Clinical Advances of Endoscopy in Pancreaticobiliary Disease

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Gastroenterology & Hepatopancreatobiliary Medicine".

Deadline for manuscript submissions: closed (15 February 2022) | Viewed by 27413

Special Issue Editor

Department of Gastroenterology, Dokkyo Medical University, Tochigi, Japan
Interests: interventional endoscopy; interventional endoscopic ultrasound; pancreaticobiliary disease; portal hypertension
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

The progress of endoscopy in the pancreaticobiliary field is remarkable. Various pancreaticobiliary diseases (early-stage pancreaticobiliary cancer, early-stage chronic pancreatitis, etc.), which were previously difficult to diagnose, have become more accurate with the progress of ERCP and EUS. Moreover, the new development of cholangioscopy and pancreatoscopy have bought further possibilities with high diagnostic ability. On the other hand, endoscopic treatment has also made significant progress. Therapeutic indications have expanded steadily, and new therapies that have never existed are being developed and implemented. In particular, the advancement of interventional EUS has revolutionized endoscopic treatment for pancreaticobiliary disease. In this Special Issue, we welcome authors to submit papers on the clinical advance of biliary and pancreatic endoscopy in terms of both diagnosis and treatment.

Prof. Dr. Atsushi Irisawa
Guest Editor

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Keywords

  • ERCP
  • EUS
  • Pancreatoscopy
  • Cholangioscopy
  • Pancreatic cancer
  • Pancreatitis
  • Biliary cancer
  • Cholangitis
  • IgG4- related disease
  • Walled-off necrosis

Published Papers (12 papers)

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Research

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10 pages, 3066 KiB  
Article
Comparison of Radiation Exposure between Endoscopic Ultrasound-Guided Hepaticogastrostomy and Hepaticogastrostomy with Antegrade Stenting
by Mamoru Takenaka, Madan M. Rehani, Makoto Hosono, Tomohiro Yamazaki, Shunsuke Omoto, Kosuke Minaga, Ken Kamata, Kentaro Yamao, Shiro Hayashi, Tsutomu Nishida and Masatoshi Kudo
J. Clin. Med. 2022, 11(6), 1705; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11061705 - 19 Mar 2022
Viewed by 1708
Abstract
Fluoroscopy forms an essential part of endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) and hepaticogastrostomy with antegrade stenting (EUS-HGAS). To date, no study has assessed and compared radiation exposure between EUS-HGS and EUS-HGAS. This study aimed to compare the radiation exposure parameters between EUS-HGS and EUS-HGAS. [...] Read more.
Fluoroscopy forms an essential part of endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) and hepaticogastrostomy with antegrade stenting (EUS-HGAS). To date, no study has assessed and compared radiation exposure between EUS-HGS and EUS-HGAS. This study aimed to compare the radiation exposure parameters between EUS-HGS and EUS-HGAS. This retrospective single-center cohort study included consecutive patients who underwent EUS-HGS or EUS-HGAS from October 2017 to March 2019. The air kerma (AK: mGy), kerma–area product (KAP: Gycm2), fluoroscopy time (FT: min), and procedure time (PT: min) were assessed and compared between the two procedures. Altogether, 45 and 24 patients underwent EUS-HGS and EUS-HGAS, respectively. The median AK, KAP, FT, and PT were higher in the EUS-HGAS group than in the EUS-HGS group. A comparison revealed no difference in the technical success rate, complications rate, adverse event occurrence rate, and re-intervention rate between both procedures. This is the first report in which radiation exposure was used as a comparative parameter between EUS-HGS and EUS-HGAS. This study revealed that radiation exposure is significantly higher in EUS-HGAS than in EUS-HGS. Increased awareness on radiation exposure is warranted among gastroenterologists so that they choose the procedure with lower radiation exposure in cases where both procedures are indicated. Full article
(This article belongs to the Special Issue Clinical Advances of Endoscopy in Pancreaticobiliary Disease)
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12 pages, 2263 KiB  
Article
The Efficacy and Safety of Balloon Enteroscopy-Assisted Endoscopic Retrograde Cholangiography in Pediatric Patients with Surgically Altered Gastrointestinal Anatomy
by Kensuke Yokoyama, Tomonori Yano, Atsushi Kanno, Eriko Ikeda, Kozue Ando, Tetsurou Miwata, Hiroki Nagai, Yuki Kawasaki, Yamato Tada, Yukihiro Sanada, Kiichi Tamada, Alan Kawarai Lefor and Hironori Yamamoto
J. Clin. Med. 2021, 10(17), 3936; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10173936 - 31 Aug 2021
Cited by 2 | Viewed by 2056
Abstract
Balloon enteroscopy-assisted endoscopic retrograde cholangiography (BEA-ERC) is useful and feasible in adults with pancreatobiliary diseases, but its efficacy and safety have not been established in pediatric patients. We compared the success rate and safety of BEA-ERC between adults and pediatric patients. This single-center [...] Read more.
Balloon enteroscopy-assisted endoscopic retrograde cholangiography (BEA-ERC) is useful and feasible in adults with pancreatobiliary diseases, but its efficacy and safety have not been established in pediatric patients. We compared the success rate and safety of BEA-ERC between adults and pediatric patients. This single-center retrospective study reviewed 348 patients (pediatric: 57, adult: 291) with surgically altered gastrointestinal anatomies who underwent BEA-ERC for biliary disorders from January 2007 to December 2019. The success rate of reaching the anastomosis or duodenal papilla was significantly lower in pediatric patients than in adult patients (66.7% vs. 88.0%, p < 0.01). The clinical success rate was also significantly lower in pediatric patients (64.9% vs. 80.4%, p = 0.014). The rate of adverse events was significantly higher in pediatric patients than in adults (14.2% vs. 7.7%, p = 0.037). However, if the anastomotic sites were reached in pediatric patients, the treatment was highly successful (97.3%). The time of reaching target site was significantly longer in pediatric patients than in adult patients. This study shows that BEA-ERC in pediatric patients is more difficult than that in adult patients. However, in patients where the balloon enteroscope was advanced to the anastomosis, clinical outcomes comparable to those in adults can be achieved. Full article
(This article belongs to the Special Issue Clinical Advances of Endoscopy in Pancreaticobiliary Disease)
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9 pages, 1291 KiB  
Article
Comparison of Histological Sample Volumes among Various Endoscopic Ultrasound-Guided Biopsy Needles
by Kosuke Takahashi, Ichiro Yasuda, Tatsuyuki Hanaoka, Yuka Hayashi, Iori Motoo, Shinya Kajiura, Takayuki Ando, Haruka Fujinami, Kazuto Tajiri, Johji Imura, Eisuke Ozawa, Satoshi Miuma, Hisamitsu Miyaaki and Kazuhiko Nakao
J. Clin. Med. 2021, 10(16), 3560; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10163560 - 13 Aug 2021
Cited by 10 | Viewed by 1600
Abstract
Endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) enables easy and accurate pathological assessment. Here, we compared and assessed the area of samples on glass slides for three needle types: a 19-gauge Franseen needle (Acquire, Boston Scientific, Natick, MA, USA), a 22-gauge Franseen needle, and a [...] Read more.
Endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) enables easy and accurate pathological assessment. Here, we compared and assessed the area of samples on glass slides for three needle types: a 19-gauge Franseen needle (Acquire, Boston Scientific, Natick, MA, USA), a 22-gauge Franseen needle, and a 19-gauge fine-needle aspiration (FNA) needle (EZ Shot 3 Plus; Olympus, Tokyo, Japan). Among patients with suspected pancreatic cancer, with a ≥20 mm tumor located in the pancreatic body and tail, and who underwent EUS-FNA or FNB between June 2018 and March 2020, 10 were randomly selected to test each needle. The areas of histological tissue and blood clot samples were measured using the BZ-X800 imaging software (Keyence Corporation, Osaka, Japan). Baseline patient characteristics and pathological sample data showed no significant differences among the needles. The 19-gauge Franseen needle obtained significantly more histological tissue samples than the 19-gauge conventional needle (p = 0.010) and 22-gauge Franseen needle (p = 0.008). Conversely, there was no significant difference between the 19-gauge conventional needle and 22-gauge Franseen needle (p = 0.838) in this regard. The 19-gauge Franseen needle could collect more samples than the other needles, contributing to giving a more precise pathological diagnosis and more information, including genomic profiling. Full article
(This article belongs to the Special Issue Clinical Advances of Endoscopy in Pancreaticobiliary Disease)
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11 pages, 9158 KiB  
Article
Usefulness of the Novel Snare-over-the-Guidewire Method for Transpapillary Plastic Stent Replacement (with Video)
by Akihiro Yoshida, Mamoru Takenaka, Kota Takashima, Hidekazu Tanaka, Ayana Okamoto, Tomohiro Yamazaki, Atsushi Nakai, Shunsuke Omoto, Kosuke Minaga, Ken Kamata, Kentaro Yamao, Yoriaki Komeda, Naoshi Nishida and Masatoshi Kudo
J. Clin. Med. 2021, 10(13), 2858; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10132858 - 28 Jun 2021
Cited by 4 | Viewed by 1657
Abstract
Unsuccessful stent replacement in transpapillary biliary drainage with plastic stents (PSs) has a significant impact on patient prognosis; thus, a safe and reliable replacement method is required. We aimed to compare the snare-over-the-guidewire (SOG) method, wherein the PS lumen is used as an [...] Read more.
Unsuccessful stent replacement in transpapillary biliary drainage with plastic stents (PSs) has a significant impact on patient prognosis; thus, a safe and reliable replacement method is required. We aimed to compare the snare-over-the-guidewire (SOG) method, wherein the PS lumen is used as an access route to the biliary tract and the PS is removed with a snare inserted via the inserted guidewire, with the conventional side-of-stent (SOS) method, wherein the biliary approach is performed from the side of the PS. This retrospective single-center study included 244 consecutive patients who underwent biliary PS replacement between January 2018 and July 2020. The procedural success rates were compared between the two methods. A predictive analysis of unsuccessful PS replacement was also performed. The procedural success rate in the SOG group was significantly higher than that in the SOS group (p = 0.026). In the proximal biliary stenosis lesion, the same trend was observed (p = 0.025). Multivariate analysis also showed that the SOS method (p = 0.0038), the presence of proximal biliary stenosis (p < 0.0001), and parapapillary diverticulum (p = 0.0007) were predictors of unsuccessful PS replacement. The SOG method may be useful for biliary PS replacement, especially in cases of proximal hilar bile duct stenosis. Full article
(This article belongs to the Special Issue Clinical Advances of Endoscopy in Pancreaticobiliary Disease)
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8 pages, 1184 KiB  
Article
Micro-RNA Analysis of Pancreatic Cyst Fluid for Diagnosing Malignant Transformation of Intraductal Papillary Mucinous Neoplasm by Comparing Intraductal Papillary Mucinous Adenoma and Carcinoma
by Yohei Shirakami, Takuji Iwashita, Shinya Uemura, Hisashi Imai, Katsutoshi Murase and Masahito Shimizu
J. Clin. Med. 2021, 10(11), 2249; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10112249 - 22 May 2021
Cited by 10 | Viewed by 2021
Abstract
Although intraductal papillary mucinous neoplasm (IPMN) is thought to be a precursor lesion of pancreatic cancer, diagnosing malignant transformation of IPMN using non-invasive diagnostic methods is difficult and complicated. Micro-RNAs (miRNAs) are currently recognized as biomarkers and molecular targets of various diseases, including [...] Read more.
Although intraductal papillary mucinous neoplasm (IPMN) is thought to be a precursor lesion of pancreatic cancer, diagnosing malignant transformation of IPMN using non-invasive diagnostic methods is difficult and complicated. Micro-RNAs (miRNAs) are currently recognized as biomarkers and molecular targets of various diseases, including malignancy. In this study, we investigated a potential diagnostic approach using miRNA in pancreatic cyst fluid as a marker for evaluating malignant alternation of IPMN. Cystic fluid was sampled mainly during surgical resection. The collected samples were evaluated by performing comprehensive analysis of miRNA using a highly sensitive DNA chip. miRNA expression was compared between IPM adenoma (IPMA) and IPM carcinoma (IPMC) to evaluate the related biomarkers for malignant transformation of IPMN. miRNA analysis revealed that six miRNAs (miR-711, miR-3679-5p, miR-6126, miR-6780b-5p, miR-6798-5p, and miR-6879-5p) in IPMC were significantly enriched compared to those in IPMA. The difference was validated using quantitative real-time PCR. Cyst fluid miRNA analysis might be useful for diagnosing malignant alteration of IPMN. Further evaluations of diagnostic capability as well as functional analysis using the identified miRNAs are required with larger cohorts to confirm its efficacy. Full article
(This article belongs to the Special Issue Clinical Advances of Endoscopy in Pancreaticobiliary Disease)
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12 pages, 1958 KiB  
Article
Should Contrast-Enhanced Harmonic Endoscopic Ultrasound Be Incorporated into the International Consensus Guidelines to Determine the Appropriate Treatment of Intraductal Papillary Mucinous Neoplasm?
by Tomohiro Yamazaki, Mamoru Takenaka, Shunsuke Omoto, Tomoe Yoshikawa, Rei Ishikawa, Ayana Okamoto, Atsushi Nakai, Kosuke Minaga, Ken Kamata, Kentaro Yamao, Yoriaki Komeda, Tomohiro Watanabe, Naoshi Nishida, Keiko Kamei, Ippei Matsumoto, Yoshifumi Takeyama, Takaaki Chikugo, Yasutaka Chiba and Masatoshi Kudo
J. Clin. Med. 2021, 10(9), 1818; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10091818 - 22 Apr 2021
Cited by 1 | Viewed by 1676
Abstract
This study aimed to investigate whether the incorporation of contrast-enhanced harmonic endoscopic ultrasound (CH-EUS) into the international consensus guidelines (ICG) for the management of intraductal papillary mucinous neoplasm (IPMN) could improve its malignancy diagnostic value. In this single-center retrospective study, 109 patients diagnosed [...] Read more.
This study aimed to investigate whether the incorporation of contrast-enhanced harmonic endoscopic ultrasound (CH-EUS) into the international consensus guidelines (ICG) for the management of intraductal papillary mucinous neoplasm (IPMN) could improve its malignancy diagnostic value. In this single-center retrospective study, 109 patients diagnosed with IPMN who underwent preoperative CH-EUS between March 2010 and December 2018 were enrolled. We analyzed each malignancy diagnostic value (sensitivity (Se), specificity (Sp), positive predictive value (PPV), and negative predictive value (NPV)) by replacing fundamental B-mode EUS with CH-EUS as the recommended test for patients with worrisome features (WF) (the CH-EUS incorporation ICG) and comparing the results to those obtained using the 2017 ICG. The malignancy diagnostic values as per the 2017 ICG were 78.9%, 42.3%, 60.0%, and 64.7% for Se, Sp, PPV, and NPV, respectively. The CH-EUS incorporation ICG plan improved the malignancy diagnostic values (Se 78.9%/Sp, 53.8%/PPV, 65.2%/NPV 70.0%). CH-EUS may be useful in determining the appropriate treatment strategies for IPMN. Full article
(This article belongs to the Special Issue Clinical Advances of Endoscopy in Pancreaticobiliary Disease)
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12 pages, 492 KiB  
Article
Clinical Outcomes of Digital Cholangioscopy-Guided Procedures for the Diagnosis of Biliary Strictures and Treatment of Difficult Bile Duct Stones: A Single-Center Large Cohort Study
by Hirohito Minami, Shuntaro Mukai, Atsushi Sofuni, Takayoshi Tsuchiya, Kentaro Ishii, Reina Tanaka, Ryosuke Tonozuka, Mitsuyoshi Honjo, Kenjiro Yamamoto, Kazumasa Nagai, Yukitoshi Matsunami, Yasutsugu Asai, Takashi Kurosawa, Hiroyuki Kojima, Toshihiro Homma and Takao Itoi
J. Clin. Med. 2021, 10(8), 1638; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10081638 - 12 Apr 2021
Cited by 11 | Viewed by 2040
Abstract
Although Spy DS (SpyGlass DS Direct Visualization System) is considered to be useful for the diagnosis of bile duct strictures and the treatment of bile duct stones, there is limited data to date validating its efficacy. We hence retrospectively evaluated the clinical outcomes [...] Read more.
Although Spy DS (SpyGlass DS Direct Visualization System) is considered to be useful for the diagnosis of bile duct strictures and the treatment of bile duct stones, there is limited data to date validating its efficacy. We hence retrospectively evaluated the clinical outcomes of the use of Spy DS in a large number of patients. A total of 183 patients who underwent Spy DS-guided procedures for indeterminate bile duct strictures (n = 93) and bile duct stones (n = 90) were analyzed retrospectively. All patients (93/93) with bile duct strictures successfully underwent visual observation, and 95.7% (89/93) of these patients successfully underwent direct biopsy. The sensitivity, specificity, and overall accuracy were 94.7%, 83.3%, and 90.3%, respectively, for visual impression; 80.9%, 100%, and 89.2%, respectively, for histopathological analysis of a direct biopsy; and 96.5%, 91.7%, and 94.6%, respectively, for visual impression combined with biopsy. Successful visualization of the stones was achieved in 98.9% (89/90) of the patients, and complete stone removal was achieved in 92.2% (83/90) of the patients, with an average of 3.3 procedures. The adverse events rate was 17.5% (32/183; cholangitis in 15 patients, fever the following day in 25, pancreatitis in 1, hemorrhage in 1, and gastrointestinal perforation in 1). No administration of antibiotics before the procedure was found to be a statistically significant risk factor for the development of fever after the procedure (p < 0.01). Spy DS-guided procedures are effective for the diagnosis and treatment of bile duct lesions and can be performed with a low risk of serious adverse events. Full article
(This article belongs to the Special Issue Clinical Advances of Endoscopy in Pancreaticobiliary Disease)
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11 pages, 247 KiB  
Article
Factors Affecting Technical Difficulty in Balloon Enteroscopy-Assisted Endoscopic Retrograde Cholangiopancreatography in Patients with Surgically Altered Anatomy
by Naoya Izawa, Kohei Tsuchida, Keiichi Tominaga, Koh Fukushi, Fumi Sakuma, Ken Kashima, Yasuhito Kunogi, Mimari Kanazawa, Takanao Tanaka, Kazunori Nagashima, Takahito Minaguchi, Mari Iwasaki, Akira Yamamiya, Hidehito Jinnai, Akane Yamabe, Koki Hoshi, Takeshi Sugaya, Makoto Iijima, Kenichi Goda and Atsushi Irisawa
J. Clin. Med. 2021, 10(5), 1100; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10051100 - 06 Mar 2021
Cited by 3 | Viewed by 1515
Abstract
Success rates of balloon enteroscopy-assisted endoscopic retrograde cholangiopancreatography (BE-ERCP) for patients with a reconstructed intestinal tract after surgical procedures are unsatisfactory. We retrospectively investigated the factors associated with unsuccessful BE-ERCP. Ninety-one patients who had a reconstructed intestinal tract after gastrectomy or choledochojejunostomy were [...] Read more.
Success rates of balloon enteroscopy-assisted endoscopic retrograde cholangiopancreatography (BE-ERCP) for patients with a reconstructed intestinal tract after surgical procedures are unsatisfactory. We retrospectively investigated the factors associated with unsuccessful BE-ERCP. Ninety-one patients who had a reconstructed intestinal tract after gastrectomy or choledochojejunostomy were enrolled. Age, sex, operative method, malignancy, endoscope type, endoscopist’s skill, emergency procedure, and time required to reach the papilla/anastomosis were examined. The primary endpoints were the factors associated with unsuccessful BE-ERCP selective cannulation, while the secondary endpoints were the rate of reaching the papilla/anastomosis, causes of failure to reach the papilla/anastomosis, cannulation success rate, procedure success rate, and rate of adverse events. Younger age (odds ratio, 0.832; 95% CI, 0.706–0.982; p = 0.001) and Roux-en-Y partial gastrectomy (odds ratio, 54.9; 95% CI, 1.09–2763; p = 0.045) were associated with unsuccessful BE- ERCP. The rate of reaching the papilla/anastomosis was 92.3%, the success rate of biliary duct cannulation was 90.5%, procedure success rate was 78.0%, and the rate of adverse events was 5.6%. In conclusion, Roux-en-Y partial gastrectomy and younger age were associated with unsuccessful BE-ERCP. If BE-ERCP is extremely difficult to perform in such patients after Roux-en-Y partial gastrectomy, alternative procedures should be considered early. Full article
(This article belongs to the Special Issue Clinical Advances of Endoscopy in Pancreaticobiliary Disease)

Review

Jump to: Research

12 pages, 2426 KiB  
Review
Recent Advances in Endosonography—Elastography: Literature Review
by Akira Yamamiya, Atsushi Irisawa, Koki Hoshi, Akane Yamabe, Naoya Izawa, Kazunori Nagashima, Takahito Minaguchi, Masamichi Yamaura, Yoshitsugu Yoshida, Ken Kashima, Yasuhito Kunogi, Fumi Sakuma, Keiichi Tominaga, Makoto Iijima and Kenichi Goda
J. Clin. Med. 2021, 10(16), 3739; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10163739 - 23 Aug 2021
Cited by 13 | Viewed by 2997
Abstract
Ultrasonographic elastography is a modality used to visualize the elastic properties of tissues. Technological advances in ultrasound equipment have supported the evaluation of elastography (EG) in endosonography (EUS). Currently, the usefulness of not only EUS-strain elastography (EUS-SE) but also EUS-shear wave elastography (EUS-SWE) [...] Read more.
Ultrasonographic elastography is a modality used to visualize the elastic properties of tissues. Technological advances in ultrasound equipment have supported the evaluation of elastography (EG) in endosonography (EUS). Currently, the usefulness of not only EUS-strain elastography (EUS-SE) but also EUS-shear wave elastography (EUS-SWE) has been reported. We reviewed the literature on the usefulness of EUS-EG for various diseases such as chronic pancreatitis, pancreatic solid lesion, autoimmune pancreatitis, lymph node, and gastrointestinal and subepithelial lesions. The importance of this new diagnostic parameter, “tissue elasticity” in clinical practice might be applied not only to the diagnosis of liver fibrosis but also to the elucidation of the pathogeneses of various gastrointestinal diseases, including pancreatic diseases, and to the evaluation of therapeutic effects. The most important feature of EUS-EG is that it is a non-invasive modality. This is an advantage not found in EUS-guided fine needle aspiration (EUS-FNA), which has made remarkable progress in the field of diagnostics in recent years. Further development of artificial intelligence (AI) is expected to improve the diagnostic performance of EUS-EG. Future research on EUS-EG is anticipated. Full article
(This article belongs to the Special Issue Clinical Advances of Endoscopy in Pancreaticobiliary Disease)
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18 pages, 14472 KiB  
Review
Diagnostic and Interventional Role of Endoscopic Ultrasonography for the Management of Pancreatic Neuroendocrine Neoplasms
by Giuseppinella Melita, Socrate Pallio, Andrea Tortora, Stefano Francesco Crinò, Antonio Macrì and Gianlorenzo Dionigi
J. Clin. Med. 2021, 10(12), 2638; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10122638 - 15 Jun 2021
Cited by 23 | Viewed by 3409
Abstract
Pancreatic neuroendocrine neoplasms (PanNENs) are relatively rare, but their incidence has increased significantly in the last decades. Precise diagnosis and prognostic stratification are crucial for proper patient management. Endoscopic ultrasound (EUS) is the modality of choice for diagnosis of solid pancreatic tumors, showing [...] Read more.
Pancreatic neuroendocrine neoplasms (PanNENs) are relatively rare, but their incidence has increased significantly in the last decades. Precise diagnosis and prognostic stratification are crucial for proper patient management. Endoscopic ultrasound (EUS) is the modality of choice for diagnosis of solid pancreatic tumors, showing a higher tumor detection rate than other imaging modalities, especially for small size lesions. EUS also serves as a guide for preoperative sampling and other interventions. EUS-tissue acquisition is a safe and highly accurate technique for cyto/histological diagnosis of PanNENs with a well-demonstrated correlation between Ki-67 proliferation index values and tumor grading on EUS and surgical specimens according to the WHO 2017 classification. Furthermore, the possibility of a preoperative EUS-guided fine needle tattooing or fiducial markers placement may help the surgeon to locate small and deep tumors, thus avoiding formal pancreatic resections in favor of parenchymal-sparing surgery. Finally, locoregional ablative treatments using either ethanol injection or radiofrequency ablation have been proposed in recent studies with promising results in order to control symptoms or reduce tumor burden in selected patients unfit for surgery with functioning or non-functioning PanNENs. This article review highlights the current role of EUS in PanNENs management, focusing on the present and future applications of EUS-guided interventions. Full article
(This article belongs to the Special Issue Clinical Advances of Endoscopy in Pancreaticobiliary Disease)
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14 pages, 7004 KiB  
Review
Diagnosis of Pancreatic Solid Lesions, Subepithelial Lesions, and Lymph Nodes Using Endoscopic Ultrasound
by Akashi Fujita, Shomei Ryozawa, Masafumi Mizuide, Yuki Tanisaka, Tomoya Ogawa, Masahiro Suzuki, Hiromune Katsuda, Yoichi Saito, Tomoaki Tashima, Kazuya Miyaguchi, Eiichi Arai, Tomonori Kawasaki and Yumi Mashimo
J. Clin. Med. 2021, 10(5), 1076; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10051076 - 05 Mar 2021
Cited by 2 | Viewed by 2591
Abstract
Currently, endoscopic ultrasound (EUS) has become widely accepted and has considerable advantages over computed tomography (CT) and other imaging modalities, given that it enables echostructure assessment in lesions with <1 cm diameter and permits high resolution imaging. EUS-guided tissue acquisition (EUS-TA) provides consistent [...] Read more.
Currently, endoscopic ultrasound (EUS) has become widely accepted and has considerable advantages over computed tomography (CT) and other imaging modalities, given that it enables echostructure assessment in lesions with <1 cm diameter and permits high resolution imaging. EUS-guided tissue acquisition (EUS-TA) provides consistent results under ultrasound guidance and has been considered more effective compared to CT- or ultrasound-guided lesion biopsy. Moreover, complication rates, including pancreatitis and bleeding, have been extremely low, with <1% morbidity and mortality rates, thereby suggesting the exceptional overall safety of EUS-TA. The aggressive use of EUS for various lesions has been key in facilitating early diagnosis and therapy. This review summarizes the diagnostic ability of EUS for pancreatic solid lesions, subepithelial lesions, and lymph nodes where it is mainly used. EUS has played an important role in diagnosing these lesions and planning treatment strategies. Future developments in EUS imaging technology, such as producing images close to histopathological findings, are expected to further improve its diagnostic ability. Moreover, tissue acquisition via EUS is expected to be used for precision medicine, which facilitates the selection of an appropriate therapeutic agent by increasing the amount of tissue collected and improving genetic analysis. Full article
(This article belongs to the Special Issue Clinical Advances of Endoscopy in Pancreaticobiliary Disease)
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15 pages, 2302 KiB  
Review
Diagnostic Process Using Endoscopy for Biliary Strictures: A Narrative Review
by Yuki Tanisaka, Masafumi Mizuide, Akashi Fujita, Tomoya Ogawa, Masahiro Suzuki, Hiromune Katsuda, Youichi Saito, Kazuya Miyaguchi, Tomoaki Tashima, Yumi Mashimo and Shomei Ryozawa
J. Clin. Med. 2021, 10(5), 1048; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10051048 - 03 Mar 2021
Cited by 14 | Viewed by 2735
Abstract
The diagnostic process for biliary strictures remains challenging in some cases. A broad differential diagnosis exists for indeterminate biliary strictures, including benign or malignant lesions. The diagnosis of indeterminate biliary strictures requires a combination of physical examination, laboratory testing, imaging modalities, and endoscopic [...] Read more.
The diagnostic process for biliary strictures remains challenging in some cases. A broad differential diagnosis exists for indeterminate biliary strictures, including benign or malignant lesions. The diagnosis of indeterminate biliary strictures requires a combination of physical examination, laboratory testing, imaging modalities, and endoscopic procedures. Despite the progress of less invasive imaging modalities such as transabdominal ultrasonography, computed tomography, and magnetic resonance imaging, endoscopy plays an essential role in the accurate diagnosis, including the histological diagnosis. Imaging findings and brush cytology and/or forceps biopsy under fluoroscopic guidance with endoscopic retrograde cholangiopancreatography (ERCP) are widely used as the gold standard for the diagnosis of biliary strictures. However, ERCP cannot provide an intraluminal view of the biliary lesion, and its outcomes are not satisfactory. Recently, peroral cholangioscopy, confocal laser endomicroscopy, endoscopic ultrasound (EUS), and EUS-guided fine-needle aspiration have been reported as useful for indeterminate biliary strictures. Appropriate endoscopic modalities need to be selected according to the patient’s condition, the lesion, and the expertise of the endoscopist. The aim of this review article is to discuss the diagnostic process for indeterminate biliary strictures using endoscopy. Full article
(This article belongs to the Special Issue Clinical Advances of Endoscopy in Pancreaticobiliary Disease)
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