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Diagnostic evaluation of endoscopic ultrasonography with submucosal saline injection for differentiating between T1a and T1b early gastric cancer

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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

Large leiomyoma of lower esophagus diagnosed by endoscopic ultrasonography–fine needle aspiration:A case report

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World Journal of Clinical Cases 2020年第22期8卷 5809-5815页

作者： Min Rao Qing-Qing Meng Pu-Jun Gao Department of Hepatology and Gastroenterology The Second Part of First Hospital of Jilin UniversityChangchun 130021Jilin ProvinceChina Department of Hepatology The First Hospital of Jilin UniversityChangchun 130021Jilin ProvinceChina

BACKGROUND Benign esophageal tumors are rare accounting for5 cm are rare.We describe a case of a large esophageal leiomyoma involving the cardia and diaphragm.CASE SUMMARY A 35-year-old woman presented to the doctor because of a choking sensation after eating.Physical examination showed no positive signs.Gastroscopy indicated an uplifted change in the cardia.Enhanced computed tomography revealed spaceoccupying lesions in the lower part of the esophagus and cardia,which were likely to be malignant.Positron emission tomography–computed tomography showed increased metabolism of soft tissue masses in the lower esophagus and near the cardia.Malignant lesions were considered,and mesenchymal tumors were not excluded.endoscopic ultrasonography was performed to examine a hypoechoic mass in the lower esophagus,which was unclear from the esophageal wall.Clinical evaluation suggested diagnosis of esophageal and cardiac stromal tumors.Finally,histological specimens obtained by endoscopic ultrasonography–fine needle aspiration suggested leiomyoma.The patient underwent laparoscopic local resection of the tumor.The postoperative pathological diagnosis was leiomyoma.CONCLUSION endoscopic ultrasonography-fine needle aspiration is necessary for the diagnosis of gastrointestinal leiomyomas.It provides a strong basis for diagnosis of gastrointestinal tumors of unknown nature and origin.

关键词： Esophageal tumor Leiomyoma endoscopic ultrasonography Fine needle aspiration endoscopic ultrasonography-fine needle aspiration Case report

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

Colonoscopy in the diagnosis and management of appendiceal disease

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World Journal of Gastrointestinal Endoscopy 2024年第4期16卷 187-192页

作者： Yuan Gao Bing Hu Department of Gastroenterology and Hepatology/Medical Engineering Integration Laboratory of Digestive Endoscopy West China HospitalSichuan UniversityChengdu 610041Sichuan ProvinceChina

In this editorial,we comment on the article published in the recent issue of the World Journal of Gastrointestinal Endoscopy.We focused on the understanding of appendiceal disease,and the various options for diagnosis and treatment via endoscopy.Some factors affecting the diagnosis and management of appendiceal diseases are also discussed.The existence of any organ has its natural rationality,and the appendix is such a magical organ.A growing number of experts and scholars have gradually come to a consensus that the appendix is not a useless evolutionary relic.There are many lymphocytes and lymph nodes in the appendix wall,which has a strong immune function,and this function is particularly important for children and adolescents.Many intestinal probiotics in the appendix are very helpful for maintaining the balance of the intestinal flora.With the continuous progress of endoscopic technology,endoscopic treatment involving preservation of the appendix has shown great advantages over surgery.In the diagnosis of appendiceal inflammation and neoplasms,colonoscopy,endoscopic retrograde appendicography and choledochoscopy help assess conditions of the appendix.endoscopic retrograde appendicitis therapy,abscess drainage under colonoscopy,fenestration of abscess under colonoscopy,and endoscopic or natural orifice transluminal endoscopic surgery resection of appendiceal neoplasms are safe and effective endoscopic treatments for appendiceal disease.New breakthroughs in the application of endoscopy in the appendix are expected to occur in the near future.

关键词： Appendicitis Appendiceal neoplasms Colonoscopy endoscopic ultrasonography

Machine learning in endoscopic ultrasonography and the pancreas:The new frontier?

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Artificial Intelligence in Gastroenterology 2022年第2期3卷 54-65页

作者： Cem Simsek Linda S Lee Department of Gastroenterology Hepatology and EndoscopyDepartment of MedicineBrigham and Women's HospitalHarvard Medical SchoolBostonMA 02215United States Division of Gastroenterology Hepatology and EndoscopyDepartment of MedicineBrigham and Women's HospitalHarvard Medical SchoolBostonMA 02115United States

Pancreatic diseases have a substantial burden on society which is predicted to increase further over the next decades.endoscopic ultrasonography(EUS)remains the best available diagnostic method to assess the pancreas,however,there remains room for improvement.Artificial intelligence(AI)approaches have been adopted to assess pancreatic diseases for over a decade,but this methodology has recently reached a new era with the innovative machine learning algorithms which can process,recognize,and label endosonographic images.Our review provides a targeted summary of AI in EUS for pancreatic diseases.Included studies cover a wide spectrum of pancreatic diseases from pancreatic cystic lesions to pancreatic masses and diagnosis of pancreatic cancer,chronic pancreatitis,and autoimmune pancreatitis.For these,AI models seemed highly successful,although the results should be evaluated carefully as the tasks,datasets and models were greatly heterogenous.In addition to use in diagnostics,AI was also tested as a procedural real-time assistant for EUS-guided biopsy as well as recognition of standard pancreatic stations and labeling anatomical landmarks during routine examination.Studies thus far have suggested that the adoption of AI in pancreatic EUS is highly promising and further opportunities should be explored in the field.

关键词： Artificial intelligence Pancreas endoscopic ultrasonography Pancreatic cancer Autoimmune pancreatitis Pancreatic cystic lesions

Misdiagnosis of hemangioma of left triangular ligament of the liver as gastric submucosal stromal tumor:Two case reports

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World Journal of Gastrointestinal Surgery 2024年第7期16卷 2351-2357页

作者： Jing-Jie Wang Fen-Ming Zhang Wei Chen Hua-Tuo Zhu Ning-Long Gui Ai-Qing Li Hong-Tan Chen Department of Gastroenterology The First Affiliated HospitalZhejiang University School of MedicineHangzhou 310003Zhejiang ProvinceChina

BACKGROUND Extragastric lesions are typically not misdiagnosed as gastric submucosal tumor(SMT).However,we encountered two rare cases where extrinsic lesions were misdiagnosed as gastric SMTs.CASE SUMMARY We describe two cases of gastric SMT-like protrusions initially misdiagnosed as gastric SMTs by the abdominal contrast-enhanced computed tomography(CT)and endoscopic ultrasound(EUS).Based on the CT and EUS findings,the patients underwent gastroscopy;however,no tumor was identified after incising the gastric wall.Subsequent surgical exploration revealed no gastric lesions in both patients,but a mass was found in the left triangular ligament of the liver.The patients underwent laparoscopic tumor resection,and the postoperative diagnosis was hepatic hemangiomas.CONCLUSION During EUS procedures,scanning across different layers and at varying degrees of gastric cavity distension,coupled with meticulous image analysis,has the potential to mitigate the likelihood of such misdiagnoses.

关键词： Submucosal tumor Extragastric compression endoscopic ultrasonography Computed tomography Hemangioma of the left triangular ligament of the liver Case report

Laparoscopic resection and endoscopic submucosal dissection for treating gastric ectopic pancreas

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World Journal of Gastrointestinal Surgery 2023年第12期15卷 2799-2808页

作者： Hui-Da Zheng Qiao-Yi Huang Yun-Huang Hu Kai Ye Jian-Hua Xu Department of Gastrointestinal Surgery The Second Affiliated Hospital of Fujian Medical UniversityQuanzhou 362000Fujian ProvinceChina Department of Gynaecology and Obstetrics The Second Affiliated Hospital of Fujian Medical UniversityQuanzhou 362000Fujian ProvinceChina

BACKGROUND Gastric ectopic pancreas(GEP)is a rare developmental abnormality that refers to the existence of pancreatic tissue in the stomach with no anatomical relationship with the main pancreas.It is usually difficult to diagnose through histological examination,and the choice of treatment method is crucial.AIM To describe the endoscopic ultrasound characteristics of GEP and evaluate the value of laparoscopic resection(LR)and endoscopic submucosal dissection(ESD).METHODS Forty-nine patients with GEP who underwent ESD and LR in the Second Affiliated Hospital of Fujian Medical University from May 2018 to July 2023 were retrospectively included.Data on clinical characteristics,endoscopic ultrasonography(EUS),ESD,and LR were collected and analyzed.The characteristics of EUS and the efficacy of the two treatments were analyzed.RESULTS The average age of the patients was 43.31±13.50 years,and the average maximum diameter of the lesions was 1.55±0.70 cm.The lesion originated from the mucosa in one patient(2.04%),from the submucosa in 42 patients(85.71%),and from the muscularis propria in 6 patients(12.25%).Twenty-nine patients(59.20%)with GEP showed umbilical depression on endoscopy.The most common initial symptom of GEP was abdominal pain(40.82%).Tumor markers,including carcinoembryonic antigen(CEA)and carbohydrate antigen 19-9(CA19-9),were generally within the normal range.One patient(2.04%)with GEP had increased CEA and CA-19-9 levels.However,no cancer tissue was found on postoperative pathological examination,and tumor markers returned to normal levels after resecting the lesion.There was no significant difference in surgery duration(72.42±23.84 vs 74.17±12.81 min)or hospital stay(3.70±0.91 vs 3.83±0.75 d)between the two methods.LR was more often used for patients with larger tumors and deeper origins.The amount of bleeding was significantly higher in LR than in ESD(11.28±16.87 vs 16.67±8.76 mL,P<0.05).Surgery was associated with complete resection of the lesion without any serious complications;there were no case

关键词： Ectopic pancreas endoscopic ultrasonography endoscopic submucosal dissection Laparoscopic resection

endoscopic ultrasound-guided intraportal injection of autologous bone marrow in patients with decompensated liver cirrhosis:A case series

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World Journal of Gastrointestinal Surgery 2023年第4期15卷 655-663页

作者： Shao-Peng Zheng Ao-Jian Deng Jing-Jing Zhou Ling-Zhi Yuan Xiao Shi Fen Wang Department of Gastroenterology Third Xiangya Hospital of Central South UniversityChangsha 410013Hunan ProvinceChina Hunan Key Laboratory of Nonresolving Inflammation and Cancer Central South UniversityChangsha 410000Hunan ProvinceChina

BACKGROUND Recently,stem cell therapy has been extensively studied as a promising treatment for decompensated liver cirrhosis(DLC).Technological advances in endoscopic ultrasonography(EUS)have facilitated EUS-guided portal vein(PV)access,through which stem cells can be precisely infused.AIM To investigate the feasibility and safety of fresh autologous bone marrow injection into the PV under EUS guidance in patients with DLC.METHODS Five patients with DLC were enrolled in this study after they provided written informed consent.EUS-guided intraportal bone marrow injection with a 22G FNA needle was performed using a transgastric,transhepatic approach.Several parameters were assessed before and after the procedure for a follow-up period of 12 mo.RESULTS Four males and one female with a mean age of 51 years old participated in this study.All patients had hepatitis B virus-related DLC.EUS-guided intraportal bone marrow injection was performed in all patients successfully without any complications such as hemorrhage.The clinical outcomes of the patients revealed improvements in clinical symptoms,serum albumin,ascites,and Child-Pugh scores throughout the 12-mo follow-up.CONCLUSION The use of EUS-guided fine needle injection for intraportal delivery of bone marrow was feasible and safe and appeared effective in patients with DLC.This treatment may thus be a safe,effective,non-radioactive,and minimally invasive treatment for DLC.

关键词： endoscopic ultrasonography Fine needle injection Portal vein Decompensated liver cirrhosis Bone marrow

Submucosal protuberance caused by a fish bone in the absence of preoperative positive signs:A case report

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World Journal of Clinical Cases 2022年第5期10卷 1586-1591页

作者： Wei-Wei Du Tao Huang Guo-Dong Yang Jing Zhang Jing Chen Ying-Bang Wang Department of Gastroenterology The Third People's Hospital of ChengduThe Affiliated Hospital of Southwest Jiaotong UniversityChengdu610000Sichuan ProvinceChina Department of Gastroenterology and Hepatology Affiliated Hospital of North Sichuan Medical CollegeNanchong 637000Sichuan ProvinceChina Department of Radiology Affiliated Hospital of North Sichuan Medical CollegeNanchong 637000Sichuan ProvinceChina

BACKGROUND Submucosal protuberance caused by fish bone insertion into the digestive tract has rarely been reported.These cases usually include patients with clear signs such as a history of fish intake,pain,and dysphagia,as well as positive findings on endoscopy and imaging.Here,we report a case of a fish bone hidden in the submucosal protuberance of the gastric antrum during endoscopic submucosal dissection without preoperative obvious positive signs.CASE SUMMARY A 58-year-old woman presented with epigastric pain for the past 20 d and a submucosal protuberance.Abdominal computed tomography and endoscopic ultrasonography did not indicate the presence of a fish bone.We assumed the cause to be an ordinary submucosal eminence and performed an endoscopic submucosal dissection to confirm its essence.During the operation,a fish bone approximately 20 mm in length was found incidentally.CONCLUSION Our report could potentially prevent the oversight of embedded fish bones and associated adverse effects in patients with similar presentation.

关键词： Gastric submucosal protuberance endoscopic mucosal dissection Computed tomography endoscopic ultrasonography Case report