Publications by authors named "Mitsuru Okuno"
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.
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.
Background: Benign choledochojejunal anastomotic stricture (CJS) is a complication of pancreaticoduodenectomy and choledochojejunostomy. Typically managed with endoscopic balloon dilatation, CJS has a high recurrence rate. Covered metallic stent (CMS) placement is a potential alternative; however, a comprehensive evaluation is lacking.
View Article and Find Full Text PDFGemcitabine plus nab-paclitaxel (GnP) and FOLFIRINOX are widely used as first-line regimens for unresectable pancreatic cancer (PC). When GnP therapy is selected, considering patient age or condition, second-line FOLFIRINOX is sometimes difficult to administer owing to its toxicity. This study aimed to determine the recommended dose (RD) of S-IROX (S-1, oxaliplatin, and irinotecan combination) regimens in patients with unresectable PC after first-line GnP failure.
View Article and Find Full Text PDFThe identification of anticancer therapies using next-generation sequencing (NGS) is necessary for the treatment of cholangiocarcinoma. NGS can be easily performed when cell blocks (CB) are obtained from bile stored overnight. We compared NGS results of paired CB and surgically resected specimens (SRS) from the same cholangiocarcinoma cases.
View Article and Find Full Text PDFBackground And Aims: Pancreatic juice cytology is useful for diagnosing pancreatic duct strictures and cystic lesions. However, some cases cannot be diagnosed using cytology. This study aimed to evaluate the utility of the overnight-stored pancreatic juice cell block (CB) method for diagnosing pancreatic disease.
View Article and Find Full Text PDFArticle 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 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
- 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.
Although endoscopic necrosectomy (EN) is a less invasive therapy for walled-off necrosis (WON), arterial bleeding can occur during EN. A 60-year-old man with infected WON underwent the EN procedure. During EN, the artery in the WON cavity was injured.
View Article and Find Full Text PDFObjectives: 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.
View Article and Find Full Text PDFArticle Synopsis
- This study evaluates the effectiveness of two types of 19-gauge needles (conventional and Franseen) used for endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) in diagnosing lymphadenopathy and classifying malignant lymphoma.
- It analyzed various factors, including patient characteristics, number of needle passes, and diagnostic accuracy, finding that the conventional needle required fewer passes than the Franseen needle.
- Both needle types demonstrated high diagnostic accuracy without significant differences in outcomes, but the conventional needle is recommended for its efficiency and lower risk of adverse events.
Article Synopsis
- 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.
A 60-year-old man with a high IgG4 level was found to have pancreatic tail enlargement on computed tomography (CT), and autoimmune pancreatitis (AIP) was confirmed by a histological diagnosis. He was treated with prednisolone for one year and seven months, at which point his treatment finished. Four months later, however, he had hematemesis from gastric varices.
View Article and Find Full Text PDFBackground 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.
Article Synopsis
- - The study investigated the effectiveness of balloon dilation with balloon endoscopy-assisted endoscopic retrograde cholangiopancreatography (BE-ERCP) for treating benign choledochojejunal anastomotic stricture (CJS) following surgical procedures from 2009 to 2022.
- - Out of 40 patients, the success rates for the procedure were high—93% for technical success and 100% for clinical success—while 32% experienced recurrence of CJS, with no procedure-related complications reported.
- - Key risk factors for CJS recurrence included the timing of the recurrence after surgery and the presence of residual waist during the dilation, highlighting the importance of careful monitoring and technique in the management of
A 59-year-old man receiving sunitinib chemotherapy for postoperative recurrence of renal cell carcinoma (RCC) metastases was found to have multiple metastases on contrast-enhanced computed tomography (CECT). CECT revealed a typical hyperdense enhanced nodule in the arterial phase of the stomach and head and tail of the pancreas. However, in the uncinate process of the pancreas, CECT revealed an atypical image and a hypodense enhanced nodule in each phase.
View Article and Find Full Text PDFArticle Synopsis
- EUS-AG and BE-ERCP are two procedures used to treat bile duct stones in patients who have had certain surgeries affecting their anatomy, but how they compare has not been extensively researched.
- A study compared the clinical outcomes of these procedures by reviewing data from two hospitals and assessing success rates at various stages, including access to bile ducts and extraction of stones.
- Results showed that both procedures had similar overall success rates and adverse event rates, though there were differences in performance at specific steps, which could influence the choice of procedure based on individual patient needs.