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Original Article
Safety and efficacy of trans-afferent loop endoscopic ultrasound-guided pancreaticojejunostomy for post pancreaticoduodenectomy anastomotic stricture using the forward-viewing echoendoscope: a retrospective study from Japan
Ahmed Sadek, Kazuo Hara, Nozomi Okuno, Shin Haba, Takamichi Kuwahara, Toshitaka Fukui, Minako Urata, Takashi Kondo, Yoshitaro Yamamoto, Kenneth Tachi
Received April 12, 2024  Accepted May 31, 2024  Published online August 26, 2024  
DOI: https://doi.org/10.5946/ce.2024.089    [Epub ahead of print]
Graphical AbstractGraphical Abstract AbstractAbstract PDFSupplementary MaterialPubReaderePub
Background
/Aims: Endoscopic ultrasound (EUS)-guided pancreatic duct drainage is a well-established procedure for managing pancreaticojejunostomy anastomotic strictures (PJAS) post-Whipple surgery. In this study, we examined the effectiveness and safety of EUS-guided pancreaticojejunostomy (EUS-PJS).
Methods
This retrospective, single-arm study was performed at Aichi Cancer Center Hospital on 10 patients who underwent EUS-guided pancreaticojejunostomy through the afferent jejunal loop using a forward-viewing echoendoscope when endoscopic retrograde pancreatography failed. Our primary endpoint was technical success rate, defined as successful stent insertion. The secondary endpoints were early and late adverse events.
Results
A total of 10 patients underwent EUS-PJS between February 2019 and October 2023. The technical success rate was 100%. The median procedure time was 23.5 minutes. No remarkable early or late adverse events related to the procedure, except for fever, occurred in two patients. The median follow-up duration was 9.5 months, and the median number of stent exchanges was two. A stent-free state was achieved in three patients.
Conclusions
EUS-PJS for PJAS management after pancreaticoduodenectomy appears to be an effective and safe procedure with the potential advantages of fewer reinterventions and the creation of a permanent drainage fistula.
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Systematic Review and Meta-analysis
Coaxial plastic stent placement within lumen-apposing metal stents for the management of pancreatic fluid collections: a systemic review and meta-analysis
Jad AbiMansour, Veeravich Jaruvongvanich, Saran Velaga, Ryan Law, Andrew C. Storm, Mark Topazian, Michael J. Levy, Ryan Alexander, Eric J. Vargas, Aliana Bofill-Garica, John A. Martin, Bret T. Petersen, Barham K. Abu Dayyeh, Vinay Chandrasekhara
Clin Endosc 2024;57(5):595-603.   Published online July 24, 2024
DOI: https://doi.org/10.5946/ce.2023.297
Graphical AbstractGraphical Abstract AbstractAbstract PDFSupplementary MaterialPubReaderePub
Background
/Aims: Coaxial placement of double pigtail plastic stents (DPPS) through lumen-apposing metal stents (LAMSs) is commonly performed to reduce the risk of LAMS obstruction, bleeding, and stent migration when used for the drainage of pancreatic fluid collections (PFCs). A systematic review and meta-analysis were performed to compare the outcomes of LAMS alone and LAMS with coaxial DPPS placement in the management of PFCs.
Methods
A systematic review was conducted to identify studies comparing LAMS and LAMS/DPPS for PFC drainage. Primary outcomes included the rate of clinical success, overall adverse events (AEs), bleeding, infection, occlusion, and stent migration. The pooled effect size was summarized using a random-effects model and compared between LAMS and LAMS/DPPS by calculating odds ratios (ORs).
Results
Nine studies involving 709 patients were identified (338 on LAMS and 371 on LAMS/DPPS). LAMS/DPPS was associated with a reduced risk of stent obstruction (OR, 0.59; p=0.004) and infection (OR, 0.55; p=0.001). No significant differences were observed in clinical success (OR, 0.96; p=0.440), overall AEs (OR, 0.57; p=0.060), bleeding (OR, 0.61; p=0.120), or stent migration (OR, 1.03; p=0.480).
Conclusions
Coaxial DPPS for LAMS drainage of PFCs is associated with a reduced risk of stent occlusion and infection; however, no difference was observed in the overall AE rates or bleeding.
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Review
Advances in self-expandable metal stents for endoscopic ultrasound-guided interventions
Dong Kee Jang, Dong Wook Lee, Seong-Hun Kim, Kwang Bum Cho, Sundeep Lakhtakia
Clin Endosc 2024;57(5):588-594.   Published online July 9, 2024
DOI: https://doi.org/10.5946/ce.2023.169
AbstractAbstract PDFPubReaderePub
Endoscopic ultrasound (EUS)-guided interventions have evolved rapidly in recent years, with dedicated metal stents playing a crucial role in this process. Specifically, the invention of biflanged short metal-covered stents, including lumen-apposing metal stents (LAMS), and modifications in a variety of tubular self-expandable metal stents (SEMS), have led to innovations in EUS-guided interventions. LAMS or non-LAMS stents are commonly used in the EUS-guided drainage of pancreatic fluid collections, especially in cases of walled-off necrosis. Additionally, LAMS is commonly considered for drainage of the EUS-guided gallbladder or dilated common bile duct and EUS-guided gastroenterostomy. Fully or partially covered tubular SEMS with several new designs are being considered for EUS-guided biliary drainage. This review focuses on advances in SEMS for EUS-guided interventions and discusses related research results.
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Original Article
Effectiveness of endoscopic ultrasound-guided tissue acquisition with stereomicroscopic on-site evaluation for preoperative diagnosis of resectable or borderline resectable pancreatic cancer: a prospective study
Junro Ishizaki, Kosuke Okuwaki, Masafumi Watanabe, Hiroshi Imaizumi, Tomohisa Iwai, Rikiya Hasegawa, Takahiro Kurosu, Masayoshi Tadehara, Takaaki Matsumoto, Kai Adachi, Taro Hanaoka, Mitsuhiro Kida, Chika Kusano
Received October 25, 2023  Accepted January 15, 2024  Published online May 24, 2024  
DOI: https://doi.org/10.5946/ce.2023.277    [Epub ahead of print]
Graphical AbstractGraphical Abstract AbstractAbstract PDFPubReaderePub
Background
/Aims: To validate endoscopic ultrasound-guided tissue acquisition (EUS-TA) used in conjunction with stereomicroscopic on-site evaluation (SOSE) as a preoperative diagnostic tool for resectable pancreatic cancer (R-PC) and borderline resectable PC (BR-PC).
Methods
Seventy-eight consecutive patients who underwent EUS-TA for suspected R-PC or BR-PC were enrolled. The primary endpoint was the sensitivity of EUS-TA together with SOSE based on the stereomicroscopically visible white core (SVWC) cutoff value. One or two sites were punctured by using a 22-gauge biopsy needle for EUS-TA, based on the SOSE findings.
Results
We collected 99 specimens from 56 and 22 patients with R-PC and BR-PC, respectively. Based on the SOSE results, we performed 57 procedures with one puncture. The SVWC cutoff values were met in 73.7% and 73.1% of all specimens and in those obtained during the first puncture, respectively. The final diagnoses were malignant and benign tumors in 76 and two patients, respectively. The overall sensitivity, specificity, and accuracy of EUS-TA for the 78 lesions were 90.8%, 100%, and 91.0%, respectively. The sensitivity for malignant diagnosis based on the SVWC cutoff value were 89.5% and 90.4% for the first puncture and all specimens, respectively.
Conclusions
The sensitivity of EUS-TA in conjunction with SOSE for malignancy diagnosis in patients with suspected R-PC or BR-PC was 90.4%.
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Review
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
Received October 3, 2023  Accepted November 1, 2023  Published online May 17, 2024  
DOI: https://doi.org/10.5946/ce.2023.254    [Epub ahead of print]
AbstractAbstract PDFPubReaderePub
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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Original Articles
Outcomes of partially covered self-expandable metal stents with different uncovered lengths in endoscopic ultrasound-guided hepaticogastrostomy: a Japanese retrospective study
Takeshi Okamoto, Takashi Sasaki, Tsuyoshi Takeda, Tatsuki Hirai, Takahiro Ishitsuka, Manabu Yamada, Hiroki Nakagawa, Takafumi Mie, Takaaki Furukawa, Akiyoshi Kasuga, Masato Ozaka, Naoki Sasahira
Clin Endosc 2024;57(4):515-526.   Published online May 10, 2024
DOI: https://doi.org/10.5946/ce.2023.142
Graphical AbstractGraphical Abstract AbstractAbstract PDFSupplementary MaterialPubReaderePub
Background
/Aims: The optimal length of the uncovered portion of partially covered self-expandable metal stents (PCSEMSs) used in endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) remains unclear. This study investigated the safety and efficacy of PCSEMSs with different uncovered lengths, with a focus on stent migration and time to recurrent biliary obstruction (RBO).
Methods
Outcomes of patients undergoing EUS-HGS using PCSEMSs with 5-mm and 20-mm uncovered portions at our institution from January 2016 to December 2021 were compared.
Results
Sixty-two patients underwent EUS-HGS using PCSEMS (5/20-mm uncovered portions: 32/30). Stent migration occurred only in the 5-mm group. There were no differences in RBO rates (28.1% vs. 40.0%) or median time to RBO (6.8 vs. 7.1 months) between the two groups. Median overall survival (OS) was longer in the 20-mm group (3.1 vs. 4.9 months, p=0.037) due to the higher number of patients that resumed chemotherapy after EUS-HGS (56.7% vs. 28.1%, p=0.029). Good performance status, absence of hepatic metastases, and chemotherapy after EUS-HGS were independent predictors of longer OS.
Conclusions
No migration was observed in patients treated with PCSEMS with 20-mm uncovered portions. Patients treated with PCSEMS with 20-mm uncovered portions performed at least as well as those treated with 5-mm uncovered portions in all material respects.

Citations

Citations to this article as recorded by  
  • Migration of covered expandable metal stents after endoscopic ultrasound-guided hepaticogastrostomy: stent covering versus stent design?
    Todd H. Baron
    Clinical Endoscopy.2024; 57(4): 471.     CrossRef
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  • 1 Crossref
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Endoscopic ultrasound-guided gastrojejunostomy with a direct technique without previous intestinal filling using a tubular fully covered self-expandable metallic stent
Hakan Şentürk, İbrahim Hakkı Köker, Koray Koçhan, Sercan Kiremitçi, Gülseren Seven, Ali Tüzün İnce
Clin Endosc 2024;57(2):209-216.   Published online July 3, 2023
DOI: https://doi.org/10.5946/ce.2023.022
Graphical AbstractGraphical Abstract AbstractAbstract PDFSupplementary MaterialPubReaderePub
Background
/Aims: Endoscopic ultrasonography-guided gastrojejunostomy is a minimally invasive method for the management of gastric outlet obstruction. Conventionally, a lumen-apposing metal stent (LAMS) is used to create an anastomosis. However, LAMS is expensive and not widely available. In this report, we described a tubular fully covered self-expandable metallic stent (T-FCSEMS) for this purpose.
Methods
Twenty-one patients (15 men [71.4%]; median age, 66 years; range, 40–87 years) were included in this study. A total of 19 malignant (12 pancreatic, 6 gastric, and 1 metastatic rectal cancer) and 2 benign cases were observed. The proximal jejunum was punctured with a 19 G needle. The stomach and jejunum walls were dilated with a 6 F cystotome, and a 20×80 mm polytetrafluoroethylene T-FCSEMS (Hilzo) was deployed. Oral feeding was initiated after 12 to 18 hours and solid foods after 48 hours.
Results
The median procedure time was 33 minutes (range, 23–55 minutes). After two weeks, 19 patients tolerated oral feeding. In patients with malignancy, the median survival time was 118 days (range, 41–194 days). No serious complications or deaths occurred. All patients with malignancy tolerated oral food intake until they expired.
Conclusions
T-FCSEMS is safe and effective. This stent should be considered as an alternative to LAMS for gastric outlet obstruction.

Citations

Citations to this article as recorded by  
  • Tubular fully covered self-expandable metallic stents for endoscopic ultrasound-guided gastrojejunostomy: moving forward or taking a step back?
    Rami G. El Abiad, Mouen A. Khashab
    Clinical Endoscopy.2024; 57(2): 193.     CrossRef
  • Advances in self-expandable metal stents for endoscopic ultrasound-guided interventions
    Dong Kee Jang, Dong Wook Lee, Seong-Hun Kim, Kwang Bum Cho, Sundeep Lakhtakia
    Clinical Endoscopy.2024; 57(5): 588.     CrossRef
  • Endoscopic stenting for malignant gastric outlet obstruction: focusing on comparison of endoscopic stenting and surgical gastrojejunostomy
    Sun Gyo Lim, Chan Gyoo Kim
    Clinical Endoscopy.2024; 57(5): 571.     CrossRef
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  • 2 Web of Science
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Clinical outcomes of permanent stenting with endoscopic ultrasound gallbladder drainage
Eisuke Suzuki, Yuji Fujita, Kunihiro Hosono, Yuji Koyama, Seitaro Tsujino, Takuma Teratani, Atsushi Nakajima, Nobuyuki Matsuhashi
Clin Endosc 2023;56(5):650-657.   Published online April 5, 2023
DOI: https://doi.org/10.5946/ce.2022.190
Graphical AbstractGraphical Abstract AbstractAbstract PDFPubReaderePub
Background
/Aims: Endoscopic ultrasound gallbladder drainage (EUS-GBD) is gaining attention as a treatment method for cholecystitis. However, only a few studies have assessed the outcomes of permanent stenting with EUS-GBD. Therefore, we evaluated the clinical outcomes of permanent stenting using EUS-GBD.
Methods
This was a retrospective, single-center cohort study. The criteria for EUS-GBD at our institution are a high risk for surgery, inability to perform surgery owing to poor performance status, and inability to obtain consent for emergency surgery. EUS-GBD was performed using a 7-Fr double-pigtail plastic stent with a dilating device. The primary outcomes were the recurrence-free rate of cholecystitis and the late-stage complication-avoidance rate. Secondary outcomes were technical success, clinical success, and procedural adverse events.
Results
A total of 41 patients were included in the analysis. The median follow-up period was 168 (range, 10–1,238) days. The recurrence-free and late-stage complication-avoidance rates during the follow-up period were 95% (38 cases) and 90% (36 cases), respectively. There were only two cases of cholecystitis recurrence during the study period.
Conclusions
EUS-GBD using double-pigtail plastic stent was safe and effective with few complications, even in the long term, in patients with acute cholecystitis.

Citations

Citations to this article as recorded by  
  • Revolutionizing outcomes: endoscopic ultrasound-guided gallbladder drainage using innovative electrocautery enhanced-lumen apposing metal stents for high-risk surgical patients
    Hyung Ku Chon, Yun Chae Lee, Tae Hyeon Kim, Seung Ok Lee, Seong-Hun Kim
    Scientific Reports.2024;[Epub]     CrossRef
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Medical disputes related to advanced endoscopic procedures with endoscopic retrograde cholangiopancreatography or endoscopic ultrasonography for the management of pancreas and biliary tract diseases
Yoon Suk Lee, Jae-Young Jang, Jun Yong Bae, Eun Hye Oh, Yehyun Park, Yong Hwan Kwon, Jeong Eun Shin, Jun Kyu Lee, Tae Hee Lee, Chang Nyol Paik
Clin Endosc 2023;56(4):499-509.   Published online March 28, 2023
DOI: https://doi.org/10.5946/ce.2022.208
Graphical AbstractGraphical Abstract AbstractAbstract PDFSupplementary MaterialPubReaderePub
Background
/Aims: This study aimed to evaluate the characteristics of endoscopic retrograde cholangiopancreatography (ERCP) or endoscopic ultrasonography (EUS)-related adverse events (AEs) that eventually lead to medical disputes or claims on medical professional liability.
Methods
Medical disputes for ERCP/EUS-related AEs filed in the Korea Medical Dispute Mediation and Arbitration Agency between April 2012 and August 2020 were evaluated using corresponding medical records. AEs were categorized into three sections: procedure-related, sedation-related, and safety-related AEs.
Results
Among a total of 34 cases, procedure-related AEs were 26 (76.5%; 12 duodenal perforations, 7 post-ERCP pancreatitis, 5 bleedings, 2 perforations combined with post-ERCP pancreatitis); sedation-related AEs were 5 (14.7%; 4 cardiac arrests, 1 desaturation), and safety-related AEs were 5 (8.8%; 1 follow-up loss for stent removal, 1 asphyxia, 1 fall). Regarding clinical outcomes, 20 (58.8%) were fatal and eventually succumbed to AEs. For the types of medical institutions, 21 cases (61.8%) occurred at tertiary or academic hospitals, and 13 (38.2%) occurred at community hospitals.
Conclusions
The ERCP/EUS-related AEs filed in Korea Medical Dispute Mediation and Arbitration Agency showed distinct features: duodenal perforation was the most frequent AE, and clinical outcomes were fatal, resulting in at least more than permanent physical impairment.

Citations

Citations to this article as recorded by  
  • Diagnostic Assessment of Endoscopic Ultrasonography–Fine Needle Aspiration Cytology in the Pancreas: A Comparison between Liquid-Based Preparation and Conventional Smear
    Jung-Soo Pyo, Dae Hyun Lim, Kyueng-Whan Min, Nae Yu Kim, Il Hwan Oh, Byoung Kwan Son
    Medicina.2024; 60(6): 930.     CrossRef
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Review
Usefulness of the double-guidewire technique for endoscopic procedures in the field of biliary and pancreatic diseases
Mamoru Takenaka, Masatoshi Kudo
Clin Endosc 2022;55(5):605-614.   Published online August 23, 2022
DOI: https://doi.org/10.5946/ce.2022.032
AbstractAbstract PDFPubReaderePub
The double-guidewire method has been increasingly used in endoscopic procedures for biliary and pancreatic diseases in recent years, including endoscopic retrograde cholangiopancreatography and endoscopic ultrasonography-related procedures. In addition, double-lumen catheters with uneven distal and proximal lumen openings have been introduced, making it possible to easily create a double-guidewire situation, and the usefulness of the double-guidewire technique using uneven double-lumen cannulas has been widely reported. Although the advantages of using two guidewires depend on the particular situation and the appropriate use of the two guidewires, deepening the knowledge of the double-guidewire method will contribute greatly to troubleshooting in daily practice. In this review, the usefulness of the double-guidewire technique is discussed with respect to two main areas: selective insertion of guidewires and devices and biliary cannulation.

Citations

Citations to this article as recorded by  
  • Advancements in Research on Challenges in Selective Biliary Cannulation during Endoscopic Retrograde Cholangiopancreatography (ERCP)
    天雨 张
    Journal of Clinical Personalized Medicine.2024; 03(01): 100.     CrossRef
  • Double-guidewire technique for selective biliary cannulation does not increase the rate of post-endoscopic retrograde cholangiopancreatography pancreatitis in patients with naïve papilla
    Han Taek Jeong, June Hwa Bae, Ho Gak Kim, Jimin Han
    Clinical Endoscopy.2024; 57(2): 226.     CrossRef
  • Dedicated Echoendoscope for Interventional Endoscopic Ultrasound: Comparison with a Conventional Echoendoscope
    Toshio Fujisawa, Shigeto Ishii, Yousuke Nakai, Hirofumi Kogure, Ko Tomishima, Yusuke Takasaki, Koichi Ito, Sho Takahashi, Akinori Suzuki, Hiroyuki Isayama
    Journal of Clinical Medicine.2024; 13(10): 2840.     CrossRef
  • INTRAOPERATIVE SIGNS OF ACUTE BILIARY PANCREATITIS
    S. M. Vasyliuk, O. V. Prudnikov, V. V. Ivanyna, O. S. Tkachuk, N. M. Pavliuk, B. V. Krysa, V. M. Atamaniuk
    Kharkiv Surgical School.2022; (4-5): 55.     CrossRef
  • 3,181 View
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  • 2 Web of Science
  • 4 Crossref
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Original Articles
Comparison of diagnostic performances of slow-pull suction and standard suction in endoscopic ultrasound-guided fine needle biopsy for gastrointestinal subepithelial tumors
Joon Seop Lee, Chang Min Cho, Yong Hwan Kwon, An Na Seo, Han Ik Bae, Man-Hoon Han
Clin Endosc 2022;55(5):637-644.   Published online August 17, 2022
DOI: https://doi.org/10.5946/ce.2021.257
AbstractAbstract PDFPubReaderePub
Background
/Aims: Endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) is integral to the diagnosis of gastrointestinal (GI) subepithelial tumors (SETs). The impact of different EUS-FNB tissue sampling techniques on specimen adequacy and diagnostic accuracy in SETs has not been fully evaluated. This study aimed to compare the diagnostic outcomes of slow-pull (SP) and standard suction (SS) in patients with GI SETs.
Methods
In this retrospective comparative study, 54 patients were enrolled. Medical records were reviewed for location and size of the target lesion, FNB needle type/size, technical order, specimen adequacy, diagnostic yield, and adverse events. The acquisition rate of adequate specimens and diagnostic accuracy were compared according to EUS-FNB techniques.
Results
The mean lesion size was 42.6±36.4 mm, and most patients were diagnosed with GI stromal tumor (75.9%). The overall diagnostic accuracies of the SP and SS techniques were 83.3% and 81.5%, respectively (p=0.800). The rates of obtaining adequate core tissue were 79.6% and 75.9%, respectively (p=0.799). No significant clinical factors affected the rate of obtaining adequate core tissue, including lesion location and size, FNB needle size, and final diagnosis.
Conclusions
SP and SS had comparable diagnostic accuracies and adequate core tissue acquisition for GI SETs via EUS-FNB.

Citations

Citations to this article as recorded by  
  • Endoscopic ultrasound-guided fine-needle aspiration for gastrointestinal subepithelial lesions
    Takuto Hikichi, Minami Hashimoto, Takumi Yanagita, Tsunetaka Kato, Jun Nakamura
    Journal of Medical Ultrasonics.2024; 51(2): 195.     CrossRef
  • What method can we choose if rapid on-site evaluation is not available for the endoscopic ultrasound-guided tissue acquisition of upper gastrointestinal subepithelial lesions?
    Yu Kyung Cho
    Clinical Endoscopy.2024; 57(1): 53.     CrossRef
  • The Diagnostic Approach of Benign Esophageal Tumors: A Narrative Review
    Alex R. Jones, Preksha Vankawala, Tarek Sawas
    Current Treatment Options in Gastroenterology.2024; 22(2): 44.     CrossRef
  • Diagnostic yield of endoscopic and EUS-guided biopsy techniques in subepithelial lesions of the upper GI tract: a systematic review
    Cynthia A. Verloop, Jacqueline A.C. Goos, Marco J. Bruno, Rutger Quispel, Lydi M.J.W. van Driel, Lieke Hol
    Gastrointestinal Endoscopy.2024; 99(6): 895.     CrossRef
  • EUS‐guided tissue acquisition from gastric subepithelial lesions—The optimal technique still remains undecided
    Suprabhat Giri, Sridhar Sundaram
    Australasian Journal of Ultrasound in Medicine.2024;[Epub]     CrossRef
  • An Esophageal Leiomyoma with Cystic Degeneration Mimicking a Malignant Neoplasm
    Gwang Ha Kim, Dong Chan Joo, Moon Won Lee, Bong Eun Lee, Kyungbin Kim
    The Ewha Medical Journal.2023;[Epub]     CrossRef
  • Prevalence, natural progression, and clinical practices of upper gastrointestinal subepithelial lesions in Korea: a multicenter study
    Younghee Choe, Yu Kyung Cho, Gwang Ha Kim, Jun-Ho Choi, Eun Soo Kim, Ji Hyun Kim, Eun Kwang Choi, Tae Hyeon Kim, Seong-Hun Kim, Do Hoon Kim
    Clinical Endoscopy.2023; 56(6): 744.     CrossRef
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Bispectral index-guided propofol sedation during endoscopic ultrasonography
Ayana Okamoto, Ken Kamata, Takeshi Miyata, Tomoe Yoshikawa, Rei Ishikawa, Tomohiro Yamazaki, Atsushi Nakai, Shunsuke Omoto, Kosuke Minaga, Kentaro Yamao, Mamoru Takenaka, Yasutaka Chiba, Toshiharu Sakurai, Naoshi Nishida, Masayuki Kitano, Masatoshi Kudo
Clin Endosc 2022;55(4):558-563.   Published online July 12, 2022
DOI: https://doi.org/10.5946/ce.2022.001
AbstractAbstract PDFPubReaderePub
Background
/Aims: Bispectral index (BIS) monitors process and display electroencephalographic data are used to assess the depth of anesthesia. This study retrospectively evaluated the usefulness of BIS monitoring during endoscopic ultrasonography (EUS).
Methods
This study included 725 consecutive patients who underwent EUS under sedation with propofol. BIS monitoring was used in 364 patients and was not used in 361. The following parameters were evaluated: (1) median dose of propofol; (2) respiratory and circulatory depression; (3) occurrence of body movements; (4) awakening score >8 at the time; and (5) awakening score 2 hours after leaving the endoscopy room.
Results
The BIS group received a significantly lower median dose of propofol than the non-BIS group (159.2 mg vs. 167.5 mg; p=0.015) in all age groups. For patients aged ≥75 years, the reduction in heart rate was significantly lower in the BIS group than in the non-BIS group (1.2% vs. 9.1%; p=0.023). Moreover, the occurrence of body movements was markedly lower in the BIS group than in the non-BIS group (8.5% vs. 39.4%; p<0.001).
Conclusions
During EUS examination, BIS monitoring is useful for maintaining a constant depth of anesthesia, especially in patients 75 years of age or older.

Citations

Citations to this article as recorded by  
  • General anesthesia and/or deep hypnotic state in propofol-based conscious sedation for endoscopy
    Halim Bou Daher, Ali El Mokahal, Mohamad Ali Ibrahim, Rana Yamout, Nour Hochaimi, Chakib Ayoub, Yasser H. Shaib, Ala I. Sharara
    iGIE.2024; 3(2): 286.     CrossRef
  • EEG bispectral index sensor guidance improves accuracy and safety of procedural sedation
    A. Oh, N. Karim, A. Pitt, S. Hodgetts, D.W. Edwards, D. Mullan, H-U. Laasch
    Clinical Radiology.2024;[Epub]     CrossRef
  • Advances in Analgosedation and Periprocedural Care for Gastrointestinal Endoscopy
    Sonja Skiljic, Dino Budrovac, Ana Cicvaric, Nenad Neskovic, Slavica Kvolik
    Life.2023; 13(2): 473.     CrossRef
  • Clinical and economic value of bispectral index monitoring for adequate endoscopic sedation
    Se Woo Park
    Clinical Endoscopy.2022; 55(4): 518.     CrossRef
  • Respiratory Failure during BIS-Guided Sedation in a Patient with Relapsing Polychondritis: A Case Report
    Jaesang Lee, Hosik Moon, Sungjin Hong, Jinyoung Chon, Hyejin Kwon, Hunwoo Park, Jiyung Lee
    Medicina.2022; 59(1): 65.     CrossRef
  • 3,850 View
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  • 5 Web of Science
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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
AbstractAbstract PDFPubReaderePub
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.

Citations

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  • 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
AbstractAbstract PDFPubReaderePub
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.

Citations

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  • 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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Predictive Factors for Differentiating Gastrointestinal Stromal Tumors from Leiomyomas Based on Endoscopic Ultrasonography Findings in Patients with Gastric Subepithelial Tumors: A Multicenter Retrospective Study
Sun Moon Kim, Eun Young Kim, Jin Woong Cho, Seong Woo Jeon, Ji Hyun Kim, Tae Hyeon Kim, Jeong Seop Moon, Jin-Oh Kim, the Research Group for Endoscopic Ultrasound of the Korean Society of Gastrointestinal Endoscopy
Clin Endosc 2021;54(6):872-880.   Published online November 18, 2021
DOI: https://doi.org/10.5946/ce.2021.251
AbstractAbstract PDFPubReaderePub
Background
/Aims: The utility of endoscopic ultrasonography (EUS) for differentiating gastrointestinal stromal tumors (GISTs) and leiomyomas of the stomach is not well known. We aimed to evaluate the ability of EUS for differentiating gastric GISTs and leiomyomas.
Methods
We retrospectively reviewed the medical records of patients with histopathologically proven GISTs (n=274) and leiomyomas (n=87). In two consensus meetings, the inter-observer variability in the EUS image analysis was reduced. Using logistic regression analyses, we selected predictive factors and constructed a predictive model and nomogram for differentiating GISTs from leiomyomas. A receiver operating characteristic (ROC) curve analysis was performed to measure the discrimination performance in the development and internal validation sets.
Results
Multivariate analysis identified heterogeneity (odds ratio [OR], 9.48), non-cardia (OR, 19.11), and older age (OR, 1.06) as independent predictors of GISTs. The areas under the ROC curve of the predictive model using age, sex, and four EUS factors (homogeneity, location, anechoic spaces, and dimpling or ulcer) were 0.916 (sensitivity, 0.908; specificity, 0.793) and 0.904 (sensitivity, 0.908; specificity, 0.782) in the development and internal validation sets, respectively.
Conclusions
The predictive model and nomogram using age, sex and homogeneity, tumor location, presence of anechoic spaces, and presence of dimpling or ulcer on EUS may facilitate differentiation between GISTs and leiomyomas.

Citations

Citations to this article as recorded by  
  • Diagnostic Endoscopic Ultrasound (EUS) of the Luminal Gastrointestinal Tract
    Giovanna Impellizzeri, Giulio Donato, Claudio De Angelis, Nico Pagano
    Diagnostics.2024; 14(10): 996.     CrossRef
  • Endoscopic Ultrasound Advanced Techniques for Diagnosis of Gastrointestinal Stromal Tumours
    Socrate Pallio, Stefano Francesco Crinò, Marcello Maida, Emanuele Sinagra, Vincenzo Francesco Tripodi, Antonio Facciorusso, Andrew Ofosu, Maria Cristina Conti Bellocchi, Endrit Shahini, Giuseppinella Melita
    Cancers.2023; 15(4): 1285.     CrossRef
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    Masaya Iwamuro, Toshiharu Mitsuhashi, Tomoki Inaba, Kazuhiro Matsueda, Teruya Nagahara, Yoji Takeuchi, Hisashi Doyama, Masakatsu Mizuno, Tomoyuki Yada, Yoshinari Kawai, Jun Nakamura, Minoru Matsubara, Hiroko Nebiki, Keiko Niimi, Tatsuya Toyokawa, Ryuta Ta
    Digestive Endoscopy.2023;[Epub]     CrossRef
  • Endoscopic ultrasound artificial intelligence-assisted for prediction of gastrointestinal stromal tumors diagnosis: A systematic review and meta-analysis
    Rômulo Sérgio Araújo Gomes, Guilherme Henrique Peixoto de Oliveira, Diogo Turiani Hourneaux de Moura, Ana Paula Samy Tanaka Kotinda, Carolina Ogawa Matsubayashi, Bruno Salomão Hirsch, Matheus Oliveira Veras, João Guilherme Ribeiro Jordão Sasso, Roberto Pa
    World Journal of Gastrointestinal Endoscopy.2023; 15(8): 528.     CrossRef
  • Prevalence, natural progression, and clinical practices of upper gastrointestinal subepithelial lesions in Korea: a multicenter study
    Younghee Choe, Yu Kyung Cho, Gwang Ha Kim, Jun-Ho Choi, Eun Soo Kim, Ji Hyun Kim, Eun Kwang Choi, Tae Hyeon Kim, Seong-Hun Kim, Do Hoon Kim
    Clinical Endoscopy.2023; 56(6): 744.     CrossRef
  • Significance of Ultrasound Endoscopy in the Differential Diagnosis of Cardiac Leiomyomas and Gastrointestinal Stromal Tumors
    燊 苏
    Advances in Clinical Medicine.2023; 13(11): 17185.     CrossRef
  • The Diagnosis of Small Gastrointestinal Subepithelial Lesions by Endoscopic Ultrasound-Guided Fine Needle Aspiration and Biopsy
    Masanari Sekine, Takeharu Asano, Hirosato Mashima
    Diagnostics.2022; 12(4): 810.     CrossRef
  • Diagnostic accuracy of endoscopic ultrasound with artificial intelligence for gastrointestinal stromal tumors: A meta‐analysis
    Xiao Hua Ye, Lin Lin Zhao, Lei Wang
    Journal of Digestive Diseases.2022; 23(5-6): 253.     CrossRef
  • 4,303 View
  • 187 Download
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Case Report
Endoscopic Ultrasound-Guided Transgastric Puncture and Drainage of an Adrenal Abscess in an Immunosuppressed Patient
Carlos Andrés Regino, Jean Paul Gómez, Gabriel Mosquera-Klinger
Clin Endosc 2022;55(2):302-304.   Published online November 16, 2021
DOI: https://doi.org/10.5946/ce.2021.090
AbstractAbstract PDFPubReaderePub
Adrenal gland infection is a clinical entity of great importance, but it is a largely unrecognized pathology. Immunosuppressed individuals are at a higher risk of presentation. Herein, we describe a young female patient, recently diagnosed with HIV, who presented with severe sepsis due to methicillin-resistant Staphylococcus aureus, associated with a left adrenal abscess. She was initially treated with antibiotics; however, due to the persistence of the systemic inflammatory response and bacteremia, endoscopic ultrasound-guided drainage was performed. This procedure was successful in resolving the clinical situation. Endoscopic ultrasound-guided adrenal gland drainage can be a safe, efficacious, and minimally invasive option for managing antibiotic-refractory adrenal abscesses in immunosuppressed patients.
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Original Article
High Sensitivity of Endoscopic Ultrasound-Guided Fine-Needle Aspiration and Endoscopic Ultrasound-Guided Fine-Needle Biopsy in Lymphadenopathy Caused by Metastatic Disease: A Prospective Comparative Study
Per Hedenström, Vasilis Chatzikyriakos, Roozbeh Shams, Catarina Lewerin, Riadh Sadik
Clin Endosc 2021;54(5):722-729.   Published online March 4, 2021
DOI: https://doi.org/10.5946/ce.2020.283
AbstractAbstract PDFPubReaderePub
Background
/Aims: The diagnostic work-up of lymphadenopathy is challenging but important to determine the correct therapy. Nevertheless, few studies have addressed the topic of endosonography (EUS)-guided tissue acquisition in lymphadenopathy. Therefore, we aimed to evaluate the accuracy and safety of EUS-guided fine-needle biopsy sampling (EUS-FNB) in intrathoracic and intraabdominal lymphadenopathy.
Methods
In a tertiary care center, patients with lymphadenopathy referred for EUS-guided sampling were included prospectively from 2014 to 2019 (NCT02360839). In all cases, EUS-FNB (22 gauge) and EUS-guided fine-needle aspiration (EUS-FNA) (25 gauge) were performed. The patients were randomized to the first needle pass with FNB or FNA. Study outcomes were the diagnostic accuracy and adverse event rate.
Results
Forty-eight patients were included (median age: 69 years [interquartile range, 59–76]; 24/48 females [50%]). The final diagnoses were metastasis (n=17), lymphoma (n=11), sarcoidosis (n=6), and inflammatory disease (n=14). The diagnostic performance of the two modalities was comparable, including a high sensitivity for metastatic nodes (EUS-FNB: 87% vs. EUSFNA: 100%, p=0.5). The sensitivity for lymphoma was borderline superior in favor of EUS-FNB (EUS-FNB: 55% vs. EUS-FNA: 9%, p=0.06). No adverse events were recorded.
Conclusions
In lymphadenopathy, both EUS-FNB and EUS-FNA are safe and highly sensitive for metastatic lymph node detection. Lymphoma diagnosis is challenging regardless of the needle used.

Citations

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  • Transesophageal Bronchoscopic Ultrasound-guided Cryobiopsy (EUS-B-Cryo) for mediastinal lesions in critical airway obstruction: a case series with a systematic review
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    Mitsuru Sugimoto, Tadayuki Takagi, Rei Suzuki, Naoki Konno, Hiroyuki Asama, Yuki Sato, Hiroki Irie, Jun Nakamura, Mika Takasumi, Minami Hashimoto, Tsunetaka Kato, Yuko Hashimoto, Takuto Hikichi, Hiromasa Ohira
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    Flaminia Bellisario, Fabia Attili, Fabrizia Campana, Federica Borrelli de Andreis, Silvia Bellesi, Elena Maiolo, Eleonora Alma, Rosalia Malafronte, Giuseppe Macis, Luigi Maria Larocca, Salvatore Annunziata, Francesco D’Alò, Stefan Hohaus
    Diagnostics.2023; 13(17): 2839.     CrossRef
  • Endoscopic ultrasound fine-needle biopsy vs fine-needle aspiration for lymph nodes tissue acquisition: a systematic review and meta-analysis
    Antonio Facciorusso, Stefano Francesco Crinò, Paraskevas Gkolfakis, Daryl Ramai, Andrea Lisotti, Ioannis S Papanikolaou, Benedetto Mangiavillano, Ilaria Tarantino, Andrea Anderloni, Carlo Fabbri, Konstantinos Triantafyllou, Pietro Fusaroli
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  • A Novel Approach to Classification and Reporting of Lymph Node Fine-Needle Cytology: Application of the Proposed Sydney System
    Elena Vigliar, Gennaro Acanfora, Antonino Iaccarino, Massimo Mascolo, Daniela Russo, Giulia Scalia, Roberta Della Pepa, Claudio Bellevicine, Marco Picardi, Giancarlo Troncone
    Diagnostics.2021; 11(8): 1314.     CrossRef
  • Endoscopic Ultrasound Fine-Needle Biopsy versus Fine-Needle Aspiration for Tissue Sampling of Abdominal Lymph Nodes: A Propensity Score Matched Multicenter Comparative Study
    Antonio Facciorusso, Stefano Francesco Crinò, Nicola Muscatiello, Paraskevas Gkolfakis, Jayanta Samanta, Juliana Londoño Castillo, Christian Cotsoglou, Daryl Ramai
    Cancers.2021; 13(17): 4298.     CrossRef
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Focused Review Series: Endoscopic Ultrasound-Guided Therapeutic Intervention: Focus on Technique and Practical Tips
Endoscopic Ultrasonography-Guided Gastroenterostomy Techniques for Treatment of Malignant Gastric Outlet Obstruction
Ryosuke Tonozuka, Takayoshi Tsuchiya, Shuntaro Mukai, Yuichi Nagakawa, Takao Itoi
Clin Endosc 2020;53(5):510-518.   Published online September 23, 2020
DOI: https://doi.org/10.5946/ce.2020.151
AbstractAbstract PDFPubReaderePub
Gastric outlet obstruction (GOO) can be caused by periampullary malignancies and often leads to a reduction in a patient’s quality of life. Recently, endoscopic ultrasonography-guided gastroenterostomy (EUS-GE) using a lumen-apposing self-expandable metal stent (LAMS) has been developed as a minimally invasive and durable endoscopic treatment for GOO. There are three types of EUS-GE technique: (1) the direct technique; (2) device-assisted techniques, such as a balloon catheter, nasobiliary drainage tube, and ultraslim endoscopy; and (3) EUS-guided double balloon-occluded gastrojejunostomy bypass. Previous reports of EUS-GE with LAMS have shown technical and clinical success rates (regardless of technique and etiology) of 87%–100% and 84%–100%, respectively. Studies comparing EUS-GE and surgical gastrojejunostomy have shown similar success rates, reintervention rates, and cost benefits, with a lower rate of early adverse events in EUS-GE. A comparison of EUS-GE and endoscopic enteral stent placement revealed similar technical success rates, but initial clinical success rate was higher and the rate of stent failure requiring reintervention was lower with EUS-GE.

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Review
Diagnosing Gastric Mesenchymal Tumors by Digital Endoscopic Ultrasonography Image Analysis
Moon Won Lee, Gwang Ha Kim
Clin Endosc 2021;54(3):324-328.   Published online June 18, 2020
DOI: https://doi.org/10.5946/ce.2020.061
AbstractAbstract PDFPubReaderePub
Gastric mesenchymal tumors (GMTs) are incidentally discovered in national gastric screening programs in Korea. Endoscopic ultrasonography (EUS) is the most useful diagnostic modality for evaluating GMTs. The differentiation of gastrointestinal stromal tumors from benign mesenchymal tumors, such as schwannomas or leiomyomas, is important to ensure appropriate clinical management. However, this is difficult and operator dependent because of the subjective interpretation of EUS images. Digital image analysis computes the distribution and spatial variation of pixels using texture analysis to extract useful data, enabling the objective analysis of EUS images and decreasing interobserver and intraobserver agreement in EUS image interpretation. This review aimed to summarize the usefulness and future of digital EUS image analysis for GMTs based on published reports and our experience.

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  • Schwannoma gástrico. Reporte de un caso
    Darío Montes N, Nixon Cevallos R, Rubén Montes N
    Oncología (Ecuador).2024; 34(1): 52.     CrossRef
  • Artificial Intelligence-Based Diagnosis of Gastric Mesenchymal Tumors Using Digital Endosonography Image Analysis
    Dong Chan Joo, Gwang Ha Kim, Moon Won Lee, Bong Eun Lee, Ji Woo Kim, Kwang Baek Kim
    Journal of Clinical Medicine.2024; 13(13): 3725.     CrossRef
  • A combined radiomic model distinguishing GISTs from leiomyomas and schwannomas in the stomach based on endoscopic ultrasonography images
    Xian‐Da Zhang, Ling Zhang, Ting‐Ting Gong, Zhuo‐Ran Wang, Kang‐Li Guo, Jun Li, Yuan Chen, Jian‐Tao Zhang, Ben‐Gong Ye, Jin Ding, Jian‐Wei Zhu, Feng Liu, Duan‐Min Hu, JianGang Chen, Chun‐Hua Zhou, Duo‐Wu Zou
    Journal of Applied Clinical Medical Physics.2023;[Epub]     CrossRef
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    Gwang Ha Kim, Dong Chan Joo, Moon Won Lee, Bong Eun Lee, Kyungbin Kim
    The Ewha Medical Journal.2023;[Epub]     CrossRef
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    Osamu Goto, Mitsuru Kaise, Katsuhiko Iwakiri
    Gut and Liver.2022; 16(3): 321.     CrossRef
  • Schwannoma gástrico. Diagnóstico diferencial de tumores submucosos
    M. Reyes Busta Nistal, Noelia Alcaide Suarez, Luis Fernández Salazar, Daniel Corrales Cruz
    Gastroenterología y Hepatología.2021;[Epub]     CrossRef
  • Scoring systems for differentiating gastrointestinal stromal tumors and schwannomas from leiomyomas in the stomach
    Shotaro Okanoue, Masaya Iwamuro, Takehiro Tanaka, Takuya Satomi, Kenta Hamada, Hiroyuki Sakae, Makoto Abe, Yoshiyasu Kono, Hiromitsu Kanzaki, Seiji Kawano, Yoshiro Kawahara, Hiroyuki Okada
    Medicine.2021; 100(40): e27520.     CrossRef
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Original Article
Feasibility and Accuracy of Transduodenal Endoscopic Ultrasound-Guided Fine-Needle Aspiration of Solid Lesions Using a 19-Gauge Flexible Needle: A Multicenter Study
Germana de Nucci, Maria Chiara Petrone, Nicola Imperatore, Edoardo Forti, Roberto Grassia, Silvia Giovanelli, Laura Ottaviani, Vincenzo Mirante, Giuseppe Sabatino, Carlo Fabbri, Mauro Manno, Paolo Giorgio Arcidiacono, Gianpiero Manes
Clin Endosc 2021;54(2):229-235.   Published online May 25, 2020
DOI: https://doi.org/10.5946/ce.2020.056
AbstractAbstract PDFPubReaderePub
Background
/Aims: Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is the go-to method for obtaining samples from gastrointestinal tract and pancreatic lesions. When the transduodenal approach is utilized, the use of a more flexible needle, such as a nitinol 19-gauge (G) needle, has been recommended. The aim of this study was to evaluate the feasibility and accuracy of 19-G flexible aspiration needles in obtaining samples from solid lesions through a transduodenal approach.
Methods
This was a retrospective analysis of prospectively collected data from eight Italian endoscopy centers. Consecutive patients with solid lesions who underwent transduodenal EUS-FNA with a 19-G flexible needle were included.
Results
A total of 201 patients were enrolled. According to histology, EUS, radiology and 12 months of follow-up, 151 patients had malignant lesions and 50 patients had benign lesions. EUS-FNA was feasible in all cases. An adequate histologic sample was obtained in all except eight cases (96.1%). The sensitivity of EUS-FNA was 92.1% (95% confidence interval [CI], 86.8%–95.7%), and the specificity was 100% (95% CI, 90.5%–100%). The positive predictive value was 100% (95% CI, 93.4%–100%), and the negative predictive value was 74% (95% CI, 62.8%–82.7%). The diagnostic accuracy was 93.5% (95% CI, 89.2%–96.5%).
Conclusions
The transduodenal approach for obtaining samples from solid lesions using a 19-G flexible needle seems feasible and accurate.

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  • Comparation of 5 ml and 10 ml Negative Pressures with Wet-suction Techniques for EUS-FNA of Solid Lesions
    Yuchun Zhu, Yang Su, Peng Yang, Jiaojun Li, Tai Yu, Yi Wang, Xi Zhou, Ming Zhao, Xiaobin Sun, Jing Shan
    Journal of Clinical Gastroenterology.2024;[Epub]     CrossRef
  • Diagnostic Ability of Endoscopic Ultrasound-Guided Tissue Acquisition Using 19-Gauge Fine-Needle Biopsy Needle for Abdominal Lesions
    Kotaro Takeshita, Susumu Hijioka, Yoshikuni Nagashio, Yuta Maruki, Yuki Kawasaki, Kosuke Maehara, Yumi Murashima, Mao Okada, Go Ikeda, Natsumi Yamada, Tetsuro Takasaki, Daiki Agarie, Hidenobu Hara, Yuya Hagiwara, Kohei Okamoto, Daiki Yamashige, Akihiro Oh
    Diagnostics.2023; 13(3): 450.     CrossRef
  • Effect of wet-heparinized suction on the quality of mediastinal solid tumor specimens obtained by endoscopic ultrasound-guided fine-needle aspiration: a retrospective study from a single center
    Bo Xu, Qian Lu, Rong Fang, Xiaojuan Dai, Haiyan Xu, Xiangwu Ding, Huawei Gui
    BMC Gastroenterology.2023;[Epub]     CrossRef
  • Comparison of Endoscopic Ultrasound-Guided Fine Needle Aspiration with 19-Gauge and 22-Gauge Needles for Solid Pancreatic Lesions
    Changjuan Li, Jianwei Mi, Fulai Gao, Xinying Zhu, Miao Su, Xiaoli Xie, Dongqiang Zhao
    International Journal of General Medicine.2021; Volume 14: 10439.     CrossRef
  • 4,705 View
  • 113 Download
  • 6 Web of Science
  • 4 Crossref
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Case Reports
Endoscopic Ultrasound-Guided Vascular Therapy for Portoduodenal Fistula
Tanyaporn Chantarojanasiri, Apichet Sirinawasatien, Chalermrat Bunchorntavakul, Aroon Siripun, Sa-ard Treepongkaruna, Thawee Ratanachu-ek
Clin Endosc 2020;53(6):750-753.   Published online February 13, 2020
DOI: https://doi.org/10.5946/ce.2019.167
AbstractAbstract PDFPubReaderePub
Portoenteric fistula is a rare cause of massive upper gastrointestinal bleeding. Most cases can be treated with radiointervention or surgery, but portoenteric fistula is associated with a high mortality. We reported a case of intermittent massive upper gastrointestinal bleeding in a 33-year-old man with cholangiocarcinoma who underwent surgical resection followed by chemoradiation. A portoduodenal fistula due to chronic duodenal ulceration was identified. The bleeding was successfully controlled by endoscopic ultrasound-guided coil placement through the duodenal bulb using the anchoring technique. Follow-up endoscopy and computed tomography scan showed multiple coil placements between a part of the portal vein and the duodenal bulb without any evidence of portal vein thrombosis. There were no complications, and bleeding did not recur during the 8-month follow-up period.

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  • Management of non-variceal upper gastrointestinal bleeding: role of endoscopic ultrasound-guided treatments
    Chaoqun Han, Xin Ling, Jun Liu, Rong Lin, Zhen Ding
    Therapeutic Advances in Gastroenterology.2022; 15: 175628482110561.     CrossRef
  • A Case of an Internal Pancreatic Stent Penetrating the Portal Vein after Pancreaticoduodenectomy for Ampullary Carcinoma
    Masanobu Taniguchi, Atsushi Mitsunaka, Yumi Zen, Takayuki Higashiguchi, Masaru Nagato, Yasuhisa Tango, Ichiro Nakamura, Tomoaki Nakamura, Hisanori Shiomi
    The Japanese Journal of Gastroenterological Surgery.2022; 55(2): 99.     CrossRef
  • Endoscopic ultrasound-guided portal vein coiling: troubleshooting interventional endoscopic ultrasonography
    Shin Haba, Kazuo Hara, Nobumasa Mizuno, Takamichi Kuwahara, Nozomi Okuno, Akira Miyano, Daiki Fumihara, Moaz Elshair
    Clinical Endoscopy.2022; 55(3): 458.     CrossRef
  • 4,402 View
  • 98 Download
  • 2 Web of Science
  • 3 Crossref
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A remnant choledochal cyst after choledochal cyst excision treated with a lumen-apposing metal stent: a case report
Bo Kyung Kim, Jung Won Chun, Sang Hyub Lee, Ji Kon Ryu, Yong-Tae Kim, Woo Hyun Paik
Clin Endosc 2022;55(4):564-569.   Published online January 8, 2020
DOI: https://doi.org/10.5946/ce.2019.176
AbstractAbstract PDFPubReaderePub
A lumen-apposing metal stent (LAMS) is a saddle-shaped stent with large flanges at both ends, thereby preventing stent migration and helping with approximation of the adjacent structures. We report the case of a 25-year-old female with remnant choledochal cyst which was successfully treated with LAMS after initial treatment failure with a plastic stent. Although complete excision of the cyst is the definite treatment of choledochal cysts, endoscopic ultrasonography-guided cystoduodenostomy can be considered in cases wherein surgery is not feasible and dysplasia is not present. LAMS may be preferred to plastic stents for effective resolution of remnant choledochal cyst and prevention of ascending infection.

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  • Hepatic multiple hyperintense cystic lesions: a rare caroli disease
    Mohammed H. Alsharif, Nagi M. Bakhit, Abdulaziz Alarifi, Elbagir M. Nassir, Abair A. Mahdi, Juman M. Almasaad, Abubaker Y. Elamin, Khalid M. Taha
    THE NEW ARMENIAN MEDICAL JOURNAL.2023; (1, 17 (202): 41.     CrossRef
  • Hepatic multiple hyperintense cystic lesions: a rare caroli disease.
    Mohammed H. Alsharif, Nagi.M Bakhit, Abdulaziz Alarifi, Elbagir M. Nassir, Abair A. Mahdi, Juman M. Almasaad, Abubaker.Y. Elamin, Khalid M. Taha
    THE NEW ARMENIAN MEDICAL JOURNAL.2023; (1, 17 (202): 41.     CrossRef
  • 5,196 View
  • 223 Download
  • 1 Web of Science
  • 2 Crossref
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Focused review series
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
AbstractAbstract PDFPubReaderePub
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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  • Impact of endoscopic ultrasound-guided radiofrequency ablation in managing pancreatic malignancy
    Cosmas Rinaldi Adithya Lesmana
    World Journal of Gastrointestinal Surgery.2023; 15(2): 163.     CrossRef
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    Arkadeep Dhali, Vincent Kipkorir, Bahadar S. Srichawla, Harendra Kumar, Roger B. Rathna, Ibsen Ongidi, Talha Chaudhry, Gisore Morara, Khulud Nurani, Doreen Cheruto, Jyotirmoy Biswas, Leonard R. Chieng, Gopal Krishna Dhali
    International Journal of Surgery.2023; 109(12): 4298.     CrossRef
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    Vaneet Jearth, Surinder S. Rana
    Journal of Digestive Endoscopy.2022; 13(01): 019.     CrossRef
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    Dong Wook Lee, Eun Young Kim
    Digestive Diseases and Sciences.2022; 67(5): 1635.     CrossRef
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    Armando Pereyra-Talamantes, Juan Eduardo Flores-Martín, Marco Antonio Gallaga-Rojas, Jesús Emmanuel Rodríguez-Silverio, Erikc González-Azua, Mario Eduardo Alonso-Calamaco, Enrique Jiménez-Chavarría, Héctor F Noyola-Villalobos
    Revista Mexicana de Cirugía Endoscópica.2022; 23(1-2): 41.     CrossRef
  • Dynamic Doppler Ultrasound Assessment of Tissue Perfusion Is a Better Tool than a Single Vessel Doppler Examination in Differentiating Malignant and Inflammatory Pancreatic Lesions
    Przemysław Dyrla, Arkadiusz Lubas, Jerzy Gil, Marek Saracyn, Maciej Gonciarz
    Diagnostics.2021; 11(12): 2289.     CrossRef
  • Differential diagnosis of solid pancreatic masses
    Julio Iglesias-Garcia, Daniel de la Iglesia-Garcia, José M. Olmos-Martinez, José Lariño-Noia, J. Enrique Dominguez-Muñoz
    Minerva Gastroenterologica e Dietologica.2020;[Epub]     CrossRef
  • 5,769 View
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Case Report
Duodenal Stricture due to Necrotizing Pancreatitis following Endoscopic Ultrasound-Guided Ethanol Ablation of a Pancreatic Cyst: A Case Report
Jung Won Chun, Sang Hyub Lee, Jin Ho Choi, Woo Hyun Paik, Ji Kon Ryu, Yong-Tae Kim
Clin Endosc 2019;52(5):510-515.   Published online July 4, 2019
DOI: https://doi.org/10.5946/ce.2018.191
AbstractAbstract PDFPubReaderePub
The frequency of incidental detection of pancreatic cystic lesions (PCLs) is increasing because of the frequent use of cross-sectional imaging. The appropriate treatment for PCLs is challenging, and endoscopic ultrasound-guided ablation for PCLs has been reported in several studies. Although the feasibility and efficacy of this therapeutic modality have been shown, the safety issues associated with the procedure are still a concern. We present a case of a 61-year-old man who underwent ultrasound-guided ethanol ablation for PCL and needed repeated endoscopic balloon dilatation for severe duodenal stricture caused by necrotizing pancreatitis after the cyst ablation therapy.

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  • Benign Duodenal Stricture Treated with Surgical Correction and Dietary Therapy in a Golden Retriever
    John C. Rowe, Alice A. Huang, Jin Heo, Nolie K. Parnell, Adam J. Rudinsky
    Case Reports in Veterinary Medicine.2020; 2020: 1.     CrossRef
  • Endoscopic ultrasound-guided injective ablative treatment of pancreatic cystic neoplasms
    Chen Du, Ning-Li Chai, En-Qiang Linghu, Hui-Kai Li, Xiu-Xue Feng
    World Journal of Gastroenterology.2020; 26(23): 3213.     CrossRef
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  • 1 Web of Science
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Original Articles
Comparison of Clinical Outcomes between Plastic Stent and Novel Lumen-apposing Metal Stent for Endoscopic Ultrasound-Guided Drainage of Peripancreatic Fluid Collections
Ho Cheol Shin, Chang Min Cho, Min Kyu Jung, Seong Jae Yeo
Clin Endosc 2019;52(4):353-359.   Published online March 13, 2019
DOI: https://doi.org/10.5946/ce.2018.154
AbstractAbstract PDFPubReaderePub
Background
/Aims: Endoscopic ultrasound (EUS)-guided transmural drainage for peripancreatic fluid collections (PFCs) has gained wide acceptance as a nonsurgical intervention. Although a lumen-apposing metal stent (LAMS) was recently introduced, there are few data comparing the clinical outcomes between LAMS and plastic stent (PS) drainage.
Methods
Endoscopy databases of all patients who had undergone EUS-guided drainage for PFCs were searched and the clinical outcomes of EUS-guided drainage according to stent-type used were compared.
Results
A total of 27 patients (median age, 56 years) with PFCs underwent EUS-guided transmural drainage between January 2011 and December 2017. Of these, 17 underwent PS placement and 10 underwent LAMS placement. There was no significant difference in the technical success rate between the 2 groups (94.1% vs. 100%, p=1.0). Procedure time was shorter in the LAMS group compared to that in the PS group (10.6±2.5 min vs. 21.4±9.5 min, p=0.002). Among subjects with clinical success, recurrence of PFC after stent removal occurred in 5 of 12 patients with PS and 4 of 10 with LAMS, without statistical difference (41.7% vs. 40.0%, p=1.0).
Conclusions
Although our study showed similar clinical outcomes for LAMS and PS, further prospective trials are required to validate the superiority of LAMS.

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  • Efficacy and safety of long-term indwelling plastic stents after resolution of pancreatic fluid collections with endoscopic transmural drainage: a systematic review and meta-analysis
    Fadi Hawa, Jean M. Chalhoub, Ana Vilela, Elit Quingalahua, Carol Shannon, George M. Philips, Richard S. Kwon, Erik-Jan Wamsteker, Allison R. Schulman, Matthew J. DiMagno, Jorge D. Machicado
    Surgical Endoscopy.2024; 38(5): 2350.     CrossRef
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    Chen-Shuan Chung, Yu-Ting Kuo, Yi-Chun Chiu, Yang-Chao Lin, Chi-Ying Yang, Kuan-Chih Chen, Szu-Chia Liao, Cheuk-Kay Sun, Yen-Chih Lin, Hsiu-Po Wang
    Scientific Reports.2024;[Epub]     CrossRef
  • Endoscopic management of pancreatic collections. Endoscopic Ultrasound Group from the Spanish Society of Digestive Endoscopy (GSEED-USE) Clinical Guidelines
    Mariano González-Haba Ruiz, María Teresa Betés Ibáñez, Belén Martínez Moreno , Alejandro Repiso Ortega, Carlos de la Serna Higuera, Julio Iglesias García, Oriol Sendino García, María Moris Felgueroso, Belén Agudo Castillo, José Miguel Esteban Lóp
    Revista Española de Enfermedades Digestivas.2024;[Epub]     CrossRef
  • Endoscopic ultrasound-guided pancreatic fluid collection drainage: Where are we?
    Anupam Kumar Singh, Manish Manrai, Rakesh Kochhar
    World Journal of Gastrointestinal Endoscopy.2024; 16(6): 273.     CrossRef
  • Comparative Efficacy and Safety of Different Stent Types for Pancreatic Fluid Collections: A Systematic Review and Network Meta-Analysis
    Faisal Kamal, Muhammad Aziz, Wade Lee-Smith, Sachit Sharma, Ashu Acharya, Muhammad Ali Khan, Umer Farooq, Zahid Ijaz Tarar, Manesh Kumar Gangwani, Umar Hayat, Anand Kumar, Alexander Schlacterman, Thomas Kowalski, Douglas G. Adler
    Digestive Diseases and Sciences.2024; 69(9): 3466.     CrossRef
  • Head‐to‐head comparison between endoscopic ultrasound guided lumen apposing metal stent and plastic stents for the treatment of pancreatic fluid collections: A systematic review and meta‐analysis
    Edson Guzmán‐Calderón, Alfonso Chacaltana, Ramiro Díaz, Bruno Li, Belen Martinez‐Moreno, José Ramón Aparicio
    Journal of Hepato-Biliary-Pancreatic Sciences.2022; 29(2): 198.     CrossRef
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    Tadahiro Takada, Shuji Isaji, Toshihiko Mayumi, Masahiro Yoshida, Yoshifumi Takeyama, Takao Itoi, Keiji Sano, Yusuke Iizawa, Atsushi Masamune, Morihisa Hirota, Kohji Okamoto, Dai Inoue, Nobuya Kitamura, Yasuhisa Mori, Shuntaro Mukai, Seiki Kiriyama, Kunih
    Journal of Hepato-Biliary-Pancreatic Sciences.2022; 29(10): 1057.     CrossRef
  • Comparison Between Lumen-Apposing Metal Stents and Plastic Stents in Endoscopic Ultrasound–Guided Drainage of Pancreatic Fluid Collection
    Yunxiao Lyu, Ting Li, Bin Wang, Yunxiao Cheng, Liang Chen, Sicong Zhao
    Pancreas.2021; 50(4): 571.     CrossRef
  • Current status of treatments of pancreatic and peripancreatic collections of acute pancreatitis
    Nian-Jun Xiao, Ting-Ting Cui, Fang Liu, Wen Li
    World Journal of Gastrointestinal Surgery.2021; 13(7): 633.     CrossRef
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    V. M. Durleshter, S. R. Genrikh, A. V. Makarenko, D. S. Kirakosyan
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    Xianzhu Zhou, Han Lin, Xiaoju Su, Pingping Zhang, Chunting Fu, Xiangyu Kong, Zhendong Jin, Zhaoshen Li, Yiqi Du, Huiyun Zhu
    Journal of Clinical Gastroenterology.2021; 55(8): 652.     CrossRef
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    Gwang Ha Kim, Kwang An Kwon, Do Hyun Park, Jimin Han
    Clinical Endoscopy.2021; 54(5): 633.     CrossRef
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    Shali Tan, Chunyu Zhong, Yutang Ren, Xujuan Luo, Jin Xu, Yan Peng, Xiangsheng Fu, Xiaowei Tang
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    Patrick Suggs, Timothy NeCamp, John Alfred Carr
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    Eun Young Kim, Robert H. Hawes
    Clinical Endoscopy.2019; 52(4): 299.     CrossRef
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  • 14 Web of Science
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The Utility of Endoscopic Ultrasound in Patients with Isolated Elevations in Serum Amylase and/or Lipase
Lalitha M. Sitaraman, Amit H. Sachdev, Tamas A. Gonda, Amrita Sethi, John M. Poneros, Frank G. Gress
Clin Endosc 2019;52(2):175-181.   Published online January 16, 2019
DOI: https://doi.org/10.5946/ce.2018.110
AbstractAbstract PDFPubReaderePub
Background
/Aims: The aim of this study was to describe the diagnostic yield of endoscopic ultrasound (EUS) in patients with isolated elevated levels of amylase and/or lipase.
Methods
A retrospective chart review was conducted at a large academic medical center from 2000 to 2016. Patients were selected based on having elevated amylase, lipase, or both, but without a diagnosis of pancreatitis or known pancreatobiliary disease. Patients were excluded if they had abnormal liver function tests or abnormal imaging of the pancreas.
Results
Of 299 EUS procedures performed, 38 met inclusion criteria. Symptoms were present in 31 patients, most frequently abdominal pain (87%). In 20 patients (53%), initial EUS most commonly found chronic pancreatitis (n=7; 18%), sludge (5; 13%), or new diagnosis of pancreas divisum (3; 8%). In the asymptomatic patients (7), 3 had a finding on EUS, most importantly sludge (2), stone (1), and pancreas divisum (1). No patients were diagnosed with a mass or pancreatic cyst. During the follow up period, 6 patients (22%) had cholecystectomy.
Conclusions
In our study of patients with isolated elevations in amylase and/or lipase without acute pancreatitis who underwent EUS, approximately 50% had a pancreatobiliary finding, most commonly chronic pancreatitis or biliary sludge.

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  • Endosonographic features in patients with non-alcoholic early chronic pancreatitis improved with treatment at one year follow up
    Kazutoshi Higuchi, Seiji Futagami, Hiroshi Yamawaki, Makoto Murakami, Kumiko Kirita, Shuhei Agawa, Go Ikeda, Hiroto Noda, Yasuhiro Kodaka, Nobue Ueki, Keiko Kaneko, Katya Gudis, Ryuji Ohashi, Katsuhiko Iwakiri
    Journal of Clinical Biochemistry and Nutrition.2021; 68(1): 86.     CrossRef
  • Do Patients with Pancreatic Hyperenzymemia without Abnormal Imaging Need Additional Endoscopic Ultrasound?
    Jung Wan Choe, Jong Jin Hyun
    Clinical Endoscopy.2019; 52(2): 97.     CrossRef
  • 9,525 View
  • 162 Download
  • 3 Web of Science
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Predictive Factors for Inaccurate Diagnosis of Swollen Lymph Nodes in Endoscopic Ultrasound-Guided Fine Needle Aspiration
Yuki Fujii, Yoshihide Kanno, Shinsuke Koshita, Takahisa Ogawa, Hiroaki Kusunose, Kaori Masu, Toshitaka Sakai, Keisuke Yonamine, Yujiro Kawakami, Toji Murabayashi, Fumisato Kozakai, Yutaka Noda, Hiroyuki Okada, Kei Ito
Clin Endosc 2019;52(2):152-158.   Published online January 7, 2019
DOI: https://doi.org/10.5946/ce.2018.125
AbstractAbstract PDFPubReaderePub
Background
/Aims: This study aimed to identify the predictive factors for inaccurate endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) diagnosis of swollen lymph nodes without rapid on-site cytopathological evaluation.
Methods
Eighty-three consecutive patients who underwent EUS-FNA for abdominal or mediastinal lymph nodes from January 2008 to June 2017 were included from a prospectively maintained EUS-FNA database and retrospectively reviewed. The sensitivity, specificity, and accuracy of EUS-FNA for the detection of neoplastic diseases were calculated. Candidate factors for inaccurate diagnosis (lymph node size and location, needle type, puncture route, number of passes, and causative disease) were evaluated by comparison between accurately diagnosed cases and others.
Results
The final diagnosis of the punctured lymph node was classified as neoplastic (65 cases: a metastatic lymph node, malignant lymphoma, or Crow-Fukase syndrome) or non-neoplastic (18 cases: a reactive node or amyloidosis). The sensitivity, specificity, and accuracy were 83%, 94%, and 86%, respectively. On multivariate analyses, small size of the lymph node was the sole predictive factor for inaccurate EUS-FNA diagnosis with a significant difference (odds ratios, 19.8; 95% confidence intervals, 3.15–124; p=0.0015).
Conclusions
The lymph node size of <16 mm was the only independent factor associated with inaccurate EUS-FNA diagnosis of swollen lymph nodes.

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  • Role of EBUS‐TBNA/EUS‐FNA and mass spectrometry for diagnosis and typing of lymph node amyloidosis: 10‐year experience in two tertiary care academic centers
    Asghar Naqvi, Michael Bonert, Christian Finley, Katarzyna Czarnecka‐Kujawa, Kazuhiro Yasufuku, Joerg Schwock, Vathany Kulasingam, Rohan John, Hyang‐Mi Ko
    Cancer Cytopathology.2023; 131(11): 724.     CrossRef
  • Endoscopic Ultrasound-Guided Fine Needle Biopsy in the Diagnostic Work-Up of Deep-Seated Lymphadenopathies and Spleen Lesions: A Monocentric Experience
    Flaminia Bellisario, Fabia Attili, Fabrizia Campana, Federica Borrelli de Andreis, Silvia Bellesi, Elena Maiolo, Eleonora Alma, Rosalia Malafronte, Giuseppe Macis, Luigi Maria Larocca, Salvatore Annunziata, Francesco D’Alò, Stefan Hohaus
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    Vladislav V. Makarenko, Michelle E. DeLelys, Robert P. Hasserjian, Amy Ly
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  • Diagnostic accuracy and clinical impact of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) in Positron Emission Tomography - Computed Tomography (PET-CT)-positive mediastinal lymphadenopathies in patients with thoracic or extra-thoracic mali
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    Linbin Chen, Yin Li, Xiaoyan Gao, Shiyong Lin, Longjun He, Guangyu Luo, Jianjun Li, Chunyu Huang, Guobao Wang, Qing Yang, Hongbo Shan
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  • Comparison of Endoscopic Ultrasound-Guided Fine-Needle Aspiration and Biopsy Device for Lymphadenopathy
    Yuki Tanisaka, Masafumi Mizuide, Akashi Fujita, Tomoya Ogawa, Ryuichiro Araki, Masahiro Suzuki, Hiromune Katsuda, Youichi Saito, Kazuya Miyaguchi, Tomoaki Tashima, Yumi Mashimo, Masami Yasuda, Shomei Ryozawa, Konstantinos Triantafyllou
    Gastroenterology Research and Practice.2021; 2021: 1.     CrossRef
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    Tae Hyeon Kim
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Focused Review Series: Expanding Indication: Interventional Endoscopic Management for Pancreaticobiliary Diseases
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
AbstractAbstract PDFPubReaderePub
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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Case Report
Primary Gastric Small Cell Carcinoma (Presenting as Linitis Plastica) Diagnosed Using Endoscopic Ultrasound-Guided Biopsy: A Case Report
Ra Ri Cha, Jin Kyu Cho, Wan Soo Kim, Jin Joo Kim, Jae Min Lee, Sang Soo Lee, Hyun Jin Kim
Clin Endosc 2019;52(3):278-282.   Published online October 5, 2018
DOI: https://doi.org/10.5946/ce.2018.114
AbstractAbstract PDFPubReaderePub
Small cell carcinomas are the most aggressive, highly malignant neuroendocrine tumors; among these, gastric small cell carcinoma (GSCC) is extremely rare. Here we report a case of a patient with primary GSCC, presenting as linitis plastic, who was diagnosed using endoscopic ultrasound (EUS)-guided biopsy. With undiagnosed linitis plastica, an 80-year-old woman was referred to our institution. Abdominal computed tomography revealed irregular wall thickening extending from the gastric body to the antrum. Endoscopy suspected to have Borrmann type IV advanced gastric cancer. EUS of the stomach showed diffuse submucosal thickening of the gastric wall, mainly the antrum. EUS-guided bite-on-bite biopsy confirmed the diagnosis of GSCC. In general, GSCC is difficult to diagnose and careful examination is necessary to determine the therapeutic strategy; however, EUS is particularly helpful in the differential diagnosis of a lesion presenting as linitis plastica.

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  • An online tool for survival prediction of extrapulmonary small cell carcinoma with random forest
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Review
De-novo Gastrointestinal Anastomosis with Lumen Apposing Metal Stent
Deepanshu Jain, Ankit Chhoda, Abhinav Sharma, Shashideep Singhal
Clin Endosc 2018;51(5):439-449.   Published online September 27, 2018
DOI: https://doi.org/10.5946/ce.2018.077
AbstractAbstract PDFPubReaderePub
Gastric outlet obstruction, afferent or efferent limb obstruction, and biliary obstruction among patients with altered anatomy often require surgical intervention which is associated with significant morbidity and mortality. Endoscopic dilation for benign etiologies requires multiple sessions, whereas self-expandable metal stents used for malignant etiologies often fail due to tumor in-growth. Lumen apposing metal stents, placed endoscopically with the intent of creating a de-novo gastrointestinal anastomosis bypassing the site of obstruction, can potentially achieve similar efficacy, with a much lower complication rate. In our study cohort (n=79), the composite technical success rate and clinical success rate was 91.1% (72/79) and 97.2% (70/72), respectively. Five different techniques were used: 43% (34/79) underwent the balloon-assisted method, 27.9% (22/79) underwent endoscopic ultrasound-guided balloon occluded gastro-jejunostomy bypass, 20.3% (16/79) underwent the direct technique, 6.3% (5/79) underwent the hybrid rendezvous technique, and 2.5% (2/79) underwent natural orifice transluminal endoscopic surgery (NOTES)-assisted procedure. All techniques required an echoendoscope except NOTES. In all, 53.2% (42/79) had non-cautery enhanced Axios stent, 44.3% (35/79) had hot Axios stent, and 2.5% (2/79) had Niti-S spaxus stent. Symptom-recurrence was seen in 2.8%, and 6.3% had a complication (bleeding, abdominal pain or peritonitis). All procedures were performed by experts at centers of excellence with adequate surgical back up.

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