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Terumi Kamisawa - One of the best experts on this subject based on the ideXlab platform.
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BASIC RESEARCH Usefulness of biopsying the Major Duodenal Papilla to diagnose autoimmune pancreatitis: A prospective study using IgG4-immunostaining
2015Co-Authors: Terumi Kamisawa, Hitoshi Nakajima, Naoto Egawa, Kouji Tsuruta, Atsutake OkamotoAbstract:AIM: To examine the histological and immunohisto-chemical findings of biopsy specimens taken from the Major Duodenal Papilla of autoimmune pancreatitis (AIP) patients. METHODS: The Major Duodenal Papilla in the resected pancreas of 3 patients with AIP and of 5 control patients [pancreatic carcinoma (n = 3) and chronic alcoholic pan-creatitis (n = 2)] was immunostained using anti-CD4-T cell, CD8-T cell and IgG4 antibodies. Forceps biopsy specimens taken from the Major Duodenal Papilla of 2 patients with AIP and 5 control patients with suspected papillitis were prospectively taken during duodenoscopy and immunohistochemically examined. RESULTS: Moderate or severe lymphoplasmacytic in
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immunoglobulin g4 related gastrointestinal diseases are they immunoglobulin g4 related diseases
World Journal of Gastroenterology, 2013Co-Authors: Satomi Koizumi, Go Kuwata, Yuka Endo, Koichi Koizumi, Susumu Iwasaki, Kazuro Chiba, Taku Tabata, Terumi Kamisawa, Sawako Kuruma, Tooru ShimosegawaAbstract:In immunoglobulin G4 (IgG4)-related disease (RD), organ enlargement or nodular lesions consisting of abundant infiltration of lymphocytes and IgG4-positive plasma cells and fibrosis are seen in various organs. Although infiltration of many IgG4-positive plasma cells is detected in the gastric and colonic mucosa and Major Duodenal Papilla of patients with autoimmune pancreatitis, it cannot be diagnosed as a gastrointestinal lesion involved in IgG4-RD, because none of the following is observed in these lesions: a mass-like formation; dense fibrosis; or obliterative phlebitis. Based on our review of the literature, there appear to be two types of IgG4-related gastrointestinal disease. One is a gastrointestinal lesion showing marked thickening of the wall of the esophagus and stomach, consisting of dense fibrosis with abundant infiltration of IgG4-positive plasma cells, which usually show submucosal spreading. The other is an IgG4-related pseudotumor occurring in gastrointestinal regions such as the stomach, colon, and Major Duodenal Papilla, showing polypoid or mass-like lesions. Most solitary IgG4-related gastrointestinal lesions that are not associated with other IgG4-RD appear to be difficult to diagnose. It is of utmost importance to rule out malignancy. However, these lesions may respond to steroid therapy. To avoid unnecessary resection, IgG4-related gastrointestinal diseases should be considered in the differential diagnosis.
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k ras mutation in the Major Duodenal Papilla and gastric and colonic mucosa in patients with autoimmune pancreatitis
Journal of Gastroenterology, 2010Co-Authors: Terumi Kamisawa, Shinichirou Horiguchi, Yukiko K Hayashi, Xiaoqing Yun, Toshikazu Yamaguchi, Koji Tsuruta, Tsuneo SasakiAbstract:Pancreatic cancer occurs in some patients with autoimmune pancreatitis (AIP). Significant K-ras mutations are frequently detected in the pancreas of AIP patients. AIP may be a pancreatic lesion of IgG4-related systemic disease. Gastric and colonic cancer can occur during the follow up of AIP patients. We examined K-ras mutations in the Major Duodenal Papilla and gastric and colonic mucosa of AIP patients. K-ras analysis and/or immunohistochemical study was performed on the tissues of the Major Duodenal Papilla (n = 8), gastric mucosa (n = 5), colonic mucosa (n = 3), pancreas (n = 5), common bile duct (n = 5), and gallbladder (n = 4) of 12 AIP patients. Significant K-ras mutations were detected in the Major Duodenal Papilla of 4 of 8 cases [GAT (n = 4)], in the gastric mucosa of 2 of 4 cases [AGT (n = 2)], and in the colonic mucosa of 2 of 3 cases [GAT (n = 2)]. Significant K-ras mutations were detected in the pancreas of all 5 cases [GAT (n = 5), in the common bile duct of 4 cases (GAT (n = 2), TGT (n = 1), and GCT/TGT (n = 1)], and in the gallbladder epithelium of 3 cases [GAT (n = 1), GCT (n = 1), and GTT (n = 1)]. K-ras mutations were detected in the organs associated with IgG4-related fibroinflammation with abundant infiltration of T lymphocytes and forkhead box P3-positive cells. Significant K-ras mutations were frequently detected in the Major Duodenal Papilla and gastric and colonic mucosa of AIP patients. AIP patients may have risk factors for gastric and colonic cancer, but the mechanisms of K-ras mutation and its clinical implications are not clear.
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Major Duodenal Papilla in autoimmune pancreatitis
Digestive Surgery, 2010Co-Authors: Myunghwan Kim, Sunghoon Moon, Terumi KamisawaAbstract:Autoimmune pancreatitis (AIP) is a distinctive form of chronic pancreatitis that can mimic pancreatobiliary malignancies. If AIP is properly diagnosed, it can be treated without laparotomy or pancreatic resection due to its dramatic response to steroid therapy. In addition to elevated serum IgG4 levels, IgG4 immunostaining of involved tissue is often used to support the diagnosis of AIP. The Major Duodenal Papilla is a conduit between the duodenum and the pancreatobiliary system and occasionally reflects underlying pancreatobiliary disorders. Previous studies demonstrated that IgG4-positive lymphoplasmacytic infiltration was detected in the Major Duodenal Papilla in connection to the pancreatic head in patients with AIP, and IgG4 immunostaining of biopsy specimens obtained from the Major Papilla could support a preoperative diagnosis of AIP. This review discusses macro- and microscopic findings of the Major Duodenal Papilla of AIP patients, especially focusing on the diagnostic value of IgG4 immunostaining of Duodenal Papillary biopsy specimens.
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Major Duodenal Papilla and its normal anatomy
Digestive Surgery, 2010Co-Authors: Shinichiro Horiguchi, Terumi KamisawaAbstract:The Major Duodenal Papilla (Papilla of Vater) is the point where the dilated junction of the bile and pancreatic ducts (ampulla of Vater) enter the duodenum. The ampulla is surrounded by the sphincter of Oddi, which not only controls the flow of bile and pancreatic juice into the duodenum, but also prevents the reflux of Duodenal contents, bile and pancreatic juice into the bile and pancreatic ducts.
Myunghwan Kim - One of the best experts on this subject based on the ideXlab platform.
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Major Duodenal Papilla in autoimmune pancreatitis
Digestive Surgery, 2010Co-Authors: Myunghwan Kim, Sunghoon Moon, Terumi KamisawaAbstract:Autoimmune pancreatitis (AIP) is a distinctive form of chronic pancreatitis that can mimic pancreatobiliary malignancies. If AIP is properly diagnosed, it can be treated without laparotomy or pancreatic resection due to its dramatic response to steroid therapy. In addition to elevated serum IgG4 levels, IgG4 immunostaining of involved tissue is often used to support the diagnosis of AIP. The Major Duodenal Papilla is a conduit between the duodenum and the pancreatobiliary system and occasionally reflects underlying pancreatobiliary disorders. Previous studies demonstrated that IgG4-positive lymphoplasmacytic infiltration was detected in the Major Duodenal Papilla in connection to the pancreatic head in patients with AIP, and IgG4 immunostaining of biopsy specimens obtained from the Major Papilla could support a preoperative diagnosis of AIP. This review discusses macro- and microscopic findings of the Major Duodenal Papilla of AIP patients, especially focusing on the diagnostic value of IgG4 immunostaining of Duodenal Papillary biopsy specimens.
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endoscopic papillectomy for adenomas of the Major Duodenal Papilla with video
Gastrointestinal Endoscopy, 2006Co-Authors: Jimin Han, Myunghwan KimAbstract:Tumors arising from the Major Duodenal Papilla account for 5% of GI neoplasms but are being identified more frequently with increasing use of upper endoscopic examination and ERCP. Of a wide variety of benign Papillary tumors, adenoma is the most common. It is clinically important because of its premalignant potential. Although complete resection of Papillary adenomas is standard practice, opinions differ as to the optimal method of excision. Adenoma of the Major Duodenal Papilla can be excised either surgically or endoscopically. The surgical options include transDuodenal local excision (ampullectomy) and radical pancreatoduodenectomy. Endoscopic treatmentmethods consist of endoscopic resection and thermal ablation. Surgical resection has been the mainstay for resection of adenomas of the Major Duodenal Papilla. Accumulating evidence indicates that endoscopic papillectomy can be used as an alternative first-line therapy. Because the ampulla of Vater is strategically located at the confluence of the pancreatic and common bile ducts, endoscopic resection of Papillary neoplasms may be technically different from EMR in other parts of the GI tract. The best method of endoscopic ablation and the optimal period for surveillance have not been established. This is a systematic review on the indication, the outcome, and the complication of endoscopic papillectomy for adenomas of the Major Duodenal Papilla, with special focus on the techniques.
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treatment outcome after endoscopic papillectomy of tumors of the Major Duodenal Papilla
The Korean Journal of Gastroenterology, 2005Co-Authors: Jimin Han, Sung Koo Lee, Dong Wan Seo, Sang Soo Lee, Do Hyun Park, Jung Sik Choi, Myunghwan KimAbstract:Background/aims Endoscopic papillectomy is reported to be relatively safe and reliable for complete resection of benign tumors of the Major Duodenal Papilla. We evaluated methods and treatment outcome of the patients who have undergone endoscopic papillectomy. Methods Medical records of 22 consecutive patients with tumor of the Major Duodenal Papilla (10 women, 12 men; mean age 55.8+/-2.8 yrs) who have undergone endoscopic papillectomy were reviewed retrospectively. Endoscopic papillectomy was defined the successful when complete excision of the tumor was achieved. Results Mean duration of follow-up was 8.4+/-2.4 months (range 1-43 months). Endoscopic papillectomy was successful in 16 patients (72.7%), but incomplete resection occurred in 6 patients. Only one patient showed recurrence. Histopathologic evaluation after endoscopic papillectomy revealed adenoma (n=11, 50%), high-grade dysplasia (n=3, 13.6%), adenocarcinoma (n=2, 9.1%), carcinoid (n=1), chronic inflammation (n=3, 13.6%), Papillary adenomatous hyperplasia (n=1), and cavernous lymphangioma (n=1). The mean size of the resected lesions was 10.3+/-1.2 mm (range 2-20 mm). There was no factor which could predict the endoscopic success statistically. A pancreatic duct stent was placed in 11 patients (50.0%) and was removed after 3 to 39 days. There were 8 (36.8%) procedure-related complications: bleeding (n=4), Papillary stenosis (n=1), perforation (n=1), cholangitis (n=1), and asymptomatic liver function abnormality (n=1). There was no pancreatitis or mortality. All the complications resolved with conservative management. Conclusions Endoscopic papillectomy in selected patients seemed to be highly successful and safe. Longer follow-up is needed to assess the long-term efficacy.
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the clinical significance of papillitis of the Major Duodenal Papilla
Gastrointestinal Endoscopy, 2002Co-Authors: Ju Sang Park, Myunghwan Kim, Sung Koo Lee, Dong Wan Seo, Sang Soo Lee, Hyesook Chang, Jimin Han, Jungsun Kim, Young Il MinAbstract:Abstract Background: This study investigated the clinical significance of papillitis of the Major Duodenal Papilla and analyzed the correlation between endoscopic and histologic papillitis in patients with biliary or pancreatic disorders. Methods: Eighty-seven patients and 12 healthy control subjects were enrolled. The endoscopic appearance of papillitis was classified by two blinded endoscopists, and biopsy specimens were taken of the Papilla. Various factors were prospectively analyzed to identify any relationship with the endoscopic severity of the papillitis. Results: By univariate analysis, a clinically acute inflammatory condition and elevation of serum transaminase levels were significantly associated with moderate and severe endoscopic papillitis ( p p Conclusions: Moderate and severe endoscopic papillitis were significantly more common in patients with biliary or pancreatic disorders plus a clinically acute inflammatory condition, whereas moderate and severe papillitis were not observed in healthy volunteers. Moderate and severe endoscopic papillitis are characteristic of biliary or pancreatic disorders. (Gastrointest Endosc 2002;55:877-82.)
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tumors of the Major Duodenal Papilla
Gastrointestinal Endoscopy, 2001Co-Authors: Myunghwan Kim, Sung Koo Lee, Sang Soo Lee, Dougwan Seo, Sun Young Won, Young Il MinAbstract:A wide variety of tumors arise at the Major Duodenal Papilla. The special significance of these lesions is that they represent a less serious prognosis for patients compared with that for other periPapillary neoplasms.1 However, cure depends on correct diagnosis at an early stage. Endoscopy is the most valuable of the available imaging methods because it provides not only direct visualization of the lesion but often a tissue diagnosis as well. Moreover, because the Major Duodenal Papilla is encountered during routine upper endoscopy, albeit only partially seen in most cases, it is important to recognize and understand the characteristic endoscopic findings of Papillary tumors. In addition, endoscopy now plays an important role in the treatment of these tumors.
Erik Haraldsson - One of the best experts on this subject based on the ideXlab platform.
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macroscopic appearance of the Major Duodenal Papilla influences bile duct cannulation a prospective multicenter study by the scandinavian association for digestive endoscopy study group for ercp
Gastrointestinal Endoscopy, 2019Co-Authors: Erik Haraldsson, Leena Kylanpaa, Juha Gronroos, Arto Saarela, Ervin Toth, Gunnar Qvigstad, Mari Hult, Outi Lindstrom, Simo Laine, Heikki KarjulaAbstract:Background and Aims Certain appearances of the Major Duodenal Papilla have been claimed to make cannulation more difficult during ERCP. This study uses a validated classification of the endoscopic appearance of the Major Duodenal Papilla to determine if certain types of Papilla predispose to difficult cannulation. Methods Patients with a naive Papilla scheduled for ERCP were included. The Papilla was classified into 1 of 4 Papilla types before cannulation started. Time to successful bile duct cannulation, attempts, and number of pancreatic duct passages were recorded. Difficult cannulation was defined as after 5 minutes, 5 attempts, or 2 pancreatic guidewire passages. Results A total of 1401 patients were included from 9 different centers in the Nordic countries. The overall frequency of difficult cannulation was 42% (95% confidence interval [CI], 39%-44%). Type 2 small Papilla (52%; 95% CI, 45%-59%) and type 3 protruding or pendulous Papilla (48%; 95% CI, 42%-53%) were more frequently difficult to cannulate compared with type 1 regular Papilla (36%; 95% CI, 33%-40%; both P Conclusions The endoscopic appearance of the Major Duodenal Papilla influences bile duct cannulation. Small type 2 and protruding or pendulous type 3 Papillae are more frequently difficult to cannulate. In addition, cannulation might even fail more frequently if a beginner starts cannulation. These findings should be taken into consideration when performing studies regarding bile duct cannulation and in training future generations of endoscopists.
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endoscopic papillectomy and kras expression in the treatment of adenoma in the Major Duodenal Papilla
Scandinavian Journal of Gastroenterology, 2015Co-Authors: Erik Haraldsson, Fredrik Swahn, Caroline S Verbeke, Johanna Sofia Margareta Mattsson, Lars Enochsson, Kjellarne Ung, Lars Lundell, Rainer Heuchel, Jmatthias Lohr, Urban ArneloAbstract:OBJECTIVE: The use of endoscopic papillectomy for resecting adenomas in the Major Duodenal Papilla is increasing. This study focuses on the following three issues: Can endoscopic papillectomy be pe ...
Heikki Karjula - One of the best experts on this subject based on the ideXlab platform.
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macroscopic appearance of the Major Duodenal Papilla influences bile duct cannulation a prospective multicenter study by the scandinavian association for digestive endoscopy study group for ercp
Gastrointestinal Endoscopy, 2019Co-Authors: Erik Haraldsson, Leena Kylanpaa, Juha Gronroos, Arto Saarela, Ervin Toth, Gunnar Qvigstad, Mari Hult, Outi Lindstrom, Simo Laine, Heikki KarjulaAbstract:Background and Aims Certain appearances of the Major Duodenal Papilla have been claimed to make cannulation more difficult during ERCP. This study uses a validated classification of the endoscopic appearance of the Major Duodenal Papilla to determine if certain types of Papilla predispose to difficult cannulation. Methods Patients with a naive Papilla scheduled for ERCP were included. The Papilla was classified into 1 of 4 Papilla types before cannulation started. Time to successful bile duct cannulation, attempts, and number of pancreatic duct passages were recorded. Difficult cannulation was defined as after 5 minutes, 5 attempts, or 2 pancreatic guidewire passages. Results A total of 1401 patients were included from 9 different centers in the Nordic countries. The overall frequency of difficult cannulation was 42% (95% confidence interval [CI], 39%-44%). Type 2 small Papilla (52%; 95% CI, 45%-59%) and type 3 protruding or pendulous Papilla (48%; 95% CI, 42%-53%) were more frequently difficult to cannulate compared with type 1 regular Papilla (36%; 95% CI, 33%-40%; both P Conclusions The endoscopic appearance of the Major Duodenal Papilla influences bile duct cannulation. Small type 2 and protruding or pendulous type 3 Papillae are more frequently difficult to cannulate. In addition, cannulation might even fail more frequently if a beginner starts cannulation. These findings should be taken into consideration when performing studies regarding bile duct cannulation and in training future generations of endoscopists.
Takuji Gotoda - One of the best experts on this subject based on the ideXlab platform.
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a novel approach emphasizing preoperative margin enhancement of tumor of the Major Duodenal Papilla with narrow band imaging in comparison to indigo carmine chromoendoscopy with videos
Gastrointestinal Endoscopy, 2009Co-Authors: Takao Itoi, Shujiro Tsuji, Atsushi Sofuni, Fumihide Itokawa, Toshio Kurihara, Takayoshi Tsuchiya, Kentaro Ishii, Nobuhito Ikeuchi, Masahiro Igarashi, Takuji GotodaAbstract:Background Endoscopic papillectomy (EP) has been recognized as a safe and reliable treatment for tumor of the Duodenal Papilla. For complete resection, precise assessment of not only the intraductal extent but also the lateral margins of the tumor is mandatory before resection. Objective Our purpose was to prospectively assess the enhancement of the lateral margins of tumor of the Duodenal Papilla for the treatment of EP by comparing narrow-band imaging (NBI) and indigo carmine (IC) chromoendoscopy. Design Prospective study. Setting This procedure was performed in Tokyo Medical University Hospital. Patients Fourteen consecutive cases of tumors of the Major Duodenal Papilla. Intervention All patients underwent EP after evaluation by NBI and IC. Main Outcome Measurement Histologic evaluation of diagnosis of NBI and IC by comparison with en bloc tissue. Results In all lesions, either IC or NBI were superior to conventional white-light imaging except in 1 IC case. The ability of NBI observation to emphasize the tumor margin was statistically significantly better than IC observation ( P Limitations The lesions resected were all relatively small. This was not a blinded randomized study. Conclusion This study demonstrated the feasibility and a certain degree of efficacy of NBI for enhancement of the tumor margin of Duodenal Papilla. Further blinded randomized studies involving large Duodenal Papillary tumors are required.
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a novel approach emphasizing preoperative margin enhancement of tumor of the Major Duodenal Papilla with narrow band imaging in comparison to indigo carmine chromoendoscopy with videos
Gastrointestinal Endoscopy, 2009Co-Authors: Takao Itoi, Shujiro Tsuji, Atsushi Sofuni, Fumihide Itokawa, Toshio Kurihara, Takayoshi Tsuchiya, Kentaro Ishii, Nobuhito Ikeuchi, Masahiro Igarashi, Takuji GotodaAbstract:BACKGROUND: Endoscopic papillectomy (EP) has been recognized as a safe and reliable treatment for tumor of the Duodenal Papilla. For complete resection, precise assessment of not only the intraductal extent but also the lateral margins of the tumor is mandatory before resection. OBJECTIVE: Our purpose was to prospectively assess the enhancement of the lateral margins of tumor of the Duodenal Papilla for the treatment of EP by comparing narrow-band imaging (NBI) and indigo carmine (IC) chromoendoscopy. DESIGN: Prospective study. SETTING: This procedure was performed in Tokyo Medical University Hospital. PATIENTS: Fourteen consecutive cases of tumors of the Major Duodenal Papilla. INTERVENTION: All patients underwent EP after evaluation by NBI and IC. MAIN OUTCOME MEASUREMENT: Histologic evaluation of diagnosis of NBI and IC by comparison with en bloc tissue. RESULTS: In all lesions, either IC or NBI were superior to conventional white-light imaging except in 1 IC case. The ability of NBI observation to emphasize the tumor margin was statistically significantly better than IC observation (P< .05). The en bloc EP was endoscopically successful in all cases, without fatal adverse events. En bloc tissue revealed 13 adenomas and 1 adenoma with focal adenocarcinoma. There was no residual adenoma in lateral margin specimens, either endoscopically or histologically. LIMITATIONS: The lesions resected were all relatively small. This was not a blinded randomized study. CONCLUSION: This study demonstrated the feasibility and a certain degree of efficacy of NBI for enhancement of the tumor margin of Duodenal Papilla. Further blinded randomized studies involving large Duodenal Papillary tumors are required.
