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2017| November-December | Volume 6 | Issue 6
Online since
December 15, 2017
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CLINICAL GUIDELINES
Practice guidelines for endoscopic ultrasound-guided celiac plexus neurolysis
Jonathan M Wyse, Robert Battat, Siyu Sun, Adrian Saftoiu, Ali A Siddiqui, Ang Tiing Leong, Brenda Lucia Arturo Arias, Carlo Fabbri, Douglas G Adler, Erwin Santo, Evangelos Kalaitzakis, Everson Artifon, Girish Mishra, Hussein Hassan Okasha, Jan Werner Poley, Jintao Guo, Juan J Vila, Linda S Lee, Malay Sharma, Manoop S Bhutani, Marc Giovannini, Masayuki Kitano, Mohamad Ali Eloubeidi, Mouen A Khashab, Nam Q Nguyen, Payal Saxena, Peter Vilmann, Pietro Fusaroli, Pramod Kumar Garg, Sammy Ho, Shuntaro Mukai, Silvia Carrara, Subbaramiah Sridhar, Sundeep Lakhtakia, Surinder S Rana, Vinay Dhir, Anand V Sahai
November-December 2017, 6(6):369-375
DOI
:10.4103/eus.eus_97_17
PMID
:29251270
Objectives:
The objective of guideline was to provide clear and relevant consensus statements to form a practical guideline for clinicians on the indications, optimal technique, safety and efficacy of endoscopic ultrasound guided celiac plexus neurolysis (EUS-CPN).
Methods:
Six important clinical questions were determined regarding EUS-CPN. Following a detailed literature review, 6 statements were proposed attempting to answer those questions. A group of expert endosonographers convened in Chicago, United States (May 2016), where the statements were presented and feedback provided. Subsequently a consensus group of 35 expert endosonographers voted based on their individual level of agreement. A strong recommendation required 80% voter agreement. The modified GRADE (Grading of Recommendations Assessment, Development, and Evaluation) criteria were used to rate the strength of recommendations and the quality of evidence.
Results:
Eighty percent agreement was reached on 5 of 6 consensus statements, 79.4% agreement was reached on the remaining one.
Conclusions:
EUS-CPN is efficacious, should be integrated into the management of pancreas cancer pain, and can be considered early at the time of diagnosis of inoperable disease. Techniques may still vary based on operator experience. Serious complications exist, but are rare.
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ORIGINAL ARTICLES
A retrospective study evaluating endoscopic ultrasound-guided drainage of pancreatic fluid collections using a novel lumen-apposing metal stent on an electrocautery enhanced delivery system
Douglas G Adler, Linda Jo Taylor, Raza Hasan, Ali A Siddiqui
November-December 2017, 6(6):389-393
DOI
:10.4103/eus.eus_4_17
PMID
:29251273
Objectives:
To report the safety and clinical efficacy with the novel lumen-apposing metal stent (LAMS) with an electrocautery enhanced delivery system for the drainage of pancreatic fluid collections (PFCs).
Methods:
This was a retrospective analysis of all consecutive patients with PFCs who underwent endoscopic ultrasound (EUS)-guided drainage using the LAMS with an electrocautery enhanced delivery system in 2 US centers.
Results:
Thirteen patients with PFCs (69% with walled-off necrosis [WON]) underwent drainage using the study device. Successful stent placement was accomplished in all patients. Direct endoscopic necrosectomy was carried out in all nine patients with WON complete resolution of the PFC was obtained in all 13 cases, with no recurrence during follow-up. There was one procedure-related adverse event. In one patient, the LAMS was dislodged immediately after deployment, falling into the stomach where it was removed. A second electrocautery enhanced LAMS was placed in this patient immediately afterward.
Conclusions:
EUS-guided drainage using the LAMS with the electrocautery-enhanced delivery system is a safe, easily performed, and a highly effective for the drainage of PFCs.
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Low diagnostic yield of transduodenal endoscopic ultrasound-guided fine needle biopsy using the 19-gauge Flex needle: A large multicenter prospective study
Fabia Attili, Carlo Fabbri, Ichiro Yasuda, Lorenzo Fuccio, Laurent Palazzo, Ilaria Tarantino, John Dewitt, Leonardo Frazzoni, Mihai Rimbaş, Alberto Larghi
November-December 2017, 6(6):402-408
DOI
:10.4103/eus.eus_54_17
PMID
:29251275
Background and Objectives:
Previous limited experiences have reported the 19-gauge flexible needle to be highly effective in performing endoscopic ultrasound-guided fine needle biopsy (EUS-FNB) for transduodenal lesions. We designed a large multicenter prospective study with the aim at evaluating the performance of this newly developed needle.
Patients and Methods:
Consecutive patients with solid lesions who needed to undergo EUS sampling from the duodenum were enrolled in 6 tertiary care referral centers. Puncture of the lesion was performed with the 19-gauge flexible needle (Expect™ and Slimline Expect™ 19 Flex). The feasibility, procurement yield, and diagnostic accuracy were evaluated.
Results:
Totally, 246 patients (144 males, mean age 65.1 ± 12.7 years) with solid lesions (203 cases) or enlarged lymph nodes (43 cases) were enrolled, with a mean size of 32.6 ± 12.2 mm. The procedure was technically feasible in 228 patients, with an overall procurement yield of 76.8%. Two centers had suboptimal procurement yields (66.7% and 64.2%). Major complications occurred in six cases: two of bleeding, two of mild acute pancreatitis, one perforation requiring surgery, and one duodenal hematoma. Considering malignant
versus
nonmalignant disease, the sensitivity, specificity, positive/negative likelihood ratios, and diagnostic accuracy were 70.7% (95% confidence interval [CI]: 64.3–76.6), 100% (95% CI: 79.6–100), 35.3 (95% CI: 2.3–549.8)/0.3 (95% CI: 0.2–0.4), and 73.6% (95% CI: 67.6–79). On multivariate analysis, the only determinant of successful EUS-FNB was the center in which the procedure was performed.
Conclusions:
Our results suggest that the use of the 19-gauge flexible needle cannot be widely advocated and its implementation should receive local validation after careful evaluation of both the technical success rates and diagnostic yield.
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REVIEW ARTICLES
Endoscopic ultrasound-guided fine-needle aspiration from ascites and peritoneal nodules: A scoping review
Vishal Sharma, Surinder Singh Rana, Sobur Uddin Ahmed, Sonali Guleria, Ravi Sharma, Rajesh Gupta
November-December 2017, 6(6):382-388
DOI
:10.4103/eus.eus_96_17
PMID
:29251272
The peritoneum is involved in many diseases such as primary malignancy (mesothelioma), infectious disease (tuberculosis), and disseminated malignancy (peritoneal carcinomatosis). The peritoneal disease may manifest as ascites and/or peritoneal masses or nodules. Endoscopic ultrasound (EUS), due to its ability to provide high-resolution images, has revolutionized the imaging and diagnosis of pancreaticobiliary diseases among other gastrointestinal conditions. EUS can not only help in imaging of various lesions close to the gastrointestinal lumen but also aspirate/biopsy them. We conducted a systematic search to identify published literature on the value of EUS in detection and diagnosis of peritoneal disorders. This review aims to summarize the available literature on the use of EUS-guided paracentesis and fine-needle aspiration from peritoneal nodules.
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EDITORIAL
Retrievable puncture anchor-assisted gallbladder drainage: Throwing the gallbladder a lifeline
Kai Zhang, Jintao Guo, Siyu Sun
November-December 2017, 6(6):355-358
DOI
:10.4103/eus.eus_101_17
PMID
:29251268
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IMAGES AND VIDEOS
Endoscopic ultrasound to diagnose pneumatosis cystoides intestinalis (with video)
Davide Giuseppe Ribaldone, Mauro Bruno, Silvia Gaia, Giorgio Maria Saracco, Claudio De Angelis
November-December 2017, 6(6):416-417
DOI
:10.4103/eus.eus_88_17
PMID
:29251277
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ORIGINAL ARTICLES
Interventional endoscopic ultrasound: A new promising way for intrahepatic portosystemic shunt with portal pressure gradient
Laurent Poincloux, Pascal Chabrot, Aurélien Mulliez, Julien Genes, Louis Boyer, Armando Abergel
November-December 2017, 6(6):394-401
DOI
:10.4103/eus.eus_42_17
PMID
:29251274
Background and Objectives:
Interventional endoscopic ultrasound (EUS) is a promising novel approach for intravascular interventions. The aim of this study was to assess the feasibility and safety of a EUS-guided intrahepatic portosystemic shunt (EGIPS) with portal pressure gradient measurement in a live porcine model.
Methods:
The left hepatic vein (LHV) or the inferior vena cava (IVC) was punctured with a needle that advanced into the portal vein (PV). A guidewire was then inserted into the PV, and a needle knife was used to create an intrahepatic fistula between LHV and PV. Portal pressure was recorded. The fistula was dilated with a balloon and a biliary metal stent was deployed between LHV and PV under sonographic and fluoroscopic observation. A portocavography validated the patency of the stent. Necropsies were realized after euthanasia.
Results:
Portosystemic stenting was achieved in 19/21 pigs. Final portocavography confirmed stent patency between PV and LHV or IVC in 17 pigs (efficacy of 81%): Four stents were dysfunctional as two were thrombosed and two were poor positioned. Portal pressure was documented before and after shunting in 20/21 pigs. Necropsies revealed that 19/21 procedures were transesophageal and two were transgastric. Hemoperitoneum and pneumothorax were found in one pig and hemothorax was found in two pigs. Morbidity was 14.2% (3/21 animals).
Conclusion:
EGIPS was feasible in 91% of cases, functional in 81%, with 14.2% per procedure morbidity. EGIPS still needs to be assessed in portal hypertension pig models with longer follow-up before being considered as an alternative when the transjugular intrahepatic portosystemic shunt fails.
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REVIEW ARTICLES
Can endoscopic ultrasound-guided needle-based confocal laser endomicroscopy replace fine-needle aspiration for pancreatic and mediastinal diseases?
Jintao Guo, Manoop S Bhutani, Marc Giovannini, Zhaoshen Li, Zhendong Jin, Aiming Yang, Guoqiang Xu, Guiqi Wang, Siyu Sun
November-December 2017, 6(6):376-381
DOI
:10.4103/eus.eus_87_17
PMID
:29251271
New applications of confocal laser endomicroscopy (CLE) have been developed, such as needle-based CLE (nCLE) for pancreatic masses, pancreatic cystic tumors, and lymph nodes. nCLE is feasible during endoscopic ultrasound (EUS) examination, and preliminary results are very encouraging and suggest this technology may be used in future as a useful adjunct in cases of inconclusive EUS-guided fine-needle aspiration. The aim of this paper is to give an update in this new technology and to define its place in the diagnosis of pancreatic masses and mediastinal diseases.
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CLINICAL GUIDELINES
II Brazilian consensus statement on endoscopic ultrasonography
Fauze Maluf-Filho, Joel Fernandez de Oliveira, Ernesto Quaresma Mendonça, Augusto Carbonari, Bruno Antônio Maciente, Bruno Chaves Salomão, Bruno Frederico Medrado, Carlos Marcelo Dotti, César Vivian Lopes, Cláudia Utsch Braga, Daniel Alencar M. Dutra, Felipe Retes, Frank Nakao, Giovana Biasia de Sousa, Gustavo Andrade de Paulo, Jose Celso Ardengh, Juliana Bonfim dos Santos, Luciana Moura Sampaio, Luciano Okawa, Lucio Rossini, Manoel Carlos de Brito Cardoso, Marco Antonio Ribeiro Camunha, Marcos Clarêncio, Marcos Eduardo Lera dos Santos, Matheus Franco, Nutianne Camargo Schneider, Ramiro Mascarenhas, Rodrigo Roda, Sérgio Matuguma, Simone Guaraldi, Viviane Figueiredo
November-December 2017, 6(6):359-368
DOI
:10.4103/eus.eus_32_17
PMID
:29251269
Background and Objectives:
At the time of its introduction in the early 80s, endoscopic ultrasonography (EUS) was indicated for diagnostic purposes. Recently, EUS has been employed to assist or to be the main platform of complex therapeutic interventions.
Methods:
From a series of relevant new topics in the literature and based on the need to complement the I Brazilian consensus on EUS, twenty experienced endosonographers identified and reviewed the pertinent literature in databases. The quality of evidence, strength of recommendations, and level of consensus were graded and voted on.
Results:
Consensus was reached for eight relevant topics: treatment of gastric varices, staging of nonsmall cell lung cancer, biliary drainage, tissue sampling of subepithelial lesions (SELs), treatment of pancreatic fluid collections, tissue sampling of pancreatic solid lesions, celiac neurolysis, and evaluation of the incidental pancreatic cysts.
Conclusions:
There is a high level of evidence for staging of nonsmall cell lung cancer; biopsy of SELs as the safest method; unilateral and bilateral injection techniques are equivalent for EUS-guided celiac neurolysis, and in patients with visible ganglia, celiac ganglia neurolysis appears to lead to better results. There is a moderate level of evidence for: yield of tissue sampling of pancreatic solid lesions is not influenced by the needle shape, gauge, or employed aspiration technique; EUS-guided and percutaneous biliary drainage present similar clinical success and adverse event rates; plastic and metallic stents are equivalent in the EUS-guided treatment of pancreatic pseudocyst. There is a low level of evidence in the routine use of EUS-guided treatment of gastric varices.
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IMAGES AND VIDEOS
Malignant melanoma metastatic to the gallbladder diagnosed by endoscopic ultrasonography-guided fine-needle aspiration
Hiroshi Kawakami, Yoshimasa Kubota
November-December 2017, 6(6):414-415
DOI
:10.4103/eus.eus_52_17
PMID
:29251276
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Diagnostic dilemma in gastric varices: Endoscopic ultrasound resolves the issue (with videos)
Malay Sharma, Parvinder Singh, Amit Pathak, Shalini Arya
November-December 2017, 6(6):409-411
DOI
:10.4103/2303-9027.199764
PMID
:28663534
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Achievement of long-term stent patency in endoscopic ultrasonography-guided right bile duct drainage after left hepatic lobectomy (with video)
Kosuke Minaga, Mamoru Takenaka, Takeshi Miyata, Kentaro Yamao, Ken Kamata, Masayuki Kitano, Masatoshi Kudo
November-December 2017, 6(6):412-413
DOI
:10.4103/eus.eus_9_17
PMID
:28685748
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LETTER TO EDITOR
Large liver abscess after endoscopic ultrasound-guided fiducial placement
Galab M Hassan, Sarto C Paquin, Anand V Sahai
November-December 2017, 6(6):418-419
DOI
:10.4103/eus.eus_17_17
PMID
:28836513
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