New Approach To Treating Pancreatic Disease – Medical Frontiers
[Music] Diseases of the pancreas are extremely difficult to detect early. In the case of pancreatic cancer, 7.8% of cases are discovered at stage 1. Nearly half of patients are already in the most advanced stage 4 by the time they are diagnosed. [Music] The key to early detection and protecting the pancreas is a procedure called endoscopic ultrasound or EU. [Music] Today on the program, we’re going to explore how endoscopic ultrasound or EU technology is being used to protect the pancreas from early diagnosis to treatment. And we’re going to take you to the forefront in Japan where a groundbreaking approach to pancreatic treatment using EU has been developed. The pancreas is often called a silent organ because symptoms rarely appear in the early stages of disease. Its deep location inside the body also makes testing and treatment difficult. [Music] Let’s see where it sits in the body using an anatomical model. Here we see the liver, stomach, and intestines. When the liver and the stomach are removed, part of the pancreas, hidden behind the stomach, finally comes into view. [Music] Behind the pancreas are the kidneys and the spine. The pancreas is surrounded by organs on all sides. [Music] Pancreatic exams usually begin with an abdominal ultrasound. Ultrasound waves are sent from outside the body, but because the pancreas lies deep inside, they have difficulty reaching it. This can make it hard to see the entire organ clearly. [Music] When necessary, doctors also perform CT or MRI scans. Even so, early detection remains challenging. That’s where EU comes in. It involves an endoscope equipped with ultrasound. Inserted through the mouth, it sends ultrasound waves to the pancreas from inside the body. This produces clear images that can reveal even small abnormalities. Ittoy Tako leads one of the world’s top teams using EU for both diagnosis and treatment. Thank you so much for your time. It’s often said that pancreatic diseases, whether it be pancreatitis or particularly pancreatic cancer, diagnosed too late. So what makes EOS so incredibly effective for early detection? [Music] Foreign speech. Foreign speech. Foreign speech. This is a CT image of a patient with pancreatic disease. The circled area is part of the pancreas. The scan shows no obvious abnormalities. Even specialists could not detect anything unusual. Let’s take a look at the same patients pancreas with EU. [Music] Part of the pancreas is marked in white. Inside a 6 mm tumor appears black. ES captured this tiny tumor that did not show up on CT. [Music] CT and MRI are valuable for providing an overall view showing how the pancreas relates to surrounding organs and blood vessels. Combined with EU, they can help catch pancreatic disease at an early stage. [Music] This patient is suspected of having pancreatic cancer and requires a detailed examination with EU. The EU scope is about 1.2 m long and 14 mm across. Like a standard endoscope, it has a camera and a light to illuminate the body’s interior. At its tip is an ultrasound device which is crucial for observing the pancreas. [Music] The scope is guided through the stomach and the dadum to get as close as possible to the pancreas where it emits ultrasound. Doctors observe the images from the device in real time. The patient was found not to have cancer, but the doctors decided on careful follow-up observation. [Music] The EU scope can also be fitted with a needle. If EU finds a tumor, doctors can insert the needle into it to collect cells for examination. [Music] The samples are then sent for detailed analysis to determine if they are cancerous. I would imagine in the last decade, two decades, there’s been huge advancements also in the technology itself. The pancreas plays two vital roles closely tied to our diet. [Music] First, it produces a powerful digestive fluid called pancreatic juice. This fluid flows through the pancreatic duct into the dadum where it breaks down food. Second, it produces various hormones that regulate blood sugar and the secretion of digestive fluids. These hormones travel through the bloodstream to carry out their functions. In recent years, cases of acute and chronic pancreatitis, both marked by inflammation of the pancreas as well as pancreatic cancer, have been increasing. One reason is dietary changes that put more strain on the organ. Pancreatic cancer in particular has increased nearly eight-fold over the past 40 plus years. The later the diagnosis, the lower the 5-year survival rate. A survey in Japan found that just 1.6% of patients diagnosed at stage 4 survive 5 years. Doctors worldwide are working to detect the disease as early as possible using EU. Kato Yasco is among those who have benefited from the procedure. In March 2025, she was diagnosed with stage 1 pancreatic cancer. [Music] Kato had an MRI for another condition which happened to reveal a suspicious change in her pancreas. [Music] She was referred for EU to get a closer look. This is one of the images. [Music] The black tubeike structure is the pancreatic duct. A closer look shows a slight narrowing in the circled area. [Music] [Music] [Music] The doctors went on to examine her pancreatic juice and found she had stage 1 pancreatic cancer. [Music] today. Kato underwent surgery in May 2025. Half of her pancreas was removed and the cancer was completely taken out. She is now receiving oral anti-cancer drugs to prevent recurrence. Foreign [Music] speech. Foreign speech. Foreign speech. [Music] foreign. [Music] Today, EU is used not only for testing but also increasingly for treating pancreatic disease. On this day, it toy treated a patient with chronic pancreatitis. [Music] In chronic pancreatitis, long-term inflammation gradually hardens the pancreas and impairs its function. The disease is thought to increase the risk of pancreatic cancer more than 10fold. Proper treatment is essential. [Music] Chronic pancreatitis often causes narrowing or blockage in the pancreatic duct. This disrupts the flow of pancreatic juice, building up pressure in the duct and causing pain. Usually, doctors insert a stent at the duct’s opening into the dadum to drain the accumulated pancreatic juice and restore smooth flow. [Music] But in this patient’s case, a large stone was blocking the duct near its exit. It toy tried the usual approach, but it proved impossible. So instead, he decided to use EU to insert the stent from the stomach, creating a new route to drain the pancreatic juice into it. The EU scope was advanced into the stomach. [Music] The target was the pancreatic duct located in the pancreas just behind the stomach. He toy inserted a needle into the duct. Then he widened the duct to make it easier to place the stent. For this treatment, he used a special stent he developed himself. It’s straight at one end and curls like a pig’s tail at the other. Until recently, doctors used a straight stent in conventional treatment, but organ movement could cause it to slip further into the duct. With the specially developed stent, the curled end stays firmly inside the stomach. This creates a stable passage between the pancreatic duct and the stomach, allowing pancreatic juice to drain and easing symptoms. [Music] The device is called the IT stent after it toy initials. It has been in use in Japan since 2015. and is already adopted by many hospitals. X-ray images also confirmed that the stent was securely in place. [Music] Without EU, this patient would have needed open surgery. This greatly reduced strain on the patient. I would imagine a huge amount of skill is involved as well. foreignch. [Music] Hi, good to see you. Can you hear me? Good to see you. Very well. Yeah. So, it toy and his team developed a new treatment for patients with advanced pancreatic cancer. has gastric obstruction of hot. It’s called E USG guided gastroenterostomy bypass or EPASS. At the request of doctors overseas, he often demonstrates the procedure live to teach the technique and push slowly and get in and more the pushing. Okay. Fantastic. Thank you so much. Fantastic. In its advanced stages, pancreatic cancer often presses on the neighboring dwadnum, causing it to narrow. This can make eating difficult. Treatment involves connecting the stomach to a part of the small intestine called the gigenum to create a new pathway for food. so patients can eat again. Normally this requires surgery but that can be a major burden on patients undergoing chemotherapy and other treatments who are unable to eat properly. [Music] Ittoy and his team have developed a treatment using EU that achieves the same effect in about 15 minutes. They insert two balloons into the gigenum, inflate them, and fill the space between with water that has been dyed blue. The water shows up clearly on ultrasound, making it easier to confirm the location with EU and carry out a safe procedure. It toy inserts the EU scope into the stomach and observes the inflated ginum to find the best spot to create the bypass. [Music] Once the site is decided, an electric current is used to make openings in the stomach and the gigum. The stent is then placed there. [Music] [Applause] He confirms with the camera that the stent is securely in place. Seeing the blue water that was in the gigum confirms the bypass was created correctly. [Music] Being able to eat properly helps patients maintain their strength. That makes it easier to continue pancreatic cancer treatment. As of 2025, the E-PASS procedure is offered only at ETOY’s hospital. He is working to have it adopted widely in Japan and abroad as soon as possible. The American Society for Gastrointestinal endoscopies former president Robert Haw was among the first to introduce EU in the United States. He hopes Ittoy’s vision and technique will be shared with future generations. The only way you expand a procedure and help more patients is to have more physicians doing a procedure. I’m always impressed because if you ask him a question, he answers it based on an inquisitive nature that he has. I think another aspect uh that I like is um he he’s very interested in in developing younger people. uh and younger people seem to really be attracted to him. He’s got a great sense of humor. Uh he he enjoys life and enjoys people. I expect him to encourage younger people to continue along the pathway that he set forth. It’s such a powerful and such a moving message. Lastly, it toy explains the risk factors for pancreatic diseases such as cancer and chronic pancreatitis. He says people with any of the following seven factors should be cautious in their daily lives. [Music] Drinking alcohol daily for over 10 years. Liking fatty foods. Being obese, lack of exercise, smoking cigarettes, stress from work or personal relationships and diabetes. [Music] I think probably for me stress. And professor, can I ask how about you in terms of exercise? Um, so I have no time to do I’m sure you have no time, right? Cuz I think with alcohol, everybody thinks about the liver. Nobody thinks about the pancreas. We all think about our liver. Many pancreatic diseases progress silently. It toy says that if you notice any of the following eight signs, you should see a doctor right away. [Music] Loss of appetite, weight loss, abdominal bloating, persistent indigestion or heartburn, pain in the upper abdomen or the back. diarrhea or whitish stools, jaundice and worsening of diabetes. [Music] Even if you have only one uh sign, please go to see a doctor. Probably there is some uh list of the such kind of pancreatic diseases. So, uh, please call. That’s great advice. Yeah. I will I’ll go and have it checked out. Yeah. Yeah. So, thank you so much. Thank you. I was deeply impressed by the remarkable advances in diagnosis and treatment using EU and by the incredible dedication of the doctors leading this progress. And as we look ahead to even greater breakthroughs in treatments and research, I’m inspired to be more mindful of my own pancreatic health. And I hope you are, too. [Music]
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Groundbreaking developments in diagnosing and treating pancreatic diseases are providing less invasive options and improved outcomes for patients.