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Small invasive ductal carcinoma of the pancreas distinct from branch duct intraductal papillary mucinous neoplasm

World Journal of Gastroenterology 2009年第43期15卷 5489-5492页

作者： Hiroki Sakamoto masayuki kitano Takamitsu Komaki Hajime Imai Ken Kamata Masatomo Kimura Yoshifumi Takeyama Masatoshi Kudo Division of Gastroenterology and Hepatology Department of Internal MedicineKinki University School of Medicine377-2Ohno-HigashiOsaka-Sayama 589-8511Japan Department of Pathology Kinki University School of Medicine377-2Ohno-HigashiOsaka-Sayama 589- 8511Japan Department of Surgery Kinki University School of Medicine377-2Ohno-HigashiOsaka-Sayama 589-8511Japan

Endoscopic ultrasonography （EUS） is a highly sensitive diagnostic method for the detection of small pancreatic carcinomas. Recently, there have been some reports describing the utility of contrast-enhanced harmonic EUS （CEH-EUS） which uses sonographic contrast agent for differentiation of a pancreatic mass. This report describes a case of small adenocarcinoma of the pancreas distinct from branch duct intraductal papillary mucinous neoplasm （IPMN） in which investigation by EUS took place every 6 mo and diagnosis was made accurately by additional CEH-EUS during the follow-up of the branch duct IPMN. A 68-year-old female was admitted to our hospital because of a branch duct IPMN in the pancreatic body. She had been followed-up by EUS every 6 too. However, after 2 years EUS demonstrated a low echoic area distinct from the branch duct IPMN which was vaguely discernible by EUS, and accurate sizing and differential diagnosis were considered difficult on the EUS imaging. CHEUS with Sonazoid revealed a hypovascular tumor and we suspected small pancreatic carcinoma. The histopathological diagnosis was adenocarcinoma （10 mm） in the pancreatic tail, distinct from the branch duct IPMN of the pancreatic body. EUS and CEH-EUS may play an important role in the correct diagnosis of small pancreatic tumors, including synchronous and metachronous occurrence of IPMN and ductal adenocarcinoma of the pancreas.

关键词： Intraductal papillary mucinous adenoma Small pancreatic cancer Endoscopic ultrasonography Contrast-enhanced harmonic endoscopic ultrasonography Pancreatic cancer Pancreas Contrast enhanced endoscopic ultrasonography

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Can the biliary enhancement of Gd-EOB-DTPA predict the degree of liver function?

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Hepatobiliary & Pancreatic Diseases International 2012年第3期11卷 307-313页

作者： Masahiro Okada Kazunari Ishii Kazushi Numata Tomoko Hyodo Seishi Kumano masayuki kitano Masatoshi Kudo Takamichi Murakami Department of Radiology Kinki University Faculty of Medicine Gastroenterological Center Yokohama City University Medical Center Department of Radiology and Department of Gastroenterology and Hepatology Kinki University Faculty of Medicine

BACKGROUND: Excretion of gadolinium-ethoxybenzyl-diethyl- enetriamine pentaacetic acid (Gd-EOB-DTPA) in the bile may be related to liver function, because of elimination from the liver after preferential uptake by hepatocytes. The purpose of this study was to investigate the relation between liver and biliary enhancement in patients with or without liver dysfunction, and to compare the tumor-to-liver contrast in these patients. METHODS: Forty patients [group 1: normal liver and Child Pugh class A in 20 patients, group 2: Child-Pugh class B in 18 patients and Child-Pugh C in 2] were evaluated. All patients underwent MR imaging of the liver using a 1.5-Tesla system. T1 weighted 3D images were obtained at 5, 10, 15 and 20 minutes after Gd-EOB-DTPA injection. The relation between group 3 (total bilirubin <1.8 mg/dL) and group 4 (total bilirubin ≥1.8 mg/dL) was investigated at 20 minutes. Liver and biliary signals were measured, and compared between groups 1 and 2 or groups 3 and 4. Tumor-to-liver ratio was also evaluated between groups 1 and 2. Scheffé’s post-hoc test after two-way repeated measures ANOVA and Pearson’s correlation test were used for statistical analysis. RESULTS: Liver enhancement showed significant difference at all time points between groups 1 and 2. Biliary enhancement did not show a significant difference between groups 1 and 2 at 5 minutes, but did at 10, 15 and 20 minutes. At 20 minutes significant differences between groups 3 and 4 were seen for liver and biliary enhancement. At all time points, liver enhancement correlated with biliary enhancement in both groups. At 5 minutes and 20 minutes, statistical differences between groups 1 and 2 were seen for tumor-to-liver ***: The degree of biliary enhancement has a close correlation to that of liver enhancement. It is especially important that insufficient liver enhancement causes lower tumor-to-liver contrast in the hepatobiliary phase of Gd-EOB- DTPA.

关键词： magnetic resonance imaging Gd-EOB-DTPA liver bile duct hepatobiliary phase

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Urgent endoscopic ultrasound-guided choledochoduodenostomy for acute obstructive suppurative cholangitis-induced sepsis

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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 cholangitis Sepsis Life-saving endoscopy

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Endoscopic ultrasound-guided gallbladder drainage for acute cholecystitis: Long-term outcomes after removal of a self-expandable metal stent

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World Journal of Gastroenterology 2017年第4期23卷 661-667页

作者： Ken Kamata Mamoru Takenaka masayuki kitano Shunsuke Omoto Takeshi Miyata Kosuke Minaga Kentaro Yamao Hajime Imai Toshiharu Sakurai Tomohiro Watanabe Naoshi Nishida Masatoshi Kudo Department of Gastroenterology and Hepatology Kindai University Faculty of MedicineOsaka-Sayama 589-8511Japan

AIM To assess the long-term outcomes of this procedure after removal of self-expandable metal stent(SEMS). The efficacy and safety of endoscopic ultrasoundguided gallbladder drainage(EUS-GBD) with SEMS were also *** Between January 2010 and April 2015, 12 patients with acute calculous cholecystitis, who were deemed unsuitable for cholecystectomy, underwent EUSGBD with a SEMS. EUS-GBD was performed under the guidance of EUS and fluoroscopy, by puncturing the gallbladder with a needle, inserting a guidewire, dilating the puncture hole, and placing a SEMS. TheSEMS was removed and/or replaced with a 7-Fr plastic pigtail stent after cholecystitis improved. The technical and clinical success rates, adverse event rate, and recurrence rate were all *** The rates of technical success, clinical success, and adverse events were 100%, 100%, and 0%, respectively. After cholecystitis improved, the SEMS was removed without replacement in eight patients, whereas it was replaced with a 7-Fr pigtail stent in four patients. Recurrence was seen in one patient(8.3%) who did not receive a replacement pigtail stent. The median follow-up period after EUS-GBD was 304 d(78-1492).CONCLUSION EUS-GBD with a SEMS is a possible alternative treatment for acute cholecystitis. Long-term outcomes after removal of the SEMS were excellent. Removal of the SEMS at 4-wk after SEMS placement and improvement of symptoms might avoid migration of the stent and recurrence of cholecystitis due to food impaction.

关键词： Endoscopic ultrasound-guided gallbladder drainage Cholecystitis Endoscopic ultrasound-guided biliary drainage

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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 ultrasonography-guided drainage Acute pancreatitis

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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 Anti-migration property

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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 enrolled. In the primary analysis, patients with successful EUS-fine 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 EUS-FNA 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 cut-off ≥ 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 Pancreatobiliary carcinoma Endoscopic ultrasonography-fine needle aspiration

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Removal of diminutive colorectal polyps: A prospective randomized clinical trial between cold snare polypectomy and hot forceps biopsy

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World Journal of Gastroenterology 2017年第2期23卷 328-335页

作者： Yoriaki Komeda Hiroshi Kashida Toshiharu Sakurai George Tribonias Kazuki Okamoto Masashi Kono Mitsunari Yamada Teppei Adachi Hiromasa Mine Tomoyuki Nagai Yutaka Asakuma Satoru Hagiwara Shigenaga Matsui Tomohiro Watanabe masayuki kitano Takaaki Chikugo Yasutaka Chiba Masatoshi Kudo Department of Gastroenterology and Hepatology Kindai University Faculty of Medicine Department of Pathology Kindai University Faculty of Medicine Clinical Research Center Kindai University Hospital

AIMTo compare the efficacy and safety of cold snare polypectomy (CSP) and hot forceps biopsy (HFB) for diminutive colorectal *** prospective, randomized single-center clinical trial included consecutive patients ≥ 20 years of age with diminutive colorectal polyps 3-5 mm from December 2014 to October 2015. The primary outcome measures were en-bloc resection (endoscopic evaluation) and complete resection rates (pathological evaluation). The secondary outcome measures were the immediate bleeding or immediate perforation rate after polypectomy, delayed bleeding or delayed perforation rate after polypectomy, use of clipping for bleeding or perforation, and polyp retrieval rate. Prophylactic clipping after polyp removal wasn’t routinely *** hundred eight patients were randomized into the CSP (102), HFB (106) and 283 polyps were evaluated (CSP: 148, HFB: 135). The en-bloc resection rate was significantly higher with CSP than with HFB [99.3% (147/148) vs 80.0% (108/135), P < 0.0001]. The complete resection rate was significantly higher with CSP than with HFB [80.4% (119/148) vs 47.4% (64/135), P < 0.0001]. The immediate bleeding rate was similar between the groups [8.6% (13/148) vs 8.1% (11/135), P = 1.000], and endoscopic hemostasis with hemoclips was successful in all cases. No cases of perforation or delayed bleeding occurred. The rate of severe tissue injury to the pathological specimen was higher HFB than CSP [52.6% (71/135) vs 1.3% (2/148), P < 0.0001]. Polyp retrieval failure was encountered CSP (7), HFB (2).CONCLUSIONCSP is more effective than HFB for resecting diminutive polyps. Further long-term follow-up study is required.

关键词： Cold snare polypectomy Colonoscopy Polypectomy Colorectal diminutive polyps Hot forceps biopsy

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Familial pancreatic cancer: Concept, management and issues

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World Journal of Gastroenterology 2017年第6期23卷 935-948页

作者： Hiroyuki Matsubayashi Kyoichi Takaori Chigusa Morizane Hiroyuki Maguchi Masamichi Mizuma Hideaki Takahashi Keita Wada Hiroko Hosoi Shinichi Yachida Masami Suzuki Risa Usui Toru Furukawa Junji Furuse Takamitsu Sato Makoto Ueno Yoshimi Kiyozumi Susumu Hijioka Nobumasa Mizuno Takeshi Terashima Masaki Mizumoto Yuzo Kodama Masako Torishima Takahisa Kawaguchi Reiko Ashida masayuki kitano Keiji Hanada masayuki Furukawa Ken Kawabe Yoshiyuki Majima Toru Shimosegawa Division of Endoscopy Shizuoka Cancer Center Clinic of Genetic Medicine Shizuoka Cancer Center Department of Surgery Kyoto University Graduate School of Medicine Division of Hepatobiliary and Pancreatic Oncology National Cancer Center Hospital Center for Gastroenterology Teine-Keijinkai Hospital Department of Surgery Tohoku University Graduate School of Medicine Department of Hepatobiliary and Pancreatic Oncology National Cancer Center Hospital East Department of Surgery Teikyo University School of Medicine Division of Cancer Genomics National Cancer Center Research Institute Institute for Integrated Medical Sciences Tokyo Women’s Medical University Department of Internal Medicine Kyorin University School of Medicine Division of Gastroenterology Yokohama City University Graduate School of Medicine Division of Hepatobiliary and Pancreatic Medical Oncology Kanagawa Cancer Center Department of Gastroenterology Aichi Cancer Center Hospital Department of Gastroenterology Kanazawa University Graduate School of Medicine Department of Surgery Japan Bapist Hospital Department of Gastroenterology and Hepatology Kyoto University Graduate School of Medicine Clinical Genetics Unit Kyoto University Graduate School of Medicine Center for Genomic Medicine Kyoto University Graduate School of Medicine Osaka Medical Center for Cancer and Cardiovascular Diseases Second Department of Internal Medicine Wakayama Medical University Department of Gastroenterology Onomichi General Hospital Department of Gastroenterology NationalKyushu Cancer Center Department of Medicine and Bioregulatory Sciences Kyushu University Graduate School of Medical Science Pancreatic Cancer Action Network Department of Gastroenterology Tohoku University Graduate School of Medicine

Familial pancreatic cancer (FPC) is broadly defined as two first-degree-relatives with pancreatic cancer (PC) and accounts for 4%-10% of PC. Several genetic syndromes, including Peutz-Jeghers syndrome, hereditary pancreatitis, hereditary breast-ovarian cancer syndrome(HBOC), Lynch syndrome, and familial adenomatous polyposis (FAP), also have increased risks of PC, but the narrowest definition of FPC excludes these known syndromes. When compared with other familial tumors, proven genetic alterations are limited to a small proportion (Caucasian) and a younger onset are common also in FPC. In European countries, "anticipation" is reported in FPC families, as with other hereditary syndromes; a trend toward younger age and worse prognosis is recognized in the late years. The resected pancreases of FPC kindred often show multiple pancreatic intraepithelial neoplasia (Pan IN) foci, with various K-ras mutations, similar to colorectal polyposis seen in the FAP patients. As with HBOC patients, a patient who is a BRCA mutation carrier with unresectable pancreatic cancer (accounting for 0%-19% of FPC patients) demonstrated better outcome following platinum and Poly (ADP-ribose) polymerase inhibitor treatment. Western countries have established FPC registries since the 1990 s and several surveillance projects for highrisk individuals are now ongoing to detect early PCs. Improvement in lifestyle habits, including non-smoking, is recommended for individuals at risk. In Japan, the FPC study group was initiated in 2013 and the Japanese FPC registry was established in 2014 by the Japan Pancreas Society.

关键词： familial pancreatic cancer registry high risk genetic surveillance

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Laser-assisted direct roller imprinting of large-area microstructured optical surfaces

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Microsystems & Nanoengineering 2024年第1期10卷 257-266页

作者： Keisuke Nagato Ken Takahashi Yuki Yajima masayuki Nakao Department of Mechanical Engineering Graduate School of EngineeringThe University of Tokyo7-3-1 HongoBunkyo-kuTokyo 113-8656Japan

In this study,a high-throughput fabrication method called laser-assisted direct roller imprinting(LADRI)was developed to lower the cost of nanoimprinting large-area polymer films and to address problems associated with nanoimprinting,namely,microstructural damage and precision in flatness of entire *** LADRI,the laser directly heats the microstructured surface of the roller mold,which heats and melts the surface of a polymethyl methacrylate(PMMA)film to replicate the microstructures on the mold *** this study,the effects of laser power density,scanning speed,size of the microstructures,and contact pressure on the replication speed were investigated *** replication speed increased as the power and scanning speed ***,because the film required heating until it filled the entire depth of the microstructure,an appropriate replication speed was *** result was supported by simulation of the temperature distribution inside the mold and the PMMA using transient heat conduction *** demonstrate the applications of LADRI,two different optical surfaces were replicated:an antireflection(AR)structure with conical structures sized several hundred nanometers and a lightextraction structure with a microlens array(MLA)comprising 10μm lenses,for display and illumination,*** replication degree of the MLA was governed by the contact *** flow simulation indicated that the heat conduction and flow speeds of the melted PMMA surface were comparable within several tens of *** addition,the reflectivity of the AR structure decreased from 4 to 0.5%,and the light intensity of the light-extraction structure increased by a factor of 1.47.

关键词： microstructure roller conduction

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