Endoscopic Ultrasound最新文献

Background and objectives: Hyperplasia at the distal side of an EUS-guided hepaticogastrostomy (HGS) stent is one of the most frequent causes of stent dysfunction. However, risk factors for hyperplasia during EUS-HGS remain unclear. The aim of the present study was to determine the most appropriate stent site during EUS-HGS to obtain prolonged stent patency.

Method: This study included 100 consecutive patients who underwent successful EUS-HGS using a partially covered, self-expandable, metal stent (PCSEMS) between January 2017 and September 2022. The patients were divided into 2 groups according to the distal site of the PCSEMS at the intrahepatic bile duct, the peripheral side group and the central side group.

Results: There were 30 patients in the peripheral side group and 70 in the central side group. The diameter of the intrahepatic bile duct at the PCSEMS deployment site was significantly greater in the central side group (mean 7.90 mm) than in the peripheral side group (mean 4.25 mm; P < 0.05). Stent patency was significantly longer in the central side group than in the peripheral side group (median, 60 days vs. 144 days, P = 0.011), although overall survival was not significantly different. Hyperplasia was significantly more frequent in the peripheral side group. On multivariate analysis, the site of the PCSEMS (peripheral) was the only risk factor for stent dysfunction.

Conclusions: In conclusion, the distal site of the PCSEMS deployed at the hepatic hilar site from the confluence between B2 and B3 might play a role in obtaining longer stent patency.

Background and objectives: Recent technological advances in interventional EUS have improved EUS-guided drainage/anastomosis (EUS-D/A), yet challenges remain. This study evaluated the safety and feasibility of a square flare fully covered self-expandable metallic stent (SF-FCSEMS) with anti-migration properties for EUS-D/A.

Methods: This retrospective cohort study was performed at 2 academic centers and analyzed patients who underwent SF-FCSEMS placement for EUS-D/A from April 2015 to November 2022. We have used an SF-FCSEMS that has a square flare at both ends that is 4 mm larger in diameter than the stent body, providing an anti-migration effect.

Results: Thirty-six patients (median age: 74 years), 41.6% male, were included. Malignancies accounted for 83.3%. Among the EUS-D/A procedure types, EUS-abscess drainage was performed in 52.8%, EUS-guided gallbladder drainage in 30.6%, and EUS-guided abscess drainage in 16.7%. The technical success rate was 97.2%, and the clinical success rate was 97.1%. The median procedure time was 36 minutes, with puncture tract dilation conducted in all cases. Adverse events occurred in 11.1%; recurrent symptoms were observed in 11.8%, with no migration. SF-FCSEMS removal was performed in 26.5% of patients during the follow-up period, with a median duration of 154 days. The total cost of deploying SF-FCSEMS was approximately 40% less than that of using lumen apposing metal stent.

Conclusions: EUS-D/A with an SF-FCSEMS, which has anti-migration properties, not only was effective and feasible in the present study but also demonstrated a cost advantage.

Background and objectives: Fatty pancreas (FP), traditionally perceived as a benign finding, has been undergoing scrutiny lately due to growing evidence linking it to various disease states, including increased risk for pancreatic cancer (PC).

Methods: A retrospective study of patients who underwent EUS at a single institution from August 2007 to October 2023, conducted by one endosonographer with more than 25 years of experience. Focusing on individuals identified with FP during EUS, we compared these findings with corresponding findings on computed tomography/magnetic resonance imaging (CT/MRI) conducted within 3 months or 1 year prior to or following EUS.

Results: Ninety-one patients were included and identified as having FP on their EUS exams. The most common indication for EUS was PC screening in high-risk patients (35.16%). At the time of conducting EUS, 65.93% of patients had a body mass index (BMI) ≥30, 63.73% had hypertension, and 32.96% had type 2 diabetes mellitus (DM). Of the 91 patients, 70 had CT or MRI done within 3 months of the EUS date, and only 15 (21.43%) had FP reported on imaging. All 91 patients had CT or MRI within 1 year, and only 16 (17.58%) had FP reported on imaging.

Conclusion: Only 21.43% of patients had FP on their CT/MRI within 3 months despite EUS findings, suggesting either lower accuracy of CT/MRI compared to EUS in identifying FP or potential underreporting in a real-world setting, even in a tertiary care center. This discrepancy in reporting is noteworthy considering FP's role as a potential precursor to several important conditions and promoting pancreatic carcinogenesis pathways.

Objectives: To explore the safety and efficacy of injections of 1%, 2%, or 3% lauromacrogol during EUS-guided lauromacrogol ablation (EUS-LA) for the treatment of pancreatic cystic neoplasms (PCNs) and to determine the optimal concentration of lauromacrogol for use in EUS-LA therapeutic regimens.

Methods: From May 2021 to January 2023, patients who met the indications for EUS-LA were randomly divided into 3 groups: A, B, and C; the patients in these groups were injected with 1%, 2%, and 3% lauromacrogol during EUS-LA, respectively. Safety was evaluated based on the incidence of postoperative complications. Efficacy was comprehensively evaluated by assessing the ablation rate and ablation effect.

Results: Forty-two patients underwent EUS-LA, and 31 patients completed at least 1 postoperative re-examination. No acute pancreatitis was observed in the 1% and 2% lauromacrogol groups, and 1 case of acute pancreatitis occurred in the 3% lauromacrogol group. The total complication rate was 2.4%. The median ablation rates of the groups were 94.1%, 82.0%, and 100.0%, respectively. There were statistically significant differences in the EUS-LA ablation rate between the 1% and 3% lauromacrogol groups and between the 2% and 3% lauromacrogol groups. There was a statistically significant difference in complete disappearance between the 1% and 3% lauromacrogol groups as well as between the 2% and 3% lauromacrogol groups.

Conclusion: The short-term outcomes showed that injections of 1%, 2%, and 3% lauromacrogol were safe for use in EUS-LA, and injection of 3% lauromacrogol was the most effective for EUS-LA.

Introduction: EUS-guided fine-needle organoid creation (EUS-FNO) from pancreatic cancer (PC) has been increasingly important for precision medicine. The cost for pancreatic organoid creation is substantial and close to 2000 USD/specimen in our institution, and the specimen has to be processed immediately after tissue acquisition so the more passes and specimens, the higher cost of organoid creation will incur. To date, no prospective comparison trial has answered how many needle passes of EUS-FNO needed for a successful organoid creation.

Methods: A prospective trial comparing the success rate of EUS-FNO between the first-pass (group A) versus combination of the first and the second-pass group (group B) was conducted at King Chulalongkorn Memorial Hospital, Thailand. Successful EUS-FNO in group B was defined as positive EUS-FNO from either 1 of 2 passes of EUS-FNO. Techniques for taking tissue from pancreatic cancer are the standard technique of EUS-guided fine needle biopsy (EUS-FNB) using a 20-gauge forward-bevel needle. Tissues from the first and second puncture were collected into separate test tubes that were frozen to control temperature and taken to a laboratory room for organoid culture. The success in pancreatic organoid creation is considered initial success when we could isolate organoids (P0). When organoids grow and are confluent in the Matrigel plate, we would pass the cell to grow in the other Matrigel plate and repeat the passing process until 5 passages of growth. Complete success is defined when we could establish pancreatic organoid lines for ≥5 passages of growth (P5). These processes were performed before standard EUS-FNB for histopathology. We then compared the success rate of pancreatic organoid establishment (P5) in cell culture between single versus two passages. McNemar's test was used for comparison between 2 groups.

Results: Fifty-two patients (33 females, 19 males) with PC underwent EUS-FNO during the period from September 15, 2020, to February 28, 2022, were recruited. Median age (range) was 64.0 (46-88) years. Median BMI (range) was 20.0 (14.6-30.8) kg/m². Tumors were located on the pancreatic head, neck, body, and tail of the pancreas at 57.7%, 7.7%, 25.0%, and 9.6%, respectively. Median size (range) of tumors was 41 (20-134) mm. Median CA19-9 level (range) was 187 units/mL (2.35-35,474). All initially generated pancreatic organoids (P0) could be successfully established (P5). The success rate of EUS-FNO from group A versus B was equally 78.8% (41 from 52 patients) versus 80.8% (42 from 52 patients) (P = 1.00).

Conclusion: Results from this current prospective trial showed that a single pass of EUS-FNO from a PC by using a 20-G forward-bevel needle provided a high success rate. Adding the second pass did not increase the success rate of EUS-FNO.

Background: EUS-guided fine-needle biopsy is the procedure of choice for the diagnosis of pancreatic ductal adenocarcinoma (PDAC). Nevertheless, the samples obtained are small and require expertise in pathology, whereas the diagnosis is difficult in view of the scarcity of malignant cells and the important desmoplastic reaction of these tumors. With the help of artificial intelligence, the deep learning architectures produce a fast, accurate, and automated approach for PDAC image segmentation based on whole-slide imaging. Given the effectiveness of U-Net in semantic segmentation, numerous variants and improvements have emerged, specifically for whole-slide imaging segmentation.

Methods: In this study, a comparison of 7 U-Net architecture variants was performed on 2 different datasets of EUS-guided fine-needle biopsy samples from 2 medical centers (31 and 33 whole-slide images, respectively) with different parameters and acquisition tools. The U-Net architecture variants evaluated included some that had not been previously explored for PDAC whole-slide image segmentation. The evaluation of their performance involved calculating accuracy through the mean Dice coefficient and mean intersection over union (IoU).

Results: The highest segmentation accuracies were obtained using Inception U-Net architecture for both datasets. PDAC tissue was segmented with the overall average Dice coefficient of 97.82% and IoU of 0.87 for Dataset 1, respectively, overall average Dice coefficient of 95.70%, and IoU of 0.79 for Dataset 2. Also, we considered the external testing of the trained segmentation models by performing the cross evaluations between the 2 datasets. The Inception U-Net model trained on Train Dataset 1 performed with the overall average Dice coefficient of 93.12% and IoU of 0.74 on Test Dataset 2. The Inception U-Net model trained on Train Dataset 2 performed with the overall average Dice coefficient of 92.09% and IoU of 0.81 on Test Dataset 1.

Conclusions: The findings of this study demonstrated the feasibility of utilizing artificial intelligence for assessing PDAC segmentation in whole-slide imaging, supported by promising scores.