Publications by authors named "Tsuyoshi Hamada"
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 effects of homologous recombination deficiency (HRD) on time-to-treatment failure (TTF) in patients with unresectable and recurrent pancreatic cancer (PC) receiving first-line chemotherapy.
- Among 1,394 patients analyzed, HRD was identified in 7.6% through genetic testing, with commonly affected genes being BRCA2 and ATM.
- Results showed no significant TTF difference in the gemcitabine plus nab-paclitaxel (GnP) group; however, in the FOLFIRINOX (FFX) group, HRD patients had a significantly longer TTF compared to non-HRD patients, suggesting HRD may influence treatment outcomes in certain chemotherapy regimens
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 compares two emerging procedures, Balloon Endoscopy-Assisted Endoscopic Retrograde Cholangiopancreatography (BE-ERCP) and Endoscopic Ultrasonography-Guided Biliary Drainage (EUS-BD), for treating malignant biliary obstruction (MBO) in patients with altered surgical anatomy.
- Results show EUS-BD had a significantly higher technical success rate (94%) compared to BE-ERCP (70%), while the clinical success rates and adverse events were similar between the two methods.
- The findings suggest that EUS-BD is more effective than BE-ERCP, particularly in patients with an intact papilla, where BE-ERCP's technical
Article Synopsis
- Research investigates the role of Caveolin-1 (Cav1) in cancer cells and associated fibroblasts on the survival and recurrence of patients with pancreatic ductal adenocarcinoma (PDAC) post-surgery.
- Analysis of tissue samples from 615 PDAC patients revealed that Cav1 presence in cancer cells (cCav1) was linked to poorer overall and recurrence-free survival, marking it as an independent prognostic factor.
- Neoadjuvant chemotherapy (NAC) improved survival outcomes for patients with cCav1, and cCav1 status may help personalize treatment strategies for PDAC 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.
Article Synopsis
- * A total of 56 patients were enrolled, and results showed both methods had high success rates, but EUS-HGS had a lower rate of early recurrent biliary obstruction (RBO) at 8% compared to 29% for ERCP-BD.
- * The findings suggest that EUS-HGS could be a promising treatment option for managing biliary issues in pancreatic cancer patients with asymptomatic DI, potentially reducing early complications.
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.
Article Synopsis
- A study examined the relationship between the age at diagnosis of intraductal papillary mucinous neoplasms (IPMNs) and the long-term risk of developing pancreatic cancer in a cohort of over 3,000 patients.!
- Results indicated that older patients diagnosed with IPMNs had a significantly increased risk of pancreatic carcinoma, with those aged 75 and older showing the highest risk.!
- The findings suggest that older patients may benefit from regular surveillance to monitor for pancreatic cancer, as targeted monitoring could help reduce cancer-related mortality in this group.!
Article Synopsis
- Pancreatitis can be a serious complication resulting from the placement of a self-expandable metal stent (SEMS) for malignant biliary obstruction (MBO), and deep learning hasn't been previously used to predict this risk.
- A study analyzed CT images of 70 patients who had SEMS placed, developing a convolutional neural network (CNN) to predict pancreatitis, which showed moderate accuracy with an AUC of 0.67.
- Adding CNN-based predictions enhanced the accuracy of traditional machine learning models, notably improving logistic regression metrics, highlighting the potential of deep learning to better forecast complications in pancreatobiliary procedures.
Article Synopsis
- Excess body weight and BMI were examined for their impact on overall survival in patients with advanced biliary tract cancer receiving gemcitabine-based chemotherapy, using data from 360 patients and validated with a larger cohort of 8,324 patients.
- The study found no significant association between BMI and overall survival rates, with hazard ratios indicating similar survival outcomes across different BMI categories.
- The conclusion suggests that further research is needed to explore detailed body composition metrics to understand the role of adiposity in the prognosis of biliary tract cancer.
Walled-off necrosis (WON) develops as local complications after acute necrotizing pancreatitis. Although less invasive interventions such as endoscopic ultrasonography (EUS)-guided drainage and endoscopic necrosectomy are selected over surgical interventions, delayed and step-up interventions are still preferred to avoid procedure-related adverse events. However, there is a controversy about the appropriate timing of drainage and subsequent necrosectomy.
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- * Among 3,336 patients analyzed, those with high-risk stigmata showed a significant prevalence of pancreatic cancer in the short term, while specific worrisome features indicated higher long-term cancer risk.
- * The findings support using the revised criteria to enhance patient management by identifying those at greater risk for developing pancreatic carcinoma based on their individual characteristics.
Article Synopsis
- The TOKYO criteria, initially proposed for standardized reporting of endoscopic transpapillary biliary drainage outcomes, face limitations in newer techniques like endoscopic ultrasound and device-assisted endoscopy.
- A new committee is updating these criteria to better reflect current clinical practices in managing various biliary conditions, recognizing the need for comprehensive outcome evaluations beyond just stent patency.
- The revised TOKYO criteria 2024 aim to enhance the design and reporting of clinical studies by introducing a "stent-demanding time" concept for a more thorough assessment of endoscopic biliary drainage outcomes.
Article Synopsis
- Postoperative pancreatic fistulas (POPFs) are frequent complications following pancreatic surgery, and their management is crucial for patient recovery.
- Endoscopic ultrasonography (EUS)-guided drainage is the preferred treatment for both POPFs and pancreatic fluid collections (PFCs), but approaches must be adjusted based on the presence of fluid collections and surgical drains.
- The review emphasizes the need for further research to clarify the guidelines for managing POPFs, particularly concerning intervention timing and methods, comparing them to the treatment of PFCs following acute pancreatitis.
Can Endoscopic Ultrasound-guided Ablation Prolong Disease-specific Survival In Pancreatic Cysts?
Clin Gastroenterol Hepatol
January 2025
Article Synopsis
- The study evaluated the use of endoscopic ultrasound-guided tissue acquisition (EUS-TA) with a 22-gauge Franseen needle for collecting tissue samples from solid tumors, focusing on its application in comprehensive genomic profiling (CGP) tests, especially for pancreatobiliary cancer.
- A total of 50 patients were analyzed, showing that the success rates for obtaining suitable samples for CGP were 86% and 76% through two quality control checks, with an adverse event rate of 4%.
- The findings indicated that while EUS-TA using this method is feasible, a significant portion of the specimens did not meet CGP criteria, raising questions about sample adequacy for genomic analysis despite successful tests.