The Experts below are selected from a list of 543 Experts worldwide ranked by ideXlab platform
Takao Itoi - One of the best experts on this subject based on the ideXlab platform.
-
Novel peroral direct digital cholangioscopy-assisted lithotripsy using a monorail technique through the overtube in patients with surgically altered anatomy (with video).
Digestive Endoscopy, 2019Co-Authors: Ryosuke Tonozuka, Takao Itoi, Atsushi Sofuni, Takayoshi Tsuchiya, Kentaro Ishii, Reina Tanaka, Mitsuyoshi Honjo, Shuntaro Mukai, Kenjiro Yamamoto, Mitsuru FujitaAbstract:Efficacy of cholangioscopy-assisted lithotripsy for difficult stones such as huge stones, multiple large stones and an impacted stone in patients with non-altered anatomy has been reported. Herein, we describe peroral direct digital cholangioscopy (PDCS)-assisted electrohydraulic lithotripsy (EHL) with a new technique in patients with surgically altered anatomy. Five patients received PDCS-assisted EHL with the monorail technique due to failed conventional stone extraction. Balloon enteroscope was removed, leaving the stiff guidewire in the bile duct and an overtube with inflated balloons. The Cholangioscope was then inserted into the bile duct over the wire through the overtube. After direct visualization of the stone, PDCS-assisted EHL was carried out. This technique was named the 'monorail technique'. Complete removal of biliary stones in one session was accomplished in four patients and only one case required two sessions. There was no adverse event in any of the cases. PDCS-assisted EHL using the monorail technique was effective and safe for difficult biliary stones in patients with surgically altered anatomy.
-
novel ex vivo training model for free hand insertion using a double bending peroral direct Cholangioscope
Journal of Gastroenterology and Hepatology, 2018Co-Authors: Sakiko Naito, Takao Itoi, Takayoshi Tsuchiya, Shujiro Tsuji, Reina Tanaka, Mitsuyoshi Honjo, Shuntaro Mukai, Kenjiro Yamamoto, Yukitoshi Matsunami, Yasutsugu AsaiAbstract:Background and Aim Several experts of direct peroral videocholangioscopy (D-PVCS) using a conventional ultraslim endoscope have reported its usefulness for the diagnosis and therapy of biliary tract diseases. We have additionally developed a dedicated double-bending D-PVCS (DBD-PVCS) technique for free-hand scope insertion. In this study, we developed an ex-vivo training model for the free-hand DBD-PVCS technique and compared it with the technique using a conventional ultraslim endoscope. Methods The ex-vivo model was made for training using a U-shape insertion pattern. A 3rd prototype endoscope and an ultraslim upper GI endoscope were used. Two experts and 9 non-experts performed D-PVCS using the free-hand technique. Results The 2 experts could not advance the tip of the endoscope to the hilar portion using the free-hand technique, but they could achieve technical successful insertion to the hilar portion with the 3rd prototype Cholangioscope using the free-hand technique alone. The non-experts could not advance the tip of the endoscope to the bile duct using the free-hand technique. On the other hand, 2 (22.2%) non-experts could advance the tip of the 3rd prototype Cholangioscope using the free-hand technique before the training conducted by the experts. After the training, all the non-experts could advance the tip of the 3rd prototype Cholangioscope to the hilar portion. Conclusions The novel ex-vivo model using a 3rd prototype Cholangioscope was useful for training in the use of the free-hand D-PVCS technique.
-
Types of Peroral Cholangioscopy: How to Choose the Most Suitable Type of Cholangioscopy
Current Treatment Options in Gastroenterology, 2016Co-Authors: Yusuke Ishida, Takao Itoi, Yoshinobu OkabeAbstract:A number of case studies have described the usefulness of peroral cholangioscopy for diagnosis and therapy, performed by visualizing the inner cavity of the bile duct. Currently available types of peroral cholangioscopy include peroral videocholangioscopy (POCS) using a mother-baby scope system (MBSS), direct peroral videocholangioscopy (D-POCS), and SpyGlass™ Direct Visualization System (SGDVS). POCS started with cholangioscopy using MBSS, requiring two skilled endoscopists using two endoscopic systems. On the other hand, D-POCS and SGDVS were developed as single-operator techniques. In MBSS, the videoCholangioscope is inserted into the bile duct through the accessory channel of a conventional therapeutic duodenoscope. MBSS enables comparatively easy scope insertion into the bile duct and stable scope positioning. POCS using MBSS provides excellent images and can be coupled with an image-enhanced function system. However, it has a smaller accessory channel, limiting the devices that can be used. Additionally, scope fragility is serious problem. D-POCS using an ultraslim upper endoscope has been introduced to overcome the drawback of POCS using MBSS. D-POCS has a larger working channel and requires only one endoscopist. D-POCS allows a greater variety of procedures under excellent imaging even with an image-enhanced function system; however, scope insertion is still challenging. SGDVS is designed for single-operator use and is dedicated to procedural purposes. It comprises a reusable optical probe and disposable delivery catheter, which has four-way deflected steering and dedicated irrigation channels. These features lead to good maneuverability, although image quality is poor due to its optical probe system. All systems’ features should be recognized and the appropriate system used depending on the need. Cholangioscopy has shown dramatic progress from diagnosis to therapy with high future growth potential.
-
clinical evaluation of a prototype multi bending peroral direct Cholangioscope
Digestive Endoscopy, 2014Co-Authors: Takao Itoi, Rajesh Gupta, Mohan Ramchandani, Atsushi Sofuni, Fumihide Itokawa, Toshio Kurihara, Takayoshi Tsuchiya, Kentaro Ishii, Nageshwar D Reddy, Nobuhito IkeuchiAbstract:Background Although peroral direct cholangioscopy (PDCS) is emerging as an alternative to traditional mother-daughter cholangioscopy, it is associated with high failure rates. The aim of the present study was to evaluate the ability to insert and carry out interventions using a prototype multi-bending PDCS. Patients and Methods Prospective, observational clinical feasibility study was done in 41 patients with a variety of biliary diseases. A multi-bending PDCS prototype was inserted using a free-hand technique, a guidewire alone, or with a 5-Fr diameter anchoring balloon. Diagnostic and therapeutic procedures were carried out. Results The free-hand direct insertion technique failed in all attempted cases (n = 7). Of the remaining 34 cases, successful rate of PDCS insertion into the distal bile duct was achieved by passing the PDCS over a guidewire alone (n = 6) and/or with a guidewire plus anchoring balloon (n = 28) for an overall successrate of 88.2% (30/34). In 13 (92.9%) patients without an underlying biliary stricture, PDCS insertion proximal to the bifurcation was possible. In 25 cases, biliary interventions were attempted including biopsy (n = 13), stone removal (n = 6), stent removal (n = 1), and intraductal electrohydraulic lithotripsy (n = 2) and were successful in 22 (88%). Other than two patients with procedure-related cholangitis with a mild grade of severity, no complications were observed. Conclusions Using a novel multi-bending prototype peroral direct Cholangioscope, cholangioscopy had a high diagnostic and therapeutic success rate only when passed over a guidewire and anchoring balloon but not with the free-hand insertion technique. Comparative studies of direct cholangioscopy are warranted.
-
The role of peroral video cholangioscopy in patients with IgG4-related sclerosing cholangitis
Journal of Gastroenterology, 2013Co-Authors: Takao Itoi, Fumihide Itokawa, Hiroshi Kawakami, Masaki Kuwatani, Terumi Kamisawa, Yoshinori Igarashi, Ichiro Yasuda, Yuui Kishimoto, Seiichi Hara, Fuminori MoriyasuAbstract:Background The cholangioscopic features of IgG4-related sclerosing cholangitis (IgG4-SC) remain undefined. The aim of this study was to clarify these endoscopic features using peroral video cholangioscopy (PVCS) in IgG4-SC patients. Methods PVCS was performed in 33 patients: IgG4-SC ( n = 13); primary sclerosing cholangitis (PSC; n = 5); and cholangiocarcinoma ( n = 15), which included hilar cholangiocarcinoma (HCCA; n = 5) and distal cholangiocarcinoma (DCCA; n = 10). Results The most frequent findings on PVCS in the IgG4-SC patients were dilated (62 %) and tortuous (69 %) vessels, and absence of partially enlarged vessels. The incidence of dilated and tortuous vessels was significantly higher in IgG4-SC patients than in PSC patients ( p = 0.015). Scarring and pseudodiverticula were found significantly more often in PSC patients than in IgG4-SC patients ( p = 0.001 and p = 0.0007, respectively). The incidence of partially enlarged vessels was significantly higher in DCCA patients than in IgG4-SC patients ( p = 0.004). In contrast, the incidence of dilated vessels was significantly higher in IgG4-SC patients than in HCCA patients ( p = 0.015). PVCS performed after corticosteroid therapy showed resolution of bile duct stenosis and dilated, tortuous, or partially enlarged vessels, as well as resolution of friability in all patients with IgG4-SC. Conclusion Cholangioscopy was useful in differentiating IgG4-SC from PSC. In addition, monitoring the patterns of proliferative vessels on PVCS may be useful to differentiate IgG4-SC from cholangiocarcinoma.
Mansour A Parsi - One of the best experts on this subject based on the ideXlab platform.
-
randomized study of digital single operator Cholangioscope compared to fiberoptic single operator Cholangioscope in a novel cholangioscopy bench model
Endoscopy International Open, 2018Co-Authors: Raj J. Shah, Mansour A Parsi, Horst Neuhaus, Nageshwar D Reddy, Douglas K PleskowAbstract:Background and study aims Cholangiopancreatoscopy is utilized for diagnosis and therapy of pancreaticobiliary disorders. a fully-disposable, digital, single-operator Cholangioscope (DSOC) was developed with high image resolution and wide field-of-view. This bench study compared the new DSOC to the previous semi-disposable, fiber-optic Cholangioscope (FSOC) prior to the clinical availability of the DSOC system. Methods Five experts performed one practice run followed by randomized runs comparing DSOC to FSOC in a biliary tract model consisting of three fixed left-intrahepatic tracts (LIHD), and variable common bile duct (CBD) and right-intrahepatic tracts (RIHD) with seven total lesions in multiple configurations. Timed runs aimed to visualize and target each lesion using miniature biopsy forceps. Definitions: visual success, visualizing targets; targeting success, touching target with forceps; complete run, touching seven targets within 20 minutes. Image quality, ease-of-use, and time to completion were recorded. Results Thirty-seven evaluable runs (20 DSOC, 17 FSOC) were completed. DSOC was superior to FSOC in Visual (99 % vs. 67 %, P Conclusions In this model, DSOC performed superiorly to FSOC in image quality, visualization, and maneuverability. The model could potentially be utilized for training endoscopists less experienced with cholangiopancreatoscopy.
-
digital single operator cholangiopancreatoscopy in the diagnosis and management of pancreatobiliary disorders a multicenter clinical experience with video
Gastrointestinal Endoscopy, 2016Co-Authors: Udayakumar Navaneethan, John J Vargo, Muhammad K Hasan, Kiran Kumar Kommaraju, Xiang Zhu, Shantel Hebertmagee, Robert H Hawes, Shyam Varadarajulu, Mansour A ParsiAbstract:Background and Aims Digital Cholangioscopes provide higher-resolution imaging of the pancreatobiliary tract compared with fiberoptic instruments. The role of a new, digital, single-operator cholangiopancreatoscopy (SOC) system for diagnosis and treatment of pancreatobiliary disorders in clinical practice is not known. Methods We performed a multicenter, observational study of 105 consecutive patients with suspected pancreatobiliary disorders. The main outcome measures were (1) sensitivity and specificity of SOC visual appearance and biopsies in the diagnosis of indeterminate biliary strictures and (2) achieving complete duct clearance in patients with biliary or pancreatic duct stones. Results A total of 98 cholangioscopy and 7 pancreatoscopy procedures were performed in 105 patients. Superior views of the ductal lumen and mucosa were obtained in all 44 patients with indeterminate biliary strictures. Among the 44 patients who underwent SOC-guided biopsies, the specimen was adequate for histologic evaluation in 43 patients (97.7%). The sensitivity and specificity of SOC visual impression for diagnosis of malignancy was 90% (95% confidence interval [CI], 69.9%-97.2%) and 95.8% (95% CI, 79.8%-99.3%), respectively. The sensitivity and specificity of SOC-guided biopsies for diagnosis of malignancy was 85% (95% CI, 64.0%-94.8%) and 100% (95% CI, 86.2%-100%). In patients with biliary or pancreatic duct stones (N = 36), complete duct clearance with stone removal in 1 session was accomplished in 86.1% of patients (31/36). Three patients (2.9%) experienced SOC-related adverse events that included cholangitis in 2 patients and postprocedure pancreatitis in 1 patient. Conclusions SOC has become an integral part of the ERCP armamentarium and has high accuracy in the evaluation of indeterminate biliary strictures. Complete stone clearance was achieved in all but 1 patient with challenging biliary or pancreatic duct stones. (Clinical trial registration number: NCT01815619.)
-
diagnostic and therapeutic cholangiopancreatoscopy performance of a new digital Cholangioscope
Gastrointestinal Endoscopy, 2014Co-Authors: Mansour A Parsi, Sunguk Jang, Madhusudhan R Sanaka, Tyler Stevens, John J VargoAbstract:Background High-definition Cholangioscopes provide excellent images of the pancreatobiliary ductal system and may play a significant role in diagnosis and treatment of various pancreatobiliary disorders. Objective To assess the performance of a new digital Cholangioscope for diagnosis and treatment of pancreatobiliary disorders in clinical practice. Design Prospective study. Setting Academic hospital, tertiary-care referral center. Patients Consecutive patients with suspected pancreatobiliary disorders. Intervention Diagnostic or therapeutic high-definition digital cholangiopancreatoscopy. Main Outcome Measurements Satisfactory visualization of the ductal mucosa and lumen and treatment of pancreatobiliary disorders when indicated. Results A total of 28 cholangioscopy and 4 pancreatoscopy procedures were completed before breakdown of the Cholangioscope. Excellent views of the ductal lumen and mucosa were obtained in all patients. In the 18 patients with indeterminate biliary strictures, high-definition cholangioscopy identified all cholangiocarcinomas but labeled as malignant only 1 of 4 strictures caused by pancreatic cancer (sensitivity 73%). All benign strictures were correctly labeled (specificity 100%). Cholangioscopy proved helpful in evaluation of various biliary disorders and lithotripsy of pancreatic stones under direct vision. Limitations Single center, small number of patients. Conclusion High-definition cholangioscopy is a useful adjunct to ERCP in the diagnosis and treatment of pancreatobiliary disorders. Although fragility of the Cholangioscope remains a problem, the changes made in the construction of this prototype digital Cholangioscope have significantly increased its durability.
-
Direct peroral cholangioscopy
World Journal of Gastrointestinal Endoscopy, 2014Co-Authors: Mansour A ParsiAbstract:Peroral cholangioscopy is an important tool for diagnosis and treatment of various biliary disorders. Peroral cholangioscopy can be performed by using a dedicated Cholangioscope that is advanced through the accessory channel of a duodenoscope, or by direct insertion of a small-diameter endoscope into the bile duct. Direct peroral cholangioscopy refers to insertion of an ultraslim endoscope directly into the bile duct for visualization of the biliary mucosa and lumen. This approach provides a valuable and economic solution for diagnostic and therapeutic applications in the biliary tree. Compared to ductoscopy using a dedicated Cholangioscope, the direct approach has several advantages and disadvantages. In this editorial, I discuss the advantages, disadvantages, and possible future developments pertaining to direct peroral cholangioscopy.
-
Utility of a prototype peroral video cholangioscopy system with narrow-band imaging for evaluation of biliary disorders (with videos)
Gastrointestinal Endoscopy, 2011Co-Authors: Mansour A Parsi, Tyler Stevens, James Collins, John J VargoAbstract:h m a h e The role of peroral cholangioscopy for diagnosis and treatment of biliary disorders has been well-established.1 One of the major shortcomings of peroral cholangioscopy has been the relatively poor image quality offered by fiberoptic Cholangioscopes. Introduction of video Cholangioscopes at the turn of the century remedied this shortcoming.2 Continued progress in imaging technology has led to further enhancements in the image resolution of video Cholangioscopes. However, video Cholangioscopes are expensive, require two endoscopists in most instances, and are fragile and break easily. Furthermore, there is limited access to these Cholangioscopes.3 These factors ave prevented widespread use of video cholangioscopy or diagnosis and treatment of biliary disorders. Currently, early all video cholangioscopy examinations are perormed at academic medical centers with special interest n biliary diseases. Narrow-band imaging (NBI) is an imaging technique hat has shown promise for detailed evaluation of mucosal bnormalities. Although there are multiple studies on the se of this technology in evaluation of mucosal aberraions in the GI tract, its use in the biliary tree has been imited.4 Video cholangioscopy systems with NBI capabilty have been developed, and their use in the biliary ystem has shown promise, based on a few published eports from Asian academic medical centers.5,6
Fumihide Itokawa - One of the best experts on this subject based on the ideXlab platform.
-
clinical evaluation of a prototype multi bending peroral direct Cholangioscope
Digestive Endoscopy, 2014Co-Authors: Takao Itoi, Rajesh Gupta, Mohan Ramchandani, Atsushi Sofuni, Fumihide Itokawa, Toshio Kurihara, Takayoshi Tsuchiya, Kentaro Ishii, Nageshwar D Reddy, Nobuhito IkeuchiAbstract:Background Although peroral direct cholangioscopy (PDCS) is emerging as an alternative to traditional mother-daughter cholangioscopy, it is associated with high failure rates. The aim of the present study was to evaluate the ability to insert and carry out interventions using a prototype multi-bending PDCS. Patients and Methods Prospective, observational clinical feasibility study was done in 41 patients with a variety of biliary diseases. A multi-bending PDCS prototype was inserted using a free-hand technique, a guidewire alone, or with a 5-Fr diameter anchoring balloon. Diagnostic and therapeutic procedures were carried out. Results The free-hand direct insertion technique failed in all attempted cases (n = 7). Of the remaining 34 cases, successful rate of PDCS insertion into the distal bile duct was achieved by passing the PDCS over a guidewire alone (n = 6) and/or with a guidewire plus anchoring balloon (n = 28) for an overall successrate of 88.2% (30/34). In 13 (92.9%) patients without an underlying biliary stricture, PDCS insertion proximal to the bifurcation was possible. In 25 cases, biliary interventions were attempted including biopsy (n = 13), stone removal (n = 6), stent removal (n = 1), and intraductal electrohydraulic lithotripsy (n = 2) and were successful in 22 (88%). Other than two patients with procedure-related cholangitis with a mild grade of severity, no complications were observed. Conclusions Using a novel multi-bending prototype peroral direct Cholangioscope, cholangioscopy had a high diagnostic and therapeutic success rate only when passed over a guidewire and anchoring balloon but not with the free-hand insertion technique. Comparative studies of direct cholangioscopy are warranted.
-
The role of peroral video cholangioscopy in patients with IgG4-related sclerosing cholangitis
Journal of Gastroenterology, 2013Co-Authors: Takao Itoi, Fumihide Itokawa, Hiroshi Kawakami, Masaki Kuwatani, Terumi Kamisawa, Yoshinori Igarashi, Ichiro Yasuda, Yuui Kishimoto, Seiichi Hara, Fuminori MoriyasuAbstract:Background The cholangioscopic features of IgG4-related sclerosing cholangitis (IgG4-SC) remain undefined. The aim of this study was to clarify these endoscopic features using peroral video cholangioscopy (PVCS) in IgG4-SC patients. Methods PVCS was performed in 33 patients: IgG4-SC ( n = 13); primary sclerosing cholangitis (PSC; n = 5); and cholangiocarcinoma ( n = 15), which included hilar cholangiocarcinoma (HCCA; n = 5) and distal cholangiocarcinoma (DCCA; n = 10). Results The most frequent findings on PVCS in the IgG4-SC patients were dilated (62 %) and tortuous (69 %) vessels, and absence of partially enlarged vessels. The incidence of dilated and tortuous vessels was significantly higher in IgG4-SC patients than in PSC patients ( p = 0.015). Scarring and pseudodiverticula were found significantly more often in PSC patients than in IgG4-SC patients ( p = 0.001 and p = 0.0007, respectively). The incidence of partially enlarged vessels was significantly higher in DCCA patients than in IgG4-SC patients ( p = 0.004). In contrast, the incidence of dilated vessels was significantly higher in IgG4-SC patients than in HCCA patients ( p = 0.015). PVCS performed after corticosteroid therapy showed resolution of bile duct stenosis and dilated, tortuous, or partially enlarged vessels, as well as resolution of friability in all patients with IgG4-SC. Conclusion Cholangioscopy was useful in differentiating IgG4-SC from PSC. In addition, monitoring the patterns of proliferative vessels on PVCS may be useful to differentiate IgG4-SC from cholangiocarcinoma.
-
initial experience with a prototype peroral direct Cholangioscope to perform intraductal lithotripsy with video
Gastrointestinal Endoscopy, 2011Co-Authors: Takao Itoi, Atsushi Sofuni, Fumihide Itokawa, Toshio Kurihara, Takayoshi Tsuchiya, Kentaro Ishii, Shujiro Tsuji, Takuji Gotoda, Jong Ho MoonAbstract:F s h Urakami et al1 first reported a peroral direct cholangiosopy (PDCS) procedure 3 decades ago. Recently, PDCS using ltraslim upper endoscopes has been described for diagnosic and therapeutic purposes.2-9 However, those endoscopes re not dedicated Cholangioscopes. This is the first report of he use of a dedicated prototype peroral direct cholangiocope to fragment a difficult bile duct stone.
-
a novel technique for endoscopic sphincterotomy when using a percutaneous transhepatic Cholangioscope in patients with an endoscopically inaccessible papilla
Gastrointestinal Endoscopy, 2004Co-Authors: Takao Itoi, Atsushi Sofuni, Fumihide Itokawa, Yasushi Shinohara, Kazuya Takeda, Kazuto Nakamura, Fuminori Moriyasu, Akihiko TsuchidaAbstract:Abstract Background Endoscopic sphincterotomy is difficult and sometimes impossible in patients who have undergone gastrectomy or partial gastrectomy with Billroth II reconstruction. For such patients, a novel technique was developed in which endoscopic sphincterotomy is performed via percutaneous transhepatic cholangioscopy. This report describes an initial experience with this technique. Methods After dilation of the percutaneous fistula, a Cholangioscope with a push-type sphincterotome attached was inserted into the bile duct via the fistula and then through the papilla into the duodenum. The tip of the instrument then was retroverted to obtain a frontal view of the papilla. Then, a sphincterotomy incision was extended to the proximal, orad margin of the papillary eminence. Observations Percutaneous transhepatic biliary drainage was performed in 3 patients with obstructive jaundice and bile duct stones. In all patients, percutaneous transhepatic cholangioscopic sphincterotomy was performed successfully, without procedure-related complication. Thereafter, all stones and stone fragments cleared from the duct by spontaneous migration. Conclusions Endoscopic sphincterotomy via percutaneous transhepatic cholangioscopy potentially is an innovative technique for endoscopic sphincterotomy in patients with an endoscopically inaccessible papilla.
John J Vargo - One of the best experts on this subject based on the ideXlab platform.
-
digital single operator cholangiopancreatoscopy in the diagnosis and management of pancreatobiliary disorders a multicenter clinical experience with video
Gastrointestinal Endoscopy, 2016Co-Authors: Udayakumar Navaneethan, John J Vargo, Muhammad K Hasan, Kiran Kumar Kommaraju, Xiang Zhu, Shantel Hebertmagee, Robert H Hawes, Shyam Varadarajulu, Mansour A ParsiAbstract:Background and Aims Digital Cholangioscopes provide higher-resolution imaging of the pancreatobiliary tract compared with fiberoptic instruments. The role of a new, digital, single-operator cholangiopancreatoscopy (SOC) system for diagnosis and treatment of pancreatobiliary disorders in clinical practice is not known. Methods We performed a multicenter, observational study of 105 consecutive patients with suspected pancreatobiliary disorders. The main outcome measures were (1) sensitivity and specificity of SOC visual appearance and biopsies in the diagnosis of indeterminate biliary strictures and (2) achieving complete duct clearance in patients with biliary or pancreatic duct stones. Results A total of 98 cholangioscopy and 7 pancreatoscopy procedures were performed in 105 patients. Superior views of the ductal lumen and mucosa were obtained in all 44 patients with indeterminate biliary strictures. Among the 44 patients who underwent SOC-guided biopsies, the specimen was adequate for histologic evaluation in 43 patients (97.7%). The sensitivity and specificity of SOC visual impression for diagnosis of malignancy was 90% (95% confidence interval [CI], 69.9%-97.2%) and 95.8% (95% CI, 79.8%-99.3%), respectively. The sensitivity and specificity of SOC-guided biopsies for diagnosis of malignancy was 85% (95% CI, 64.0%-94.8%) and 100% (95% CI, 86.2%-100%). In patients with biliary or pancreatic duct stones (N = 36), complete duct clearance with stone removal in 1 session was accomplished in 86.1% of patients (31/36). Three patients (2.9%) experienced SOC-related adverse events that included cholangitis in 2 patients and postprocedure pancreatitis in 1 patient. Conclusions SOC has become an integral part of the ERCP armamentarium and has high accuracy in the evaluation of indeterminate biliary strictures. Complete stone clearance was achieved in all but 1 patient with challenging biliary or pancreatic duct stones. (Clinical trial registration number: NCT01815619.)
-
diagnostic and therapeutic cholangiopancreatoscopy performance of a new digital Cholangioscope
Gastrointestinal Endoscopy, 2014Co-Authors: Mansour A Parsi, Sunguk Jang, Madhusudhan R Sanaka, Tyler Stevens, John J VargoAbstract:Background High-definition Cholangioscopes provide excellent images of the pancreatobiliary ductal system and may play a significant role in diagnosis and treatment of various pancreatobiliary disorders. Objective To assess the performance of a new digital Cholangioscope for diagnosis and treatment of pancreatobiliary disorders in clinical practice. Design Prospective study. Setting Academic hospital, tertiary-care referral center. Patients Consecutive patients with suspected pancreatobiliary disorders. Intervention Diagnostic or therapeutic high-definition digital cholangiopancreatoscopy. Main Outcome Measurements Satisfactory visualization of the ductal mucosa and lumen and treatment of pancreatobiliary disorders when indicated. Results A total of 28 cholangioscopy and 4 pancreatoscopy procedures were completed before breakdown of the Cholangioscope. Excellent views of the ductal lumen and mucosa were obtained in all patients. In the 18 patients with indeterminate biliary strictures, high-definition cholangioscopy identified all cholangiocarcinomas but labeled as malignant only 1 of 4 strictures caused by pancreatic cancer (sensitivity 73%). All benign strictures were correctly labeled (specificity 100%). Cholangioscopy proved helpful in evaluation of various biliary disorders and lithotripsy of pancreatic stones under direct vision. Limitations Single center, small number of patients. Conclusion High-definition cholangioscopy is a useful adjunct to ERCP in the diagnosis and treatment of pancreatobiliary disorders. Although fragility of the Cholangioscope remains a problem, the changes made in the construction of this prototype digital Cholangioscope have significantly increased its durability.
-
Utility of a prototype peroral video cholangioscopy system with narrow-band imaging for evaluation of biliary disorders (with videos)
Gastrointestinal Endoscopy, 2011Co-Authors: Mansour A Parsi, Tyler Stevens, James Collins, John J VargoAbstract:h m a h e The role of peroral cholangioscopy for diagnosis and treatment of biliary disorders has been well-established.1 One of the major shortcomings of peroral cholangioscopy has been the relatively poor image quality offered by fiberoptic Cholangioscopes. Introduction of video Cholangioscopes at the turn of the century remedied this shortcoming.2 Continued progress in imaging technology has led to further enhancements in the image resolution of video Cholangioscopes. However, video Cholangioscopes are expensive, require two endoscopists in most instances, and are fragile and break easily. Furthermore, there is limited access to these Cholangioscopes.3 These factors ave prevented widespread use of video cholangioscopy or diagnosis and treatment of biliary disorders. Currently, early all video cholangioscopy examinations are perormed at academic medical centers with special interest n biliary diseases. Narrow-band imaging (NBI) is an imaging technique hat has shown promise for detailed evaluation of mucosal bnormalities. Although there are multiple studies on the se of this technology in evaluation of mucosal aberraions in the GI tract, its use in the biliary tree has been imited.4 Video cholangioscopy systems with NBI capabilty have been developed, and their use in the biliary ystem has shown promise, based on a few published eports from Asian academic medical centers.5,6
Takayoshi Tsuchiya - One of the best experts on this subject based on the ideXlab platform.
-
Novel peroral direct digital cholangioscopy-assisted lithotripsy using a monorail technique through the overtube in patients with surgically altered anatomy (with video).
Digestive Endoscopy, 2019Co-Authors: Ryosuke Tonozuka, Takao Itoi, Atsushi Sofuni, Takayoshi Tsuchiya, Kentaro Ishii, Reina Tanaka, Mitsuyoshi Honjo, Shuntaro Mukai, Kenjiro Yamamoto, Mitsuru FujitaAbstract:Efficacy of cholangioscopy-assisted lithotripsy for difficult stones such as huge stones, multiple large stones and an impacted stone in patients with non-altered anatomy has been reported. Herein, we describe peroral direct digital cholangioscopy (PDCS)-assisted electrohydraulic lithotripsy (EHL) with a new technique in patients with surgically altered anatomy. Five patients received PDCS-assisted EHL with the monorail technique due to failed conventional stone extraction. Balloon enteroscope was removed, leaving the stiff guidewire in the bile duct and an overtube with inflated balloons. The Cholangioscope was then inserted into the bile duct over the wire through the overtube. After direct visualization of the stone, PDCS-assisted EHL was carried out. This technique was named the 'monorail technique'. Complete removal of biliary stones in one session was accomplished in four patients and only one case required two sessions. There was no adverse event in any of the cases. PDCS-assisted EHL using the monorail technique was effective and safe for difficult biliary stones in patients with surgically altered anatomy.
-
novel ex vivo training model for free hand insertion using a double bending peroral direct Cholangioscope
Journal of Gastroenterology and Hepatology, 2018Co-Authors: Sakiko Naito, Takao Itoi, Takayoshi Tsuchiya, Shujiro Tsuji, Reina Tanaka, Mitsuyoshi Honjo, Shuntaro Mukai, Kenjiro Yamamoto, Yukitoshi Matsunami, Yasutsugu AsaiAbstract:Background and Aim Several experts of direct peroral videocholangioscopy (D-PVCS) using a conventional ultraslim endoscope have reported its usefulness for the diagnosis and therapy of biliary tract diseases. We have additionally developed a dedicated double-bending D-PVCS (DBD-PVCS) technique for free-hand scope insertion. In this study, we developed an ex-vivo training model for the free-hand DBD-PVCS technique and compared it with the technique using a conventional ultraslim endoscope. Methods The ex-vivo model was made for training using a U-shape insertion pattern. A 3rd prototype endoscope and an ultraslim upper GI endoscope were used. Two experts and 9 non-experts performed D-PVCS using the free-hand technique. Results The 2 experts could not advance the tip of the endoscope to the hilar portion using the free-hand technique, but they could achieve technical successful insertion to the hilar portion with the 3rd prototype Cholangioscope using the free-hand technique alone. The non-experts could not advance the tip of the endoscope to the bile duct using the free-hand technique. On the other hand, 2 (22.2%) non-experts could advance the tip of the 3rd prototype Cholangioscope using the free-hand technique before the training conducted by the experts. After the training, all the non-experts could advance the tip of the 3rd prototype Cholangioscope to the hilar portion. Conclusions The novel ex-vivo model using a 3rd prototype Cholangioscope was useful for training in the use of the free-hand D-PVCS technique.
-
clinical evaluation of a prototype multi bending peroral direct Cholangioscope
Digestive Endoscopy, 2014Co-Authors: Takao Itoi, Rajesh Gupta, Mohan Ramchandani, Atsushi Sofuni, Fumihide Itokawa, Toshio Kurihara, Takayoshi Tsuchiya, Kentaro Ishii, Nageshwar D Reddy, Nobuhito IkeuchiAbstract:Background Although peroral direct cholangioscopy (PDCS) is emerging as an alternative to traditional mother-daughter cholangioscopy, it is associated with high failure rates. The aim of the present study was to evaluate the ability to insert and carry out interventions using a prototype multi-bending PDCS. Patients and Methods Prospective, observational clinical feasibility study was done in 41 patients with a variety of biliary diseases. A multi-bending PDCS prototype was inserted using a free-hand technique, a guidewire alone, or with a 5-Fr diameter anchoring balloon. Diagnostic and therapeutic procedures were carried out. Results The free-hand direct insertion technique failed in all attempted cases (n = 7). Of the remaining 34 cases, successful rate of PDCS insertion into the distal bile duct was achieved by passing the PDCS over a guidewire alone (n = 6) and/or with a guidewire plus anchoring balloon (n = 28) for an overall successrate of 88.2% (30/34). In 13 (92.9%) patients without an underlying biliary stricture, PDCS insertion proximal to the bifurcation was possible. In 25 cases, biliary interventions were attempted including biopsy (n = 13), stone removal (n = 6), stent removal (n = 1), and intraductal electrohydraulic lithotripsy (n = 2) and were successful in 22 (88%). Other than two patients with procedure-related cholangitis with a mild grade of severity, no complications were observed. Conclusions Using a novel multi-bending prototype peroral direct Cholangioscope, cholangioscopy had a high diagnostic and therapeutic success rate only when passed over a guidewire and anchoring balloon but not with the free-hand insertion technique. Comparative studies of direct cholangioscopy are warranted.
-
initial experience with a prototype peroral direct Cholangioscope to perform intraductal lithotripsy with video
Gastrointestinal Endoscopy, 2011Co-Authors: Takao Itoi, Atsushi Sofuni, Fumihide Itokawa, Toshio Kurihara, Takayoshi Tsuchiya, Kentaro Ishii, Shujiro Tsuji, Takuji Gotoda, Jong Ho MoonAbstract:F s h Urakami et al1 first reported a peroral direct cholangiosopy (PDCS) procedure 3 decades ago. Recently, PDCS using ltraslim upper endoscopes has been described for diagnosic and therapeutic purposes.2-9 However, those endoscopes re not dedicated Cholangioscopes. This is the first report of he use of a dedicated prototype peroral direct cholangiocope to fragment a difficult bile duct stone.
-
Magnetic compression anastomosis: a novel technique for canalization of severe hilar bile duct strictures.
Endoscopy, 2005Co-Authors: Takao Itoi, Toshio Kurihara, Takayoshi Tsuchiya, Akihiko Tsuchida, Eigoro Yamanouchi, Takahisa Ikeda, A. Sofuni, Kazuhiko Kasuya, Fuminori MoriyasuAbstract:This report describes a successful choledochocholedochostomy using magnetic compression anastomosis in a patient with severe hilar bile duct stricture, in whom previous attempts at canalization via conventional endoscopic and percutaneous transhepatic routes had failed. An endoscope was used to position a magnet at the superior end of the hilar biliary stricture and another magnet at the inferior end. These magnets had been introduced via the percutaneous transhepatic biliary drainage (PTBD) route and via the papilla of Vater, respectively. After this procedure, two guide wires were passed easily through the segment in which the magnets adhered to one another, using a percutaneous transhepatic Cholangioscope, to reach the lower common bile duct. It was then possible to place two PTBD tubes across the hilar bile duct stricture. There were no procedure-related complications.