Publications by authors named "Ichiro Yasuda"
Background And Aims: Endoscopic ultrasound (EUS)-guided transmural drainage with on-demand endoscopic necrosectomy (EN) is increasingly utilized to manage walled-off necrosis (WON). It has not been fully elucidated how EN and its timing are correlated with treatment outcomes compared to the drainage-based approach.
Methods: Within a multi-institutional cohort of 423 patients with pancreatic fluid collections including 227 patients with WON, we identified 153 patients who received the step-up treatment following the initial EUS-guided drainage of symptomatic WON, including 102 EN patients and 51 non-EN (drainage) patients.
Background And Aims: EUS-guided hepaticogastrostomy (EUS-HGS) carries a risk of serious adverse events (AEs). A newly designed, partially covered laser-cut stent with antimigration anchoring hooks and a thin tapered tip (7.2F), called a Hook stent (Zeon Medical, Tokyo, Japan), has been developed to prevent serious AEs associated with EUS-HGS.
View Article and Find Full Text PDFWe report a rare case of a patient with initially unresectable gallbladder cancer who underwent conversion surgery with durvalumab in combination with gemcitabine plus cisplatin and achieved an R0 resection. A 68 year-old woman was found to have gallbladder cancer and multiple enlarged lymph nodes around the suprapancreatic rim and hepatic hilum invading the proper hepatic artery on computed tomography. The diagnosis was cT3cN2cM0, cStage IVB.
View Article and Find Full Text PDFDisconnected pancreatic duct syndrome: diagnostic and therapeutic challenges and future directions.
Expert Rev Gastroenterol Hepatol
October 2024
Introduction: Disconnected pancreatic duct syndrome (DPDS) is a pathological condition that causes various symptoms due to the continuous secretion of pancreatic enzymes from the pancreas upstream, which has been separated due to disconnection of the pancreatic duct (DPD) for various reasons.Acute necrotizing pancreatitis includes a certain probability of DPDS appearance, which makes it necessary to provide various treatments for DPDS. Furthermore, DPDS can impact long-term results, such as recurrence and impaired pancreatic function.
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- *The Subcommittee defined five types of I-EUS procedures based on their purpose and method: EUS-guided sampling, EUS-guided through-the-needle examination, EUS-guided drainage/anastomosis, ESCR procedures, and EUS-guided delivery.
- *The proposed classifications aim to clarify I-EUS procedures and will be updated as new techniques and concepts arise in the field.*
Article Synopsis
- The study investigates the impact of comorbidity status, measured by the Charlson Comorbidity Index (CCI), on clinical outcomes following EUS-guided treatment for pancreatic fluid collections (PFCs) using data from two cohorts: a clinical cohort of 406 patients and a nationwide cohort of 4053 patients from Japan.
- Findings indicate that higher CCI scores are linked to increased in-hospital mortality risk, with adjusted odds ratios showing a notable rise in risk as CCI increases.
- The results suggest that CCI could be useful for predicting periprocedural mortality risk in patients undergoing this treatment, although it did not correlate with the likelihood of procedure-related adverse events.
Article Synopsis
- The study focuses on the importance of measuring hepatitis B surface antigen (HBsAg) for the management of chronic hepatitis B virus infection (CHB) and examines preS1 protein expression in patients.
- Researchers used seven monoclonal antibodies to analyze preS1 from various hepatitis B genotypes, discovering that the epitopes crucial for recognition are largely located in the aa33-47 region.
- Findings indicate that preS1 expression remains stable across different HBsAg levels and genotypes, emphasizing its potential as a therapeutic target in treating CHB.
Article Synopsis
- Pembrolizumab, nivolumab, and the combination therapies have emerged as first-line treatments for advanced esophageal cancer, although their efficacy on primary tumors was previously unclear.
- In a study of 23 patients experiencing esophageal dysphagia, significant improvement in swallowing was noted in 82.6%, with a median time to improvement of about 26 days.
- While 10 patients experienced immune-related adverse events, the treatments provided high response rates and prolonged survival, indicating promising effectiveness against primary tumors.
Article Synopsis
- The WONDER-02 trial is a randomized controlled study aimed at comparing the effectiveness of plastic stents versus lumen-apposing metal stents (LAMSs) for treating symptomatic pancreatic pseudocysts through endoscopic ultrasound (EUS) drainage.
- The trial will enroll 80 patients from 26 centers in Japan, dividing them into two groups of 40 to receive either type of stent and assessing outcomes like pseudocyst size reduction and overall health improvements.
- The results will help determine if plastic stents are just as effective as LAMSs, potentially influencing future treatment guidelines for pancreatic pseudocyst patients.
Diagnosis of isolated hilar-/extrahepatic-type IgG-4-related sclerosing cholangitis can be increased by improved recognition of this condition-A Japanese multicenter analysis.
J Hepatobiliary Pancreat Sci
September 2024
Background: Patients with isolated IgG4-related sclerosing cholangitis (IgG4-SC) often undergo unnecessary resection. The aim of this study was to validate the revised Japanese diagnostic criteria for isolated IgG-4-SC and to improve awareness about this condition in the population.
Methods: This was a Japanese retrospective multicenter study.
Article Synopsis
- * Investigations showed low serum ceruloplasmin levels, high urinary copper excretion, and a known mutation in the ATP7B gene linked to copper metabolism.
- * A new mutation was identified in the patient's other allele, classified as 'likely pathogenic' based on guidelines from the American College of Medical Genetics, confirming a diagnosis of Wilson's disease.
Article Synopsis
- Anamorelin, Japan's first treatment for cancer cachexia, was introduced in 2021, prompting a study at Toyama University Hospital to assess its prescription trends among patients from July 2021 to December 2022.
- The analysis involved 88 cases, focusing on demographics, cancer types, prescription locations, and changes in meal intake, revealing that anamorelin was mainly used during chemotherapy, particularly for pancreatic cancer patients in outpatient settings.
- Results showed that around 30% of patients experienced increased meal intake, and those starting anamorelin during chemotherapy had a significantly longer treatment duration (55 days) compared to those receiving only supportive care (12 days), highlighting the need for personalized treatment strategies.
Walled-off necrosis (WON) develops as local complications after acute necrotizing pancreatitis. Although less invasive interventions such as endoscopic ultrasonography (EUS)-guided drainage and endoscopic necrosectomy are selected over surgical interventions, delayed and step-up interventions are still preferred to avoid procedure-related adverse events. However, there is a controversy about the appropriate timing of drainage and subsequent necrosectomy.
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- The TOKYO criteria, initially proposed for standardized reporting of endoscopic transpapillary biliary drainage outcomes, face limitations in newer techniques like endoscopic ultrasound and device-assisted endoscopy.
- A new committee is updating these criteria to better reflect current clinical practices in managing various biliary conditions, recognizing the need for comprehensive outcome evaluations beyond just stent patency.
- The revised TOKYO criteria 2024 aim to enhance the design and reporting of clinical studies by introducing a "stent-demanding time" concept for a more thorough assessment of endoscopic biliary drainage outcomes.
Article Synopsis
- Postoperative pancreatic fistulas (POPFs) are frequent complications following pancreatic surgery, and their management is crucial for patient recovery.
- Endoscopic ultrasonography (EUS)-guided drainage is the preferred treatment for both POPFs and pancreatic fluid collections (PFCs), but approaches must be adjusted based on the presence of fluid collections and surgical drains.
- The review emphasizes the need for further research to clarify the guidelines for managing POPFs, particularly concerning intervention timing and methods, comparing them to the treatment of PFCs following acute pancreatitis.
[A case of small intestinal endometriosis with bowel obstruction and perforation].
Nihon Shokakibyo Gakkai Zasshi
May 2024
Article Synopsis
- - A 47-year-old woman experienced ongoing lower abdominal pain for over two weeks, leading to a diagnosis of small bowel obstruction caused by a mass in the terminal ileum after imaging tests.
- - Despite initial treatment efforts, her condition worsened, and emergency surgery was performed, revealing severe stenosis and an ileal perforation.
- - Pathological analysis confirmed the patient had intestinal endometriosis, highlighting the need to consider this rare condition in cases of bowel obstruction in women of childbearing age.
Article Synopsis
- This study compares two methods for treating pancreatic stones in chronic pancreatitis: extracorporeal shock wave lithotripsy (ESWL) and peroral pancreatoscopy-guided lithotripsy (POPS-L).
- A retrospective analysis of 66 patients showed that POPS-L had a higher stone clearance rate (78.9%) compared to ESWL (70.2%), although the difference was not statistically significant.
- POPS-L also required fewer treatment sessions on average (1 session) compared to ESWL (5 sessions), while both methods had similar complication and recurrence rates.
Article Synopsis
- - The study focuses on improving gastric endoscopic submucosal dissection (ESD) by utilizing artificial intelligence (AI) to identify blood vessels that need post-ESD coagulation (PEC) in real time, addressing the issue of delayed bleeding.
- - Data for training the AI was drawn from 153 gastric ESD videos, annotated to distinguish between vessels that bled with or without PEC and those that did not bleed at all.
- - The AI was tested on 12 new videos, correctly identifying 73.4% of the vessels that did not need additional treatment and successfully detecting all bleeding vessels in cases needing more coagulation, though it also overestimated the need for PEC in 22.9%
Article Synopsis
- - This study analyzed 322 patients with unresectable malignant hilar biliary obstruction to compare the effectiveness and safety of different types of plastic stent placements, such as intraductal plastic stents (IS) and across-the-papilla plastic stents (aPS), in providing drainage and facilitating reintervention. - Results showed no significant differences in overall success rates or adverse events among the stent types, but the time to recurrent biliary obstruction was notably shorter with aPS compared to IS and self-expandable metallic stents (SEMS), indicating a potential trade-off between initial effectiveness and longevity. - The study concluded that bilateral IS and SEMS offer longer patency after follow-up procedures, with IS placement being faster and allowing for
Article Synopsis
- No reliable marker for predicting peritoneal metastasis during chemotherapy for advanced gastric cancer (AGC) currently exists, which complicates treatment effectiveness.
- A study examining 73 AGC patients receiving TAX/RAM therapy found that elevated serum CA125 levels were significantly associated with the presence of peritoneal metastasis, with 80.6% of patients showing increased CA125 levels having this condition.
- The study concluded that monitoring CA125 kinetics can serve as an early indicator of peritoneal metastasis progress in patients undergoing this chemotherapy regimen.
Article Synopsis
- * A systematic review and meta-analysis of studies up to September 2022 compared PFC recurrence rates in patients with long-term PS versus those without, revealing that long-term PS significantly lowers recurrence rates (OR = 0.23).
- * However, while PS placement reduces recurrence risk, it significantly increases adverse events (AEs) (OR = 14.77), indicating that more research is needed to weigh the benefits against the risks of long-term PS use.
Article Synopsis
- * A retrospective study from December 2021 to June 2023 analyzed 106 AGC patients, focusing on those with severe peritoneal metastasis who received nivolumab plus mFOLFOX6, finding that 19.8% of patients had severe cases.
- * Results showed a median progression-free survival of 7.4 months and median overall survival of 10.7 months, with notable improvements in symptoms for a number of patients; however, some experienced significant
Article Synopsis
- Immune checkpoint inhibitors, specifically atezolizumab, can cause rare but serious side effects like aseptic meningitis during treatment for advanced cancer, such as hepatocellular carcinoma (HCC).
- A 74-year-old woman experienced symptoms including anorexia, fatigue, and fever after receiving three cycles of atezolizumab combined with bevacizumab, leading to a diagnosis of aseptic meningitis confirmed through cerebrospinal fluid and MRI findings.
- Prompt steroid treatment effectively improved her symptoms and resolved imaging abnormalities, highlighting the need for careful monitoring of immune-related adverse events in patients undergoing checkpoint inhibitor therapy.