Pub Date : 2025-03-01DOI: 10.1016/j.bpg.2025.101984
Annemijn D.I. Maan, Laurèlle van Tilburg, Arjun D. Koch
The incidence of oesophageal squamous cell carcinoma accounts for almost 85 % of all oesophageal cancers worldwide. Patients with oesophageal cancer can present with clinical symptoms including dysphagia, weight loss, retrosternal discomfort or regurgitation. Nevertheless, most cancers remain asymptomatic and thereby undetected until the cancer has reached advanced or even incurable stages. This results in poor prognosis and relatively low long-term survival rates. The identification of patients at high risk for oesophageal cancer development is therefore an important cornerstone in the detection of oesophageal cancer in early and curable stages. This group contains patients with a history of cancer in the aerodigestive tract, squamous dysplasia, certain lifestyle aspects, three types of genetic syndromes, caustic or radiation induced injury to the oesophagus and achalasia. In this review, we evaluate different risk factors for the development of oesophageal squamous cell carcinoma and discuss whether screening of these patients might be justified.
{"title":"Increased risk of oesophageal squamous cell carcinoma development","authors":"Annemijn D.I. Maan, Laurèlle van Tilburg, Arjun D. Koch","doi":"10.1016/j.bpg.2025.101984","DOIUrl":"10.1016/j.bpg.2025.101984","url":null,"abstract":"<div><div>The incidence of oesophageal squamous cell carcinoma accounts for almost 85 % of all oesophageal cancers worldwide. Patients with oesophageal cancer can present with clinical symptoms including dysphagia, weight loss, retrosternal discomfort or regurgitation. Nevertheless, most cancers remain asymptomatic and thereby undetected until the cancer has reached advanced or even incurable stages. This results in poor prognosis and relatively low long-term survival rates. The identification of patients at high risk for oesophageal cancer development is therefore an important cornerstone in the detection of oesophageal cancer in early and curable stages. This group contains patients with a history of cancer in the aerodigestive tract, squamous dysplasia, certain lifestyle aspects, three types of genetic syndromes, caustic or radiation induced injury to the oesophagus and achalasia. In this review, we evaluate different risk factors for the development of oesophageal squamous cell carcinoma and discuss whether screening of these patients might be justified.</div></div>","PeriodicalId":56031,"journal":{"name":"Best Practice & Research Clinical Gastroenterology","volume":"75 ","pages":"Article 101984"},"PeriodicalIF":3.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144167887","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01DOI: 10.1016/j.bpg.2025.101977
R.A.H. van Eijck van Heslinga, J.J.G.H.M. Bergman, A.J. de Groof
Barrett's esophagus (BE) is a known precursor for esophageal adenocarcinoma. Despite advances in endoscopic imaging modalities, endoscopic detection of BE neoplasia remains challenging, with considerable miss rates. Over the past years, artificial intelligence (AI) has emerged as a promising tool that may be a useful adjunct to the endoscopist. In this review, we provide an overview of the current role of AI in the management of BE and elaborate on the key challenges that need be addressed to enable its successful integration into daily endoscopic practice.
{"title":"The role of artificial intelligence in Barrett's esophagus: Current status and future challenges","authors":"R.A.H. van Eijck van Heslinga, J.J.G.H.M. Bergman, A.J. de Groof","doi":"10.1016/j.bpg.2025.101977","DOIUrl":"10.1016/j.bpg.2025.101977","url":null,"abstract":"<div><div>Barrett's esophagus (BE) is a known precursor for esophageal adenocarcinoma. Despite advances in endoscopic imaging modalities, endoscopic detection of BE neoplasia remains challenging, with considerable miss rates. Over the past years, artificial intelligence (AI) has emerged as a promising tool that may be a useful adjunct to the endoscopist. In this review, we provide an overview of the current role of AI in the management of BE and elaborate on the key challenges that need be addressed to enable its successful integration into daily endoscopic practice.</div></div>","PeriodicalId":56031,"journal":{"name":"Best Practice & Research Clinical Gastroenterology","volume":"75 ","pages":"Article 101977"},"PeriodicalIF":3.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144167891","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01DOI: 10.1016/j.bpg.2025.101982
N.E.A. Kapteijn , D.T. Mülder , I. Lansdorp-Vogelaar
Background
Gastric cancer (GC) is the fourth leading cause of cancer-related deaths worldwide, with highest incidence rates in Asia. Endoscopic screening may facilitate early detection and reduces mortality, but its cost-effectiveness in Western populations, where GC is less prevalent, remains unclear. This review aimed to evaluate the cost-effectiveness of endoscopic screening and surveillance for GC in Western countries, considering regional epidemiologic and economic differences.
Methods
A systematic search of literature was conducted using PubMed and Embase databases, focusing on studies evaluating the cost-effectiveness of endoscopy in asymptomatic individuals or high-risk subgroups in Western populations. Studies reporting incremental cost-effectiveness ratios (ICERs) compared to no screening/surveillance were included.
Results
In total fourteen studies were evaluated. Six studies reported on endoscopic screening in the general population, three on screening in high-risk individuals, and seven on endoscopic surveillance, with varying intervals ranging from one-time procedures to procedures every ten years. Endoscopic screening was generally not cost-effective in Western populations. However, screening for high-risk subgroups, or combined with colonoscopy, following a positive fecal immunochemical test, improved cost-effectiveness. Endoscopic surveillance was consistently cost-effective, particularly for individuals with gastric intestinal metaplasia (GIM), showing the best cost-effectiveness at a three-to five-year interval, with ICERs ranging from €18,336 per Quality-Adjusted Life Year (QALY) in Europe to $87,000 per QALY in the USA. For higher-risk lesions, like dysplasia or incomplete GIM, shorter surveillance intervals may be beneficial.
Conclusion
While routine endoscopic screening may not be cost-effective in Western populations, surveillance for GIM every three to five years is economically sustainable. Higher-risk individuals with dysplasia or incomplete GIM may benefit from more frequent surveillance.
{"title":"Cost-effectiveness of upper endoscopy for gastric cancer screening and surveillance in Western populations","authors":"N.E.A. Kapteijn , D.T. Mülder , I. Lansdorp-Vogelaar","doi":"10.1016/j.bpg.2025.101982","DOIUrl":"10.1016/j.bpg.2025.101982","url":null,"abstract":"<div><h3>Background</h3><div>Gastric cancer (GC) is the fourth leading cause of cancer-related deaths worldwide, with highest incidence rates in Asia. Endoscopic screening may facilitate early detection and reduces mortality, but its cost-effectiveness in Western populations, where GC is less prevalent, remains unclear. This review aimed to evaluate the cost-effectiveness of endoscopic screening and surveillance for GC in Western countries, considering regional epidemiologic and economic differences.</div></div><div><h3>Methods</h3><div>A systematic search of literature was conducted using PubMed and Embase databases, focusing on studies evaluating the cost-effectiveness of endoscopy in asymptomatic individuals or high-risk subgroups in Western populations. Studies reporting incremental cost-effectiveness ratios (ICERs) compared to no screening/surveillance were included.</div></div><div><h3>Results</h3><div>In total fourteen studies were evaluated. Six studies reported on endoscopic screening in the general population, three on screening in high-risk individuals, and seven on endoscopic surveillance, with varying intervals ranging from one-time procedures to procedures every ten years. Endoscopic screening was generally not cost-effective in Western populations. However, screening for high-risk subgroups, or combined with colonoscopy, following a positive fecal immunochemical test, improved cost-effectiveness. Endoscopic surveillance was consistently cost-effective, particularly for individuals with gastric intestinal metaplasia (GIM), showing the best cost-effectiveness at a three-to five-year interval, with ICERs ranging from €18,336 per Quality-Adjusted Life Year (QALY) in Europe to $87,000 per QALY in the USA. For higher-risk lesions, like dysplasia or incomplete GIM, shorter surveillance intervals may be beneficial.</div></div><div><h3>Conclusion</h3><div>While routine endoscopic screening may not be cost-effective in Western populations, surveillance for GIM every three to five years is economically sustainable. Higher-risk individuals with dysplasia or incomplete GIM may benefit from more frequent surveillance.</div></div>","PeriodicalId":56031,"journal":{"name":"Best Practice & Research Clinical Gastroenterology","volume":"75 ","pages":"Article 101982"},"PeriodicalIF":3.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144167883","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01DOI: 10.1016/S1521-6918(25)00050-2
{"title":"Copyright Information","authors":"","doi":"10.1016/S1521-6918(25)00050-2","DOIUrl":"10.1016/S1521-6918(25)00050-2","url":null,"abstract":"","PeriodicalId":56031,"journal":{"name":"Best Practice & Research Clinical Gastroenterology","volume":"75 ","pages":"Article 102023"},"PeriodicalIF":3.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144167881","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01DOI: 10.1016/j.bpg.2025.102003
Mie Thu Ko , Adriel Fung , Anjana Kumar , Alistair McArdle , Leo Alexandre
The overall prognosis of upper gastrointestinal cancer remains very poor. Early diagnosis is key to avoid morbidity and improve long-term survival. While gastroscopy is the gold standard diagnostic test, premalignant or malignant abnormalities may be overlooked or subject to sub-optimal management, leading to delayed diagnosis and patient harm. Patients with persistent symptoms after a “cancer-negative” gastroscopy may be given false reassurance. Upper gastrointestinal malignancies diagnosed within three years of a “cancer-negative”, index gastroscopy are defined as post-endoscopy upper gastrointestinal cancers (PEUGIC). They are surprisingly common, accounting for 11 % of upper gastrointestinal malignancies internationally. Abnormalities in the endoscopy preceding diagnosis are very common, and include premalignant findings and cancer-related lesions. Root cause analysis suggests deficiencies in endoscopy quality, decision-making and administration. This suggests avoidable PEUGIC cases, and crucially, an opportunity to improve endoscopy quality and outcomes. This narrative review summarises the epidemiology, presentation, contexts and root causes of PEUGIC and makes recommendations for clinical practice and research.
{"title":"Post-endoscopy upper gastrointestinal cancer: Emerging data and opportunities to improve early detection","authors":"Mie Thu Ko , Adriel Fung , Anjana Kumar , Alistair McArdle , Leo Alexandre","doi":"10.1016/j.bpg.2025.102003","DOIUrl":"10.1016/j.bpg.2025.102003","url":null,"abstract":"<div><div>The overall prognosis of upper gastrointestinal cancer remains very poor. Early diagnosis is key to avoid morbidity and improve long-term survival. While gastroscopy is the gold standard diagnostic test, premalignant or malignant abnormalities may be overlooked or subject to sub-optimal management, leading to delayed diagnosis and patient harm. Patients with persistent symptoms after a “cancer-negative” gastroscopy may be given false reassurance. Upper gastrointestinal malignancies diagnosed within three years of a “cancer-negative”, index gastroscopy are defined as post-endoscopy upper gastrointestinal cancers (PEUGIC). They are surprisingly common, accounting for 11 % of upper gastrointestinal malignancies internationally. Abnormalities in the endoscopy preceding diagnosis are very common, and include premalignant findings and cancer-related lesions. Root cause analysis suggests deficiencies in endoscopy quality, decision-making and administration. This suggests avoidable PEUGIC cases, and crucially, an opportunity to improve endoscopy quality and outcomes. This narrative review summarises the epidemiology, presentation, contexts and root causes of PEUGIC and makes recommendations for clinical practice and research.</div></div>","PeriodicalId":56031,"journal":{"name":"Best Practice & Research Clinical Gastroenterology","volume":"75 ","pages":"Article 102003"},"PeriodicalIF":3.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144167886","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.bpg.2025.101998
Federico De Stefano , Riccardo Pellegrini , Giovanni Marchegiani , Stefano Crippa
Pancreatic cystic neoplasms are a common condition, with intraductal papillary mucinous neoplasms (IPMNs) and mucinous cystic neoplasms (MCNs) being of particular concern due to their potential for malignant transformation. Resection of these lesions before progression to invasive cancer represents a crucial opportunity to reduce the burden of pancreatic cancer. However, the benefit of early-resection must be weighed against the risk of overtreatment. Applying current guidelines, nearly half of the patients who undergo resection for IPMN might not have required surgery, while malignancy is detected in only 16 % of resected MCNs. This raises concerns, particularly given the increasing detection of small cysts with the widespread use of radiological imaging and the significant postoperative risks, including exocrine and endocrine insufficiency. Emerging evidence suggests that surveillance strategies could be more broadly applied, reducing unnecessary surgeries. This review aims to reassess the current evidence regarding both surgical resection and surveillance of IPMNs and MCNs.
{"title":"Reducing the burden of pancreatic cancer by surveilling mucinous cystic neoplasms: are we there yet?","authors":"Federico De Stefano , Riccardo Pellegrini , Giovanni Marchegiani , Stefano Crippa","doi":"10.1016/j.bpg.2025.101998","DOIUrl":"10.1016/j.bpg.2025.101998","url":null,"abstract":"<div><div>Pancreatic cystic neoplasms are a common condition, with intraductal papillary mucinous neoplasms (IPMNs) and mucinous cystic neoplasms (MCNs) being of particular concern due to their potential for malignant transformation. Resection of these lesions before progression to invasive cancer represents a crucial opportunity to reduce the burden of pancreatic cancer. However, the benefit of early-resection must be weighed against the risk of overtreatment. Applying current guidelines, nearly half of the patients who undergo resection for IPMN might not have required surgery, while malignancy is detected in only 16 % of resected MCNs. This raises concerns, particularly given the increasing detection of small cysts with the widespread use of radiological imaging and the significant postoperative risks, including exocrine and endocrine insufficiency. Emerging evidence suggests that surveillance strategies could be more broadly applied, reducing unnecessary surgeries. This review aims to reassess the current evidence regarding both surgical resection and surveillance of IPMNs and MCNs.</div></div>","PeriodicalId":56031,"journal":{"name":"Best Practice & Research Clinical Gastroenterology","volume":"74 ","pages":"Article 101998"},"PeriodicalIF":3.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143792044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.bpg.2025.101976
Apostolis Papaefthymiou , Rosario Landi , Marianna Arvanitakis , Andrea Tringali , Paraskevas Gkolfakis
Endoscopic retrograde cholangiopancreatography (ERCP) was initially introduced in clinical practice as diagnostic tool. However, the presence of adverse events and the development of non-invasive techniques, such as magnetic resonance cholangiopancreatography (MRCP) and endoscopic ultrasound (EUS), limited its role as a stand-alone diagnostic choice, modifying its role to the leader of therapeutic pancreatobiliary endoscopy. Despite technological advances, there are still conditions where non-invasive diagnostic modalities are inconclusive, such as indeterminate biliary and pancreatic duct strictures, primary sclerosing cholangitis functional stenoses, intraductal papillary mucinous neoplasms (IPMNs) and paediatric indications, such as congenital anatomical abnormalities. This narrative review aimed to identify and analyse indications of diagnostic ERCP, without the need for therapeutic manipulations.
{"title":"Endoscopic retrograde cholangiopancreatography: A comprehensive review as a single diagnostic tool","authors":"Apostolis Papaefthymiou , Rosario Landi , Marianna Arvanitakis , Andrea Tringali , Paraskevas Gkolfakis","doi":"10.1016/j.bpg.2025.101976","DOIUrl":"10.1016/j.bpg.2025.101976","url":null,"abstract":"<div><div>Endoscopic retrograde cholangiopancreatography (ERCP) was initially introduced in clinical practice as diagnostic tool. However, the presence of adverse events and the development of non-invasive techniques, such as magnetic resonance cholangiopancreatography (MRCP) and endoscopic ultrasound (EUS), limited its role as a stand-alone diagnostic choice, modifying its role to the leader of therapeutic pancreatobiliary endoscopy. Despite technological advances, there are still conditions where non-invasive diagnostic modalities are inconclusive, such as indeterminate biliary and pancreatic duct strictures, primary sclerosing cholangitis functional stenoses, intraductal papillary mucinous neoplasms (IPMNs) and paediatric indications, such as congenital anatomical abnormalities. This narrative review aimed to identify and analyse indications of diagnostic ERCP, without the need for therapeutic manipulations.</div></div>","PeriodicalId":56031,"journal":{"name":"Best Practice & Research Clinical Gastroenterology","volume":"74 ","pages":"Article 101976"},"PeriodicalIF":3.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143792049","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.bpg.2025.101997
Calogero Casà , Daniel Portik , Ahmed Nadeem Abbasi , Francesco Miccichè
Radiomics is transforming the field of early detection of bilio-pancreatic lesions, offering significant advancements in diagnostic accuracy and personalized treatment planning. By extracting high-dimensional data from medical images such as computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET), radiomics reveals complex patterns that remain undetectable through traditional imaging evaluation. This review synthesizes recent developments in radiomics, particularly its application to early detection of pancreatic cancer (PC) and biliary duct cancer (BDC). It highlights the role of machine learning algorithms and multi-parametric models in improving diagnostic performance and discusses challenges such as standardization, reproducibility, and the need for larger, multicenter datasets. The integration of radiomics with genomic data and liquid biopsies also presents future opportunities for more individualized patient care.
{"title":"Radiomics in early detection of bilio-pancreatic lesions: A narrative review","authors":"Calogero Casà , Daniel Portik , Ahmed Nadeem Abbasi , Francesco Miccichè","doi":"10.1016/j.bpg.2025.101997","DOIUrl":"10.1016/j.bpg.2025.101997","url":null,"abstract":"<div><div>Radiomics is transforming the field of early detection of bilio-pancreatic lesions, offering significant advancements in diagnostic accuracy and personalized treatment planning. By extracting high-dimensional data from medical images such as computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET), radiomics reveals complex patterns that remain undetectable through traditional imaging evaluation. This review synthesizes recent developments in radiomics, particularly its application to early detection of pancreatic cancer (PC) and biliary duct cancer (BDC). It highlights the role of machine learning algorithms and multi-parametric models in improving diagnostic performance and discusses challenges such as standardization, reproducibility, and the need for larger, multicenter datasets. The integration of radiomics with genomic data and liquid biopsies also presents future opportunities for more individualized patient care.</div></div>","PeriodicalId":56031,"journal":{"name":"Best Practice & Research Clinical Gastroenterology","volume":"74 ","pages":"Article 101997"},"PeriodicalIF":3.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143792051","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.bpg.2025.101987
Julio Iglesias-Garcia , Daniel de la Iglesia , Pietro Fusaroli
The diagnostic paradigm for biliopancreatic lesions has been revolutionized by continuous advancements in endoscopic ultrasound (EUS) technologies and techniques. This review examines the expanding diagnostic toolkit available to clinicians, emphasizing innovations that have significantly enhanced precision and early detection capabilities.
One of the most transformative advancements is the development of fine-needle biopsy (FNB) needles. Modern designs, including Franseen, and fork-tip configurations, have optimized tissue sampling, achieving diagnostic accuracies exceeding 90 % while minimizing the number of needle passes required. These innovations facilitate the acquisition of high-quality histological specimens suitable for comprehensive molecular profiling, paving the way for personalized therapeutic approaches.
Concurrent advancements in sampling techniques have bolstered these needle design improvements. The fanning technique has been particularly effective, increasing diagnostic yields from 71 % to 88 %. Wet suction methods preserve tissue integrity better than traditional approaches, while standardized protocols for needle passes enhance procedural efficiency. For specimen evaluation, Rapid On-Site Evaluation (ROSE) offers 93 % sensitivity, while alternatives like Macroscopic On-Site Evaluation (MOSE) provide comparable accuracy while reducing dependency on specialized personnel and resources.
Image enhancement technologies have markedly improved the ability to characterize lesions. Contrast Harmonic EUS (CH-EUS) is particularly effective in differentiating pancreatic cancer from other solid lesions, with meta-analyses confirming sensitivity and specificity of 94 % and 89 %, respectively. Its ability to detect lesions as small as 15 mm makes it invaluable for early diagnosis. In cystic lesions, CH-EUS excels in identifying malignant mural nodules, with diagnostic accuracies reaching 96 %.
The integration of elastography and advanced digital imaging technologies has further expanded diagnostic capabilities. Strain elastography provides qualitative insights into tissue characteristics, while shear wave elastography offers quantitative measurements of stiffness, adding diagnostic precision. Similarly, technologies like detective flow imaging match the accuracy of contrast-enhanced techniques in pancreatic cancer detection and enhance vascular assessment.
For cystic lesions, diagnostics have progressed beyond traditional fluid analysis. Techniques such as through-the-needle biopsy (TTNB) have improved diagnostic yields to 74 %, albeit with a modest risk of complications. Incorporating molecular markers and next-generation sequencing allows differentiation between cystic lesion subtypes and more accurate assessment of malignant potential.
This array of diagnostic tools offers unprecedented potential for early and precise diagnosis of biliopancreatic lesions. Integrating th
{"title":"Endoscopic Ultrasound armamentarium for precise and early diagnosis of biliopancreatic lesions","authors":"Julio Iglesias-Garcia , Daniel de la Iglesia , Pietro Fusaroli","doi":"10.1016/j.bpg.2025.101987","DOIUrl":"10.1016/j.bpg.2025.101987","url":null,"abstract":"<div><div>The diagnostic paradigm for biliopancreatic lesions has been revolutionized by continuous advancements in endoscopic ultrasound (EUS) technologies and techniques. This review examines the expanding diagnostic toolkit available to clinicians, emphasizing innovations that have significantly enhanced precision and early detection capabilities.</div><div>One of the most transformative advancements is the development of fine-needle biopsy (FNB) needles. Modern designs, including Franseen, and fork-tip configurations, have optimized tissue sampling, achieving diagnostic accuracies exceeding 90 % while minimizing the number of needle passes required. These innovations facilitate the acquisition of high-quality histological specimens suitable for comprehensive molecular profiling, paving the way for personalized therapeutic approaches.</div><div>Concurrent advancements in sampling techniques have bolstered these needle design improvements. The fanning technique has been particularly effective, increasing diagnostic yields from 71 % to 88 %. Wet suction methods preserve tissue integrity better than traditional approaches, while standardized protocols for needle passes enhance procedural efficiency. For specimen evaluation, Rapid On-Site Evaluation (ROSE) offers 93 % sensitivity, while alternatives like Macroscopic On-Site Evaluation (MOSE) provide comparable accuracy while reducing dependency on specialized personnel and resources.</div><div>Image enhancement technologies have markedly improved the ability to characterize lesions. Contrast Harmonic EUS (CH-EUS) is particularly effective in differentiating pancreatic cancer from other solid lesions, with meta-analyses confirming sensitivity and specificity of 94 % and 89 %, respectively. Its ability to detect lesions as small as 15 mm makes it invaluable for early diagnosis. In cystic lesions, CH-EUS excels in identifying malignant mural nodules, with diagnostic accuracies reaching 96 %.</div><div>The integration of elastography and advanced digital imaging technologies has further expanded diagnostic capabilities. Strain elastography provides qualitative insights into tissue characteristics, while shear wave elastography offers quantitative measurements of stiffness, adding diagnostic precision. Similarly, technologies like detective flow imaging match the accuracy of contrast-enhanced techniques in pancreatic cancer detection and enhance vascular assessment.</div><div>For cystic lesions, diagnostics have progressed beyond traditional fluid analysis. Techniques such as through-the-needle biopsy (TTNB) have improved diagnostic yields to 74 %, albeit with a modest risk of complications. Incorporating molecular markers and next-generation sequencing allows differentiation between cystic lesion subtypes and more accurate assessment of malignant potential.</div><div>This array of diagnostic tools offers unprecedented potential for early and precise diagnosis of biliopancreatic lesions. Integrating th","PeriodicalId":56031,"journal":{"name":"Best Practice & Research Clinical Gastroenterology","volume":"74 ","pages":"Article 101987"},"PeriodicalIF":3.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143792048","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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