Publications by authors named "Tezuka Ryuichi"

A 73-year-old man presented with left hypochondral pain. Dynamic computed tomography (CT) revealed abnormal vessels surrounding the pancreas, leading to a suspected diagnosis of pancreatic arteriovenous malformation (PAVM). At the time of the initial examination, dynamic CT revealed mild acute pancreatitis, and PAVM was diagnosed based on the findings of dynamic CT.

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Endoscopic retrograde cholangiopancreatography (ERCP) is the standard procedure for the diagnosis and treatment of biliary diseases. However, selective biliary cannulation, the essential first step in ERCP, can sometimes fail due to anatomical variations or technical limitations. In these cases, the endoscopic ultrasound-guided rendezvous technique (EUS-RV) offers a valuable salvage option.

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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.

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Gemcitabine 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.

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Background 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.

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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.
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Endoscopic ultrasound-guided fine needle aspiration and biopsy have significantly evolved since they offer a minimally invasive approach for obtaining pathological specimens from lesions adjacent to or within the intestine. This paper reviews advancements in endoscopic ultrasound-guided fine needle aspiration and biopsy techniques and devices, emphasizing the importance of handling specimens for diagnostic accuracy. Innovations of fine needle biopsy needles with features like side holes and Franseen shapes have enhanced histological sampling capabilities.

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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.

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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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Autoimmune pancreatitis (AIP) is considered to have a good steroid response and is recognized as a disease with a favorable prognosis. However, it has been reported that patients with AIP have malignant diseases. We herein report two cases of pancreatic cancer during the follow-up of AIP, in which both patients died of pancreatic cancer.

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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.

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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.

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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
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Article 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.
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Unlabelled: In the treatment of advanced pancreatic cancer (APC), FOLFIRINOX (FX), including its dose-modified regimen (mFX), is considered an effective regimen; however, FX is also known to be associated with a high incidence of adverse events due to its multi-agent combination regimen. The efficacy and safety in elderly patients with APC have not been well studied.

Aim: To compare the safety and efficacy of first-line mFX for unresectable APC in elderly and young patients.

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Article Synopsis
  • Sludge occlusion is a common cause of recurrent biliary obstruction after the placement of self-expandable metallic stents (SEMS), and this study investigates the effectiveness of ursodeoxycholic acid (UDCA) in addressing this issue.
  • The research involved 354 patients, with a comparison between 60 who received UDCA and 110 matched patients who did not, focusing on how long it takes for recurrent biliary obstruction to occur.
  • Results showed that UDCA did not significantly extend the time to recurrent biliary obstruction and may even have increased the risk of sludge occlusion when taken for more than a month.
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Endoscopic management of biliary diseases in patients with surgically altered anatomy can be challenging because the altered anatomy makes it difficult to insert an endoscope into the biliary orifice. Even if insertion is feasible, the worse maneuverability of the endoscope and the restriction in available devices and techniques could complicate the procedure. Recently, endoscopic ultrasound-guided antegrade intervention (EUS-AG) has been reported as a useful management method for biliary diseases, especially in patients with surgically altered anatomy.

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The specimen collection and subsequent pathological diagnosis of malignant biliary stricture (MBS) are difficult. This study aimed to determine whether the cell block (CB) method using overnight-stored bile is useful in the diagnosis of MBS. This trial was a single-arm prospective study involving a total of 59 patients with suspected MBS.

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After an abdominal injury, a woman in her 20s presented to our hospital with abdominal pain. Pancreatic trauma was discovered on computed tomography, along with a pancreatic duct injury and pancreatic juice leakage. Endoscopic retrograde pancreatography revealed a 10-mm rupture of the pancreatic body's main pancreatic duct (MPD) and intraperitoneal leakage of contrast enzyme from the MPD.

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Background: Expanding indications for neoadjuvant chemotherapy (NAC) for resectable pancreatic cancer prolong the period from diagnosis to surgery. In resectable pancreatic cancer with malignant biliary obstruction (MBO), the biliary drainage method without any biliary events is ideally required to safely perform NAC as planned. Plastic stents (PS) have been traditionally used for preoperative biliary drainage; however, recently, covered self-expandable metallic stents (CSEMS) have emerged as a tool for preoperative biliary drainage.

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Video 1After insertion of the cholangioscope into the common bile duct, electrohydraulic lithotripsy was performed. All common bile duct stones were shattered and successfully removed using a basket and balloon catheter.

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Preoperative assessment of the superficial ductal spread (SDS) of perihilar cholangiocarcinoma (PCCA) is important for determining its resectability. A virtual endoscopic imaging method, magnetic resonance cholangioscopy (MRCS), wherein a three-dimensional image is created from magnetic resonance imaging (MRI) data, can evaluate all aspects of arbitrary bile ducts. Overall, 15 patients with PCCA who underwent preoperative MRI were enrolled.

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