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   Table of Contents - Current issue
Coverpage
July-August 2021
Volume 10 | Issue 4
Page Nos. 227-316

Online since Sunday, August 15, 2021

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EDITORIAL  

EUS-guided biliary drainage: A realistic perspective p. 227
Monique T Barakat, Douglas G Adler
DOI:10.4103/EUS-D-21-00173  PMID:34396991
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REVIEW ARTICLE Top

Application of EUS-based techniques in the evaluation of pancreatic cystic neoplasms p. 230
Liqi Sun, Haojie Huang, Zhendong Jin
DOI:10.4103/EUS-D-20-00216  PMID:34213426
Pancreatic cystic neoplasms (PCNs) are being detected increasingly frequently due to the widespread use of high-resolution abdominal imaging modalities. Some subtypes of PCNs have the potential for malignant transformation. Therefore, accurate diagnosis of PCNs is crucial to determine whether surgical resection or surveillance is the best management strategy. However, the current cross-section imaging modalities are not accurate enough to enable definite diagnoses. In the last decade, EUS-based techniques have emerged, aiming to overcome the limitations of standard cross-section imaging modalities. These novel EUS-based techniques were primarily designed to acquire distinct images to make radiological diagnoses, collect cyst fluid to undergo biochemical or molecular analyses, and obtain tissue to conclude the pathological diagnoses. In this article, we present a comprehensive and critical review of these emerging EUS techniques for the diagnosis of PCNs, with emphasis being placed on the advantages, feasibilities, diagnostic performances, and limitations of these novel techniques.
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TRAINING COURSE Top

Pitfalls in interventional EUS procedures and coping strategies for endoscopy assistants (with video) p. 241
Caixia Wang, Sheng Wang, Jintao Guo, Nan Ge, Fan Yang, Bitian Liu, Yuanyuan Chen, Ling Fan, Siyu Sun
DOI:10.4103/EUS-D-21-00132  PMID:34396992
In recent years, the application of EUS in the diagnosis and treatment has become increasingly popular due to the rapid technological advancements in this field. With the application of new technologies, EUS assistants encounter various problems or “pitfalls” during clinical operations, which may pose challenges to the successful completion of relevant procedures. For example, a needle tip may not be visualized by ultrasonography during EUS-FNA; a stiff fine needle may not be introduced through the working channel of the endoscope in the duodenum, and withdrawal of a guidewire in a needle may be associated with tearing and peeling of the guidewire in EUS-guided biliary drainage. In view of these commonly encountered problems, this article summarizes the countermeasures that EUS assistants can take for EUS-FNA and EUS-guided drainage to improve the efficiency of the procedures and reduce the occurrence of adverse events.
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Controversies in EUS: Do we need miniprobes? p. 246
Hans Seifert, Pietro Fusaroli, Paolo Giorgio Arcidiacono, Barbara Braden, Felix Herth, Michael Hocke, Alberto Larghi, Bertrand Napoleon, Mihai Rimbas, Bogdan Silvio Ungureanu, Adrian Sãftoiu, Anand V Sahai, Christoph F Dietrich
DOI:10.4103/EUS-D-20-00252  PMID:34380805
This is the fifth in a series of papers entitled “Controversies in EUS.” In the current paper, we deal with high-resolution catheter probes, otherwise known as EUS miniprobes (EUS-MPs). The application of miniprobes for early carcinomas in the entire intestinal tract, for subepithelial lesions, and for findings in the bile duct and pancreatic duct as well as endobronchial use is critically discussed. Submucous lesions, especially in the colon, but also early carcinomas in special cases are considered the most important indications. The argument is illustrated by numerous examples.
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ORIGINAL ARTICLES Top

EUS-guided biopsy versus confocal laser endomicroscopy in patients with pancreatic cystic lesions: A systematic review and meta-analysis p. 270
Bojan Kovacevic, Giulio Antonelli, Pia Klausen, Cesare Hassan, Alberto Larghi, Peter Vilmann, John Gásdal Karstensen
DOI:10.4103/EUS-D-20-00172  PMID:34290168
Background and Objectives: Pancreatic cystic lesions (PCLs) are frequent incidental findings on cross-sectional imaging and represent a diagnostic challenge as different kinds of PCLs harbor a dissimilar risk of malignancy. Two diagnostic tools have recently been developed and introduced: through-the-needle biopsy (TTNB) and needle-based confocal laser endomicroscopy (nCLE). The aim of this meta-analysis was to compare the diagnostic yield and performance, as well as the safety profile of the two methods. Methods: This meta-analysis was performed in accordance with the PRISMA statement. Medline, Embase, Web of Science, and Cochrane Library databases were searched for studies with five or more patients undergoing either endoscopic ultrasound (EUS)-TTNB or EUS-nCLE for a PCL. Reviews, case reports, editorials, conference abstracts, and studies on exclusively solid pancreatic lesions were excluded. Outcomes of interest were diagnostic yield and performance, safety, and technical success. Results: Twenty studies with 1023 patients were included in the meta-analysis. Pooled diagnostic yield of EUS-nCLE was higher compared to EUS-TTNB (85% vs. 74%, P < 0.0001), while diagnostic performance was high and comparable for both methods (pooled sensitivity: 80% vs. 86% and pooled specificity: 80% vs. 83% for TTNB and nCLE, respectively, P > 0.05). Pooled estimate of total adverse event (AE) rate was 5% in the TTNB group and 3% in the nCLE group, P = 0.302. Technical success rates were high and comparable (94% and 99% for EUS-TTNB and nCLE, respectively; P = 0.07). Conclusion: EUS-TTNB and EUS-nCLE have a similar safety profile with a relatively low number of AEs. Technical success, sensitivity, and specificity are comparable; however, EUS-nCLE seems to have a slightly higher diagnostic yield.
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The role of EUS in diagnosing focal autoimmune pancreatitis and differentiating it from pancreatic cancer p. 280
Tao Guo, Tao Xu, Shengyu Zhang, Yamin Lai, Xi Wu, Dongsheng Wu, Yunlu Feng, Qingwei Jiang, Qiang Wang, Jiaming Qian, Aiming Yang
DOI:10.4103/EUS-D-20-00212  PMID:34213428
Background and Objectives: The clinical presentation of focal autoimmune pancreatitis (FAIP) and together with radiological overlap can mimic pancreatic cancer (PC). The aim of this study is to construct and validate a prediction model for differentiating FAIP from PC according to EUS characteristics. Patients and Methods: Ninety patients with FAIP and 196 patients with PC, who consecutively underwent EUS at our center from January 2013 to December 2018, were retrospectively included in the study. The enrolled patients were randomly divided into either a derivation sample or a validation sample. According to EUS characteristics, multivariate stepwise logistic regression and receiver operating characteristics (ROC) analyses were used to construct a prediction model in derivation sample, and then, the efficacy was assessed in validation sample. Results: EUS characteristics that were suggestive of FAIP included diffuse hypoechogenicity, hyperechoic foci/stands or lobularity (parenchymal heterogeneity), bile duct wall thickening and peripancreatic hypoechoic margin; and EUS features favoring PC included focal hypoechogenicity, absence of parenchymal heterogeneity, pancreatic duct dilation, and vessel involvement. The prediction model, with an area under the ROC curve of more than 0.95, had a good capability to distinguish FAIP from PC. By using the optimal cutoff value, the efficacy of model for diagnosing PC showed 83.7%–91.8% sensitivity and 93.3%–95.6% specificity. Conclusions: It is feasible to differentiate FAIP from PC based on EUS characteristics. The prediction model built in this study needs to be further confirmed by multicenter prospective researches.
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Diagnostic utility of EUS-guided tissue acquisition in children: A tertiary care center experience p. 288
Zaheer Nabi, Sundeep Lakhtakia, Radhika Chavan, Shujaath Asif, Jahangeer Basha, Rajesh Gupta, Raghavendra Yarlagadda, Palle Manohar Reddy, Rakesh Kalapala, D Nageshwar Reddy
DOI:10.4103/EUS-D-20-00203  PMID:34213427
Background and Objectives: EUS is frequently utilized for tissue acquisition in adult patients. However, the literature is limited regarding the utility of EUS-guided fine-needle aspiration or biopsy (FNA or FNB) in children. In this study, we aim to evaluate the feasibility, safety, and diagnostic utility of EUS-FNA/FNB in children with various gastrointestinal diseases. Methods: The data of children (≤18 years) who underwent EUS-FNA/FNB from March 2014 to June 2020 were analyzed, retrospectively. The following parameters were analyzed: technical success, adverse events, and impact on the final diagnosis. Results: Sixty-seven children (32 – boys, 14.8 ± 2.9 years, range 8–18 years), underwent EUS-guided tissue acquisition procedures using standard therapeutic echoendoscope during the study period. The indications included solid pancreatic lesions in 29 (43.3%), mediastinal or abdominal lymphadenopathy in 30 (44.7%), cystic pancreatic lesions in 5 (7.5%), subepithelial lesions in 2 (3%), and retroperitoneal mass in 1 (1.5%). EUS-FNA and-FNB were performed in 42 and 25 children, respectively. All the procedures could be successfully performed and there was no major procedure-related adverse event. Minor adverse events included self-limiting throat pain (10) and abdominal pain (3), self-limited bleeding at puncture site (3), and transient fever (1). EUS-FNA/FNB provided a histopathological diagnosis in 59 (88.1%) children. Conclusion: EUS-guided tissue acquisition using standard echoendoscope is feasible and safe in the pediatric age group. EUS-FNA/FNB establishes diagnosis in majority of the children when performed for appropriate clinical indication.
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EUS-guided hepaticoenterostomy with using a dedicated plastic stent for the benign pancreaticobiliary diseases: A single-center study of a large case series p. 294
Yukitoshi Matsunami, Takao Itoi, Atsushi Sofuni, Takayoshi Tsuchiya, Kentaro Ishii, Reina Tanaka, Ryosuke Tonozuka, Mitsuyoshi Honjo, Shuntaro Mukai, Kazumasa Nagai, Kenjiro Yamamoto, Yasutsugu Asai, Takashi Kurosawa, Hiroyuki Kojima, Eri Joyama, Yuichi Nagakawa
DOI:10.4103/EUS-D-20-00232  PMID:34259218
Background and Objectives: EUS-guided biliary drainage (EUS-BD) has recently been used for the treatment of not only malignant pancreaticobiliary diseases, but also for benign diseases. In most previous studies, EUS-BD was performed using a fully covered self-expandable metallic stent (SEMS), and data focusing on the usability of plastic stents for benign diseases are limited. We previously developed a plastic stent dedicated to EUS-guided hepaticoenterostomy (EUS-HES), and achieved favorable results in a feasibility study, although most of the patients had malignant diseases. Therefore, the aim of the present study was to evaluate the usability of dedicated plastic stents for EUS-HES in patients with benign pancreaticobiliary diseases. Patients and Methods: A total of 57 consecutive patients (28 men, median age: 68 years; range: 7–90 years) of normal and surgically altered anatomy with benign pancreaticobiliary diseases who underwent EUS-HES using the dedicated plastic stent between Jan. 2015 and Jun. 2020 were retrospectively analyzed. Results: The overall technical success rate of EUS-HES was 92.9% (53/57). Among the 4 cases of technical failure of plastic stent placement, a SEMS was placed in 1; percutaneous transhepatic biliary drainage was performed in 1; EUS-HES was reperformed 1 week later in 1; and observational management was selected in 1 patient. Adverse events associated with the procedure were seen in 15.7% (9/57) of the patients, namely, biliary peritonitis in 4, bleeding in 2, cholecystitis in 2, and pneumoperitoneum in 1 patient. Except for 1 patient who required blood transfusion owing to bleeding and 1 patient with cholecystitis who required percutaneous transhepatic gallbladder drainage, the other 7 patients were treated by conservative therapy. There were no intervention-associated deaths. Conclusion: Our results demonstrated that for patients with benign pancreaticobiliary diseases in whom conventional ERCP was unsuccessful, EUS-HES using a dedicated plastic stent was safe and feasible.
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IMAGES AND VIDEOS Top

Jumping technique for guidewire manipulation within an intrahepatic bile duct during EUS-guided biliary drainage (with video) p. 305
Takeshi Ogura, Saori Ueno, Atsushi Okuda, Nobu Nishioka, Kazuhide Higuchi
DOI:10.4103/EUS-D-20-00194  PMID:33884999
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Primary EUS-guided therapy of a giant visceral artery pseudoaneurysm: Expanding horizons (with video) p. 307
Jimil Shah, Jayanta Samanta, Gaurav Muktesh, Naveen Kumar, Pankaj Gupta, K Hemanth Kumar, Rakesh Kochhar
DOI:10.4103/EUS-D-20-00210  PMID:33586691
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Safe removal of lumen-apposing metal stent using argon plasma coagulation after EUS-guided cyst gastrostomy (with video) p. 309
Haruo Miwa, Kazuya Sugimori, Hiromi Tsuchiya, Masaki Nishimura, Yuichiro Tozuka, Takashi Kaneko, Shin Maeda
DOI:10.4103/EUS-D-20-00211  PMID:33586692
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Von Hippel-Lindau syndrome with pancreatic adenocarcinoma (with videos) Highly accessed article p. 311
Chenchen Zhang, Ning Zhong, Xiao Wang, Qingqing Qi, Zhen Li
DOI:10.4103/EUS-D-20-00213  PMID:33586693
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LETTERS TO EDITOR Top

Role of EUS in idiopathic ulcerative colitis p. 313
Surinder Singh Rana, Bhaskar Kante, Jimil Shah, Ritambhra Nada, Navin Kalra, Rajesh Gupta
DOI:10.4103/EUS-D-20-00224  PMID:34213429
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EUS-FNA biopsy of parathyroid gland p. 315
Evgeny G Solonitsyn, Ivan N Danilov, Anna V Poddymova, Elena V Ivaniha, Lubov B Mitrofanova
DOI:10.4103/EUS-D-20-00215  PMID:33666184
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