Clinical Endoscopy

Yousuke Nakai

9 Articles

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; Clin Endosc 2025;58(1):134-143. Published online August 23, 2024; DOI: https://doi.org/10.5946/ce.2024.031

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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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Biliary drainage in pancreatic cancer with duodenal invasion: which route is the best?
Tanyaporn Chantarojanasiri, Thawee Ratanachu-Ek
Clinical Endoscopy.2025; 58(1): 82. CrossRef

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Drainage for fluid collections post pancreatic surgery and acute pancreatitis: similar but different?: Yousuke Nakai, Saburo Matsubara, Tsuyoshi Mukai, Tsuyoshi Hamada, Takashi Sasaki, Hirotoshi Ishiwatari, Susumu Hijioka, Hideyuki Shiomi, Mamoru Takenaka, Takuji Iwashita, Atsuhiro Masuda, Tomotaka Saito, Hiroyuki Isayama, Ichiro Yasuda, for the WONDERFUL study group in Japan; Clin Endosc 2024;57(6):735-746. Published online May 17, 2024; DOI: https://doi.org/10.5946/ce.2023.254

Abstract PDF PubReader ePub: Postoperative pancreatic fistulas (POPFs) are common adverse events that occur after pancreatic surgery. Endoscopic ultrasonography (EUS)-guided drainage (EUS-D) is a first-line treatment, similar to that for pancreatic fluid collection (PFCs) after acute pancreatitis. However, some POPFs do not develop fluid collections depending on the presence or location of the surgical drain, whereas others develop fluid collections, such as postoperative fluid collections (POPFCs). Although POPFCs are similar to PFCs, the strategy and modality for POPF management need to be modified according to the presence of fluid collections, surgical drains, and surgical type. As discussed for PFCs, the indications, timing, and selection of interventions or stents for EUS-D have not been fully elucidated for POPFs. In this review, we discuss the management of POPFs and POPFCs in comparison with PFCs due to acute pancreatitis and summarize the topics that should be addressed in future studies.

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Evaluation of the mechanical properties of current biliary self-expandable metallic stents: axial and radial force, and axial force zero border: Wataru Yamagata, Toshio Fujisawa, Takashi Sasaki, Rei Ishibashi, Tomotaka Saito, Shuntaro Yoshida, Shizuka No, Kouta Inoue, Yousuke Nakai, Naoki Sasahira, Hiroyuki Isayama; Clin Endosc 2023;56(5):633-649. Published online April 10, 2023; DOI: https://doi.org/10.5946/ce.2022.201

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Background
/Aims: Mechanical properties (MPs) and axial and radial force (AF and RF) may influence the efficacy and complications of self-expandable metallic stent (SEMS) placement. We measured the MPs of various SEMSs and examined their influence on the SEMS clinical ability.
Methods
We evaluated the MPs of 29 types of 10-mm SEMSs. RF was measured using a conventional measurement device. AF was measured using the conventional and new methods, and the correlation between the methods was evaluated.
Results
A high correlation in AFs was observed, as measured by the new and conventional manual methods. AF and RF scatterplots divided the SEMSs into three subgroups according to structure: hook-and-cross-type (low AF and RF), cross-type (high AF and low RF), and laser-cut-type (intermediate AF and high RF). The hook-and-cross-type had the largest axial force zero border (>20°), followed by the laser-cut and cross types.
Conclusions
MPs were related to stent structure. Hook-and-cross-type SEMSs had a low AF and high axial force zero border and were considered safest because they caused minimal stress on the biliary wall. However, the increase in RF must be overcome.

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Late-onset Rupture of the Intrahepatic Pseudoaneurysm Developed by Endoscopic Ultrasonography-guided Hepaticogastrostomy: A Case Report and Literature Review
Tesshin Ban, Yoshimasa Kubota, Takuya Takahama, Shun Sasoh, Satoshi Tanida, Makoto Nakamura, Tomoaki Ando, Takashi Joh
Internal Medicine.2025; 64(2): 217. CrossRef
Endoscopic biliary drainage for distal bile duct obstruction due to pancreatic cancer
Masahiro Itonaga, Masayuki Kitano
Clinical Endoscopy.2025; 58(1): 40. CrossRef
Evaluation of the effect of metal stents on dose perturbation in the carbon beam irradiation field
Yuya Miyasaka, Tetsuya Ishizawa, Yoshihito Nawa, Hikaru Souda, Shohei Kawashiro, Hongbo Chai, Miyu Ishizawa, Hiraku Sato, Takeo Iwai
Journal of Applied Clinical Medical Physics.2025;[Epub] CrossRef
Photo-responsive self-expanding catheter with photosensitizer-integrated silicone-covered membrane for minimally invasive local therapy in malignant esophageal cancer
Dae Sung Ryu, Hyeonseung Lee, Seung Jin Eo, Ji Won Kim, Yuri Kim, Seokin Kang, Jin Hee Noh, Sanghee Lee, Jung-Hoon Park, Kun Na, Do Hoon Kim
Biomaterials.2025; 320: 123265. CrossRef
The anti‐migration effect of partially covered self‐expandable metal stents for unresectable malignant distal biliary obstruction: A multicenter comparative study
Shinya Kohashi, Arata Sakai, Keisuke Furumatsu, Takeshi Ezaki, Takao Iemoto, Takeshi Tanaka, Masahiro Tsujimae, Takashi Kobayashi, Atsuhiro Masuda, Yuzo Kodama
DEN Open.2025;[Epub] CrossRef
Characteristics of four commonly used self-expanding biliary stents: an in vitro study
Jiaywei Tsauo, Yan Fu, Yue Liu, Xiaowu Zhang, He Zhao, Xiao Li
European Radiology Experimental.2024;[Epub] CrossRef
Outcomes of 6‐mm diameter fully covered self‐expandable metal stents for preoperative biliary drainage in pancreatic cancer
Hiroki Nakagawa, Tsuyoshi Takeda, Takeshi Okamoto, Takafumi Mie, Akiyoshi Kasuga, Takashi Sasaki, Masato Ozaka, Takahisa Matsuda, Yoshinori Igarashi, Naoki Sasahira
DEN Open.2024;[Epub] CrossRef
Dosimetric characteristics of self-expandable metallic and plastic stents for transpapillary biliary decompression in external beam radiotherapy
Yoshihiro Ueda, Kenji Ikezawa, Tomohiro Sagawa, Masaru Isono, Shingo Ohira, Masayoshi Miyazaki, Ryoji Takada, Takuo Yamai, Kazuyoshi Ohkawa, Teruki Teshima, Koji Konishi
Physical and Engineering Sciences in Medicine.2024; 47(4): 1323. CrossRef
Radial force and wire structure determine the onset of covered self‐expandable metal stent migration in endoscopic ultrasound‐guided hepaticogastrostomy: Measurement of sliding‐resistance force using a porcine model
Takehiko Koga, Hiroshi Yamada, Yusuke Ishida, Naoaki Tsuchiya, Takanori Kitaguchi, Keisuke Matsumoto, Makoto Fukuyama, Norihiro Kojima, Fumihito Hirai
Journal of Hepato-Biliary-Pancreatic Sciences.2024; 31(11): 840. CrossRef
Biliary stents for active materials and surface modification: Recent advances and future perspectives
Yuechuan Li, Kunshan Yuan, Chengchen Deng, Hui Tang, Jinxuan Wang, Xiaozhen Dai, Bing Zhang, Ziru Sun, Guiying Ren, Haijun Zhang, Guixue Wang
Bioactive Materials.2024; 42: 587. CrossRef
Manufacturing, Processing, and Characterization of Self-Expanding Metallic Stents: A Comprehensive Review
Saeedeh Vanaei, Mahdi Hashemi, Atefeh Solouk, Mohsen Asghari Ilani, Omid Amili, Mohamed Samir Hefzy, Yuan Tang, Mohammad Elahinia
Bioengineering.2024; 11(10): 983. CrossRef
Understanding mechanical properties of biliary metal stents for wise stent selection
Seok Jeong
Clinical Endoscopy.2023; 56(5): 592. CrossRef
How to reduce fistula formation after self-expandable metallic stent insertion for treating malignant esophageal stricture?
Kwang Bum Cho
Clinical Endoscopy.2023; 56(6): 735. CrossRef

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Endoscopic Biliary Drainage for Hilar Obstruction: Further Evidence But Still A Long Way To Go: Yousuke Nakai; Clin Endosc 2021;54(5):629-630. Published online June 23, 2021; DOI: https://doi.org/10.5946/ce.2021.158

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Loop technique for guidewire manipulation during endoscopic ultrasound‐guided hepaticogastrostomy
Haruo Miwa, Kazuya Sugimori, Yuto Matsuoka, Kazuki Endo, Ritsuko Oishi, Masaki Nishimura, Yuichiro Tozuka, Takashi Kaneko, Kazushi Numata, Shin Maeda
JGH Open.2023; 7(5): 358. CrossRef

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Current Status of Endoscopic Ultrasound Techniques for Pancreatic Neoplasms: Yousuke Nakai, Naminatsu Takahara, Suguru Mizuno, Hirofumi Kogure, Kazuhiko Koike; Clin Endosc 2019;52(6):527-532. Published online July 24, 2019; DOI: https://doi.org/10.5946/ce.2019.025

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Endoscopic ultrasound (EUS) now plays an important role in the management of pancreatic neoplasms. There are various types of pancreatic neoplasms, from benign to malignant lesions, and the role of EUS ranges from the imaging diagnosis to treatment. EUS is useful for the detection, characterization, and tissue acquisition of pancreatic lesions. Recent advancement of contrast-enhanced harmonic EUS and elastography enables better characterization of pancreatic lesions. In addition to these enhanced EUS imaging techniques, EUS-guided tissue acquisition is now the standard procedure to establish the pathological diagnosis of pancreatic neoplasms. While these diagnostic roles of EUS have been established, EUS-guided interventions such as ablation and drainage are also increasingly utilized in the management of pancreatic neoplasms. However, most of these EUS-guided interventions are not yet standardized in terms of techniques and devices and thus need further investigations.

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Is the July Effect Real in Patients Undergoing Endoscopic Retrograde Cholangiopancreatography?: Tae Yoon Lee, Yousuke Nakai; Clin Endosc 2019;52(5):399-400. Published online July 25, 2019; DOI: https://doi.org/10.5946/ce.2019.132

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Increased ERCP volume improves cholangiogram interpretation: a new performance measure for ERCP training?
Shyam Vedantam, Sunil Amin, Ben Maher, Saqib Ahmad, Shanil Kadir, Saad Khalid Niaz, Mark Wright, Nadeem Tehami
Clinical Endoscopy.2022; 55(3): 426. CrossRef

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Endoscopic Ultrasound-Guided Biliary Drainage for Unresectable Hilar Malignant Biliary Obstruction: Yousuke Nakai, Hirofumi Kogure, Hiroyuki Isayama, Kazuhiko Koike; Clin Endosc 2019;52(3):220-225. Published online November 29, 2018; DOI: https://doi.org/10.5946/ce.2018.094

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Endoscopic transpapillary biliary drainage is the current standard of care for unresectable hilar malignant biliary obstruction (MBO) and bilateral metal stent placement is shown to have longer patency. However, technical and clinical failure is possible and percutaneous transhepatic biliary drainage (PTBD) is sometimes necessary. Endoscopic ultrasound-guided biliary drainage (EUS-BD) is increasingly being reported as an alternative rescue procedure to PTBD. EUS-BD has a potential advantage of not traversing the biliary stricture and internal drainage can be completed in a single session. Some approaches to bilateral biliary drainage for hilar MBO under EUS-guidance include a bridging method, hepaticoduodenostomy, and a combination of EUS-BD and transpapillary biliary drainage. The aim of this review is to summarize data on EUS-BD for hilar MBO and to clarify its advantages over the conventional approaches such as endoscopic transpapillary biliary drainage and PTBD.

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Novel approach to bilateral biliary drainage: EUS-guided hepaticoduodenodenostomy plus hepaticogastrostomy in malignant hilar biliary obstruction
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Retrospective comparative study of new slim‐delivery and conventional large‐cell stents for stent‐in‐stent methods for hilar malignant biliary obstruction
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Three-year evaluation of a novel, nonfluoroscopic, all-artificial model for EUS-guided biliary drainage training for the impact to practice: A prospective observational study (with videos)
Tanyaporn Chantarojanasiri, Aroon Siripun, Pradermchai Kongkam, Nonthalee Pausawasdi, Thawee Ratanachu-ek
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A case of malignant hilar biliary obstruction after total gastrectomy treated by EUS-HJS + bridging stenting
Yurie Tokito, Ryunosuke Hakuta, Hirofumi Kogure, Yousuke Nakai, Mitsuhiro Fujishiro
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Current endoscopic approaches to biliary strictures
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Retrospective Comparative Study of Side-by-Side and Stent-in-Stent Metal Stent Placement for Hilar Malignant Biliary Obstruction
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Radiologic Assessment for Endoscopic US-guided Biliary Drainage
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Endoscopic ultrasound‐guided bilateral biliary drainage through the mesh of the metal stents using a balloon occlusion method
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Simultaneous endoscopic ultrasound-guided hepaticogastrostomy and bridging stenting with partial stent-in-stent method
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En-Ling Leung Ki EL, Bertrand Napoleon
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Endoscopic Ultrasound-Guided Biliary Drainage for Benign Biliary Diseases: Yousuke Nakai, Hirofumi Kogure, Hiroyuki Isayama, Kazuhiko Koike; Clin Endosc 2019;52(3):212-219. Published online March 14, 2019; DOI: https://doi.org/10.5946/ce.2018.188

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Although endoscopic retrograde cholangiopancreatography (ERCP) is the first-line treatment for benign biliary diseases, this procedure is technically difficult in some conditions such as a surgically altered anatomy and gastric outlet obstruction. After a failed ERCP, a surgical or a percutaneous approach is selected as a rescue procedure; however, various endoscopic ultrasound (EUS)-guided interventions are increasingly utilized in pancreatobiliary diseases, including EUS-guided rendezvous for failed biliary cannulation, EUS-guided antegrade treatment for stone management, and EUS-guided hepaticogastrostomy for anastomotic strictures in patients with a surgically altered anatomy. There are some technical hurdles in EUS-guided interventions for benign biliary diseases owing to the difficulty in puncturing a relatively small bile duct and in subsequent guidewire manipulation, as well as the lack of dedicated devices. A recent major advancement in this field is the introduction of a 2-step approach, in which EUS-guided drainage is placed in the first session and antegrade treatment is performed in subsequent sessions. This approach allows the use of various techniques such as mechanical lithotripsy and cholangioscopy without a risk of bile leak. In summary, EUS-guided interventions are among the treatment options for benign biliary diseases; however, standardization of the procedure and development of a treatment algorithm are needed.

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Endoscopic approach to indeterminate biliary strictures: Yousuke Nakai, Ryunosuke Hakuta, Yutaka Shimamatsu, Nao Otsuka, Yukiko Takayama; Received February 19, 2025 Accepted March 17, 2025 Published online April 23, 2025; DOI: https://doi.org/10.5946/ce.2025.052

Abstract PubReader ePub: Diagnosis of biliary strictures remains challenging because of the low sensitivity of conventional transpapillary sampling using endoscopic retrograde cholangiopancreatography. New devices and tips have been developed to increase the diagnostic yield of conventional transpapillary sampling. However, additional endoscopic procedures are often necessary for indeterminate biliary strictures. Two major approaches for indeterminate biliary strictures are endoscopic ultrasonography-guided sampling and peroral cholangioscopy (POCS)-guided biopsy. The selection of modalities should be considered based on the stricture location. Although endoscopic ultrasound is the preferred approach for distal biliary strictures, POCS is preferred for perihilar biliary strictures. Endoscopic ultrasonography-guided sampling is highly sensitive in cases with a mass, but the sensitivity of POCS-guided biopsies is unsatisfactory, and discrepancy with the visual diagnosis of POCS is common. Whether these advanced techniques should be performed as the initial procedure or as a rescue after a failed diagnosis by conventional transpapillary sampling needs to be clarified in terms of diagnostic yield and cost-effectiveness.

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