Publications by authors named "Akira Mitoro"
Recently, endoscopic ultrasound-guided tissue acquisition (EUS-TA) has been widely used to diagnose pancreatic ductal adenocarcinoma (PDAC). The histological examination of core tissues acquired using novel biopsy needles is the primary diagnostic approach for patients with PDAC. However, in patients with early-stage PDAC, such as Stages 0 and I, EUS-TA can be challenging, and its diagnostic accuracy may be limited.
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- - The study evaluated the effectiveness of inside stent therapy for patients with unresectable malignant hilar biliary obstruction, showing a high clinical success rate of 95.5% in resolving jaundice.
- - Analysis identified factors influencing stent patency duration; unilateral drainage and chemotherapy were linked to significantly longer stent patency compared to bilateral drainage and no chemotherapy.
- - The procedure was considered safe, with only a small percentage of patients experiencing early adverse events such as cholangitis and pancreatitis.
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- - The study evaluated how the COVID-19 pandemic affected the treatment of acute cholangitis due to choledocholithiasis by analyzing medical records from April 2017 to December 2022 during a declared state of emergency in Japan.
- - Results showed an increase in the number of endoscopic retrograde cholangiopancreatography (ERCP) cases and successful stone removals after the state of emergency. Additionally, patients treated during this time tended to be in better health, while those on certain medications and with previous health issues were fewer.
- - The findings indicated that the pandemic led to more efficient single-stage endoscopic treatments and shorter hospital stays without increasing safety risks for patients undergoing ERCP.
Article Synopsis
- Portal vein thrombosis (PVT) is a serious condition often found in patients with liver cirrhosis, linked to high mortality rates, and is influenced by enzyme and factor imbalances causing increased blood clotting.
- A study involving 345 liver cirrhosis patients identified two groups: 40 with PVT and 305 without, noticing that 81% were excluded due to various health issues.
- The findings showed that lower plasma levels of ADAMTS-13 activity indicate a higher risk for developing PVT, making it a potential diagnostic and prognostic biomarker, especially in Japanese patients.
Article Synopsis
- The study investigates the risk factors for severe-to-fatal post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) in 3739 ERCP patients with biliary disease over a one-year period.
- Key risk factors identified include pancreatic guidewire-assisted biliary cannulation, post-ERCP NSAID use, and a history of previous pancreatitis, all significantly increasing the likelihood of severe-to-fatal PEP.
- Preventive measures that showed effectiveness include endoscopic biliary sphincterotomy and prophylactic pancreatic stents, both of which significantly reduced the risk of severe-to-fatal PEP.
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- The study aimed to examine the von Willebrand factor to ADAMTS13 ratio (VWF:Ag/ADAMTS13:AC) as a biomarker for predicting outcomes in patients with acute kidney injury (AKI) related to liver cirrhosis (LC).
- Researchers compared 91 patients with AKI against 91 control patients without AKI, measuring plasma levels of VWF and ADAMTS13 to identify risk factors.
- Results showed that higher VWF:Ag/ADAMTS13:AC ratios were linked to increased risk of AKI onset, higher 90-day mortality rates, and poorer treatment responses, suggesting this ratio could be a significant predictor for patients with LC.
Article Synopsis
- * An initial attempt to treat his condition using endoscopic techniques was unsuccessful due to adhesions, leading to a successful placement of a plastic stent that improved his symptoms.
- * After replacing the plastic stent with a metal one due to frequent occlusions, the patient experienced cholangitis again and the metal stent had migrated; however, he was able to undergo a successful retreatment through the existing fistula.
Article Synopsis
- Alcohol significantly contributes to liver cirrhosis (LC), and this study focused on identifying a surrogate marker for sarcopenia in LC patients with different causes, particularly comparing alcoholic cirrhosis (AC) and nonalcoholic cirrhosis (NAC).
- The analysis involved 451 patients out of 775, measuring handgrip strength, skeletal muscle mass, and endotoxin activity (EA), revealing that AC patients had higher platelet counts and lower blood urea nitrogen levels compared to NAC patients.
- Key risk factors for sarcopenia included age, sex, liver function, and hemoglobin levels, with hemoglobin being a strong predictor of sarcopenia; combining hemoglobin with endotoxin
Article Synopsis
- The study examined the safety and feasibility of cell-free and concentrated ascites reinfusion therapy (CART) for patients with cirrhosis and refractory ascites, focusing on changes in coagulation factors in the ascitic fluid.
- Out of 23 patients, CART led to significant decreases in body weight and waist circumference, along with increases in important proteins and coagulation factors in the reinfused fluid.
- The results indicate that CART is both effective and safe, resulting in improved patient symptoms as measured by the Ascites Symptom Inventory-7 scale.
Article Synopsis
- - The study investigated a potential marker for sarcopenia in patients with liver cirrhosis, analyzing data from 424 patients divided into sarcopenia (Group S) and nonsarcopenia (Group NS) groups.
- - Results indicated that Group S had significantly lower handgrip strength, skeletal muscle index, and hemoglobin levels, while showing higher levels of certain collagen biomarkers compared to Group NS.
- - The study concluded that hemoglobin levels could serve as a predictive biomarker for sarcopenia in liver cirrhosis patients, suggesting the need for further research in this area.
Intrahepatic cholangiocarcinoma (iCCA), the second most common primary liver cancer, has high mortality rates because of its limited treatment options and acquired resistance to chemotherapy. Sulforaphane (SFN), a naturally occurring organosulfur compound found in cruciferous vegetables, exhibits multiple therapeutic properties, such as histone deacetylase (HDAC) inhibition and anti-cancer effects. This study assessed the effects of the combination of SFN and gemcitabine (GEM) on human iCCA cell growth.
View Article and Find Full Text PDFBackground: There is no consensus on the necessity of endoscopic sphincterotomy (ES) to prevent post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) after endoscopic stenting in patients with malignant biliary obstruction. We investigated the incidence of PEP after endoscopic biliary stenting for malignant biliary obstruction with or without ES in a multicenter prospective cohort study.
Methods: We enrolled 807 patients who underwent endoscopic biliary stenting for malignant biliary obstruction with a native papilla at 36 hospitals between April 2017 and March 2018.
Article Synopsis
- Serial pancreatic juice aspiration cytological examination (SPACE) using liquid-based cytology (LBC) is an effective method for diagnosing early-stage pancreatic cancers that are hard to detect through traditional fine needle aspiration techniques.
- In a study of 24 patients, SPACE correctly identified 9 cases of malignancy with a high sensitivity of 81.8% and specificity of 100%, achieving an overall diagnostic accuracy of 91.7%.
- The procedure had a low complication rate and demonstrated adequate sample collection, making it a promising diagnostic tool for pancreatic cancer.
Article Synopsis
- The study assessed the effectiveness and safety of combining atezolizumab and bevacizumab in patients with advanced hepatocellular carcinoma, finding a median progression-free survival of 119 days.
- In 23 patients, the objective response rate was 21.7% according to standard criteria, with a higher response noted in hepatitis B/C-related cases and early-stage patients compared to advanced stages.
- The treatment was generally well-tolerated, with adverse event rates of 65.2% for any grade and 21.7% for severe events, suggesting its potential for managing this type of cancer, though further research is needed.
Background: Treatments for patients with gastric outlet obstruction (GOO) due to unresectable pancreatic cancers (URPC) include gastrojejunostomy (GJJ) and endoscopic duodenal stent placement (EDSP). This study compared the efficacy and safety of GJJ and EDSP in patients with GOO due to URPC.
Methods: This study retrospectively evaluated consecutive patients with GOO due to URPC who underwent GJJ or EDSP between April 2016 and March 2020.
Background/aim: To identify predictors of severe adverse events (≥grade 3) in patients with advanced hepatocellular carcinoma treated with lenvatinib.
Patients And Methods: Of 41 patients, 25 and 16 were stratified into the severe and non-severe adverse events groups, respectively. Of these, 19 formed a lactulose-mannitol test subgroup, which was divided into severe adverse events (n=11) and non-severe adverse events (n=8) groups.
Primary biliary cholangitis (PBC) has a wide variation in clinical presentation and course. There is no significant correlation between these symptoms and the disease stage, although patients with more advanced stages generally have more symptoms. It is important to develop biomarkers in order to identify patients with an increased risk of complications and end-stage liver disease.
View Article and Find Full Text PDFBackground And Objectives: Currently, there are no reports on the learning curve of endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) using dedicated plastic stents. Therefore, we evaluated the outcomes of EUS-HGS using dedicated plastic stents at tertiary referral centers during the initial development phase of EUS-HGS.
Materials And Methods: Endoscopic retrograde cholangiopancreatography (ERCP) was strictly prioritized over EUS-HGS.
Article Synopsis
- Endoscopic ultrasound-guided tissue acquisition (EUS-TA) is essential for diagnosing pancreatic tumors, and this study focused on needle tract seeding (NTS) occurrences post-EUS-TA in Japan.
- A survey of over 12,000 patients revealed an overall NTS incidence of 0.330%, notably higher in those with pancreatic ductal adenocarcinomas (PDACs) compared to other tumors.
- NTS was only found after transgastric procedures, with the majority located in the gastric wall, and patients who underwent resection of NTS lesions had significantly better survival rates.
Background: Ascites commonly complicates cirrhosis and is refractory to the vasopressin-2 antagonist tolvaptan and fluid restriction in approximately 60% of patients. We aimed to identify risk factors associated with adverse events following cell-free and concentrated ascites reinfusion therapy (CART) in patients with cirrhosis and ascites.
Patients And Methods: We evaluated the efficacy and tolerability to the CART system in 18 patients with decompensated liver cirrhosis and ascites.
Article Synopsis
- Patients with cirrhosis often suffer from sarcopenia, which can increase mortality rates, and this study investigates the impact of subclinical zinc deficiency on this condition.
- The research involved 151 cirrhosis patients, categorizing them into two groups: those with normal zinc levels and those with subclinical zinc deficiency, revealing a higher prevalence of sarcopenia in the latter.
- Results indicated a significant correlation between low zinc levels and increased sarcopenia risk, suggesting that maintaining adequate zinc levels could be important for improving patient outcomes.