1.Efficacy of Hypertonic Saline-Epinephrine Local Injection Around the Anal Side before Endoscopic Papillectomy for Ampullary Tumors
Naoki OKANO ; Yoshinori IGARASHI ; Ken ITO ; Saori MIZUTANI ; Hiroki NAKAGAWA ; Kouji WATANABE ; Yuuto YAMADA ; Kensuke YOSHIMOTO ; Yuusuke KIMURA ; Susumu IWASAKI ; Kensuke TAKUMA ; Seiichi HARA ; Yuui KISHIMOTO
Clinical Endoscopy 2021;54(5):706-712
Background/Aims:
Bleeding is a complication of endoscopic snare papillectomy for ampullary tumors. This study aimed to investigate the clinical efficacy of hypertonic saline-epinephrine (HSE) local injection before endoscopic papillectomy for prevention of bleeding.
Methods:
We retrospectively reviewed the data of 107 consecutive patients with ampullary tumors who underwent endoscopic papillectomy. The rates of en bloc resection, pathological resection margins, and prevention of immediate or delayed bleeding in the simple snaring resection group (Group A) and the HSE injection group (Group B) were compared.
Results:
A total of 44 and 63 patients were enrolled in Groups A and B, respectively. The total complete resection rate was 89.7% (96/107); the clinical complete resection rates in Group A and Group B were 86.3% (38/44) and 92.1% (58/63), respectively (p=0.354). Post-papillectomy bleeding occurred in 22 patients. In Groups A and B, the immediate bleeding rates were 20.5% (9/44) and 4.8% (3/63), respectively (p=0.0255), while the delayed bleeding rates were 7% (3/44) and 11% (7/63), respectively (p=0.52). The rates of positive horizontal and vertical pathological margin in both groups were 27% and 16%, respectively.
Conclusions
HSE local injection was effective in preventing immediate bleeding and was useful for safely performing endoscopic papillectomy for ampullary tumors.
2.Efficacy of Hypertonic Saline-Epinephrine Local Injection Around the Anal Side before Endoscopic Papillectomy for Ampullary Tumors
Naoki OKANO ; Yoshinori IGARASHI ; Ken ITO ; Saori MIZUTANI ; Hiroki NAKAGAWA ; Kouji WATANABE ; Yuuto YAMADA ; Kensuke YOSHIMOTO ; Yuusuke KIMURA ; Susumu IWASAKI ; Kensuke TAKUMA ; Seiichi HARA ; Yuui KISHIMOTO
Clinical Endoscopy 2021;54(5):706-712
Background/Aims:
Bleeding is a complication of endoscopic snare papillectomy for ampullary tumors. This study aimed to investigate the clinical efficacy of hypertonic saline-epinephrine (HSE) local injection before endoscopic papillectomy for prevention of bleeding.
Methods:
We retrospectively reviewed the data of 107 consecutive patients with ampullary tumors who underwent endoscopic papillectomy. The rates of en bloc resection, pathological resection margins, and prevention of immediate or delayed bleeding in the simple snaring resection group (Group A) and the HSE injection group (Group B) were compared.
Results:
A total of 44 and 63 patients were enrolled in Groups A and B, respectively. The total complete resection rate was 89.7% (96/107); the clinical complete resection rates in Group A and Group B were 86.3% (38/44) and 92.1% (58/63), respectively (p=0.354). Post-papillectomy bleeding occurred in 22 patients. In Groups A and B, the immediate bleeding rates were 20.5% (9/44) and 4.8% (3/63), respectively (p=0.0255), while the delayed bleeding rates were 7% (3/44) and 11% (7/63), respectively (p=0.52). The rates of positive horizontal and vertical pathological margin in both groups were 27% and 16%, respectively.
Conclusions
HSE local injection was effective in preventing immediate bleeding and was useful for safely performing endoscopic papillectomy for ampullary tumors.
3.Peroral pancreatoscopy with videoscopy and narrow-band imaging in intraductal papillary mucinous neoplasms with dilatation of the main pancreatic duct
Yui KISHIMOTO ; Naoki OKANO ; Ken ITO ; Kensuke TAKUMA ; Seiichi HARA ; Susumu IWASAKI ; Kensuke YOSHIMOTO ; Yuto YAMADA ; Koji WATANABE ; Yusuke KIMURA ; Hiroki NAKAGAWA ; Yoshinori IGARASHI
Clinical Endoscopy 2023;56(2):261-261
4.Are Newer Extracorporeal Shock Wave Lithotripsy Models Truly Improving Pancreatolithiasis Lithotripsy Performance? A Japanese Single-Center Study Using Endoscopic Adjunctive Treatment
Ken ITO ; Naoki OKANO ; Kensuke TAKUMA ; Susumu IWASAKI ; Koji WATANABE ; Yusuke KIMURA ; Yuto YAMADA ; Kensuke YOSHIMOTO ; Seiichi HARA ; Yui KISHIMOTO ; Takahisa MATSUDA ; Yoshinori IGARASHI
Gut and Liver 2023;17(4):647-658
Background/Aims:
Many Japanese institutions use electromagnetic extracorporeal shock wave lithotripsy (ESWL) systems for treating pancreatic duct stones. However, there are no reports on direct comparisons between recent electromagnetic lithotripters. This study aimed to verify whether the new electromagnetic lithotripter can improve the efficiency of pancreatic stone fragmentation, and to clarify the role of combined endoscopic treatment on the clearance of pancreatic duct stones.
Methods:
We retrospectively identified 208 patients with pancreatolithiasis who underwent endoscopic adjunctive treatment after pancreatic ESWL at a single Japanese center over a 17-year period. We evaluated the outcome data of this procedure performed with SLX-F2 (last 2 years; group A) and Lithostar/Lithoskop (first 15 years; group B), as well as additional endoscopic treatments for pancreatolithiasis. We also performed logistic regression analysis to detect various factors associated with the procedure.
Results:
For pancreatic head stones, ESWL disintegration was achieved in 93.7% of group A patients and 69.0% of group B patients (p=0.004), and adjunctive endoscopic treatment removed stones in 96.8% of group A patients and 73.0% of group B patients (p=0.003). Multivariate analysis revealed that lithotripter type (odds ratio, 6.99; 95% confidence interval, 1.56 to 31.33; p<0.01) and main pancreatic duct stricture (odds ratio, 2.87; 95% confidence interval, 1.27 to 6.45; p<0.01) were significant factors for ESWL fragmentation.
Conclusions
The SLX F2 showed high performance in fragmenting the pancreatic duct stones.In addition, endoscopic adjunctive treatment improved the overall success rate of the procedure. The improved ESWL lithotripter has many advantages for patients undergoing pancreatic lithotripsy treatment.
5.A Case of Palliative Radiotherapy for Headache Due to Postoperative Skull Metastasis of Pancreatic Cancer
Kensuke YAMADA ; Mitsuhiro NAKAO ; Koichi YOSHIKAWA ; Hirokazu SADAHIRO ; Masako KARITA ; Yuki MANABE ; Hidekazu TANAKA ; Tomomitsu SATO ; Eishi MIZUTA
Palliative Care Research 2024;19(1):41-46
Introduction: Pancreatic cancer often recurs as local recurrence or peritoneal dissemination, causing severe abdominal and back pain. We report a case of postoperative skull metastasis of pancreatic cancer that caused headache and was treated effectively with radiotherapy. Case: A 67-year-old woman underwent surgery for pancreatic cancer. She had epigastric pain due to local recurrence and peritoneal dissemination, which was controlled with loxoprofen and fentanyl transdermal patch. She had right-sided headache, which gradually increased in intensity, but lacked intracranial hypertension and focal neurological symptoms. Acetaminophen and Goreisan did not provide adequate pain relief. Although CT showed no brain or bone metastasis, MRI showed metastasis in the right frontal bone. Palliative radiotherapy was administered. Subsequently, headache decreased from 7–8/10 to 2–3/10 on the Numerical Rating Scale. Conclusion: Skull metastases in cancer patients may be diagnosed using MRI, even when they remain undetectable by CT.
6.Virtual Hospital Tour and Observership for First and Second-year Medical Students
Keiichiro ISHIBASHI ; Satomi SHIBAZAKI ; Tomoe SUGIYAMA ; Yumi YONEOKA ; Ryuichiro ARAKI ; Makiko UEMURA ; Kyoko ONISHI ; Yasuko YAMADA ; Yuuki KAWAMURA ; Kensuke NAKAHIRA ; Kohei KANEDA ; Yuka SHIBAZAKI ; Masafumi OYAMA ; Takeo TAKAHASHI ; Koji TOMORI ; Morihiro HIGASHI ; Michio SHIIBASHI ; Shigehisa MORI
Medical Education 2021;52(3):221-226
Students in all years, including those in lower years, were prohibited from coming to campus because of COVID-19, which began to spread in January 2020. However, we believed that a hospital tour and observership would be important practical training for first and second year medical students as part of the early exposure program, which aims to increase student motivation. Thus, we decided to conduct a virtual hospital tour and a virtual observation of medical doctors’ work. We used Zoom to conduct a virtual hospital tour for first-year students in June, and a virtual observation of physicians’ work for second-year students in December. Although this offered less of an opportunity to experience the reality of the clinic, there have been benefits in terms of increased learning content, fairness of learning opportunities delivered, and the promotion of independent learning. With regard to a “Hospital Tour” and the “Observation of Medical Doctors’ Work” , we believe that hybrid forms, which are able to skillfully combine the strengths of the two methods, would be effective.