Endoscopic Ultrasound最新文献

{"title":"Distinct ways to perform a liver biopsy: The core technique setups and updated understanding of these modalities","authors":"Chao Sun, Xingliang Zhao, Lei Shi, Xiaofei Fan, Xiaolong Qi","doi":"10.1097/eus.0000000000000035","DOIUrl":"https://doi.org/10.1097/eus.0000000000000035","url":null,"abstract":"\u0000 There is dramatically increased incidence of several liver diseases worldwide; thus, an unmet need to diagnose and stage these pathological entities heralds the wide application of liver biopsy (LB) techniques. The ways of LB are versatile, including percutaneous LB, transjugular LB, and more recently an approach of minimal invasiveness, that is, EUS-guided LB (EUS-LB). In this review article, we come to the conclusion that EUS-LB may serve as a feasible, reliable, and safe alternative to percutaneous LB and transjugular LB in terms of improved diagnostic yield, excellent sampling performance, and controlled adverse events among patients with focal, infiltrative, and parenchymal liver diseases. Furthermore, extensive efforts have been made to optimize and refine several technical pillars within EUS-LB modality such as the selection of needle size/type, priming manner of biopsy needle, and choice of pass/actuation technique, all of which aim at obtaining better specimen quantity and quality. Another advantageous aspect and unique property pertinent to EUS-guided modality indicate that multiple screening, surveillance, and intervention procedures can be combined into one single endoscopic session. Accordingly, some pilot studies have clarified the clinical usefulness by integrating EUS-LB with simultaneous measurement of portal pressure gradient or examination of liver stiffness. However, more studies, in particular, randomized controlled trials or real-world evidence, are practically warranted to elucidate the validity and safety of EUS-LB as a regular/routine part of managing liver diseases.","PeriodicalId":11577,"journal":{"name":"Endoscopic Ultrasound","volume":"1 3","pages":""},"PeriodicalIF":4.5,"publicationDate":"2023-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139008846","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The first case to decompress the pancreatic duct by reopening a surgical cystogastrostomical fistula using EUS–guided pancreatic drainage","authors":"Zhipeng Lin, Yingchun Wang, Wenzheng Liu, Xiue Yan, Hong Chang, Yingchun Huang","doi":"10.1097/eus.0000000000000042","DOIUrl":"https://doi.org/10.1097/eus.0000000000000042","url":null,"abstract":"","PeriodicalId":11577,"journal":{"name":"Endoscopic Ultrasound","volume":"67 9","pages":""},"PeriodicalIF":4.5,"publicationDate":"2023-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138606677","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Controversies in endobronchial ultrasound","authors":"Christoph F. Dietrich, Antonio Bugalho, Silvia Carrara, P. Clementsen, Yi Dong, M. Hocke, S. Kolekar, Lars Konge, A. Ignee, Axel Löwe, C. Jenssen","doi":"10.1097/eus.0000000000000034","DOIUrl":"https://doi.org/10.1097/eus.0000000000000034","url":null,"abstract":"\u0000 Endobronchial ultrasound (EBUS) is a minimally invasive highly accurate and safe endoscopic technique for the evaluation of mediastinal lymphadenopathy and mediastinal masses including centrally located lung tumors. The combination of transbronchial and transoesophageal tissue sampling has improved lung cancer staging, reducing the need for more invasive and surgical diagnostic procedures.\u0000 Despite the high level of evidence regarding EBUS use in the aforementioned situations, there are still challenges and controversial issues such as follows: Should informed consent for EBUS and flexible bronchoscopy be different? Is EBUS able to replace standard bronchoscopy in patients with suspected lung cancer? Which is the best position, screen orientation, route of intubation, and sedation/anesthesia to perform EBUS? Is it advisable to use a balloon in all procedures? How should the operator acquire skills and how should competence be ensured? This Pro-Con article aims to address these open questions.","PeriodicalId":11577,"journal":{"name":"Endoscopic Ultrasound","volume":"28 6","pages":""},"PeriodicalIF":4.5,"publicationDate":"2023-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138606798","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"EUS coil and glue for gastric varices-prevent, treat and rescue, one therapy to rule them all?","authors":"Rajesh Puri, Z. Sharma, Saurabh K. Patle, S. Bhagat, Abhishek Kathuria","doi":"10.1097/eus.0000000000000038","DOIUrl":"https://doi.org/10.1097/eus.0000000000000038","url":null,"abstract":"\u0000 \u0000 \u0000 In portal hypertension, gastric varix–associated bleeding is known to have higher transfusion requirements, uncontrolled bleeding, rebleeding, intensive care unit requirements, and death. EUS–guided coil insertion is now an acceptable modality for endoscopic management in cases of gastric varices. With this study, we discuss our large single-center experience in the use of EUS for coil and glue injection in gastric varices. We also look into adverse events associated with and possibilities of using this modality as both primary prophylaxis and a rescue therapy.\u0000 \u0000 \u0000 \u0000 The study was conducted in a tertiary care center in India. A total of 86 patients were included in the study. The indication for EUS-guided coil and glue was divided into 3 clinical situations, namely, rebleed, rescue, and primary. The technical success and clinical success, that is, control of bleed in patients, were confirmed by absence of Doppler signal on EUS, endoscopic view, and stabilized hemoglobin with no need of blood product transfusion to maintain hemoglobin.\u0000 \u0000 \u0000 \u0000 The mean Child-Turcotte-Pugh score and Model for End-Stage Liver Disease–Na score were 9.2 and 14.6, respectively. The mean size of the gastric varices was 18.9 mm. The mean number of coils used was 2.9, and the average quantity of glue required was 1.6 mL. The technical success was 100% across the patient group. Clinical success was seen in 90% of the patient group. Mean follow-up was seen for 175.2 days.\u0000 \u0000 \u0000 \u0000 EUS-guided coil and glue therapy has a role in different clinical settings, as primary therapy, rebleed, and rescue therapy. It has significant technical and clinical success. Its role in treatment algorithms needs to be further studied in prospective studies. It may offer a cost advantage in comparison to interventional radiology-led interventions.\u0000","PeriodicalId":11577,"journal":{"name":"Endoscopic Ultrasound","volume":"36 3","pages":""},"PeriodicalIF":4.5,"publicationDate":"2023-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138606774","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endohepatology in clinical practice: EUS-guided portal pressure measurement combined with EUS-guided liver biopsy and variceal screening and treatment in outpatients","authors":"Sung Kim, Scot Lewey, Laura Meuller, Douglas G. Adler","doi":"10.1097/eus.0000000000000030","DOIUrl":"https://doi.org/10.1097/eus.0000000000000030","url":null,"abstract":"\u0000 \u0000 \u0000 EUS-guided portal pressure gradient (PPG) is a novel technique that permits a true, direct measure of portal vein pressure and hepatic vein pressure. This article details our experience and lessons learned from 20 consecutive outpatient EUS-PPG procedures performed at a single center, along with simultaneous EUS-guided liver biopsy, variceal screening, and variceal banding.\u0000 \u0000 \u0000 \u0000 Data on the first 20 patients who underwent EUS-PPG at a single center were retrospectively viewed and analyzed. The effects of various liver diseases or other patient-related factors on the clinical and technical success of EUS-PPG measurements, as well as EUS-guided liver biopsy (EUS-LB), were evaluated. During the procedure, if esophageal varices were encountered, they were assessed, and if felt to be clinically indicated, endoscopic variceal ligation was performed.\u0000 \u0000 \u0000 \u0000 The 20 patients included 10 male and 10 female patients. All procedures were technically successful. In all patients, the portal vein and hepatic veins could be easily identified. One adverse event of bleeding occurred during the EUS-PPG measuring procedure. All 20 EUS-LBs were technically successful and yielded adequate samples for histological evaluations, with an average of 25 complete portal tracts per sample. Among patients with esophageal varices, 40% of patients underwent banding. The mean EUS-PPG among 5 patients with esophageal varices was 11.6 mm Hg, compared with 3.2 mm Hg among 15 patients without esophageal varices.\u0000 \u0000 \u0000 \u0000 This study demonstrates that EUS-PPG is a novel, safe, reproducible, and effective technique. Also, the fact that EUS-PPG, EUS-LB, variceal screening, and variceal banding could be performed in 1 session and on an outpatient basis speaks to the growing relevance and impact of the nascent field of endohepatology.\u0000","PeriodicalId":11577,"journal":{"name":"Endoscopic Ultrasound","volume":"119 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2023-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138607235","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"EUS-guided versus percutaneous liver abscess drainage: A multicenter collaborative study","authors":"H. Shahid, A. Tyberg, A. Sarkar, Monica Gaidhane, N. Mahpour, Roohi Patel, Victor K Flumignan, E. Vazquez-Sequeiros, Guadalupe Ma Martínez, E. Artifon, M. Kahaleh","doi":"10.1097/eus.0000000000000033","DOIUrl":"https://doi.org/10.1097/eus.0000000000000033","url":null,"abstract":"\u0000 \u0000 \u0000 Management of hepatic abscesses has traditionally been performed by image-guided percutaneous techniques. More recently, EUS drainage has been shown to be efficacious and safe. The aim of this study is to compare EUS-guided versus percutaneous catheter drainage (PCD) of hepatic abscesses.\u0000 \u0000 \u0000 \u0000 Patients who underwent EUS-guided drainage or PCD of hepatic abscesses from January 2018 through November 2021 from 4 international academic centers were included in a dedicated registry. Demographics, clinical data preprocedure and postprocedure, abscess characteristics, procedural data, adverse events, and postprocedure care were collected.\u0000 \u0000 \u0000 \u0000 Seventy-four patients were included (mean age, 63.9 years; 45% male): EUS-guided (n = 30), PCD (n = 44). Preprocedure Charlson Comorbidity Index scores were 4.3 for the EUS group and 4.3 for the PCD group. The median abscess size was 8.45 × 6 cm (length × width) in the EUS group versus 7.3 × 5.5 cm in the PCD group. All of the abscesses in the EUS group were left-sided, whereas the PCD group contained both left- and right-sided abscesses (29 and 15, respectively). Technical success was 100% in both groups. Ten-millimeter-diameter stents were used in most cases in the EUS group, and 10F catheters were used in the PCD group. The duration to resolution of symptoms from the initial procedure was 10.9 days less in the EUS group compared with the PCD group (P < 0.00001). Hospital length of stay was shorter in the EUS group by 5.2 days (P = 0.000126). The EUS group had significantly fewer number of repeat sessions: mean of 2 versus 7.7 (P < 0.00001) and trended toward fewer number of procedure-related readmissions: 10% versus 34%. The PCD group had a significantly higher number of adverse events (n = 27 [61%]) when compared with the EUS group (n = 5 [17%]; P = 0.0001).\u0000 \u0000 \u0000 \u0000 EUS-guided drainage is an efficacious and safe intervention for the management of hepatic abscesses. EUS-guided drainage allows for quicker resolution of symptoms, shorter length of hospital stay, fewer adverse events, and fewer procedural sessions needed when compared with the PCD technique. However, EUS-guided drainage may not be feasible in right-sided lesions.\u0000","PeriodicalId":11577,"journal":{"name":"Endoscopic Ultrasound","volume":"123 20","pages":""},"PeriodicalIF":4.5,"publicationDate":"2023-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138607192","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical utility of the forward-viewing echoendoscope in patients after pancreatoduodenectomy: A prospective study","authors":"Hirotoshi Ishiwatari, Junichi Kaneko, Junya Sato, Tatsunori Satoh, Kazuma Ishikawa, Fumitaka Niiya, Hiroyuki Matsubayashi, Tatsunori Minamide, Yuki Maeda, Youichi Yamamoto, Yoshihiro Kishida, Masao Yoshida, Sayo Ito, Noboru Kawata, Kenichiro Imai, Kinichi Hotta, Taisuke Imamura, Teiichi Sugiura, Katsuhiko Uesaka, Hiroyuki Ono","doi":"10.1097/eus.0000000000000027","DOIUrl":"https://doi.org/10.1097/eus.0000000000000027","url":null,"abstract":"ABSTRACT Background and Objectives Endoscopic treatment of obstructive jaundice and pancreatitis due to hepaticojejunostomy (H-J), pancreatojejunostomy (P-J) strictures, and tumor recurrence after pancreatoduodenectomy (PD) is technically challenging. Treatment of P-J strictures results in poor outcomes. Although conventional EUS that has an oblique view is not suitable for such patients, forward-viewing EUS (FV-EUS) may become a useful option. This study aimed to evaluate the feasibility and efficacy of FV-EUS in patients who have undergone PD. Patients and methods Patients with PD who were scheduled to undergo diagnosis and treatment using FV-EUS for H-J or P-J lesions were enrolled in this single-center prospective study. After observation of the P-J and H-J using FV-EUS according to a predetermined protocol, treatment using FV-EUS was performed as needed. Results A total of 30 patients were enrolled, and FV-EUS was used to observe P-J and H-J in 24 and 28 patients, respectively. The detection rates of P-J and H-J by endoscopy were 50% (12/24) and 96.4% (27/28), respectively, and by EUS were 70.8% (17/24) and 100% (28/28), respectively. Of these, P-J and H-J were found by endoscopy only after EUS observation in 3 and 1 patient, respectively. The success rates of endoscopic treatment using FV-EUS were 66.7% (2/3), 95.2% (20/21), and 25% (1/4) for benign P-J strictures, benign H-J strictures, and tumor recurrence, respectively. Conclusions Endoscopic treatment using FV-EUS is feasible and effective for patients after PD. Moreover, FV-EUS increases the P-J lesion detection rate by adding EUS observation.","PeriodicalId":11577,"journal":{"name":"Endoscopic Ultrasound","volume":"51 21","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135818844","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparing the diagnostic adequacy of 25-Gauge fork-tip versus franseen versus reverse-bevel-type needles in EUS–guided tissue acquisition: A prospective randomized study with a retrospective control","authors":"Adam Haig, Andrew St John, Kasturi Vaska, Xuan Banh, Alexander Huelsen","doi":"10.1097/eus.0000000000000025","DOIUrl":"https://doi.org/10.1097/eus.0000000000000025","url":null,"abstract":"<h3>Background and Objectives </h3>\u0000<p>EUS–guided fine-needle biopsy (FNB) is an established technique for the acquisition of tissue to diagnose lesions of the gastrointestinal tract and surrounding organs. Recently, newer-generation FNB needles have been introduced, including a second-generation reverse-bevel and the third-generation fork-tip and Franseen needles. We aimed to determine if there was any difference between these needles in terms of cytopathological diagnostic yield, sample cellularity, or sample bloodiness.</p>\u0000<h3>Methods </h3>\u0000<p>One hundred twenty-seven consecutive patients undergoing EUS–guided FNB of any solid lesion were randomized to use either a Franseen or fork-tip needle in a 1:1 ratio and were compared with 60 consecutive historical cases performed with reverse-bevel needles. Patient and procedure characteristics were recorded. Cases were reviewed by a blinded cytopathologist and graded based on cellularity and bloodiness. Overall diagnostic yield was calculated for each study arm.</p>\u0000<h3>Results </h3>\u0000<p>One hundred seventy-six cases were eligible for analysis, including 109 pancreatic masses, 24 lymphoid lesions, 17 subepithelial lesions, and 26 other lesions. The final diagnosis was malignancy in 127 cases (72%). EUS–guided FNB was diagnostic in 141 cases (80%) overall and in 89% of cases where malignancy was the final diagnosis. There was no difference in diagnostic yield, sample cellularity, or sample bloodiness between the different needle types. There was no difference in adverse events between groups.</p>\u0000<h3>Conclusions </h3>\u0000<p>EUS–guided FNB performed using 25-gauge Franseen, fork-tip, and reverse-bevel needles resulted in similar diagnostic yield, sample cellularity, and sample bloodiness. Our results may not be extrapolated to larger-caliber needles of the same design.</p>","PeriodicalId":11577,"journal":{"name":"Endoscopic Ultrasound","volume":"24 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2023-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140056490","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"<i>E</i>US-guided <i>r</i>adiofrequency <i>a</i>blation plus chemotherapy <i>versus</i> chemotherapy alone for <i>p</i>ancreatic cancer (ERAP): An observational open-label pilot study.","authors":"Pradermchai Kongkam, Kasenee Tiankanon, Dong Wan Seo, Thanawat Luangsukrerk, Virote Sriuranpong, Chonnipa Nantavithya, Trirat Jantarattana, Arlyn Cañones, Stephen J Kerr, Kittithat Tantitanawat, Phonthep Angsuwatcharakon, Wiriyaporn Ridtitid, Pinit Kullavanijaya, Rungsun Rerknimitr","doi":"10.1097/eus.0000000000000003","DOIUrl":"https://doi.org/10.1097/eus.0000000000000003","url":null,"abstract":"<p><strong>Background: </strong>No study has compared EUS-guided radiofrequency ablation (EUS-RFA) plus systemic chemotherapy (CMT) with CMT alone for unresectable pancreatic ductal adenocarcinoma.</p><p><strong>Methods: </strong>This study compared the results of treatment in patients receiving EUS-RFA plus concomitant CMT (group A; <i>n</i> = 14) with those receiving CMT (group B; <i>n</i> = 14) as a pilot study.</p><p><strong>Results: </strong>From July 2017 to August 2018, 4 and 2 patients from groups A and B, respectively, withdrew from the study because of progression of the disease. In total, 10 and 12 patients from groups A and B, respectively, completed the study. All 30 EUS-RFA procedures were successful. Mean maximal tumor diameter before treatment of group A (<i>n</i> = 10) <i>versus</i> B (<i>n</i> = 12) was 62.2 ± 21.0 <i>versus</i> 50.5 ± 22.0 mm, respectively (<i>P</i> = not significant). After treatment, no statistically significant difference in mean maximal tumor diameter was found between both groups. However, in group B, mean maximal tumor diameter was significantly increased from 50.5 ± 22.0 to 56.3 ± 18.7 mm, respectively (<i>P</i> = 0.017). Tumor necrosis occurred in group A <i>versus</i> B at 10 of 10 (100%) <i>versus</i> 6 of 12 (50%) patients, respectively (<i>P</i> = 0.014). After treatment, group A patients could reduce the mean narcotic pain drug dosage at 26.5 mg of morphine equivalent per day (from 63.6 to 37.1 mg, <i>P</i> = 0.022), whereas group B patients could not reduce the dosage of pain-controlled medication. No statistically significant difference in 6-month mortality rate was found. In group A, 1 procedure-related nonsevere adverse event (<i>n</i> = 1 of 30 [3.3%]) occurred in 1 patient (<i>n</i> = 1 of 14 [7.1%]).</p><p><strong>Conclusions: </strong>In this study, the mean tumor diameter of group B was significantly increased after the treatment. Group A had a significantly higher rate of necrosis of tumor and required less narcotic.</p>","PeriodicalId":11577,"journal":{"name":"Endoscopic Ultrasound","volume":"12 5","pages":"402-408"},"PeriodicalIF":4.5,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10631592/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134648706","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The features of early intraductal papillary mucinous neoplasms and postoperative sutures under high-definition pancreatoscopy and EUS (with video).","authors":"Wengang Zhang, Ningli Chai, Enqiang Linghu","doi":"10.1097/eus.0000000000000004","DOIUrl":"https://doi.org/10.1097/eus.0000000000000004","url":null,"abstract":"A 65-year-old man underwent distal pancreatectomy for the suspected IPMNs in the pancreas tail 2 years ago. The postoperative pathology result turned out to be IPMN with obvious moderate dysplasia lesion in the main pancreatic duct (PD), and the excision site was lesion-free. This patient was followed up with magnetic resonance cholangiopancreatography once every 6 months, and the remnant PD grew wider gradually [Figure 1]. Moreover, an obvious hyperechoic mass was found in the dilated PD close to the excision site under the latest EUS examination [Figure 2A]. Therefore, we performed endoscopic retrograde cholangiopancreatography and high-definition pancreatoscopy inspection (eyeMAX, 9F; Micro-Tech, Nanjing, China) for the patient. First, typical fish-eye sign was found on the main papilla [Figure 3], and pancreatography confirmed the obviously dilated proximal PD. Subsequently, the pancreatoscopy was inserted into the PD, and some postoperative sutures, which presented a hyperechoic mass under EUS, were found in the excision site of distal PD unexpectedly [Figure 2B]. Moreover, a lot of white translucent papillary lesions were found growing from the wall of PD or floating in the pancreatic liquid [Figure 4]. Finally, biopsy was conducted under pancreatoscopy, and the pathology result turned out to be papillary tissue covered with mucoid epithelium [Figure 5], consistent with IPMN. Previous studies have confirmed that pancreatoscopy was helpful for the diagnosis of suspected IPMN. [1,2] However, the appearance of early IPMN under pancreatoscopy was not known to endoscopists. This study presented the features of early IPMN using a high-definition","PeriodicalId":11577,"journal":{"name":"Endoscopic Ultrasound","volume":"12 5","pages":"428-430"},"PeriodicalIF":4.5,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10631609/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134650864","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}