Eiji Miyata

Randomized crossover trial comparing EUS-guided fine-needle aspiration with EUS-guided fine-needle biopsy for gastric subepithelial tumors

The purpose of this study is to compare the diagnostic yield of endoscopic ultrasound (EUS)‐guided fine‐needle aspiration (EUS‐FNA) and EUS‐guided fine‐needle biopsy (EUS‐FNB) for gastric subepithelial tumors (SET).

Endoscopic ultrasonography diagnosis of subepithelial lesions

Using endoscopic ultrasonography (EUS), it is practicable to diagnose subepithelial lesions (SEL) with originating layer, echo level, and internal echo pattern etc. Lipoma, lymphangioma, and cyst have characteristic features; therefore, there is no need for endoscopic ultrasound‐guided fine‐needle aspiration (EUS‐FNA). Ectopic pancreas and glomus tumors, which originate from the third and fourth layers, are frequently seen in the antrum. However, ectopic pancreas located in the fundus or body is large and originates from the third and fourth layers (thickening of fourth layer). Each subepithelial lesion has characteristic findings. However, imaging differentiation of tumors originating from the fourth layer is very difficult, even if contrast echo is used. Therefore, EUS‐FNA should be done in these tumors, but the diagnostic yield for small lesions is not sufficient for clinical demands. Generally, those tumors, including small ones, should be first followed up in 6 months, then yearly follow up in cases of no significant change in size and features. When those tumors become larger than 1–2 cm, EUS‐FNA is recommended. Furthermore, unusual SEL and SEL with malignant findings such as nodular, heterogeneous, anechoic area, and ulceration indicate EUS‐FNA. Cap‐attached forward‐viewing echoendoscope is very helpful for EUS‐FNA of small SEL.

Influence of cholangitis after preoperative endoscopic biliary drainage on postoperative pancreatic fistula in patients with middle and lower malignant biliary strictures

Preoperative cholangitis after preoperative drainage has been reported to increase postoperative complications, particularly pancreatic fistula. We therefore examined the effects of cholangitis after preoperative endoscopic biliary drainage (EBD) on postoperative pancreatic fistula in patients with middle and lower malignant biliary strictures.

The large-balloon occupation technique: a new technique for removing multiple biliary stones from a large-diameter bile duct

Multiple stones, a periampullary diverticulum, and advanced patient age are factors that contribute to difficulty in stone removal [1]. We were able to completely remove the bile duct stones in a 93-year-old woman with a periampullary diverticulum, multiple stones (about 100), and common bile duct of 35mm in diameter using the large-balloon occupation technique (LBOT). The patient visited our hospital because of abdominal pain, and gallstone pancreatitis was diagnosed. Computed tomography (CT) scanning showed about 100 stones in the bile duct (▶Fig. 1) and an impacted stone in the papilla. Emergency endoscopic biliary drainage was therefore performed. After the patient’s pancreatitis had improved, endoscopic lithotripsy was performed. Endoscopic retrograde cholangiography (ERC) showed a markedly dilated bile duct (35mm) and many filling defects with diameters of 3–12mm (▶Fig. 2). At the first session of endoscopic lithotripsy, we were unable to E-Videos