Publications by authors named "Shin Yagi"
Objective: Whether metal stents (MS) or plastic stents (PS) yield better outcomes for malignant biliary obstruction in endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) is controversial. We aimed to compare outcomes of initial EUS-HGS performed with MS or PS.
Methods: In this single-center retrospective study, we included patients (MS/PS groups: n = 151/72) with unresectable malignant biliary obstruction and performed multivariable analysis.
Endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) often requires fistula dilation owing to the placement of a large diameter of the delivery stent. The recently developed delivery devices, which are as thin as 5.9/6.
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- The study aimed to assess the safety and effectiveness of propofol sedation in complex endoscopic procedures like endoscopic cholangiopancreatography, focusing on risk factors for excessive sedation.
- A review of 870 patient cases highlighted sedation-related issues, revealing rates of excessive sedation (7.8%), hypoxemia (6.0%), and hypotension (1.8%), with obesity and sleep apnea significantly linked to higher sedation risks.
- The findings suggest that sedation strategies for these patients should be personalized, especially for those with identified risk factors such as obesity and prolonged procedure times.
Tissue sampling in biliary tract cancer (BTC) is generally performed through transpapillary biopsy (TPB) or endoscopic ultrasound-guided tissue acquisition (EUS-TA). For the first time, we compared the suitability of specimens obtained using TPB and EUS-TA to determine the optimal tissue-sampling method for comprehensive genome profiling (CGP) analysis in patients with unresectable BTC (UR-BTC). Pathology precheck criteria for CGP analysis comprised the OncoGuide NCC Oncopanel System (NCCOP) and FoundationOne CDx (F1CDx).
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- The PRIMATE study focuses on optimizing tissue collection methods through EUS-guided fine-needle aspiration (EUS-TA) for patients with unresectable pancreatic cancer to improve genomic profiling.
- The study compares success rates of tissue specimens from both primary and metastatic lesions to meet specific analysis criteria established by the OncoGuide NCC Oncopanel.
- Results will be shared in an international conference and peer-reviewed journal, and the study has been approved by the National Cancer Center Institutional Review Board (Research No. 2022-168).
Article Synopsis
- Endoscopic ultrasound-guided hepaticogastrostomy with bridging shows a high technical success rate (90%) and minimal adverse events, making it a viable alternative to traditional drainage methods for malignant hilar biliary obstruction.
- In terms of stent patency, patients receiving this method experienced a significantly lower rate of recurrent biliary obstruction (17.6%) compared to those undergoing endoscopic transpapillary drainage-multi-stenting (58.5%).
- Results indicated that the endoscopic ultrasound-guided hepaticogastrostomy with bridging method provided longer median times to recurrent biliary obstruction, with strong potential for improved long-term outcomes, suggesting a need for further prospective studies.
Article Synopsis
- Endoscopic ultrasound-guided gastroenterostomy is a procedure to connect the stomach with an afferent loop affected by dilation, aimed at treating afferent loop syndrome; the study assesses its effectiveness and safety.
- The research found a 100% technical success rate and a 96% clinical success rate among 25 patients, with some serious early adverse events related to fluid leakage but no late complications.
- The procedure demonstrated a 32% rate of recurrent intestinal obstruction after a median of 6.5 months, but was highly successful in re-interventions, confirming its overall effectiveness and safety for this condition.
Article Synopsis
- Endoscopic ultrasound-guided pancreatic duct drainage (EUS-PD) is becoming a viable alternative for treating obstructive pancreatitis when traditional methods fail, but it has a concerning 20% rate of adverse events.
- A new plastic stent designed for EUS-PD was tested in a study involving 10 patients, where both technical and clinical success rates reached 100%, with only one experiencing a mild adverse event.
- Overall, the findings suggest that this novel stent appears to be a safe and effective option for EUS-PD, with a low recurrence rate of pancreatic duct obstruction.
Endoscopic gastroduodenal stent (GDS) deployment is currently a standard treatment for malignant gastric outlet obstruction (mGOO) in patients with limited life expectancy; however, stent dysfunction (SD) and complicated pancreatitis often occur after GDS deployment. We investigated incidence and contributing factors of SD and complicated pancreatitis. We retrospectively reviewed 203 patients who underwent initial GDS deployment for palliation of mGOO symptoms between October 2017 and July 2022, including 109 who underwent GDS deployment across the duodenal papilla (sub-cohort).
View Article and Find Full Text PDFBackground: The risk and prognosis of pancreatobiliary cancer and in patients with autoimmune pancreatitis (AIP) and IgG4-related sclerosing cholangitis (IgG4-SC) remain unclear. Therefore, we retrospectively investigated the risk of pancreatobiliary cancer and prognosis in patients with AIP and IgG4-SC.
Methods: Patients with AIP and IgG4-SC at seven centers between 1998 and 2022 were investigated.
Article Synopsis
- * The primary goal is to assess the long-term non-restenosis rate at 12 months, which hasn't been the main focus in previous studies.
- * Conducted as a multicenter, prospective intervention, the study is approved by the National Cancer Center in Japan and plans to enroll 50 participants.
Article Synopsis
- The study compared the effectiveness of two types of self-expandable metallic stents (L-type and B-type) for treating distal malignant biliary obstruction (DMBO), focusing on reducing recurrent biliary obstruction (RBO).
- It found that B-type stents had a significantly lower rate of RBO within one year (17.2%) compared to L-type stents (44.4%), although both types had similar safety profiles.
- Overall survival times were not significantly different between the groups, with median survival times of 158 days for L-type and 204 days for B-type stents.
Endoscopic papillectomy could be rewarding to patients with early stage duodenal ampullary carcinoma?
J Hepatobiliary Pancreat Sci
March 2024
Background/purpose: There is currently no consensus on the use of endoscopic papillectomy (EP) for early stage duodenal ampullary adenocarcinoma. This study aimed to evaluate the feasibility of EP for patients with early stage duodenal ampullary adenocarcinoma.
Methods: Patients who underwent EP for ampullary adenocarcinomas were investigated.
Background/purpose: This study aimed to investigate the efficacy of intensive fluid-loading therapy post-endoscopic retrograde cholangiopancreatography (ERCP) for the prevention of post-ERCP pancreatitis (PEP) in at-risk patients.
Methods: In this retrospective study, data of 1200 patients at risk for PEP were investigated. After propensity score matching, 404 patients were included in the normal (n = 202) and hydration (n = 202) groups.
Background And Purpose: During endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS), tract dilation is one of the most important steps, and the placement of conventional metal stents with 8.5 Fr delivery devices is difficult due to the large outer shape of the device. Fine-gauge balloon catheters have become popular because of their stricture penetration ability and ease of dilation.
View Article and Find Full Text PDFRequest for biliary drainage for IgG4-SC could be waived before steroid administration?
J Hepatobiliary Pancreat Sci
March 2023
Article Synopsis
- The study focused on patients with IgG4-related sclerosing cholangitis (IgG4-SC) to analyze whether biliary drainage (BD) is beneficial before starting steroid treatment.
- A total of 52 patients were examined, with 28 ultimately included in the analysis, showing no significant difference in liver function markers (ALP and T-Bil) between those who had BD and those who did not prior to steroid treatment.
- After 8 weeks of steroid therapy, both groups showed similar rates of improvement in liver damage, suggesting that BD may not be necessary for treating jaundice in IgG4-SC patients.
Article Synopsis
- Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is effective for diagnosing subepithelial lesions (SELs) and requires adequate tissue sampling to differentiate between benign and malignant conditions.
- A study involving 130 patients aimed to evaluate the effectiveness of Franseen needles compared to conventional needles for EUS-FNA of SELs.
- Results showed that Franseen needles had a higher sampling adequacy rate (95% vs. 76.7%) and required fewer punctures (2.80 vs. 3.42) compared to conventional needles, making them a better option for accurate diagnosis.
Background/purpose: The detection ability and role of different imaging modalities to detect pancreatic neuroendocrine neoplasms (PNENs) including small lesions is unclear. This study aimed to compare the ability of endoscopic ultrasound (EUS) and computed tomography (CT) to detect PNENs.
Methods: Data of patients who underwent EUS and contrast-enhanced CT and were diagnosed with PNENs were analyzed.
Background: Endoscopic retrograde cholangiopancreatography (ERCP) in patients with surgically altered anatomy is technically difficult. Extensive training is required to develop the ability to perform this procedure.
Aims: To investigate the learning curve of single-balloon-assisted enteroscopy ERCP (SBE-ERCP).
IgG4-related sclerosing cholangitis may be a risk factor for cancer.
J Hepatobiliary Pancreat Sci
June 2021
Background/purpose: The relationship between autoimmune pancreatitis (AIP) and malignancy has been reported. However, the potential risk for cancer in patients with immunoglobulin 4 (IgG4)-related sclerosing cholangitis (IgG4-SC) is unclear. The present study aimed to evaluate the incidence of cancer in IgG4-SC patients.
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- The study assesses the effectiveness of different stents for preoperative biliary drainage in patients with pancreatic head cancer undergoing neoadjuvant therapy.
- Results show that covered metal stents (CMS) lead to significantly lower rates of recurrent biliary obstruction compared to plastic stents (PS), providing a more reliable option for these patients.
- The use of CMS allows for effective chemotherapy treatment without major complications, enabling timely surgical procedures without significant delays.