Publications by authors named "Maruta A"
Background And Aims: Endoscopic ultrasound-guided peripancreatic fluid drainage (EUS-PFD) with on-demand endoscopic necrosectomy, increasingly utilized to manage walled-off necrosis (WON), is associated with substantial morbidity and mortality. This multicenter study aimed to externally validate recently developed quadrant (an abdominal quadrant distribution), necrosis, and infection (QNI) criteria for risk stratification in this setting.
Methods: Of 423 patients with pancreatic fluid collections treated in a large multi-institutional cohort between 2010 and 2020, 212 with available preprocedural computed tomography images were included.
Background: Mapping biopsy (MB) can evaluate superficial ductal spread (SDS) through the histopathological diagnosis of cholangiocarcinoma, enabling the selection of an appropriate surgical procedure. This retrospective study evaluated the efficacy of MB using a novel sheath system in distal cholangiocarcinoma (dCCA) cases.
Methods: A total of 199 cholangiocarcinoma cases underwent preoperative diagnosis.
Background And Aims: EUS-guided transmural drainage with on-demand endoscopic necrosectomy (EN) is increasingly used to manage walled-off necrosis (WON). It has not been fully elucidated how EN and its timing are correlated with treatment outcomes compared with the drainage-based approach.
Methods: Within a multi-institutional cohort of 423 patients with pancreatic fluid collections, including 227 patients with WON, 153 patients were identified who received the step-up treatment after the initial EUS-guided drainage of symptomatic WON; this included 102 EN patients and 51 non-EN (drainage) patients.
Disconnected pancreatic duct syndrome: diagnostic and therapeutic challenges and future directions.
Expert Rev Gastroenterol Hepatol
October 2024
Article Synopsis
- Disconnected pancreatic duct syndrome (DPDS) arises from issues with the pancreatic duct and can lead to continuous enzyme secretion, often following acute necrotizing pancreatitis.
- Diagnosis and treatment are challenging due to the lack of consensus on definition and classification, which can result in delays and overlooked cases.
- A standardized definition is crucial for future clinical studies aimed at improving the management and understanding of DPDS.
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 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.
Background: Alcohol-based handrub (ABHR) is the gold standard for hand hygiene (HH) and is a cornerstone of infection prevention and control (IPC) strategies. However, several factors influence the efficient use of ABHR by health workers. This study evaluated the tolerability and acceptability of a locally produced ABHR product and HH behaviour among health workers.
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- 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 compares one-stage and two-stage endoscopic management for treating acute cholangitis caused by common bile duct stones (CBDS) using data from 577 patients between 2010 and 2020.
- - Results showed that while both approaches had similar success rates, the one-stage management led to shorter hospital stays and a lower incidence of early pancreatitis compared to the two-stage approach.
- - However, the one-stage management had a higher rate of cumulative late adverse events, indicating that careful postoperative monitoring for CBDS recurrence is important.
Objectives: The placement of plastic stents (PS), including intraductal PS (IS), is useful in patients with unresectable malignant hilar biliary obstruction (UMHBO) because of patency and ease of endoscopic reintervention (ERI). However, the optimal stent replacement method for PS remains unclear.
Methods: This retrospective study included 322 patients with UMHBO.
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.
Objective: Inappropriate use of antibiotics is a major driver of antibiotic resistance. A few studies conducted in Africa have documented that about half of hospitalised patients who receive antibiotics should not have received them. A few hospital-based studies that have been conducted in Sierra Leone have documented a high usage of antibiotics in hospitals.
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- This study examines the effectiveness of bilateral intraductal plastic stent (IS) placement for treating unresectable malignant hilar biliary obstruction (UMHBO) compared to unilateral placement.
- The research found that both unilateral and bilateral IS placements achieved high technical (100%) and clinical success rates (93% for unilateral and 96% for bilateral), with similar rates of complications.
- However, patients with bilateral IS had a significantly longer median time to recurrent biliary obstruction (226 days) compared to those with unilateral IS (129 days), suggesting that while bilateral stenting is effective, it may lead to longer-term issues.
Article Synopsis
- Covered self-expandable metallic stents are effective in treating unresectable malignant distal biliary obstruction, with the 12-mm stent showing longer patency than the 10-mm stent due to reduced sludge formation.
- A randomized controlled trial with 81 patients revealed that stents measuring 12 mm had a significantly lower rate of recurrent biliary obstruction at 6 months compared to the 10-mm stents.
- The study concluded that the 12-mm stents not only delayed recurrence of obstruction but were also associated with factors like receiving chemotherapy that impacted treatment outcomes.
Nonalcoholic steatohepatitis (NASH) can progress to hepatic fibrosis, and is associated with cardiovascular and liver-related mortality. To understand the pathogenesis of NASH, reliable animal models of the disease are useful. In animal studies, the animals are usually fasted overnight before biospecimens are taken, but little is known about the effects of fasting.
View Article and Find Full Text PDFBackground: Although one of the main drivers of antimicrobial resistance is inappropriate antibiotic prescribing, there are limited resources to support the surveillance of antibiotic consumption in low-income countries. In this study, we aimed to assess antibiotic use and consumption among medical patients of two hospitals in different geographic regions of Sierra Leone.
Methods: This is a cross-sectional study of adult (18 years or older) patients receiving medical care at two hospitals (34 Military Hospital-MH and Makeni Government Hospital-MGH) between March 2021 and October 2021.
Objectives: Bilateral self-expandable metallic stent (SEMS) placement for unresectable malignant hilar biliary obstruction (UMHBO) is an effective option for biliary drainage with long-term stent patency. Laser-cut and braided SEMS can be used for bilateral SEMS placement. This study aimed to clarify any differences in the clinical features and proper use of the laser-cut and braided SEMS placement using the stent-in-stent method for UMHBO.
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- A comprehensive study examined the short- and long-term adverse outcomes of endoscopic ultrasound (EUS)-guided treatment for pancreatic fluid collections (PFCs), focusing on walled-off necrosis (WON) and pseudocysts.
- The study involved 357 patients, identifying specific risk factors for procedure-related adverse events, clinical failure, and recurrence, particularly noting that WON had more adverse events compared to pseudocysts.
- Key findings highlighted that factors like extension of WON to the pelvis and multiple procedures for pseudocysts significantly increased the risks of complications and treatment failure, suggesting the need for more tailored strategies for high-risk patients.
Background And Aims: Intraductal plastic stent (IS) placement for unresectable malignant hilar biliary obstruction (UMHBO) is an effective option for biliary drainage. However, the effectiveness of bilateral IS placement compared with bilateral self-expandable metal stent (SEMS) placement remains unclear.
Methods: Overall, 301 patients with UMHBO were enrolled; 38 patients underwent bilateral IS placement (IS group) and 38 patients underwent SEMS placement (SEMS group) in the propensity score-based cohort.
Background: Endoscopic transpapillary naso-gallbladder drainage (ENGBD) has been reported to be an effective treatment option for acute cholecystitis. At our institution, ENGBD was first placed for external fistula management, and endoscopic internalization by cutting was performed, shifting to endoscopic transpapillary gallbladder stenting (EGBS) after improvement of cholecystitis. However, there has been no comparative study to define which preoperative management is better: converting ENGBD to EGBS or removing ENGBD.
View Article and Find Full Text PDFBackground: With the increasing popularity of endoscopic ultrasound (EUS)-guided transmural interventions, walled-off necrosis (WON) of the pancreas is increasingly managed via non-surgical endoscopic interventions. However, there has been an ongoing debate over the appropriate treatment strategy following the initial EUS-guided drainage. Direct endoscopic necrosectomy (DEN) removes intracavity necrotic tissue, potentially facilitating early resolution of the WON, but may associate with a high rate of adverse events.
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- * A less invasive "step-up approach," which combines endoscopic ultrasound-guided drainage with necrosectomy, is becoming more common for managing these collections, supported by advancements in specific devices.
- * There is still uncertainty regarding the optimal timing of treatments and the effectiveness of noninterventional supportive care, highlighting the need for large studies to improve patient management and outcomes for those with PFCs.
In this study, we aimed to analyze the role of the Homocysteine-responsive endoplasmic reticulum-resident ubiquitin-like domain member 1 (Herpud1) gene in the development of cardiomyocyte hypertrophy in association with Calmodulin (CaM) nuclear translocation and cytosolic Ca levels. To observe the mobilization of CaM in cardiomyocytes, we stably expressed eGFP-CaM in rat myocardium-derived H9C2 cells. These cells were then treated with Angiotensin II (Ang II), which stimulates a cardiac hypertrophic response, or dantrolene (DAN), which blocks the release of intracellular Ca.
View Article and Find Full Text PDFBackground: Both endoscopic nasogallbladder drainage (ENGBD) and endoscopic gallbladder stenting (EGBS) are effective management for acute cholecystitis, although ENGBD can cause discomfort due to its nature of external drainage. Converting ENGBD to EGBS after improvement of cholecystitis might be one treatment strategy. The drainage tube of ENGBD could be endoscopically cut inside the stomach to convert to internal drainage without additional endoscopic retrograde cholangiography (ERCP).
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