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Diagnostic endoscopic ultrasonography:Assessment of safety and prevention of complications

World Journal of Gastroenterology 2012年第34期18卷 4659-4676页

作者： Christian Jenssen Maria Victoria Alvarez-Sánchez Bertrand Napoléon Siegbert Faiss Department of Internal Medicine Krankenhaus M rkisch-Oderland GmbHD15344 StrausbergGermany Department of Gastroenterology and Hepatology Hopital Privé Jean MermozF69008 LyonFrance Department of Gastroenterology and Hepatology Asklepios Klinik BarmbekD22291 HamburgGermany

Endoscopic ultrasonography (EUS) has gained wide acceptance as an important, minimally invasive diagnostic tool in gastroenterology, pulmonology, visceral surgery and oncology. This review focuses on data regarding risks and complications of non-interventional diagnostic EUS and EUS-guided fine-needle biopsy (EUS-FNB). Measures to improve the safety of EUS und EUS-FNB will be discussed. Due to the specific mechanical properties of echoendoscopes in EUS, there is a low but noteworthy risk of perforation. To minimize this risk, endoscopists should be familiar with the specific features of their equipment and their patients' specific anatomical situations (e.g., tumor stenosis, diverticula). Most diagnostic EUS complications occur during EUS-FNB. Pain, acute pancreatitis, infection and bleeding are the primary adverse effects, occurring in 1% to 2% ofpatients. Only a few cases of needle tract seeding and peritoneal dissemination have been reported. The mortality associated with EUS and EUS-FNB is 0.02%. The risks associated with EUS-FNB are affected by endoscopist experience and target lesion. EUS-FNB of cystic lesions is associated with an increased risk of infection and hemorrhage. Peri-interventional antibiotics are recommended to prevent cyst infection. Adequate education and training, as well consideration of contraindications, are essential to minimize the risks of EUS and EUS-FNB. Restricting EUS-FNB only to patients in whom the cytopathological results may be expected to change the course of management is the best way of reducing the number of complications.

关键词：内视镜的 ultrasonography 内视镜的指导 ultrasonography 的好针的活体检视复杂并发症禁止徵候风险安全穿孔流血感染尖锐胰腺炎

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Oval mucosal opening bloc biopsy after incision and widening by ring thread traction for submucosal tumor

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World Journal of Gastroenterology 2017年第39期23卷 7185-7190页

作者： Hirohito Mori Hideki Kobara Yu Guan Yasuhiro Goda Nobuya Kobayashi Noriko Nishiyama Tsutomu Masaki Department of Gastroenterology and Neurology Kagawa University Departments of Pharmacology Kagawa University

Gastric submucosal tumors(SMTs) less than 2 cm are generally considered benign neoplasms, and endoscopic observation is recommended, but SMTs over 2 cm, 40% of which are gastrointestinal stromal tumors(GISTs), have malignant potential. Although the Japanese Guidelines for GIST recommend partial surgical resection for GIST over 2 cm with malignant potential as well as en bloc large tissue sample to obtain appropriate and large specimens of SMTs, several reports have been published on tissue sampling of SMTs, such as with endoscopic ultrasound sound fine needle aspiration, submucosal tunneling bloc biopsy, and the combination of bite biopsy and endoscopic mucosal resection. Because a simpler, more accurate method is needed for appropriate treatment, we developed oval mucosal opening bloc biopsy after incision and widening by ring thread traction for submucosal tumor(OMOB) approach. OMOB was simple and enabled us to obtain large samples under direct procedure view as well as allowed us to restore to original mucosa.

关键词：胃的 submucosal 肿瘤胃肠的 stromal 肿瘤可逆开始活体检视内视镜的 ultrasonography 大样品

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Gastric metastasis from ovarian adenocarcinoma presenting as a subepithelial tumor and diagnosed by endoscopic ultrasound-guided tissue acquisition

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World Journal of Gastrointestinal Oncology 2017年第11期9卷 452-456页

作者： Filippo Antonini Liboria Laterza Lorenzo Fuccio Massimo Marcellini Lucia Angelelli Sonia Calcina Corrado Rubini Giampiero Macarri Department of Gastroenterology A. Murri Hospital Polytechnic University of Marche Endoscopy Unit AUSL Department of Medical and Surgical Sciences S. Orsola-Malpighi Hospital University of Bologna Medical Oncology Principe di Piemonte Hospital Medical Oncology Mazzoni Hospital Department of Gastroenterology San Salvatore Hospital University of L’Aquila Department of Biomedical Sciences and Public Health Pathological Anatomy and Histopathology Polytechnic University of Marche

We describe an uncommon case of a patient with a metastatic adenocarcinoma of ovarian origin presented as a gastric subepithelial tumor(SET) and that was diagnosed by endoscopic ultrasound fine-needle biopsy(EUS-FNB). Malignant gastric lesions are rarely metastatic and the primary tumor is mainly breast, lung, esophageal cancer or cutaneous melanoma. Gastric metastasis from ovarian cancer is unusual, presenting synchronously with the primary tumor but also several years later than the initial diagnosis. From an endoscopic point of view, gastric metastasis does not present specific features. They may mimic both a primary gastric tumor or, less frequently, an SET.This case demonstrates the importance of EUS-FNB in distinguishing SETs and how this may alter treatment and prognosis.

关键词：转移 Subepithelial 损害胃的癌症卵巢内视镜的 ultrasonography

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Randomized controlled study of the safety and efficacy of nitrous oxide-sedated endoscopic ultrasound-guided fine needle aspiration for digestive tract diseases

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World Journal of Gastroenterology 2016年第46期22卷 10242-10248页

作者： Cai-Xia Wang Jian Wang Yuan-Yuan Chen Jia-Ni Wang Xin Yu Feng Yang Si-Yu Sun Endoscopy Center Shengjing Hospital of China Medical University Endoscopic Center Liao Dongwan Branch Courts Shengjing Hospital of China Medical University

AIM To evaluate the efficacy and safety of nitrous oxidesedated endoscopic ultrasound-guided fine needle aspiration. METHODS Enrolled patients were divided randomly into an experimental group(inhalation of nitrous oxide) and a control group(inhalation of pure oxygen) and heart rate, blood oxygen saturation, blood pressure, electrocardiogram(ECG) changes, and the occurrence of complications were monitored and recorded. All patients and physicians completed satisfaction questionnaires about the examination and scored the process using a visual analog scale. RESULTS There was no significant difference in heart rate, blood oxygen saturation, blood pressure, ECG changes, or complication rate between the two groups of patients(P > 0.05). However, patient and physician satisfaction were both significantly higher in the nitrous oxide compared with the control group(P < 0.05).CONCLUSION Nitrous oxide-sedation is a safe and effective option for patients undergoing endoscopic ultrasound-guided fine needle aspiration.

关键词：内视镜的 ultrasonography 氧化氩氮镇静好针渴望

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Clinical implications of doubling time of gastrointestinal submucosal tumors

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World Journal of Gastroenterology 2016年第45期22卷 10015-10023页

作者： Shuko Koizumi Mitsuhiro Kida Hiroshi Yamauchi Kosuke Okuwaki Tomohisa Iwai Shiro Miyazawa Miyoko Takezawa Hiroshi Imaizumi Wasaburo Koizumi Department of Gastroenterology Kitasato University School of Medicine

AIM To evaluate the efficacy of doubling time(DT) of gastrointestinal submucosal tumors(GIST).METHODS From April 1987 through November 2012, a total of 323 patients were given a final histopathological diagnosis of GISTs on surgical resection or endoscopic ultrasound-guided fine-needle aspiration(EUS-FNA) in Kitasato University East Hospital or Kitasato University Hospital. We studied 53 of these patients(34 with resected tumors and 19 with unresected tumors) whose tumors could be measured on EUS on at least two successive occasions. The histopathological diagnosis was GIST in 34 patients, leiomyoma in 5, schwannoma in 3, ectopic pancreas in 1, hamartoma in 1, cyst in 1, Brunner's adenoma in 1, and spindle-cell tumor in 7. We retrospectively calculated the DT of GISTs on the basis of the time course of EUS findings to estimate the growth rate of such tumors.RESULTS The DT was 17.2 mo for GIST, as compared with 231.2 mo for leiomyoma, 104.7 mo for schwannoma, 274.9mo for ectopic pancreas, 61.2 mo for hamartoma, 49.0 mo for cyst, and 134.7 mo for Brunner's adenoma. The GISTs were divided into risk classes on the basis of tumor diameters and mitotic figures(Fletcher's classification). The classification was extremely low risk or low risk in 28 patients, intermediate risk in 3, and high risk in 3. DT of GIST according to risk was 24.0 mo for extremely low-risk plus low-risk GIST, 17.1 mo for intermediate-risk GIST, and 3.9 mo for high-risk GIST. DT of GIST was significantly shorter than that of leiomyoma plus schwannoma(P < 0.05), and DT of high-risk GIST was significantly shorter than that of extremely low-risk plus low-risk GIST(P < 0.05).CONCLUSION For GIST, a higher risk grade was associated with a significantly shorter DT. Small SMTs should initially be followed up within 6 mo after detection.

关键词：胃肠的 submucosal 肿瘤双倍工资 Submucosal 肿瘤起始的观察持续时间内视镜的 ultrasonography 内视镜的指导 ultrasonography 的好针渴望 Fletcher’ s 分类

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Role of endoscopic ultrasonography in the loco-regional staging of patients with rectal cancer

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World Journal of Gastrointestinal Endoscopy 2015年第7期7卷 688-701页

作者： Pietro Marone Mario de Bellis Valentina D'Angelo Paolo Delrio Valentina Passananti Elena Di Girolamo Giovanni Battista Rossi Daniela Rega Maura Claire Tracey Alfonso Mario Tempesta Endoscopy Unit Istituto Nazionale Tumori-IRCCS Division of Colorectal Surgical Oncology Istituto Nazionale Tumori-IRCCS Division of Gastroenterology Medical School University Federico II Division of Thoracic Surgery Istituto Nazionale Tumori-IRCCS

The prognosis of rectal cancer(RC) is strictly related to both T and N stage of the disease at the time of diagnosis. RC staging is crucial for choosing the best multimodal therapy: patients with high risk locally advanced RC(LARC) undergo surgery after neoadjuvant chemotherapy and radiotherapy(NAT); those with low risk LARC are operated on after a preoperative short-course radiation therapy; finally, surgery alone is recommended only for early RC. Several imaging methods are used for staging patients with RC: computerized tomography, magnetic resonance imaging, positron emission tomography, and endoscopic ultrasound(EUS). EUS is highly accurate for the loco-regional staging of RC, since it is capable to evaluate precisely the mural infiltration of the tumor(T), especially in early RC. On the other hand, EUS is less accurate in restaging RC after NAT and before surgery. Finally, EUS is indicated for follow-up of patients operated on for RC, where there is a need for the surveillance of the anastomosis. The aim of this review is to highlight the impact of EUS on the management of patients with RC, evaluating its role in both preoperative staging and follow-up of patients after surgery.

关键词：直肠的癌症阶段内视镜的 ultrasonography 精确性治疗学的策略

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Endoscopic ultrasonography-emerging applications in hepatology

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World Journal of Gastrointestinal Endoscopy 2017年第8期9卷 378-388页

作者： Joana Magalhaes Sara Monteiro Sofia Xavier Sílvia Leite Francisca Dias de Castro JoséCotter Gastroenterology Department Hospital Senhora da Oliveira School of Medicine University of Minho Life and Health Sciences Research Institute/3B’s PT Government Associate Laboratory

The inspection of the liver is a valuable part of the upper endoscopic ultrasonography(EUS) studies,regardless of the primary indication for the examination.The detailed images of the liver segments provided by EUS allows the use of this technique in the study of parenchymal liver disease and even in the diagnosis and classification of focal liver lesions.EUS has also emerged as an important tool in understanding the complex collateral circulation in patients with portal hypertension and their clinical and prognostic value.Recently,EUS-guided portal vein catheterization has been performed for direct portal pressure measurement as an alternative method to evaluate portal hemodynamics.In this review,the authors summarize the available evidence regarding the application of EUS to patients with liver diseases and how we can apply it in our current clinical practice.

关键词：内视镜的 ultrasonography 门高血压 Gastroesophageal 静脉曲张焦点的肝损害肝活体检视

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Endoscopicultrasonographyforsurveillanceofindividualsathighriskfor pancreaticcancer

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World Journal of Gastrointestinal Endoscopy 2014年第7期6卷 272-285页

作者： Lami G Biagini MR Galli A Gabriele Lami Maria Rosa Biagini Andrea Galli Gastroenterology Unit Department of Clinical Pathophysiology University of Florence Medical School 50139 Florence Italy

Pancreatic cancer is a highly lethal disease with a ge-netic susceptibility and familial aggregation found in 3%-16% of patients. Early diagnosis remains the only hope for curative treatment and improvement of prog-nosis. This can be reached by the implementation of an intensive screening program, actually recommended for individuals at high-risk for pancreatic cancer de-velopment. The aim of this strategy is to identify pre-malignant precursors or asymptomatic pancreatic can-cer lesions, curable by surgery. Endoscopic ultrasound (EUS) with or without fine needle aspiration(FNA) seems to be the most promising technique for early de-tection of pancreatic cancer. It has been described as a highly sensitive and accurate tool, especially for small and cystic lesions. Pancreatic intraepithelial neoplasia, a precursor lesion which is highly represented in high-risk individuals, seems to have characteristics chronic pancreatitis-like changes well detected by EUS. Many screening protocols have demonstrated high diagnostic yields for pancreatic pre-malignant lesions, allowing prophylactic pancreatectomies. However, it shows a high interobserver variety even among experienced en-dosonographers and a low sensitivity in case of chronic pancreatitis. Some new techniques such as contrast-en-hanced harmonic EUS, computer-aided diagnostic tech-niques, confocal laser endomicroscopy miniprobe andthe detection of DNA abnormalities or protein markersby FNA, promise improvement of the diagnostic yield ofEUS. As the resolution of imaging improves and as ourknowledge of precursor lesions grows, we believe thatEUS could become the most suitable method to detectcurable pancreatic neoplasms in correctly identifiedasymptomatic at-risk patients.

关键词：内视镜的 ultrasonography 胰腺的癌症监视

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