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World Journal of Gastroenterology 2022年第46期28卷 6564-6572页

作者： Ji Young Park Tae Joo Jeon Department of Internal Medicine Inje University College of MedicineSanggye Paik HospitalSeoul 01757South Korea Department of Internal Medicine Yonsei University College of MedicineSeoul 03722South Korea

BACKGROUND Endoscopic Ultrasonography(EUS)has become a reliable method for predicting the invasion depth of early gastric cancer(EGC).However,diagnostic accuracy of EUS is affected by several factors.In particular,it is difficult to differentiate between T1a and T1b EGC through EUS.AIM To confirm whether submucosal saline injection(SSI)could improve the accuracy of EUS in distinguishing T1a and T1b lesions in EGC.METHODS Twenty-four patients with EGC were examined by EUS and subsequently by SSI combined EUS to compare the degree of tumor invasion.Then,they underwent endoscopic or surgical resection within 7 d.The diagnostic accuracy of EUS and SSI combined EUS was evaluated based on the final pathological findings postoperatively.Saline injected into the submucosa acted as an echoic contrast enhancing agent and had the effect of distinguishing the mucosal and submucosal layers clearly.RESULTS Of total 24 patients,23 were diagnosed with EGC(T1 cancer:13 as T1a,and 10 as T1b).Standard EUS identified 6 of 13 T1a cancer patients and 3 of 10 T1b cancer patients.Whereas,EUS-SSI identified 12 of 13 T1a cancer patients and 6 of 10 T1b cancer patients.In this study,SSI combined EUS was more accurate than EUS alone in diagnosing T1a and T1b lesions of EGC(75.0%and 37.5%,respectively).CONCLUSION SSI improved the diagnostic accuracy of EUS in distinguishing between the T1a and T1b stages in EGC.

关键词： Endoscopic Ultrasonography Gastric cancer Endoscopy Surgery

Is Endoscopic Ultrasonography essential for endoscopic resection of small rectal neuroendocrine tumors?

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World Journal of Gastroenterology 2017年第11期23卷 2037-2043页

作者： Su Bum Park Dong Jun Kim Hyung Wook Kim Cheol Woong Choi Dae Hwan Kang Su Jin Kim Hyeong Seok Nam Department of Internal Medicine Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and TechnologyPusan National University Yangsan HospitalYangsanGyeongsangnam-do 626-770South Korea

AIM To evaluate the importance of Endoscopic Ultrasonography(EUS) for small(≤ 10 mm) rectal neuroendocrine tumor(NET) treatment.METHODS Patients in whom rectal NETs were diagnosed by endoscopic resection(ER) at the Pusan National University Yangsan Hospital between 2008 and 2014 were included in this study. A total of 120 small rectal NETs in 118 patients were included in this study. Histologic features and clinical outcomes were analyzed, and the findings of endoscopy, EUS and histology were compared. RESULTS The size measured by endoscopy was not significantly different from that measured by EUS and histology(r = 0.914 and r = 0.727 respectively). Accuracy for the depth of invasion was 92.5% with EUS. No patients showed invasion of the muscularis propria or metastasis to the regional lymph nodes. All rectal NETswere classified as grade 1 and demonstrated an L-cell phenotype. Mean follow-up duration was 407.54 ± 374.16 d. No patients had local or distant metastasis during the follow-up periods. CONCLUSION EUS is not essential for ER in the patient with small rectal NETs because of the prominent morphology and benign behavior.

关键词： Neuroendocrine tumor Small Rectal Endoscopic Ultrasonography Histology Endoscopy

Endoscopic Ultrasonography-related diagnostic accuracy and clinical significance on small rectal neuroendocrine neoplasms

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World Journal of Gastroenterology 2024年第7期30卷 774-778页

作者： Jun Weng Yu-Fan Chen Shu-Han Li Yan-Hua Lv Ruo-Bing Chen Guo-Liang Xu Shi-Yong Lin Kun-Hao Bai Department of Endoscopy Sun Yat-Sen University Cancer CenterGuangzhou 510060Guangdong ProvinceChina State Key Laboratory of Oncology in South China Guangzhou 510060Guangdong ProvinceChina Guangdong Provincial Clinical Research Center for Cancer Guangzhou 510060Guangdong ProvinceChina Department of Management Clinical Medical College of Tianjin Medical UniversityTianjin 300000China Cancer Prevention Center Sun Yat-Sen University Cancer CenterGuangzhou 510060Guangdong ProvinceChina

This research aimed to examine the diagnostic accuracy and clinical significance of Endoscopic Ultrasonography(EUS)in the context of small rectal neuroendocrine neoplasms(NENs).A total of 108 patients with rectal sube... 详细信息

关键词： Rectal neuroendocrine neoplasms Endoscopic Ultrasonography Diagnosis Depth of invasion

Are biopsies during Endoscopic Ultrasonography necessary for a suspected esophageal leiomyoma?Is laparoscopy always feasible?

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World Journal of Clinical Cases 2023年第9期11卷 2116-2118页

作者： Hazem Beji Mohamed Fadhel Chtourou Slim Zribi Yassine Kallel Mahdi Bouassida Hassen Touinsi Department of General Surgery Hospital Mohamed Taher Maamouri Nabeul University of Tunis El Manar-Faculty of Medicine of TunisNabeul 8000Tunisia

The present letter to the editor is related to the work entitled“Large leiomyoma of lower esophagus diagnosed by Endoscopic Ultrasonography-fine needle aspiration:A case report.”Although Endoscopic Ultrasonography seems necessary in a suspected leiomyoma of the esophagus,the performance of biopsies via fine needle aspiration is controversial as it increases the risk of complications such as bleeding,infection,and intraoperative perforations.Laparoscopy is the best treatment strategy for small tumors.Laparotomy with tumor enucleation or esophageal resection can be considered in large leiomyomas.

关键词： Esophageal Leiomyoma Endoscopic Ultrasonography Biopsy Surgical resection

Application of Endoscopic Ultrasonography for detecting esophageal lesions based on convolutional neural network

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World Journal of Gastroenterology 2022年第22期28卷 2457-2467页

作者： Gao-Shuang Liu Pei-Yun Huang Min-Li Wen Shuai-Shuai Zhuang Jie Hua Xiao-Pu He Department of Gastroenterology Nanjing BenQ Medical CenterThe Affiliated BenQ Hospital of Nanjing Medical UniversityNanjing 210000Jiangsu ProvinceChina Department of Geriatric Gastroenterology The First Affiliated Hospital of Nanjing Medical UniversityNanjing 210000Jiangsu ProvinceChina School of Computer Science and Engineering Southeast UniversityNanjing 211102Jiangsu ProvinceChina Department of Gastroenterology The First Affiliated Hospital of Nanjing Medical UniversityNanjing 210000Jiangsu ProvinceChina

BACKGROUND A convolutional neural network(CNN) is a deep learning algorithm based on the principle of human brain visual cortex processing and image recognition.AIM To automatically identify the invasion depth and origin of esophageal lesions based on a CNN.METHODS A total of 1670 white-light images were used to train and validate the CNN system.The method proposed in this paper included the following two parts:(1)Location module,an object detection network,locating the classified main image feature regions of the image for subsequent classification tasks;and(2) Classification module,a traditional classification CNN,classifying the images cut out by the object detection network.RESULTS The CNN system proposed in this study achieved an overall accuracy of 82.49%,sensitivity of 80.23%,and specificity of 90.56%.In this study,after follow-up pathology,726 patients were compared for endoscopic pathology.The misdiagnosis rate of endoscopic diagnosis in the lesion invasion range was approximately 9.5%;41 patients showed no lesion invasion to the muscularis propria,but 36 of them pathologically showed invasion to the superficial muscularis propria.The patients with invasion of the tunica adventitia were all treated by surgery with an accuracy rate of 100%.For the examination of submucosal lesions,the accuracy of Endoscopic Ultrasonography(EUS) was approximately 99.3%.Results of this study showed that EUS had a high accuracy rate for the origin of submucosal lesions,whereas the misdiagnosis rate was slightly high in the evaluation of the invasion scope of lesions.Misdiagnosis could be due to different operating and diagnostic levels of endoscopists,unclear ultrasound probes,and unclear lesions.CONCLUSION This study is the first to recognize esophageal EUS images through deep learning,which can automatically identify the invasion depth and lesion origin of submucosal tumors and classify such tumors,thereby achieving good accuracy.In future studies,this method can provide guidance and help to clinical endoscopists.

关键词： Endoscopic Ultrasonography Convolutional neural network Esophageal lesion Automatically Classify Identify

Determination of the ED95 of intranasal sufentanil combined with intranasal dexmedetomidine for moderate sedation during Endoscopic Ultrasonography

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World Journal of Clinical Cases 2022年第9期10卷 2773-2782页

作者： Yi Zou Na Li Liu-Jia-Zi Shao Fu-Kun Liu Fu-Shan Xue Xing Tao Department of Anesthesiology Beijing Friendship HospitalCapital Medical UniversityBeijing 100050China

BACKGROUND Sedation during Endoscopic Ultrasonography(EUS)poses many challenges and moderate-to-deep sedation are often required.The conventional method to preform moderate-to-deep sedation is generally intravenous benzodiazepine alone or in combination with opioids.However,this combination has some limitations.Intranasal medication delivery may be an alternative to this sedation regimen.AIM To determine,by continual reassessment method(CRM),the minimal effective dose of intranasal sufentanil(SUF)when combined with intranasal dexmedetomidine(DEX)for moderate sedation of EUS in at least 95%of patients(ED95).METHODS Thirty patients aged 18-65 and scheduled for EUS were recruited in this study.Subjects received intranasal DEX and SUF for sedation.The dose of DEX(1μg/kg)was fixed,while the dose of SUF was assigned sequentially to the subjects using CRM to determine ED95.The sedation status was assessed by modified observer’s assessment of alertness/sedation(MOAA/S)score.The adverse events and the satisfaction scores of patients and endoscopists were recorded.RESULTS The ED95 was intranasal 0.3μg/kg SUF when combined with intranasal 1μg/kg DEX,with an estimated probability of successful moderate sedation for EUS of 94.9%(95%confidence interval:88.1%-98.9%).When combined with intranasal 1μg/kg DEX,probabilities of successful moderate sedation at each dose level of intranasal SUF were as follows:0μg/kg SUF,52.8%;0.1μg/kg SUF,75.4%;0.2μg/kg SUF,89.9%;0.3μg/kg SUF,94.9%;0.4μg/kg SUF,98.0%;0.5μg/kg SUF,99.0%.CONCLUSION The ED95 needed for moderate sedation for EUS is intranasal 0.3μg/kg SUF when combined with intranasal 1μg/kg DEX,based on CRM.

关键词： Moderate sedation Intranasal administration Dexmedetomidine Sufentanil Continual reassessment method Endoscopic Ultrasonography

Intranasal sufentanil combined with intranasal dexmedetomidine: A promising method for non-anesthesiologist sedation during Endoscopic Ultrasonography

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World Journal of Clinical Cases 2022年第23期10卷 8428-8431页

作者： Yong Wang Zhi-Jun Ge Chao Han Department of Anesthesiology The Affiliated Yixing Hospital of Jiangsu UniversityYixing 214200Jiangsu ProvinceChina School of Medical Jiangsu UniversityZhenjiang 212013Jiangsu ProvinceChina

Intranasal sufentanil combined with intranasal dexmedetomidine exhibited an estimated sedation success probability as high as 94.9%,higher satisfaction scores,and only minor adverse events during endoscopic ultrasonog... 详细信息

关键词： Intranasal Sufentanil Dexmedetomidine Sedation Endoscopic Ultrasonography

Endoscopic Ultrasonography in the evaluation of condition and prognosis of ulcerative colitis

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World Journal of Clinical Cases 2022年第15期10卷 4818-4826页

作者： Rui-Fang Jin Yi-Man Chen Ren-Pin Chen Hua-Jun Ye Department of Gastroenterology The First Affiliated Hospital of Wenzhou Medical UniversityWenzhou 325000Zhejiang ProvinceChina

BACKGROUND Ulcerative colitis(UC)is usually diagnosed through histopathology,enteroscopy,clinical symptoms,and physical findings;however,it is difficult to accurately evaluate disease severity.AIM To investigate the value of Endoscopic Ultrasonography(EUS)in the evaluation of the severity and prognosis of UC.METHODS Patients with UC who were seen in our hospital from March 2019 to December 2020 were eligible,and disease severity was evaluated according to the modified Truelove and Witts and Mayo scores.We performed EUS,calculated the UC endoscopic index of severity(UCEIS)and EUS-UC scores,and administered appropriate treatment.The UCEIS and EUS-UC scores of patients were assessed in relation to disease severity,and the correlations between UCEIS and EUS-UC scores and disease severity was also analyzed.The UCEIS and EUS-UC scores before and after treatment were also compared.RESULTS A total of 79 patients were included in this study.According to the Mayo Index,23,32,and 24 patients had mild,moderate and severe UC,respectively.The UCEIS and EUS-UC scores were higher in moderate cases(4.98±1.04 and 5.01±0.99,respectively)than in mild cases(1.56±0.82 and 1.64±0.91,respectively,P<0.05).Furthermore,the UCEIS and EUS-UC scores(7.31±1.10 and 7.59±1.02,respectively)were higher in severe cases than in moderate cases(P<0.05).According to the modified Truelove and Witts scores,21,36,and 22 patients were classified as having mild,moderate and severe disease,respectively.The UCEIS and EUS-UC scores were significantly higher in moderate disease(4.79±1.11 and 4.96±1.23,respectively)than in mild disease(1.71±0.78 and 1.69±0.88,respectively,P<0.05).Additionally,the UCEIS and EUS-UC scores in severe disease(7.68±1.22 and 7.81±0.90,respectively)were significantly higher than in moderate disease(P<0.05).The UCEIS and EUSUC scores were significantly and positively correlated with disease severity according to the modified Truelove and Witts score and Mayo score(P<0.05).The UCEIS and EUS-UC scores after 2 mo of treatment(3.88±0.95 and

关键词： Endoscopic Ultrasonography Ulcerative colitis Disease severity Prognosis Ulcerative colitis endoscopic index of severity score Endoscopic Ultrasonography-ulcerative colitis score Mayo disease activity index

New treatment for gastric duplication cyst:Endoscopic Ultrasonography-guided fine-needle aspiration combined with lauromacrogol sclerotherapy:A case report

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World Journal of Clinical Cases 2023年第32期11卷 7905-7910页

作者： Ya-Wei Bu Ruo-Qi Han Wen-Qian Ma Gong-Ning Wang Li-Mian Er Department of Endoscopy The Fourth Hospital of Hebei Medical UniversityShijiazhuang 050000Hebei ProvinceChina Department of General Medicine The Fourth Hospital of Hebei Medical UniversityShijiazhuang 050000Hebei ProvinceChina

BACKGROUND Gastric duplication cysts are very rare disease that are mainly diagnosed by endoscopic ultrasonographic fine-needle aspiration biopsy.In the past,this disease was usually treated with traditional surgery and rarely with minimally invasive endoscopic surgery.However,minimally invasive endoscopic therapy has many advantages,such as no skin wound,organ preservation,postoperative pain reduction,early food intake,fewer postoperative complications,and shorter post-procedure hospitalization.CASE SUMMARY We report a case of Endoscopic Ultrasonography-guided fine-needle aspiration(EUS-FNA)combined with lauromacrogol sclerotherapy for pyloric obstruction due to gastric duplication cysts.CONCLUSION EUS-FNA combined with lauromacrogol sclerotherapy provides a new option for the treatment of gastrointestinal duplication cysts.

关键词： Gastric duplication cysts Endoscopic Ultrasonography Fine-needle aspiration Lauromacrogol sclerotherapy Case report

Endoscopic Ultrasonography diagnosis of gastric glomus tumors

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World Journal of Clinical Cases 2021年第33期9卷 10126-10133页

作者： Bing Bai Chong-Shan Mao Zhen Li Sheng-Li Kuang Oncology Center Henan Provincial People's Hospital(People's Hospital of Zhengzhou University)Zhengzhou 450003Henan ProvinceChina Public Health Medical Center Henan Provincial People's Hospital(People's Hospital of Zhengzhou University)Zhengzhou 450003Henan ProvinceChina Department of Digestive Disease Henan Provincial People's HospitalZhengzhou 450003Henan ProvinceChina

BACKGROUND A gastric glomus tumor is relatively rare,and there is little knowledge on its endoscopic ultrasound findings.AIM To assess the accuracy of Endoscopic Ultrasonography(EUS)in the diagnosis of gastric glomus tumor and to discuss its value by reviewing the literature.METHODS A retrospective analysis of the EUS characteristics of gastric glomus tumor(such as tumor location,shape,size,echogenicity,homogeneity,margins,layer of origin,and so on)was performed.The study included 12 cases of gastric glomus tumor confirmed by surgery and pathology(7 females and 5 males,age range 36-74 years,average age was 58.2 years).RESULTS All the lesions were located in the gastric antrum(12 cases),protruding into the cavity,with a diameter between 1 and 3.5 cm.Glomus tumor of the stomach manifested as a circumscribed and slightly hypoechoic mass in the fourth layer,with an internal heterogeneous echo mixed with hyperechogenic spots and a marginal more hypoechoic halo.Smooth muscle actin,h-caldesmon and vimentin were shown to be positive by immunohistochemistry.CONCLUSION Although glomus tumor of the stomach is relatively rare,a typical glomus tumor of the stomach has characteristic changes under EUS.

关键词： Glomus tumor Endoscopic Ultrasonography Computed tomography Pathology