Junichi Shimura

Endosonographic diagnosis of intraductal papillary‐mucinous pancreatic tumors by intraductal ultrasonography

Background:  Intraductal papillary‐mucinous pancreatic tumors (IPMT) are intraductal lesions formed by mucin‐producing epithelium, which proliferates in a papillary pattern, and presents a spectrum from hyperplasia to adenocarcinoma. The value of intraductal ultrasonography (IDUS) for excluding malignancy has not been assessed in a case series previously.

ENDOSCOPIC STENTING OF DISTAL MALIGNANT BILIARY OBSTRUCTION

a plastic stent.8 In later stage EBS, a comparison between the size and the patency of 10Fr, 12Fr and 14Fr plastic stents (Olympus Optical Co.), used to treat malignant strictures due to pancreatic carcinoma, found that larger stent size was positively correlated with longer time periods of stent patency (10Fr, 87 days; 12Fr, 105 days; 14Fr, 136 days). Because clogging often occurred at the side hole of plastic stents, the absence of a side hole led to better stent patency.7 Teflon accrued significantly less sludge than polyurethane and all other materials that were tested. Smoother lumen surfaces are associated with less clogging of plastic stents. Clogging is generally due to protein, blood or sludge, and before stent occlusion, small INTRODUCTION

CURRENT STATE OF SELF‐EXPANDABLE METALLIC STENT PLACEMENT FOR GASTRIC OUTLET OBSTRUCTION

Self‐expandable metallic stents are being used increasingly to maintain luminal patency in patients with unresectable gastric outlet obstruction. Stent technology has facilitated placement of the stent in the pyloric or duodenal obstruction. An example of advances in technology is the innovative through‐the‐scope (TTS) stent, which is not yet commercially available in Japan. Enteral stents provide a high success rate, quick relief from symptoms, and an improvement in the performance score, although some complications remain. This article reviews the current status of stent placement for gastric outlet obstructions. The self‐expandable metallic stent seems to provide a potentially attractive alternative to surgical bypass, since most of these patients are terminally ill with a limited life expectancy. Available data is currently insufficient to clarify the use of stents for gastric outlet obstructions, therefore a prospective randomized comparison is required to compare this procedure with surgical alternatives.

Evaluation by biliary scintigraphy of recurrence of choledocholithiasis after endoscopic sphincterotomy

Background:   It is difficult to predict recurrence of choledocholithiasis after endoscopic sphincterotomy (EST). Because cholestasis is considered to cause recurrence of choledocholithiasis, it may be possible to predict recurrence by objective evaluation of cholestasis. The aim of the present study was to examine the relationship between cholestasis and recurrence of choledocholithiasis by biliary scintigraphy in post‐EST cases.