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   Table of Contents - Current issue
Coverpage
January-February 2019
Volume 8 | Issue 1
Page Nos. 1-71

Online since Thursday, February 14, 2019

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EDITORIAL  

Robotic ultrasound and ultrasonic robot p. 1
Jintao Guo, Hongyi Li, Yunliang Chen, Peng Chen, Xiang Li, Siyu Sun
DOI:10.4103/eus.eus_69_18  
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REVIEW ARTICLES Top

What should be known prior to performing EUS? p. 3
Christoph F Dietrich, Paolo Giorgio Arcidiacono, Barbara Braden, Sean Burmeister, Silvia Carrara, Xinwu Cui, Milena Di Leo, Yi Dong, Pietro Fusaroli, Odd Helge Gilja, Andrew J Healey, Michael Hocke, Stephan Hollerbach, Julio Iglesias Garcia, André Ignee, Christian Jürgensen, Michel Kahaleh, Masayuki Kitano, Rastislav Kunda, Alberto Larghi, Kathleen Möller, Bertrand Napoleon, Kofi W Oppong, Maria Chiara Petrone, Adrian Saftoiu, Rajesh Puri, Anand V Sahai, Erwin Santo, Malay Sharma, Assaad Soweid, Siyu Sun, Anthony Yuen Bun Teoh, Peter Vilmann, Christian Jenssen
DOI:10.4103/eus.eus_54_18  
Direct referral of patients for EUS – instead of preprocedural consultation with the endosonographer – has become standard practice (like for other endoscopic procedures) as it is time- and cost-effective. To ensure appropriate indications and safe examinations, the endosonographer should carefully consider what information is needed before accepting the referral. This includes important clinical data regarding relevant comorbidities, the fitness of the patient to consent and undergo the procedure, and the anticoagulation status. In addition, relevant findings from other imaging methods to clarify the clinical question may be necessary. Appropriate knowledge and management of the patients' anticoagulation and antiplatelet therapy, antibiotic prophylaxis, and sedation issues can avoid unnecessary delays and unsafe procedures. Insisting on optimal preparation, appropriate indications, and clear clinical referral questions will increase the quality of the outcomes of EUS. In this paper, important practical issues regarding EUS preparations are raised and discussed from different points of view.
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Psychological impact of pancreatic cancer screening by EUS or magnetic resonance imaging in high-risk individuals: A systematic review p. 17
Irina Mihaela Cazacu, Adriana Alexandra Luzuriaga Chavez, Adrian Saftoiu, Manoop S Bhutani
DOI:10.4103/eus.eus_25_18  PMID:30246710
Background and Objectives: There is an increasing global interest in screening programs aiming to detect pancreatic cancer (PC) in an early and potentially curable stage. Concerns still remain as to whether screening would confer any survival benefit. Another approach to evaluate the benefits of the pancreatic screening programs would be to consider its impact on the quality of life of the individuals who at risk of developing cancer. The aim of this systematic review was to investigate the current knowledge regarding the psychological impact of participation in routine screening for PC. Methods: A systematic literature search was carried out in January 2018 in three major databases which are as follows: PubMed, Scopus, and Web of Science. Cross-sectional and prospective studies evaluating the psychological aspects of screening in high-risk individuals were included in the study. For each study, the following data were recorded: name of first author, year of publication, study design, study population, aims, screening protocol, outcomes and instruments, main results, and summary of findings. Results: Six cohort studies and one cross-sectional study that addressed the psychological aspects of PC screening were included in the analysis. Overall, studies have shown that high-risk individuals have positive psychological outcomes from participating in PC screening programs. Conclusions: Although screening might not always be reassuring, it may improve individuals' quality of life, and this should be an important aspect when considering PC screening.
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ORIGINAL ARTICLES Top

Use of simulator for EUS training in the diagnosis of pancreatobiliary diseases p. 25
Jie Gao, Jun Fang, Zhendong Jin, Dong Wang, Zhaoshen Li
DOI:10.4103/2303-9027.252232  
Background and Objectives: EUS has been widely used in the diagnosis of pancreatobiliary diseases. However, improvements in the conventional training pattern of EUS are needed urgently. In this study, we compared the results achieved after use of clinical practice training patterns combined with or without simulator training and evaluated the effectiveness of simulator use in EUS training. Subjects and Methods: The trainees were randomly divided into two groups: the experimental group was trained with both clinical practice and simulator training system and the control group was only trained through clinical practice. After 1 month of training, trainees of both groups were tested with an established technical evaluation procedure that aimed to assess trainees' ability to examine the normal anatomical structure. Then, trainees in the experimental group completed a questionnaire. Results: The mean test score of the experimental group (64.53 ± 4.91) was significantly greater than that of the control group (60.09 ± 5.49; P= 0.028). Moreover, the individual test score of trainees in the experimental group was positively correlated with the frequency of simulator use (P = 0.242). Conclusion: Simulator training can promote trainees' ability to evaluate the normal anatomical structure, and thus, can improve the efficiency of the EUS training program.
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A novel, stepwise approach combining conventional and endobronchial ultrasound needle aspiration for mediastinal lymph node sampling p. 31
Levy Liran, Kuint Rottem, Fridlender Zvi Gregorio, Abutbul Avi, Berkman Neville
DOI:10.4103/eus.eus_29_17  PMID:28879863
Background and Objectives: Since the introduction of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), most pulmonary centers use this technique exclusively for mediastinal lymph node (LN) sampling. Conventional “blind” TBNA (cTBNA), however, is cheaper, more accessible, provides more tissue, and requires less training. We evaluated whether sampling of mediastinal LN using EBUS-TBNA or cTBNA according to a predefined set of criteria provides acceptable diagnostic yield. Materials and Methods: Sampling method was determined prospectively according to a predefined set of criteria based on LN station, LN size, and presumed diagnosis. Sensitivity, specificity, positive, and negative predictive value were evaluated for each modality. Results: One hundred and eighty-six biopsies were carried out over a 3-year period (86 cTBNA, 100 EBUS-TBNA). Seventy-seven percent of LN biopsied by EBUS-TBNA were <20 mm, while 83% of cTBNA biopsies were ≥20 mm. Most common sites of cTBNA sampling were station 7, 4R, and 11R as opposed to 7, 11R, 4R, and 4 L in the case of EBUS-TBNA. Most common EBUS-TBNA diagnosis was malignancy versus sarcoidosis in cTBNA. EBUS-TBNA and cTBNA both had a true positive yield of 65%, but EBUS-TBNA had a higher true negative rate (21% vs. 2% for cTBNA) and a lower false negative rate (7% vs. 28%). Sensitivity, specificity, positive predictive value, and negative predictive value for EBUS-TBNA were 90%, 100%, 100%, and 75%, respectively, and for cTBNA were 68%, 100%, 100%, and 7%, respectively. Conclusion: A stepwise approach based on LN size, station, and presumed diagnosis may be a reasonable, cost-effective approach in choosing between cTBNA and EBUS-TBNA.
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Placement of lumen-apposing metal stents to drain pseudocysts and walled-off pancreatic necrosis can be safely performed on an outpatient basis: A multicenter study Highly accessed article p. 36
Douglas G Adler, Janak Shah, Jose Nieto, Kenneth Binmoeller, Yasser Bhat, Linda Jo Taylor, Ali A Siddiqui
DOI:10.4103/eus.eus_30_17  PMID:29770780
Backgrounds and Objectives: No study on the use of lumen-apposing fully covered self-expanding metal stent(LAMS) to drain pancreatic fluid collections(PFCs) has evaluated outcomes of patients in the outpatient setting. The objective of this multicenter study was to evaluate the clinical outcomes, success rate, and adverse events of the LAMS for endoscopic ultrasound(EUS)-guided transmural drainage of patients with symptomatic PFCs on an inpatient versus an outpatient basis. Methods: This was a multicenter, retrospective study conducted at 4 tertiary care centers. Results: We identified eighty patients with PFCs in whom EUS-guided transmural drainage using the LAMS was performed. The mean age of the patients was 53.1 years old. Mean size of the PFC was 11.8±5.1cm. Atotal of 33patients had PFCs drained in an outpatient setting while 47patients underwent PFC drainage as inpatients. The overall technical success(ability to access and drain a PFC by placement of transmural stents) was 98.7%(79patients). There was no statistically significant difference in the technical success rate between the inpatient and outpatient groups(100% vs. 98%, respectively, P =1). There was no significant difference in resolution of PFCs in the inpatient and outpatient groups(91% vs. 87% respectively; P =1). The number of procedures required for PFC resolution was significantly lower in the inpatient group as compared to the outpatients (2.3vs. 3.1 respectively, P =0.025). Procedure-related adverse events were significantly lower in the inpatient group compared to the outpatient group(P<0.01). There was no significant difference in the 2 groups in terms of development of adverse events requiring endoscopic reintervention within 30days of initial stent placement(P=0.69). Conclusion: This study shows that LAMS placement for PFCs can be performed safely on an outpatient basis with overall technical and clinical outcomes that are comparable to those seen in inpatients.
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Characterization of subepithelial lesions of the stomach and esophagus by contrast-enhanced EUS: A retrospective study p. 43
Christian Pesenti, Erwan Bories, Fabrice Caillol, Jean Philippe Ratone, Sebastien Godat, Genevieve Monges, Flora Poizat, Jean Luc Raoul, Pauline Ries, Marc Giovannini
DOI:10.4103/eus.eus_89_17  PMID:30264741
Background and Objectives: Subepithelial lesions (SELs) of the upper part of the digestive tract are rare, and it can be difficult to characterize them. Recently, contrast-enhanced endosonography (EUS) and elastometry have been reported as useful adjuncts to EUS and EUS-guided fine needle aspiration (EUS-FNA) in cases of pancreatic mass and lymph node involvement. The aim of this retrospective analysis was to evaluate whether contrast-enhanced EUS can discriminate benign submucosal lesions from malignant ones. We describe our retrospective experience using the contrast agent SonoVue® (Bracco Imaging, Milan, Italy) in an attempt to increase the diagnostic yield. Patients and Methods: Between May 2011 and September 2014, 14 patients (5 men, 9 women; median age 64 years, range 31–80 years) with SELs of the stomach or esophagus underwent EUS with SonoVue® (low mechanical index). There were 3 esophageal lesions and 11 gastric lesions. Mean size of the lesions was 30 mm (range 11–50 mm). They were discovered after anemia (n = 5), dysphagia (n = 1), and pain (n = 4) and during follow-up for resected gastrointestinal stromal tumors (GISTs) (n = 1) and a standard upper gastrointestinal endoscopy (n = 3). On endoscopic sonograms, 10 of these lesions were hypoechoic and located in the fourth layer (muscularis), and 4 were in the second or third layer (mucosa and submucosa). Contrast enhancement was assessed in the early phase (after several seconds) and late phase (>30 seconds); a final diagnosis was made based on the findings of EUS-FNA using a 19-gauge ProCore (Cook Medical, Bloomington, IN) (n = 9) or 22-gauge FNA system (Cook Medical) (n = 1), the resected specimen (n = 3), or deep biopsy (n = 1). Different immunostaining was used in the pathologic studies (RNA was analyzed later using the C-kit, CD-117, CD-34, desmin, DOG-1, α-smooth actin, caldesmon, PS-100, and Ki-67 antibodies). Results: Final diagnoses were leiomyoma (n = 4), GIST (n = 5), schwannoma (n = 1), inflammatory tumor of Helvig (n = 1), pancreas rest (n = 2), and fibrosis (n = 1). No complications occurred. All 5 GISTs showed enhancement in the early and late phases, whereas the 8 remaining lesions did not show any enhancement. Only 1 leiomyoma showed heterogeneous enhancement. Limitations: The monocentric and retrospective study design and small number of patients. Conclusions: In cases of SELs of the stomach or esophagus, SonoVue® could be a complementary tool to endosonography to differentiate GISTs (early and clear enhancement) from other SELs (few or no enhancement), such as leiomyomas or pancreatic rest. These results are similar to those of the few, small studies published on this topic, but more studies with a larger number of patients are needed to confirm these findings.
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A retrospective histological comparison of EUS-guided fine-needle biopsy using a novel franseen needle and a conventional end-cut type needle Highly accessed article p. 50
Shuntaro Mukai, Takao Itoi, Hiroshi Yamaguchi, Atsushi Sofuni, Takayoshi Tsuchiya, Reina Tanaka, Ryosuke Tonozuka, Mitsuyoshi Honjo, Mitsuru Fujita, Kenjiro Yamamoto, Yukitoshi Matsunami, Yasutsugu Asai, Takashi Kurosawa, Yuichi Nagakawa
DOI:10.4103/eus.eus_11_18  PMID:29786033
Background and Objectives: Recently, a 22G Franseen needle for EUS-guided fine-needle biopsy (EUS-FNB) with three novel symmetric heels has been developed to adequately obtain a core tissue. Methods: All 38 consecutive patients with pancreatic masses who underwent EUS-FNB using a Franseen needle were investigated retrospectively to assess the efficacy and safety of EUS-FNB using the Franseen needle. Then, the EUS-FNB outcomes and histological assessments of the tissue obtained by EUS-FNB using the Franseen needle and EUS-FNA using the conventional end-cut type needle for each of the 30 pancreatic ductal adenocarcinoma cases were compared. Results: An accurate histological diagnosis of the Franseen needle was achieved with a mean of 2 passes in 97.4% of patients. Although the accurate histological diagnosis rate of pancreatic ductal adenocarcinoma was not significantly different (96.7% vs. 93.3%, P = 0.55), the mean number of passes in the Franseen needle was significantly less than that in the conventional needle (2.1 ± 0.4 vs. 3.2 ± 0.8, P < 0.001). The presence of desmoplastic fibrosis with neoplastic cellular elements and venous invasion were significantly higher (96.7% vs. 40.0%, P < 0.001 and 23.3% vs. 0%, P < 0.01, respectively) and the amount of obtained tissue was significantly larger with the Franseen needle (2.13 mm2 vs. 0.45 mm2, P < 0.001). Conclusions: EUS-FNB using the Franseen needle enables the acquisition of a larger amount of tissue sample and achieves an accurate histological diagnosis with a smaller number of passes than the conventional end-cut type needle.
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IMAGES AND VIDEOS Top

EUS-guided n-butyl-2-cyanoacrylate injection therapy for ruptured isolated left gastric artery pseudoaneurysm Highly accessed article p. 58
Yusuke Hashimoto, Izumi Ohno, Hideaki Takahashi, Mitsuhito Sasaki, Hiroshi Imaoka, Kazuo Watanabe, Kumiko Umemoto, Gen Kimura, Shuichi Mitsunaga, Masafumi Ikeda
DOI:10.4103/eus.eus_109_17  PMID:29536953
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SpyGlass findings of mucinous cystic neoplasm by introducing the fiber-optic into the cyst through a 19-gauge needle during endoscopic ultrasound p. 60
Wengang Zhang, Enqiang Linghu
DOI:10.4103/eus.eus_24_17  PMID:28836517
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Stent removal using novel balloon catheter after rupture of stent for EUS-guided pancreatic duct drainage Highly accessed article p. 63
Takeshi Ogura, Atsushi Okuda, Nobu Nishioka, Rieko Kamiyama, Kazuhide Higuchi
DOI:10.4103/eus.eus_10_18  PMID:29798940
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Hepaticogastrostomy under EUS guidance for a patient with a history of bypass surgery with a new stent design (with video) p. 66
Omar Coro, Fabrice Caillol, Laurent Poincloux, Erwan Bories, Christian Pesenti, Jean Philippe Ratone, Marc Giovannini
DOI:10.4103/eus.eus_15_18  PMID:30168478
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LETTER TO EDITOR Top

Vascular endothelial growth factor receptor 2-targeted ultrasound contrast agent selectively accumulates in pancreatic carcinoma in the allograft mouse model: A pilot study using time-intensity curve analysis of EUS imaging p. 69
Nana Shimamoto, Hiroo Imazu, Sadamu Homma, Kazuki Sumiyama
DOI:10.4103/eus.eus_43_18  
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