Background: Endoscopic ultrasound-guided drainage (EUSD) is an effective treatment for postoperative pancreatic fluid collections (POPFCs); however, standards regarding stents used for EUSD have not been established. This study analyzed the outcomes of EUSD of POPFCs at our hospital and examined the safety and effectiveness of plastic stents/tubes. Methods: This retrospective, single-center study focused on EUSD of POPFCs performed at our hospital. We examined the rates of technical success, clinical success, adverse events, and recurrence. Results: Twenty-seven patients were included in this study. The initial drainage methods comprised one nasocystic plastic tube (NPT) and one double-pigtail plastic stent (DPS) for 19 (70.4%) patients, two DPS for four (14.8%) patients, one NPT for three (11.1%) patients, and one lumen-apposing metal stent for one (3.7%) patient. The technical success and clinical success rates were both 100%. Fourteen of the 19 patients with one NPT and one DPS improved, but five patients required additional interventions and improved with fistula site dilation. Although recurrence occurred in one patient, improvement was achieved with second EUSD. Early adverse events comprised one case of bleeding for which hemostasis was achieved by performing coil embolization. Late adverse events comprised three cases of DPS migration; however, no additional intervention was required. Conclusion The use of plastic tubes/stents is safe and effective for EUSD of POPFCs.

Background: Endoscopic ultrasound-guided drainage (EUSD) is an effective treatment for postoperative pancreatic fluid collections (POPFCs); however, standards regarding stents used for EUSD have not been established. This study analyzed the outcomes of EUSD of POPFCs at our hospital and examined the safety and effectiveness of plastic stents/tubes. Methods: This retrospective, single-center study focused on EUSD of POPFCs performed at our hospital. We examined the rates of technical success, clinical success, adverse events, and recurrence. Results: Twenty-seven patients were included in this study. The initial drainage methods comprised one nasocystic plastic tube (NPT) and one double-pigtail plastic stent (DPS) for 19 (70.4%) patients, two DPS for four (14.8%) patients, one NPT for three (11.1%) patients, and one lumen-apposing metal stent for one (3.7%) patient. The technical success and clinical success rates were both 100%. Fourteen of the 19 patients with one NPT and one DPS improved, but five patients required additional interventions and improved with fistula site dilation. Although recurrence occurred in one patient, improvement was achieved with second EUSD. Early adverse events comprised one case of bleeding for which hemostasis was achieved by performing coil embolization. Late adverse events comprised three cases of DPS migration; however, no additional intervention was required. Conclusion The use of plastic tubes/stents is safe and effective for EUSD of POPFCs.

Background: Endoscopic ultrasound-guided drainage (EUSD) is an effective treatment for postoperative pancreatic fluid collections (POPFCs); however, standards regarding stents used for EUSD have not been established. This study analyzed the outcomes of EUSD of POPFCs at our hospital and examined the safety and effectiveness of plastic stents/tubes. Methods: This retrospective, single-center study focused on EUSD of POPFCs performed at our hospital. We examined the rates of technical success, clinical success, adverse events, and recurrence. Results: Twenty-seven patients were included in this study. The initial drainage methods comprised one nasocystic plastic tube (NPT) and one double-pigtail plastic stent (DPS) for 19 (70.4%) patients, two DPS for four (14.8%) patients, one NPT for three (11.1%) patients, and one lumen-apposing metal stent for one (3.7%) patient. The technical success and clinical success rates were both 100%. Fourteen of the 19 patients with one NPT and one DPS improved, but five patients required additional interventions and improved with fistula site dilation. Although recurrence occurred in one patient, improvement was achieved with second EUSD. Early adverse events comprised one case of bleeding for which hemostasis was achieved by performing coil embolization. Late adverse events comprised three cases of DPS migration; however, no additional intervention was required. Conclusion The use of plastic tubes/stents is safe and effective for EUSD of POPFCs.

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.

Background/Aims: Endoscopic evaluation of intraductal papillary mucinous neoplasms (IPMNs) is useful in determining whether the lesions are benign or malignant. This study aimed to examine the usefulness of peroral pancreatoscopy (POPS) in determining the prognosis of IPMNs. Methods: POPS with videoscopy was performed using the mother–baby scope technique. After surgery, computed tomography/magnetic resonance cholangiopancreatography or ultrasonography and blood tests were performed every 6 months during the follow-up. Results: A total of 39 patients with main pancreatic duct (MPD)–type IPMNs underwent POPS using a videoscope, and the protrusions in the MPD were observed in 36 patients. The sensitivity and specificity of cytology/biopsy performed at the time of POPS were 85% and 87.5%, respectively. Of 19 patients who underwent surgery, 18 (95%) patients had negative surgical margins and 1 (5%) patient had a positive margin. Conclusions In IPMNs with dilatation of the MPD, POPS is considered effective if the lesions can be directly observed. The diagnosis of benign and malignant lesions is possible depending on the degree of lesion elevation. However, in some cases, slightly elevated lesions may increase in size during the follow-up or multiple lesions may be simultaneously present; therefore, careful follow-up is necessary.

The patient was a 13-­year-­old male who had experienced periodic fever since he was in the 5th grade. After he moved into the 8th grade, he developed fever, abdominal pain, and vomiting continuously, which caused him to miss school or leave school early once every one to two weeks. Various Kampo extract preparations prescribed at a nearby clinic did not improve the symptoms, and the patient was referred to our hospital. Ad­ministration of bukuryoshigyakuto and shokenchuto reduced the fatigue, but the fever could not be controlled. Subsequently, a grasp of “the disease byakugobyo turned into fever” was made, and he was put on byaku­gokassekisanryo, which eliminated the fever. Therapeutic approaches for disease known as the disease ebyo that arises after treatment of cold damage diseases (shokan) are discussed in the On Pulse Syndrome Complex and Treatment of Bai He, Hu Huo, and Yin Yang Du Diseases section of the synopsis of prescriptions of the golden chamber “Kinkiyoryaku”. Children, especially adolescents, are prone to fall ill because of rapid changes of the body, including sexual maturation. Clinical manifestations of such illnesses further change with growth and maturation, and it can be difficult to find clues for treatment at first glance due to complicated states of yin­yang and deficiency-­excess. As seen in this case, illnesses of adolescence is likely to include un­diagnosed cases of byakugobyo that manifests clinical signs similar to those of ebyo.

We report two cases of chest and abdominal symptoms, the causes of which can not be established in a medical sense, successfully treated with daisaikoto. The first case was an 81-year-old male. He complained of tightness in his chest. Since the frequency of his symptom was increasing, he underwent further evaluation in hospital, but no abnormalities were found. We administered daisaikoto with reference to his constipation and kyo-kyo-kuman (subchondrial resistance and discomfort), the tightness in his chest disappeared and three months later his qi stagnation score and SDS score had improved.
The second case was an 83-year-old male. He had been suffering epigastric pain, tightness of chest and abdomen and a feeling of fullness in the abdomen since two years previously, when he suffered multiple traumatic injuries. We administered daisaikoto in light of his epigastric pain, constipation and kyo-kyo-kuman.The epigastric pain and tightness of the chest and abdomen gradually disappeared, and the number of his unscheduled visits to the clinic decreased.
Thus, daisaikoto may be used to treat patients with chest or abdominal symptoms and depression, the cause of which can not be established in any medical sense.

We report a case of systemic sclerosis complicated with primary biliary cirrhosis successfully treated with orengedokuto (wanbinghuichun) and sekiganryo. The patient was a 68-year-old female. She had been diagnosed with systemic sclerosis 20 years previously, and primary biliary cirrhosis 17 years previously. She received modern Western medical treatment for skin itching and scleroderma, but her symptoms showed little improvement. Therefore, she consulted our clinic in order to receive Kampo therapy. We prescribed orengedokuto (wanbinghuichun), and the skin itching improved in 5 days. As a result of administering sekiganryo in addition to orengedokuto (wanbinghuichun) for severe coldness, the scleroderma was also ameliorated. We consider this to be a case of diseases overlapping between yin and yang syndrome.

A 54-year-old female had left femoral incarcerated hernia. One month later, she received a radical operation for it, but was admitted to our hospital twice because of ileus. Various tests showed no mechanical intestinal obstruction, but small-intestinal edema. She was transferred to our department to receive Kampo medicine. She could not eat any food and her weight decreased from 47 to 37.5 kg. We therefore administered intravenous hyperalimentation. She had a cold sweat on her face and was prone to bed rest because of severe abdominal pain as if in labor, and general fatigue. Her skin was dry, her radial pulse was weak and her abdominal tonus was weak. In addition, lower abdominal tension was more intense than upper and we could observe bowel movements from her skin. At first, we administered bushikobeito, but it had no effect. Referring to her abdominal findings, we considered that daikenchuto and tokikenchuto were compatible in her case, and after changing to chukenchutokatoki her abdominal pain disappeared in 5 days. Thus, Kampo medicine was effective for post-operative pseudo-obstruction.