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Sagami Ryota,Yamao Kentaro,Minami Ryuki,Nakahodo Jun,Akiyama Hidetoshi,Nishikiori Hidefumi,Mizukami Kazuhiro,Yamao Kenji,Bhatia Vikram,Amano Yuji,Murakami Kazunari 거트앤리버 소화기연관학회협의회 2024 Gut and Liver Vol.18 No.2
Background/Aims: High-grade pancreatic intraepithelial neoplasia and invasive pancreatic ductal adenocarcinoma ≤10 mm are targets for early detection of pancreatic cancer. However, their imaging characteristics are unknown. We aimed to identify endoscopic ultrasound findings for the detection of these lesions. Methods: Patients diagnosed with high-grade pancreatic intraepithelial neoplasia (n=29), pancreatic ductal adenocarcinoma ≤10 mm (n=11) (who underwent surgical resection), or benign main pancreatic duct stenosis (n=20) between January 2014 and January 2021 were retrospectively included. Six features differentiating these lesions were examined by endoscopic ultrasonography: main pancreatic duct stenosis, upstream main pancreatic duct dilation, hypoechoic areas surrounding the main pancreatic duct irregularities (mottled areas without demarcation or round areas with demarcation), branch duct dilation, prominent lobular segmentation, and atrophy. Interobserver agreement was assessed by two independent observers. Results: Hypoechoic areas surrounding the main pancreatic duct irregularities were observed more frequently in high-grade pancreatic intraepithelial neoplasia (82.8%) and pancreatic ductal adenocarcinoma ≤10 mm (90.9%) than in benign stenosis (15.0%) (p<0.001). High-grade pancreatic intraepithelial neoplasia exhibited mottled hypoechoic areas more frequently (79.3% vs 18.9%, p<0.001), and round hypoechoic areas less frequently (3.4% vs 72.7%, p<0.001), than pancreatic ductal adenocarcinoma ≤10 mm. The sensitivity and specificity of hypoechoic areas for differentiating high-grade pancreatic intraepithelial neoplasia, pancreatic ductal adenocarcinoma ≤10 mm, and benign stenosis were both 85.0%, with moderate interobserver agreement. Conclusions: The hypoechoic areas surrounding main pancreatic duct irregularities on endoscopic ultrasound may differentiate between high-grade pancreatic intraepithelial neoplasia, pancreatic ductal adenocarcinoma ≤10 mm, and benign stenosis (Trial Registration: UMIN Clinical Trials Registry (UMIN000044789).
Impact of sarcopenia on biliary drainage during neoadjuvant therapy for pancreatic cancer
Kunio Kataoka,Eizaburo Ohno,Takuya Ishikawa,Kentaro Yamao,Yasuyuki Mizutani,Tadashi Iida,Hideki Takami,Osamu Maeda,Junpei Yamaguchi,Yukihiro Yokoyama,Tomoki Ebata,Yasuhiro Kodera,Hiroki Kawashima 대한소화기내시경학회 2024 Clinical Endoscopy Vol.57 No.1
Background/Aims: Since the usefulness of neoadjuvant chemo(radiation) therapy (NAT) for pancreatic cancer has been demonstrated, recurrent biliary obstruction (RBO) in patients with pancreatic cancer with a fully covered self-expandable metal stent (FCSEMS) during NAT is expected to increase. This study investigated the impact of sarcopenia on RBO in this setting. Methods: Patients were divided into normal and low skeletal muscle index (SMI) groups and retrospectively analyzed. Patient characteristics, overall survival, time to RBO (TRBO), stent-related adverse events, and postoperative complications were compared between the two groups. A Cox proportional hazard model was used to identify the risk factors for short TRBO. Results: A few significant differences were observed in patient characteristics, overall survival, stent-related adverse events, and postoperative complications between 38 patients in the normal SMI group and 17 in the low SMI group. The median TRBO was not reached in the normal SMI group and was 112 days in the low SMI group (p=0.004). In multivariate analysis, low SMI was the only risk factor for short TRBO, with a hazard ratio of 5.707 (95% confidence interval, 1.148–28.381; p=0.033). Conclusions: Sarcopenia was identified as an independent risk factor for RBO in patients with pancreatic cancer with FCSEMS during NAT.
New endoscopic ultrasonography techniques for pancreaticobiliary diseases
Ken Kamata,Masayuki Kitano,Shunsuke Omoto,Kumpei Kadosaka,Takeshi Miyata,Kosuke Minaga,Kentaro Yamao,Hajime Imai,Masatoshi Kudo 대한초음파의학회 2016 ULTRASONOGRAPHY Vol.35 No.3
Endoscopic ultrasonography (EUS) is widely used to evaluate pancreaticobiliary diseases,especially pancreatic masses. EUS has a good ability to detect pancreatic masses, but it isnot sufficient for the differential diagnosis of various types of lesions. In order to address thelimitations of EUS, new techniques have been developed to improve the characterization ofthe lesions detected by EUS. EUS-guided fine needle aspiration (EUS-FNA) has been used fordiagnosing pancreatic tumors. In order to improve the histological diagnostic yield, a EUS-FNAneedle with a core trap has recently been developed. Contrast-enhanced harmonic EUS is a newimaging modality that uses an ultrasonographic contrast agent to visualize blood flow in finevessels. This technique is useful in the diagnosis of pancreatic solid lesions and in confirmingthe presence of vascularity in mural nodules for cystic lesions. EUS elastography analyzes severaldifferent variables to measure tissue elasticity, color patterns, and strain ratio, using analyticaltechniques such as hue-histogram analysis, and artificial neural networks, which are useful forthe diagnosis of chronic pancreatitis and pancreatic cancer.
Bispectral index-guided propofol sedation during endoscopic ultrasonography
Ayana Okamoto,Ken Kamata,Takeshi Miyata,Tomoe Yoshikawa,Rei Ishikawa,Tomohiro Yamazaki,Atsushi Nakai,Shunsuke Omoto,Kosuke Minaga,Kentaro Yamao,Mamoru Takenaka,Yasutaka Chiba,Toshiharu Sakurai,Naoshi 대한소화기내시경학회 2022 Clinical Endoscopy Vol.55 No.4
Background/Aims: Bispectral index (BIS) monitors process and display electroencephalographic data are used to assess the depth ofanesthesia. This study retrospectively evaluated the usefulness of BIS monitoring during endoscopic ultrasonography (EUS). Methods: This study included 725 consecutive patients who underwent EUS under sedation with propofol. BIS monitoring was usedin 364 patients and was not used in 361. The following parameters were evaluated: (1) median dose of propofol; (2) respiratory and circulatorydepression; (3) occurrence of body movements; (4) awakening score >8 at the time; and (5) awakening score 2 hours afterleaving the endoscopy room. Results: The BIS group received a significantly lower median dose of propofol than the non-BIS group (159.2 mg vs. 167.5 mg;p=0.015) in all age groups. For patients aged ≥75 years, the reduction in heart rate was significantly lower in the BIS group than in thenon-BIS group (1.2% vs. 9.1%; p=0.023). Moreover, the occurrence of body movements was markedly lower in the BIS group than inthe non-BIS group (8.5% vs. 39.4%; p<0.001). Conclusions: During EUS examination, BIS monitoring is useful for maintaining a constant depth of anesthesia, especially in patients75 years of age or older.