Hiroaki Yamashita

Unilateral versus bilateral endoscopic metal stenting for malignant hilar biliary obstruction.

Background and Aim:  The extent of liver drainage for palliative treatment of malignant hilar biliary obstruction is controversial. The aim of this study was to compare endoscopic unilateral versus bilateral drainage in patients with malignant hilar biliary obstruction using a self‐expanding metal stent (SEMS).

Usefulness of transpapillary bile duct brushing cytology and forceps biopsy for improved diagnosis in patients with biliary strictures

Background and Aim:  Transpapillary bile duct brushing cytology and/or forceps biopsy was performed in the presence of an indwelling guidewire in patients with biliary stricture, and the treatment time, overall diagnosis rate, diagnosis rate of each disease, complications, and influences on subsequent biliary drainage were investigated.

Predictive factors for pancreatitis and cholecystitis in endoscopic covered metal stenting for distal malignant biliary obstruction

Pancreatitis and cholecystitis are major complications after self‐expandable metal stent (SEMS) placement in distal malignant biliary obstruction. We aimed to clarify predictive factors for pancreatitis and cholecystitis after covered SEMS placement.

Clinical differences between mass-forming autoimmune pancreatitis and pancreatic cancer

Abstract Objective. Autoimmune pancreatitis (AIP) needs to be differentiated from pancreatic cancer (PC). We aimed to clarify the findings specific for AIP by comparing the clinical differences between mass-forming AIP and PC. Material and methods. We retrospectively compared 36 patients with mass-forming AIP and 60 with PC without metastasis regarding clinical, imaging, serological, histological differences and other organ involvement (OOI). We evaluated the sensitivity, specificity and accuracy of these findings for the differential diagnosis between AIP and PC. Results. The findings 100% specific for AIP were a capsule-like rim on computed tomography (CT), skipped lesion of main pancreatic duct (MPD) on endoscopic retrograde pancreatography (ERP) or magnetic resonance cholangiopancreatography (MRCP), γ-globulin > 2 g/dl, OOI (extrapancreatic biliary stricture, salivary gland swelling and retroperitoneal fibrosis) and ruling out PC by histopathological findings of endoscopic ultrasonography-guided fine-needle aspiration. The findings over 90% specific were IgG4 > 280 mg/dl (98%), IgG > 1800 mg/dl (97%), maximal diameter of upstream MPD < 5 mm on MRCP (95%) and IgG4 > 135 mg/dl (94%), respectively. Conclusions. Clinical, imaging, serological, histological findings and OOI differed between mass-forming AIP and PC. Capsule-like rim on CT, skipped lesion of MPD on ERP or MRCP, IgG4 > 280 mg/dl, and OOI were highly specific findings for AIP. These findings are useful in the differential diagnosis of mass-forming AIP from PC.

Feasibility of endoscopic retrograde cholangiopancreatography-related procedures in hemodialysis patients

The opportunities of endoscopic retrograde cholangiopancreatography (ERCP)‐related procedure for hemodialysis (HD) patients have been increasing recently. However, the complication rate of ERCPs in HD patients has not been evaluated sufficiently. We aimed to clarify the feasibility of ERCPs in HD patients.

Clinical evaluation of international consensus diagnostic criteria for type 1 autoimmune pancreatitis in comparison with Japanese diagnostic criteria 2011.

Objectives The objective of this study was to evaluate the International Consensus Diagnostic Criteria (ICDC) for type 1 autoimmune pancreatitis (AIP) in comparison with the Japanese criteria 2011 (JPS2011). Methods We retrospectively investigated the usefulness of ICDC in comparison with JPS2011 in 64 patients with AIP and 90 patients with pancreatic cancer. Results The sensitivity and specificity of ICDC for AIP were 98.4% (63/64) and 100% (90/90), respectively. The sensitivities and specificities of ductal imaging, serology, other organ involvement, and pancreatic histology were 74.1%, 89.1%, 53.1%, and 26.1% and 94.7%, 94.5%, 100%, and 100%, respectively. On the other hand, the sensitivities and specificities of JPS2011 for AIP were 84.4% (54/64) and 100% (90/90), respectively. The condition of all the 10 patients who were deniable or possible under the JPS2011 could be diagnosed as definitive AIP under the ICDC. The sensitivities and specificities of Japanese criteria 2006, Asian Diagnostic Criteria, and HISORt criteria were 80.6%, 84.4%, and 92.2% and 95.8%, 87.8%, and 100%, respectively. Conclusions The sensitivity and specificity of ICDC are higher than those of previous criteria. The JPS2011 is easy to handle for general practice, and specificity is very high. However, the sensitivity of JPS2011 is lower than that of ICDC, and improvement of sensitivity is to be hoped in the future.

Intraductal papillary mucinous neoplasm associated with autoimmune pancreatitis.

raphy from the major duodenal papilla, the DPD appeared via the loop-forming communicating duct called the ansa pancreatica (Fig. 1A). Next, the VPD ascended making a loop cranially, and it joined the DPD again (Fig. 1B). A cyst was enhanced through the DPD. Pancreatography from the minor duodenal papilla showed the entirely dilated DPD and the VPD. A second pancreatography via the catheter deeply inserted into the VPD revealed the DPD, and communication between this VPD and the DPD was clearly demonstrated using a guide wire (Fig. 1C). The DPD connected the DPD at 2 points (Fig. 1D). Both major and minor duodenal papillae were normal, and the cytology of pancreatic juice obtained from the VPD and DPD was negative. On suspicion of chronic pancreatitis or intraductal papillary mucinous neoplasm, he is currently followed up.

8-mm versus 10-mm diameter self-expandable metallic stent in bilateral endoscopic stent-in-stent deployment for malignant hilar biliary obstruction

We aimed to clarify the clinical benefits of using 8‐mm versus 10‐mm diameter self‐expandable metallic stent (SEMS) in bilateral endoscopic stent‐in‐stent (SIS) deployment for malignant hilar biliary obstruction (MHBO).

Efficacy of pancreatic stenting prior to extracorporeal shock wave lithotripsy for pancreatic stones

BACKGROUND Extracorporeal shock wave lithotripsy is the first-line therapy for large pancreatic duct stones; however, it requires a long duration of therapy. AIMS To clarify the effect of pancreatic stenting prior to extracorporeal shock wave lithotripsy on shortening the duration of therapy and reducing complications. METHODS We retrospectively compared 45 patients who underwent pancreatic stenting prior to extracorporeal shock wave lithotripsy (stenting group) and 35 patients who did not undergo stenting prior to extracorporeal shock wave lithotripsy (non-stenting group) with regard to the cumulative number of shock waves required for stone fragmentation (stone size <3mm) and the rate of complications. RESULTS The stenting group was associated with a significantly lower cumulative number of shock waves in univariate analysis (log-rank, p=0.046) and multivariate Cox proportional hazard analysis (hazard ratio, 1.88; 95% confidence interval, 1.13-3.14; p=0.015) than the non-stenting group. The frequency of pancreatitis tends to be lower in the stenting group than the non-stenting group (2.2% [1/45] vs 11.4% [4/35]; p=0.162). CONCLUSIONS Pancreatic stenting prior to extracorporeal shock wave lithotripsy reduced the cumulative number of shock waves required for pancreatic stone fragmentation, and could be useful to shorten the duration of therapy.

Persistent reflux symptoms cause anxiety, depression, and mental health and sleep disorders in gastroesophageal reflux disease patients.

Some patients with gastroesophageal reflux disease experience persistent reflux symptoms despite proton pump inhibitor therapy. These symptoms reduce their health-related quality of life. Our aims were to evaluate the relationship between proton pump inhibitor efficacy and health-related quality of life and to evaluate predictive factors affecting treatment response in Japanese patients. Using the gastroesophageal reflux disease questionnaire, 145 gastroesophageal reflux disease patients undergoing proton pump inhibitor therapy were evaluated and classified as responders or partial-responders. Their health-related quality of life was then evaluated using the 8-item Short Form Health Survey, the Pittsburgh Sleep Quality Index, and the Hospital Anxiety and Depression Scale questionnaires. Sixty-nine patients (47.6%) were partial responders. These patients had significantly lower scores than responders in 5/8 subscales and in the mental health component summary of the 8-item Short Form Health Survey. Partial responders had significantly higher Pittsburgh Sleep Quality Index and Hospital Anxiety and Depression Scale scores, including anxiety and depression scores, than those of responders. Non-erosive reflux disease and double proton pump inhibitor doses were predictive factors of partial responders. Persistent reflux symptoms, despite proton pump inhibitor therapy, caused mental health disorders, sleep disorders, and psychological distress in Japanese gastroesophageal reflux disease patients.