Research

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10 pages, 246 KiB

Open AccessArticle

Endoscopic Ultrasound-Guided Fine-Needle Biopsy Using 22G Franseen Needles without Rapid On-Site Evaluation for Diagnosis of Intraabdominal Masses

by Nonthalee Pausawasdi, Kunsuda Cheirsilpa, Wipapat Chalermwai, Ishan Asokan, Tassanee Sriprayoon and Phunchai Charatcharoenwitthaya

J. Clin. Med. 2022, 11(4), 1051; https://doi.org/10.3390/jcm11041051 - 17 Feb 2022

Cited by 5 | Viewed by 1628

Abstract

Background: The impact of rapid on-site cytologic evaluation (ROSE) on endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) is widely debated. This study aims to assess the diagnostic performance of EUS-FNB in the absence of ROSE in abdominal masses. Methods: Patients with abdominal masses undergoing EUS-FNB [...] Read more.

Background: The impact of rapid on-site cytologic evaluation (ROSE) on endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) is widely debated. This study aims to assess the diagnostic performance of EUS-FNB in the absence of ROSE in abdominal masses. Methods: Patients with abdominal masses undergoing EUS-FNB using 22-gauge Franseen needles and the slow-pull technique were prospectively enrolled in this study. Macroscopic on-site evaluation (MOSE) was performed without ROSE. Results: 100 patients were recruited between 2018 and 2020. Seventy-eight patients had neoplasms, and twenty-two patients had benign diseases. Common diagnoses included pancreatic cancer (n = 27), mesenchymal tumors (n = 17), and metastatic tumors (n = 14). The mean mass size was 3.9 ± 2.6 cm. The median pass number was three. Eighty-nine percent had adequate specimens for histologic evaluation. Malignancy increased the odds of obtaining adequate tissue (OR 5.53, 95% CI, 1.36–22.5). For pancreatic cancer, FNB had a sensitivity of 92.3%, a specificity of 100%, a positive predictive value (PPV) of 100%, a negative predictive value (NPV) of 97%, and an AUROC of 0.96. The sensitivity, specificity, PPV, NPV, and AUROC for mesenchymal cell tumors were 100%, 95.9%, 84.2%, 100%, and 0.98, respectively. For metastatic tumors, FNB was 100% sensitive and specific, with an AUROC of 1.00. There were no procedure-related complications. Conclusions: 22-gauge Franseen needles with the slow-pull technique and MOSE without ROSE provide excellent diagnostic performances for malignant lesions. Thus, MOSE should be implemented in real-world practice, and ROSE can be obviated when EUS-FNB is employed. Full article

(This article belongs to the Special Issue Recent Advances and Future Trends in Digestive Endoscopy)

12 pages, 1354 KiB

Open AccessArticle

Bleeding Risk Factors after Endoscopic Submucosal Dissection in Early Gastric Cancer and the Necessity of “Second-Look” Endoscopic Examination on the following Day

by Rika Kobayashi, Ken Kawaura, Tohru Ito, Sadafumi Azukisawa, Hiroaki Kunou, Junji Kamai, Kazu Hamada, Tsuyoshi Mukai, Hidekazu Kitakata and Yasuhito Ishigaki

J. Clin. Med. 2022, 11(4), 914; https://doi.org/10.3390/jcm11040914 - 09 Feb 2022

Cited by 2 | Viewed by 1854

Abstract

Background and Aim: Hemorrhage is often encountered after endoscopic submucosal dissection (ESD). In addition to active bleeding after resection, exposed blood vessels and blood clots without active bleeding on the post-dissection ulcer floor have been recognized within our department. We consider exposed and/or [...] Read more.

Background and Aim: Hemorrhage is often encountered after endoscopic submucosal dissection (ESD). In addition to active bleeding after resection, exposed blood vessels and blood clots without active bleeding on the post-dissection ulcer floor have been recognized within our department. We consider exposed and/or observable vessel findings and clots on the ulcer floor after re-section as important risk factors for hemorrhage. Here, we compared and examined the active bleeding frequency and “post-resection ulcer at risk of bleeding” on the day following ESD, in relation to their risk factors. Method: We retrospectively examined 447 patients who underwent second-look endoscopy in our department between August 2008 and March 2018. Logistic regression analyses were performed to determine the hazard ratio and 95% confidence interval. We compared the association of each factor mentioned above with active bleeding on the day after ESD and the presence of ulcers at risk of bleeding after resection. Results: Our retrospective analysis revealed that the risk factors were larger ulcer sizes and the administration of antithrombotic drugs. Additionally, the risk was low for upper body lesions but high for antral lesions. Conclusion: Our results may help determine whether second-look endoscopy should be performed to minimize active bleeding after ESD, reduce postoperative complications, and improve medical safety. Full article

(This article belongs to the Special Issue Recent Advances and Future Trends in Digestive Endoscopy)

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10 pages, 1020 KiB

Open AccessArticle

Peroral Cholangioscopy-Guided Targeted Biopsy versus Conventional Endoscopic Transpapillary Forceps Biopsy for Biliary Stricture with Suspected Bile Duct Cancer

by Katsunori Sekine, Ichiro Yasuda, Shinpei Doi, Noriyuki Kuniyoshi, Takayuki Tsujikawa, Yuichi Takano, Masatoshi Mabuchi, Kosuke Takahashi, Masashi Kawamoto, Mikiko Takahashi, Tatsuya Aso, Tatsuhiko Miyazaki and Takuji Iwashita

J. Clin. Med. 2022, 11(2), 289; https://doi.org/10.3390/jcm11020289 - 06 Jan 2022

Cited by 4 | Viewed by 1998

Abstract

Background: The recent improvement of peroral cholangioscopy (POCS) maneuverability has enabled the precise, targeted biopsy of bile duct lesions under direct cholangioscopic vision. However, as only small-cup biopsy forceps can pass through the scope channel, the resulting small sample size may limit the [...] Read more.

Background: The recent improvement of peroral cholangioscopy (POCS) maneuverability has enabled the precise, targeted biopsy of bile duct lesions under direct cholangioscopic vision. However, as only small-cup biopsy forceps can pass through the scope channel, the resulting small sample size may limit the pathological diagnosis of biopsy specimens. This study compared the diagnostic abilities of POCS-guided biopsy and conventional fluoroscopy-guided biopsy for bile duct cancer. Method: This multicenter, retrospective cohort study included patients exhibiting bile duct stricture with suspected cholangiocarcinoma in whom POCS-guided and fluoroscopy-guided biopsies were performed in the same session. The primary endpoint was the diagnostic sensitivity for malignancy. The size and quality of the biopsy specimens were also compared. Result: A total of 59 patients were enrolled. The sensitivity of POCS-guided biopsy was similar to that of fluoroscopy-guided biopsy (54.0% and 64.0%, respectively). However, when the modalities were combined, the sensitivity increased to 80.0%. The mean specimen size from POCS-guided biopsy was significantly smaller than that from fluoroscopy-guided biopsy. The specimen quality using fluoroscopy-guided biopsy was also better than that using POCS-guided biopsy. Conclusions: The diagnostic sensitivity of POCS-guided biopsy is still insufficient, mainly because of the limited specimen quantity and quality. Therefore, conventional fluoroscopy-guided biopsy would be helpful to improve diagnostic sensitivity. Full article

(This article belongs to the Special Issue Recent Advances and Future Trends in Digestive Endoscopy)

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11 pages, 905 KiB

Open AccessArticle

Diagnostic Value of EUS-Guided Fine-Needle Aspiration Biopsy for Gastric Linitis Plastica with Negative Endoscopic Biopsy

by Ryutaro Takada, Kosuke Minaga, Akane Hara, Yasuo Otsuka, Shunsuke Omoto, Ken Kamata, Kentaro Yamao, Mamoru Takenaka, Satoru Hagiwara, Hajime Honjo, Shigenaga Matsui, Takaaki Chikugo, Tomohiro Watanabe and Masatoshi Kudo

J. Clin. Med. 2021, 10(16), 3716; https://doi.org/10.3390/jcm10163716 - 20 Aug 2021

Cited by 7 | Viewed by 2570

Abstract

Due to the tendency of gastric linitis plastica (GLP) to cause extensive submucosal infiltration, a superficial endoscopic biopsy sometimes yields no evidence of malignancy, hindering definite diagnosis. The present study was a single-center retrospective analysis of 54 consecutive patients diagnosed with GLP between [...] Read more.

Due to the tendency of gastric linitis plastica (GLP) to cause extensive submucosal infiltration, a superficial endoscopic biopsy sometimes yields no evidence of malignancy, hindering definite diagnosis. The present study was a single-center retrospective analysis of 54 consecutive patients diagnosed with GLP between 2016 and 2020 to evaluate EUS-guided fine-needle aspiration (EUS-FNA) biopsy outcomes in patients with negative endoscopic biopsy findings. A pathological GLP diagnosis was achieved by endoscopic biopsy in 40 patients (74.1%). EUS-FNA biopsy with a 22-gauge needle was performed in 13 of the remaining 14 patients, and GLP diagnosis was confirmed in 10 patients, with a median of three needle passes. The remaining four patients were laparoscopically diagnosed with GLP. The diagnostic ability of EUS-FNA biopsy for GLP was 76.9%, and EUS-FNA biopsy contributed to GLP diagnosis in 18.5% (10/54) of all cases. None of the 13 patients exhibited EUS-FNA biopsy-related adverse events. Univariable and multivariable analyses revealed an absence of superficial ulcerations as a predictor of false-negative endoscopic biopsy findings in patients with GLP. These results suggest EUS-FNA biopsy as a minimally invasive and safe alternative diagnostic modality for GLP in cases where conventional endoscopic biopsy fails to verify malignancy, although prospective studies with larger cohorts are warranted to confirm these findings. Full article

(This article belongs to the Special Issue Recent Advances and Future Trends in Digestive Endoscopy)

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12 pages, 4325 KiB

Open AccessArticle

Automatic Segmentation of Pancreatic Tumors Using Deep Learning on a Video Image of Contrast-Enhanced Endoscopic Ultrasound

by Yuhei Iwasa, Takuji Iwashita, Yuji Takeuchi, Hironao Ichikawa, Naoki Mita, Shinya Uemura, Masahito Shimizu, Yu-Ting Kuo, Hsiu-Po Wang and Takeshi Hara

J. Clin. Med. 2021, 10(16), 3589; https://doi.org/10.3390/jcm10163589 - 15 Aug 2021

Cited by 20 | Viewed by 2866

Abstract

Background: Contrast-enhanced endoscopic ultrasound (CE-EUS) is useful for the differentiation of pancreatic tumors. Using deep learning for the segmentation and classification of pancreatic tumors might further improve the diagnostic capability of CE-EUS. Aims: The aim of this study was to evaluate the capability [...] Read more.

Background: Contrast-enhanced endoscopic ultrasound (CE-EUS) is useful for the differentiation of pancreatic tumors. Using deep learning for the segmentation and classification of pancreatic tumors might further improve the diagnostic capability of CE-EUS. Aims: The aim of this study was to evaluate the capability of deep learning for the automatic segmentation of pancreatic tumors on CE-EUS video images and possible factors affecting the automatic segmentation. Methods: This retrospective study included 100 patients who underwent CE-EUS for pancreatic tumors. The CE-EUS video images were converted from the originals to 90-s segments with six frames per second. Manual segmentation of pancreatic tumors from B-mode images was performed as ground truth. Automatic segmentation was performed using U-Net with 100 epochs and was evaluated with 4-fold cross-validation. The degree of respiratory movement (RM) and tumor boundary (TB) were divided into 3-degree intervals in each patient and evaluated as possible factors affecting the segmentation. The concordance rate was calculated using the intersection over union (IoU). Results: The median IoU of all cases was 0.77. The median IoUs in TB-1 (clear around), TB-2, and TB-3 (unclear more than half) were 0.80, 0.76, and 0.69, respectively. The IoU for TB-1 was significantly higher than that of TB-3 (p < 0.01). However, there was no significant difference between the degrees of RM. Conclusions: Automatic segmentation of pancreatic tumors using U-Net on CE-EUS video images showed a decent concordance rate. The concordance rate was lowered by an unclear TB but was not affected by RM. Full article

(This article belongs to the Special Issue Recent Advances and Future Trends in Digestive Endoscopy)

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12 pages, 894 KiB

Open AccessArticle

Pilot Study of Acupuncture’s Antispasmodic Effect on Upper Gastrointestinal Tract during Endoscopic Submucosal Dissection for Early Gastric Cancer: Controlled Clinical Trial

by Masao Suzuki, Naoto Ishizaki, Takumi Kayo, Taiga Furuta, Ryo Igarashi, Takumi Maki, Koki Hoshi, Akane Yamabe, Mariko Fujisawa, Akira Funakubo, Tadamichi Mitsuma, Atsushi Irisawa and Goro Shibukawa

J. Clin. Med. 2021, 10(14), 3050; https://doi.org/10.3390/jcm10143050 - 09 Jul 2021

Cited by 1 | Viewed by 2460

Abstract

A prospective study was conducted in patients with early-stage gastric cancer to determine the efficacy and safety of acupuncture stimulation as an antispasmodic compared with conventional medication during the procedure of endoscopic submucosal dissection (ESD) of the upper gastrointestinal tract. This study was [...] Read more.

A prospective study was conducted in patients with early-stage gastric cancer to determine the efficacy and safety of acupuncture stimulation as an antispasmodic compared with conventional medication during the procedure of endoscopic submucosal dissection (ESD) of the upper gastrointestinal tract. This study was a prospective single blinded quasi-randomized controlled trial. Seventy-three patients who were scheduled to undergo ESD for gastric cancer at Aizu Medical Center between 19 February 2016 and 30 June 2016 were assessed for eligibility for the study. Sixty out of 73 patients were included in the study and assigned into two intervention groups: medication group (MG) and acupuncture group (AG). Ease of the procedure was evaluated using modified NIWA classification (MNC) by endoscopist considering the frequency and amplitude of the upper gastrointestinal peristalsis. For the statistical analysis, Mann–Whitney test was used to compare the differences of MNC values (baseline and end of procedure) between two groups. The difference of MNC found in the AG (−2.00 (−3.0 to −2.0)) was significantly greater than that in the MG (−1.00 (−2.0 to −1.0), p < 0.0001, Mann–Whitney test). We consider that acupuncture to the abdomen could be an alternative antispasmodic method during upper gastrointestinal endoscopic procedure. Full article

(This article belongs to the Special Issue Recent Advances and Future Trends in Digestive Endoscopy)

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Review

Jump to: Research

13 pages, 1268 KiB

Open AccessReview

Percutaneous Endoscopic Necrosectomy—A Review of the Literature

by Mateusz Jagielski, Agata Chwarścianek, Jacek Piątkowski and Marek Jackowski

J. Clin. Med. 2022, 11(14), 3932; https://doi.org/10.3390/jcm11143932 - 06 Jul 2022

Cited by 3 | Viewed by 1816

Abstract

In this article, an attempt was made to clarify the role of percutaneous endoscopic necrosectomy (PEN) in the interventional treatment of pancreatic necrosis. A comprehensive review of the current literature was performed to identify publications on the role of PEN in patients with [...] Read more.

In this article, an attempt was made to clarify the role of percutaneous endoscopic necrosectomy (PEN) in the interventional treatment of pancreatic necrosis. A comprehensive review of the current literature was performed to identify publications on the role of PEN in patients with consequences of acute necrotizng pancreatitis. The aim of the study was to review the literature on minimal invasive necrosectomy, with emphasis on PEN using esophageal self-expanding metal stents (SEMS). The described results come from 15 studies after a review of the current literature. The study group comprised 52 patients (36 men and 16 women; mean age, 50.87 (13–75) years) with walled-off pancreatic necrosis, in whom PEN using a self-expandable esophageal stent had been performed. PEN was successfully completed in all 52 patients (100%). PEN complications were observed in 18/52 (34.62%) patients. Clinical success was achieved in 42/52 (80.77%) patients, with follow-up continuing for an average of 136 (14–557) days. In conclusion, the PEN technique is potentially effective, with an acceptable rate of complications and may be implemented with good clinical results in patients with pancreatic necrosis. Full article

(This article belongs to the Special Issue Recent Advances and Future Trends in Digestive Endoscopy)

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15 pages, 1671 KiB

Open AccessReview

Current Status of Endoscopic Biliary Drainage in Patients with Distal Malignant Biliary Obstruction

by Yuki Tanisaka, Masafumi Mizuide, Akashi Fujita, Tomoya Ogawa, Hiromune Katsuda, Youichi Saito, Kazuya Miyaguchi, Ryuhei Jinushi, Rie Terada, Yuya Nakano, Tomoaki Tashima, Yumi Mashimo and Shomei Ryozawa

J. Clin. Med. 2021, 10(19), 4619; https://doi.org/10.3390/jcm10194619 - 08 Oct 2021

Cited by 4 | Viewed by 2283

Abstract

Distal malignant biliary obstruction is caused by various malignant diseases that require biliary drainage. In patients with operable situations, preoperative biliary drainage is required to control jaundice and cholangitis until surgery. In view of tract seeding, endoscopic biliary drainage is the first choice. [...] Read more.

Distal malignant biliary obstruction is caused by various malignant diseases that require biliary drainage. In patients with operable situations, preoperative biliary drainage is required to control jaundice and cholangitis until surgery. In view of tract seeding, endoscopic biliary drainage is the first choice. Since neoadjuvant therapies are being developed, the time to surgery is increasing, especially in pancreatic cancer cases. Therefore, it requires long stent patency. Recently, preoperative biliary drainage using self-expandable metal stents has been reported as a useful modality to secure long stent patency. In patients with unresectable distal malignant biliary obstruction, self-expandable metal stent is the first choice for maintaining long stent patency. Although there are many comparison studies between a covered and an uncovered self-expandable metal stent, their use is still controversial. Recently, endoscopic ultrasound-guided biliary drainage has been performed as an alternative treatment. The clinical success and stent patency are favorable. We should take into consideration that both endoscopic retrograde cholangiopancreatography-guided biliary drainage and endoscopic ultrasound-guided biliary drainage have advantages and disadvantages and chose the drainage method depending on the patient’s situation or the expertise of the endoscopist. Here, we discuss the current status of endoscopic biliary drainage in patients with distal malignant biliary obstruction. Full article

(This article belongs to the Special Issue Recent Advances and Future Trends in Digestive Endoscopy)

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10 pages, 2543 KiB

Open AccessReview

Current Status and Future Perspective of Artificial Intelligence in the Management of Peptic Ulcer Bleeding: A Review of Recent Literature

by Hsu-Heng Yen, Ping-Yu Wu, Mei-Fen Chen, Wen-Chen Lin, Cheng-Lun Tsai and Kang-Ping Lin

J. Clin. Med. 2021, 10(16), 3527; https://doi.org/10.3390/jcm10163527 - 11 Aug 2021

Cited by 14 | Viewed by 6501

Abstract

With the decreasing incidence of peptic ulcer bleeding (PUB) over the past two decades, the clinician experience of managing patients with PUB has also declined, especially for young endoscopists. A patient with PUB management requires collaborative care involving the emergency department, gastroenterologist, radiologist, [...] Read more.

With the decreasing incidence of peptic ulcer bleeding (PUB) over the past two decades, the clinician experience of managing patients with PUB has also declined, especially for young endoscopists. A patient with PUB management requires collaborative care involving the emergency department, gastroenterologist, radiologist, and surgeon, from initial assessment to hospital discharge. The application of artificial intelligence (AI) methods has remarkably improved people’s lives. In particular, AI systems have shown great potential in many areas of gastroenterology to increase human performance. Colonoscopy polyp detection or diagnosis by an AI system was recently introduced for commercial use to improve endoscopist performance. Although PUB is a longstanding health problem, these newly introduced AI technologies may soon impact endoscopists’ clinical practice by improving the quality of care for these patients. To update the current status of AI application in PUB, we reviewed recent relevant literature and provided future perspectives that are required to integrate such AI tools into real-world practice. Full article

(This article belongs to the Special Issue Recent Advances and Future Trends in Digestive Endoscopy)

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