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Efficacy of endoscopic ultrasound in the evaluation of small gastrointestinal stromal tumors

World Journal of Gastroenterology 2022年第37期28卷 5457-5468页

作者： Qi-Chao Ge Yu-Fan Wu Zi-Ming Liu Zhe Wang Sheng Wang Xiang Liu Nan Ge Jin-Tao Guo Si-Yu Sun Department of Gastroenterology Shengjing Hospital of China Medical UniversityShenyang 110004Liaoning ProvinceChina Department of Pathology Shengjing Hospital of China Medical UniversityShenyang 110004Liaoning ProvinceChina

BACKGROUND Gastrointestinal stromal tumors(GISTs)with a diameter of5/50 high power field in 8(3.1%)*** irregularity,ulceration,strong echo foci,and heterogeneity were detected in 1(0.4%),2(0.8%),22(8.6%),and 67(65.1%)... 详细信息

BACKGROUND Gastrointestinal stromal tumors(GISTs)with a diameter ofendoscopic ultrasound(EUS)is widely used as a regular followup method for GISTs,which can also provide a preliminary basis for judging the malignancy potential of ***,there are no studies on the accuracy of EUS to assess the malignant potential of small *** To evaluate the efficacy of EUS in the diagnosis and risk assessment of small *** We collected data from patients with small GISTs who were admitted to Shengjing Hospital of China Medical University between October 2014 and July *** accurate diagnosis and risk classifications of patients were based on the pathological assessment according to the modified National Institute of Health criteria after endoscopic resection or laparoscopic *** EUS features(marginal irregularity,cystic changes,homogeneity,ulceration,and strong echogenic foci)were retrospectively *** assessment results based on EUS features were compared with the pathological *** A total of 256 patients(69 men and 187 women)were *** results included 232,16,7,and 1 very low-,low-,intermediate-,and high-risk cases,*** most frequent tumor location was the gastric fundus(78.1%),and mitoses were calculated as>5/50 high power field in 8(3.1%)*** irregularity,ulceration,strong echo foci,and heterogeneity were detected in 1(0.4%),2(0.8%),22(8.6%),and 67(65.1%)patients,***,cystic changes were not *** size was positively correlated with the mitotic index(P1.48 cm was associated with higher risk classification(P1.48 cm)with positive EUS features should receive intensive surveillance or unde

关键词： Gastrointestinal stromal tumors endoscopic ultrasound Diagnosis Risk classification

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Percutaneous transhepatic cholangiography vs endoscopic ultrasound-guided biliary drainage:A systematic review

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World Journal of Gastroenterology 2022年第27期28卷 3514-3523页

作者： Zeinab Hassan Eyad Gadour Internal Medicine Stockport Hospitals NHS Foundation TrustManchester SK27JEUnited Kingdom Department of Gastroenterology University Hospitals of Morecambe Bay NHS Foundation TrustLancaster LA14RPUnited Kingdom

BACKGROUND Percutaneous transhepatic cholangiography is a diagnostic and therapeutic procedure that involves inserting a needle into the biliary tree,followed by the immediate insertion of a *** ultrasound-guided biliary drainage(EUS-BD)is a novel technique that allows BD by echoendoscopy and fluoroscopy using a stent from the biliary tree to the gastrointestinal *** To compare the technical aspects and outcomes of percutaneous transhepatic BD(PTBD)and *** Different databases,including PubMed,Embase,***,the Cochrane library,Scopus,and Google Scholar,were searched according to the guidelines for Preferred Reporting Items for Systematic reviews and Meta-Analyses to obtain studies comparing PTBD and *** Among the six studies that fulfilled the inclusion criteria,PTBD patients underwent significantly more reinterventions(4.9 vs 1.3),experienced more postprocedural pain(4.1 vs 1.9),and experienced more late adverse events(53.8%vs 6.6%)than EUS-BD *** was a significant reduction in the total bilirubin levels in both the groups(16.4-3.3μmol/L and 17.2-3.8μmol/L for EUSBD and PTBD,respectively;P=0.002)at the 7-d *** were no significant differences observed in the complication rates between PTBD and EUSBD(3.3 vs 3.8).PTBD was associated with a higher adverse event rate than EUSBD in all the procedures,including reinterventions(80.4%vs 15.7%,respectively)and a higher index procedure(39.2%vs 18.2%,respectively).CONCLUSION The findings of this systematic review revealed that EUS-BD is linked with a higher rate of effective BD and a more manageable procedure-related adverse event profile than *** findings highlight the evidence for successful EUS-BD implementation.

关键词： Percutaneous transhepatic cholangiography endoscopic ultrasound Biliary drainage Obstructive cholangiopathy

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A pilot proof-of-concept study of a modified device for one-step endoscopic ultrasound-guided biliary drainage in a new experimental biliary dilatation animal model

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World Journal of Gastroenterology 2014年第19期20卷 5859-5866页

作者： Tae Hoon Lee Jun Hyuck Choi Sang Soo Lee Hyun Deuk Cho Dong Wan Seo Sang-Heum Park Sung Koo Lee Myung-Hwan Kim Do Hyun Park Division of Gastroenterology Department of Internal MedicineSoonchunhyang University School of MedicineCheonan HospitalChungcheongnamdo 330-721South Korea Division of Gastroenterology Department of Internal MedicineUniversity of Ulsan College of MedicineSeoul 138-736South Korea Department of Pathology Soonchunhyang University School of MedicineCheonan HospitalChungcheongnam-do 330-721South Korea

AIM: To evaluate the technical feasibility of a modified tapered metal tip and low profile introducer for one-step endoscopic ultrasound (EUS)-guided biliary drainage (EUS-BD) in a new experimental biliary dilatation ... 详细信息

关键词： endoscopic ultrasound Biliary drainage Biliary dilation Feasibility Complications

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Role of endoscopic ultrasound in idiopathic pancreatitis

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World Journal of Gastroenterology 2017年第38期23卷 6952-6961页

作者： Piyush Somani Tagore Sunkara Malay Sharma Department of Gastr-oenterology Jaswant Rai Speciality Hospital Department of Gastroenterology and Hepatology The Brooklyn Hospital Center Clinical Affliate of The Mount Sinai Hospital

Recurrent acute pancreatitis(RAP) is defined based on the occurrence of two or more episodes of acute pancreatitis. The initial evaluation fails to detect the cause of RAP in 10%-30% of patients, whose condition is classified as idiopathic RAP(IRAP). Idiopathic acute pancreatitis(IAP) is a diagnostic challenge for gastroenterologists. In view of associated morbidity and mortality, it is important to determine the aetiology of pancreatitis to provide early treatment and prevent recurrence. endoscopic ultrasound(EUS) is an investigation of choice for imaging of pancreas and biliary tract. In view of high diagnostic accuracy and safety of EUS, a EUS based management strategy appears to be a reasonable approach for evaluation of patients with a single/recurrent idiopathic pancreatitis. The most common diagnoses by EUS in IAP is biliary tract disease. The present review aims to discuss the role of EUS in the clinical management and diagnosis of patients with IAP. It elaborates the diagnostic approach to IAP in relation to EUS and other different modalities. Controversial issues in IAP like when to perform EUS, whether to perform after first episode or recurrent episodes, comparison among different investigations and the latest evidence significance are detailed.

关键词： endoscopic ultrasound Pancreatitis ERCP MRCP USG CT Idiopathic recurrent pancreatitis Ascariasis Pancreatic cancer Biliary sludge Gallstones Microlithiasis Common bile duct stones

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High-flow nasal oxygen availability for sedation decreases the use of general anesthesia during endoscopic retrograde cholangiopancreatography and endoscopic ultrasound

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World Journal of Gastroenterology 2016年第47期22卷 10398-10405页

作者： Roman Schumann Nikola S Natov Klifford A Rocuts-Martinez Matthew D Finkelman Tom V Phan Sanjay R Hegde Robert M Knapp Department of Anesthesiology and Perioperative Medicine Tufts Medical CenterBoston MA 02111United States The Gastroenterology/Hepatology Division Tufts Medical CenterBoston MA 02111United States Critical Care Medicine Dartmouth-Hitchcock Medical CenterLebanon NH 03756 United States Tufts University School of Dental Medicine Boston MA 02111United States Tufts University School of Medicine Boston MA 02111United States

AIM To examine whether high-flow nasal oxygen(HFNO) availability influences the use of general anesthesia(GA) in patients undergoing endoscopic retrograde cholangiopancreatography(ERCP) and endoscopic ultrasound(EUS) and associated *** In this retrospective study, patients were stratified into 3 eras between October 1, 2013 and June 30, 2014 based on HFNO availability for deep sedation at the time of their endoscopy. During the first and last 3-mo eras(era 1 and 3), no HFNO was available, whereas it was an option during the second 3-mo era(era 2). The primary outcome was the percent utilization of GA vs deep sedation in each period. Secondary outcomes included oxygen saturation nadir during sedation between periods, as well as procedure duration, and anesthesia-only time between periods and for GA vs sedation cases *** During the study period 238 ERCP or EUS cases were identified for analysis. Statistical testing was employed and a P < 0.050 was significant unless the Bonferroni correction for multiple comparisons was used. General anesthesia use was significantly lower in era 2 compared to era 1 with the same trend between era 2 and 3(P = 0.012 and 0.045 respectively). The oxygen saturation nadir during sedation was significantly higher in era 2 compared to era 3(P < 0.001) but not between eras 1 and 2(P = 0.028) or 1 and 3(P = 0.069). The procedure time within each era was significantly longer under GA compared to deep sedation(P ≤ 0.007) as was the anesthesia-only time(P ≤ 0.001).CONCLUSION High-flow nasal oxygen availability was associated with decreased GA utilization and improved oxygenation for ERCP and EUS during sedation.

关键词： endoscopic ultrasound endoscopic retrograde cholangiopancreatography Endoscopy Sedation Anesthesia Oxygenation High flow nasal oxygen

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Celiac plexus neurolysis in pancreatic cancer:The endoscopic ultrasound approach

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World Journal of Gastroenterology 2014年第1期20卷 110-117页

作者： Andrada Seicean Regional Institute of Gastroenterology and Hepatology Cluj-Napoca University of Medicine and Pharmacy "Iuliu Hatieganu"400162 Cluj-NapocaRomania

Pain in pancreatic cancer is often a major problem of *** of opioids is frequently limited by side effects or insufficient *** ultrasound-guided celiac plexus neurolysis(EUS-CPN)represents an alternative for the palliative treatment of visceral pain in patients with pancreatic *** review focuses on the indications,technique,outcomes of EUS-CPN and predictors of pain ***-CPN should be considered as the adjunct method to standard pain *** moderately reduces pain in pancreatic cancer,without eliminating *** all patients need to continue opioid use,often at a constant *** effect on quality of life is controversial and survival is not *** approach could be done in the central position of the celiac axis,which is easy to perform,or in the bilateral position of the celiac axis,with similar results in terms of pain *** EUS-CPN with multiple intraganglia injection approach seems to have better results,although extended studies are still *** trials are required to enable more confident conclusions regarding timing,quantity of alcohol injected and the method of *** complications have rarely been reported,and great care should be taken in choosing the site of alcohol injection.

关键词： endoscopic ultrasound Celiac neurolysis Pancreas Cancer Pain

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Utility of endoscopic ultrasound in patients with portal hypertension

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World Journal of Gastroenterology 2014年第39期20卷 14230-14236页

作者： Ghassan M Hammoud Jamal A Ibdah Division of Gastroenterology and Hepatology University of Missouri School of Medicine Columbia MO 65212 United States

endoscopic ultrasound(EUS) has revolutionized the diagnostic and therapeutic approach to patients with gastrointestinal disorders. Its application in patients with liver disease and portal hypertension is increasing. Patients with chronic liver disease are at risk for development of portal hypertension sequale such as ascites, spontaneous bacterial peritonitis and gastroesophageal varices. Bleeding esophageal and gastric varices are among the most common causes of mortality in patients with cirrhosis. Thus, early detection and treatment improve the outcome in this population. EUS can improve the detection and diagnosis of gastroesophageal varices and collateral veins and can provide endoscopic therapy of gastroesophageal varices such as EUS-guided sclerotherapy of esophageal collateral vessels and EUS-guided cynoacrylate(Glue) injection of gastric varices. EUS can also provide knowledge on the efficacy of pharmacotherapy of portal hypertension. Furthermore, EUS can provide assessment and prediction of variceal recurrence after endoscopic therapy and assessment of portal hemodynamics such as E-Flow and Doppler study of the azygous and portal veins. Moreover, EUS-guided fine needle aspiration may provide cytologic diagnosis of focal hepatic tumors andanalysis of free abdominal *** specialized EUSguided needle biopsy,a sample of liver tissue can be obtained to diagnose and evaluate for chronic liver ***-guided fine needle injection can be used to study portal vein pressure and hemodynamics,and potentially could be used to assist in exact measurement of portal vein pressure and placement of intrahepatic portosystemic shunt.

关键词： endoscopic ultrasound Cirrhosis Portal hypertension Gastroesophageal varices Cyanoacrylate Hepatocellular carcinoma Fine needle aspiration

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Comparison of endoscopic ultrasound, computed tomography and magnetic resonance imaging in assessment of detailed structures of pancreatic cystic neoplasms

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World Journal of Gastroenterology 2017年第17期23卷 3184-3192页

作者： Chen Du Ning-Li Chai En-Qiang Linghu Hui-Kai Li Li-Hua Sun Lei Jiang Xiang-Dong Wang Ping Tang Jing Yang Department of Gastroenterology and Hepatology Chinese People’s Liberation Army General Hospital

AIM To evaluate the advantages of endoscopic ultrasound(EUS) in the assessment of detailed structures of pancreatic cystic neoplasms(PCNs) compared to computed tomography(CT) and magnetic resonance imaging(MRI).METHODS All patients with indeterminate PCNs underwent CT, MRI, and EUS. The detailed information, including size, number, the presence of a papilla/nodule, the presence of a septum, and the morphology of the pancreatic duct of PCNs were compared among the three imaging modalities. The size of each PCN was determined using the largest diameter measured. A cyst consisting of several small cysts was referred to as a motherdaughter cyst. Disagreement among the three imaging modalities regarding the total number of mother cysts resulted in the assumption that the correct number was the one in which the majority of imaging modalities *** A total of 52 females and 16 males were evaluated. The median size of the cysts was 42.5 mm by EUS, 42.0 mm by CT and 38.0 mm by MRI; there was no significant difference in size as assessed among the three imaging techniques. The diagnostic sensitivity and ability of EUS to classify PCNs were 98.5%(67/68) and 92.6%(63/68), respectively. These percentages were higher than those of CT(73.1%, P < 0.001; 17.1%, P < 0.001) and MRI(81.3%, P = 0.001; 20.3%, P < 0.001). EUS was also able to better assess the number of daughter cysts in mother cysts than CT(P = 0.003); however, there was no significant difference between EUS and MRI in assessing mother-daughter cysts(P = 0.254). The papilla/nodule detection rate by EUS was 35.3%(24/68), much higher than those by CT(5.8%, 3/52) and MRI(6.3%, 4/64). The detection rate of the septum by EUS was 60.3%(41/68), which was higher than those by CT(34.6%, 18/52) and by MRI(46.9%, 30/64); the difference between EUS and CT was significant(P = 0.02). The rate of visualizing the pancreatic duct using EUS was 100%, whereas using CT and MRI it was less than 10%.CONCLUSION EUS helps visualize

关键词： endoscopic ultrasound Detailed structures Computed tomography Magnetic resonance imaging Pancreatic cystic neoplasms

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Experimental model standardizing polyvinyl alcohol hydrogel to simulate endoscopic ultrasound and endoscopic ultrasoundelastography

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World Journal of Gastroenterology 2020年第34期26卷 5169-5180页

作者： Elymir S Galvis-García Sergio Sobrino-Cossío Arturo Reding-Bernal Yesica Contreras-Marín Karina Solórzano-Acevedo Patricia González-Zavala Rosa M Quispe-Siccha Unidad de Endoscopía Gastrointestinal Hospital General de México"Dr.Eduardo Liceaga"Mexico 06720Mexico Unidad de Endoscopia y Fisiología Digestiva HospitalÁngeles del PedregalMexico 10700Mexico Dirección de Investigación Hospital General de México“Dr.Eduardo Liceaga”Mexico 06720Mexico Unidad Profesional Interdisciplinaria de Biotecnología and Unidad de Investigación y Desarrollo Tecnológico Instituto Politécnico Nacional and Hospital General de México"Dr.Eduardo Liceaga"Mexico 06720Mexico Instituto de Investigaciones en Materiales and Unidad de Investigación y Desarrollo Tecnológico Universidad Nacional Autónoma de México and Hospital General de México"Dr.Eduardo Liceaga"Mexico 06720Mexico Unidad de Investigación y Desarrollo Tecnológico Hospital General de México"Dr.Eduardo Liceaga"Mexico 06720Mexico

BACKGROUND endoscopic ultrasound(EUS)and endoscopic ultrasound elastography(EUS-E)simulation lessens the learning curve;however,models lack realism,diminishing *** To standardize the mechanical properties of polyvinyl alcohol(PVA)hydrogel for simulating organs and digestive *** PVA hydrogel(Sigma Aldrich,degree of hydrolysis 99%)for simulating EUS/EUS-E lesions was investigated in Unidad de Investigación y Desarrollo Tecnológico at Hospital General de México“*** Liceaga”,Mexico *** evaluated physical,contrast,elasticity and deformation coefficient characteristics in lesions,applying Kappa’s concordance and satisfaction questionnaire(Likert 4-points).RESULTS PVA hydrogel showed stable mechanical *** depended on molecular weight(MW)and concentration(C).PVA bblocks with the greatest density showed lowest tensile strength(r=-0.8,P=0.01).Lesions were EUSgraphically *** and heterogeneous examples were created from PVA blocks or PVA phantoms,exceeding(MW2=146000-186000,C9=15%and C10=20%)with a density under(MW1=85000-124000,C1=7%and C2=9%).We calculated elasticity and deformation parameters of solid(blue)areas,contrasting with the norm(Kappa=0.8;high degree of satisfaction).CONCLUSION PVA hydrogels were appropriate for simulating organs and digestive lesions using EUS/EUS-E,facilitating practice and reducing *** amplified skills,while reducing the learning curve.

关键词： endoscopic ultrasound simulators in endoscopy Polyvinyl alcohol endoscopic ultrasound endoscopic ultrasound elastography Strain Elasticity

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Simultaneous multiple primary malignancies diagnosed by endoscopic ultrasound-guided fine-needle aspiration:A case report

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World Journal of Clinical Cases 2022年第17期10卷 5764-5769页

作者： Jian Yang Yan Zeng Jun-Wen Zhang Department of Gastroenterology The First Affiliated Hospital of Chongqing Medical UniversityChongqing 400016China Department of Psychology The Second Affiliated Hospital of Chongqing Medical UniversityChongqing 400010China

BACKGROUND Multiple primary malignancies(MPMs)refer to more than one primary malignancy in the same or separate organs of the same patient,and MPMs are considered when different histological characteristics are detected in epidemiological ***,we report a case presumed to be primary pancreatic cancer with multiple liver metastases by positron-emission tomography/computed tomography(PET/CT)and confirmed to be synchronous liver and pancreatic MPMs by endoscopic ultrasound-guided fine-needle aspiration(EUSFNA).CASE SUMMARY A 50-year-old man was referred to our hospital due to abdominal discomfort for 2 *** CT at a local hospital revealed a pancreatic mass with multiple liver *** being transferred to our hospital,PET/CT confirmed all these lesions to have elevated metabolic activity,and therefore primary pancreatic cancer with multiple liver metastases was ***-guided liver aspiration unexpectedly found signet-ring cells with a high Ki-67 positive rate(20%),while EUS-guided pancreatic aspiration detected pancreatic neuroendocrine cells with a relatively low Ki-67 positive rate(1%).The final diagnosis from the multidisciplinary team was simultaneous liver and pancreatic *** patient returned to his local hospital for neoadjuvant chemotherapy and surgery,and he is still alive during the 6-mo postoperative *** Although rare,MPMs should be considered when treating pancreatic mass with suspected metastatic lesions,and EUS-FNA has proved minimally invasive and accurate.

关键词： Multiple primary malignancies endoscopic ultrasound Fine-needle aspiration Pancreatic cancer Liver cancer Case report

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