Is endoscopic ultrasound a promising technique in the diagnosis and treatment of liver diseases?

Percutaneous ultrasound has been a longstanding method in the diagnostics and interventional procedures of liver diseases.In some countries,its use is restricted to radiologists,limiting access for other clinicians,such as gastroenterologists.Endoscopic ultrasound,as a novel technique,plays a crucial role in diagnosis and treatment of digestive diseases.However,its use is sometimes recommended for conditions where no clear advantage over percutaneous ultrasound exists,leaving the impression that clinicians sometimes resort to an endoscopic approach due to the unavailability of percutaneous options.

Could near focus endoscopy,narrow-band imaging,and acetic acid improve the visualization of microscopic features of stomach mucosa?

BACKGROUND Conventional magnifying endoscopy with narrow-band imaging(NBI)observation of the gastric body mucosa shows dominant patterns in relation to the regular arrangement of collecting venules,subepithelial capillary network,and gastric pits.AIM To evaluate the effectiveness of a new one-dual(near)focus,NBI mode in the assessment of the microscopic features of gastric body mucosa compared to conventional magnification.METHODS During 2021 and 2022,68 patients underwent proximal gastrointestinal endoscopy using magnification endoscopic modalities subsequently applying acetic acid(AA).The GIF-190HQ series NBI system with dual focus capability was used for the investigation of gastric mucosa.At the time of the endoscopy,the gastric body mucosa of all enrolled patients was photographed using the white light endoscopy(WLE),near focus(NF),NF-NBI,AA-NF,and AA-NF-NBI modes.RESULTS The WLE,NF and NF-NBI endoscopic modes for all patients(204 images)were classified in the same order into three groups.Two images from each patient for the AA-NF and AA-NF-NBI endoscopic modes were classified in the same order.According to all three observers who completed the work independently,NF magnification was significantly superior to WLE(P<0.01),and the NF-NBI mode was significantly superior to NF magnification(P<0.01).After applying AA,the three observers confirmed that AA-NF-NBI was significantly superior to AA-NF(P<0.01).Interobserver kappa values for WLE were 0.609,0.704,and 0.598,respectively and were 0.600,0.721,and 0.637,respectively,for NF magnification.For the NF-NBI mode,the values were 0.378,0.471,and 0.553,respectively.For AA-NF,they were 0.453,0.603,and 0.480,respectively,and for AA-NF-NBI,they were 0.643,0.506,and 0.354,respectively.CONCLUSION When investigating gastric mucosa in microscopic detail,NF-NBI was the most powerful endoscopic mode for assessing regular arrangement of collecting venules,subepithelial capillary network,and gastric pits among the five endoscopic modalities investigated in this study.AA-NF-NBI was the most powerful endoscopic mode for analyzing crypt opening and intervening part.

Current trends in acute pancreatitis:Diagnostic and therapeutic challenges

Acute pancreatitis(AP)is an inflammatory disease of the pancreas,which can progress to severe AP,with a high risk of death.It is one of the most complicated and clinically challenging of all disorders affecting the abdomen.The main causes of AP are gallstone migration and alcohol abuse.Other causes are uncommon,controversial and insufficiently explained.The disease is primarily characterized by inappropriate activation of trypsinogen,infiltration of inflammatory cells,and destruction of secretory cells.According to the revised Atlanta classification,severity of the disease is categorized into three levels:Mild,moderately severe and severe,depending upon organ failure and local as well as systemic complications.Various methods have been used for predicting the severity of AP and its outcome,such as clinical evaluation,imaging evaluation and testing of various biochemical markers.However,AP is a very complex disease and despite the fact that there are of several clinical,biochemical and imaging criteria for assessment of severity of AP,it is not an easy task to predict its subsequent course.Therefore,there are existing controversies regarding diagnostic and therapeutic modalities,their effectiveness and complications in the treatment of AP.The main reason being the fact,that the pathophysiologic mechanisms of AP have not been fully elucidated and need to be studied further.In this editorial article,we discuss the efficacy of the existing diagnostic and therapeutic modalities,complications and treatment failure in the management of AP.

Portal vein aneurysm-etiology,multimodal imaging and current management

Portal vein aneurysm(PVA)is a rare vascular abnormality,representing 3%of all venous aneurysms in the human body,and is not well understood.It can be congenital or acquired,located mainly at the level of confluence,main trunk,branches and bifurcation.A PVA as an abnormality of the portal venous system was first reported in 1956 by Barzilai and Kleckner.A review from 2015 entitled“Portal vein aneurysm:What to know”considered fewer than 200 cases.In the last seven years,there has been an increase in the number of PVAs diagnosed thanks to routine abdominal imaging.The aim of this review is to provide a comprehensive update of PVA,including aetiology,epidemiology,and clinical assessment,along with an evaluation of advanced multimodal imaging features of aneurysm and management approaches.