Endoscopic Ultrasound最新文献

Background and objective: Although the impact of biliary stents on the accuracy of EUS-guided tissue acquisition (EUS-TA) is still controversial, the influence of biliary-pancreatic double stents on EUS-TA is even more inconclusive. The aim of the study was to determine whether the diagnostic yield of EUS-FNA in the diagnosis of solid pancreatic lesions will be affected after placement of biliary-pancreatic double stents.

Methods: A multicenter retrospective study including patients who underwent EUS-FNA with biliary duct obstruction was performed. Patients were divided into 2 groups according to whether there were biliary-pancreatic double stents before EUS-FNA. The patients' EUS-FNA report, histopathological results, and clinical case data were reviewed and compared.

Results: Ninety-two patients were included, 42 with biliary-pancreatic double stents and 50 without any stents. The puncture time taken by EUS-FNA was significantly longer in the stent group than the no-stent group (19 vs. 15 min, P < 0.001). No significant differences were observed in accuracy (90.5% vs. 94%), sensitivity (89.5% vs. 93.6%), specificity (100% vs. 100%), NPV (50% vs. 50%), PPV (100% vs. 100%), respectively, in both groups. Patients with larger lesions (OR = 1.600, 95% CI: 1.124-2.277) and those who required more passes had a higher diagnostic yield (OR = 9.376, 95% CI: 1.356-64.819) by multivariate analysis.

Conclusions: ERCP before EUS-FNA is feasible for the treatment of solid pancreatic lesions causing obstructive jaundice. It will not have a negative impact on the diagnostic accuracy and surgical complications, but the EUS-FNA operation time will be prolonged.

Background and objectives: Sulfur hexafluoride is an inert gas that creates microbubbles to enhance diagnostic accuracy in a variety of ultrasound (US) studies and is widely used in EUS. We analyzed the reported adverse events (AEs) of the US contrast agent, sulfur hexafluoride, extensively used during EUS procedures using a US national database.

Methods: From December 2008 to January 2024, AEs reported in the Federal Drug Administration Adverse Event Reporting System database for sulfur hexafluoride were examined.

Results: There were 1069 individual reports analyzed. Reports were excluded if they contained drugs other than sulfur hexafluoride. Echocardiogram (70.9%) was the common diagnostic study in which sulfur hexafluoride was administered. The most common AE reported was anaphylactic reaction (n = 179, 16.7%), followed by hypotension (n = 162, 15.2%), cardiac arrest (n = 161, 15.1%), and dyspnea (n = 159, 14.9%). The most common gastrointestinal AE was nausea (n = 135, 12.6%). Severity of AEs ranged from nonserious to death. Death associated with sulfur hexafluoride use was reported in 58 patients (5.4% of AE reports).

Conclusions: Anaphylactic reaction was the most common AE reported with sulfur hexafluoride use, and severe AEs including death may be more common than prior large, retrospective, observational studies to date have suggested.

Background and objectives: There are two different endoscopic ultrasonographic manifestations of gastric signet ring cell carcinoma (GSRCC). No studies have been reported on the differences in the clinical profiles of patients based on EUS examination. We aim to study the variations in clinicopathological characteristics between two distinct endoscopic ultrasonographic manifestations of GSRCC.

Methods: A total of 302 patients with GSRCC confirmed by pathological examination who underwent EUS were enrolled in the study. Based on the endoscopic ultrasonographic features, patients were categorized into two groups: type 1, where the entire layer structure disappeared, and type 2, where the layer structure was still present and appeared lymphomatoid. Clinicopathologic features were collected retrospectively and analyzed.

Results: Compared with type 2 patients, type 1 patients tended to develop GSRCC at an older age (P = 0.033) and had higher serum levels of tumor markers and were more likely to experience anemia (P < 0.001) and weight loss (P < 0.001) during the disease progression. Significant increases in the tumor size (P < 0.001), thickness of the affected gastric wall (P < 0.001), and depth of tumor invasion (P < 0.001) were observed in type 1 patients. Furthermore, type 1 patients had higher prevalence of affected blood vessels (P < 0.001), nerves (P < 0.001), lymph nodes (P < 0.001), and peritoneal metastasis (P < 0.001). However, no difference was found in the duration of disease between the two groups, and all deficient mismatch repairs were observed in type 1 patients.

Conclusions: The two distinct endoscopic ultrasonographic manifestations of GSRCC exhibited different clinicopathological characteristics, suggesting that they may represent different subtypes of the disease that require special attention in management strategies.

Background and objectives: According to previous reports, EUS-fine-needle biopsy (FNB) with or without rapid on-site evaluation (ROSE) showed the nonsuperiority of EUS-FNB + ROSE over EUS-FNB. However, previous studies included various kinds of FNB needle. This might be a critical limitation due to heterogeneity. Therefore, the aim of the present multicenter, randomized controlled trial was to compare the diagnostic accuracy of the fork-tip needle with or without ROSE for pancreatic lesions.

Methods: In the ROSE group, if an adequate sample was obtained to diagnose by on-site evaluation, EUS-FNB was stopped. If cytological results were insufficient or indeterminate, EUS-FNB was repeated. In the macroscopic on-site evaluation (MOSE) group, if a 4-mm length of visible core tissue was obtained, EUS-FNB was finished. If visible core tissue was not obtained or was less than 4 mm in length, a second puncture was attempted.

Results: One hundred seventy-one patients were randomized, 85 to the ROSE group and 86 to the MOSE group. In the MOSE group, diagnostic sensitivity and accuracy were 94.4% and 91.8%, respectively, for visible core tissue and 80.6% and 70.0%, respectively, for red tissue. Finally, overall diagnostic sensitivity and accuracy were 97.1% and 95.3%, respectively, in the ROSE group and 95.8% and 95.3%, respectively, in the MOSE group. Although there were no significant differences regarding adverse events between groups, the mean number of punctures was significantly lower in the MOSE group than in the ROSE group (1.47 vs. 1.20, P = 0.0171).

Conclusions: EUS-FNB using a fork-tip needle for pancreatic lesions has high diagnostic yield even without ROSE.

Objective 

To prepare a set of practice guidelines to standardize the entire process, from diagnosis to treatment and follow-up, for pancreatic pseudocysts and walled-off necrosis.

Methods 

Thirty-six experts in the fields of digestive endoscopy, pancreatic surgery, interventional radiology, and others presented their opinions via discussions in online conferences by referring to the patient, intervention, comparison, and outcomes principles and then reviewed the evidence and statements using the Delphi method to reach a consensus. The consensus of >80% was finally achieved for the items.

Results 

The experts discussed and reached a consensus on 29 statements including 10 categories: (1) definition and classification, (2) imaging and endoscopic diagnosis, (3) therapeutic implications, (4) surgical therapy, (5) percutaneous catheter drainage, (6) endoscopic retrograde cholangiopancreatography, (7) EUS-guided drainage, (8) stent selection for EUS-guided drainage, (9) complication related to stents for cyst drainage, and (10) drug treatment and follow-up.

Conclusion 

This consensus based on the clinical experience of experts in various fields and international evidence-based medicine further standardizes the multidisciplinary diagnosis and treatment processes for pancreatic pseudocysts and walled-off necrosis.

Background and Objectives 

Radial endobronchial ultrasound (R-EBUS) plays an important role during transbronchial sampling of peripheral pulmonary lesions (PPLs). However, existing navigational bronchoscopy systems provide no guidance for R-EBUS. To guide intraoperative R-EBUS probe manipulation, we aimed to simulate R-EBUS images of PPLs from preoperative computed tomography (CT) data using deep learning.

Materials and Methods 

Preoperative CT and intraoperative ultrasound data of PPLs in 250 patients who underwent R-EBUS–guided transbronchial lung biopsy were retrospectively collected. Two-dimensional CT sections perpendicular to the biopsy path were transformed into ultrasonic reflection and transmission images using an ultrasound propagation model to obtain the initial simulated R-EBUS images. A cycle generative adversarial network was trained to improve the realism of initial simulated images. Objective and subjective indicators were used to evaluate the similarity between real and simulated images.

Results 

Wasserstein distances showed that utilizing the cycle generative adversarial network significantly improved the similarity between real and simulated R-EBUS images. There was no statistically significant difference in the long axis, short axis, and area between real and simulated lesions (all P > 0.05). Based on the experts’ evaluation, a median similarity score of ≥4 on a 5-point scale was obtained for lesion size, shape, margin, internal echoes, and overall similarity.

Conclusions 

Simulated R-EBUS images of PPLs generated by our method can closely mimic the corresponding real images, demonstrating the potential of our method to provide guidance for intraoperative R-EBUS probe manipulation.

The focus of the review is on primary benign mesenchymal pancreatic tumors and their imaging appearance. These tumors are extremely rare. Usually, they are not diagnosed until postoperative histology is available, and so even benign tumors have undergone extensive pancreatic resection. The very limited data on abdominal and EUS findings including contrast-enhanced techniques of these pancreatic lesions are summarized here. Case reports will be presented for some of these rare tumors with application of modern ultrasound and endosonographic techniques.