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2018| March-April | Volume 7 | Issue 2
Online since
April 16, 2018
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COMMENTARY
The development of peroral cholecystoscopy and advanced gallbladder interventions
Joey Ho Yi Chan, Anthony Yuen Bun Teoh
March-April 2018, 7(2):85-88
DOI
:10.4103/eus.eus_7_18
PMID
:29667622
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ORIGINAL ARTICLES
Significance of normal appearance on endoscopic ultrasonography in the diagnosis of early chronic pancreatitis
Ai Sato, Atsushi Irisawa, Manoop S Bhutani, Goro Shibukawa, Akane Yamabe, Mariko Fujisawa, Ryo Igarashi, Noriyuki Arakawa, Yoshitsugu Yoshida, Yoko Abe, Takumi Maki, Koki Hoshi, Hiromasa Ohira
March-April 2018, 7(2):110-118
DOI
:10.4103/2303-9027.209870
PMID
:28685746
Background and Objectives:
The Rosemont classification (RC) was developed as a consensus-based standard for the diagnosis of chronic pancreatitis (CP) by endoscopic ultrasonography (EUS), however, it is more complicated than the conventional scoring system. We have noticed that in the early stages of CP, it is not unusual to observe pancreas with abnormal appearance coexisting with the areas of normal parenchyma. The aim of this study was to investigate the validity of a “normal” pancreas appearance and to evaluate the usefulness of modified diagnostic criteria in comparison to the traditional EUS criteria and the RC.
Patients and Methods:
One hundred and seventy-seven patients who had undergone both EUS and endoscopic retrograde pancreatography (ERP) within 2 months were enrolled in the study, and patients with pancreatic cancer were excluded from the study. ERP findings were used as the gold standard for the diagnosis of CP. The EUS images obtained were classified according to both the RC and our new modified criteria. The latter includes an additional criterion to the modified traditional criteria: fine-reticular pattern (F-RP) was defined as a normal pancreatic parenchyma. We compared the accuracy between the new modified EUS criteria and the RC.
Results:
(1) Normal or equivocal findings on ERP were obtained for 132 patients; 113 patients had F-RP on EUS. In contrast, F-RP was found in only 6 out of 45 CP cases on ERP (
P
< 0.0001). (2) We investigated the diagnostic capability of our new criteria for endoscopic retrograde cholangiopancreatography normal/equivocal pancreas compared to the traditional criteria. In cases where fewer than two points were defined as normal, the incidence of normal pancreas was significantly higher based on the new criteria than on the traditional criteria (
P
= 0.002). (3) No significant differences were found between the new criteria and the RC across all ERP grades.
Conclusion:
Our new proposed “normal-added EUS criteria” for diagnosing CP was equivalent to the RC.
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IMAGES AND VIDEOS
New curved linear echoendoscope for endoscopic ultrasonography-guided fine-needle aspiration in patients with Roux-en-Y reconstruction (with videos)
Hiroshi Kawakami, Yoshimasa Kubota
March-April 2018, 7(2):128-129
DOI
:10.4103/eus.eus_11_17
PMID
:28685741
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ORIGINAL ARTICLES
Ultrasound imaging features of isolated pancreatic tuberculosis
Yi Dong, Christian Jürgensen, Rajesh Puri, Mirko D'Onofrio, Michael Hocke, Wen-Ping Wang, Nathan Atkinson, Malay Sharma, Christoph F Dietrich
March-April 2018, 7(2):119-127
DOI
:10.4103/2303-9027.210901
PMID
:28721972
Background and Objectives:
Isolated pancreatic tuberculosis (PTB) is extremely rare worldwide. The purpose of this multicenter retrospective study is to analyze imaging features of histologically confirmed isolated PTB in order to determine the diagnostic features of the new methods contrast enhanced ultrasound (CEUS), ultrasound elastography and contrast enhanced endoscopic ultrasound (CE-EUS).
Patients and Methods:
We report on a retrospective data collection of 12 cases of PTB confirmed by histology or cytology. All examinations were interpreted by two independent readers in consensus. CEUS, CE-EUS and ultrasound elastography were performed according to the European Federation of Societies for Ultrasound in Medicine and Biology guidelines.
Results:
In PTB patients the common bile duct was never dilated. Multiple retroperitoneal lymph nodes are the second important B-mode ultrasound feature detected in 75% of PTB patients. CE-EUS was performed in three PTB patients demonstrating hyperenhancement. On elastography, all PTB lesions were markedly stiffer than surrounding pancreatic parenchyma.
Conclusions:
Here we report the first time on CEUS and elastography features of PTB. PTB had some typical imaging features with iso- or hyperenhancement on CE(E) US. PTB is markedly stiffer on elastography. If clinicians are aware of clinical features of PTB and conduct appropriate investigations with multiple modalities including B-mode ultrasound, CEUS, and EUS guided fine needle aspiration, diagnosis of PTB without laparotomy is possible and the disease can be effectively treated with anti-tuberculous drugs.
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COMMENTARY
EUS-guided gallbladder drainage
vs
. percutaneous gallbladder drainage
Aaron Justin Small, Shayan Irani
March-April 2018, 7(2):89-92
DOI
:10.4103/eus.eus_8_18
PMID
:29667623
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Converting percutaneous gallbladder drainage to internal drainage using EUS-guided therapy: A review of current practices and procedures
Theodore W James, Todd H Baron
March-April 2018, 7(2):93-96
DOI
:10.4103/eus.eus_110_17
PMID
:29667624
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Long-term outcomes after EUS-guided gallbladder drainage
Monica Saumoy, Aleksey Novikov, Michel Kahaleh
March-April 2018, 7(2):97-101
DOI
:10.4103/eus.eus_9_18
PMID
:29667625
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Development of EUS-guided gallbladder drainage and current indications
Takao Itoi, Takayoshi Tsuchiya, Atsushi Sofuni, Reina Tanaka, Ryosuke Tonozuka, Mitsuyoshi Honjo, Shuntaro Mukai, Mitsuru Fujita, Kenjiro Yamamoto, Yasutsugu Asai, Takashi Kurosawa, Shingo Tachibana, Yuichi Nagakawa
March-April 2018, 7(2):76-78
DOI
:10.4103/eus.eus_4_18
PMID
:29667619
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Technical considerations in EUS-guided gallbladder drainage
Manuel Perez-Miranda
March-April 2018, 7(2):79-82
DOI
:10.4103/eus.eus_5_18
PMID
:29667620
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EUS-guided gallbladder drainage and gallbladder interventions in China
Jintao Guo, Siyu Sun
March-April 2018, 7(2):83-84
DOI
:10.4103/eus.eus_6_18
PMID
:29667621
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EDITORIAL
Remember, interventional EUS is performed using an elevator-containing scope as well
Siyu Sun, Caixia Wang, Sheng Wang
March-April 2018, 7(2):73-75
DOI
:10.4103/eus.eus_14_18
PMID
:29667618
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IMAGES AND VIDEOS
Stent drainage achieved by endoscopic ultrasonography-guided puncture from duodenal bulb to the minor pancreatic duct for the treatment of acute epigastric pain in a patient with pancreas divisum
Bin Cheng, Demin Li, Xiaoli Wu, Zhicheng Zhang, Min Zhang, Min Yang, Qiaozhen Guo, Qiu Zhao
March-April 2018, 7(2):130-132
DOI
:10.4103/eus.eus_35_17
PMID
:28685743
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Direct puncture of the ampulla as a modified Endoscopic ultrasound-guided rendezvous technique
Kazumichi Kawakubo, Masaki Kuwatani, Shin Kato, Ryo Sugiura, Itsuki Sano, Naoya Sakamoto
March-April 2018, 7(2):133-134
DOI
:10.4103/eus.eus_31_17
PMID
:28836519
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LETTERS TO EDITOR
EUS -guided liquid fiducial placement for stereotactic radiotherapy in pancreatic cancer: Feasibility study
Vivian Ussui, Nicolas Kuritzky, Manuel Berzosa
March-April 2018, 7(2):135-136
DOI
:10.4103/eus.eus_98_17
PMID
:29536955
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REVIEW ARTICLE
EUS-FNA in cystic pancreatic lesions: Where are we now and where are we headed in the future?
Jose Lariño-Noia, Julio Iglesias-Garcia, Daniel de la Iglesia-Garcia, J Enrique Dominguez-Muñoz
March-April 2018, 7(2):102-109
DOI
:10.4103/eus.eus_93_17
PMID
:29667626
EUS-FNA is often performed in the evaluation of Cystic Pancreatic Lesions (CPL) for a better preoperative characterization. The objective is to identify premalignant lesions as Mucinous Cystic Neoplasms, and/or a malignant transformation of them (adenocarcinoma). The role of cytological evaluation in this setting is discouraging and intracystic markers analysis, mainly CEA, lacks of a good specificity for the detection of mucinous neoplasms. New devices and approaches have emerged to overcome these problems as the cytology brush (Echobrush), the small mini-biopsy foceps, the cystoscopy and the needle Confocal LASER Endomicroscopy (nCLE), showing in some studies good rates of accuracy for distinguishing among mucinosus and non-mucinous neoplasms. However, intracystic molecular marker analysis, by identifying mutations in DNA of particular genes as KRAS,GNAS,VHL, CDKN2A and others constitute the most relevant advancement of last years and will contribute in the next future to a better management of CPL. The role of EUS-FNA according to international guidelines is still controversial. While 2012 Fukuoka guidelines are restrictive in their indications AGA 2015 guidelines support it when high risk features are present, enhancing the role of the cytological evaluation in taking decisions.
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