BACKGROUND: Pulmonary sarcoidosis often involves mediastinal or hilar lymph nodes in the lung parenchyma. Mediastinoscopy is the gold standard for diagnosis, but it is invasive and expensive. Transbronchial needle aspiration using conventional bronchoscope is less invasive than mediastinoscopy, but its diagnostic accuracy is in question due to the blind approach to targeting lymph nodes. Transbronchial needle aspiration (TBNA) via endobronchial ultrasound (EBUS) has high diagnostic value due to direct visualization of lymph nodes and to its relatively safeness. The purpose of this study was to assess the usefulness of EBUS-TBNA in the diagnosis of pulmonary sarcoidosis. METHODS: Twenty-five patients with symptoms of sarcoidosis were enrolled into this study. Core tissue was obtained for a definitive diagnosis. Endobronchial biopsy, transbronchial lung biopsy, and bronchoalveolar lavage were performed to verify diagnosis. For patients without a confirmed diagnosis after the above procedures were performed, the additional procedures of mediastinoscopy or video-associated thoracoscopic surgery were performed to confirm a final diagnosis. RESULTS: A total 25 EBUS procedures were done and 50 lymph nodes were aspirated. Thirty-three (37) out of 50 lymph nodes were consistent with non-caseating granuloma, confirming sarcoidosis as the final diagnosis. Sarcoidosis was the final diagnosis for all 25 patients, and 21 required EBUS-TBNA for a final diagnosis. There were no complications associated with the procedure. CONCLUSION: EBUS-TBNA is already a well-known procedure for diagnosing mediastinal or hilar lymphadenopathy. We used EBUS-TBNA for the diagnosis of pulmonary sarcoidosis and our results showed 84% diagnostic accuracy and no complications related to the procedure. EBUS-TBNA is a reliable and practical diagnostic modality in the diagnosis of pulmonary sarcoidosis.
Biopsy ; Biopsy, Fine-Needle ; Bronchoalveolar Lavage ; Bronchoscopes ; Bronchoscopy ; Granuloma ; Humans ; Lung ; Lymph Nodes ; Lymphatic Diseases ; Mediastinoscopy ; Needles ; Sarcoidosis ; Sarcoidosis, Pulmonary ; Thoracoscopy

Endoscopic ultrasonography (EUS) combines endoscopy and intraluminal ultrasonography, and allows imaging with a high-frequency transducer over a short distance to generate high-resolution ultrasonographic images. EUS is now a widely accepted modality for diagnosing pancreatobiliary diseases. EUS-guided fine-needle aspiration (EUS-FNA) using a curved linear-array echoendoscope was initially described more than 20 years ago, and since then many researchers have expanded its indications to sample diverse lesions and have also used it for various therapeutic purposes. EUS-guided biliary drainage (EUS-BD) is one of the therapeutic procedures that has been developed using a curved linear-array echoendoscope. Technically, EUS-BD includes rendezvous techniques via transesophageal, transgastric, and transduodenal routes, EUS-guided choledochoduodenostomy (EUS-CDS), and EUS-guided hepaticogastrostomy (EUS-HGS). Published data have demonstrated a high success rate, albeit with a comparatively high rate of nonfatal complications for EUS-CDS and EUS-HGS, and a comparatively low success rate with a low complication rate for the rendezvous technique. At present, these procedures represent an alternative to surgery or percutaneous transhepatic biliary drainage (PTBD) for patients with obstructive jaundice when endoscopic biliary drainage (EBD) has failed. However, these procedures should be performed in centers with extensive experience in linear EUS and therapeutic biliary ERCP. Large prospective studies are needed in the near future to establish standardized EUS-BD procedures as well as to perform controlled comparative trials between EUS-BD and PTBD, between rendezvous techniques and direct-access techniques (EUS-CDS and EUS-HGS), and between EBD and EUS-BD.
Biopsy, Fine-Needle ; Cholangiopancreatography, Endoscopic Retrograde ; Choledochostomy ; Dioxolanes ; Drainage ; Endoscopy ; Endosonography ; Fluorocarbons ; Humans ; Jaundice, Obstructive ; Transducers

BACKGROUND: A pleural effusion is not a disease entity but a clincial sign of systemic or pleural disease. Although the diagnosis of pleural effusion can often be done by toracentesis and pleural needle biopsy the yeild of positive diagnosis is low.
Biopsy, Needle ; Diagnosis ; Pleural Diseases ; Pleural Effusion* ; Thoracoscopy*

For tissue diagnosis of suspected pancreatic cancer, endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is the procedure of choice with high safety and accuracy profiles. However, about 10% of cytologic findings of EUS-FNA are inconclusive. In that situation, careful observation, surgical exploration, or alternative diagnostic tools such as bile duct brushing with endoscopic retrograde cholangiopancreatography or computed tomography-guided biopsy can be considered. However, some concerns and/or risks of these options render repeat EUS-FNA a reasonable choice. Repeated EUS-FNA may impose substantial clinical impact with low risk.
Bile Ducts ; Biopsy ; Cholangiopancreatography, Endoscopic Retrograde ; Endoscopic Ultrasound-Guided Fine Needle Aspiration ; Endosonography ; Pancreatic Neoplasms

In 1980, endoscopic ultrasound (EUS) was introduced as a diagnostic tool for evaluation of the pancreas. Since the introduction of curvilinear-array echoendoscopy, EUS has been used for a variety of gastrointestinal interventions, including fine needle aspiration, tumor ablation, and pancreatobiliary access. One of the main therapeutic roles of EUS is biliary drainage as an alternative to endoscopic retrograde biliary drainage (ERBD) or percutaneous transhepatic biliary drainage (PTBD). This article summarizes three different methods of EUS-guided biliary access, with focus on technique and practical tips.
Biopsy, Fine-Needle ; Cholangiopancreatography, Endoscopic Retrograde ; Cholestasis ; Drainage ; Endosonography ; Pancreas ; Ultrasonography

Lymphoepithelioma-like carcinoma (LELC) is a rare cancer and it makes up about 1~4% of all gastric malignancies. The main histologic feature of LELC is a lymphoid stroma. LELC is rare in that its shape is similar to that of submucosal tumor (SMT). Although SMT can be divided into malignant and benign tumors, using endoscopic ultrasonography (EUS) and EUS-guided fine needle aspiration, there are still many cases that can't be discriminated, and it is especially difficult to obtain specimens due to the small size of SMT. There have been some recent trials to endoscopic remove small SMTs for the purpose of making an exact diagnosis and guiding therapy. We report here a case of gastric LELC that exhibited the features of a submucosal tumor, and this LELC was removed by endoscopic enucleation. We also briefly review the relevant medical literature.
Biopsy, Fine-Needle ; Endoscopy ; Endosonography

A 34-year-old man was referred to our department for evaluation of his elevated liver function test. He was diagnosed with Langerhans cell histiocytosis 7 years ago because of recurrent pneumothorax. A CT scan showed multifocal intrahepatic duct dilatation with soft tissue infiltration in the right lobe of the liver. An ERCP showed diffuse multifocal strictures of the intrahepatic duct intervening among the normal segments of the duct. A percutaneous needle biopsy of the liver disclosed ductular proliferation, inflammatory cell infiltration and focal cholestasis. Therefore, he was diagnosed with sclerosing cholangitis. He underwent colonoscopy to evaluate for the possibility of ulcerative colitis. The colonoscopy showed erosions and erythema on the mucosa of the appendiceal orifice, another site of erosion at 35 cm from the anal verge and multiple 3~8 mm sized sessile polyps. Biopsies of the colon mucosa disclosed an infiltration of Langerhans cell histiocytosis. We report here on a very rare case of colon involvement of Langerhans cell histiocytosis.
Adult ; Biopsy ; Biopsy, Needle ; Cholangiopancreatography, Endoscopic Retrograde ; Cholangitis, Sclerosing ; Cholestasis ; Colitis, Ulcerative ; Colon ; Colonoscopy ; Constriction, Pathologic ; Dilatation ; Erythema ; Histiocytosis, Langerhans-Cell ; Humans ; Liver ; Liver Function Tests ; Mucous Membrane ; Pneumothorax ; Polyps

The risk of complications associated with endoscopic procedures, including bleeding and perforation, tends to increase due to the magnification of the therapeutic endoscopic spectrum. In cases of duodenal perforation, surgical closure is the treatment of choice; however, there have been some cases in which the nonsurgical treatment of an iatrogenic duodenal perforation during an endoscopic procedure was effected via endoscopic clipping closure. Here, we report two cases of successful endoscopic clipping closure of an iatrogenic duodenal perforation occur ring during a duodenoscopy insertion for ERCP and endoscopic mucosal resection for the treatment of duodenal adenoma.
Adenoma ; Cholangiopancreatography, Endoscopic Retrograde ; Duodenoscopy ; Hemorrhage

Small cell neuroendocrine carcinoma in the ampulla of Vater is a rare disease and there have only been three cases reported in Korea. In these three cases, the patients had symptoms of abdominal pain and jaundice. A biopsy via endoscopic retrograde cholangiopancreatography confirmed a small cell neuroendocrine carcinoma; thus, each patient underwent surgical treatment. Recently, we experienced a case of small cell neuroendocrine carcinoma in an asymptomatic patient. An ulcerative lesion was identified during screening gastroduodenoscopy. Here, we report this case and review the relevant literature.
Abdominal Pain ; Ampulla of Vater* ; Biopsy ; Carcinoma, Neuroendocrine* ; Cholangiopancreatography, Endoscopic Retrograde ; Duodenoscopy ; Humans ; Jaundice ; Korea ; Mass Screening ; Rare Diseases ; Ulcer

OBJECTIVETo evaluate the feasibility of kidney biopsy by transgastric and transvesical combined approach in the porcine model.

METHODSFive female pigs (20 to 30 kg) were included in this study. All procedures were performed with pigs under general anesthesia. The transvesical access was established by the ureteroscope. Then monitored by ureteroscopy, the transgastric access was established by a needle knife with cautery. The puncture dilation was performed with balloon through the gastroscope. The vesical hole was enlarged with the dilator of ureteroscope sheath. The kidney biopsy was finished by the scissor from the transvesical access and the grasping forcep from the work channel of gastroscope.

RESULTSAmong five cases the procedure were successful in three cases with 380 min, 180 min, 78 min respectively. Establishment of transvesical and transgastric accesses took place without complications. The exposure and biopsy of the kidney were easily achieved during operation. The transgastric and transvesical access were not closed in the end.

CONCLUSIONSThis new method is a technically feasible procedure in a porcine model. But the safety and the clinical future of it needs more study.