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Endoscopic approach to the diagnosis of pancreatic cystic tumor

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World Journal of Gastrointestinal Oncology 2016年第2期8卷 159-164页

作者： Yoshiaki Kawaguchi Tetsuya Mine department of gastroen-terology tokai university school of medicineIsehara 259-1193Japan

Because of the aging of the population,prevalence of medical checkups,and advances in imaging studies,the number of pancreatic cystic lesions detected has increased. Once these lesions are detected,neoplastic cysts should be differentiated from non-neoplastic cysts. Furthermore,because of the malignant potential of some neoplastic pancreatic cysts,further differentiation between benign and malignant cysts should be made regardless of their size. Although endoscopic ultrasound(EUS) has a very high diagnostic performance for pancreatic cystic lesions among the various imaging modalities,EUS findings alone are insufficient for the differentiation of pancreatic cysts and diagnosis of malignancy. In addition,cytology by EUS-guided fine-needle aspiration(FNA) has a high specificity but a low sensitivity for diagnosing malignancy in pancreatic cystic tumors. The levels of amylase,lipase,and tumor markers in pancreatic cystic fluid are considered auxiliary parameters for diagnosis of benign and malignant cysts,and a definitive diagnosis of malignancy using these parameters is difficult. Thus,in addition to EUS,cytology by EUS-FNA,and cystic fluid analysis,new techniques based on EUS-guided through-the-needle imaging,such as confocal laser endomicroscopy and cystoscopy,have been explored in recent years.

关键词： Endoscopic ultrasound Endoscopic retrogradecholangiopancreatography Endoscopic ultrasound-needleaspiration Pancreatic cystic tumor Cytology

Innovations and techniques for balloon-enteroscopeassisted endoscopic retrograde cholangiopancreatography in patients with altered gastrointestinal anatomy

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World Journal of Gastroenterology 2015年第21期21卷 6460-6469页

作者： Hiroshi Yamauchi Mitsuhiro Kida Hiroshi Imaizumi Kosuke Okuwaki Shiro Miyazawa Tomohisa Iwai Wasaburo Koizumi Department of Gastroenterology Kitasato University Hospital

Endoscopic retrograde cholangiopancreatography(ERCP) remains challenging in patients who have undergone surgical reconstruction of the ***,many studies have reported that balloonenteroscope-assisted ERCP(BEA-ERCP) is a safe and effective ***,further improvements in outcomes and the development of simplified procedures are *** treatment,Laparoscopy-assisted ERCP,endoscopic ultrasoundguided anterograde intervention,and open surgery are effective ***,treatment should be noninvasive,effective,and *** believe that these procedures should be performed only in difficult-to-treat patients because of many potential ***-ERCP still requires high expertiselevel techniques and is far from a routinely performed *** techniques have been proposed to facilitate scope insertion(insertion with percutaneous transhepatic biliary drainage(PTBD) rendezvous technique,Short type single-balloon enteroscopes with passive bending section,Intraluminal injection of indigo carmine,CO2 inflation guidance),cannulation(PTBD or percutaneous transgallbladder drainage rendezvous technique,Dilation using screw drill,Rendezvous technique combining DBE with a cholangioscope,endoscopic ultrasound-guided rendezvous technique),and treatment(overtube-assisted technique,Short type balloon enteroscopes) during *** use of these techniques may allow treatment to be performed by BEA-ERCP in many patients.A standard procedure for ERCP yet to be established for patients with a reconstructed *** present,BEA-ERCP is considered the safest and most effective procedure and is therefore likely to be recommended as firstline *** this article,we discuss the current status of BEA-ERCP in patients with surgically altered gastrointestinal anatomy.

关键词： Balloon enteroscopy Endoscopic retrogradecholangiopancreatography Altered gastrointestinal anatomy Balloon-enteroscope-assisted endoscopicretrograde cholangiopancreatography

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 ***: 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

关键词： Cholangioscopy Endoscopic retrogradecholangiopancreatography Pancreatoscopy Singleoperator SpyGlass

0.025-inch vs 0.035-inch guide wires for wire-guided cannulation during endoscopic retrograde cholangio pancreatography:A randomized study

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World Journal of Gastroenterology 2015年第30期21卷 9182-9188页

作者： Katsuya Kitamura Akira Yamamiya Yu Ishii Yoshiki Sato Tomoyuki Iwata Tomohiro Nomoto Akitoshi Ikegami Hitoshi Yoshida Division of Gastroenterology Department of MedicineShowa University School of Medicine

AIM:To compare the clinical outcomes between 0.025-inch and 0.035-inch guide wires(GWs) when used in wire-guided cannulation(WGC).METHODS:A single center,randomized study was conducted between April 2011 and March 2013. This study was approved by the Medical Ethics Committee at our hospital. Informed,written consent was obtained from each patient prior to study enrollment. Three hundred and twenty-two patients with a na?ve papilla of Vater who underwent endoscopic retrograde cholangiopancreatography(ERCP) for the purpose of selective bile duct cannulation with WGC were enrolled in this study. Fifty-three patients were excluded based on the exclusion criteria,and 269 patients were randomly allocated to two groups by a computer and analyzed:the 0.025-inch GW group(n = 109) and the 0.035-inch GW group(n = 160). The primary endpoint was the success rate of selective bile duct cannulation with WGC. Secondary endpoints were the success rates of the pancreatic GW technique and precutting,selective bile duct cannulation time,ERCP procedure time,the rate of pancreatic duct stent placement,the final success rate of selective bile duct cannulation,andthe incidence of post-ERCP pancreatitis(PEP).RESULTS:The primary success rates of selective bile duct cannulation with WGC were 80.7%(88/109) and 86.3%(138/160) for the 0.025-inch and the 0.035-inch groups,respectively(P = 0.226). There were no statistically significant differences in the success rates of selective bile duct cannulation using the pancreatic duct GW technique(46.7% vs 52.4% for the 0.025-inch and 0.035-inch groups,respectively; P = 0.884) or in the success rates of selective bile duct cannulation using precutting(66.7% vs 63.6% for the 0.025-inch and 0.035-inch groups,respectively; P = 0.893). The final success rates for selective bile duct cannulation using these procedures were 92.7%(101/109) and 97.5%(156/160) for the 0.025-inch and 0.035-inch groups,respectively(P = 0.113). There were no significant differences

关键词： Endoscopic retrograde cholangiopancreatography Guide wire Post-endoscopic retrogradecholangiopancreatography pancreatitis Selective bileduct cannulation Wire-guided cannulation

Efficacy of SpyGlass^(TM)-directed biopsy compared to brush cytology in obtaining adequate tissue for diagnosis in patients with biliary strictures

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World Journal of Gastrointestinal Endoscopy 2014年第4期6卷 137-143页

作者： Johannes Wilhelm Rey Torsten Hansen Sebastian Dümcke Achim Tresch Katja Kramer Peter Robert Galle Martin Goetz Marcus Schuchmann Ralf Kiesslich Arthur Hoffman Department of Internal Medicine I University Medical Center Department of Internal Medicine St. Mary’s Hospital Institute of Pathology Klinikum Lippe GmbH Max Planck-Institute for Plant Breeding Research Institute for Genetics University of Cologne Department of Internal Medicine I University Hospital of Tuebingen

AIM: To evaluate the diagnostic yield(inflammatory activity) and efficiency(size of the biopsy specimen) of SpyGlassTM-guided biopsy vs standard brush cytology in patients with and without primary sclerosing cholangitis(PSC).METHODS: At the University Medical Center Mainz, Germany, 35 consecutive patients with unclear biliarylesions(16 patients) or long-standing PSC(19 patients) were screened for the study. All patients underwent a physical examination, lab analyses, and abdominal ultrasound. Thirty-one patients with non-PSC strictures or with PSC were scheduled to undergo endoscopic retrograde cholangiography(ERC) and subsequent per-oral cholangioscopy(POC). Standard ERC was initially performed, and any lesions or strictures were localized. POC was performed later during the same session. The Boston Scientific SpyGlass SystemTM(Natick, MA, United States) was used for choledochoscopy. The biliary tree was visualized, and suspected lesions or strictures were biopsied, followed by brush cytology of the same area. The study endpoints(for both techniques) were the degree of inflammation, tissue specimen size, and the patient populations(PSC vs non-PSC). Inflammatory changes were divided into three categories: none, low activity, and high activity. The specimen quantity was rated as low, moderate, or ***: SpyGlassTM imaging and brush cytology with material retrieval were performed in 29 of 31(93.5%) patients(23 of the 29 patients were male). The median patient age was 45 years(min, 20 years; max, 76 years). Nineteen patients had known PSC, and 10 showed non-PSC strictures. No procedure-related complications were encountered. However, for both methods, tissues could only be retrieved from 29 pa-tients. In cases of inflammation of the biliary tract, the diagnostic yield of the SpyGlassTM-directed biopsies was greater than that using brush cytology. More tissue material was obtained for the biopsy method than for the brush cytology method(P = 0.021). The biop

关键词： Cholangioscopy Endoscopic retrogradecholangiopancreatography Primary sclerosing cholangitis Brush cytology Biopsy

What is the current role of endoscopy in primary sclerosing cholangitis?

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World Journal of Gastrointestinal Endoscopy 2015年第10期7卷 920-927页

作者： Benjamin Tharian Nayana Elizabeth George Tony Chiew Keong Tham Center for Interventional Endoscopy Florida Hospital Orlando FL 32803 United States Western Hospital Melbourne Victoria 3011 Australia Division of Gastroenterology Ulster Hospital N Ireland BT16 1RH Belfast United Kingdom

Endoscopy has important roles in the management of primary sclerosing cholangitis(PSC),ranging fromnarrowing down the differential diagnoses,screening for complications,determining prognosis and *** the need for a diagnostic endoscopic retrograde cholangiopancreatography(ERCP)may be obviated by a positive magnetic resonance cholangiopancreatography(MRCP),a negative MRCP does not exclude PSC and may therefore necessitate an ERCP,which is traditionally regarded as the gold *** this editorial we have not covered the endoscopic management of inflammatory bowel disease in the context of PSC nor of endoscopic surveil ance and treatment of portal hypertension complicating PSC.

关键词： Sclerosing cholangitis Endoscopic retrogradecholangiopancreatography Endosonography Cholangiocarcinoma Stents Fluorescence in situ hybridizationtechnique Biochemical markers

Review of diagnostic and therapeutic endoscopic retrograde cholangiopancreatography using several endoscopic methods in patients with surgically altered gastrointestinal anatomy

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World Journal of Gastrointestinal Endoscopy 2015年第6期7卷 617-627页

作者： Masaaki Shimatani Makoto Takaoka Mitsuo Tokuhara Hideaki Miyoshi Tsukasa Ikeura Kazuichi Okazaki Third Department of Internal Medicine Kansai Medical University

The endoscopic approach for biliary diseases in patients with surgically altered gastrointestinal anatomy(SAGA) had been generally deemed impractical. However, it was radically made feasible by the introduction of double balloon endoscopy(DBE) that was originally developed for diagnosis and treatments for small-bowel diseases. Followed by the subsequent development of singleballoon endoscopy(SBE) and spiral endoscopy(SE), interventions using several endoscopes for biliary disease in patients with SAGA widely gained an acceptance as a new modality. Many studies have been made on this new technique. Yet, some problems are to be solved. For instance, the mutual unavailability among devices due to different working lengths and channels, and unestablished standardization of procedural techniques can be raised. Additionally, in an attempt to standardize endoscopic procedures, it is important to evaluate biliary cannulating methods by case with existence of papilla or not. A full comprehension of the features of respective scope types is also required. However there are not many papers written as a review. In our manuscript, we would like to evaluate and make a review of the present status of diagnostic and therapeutic endoscopic retrograde cholangiopancreatography applying DBE, SBE and SE for biliary diseases in patients with SAGA for establishment of these modalities as a new technology and further improvement of the scopes and devices.

关键词： Double balloon endoscopy Single balloonendoscopy Spiral endoscopy Endoscopic retrogradecholangiopancreatography Roux-en-Y reconstruction