Endoscopic Ultrasound最新文献

Background and objectives: Recurrence of benign bilioenteric anastomotic strictures (BAS) is common after enteroscopy-assisted endoscopic retrograde cholangiopancreatography (ERCP), percutaneous intervention, or EUS-guided antegrade intervention (EUS-AI). This study evaluated the long-term outcomes of EUS-AI with transmural and transanastomotic stenting (TAS) following EUS-guided hepaticogastrostomy (HGS) in BAS.

Methods: Consecutive patients with BAS undergoing EUS-AI with or without TAS after failed deep enteroscopy between January 2016 and June 2023 were retrospectively analyzed. The primary outcome was BAS recurrence rate after TAS removal; secondary outcomes included technical success of AI, on demand endoscopic procedure (DP) rate, the time to DP, and adverse events.

Results: Among 38 patients who underwent EUS-HGS, EUS-AI succeeded in 34 (89.5%), and 28 (73.7%) proceeded to TAS. The median follow-up duration for 28 patients with TAS was 53.4 months (IQR, 22.8-85.2). During TAS placement without regular stent change, DP occurred in 43% (12/28) at a median time of 23 months. The 1-year procedure-free rate was 81.2%. After TAS removal (n = 12), with a median stent duration of 21.6 months, there was no BAS recurrence (0%).

Conclusion: EUS-AI with indwelling TAS, without regular stent change, may offer promising long-term outcomes for BAS by reducing recurrence.

Background and objectives: EUS-guided portal pressure gradient (EUS-PPG) measurement has been proposed as a novel direct manometry to quantify portal hypertension. This study aimed to explore the ability of EUS-PPG measurements to evaluate the severity of portal hypertension.

Methods: The clinical features of patients with diagnosed cirrhosis or chronic liver disease who underwent EUS-PPG measurement at a single center were retrospectively analyzed. The correlations between the clinical features of portal hypertension and the EUS-PPG measurements were analyzed, and then receiver operating characteristic curves were used to evaluate the ability of the EUS-PPG measurements to evaluate disease severity.

Results: A total of 197 patients were included in this study. The EUS-PPG measurements varied significantly among patients categorized by gastroesophageal varices, red signs, variceal bleeding, ascites, hepatic encephalopathy, thrombocytopenia, hypoproteinemia, prothrombin time, international normalized ratio, or Child-Pugh grade (P < 0.05). The areas under the receiver operating characteristic curves for gastroesophageal varices, decompensated cirrhosis, ascites, and recent variceal bleeding were 0.919, 0.847, 0.813, and 0.804, respectively (P < 0.001). Furthermore, the optimal EUS-PPG cutoff values for gastroesophageal varices, decompensated cirrhosis, ascites, and recent variceal bleeding were 11.5 mm Hg (sensitivity = 80.3%, specificity = 89.5%), 12.75 mm Hg (sensitivity = 77.8%, specificity = 76.7%), 15.75 mm Hg (sensitivity = 66.7%, specificity = 83.1%), and 16.75 mm Hg (sensitivity = 76.2%, specificity = 70.1%), respectively.

Conclusions: EUS-PPG measurement seems to be an effective technique for assessing disease severity and risk of variceal bleeding in patients with diagnosed cirrhosis or chronic liver disease.

Patients with distal malignant biliary obstruction (dMBO) needing biliary drainage (BD) undergo ERCP as a first approach. EUS-guided gallbladder drainage (EUS-GBD) is now accepted as a rescue alternative for the palliation of jaundice in those patients with dMBO who fail ERCP and cannot undergo EUS-BD. This is a systematic review with meta-analysis for evaluating the efficacy and safety of EUS-GBD in this scenario. A comprehensive search through the main database platforms was conducted to May 2024. Pooled estimates were obtained using a fixed-effects model with the generic inverse variance method. Study quality was evaluated using the Newcastle-Ottawa quality assessment scale (NOS). Heterogeneity was evaluated with I ² statistic. Clinical success, adverse events (AEs) rate, and reintervention rate were the main outcomes. Sensitivity analyses were also conducted. Eight studies including 183 patients were identified. Pooled clinical success was 89% (95% CI, 84%-93%). The pooled clinical success of full-text publication was 88% (95% CI, 83%-93%; I ² = 0%). Reintervention rate was 8% (95% CI, 4%-12%; I ² = 0%). The overall AE rate was 10% (95% CI, 6%-15%; I ² = 0%). The NOS allocated moderate quality in 7 studies. In conclusion, our findings confirm that EUS-GBD in dMBO is a feasible, effective, and safe technique as rescue therapy after failure of ERCP or EUS-BD.

Background and objectives: Pancreatic neuroendocrine tumors (pNETs) are relatively rare and consist of 2% of the all pancreatic tumors. Although some of pNETs have a benign, nonprogressive course, some may be progressive and result with metastasis. We aimed to estimate the grade of pNETs by using artificial intelligence (AI) via deep learning (DL) algorithms as indexing to cyto/histopathological classification according to the World Health Organization 2017.

Methods: A total of 803 EUS images were collected from 44 patients who had a cyto/histo-pathologically confirmed diagnosis with EUS fine-needle aspiration or biopsy (FNA/B). First, raw EUS images were prepared for processing by AI via DL algorithms, and convolutional neural networks were utilized to train the machine to predict the grades from EUS images. IBM SPSS 25.0 program was used for statistical analyses.

Results: Thirty of the 44 patients (68%) were female, with a median age of 61 (range, 16-80) years. pNETs were mostly located in the pancreatic head: 24 cases (55%). Location was the neck in 3 (7%), body in 10 (22%), and tail in 7 (16%) patients. According to EUS-FNA/B results, 27 patients were grade 1 (G1) (61%); 12, grade 2 (G2) (27%); and 5, grade 3 (G3) (12%). In reference to the performance of AI for predicting the pathological grade, sensitivity was 94.29%; specificity, 97.14%; and accuracy, 96.19%. When the patient groups were subanalyzed as G1, G2, and G3 by the AI model to predict the pathological grade, the accuracy was as follows: for G1, 93.15%; for G2, 91.61%; and for G3, 98.05%.

Conclusions: This pilot study suggests that pNET grade prediction can be reliably done on EUS images using AI-based technology.

Background and objectives: Chronic liver inflammation leads to fibrosis and cirrhosis. To avoid portal hypertension-related complications, fibrosis' early detection is imperative. Biopsy remains the gold standard, but magnetic resonance elastography (MRE) and EUS-guided elastography are noninvasive procedures currently used for liver stiffness measurement (LSM). Two-dimensional EUS-guided shear-wave elastography (EUS-SWE) represents a more-every-day used technique.The aim of this study is to correlate LSM determined by vibration-controlled transient elastography (VCTE) and EUS-SWE and determine the measurements' accuracy in diagnosing cirrhosis.

Methods: A single-center, nested case-control study was performed between March 2020 and November 2021. Patients were classified into 2 study groups: the cirrhosis group and the control group. Patients from both groups underwent VCTE and EUS-SWE for LSM. A P value < 0.05 was considered statistically significant.

Results: Of the 59 participants included (mean age 63.5 years; 71.1% female), 29 had cirrhosis (49.15%) and 30 were controls (50.84%). In cirrhosis patients, liver fibrosis (F) was staged as F3-4 by VCTE in 82.8%, with a median LSM of 17.8 kPa; through EUS-SWE, 27 kPa in the right hepatic lobe (RHL) and 25 kPa in the left hepatic lobe (LHL). Controls fibrosis was staged as F0-2 by VCTE in 30/30 (100%), with a median LSM of 4.6 kPa (P < 0.001); through EUS-SWE, 5.6 kPa in the RHL (P < 0.001) and 6.5 kPa in the LHL (P < 0.001). The observed agreement was 91.5% for VCTE, 93.2% for RHL-EUS-SWE, and 96.6% for LHL-EUS-SWE. The AUROCs for EUS-SWE and VCTE were over 0.95.

Conclusions: VCTE and EUS-SWE are comparable techniques for diagnosing cirrhosis; however, EUS-SWE had a higher agreement than VCTE, especially in LHL assessment.

Background and objectives: Endoscopic retrograde cholangiopancreatography (ERCP) is the primary intervention for malignant distal biliary obstruction (MDBO). However, ERCP may fail for various reasons, requiring alternative interventions such as EUS-guided biliary drainage. Among EUS-guided biliary drainage (EUS-BD) methods, EUS-guided gallbladder drainage (EUS-GBD) is emerging as a viable option for patients who have failed ERCP and EUS-BD. The aim of this study is to evaluate the efficacy and safety of EUS-GBD as salvage therapy for MDBO and its potential role in allowing the initiation of chemotherapy.

Methods: This is a retrospective multicenter study of consecutive patients with MDBO with failed ERCP and/or EUS-BD that subsequently underwent EUS-GBD with lumen-apposing metal stent.

Results: Ninety-six patients from 9 centers in Spain were included. Technical success was achieved in 99% of patients, while clinical success, defined as bilirubin reduction <50% within 14 days after the procedure, was achieved in 78.1% of patients. Bilirubin levels were normalized in 65.6% of patients. The median time to normalization of bilirubin levels was 15 (7-27) days. Related to continuation of oncological treatment, 44/77 (57.1%) eligible patients were able to start chemotherapy after the procedure, and 12/17 (70.6%) eligible patients underwent surgery in the end. Adverse events were observed in 26.3% of cases, with 3 patients requiring surgery and 3 deaths related to EUS-GBD.

Conclusions: EUS-GBD represents a potential alternative to MDBO in cases where ERCP has failed, with an appropriate profile of patients starting chemotherapy. However, in light of the considerable number of adverse events and the moderate efficacy, it may be advisable to consider this approach as a second-line option.