Search Results (59)

Background/Objectives: Contrast-enhanced harmonic endoscopic ultrasonography (CH-EUS) is a promising tool for differentiating gastric subepithelial tumors (SETs). However, most published studies have mainly included gastrointestinal stromal tumors (GIST) and leiomyomas in the gastrointestinal tract, not limited to gastric SETs. This study evaluated the diagnostic performance of CH-EUS in gastric SETs encountered in clinical practice. Methods: We retrospectively analyzed 68 patients who underwent CH-EUS for gastric SETs between March 2021 and July 2025 at our institution. Gastric SETs were classified into benign (n = 27: ectopic pancreas, leiomyoma, schwannoma, glomus tumor, plexiform fibromyxoma, desmoid tumor, solitary fibrous tumor, and abscess) and GIST groups (n = 41). CH-EUS features, including arterial enhancement, irregular vessels, and diffuse enhancement, were assessed. Histopathological confirmation was obtained through EUS-guided fine-needle biopsy or endoscopic/surgical resection. Results: The GIST group showed significantly higher rates of arterial enhancement (95.1% vs. 74.1%, p = 0.024), irregular vessels (51.2% vs. 22.2%, p = 0.017), and diffuse enhancement (87.8% vs. 66.7%, p = 0.035) than the benign SETs. The diagnostic performance of arterial enhancement showed a sensitivity of 95.1% and specificity of 25.9%, while irregular vessels demonstrated a sensitivity of 51.2% and specificity of 77.8%, and diffuse enhancement showed a sensitivity of 87.8% and specificity of 33.3%. When combining ≥2 CH-EUS features, the sensitivity and specificity were 92.7% and 33.3%, respectively, with an overall accuracy of 69.1%. The presence of all three features yielded a specificity of 81.5% but a lower sensitivity (46.3%). Conclusions: CH-EUS exhibited a high sensitivity but low specificity in differentiating GISTs from various benign gastric SETs when using a combination of at least two CE-EUS features, including arterial enhancement, irregular vessels, and diffuse enhancement. Full article

Metastases to the pancreas (PM), although rare, have been increasingly identified in recent years, especially among high-volume pancreatic centers. They are often asymptomatic and incidentally detected during follow-up examinations, even several years after the treatment of the primary tumor. In this scenario, endoscopic ultrasound (EUS) has emerged as a crucial diagnostic tool for PM, being capable of providing a detailed morphological characterization and safe and effective tissue acquisition for cytohistological examination. The aim of our study was to extensively review the current evidence concerning the role of EUS in the diagnosis of PM, specifically focusing on its morphological features, contrast-enhancement patterns, and tissue acquisition techniques. Full article

Pancreatic ductal adenocarcinoma (PDAC) remains one of the most aggressive malignancies, with overall survival outcomes that have improved only modestly in recent years. Careful preoperative evaluation is essential for defining resectability and planning surgery. Modern imaging modalities, including high-resolution, contrast-enhanced CT, MRI and endoscopic ultrasound, provide a detailed assessment of vascular involvement and allow accurate staging according to various international criteria and consensus statements. In borderline and locally advanced cases, neoadjuvant therapy can aid in downsizing the tumor and increasing the likelihood of achieving negative margin resection (R0), offering long-term survival along with quality of life. When vascular invasion limits resectability, venous resection and reconstruction may permit an R0 resection in patients with borderline resectable disease that is both technically operable and physiologically tolerable for the patient. Arterial resection, however, remains controversial and is rarely justified because of its limited perioperative and survival benefits. Arterial divestment has emerged as an interesting alternative, allowing tumor clearance while avoiding full arterial reconstruction. Vascular reconstructions can be achieved through venorrhapy, end-to-end anastomosis, or segmental replacement using either autologous or synthetic grafts. With the advances in neoadjuvant treatment, the appropriate selection of candidates for vascular resection significantly increases the resectability rate, offering long-term survival along with satisfactory quality of life. In this review, a detailed literature review is performed regarding the best strategies in the diagnosis and surgical management of patients with borderline resectable and locally advanced pancreatic cancer requiring vascular resection. Full article

Endoscopic ultrasound (EUS) with fine-needle biopsy (FNB) is one of the techniques applied for sampling subepithelial lesions (SELs) of the gastrointestinal tract. Elastography and contrast-enhanced evaluation could permit identification of different patterns among areas of the lesions, depending on their consistence and the presence of vital cells or necrosis. Targeting a specific area when performing FNB in the case of large lesions could potentially permit an increase in accuracy and reduce the need for re-sampling. A 61-year-old woman was admitted reporting severe abdominal pain. The patient underwent cholecystectomy many years ago. She had no known family history of gastrointestinal, hepatic, biliary, or pancreatic disease. Laboratory tests were normal. A computed tomography scan showed a large lesion between the stomach and the pancreatic body, suspected to originate from the gastric wall. An endoscopic view showed a large bulging into the gastric lumen and EUS identified a lesion originating from the muscular layer of the gastric wall. Elastography and contrast-enhanced EUS identified two different areas, one softer with lower enhancement (A) and the other harder with higher enhancement after contrast injection (B). FNB was performed targeting both the areas, sending samples for separate histological evaluation. Histology showed a gastrointestinal stromal tumor (GIST), finding differences in amount of necrotic and neoplastic cells between the two areas. EUS-FNB guided by elastography and/or contrast-enhanced EUS could identify differences within large SELs, allowing targeting of areas more likely to collect diagnostic samples. Full article

Background and Aims: Gastric cancer (GC) remains a leading cause of cancer-related mortality, frequently diagnosed at advanced stages. High-risk features—tumor size ≥ 40 mm, cT3/cT4, nodal involvement, diffuse histology, and Borrmann type III/IV—are associated with peritoneal metastasis (PM). Staging laparoscopy with peritoneal washing (PW) is superior to conventional preoperative imaging modalities, including contrast-enhanced CT, MRI, PET/CT and endoscopic ultrasound, in detecting occult peritoneal disease. In this era of personalized medicine and expanding loco-regional strategies such as cytoreductive surgery (CRS)/Hyperthermic IntraPEritoneal Chemotherapy (HIPEC) and Pressurized IntraPeritoneal Aerosol Chemotherapy (PIPAC), accurate staging is crucial. This study assessed the impact of SL and PW in high-risk GC. Methods: We retrospectively analyzed 113 consecutive high-risk GC patients who underwent SL and PW between 2014 and 2024 at our institution. The primary endpoint was detection of PM or positive cytology (CY+). Secondary endpoints were treatment modification, eligibility for loco-regional therapy, and safety. Results: SL/PW identified PM or CY+ in 26 patients (23%), including 16 with CY+ only. None had radiologic signs of peritoneal disease. SL findings altered treatment in all cases: 21 patients (81%) with Peritoneal Cancer Index (PCI) < 6 underwent induction chemotherapy followed by CRS + HIPEC; 5 patients (PCI > 6) were spared non-therapeutic laparotomy and treated with bidirectional systemic chemotherapy and PIPAC. In 10 patients, systemic therapy was shifted from FLOT (fluorouracil, leucovorin, oxaliplatin, and docetaxel) to FOLFOX (fluorouracil, leucovorin, and oxaliplatin) ± nivolumab. No perioperative complications occurred; all patients were discharged within 24 h without delay in systemic treatment. Conclusions: SL with PW is safe and significantly improves staging accuracy in high-risk GC, enabling personalized therapeutic planning. Routine integration of SL should be considered essential in treatment algorithms to guide systemic and loco-regional strategies. Full article

Background and Aims: Solid pseudopapillary neoplasms (SPN) are rare neoplasms of the pancreatic gland. Despite the indolent behavior, surgical resection is required according to the risk of metastasis development. Few data are available on endoscopic ultrasound (EUS) features, comparison between the features described at EUS and contrast-enhanced, and diagnostic accuracy and safety of EUS-guided FNB in these tumors. Patients and Methods: All consecutive patients with a EUS-guided FNB-based pathological diagnosis of SPN were extrapolated from a prospectively maintained database. Demographic, radiologic, and echo-endoscopic features were collected. FNB specimens were re-evaluated from two expert pathologist and the main histological features of SPN were investigated. Results: Thirty-seven patients were included (32 females and 5 males), with a mean age of 35.8 ± 15.8 years. Contrast-enhanced imaging based diagnosis was accurate in 20 patients (54.1%). EUS features were significantly different compared to contrast-enhanced imaging in terms of cystic appearance (40.5% vs. 16.2%; p = 0.03) and vascular pattern (p = 0.01). FNB-based diagnosis of SPN was confirmed on surgical specimen in all, 37 patients, resulting in a diagnostic accuracy of EUS-guided FNB of 100%. Only one patient (2.6%) experienced a mild procedure-related adverse event. Discussion: Contrast-enhanced imaging based diagnosis of SPN is difficult. Despite the rarity of the disease, EUS-guided FNB with 22-gauge fork-tip needle has a very high diagnostic accuracy for SPN, with rare and mild adverse events. Full article

Esophageal squamous cell carcinoma (ESCC) remains a major global health challenge due to its aggressive nature and frequent late-stage diagnosis. Accurate locoregional staging is critical for guiding appropriate therapy, and endoscopic ultrasound (EUS) has emerged as the preferred modality for assessing tumor depth and regional lymph node involvement. In this narrative review, we provide a comprehensive overview of the role of EUS in the management of ESCC, from initial staging to post-treatment assessment. We discuss its strengths and limitations, particularly in differentiating early-stage disease and in restaging after neoadjuvant therapy. The importance of a multimodal approach—integrating EUS with computed tomography (CT), positron emission tomography (PET), and histologic sampling—is emphasized to improve diagnostic precision. We also explore emerging techniques, such as contrast-enhanced EUS, elastography, and novel therapeutic strategies including immune checkpoint inhibitors and endoscopic mucosal resurfacing. While EUS remains a cornerstone in the management of ESCC, ongoing innovation and integration with personalized medicine are expected to further enhance its clinical impact. Full article

Background/Objectives: There is limited evidence on imaging characteristics and pathological grading of small pancreatic neuroendocrine tumors (PNENs). This study aimed to compare imaging features and histopathological diagnoses of PNENs based on tumor size. Methods: Patients with PNEN who underwent pathological diagnosis at Hiroshima University Hospital were retrospectively reviewed. Detection rates, imaging findings, and diagnostic accuracy of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) were analyzed according to tumor size. Results: Among 107 patients with PNEN, 42 had tumors ≤10 mm, and 65 had tumors >10 mm. The detection rate for lesions ≤10 mm was 92.3% according to EUS and 83.3% according to contrast-enhanced CT, showing the superior sensitivity of EUS. Typical imaging features—well-defined margins, homogeneous internal structure, and early enhancement—were significantly more frequent in tumors ≤10 mm (p < 0.001). There were no significant differences in imaging findings between G1 and G2 tumors ≤10 mm. The diagnostic sensitivity of EUS-FNA was 91.2% for tumors ≤10 mm and 86.3% for tumors >10 mm, with no significant difference. However, the concordance rate between EUS-FNA and surgical histology for tumor grading was significantly higher in the ≤10 mm group (87.5% vs. 56.3%, p = 0.012). Discussion: In small PNENs (≤10 mm), imaging features are often typical but do not reliably determine tumor grade. In our cohort, EUS-FNA showed high diagnostic accuracy and provided essential pathological information to guide management, including the choice between surveillance and surgery. Full article

Gastric cancer remains the fourth leading cause of cancer-related mortality worldwide. Advanced disease is associated with a poor prognosis, emphasizing the critical importance of early diagnosis through endoscopy. In addition to prognosis, disease extent also plays a pivotal role in guiding management strategies. Therefore, accurate locoregional staging (T and N staging) is vital for optimal prognostic and therapeutic planning. Endoscopic ultrasound (EUS) has long been an essential tool in this regard, with computed tomography (CT) and, more recently, positron emission tomography–computed tomography (PET–CT) serving as alternative imaging modalities. EUS is particularly valuable in the assessment of early gastric cancer, defined as tumor invasion confined to the mucosa or submucosa. These tumors are increasingly managed by endoscopic resection techniques offering improved post-treatment quality of life. EUS has also recently been utilized in the restaging process after neoadjuvant chemotherapy, aiding in the evaluation of tumor resectability and prognosis. Its performance may be further enhanced through the application of emerging techniques such as contrast-enhanced endosonography, EUS elastography, and artificial intelligence systems. In advanced, unresectable disease, complications such as gastric outlet obstruction (GOO) severely impact patient quality of life. In this setting, EUS-guided gastroenterostomy (EUS-GE) offers a less invasive alternative to surgical gastrojejunostomy. This review summarizes and critically analyzes the role of EUS in the context of gastric cancer, highlighting its applications across different stages of the disease and evaluating its performance relative to other diagnostic modalities. Full article

Pancreatic ductal adenocarcinoma (PDAC) remains among the most lethal malignancies, with a five-year survival rate below 12%, largely attributable to its asymptomatic onset, late-stage diagnosis, and limited curative treatment options. Although PDAC accounts for approximately 3% of all cancers, it is projected to become the second leading cause of cancer-related mortality in the United States by 2030. A major contributor to its dismal prognosis is the lack of validated early detection strategies for asymptomatic individuals. In this review, we present a comprehensive synthesis of current advances in the early detection of PDAC, with a focus on the identification of high-risk populations, novel biomarker platforms, advanced imaging modalities, and artificial intelligence (AI)-driven tools. We highlight high-risk groups—such as those with new-onset diabetes after age 50, pancreatic steatosis, chronic pancreatitis, cystic precursor lesions, and hereditary cancer syndromes—as priority populations for targeted surveillance. Novel biomarker panels, including circulating tumor DNA (ctDNA), miRNAs, and exosomes, have demonstrated improved diagnostic accuracy in early-stage disease. Recent developments in imaging, such as multiparametric MRI, contrast-enhanced endoscopic ultrasound, and molecular imaging, offer improved sensitivity in detecting small or precursor lesions. AI-enhanced radiomics and machine learning models applied to prediagnostic CT scans and electronic health records are emerging as valuable tools for risk prediction prior to clinical presentation. We further refine the Define–Enrich–Find (DEF) framework to propose a clinically actionable strategy that integrates these innovations. Collectively, these advances pave the way for personalized, multimodal surveillance strategies with the potential to improve outcomes in this historically challenging malignancy. Full article

Endoscopic ultrasound (EUS) is a helpful tool for the study of the mediastinum, a challenging region for both transesophageal and endobronchial (EBUS) endosonography. This area is divided into sections and contains numerous lymph nodes essential for the staging and diagnosis of conditions like lung cancer, sarcoidosis, and infections. EUS allows for detailed examination of the mediastinal region, identifying various kinds of abnormalities, whether they are benign cysts or malignant tumors. The aim of this narrative review is to provide a clear overview of how EUS contributes to mediastinal diagnostics and to offer practical insights for clinicians. A comprehensive, non-systematic search of PubMed was conducted by the authors to identify relevant studies. EUS methods, such as elastography and contrast-enhanced imaging, have improved diagnosis by analyzing tissue stiffness and blood flow, and they help endosonographers distinguish between different conditions. EUS-guided tissue sampling techniques, like fine needle aspiration and biopsy, are crucial for detecting cancer and examining lymph nodes in a minimally invasive way. By combining EUS with endobronchial ultrasound, operators can achieve more accurate results, especially in cancer staging and treatment planning. Overall, this approach is a key tool in treating thoracic and mediastinal conditions. Full article

Rectal cancer management necessitates a rigorous multidisciplinary strategy, emphasizing precise staging and detailed risk stratification to inform optimal therapeutic decision-making. Obtaining an accurate histological diagnosis before initiating treatment is essential. Comprehensive staging integrates clinical evaluation, thorough medical history analysis, assessment of carcinoembryonic antigen (CEA) levels, and computed tomography (CT) imaging of the abdomen and thorax. High-resolution pelvic magnetic resonance imaging (MRI), utilizing dedicated rectal protocols, is critical for identifying recurrence risks and delineating precise anatomical relationships. Endoscopic ultrasound further refines staging accuracy by determining the tumor infiltration depth in early-stage cancers, while preoperative colonoscopy effectively identifies synchronous colorectal lesions. In early-stage rectal cancers (T1–T2, N0, and M0), radical surgical resection remains the standard of care, although transanal local excision can be selectively indicated for certain T1N0 tumors. In contrast, locally advanced rectal cancers (T3, T4, and N+) characterized by microsatellite stability or proficient mismatch repair are optimally managed with total neoadjuvant therapy (TNT), which combines chemoradiotherapy with oxaliplatin-based systemic chemotherapy. Additionally, tumors exhibiting high microsatellite instability or mismatch repair deficiency respond favorably to immune checkpoint inhibitors (ICIs). The evaluation of tumor response following neoadjuvant therapy, utilizing MRI and endoscopic assessments, facilitates individualized treatment planning, including non-operative approaches for patients with confirmed complete clinical responses who comply with rigorous follow-up. Recent advancements in molecular characterization, targeted therapies, and immunotherapy highlight a significant evolution towards personalized medicine. The effective integration of these innovations requires enhanced interdisciplinary collaboration to improve patient prognosis and quality of life. Full article

Gastro-entero-pancreatic neuroendocrine tumors (GEP-NETs) represent a rare and varied class of neoplasms, characterized by diverse clinical presentations and prognostic trajectories. Accurate and prompt diagnosis is vital to inform and optimize therapeutic decisions. Ultrasound, including standard B-mode imaging and advanced methods such as contrast-enhanced ultrasound (CEUS) and endoscopic ultrasound (EUS), serves as a key component in the diagnostic evaluation of these tumors. B-mode US and CEUS provide non-invasive, accessible methods for early detection and characterization. On B-mode imaging, GEP-NETs typically present as well-defined, hyperechoic, or iso-echoic lesions, while CEUS highlights their characteristic vascularity, marked by arterial-phase hyperenhancement and venous-phase washout. Compared to CT and MRI, ultrasound offers real-time, dynamic imaging without ionizing radiation or nephrotoxic contrast agents, making it particularly advantageous for patients requiring frequent monitoring or with contraindications to other imaging modalities. CT and MRI are widely regarded as the preferred methods for staging and surgical planning due to their detailed anatomical visualization. However, ultrasound, especially CEUS, provides a significant adjunctive role in both early detection and the follow-up on GEP-NETs. This analysis delves into the strengths, challenges, and innovations in ultrasound technology for diagnosing pancreatic NETs, focusing on its contribution to comprehensive imaging strategies and its impact on patient care decisions. Full article

Pancreatic cystic lesions (PCLs) are increasingly identified via computerized tomography (CT) and magnetic resonance (MR), with a prevalence of 2–45%. Distinguishing mucinous PCLs (M-PCLs), which include intraductal papillary mucinous neoplasms (IPMNs) and mucinous cystic neoplasms (MCNs) that can progress to pancreatic ductal adenocarcinoma, from non-mucinous PCLs (NM-PCLs) is essential. Carcinoembryonic antigen (CEA) remains widely used but often demonstrates limited sensitivity and specificity. In contrast, endoscopic ultrasound-guided measurement of intracystic glucose more accurately differentiates PCL subtypes, as tumor-related metabolic changes lower cyst fluid glucose in mucinous lesions. Numerous prospective and retrospective studies suggest a glucose cut-off between 30 and 50 mg/dL, yielding a sensitivity of 88–95% and specificity of 76–91%, frequently outperforming CEA. Additional benefits include immediate point-of-care assessment via standard glucometers and minimal interference from blood contamination. DNA-based biomarkers, including KRAS and GNAS mutations, enhance specificity (up to 99%) but exhibit moderate sensitivity (61–71%) and necessitate specialized, expensive platforms. Molecular analyses can be crucial in high-risk lesions, yet their uptake is constrained by technical challenges. In practice, combining glucose assessment with targeted molecular assays refines risk stratification and informs the choice between surgical resection or active surveillance. Future investigations should establish standardized glucose thresholds, improve the cost-effectiveness of genetic testing, and integrate advanced biomarkers into routine protocols. Ultimately, these strategies aim to optimize patient management, limit unnecessary interventions for benign lesions, and ensure timely therapy for lesions at risk of malignant transformation. Full article

Technological advances have greatly expanded the diagnostic and therapeutic capabilities of endoscopic ultrasound (EUS). The integration of cutting-edge imaging techniques, including tissue harmonic echo, contrast-enhanced harmonic EUS, elastography, and needle-based confocal laser endomicroscopy, have significantly enhanced lesion characterization and diagnostic accuracy. Additionally, developments in stent design and the introduction of new accessories have broadened the therapeutic applications of EUS. Ongoing innovations in clinical practice have transformed procedures such as drainage, tumor ablation, EUS-directed transgastric endoscopic retrograde cholangiopancreatography (ERCP), the placement of fiducial markers, advancements in endohepatology, lesion characterization, and treatment. These developments continue to expand the role of EUS in delivering precise and effective therapeutic interventions. Full article