Clinical Endoscopy

Original Article

Touch imprint cytology for rapid on-site evaluation in endoscopic ultrasound-guided tissue acquisition of pancreatic tumors: diagnostic performance and practical value—a single-center retrospective observational study from Japan: Motoyasu Kan, Sodai Uchida, Taiga Sudo, Kouki Yokozuka, Yoshiki Nakaya, Akinori Abe, Hiroki Kurosaki, Yoshiki Ogane, Kazuki Watabe, Miho Sakai, Yu Sekine, Mayu Ouchi, Masayuki Yokoyama, Hiroshi Ohyama, Jun Kato; Received August 1, 2025 Accepted October 29, 2025 Published online January 29, 2026; DOI: https://doi.org/10.5946/ce.2025.264 [Epub ahead of print]

Graphical Abstract Abstract PDF Supplementary Material PubReader ePub: Background
/Aims: Among various specimen preparation techniques for rapid on-site evaluation (ROSE), touch imprint cytology (TIC) is widely used; however, its utility for pancreatic lesions has not been fully validated. This study aimed to evaluate the diagnostic performance of TIC-based ROSE during endoscopic ultrasound-guided tissue acquisition (EUS-TA) for pancreatic lesions.
Methods
This retrospective study included 385 patients who underwent EUS-TA for pancreatic lesions at a single center. ROSE using TIC was performed in 370 cases (96.1%). Diagnostic concordance between TIC-based ROSE and histology, as well as diagnostic accuracy relative to the final diagnosis, were assessed. The diagnostic performance of TIC was compared with that of spray cytology (SC) and instrument rinse cytology (IRC). Multivariate analysis was conducted to identify factors associated with discordance between TIC-based ROSE and histology.
Results
The concordance rate between TIC-based ROSE and histology was 85.1% (κ=0.575). For the final diagnosis, TIC-based ROSE demonstrated a sensitivity of 92.3%, specificity of 96.9%, and accuracy of 92.7%, showing superior diagnostic performance within the same workflow compared with SC and IRC. Smaller lesion size and the use of a 25-gauge needle were identified as independent factors for discordance.
Conclusions
TIC is a reliable ROSE technique in EUS-TA for pancreatic lesions, providing high diagnostic accuracy and a low inadequacy rate.

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Review

Endoscopic ultrasound-guided strain and shear wave elastography for pancreatic and liver diseases: Raymond S.Y. Tang, Ting Ting Chan; Received August 2, 2025 Accepted August 13, 2025 Published online January 5, 2026; DOI: https://doi.org/10.5946/ce.2025.258 [Epub ahead of print]

Abstract PDF PubReader ePub: Endoscopic ultrasound (EUS)-guided elastography is an advanced imaging technique designed to improve assessment of lesion characteristics and disease diagnosis. It allows real-time assessment of tissue stiffness and is currently available in the form of strain elastography (SE) and shear wave elastography (SWE). While EUS-guided SE has high sensitivity for diagnosing malignant solid pancreatic lesions, its specificity remains modest. SWE is a novel technology currently available on the EUS platform. Promising data have been reported on the utility of EUS-guided SWE in various diseases of the pancreas and liver. This review aims to discuss the applications of EUS-guided SE and SWE in pancreatic and liver diseases.

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Original Articles

Endoscopic ultrasound-guided plugged liver biopsy using a fine-needle biopsy needle and coils in patients with deranged coagulation parameters: proof of concept study for feasibility and safety from India: Biswa Ranjan Patra, Shubham Gupta, Yash Kallurwar, Chetan Saner, Sidharth Harindranath, Ankita Singh, Arun Vaidya, Michael Kuruthukulangara, Jitendra Yadav, Gaurav Lodha, Souradeep Pal, Akash Shukla; Received June 11, 2025 Accepted September 7, 2025 Published online December 23, 2025; DOI: https://doi.org/10.5946/ce.2025.188 [Epub ahead of print]

Graphical Abstract Abstract PDF PubReader ePub: Background
/Aims: Endoscopic ultrasound (EUS)-guided liver biopsy in patients with coagulopathy remains unexplored mainly because of the lack of effective hemostatic techniques in the event of post-biopsy bleeding. This study evaluated the feasibility and safety of a novel technique, EUS-guided plugged liver biopsy (EUS-PLB), which incorporates coil embolization for tract hemostasis.
Methods
In a pilot study, 20 patients with coagulopathy (platelets 20,000–50,000/μL or international normalized ratio 1.5–2.5) underwent EUS-PLB using a modified heparinized wet suction technique. Hemostasis was achieved via real-time EUS-guided deployment of 1 to 2 coils (35-5-3) into the needle tract. Outcomes included technical and clinical success, sample adequacy, and adverse events.
Results
Coil placement was technically successful in all patients. Persistent needle-tract bleeding occurred in five cases and was effectively controlled. The clinical success rate for preventing significant bleeding (early or delayed) was 100%. Adequate biopsy samples were obtained in 18/20 patients (90%), with a mean total specimen length of 3.34±0.88 cm and median complete portal tracts of 18 (range, 6–25). Histological diagnosis was possible in 95% of cases. One patient experienced a mild adverse event (5%).
Conclusions
This novel EUS-PLB technique with coil embolization may offer a safe and effective biopsy solution for patients with coagulopathy and warrants further investigation.

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The feasibility and safety of trans-colorectal endoscopic ultrasound-guided fine-needle aspiration: a retrospective study of Japan: Takashi Kondo, Kazuo Hara, Nozomi Okuno, Shin Haba, Takamichi Kuwahara, Hiroki Koda, Yoshitaro Yamamoto, Minako Urata, Keigo Oshiro, Tomoki Ogata, Ren Kuwabara, Indria Melianti, Yousik Myung, Adwoa Afrakoma Agyei-Nkansah; Clin Endosc 2025;58(6):890-897. Published online November 27, 2025; DOI: https://doi.org/10.5946/ce.2025.042

Graphical Abstract Abstract PDF PubReader ePub: Background
/Aims: Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is an effective diagnostic technique; however, few studies have evaluated the efficacy of trans-colorectal EUS-FNA. This study assessed the feasibility of trans-colorectal EUS-FNA.
Methods
We retrospectively analyzed 76 consecutive patients who underwent trans-colorectal EUS-FNA for pelvic lesions between January 2013 and September 2023.
Results
A total of 76 pelvic lesions were identified. The median number of EUS-FNA punctures was 3 (1–8). The median lesion size was 18.9 (8.2–100.0) mm. The success rate was 98.7% (75/76), with no reported adverse events. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of EUS-FNA were 94.3% (50/53), 100% (22/22), 100% (50/50), 88.0% (22/25), and 96.0% (72/75), respectively. Malignancy was initially suspected in 65 patients before EUS-FNA; however, 25 patients showed benign results. Of these, three were later reexamined and diagnosed with malignancy, three underwent surgery and were found to have benign pathology, and 19 avoided unnecessary surgery.
Conclusions
Trans-colorectal EUS-FNA is a safe and effective diagnostic procedure.

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Efficacy of primary endoscopic ultrasound-guided biliary drainage with the placement of multiple plastic stents in the management of hepaticojejunostomy stricture: a retrospective, single-center study in Japan: Mako Ushio, Toshio Fujisawa, Ko Tomishima, Yusuke Takasaki, Shigeto Ishii, Koichi Ito, Akinori Suzuki, Daisuke Namima, Sho Takahashi, Taito Fukuma, Hiroto Ota, Daishi Kabemura, Muneo Ikemura, Ippei Ikoma, Yasuhisa Jimbo, Haruka Hagiwara, Yusuke Yamaguchi, Takumi Okuaki, Shin Arii, Hiroyuki Isayama; Clin Endosc 2025;58(6):909-917. Published online November 6, 2025; DOI: https://doi.org/10.5946/ce.2025.006

Graphical Abstract Abstract PDF PubReader ePub: Background
/Aims: Hepaticojejunostomy strictures (HJSS), recurrent cholangitis, and jaundice are major complications of surgical hepaticojejunostomy. Previously, HJSS was managed using percutaneous procedures and balloon enteroscopy-assisted endoscopic retrograde cholangiopancreatography. However, endoscopic ultrasound-biliary drainage (EUS-BD) was recently reported to be an effective salvage procedure. EUS-BD as a primary drainage method using a trans-endosonographically created route (trans-ESCR) has not been previously evaluated.
Methods
We enrolled consecutive patients who underwent EUS-BD for HJSS at the Juntendo University Hospital between March 2017 and December 2022. After ESCR maturation, multiple plastic stents were placed for 1 year with or without cholangioscopic evaluation. We evaluated the technical and clinical success rates, stent removal, HJSS recurrence, and related adverse events.
Results
Thirty-seven patients required EUS-guided hepaticogastrostomy/hepaticojejunostomy (n=36/1). The technical and clinical success rates were 94.6% and 100.0%, respectively, and 17% of patients experienced adverse events. Cholangioscopy via ESCR was performed in 19 patients to evaluate the strictures and manage concomitant stones. The success rate of stent removal after multiple stent placements for more than 1 year was 83%.
Conclusions
Primary EUS-BD and trans-ESCR are feasible and effective in the management of HJSS. Further prospective studies are needed to confirm the results of this pilot study.

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A retrospective study on the comparative use of fine-needle biopsy and aspiration for the diagnosis and classification of malignant lymphoma in Japan: Fumitaka Niiya, Akihiro Nakamura, Yasuo Ueda, Takafumi Ogawa, Naoki Tamai, Masataka Yamawaki, Jun Noda, Tetsushi Azami, Yuichi Takano, Masatsugu Nagahama; Clin Endosc 2025;58(5):757-765. Published online May 27, 2025; DOI: https://doi.org/10.5946/ce.2024.320

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Background
/Aims: Endoscopic ultrasound-guided tissue acquisition (EUS-TA) is essential for diagnosing malignant lymphoma (ML). However, the optimal needle type for maximizing the diagnostic yield and tissue quality remains unclear. We compared the diagnostic performance and histological tissue quality between fine-needle biopsy (FNB) and fine-needle aspiration (FNA) needles in EUS-TA for ML.
Methods
This retrospective study included patients who underwent EUS-TA for suspected ML. The diagnostic accuracy, histological sample quality assessed by scoring, and adverse events were compared between the FNB and FNA groups. A subgroup analysis was performed for 22-gauge needles.
Results
FNB demonstrated higher diagnostic accuracy (75%) than FNA (50%) for cytology, with 100% sensitivity for histological diagnosis compared with 78.9% for FNA. The FNB group had significantly higher diagnostic rates for the World Health Organization subclassification of ML (71.4% vs. 31.6%, p=0.037). Additionally, FNB obtained superior histological quality, with 71.4% of samples scoring 5 compared with 41.2% in the FNA group. Adverse events were minimal in both groups.
Conclusions
EUS-FNB showed better diagnostic performance and histological tissue quality than EUS-FNA for ML, particularly in obtaining adequate samples for histological evaluation and subclassification. Therefore, EUS-FNB can be safely performed. Future research with larger sample sizes and genetic testing is warranted.

Citations

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Endoscopic Ultrasound as a Diagnostic Tool for the Mediastinum and Thorax
Sara Nikolic, Lucía Guilabert, Giuseppe Vanella, Catalina Vladut, Giuseppe La Mattina, Giuseppe Infantino, Elio D’Amore, Cecilie Siggaard Knoph, Giacomo Emanuele Maria Rizzo
Journal of Clinical Medicine.2025; 14(14): 4836. CrossRef
Refining the diagnostic strategy for malignant lymphoma: advantages of endoscopic ultrasound-guided fine-needle biopsy over aspiration
Kyong Joo Lee, Se Woo Park
Clinical Endoscopy.2025; 58(5): 701. CrossRef

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Systematic Review and Meta-Analysis

A systematic review on endoscopic ultrasound in gastric neuroendocrine neoplasms: guidelines outpacing evidence: Matteo Marasco, Gianluca Esposito, Marianna Signoretti, Maria Rinzivillo, Francesco Panzuto; Clin Endosc 2025;58(4):525-532. Published online April 24, 2025; DOI: https://doi.org/10.5946/ce.2024.343

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Background
/Aims: Gastric neuroendocrine neoplasms (g-NENs), though rare, have shown a rise in incidence due to increased endoscopic screening and improved diagnostic awareness. International guidelines recommend the use of endoscopic ultrasound (EUS) in managing g-NENs to evaluate subepithelial lesion size, depth, and lymph node involvement before endoscopic resection. However, the supporting evidence for EUS’s role in g-NENs is scarce and limited.
Methods
According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a comprehensive literature search was conducted on PubMed to identify studies about the role of EUS in g-NENs, including both retrospective and prospective human studies.
Results
A total of 355 studies were considered; however, only seven studies focusing on EUS’s diagnostic utility in g-NENs were selected, including only 44 patients. EUS showed promise in assessing tumor characteristics critical for endoscopic resection. Nevertheless, its diagnostic accuracy remained variable across lesion types, and its impact on clinical decision-making in g-NENs lacked robust evidence. EUS contributed to subepithelial lesion staging but was underrepresented in neuroendocrine tumor-specific studies, creating a knowledge gap.
Conclusions
This review underscores the need for larger multicenter studies to validate EUS’s efficacy and reliability in g-NEN management. Prospective trials are crucial to strengthen guidelines and provide clearer clinical guidance for managing these tumors.

Citations

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Step‐by‐Step Approach to the Incidental Diagnosis of Type I Gastric Neuroendocrine Tumors: Practical Insights
Laura Baldini, Elisabetta Dell'Unto, Maria Rinzivillo, Gianluca Esposito, Francesco Panzuto
JGH Open.2025;[Epub] CrossRef
Differences in Endoscopic Features of Gastric Neuroendocrine Tumor and Neuroendocrine Carcinoma From a Clinicopathological Perspective
Katsunori Matsueda, Noriya Uedo, Masanori Kitamura, Seiji Kawano, Motoyuki Otsuka
JGH Open.2025;[Epub] CrossRef

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Original Article

Predictive factors for the diagnosis of autoimmune pancreatitis using endoscopic ultrasound-guided tissue acquisition: a retrospective study in Japan: Keisuke Yonamine, Shinsuke Koshita, Yoshihide Kanno, Takahisa Ogawa, Hiroaki Kusunose, Toshitaka Sakai, Kazuaki Miyamoto, Fumisato Kozakai, Haruka Okano, Yuto Matsuoka, Kento Hosokawa, Hidehito Sumiya, Yutaka Noda, Kei Ito; Clin Endosc 2025;58(3):457-464. Published online March 28, 2025; DOI: https://doi.org/10.5946/ce.2024.238

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Background
/Aims: The factors affecting the detection rate of lymphoplasmacytic sclerosing pancreatitis (LPSP) using endoscopic ultrasound-guided tissue acquisition (EUS-TA) in patients with type 1 autoimmune pancreatitis (AIP) have not been thoroughly studied. Therefore, we conducted a retrospective study to identify the predictive factors for histologically detecting level 1 or 2 LPSP using EUS-TA.
Methods
Fifty patients with AIP were included in this study, and the primary outcome measures were the predictive factors for histologically detecting level 1 or 2 LPSP using EUS-TA.
Results
Multivariate analysis identified the use of fine needle biopsy (FNB) needles as a significant predictive factor for LPSP detection (odds ratio, 15.1; 95% confidence interval, 1.62–141; ¬¬p=0.017). The rate of good-quality specimens (specimen adequacy score ≥4) was significantly higher for the FNB needle group than for the fine needle aspiration (FNA) needle group (97% vs. 56%; p<0.01), and the FNB needle group required significantly fewer needle passes than the FNA needle group (median, 2 vs. 3; p<0.01).
Conclusions
The use of FNB needles was the most important factor for the histological confirmation of LPSP using EUS-TA in patients with type 1 AIP.

Citations

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A new era for autoimmune pancreatitis diagnosis: fine-needle biopsy outperforms fine-needle aspiration in endoscopic ultrasound-guided tissue acquisition
Gunn Huh, Tae Jun Song
Clinical Endoscopy.2025; 58(3): 406. CrossRef

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Systematic Review and Meta-analysis

Efficacy of endoscopic ultrasound-guided biliary drainage of malignant biliary obstruction: a systematic review and meta-analysis of randomized controlled trials: Yousaf Zafar, Hafsa Azam, Muhammad Abdullah Bin Azhar, Fabeeha Shaheen, Syed Sarmad Javaid, Laila Manzoor, Muaaz Masood, Rajesh Krishnamoorthi; Clin Endosc 2025;58(4):533-543. Published online February 24, 2025; DOI: https://doi.org/10.5946/ce.2024.183

Graphical Abstract Abstract PDF Supplementary Material PubReader ePub

Background
/Aims: Malignant biliary obstruction is a major clinical challenge. We assessed the efficacy of endoscopic ultrasound-guided biliary drainage (EUS-BD) compared with that of endoscopic retrograde cholangiopancreatography biliary drainage (ERCP-BD) or percutaneous transhepatic biliary drainage (PTBD).
Methods
We searched for randomized controlled trials comparing EUS-BD with ERCP or PTBD in treating malignant biliary obstruction. Using random-effects models, we synthesized risk ratios (RRs) and weighted mean differences (WMDs) with 95% confidence intervals (CIs). A subgroup analysis was performed using a comparator (ERCP or PTBD).
Results
EUS-BD significantly reduced the risk of stent dysfunction (RR, 0.46; 95% CI, 0.33–0.64), with consistent results in subgroup analysis for ERCP (RR, 0.54; 95% CI, 0.35–0.84) and PTBD (RR, 0.37; 95% CI, 0.22–0.61). It also lowered the risk of post-procedure pancreatitis (RR, 0.24; 95% CI, 0.07–0.83) and reduced tumor ingrowth or overgrowth risk (RR, 0.27; 95% CI, 0.11–0.65), even when compared to ERCP alone (RR, 0.28; 95% CI, 0.11–0.70). EUS-BD demonstrated a lower risk of adverse events compared to PTBD (RR, 0.37; 95% CI, 0.14–0.97) and reduced length of hospital stay (WMD, –1.03; 95% CI, –1.53 to –0.53) when compared to ERCP.
Conclusions
EUS-BD outperformed ERCP-BD and PTBD in reducing stent dysfunction, postprocedural pancreatitis, and tumor ingrowth or overgrowth.

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Biliary Drainage in Altered Anatomy: A Comprehensive Literature Review
Rishi Chowdhary, Jorge D. Machicado, Veeral M. Oza
Journal of Digestive Endoscopy.2026;[Epub] CrossRef
A Time-Based and Clinical Status Stratified Protocol for Major Bile Duct Injury After Cholecystectomy: Retrospective, Single-Center Outcomes From a Resource-Limited Setting
Ahmed Ateik, Saif A Ghabisha, Lamia Abdulmughni, Fares Awn
Cureus.2026;[Epub] CrossRef
Biliary Drainage During Neoadjuvant Chemotherapy in Pancreatic Cancer: Evidence and Practical Recommendations
Tadahisa Inoue, Masanao Nakamura, Kiyoaki Ito
Cancers.2026; 18(3): 467. CrossRef
Reply
Joan B. Gornals, Albert Sumalla-Garcia, Carme Loras
Clinical Gastroenterology and Hepatology.2025;[Epub] CrossRef

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Original Articles

In-room cytologic evaluation by trained endosonographer for determination of procedure end in endoscopic ultrasound-guided fine needle biopsy of solid pancreatic lesions: a prospective study in Taiwan: Weng-Fai Wong, Yu-Ting Kuo, Wern-Cherng Cheng, Chia-Tung Shun, Ming-Lun Han, Chieh-Chang Chen, Hsiu-Po Wang; Clin Endosc 2025;58(3):465-473. Published online December 12, 2024; DOI: https://doi.org/10.5946/ce.2024.143

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Background
/Aims: Endoscopic ultrasound-guided fine needle biopsy (EUS-FNB) is an essential tool for tissue acquisition in solid pancreatic tumors. Rapid on-site evaluation (ROSE) by cytologists ensures diagnostic accuracy. However, the universal application of the ROSE is limited by its availability. Therefore, we aimed to investigate the feasibility of determining the end of the procedure based on the results of in-room cytological evaluation by trained endosonographers (IRCETE).
Methods
A training course focusing on the cytological interpretation of common pancreatic tumors was provided to the three endosonographers. After training, the decision to terminate EUS-FNB was made based on IRCETE results. The diagnostic accuracy, concordance rate of diagnostic categories, and sample adequacy were compared with those determined by board-certified cytologists and macroscopic on-site evaluation (MOSE).
Results
We enrolled 65 patients with solid pancreatic tumors, most of whom were malignant (86.2%). The diagnostic accuracy was 90.8% when the end of the procedure was determined based on IRCETE, compared to 87.7% and 98.5% when determined by MOSE and cytologists, respectively (p=0.060). Based on the cytologists’ results, the accuracy of IRCETE in diagnostic category interpretation was 97.3%.
Conclusions
In the absence of ROSE, IRCETE can serve as a supplementary alternative to MOSE in determining the end of tissue sampling with a high accuracy rate.

Citations

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Diagnostic accuracy and sensitivity of the rapid on-site evaluation (ROSE) versus macroscopic on-site evaluation (MOSE) in endoscopic ultrasound (EUS)-guided sampling: a systematic review
Eyad Gadour, Bogdan Miutescu, Sarah Al Ghamdi, Calin Burciu, Hossam Shaaban, Deiana Vuletici, Aymen Almuhaidb, Iulia Ratiu, Emad Aljahdli, Hussein Okasha
Frontline Gastroenterology.2025; 16(6): 489. CrossRef

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Efficacy and safety of endoscopic ultrasound-guided hepaticogastrostomy for biliary drainage in hypervascular hepatocellular carcinoma: a retrospective study from Japan: Kenneth Tachi, Kazuo Hara, Nozomi Okuno, Shin Haba, Takamichi Kuwahara, Toshitaka Fukui, Ahmed Mohammed Sadek, Hossam El-Din Shaaban Mahmoud Ibrahim, Minako Urata, Takashi Kondo, Yoshitaro Yamamoto; Clin Endosc 2025;58(3):448-456. Published online November 11, 2024; DOI: https://doi.org/10.5946/ce.2024.079

Graphical Abstract Abstract PDF PubReader ePub: Background
/Aims: Biliary obstruction drainage in patients with hepatocellular carcinoma (HCC) is associated with symptom palliation, improved access to chemotherapy, and improved survival. Stent placement and exchange via endoscopic retrograde cholangiopancreatography biliary drainage risk traversing the HCC, a hypervascular tumor and causing bleeding. Endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) potentially prevents procedure-related bleeding. Therefore, we evaluated the efficacy and safety of EUS-HGS as an alternative treatment for biliary obstruction in patients with HCC.
Methods
This was a retrospective study of all EUS-HGS procedures performed in patients with HCC at the Aichi Cancer Center Hospital, Japan, from February 2017 to August 2023.
Results
A total of 14 EUS-HGS procedures (42.9% primary) were attempted in 10 HCC patients (mean age 71.5 years, 80.0% male). Clinical and technical success rates were 92.9% and 90.9%, respectively. The observed procedure details in the 13 successful procedures included B3 puncture (53.8%), 22-G needle (53.8%), fully covered self-expandable metal stent (100%), and mean procedure time (32.7 minutes). There was no bleeding. Mild complications occurred in 27.3%. All patients resumed oral intake within 24 hours.
Conclusions
EUS-HGS is a technically feasible and clinically effective initial or salvage drainage option for the treatment of biliary obstruction in patients with HCC.

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Review

Endoscopic biliary drainage for distal bile duct obstruction due to pancreatic cancer: Masahiro Itonaga, Masayuki Kitano; Clin Endosc 2025;58(1):40-52. Published online September 26, 2024; DOI: https://doi.org/10.5946/ce.2023.294

Abstract PDF PubReader ePub

Approximately 60% of pancreatic cancers occur in the pancreatic head and may present as obstructive jaundice due to bile duct invasion. Obstructive jaundice often leads to poor general conditions and acute cholangitis, interfering with surgery and chemotherapy and requiring biliary drainage. The first choice of treatment for biliary drainage is the endoscopic transpapillary approach. In unresectable tumors, self-expandable metal stents (SEMSs) are most commonly used and are classified into uncovered and covered SEMSs. Recently, antireflux metal stents and large- or small-diameter SEMSs have become commercially available, and their usefulness has been reported. Plastic stents are infrequently used in patients with resectable biliary obstruction; however, owing to the recent trend in preoperative chemotherapy, SEMSs are frequently used because of the long time to recurrent biliary obstruction. Endoscopic ultrasound-guided biliary drainage (EUS-BD) is often performed in patients who are not eligible for the transpapillary approach, and favorable outcomes have been reported. Different EUS-BD techniques and specialized stents have been developed and can be safely used in high-volume centers. The indications for EUS-BD are expected to further expand in the future.

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Comparative Evaluation of Percutaneous Transhepatic Biliary Drainage and Endoscopic Ultrasound‐Guided Biliary Drainage for Preoperative Management of Malignant Distal Bile Duct Obstruction After Failed ERCP: A Multicenter Retrospective Analysis
Masahiro Itonaga, Mamoru Takenaka, Hideyuki Shiomi, Koh Kitagawa, Shuhei Shintani, Hirotsugu Maruyama, Ryota Sagami, Tsukasa Ikeura, Takeshi Ogura, Yusuke Ishida, Koichiro Mandai, Satoshi Sugimori, Yoshiki Imamura, Atsuhiro Masuda, Kenji Ikezawa, Atsushi
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Yang Liu, Yongfeng Li, Heng Ma, Shichang Deng, Chao Cheng
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Silvia Cocca, Flavia Pigò, Helga Bertani, Roberta Rea, Giuseppina Pontillo, Michele Campigotto, Giuseppe Grande, Salvatore Russo, Margherita Marocchi, Marinella Lupo, Gian Maria Prati, Giovanni Aragona, Raffaele Manta, Carmelo Barbera, Fabio Monica, Franc
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Comparison of approaches: multiple plastic versus single plastic biliary stenting
E.N. Solodinina, N.S. Politov
Russian Journal of Evidence-Based Gastroenterology.2026; 15(1): 37. CrossRef
Balloon Enteroscopy‐Assisted ERCP Versus Endoscopic Ultrasound‐Guided Biliary Drainage for Unresectable Malignant Biliary Obstruction in Patients With Surgically Altered Anatomy: A Multicenter Prospective Registration Study
Masahiro Itonaga, Mamoru Takenaka, Kenji Ikezawa, Tsukasa Ikeura, Masaaki Shimatani, Masanori Asada, Nao Fujimori, Ryota Sagami, Takeshi Ogura, Hajime Imai, Kazuyuki Matsumoto, Shuhei Shintani, Hideyuki Shiomi, Keiichi Hatamaru, Kosuke Minaga, Ryoji Takad
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Reiko Yamada, Tetsuro Miwata, Yoshifumi Nakamura, Kenji Nose, Takamitsu Tanaka, Hirono Owa, Minako Urata, Yasuaki Shimada, Hayato Nakagawa
Cancers.2025; 17(16): 2644. CrossRef
Successful conversion of percutaneous transhepatic gallbladder drainage to endoscopic ultrasound-guided hepaticogastrostomy combined with antegrade stenting for a malignant distal biliary obstruction due to invasive intraductal papillary mucinous carcinom
Taiji Yoshimoto, Takeshi Takajo, Hiroshi Takihara, Ryuichi Yamamoto
Journal of Medical Case Reports.2025;[Epub] CrossRef
Adverse Events of EUS‐Guided Biliary Drainage for Malignant Biliary Obstruction: A Large Multicenter Study
Masahiro Itonaga, Takeshi Ogura, Mamoru Takenaka, Kazuyuki Matsumoto, Hideyuki Shiomi, Shuhei Shintani, Hideki Kamada, Taro Yamashita, Koichiro Mandai, Masanori Asada, Hajime Imai, Kotaro Takeshita, Tsukasa Ikeura, Nao Fujimori, Makiko Kinoshita, Kenji Ik
Journal of Hepato-Biliary-Pancreatic Sciences.2025;[Epub] CrossRef

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Original Articles

Endoscopic ultrasound-guided hepaticogastrostomy and endoscopic retrograde cholangiopancreatography-guided biliary drainage for distal malignant biliary obstruction due to pancreatic cancer with asymptomatic duodenal invasion: a retrospective, single-center study in Japan: Naminatsu Takahara, Yousuke Nakai, Kensaku Noguchi, Tatsunori Suzuki, Tatsuya Sato, Ryunosuke Hakuta, Kazunaga Ishigaki, Tomotaka Saito, Tsuyoshi Hamada, Mitsuhiro Fujishiro; Clin Endosc 2025;58(1):134-143. Published online August 23, 2024; DOI: https://doi.org/10.5946/ce.2024.031

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Background
/Aims: Duodenal invasion (DI) is a risk factor for early recurrent biliary obstruction (RBO) in endoscopic retrograde cholangiopancreatography-guided biliary drainage (ERCP-BD). Endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) may reduce early RBO in cases of asymptomatic DI, even when ERCP is possible.
Methods
We enrolled 56 patients with pancreatic cancer and asymptomatic DI who underwent EUS-HGS (n=25) or ERCP-BD (n=31). Technical and clinical success, early (<3 months) and overall RBO rates, time to RBO (TRBO), and adverse events were compared between the EUS-HGS and ERCP-BD groups. Risk factors for early RBO were also evaluated.
Results
Baseline characteristics were similar between the groups. Both procedures demonstrated 100% technical and clinical success rates, with a similar incidence of adverse events (48% vs. 39%, p=0.59). While the median TRBO was comparable (5.7 vs. 8.8 months, p=0.60), EUS-HGS was associated with a lower incidence of early RBO compared to ERCP-BD (8% vs. 29%, p=0.09). The major causes of early RBO in ERCP-BD were sludge and food impaction, rarely occurring in EUS-HGS. EUS-HGS was potentially reduced early RBO (odds ratio, 0.32; p=0.07).
Conclusions
EUS-HGS can be a viable option for treating pancreatic cancer with asymptomatic DI.

Citations

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Tsuyoshi Takeda, Takashi Sasaki, Tatsuki Hirai, Yoichiro Sato, Yuri Maegawa, Takafumi Mie, Takaaki Furukawa, Yukari Suzuki, Takeshi Okamoto, Masato Ozaka, Naoki Sasahira
DEN Open.2026;[Epub] CrossRef
Impact of Peri‐Procedural Antibiotics on Post‐ERCP Infectious Adverse Events With Distal Malignant Biliary Obstruction
Tatsunori Satoh, Haruna Takahashi, Eiji Nakatani, Yosuke Kobayashi, Fumitaka Niiya, Junichi Kaneko, Kazuma Ishikawa, Kenta Ito, Tetsushi Azami, Jun Noda, Shinya Kawaguchi
Journal of Gastroenterology and Hepatology.2026; 41(2): 696. CrossRef
Endoscopic Ultrasound‐Guided Hepaticogastrostomy With Plastic Stents in Comparison to Transpapillary Drainage With Metallic Stents for Unresectable Malignant Distal Biliary Obstructions
Hidehito Sumiya, Yoshihide Kanno, Shinsuke Koshita, Takahisa Ogawa, Hiroaki Kusunose, Toshitaka Sakai, Keisuke Yonamine, Kazuaki Miyamoto, Fumisato Kozakai, Haruka Okano, Kento Hosokawa, Shun Nozaki, Kei Ito
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Biliary drainage in pancreatic cancer with duodenal invasion: which route is the best?
Tanyaporn Chantarojanasiri, Thawee Ratanachu-Ek
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EUS-Guided Gallbladder Drainage of Inoperable Malignant Distal Biliary Obstruction by Lumen-Apposing Metal Stent: Systematic Review and Meta-Analysis
Tawfik Khoury, Moaad Farraj, Wisam Sbeit, Pietro Fusaroli, Giovanni Barbara, Cecilia Binda, Carlo Fabbri, Maamoun Basheer, Sarah Leblanc, Fabien Fumex, Rodica Gincul, Anthony Yuen Bun Teoh, Jérémie Jacques, Bertrand Napoléon, Andrea Lisotti
Cancers.2025; 17(12): 1983. CrossRef
Primary Endoscopic Ultrasound-Guided Biliary Drainage for Malignant Biliary Obstruction
Yousuke Nakai, Ryunosuke Hakuta, Ryota Nakabayashi, Yutaka Shimamatsu, Nao Otsuka, Yukiko Takayama
The Korean Journal of Pancreas and Biliary Tract.2025; 30(4): 159. CrossRef

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Hepatobiliary scintigraphy of bile excretion after endoscopic ultrasound-guided hepaticogastrostomy for malignant biliary obstruction: a retrospective study in Japan: Masanori Yamada, Kazuo Hara, Shin Haba, Takamichi Kuwahara, Nozomi Okuno, Yasuhiro Kuraishi, Takafumi Yanaidani, Sho Ishikawa, Tsukasa Yasuda, Toshitaka Fukui; Clin Endosc 2024;57(6):798-806. Published online August 20, 2024; DOI: https://doi.org/10.5946/ce.2023.291

Graphical Abstract Abstract PDF Supplementary Material PubReader ePub: Background
/Aims: Hepatobiliary scintigraphy (HBS) is used to evaluate bile excretion. This study aimed to evaluate biliary excretion during endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) using HBS.
Methods
We retrospectively evaluated 78 consecutive patients with malignant extrahepatic biliary obstruction, who underwent HBS after EUS-HGS between April 2015 and July 2022. The peak time and decay rate were scored with 0, 1, or 2 points based on thresholds of 20 and 35 minutes, and 10% and 50%, respectively. A total score of 4 or 3 was considered indicative of good bile excretion, whereas scores of 2, 1, or 0 indicated poor bile excretion.
Results
The good and poor bile excretion groups included 40 and 38 cases, respectively. The group with good bile excretion had a significantly longer time to recurrent biliary obstruction compared to the poor bile excretion group (not reached vs. 124 days, p=0.026). Multivariate analysis identified the site of obstruction as a significant factor influencing good bile excretion (odds ratio, 3.39; 95% confidence interval, 1.01–11.4, p=0.049), with superior bile excretion observed in cases involving upper biliary obstruction compared to middle or lower biliary obstruction.
Conclusions
In patients with malignant biliary obstruction who underwent HGS, the site of obstruction is significantly associated with stent patency.

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Evaluation of cryoablation using a prototype cryoablation needle in swine liver: Hyunjoon Son, Jonghyun Lee, Sung Yong Han, Tae In Kim, Dong Uk Kim, Daejin Kim, Gun-Ho Kim; Clin Endosc 2024;57(5):675-682. Published online July 29, 2024; DOI: https://doi.org/10.5946/ce.2024.024

Graphical Abstract Abstract PDF PubReader ePub: Background
/Aims: Pancreatic cancer poses significant challenges due to its tendency for late-stage diagnosis and high mortality rates. Cryoablation, a technique used to treat various types of cancer, has shown potential in enhancing the prognosis of pancreatic cancer when combined with other therapies. However, its implementation is often limited by the need for lengthy procedures and specialized equipment. This study aims to develop a cryoablation needle optimized for endoscopic ultrasonography to simplify its application in treating pancreatic cancer.
Methods
The study involved conducting cryoablation experiments on swine liver tissue. It utilized cryo-needles to evaluate the extent of cell death across various temperatures and durations of cryoablation.
Results
The cryoablation system, which employed liquid carbon dioxide, achieved rapid cooling, reaching temperatures below –60 °C within 30 seconds and maintained the cryoablation process for 200 seconds. These conditions resulted in necrosis of the liver tissue. Notable cellular changes were observed up to 15 mm away from the cryoablation needle.
Conclusions
This experimental study successfully demonstrated the efficacy of using a cryo-needle for cryoablation in swine liver tissue. Further trials involving pancreatic tissue are expected to verify its effectiveness, underscoring the importance of continued research to establish its role as a complementary therapy in pancreatic cancer treatment.

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Puncture angle on an endoscopic ultrasound image is independently associated with unsuccessful guidewire manipulation of endoscopic ultrasound-guided hepaticogastrostomy: a retrospective study in Japan: Akihisa Ohno, Nao Fujimori, Toyoma Kaku, Kazuhide Matsumoto, Masatoshi Murakami, Katsuhito Teramatsu, Keijiro Ueda, Masayuki Hijioka, Akira Aso, Yoshihiro Ogawa; Clin Endosc 2024;57(5):656-665. Published online July 26, 2024; DOI: https://doi.org/10.5946/ce.2023.244

Graphical Abstract Abstract PDF Supplementary Material PubReader ePub

Background
/Aims: Although endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) is performed globally, the procedure remains challenging. Guidewire manipulation is the most difficult step, and there are few reports on the factors associated with unsuccessful guidewire manipulation. This study aimed to assess the significance of the puncture angle on EUS images and identify the most effective guidewire rescue method for patients with unsuccessful guidewire manipulation.
Methods
We retrospectively enrolled 115 patients who underwent EUS-HGS between May 2016 and April 2022 at two centers. The puncture angle between the needle and the intrahepatic bile duct was measured through EUS movie records.
Results
Guidewire manipulation was unsuccessful in 28 patients. Receiver operating characteristic (ROC) curves identified an optimal puncture angle cutoff value of 85° (cutoff value, 85°; area under the ROC curve, 0.826; sensitivity, 85.7%; specificity, 81.6%). Multivariate analysis demonstrated that a puncture angle <85° was a significant risk factor for unsuccessful guidewire manipulation (odds ratio, 19.8; 95% confidence interval, 6.42–61.5; p<0.001). Among the 28 unsuccessful cases, 24 patients (85.7%) achieved successful guidewire manipulation using various rescue methods.
Conclusions
The puncture angle observed on EUS is crucial for guidewire manipulation. A puncture angle of <85° was associated with unsuccessful guidewire manipulation.

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Backward leap technique using a novel 0.018-inch guidewire
Kosuke Takahashi, Eisuke Ozawa, Yasuhiko Nakao, Masanori Fukushima, Hisamitsu Miyaaki, Kazuhiko Nakao
Endoscopy.2025; 57(S 01): E90. CrossRef
The Role and Appropriate Selection of Guidewires in Biliopancreatic Endoscopy
Daniele Alfieri, Claudia Delogu, Stefano Mazza, Aurelio Mauro, Erica Bartolotta, Alessandro Cappellini, Davide Scalvini, Francesca Torello Viera, Marco Bardone, Andrea Anderloni
Medicina.2025; 61(5): 913. CrossRef
Consensus document for the transcystic approach to choledocholithiasis with ultrathin flexible choledochoscope
Alejandra García-Botella, Juan Pablo Arjona Trujillo, Sofía de la Serna, Pedro José Gil Vázquez, Santos Jiménez-Galanes Marchán, Erik Llàcer-Millán, Ana Belén Martín Arnau, David Martínez-Cecilia, Alba Zárate Pinedo, Alberto Martínez-Isla
Cirugía Española (English Edition).2025; : 800259. CrossRef

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Review

Endoscopic ultrasound-guided needle-based confocal laser endomicroscopy for pancreatic cystic lesions: current status and future prospects: Clement Chun Ho Wu, Samuel Jun Ming Lim, Damien Meng Yew Tan; Clin Endosc 2024;57(4):434-445. Published online July 8, 2024; DOI: https://doi.org/10.5946/ce.2023.157

Abstract PDF PubReader ePub

Pancreatic cystic lesions (PCLs) have increased in prevalence due to the increased usage and advancements in cross-sectional abdominal imaging. Current diagnostic techniques cannot distinguish between PCLs requiring surgery, close surveillance, or expectant management. This has increased the morbidity and healthcare costs from inappropriately aggressive and conservative management strategies. Endoscopic ultrasound (EUS) needle-based confocal laser endomicroscopy (nCLE) allows for microscopic examination and delineation of the surface epithelium of PCLs. Landmark studies have identified characteristics distinguishing various types of PCLs, confirmed the high diagnostic yield of EUS-nCLE (especially for PCLs with an equivocal diagnosis), and shown that EUS-nCLE helps to change management and reduce healthcare costs. Refining procedure technique and reducing procedure length have improved the safety of EUS-nCLE. The utilization of artificial intelligence and its combination with other EUS-based advanced diagnostic techniques would further improve the results of EUS-based PCL diagnosis. A structured training program and device improvements to allow more complete mapping of the pancreas cyst epithelium will be crucial for the widespread adoption of this promising technology.

Citations

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Recent Advances in Endoscopic Ultrasound (EUS) for Pancreatic Cystic Lesions
Veeral M. Oza, Anuroop Yekula, Truptesh H. Kothari
Journal of Digestive Endoscopy.2026;[Epub] CrossRef
Endoscopic techniques for the diagnosis of pancreatic cystic lesions
Sahib Singh, Saurabh Chandan, Rakesh Vinayek, Jahnvi Dhar, Jayanta Samanta, Gabriele Capurso, Ivo Boskoski, Cristiano Spada, Jorge D Machicado, Stefano Francesco Crinò, Antonio Facciorusso
World Journal of Gastroenterology.2025;[Epub] CrossRef
Endoscopic ultrasound through-the-needle biopsy of pancreatic cystic neoplasms: Update on indications, safety profile, and research directions
Joana Mota, Tiago Ribeiro, Maria Cristina Conti Bellocchi, Nicolò De Pretis, Luca Frulloni, Joanne Lopes, Sokol Sina, Jahnvi Dhar, Jayanta Samanta, Guilherme Macedo, Filipe Vilas-Boas, Stefano Francesco Crinò
Best Practice & Research Clinical Gastroenterology.2025; : 102058. CrossRef
Pathognomonic Signs in Pancreatic Cystic Lesions: What Gastroenterologists and Involved Clinicians Need to Know
Alberto Martino, Luca Barresi, Francesco Paolo Zito, Michele Amata, Roberto Fiorentino, Severo Campione, Alessandro Iacobelli, Enrico Crolla, Roberto Di Mitri, Carlo Molino, Marco Di Serafino, Giovanni Lombardi
Gastroenterology Insights.2024; 15(3): 810. CrossRef

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Original Articles

Effectiveness of endoscopic ultrasound-guided tissue acquisition with stereomicroscopic on-site evaluation for preoperative diagnosis of resectable or borderline resectable pancreatic cancer: a prospective study: Junro Ishizaki, Kosuke Okuwaki, Masafumi Watanabe, Hiroshi Imaizumi, Tomohisa Iwai, Rikiya Hasegawa, Takahiro Kurosu, Masayoshi Tadehara, Takaaki Matsumoto, Kai Adachi, Taro Hanaoka, Mitsuhiro Kida, Chika Kusano; Clin Endosc 2024;57(6):807-813. Published online May 24, 2024; DOI: https://doi.org/10.5946/ce.2023.277

Graphical Abstract Abstract PDF PubReader ePub

Background
/Aims: To validate endoscopic ultrasound-guided tissue acquisition (EUS-TA) used in conjunction with stereomicroscopic on-site evaluation (SOSE) as a preoperative diagnostic tool for resectable pancreatic cancer (R-PC) and borderline resectable PC (BR-PC).
Methods
Seventy-eight consecutive patients who underwent EUS-TA for suspected R-PC or BR-PC were enrolled. The primary endpoint was the sensitivity of EUS-TA together with SOSE based on the stereomicroscopically visible white core (SVWC) cutoff value. One or two sites were punctured by using a 22-gauge biopsy needle for EUS-TA, based on the SOSE findings.
Results
We collected 99 specimens from 56 and 22 patients with R-PC and BR-PC, respectively. Based on the SOSE results, we performed 57 procedures with one puncture. The SVWC cutoff values were met in 73.7% and 73.1% of all specimens and in those obtained during the first puncture, respectively. The final diagnoses were malignant and benign tumors in 76 and two patients, respectively. The overall sensitivity, specificity, and accuracy of EUS-TA for the 78 lesions were 90.8%, 100%, and 91.0%, respectively. The sensitivity for malignant diagnosis based on the SVWC cutoff value were 89.5% and 90.4% for the first puncture and all specimens, respectively.
Conclusions
The sensitivity of EUS-TA in conjunction with SOSE for malignancy diagnosis in patients with suspected R-PC or BR-PC was 90.4%.

Citations

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A case of needle tract seeding of pancreatic adenosquamous carcinoma after a single endoscopic ultrasound-guided tissue acquisition
Taro Hanaoka, Kosuke Okuwaki, Nobuyuki Nishizawa, Masafumi Watanabe, Kai Adachi, Akihiro Tamaki, Tomohisa Iwai, Mitsuhiro Kida, Yusuke Kumamoto, Chika Kusano
Clinical Journal of Gastroenterology.2025; 18(1): 234. CrossRef

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Clinical utility of endoscopic ultrasound-guided tissue acquisition for comprehensive genomic profiling of patients with biliary tract cancer, especially with intrahepatic cholangiocarcinoma: Takafumi Yanaidani, Kazuo Hara, Nozomi Okuno, Shin Haba, Takamichi Kuwahara, Yasuhiro Kuraishi, Nobumasa Mizuno, Sho Ishikawa, Masanori Yamada, Tsukasa Yasuda; Clin Endosc 2024;57(3):384-392. Published online February 15, 2024; DOI: https://doi.org/10.5946/ce.2023.139

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Background
/Aims: Endoscopic ultrasound-guided tissue acquisition (EUS-TA) is a standard diagnostic method for biliary tract cancer (BTC), and samples obtained in this manner may be used for comprehensive genomic profiling (CGP). This study evaluated the utility of EUS-TA for CGP in a clinical setting and determined the factors associated with the adequacy of CGP in patients with BTC.
Methods
CGP was attempted for 105 samples from 94 patients with BTC at the Aichi Cancer Center, Japan, from October 2019 to April 2022.
Results
Overall, 77.1% (81/105) of the samples were adequate for CGP. For 22-G or 19-G fine-needle biopsy (FNB), the sample adequacy was 85.7% (36/42), which was similar to that of surgical specimens (94%, p=0.45). Univariate analysis revealed that 22-G or larger FNB needle usage (86%, p=0.003), the target primary lesions (88%, p=0.015), a target size ≥30 mm (100%, p=0.0013), and number of punctures (90%, p=0.016) were significantly positively associated with CGP sample adequacy.
Conclusions
EUS-TA is useful for CGP tissue sampling in patients with BTC. In particular, the use of 22-G or larger FNB needles may allow for specimen adequacy comparable to that of surgical specimens.

Citations

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Adequacy evaluation of 22‐gauge needle endoscopic ultrasound‐guided tissue acquisition samples and glass slides preparation for successful comprehensive genomic profiling testing: A single institute experience
Tami Nagatani, Yoji Wani, Masahiro Takatani, Soichiro Fushimi, Hirofumi Inoue, Shinichiro Hori, Kyohei Kai, Hideki Yamamoto, Tetsuya Okazaki, Maki Tanioka, Hiroyuki Okada, Akira Hirasawa
DEN Open.2026;[Epub] CrossRef
Tissue-preserving sectioning as the tip of comprehensive genomic profiling testing using biliary tract cancer tissue obtained by 22-gauge endoscopic ultrasound tissue acquisition
Yoji Wani, Tami Nagatani, Masahiro Takatani
Clinical Endoscopy.2026; 59(1): 160. CrossRef
A rare case of needle tract seeding following endoscopic ultrasound‐guided tissue acquisition for cholangiocarcinoma
Tatsunori Satoh, Haruna Takahashi, Shinya Kawaguchi
Journal of Hepato-Biliary-Pancreatic Sciences.2025;[Epub] CrossRef
Enhancing comprehensive genome profiling of liver tumors using endoscopic ultrasound-guided fine-needle biopsy
Fumitaka Niiya, Akihiro Nakamura, Yasuo Ueda, Takafumi Ogawa, Naoki Tamai, Masataka Yamawaki, Jun Noda, Tetsushi Azami, Yuichi Takano, Masatsugu Nagahama
Endoscopy International Open.2025;[Epub] CrossRef
Recent Advances in Endoscopic Ultrasound-Guided Tissue Acquisition
Panotpol Termsinsuk, Nonthalee Pausawasdi
Journal of Digestive Endoscopy.2025;[Epub] CrossRef
Is genomic analysis possible in a tissue acquired via endoscopic ultrasound-guided fine-needle biopsy in cholangiocarcinoma?
Jonghyun Lee, Sung Yong Han
Clinical Endoscopy.2024; 57(3): 332. CrossRef
Utility of Transpapillary Biopsy and Endoscopic Ultrasound-Guided Tissue Acquisition for Comprehensive Genome Profiling of Unresectable Biliary Tract Cancer
Soma Fukuda, Susumu Hijioka, Yoshikuni Nagashio, Daiki Yamashige, Daiki Agarie, Yuya Hagiwara, Kohei Okamoto, Shin Yagi, Yasuhiro Komori, Masaru Kuwada, Yuta Maruki, Chigusa Morizane, Hideki Ueno, Nobuyoshi Hiraoka, Kiichiro Tsuchiya, Takuji Okusaka
Cancers.2024; 16(16): 2819. CrossRef
Endoscopic Ultrasound and Intraductal Ultrasound in the Diagnosis of Biliary Tract Diseases: A Narrative Review
Akiya Nakahata, Yasunobu Yamashita, Masayuki Kitano
Diagnostics.2024; 14(18): 2086. CrossRef

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22-gauge Co-Cr versus stainless-steel Franseen needles for endoscopic ultrasound-guided tissue acquisition in patients with solid pancreatic lesions: Yuki Tanisaka, Masafumi Mizuide, Akashi Fujita, Ryuhei Jinushi, Rie Shiomi, Takahiro Shin, Kei Sugimoto, Tomoaki Tashima, Yumi Mashimo, Shomei Ryozawa; Clin Endosc 2024;57(2):237-245. Published online January 26, 2024; DOI: https://doi.org/10.5946/ce.2023.011

Graphical Abstract Abstract PDF PubReader ePub

Background
/Aims: Endoscopic ultrasound-guided tissue acquisition (EUS-TA) using Franseen needles is reportedly useful for its high diagnostic yield. This study compared the diagnostic yield and puncturing ability of EUS-TA using 22-gauge cobalt-chromium (CO-Cr) needles with those of stainless-steel Franseen needles in patients with solid pancreatic lesions.
Methods
Outcomes were compared between the 22-gauge Co-Cr Franseen needle (December 2019 to November 2020; group C) and stainless-steel needle (November 2020 to May 2022; group S).
Results
A total of 155 patients (group C, 75; group S, 80) were eligible. The diagnostic accuracy was 92.0% in group C and 96.3% in group S with no significant intergroup differences (p=0.32). The rate of change in the operator (from training fellows to experts) was 20.0% (15/75) in group C and 7.5% (6/80) in group S. Stainless-steel Franseen needles showed less inter-operator difference than Co-Cr needles (p=0.03).
Conclusions
Both Co-Cr and stainless-steel Franseen needles showed high diagnostic ability. Stainless-steel Franseen needles are soft and flexible; therefore, the range of puncture angles can be widely adjusted, making them suitable for training fellows to complete the procedure.

Citations

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The correlation between tumoral CD8 expression and clinical course in patients with unresectable pancreatic cancer using tissue samples acquired by endoscopic ultrasound‐guided tissue acquisition
Yuki Tanisaka, Shomei Ryozawa, Masafumi Mizuide, Akashi Fujita, Ryuhei Jinushi, Ryuichi Watanabe, Ryo Sato, Masanori Yasuda
Journal of Hepato-Biliary-Pancreatic Sciences.2025; 32(2): 132. CrossRef
Optimal tissue acquisition method for pancreatic mass
Kwang Hyun Chung, Sang Hyub Lee
Digestive Endoscopy.2025; 37(6): 629. CrossRef
Endosonographic-guided tissue acquisition for solid pancreatic lesions: Have we reached the ceiling?
Natalie Cosgrove
Gastrointestinal Endoscopy.2025; 102(5): 714. CrossRef
Curved puncture technique using a flexible stainless-steel needle in endoscopic ultrasound-guided hepaticogastrostomy
Haruo Miwa, Yuichi Suzuki, Shotaro Tsunoda, Kazuki Endo, Ritsuko Oishi, Hiromi Tsuchiya, Shin Maeda
Endoscopy.2024; 56(S 01): E1082. CrossRef

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The role of needle-based confocal laser endomicroscopy in the diagnosis of pancreatic neuroendocrine tumors: Masanori Yamada, Kazuo Hara, Nobumasa Mizuno, Shin Haba, Takamichi Kuwahara, Nozomi Okuno, Yasuhiro Kuraishi, Takafumi Yanaidani, Sho Ishikawa, Tsukasa Yasuda, Toshitaka Fukui; Clin Endosc 2024;57(3):393-401. Published online September 12, 2023; DOI: https://doi.org/10.5946/ce.2023.068

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Background
/Aims: Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is a highly accurate method for diagnosing pancreatic neuroendocrine tumors (PNETs); however, some PNETs are difficult to diagnose. Recently, the efficacy of needle-based confocal laser endomicroscopy (nCLE) in diagnosing solid pancreatic masses has been reported. However, the efficacy of nCLE in the diagnosis of PNETs remains unknown and only a small number of cases have been reported. Hence, this study aimed to evaluate the efficacy of nCLE in the diagnosis of PNETs.
Methods
This single-center retrospective study evaluated 30 consecutive patients with suspected PNETs on contrast-enhanced computed tomography, who consented to nCLE combined with EUS-FNA and were diagnosed using EUS-FNA or surgical resection. The diagnostic criteria for PNETs using nCLE were based on the nesting and trabecular and glandular arrangement of tumor cell clusters surrounded by capillary vessels and fibrosis, as reported in previous studies.
Results
The diagnosis using nCLE was classified into three categories: misdiagnosis in three cases (10%), non-diagnostic in six cases (20%), and diagnostic in 21 cases (70%). nCLE was able to diagnose PNET in one of the two cases with inconclusive EUS-FNA.
Conclusions
Although further development of the resolution and optimization of the diagnostic criteria are required, nCLE may constitute a useful diagnostic option in cases of inconclusive EUS-FNA for PNETs.

Citations

Citations to this article as recorded by

Recent Advances in Endoscopic Ultrasound (EUS) for Pancreatic Cystic Lesions
Veeral M. Oza, Anuroop Yekula, Truptesh H. Kothari
Journal of Digestive Endoscopy.2026;[Epub] CrossRef
Recent developments in the diagnosis of pancreatic neuroendocrine neoplasms
Anna Battistella, Matteo Tacelli, Paola Mapelli, Marco Schiavo Lena, Valentina Andreasi, Luana Genova, Francesca Muffatti, Francesco De Cobelli, Stefano Partelli, Massimo Falconi
Expert Review of Gastroenterology & Hepatology.2024; 18(4-5): 155. CrossRef
Advancements and challenges in gastrointestinal imaging
Eun Jeong Gong, Chang Seok Bang
World Journal of Clinical Cases.2024; 12(33): 6591. CrossRef

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Comparison of 19-gauge conventional and Franseen needles for the diagnosis of lymphadenopathy and classification of malignant lymphoma using endoscopic ultrasound fine-needle aspiration: Mitsuru Okuno, Keisuke Iwata, Tsuyoshi Mukai, Yusuke Kito, Takuji Tanaka, Naoki Watanabe, Senji Kasahara, Yuhei Iwasa, Akihiko Sugiyama, Youichi Nishigaki, Yuhei Shibata, Junichi Kitagawa, Takuji Iwashita, Eiichi Tomita, Masahito Shimizu; Clin Endosc 2024;57(3):364-374. Published online September 8, 2023; DOI: https://doi.org/10.5946/ce.2023.095

Graphical Abstract Abstract PDF Supplementary Material PubReader ePub

Background
/Aims: Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) using a 19-gauge needle is an efficient sampling method for the diagnosis of lymphadenopathy. This study compared 19-gauge conventional and Franseen needles for the diagnosis of lymphadenopathy and classification of malignant lymphoma (ML).
Methods
Patient characteristics, number of needle passes, puncture route, sensitivity, specificity, and accuracy of cytology/histology for lymphadenopathy were analyzed in patients diagnosed with lymphadenopathy by EUS-FNA using conventional or Franseen needles.
Results
Between 2012 and 2022, 146 patients met the inclusion criteria (conventional [n=70] and Franseen [n=76]). The median number of needle passes was significantly lower in the conventional group than in the Franseen group (3 [1–6] vs. 4 [1–6], p=0.023). There were no significant differences in cytological/histological diagnoses between the two groups. For ML, the immunohistochemical evaluation rate, sensitivity of flow cytometry, and cytogenetic assessment were not significantly different in either group. Bleeding as adverse events (AEs) were observed in three patients in the Franseen group.
Conclusions
Both the 19-gauge conventional and Franseen needles showed high accuracy in lymphadenopathy and ML classification. Considering sufficient tissue collection and the avoidance of AEs, the use of 19-gauge conventional needles seems to be a good option for the diagnosis of lymphadenopathy.

Citations

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A retrospective study on the comparative use of fine-needle biopsy and aspiration for the diagnosis and classification of malignant lymphoma in Japan
Fumitaka Niiya, Akihiro Nakamura, Yasuo Ueda, Takafumi Ogawa, Naoki Tamai, Masataka Yamawaki, Jun Noda, Tetsushi Azami, Yuichi Takano, Masatsugu Nagahama
Clinical Endoscopy.2025; 58(5): 757. CrossRef
Refining the diagnostic strategy for malignant lymphoma: advantages of endoscopic ultrasound-guided fine-needle biopsy over aspiration
Kyong Joo Lee, Se Woo Park
Clinical Endoscopy.2025; 58(5): 701. CrossRef
Choosing needles wisely: 19-G conventional vs. Franseen needles in endoscopic ultrasound-guided fine-needle aspiration for malignant lymphoma diagnosis and classification
Kajornvit Raghareutai, Worapoth Yingyongthawat, Nonthalee Pausawasdi
Clinical Endoscopy.2024; 57(4): 473. CrossRef

4,638 View
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Safety of endoscopic ultrasound-guided hepaticogastrostomy in patients with malignant biliary obstruction and ascites: Tsukasa Yasuda, Kazuo Hara, Nobumasa Mizuno, Shin Haba, Takamichi Kuwahara, Nozomi Okuno, Yasuhiro Kuraishi, Takafumi Yanaidani, Sho Ishikawa, Masanori Yamada, Toshitaka Fukui; Clin Endosc 2024;57(2):246-252. Published online September 7, 2023; DOI: https://doi.org/10.5946/ce.2023.075

Graphical Abstract Abstract PDF Supplementary Material PubReader ePub

Background
/Aims: Endoscopic ultrasound (EUS)-guided hepaticogastrostomy (EUS-HGS) is useful for patients with biliary cannulation failure or inaccessible papillae. However, it can lead to serious complications such as bile peritonitis in patients with ascites; therefore, development of a safe method to perform EUS-HGS is important. Herein, we evaluated the safety of EUS-HGS with continuous ascitic fluid drainage in patients with ascites.
Methods
Patients with moderate or severe ascites who underwent continuous ascites drainage, which was initiated before EUS-HGS and terminated after the procedure at our institution between April 2015 and December 2022, were included in the study. We evaluated the technical and clinical success rates, EUS-HGS-related complications, and feasibility of re-intervention.
Results
Ten patients underwent continuous ascites drainage, which was initiated before EUS-HGS and terminated after completion of the procedure. Median duration of ascites drainage before and after EUS-HGS was 2 and 4 days, respectively. Technical success with EUS-HGS was achieved in all 10 patients (100%). Clinical success with EUS-HGS was achieved in 9 of the 10 patients (90 %). No endoscopic complications such as bile peritonitis were observed.
Conclusions
In patients with ascites, continuous ascites drainage, which is initiated before EUS-HGS and terminated after completion of the procedure, may prevent complications and allow safe performance of EUS-HGS.

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Prevention of Adverse Events in Endoscopic Ultrasound‐Guided Biliary Drainage
Hirotoshi Ishiwatari, Hiroki Sakamoto, Takuya Doi, Masahiro Yamamura
DEN Open.2026;[Epub] CrossRef
Clinical Outcomes and Learning Curve of Endoscopic Ultrasound‐Guided Hepaticogastrostomy During the Implementation Phase in Inexperienced Centers: A Multicenter Retrospective Study
Junichi Kaneko, Tatsunori Satoh, Yosuke Kobayashi, Azumi Suzuki, Shinya Kawaguchi
DEN Open.2026;[Epub] CrossRef
EUS-guided pancreatic duct drainage—technical tips and outcomes: narrative review
Yasunobu Yamashita, Masayuki Kitano
Therapeutic Advances in Gastroenterology.2026;[Epub] CrossRef
Feasibility and safety of EUS-guided biliary drainage in inexperienced centers: a multicenter study in southwest Japan
Takehiko Koga, Yusuke Ishida, Shunpei Hashigo, Yuzo Shimokawa, Hirofumi Harima, Kazuhisa Okamoto, Akihisa Ohno, Tsukasa Miyagahara, Toshihiro Fujita, Satoshi Fukuchi, Kosuke Takahashi, Hiroki Taguchi, Norimasa Araki, Yuichiro Ohtsuka, Toshiyuki Uekitani,
Gastrointestinal Endoscopy.2025; 101(4): 843. CrossRef
Clinical effect of percutaneous hepatic puncture biliary drainage combined with metal stent implantation in the treatment of malignant obstructive jaundice
Shoulin Zhang, Shaopeng Huang, Zheng Xing, Youwen Song, Fujian Yuan
BMC Surgery.2025;[Epub] CrossRef
Efficacy and safety of endoscopic ultrasound-guided hepaticogastrostomy for biliary drainage in hypervascular hepatocellular carcinoma: a retrospective study from Japan
Kenneth Tachi, Kazuo Hara, Nozomi Okuno, Shin Haba, Takamichi Kuwahara, Toshitaka Fukui, Ahmed Mohammed Sadek, Hossam El-Din Shaaban Mahmoud Ibrahim, Minako Urata, Takashi Kondo, Yoshitaro Yamamoto
Clinical Endoscopy.2025; 58(3): 448. CrossRef
Technical Review on Endoscopic Ultrasound-Guided Hepaticogastrostomy
Vivek Kumar Singh, Vinay Dhir
Journal of Digestive Endoscopy.2025; 16(04): 213. CrossRef
Moderne Ansätze der Gallengangsdrainage: Endosonografisch geführte Techniken im Vergleich
Kai Koch, Markus Dollhopf
Gastroenterologie up2date.2025; 21(03): 221. CrossRef
Management of iatrogenic perforations during endoscopic interventions in the hepato-pancreatico-biliary tract
Kirsten Boonstra, Rogier P. Voermans, Roy L.J. van Wanrooij
Best Practice & Research Clinical Gastroenterology.2024; 70: 101890. CrossRef
Is Endoscopic Ultrasound-Guided Hepaticogastrostomy Safe and Effective after Failed Endoscopic Retrograde Cholangiopancreatography?—A Systematic Review and Meta-Analysis
Saqr Alsakarneh, Mahmoud Y. Madi, Dushyant Singh Dahiya, Fouad Jaber, Yassine Kilani, Mohamed Ahmed, Azizullah Beran, Mohamed Abdallah, Omar Al Ta’ani, Anika Mittal, Laith Numan, Hemant Goyal, Mohammad Bilal, Wissam Kiwan
Journal of Clinical Medicine.2024; 13(13): 3883. CrossRef
Endoscopic ultrasound-guided antegrade stenting combined with closure of the puncture route using self-assembling peptide solution in a jaundiced patient with ascites
Hirotsugu Maruyama, Kojiro Tanoue, Tatsuya Kurokawa, Yoshinori Shimamoto, Yuki Ishikawa-Kakiya, Akira Higashimori, Yasuhiro Fujiwara
Endoscopy.2024; 56(S 01): E953. CrossRef
The Role of Therapeutic Endoscopic Ultrasound in Management of Malignant Double Obstruction (Biliary and Gastric Outlet): A Comprehensive Review with Clinical Scenarios
Giuseppe Dell’Anna, Rubino Nunziata, Claudia Delogu, Petra Porta, Maria Vittoria Grassini, Jahnvi Dhar, Rukaia Barà, Sarah Bencardino, Jacopo Fanizza, Francesco Vito Mandarino, Ernesto Fasulo, Alberto Barchi, Francesco Azzolini, Guglielmo Albertini Petron
Journal of Clinical Medicine.2024; 13(24): 7731. CrossRef

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12 Crossref

Anesthesia care provider sedation versus conscious sedation for endoscopic ultrasound–guided tissue acquisition: a retrospective cohort study: Sneha Shaha, Yinglin Gao, Jiahao Peng, Kendrick Che, John J. Kim, Wasseem Skef; Clin Endosc 2023;56(5):658-665. Published online July 3, 2023; DOI: https://doi.org/10.5946/ce.2023.006

Graphical Abstract Abstract PDF PubReader ePub: Background
/Aims: We aimed to study the effects of sedation on endoscopic ultrasound–guided tissue acquisition.
Methods
We conducted a retrospective study evaluating the role of sedation in endoscopic ultrasound–guided tissue acquisition by comparing two groups: anesthesia care provider (ACP) sedation and endoscopist-directed conscious sedation (CS).
Results
Technical success was achieved in 219/233 (94.0%) in the ACP group and 114/136 (83.8%) in the CS group (p=0.0086). In multivariate analysis, the difference in technical success between the two groups was not significant (adjusted odds ratio [aOR], 0.5; 95% confidence interval [CI], 0.234–1.069; p=0.0738). A successful diagnostic yield was present in 146/196 (74.5%) in the ACP group and 66/106 (62.3%) in the CS group, respectively (p=0.0274). In multivariate analysis, the difference in diagnostic yield between the two groups was not significant (aOR, 0.643; 95% CI, 0.356–1.159; p=0.142). A total of 33 adverse events (AEs) were observed. The incidence of AEs was significantly lower in the CS group (5/33 CS vs. 28/33 ACP; OR, 0.281; 95% CI, 0.095–0.833; p=0.022).
Conclusions
CS provided equivalent technical success and diagnostic yield for malignancy in endoscopic ultrasound–guided tissue acquisition. Increased AEs were associated with anesthesia for the endoscopic ultrasound–guided tissue acquisition.

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Systematic Review and Meta-analysis

No difference in outcomes with 15 mm vs. 20 mm lumen-apposing metal stents for endoscopic ultrasound-guided gastroenterostomy for gastric outlet obstruction: a meta-analysis: Shyam Vedantam, Rahil Shah, Sean Bhalla, Shria Kumar, Sunil Amin; Clin Endosc 2023;56(3):298-307. Published online May 22, 2023; DOI: https://doi.org/10.5946/ce.2022.299

Abstract PDF Supplementary Material PubReader ePub

Background
/Aims: We compared outcomes between use of 15 vs. 20 mm lumen-apposing metal stents (LAMSs) in endoscopic ultrasound-guided gastroenterostomy (EUS-GE) for gastric outlet obstruction.
Methods
Databases were queried for studies that used LAMS for EUS-GE to relieve gastric outlet obstruction, and a proportional meta-analysis was performed.
Results
Thirteen studies were included. The 15 mm and 20 mm LAMS had pooled technical success rates of 93.2% (95% confidence interval [CI], 90.5%–95.2%) and 92.1% (95% CI, 68.4%–98.4%), clinical success rates of 88.6% (95% CI, 85.4%–91.1%) and 89.6% (95% CI, 79.0%–95.1%), adverse event rates of 11.4% (95% CI, 8.1%–15.9%) and 14.7% (95% CI, 4.4%–39.1%), and reintervention rates of 10.3% (95% CI, 6.7%–15.4%) and 3.5% (95% CI, 1.6%–7.6%), respectively. Subgroup analysis revealed no significant differences in technical success, clinical success, or adverse event rates. An increased need for reintervention was noted in the 15 mm stent group (pooled odds ratio, 3.59; 95% CI, 1.40–9.18; p=0.008).
Conclusions
No differences were observed in the technical, clinical, or adverse event rates between 15 and 20 mm LAMS use in EUS-GE. An increased need for reintervention is possible when using a 15 mm stent compared to when using a 20 mm stent.

Citations

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Role of Endoscopic Ultrasound‐guided Gastroenterostomy for Benign Gastric Outlet Obstruction
Suprabhat Giri, Saroj Kanta Sahu, Gaurav Khatana, Prasanna Gore, Preetam Nath, Bipadabhanjan Mallick, Jimmy Narayan, Aditya Kale, Sridhar Sundaram
DEN Open.2026;[Epub] CrossRef
Standardizing Success and Troubleshooting in EUS-Guided Gastroenterostomy
Giuseppe Vanella, Francesco Frigo, Michiel Bronswijk, Roy L.J. van Wanrooij, Yen-I Chen, Kenneth F. Binmoeller, Manuel Perez-Miranda, Roberto Leone, Prabhleen Chahal, Shannon M. Chan, Manol Jovani, Amy Tyberg, Enrique Pérez-Cuadrado-Robles, Reem Sharaiha,
Journal of Clinical Gastroenterology.2026; 60(3): 197. CrossRef
Is It Time to Replace the Duodenal Self-Expandable Metal Stent with Endoscopic Ultrasonography-Guided Gastroenterostomy for Malignant Gastric Outlet Obstruction in Patients with Pancreatic Cancer?
Hsiao-Sheng Lu, Kuei-Chuan Lee, Ming-Chih Hou
Gut and Liver.2026; 20(1): 37. CrossRef
Benign biliary stricture caused by transduodenal lumen-apposing metal stent placement for pancreatic acute necrotic collection
Shuhei Shintani, Takuya Okamoto, Kosuke Hiroe, Hidenori Kimura, Hiroto Inoue, Atsushi Nishida, Osamu Inatomi
International Journal of Gastrointestinal Intervention.2025; 14(1): 24. CrossRef
Endoscopic ultrasound-guided gastroenterostomy, with focus on technique and practical tips
Chi-Ying Yang, Wen-Hsin Huang, Hsing-Hung Cheng
Clinical Endoscopy.2025; 58(2): 201. CrossRef
EUS guided gastrojejunostomy: techniques and outcomes
Sachin Hosahally Jayanna, Surinder Singh Rana
Expert Review of Gastroenterology & Hepatology.2025; 19(7): 745. CrossRef
Best practices for endoscopic ultrasound-guided gastroenterostomy: technical recommendations from an international modified Delphi process
Giuseppe Vanella, Roberto Leone, Francesco Frigo, Michiel Bronswijk, Roy L.J. van Wanrooij, Yen-I. Chen, Kenneth F. Binmoeller, Manuel Perez-Miranda, Prabhleen Chahal, Manol Jovani, Amy Tyberg, Enrique Pérez-Cuadrado-Robles, Marc Barthet, Pierre Deprez, M
Gastrointestinal Endoscopy.2025;[Epub] CrossRef
Endoscopic gastrointestinal bypass anastomosis using deformable self-assembled magnetic anastomosis rings (DSAMARs) in a pig model
Miaomiao Zhang, Jianqi Mao, Jia Ma, Shuqin Xu, Yi Lyu, Xiaopeng Yan
BMC Gastroenterology.2024;[Epub] CrossRef
Revealing Insights: A Comprehensive Overview of Gastric Outlet Obstruction Management, with Special Emphasis on EUS-Guided Gastroenterostomy
Dimitrios Ziogas, Thomas Vasilakis, Christina Kapizioni, Eleni Koukoulioti, Georgios Tziatzios, Paraskevas Gkolfakis, Antonio Facciorusso, Ioannis S. Papanikolaou
Medical Sciences.2024; 12(1): 9. CrossRef
Lumen-apposing metal stents: A primer on indications and technical tips
Sridhar Sundaram, Suprabhat Giri, Kenneth Binmoeller
Indian Journal of Gastroenterology.2024; 43(5): 886. CrossRef
Advances in self-expandable metal stents for endoscopic ultrasound-guided interventions
Dong Kee Jang, Dong Wook Lee, Seong-Hun Kim, Kwang Bum Cho, Sundeep Lakhtakia
Clinical Endoscopy.2024; 57(5): 588. CrossRef
Endoscopic stenting for malignant gastric outlet obstruction: focusing on comparison of endoscopic stenting and surgical gastrojejunostomy
Sun Gyo Lim, Chan Gyoo Kim
Clinical Endoscopy.2024; 57(5): 571. CrossRef
III BRAZILIAN CONSENSUS STATEMENT ON ENDOSCOPIC ULTRASOUND
Ricardo Rangel de Paula PESSOA, Alexandre Moraes BESTETTI, Victor Lira de OLIVEIRA, Wladimir Campos de ARAUJO, Simone GUARALDI, Rodrigo Roda RODRIGUES SILVA, Francisco Antonio Araujo OLIVEIRA, Maria Sylvia Ierardi RIBEIRO, Fred Olavo Aragão Andrade CARNEI
Arquivos de Gastroenterologia.2024;[Epub] CrossRef
The Role of Luminal Apposing Metal Stents on the Treatment of Malignant and Benign Gastric Outlet Obstruction
Mihai Rimbaș, Kar Wai Lau, Giulia Tripodi, Gianenrico Rizzatti, Alberto Larghi
Diagnostics.2023; 13(21): 3308. CrossRef

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Case Reports

Refractory benign biliary stricture due to chronic pancreatitis in two patients treated using endoscopic ultrasound-guided choledochoduodenostomy fistula creation: case reports: Sho Ishikawa, Nozomi Okuno, Kazuo Hara, Nobumasa Mizuno, Shin Haba, Takamichi Kuwahara, Yasuhiro Kuraishi, Takafumi Yanaidani; Clin Endosc 2024;57(1):122-127. Published online May 16, 2023; DOI: https://doi.org/10.5946/ce.2022.149

Abstract PDF PubReader ePub

Benign biliary stricture (BBS) is a complication of chronic pancreatitis (CP). Despite endoscopic biliary stenting, some patients do not respond to treatment, and they experience recurrent cholangitis. We report two cases of CP with refractory BBS treated using endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) fistula creation. A 50-year-old woman and a 60-year-old man both presented with obstructive jaundice secondary to BBS due to alcoholic CP. They underwent repeated placement of a fully covered self-expandable metal stent for biliary strictures. However, the strictures persisted, causing repeated episodes of cholangitis. Therefore, an EUS-CDS was performed. The stents were eventually removed and the patients became stent-free. These fistulas have remained patent without cholangitis for more than 2.5 years. Fistula creation using EUS-CDS is an effective treatment option for BBS.

Citations

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Endoscopic Ultrasound-Guided Lumen-Apposing Metal Stent Drainage in Benign Pancreatobiliary and Gastrointestinal Disease: Evolving Techniques and Clinical Outcomes
Filippo Antonini, Marco Valvano, Edoardo Troncone, Domenico Galasso, Amedeo Montale, Mario Capasso, Matteo Marasco, Benedetto Mangiavillano, Giovanna Del Vecchio Blanco, Mauro Dalla Libera, Antonella Scarcelli, Antonio Facciorusso, Lorenzo Fuccio, Massimi
Diagnostics.2026; 16(4): 522. CrossRef
Endoscopic ultrasound-guided choledochoduodenojejunostomy via afferent limb: a novel approach for hepaticojejunostomy stricture
Nozomi Okuno, Kazuo Hara, Shin Haba, Takamichi Kuwahara, Shimpei Matsumoto, Hiroki Koda, Tomoki Ogata
Endoscopy.2025; 57(S 01): E1407. CrossRef
Forward viewing liner echoendoscopy for therapeutic interventions
Kazuo Hara, Nozomi Okuno, Shin Haba, Takamichi Kuwahara
Clinical Endoscopy.2024; 57(2): 175. CrossRef
Successful sequential management of traumatic choledochal leak and stenosis in children using ERCP: a case report and literature review
Cuo Leng, Yu Zou, Zhoujian Yang, Xinhua Zhao
Frontiers in Medicine.2024;[Epub] CrossRef

4,783 View
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4 Crossref

Endoscopic ultrasound-guided hepaticogastrostomy by puncturing both B2 and B3: a single center experience: Moaz Elshair, Kazuo Hara, Nozomi Okuno, Shin Haba, Takamichi Kuwahara, Asmaa Bakr, Abdou Elshafei, Mohamed Z. Abu-Amer; Clin Endosc 2024;57(4):542-546. Published online May 3, 2023; DOI: https://doi.org/10.5946/ce.2022.209

Abstract PDF PubReader ePub

Endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) through ducts B2 or B3 is effective in most patients with biliary obstruction, because B2 and B3 commonly join together. However, in some patients, B2 and B3 do not join each other due to invasive hilar tumors; therefore, single-route drainage is insufficient. Here, we investigated the feasibility and efficacy of EUS-HGS through both B2 and B3 simultaneously in seven patients. We decided to perform EUS-HGS through both B2 and B3 to achieve adequate biliary drainage because these two ducts were separate from each other. Here, we report a 100% technical and overall clinical success rate. Early adverse effects were closely monitored. Minimal bleeding was reported in one patient (1/7) and mild peritonitis in one patient (1/7). None of the patients experienced stent dysfunction, fever, or bile leakage after the procedure. EUS-HGS through both B2 and B3 simultaneously is safe, feasible, and effective for biliary drainage in patients with separated ducts.

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A novel technique of B2–B3 single-puncture bridging through liver parenchyma enabling endoscopic ultrasound-guided hepaticogastrostomy for rescue drainage
Hiroki Koda, Kazuo Hara, Nozomi Okuno, Shin Haba, Takamichi Kuwahara, Shimpei Matsumoto, Tomoki Ogata
Endoscopy.2025; 57(S 01): E936. CrossRef

4,516 View
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1 Crossref

Original Articles

Stereomicroscopic on-site evaluation in endoscopic ultrasound-guided tissue acquisition of upper gastrointestinal subepithelial lesions: Seigo Nakatani, Kosuke Okuwaki, Masafumi Watanabe, Hiroshi Imaizumi, Tomohisa Iwai, Takaaki Matsumoto, Rikiya Hasegawa, Hironori Masutani, Takahiro Kurosu, Akihiro Tamaki, Junro Ishizaki, Ayana Ishizaki, Mitsuhiro Kida, Chika Kusano; Clin Endosc 2024;57(1):89-95. Published online April 18, 2023; DOI: https://doi.org/10.5946/ce.2022.288

Graphical Abstract Abstract PDF PubReader ePub

Background
/Aims: In stereomicroscopic sample isolation processing, the cutoff value (≥4 mm) of stereomicroscopically visible white cores indicates high diagnostic sensitivity. We aimed to evaluate endoscopic ultrasound-guided tissue acquisition (EUS-TA) using a simplified stereomicroscopic on-site evaluation of upper gastrointestinal subepithelial lesions (SELs).
Methods
In this multicenter prospective trial, we performed EUS-TA using a 22-gauge Franseen needle in 34 participants with SELs derived from the upper gastrointestinal muscularis propria, requiring pathological diagnosis. The presence of stereomicroscopically visible white core (SVWC) in each specimen was assessed using stereomicroscopic on-site evaluation. The primary outcome was EUS-TA’s diagnostic sensitivity with stereomicroscopic on-site evaluation based on the SVWC cutoff value (≥4 mm) for malignant upper gastrointestinal SELs.
Results
The total number of punctures was 68; 61 specimens (89.7%) contained stereomicroscopically visible white cores ≥4 mm in size. The final diagnoses were gastrointestinal stromal tumor, leiomyoma, and schwannoma in 76.5%, 14.7%, and 8.8% of the cases, respectively. The sensitivity of EUS-TA with stereomicroscopic on-site evaluation based on the SVWC cutoff value for malignant SELs was 100%. The per-lesion accuracy of histological diagnosis reached the highest level (100%) at the second puncture.
Conclusions
Stereomicroscopic on-site evaluation showed high diagnostic sensitivity and could be a new method for diagnosing upper gastrointestinal SELs using EUS-TA.

Citations

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Adverse events of 20–22G second‐generation endoscopic ultrasound‐guided fine‐needle biopsy needles for solid lesions in the upper gastrointestinal tract and adjacent organs: Systematic review and meta‐analysis
Cheng‐ye Pan, Shi‐min Wang, Dong‐hao Cai, Jia‐yi Ma, Shi‐yu Li, Yibin Guo, Sun Jing, Jin Zhendong, Kaixuan Wang
Digestive Endoscopy.2025; 37(5): 490. CrossRef
Case Report: Rare duodenal schwannoma diagnosis and treatment process report
Shan Li, Lingyu Tu, Ting Li, Xiongchuan Pei, Xijin Wang, Yanqing Shi
Frontiers in Oncology.2025;[Epub] CrossRef
Advancements in endoscopic resection of subepithelial tumors: toward safer, recurrence-free techniques
Won Shik Kim, Moon Kyung Joo
Clinical Endoscopy.2025; 58(2): 256. CrossRef
Feasibility of Endoscopic Ultrasound‐Guided Tissue Acquisition for < 20‐mm Upper Gastrointestinal Subepithelial Lesions
Masafumi Watanabe, Kosuke Okuwaki, Tomohisa Iwai, Mitsuhiro Kida, Hiroshi Imaizumi, Kai Adachi, Akihiro Tamaki, Junro Ishizaki, Taro Hanaoka, Chika Kusano
Journal of Gastroenterology and Hepatology.2025; 40(8): 2046. CrossRef
Diagnostic accuracy of stereomicroscopy assessment of invasion depth in ex vivo specimens of early gastric cancer
Jing Wang, Lin Chang, Dong-Feng Niu, Yan Yan, Chang-Qi Cao, Shi-Jie Li, Qi Wu
World Journal of Gastroenterology.2025;[Epub] CrossRef
What method can we choose if rapid on-site evaluation is not available for the endoscopic ultrasound-guided tissue acquisition of upper gastrointestinal subepithelial lesions?
Yu Kyung Cho
Clinical Endoscopy.2024; 57(1): 53. CrossRef
Endoscopic Ultrasound-Guided Tissue Acquisition Using Fork-Tip Needle for Subepithelial Lesions: A Single-Center Validation Study
Masafumi Watanabe, Kosuke Okuwaki, Tomohisa Iwai, Mitsuhiro Kida, Hiroshi Imaizumi, Kai Adachi, Akihiro Tamaki, Junro Ishizaki, Taro Hanaoka, Chika Kusano
Digestive Diseases and Sciences.2024; 69(7): 2567. CrossRef
Impact of macroscopic on-site evaluation (MOSE) on accuracy of endoscopic ultrasound-guided fine-needle aspiration/biopsy of solid lesions
Hussein Okasha, Ahmed Ebrahim, Ihab Samih, Mohammed Sayed
International Journal of Gastrointestinal Intervention.2024; 13(3): 98. CrossRef
Role of macroscopic on-site evaluation of endoscopic ultrasound-guided fine-needle aspiration/biopsy: Results of a multicentric prospective study
Hussein H Okasha, Hiwa A Hussein, Khaled M Ragab, Omar Abdallah, Fedoua Rouibaa, Borahma Mohamed, Fahd Ghalim, Mahmoud Farouk, Mohamed Lasheen, Mohamed A Elbasiony, Ahmed E Alzamzamy, Ahmed El Deeb, Hassan Atalla, Mahmoud El-Ansary, Sahar Mohamed, Moaz El
World Journal of Gastrointestinal Endoscopy.2024; 16(11): 595. CrossRef
An Esophageal Leiomyoma with Cystic Degeneration Mimicking a Malignant Neoplasm
Gwang Ha Kim, Dong Chan Joo, Moon Won Lee, Bong Eun Lee, Kyungbin Kim
The Ewha Medical Journal.2023;[Epub] CrossRef

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Covered self-expandable metallic stents versus plastic stents for endoscopic ultrasound-guided hepaticogastrostomy in patients with malignant biliary obstruction: Taro Shibuki, Kei Okumura, Masanari Sekine, Ikuhiro Kobori, Aki Miyagaki, Yoshihiro Sasaki, Yuichi Takano, Yusuke Hashimoto; Clin Endosc 2023;56(6):802-811. Published online April 5, 2023; DOI: https://doi.org/10.5946/ce.2022.211

Graphical Abstract Abstract PDF PubReader ePub

Background
/Aims: Covered self-expandable metallic stents (cSEMS) have become popular for endoscopic ultrasound-guided hepaticogastrostomy with transmural stenting (EUS-HGS). We compared the time to recurrent biliary obstruction (TRBO), complications, and reintervention rates between EUS-HGS using plastic stent (PS) and cSEMS in patients with unresectable malignancies at multicenter institutions in Japan.
Methods
Patients with unresectable malignant biliary obstruction who underwent EUS-HGS between April 2015 and July 2020 at any of the six participating facilities were enrolled. Primary endpoint: TRBO; secondary endpoints: rate of complications other than recurrent biliary obstruction and technical success rate of reintervention were evaluated.
Results
PS and cSEMS were used for EUS-HGS in 109 and 43 patients, respectively. The TRBO was significantly longer in the cSEMS group than in the PS group (646 vs. 202 days). Multivariate analysis identified two independent factors associated with a favorable TRBO: combined EUS-guided antegrade stenting with EUS-HGS and the use of cSEMS. No significant difference was observed in the rate of complications other than recurrent biliary obstruction between the two groups. The technical success rate of reintervention was 85.7% for PS and 100% for cSEMS (p=0.309).
Conclusions
cSEMS might be a better option for EUS-HGS in patients with unresectable malignancies, given the longer TRBO.

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Hidehito Sumiya, Yoshihide Kanno, Shinsuke Koshita, Takahisa Ogawa, Hiroaki Kusunose, Toshitaka Sakai, Keisuke Yonamine, Kazuaki Miyamoto, Fumisato Kozakai, Haruka Okano, Kento Hosokawa, Shun Nozaki, Kei Ito
DEN Open.2026;[Epub] CrossRef
Stent selection in elderly biliary drainage: A pragmatic guide from benign to malignant
Amira A A Othman
World Journal of Gastrointestinal Endoscopy.2026;[Epub] CrossRef
Metal stent versus plastic stent in endoscopic ultrasound‐guided hepaticogastrostomy for unresectable malignant biliary obstruction: Large single‐center retrospective comparative study
Daiki Yamashige, Susumu Hijioka, Yoshikuni Nagashio, Yuta Maruki, Yasuhiro Komori, Masaru Kuwada, Soma Fukuda, Shin Yagi, Kohei Okamoto, Daiki Agarie, Mark Chatto, Chigusa Morizane, Hideki Ueno, Shunsuke Sugawara, Miyuki Sone, Yutaka Saito, Takuji Okusaka
Digestive Endoscopy.2025; 37(1): 117. CrossRef
Impact of self-expandable metal stent deployment site on stent dysfunction during EUS-guided hepaticogastrostomy
Takeshi Ogura, Saori Ueno, Atsushi Okuda, Nobu Nishioka, Jun Sakamoto, Masanori Yamada, Masahiro Yamamura, Yuki Uba, Mitsuki Tomita, Nobuhiro Hattori, Junichi Nakamura, Kimi Bessho, Hiroki Nishikawa
Endoscopic Ultrasound.2025; 14(1): 26. CrossRef
Evaluating the use of EUS-guided hepaticogastrostomy combined with antegrade stenting for malignant biliary obstruction and comparing to EUS-guided hepaticogastrostomy alone for patients who failed ERCP: a pairwise and single-arm meta-analysis
Otavio Cosendey Martins, Vanio Antunes, Marcelo Cristalli Pacheco da Costa, Cynthia Florêncio de Mesquita, Tulio L. Correa, Matheus Vanzin Fernandes, Natália Junkes Milioli, Stefano Baraldo
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Balloon Catheter Versus Drill Dilator for EUS‐Guided Hepaticogastrostomy Stent Placement: A Randomized Clinical Trial
Takeshi Ogura, Saori Ueno, Akitoshi Hakoda, Atsushi Okuda, Nobu Nishioka, Jun Sakamoto, Jun Matsuno, Yuki Uba, Mitsuki Tomita, Nobuhiro Hattori, Junichi Nakamura, Kimi Bessho, Taro Iwatsubo, Toshifumi Yamaguchi, Ahmad F. Aboelezz, Hiroki Nishikawa
United European Gastroenterology Journal.2025; 13(8): 1429. CrossRef
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Kaixuan Wang, Jiayi Ma, Jun Li, Zhaoshen Li, Siyu Sun, Zhendong Jin
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Prospective, multicentre trial on preoperative biliary drainage by endoscopic ultrasound-guided hepaticogastrostomy for resectable/borderline resectable pancreatic cancer with biliary obstruction: the PROLOGUE study – a study protocol
Shin Yagi, Susumu Hijioka, Yoshikuni Nagashio, Shota Harai, Daiki Agarie, Daiki Yamashige, Kohei Okamoto, Souma Fukuda, Masaru Kuwada, Yasuhiro Komori, Yusuke Kurita, Sho Hasegawa, Kensuke Kubota, Yusuke Ishida, Jun Ushio, Kotaro Takeshita, Kohei Yoshino,
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Mitsuru Sugimoto, Yuki Nakajima, Yutaro Takeda, Yuki Sato, Tadayuki Takagi, Rei Suzuki, Hiroyuki Asama, Hiroshi Shimizu, Kentaro Sato, Rei Ohira, Jun Nakamura, Tsunetaka Kato, Takumi Yanagita, Mitsuru Otsuka, Takuto Hikichi, Hiromasa Ohira
World Journal of Gastrointestinal Endoscopy.2025;[Epub] CrossRef
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Masahiro Itonaga, Takeshi Ogura, Mamoru Takenaka, Kazuyuki Matsumoto, Hideyuki Shiomi, Shuhei Shintani, Hideki Kamada, Taro Yamashita, Koichiro Mandai, Masanori Asada, Hajime Imai, Kotaro Takeshita, Tsukasa Ikeura, Nao Fujimori, Makiko Kinoshita, Kenji Ik
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Mitsuru Sugimoto, Tadayuki Takagi, Rei Suzuki, Yuichi Waragai, Hiroyuki Asama, Hiroshi Shimizu, Kentaro Sato, Kento Osawa, Rei Ohira, Jun Nakamura, Mika Takasumi, Tsunetaka Kato, Takumi Yanagita, Mitsuru Otsuka, Takuto Hikichi, Hiromasa Ohira
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Kotaro Takeshita, Susumu Hijioka, Yoshikuni Nagashio, Yuta Maruki, Akihiro Ohba, Yuki Kawasaki, Tetsuro Takasaki, Shin Yagi, Daiki Agarie, Hidenobu Hara, Yuya Hagiwara, Daiki Yamashige, Kohei Okamoto, Soma Fukuda, Masaru Kuwada, Mark Chatto, Shunsuke Kond
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Dong Kee Jang, Dong Wook Lee, Seong-Hun Kim, Kwang Bum Cho, Sundeep Lakhtakia
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The updated Asia-Pacific consensus statement on the role of endoscopic management in malignant hilar biliary obstruction
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Endoscopy International Open.2024; 12(09): E1065. CrossRef
Hepaticogastrostomy versus hepaticogastrostomy with antegrade stenting for malignant biliary obstruction: a systematic review and meta-analysis
Panagiotis Paraskevopoulos, Mahmoud Obeidat, Dániel Bednárik, Petrana Martinekova, Dániel Sándor Veres, Nándor Faluhelyi, Alexandra Mikó, Péter Mátrai, Péter Hegyi, Bálint Erőss
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Samuel Han, Georgios I. Papachristou
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6,210 View
255 Download
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Diagnostic value of homogenous delayed enhancement in contrast-enhanced computed tomography images and endoscopic ultrasound-guided tissue acquisition for patients with focal autoimmune pancreatitis: Keisuke Yonamine, Shinsuke Koshita, Yoshihide Kanno, Takahisa Ogawa, Hiroaki Kusunose, Toshitaka Sakai, Kazuaki Miyamoto, Fumisato Kozakai, Hideyuki Anan, Haruka Okano, Masaya Oikawa, Takashi Tsuchiya, Takashi Sawai, Yutaka Noda, Kei Ito; Clin Endosc 2023;56(4):510-520. Published online April 5, 2023; DOI: https://doi.org/10.5946/ce.2022.142

Graphical Abstract Abstract PDF PubReader ePub

Background
/Aims: We aimed to investigate (1) promising clinical findings for the recognition of focal type autoimmune pancreatitis (FAIP) and (2) the impact of endoscopic ultrasound (EUS)-guided tissue acquisition (EUS-TA) on the diagnosis of FAIP.
Methods
Twenty-three patients with FAIP were involved in this study, and 44 patients with resected pancreatic ductal adenocarcinoma (PDAC) were included in the control group.
Results
(1) Multivariate analysis revealed that homogeneous delayed enhancement on contrast-enhanced computed tomography was a significant factor indicative of FAIP compared to PDAC (90% vs. 7%, p=0.015). (2) For 13 of 17 FAIP patients (76.5%) who underwent EUS-TA, EUS-TA aided the diagnostic confirmation of AIPs, and only one patient (5.9%) was found to have AIP after surgery. On the other hand, of the six patients who did not undergo EUS-TA, three (50.0%) underwent surgery for pancreatic lesions.
Conclusions
Homogeneous delayed enhancement on contrast-enhanced computed tomography was the most useful clinical factor for discriminating FAIPs from PDACs. EUS-TA is mandatory for diagnostic confirmation of FAIP lesions and can contribute to a reduction in the rate of unnecessary surgery for patients with FAIP.

Citations

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Predictive factors for the diagnosis of autoimmune pancreatitis using endoscopic ultrasound-guided tissue acquisition: a retrospective study in Japan
Keisuke Yonamine, Shinsuke Koshita, Yoshihide Kanno, Takahisa Ogawa, Hiroaki Kusunose, Toshitaka Sakai, Kazuaki Miyamoto, Fumisato Kozakai, Haruka Okano, Yuto Matsuoka, Kento Hosokawa, Hidehito Sumiya, Yutaka Noda, Kei Ito
Clinical Endoscopy.2025; 58(3): 457. CrossRef
A new era for autoimmune pancreatitis diagnosis: fine-needle biopsy outperforms fine-needle aspiration in endoscopic ultrasound-guided tissue acquisition
Gunn Huh, Tae Jun Song
Clinical Endoscopy.2025; 58(3): 406. CrossRef
Role of endoscopic ultrasound in diagnosis and management of autoimmune pancreatitis
Gauri Kumbhar, Akhil Mahajan, Rahul Puri, Sridhar Sundaram
Indian Journal of Gastroenterology.2025; 44(6): 824. CrossRef
A multidisciplinary approach is essential for differentiating autoimmune pancreatitis from pancreatic adenocarcinoma
Sung-Hoon Moon
Clinical Endoscopy.2023; 56(4): 457. CrossRef

4,811 View
102 Download
4 Web of Science
4 Crossref

Case Report

Single-pigtail plastic stent made from endoscopic nasobiliary drainage tubes in endoscopic ultrasound-guided gallbladder drainage: a retrospective case series: Koichi Soga; Clin Endosc 2024;57(2):263-267. Published online April 4, 2023; DOI: https://doi.org/10.5946/ce.2022.213

Abstract PDF Supplementary Material PubReader ePub

Technical failure of endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) is often attributed to device failure. To rectify this problem, we developed a single-pigtail plastic stent (SPPS) for EUS-GBD. We retrospectively reviewed the cases of four patients who underwent EUS-GBD for acute cholecystitis. To prepare the SPPS, a 7.5-Fr endoscopic nasobiliary drainage tube was cut to an appropriate length. The use of SPPS during EUS-GBD was successful from both technical and clinical standpoints. The SPPS spontaneously detached 57 days after the procedure in patient 4 and 412 days after the procedure in patient 1. Patient 1 developed cholecystitis after 426 days and was managed with antibiotics. The other three patients did not develop any complications after surgery. In conclusion, we designed a new SPPS dedicated to EUS-GBD and established its technical feasibility and clinical effectiveness.

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Direct-view endoscopic ultrasound-guided fibrotic hepaticojejunostomy stricture managed with a modified stent tube
Koichi Soga, Mayumi Yamaguchi, Masaru Kuwada, Ryosaku Shirahashi, Ikuhiro Kobori, Masaya Tamano
Endoscopy.2026; 58(S 01): E104. CrossRef
Adjunctive Role of a Modified Single-Pigtail Plastic Stent in Managing Mucin-Related Stent Dysfunction in IPMN
Koichi Soga, Ikuhiro Kobori, Masaya Tamano
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Wen-Jing Li, Na Mi, Xi Huang, Chang-Sha Liu, Shu-Ting Zhang, Yu Liao, Yan Yu
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Endoscopic ultrasound-guided retrieval of a migrated plastic stent from a pelvic abscess
Koichi Soga, Yuto Suzuki, Fuki Hayakawa, Takeshi Fujiwara, Yo Fujimoto, Ikuhiro Kobori, Masaya Tamano
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Usefulness of inserting a modified single‐pigtail plastic stent into a metallic stent in endoscopic ultrasound-guided gallbladder drainage
Koichi Soga
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Original Article

Clinical utility of endoscopic ultrasound-guided tissue acquisition for comprehensive genomic profiling of pancreatic cancer: Nozomi Okuno, Kazuo Hara, Nobumasa Mizuno, Shin Haba, Takamichi Kuwahara, Yasuhiro Kuraishi, Daiki Fumihara, Takafumi Yanaidani; Clin Endosc 2023;56(2):221-228. Published online March 7, 2023; DOI: https://doi.org/10.5946/ce.2022.086

Abstract PDF PubReader ePub

Background
/Aims: Endoscopic ultrasound-guided tissue acquisition (EUS-TA) is essential for the diagnosis of pancreatic cancer. The feasibility of comprehensive genomic profiling (CGP) using samples obtained by EUS-TA has been under recent discussion. This study aimed to evaluate the utility of EUS-TA for CGP in a clinical setting.
Methods
CGP was attempted in 178 samples obtained from 151 consecutive patients with pancreatic cancer at the Aichi Cancer Center between October 2019 and September 2021. We evaluated the adequacy of the samples for CGP and determined the factors associated with the adequacy of the samples obtained by EUS-TA retrospectively.
Results
The overall adequacy for CGP was 65.2% (116/178), which was significantly different among the four sampling methods (EUS-TA vs. surgical specimen vs. percutaneous biopsy vs. duodenal biopsy, 56.0% [61/109] vs. 80.4% [41/51] vs. 76.5% [13/17] vs. 100.0% [1/1], respectively; p=0.022). In a univariate analysis, needle gauge/type was associated with adequacy (22 G fine-needle aspiration vs. 22 G fine-needle biopsy [FNB] vs. 19 G-FNB, 33.3% (5/15) vs. 53.5% (23/43) vs. 72.5% (29/40); p=0.022). The sample adequacy of 19 G-FNB for CGP was 72.5% (29/40), and there was no significant difference between 19 G-FNB and surgical specimens (p=0.375).
Conclusions
To obtain adequate samples for CGP with EUS-TA, 19 G-FNB was shown to be the best in clinical practice. However, 19 G-FNB was not still sufficient, so further efforts are required to improve adequacy for CGP.

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220 Download
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Review

Endoscopic ultrasound-guided intervention for inaccessible papilla in advanced malignant hilar biliary obstruction: Partha Pal, Sundeep Lakhtakia; Clin Endosc 2023;56(2):143-154. Published online February 17, 2023; DOI: https://doi.org/10.5946/ce.2022.198

Abstract PDF PubReader ePub

Advanced malignant hilar biliary obstruction (MHBO) with inaccessible papilla poses a significant challenge to endoscopists, as drainage of multiple liver segments may be warranted. Transpapillary drainage may not be feasible in patients with surgically altered anatomy, duodenal stenosis, prior duodenal self-expanding metal stent, and after initial transpapillary drainage, but require re-intervention for draining separated liver segments. Endoscopic ultrasound-guided biliary drainage (EUS-BD) and percutaneous trans-hepatic biliary drainage are the feasible options in this scenario. The major advantages of EUS-BD over percutaneous trans-hepatic biliary drainage include a reduction in patient discomfort and internal drainage away from the tumor, thus reducing the possibility of tissue or tumor ingrowth. With innovations, EUS-BD is helpful not only for bilateral communicating MHBO but also for non-communicating systems with bridging hilar stents or isolated right intra-hepatic duct drainage by hepatico-duodenostomy. EUS-guided multi-stent drainage with specially designed cannulas and guidewires has become a reality. A combined approach with endoscopic retrograde cholangiopancreatography for re-intervention, interventional radiology, and intraductal tumor ablative therapies has been reported. Stent migration and bile leakage can be minimized with proper stent selection and technique, and stent blocks can be managed with EUS-guided interventions in a majority of cases. Future comparative studies are required to establish the role of EUS-guided interventions in MHBO as rescue or primary therapy.

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Endoscopic Ultrasound‐Guided Bilateral Stent‐in‐Stent Deployment With Hepaticoenterostomy in patients With Malignant Hilar Biliary Obstruction
Tadahisa Inoue, Rena Kitano, Tomoya Kitada, Kazumasa Sakamoto, Satoshi Kimoto, Jun Arai, Kiyoaki Ito
Journal of Gastroenterology and Hepatology.2026;[Epub] CrossRef
Feasibility of Endoscopic Ultrasound-Guided Hepaticogastrostomy for Malignant Hilar Biliary Obstruction
Akihisa Ohno, Nao Fujimori, Toyoma Kaku, Yuzo Shimokawa, Tsukasa Miyagahara, Yuta Suehiro, Anthony Gerodias, Shotaro Kakehashi, Kazuhide Matsumoto, Masatoshi Murakami, Keijiro Ueda, Yoshihiro Ogawa
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Rui Chen, Jingyi Zhang, Tianhao Chen, Jie Zhang, Rongxing Zhou
Endoscopy.2025; 57(S 01): E304. CrossRef
Novel approach to bilateral biliary drainage: EUS-guided hepaticoduodenodenostomy plus hepaticogastrostomy in malignant hilar biliary obstruction
Susumu Hijioka, Yoshikuni Nagashio, Yuta Maruki, Shota Harai, Daiki Agarie, Daiki Yamashige, Kohei Okamoto, Shin Yagi, Soma Fukuda, Yasuhiro Komori, Masaru Kuwada, Yutaka Saito, Takuji Okusaka
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First case of ultrasound-guided percutaneous transhepatic cholangioscopy with bridging for bilateral biliary drainage of malignant hilar biliary obstruction (with video)
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Daiki Yamashige, Susumu Hijioka, Yoshikuni Nagashio, Shota Harai, Yasuhiro Komori, Aoi Kita, Masaru Kuwada, Soma Fukuda, Shin Yagi, Kohei Okamoto, Daiki Agarie, Shunsuke Sugawara, Miyuki Sone, Yutaka Saito, Takuji Okusaka
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Woo Hyun Paik, Do Hyun Park
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Systematic Review and Meta-analysis

Influence of biliary stents on the diagnostic outcome of endoscopic ultrasound–guided tissue acquisition from solid pancreatic lesions: a systematic review and meta-analysis: Suprabhat Giri, Shivaraj Afzalpurkar, Sumaswi Angadi, Jijo Varghese, Sridhar Sundaram; Clin Endosc 2023;56(2):169-179. Published online February 15, 2023; DOI: https://doi.org/10.5946/ce.2022.282

Abstract PDF Supplementary Material PubReader ePub

Background
/Aims: This meta-analysis analyzed the effect of an indwelling biliary stent on endoscopic ultrasound (EUS)–guided tissue acquisition from pancreatic lesions.
Methods
A literature search was performed to identify studies published between 2000 and July 2022 comparing the diagnostic outcomes of EUS-TA in patients with or without biliary stents. For non-strict criteria, samples reported as malignant or suspicious for malignancy were included, whereas for strict criteria, only samples reported as malignant were included in the analysis.
Results
Nine studies were included in this analysis. The odds of an accurate diagnosis were significantly lower in patients with indwelling stents using both non-strict (odds ratio [OR], 0.68; 95% confidence interval [CI], 0.52–0.90) and strict criteria (OR, 0.58; 95% CI, 0.46–0.74). The pooled sensitivity with and without stents were similar (87% vs. 91%) using non-strict criteria. However, patients with stents had a lower pooled sensitivity (79% vs. 88%) when using strict criteria. The sample inadequacy rate was comparable between groups (OR, 1.12; 95% CI, 0.76–1.65). The diagnostic accuracy and sample inadequacy were comparable between plastic and metal biliary stents.
Conclusions
The presence of a biliary stent may negatively affect the diagnostic outcome of EUS-TA for pancreatic lesions.

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Comparison of standard vs auxiliary (contrast or elastography) endoscopic ultrasound-guided fine needle aspiration/biopsy in solid pancreatic lesions: A meta-analysis
Mitali Madhumita Rath, Prajna Anirvan, Jijo Varghese, Tara Prasad Tripathy, Ranjan K Patel, Manas Kumar Panigrahi, Suprabhat Giri
World Journal of Methodology.2025;[Epub] CrossRef
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Abhirup Chatterjee, Jimil Shah
Diagnostics.2023; 14(1): 78. CrossRef

5,078 View
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2 Crossref

Original Articles

Role of interventional endoscopic ultrasound in a developing country: Hasan Maulahela, Nagita Gianty Annisa, Achmad Fauzi, Kaka Renaldi, Murdani Abdullah, Marcellus Simadibrata, Dadang Makmun, Ari Fahrial Syam; Clin Endosc 2023;56(1):100-106. Published online January 17, 2023; DOI: https://doi.org/10.5946/ce.2022.058

Abstract PDF PubReader ePub

Background
/Aims: Endoscopic ultrasound (EUS) has become an essential diagnostic and therapeutic tool. EUS was introduced in 2013 in Indonesia and is considered relatively new. This study aimed to describe the current role of interventional EUS at our hospital as a part of the Indonesian tertiary health center experience.
Methods
This retrospective study included all patients who underwent interventional EUS (n=94) at our center between January 2015 and December 2020. Patient characteristics, technical success, clinical success, and adverse events associated with each type of interventional EUS procedure were evaluated.
Results
Altogether, 94 interventional EUS procedures were performed at our center between 2015 and 2020 including 75 cases of EUS-guided biliary drainage (EUS-BD), 14 cases of EUS-guided pancreatic fluid drainage, and five cases of EUS-guided celiac plexus neurolysis. The technical and clinical success rates of EUS-BD were 98.6% and 52%, respectively. The technical success rate was 100% for both EUS-guided pancreatic fluid drainage and EUS-guided celiac plexus neurolysis. The adverse event rates were 10.6% and 7.1% for EUS-BD and EUS-guided pancreatic fluid drainage, respectively.
Conclusions
EUS is an effective and safe tool for the treatment of gastrointestinal and biliary diseases. It has a low rate of adverse events, even in developing countries.

Citations

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EUS-guided interventional therapies for pancreatic diseases
Rongmin Xu, Kai Zhang, Nan Ge, Siyu Sun
Frontiers in Medicine.2024;[Epub] CrossRef

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184 Download
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A multicenter comparative study of endoscopic ultrasound-guided fine-needle biopsy using a Franseen needle versus conventional endoscopic ultrasound-guided fine-needle aspiration to evaluate microsatellite instability in patients with unresectable pancreatic cancer: Tadayuki Takagi, Mitsuru Sugimoto, Hidemichi Imamura, Yosuke Takahata, Yuki Nakajima, Rei Suzuki, Naoki Konno, Hiroyuki Asama, Yuki Sato, Hiroki Irie, Jun Nakamura, Mika Takasumi, Minami Hashimoto, Tsunetaka Kato, Ryoichiro Kobashi, Yuko Hashimoto, Goro Shibukawa, Shigeru Marubashi, Takuto Hikichi, Hiromasa Ohira; Clin Endosc 2023;56(1):107-113. Published online January 16, 2023; DOI: https://doi.org/10.5946/ce.2022.019

Abstract PDF PubReader ePub

Background
/Aims: Immune checkpoint blockade has recently been reported to be effective in treating microsatellite instability (MSI)-high tumors. Therefore, sufficient sampling of histological specimens is necessary in cases of unresectable pancreatic cancer (UR-PC). This multicenter study investigated the efficacy of endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) using a Franseen needle for MSI evaluation in patients with UR-PC.
Methods
A total of 89 patients with UR-PC who underwent endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) or EUS-FNB using 22-G needles at three hospitals in Japan (2018–2021) were enrolled. Fifty-six of these patients (FNB 23 and FNA 33) were followed up or evaluated for MSI. Patient characteristics, UR-PC data, and procedural outcomes were compared between patients who underwent EUS-FNB and those who underwent EUS-FNA.
Results
No significant difference in terms of sufficient tissue acquisition for histology was observed between patients who underwent EUS-FNB and those who underwent EUS-FNA. MSI evaluation was possible significantly more with tissue samples obtained using EUS-FNB than with tissue samples obtained using EUS-FNA (82.6% [19/23] vs. 45.5% [15/33], respectively; p<0.01). In the multivariate analysis, EUS-FNB was the only significant factor influencing the possibility of MSI evaluation.
Conclusions
EUS-FNB using a Franseen needle is desirable for ensuring sufficient tissue acquisition for MSI evaluation.

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Mitsuru Sugimoto, Tadayuki Takagi, Rei Suzuki, Naoki Konno, Hiroyuki Asama, Yuki Sato, Hiroki Irie, Jun Nakamura, Mika Takasumi, Minami Hashimoto, Tsunetaka Kato, Yuko Hashimoto, Takuto Hikichi, Hiromasa Ohira
Journal of Clinical Gastroenterology.2025; 59(4): 369. CrossRef
Adverse events of 20–22G second‐generation endoscopic ultrasound‐guided fine‐needle biopsy needles for solid lesions in the upper gastrointestinal tract and adjacent organs: Systematic review and meta‐analysis
Cheng‐ye Pan, Shi‐min Wang, Dong‐hao Cai, Jia‐yi Ma, Shi‐yu Li, Yibin Guo, Sun Jing, Jin Zhendong, Kaixuan Wang
Digestive Endoscopy.2025; 37(5): 490. CrossRef
Benefits of macroscopic on-site evaluation in endoscopic ultrasound-guided tissue acquisition for comprehensive genomic profiling
Junya Sato, Hirotoshi Ishiwatari, Kazuma Ishikawa, Hiroki Sakamoto, Takuya Doi, Masahiro Yamamura, Kazunori Takada, Yoichi Yamamoto, Masao Yoshida, Sayo Ito, Noboru Kawata, Kenichiro Imai, Kinichi Hotta, Hiroyuki Ono
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Oil blotting paper for formalin fixation increases endoscopic ultrasound‐guided tissue acquisition‐collected sample volumes on glass slides
Takuo Yamai, Kenji Ikezawa, Yusuke Seiki, Ko Watsuji, Yasuharu Kawamoto, Takeru Hirao, Kazuma Daiku, Shingo Maeda, Makiko Urabe, Yugo Kai, Ryoji Takada, Kaori Mukai, Tasuku Nakabori, Hiroyuki Uehara, Sayoko Tsuzaki, Ayumi Ryu, Satoshi Tanada, Shigenori Na
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MSI-H Detection by ddPCR in Endoscopic Ultrasound Fine Needle Biopsy (EUS-FNB) from Pancreatic Ductal Adenocarcinoma
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International Journal of Molecular Sciences.2024; 25(20): 11090. CrossRef

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Utility of forward-view endoscopic ultrasound in fine-needle aspiration in patients with a surgically altered upper gastrointestinal anatomy: Asmaa Bakr, Kazuo Hara, Moaz Elshair, Shin Haba, Takamichi Kuwahara, Nozomi Okuno, Daiki Fumihara, Takafumi Yanaidani, Samy Zaky, Hanaa Omar; Clin Endosc 2023;56(3):367-374. Published online January 5, 2023; DOI: https://doi.org/10.5946/ce.2021.238

Graphical Abstract Abstract PDF PubReader ePub

Background
/Aims: Endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) using oblique-view EUS in patients with a surgically altered anatomy (SAA) of the upper gastrointestinal tract is limited because of difficult scope insertion due to the disturbed anatomy. This study aimed to investigate the efficiency of forward-view (FV)-EUS in performing FNA in patients with a SAA.
Methods
We retrospectively investigated 32 patients with a SAA of the upper gastrointestinal tract who visited Aichi Cancer Center Hospital in Nagoya, Japan, between January 2014 and December 2020. We performed-upper gastrointestinal EUS-FNA using FV-EUS combined with fluoroscopic imaging to confirm tumor recurrence or to make a decision before chemotherapy or after a failure of diagnosis by radiology.
Results
We successfully performed EUS-FNA in all studied patients (100% technical success), with the specificity, sensitivity, and accuracy of 100%, 87.5%, and 87.8%, respectively, with no complications.
Conclusions
EUS-FNA using FV-EUS combined with fluoroscopic imaging is an effective and safe technique for tissue acquisition in patients with a SAA.

Citations

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Endoscopic ultrasonography-guided vascular intervention for bile duct–jejunal anastomotic variceal bleeding
Takashi Kondo, Kazuo Hara, Nozomi Okuno, Shin Haba, Takamichi Kuwahara, Minako Urata, Yoshitaro Yamamoto
Endoscopy.2025; 57(S 01): E335. CrossRef
Role of the EUS in the Treatment of Biliopancreatic Disease in Patients with Surgically Altered Anatomy
Marcello Cintolo, Edoardo Forti, Giulia Bonato, Michele Puricelli, Lorenzo Dioscoridi, Marianna Bravo, Camilla Gallo, Francesco Pugliese, Andrea Palermo, Alessia La Mantia, Massimiliano Mutignani
Diagnostics.2025; 15(21): 2707. CrossRef

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Endoscopic ultrasound-guided coiling and glue is safe and superior to endoscopic glue injection in gastric varices with severe liver disease: a retrospective case control study: Kapil D. Jamwal, Rajesh K. Padhan, Atul Sharma, Manoj K. Sharma; Clin Endosc 2023;56(1):65-74. Published online January 3, 2023; DOI: https://doi.org/10.5946/ce.2021.119

Graphical Abstract Abstract PDF Supplementary Material PubReader ePub

Background
/Aims: Gastric varices (GV) are present in 25% of cirrhotic patients with high rates of rebleeding and mortality. Data on endoscopic ultrasound (EUS)-guided treatment in severe liver disease (model for end stage liver disease sodium [MELD-Na] >18 and Child-Turcotte-Pugh [CTP] C with GV) are scarce. Thus, we performed a retrospective comparison of endoscopic glue injection with EUS-guided therapy in cirrhotic patients with large GV.
Methods
A retrospective study was performed in the tertiary hospitals of India. A total of 80 patients were recruited. The inclusion criteria were gastroesophageal varices type 2, isolated gastric varices type 1, bleeding within 6 weeks, size of GV >10 mm, and a MELD-Na >18. Treatment outcomes and complications of endoscopic glue injection and EUS-guided GV therapy were compared.
Results
In this study, the patients’ age, sex, liver disease severity (CTP, MELD-Na) and clinical parameters were comparable. The median number of procedures, injected glue volume, complications, and GV obturation were better in the EUS group, respectively. On subgroup analysis of the EUS method (e.g., direct gastric fundus vs. paragastric collateral [PGC] coil placement), PGC coil placement showed decreased coil requirement, less injected glue volume, decreased luminal coil extrusion, and increased successful GV obturation.
Conclusions
EUS-guided treatment is more efficient and safer, and requires a smaller number of treatment sessions, as compared to endoscopic treatment in severe liver disease patients with large GV. Furthermore, PGC coil placement increases the complete obliteration of GV.

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Endohepatology: Evolving Indications, Challenges, Unmet Needs and Opportunities
Akash Roy, Mithun Sharma, Anand V. Kulkarni, Sundeep Lakhtakia, Aniruddha Pratap Singh, Rakesh Kalapala, Gregory G. Ginsberg, D.Nageshwar Reddy, K. Rajender Reddy
Gastro Hep Advances.2026; 5(2): 100838. CrossRef
Endoscopic Ultrasound‐Guided Coiling Plus Glue Injection Compared With Other Endoscopic Modalities in Managing Gastric Varices: A Systematic Review and Meta‐Analysis
Zinat Mohammadpour, Maria Castrejon Moreno, Bobak Moazzami, Sanjivan Mudaliar, Roberto Trasolini, Arka De, Sahaj Rathi, Rajit Aziz Gilhotra
Journal of Gastroenterology and Hepatology.2026; 41(2): 413. CrossRef
In an era of EUS-guided interventions, direct glue injection remains relevant in management algorithm for bleeding isolated gastric varices -1
P. Krishna Bharadwaj, Santhosh E. Kumar, Sudipta Dhar Chowdhury, Ebby George Simon, Shyamkumar Nidugala Keshava, A. J. Joseph, Reuben Thomas Kurien, Uday George Zachariah, Ashish Goel
Indian Journal of Gastroenterology.2025; 44(3): 392. CrossRef
EUS-guided coiling plus glue injection compared with endoscopic glue injection alone in endoscopic treatment for gastric varices: a systematic review and meta-analysis
Cynthia Florencio de Mesquita, Vanio L.J. Antunes, Natalia Junkes Milioli, Matheus Vanzin Fernandes, Tulio L. Correa, Otavio Cosendey Martins, Radhika Chavan, Stefano Baraldo
Gastrointestinal Endoscopy.2025; 101(2): 331. CrossRef
Endoscopic Cyanoacrylate Injection in the Management of Gastric Varices: Long-Term Safety and Efficacy
Anand Kumar Raghavendran, Shiran Shetty, Balaji Musunuri, Siddheesh Rajpurohit, Preety Kumari, Suriya Nedunchezhian, Athish Shetty, C. Ganesh Pai, Ganesh Bhat
Journal of Digestive Endoscopy.2025; 16(01): 037. CrossRef
Advances in Endo-Hepatology: The Role of Endoscopic Ultrasound in the Management of Portal Hypertension
Angelo Bruni, Giuseppe Dell’Anna, Jayanta Samanta, Jacopo Fanizza, Francesco Vito Mandarino, Jahnvi Dhar, Antonio Facciorusso, Vito Annese, Sara Massironi, Alberto Malesci, Giovanni Marasco, Elton Dajti, Leonardo Henry Eusebi, Giovanni Barbara, Gianfranco
Diagnostics.2025; 15(8): 967. CrossRef
Endoscopic ultrasound-guided coil embolization for gastric varices: A promising alternative to traditional therapies
Anthony El Dada, Mandy El Khoury, Peter Stephan, Fredy Nehme
World Journal of Gastrointestinal Endoscopy.2025;[Epub] CrossRef
Endoscopic Histoacryl injection with clips is associated with lower early rebleeding compared to Histoacryl injection alone in the treatment of gastric varices
Yingfeng Wei, Shenggang Huang, Chunping Zhu, Jiaming Huang
BMC Gastroenterology.2025;[Epub] CrossRef
Efficacy of clip-assisted endoscopic cyanoacrylate injection therapy for gastric varices: A Meta-analysis
Yong-Cai Lv, Yan-Hua Yao, Jing-Jing Lei
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Xin‐Tong Chi, Ting‐Ting Lian, Ze‐Hao Zhuang
Digestive Endoscopy.2024; 36(8): 884. CrossRef
EUS-Guided Vascular Interventions: Recent Advances
Sahib Singh, Saurabh Chandan, Sumant Inamdar, Kambiz S. Kadkhodayan, Jahnvi Dhar, Jayanta Samanta, Antonio Facciorusso
Journal of Clinical Medicine.2024; 13(16): 4835. CrossRef
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S.V. Mikhin, P.V. Mozgovoy, A.V. Kitaeva, D.E. Gorbunov, I.V. Mikhin
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EUS-Guided Coil Placement for Secondary Prophylaxis in Large Gastric Varices - A Pediatric Case Report Authors
Guillermo Costaguta, Alejandro Costaguta
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Endoscopic ultrasound-guided therapies in the treatment of gastric varices: An in-depth examination of associated adverse events
Anastasios Manolakis, Kyriaki Tsagkidou, Konstantinos Eleftherios Koumarelas
World Journal of Gastrointestinal Endoscopy.2024; 16(12): 640. CrossRef
Safety and Efficacy of Novel Cost-Effective EUS Coiling and Glue Technique for the Management of Large Gastric Varices: A Long-Term Follow-up Study
Shivam Khare, Anil Arora, Jijo Varghese, Vikas Singla, Asif Rahman, Ashish Kumar, Piyush Ranjan, Mandhir Kumar, Praveen Sharma, Naresh Bansal, Shrihari Anikhindi, Munish Sachdeva, Asheish Khandelwal, Mayank Gupta, Suprabhat Giri
Journal of Digestive Endoscopy.2024; 15(04): 222. CrossRef
Role of endoscopic ultrasound in the secondary prevention of gastric varices
Joung-Ho Han
Clinical Endoscopy.2023; 56(1): 50. CrossRef
Management of Gastric Varices: GI Perspective
Catherine Vozzo, Vibhu Chittajallu, Brooke Glessing, Ashley Faulx, Amitabh Chak, Richard C.K. Wong
Digestive Disease Interventions.2023; 07(04): 266. CrossRef

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Is antibiotic prophylaxis necessary after endoscopic ultrasound–guided fine-needle aspiration of pancreatic cysts?: Seifeldin Hakim, Mihajlo Gjeorgjievski, Zubair Khan, Michael E. Cannon, Kevin Yu, Prithvi Patil, Roy Tomas DaVee, Sushovan Guha, Ricardo Badillo, Laith Jamil, Nirav Thosani, Srinivas Ramireddy; Clin Endosc 2022;55(6):801-809. Published online November 10, 2022; DOI: https://doi.org/10.5946/ce.2021.150

Abstract PDF PubReader ePub

Background
/Aims: Current society guidelines recommend antibiotic prophylaxis for 3 to 5 days after endoscopic ultrasound–guided fine-needle aspiration (EUS-FNA) of pancreatic cystic lesions (PCLs). The overall quality of the evidence supporting this recommendation is low. In this study, we aimed to assess cyst infection and adverse event rates after EUS-FNA of PCLs among patients treated with or without postprocedural prophylactic antibiotics.
Methods
We retrospectively reviewed all patients who underwent EUS-FNA of PCLs between 2015 and 2019 at two large-volume academic medical centers with different practice patterns of postprocedural antibiotic prophylaxis. Data on patient demographics, cyst characteristics, fine-needle aspiration technique, periprocedural and postprocedural antibiotic prophylaxis, and adverse events were retrospectively extracted.
Results
A total of 470 EUS-FNA procedures were performed by experienced endosonographers for the evaluation of PCLs in 448 patients, 58.7% of whom were women. The mean age was 66.3±12.8 years. The mean cyst size was 25.7±16.9 mm. Postprocedural antibiotics were administered in 274 cases (POSTAB+ group, 58.3%) but not in 196 cases (POSTAB– group, 41.7%). None of the patients in either group developed systemic or localized infection within the 30-day follow-up period. Procedure-related adverse events included mild abdominal pain (8 patients), intra-abdominal hematoma (1 patient), mild pancreatitis (1 patient), and perforation (1 patient). One additional case of pancreatitis was recorded; however, the patient also underwent endoscopic retrograde cholangiopancreatography.
Conclusions
The incidence of infection after EUS-FNA of PCLs is negligible. Routine use of postprocedural antibiotics does not add a significant benefit.

Citations

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Risk of Pancreatitis After Endoscopic Ultrasound-Guided Fine-Needle Aspiration of Pancreatic Cystic Lesions: A Systematic Review and Meta-Analysis
Patrick T. Magahis, Ankit Chhoda, Tyler M. Berzin, James J. Farrell, Drew N. Wright, Anam Rizvi, Mark Hanscom, David L. Carr-Locke, Kartik Sampath, Reem Z. Sharaiha, SriHari Mahadev
American Journal of Gastroenterology.2024; 119(11): 2174. CrossRef
III BRAZILIAN CONSENSUS STATEMENT ON ENDOSCOPIC ULTRASOUND
Ricardo Rangel de Paula PESSOA, Alexandre Moraes BESTETTI, Victor Lira de OLIVEIRA, Wladimir Campos de ARAUJO, Simone GUARALDI, Rodrigo Roda RODRIGUES SILVA, Francisco Antonio Araujo OLIVEIRA, Maria Sylvia Ierardi RIBEIRO, Fred Olavo Aragão Andrade CARNEI
Arquivos de Gastroenterologia.2024;[Epub] CrossRef

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Review

Endoscopic ultrasound-directed transgastric endoscopic retrograde cholangiopancreatography for patients with Roux-en-Y gastric bypass anatomy: technical overview: Hirokazu Honda, Jeffrey D. Mosko, Ryosuke Kobayashi, Andras Fecso, Bong Sik Kim, Schoeman Scott, Gary R. May; Clin Endosc 2022;55(6):736-741. Published online October 5, 2022; DOI: https://doi.org/10.5946/ce.2022.114

Abstract PDF PubReader ePub

Endoscopic retrograde cholangiopancreatography (ERCP) in patients with Roux-en-Y gastric bypass anatomy is a well-documented challenge. Traditionally, this problem has been overcome with adjunctive techniques, such as device-assisted ERCP, including double-balloon or single-balloon enteroscopy and laparoscopy-assisted transgastric ERCP. Endoscopic ultrasound-directed transgastric ERCP (EDGE) is a novel technique that enables access to the ampulla using a duodenoscope without surgical intervention and has shown high clinical and technical success rates in recent studies. However, this approach is technically demanding, necessitating a thorough understanding of the gastrointestinal anatomy as well as high operator experience. In this review, we provide a technical overview of EDGE in parallel with our personal experience at our center and propose a simple algorithm to select patients for its appropriate application. In conjunction, the outcomes of EDGE compared with those of device-assisted and laparoscopy-assisted transgastric ERCP will be discussed.

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Surgical Palliation for Pancreatic Cancer
Adriana C. Gamboa, Rebecca A. Snyder
Surgical Oncology Clinics of North America.2026; 35(1): 167. CrossRef
Biliary Drainage in Altered Anatomy: A Comprehensive Literature Review
Rishi Chowdhary, Jorge D. Machicado, Veeral M. Oza
Journal of Digestive Endoscopy.2026;[Epub] CrossRef
Interventional Endoscopic Ultrasonography: Advances in Application
Haidar Khan, Sharon Slomovich, Neal C. Shah, Frank Gress
Journal of Clinical Medicine.2025; 14(10): 3286. CrossRef
Endoscopic Ultrasound-Directed Transgastric Endoscopic Retrograde Cholangiopancreatography (EDGE): Techniques, Outcomes and Safety Profiles
Filippo Antonini, Giacomo Emanuele Maria Rizzo, Giuseppe Vanella, Lorenzo Fuccio, Andrea Lisotti, Michiel Bronswijk, Enrique Pérez-Cuadrado-Robles, Cecilia Binda, Stefano Mazza, Andrea Anderloni, Carlo Fabbri, Ilaria Tarantino
Journal of Clinical Medicine.2025; 14(16): 5675. CrossRef
Current status and further directions of endoscopic ultrasound-directed transgastric ERCP and endoscopic ultrasound-directed transenteric ERCP in the management of pancreaticobiliary diseases in surgically altered anatomy: a comprehensive review
Giuseppe Dell’Anna, Angelo Bruni, Jacopo Fanizza, Paolo Biamonte, Sarah Bencardino, Francesco Vito Mandarino, Ernesto Fasulo, Alberto Barchi, Camilla Gallo, Jahnvi Dhar, Jayanta Samanta, Antonio Facciorusso, Ivo Boskoski, Sara Massironi, Vito Annese, Albe
Therapeutic Advances in Gastroenterology.2025;[Epub] CrossRef
Endoscopic ultrasound-directed transgastric endoscopic retrograde cholangiopancreatography procedure for choledocholithiasis after sleeve gastrectomy and Roux-en-Y
Reid D. Wasserman, Varun Kesar, Vivek Kesar, Paul Yeaton, Shehriyar Mehershahi
Endoscopy.2024; 56(S 01): E390. CrossRef
Complications of Post-Roux-en-Y Gastric Bypass: A Case of Excluded Stomach Perforation
C. Ryan Williams, Nathaniel Grabill, Mena Louis, Deepak Dev Vivekanandan, Timothy Stevens
Cureus.2024;[Epub] CrossRef
A novel endoscopic ultrasound-guided transluminal anchor device
Abhishek Agnihotri, Alexander Schlachterman
Endoscopy.2023; 55(S 01): E775. CrossRef

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Systematic Review and Meta-Analysis

Mucosal incision-assisted biopsy versus endoscopic ultrasound-assisted tissue acquisition for subepithelial lesions: a systematic review and meta-analysis: Suprabhat Giri, Shivaraj Afzalpurkar, Sumaswi Angadi, Sridhar Sundaram; Clin Endosc 2022;55(5):615-625. Published online August 4, 2022; DOI: https://doi.org/10.5946/ce.2022.133

Abstract PDF Supplementary Material PubReader ePub

Background
/Aims: Mucosal incision-assisted biopsy (MIAB) for tissue acquisition (TA) from subepithelial lesions (SELs) is emerging as an alternative to endoscopic ultrasound (EUS)-guided TA. Only a limited number of studies compared the diagnostic utility of MIAB and EUS for upper gastrointestinal (GI) SELs; therefore, we conducted this systematic review and meta-analysis.
Methods
A comprehensive literature search from January 2020 to January 2022 was performed to compare the diagnostic accuracy and safety of MIAB and EUS-guided TA for upper GI SELs.
Results
Seven studies were included in this meta-analysis. The pooled technical success rate (risk ratio [RR], 0.96; 95% confidence interval [CI], 0.89–1.04) and procedural time (mean difference=–4.53 seconds; 95% CI, –22.38 to 13.31] were comparable between both the groups. The overall chance of obtaining a positive diagnostic yield was lower with EUS than with MIAB for all lesions (RR, 0.83; 95% CI, 0.71–0.98) but comparable when using a fine-needle biopsy needle (RR, 0.93; 95% CI, 0.83–1.04). The positive diagnostic yield of MIAB was higher for lesions <20 mm (RR, 0.75; 95% CI, 0.63–0.89). Six studies reported no adverse events.
Conclusions
MIAB can be considered an effective alternative to EUS-guided TA for upper GI SELs without an increased risk of adverse events.

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Endoscopic Diagnosis of Gastric Subepithelial Lesions < 20 mm: Current Strategies and Emerging Solutions
Yosuke Minoda, Shuzaburo Nagatomo, Haruei Ogino, Nao Fujimori, Eikichi Ihara
Digestive Endoscopy.2026;[Epub] CrossRef
Population-Based Efficacy of Tissue Acquisition for Subepithelial Lesions in the Upper Gastrointestinal Tract
Cynthia A. Verloop, Lieke Hol, Lars Perk, Femme Dircksmeier-Harinck, Pieter Honkoop, Tessa Romkens, Ingrid Schot, Jilling Bergmann, Rutger Quispel, Marco J. Bruno, Lydi M.J.W. van Driel
Journal of Clinical Gastroenterology.2026;[Epub] CrossRef
Diagnostic ability and adverse events of mucosal incision‐assisted biopsy for gastric subepithelial tumors: Systematic review and meta‐analysis
Eriko Koizumi, Osamu Goto, Akihisa Matsuda, Toshiaki Otsuka, Yumiko Ishikawa, Shun Nakagome, Masahiro Niikawa, Tsugumi Habu, Keiichiro Yoshikata, Kumiko Kirita, Hiroto Noda, Kazutoshi Higuchi, Takeshi Onda, Jun Omori, Naohiko Akimoto, Hiroshi Yoshida, Kat
Digestive Endoscopy.2025; 37(3): 236. CrossRef
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Yulia V. Mikheeva, Pavel O. Rumyantsev, Konstantin K. Puzakov, Konstantin Yu. Slashchuk, Daniil D. Omelchuk, Anastasia V. Potapenko, Sergey P. Medvedev
Russian Journal of Oncology.2025; 30(1): 41. CrossRef
Approach to upper gastrointestinal subepithelial lesions
Shrihari Anil Anikhindi, Rajesh Puri, Noriya Uedo, Kamlesh Taori, Anil Arora
Expert Review of Gastroenterology & Hepatology.2025; 19(7): 789. CrossRef
Diagnostic challenges of inflammatory submucosal tumor-like lesions: a multicenter propensity score-matching analysis
Mengting Yu, Jiao Li, Yongfeng Yan, Xiaoxiang Wang, Yanhui Mao, Dandan Jiang, Zhengkui Zhou, Yuanyuan Chen, Xiaobin Sun
BMC Gastroenterology.2025;[Epub] CrossRef
Technical outcomes and postprocedural courses of mucosal incision‐assisted biopsy for possible gastric gastrointestinal stromal tumors: A series of 48 cases (with video)
Eriko Koizumi, Osamu Goto, Shun Nakagome, Tsugumi Habu, Yumiko Ishikawa, Kumiko Kirita, Hiroto Noda, Kazutoshi Higuchi, Takeshi Onda, Teppei Akimoto, Jun Omori, Naohiko Akimoto, Katsuhiko Iwakiri
DEN Open.2024;[Epub] CrossRef
The Diagnostic Approach of Benign Esophageal Tumors: A Narrative Review
Alex R. Jones, Preksha Vankawala, Tarek Sawas
Current Treatment Options in Gastroenterology.2024; 22(2): 44. CrossRef
Unroofing of subepithelial lesions in the upper gastrointestinal tract using cold snare: an easy and efficient technique for diagnosis
Bernhard Morell, Frans Olivier The, Christoph Gubler, Fritz Ruprecht Murray
Clinical Endoscopy.2024; 57(2): 274. 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
Small gastric subepithelial lesions: A sand in the eye
Tanyaporn Chantarojanasiri, Nikhil Sonthalia, Rashid N. Lui
Journal of Gastroenterology and Hepatology.2024; 39(7): 1207. CrossRef
EUS‐guided tissue acquisition from gastric subepithelial lesions—The optimal technique still remains undecided
Suprabhat Giri, Sridhar Sundaram
Australasian Journal of Ultrasound in Medicine.2024; 27(4): 263. 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
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Efficacy of EUS-guided keyhole biopsies in diagnosing subepithelial lesions of the upper gastrointestinal tract
Sen Verhoeve, Cynthia Verloop, Marco Bruno, Valeska Terpstra, Lydi Van Driel, Lars Perk, Lieke Hol
Endoscopy International Open.2024; 12(10): E1183. CrossRef
Approach to Small Gastric Subepithelial Lesions
Moon Won Lee, Bong Eun Lee
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Is the canalization to obtain deep biopsy of gastrointestinal subepithelial tumors miniprobe-guidded as an alternative to conventional known techniques?
Modesto Varas Lorenzo, Ramón Abad Belando
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Harishankar Gopakumar, Vinay Jahagirdar, Jagadish Koyi, Dushyant Singh Dahiya, Hemant Goyal, Neil R. Sharma, Abhilash Perisetti
Cancers.2023; 15(16): 4175. CrossRef

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Case Reports

Endoscopic ultrasound-guided portal vein coiling: troubleshooting interventional endoscopic ultrasonography: Shin Haba, Kazuo Hara, Nobumasa Mizuno, Takamichi Kuwahara, Nozomi Okuno, Akira Miyano, Daiki Fumihara, Moaz Elshair; Clin Endosc 2022;55(3):458-462. Published online November 30, 2021; DOI: https://doi.org/10.5946/ce.2021.114

Abstract PDF Supplementary Material PubReader ePub

Endoscopic ultrasound (EUS)-guided hepaticogastrostomy (HGS) is widely performed not only as an alternative to transpapillary biliary drainage, but also as primary drainage for malignant biliary obstruction. For anatomical reasons, this technique carries an unavoidable risk of mispuncturing intrahepatic vessels. We report a technique for troubleshooting EUS-guided portal vein coiling to prevent bleeding from the intrahepatic portal vein after mispuncture during interventional EUS. EUS-HGS was planned for a 59-year-old male patient with unresectable pancreatic cancer. The dilated bile duct (lumen diameter, 2.8 mm) was punctured with a 19-gauge needle, and a guidewire was inserted. After bougie dilation, the guidewire was found to be inside the intrahepatic portal vein. Embolizing coils were placed to prevent bleeding. Embolization coils were successfully inserted under stabilization of the catheter using a double-lumen cannula with a guidewire. Following these procedures, the patient was asymptomatic. Computed tomography performed the next day revealed no complications.

Citations

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Endoscopic ultrasound-guided glue embolization to prevent hemorrhage after accidental tract formation to the portal venous system during hepaticogastrostomy
Chloë Hanssens, Elisabeth Dhondt, Pieter Hindryckx
Endoscopy.2026; 58(S 01): E318. CrossRef
An unusual case of high gastrointestinal bleeding after Whipple surgery
E Dubois, R Geelen
Acta Gastro Enterologica Belgica.2024; 87(3): 430. CrossRef

5,659 View
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Endoscopic Ultrasound-Guided Transgastric Puncture and Drainage of an Adrenal Abscess in an Immunosuppressed Patient: Carlos Andrés Regino, Jean Paul Gómez, Gabriel Mosquera-Klinger; Clin Endosc 2022;55(2):302-304. Published online November 16, 2021; DOI: https://doi.org/10.5946/ce.2021.090

Abstract PDF PubReader ePub: Adrenal gland infection is a clinical entity of great importance, but it is a largely unrecognized pathology. Immunosuppressed individuals are at a higher risk of presentation. Herein, we describe a young female patient, recently diagnosed with HIV, who presented with severe sepsis due to methicillin-resistant Staphylococcus aureus, associated with a left adrenal abscess. She was initially treated with antibiotics; however, due to the persistence of the systemic inflammatory response and bacteremia, endoscopic ultrasound-guided drainage was performed. This procedure was successful in resolving the clinical situation. Endoscopic ultrasound-guided adrenal gland drainage can be a safe, efficacious, and minimally invasive option for managing antibiotic-refractory adrenal abscesses in immunosuppressed patients.

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146 Download

Focused Review Series: Endoscopic Management of Postoperative Gastrointestinal Complication: What’s New?

Endoscopic Ultrasound-Guided Gastroenterostomy for Afferent Loop Syndrome: Hideyuki Shiomi, Arata Sakai, Ryota Nakano, Shogo Ota, Takashi Kobayashi, Atsuhiro Masuda, Hiroko Iijima; Clin Endosc 2021;54(6):810-817. Published online November 15, 2021; DOI: https://doi.org/10.5946/ce.2021.234

Abstract PDF PubReader ePub

Afferent loop syndrome (ALS) is a mechanical obstruction of the afferent limbs after gastrectomy with gastrojejunostomy reconstruction. Patients with cancer recurrence require immediate and less invasive treatment because of their poor condition. Percutaneous transhepatic/transluminal drainage (PTD) and endoscopic enteral stenting offer reasonable palliative treatment for malignant ALS but are not fully satisfactory in terms of patient quality of life (QoL) and stent patency. Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) using a lumen-apposing metal stent may address these shortcomings. Clinical data from 11 reports showed that all patients who had undergone EUS-GE had positive technical and clinical outcomes. The adverse event rate was 11.4%, including only mild or moderate abdominal pain, with no severe adverse events. Indirect comparative studies indicated that patients who had undergone EUS-GE had a significantly superior QoL, a higher clinical success rate, and a lower reintervention rate than those who had undergone PTD or endoscopic enteral stenting. Although the evidence is limited, EUS-GE may be considered as a first-line treatment for malignant ALS because it has better clinical outcomes than other less invasive treatments, such as PTD or endoscopic enteral stenting. Further prospective randomized control trials are necessary to establish EUS-GE as a standard treatment for ALS.

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Role of Endoscopic Ultrasound‐guided Gastroenterostomy for Benign Gastric Outlet Obstruction
Suprabhat Giri, Saroj Kanta Sahu, Gaurav Khatana, Prasanna Gore, Preetam Nath, Bipadabhanjan Mallick, Jimmy Narayan, Aditya Kale, Sridhar Sundaram
DEN Open.2026;[Epub] CrossRef
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Reviews

Technical Review of Developments in Endoscopic Ultrasound-Guided Hepaticogastrostomy: Takeshi Ogura, Kazuhide Higuchi; Clin Endosc 2021;54(5):651-659. Published online April 26, 2021; DOI: https://doi.org/10.5946/ce.2021.020-KDDW

Abstract PDF PubReader ePub

Endoscopic ultrasound-guided biliary drainage has been developed as an alternative method for biliary drainage. EUS-guided hepaticogastrostomy (EUS-HGS) can be attempted via the trans-gastric route. These procedures are technically complex for two reasons. First, puncture of the intrahepatic bile duct via the trans-gastric route can be more difficult than that by other approaches because of the small diameter of the target site, and guidewire insertion or manipulation is challenging during EUS-HGS. Second, critical adverse events, such as stent migration into the abdominal cavity, could occur because of the greater mobility of the stomach compared to the duodenum. Therefore, endoscopists should be cautious when performing EUS-HGS. An advantage of EUS-HGS is that it can be performed in patients with complications such as duodenal bulb obstruction or surgically altered anatomy. Recent advances in technique and improvements in devices and stents for EUS-HGS have shown promise for improving the technical success rate of EUS-HGS and reducing the rate of adverse events. However, endoscopists should remain aware of the possibility of critical adverse events such as stent migration.

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Clinical and Technical Guideline for Endoscopic Ultrasound (EUS)-Guided Tissue Acquisition of Pancreatic Solid Tumor: Korean Society of Gastrointestinal Endoscopy (KSGE): Moon Jae Chung, Se Woo Park, Seong-Hun Kim, Chang Min Cho, Jun-Ho Choi, Eun Kwang Choi, Tae Hoon Lee, Eunae Cho, Jun Kyu Lee, Tae Jun Song, Jae Min Lee, Jun Hyuk Son, Jin Suk Park, Chi Hyuk Oh, Dong-Ah Park, Jeong-Sik Byeon, Soo Teik Lee, Ho Gak Kim, Hoon Jai Chun, Ho Soon Choi, Chan Guk Park, Joo Young Cho; Clin Endosc 2021;54(2):161-181. Published online March 24, 2021; DOI: https://doi.org/10.5946/ce.2021.069

Abstract PDF PubReader ePub

Endoscopic ultrasound (EUS)-guided tissue acquisition of pancreatic solid tumor requires a strict recommendation for its proper use in clinical practice because of its technical difficulty and invasiveness. The Korean Society of Gastrointestinal Endoscopy (KSGE) appointed a Task Force to draft clinical practice guidelines for EUS-guided tissue acquisition of pancreatic solid tumor. The strength of recommendation and the level of evidence for each statement were graded according to the Minds Handbook for Clinical Practice Guideline Development 2014. The committee, comprising a development panel of 16 endosonographers and an expert on guideline development methodology, developed 12 evidence-based recommendations in 8 categories intended to help physicians make evidence-based clinical judgments with regard to the diagnosis of pancreatic solid tumor. This clinical practice guideline discusses EUS-guided sampling in pancreatic solid tumor and makes recommendations on circumstances that warrant its use, technical issues related to maximizing the diagnostic yield (e.g., needle type, needle diameter, adequate number of needle passes, sample obtaining techniques, and methods of specimen processing), adverse events of EUS-guided tissue acquisition, and learning-related issues. This guideline was reviewed by external experts and suggests best practices recommended based on the evidence available at the time of preparation. This guideline may not be applicable for all clinical situations and should be interpreted in light of specific situations and the availability of resources. It will be revised as necessary to cover progress and changes in technology and evidence from clinical practice.

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Original Article

Role of Endoscopic Ultrasound-Guided Fine-Needle Aspiration of Portal Vein Thrombus in the Diagnosis and Staging of Hepatocellular Carcinoma: Dina Eskandere, Hazem Hakim, Magdy Attwa, Wagdi Elkashef, Ahmed Youssef Altonbary; Clin Endosc 2021;54(5):745-753. Published online March 15, 2021; DOI: https://doi.org/10.5946/ce.2020.240

Abstract PDF PubReader ePub

Background
/Aims: Malignant portal vein thrombus (PVT) is found in up to 44% of patients with hepatocellular carcinoma (HCC). The nature of the thrombus influences treatment selection. The aim of this study was to assess the safety and efficacy of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) in determining the nature of PVT in liver cirrhosis and/or HCC.
Methods
A prospective study was conducted in 34 patients with liver cirrhosis and/or HCC with PVT. Under EUS guidance, PVT was punctured using a 22 G FNA needle (Cook Medical, Bloomington, IN, USA) followed by monitoring of the puncture tract using color Doppler. Patients were followed for adverse events 2 hours after recovery.
Results
Throughout the 30-month study period, 34 patients, including 24 males with a mean age of 59±8 years, were enrolled. There were 8 patients with known HCC and 26 with no liver masses detected by computed tomography (CT). EUS-FNA from PVT was positive for malignancy in 3 patients (8.8%), of which only 1 patient was diagnosed with HCC by CT and 2 patients were newly diagnosed with HCC after EUS-FNA. No major complications were reported.
Conclusions
EUS-FNA is a safe and effective technique for determining the nature of PVT that does not fulfill the malignant criteria via imaging studies in patients with liver cirrhosis and/or HCC.

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Case Report

Gastric Angiolipoma Resected with Endoscopic Submucosal Dissection: Sang Myung Yeo, Jae Kwang Lee, Hyun Soo Kim, Chang Geun Park, Jae Kwon Jung, Dae Jin Kim, Yun Jin Chung, Han Jun Ryu; Clin Endosc 2021;54(3):432-435. Published online March 15, 2021; DOI: https://doi.org/10.5946/ce.2020.146

Abstract PDF PubReader ePub

Angiolipoma is a benign fatty neoplasm that has components of proliferating blood vessels. These types of lesions commonly occur in the subcutaneous tissue of the limbs and trunk. Angiolipoma in the gastrointestinal tract is extremely rare, and the final diagnosis generally depends on histological examination of the excised biopsy. In most previously reported cases, the lesions were diagnosed and treated with surgical management. In this study, we report a case of gastric angiolipoma of approximately 4 cm in size that was diagnosed and treated with endoscopic submucosal dissection.

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Original Articles

High Sensitivity of Endoscopic Ultrasound-Guided Fine-Needle Aspiration and Endoscopic Ultrasound-Guided Fine-Needle Biopsy in Lymphadenopathy Caused by Metastatic Disease: A Prospective Comparative Study: Per Hedenström, Vasilis Chatzikyriakos, Roozbeh Shams, Catarina Lewerin, Riadh Sadik; Clin Endosc 2021;54(5):722-729. Published online March 4, 2021; DOI: https://doi.org/10.5946/ce.2020.283

Abstract PDF PubReader ePub

Background
/Aims: The diagnostic work-up of lymphadenopathy is challenging but important to determine the correct therapy. Nevertheless, few studies have addressed the topic of endosonography (EUS)-guided tissue acquisition in lymphadenopathy. Therefore, we aimed to evaluate the accuracy and safety of EUS-guided fine-needle biopsy sampling (EUS-FNB) in intrathoracic and intraabdominal lymphadenopathy.
Methods
In a tertiary care center, patients with lymphadenopathy referred for EUS-guided sampling were included prospectively from 2014 to 2019 (NCT02360839). In all cases, EUS-FNB (22 gauge) and EUS-guided fine-needle aspiration (EUS-FNA) (25 gauge) were performed. The patients were randomized to the first needle pass with FNB or FNA. Study outcomes were the diagnostic accuracy and adverse event rate.
Results
Forty-eight patients were included (median age: 69 years [interquartile range, 59–76]; 24/48 females [50%]). The final diagnoses were metastasis (n=17), lymphoma (n=11), sarcoidosis (n=6), and inflammatory disease (n=14). The diagnostic performance of the two modalities was comparable, including a high sensitivity for metastatic nodes (EUS-FNB: 87% vs. EUSFNA: 100%, p=0.5). The sensitivity for lymphoma was borderline superior in favor of EUS-FNB (EUS-FNB: 55% vs. EUS-FNA: 9%, p=0.06). No adverse events were recorded.
Conclusions
In lymphadenopathy, both EUS-FNB and EUS-FNA are safe and highly sensitive for metastatic lymph node detection. Lymphoma diagnosis is challenging regardless of the needle used.

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Comparison of Endoscopic Ultrasound-Guided Tissue Acquisition Using a 20-Gauge Menghini Needle with a Lateral Forward Bevel and a 22-Gauge Franseen Needle: A Single-Center Large Cohort Study: Takafumi Mie, Takashi Sasaki, Ryo Kanata, Takaaki Furukawa, Tsuyoshi Takeda, Akiyoshi Kasuga, Masato Matsuyama, Masato Ozaka, Naoki Sasahira; Clin Endosc 2021;54(5):730-738. Published online March 4, 2021; DOI: https://doi.org/10.5946/ce.2020.251

Abstract PDF PubReader ePub

Background
/Aims: Several fine-needle biopsy (FNB) needles are available for endoscopic ultrasound (EUS)-guided tissue acquisition. However, there is disagreement on which type of needle has the best diagnostic yield. The aim of this study was to compare the performance and safety of two commonly used EUS-FNB needles.
Methods
We retrospectively analyzed consecutive patients who underwent EUS-FNB between June 2016 and March 2020 in our hospital. Two types of needles were evaluated: a 20-gauge Menghini needle with a lateral forward bevel and a 22-gauge Franseen needle. Rapid on-site evaluation was performed in all the cases. A multivariate analysis was performed to clarify the negative predictive factors for obtaining a histological diagnosis. Propensity score matching was performed to compare the diagnostic yields of these two needles.
Results
We analyzed 666 patients and 690 lesions. The overall diagnostic rate of histology alone was 88.8%, and the overall adverse event rate was 1.5%. Transduodenal access and small lesions (≤2 cm) were identified as negative predictive factors for obtaining a histological diagnosis. After propensity score matching, 482 lesions were analyzed. The diagnostic accuracy rates of histology in the M and F needle groups were 89.2% and 88.8%, respectively (p=1.00).
Conclusions
Both the needles showed high diagnostic yield, and no significant difference in performance was observed between the two.

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