Endoscopic ultrasonography-related diagnostic accuracy and clinical significance on small rectal neuroendocrine neoplasms

This research aimed to examine the diagnostic accuracy and clinical significance of endoscopic ultrasonography(EUS)in the context of small rectal neuroendocrine neoplasms(NENs).A total of 108 patients with rectal subepithelial lesions(SELs)with a diameter of<20 mm were included in the analysis.The diagnosis and depth assessment of EUS was compared to the histology findings.The prevalence of NENs in rectal SELs was 78.7%(85/108).The sensitivity of EUS in detecting rectal NENs was 98.9%(84/85),while the specificity was 52.2%(12/23).Overall,the diagnostic accuracy of EUS in identifying rectal NENs was 88.9%(96/108).The overall accuracy rate for EUS in assessing the depth of invasion in rectal NENs was 92.9%(78/84).Therefore,EUS demonstrates reasonable diagnostic accuracy in detecting small rectal NENs,with good sensitivity but inferior specificity.EUS may also assist physicians in assessing the depth of invasion in small rectal NENs before endoscopic excision.

Comprehensive review on the diagnostic strategies for esophageal tuberculosis:the role of endoscopic ultrasonography

Esophageal tuberculosis(ET)is a relatively rare clinical condition,characterized by often atypical clinical features.The lack of specificity in diagnostic methods,such as esophagogastroduodenoscopy and various imaging techniques,frequently leads to misdiagnosis and inappropriate treatments.Compared to esophagogastroduodenoscopy,endoscopic ultrasonography(EUS)offers a more comprehensive examination of esophageal tuberculosis lesions,including the extent of wall layer involvement and the internal structure characteristics of the lesions.Furthermore,when necessary,endoscopic ultrasonography-guided fine-needle aspiration can be employed to acquire deeper pathological tissue,significantly aiding diagnosis.When combined with the patient’s clinical presentation,endoscopic findings,and pathological features,EUS plays a crucial role in the definitive diagnosis of ET and in the differential diagnosis process.This article meticulously reviews both national and international literature to summarize the relevant features of ET,with a focus on its appearance under EUS,and to highlight the clinical value of EUS in enhancing the diagnosis of ET and in distinguishing it from other conditions.The aim is to offer guidance for the accurate diagnosis of ET.

TACC diagnosed by transoesophageal endoscopic ultrasonography:A case report

BACKGROUND Primary adenoid cystic carcinoma in the trachea(TACC)is a rare tumour.Tracheal bronchoscopy is always chosen as a routine approach to obtain a pathological diagnosis,but it can be associated with an increased risk of asphyxia.CASE SUMMARY We describe a case of TACC in a patient evaluated by chest computed tomography(CT)with three-dimensional reconstruction imaging and diagnosed by transoesophageal endoscopic ultrasonography.The pathological diagnosis confirmed tracheal adenoid cystic carcinoma.CONCLUSION We highlight the importance of CT and provide a successful exploration of transoesophageal biopsy as a safe alternative approach.

Are biopsies during endoscopic ultrasonography necessary for a suspected esophageal leiomyoma?Is laparoscopy always feasible?

The present letter to the editor is related to the work entitled“Large leiomyoma of lower esophagus diagnosed by endoscopic ultrasonography-fine needle aspiration:A case report.”Although endoscopic ultrasonography seems necessary in a suspected leiomyoma of the esophagus,the performance of biopsies via fine needle aspiration is controversial as it increases the risk of complications such as bleeding,infection,and intraoperative perforations.Laparoscopy is the best treatment strategy for small tumors.Laparotomy with tumor enucleation or esophageal resection can be considered in large leiomyomas.

New treatment for gastric duplication cyst:Endoscopic ultrasonography-guided fine-needle aspiration combined with lauromacrogol sclerotherapy:A case report

BACKGROUND Gastric duplication cysts are very rare disease that are mainly diagnosed by endoscopic ultrasonographic fine-needle aspiration biopsy.In the past,this disease was usually treated with traditional surgery and rarely with minimally invasive endoscopic surgery.However,minimally invasive endoscopic therapy has many advantages,such as no skin wound,organ preservation,postoperative pain reduction,early food intake,fewer postoperative complications,and shorter post-procedure hospitalization.CASE SUMMARY We report a case of endoscopic ultrasonography-guided fine-needle aspiration(EUS-FNA)combined with lauromacrogol sclerotherapy for pyloric obstruction due to gastric duplication cysts.CONCLUSION EUS-FNA combined with lauromacrogol sclerotherapy provides a new option for the treatment of gastrointestinal duplication cysts.

Large leiomyoma of lower esophagus diagnosed by endoscopic ultrasonography–fine needle aspiration:A case report

BACKGROUND Benign esophageal tumors are rare accounting for<1%of esophageal tumors;two-thirds of which are leiomyomas.Esophageal leiomyoma is a benign tumor derived from mesenchymal tissue that is completely muscularly differentiated.Most esophageal leiomyomas are<5 cm.Esophageal leiomyomas>5 cm are rare.We describe a case of a large esophageal leiomyoma involving the cardia and diaphragm.CASE SUMMARY A 35-year-old woman presented to the doctor because of a choking sensation after eating.Physical examination showed no positive signs.Gastroscopy indicated an uplifted change in the cardia.Enhanced computed tomography revealed spaceoccupying lesions in the lower part of the esophagus and cardia,which were likely to be malignant.Positron emission tomography–computed tomography showed increased metabolism of soft tissue masses in the lower esophagus and near the cardia.Malignant lesions were considered,and mesenchymal tumors were not excluded.Endoscopic ultrasonography was performed to examine a hypoechoic mass in the lower esophagus,which was unclear from the esophageal wall.Clinical evaluation suggested diagnosis of esophageal and cardiac stromal tumors.Finally,histological specimens obtained by endoscopic ultrasonography–fine needle aspiration suggested leiomyoma.The patient underwent laparoscopic local resection of the tumor.The postoperative pathological diagnosis was leiomyoma.CONCLUSION Endoscopic ultrasonography-fine needle aspiration is necessary for the diagnosis of gastrointestinal leiomyomas.It provides a strong basis for diagnosis of gastrointestinal tumors of unknown nature and origin.

Endoscopic ultrasonography in the evaluation of condition and prognosis of ulcerative colitis

BACKGROUND Ulcerative colitis(UC)is usually diagnosed through histopathology,enteroscopy,clinical symptoms,and physical findings;however,it is difficult to accurately evaluate disease severity.AIM To investigate the value of endoscopic ultrasonography(EUS)in the evaluation of the severity and prognosis of UC.METHODS Patients with UC who were seen in our hospital from March 2019 to December 2020 were eligible,and disease severity was evaluated according to the modified Truelove and Witts and Mayo scores.We performed EUS,calculated the UC endoscopic index of severity(UCEIS)and EUS-UC scores,and administered appropriate treatment.The UCEIS and EUS-UC scores of patients were assessed in relation to disease severity,and the correlations between UCEIS and EUS-UC scores and disease severity was also analyzed.The UCEIS and EUS-UC scores before and after treatment were also compared.RESULTS A total of 79 patients were included in this study.According to the Mayo Index,23,32,and 24 patients had mild,moderate and severe UC,respectively.The UCEIS and EUS-UC scores were higher in moderate cases(4.98±1.04 and 5.01±0.99,respectively)than in mild cases(1.56±0.82 and 1.64±0.91,respectively,P<0.05).Furthermore,the UCEIS and EUS-UC scores(7.31±1.10 and 7.59±1.02,respectively)were higher in severe cases than in moderate cases(P<0.05).According to the modified Truelove and Witts scores,21,36,and 22 patients were classified as having mild,moderate and severe disease,respectively.The UCEIS and EUS-UC scores were significantly higher in moderate disease(4.79±1.11 and 4.96±1.23,respectively)than in mild disease(1.71±0.78 and 1.69±0.88,respectively,P<0.05).Additionally,the UCEIS and EUS-UC scores in severe disease(7.68±1.22 and 7.81±0.90,respectively)were significantly higher than in moderate disease(P<0.05).The UCEIS and EUSUC scores were significantly and positively correlated with disease severity according to the modified Truelove and Witts score and Mayo score(P<0.05).The UCEIS and EUS-UC scores after 2 mo of treatment(3.88±0.95 and 4.01±1.14,respectively)and after 6 mo of treatment(1.59±0.63 and 1.64±0.59,respectively)were lower than the respective scores before treatment(5.93±1.79 and 6.04±2.01)(P<0.05).CONCLUSION EUS can clarify the status of UC and accurately evaluate the treatment response,providing an objective basis for formulation and adjustment of the treatment plan.

Is endoscopic ultrasonography essential for endoscopic resection of small rectal neuroendocrine tumors?

AIM To evaluate the importance of endoscopic ultrasonography(EUS) for small(≤ 10 mm) rectal neuroendocrine tumor(NET) treatment.METHODS Patients in whom rectal NETs were diagnosed by endoscopic resection(ER) at the Pusan National University Yangsan Hospital between 2008 and 2014 were included in this study. A total of 120 small rectal NETs in 118 patients were included in this study. Histologic features and clinical outcomes were analyzed, and the findings of endoscopy, EUS and histology were compared. RESULTS The size measured by endoscopy was not significantly different from that measured by EUS and histology(r = 0.914 and r = 0.727 respectively). Accuracy for the depth of invasion was 92.5% with EUS. No patients showed invasion of the muscularis propria or metastasis to the regional lymph nodes. All rectal NETswere classified as grade 1 and demonstrated an L-cell phenotype. Mean follow-up duration was 407.54 ± 374.16 d. No patients had local or distant metastasis during the follow-up periods. CONCLUSION EUS is not essential for ER in the patient with small rectal NETs because of the prominent morphology and benign behavior.

Diagnostic evaluation of endoscopic ultrasonography with submucosal saline injection for differentiating between T1a and T1b early gastric cancer

BACKGROUND Endoscopic ultrasonography(EUS)has become a reliable method for predicting the invasion depth of early gastric cancer(EGC).However,diagnostic accuracy of EUS is affected by several factors.In particular,it is difficult to differentiate between T1a and T1b EGC through EUS.AIM To confirm whether submucosal saline injection(SSI)could improve the accuracy of EUS in distinguishing T1a and T1b lesions in EGC.METHODS Twenty-four patients with EGC were examined by EUS and subsequently by SSI combined EUS to compare the degree of tumor invasion.Then,they underwent endoscopic or surgical resection within 7 d.The diagnostic accuracy of EUS and SSI combined EUS was evaluated based on the final pathological findings postoperatively.Saline injected into the submucosa acted as an echoic contrast enhancing agent and had the effect of distinguishing the mucosal and submucosal layers clearly.RESULTS Of total 24 patients,23 were diagnosed with EGC(T1 cancer:13 as T1a,and 10 as T1b).Standard EUS identified 6 of 13 T1a cancer patients and 3 of 10 T1b cancer patients.Whereas,EUS-SSI identified 12 of 13 T1a cancer patients and 6 of 10 T1b cancer patients.In this study,SSI combined EUS was more accurate than EUS alone in diagnosing T1a and T1b lesions of EGC(75.0%and 37.5%,respectively).CONCLUSION SSI improved the diagnostic accuracy of EUS in distinguishing between the T1a and T1b stages in EGC.

Endoscopic ultrasonography diagnosis of gastric glomus tumors

BACKGROUND A gastric glomus tumor is relatively rare,and there is little knowledge on its endoscopic ultrasound findings.AIM To assess the accuracy of endoscopic ultrasonography(EUS)in the diagnosis of gastric glomus tumor and to discuss its value by reviewing the literature.METHODS A retrospective analysis of the EUS characteristics of gastric glomus tumor(such as tumor location,shape,size,echogenicity,homogeneity,margins,layer of origin,and so on)was performed.The study included 12 cases of gastric glomus tumor confirmed by surgery and pathology(7 females and 5 males,age range 36-74 years,average age was 58.2 years).RESULTS All the lesions were located in the gastric antrum(12 cases),protruding into the cavity,with a diameter between 1 and 3.5 cm.Glomus tumor of the stomach manifested as a circumscribed and slightly hypoechoic mass in the fourth layer,with an internal heterogeneous echo mixed with hyperechogenic spots and a marginal more hypoechoic halo.Smooth muscle actin,h-caldesmon and vimentin were shown to be positive by immunohistochemistry.CONCLUSION Although glomus tumor of the stomach is relatively rare,a typical glomus tumor of the stomach has characteristic changes under EUS.

Application of endoscopic ultrasonography for detecting esophageal lesions based on convolutional neural network

BACKGROUND A convolutional neural network(CNN) is a deep learning algorithm based on the principle of human brain visual cortex processing and image recognition.AIM To automatically identify the invasion depth and origin of esophageal lesions based on a CNN.METHODS A total of 1670 white-light images were used to train and validate the CNN system.The method proposed in this paper included the following two parts:(1)Location module,an object detection network,locating the classified main image feature regions of the image for subsequent classification tasks;and(2) Classification module,a traditional classification CNN,classifying the images cut out by the object detection network.RESULTS The CNN system proposed in this study achieved an overall accuracy of 82.49%,sensitivity of 80.23%,and specificity of 90.56%.In this study,after follow-up pathology,726 patients were compared for endoscopic pathology.The misdiagnosis rate of endoscopic diagnosis in the lesion invasion range was approximately 9.5%;41 patients showed no lesion invasion to the muscularis propria,but 36 of them pathologically showed invasion to the superficial muscularis propria.The patients with invasion of the tunica adventitia were all treated by surgery with an accuracy rate of 100%.For the examination of submucosal lesions,the accuracy of endoscopic ultrasonography(EUS) was approximately 99.3%.Results of this study showed that EUS had a high accuracy rate for the origin of submucosal lesions,whereas the misdiagnosis rate was slightly high in the evaluation of the invasion scope of lesions.Misdiagnosis could be due to different operating and diagnostic levels of endoscopists,unclear ultrasound probes,and unclear lesions.CONCLUSION This study is the first to recognize esophageal EUS images through deep learning,which can automatically identify the invasion depth and lesion origin of submucosal tumors and classify such tumors,thereby achieving good accuracy.In future studies,this method can provide guidance and help to clinical endoscopists.

Determination of the ED95 of intranasal sufentanil combined with intranasal dexmedetomidine for moderate sedation during endoscopic ultrasonography

BACKGROUND Sedation during endoscopic ultrasonography(EUS)poses many challenges and moderate-to-deep sedation are often required.The conventional method to preform moderate-to-deep sedation is generally intravenous benzodiazepine alone or in combination with opioids.However,this combination has some limitations.Intranasal medication delivery may be an alternative to this sedation regimen.AIM To determine,by continual reassessment method(CRM),the minimal effective dose of intranasal sufentanil(SUF)when combined with intranasal dexmedetomidine(DEX)for moderate sedation of EUS in at least 95%of patients(ED95).METHODS Thirty patients aged 18-65 and scheduled for EUS were recruited in this study.Subjects received intranasal DEX and SUF for sedation.The dose of DEX(1μg/kg)was fixed,while the dose of SUF was assigned sequentially to the subjects using CRM to determine ED95.The sedation status was assessed by modified observer’s assessment of alertness/sedation(MOAA/S)score.The adverse events and the satisfaction scores of patients and endoscopists were recorded.RESULTS The ED95 was intranasal 0.3μg/kg SUF when combined with intranasal 1μg/kg DEX,with an estimated probability of successful moderate sedation for EUS of 94.9%(95%confidence interval:88.1%-98.9%).When combined with intranasal 1μg/kg DEX,probabilities of successful moderate sedation at each dose level of intranasal SUF were as follows:0μg/kg SUF,52.8%;0.1μg/kg SUF,75.4%;0.2μg/kg SUF,89.9%;0.3μg/kg SUF,94.9%;0.4μg/kg SUF,98.0%;0.5μg/kg SUF,99.0%.CONCLUSION The ED95 needed for moderate sedation for EUS is intranasal 0.3μg/kg SUF when combined with intranasal 1μg/kg DEX,based on CRM.

Intranasal sufentanil combined with intranasal dexmedetomidine: A promising method for non-anesthesiologist sedation during endoscopic ultrasonography

Intranasal sufentanil combined with intranasal dexmedetomidine exhibited an estimated sedation success probability as high as 94.9%,higher satisfaction scores,and only minor adverse events during endoscopic ultrasonography(EUS).This is a promising method for EUS sedation that does not require the presence of an anesthesiologist.

Endoscopic ultrasonography drainage and debridement of an infected subcapsular hepatic hematoma:A case report

BACKGROUND Endoscopic ultrasonography(EUS)has evolved in the last years making it not only a diagnostic modality but a therapeutic procedure.EUS is now used as an alternative technique to percutaneous and surgical drainage.Even though EUS is a challenging procedure and not always suitable compared to percutaneous drainage,there is a need for developing new therapeutic approaches to the liver for when percutaneous drainage is not feasible.CASE SUMMARY We present the case of a 82 years old male who developed an infected subcapsular hepatic hematoma(SHH)of the left lobe following percutaneous biliary drainage.After 2 failed attempts of percutaneous drainage of the SHH and because the patients couldn’t withstand surgery,we conducted a EUS drainage and debridement of the SHH.Using a lumen apposing metal stent(LAMS)by a transgastric approach,we were able to gain endoscopic access to the SHH.With our experience in the debridement of walled off pancreatic necrosis using this technique,we were confident it was the right approach.After four debridement sessions,the computed tomography scan showed a clear regression of the SHH.CONCLUSION To our knowledge,this is the first case of successful endoscopic debridement of a SHH using a LAMS which appear to be feasible and safe in this specific case.

Machine learning in endoscopic ultrasonography and the pancreas:The new frontier?

Pancreatic diseases have a substantial burden on society which is predicted to increase further over the next decades.Endoscopic ultrasonography(EUS)remains the best available diagnostic method to assess the pancreas,however,there remains room for improvement.Artificial intelligence(AI)approaches have been adopted to assess pancreatic diseases for over a decade,but this methodology has recently reached a new era with the innovative machine learning algorithms which can process,recognize,and label endosonographic images.Our review provides a targeted summary of AI in EUS for pancreatic diseases.Included studies cover a wide spectrum of pancreatic diseases from pancreatic cystic lesions to pancreatic masses and diagnosis of pancreatic cancer,chronic pancreatitis,and autoimmune pancreatitis.For these,AI models seemed highly successful,although the results should be evaluated carefully as the tasks,datasets and models were greatly heterogenous.In addition to use in diagnostics,AI was also tested as a procedural real-time assistant for EUS-guided biopsy as well as recognition of standard pancreatic stations and labeling anatomical landmarks during routine examination.Studies thus far have suggested that the adoption of AI in pancreatic EUS is highly promising and further opportunities should be explored in the field.

Endoscopic ultrasonography: an advancing option with duality in both diagnosis and treatment of gastrointestinal oncology

Since their introduction into the clinical practices in 1980s, techniques of endoscopic ultrasonography（EUS） have been rapidly developing and are now in widespread use in gastrointestinal oncology. Evolving from the classical option, EUS today has been much innovated with addition of a variety of novel ideation which makes it a powerful tool with encouraging duality for both diagnostic and therapeutic purposes. There is a dire need for physicians in this field to understand the status quo of EUS as related to the management and detection of gastrointestinal tumors, which is globally reviewed in this paper.

Early endoscopic management of an infected acute necrotic collection misdiagnosed as a pancreatic pseudocyst: A case report

BACKGROUND Infected acute necrotic collection(ANC)is a fatal complication of acute pancre-atitis with substantial morbidity and mortality.Drainage plays an exceedingly important role as the first step in invasive intervention for infected necrosis;however,there is great controversy about the optimal drainage time,and better treatment should be explored.CASE SUMMARY We report the case of a 43-year-old man who was admitted to the hospital with severe intake reduction due to early satiety 2 wk after treatment for acute pancre-atitis;conservative treatment was ineffective,and a pancreatic pseudocyst was suspected on contrast-enhanced computed tomography(CT).Endoscopic ultra-sonography(EUS)suggested hyperechoic necrotic tissue within the cyst cavity.The wall was not completely mature,and the culture of the puncture fluid was positive for A-haemolytic Streptococcus.Thus,the final diagnosis of ANC in-fection was made.The necrotic collection was not walled off and contained many solid components;therefore,the patient underwent EUS-guided aspiration and lavage.Two weeks after the collection was completely encapsulated,pancreatic duct stent drainage via endoscopic retrograde cholangiopancreatography(ERCP)was performed,and the patient was subsequently successfully discharged.On repeat CT,the pancreatic cysts had almost disappeared during the 6-month fo-llow-up period after surgery.CONCLUSION Early EUS-guided aspiration and lavage combined with late ERCP catheter drainage may be effective methods for intervention in infected ANCs.

Endoscopic ultrasonography and submucosal resection in the diagnosis and treatment of rectal carcinoid tumors

Rectal carcinoid tumors are often diagnosed as .submucosal tumors on radiological or endoscopic examinations. Usually, its definite size and character, the infiltration of muscularis propria and vessels can not be correctly diagnosed preoperatively. In recent years, endoscopic ultrasonography （EUS） has been used in the diagnosis of submucosal tumors of the gastrointestinal tracts , Conventional endoscopic polypectomy allows local excision of local tumors, but is often associated with tumor involvement of the resection margin necessitates further interventions.

Laparoscopic resection and endoscopic submucosal dissection for treating gastric ectopic pancreas

BACKGROUND Gastric ectopic pancreas(GEP)is a rare developmental abnormality that refers to the existence of pancreatic tissue in the stomach with no anatomical relationship with the main pancreas.It is usually difficult to diagnose through histological examination,and the choice of treatment method is crucial.AIM To describe the endoscopic ultrasound characteristics of GEP and evaluate the value of laparoscopic resection(LR)and endoscopic submucosal dissection(ESD).METHODS Forty-nine patients with GEP who underwent ESD and LR in the Second Affiliated Hospital of Fujian Medical University from May 2018 to July 2023 were retrospectively included.Data on clinical characteristics,endoscopic ultrasonography(EUS),ESD,and LR were collected and analyzed.The characteristics of EUS and the efficacy of the two treatments were analyzed.RESULTS The average age of the patients was 43.31±13.50 years,and the average maximum diameter of the lesions was 1.55±0.70 cm.The lesion originated from the mucosa in one patient(2.04%),from the submucosa in 42 patients(85.71%),and from the muscularis propria in 6 patients(12.25%).Twenty-nine patients(59.20%)with GEP showed umbilical depression on endoscopy.The most common initial symptom of GEP was abdominal pain(40.82%).Tumor markers,including carcinoembryonic antigen(CEA)and carbohydrate antigen 19-9(CA19-9),were generally within the normal range.One patient(2.04%)with GEP had increased CEA and CA-19-9 levels.However,no cancer tissue was found on postoperative pathological examination,and tumor markers returned to normal levels after resecting the lesion.There was no significant difference in surgery duration(72.42±23.84 vs 74.17±12.81 min)or hospital stay(3.70±0.91 vs 3.83±0.75 d)between the two methods.LR was more often used for patients with larger tumors and deeper origins.The amount of bleeding was significantly higher in LR than in ESD(11.28±16.87 vs 16.67±8.76 mL,P<0.05).Surgery was associated with complete resection of the lesion without any serious complications;there were no cases of recurrence during the follow-up period.CONCLUSION GEP has unique characteristics in EUS.LR and ESD seem to be good choices for treating GEP.LR is better for large GEP with a deep origin.However,due to the rarity of GEP,multicenter large-scale studies are needed to describe its characteristics and evaluate the safety of LR and ESD.

Role of endoscopic ultrasound and endoscopic ultrasound-guided tissue acquisition in diagnosing hepatic focal lesions

BACKGROUND Endoscopic ultrasonography(EUS)has become an established method in diagnostic and therapeutic procedures in gastroenterology;however,it has recently gained a growing role in hepatology.AIM To evaluate the role of EUS features,strain elastography(SE),and EUS-tissue acquisition in diagnosing hepatic focal lesions(HFLs)that could affect further management.METHODS This cross-sectional study included 215 patients with pancreatic,biliary,or gastrointestinal malignancies referred for EUS examination.HFLs were identified in 43 patients(20%),and EUSguided tissue acquisition was performed from these lesions.RESULTS EUS features were highly sensitive(100%)but much less specific(57%)in diagnosing HFLs;the overall accuracy was 94%.Real-time elastography was also very sensitive(97%)but less specific(67%)in diagnosing HFLs;however,the overall accuracy was 92%.EUS tissue acquisition was extremely sensitive(100%)and specific(100%),with a 100%overall diagnostic accuracy.CONCLUSION The diagnostic utility of EUS-guided tissue acquisition was extremely accurate in diagnosing HFLs.EUS characteristics and real-time SE accurately predicted the histological diagnosis of both benign and malignant HFLs.