Endoscopic Ultrasound最新文献

{"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}

{"title":"EUS-Guided jejunojejunostomy using a novel dilator for malignant afferent loop obstruction (with video).","authors":"Takeshi Ogura,&nbsp;Kimi Bessho,&nbsp;Yuki Uba,&nbsp;Mitsuki Tomita,&nbsp;Hiroki Nishikawa","doi":"10.1097/eus.0000000000000012","DOIUrl":"10.1097/eus.0000000000000012","url":null,"abstract":"Malignant afferent loop obstruction (MALO) can cause cholangitis or pancreatitis due to blind loop dilatation. Malignant afferent loop obstruction is traditionally treated by surgery, percutaneous drainage, or self-expandable metal stent (SEMS) deployment under enteroscopic guidance. EUS–guided drainage has recently been attempted forMALOusing a lumen-apposingmetal stent (LAMS). Although a LAMS has clinical impact, the diameter of the target lesionmust be large enough to enable deployment of the distal flange of the LAMS. In contrast, conventional SEMS is easily deployed but requires intestinal wall dilatation before insertion of the stent delivery system. If force is used while attempting EUS-guided drainage for MALO, the afferent loop can be pushed away from the echoendoscope, after which it may be difficult to insert the device. A novel drill dilator has recently become available in Japan (Tornus ES; Asahi Intecc, Aichi, Japan) [Figure 1A]. Using this device, the tract is dilated using a clockwise rotationwithout needing","PeriodicalId":11577,"journal":{"name":"Endoscopic Ultrasound","volume":"12 4","pages":"384-385"},"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/a7/c2/eusj-12-384.PMC10547239.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41106216","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":"Complete duodenal obstruction and EUS-guided gastroenterostomy: What to do? (with video).","authors":"Maria Puigcerver-Mas,&nbsp;Dani Luna-Rodriguez,&nbsp;Albert Garcia-Sumalla,&nbsp;Sergi Quintana-Carbo,&nbsp;Sandra Maisterra,&nbsp;Joan B Gornals","doi":"10.1097/eus.0000000000000019","DOIUrl":"10.1097/eus.0000000000000019","url":null,"abstract":"Gastroenterostomy using a lumen-apposing metal stent (LAMS) is an effective procedure to solve gastric outlet obstruction, but usually, an oroenteral catheter is necessary for filling the small bowel. [1] What to do in cases of complete obstruction when it is not possible even to advance a guidewire through? The academic purpose of this work was to expose a useful approach that may be considered in this scenario. A 64-year-old woman was referred for a complete duodenal obstruction due to pancreatic adenocarcinoma: first, EUS – guided identification of the collapsed small bowel at the Treitz area, and second, EUS-guided puncture using a 22G needle (without stylet and flushed with saline to avoid air injection), filling contrast and saline into the lumen bowel. A submucosal injection of the enteral wall can be recognized as easy to perform and can help to access nicely the enteral lumen, without doubts and fluoroscopy assistance [","PeriodicalId":11577,"journal":{"name":"Endoscopic Ultrasound","volume":"12 4","pages":"388-389"},"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/b3/8d/eusj-12-388.PMC10547241.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41120198","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 therapies for primary and secondary prophylaxis in gastric varices-An updated systematic review and meta-analysis.","authors":"Saurabh Chandan,&nbsp;Andrew Khoi Nguyen,&nbsp;Babu P Mohan,&nbsp;Smit Deliwala,&nbsp;Daryl Ramai,&nbsp;Lena L Kassab,&nbsp;Arunkumar Muthusamy,&nbsp;Antonio Facciorusso,&nbsp;Faisal Kamal,&nbsp;Mohammad Bilal,&nbsp;Jayanta Samanta,&nbsp;Douglas G Adler","doi":"10.1097/eus.0000000000000017","DOIUrl":"10.1097/eus.0000000000000017","url":null,"abstract":"<p><strong>Background and objectives: </strong>Gastric varices (GVs) are associated with a higher risk of uncontrolled bleeding and death when compared with esophageal varices. While endoscopic glue injection therapy has been traditionally used for secondary prophylaxis in GV, data regarding primary prophylaxis continue to emerge. Recently, EUS-guided therapies have been used in GV bleeding.</p><p><strong>Methods: </strong>We conducted a comprehensive search of several major databases from inception to June 2022. Our primary goals were to estimate the pooled rates of treatment efficacy, GV obliteration, GV recurrence, and rebleeding with EUS-guided therapy in primary and secondary prophylaxis. Overall adverse events and technical failures were assessed. Random-effects model was used for our meta-analysis, and heterogeneity was assessed using the <i>I</i>² % statistics.</p><p><strong>Results: </strong>Eighteen studies with 604 patients were included. In primary prophylaxis, pooled rate of GV obliteration was 90.2% (confidence interval [CI], 81.1-95.2; <i>I</i>² = 0). With combination EUS-glue and coil therapy, the rate was 95.4% (CI, 86.7%-98.5%; <i>I</i>² = 0). Pooled rate of posttherapy GV bleeding was 4.9% (CI, 1.8%-12.4%; <i>I</i>² = 0). In secondary prophylaxis, pooled rate of treatment efficacy was 91.9% (CI, 86.8%-95.2%; <i>I</i>² = 12). With EUS-glue, EUS-coil, and combination EUS-glue and coil, the rates were 94.3% (CI, 88.9%-97.1%; <i>I</i>² = 0), 95.5% (CI, 80.3%-99.1%; <i>I</i>² = 0), and 88.7% (CI, 76%-95.1%; <i>I</i>² = 14), respectively. Pooled rate of GV obliteration was 83.6% (CI, 71.5%-91.2%; <i>I</i>² = 74). With EUS-glue, EUS-coil, and combination EUS-glue and coil, the rates were 84.6% (CI, 75.9%-90.6%; <i>I</i>² = 31), 92.3% (CI, 81.1%-97.1%; <i>I</i>² = 0), and 84.5% (CI, 50.8%-96.7%; <i>I</i>² = 75), respectively. Pooled rates of GV rebleeding and recurrence were 18.1% (CI, 13.1%-24.3%; <i>I</i>² = 16) and 20.6% (CI, 9.3%-39.5%; <i>I</i>² = 66), respectively.</p><p><strong>Conclusion: </strong>Our analysis shows that EUS-guided therapy for GVs is technically feasible and clinically successful in both primary and secondary prophylaxis of GV.</p>","PeriodicalId":11577,"journal":{"name":"Endoscopic Ultrasound","volume":"12 4","pages":"351-361"},"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/22/9f/eusj-12-351.PMC10547242.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41135566","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}