Background/Purpose
The role of endoscopic preoperative biliary drainage for pancreatic head cancer is controversial because of the high incidence of stent occlusion before surgery. We sought to ...validate a suitable stent for biliary drainage in patients with pancreatic cancer undergoing neoadjuvant chemotherapy (NAC)/neoadjuvant chemoradiotherapy (NAC‐RT).
Methods
We evaluated patients who received preoperative neoadjuvant therapy for pancreatic head cancer between January 2013 and December 2019. A covered metal (CMS) or plastic stent (PS) was inserted in symptomatic patients for biliary drainage. Recurrent biliary obstruction (RBO), success rate of endoscopic drainage, adverse events, and surgical outcomes were compared between the CMS and PS groups.
Results
Occurrence rate of RBO was significantly higher with PS (97%) vs CMS (15%, P < .001), and time to RBO was significantly longer with CMS vs PS (not reached vs 40.5 days, P < .001). Delayed schedule associated with RBO for neoadjuvant chemotherapy was significantly lower in CMS vs PS (14% vs 50%, P < .05). There was no difference in postoperative bleeding, operation time, complications, and rate of a microscopically margin‐negative resection between groups.
Conclusions
Use of CMS during NAC/NAC‐RT allows for safe chemotherapy without causing cholangitis or biliary obstruction and for surgery to be performed.
Highlight
In this single‐center retrospective study, Hasegawa and colleagues analyzed appropriate biliary drainage for patients with pancreatic cancer and obstructive jaundice during neoadjuvant chemo‐radiation therapy, comparing a plastic stent and a covered metal stent in terms of stent patency and surgical outcomes. The covered metal stent may be a suitable first choice.
Full text
Available for:
FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
Pirfenidone (PFD) is an anti-fibrotic agent used to treat idiopathic pulmonary fibrosis (IPF), but its precise mechanism of action remains elusive. Accumulation of profibrotic myofibroblasts is a ...crucial process for fibrotic remodeling in IPF. Recent findings show participation of autophagy/mitophagy, part of the lysosomal degradation machinery, in IPF pathogenesis. Mitophagy has been implicated in myofibroblast differentiation through regulating mitochondrial reactive oxygen species (ROS)-mediated platelet-derived growth factor receptor (PDGFR) activation. In this study, the effect of PFD on autophagy/mitophagy activation in lung fibroblasts (LF) was evaluated, specifically the anti-fibrotic property of PFD for modulation of myofibroblast differentiation during insufficient mitophagy.
Transforming growth factor-β (TGF-β)-induced or ATG5, ATG7, and PARK2 knockdown-mediated myofibroblast differentiation in LF were used for in vitro models. The anti-fibrotic role of PFD was examined in a bleomycin (BLM)-induced lung fibrosis model using PARK2 knockout (KO) mice.
We found that PFD induced autophagy/mitophagy activation via enhanced PARK2 expression, which was partly involved in the inhibition of myofibroblast differentiation in the presence of TGF-β. PFD inhibited the myofibroblast differentiation induced by PARK2 knockdown by reducing mitochondrial ROS and PDGFR-PI3K-Akt activation. BLM-treated PARK2 KO mice demonstrated augmentation of lung fibrosis and oxidative modifications compared to those of BLM-treated wild type mice, which were efficiently attenuated by PFD.
These results suggest that PFD induces PARK2-mediated mitophagy and also inhibits lung fibrosis development in the setting of insufficient mitophagy, which may at least partly explain the anti-fibrotic mechanisms of PFD for IPF treatment.
Full text
Available for:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Background and Aim
In chronic pancreatitis (CP) patients, diagnosis of small pancreatic lesions by endoscopic ultrasound‐guided fine‐needle aspiration (EUS‐FNA) is challenging. Thus, the aim of the ...present study was to investigate whether CP influences the diagnostic ability of EUS‐FNA for pancreatic lesions ≤10 mm.
Methods
One hundred and seventeen patients who underwent EUS‐FNA for pancreatic lesions ≤10 mm in size were enrolled. Patients were classified into two groups based on features of CP observed by EUS (EUS‐CP features) in accordance with the Rosemont classification. The CP group was defined as cases consistent with CP or suggestive of CP, and the non‐CP group was defined as cases indeterminate for CP or normal. Factors influencing the diagnostic accuracy of EUS‐FNA and CP status in pancreatic tumors were also investigated.
Results
Diagnostic ability of EUS‐FNA (overall cases, non‐CP vs CP) had sensitivity (80.4%, 96.7% vs 57.1%; P < 0.001), specificity (100%, 100% vs 100%; P > 0.05), and accuracy (91.5%, 98.6% vs 80.4%; P = 0.001). In multivariate analysis of factors influencing the accuracy of EUS‐FNA, CP significantly lowered the accuracy (P = 0.048; odds ratio OR = 9.21). Among pancreatic cancer patients, the number of CP patients was significantly higher than the number of patients with benign lesions (P = 0.023). In multivariate analysis, lobularity without honeycombing was more frequently observed in cases of pancreatic cancer (P = 0.018; OR, 12.65).
Conclusion
Endoscopic ultrasound‐guided FNA offers high accuracy for small pancreatic lesions ≤10 mm. However, in cases with CP, the diagnostic ability of EUS‐FNA is significantly reduced.
Full text
Available for:
DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, UILJ, UKNU, UL, UM, UPUK
Background/Purpose
The relationship between autoimmune pancreatitis (AIP) and malignancy has been reported. However, the potential risk for cancer in patients with immunoglobulin 4 (IgG4)‐related ...sclerosing cholangitis (IgG4‐SC) is unclear. The present study aimed to evaluate the incidence of cancer in IgG4‐SC patients.
Methods
We retrospectively collected clinical data for 121 patients diagnosed with IgG4‐SC from 7 hospitals. We calculated the standardized incidence ratio (SIR) of cancer in IgG4‐SC patients based on the national cancer rates. The SIR of the period after the diagnosis of IgG4‐SC were calculated.
Results
The mean follow‐up period was 6.4 years, with 121 IgG4‐SC patients. During the follow‐up period, 26 patients had cancer, and 29 cancers were diagnosed. The SIR of cancer after the diagnosis of IgG4‐SC was 1.90 (95% confidence interval CI 1.67‐2.21). The SIR of pancreatic and bile duct cancer was 10.30 and 8.88, respectively. The SIR of cancer in <1 year, 1‐5 years, and >5 years after diagnosis of IgG4‐SC were 2.58, 1.01, and 2.44, respectively.
Conclusions
IgG4‐SC patients have a high risk of cancer including pancreatic and bile duct cancer. The risk of cancer was high less <1 year and >5 years after diagnosis of IgG4‐SC. Therefore, IgG4‐SC patients may require careful long‐term follow‐up.
Highlight
In this retrospective study, Kurita and colleagues found that the risk of cancer, including pancreatic and bile duct cancer, is high in patients with IgG4‐related sclerosing cholangitis. The risk was high <1 year and >5 years after diagnosis, suggesting that patients with IgG4‐related sclerosing cholangitis may require careful long‐term follow‐up.
Full text
Available for:
FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
Background and Aim
Immunoglobulin G4‐related sclerosing cholangitis (IgG4‐SC) presents as isolated proximal‐type sclerosing cholangitis (i‐SC). The present study sought to clarify the imaging ...differences between i‐SC and Klatskin tumor. Differences between i‐SC and IgG4‐SC associated with autoimmune pancreatitis (AIP‐SC) were also studied.
Methods
Differentiating factors between i‐SC and Klatskin tumor were studied. Serum IgG4 level, CA19‐9 level, computed tomography (CT) findings, cholangiography findings (symmetrical smooth long stricture extending into the upper bile duct SSLS), endosonographic features (continuous symmetrical mucosal lesion to the hilar part CSML), endoscopic biopsy results, treatment, relapse, and survival were also compared between patients with i‐SC and those with AIP‐SC.
Results
For a differential diagnosis between i‐SC (N = 9) and Klatskin tumor (N = 47), the cut‐off value of serum IgG4 level was 150 mg/dL (sensitivity, 0.857, specificity, 0.966). Logistic regression analysis indicated that serum IgG4 level, presence of SSLS, presence of CSML, and presence of swollen ampulla are independent factor for identifying i‐SC. Relapse rate was significantly higher in the IgG4‐SC with AIP group than in the i‐SC group (log rank, P = 0.046).
Conclusion
Isolated proximal‐type sclerosing cholangitis presents as a nodular lesion with SSLS and/or CSML mimicking a Klatskin tumor. Those endoscopic features might provide a diagnostic clue for i‐SC. i‐SC is likely to have a more favorable prognosis than IgG4‐SC with AIP.
Full text
Available for:
DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, UILJ, UKNU, UL, UM, UPUK
Background and Purpose: During endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS), tract dilation is one of the most important steps, and the placement of conventional metal stents with 8.5 ...Fr delivery devices is difficult due to the large outer shape of the device. Fine-gauge balloon catheters have become popular because of their stricture penetration ability and ease of dilation. This study aimed to evaluate the utility of fine-gauge balloon catheters. Patients and Methods: This retrospective study involved 38 patients who underwent conventional metal stent placement. The patients were classified into two groups: those who underwent dilation with a fine-gauge balloon catheter before initial metal stenting (balloon dilation group) and those who underwent bougie dilation only (non-balloon dilation group). We evaluated the stenting success rate after initial dilation and adverse events. Results: Seventeen and twenty-one patients were included in the balloon dilation and non-balloon dilation groups, respectively. The stenting success rate after initial dilation was 100% (17/17) in the balloon dilation group and 71.4% (15/21) in the non-balloon dilation group (p = 0.024). As adverse events, peritonitis was observed in one case (4.8%) in the balloon dilation group, and in three cases (14.3%) in the non-balloon dilation group (p = 0.613). Conclusions: Dilation using a fine-gauge balloon catheter before conventional metal stent with 8.5 Fr delivery device placement is considered effective in EUS-HGS.
Peptide receptor activation therapy (PRRT) is a promising treatment option for metastatic neuroendocrine tumors (NETs). However, predicting tumor shrinkage before treatment is challenging. We ...analyzed the shrinkage rate of each metastatic tumor lesion to identify predictive factors related to shrinkage. Patients with metastatic NET who underwent PRRT were included in this retrospective study. For each patient, between one to five metastatic lesions were selected in descending order of size, and the change in the maximum tumor diameter after treatment was defined as the shrinkage rate per lesion (L-SR). We analyzed the relationship between pretreatment clinicopathological factors and L-SR. The median L-SR of all 75 lesions in 20 patients was 20% (95% CI: 4.8−26.1%). While previous treatment with cytotoxic agents (34.4%, p < 0.05) and primary tumor of the pancreas (27.8%, p < 0.05) were significantly favorable factors, a primary tumor of the rectum was significantly more resistant to shrinkage (−20.5%, p < 0.001). Therefore, lesion-based analysis of PRRT for NETs showed that pancreatic NET and previous treatment with cytotoxic agents were favorable factors for tumor shrinkage; however, rectal NET was a factor associated with resistance to shrinkage.
Full text
Available for:
IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
Background/Purpose
The detection ability and role of different imaging modalities to detect pancreatic neuroendocrine neoplasms (PNENs) including small lesions is unclear. This study aimed to compare ...the ability of endoscopic ultrasound (EUS) and computed tomography (CT) to detect PNENs.
Methods
Data of patients who underwent EUS and contrast‐enhanced CT and were diagnosed with PNENs were analyzed. The detection rates of pancreatic lesions with EUS and CT based on tumor size and influencing factors were investigated.
Results
For 256 PNEN lesions, the detection rate of EUS was better than that of CT (94.5% vs 86.3%; P < .001). EUS was significantly superior to CT for PNENs ≤5 mm (58.3% vs 16.7%; P = .006) and 5‐10 mm (97.7% vs 79.5%; P = .008). There was no significant difference in the detection rate between EUS and CT for PNENs >10 mm (98.4% vs 96.4%; P = .375). Size (≤5 mm) and insulinoma were independent factors associated with poor EUS and CT detection rates.
Conclusions
Endoscopic ultrasound exhibited better detection ability than CT, with an excellent detection rate for PNENs >5 mm, except for insulinomas. CT could detect PNENs >10 mm, which are amenable to treatment.
Kurita et al found that endoscopic ultrasound had the best detection ability among imaging modalities for pancreatic neuroendocrine neoplasms. It may be desirable to detect and identify lesions suitable for treatment using computed tomography, and then accurately locate and diagnose pancreatic neuroendocrine neoplasms using endoscopic ultrasound before treatment, including surgery.
Full text
Available for:
FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
Background and Aims
Although the technique of endoscopic ultrasound‐guided choledochoduodenostomy (EUS‐CDS) is becoming standardized, its safety issues have not been sufficiently investigated. ...Therefore, we aimed to identify factors associated with adverse events and stent patency in EUS‐CDS.
Methods
Consecutive patients who underwent EUS‐CDS between September 2003 and July 2017 were included. Technical/clinical success, adverse events and stent dysfunctions were analyzed retrospectively.
Results
A total of 151 patients underwent EUS‐CDS. In nine patients, procedures were discontinued before puncture. Technical and clinical success rates were 96.5% (137/142) and 98.5% (135/137), respectively. The adverse event rate was 20.4% (29/142). As a risk factor for peritonitis, plastic stents (PS) showed a significantly high odds ratio (OR) compared with covered self‐expandable metal stents (CSEMS; OR, 4.31; P = 0.030). CSEMS cases showed a significantly longer patency period than PS cases (329 vs 89 days; HR, 0.35; P < 0.001). As a risk factor for early stent dysfunction (within 14 days), stent direction to the oral side showed a significantly high OR (OR, 43.47; P < 0.001). In cases with oblique‐viewing EUS, double penetration of the duodenum occurred at significantly higher frequency than in cases with forward‐viewing EUS (7.0 vs 0.0%; P = 0.024).
Conclusions
Plastic stents and stent direction to the oral side were risk factors for peritonitis and early stent dysfunction, respectively. Using covered self‐expandable metal stents and changing stent direction to the anal side seemed appropriate to prevent peritonitis and early stent dysfunction.
Full text
Available for:
DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, UILJ, UKNU, UL, UM, UPUK
PDF
