Clinical Endoscopy

Current status of gastrointestinal endoscopy in Thailand: Tanyaporn Chantarojanasiri, Wiriyaporn Ridtitid, Nonthalee Pausawasdi; Received July 13, 2025 Accepted October 26, 2025 Published online December 19, 2025; DOI: https://doi.org/10.5946/ce.2025.230 [Epub ahead of print]

Abstract PDF: The Thai Association for Gastrointestinal Endoscopy (TAGE) has played a pivotal role in advancing gastrointestinal (GI) endoscopy in Thailand through its strategic focus on clinical services, education, and research. Since its establishment in 2005, TAGE has united gastroenterologists and surgeons, helping standardize endoscopic practices across the country. Through national training programs, clinical guideline development, hands-on workshops, and international collaborations, TAGE has elevated the quality and accessibility of endoscopic care. Despite challenges such as workforce shortages and the uneven distribution of services, particularly in rural areas, TAGE continues to address these gaps through outreach training, model development, and regional research initiatives. Society leadership in cholangiocarcinoma management, advanced endoscopy, and educational model innovation reflects its commitment to improving outcomes and establishing Thailand as a regional hub for GI endoscopy.

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Choosing needles wisely: 19-G conventional vs. Franseen needles in endoscopic ultrasound-guided fine-needle aspiration for malignant lymphoma diagnosis and classification: Kajornvit Raghareutai, Worapoth Yingyongthawat, Nonthalee Pausawasdi; Clin Endosc 2024;57(4):473-475. Published online July 29, 2024; DOI: https://doi.org/10.5946/ce.2024.129

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Heparin Wet Suction Versus Conventional Suction in Endoscopic Ultrasound–Guided Fine‐Needle Biopsy for Solid Pancreatic Masses: A Multicenter Randomized Crossover Study
Hyung Ku Chon, Dong Kee Jang, Woo Hyun Paik, Seong‐Hun Kim, Dongwook Oh, Eunae Cho, Se Woo Park, Jung Wan Choe, Eui Joo Kim, Sung Yong Han, Jae Hee Cho, Sang Hyub Lee
Journal of Gastroenterology and Hepatology.2026;[Epub] CrossRef

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Role of Endoscopic Ultrasound-Guided Fine-Needle Aspiration in the Evaluation of Abdominal Lymphadenopathy of Unknown Etiology: Nonthalee Pausawasdi, Kotchakon Maipang, Tassanee Sriprayoon, Phunchai Charatcharoenwitthaya; Clin Endosc 2022;55(2):279-286. Published online January 3, 2022; DOI: https://doi.org/10.5946/ce.2021.218-IDEN

Abstract PDF

Background
/Aims: Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is a standard procedure for obtaining tissue from lesions near the gastrointestinal lumen. However, there is a scarcity of information on the diagnostic performance of EUS-FNA for abdominal lymphadenopathy of unknown causes. To assess the accuracy of EUS-FNA in diagnosing abdominal lymphadenopathy of unknown etiology.
Methods
The EUS records of patients with undiagnosed abdominal lymphadenopathy between 2010 and 2015 were reviewed.
Results
A total of 42 patients were included in this study. Adequate specimens were obtained from 40 patients (95%). The final diagnoses were metastatic cancer (n=16), lymphoma (n=9), tuberculosis (n=8), inflammatory changes (n=6), and amyloidosis (n=1). For diagnosing malignancy, EUS-FNA had a sensitivity of 84.6%, specificity of 95.7%, positive predictive value of 91.7%, negative predictive value of 91.7%, and area under the receiver operating characteristic curve (AUROC) of 0.901. For the diagnosis of lymphoma, EUS-FNA was 100% accurate when combined with cytologic evaluation and immunohistochemical staining. The diagnostic sensitivity decreased to 75%, whereas the specificity remained 100%, for tuberculosis. The overall AUROC was 0.850. No procedure-related complications occurred.
Conclusions
EUS-FNA showed high diagnostic performance for abdominal lymphadenopathy of unknown causes, especially malignancy, lymphoma, and tuberculosis. Therefore, it is a crucial diagnostic tool for this patient population.

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Endoscopic Ultrasound-Guided Fine Needle Biopsy for Periportal Lymphadenopathy: Clinical Utility, Diagnostic Accuracy, and Correlation of Imaging Features with Etiology
J Chudasama, Y Kokate, R Pravin
Endoscopy.2026; 58(S 03): S404. CrossRef
Extrapulmonary tuberculosis presenting with proximal esophageal fistula and abdominal lymphadenopathy in a young man: A case report
Lama Mohamed, Ghassan Elsayed, Mohammed Kambal, Rami Soliman, Sufian Sirelkhatim, Eyad Gadour
World Journal of Clinical Cases.2026;[Epub] CrossRef
Refining the diagnostic strategy for malignant lymphoma: advantages of endoscopic ultrasound-guided fine-needle biopsy over aspiration
Kyong Joo Lee, Se Woo Park
Clinical Endoscopy.2025; 58(5): 701. CrossRef
Endoscopic ultrasound-guided biopsy for TB lymphadenopathy: role of PCR and Gene X-pert
Hussein Hassan Okasha, Rasha M. M. Ahmed, Abeer Abdellatef, Mona A. Wassef, Hossam El-Din Shaaban, Rasha Matar
The Egyptian Journal of Internal Medicine.2025;[Epub] CrossRef
A retrospective study on the comparative use of fine-needle biopsy and aspiration for the diagnosis and classification of malignant lymphoma in Japan
Fumitaka Niiya, Akihiro Nakamura, Yasuo Ueda, Takafumi Ogawa, Naoki Tamai, Masataka Yamawaki, Jun Noda, Tetsushi Azami, Yuichi Takano, Masatsugu Nagahama
Clinical Endoscopy.2025; 58(5): 757. CrossRef
Clinicopathological Spectrum of Intra-Abdominal Lesions Evaluated by Endoscopic Ultrasound-Guided Fine Needle Aspiration Cytology
Fazlur Rahman, Zannatul Ferdous, AHM Towhidul Alam, Manir Hossain Khan, Kaniz Naima, MM Zahidul Islam, Habibur Rahman
Islami Bank Medical College Journal.2025; 20(2): 59. CrossRef
Pancreatobiliary Lymphadenopathy: Etiology, Location, and Factors Predicting Good Yield of Endoscopic Ultrasound-guided Biopsy
Taha Yaseen, Abbas Ali Tasneem, Syed Mudassir Laeeq, Zain Majid, Nasir Hassan Luck
Euroasian journal of hepato-gastroenterology.2024; 14(1): 40. CrossRef
Choosing needles wisely: 19-G conventional vs. Franseen needles in endoscopic ultrasound-guided fine-needle aspiration for malignant lymphoma diagnosis and classification
Kajornvit Raghareutai, Worapoth Yingyongthawat, Nonthalee Pausawasdi
Clinical Endoscopy.2024; 57(4): 473. CrossRef
Diagnostic role of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) in abdominal lymphadenopathy of unknown etiology
Wenli Wang, Chaoqun Han, Xin Ling, Xianwen Guo, Jun Liu, Rong Lin, Zhen Ding
Frontiers in Medicine.2023;[Epub] CrossRef
Detection of Lymphadenopathy as a Precursor to Autoimmune Liver Diseases Before Clinical Hepatitis Became Apparent: A Report of Two Cases
Hiroshi Okano, Hiroki Tanaka, Shimpei Matsusaki, Katsumi Mukai, Akira Nishimura, Kana Asakawa, Youichirou Baba, Tetsuya Murata
Cureus.2023;[Epub] CrossRef
Mediastinal Nodal Staging Performance of Combined Endobronchial and Esophageal Endosonography in Lung Cancer Cases: A Systematic Review and Meta-Analysis
Xiaozhen Liu, Kun Yang, Weihong Guo, Muqi Ye, Shaozhong Liu
Frontiers in Surgery.2022;[Epub] CrossRef
Current role of endoscopic ultrasound for gastrointestinal and abdominal tuberculosis
Hasan Maulahela, Achmad Fauzi, Kaka Renaldi, Qorina P Srisantoso, Amirah Jasmine
JGH Open.2022; 6(11): 745. CrossRef

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Diagnostic Value of Endoscopic Ultrasonography for Common Bile Duct Dilatation without Identifiable Etiology Detected from Cross-Sectional Imaging: Nonthalee Pausawasdi, Penprapai Hongsrisuwan, Lubna Kamani, Kotchakon Maipang, Phunchai Charatcharoenwitthaya; Clin Endosc 2022;55(1):122-127. Published online January 3, 2022; DOI: https://doi.org/10.5946/ce.2021.122

Abstract PDF

Background
/Aims: Endoscopic ultrasonography (EUS) is warranted when cross-sectional imaging demonstrates common bile duct (CBD) dilatation without identifiable causes. This study aimed to assess the diagnostic performance of EUS in CBD dilatation of unknown etiology.
Methods
Retrospective review of patients with dilated CBD without definite causes undergoing EUS between 2012 and 2017.
Results
A total of 131 patients were recruited. The mean age was 63.2±14.1 years. The most common manifestation was abnormal liver chemistry (85.5%). The mean CBD diameter was 12.2±4.1 mm. The area under the receiver operating characteristic curve (AUROC) of EUS-identified pathologies, including malignancy, choledocholithiasis, and benign biliary stricture (BBS), was 0.98 (95% confidence interval [CI], 0.95-1.00). The AUROC of EUS for detecting malignancy, choledocholithiasis, and BBS was 0.91 (95% CI, 0.85-0.97), 1.00 (95% CI, 1.00-1.00), and 0.93 (95% CI, 0.87-0.99), respectively. Male sex, alanine aminotransferase ≥3× the upper limit of normal (ULN), alkaline phosphatase ≥3× the ULN, and intrahepatic duct dilatation were predictors for pathological obstruction, with odds ratios of 5.46 (95%CI, 1.74-17.1), 5.02 (95% CI, 1.48-17.0), 4.63 (95% CI, 1.1-19.6), and 4.03 (95% CI, 1.37-11.8), respectively.
Conclusions
EUS provides excellent diagnostic value in identifying the etiology of CBD dilatation detected by cross-sectional imaging.

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Predictive Clinical Factors for Endoscopic Ultrasound Diagnosis in Undiagnosed Common Bile Duct Dilatation on Cross-Sectional Imaging
Mayank Chotrani, Jay Chudasama, Sanjay Chandnani, Sameet T Patel, Neil Prabhu, Yogita Kokate, Harsh Gandhi, Rishikesh Malokar, Mavuri Vishal, Deepika Pandey, Shubham Jain, Suwayed Khan, Pravin M Rathi
Cureus.2026;[Epub] CrossRef
Development and validation of ‘Gallbladder-CBD diameter-Age-Liver function score’ to determine the need for endoscopic ultrasound in patients with unexplained bile duct dilatation
Aditya Kale, Mayur Satai, Suprabhat Giri, Sridhar Sundaram, Harish Darak, Gautam Jain, Abu Asim Ansari, Prajakta Mane, Nagma Khan, Leela Shinde, Kashmira Kawli, Akash Shukla
Indian Journal of Gastroenterology.2026;[Epub] CrossRef
Iatrogenic bile duct injuries in laparoscopic cholecystectomy: a contemporary review of epidemiology, diagnosis, and management with a clinical case of Roux-en-Y hepaticojejunostomy reconstruction
H.M.H. Karkhani, E.A. Gallyamov, A.S. Vorotyntsev, A.B. Shalygin, A.Yu. Emelyanov, A.A. Gvozdev, M.V. Shubenok
Endoscopic Surgery.2026; 32(3): 42. CrossRef
Endoscopic Ultrasonography Helps to Identify Benign Biliary Neurofibroma
Xuan Bai, Yu Zhang, Ting Li, Zan Zuo
Digestive Diseases and Sciences.2025; 70(8): 2581. CrossRef
Incidental findings of gallbladder and bile ducts – Management strategies: Normal findings, anomalies, “silent gallstones” and bile duct dilatation - A World Federation of Ultrasound in Medicine and Biology (WFUMB) position paper
Christian Jenssen, Christian P. Nolsøe, Torben Lorentzen, Jae Young Lee, Nitin Chaubal, Kathleen Möller, Caroline Ewertsen, Xin Wu Cui, Edda Leonor Chaves, Alina Popescu, Yi Dong, Christoph F. Dietrich
WFUMB Ultrasound Open.2024; 2(1): 100034. CrossRef
Diagnostic yield of endoscopic ultrasound in dilated common bile duct with non-diagnostic cross-sectional imaging
Ankit Mahajan, Kshaunish Das, Kishalaya, Debashis Misra, Kausik Das, Gopal Krishna Dhali
BMC Gastroenterology.2024;[Epub] CrossRef
Role of endoscopic ultrasound in the evaluation of unexplained extrahepatic bile duct dilatation
Long-Jiang Chen, Xiao-Yi Wang, Jian-Hua Dai, Zhi-Gang Tang
European Journal of Gastroenterology & Hepatology.2023; 35(1): 73. CrossRef
The Endoscopic Retrograde Cholangiopancreatography and Endoscopic Ultrasound Connection: Unity Is Strength, or the Endoscopic Ultrasonography Retrograde Cholangiopancreatography Concept
Claudio Giovanni De Angelis, Eleonora Dall’Amico, Maria Teresa Staiano, Marcantonio Gesualdo, Mauro Bruno, Silvia Gaia, Marco Sacco, Federica Fimiano, Anna Mauriello, Simone Dibitetto, Chiara Canalis, Rosa Claudia Stasio, Alessandro Caneglias, Federica Me
Diagnostics.2023; 13(20): 3265. CrossRef
Value of Endoscopic Ultrasonography in Evaluating Unexplained Isolated Common Bile Duct Dilation on Imaging
Seifeldin Hakim, Amrita Sethi
Clinical Endoscopy.2022; 55(1): 47. CrossRef

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Perception of Gastrointestinal Endoscopy Personnel on Society Recommendations on Personal Protective Equipment, Case Selection, and Scope Cleaning During Covid-19 Pandemic: An International Survey Study: Parit Mekaroonkamol, Kasenee Tiankanon, Rapat Pittayanon, Wiriyaporn Ridtitid, Fariha Shams, Ghias Un Nabi Tayyab, Julia Massaad, Saurabh Chawla, Stanley Khoo, Siriboon Attasaranya, Nonthalee Pausawasdi, Qiang Cai, Thawee Ratanachu-ek, Pradermchai Kongkham, Rungsun Rerknimitr; Clin Endosc 2022;55(2):215-225. Published online September 29, 2021; DOI: https://doi.org/10.5946/ce.2021.051

Abstract PDF Supplementary Material: Background
/Aims: The Thai Association for Gastrointestinal Endoscopy published recommendations on safe endoscopy during the coronavirus disease 2019 (COVID-19) pandemic. This study aimed to assess the practicality and applicability of the recommendations and the perceptions of endoscopy personnel on them.
Methods
A validated questionnaire was sent to 1290 endoscopy personnel globally. Of these, the data of all 330 responders (25.6%) from 15 countries, related to the current recommendations on proper personal protective equipment (PPE), case selection, scope cleaning, and safety perception, were analyzed. Ordinal logistic regression was used to determine the relationships between the variables.
Results
Despite an overwhelming agreement with the recommendations on PPE (94.5%) and case selection (95.5%), their practicality and applicability on PPE recommendations and case selection were significantly lower (p=0.001, p=0.047, p<0.001, and p=0.032, respectively). Factors that were associated with lower sense of safety in endoscopy units were younger age (p=0.004), less working experience (p=0.008), in-training status (p=0.04), and higher national prevalence of COVID-19 (p=0.003). High prevalent countries also had more difficulty implementing the guidelines (p<0.001) and they considered the PPE recommendations less practical and showed lower agreement with them (p<0.001 and p=0.008, respectively). A higher number of in-hospital COVID-19 patients was associated with less agreement with PPE recommendations (p=0.039).
Conclusions
Using appropriate PPE and case selection in endoscopic practice during a pandemic remains a challenge. Resource availability and local prevalence are critical factors influencing the adoption of the current guidelines.

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Gastroduodenal intussusception of a gastrointestinal stromal tumor: a rare cause of acute pancreatitis: Pornpayom Numpraphrut, Sorachat Niltwat, Thammawat Parakonthun, Nonthalee Pausawasdi; Clin Endosc 2022;55(3):447-451. Published online June 22, 2021; DOI: https://doi.org/10.5946/ce.2021.073

Abstract PDF Supplementary Material

Patients with symptomatic gastrointestinal stromal tumor (GIST) typically present with gastrointestinal bleeding and abdominal pain. This report presents an unusual case of fundic GIST complicated by gastroduodenal intussusception, manifesting as acute pancreatitis. The patient presented with epigastric pain and pancreatic enzyme elevation; thus, he was diagnosed with acute pancreatitis. Computed tomography showed evidence of pancreatitis and a 4×4.7 cm well-defined hyperdense lesion in the 2nd part of the duodenum, compressing the pancreatic head and pancreatic duct. Esophagogastroduodenoscopy revealed invagination of the gastric folds into the duodenum, causing pyloric canal blockage consistent with gastroduodenal intussusception. Spontaneous reduction of the lesion during endoscopy revealed a 4 cm pedunculated subepithelial mass with central ulceration originating from the gastric fundus. Endoscopic ultrasound demonstrated a heterogeneous hypoechoic lesion originating from the 4th layer of the gastric wall. Laparoscopic-endoscopic intragastric wedge resection of the fundic lesion was subsequently performed, and surgical histology confirmed GIST.

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A case report of gastroduodenal intussusception caused by gastric gastrointestinal stromal tumor
Congpu Wen, Shengwei Ji, Maowei Pei, Lili Jin
Frontiers in Oncology.2026;[Epub] CrossRef
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Soumyadip Sain, Vidit A. Dholakia, Suvendu Sekhar Jena, Amitabh Yadav, Samiran Nundy
American Journal of Case Reports.2026;[Epub] CrossRef
Pathological lead points in pediatric secondary intussusception
Jinrong Chen, Fengguang Ye, Weicheng Huang, Yanhui Wang, Huafang Li, Xiuhui Cai, Wenyou Chen
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Gastric endophytic gastrointestinal stromal tumor (GIST) as a rare cause of gastroduodenal intussusception: case report and literature review
Shengwei Ji, Weijie Chen, Beiwei Zhu, Maowei Pei
Diagnostic Pathology.2025;[Epub] CrossRef
Gastroduodenal Intussusception Due to a Gastric Gastrointestinal Stromal Tumor in Adult from Sonographer's Perspective
Ge, MD Xifeng, Liu, MD Wenzheng, Chen, MD Wen, Mei, MD Fang, Cui, MD Ligang
ADVANCED ULTRASOUND IN DIAGNOSIS AND THERAPY.2024; 8(4): 255. CrossRef
Gastroduodenal intussusception caused by gastric gastrointestinal stromal tumor in adults: a case report and literature review
Wenbing Zhang, Haifeng Chen, Lulu Zhu, Zhiyuan Kong, Tingting Wang, Weiping Li
Journal of International Medical Research.2022;[Epub] CrossRef

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What You Need to Know Before Performing Endoscopic Ultrasound-guided Hepaticogastrostomy: Tanyaporn Chantarojanasiri, Thawee Ratanachu-Ek, Nonthalee Pausawasdi; Clin Endosc 2021;54(3):301-308. Published online May 28, 2021; DOI: https://doi.org/10.5946/ce.2021.103

Abstract PDF

Endoscopic retrograde cholangiopancreatography (ERCP) is the primary treatment modality for bile duct obstruction. When ERCP is unsuccessful, percutaneous transhepatic biliary drainage can be an alternative method. Endoscopic ultrasound-guided biliary drainage (EUS-BD) has emerged as a treatment option for biliary obstruction, especially after ERCP failure. EUS-BD offers transluminal intrahepatic and extrahepatic drainage through a transgastric and transduodenal approach. EUS-guided hepaticogastrostomy (EUS-HGS) is an excellent choice for patients with hilar strictures or those with a surgically altered anatomy. The optimal steps in EUS-HGS are case selection, bile duct visualization, puncture-site selection, wire insertion and manipulation, tract dilation, and stent placement. Caution should be taken at each step to prevent complications. Dedicated devices for EUS-HGS have been developed to improve the technical success rate and reduce complications. This technical review focuses on the essential practical points at each step of EUS-HGS.

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Bridging the Gap between Literature and Practice: Nationwide Outcomes of Endoscopic Ultrasound-guided Hepatico-gastrostomy
David M. de Jong, Lydi M.J.W. van Driel, Jurriën G.P. Reijnders, Akin Inderson, Jan Werner Poley, Roy L.J. van Wanrooij, Rogier P. Voermans, Paul Didden, Thomas R. de Wijkerslooth, Foke van Delft, Niels G. Venneman, Robert C. Verdonk, Johanna P. van Nes,
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Quality Indicators for EUS
Girish Mishra, Anne Marie Lennon, Nonthalee Pausawasdi, Vanessa M. Shami, Reem Z. Sharaiha, B. Joseph Elmunzer
American Journal of Gastroenterology.2025; 120(5): 973. CrossRef
Quality indicators for EUS
Girish Mishra, Anne Marie Lennon, Nonthalee Pausawasdi, Vanessa M. Shami, Reem Z. Sharaiha, B. Joseph Elmunzer
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Junichi Nakamura, Takeshi Ogura, Saori Ueno, Atsushi Okuda, Nobu Nishioka, Yuki Uba, Mitsuki Tomita, Kimi Bessho, Nobuhiro Hattori, Hiroki Nishikawa
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Saburo Matsubara, Keito Nakagawa, Kentaro Suda, Takeshi Otsuka, Masashi Oka, Sumiko Nagoshi
Journal of Clinical Medicine.2022; 11(6): 1591. CrossRef
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Journal of Digestive Endoscopy.2022; 13(02): 082. CrossRef

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Redesigning the Landscape for Women and Leadership: Insights Gained from the Covid-19 Pandemic. On Behalf of Women in Gastroenterology Network Asia Pacific (WIGNAP) and Women in Endoscopy (WIE): Lubna Kamani, Nonthalee Pausawasdi, Jeanin E.Van Hooft, Amrita Sethi, Sharmila Sachithanandan; Clin Endosc 2020;53(5):620-622. Published online September 29, 2020; DOI: https://doi.org/10.5946/ce.2020.202

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Feminist transformative leadership for health equity in the Asia Pacific region
Johanna Riha, Zaida Orth, Pascale Allotey
Gender & Development.2025; 33(2): 449. CrossRef
The Emerging Leaders Committee: Turning a new page for APAGE to nurture the next generation of Asia‐Pacific leaders in digestive health
Rashid N. Lui, Ting Ting Chan, Tanyaporn Chantarojanasiri, Mu‐Ming Chien, Viet‐Hang Dao, Jalpa Devi, Daniel Q. Huang, Eun‐Hyo Jin, Tsevelnorov Khurelbaatar, Zaheer Nabi, Koji Otani, Mara Teresa T. Panlilio, Sang Hyoung Park, Rabbinu Rangga Pribadi, Yuqi Q
Journal of Gastroenterology and Hepatology.2024; 39(8): 1453. CrossRef

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Successful Closure of a Benign Refractory Tracheoesophageal Fistula Using an Over-the-Scope Clip after Failed Esophageal Stent Placement and Surgical Management: Nonthalee Pausawasdi, Chotirot Angkurawaranon, Tanyaporn Chantarojanasiri, Arunchai Chang, Wanchai Wongkornrat, Somchai Leelakusolvong, Asada Methasate; Clin Endosc 2020;53(3):361-365. Published online October 28, 2019; DOI: https://doi.org/10.5946/ce.2019.106

Abstract PDF Supplementary Material

Tracheoesophageal fistulas (TEFs) have traditionally been managed surgically, but the endoscopic approach is widely performed as a less invasive alternative. Different closure techniques have been proposed with inconsistent results. An over-the-scope clip (OTSC) appears to be a reasonable option, but long-term results have not been well defined. We report the long-term outcomes of a complex case of successful closure of a benign refractory TEF using an OTSC after failed surgical management and esophageal stent placement.

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Xin Li, Rongfen Wei, Jianfu Qin, Fei Qin, Peng Peng, Mengbin Qin, Shiquan Liu, Jiean Huang, Piero Chirletti
Gastroenterology Research and Practice.2021; 2021: 1. CrossRef

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