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2017| July-August | Volume 6 | Issue 4
Online since
August 16, 2017
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REVIEW ARTICLE
Endoscopic ultrasound-guided gastroenterostomy: Are we ready for prime time?
Mihai Rimbas, Alberto Larghi, Guido Costamagna
July-August 2017, 6(4):235-240
DOI
:10.4103/eus.eus_47_17
PMID
:28820145
Interventional endoscopic ultrasonography (EUS) is currently becoming the less invasive therapeutic approach for the drainage of pancreatic fluid collections, of acute cholecystitis in patients unfit for surgery and for biliary drainage after failed endoscopic retrograde cholangiopancreatography. In addition, EUS-guided gastroenterostomy (EUS-GE) has recently emerged as a feasible procedure to treat patients with gastric outlet obstruction, as an alternative to surgery or to standard endoscopy when endoscopic stent placement is not possible. Prior animal studies have shown that the procedure is safe and can create a stable anastomosis. However, the major challenge in translating the results of the animal studies into clinical practice is represented by the proper identification of the distal duodenal or proximal jejunal loop to be accessed in order to create the anastomosis. Currently, there are three EUS-GE techniques available: the direct EUS-GE technique, assisted EUS-GE technique, and its variant called the EUS-guided double-balloon-occluded gastrojejunostomy bypass. The present review describes the current EUS-GE techniques, depicts the different procedural aspects of the procedure, and presents the clinical evidences available so far, with a focus on the future perspectives of this EUS-guided technique.
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EDITORIAL
Endoscopic ultrasound-guided drainage of pelvic abscesses with lumen-apposing metal stents
Amar Manvar, Kunal Karia, Sammy Ho
July-August 2017, 6(4):217-218
DOI
:10.4103/eus.eus_46_17
PMID
:28820143
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ORIGINAL ARTICLES
Impact of sedation technique on the diagnostic accuracy of endobronchial ultrasound-guided transbronchial needle aspiration
Daniel Franzen, Didier Schneiter, Walter Weder, Malcolm Kohler
July-August 2017, 6(4):257-263
DOI
:10.4103/2303-9027.190925
PMID
:28663531
Background and Objectives:
There is a paucity of data concerning the impact of the sedation technique used for endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) on diagnostic accuracy. The aim of this retrospective study was to compare the diagnostic accuracy of EBUS-TBNA in deep and moderate sedations, and to investigate other possible determinants of diagnostic accuracy in three lymph node locations (mediastinal, subcarinal, and hilar).
Materials and Methods:
The first consecutive patients at our institution undergoing EBUS-TBNA for selective sampling in deep sedation were compared with the first consecutive patients in moderate sedation between 2006 and 2014. Diagnoses based on EBUS-TBNA were compared with those on surgical or radiological follow-up.
Results:
In a total of 232 patients, the overall diagnostic accuracy for correct diagnosis at the mediastinal, subcarinal, and hilar locations irrespective of the sedation technique was 91%, 93%, and 92%, respectively. At the three mentioned lymph node locations, overall diagnostic accuracy of EBUS-TBNA in deep sedation compared to moderate sedation was 88.5% and 95.5% (
P
= 0.3), 93.2 and 93.6% (
P
= 0.9), and 88.6 and 94.0% (
P
= 0.4), respectively.
Conclusions:
The sedation technique does not seem to influence the diagnostic accuracy of EBUS-TBNA.
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Contribution of cell block obtained by endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis of malignant diseases and sarcoidosis
Onur Fevzi Erer, Serhat Erol, Ceyda Anar, Zekiye Aydoğdu, Serir Aktoğu Özkan
July-August 2017, 6(4):265-268
DOI
:10.4103/2303-9027.180763
PMID
:27121292
Aim:
Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a safe and minimally invasive procedure that can be performed in outpatient settings. Several studies have demonstrated the usefulness of EBUS-TBNA in the diagnosis of sarcoidosis and malignant diseases. This study focused on the role of cell block (CB) analysis in determining the diagnostic yield of EBUS-TBNA in malignant diseases and sarcoidosis.
Materials and Methods:
The study was conducted at a training and research hospital. Records of patients who underwent EBUS-TBNA between March 2011 and December 2014 for diagnosed sarcoidosis or malignancy were retrospectively analyzed. Results of all EBUS-TBNA smears and CB were separately evaluated to determine the diagnostic value of each.
Results:
There were 84 sarcoidosis and 179 malignancy patients. In the malignancy group, CB contributed to cancer diagnosis in 15 (8.3%) patients and subclassification in 19 (10.6%) patients. In the sarcoidosis group, for 45.2% of patients (38/84), smears were not diagnostic but CB showed granulomatous inflammation.
Conclusion:
CB significantly increases the diagnostic yield of EBUS-TBNA for sarcoidosis. In our study, in the malignancy group the diagnostic yield was low but it was helpful for subclassification, especially for adenocarcinoma.
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227
Colon carcinoma staging by endoscopic ultrasonography miniprobes
Fernando M Castro-Poças, Mário Dinis-Ribeiro, Anabela Rocha, Marisa Santos, Tarcísio Araújo, Isabel Pedroto
July-August 2017, 6(4):245-251
DOI
:10.4103/2303-9027.190921
PMID
:28663528
Background and Objectives:
Due to the increasing use of endoscopic techniques for colon cancer resection, pretreatment locoregional staging may gain critical interest. The use of endoscopic ultrasonography (EUS) miniprobes in this context has been seldom reported. Our aim was to determine the accuracy of EUS miniprobes for colon cancer staging.
Materials and Methods:
Forty patients with colon cancer (2 in the cecum, 9 in the ascending colon, 5 in the transverse colon, 5 in the descending colon, and 19 in the sigmoid colon) were submitted to staging using 12 MHz EUS miniprobes. EUS and the anatomopathological results were compared with regard to the T and N stages. It was assessed if the location, longitudinal extension, or circumferential extension of the tumor had any influence on the accuracy in EUS staging.
Results:
Tumor staging was feasible in 39 (98%) patients except in one case with a stenosing tumor (out of 6). Globally, T stage was accurately determined in 88% of the cases. In the assessment of the presence or absence of lymph node metastasis, miniprobes presented an accuracy of 82% with a sensitivity of 67%. These results were neither affected by the location nor by the longitudinal or circumferential extension of the tumor.
Conclusions:
EUS miniprobes may play an important role in assessing T and N stages in colon cancer and may represent an incentive to the research of new therapeutic areas for this disease.
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CASE REPORT
Extramedullary plasmacytoma mimicking pancreatic cancer: A case report and literature review
Jae Hyung Kim, Woo Hyun Paik, Mee Joo, Jung Gon Kim, Jong Wook Kim, Won Ki Bae, Nam-Hoon Kim, Kyung-Ah Kim, June Sung Lee
July-August 2017, 6(4):269-272
DOI
:10.4103/2303-9027.190923
PMID
:28663530
Pancreatic adenocarcinoma may account for more than 80% of all pancreatic neoplasms. Occasionally, other rare tumors such as lymphoma, metastatic tumor, and solid pseudopapillary neoplasm can be considered in the differential diagnosis. We report the case of an 82-year-old man with a pancreatic solid mass. This case suggests that endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) with biopsy, that is, EUS-FNA is recommended in the differential diagnosis of the pancreatic solid mass apart from pancreatic adenocarcinoma. In particular, the histologic core obtained by EUS-guided biopsy is helpful for the immunostaining of molecular markers to confirm the final diagnosis.
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3,005
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RAPID COMMUNICATION
Endorectal fusion imaging: A description of a new technique
Andre Ignee, Yi Dong, Gudrun Schuessler, Ulrich Baum, Christoph F Dietrich
July-August 2017, 6(4):241-244
DOI
:10.4103/2303-9027.209868
PMID
:28685744
Background:
Fusion imaging is an accepted method in abdominal imaging allowing a simultaneous display of reference imaging with a live ultrasound (US) investigation. For prostate cancer, promising results have been published for endorectal US (ERUS)-guided biopsy of suspicious lesions in magnetic resonance imaging (MRI). To our knowledge, no other indication for the fusion of ERUS with MRI has been reported so far.
Methods:
We report on three patients scheduled for ERUS due to anorectal fistulae after treatment (
n
= 2) or rectal carcinoma (
n
= 1), which were scheduled for real-time virtual onography (RVS), a method for the fusion of MRI imaging with US.
Results:
In all patients, RVS was successful. The course of the fistulae could be defined and the success of the treatment could be confirmed. In the patient with rectal carcinoma, the lymph nodes suspicious in MRI could be identified.
Conclusions:
MRI/ERUS fusion has the potential for follow-up of anorectal fistulae and abscesses, and staging of anal and rectal tumors.
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COMMENTARY
Seagulls of endoscopic ultrasound
Amit Pathak, Abid Shoukat, NS Thomas, Divij Mehta, Malay Sharma
July-August 2017, 6(4):231-234
DOI
:10.4103/2303-9027.190919
PMID
:28663526
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3,488
350
IMAGES AND VIDEOS
Endoscopic ultrasound-guided fine needle aspiration and diagnosis of omental plasmacytoma
Venkata Muddana, Abha Goyal, Prabhleen Chahal
July-August 2017, 6(4):278-279
DOI
:10.4103/2303-9027.190920
PMID
:28663527
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GUIDELINE
Chinese expert consensus statement on issues related to small specimen sampling of lung cancer
Chinese Thoracic Society, Chinese Alliance against Lung Cancer
July-August 2017, 6(4):219-230
DOI
:10.4103/eus.eus_37_17
PMID
:28820144
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1,917
216
IMAGES AND VIDEOS
Chronic diarrhea and diffuse gastric wall thickening: What is the common link?
Surinder Singh Rana, Vishal Sharma, Chalapathi Rao, Kim Vaiphei, Rajesh Gupta, Mandeep Kang, Bhagwant R Mittal, Deepak K Bhasin
July-August 2017, 6(4):273-275
DOI
:10.4103/2303-9027.199765
PMID
:28663535
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1,964
186
Endoscopic ultrasound for the diagnosis of an uncommon cause of obstructive jaundice masquerading as malignancy
Filippo Antonini, Giampiero Macarri
July-August 2017, 6(4):276-277
DOI
:10.4103/2303-9027.190926
PMID
:28663532
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ORIGINAL ARTICLES
Impact of introduction of endoscopic ultrasound on volume, success, and complexity of endoscopic retrograde cholangiopancreatography in a tertiary referral center
Harathi Yandrapu, Sherif Elhanafi, Farhanaz Chowdhury, Jiayang Liu, Eduardo J Onate, Alok Dwivedi, Mohamed O Othman
July-August 2017, 6(4):252-256
DOI
:10.4103/2303-9027.190922
PMID
:28663529
Background and Objectives:
Endoscopic ultrasound (EUS) is commonly used to examine pancreaticobiliary disorders. We hypothesize that the introduction of EUS service may change the pattern and the complexity of endoscopic retrograde cholangiopancreatographies (ERCPs) performed. The aim of this study is to assess the impact of introducing EUS on the volume, success, and complexity of ERCP.
Materials and Methods:
This is a single-center retrospective data review of ERCP procedures done “before” and “after” the introduction of EUS (before EUS and after EUS). Patients' demographics, ERCP indications, types of sedation, therapeutic interventions, outcomes, complications, and complexity of ERCP were collected. The categorical and continuous variables were compared using Fisher's exact test and the unpaired
t
-test, respectively. Multivariable logistic regression analysis was used to compare ERCP outcomes.
Results:
A total of 945 ERCPs performed over a 3-year period between January 2010 and January 2013 (411 and 534 in the “before EUS” and “after EUS” time periods, respectively) were included in this study. There was a 30% relative increase in the volume of ERCPs after the introduction of EUS. ERCP success rate was higher after the introduction of EUS, even after adjusting the complexity grade [odds ratio (OR) = 4.54,
P
= 0.001]. Significant increase in the complexity of ERCP was observed after the introduction of EUS service. The OR of performing grade 4 ERCP was 4.44 (
P
= 0.0005) after the introduction of EUS.
Conclusions:
The introduction of a new EUS service in our tertiary referral university medical center is associated with an increase in the volume, success, and complexity of ERCP procedures. EUS expertise may be valuable for better ERCP outcomes.
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