Endoscopic Ultrasound最新文献

Background and objectives: Despite the emergence of advanced ancillary technologies, the transbronchial method to peripheral pulmonary lesions (PPLs) remains a challenge for bronchoscopists. The objective of the study is to assess the diagnostic value and safety of a novel thin Convex Probe Endobronchial Ultrasound (TCP-EBUS) scope in transbronchial needle aspiration (TBNA) for PPLs suspicious of malignancy.

Methods: This single-center feasibility study prospectively enrolled patients with PPLs between August 2022 and January 2023. All lesions were biopsied by EBUS-TBNA using the novel TCP-EBUS scope (BF-UC290F, Olympus) and the prototype 22G aspiration needle (Vizishot2 22G, Olympus). The primary end point was the diagnostic yield.

Results: Thirty-three subjects were evaluated, and 30 subjects were included in the final analysis. The mean patients' age was 62.4 ± 10.2 years, and 60% were male. The mean lesion size was 25.7 ± 6.8 mm, and 22 nodules were ≤30 mm. PPLs were situated adjacent to the subsegmental or sub-subsegmental bronchi (25 and 5, respectively), and the EBUS scope was advanced into segmental or subsegmental bronchi (12 and 18, respectively). Average number of punctures was 3.8 ± 1.3. Adequate specimens were obtained in all 30 (100%) of the cases. The overall diagnostic yield was 90% (27/30). No serious adverse events were observed.

Conclusions: The TCP-EBUS has decent accessibility to more distal intrapulmonary lesions. TCP-EBUS-TBNA is a safe real-time procedure with a high sensitivity for malignant PPLs in the inner two-thirds of the lung, irrespective of the presence of a bronchus sign.

Background and objectives: Accurate differentiation of solid pancreatic lesions (SPLs) is crucial for treatment planning, but current methods still have limitations. Artificial intelligence (AI) has the potential to contribute to such diagnoses, yet existing AI models are restricted to focusing on a single modality. This study aims to develop a deep learning-based multimodal AI system to improve diagnostic accuracy for SPLs.

Methods: A retrospective analysis was conducted on 492 patients who underwent EUS for SPLs at Renmin Hospital of Wuhan University between December 2016 and September 2024. The AI system consisted of four deep learning models: DCNN1 for focal pancreatic lesion detection, DCNN2 for classifying pancreatic lesions as cystic or solid, DCNN3 for lesion boundary segmentation and size measurement, and DCNN4 for classifying carcinoma and noncancerous lesions. For DCNN4, four different modality models were constructed: (1) model A: EUS B-mode images only. (2) model B: EUS-E images only. (3) model C: EUS B-mode images and EUS-E images. and (4) model D: EUS B-mode images, EUS-E images, and clinical data. The model performance was compared with the diagnostic performance of endoscopists.

Results: The accuracy values of DCNN1 and DCNN2 were 96.8% and 98.9%, respectively. The Dice coefficient of the DCNN3 was 0.876. Our AI system demonstrated high accuracy, sensitivity, and specificity in differentiating carcinoma from noncancerous SPLs. The multimodal models, particularly those integrating EUS B-mode and EUS-E images, outperformed single-modality models, achieving an accuracy of 94.0% and an AUC of 0.937. The AI model showed superior performance compared to endoscopists, with improved diagnostic consistency and sensitivity.

Conclusion: The multimodal AI system significantly improves the diagnostic accuracy of SPLs, providing a promising tool for the early detection and differentiation of pancreatic cancer.

Background and objectives: Disconnected pancreatic duct syndrome (DPDS) is a significant cause of pancreatic fluid collection (PFC) recurrence in patients with necrotizing pancreatitis (NP). Effective management strategies for DPDS are crucial to improve patient outcomes. This study aimed to evaluate the efficacy and safety of indwelling double-pigtail stents (DPSs) after endoscopic necrosectomy (EN) in patients with NP complicated with DPDS, focusing on the impact on PFC recurrence rates and readmission.

Methods: We conducted a 1-year follow-up of patients with NP complicated with DPDS who underwent drainage or/and EN from June 2015 to November 2022. Patients were divided into 2 groups according to whether with DPS after removal of the metal stent. Additionally, a subgroup analysis was performed to evaluate the impact of stent type (7Fr and 10Fr DPS) after EN. The primary outcome was to assess the 1-year PFC recurrence rate.

Results: Seventy-eight patients with DPDS were included in the study. Recurrence was seen in 7/30 (23.3%) patients with DPS replacement and 34/48 (70.83%) without DPS replacement within 1 year of discharge; the difference was statistically significant. Additionally, the readmission rate significantly decreased in the group with DPS (10.00% vs. 31.25%, P = 0.03). Subgroup analysis indicated that 7Fr DPSs were associated with lower PFC recurrence and adverse event rates compared to 10Fr DPSs.

Conclusion: In patients with NP complicated with DPDS, the replacement and long-term indwelling of DPS can reduce the recurrence rate and hospital readmission rate. Furthermore, the 7Fr DPS size may offer better outcomes in terms of recurrence and safety.

Background and objectives: Endobronchial ultrasound (EBUS)-guided transbronchial mediastinal cryobiopsy (TBMC) has potential superiority compared with EBUS-guided transbronchial needle aspiration (TBNA) in the diagnosis of patients with intrathoracic sarcoidosis. However, high-quality clinical evidence is lacking. The aim of this study was to compare the efficacy and safety of EBUS-TBMC and EBUS-TBNA in diagnosing patients with intrathoracic sarcoidosis.

Methods: A multicenter randomized controlled trial was conducted in patients with suspected stage I/II sarcoidosis. Following identification of the mediastinal lesion via EBUS, TBNA and TBMC were sequentially performed in a randomized order. The granuloma detection rate was the primary outcome. The final diagnosis was based on pathology results and clinical follow-up at 6 months after randomization.

Results: A total of 128 patients with suspected stage I/II sarcoidosis were recruited for this study. Among them, 116 patients were diagnosed with sarcoidosis at 6 months after randomization. The granuloma detection rate was 89.8% (95% confidence interval [CI], 83.3-94.5) for EBUS-TBMC and 78.1% (95% CI, 70.0-84.9) for EBUS-TBNA, and the difference was significant (P < 0.001). The histological quality of the EBUS-TBMC samples was superior to that of the EBUS-TBNA samples (P < 0.001). Only one case of pneumothorax was detected by chest radiography, which resolved spontaneously without the need for drainage or other interventions.

Conclusions: Compared with EBUS-TBNA, EBUS-TBMC had superior granuloma detection rate and histological quality of samples with acceptable safety in patients suspected with stage I/II sarcoidosis.

Pancreatic cystic lesions (PCLs) are a globally prevalent condition, with incidence increasing with age. The proper treatment modality for PCLs remains a controversial topic. EUS-guided ablation represents an innovative and promising minimally invasive treatment for selected PCL patients, including EUS-guided pancreatic cyst chemoablation (EUS-PCC, such as ethanol, lauromacrogol, chemotherapeutic agents, and combination therapies) and EUS-guided radiofrequency ablation (EUS-RFA). Each treatment modality varies in treatment indications, efficacy, and safety. Herein, with ongoing advancements in clinical research, we present a comprehensive, updated review of procedural techniques, patient selection, clinical outcomes, and adverse events for EUS-PCC and EUS-RFA.

Background and objectives: We recently developed a balloon-assisted device for EUS-guided gastroenterostomy (EUS-GE) to enhance the safety and convenience of the procedure. This pilot study was conducted to evaluate the safety and feasibility of this device.

Methods: A retrospective analysis of data of patients who underwent EUS-GE using this balloon-assisted device at our institution from March 2024 to July 2024 was conducted. The primary end point was the procedure time, and the secondary end points were the volume of water injection, technical success rate, clinical success rate, and adverse events (AEs).

Results: A total of 20 patients (male: 55%; female: 45%) were enrolled, with a mean age of 67.7 ± 9.9 years. The mean procedure time was 29.3 ± 9.4 minutes, and the mean intraoperative water infusion in the jejunum was 92.5 (80-117.5) mL. The technical success rate was 100% (20/20). The clinical success rate was 95% (19/20). One patient (5%) experienced mild abdominal pain after the procedure. No other AEs, such as bleeding, perforation, stent occlusion, or migration, were observed during follow-up. The median follow-up duration was 132 (74-170) days.

Conclusion: The balloon-assisted device facilitates the application of EUS-GE, with short procedure time, less intraoperative water injection, high technical success rate, and low incidence of AEs.