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| 1 | Improved techniques for double-balloon-enteroscopy-assisted endoscopic retrograde cholangiopancreatography显示文摘AIM: To investigate the clinical outcome of double balloon enteroscopy (DBE)-assisted endoscopic retrograde cholangiopancreatography (DB-ERCP) in patients with altered gastrointestinal anatomy. METHODS: Between September 2006 and April 2011, 47 procedures of DB-ERCP were performed in 28 patients with a Roux-en-Y total gastrectomy (n = 11), Billroth Ⅱ gastrectomy (n = 15), or Roux-en-Y anastomosis with hepaticojejunostomy (n = 2). DB-ERCP was performed using a short-type DBE combined with several technical innovations such as using an endoscope attachment, marking by submucosal tattooing,selectively applying contrast medium, and CO2 insufflations. RESULTS: The papilla of Vater or hepaticojejunostomy site was reached in its entirety with a 96% success rate (45/47 procedures). There were no significant differences in the success rate of reaching the blind end with a DBE among Roux-en-Y total gastrectomy (96%), Billroth Ⅱ reconstruction (94%), or pancreatoduodenectomy (100%), respectively (P = 0.91). The total successful rate of cannulation and contrast enhancement of the target bile duct in patients whom the blind end was reached with a DBE was 40/45 procedures (89%). Again, there were no significant differences in the success rate of cannulation and contrast enhancement of the target bile duct with a DBE among Roux-en-Y total gastrectomy (88 %), Billroth Ⅱ reconstruction (89%), or pancreatoduodenectomy (100%), respectively (P = 0.67). Treatment was achieved in all 40 procedures (100%) in patients whom the contrast enhancement of the bile duct was successful. Common endoscopic treatments were endoscopic biliary drainage (24 procedures) and extraction of stones (14 procedures). Biliary drainage was done by placement of plastic stents. Stones extraction was done by lithotomy with the mechanical lithotripter followed by extraction with a basket or by the balloon pull-through method. Endoscopic sphincterotomy was performed in 14 procedures with a needle precutting knife using a guidewire. The mean total duration of the procedure was 93.6 ± 6.8 min and the mean time required to reach the papilla was 30.5 ± 3.7 min. The mean time required to reach the papilla tended to be shorter in Billroth Ⅱ reconstruction (20.9 ± 5.8 min) than that in Roux-en-Y total gastrectomy (37.1 ± 4.9 min) but there was no significant difference (P = 0.09). A major complication occurred in one patient (3.5%); perforation of the long limb in a patient with Billroth Ⅱ anastomosis.CONCLUSION: Short-type DBE combined with several technical innovations enabled us to perform ERCP in most patients with altered gastrointestinal anatomy. | Takashi Osoegawa Yasuaki Motomura Kazuya Akahoshi Naomi Higuchi Yoshimasa Tanaka Terumasa Hisano Souichi Itaba Junya Gibo Mariko Yamada Masaru Kubokawa Yorinobu Sumida Hirotada Akiho Eikichi Ihara Kazuhiko Nakamura | 2012 | World Journal of Gastroenterology2012，18，46： | 7 |
| 2 | Immediate detection of endoscopic retrograde cholangiopancreatographyrelated periampullary perforation: Fluoroscopy or endoscopy?显示文摘AIM:To investigate the causes and intraoperative detection of endoscopic retrograde cholangiopancreatography(ERCP)-related perforations to support immediate or early diagnosis.METHODS:Consecutive patients who underwent ERCP procedures at our hospital between January2008 and June 2013 were retrospectively enrolled in the study(n=2674).All procedures had been carried out using digital fluoroscopic assistance with the patient under conscious sedation.For patients showing alterations in the gastrointestinal anatomy,a short-type double balloon enteroscope had been applied.Cases of perforation had been identified by the presence of air in or leakage of contrast medium into the retroperitonealspace,or upon endoscopic detection of an abdominal cavity related to the perforated lumen.For patients with ERCP-related perforations,the data on medical history,endoscopic findings,radiologic findings,diagnostic methods,management,and clinical outcomes were used for descriptive analysis.RESULTS:Of the 2674 ERCP procedures performed during the 71-mo study period,only six(0.22%)resulted in perforations(male/female,2/4;median age:84 years;age range:57-97 years).The cases included an endoscope-related duodenal perforation,two periampullary perforations related to endoscopic sphincterotomy,two periampullary perforations related to endoscopic papillary balloon dilation,and a periampullary or bile duct perforation secondary to endoscopic instrument trauma.No cases of guidewire-related perforation occurred.The video endoscope system employed in all procedures was only able to immediately detect the endoscope-related perforation;the other five perforation cases were all detected by subsequent digital fluoroscope applied intraoperatively(at a median post-ERCP intervention time of 15 min).Three out of the six total perforation cases,including the single case of endoscope-related duodenal injury,were surgically treated;the remaining three cases were treated with conservative management,including trans-arterial embolization to control the bleeding in one of the cases.All patients recovered without further incident.CONCLUSION:ERCP-related perforations may be difficult to diagnose by video endoscope and digital fluoroscope detection of retroperitoneal free air or contrast medium leakage can facilitate diagnosis. | Yasuaki Motomura Kazuya Akahoshi Junya Gibo Kenji Kanayama Shinichiro Fukuda Shouhei Hamada Yoshihiro Otsuka Masaru Kubokawa Kiyoshi Kajiyama Kazuhiko Nakamura | 2014 | World Journal of Gastroenterology2014，20，42： | 5 |
| 3 | Clinical outcomes of Clutch Cutter endoscopic submucosal dissection for older patients with early gastric cancer显示文摘AIM To evaluate the clinical outcome of endoscopic submucosal dissection using the Clutch Cutter(ESDCC) in older patients. METHODS We reviewed 232 consecutive patients with early gastric cancer who underwent ESDCC between June 2010 and February 2014 at Aso Iizuka Hospital. We divided patients into two groups according to age: Older patients(> 80 years, n = 64) and non-older patients(≤ 80 years, n = 168). We retrospectively compared the prevalence rates of pre-existing comorbidities, anticoagulant therapy, en bloc resection, mean duration of hospitalization, incidence of ESDCC-related complications, change in performance status(PS) before and after ESDCC, and financial cost of admission. RESULTS The older group comprised 64 patients with a mean age of 84.1 years, and the non-older group comprised 168 patients with a mean age of 69.5 years. Older patients had significantly more pre-existing comorbidities than did non-older patients, specifically heart disease(P < 0.05). The en bloc resection rate in non-older patients was significantly higher than that in older patients(100% vs 95.3%, P = 0.02). There were no significant differences between the older and non-older groups in the incidence of ESDCC-related complications(i.e., postoperative bleeding and perforation) and the post-ESDCC change in PS. There were also no significant differences between the older and non-older groups in the mean duration of hospitalization(11.4 and 10.7 d, respectively) and financial cost of admission(657040 JPY and 574890 JPY, respectively).CONCLUSION ESDCC has a good clinical outcome in older patients. | Yoshihiro Otsuka Kazuya Akahoshi Kayoko Yasunaga Masaru Kubokawa Junya Gibo Shigeki Osada Kayo Tokumaru Kazuaki Miyamoto Takao Sato Yuki Shiratsuchi Masafumi Oya Hidenobu Koga Eikichi Ihara Kazuhiko Nakamura | 2017 | World Journal of Gastrointestinal Oncology2017，9，10： | 4 |
| 4 | Treatment for autoimmune pancreatitis: consensus on the treatment for patients with autoimmune pancreatitis in Japan显示文摘 | Tetsuhide Ito Isao Nishimori Naoko Inoue Ken Kawabe Junya Gibo Yoshiyuki Arita Kazuichi Okazaki Ryoichi Takayanagi Makoto Otsuki | 2007 | Journal of Gastroenterology2007，，18： | 1 |
| 5 | Treatment for autoimmune pancreatitis: consensus on the treatment for patients with autoimmune pancreatitis in Japan显示文摘 | Tetsuhide Ito Isao Nishimori Naoko Inoue Ken Kawabe Junya Gibo Yoshiyuki Arita Kazuichi Okazaki Ryoichi Takayanagi Makoto Otsuki | 2007 | Journal of Gastroenterology2007，，18： | 1 |
| 6 | Treatment for autoimmune pancreatitis: consensus on the treatment for patients with autoimmune pancreatitis in Japan显示文摘 | Tetsuhide Ito Isao Nishimori Naoko Inoue Ken Kawabe Junya Gibo Yoshiyuki Arita Kazuichi Okazaki Ryoichi Takayanagi Makoto Otsuki | 2007 | Journal of Gastroenterology2007，，18： | 1 |
| 7 | Endoscopic submucosal dissection of gastric adenomas using the clutch cutter显示文摘AIM To evaluate the efficacy and safety of endoscopic submucosal dissection(ESD) using the clutch cutter(CC)(ESD-CC) for gastric adenoma(GA).METHODS From June 2007 to August 2015,122 consecutive patients with histological diagnoses of GA from specimens resected by ESD-CC were enrolled in this prospective study.The CC was used for all ESD steps(marking,mucosal incision,submucosal dissection,and hemostatic treatment),and itstherapeutic efficacy and safety were assessed.RESULTS Both the en-bloc resection rate and the R0 resection rate were 100%(122/122).The mean surgical time was 77.4 min,but the time varied significantly according to tumor size and location.No patients suffered perforation.Post-ESD-CC bleeding occurred in six cases(4.9%) that were successfully resolved by endoscopic hemostatic treatment.CONCLUSION ESD-CC is a technically efficient,safe,and easy method for resecting GA. | Kazuya Akahoshi Masaru Kubokawa Junya Gibo Shigeki Osada Kayo Tokumaru Eriko Yamaguchi Hiroko Ikeda Takao Sato Kazuaki Miyamoto Yusuke Kimura Yuki Shiratsuchi Kazuaki Akahoshi Masafumi Oya Hidenobu Koga Eikichi Ihara Kazuhiko Nakamura | 2017 | World Journal of Gastrointestinal Endoscopy2017，9，7： | 0 |
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