Yoko Abe

Human equilibrative nucleoside transporter 1 and Notch3 can predict gemcitabine effects in patients with unresectable pancreatic cancer

Background:Pancreatic ductal carcinoma (PDC) is one of the most lethal human carcinomas. Expression patterns of some genes may predict gemcitabine (GEM) treatment efficacy. We examined predictive indicators of survival in GEM-treated patients by quantifying the expression of several genes in pre-treatment endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) samples from patients with PDC.Methods:The expressions of human equilibrative nucleoside transporter 1 (hENT1), deoxycitidine kinase, ribonucleoside reductase 1, ribonucleoside reductase 2 and Notch3 in EUS-FNA tissue samples from 71 patients with unresectable PDC were quantified using real-time reverse transcription–polymerase chain reactions and examined for correlations with GEM sensitivity.Results:The log-rank test detected no significant differences in overall survival between GEM-treated patients with low and high mRNA levels of all genes examined. However, low Notch3 mRNA expression was significantly associated with longer overall survival in a multivariate analysis for survival (P=0.0094). High hENT1 expression level was significantly associated with a longer time to progression (P=0.039). Interaction tests for GEM administration and hENT1 or Notch3 mRNA expression were statistically significant (P=0.0054 and 0.0047, respectively).Conclusion:hENT1 and Notch3 mRNA expressions in EUS-FNA specimens were the key predictive biomarkers of GEM effect and GEM sensitivity in patients with unresectable PDC.

Influence of the safety and diagnostic accuracy of preoperative endoscopic ultrasound-guided fine-needle aspiration for resectable pancreatic cancer on clinical performance

AIM To evaluate the safety and diagnostic accuracy of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) in a cohort of pancreatic cancer patients. METHODS Of 213 patients with pancreatic cancer evaluated between April 2007 and August 2011, 82 were thought to have resectable pancreatic cancer on the basis of cross-sectional imaging findings. Of these, 54 underwent EUS-FNA before surgery (FNA+ group) and 28 underwent surgery without preoperative EUS-FNA (FNA- group). RESULTS All 54 lesions were visible on EUS, and all 54 attempts at FNA were technically successful. The diagnostic accuracy according to cytology and histology findings was 98.1% (53/54) and 77.8% (42/54), respectively, and the total accuracy was 98.1% (53/54). One patient developed mild pancreatitis after EUS-FNA but was successfully treated by conservative therapy. No severe complications occurred after EUS-FNA. In the FNA+ and FNA- groups, the median relapse-free survival (RFS) was 742 and 265 d, respectively (P = 0.0099), and the median overall survival (OS) was 1042 and 557 d, respectively (P = 0.0071). RFS and OS were therefore not inferior in the FNA+ group. These data indicate that the use of EUS-FNA did not influence RFS or OS, nor did it increase the risk of peritoneal recurrence. CONCLUSION In patients with resectable pancreatic cancer, preoperative EUS-FNA is a safe and accurate diagnostic method.

Transpapillary dilation of refractory severe biliary stricture or main pancreatic duct by using a wire-guided diathermic dilator (with video)

Benign and malignant tumors generally cause strictures in the bile duct (BD) or the pancreatic duct (PD) and result in jaundice or abdominal pain. An appropriate technique for dilation of these strictures is therefore necessary. Endoscopic stent placement has been reported to improve the severity of abdominal pain in selected patients with benign and malignant BD and PD strictures. 1 During ERCP, a guidewire is passed through the stricture into the proximal BD or PD. Subsequently, a plastic stent(s) or self-expandable metallic stent is placed at the stricture. Although these stents are sometimes placed after dilation of the stricture, dilation may be unnecessary in most cases. Severe ductal strictures can usually be dilated using balloon dilation or a dilation catheter. However, this type of dilation is not possible when the BD or PD stricture is severe; in such refractory cases, only the guidewire can pass through it, and a screw drill may be used. 2,3 Several investigators have described the dissection of difficult PD strictures using a needle-knife or wire-guided snare forceps. 4-6 Diathermic dilators, which are commonly used for pancreatic fluid collection drainage, are effective for creating and enlarging the fistula channels between the stomach or duodenum and a pancreatic pseudocyst, PD, or gallbladder. 7,8 We recently reported our experience using a diathermic dilator to treat severe BD strictures. 9 The current prospective observational cohort study was conducted to evaluate whether a wire-guided diathermic dilator could pass through BD or PD strictures. We also evaluated the rate of adverse events after diathermic dilation of BD or PD strictures.

Risk factors for technical failure of endoscopic double self-expandable metallic stent placement by partial stent-in-stent method

Endoscopic double self‐expandable metallic stent (SEMS) placement by the partial stent‐in‐stent (PSIS) method has been reported to be useful for the management of unresectable hilar malignant biliary obstruction. However, it is technically challenging, and the optimal SEMS for the procedure remains unknown. The aim of this study was to identify the risk factors for technical failure of endoscopic double SEMS placement for unresectable malignant hilar biliary obstruction (MHBO).

Single-step simultaneous side-by-side placement of a self-expandable metallic stent with a 6-Fr delivery system for unresectable malignant hilar biliary obstruction : a feasibility study

Bilateral self‐expandable metallic stent (SEMS) placement for the management of unresectable malignant hilar biliary obstruction (UMHBO) is technically challenging to perform using the existing metallic stents with thick delivery systems. The recently developed 6‐Fr delivery systems could facilitate a single‐step simultaneous side‐by‐side placement through the accessory channel of the duodenoscope. The aim of this study was to evaluate the feasibility of this procedure.

High sensitivity of the turtle olfactory system to nonvolatile substances: comparison of response properties with those in gustatory systems

The olfactory responses of the aquatic turtles, Geocylemys reevesii whose nostrils are closed underwater to nonvolatile substances were measured by recording the olfactory bulbar responses. Various salts, acids and bitter substances elicited large responses, while sugars and amino acids did not elicit the responses. The thresholds for the salts were much lower than those of corresponding salts in the rat gustatory system. The responses to the salts were partially suppressed by amiloride. Various acids induced large responses and the magnitudes greatly depended on the anion species. The thresholds for the bitter substances were much lower than those of corresponding substances in the taste systems. Similar to the responses in taste systems, both electrostatic and hydrophobic interactions contribute to the binding of the substances to the receptor membranes. Similar to the taste systems, the response to quinine hydrochloride showed a sharp temperature dependence having a peak around 25 degrees C, while the responses to odorants did not show such peak. The present results suggest that the olfactory system has similar abilities to respond to salts, acids and bitter substances to those in gustatory systems and that the high sensitivity of the olfactory system to chemical stimuli is not only attributable to the second messenger amplification system, but also to the basic property of the receptor membrane independent of the amplification system.

Safety and Utility of Single-Session Endoscopic Ultrasonography and Endoscopic Retrograde Cholangiopancreatography for the Evaluation of Pancreatobiliary Diseases

Endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) are essential for diagnosing and treating pancreatobiliary diseases. Single-session EUS and ERCP are considered to be essential in reducing the duration of hospital stays; however, complications are a primary concern. The aim of this study was to evaluate the safety and efficacy of single-session EUS and ERCP. Sixty-eight patients underwent single-session EUS and ERCP at a tertiary referral center between June 2008 and December 2012. We retrospectively reviewed patient data from a prospectively maintained EUS-ERCP database and evaluated the procedural characteristics and complications. Thirty-eight patients (56%) underwent diagnostic EUS, and 30 patients (44%) underwent EUS fine-needle aspiration, which had an overall accuracy of 100%. Sixty patients (89%) underwent therapeutic ERCP, whereas the remaining eight procedures were diagnostic. Thirteen patients underwent biliary stone extraction, and 48 underwent biliary drainage. The median total procedural time was 75 minutes. Complications were observed in seven patients (10%). Six complications were post-ERCP pancreatitis, which were resolved using conservative management. One patient developed Mallory-Weiss syndrome, which required endoscopic hemostasis. No sedation-related cardiopulmonary complications were observed. Single-session EUS and ERCP provided accurate diagnosis and effective management with a minimal complication rate.

Endoscopic ultrasonography-guided liver abscess drainage using a dedicated, wide, fully covered self-expandable metallic stent with flared-ends

Title Endoscopic ultrasonography-guided liver abscess drainage using a dedicated, wide, fully covered self-expandable metallic stent with flared-ends Author(s) Kawakami, Hiroshi; Kawakubo, Kazumichi; Kuwatani, Masaki; Kubota, Yoshimasa; Abe, Yoko; Kawahata, Shuhei; Kubo, Kimitoshi; Sakamoto, Naoya Citation Endoscopy, 46(S 01): E982-E983 Issue Date 2014-12-19 Doc URL http://hdl.handle.net/2115/60351 Rights

Endoscopic ultrasound-guided antegrade diathermic dilation followed by self-expandable metal stent placement for malignant distal biliary stricture.

Endoscopic ultrasound (EUS)-guided antegrade stenting (AGS) is established as an alternative interventional technique in patients in whom endoscopic transpapillary stenting has failed [1,2]. Here, we present a patient who underwent EUSAGS after diathermic dilation with placement of a self-expandable metal stent (SEMS) for a malignant distal biliary stricture. A 58-year-old woman with cancer of unknown origin and obstructive jaundice was referred to our hospital. She had undergone transpapillary stenting using a plastic stent at another hospital 2 months previously. Esophagogastroduodenoscopy (EGD) to reach the papilla of Vater was not feasible because of gastric outlet obstruction. Therefore, we attempted EUS-AGS via the stomach. First the intrahepatic bile

Recent advances in endoscopic ultrasonography-guided biliary interventions

Interventional endoscopic ultrasonography (EUS) based on EUS-guided fine-needle aspiration has rapidly spread as a minimally invasive procedure. Especially in patients with failed endoscopic retrograde cholangiopancreatography, EUS-guided biliary intervention is reported to be useful as salvage therapy. EUS-guided biliary interventions are carried out using three techniques: EUS-guided bilioenteric anastomosis, EUS-guided rendezvous procedure, and EUS-guided antegrade treatment. Although interventional EUS is not yet a standardized procedure, there have been recent advances in this field that address various biliary diseases. Here, we summarize the indications, techniques, clinical results of previous studies, and future perspectives.