Endoscopic Ultrasound最新文献

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.

Background and objectives: EUS-guided drainage using lumen-apposing metal stents (LAMSs) has become standard treatment of symptomatic walled-off pancreatic necrosis (WOPN). Delivery systems with integrated electrocautery (EC) enable direct access and stent deployment, whereas the conventional stent insertion requires several steps including access using a needle or cystotome, wire insertion, and enlargement of the created tract before the stent placement. This study aimed to compare the practicality of EUS-guided procedures and their outcomes between conventional LAMSs (cLAMSs) and integrated EC (EC-LAMSs).

Methods: In consecutive patients undergoing EUS-guided LAMS insertion with or without integrated EC, data on procedure time, sedation, and technical and clinical success, as well as adverse events, were analyzed.

Results: From our prospectively maintained database, we analyzed 107 consecutive procedures of transmural EUS-stenting for drainage of WOPN. Thirty-nine cLAMSs and 68 EC-LAMSs were placed. Mean WOPN size was 12.9 ± 4.2 cm with mean 30% ± 15% solid necrosis.Procedure times were shorter with EC-LAMSs (18.0 ± 6.6 vs. 39.7 ± 8.3 minutes; P < 0.05). All EUS-guided procedures with cLAMS drainage were performed under propofol sedation administered by anesthetist. In the EC-LAMS group, 36 patients tolerated the procedure under intravenous sedation (fentanyl/midazolam), and 17 interventions were performed as day case procedures. Adverse events and clinical outcome did not differ between both groups.

Conclusion: Compared with cLAMS, EC-LAMS deployment is faster and technically less demanding. This allows performing the procedure under conventional intravenous sedation and as day case procedure in selected patients.

Background and objectives: Effective management of gastrointestinal stromal tumors (GISTs) requires accurate risk assessment due to their variable carcinogenic potential.This study aimed to improve GIST classification using a novel deep learning-based GIST risk prediction model based on EUS imaging modalities.

Methods: We retrospectively analyzed EUS images of 341 patients diagnosed with GIST at a tertiary medical center between January 2016 and March 2022. Patients were selected based on specific criteria, including pathologic validation of surgical outcomes. The dataset allowed for the development and validation of a deep learning risk prediction model (DLRPM), a traditional risk prediction model (TRPM), and a combined risk prediction model (CRPM). Model performance was evaluated using sensitivity, specificity, positive and negative predictive values, accuracy, and statistical analysis.

Results: The efficacy of the 3 prognostic models (TRPM, DLRPM, and CRPM) for GIST classification was evaluated using a dataset consisting of 1019 EUS images from 341 patients. These models were developed using a training subset of 310 patients and subsequently validated in a defined group of 31 consecutive patients. Using multivariate logistic regression, TRPM showed an accuracy rate of 71.10%. Using a DenseNet-121 framework developed specifically for medical imaging, the DLRPM demonstrated superior predictive capabilities with an accuracy rate of 92.65%. The CRPM achieved a prediction accuracy of 90.32%. In addition, receiver operating characteristic curve analysis revealed area under the curve values of 0.909, 0.932, and 0.843 for CRPM, DLRPM, and TRPM, respectively. However, comparative statistical evaluation between these models showed no significant differences in area under the curve.

Conclusions: The novel DLRPM improved the accuracy of GIST risk stratification by EUS. CRPM is a promising method to integrate deep learning with traditional statistical methods, potentially optimizing clinical decision-making and patient outcomes in gastroenterological oncology.

Background and objectives: EUS-guided biliary drainage is a potential alternative to endoscopic retrograde cholangiopancreatography (ERCP) for distal malignant biliary obstruction (DMBO). However, its role as a primary intervention remains uncertain. This study compares the clinical outcomes of 4 primary endoscopic drainage modalities: ERCP, EUS-hepaticogastrostomy (HGS), EUS-choledochoduodenostomy (CDS) with lumen-apposing metal stent (LAMS), and EUS-CDS with self-expandable metal stents (SEMSs).

Methods: The literature was searched up until July 2024. A network meta-analysis of 5 randomized controlled trials and 3 comparative studies, including 796 patients (444 ERCP, 180 EUS-CDS-LAMS, 116 EUS-CDS-SEMS, 56 EUS-HGS), was conducted. Outcomes assessed included clinical success, technical success, procedural time, adverse events, reintervention rates, and stent patency.

Results: Clinical success was comparable across all modalities. EUS-CDS-LAMS demonstrated higher technical success compared with ERCP (odds ratio [OR], 3.95; 95% confidence interval [CI], 1.54-10.12) and EUS-CDS-SEMS (OR, 4.37; 95% CI, 1.03-18.55). EUS-CDS-LAMS also had a shorter procedural time compared with ERCP (standardized mean difference, -11.67; 95% CI, -15.66 to -7.68), EUS-CDS-SEMS, and EUS-HGS. Adverse event rates were similar across all groups. EUS-HGS had fewer reinterventions compared with ERCP (OR, 0.20; 95% CI, 0.08-0.52) and EUS-CDS-LAMS (OR, 0.22; 95% CI, 0.07-0.74). At 6 months, stent patency rates were 88.7% for EUS-HGS, 84.5% for EUS-CDS-SEMS, 73.1% for EUS-CDS-LAMS, and 64.8% for ERCP.

Conclusions: Clinical success and adverse event rates were comparable among modalities. EUS-CDS-LAMS showed superior technical success and shorter procedural time. In contrast, EUS-HGS showed fewer reinterventions and better stent patency than ERCP.

Background and objectives: The EUS-guided gastroenterostomy (EUS-GE) technique remains nonstandardized. We primarily aimed at standardizing parallel enteric tube (PET)-assisted EUS-GE, secondarily assessing reproducibility and outcomes.

Methods: This prospective multicenter study included consecutive adult patients with unresectable malignant gastric outlet obstruction undergoing primary EUS-GE between August 2019 and April 2021. Hierarchical task analysis predefined procedural steps into tasks and subtasks. Subtasks were further categorized into essential (performed in all centers and in more than 85% of the procedures) or optional. Subtask methodology was considered established if performed similarly in all centers or variable if not. Procedure times, injected fluid volume, accessories, adverse events (AEs), and outcomes were recorded.

Results: Seven endoscopists performed EUS-GE in 65 patients (50.8% male, median [interquartile range] age 77.5 [65.7-86.5] years). EUS-GE was categorized into 4 tasks (enteric tube placement, endoscope exchange, small bowel distention plus targeting, lumen-apposing metal stent placement) and 10 subtasks (7 essential, 3 optional). Five essential subtasks involved an established methodology (guidewire and PET placement, endoscope exchange, delivery system insertion, and lumen-apposing metal stent deployment).Technical and clinical success rates were 98.5% and 83.3%, respectively. AEs occurred in 10 (15.4%) patients. Success and AE rates were not different between expert and nonexperts. Procedure time was longer (35 [30.6-43.7] vs. 21.8 [16.4-29.5] minutes, P < 0.001) and injected fluid volume higher (510 [439-870] vs. 415 [255-480] mL, P = 0.01) in nonexperts.

Conclusions: PET-assisted EUS-GE was standardized, identifying its key steps and technique variants. PET-assisted EUS-GE appears to be a reproducible procedure among advanced endoscopists with different levels of experience.(ClinicalTrials identification no. NCT04660695).

Background and objective: EUS-guided gallbladder drainage (EUS-GBD) has emerged as a viable alternative for patients with acute cholecystitis who are unfit for surgery. However, standardized guidelines for its indications, techniques, and management remain limited. The objective of this study is to develop evidence-based consensus recommendations for EUS-GBD in benign and malignant conditions, aimed at guiding clinical decision-making and improving patient outcomes.

Methods: A 3-step modified Delphi process was used by the Interventional Endoscopy and Ultrasound Group, involving multidisciplinary experts in gastroenterology, surgery, and radiology. Four task forces conducted systematic literature reviews and generated PICO (Patients, Interventions, Comparator, and Outcomes)-formatted clinical questions. Evidence was graded using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) system, and consensus was defined as ≥80% agreement among panelists.

Results: Twenty-two clinical questions were addressed, covering indications, timing, techniques, device selection, procedural aspects, and postprocedural care for EUS-GBD. Recommendations include the preferential use of EUS-GBD over percutaneous and transpapillary approaches in high-risk patients, early intervention in select cases, the use of lumen-apposing metal stents, and tailored postprocedural strategies. All recommendations were conditional, except for one strong recommendation in favor of EUS-GBD over other modalities, supported by moderate-quality evidence.

Conclusions: This consensus offers a comprehensive, multidisciplinary guideline for the safe and effective use of EUS-GBD in clinical practice. These recommendations aim to standardize care and support future research in this rapidly evolving field.