Tesshin Ban

Stent under-expansion on the procedure day, a predictive factor for poor oral intake after metallic stenting for gastric outlet obstruction.

Self‐expandable metallic stents (SEMS) have been widely accepted as palliation therapy for malignant gastric outlet obstruction (GOO). However, the factors predictive of poor oral intake after SEMS placement have not been elucidated sufficiently. We aimed to clarify both the patient and stent‐related predictive factors.

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).

Maltotriose Conjugation to a Chlorin Derivative Enhances the Antitumor Effects of Photodynamic Therapy in Peritoneal Dissemination of Pancreatic Cancer

Peritoneal dissemination is a major clinical issue associated with dismal prognosis and poor quality of life for patients with pancreatic cancer; however, no effective treatment strategies have been established. Herein, we evaluated the effects of photodynamic therapy (PDT) with maltotriose-conjugated chlorin (Mal3-chlorin) in culture and in a peritoneal disseminated mice model of pancreatic cancer. The Mal3-chlorin was prepared as a water-soluble chlorin derivative conjugated with four Mal3 molecules to improve cancer selectivity. In vitro, Mal3-chlorin showed superior uptake into pancreatic cancer cells compared with talaporfin, which is clinically used. Moreover, the strong cytotoxic effects of PDT with Mal3-chlorin occurred via apoptosis and reactive oxygen species generation, whereas Mal3-chlorin alone did not cause any cytotoxicity in pancreatic cancer cells. Notably, using a peritoneal disseminated mice model, we demonstrated that Mal3-chlorin accumulated in xenograft tumors and suppressed both tumor growth and ascites formation with PDT. Furthermore, PDT with Mal3-chlorin induced robust apoptosis in peritoneal disseminated tumors, as indicated by immunohistochemistry. Taken together, these findings implicate Mal3-chlorin as a potential next-generation photosensitizer for PDT and the basis of a new strategy for managing peritoneal dissemination of pancreatic cancer. Mol Cancer Ther; 16(6); 1124–32. ©2017 AACR.

Predictors of stent dysfunction after self-expandable metal stent placement for malignant gastric outlet obstruction: tumor ingrowth in uncovered stents and migration of covered stents

BackgroundEndoscopic metallic stenting is widely accepted as a palliation therapy for malignant gastric outlet obstruction (GOO). However, the predictors of stent dysfunction have not been clarified. We aimed to evaluate the predictors, especially tumor ingrowth in uncovered self-expandable metallic stents (U-SEMS) and migration of covered self-expandable metallic stents (C-SEMS), which are the main causes related to the stent characteristics.MethodsIn this multicenter retrospective study, we compared patients with U-SEMS and C-SEMS in terms of clinical outcomes, and predictors of stent dysfunction.ResultsIn total, 252 patients (126 with U-SEMS and 126 with C-SEMS) were enrolled. There were no significant differences in technical success, clinical success, GOO score, or time to stent dysfunction. Tumor ingrowth was significantly more frequent in U-SEMS (U-SEMS, 11.90% vs. C-SEMS, 0.79%; p = 0.002), and stent migration was significantly more frequent for C-SEMS (C-SEMS, 8.73% vs. U-SEMS, 0.79%; p = 0.005). Karnofsky performance status (p = 0.04), no presence of ascites (p = 0.02), and insufficient (<30%) stent expansion (p = 0.003) were significantly associated with tumor ingrowth in U-SEMS. Meanwhile, a shorter stent length (p = 0.05) and chemotherapy (p = 0.03) were predictors of C-SEMS migration.ConclusionsBoth U-SEMS and C-SEMS are effective with comparable patencies. Tumor ingrowth and stent migration are the main causes of stent dysfunction for U-SEMS and C-SEMS, respectively. With regard to stent dysfunction, U-SEMS might be a good option for patients receiving chemotherapy, while C-SEMS with longer stents for patients in good condition. (Clinical trial registration number: UMIN000024059).

Novel characteristics of traction force in biliary self-expandable metallic stents

In recent years, knowledge concerning the mechanical properties of self‐expandable metallic stents (SEMS) has increased. In a previous study, we defined traction force and traction momentum and reported that these characteristics are important for optimal stent deployment. However, traction force and traction momentum were represented as relative values and were not evaluated in various conditions. The purpose of the present study was to measure traction force in various situations assumed during SEMS placement.

Ultra-early occlusion of the normal bile duct after uncovered self-expandable metallic stent placement in unresectable perihilar bile duct cancer

Uncovered self-expandable metallic stents (USEMS) are superior to plastic stents in patients with unresectable malignant perihilar biliary obstruction (UMHBO) 1 . The causes of SEMS occlusion include: tumor ingrowth/mucosal hyperplasia, tumor overgrowth, sludge with/without stone, hemobilia, food impaction, bile duct kinking, ulceration, perforation, and fibrin clots 2-3 . We present a rare case of ultra-early occlusion of the normal bile duct after USEMS placement for UMHBO. This article is protected by copyright. All rights reserved.

Novel short curved sphincterotome for wire-guided cannulation and endoscopic sphincterotomy

SINCE THE FIRST use of endoscopic sphincterotomy (ES), ES has been well established and plays a central role in therapeutic biliary intervention. With regard to wireguided cannulation (WGC), use of a sphincterotome has been reported to have a higher selective bile duct cannulation (SBDC) success rate and lower occurrence rate of postendoscopic retrograde cholangiopancreatography (ERCP) pancreatitis. Although Japanese randomized controlled trials did not affirm the results of previous meta-analyses, the European Society of Gastrointestinal Endoscopy guidelines place WGC as the first-line SBDC technique. The most important step of SBDC is to adjust the catheter to the bile duct axis, and the bow-up function of a sphincterotome facilitates this. Thus, sphincterotomes have an important role not only in ES but also in SBDC. Currently available sphincterotome (CleverCut3V; Olympus, Tokyo, Japan) has a coating over the proximal end of the cutting wire, which provides safe ES by protecting the duodenal mucosa and avoiding perforation in cases of overhanging folds. However, this cutting wire is sometimes too long. Therefore, bowing-up viewing the entire cutting wire for easier SBDC requires some distance between the endoscope and the orifice, and that may be too far for precise adjustment of the catheter tip (Fig. 1). To overcome this limitation, we developed a new sphincterotome (New CleverCut3V; KDVC412Q-0215, catheter tip length 2 mm, cutting wire length 15 mm; Olympus) (Fig. 2A). This sphincterotome has a shorter catheter tip and cutting wire with a coating over the proximal end of the cutting wire. Easier and compact bow-up manipulation is obtained during SBDC

Iatrogenic hepatic portal venous gas following balloon endoscopy in a patient with hepaticojejunostomy stricture

Hepatic portal venous gas (HPVG) is caused by gastrointestinal (GI) mucosal damage alone or in combination with bowel distension, sepsis, and invasion by gas-producing bacteria. The most common cause is mesenteric ischemia associated with bowel necrosis. Iatrogenic HPVG is a rare condition that occurs following various endoscopic procedures 1 . Herein, we present an unusual case of HPVG following balloon endoscopy (BE). This article is protected by copyright. All rights reserved.

Transgastric reintervention for self-expandable metallic stent dysfunction following endoscopic ultrasonography-guided hepaticogastrostomy

EUS-guided hepaticogastrostomy (EUS-HGS) using a self-expandable metallic stent (SEMS) is recognized as an alternative to transpapillary access for performing biliary drainage.1,2 However, reintervention to mitigate stent dysfunction remains challenging.3-5 Here, we present a case of successful transgastric exchange of occluded SEMS. A 53-year-old woman with pancreatic cancer was admitted with acute cholangitis. Five months before, she underwent EUS-HGS using partially covered SEMS (6 mm×12 cm Niti-STM S Biliary Stent; Taewoong Medical Co., Ltd., Gimpo-si, Korea). This article is protected by copyright. All rights reserved.

Tu1699 The Relationship Between Meal Intake and Stent Expansion Three- Days After Wallflex Duodenal Stent Placement in 23 Malignant Gastric-Duodenal Obstructions

elucidated the indication criteria of ESD and examined its usefulness for early gastric cancer in elderly patients ( 65 years) by comparison with non-elderly patients. Methods: The subjects were selected from 515 consecutive lesions with early gastric cancer for which ESD was performed between June 2002 and February 2010. Results: In the elderly, four (1.0%) were from the elderly with a Performance Status: PS of 3. The number of PS increased to six (1.6%) after the procedure. None of the non-elderly had a PS of 3 before or after the procedure. In the elderly, 76.9% were from the elderly with preexisting comorbidity. In the non-elderly, 43.4% were from the non-elderly with preexisting comorbidity. There were no differences between the two groups in the distribution of the following: location of gastric lesions where ESD was performed, macroscopic type, tumor size, histological type, depth of invasion, and category of lesions. Overall, the two groups had no significant difference in their durations of hospitalization. However, the elderly with perforation had significantly longer duration of hospitalization compared to the elderly without perforation. The elderly and non-elderly groups also had no significant difference in their operating times for ESD or in the incidence rates of complications. In the elderly, 10.2% were from the elderly who had anti-coagulant therapy. In the non-elderly, 1.4% were from the non-elderly who had anti-coagulant therapy. The percentage was significantly higher in the elderly. In patients with anti-coagulant therapy, the durations of hospitalization were 15.5 and 10.0 days in the elderly and nonelderly groups, respectively. The duration tended to be longer in the elderly but no significant difference was found. Overall, there was no significant difference in the incidence of postoperative hemorrhage. There was postoperative hemorrhage in 5.1% of the lesions in the elderly group and 4.9% of the lesions in the non-elderly group. None of the non-elderly with postoperative hemorrhage had received anti-coagulant therapy. In the elderly with postoperative hemorrhage, 15.8% of the lesions were from the elderly who had received anticoagulant therapy, indicating a significantly higher percentage of such lesions in the elderly group. Conclusion: We conclude that the following should be considered when making the final decision of performing ESD in elderly patients. These patients should have a PS of 0, 1, or 2. One should determine whether or not anti-coagulant therapy can be discontinued and whether or not treatment can be performed reliably without complications.