Publications by authors named "Tomoaki Tashima"

49 Publications

Current Status of Endoscopic Biliary Drainage in Patients with Distal Malignant Biliary Obstruction.

J Clin Med 2021 Oct 8;10(19). Epub 2021 Oct 8.

Department of Gastroenterology, Saitama Medical University International Medical Center, 1397-1, Yamane, Hidaka, Saitama 350-1298, Japan.

Distal malignant biliary obstruction is caused by various malignant diseases that require biliary drainage. In patients with operable situations, preoperative biliary drainage is required to control jaundice and cholangitis until surgery. In view of tract seeding, endoscopic biliary drainage is the first choice. Since neoadjuvant therapies are being developed, the time to surgery is increasing, especially in pancreatic cancer cases. Therefore, it requires long stent patency. Recently, preoperative biliary drainage using self-expandable metal stents has been reported as a useful modality to secure long stent patency. In patients with unresectable distal malignant biliary obstruction, self-expandable metal stent is the first choice for maintaining long stent patency. Although there are many comparison studies between a covered and an uncovered self-expandable metal stent, their use is still controversial. Recently, endoscopic ultrasound-guided biliary drainage has been performed as an alternative treatment. The clinical success and stent patency are favorable. We should take into consideration that both endoscopic retrograde cholangiopancreatography-guided biliary drainage and endoscopic ultrasound-guided biliary drainage have advantages and disadvantages and chose the drainage method depending on the patient's situation or the expertise of the endoscopist. Here, we discuss the current status of endoscopic biliary drainage in patients with distal malignant biliary obstruction.
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http://dx.doi.org/10.3390/jcm10194619DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8509542PMC
October 2021

Outcomes of endoscopic resection for superficial duodenal tumors: 10 years' experience in 18 Japanese high-volume centers.

Endoscopy 2021 Sep 8. Epub 2021 Sep 8.

Cancer Center, School of Medicine, Keio University, Tokyo, Japan.

Background And Study Aim: There is no enough data for endoscopic resection (ER) of superficial duodenal epithelial tumors (SDETs) due to its rarity. There are two main kinds of ER techniques for SDETs: EMR and ESD. In addition, modified EMR techniques, underwater EMR (UEMR) and cold polypectomy (CP), are getting popular. We conducted a large-scale retrospective multicenter study to clarify detailed outcomes of duodenal ER.

Patients And Methods: Patients with SDETs who underwent ER at 18 institutions from January 2008 to December 2018 were included. The rates of en bloc resection and delayed adverse events (AEs) (defined as delayed bleeding or perforation) were analyzed. Local recurrence was analyzed using Kaplan-Meier method.

Results: In total, 3107 patients (including 1017 receiving ESD) were included. En bloc resection rates were 79.1%, 78.6%, 86.8%, and 94.8%, and delayed AE rates were 0.5%, 2.2%, 2.8%, and 7.3% for CP, UEMR, EMR and ESD, respectively. The delayed AE rate was significantly higher for ESD group than non-ESD group among lesions less than 19 mm (7.4% vs 1.9%, p<0.0001), but not among lesions larger than 20 mm (6.1% vs 7.1%, p=0.6432). The local recurrence rate was significantly lower in ESD group than non-ESD group (p<0.001). Furthermore, for lesions larger than 30 mm, the cumulative local recurrence rate at 2 years was 22.6% in non-ESD group compared to only 1.6% in ESD group (p<0.0001).

Conclusions: ER outcomes for SDETs were generally acceptable. ESD by highly experienced endoscopists might be an option for very large SDETs.
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http://dx.doi.org/10.1055/a-1640-3236DOI Listing
September 2021

A retrospective cohort study of factors influencing long procedure times in colorectal endoscopic submucosal dissection.

Scand J Gastroenterol 2021 10 29;56(10):1255-1263. Epub 2021 Jul 29.

Department of Gastroenterology, Saitama Medical University International Medical Center, Saitama, Japan.

Objective: To evaluate the outcomes and factors influencing colorectal endoscopic submucosal dissection (ESD) with a long procedure time.

Materials And Methods: In this single-center, retrospective study, we included 1,100 patients with 1,199 lesions who underwent colorectal ESD between April 2016 and December 2020. ESD was performed using an advanced system knife for lesions >20 mm. An S-O clip was used as the traction device. The long-time group (LP; procedure time >120 min) and normal-time group (NP; procedure time <120 min) were compared.

Results: The procedure times were 166.86 and 44.72 min in the LP and NP groups, respectively. The completion rate was higher in the NP group (96.5% vs. 83.5%,  = .001); the completed lesions were resected en bloc. Multivariate analysis revealed 18.8% and 7.8% of submucosal fibrosis in the LP and NP groups, respectively (odds ratio [OR] = 2.410,  = .026). Compared to the NP group, the LP group presented larger maximum lesion sizes and higher rates of R1 resection, and traction device use. Time to introduction of traction device use was longer in the LP than in the NP group (126.05 vs. 21.72 min;  < .001). Fibrosis tends to occur cecal lesions (OR 2.436,  = .011) and laterally spreading tumor-non-granular-pseudo-depressed (LST-NG-PD) (OR 2.6181,  = .001).

Conclusions: Lesion size and fibrosis were factors associated with a long procedure time in colonic ESD. For fibrotic lesions (LST-NG-PD and cecal lesions), it is necessary to consider early use of traction devices and advisable to plan a strategy for the use of traction devices.
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http://dx.doi.org/10.1080/00365521.2021.1958000DOI Listing
October 2021

Gel immersion endoscopic submucosal dissection for an anorectal tumor with hemorrhoids close to the dentate line.

Endoscopy 2021 Jul 2. Epub 2021 Jul 2.

Department of Gastroenterology, Saitama Medical University International Medical Center, Saitama, Japan.

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http://dx.doi.org/10.1055/a-1519-6939DOI Listing
July 2021

Endoscopic resection using an over-the-scope clip for duodenal neuroendocrine tumors.

Endosc Int Open 2021 May 22;9(5):E659-E666. Epub 2021 Apr 22.

Department of Pathology, Saitama Medical University International Medical Center, Saitama, Japan.

Endoscopic resection of duodenal neuroendocrine tumors (DNETs) remains controversial, and its indications are still unclear. This study aimed to evaluate short-term outcomes of a newly developed endoscopic muscularis resection (EMR) method that utilizes an over-the-scope clip (OTSC), termed EMRO, for treating DNETs. In total, 13 consecutive patients with 14 small (≤ 10 mm) DNETs who underwent EMRO from September 2017 to March 2020 were retrospectively enrolled. EMRO was performed by a single experienced endoscopist. Patients' characteristics and treatment outcomes were assessed. The En bloc and R0 resection rates were 100 % (14/14) and 92.9 % (13/14), respectively. The median pathological resected specimen size was 10 mm, with a median pathological resected tumor size of 6 mm. During the EMRO procedure, there was no occurrence of misplacement of the OTSC to the target lesion. With respect to the pathological resection depth, nine cases (64.3 %) and five cases (35.7 %) were categorized as deep submucosal resection and muscularis resection, respectively, whereas no case was categorized as full-thickness resection. There were no intraoperative or delayed perforations. However, delayed bleeding occurred in two cases. At a median follow-up of 12 months (range 7-36) after EMRO, there was no incidence of local recurrence. At the first follow-up endoscopy performed at 6 months after EMRO, the OTSC was retained in place in two of 14 DNETs (14.3 %). EMRO can be performed safely, by an experienced endoscopist, for small (≤ 10 mm) DNETs.
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http://dx.doi.org/10.1055/a-1374-6141DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8062228PMC
May 2021

Comparison of Endoscopic Ultrasound-Guided Fine-Needle Aspiration and Biopsy Device for Lymphadenopathy.

Gastroenterol Res Pract 2021 15;2021:6640862. Epub 2021 Apr 15.

Department of Gastroenterology, Saitama Medical University International Medical Center, Japan.

Background: Accurate diagnosis of benign and malignant lymphadenopathy is important for determining the appropriate treatment and prognosis. This study evaluated the diagnostic accuracy and usefulness of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) with a conventional needle compared to endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) with a Franseen needle for diagnosing lymphadenopathy.

Methods: Patients who underwent EUS-FNA or EUS-FNB for mediastinal or abdominal lymphadenopathy between July 2013 and August 2020 were enrolled in the study. The outcomes between EUS-FNA patients (July 2013 to January 2017; 22-gauge conventional needle; Group A) and EUS-FNB patients (February 2017 to August 2020; 22-gauge Franseen needle; Group B) were compared.

Results: A total of 154 patients (Group A: 83; Group B: 71) were analyzed. The diagnostic accuracy (differentiating between malignant and benign lesions) was 88.0% (95% confidence interval [CI], 79.2-93.3%) in Group A and 95.8% (95% CI, 88.3-98.8%) in Group B. Group B had high diagnostic accuracy, but there was no difference between the groups ( = 0.14). Group B had significantly fewer passes (median 2, interquartile range (IQR): 2-4) than Group A (median 3, IQR: 3-4) ( < 0.001). No procedural adverse events occurred in either group.

Conclusions: Although the diagnostic accuracy between the groups was not statistically significant, EUS-FNB with a Franseen needle provided high diagnostic accuracy and required fewer passes to establish a diagnosis. Thus, EUS-FNB is useful for diagnosing lymphadenopathy.
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http://dx.doi.org/10.1155/2021/6640862DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8062193PMC
April 2021

Recent Advances of Interventional Endoscopic Retrograde Cholangiopancreatography and Endoscopic Ultrasound for Patients with Surgically Altered Anatomy.

J Clin Med 2021 Apr 12;10(8). Epub 2021 Apr 12.

Department of Gastroenterology, Saitama Medical University International Medical Center, 1397-1, Yamane, Hidaka, Saitama 350-1298, Japan.

Endoscopic retrograde cholangiopancreatography (ERCP) is considered to be the gold standard for diagnosis and interventions in biliopancreatic diseases. However, ERCP in patients with surgically altered anatomy (SAA) appears to be more difficult compared to cases with normal anatomy. Since the production of a balloon enteroscope (BE) for small intestine disorders, BE had also been used for biliopancreatic diseases in patients with SAA. Since the development of BE-assisted ERCP, the outcomes of procedures, such as stone extraction or drainage, have been reported as favorable. Recently, an interventional endoscopic ultrasound (EUS), such as EUS-guided biliary drainage (EUS-BD), has been developed and is available mainly for patients with difficult cases of ERCP. It is a good option for patients with SAA. The effectiveness of interventional EUS for patients with SAA has been reported. Both BE-assisted ERCP and interventional EUS have advantages and disadvantages. The choice of procedure should be individualized to the patient's condition or the expertise of the endoscopists. The aim of this review article is to discuss recent advances in interventional ERCP and EUS for patients with SAA.
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http://dx.doi.org/10.3390/jcm10081624DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8070513PMC
April 2021

Gel immersion endoscopic submucosal dissection using a novel gel product for a duodenal epithelial tumor.

Endoscopy 2021 Apr 28. Epub 2021 Apr 28.

Department of Gastroenterology, Saitama Medical University International Medical Center, Saitama, Japan.

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http://dx.doi.org/10.1055/a-1443-4796DOI Listing
April 2021

Successful duodenal endoscopic submucosal dissection using multiple clip-and-thread traction for a large tumor located in the duodenal bulb.

VideoGIE 2021 Apr 23;6(4):178-180. Epub 2021 Jan 23.

Department of Gastroenterology, Saitama Medical University International Medical Center, Saitama, Japan.

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http://dx.doi.org/10.1016/j.vgie.2020.12.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8058531PMC
April 2021

Hazardous repeat bleeding after colorectal endoscopic submucosal dissection in a patient with immune thrombocytopenia: complete hemostasis using an over-the-scope clip.

Clin J Gastroenterol 2021 Aug 3;14(4):1126-1130. Epub 2021 Apr 3.

Department of Gastroenterology, Saitama Medical University International Medical Center, 1397-1, Yamane, Hidaka, Saitama, 350-1298, Japan.

A 76-year-old man diagnosed with early-stage colorectal cancer was referred to our hospital for endoscopic submucosal dissection (ESD). The patient had a low platelet count (31,000/µL) due to immune thrombocytopenia (ITP). The cancerous lesion was completely resected without any adverse events. A blood test performed 1 day post-ESD showed no progression of anemia and the initial postoperative course was uneventful. However, 7 days after ESD, dark red stools were observed, and we performed an emergency colonoscopy. We stopped the bleeding twice using hemoclips and hemostatic forceps. Since the patient's platelet count remained below 50,000/µL, we started thrombopoietin receptor agonist treatment with eltrombopag (12.5 mg/day) for thrombocytopenia. Although the platelet count increased, the patient experienced rebleeding for the fourth time and underwent an emergency colonoscopy, during which we used an over-the-scope clip (OTSC) to achieve hemostasis. No rebleeding occurred after OTSC intervention, and the platelet count stabilized at approximately 50,000/µL. We discharged the patient on Day 34 after ESD. Although the guidelines do not specify a target platelet count for performing ESD, a platelet count < 50,000/µL should be considered low. Furthermore, an OTSC may be useful for treating intractable bleeding.
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http://dx.doi.org/10.1007/s12328-021-01401-xDOI Listing
August 2021

Diagnosis of Pancreatic Solid Lesions, Subepithelial Lesions, and Lymph Nodes Using Endoscopic Ultrasound.

J Clin Med 2021 Mar 5;10(5). Epub 2021 Mar 5.

Department of Gastroenterology, Saitama Medical University International Medical Center, 1397-1, Yamane, Hidaka, Saitama 350-1298, Japan.

Currently, endoscopic ultrasound (EUS) has become widely accepted and has considerable advantages over computed tomography (CT) and other imaging modalities, given that it enables echostructure assessment in lesions with <1 cm diameter and permits high resolution imaging. EUS-guided tissue acquisition (EUS-TA) provides consistent results under ultrasound guidance and has been considered more effective compared to CT- or ultrasound-guided lesion biopsy. Moreover, complication rates, including pancreatitis and bleeding, have been extremely low, with <1% morbidity and mortality rates, thereby suggesting the exceptional overall safety of EUS-TA. The aggressive use of EUS for various lesions has been key in facilitating early diagnosis and therapy. This review summarizes the diagnostic ability of EUS for pancreatic solid lesions, subepithelial lesions, and lymph nodes where it is mainly used. EUS has played an important role in diagnosing these lesions and planning treatment strategies. Future developments in EUS imaging technology, such as producing images close to histopathological findings, are expected to further improve its diagnostic ability. Moreover, tissue acquisition via EUS is expected to be used for precision medicine, which facilitates the selection of an appropriate therapeutic agent by increasing the amount of tissue collected and improving genetic analysis.
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http://dx.doi.org/10.3390/jcm10051076DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7961381PMC
March 2021

Diagnostic Process Using Endoscopy for Biliary Strictures: A Narrative Review.

J Clin Med 2021 Mar 3;10(5). Epub 2021 Mar 3.

Department of Gastroenterology, Saitama Medical University International Medical Center, 1397-1, Yamane, Hidaka, Saitama 350-1298, Japan.

The diagnostic process for biliary strictures remains challenging in some cases. A broad differential diagnosis exists for indeterminate biliary strictures, including benign or malignant lesions. The diagnosis of indeterminate biliary strictures requires a combination of physical examination, laboratory testing, imaging modalities, and endoscopic procedures. Despite the progress of less invasive imaging modalities such as transabdominal ultrasonography, computed tomography, and magnetic resonance imaging, endoscopy plays an essential role in the accurate diagnosis, including the histological diagnosis. Imaging findings and brush cytology and/or forceps biopsy under fluoroscopic guidance with endoscopic retrograde cholangiopancreatography (ERCP) are widely used as the gold standard for the diagnosis of biliary strictures. However, ERCP cannot provide an intraluminal view of the biliary lesion, and its outcomes are not satisfactory. Recently, peroral cholangioscopy, confocal laser endomicroscopy, endoscopic ultrasound (EUS), and EUS-guided fine-needle aspiration have been reported as useful for indeterminate biliary strictures. Appropriate endoscopic modalities need to be selected according to the patient's condition, the lesion, and the expertise of the endoscopist. The aim of this review article is to discuss the diagnostic process for indeterminate biliary strictures using endoscopy.
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http://dx.doi.org/10.3390/jcm10051048DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7961606PMC
March 2021

Intraperitoneal Abscess as a Postoperative Complication of Gastric Endoscopic Submucosal Dissection.

Intern Med 2021 Sep 22;60(17):2777-2781. Epub 2021 Mar 22.

Department of Gastroenterology, Saitama Medical University International Medical Center, Japan.

We herein report a case of intraperitoneal abscess as a postoperative complication of gastric endoscopic submucosal dissection (ESD). A 70-year-old man who underwent ESD for early gastric cancer sought consultation for abdominal pain on postoperative day 28. Abdominal computed tomography revealed intraperitoneal abscess rupture. He underwent image-guided laparoscopic irrigation. His postoperative course was favorable, and he was discharged after 27 days. Intraoperatively, a white plaque adhering to the gastric wall was surrounded by a large pus volume and suspected to be ESD-associated. We present this case with a literature review of the association between intraperitoneal abscess and ESD.
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http://dx.doi.org/10.2169/internalmedicine.6936-20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8479230PMC
September 2021

Novel retrieval basket facilitates the extraction of difficult bile duct stones in a patient with surgically altered anatomy.

J Hepatobiliary Pancreat Sci 2021 May 12;28(5):e17-e18. Epub 2021 Mar 12.

Department of Gastroenterology, Saitama Medical University International Medical Center, Hidaka, Japan.

Highlight Bile duct stone extraction is sometimes difficult in patients with surgically altered anatomy. Tanisaka and colleagues present a video case report demonstrating the usefulness of a novel retrieval basket with a unique helical shape, which facilitates the extraction of difficult bile duct stones, even in patients with surgically altered anatomy.
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http://dx.doi.org/10.1002/jhbp.919DOI Listing
May 2021

Diagnosis of Biliary Strictures Using Probe-Based Confocal Laser Endomicroscopy under the Direct View of Peroral Cholangioscopy: Results of a Prospective Study (with Video).

Gastroenterol Res Pract 2020 31;2020:6342439. Epub 2020 Dec 31.

Saitama Medical University, Community Health Science Center, Japan.

Background: The accurate diagnosis of biliary strictures remains problematic. The aim of the present study was to prospectively evaluate the clinical utility of probe-based confocal laser endomicroscopy (pCLE) under the direct view of peroral cholangioscopy (POCS) for the diagnosis of biliary strictures.

Methods: Consecutive patients with biliary strictures were included. We investigated sensitivity, specificity, and accuracy to diagnose malignancy for (1) ERCP alone, (2) POCS, (3) pCLE under the direct view of POCS, and (4) tissue sampling under the direct view of POCS.

Results: A total of 30 patients (17 with malignant lesions) were prospectively enrolled. (1) ERCP alone showed 88.2% sensitivity, 46.2% specificity, and 70% (95% confidence interval (CI), 52.1%-83.3%) accuracy. (2) POCS showed 100% sensitivity, 76.9% specificity, and 90% (95% CI, 74.4%-96.5%) accuracy. (3) pCLE under the direct view of POCS showed 94.1% sensitivity, 92.3% specificity, and 93.3% (95% CI, 78.7%-98.8%) accuracy. (4) Tissue sampling under the direct view of POCS showed 82.4% sensitivity, 100% specificity, and 90% (95% CI, 74.4%-96.5%) accuracy.

Conclusions: pCLE under the direct view of POCS provided highly accurate and sensitive characterization of biliary strictures and showed the potential for more diagnostic reliability and reduction of delays in diagnosis. This trial was registered at UMIN (registration number: UMIN000033801).
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http://dx.doi.org/10.1155/2020/6342439DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7790558PMC
December 2020

Usefulness of self-expandable metal stents for malignant biliary obstruction using a short-type single-balloon enteroscope in patients with surgically altered anatomy.

J Hepatobiliary Pancreat Sci 2021 Mar 24;28(3):272-279. Epub 2021 Jan 24.

Community Health Science Center, Saitama Medical University, Moroyama, Japan.

Objectives: To evaluate the efficacy and safety of self-expandable metal stent (SEMS) placement for unresectable malignant biliary obstruction (MBO) using a short-type single-balloon enteroscopy (short SBE) in patients with surgically altered anatomy (SAA).

Methods: The technical success rate, clinical success rate, recurrent biliary obstruction (RBO), time to RBO (TRBO), procedure related adverse events, and reintervention after RBO were evaluated from September 2011 to June 2020.

Results: Thirty-seven patients (11 patients with distal MBO and 26 with hilar MBO) who underwent SEMS placement were included in the analysis. The technical and clinical success rates were 100% and 94.6%. Seven patients underwent bilateral stenting (partial stent-in-stent placement) for hilar MBO. The RBO rate was 13.5% (5/37) and the median TRBO was 212 (interquartile range [IQR], 154-296) days. No food impaction occurred in this study. Procedure related adverse events occurred in 5.4% (2/37) of cases. Reintervention was attempted in five patients and all succeeded (four patients underwent SEMS replacement, and one underwent plastic stent placement).

Conclusions: SEMS placement for unresectable MBO using a short SBE in patients with SAA is effective and safe in similar ways to that in patients with normal anatomy in terms of bilateral stenting, stent patency, and reintervention.
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http://dx.doi.org/10.1002/jhbp.889DOI Listing
March 2021

Evaluation of endoscopic ultrasound-guided fine-needle biopsy for preoperative pancreatic solid lesions.

Scand J Gastroenterol 2021 Feb 9;56(2):188-192. Epub 2020 Dec 9.

Department of Gastroenterology, Saitama Medical University International Medical Center, Saitama, Japan.

Objectives: Obtaining an accurate preoperative diagnosis is crucial. This study aimed to evaluate the diagnostic accuracy and utility of endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) for preoperative pancreatic solid lesions.

Materials And Methods: We retrospectively assessed all patients who underwent endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) or EUS-FNB to evaluate solid pancreatic lesions preoperatively at our center between July 2013 and June 2020. We enrolled 71 patients who underwent EUS-FNA using a 22 G conventional needle (FNA group) and 34 patients who underwent EUS-FNB using a 22 G Franseen needle (FNB group). Overall, 105 patients were analyzed. We employed propensity-matched analysis and adjusted the confounders.

Results: No procedural adverse events were encountered. Both groups showed no significant differences in the procedure time, technical success rate, and rate of operator changes from trainee to expert. Regarding diagnostic accuracy, the FNB group (88.2%; 30/34) was higher but not significantly different from the FNA group (85.3%; 29/34) ( > .99). Furthermore, the FNB group (median 2, IQR;2-3) had a significantly lower number of punctures than the FNA group (median 3, IQR; 2-4) ( = .01).

Conclusions: The FNB needle provides higher diagnostic accuracy and requires significantly fewer punctures than conventional needles even at facilities with no available rapid on-site evaluation. Thus, using the FNB needle can be useful for preoperative pancreatic solid lesions.
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http://dx.doi.org/10.1080/00365521.2020.1857828DOI Listing
February 2021

Complete resection of a previously unsuspected 5 mm duodenal submucosal carcinoma.

Dig Liver Dis 2020 Nov 25. Epub 2020 Nov 25.

Department of Gastroenterology, Saitama Medical University International Medical Center, Saitama, Japan.

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http://dx.doi.org/10.1016/j.dld.2020.11.011DOI Listing
November 2020

Colorectal and gastric metastases from lobular breast cancer that resembled superficial neoplastic lesions.

Clin J Gastroenterol 2021 Feb 7;14(1):103-108. Epub 2020 Nov 7.

Department of Gastroenterology, Saitama Medical University International Medical Center, 1397-1, Yamane, Hidaka-city, Saitama, 350-1298, Japan.

Breast cancer is the most common malignancy in women and has a risk of late recurrence. We report a case of metastasis to the stomach and colon 23 years after surgery, with characteristic findings. A 74-year-old woman underwent breast cancer resection at the age of 51. At the time, no additional therapy was performed despite the histological diagnosis of invasive lobular carcinoma with lymph node metastasis. Upper gastrointestinal endoscopy, which was performed as a follow-up for her chronic gastritis, revealed multiple erosions. Histology revealed diffuse proliferation of signet ring cell-like atypical cells, that were positive for cytokeratin CAM5.2 and estrogen receptor. These findings suggested metastasis from the invasive lobular breast carcinoma. Positron-emission tomography revealed sternal and vertebral metastases. Colonoscopy also performed to screen for intestinal metastasis revealed several lesions that resembled hyperplastic polyps. Although these lesions were not strongly suspected of metastasis, histology surprisingly revealed the same findings as the gastric metastasis. This case involved gastric and colorectal superficial metastases that were synchronously detected 23 years after primary treatment. We report that early-stage colorectal metastasis may resemble hyperplastic polyps, and biopsy should always be considered in patients with a history of breast cancer, regardless of years elapsed since treatment.
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http://dx.doi.org/10.1007/s12328-020-01285-3DOI Listing
February 2021

Status of single-balloon enteroscopy-assisted endoscopic retrograde cholangiopancreatography in patients with surgically altered anatomy: Systematic review and meta-analysis on biliary interventions.

Dig Endosc 2020 Oct 18. Epub 2020 Oct 18.

Department of Gastroenterology, Saitama Medical University International Medical Center, Saitama, Japan.

Background And Aims: Endoscopic retrograde cholangiopancreatography (ERCP) in patients with surgically altered anatomy is still challenging. Usefulness of single-balloon enteroscopy (SBE)-assisted ERCP has been increasingly reported. Short SBE is considered beneficial with a 152-cm working length and a 3.2-mm working channel. This has increased the variety of devices that can be used during ERCP procedures. The aim of this pooled analysis was to evaluate the efficacy of SBE-assisted ERCP in patients with surgically altered anatomy and elucidate the current status.

Methods: This systematic review only involved biliary interventions which excluded pancreatic cases. Studies involving SBE-assisted ERCP in patients with Roux-en-Y gastrectomy, hepaticojejunostomy with Roux-en-Y, pancreaticoduodenectomy (Whipple or Child procedure), or Billroth II gastrectomy were analyzed. Enteroscopy, biliary cannulation, and procedural success were assessed by pooling data in a random-effect model, according to the degree of heterogeneity, to obtain a proportion with 95% confidence interval (CI). The outcomes observed for conventional and short SBE cases were also reported.

Results: Overall, 1227 SBE-assisted ERCP procedures from 21 studies were included. The pooled enteroscopy, biliary cannulation, and procedural success rates were 86.6% (95% CI, 82.4-90.3%), 90% (95% CI, 87.1-92.5%), and 75.8% (95% CI, 71.0-80.3%), respectively. Adverse events occurred in 6.6% (95% CI, 5.3-8.2%) of the procedures. Although good outcomes were reported for short SBE-assisted ERCP, these should not be directly compared to the outcomes observed for conventional SBE, as they assume different backgrounds and include confounding variables.

Conclusions: Single-balloon enteroscopy-assisted ERCP in patients with surgically altered anatomy on biliary interventions is effective.
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http://dx.doi.org/10.1111/den.13878DOI Listing
October 2020

Endoscopic closure assisted by a novel traction device after duodenal endoscopic submucosal dissection.

VideoGIE 2020 Sep 17;5(9):425-427. Epub 2020 Jun 17.

Department of Gastroenterology, Saitama Medical University International Medical Center, Saitama, Japan.

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http://dx.doi.org/10.1016/j.vgie.2020.04.028DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7482248PMC
September 2020

Fractured guidewire fragment on the peripheral side of a malignant biliary obstruction: successful removal using a biliary balloon dilation catheter.

Endoscopy 2021 05 2;53(5):E183-E184. Epub 2020 Sep 2.

Department of Gastroenterology, Saitama Medical University International Medical Center, Saitama, Japan.

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http://dx.doi.org/10.1055/a-1230-3170DOI Listing
May 2021

Successful further endoscopic mucosal resection with an over-the-scope clip with circumferential mucosal incision for a residual rectal neuroendocrine tumor.

Dig Endosc 2020 May 13;32(4):629. Epub 2020 Feb 13.

Department of Gastroenterology, Saitama Medical University International Medical Center, Saitama, Japan.

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http://dx.doi.org/10.1111/den.13624DOI Listing
May 2020

Successful endoscopic retrograde cholangiopancreatography using pancreatic guidewire placement for biliary cannulation in a patient with situs inversus and Billroth-I gastrectomy (with video).

JGH Open 2019 Dec 20;3(6):540-541. Epub 2019 Feb 20.

Department of Gastroenterology Saitama Medical University International Medical Center Hidaka Saitama Japan.

We reported a 95-year-old man with cholangitis who underwent Billroth-I gastrectomy. He was diagnosed with situs inversus viscerum and ERCP was performed. A stable field of view could not be secured due to anatomical factors (Billroth-I gastrectomy) and strong respiratory variations. However, pancreatic duct cannulation was possible. A pancreatic guidewire was placed to achieve selective biliary cannulation. This stabilized the field of view. The catheter was inserted on the right side of the guidewire. Cannulation to the 1 o'clock direction achieved biliary cannulation. Intended procedure was completed safely in the present case.
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http://dx.doi.org/10.1002/jgh3.12163DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6891017PMC
December 2019

Duodenal endoscopic submucosal dissection for a large protruded lesion located just behind the pyloric ring with a scissor-type knife.

VideoGIE 2019 Oct 18;4(10):447-450. Epub 2019 Jul 18.

Department of Pathology, Saitama Medical University International Medical Center, Saitama, Japan.

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http://dx.doi.org/10.1016/j.vgie.2019.06.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6831912PMC
October 2019

Does endoscopic ultrasound-guided fine needle biopsy using a Franseen needle really offer high diagnostic accuracy? A propensity-matched analysis.

Endosc Int Open 2019 Nov 22;7(11):E1327-E1332. Epub 2019 Oct 22.

Department of Gastroenterology, Saitama Medical University International Medical Center, Saitama, Japan.

 This study aimed to investigate the diagnostic accuracy and utility of endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) performed using a Franseen needle on solid pancreatic lesions.  This study included 132 consecutive lesions sampled by endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) using a 22-G conventional needle and 95 consecutive lesions evaluated by EUS-FNB using a 22-G Franseen needle to evaluate solid pancreatic lesions at our medical center between July 2013 and November 2018. We used propensity-matched analysis with adjustment for confounders. Patient data were analyzed retrospectively.  Diagnostic accuracy was higher in the Franseen needle group (Group F; 91.6 %, 87 /95) than in the conventional needle group (Group C; 86.3 %, 82 /95), showing no significant difference (  = 0.36). In Group F, diagnostic accuracies for pancreatic head lesions and lesions sampled by transduodenal puncture were 98.0 % (48/49) and 97.9 % (46/47), respectively. These values were significantly higher than values in Group C (  = 0.013, 0.01). Group F displayed a significantly lower number of punctures. In terms of differentiating benign from malignant lesions, Group C showed 85.1 % sensitivity (74/87), 100 % specificity (8/8), 100 % positive predictive value (74/74), and 38.1 % negative predictive value (8/21), compared to values of 90.1 % (73/81), 100 % (14/14), 100 % (73/73), and 63.6 % (14/22), respectively, in Group F. Sensitivity and negative predictive value were better in Group F.  Franseen needles for EUS-FNB of solid pancreatic lesions offer similar puncture performance at different lesion sites while requiring fewer punctures than conventional needles.
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http://dx.doi.org/10.1055/a-0957-3005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6805192PMC
November 2019

Successful endoscopic mucosal resection with over-the-scope clip for gastric cancer of fundic gland type apparently inappropriate for endoscopic submucosal dissection.

Dig Endosc 2019 Sep 17;31(5):e92-e93. Epub 2019 Jun 17.

Department of Gastroenterology, Saitama Medical University International Medical Center, Saitama, Japan.

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http://dx.doi.org/10.1111/den.13450DOI Listing
September 2019

Successful endoscopic en bloc full-thickness and complete resection for two adjacent rectal neuroendocrine tumors.

Dig Endosc 2019 Sep 27;31(5):592. Epub 2019 Jun 27.

Department of Gastroenterology, Saitama Medical University International Medical Center, Saitama, Japan.

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http://dx.doi.org/10.1111/den.13455DOI Listing
September 2019

Successful traction-assisted endoscopic submucosal dissection using dental floss and a clip for a huge superficial nonampullary duodenal epithelial tumor with severe fibrosis (with video).

JGH Open 2019 Apr 12;3(2):179-181. Epub 2018 Dec 12.

Department of Gastroenterology Saitama Medical University International Medical Center Saitama Japan.

Recently, traction-assisted endoscopic submucosal dissection (ESD) using a clip and thread was reported as useful for treating lesions in the esophagus, stomach, and colorectum in terms of shortening the duration of the procedures and reducing the risk of intraoperative perforation. However, no traction method using the thread and clip for duodenal ESD as described in this article has been reported to date. We report a case in which traction-assisted ESD using dental floss and a clip was successfully performed on a huge superficial nonampullary duodenal epithelial tumor accompanied by severe fibrosis caused by preoperative biopsies. A 65-year-old woman had a 55-mm flat-elevated tumor in the second part of the duodenum. Severe fibrosis of the submucosal layer was expected due to repeated biopsies at the same site by the patient's previous endoscopist. We selected ESD for this lesion, and the initial incision was started from the side proximal to the lesion, but it was difficult to insert the scope under the submucosal layer directly beneath the biopsy scar. Therefore, traction with an endoclip and dental floss was performed to lift the lesion. Excellent traction allowed safe resection of the fibrotic part under accurate visual observation. Finally, the lesion was resected without adverse events. Traction-assisted ESD using dental floss and a clip is likely to be an effective adjunctive technique for quick, safe, and successful resection of lesions in the duodenum on which it is difficult to perform ordinary ESD and that have a high probability of intraoperative perforation and massive bleeding.
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http://dx.doi.org/10.1002/jgh3.12118DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6487824PMC
April 2019

Analysis of the factors involved in procedural failure: Endoscopic retrograde cholangiopancreatography using a short-type single-balloon enteroscope for patients with surgically altered gastrointestinal anatomy.

Dig Endosc 2019 Nov 24;31(6):682-689. Epub 2019 Apr 24.

Community Health Science Center, Saitama Medical University, Saitama, Japan.

Aim: To analyze factors involved in procedural failure and to discuss responses to procedural failure by using the outcomes of endoscopic retrograde cholangiopancreatography (ERCP) carried out using a short-type single-balloon enteroscope (short SBE) in patients with surgically altered gastrointestinal anatomy.

Methods: The study sample included patients who underwent ERCP-related procedures using a short SBE between September 2011 and September 2018 at our hospital. Outcomes, including procedural success rate, were studied retrospectively to analyze the factors involved in procedural failure.

Results: Analysis included 191 procedures carried out in 121 patients. Procedural success rate was 85.9% with an adverse event rate of 8.4%. Causes of procedural failure included malignant biliary obstruction (odds ratio [OR] 2.89, 95% confidence interval [CI] 1.19-7.25, P = 0.02), first ERCP attempt (OR: 5.32, 95% CI: 1.30-36.30, P = 0.02), and Roux-en-Y reconstruction (OR: 0.08, 95% CI: 0.004-0.39, P < 0.001). With regard to the response to failure, in cases of malignant biliary obstruction, reattempted short SBE-assisted ERCP was difficult because of invasion of the small intestine or papilla. A large number of these cases required alternative treatment (10 of 15 cases, 66.7%) using percutaneous transhepatic biliary drainage (PTBD) or endoscopic ultrasound-guided biliary drainage (EUS-BD).

Conclusion: Endoscopic retrograde cholangiopancreatography using a short SBE is safe and effective, with malignant biliary obstruction being a specific cause of failure. Technical proficiency with different modalities, such as PTBD and EUS-BD, is necessary to respond to failure in these cases.
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http://dx.doi.org/10.1111/den.13414DOI Listing
November 2019
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