lower in the rabbits which received intravitreal TA injections than those treated with sub-Tenon injection throughout the study period in plasma.Optical discharge probably caused by systemic circulation of TA was observed by receiving sub-Tenon TA injection.Meanwhile,technicassociated toxicological ocular symptoms and findings were more frequently observed in intravitreal injection than in sub-Tenon injection.CONCLUSION:There are significant differences in kinetics and distribution of TA in vitreous body,aqueous humor and plasma,between the two injection methods.Although further study is needed to explain the species difference between human and rabbit,it is assumed that the difference in the frequency of intraocular pressure elevation and cataract formation by TA between the two injection methods are directly related to the TA concentrations in aqueous humor and vitreous body in each injection methods.Systemic toxicity and technic-associated toxicity are also closely related to kinetics of TA in plasma and each injection method itself,respectively.

关键词： corticosteroid(s) pharmacokinetics injection ophthalmic drug delivery toxicity

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