The 7th Joint Session between JDDW-KDDW-TDDW3(JDDW)
Thu. November 2nd   9:00 - 12:00   Room 10: Portopia Hotel Waraku
JKT3-1
 Current status and future perspectives of Interventional EUS in Japan
Akio Katanuma
Center for Gastroenterology, Teine-Keijinkai Hospital
Interventional EUS has made dramatic progress in Japan since EUS-FNA was covered by insurance in 2010. In Japan, there was a negative opinion about FNA due to the high level of trust in imaging diagnosis and the risk of needle tract seeding caused by puncture of malignant tumors. After reports on the usefulness of neoadjuvant treatment (NAT) for pancreatic cancer, there is a growing consensus that it is necessary to obtain histological confirmation by FNA. In addition, there have been many reports on the high histological diagnostic capability of FNA, as well as biomarker and gene evaluation, and FNA has become a well-established technique. However, there are many reports from Japan of needle tract seeding after FNA, and many institutions still consider that FNA is contraindication for cystic pancreatic tumors.
In terms of therapeutic indication, drainage of pancreatic cysts has been performed and the indications have expanded to include drainage of the biliary tract and pancreatic ducts, etc. In 2019, the guideline for EUS-BD was published in Japan, which have contributed greatly to the safe technique of interventional EUS. EUS-guided drainage requires several steps such as puncture, dilation, and stent deployment. In the past, without dedicated devices for interventional EUS made the procedure was challenging, and several serious adverse events were reported. Recently, dedicated dilation devices such as mechanical dilators, cautery dilators, and drill-type dilators, have been developed and are now available to use in Japan. In addition, specialized stents that can be easily deployed are also commercially available. The development of specialized devices is considered to have made it possible to perform the procedure more safely and reliably. Lumen apposing metal stent (LAMS) is now covered by medical insurance for use in peri-pancreatic fluid collection (PFC) in Japan. LAMS can be used only for PFC, and the indication has not been expanded to the gallbladder drainage.
Interventional EUS will continue to progress in Japan, but it is unlikely that all procedures will replace ERCP. The education program is required to perform for the safe interventional EUS procedures.
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