Endosonography ; methods ; Humans ; Male ; Middle Aged ; Pulmonary Embolism ; diagnosis

Endoscopic transpapillary biliary drainage is the current standard of care for unresectable hilar malignant biliary obstruction (MBO) and bilateral metal stent placement is shown to have longer patency. However, technical and clinical failure is possible and percutaneous transhepatic biliary drainage (PTBD) is sometimes necessary. Endoscopic ultrasound-guided biliary drainage (EUS-BD) is increasingly being reported as an alternative rescue procedure to PTBD. EUS-BD has a potential advantage of not traversing the biliary stricture and internal drainage can be completed in a single session. Some approaches to bilateral biliary drainage for hilar MBO under EUS-guidance include a bridging method, hepaticoduodenostomy, and a combination of EUS-BD and transpapillary biliary drainage. The aim of this review is to summarize data on EUS-BD for hilar MBO and to clarify its advantages over the conventional approaches such as endoscopic transpapillary biliary drainage and PTBD.
Constriction, Pathologic ; Drainage ; Endosonography ; Methods ; Standard of Care ; Stents

BACKGROUND/AIMS: Contrast-enhanced harmonic endoscopic ultrasonography (CEH-EUS) is a promising imaging modality that can differentiate subepithelial tumors (SETs) by detecting the degree of enhancement. However, whether CEH-EUS alone can predict the malignancy risk of gastrointestinal stromal tumors (GISTs) remains unclear. This study aimed to evaluate the feasibility of CEH-EUS by using perfusion analysis software for distinguishing among SETs and predicting the malignancy risk of GISTs. METHODS: We retrospectively included patients with SETs who underwent preoperative CEH-EUS. In this study, 44 patients with histologically proven GISTs and benign SETs were enrolled. Perfusion analysis was performed using perfusion quantification software. Peak enhancement (PE), wash-in rate (WiR), wash-in perfusion index (WiPI), and wash-in and wash-out areas under the time-intensity curve (WiWoAUC) were calculated and compared between the GISTs and benign SETs. RESULTS: When we allocated the enrolled patients into the leiomyoma group and low- and high-grade malignancy GIST groups, significant statistical differences in PE (p<0.001), WiR (p=0.009), WiPI (p<0.001), and WiWoAUC (p<0.001) were identified in the high-grade malignancy group compared with the leiomyoma group. CONCLUSIONS: CEH-EUS with perfusion analysis using perfusion analysis software could be a quantitative and independent method for predicting malignancy risk in gastrointestinal SETs.
Endosonography ; Gastrointestinal Stromal Tumors ; Humans ; Leiomyoma ; Methods ; Perfusion ; Retrospective Studies

BACKGROUNDEndobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is an effective technique used to precisely detect enlarged mediastinal lymph nodes. The efficacy of EBUS-TBNA versus standard modalities for the diagnosis of sarcoidosis remains to be elucidated. In this meta-analysis, we compared the efficacies of these methods.

METHODSWe searched PubMed, Embase, The Cochrane Library, Wanfang, Cpvip, CNKI, and the bibliographies of the relevant references. We analyzed the data obtained with Revman 5.2 (Nordic Cochrane Center, Copenhagen, Denmark) and Stata 12.0 software (Stata Corporation, College Station, TX, USA). The Mantel-Haenszel method was used to calculate the pooled odds ratio (OR) and 95% confidence intervals (CIs).

RESULTSSixteen studies with a total of 1823 participants met the inclusion criteria, and data were extracted regarding the diagnostic yield of each approach. The ORs for EBUS-TBNA versus transbronchial lung biopsy (TBLB) for the diagnosis of sarcoidosis ranged from 0.26 to 126.58, and the pooled OR was 5.89 (95% CI, 2.20-15.79, P = 0.0004). These findings indicated that EBUS-TBNA provided a much higher diagnostic yield than TBLB. The pooled OR for EBUS-TBNA + TBLB + endobronchial biopsy (EBB) versus TBNA + TBLB + EBB was 1.54 (95% CI, 0.61-3.93, P = 0.36), implying that there was no significant difference between their diagnostic yields. However, clinical heterogeneity was reflected in the nature of the studies and in the operative variables.

CONCLUSIONSThe results of this meta-analysis suggest that EBUS-TBNA + TBLB + EBB could be used for the diagnosis of sarcoidosis, if available. At medical centers without EBUS-TBNA, TBNA + TBLB + EBB could be used instead.

Biopsy, Fine-Needle ; methods ; Bronchoscopy ; methods ; Endosonography ; methods ; Female ; Humans ; Image-Guided Biopsy ; methods ; Male ; Sarcoidosis, Pulmonary ; diagnosis ; Ultrasonography ; methods

Elastography is an imaging modality for the evaluation of tissue stiffness, which has been used for the analysis of superficial organs, such as those of the breast and prostate. The measurement of tissue elasticity has been reported to be useful for the diagnosis and differentiation of tumors, which are stiffer than normal tissues. Endoscopic ultrasonography elastography (EUS-EG) is a promising imaging technique with a high degree of accuracy for the differential diagnosis of solid pancreatic tumors. Recent introduction of second generation EUS-EG allows for the quantitative analysis of tissue stiffness. Here, we review our knowledge and preliminary experience with the use of EUS-elastography for the diagnosis of pancreatic disease.
Diagnosis, Differential ; Elasticity Imaging Techniques/*methods ; Endosonography/*methods ; Humans ; Pancreas/*ultrasonography ; Pancreatic Diseases/*ultrasonography ; Sensitivity and Specificity

In this paper, we introduce a coded excitation circuit for medical ultrasonic endoscope imaging system. This circuit is composed of TC6320 and its drive chip. The experiment demonstrates that this circuit can export frequency-adjustable, duration-controllable coded signals, and its voltage reaches +/-60 V. It still works well when excitant frequency reaches 30 MHz. Compared with the conventional medical ultrasonic pulse-echo imaging system, this coded excitation system has the potential of higher SNR and deeper penetration depth, especially for the small emission power system. This method has a bright future.
Endosonography ; instrumentation ; methods ; Equipment Design ; Humans ; Image Interpretation, Computer-Assisted ; methods ; Transducers

Biopsy, Fine-Needle ; methods ; Bronchi ; diagnostic imaging ; pathology ; China ; Endosonography ; methods ; Humans ; Lung Neoplasms ; diagnosis

OBJECTIVE: To demonstrate a comprehensive review of published articles regarding endoscopic ultrasound (EUS)-guided biliary drainage. MATERIALS AND METHODS: Review of studies regarding EUS-guided biliary drainage including case reports, case series and previous reviews. RESULTS: EUS-guided hepaticogastrostomy, coledochoduodenostomy and choledoantrostomy are advanced biliary and pancreatic endoscopy procedures, and together make up the echo-guided biliary drainage. Hepaticogastrostomy is indicated in cases of hilar obstruction, while the procedure of choice is the coledochoduodenostomy or choledochoantrostomy in distal lesions. Both procedures must be performed only after unsuccessful ERCPs. The indication of these procedures must be made under a multidisciplinary view while sharing information with the patient or legal guardian. CONCLUSION: Hepaticogastrostomy and coledochoduodenostomy or choledochoantrostomy are feasible when performed by endoscopists with expertise in biliopancreatic endoscopy. Advanced echo-endoscopy should currently be performed under a rigorous protocol in educational institutions.
Bile Duct Diseases/*surgery/ultrasonography ; Cholangiopancreatography, Endoscopic Retrograde ; Choledochostomy/methods ; Drainage/*methods ; Endosonography/*methods ; Gastrostomy/methods ; Humans ; *Ultrasonography, Interventional

The low-resolution ultrasound images have poor visual effects. Herein we propose a method for generating clearer intravascular ultrasound images based on super-resolution reconstruction combined with generative adversarial networks. We used the generative adversarial networks to generate the images by a generator and to estimate the authenticity of the images by a discriminator. Specifically, the low-resolution image was passed through the sub-pixel convolution layer -feature channels to generate -feature maps in the same size, followed by realignment of the corresponding pixels in each feature map into × sub-blocks, which corresponded to the sub-block in a high-resolution image; after amplification, an image with a -time resolution was generated. The generative adversarial networks can obtain a clearer image through continuous optimization. We compared the method (SRGAN) with other methods including Bicubic, super-resolution convolutional network (SRCNN) and efficient sub-pixel convolutional network (ESPCN), and the proposed method resulted in obvious improvements in the peak signal-to-noise ratio (PSNR) by 2.369 dB and in structural similarity index by 1.79% to enhance the diagnostic visual effects of intravascular ultrasound images.
Blood Vessels ; diagnostic imaging ; Endosonography ; methods ; Image Enhancement ; methods ; Image Processing, Computer-Assisted ; methods ; Signal-To-Noise Ratio

Endoscopic ultrasonography-guided gallbladder drainage (EUS-GBD) has been developed as an alternative drainage method in patients with malignant cystic duct obstruction. However, the procedure of track dilation is difficult in case of severe gallbladder wall thickening with tumor involvement or inflammation. The rendezvous technique via external fistulous track is considered in failed attempts to dilate an internal track between the gallbladder and the stomach/duodenum using conventional approach of EUS-GBD. This report presents a 56-year-old man with pancreatic cancer with malignant cystic duct obstruction who underwent percutaneous transhepatic gallbladder drainage. The patient was successfully treated using rendezvous EUS-GBD technique after he failed the conventional EUS-GBD procedure of internal track dilation.
Cystic Duct* ; Drainage* ; Endosonography ; Gallbladder* ; Humans ; Inflammation ; Methods ; Middle Aged ; Pancreatic Neoplasms