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Pancreatic Neoplasms: HELP
Articles by Yoshinori Igarashi
Based on 10 articles published since 2010
(Why 10 articles?)
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Between 2010 and 2020, Yoshinori Igarashi wrote the following 10 articles about Pancreatic Neoplasms.
 
+ Citations + Abstracts
1 Editorial Strategy to differentiate autoimmune pancreatitis from pancreas cancer. 2012

Takuma, Kensuke / Kamisawa, Terumi / Gopalakrishna, Rajesh / Hara, Seiichi / Tabata, Taku / Inaba, Yoshihiko / Egawa, Naoto / Igarashi, Yoshinori. · ·World J Gastroenterol · Pubmed #22416175.

ABSTRACT: Autoimmune pancreatitis (AIP) is a newly described entity of pancreatitis in which the pathogenesis appears to involve autoimmune mechanisms. Based on histological and immunohistochemical examinations of various organs of AIP patients, AIP appears to be a pancreatic lesion reflecting a systemic "IgG4-related sclerosing disease". Clinically, AIP patients and patients with pancreatic cancer share many features, such as preponderance of elderly males, frequent initial symptom of painless jaundice, development of new-onset diabetes mellitus, and elevated levels of serum tumor markers. It is of uppermost importance not to misdiagnose AIP as pancreatic cancer. Since there is currently no diagnostic serological marker for AIP, and approach to the pancreas for histological examination is generally difficult, AIP is diagnosed using a combination of clinical, serological, morphological, and histopathological features. Findings suggesting AIP rather than pancreatic cancer include: fluctuating obstructive jaundice; elevated serum IgG4 levels; diffuse enlargement of the pancreas; delayed enhancement of the enlarged pancreas and presence of a capsule-like rim on dynamic computed tomography; low apparent diffusion coefficient values on diffusion-weighted magnetic resonance image; irregular narrowing of the main pancreatic duct on endoscopic retrograde cholangiopancreatography; less upstream dilatation of the main pancreatic duct on magnetic resonance cholangiopancreatography, presence of other organ involvement such as bilateral salivary gland swelling, retroperitoneal fibrosis and hilar or intrahepatic sclerosing cholangitis; negative work-up for malignancy including endoscopic ultrasound-guided fine needle aspiration; and steroid responsiveness. Since AIP responds dramatically to steroid therapy, accurate diagnosis of AIP can avoid unnecessary laparotomy or pancreatic resection.

2 Review Autoimmune pancreatitis and IgG4-related sclerosing cholangitis. 2011

Takuma, Kensuke / Kamisawa, Terumi / Igarashi, Yoshinori. ·Department of Internal Medicine, Tokyo Metropolitan Komagome Hospital, Bunkyo-ku, Tokyo, Japan. ·Curr Opin Rheumatol · Pubmed #21124090.

ABSTRACT: PURPOSE OF REVIEW: Autoimmune pancreatitis (AIP) is a peculiar type of pancreatitis with a presumed autoimmune etiology. AIP is frequently associated with stenosis of the bile duct in the form of IgG4-related sclerosing cholangitis. This article reviews recent advances in clinicopathological findings for AIP and IgG4-related sclerosing cholangitis. RECENT FINDINGS: AIP is currently diagnosed based on characteristic radiological findings (irregular narrowing of the main pancreatic duct and enlargement of the pancreas) in combination with serological findings (elevated serum IgG4 and presence of autoantibodies) and histopathological findings (dense infiltration of IgG4-positive plasma cells and lymphocytes with fibrosis and obliterative phlebitis in the pancreas). Other clinical characteristics include preponderance toward elderly men, common initial symptoms of obstructive jaundice, and favorable response to steroid therapy. Differentiation of AIP from pancreatic cancer is crucial. As AIP is frequently associated with various sclerosing extrapancreatic lesions showing the same peculiar histological findings seen in the pancreas, AIP is currently considered to represent a pancreatic manifestation of IgG4-related sclerosing disease. Considering the age of onset, associated diseases, cholangiography, serum IgG4 levels, and steroid responsiveness, IgG4-related sclerosing cholangitis differs from primary sclerosing cholangitis. SUMMARY: AIP and associated extrapancreatic lesions are considered to represent clinical manifestations of IgG4-related sclerosing disease.

3 Article Comparison between the location and the histomorphological/immunohistochemical characteristics of noninvasive neoplasms of the ampulla of Vater. 2014

Yamamoto, Yoshiro / Nemoto, Tetsuo / Okubo, Yoichiro / Nihonyanagi, Yasuhiro / Ishiwatari, Takao / Takuma, Kensuke / Tochigi, Naobumi / Okano, Naoki / Wakayama, Megumi / Igarashi, Yoshinori / Shibuya, Kazutoshi. ·Department of Surgical Pathology, Toho University School of Medicine, Ota-ku, Tokyo 143-8541, Japan; Division of Gastroenterology and Hepatology, Department of Internal Medicine, Toho University Omori Medical Center, Ota-ku, Tokyo 143-8541, Japan. · Department of Surgical Pathology, Toho University School of Medicine, Ota-ku, Tokyo 143-8541, Japan. Electronic address: tetsuo.nemoto@med.toho-u.ac.jp. · Department of Surgical Pathology, Toho University School of Medicine, Ota-ku, Tokyo 143-8541, Japan. · Division of Gastroenterology and Hepatology, Department of Internal Medicine, Toho University Omori Medical Center, Ota-ku, Tokyo 143-8541, Japan. ·Hum Pathol · Pubmed #25081540.

ABSTRACT: To determine useful factors when selecting an appropriate procedure for noninvasive ampullary neoplasia, we investigated the relationship between the location and the histomorphological/immunohistochemical characteristics of 56 noninvasive ampullary neoplasms obtained by endoscopic papillectomy (EP). All subjects were classified according to histomorphology and location of neoplasms, and we evaluated the characteristics of each classified group using complementary immunohistochemical procedures. The CK20-positive rates of each location type were also evaluated. Subjects presented with 52 intestinal-type adenomas (low/high grade, 32:20) and 4 noninvasive pancreatobiliary papillary neoplasms (low/high grade, 1:3). Twenty-seven periampullary (peri-AMP)-type tumors and 23 extended-type tumors comprised the intestinal type, and the intra-ampullary (intra-AMP) type was composed of 4 pancreatobiliary and 2 intestinal histomorphological types. The CK20-positive rates of these 3 location types differed significantly (peri-AMP type, 50.6% ± 21.0%; extended type, 35.4% ± 18.6%; intra-AMP type, 6.9% ± 6.3%). The CK20-positive rate for intestinal-type tumors of the intra-AMP location type was lower than that of the peri-AMP location type. Intestinal-type tumors without CDX2 expression included extended and intra-AMP types, which are tumors that may show positive vertical margins when EP is performed. In this study, we found that an understanding of pancreatobiliary-type histology is an important aspect for the investigation of tumors involving the common channel of the ampulla. Furthermore, immunostaining of CDX2 and CK20 provides beneficial information if considering whether to perform an EP.

4 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.

5 Article Results of a Japanese multicenter, randomized trial of endoscopic stenting for non-resectable pancreatic head cancer (JM-test): Covered Wallstent versus DoubleLayer stent. 2011

Isayama, Hiroyuki / Yasuda, Ichiro / Ryozawa, Shomei / Maguchi, Hiroyuki / Igarashi, Yoshinori / Matsuyama, Yutaka / Katanuma, Akio / Hasebe, Osamu / Irisawa, Atsushi / Itoi, Takao / Mukai, Hidekazu / Arisaka, Yoshifumi / Okushima, Kazumu / Uno, Koji / Kida, Mitsuhiro / Tamada, Kiichi. ·Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan. isayama-tky@umin.ac.jp ·Dig Endosc · Pubmed #21951091.

ABSTRACT: BACKGROUND: No study has compared covered metallic stents with Tannenbaum stents. We evaluated the efficacy of the DoubleLayer stent (DLS) and Covered Wallstent (CWS) in patients with pancreatic head cancer (PHC). PATIENTS & METHODS: This was a multicenter, prospective randomized study. Between October 2005 and December 2007, we enrolled 113 patients (58 DLS, 55 CWS) with unresectable PHC with distal biliary obstructions and observed them for at least 6 months. RESULTS: No significant difference in patient survival was found between groups, with a median survival of 231 and 248 days in the DLS and CWS groups, respectively. The cumulative stent patency was significantly higher (P = 0.0072) in the CWS group. The respective mean and median stent patency was 202 and 133 days in the DLS group and 285 and 419 days in the CWS group. The incidence of DLS occlusion (53.5%) was significantly higher than that of CWS (23.6%; P = 0.0019). The respective causes of occlusion were tumor overgrowth (0, 1), ingrowth (0, 2), sludge (24, 2), food impaction (3, 5), kinking bile duct (2, 0), and other (2, 3). Other complications were cholecystitis (0, 4), pancreatitis (0, 1), migration (1, 5), liver abscess (2, 0), and other (1, 2). No significant difference in the incidence of complications between groups was observed. CONCLUSION: CWS had significantly longer patency than DLS for the management of PHC with obstructive jaundice. The incidence of complications other than stent occlusion was higher in CWS, but this difference did not reach significance.

6 Article Utility of pancreatography for diagnosing autoimmune pancreatitis. 2011

Takuma, Kensuke / Kamisawa, Terumi / Tabata, Taku / Inaba, Yoshihiko / Egawa, Naoto / Igarashi, Yoshinori. ·Department of Internal Medicine, Tokyo Metropolitan Komagome Hospital, Tokyo 113-8677, Japan. ·World J Gastroenterol · Pubmed #21633599.

ABSTRACT: AIM: To identify pancreatographic findings that facilitate differentiating between autoimmune pancreatitis (AIP) and pancreatic cancer (PC) on endoscopic retrograde cholangiopancreatography (ERCP) and magnetic resonance cholangiopancreatography (MRCP). METHODS: ERCP findings of 48 AIP and 143 PC patients were compared. Diagnostic accuracies for AIP by ERCP and MRCP were compared in 30 AIP patients. RESULTS: The following ERCP findings suggested a diagnosis of AIP rather than PC. Obstruction of the main pancreatic duct (MPD) was more frequently detected in PC (P < 0.001). Skipped MPD lesions were detected only in AIP (P < 0.001). Side branch derivation from the narrowed MPD was more frequent in AIP (P < 0.001). The narrowed MPD was longer in AIP (P < 0.001), and a narrowed MPD longer than 3 cm was more frequent in AIP (P < 0.001). Maximal diameter of the upstream MPD was smaller in AIP (P < 0.001), and upstream dilatation of the MPD less than 5 mm was more frequent in AIP (P < 0.001). Stenosis of the lower bile duct was smooth in 87% of AIP and irregular in 65% of PC patients (P < 0.001). Stenosis of the intrahepatic or hilar bile duct was detected only in AIP (P = 0.001). On MRCP, diffuse narrowing of the MPD on ERCP was shown as a skipped non-visualized lesion in 50% and faint visualization in 19%, but segmental narrowing of the MPD was visualized faintly in only 14%. CONCLUSION: Several ERCP findings are useful for differentiating AIP from PC. Although MRCP cannot replace ERCP for the diagnostic evaluation of AIP, some MRCP findings support the diagnosis of AIP.

7 Article Predictors of malignancy and natural history of main-duct intraductal papillary mucinous neoplasms of the pancreas. 2011

Takuma, Kensuke / Kamisawa, Terumi / Anjiki, Hajime / Egawa, Naoto / Kurata, Masanao / Honda, Goro / Tsuruta, Koji / Horiguchi, Shin-Ichiro / Igarashi, Yoshinori. ·Department of Internal Medicine, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan. ·Pancreas · Pubmed #21206326.

ABSTRACT: OBJECTIVES: Because the prevalence of carcinoma is high in main-duct intraductal papillary mucinous neoplasms (IPMNs) of the pancreas, surgical resection is recommended for all main-duct type IPMNs. This study aimed to investigate the clinical predictors of malignancy and natural history of main-duct IPMNs. METHODS: Preoperative clinical characteristics reliably correlated with malignancy in 26 surgically resected patients with main-duct IPMN, and long-term outcome in 20 conservatively followed patients with main-duct IPMN was examined. RESULTS: Age at diagnosis was significantly older in conservatively followed IPMN patients than in surgically resected IPMN patients. Main pancreatic duct (MPD) dilatation 10 mm or greater and mural nodules were significantly more frequent in malignant IPMNs. Obvious progression of dilatation of the MPD was detected in all 4 conservatively followed patients who developed invasive pancreatic carcinoma. The histology of IPMN at autopsy of 4 conservatively followed patients who died of other causes 21 to 120 months later was adenoma. Seven conservatively followed without malignant findings did not show obvious progression of MPD dilatation. CONCLUSIONS: Although surgical resection is indicated for many main-duct IPMNs, conservative follow-up may be an option for elderly asymptomatic patients with main-duct IPMNs with the MPD less than 10 mm, no obvious mural nodule, and negative cytology.

8 Article [Elastase-1]. 2010

Miura, Tomihiro / Makino, Hiroyuki / Yamamuro, Wataru / Igarashi, Yoshinori / Miki, Kazumasa. ·Division of Gastroenterology and Hepatology, Department of Internal Medicine, Saiseikai Yokohamashi Tobu Hospital. ·Nihon Rinsho · Pubmed #20960867.

ABSTRACT: -- No abstract --

9 Article Pancreatic diseases associated with pancreas divisum. 2010

Takuma, Kensuke / Kamisawa, Terumi / Tabata, Taku / Egawa, Naoto / Igarashi, Yoshinori. ·Department of Internal Medicine, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan. ·Dig Surg · Pubmed #20551661.

ABSTRACT: AIM: To clarify the features of acute or chronic pancreatitis and pancreatic tumors associated with complete and incomplete pancreas divisum. METHODS: Clinical features of pancreatic diseases associated with complete (n = 54) and incomplete (n = 50) pancreas divisum were examined. RESULTS: Acute and chronic pancreatitis occurred more frequently in patients with complete pancreas divisum (22.2%: 12/54, and 18.5%: 10/54, respectively) than in controls (5.6%: 183/3,246, and 4.9%: 159/3,246, respectively; p < 0.01). In 8 patients with chronic pancreatitis, the dorsal pancreatic duct was irregularly dilated from the orifice to the tail, whereas the ventral pancreatic duct was not dilated (isolated dorsal pancreatitis). None of the 12 complete pancreas divisum patients with acute pancreatitis consumed heavy or moderate amounts of alcohol. Although 6 of 10 patients with chronic pancreatitis consumed heavy or moderate amounts of alcohol, 31 of 32 patients with this malformation who did not exhibit pancreatitis consumed little or no alcohol. Chronic pancreatitis occurred more frequently in patients with incomplete pancreas divisum (18.0%: 9/50) than in controls (4.9%: 159/3,246; p < 0.01). Of 54 patients with complete pancreas divisum, 6 patients (11.1%) were associated with pancreatic tumor. All tumors developed from the dorsal pancreas of pancreas divisum. CONCLUSIONS: Complete pancreas divisum can be the sole etiology of acute or chronic pancreatitis. The presence of another factor, such as alcohol abuse, may be required for chronic pancreatitis to develop in some patients with complete or incomplete pancreas divisum. In complete pancreas divisum, the dorsal pancreatic duct might be a factor that promotes oncogenesis.

10 Article Endoscopic diagnosis of intraductal papillary-mucinous neoplasm of the pancreas by means of peroral pancreatoscopy using a small-diameter videoscope and narrow-band imaging. 2010

Miura, Tomihiro / Igarashi, Yoshinori / Okano, Naoki / Miki, Kazumasa / Okubo, Yoichiro. ·Department of Internal Medicine, Toho University Omori Medical Center, Omorinishi, Ohta-ku, Tokyo, Japan. t_miura@tobu.saiseikai.or.jp ·Dig Endosc · Pubmed #20447205.

ABSTRACT: BACKGROUND: Intraductal papillary-mucinous neoplasm (IPMN) is an intraductal tumor in which the mucin-producing epithelium shows proliferated papillary and a wide variety of pathological changes ranging from hyperplasia to adenocarcinoma. Therefore, it is important to determine whether an IPMN is benign or malignant. In the present study of patients with IPMN, the protrusion was observed by a peroral pancreatoscopy (PPS) using a small-diameter videoscope and narrow-band imaging (NBI). We carried out the differential diagnosis of benign lesion to malignant lesion. METHODS: Between April 2003 and May 2009, PPS using a small-diameter videoscope by means of NBI was carried out on 21 hospitalized patients with IPMN (10 cases of adenocarcinoma, 11 cases of adenoma or hyperplasia; 14 males and seven females, with a mean age of 69.4 years). RESULTS: Fifteen focal lesions of the 16 cases in the head of the pancreas (93.7%) and four focal lesions of the five cases in the pancreatic body (80%) were observable, whereas two lesions (adenocarcinoma in the pancreatic body, and adenoma in the uncus of pancreas) were not observable. Endoscopically, seven cases were classified as villous type and two cases as vegetative type, and nine cases were diagnosed as adenocarcinoma. Ten cases with sessile type or semipedunculated type were diagnosed as adenoma or hyperplasia. Vascular patterns and protrusions were detected more clearly in the NBI images than under white light observation. CONCLUSIONS: When combined with a videoscope and NBI, pancreatoscopy provided a clear image and was useful for evaluating whether the IPMN was benign or malignant.