• Clinical Endoscopy
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• v.57 no.1
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• pp.96-104
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• 2024

Background/Aims: Selective bile duct or pancreatic duct cannulation remains a significant initial hurdle in endoscopic retrograde cholangiopancreatography (ERCP) despite advances in endoscopy and accessories. This study evaluated our experience with a rotatable sphincterotome in cases of difficult cannulation. Methods: We retrospectively reviewed ERCP cases using TRUEtome, a rotatable sphincterotome, as a rescue device for cannulation at a cancer institute in Japan from October 2014 to December 2021. Results: TRUEtome was used in 88 patients. Duodenoscopes were used for 51 patients, while single-balloon enteroscopes (SBE) were used for 37 patients. TRUEtome was used for biliary and pancreatic duct cannulation (84.1%), intrahepatic bile duct selection (12.5%), and strictures of the afferent limb (3.4%). Cannulation success rates were similar in the duodenoscope and SBE groups (86.3% vs. 75.7%, p=0.213). TRUEtome was more commonly used in cases with steep cannulation angles in the duodenoscope group and in cases requiring cannulation in different directions in the SBE group. There were no significant differences in adverse events between the two groups. Conclusions: The cannulation sphincterotome was useful for difficult cannulations in both unaltered and surgically altered anatomies. It may be an option to consider before high-risk procedures such as precut and endoscopic ultrasound-guided rendezvous techniques.

• Journal of Digestive Cancer Research
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• v.4 no.2
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• pp.88-91
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• 2016

Pancreatic cancer is the lethal disease and the prognosis of pancreatic cancer has remained largely unchanged over the past years. Borderline advanced pancreatic cancer is a biological different from resectable pancreatic cancer due to higher risk of early recurrence because of artery/vein abutment. Therefore this unique subset of pancreatic cancer has a controversial issue with regard to their treatment policy. Some institutes managed borderline advanced pancreatic cancer by up-front neoadhuvant chemotherapy because neoadjuvant chemotherapy provide the opportunity to treat early micro-metastasis with unfavorable tumor biology. But, some institutes try aggressive up-front surgical procedures to provide a chance of long-term survival in highly selected patients. Therefore this unique subset of pancreatic cancer has a controversial issue with regard to their treatment policy. This review address recent treatment trend for patients with borderline advanced pancreatic cancer.

• Journal of Digestive Cancer Research
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• v.12 no.2
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• pp.102-105
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• 2024

Chronic pancreatitis, a significant risk factor for pancreatic cancer, necessitates monitoring for pancreatic cancer development. Chronic pancreatitis can be broadly categorized into hereditary and sporadic. Given the variability in the risk for pancreatic cancer based on the presence and type of genetic mutations, it is crucial to establish and be aware of guidelines for screening and surveillance tailored to each risk level. In cases of hereditary chronic pancreatitis with PRSS1 mutations, patients demonstrated a high incidence of pancreatic cancer, justifying the rationale for screening and surveillance. However, the incidence of pancreatic cancer is relatively low in hereditary chronic pancreatitis with other genetic mutations and sporadic chronic pancreatitis; thus, precise screening and periodic surveillance are not recommended. For individuals with PRSS1 mutation-related hereditary chronic pancreatitis, surveillance may be considered from the age of 40 years. While computed tomography or magnetic resonance imaging is suitable for pancreatic cancer screening, endoscopic ultrasonography is not recommended because of parenchymal inflammation, fibrosis, and calcification. However, in cases of sporadic chronic pancreatitis where various risk factors for pancreatic cancer coexist, the incidence of pancreatic cancer significantly increases. Therefore, in 5 years after the diagnosis of chronic pancreatitis, the pancreatic cancer incidence has been observed to continuously increase. In such cases, individualized screening tests and surveillance based on the patient's symptoms and specific circumstances must be considered.

• Clinical Endoscopy
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• v.55 no.4
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• pp.549-557
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• 2022

Background/Aims: Digital single-operator cholangioscopy (DSOC)-guided mapping biopsy (DMB) and tube-assisted mapping biopsy (TMB) are two techniques used for preoperative evaluation of biliary tract cancer (BTC). However, data regarding the diagnostic performance of these techniques are limited. Methods: We retrospectively examined consecutive patients with BTC who underwent either technique at our institution between 2018 and 2020. We evaluated the technical success rate, adequate tissue acquisition rate, and diagnostic performance of these techniques for the evaluation of lateral spread of BTC. Results: A total of 54 patients were included in the study. The technical success rate of reaching the target sites was 95% for DMB and 100% for TMB. The adequate tissue acquisition rate was 61% for DMB and 69% for TMB. The adequate tissue acquisition rate was low, especially for target sites beyond the secondary biliary radicles. The sensitivity of DMB alone was 39%, which improved to 65% when combined with visual impression. Experts demonstrated a higher negative predictive value and diagnostic accuracy with respect to both DSOC visual impression and DMB for the evaluation of lateral spread of BTC compared to trainees. Conclusions: Adequate tissue acquisition rates were similar between the two techniques. Since DMB requires expertise, TMB may be an acceptable option when DSOC is unavailable or when DSOC expertise is limited.

• Journal of Digestive Cancer Research
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• v.11 no.1
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• pp.1-8
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• 2023

Pancreatic cancer treatment has advanced. In particular, effective chemotherapy regimen development has fundamentally altered the therapeutic concept and strategy for pancreatic cancer treatment. Consequently, the prognosis of patients with pancreatic cancer has gradually improved. Conversion surgery for locally advanced pancreatic cancer may offer long-term survival or even a full recovery in some individuals. In contrast, metastatic pancreatic cancer has long been considered a surgical contraindication because aggressive surgical resection of the metastatic lesions does not prolong patient survival. Unexpectedly positive benefits of anticancer therapy in recent clinical experience were observed even with metastatic pancreatic cancer. To date, little evidence presented the success of surgical resection for metastatic pancreatic cancer treatment in such rare cases. However, hope and concern are growing that surgical intervention, even in patients with metastatic cancer, may result in favorable outcomes. Several studies suggested different surgical intervention effects depending on metastasis sites and patterns. Thus, this review summarizes the current status of surgery in the multidisciplinary treatment of oligometastatic pancreatic cancer and discusses future perspectives.

• Clinical Endoscopy
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• v.57 no.2
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• pp.253-262
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• 2024

Background/Aims: Hepaticojejunostomy anastomotic stricture (HJAS) is a feared adverse event associated with hepatopancreatobiliary surgery. Although balloon dilation for benign HJAS during endoscopic retrograde cholangiopancreatography with balloon-assisted enteroscopy has been reported to be useful, the treatment strategy remains controversial. Therefore, we evaluated the outcomes and risk factors of recurrent stenosis after balloon dilation alone for benign HJAS. Methods: We retrospectively analyzed consecutive patients who underwent balloon-assisted enteroscopy-endoscopic retrograde cholangiopancreatography for benign HJAS at our institution between July 2014 and December 2020. Results: Forty-six patients were included, 16 of whom had recurrent HJAS after balloon dilation. The patency rates at 1 and 2 years after balloon dilation were 76.8% and 64.2%, respectively. Presence of a residual balloon notch during balloon dilation was an independent predictor of recurrence (hazard ratio, 2.80; 95% confidence interval, 1.01-7.78; p=0.048), whereas HJAS within postoperative 1 year tended to be associated with recurrence (hazard ratio, 2.43; 95% confidence interval, 0.85-6.89; p=0.096). The patency rates in patients without a residual balloon notch were 82.1% and 73.1% after 1 and 2 years, respectively. Conclusions: Balloon dilation alone may be a viable option for patients with benign HJAS without residual balloon notches on fluoroscopy.

• CELLMED
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• v.13 no.12
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• pp.46.1-46.7
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• 2023

Objective: Report cases of improvement in pancreatic cancer through Ortho-Cellular Nutrition Therapy. Methods: Korean males in their 70's were suffering from pancreatic cancer following full recovery from prostate cancer. Results: There was the improvement in pancreatic cancer following implementation of OCNT. Conclusion: Application of OCNT to pancreatic cancer can be helpful in alleviating symptoms.

• Asian Pacific Journal of Cancer Prevention
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• v.15 no.18
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• pp.7947-7950
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• 2014

Background: Pancreatic cancer is the sixth leading cause of cancer death with an increasing trend in China. Dietary intake is believed to play an important role in pancreatic cancer carcinogenesis. The aim of this paper was to evaluate associations between some dietary factors and risk of pancreatic cancer in a multi-centre case-control study conducted in China. Materials and Methods: Cases (n=323) were ascertained from four provincial cancer hospitals. Controls (n=323) were randomly selected from the family members of patients without pancreatic cancer in the same hospitals, 1:1 matched to cases by gender, age and study center. Data were collected with a questionnaire by personal interview. Odds ratios (OR) and 95% confidence intervals (95%CI) were estimated using conditional logistic regression. Results: Tea intake (OR =0.49; 95%CI: 0.30-0.80) was associated with a half reduction in risk of pancreatic cancer. Reduced vegetable consumption (P trend: 0.04) was significant related to pancreatic cancer. Although no significant association was found for meat and fruit, ORs were all above or below the reference group. A protective effect was found for fruit (OR=1.73 for consumption of 1-2 times/week vs more than 3 times/week; 95%CI: 1.05-2.86). A high intake of meat was associated to a higher risk of pancreatic cancer (OR=0.59 for consumption of 1-2 times/week vs. more than 3 times/week; 95%CI: 0.35-0.97). Conclusions: The present study supports fruit consumption to reduce pancreatic cancer risk and indicates that high consumption of meat is related to an elevated risk. Direct inverse relations with tea and vegetable intake were also confirmed.

• Journal of Digestive Cancer Research
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• v.11 no.3
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• pp.147-156
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• 2023

Pancreatic cancer is one of the most aggressive cancers, and it is expected to become the second-leading cause of cancer-related death in the United States by 2030. Its 5-year survival rate is <10% and approximately 15% of cases are eligible for surgical treatment during diagnosis. Furthermore, the risk of recurrence within 1 year postoperative is as high as 50%. Therefore, chemotherapy plays a crucial role in pancreatic cancer treatment. Survival rates are speculated to have improved since the introduction of FOLFIRINOX and gemcitabine/nab-paclitaxel combination therapy for metastatic pancreatic cancer in the 2010s. Additionally, the implementation of both neoadjuvant and adjuvant treatments in resectable and borderline resectable pancreatic cancer caused better outcomes compared to upfront surgery. Recently, not only have these medications advanced in development, but so have PARP inhibitors and KRAS inhibitors, contributing to the treatment landscape. This study aimed to explore the latest insights into chemotherapy for pancreatic cancer.

• Annals of Hepato-Biliary-Pancreatic Surgery
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• v.26 no.1
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• pp.1-16
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• 2022

Pancreatic cancer is the eighth most common cancer and the fifth most common cause of cancer-related deaths in Korea. Despite the increasing incidence and high mortality rate of pancreatic cancer, there are no appropriate surgical practice guidelines for the current domestic medical situation. To enable standardization of management and facilitate improvements in surgical outcome, a total of 10 pancreatic surgical experts who are members of Korean Association of Hepato-Biliary-Pancreatic Surgery have developed new recommendations that integrate the most up-to-date, evidence-based research findings and expert opinions. This is an English version of the Korean Surgical Practice Guideline for Pancreatic Cancer 2022. This guideline includes 13 surgical questions and 15 statements. Due to the lack of high-level evidence, strong recommendation is almost impossible. However, we believe that this guideline will help surgeons understand the current status of evidence and suggest what to investigate further to establish more solid recommendations in the future.