The gallbladder(GB)is a susceptible organ,prone to various pathologies that can be identified using different imaging techniques.Transabdominal ultrasound(TUS)is typically the initial diagnostic method due to its nume...The gallbladder(GB)is a susceptible organ,prone to various pathologies that can be identified using different imaging techniques.Transabdominal ultrasound(TUS)is typically the initial diagnostic method due to its numerous well-established advantages.However,in cases of uncertainty or when a definitive diagnosis cannot be established,computed tomography(CT)or magnetic resonance imaging may be employed to provide more detailed information.Nevertheless,CT scans may sometimes offer inadequate spatial resolution,which can limit the differentiation of GB lesions,particularly when smaller yet clinically relevant abnormalities are involved.Conversely,endoscopic ultrasound(EUS)provides higher frequency compared to TUS,superior spatial resolution,and the option for contrast-enhanced harmonic imaging,enabling a more comprehensive examination.Thus,EUS can serve as a supplementary tool when conventional imaging methods are insufficient.This review will describe the standard EUS examination of the GB,focusing on its endosonographic characteristics in various GB path-ologies.展开更多
Therapeutic flexible endoscopic robotic systems have been developed primarily as a platform for endoscopic submucosal dissection(ESD)in the treatment of earlystage gastrointestinal cancer.Since ESD can only be perform...Therapeutic flexible endoscopic robotic systems have been developed primarily as a platform for endoscopic submucosal dissection(ESD)in the treatment of earlystage gastrointestinal cancer.Since ESD can only be performed by highly skilled endoscopists,the goal is to lower the technical hurdles to ESD by introducing a robot.In some cases,such robots have already been used clinically,but they are still in the research and development stage.This paper outlined the current status of development,including a system by the author’s group,and discussed future challenges.展开更多
Gastric cancer(GC)represents the fourth leading cause of cancer death worldwide and many factors can influence its development(diet,geographic area,genetic,Helicobacter pylori or Epstein-Barr virus infections).High qu...Gastric cancer(GC)represents the fourth leading cause of cancer death worldwide and many factors can influence its development(diet,geographic area,genetic,Helicobacter pylori or Epstein-Barr virus infections).High quality endoscopy represents the modality of choice for GC diagnosis.The correct morphologic classification during a high-resolution endoscopy is fundamental for oncologic diagnosis,staging and therapeutic decisions.Since its initial introduction in clinical practice the endoscopic ultrasound(EUS)has been considered a valuable tool for tumor(T-)and lymph nodes(N-)staging also in GC,in order to establish the best therapeutic strategy for the patient(e.g.,upfront surgery vs neoadjuvant treatments).EUS tools as elastography,Doppler and contrast administration can improve diagnosis mainly in case of malignant lymph node evaluation.EUS has a marginal role in disease staging but has a fundamental role in case of a pre-endoscopic resection management and in the new era of endoscopic mucosal resection or submucosal dissection as minimally invasive surgery.Diagnosis and locoregional staging of GC with EUS are a method of inarguable value for the assessment of gastric wall involvement and presence of infiltrated paragastric lymph nodes.EUS can also have a role in disease restaging in those patients who have undergone neoadjuvant treatment.EUS can also have a role in the advanced phases of the disease,in facilitating palliative,minimallyinvasive treatments,such as gastroenterostomy or biliary drainages.This review intends to discuss the modern role of EUS in GC topic.展开更多
The authors report their experience about 8 cases of intrabiliary rupture of hepatobiliary hydatid disease, and add an algorithm for treatment. To our opinion, the use of diagnostic and therapeutic endoscopic retrogra...The authors report their experience about 8 cases of intrabiliary rupture of hepatobiliary hydatid disease, and add an algorithm for treatment. To our opinion, the use of diagnostic and therapeutic endoscopic retrograde cholangiopancreatography (ERCP) in the management of hepatobiliary hydatid disease was not stated properly in their proposed algorithm. According to the algorithm, the use of ERCP and related modalities was only stated in the case of postoperative biliary fistulae. We think that postoperative persistant fistula is not a sole indication, there are many indications for ERCP and related techniques namely sphincterotomy, extraction, nasobiliary drainage and stenting, in the treatment algorithm before or after surgery.展开更多
Gastroenterologists have long been spearheading the care of patients with various forms of liver disease.The diagnosis and management of liver disease has traditionally been a combination of clinical,laboratory,and im...Gastroenterologists have long been spearheading the care of patients with various forms of liver disease.The diagnosis and management of liver disease has traditionally been a combination of clinical,laboratory,and imaging findings coupled with percutaneous and intravascular procedures with endoscopy largely limited to screening for and therapy of esophageal and gastric varices.As the applications of diagnostic and therapeutic endoscopic ultrasound(EUS)have evolved,it has found a particular niche within hepatology now coined.Here we discuss several EUS-guided procedures such as liver biopsy,shear wave elastography,direct portal pressure measurement,paracentesis,as well as EUSguided therapies for variceal hemorrhage.展开更多
文摘The gallbladder(GB)is a susceptible organ,prone to various pathologies that can be identified using different imaging techniques.Transabdominal ultrasound(TUS)is typically the initial diagnostic method due to its numerous well-established advantages.However,in cases of uncertainty or when a definitive diagnosis cannot be established,computed tomography(CT)or magnetic resonance imaging may be employed to provide more detailed information.Nevertheless,CT scans may sometimes offer inadequate spatial resolution,which can limit the differentiation of GB lesions,particularly when smaller yet clinically relevant abnormalities are involved.Conversely,endoscopic ultrasound(EUS)provides higher frequency compared to TUS,superior spatial resolution,and the option for contrast-enhanced harmonic imaging,enabling a more comprehensive examination.Thus,EUS can serve as a supplementary tool when conventional imaging methods are insufficient.This review will describe the standard EUS examination of the GB,focusing on its endosonographic characteristics in various GB path-ologies.
基金Supported by Grant-in-Aid for Scientific Research (KAKENHI),No. 23500573, No. 263500554, No. 17K01431 and No. 20K12700Grant of the Princess Takamatsu Cancer Research Fund,No. 13-24505Terumo Life Science Foundation,No. 15-I101 and No. 20-III119
文摘Therapeutic flexible endoscopic robotic systems have been developed primarily as a platform for endoscopic submucosal dissection(ESD)in the treatment of earlystage gastrointestinal cancer.Since ESD can only be performed by highly skilled endoscopists,the goal is to lower the technical hurdles to ESD by introducing a robot.In some cases,such robots have already been used clinically,but they are still in the research and development stage.This paper outlined the current status of development,including a system by the author’s group,and discussed future challenges.
文摘Gastric cancer(GC)represents the fourth leading cause of cancer death worldwide and many factors can influence its development(diet,geographic area,genetic,Helicobacter pylori or Epstein-Barr virus infections).High quality endoscopy represents the modality of choice for GC diagnosis.The correct morphologic classification during a high-resolution endoscopy is fundamental for oncologic diagnosis,staging and therapeutic decisions.Since its initial introduction in clinical practice the endoscopic ultrasound(EUS)has been considered a valuable tool for tumor(T-)and lymph nodes(N-)staging also in GC,in order to establish the best therapeutic strategy for the patient(e.g.,upfront surgery vs neoadjuvant treatments).EUS tools as elastography,Doppler and contrast administration can improve diagnosis mainly in case of malignant lymph node evaluation.EUS has a marginal role in disease staging but has a fundamental role in case of a pre-endoscopic resection management and in the new era of endoscopic mucosal resection or submucosal dissection as minimally invasive surgery.Diagnosis and locoregional staging of GC with EUS are a method of inarguable value for the assessment of gastric wall involvement and presence of infiltrated paragastric lymph nodes.EUS can also have a role in disease restaging in those patients who have undergone neoadjuvant treatment.EUS can also have a role in the advanced phases of the disease,in facilitating palliative,minimallyinvasive treatments,such as gastroenterostomy or biliary drainages.This review intends to discuss the modern role of EUS in GC topic.
文摘The authors report their experience about 8 cases of intrabiliary rupture of hepatobiliary hydatid disease, and add an algorithm for treatment. To our opinion, the use of diagnostic and therapeutic endoscopic retrograde cholangiopancreatography (ERCP) in the management of hepatobiliary hydatid disease was not stated properly in their proposed algorithm. According to the algorithm, the use of ERCP and related modalities was only stated in the case of postoperative biliary fistulae. We think that postoperative persistant fistula is not a sole indication, there are many indications for ERCP and related techniques namely sphincterotomy, extraction, nasobiliary drainage and stenting, in the treatment algorithm before or after surgery.
文摘Gastroenterologists have long been spearheading the care of patients with various forms of liver disease.The diagnosis and management of liver disease has traditionally been a combination of clinical,laboratory,and imaging findings coupled with percutaneous and intravascular procedures with endoscopy largely limited to screening for and therapy of esophageal and gastric varices.As the applications of diagnostic and therapeutic endoscopic ultrasound(EUS)have evolved,it has found a particular niche within hepatology now coined.Here we discuss several EUS-guided procedures such as liver biopsy,shear wave elastography,direct portal pressure measurement,paracentesis,as well as EUSguided therapies for variceal hemorrhage.