Kazunaga Ishigaki

Indications for endoscopic ultrasonography (EUS)-guided biliary intervention: Does EUS always come after failed endoscopic retrograde cholangiopancreatography?

Endoscopic ultrasonography‐guided biliary drainage (EUS‐BD), first reported as an alternative to percutaneous transhepatic biliary drainage (PTBD) after failed endoscopic retrograde cholangiopancreatography (ERCP), is increasingly reported as a primary procedure without failed ERCP. The present study aims to evaluate the outcomes of therapeutic biliary ERCP and to compare the safety and effectiveness of primary EUS‐BD with those of ERCP, rescue EUS‐BD and PTBD.

Prevalence of Pancreatic Cystic Lesions Is Associated With Diabetes Mellitus and Obesity: An Analysis of 5296 Individuals Who Underwent a Preventive Medical Examination

Objectives Pancreatic cystic lesions (PCLs) are considered precursors of pancreatic cancer. Diabetes mellitus (DM) and obesity are known as risk factors for pancreatic cancer. We investigated the prevalence of PCLs in the general population and the relationship between PCLs and DM/obesity. Methods This cross-sectional analysis included 5296 individuals who underwent a preventive medical examination between October 2006 and June 2013 at our institution. Magnetic resonance imaging, including magnetic resonance cholangiopancreatography, was performed using a 3.0-T system as part of a comprehensive health screening program. We investigated the prevalence and risk factors of PCLs. Results The prevalence of PCLs was 13.7%, which was increased according to age. Individuals with PCLs were more prone to obesity (body mass index, 24.0 vs 23.7 kg/m2 [P = 0.015]; waist circumference, 87.4 vs 85.5 cm [P < 0.001]). DM was more prevalent in individuals with PCLs (18.4% vs 10.5%, P < 0.001). In a multivariate analysis, age (odds ratio [OR], 1.06; P < 0.001), excess body mass index (OR, 1.26; P = 0.039), and DM (OR, 1.39; P = 0.005) were associated with PCLs. Conclusions The prevalence of PCLs detected by magnetic resonance imaging in a preventive medical examination was 13.7%. Pancreatic cystic lesions were significantly associated with DM and obesity.

Thromboembolisms in Advanced Pancreatic Cancer: A Retrospective Analysis of 475 Patients

OBJECTIVES Pancreatic cancer is reported to be highly associated with thromboembolism (TE). The aim of this analysis is to clarify risk factors for TE and its clinical impact in Japanese patients with pancreatic cancer. METHODS Data on consecutive pancreatic cancer patients receiving systemic chemotherapy between August 1999 and July 2015 were retrospectively studied. Both symptomatic and asymptomatic, arterial and venous TEs were included in the analysis. Risk factors for TE development were analyzed using a proportional hazards model with death without TE as a competing risk. The impact of TE on survival was also evaluated using a time-dependent covariate multiple Cox model. RESULTS A total of 475 patients were included in the analysis, and 57 TEs (12%) were identified: 45 venous TEs and 12 arterial TEs. The median time to TE was 169 days and the median survival from TE was 65 days. Liver metastasis was the only significant risk factor for TE (subdistribution hazards ratio, 2.15; P = 0.01), and TE was significantly associated with poor prognosis (hazards ratio, 3.31; P < 0.01). CONCLUSIONS Thromboembolism was not uncommon in Japanese patients receiving chemotherapy for advanced pancreatic cancer and was associated with poor prognosis. Liver metastasis was the risk factor for TE.Objectives Pancreatic cancer is reported to be highly associated with thromboembolism (TE). The aim of this analysis is to clarify risk factors for TE and its clinical impact in Japanese patients with pancreatic cancer. Methods Data on consecutive pancreatic cancer patients receiving systemic chemotherapy between August 1999 and July 2015 were retrospectively studied. Both symptomatic and asymptomatic, arterial and venous TEs were included in the analysis. Risk factors for TE development were analyzed using a proportional hazards model with death without TE as a competing risk. The impact of TE on survival was also evaluated using a time-dependent covariate multiple Cox model. Results A total of 475 patients were included in the analysis, and 57 TEs (12%) were identified: 45 venous TEs and 12 arterial TEs. The median time to TE was 169 days and the median survival from TE was 65 days. Liver metastasis was the only significant risk factor for TE (subdistribution hazards ratio, 2.15; P = 0.01), and TE was significantly associated with poor prognosis (hazards ratio, 3.31; P < 0.01). Conclusions Thromboembolism was not uncommon in Japanese patients receiving chemotherapy for advanced pancreatic cancer and was associated with poor prognosis. Liver metastasis was the risk factor for TE.

Risk factor of thrombosis and impact on prognosis in patients with pancreatic cancer receiving chemotherapy.

218 Background: Thromboembolism (TE) is common in cancer patients, and pancreatic cancer is reported to be highly associated with TE. The aim of this analysis is to clarify risk factors for TE and its clinical impact in pancreatic cancer patients. Methods: Data on consecutive pancreatic cancer patients receiving systemic chemotherapy between August 1999 and July 2015 were retrospectively studied. The diagnosis of TE was made on CT scan either performed for suspicious symptoms of TE or for evaluation of chemotherapy response, and TE was classified into two groups: arterial events including coronary artery disease (CAD), cerebrovascular disease and other artery thrombosis, and venous events including deep vein thrombosis/pulmonary embolism (DVT/PE), portal vein thrombosis (PVT) and IVC thrombosis. Overall survival and time to TE (TTE) were calculated by Kaplan-Meier analysis. Risk factors for TE development were analyzed using a Cox proportional hazards model. To evaluate the impact of TE on survival, multi...