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| 1 | Diagnostic and therapeutic single-operator cholangiopancreatoscopy in biliopancreatic diseases:Prospective multicenter study in Japan显示文摘AIM: To assess the utility and safety of single-operator cholangiopancreatoscopy(SOCPS) using the Spy Glass system in widespread clinical application for biliary and pancreatic diseases.METHODS: This study was a prospective case series conducted in 20 referral centers in Japan. There were 148 patients who underwent SOCPS; 124 for biliary diseases and 24 for pancreatic diseases. The attempted interventions were SOCPS examination, SOCPS-directed tissue sampling, and therapy for stone removal, among others. The main outcomes were related to the procedure success rate in terms of visualizing the target lesions, SOCPS-directed adequate tissue sampling, and complete stone removal. RESULTS: A total of 148 patients were enrolled for the diagnosis of indeterminate biliary and pancreatic lesions or treatment of biliary and pancreatic disease. The overall procedure success rate of visualizing the target lesions was 91.2%(135/148). The overall procedural success rates of visualizing the target lesions of diagnostic SOCPS in the bile duct and pancreatic duct were 95.5%(84/89) and 88.2%(15/17), respectively. Diagnosis: the overall adequate tissue for histologic examination was secured in 81.4% of the 86 patients who underwent biopsy under SOCPS(bile duct, 60/75, 80.0%; pancreatic duct, 10/11, 90.9%). The accuracy of histologic diagnosis using SOCPS-directed biopsies in indeterminate bile duct lesions was 70.7%(53/75). In the pancreatic duct, the accuracy of SOCPS visual impression of intraductal papillary mucinous neoplasm was 87.5%(14/16). Stone therapy: complete biliary and pancreatic stone clearance combined with SOCPS-directed stone therapy using electrohydraulic lithotripsy or laser lithotripsy was achieved in 74.2%(23/31) and 42.9%(3/7) of the patients, respectively. Others: SOCPS using the Spy Glass system was used in cannulation of the cystic duct in two patients and for passing across the obstructed self-expandable metallic stent for a malignant biliary stricture in two patients. All procedures were successful in both SOCPS-guided therapies. The incidence of procedure-related adverse events was 5.4%(8/148). CONCLUSION: SOCPS with direct visualization and biopsy for diagnosis and SOCPS-directed therapy for biliary and pancreatic diseases can be safely performed with a high success rate. | Toshio Kurihara Ichiro Yasuda Hiroyuki Isayama Toshio Tsuyuguchi Taketo Yamaguchi Ken Kawabe Yoshinobu Okabe Keiji Hanada Tsuyoshi Hayashi Takao Ohtsuka Syuhei Oana Hiroshi Kawakami Yoshinori Igarashi Kazuya Matsumoto Kiichi Tamada Shomei Ryozawa Hiroki Kawashima Yutaka Okamoto Iruru Maetani Hiroyuki Inoue Takao Itoi | 2016 | World Journal of Gastroenterology2016，22，5： | 20 |
| 2 | Multicenter study of endoscopic preoperative biliary drainage for malignant distal biliary obstruction显示文摘AIM: To determine the optimal method of endoscopic preoperative biliary drainage for malignant distal biliary obstruction.METHODS: Multicenter retrospective study was conducted in patients who underwent plastic stent(PS) or nasobiliary catheter(NBC) placement for resectable malignant distal biliary obstruction followed by surgery between January 2010 and March 2012. Procedurerelated adverse events, stent/catheter dysfunction(occlusion or migration of PS/NBC, developmentof cholangitis, or other conditions that required repeat endoscopic biliary intervention), and jaundice resolution(bilirubin level < 3.0 mg/d L) were evaluated. Cumulative incidence of jaundice resolution and dysfunction of PS/NBC were estimated using competing risk analysis. Patient characteristics and preoperative biliary drainage were also evaluated for association with the time to jaundice resolution and PS/NBC dysfunction using competing risk regression analysis.RESULTS: In total, 419 patients were included in the study(PS, 253 and NBC, 166). Primary cancers included pancreatic cancer in 194 patients(46%), bile duct cancer in 172(41%), gallbladder cancer in three(1%), and ampullary cancer in 50(12%). The median serum total bilirubin was 7.8 mg/d L and 324 patients(77%) had ≥ 3.0 mg/d L. During the median time to surgery of 29 d [interquartile range(IQR), 30-39 d]. PS/NBC dysfunction rate was 35% for PS and 18% for NBC [Subdistribution hazard ratio(SHR) = 4.76; 95%CI: 2.44-10.0, P < 0.001]; the pig-tailed tip was a risk factor for PS dysfunction. Jaundice resolution was achieved in 85% of patients and did not depend on the drainage method(PS or NBC).CONCLUSION: PS has insufficient patency for preoperative biliary drainage. Given the drawbacks of external drainage via NBC, an alternative method of internal drainage should be explored. | Naoki Sasahira Tsuyoshi Hamada Osamu Togawa Ryuichi Yamamoto Tomohisa Iwai Kiichi Tamada Yoshiaki Kawaguchi Kenji Shimura Takero Koike Yu Yoshida Kazuya Sugimori Shomei Ryozawa Toshiharu Kakimoto Ko Nishikawa Katsuya Kitamura Tsunao Imamura Masafumi Mizuide Nobuo Toda Iruru Maetani Yuji Sakai Takao Itoi Masatsugu Nagahama Yousuke Nakai Hiroyuki Isayama | 2016 | World Journal of Gastroenterology2016，22，14： | 18 |
| 3 | Acute appendicitis following endoscopic mucosal resection of cecal adenoma显示文摘Endoscopic mucosal resection(EMR) allows the removal of flat or sessile lesions, laterally spreading tumors, and carcinoma of the colon or the rectum limited to the mucosa or the superficial submucosa. Acute appendicitis is the most common abdominal emergency requiring emergency surgery, and it is also a rare complication of diagnostic colonoscopy and therapeutic endoscopy, including EMR. In the case presented here, a 53-year-old female underwent colonoscopy due to a positive fecal occult blood test and was diagnosed with cecal adenoma. She was referred to our hospital and admitted for treatment. The patient had no other symptoms. EMR was performed, and 7 h after the surgery, the patient experienced right-lower abdominal pain. Laboratory tests performed the following day revealed a WBC count of 16000/mm3, a neutrophil count of 14144/mm3, and a C-reactive protein level of 2.20 mg/d L, indicating an inflammatory response. Computed tomography also revealed appendiceal wall thickening and swelling, so acute appendicitis following EMR was diagnosed. Antibiotics were initiated leading to total resolution of the symptoms, and the patient was discharged on the sixth post-operative day. Pathological analysis revealed a high-grade cecal tubular adenoma. Such acute appendicitis following EMR is extremely rare, and EMR of the cecum may be a rare cause of acute appendicitis. | Yukako Nemoto Junya Tokuhisa Nagasato Shimada Tatsuya Gomi Iruru Maetani | 2015 | World Journal of Gastroenterology2015，21，27： | 9 |
| 4 | Efficacy of intra-arterial contrast-enhanced ultrasonography during transarterial chemoembolization with drug-eluting beads for hepatocellular carcinoma显示文摘AIM To assess the usefulness of intra-arterial contrastenhanced ultrasonography(IAUS) during transarterial chemoembolization(TACE) with drug-eluting beads(DEB) for hepatocellular carcinoma(HCC).METHODS Thirty two patients with 39 HCC underwent DEB-TACE guided with IAUS, and examined by contrast-enhanced ultrasonography(CEUS) or dynamic CT after DEB-TACE were enrolled in this study. CEUS findings before DEBTACE and IAUS findings were compared. Treatments judged to be complete and incomplete for lesions were appropriate and insufficient, respectively. Findings on CEUS and/or dynamic CT performed 1, 3 and 6 mo after DEB-TACE were evaluated using m RECIST(CR/PR/SD/PD).RESULTS The treatments were complete and incomplete in 26 and 13 lesions, respectively. On imaging evaluation using CEUS and/or dynamic CT one month after treatment, 25 and 1 lesions were judged to be CR and PR, respectively, and at 6 mo after treatment, the results were CR, PR, SD and PD for 24, 1, 0 and 1 of these lesions, respectively, in the 26 completely treated lesions. Of the 13 lesions in which treatment was incomplete, the results on imaging at one month after treatment were CR, PR, SD and PD for 0, 6, 4 and 3 lesions, respectively. The overall CR rate at 6 mo after treatment was 61.5%(24/39).CONCLUSION A combination of DEB-TACE with IAUS can improve the therapeutic effects in patients with HCC. | Kazue Shiozawa Manabu Watanabe Takashi Ikehara Shuhei Yamamoto Takashi Matsui Yoshinori Saigusa Yoshinori Igarashi Iruru Maetani | 2018 | World Journal of Hepatology2018，10，1： | 7 |
| 5 | Successful outcomes of EMR-L with 3D-EUS for rectal carcinoids compared with historical controls显示文摘AIM: To assess the results of endoscopic mucosal re-section with a ligation device (EMR-L) combined with three dimensional endoscopic ultrasonography (3D-EUS) using an ultrasonic probe for rectal carcinoids. In addition, diagnosis of the depth and size of lesions by EUS was evaluated. METHODS: Between January 2003 and March 2007, 20 patients underwent EMR-L with 3D-EUS using an ultrasonic probe (group A). 3D-EUS was combined with EMR-L at the time of injection of sterile physiological saline into the submucosal layer. For comparison, 14 rectal carcinoids that had been treated by EMR-L with-out 3D-EUS between April 1998 and December 2002 were evaluated as historical controls (group B). EUS was conducted for all of the patients before treatment to evaluate tumor diameter and depth of invasion. The percentage of complete resection and the verti-cal resection margin were compared between the two groups. RESULTS: The depth of invasion upon histopathologi-cal examination was in complete agreement with the pre-operative fi ndings by EUS. The tumor diameter de-termined by EUS approximated that found in the tissue samples. There were no signifi cant differences in the gender, tumor sites or tumor diameters between the two groups. The rate of complete resection for groups A and B was 100% and 71%, respectively (P < 0.05). The vertical resection margin of group A was longer than that of group B. CONCLUSION: EMR-L is effective as an endoscopictreatment for rectal carcinoids. In combination with 3D-EUS, safe and complete resection is further as-sured. | Tsuyoshi Abe Tadayoshi Kakemura Sumio Fujinuma Iruru Maetani | 2008 | World Journal of Gastroenterology2008，14，25： | 7 |
| 6 | Is endoscopic papillary large balloon dilatation without endoscopic sphincterotomy effective?显示文摘AIM: To evaluate the safety and efficacy of endoscopic papillary large balloon dilatation(EPLBD) without endoscopic sphincterotomy in a prospective study.METHODS: From July 2011 to August 2013, we performed EPLBD on 41 patients with nae papillae prospectively. For sphincteroplasty of EPLBD,endoscopic sphincterotomy(EST) was not performed,and balloon diameter selection was based on the distal common bile duct diameter. The balloon was inflated to the desired pressure. If the balloon waist did not disappear, and the desired pressure was satisfied, we judged the dilatation as complete. We used a retrieval balloon catheter or mechanical lithotripter(ML) to remove stones and assessed the rates of complete stone removal, number of sessions, use of ML and adverse events. Furthermore, we compared the presence or absence of balloon waist disappearance with clinical characteristics and endoscopic outcome.RESULTS: The mean diameters of the distal and maximum common bile duct were 13.5 ± 2.4 mm and16.4 ± 3.1 mm, respectively. The mean maximum transverse-diameter of the stones was 13.4 ± 3.4mm, and the mean number of stones was 3.0 ± 2.4.Complete stone removal was achieved in 97.5%(40/41)of cases, and ML was used in 12.2%(5/41) of cases.The mean number of sessions required was 1.2 ± 0.62.Pancreatitis developed in two patients and perforation in one. The rate of balloon waist disappearance was73.1%(30/41). No significant differences were noted in procedure time, rate of complete stone removal(100% vs 100%), number of sessions(1.1 vs 1.3, P= 0.22), application of ML(13% vs 9%, P = 0.71),or occurrence of pancreatitis(3.3% vs 9.1%, P =0.45) between cases with and without balloon waist disappearance.CONCLUSION: EST before sphincteroplasty may be unnecessary in EPLBD. Further investigations are needed to verify the relationship between the presence or absence of balloon waist disappearance. | Shigefumi Omuta Iruru Maetani Michihiro Saito Hiroaki Shigoka Katsushige Gon Junya Tokuhisa Mieko Naruki | 2015 | World Journal of Gastroenterology2015，21，23： | 5 |
| 7 | Efficacy of the revised Vienna Classification for diagnosing colorectal epithelial neoplasias显示文摘AIM:To prospectively investigate the effi cacy of the revised Vienna Classifi cation for diagnosing colorectal epithelial neoplastic lesions in cold biopsy specimens.METHODS:Patients were selected for inclusion if they had colorectal epithelial lesions that were not considered suitable for direct endoscopic resection.These included colorectal polyps ≥ 10 mm and lesions suspected of being carcinomas capable of invading the colorectal submucosa or beyond,including strictures,based on the cold biopsies obtained from each lesion prior to resection.We investigated the relationship between diagnoses based on cold biopsy samples using the revised Vienna Classification and resected specimens of the same lesions,and the therapeutic implications of diagnoses made using the revised Vienna Classification.The same cold biopsy specimens were also examined using the Japanese Group Classifi cation guidelines,and compared with the resected specimens of the same lesions for reference.RESULTS:A total of 179 lesions were identified.The sensitivity,specificity,positive and negative predictive values of the revised Vienna Classification for distinguishing between intramucosal lesions and submucosal invasive carcinomas in cold biopsy specimens was 22.2%,100%,100%,and 71.4%,respectively,and for distinguishing between intramucosal lesions and those invading the submucosa or beyond was 59.7%,100%,100%,and 37.6%,respectively.The sensitivity,specificity,positive and negative predictive values of the Japanese Group Classification for distinguishing between intramucosal lesions and submucosal invasive carcinomas in cold biopsy specimens was 83.3%,91.4%,83.3%,and 91.4%,respectively,and for distinguishing between intramucosal lesions and those invading the submucosa or beyond was 95.1%,91.4%,97.9%,and 82.1%,respectively.A total of 137 of 144 carcinomas that had invaded the submucosa or beyond and three high-grade intraepithelial neoplasias were diagnosed as 'carcinoma' using the Japanese Group Classif ication system.CONCLUSION:The revised Vienna Classifi cation for cold biopsy specimens has high positive predictive value in the diagnosis of colorectal carcinoma invasive to the submucosa or beyond. | Kenji Tominaga Sumio Fujinuma Takuro Endo Yoshihisa Saida Kei Takahashi Iruru Maetani | 2009 | World Journal of Gastroenterology2009，15，19： | 5 |
| 8 | Randomized phase II study of gemcitabine and S-1 combination versus gemcitabine alone in the treatment of unresectable advanced pancreatic cancer (Japan Clinical Cancer Research Organization PC-01 study)显示文摘 | Masato Ozaka Yuji Matsumura Hiroshi Ishii Yasushi Omuro Takao Itoi Hisatsugu Mouri Keiji Hanada Yasutoshi Kimura Iruru Maetani Yoshinobu Okabe Masaji Tani Takaaki Ikeda Susumu Hijioka Ryouhei Watanabe Shinya Ohoka Yuki Hirose Masafumi Suyama Naoto Egawa A | 2012 | Cancer Chemotherapy and Pharmacology2012，，5： | 3 |
| 9 | Treating bilio-duodenal obstruction: Combining new endoscopic technique with 6 Fr stent introducer显示文摘Periampullary cancer may cause not only biliary but also duodenal obstructions. In patients with concomitant duodenal obstructions, endoscopic biliary stenting remains technically difficult and may often require percutaneous transhepatic biliary drainage. We describe a method of metal stent placement via a thin forwardviewing endoscope in patients with simultaneous biliary and duodenal obstruction. In two consecutive patients with biliary and duodenal obstruction due to pancreatic cancer, a new biliary metal stent mounted in a slim delivery catheter was placed via a thin forward viewing endoscope after passage across the duodenal stenosis without balloon dilation. In both patients, with our new placement technique, metallic stents were successfully placed in a short time without adverse events. After biliary stenting, one patient received curative resection and the other received duodenal stenting for palliation. Metallic stent placement with a forward-viewing thin endoscope is a beneficial technique, which can avoid percutaneous drainage in patients with bilio-duodenal obstructions due to periampullary cancer. | Iruru Maetani Tomoko Nambu Shigefumi Omuta Takeo Ukita Hiroaki Shigoka | 2010 | World Journal of Gastroenterology2010，16，22： | 2 |
| 10 | Wire-guided selective cannulation of the bile duct with a sphincterotome: a prospective randomized comparative study with the standard method显示文摘 | Tomoko Nambu Takeo Ukita Hiroaki Shigoka Shigefumi Omuta Iruru Maetani | 2011 | Scandinavian Journal of Gastroenterology2011，，1： | 1 |
| 11 | Clinical outcome of endoscopic resection for nonampullary duodenal tumors显示文摘 | Satoru Nonaka Ichiro Oda Kazuhiro Tada Genki Mori Yoshinori Sato Seiichiro Abe Haruhisa Suzuki Shigetaka Yoshinaga Takeshi Nakajima Takahisa Matsuda Hirokazu Taniguchi Yutaka Saito Iruru Maetani | 2014 | Endoscopy2014，，： | 1 |
| 12 | Comparison of modified introducer method with pull method for percutaneous endoscopic gastrostomy: Prospective randomized study显示文摘 | Hiroaki Shigoka Iruru Maetani Kenji Tominaga Katsushige Gon Michihiro Saitou Yukio Takenaka | 2012 | Digestive Endoscopy2012，，6： | 1 |
| 13 | Direct peroral cholangioscopy using an ultraslim upper endoscope for biliary lesions显示文摘BACKGROUND: The development of direct peroral cholangioscopy(DPOC) using an ultraslim endoscope simplifies biliary cannulation. The conventional techniques are cumbersome to perform and require advanced skills. The recent introduction of the guidewires and balloons has improved the therapeutic outcomes. Here we describe an effective and easier method for performing DPOC using an ultraslim upper endoscope. METHODS: Indications for DPOC were the presence of stones on follow-up of patients who had previously undergone complete sphincteroplasty, including endoscopic sphincterotomy or endoscopic papillary large balloon dilatation. Fifteen patients underwent DPOC. An ultraslim endoscope was inserted perorally and was advanced into the major papilla. The ampulla of Vater was visualized by retroflexing the endoscope in the distal second portion of the duodenum, and then DPOC was performed using a wire-guided cannulation technique with an anchored intraductal balloon catheter. RESULTS: One patient failed in the treatment due to looping of the endoscope in the fornix of the stomach. Fourteen(93.3%) were successfully treated with our modified DPOC technique. Only one patient(6.7%) experienced an adverse event(pancreatitis) who responded well to conservative management. Residual stones of the common bile duct were completely removed in 3 patients. CONCLUSION: The modified method of DPOC is simple, safe and easy to access the bile duct. | Shigefumi Omuta Iruru Maetani Takeo Ukita Tomoko Nambu Katsushige Gon Hiroaki Shigoka Yoshinori Saigusa Michihiro Saito | 2014 | Hepatobiliary & Pancreatic Diseases International2014，13，1： | 1 |
| 14 | PEG with introducer or pull method: A prospective randomized comparison显示文摘 | Iruru Maetani Tomoko Tada Takeo Ukita Hirokazu Inoue Yoshihiro Sakai Masao Yoshikawa | 2003 | Gastrointestinal Endoscopy2003，，7： | 1 |
| 15 | A randomized phase II study of gemcitabine and S-1 combination therapy versus gemcitabine monotherapy for advanced biliary tract cancer显示文摘 | Takashi Sasaki Hiroyuki Isayama Yousuke Nakai Yukiko Ito Ichiro Yasuda Nobuo Toda Hirofumi Kogure Keiji Hanada Hiroyuki Maguchi Naoki Sasahira Hideki Kamada Tsuyoshi Mukai Yoshihiro Okabe Osamu Hasebe Iruru Maetani Kazuhiko Koike | 2013 | Cancer Chemotherapy and Pharmacology2013，，4： | 1 |
| 16 | Placement of a triple‐layered covered versus uncovered metallic stent for palliation of malignant gastric outlet obstruction: A multicenter randomized trial显示文摘 | Iruru Maetani Yoshinori Mizumoto Hiroaki Shigoka Shigefumi Omuta Michihiro Saito Junya Tokuhisa Toshio Morizane | 2014 | Digestive Endoscopy2014，，2： | 1 |
| 17 | Self-expandable metallic stent placement for palliation in gastric outlet obstructions caused by gastric cancer: a comparison with surgical gastrojejunostomy显示文摘 | Iruru Maetani Sotaro Akatsuka Masaki Ikeda Tomoko Tada Takeo Ukita Yoichi Nakamura Jiro Nagao Yoshihiro Sakai | 2005 | Journal of Gastroenterology2005，，10： | 1 |
| 18 | Newly designed J-shaped tip guidewire: A preliminary feasibility study in wire-guided cannulation显示文摘AIM: To perform wire-guided cannulation using a newly designed J-shaped tip guidewire, and to verify feasibility and safety for use. METHODS: The study was conducted on endoscopic retrograde cholangiopancreatography (ERCP) patients with na ve papilla undergoing diagnosis and treatment of biliary diseases between September 2011 and July 2012. We performed ERCP in a succession of 50 cases with a J-shaped tip guidewire. The first insertion attempt began with a trainee who had 5 min to complete cannulation, followed if necessary by the trainer for another 5 min. We assessed the primary success rate of selective biliary cannulation within 10 min and adverse events such as post-ERCP pancreatitis (PEP), bleeding or perforation.RESULTS: The primary success rate was 90% (45/50) within 10 min, the initial success rate within 5 min by trainee staff was 76% (38/50). The rate of PEP was 6% (3/50), but all 3 cases were mild pancreatitis. All patients were managed successfully with conservative treatment. There was no bleeding or perforation. CONCLUSION: A newly designed J-shaped tip guidewire has the possibility to facilitate selective biliary cannulation for ERCP and appears to be safe. | Shigefumi Omuta Iruru Maetani Hiroaki Shigoka Katsushige Gon Michihiro Saito Junya Tokuhisa Mieko Naruki | 2013 | World Journal of Gastroenterology2013，19，28： | 1 |
| 19 | Effect of extracorporeal shockwave lithotripsy and endoscopic treatment on sysmptoms and pancreatic function in pancreatolithiasis显示文摘 | Tomoko Td Takeo Ukita Iruru Maetani | 2006 | Digestive Endoscopy2006，18，1： | 1 |
| 20 | Treatment outcomes of chemotherapy between unresectable and recurrent biliary tract cancer显示文摘AIM:To evaluate the differences in the treatment outcomes between the unresectable and recurrent biliary tract cancer patients who received chemotherapy.METHODS:Patients who were treated with gemcitabine and S-1 combination therapy in the previous prospective studies were divided into groups of unresectable and recurrent cases.The tumor response,time-toprogression,overall survival,toxicity,and dose intensity were compared between these two groups.RESULTS:Response rate of the recurrent group was higher than that of the unresectable group(40.0%vs25.5%;P=0.34).Median time-to-progression of the recurrent and unresectable groups were 8.7 mo(95%CI),1.2 mo,not reached)and 5.7 mo(95%CI:4.0-7.0 mo),respectively(P=0.14).Median overall survival of the recurrent and the unresectable groups were 16.1 mo(95%CI:2.0 mo-not reached)and 9.6 mo(95%CI:7.1-11.7 mo),respectively(P=0.10).Dose intensities were significantly lower in the recurrent groups(gemcitabine:recurrent group 83.5%vs unresectable group 96.8%;P<0.01,S-1:Recurrent group 75.9%vs unresectable group 91.8%;P<0.01).Neutropenia occurred more frequently in recurrent group(recurrent group 90%vs unresectable group 55%;P=0.04).CONCLUSION:Not only the efficacy but also the toxicity and dose intensity were significantly different between unresectable and recurrent biliary tract cancer. | Takashi Sasaki Hiroyuki Isayama Yousuke Nakai Yukiko Ito Ichiro Yasuda Nobuo Toda Hiroshi Yagioka Saburo Matsubara Keiji Hanada Hiroyuki Maguchi Hideki Kamada Osamu Hasebe Tsuyoshi Mukai Yoshihiro Okabe Iruru Maetani Kazuhiko Koike | 2014 | World Journal of Gastroenterology2014，20，48： | 0 |
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