Endoscopic Ultrasound最新文献

{"title":"Endoscopic management of rectal anastomotic leakage: A case report on tissue glue and microprobe EUS utilization (with video).","authors":"Meng Zhang, Jiao Liu, Wen Jia, Zhuo Yang","doi":"10.1097/eus.0000000000000117","DOIUrl":"10.1097/eus.0000000000000117","url":null,"abstract":"","PeriodicalId":11577,"journal":{"name":"Endoscopic Ultrasound","volume":"14 4","pages":"232-233"},"PeriodicalIF":5.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12829689/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146050912","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":"Risk stratification system of gastrointestinal stromal tumors under EUS elastography based on artificial intelligence.","authors":"Chenxia Zhang, Wei Tan, Xun Li, Xiao Tao, Bing Xiao, Wei Zhou, Honggang Yu","doi":"10.1097/eus.0000000000000136","DOIUrl":"10.1097/eus.0000000000000136","url":null,"abstract":"<p><strong>Background and objectives: </strong>Gastrointestinal stromal tumors (GISTs) are tumors with malignant potential, and preoperative risk stratification is critical for clinical management. Endoscopic ultrasound elastography (EUS-E) can assess tissue stiffness and may assist in evaluating the malignant potential of GISTs. However, similar studies have not been conducted, and current elasticity evaluation methods are still highly influenced by operator's subjectivity. An effective and objective tool is needed to aid in the risk stratification of GISTs under EUS-E.</p><p><strong>Methods: </strong>One hundred eighty-nine patients with submucosal tumors (SMTs) who underwent EUS-E from January 2018 to August 2024 were retrospectively collected, of which 110 cases were GISTs. A total of 2625 EUS B-mode images were collected to construct the classification and segmentation model to distinguish GISTs from non-GISTs and to segment the lesion areas of GIST automatically. The elasticity value (EUS-E-AI) of the lesion area was extracted based on the color features of the elastography images. We evaluated the diagnostic performance of this system in distinguishing GISTs from other SMTs, as well as its ability to stratify GISTs based on their malignant potential.</p><p><strong>Results: </strong>The accuracy of the classification model and the Dice coefficient of the segmentation model were 95.8% and 0.967, respectively. The EUS-E-AI value in the low-risk malignancy group (0.268 [IQR, 0.243-0.333]) was significantly higher than that in the high-risk malignancy group (0.186 [IQR, 0.176-0.199], <i>P</i> < 0.001). A cutoff value of 0.224 for the EUS-E-AI was found to effectively differentiate the low-risk from the high-risk group, with an accuracy of 92.6% (95% CI, 89.1-96.1). These findings were also confirmed in small GISTs.</p><p><strong>Conclusion: </strong>We developed an AI-based system and elasticity indicator for the accurate and objective identification and risk stratification of GISTs using EUS.</p>","PeriodicalId":11577,"journal":{"name":"Endoscopic Ultrasound","volume":"14 4","pages":"220-227"},"PeriodicalIF":5.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12829722/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146050962","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":"Evaluation of endoscopic resectability for ampullary tumors by EUS and side-viewing duodenoscopy.","authors":"Ting-Ting Cao, Jia Xie, Xiao-Xi Xie, Yao-Yu Guo, Yan Qin, Mo-Jin Wang, Rui Wang","doi":"10.1097/eus.0000000000000139","DOIUrl":"10.1097/eus.0000000000000139","url":null,"abstract":"<p><strong>Background and objectives: </strong>Accurate preoperative assessment of ampullary tumors is vital in planning an appropriate endoscopic papillectomy strategy. The use of EUS and side-viewing duodenoscopy (SVD) with narrow band imaging (NBI) varies across studies. Reports on critical features under EUS and SVD + NBI are lacking. We aimed to demonstrate (1) the theoretical and real-world management of ampullary lesions, (2) the implementation of preresection biopsy or fine needle aspiration (FNA), and (3) critical features under EUS and SVD + NBI for preoperative assessment.</p><p><strong>Methods: </strong>Data from consecutive patients with suspected papillary lesions referred for EUS and SVD + NBI from January 2020 to December 2023 were retrospectively analyzed. The primary outcomes were the difference between theory and reality for management for ampullary nontumor-adenoma-adenocarcinoma, and the high-risk features under EUS and SVD + NBI for adenocarcinoma, T1 stage and ductal invasion. The secondary outcomes were the value of preoperative biopsy and FNA.</p><p><strong>Results: </strong>A total of 121 patients with suspected ampullary tumors were included in the analysis. Less than half (27.40%) of the patients in the surgery group could have been classified as endoscopically resectable. A total of 46.4% and 35% of the biopsy and FNA pathological results, respectively, were inconsistent with the postoperative results. Protrusion with atypical ulcers, NBI type III, EUS size ≥3.0 cm, hypoechoicity, poor blood supply, and EUS ductal invasion were high-risk factors for adenocarcinoma. A size ≥3.0 cm and hypoechoic status were high-risk factors for T1 and ductal invasion. The cutoff value of the stain ratio for adenocarcinoma was 5.35, with a sensitivity, specificity, and accuracy of 88.5%, 93.0%, and 90.8%, respectively.</p><p><strong>Conclusions: </strong>Preoperative assessment of ampullary tumors is necessary, but biopsy and FNA are not sufficient. EUS and SVD + NBI, which focus on essential features, are valuable for evaluating ampullary tumors for endoscopic resectability.</p>","PeriodicalId":11577,"journal":{"name":"Endoscopic Ultrasound","volume":"14 4","pages":"188-195"},"PeriodicalIF":5.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12829696/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146050952","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":"Use of the forward-viewing curvilinear array echoendoscope for combined esophagogastroduodenoscopy and EUS-guided liver biopsy.","authors":"Sanjeevani Tomar, Amit S Johal, Bradley D Confer, Harshit S Khara, David L Diehl","doi":"10.1097/eus.0000000000000124","DOIUrl":"10.1097/eus.0000000000000124","url":null,"abstract":"","PeriodicalId":11577,"journal":{"name":"Endoscopic Ultrasound","volume":"14 4","pages":"234-235"},"PeriodicalIF":5.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12829703/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146050894","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 in pediatric patients.","authors":"Christoph F Dietrich, Barbara Braden, Kathleen Möller, Andrè Ignee, Christian Jenssen, Yi Dong, Dagmar Schreiber-Dietrich, Christoph Ehrsam, Siyu Sun, Michael Hocke","doi":"10.1097/eus.0000000000000140","DOIUrl":"10.1097/eus.0000000000000140","url":null,"abstract":"<p><p>EUS has become an essential tool in pediatric gastroenterology for high-resolution imaging of the gastrointestinal tract and surrounding organs. This review describes the clinical applications and outcomes of EUS in diagnosing and managing pediatric gastrointestinal, pancreatic, biliary, and intestinal diseases. EUS is particularly useful in abdominal diseases, offering an accurate and high-resolution imaging method without radiation exposure. Despite its proven efficacy in children, EUS remains underutilized due to technical challenges and limited pediatric-specific expertise. Thus, the study highlights the importance of increasing the availability and training for pediatric EUS to enhance diagnostic precision and therapeutic options in children.</p>","PeriodicalId":11577,"journal":{"name":"Endoscopic Ultrasound","volume":"14 4","pages":"177-187"},"PeriodicalIF":5.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12829723/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146046332","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 new classification of gastric submucosal tumors under EUS based on blood flow signals.","authors":"Huikai Li, Yujie Feng, Xiuxue Feng, Fei Gao, Enqiang Linghu","doi":"10.1097/eus.0000000000000142","DOIUrl":"10.1097/eus.0000000000000142","url":null,"abstract":"<p><strong>Background and objectives: </strong>Once gastrointestinal stromal tumor is suspected to have a malignant possibility, prompt medical intervention should be initiated. Neovascularization plays a significant role in the initiation and progressing of tumors. This study aims to investigate the morphology and distribution of blood vessels in submucosal tumors (SMTs), thereby providing theoretical support for vascular-targeted therapies.</p><p><strong>Methods: </strong>This study enrolled patients who underwent EUS at the First Medical Center of PLA General Hospital and stored images in the medical system, which were considered as SMTs with a definitive pathological diagnosis. The proportion of various blood flow signal under EUS was counted, and the correlation between blood flow signal and tumor pathology, ultrasonic features, location, and other factors was analyzed.</p><p><strong>Results: </strong>The overall occurrence rate of blood flow signal in SMTs was 69.4%. Appearance of blood flow signal of intratumor was 38.8%. Among them, spot-like, stripe-like, and patches-like were 26.5%, 10.2%, and 2.0%, respectively. As for peritumoral, the occurrence rate was 46.9% and was 36.7%, 6.1%, and 4.1% of the above 3 blood flow signals. The appearance of blood flow signals showed a significant correlation with the long diameter of the tumor (<i>P</i> = 0.042; odds ratio, 1.142; 95% confidence interval, 1.005-1.297), whereas no apparent correlations were observed between tumor types, presence of anechoic area, boundary, origin layer, and growth patterns.</p><p><strong>Conclusions: </strong>We propose a new EUS classification of gastric SMTs based on blood flow morphology, revealing a significantly high occurrence rate of blood flow signals in these tumors.</p>","PeriodicalId":11577,"journal":{"name":"Endoscopic Ultrasound","volume":"14 4","pages":"212-219"},"PeriodicalIF":5.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12829626/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146050896","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":"Comparing EUS-guided lumen-apposing metal stents with and without integrated electrocautery for endoscopic drainage of walled-off pancreatic necrosis.","authors":"Barbara Braden, Emmanuel Selvaraj, Christoph F Dietrich, Noor Bekkali","doi":"10.1097/eus.0000000000000131","DOIUrl":"10.1097/eus.0000000000000131","url":null,"abstract":"<p><strong>Background and objectives: </strong>EUS-guided drainage using lumen-apposing metal stents (LAMSs) has become standard treatment of symptomatic walled-off pancreatic necrosis (WOPN). Delivery systems with integrated electrocautery (EC) enable direct access and stent deployment, whereas the conventional stent insertion requires several steps including access using a needle or cystotome, wire insertion, and enlargement of the created tract before the stent placement. This study aimed to compare the practicality of EUS-guided procedures and their outcomes between conventional LAMSs (cLAMSs) and integrated EC (EC-LAMSs).</p><p><strong>Methods: </strong>In consecutive patients undergoing EUS-guided LAMS insertion with or without integrated EC, data on procedure time, sedation, and technical and clinical success, as well as adverse events, were analyzed.</p><p><strong>Results: </strong>From our prospectively maintained database, we analyzed 107 consecutive procedures of transmural EUS-stenting for drainage of WOPN. Thirty-nine cLAMSs and 68 EC-LAMSs were placed. Mean WOPN size was 12.9 ± 4.2 cm with mean 30% ± 15% solid necrosis.Procedure times were shorter with EC-LAMSs (18.0 ± 6.6 <i>vs.</i> 39.7 ± 8.3 minutes; <i>P</i> < 0.05). All EUS-guided procedures with cLAMS drainage were performed under propofol sedation administered by anesthetist. In the EC-LAMS group, 36 patients tolerated the procedure under intravenous sedation (fentanyl/midazolam), and 17 interventions were performed as day case procedures. Adverse events and clinical outcome did not differ between both groups.</p><p><strong>Conclusion: </strong>Compared with cLAMS, EC-LAMS deployment is faster and technically less demanding. This allows performing the procedure under conventional intravenous sedation and as day case procedure in selected patients.</p>","PeriodicalId":11577,"journal":{"name":"Endoscopic Ultrasound","volume":"14 3","pages":"137-141"},"PeriodicalIF":5.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12829646/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146050889","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":"E-ASSIST: EUS-guided antegrade stent in stent for malignant hilar obstruction-a new management paradigm (with video).","authors":"Deborah Chia Hsin Chew, James Emmanuel, Wing Hang Woo, Tiong See Lee","doi":"10.1097/eus.0000000000000125","DOIUrl":"https://doi.org/10.1097/eus.0000000000000125","url":null,"abstract":"","PeriodicalId":11577,"journal":{"name":"Endoscopic Ultrasound","volume":"14 3","pages":"156-157"},"PeriodicalIF":5.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12829695/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146050922","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":"Enhancing gastrointestinal stromal tumor risk stratification: A novel deep learning approach applied to EUS imaging.","authors":"Hui Qu, Fei Yang, Tingting Chen, Xiaoyu Cui, Siyu Sun","doi":"10.1097/eus.0000000000000119","DOIUrl":"10.1097/eus.0000000000000119","url":null,"abstract":"<p><strong>Background and objectives: </strong>Effective management of gastrointestinal stromal tumors (GISTs) requires accurate risk assessment due to their variable carcinogenic potential.This study aimed to improve GIST classification using a novel deep learning-based GIST risk prediction model based on EUS imaging modalities.</p><p><strong>Methods: </strong>We retrospectively analyzed EUS images of 341 patients diagnosed with GIST at a tertiary medical center between January 2016 and March 2022. Patients were selected based on specific criteria, including pathologic validation of surgical outcomes. The dataset allowed for the development and validation of a deep learning risk prediction model (DLRPM), a traditional risk prediction model (TRPM), and a combined risk prediction model (CRPM). Model performance was evaluated using sensitivity, specificity, positive and negative predictive values, accuracy, and statistical analysis.</p><p><strong>Results: </strong>The efficacy of the 3 prognostic models (TRPM, DLRPM, and CRPM) for GIST classification was evaluated using a dataset consisting of 1019 EUS images from 341 patients. These models were developed using a training subset of 310 patients and subsequently validated in a defined group of 31 consecutive patients. Using multivariate logistic regression, TRPM showed an accuracy rate of 71.10%. Using a DenseNet-121 framework developed specifically for medical imaging, the DLRPM demonstrated superior predictive capabilities with an accuracy rate of 92.65%. The CRPM achieved a prediction accuracy of 90.32%. In addition, receiver operating characteristic curve analysis revealed area under the curve values of 0.909, 0.932, and 0.843 for CRPM, DLRPM, and TRPM, respectively. However, comparative statistical evaluation between these models showed no significant differences in area under the curve.</p><p><strong>Conclusions: </strong>The novel DLRPM improved the accuracy of GIST risk stratification by EUS. CRPM is a promising method to integrate deep learning with traditional statistical methods, potentially optimizing clinical decision-making and patient outcomes in gastroenterological oncology.</p>","PeriodicalId":11577,"journal":{"name":"Endoscopic Ultrasound","volume":"14 3","pages":"120-128"},"PeriodicalIF":5.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12829681/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146046259","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":"Comparison of 4 first-line endoscopic biliary drainage modalities in distal malignant biliary obstruction: A systematic review and network meta-analysis.","authors":"Gunn Huh, Won-Mook Choi, Jung Bok Lee, John J Vargo, Sunguk Jang, Taehyung Lee, Ce Hwan Park, Steven A Edmundowicz, Do Hyun Park","doi":"10.1097/eus.0000000000000126","DOIUrl":"10.1097/eus.0000000000000126","url":null,"abstract":"<p><strong>Background and objectives: </strong>EUS-guided biliary drainage is a potential alternative to endoscopic retrograde cholangiopancreatography (ERCP) for distal malignant biliary obstruction (DMBO). However, its role as a primary intervention remains uncertain. This study compares the clinical outcomes of 4 primary endoscopic drainage modalities: ERCP, EUS-hepaticogastrostomy (HGS), EUS-choledochoduodenostomy (CDS) with lumen-apposing metal stent (LAMS), and EUS-CDS with self-expandable metal stents (SEMSs).</p><p><strong>Methods: </strong>The literature was searched up until July 2024. A network meta-analysis of 5 randomized controlled trials and 3 comparative studies, including 796 patients (444 ERCP, 180 EUS-CDS-LAMS, 116 EUS-CDS-SEMS, 56 EUS-HGS), was conducted. Outcomes assessed included clinical success, technical success, procedural time, adverse events, reintervention rates, and stent patency.</p><p><strong>Results: </strong>Clinical success was comparable across all modalities. EUS-CDS-LAMS demonstrated higher technical success compared with ERCP (odds ratio [OR], 3.95; 95% confidence interval [CI], 1.54-10.12) and EUS-CDS-SEMS (OR, 4.37; 95% CI, 1.03-18.55). EUS-CDS-LAMS also had a shorter procedural time compared with ERCP (standardized mean difference, -11.67; 95% CI, -15.66 to -7.68), EUS-CDS-SEMS, and EUS-HGS. Adverse event rates were similar across all groups. EUS-HGS had fewer reinterventions compared with ERCP (OR, 0.20; 95% CI, 0.08-0.52) and EUS-CDS-LAMS (OR, 0.22; 95% CI, 0.07-0.74). At 6 months, stent patency rates were 88.7% for EUS-HGS, 84.5% for EUS-CDS-SEMS, 73.1% for EUS-CDS-LAMS, and 64.8% for ERCP.</p><p><strong>Conclusions: </strong>Clinical success and adverse event rates were comparable among modalities. EUS-CDS-LAMS showed superior technical success and shorter procedural time. In contrast, EUS-HGS showed fewer reinterventions and better stent patency than ERCP.</p>","PeriodicalId":11577,"journal":{"name":"Endoscopic Ultrasound","volume":"14 3","pages":"142-150"},"PeriodicalIF":5.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12829709/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146050877","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}