Masanori Kuroiwa

New technique using intraductal ultrasonography for the diagnosis of bile duct cancer

We investigated the extent to which BDca can be visualized and diagnosed via a percutaneous fistula using IDUS. IDUS was performed in 42 cases, including 15 of normal bile ducts; 12 of choledocholithiasis, and 15 of BDca. The depth of invasion of the BDca was diagnosed with a 93% accuracy rate by visualizing the EP or MA or both. The infiltration of BDca into the surrounding organs was clearly visualized and diagnosed with an accuracy of 100% in the RHA, 93% in the PV, and 93% in the pancreas. These accuracy rates were higher than those obtained by computed tomography or angiography. We believe, therefore, that IDUS should be further studied as a diagnostic modality for staging malignancy in the biliary field.

Intraductal ultrasonography for the examination of duodenal papillary region.

The purpose of this study was to provide basic criteria for interpreting images of the normal duodenal papillary region obtained by intraductal ultrasonography at the frequency of 20 MHz. Our in vitro examination of autopsy specimens from 15 patients revealed that the images could be classified into three patterns according to the spatial relationships between the duodenal muscularis propria and the bile duct, or the common duct. Oddis muscle was clearly demonstrated surrounding the mucosa of the bile duct or the common duct, which was visualized as a hypoechoic layer. The images obtained using in vivo examination of 60 patients with pancreato‐biliary disease via either the percutaneous or the peroral approach were similar to the images obtained in vitro. In eight patients with cancer of the papilla of Vater, the tumor was demonstrated clearly on intraductal sonograms. The intraductal imaging features of the normal papillary region were clarified, and the clinical usefulness of this technique in the evaluation of the tumor extent in patients with cancer of the papilla of Vater is suggested.

Intraductal ultrasonography for the diagnosis of proximal invasion in extrahepatic bile duct cancer

Intraductal ultrasonograpy (IDUS) was performed on 22 patients with extrahepatic bile duct cancer, using the percutaneous transhepatic approach. Intraductal ultrasonograpy images of the proximal invasion of the bile duct cancer were defined. In addition, three patients were examined through the peroral approach, to try to diagnose whether or not the cancer invaded to the bifurcation of the hepatic duct. Intraductal ultrasonograpy images obtained through the percutaneous approach could be classified into three patterns, types 1, 2 and 3, according to the features of the interior surface of the bile duct and the thickness of the bile duct wall. Type 1 images, which did not show protrusions into the bile duct lumen and had a bile duct wall of even thickness, were not likely to show bile duct cancer. Type 2 images showed protrusions of the tumour into the bile duct lumen and the surfaces of the protrusions were irregular. Type 3 images showed single or multiple low echoic papillary masses in the bile duct. Using the peroral technique, we considered all three cases to be type 1 and could diagnose that cancer had not invaded to the bifurcation of the hepatic ducts. From the results of this study, we suggest that proximal invasion of extrahepatic bile duct cancer can be diagnosed using IDUS.

New Endoscopic Approach to Diagnosing Pancreatic Diseases Using an Intraductal Ultrasound System

Abstract: We found that pancreatic diseases can be accurately visualized and diagnosed from the main pancreatic duct via the major papilla using an intraductal ultrasound (IDUS) catheter at a frequency of 30 MHz to create a 360 real‐time image. Herein we present the problems and potential future development of the IDUS system in visualizing pancreatic diseases. The clinical application of the IDUS was evaluated in 16 patients with pancreatic diseases (3 with pancreatic cancer, 6 with a mucin‐producing tumor and 7 with chronic pancreatitis). Insertion was successful in all 4 patients (100%) with a wide‐open orifice and in 9 out of 12 patients (75%) with a normal orifice.

Endoscopic diagnosis of ileocecal mucosa-associated lymphoid tissue lymphoma ☆ ☆☆

Mucosa-associated lymphoid tissue lymphoma (MALT lymphoma) is a distinctive type of B-cell lymphoma that arises from mucosa-associated lymphoid tissue (MALT) in the GI tract, lung, salivary gland, and thyroid. 1 In the GI tract, MALT lymphomas occur most commonly in the stomach, whereas intestinal MALT lymphomas are rare. MALT lymphoma of the ileocecal valve has not been reported. We report here the endoscopic and clinicopathologic features of two cases of early MALT lymphoma that arose from the ileocecal valve.

Randomized Phase II Study of Consecutive-Day versus Alternate-Day Treatment with S-1 as Second-Line Chemotherapy in Advanced Pancreatic Cancer

Objective: To evaluate the efficacy and safety of alternate-day administration of S-1 as second-line chemotherapy for unresectable pancreatic cancer in a multicenter, randomized, phase II study. Methods: Patients with histologically proven, unresectable pancreatic cancer treated with chemotherapy not including S-1 as first-line therapy were randomly assigned to receive either daily or alternate-day treatment with S-1. The primary end point was overall survival (OS), and the secondary end points were progression-free survival (PFS), time to treatment failure (TTF), response rate, and adverse events. Results: A total of 77 patients were enrolled, of which 75 were included in the final analysis. The median OS was 4.5 months in the daily group and 4.4 months in the alternate-day group (HR 1.178; 95% CI 0.741–1.875), with no significance in PFS and TTF. The response rate was 2.8% in the daily group and 0% in the alternate-day group. Grade 3 or higher adverse events occurred with significantly higher incidence in the daily group (47.2 vs. 25.6%, p = 0.044). Conclusion: As a second-line chemotherapy for unresectable pancreatic cancer, although the efficacy in both groups was comparable and we can expect fewer toxicities with alternate-day administration of S-1, the noninferiority of alternate-day treatment to daily treatment with S-1 was not verified.