Clinical Endoscopy

Review

Endoscopic ultrasound-guided strain and shear wave elastography for pancreatic and liver diseases: Raymond S.Y. Tang, Ting Ting Chan; Received August 2, 2025 Accepted August 13, 2025 Published online January 5, 2026; DOI: https://doi.org/10.5946/ce.2025.258 [Epub ahead of print]

Abstract PDF PubReader ePub: Endoscopic ultrasound (EUS)-guided elastography is an advanced imaging technique designed to improve assessment of lesion characteristics and disease diagnosis. It allows real-time assessment of tissue stiffness and is currently available in the form of strain elastography (SE) and shear wave elastography (SWE). While EUS-guided SE has high sensitivity for diagnosing malignant solid pancreatic lesions, its specificity remains modest. SWE is a novel technology currently available on the EUS platform. Promising data have been reported on the utility of EUS-guided SWE in various diseases of the pancreas and liver. This review aims to discuss the applications of EUS-guided SE and SWE in pancreatic and liver diseases.

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Original Articles

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; Clin Endosc 2025;58(5):757-765. Published online May 27, 2025; DOI: https://doi.org/10.5946/ce.2024.320

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Background
/Aims: Endoscopic ultrasound-guided tissue acquisition (EUS-TA) is essential for diagnosing malignant lymphoma (ML). However, the optimal needle type for maximizing the diagnostic yield and tissue quality remains unclear. We compared the diagnostic performance and histological tissue quality between fine-needle biopsy (FNB) and fine-needle aspiration (FNA) needles in EUS-TA for ML.
Methods
This retrospective study included patients who underwent EUS-TA for suspected ML. The diagnostic accuracy, histological sample quality assessed by scoring, and adverse events were compared between the FNB and FNA groups. A subgroup analysis was performed for 22-gauge needles.
Results
FNB demonstrated higher diagnostic accuracy (75%) than FNA (50%) for cytology, with 100% sensitivity for histological diagnosis compared with 78.9% for FNA. The FNB group had significantly higher diagnostic rates for the World Health Organization subclassification of ML (71.4% vs. 31.6%, p=0.037). Additionally, FNB obtained superior histological quality, with 71.4% of samples scoring 5 compared with 41.2% in the FNA group. Adverse events were minimal in both groups.
Conclusions
EUS-FNB showed better diagnostic performance and histological tissue quality than EUS-FNA for ML, particularly in obtaining adequate samples for histological evaluation and subclassification. Therefore, EUS-FNB can be safely performed. Future research with larger sample sizes and genetic testing is warranted.

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Endoscopic Ultrasound as a Diagnostic Tool for the Mediastinum and Thorax
Sara Nikolic, Lucía Guilabert, Giuseppe Vanella, Catalina Vladut, Giuseppe La Mattina, Giuseppe Infantino, Elio D’Amore, Cecilie Siggaard Knoph, Giacomo Emanuele Maria Rizzo
Journal of Clinical Medicine.2025; 14(14): 4836. 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

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Predictive factors for the diagnosis of autoimmune pancreatitis using endoscopic ultrasound-guided tissue acquisition: a retrospective study in Japan: Keisuke Yonamine, Shinsuke Koshita, Yoshihide Kanno, Takahisa Ogawa, Hiroaki Kusunose, Toshitaka Sakai, Kazuaki Miyamoto, Fumisato Kozakai, Haruka Okano, Yuto Matsuoka, Kento Hosokawa, Hidehito Sumiya, Yutaka Noda, Kei Ito; Clin Endosc 2025;58(3):457-464. Published online March 28, 2025; DOI: https://doi.org/10.5946/ce.2024.238

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Background
/Aims: The factors affecting the detection rate of lymphoplasmacytic sclerosing pancreatitis (LPSP) using endoscopic ultrasound-guided tissue acquisition (EUS-TA) in patients with type 1 autoimmune pancreatitis (AIP) have not been thoroughly studied. Therefore, we conducted a retrospective study to identify the predictive factors for histologically detecting level 1 or 2 LPSP using EUS-TA.
Methods
Fifty patients with AIP were included in this study, and the primary outcome measures were the predictive factors for histologically detecting level 1 or 2 LPSP using EUS-TA.
Results
Multivariate analysis identified the use of fine needle biopsy (FNB) needles as a significant predictive factor for LPSP detection (odds ratio, 15.1; 95% confidence interval, 1.62–141; ¬¬p=0.017). The rate of good-quality specimens (specimen adequacy score ≥4) was significantly higher for the FNB needle group than for the fine needle aspiration (FNA) needle group (97% vs. 56%; p<0.01), and the FNB needle group required significantly fewer needle passes than the FNA needle group (median, 2 vs. 3; p<0.01).
Conclusions
The use of FNB needles was the most important factor for the histological confirmation of LPSP using EUS-TA in patients with type 1 AIP.

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A new era for autoimmune pancreatitis diagnosis: fine-needle biopsy outperforms fine-needle aspiration in endoscopic ultrasound-guided tissue acquisition
Gunn Huh, Tae Jun Song
Clinical Endoscopy.2025; 58(3): 406. CrossRef

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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; Clin Endosc 2024;57(6):807-813. Published online May 24, 2024; DOI: https://doi.org/10.5946/ce.2023.277

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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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A case of needle tract seeding of pancreatic adenosquamous carcinoma after a single endoscopic ultrasound-guided tissue acquisition
Taro Hanaoka, Kosuke Okuwaki, Nobuyuki Nishizawa, Masafumi Watanabe, Kai Adachi, Akihiro Tamaki, Tomohisa Iwai, Mitsuhiro Kida, Yusuke Kumamoto, Chika Kusano
Clinical Journal of Gastroenterology.2025; 18(1): 234. CrossRef

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Diagnostic value of homogenous delayed enhancement in contrast-enhanced computed tomography images and endoscopic ultrasound-guided tissue acquisition for patients with focal autoimmune pancreatitis: Keisuke Yonamine, Shinsuke Koshita, Yoshihide Kanno, Takahisa Ogawa, Hiroaki Kusunose, Toshitaka Sakai, Kazuaki Miyamoto, Fumisato Kozakai, Hideyuki Anan, Haruka Okano, Masaya Oikawa, Takashi Tsuchiya, Takashi Sawai, Yutaka Noda, Kei Ito; Clin Endosc 2023;56(4):510-520. Published online April 5, 2023; DOI: https://doi.org/10.5946/ce.2022.142

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Background
/Aims: We aimed to investigate (1) promising clinical findings for the recognition of focal type autoimmune pancreatitis (FAIP) and (2) the impact of endoscopic ultrasound (EUS)-guided tissue acquisition (EUS-TA) on the diagnosis of FAIP.
Methods
Twenty-three patients with FAIP were involved in this study, and 44 patients with resected pancreatic ductal adenocarcinoma (PDAC) were included in the control group.
Results
(1) Multivariate analysis revealed that homogeneous delayed enhancement on contrast-enhanced computed tomography was a significant factor indicative of FAIP compared to PDAC (90% vs. 7%, p=0.015). (2) For 13 of 17 FAIP patients (76.5%) who underwent EUS-TA, EUS-TA aided the diagnostic confirmation of AIPs, and only one patient (5.9%) was found to have AIP after surgery. On the other hand, of the six patients who did not undergo EUS-TA, three (50.0%) underwent surgery for pancreatic lesions.
Conclusions
Homogeneous delayed enhancement on contrast-enhanced computed tomography was the most useful clinical factor for discriminating FAIPs from PDACs. EUS-TA is mandatory for diagnostic confirmation of FAIP lesions and can contribute to a reduction in the rate of unnecessary surgery for patients with FAIP.

Citations

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Predictive factors for the diagnosis of autoimmune pancreatitis using endoscopic ultrasound-guided tissue acquisition: a retrospective study in Japan
Keisuke Yonamine, Shinsuke Koshita, Yoshihide Kanno, Takahisa Ogawa, Hiroaki Kusunose, Toshitaka Sakai, Kazuaki Miyamoto, Fumisato Kozakai, Haruka Okano, Yuto Matsuoka, Kento Hosokawa, Hidehito Sumiya, Yutaka Noda, Kei Ito
Clinical Endoscopy.2025; 58(3): 457. CrossRef
A new era for autoimmune pancreatitis diagnosis: fine-needle biopsy outperforms fine-needle aspiration in endoscopic ultrasound-guided tissue acquisition
Gunn Huh, Tae Jun Song
Clinical Endoscopy.2025; 58(3): 406. CrossRef
Role of endoscopic ultrasound in diagnosis and management of autoimmune pancreatitis
Gauri Kumbhar, Akhil Mahajan, Rahul Puri, Sridhar Sundaram
Indian Journal of Gastroenterology.2025; 44(6): 824. CrossRef
A multidisciplinary approach is essential for differentiating autoimmune pancreatitis from pancreatic adenocarcinoma
Sung-Hoon Moon
Clinical Endoscopy.2023; 56(4): 457. CrossRef

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Systematic Review and Meta-analysis

Influence of biliary stents on the diagnostic outcome of endoscopic ultrasound–guided tissue acquisition from solid pancreatic lesions: a systematic review and meta-analysis: Suprabhat Giri, Shivaraj Afzalpurkar, Sumaswi Angadi, Jijo Varghese, Sridhar Sundaram; Clin Endosc 2023;56(2):169-179. Published online February 15, 2023; DOI: https://doi.org/10.5946/ce.2022.282

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Background
/Aims: This meta-analysis analyzed the effect of an indwelling biliary stent on endoscopic ultrasound (EUS)–guided tissue acquisition from pancreatic lesions.
Methods
A literature search was performed to identify studies published between 2000 and July 2022 comparing the diagnostic outcomes of EUS-TA in patients with or without biliary stents. For non-strict criteria, samples reported as malignant or suspicious for malignancy were included, whereas for strict criteria, only samples reported as malignant were included in the analysis.
Results
Nine studies were included in this analysis. The odds of an accurate diagnosis were significantly lower in patients with indwelling stents using both non-strict (odds ratio [OR], 0.68; 95% confidence interval [CI], 0.52–0.90) and strict criteria (OR, 0.58; 95% CI, 0.46–0.74). The pooled sensitivity with and without stents were similar (87% vs. 91%) using non-strict criteria. However, patients with stents had a lower pooled sensitivity (79% vs. 88%) when using strict criteria. The sample inadequacy rate was comparable between groups (OR, 1.12; 95% CI, 0.76–1.65). The diagnostic accuracy and sample inadequacy were comparable between plastic and metal biliary stents.
Conclusions
The presence of a biliary stent may negatively affect the diagnostic outcome of EUS-TA for pancreatic lesions.

Citations

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Comparison of standard vs auxiliary (contrast or elastography) endoscopic ultrasound-guided fine needle aspiration/biopsy in solid pancreatic lesions: A meta-analysis
Mitali Madhumita Rath, Prajna Anirvan, Jijo Varghese, Tara Prasad Tripathy, Ranjan K Patel, Manas Kumar Panigrahi, Suprabhat Giri
World Journal of Methodology.2025;[Epub] CrossRef
Role of Endoscopic Ultrasound in Diagnosis of Pancreatic Ductal Adenocarcinoma
Abhirup Chatterjee, Jimil Shah
Diagnostics.2023; 14(1): 78. CrossRef

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Original Article

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

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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.

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Advancements in endoscopic resection of subepithelial tumors: toward safer, recurrence-free techniques
Won Shik Kim, Moon Kyung Joo
Clinical Endoscopy.2025; 58(2): 256. CrossRef
Current Practices in Histological Diagnosis and Management of Asymptomatic Gastric Subepithelial Lesions: A Multicenter Survey in Korea
Sang Hoon Kim, Jae Yong Park, Ayoung Lee, Bong Eun Lee, Byung-Hoon Min, Chan Hyuk Park, Da Hyun Jung, Hyeong Ho Jo, Hyunsoo Chung, In Hyuk Yoo, Seon Young Park, Seung-Woo Lee, Yonghoon Choi, Jeong Hoon Lee, Seung Han Kim, Jae Myung Park, Joon Sung Kim, Su
The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2025; 25(2): 159. CrossRef
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; 27(4): 263. 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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Review

Clinical and Technical Guideline for Endoscopic Ultrasound (EUS)-Guided Tissue Acquisition of Pancreatic Solid Tumor: Korean Society of Gastrointestinal Endoscopy (KSGE): Moon Jae Chung, Se Woo Park, Seong-Hun Kim, Chang Min Cho, Jun-Ho Choi, Eun Kwang Choi, Tae Hoon Lee, Eunae Cho, Jun Kyu Lee, Tae Jun Song, Jae Min Lee, Jun Hyuk Son, Jin Suk Park, Chi Hyuk Oh, Dong-Ah Park, Jeong-Sik Byeon, Soo Teik Lee, Ho Gak Kim, Hoon Jai Chun, Ho Soon Choi, Chan Guk Park, Joo Young Cho; Clin Endosc 2021;54(2):161-181. Published online March 24, 2021; DOI: https://doi.org/10.5946/ce.2021.069

Abstract PDF PubReader ePub

Endoscopic ultrasound (EUS)-guided tissue acquisition of pancreatic solid tumor requires a strict recommendation for its proper use in clinical practice because of its technical difficulty and invasiveness. The Korean Society of Gastrointestinal Endoscopy (KSGE) appointed a Task Force to draft clinical practice guidelines for EUS-guided tissue acquisition of pancreatic solid tumor. The strength of recommendation and the level of evidence for each statement were graded according to the Minds Handbook for Clinical Practice Guideline Development 2014. The committee, comprising a development panel of 16 endosonographers and an expert on guideline development methodology, developed 12 evidence-based recommendations in 8 categories intended to help physicians make evidence-based clinical judgments with regard to the diagnosis of pancreatic solid tumor. This clinical practice guideline discusses EUS-guided sampling in pancreatic solid tumor and makes recommendations on circumstances that warrant its use, technical issues related to maximizing the diagnostic yield (e.g., needle type, needle diameter, adequate number of needle passes, sample obtaining techniques, and methods of specimen processing), adverse events of EUS-guided tissue acquisition, and learning-related issues. This guideline was reviewed by external experts and suggests best practices recommended based on the evidence available at the time of preparation. This guideline may not be applicable for all clinical situations and should be interpreted in light of specific situations and the availability of resources. It will be revised as necessary to cover progress and changes in technology and evidence from clinical practice.

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An optimal curriculum for training in endoscopic ultrasound: a summarized evidence-based literature systematic review
Julieta Montanelli, Ariosto Honorio Hernandez Lara, Ana Karla Uribe Rivera, Juan Manuel Verde, Eike Burmester, Mohammad A. Al-Haddad, Stephan Hollerbach, Peter Vilmann, Monder Abu-Suboh Abadia, Abdenor Badaoui, Paolo Giorgio Arcidiacono, Christoph Schlag,
Surgical Endoscopy.2025; 39(7): 4076. CrossRef
Expanding the horizon of diagnostic endosonograpy: the promise of trans-colorectal endoscopic ultrasound-guided fine-needle aspiration
Hao-Che Chang, Ping-Huei Tseng, Li-Chun Chang
Clinical Endoscopy.2025; 58(6): 859. CrossRef
Role of Endoscopic Ultrasound in the Management of Pancreatic Cancer
Balaji Musunuri, Shiran Shetty
Indian Journal of Surgical Oncology.2024; 15(S2): 269. CrossRef
Endoscopic Ultrasound (EUS) guided biopsy of healthy pig pancreas: Towards the histological diagnosis of chronic pancreatitis.
Julio Iglesias-García, Yessica Domínguez-Novoa, Héctor Lazare-Iglesias, Antonio González-Cantalapiedra, Ihab Abdulkader-Nallib, Óscar Varela-López, José Lariño-Noia, Enrique Domínguez-Muñoz
Revista Española de Enfermedades Digestivas.2024;[Epub] CrossRef
When ROSE is not possible: Evaluating the diagnostic yield of>4mm tissue specimen with macroscopi c onsite evaluation. 22G EUS-FNB Acquire needle experience
S. Karim, S. Kadir, A. Faryal
Endoscopy.2024; 56(S 02): S153. CrossRef
Optimising EUS-FNB guided tissue acquisition: The significance of TRAP score in solid pancreatic and gastrointestinal lesions for positive diagnostic output
S. Karim, S. Kadir, A. Faryal
Endoscopy.2024; 56(S 02): S380. CrossRef
Endoscopic ultrasound-guided tissue acquisition for personalized treatment in pancreatic adenocarcinoma
Sang Myung Woo
Clinical Endoscopy.2023; 56(2): 183. CrossRef
Pancreatic duct lavage cytology combined with a cell-block method for patients with possible pancreatic ductal adenocarcinomas, including pancreatic carcinoma in situ
Hiroaki Kusunose, Shinsuke Koshita, Yoshihide Kanno, Takahisa Ogawa, Toshitaka Sakai, Keisuke Yonamine, Kazuaki Miyamoto, Fumisato Kozakai, Hideyuki Anan, Kazuki Endo, Haruka Okano, Masaya Oikawa, Takashi Tsuchiya, Takashi Sawai, Yutaka Noda, Kei Ito
Clinical Endoscopy.2023; 56(3): 353. CrossRef
Anesthesia care provider sedation versus conscious sedation for endoscopic ultrasound–guided tissue acquisition: a retrospective cohort study
Sneha Shaha, Yinglin Gao, Jiahao Peng, Kendrick Che, John J. Kim, Wasseem Skef
Clinical Endoscopy.2023; 56(5): 658. CrossRef
Endoscopic ultrasound-guided tissue acquisition and gene panel testing for pancreatic cancer
Kentaro SUDO, Emiri KITA, Akiko TSUJIMOTO, Kazuyoshi NAKAMURA, Akiko ODAKA, Makiko ITAMI, Sana YOKOI, Hiroshi ISHII
Suizo.2022; 37(1): 8. CrossRef
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Irem Guvendir, Itir Ebru Zemheri, Kamil Ozdil
BMC Gastroenterology.2022;[Epub] CrossRef
Endoscopic Ultrasound Guided Fine Needle Aspiration and Biopsy for Pancreatic Disease
Kwang Hyuck Lee
The Korean Journal of Pancreas and Biliary Tract.2021; 26(4): 241. CrossRef

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Original Articles

Efficacy of the Envelope Method in Applying Polyglycolic Acid Sheets to Post-Endoscopic Submucosal Dissection Ulcers in Living Pigs: Hiroya Sakaguchi, Toshitatsu Takao, Yoshitaka Takegawa, Yuki Koga, Kazunori Yamanaka, Masataka Sagata, Shinwa Tanaka, Yoshinori Morita, Takashi Toyonaga, Yuzo Kodama; Clin Endosc 2021;54(1):64-72. Published online July 16, 2020; DOI: https://doi.org/10.5946/ce.2020.014

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Background
/Aims: Application of polyglycolic acid (PGA) sheets using fibrin glue in post-endoscopic submucosal dissection (ESD) ulcers to prevent bleeding has been reported to be difficult with the conventional delivery method because of gravity. This study assessed the usefulness of the envelope-based delivery system with and against gravity in living pigs.
Methods
PGA sheets were applied on post-ESD ulcers with and against gravity six times each using the conventional and envelope methods, respectively. The PGA sheet delivery time and the endoscopic and histological findings of the treated ulcer floors were compared.
Results
With gravity, the median PGA sheet application time was 1.00 (0.68–1.30) min/cm² and 0.32 (0.18–0.52) min/cm² with the conventional and envelope techniques (p=0.002), respectively, and against gravity, it was 1.20 (1.13–1.63) min/cm² and 0.50 (0.39–0.58) min/cm² (p=0.002), respectively. Against gravity, the endoscopic and histological findings revealed that the conventional group had insufficient fixation of the PGA sheets, but the envelope groups had sufficient fixation. The results with gravity were similar between the groups.
Conclusions
The envelope method makes it possible to deliver PGA sheets to the stomach quickly and cover ulcers appropriately both with and against gravity in living pigs.

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International Journal of Biological Macromolecules.2025; 306: 141146. CrossRef
Endoscopic sealing hemostasis with polyglycolic acid sheet and fibrin glue as a novel endoscopic hemostatic technique: a report of three cases
Kai Korekawa, Atsushi Kunimitsu
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Clinical Endoscopy.2022; 55(1): 86. CrossRef
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Yoshitaka Takegawa, Toshitatsu Takao, Hiroya Sakaguchi, Tatsuya Nakai, Kazuhiro Takeo, Yoshinori Morita, Takashi Toyonaga, Yuzo Kodama
Scientific Reports.2022;[Epub] CrossRef
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Meng Li, Haifeng Jin, Changpei Shi, Bin Lyu, Xiao Ying, Yuan Shi
Frontiers in Pharmacology.2021;[Epub] CrossRef

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Modified Endoscopic Ultrasound Needle to Obtain Histological Core Tissue Samples: A Retrospective Analysis: Munish Ashat, Kaartik Soota, Jagpal S. Klair, Sarika Gupta, Chris Jensen, Arvind R. Murali, Randhir Jesudoss, Rami El-Abiad, Henning Gerke; Clin Endosc 2020;53(4):471-479. Published online February 5, 2020; DOI: https://doi.org/10.5946/ce.2019.108

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Background
/Aims: Endoscopic ultrasound (EUS)-guided fine-needle aspiration is very effective for providing specimens for cytological evaluation. However, the ability to provide sufficient tissue for histological evaluation has been challenging due to the technical limitations of dedicated core biopsy needles. Recently, a modified EUS needle has been introduced to obtain tissue core samples for histological analysis. We aimed to determine (1) its ability to obtain specimens for histological assessment and (2) the diagnostic accuracy of EUS-guided fine-needle biopsy (EUS-FNB) using this needle.
Methods
We retrospectively analyzed consecutive cases of FNB using modified EUS needles for 342 lesions in 303 patients. The cytology and histological specimens were analyzed. Diagnostic accuracy was calculated.
Results
Adequate cytological and histological assessment was possible in 293/342 (86%) and 264/342 (77%) lesions, respectively. Diagnostic accuracy of the cytological specimen was 294/342 (86%) versus 254/342 (74%) for the histological specimen (p<0.01). Diagnostic accuracy of the combined cytological and histological assessment was 323/342 (94.4%), which was significantly higher than that of both histology alone (p<0.001) and cytology alone (p=0.001).
Conclusions
EUS-FNB with the modified EUS needle provided histologic tissue cores in the majority of cases and achieved excellent diagnostic accuracy with few needle passes.

Citations

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Randomized trial comparing the Franseen needle versus 2 types of sharpened-tip 3-prong needles in EUS-guided tissue acquisition from solid pancreatic lesions
Takuya Ishikawa, Hirotaka Suzuki, Yasuki Hori, Jun Yashika, Hiroki Suhara, Hajime Sumi, Masahiko Ando, Yachiyo Kuwatsuka, Kentaro Yamao, Yasuyuki Mizutani, Tadashi Iida, Kota Uetsuki, Takeshi Yamamura, Kazuhiro Furukawa, Masanao Nakamura, Hiromi Kataoka,
Gastrointestinal Endoscopy.2025; 102(5): 703. 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
Randomized controlled trial comparing the Franseen needle with the Fork-tip needle for EUS-guided fine-needle biopsy
Munish Ashat, Jagpal S. Klair, Sydney L. Rooney, Sagar J. Vishal, Chris Jensen, Nadav Sahar, Arvind R. Murali, Rami El-Abiad, Henning Gerke
Gastrointestinal Endoscopy.2021; 93(1): 140. CrossRef

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Endoscopic Ultrasound Fine-Needle Aspiration versus Fine-Needle Biopsy for Lymph Node Diagnosis: A Large Multicenter Comparative Analysis: Diogo Turiani Hourneaux de Moura, Thomas R. McCarty, Pichamol Jirapinyo, Igor Braga Ribeiro, Galileu Ferreira Ayala Farias, Marvin Ryou, Linda S. Lee, Christopher C. Thompson; Clin Endosc 2020;53(5):600-610. Published online December 3, 2019; DOI: https://doi.org/10.5946/ce.2019.170

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Background
/Aims: Endoscopic ultrasound fine-needle aspiration (EUS-FNA) is preferred for sampling of lymph nodes (LNs) adjacent to the gastrointestinal wall; however, fine-needle biopsy (FNB) may provide improved diagnostic outcomes. This study aimed to evaluate the comparative efficacy and safety of FNA versus FNB for LN sampling.
Methods
This was a multicenter retrospective study of prospectively collected data to evaluate outcomes of EUS-FNA and EUS-FNB for LN sampling. Characteristics analyzed included sensitivity, specificity, accuracy, the number of needle passes, diagnostic adequacy of rapid on-site evaluation (ROSE), cell-block analysis, and adverse events.
Results
A total of 209 patients underwent EUS-guided LN sampling. The mean lesion size was 16.22±8.03 mm, with similar sensitivity and accuracy between FNA and FNB ([67.21% vs. 75.00%, respectively, p=0.216] and [78.80% vs. 83.17%, respectively, p=0.423]). The specificity of FNB was better than that of FNA (100.00% vs. 93.62%, p=0.01). The number of passes required for diagnosis was not different. Abdominal and peri-hepatic LN location demonstrated FNB to have a higher sensitivity (81.08% vs. 64.71%, p=0.031 and 80.95% vs. 58.33%, p=0.023) and accuracy (88.14% vs. 75.29%, p=0.053 and 88.89% vs. 70.49%, p=0.038), respectively. ROSE was a significant predictor for accuracy (odds ratio, 5.16; 95% confidence interval, 1.15–23.08; p=0.032). No adverse events were reported in either cohort.
Conclusions
Both EUS-FNA and EUS-FNB are safe for the diagnosis of LNs. EUS-FNB is preferred for abdominal LN sampling. EUSFNA+ ROSE was similar to EUS-FNB alone, showing better diagnosis for EUS-FNB than traditional FNA. While ROSE remained a significant predictor for accuracy, due to its poor availability in most centers, its use may be limited to cases with previous inconclusive diagnoses.

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Utility of Forward-View Echoendoscopy for Transcolonic Fine-Needle Aspiration of Extracolonic Lesions: An Institutional Experience: Nithi Thinrungroj, Kazuo Hara, Nobumasa Mizuno, Takamichi Kuwahara, Nozomi Okuno; Clin Endosc 2020;53(1):60-64. Published online September 5, 2019; DOI: https://doi.org/10.5946/ce.2019.081

Abstract PDF PubReader ePub

Background
/Aims: Non-invasive tissue sampling from the lower intra-abdominal and pelvic cavity is challenging. The role of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) in this situation is not well-established because of the limitations of the curved linear-array echoendoscopy-EUS for colonic insertion. The aim of this study was to report our institutional experience of transcolonic EUS-FNA using forward-viewing therapeutic linear echoendoscopy-EUS (FV-EUS) in combination with fluoroscopic guidance.
Methods
Medical records of 13 patients who underwent transcolonic EUS-FNA of extracolonic lesions using FV-EUS in combination with fluoroscopic guidance at Aichi Cancer Center Hospital, Nagoya, Japan from June 2015 to November 2018 were retrospectively reviewed.
Results
Using FV-EUS under fluoroscopic guidance, the FNA procedure could be performed successfully in all patients (100% technical success), with a median procedure time of 31 minutes. The sensitivity, specificity, and accuracy of EUS-FNA for detecting malignant lesions in this study were 91%, 100%, and 92%, respectively. There were no adverse events associated with the EUS-FNA procedure.
Conclusions
FV-EUS in combination with fluoroscopic guidance is an easy, safe, and effective technique for FNA of extracolonic lesions in the lower abdomen.

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Phase 1 trial of lavage cytology collected with endoscopic ultrasound-guided fine-needle aspiration for preoperative pancreatic cancer
Nozomi Okuno, Kazuo Hara, Shin Haba, Takamichi Kuwahara, Shimpei Matsumoto, Hiroki Koda, Keigo Oshiro, Tomoki Ogata, Yuki Uba, Tomoyuki Tanaka, Yuma Yamazaki, Saki Yamazoe
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Indria Melianti, Kazuo Hara, Nozomi Okuno
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Prospective Assessment of the Performance of a New Fine Needle Biopsy Device for EUS-Guided Sampling of Solid Lesions: Ihab I. El Hajj, Howard Wu, Sarah Reuss, Melissa Randolph, Akeem Harris, Mark A. Gromski, Mohammad Al-Haddad; Clin Endosc 2018;51(6):576-583. Published online July 13, 2018; DOI: https://doi.org/10.5946/ce.2018.053

Abstract PDF PubReader ePub

Background
/Aims: Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) remains the most common EUS-guided tissue acquisition technique. This study aimed to evaluate the performance of a new Franseen tip fine needle biopsy (FNB) device for EUSguided sampling of solid lesions and compare it with the historical FNA technique.
Methods
Acquire® 22 G FNB needle (Boston Scientific Co., Natick, MA, USA) was used for solid tumor sampling (Study group). Tissue was collected for rapid on-site evaluation, and touch and crush preparations were made. Historical EUS-FNA samples obtained using Expect® 22 G FNA needle (Boston Scientific Co.) were used as controls (Control group). All specimens were independently evaluated by two cytopathologists blinded to the formal cytopathological diagnosis.
Results
Mean cell block histology scores were significantly higher (p=0.046) in the FNB group (51 samples) despite a significantly lower (p<0.001) mean number of passes compared to the FNA group (50 specimens). The overall diagnostic yields for the FNB vs. FNA groups were 96% vs. 88%. The degree of tumor differentiation was adequately assessed in all cell block qualifying lesions in the FNB group. Two patients developed post-FNB abdominal pain.
Conclusions
The new Franseen tip FNB device provides histologically superior and cytologically comparable specimens to those obtained by FNA, but with fewer passes.

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Priscilla A. van Riet, Nicole S. Erler, Marco J. Bruno, Djuna L. Cahen
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Masato Suzuki, Yusuke Sekino, Kunihiro Hosono, Kenichi Kawana, Hajime Nagase, Kensuke Kubota, Atsushi Nakajima
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Mika Takasumi, Takuto Hikichi, Minami Hashimoto, Jun Nakamura, Tsunetaka Kato, Ryoichiro Kobashi, Takumi Yanagita, Rei Suzuki, Mitsuru Sugimoto, Yuki Sato, Hiroki Irie, Tadayuki Takagi, Masao Kobayakawa, Yuko Hashimoto, Hiromasa Ohira
Diagnostics.2021; 11(10): 1883. CrossRef
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Diogo Turiani Hourneaux Moura, Thomas R McCarty, Pichamol Jirapinyo, Igor Braga Ribeiro, Galileu Ferreira Ayala Farias, Antonio Coutinho Madruga-Neto, Marvin Ryou, Christopher C Thompson
World Journal of Clinical Cases.2021; 9(34): 10507. CrossRef
Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration (EBUS-TBNA): Technical Updates and Pathological Yield
Huzaifa A. Jaliawala, Samid M. Farooqui, Kassem Harris, Tony Abdo, Jean I. Keddissi, Houssein A. Youness
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Khaled Alkhateeb, Beatrice B. Lee, Houda Alatassi, Mary A. Sanders, Endashaw M. Omer, Stephen A. McClave, Mostafa Fraig
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De‐Feng Li, Jian‐yao Wang, Mei‐feng Yang, Feng Xiong, Ding‐guo Zhang, Zheng‐lei Xu, Min‐Han Luo, Zhen‐dong Jing, Kai‐Xuan Wang, Li‐sheng Wang, Jun Yao
Journal of Gastroenterology and Hepatology.2020; 35(8): 1264. CrossRef
An exclusive fine-needle biopsy approach to sampling solid lesions under EUS guidance: a prospective cohort study
Lindsey M Temnykh, Mahmoud A Rahal, Zahra Zia, Mohammad A Al-Haddad
Gastroenterology Report.2020; 8(5): 349. CrossRef
Diagnostic efficacy of three suction techniques for endoscopic ultrasound-guided fine-needle biopsy of solid pancreatic lesions: protocol for a multicenter randomized cross-over clinical trial
Shi-yu Li, Wei Zhou, Lei Shi, Zhen Ding, Jun Yao, Yue-ping Jiang, Li Gao, Hui Jiang, Zhen-dong Jin, Kai-xuan Wang
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Core needle biopsy with endobronchial ultrasonography: single center experience with 100 cases
Akshu Balwan, Billie Bixby, Cassi Grotepas, Benjamin L. Witt, Aidin Iravani, Sikandar Ansari, Chakravarthy B. Reddy
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Current status of newer generation endoscopic ultrasound core needles in the diagnostic evaluation of gastrointestinal lesions
Amin K. Soltani, Kumar Krishnan
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Diagnostic yield of endoscopic ultrasound-guided tissue acquisition for small solid pancreatic lesions
Takafumi Mie, Takashi Sasaki, Ryo Kanata, Takaaki Furukawa, Tsuyoshi Takeda, Akiyoshi Kasuga, Masato Matsuyama, Masato Ozaka, Naoki Sasahira
Endoscopy International Open.2020; 08(10): E1359. CrossRef
Endoscopic Ultrasound Fine-Needle Aspiration versus Fine-Needle Biopsy for Lymph Node Diagnosis: A Large Multicenter Comparative Analysis
Diogo Turiani Hourneaux de Moura, Thomas R. McCarty, Pichamol Jirapinyo, Igor Braga Ribeiro, Galileu Ferreira Ayala Farias, Marvin Ryou, Linda S. Lee, Christopher C. Thompson
Clinical Endoscopy.2020; 53(5): 600. CrossRef
Endoscopic ultrasound-fine needle biopsies of pancreatic lesions: Prospective study of histology quality using Franseen needle
Petros Stathopoulos, Anika Pehl, Lutz Philipp Breitling, Christian Bauer, Tobias Grote, Thomas Mathias Gress, Carsten Denkert, Ulrike Walburga Denzer
World Journal of Gastroenterology.2020; 26(37): 5693. CrossRef
Comparison of the reverse bevel versus Franseen type endoscopic ultrasound needle
Chi Wing Chow, Syeda Asma Haider, Krish Ragunath, Guruprasad P Aithal, Martin W James, Jacobo Ortiz-Fernandez-Sordo, Aloysious Dominic Aravinthan, Suresh Vasan Venkatachalapathy
World Journal of Gastrointestinal Endoscopy.2020; 12(9): 266. CrossRef
Usefulness of endoscopic ultrasound-guided fine-needle biopsy for the diagnosis of autoimmune pancreatitis using a 22-gauge Franseen needle: a prospective multicenter study
Takuya Ishikawa, Hiroki Kawashima, Eizaburo Ohno, Hiroki Suhara, Daijuro Hayashi, Takeshi Hiramatsu, Hiroshi Matsubara, Takahisa Suzuki, Takamichi Kuwahara, Eri Ishikawa, Yoshie Shimoyama, Fumie Kinoshita, Yoshiki Hirooka, Mitsuhiro Fujishiro
Endoscopy.2020; 52(11): 978. CrossRef
Overlooked risk for needle tract seeding following endoscopic ultrasound-guided minimally invasive tissue acquisition
Ruo-Yu Gao, Ben-Hua Wu, Xin-Ying Shen, Tie-Li Peng, De-Feng Li, Cheng Wei, Zhi-Chao Yu, Ming-Han Luo, Feng Xiong, Li-Sheng Wang, Jun Yao
World Journal of Gastroenterology.2020; 26(40): 6182. CrossRef
Efficacy of EUS-guided FNB using a Franseen needle for tissue acquisition and microsatellite instability evaluation in unresectable pancreatic lesions
Mitsuru Sugimoto, Hiroki Irie, Tadayuki Takagi, Rei Suzuki, Naoki Konno, Hiroyuki Asama, Yuki Sato, Jun Nakamura, Mika Takasumi, Minami Hashimoto, Tsunetaka Kato, Ryoichiro Kobashi, Yasuyuki Kobayashi, Yuko Hashimoto, Takuto Hikichi, Hiromasa Ohira
BMC Cancer.2020;[Epub] CrossRef
Endoscopic Ultrasound-Guided Tissue Acquisition by 22-Gauge Franseen and Standard Needles for Solid Pancreatic Lesions
Kazunaga Ishigaki, Yousuke Nakai, Hiroki Oyama, Sachiko Kanai, Tatsunori Suzuki, Tomoka Nakamura, Tatsuya Sato, Ryunosuke Hakuta, Kei Saito, Tomotaka Saito, Naminatsu Takahara, Tsuyoshi Hamada, Suguru Mizuno, Hirofumi Kogure, Minoru Tada, Hiroyuki Isayama
Gut and Liver.2020; 14(6): 817. CrossRef
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Takuya Ishikawa, Hiroki Kawashima, Eizaburo Ohno, Hiroyuki Tanaka, Daisuke Sakai, Tadashi Iida, Ryo Nishio, Takeshi Yamamura, Kazuhiro Furukawa, Masanao Nakamura, Ryoji Miyahara, Senju Hashimoto, Masatoshi Ishigami, Yoshiki Hirooka
Canadian Journal of Gastroenterology and Hepatology.2019; 2019: 1. CrossRef
Recent advancement in EUS-guided fine needle sampling
Pujan Kandel, Michael B. Wallace
Journal of Gastroenterology.2019; 54(5): 377. CrossRef
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Ihab I. El Hajj, Mohammad Al-Haddad
Clinical Endoscopy.2019; 52(4): 297. CrossRef
Present and Future of Endoscopic Ultrasound-Guided Tissue Acquisition in Solid Pancreatic Tumors
Jae Keun Park, Kwang Hyuck Lee
Clinical Endoscopy.2019; 52(6): 541. CrossRef
Will New Instruments for Endoscopic Ultrasound-Guided Tissue Acquisition Make Us Happy?
Chang-Il Kwon
Clinical Endoscopy.2018; 51(6): 510. CrossRef

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45 Crossref

Review

Fine-Needle Biopsy: Should This Be the First Choice in Endoscopic Ultrasound-Guided Tissue Acquisition?: Eun Young Kim; Clin Endosc 2014;47(5):425-428. Published online September 30, 2014; DOI: https://doi.org/10.5946/ce.2014.47.5.425

Abstract PDF PubReader ePub

Endoscopic ultrasound (EUS)-guided tissue acquisition is an indispensable technique for the diagnosis of many diseases of the gastrointestinal tract and adjacent structures. EUS-guided fine-needle aspiration (EUS-FNA) is known for its high accuracy and low complication rate. However, the outcome of EUS-FNA highly depends on several factors such as the location and characteristics of the lesion, endosonographer's experience, technique of sampling and sample preparation, type and size of the needle used, and presence of a cytopathologist for rapid on-site examination. EUS-guided fine-needle biopsy is useful to obtain core tissue samples with relatively fewer passes. Aspiration of core tissue with preserved architecture is beneficial for the diagnosis of certain diseases and the performance of ancillary testing such as tumor molecular profiling. Issues related to needle size, type, and their acquired samples for cytologic and histologic evaluation are discussed here.

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Dong Wook Lee, Eun Young Kim
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Successful creation of pancreatic cancer organoids by means of EUS-guided fine-needle biopsy sampling for personalized cancer treatment
Herve Tiriac, Juan Carlos Bucobo, Demetrios Tzimas, Suman Grewel, Joseph F. Lacomb, Leahana M. Rowehl, Satish Nagula, Maoxin Wu, Joseph Kim, Aaron Sasson, Shivakumar Vignesh, Laura Martello, Maria Munoz-Sagastibelza, Jonathan Somma, David A. Tuveson, Elle
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Esophagus lyomyoma diagnosed with convex endobronchial ultrasound (EBUS)
Paul Zarogoulidis, Stella Laskou, Athanasios Katsaounis, Efstathios Pavlidis, Dimitrios Giannakidis, Charilaos Koulouris, Stylianos Mantalovas, Ioanna Kougioumtzi, Nikolaos Katsikogiannis, Fotis Konstantinou, Wolfgang Hohenforst-Schmidt, Haidong Huang, Ch
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Case Reports

A Case of Mucosa-Associated Lymphoid Tissue Lymphoma of the Sigmoid Colon Presenting as a Semipedunculated Polyp: Myung Hwan Kim, Jin Tae Jung, Eui Jung Kim, Tae Won Kim, Seon Young Kim, Joong Goo Kwon, Eun Young Kim, Woo Jung Sung; Clin Endosc 2014;47(2):192-196. Published online March 31, 2014; DOI: https://doi.org/10.5946/ce.2014.47.2.192

Abstract PDF PubReader ePub

Mucosa-associated lymphoid tissue (MALT) lymphomas are characterized by lymphoepithelial lesions pathologically. Colonic MALT lymphomas are relatively rarer than lymphomas of the stomach or small intestine. Endoscopically, colonic MALT lymphoma frequently appears as a nonpedunculated protruding polypoid mass and/or an ulceration in the cecum and/or rectum. We report a unique case of a colonic MALT lymphoma presenting as a semipedunculated polyp. A 54-year-old man was found to have a 2-cm semipedunculated polyp in the sigmoid colon during screening colonoscopy. The polyp was removed by endoscopic mucosal resection. Histologic examination of the resected polyp revealed diffuse epithelial infiltration by discrete aggregates of lymphoma cells. We diagnosed the tumor as low-grade B-cell MALT lymphoma by immunohistochemical staining.

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Clinical Characteristics and Long-Term Prognosis of Colorectal Mucosa-Associated Lymphoid Tissue Lymphoma According to the Endoscopic Classification and Treatment Modality: A Multicenter Study
Seung Min Hong, Dong Hoon Baek, Geun Am Song, Hong Sub Lee, Seung Bum Lee, Ra Ri Cha, Tae-Oh Kim, Jae Hyun Kim, Jong Hoon Lee
Cancers.2025; 17(5): 750. CrossRef
Value of CD5 and CD79 in Evaluation of GIT Lymphoma
Huda Mohammed Abdulwahid, Haider AbdulRidha Alkafaji, Zainab Wehab Al Maaroof
Medical Journal of Babylon.2025; 22(2): 406. CrossRef
Unusual Instance of Mucosa-Associated Lymphoid Tissue (MALT) Lymphoma Confined to a Colonic Polyp
Amy Kiamos, Reeba Omman, JR Quan
Cureus.2023;[Epub] CrossRef
Colonic mucosa–associated lymphoid tissue lymphoma: A case report
Dan Chen, Ding-Fu Zhong, Yi Yang, Si-Shuang Chen, Dong Liu
Frontiers in Surgery.2023;[Epub] CrossRef
A focally flat-elevated lesion in distal transverse colon resembling a subepithelial tumor
Shin-Hee Lee, Sang-Bum Kang
Clinical Endoscopy.2023; 56(3): 388. CrossRef
A Rare Case of Primary Extra-Nodal Marginal Zone Lymphoma of Mucosa-Associated Lymphoid Tissue (MALT) in the Rectum
Ali Tariq Alvi, Murali Shankar
Cureus.2023;[Epub] CrossRef
A case of colonic MALT lymphoma with intra-abdominal abscess and lung metastasis: A case report
Kangkook Lee, Jin Wook Lee, Hye Ra Jung, Myeongsoon Park, Kwang Bum Cho, Ju Yup Lee
Medicine.2023; 102(43): e35778. CrossRef
Mucosa-Associated Lymphoid Tissue (MALT) Lymphoma in the Gastrointestinal Tract in the Modern Era
Eri Ishikawa, Masanao Nakamura, Akira Satou, Kazuyuki Shimada, Shotaro Nakamura
Cancers.2022; 14(2): 446. CrossRef
Primary gastrointestinal lymphoma with intestinal perforation
T Zhu, H Lei, Y -H Wang, L -P Liu, Y -L Lei, N Wang, Y -H Zheng
QJM: An International Journal of Medicine.2022;[Epub] CrossRef
Successful Endoscopic Resection of Residual Colonic Mucosa-Associated Lymphoid Tissue Lymphoma after Polypectomy
Jeongmin Choi
Clinical Endoscopy.2021; 54(5): 759. CrossRef
Colonic mucosa-associated lymphoid tissue lymphoma: a case series
Jenny Tannoury, Aurélien Amiot, François Lemonnier, Jehan Dupuis, Charlotte Gagnière, Karim Belhadj, Fabien Le Bras, Iradj Sobhani, Corinne Haioun, Christiane Copie-Bergman, Michaël Lévy
Leukemia & Lymphoma.2020; 61(3): 582. CrossRef
MALT lymphoma of the colon: a clinicopathological review
Norris Hollie, Saja Asakrah
Journal of Clinical Pathology.2020; 73(7): 378. CrossRef
Synchronous colonic mucosa-associated lymphoid tissue lymphoma found after surgery for adenocarcinoma: A case report and review of literature
Juan-Juan Li, Bing-Chen Chen, Jie Dong, Yuan Chen, You-Wei Chen
World Journal of Clinical Cases.2020; 8(24): 6456. CrossRef
Successful Endoscopic Resection of Mucosa-Associated Lymphoid Tissue Lymphoma of the Colon
Brian L. Schwartz, Robert C. Lowe
ACG Case Reports Journal.2019; 6(10): e00228. CrossRef
Endoscopic features and clinical outcomes of colorectal mucosa-associated lymphoid tissue lymphoma
Min Kyung Jeon, Hoonsub So, Jooryung Huh, Hee Sang Hwang, Sung Wook Hwang, Sang Hyoung Park, Dong-Hoon Yang, Kee Don Choi, Byong Duk Ye, Seung-Jae Myung, Suk-Kyun Yang, Jeong-Sik Byeon
Gastrointestinal Endoscopy.2018; 87(2): 529. CrossRef
Synchronous MALT lymphoma of the colon and stomach and regression after eradication ofStrongyloides stercoralisandHelicobacter pylori
Kevin Singh, Soren Gandhi, Behzad Doratotaj
BMJ Case Reports.2018; 2018: bcr-2018-224795. CrossRef
Colonic Mucosa-Associated Lymphoid Tissue Lymphoma Presented as Multiple Polyposis at Colonoscopy in a Nigerian Man: Case Report of a Rare Occurrence and Brief Review of Literature
Aderemi Oluyemi, Nicholas Awolola
Journal of Global Oncology.2017; 3(4): 418. CrossRef
Mucosa-Associated Lymphoid-Tissue Lymphoma of the Cecum and Rectum: A Case Report
Myung Jin Nam, Byung Chang Kim, Sung Chan Park, Chang Won Hong, Kyung Su Han, Dae Kyung Sohn, Weon Seo Park, Hee Jin Chang, Jae Hwan Oh
Annals of Coloproctology.2017; 33(1): 35. CrossRef
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Seungjun Gim, Kang Nyeong Lee, Donghoon Lee, Hye Young Lee, Ki Sul Chang, Oh Young Lee, Ho Soon Choi
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Mucosa-Associated Lymphoid Tissue (MALT) Lymphoma of the Colon: A Case Report and a Literature Review
Hafsa Abbas, Masooma Niazi, Jasbir Makker
American Journal of Case Reports.2017; 18: 491. CrossRef
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Masaya Iwamuro, Hiroyuki Okada, Katsuyoshi Takata, Ryuta Takenaka, Tomoki Inaba, Motowo Mizuno, Haruhiko Kobashi, Shouichi Tanaka, Masao Yoshioka, Eisei Kondo, Tadashi Yoshino, Kazuhide Yamamoto
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Colonic mucosa-associated lymphoid tissue lymphoma identified by chromoendoscopy
Sang-Wook Seo
World Journal of Gastroenterology.2014; 20(48): 18487. CrossRef

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A Polypoid Mucosa-Associated Lymphoid Tissue Lymphoma of the Stomach Treated with Endoscopic Polypectomy: Shin Young Min, Jun Haeng Lee, Poong-Lyul Rhee; Clin Endosc 2013;46(6):647-650. Published online November 19, 2013; DOI: https://doi.org/10.5946/ce.2013.46.6.647

Abstract PDF PubReader ePub

Mucosa-associated lymphoid tissue (MALT) lymphoma of the stomach is the most common extranodal lymphoma of the gastrointestinal tract. It is usually accompanied by Helicobacter pylori infection, and eradication of H. pylori remains the mainstay of treatment for gastric MALT lymphoma. However, there is no consensus on the second-line treatment for patients with gastric MALT lymphoma who do not improve after successful H. pylori eradication. Here, we report the case of a 34-year-old woman who presented with a polypoid type of gastric MALT lymphoma on the greater curvature side of the upper body. Despite successful H. pylori eradication, the tumor did not regress after 6 months. Because the tumor had a semipedunculated polypoid morphology, gastric polypectomy was implemented as a second-line treatment. No recurrence occurred during the 3-year follow-up period. We suggest that gastric polypectomy be considered an alternative treatment modality for polypoid gastric MALT lymphoma that is unresponsive to H. pylori eradication.

Citations

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A polypoid mucosa-associated lymphoid tissue lymphoma causing gastric outlet obstruction: A case report and literature review
Chakib Khoury, Rebal Nahas, Karam Karam, Emanuel-Youssef Dib, Elias Fiani
Medical Reports.2025; 13: 100313. CrossRef

8,129 View
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1 Crossref

Duodenal Mucosa-Associated Lymphoid Tissue Lymphomas: Two Cases and the Evaluation of Endoscopic Ultrasonography: Su Jin Kim, Hyung Wook Kim, Choel Woong Choi, Jong Kun Ha, Young Mi Hong, Jin Hyun Park, Soo Bum Park, Dae Hwan Kang; Clin Endosc 2013;46(5):563-567. Published online September 30, 2013; DOI: https://doi.org/10.5946/ce.2013.46.5.563

Abstract PDF PubReader ePub

Mucosa-associated lymphoid tissue lymphoma mainly arises in the stomach, with fewer than 30% arising in the small intestine. We describe here two cases of primary duodenal mucosa-associated lymphoid tissue lymphoma which were evaluated by endoscopic ultrasonography. A 52-year-old man underwent endoscopy due to abdominal pain, which demonstrated a depressed lesion on duodenal bulb. Endoscopic ultrasonographic finding was hypoechoic lesion invading the submucosa. The other case was a previously healthy 51-year-old man. Endoscopy showed a whitish granular lesion on duodenum third portion. Endoscopic ultrasonography image was similar to the first case, whereas abdominal computed tomography revealed enlargement of multiple lymph nodes. The first case was treated with eradication of Helicobacter pylori, after which the mucosal change and endoscopic ultrasound finding were normalized in 7 months. The second case was treated with cyclophosphamide, vincristine, prednisolone, and rituximab every 3 weeks. After 6 courses of chemotherapy, the patient achieved complete remission.

Citations

Citations to this article as recorded by

Primary Gastric and Duodenal Mucosa-Associated Lymphoid Tissue Lymphoma With Symptomatic Anemia
Abdulla Alabed, Faisal Abubaker, Omar Sharif, Alddana Zayed, Eman Aljufairi
ACG Case Reports Journal.2024; 11(7): e01438. CrossRef
Review of lymphoma in the duodenum: An update of diagnosis and management
Masaya Iwamuro, Takehiro Tanaka, Hiroyuki Okada
World Journal of Gastroenterology.2023; 29(12): 1852. CrossRef
Synchronous duodenal mucosa-associated lymphoid tissue lymphoma and gastric cancer
Keiichiro Yokota, Tsutomu Namikawa, Masahiro Maeda, Nobuhisa Tanioka, Jun Iwabu, Sunao Uemura, Masaya Munekage, Hiromichi Maeda, Hiroyuki Kitagawa, Michiya Kobayashi, Kazuhiro Hanazaki
Clinical Journal of Gastroenterology.2021; 14(1): 109. CrossRef
Early, Isolated Duodenal Mucosa-Associated Lymphoid Tissue Lymphoma Presenting without Symptoms or Grossly Apparent Endoscopic Lesions and Diagnosed by Random Duodenal Biopsies
Mihajlo Gjeorgjievski, Issa Makki, Pradeep Khanal, Mitual B. Amin, Ann Marie Blenc, Tusar Desai, Mitchell S. Cappell
Case Reports in Gastroenterology.2016; 10(2): 323. CrossRef

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Original Articles

Assessment on the Potential Role of Applying Cryoprobe for Tissue Ablation: Min Ho Seo, Yoon Tae Jeen, Sang Jung Park, Sun Young Kim, Hye Jin Cho, Hyuk Sun Choi, Hoon Jai Chun, Chang Duck Kim, Ho Sang Ryu, Yang Seok Chae; Clin Endosc 2012;45(1):67-72. Published online March 31, 2012; DOI: https://doi.org/10.5946/ce.2012.45.1.67

Abstract PDF PubReader ePub: Background/Aims
Cryotherapy is the therapeutic application for tissue ablation. Clinical applications of cryotherpy such as in pulmonology have increased. Until now, its development in gastroenterology has been insignificant. But, as clinical application such as mucosal ablation on Barrett's esophagus became possible, various applications have been developed. Therefore, it is important to make standards of tissue injury's extent in cryotherapy prior to clinical trial. We evaluated the tissue injury according to the application of cryoprobe with a pig model.
Methods
Cryoprobe was applied to several different segments of the esophagus and stomach for various lengths of time using various number of probe's contact in a pig model. After 48 hours, esophagus and stomach were harvested and histological tissue injury was assessed. The extent of tissue injury was decided by the injury of the deepest layer.
Results
Endoscopic application of cryoprobe on esophagus and stomach resulted in a dose-dependent injury: esophageal necrosis was limited to the submucosa after 10 seconds of cryotherapy, and extended to involve the transmural necrosis after over 15 seconds. Necrosis on stomach was extended to involve the transmural necrosis after over 20 seconds.
Conclusions
Positive relationship was seen between the duration and frequency of cryoprobe application and the extent of tissue injury.

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Low Grade Gastric Mucosa-associated Lymphoid Tissue Lymphoma: Clinicopathological Factors Associated with Helicobacter pylori Eradication and Tumor Regression: Yoon Jin Choi, Dong Ho Lee, Ji Yeon Kim, Ji Eun Kwon, Jae Yeon Kim, Hyun Jin Jo, Cheol Min Shin, Hyun Young Kim, Young Soo Park, Nayoung Kim, Hyun Chae Jung, In Sung Song; Clin Endosc 2011;44(2):101-108. Published online December 31, 2011; DOI: https://doi.org/10.5946/ce.2011.44.2.101

Abstract PDF PubReader ePub

Background/Aims

Eradication of Helicobacter pylori is widely accepted as initial therapy for low-grade gastric mucosa-associated lymphoid tissue (MALT) lymphoma. However, approximately 20% of patients with this disease are not responsive to H. pylori eradication therapy. The aim of this study was to assess remission and relapse rates of low-grade gastric MALT lymphoma after H. pylori eradication and identify the clinical factors that affect remission.

Methods

Thirty-nine patients diagnosed with gastric MALT lymphoma (May 2003 to May 2010) were retrospectively analyzed.

Results

Of the 39 patients, 30 (77%) had a H. pylori infection. There were 35/39 (90%) patients with stage I. Among stage I, 25 patients with the infection underwent eradication therapy and 22/25 (88%) achieved remission. The total regression rate with eradication only in stage I was 24/28 (86%). The median time to remission was 98 days (range, 22 to 397 days). Age, tumor location, invasion depth, H. pylori burden, and severity of mononuclear leukocyte and neutrophil infiltration were not related to remission. However, patients with less neutrophil infiltration were more likely to achieve a successful first H. pylori eradication (p=0.049).

Conclusions

The results show that the rate of low-grade gastric MALT lymphoma regression (86%) with H. pylori eradication alone was higher than that in Western studies (77.8%) and that neutrophil infiltration was inversely related to success of the first H. pylori eradication procedure.

Citations

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Value of endoscopic submucosal dissection in diagnosing gastric mucosa-associated lymphoid tissue lymphoma: A case report
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A Case of Primary B Cell Mucosa-associated Lymphoid Tissue Lymphoma Presenting as a Solitary Rectal Mass: Jong Hoon Kim, M.D., Young-Soo Moon, M.D., Seuk Hyun Lee, M.D., Jun Sup Park, M.D.*, Won Ki Bae, M.D., Nam-Hoon Kim, M.D., Sunhee Chang, M.D.^†, Kyung-Ah Kim, M.D., Hye Ran Lee, M.D. and June Sung Lee, M.D.; Korean J Gastrointest Endosc 2008;36(2):102-106. Published online February 27, 2008

Abstract PDF: Primary extranodal B cell lymphoma of mucosa- associated lymphoid tissue (MALT) can develop in diverse anatomic locations such as the stomach, salivary gland, thyroid, lung, and breast. Its distribution in the GI tract is as follows: 50∼60% in the stomach, 20∼30% in the small intestine and ileocecal area and 10% in the colorectal area. Although autoimmune and infectious diseases are known as the main etiologies, H. pylori infection has been clearly shown to play a causative role in lymphomagenesis, especially in the stomach. H. pylori eradication therapy only can induce disease remission nearly in 80% of the cases of gastric MALT lymphoma. However, there is lack of evidence for the extragastric area. In this case, a 71-year-old woman with low abdominal pain was diagnosed as having a rectal MALT lymphoma that was noted as a solitary rectal mass in a colonoscopic examination. Remission induction was commenced by H. pylori eradication and radiation therapy. (Korean J Gastrointest Endosc 2008;36:102-106)

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A Case of Primary Rectal MALT Lymphoma Presented as Multiple Submucosal Tumors: Hee Sun Mun, M.D., Hyo Jin Park, M.D., Ki Byung Lee, M.D., In Su Jung, M.D., Woo Ick Yang, M.D.*, Soon Won Hong, M.D.* and Jung Hwan Kim, M.D.^†; Korean J Gastrointest Endosc 2007;35(4):272-276. Published online October 30, 2007

Abstract PDF: MALT (mucosa-associated lymphoid tissue) lymphomas are the most common primary gastrointestinal (GI) lymphomas. MALT lymphomas of the GI tract tend to occur most commonly in the stomach, followed by the small intestine, ileocecal area, colon and the esophagus. However, MALT lymphomas of the large intestine are rare. Previously, a diagnosis was commonly established by the surgical specimens but endoscopic biopsy specimens are currently used to make a diagnosis. A 61-year-old woman was found to have multiple submucosal tumors of the rectum during a screening colonoscopy. The tumors were removed by a polypectomy. The histology revealed the diffuse infiltration of centrocyte-like cells and a lymphoepithelial lesion. Immunohistochemical staining confirmed the diagnosis of a low grade B cell lymphoma of the MALT type. No other site of involvement was identified on the CT of the chest, abdomen and pelvis. (Korean J Gastrointest Endosc 2007;35:272-276)

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A Case of Diffuse Large B Cell Lymphoma Transformed from a Duodenal Low Grade MALT Lymphoma: Soon Joo Kim, M.D., Gin Hyug Lee, M.D., Sang Hyun Park, M.D., Hyun Deok Shin, M.D., Chang Lae Jo, M.D., Tae Hyup Kim, M.D., Ho June Song, M.D., Kee Don Choi, M.D., Hwoon-Yong Jung, M.D. and Jin Ho Kim, M.D.; Korean J Gastrointest Endosc 2007;34(2):103-107. Published online March 2, 2007

Abstract PDF: Duodenal mucosa-associated lymphoid tissue (MALT) lymphoma is a very rare neoplasm. We report here a case of a 67-year-old woman with a diffuse large B cell lymphoma arising in a low grade MALT lymphoma in the duodenal bulb. She was asymptomatic and on a general health evaluation an upper endoscopy showed an extensive erosive lesion on the duodenal bulb. The biopsy specimen showed lymphocyte infiltration with lymphoepithelial lesions suggesting a low grade MALT lymphoma. A second upper endoscopy with biopsy discovered a focal diffuse large B cell lymphoma in the background of a low grade MALT lymphoma. A meticulous staging work-up revealed that the lymphoma was confined to the duodenum and regional lymph nodes. Finally, the patient was diagnosed as having a diffuse large B cell lymphoma transformed from a duodenal low grade MALT lymphoma. The patient was undergoing combination chemotherapy including the use of an anti-CD20 monoclonal antibody.

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A Case of Mucosa-Associated Lymphoid Tissue Lymphoma in the Esophagus Accompanied by Bronchus-Associated Lymphoid Tissue Lymphoma: Chang Mo Moon, M.D., Hee Man Kim, M.D., Jong Won Choi, M.D., Jung Hun Seo, M.D.*, Sun Young Won, M.D.*, Chun Gyun Lee, M.D.*, In Suh Park, M.D.*, Jin Suk Kim, M.D.^†, Jung Hye Ki, M.D.^‡ and Yong Suk Cho, M.D.*; Korean J Gastrointest Endosc 2003;27(3):137-142. Published online September 30, 2003

Abstract PDF: Mucosa-associated lymphoid tissue (MALT) is specially adapted component of the immune system protecting the permeable surface of the gastrointestinal mucosa, bronchial mucosa and other mucosa. Chronic infection of the stomach by Helicobacter pylori, Hashimoto's thyroiditis, Sjögren syndrome in the salivary gland and other chronic inflammatory and autoimmune disease lead to the accumulation of MALT in the mucosa and MALT lymphoma arises from this acquired MALT. MALT lymphoma is histologically characterized by proliferation of centrocyte-like cells that invade the epithelium and lymphoepithelial lesion form. Gastrointestinal MALT lymphoma is clinically important because it is a localized, slow progressive disease and has a long survival and favorable clinical course compared with other lymphoma. Esophageal MALT lymphoma is extremely rare, so we report, radiologic, endoscopic and pathological findings and clinical course in a case of esophageal MALT lymphoma with brouchas-associated lymphoid tissue (BALT) lymphoma with a review of literature.

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다발성 용종으로 발현된 대장의 MALT 림프종 1 예 ( A Case of Mucosa - Associated Lymphoid Tissue Lymphoma of Colon as Multiple Large Polypoid Lesions ): Korean J Gastrointest Endosc 2001;23(2):122-126. Published online November 30, 2000

Abstract PDF: Mucosa-associated lymphoid tissue (MALT) lymphoma of colon usually presents with a solitary lesion of polypoid appearance but may rarely present with multiple polypoid lesions. MALT lymphoma of colon presented as multiple polypoid lesions are not easy to differentiate from multiple lymphomatous polyposis. We experienced a case of MALT lymphoma of colon with a large mass in proximal ascending colon involving ileocecal valve and multiple polypoid lesions in entire colon, (Korean J Gastrointest Endosc 2001;23:122-126)

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원발성 점막연관 림프조직형 위 림프종에서 초음파 내시경의 역할 ( The Role of Endoscopic Ultrasonography in Primary Gastric Lymphoma of MALT ): Korean J Gastrointest Endosc 1999;19(6):869-877. Published online November 30, 1998

Abstract PDF: Background
/Aims: Endoscopic ultrasonography (EUS) is a useful diagnostic method for diagnosing local invasion and lymph node metastasis of primary gastric lymphoma including mucosa-associated lymphoid tissue (MALT) lymphoma, but the role of follow-up EUS after histologic regression of MALT lymphoma has not been well established until now. Therefore the usefulness of EUS in initial and follow up studies after Helicobacter pylori eradication therapy was investigated. Methods: From January 1995 to October 1998, nineteen MALT lymphoma patients were investigated. All but four patients underwent EUS exam at diagnosis and 3∼23 months thereafter. 17 patients recieved H. pylori eradication therapy and 2 patients recieved operations without medical treatment. Results: 16 of the 17 patients (94%) were cured of H. pylori infection after antimicrobial therapy. but on the histologic criteria, 13 of the 16 cases (81%) who were cured of H. pylori infection showed complete regression of MALT lymphoma. Histologic regression of MALT lymphoma was observed 6 weeks to 23 months after H. pylori eradication. In follow up EUS exam, gastric wall abnormalities returned to normal in 9 cases (69%) and remained abnormal in 4 cases (31%) among the completely regressed 13 cases. Conclusions: Considerable portion (31%) of follow up EUS exam showed persistent abnormalities of gastric wall such as thickening of mucosa and/or submucosa after histologic regression of MALT lymphoma. To evaluate the usefulness of EUS, follow up EUS exam with regular interval for longer periods after histologic regression is needed. (Korean J Gastrointest Endosc 19: 869∼877, 1999)

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증례 : 식도 위장관 ; 소장에 발생한 MALT 림프종 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Mucosa - associated Lymphoid Tissue Lymphoma in Small Intestine ): Korean J Gastrointest Endosc 1997;17(3):423-429. Published online November 30, 1996

Abstract PDF: Mucosa-associated lymphoid tissue (MALT) lymphoma is the disease of distinctive clinicopathologic entities most of which are different from current lymph-node based lym- phoma classification. According to the circulatory properties of the lymphocytes and specific immunoglobulin isotype distribution, MALT is defined as the central lymphoid tissue and is opposed to peripheral somatic lymphoid tissue. It occurs most often in the gastrointestinal mucosa and the bronchial mucosa and may occur in other organs such as salivary gland, thyroid gland, conjunctiva, skin. The most common site of MALT lymphoma is gastrointestinal tract but non-gastrointestinal MALT lymphoma may present. The characteristics of pathology are reactive follicles surrounded by the diffuse infiltration of centrocyte-like (CCL) cells and lymphoepithelial lesion due to the gland invasion of CCL cells. It is a localized disease and has a long survival, Isaacson et al suggested the classification of primary gastrointestinal MALT lymphoma as low grade, high grade, immunoproliferative small intestinal disease (IPSID). The distribution is more often in the stomach than in the intestine. Intestinal MALT lymphomas have less favorable clinicnl courses than the gastric MALT lymphomas. Recurrences may appear in the same organ or in other extranodal sites. We report clinical, pathologic findings, and clinical course in a case of primary small intestinal MALT lymphoma in terminal ileum with literature review. (Korean J Gastrointest Endosc 17: 423-429, 1997)

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