Clinical Endoscopy

Endoscopic biliary drainage for distal bile duct obstruction due to pancreatic cancer: Masahiro Itonaga, Masayuki Kitano; Received November 28, 2023 Accepted March 5, 2024 Published online September 26, 2024; DOI: https://doi.org/10.5946/ce.2023.294 [Epub ahead of print]

Abstract PDF PubReader ePub: Approximately 60% of pancreatic cancers occur in the pancreatic head and may present as obstructive jaundice due to bile duct invasion. Obstructive jaundice often leads to poor general conditions and acute cholangitis, interfering with surgery and chemotherapy and requiring biliary drainage. The first choice of treatment for biliary drainage is the endoscopic transpapillary approach. In unresectable tumors, self-expandable metal stents (SEMSs) are most commonly used and are classified into uncovered and covered SEMSs. Recently, antireflux metal stents and large- or small-diameter SEMSs have become commercially available, and their usefulness has been reported. Plastic stents are infrequently used in patients with resectable biliary obstruction; however, owing to the recent trend in preoperative chemotherapy, SEMSs are frequently used because of the long time to recurrent biliary obstruction. Endoscopic ultrasound-guided biliary drainage (EUS-BD) is often performed in patients who are not eligible for the transpapillary approach, and favorable outcomes have been reported. Different EUS-BD techniques and specialized stents have been developed and can be safely used in high-volume centers. The indications for EUS-BD are expected to further expand in the future.

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Endoscopic ultrasound-guided hepaticogastrostomy and endoscopic retrograde cholangiopancreatography-guided biliary drainage for distal malignant biliary obstruction due to pancreatic cancer with asymptomatic duodenal invasion: a retrospective, single-center study in Japan: Naminatsu Takahara, Yousuke Nakai, Kensaku Noguchi, Tatsunori Suzuki, Tatsuya Sato, Ryunosuke Hakuta, Kazunaga Ishigaki, Tomotaka Saito, Tsuyoshi Hamada, Mitsuhiro Fujishiro; Received February 14, 2024 Accepted May 13, 2024 Published online August 23, 2024; DOI: https://doi.org/10.5946/ce.2024.031 [Epub ahead of print]

Graphical Abstract Abstract PDF PubReader ePub: Background
/Aims: Duodenal invasion (DI) is a risk factor for early recurrent biliary obstruction (RBO) in endoscopic retrograde cholangiopancreatography-guided biliary drainage (ERCP-BD). Endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) may reduce early RBO in cases of asymptomatic DI, even when ERCP is possible.
Methods
We enrolled 56 patients with pancreatic cancer and asymptomatic DI who underwent EUS-HGS (n=25) or ERCP-BD (n=31). Technical and clinical success, early (<3 months) and overall RBO rates, time to RBO (TRBO), and adverse events were compared between the EUS-HGS and ERCP-BD groups. Risk factors for early RBO were also evaluated.
Results
Baseline characteristics were similar between the groups. Both procedures demonstrated 100% technical and clinical success rates, with a similar incidence of adverse events (48% vs. 39%, p=0.59). While the median TRBO was comparable (5.7 vs. 8.8 months, p=0.60), EUS-HGS was associated with a lower incidence of early RBO compared to ERCP-BD (8% vs. 29%, p=0.09). The major causes of early RBO in ERCP-BD were sludge and food impaction, rarely occurring in EUS-HGS. EUS-HGS was potentially reduced early RBO (odds ratio, 0.32; p=0.07).
Conclusions
EUS-HGS can be a viable option for treating pancreatic cancer with asymptomatic DI.

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Evaluation of cryoablation using a prototype cryoablation needle in swine liver: Hyunjoon Son, Jonghyun Lee, Sung Yong Han, Tae In Kim, Dong Uk Kim, Daejin Kim, Gun-Ho Kim; Clin Endosc 2024;57(5):675-682. Published online July 29, 2024; DOI: https://doi.org/10.5946/ce.2024.024

Graphical Abstract Abstract PDF PubReader ePub: Background
/Aims: Pancreatic cancer poses significant challenges due to its tendency for late-stage diagnosis and high mortality rates. Cryoablation, a technique used to treat various types of cancer, has shown potential in enhancing the prognosis of pancreatic cancer when combined with other therapies. However, its implementation is often limited by the need for lengthy procedures and specialized equipment. This study aims to develop a cryoablation needle optimized for endoscopic ultrasonography to simplify its application in treating pancreatic cancer.
Methods
The study involved conducting cryoablation experiments on swine liver tissue. It utilized cryo-needles to evaluate the extent of cell death across various temperatures and durations of cryoablation.
Results
The cryoablation system, which employed liquid carbon dioxide, achieved rapid cooling, reaching temperatures below –60 °C within 30 seconds and maintained the cryoablation process for 200 seconds. These conditions resulted in necrosis of the liver tissue. Notable cellular changes were observed up to 15 mm away from the cryoablation needle.
Conclusions
This experimental study successfully demonstrated the efficacy of using a cryo-needle for cryoablation in swine liver tissue. Further trials involving pancreatic tissue are expected to verify its effectiveness, underscoring the importance of continued research to establish its role as a complementary therapy in pancreatic cancer treatment.

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Role of contrast-enhanced harmonic endoscopic ultrasonography (EUS) and EUS elastography in pancreatic lesions: Yasunobu Yamashita, Masayuki Kitano; Clin Endosc 2024;57(2):164-174. Published online January 17, 2024; DOI: https://doi.org/10.5946/ce.2023.074

Abstract PDF PubReader ePub

Pancreatic cancers have a poor prognosis, and their incident rates have risen. Endoscopic ultrasonography (EUS) is an efficient and reliable diagnostic modality for pancreatic lesions, providing high spatial resolution. However, while EUS helps to detect minor pancreatic lesions, nearly all solid pancreatic lesions are hypoechoic, which creates difficulty in making differential diagnoses of pancreatic lesions. When diagnosing pancreatic lesions, the performance of image-enhanced EUS techniques is essential, such as EUS elastography or contrast-enhanced harmonic EUS (CH-EUS). CH-EUS diagnosis is based on assessing the vascularity of lesions, whereas tissue elasticity is measured via EUS elastography. Elastography is either strain or shear-wave, depending on the different mechanical properties being evaluated. The usefulness of enhanced EUS techniques is demonstrated in this review for the differential diagnosis of pancreatic lesions, including solid and cystic lesions, and pancreatic cancer staging.

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Endoscopic Contrast-Enhanced Ultrasound and Fine-Needle Aspiration or Biopsy for the Diagnosis of Pancreatic Solid Lesions: A Systematic Review and Meta-Analysis
Giorgio Esposto, Giuseppe Massimiani, Linda Galasso, Paolo Santini, Raffaele Borriello, Irene Mignini, Maria Elena Ainora, Alberto Nicoletti, Lorenzo Zileri Dal Verme, Antonio Gasbarrini, Sergio Alfieri, Giuseppe Quero, Maria Assunta Zocco
Cancers.2024; 16(9): 1658. CrossRef
Endoscopic Ultrasound and Gastric Sub-Epithelial Lesions: Ultrasonographic Features, Tissue Acquisition Strategies, and Therapeutic Management
Marzia Varanese, Marco Spadaccini, Antonio Facciorusso, Gianluca Franchellucci, Matteo Colombo, Marta Andreozzi, Daryl Ramai, Davide Massimi, Roberto De Sire, Ludovico Alfarone, Antonio Capogreco, Roberta Maselli, Cesare Hassan, Alessandro Fugazza, Alessa
Medicina.2024; 60(10): 1695. CrossRef
Endoscopic Ultrasound-Guided Pancreatic Tissue Sampling: Lesion Assessment, Needles, and Techniques
Jahnvi Dhar, Jayanta Samanta, Zaheer Nabi, Manik Aggarwal, Maria Cristina Conti Bellocchi, Antonio Facciorusso, Luca Frulloni, Stefano Francesco Crinò
Medicina.2024; 60(12): 2021. CrossRef

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Impact of sarcopenia on biliary drainage during neoadjuvant therapy for pancreatic cancer: Kunio Kataoka, Eizaburo Ohno, Takuya Ishikawa, Kentaro Yamao, Yasuyuki Mizutani, Tadashi Iida, Hideki Takami, Osamu Maeda, Junpei Yamaguchi, Yukihiro Yokoyama, Tomoki Ebata, Yasuhiro Kodera, Hiroki Kawashima; Clin Endosc 2024;57(1):112-121. Published online July 18, 2023; DOI: https://doi.org/10.5946/ce.2022.278

Graphical Abstract Abstract PDF PubReader ePub

Background
/Aims: Since the usefulness of neoadjuvant chemo(radiation) therapy (NAT) for pancreatic cancer has been demonstrated, recurrent biliary obstruction (RBO) in patients with pancreatic cancer with a fully covered self-expandable metal stent (FCSEMS) during NAT is expected to increase. This study investigated the impact of sarcopenia on RBO in this setting.
Methods
Patients were divided into normal and low skeletal muscle index (SMI) groups and retrospectively analyzed. Patient characteristics, overall survival, time to RBO (TRBO), stent-related adverse events, and postoperative complications were compared between the two groups. A Cox proportional hazard model was used to identify the risk factors for short TRBO.
Results
A few significant differences were observed in patient characteristics, overall survival, stent-related adverse events, and postoperative complications between 38 patients in the normal SMI group and 17 in the low SMI group. The median TRBO was not reached in the normal SMI group and was 112 days in the low SMI group (p=0.004). In multivariate analysis, low SMI was the only risk factor for short TRBO, with a hazard ratio of 5.707 (95% confidence interval, 1.148–28.381; p=0.033).
Conclusions
Sarcopenia was identified as an independent risk factor for RBO in patients with pancreatic cancer with FCSEMS during NAT.

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Endeavors to prevent stent malfunction: new insights into the risk factors for recurrent biliary obstruction
Sung-Jo Bang
Clinical Endoscopy.2024; 57(1): 56. CrossRef
Skeletal muscle status and survival among patients with advanced biliary tract cancer
Shinya Takaoka, Tsuyoshi Hamada, Naminatsu Takahara, Kei Saito, Go Endo, Ryunosuke Hakuta, Kota Ishida, Kazunaga Ishigaki, Sachiko Kanai, Kohei Kurihara, Hiroki Oyama, Tomotaka Saito, Tatsuya Sato, Tatsunori Suzuki, Yukari Suzuki, Shuichi Tange, Yurie Tok
International Journal of Clinical Oncology.2024; 29(3): 297. CrossRef

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Endoscopic Ultrasound–Guided Fiducial Placement for Stereotactic Body Radiation Therapy in Pancreatic Malignancy: Seong-Hun Kim, Eun Ji Shin; Clin Endosc 2021;54(3):314-323. Published online May 28, 2021; DOI: https://doi.org/10.5946/ce.2021.102

Abstract PDF PubReader ePub

Stereotactic body radiation therapy (SBRT) is an important treatment option for pancreatic cancer, which is known to be one of the malignancies with the worst prognosis. However, the high radiation doses delivered during SBRT may cause damage to adjacent radiosensitive organs. To minimize such damage, fiducial markers are used for localization during SBRT for pancreatic cancer. The development of endoscopic ultrasound (EUS) has enabled fiducial markers to be inserted into the pancreas using an EUS fine-needle aspiration (FNA) needle, unlike in the past when percutaneous placement was generally performed. For successful EUS-guided fiducial marker placement, it is necessary for the fiducial markers to be loaded within the EUS-FNA needles to have a low probability of complications and a low migration risk, and to be stably observed in SBRT imaging. A systematic review has shown that the technical success rate of EUS-guided fiducial marker placement is 96.27%, whereas the fiducial marker migration and adverse event rates are 4.33% and 4.85%, respectively. Nonetheless, standardized techniques for fiducial marker placement and the characteristics of optimal fiducial markers have not yet been established. This review will introduce the characteristics (e.g., materials and shapes) of fiducial markers used in fiducial marker placement for pancreatic cancer and will discuss conventional techniques along with their success rates, difficulties, and adverse events.

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A Preliminary Controlled Trial of Endoscopic Ultrasound-guided Fiducial Markers to Guide Pancreas Surgery
Patrick W. Chang, Jonathan Sadik, Ara B. Sahakian, Ravi Kankotia, Christopher Ko, Jessica Serna, Alex Rodriguez, Helen Lee, Sujit Kulkarni, Yuri Genyk, Mohd Sheikh, James L. Buxbaum
Journal of Clinical Gastroenterology.2024; 58(9): 931. CrossRef
EUS-guided interventional therapies for pancreatic diseases
Rongmin Xu, Kai Zhang, Nan Ge, Siyu Sun
Frontiers in Medicine.2024;[Epub] CrossRef
Cardiac migration of an implanted hepatic fiducial marker used for stereotactic body radiation therapy - A case report
Youstina Soliman, Febin Antony, Mark Vivian, Sankar Venkatraman, Maged Nashed
Journal of Cancer Research and Therapeutics.2024; 20(5): 1628. CrossRef
Endoscopic Ultrasound-Guided Treatments for Pancreatic Cancer: Understanding How Endoscopic Ultrasound Has Revolutionized Management of Pancreatic Cancer
Sahib Singh, Antonio Facciorusso, Rakesh Vinayek, Sudhir Dutta, Dushyant Singh Dahiya, Ganesh Aswath, Neil Sharma, Sumant Inamdar
Cancers.2024; 17(1): 89. CrossRef
Development of devices for interventional endoscopic ultrasound for the management of pancreatobiliary diseases
Masahiro Itonaga, Masayuki Kitano, Reiko Ashida
Digestive Endoscopy.2023; 35(3): 302. CrossRef
Endoscopic Ultrasound-Guided Fiducial Placement for Stereotactic Body Radiation Therapy in Patients with Pancreatic Cancer
Irina M. Cazacu, Ben S. Singh, Rachael M. Martin-Paulpeter, Sam Beddar, Stephen Chun, Emma B. Holliday, Albert C. Koong, Prajnan Das, Eugene J. Koay, Cullen Taniguchi, Joseph M. Herman, Manoop S. Bhutani
Cancers.2023; 15(22): 5355. CrossRef
Endoscopic Management of Pancreatobiliary Malignancies
Dong Wook Lee, Eun Young Kim
Digestive Diseases and Sciences.2022; 67(5): 1635. CrossRef
Hot topics in therapeutic EUS
Daniela Tabacelia, Alexandru Martiniuc, Daniela Elena Burtea, Adrian Saftoiu, Cezar Stroescu
Endoscopic Ultrasound.2022; 11(3): 153. CrossRef

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Endoscopic Ultrasound-Guided Local Therapy for Pancreatic Neoplasms: Jun Seong Hwang, Hyun Don Joo, Tae Jun Song; Clin Endosc 2020;53(5):535-540. Published online September 29, 2020; DOI: https://doi.org/10.5946/ce.2020.181

Abstract PDF PubReader ePub

Surgical resection is considered the only treatment option for pancreatic cancer and other pancreatic neoplasms with malignant potential, such as neuroendocrine tumors, mucinous cystic neoplasms, and intraductal papillary mucinous neoplasms. However, only 10%–20% of all patients with pancreatic cancer present with resectable forms of the disease as the symptoms are rarely manifested during the early stages, and the disease tends to progress rapidly. Furthermore, pancreatic surgery is associated with high rates of morbidity and mortality. The development of linear-array endoscopic ultrasound (EUS) techniques has increased the indications of EUS-guided local therapy for pancreatic neoplasms. We assessed the studies that investigated various treatment modalities, such as fine-needle injection, radiofrequency ablation, irreversible electroporation, and radiotherapy, under EUS guidance to better understand the usefulness of these techniques with respect to the efficacy and associated complications.

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Application of nanoultrasonography in early diagnosis of coronary heart disease
Weiping Wan, Jianmin Zhou, Xiaoming Ha, Chao Han
Nanomedicine.2025; 20(1): 79. CrossRef
Anticancer effect of a pyrrole‐imidazole polyamide‐triphenylphosphonium conjugate selectively targeting a common mitochondrial DNA cancer risk variant in cervical cancer cells
Jihang Yao, Keizo Takenaga, Nobuko Koshikawa, Yuki Kida, Jason Lin, Takayoshi Watanabe, Yoshiaki Maru, Yoshitaka Hippo, Seigi Yamamoto, Yuyan Zhu, Hiroki Nagase
International Journal of Cancer.2023; 152(5): 962. CrossRef
Endoscopic Ultrasound-Guided Local Ablative Therapies for the Treatment of Pancreatic Neuroendocrine Tumors and Cystic Lesions: A Review of the Current Literature
Alexander M. Prete, Tamas A. Gonda
Journal of Clinical Medicine.2023; 12(9): 3325. CrossRef
Response of Locally Advanced Pancreatic Cancer to Intratumoral Injection of Large Surface Area Microparticle Paclitaxel
Neil R. Sharma, Simon K. Lo, Andrew Hendifar, Mohamed O. Othman, Kalpesh Patel, Antonio Mendoza-Ladd, Shelagh Verco, Holly A. Maulhardt, James Verco, Alison Wendt, Alyson Marin, Christian Max Schmidt, Gere diZerega
Pancreas.2023; 52(3): e179. CrossRef
Multisite Is Superior to Single-Site Intratumoral Chemotherapy to Retard the Outcomes of Pancreatic Ductal Adenocarcinoma in a Murine Model
Janette Lazarovits, Ron Epelbaum, Jesse Lachter, Yaron Amikam, Jacob Ben Arie
Cancers.2023; 15(24): 5801. CrossRef
Endoscopic ultrasound-guided injectable therapy for pancreatic cancer: A systematic review
Jyotroop Kaur, Veeravich Jaruvongvanich, Vinay Chandrasekhara
World Journal of Gastroenterology.2022; 28(21): 2383. CrossRef

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Predictive Value of Localized Stenosis of the Main Pancreatic Duct for Early Detection of Pancreatic Cancer: Yoshihide Kanno, Shinsuke Koshita, Takahisa Ogawa, Hiroaki Kusunose, Kaori Masu, Toshitaka Sakai, Keisuke Yonamine, Yujiro Kawakami, Yuki Fujii, Kazuaki Miyamoto, Toji Murabayashi, Fumisato Kozakai, Jun Horaguchi, Yutaka Noda, Masaya Oikawa, Takaho Okada, Kei Ito; Clin Endosc 2019;52(6):588-597. Published online November 20, 2019; DOI: https://doi.org/10.5946/ce.2019.018

Abstract PDF PubReader ePub

Background
/Aims: In this study, we aimed to evaluate the predictive value of localized stenosis of the main pancreatic duct (MPD) for early detection of pancreatic cancer.
Methods
Among 689 patients who underwent endoscopic retrograde pancreatography from January 2008 to September 2018, 19 patients with MPD findings were enrolled. These patients showed findings for indicating suspicious pancreatic cancer at an early stage (FiCE); FiCE was defined as a single, localized stenosis in the MPD without a detectable mass (using any other imaging methods) and without other pancreatic diseases, such as definite chronic pancreatitis, intraductal papillary mucinous neoplasm, and autoimmune pancreatitis. Final diagnoses were established by examining resected specimens or through follow-up examinations after an interval of >5 years.
Results
Among 19 patients with FiCE, 11 underwent surgical resection and 8 were evaluated after a >5-year observation period. The final diagnosis of the MPD stenosis was judged to be pancreatic cancer in 9 patients (47%), including 3 with intraepithelial cancer, and to be a non-neoplastic change in 10. The sensitivity, specificity, and accuracy of preoperative pancreatic juice cytology were 75%, 100%, and 88%, respectively.
Conclusions
The predictive value of FiCE for pancreatic cancer prevalence was 47%. Histological confirmation with pancreatic juice cytology is necessary before surgical resection.

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Efficient Assessment of Tumor Vascular Shutdown by Photodynamic Therapy on Orthotopic Pancreatic Cancer Using High-Speed Wide-Field Waterproof Galvanometer Scanner Photoacoustic Microscopy
Jaeyul Lee, Sangyeob Han, Til Bahadur Thapa Magar, Pallavi Gurung, Junsoo Lee, Daewoon Seong, Sungjo Park, Yong-Wan Kim, Mansik Jeon, Jeehyun Kim
International Journal of Molecular Sciences.2024; 25(6): 3457. CrossRef
Role of endoscopic retrograde cholangiopancreatography in early diagnosis of pancreatic cancer
Yasutaka ISHII, Masahiro SERIKAWA, Shinya NAKAMURA, Juri IKEMOTO, Shiro OKA
Suizo.2024; 39(4): 247. CrossRef
Repeated pancreatic juice cytology via endoscopic nasopancreatic drainage catheter combined with clinical findings improves diagnostic ability for malignant cases of suspected pancreatic cancer with non-identifiable tumors
Tatsunori Satoh, Junichi Kaneko, Eiji Nakatani, Hirotoshi Ishiwatari, Junya Sato, Akihiko Ohata, Reiko Yamada, Tetsuro Miwata, Kazuma Ishikawa, Fumitaka Niiya, Yosuke Kobayashi, Yasushi Hamaya, Jun Ito, Kazuhito Kawata, Azumi Suzuki, Yasunari Sakamoto, Yu
Pancreatology.2024;[Epub] CrossRef
Difference of Risk of Pancreatic Cancer in New-Onset Diabetes and Long-standing Diabetes: A Population-based Cohort Study
Hee Seung Lee, Wonjeong Chae, Min Je Sung, Jiyoung Keum, Jung Hyun Jo, Moon Jae Chung, Jeong Youp Park, Seung Woo Park, Si Young Song, Eun-Cheol Park, Chung Mo Nam, Sung-In Jang, Seungmin Bang
The Journal of Clinical Endocrinology & Metabolism.2023; 108(6): 1338. CrossRef
Pancreatic duct lavage cytology combined with a cell-block method for patients with possible pancreatic ductal adenocarcinomas, including pancreatic carcinoma in situ
Hiroaki Kusunose, Shinsuke Koshita, Yoshihide Kanno, Takahisa Ogawa, Toshitaka Sakai, Keisuke Yonamine, Kazuaki Miyamoto, Fumisato Kozakai, Hideyuki Anan, Kazuki Endo, Haruka Okano, Masaya Oikawa, Takashi Tsuchiya, Takashi Sawai, Yutaka Noda, Kei Ito
Clinical Endoscopy.2023; 56(3): 353. CrossRef
Main pancreatic duct stenosis without detecting tumor
Katsuhiko SATO, Minoru SHIGEKAWA, Teppei YOSHIOKA, Shuhei YAMAMOTO, Takayuki MATSUMAE, Kazuhiro KOZUMI, Yu SATO, Jyunya OKABE, Takahiro KODAMA, Hayato HIKITA, Tomohide TATSUMI, Tetsuo TAKEHARA
Suizo.2023; 38(2): 147. CrossRef
Diagnostic Ability and Safety of Repeated Pancreatic Juice Cytology Using an Endoscopic Nasopancreatic Drainage Catheter for Pancreatic Ductal Adenocarcinoma: A Multicenter Prospective Study
Shinya Nakamura, Yasutaka Ishii, Masahiro Serikawa, Keiji Hanada, Noriaki Eguchi, Tamito Sasaki, Yoshifumi Fujimoto, Atsushi Yamaguchi, Shinichiro Sugiyama, Bunjiro Noma, Michihiro Kamigaki, Tomoyuki Minami, Akihito Okazaki, Masanobu Yukutake, Teruo Mouri
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Endoscopic approach in the diagnosis of high‐grade pancreatic intraepithelial neoplasia
Keiji Hanada, Akihiro Shimizu, Keisuke Kurihara, Morito Ikeda, Takuya Yamamoto, Yasuhiro Okuda, Susumu Tazuma
Digestive Endoscopy.2022; 34(5): 927. CrossRef
Current Screening Strategies for Pancreatic Cancer
Petr Vanek, Ondrej Urban, Vincent Zoundjiekpon, Premysl Falt
Biomedicines.2022; 10(9): 2056. CrossRef
Pre-Operative Imaging and Pathological Diagnosis of Localized High-Grade Pancreatic Intra-Epithelial Neoplasia without Invasive Carcinoma
Ryota Sagami, Kentaro Yamao, Jun Nakahodo, Ryuki Minami, Masakatsu Tsurusaki, Kazunari Murakami, Yuji Amano
Cancers.2021; 13(5): 945. CrossRef
New-Onset or Exacerbation of Diabetes Mellitus Is a Clue to the Early Diagnosis of Pancreatic Cancer
Tetsuya Takikawa, Kazuhiro Kikuta, Kiyoshi Kume, Shin Hamada, Shin Miura, Naoki Yoshida, Seiji Hongo, Yu Tanaka, Ryotaro Matsumoto, Takanori Sano, Mio Ikeda, Masahiro Iseki, Michiaki Unno, Atsushi Masamune
The Tohoku Journal of Experimental Medicine.2020; 252(4): 353. CrossRef
Can Localized Stenosis of the Main Pancreatic Duct be a Predictive Factor for Early Detection of Pancreatic Cancer?
Mamoru Takenaka, Kentaro Yamao, Masatoshi Kudo
Clinical Endoscopy.2019; 52(6): 523. CrossRef

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Diagnostic Ability of Convex-Arrayed Endoscopic Ultrasonography for Major Vascular Invasion in Pancreatic Cancer: Yuki Fujii, Kazuyuki Matsumoto, Hironari Kato, Yosuke Saragai, Saimon Takada, Sho Mizukawa, Shinichiro Muro, Daisuke Uchida, Takeshi Tomoda, Shigeru Horiguchi, Noriyuki Tanaka, Hiroyuki Okada; Clin Endosc 2019;52(5):479-485. Published online May 16, 2019; DOI: https://doi.org/10.5946/ce.2018.163

Abstract PDF PubReader ePub

Background
/Aims: This study aimed to examine the diagnostic ability of endoscopic ultrasonography (EUS) for major vascular invasion in pancreatic cancer and to evaluate the relationship between EUS findings and pathological distance.
Methods
In total, 57 consecutive patients who underwent EUS for pancreatic cancer before surgery were retrospectively reviewed. EUS image findings were divided into four types according to the relationship between the tumor and major vessel (types 1 and 2: invasion, types 3 and 4: non-invasion). We also compared the EUS findings and pathologically measured distances between the tumors and evaluated vessels.
Results
The sensitivity, specificity, and accuracy of EUS diagnosis for vascular invasion were 89%, 92%, and 91%, respectively, in the veins and 83%, 94%, and 93%, respectively, in the arteries. The pathologically evaluated distances of cases with type 2 EUS findings were significantly shorter than those of cases with type 3 EUS findings in both the major veins (median [interquartile range], 96 [0–742] µm vs. 2,833 [1,076–5,694] µm, p=0.012) and arteries (623 [0–854] µm vs. 3,097 [1,396–6,000] µm, p=0.0061). All cases with a distance of ≥1,000 µm between the tumors and main vessels were correctly diagnosed.
Conclusions
Tumors at a distance ≥1,000 µm from the main vessels were correctly diagnosed by EUS.

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Role of Endoscopic Ultrasound in Staging and Vascular Assessment of Pancreatic Cancer
Mohammed A El-Nady, Khalid A Ead, Mustafa A Haridy, Nour Shaheen, Abdulqadir J Nashwan, Saad R Abdelwahid, Mohammed F Mohammed, Omran Mohamed, Safwat S Sawy, Emad Abdelrazzak, Amro M Hassan
Cureus.2024;[Epub] CrossRef
The diagnostic accuracy of endoscopic ultrasound vs. contrast-enhanced computed tomography in local staging of pancreatic adenocarcinoma: a bi-national multicenter study
Wisam Sbeit, Mahmoud Salman, Abed Khalaileh, Ahmad Zoabi, Zakhar Bramnik, David Hovel, Mahmud Mahamid, Eran Israeli, Lior Katz, Reem Khoury, Nama Mubariki, Andrea Lisotti, Halim Awadie, Tawfik Khoury
European Journal of Gastroenterology & Hepatology.2023; 35(9): 974. CrossRef
Role of Endoscopic Ultrasound in Diagnosis of Pancreatic Ductal Adenocarcinoma
Abhirup Chatterjee, Jimil Shah
Diagnostics.2023; 14(1): 78. CrossRef
The expanding role of endoscopic ultrasound elastography
Jahnvi Dhar, Jayanta Samanta
Clinical Journal of Gastroenterology.2022; 15(5): 841. CrossRef
Experience of introduction of endoscopic ultrasonography into daily clinical practice in a surgical hospital
A.V. Zhdanov, E.G. Solonitsyn, E.A. Korymasov
Endoskopicheskaya khirurgiya.2020; 26(5): 24. CrossRef
Endoscopic Ultrasonography for Vascular Invasion in Pancreatic Cancer
Seong-Hun Kim
Clinical Endoscopy.2019; 52(5): 397. CrossRef

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Endoscopic Ultrasound in the Diagnosis of Pancreatoduodenal Groove Pathology: Report of Three Cases and Brief Review of the Literature: Inés C. Oría, Juan E. Pizzala, Augusto M. Villaverde, Juan C. Spina, Analía V. Pasqua, Julio C. Lazarte, Oscar M. Mazza, Mariano M. Marcolongo; Clin Endosc 2019;52(2):196-200. Published online November 9, 2018; DOI: https://doi.org/10.5946/ce.2018.097

Abstract PDF PubReader ePub

The pancreatoduodenal groove is a small area where pathologic processes involving the distal bile duct, duodenum, pancreatic head, ampulla of Vater, and retroperitoneum converge. Despite great advances in imaging techniques, a definitive preoperative diagnosis is challenging because of the complex anatomy of this area. Therefore, surgical intervention is frequently required because of the inability to completely exclude malignancy.
We report 3 cases of patients with different groove pathologies but similar clinical and imaging presentation, and show the essential role of endoscopic ultrasound (EUS) in making a specific preoperative diagnosis, excluding malignancy in the first case, changing diagnosis in the second case, and confirming malignancy in the third case. EUS was a fundamental tool in this cohort of patients, not only because of its ability to provide superior visualization of a difficult anatomical region, but because of the ability to guide precise, realtime procedures, such as fine-needle aspiration.

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Groove pancreatitis presenting with upper gastrointestinal obstruction and abnormal renal function: A case report and literature review
Xiaoyuan Fan, Chihong Shi, Dewen Lu
Experimental and Therapeutic Medicine.2024;[Epub] CrossRef
Groove Pancreatitis: Clinical Cases and Review of the Literature
Catarina Neto do Nascimento, Carolina Palmela, António Sampaio Soares, Maria Lobo Antunes, Catarina Andrade Fidalgo, Luísa Glória
GE - Portuguese Journal of Gastroenterology.2023; 30(6): 437. CrossRef
Cytopathology of Inflammatory Lesions of the Pancreatobiliary Tree
Barbara A Centeno
Archives of Pathology & Laboratory Medicine.2023; 147(3): 267. CrossRef
Diagnostic value of endoscopic ultrasound in groove pancreatitis
Yu Mo She, Nan Ge
Annals of Medicine.2023;[Epub] CrossRef
Complete duodenal obstruction induced by groove pancreatitis: A case report
Ya-Li Wang, Chen-Hao Tong, Jian-Hua Yu, Zhi-Liang Chen, Hong Fu, Jian-Hui Yang, Xin Zhu, Bao-Chun Lu
World Journal of Clinical Cases.2019; 7(23): 4106. CrossRef

6,005 View
147 Download
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A Case of Pancreatic Cancer and Opioid Withdrawal after Endoscopic Ultrasound-guided Celiac Plexus Neurolysis: Soo Hwan Seol, M.D., Hyun Soo Kim, M.D., Byung Sik Hwang, M.D., Dae Myung Oh, M.D., In Yub Baek, M.D., Min Kyu Park, M.D., Hyon Uk Ryu, M.D. and Jong Kyu Kwon, M.D.; Korean J Gastrointest Endosc 2011;42(5):323-326. Published online May 28, 2011

Abstract PDF: Pancreatic cancer is usually unresectable upon diagnosis, and treatment aims to optimize the quality of the patient's life by managing symptoms, and, particularly, by providing adequate pain control. When the pain is refractory to opioids, interventions such as celiac plexus neurolysis (CPN) can be considered. Endoscopic ultrasound (EUS)-guided CPN has been introduced for pancreatic cancer. Reported herein is a case of a 75 year-old man with pancreatic cancer who was treated with opioids due to severe abdominal pain. EUS-guided CPN was performed for pain control, and the opioid administration was discontinued as the pain improved dramatically. However, the patient experienced opioid withdrawal symptoms, including anxiety, insomnia, nausea, and vomiting. Thus, although EUS-guided CPN successfully reduced pain in a patient undergoing such treatment and to whom opioid was administered, opioid administration should not be abruptly discontinued. Rather, the opioid dose should be reduced gradually to avoid drug withdrawal. (Korean J Gastrointest Endosc 2011;42:323-326)

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Adenosquamous Carcinoma of the Pancreas: A Case Report: Jun Hyuk Son, M.D., Sang Hyub Lee, M.D., Byung Hyo Cha, M.D.^§, Jin Hyeok Hwang, M.D., Yun Bin Lee, M.D., Yoo Seok Yoon, M.D^*, So Yeon Kim, M.D.^† and Hae Ryoung Kim, M.D.^‡; Korean J Gastrointest Endosc 2011;42(6):433-436. Published online May 25, 2011

Abstract PDF: Adenosquamous carcinoma of the pancreas is a rare tumor, which is difficult to diagnose. A 65-year-old man was admitted complaining of abdominal pain. Abdominal computed tomography (CT) demonstrated a cystic mass in the pancreatic body. Endoscopic ultrasound (EUS) showed an approximate 1.0 cm-sized hypoechoic cystic mass with a solid portion in the pancreatic body and narrowing of the main pancreatic duct. Under the impression of acute pancreatitis with a pseudocyst diagnosis, medical therapy including pancreatic stent insertion was administered to the patient for 4 weeks. A distal pancreatectomy was performed with the suspicion of pancreatic cancer due to the remaining mass on a follow-up CT scan, and the tumor was histopathologically diagnosed as stage I (TNM classification) adenosquamous carcinoma of the pancreatic body. The patient was discharged without any problems and has been on follow-up without recurrence. We report a case of adenosquamous carcinoma of the pancreas that was diagnosed relatively early with the help of EUS.

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Spontaneous Biloma Caused by Pancreatic Cancer and Treated by Endoscopic Biliary Stenting: Ji Young Park, M.D., Jin Lee, M.D., Soon Jae Lee, M.D., Se Ah Kwon, M.D., Dong Hee Koh, M.D., Min Ho Choi, M.D., Hyun Joo Jang, M.D. and Sea Hyub Kae, M.D.; Korean J Gastrointest Endosc 2011;42(3):190-194. Published online March 28, 2011

Abstract PDF: Biloma is a rare disorder, and is defined as an abnormal extrahepatic or intrahepatic collection of bile within a defined capsular space. The common causes of biloma are iatrogenic and trauma. Spontaneous biloma, especially caused by pancreatic cancer, is very rare. An 86-year-old man was admitted with abdominal pain and fever. The patient denied a history of abdominal surgery, endoscopic retrograde cholangiography, or trauma. Abdominal computed tomography demonstrated a huge collection of fluid in the left lobe of the liver, dilatation of the intra and proximal common bile duct, and a heterogeneous enhancing mass in the pancreatic head portion. Percutaneous drainage under ultrasound guidance was performed, and the fluid analysis was compatible with biloma. A plastic stent was endoscopically inserted into the common bile duct to treat continuous drainage of the fluid despite percutaneous drainage. We report a case of biloma developed spontaneously in a patient with pancreatic cancer and successfully treated by endoscopic biliary stenting. (Korean J Gastrointest Endosc 2011;42:190-194)

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A Case of Pancreatic Duct-Portal Vein Fistulae in Pancreatic Cancer: Hyun Jeong Kim, M.D., Young Koog Cheon, M.D., Jong Ho Moon, M.D., Young Duck Cho, M.D., June Seong Lee, M.D., Moon Sung Lee, M.D. and Chan Sup Shim M.D.; Korean J Gastrointest Endosc 2005;31(2):130-132. Published online August 30, 2005

Abstract PDF: Pancreatic fistulae follows pancreatic duct disruption and may develop as a complication of pancreatic disease or injury. The escaping fluid may be walled off by the surrounding viscera to form a pseudocyst or an abscess. Fistulae may drain spontaneously into adjacent hollow viscera or communicate with the body surface externally. Although internal pancreatic fistulas that communicate with adjacent internal organs are much less common, vascular communication with the pancreatic ductal system is especially unusual and generally represents a serious clinical situation. We experienced one case of pancreatic duct-portal vein fistula in a patient with pancreatic cancer. Endoscopic retrograde cholangiopancreatography revealed a large vascular structure representing the portal vein filled at the time of the contrast injection, indicating the presence of a pancreatic duct-portal vein fistulae. (Korean J Gastrointest Endosc 2005;31:130⁣133)

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췌장암 환자에서 ERCP 후에 발생한 중증 급성 췌장염 1예: Korean J Gastrointest Endosc 2003;27(5):494-494. Published online November 20, 2003

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Migration of Pyloric Self-Expanding Metallic Stent to the Esophagus: Young Gyun Kim, M.D., Jun Pyo Chung, M.D., Seung Hyun Cho, M.D., Seoung Joon Hwang, M.D., Dok Yong Lee, M.D., Sang Won Ji, M.D., Yong-Han Paik, M.D., Se Joon Lee, M.D., Byung Soo Moon, M.D., Kwan Sik Lee, M.D., Sang In Lee, M.D. and Jin Kyung Kang, M.D.; Korean J Gastrointest Endosc 2003;27(2):80-83. Published online August 30, 2003

Abstract PDF: Self-expandable metallic stent (SEMS) has been reported to provide effective treatment alternatives with minimal morbidity for patients with malignant gastroduodenal obstruction. Limitations of SEMSs are stent occlusion due to tumor ingrowth or overgrowth and stent migration. Migrated stents may remain in the stomach or travel distally. To our knowledge, however, migration of pyloric SEMS to the esophagus has not been reported. We experienced such a case in a 65-year-old woman who had undergone a gastrojejunostomy and choledochojejunostomy due to unresectable pancreatic head cancer. Pyloric SEMSs (Niti-S Pyloric Bare Stent, 18⁓60 mm, Taewoong Medical, Korea) were deployed at the obstructed efferent and afferent loops. After severe vomiting, a pyloric SEMS placed at the afferent loop migrated into the esophagus, which caused severe chest pain and intractable hiccup. It was removed endoscopically. This case illustrates that pyloric SEMS can migrate to the esophagus through the lower esophageal sphincter. (Korean J Gastrointest Endosc 2003;27:80⁣83)

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64세 여자, 2주 동안의 간헐적인 흑색변: Korean J Gastrointest Endosc 2003;26(5):393-393. Published online May 30, 2003

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