The aim of this study was to further examine the utility of mucin (MUC) expression profiles as pr... more The aim of this study was to further examine the utility of mucin (MUC) expression profiles as prognostic factors in pancreatic ductal adenocarcinoma (PDAC). Mucin expression was examined by immunohistochemistry analysis in endoscopic ultrasound-guided fine-needle aspiration specimens obtained from 114 patients with PDAC. The rate of expression of each MUC was compared with clinicopathologic features. The expression rates of MUCs in cancer lesions were MUC1, 87.7%; MUC2, 0.8%; MUC4, 93.0%; MUC5AC, 78.9%; MUC6, 24.6%; and MUC16, 67.5%. MUC1 and MUC4 were positive, and MUC2 was negative in most PDACs. Patients with advanced stage of PDAC with MUC5AC expression had a significantly better outcome than those who were MUC5AC-negative (P = 0.002). With increasing clinical stage, total MUC6 expression decreased (P for trend = 0.001) and MUC16 cytoplasmic expression increased (P for trend = 0.02). The prognosis of patients with MUC16 cytoplasmic expression was significantly poorer than those...
Clinical cancer research : an official journal of the American Association for Cancer Research, Jan 28, 2017
Purpose: Patients with pancreatic neuroendocrine neoplasm grade-3 (PanNEN-G3) show variable respo... more Purpose: Patients with pancreatic neuroendocrine neoplasm grade-3 (PanNEN-G3) show variable responses to platinumbased chemotherapy. Recent studies indicated that PanNEN-G3 includes well-differentiated neuroendocrine tumor with G3 (NET-G3). Here, we examined the clinicopathologic and molecular features of PanNEN-G3 and assessed the responsiveness to chemotherapy and survival. Experimental Design: A total of 100 patients with PanNEN-G3 were collected from 31 institutions, and after central review characteristics of each histologic subtype [NET-G3 vs. pancreatic neuroendocrine carcinoma (NEC-G3)] were analyzed, including clinical, radiological, and molecular features. Factors that correlate with response to chemotherapy and survival were assessed. Results: Seventy patients analyzed included 21 NETs-G3 (30%) and 49 NECs-G3 (70%). NET-G3 showed lower Ki67labeling index (LI; median 28.5%), no abnormal Rb expression (0%), and no mutated KRAS (0%), whereas NEC-G3 showed higher Ki67-LI (median 80.0%), Rb loss (54.5%), and KRAS mutations (48.7%). Chemotherapy response rate (RR), platinum-based chemotherapy RR, and prognosis differed significantly between NET-G3 and NEC-G3. Chemotherapeutic outcomes were worse in NET-G3 (P < 0.001). When we stratified PanNEN-G3 with Rb and KRAS, PanNENs-G3 with Rb loss and those with mutated KRAS showed significantly higher RRs to platinum-based chemotherapy than those without (Rb loss, 80% vs. normal Rb, 24%, P ¼ 0.006; mutated KRAS, 77% versus wild type, 23%, P ¼ 0.023). Rb was a predictive marker of response to platinum-based chemotherapy even in NEC-G3 (P ¼ 0.035). Conclusions: NET-G3 and NEC-G3 showed distinct clinicopathologic characteristics. Notably, NET-G3 does not respond to platinum-based chemotherapy. Rb and KRAS are promising predictors of response to platinum-based chemotherapy for PanNEN-G3, and Rb for NEC-G3. Clin Cancer Res; 23(16); 4625-32. Ó2017 AACR.
661 Background: Gemcitabine plus nab-paclitaxel (GnP) and FOLFIRINOX (FFX) have been established ... more 661 Background: Gemcitabine plus nab-paclitaxel (GnP) and FOLFIRINOX (FFX) have been established as standard first-line combination chemotherapy (CTx) for patients with metastatic pancreatic cancer (MPC). However, the efficacy of second-line CTx and the significance of combination CTx in clinical practice are unclear. We therefore investigated the efficacy of second-line CTx in patients with MPC. Methods: Data were collected from CTx-naive MPC patients treated with first-line combination CTx at 14 hospitals in the Kyushu area of Japan from December 2013 to June 2018. The median overall survival (mOS) from second-line treatment was compared between patients who received second-line CTx (CT group) and those who received best supportive care (BSC group). Furthermore, in the CT group, the mOS was compared between the patients who received combination CTx and those who received mono-CTx. To control potential bias in the selection of second-line treatment, we also conducted a propensity s...
Background. The role of surgery in pancreatic neuroendocrine neoplasm grade 3 (pNEN-G3) treatment... more Background. The role of surgery in pancreatic neuroendocrine neoplasm grade 3 (pNEN-G3) treatment remains unclear. We aimed to clarify the role of surgery for pNEN-G3, which has recently been reclassified as pancreatic
A 63-year-old woman was admitted with epigastric pain, eosinophilia, and elevated hepatobiliary e... more A 63-year-old woman was admitted with epigastric pain, eosinophilia, and elevated hepatobiliary enzyme levels. An upper gastrointestinal endoscopic examination showed that the mucosa of the gastroduodenal wall was edematous. Eosinophilic gastroenteritis (EGE) was diagnosed based on eosinophilic infiltration of the gastroduodenal mucosa. Computed tomography showed invagination of the duodenal wall into the common bile duct. The invagination of the duodenal wall improved after conservative therapy, while bile duct drainage was impossible due to the narrowing of the duodenal lumen. EGE was successfully treated without recurrence with steroids and antiallergic therapy. We herein report a rare case of EGE with obstructive jaundice.
Objectives: There is a paucity of data on the diagnostic efficacy of liquid-based cytology (LBC) ... more Objectives: There is a paucity of data on the diagnostic efficacy of liquid-based cytology (LBC) for pancreatic samples obtained by endoscopic ultrasound-guided fine needle aspiration (EUS-FNA). Using propensity score matching, we retrospectively analyzed the additional diagnostic value of LBC compared to a conventional Papanicolaou smear (CPS) for samples of solid pancreatic lesions obtained via EUS-FNA. Methods: This cohort study included 126 matched patients who underwent initial EUS-FNA for solid pancreatic lesions between January 2009 and August 2014. CPS was used for cytology of EUS-FNA samples obtained until May 2012 (63 patients). Subsequently, LBC was used for cytological analysis (63 patients). The diagnostic yields of CPS and LBC for malignancy were compared. Risk factors for cytological misdiagnosis with LBC were investigated. Results: The overall rate of malignancy was 86% after matching. LBC had higher diagnostic sensitivity and accuracy than CPS (96.6% vs. 84.0%, P = 0.03; and 96.8% vs. 87.3%, P = 0.05). LBC was significantly more sensitive for diagnosing pancreatic head lesions (96.4% vs. 78.1%, P = 0.04). The sensitivity for pancreatic ductal adenocarcinoma (PDAC) with LBC was higher (98.1% vs. 83.0%, P = 0.009). Multivariate analysis revealed that malignant tumors other than PDAC (P = 0.004) and lesion size ≤20 mm (P = 0.046) were risk factors for LBC misdiagnosis in all participants. Conclusions: For solid pancreatic lesions, LBC of EUS-FNA samples contributes to the diagnosis of malignancy. Malignant tumors other than PDAC and small tumors are difficult to diagnose using EUS-FNA and LBC.
Metabolic syndrome based on insulin resistance (IR) and hypertension is a risk factor for advance... more Metabolic syndrome based on insulin resistance (IR) and hypertension is a risk factor for advanced liver disease and cardiovascular disease in patients with nonalcoholic steatohepatitis (NASH). The present study investigated the effects of severe hypertension induced by a high‑salt (HS) diet and antihypertensive therapy on the pathophysiological condition of spontaneously hypertensive rats (SHRs) with steatohepatitis. Steatohepatitis was induced using a choline-deficient, L-amino acid-defined diet (CDAA). Male SHRs (7‑week‑old) were randomly divided into five groups: Those receiving 6 weeks of standard chow with a normal salt concentration, followed by an additional 8 weeks of standard chow or CDAA with a normal salt concentration (control and CDAA groups, respectively); and those receiving 6 weeks of standard chow with HS, followed by CDAA with HS for an additional 8 weeks, with or without the antihypertensive agents, amlodipine (Aml) or hydralazine. In the CDAA and CDAA+HS groups,...
Metabolic syndrome has been more widespread due to a rise in obesity rates among adults. We have ... more Metabolic syndrome has been more widespread due to a rise in obesity rates among adults. We have thus increased opportunities to perform endoscopic submucosal dissection (ESD) for patients with esophago-gastric tumors complicated with type 2 diabetes (DM), hypertension (HT) and hyperlipidemia (HL). These patients are at risk for atherosclerosis and often taking antithrombotic agents, which are likely to be risk for bleeding in ESD. However, the potential risk of post-ESD bleeding in these patients was still unclear. Therefore, we investigated whether DM, HT and HL were associated with increased risk of bleeding post-ESD. Methods: 185 consecutive patients, who underwent ESD for 28 esophageal tumors and
Endoscopic submucosal dissection (ESD) enables wider tumor resection compared with endoscopic muc... more Endoscopic submucosal dissection (ESD) enables wider tumor resection compared with endoscopic mucosal resection and en bloc resection of superficial esophageal neoplasms. However, ESD may cause difficult-to-treat stricture of the esophagus, and therefore, prediction of and measures against postoperative esophageal stricture are critical. The aim of this study was to evaluate the effect of ESD on superficial esophageal neoplasms and identify risk factors associated with esophageal stricture after ESD.This study included 165 lesions in 120 patients with superficial esophageal neoplasms, including cancer and neoplasia, who underwent ESD from 2009 to 2013.The complete resection rate of superficial esophageal neoplasms by ESD was 90.9%. After ESD, 22 subjects (18.3%) had symptomatic esophageal stricture, 12 (10.0%) had aspiration pneumonia of grade 2, and 7 (5.8%) had mediastinal emphysema of grade 2. Comparison of the 22 subjects with stricture with the 98 subjects without stricture sho...
Direct percutaneous endoscopic jejunostomy (D-PEJ) 1 is not yet globally carried out because of t... more Direct percutaneous endoscopic jejunostomy (D-PEJ) 1 is not yet globally carried out because of two technical difficulties in the procedure. The first is difficulty in reaching the jejunum with good maneuverability by conventional endoscopy. The second involves the anatomical features of the jejunum. The jejunal lumen is much smaller than that of the stomach. In addition, the location of the jejunal loop is not stable in relation to the abdominal wall. To solve these problems, we developed a new technique for D-PEJ using double-balloon endoscopy (DBE) and magnetic anchors. DBE was used for the access to the jejunum. Two magnetic anchors were prepared for the inside and outside anchors. The inside anchor was tied to the tip of the endoscope. Two anchors were used to fix the jejunal wall to the abdominal wall. Puncture was carried out from the abdominal wall beside the outside anchor without fluoroscopy. The jejunal wall was fixed to the abdominal wall by suturing the fixing thread. 2 Percutaneous endoscopic gastrostomy (PEG) tube was placed through the overtube of DBE (Fig. 1). To evaluate the feasibility and safety, placement of D-PEJ using DBE and magnetic anchors was carried out on eight pigs with survival. Procedure of the animal experiments was investigated and permitted by The Judging Committee of Experimental Animal Ethics of Jichi Medical University. D-PEJ was successfully placed in all eight pigs. DBE and magnetic anchors were useful for stabilization of the maneuvers. PEG tube placement through the overtube was useful for preventing contamination of the tube and trauma of the intestinal wall. The mean procedure time was 89 min. There were no complications. D-PEJ using DBE and magnetic anchors was feasible and safe in the porcine model.
Nihon rinsho. Japanese journal of clinical medicine, 2007
Double balloon endoscopy (DBE) and video capsule endoscopy (VCE) are breakthrough methods for end... more Double balloon endoscopy (DBE) and video capsule endoscopy (VCE) are breakthrough methods for endoscopic examination of the small intestine. Using these modalities, it has been clarified that use of nonsteroidal anti-inflammatory drugs (NSAIDs) induces ulcers not only in upper gastrointestinal tract but also in the small intestine. Furthermore, concentric membranous strictures, so called "diaphragm disease" can be induced with long-term NSAID use in some cases. The best therapy for ulcers induced by NSAIDs in small intestine is cessation of NSAIDs use so far. For these diaphragm-like small intestinal strictures, a balloon dilation therapy using DBE can be performed safety and effectively.
Infected hepatic cysts are very rare compared to simple liver cysts and abscesses. We treated a 7... more Infected hepatic cysts are very rare compared to simple liver cysts and abscesses. We treated a 77-year-old man with an infected hepatic cyst in the lateral segment caused by Edwardsiella tarda, which has not been previously reported as a pathogenic organism associated with infected hepatic cysts. Percutaneous drainage was temporarily effective, but infection recurred after the drainage tube was removed. We then inserted two drainage tubes into the cyst using an endoscopic ultrasonography (EUS)-guided technique, which was developed from EUS-guided fine needle aspiration (EUS-FNA). The internal drainage tube was a 7 Fr double pigtail stent, and the external tube was a 6 Fr nasobiliary drainage tube. Lavage through the external drainage tube was carried out for one week. The external drainage tube was discontinued when the patient&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s condition improved significantly. Sixteen days after tube insertion, he was discharged with the internal tube draining the hepatic cyst into the stomach. Fifteen months after EUS-guided drainage, CT examination showed no recurrence of the hepatic cyst. EUS-guided drainage is an effective treatment for infected hepatic cysts.
The aim of this study was to further examine the utility of mucin (MUC) expression profiles as pr... more The aim of this study was to further examine the utility of mucin (MUC) expression profiles as prognostic factors in pancreatic ductal adenocarcinoma (PDAC). Mucin expression was examined by immunohistochemistry analysis in endoscopic ultrasound-guided fine-needle aspiration specimens obtained from 114 patients with PDAC. The rate of expression of each MUC was compared with clinicopathologic features. The expression rates of MUCs in cancer lesions were MUC1, 87.7%; MUC2, 0.8%; MUC4, 93.0%; MUC5AC, 78.9%; MUC6, 24.6%; and MUC16, 67.5%. MUC1 and MUC4 were positive, and MUC2 was negative in most PDACs. Patients with advanced stage of PDAC with MUC5AC expression had a significantly better outcome than those who were MUC5AC-negative (P = 0.002). With increasing clinical stage, total MUC6 expression decreased (P for trend = 0.001) and MUC16 cytoplasmic expression increased (P for trend = 0.02). The prognosis of patients with MUC16 cytoplasmic expression was significantly poorer than those...
Clinical cancer research : an official journal of the American Association for Cancer Research, Jan 28, 2017
Purpose: Patients with pancreatic neuroendocrine neoplasm grade-3 (PanNEN-G3) show variable respo... more Purpose: Patients with pancreatic neuroendocrine neoplasm grade-3 (PanNEN-G3) show variable responses to platinumbased chemotherapy. Recent studies indicated that PanNEN-G3 includes well-differentiated neuroendocrine tumor with G3 (NET-G3). Here, we examined the clinicopathologic and molecular features of PanNEN-G3 and assessed the responsiveness to chemotherapy and survival. Experimental Design: A total of 100 patients with PanNEN-G3 were collected from 31 institutions, and after central review characteristics of each histologic subtype [NET-G3 vs. pancreatic neuroendocrine carcinoma (NEC-G3)] were analyzed, including clinical, radiological, and molecular features. Factors that correlate with response to chemotherapy and survival were assessed. Results: Seventy patients analyzed included 21 NETs-G3 (30%) and 49 NECs-G3 (70%). NET-G3 showed lower Ki67labeling index (LI; median 28.5%), no abnormal Rb expression (0%), and no mutated KRAS (0%), whereas NEC-G3 showed higher Ki67-LI (median 80.0%), Rb loss (54.5%), and KRAS mutations (48.7%). Chemotherapy response rate (RR), platinum-based chemotherapy RR, and prognosis differed significantly between NET-G3 and NEC-G3. Chemotherapeutic outcomes were worse in NET-G3 (P < 0.001). When we stratified PanNEN-G3 with Rb and KRAS, PanNENs-G3 with Rb loss and those with mutated KRAS showed significantly higher RRs to platinum-based chemotherapy than those without (Rb loss, 80% vs. normal Rb, 24%, P ¼ 0.006; mutated KRAS, 77% versus wild type, 23%, P ¼ 0.023). Rb was a predictive marker of response to platinum-based chemotherapy even in NEC-G3 (P ¼ 0.035). Conclusions: NET-G3 and NEC-G3 showed distinct clinicopathologic characteristics. Notably, NET-G3 does not respond to platinum-based chemotherapy. Rb and KRAS are promising predictors of response to platinum-based chemotherapy for PanNEN-G3, and Rb for NEC-G3. Clin Cancer Res; 23(16); 4625-32. Ó2017 AACR.
661 Background: Gemcitabine plus nab-paclitaxel (GnP) and FOLFIRINOX (FFX) have been established ... more 661 Background: Gemcitabine plus nab-paclitaxel (GnP) and FOLFIRINOX (FFX) have been established as standard first-line combination chemotherapy (CTx) for patients with metastatic pancreatic cancer (MPC). However, the efficacy of second-line CTx and the significance of combination CTx in clinical practice are unclear. We therefore investigated the efficacy of second-line CTx in patients with MPC. Methods: Data were collected from CTx-naive MPC patients treated with first-line combination CTx at 14 hospitals in the Kyushu area of Japan from December 2013 to June 2018. The median overall survival (mOS) from second-line treatment was compared between patients who received second-line CTx (CT group) and those who received best supportive care (BSC group). Furthermore, in the CT group, the mOS was compared between the patients who received combination CTx and those who received mono-CTx. To control potential bias in the selection of second-line treatment, we also conducted a propensity s...
Background. The role of surgery in pancreatic neuroendocrine neoplasm grade 3 (pNEN-G3) treatment... more Background. The role of surgery in pancreatic neuroendocrine neoplasm grade 3 (pNEN-G3) treatment remains unclear. We aimed to clarify the role of surgery for pNEN-G3, which has recently been reclassified as pancreatic
A 63-year-old woman was admitted with epigastric pain, eosinophilia, and elevated hepatobiliary e... more A 63-year-old woman was admitted with epigastric pain, eosinophilia, and elevated hepatobiliary enzyme levels. An upper gastrointestinal endoscopic examination showed that the mucosa of the gastroduodenal wall was edematous. Eosinophilic gastroenteritis (EGE) was diagnosed based on eosinophilic infiltration of the gastroduodenal mucosa. Computed tomography showed invagination of the duodenal wall into the common bile duct. The invagination of the duodenal wall improved after conservative therapy, while bile duct drainage was impossible due to the narrowing of the duodenal lumen. EGE was successfully treated without recurrence with steroids and antiallergic therapy. We herein report a rare case of EGE with obstructive jaundice.
Objectives: There is a paucity of data on the diagnostic efficacy of liquid-based cytology (LBC) ... more Objectives: There is a paucity of data on the diagnostic efficacy of liquid-based cytology (LBC) for pancreatic samples obtained by endoscopic ultrasound-guided fine needle aspiration (EUS-FNA). Using propensity score matching, we retrospectively analyzed the additional diagnostic value of LBC compared to a conventional Papanicolaou smear (CPS) for samples of solid pancreatic lesions obtained via EUS-FNA. Methods: This cohort study included 126 matched patients who underwent initial EUS-FNA for solid pancreatic lesions between January 2009 and August 2014. CPS was used for cytology of EUS-FNA samples obtained until May 2012 (63 patients). Subsequently, LBC was used for cytological analysis (63 patients). The diagnostic yields of CPS and LBC for malignancy were compared. Risk factors for cytological misdiagnosis with LBC were investigated. Results: The overall rate of malignancy was 86% after matching. LBC had higher diagnostic sensitivity and accuracy than CPS (96.6% vs. 84.0%, P = 0.03; and 96.8% vs. 87.3%, P = 0.05). LBC was significantly more sensitive for diagnosing pancreatic head lesions (96.4% vs. 78.1%, P = 0.04). The sensitivity for pancreatic ductal adenocarcinoma (PDAC) with LBC was higher (98.1% vs. 83.0%, P = 0.009). Multivariate analysis revealed that malignant tumors other than PDAC (P = 0.004) and lesion size ≤20 mm (P = 0.046) were risk factors for LBC misdiagnosis in all participants. Conclusions: For solid pancreatic lesions, LBC of EUS-FNA samples contributes to the diagnosis of malignancy. Malignant tumors other than PDAC and small tumors are difficult to diagnose using EUS-FNA and LBC.
Metabolic syndrome based on insulin resistance (IR) and hypertension is a risk factor for advance... more Metabolic syndrome based on insulin resistance (IR) and hypertension is a risk factor for advanced liver disease and cardiovascular disease in patients with nonalcoholic steatohepatitis (NASH). The present study investigated the effects of severe hypertension induced by a high‑salt (HS) diet and antihypertensive therapy on the pathophysiological condition of spontaneously hypertensive rats (SHRs) with steatohepatitis. Steatohepatitis was induced using a choline-deficient, L-amino acid-defined diet (CDAA). Male SHRs (7‑week‑old) were randomly divided into five groups: Those receiving 6 weeks of standard chow with a normal salt concentration, followed by an additional 8 weeks of standard chow or CDAA with a normal salt concentration (control and CDAA groups, respectively); and those receiving 6 weeks of standard chow with HS, followed by CDAA with HS for an additional 8 weeks, with or without the antihypertensive agents, amlodipine (Aml) or hydralazine. In the CDAA and CDAA+HS groups,...
Metabolic syndrome has been more widespread due to a rise in obesity rates among adults. We have ... more Metabolic syndrome has been more widespread due to a rise in obesity rates among adults. We have thus increased opportunities to perform endoscopic submucosal dissection (ESD) for patients with esophago-gastric tumors complicated with type 2 diabetes (DM), hypertension (HT) and hyperlipidemia (HL). These patients are at risk for atherosclerosis and often taking antithrombotic agents, which are likely to be risk for bleeding in ESD. However, the potential risk of post-ESD bleeding in these patients was still unclear. Therefore, we investigated whether DM, HT and HL were associated with increased risk of bleeding post-ESD. Methods: 185 consecutive patients, who underwent ESD for 28 esophageal tumors and
Endoscopic submucosal dissection (ESD) enables wider tumor resection compared with endoscopic muc... more Endoscopic submucosal dissection (ESD) enables wider tumor resection compared with endoscopic mucosal resection and en bloc resection of superficial esophageal neoplasms. However, ESD may cause difficult-to-treat stricture of the esophagus, and therefore, prediction of and measures against postoperative esophageal stricture are critical. The aim of this study was to evaluate the effect of ESD on superficial esophageal neoplasms and identify risk factors associated with esophageal stricture after ESD.This study included 165 lesions in 120 patients with superficial esophageal neoplasms, including cancer and neoplasia, who underwent ESD from 2009 to 2013.The complete resection rate of superficial esophageal neoplasms by ESD was 90.9%. After ESD, 22 subjects (18.3%) had symptomatic esophageal stricture, 12 (10.0%) had aspiration pneumonia of grade 2, and 7 (5.8%) had mediastinal emphysema of grade 2. Comparison of the 22 subjects with stricture with the 98 subjects without stricture sho...
Direct percutaneous endoscopic jejunostomy (D-PEJ) 1 is not yet globally carried out because of t... more Direct percutaneous endoscopic jejunostomy (D-PEJ) 1 is not yet globally carried out because of two technical difficulties in the procedure. The first is difficulty in reaching the jejunum with good maneuverability by conventional endoscopy. The second involves the anatomical features of the jejunum. The jejunal lumen is much smaller than that of the stomach. In addition, the location of the jejunal loop is not stable in relation to the abdominal wall. To solve these problems, we developed a new technique for D-PEJ using double-balloon endoscopy (DBE) and magnetic anchors. DBE was used for the access to the jejunum. Two magnetic anchors were prepared for the inside and outside anchors. The inside anchor was tied to the tip of the endoscope. Two anchors were used to fix the jejunal wall to the abdominal wall. Puncture was carried out from the abdominal wall beside the outside anchor without fluoroscopy. The jejunal wall was fixed to the abdominal wall by suturing the fixing thread. 2 Percutaneous endoscopic gastrostomy (PEG) tube was placed through the overtube of DBE (Fig. 1). To evaluate the feasibility and safety, placement of D-PEJ using DBE and magnetic anchors was carried out on eight pigs with survival. Procedure of the animal experiments was investigated and permitted by The Judging Committee of Experimental Animal Ethics of Jichi Medical University. D-PEJ was successfully placed in all eight pigs. DBE and magnetic anchors were useful for stabilization of the maneuvers. PEG tube placement through the overtube was useful for preventing contamination of the tube and trauma of the intestinal wall. The mean procedure time was 89 min. There were no complications. D-PEJ using DBE and magnetic anchors was feasible and safe in the porcine model.
Nihon rinsho. Japanese journal of clinical medicine, 2007
Double balloon endoscopy (DBE) and video capsule endoscopy (VCE) are breakthrough methods for end... more Double balloon endoscopy (DBE) and video capsule endoscopy (VCE) are breakthrough methods for endoscopic examination of the small intestine. Using these modalities, it has been clarified that use of nonsteroidal anti-inflammatory drugs (NSAIDs) induces ulcers not only in upper gastrointestinal tract but also in the small intestine. Furthermore, concentric membranous strictures, so called "diaphragm disease" can be induced with long-term NSAID use in some cases. The best therapy for ulcers induced by NSAIDs in small intestine is cessation of NSAIDs use so far. For these diaphragm-like small intestinal strictures, a balloon dilation therapy using DBE can be performed safety and effectively.
Infected hepatic cysts are very rare compared to simple liver cysts and abscesses. We treated a 7... more Infected hepatic cysts are very rare compared to simple liver cysts and abscesses. We treated a 77-year-old man with an infected hepatic cyst in the lateral segment caused by Edwardsiella tarda, which has not been previously reported as a pathogenic organism associated with infected hepatic cysts. Percutaneous drainage was temporarily effective, but infection recurred after the drainage tube was removed. We then inserted two drainage tubes into the cyst using an endoscopic ultrasonography (EUS)-guided technique, which was developed from EUS-guided fine needle aspiration (EUS-FNA). The internal drainage tube was a 7 Fr double pigtail stent, and the external tube was a 6 Fr nasobiliary drainage tube. Lavage through the external drainage tube was carried out for one week. The external drainage tube was discontinued when the patient&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s condition improved significantly. Sixteen days after tube insertion, he was discharged with the internal tube draining the hepatic cyst into the stomach. Fifteen months after EUS-guided drainage, CT examination showed no recurrence of the hepatic cyst. EUS-guided drainage is an effective treatment for infected hepatic cysts.
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Papers by Hiroki Taguchi