Endoscopic Ultrasound最新文献

{"title":"Prospective clinical trial of EUS-guided choledochoduodenostomy without fistula dilation for malignant distal biliary obstruction.","authors":"Takehiko Koga, Susumu Hijioka, Yoshikuni Nagashio, Yuta Maruki, Kosuke Maehara, Yumi Murashima, Yuki Kawasaki, Kotaro Takeshita, Natsumi Yamada, Motohiro Yoshinari, Yuya Hisada, Shota Harai, Hidetoshi Kitamura, Shun Kawahara, Akihiro Ohba, Chigusa Morizane, Yusuke Ishida, Fumihito Hirai, Takuji Okusaka","doi":"10.1097/eus.0000000000000009","DOIUrl":"https://doi.org/10.1097/eus.0000000000000009","url":null,"abstract":"<p><strong>Background and objectives: </strong>During EUS-guided choledochoduodenostomy (EUS-CDS), fistula dilation before stent insertion is associated with adverse events (AEs), such as bile leakage and peritonitis. We hypothesized that EUS-CDS without fistula dilation using a novel self-expandable metal stent (SEMS) with a thin delivery system could overcome this problem, and we conducted this study to evaluate its feasibility and safety.</p><p><strong>Methods: </strong>This was an open-label, single-arm, phase II study at a single institution. We planned EUS-CDS without fistula dilation using a fully covered SEMS with a 5.9-Fr delivery system for unresectable malignant distal biliary obstruction. The primary outcome was overall technical success. Secondary outcomes were technical success without fistula dilation, procedure time, functional success, time to recurrent biliary obstruction, and AEs. The planned sample size was 25 patients.</p><p><strong>Results: </strong>In total, 24 patients were included in this study. In 21 patients, EUS-CDS was performed as primary drainage. The overall technical success rate was 100% (24 of 24 patients). The technical success rate without fistula dilation was 96% (23 of 24). The median procedure time was 16 min (range, 10-66 min). The functional success rate was 96% (23 of 24). The median time to recurrent biliary obstruction was 148 days (95% confidence interval, 29-266 days). There were no procedure-related AEs. Furthermore, computed tomography immediately after the procedure showed no leakage of contrast medium into the abdominal cavity in any patient.</p><p><strong>Conclusions: </strong>EUS-guided choledochoduodenostomy without fistula dilation using a fully covered SEMS with a 5.9-Fr delivery system is feasible with a high probability and can be achieved quickly while effectively preventing bile leakage and peritonitis.</p>","PeriodicalId":11577,"journal":{"name":"Endoscopic Ultrasound","volume":"12 5","pages":"409-416"},"PeriodicalIF":4.5,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10631599/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134648713","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":"A deep learning-based system for mediastinum station localization in linear EUS (with video).","authors":"Liwen Yao, Chenxia Zhang, Bo Xu, Shanshan Yi, Juan Li, Xiangwu Ding, Honggang Yu","doi":"10.1097/eus.0000000000000011","DOIUrl":"10.1097/eus.0000000000000011","url":null,"abstract":"<p><strong>Background and objectives: </strong>EUS is a crucial diagnostic and therapeutic method for many anatomical regions, especially in the evaluation of mediastinal diseases and related pathologies. Rapidly finding the standard stations is the key to achieving efficient and complete mediastinal EUS imaging. However, it requires substantial technical skills and extensive knowledge of mediastinal anatomy. We constructed a system, named EUS-MPS (EUS-mediastinal position system), for real-time mediastinal EUS station recognition.</p><p><strong>Methods: </strong>The standard scanning of mediastinum EUS was divided into 7 stations. There were 33 010 images in mediastinum EUS examination collected to construct a station classification model. Then, we used 151 videos clips for video validation and used 1212 EUS images from 2 other hospitals for external validation. An independent data set containing 230 EUS images was applied for the man-machine contest. We conducted a crossover study to evaluate the effectiveness of this system in reducing the difficulty of mediastinal ultrasound image interpretation.</p><p><strong>Results: </strong>For station classification, the model achieved an accuracy of 90.49% in image validation and 83.80% in video validation. At external validation, the models achieved 89.85% accuracy. In the man-machine contest, the model achieved an accuracy of 84.78%, which was comparable to that of expert (83.91%). The accuracy of the trainees' station recognition was significantly improved in the crossover study, with an increase of 13.26% (95% confidence interval, 11.04%-15.48%; <i>P</i> < 0.05).</p><p><strong>Conclusions: </strong>This deep learning-based system shows great performance in mediastinum station localization, having the potential to play an important role in shortening the learning curve and establishing standard mediastinal scanning in the future.</p>","PeriodicalId":11577,"journal":{"name":"Endoscopic Ultrasound","volume":"12 5","pages":"417-423"},"PeriodicalIF":4.5,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10631614/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134648707","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":"EUS-guided transhepatic metal stent deployment technique without tract dilation using a 0.018-inch guidewire (with video).","authors":"Takeshi Ogura, Jyunichi Kawai, Kyohei Nishiguchi, Yoshitaro Yamamoto, Kazuhide Higuchi","doi":"10.1097/eus.0000000000000014","DOIUrl":"https://doi.org/10.1097/eus.0000000000000014","url":null,"abstract":"","PeriodicalId":11577,"journal":{"name":"Endoscopic Ultrasound","volume":"12 5","pages":"431-432"},"PeriodicalIF":4.5,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10631611/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134648710","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":"A novel case of EUS-guided targeted radiofrequency ablation of metastatic duodenal renal cell carcinoma.","authors":"Muhammad Vohra, Hemant Goyal, Putao Cen, Mairin Joseph-Talreja, Nirav Thosani","doi":"10.1097/eus.0000000000000026","DOIUrl":"10.1097/eus.0000000000000026","url":null,"abstract":"","PeriodicalId":11577,"journal":{"name":"Endoscopic Ultrasound","volume":"12 5","pages":"433-434"},"PeriodicalIF":4.4,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10631612/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134648708","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":"Mishaps with EUS-guided lumen-apposing metal stents in therapeutic pancreatic EUS: Management and prevention.","authors":"Barbara Braden, Michael Hocke, Emmanuel Selvaraj, Kanav Kaushal, Kathleen Möller, Andrè Ignee, Giuseppe Vanella, Paolo Giorgio Arcidiacono, Anthony Teoh, Alberto Larghi, Mihai Rimbas, Stefan Hollerbach, Bertrand Napoleon, Yi Dong, Christoph F Dietrich","doi":"10.1097/eus.0000000000000018","DOIUrl":"https://doi.org/10.1097/eus.0000000000000018","url":null,"abstract":"<p><p>EUS-guided interventions have become widely accepted therapeutic management options for drainage of peripancreatic fluid collections. Apart from endosonographic skills, EUS interventions require knowledge of the endoscopic stenting techniques and familiarity with the available stents and deployment systems. Although generally safe and effective, technical failure of correct stent positioning or serious adverse events can occur, even in experts' hands. In this article, we address common and rare adverse events in transmural EUS-guided stenting, ways to prevent them, and management options when they occur. Knowing the risks of what can go wrong combined with clinical expertise, high levels of technical skills, and adequate training allows for the safe performance of EUS-guided drainage procedures. Discussing the procedural risks and their likelihood with the patient is a fundamental part of the consenting process.</p>","PeriodicalId":11577,"journal":{"name":"Endoscopic Ultrasound","volume":"12 5","pages":"393-401"},"PeriodicalIF":4.5,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10631618/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134648711","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":"Device malfunctions with use of EUS-guided fine-needle biopsy devices: Analysis of the MAUDE database.","authors":"Achintya D Singh, Deepak Madhu, Mythili Menon Pathiyil, Daryl Ramai, Babu P Mohan, Bhavesh Shah, Douglas G Adler","doi":"10.1097/eus.0000000000000016","DOIUrl":"https://doi.org/10.1097/eus.0000000000000016","url":null,"abstract":"<p><strong>Background: </strong>The safety of endoscopic ultrasound-guided tissue acquisition through fine-needle biopsy devices is well-established in clinical trials. The real-world experience of using these devices is not known. The authors analyzed the postmarketing surveillance data from the Food and Drug Administration Manufacturer and User Facility Device Experience (MAUDE) database to answer this question.</p><p><strong>Methods: </strong>The Food and Drug Administration MAUDE database from January 2012 to June 2022 was accessed to evaluate for device malfunctions and patient-related adverse consequences of these malfunctions.</p><p><strong>Results: </strong>There were 344 device-related issues. Most issues were due to detachment or breakage of the device (<i>n</i> = 185 [53.7%]). Seventy-six of the breakages (40.8%) occurred during the procedure, whereas 89 cases (47.8%) occurred while removing the needle from the endoscope. The most common site of tissue biopsy at the time of needle breakage was the pancreas (44 [23.8%]).The common patient-related adverse events were retained foreign body (<i>n</i> = 50 [14.5%]) followed by bleeding (16, 4.6%). Six patients (3.4%) required a second intervention for removal of the retained foreign bodies including surgery in 2 cases. The device breakage damaged the endoscope in 3 cases (1.7%), and there was 1 case of needlestick injury to the nurse.</p><p><strong>Conclusion: </strong>The fine-needle biopsy devices can be associated with needle breakage and bending; these adverse events were not previously reported. Needle breakages can result in a retained foreign body that may require additional procedures including surgery. These real-world findings from the MAUDE database may inform clinical decisions and help improve clinical outcomes.</p>","PeriodicalId":11577,"journal":{"name":"Endoscopic Ultrasound","volume":"12 5","pages":"424-427"},"PeriodicalIF":4.5,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10631607/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134648709","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":"Pancreatic leiomyosarcoma: EUS findings of an uncommon pancreatic mass (with video).","authors":"Marcantonio Gesualdo, Noemi Sara Bertetti, Umberto Mortara, Francesca Maletta, Francesco Moro, Marco Sacco, Mauro Bruno, Claudio Giovanni De Angelis, Silvia Gaia","doi":"10.1097/eus.0000000000000037","DOIUrl":"https://doi.org/10.1097/eus.0000000000000037","url":null,"abstract":"Stromal pancreatic neoplasms are extremely rare, perhaps due to the poor representation of this tissue in the normal parenchyma. [1] Although leiomyosarcoma is the most common primary malignant mesenchymal pancreatic tumor, it represents only 0.1% of malignant pancreatic tumors and 0.5% of all adult soft tissue sarcomas. [2] This neoplasm mainly affects females (70% – 80%), occurs predominantly between the fifth and sixth decades of life, and has significant metastatic potential with poor prognosis. [3,4] We present a case of an 83-year-old woman referred to our center for dysgeusia and weight loss. In the diagnostic workup, an abdominal computed tomographic scan was performed in December 2021; a 28-mm-diameter mass in the pancreatic body, with sharp margin and bulging on the splenic vein, was found. Successively an abdominal magnetic resonance imaging described a nodular lesion at the passage between body and tail hyperintense in diffusion-weighted imaging (DWI), hypointense in T1, and isointense in T2 sequences. Contrast enhancement was slight and progressive, and all the features were not typical for adenocarcinoma. Biochemical analysis and oncological markers were all within the reference range, except chromogranin A (402 ng/mL, upper normal value <98 ng/mL). Because of this positivity, a PET-Ga-68-DOTATOC positron emission tomography (PET)/ computerized tomography (CT)wasprescribedinFebruary2022,whichdemonstratesanabnor-maltracer uptake in the pancreatic tail.To characterize the mass, EUS with fine needle aspiration was","PeriodicalId":11577,"journal":{"name":"Endoscopic Ultrasound","volume":"12 5","pages":"435-436"},"PeriodicalIF":4.5,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10631615/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134648712","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":"Echoes","authors":"Allison Harris","doi":"10.1177/1742271x231184015","DOIUrl":"https://doi.org/10.1177/1742271x231184015","url":null,"abstract":"","PeriodicalId":11577,"journal":{"name":"Endoscopic Ultrasound","volume":"85 1","pages":"239 - 240"},"PeriodicalIF":4.5,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88545350","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":"Endoscopic treatment of a giant stone in a patient with acute cholecystitis at a high surgical risk: breaking the paradigm (with videos).","authors":"Alberto Larghi,&nbsp;Gianenrico Rizzatti,&nbsp;Mario Gagliardi,&nbsp;Arianna Amato,&nbsp;Fabio Grilli,&nbsp;Gabriele Sganga","doi":"10.1097/eus.0000000000000015","DOIUrl":"10.1097/eus.0000000000000015","url":null,"abstract":"An 84-year-old man with chronic renal failure on dialysis, chronic heart failure, and obesity presented to the emergency room with right upper quadrant pain and fever. Laboratory tests revealed elevated white blood cells (19.5 (cid:1) 10 9 /L) and serum C-reactive protein (175 mg/dL). Abdominal ultrasound showed gallbladder (GB) wall thickening and a 7.4-cm stone occupying most of the GB lumen. A diagnosis of acute cholecystitis was made. Because of the increased surgical risk, EUS – guided GB drainage (EUS-GBD) with intracholecystic lithotripsy was offered to the patient, who signed informed consent. EUS examination showed presence of a giant stone, producing a shadow covering almost all the GB field","PeriodicalId":11577,"journal":{"name":"Endoscopic Ultrasound","volume":"12 4","pages":"386-387"},"PeriodicalIF":4.5,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/a2/11/eusj-12-386.PMC10547244.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41114104","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":"EUS-guided esophageal lumen restoration in a young patient with complete luminal obstruction (with video).","authors":"Silvia Carrara,&nbsp;Marco Spadaccini,&nbsp;Roberta Maselli,&nbsp;Alessandro Fugazza,&nbsp;Kareem Khalaf,&nbsp;Glenn Koleth,&nbsp;Alessandro Repici","doi":"10.1097/eus.0000000000000002","DOIUrl":"10.1097/eus.0000000000000002","url":null,"abstract":"A 28-year-old woman with type 1 diabetes presented with severe dysphagia after pregnancy. Endoscopy showed a “ blind ” esophagus, with complete esophageal obstruction [Figure 1]. An endoscopic approach was unsuccessful in finding an access for the guidewire, and no evidence of contrast medium passage was seen. EUS was used to study the esophageal layers and try to see behind the stricture. The wall was thickened (10 mm), with prevalence of the submucosa. A mild insufflation of air, used as ultrasonographic contrast, allowed the endosonographer to see a hyperechoic line that was interpreted as the submillimetric remnant of the esophageal lumen [Figure 2]. A 19-gauge access needle was used to puncture, under EUS guidance, the esophageal wall [Figure 3] starting from the hyperechoic line inside the esophagus. After initial resistance, under fluoroscopic view of the needle path, a point of least resistance was felt, and the needle tip, inserted for almost 5 cm, was visualized below the diaphragm. A guidewire was inserted into the needle and under fluoroscopic view was seen creating a loop inside the stomach [Figure 4]. A Hurricane RX biliary balloon dilation catheter (6-mm diameter, 4-cm length), (Boston Scientific Corp., Natick, MA) was passed through the stricture, and the first dilation was performed [Figure 5]. In the following weeks, other dilations were performed with Savary bougies (Boston Scientific Corp., Natick, MA), and the esophageal lumen was restored [Video 1]. Forceps biopsies revealed acute and chronic inflammation, with severe fibrosis and no signs of","PeriodicalId":11577,"journal":{"name":"Endoscopic Ultrasound","volume":"12 4","pages":"382-383"},"PeriodicalIF":4.5,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/e8/2e/eusj-12-382.PMC10547246.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41104011","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}