Yoshihide Kanno

Impact of a transparent hood on the performance of total colonoscopy : a randomized controlled trial

BACKGROUND Clinical demand for total colonoscopy (TCS) is increasing. Improvement of the cecal intubation rate and shortening of the examination time would expand the capacity for TCS. OBJECTIVE To assess the efficacy of a transparent hood attached to the tip of a colonoscope for cecal intubation in TCS. DESIGN Prospective, randomized, controlled study. SETTING Single tertiary-referral center. INTERVENTIONS TCS. MAIN OUTCOME MEASUREMENTS Cecal intubation time and rate, complications, patient discomfort, and detection rate of colonic polyps. METHODS Patients who were to undergo screening and/or surveillance TCS for colorectal cancer were invited to participate in the study. Cecal intubation time and rate, complications, patient discomfort, and detection rate of colonic polyps were evaluated. RESULTS A total of 592 patients enrolled in this study were randomly allocated to the hood group and no-hood group. The mean (SD) cecal intubation time in the hood group and the no-hood group was 10.2 +/- 12.5 minutes and 13.4 +/- 15.8 minutes, respectively (P = .0241). The effect of its use was more prominent in the expert endoscopists group compared with those with moderate experience. The cecal intubation rate and the detection rate of small polyps in the 2 groups were similar. The grade of patient discomfort was significantly lower in the hood group. No complications were encountered with the use of the hood. CONCLUSIONS Use of a transparent hood on the tip of a colonoscope shortened the time required for cecal intubation and decreased patient discomfort; such use was more effective among experts in shortening the examination time.

ENDOSONOGRAPHY-GUIDED BILIARY DRAINAGE IN CASES WITH DIFFICULT TRANSPAPILLARY ENDOSCOPIC BILIARY DRAINAGE

Background:  Recently, reports on a new endoscopic biliary drainage technique utilizing endosonographic guidance (endosonography‐guided biliary drainage [ESBD]) have been increasing. The aim of this study was to evaluate the efficacy of ESBD in cases with difficult transpapillary endoscopic biliary drainage (EBD).

Intraductal papillary mucinous neoplasms of the pancreas showing fistula formation into other organs

BackgroundThis study assessed the mechanism of fistula formation in intraductal papillary mucinous neoplasm (IPMN) of the pancreas.MethodsA total of 274 patients with IPMN who had been diagnosed by endoscopic retrograde cholangiopancreatography and endoscopic ultrasonography (EUS) at our center were enrolled. The patients with IPMN which had fistula formation into other organs were investigated retrospectively as to (1) clinical prevalence and the organs penetrated by IPMN, (2) analysis of the mechanism of fistula formation by immunohistopathological study, (3) efficacy of EUS in progression assessment, and (4) prognosis.ResultsAmong the subjects, fistula formation into other organs was observed in 18 patients (6.6%) and into 28 organs. There were 7 patients (39%) in whom multiple organs were penetrated. Of 16 patients who had undergone investigation of the expression of mucin markers, 94% had an intestinal-type tumor. Of 9 patients who had undergone surgery or autopsy, 67% showed mechanical penetration without invasion around the fistula. Only papillary protrusions were seen by EUS in 4 of these patients with noninvasive papillary adenocarcinoma showing mechanical penetration. All 5 patients who had pancreatic parenchymal invasion showed a mass with a mixed-echo pattern in addition to papillary protrusions shown by EUS, corresponding to colloid carcinoma.ConclusionsThere were 2 processes in the development of fistulas in IPMN. Of those patients showing fistula formation, 94% had intestinal-type IPMN, and 67% showed mechanical penetration. Delineation of a mass with the mixed-echo pattern suggested an invasive penetration due to colloid carcinoma.

Therapeutic endoscopic retrograde cholangiography using a single-balloon enteroscope in patients with Roux-en-Y anastomosis

The aim of the present study was to evaluate the usefulness of a single‐balloon enteroscope (SBE) including a newly developed short SBE (SIF‐Y0004) for therapeutic endoscopic retrograde cholangiography (ERC) in patients with Roux‐en‐Y (R‐Y) anastomosis.

Clinical usefulness of double‐guidewire technique for difficult biliary cannulation in endoscopic retrograde cholangiopancreatography

Although biliary cannulation with pancreatic guidewire placement (P‐GW) is useful for difficult cases in endoscopic retrograde cholangiopancreatography (ERCP), the clinical significance of wire‐guided cannulation with P‐GW (double‐guidewire technique: DGT) has not been clarified. The aim of the present study was to evaluate the usefulness of DGT for difficult biliary cannulation after unsuccessful biliary cannulation using a cannula/sphincterotome under guidance of injected contrast with P‐GW (single‐guidewire technique: SGT).

Single-session endoscopic bilateral y-configured placement of metal stents for hilar malignant biliary obstruction.

Background:  The aim of this study was to evaluate the efficacy and safety of endoscopic bilateral biliary metal stent placement for hilar malignant obstruction.

Impact of technical modification of endoscopic papillectomy for ampullary neoplasm on the occurrence of complications.

Aim:  To evaluate the usefulness of a modified technique of endoscopic papillectomy (EP) for lessening the occurrence of complications.

LATERAL SPREAD ALONG THE MAIN PANCREATIC DUCT IN BRANCH-DUCT INTRADUCTAL PAPILLARY-MUCINOUS NEOPLASMS OF THE PANCREAS: USEFULNESS OF INTRADUCTAL ULTRASONOGRAPHY FOR ITS EVALUATION

Background:  Intraductal papillary mucinous neoplasms (IPMN) of the pancreas tend to spread intraepithelially along the pancreatic duct wall. We evaluated histopathological intraductal lateral spread (LS) along the main pancreatic duct (MPD) from branch‐duct IPMN and investigated the usefulness of intraductal ultrasonography (IDUS) for its preoperative diagnosis.

Invasive carcinoma derived from “flat type” branch duct intraductal papillary mucinous neoplasms of the pancreas: impact of classification according to the height of mural nodule on endoscopic ultrasonography

It has been reported that many branch duct intraductal papillary mucinous neoplasms (BD‐IPMN) with a mural nodule (MN) reveal adenocarcinomas. On the other hand, invasive cancer derived from BD‐IPMN without MN on endoscopic ultrasound (EUS) also exists. The aim of this study was to elucidate the clinicopathological features of invasive cancer derived from BD‐IPMN without MN on EUS.

Metallic stent deployment in endosonography-guided biliary drainage: Long-term follow-up results in patients with bilio-enteric anastomosis

Background and Aim:  Although reports on endosonography‐guided biliary drainage (ESBD) have been increasing, only a few reports on deployment of a self‐expandable metal stents (SEMS) have been reported. The aim of the present study was to evaluate the safety and efficacy of SEMS deployment in ESBD.