Endoscopic Ultrasound最新文献

In recent years, EUS-guided biliary drainage has been widely implemented in China, and standardization of this procedure has become an urgent matter. As EUS-guided biliary drainage technology and accessories continue to advance, the understanding of its clinical benefits and complications is also evolving. This expert consensus summarizes the current evidence and presents 12 clinical questions and 40 recommendations in the form of questions and answers regarding indications and contradictions, techniques, accessory selection, complications, perioperative management, and learning and training. The goal of this consensus is to assist in decision-making and standardize the treatment process.

Background and objectives: EUS is typically performed under sedation, often with concomitant analgesics to reduce pain. Traditionally used pharyngeal anesthesia, commonly with lidocaine, may cause pharyngeal discomfort and allergic reactions. This study investigated whether lidocaine-based pharyngeal anesthesia is necessary for EUS under sedation with analgesics.

Methods: A double-blind, randomized, noninferiority study was conducted on EUS cases that met the selection criteria. Patients were randomly assigned to receive either 5 sprays of 8% lidocaine (lidocaine group: LG) or saline spray (placebo group: PG) as endoscopy pretreatment. The primary outcome was EUS tolerability, analyzed separately for endoscopists and patients, with a noninferiority margin set at 15%. Secondary outcomes included endoscopist and patient satisfaction, midazolam/pethidine doses, number of gag events, number of esophageal insertion attempts, use of sedative/analgesic antagonists, interruptions due to body movements, throat symptoms after endoscopy, and sedation-related adverse events.

Results: Favorable tolerance was 85% in LG and 88% for PG among endoscopists (percent difference: 3.0 [95% confidence interval, -6.6 to 12.6]) and 90% in LG and 91% in PG among patients (percent difference, 0.94 [95% confidence interval, -7.5 to 9.4]). Both groups exceeded the noninferiority margin (P = 0.0002 for endoscopists and patients). Patient satisfaction was significantly higher in PG (P = 0.0080), but no intergroup differences were found in other secondary outcomes.

Conclusions: PG was noninferior to LG for pharyngeal anesthesia during EUS with sedation and analgesics. These results suggest that pharyngeal anesthesia with lidocaine can be omitted when performing EUS under sedation with concomitant analgesics. Omitting pharyngeal anesthesia with lidocaine may prevent discomfort and complications caused by pharyngeal anesthesia, shorten examination times, and reduce medical costs.

Background and objective: Endoscopic retrograde cholangiopancreatography (ERCP) is the gold standard for managing malignant biliary obstruction (MBO), but it is challenging in patients with surgically altered anatomy (SAA). EUS-guided hepaticogastrostomy (EUS-HGS) and enteroscopy-assisted ERCP are alternative techniques, but their comparative efficacy and safety in this population are not well-researched. Herein, we evaluated the outcomes of EUS-HGS versus single-balloon-assisted enteroscopy ERCP (SBE-ERCP) in MBO patients with SAA.

Patients and methods: This retrospective study included 70 patients with MBO who underwent EUS-HGS (n = 29) or SBE-ERCP (n = 41) at a single center between April 2015 and June 2024. Data on the patient characteristics, procedure details, time to recurrent biliary obstruction (TRBO), and adverse events (AEs) were analyzed.

Results: The EUS-HGS group showed a higher technical success rate (100% vs. 68%, P = 0.002), shorter procedure time (23 vs. 50 min, P < 0.001), and longer TRBO (251 vs. 103 d, P = 0.020) as compared with the SBE-ERCP group. Subgroup analysis revealed that pancreatobiliary cancer and SBE-ERCP were significantly associated with a shorter TRBO. When stratified by stent type, the median TRBO in the SBE-ERCP with PS group was 49 days, serving as the reference. In comparison, the median TRBO was 140 days in the SBE-ERCP with the self-expandable metallic stent group (hazard ratio [HR], 0.46; P = 0.181), 127 days in the EUS-HGS with PS group (HR, 0.38; P = 0.055), and 701 days in the EUS-HGS with the self-expandable metallic stent group (HR, 0.13; P = 0.014). The overall incidence of AEs was comparable between the 2 groups (20.6% vs. 17.1%), and there were no severe AEs. Regarding reintervention, there was no significant difference in technical success rate and procedure time between EUS-HGS and SBE-ERCP.

Conclusion: EUS-HGS was associated with a superior technical success rate, shorter procedure time, and longer stent patency, without an increased risk of AEs, as compared with SBE-ERCP. Thus, EUS-HGS should be appropriate for managing MBO patients with SAA.

Background and objectives: Gastrointestinal stromal tumors (GISTs) are tumors with malignant potential, and preoperative risk stratification is critical for clinical management. Endoscopic ultrasound elastography (EUS-E) can assess tissue stiffness and may assist in evaluating the malignant potential of GISTs. However, similar studies have not been conducted, and current elasticity evaluation methods are still highly influenced by operator's subjectivity. An effective and objective tool is needed to aid in the risk stratification of GISTs under EUS-E.

Methods: One hundred eighty-nine patients with submucosal tumors (SMTs) who underwent EUS-E from January 2018 to August 2024 were retrospectively collected, of which 110 cases were GISTs. A total of 2625 EUS B-mode images were collected to construct the classification and segmentation model to distinguish GISTs from non-GISTs and to segment the lesion areas of GIST automatically. The elasticity value (EUS-E-AI) of the lesion area was extracted based on the color features of the elastography images. We evaluated the diagnostic performance of this system in distinguishing GISTs from other SMTs, as well as its ability to stratify GISTs based on their malignant potential.

Results: The accuracy of the classification model and the Dice coefficient of the segmentation model were 95.8% and 0.967, respectively. The EUS-E-AI value in the low-risk malignancy group (0.268 [IQR, 0.243-0.333]) was significantly higher than that in the high-risk malignancy group (0.186 [IQR, 0.176-0.199], P < 0.001). A cutoff value of 0.224 for the EUS-E-AI was found to effectively differentiate the low-risk from the high-risk group, with an accuracy of 92.6% (95% CI, 89.1-96.1). These findings were also confirmed in small GISTs.

Conclusion: We developed an AI-based system and elasticity indicator for the accurate and objective identification and risk stratification of GISTs using EUS.

Background and objectives: Accurate preoperative assessment of ampullary tumors is vital in planning an appropriate endoscopic papillectomy strategy. The use of EUS and side-viewing duodenoscopy (SVD) with narrow band imaging (NBI) varies across studies. Reports on critical features under EUS and SVD + NBI are lacking. We aimed to demonstrate (1) the theoretical and real-world management of ampullary lesions, (2) the implementation of preresection biopsy or fine needle aspiration (FNA), and (3) critical features under EUS and SVD + NBI for preoperative assessment.

Methods: Data from consecutive patients with suspected papillary lesions referred for EUS and SVD + NBI from January 2020 to December 2023 were retrospectively analyzed. The primary outcomes were the difference between theory and reality for management for ampullary nontumor-adenoma-adenocarcinoma, and the high-risk features under EUS and SVD + NBI for adenocarcinoma, T1 stage and ductal invasion. The secondary outcomes were the value of preoperative biopsy and FNA.

Results: A total of 121 patients with suspected ampullary tumors were included in the analysis. Less than half (27.40%) of the patients in the surgery group could have been classified as endoscopically resectable. A total of 46.4% and 35% of the biopsy and FNA pathological results, respectively, were inconsistent with the postoperative results. Protrusion with atypical ulcers, NBI type III, EUS size ≥3.0 cm, hypoechoicity, poor blood supply, and EUS ductal invasion were high-risk factors for adenocarcinoma. A size ≥3.0 cm and hypoechoic status were high-risk factors for T1 and ductal invasion. The cutoff value of the stain ratio for adenocarcinoma was 5.35, with a sensitivity, specificity, and accuracy of 88.5%, 93.0%, and 90.8%, respectively.

Conclusions: Preoperative assessment of ampullary tumors is necessary, but biopsy and FNA are not sufficient. EUS and SVD + NBI, which focus on essential features, are valuable for evaluating ampullary tumors for endoscopic resectability.

EUS has become an essential tool in pediatric gastroenterology for high-resolution imaging of the gastrointestinal tract and surrounding organs. This review describes the clinical applications and outcomes of EUS in diagnosing and managing pediatric gastrointestinal, pancreatic, biliary, and intestinal diseases. EUS is particularly useful in abdominal diseases, offering an accurate and high-resolution imaging method without radiation exposure. Despite its proven efficacy in children, EUS remains underutilized due to technical challenges and limited pediatric-specific expertise. Thus, the study highlights the importance of increasing the availability and training for pediatric EUS to enhance diagnostic precision and therapeutic options in children.