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Takao Itoi - One of the best experts on this subject based on the ideXlab platform.

  • Endoscopic Ultrasonography-Guided Gastroenterostomy Techniques for Treatment of Malignant Gastric Outlet Obstruction.
    Clinical Endoscopy, 2020
    Co-Authors: Ryosuke Tonozuka, Takayoshi Tsuchiya, Shuntaro Mukai, Yuichi Nagakawa, Takao Itoi
    Abstract:

    Gastric outlet obstruction (GOO) can be caused by periampullary malignancies and often leads to a reduction in a patient's quality of life. Recently, Endoscopic Ultrasonography-guided gastroenterostomy (EUS-GE) using a lumen-apposing self-expandable metal stent (LAMS) has been developed as a minimally invasive and durable Endoscopic treatment for GOO. There are three types of EUS-GE technique: (1) the direct technique; (2) device-assisted techniques, such as a balloon catheter, nasobiliary drainage tube, and ultraslim endoscopy; and (3) EUS-guided double balloon-occluded gastrojejunostomy bypass. Previous reports of EUS-GE with LAMS have shown technical and clinical success rates (regardless of technique and etiology) of 87%-100% and 84%-100%, respectively. Studies comparing EUS-GE and surgical gastrojejunostomy have shown similar success rates, reintervention rates, and cost benefits, with a lower rate of early adverse events in EUS-GE. A comparison of EUS-GE and Endoscopic enteral stent placement revealed similar technical success rates, but initial clinical success rate was higher and the rate of stent failure requiring reintervention was lower with EUS-GE.

  • interventional Endoscopic Ultrasonography for benign biliary diseases in patients with surgically altered anatomy
    Current Opinion in Gastroenterology, 2019
    Co-Authors: Shuntaro Mukai, Takayoshi Tsuchiya, Takao Itoi
    Abstract:

    Purpose of reviewAt present, balloon enteroscopy-assisted Endoscopic retrograde cholangiopancreatography (ERCP) is the mainstay of therapy for benign biliary diseases in patients with surgically altered anatomy (SAA). Recently interventional Endoscopic Ultrasonography (EUS) techniques have been used

  • Endoscopic Ultrasonography guided biliary and pancreatic duct interventions
    Digestive Endoscopy, 2017
    Co-Authors: Vinay Dhir, Takao Itoi, Hiroyuki Isayama, Majid A Almadi, Aroon Siripun, Anthony Yuen Bun Teoh
    Abstract:

    Drainage of obstructed bile duct and pancreatic duct under Endoscopic Ultrasonography (EUS) guidance has evolved into viable techniques suitable for patients with failed Endoscopic retrograde cholangiopancreatography (ERCP) and/or altered surgical anatomy. One of the major advantages of EUS guidance is the possibility of multiple access points depending upon patient and ductal anatomy. Unlike ERCP, an approachable papilla is not a requisite for successful EUS-guided biliary or pancreatic ductal drainage. Moreover, as the access is away from the papilla, there is the possibility of reduced pancreatitis. A variety of procedures have become available for EUS-guided drainage, and it is important to develop standard terminology and procedural details. EUS-specific stents, including lumen-apposing metal stents have recently become available, and are likely to impact the outcomes of these procedures. Available data show a high success rate and acceptable adverse event rate for EUS-guided biliary drainage. Success rate appears to be low for pancreatic duct drainage because of a variety of reasons. Outcomes of EUS-guided biliary drainage appear equivalent to percutaneous drainage and ERCP. EUS-guided gallbladder drainage appears promising for patients requiring gallbladder drainage but unfit for surgery. Further large controlled studies are needed to evaluate the exact role of these procedures.

  • Technical review of Endoscopic Ultrasonography-guided gastroenterostomy in 2017.
    Digestive Endoscopy, 2017
    Co-Authors: Takao Itoi, Takayoshi Tsuchiya, Vinay Dhir, Todd H. Baron, Mouen A. Khashab, Shayan Irani, Anthony Y. Teoh
    Abstract:

    Gastric outlet obstruction (GOO) can be caused by benign and malignant diseases and often leads to a reduction in patient quality of life. Lately, Endoscopic Ultrasonography (EUS)-guided gastroenterostomy (EUS-GE) has emerged. At the present time, there are three types of EUS-GE using lumen-apposing biflanged metal stents (LAMS): (i) direct EUS-GE; (ii) assisted EUS-GE using retrieval/dilating balloon, single balloon overtube, nasobiliary drain and ultraslim endoscope; and (iii) EUS-guided double-balloon-occluded gastrojejunostomy bypass (EPASS). Overall technical success rate is approximately 90% regardless of technique used, although this is based on two retrospective studies only. In the EPASS procedure, the success rate of the one-step procedure was higher than that of the two-step procedure (100% vs 82%). Clinical success was almost uniform when stent placement was technically successful. Although there have been no-stent induced procedural deaths, adverse events were seen in several cases. One technically failed case carried out using balloon-assisted EUS-GE was converted to laparoscopic gastrojejunostomy. Two failed cases in EPASS procedure improved with conservative treatment. In the present review, we show the feasibility and outcomes using novel EUS-GE using LAMS. Clinical prospective trials with comparison to luminal enteral stents and surgical GE are warranted.

  • Endoscopic Ultrasonography guided biliary drainage an alternative to percutaneous transhepatic puncture
    Gastrointestinal intervention, 2015
    Co-Authors: Nobuhito Ikeuchi, Takao Itoi
    Abstract:

    Endoscopic retrograde cholangiopancreatography (ERCP) is the first-choice treatment for patients with obstructive jaundice. However, there are patients in whom bile duct access is not possible. In these patients, percutaneous transhepatic biliary drainage (PTBD) may be performed as an alternative biliary drainage method. PTBD is reportedly associated with a moderate mortality rate. In recent years, Endoscopic Ultrasonography-guided biliary drainage (EUS-BD) in patients with failed ERCP has been reported as an alternative to PTBD. EUS-BD is classified into three techniques: (1) EUS-guided choledocoduodenostomy (EUS-CDS); (2) EUS-guided hepatogastrostomy (EUS-HGS); and (3) EUS-guided antegrade (EUS-AG) approach. Herein, we focus on the current status of EUS-BD in light of these techniques.

Yasumasa Niwa - One of the best experts on this subject based on the ideXlab platform.

  • interventional Endoscopic Ultrasonography for pancreatic cancer
    World journal of clinical oncology, 2011
    Co-Authors: Kazuo Hara, Nobumasa Mizuno, Kenji Yamao, Akira Sawaki, Yasuhiro Shimizu, Susumu Hijioka, Masahiro Tajika, Hiroki Kawai, Shinya Kondo, Yasumasa Niwa
    Abstract:

    Endoscopic Ultrasonography (EUS) represents the combination of endoscopy and intraluminal Ultrasonography. This allows use of a high-frequency transducer (5-20 MHz) that, due to the short distance to the target lesion, provides ultrasonographic images of higher resolution than those obtained from other imaging modalities, including multiple-detector-row-computed tomography, magnetic resonance imaging, and positron emission tomography. EUS is now a widely accepted modality for diagnosing pancreatic diseases. However, the most important limitation of EUS has been the lack of specificity in differentiating between benign and malignant changes. In 1992, EUS-guided fine needle aspiration (FNA) of lesions in the pancreas head was introduced into clinical practice, using a curved linear-array echoendoscope. Since then, EUS has evolved from EUS imaging to EUS-FNA and wider applications. Interventional EUS for pancreatic cancer includes EUS-FNA, EUS-guided fine needle injection, EUS-guided biliary drainage and anastomosis, EUS-guided celiac neurolysis, radiofrequency ablation, brachytherapy, and delivery of a growing number of anti-tumor agents. This review focuses on interventional EUS, including EUS-FNA and therapeutic EUS for pancreatic cancer.

  • usefulness of contrast enhanced Endoscopic Ultrasonography in the differentiation between malignant and benign lymphadenopathy
    The American Journal of Gastroenterology, 2006
    Co-Authors: Akira Kanamori, Yoshiki Hirooka, Akihiro Itoh, Senju Hashimoto, Hiroki Kawashima, Kazuo Hara, Hiroki Uchida, Jun Goto, Naoki Ohmiya, Yasumasa Niwa
    Abstract:

    Usefulness of Contrast-Enhanced Endoscopic Ultrasonography in the Differentiation Between Malignant and Benign Lymphadenopathy *

  • carcinoid tumors of the gastrointestinal tract evaluation with Endoscopic Ultrasonography
    Gastrointestinal Endoscopy, 1993
    Co-Authors: H Yoshikane, Keiji Mizutani, S. Hase, Yoshihisa Tsukamoto, Yasumasa Niwa, Hidemi Goto, Tsuneya Nakamura
    Abstract:

    To evaluate the usefulness of Endoscopic Ultrasonography for carcinoid tumors, we examined 29 patients with gastrointestinal carcinoid tumors (5 gastric, 7 duodenal, and 17 rectal). The smallest size detectable by Endoscopic Ultrasonography was 2mm in diameter histologically. The cross-sectional image of the tumors was primarily oval to round. The internal echo was generally hypoechoic and homogeneous. The margins were clearly visualized, and the contour was somewhat smooth. The tumors were mainly located in the third layer. The second layer covered the tumor with the third layer at its base, and it abutted the tumor and became indistinct near its upper interface. These findings were especially recognized in lesions with submucosal invasion and were similar at all sites. The overall accuracy of determining the depth of invasion using Endoscopic Ultrasonography was 75% (27 of 36 lesions). Limited to the lesions detectable by Endoscopic Ultrasonography, the accuracy was 90%. Endoscopic Ultrasonography was useful in determining the presence of local metastases. Moreover, Endoscopic Ultrasonography allowed direct detection of perigastrointestinal lymph node metastases (75%, three of four patients). In conclusion, Endoscopic Ultrasonography was found to be useful for the staging of gastrointestinal carcinoid tumors by determining depth of involvement and presence of perigastrointestinal lymph node metastases.

Hajime Nawata - One of the best experts on this subject based on the ideXlab platform.

  • Endoscopic Ultrasonography findings in acute gastric anisakiasis
    The American Journal of Gastroenterology, 1992
    Co-Authors: K Sakai, Yoshiharu Chijiiwa, Kazushi Hiroshige, Tadashi Misawa, A. Ohtani, Hiroaki Muta, A Ohkubo, K. Tominaga, Hiroshi Fujishima, Hajime Nawata
    Abstract:

    : To clarify the components of the thickened gastric wall in acute gastric anisakiasis, we evaluated Endoscopic Ultrasonography (EUS) findings of acute gastric anisakiasis. Ten patients with acute gastric anisakiasis underwent Endoscopic Ultrasonography immediately after anisakiasis was diagnosed by endoscopy. In the acute phase of gastric anisakiasis, Endoscopic Ultrasonography (EUS) detected a thickening of the gastric wall made of mainly thickened third layer with low echoic changes. When EUS was performed 7 to 11 days later in seven patients, the EUS findings had normalized. We made clear EUS findings in acute gastritis due to gastric anisakiasis. Consequently, we found, by EUS, that the main inflammatory lesion in anisakiasis was in the submucosal layer of gastric wall.

  • Endoscopic Ultrasonography findings in acute gastric anisakiasis
    The American Journal of Gastroenterology, 1992
    Co-Authors: K Sakai, Yoshiharu Chijiiwa, Kazushi Hiroshige, Tadashi Misawa, A. Ohtani, Hiroaki Muta, A Ohkubo, K. Tominaga, Hiroshi Fujishima, Hajime Nawata
    Abstract:

    : To clarify the components of the thickened gastric wall in acute gastric anisakiasis, we evaluated Endoscopic Ultrasonography (EUS) findings of acute gastric anisakiasis. Ten patients with acute gastric anisakiasis underwent Endoscopic Ultrasonography immediately after anisakiasis was diagnosed by endoscopy. In the acute phase of gastric anisakiasis, Endoscopic Ultrasonography (EUS) detected a thickening of the gastric wall made of mainly thickened third layer with low echoic changes. When EUS was performed 7 to 11 days later in seven patients, the EUS findings had normalized. We made clear EUS findings in acute gastritis due to gastric anisakiasis. Consequently, we found, by EUS, that the main inflammatory lesion in anisakiasis was in the submucosal layer of gastric wall.

Frank G Gress - One of the best experts on this subject based on the ideXlab platform.

  • Endoscopic Ultrasonography guided fine needle aspiration biopsy of suspected pancreatic cancer
    Annals of Internal Medicine, 2001
    Co-Authors: Frank G Gress, Klaus Gottlieb, Stuart Sherman, Glen A Lehman
    Abstract:

    Endoscopic Ultrasonography–guided fine-needle aspiration biopsy may be valuable in the evaluation of a pancreatic mass when results on other biopsy methods are negative but pancreatic cancer is sus...

  • Endoscopic Ultrasonography fine needle aspiration biopsy guided by Endoscopic Ultrasonography and computed tomography in the preoperative staging of non small cell lung cancer a comparison study
    Annals of Internal Medicine, 1997
    Co-Authors: Frank G Gress, Thomas J Savides, Alan Sandler, Kenneth Kesler, Dewey J Conces, Oscar W Cummings, Praveen N Mathur, Steven O Ikenberry, Sandy Bilderback, Robert H Hawes
    Abstract:

    Background: Current methods for detecting mediastinal lymph node involvement with non-small-cell lung cancer can be inaccurate and are often invasive and expensive. Objective: To assess the utility of Endoscopic Ultrasonography, fine-needle aspiration biopsy guided by Endoscopic Ultrasonography, and computed tomography for the detection of metastases to the posterior mediastinal lymph nodes in non-small-cell lung cancer. Design: Prospective preoperative evaluation of the diagnostic operating characteristics of these procedures. Setting: Referral-based academic medical center. Patients: 130 consecutive patients with non-small-cell lung cancer who were otherwise good surgical candidates. Interventions: All patients had initial computed tomography of the chest; those with enlarged nodes were referred for Endoscopic Ultrasonography. Endoscopic Ultrasonography-guided fine-needle aspiration biopsy was done on suspicious contralateral posterior mediastinal or subcarinal lymph nodes identified by Ultrasonography. At surgery, lymph nodes were dissected and categorized by location and underwent histopathologic evaluation. Results: 52 patients were ultimately enrolled in the study: Thirty-one had thoracotomy with mediastinal dissection, and 21 had tumors considered unresectable on the basis of preoperative evaluation. Ultrasonography without aspiration biopsy had an overall accuracy of 84% for predicting metastasis to lymph nodes; computed tomography had an accuracy of 49% (P < 0.025). Twenty-four patients had Ultrasonography-guided aspiration biopsy; 14 of the 24 were ineligible for surgery because cytology showed malignancy. Results of surgical pathology correlated with negative aspiration cytology results in 9 of 10 patients; the one node with false-negative results contained a 2-mm focus of cancer. The accuracy of Ultrasonography-guided aspiration biopsy in diagnosing metastasis to lymph nodes was 96%; the results of this test prompted a change in management in 95% of the patients who had the procedure. Conclusions: Endoscopic Ultrasonography alone or with fine-needle aspiration biopsy adds useful diagnostic information in determining metastasis to posterior mediastinal or subcarinal lymph nodes in patients with non-small-cell lung cancer. These procedures are especially helpful in the preoperative evaluation of patients with suspicious contralateral mediastinal or bulky subcarinal nodes.

Meinhard Classen - One of the best experts on this subject based on the ideXlab platform.

  • staging of pancreatic and ampullary carcinoma by Endoscopic Ultrasonography comparison with conventional sonography computed tomography and angiography
    Gastroenterology, 1992
    Co-Authors: Thomas Rosch, Christine Braig, Thomas Gain, Stefan Feuerbach, J R Siewert, V Schusdziarra, Meinhard Classen
    Abstract:

    In a prospective study, Endoscopic Ultrasonography was compared with transabdominal Ultrasonography, computed tomography, and angiography in 60 consecutive patients with pancreatic (n = 46) and ampullary (n = 14) cancer considered to be candidates for surgery. The diagnostic value of these imaging procedures in determining local resectability was assessed. The diagnosis of ampullopancreatic malignancy was made by operation (n = 40) or puncture/biopsy (n = 20). In the 40 patients who underwent surgery, Endoscopic Ultrasonography was significantly superior to abdominal Ultrasonography and computed tomography in determining tumor size and extent and lymph node metastases of pancreatic and ampullary cancer. Furthermore, involvement of the portal venous system as judged by histopathology or surgical exploration was correctly assessed by Endoscopic Ultrasonography in 95%, whereas angiography (85%), computed tomography (75%) and abdominal Ultrasonography (55%) were less sensitive. Of 11 cases of portal venous infiltration found at surgery, Endoscopic Ultrasonography correctly predicted 10, abdominal Ultrasonography only 1, computed tomography 4, and angiography 5 (P less than 0.05 for all three comparisons). Twenty patients did not undergo surgery for different reasons: of those, 9 patients were excluded from operation because of portal venous involvement as shown by angiography. Endoscopic Ultrasonography detected portal venous invasion in all these cases. In contrast to the venous system, arterial encasement was less reliably detected by Endoscopic Ultrasonography. In conclusion, Endoscopic Ultrasonography is the most effective single imaging procedure for local tumor staging in pancreatic and ampullary cancer. Thus, Endoscopic Ultrasonography will improve the assessment of tumor resectability and further decrease the need for explorative laparotomy.

  • staging of pancreatic and ampullary carcinoma by Endoscopic Ultrasonography comparison with conventional sonography computed tomography and angiography
    Gastroenterology, 1992
    Co-Authors: Thomas Rosch, Christine Braig, Thomas Gain, Stefan Feuerbach, J R Siewert, V Schusdziarra, Meinhard Classen
    Abstract:

    Abstract In a prospective study, Endoscopic Ultrasonography was compared with transabdominal Ultrasonography, computed tomography, and angiography in 60 consecutive patients with pancreatic (n = 46) and ampullary (n = 14) cancer considered to be candidates for surgery. The diagnostic value of these imaging procedures in determining local resectability was assessed. The diagnosis of ampullopancreatic malignancy was made by operation (n = 40) or puncture/biopsy (n = 20). In the 40 patients who underwent surgery, Endoscopic Ultrasonography was significantly superior to abdominal Ultrasonography and computed tomography in determining tumor size and extent and lymph node metastases of pancreatic and ampullary cancer. Furthermore, involvement of the portal venous system as judged by histopathology or surgical exploration was correctly assessed by Endoscopic Ultrasonography in 95%, whereas angiography (85%), computed tomography (75%) and abdominal Ultrasonography (55%) were less sensitive. Of 11 cases of portal venous infiltration found at surgery, Endoscopic Ultrasonography correctly predicted 10, abdominal Ultrasonography only 1, computed tomography 4, and angiography 5 ( P