Search Results (644)

Background: Carpal tunnel syndrome is the most common entrapment neuropathy of the upper limb and an important cause of pain, sensory disturbance, and hand dysfunction. Open and endoscopic carpal tunnel release are effective, but they may be associated with scar-related pain, wound complications, and delayed return to work. Ultrasound-guided techniques have been developed to reduce soft-tissue trauma, enable real-time visualization of neurovascular structures, and facilitate faster recovery. Methods: A systematic search of PubMed, PubMed Central, and Scopus was conducted according to PRISMA guidelines for English-language studies published over the last 14 years. Eligible studies reported ultrasound-guided carpal tunnel release techniques and/or compared them with open, mini-open, or endoscopic procedures. Data on procedural technique, study population, follow-up, clinical outcomes, complications, and methodological characteristics were extracted and qualitatively synthesized. Results: Twenty-eight studies were included. Sample sizes ranged from 14 to 152 patients, and follow-up ranged from 3 to 74 months. The most frequently reported ultrasound-guided approaches were device-assisted carpal tunnel release, thread carpal tunnel release, and percutaneous carpal tunnel release. Most studies reported clinically meaningful improvement in symptoms and hand function, small incisions, rapid return to daily activities, and low rates of serious complications. Reported adverse events were mostly minor and transient. However, the evidence was limited by small samples, heterogeneous outcomes, single-center designs, limited long-term follow-up, and potential conflicts of interest. Conclusions: Ultrasound-guided carpal tunnel release appears to be a promising, minimally invasive alternative to traditional surgery, though current evidence is of low certainty. Larger independent comparative trials with standardized outcomes and long-term follow-up are needed. Full article

Background: The therapeutic paradigm of Crohn’s disease (CD) has progressively evolved from symptom control toward objective treatment targets aimed at modifying disease course. Although endoscopic mucosal healing (MH) is currently regarded as a major treatment goal, it may inadequately reflect residual inflammation in a condition characterized by transmural bowel involvement. Consequently, transmural healing (TH), assessed through cross-sectional imaging modalities, has emerged as a potential marker of deeper disease control. Methods: A comprehensive literature review was conducted to identify studies evaluating the definition, assessment, prognostic significance, and achievability of TH in CD. Original studies, randomized controlled trials, systematic reviews, consensus statements, and international guidelines were included. Results: Accumulating evidence indicates that TH is associated with superior long-term outcomes compared with MH alone, including lower risks of hospitalization, surgery, treatment escalation, disease relapse, and bowel damage progression. However, substantial heterogeneity persists regarding the definition of TH across imaging modalities, with intestinal ultrasound and magnetic resonance enterography representing the principal tools for its assessment. Available data suggest that TH can be achieved in a meaningful proportion of patients receiving advanced therapies, particularly when treatment is initiated early in the disease course, although rates vary considerably according to therapeutic class, disease characteristics, and the definition adopted. Emerging technologies may further refine the assessment of transmural disease activity. Conclusions: TH represents a promising therapeutic target that may better capture the full burden of inflammation in CD than mucosal endpoints alone. Future efforts should focus on harmonizing imaging criteria and determining whether targeting TH can translate into meaningful disease modification and improved long-term outcomes. Full article

Background and Clinical Significance: Primary pancreatic extramedullary plasmacytomas (EMP) are extremely uncommon, representing less than 0.1% of all pancreatic masses and being far more uncommon than secondary involvement by an underlying multiple myeloma. Case presentation: A 69-year-old male was found with a solitary pancreatic mass. Endoscopic ultrasound (EUS)-guided fine-needle biopsy (FNB) revealed a monoclonal plasmacytic proliferation with molecularly confirmed KRAS (A146V) and BRAF (G469V) mutations. Multidisciplinary assessment ruled out a secondary localization, thus leading to the ultimate diagnosis of primary pancreatic EMP. Conclusions: Reaching a definitive diagnosis of primary pancreatic EMP requires a negative bone marrow biopsy and histological confirmation of the plasma cell nature of the pancreatic process. As for the latter, EUS-FNB may be a pivotal technique to avoid upfront surgical procedures. Full article

Background/Objectives: Interventional endoscopic ultrasound (I-EUS) has evolved from a diagnostic imaging modality into a transformative therapeutic platform encompassing biliary drainage, pancreatic interventions, luminal bypass, pain management, and ablative therapies. Despite the rapid proliferation of I-EUS research, a comprehensive bibliometric analysis characterizing the global intellectual architecture of this field is lacking. Methods: A Web of Science Core Collection search identified 4340 records, of which 2237 were included (2001–2024), analyzed with R bibliometrix (version 5.0) and VOSviewer (version 1.6.20). Results: Publication output demonstrated three distinct phases with pronounced acceleration from 2017. The United States led global output (n = 625, 27.9%), followed by Japan (n = 435, 19.4%) and Italy (n = 166, 7.42%). At the continental level, Asia collectively produced the largest share of output (n = 884, 39.5% of the total corpus), exceeding the Americas (n = 687, 30.7%) and Europe (n = 492, 22.0%). Gastrointestinal Endoscopy was the most productive journal (n = 173). Tokyo Medical University was the most productive institution (n = 93, 4.16%). Four thematic clusters were identified: EUS-guided biliary and pancreatic ductal drainage; diagnostic, ablative, and injection EUS for pancreatic tumors; LAMS-enabled luminal bypass and gallbladder drainage; and pancreatic fluid collections and necrotizing pancreatitis. Temporal overlay confirmed EUS-guided gastroenterostomy, EUS-guided gallbladder drainage, and EUS-guided radiofrequency ablation as the leading research frontiers. Annual output showed no discernible contraction during the COVID-19 pandemic period (2020–2021). Conclusions: The United States led global I-EUS research output with higher rates of international collaboration compared with East Asian nations, although Asia as a continent generated the largest aggregate volume of publications. EUS-guided biliary drainage and pancreatic fluid collection management constitute the established, high-volume core of the field, while EUS-guided gastroenterostomy and novel ablative technologies represent the most dynamic investigative frontiers. Full article

Background/Objectives: Acute cholecystitis in patients with malignant biliary obstruction (MBO) is challenging to manage. Evidence for endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) using double-pigtail plastic stents (DPPS) in this setting remains limited. We evaluated the efficacy and safety of EUS-GBD using DPPS for acute cholecystitis in patients with MBO. Methods: We retrospectively reviewed 41 consecutive patients who underwent EUS-GBD using DPPS at two centers. The primary endpoint was technical success; secondary endpoints included clinical success, adverse events, recurrence, and subsequent oncologic treatment. Results: Technical success was achieved in 95.1% (39/41), with clinical success in all technically successful cases. Adverse events included biliary peritonitis (14.6%) and procedure-related DPPS migration (2.4%). Recurrence occurred in 2.6% of patients. Systemic therapy was resumed in 10 of 18 patients (55.6%) at a median of 15 days after EUS-GBD. Conclusions: EUS-GBD using DPPS achieved high technical and clinical success rates with a low recurrence rate in selected patients with acute cholecystitis and MBO. Systemic therapy could be resumed in a subset of patients following successful drainage. These findings suggest that DPPS-based EUS-GBD may be a feasible internal drainage option in this setting, although prospective comparative studies are needed to further establish its safety and effectiveness. Full article

Ulcerative colitis affects millions of people worldwide, and acute severe ulcerative colitis (ASUC) remains one of its most urgent presentations because delayed recognition of steroid non-response can expose patients to colectomy, postoperative complications, and prolonged hospitalization. The Truelove and Witts (T&W) criteria, first published in 1955, remain historically important because they provide a simple bedside definition of severe disease and continue to inform admission thresholds in contemporary practice. This opinion article argues that the T&W criteria should be retained as an entry definition for classic ASUC but should no longer be used as a standalone framework for dynamic risk stratification or treatment escalation. Modern guidelines and consensus statements increasingly supplement clinical toxicity with C-reactive protein (CRP), albumin, fecal calprotectin, validated endoscopic scores, intestinal ultrasound, and early prognostic indices. These tools do not replace bedside assessment; rather, they help clinicians identify steroid non-response and inflammatory burden before systemic toxicity alone becomes decisive. A balanced interpretation is therefore required: the T&W criteria remain useful because they are simple, familiar, and globally applicable, but they are insufficient by themselves for treat-to-target decision-making. Future ASUC severity classifications should integrate traditional clinical assessment with objective biomarkers, endoscopic findings, imaging, and prospective validation across both resource-rich and resource-limited settings. Full article

Contrast-enhanced low-mechanical-index endoscopic ultrasound (CELMI-EUS) extends the diagnostic capabilities of endoscopic ultrasound by enabling real-time assessment of hepatic microvascularization and perfusion using intravenous ultrasound contrast agents. Owing to its close proximity to the liver and high spatial resolution, CELMI-EUS is particularly suited for the detection and characterization of small or otherwise inconspicuous focal liver lesions. This review summarizes the technical principles of CELMI-EUS, contrast agent usage, vascular phase interpretation, and standardized assessment of benign and malignant focal liver lesions, including the potential and provisional application of CEUS Liver Imaging Reporting and Data System (LI-RADS) terminology in patients at risk for hepatocellular carcinoma, while acknowledging that dedicated validation for CELMI-EUS is lacking. Typical enhancement patterns of common benign lesions such as hemangioma, focal nodular hyperplasia, hepatocellular adenoma, biliary hamartomas, and abscesses are discussed, as well as malignant entities including metastases, hepatocellular carcinoma, and cholangiocarcinoma. In addition, the role of CELMI-EUS in lesion detection, interventional guidance, and its limitations and pitfalls are addressed. Integrated into a multimodality imaging approach alongside transcutaneous CEUS and cross-sectional imaging, CELMI-EUS represents a valuable complementary tool that improves diagnostic confidence and supports optimized management of patients with focal liver lesions. Full article

Elastography is an ultrasound-based technique that enables the non-invasive assessment of tissue stiffness. In endoscopic ultrasound (EUS), elastography was initially introduced as a strain-based method, providing qualitative or semi-quantitative information on tissue deformation. More recent technological developments have enabled the integration of shear-wave-based elastography into EUS platforms, including shear-wave measurement (SWM), point shear-wave elastography (pSWE), and two-dimensional shear-wave elastography (2D-SWE). Unlike strain elastography, shear-wave techniques provide quantitative estimates of tissue stiffness by measuring shear-wave velocity or a derived elastic modulus. This invited narrative review summarizes the technical principles, terminology, quality-control requirements, and current clinical evidence for EUS-guided shear-wave-based elastography in pancreatic and hepatobiliary diseases. Because much of the available EUS literature derives from EUS-SWM or point SWE rather than true 2D-SWE, acquisition mode is a central determinant when interpreting clinical evidence and clinical readiness. Current data suggest that EUS-guided shear-wave-based elastography is technically feasible and biologically plausible, but its clinical maturity remains indication-specific. Evidence is most encouraging in chronic pancreatitis, early chronic pancreatitis, autoimmune pancreatitis activity monitoring, and selected endo-hepatology settings, particularly liver fibrosis assessment in patients in whom transabdominal techniques may be suboptimal. In contrast, available evidence does not support EUS-guided shear-wave-based elastography as a standalone diagnostic test for differentiating solid pancreatic lesions, including pancreatic ductal adenocarcinoma, because absolute stiffness values often overlap among malignant lesions, inflammatory masses, and background parenchyma. Before routine clinical implementation, standardized acquisition protocols, disease-specific cut-offs, multicenter reproducibility data, and evidence of incremental clinical value beyond established diagnostic pathways are required. Full article

Background: Minimally invasive carpal tunnel release (CTR) approaches, including endoscopic and ultrasound-guided, encompass a range of distinct techniques. These approaches have been increasingly adopted across both surgical and non-surgical specialties. However, the literature frequently groups the techniques into broad categories, obscuring clinically meaningful differences in transection mechanism, safety profile, and learning curve. Methods: This narrative review organizes minimally invasive CTR into eight distinct techniques, two endoscopic and six ultrasound-guided, classified by their primary transection mechanism. Results: Single-portal endoscopic CTR has the largest evidence base, with network meta-analysis data demonstrating significant early functional advantages over open CTR. Among ultrasound-guided techniques, the retractable retrograde blade is the most widely adopted, with randomized trial data supporting comparable outcomes to mini-open CTR. Hook-knife retrograde and thread-loop techniques have demonstrated feasibility and durable outcomes, though experience is concentrated among a few high-volume operators. The antegrade cutting, pinhole scalpel, and needle-knife have more limited evidence. Earlier return to work is the most reproducible benefit across all minimally invasive approaches. Endoscopic CTR carries a modestly higher revision rate, while long-term data for ultrasound-guided techniques remain lacking. Conclusions: This mechanism-based classification highlights important differences between techniques in safety features, evidence maturity, and learning curves. Head-to-head trials comparing endoscopic and ultrasound-guided techniques and device-specific registries with standardized outcome reporting are needed to inform evidence-based adoption. Full article

Background: Machine learning (ML) is increasingly applied in medicine, underscoring the need for transparent and clinically relevant models. In gastrointestinal oncology, most ML studies rely on raw imaging data, which limits clinical adoption due to poor interpretability and the difficulty of collecting high-quality, large-scale video and image datasets in routine practice. Endoscopic ultrasound (EUS) plays a central role in the evaluation of pancreatic cancer; however, structured EUS features remain underused in predictive modeling. Objective: To assess the performance and interpretability of ML models for diagnosing pancreatic ductal adenocarcinoma (PDAC) using routinely collected EUS variables. Methods: We conducted a retrospective multicenter study using data from two Italian hospitals (n = 641) for model training and internal validation and from a third hospital (n = 120) for external validation, collected from 2015 to 2023. Decision trees, random forests, naïve Bayes and other classifiers were developed and evaluated. Model performance was assessed in terms of discriminative ability, calibration, and selective prediction. Results: All models demonstrated high discriminative performance (AUC ≥ 0.90). Decision trees provided the most favorable balance between interpretability and accuracy (balanced accuracy = 0.87; sensitivity = 0.89). Calibration and selective prediction analyses confirmed the robustness of the models. Conclusions: These findings demonstrate the feasibility of implementing interpretable yet high-performing ML models for PDAC diagnosis in real-life endoscopic settings. Full article

Background: Acute cholecystitis (AC) is a common inflammatory disease of the gallbladder. Although laparoscopic cholecystectomy remains the standard treatment, gallbladder drainage may be required in patients who are unsuitable for early surgery. Endoscopic transpapillary gallbladder drainage (ETGBD), including endoscopic nasogallbladder drainage (ENGBD) and endoscopic gallbladder stenting (EGBS), has increasingly been used as a minimally invasive internal drainage approach. Aims: This review aims to clarify the role of ETGBD in AC by integrating stepwise technical failure analysis with a practical selection framework among other drainage techniques. Methods: This narrative review was conducted through a structured literature search of PubMed, Embase, Web of Science, and the Cochrane Library up to 30 April 2026. Results: ETGBD preserves native gallbladder anatomy and may have specific value in selected patients, particularly when gallbladder preservation is desirable or concomitant endoscopic retrograde cholangiopancreatography (ERCP) is indicated. Recent technical developments, including cholangioscopy and advanced drainage devices, may support procedural planning and clinical management in selected difficult cases. Compared with percutaneous transhepatic gallbladder drainage (PTGBD) or endoscopic ultrasound-guided gallbladder drainage (EUS-GBD), ETGBD should be regarded as a complementary option rather than a universal substitute, and its application remains limited by variable technical success, cystic duct anatomy, operator expertise, and center experience. However, ETGBD may also be combined with other techniques, providing additional options in selected complex clinical scenarios. Conclusions: Adequately powered multicenter comparative studies with standardized outcome definitions are needed to clarify the optimal role, safety, recurrence risk, and long-term stent management of ETGBD. Full article

Cronkhite–Canada syndrome is a rare, non-hereditary polyposis syndrome characterized by non-specific gastrointestinal symptoms accompanied by alopecia, cutaneous hyperpigmentation, and nail dystrophy. Characteristic endoscopic findings are diffuse sessile polypoid lesions with edematous mucosa. We report a case of a 44-year-old woman in whom intestinal ultrasound and CT revealed diffuse mucosal thickening and an ileocecal intussusception—findings that may not be pathognomonic but are highly unusual in adults. These imaging features served as critical red flags that directed the clinical suspicion toward Cronkhite–Canada syndrome and prompted timely endoscopic confirmation. Full article

Background/Objectives: Magnetotactic bacteria therapy is an emerging active intratumoral drug delivery platform in which drug-loaded, magnetically responsive bacteria are injected into a tumor and navigated through its microenvironment toward defined targets using an external magnetic field, fundamentally distinct from passive intratumoral injection. No endoscopic ultrasound (EUS)- or ultrasound (US)-guided delivery workflow for MTBT has been described, and five critical technical prerequisites for clinical translation remain unaddressed: three-body image registration, minimum contrast concentration for cone-beam computed tomography (CBCT) bolus localization, needle repositioning accuracy, optimal fiducial strategy, and EUS/US procedural feasibility within the magnetic guidance apparatus. Methods: In three healthy female swine, we tested an image-guided intratumoral workflow at pancreatic and rectal sites. Gold rod fiducials were implanted under EUS in two animals and via transabdominal/endorectal US in one animal. A needle was navigated toward the implanted fiducial group using real-time gold-fiducial shine-through, and 2 mL of saline mixed with iodine contrast (Isovue-370) at 15%, 10%, or 5% v/v (one concentration per animal) was injected. Scan with CBCT was acquired before and after injection; fiducials, needle tip, and contrast bolus were segmented in 3D Slicer and their centroids compared to quantify targeting accuracy. Contrast visibility and artifact were scored by an expert radiologist on a five-point Likert scale. EUS feasibility within the magnetic apparatus was assessed using a full-scale cardboard replica of the CuraDrone PolarTrak. Results: Five percent v/v Isovue-370 was the minimum concentration for reliable CBCT bolus identification (280–360 HU; 1:1 injection-to-volume ratio). Needle repositioning accuracy was ≤2 cm in 5/6 sites using fiducial shine-through guidance. Gold rod fiducials served a dual role: CBCT tumor registration and real-time EUS/US navigation, not previously described for intratumoral injection. EUS was feasible within the PolarTrak with defined workflow adaptations. Conclusions: This pilot study demonstrates the technical feasibility of an EUS/US–CBCT workflow for MTBT, yielding quantitative, actionable parameters for first-in-human trial design. These feasibility findings, obtained in a small healthy animal cohort, are intended to inform the design of subsequent clinical studies. Full article

Background/Objectives: Intestinal ultrasound (IUS) is a non-invasive and reliable technique for the assessment and monitoring of ulcerative colitis (UC) in the era of tight disease control, although its accuracy is reduced for rectal evaluation. Its utility is further enhanced by transperineal ultrasonography (TPUS) and has also been demonstrated in patients with acute severe ulcerative colitis (ASUC) and in the postoperative assessment of ileal pouch function. Methods: We performed a narrative review on the emerging applications of IUS in UC with the findings obtained from research on the abovementioned topic on the PubMed database. Our search terms were “inflammatory bowel disease”, “IBD”, “ulcerative colitis”, “intestinal ultrasound”, “TPUS”, “HH”, “point of care ultrasound”, and “bowel ultrasound”. Results: IUS can assess UC disease activity and could be used in monitoring treatment response. Rectal assessment may represent a limitation of standard IUS, but the use of TPUS can overcome this issue, thus also allowing pouch evaluation after surgery. Another emerging application of IUS is in ASUC, a potential life-threatening condition where complete endoscopic assessment may not be feasible, so IUS could be a valid technique to assess disease extension and, in the first days, response to rescue therapy. Moreover, the use of hand-held sonography (HH), with portable ultrasonographic devices allowing point-of-care, bedside examination in various settings, is rising, showing accuracy comparable to standard techniques. Conclusions: IUS is emerging as a valuable tool in the management of patients with UC and could be an attractive option for point-of-care evaluation in the diagnosis, monitoring and prediction of long-term disease course, even after surgery or in the setting of ASUC. Complementary tools, such as TPUS and hand-held ultrasound, represent promising technologies, requiring prospective multicenter validation before routine clinical implementation. Full article

Background/Objectives: Pancreatic metastases are uncommon, and local treatment is reserved for selected patients with limited disease. Surgery remains the standard option when feasible, but may be inappropriate in patients with small, multifocal, anatomically challenging, or medically high-risk lesions. This study evaluated endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) as an organ-preserving local treatment for pancreatic metastases. Methods: Consecutive adult patients undergoing EUS-RFA for histologically confirmed pancreatic metastases at a tertiary endoscopy center between February 2021 and December 2025 were included. All cases were discussed in a multidisciplinary setting. EUS-RFA was performed using a 19G internally cooled RFA needle under real-time EUS guidance. The primary endpoint was initial complete radiological response, defined as complete ablation on first follow-up imaging. Secondary endpoints included technical success, radiological response, repeat EUS-RFA, adverse events, follow-up, and survival. Results: Eleven patients were treated; the mean age was 72.4 ± 6.4 years, and 7/11 (63.6%) were women. Primary tumors included renal cell carcinoma in 7/11 (63.6%), breast cancer in 2/11 (18.2%), melanoma in 1/11 (9.1%), and colorectal cancer in 1/11 (9.1%). Median lesion size was 10.5 mm. Technical success was achieved in 11/11 patients (100%). Initial complete radiological response at first follow-up was observed in 10/11 patients (90.9%); the remaining patient achieved complete response after repeat EUS-RFA. Adverse events occurred in 3/11 patients (27.3%), all mild and conservatively managed. No bleeding, perforation, pancreatic duct stenosis, pancreatic collection, or procedure-related death occurred. Median follow-up was 338 days. Conclusions: EUS-RFA appears feasible and generally well tolerated in carefully selected patients with pancreatic metastases, particularly small, well-visualized lesions when surgery is not feasible or an organ-preserving strategy is preferred. Larger prospective multicenter studies are needed. Although formal subgroup comparisons were not possible in this small cohort, lesion size, anatomical location, and primary tumor biology are likely to influence technical difficulty, local response, and the need for staged or repeat treatment. Full article