Greetings
Until now, pancreatic and biliary tract diseases, including pancreatic cancer and gallbladder cancer, have been extremely difficult to diagnose and treat, and the difficulty of early detection has been cited as the cause of their poor prognosis. However, endoscopic diagnosis, treatment, and surgery of the pancreas and biliary tract have seen remarkable technological innovation and development in recent years. However, surgery for these diseases is highly challenging, making it one of the most challenging areas of abdominal surgery. While advances in surgical techniques and perioperative management have reduced the incidence of surgery-related deaths and postoperative complications, they remain high. Certified by the Japanese Society of Hepato-Biliary-Pancreatic (HBP) Surgery, a high-level training facility “A” is a facility that performs more than 50 high-level hepato-biliary-pancreatic surgical procedures per year. Our facility is also certified, and high-volume centers tend to have low rates of complications and operative deaths. Furthermore, because it is necessary to provide optimal diagnosis and treatment tailored to each patient's individual condition, including not only diagnosis and surgery but also radiation therapy, chemotherapy, pathological diagnosis, and palliative care, we have recently established Pancreatic and Biliary Diseases Center, where medical care is provided through organic collaboration among the Department of HBP Surgery, HBP gastroenterological medicine, Diagnostic/Interventional Radiology, Medical Oncology, and Diagnostic Pathology under this center, specialists from each department hold regular weekly conferences to provide the best medical care tailored to each patient's condition.
Director of Pancreatic and Biliary Diseases Center
Kenichi Okada
Overview
Department Introduction
Diseases of the pancreas and biliary tract (the bile ducts and gallbladder, which are the pathways for bile) are difficult to diagnose, and malignant tumors in this area are often discovered at an advanced stage. Compared to other cancers, they are considered particularly difficult to treat, and in recent years, this area has seen the occurrence of cancers with particularly high mortality rates. Our hospital opened Pancreatic and Biliary Diseases Cente on April 1, 2024, to address these issues. We provide advanced medical care not only for malignant pancreatic and biliary tract diseases, but also for benign conditions such as gallstones, cholangitis, acute pancreatitis, and chronic pancreatitis. Patients who have been told that treatment is difficult at other hospitals are also welcome to consult with us.
At our center, all relevant departments collaborate and pool their organizational strength to provide treatment and conduct research. Diagnosis, endoscopic procedures, endoscopic treatment, and chemotherapy for pancreatic and biliary tract diseases are primarily handled by Gastroenterology, while invasive procedures, surgery, and pre- and post-operative chemotherapy are handled by Gastroenterological Surgery. Pathologists specializing in the pancreatic and biliary tract, radiologists, interventional radiologists, and cancer treatment specialists well-versed in cancer genomics work closely with their respective teams to advance treatment. Weekly conferences are held to share patient information, determine treatment plans, and provide feedback on post-operative cases. We also regularly hold pathology conferences using pathological tissue from surgical cases.
The role of Pancreatic and Biliary Diseases Center
We provide practical diagnosis and treatment for pancreatic and biliary tract diseases, conduct education and research related to diagnosis and treatment, serve as a consultation service for pancreatic and biliary tract diseases, provide information, and collaborate with other medical institutions.
We will work closely and collaboratively to provide the latest and most appropriate medical care for pancreatic and biliary tract diseases, including both benign and malignant conditions, with the patient at the center of our efforts.
We will be collaborating with medical institutions in western Kanagawa Prefecture and the health checkup department of Tokai University Hospital to advance a project aimed at detecting early-stage pancreatic and biliary tract cancers. Our health checkups include high-quality imaging tests, so we encourage patients concerned about early-stage pancreatic cancer to undergo our health checkup.
Diseases to be diagnosed and treated
Pancreatic diseases: pancreatic cancer, intraductal papillary mucinous neoplasm, pancreatic neuroendocrine tumor, acute pancreatitis, recurrent pancreatitis, chronic pancreatitis, pancreatic stones, severe post-pancreatitis pseudocyst/encapsulated pancreatic necrosis (WON), autoimmune pancreatitis, cystic pancreatic tumor, pancreatic ductal anomaly (pancreatic duct nonfusion)
• Biliary tract diseases: Bile duct cancer, gallbladder cancer, duodenal papilla tumor, common bile duct stones, gallstone cholecystitis, gallbladder polyps, pancreaticobiliary maljunction, anastomotic stricture or bleeding after biliary and pancreatic surgery, intrahepatic bile duct stones, congenital biliary dilatation
• Duodenal diseases: Duodenal tumors, duodenal papilla tumors (adenoma, cancer, and other tumors)
We also provide care for the transition of pediatric biliary and pancreatic diseases into adulthood.
Available treatments and surgeries
• Surgical procedures: Highly complex hepatobiliary and pancreatic surgery, robotic surgery
Medical procedures: ERCP, cholangioscopy, pancreatoscope, electrohydraulic shock wave lithotripsy (EHL), endoscopic ultrasound (EUS), invasive procedures using endoscopic ultrasound (iEUS)
• Specialized procedures at our hospital: Endoscopic papillary tumor resection (EP), extracorporeal shock wave lithotripsy (ESWL) for pancreatic stones, and endoscopic biliary and pancreatic treatment.
Report after the opening of the center
In the Department of Gastroenterological Surgery, we perform approximately 60 pancreatic resections annually (including laparoscopic distal pancreatectomy and robot-assisted distal pancreatectomy) and approximately 60 liver resections (including laparoscopic liver resection and robot-assisted liver resection). We will perform surgeries appropriately, not only for highly complex procedures but also for benign diseases, in cooperation with medical facilities in the Shonan area.
From October 2024 for one year, approximately 200 patients received chemotherapy (approximately 100 cases in Gastroenterological Surgery, approximately 110 cases Gastroenterology, with a total of approximately 2000 intravenous infusions).
Regarding endoscopic ultrasound (EUS) examinations, which are key to diagnosing pancreatic and biliary tract diseases, we have increased the number of examination slots to accommodate this need. In fiscal year 2024, there were 284 cases, but in fiscal year 2025, there will be 403 cases (182 of which will be EUS-FNA). Specialists will perform appropriate observations in a short time under sedation. In addition, as part of various drainage procedures using endoscopic ultrasound, in fiscal year 2025, we performed 19 cases of biliary tract (EUS-HGS), 1 case of pancreatic duct (EUS-PDD), and 19 cases of abscess (EUS-AD).
Regarding endoscopic retrograde cholangiopancreatography (ERCP) procedures, we prioritize safe procedures by limiting them to patients who require them, taking into account the risk of complications. Patients with pancreatic and biliary tract cancer often experience narrowing of the bile ducts and pancreatic ducts, requiring stent placement. We are also seeing an increase in referrals of patients with malignant diseases, with 748 procedures performed in 2024 and 897 in 2025. Prophylactic treatment for asymptomatic common bile duct stones has been reported to have a high incidence of complications, so at our hospital, we decide whether or not to perform treatment only after thorough consultation with the patient.
As a pancreatic and biliary tract disease center, we are equipped with a range of devices including ERCP (four side-view endoscopes), EUS (two radial endoscopes, three convex endoscopes), short and long double-balloon endoscopes, digital cholangioscopy, EHL equipment, and ESWL devices, and we actively incorporate minimally invasive treatments for our patients. In addition, we have a physician (a member of the Japanese Society of Endoscopy Guidelines Committee) who is highly skilled in endoscopic papillary tumor resection, so we would be grateful if you could refer patients with duodenal papillary tumors to us.
Regarding the management of severe pancreatitis, we have collaborated with Professor Tsuchiya of the Department of Emergency Medicine to establish a system that can appropriately handle everything from intensive care management of critically ill patients in the acute phase to specialized treatment for late-stage complications. We will respond to inquiries from physicians at medical institutions, including the transfer of patients with severe pancreatitis, so please contact the biliary and pancreatic team physicians in Gastroenterology.
inquiry
Regarding the diagnosis and treatment of pancreatic and biliary tract cancer (for patients)
If you have no symptoms but are concerned about whether you have pancreatic cancer, please take advantage of our comprehensive health checkup, which includes highly accurate abdominal ultrasound and PET-CT cancer screening. If any abnormalities are found in the screening results, you will receive thorough examination and treatment at Tokai University Hospital.
Furthermore, if you are at risk for pancreatic or biliary tract cancer (elevated pancreatic enzymes, elevated tumor markers, persistent abdominal or back pain, new onset or recent worsening of diabetes, pancreatic cysts, pancreatic duct dilation, chronic pancreatitis, or IPMN pancreatic cystic tumor; or if you have symptoms such as abdominal or back pain and have multiple cases of pancreatic or biliary tract cancer in your family or among first-degree relatives), please consult your primary physician or a doctor at a secondary medical institution first. If it is determined that a detailed examination (MRI, endoscopic ultrasound, ERCP, etc.) is necessary, please ask them to refer you to our Gastroenterology (first-time patients on Wednesdays).
If you have been referred to us for a detailed examination of pancreatic or biliary tract cancer, we will perform as many necessary tests as possible, so please refrain from eating on the day of your appointment. However, please understand that MRI and endoscopic ultrasound examinations are by appointment only, and you will need to return for these tests after your initial consultation.
We cannot answer inquiries regarding individual medical treatments by phone. Please consult with your primary care physician to obtain a referral letter and visit a specialist clinic. We also accept second opinions, so please contact the relevant department at the hospital.
Our hospital is a designated cancer genome medical center and actively utilizes gene panel testing. However, unfortunately, we do not conduct clinical trials for new drugs for pancreatic or biliary tract cancer. If new drug treatment is recommended, we will refer you to a facility that can provide it.
Regarding the diagnosis and treatment of pancreatic and biliary tract cancer (for medical professionals)
Our hospital strives for rapid cancer diagnosis and early initiation of treatment. If your facility determines that a high-risk patient requires further examination, we would appreciate a referral. The initial consultation outpatient clinic for pancreatic and biliary tract diseases is handled by Dr. Iwasaki on Wednesdays (year-round) and Dr. Kawanishi on Thursdays (April-October 2026 only). We have set aside a generous number of appointment slots, so please instruct patients to always make an appointment before coming. If it is determined that a clearly neoplastic lesion requires early diagnosis and treatment, we will see patients at the initial consultation outpatient clinic without an appointment (please ask patients to be patient regarding waiting times). In addition, for patients requiring emergency treatment such as acute pancreatitis, cholangitis, cholecystitis, and jaundice, we will see them on any day of the week without an appointment, so please refer them as needed.
We actively accept transfers of severely ill pancreatitis patients who appear to be suitable for the ICU. The Biliary and Pancreatic Team of Gastroenterology Department will act as the point of contact, and after receiving your call, we will consult with emergency physicians to coordinate the patient's admission. If the criteria for transfer to a higher-level medical institution are met, please contact the Biliary and Pancreatic Team physician via the Hospital-Clinic Liaison Office, or call Gastroenterology directly.