Endoscopic Ultrasound最新文献

Background and objectives: EUS-guided biliary drainage (EUS-BD) is an alternative to ERCP for patients with altered anatomy or duodenal obstruction. EUS-guided antegrade intervention (EUS-AG) offers physiological drainage with lower reintervention rates and higher stent patency. However, the technical complexity of EUS-AG limits its success rate, and factors associated with technical failure remain controversial. This study aimed to evaluate the learning curve for EUS-AG and identify predictors of technical failure.

Patients and methods: A cohort of 138 patients intended for EUS-AG between December 2019 and January 2025 was analyzed. CUSUM analysis was used to assess the learning curve based on procedure time. Technical failure was defined as failure to advance the antegrade guidewire across the duodenal papilla or bilioenteric anastomosis, failure of stent deployment, or failure to extract stones. Univariable and multivariable logistic regression analyses were performed to identify independent predictors of technical failure.

Results: The overall technical success rate of EUS-AG was 78.2% (108/138). The CUSUM learning curve demonstrated a significant decrease in procedure time after 50 cases, indicating the transition to the proficiency phase. Multivariable analysis identified preproficiency phase (OR, 9.70; 95% CI, 2.91-32.30; P < 0.001), hilar bile duct obstruction (HBO) (OR, 14.36; 95% CI, 3.41-60.49; P < 0.001), and excessive bile duct dilation (EBD) (OR, 17.09; 95% CI, 4.80-60.89; P < 0.001) as independent predictors of technical failure.

Conclusion: For endoscopists with proficient ERCP experience, the EUS-AG learning curve plateaued after approximately 50 cases. The preproficiency phase, HBO, and EBD were identified as independent predictors of technical failure.

Background: EUS-guided fine-needle aspiration (EUS-FNA) combined with rapid on-site evaluation (ROSE) is crucial for diagnosing pancreatic solid lesions. However, the widespread application of ROSE faces challenges, particularly the limited availability of specialized cytopathologists for immediate interpretation. Furthermore, the inherent variability in EUS-FNA sample quality (e.g., cellularity and debris) and suboptimal smear preparation during procedures can impede reliable automated analysis.This study aimed to develop and validate a novel 2-stage deep learning-based diagnostic model for the automated analysis of EUS-FNA cytological images of pancreatic solid lesions captured using mobile phones during the ROSE process, with the goal of automating diagnosis and improving efficiency.

Methods: We retrospectively collected 882 EUS-FNA cytological images from 92 patients with pancreatic solid lesions at Peking University First Hospital, captured using mobile phones, during ROSE. A 2-stage deep learning model was developed. The first stage utilized YOLOv8n-p2 for robust tissue cell detection, addressing background complexity, and enabling preprocessing steps such as cell size normalization. In the second stage, DenseNet201 was employed to classify the detected cellular regions as malignant or normal. The dataset was divided into training, validation, and testing sets. The model performance was evaluated using a dedicated test set consisting of whole images.

Results: On the independent test set, the proposed 2-stage method achieved high performance in classifying images for malignancy, yielding an accuracy of 93.3%, an area under the precision-recall curve (AUC-PR) of 0.958, and an area under the receiver operating characteristic curve (AUC-ROC) of 0.962.

Conclusion: The diagnostic accuracy of the proposed AI method is comparable to that of traditional expert-involved ROSE, while offering the potential to significantly reduce diagnostic time and dependency on immediate pathologist availability. This 2-stage deep learning approach effectively analyzes variable mobile phone-captured EUS-FNA images, demonstrating its potential as an automated, AI-assisted diagnostic system for the ROSE process. It holds significant potential for clinical application, particularly in facilitating timely pancreatic cancer diagnosis in resource-constrained settings and in scenarios where on-site pathological expertise is limited.

Background and objectives: EUS is widely used in diagnosing and treating digestive system diseases. However, its diagnostic accuracy is frequently compromised by physiological motion from respiration and cardiac activity, as well as interference from gas. To address these limitations, we developed a wireless endoscopic magnetic resonance imaging (EndoMRI) system with balloon-assisted stabilization technology.

Methods: The system features a novel wireless EndoMRI coil that uses inductive coupling technology, designed to operate through standard endoscopic working channels. An inflatable balloon with an adjustable diameter range of 10-35 mm maintains optimal coil positioning within the digestive tract. System performance was evaluated using ex vivo porcine esophageal specimens (n = 5) at 5.0T magnetic field strength. Comparative analysis with miniprobe EUS encompassed image quality assessment and histopathological correlation.

Results: The results demonstrated that EndoMRI achieved superior esophageal image stability compared to EUS microprobes (P < 0.05). In a thermal injury model, EndoMRI signal continuity showed a strong correlation with histopathological findings of tissue damage, enabling accurate assessment of both lesion depth and severity. The wireless balloon-equipped EndoMRI system provides stable and reliable continuous imaging of ex vivo esophagi.

Conclusions: These findings establish EndoMRI as a promising technology in digestive system evaluation.

EUS-guided liver biopsy (EUS-LB) is an alternative to traditional percutaneous and transjugular approaches. Determining the optimal needle gauge requires balancing diagnostic yield with procedural safety. This meta-analysis compares the efficacy and safety of 19-gauge (19G) versus 22-gauge (22G) fine needle biopsy (FNB) needles in EUS-LB. We searched PubMed, Google Scholar, and Cochrane databases for studies comparing 19G and 22G FNB needles with Franseen or Fork tip designs. Outcomes assessed included tissue adequacy, diagnostic adequacy, number of complete portal tracts (CPTs), length of the longest tissue segment, and total specimen length (TSL). Data were analyzed using a random-effects model, presenting results as standardized mean differences (SMDs) and relative risks (RRs) with 95% confidence intervals (CIs). Five studies with 205 patients were included. The 19G needle demonstrated higher tissue adequacy (RR, 1.596; 95% CI, 0.969-2.631; P = 0.066) and diagnostic adequacy (RR, 1.421; 95% CI, 0.942-2.145; P = 0.094) compared to the 22G needle. It yielded greater CPTs (SMD, 1.705; 95% CI, -0.652 to 4.062; I ² = 97.34%), longer tissue segments (SMD, 5.039; 95% CI, -0.276 to 10.354; I ² = 97.24%), and increased TSL (SMD, 4.156; 95% CI, -0.268 to 8.579; I ² = 98.75%). The 19G needle may provide superior tissue and diagnostic outcomes in EUS-LB without increasing adverse effects compared to the 22G needle, although these differences were not statistically significant. This suggests a need for further high-quality research to confirm these preliminary findings.

Background and objectives: Pancreatic cancer is a highly aggressive malignancy with poor prognosis. Surgery is the only curative treatment, but it carries a significant risk of morbidity. The role of preoperative EUS-guided biopsy (EUS-B) in up-front resectable patients has been a matter of debate, with some centers strongly advocating its use, whereas others limit it to indeterminate cases.We aimed to examine whether preoperative EUS-guided biopsy (EUS-B) has an impact on overall survival (OS) using nationwide data.

Methods: The data of patients who underwent curatively intended surgical resection for pancreatic cancer were retrieved from the prospectively maintained national Danish Pancreatic Cancer Group database. Associations between preoperative EUS-B and survival were evaluated using Kaplan-Meier plots and univariable and multivariable Cox proportional hazards models. OS was examined in the overall cohort and in a propensity score-matched subgroup, where EUS-B cases were matched to controls in a 1:2 ratio.

Results: Between 2011 and 2023, 1889 patients who underwent surgery for pancreatic cancer constituted the overall cohort. The mean age was 67.4 (SD, 9.1) years, and 53.5% were male. The median overall survival was 28.5 months in the EUS-B group compared to 26.7 months in the non-EUS-B group (HR, 1.07; 95% CI, 0.91-1.26; P = 0.411). In the propensity score-matched subgroup (n = 582), the median survival time was 28.6 months (EUS-B group) and 24.7 months (non-EUS-B group; HR, 1.04; 95% CI, 0.84-1.29; P = 0.691).

Conclusions: Preoperative EUS-B did not influence survival in patients with pancreatic cancer in this nationwide retrospective study.

Background and objectives: Bleeding from isolated gastric varix type I (IGV1) is less common but more dangerous and fatal than other varices. This study compared the safety and efficacy of endoscopic clipping and cyanoacrylate injection (EC-CYA) with EUS-guided coil and cyanoacrylate injection (EUS-coil/CYA) in the secondary prophylaxis of IGV1.

Methods: A retrospective study was conducted on 131 patients with cirrhosis and a history of IGV1 bleeding who underwent either EC-CYA (n = 55) or EUS-coil/CYA (n = 76) at three medical centers. Primary outcomes were gastric variceal rebleeding and ectopic embolism. Secondary outcomes were technical success, variceal obliteration rate, cyanoacrylate volume, cyanoacrylate embolization efficiency, other causes of rebleeding, other adverse events, and mortality.

Results: In the EC-CYA group, the gastric variceal rebleeding rate (14.5% vs. 8.7%, P = 0.307), technical success rate (96.4% vs. 94.7%, P > 0.999), other causes of rebleeding rate (12.7% vs. 5.8%, P = 0.303), other adverse events rate (5.5% vs. 5.8%, P > 0.999), and mortality (12.7% vs. 8.7%, P = 0.467) showed no significant differences compared with the EUS-coil/CYA group. No ectopic embolism was found in either group. The EC-CYA group had a higher cyanoacrylate volume (3.14 ± 1.45 mL vs. 1.99 ± 0.72 mL, P < 0.001) and a higher variceal obliteration rate at first follow-up (82.23% ± 27.09% vs. 66.59% ± 30.28%, P = 0.032). However, the EUS-coil/CYA group was superior to the EC-CYA group in terms of cyanoacrylate embolization efficiency (2.85 ± 2.05 cm²/mL vs. 1.98 ± 1.46 cm²/mL, P = 0.044).

Conclusions: Both EC-CYA and EUS-coil/CYA are safe and effective in preventing rebleeding of IGV1. The EUS-coil/CYA has better embolization efficiency, whereas EC-CYA has better operational convenience.

Background and objectives: Comparative studies have demonstrated that EUS-guided liver biopsy (EUS-LB) is a useful and safe technique. However, there is not sufficient evidence information on their cost differences and potential applications. We aimed to investigate whether EUS-LB is a cost-effective alternative to traditional LB methods (percutaneous [PC-LB], transjugular [TJ-LB]) and determine its indications in clinical practice.

Methods: In this observational, prospective, and multicenter study, patients who underwent EUS-LB at different tertiary centers (N = 52) were compared with a similar number of PC-LB (N = 50) and TJ-LB (N = 37) collected retrospectively. Diagnostic yield (percentage of conclusive histological diagnosis), specimen quality, adverse events, and cost-effectiveness were analyzed.

Results: EUS-LB had 87% of diagnostic yield and 4% of mild adverse events, similar to traditional techniques (P = 0.097 and P = 0.252, respectively). Despite higher tissue fragmentation and lower longest specimen length in EUS-LB, no differences were found in the number of complete portal tracts, tissue adequacy (EUS-LB, 19%; PC-LB, 30%; TJ-LB, 36%; P = 0.164) or pathologist satisfaction, allowing adequate fibrosis stage assessment, particularly in metabolic dysfunction-associated steatotic liver disease. EUS-LB was more cost-effective when both LB and EUS were indicated (saving: €112.20 × 15% additional histological diagnosis [AHD]); in patients with cholestasis unsuitable for magnetic resonance cholangiopancreatography (MRCP) prior to LB; contraindication for the PC-LB, including cases of uncooperative individuals (saving: €234.75 × 15% AHD).

Conclusions: EUS-LB is a useful alternative to traditional methods and the most cost-effective option when both LB and EUS are indicated, in cases of cholestasis as an alternative to MRCP and when the PC route is contraindicated.