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Pancreatic Neoplasms: HELP
Articles by Keiji Hanada
Based on 31 articles published since 2009
(Why 31 articles?)
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Between 2009 and 2019, Keiji Hanada wrote the following 31 articles about Pancreatic Neoplasms.
 
+ Citations + Abstracts
Pages: 1 · 2
1 Guideline Clinical Practice Guidelines for Pancreatic Cancer 2016 From the Japan Pancreas Society: A Synopsis. 2017

Yamaguchi, Koji / Okusaka, Takuji / Shimizu, Kyoko / Furuse, Junji / Ito, Yoshinori / Hanada, Keiji / Shimosegawa, Tooru / Okazaki, Kazuichi / Anonymous7740903. ·From the *Clinic of Fukuoka Government Building, Hamanomachi Hospital, Fukuoka; †Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital; ‡Department of Gastroenterology, Tokyo Women's Medical University; §Department of Medical Oncology, Faculty of Medicine, Kyorin University; ∥Department of Radiation Oncology, National Cancer Center Hospital, Tokyo; ¶Department of Gastroenterology, JA Onomichi General Hospital, Onomichi; #Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai; and **Department of Gastroenterology and Hepatology, Kansai Medical University, Hirakata, Japan. ·Pancreas · Pubmed #28426492.

ABSTRACT: OBJECTIVES: Clinical Practice Guidelines for Pancreatic Cancer based on Evidence-Based Medicine 2006 were first published by the Japan Pancreas Society, and they were revised to Clinical Practice Guidelines for Pancreatic Cancer 2009 in July 2009 and were further revised to Clinical Practice Guidelines for Pancreatic Cancer 2013 in October 2013. These guidelines were established according to evidence-based medicine. In October 2016, the Clinical Practice Guidelines for Pancreatic Cancer were newly revised in Japanese. METHODS: In the revised version, we introduced the concepts of GRADE - grading recommendations assessment, development, and evaluation approach for better understanding of the current guidelines. RESULTS: The guidelines show algorithms for the diagnosis, treatment, and chemotherapy of pancreatic cancer and address 7 subjects: diagnosis, surgical therapy, adjuvant therapy, radiation therapy, chemotherapy, stent therapy, and palliative medicine. They include 51 clinical questions and 76 statements. There are statements corresponding to clinical questions, evidence levels, recommended strengths, and agreement rates. CONCLUSIONS: These guidelines represent the most standard clinical and practical management at this time in Japan. This is the English synopsis of the Clinical Practice Guidelines for Pancreatic Cancer 2016 in Japanese, which aims to disseminate the Japanese guidelines worldwide for the introduction of Japanese clinical management of these diseases.

2 Guideline EBM-based Clinical Guidelines for Pancreatic Cancer (2013) issued by the Japan Pancreas Society: a synopsis. 2014

Yamaguchi, Koji / Okusaka, Takuji / Shimizu, Kyoko / Furuse, Junji / Ito, Yoshinori / Hanada, Keiji / Shimosegawa, Tooru / Anonymous6910805. ·Department of Advanced Treatment of Pancreatic Diseases, School of Medicine, University of Occupational and Environmental Health, Kitakyushu yamaguch@med.uoeh-u.ac.jp. · Hepatobiliary and Pancreatic Oncology Division, National Cancer Center, Tokyo. · Department of Gastroenterology, Tokyo Women's Medical University, Tokyo. · Department of Internal Medicine, Medical Oncology, Kyorin University School of Medicine, Tokyo. · Department of Radiation Oncology, National Cancer Center, Tokyo. · Department of Gastroenterology, JA Onomichi General Hospital, Onomichi. · Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan. ·Jpn J Clin Oncol · Pubmed #25205672.

ABSTRACT: Clinical practice guidelines for pancreatic cancer based on evidence-based medicine (2006) were published by the Japan Pancreas Society (Committee for revision of clinical guidelines for pancreatic cancer) in March 2009 in Japanese, revised to Clinical Practice Guidelines for Pancreatic Cancer based on evidence-based medicine (2009) in July 2009 in Japanese and further revised to Clinical Practice Guidelines for Pancreatic Cancer (2013) in October 2013 in Japanese. These guidelines were established according to evidence-based medicine. A total of 629 papers were collected from among 4612 reports concerning pancreatic cancer listed in PubMed and Igakuchuo Zasshi between May 2007 and January 2011. This new set of guidelines was written by members of the Committee for the Revision of Clinical Practice Guidelines for Pancreatic Cancer in the Japan Pancreas Society. The guidelines provide an algorithm for the diagnosis (Fig. 1) and treatment (Fig. 2) of pancreatic cancer and address six subjects (Diagnosis, Surgery, Adjuvant therapy, Radiation therapy, Chemotherapy and stent therapy), with 35 clinical questions and 57 recommendations.

3 Review Familial pancreatic cancer: Concept, management and issues. 2017

Matsubayashi, Hiroyuki / Takaori, Kyoichi / Morizane, Chigusa / Maguchi, Hiroyuki / Mizuma, Masamichi / Takahashi, Hideaki / Wada, Keita / Hosoi, Hiroko / Yachida, Shinichi / Suzuki, Masami / Usui, Risa / Furukawa, Toru / Furuse, Junji / Sato, Takamitsu / Ueno, Makoto / Kiyozumi, Yoshimi / Hijioka, Susumu / Mizuno, Nobumasa / Terashima, Takeshi / Mizumoto, Masaki / Kodama, Yuzo / Torishima, Masako / Kawaguchi, Takahisa / Ashida, Reiko / Kitano, Masayuki / Hanada, Keiji / Furukawa, Masayuki / Kawabe, Ken / Majima, Yoshiyuki / Shimosegawa, Toru. ·Hiroyuki Matsubayashi, Division of Endoscopy, Shizuoka Cancer Center, Shizuoka 411-8777, Japan. ·World J Gastroenterol · Pubmed #28246467.

ABSTRACT: Familial pancreatic cancer (FPC) is broadly defined as two first-degree-relatives with pancreatic cancer (PC) and accounts for 4%-10% of PC. Several genetic syndromes, including Peutz-Jeghers syndrome, hereditary pancreatitis, hereditary breast-ovarian cancer syndrome (HBOC), Lynch syndrome, and familial adenomatous polyposis (FAP), also have increased risks of PC, but the narrowest definition of FPC excludes these known syndromes. When compared with other familial tumors, proven genetic alterations are limited to a small proportion (< 20%) and the familial aggregation is usually modest. However, an ethnic deviation (Ashkenazi Jewish > Caucasian) and a younger onset are common also in FPC. In European countries, "anticipation" is reported in FPC families, as with other hereditary syndromes; a trend toward younger age and worse prognosis is recognized in the late years. The resected pancreases of FPC kindred often show multiple pancreatic intraepithelial neoplasia (PanIN) foci, with various K-

4 Review Effective screening for early diagnosis of pancreatic cancer. 2015

Hanada, Keiji / Okazaki, Akihito / Hirano, Naomichi / Izumi, Yoshihiro / Minami, Tomoyuki / Ikemoto, Juri / Kanemitsu, Kozue / Hino, Fumiaki. ·Department of Gastroenterology, Onomichi General Hospital, 1-10-23, Hirahara, Onomichi, 722-8508, Japan. Electronic address: kh-ajpbd@nifty.com. · Department of Gastroenterology, Onomichi General Hospital, 1-10-23, Hirahara, Onomichi, 722-8508, Japan. Electronic address: ak.from.coast@gmail.com. · Department of Gastroenterology, Onomichi General Hospital, 1-10-23, Hirahara, Onomichi, 722-8508, Japan. Electronic address: n.hirano@ebony.plala.or.jp. · Department of Gastroenterology, Onomichi General Hospital, 1-10-23, Hirahara, Onomichi, 722-8508, Japan. Electronic address: y.izumi1213@gmail.com. · Department of Gastroenterology, Onomichi General Hospital, 1-10-23, Hirahara, Onomichi, 722-8508, Japan. Electronic address: t.minami@beach.ocn.ne.jp. · Department of Gastroenterology, Onomichi General Hospital, 1-10-23, Hirahara, Onomichi, 722-8508, Japan. Electronic address: ikejurichan@yahoo.co.jp. · Department of Gastroenterology, Onomichi General Hospital, 1-10-23, Hirahara, Onomichi, 722-8508, Japan. Electronic address: pinosuke84@yahoo.co.jp. · Department of Gastroenterology, Onomichi General Hospital, 1-10-23, Hirahara, Onomichi, 722-8508, Japan. Electronic address: h.fams@blue.megaegg.ne.jp. ·Best Pract Res Clin Gastroenterol · Pubmed #26651254.

ABSTRACT: Diagnosis of pancreatic cancer (PC) at an early stage with curative surgery should improve long-term patient outcome. At present, improving survival should lie in identifying those cases with high-risk factors or precursor lesions through an effective screening including ultrasonography, some biological markers, or national familial pancreatic cancer registration. Recently, cases with PC < 10 mm with a favorable prognosis have been reported. For the diagnoses of cases with PC < 10 mm, the rate of tumor detection was higher on endoscopic ultrasonography (EUS) than on CT or other modalities, and EUS-guided fine needle aspiration was helpful in confirming the histologic diagnosis. Additionally, for the diagnosis of cases with PC in situ, EUS and magnetic resonance cholangiopancreatography (MRCP) may play important roles in detecting the local irregular stenosis of the pancreatic duct. Cytodiagnosis of pancreatic juice using endoscopic nasopancreatic drainage multiple times may be useful in the final diagnosis.

5 Review Diagnostic strategies for early pancreatic cancer. 2015

Hanada, Keiji / Okazaki, Akihito / Hirano, Naomichi / Izumi, Yoshihiro / Teraoka, Yuji / Ikemoto, Juri / Kanemitsu, Kozue / Hino, Fumiaki / Fukuda, Toshikatsu / Yonehara, Shuji. ·Department of Gastroenterology, Onomichi General Hospital, 1-10-23 Hirahara, Onomichi, 722-8508, Japan, kh-ajpbd@nifty.com. ·J Gastroenterol · Pubmed #25501287.

ABSTRACT: Diagnosis of pancreatic cancer (PC) at an early stage with curative surgery is the approach with the potential to significantly improve long-term patient outcome. Recently, some reports showed that patients with pancreatic tumors smaller than 10 mm showed a favorable prognosis. However, the rate of tumor detection on computed tomography in patients with small pancreatic tumors is low. For the diagnoses of PC with tumors smaller than 10 mm, the rate of tumor detection was higher on endoscopic ultrasonography (EUS) than on computed tomography or other modalities, and histologic diagnosis using EUS-guided fine-needle aspiration was helpful in confirming the diagnosis. For the diagnosis of PC in situ, EUS and magnetic resonance cholangiopancreatography may play important roles in detecting the local irregular stenosis of the pancreatic duct. Endoscopic retrograde pancreatography and sequential cytodiagnosis using pancreatic juice obtained by endoscopic nasopancreatic drainage multiple times was useful in the final diagnosis of PC in situ. At present, improving survival lies in identifying those individuals with high-risk factors or precursor lesions through an effective screening method. For example, these should include ultrasonography, various biological markers, or national familial pancreatic cancer registration. Additionally, the relationship between specialists in PC from medical centers and practicing physicians plays an important role in the early diagnosis of PC.

6 Review [Recent advances in the early diagnosis of pancreatic cancer]. 2013

Hanada, Keiji / Iiboshi, Tomohiro. ·Department of Gastroenterology, Onomichi General Hospital. ·Nihon Shokakibyo Gakkai Zasshi · Pubmed #24305092.

ABSTRACT: -- No abstract --

7 Clinical Trial Randomized phase II study of gemcitabine and S-1 combination versus gemcitabine alone in the treatment of unresectable advanced pancreatic cancer (Japan Clinical Cancer Research Organization PC-01 study). 2012

Ozaka, Masato / Matsumura, Yuji / Ishii, Hiroshi / Omuro, Yasushi / Itoi, Takao / Mouri, Hisatsugu / Hanada, Keiji / Kimura, Yasutoshi / Maetani, Iruru / Okabe, Yoshinobu / Tani, Masaji / Ikeda, Takaaki / Hijioka, Susumu / Watanabe, Ryouhei / Ohoka, Shinya / Hirose, Yuki / Suyama, Masafumi / Egawa, Naoto / Sofuni, Atsushi / Ikari, Takaaki / Nakajima, Toshifusa. ·Department of Gastroenterology, Cancer Institute Hospital, 3-8-31 Ariake, Koto-ku, Tokyo 135-8550, Japan. masato.ozaka@jfcr.or.jp ·Cancer Chemother Pharmacol · Pubmed #22249272.

ABSTRACT: PURPOSE: To evaluate the efficacy and safety of the combination of gemcitabine (GEM) and S-1 (GS) in comparison to GEM alone (G) for unresectable pancreatic cancer. METHODS: In this multicenter randomized phase II study, we randomly assigned unresectable pancreatic cancer patients to either the GS group or the G group. The GS group regimen consists of intravenous 1,000 mg/m(2) GEM during 30 min on days 1 and 8, combined with 80 mg/m(2) oral S-1 twice daily on days 1-14, repeated every 3 weeks. On the other hand, the G group regimen consists of intravenous 1,000 mg/m(2) GEM on days 1, 8, and 15, repeated every 4 weeks. The primary endpoint was objective response rate (ORR). Secondary end points included treatment toxicity, clinical response benefit, progression-free survival (PFS), and overall survival. RESULTS: We registered 117 patients from 16 institutions between June 2007 and August, 2010. The ORR of the GS group was 28.3%, whereas that of the G group was 6.8%. This difference was statistically significant (P = 0.005). The disease control rate was 64.2% in the GS group and 44.1% in the G group. Median PFS was 6.15 months in the GS group and 3.78 month in the G group. This was also statistically significant (P = 0.0007). Moreover, the median overall survival (OS) of the GS group was significantly longer than that of the G group (13.7 months vs. 8.0 months; P = 0.035). The major grade 3-4 adverse events were neutropenia (54.7% in the GS group and 22.0% in the G group), thrombocytopenia (15.1% in the GS group and 5.1% in the G group), and skin rash (9.4% in the GS group). CONCLUSIONS: The GS group showed stronger anticancer activity than the G group, suggesting the need for a large randomized phase III study to confirm GS advantages in a specific subset.

8 Article Clinical and Pathological Features of Solid Pseudopapillary Neoplasms of the Pancreas: A Nationwide Multicenter Study in Japan. 2018

Hanada, Keiji / Kurihara, Keisuke / Itoi, Takao / Katanuma, Akio / Sasaki, Tamito / Hara, Kazuo / Nakamura, Masafumi / Kimura, Wataru / Suzuki, Yutaka / Sugiyama, Masanori / Ohike, Nobuyuki / Fukushima, Noriyoshi / Shimizu, Michio / Ishigami, Kousei / Gabata, Toshifumi / Okazaki, Kazuichi. ·Department of Gastroenterology and Metabolism, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima. · Department of Gastroenterology, Tokyo Medical University, Tokyo. · Center for Gastroenterology, Teine-Keijinkai Hospital, Sapporo. · Department of Gastroenterology, Hiroshima Prefectural Hospital, Hiroshima. · Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya. · Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka. · Faculty of Medicine, First Department of Surgery, Yamagata University, Yamagata. · Department of Surgery, Kyorin University School of Medicine. · Department of Pathology, Showa University Fujigaoka Hospital, Yokohama, Kanagawa. · Department of Pathology, Jichi Medical University, Tochigi. · Diagnostic Pathology Center, Hakujikai Memorial Hospital, Tokyo. · Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka. · Department of Radiology, Kanazawa University Graduate School of Medical Sciences, Kanazawa. · Department of Gastroenterology, Kansai Medical University, Osaka, Japan. ·Pancreas · Pubmed #30059473.

ABSTRACT: OBJECTIVE: The aim of this study was to evaluate the clinicopathological features of solid pseudopapillary neoplasms (SPNs). METHODS: In this retrospective study, 288 SPNs were analyzed. RESULTS: Overall, 214 patients (74%) were female. Distant metastases occurred in 4 patients, and splenic vein tumor thrombus occurred in 1 patient. Although imaging findings showed large (>2.0 cm) SPNs with clear, regular border, and heterogeneous internal structure, small SPNs appeared as almost entirely solid. Surgical resection was performed in 278 cases. The 5-year survival rate was 98.8%. Six patients had tumor recurrence after the initial resection. The detection rate in typical pathological findings was low for small SPNs. Tumor extension to the pancreatic parenchyma was detected in greater than 70% of the cases. Tumor invasion to adjacent organs was detected in 13 cases. One was given a diagnosis of apparent high-grade malignant transformation. CONCLUSIONS: The proportion of male cases was higher than that in previous studies, and there were statistically significant differences in the onset age and tumor diameter between male and female patients. Therefore, women seemed to have an early occurrence of SPNs, suggesting a difference in the developmental stage between men and women. Images and pathological findings of SPNs varied according to tumor size. Our findings indicated that SPN patients have excellent survival after margin-negative surgical resection.

9 Article Preoperative neutrophil-to-lymphocyte ratio as a prognosticator in early stage pancreatic ductal adenocarcinoma. 2018

Abe, Tomoyuki / Amano, Hironobu / Kobayashi, Tsuyoshi / Hanada, Keiji / Nakahara, Masahiro / Ohdan, Hideki / Noriyuki, Toshio. ·Department of Surgery, Onomichi General Hospital, Onomichi, Hiroshima, Japan. · Department of Surgery, Onomichi General Hospital, Onomichi, Hiroshima, Japan; Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan. Electronic address: amanojack@star.odn.ne.jp. · Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan. · Department of Gastroenterology, Onomichi General Hospital, Onomichi, Hiroshima, Japan. · Department of Surgery, Onomichi General Hospital, Onomichi, Hiroshima, Japan; Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan. ·Eur J Surg Oncol · Pubmed #29807728.

ABSTRACT: BACKGROUND: The neutrophil-to-lymphocyte ratio (NLR), which reflects the cancer-induced systemic inflammation response, has been proposed as a risk factor for poor long-term prognosis in cancer. We investigated the prognostic role of the NLR and the relationship between the NLR and TNM stage in pancreatic ductal adenocarcinoma (PDAC) patients following curative resection. METHODS: One-hundred thirty-eight consecutive patients with resected PDAC were enrolled between 2004 and 2014. Univariate and multivariate analyses identified variables associated with overall survival (OS) and recurrence-free survival (RFS). Patients were stratified according to the NLR, with an NLR cut-off value of 2.2 being estimated by receiver operating characteristic curve. RESULTS: Compared to patients with a low NLR (≤2.2), those with a high preoperative NLR (>2.2) had worse OS and RFS (P = 0.017, P = 0.029, respectively). For early-stage tumors, tumor size ≥20 mm and a high NLR were independent risk factors for poor OS (hazard ratio (HR): 3.255, 95% confidence interval (CI): 1.082-9.789, P = 0.036; HR: 3.690, 95% CI: 1.026-13.272, P = 0.046, respectively) and RFS (HR: 3.575, 95% CI: 1.174-10.892, P = 0.025; HR: 5.380, 95% CI: 1.587-18.234, P = 0.007, respectively). The NLR was not correlated with prognosis in patients with advanced stages. CONCLUSIONS: An elevated preoperative NLR was an important prognosticator for early TNM stage PDAC. The NLR, which is calculated using inexpensive and readily available biomarkers, could be a novel tool for predicting long-term survival in patients, especially those with early stage PDAC.

10 Article [Social programs for early diagnosis of pancreatic cancer -establishment of network between special doctors and practicing doctors]. 2018

Hanada, Keiji / Shimizu, Akinori / Minami, Tomoyuki. ·Department of Gastroenterology, Onomichi General Hospital. ·Nihon Shokakibyo Gakkai Zasshi · Pubmed #29643285.

ABSTRACT: -- No abstract --

11 Article Prospective Follow-up Study of the Recurrence of Pancreatic Cancer Diagnosed at an Early Stage: The Value of Endoscopic Ultrasonography for Early Diagnosis of Recurrence in the Remnant Pancreas. 2018

Ikemoto, Juri / Hanada, Keiji / Minami, Tomoyuki / Okazaki, Akihito / Abe, Tomoyuki / Amano, Hironobu / Yonehara, Shuji. · ·Pancreas · Pubmed #29517631.

ABSTRACT: OBJECTIVES: Most patients with pancreatic cancer (PC) demonstrate recurrences in the form of metastatic disease. We prospectively evaluated recurrence in PC cases diagnosed at an early stage. METHODS: Thirty cases of PC stage 0 or IA were prospectively followed for at least 1 year after initial surgery. We performed blood tests and contrast-enhanced computed tomography (CT) every 3 to 6 months. Endoscopic ultrasonography (EUS) was performed if CT revealed abnormal findings in the remnant pancreas (RP). RESULTS: The median follow-up period was 53.9 months. Pancreatic cancer recurred in the RP (n = 8) and liver (n = 1). Computed tomography revealed mass lesions in 5 cases, a cystic lesion in 2 cases, and pancreatic duct dilatation in 1 case. Endoscopic ultrasonography detected mass lesions in 3 cases without a detectable mass on CT. The sensitivity of EUS-guided fine-needle aspiration and pancreatic juice cytology was 75%. Five of 8 cases underwent total resection of the RP, with pathologic findings revealing stage IA in 1 case, stage II in 1 case, and stage III in 3 cases. CONCLUSIONS: Careful long-term follow-up including EUS should be performed in resected PC cases diagnosed at an early stage to check recurrence in the RP.

12 Article A case of mixed adenoneuroendocrine carcinoma of the pancreas mimicking intraductal papillary mucinous carcinoma. 2018

Mori, Hideki / Hanada, Keiji / Minami, Tomoyuki / Yano, Shigeki / Fukuhara, Motomitsu / Maruyama, Hirotsugu / Shimizu, Akinori / Hirano, Naomichi / Hino, Fumiaki / Amano, Hironobu / Yonehara, Shuji. ·Department of Gastroenterology, Onomichi General Hospital, 1-10-23, Hirahara, Onomichi, 722-8508, Japan. morihideki2012@gmail.com. · Department of Gastroenterology, Onomichi General Hospital, 1-10-23, Hirahara, Onomichi, 722-8508, Japan. · Department of Surgery, Onomichi General Hospital, 1-10-23, Hirahara, Onomichi, 722-8508, Japan. · Department of Pathology, Onomichi General Hospital, 1-10-23, Hirahara, Onomichi, 722-8508, Japan. ·Clin J Gastroenterol · Pubmed #29442219.

ABSTRACT: A previously healthy 52-year-old man was referred to our hospital for further evaluation of main pancreatic duct dilatation. The preoperative work-up was consistent with intraductal papillary mucinous carcinoma (IPMC) derived from a mixed type intraductal papillary mucinous neoplasm (IPMN), because multilocular cysts with enhancing thickened pancreatic head walls and dilated pancreatic ducts lined with dysplastic mucinous epithelium, with papillary proliferation from the pancreatic body to the tail, were observed; in addition, the pancreatic juice cytology was class V, which is suggestive of adenocarcinoma. Total pancreatectomy was performed because a definite mass was not found before surgical resection and the tumors could have spread to the tail. The pathological diagnosis was mixed adenoneuroendocrine carcinoma of the pancreatic head. IPMN with high- or low-grade dysplasia was not observed anywhere in the pancreatic duct. The pancreatic ductal adenocarcinoma consisted of large caliber malignant glands with intraluminal flat or papillary structures; therefore, we were unable to recognize a definite pancreatic mass before surgical resection, and suspected an IPMC derived from a mixed type IPMN.

13 Article Outcomes of endoscopic biliary drainage in pancreatic cancer patients with an indwelling gastroduodenal stent: a multicenter cohort study in West Japan. 2018

Yamao, Kentaro / Kitano, Masayuki / Takenaka, Mamoru / Minaga, Kosuke / Sakurai, Toshiharu / Watanabe, Tomohiro / Kayahara, Takahisa / Yoshikawa, Tomoe / Yamashita, Yukitaka / Asada, Masanori / Okabe, Yoshihiro / Hanada, Keiji / Chiba, Yasutaka / Kudo, Masatoshi. ·Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan. · Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan; Second Department of Internal Medicine, School of Medicine, Wakayama Medical University, Wakayama, Japan. · Department of Gastroenterology and Hepatology, Kurashiki Central Hospital, Okayama, Japan. · Department of Gastroenterology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan. · Department of Gastroenterology and Hepatology, Osaka Red Cross Hospital, Osaka, Japan. · Department of Gastroenterology, Onomichi General Hospital, Onomichi, Japan. · Division of Biostatistics, Clinical Research Center, Kinki University Faculty of Medicine, Osaka-Sayama, Japan. ·Gastrointest Endosc · Pubmed #29382465.

ABSTRACT: BACKGROUND AND AIMS: Gastroduodenal and biliary obstruction may occur synchronously or asynchronously in advanced pancreatic cancer, and endoscopic double stent placement may be required. EUS-guided biliary drainage (EUS-BD) often is performed after unsuccessful placement of an endoscopic transpapillary stent (ETS), and EUS-BD may be beneficial in double stent placement. This retrospective multicenter cohort study compared the outcomes of ETS placement and EUS-BD in patients with an indwelling gastroduodenal stent (GDS). METHODS: We recorded the clinical outcomes of patients at 5 tertiary-care medical centers who required biliary drainage after GDS placement between March 2009 and March 2014. RESULTS: Thirty-nine patients were included in this study. Patients' mean age was 68.5 years; 23 (59.0%) were men. The GDS overlay the papilla in 23 patients (59.0%). The overall technical success rate was significantly higher with EUS-BD (95.2%) than with ETS placement (56.0%; P < .01). Furthermore, the technical success rate was significantly higher with EUS-BD (93.3%) than with ETS placement (22.2%; P < .01) when the GDS overlies the papilla. The overall clinical success rate of EUS-BD also was significantly higher than for ETS placement (90.5% vs 52.0%, respectively; P = .01), and there was no significant difference in the incidence of adverse events (ETS, 32.0% vs EUS-BD, 42.9%; P = .65). CONCLUSION: Endoscopic double stent placement with EUS-BD is technically and clinically superior to ETS placement in patients with an indwelling GDS. EUS-BD should be considered the first-line treatment option for patients with an indwelling GDS that overlies the papilla. ETS placement remains a reasonable alternative when the papilla is not covered by the GDS.

14 Article Visceral Adipose Tissue and Skeletal Muscle Index Distribution Predicts Severe Pancreatic Fistula Development After Pancreaticoduodenectomy. 2018

Yamane, Hiroaki / Abe, Tomoyuki / Amano, Hironobu / Hanada, Keiji / Minami, Tomoyuki / Kobayashi, Tsuyoshi / Fukuda, Toshikatsu / Yonehara, Shuji / Nakahara, Masahiro / Ohdan, Hideki / Noriyuki, Toshio. ·Department of Surgery, Onomichi General Hospital, Onomichi, Japan. · Department of Surgery, Onomichi General Hospital, Onomichi, Japan t.abe.hiroshima@gmail.com. · Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan. · Department of Gastroenterology, Onomichi General Hospital, Onomichi, Japan. · Department of Surgery, Hiroshima General Hospital of West Japan Railway Company, Hiroshima, Japan. · Department of Pathology, Onomichi General Hospital, Onomichi, Japan. ·Anticancer Res · Pubmed #29374741.

ABSTRACT: BACKGROUND/AIM: In this study, we investigated the effect of body composition on pancreatic fistula (PF) development after pancreaticoduodenectomy (PD). MATERIALS AND METHODS: All consecutive patients with pancreatic and extrahepatic biliary malignancy following PD who were treated between 2006 and 2016 were enrolled. RESULTS: PF developed in 30.3% of cases (30/99 patients), including a grade B PF in 25.3% of cases (25/99 patients) and a grade C PF in 5.1% of cases (5/99 patients). Univariate analysis identified that body mass index ≥25 kg/m CONCLUSION: Elevated VATA/SMI was the only preoperative key factor for PF after PD.

15 Article Multicenter study of early pancreatic cancer in Japan. 2018

Kanno, Atsushi / Masamune, Atsushi / Hanada, Keiji / Maguchi, Hiroyuki / Shimizu, Yasuhiro / Ueki, Toshiharu / Hasebe, Osamu / Ohtsuka, Takao / Nakamura, Masafumi / Takenaka, Mamoru / Kitano, Masayuki / Kikuyama, Masataka / Gabata, Toshifumi / Yoshida, Koji / Sasaki, Tamito / Serikawa, Masahiro / Furukawa, Toru / Yanagisawa, Akio / Shimosegawa, Tooru / Anonymous880928. ·Division of Gastroenterology, Tohoku University, Graduate School of Medicine, Japan. Electronic address: atsushih@med.tohoku.ac.jp. · Division of Gastroenterology, Tohoku University, Graduate School of Medicine, Japan. · Department of Gastroenterology, JA Onomichi General Hospital, Japan. · Center for Gastroenterology, Teine-Keijinkai Hospital, Japan. · Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Japan. · Department of Gastroenterology, Fukuoka University Chikushi Hospital, Japan. · Department of Gastroenterology, Nagano Municipal Hospital, Japan. · Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Japan. · Department of Gastroenterology and Hepatology, Kindai University, Faculty of Medicine, Japan. · Second Department of Internal Medicine, Wakayama Medical University, School of Medicine, Japan. · Division of Gastroenterology, Shizuoka General Hospital, Japan. · Department of Radiology, Kanazawa University Hospital, Japan. · Department of Interventional Bilio-Pancreatology, Kawasaki Medical School, Japan. · Department of Gastroenterology, Hiroshima Prefectural Hospital, Japan. · Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Japan. · Institute for Integrated Medical Sciences, Tokyo Women's Medical University, Japan; Department of Histopathology, Tohoku University, Graduate School of Medicine, Japan. · Department of Pathology, Kyoto Prefectural University of Medicine, Japan. ·Pancreatology · Pubmed #29170051.

ABSTRACT: BACKGROUND/OBJECTIVES: The diagnosis of early-stage pancreatic ductal adenocarcinoma (PDAC) is still challenging. We conducted a multicenter study to clarify the clinical features of early-stage PDAC in Japan. METHODS: We collected patients with stage 0 and stage I PDAC according to the sixth edition of the Japanese Classification of Pancreatic Carcinoma. We retrospectively analyzed the clinical profiles including opportunities for medical examination, imaging modalities and findings, methods of cytological diagnosis, and prognosis according to the stages at diagnosis. RESULTS: Two hundred cases with Stage 0 and stage I PDAC were reported from 14 institutions, which accounted for approximately 0.7% and 3% of all PDAC cases, respectively. Overall, 20% of the early-stage PDAC cases were symptomatic. Indirect imaging findings such as dilatation of the main pancreatic duct were useful to detect early-stage PDAC. In particular, local fatty changes may be specific to early-stage PDAC. For preoperative pathologic diagnosis, cytology during endoscopic retrograde cholangiopancreatography was more commonly applied than endoscopic ultrasound fine-needle aspiration. Although the overall prognosis was favorable, new PDAC lesions developed in the remnant pancreas in 11.5% cases. CONCLUSIONS: This multicenter study revealed several key points concerning the diagnosis and management of early-stage PDAC, including screening of asymptomatic cases, importance of indirect imaging findings, application of cytology during endoscopic retrograde cholangiopancreatography, and the risk of carcinogenesis in the remnant pancreas.

16 Article Acute pancreatitis-onset carcinoma in situ of the pancreas with focal fat replacement diagnosed using serial pancreatic-juice aspiration cytologic examination (SPACE). 2017

Satoh, Tatsunori / Kikuyama, Masataka / Kawaguchi, Shinya / Kanemoto, Hideyuki / Muro, Hiroyuki / Hanada, Keiji. ·Department of Gastroenterology, Shizuoka General Hospital, 4-27-1, Kita-ando, Aoiku, Shizuoka, 420-8527, Japan. tatsunori-sato@i.shizuoka-pho.jp. · Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Disease Center Komagome Hospital, Tokyo, Japan. · Department of Gastroenterology, Shizuoka General Hospital, 4-27-1, Kita-ando, Aoiku, Shizuoka, 420-8527, Japan. · Department of Surgery, Shizuoka General Hospital, Shizuoka, Japan. · Department of Pathology, Shizuoka General Hospital, Shizuoka, Japan. · Department of Gastroenterology, JA Onomichi General Hospital, Hiroshima, Japan. ·Clin J Gastroenterol · Pubmed #28986726.

ABSTRACT: A 59-year-old woman was admitted for acute pancreatitis. Abdominal computed tomography and magnetic resonance imaging revealed a swollen pancreatic parenchyma with dilatation of the main pancreatic duct (MPD) of the pancreas tail, which was separated from the normal pancreas body side by a locally atrophic part of the pancreas. Magnetic resonance cholangiopancreatography showed MPD stricture in the pancreas tail with dilatation of the upstream MPD. Endoscopic ultrasonography revealed that the MPD stricture of the pancreas tail was surrounded by a blurred and hypoechoic area. Endoscopic retrograde cholangiopancreatography was performed for serial pancreatic-juice aspiration cytologic examination (SPACE). The result indicated adenocarcinoma. Distal pancreatectomy was performed, and the histopathological examination showed high-grade PanIN (carcinoma in situ of the pancreatic duct) of the pancreas tail with atrophy and fibrosis of the pancreatic parenchyma, and local fat replacement adjacent to the lesion. The final histopathological diagnosis was carcinoma in situ of the pancreatic duct of the pancreas tail. Acute pancreatitis and local fatty change of the pancreatic parenchyma with MPD stricture are important clinical manifestations of pancreatic carcinoma in situ (PCIS) and performing SPACE in cases of MPD stricture without a recognizable mass is preferable for a diagnosis of PCIS.

17 Article Perioperative Red Blood Cell Transfusion Is Associated with Poor Long-term Survival in Pancreatic Adenocarcinoma. 2017

Abe, Tomoyuki / Amano, Hironobu / Hanada, Keiji / Minami, Tomoyuki / Yonehara, Shuji / Hattori, Minoru / Kobayashi, Tsuyoshi / Fukuda, Toshikatsu / Nakahara, Masahiro / Ohdan, Hideki / Noriyuki, Toshio. ·Department of Surgery, Onomichi General Hospital, Onomichi, Japan. · Department of Surgery, Onomichi General Hospital, Onomichi, Japan amanojack@star.odn.ne.jp. · Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan. · Department of Gastroenterology, Onomichi General Hospital, Onomichi, Japan. · Department of Pathology, Onomichi General Hospital, Onomichi, Japan. · Advanced Medical Skill Training Center, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan. · Department of Surgery, Medical Corporation Japan Railway Hiroshima Hospital, Hiroshima, Japan. ·Anticancer Res · Pubmed #28982913.

ABSTRACT: BACKGROUND/AIM: Perioperative red blood cell transfusion (RBCT) can negatively affect the host's immune system. We investigated the effects of perioperative RBCT on long-term survival among patients with pancreatic ductal adenocarcinoma (PDAC). PATIENTS AND METHODS: We retrospectively evaluated 148 patients with PDAC who underwent surgery with curative intent (33 who received RBCTs and 115 who did not). Significant prognostic variables on univariate analysis were subjected to multivariate analyses using a Cox proportional hazard regression model. RESULTS: Both groups exhibited significant differences in age, preoperative haemoglobin levels, carbohydrate antigen 19-9 levels, maximum tumour size, tumour staging, operative time, intraoperative blood loss, major vascular resection, and the proportion of pancreaticoduodenectomies performed. Patients who underwent RBCTs exhibited significantly poorer overall survival (p<0.001) and recurrence-free survival (p<0.001) compared to patients who did not. CONCLUSION: Perioperative RBCT was associated with poorer long-term survival among patients with PDAC who underwent surgery with curative intent.

18 Article Genetic analyses of isolated high-grade pancreatic intraepithelial neoplasia (HG-PanIN) reveal paucity of alterations in TP53 and SMAD4. 2017

Hosoda, Waki / Chianchiano, Peter / Griffin, James F / Pittman, Meredith E / Brosens, Lodewijk Aa / Noë, Michaël / Yu, Jun / Shindo, Koji / Suenaga, Masaya / Rezaee, Neda / Yonescu, Raluca / Ning, Yi / Albores-Saavedra, Jorge / Yoshizawa, Naohiko / Harada, Kenichi / Yoshizawa, Akihiko / Hanada, Keiji / Yonehara, Shuji / Shimizu, Michio / Uehara, Takeshi / Samra, Jaswinder S / Gill, Anthony J / Wolfgang, Christopher L / Goggins, Michael G / Hruban, Ralph H / Wood, Laura D. ·Department of Pathology, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. · Department of Surgery, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. · Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York, USA. · Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands. · Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. · Department of Pathology, Medica Sur Clinic and Foundation, Mexico City, Mexico. · The First Department of Internal Medicine, Mie University School of Medicine, Tsu, Japan. · Department of Human Pathology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan. · Department of Diagnostic Pathology, Kyoto University Hospital, Kyoto, Japan. · Center for Gastroendoscopy, Onomichi General Hospital, Onomichi, Japan. · Department of Pathology, Onomichi General Hospital, Onomich, Japan. · Diagnostic Pathology Center, Hakujikai Memorial Hospital, Tokyo, Japan. · Department of Laboratory Medicine, Shinshu University School of Medicine, Matsumoto, Japan. · Department of Gastrointestinal Surgery, Royal North Shore Hospital and Discipline of Surgery, University of Sydney, Sydney, Australia. · Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research Royal North Shore Hospital and University of Sydney, Sydney, Australia. · Department of Oncology, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. · Department of Medicine, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. ·J Pathol · Pubmed #28188630.

ABSTRACT: High-grade pancreatic intraepithelial neoplasia (HG-PanIN) is the major precursor of pancreatic ductal adenocarcinoma (PDAC) and is an ideal target for early detection. To characterize pure HG-PanIN, we analysed 23 isolated HG-PanIN lesions occurring in the absence of PDAC. Whole-exome sequencing of five of these HG-PanIN lesions revealed a median of 33 somatic mutations per lesion, with a total of 318 mutated genes. Targeted next-generation sequencing of 17 HG-PanIN lesions identified KRAS mutations in 94% of the lesions. CDKN2A alterations occurred in six HG-PanIN lesions, and RNF43 alterations in five. Mutations in TP53, GNAS, ARID1A, PIK3CA, and TGFBR2 were limited to one or two HG-PanINs. No non-synonymous mutations in SMAD4 were detected. Immunohistochemistry for p53 and SMAD4 proteins in 18 HG-PanINs confirmed the paucity of alterations in these genes, with aberrant p53 labelling noted only in three lesions, two of which were found to be wild type in sequencing analyses. Sixteen adjacent LG-PanIN lesions from ten patients were also sequenced using targeted sequencing. LG-PanIN harboured KRAS mutations in 94% of the lesions; mutations in CDKN2A, TP53, and SMAD4 were not identified. These results suggest that inactivation of TP53 and SMAD4 are late genetic alterations, predominantly occurring in invasive PDAC. Copyright © 2017 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.

19 Article Diagnostic and Therapeutic Endoscopic Retrograde Cholangiography Using a Short-Type Double-Balloon Endoscope in Patients With Altered Gastrointestinal Anatomy: A Multicenter Prospective Study in Japan. 2016

Shimatani, Masaaki / Hatanaka, Hisashi / Kogure, Hirofumi / Tsutsumi, Koichiro / Kawashima, Hiroki / Hanada, Keiji / Matsuda, Tomoki / Fujita, Tomoki / Takaoka, Makoto / Yano, Tomonori / Yamada, Atsuo / Kato, Hironari / Okazaki, Kazuichi / Yamamoto, Hironori / Ishikawa, Hideki / Sugano, Kentaro / Anonymous411096. ·The Third Department of Internal Medicine, Division of Gastroenterology and Hepatology, Kansai Medical University, Osaka, Japan. · Department of Medicine, Division of Gastroenterology, Jichi Medical University, Tochigi, Japan. · Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan. · Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan. · Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan. · Department of Gastroenterology, Onomichi General Hospital, Hiroshima, Japan. · Digestive Endoscopy Center, Sendai Kousei Hospital, Sendai, Japan. · Center for Gastroenterology, Otaru Ekisaikai Hospital, Hokkaido, Japan. · Department of Molecular-Targeting Cancer Prevention, Kyoto Prefectural University of Medicine, Kyoto, Japan. ·Am J Gastroenterol · Pubmed #27670601.

ABSTRACT: OBJECTIVES: To evaluate the utility and safety of a short-type double-balloon endoscope (DBE) in the treatment of biliary disease in patients with surgically altered gastrointestinal (GI) anatomy. METHODS: This study was conducted as a multicenter, single-arm, prospective trial at five tertiary academic care centers and three community-based hospitals in Japan. Consecutive patients with biliary disease with altered GI anatomy were prospectively included in this study. RESULTS: A total of 311 patients underwent double-balloon endoscopic retrograde cholangiography (ERC). The success rate of reaching the target site, the primary end point, was 97.7% (95% confidence interval (CI): 95.4-99.1). The success rate of biliary cannulation and contrast injection of the targeted duct, the secondary end point, was 96.4% (95% CI: 93.6-98.2), and the therapeutic success rate was 97.9% (95% CI: 95.4-99.2). Adverse events occurred in 33 patients (10.6%, 95% CI: 7.1-14.0) and were managed conservatively in all patients with the exception of 1 in whom a perforation developed, requiring emergency surgery. CONCLUSIONS: ERC using a short-type DBE resulted in an excellent therapeutic success rate and a low rate of adverse events. This treatment can be a first-line treatment for biliary disease in patients with surgically altered GI anatomy.

20 Article A case report on metastatic pancreatic tumor from pulmonary adenocarcinoma that difficult to differentiate from primary pancreatic ductal carcinoma. 2016

Takei, Daisuke / Okazaki, Akihito / Minami, Tomoyuki / Ikemoto, Juri / Hirano, Naomichi / Hanada, Keiji / Teraoka, Yuji / Fukuda, Toshikatsu / Yonehara, Shuji. ·Department of Surgery, Onomichi General Hospital. ·Nihon Shokakibyo Gakkai Zasshi · Pubmed #27498937.

ABSTRACT: A woman was admitted to our department for lung adenocarcinoma and she was treated with left upper lobectomy. The carcinoembryonic antigen level had increased. Enhanced computed tomography showed a hypovascular tumor in the pancreatic tail and in the extension of the distal main pancreatic duct. Endoscopic ultrasonography (EUS) clearly showed a low echoic lesion, and histological examination revealed adenocarcinoma. On immunostaining, the lesion was diagnosed as metastatic adenocarcinoma of the lungs. The patient was treated with chemotherapy for lung cancer and survived for 4 years after diagnosis. Differentiating a metastatic lesion to the pancreas from pancreatic ductal adenocarcinoma is very important. Accurate diagnosis enables administration of appropriate treatment. In this case, EUS was especially useful for assessing the tumor in the pancreas. When patients with a history of extra-pancreatic cancer present with a pancreatic lesion, pancreatic metastases should be considered, regardless of the time elapsed since occurrence of the primary cancer. EUS-fine needle aspiration (FNA) with histological examination is the best method for definitive diagnosis of pancreatic disease in this group of patients. This approach has very high sensitivity and accuracy for the diagnosis of pancreatic metastases.

21 Article [The social program between medical centers and practicing doctors for the early diagnosis of pancreatic carcinoma]. 2015

Hanada, Keiji / Okazaki, Akihito / Izumi, Yoshihiro / Hirano, Naomichi. · ·Nihon Rinsho · Pubmed #25857061.

ABSTRACT: -- No abstract --

22 Article Natural history of branch duct intraductal papillary mucinous neoplasm with mural nodules: a Japan Pancreas Society multicenter study. 2014

Kobayashi, Go / Fujita, Naotaka / Maguchi, Hiroyuki / Tanno, Satoshi / Mizuno, Nobumasa / Hanada, Keiji / Hatori, Takashi / Sadakari, Yoshihiko / Yamaguchi, Taketo / Tobita, Kousuke / Doi, Ryuichiro / Yanagisawa, Akio / Tanaka, Masao / Anonymous3181005. ·From the *Department of Gastroenterology, Sendai City Medical Center, Sendai; †Center for Gastroenterology, Teine-Keijinkai Hospital, Sapporo; ‡Department of General Medicine, Asahikawa Medical College, Asahikawa; §Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya; ∥Center for Gastroendoscopy, Onomichi General Hospital, Hiroshima; ¶Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo; #Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka; **Department of Gastroenterology, Chiba Cancer Center, Chiba; ††Department of Gastroenterological Surgery, Tokai University School of Medicine, Kanagawa; ‡‡Department of Hepato-Biliary-Pancreatic Surgery and Transplantation, Kyoto University; and §§Department of Pathology, Kyoto Prefectural University of Medicine, Kyoto, Japan. ·Pancreas · Pubmed #24717801.

ABSTRACT: OBJECTIVE: This study aimed to elucidate the natural history of intraductal papillary mucinous neoplasm (IPMN) of the pancreas with mural nodules (MNs) in branch duct IPMN (BD-IPMN). METHODS: Among the 402 registered patients with BD-IPMN on long-term follow-up at 10 institutions in Japan, 53 patients with MNs of less than 10 mm in height detected by endosonography were included in this study. The morphological changes of the BD-IPMN in these patients and histologic findings of the resected specimen were investigated. RESULTS: The median height of the MNs at the initial diagnosis was 3 mm (range, 1-8 mm), and 12 (23%) of the 53 patients showed an increase in the height of the MNs during follow-up (mean duration, 42 months). Six patients underwent surgery because of an increase in the height of MNs, yielding high-grade dysplasia in 1 patient and low-grade dysplasia in 5 patients. No patients developed invasive carcinoma derived from IPMN, and distinct pancreatic ductal adenocarcinoma developed in 1 (2%) patient. The incidence of the development of malignancy in BD-IPMNs, including distinct pancreatic ductal adenocarcinoma, was similar to that of those without MNs. CONCLUSIONS: In patients who have BD-IPMN with MNs of less than 10 mm in height, observation instead of immediate resection is considered to be possible.

23 Article Multicenter retrospective study of endoscopic ultrasound-guided biliary drainage for malignant biliary obstruction in Japan. 2014

Kawakubo, Kazumichi / Isayama, Hiroyuki / Kato, Hironari / Itoi, Takao / Kawakami, Hiroshi / Hanada, Keiji / Ishiwatari, Hirotoshi / Yasuda, Ichiro / Kawamoto, Hirofumi / Itokawa, Fumihide / Kuwatani, Masaki / Iiboshi, Tomohiro / Hayashi, Tsuyoshi / Doi, Shinpei / Nakai, Yousuke. ·Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan; Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan. ·J Hepatobiliary Pancreat Sci · Pubmed #24026963.

ABSTRACT: BACKGROUND: Endoscopic ultrasound-guided biliary drainage (EUS-BD) is considered to be an effective salvage procedure for failed endoscopic retrograde cholangiopancreatography in patients with unresectable malignant biliary obstruction. The aim of this retrospective study was to evaluate the efficacy and feasibility of EUS-BD. METHODS: From November 2006 to May 2012, a total of 64 patients who underwent EUS-BD (44 EUS-guided choledochoduodenostomy [EUS-CDS] and 20 EUS-guided hepaticogastrostomy [EUS-HGS]) at seven tertiary-care referral centers in Japan were included. The primary outcome was the technical success rate, and the secondary outcomes were the incidence of complications, stent dysfunction rate, time to stent dysfunction, and overall survival. RESULTS: The technical success rate for both EUS-CDS and EUS-HGS was 95%. The reasons for technical failure were two failed dilations of the anastomosis in EUS-CDS and one puncture failure in EUS-HGS. The stent dysfunction rate and 3-month dysfunction-free patency rate were 21% and 80% for EUS-CDS and 32% and 51% for EUS-HGS. There were 12 (six in EUS-CDS and six in EUS-HGS) procedure-related complications (19%): five cases of bile leakage (3/2), three stent misplacements (1/2), one pneumoperitoneum (1/0), two cases of bleeding (1/1), one perforation (1/0), and one biloma (0/1). Bile leakage was more frequently observed in patients who underwent plastic stent placement (11%) than in those with covered metal stents (4%). CONCLUSIONS: This Japanese multicenter study revealed a high success rate in EUS-BD. However, the complication rate was as high as that in previous series. Covered metal stents may be useful to reduce bile leakage in EUS-BD.

24 Article Value of cytodiagnosis using endoscopic nasopancreatic drainage for early diagnosis of pancreatic cancer: establishing a new method for the early detection of pancreatic carcinoma in situ. 2012

Iiboshi, Tomohiro / Hanada, Keiji / Fukuda, Toshikatsu / Yonehara, Shuji / Sasaki, Tamito / Chayama, Kazuaki. ·Department of Gastroenterology, JA Onomichi General Hospital, Onomichi, Japan. e-boshi@hotmail.co.jp ·Pancreas · Pubmed #22504379.

ABSTRACT: OBJECTIVES: We examined the results of pancreatic juice cytodiagnosis using the method of endoscopic nasopancreatic drainage (ENPD) to identify pancreatic carcinoma in situ and compared the images and pathologic diagnosis of pancreatic carcinoma in situ as well as clinicopathologic characteristics. METHODS: In patients who underwent endoscopic retrograde cholangiopancreatography and had ENPD place, only patients presenting with focal stenosis and distal dilatation of the main pancreatic duct were included in the ENPD placement group. Endoscopic nasopancreatic drainage was conducted 27 times in 20 patients in the ENPD placement group. In an average session, cytodiagnosis of the pancreatic juice was conducted 5.3 times (range, 2-11 times). RESULTS: Results of cytodiagnosis were positive in 15 of 20 patients. Results of ENPD cytodiagnosis and diagnosis of pancreatic cancer showed sensitivity of 100%, specificity of 83.3%, and accuracy of 95%. Seven of 15 patients were diagnosed with carcinoma in situ. In these 7 patients, tumor markers (carcinoembryonic antigen, CA-19-9) were within reference limits, and the tumors were not visible on imaging tests. Pathologic histology revealed a propensity for the cancer to proliferate around the stenosis of the pancreatic duct. CONCLUSIONS: Cytodiagnosis of pancreatic juice using ENPD multiple times proved to be useful in the diagnosis of pancreatic carcinoma in situ.

25 Article Comparison of partially covered nitinol stents with partially covered stainless stents as a historical control in a multicenter study of distal malignant biliary obstruction: the WATCH study. 2012

Isayama, Hiroyuki / Mukai, Tsuyoshi / Itoi, Takao / Maetani, Iruru / Nakai, Yousuke / Kawakami, Hiroshi / Yasuda, Ichiro / Maguchi, Hiroyuki / Ryozawa, Shomei / Hanada, Keiji / Hasebe, Osamu / Ito, Kei / Kawamoto, Hirofumi / Mochizuki, Hitoshi / Igarashi, Yoshinori / Irisawa, Atsushi / Sasaki, Tamito / Togawa, Osamu / Hara, Taro / Kamada, Hideki / Toda, Nobuo / Kogure, Hirofumi. ·Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan. ·Gastrointest Endosc · Pubmed #22482918.

ABSTRACT: BACKGROUND: Covered self-expandable metal stents (CSEMSs) were developed to prevent tumor ingrowth, but stent migration is one of the problems with CSEMSs. OBJECTIVE: To evaluate a new, commercially available CSEMS with flared ends and low axial force compared with a commercially available CSEMS without the anti-migration system and high axial force. DESIGN: Multicenter, prospective study with a historical cohort. SETTING: Twenty Japanese referral centers. PATIENTS: This study involved patients with unresectable distal malignant biliary obstruction. INTERVENTION: Placement of a new, commercially available, partially covered SEMS. MAIN OUTCOME MEASUREMENTS: Recurrent biliary obstruction rate, time to recurrent biliary obstruction, stent-related complications, survival. RESULTS: Between April 2009 and March 2010, 141 patients underwent partially covered nitinol stent placement, and between May 2001 and January 2007, 138 patients underwent placement of partially covered stainless stents as a historical control. The silicone cover of the partially covered nitinol stents prevented tumor ingrowth. There were no significant differences in survival (229 vs 219 days; P = .250) or the rate of recurrent biliary obstruction (33% vs 38%; P = .385) between partially covered nitinol stents and partially covered stainless stents. Stent migration was less frequent (8% vs 17%; P = .019), and time to recurrent biliary obstruction was significantly longer (373 vs 285 days; P = .007) with partially covered nitinol stents. Stent removal was successful in 26 of 27 patients (96%). LIMITATIONS: Nonrandomized, controlled trial. CONCLUSION: Partially covered nitinol stents with an anti-migration system and less axial force demonstrated longer time to recurrent biliary obstruction with no tumor ingrowth and less stent migration.

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