Publications by authors named "Kentaro Yamao"

Small bowel stenosis in patients with Crohn's disease leads to abdominal symptoms and can affect prognosis. The Simple Endoscopic Score for Crohn's Disease for the large bowel has been applied to the small bowel; however, stenosis scoring may be overestimated since it has a long diameter. This retrospective study aimed to devise a new endoscopic scoring system including the small bowel and evaluate whether it predicts the prognosis of Crohn's disease.

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A 73-year-old man underwent upper gastrointestinal endoscopy for abdominal pain, which revealed an ampullary adenoma with no obvious extension into the bile or pancreatic ducts. Endoscopic papillectomy (EP) was performed and a 5-Fr 5-cm stent was placed in the pancreatic duct. The patient developed acute pancreatitis on postoperative day (POD) 1 and contrast-enhanced computed tomography performed on POD 2 revealed that the proximal end of the stent had migrated into the retroperitoneum, forming a pancreatic fistula.

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Vedolizumab is a treatment option for ulcerative colitis but data on predictors of treatment response remain insufficient to establish personalized treatment strategies. We aimed to investigate the real-world effectiveness of vedolizumab in adult patients with ulcerative colitis and explore factors involved in predicting treatment response. This single-center, single-arm, prospective observational study included 26 patients with clinically active ulcerative colitis patients' characteristics at baseline, epidemiological information, existing treatment, clinical activity index score, endoscopic score, and blood test data were collected.

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Background Gangliocytic paraganglioma (GP) significantly affects patients' quality of life. However, studies on endoscopic papillectomy (EP) for ampullary GP are limited. We therefore evaluated the safety and efficacy of EP for treating ampullary GP.

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Background/purpose: The usefulness of endoscopic biliary stenting by deploying a plastic stent suprapapillary, called inside-stent (IS) placement, as preoperative biliary drainage (PBD) for perihilar biliary malignancy (PHBM) has been demonstrated. This study investigated risk factors for recurrent biliary obstruction (RBO) after IS placement.

Methods: Consecutive patients with potentially resectable PHBM treated with IS placement as PBD between 2017 and 2023 at Nagoya University Hospital were retrospectively reviewed.

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Article Synopsis
  • Inflammation in ulcerative colitis (UC) begins in the colorectal mucosa, and studying the intestinal mucus could reveal valuable biomarkers for this condition.
  • Researchers used colonoscopy to collect mucus and mucosal samples, allowing them to analyze RNA and protein levels of neuropeptides in both active and remission areas of UC.
  • They found that somatostatin (SST) levels were higher in remission areas of the mucus, suggesting its role as a key indicator of UC activity and potential therapeutic target.
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  • Crohn's disease (CD) leads to ongoing inflammation in the gastrointestinal tract, with small bowel capsule endoscopy (SBCE) being crucial for monitoring patency and treatment progress, especially in the small bowel.
  • This study analyzed 120 out of 166 patients who underwent SBCE, focusing on the timing of clinical changes, stricture-free rates, and treatment strategies after the procedure.
  • Results showed a significant portion of patients needed treatment changes over time, with the GI patency rate dropping after 2 years, suggesting patients without treatment changes should undergo SBCE every 2 years for effective monitoring.
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  • The study aimed to evaluate how effective and safe endoscopic ultrasound-guided fine needle biopsy (EUS-FNB) is for diagnosing autoimmune pancreatitis (AIP) using a specific 19-gauge Franseen needle.
  • Out of 20 patients suspected of having type 1 AIP, 95% were able to provide specimens for histological analysis, with a diagnosis rate of 65%, though 15% experienced adverse effects during the procedure.
  • The use of the 19-gauge needle resulted in larger tissue samples compared to a 22-gauge needle, but maneuverability issues were noted, suggesting that the choice of needle should depend on the puncture location.
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  • In primary sclerosing cholangitis (PSC), it is challenging to identify cholangiocarcinoma due to inflammation, making accurate pathology crucial for surveillance during endoscopic procedures.
  • A study involving 59 PSC patients revealed that transpapillary bile duct biopsy has significantly higher sensitivity, specificity, and accuracy for detecting malignancies compared to bile cytology.
  • Findings indicated that in cases of cholangiocarcinoma, patients exhibited larger diameters of upstream bile ducts and significant differences in diameters, particularly when these differences exceeded 5 mm, warranting suspicion of cancer.
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An asymptomatic 77-year-old man with intrahepatic bile duct dilation was referred to our hospital. Cholangiography revealed alternations between strictures and dilated segments from the right and left hepatic ducts to the lower bile ducts, with findings of a pruned tree, beaded, shaggy appearance, and diverticulum-like outpouching. Histopathology revealed abundant immunoglobulin G4 (IgG4)-positive plasma cells (> 10 per high-power field) with an IgG4/IgG-positive cell ratio of 40-50%.

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  • - Endoscopic papillectomy is a procedure used primarily to treat duodenal papillary tumors, mainly adenomas that don't extend into the bile or pancreatic ducts, and it's performed more frequently at specialized medical centers.
  • - There is caution about expanding treatment indications despite reports of well-differentiated adenocarcinomas being eligible, primarily due to inconsistent biopsy results and limitations in imaging techniques for determining any invasion into the sphincter of Oddi.
  • - While complications have been reduced and can be managed with techniques like pancreatic duct stenting, the overall safety of the procedure is still uncertain; advancements in technology could potentially broaden its applications and enhance diagnostic accuracy in the future.
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  • - The article reviews advancements in endoscopic ultrasound-guided tissue acquisition (EUS-TA), focusing on its role in diagnosing solid pancreatic lesions (SPLs) using techniques like fine-needle aspiration (EUS-FNA) and fine-needle biopsy (EUS-FNB).
  • - It discusses improvements in needle design, sampling methods, and the use of artificial intelligence (AI) and comprehensive genomic profiling (CGP) to enhance diagnostic performance and treatment precision.
  • - Key techniques like door-knocking and fanning are highlighted for improving outcomes, while the importance of macroscopic on-site evaluation (MOSE) and ongoing research for future developments are emphasized.
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  • * The study involved 31 patients treated with UST, with clinical remission rates improving from 9.7% at 2 weeks to 64.5% at 48 weeks; however, 38.7% of patients discontinued treatment, primarily due to primary failure.
  • * High baseline C-reactive protein (CRP) levels were identified as a significant risk factor for discontinuation of UST, highlighting the need for clinicians to consider CRP when making treatment decisions for UC patients.
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Background/purpose: Data on the prognosis of endoscopic papillectomy (EP) for ampullary carcinoma (AC) is limited; therefore, we aimed to identify the factors associated with endoscopically controlled AC.

Methods: Between January 2003 and October 2022, 75 patients underwent EP for ampullary tumors and were diagnosed with AC based on the pathological features of the resected tissue. The factors associated with additional surgery after EP were also evaluated.

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  • A Phase II trial was conducted to evaluate the effectiveness and tolerability of low-dose gemcitabine plus nab-paclitaxel (GnP) in elderly patients with metastatic pancreatic cancer compared to the standard-dose treatment.
  • A total of 60 patients aged 65 or older were randomly assigned to receive either low-dose or standard-dose GnP, with the lower dose showing a significant reduction in the need for dose adjustments.
  • Overall, both treatment groups had similar efficacy results in terms of response rate, progression-free survival, and overall survival, but the low-dose regimen did not lead to a decrease in treatment-related adverse events.
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  • Obscure gastrointestinal bleeding can occur when the source of bleeding is unknown, even after procedures like balloon-assisted endoscopy; Dieulafoy's lesion in the small bowel is often suspected as the cause.
  • A retrospective study analyzed 38 patients diagnosed with Dieulafoy's lesion through double-balloon endoscopy, focusing on their clinical characteristics and whether bleeding could be predicted before the procedure.
  • The median age of patients was 72, with a high comorbidity rate; most lesions were found in the upper jejunum and lower ileum, with a 21% rebleeding rate after endoscopic treatment, and multiple episodes of hematochezia linked to the likelihood of receiving multiple diagnoses.
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Background And Aims: The diagnostic performance of EUS-guided fine-needle aspiration/biopsy sampling (EUS-FNAB) for pancreatic ductal adenocarcinoma (PDAC) ≤10 mm in diameter is relatively low. Pancreatic juice cytology (PJC) has gained attention because of its high sensitivity for small PDACs. We aimed to clarify the diagnostic ability of EUS-FNAB and the salvage ability of PJC for PDAC ≤10 mm.

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Background: This prospective cohort study evaluated the feasibility of using endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) samples for comprehensive mutational analysis of cancer-related genes using microtissues.

Methods: Fifty patients with suspected pancreatic cancer presenting consecutively at the Kindai University Hospital between January 2018 and January 2019 were enrolled. Cancerous tissues from EUS-FNB were obtained from each tumor and subjected to histological examination and mutational analysis.

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  • - The study explores how sarcopenia (low muscle mass) affects recurrent biliary obstruction (RBO) in pancreatic cancer patients undergoing neoadjuvant therapy with a fully covered self-expandable metal stent (FCSEMS).
  • - Researchers analyzed patient data, comparing those with normal and low skeletal muscle indexes (SMI), finding that low SMI significantly increased the risk of shorter time to RBO.
  • - The results suggest that sarcopenia is an important independent risk factor for RBO in these patients, highlighting the potential need to address muscle mass in treatment planning.
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Objectives: In this study we aimed to develop an artificial intelligence-based model for predicting postendoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP).

Methods: We retrospectively reviewed ERCP patients at Nagoya University Hospital (NUH) and Toyota Memorial Hospital (TMH). We constructed two prediction models, a random forest (RF), one of the machine-learning algorithms, and a logistic regression (LR) model.

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  • This study investigated whether performing 5 or 15 actuations (to-and-fro movements) during endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) affects the quality of specimens taken from solid pancreatic lesions.* -
  • Analyzed data from 85 patients showed that the accuracy of histological diagnoses was higher with 15 actuations (83.5%) compared to 5 actuations (77.7%), indicating that 5 actuations did not meet the noninferiority criteria.* -
  • The study concluded that 15 actuations provide better quality tissue samples, making them the preferred method for EUS-FNB in diagnosing pancreatic cancer.*
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