Endoscopic ultrasonography (EUS) has progressed beyond diagnostic imaging to include EUS-guided tissue acquisition and EUS-directed therapies. This review provides an update on EUS-guided drainage and anastomotic procedures, and other therapeutic procedures. Today, EUS-guided drainage of symptomatic walled-off pancreatic fluid collections is the norm, with endoscopic necrosectomy as an adjunct. For high-risk surgical patients unsuitable for cholecystectomy, EUS-guided gallbladder drainage of acute cholecystitis is an option. Additionally, EUS-guided drainage of obstructed biliary and pancreatic ductal system can be performed as salvage procedures after unsuccessful endoscopic retrograde cholangiopancreatography (ERCP). Bariatric procedures such as Roux-en-Y gastric bypass alter the gastric anatomy, hindering access to the major papilla. This can be overcome by creating a conduit through the excluded stomach using EUS-directed transgastric ERCP. Gastric outlet obstruction and afferent loop syndrome can be treated using EUS-guided gastrojejunostomy. These therapeutic interventions are a major advancement in the field of interventional EUS, achieving significant clinical impact.
Humans ; Endosonography/methods* ; Drainage/methods* ; Cholangiopancreatography, Endoscopic Retrograde/methods* ; Ultrasonography, Interventional/methods* ; Anastomosis, Surgical/methods*

OBJECTIVES: In recent years, the incidence and detection rate of pancreatic cystic lesions (PCLs) have increased significantly. Endoscopic ultrasound (EUS) plays an indispensable role in the diagnosis and differential diagnosis of PCLs. However, evidence comparing the diagnostic performance of EUS-guided fine-needle aspiration (EUS-FNA) and fine-needle biopsy (FNB) remains limited. This study aims to compare the diagnostic yield, adequacy of tissue acquisition, and safety between EUS-FNA and EUS-FNB in evaluating PCLs to inform clinical practice. METHODS: A retrospective review was conducted on patients with PCLs who underwent either EUS-FNA or EUS-FNB between January 2014 and August 2021. The diagnostic yield, tissue acquisition adequacy, and incidence of adverse events were compared between the 2 groups. RESULTS: A total of 90 patients with PCLs were included (52 in the FNA group and 38 in the FNB group). The diagnostic yield was similar between the FNA and FNB groups (94.2% vs 94.7%, P>0.05). The adequacy of tissue acquisition was 71.2% in the FNA group and 81.6% in the FNB group (P>0.05). No statistically significant difference was observed in the incidence of adverse events between the 2 groups (P>0.05). CONCLUSIONS Both EUS-FNA and EUS-FNB demonstrate equally high diagnostic yields and tissue adequacy in PCLs, with excellent safety profiles. Both methods are safe and effective diagnostic tools for evaluating PCLs.
Humans ; Endoscopic Ultrasound-Guided Fine Needle Aspiration/adverse effects* ; Retrospective Studies ; Female ; Male ; Pancreatic Cyst/diagnostic imaging* ; Middle Aged ; Biopsy, Fine-Needle/adverse effects* ; Aged ; Pancreatic Neoplasms/diagnosis* ; Adult ; Endosonography/methods* ; Pancreas/pathology* ; Diagnosis, Differential

Objective: To analyze the risk factors for complications of endoscopic full-thickness resection (EFTR) of upper gastrointestinal submucosal tumors (SMTs). Methods: This was a retrospective observational study. The indications for EFTR included: (1) SMTs originating from the muscularis propria layer and growing out of the cavity or infiltrating the deep part of the muscularis propria layer; (2) SMTs diameter <5 cm; and (3) tumor identified as closely adherent to the serous layer during endoscopic submucosal dissection or endoscopic mucosal resection. This study included patients with SMTs originating from the muscularis propria layer in upper digestive tract, diagnosed preoperatively by endoscopic ultrasonography or computed tomography, who were successfully treated with EFTR. Those with incomplete clinical data were excluded. The clinical data of 154 patients with upper gastrointestinal SMTs who underwent EFTR at the Department of Gastroenterology, First Affiliated Hospital of Soochow University from January 2016 to January 2022 were retrospectively analyzed. Post-EFTR complications (such as delayed perforation, delayed bleeding, and postoperative infection, including electrocoagulation syndrome) were monitored and the risk factors for them were analyzed. Results: Among the 154 study patients, 33 (21.4%) developed complications, including delayed bleeding in three (1.9%), delayed perforation in two (1.3%), and postoperative infection in 28 (18.2%). One patient with bleeding was classified as having a major complication (hospitalized for more than 10 days because of complication). According to univariate analysis, complication was associated with tumor diameter >15 mm, operation time >90 minutes, defect closure method(purse string suture), and diameter of resected specimen ≥20 mm (all P<0.05). Multivariate logistic regression analysis showed that operation time >90 minutes (OR=6.252, 95%CI: 2.530-15.446, P<0.001) and tumor diameter >15 mm (OR=4.843, 95%CI: 1.985-11.817, P=0.001) were independent risk factors for complications after EFTR in patients with upper gastrointestinal SMTs. The independent risk factors for postoperative infection in these patients were operation time>90 minutes (OR=4.993, 95%CI:1.964-12.694, P=0.001) and purse string suture (OR=7.142, 95%CI: 1.953-26.123, P=0.003). Conclusion: Patients with upper gastrointestinal SMTs undergoing EFTR with tumor diameter >15 mm or operation time >90 minutes have a significantly increased risk of postoperative complications. Postoperative monitoring is important for these patients with SMTs.
Humans ; Stomach Neoplasms/surgery* ; Endoscopic Mucosal Resection/methods* ; Gastroscopy/methods* ; Retrospective Studies ; Endosonography/adverse effects* ; Postoperative Complications/etiology* ; Treatment Outcome ; Gastric Mucosa/surgery*

BACKGROUND: Virtual bronchoscopic navigation (VBN) assisted endobronchial ultrasonography with guide sheath (EBUS-GS) has reduced the difficulty and even avoiding radiation exposure during performing transbronchus lung biopsy (TBLB). To evaluate the feasibility and safety of virtual bronchoscopic navigation assisted endobronchial ultrasonography with guide sheath for peripheral pulmonary lesions. METHODS: We performed a retrospective analysis of the patients with PPLs who received VBN assisted EBUS-GS-TBLB in Peking University Cancer Hospital from January 2016 to December 2017. Their clinicopathologic data and complications were assessed. RESULTS: A total of 121 patients were enrolled in the study. The patients included 65 men and 56 women, with a mean age of (58.8±10.3) years. A total of 121 PPLs were examined, and 108 lesions of which could be detected by EBUS. The overall diagnostic yield of EBUS-GS was 73.5%. The diagnostic yield of malignancy was 82.5%. The combination of transbronchial lung biopsy, brush smear and bronchoalveolar lavage fluid provided the greatest diagnostic yield (χ²=6.084, P=0.014). Factors that significantly affected and predicted diagnostic success were EBUS probe within the lesions (χ²=20.372, P=0.000) and PPLs located in the central two-thirds of the lung (χ²=10.810, P=0.001). 1 patient (0.8%) suffered from intraoperative bleeding which could be managed under endoscopy. CONCLUSIONS VBN assisted EBUS-GS-TBLB for PPLs was an effective and safe procedure.
Bronchoscopy ; adverse effects ; methods ; Endosonography ; adverse effects ; methods ; Female ; Humans ; Lung Neoplasms ; diagnostic imaging ; surgery ; Male ; Middle Aged ; Retrospective Studies ; Safety

Rectal neuroendocrine neoplasms (NENs) are low-grade malignancies, which are slow-growing and usually become symptomatic late in the course of the disease (Basuroy et al., 2016). In recent years, rectal NENs are increasingly frequently detected, with the widespread availability and accessibility of endoscopy and cross-sectional imaging modalities (Kos-Kudla et al., 2017). Multiple studies have shown that endoscopic ultrasound (EUS) is an advanced endoscopic technique and is currently used in the diagnosis and preoperative assessment of NENs (Kim, 2012; Liu et al., 2013; Zhang et al., 2017). However, EUS imaging of rectal NEN and differential diagnosis with other submucosal tumors (SMTs) has not been adequately reported. In this study, we reviewed and summarized the EUS imaging and pathological features of rectal NENs of 38 cases to improve preoperative diagnosis rate and reduce unreasonable treatment.
Adult ; Aged ; Endosonography/methods* ; Female ; Humans ; Male ; Middle Aged ; Neuroendocrine Tumors/therapy* ; Rectal Neoplasms/therapy*

Gastric duplication is a rare congenital anomaly accounting to 4% of all gastrointestinal tract duplications. It is usually diagnosed pre-natally or during infancy. Retroperitoneal gastric duplication is very rare in adult patients. It is generally asymptomatic or presents with non-specific symptoms. The sensitivity of classical imaging modalities for retroperitoneal gastric duplication is weak. Retroperitoneal gastric duplication could be misdiagnosed as other retroperitoneal cystic lesions and it could be definitely diagnosed by typical findings of abdominal enhanced computed tomography (CT) and endoscopic ultrasonography (EUS) plus EUS:guided fine needle aspiration biopsy in gastric duplicated cyst. A female adult patient was diagnosed by an exceptional hospital CT as retroperitoneal cystic lesion and was admitted in our hospital in March 2019. The abdominal enhanced CT in our hospital preoperatively indicated a cystic lesion above the left kidney and the maximum cross section was 9.0 cm×5.2 cm. Lymphocysts and others should be identified and the lesion might be from the stomach. The retroperitoneal gastric duplication was not diagnosed before operation. In the operation laparoscopy revealed the cystic lesion in the retroperitoneum. The pancreas, left adrenal gland, and left kidney were compressed by the cystic lesion. The top of the lesion was connected with the small curvature of the stomach, but it was not communicated with the stomach. The retroperitoneal cystic lesion was completely excised and the surrounding organs were not damaged. The retroperitoneal gastric duplication was clearly diagnosed by the findings in the operation and the pathology of the lesion. The patient was discharged a week after surgery without gastrointestinal and pancreatic injuries. Therefore, the differential diagnosis of retroperitoneal cysts should consider the possibility of retroperitoneal gastric duplication. For patients with typical CT findings or unclear boundaries between the tumor and the stomach wall, gastric duplication could be diagnosed by EUS plus EUS:guided fine needle aspiration biopsy in the cyst. Retroperitoneal gastric duplication cyst could be completely excised by laparoscopy through abdominal cavity and the stomach wall could be completely repaired.
Cysts ; Endosonography ; Female ; Humans ; Retroperitoneal Space ; Stomach Diseases

Among metastatic pancreatic tumors, malignant melanomas are rare. Here, we report a very rare case of a malignant melanoma that involved only the pancreas and liver, and was difficult to differentiate from a neuroendocrine tumor of the pancreas with a liver metastasis. A 65-year-old- male with no history of a malignant melanoma exhibited hypervascular hepatic and pancreatic tumors on computed tomography and contrast-enhanced endoscopic ultrasonography. He lacked lesions of the skin, eye, and gastrointestinal tract on physical examination, upper endoscopy, and a whole-body positron emission tomography-computed tomography scan; these sites are common primary sites of malignant melanoma. Finally, endoscopic ultrasound-guided pancreatic core biopsy and percutaneous ultrasonography-guided liver biopsy confirmed malignant melanoma of the pancreas and liver.
Biopsy ; Electrons ; Endoscopy ; Endosonography ; Gastrointestinal Tract ; Humans ; Liver ; Male ; Melanoma ; Neoplasm Metastasis ; Neuroendocrine Tumors ; Pancreas ; Pancreatic Neoplasms ; Physical Examination ; Skin

Recurrent acute pancreatitis (RAP) is defined as two or more true episodes of acute pancreatitis and about 20% of patients with acute pancreatitis experience at least one episode of recurrence. In about 10% of RAP, no definite etiology is found despite extensive evaluation. This entity is called idiopathic acute pancreatitis (IAP). Toxic-metabolic, idiopathic, genetic, autoimmune, recurrent and severe acute pancreatitis, obstructive (TIGAR-O) classification is commonly used to identify risk factors for RAP. Modalities employed to find causes of RAP and IAP include meticulous history taking, blood tests, diagnostic imaging, genetic testing, bile crystal analysis, endoscopic ultrasonography, and endoscopic retrograde cholangiopancreatography with/without sphincter of Oddi manometry. Each modality is briefly reviewed in this review.
Bile ; Cholangiopancreatography, Endoscopic Retrograde ; Classification ; Diagnosis ; Diagnostic Imaging ; Endosonography ; Genetic Testing ; Hematologic Tests ; Humans ; Manometry ; Pancreatitis ; Recurrence ; Risk Factors ; Sphincter of Oddi

BACKGROUND/AIMS: Determining the cause of suspected biliary stricture is often challenging in clinical practice. We aimed to compare the diagnostic yields of endoscopic ultrasound-guided tissue sampling (EUS-TS) and endoscopic retrograde cholangiopancreatography-guided tissue sampling (ERCP-TS) in patients with suspected biliary stricture at different primary lesions. METHODS: We enrolled patients who underwent same-session EUS- and ERCP-TS for the evaluation of suspected biliary stricture. Forceps biopsy and/or brush cytology of intraductal lesions and fine-needle aspiration for solid mass lesions were performed during ERCP and EUS, respectively. RESULTS: One hundred and twenty-five patients treated at our institution between January 2011 and September 2016, were initially considered for the study. However, 32 patients were excluded due to loss of follow-up (n=8) and ERCP-TS on the pancreatic duct (n=20) or periampullary lesions (n=4). Of the 93 patients included, 86 had a malignant tumor including cholangiocarcinoma (n=39), pancreatic cancer (n=37), and other malignancies (n=10). Seven patients had benign lesions. EUS-TS had higher rate of overall diagnostic accuracy than ERCP-TS (82.8% vs. 60.2%, p=0.001), and this was especially true for patients with a pancreatic lesion (84.4% vs. 51.1%, p=0.003). CONCLUSIONS: EUS-TS was found to be superior to ERCP-TS for evaluating suspected biliary strictures, especially those caused by pancreatic lesions.
Biopsy ; Biopsy, Fine-Needle ; Cholangiocarcinoma ; Cholangiopancreatography, Endoscopic Retrograde ; Constriction, Pathologic ; Diagnosis ; Endosonography ; Follow-Up Studies ; Humans ; Pancreatic Ducts ; Pancreatic Neoplasms ; Surgical Instruments

No abstract available.
Cholangiopancreatography, Endoscopic Retrograde ; Constriction, Pathologic ; Endosonography