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Original Article
Enhancing lymph node diagnosis: integrating deep learning with endoscopic ultrasonography: a retrospective study in China
Zijun Fan, Zhenyun Gong, Run Bao, Qinkai Li, Wei Wu, Liming Xu, Junbo Li, Xinze Li, Guilian Cheng, Duanmin Hu
Clin Endosc 2025;58(6):918-927.   Published online October 24, 2025
DOI: https://doi.org/10.5946/ce.2025.113
Graphical AbstractGraphical Abstract AbstractAbstract PDFPubReaderePub
Background
/Aims: Lymphadenopathy presents diagnostic challenges, particularly for the mediastinal and intra-abdominal lymph nodes (LNs). Endoscopic ultrasonography (EUS) has emerged as a tool for LN detection; however, its accuracy varies. To enhance the diagnostic performance and minimize medical costs, assisting LN assessment using EUS is necessary. Machine learning (ML) offers potential for medical image analysis. This study aimed to develop an ML model for classifying mediastinal and intra-abdominal LNs using gastrointestinal EUS.
Methods
EUS images of mediastinal and intra-abdominal LNs were randomly split into training and validation datasets. U-Net was selected for LN segmentation, and six deep-learning architectures were combined with the k-nearest-neighbor algorithm for LN classification. Physicians, comprising one expert group and one trainee group, reviewed the validation dataset and made individual diagnoses. A logistic regression model was generated based on LN features. We compared the diagnostic yields of ML, expert and trainee groups, logistic regression analysis, and a combination of the various methods mentioned above for diagnosing LNs.
Results
In total, 93 patients were enrolled, providing 630 images. The ResNet-50+logistic regression analysis+expert group achieved the best F1 score and sensitivity of 0.89 and 100.0%, respectively. Paired comparisons revealed that the combination outperformed both experts and trainees in terms of the area under the curve (p<0.01).
Conclusions
ML assists in predicting the mediastinal and intra-abdominal LNs based on gastrointestinal EUS images, particularly when combined with expert expertise and logistic regression models.

Citations

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  • Artificial intelligence in endoscopic ultrasound for lymph node diagnosis: perspective on an evolving frontier
    Piyapoom Pakvisal, Rungsun Rerknimitr
    Clinical Endoscopy.2025; 58(6): 862.     CrossRef
  • 936 View
  • 66 Download
  • 1 Web of Science
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Review
Endoscopic approach to indeterminate biliary strictures
Yousuke Nakai, Ryunosuke Hakuta, Yutaka Shimamatsu, Nao Otsuka, Yukiko Takayama
Received February 19, 2025  Accepted March 17, 2025  Published online July 1, 2025  
DOI: https://doi.org/10.5946/ce.2025.052    [Epub ahead of print]
AbstractAbstract PDFPubReaderePub
Diagnosis of biliary strictures remains challenging because of the low sensitivity of conventional transpapillary sampling using endoscopic retrograde cholangiopancreatography. New devices and tips have been developed to increase the diagnostic yield of conventional transpapillary sampling. However, additional endoscopic procedures are often necessary for indeterminate biliary strictures. Two major approaches for indeterminate biliary strictures are endoscopic ultrasonography-guided sampling and peroral cholangioscopy (POCS)-guided biopsy. The selection of modalities should be considered based on the stricture location. Although endoscopic ultrasound is the preferred approach for distal biliary strictures, POCS is preferred for perihilar biliary strictures. Endoscopic ultrasonography-guided sampling is highly sensitive in cases with a mass, but the sensitivity of POCS-guided biopsies is unsatisfactory, and discrepancy with the visual diagnosis of POCS is common. Whether these advanced techniques should be performed as the initial procedure or as a rescue after a failed diagnosis by conventional transpapillary sampling needs to be clarified in terms of diagnostic yield and cost-effectiveness.
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Original Article
Exploring lumen-apposing metal stents as a novel approach for managing walled-off necrosis in pediatric acute pancreatitis in Indian cohort: a prospective study
Varun Mehta, Abhinav Abhinav, Yogesh Kumar Gupta, Manisha Khubber, Ajit Sood, Manjeet Kumar Goyal
Clin Endosc 2025;58(4):595-603.   Published online May 29, 2025
DOI: https://doi.org/10.5946/ce.2024.315
Graphical AbstractGraphical Abstract AbstractAbstract PDFSupplementary MaterialPubReaderePub
Background
/Aims: Walled-off necrosis (WON) is a severe complication of acute pancreatitis in children, with limited evidence on its endoscopic management. This study evaluated the efficacy and safety of endoscopic ultrasonography (EUS)-guided lumen-apposing metal stent (LAMS) placement for WON in pediatric patients.
Methods
This open-label prospective study included pediatric patients aged 5–18 years with WON secondary to acute necrotizing pancreatitis that was managed with EUS-guided LAMS at a tertiary center from January 2021 to July 2023. Clinical success, defined as symptom resolution and WON clearance at 12 weeks, was the primary outcome. Secondary outcomes included technical success, complications, and the need for additional interventions.
Results
Eleven patients (mean age, 15.5±3.1 years) were included. Clinical success was achieved in 90.9% of the patients within 12 weeks, with a 100% technical success rate. Two patients experienced stent occlusions that were managed with saline irrigation; one case required video-assisted retroperitoneal debridement. The mean hospital stay was 5.4±3.3 days. No major adverse events were reported.
Conclusions
EUS-guided LAMS placement is a safe and effective alternative to surgery for pediatric WON, with high clinical and technical success rates and minimal complications. Further multicenter studies are required to validate these findings.

Citations

Citations to this article as recorded by  
  • The evolving role of endoscopic ultrasound-guided lumen-apposing metal stents in the management of peri-pancreatic fluid collections
    Ashita Rukmini Vuthaluru, Varun Mehta, Omesh Goyal, Prabhav Mehta, Manjeet Kumar Goyal
    Therapeutic Advances in Gastroenterology.2025;[Epub]     CrossRef
  • 2,353 View
  • 87 Download
  • 1 Web of Science
  • 1 Crossref
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Review
Endoscopic ultrasound-guided gastroenterostomy, with focus on technique and practical tips
Chi-Ying Yang, Wen-Hsin Huang, Hsing-Hung Cheng
Clin Endosc 2025;58(2):201-217.   Published online March 4, 2025
DOI: https://doi.org/10.5946/ce.2024.206
AbstractAbstract PDFPubReaderePub
Gastric outlet obstruction (GOO) is a condition characterized by a mechanical obstruction of the stomach or duodenum, caused by either benign or malignant disease. Traditionally, surgical gastrojejunostomy (SGJ) has been the standard treatment for malignant GOO and endoscopic stenting (ES) offers a less invasive option, but it often requires repeat interventions. Recently, endoscopic ultrasound (EUS)-guided gastroenterostomy (EUS-GE), an innovative technique, has been applied as an alternative to SGJ and ES for GOO patients. Direct EUS-GE, device-associated EUS-GE, and EUS-guided double balloon-occluded gastrojejunostomy bypass are the most commonly used techniques with reported technical success rates ranging from 80% to 100%, and clinical success rates between 68% and 100%. Adverse event (AE) rates range from 0% to 28.2% and the stent misdeployment is the most common while other AEs include abdominal pain, bleeding, infection, peritonitis, bowel perforation, gastric leakage, and stent migration. It is clear that EUS-GE may achieve a similar clinical success to SGJ with fewer AEs and a shorter hospital stay. Compared to ES, EUS-GE showed higher clinical success, fewer stent obstructions, and lower reintervention rates.

Citations

Citations to this article as recorded by  
  • 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
  • 5,780 View
  • 380 Download
  • 1 Crossref
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Original Articles
Primary endoscopic ultrasound-guided hepaticogastrostomy for biliary drainage prior to pancreatoduodenectomy: a retrospective study in Japan
Nozomi Okuno, Kazuo Hara, Seiji Natsume, Masataka Okuno, Shin Haba, Tomonari Asano, Takamichi Kuwahara, Hiroki Koda, Yasuhiro Shimizu
Clin Endosc 2025;58(4):604-611.   Published online February 11, 2025
DOI: https://doi.org/10.5946/ce.2024.218
Graphical AbstractGraphical Abstract AbstractAbstract PDFPubReaderePub
Background
/Aims: Malignant lesions of the pancreatic head can cause obstructive jaundice requiring biliary drainage. However, the effect of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis and metal stents on surgical resection remains controversial. This study aimed to investigate the efficacy of primary endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) performed prior to pancreatoduodenectomy, excluding patients with biliary duct cancer.
Methods
We retrospectively analyzed consecutive patients who underwent pancreatoduodenectomy at our institution between January 2019 and December 2022. The patients were divided into three groups: without biliary drainage (n=130), endoscopic biliary stenting (EBS) (n=57), and primary EUS-HGS (n=20).
Results
The positivity rate of the intraoperative bile juice culture was significantly higher in the EBS group (p<0.001). No significant difference was observed among the groups in terms of postoperative adverse events (Clavien-Dindo grade 3 or higher, p=0.784) or the positive rate of peritoneal lavage cytology (p=0.984). Seven patients in the EBS group (12.3%) experienced early adverse events related to biliary drainage (post-ERCP pancreatitis, n=3; acute cholecystitis, n=3; bile duct perforation, n=1), whereas none in the EUS-HGS group experienced adverse events.
Conclusions
Primary EUS-HGS is technically feasible as a preoperative procedure and has no short-term postoperative disadvantages.

Citations

Citations to this article as recorded by  
  • Changing the Flow: How EUS‐Guided Drainage is Reshaping the Management of Distal Malignant Biliary Obstruction
    Jeska A. Fritzsche, Inge de Vries, Jeanin E. van Hooft, Rogier P. Voermans, Roy L. J. van Wanrooij
    United European Gastroenterology Journal.2026;[Epub]     CrossRef
  • Assessment of endoscopic ultrasound-guided hepaticogastrostomy as a feasible option for preoperative biliary drainage before pancreaticoduodenectomy
    Mamoru Takenaka, Masatoshi Kudo
    Clinical Endoscopy.2025; 58(4): 549.     CrossRef
  • 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,
    BMJ Open.2025; 15(10): e106543.     CrossRef
  • Advances in EUS-Guided Biliary Drainage for the Management of Pancreatic Cancer
    Thomas Lambin, Sarah Leblanc, Bertrand Napoléon
    Cancers.2025; 17(21): 3428.     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
  • 3,810 View
  • 303 Download
  • 2 Web of Science
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Safety and efficacy of trans-afferent loop endoscopic ultrasound-guided pancreaticojejunostomy for post pancreaticoduodenectomy anastomotic stricture using the forward-viewing echoendoscope: a retrospective study from Japan
Ahmed Sadek, Kazuo Hara, Nozomi Okuno, Shin Haba, Takamichi Kuwahara, Toshitaka Fukui, Minako Urata, Takashi Kondo, Yoshitaro Yamamoto, Kenneth Tachi
Clin Endosc 2025;58(2):311-319.   Published online August 26, 2024
DOI: https://doi.org/10.5946/ce.2024.089
Graphical AbstractGraphical Abstract AbstractAbstract PDFSupplementary MaterialPubReaderePub
Background
/Aims: Endoscopic ultrasound (EUS)-guided pancreatic duct drainage is a well-established procedure for managing pancreaticojejunostomy anastomotic strictures (PJAS) post-Whipple surgery. In this study, we examined the effectiveness and safety of EUS-guided pancreaticojejunostomy (EUS-PJS).
Methods
This retrospective, single-arm study was performed at Aichi Cancer Center Hospital on 10 patients who underwent EUS-guided pancreaticojejunostomy through the afferent jejunal loop using a forward-viewing echoendoscope when endoscopic retrograde pancreatography failed. Our primary endpoint was technical success rate, defined as successful stent insertion. The secondary endpoints were early and late adverse events.
Results
A total of 10 patients underwent EUS-PJS between February 2019 and October 2023. The technical success rate was 100%. The median procedure time was 23.5 minutes. No remarkable early or late adverse events related to the procedure, except for fever, occurred in two patients. The median follow-up duration was 9.5 months, and the median number of stent exchanges was two. A stent-free state was achieved in three patients.
Conclusions
EUS-PJS for PJAS management after pancreaticoduodenectomy appears to be an effective and safe procedure with the potential advantages of fewer reinterventions and the creation of a permanent drainage fistula.

Citations

Citations to this article as recorded by  
  • Transanastomotic Forward-Viewing EUS-Guided Pancreatic Duct Drainage via Afferent Loop for Pancreaticojejunostomy Anastomotic Stricture After Pancreaticoduodenectomy
    Tadahisa Inoue, Rena Kitano, Tomoya Kitada, Kazumasa Sakamoto, Satoshi Kimoto, Jun Arai, Kiyoaki Ito
    Digestive Diseases and Sciences.2025; 70(1): 413.     CrossRef
  • Management of Pancreaticojejunostomy Strictures: A New Perspective with Forward-Viewing EUS
    Radhika Chavan
    Digestive Diseases and Sciences.2025; 70(5): 1740.     CrossRef
  • Transforming endoscopic approaches to post-pancreaticoduodenectomy anastomotic strictures: beyond the surface
    Yu-Ting Kuo
    Clinical Endoscopy.2025; 58(2): 259.     CrossRef
  • Forward-viewing echoendoscope-guided pancreaticojejunostomy for post-pancreaticoduodenectomy stricture
    Toru Kaneko, Mitsuhiro Kida, Takahiro Kurosu, Yutaro Saito, Shiori Koyama, Tomohiro Betto, Chika Kusano
    Endoscopy.2025; 57(S 01): E384.     CrossRef
  • Long-Term Outcomes of EUS-Guided Pancreatic Duct Drainage for the Management of Benign Pancreaticojejunostomy Anastomotic Stricture—A Retrospective Cohort Study
    Indria Melianti, Kazuo Hara, Takamichi Kuwahara, Shin Haba, Nozomi Okuno, Shimpei Matsumoto, Hiroki Koda, Keigo Oshiro, Tomoki Ogata
    Journal of Clinical Medicine.2025; 14(23): 8439.     CrossRef
  • 4,669 View
  • 367 Download
  • 3 Web of Science
  • 5 Crossref
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Systematic Review and Meta-analysis
Coaxial plastic stent placement within lumen-apposing metal stents for the management of pancreatic fluid collections: a systemic review and meta-analysis
Jad AbiMansour, Veeravich Jaruvongvanich, Saran Velaga, Ryan Law, Andrew C. Storm, Mark Topazian, Michael J. Levy, Ryan Alexander, Eric J. Vargas, Aliana Bofill-Garica, John A. Martin, Bret T. Petersen, Barham K. Abu Dayyeh, Vinay Chandrasekhara
Clin Endosc 2024;57(5):595-603.   Published online July 24, 2024
DOI: https://doi.org/10.5946/ce.2023.297
Graphical AbstractGraphical Abstract AbstractAbstract PDFSupplementary MaterialPubReaderePub
Background
/Aims: Coaxial placement of double pigtail plastic stents (DPPS) through lumen-apposing metal stents (LAMSs) is commonly performed to reduce the risk of LAMS obstruction, bleeding, and stent migration when used for the drainage of pancreatic fluid collections (PFCs). A systematic review and meta-analysis were performed to compare the outcomes of LAMS alone and LAMS with coaxial DPPS placement in the management of PFCs.
Methods
A systematic review was conducted to identify studies comparing LAMS and LAMS/DPPS for PFC drainage. Primary outcomes included the rate of clinical success, overall adverse events (AEs), bleeding, infection, occlusion, and stent migration. The pooled effect size was summarized using a random-effects model and compared between LAMS and LAMS/DPPS by calculating odds ratios (ORs).
Results
Nine studies involving 709 patients were identified (338 on LAMS and 371 on LAMS/DPPS). LAMS/DPPS was associated with a reduced risk of stent obstruction (OR, 0.59; p=0.004) and infection (OR, 0.55; p=0.001). No significant differences were observed in clinical success (OR, 0.96; p=0.440), overall AEs (OR, 0.57; p=0.060), bleeding (OR, 0.61; p=0.120), or stent migration (OR, 1.03; p=0.480).
Conclusions
Coaxial DPPS for LAMS drainage of PFCs is associated with a reduced risk of stent occlusion and infection; however, no difference was observed in the overall AE rates or bleeding.

Citations

Citations to this article as recorded by  
  • Efficacy of Endoscopic Ultrasound‐guided Transluminal Drainage Using Lumen‐apposing Metal Stents for the Treatment of Pancreatic Fluid Collections
    Keisuke Kinoshita, Kazuhisa Okamoto, Haruna Noguchi, Satoshi Fukuchi, Hidetoshi Akiyama, Mitsuteru Motomura, Yoshifumi Azuma, Yasuhisa Hiroshima, Takafumi Fuchino, Sotaro Ozaka, Ryota Sagami, Takuro Uchida, Yuka Hirashita, Kensuke Fukuda, Ryo Ogawa, Kazuh
    DEN Open.2026;[Epub]     CrossRef
  • Practical management of severe acute pancreatitis
    Karim Hamesch, Marcus Hollenbach, Lucía Guilabert, Tobias Lahmer, Alexander Koch
    European Journal of Internal Medicine.2025; 133: 1.     CrossRef
  • Endoscopic interventions for managing pancreatic fluid collections associated with acute pancreatitis: A state-of-the-art review (with videos)
    Randeep Rana, Soumya Jagannath Mahapatra, Pramod Kumar Garg
    Indian Journal of Gastroenterology.2025; 44(6): 777.     CrossRef
  • The evolving role of endoscopic ultrasound-guided lumen-apposing metal stents in the management of peri-pancreatic fluid collections
    Ashita Rukmini Vuthaluru, Varun Mehta, Omesh Goyal, Prabhav Mehta, Manjeet Kumar Goyal
    Therapeutic Advances in Gastroenterology.2025;[Epub]     CrossRef
  • International Association of Pancreatology Revised Guidelines on Acute Pancreatitis 2025: Supported and Endorsed by the American Pancreatic Association, European Pancreatic Club, Indian Pancreas Club, and Japan Pancreas Society
    Andrea Párniczky, Alexandra Mikó, Aliye Uc, Anand Narayan Singh, Anshuman Elhence, Ashok Saluja, Atsushi Masamune, Barham K. Abu Dayyeh, Brian Davidson, Charles Mel Wilcox, Chris Forsmark, David Whitcomb, Deepak Gunjan, Dhiraj Yadav, Djuna Cahen, D. Nages
    Pancreatology.2025; 25(6): 770.     CrossRef
  • Exploring lumen-apposing metal stents as a novel approach for managing walled-off necrosis in pediatric acute pancreatitis in Indian cohort: a prospective study
    Varun Mehta, Abhinav Abhinav, Yogesh Kumar Gupta, Manisha Khubber, Ajit Sood, Manjeet Kumar Goyal
    Clinical Endoscopy.2025; 58(4): 595.     CrossRef
  • A Critical Narrative Review of Coaxial Double-Pigtail Stenting Within the LAMS in the Management of Pancreatic Fluid Collections
    Giuseppe Infantino, Gabriele Rancatore, Dario Quintini, Lucio Carrozza, Dario Ligresti, Marco Giacchetto, Nicoletta Belluardo, Giuseppe Rizzo, Elio D’Amore, Giacomo Emanuele Maria Rizzo, Ilaria Tarantino
    Medicina.2025; 61(8): 1500.     CrossRef
  • Outcomes of lumen apposing metal stent placement in patients with surgically altered anatomy: Multicenter international experience
    Benedetto Mangiavillano, Daryl Ramai, Michel Kahaleh, Amy Tyberg, Haroon Shahid, Avik Sarkar, Jayanta Samanta, Jahnvi Dhar, Michiel Bronswijk, Schalk Van der Merwe, Abdul Kouanda, Hyun Ji, Sun-Chuan Dai, Pierre Deprez, Jorge Vargas-Madrigal, Giuseppe Vane
    Endoscopy International Open.2024; 12(10): E1143.     CrossRef
  • 5,297 View
  • 281 Download
  • 7 Web of Science
  • 8 Crossref
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Review
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
Clin Endosc 2024;57(5):588-594.   Published online July 9, 2024
DOI: https://doi.org/10.5946/ce.2023.169
AbstractAbstract PDFPubReaderePub
Endoscopic ultrasound (EUS)-guided interventions have evolved rapidly in recent years, with dedicated metal stents playing a crucial role in this process. Specifically, the invention of biflanged short metal-covered stents, including lumen-apposing metal stents (LAMS), and modifications in a variety of tubular self-expandable metal stents (SEMS), have led to innovations in EUS-guided interventions. LAMS or non-LAMS stents are commonly used in the EUS-guided drainage of pancreatic fluid collections, especially in cases of walled-off necrosis. Additionally, LAMS is commonly considered for drainage of the EUS-guided gallbladder or dilated common bile duct and EUS-guided gastroenterostomy. Fully or partially covered tubular SEMS with several new designs are being considered for EUS-guided biliary drainage. This review focuses on advances in SEMS for EUS-guided interventions and discusses related research results.

Citations

Citations to this article as recorded by  
  • Stent-Over-Sponge (SOS) as a Rescue Technique for Leak Post-Bariatric Surgery: Experience From Hôpital du Sacré-Coeur, Canada
    Majed Alanazi, Bandar Ali, Ibrahim Alonazi, Pierre Y Garneau , Denis Ronald, Radu Pescarus
    Cureus.2025;[Epub]     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
  • Endoscopic ultrasound-guided hepaticogastrostomy without tract dilation using a novel ultra-tapered slim-delivery metallic stent
    Ritsuko Oishi, Haruo Miwa, Kazuki Endo, Hiromi Tsuchiya, Yuichi Suzuki, Kazushi Numata, Shin Maeda
    Endoscopy.2025; 57(S 01): E244.     CrossRef
  • The evolving role of endoscopic ultrasound-guided lumen-apposing metal stents in the management of peri-pancreatic fluid collections
    Ashita Rukmini Vuthaluru, Varun Mehta, Omesh Goyal, Prabhav Mehta, Manjeet Kumar Goyal
    Therapeutic Advances in Gastroenterology.2025;[Epub]     CrossRef
  • Comparative outcome of metal versus plastic stents for the management of walled-off pancreatic necrosis – An updated meta-analysis of randomised studies
    Suprabhat Giri, Prasanna Gore, Gaurav Khatana, Chandramauli Mishra, Sridhar Sundaram, Vaishali Bhardwaj
    Journal of Minimal Access Surgery.2025; 21(4): 331.     CrossRef
  • Exploring lumen-apposing metal stents as a novel approach for managing walled-off necrosis in pediatric acute pancreatitis in Indian cohort: a prospective study
    Varun Mehta, Abhinav Abhinav, Yogesh Kumar Gupta, Manisha Khubber, Ajit Sood, Manjeet Kumar Goyal
    Clinical Endoscopy.2025; 58(4): 595.     CrossRef
  • Advances in EUS-Guided Biliary Drainage for the Management of Pancreatic Cancer
    Thomas Lambin, Sarah Leblanc, Bertrand Napoléon
    Cancers.2025; 17(21): 3428.     CrossRef
  • 7,593 View
  • 409 Download
  • 6 Web of Science
  • 7 Crossref
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Original Article
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 AbstractGraphical Abstract AbstractAbstract PDFPubReaderePub
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
  • 4,782 View
  • 289 Download
  • 1 Web of Science
  • 1 Crossref
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Review
Drainage for fluid collections post pancreatic surgery and acute pancreatitis: similar but different?
Yousuke Nakai, Saburo Matsubara, Tsuyoshi Mukai, Tsuyoshi Hamada, Takashi Sasaki, Hirotoshi Ishiwatari, Susumu Hijioka, Hideyuki Shiomi, Mamoru Takenaka, Takuji Iwashita, Atsuhiro Masuda, Tomotaka Saito, Hiroyuki Isayama, Ichiro Yasuda, for the WONDERFUL study group in Japan
Clin Endosc 2024;57(6):735-746.   Published online May 17, 2024
DOI: https://doi.org/10.5946/ce.2023.254
AbstractAbstract PDFPubReaderePub
Postoperative pancreatic fistulas (POPFs) are common adverse events that occur after pancreatic surgery. Endoscopic ultrasonography (EUS)-guided drainage (EUS-D) is a first-line treatment, similar to that for pancreatic fluid collection (PFCs) after acute pancreatitis. However, some POPFs do not develop fluid collections depending on the presence or location of the surgical drain, whereas others develop fluid collections, such as postoperative fluid collections (POPFCs). Although POPFCs are similar to PFCs, the strategy and modality for POPF management need to be modified according to the presence of fluid collections, surgical drains, and surgical type. As discussed for PFCs, the indications, timing, and selection of interventions or stents for EUS-D have not been fully elucidated for POPFs. In this review, we discuss the management of POPFs and POPFCs in comparison with PFCs due to acute pancreatitis and summarize the topics that should be addressed in future studies.

Citations

Citations to this article as recorded by  
  • Management of Postoperative Pancreatic Fluid Collection and Role of Endoscopy: A Case Series and Review of the Literature
    Chiara Coluccio, Ilaria Tarantino, Maria Chiara Petrone, Edoardo Forti, Stefano Francesco Crinò, Alessandro Fugazza, Roberto Di Mitri, Cecilia Binda, Davide Trama, Arnaldo Amato, Alessandro Redaelli, Germana De Nucci, Fabia Attili, Mario Luciano Brancacci
    Diagnostics.2025; 15(10): 1258.     CrossRef
  • Percutaneous mini–invasive interventions in the treatment of peripancreatic fluid accumulation after pancreatic resection
    M. V. Kostylev, V. P. Shkarban, V. I. Trachuk, V. O. Shatalo
    The Ukrainian Journal of Clinical Surgery.2025; 92(3): 20.     CrossRef
  • Acute Necrotizing Pancreatitis—Advances and Challenges in Management for Optimal Clinical Outcomes
    Ioana Dumitrascu, Narcis Octavian Zarnescu, Eugenia Claudia Zarnescu, Mihai Radu Pahomeanu, Alexandru Constantinescu, Dana Galieta Minca, Radu Virgil Costea
    Medicina.2025; 61(7): 1186.     CrossRef
  • Endoscopic ultrasound-guided drainage of a right liver fistula caused by percutaneous thermoablation
    Angelica Toppeta, Jean-Philippe Ratone, Solene Hoibian, Yanis Dahel, Antoine Assaf, Marc Giovannini, Fabrice Caillol
    Endoscopy.2025; 57(S 01): E788.     CrossRef
  • EUS-TD With Multiple Plastic Stents for Postoperative Pancreatic Fistula
    Koichiro Miyagawa, Shinji Oe, Yasuhisa Mori, Tsuyoshi Ueda, Nobuhiko Shinohara, Kosuke Hideshima, Yudai Koya, Yuichi Honma, Masaru Harada
    Surgical Laparoscopy, Endoscopy & Percutaneous Techniques.2025;[Epub]     CrossRef
  • 11,784 View
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Original Articles
Outcomes of partially covered self-expandable metal stents with different uncovered lengths in endoscopic ultrasound-guided hepaticogastrostomy: a Japanese retrospective study
Takeshi Okamoto, Takashi Sasaki, Tsuyoshi Takeda, Tatsuki Hirai, Takahiro Ishitsuka, Manabu Yamada, Hiroki Nakagawa, Takafumi Mie, Takaaki Furukawa, Akiyoshi Kasuga, Masato Ozaka, Naoki Sasahira
Clin Endosc 2024;57(4):515-526.   Published online May 10, 2024
DOI: https://doi.org/10.5946/ce.2023.142
Graphical AbstractGraphical Abstract AbstractAbstract PDFSupplementary MaterialPubReaderePub
Background
/Aims: The optimal length of the uncovered portion of partially covered self-expandable metal stents (PCSEMSs) used in endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) remains unclear. This study investigated the safety and efficacy of PCSEMSs with different uncovered lengths, with a focus on stent migration and time to recurrent biliary obstruction (RBO).
Methods
Outcomes of patients undergoing EUS-HGS using PCSEMSs with 5-mm and 20-mm uncovered portions at our institution from January 2016 to December 2021 were compared.
Results
Sixty-two patients underwent EUS-HGS using PCSEMS (5/20-mm uncovered portions: 32/30). Stent migration occurred only in the 5-mm group. There were no differences in RBO rates (28.1% vs. 40.0%) or median time to RBO (6.8 vs. 7.1 months) between the two groups. Median overall survival (OS) was longer in the 20-mm group (3.1 vs. 4.9 months, p=0.037) due to the higher number of patients that resumed chemotherapy after EUS-HGS (56.7% vs. 28.1%, p=0.029). Good performance status, absence of hepatic metastases, and chemotherapy after EUS-HGS were independent predictors of longer OS.
Conclusions
No migration was observed in patients treated with PCSEMS with 20-mm uncovered portions. Patients treated with PCSEMS with 20-mm uncovered portions performed at least as well as those treated with 5-mm uncovered portions in all material respects.

Citations

Citations to this article as recorded by  
  • Migration of covered expandable metal stents after endoscopic ultrasound-guided hepaticogastrostomy: stent covering versus stent design?
    Todd H. Baron
    Clinical Endoscopy.2024; 57(4): 471.     CrossRef
  • 5,073 View
  • 229 Download
  • 1 Web of Science
  • 1 Crossref
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Endoscopic ultrasound-guided gastrojejunostomy with a direct technique without previous intestinal filling using a tubular fully covered self-expandable metallic stent
Hakan Şentürk, İbrahim Hakkı Köker, Koray Koçhan, Sercan Kiremitçi, Gülseren Seven, Ali Tüzün İnce
Clin Endosc 2024;57(2):209-216.   Published online July 3, 2023
DOI: https://doi.org/10.5946/ce.2023.022
Graphical AbstractGraphical Abstract AbstractAbstract PDFSupplementary MaterialPubReaderePub
Background
/Aims: Endoscopic ultrasonography-guided gastrojejunostomy is a minimally invasive method for the management of gastric outlet obstruction. Conventionally, a lumen-apposing metal stent (LAMS) is used to create an anastomosis. However, LAMS is expensive and not widely available. In this report, we described a tubular fully covered self-expandable metallic stent (T-FCSEMS) for this purpose.
Methods
Twenty-one patients (15 men [71.4%]; median age, 66 years; range, 40–87 years) were included in this study. A total of 19 malignant (12 pancreatic, 6 gastric, and 1 metastatic rectal cancer) and 2 benign cases were observed. The proximal jejunum was punctured with a 19 G needle. The stomach and jejunum walls were dilated with a 6 F cystotome, and a 20×80 mm polytetrafluoroethylene T-FCSEMS (Hilzo) was deployed. Oral feeding was initiated after 12 to 18 hours and solid foods after 48 hours.
Results
The median procedure time was 33 minutes (range, 23–55 minutes). After two weeks, 19 patients tolerated oral feeding. In patients with malignancy, the median survival time was 118 days (range, 41–194 days). No serious complications or deaths occurred. All patients with malignancy tolerated oral food intake until they expired.
Conclusions
T-FCSEMS is safe and effective. This stent should be considered as an alternative to LAMS for gastric outlet obstruction.

Citations

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  • Endoscopic approaches to small bowel strictures
    Katelin DURHAM, Rami EL ABIAD, Mouen KHASHAB
    Minerva Gastroenterology.2025;[Epub]     CrossRef
  • Tubular fully covered self-expandable metallic stents for endoscopic ultrasound-guided gastrojejunostomy: moving forward or taking a step back?
    Rami G. El Abiad, Mouen A. Khashab
    Clinical Endoscopy.2024; 57(2): 193.     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
  • 8,346 View
  • 230 Download
  • 3 Web of Science
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Clinical outcomes of permanent stenting with endoscopic ultrasound gallbladder drainage
Eisuke Suzuki, Yuji Fujita, Kunihiro Hosono, Yuji Koyama, Seitaro Tsujino, Takuma Teratani, Atsushi Nakajima, Nobuyuki Matsuhashi
Clin Endosc 2023;56(5):650-657.   Published online April 5, 2023
DOI: https://doi.org/10.5946/ce.2022.190
Graphical AbstractGraphical Abstract AbstractAbstract PDFPubReaderePub
Background
/Aims: Endoscopic ultrasound gallbladder drainage (EUS-GBD) is gaining attention as a treatment method for cholecystitis. However, only a few studies have assessed the outcomes of permanent stenting with EUS-GBD. Therefore, we evaluated the clinical outcomes of permanent stenting using EUS-GBD.
Methods
This was a retrospective, single-center cohort study. The criteria for EUS-GBD at our institution are a high risk for surgery, inability to perform surgery owing to poor performance status, and inability to obtain consent for emergency surgery. EUS-GBD was performed using a 7-Fr double-pigtail plastic stent with a dilating device. The primary outcomes were the recurrence-free rate of cholecystitis and the late-stage complication-avoidance rate. Secondary outcomes were technical success, clinical success, and procedural adverse events.
Results
A total of 41 patients were included in the analysis. The median follow-up period was 168 (range, 10–1,238) days. The recurrence-free and late-stage complication-avoidance rates during the follow-up period were 95% (38 cases) and 90% (36 cases), respectively. There were only two cases of cholecystitis recurrence during the study period.
Conclusions
EUS-GBD using double-pigtail plastic stent was safe and effective with few complications, even in the long term, in patients with acute cholecystitis.

Citations

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  • Effectiveness of Preoperative Endoscopic Ultrasonography-guided Gallbladder Drainage for Acute Calculous Cholecystitis
    Atsuki NAGAO, Naoki KOBAYASHI, Daichi JINGU, Marina JIMBA, Jun SAKUMA, Motomu TANAKA, Masahi MOMIYAMA, Kentaro NAKAJIMA, Yuji KOYAMA, Yuji FUJITA, Tamaki NOIE, Shouichi SATO
    Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association).2025; 86(6): 725.     CrossRef
  • Revolutionizing outcomes: endoscopic ultrasound-guided gallbladder drainage using innovative electrocautery enhanced-lumen apposing metal stents for high-risk surgical patients
    Hyung Ku Chon, Yun Chae Lee, Tae Hyeon Kim, Seung Ok Lee, Seong-Hun Kim
    Scientific Reports.2024;[Epub]     CrossRef
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Medical disputes related to advanced endoscopic procedures with endoscopic retrograde cholangiopancreatography or endoscopic ultrasonography for the management of pancreas and biliary tract diseases
Yoon Suk Lee, Jae-Young Jang, Jun Yong Bae, Eun Hye Oh, Yehyun Park, Yong Hwan Kwon, Jeong Eun Shin, Jun Kyu Lee, Tae Hee Lee, Chang Nyol Paik
Clin Endosc 2023;56(4):499-509.   Published online March 28, 2023
DOI: https://doi.org/10.5946/ce.2022.208
Graphical AbstractGraphical Abstract AbstractAbstract PDFSupplementary MaterialPubReaderePub
Background
/Aims: This study aimed to evaluate the characteristics of endoscopic retrograde cholangiopancreatography (ERCP) or endoscopic ultrasonography (EUS)-related adverse events (AEs) that eventually lead to medical disputes or claims on medical professional liability.
Methods
Medical disputes for ERCP/EUS-related AEs filed in the Korea Medical Dispute Mediation and Arbitration Agency between April 2012 and August 2020 were evaluated using corresponding medical records. AEs were categorized into three sections: procedure-related, sedation-related, and safety-related AEs.
Results
Among a total of 34 cases, procedure-related AEs were 26 (76.5%; 12 duodenal perforations, 7 post-ERCP pancreatitis, 5 bleedings, 2 perforations combined with post-ERCP pancreatitis); sedation-related AEs were 5 (14.7%; 4 cardiac arrests, 1 desaturation), and safety-related AEs were 5 (8.8%; 1 follow-up loss for stent removal, 1 asphyxia, 1 fall). Regarding clinical outcomes, 20 (58.8%) were fatal and eventually succumbed to AEs. For the types of medical institutions, 21 cases (61.8%) occurred at tertiary or academic hospitals, and 13 (38.2%) occurred at community hospitals.
Conclusions
The ERCP/EUS-related AEs filed in Korea Medical Dispute Mediation and Arbitration Agency showed distinct features: duodenal perforation was the most frequent AE, and clinical outcomes were fatal, resulting in at least more than permanent physical impairment.

Citations

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  • Diagnostic Assessment of Endoscopic Ultrasonography–Fine Needle Aspiration Cytology in the Pancreas: A Comparison between Liquid-Based Preparation and Conventional Smear
    Jung-Soo Pyo, Dae Hyun Lim, Kyueng-Whan Min, Nae Yu Kim, Il Hwan Oh, Byoung Kwan Son
    Medicina.2024; 60(6): 930.     CrossRef
  • 4,498 View
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Review
Usefulness of the double-guidewire technique for endoscopic procedures in the field of biliary and pancreatic diseases
Mamoru Takenaka, Masatoshi Kudo
Clin Endosc 2022;55(5):605-614.   Published online August 23, 2022
DOI: https://doi.org/10.5946/ce.2022.032
AbstractAbstract PDFPubReaderePub
The double-guidewire method has been increasingly used in endoscopic procedures for biliary and pancreatic diseases in recent years, including endoscopic retrograde cholangiopancreatography and endoscopic ultrasonography-related procedures. In addition, double-lumen catheters with uneven distal and proximal lumen openings have been introduced, making it possible to easily create a double-guidewire situation, and the usefulness of the double-guidewire technique using uneven double-lumen cannulas has been widely reported. Although the advantages of using two guidewires depend on the particular situation and the appropriate use of the two guidewires, deepening the knowledge of the double-guidewire method will contribute greatly to troubleshooting in daily practice. In this review, the usefulness of the double-guidewire technique is discussed with respect to two main areas: selective insertion of guidewires and devices and biliary cannulation.

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  • 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
  • Salvaging hilar access using an uneven double-lumen cannula in endoscopic ultrasound-guided hepaticogastrostomy
    Ryosuke Sato, Kazuyuki Matsumoto, Akihiro Matsumi, Kazuya Miyamoto, Yuki Fujii, Daisuke Uchida, Motoyuki Otsuka
    Endoscopy.2025; 57(S 01): E1115.     CrossRef
  • Advancements in Research on Challenges in Selective Biliary Cannulation during Endoscopic Retrograde Cholangiopancreatography (ERCP)
    天雨 张
    Journal of Clinical Personalized Medicine.2024; 03(01): 100.     CrossRef
  • Double-guidewire technique for selective biliary cannulation does not increase the rate of post-endoscopic retrograde cholangiopancreatography pancreatitis in patients with naïve papilla
    Han Taek Jeong, June Hwa Bae, Ho Gak Kim, Jimin Han
    Clinical Endoscopy.2024; 57(2): 226.     CrossRef
  • Dedicated Echoendoscope for Interventional Endoscopic Ultrasound: Comparison with a Conventional Echoendoscope
    Toshio Fujisawa, Shigeto Ishii, Yousuke Nakai, Hirofumi Kogure, Ko Tomishima, Yusuke Takasaki, Koichi Ito, Sho Takahashi, Akinori Suzuki, Hiroyuki Isayama
    Journal of Clinical Medicine.2024; 13(10): 2840.     CrossRef
  • INTRAOPERATIVE SIGNS OF ACUTE BILIARY PANCREATITIS
    S. M. Vasyliuk, O. V. Prudnikov, V. V. Ivanyna, O. S. Tkachuk, N. M. Pavliuk, B. V. Krysa, V. M. Atamaniuk
    Kharkiv Surgical School.2022; (4-5): 55.     CrossRef
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Original Articles
Comparison of diagnostic performances of slow-pull suction and standard suction in endoscopic ultrasound-guided fine needle biopsy for gastrointestinal subepithelial tumors
Joon Seop Lee, Chang Min Cho, Yong Hwan Kwon, An Na Seo, Han Ik Bae, Man-Hoon Han
Clin Endosc 2022;55(5):637-644.   Published online August 17, 2022
DOI: https://doi.org/10.5946/ce.2021.257
AbstractAbstract PDFPubReaderePub
Background
/Aims: Endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) is integral to the diagnosis of gastrointestinal (GI) subepithelial tumors (SETs). The impact of different EUS-FNB tissue sampling techniques on specimen adequacy and diagnostic accuracy in SETs has not been fully evaluated. This study aimed to compare the diagnostic outcomes of slow-pull (SP) and standard suction (SS) in patients with GI SETs.
Methods
In this retrospective comparative study, 54 patients were enrolled. Medical records were reviewed for location and size of the target lesion, FNB needle type/size, technical order, specimen adequacy, diagnostic yield, and adverse events. The acquisition rate of adequate specimens and diagnostic accuracy were compared according to EUS-FNB techniques.
Results
The mean lesion size was 42.6±36.4 mm, and most patients were diagnosed with GI stromal tumor (75.9%). The overall diagnostic accuracies of the SP and SS techniques were 83.3% and 81.5%, respectively (p=0.800). The rates of obtaining adequate core tissue were 79.6% and 75.9%, respectively (p=0.799). No significant clinical factors affected the rate of obtaining adequate core tissue, including lesion location and size, FNB needle size, and final diagnosis.
Conclusions
SP and SS had comparable diagnostic accuracies and adequate core tissue acquisition for GI SETs via EUS-FNB.

Citations

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  • 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
  • Current Practices in Histological Diagnosis and Management of Asymptomatic Gastric Subepithelial Lesions: A Multicenter Survey in Korea
    Sang Hoon Kim, Jae Yong Park, Ayoung Lee, Bong Eun Lee, Byung-Hoon Min, Chan Hyuk Park, Da Hyun Jung, Hyeong Ho Jo, Hyunsoo Chung, In Hyuk Yoo, Seon Young Park, Seung-Woo Lee, Yonghoon Choi, Jeong Hoon Lee, Seung Han Kim, Jae Myung Park, Joon Sung Kim, Su
    The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2025; 25(2): 159.     CrossRef
  • Endoscopic ultrasound-guided fine-needle aspiration for gastrointestinal subepithelial lesions
    Takuto Hikichi, Minami Hashimoto, Takumi Yanagita, Tsunetaka Kato, Jun Nakamura
    Journal of Medical Ultrasonics.2024; 51(2): 195.     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
  • 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
  • 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
  • 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
  • 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
  • Prevalence, natural progression, and clinical practices of upper gastrointestinal subepithelial lesions in Korea: a multicenter study
    Younghee Choe, Yu Kyung Cho, Gwang Ha Kim, Jun-Ho Choi, Eun Soo Kim, Ji Hyun Kim, Eun Kwang Choi, Tae Hyeon Kim, Seong-Hun Kim, Do Hoon Kim
    Clinical Endoscopy.2023; 56(6): 744.     CrossRef
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Bispectral index-guided propofol sedation during endoscopic ultrasonography
Ayana Okamoto, Ken Kamata, Takeshi Miyata, Tomoe Yoshikawa, Rei Ishikawa, Tomohiro Yamazaki, Atsushi Nakai, Shunsuke Omoto, Kosuke Minaga, Kentaro Yamao, Mamoru Takenaka, Yasutaka Chiba, Toshiharu Sakurai, Naoshi Nishida, Masayuki Kitano, Masatoshi Kudo
Clin Endosc 2022;55(4):558-563.   Published online July 12, 2022
DOI: https://doi.org/10.5946/ce.2022.001
AbstractAbstract PDFPubReaderePub
Background
/Aims: Bispectral index (BIS) monitors process and display electroencephalographic data are used to assess the depth of anesthesia. This study retrospectively evaluated the usefulness of BIS monitoring during endoscopic ultrasonography (EUS).
Methods
This study included 725 consecutive patients who underwent EUS under sedation with propofol. BIS monitoring was used in 364 patients and was not used in 361. The following parameters were evaluated: (1) median dose of propofol; (2) respiratory and circulatory depression; (3) occurrence of body movements; (4) awakening score >8 at the time; and (5) awakening score 2 hours after leaving the endoscopy room.
Results
The BIS group received a significantly lower median dose of propofol than the non-BIS group (159.2 mg vs. 167.5 mg; p=0.015) in all age groups. For patients aged ≥75 years, the reduction in heart rate was significantly lower in the BIS group than in the non-BIS group (1.2% vs. 9.1%; p=0.023). Moreover, the occurrence of body movements was markedly lower in the BIS group than in the non-BIS group (8.5% vs. 39.4%; p<0.001).
Conclusions
During EUS examination, BIS monitoring is useful for maintaining a constant depth of anesthesia, especially in patients 75 years of age or older.

Citations

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  • Propofol‐alone sedative efficacy in observational biliopancreatic endoscopic ultrasound
    Hisaki Kato, Yuki Kawasaki, Kazuya Sumi, Yuki Shibata, Norihiro Nomura, Jun Ushio, Junichi Eguchi, Takayoshi Ito, Haruhiro Inoue
    DEN Open.2025;[Epub]     CrossRef
  • Reconsidering Sedation for Endoscopic Retrograde Cholangiopancreatography: The Potential of Remimazolam
    Kosuke Minaga, Akane Hara, Masatoshi Kudo
    Digestive Endoscopy.2025;[Epub]     CrossRef
  • General anesthesia and/or deep hypnotic state in propofol-based conscious sedation for endoscopy
    Halim Bou Daher, Ali El Mokahal, Mohamad Ali Ibrahim, Rana Yamout, Nour Hochaimi, Chakib Ayoub, Yasser H. Shaib, Ala I. Sharara
    iGIE.2024; 3(2): 286.     CrossRef
  • EEG bispectral index sensor guidance improves accuracy and safety of procedural sedation
    A. Oh, N. Karim, A. Pitt, S. Hodgetts, D.W. Edwards, D. Mullan, H-U. Laasch
    Clinical Radiology.2024; 79(12): e1490.     CrossRef
  • Comparison of bispectral index-guided endoscopic ultrasonography with continuous vs. intermittent infusion of propofol: a retrospective study in Japan
    Ayana Okamoto, Ken Kamata, Tomohiro Yamazaki, Shunsuke Omoto, Kosuke Minaga, Mamoru Takenaka, Masatoshi Kudo
    Clinical Endoscopy.2024; 57(6): 814.     CrossRef
  • Advances in Analgosedation and Periprocedural Care for Gastrointestinal Endoscopy
    Sonja Skiljic, Dino Budrovac, Ana Cicvaric, Nenad Neskovic, Slavica Kvolik
    Life.2023; 13(2): 473.     CrossRef
  • Clinical and economic value of bispectral index monitoring for adequate endoscopic sedation
    Se Woo Park
    Clinical Endoscopy.2022; 55(4): 518.     CrossRef
  • Respiratory Failure during BIS-Guided Sedation in a Patient with Relapsing Polychondritis: A Case Report
    Jaesang Lee, Hosik Moon, Sungjin Hong, Jinyoung Chon, Hyejin Kwon, Hunwoo Park, Jiyung Lee
    Medicina.2022; 59(1): 65.     CrossRef
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  • 8 Crossref
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Role of Endoscopic Ultrasound-Guided Fine-Needle Aspiration in the Evaluation of Abdominal Lymphadenopathy of Unknown Etiology
Nonthalee Pausawasdi, Kotchakon Maipang, Tassanee Sriprayoon, Phunchai Charatcharoenwitthaya
Clin Endosc 2022;55(2):279-286.   Published online January 3, 2022
DOI: https://doi.org/10.5946/ce.2021.218-IDEN
AbstractAbstract PDFPubReaderePub
Background
/Aims: Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is a standard procedure for obtaining tissue from lesions near the gastrointestinal lumen. However, there is a scarcity of information on the diagnostic performance of EUS-FNA for abdominal lymphadenopathy of unknown causes. To assess the accuracy of EUS-FNA in diagnosing abdominal lymphadenopathy of unknown etiology.
Methods
The EUS records of patients with undiagnosed abdominal lymphadenopathy between 2010 and 2015 were reviewed.
Results
A total of 42 patients were included in this study. Adequate specimens were obtained from 40 patients (95%). The final diagnoses were metastatic cancer (n=16), lymphoma (n=9), tuberculosis (n=8), inflammatory changes (n=6), and amyloidosis (n=1). For diagnosing malignancy, EUS-FNA had a sensitivity of 84.6%, specificity of 95.7%, positive predictive value of 91.7%, negative predictive value of 91.7%, and area under the receiver operating characteristic curve (AUROC) of 0.901. For the diagnosis of lymphoma, EUS-FNA was 100% accurate when combined with cytologic evaluation and immunohistochemical staining. The diagnostic sensitivity decreased to 75%, whereas the specificity remained 100%, for tuberculosis. The overall AUROC was 0.850. No procedure-related complications occurred.
Conclusions
EUS-FNA showed high diagnostic performance for abdominal lymphadenopathy of unknown causes, especially malignancy, lymphoma, and tuberculosis. Therefore, it is a crucial diagnostic tool for this patient population.

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  • 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
  • Endoscopic ultrasound-guided biopsy for TB lymphadenopathy: role of PCR and Gene X-pert
    Hussein Hassan Okasha, Rasha M. M. Ahmed, Abeer Abdellatef, Mona A. Wassef, Hossam El-Din Shaaban, Rasha Matar
    The Egyptian Journal of Internal Medicine.2025;[Epub]     CrossRef
  • 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
  • Pancreatobiliary Lymphadenopathy: Etiology, Location, and Factors Predicting Good Yield of Endoscopic Ultrasound-guided Biopsy
    Taha Yaseen, Abbas Ali Tasneem, Syed Mudassir Laeeq, Zain Majid, Nasir Hassan Luck
    Euroasian journal of hepato-gastroenterology.2024; 14(1): 40.     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
  • Diagnostic role of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) in abdominal lymphadenopathy of unknown etiology
    Wenli Wang, Chaoqun Han, Xin Ling, Xianwen Guo, Jun Liu, Rong Lin, Zhen Ding
    Frontiers in Medicine.2023;[Epub]     CrossRef
  • Detection of Lymphadenopathy as a Precursor to Autoimmune Liver Diseases Before Clinical Hepatitis Became Apparent: A Report of Two Cases
    Hiroshi Okano, Hiroki Tanaka, Shimpei Matsusaki, Katsumi Mukai, Akira Nishimura, Kana Asakawa, Youichirou Baba, Tetsuya Murata
    Cureus.2023;[Epub]     CrossRef
  • Mediastinal Nodal Staging Performance of Combined Endobronchial and Esophageal Endosonography in Lung Cancer Cases: A Systematic Review and Meta-Analysis
    Xiaozhen Liu, Kun Yang, Weihong Guo, Muqi Ye, Shaozhong Liu
    Frontiers in Surgery.2022;[Epub]     CrossRef
  • Current role of endoscopic ultrasound for gastrointestinal and abdominal tuberculosis
    Hasan Maulahela, Achmad Fauzi, Kaka Renaldi, Qorina P Srisantoso, Amirah Jasmine
    JGH Open.2022; 6(11): 745.     CrossRef
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Diagnostic Value of Endoscopic Ultrasonography for Common Bile Duct Dilatation without Identifiable Etiology Detected from Cross-Sectional Imaging
Nonthalee Pausawasdi, Penprapai Hongsrisuwan, Lubna Kamani, Kotchakon Maipang, Phunchai Charatcharoenwitthaya
Clin Endosc 2022;55(1):122-127.   Published online January 3, 2022
DOI: https://doi.org/10.5946/ce.2021.122
AbstractAbstract PDFPubReaderePub
Background
/Aims: Endoscopic ultrasonography (EUS) is warranted when cross-sectional imaging demonstrates common bile duct (CBD) dilatation without identifiable causes. This study aimed to assess the diagnostic performance of EUS in CBD dilatation of unknown etiology.
Methods
Retrospective review of patients with dilated CBD without definite causes undergoing EUS between 2012 and 2017.
Results
A total of 131 patients were recruited. The mean age was 63.2±14.1 years. The most common manifestation was abnormal liver chemistry (85.5%). The mean CBD diameter was 12.2±4.1 mm. The area under the receiver operating characteristic curve (AUROC) of EUS-identified pathologies, including malignancy, choledocholithiasis, and benign biliary stricture (BBS), was 0.98 (95% confidence interval [CI], 0.95-1.00). The AUROC of EUS for detecting malignancy, choledocholithiasis, and BBS was 0.91 (95% CI, 0.85-0.97), 1.00 (95% CI, 1.00-1.00), and 0.93 (95% CI, 0.87-0.99), respectively. Male sex, alanine aminotransferase ≥3× the upper limit of normal (ULN), alkaline phosphatase ≥3× the ULN, and intrahepatic duct dilatation were predictors for pathological obstruction, with odds ratios of 5.46 (95%CI, 1.74-17.1), 5.02 (95% CI, 1.48-17.0), 4.63 (95% CI, 1.1-19.6), and 4.03 (95% CI, 1.37-11.8), respectively.
Conclusions
EUS provides excellent diagnostic value in identifying the etiology of CBD dilatation detected by cross-sectional imaging.

Citations

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Predictive Factors for Differentiating Gastrointestinal Stromal Tumors from Leiomyomas Based on Endoscopic Ultrasonography Findings in Patients with Gastric Subepithelial Tumors: A Multicenter Retrospective Study
Sun Moon Kim, Eun Young Kim, Jin Woong Cho, Seong Woo Jeon, Ji Hyun Kim, Tae Hyeon Kim, Jeong Seop Moon, Jin-Oh Kim, the Research Group for Endoscopic Ultrasound of the Korean Society of Gastrointestinal Endoscopy
Clin Endosc 2021;54(6):872-880.   Published online November 18, 2021
DOI: https://doi.org/10.5946/ce.2021.251
AbstractAbstract PDFPubReaderePub
Background
/Aims: The utility of endoscopic ultrasonography (EUS) for differentiating gastrointestinal stromal tumors (GISTs) and leiomyomas of the stomach is not well known. We aimed to evaluate the ability of EUS for differentiating gastric GISTs and leiomyomas.
Methods
We retrospectively reviewed the medical records of patients with histopathologically proven GISTs (n=274) and leiomyomas (n=87). In two consensus meetings, the inter-observer variability in the EUS image analysis was reduced. Using logistic regression analyses, we selected predictive factors and constructed a predictive model and nomogram for differentiating GISTs from leiomyomas. A receiver operating characteristic (ROC) curve analysis was performed to measure the discrimination performance in the development and internal validation sets.
Results
Multivariate analysis identified heterogeneity (odds ratio [OR], 9.48), non-cardia (OR, 19.11), and older age (OR, 1.06) as independent predictors of GISTs. The areas under the ROC curve of the predictive model using age, sex, and four EUS factors (homogeneity, location, anechoic spaces, and dimpling or ulcer) were 0.916 (sensitivity, 0.908; specificity, 0.793) and 0.904 (sensitivity, 0.908; specificity, 0.782) in the development and internal validation sets, respectively.
Conclusions
The predictive model and nomogram using age, sex and homogeneity, tumor location, presence of anechoic spaces, and presence of dimpling or ulcer on EUS may facilitate differentiation between GISTs and leiomyomas.

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  • Nationwide Multicenter Study of Advanced Endoscopic Resection and Malignant Risk Model for Gastric Myogenic Tumors (GASTRO Trial)
    Chih-Tsung Fan, Tze-Yu Shieh, Wen-Hung Hsu, Hsi-Yuan Chien, Ching-Tai Lee, Ming-Yao Chen, Chung-Ying Lee, Wei-Chen Tai, Sz-Iuan Shiu, I-Ching Cheng, Chen-Shuan Chung
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    Jiao Li, Yongfeng Yan, Dandan Jiang, Xiaoxiang Wang, Li Wang, Li Liu, Tao Shu, Zhengkui Zhou, Xiaobin Sun
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    Shen Su, Shun-Yao Wu, Yun-He Tang, Lin-Lin Ren, Fan Yin, Yu-Shuang Xu, Xiao-Yu Li, Hua Liu, Shao-Hua Zhang, Xing-Lin Zhang, Zi-Bin Tian, Tao Mao
    BMC Gastroenterology.2025;[Epub]     CrossRef
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    Masaya Iwamuro, Toshiharu Mitsuhashi, Tomoki Inaba, Kazuhiro Matsueda, Teruya Nagahara, Yoji Takeuchi, Hisashi Doyama, Masakatsu Mizuno, Tomoyuki Yada, Yoshinari Kawai, Jun Nakamura, Minoru Matsubara, Hiroko Nebiki, Keiko Niimi, Tatsuya Toyokawa, Ryuta Ta
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    Giovanna Impellizzeri, Giulio Donato, Claudio De Angelis, Nico Pagano
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    Shiwei Zhang, Pan Qin, Hongliang Ji
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Case Report
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
AbstractAbstract PDFPubReaderePub
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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Original Article
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
AbstractAbstract PDFPubReaderePub
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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    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
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  • Endoscopic ultrasound fine-needle biopsy vs fine-needle aspiration for lymph nodes tissue acquisition: a systematic review and meta-analysis
    Antonio Facciorusso, Stefano Francesco Crinò, Paraskevas Gkolfakis, Daryl Ramai, Andrea Lisotti, Ioannis S Papanikolaou, Benedetto Mangiavillano, Ilaria Tarantino, Andrea Anderloni, Carlo Fabbri, Konstantinos Triantafyllou, Pietro Fusaroli
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    Elena Vigliar, Gennaro Acanfora, Antonino Iaccarino, Massimo Mascolo, Daniela Russo, Giulia Scalia, Roberta Della Pepa, Claudio Bellevicine, Marco Picardi, Giancarlo Troncone
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  • Endoscopic Ultrasound Fine-Needle Biopsy versus Fine-Needle Aspiration for Tissue Sampling of Abdominal Lymph Nodes: A Propensity Score Matched Multicenter Comparative Study
    Antonio Facciorusso, Stefano Francesco Crinò, Nicola Muscatiello, Paraskevas Gkolfakis, Jayanta Samanta, Juliana Londoño Castillo, Christian Cotsoglou, Daryl Ramai
    Cancers.2021; 13(17): 4298.     CrossRef
  • 6,482 View
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Focused Review Series: Endoscopic Ultrasound-Guided Therapeutic Intervention: Focus on Technique and Practical Tips
Endoscopic Ultrasonography-Guided Gastroenterostomy Techniques for Treatment of Malignant Gastric Outlet Obstruction
Ryosuke Tonozuka, Takayoshi Tsuchiya, Shuntaro Mukai, Yuichi Nagakawa, Takao Itoi
Clin Endosc 2020;53(5):510-518.   Published online September 23, 2020
DOI: https://doi.org/10.5946/ce.2020.151
AbstractAbstract PDFPubReaderePub
Gastric outlet obstruction (GOO) can be caused by periampullary malignancies and often leads to a reduction in a patient’s quality of life. Recently, endoscopic ultrasonography-guided gastroenterostomy (EUS-GE) using a lumen-apposing self-expandable metal stent (LAMS) has been developed as a minimally invasive and durable endoscopic treatment for GOO. There are three types of EUS-GE technique: (1) the direct technique; (2) device-assisted techniques, such as a balloon catheter, nasobiliary drainage tube, and ultraslim endoscopy; and (3) EUS-guided double balloon-occluded gastrojejunostomy bypass. Previous reports of EUS-GE with LAMS have shown technical and clinical success rates (regardless of technique and etiology) of 87%–100% and 84%–100%, respectively. Studies comparing EUS-GE and surgical gastrojejunostomy have shown similar success rates, reintervention rates, and cost benefits, with a lower rate of early adverse events in EUS-GE. A comparison of EUS-GE and endoscopic enteral stent placement revealed similar technical success rates, but initial clinical success rate was higher and the rate of stent failure requiring reintervention was lower with EUS-GE.

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    Michel Kahaleh
    Gastrointestinal Endoscopy.2022; 95(4): 787.     CrossRef
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    Stephanie Lok Hang Cheung, Anthony Yuen Bun Teoh
    Gut and Liver.2022; 16(2): 190.     CrossRef
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    Rajesh Krishnamoorthi, Shivanand Bomman, Petros Benias, Richard A. Kozarek, Joyce A. Peetermans, Edmund McMullen, Ornela Gjata, Shayan S. Irani
    Endoscopy International Open.2022; 10(06): E874.     CrossRef
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    Byung Sun Kim, Sung Yeol Yang, Won Dong Lee, Jae Sun Song, Min A Yang, Gum Mo Jung, Jin Woong Cho, Ji Woong Kim
    The Korean Journal of Gastroenterology.2022; 79(6): 260.     CrossRef
  • Endoscopic ultrasound-guided gastroenterostomy (gastroenteric anastomosis)
    Joel Fernandez de Oliveira, Matheus Cavalcante Franco, Gustavo Rodela, Fauze Maluf-Filho, Bruno Costa Martins
    International Journal of Gastrointestinal Intervention.2022; 11(3): 112.     CrossRef
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    Manuel Perez-Miranda
    Gastrointestinal Endoscopy.2021; 93(5): 1094.     CrossRef
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    Sebastian Stefanovic, Peter V Draganov, Dennis Yang
    World Journal of Gastrointestinal Surgery.2021; 13(7): 620.     CrossRef
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    Hideyuki Shiomi, Arata Sakai, Ryota Nakano, Shogo Ota, Takashi Kobayashi, Atsuhiro Masuda, Hiroko Iijima
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  • 13,180 View
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Review
Diagnosing Gastric Mesenchymal Tumors by Digital Endoscopic Ultrasonography Image Analysis
Moon Won Lee, Gwang Ha Kim
Clin Endosc 2021;54(3):324-328.   Published online June 18, 2020
DOI: https://doi.org/10.5946/ce.2020.061
AbstractAbstract PDFPubReaderePub
Gastric mesenchymal tumors (GMTs) are incidentally discovered in national gastric screening programs in Korea. Endoscopic ultrasonography (EUS) is the most useful diagnostic modality for evaluating GMTs. The differentiation of gastrointestinal stromal tumors from benign mesenchymal tumors, such as schwannomas or leiomyomas, is important to ensure appropriate clinical management. However, this is difficult and operator dependent because of the subjective interpretation of EUS images. Digital image analysis computes the distribution and spatial variation of pixels using texture analysis to extract useful data, enabling the objective analysis of EUS images and decreasing interobserver and intraobserver agreement in EUS image interpretation. This review aimed to summarize the usefulness and future of digital EUS image analysis for GMTs based on published reports and our experience.

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  • Acute Hemorrhagic Rectal Ulcer in a Uremic Patient: A Case Report and Literature Review
    Dongdong Liu, Xingbing Han, Min Li, Lingyan Li, Yi Huang, Jingmei Song
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    Darío Montes N, Nixon Cevallos R, Rubén Montes N
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    Dong Chan Joo, Gwang Ha Kim, Moon Won Lee, Bong Eun Lee, Ji Woo Kim, Kwang Baek Kim
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    Xian‐Da Zhang, Ling Zhang, Ting‐Ting Gong, Zhuo‐Ran Wang, Kang‐Li Guo, Jun Li, Yuan Chen, Jian‐Tao Zhang, Ben‐Gong Ye, Jin Ding, Jian‐Wei Zhu, Feng Liu, Duan‐Min Hu, JianGang Chen, Chun‐Hua Zhou, Duo‐Wu Zou
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    Gwang Ha Kim, Dong Chan Joo, Moon Won Lee, Bong Eun Lee, Kyungbin Kim
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    Gut and Liver.2022; 16(3): 321.     CrossRef
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    M. Reyes Busta Nistal, Noelia Alcaide Suarez, Luis Fernández Salazar, Daniel Corrales Cruz
    Gastroenterología y Hepatología.2021;[Epub]     CrossRef
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    Shotaro Okanoue, Masaya Iwamuro, Takehiro Tanaka, Takuya Satomi, Kenta Hamada, Hiroyuki Sakae, Makoto Abe, Yoshiyasu Kono, Hiromitsu Kanzaki, Seiji Kawano, Yoshiro Kawahara, Hiroyuki Okada
    Medicine.2021; 100(40): e27520.     CrossRef
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  • 243 Download
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Original Article
Feasibility and Accuracy of Transduodenal Endoscopic Ultrasound-Guided Fine-Needle Aspiration of Solid Lesions Using a 19-Gauge Flexible Needle: A Multicenter Study
Germana de Nucci, Maria Chiara Petrone, Nicola Imperatore, Edoardo Forti, Roberto Grassia, Silvia Giovanelli, Laura Ottaviani, Vincenzo Mirante, Giuseppe Sabatino, Carlo Fabbri, Mauro Manno, Paolo Giorgio Arcidiacono, Gianpiero Manes
Clin Endosc 2021;54(2):229-235.   Published online May 25, 2020
DOI: https://doi.org/10.5946/ce.2020.056
AbstractAbstract PDFPubReaderePub
Background
/Aims: Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is the go-to method for obtaining samples from gastrointestinal tract and pancreatic lesions. When the transduodenal approach is utilized, the use of a more flexible needle, such as a nitinol 19-gauge (G) needle, has been recommended. The aim of this study was to evaluate the feasibility and accuracy of 19-G flexible aspiration needles in obtaining samples from solid lesions through a transduodenal approach.
Methods
This was a retrospective analysis of prospectively collected data from eight Italian endoscopy centers. Consecutive patients with solid lesions who underwent transduodenal EUS-FNA with a 19-G flexible needle were included.
Results
A total of 201 patients were enrolled. According to histology, EUS, radiology and 12 months of follow-up, 151 patients had malignant lesions and 50 patients had benign lesions. EUS-FNA was feasible in all cases. An adequate histologic sample was obtained in all except eight cases (96.1%). The sensitivity of EUS-FNA was 92.1% (95% confidence interval [CI], 86.8%–95.7%), and the specificity was 100% (95% CI, 90.5%–100%). The positive predictive value was 100% (95% CI, 93.4%–100%), and the negative predictive value was 74% (95% CI, 62.8%–82.7%). The diagnostic accuracy was 93.5% (95% CI, 89.2%–96.5%).
Conclusions
The transduodenal approach for obtaining samples from solid lesions using a 19-G flexible needle seems feasible and accurate.

Citations

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  • Comparation of 5 ml and 10 ml Negative Pressures with Wet-suction Techniques for EUS-FNA of Solid Lesions
    Yuchun Zhu, Yang Su, Peng Yang, Jiaojun Li, Tai Yu, Yi Wang, Xi Zhou, Ming Zhao, Xiaobin Sun, Jing Shan
    Journal of Clinical Gastroenterology.2025; 59(1): 97.     CrossRef
  • Comparing needle types and aspiration techniques in EUS-TA to optimize diagnostic efficacy and specimen quality in patients with pancreatic lesions
    Rumin Shang, Xiangming Han, Fangwei He, Lihua Huang, Cui Zeng, Kun Chen, Fei Lv, Xiangwu Ding
    Frontiers in Medicine.2024;[Epub]     CrossRef
  • Diagnostic Ability of Endoscopic Ultrasound-Guided Tissue Acquisition Using 19-Gauge Fine-Needle Biopsy Needle for Abdominal Lesions
    Kotaro Takeshita, Susumu Hijioka, Yoshikuni Nagashio, Yuta Maruki, Yuki Kawasaki, Kosuke Maehara, Yumi Murashima, Mao Okada, Go Ikeda, Natsumi Yamada, Tetsuro Takasaki, Daiki Agarie, Hidenobu Hara, Yuya Hagiwara, Kohei Okamoto, Daiki Yamashige, Akihiro Oh
    Diagnostics.2023; 13(3): 450.     CrossRef
  • Effect of wet-heparinized suction on the quality of mediastinal solid tumor specimens obtained by endoscopic ultrasound-guided fine-needle aspiration: a retrospective study from a single center
    Bo Xu, Qian Lu, Rong Fang, Xiaojuan Dai, Haiyan Xu, Xiangwu Ding, Huawei Gui
    BMC Gastroenterology.2023;[Epub]     CrossRef
  • Comparison of Endoscopic Ultrasound-Guided Fine Needle Aspiration with 19-Gauge and 22-Gauge Needles for Solid Pancreatic Lesions
    Changjuan Li, Jianwei Mi, Fulai Gao, Xinying Zhu, Miao Su, Xiaoli Xie, Dongqiang Zhao
    International Journal of General Medicine.2021; Volume 14: 10439.     CrossRef
  • 6,686 View
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Case Reports
Endoscopic Ultrasound-Guided Vascular Therapy for Portoduodenal Fistula
Tanyaporn Chantarojanasiri, Apichet Sirinawasatien, Chalermrat Bunchorntavakul, Aroon Siripun, Sa-ard Treepongkaruna, Thawee Ratanachu-ek
Clin Endosc 2020;53(6):750-753.   Published online February 13, 2020
DOI: https://doi.org/10.5946/ce.2019.167
AbstractAbstract PDFPubReaderePub
Portoenteric fistula is a rare cause of massive upper gastrointestinal bleeding. Most cases can be treated with radiointervention or surgery, but portoenteric fistula is associated with a high mortality. We reported a case of intermittent massive upper gastrointestinal bleeding in a 33-year-old man with cholangiocarcinoma who underwent surgical resection followed by chemoradiation. A portoduodenal fistula due to chronic duodenal ulceration was identified. The bleeding was successfully controlled by endoscopic ultrasound-guided coil placement through the duodenal bulb using the anchoring technique. Follow-up endoscopy and computed tomography scan showed multiple coil placements between a part of the portal vein and the duodenal bulb without any evidence of portal vein thrombosis. There were no complications, and bleeding did not recur during the 8-month follow-up period.

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    E Dubois, R Geelen
    Acta Gastro Enterologica Belgica.2024; 87(3): 430.     CrossRef
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    Chaoqun Han, Xin Ling, Jun Liu, Rong Lin, Zhen Ding
    Therapeutic Advances in Gastroenterology.2022;[Epub]     CrossRef
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    Masanobu Taniguchi, Atsushi Mitsunaka, Yumi Zen, Takayuki Higashiguchi, Masaru Nagato, Yasuhisa Tango, Ichiro Nakamura, Tomoaki Nakamura, Hisanori Shiomi
    The Japanese Journal of Gastroenterological Surgery.2022; 55(2): 99.     CrossRef
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    Shin Haba, Kazuo Hara, Nobumasa Mizuno, Takamichi Kuwahara, Nozomi Okuno, Akira Miyano, Daiki Fumihara, Moaz Elshair
    Clinical Endoscopy.2022; 55(3): 458.     CrossRef
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  • 103 Download
  • 3 Web of Science
  • 4 Crossref
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A remnant choledochal cyst after choledochal cyst excision treated with a lumen-apposing metal stent: a case report
Bo Kyung Kim, Jung Won Chun, Sang Hyub Lee, Ji Kon Ryu, Yong-Tae Kim, Woo Hyun Paik
Clin Endosc 2022;55(4):564-569.   Published online January 8, 2020
DOI: https://doi.org/10.5946/ce.2019.176
AbstractAbstract PDFPubReaderePub
A lumen-apposing metal stent (LAMS) is a saddle-shaped stent with large flanges at both ends, thereby preventing stent migration and helping with approximation of the adjacent structures. We report the case of a 25-year-old female with remnant choledochal cyst which was successfully treated with LAMS after initial treatment failure with a plastic stent. Although complete excision of the cyst is the definite treatment of choledochal cysts, endoscopic ultrasonography-guided cystoduodenostomy can be considered in cases wherein surgery is not feasible and dysplasia is not present. LAMS may be preferred to plastic stents for effective resolution of remnant choledochal cyst and prevention of ascending infection.

Citations

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  • Hepatic multiple hyperintense cystic lesions: a rare caroli disease
    Mohammed H. Alsharif, Nagi M. Bakhit, Abdulaziz Alarifi, Elbagir M. Nassir, Abair A. Mahdi, Juman M. Almasaad, Abubaker Y. Elamin, Khalid M. Taha
    THE NEW ARMENIAN MEDICAL JOURNAL.2023; (1, 17 (202): 41.     CrossRef
  • Hepatic multiple hyperintense cystic lesions: a rare caroli disease.
    Mohammed H. Alsharif, Nagi.M Bakhit, Abdulaziz Alarifi, Elbagir M. Nassir, Abair A. Mahdi, Juman M. Almasaad, Abubaker.Y. Elamin, Khalid M. Taha
    THE NEW ARMENIAN MEDICAL JOURNAL.2023; (1, 17 (202): 41.     CrossRef
  • 6,983 View
  • 233 Download
  • 1 Web of Science
  • 2 Crossref
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Focused review series
Current Status of Endoscopic Ultrasound Techniques for Pancreatic Neoplasms
Yousuke Nakai, Naminatsu Takahara, Suguru Mizuno, Hirofumi Kogure, Kazuhiko Koike
Clin Endosc 2019;52(6):527-532.   Published online July 24, 2019
DOI: https://doi.org/10.5946/ce.2019.025
AbstractAbstract PDFPubReaderePub
Endoscopic ultrasound (EUS) now plays an important role in the management of pancreatic neoplasms. There are various types of pancreatic neoplasms, from benign to malignant lesions, and the role of EUS ranges from the imaging diagnosis to treatment. EUS is useful for the detection, characterization, and tissue acquisition of pancreatic lesions. Recent advancement of contrast-enhanced harmonic EUS and elastography enables better characterization of pancreatic lesions. In addition to these enhanced EUS imaging techniques, EUS-guided tissue acquisition is now the standard procedure to establish the pathological diagnosis of pancreatic neoplasms. While these diagnostic roles of EUS have been established, EUS-guided interventions such as ablation and drainage are also increasingly utilized in the management of pancreatic neoplasms. However, most of these EUS-guided interventions are not yet standardized in terms of techniques and devices and thus need further investigations.

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    Lu-Hong Wang, Yi Jiang, Chen-Hang Sun, Peng-Tao Chen, Yi-Nan Ding
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    Cosmas Rinaldi Adithya Lesmana
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    Arkadeep Dhali, Vincent Kipkorir, Bahadar S. Srichawla, Harendra Kumar, Roger B. Rathna, Ibsen Ongidi, Talha Chaudhry, Gisore Morara, Khulud Nurani, Doreen Cheruto, Jyotirmoy Biswas, Leonard R. Chieng, Gopal Krishna Dhali
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    Vaneet Jearth, Surinder S. Rana
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    Dong Wook Lee, Eun Young Kim
    Digestive Diseases and Sciences.2022; 67(5): 1635.     CrossRef
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    Armando Pereyra-Talamantes, Juan Eduardo Flores-Martín, Marco Antonio Gallaga-Rojas, Jesús Emmanuel Rodríguez-Silverio, Erikc González-Azua, Mario Eduardo Alonso-Calamaco, Enrique Jiménez-Chavarría, Héctor F Noyola-Villalobos
    Revista Mexicana de Cirugía Endoscópica.2022; 23(1-2): 41.     CrossRef
  • Dynamic Doppler Ultrasound Assessment of Tissue Perfusion Is a Better Tool than a Single Vessel Doppler Examination in Differentiating Malignant and Inflammatory Pancreatic Lesions
    Przemysław Dyrla, Arkadiusz Lubas, Jerzy Gil, Marek Saracyn, Maciej Gonciarz
    Diagnostics.2021; 11(12): 2289.     CrossRef
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    Julio Iglesias-Garcia, Daniel de la Iglesia-Garcia, José M. Olmos-Martinez, José Lariño-Noia, J. Enrique Dominguez-Muñoz
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Case Report
Duodenal Stricture due to Necrotizing Pancreatitis following Endoscopic Ultrasound-Guided Ethanol Ablation of a Pancreatic Cyst: A Case Report
Jung Won Chun, Sang Hyub Lee, Jin Ho Choi, Woo Hyun Paik, Ji Kon Ryu, Yong-Tae Kim
Clin Endosc 2019;52(5):510-515.   Published online July 4, 2019
DOI: https://doi.org/10.5946/ce.2018.191
AbstractAbstract PDFPubReaderePub
The frequency of incidental detection of pancreatic cystic lesions (PCLs) is increasing because of the frequent use of cross-sectional imaging. The appropriate treatment for PCLs is challenging, and endoscopic ultrasound-guided ablation for PCLs has been reported in several studies. Although the feasibility and efficacy of this therapeutic modality have been shown, the safety issues associated with the procedure are still a concern. We present a case of a 61-year-old man who underwent ultrasound-guided ethanol ablation for PCL and needed repeated endoscopic balloon dilatation for severe duodenal stricture caused by necrotizing pancreatitis after the cyst ablation therapy.

Citations

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  • EUS-guided ablation for pancreatic cystic lesions: An updated review
    Mengruo Jiang, Lisi Peng, Yuwei Sun, Shiyu Li, Zhaoshen Li, Liqi Sun, Haojie Huang, Jin Zhendong
    Endoscopic Ultrasound.2025; 14(5): 239.     CrossRef
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    John C. Rowe, Alice A. Huang, Jin Heo, Nolie K. Parnell, Adam J. Rudinsky
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    Chen Du, Ning-Li Chai, En-Qiang Linghu, Hui-Kai Li, Xiu-Xue Feng
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Original Articles
Comparison of Clinical Outcomes between Plastic Stent and Novel Lumen-apposing Metal Stent for Endoscopic Ultrasound-Guided Drainage of Peripancreatic Fluid Collections
Ho Cheol Shin, Chang Min Cho, Min Kyu Jung, Seong Jae Yeo
Clin Endosc 2019;52(4):353-359.   Published online March 13, 2019
DOI: https://doi.org/10.5946/ce.2018.154
AbstractAbstract PDFPubReaderePub
Background
/Aims: Endoscopic ultrasound (EUS)-guided transmural drainage for peripancreatic fluid collections (PFCs) has gained wide acceptance as a nonsurgical intervention. Although a lumen-apposing metal stent (LAMS) was recently introduced, there are few data comparing the clinical outcomes between LAMS and plastic stent (PS) drainage.
Methods
Endoscopy databases of all patients who had undergone EUS-guided drainage for PFCs were searched and the clinical outcomes of EUS-guided drainage according to stent-type used were compared.
Results
A total of 27 patients (median age, 56 years) with PFCs underwent EUS-guided transmural drainage between January 2011 and December 2017. Of these, 17 underwent PS placement and 10 underwent LAMS placement. There was no significant difference in the technical success rate between the 2 groups (94.1% vs. 100%, p=1.0). Procedure time was shorter in the LAMS group compared to that in the PS group (10.6±2.5 min vs. 21.4±9.5 min, p=0.002). Among subjects with clinical success, recurrence of PFC after stent removal occurred in 5 of 12 patients with PS and 4 of 10 with LAMS, without statistical difference (41.7% vs. 40.0%, p=1.0).
Conclusions
Although our study showed similar clinical outcomes for LAMS and PS, further prospective trials are required to validate the superiority of LAMS.

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The Utility of Endoscopic Ultrasound in Patients with Isolated Elevations in Serum Amylase and/or Lipase
Lalitha M. Sitaraman, Amit H. Sachdev, Tamas A. Gonda, Amrita Sethi, John M. Poneros, Frank G. Gress
Clin Endosc 2019;52(2):175-181.   Published online January 16, 2019
DOI: https://doi.org/10.5946/ce.2018.110
AbstractAbstract PDFPubReaderePub
Background
/Aims: The aim of this study was to describe the diagnostic yield of endoscopic ultrasound (EUS) in patients with isolated elevated levels of amylase and/or lipase.
Methods
A retrospective chart review was conducted at a large academic medical center from 2000 to 2016. Patients were selected based on having elevated amylase, lipase, or both, but without a diagnosis of pancreatitis or known pancreatobiliary disease. Patients were excluded if they had abnormal liver function tests or abnormal imaging of the pancreas.
Results
Of 299 EUS procedures performed, 38 met inclusion criteria. Symptoms were present in 31 patients, most frequently abdominal pain (87%). In 20 patients (53%), initial EUS most commonly found chronic pancreatitis (n=7; 18%), sludge (5; 13%), or new diagnosis of pancreas divisum (3; 8%). In the asymptomatic patients (7), 3 had a finding on EUS, most importantly sludge (2), stone (1), and pancreas divisum (1). No patients were diagnosed with a mass or pancreatic cyst. During the follow up period, 6 patients (22%) had cholecystectomy.
Conclusions
In our study of patients with isolated elevations in amylase and/or lipase without acute pancreatitis who underwent EUS, approximately 50% had a pancreatobiliary finding, most commonly chronic pancreatitis or biliary sludge.

Citations

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  • Mildly Elevated Lipase and Subsequent Risk of Acute Pancreatitis and Pancreatic Cancer
    Zaid Ansari, Akram Ahmad, Tasneem Jamal Al-Din, David Restrepo, Osama Sherjeel Khan, Ritu Channagiri, Tilak Shah
    American Journal of Gastroenterology.2025;[Epub]     CrossRef
  • Endosonographic features in patients with non-alcoholic early chronic pancreatitis improved with treatment at one year follow up
    Kazutoshi Higuchi, Seiji Futagami, Hiroshi Yamawaki, Makoto Murakami, Kumiko Kirita, Shuhei Agawa, Go Ikeda, Hiroto Noda, Yasuhiro Kodaka, Nobue Ueki, Keiko Kaneko, Katya Gudis, Ryuji Ohashi, Katsuhiko Iwakiri
    Journal of Clinical Biochemistry and Nutrition.2021; 68(1): 86.     CrossRef
  • Do Patients with Pancreatic Hyperenzymemia without Abnormal Imaging Need Additional Endoscopic Ultrasound?
    Jung Wan Choe, Jong Jin Hyun
    Clinical Endoscopy.2019; 52(2): 97.     CrossRef
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  • 3 Web of Science
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Predictive Factors for Inaccurate Diagnosis of Swollen Lymph Nodes in Endoscopic Ultrasound-Guided Fine Needle Aspiration
Yuki Fujii, Yoshihide Kanno, Shinsuke Koshita, Takahisa Ogawa, Hiroaki Kusunose, Kaori Masu, Toshitaka Sakai, Keisuke Yonamine, Yujiro Kawakami, Toji Murabayashi, Fumisato Kozakai, Yutaka Noda, Hiroyuki Okada, Kei Ito
Clin Endosc 2019;52(2):152-158.   Published online January 7, 2019
DOI: https://doi.org/10.5946/ce.2018.125
AbstractAbstract PDFPubReaderePub
Background
/Aims: This study aimed to identify the predictive factors for inaccurate endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) diagnosis of swollen lymph nodes without rapid on-site cytopathological evaluation.
Methods
Eighty-three consecutive patients who underwent EUS-FNA for abdominal or mediastinal lymph nodes from January 2008 to June 2017 were included from a prospectively maintained EUS-FNA database and retrospectively reviewed. The sensitivity, specificity, and accuracy of EUS-FNA for the detection of neoplastic diseases were calculated. Candidate factors for inaccurate diagnosis (lymph node size and location, needle type, puncture route, number of passes, and causative disease) were evaluated by comparison between accurately diagnosed cases and others.
Results
The final diagnosis of the punctured lymph node was classified as neoplastic (65 cases: a metastatic lymph node, malignant lymphoma, or Crow-Fukase syndrome) or non-neoplastic (18 cases: a reactive node or amyloidosis). The sensitivity, specificity, and accuracy were 83%, 94%, and 86%, respectively. On multivariate analyses, small size of the lymph node was the sole predictive factor for inaccurate EUS-FNA diagnosis with a significant difference (odds ratios, 19.8; 95% confidence intervals, 3.15–124; p=0.0015).
Conclusions
The lymph node size of <16 mm was the only independent factor associated with inaccurate EUS-FNA diagnosis of swollen lymph nodes.

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    Abbas A Tasneem, Nasir H Luck, Muhammed Mubarak
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    Flaminia Bellisario, Fabia Attili, Fabrizia Campana, Federica Borrelli de Andreis, Silvia Bellesi, Elena Maiolo, Eleonora Alma, Rosalia Malafronte, Giuseppe Macis, Luigi Maria Larocca, Salvatore Annunziata, Francesco D’Alò, Stefan Hohaus
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    Dominique Béchade, Carine Bellera, Lisa Gauquelin, Isabelle Soubeyran, Pippa McKelvie-Sebileau, Marc Debled, François Chomy, Guilhem Roubaud, Marianne Fonck, Simon Pernot, Alexandre Roch, Anne-Laure Cazeau
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    Linbin Chen, Yin Li, Xiaoyan Gao, Shiyong Lin, Longjun He, Guangyu Luo, Jianjun Li, Chunyu Huang, Guobao Wang, Qing Yang, Hongbo Shan
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    Akashi Fujita, Shomei Ryozawa, Masafumi Mizuide, Yuki Tanisaka, Tomoya Ogawa, Masahiro Suzuki, Hiromune Katsuda, Yoichi Saito, Tomoaki Tashima, Kazuya Miyaguchi, Eiichi Arai, Tomonori Kawasaki, Yumi Mashimo
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    Xin-Yu Lin, Dan Pan, Li-Xuan Sang, Bing Chang
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    Yuki Tanisaka, Masafumi Mizuide, Akashi Fujita, Tomoya Ogawa, Ryuichiro Araki, Masahiro Suzuki, Hiromune Katsuda, Youichi Saito, Kazuya Miyaguchi, Tomoaki Tashima, Yumi Mashimo, Masami Yasuda, Shomei Ryozawa, Konstantinos Triantafyllou
    Gastroenterology Research and Practice.2021; 2021: 1.     CrossRef
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    Tae Hyeon Kim
    Clinical Endoscopy.2019; 52(2): 93.     CrossRef
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Focused Review Series: Expanding Indication: Interventional Endoscopic Management for Pancreaticobiliary Diseases
Endoscopic Ultrasound-Guided Biliary Drainage for Unresectable Hilar Malignant Biliary Obstruction
Yousuke Nakai, Hirofumi Kogure, Hiroyuki Isayama, Kazuhiko Koike
Clin Endosc 2019;52(3):220-225.   Published online November 29, 2018
DOI: https://doi.org/10.5946/ce.2018.094
AbstractAbstract PDFPubReaderePub
Endoscopic transpapillary biliary drainage is the current standard of care for unresectable hilar malignant biliary obstruction (MBO) and bilateral metal stent placement is shown to have longer patency. However, technical and clinical failure is possible and percutaneous transhepatic biliary drainage (PTBD) is sometimes necessary. Endoscopic ultrasound-guided biliary drainage (EUS-BD) is increasingly being reported as an alternative rescue procedure to PTBD. EUS-BD has a potential advantage of not traversing the biliary stricture and internal drainage can be completed in a single session. Some approaches to bilateral biliary drainage for hilar MBO under EUS-guidance include a bridging method, hepaticoduodenostomy, and a combination of EUS-BD and transpapillary biliary drainage. The aim of this review is to summarize data on EUS-BD for hilar MBO and to clarify its advantages over the conventional approaches such as endoscopic transpapillary biliary drainage and PTBD.

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Case Report
Primary Gastric Small Cell Carcinoma (Presenting as Linitis Plastica) Diagnosed Using Endoscopic Ultrasound-Guided Biopsy: A Case Report
Ra Ri Cha, Jin Kyu Cho, Wan Soo Kim, Jin Joo Kim, Jae Min Lee, Sang Soo Lee, Hyun Jin Kim
Clin Endosc 2019;52(3):278-282.   Published online October 5, 2018
DOI: https://doi.org/10.5946/ce.2018.114
AbstractAbstract PDFPubReaderePub
Small cell carcinomas are the most aggressive, highly malignant neuroendocrine tumors; among these, gastric small cell carcinoma (GSCC) is extremely rare. Here we report a case of a patient with primary GSCC, presenting as linitis plastic, who was diagnosed using endoscopic ultrasound (EUS)-guided biopsy. With undiagnosed linitis plastica, an 80-year-old woman was referred to our institution. Abdominal computed tomography revealed irregular wall thickening extending from the gastric body to the antrum. Endoscopy suspected to have Borrmann type IV advanced gastric cancer. EUS of the stomach showed diffuse submucosal thickening of the gastric wall, mainly the antrum. EUS-guided bite-on-bite biopsy confirmed the diagnosis of GSCC. In general, GSCC is difficult to diagnose and careful examination is necessary to determine the therapeutic strategy; however, EUS is particularly helpful in the differential diagnosis of a lesion presenting as linitis plastica.

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Review
De-novo Gastrointestinal Anastomosis with Lumen Apposing Metal Stent
Deepanshu Jain, Ankit Chhoda, Abhinav Sharma, Shashideep Singhal
Clin Endosc 2018;51(5):439-449.   Published online September 27, 2018
DOI: https://doi.org/10.5946/ce.2018.077
AbstractAbstract PDFPubReaderePub
Gastric outlet obstruction, afferent or efferent limb obstruction, and biliary obstruction among patients with altered anatomy often require surgical intervention which is associated with significant morbidity and mortality. Endoscopic dilation for benign etiologies requires multiple sessions, whereas self-expandable metal stents used for malignant etiologies often fail due to tumor in-growth. Lumen apposing metal stents, placed endoscopically with the intent of creating a de-novo gastrointestinal anastomosis bypassing the site of obstruction, can potentially achieve similar efficacy, with a much lower complication rate. In our study cohort (n=79), the composite technical success rate and clinical success rate was 91.1% (72/79) and 97.2% (70/72), respectively. Five different techniques were used: 43% (34/79) underwent the balloon-assisted method, 27.9% (22/79) underwent endoscopic ultrasound-guided balloon occluded gastro-jejunostomy bypass, 20.3% (16/79) underwent the direct technique, 6.3% (5/79) underwent the hybrid rendezvous technique, and 2.5% (2/79) underwent natural orifice transluminal endoscopic surgery (NOTES)-assisted procedure. All techniques required an echoendoscope except NOTES. In all, 53.2% (42/79) had non-cautery enhanced Axios stent, 44.3% (35/79) had hot Axios stent, and 2.5% (2/79) had Niti-S spaxus stent. Symptom-recurrence was seen in 2.8%, and 6.3% had a complication (bleeding, abdominal pain or peritonitis). All procedures were performed by experts at centers of excellence with adequate surgical back up.

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    Tiffany Z. Yu, Abishek Agnihotri, Richard Zheng, Babar Bashir, Nayeem Nasher, Charles J. Yeo, Avinoam Nevler, Harish Lavu, Wilbur B. Bowne, Anand Kumar
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Focused Review Series: Expanding the Indication with Safety Issue of Endoscopic Ultrasound
Endoscopic Ultrasound-Guided Portal Pressure Measurement and Interventions
Jason B. Samarasena, Kenneth J. Chang
Clin Endosc 2018;51(3):222-228.   Published online May 31, 2018
DOI: https://doi.org/10.5946/ce.2018.079
AbstractAbstract PDFPubReaderePub
A growing number of studies have explored endoscopic ultrasound (EUS)-guided vascular catheterization. Potential clinical applications of EUS-guided portal venous access include angiography, measurement of the portosystemic pressure gradient, EUS-guided transhepatic intrahepatic portosystemic shunt creation and portal vein sampling for the evaluation in gastrointestinal cancer. The following article reviews the different devices and techniques employed in these applications.

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    I. Dragomir, C. Pojoga, C. Hagiu, V. Rednic, R. I. Orzan, P. Fischer, O. Nicoara-Farcau, H. Stefanescu, B. Procopet, A. Seicean
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    Enrico O. Souto
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  • 16 Crossref
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Case Report
A Rare Duodenal Subepithelial Tumor: Duodenal Schwannoma
Dong Hwahn Kahng, Gwang Ha Kim, Sang Gyu Park, So Jeong Lee, Do Youn Park
Clin Endosc 2018;51(6):587-590.   Published online May 15, 2018
DOI: https://doi.org/10.5946/ce.2018.050
AbstractAbstract PDFPubReaderePub
Schwannomas are uncommon neoplasms that arise from Schwann cells of the neural sheath. Gastrointestinal schwannomas are rare among mesenchymal tumors of the gastrointestinal tract, and only a few cases have been reported to date. Duodenal schwannomas are usually discovered incidentally and achieving a preoperative diagnosis is difficult. Schwannomas can be distinguished from other subepithelial tumors on endoscopic ultrasonography; however, any typical endosonographic features of duodenal schwannomas have not been reported due to the rarity of these tumors. Immunohistochemistry is essential to distinguish schwannomas from gastrointestinal stromal tumors and leiomyomas. We report a case of duodenal schwannoma found incidentally during a health check-up endoscopy. On endoscopic ultrasonography, this tumor was suspected as a gastrointestinal stromal tumor; therefore, the patient underwent laparoscopic wedge resection of the tumor. Histopathology and immunohistochemistry confirmed that the duodenal lesion was a benign schwannoma.

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    Martin Jezovit, Hasan Bakirli, Ifrat Bakirov, Khalid Hureibi, Gultakin Bakirova, Roman Okolicany, Pavol Janac, Iveta Meciarova, Nasser Alhwaymel, Ilkin Bakirli, Augustin Prochotsky, Muthukumaran Rangarajan
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Original Articles
A Prospective Blinded Study of Endoscopic Ultrasound Elastography in Liver Disease: Towards a Virtual Biopsy
Allison R. Schulman, Ming V. Lin, Anna Rutherford, Walter W. Chan, Marvin Ryou
Clin Endosc 2018;51(2):181-185.   Published online March 23, 2018
DOI: https://doi.org/10.5946/ce.2017.095
AbstractAbstract PDFPubReaderePub
Background
/Aims: Liver biopsy has traditionally been used for determining the degree of fibrosis, however there are several limitations. Endoscopic ultrasound (EUS) real-time elastography (RTE) is a novel technology that uses image enhancement to display differences in tissue compressibility. We sought to assess whether liver fibrosis index (LFI) can distinguish normal, fatty, and cirrhotic liver tissue.
Methods
A total of 50 patients undergoing EUS were prospectively enrolled. RTE of the liver was performed to synthesize the LFI in each patient. Univariate and multivariable analyses were performed. Chi-square and t-tests were performed for categorical and continuous variables, respectively. A p-value of <0.05 was considered significant.
Results
Abdominal imaging prior to endoscopic evaluation suggested normal tissue, fatty liver, and cirrhosis in 26, 16, and 8 patients, respectively. Patients with cirrhosis had significantly increased mean LFI compared to the fatty liver (3.2 vs. 1.7, p<0.001) and normal (3.2 vs. 0.8, p<0.001) groups. The fatty liver group showed significantly increased LFI compared to the normal group (3.8 vs. 1.4, p<0.001). Multivariable regression analysis suggested that LFI was an independent predictor of group features (p<0.001).
Conclusions
LFI computed from RTE images significantly correlates with abdominal imaging and can distinguish normal, fatty, and cirrhotic-appearing livers; therefore, LFI may play an important role in patients with chronic liver disease.

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Capability of Radial- and Convex-Arrayed Echoendoscopes for Visualization of the Pancreatobiliary Junction
Yoshihide Kanno, Kei Ito, Shinsuke Koshita, Takahisa Ogawa, Hiroaki Kusunose, Kaori Masu, Toshitaka Sakai, Toji Murabayashi, Sho Hasegawa, Fumisato Kozakai, Yujiro Kawakami, Yuki Fujii, Yutaka Noda
Clin Endosc 2018;51(3):274-278.   Published online September 25, 2017
DOI: https://doi.org/10.5946/ce.2017.098
AbstractAbstract PDFPubReaderePub
Background
/Aims: Although both radial- and convex-arrayed endoscopic ultrasonography (EUS) scopes are widely used for observational EUS examinations, there have been few comparative studies on their power of visualization. The aim of this study was to evaluate the capability of these EUS scopes for observation of the pancreatobiliary junction.
Methods
The rate of successful visualization of the pancreatobiliary junction was retrospectively compared between a radial-arrayed and a convex-arrayed echoendoscope, from a prospectively maintained database. Study periods were defined as January 2010 to December 2012 for the radial group, and February 2015 to October 2016 for the convex group because the respective scope was mainly used during those periods.
Results
During the study period, 1,660 cases with radial EUS and 1,984 cases with convex EUS were recruited. The success rates of observation of the pancreatobiliary junction were 80.0% and 89.5%, respectively (p<0.0001).
Conclusions
The capability of visualization of the pancreatobiliary junction in observational EUS was found to be better with a convex-arrayed than with a radial-arrayed echoendoscope.

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    Caterina Stornello, Chiara Cristofori, Davide Checchin, Maria Grazia de Palo, Sabina Grillo, Giulia Peserico, Dario Quintini, Mario Gruppo, Ottavia De Simoni, Alberto Fantin
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    Zhixian Lan, Kangyue Sun, Yuchen Luo, Haiyan Hu, Wei Zhu, Wen Guo, Jing Wen, Wenting Mi, Junsheng Chen, Xiang Chen, Venkata Akshintala, Ying Huang, Side Liu, Yue Li
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Case Report
A Rare Case of Early Gastric Cancer Combined with Underlying Heterotopic Pancreas
Jung Bin Yoon, Bong Eun Lee, Dae Hwan Kim, Do Youn Park, Hye Kyung Jeon, Dong Hoon Baek, Gwang Ha Kim, Geun Am Song
Clin Endosc 2018;51(2):192-195.   Published online August 31, 2017
DOI: https://doi.org/10.5946/ce.2017.055
AbstractAbstract PDFPubReaderePub
Heterotopic pancreas in the stomach is usually asymptomatic and benign. Here, we presented a rare case of an early gastric cancer overlying a heterotopic pancreas. A 48-year-old woman underwent esophagogastroduodenoscopy, which revealed a subepithelial mass measuring 2.0×1.5 cm on the gastric antrum with a 1-cm erosive erythematous discoloration on the surface. A biopsy specimen showed moderately differentiated tubular adenocarcinoma. Endosonography showed a heterogeneous hypoechoic mass measuring 1.3×0.6 cm, with indistinct margins in the second and third layers of the gastric wall; anechoic tubular structures within the mass were suggestive of heterotopic pancreas. Distal gastrectomy was performed, which confirmed an early gastric cancer confined to the mucosa, and a separate underlying heterotopic pancreas. Although heterotopic pancreas is most likely benign, careful endoscopic observation of the mucosal surface is necessary to avoid overlooking a coincident early gastric cancer.

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Original Article
Endoscopic Ultrasonography Can Prevent Unnecessary Diagnostic Endoscopic Retrograde Cholangiopancreatography Even in Patients with High Likelihood of Choledocholithiasis and Inconclusive Ultrasonography: Results of a Prospective Study
Ruchir Patel, Meghraj Ingle, Dhaval Choksi, Prateik Poddar, Vikas Pandey, Prabha Sawant
Clin Endosc 2017;50(6):592-597.   Published online August 9, 2017
DOI: https://doi.org/10.5946/ce.2017.010
AbstractAbstract PDFPubReaderePub
Background
/Aims: Endoscopic retrograde cholangiopancreatography (ERCP) is the initial therapy recommended for patients with high likelihood of choledocholithiasis. To determine whether endoscopic ultrasonography (EUS) can prevent diagnostic ERCPs in patients with high probability of choledocholithiasis and inconclusive ultrasonography (US).
Methods
All patients with high likelihood of choledocholithiasis and negative US underwent EUS. ERCP was performed for the patients who showed a definite stone/sludge on EUS. Patients without choledocholithiasis were followed up for 3 months. The primary outcome was avoidance of diagnostic ERCP.
Results
We included 78 patients (51 women; 27 men). Of these, 25 and 7 (total 41%) were diagnosed with choledocholithiasis and sludge, respectively; stone/sludge was removed in 96.9% of the patients. EUS ruled out choledocholithiasis in 38 patients (48.7%). Two of them were found to have choledocholithiasis on follow-up. The sensitivity, specificity, positive and negative predictive value of EUS for detecting choledocholithiasis were 93.9%, 97.3%, 96.9%, and 94.7%, respectively. Unnecessary ERCP was avoided in 57.7% of the patients by using the EUS-first approach.
Conclusions
EUS is a highly accurate and safe procedure. EUS can replace ERCP as the initial investigation in patients with a high probability of choledocholithiasis. It avoids unnecessary ERCP; hence, decreasing related costs and complications.

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Focused Review Series: Training in Endoscopy
Training in Endoscopy: Endoscopic Ultrasound
Chang Min Cho
Clin Endosc 2017;50(4):340-344.   Published online July 31, 2017
DOI: https://doi.org/10.5946/ce.2017.067
AbstractAbstract PDFPubReaderePub
Endoscopic ultrasound (EUS) has been recently established as an indispensable modality for the diagnosis and management of pancreatobiliary and gastrointestinal (GI) disorders. EUS proficiency requires both cognitive and technical abilities, including an understanding of the appropriate indications, the performance of appropriate evaluations before and after the procedure, and the management of procedure-related complications. An increasing demand for skills to handle a growing range of interventional EUS procedures and a continual shortage of EUS training programs are two major obstacles for EUS training. Acquiring the skills necessary to comprehend and conduct EUS often requires training beyond the scope of a standard GI fellowship program. In addition to traditional formal EUS training and preceptorships, regular short-term intensive EUS training programs that provide training at various levels may help EUS practitioners improve and maintain EUS-related knowledges and skills. Theoretical knowledge can be acquired from lectures, textbooks, atlases, slides, videotapes, digital video discs, interactive compact discs, and websites. Informal EUS training is generally based on 1- or 2-day intensive seminars, including didactic lectures, skills demonstrated by expert practitioners through live video-streaming of procedures, and hands-on learning using animal or phantom models.

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Review
Management of Benign and Malignant Pancreatic Duct Strictures
Enad Dawod, Michel Kahaleh
Clin Endosc 2018;51(2):156-160.   Published online July 20, 2017
DOI: https://doi.org/10.5946/ce.2017.085
AbstractAbstract PDFPubReaderePub
The diagnosis and management of pancreatic strictures, whether malignant or benign, remain challenging. The last 2 decades have seen dramatic progress in terms of both advanced imaging and endoscopic therapy. While plastic stents remain the cornerstone of the treatment of benign strictures, the advent of fully covered metal stents has initiated a new wave of interest in calibrating the pancreatic duct with fewer sessions. In malignant disease, palliation remains the priority and further data are necessary before offering systematic pancreatic stenting.

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Focused Review Series: Expanding the Indication with Safety Issue of Endoscopic Ultrasound
Safety and Complications of Interventional Endoscopic Ultrasound
Monica Saumoy, Michel Kahaleh
Clin Endosc 2018;51(3):235-238.   Published online July 19, 2017
DOI: https://doi.org/10.5946/ce.2017.081
AbstractAbstract PDFPubReaderePub
Endoscopic ultrasound (EUS) has become an essential tool for the diagnostic and therapeutic intervention of gastrointestinal diseases. Beyond the drainage of fluid collections, it enables decompression of inaccessible bile and pancreatic ducts, the gallbladder, and the creation of anastomosis within the gastrointestinal tract using fully lumen-apposing stents. This review explored the safety and efficacy of these novel procedures and discussed the training pathway that is necessary to perform them efficiently and safely.

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Case Report
Endoscopic Ultrasound-Guided Perirectal Abscess Drainage without Drainage Catheter: A Case Series
Eun Kwang Choi, Ji Hyun Kim, Seung Uk Jeong, Soo-Young Na, Sun-Jin Boo, Heung Up Kim, Byung-Cheol Song
Clin Endosc 2017;50(3):297-300.   Published online April 11, 2017
DOI: https://doi.org/10.5946/ce.2016.123
AbstractAbstract PDFPubReaderePub
A perirectal abscess is a relatively common disease entity that occurs as a postsurgical complication or as a result of various medical conditions. Endoscopic ultrasound (EUS)-guided drainage was recently described as a promising alternative treatment. Previous reports have recommended placement of a drainage catheter through the anus for irrigation, which is inconvenient to the patient and carries a risk of accidental dislodgement. We report four cases of perirectal abscess that were successfully treated with only one or two 7 F double pigtail plastic stent placements and without a drainage catheter for irrigation.

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Focused Review Series: EUS-Guided Therapeutic Interventionses
Endoscopic Ultrasound-Guided Vascular Therapy: The Present and the Future
Philip S.J. Hall, Christopher Teshima, Gary R. May, Jeffrey D. Mosko
Clin Endosc 2017;50(2):138-142.   Published online March 30, 2017
DOI: https://doi.org/10.5946/ce.2017.048
AbstractAbstract PDFPubReaderePub
Endoscopic ultrasound (EUS) offers access to many intra-abdominal vessels that until now have only been accessible to the surgeon and interventional radiologist. In addition to assisting with diagnostics, this unique access offers the potential for therapeutic intervention for a host of indications. To date, this has had the most clinical impact in the treatment of gastroesophageal varices, with EUS-guided coil and glue application growing in use worldwide. Although randomised controlled trial data is lacking, we discuss the growing body of literature behind EUS-guided therapy in the management of varices. EUS has also been used in specialized centres to assist in non-variceal gastrointestinal bleeding. The treatment of bleeding from Dieulafoy lesions, tumours and pancreatic pseudoaneurysms has all been described. The potential applications of EUS have also extended to the placement of portal vein stents and porto-systemic shunts in animal models. As medicine continues to move to increasingly less invasive interventions, EUS-guided therapies offer substantial promise for the safe and effective delivery of targeted treatment for a widening array of vascular disorders.

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Endoscopic Ultrasound-Guided Management of Pancreatic Fluid Collections: Update and Review of the Literature
Ali Alali, Jeffrey Mosko, Gary May, Christopher Teshima
Clin Endosc 2017;50(2):117-125.   Published online March 30, 2017
DOI: https://doi.org/10.5946/ce.2017.045
AbstractAbstract PDFPubReaderePub
Severe acute pancreatitis is often complicated by the development of pancreatic fluid collections (PFCs), which may be associated with significant morbidity and mortality. It is crucial to accurately classify these collections as a pseudocyst or walled-off necrosis (WON) given significant differences in outcomes and management. Interventions for PFCs have increasingly shifted to less invasive strategies, with endoscopic ultrasound (EUS)-guided methods being shown to be safer and equally effective as more invasive surgical techniques. In recent years, many new developments have improved the safety and efficacy of EUS-guided interventions, such as the introduction of lumen-apposing metal stents (LAMS), direct endoscopic necrosectomy (DEN) and multiple other adjunctive techniques. Despite these developments, treatment of PFCs, and infected WON in particular, continues to be associated with significant morbidity and mortality. In this article, we discuss the EUS-guided management of PFCs while reviewing the latest developments and controversies in the field. We end by summarizing our own approach to managing PFCs.

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Endoscopic Ultrasound-Guided Biliary Access, with Focus on Technique and Practical Tips
Woo Hyun Paik, Do Hyun Park
Clin Endosc 2017;50(2):104-111.   Published online March 30, 2017
DOI: https://doi.org/10.5946/ce.2017.036
AbstractAbstract PDFPubReaderePub
In 1980, endoscopic ultrasound (EUS) was introduced as a diagnostic tool for evaluation of the pancreas. Since the introduction of curvilinear-array echoendoscopy, EUS has been used for a variety of gastrointestinal interventions, including fine needle aspiration, tumor ablation, and pancreatobiliary access. One of the main therapeutic roles of EUS is biliary drainage as an alternative to endoscopic retrograde biliary drainage (ERBD) or percutaneous transhepatic biliary drainage (PTBD). This article summarizes three different methods of EUS-guided biliary access, with focus on technique and practical tips.

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Endoscopic Ultrasound-Guided Direct Intervention for Solid Pancreatic Tumors
Jimin Han, Kenneth J. Chang
Clin Endosc 2017;50(2):126-137.   Published online March 30, 2017
DOI: https://doi.org/10.5946/ce.2017.034
AbstractAbstract PDFPubReaderePub
Development and use of linear-array echoendoscope and endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) have made endoscopic ultrasound (EUS) more of an interventional procedure than a purely diagnostic procedure. This is a literature review of previously published clinical studies on EUS-guided direct intervention for solid pancreatic tumors, including EUS-guided fine needle injection (EUS-FNI) of antitumor agents, EUS-guided fiducial marker placement, EUS-guided brachytherapy and EUS-guided tumor ablation.

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Original Article
Sensitivity and Specificity of Magnetic Resonance Cholangiopancreatography versus Endoscopic Ultrasonography against Endoscopic Retrograde Cholangiopancreatography in Diagnosing Choledocholithiasis: The Indonesian Experience
Dadang Makmun, Achmad Fauzi, Hamzah Shatri
Clin Endosc 2017;50(5):486-490.   Published online February 28, 2017
DOI: https://doi.org/10.5946/ce.2016.159
AbstractAbstract PDFPubReaderePub
Background
/Aims: Biliary stone disease is one of the most common conditions leading to hospitalization. In addition to endoscopic retrograde cholangiopancreatography (ERCP), endoscopic ultrasonography (EUS) and magnetic resonance cholangiopancreatography (MRCP) are required in diagnosing choledocholithiasis. This study aimed to compare the sensitivity and specificity of EUS and MRCP against ERCP in diagnosing choledocholithiasis.
Methods
This retrospective study was conducted after prospective collection of data involving 62 suspected choledocholithiasis patients who underwent ERCP from June 2013 to August 2014. Patients were divided into two groups. The first group (31 patients) underwent EUS and the second group (31 patients) underwent MRCP. Then, ERCP was performed in both groups. Sensitivity, specificity, and diagnostic accuracy of EUS and MRCP were determined by comparing them to ERCP, which is the gold standard.
Results
The male to female ratio was 3:2. The mean ages were 47.25 years in the first group and 52.9 years in the second group. Sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) for EUS were 96%, 57%, 87%, 88%, and 80% respectively, and for MRCP were 81%, 40%, 68%, 74%, and 50%, respectively.
Conclusions
EUS is a better diagnostic tool than MRCP for diagnosing choledocholithiasis.

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