Clinical Endoscopy

A “Back Light System” for Identification of Sites for Endoscopic Ultrasound-Guided Fine-Needle Aspiration in Solid Pancreatic Masses: A Prospective, Randomized Study with a Crossover Design: Ryo Harada, Hironari Kato, Soichiro Fushimi, Hirofumi Inoue, Daisuke Uchida, Yutaka Akimoto, Takeshi Tomoda, Kazuyuki Matsumoto, Yasuhiro Noma, Naoki Yamamoto, Shigeru Horiguchi, Koichiro Tsutsumi, Hiroyuki Okada; Clin Endosc 2019;52(4):334-339. Published online May 16, 2019; DOI: https://doi.org/10.5946/ce.2019.004

Background
/Aims: We applied a back light system (BLS) with a magnifying glass to improve the ability to assess the adequacy of specimen sampling using endosonography. We conducted this study to evaluate the efficacy of the BLS in sampling of specimens by endoscopic ultrasound-guided fine needle aspiration of solid pancreatic masses.
Methods
This was a prospective, randomized, crossover, single-center clinical trial. An endosonographer evaluated adequacy on gross visual inspection and identified whitish specimen sampling sites with and without the BLS according to a randomization sequence in the first and second passes with a 25-G needle. On cytological evaluation, the presence of well-defined pancreatic ductal epithelium was evaluated by a cytopathologist who was blinded to any clinical information.
Results
A total of 80 consecutive patients were eligible during the study period. Adequacy was observed for 52 specimens (65%) with the BLS and 54 (68%) without the BLS (p=0.88). In assessment of specimen adequacy on gross examination, only fair agreement was observed both with and without BLS (kappa score 0.40 and 0.29, respectively).
Conclusions
The BLS did not influence the ability to identify specimen sampling sites or reliable assessment of specimen site adequacy using gross visual inspection.

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Tissue processing of endoscopic ultrasound-guided fine-needle aspiration specimens from solid pancreatic lesions
Kenji Notohara, Kaori Nakamura
Journal of Medical Ultrasonics.2024; 51(2): 261. CrossRef
Macroscopic qualitative evaluation of solid pancreatic lesion specimens from endoscopic ultrasound-guided fine needle aspiration/biopsies
Kaori Nakamura, Kenji Notohara, Ryoji Nishizaki, Etsuji Ishida, Midori Sato, Akemi Kodera, Junya Itakura, Motowo Mizuno
Pancreatology.2023; 23(8): 1028. CrossRef
Unfortunately, a “Back Light System” As a Global Positioning System Failed to Guide the Route in 25-G Fine-Needle Aspiration
Rungsun Rerknimitr, Phonthep Angsuwatcharakon
Clinical Endoscopy.2019; 52(4): 295. CrossRef

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Diagnostic Ability of Convex-Arrayed Endoscopic Ultrasonography for Major Vascular Invasion in Pancreatic Cancer: Yuki Fujii, Kazuyuki Matsumoto, Hironari Kato, Yosuke Saragai, Saimon Takada, Sho Mizukawa, Shinichiro Muro, Daisuke Uchida, Takeshi Tomoda, Shigeru Horiguchi, Noriyuki Tanaka, Hiroyuki Okada; Clin Endosc 2019;52(5):479-485. Published online May 16, 2019; DOI: https://doi.org/10.5946/ce.2018.163

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Background
/Aims: This study aimed to examine the diagnostic ability of endoscopic ultrasonography (EUS) for major vascular invasion in pancreatic cancer and to evaluate the relationship between EUS findings and pathological distance.
Methods
In total, 57 consecutive patients who underwent EUS for pancreatic cancer before surgery were retrospectively reviewed. EUS image findings were divided into four types according to the relationship between the tumor and major vessel (types 1 and 2: invasion, types 3 and 4: non-invasion). We also compared the EUS findings and pathologically measured distances between the tumors and evaluated vessels.
Results
The sensitivity, specificity, and accuracy of EUS diagnosis for vascular invasion were 89%, 92%, and 91%, respectively, in the veins and 83%, 94%, and 93%, respectively, in the arteries. The pathologically evaluated distances of cases with type 2 EUS findings were significantly shorter than those of cases with type 3 EUS findings in both the major veins (median [interquartile range], 96 [0–742] µm vs. 2,833 [1,076–5,694] µm, p=0.012) and arteries (623 [0–854] µm vs. 3,097 [1,396–6,000] µm, p=0.0061). All cases with a distance of ≥1,000 µm between the tumors and main vessels were correctly diagnosed.
Conclusions
Tumors at a distance ≥1,000 µm from the main vessels were correctly diagnosed by EUS.

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Role of Endoscopic Ultrasound in Staging and Vascular Assessment of Pancreatic Cancer
Mohammed A El-Nady, Khalid A Ead, Mustafa A Haridy, Nour Shaheen, Abdulqadir J Nashwan, Saad R Abdelwahid, Mohammed F Mohammed, Omran Mohamed, Safwat S Sawy, Emad Abdelrazzak, Amro M Hassan
Cureus.2024;[Epub] CrossRef
The diagnostic accuracy of endoscopic ultrasound vs. contrast-enhanced computed tomography in local staging of pancreatic adenocarcinoma: a bi-national multicenter study
Wisam Sbeit, Mahmoud Salman, Abed Khalaileh, Ahmad Zoabi, Zakhar Bramnik, David Hovel, Mahmud Mahamid, Eran Israeli, Lior Katz, Reem Khoury, Nama Mubariki, Andrea Lisotti, Halim Awadie, Tawfik Khoury
European Journal of Gastroenterology & Hepatology.2023; 35(9): 974. CrossRef
Role of Endoscopic Ultrasound in Diagnosis of Pancreatic Ductal Adenocarcinoma
Abhirup Chatterjee, Jimil Shah
Diagnostics.2023; 14(1): 78. CrossRef
The expanding role of endoscopic ultrasound elastography
Jahnvi Dhar, Jayanta Samanta
Clinical Journal of Gastroenterology.2022; 15(5): 841. CrossRef
Experience of introduction of endoscopic ultrasonography into daily clinical practice in a surgical hospital
A.V. Zhdanov, E.G. Solonitsyn, E.A. Korymasov
Endoskopicheskaya khirurgiya.2020; 26(5): 24. CrossRef
Endoscopic Ultrasonography for Vascular Invasion in Pancreatic Cancer
Seong-Hun Kim
Clinical Endoscopy.2019; 52(5): 397. CrossRef

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Endoscopic Ultrasound-Guided Transgastric Drainage of an IntraAbdominal Abscess following Gastrectomy: Satoru Kikuchi, Tetsushi Kubota, Shinji Kuroda, Masahiko Nishizaki, Shunsuke Kagawa, Hironari Kato, Hiroyuki Okada, Toshiyoshi Fujiwara; Clin Endosc 2019;52(4):373-376. Published online February 15, 2019; DOI: https://doi.org/10.5946/ce.2018.134

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Endoscopic ultrasound (EUS)-guided transgastric drainage has been performed as a less invasive procedure for pancreatic fistulas and intra-abdominal abscesses occurring after surgery in recent years. However, there are no reports of EUS-guided transgastric drainage of intra-abdominal abscesses following gastrectomy. This case report describes 2 patients who developed an intra-abdominal abscess following gastrectomy and underwent EUS-guided transgastric drainage. Both patients underwent laparoscopy-assisted distal gastrectomy with Billroth-I reconstruction for gastric cancer. The intra-abdominal abscesses were caused by postoperative pancreatic fistula that developed following gastrectomy. One patient underwent naso-cystic drainage and the other underwent only a needle puncture of the abscess cavity. EUS-guided drainage was performed safely and effectively, although 1 patient developed gastroduodenal anastomotic leakage related to this procedure. In summary, EUS-guided transgastric drainage is safe and technically feasible even in post-gastrectomy patients. However, it is necessary to be careful if this procedure is performed in the early period following gastrectomy.

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A Case of Intra-abdominal Abcess following a Pancreatic Fistula after Gastrectomy Treated with Endoscopic Ultrasound-guided Transgastric Drainage
Kenichi ISHIBAYASHI, Toshikatsu TSUJI, Daisuke YAMAMOTO, Hirotaka KITAMURA, Shinichi KADOYA, Hiroyuki BANDO
Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association).2020; 81(6): 1097. CrossRef

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