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Evaluation of endoscopic biliary stenting for obstructive jaundice caused by hepatocellular carcinoma

World Journal of Gastroenterology 2014年第22期20卷 6968-6973页

作者： Gen Sugiyama yoshinobu okabe Yusuke Ishida Fumihiko Saitou Ryuichi Kawahara Hiroto Ishikawa Hiroyuki Horiuchi Hisafumi Kinoshita Osamu Tsuruta Michio Sata Division of Gastroenterology Department of MedicineKurume University School of MedicineKurume 830-0011Japan

AIM:To review the usefulness of endoscopic biliary stenting for obstructive jaundice caused by hepatocellular carcinoma and identify problems that may need to be addressed.METHODS:The study population consisted of 36 patients with obstructive jaundice caused by hepatocellular carcinoma(HCC)who underwent endoscopic biliary stenting(EBS)as the initial drainage procedure at our hospital.The EBS technical success rate and drainage success rate were assessed.Drainage was considered effective when the serum total bilirubin level decreased by 50%or more following the procedure compared to the pre-drainage value.Survival time after the procedure and patient background characteristics were assessed comparatively between the successful drainage group(group A)and the non-successful drainage group(group B).The EBS stent patency duration in the successful drainage group(group A)was also assessed.RESULTS:The technical success rate was 100%for both the initial endoscopic nasobiliary drainage and EBS in all patients.Single stenting was placed in 21 patients and multiple stenting in the remaining 15 patients.The drainage successful rate was 75%and the median interval to successful drainage was 40 d(2-295 d).The median survival time was 150 d in group A and 22 d in group B,with the difference between the two groups being statistically significant(P<0.0001).There were no statistically significant differences between the two groups with respect to patient background characteristics,background liver condition,or tumor factors;on the other hand,the two groups showed statistically significant differences in patients without a history of hepatectomy(P=0.009)and those that received multiple stenting(P=0.036).The median duration of stent patency was 43 d in group A(2-757 d).No early complications related to the EBS technique were encountered.Late complications occurred in 13 patients(36.1%),including stent occlusion in 7,infection in 3,and distal migration in 3.CONCLUSION:EBS is recommended as the initial drainage procedure for obstructiv

关键词： Hepatocellular carcinoma Obstructive jaun-dice Bil

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Intraductal neoplasm of the intrahepatic bile duct: Clinicopathological study of 24 cases

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World Journal of Gastroenterology 2012年第28期18卷 3673-3680页

作者： Yoshiki Naito Hironori Kusano Osamu Nakashima Eiji Sadashima Satoshi Hattori Tomoki Taira Akihiko Kawahara yoshinobu okabe Kazuhide Shimamatsu Jun Taguchi Seiya Momosaki Koji Irie Rin Yamaguchi Hiroshi Yokomizo Michiko Nagamine Seiji Fukuda Shinichi Sugiyama Naoyo Nishida Koichi Higaki Munehiro Yoshitomi Masafumi Yasunaga Koji Okuda Hisafumi Kinoshita Masayoshi Kage Masamichi Nakayama Makiko Yasumoto Jun Akiba Hirohisa Yano Departments of Pathology Kurume University School of Medicine Kurume 830-0011 Japan Biostatistics Center Kurume University Kurume 830-0011 Japan Department of Diagnostic Pathology Kurume University Hospital Kurume 830-0011 Japan Division of Gastroenterology Department of Medicine Kurume University School of Medicine Kurume 830-0011 Japan Department of Pathology Omuta City General Hospital Omuta 836-8567 Japan Department of Pathology Asakura Medical Association Hospital Fukuoka 838-0069 Japan Department of Pathology National Hospital Organization Kyushu Medical Center Fukuoka 810-8563 Japan Department of Pathology Shin-Koga Hospital Tenjinkai 120 Tenjincho Kurume 830-0033 Japan Department of Pathology Kurume University Medical Center 155-1 Kokubumachi Kurume 839-0863 Japan Department of Surgery Japanese Red Cross Kumamoto Hospital Kumamoto 861-8520 Japan Department of Pathology Japanese Red Cross Kumamoto Hospital Kumamoto 861-8520 Japan Division of Surgery Saiseikai Kumamoto Hospital Kumamoto 861-4193 Japan Department of Pathology St Mary's Hospital Kurume 830-8543 Japan Department of Surgery Kurume University School of Medicine Kurume 830-0011 Japan

AIM: To investigate the clinicopathological features of intraductal neoplasm of the intrahepatic bile duct (INihB). METHODS: Clinicopathological features of 24 cases of INihB, which were previously diagnosed as biliary papillomatosis or intraductal growth of intrahepatic biliary neoplasm, were reviewed. Mucin immunohistochemistry was performed for mucin (MUC)1, MUC2, MUC5AC and MUC6. Ki-67, P53 and β-catenin immunoreactivity were also examined. We categorized each tumor as adenoma (low grade), borderline (intermediate grade), and malignant (carcinoma in situ , high grade including tumors with microinvasion). RESULTS: Among 24 cases of INihB, we identified 24 tumors. Twenty of 24 tumors (83%) were composed of a papillary structure; the same feature observed in intraductal papillary neoplasm of the bile duct (IPNB). In contrast, the remaining four tumors (17%) showed both tubular and papillary structures. In three of the four tumors (75%), macroscopic mucin secretion was limited but microscopic intracellular mucin was evident. Histologically, 16 tumors (67%) were malignant, three (12%) were borderline, and five (21%) were adenoma. Microinvasion was found in four cases (17%). Immunohistochemical analysis revealed that MUC1 was not expressed in the borderline/adenoma group but was expressed only in malignant lesions (P = 0.0095). Ki-67 labeling index (LI) was significantly higher in the malignant group than in the borderline/adenoma group (22.2 ± 15.5 vs 7.5 ± 6.3, P < 0.01). In the 16 malignant cases, expression of MUC5AC showed borderline significant association with high Ki-67 LI (P = 0.0622). Nuclear expression of β-catenin was observed in two (8%) of the 24 tumors, and these two tumors also showed MUC1 expression. P53 was negative in all tumors. CONCLUSION: Some cases of INihB have a tubular structure, and are subcategorized as IPNB with tubular structure. MUC1 expression in INihB correlates positively with degree of malignancy.

关键词：胆管肿瘤临床病理管内免疫组织化学方法恶性肿瘤管状结构乳头状瘤肝

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Diagnostic and therapeutic single-operator cholangiopancreatoscopy in biliopancreatic diseases:Prospective multicenter study in Japan

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World Journal of Gastroenterology 2016年第5期22卷 1891-1901页

作者： Toshio Kurihara Ichiro Yasuda Hiroyuki Isayama Toshio Tsuyuguchi Taketo Yamaguchi Ken Kawabe yoshinobu okabe Keiji Hanada Tsuyoshi Hayashi Takao Ohtsuka Syuhei Oana Hiroshi Kawakami Yoshinori Igarashi Kazuya Matsumoto Kiichi Tamada Shomei Ryozawa Hiroki Kawashima Yutaka Okamoto Iruru Maetani Hiroyuki Inoue Takao Itoi Department of Gastroenterology and Hepatology Tokyo Medical University6-7-1 NishishinjukuShinjuku-kuTokyo 160-0023Japan First Department of Internal Medicine Gifu University HospitalGifu 501-1194Japan Department of Gastroenterology Graduate School of MedicineThe University of TokyoTokyo 113-8655Japan Department of Gastroenterology and Nephrology Chiba University Graduate School of MedicineChiba 260-8677Japan Department of Gastroenterology Chiba Cancer CenterFunabashi Municipal HospitalChiba 260-8717Japan Department of Gastroenterology Clinical Research InstituteNational Hospital OrganizationKyushu Medical CenterFukuoka 810-8563Japan Division of Gastroenterology Department of MedicineKurume University School of MedicineKurume 830-0011Japan Department of Gastroenterology Onomichi General HospitalOnomichi 722-8508Japan Department of Medical Oncology and Hematology Sapporo Medical University School of MedicineSapporo 060-8543Japan Department of Surgery and Oncology Graduate School of Medical SciencesKyushu UniversityFukuoka 812-8582Japan Department of Gastroenterology Iwate Medical UniversityMorioka 020-0023Japan Department of Gastroenterology and Hepatology Graduate School of MedicineHokkaido UniversitySapporo 060-8648Japan Division of Gastroenterology and Hepatology Omori Medical CenterToho UniversityTokyo 143-0015Japan Department of Gastroenterology Tottori University HospitalYonago 683-8504Japan Department of Internal Medicine Division of GastroenterologyJichi Medical UniversityShimotsuke 329-0498Japan Department of Gastroenterology Digestive Disease CenterShowa UniversityNorthern Yokohama HospitalYokohama 224-0032Japan Department of Gastroenterology and Hepatology Graduate School of MedicineNagoya UniversityNagoya 466-8550Japan Department of Gastroenterology Mutsu General HospitalMutsu 035-0071Japan Division of Gastroenterology Department of Internal MedicineOhashi Medical CenterToho UniversityTokyo 153-0044Japan Department of Gastroenterology Mie University

AIM: To assess the utility and safety of single-operator cholangiopancreatoscopy(SOCPS) using the Spy Glass system in widespread clinical application for biliary and pancreatic diseases.METHODS: This study was a prospective case series conducted in 20 referral centers in Japan. There were 148 patients who underwent SOCPS; 124 for biliary diseases and 24 for pancreatic diseases. The attempted interventions were SOCPS examination, SOCPS-directed tissue sampling, and therapy for stone removal, among others. The main outcomes were related to the procedure success rate in terms of visualizing the target lesions, SOCPS-directed adequate tissue sampling, and complete stone removal. RESULTS: A total of 148 patients were enrolled for the diagnosis of indeterminate biliary and pancreatic lesions or treatment of biliary and pancreatic disease. The overall procedure success rate of visualizing the target lesions was 91.2%(135/148). The overall procedural success rates of visualizing the target lesions of diagnostic SOCPS in the bile duct and pancreatic duct were 95.5%(84/89) and 88.2%(15/17), respectively. Diagnosis: the overall adequate tissue for histologic examination was secured in 81.4% of the 86 patients who underwent biopsy under SOCPS(bile duct, 60/75, 80.0%; pancreatic duct, 10/11, 90.9%). The accuracy of histologic diagnosis using SOCPS-directed biopsies in indeterminate bile duct lesions was 70.7%(53/75). In the pancreatic duct, the accuracy of SOCPS visual impression of intraductal papillary mucinous neoplasm was 87.5%(14/16). Stone therapy: complete biliary and pancreatic stone clearance combined with SOCPS-directed stone therapy using electrohydraulic lithotripsy or laser lithotripsy was achieved in 74.2%(23/31) and 42.9%(3/7) of the patients, respectively. Others: SOCPS using the Spy Glass system was used in cannulation of the cystic duct in two patients and for passing across the obstructed self-expandable metallic stent for a malignant biliary stricture in two patients. All procedures were successful in both

关键词： Cholangioscopy Endoscopic retrogradecholangiopancreatography Pancreatoscopy Singleoperator SpyGlass

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