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Endo-hepatology: Why should we do endoscopic ultrasound-guided interventions to the liver that we could do through the skin?

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World Journal of Gastroenterology 2024年第40期30卷 4333-4338页

作者： Claudio Calvanese Pietro Fusaroli Gastroenterology unit Hospital of ImolaUniversity of BolognaImola 40026BolognaItaly

Endoscopic ultrasound(EUS)-guided interventions on the liver such as diffuse biopsy and portal pressure gradient measurement are emerging as potential alternatives to percutaneous *** purpose of this editorial was to address all the indications that could potentially make an EUS-guided approach a possible alternative to the percutaneous procedures with respect to the proce-dures that could join the EUS examination such as upper endoscopy for gastro-esophageal varices,pancreaticobiliary investigation with EUS,and other potential advantages in terms of patient *** issue of a holistic gastroenterologist approach was also discussed along with the potential for developing clinical research.

关键词： Endo-hepatology Endoscopic ultrasound endosonography Liver disease Liver biopsy Portal hypertension

Endoscopic ultrasound elastography for evaluation of lymph nodes and pancreatic masses:A multicenter study

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World Journal of Gastroenterology 2009年第13期15卷 1587-1593页

作者： Marc Giovannini Botelberge Thomas Bories Erwan Pesenti Christian Caillol Fabrice Esterni Benjamin Monges Geneviève Arcidiacono Paolo Deprez Pierre Yeung Robert Schimdt Walter Schrader Hanz Szymanski Carl Dietrich Christoph Eisendrath Pierre Van Laethem Jean-Luc Devière Jacques Vilmann Peter Saftoiu Andrian Endoscopy unit Paoli-Calmettes Institute Department of Pathology Paoli-Calmettes Institute endosonography unit Gastroenterology and Gastrointestinal Endoscopy UnitSan Raffaele Hospital Division of Gastroenterology University Hospital Saint-Luc Department of MedicineⅠ University Hospital Department of Internal Medicine 2 Caritas-KrankenhausBad Mergentheim Division of Gastroenterology Erasme Hospital Department of Surgical Gastroenterology Gentofte University Hospital

AIM:To evaluate the ability of endoscopic ultrasound(EUS) elastography to distinguish benign from malignant pancreatic masses and lymph ***:A multicenter study was conducted and included 222 patients who underwent EUS examination with assessment of a pancreatic mass(n=121) or lymph node(n=101).The classification as benign or malignant,based on the real time elastography pattern,was compared with the classif ication based on the B-mode EUS images and with the fi nal diagnosis obtained by EUS-guided fi ne needle aspiration(EUS-FNA) and/or by surgical *** interobserver study was ***:The sensitivity and specificity of EUS elastography to differentiate benign from malignant pancreatic lesions are 92.3% and 80.0%,respectively,compared to 92.3% and 68.9%,respectively,for the conventional B-mode *** sensitivity and specificity of EUS elastography to differentiate benign from malignant lymph nodes was 91.8% and 82.5%,respectively,compared to 78.6% and 50.0%,respectively,for the B-mode *** kappa coefficient was 0.785 for the pancreatic masses and 0.657 for the lymph ***:EUS elastography is superior compared to conventional B-mode imaging and appears to be able to distinguish benign from malignant pancreatic masses and lymph nodes with a high sensitivity,specificity and *** might be reserved as a second line examination to help characterise pancreatic masses after negative EUS-FNA and might increase the yield of EUS-FNA for lymph nodes.

关键词： Endoscopic ultrasound Elasticity coefficient Elastography Pancreatic mass Lymph node

Unveiling hidden outcomes in malignant gastric outlet obstruction research–insights from a"Pancreas 2000"review

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World Journal of Gastrointestinal Endoscopy 2024年第8期16卷 451-461页

作者： Filipe Vilas-Boas Giacomo Emanuele Maria Rizzo Charles De Ponthaud Stuart Robinson Sebastien Gaujoux Gabriele Capurso Giuseppe Vanella Bahadır Bozkırlı Department of Gastroenterology São João University HospitalPorto 4200Portugal Endoscopy Service Department of Diagnostic and Therapeutic ServicesScientific Institute for ResearchHospitalization and Healthcare-The Mediterranean Institute for Transplantation and Highly Specialized TherapiesPalermo 90127SiciliaItaly Department of Digestive Hepato-Biliary and Pancreatic Surgery and Liver TransplantationAP-HP Pitié-SalpêtriereSorbonne UniversitéParis 75013Île-de-FranceFrance Department of Hepatobiliary Pancreatic and Transplant SurgeryFreeman HospitalNewcastle NE77DNNewcastle upon TyneUnited Kingdom Division of Pancreato-Biliary Endoscopy and endosonography Pancreas Translational and Clinical Research CenterIRCCS San Raffaele Scientific InstituteVita-Salute San Raffaele UniversityMilano 20132Italy Department of General Surgery HPB-UnitAcıbadem Maslak HospitalIstanbul 34398Türkiye

Malignant gastric outlet obstruction(mGOO)is a major condition affecting patients with periampullary tumors,including pancreatic *** current treatment options include surgical gastroenterostomy,endoscopic stenting and more recently EUS-guided *** studies comparing the outcomes of the three procedures focus on technical success,clinical success and ***“occult”outcomes relevant to the patient’s viewpoints and perspective may ultimately impact on cancer-related and overall survival,such as body mass composition,nutritional biomarkers,chemotherapy tolerance and patient-reported quality of *** aim of this review is to provide an overview of potential key outcomes that should be explored in future comparative research around mGOO treatment options.

关键词： Malignant gastric outlet obstruction Endoscopic ultrasound-guided gastroenterostomy Patient-reported outcomes Body composition Nutrition Quality of life

Screening for pancreatic cancer-a compelling challenge

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Hepatobiliary Surgery and Nutrition 2021年第2期10卷 264-266页

作者： Gabriele Capurso Salvatore Paiella Massimo Falconi Pancreato-Biliary Endoscopy and endosonography Division Pancreas Translational&Clinical Research CenterSan Raffaele Scientific Institute IRCCSMilanItaly General and Pancreatic Surgery unit Pancreas InstituteUniversity of VeronaVeronaItaly Pancreatic Surgery unit Pancreas Translational&Clinical Research CenterSan Raffaele Scientific Institute IRCCSUniversitàVita-SaluteMilanItaly

Efficacy of pancreatic cancer surveillance programs The publication of the American Gastroenterology Association(AGA)Clinical Practice Update on Pancreas Cancer Screening in High-Risk Individuals(HRIs)underlines the increasing attention for this topic(1).Secondary prevention(surveillance)for pancreatic ductal adenocarcinoma(PDAC),however,remains a challenge with many unsolved questions(Table 1).

关键词： prevention cancer Cancer

Endoscopic ultrasound radiofrequency ablation of pancreatic insulinoma in elderly patients:Three case reports

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World Journal of Clinical Cases 2022年第19期10卷 6514-6519页

作者： Gemma Rossi Maria Chiara Petrone Gabriele Capurso Stefano Partelli Massimo Falconi Paolo Giorgio Arcidiacono Division of Pancreato-Biliary Endoscopy and endosonography Pancreas Translational and Clinical Research CenterSan Raffaele Scientific Institute IRCCSVita-Salute San Raffaele UniversityMilano 20132Italy Department of Pancreatic Surgery Pancreas Translational and Clinical Research CenterSan Raffaele Scientific Institute IRCCSVita-Salute San Raffaele UniversityMilano 20132Italy

BACKGROUND Endoscopic ultrasound(EUS)-guided radiofrequency ablation(RFA)has recently been proposed as a local treatment for functional pancreatic neuroendocrine neoplasms in patients unfit for surgery,in order to obtain clinical syndrome *** on the safety and long-term effectiveness of this approach are scarce,and EUS-RFA procedures are not *** SUMMARY The present case series reports 3 elderly patients with a pancreatic insulinoma and comorbidities,locally treated by EUS-guided RFA with clinical success in terms of hypoglycemic *** procedures were performed during deep sedation,under EUS control with a 19 G needle,an electrode 5-mm in size at a power of 30 W and multiple RFA applications during the same session in order to treat the whole area of the *** relief of symptoms was evident in 2 patients after the first EUS-RFA,while in the third patient a second endoscopic treatment was *** 3 patients are symptom-free without need of medications after 24 mo of follow-up with imaging follow-up showing no disease recurrence.A single adverse event of intraprocedural bleeding occurred,which was successfully treated *** EUS-RFA represents an effective and safe alternative to surgery for the treatment of insulinomas in elderly patients at high surgical ***,larger multicenter studies withlonger follow-up are needed in order to better assess its safety and clinical success.

关键词： Endoscopic ultrasound Radiofrequency ablation Insulinomas Neuroendocrine neoplasms Ablative therapies Case report

Applications of endoscopic ultrasound elastography in pancreatic diseases: From literature to real life

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World Journal of Gastroenterology 2022年第9期28卷 909-917页

作者： Clara Benedetta Conti Giacomo Mulinacci Raffaele Salerno Marco Emilio Dinelli Roberto Grassia Interventional Endoscopy unit ASST MonzaOspedale San GerardoMonza 20900Italy Gastroenterology and Endoscopy unit ASST Fatebenefratelli-SaccoMilan 20121Italy Gastroenterology and Endoscopy unit ASST CremonaCremona 26100Italy

Elastography is a non-invasive method widely used to measure the stiffness of the tissues,and it is available in most endoscopic ultrasound machines,using either qualitative or quantitative *** ultrasound elastography is a tool that should be applied to obtain a complementary evaluation of pancreatic diseases,together with other imaging tests and clinical *** can be informative,especially when studying pancreatic masses and help the clinician in the differential diagnosis between benign or malignant ***,further studies are necessary to standardize the method,increase the reproducibility and establish definitive cut-offs to distinguish between benign and malignant pancreatic ***,even if promising,elastography still provides little information in the evaluation of benign conditions.

关键词： Elastography Pancreas Pancreatic stiffness Pancreatitis Pancreatic cancer endosonography Endoscopic ultrasound Quantitative elastography Strain elastography Pancreatic diseases

Role of endoscopic ultrasound in the diagnosis of pancreatic cancer

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World Journal of Gastrointestinal Oncology 2014年第9期6卷 360-368页

作者： Juana Gonzalo-Marin Juan Jose Vila Manuel Perez-Miranda unit of Endoscopy Department of GastroenterologyQuirón Hospital unit of Endoscopy Department of GastroenterologyComplejo Hospitalario de Navarra Department of Gastroenterology Hospital Universitario Rio Hortega

Endoscopic ultrasonography(EUS) with or without fine needle aspiration has become the main technique for evaluating pancreatobiliary disorders and has proved to have a higher diagnostic yield than positron emission tomography,computed tomography(CT) and transabdominal ultrasound for recognising early pancreatic *** a diagnostic modality for pancreatic cancer,EUS has proved rates higher than 90%,especially for lesions less than 2-3 cm in size in which it reaches a sensitivity rate of 99% vs 55% for ***,EUS has a very high negative predictive value and thus EUS can reliably exclude pancreatic *** complication rate of EUS is as low as 1.1%-3.0%.New technical developments such as elastography and the use of contrast agents have recently been applied to EUS,improving its diagnostic *** has been found to be superior to the recent multidetector CT for T stagingwith less risk of overstaying in comparison to both CT and magnetic resonance imaging,so that patients are not being ruled out of a potentially beneficial *** accuracy for N staging with EUS is 64%-82%.In unresectable cancers,EUS also plays a therapeutic role by means of treating oncological pain through celiac plexus block,biliary drainage in obstructive jaundice in patients where endoscopic retrograde cholangiopancreatography is not affordable and aiding radiotherapy and chemotherapy.

关键词： endosonography Pancreatic neoplasms Endoscopy Diagnosis Neoplasm Staging Therapeutics

Gastric cancer in 2022:Is there still a role for endoscopic ultrasound?

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World Journal of Gastrointestinal Endoscopy 2023年第1期15卷 1-9页

作者： Gemma Rossi Maria Chiara Petrone Andrew J Healey Paolo Giorgio Arcidiacono Pancreato-Biliary Endoscopy and endosonography Division Pancreas Translational and Clinical Research CenterSan Raffaele Scientific Institute IRCCSVita Salute San Raffaele UniversityMilan 20132Italy Department of Clinical Surgery University of EdinburghRoyal Infirmary of EdinburghEdinburgh EH164SAUnited Kingdom

Gastric cancer(GC)represents the fourth leading cause of cancer death worldwide and many factors can influence its development(diet,geographic area,genetic,Helicobacter pylori or Epstein-Barr virus infections).High quality endoscopy represents the modality of choice for GC *** correct morphologic classification during a high-resolution endoscopy is fundamental for oncologic diagnosis,staging and therapeutic *** its initial introduction in clinical practice the endoscopic ultrasound(EUS)has been considered a valuable tool for tumor(T-)and lymph nodes(N-)staging also in GC,in order to establish the best therapeutic strategy for the patient(e.g.,upfront surgery vs neoadjuvant treatments).EUS tools as elastography,Doppler and contrast administration can improve diagnosis mainly in case of malignant lymph node *** has a marginal role in disease staging but has a fundamental role in case of a pre-endoscopic resection management and in the new era of endoscopic mucosal resection or submucosal dissection as minimally invasive *** and locoregional staging of GC with EUS are a method of inarguable value for the assessment of gastric wall involvement and presence of infiltrated paragastric lymph *** can also have a role in disease restaging in those patients who have undergone neoadjuvant *** can also have a role in the advanced phases of the disease,in facilitating palliative,minimallyinvasive treatments,such as gastroenterostomy or biliary *** review intends to discuss the modern role of EUS in GC topic.

关键词： Gastric cancer Endoscopic ultrasound Endoscopic resection Neoadjuvant chemotherapy Therapeutic endoscopic ultrasound

Endoscopic and anesthetic feasibility of EUS and ERCP combined in a single session versus two different sessions

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World Journal of Gastrointestinal Endoscopy 2011年第3期3卷 57-61页

作者： Juan J Vila Marcos Kutz Silvia Goi Miriam Ostiz Edurne Amorena Carlos Prieto Cristina Rodriguez Ignacio Fernández-Urien Francisco J Jiménez Endoscopy unit Gastroenterology DepartmentComplejo Hospitalario de Navarra

AIM:To discuss the feasibility of single session endoscopic ultrasonography(EUS) to discuss and endoscopic retrograde cholangiopancreatography(ERCP) ***:Retrospective endoscopic and anesthetic outcome comparison of performing both EUS and ERCP in a single endoscopic session(Group Ⅰ) versus performing each procedure in two different sessions(Group Ⅱ) was *** following variables were evaluated:epidemiological variables,American Society of Anesthesiologists Physical Status Classification(ASA) level,procedural time,propofol dose,anesthetic complications,endoscopic complications and diagnostic yield,and therapeutic procedures on both groups.T-student,ChiSquare and Fisher test were used for ***:We included 39 patients in Group Ⅰ(mean age:69.85 ± 9.25;27 men) and 46 in Group Ⅱ(mean age:67.46 ± 12.57;25 men).Procedural time did not differ significantly between both groups(Group Ⅰvs Group Ⅱ:93 ± 32.78 vs 98.98 ± 38.17;P >0.05) but the dose of propofol differed(Group Ⅰ vs Group Ⅱ:322.28 ± 250.54 mg vs 516.96 ± 289.06 mg;P = 0.001).Three patients had normal findings on both *** anesthetic complications [O2 desaturation(2),broncoaspiration(1)] and 9 endoscopic complications [pancreatitis(6),bleeding(1),perforation(1),cholangitis(1)] occurred without significant differences between both groups(P > 0.05).We did not find any significant difference regarding age,sex,ASA scale level,diagnostic yield or therapeutic maneuvers between both ***:The performance of EUS and ERCP in a single session offers a similar diagnostic and therapeutic yield,does not entail a higher complication risk and requires a significantly smaller dose of propofol for sedation compared with performing each exploration in a different session.

关键词： endosonography Endoscopic Retrograde Cholangiopancreatography Feasibility Studies Endoscopy Gastrointestinal Anesthesia