Clinical Endoscopy

Reviews

Self-expandable metal vs. plastic stents for preoperative biliary drainage in patients receiving neoadjuvant chemotherapy: Takashi Tamura, Reiko Ashida, Yuki Kawaji, Masahiro Itonaga, Yasunobu Yamashita, Masayuki Kitano; Clin Endosc 2025;58(6):817-825. Published online July 30, 2025; DOI: https://doi.org/10.5946/ce.2025.045

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Neoadjuvant chemotherapy (NAC) improves the rate of curative resection and overall prognosis in patients with resectable or borderline resectable pancreatic cancer. The treatment period from the initiation of NAC to surgery typically ranges from 2 to 6 months. In cases of malignant biliary obstruction caused by pancreatic cancer, maintaining preoperative biliary drainage (PBD) until surgery is essential to continue NAC. Minimizing adverse events related to endoscopic biliary drainage and avoiding perioperative adverse events are crucial. Plastic stents (PSs) are commonly used for PBD; however, the extended duration of PBD required for NAC increases the risk of recurrent biliary obstruction (RBO), potentially leading to discontinuation of NAC. Therefore, preventing RBO during PBD in patients with pancreatic cancer receiving NAC is important. The placement of self-expandable metal stents (SEMSs) for PBD significantly reduces the rate of RBO compared with PS placement. Although SEMS placement may increase the risk of pancreatitis or cholecystitis, its effect on postoperative outcomes is comparable to that of PS placement. Given their lower rate of RBO, SEMSs are considered more suitable than PSs for PBD in patients with pancreatic cancer receiving NAC.

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Role of Endoscopy in Malignant Biliary Obstruction
Ishaan Vohra, Burraq Imran, Zubair Khan, Muhammad Hasan
Diagnostics.2026; 16(5): 721. CrossRef

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Role of contrast-enhanced harmonic endoscopic ultrasonography (EUS) and EUS elastography in pancreatic lesions: Yasunobu Yamashita, Masayuki Kitano; Clin Endosc 2024;57(2):164-174. Published online January 17, 2024; DOI: https://doi.org/10.5946/ce.2023.074

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Pancreatic cancers have a poor prognosis, and their incident rates have risen. Endoscopic ultrasonography (EUS) is an efficient and reliable diagnostic modality for pancreatic lesions, providing high spatial resolution. However, while EUS helps to detect minor pancreatic lesions, nearly all solid pancreatic lesions are hypoechoic, which creates difficulty in making differential diagnoses of pancreatic lesions. When diagnosing pancreatic lesions, the performance of image-enhanced EUS techniques is essential, such as EUS elastography or contrast-enhanced harmonic EUS (CH-EUS). CH-EUS diagnosis is based on assessing the vascularity of lesions, whereas tissue elasticity is measured via EUS elastography. Elastography is either strain or shear-wave, depending on the different mechanical properties being evaluated. The usefulness of enhanced EUS techniques is demonstrated in this review for the differential diagnosis of pancreatic lesions, including solid and cystic lesions, and pancreatic cancer staging.

Citations

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Contrast-Enhanced Harmonic Endoscopic Ultrasonography for Diagnosing Gastric Subepithelial Tumors
Moon Won Lee, Dong Chan Joo, Gwang Ha Kim, Bong Eun Lee, Hye Kyung Jeon
Diagnostics.2026; 16(1): 165. CrossRef
AI-Driven Breast Cancer Diagnosis: A Systematic Review of Imaging Modalities, Deep Learning, and Explainability
Margo Sabry, Hossam Magdy Balaha, Khadiga M. Ali, Ali Mahmoud, Dibson Gondim, Mohammed Ghazal, Tayseer Hassan A. Soliman, Ayman El-Baz
Cancers.2026; 18(8): 1305. CrossRef
The evolving landscape of EUS utilization in the management of pancreatic cystic neoplasms
Daniel Marino, Tamas A. Gonda
Pancreatology.2025; 25(3): 289. CrossRef
The impact of the novel EUS scope and ultrasonographic system for diagnosis and therapy in patients with pancreatobiliary diseases (videos)
Hiroyuki Kojima, Takao Itoi, Atsushi Sofuni, Takayoshi Tsuchiya, Reina Tanaka, Ryosuke Tonozuka, Shuntaro Mukai, Kenjiro Yamamoto, Yukitoshi Matsunami, Hirohito Minami
Journal of Hepato-Biliary-Pancreatic Sciences.2025; 32(7): 544. CrossRef
Technologies used in digestive endoscopy in diagnosis and treatment
Peter Slodička, Vít Navrátil, Vincent Dansou Zoundjiekpon, Lumír Kunovský
Medicína pro praxi.2025; 22(2): 111. CrossRef
Advances in endoscopic ultrasound-guided shear wave elastography: A comprehensive review of its clinical applications
Mattia Paratore, Sara Miliani, Giulia D’Acunzo, Nicholas Viceconti, Silvia Andaloro, Giuseppe Cerniglia, Fabrizio Mancuso, Elena Melita, Gianenrico Rizzatti, Antonio Gasbarrini, Laura Riccardi, Matteo Garcovich
World Journal of Gastroenterology.2025;[Epub] CrossRef
Endoscopic Contrast-Enhanced Ultrasound and Fine-Needle Aspiration or Biopsy for the Diagnosis of Pancreatic Solid Lesions: A Systematic Review and Meta-Analysis
Giorgio Esposto, Giuseppe Massimiani, Linda Galasso, Paolo Santini, Raffaele Borriello, Irene Mignini, Maria Elena Ainora, Alberto Nicoletti, Lorenzo Zileri Dal Verme, Antonio Gasbarrini, Sergio Alfieri, Giuseppe Quero, Maria Assunta Zocco
Cancers.2024; 16(9): 1658. CrossRef
Endoscopic Ultrasound and Gastric Sub-Epithelial Lesions: Ultrasonographic Features, Tissue Acquisition Strategies, and Therapeutic Management
Marzia Varanese, Marco Spadaccini, Antonio Facciorusso, Gianluca Franchellucci, Matteo Colombo, Marta Andreozzi, Daryl Ramai, Davide Massimi, Roberto De Sire, Ludovico Alfarone, Antonio Capogreco, Roberta Maselli, Cesare Hassan, Alessandro Fugazza, Alessa
Medicina.2024; 60(10): 1695. CrossRef
Endoscopic Ultrasound-Guided Pancreatic Tissue Sampling: Lesion Assessment, Needles, and Techniques
Jahnvi Dhar, Jayanta Samanta, Zaheer Nabi, Manik Aggarwal, Maria Cristina Conti Bellocchi, Antonio Facciorusso, Luca Frulloni, Stefano Francesco Crinò
Medicina.2024; 60(12): 2021. CrossRef

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Original Article

Rapid On-Site Evaluation by Endosonographers during Endoscopic Ultrasonography-Guided Fine-Needle Aspiration for Diagnosis of Gastrointestinal Stromal Tumors: Takashi Tamura, Yasunobu Yamashita, Kazuki Ueda, Yuki Kawaji, Masahiro Itonaga, Shin-ichi Murata, Kaori Yamamoto, Takeichi Yoshida, Hiroki Maeda, Takao Maekita, Mikitaka Iguchi, Hideyuki Tamai, Masao Ichinose, Jun Kato; Clin Endosc 2017;50(4):372-378. Published online January 20, 2017; DOI: https://doi.org/10.5946/ce.2016.083

Abstract PDF PubReader ePub

Background
/Aims: Endoscopic ultrasonography-guided fine-needle aspiration (EUS-FNA) has been used to diagnose gastrointestinal submucosal tumors (SMTs). Although rapid on-site evaluation (ROSE) has been reported to improve the diagnostic accuracy of EUS-FNA for pancreatic lesions, on-site cytopathologists are not routinely available. Given this background, the usefulness of ROSE by endosonographers themselves for pancreatic tumors has also been reported. However, ROSE by endosonographers for diagnosis of SMT has not been reported. The aim of this study was to evaluate the diagnostic accuracy of EUS-FNA with ROSE by endosonographers for SMT, focusing on diagnosis of gastrointestinal stromal tumor (GIST), compared with that of EUS-FNA alone.
Methods
Twenty-two consecutive patients who underwent EUS-FNA with ROSE by endosonographers for SMT followed by surgical resection were identified. Ten historical control subjects who underwent EUS-FNA without ROSE were used for comparison.
Results
The overall diagnostic accuracy for SMT was significantly higher in cases with than without ROSE (100% vs. 80%, p=0.03). The number of needle passes by FNA with ROSE by endosonographers tended to be fewer, although accuracy was increased (3.3±1.3 vs. 5.9±3.8, p=0.06).
Conclusions
ROSE by endosonographers during EUS-FNA for SMT is useful for definitive diagnosis, particularly for GIST.

Citations

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Practice Guidelines for the Diagnosis and Treatment of Subepithelial Lesion Observed in Upper Gastrointestinal Endoscopy
Beom Jin Kim, Seung Joo Kang, Su Youn Nam, Chang Seok Bang, Byung‐Hoon Min, Sung Eun Kim, Seung Young Kim, Hyunchul Lim, Chung Hyun Tae, Moon Won Lee, Seung Han Kim, Sang Hoon Kim, Jong Yeul Lee, Byung‐Wook Kim, Jeong Seop Moon, Jong‐Jae Park, Hwoon‐Yong
Journal of Gastroenterology and Hepatology.2026; 41(2): 488. CrossRef
Practice Guidelines for the Diagnosis and Treatment of Subepithelial Lesions Observed in Upper Gastrointestinal Endoscopy
Beom Jin Kim, Seung Joo Kang, Su Youn Nam, Chang Seok Bang, Byung-Hoon Min, Sung Eun Kim, Seung Young Kim, Hyunchul Lim, Chung Hyun Tae, Moon Won Lee, Seung Han Kim, Sang Hoon Kim, Jong Yeul Lee, Byung-Wook Kim, Jeong Seop Moon, Jong-Jae Park, Hwoon-Yong
The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2025; 25(3): 234. CrossRef
Expanding the horizon of diagnostic endosonograpy: the promise of trans-colorectal endoscopic ultrasound-guided fine-needle aspiration
Hao-Che Chang, Ping-Huei Tseng, Li-Chun Chang
Clinical Endoscopy.2025; 58(6): 859. CrossRef
Diagnostic yield of endoscopic and EUS-guided biopsy techniques in subepithelial lesions of the upper GI tract: a systematic review
Cynthia A. Verloop, Jacqueline A.C. Goos, Marco J. Bruno, Rutger Quispel, Lydi M.J.W. van Driel, Lieke Hol
Gastrointestinal Endoscopy.2024; 99(6): 895. CrossRef
Gastric glomus tumor on EUS-FNA-based cytology: clinicopathologic and immunohistochemical features of 4 cases, including 1 case with associated MIR143HG-NOTCH2 fusion gene
Sameer Chhetri Aryal, Sanam Husain, Ziying Zhang, Lisi Yuan
Journal of the American Society of Cytopathology.2023; 12(4): 296. CrossRef
EUS-Guided Diagnosis of Gastric Subepithelial Lesions, What Is New?
Thomas Vasilakis, Dimitrios Ziogas, Georgios Tziatzios, Paraskevas Gkolfakis, Eleni Koukoulioti, Christina Kapizioni, Konstantinos Triantafyllou, Antonio Facciorusso, Ioannis S. Papanikolaou
Diagnostics.2023; 13(13): 2176. CrossRef
A prospective randomized noninferiority trial comparing conventional smears and SurePathTM liquid-based cytology in endoscopic ultrasound-guided sampling of esophageal, gastric, and duodenal lesions
Jae Chang Jun, Sang Hyub Lee, Han Myung Lee, Sang Gyun Kim, Hyunsoo Chung, Joo Seong Kim, Namyoung Park, Jin Ho Choi, Yoonjin Kwak, Soo-Jeong Cho
Medicine.2023; 102(29): e34321. CrossRef
The Diagnosis of Small Gastrointestinal Subepithelial Lesions by Endoscopic Ultrasound-Guided Fine Needle Aspiration and Biopsy
Masanari Sekine, Takeharu Asano, Hirosato Mashima
Diagnostics.2022; 12(4): 810. CrossRef
A Pilot Study of Image-associative Teaching Versus Traditional Didactic Teaching for Novice Endosonographers Learning Cytopathology Effectively
Yi Chu, Wenyu LI, Min Luo, HongYi Zhu, Yi Sun, Xiaolin She, Jirong Huo, Yuqian Zhou
Techniques and Innovations in Gastrointestinal Endoscopy.2022; 24(4): 324. CrossRef
Diagnostic yield of EUS-TA for gastric submucosal epithelial lesions using rapid specimen evaluation under stereomicroscopy
Tetsuhiko Hirai, Junro Ishizaki, Hiroshi Imaizumi, Myontyori Kim, Yoichi Saegusa, Akinori Tamaki, Masafumi Watanabe, Hironori Masutani, Kosuke Okuwaki, Mitsuhiro Kida, Chika Kusano
Progress of Digestive Endoscopy.2022; 100(1): 63. CrossRef
Ki‐67 index assessment on FNA specimens of gastrointestinal stromal tumor: Correlation with mitotic rate and potential predictive value for risk stratification
Xi Wang, Rita Abi‐Raad, Haiming Tang, Guoping Cai
Cancer Cytopathology.2022; 130(12): 974. CrossRef
Recent Progress and Challenges in the Diagnosis and Treatment of Gastrointestinal Stromal Tumors
Toshirou Nishida, Shigetaka Yoshinaga, Tsuyoshi Takahashi, Yoichi Naito
Cancers.2021; 13(13): 3158. CrossRef
Optimal number of needle punctures in endoscopic ultrasound-guided fine-needle biopsy for gastric subepithelial lesions without rapid on-site evaluation
Masato Suzuki, Yusuke Sekino, Kunihiro Hosono, Kenichi Kawana, Hajime Nagase, Kensuke Kubota, Atsushi Nakajima
Journal of Medical Ultrasonics.2021; 48(4): 623. CrossRef
Methodological and Technical Aspects of EUS-Guided Fine Needle Aspiration of the Upper Digestive Tract Lesions
E. A. Godzhello, N. A. Bulganina, M. V. Khrustaleva
Experimental and Clinical Gastroenterology.2020; 174(4): 107. CrossRef
Challenging biliary strictures: pathophysiological features, differential diagnosis, diagnostic algorithms, and new clinically relevant biomarkers - part 1
Jean-Marc Dumonceau, Myriam Delhaye, Nicolas Charette, Annarita Farina
Therapeutic Advances in Gastroenterology.2020;[Epub] CrossRef
Mucosal incision‐assisted biopsy versus endoscopic ultrasound‐guided fine‐needle aspiration with a rapid on‐site evaluation for gastric subepithelial lesions: A randomized cross‐over study
Takashi Osoegawa, Yosuke Minoda, Eikichi Ihara, Keishi Komori, Akira Aso, Ayako Goto, Soichi Itaba, Haruei Ogino, Kazuhiko Nakamura, Naohiko Harada, Kosuke Makihara, Shinichi Tsuruta, Hidetaka Yamamoto, Yoshihiro Ogawa
Digestive Endoscopy.2019; 31(4): 413. CrossRef
Endoscopic Ultrasound-Guided Fine Needle Aspiration and Biopsy in Gastrointestinal Subepithelial Tumors
Gyu Young Pih, Do Hoon Kim
Clinical Endoscopy.2019; 52(4): 314. CrossRef
Rapid On-Site Evaluation of Fine-Needle Aspiration by Non-Cytopathologists: A Systematic Review and Meta-Analysis of Diagnostic Accuracy Studies for Adequacy Assessment
Lauren Pearson, Rachel E. Factor, Sandra K. White, Brandon S. Walker, Lester J. Layfield, Robert L. Schmidt
Acta Cytologica.2018; 62(4): 244. CrossRef
Is a Cytopathologist Always Needed during Endoscopic Ultrasonography-Guided Tissue Acquisition?
Moon Won Lee, Gwang Ha Kim
Clinical Endoscopy.2017; 50(4): 311. CrossRef
Endoscopic Evaluation and Management of Gastric Stromal Tumors
Kambiz Kadkhodayan, Ehsan Rafiq, Robert H. Hawes
Current Treatment Options in Gastroenterology.2017; 15(4): 691. CrossRef

10,916 View
236 Download
18 Web of Science
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