Publications by authors named "Kazuo Inui"
Article Synopsis
- *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 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
- The study aimed to predict the success of nonsurgical treatment, specifically extracorporeal shock wave lithotripsy (ESWL), for removing pancreatic stones in patients and to find the optimal number of treatment sessions needed.
- Data from 164 patients treated between 1992 and 2020 indicated that 79% achieved total stone clearance, with an average of 3 ESWL sessions, and an optimal threshold of 7 sessions was identified for effective treatment.
- Results showed that patients who underwent 7 or fewer sessions had a higher clearance rate (87%) compared to those with more sessions (48%), leading to the recommendation to consider other medical or surgical options if stones remain after 7 sessions.
Article Synopsis
- The Japanese Society of Gastroenterology updated its clinical practice guidelines for cholelithiasis, reflecting new evidence on diagnosis and treatment since the previous versions published in 2010 and 2016.
- The latest guidelines categorize clinical questions into three types: background questions, clinical questions, and future research questions, addressing 52 total inquiries about the condition.
- A comprehensive flowchart was included to aid healthcare professionals in managing gallbladder and bile duct stones, making it easier for gastroenterologists and general physicians to apply these recommendations in clinical settings.
Objectives: We aimed to determine when a coexisting pseudocyst was likely to complicate the nonsurgical treatment of pancreatolithiasis.
Methods: We treated 165 patients with pancreatolithiasis nonsurgically between 1992 and 2020, including 21 with pseudocysts. Twelve patients had a single pseudocyst less than 60 mm in diameter.
Article Synopsis
- * Imaging suggested primary sclerosing cholangitis, and while steroid therapy improved some symptoms, a bile duct biopsy indicated a possible adenocarcinoma leading to surgery.
- * After surgery complications arose, leading to the need for additional surgery, and prednisolone was reintroduced to manage recurring symptoms and increased eosinophil infiltration was observed in the tissue samples.
Objectives: Optimal management of type 1 gastric neuroendocrine tumors (T1-GNETs) remains unknown, with few reports on their long-term prognosis. This study investigated the clinical characteristics and long-term prognosis of T1-GNETs.
Methods: We reviewed the medical records of patients diagnosed with T1-GNET during 1991-2019 at 40 institutions in Japan.
Background: Many guidelines for nonsurgical treatment of pancreatolithiasis suggest little guidance for patients with pancreatolithiasis who do not have abdominal pain. Some patients with pancreatolithiasis whom we have treated nonsurgically with extracorporeal shock-wave lithotripsy did not have abdominal pain, and we describe one of them here.
Methods And Results: A 42-year-old man complaining of an 8-kg weight loss over 6 months was admitted to a nearby hospital, where fasting blood sugar and hemoglobin A1c values were 500 mg/dL and 11.
Article Synopsis
- A Japanese multicenter study investigated the effectiveness of steroid therapy as the first-line treatment for patients with autoimmune pancreatitis and cyst formation.
- The analysis of 115 patients revealed that 86% of those receiving steroids achieved complete remission, compared to only 33.3% of those who did not.
- Although steroid treatment was effective, factors like varix formation significantly increased the risk of relapse after remission, indicating the need for careful monitoring in patients.
Objective: Clinical guidelines consider abdominal pain an indication for nonsurgical treatment of pancreatolithiasis. We examined benefit from nonsurgically treating asymptomatic pancreatolithiasis.
Methods: We retrospectively reviewed 165 patients with pancreatolithiasis who underwent nonsurgical treatment between 1992 and 2020.
Objectives: While chronic pancreatitis associated with pancreatolithiasis presents with pain, exocrine and endocrine pancreatic functions worsen with time. We examined outcomes of nonsurgical treatment.
Methods: Between 1992 and 2020, we treated pancreatolithiasis nonsurgically in 165 patients with chronic pancreatitis using extracorporeal shock wave lithotripsy alone or followed by endoscopic procedures.
Article Synopsis
- Due to new insights and updates to the Japanese autoimmune pancreatitis (AIP) diagnostic criteria in 2018, the existing 2013 consensus guidelines needed revision.
- A group of 20 AIP specialists analyzed 5218 articles from 1963 to 2019 to extract clinical statements and developed 39 clinical questions and statements across various aspects of AIP.
- A modified Delphi method was used to validate these statements, and with moderator evaluation, the revised Japanese consensus guidelines for AIP were proposed in 2020.
The Japan Gastroenterological Endoscopy Society has developed the "Clinical Practice Guidelines for Endoscopic Papillectomy (EP)" as a fundamental guideline using scientific approach. EP is a recently spreading therapeutic modality for ampullary tumors ranked as high risk endoscopic technique. Because of the paucity of high level of evidence, strength of recommendations had to be determined by a consensus among specialists.
View Article and Find Full Text PDFBackground: The prevalent location and incidence of intraductal papillary neoplasm of the bile duct (IPNB) and invasive carcinoma associated with them have varied markedly among studies due to differences in diagnostic criteria and tumor location.
Methods: IPNBs were classified into two types: Type 1 IPNB, being histologically similar to intraductal papillary mucinous neoplasm of the pancreas, and Type 2 IPNB, having a more complex histological architecture with irregular papillary branching or foci of solid-tubular components. Medical data were evaluated.
Some situations may require endoscopy during the COVID-19 (Coronavirus Disease 2019) pandemic. Here, we describe the necessary precautions in the form of clinical questions and answers (Q&A) regarding the safe deployment of gastrointestinal endoscopy in such situations while protecting endoscopy staff and patients from infection. Non-urgent endoscopy should be postponed.
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- Chronic pancreatitis (CP) is a serious inflammatory condition that significantly impacts quality of life and leads to lasting pancreatic damage.
- An international group of 20 experts reviewed 14 key factors affecting CP risk, finding strong agreement that alcohol, smoking, and genetic factors increase risk significantly.
- Education on healthy lifestyle choices and genetic counseling may help lower the occurrence of CP, as both personal history and environmental factors play a crucial role in its development.
All gastrointestinal endoscopic procedures have a high risk of aerosol contamination of the coronavirus disease 2019 (COVID-19) to endoscopists, nurses, and healthcare assistants. Given the current pandemic situation of COVID-19, the Japan Gastroenterological Endoscopy Society issued the recommendation for gastrointestinal (GI) endoscopy based on the status of COVID-19 as of April 9, 2020, in Japan: (i) indications for GI endoscopy in the pandemic of COVID-19; (ii) practical protective equipment for medical personnel depending on the risk for COVID-19; (iii) preprocedural management, such as pharyngeal local anesthesia using lidocaine spray which has a potential to generate the aerosols; (iv) ideal settings of the endoscopy room including the numbers of the staff and the patients; (v) postprocedural management, such as undressing and follow-up of the patients, as well as the involved staff, were documented to fit the practical scenarios in GI endoscopy, with the available data in Japan and the world. We believe that certain measures will prevent further spread of COVID-19.
View Article and Find Full Text PDFDiseases associated with gallbladder wall thickening include benign entities such as adenomyomatosis of the gallbladder, acute and chronic cholecystitis, and hyperplasia associated with pancreaticobiliary maljunction, and also cancer. Unique conditions such as sclerosing cholecystitis and cholecystitis associated with immune checkpoint inhibitor treatment can also manifest as wall thickening, as in some systemic inflammatory conditions. Gallbladder cancer, the most serious disease that can show wall thickening, can be difficult to diagnose early and to distinguish from benign causes of wall thickening, contributing to a poor prognosis.
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- Real-time tissue elastography is a non-invasive technique used to measure liver stiffness and evaluate liver fibrosis, specifically in patients with hepatitis C who have achieved sustained virological response.
- A study involving 425 chronic hepatitis C patients found that real-time tissue elastography successfully differentiated between various stages of liver fibrosis, with specific cut-off values indicating significant, severe fibrosis, and cirrhosis.
- The findings suggest that this method is reliable for predicting liver fibrosis severity in patients who have responded well to hepatitis C treatment.
Background: IgG4-related disease is a newly recognised immunopathological entity that includes autoimmune pancreatitis, IgG4-related sialadenitis, and IgG4-related kidney disease. To understand the genetic landscape of IgG4-related disease, we did a genome-wide association study.
Methods: We did a genome-wide association study of Japanese individuals, initially screening 857 patients with IgG4-related disease at 50 Japanese research institutions and DNA samples from 2082 healthy control participants from the Nagahama Prospective Genome Cohort for the Comprehensive Human Bioscience.
Background: Chronic pancreatitis (CP) is a fibro-inflammatory disease of the pancreas. Early diagnosis and intervention, before CP becomes established and irreversible, are essential to improve the long-term outcomes. The world's first diagnostic criteria for early CP were proposed in Japan in 2009, but their clinical utility remains elusive.
View Article and Find Full Text PDFThe development of endoscopic treatment for pancreatobiliary diseases in recent years is remarkable. In addition to conventional transpapillary treatments under endoscopic retrograde cholangiopancreatography (ERCP), new endoscopic ultrasound-guided therapy is being developed and implemented. On the other hand, due to the development/improvement of various devices such as new metal stents, a new therapeutic strategy under ERCP is also advocated.
View Article and Find Full Text PDFEndoscopic ultrasound/ultrasonography-guided biliary drainage (EUS-BD) is a relatively new modality for biliary drainage after failed or difficult transpapillary biliary cannulation. Despite its clinical utility, EUS-BD can be complicated by severe adverse events such as bleeding, perforation, and peritonitis. The aim of this paper is to provide practice guidelines for safe performance of EUS-BD as well as safe introduction of the procedure to non-expert centers.
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