Methods to increase the diagnostic efficiency of endoscopic ultrasound-guided fine-needle aspiration for solid pancreatic lesions:An updated review

Endoscopic ultrasound-guided fine-needle aspiration(EUS-FNA)is a means to procure adequate specimens for histological and cytologic analysis.The ideal EUS-FNA should be safe,accurate,and have a high sample adequacy rate and low adverse events rate.In recent years,many guidelines and trials on EUS-FNA have been published.The purpose of this article is to provide an update on the influence of some of the main factors on the diagnostic efficiency of EUS-FNA as well as a rare but serious complication known as needle tract seeding.

Efficacy of endoscopic ultrasound in the evaluation of small gastrointestinal stromal tumors

BACKGROUND Gastrointestinal stromal tumors(GISTs)with a diameter of<2 cm are called small GISTs.Currently,endoscopic ultrasound(EUS)is widely used as a regular followup method for GISTs,which can also provide a preliminary basis for judging the malignancy potential of lesions.However,there are no studies on the accuracy of EUS to assess the malignant potential of small GISTs.AIM To evaluate the efficacy of EUS in the diagnosis and risk assessment of small GISTs.METHODS We collected data from patients with small GISTs who were admitted to Shengjing Hospital of China Medical University between October 2014 and July 2019.The accurate diagnosis and risk classifications of patients were based on the pathological assessment according to the modified National Institute of Health criteria after endoscopic resection or laparoscopic surgery.Preoperative EUS features(marginal irregularity,cystic changes,homogeneity,ulceration,and strong echogenic foci)were retrospectively analyzed.The assessment results based on EUS features were compared with the pathological features.RESULTS A total of 256 patients(69 men and 187 women)were enrolled.Pathological results included 232,16,7,and 1 very low-,low-,intermediate-,and high-risk cases,respectively.The most frequent tumor location was the gastric fundus(78.1%),and mitoses were calculated as>5/50 high power field in 8(3.1%)patients.Marginal irregularity,ulceration,strong echo foci,and heterogeneity were detected in 1(0.4%),2(0.8%),22(8.6%),and 67(65.1%)patients,respectively.However,cystic changes were not detected.Tumor size was positively correlated with the mitotic index(P<0.001).Receiver operating curve analysis identified 1.48 cm as the best cut-off value to predict malignant potential(95%confidence interval:0.824–0.956).EUS heterogeneity with tumor diameters>1.48 cm was associated with higher risk classification(P<0.05).CONCLUSION Small GISTs(diameters>1.48 cm)with positive EUS features should receive intensive surveillance or undergo endoscopic surgery.EUS and dissection are efficient diagnostic and therapeutic approaches for small GISTs.

Peroral endoscopic myotomy for management of gastrointestinal motility disorder

Achalasia is a type of esophageal motility disorder,consisting of relaxation dysfunction of the lower esophagus and disturbed esophageal peristalsis.Related clinical symptoms include dysphagia,regurgitation,chest pain,and weight loss.Traditional treatment options include endoscopic botulinum toxin injection,endoscopic pneumatic dilation,and laparoscopic Heller’s myotomy.These therapies mainly relieve symptoms by reducing the pressure on the lower esophageal sphincter and reducing blood flow resistance at the esophagogastric junction.Based on endoscopic submucosal dissection and natural orifice transluminal endoscopic surgery,peroral endoscopic myotomy(POEM)is a purely endoscopic method of myotomy with minimal invasiveness and a low rate of adverse events when performed by experienced operators.Since then,numerous studies have shown the significant clinical efficacy and safety of POEM.The purpose of this article is to introduce different modified POEMs,special indications for different POEMs,and their advantages as well as disadvantages.