Takashi Sasaki

A Japanese prospective multicenter study of self-expandable metal stent placement for malignant colorectal obstruction: short-term safety and efficacy within 7 days of stent procedure in 513 cases.

BACKGROUNDnEndoscopic self-expandable metal stent placement has been used as an alternative to surgery for malignant colorectal obstruction; however, factors affecting its clinical outcome are unclear.nnnOBJECTIVEnTo clarify the short-term safety and efficacy of endoscopic self-expandable metal stent placement for malignant colorectal obstruction and to identify factors associated with its clinical and technical failure.nnnDESIGNnProspective clinical cohort study.nnnSETTINGnFourteen academic centers and 32 community hospitals.nnnPATIENTSnA total of 513 consecutive patients with malignant colorectal obstruction.nnnINTERVENTIONnEndoscopic self-expandable metal stent placement, sharing of stent placement methods among participating facilities.nnnMAIN OUTCOME MEASUREMENTSnThe primary endpoint was clinical success, defined as symptom and radiological finding resolution within 24 hours. Secondary endpoints were technical success and adverse events. The follow-up period was 7 days.nnnRESULTSnThe clinical and technical success rates were 95.5% and 97.9%, respectively. Major adverse events included perforation (2.1%), stent migration (1.0%), and stent occlusion (0.8%). The main causes of perforation were the procedure itself (0.8%) and comorbidities (obstructive colitis and impending perforation) not apparent before stent placement (0.6%). Extrinsic tumor origin was independently associated with the clinical failure after stent placement (odds ratio 4.23; 95% confidence interval, 1.21-14.79; P = .02). Stricture marking trended toward a negative association with technical failure (P = .09).nnnLIMITATIONSnNoncomparative study.nnnCONCLUSIONnStrict inclusion criteria and stricture marking may improve the technical and clinical success of stent placement.

Covered versus uncovered metal stents for malignant gastric outlet obstruction: Systematic review and meta-analysis

Self‐expandable metal stents (SEMS) are used for non‐resectable malignant gastric outlet obstruction (GOO). Studies of covered versus uncovered SEMS have yielded inconsistent results as a result of heterogeneity in design and patient population. We carried out a meta‐analysis to compare covered and uncovered gastroduodenal SEMS.

Gemcitabine and S-1 versus gemcitabine and cisplatin treatment in patients with advanced biliary tract cancer: a multicenter retrospective study

SummaryObjective This study aimed to compare the safety and efficacy of the combination therapy of gemcitabine and S-1 (GS) versus gemcitabine and cisplatin (GC) in patients with advanced biliary tract cancer (BTC). Methods In this multicenter retrospective cohort study, a total of 212 patients with advanced BTC receiving GS (nxa0=xa0125) or GC (nxa0=xa087) between July 2006 and August 2015 were analyzed. The primary endpoint was overall survival (OS). The secondary endpoints were progression-free survival (PFS), objective tumor response, and safety. Results Patient characteristics were well balanced between the two groups, except for tumor size (the baseline sum of the largest diameter of the tumor: 6.3xa0cm in the GS group vs. 8.6xa0cm in the GC group, pxa0=xa00.01). Although the response rate was higher in the GS group than in the GC group (28.8% vs. 10.3%, pxa0=xa00.01), the median PFS and OS were comparable between the two groups (PFS of 5.6 vs. 7.6xa0months, pxa0=xa00.74; OS of 12.4 vs. 9.2xa0months, pxa0=xa00.20, respectively). Stomatitis and skin rash were more frequently observed in the GS group, whereas anemia, thrombocytopenia, nausea, and renal toxicity were more commonly observed in the GC group. Conclusion This study demonstrates that GS and GC are similar with regard to their safety and efficacy in patients with advanced BTC. GS could serve as an alternative treatment for advanced BTC as a first-line chemotherapy.

ERCP with Device-Assisted Enteroscopy in Patients with Altered Gastrointestinal Anatomy

Diagnosis and treatment using ERCP in patients with altered gastrointestinal anatomy have progressed greatly since the emergence of the double-balloon enteroscope in 2001. The balloon-assisted enteroscope has improved steadily over time, and a short-type balloon-assisted enteroscope with a large working channel became commercially available in 2016. These short-type balloon-assisted enteroscopes accommodate most ERCP accessories, and many kinds of ERCP intervention can be performed, such as conventional ERCP for patients with normal anatomy. Although the success rate of ERCP with balloon-assisted enteroscopy in patients with altered gastrointestinal anatomy has increased to approximately 68–98%, it is still a challenging procedure for many endoscopists. Because ERCP with a balloon-assisted enteroscope is time-consuming, mandates specialized training, and requires special endoscopes and accessories, these factors limit the widespread availability outside tertiary endoscopic referral centers. Other types of device-assisted enteroscopies, including spiral enteroscopy and through-the-scope balloon-assisted enteroscopy, have also been developed to make it easier to perform ERCP in patients with altered gastrointestinal anatomy. These novel device-assisted enteroscopy instruments are still immature compared with balloon-assisted enteroscopy for ERCP in patients with altered gastrointestinal anatomy. Therefore, both device-assisted enteroscopy and ERCP accessories must be improved for this challenging procedure to become a more general procedure.

CA19-9 kinetics during systemic chemotherapy in patients with advanced or recurrent biliary tract cancer

PurposeThe role of carbohydrate antigen 19-9 (CA19-9) kinetics in patients with biliary tract cancer (BTC) receiving chemotherapy remains to be elucidated.MethodsA total of 185 advanced or recurrent BTC patients receiving a first line chemotherapy between January 2006 and March 2016, were retrospectively studied. Serum CA19-9 was measured at baseline and after two cycles of chemotherapy, and patients were categorized based on CA19-9 response: CA19-9 decrease group (≥u200930% decrease), stable group (<u200930% decrease and <u200920% increase) and increase group (≥u200920% increase). The associations of CA19-9 response with radiological tumor response, progression-free survival (PFS) and overall survival (OS) were investigated.ResultsThere was a statistically significant association between CA19-9 response and radiological tumor responses (pu2009<u20090.001). The median PFS and OS were significantly different among three groups according to CA19-9 response: PFS of 8.0, 5.7 and 3.5 months in CA19-9 decrease, stable and increase groups (pu2009<u20090.001) and OS of 18.8, 16.0 and 7.5 months in CA19-9 decrease, stable and increase groups, respectively (pu2009<u20090.001). Multivariate analyses showed that CA19-9 response was prognostic both of OS and PFS in addition, to CA19-9xa0at baseline, and performance status.ConclusionCA19-9 kinetics after the first two cycles of a first line chemotherapy was a prognostic factor for OS and PFS in patients with advanced and recurrent BTC.