Harutoshi Sugiyama

Comparison of the diagnostic accuracy of peroral video-cholangioscopic visual findings and cholangioscopy-guided forceps biopsy findings for indeterminate biliary lesions: a prospective study

BACKGROUND The diagnostic accuracy of peroral video-cholangioscopy for indeterminate biliary lesions has not been determined in a prospective study. OBJECTIVE To evaluate and compare the diagnostic accuracy of the peroral video-cholangioscopic visual findings for indeterminate biliary lesions with that of the cholangioscopy-guided forceps biopsy findings. DESIGN Prospective cohort study. SETTING Tertiary-care referral center. PATIENTS Patients who showed indeterminate biliary lesions on endoscopic retrograde cholangiography underwent peroral video-cholangioscopy for diagnosis. INTERVENTION Each patient underwent peroral video-cholangioscopy with cholangioscopy-guided forceps biopsy. MAIN OUTCOME MEASUREMENTS The accuracy of diagnosis by the peroral video-cholangioscopic visual findings and cholangioscopy-guided forceps biopsy findings compared with that of the final diagnosis by other methods (malignant or benign). RESULTS Thirty-three patients were enrolled, and the final diagnoses revealed that the lesions were malignant in 21 patients. All procedures were technically successful, and fine views were obtained in all patients. Procedure-related complications occurred in 2 patients (6.1%), but these complications were mild. The sensitivity, specificity, and accuracy were 100%, 91.7%, and 97.0%, respectively, for the peroral video-cholangioscopic visual findings and 38.1%, 100%, and 60.6%, respectively, for the cholangioscopy-guided forceps biopsy findings, and a significant difference was observed in the accuracy (P = .0018). LIMITATIONS This was not a blinded study. No comparison was made with other diagnostic modalities involving tissue sampling. CONCLUSION The diagnostic accuracy of the peroral video-cholangioscopic visual findings for indeterminate biliary lesions was excellent and significantly higher than that of the cholangioscopy-guided forceps biopsy findings. The accuracy of the cholangioscopy-guided forceps biopsy was insufficient, but the technique had an excellent specificity.

Clinical utility of intraductal US to decrease early recurrence rate of common bile duct stones after endoscopic papillotomy

Background and Aim:  The aim of the present study was to determine whether additional intraductal ultrasound (IDUS) to confirm complete stone clearance decreases the recurrence rate of common bile duct stones for a 3‐year period after endoscopic papillotomy (EPT).

Use of F-18 Fluorodeoxyglucose Positron Emission Tomography With Dual-Phase Imaging to Identify Intraductal Papillary Mucinous Neoplasm

BACKGROUND & AIMS We investigated the usefulness of dual-phase F-18 fluorodeoxyglucose positron emission tomography with computed tomography (FDG-PET/CT) to differentiate benign from malignant intraductal papillary mucinous neoplasms (IPMNs) and to evaluate branch-duct IPMNs. METHODS We used FDG-PET/CT to evaluate IPMNs in 48 consecutive patients who underwent surgical resection from May 2004 to March 2012. IPMNs were classified as benign (n = 16) or malignant (n = 32) on the basis of histology analysis. The ability of FDG-PET/CT to identify branch-duct IPMNs was compared with that of the International Consensus Guidelines. RESULTS The maximum standardized uptake value (SUVmax) was higher for early-phase malignant IPMNs than that for benign IPMNs (3.5 ± 2.2 vs 1.5 ± 0.4, P < .001). When the SUVmax cutoff value was set at 2.0, early-phase malignant IPMNs were identified with 88% sensitivity, specificity, and accuracy. The retention index values for malignant and benign IPMNs were 19.6 ± 17.8 and -2.6 ± 12.9, respectively. When the SUVmax cutoff was set to 2.0 and the retention index value to -10.0, early-phase malignant IPMNs were identified with 88% sensitivity, 94% specificity, and 90% accuracy. In identification of branch-duct IPMNs, when the SUVmax cutoff was set to 2.0, the sensitivity, specificity, and accuracy values were 79%, 92%, and 84%, respectively. By using a maximum main pancreatic duct diameter ≥7 mm, the Guidelines identified branch-duct IPMNs with greater specificity than FDG-PET/CT. The Guidelines criteria of maximum cyst size ≥30 mm and the presence of intramural nodules identified branch-duct IPMNs with almost equal sensitivity to FDG-PET/CT. CONCLUSIONS Dual-phase FDG-PET/CT is useful for preoperative identification of malignant IPMN and for evaluating branch-duct IPMN.

Ten-year long-term results after non-surgical management of hepatolithiasis, including cases with choledochoenterostomy.

Long‐term follow‐up of non‐surgical procedures for the management of hepatolithiasis has been reported, but risk factors for mortality have not been properly evaluated.

LONG-TERM OUTCOME OF ENDOSCOPIC PAPILLOTOMY FOR CHOLEDOCHOLITHIASIS WITH CHOLECYSTOLITHIASIS

Aim:  To assess long‐term outcome of endoscopic papillotomy alone without subsequent cholecystectomy in patients with choledocholithiasis and cholecystolithiasis.

Preoperative assessment of longitudinal extension of cholangiocarcinoma with peroral video-cholangioscopy: A prospective study

Preoperative assessment of longitudinal extension of cholangiocarcinoma (CCA) is essential for making decisions concerning surgical resection and selecting operative procedures. We evaluated the accuracy of peroral video‐cholangioscopy (PVCS) in diagnosing longitudinal extension of CCA.

Diagnostic value of magnetic resonance cholangiopancreatography for clinically suspicious spontaneous passage of bile duct stones.

Background and Aim:  We investigated the usefulness of magnetic resonance cholangiopancreatography (MRCP) and the need for endoscopic retrograde cholangiopancreatography (ERCP) in patients with clinically suspicious spontaneous passage of bile duct stones.

Efficacy of stone density on noncontrast computed tomography in predicting the outcome of extracorporeal shock wave lithotripsy for patients with pancreatic stones.

Objectives Patients with chronic pancreatitis are managed by extracorporeal shock wave lithotripsy (ESWL) for pancreatic stones. Stone density on noncontrast computed tomography (NCCT) is used to predict stone composition and fragility, but no report investigating the pancreatic stone density has been documented. We aimed to assess the usefulness of pancreatic stone density on NCCT in predicting the ESWL outcome. Methods We evaluated 128 consecutive patients with pancreatic stones who underwent ESWL. Pancreatic stone density on NCCT was measured in Hounsfield units. Patients with complete stone removal were compared with those with incomplete stone removal. Patient characteristics; imaging findings, including stone density; and interventions were evaluated as potential predictors. The optimal cutoff value of variables to differentiate complete removal from incomplete removal was determined by receiver operating characteristic analysis. Results Complete stone removal was achieved in 66 patients (51.6%). When the density threshold was set at 820.5 Hounsfield units, complete stone removal was achieved in 52 patients (78.8%) with lower-density stones. In multivariate analysis, single stone (P = 0.007) and lower-density stone (P < 0.001) revealed significant association with complete stone removal. Conclusions The measurement of pancreatic stone density before therapy can help predict therapeutic outcomes.

Factors affecting the accuracy of endoscopic transpapillary sampling methods for bile duct cancer

Various methods for endoscopic transpapillary sampling have been developed. However, the factors affecting the accuracy of these methods for bile duct cancer are unknown. The aim of the present study was to determine the factors affecting the accuracy of endoscopic transpapillary sampling methods.

Old age is associated with increased severity of complications in endoscopic biliary stone removal.

Various techniques are required in endoscopic biliary stone removal. Because the presence of biliary stones is a benign disease, it is essential to minimize procedure‐related complications. Having a sound knowledge of the risk factors can help reduce the number and severity of complications. We determined the risk factors for complications in patients undergoing endoscopic biliary stone removal.