Interventional endoscopic ultrasonography(EUS) based on EUS-guided fine-needle aspiration has rapidly spread as a minimally invasive procedure. Especially in patients with failed endoscopic retrograde cholangiopancrea...Interventional endoscopic ultrasonography(EUS) based on EUS-guided fine-needle aspiration has rapidly spread as a minimally invasive procedure. Especially in patients with failed endoscopic retrograde cholangiopancreatography, EUS-guided biliary intervention is reported to be useful as salvage therapy. EUS-guided biliary interventions are carried out using three techniques: EUS-guided bilioenteric anastomosis, EUS-guided rendezvous procedure, and EUS-guided antegrade treatment. Although interventional EUS is not yet a standardized procedure, there have been recent advances in this field that address various biliary diseases. Here, we summarize the indications, techniques, clinical results of previous studies, and future perspectives.展开更多
BACKGROUND Fascia iliaca compartment block is a technique that blocks three nerves,similar to a 3-in-1 nerve block.This block provides analgesia for patients undergoing lower limb surgery,and is a simple technique tha...BACKGROUND Fascia iliaca compartment block is a technique that blocks three nerves,similar to a 3-in-1 nerve block.This block provides analgesia for patients undergoing lower limb surgery,and is a simple technique that is easy to implement.Here,we report a case of fascia iliaca compartment block in a patient with myocardial infarction who underwent emergency middle thigh amputation.CASE SUMMARY A 78-year-old female patient weighing 38 kg with gangrene and occlusive peripheral atherosclerosis of the right leg underwent an emergency middle thigh amputation.The patient had a history of hypertension,coronary heart disease,cerebral infarction,anterior wall myocardial infarction,and had recently undergone percutaneous coronary intervention consisting of coronary angiography and right coronary artery stent implantation.Considering the patient's condition,an ultrasound-guided fascia iliaca compartment block combined with general anesthesia was implemented for amputation.The fascia iliaca compartment block provided analgesia for the operation,and reduced the dosage of general anesthetics.It also alleviated adverse cardiovascular effects caused by pain stress,and ensured the safety of the patient during the perioperative period.This block also provided postoperative analgesia.The patient had a good prognosis,and was subsequently discharged from hospital.CONCLUSION Fascia iliaca compartment block provides surgical analgesia.It also alleviates adverse cardiovascular effects,and ensures patient safety during the perioperative period.展开更多
AIM:To evaluate the feasibility of diagnostic and therapeutic transgastric(TG)peritoneoscopic interventions with a forward-viewing endoscopic ultrasound(FV-EUS).METHODS:This prospective endoscopic experimental study u...AIM:To evaluate the feasibility of diagnostic and therapeutic transgastric(TG)peritoneoscopic interventions with a forward-viewing endoscopic ultrasound(FV-EUS).METHODS:This prospective endoscopic experimental study used an animal model.Combined TG peritoneoscopic interventions and EUS examination of the intraabdominal organs were performed using an FV-EUS on 10 animal models(1 porcine and 9 canine).The procedures carried out include EUS evaluation and endoscopic biopsy of intraperitoneal organs,EUS-guided fine needle aspiration(EUS-FNA),EUS-guided radiofrequency ablation(EUS-RFA),and argon plasma coagulation(APC)for hemostatic control.The animals were kept alive for 7 d,and then necropsy was performed to evaluate results and complications.RESULTS:In all 10 animals,TG peritoneoscopy,followed by endoscopic biopsy for the liver,spleen,abdominal wall,and omentum,was performed successfully.APC helped control minor bleeding.Visualization of intra-abdominal solid organs with real-time EUS was accomplished with ease.Intraperitoneal EUS-FNA was successfully performed on the liver,spleen,and kidney.Similarly,a successful outcome was achieved with EUSRFA of the hepatic parenchyma.No adverse events were recorded during the study.CONCLUSION:Peritoneoscopic natural orifice transluminal endoscopic surgery(NOTES)interventions through FV-EUS were feasible in providing evaluation and performing endoscopic procedures.It promises potential as a platform for future EUS-based NOTES.展开更多
Endoscopic retrograde cholangiopancreatography(ERCP)is the preferred modality for drainage of the obstructed biliary tree.In patients with surgically altered anatomy,ERCP using standard techniques may not be feasible....Endoscopic retrograde cholangiopancreatography(ERCP)is the preferred modality for drainage of the obstructed biliary tree.In patients with surgically altered anatomy,ERCP using standard techniques may not be feasible.Enteroscope assisted ERCP is usually employed with variable success rate.With advent of endoscopic ultrasound(EUS),biliary drainage procedures in patients with biliary obstruction and surgically altered anatomy is safe and effective.In this narrative review,we discuss role of EUS guided biliary drainage in patients with altered anatomy and the various approaches used in patients with benign and malignant biliary obstruction.展开更多
Dextrocardia refers to a right-sided location of the heart within the thoracic cavity which is the primary manifestation of the abnormal lateralisation of the embryonic leftright axis.[1]As a rare cardiac malformation...Dextrocardia refers to a right-sided location of the heart within the thoracic cavity which is the primary manifestation of the abnormal lateralisation of the embryonic leftright axis.[1]As a rare cardiac malformation,the prevalence rate of dextrocardia is between 1/6000 to 1/35000 live births.[2]It is reported that the incidence rate of coronary artery disease for dextrocardia patients is similar for patients without dextrocardia.However,the detailed information including electrocardiogram(ECG)manifestation and percutaneous coronary intervention(PCI)technique for dextrocardia patients is still limited.[3,4]Herein,we report a dextrocardia patient who was diagnosed by modified ECG and treated by trans-radial PCI facilitated with guiding extension catheter(GEC).展开更多
The linear echoendoscope,introduced in the 1990s,opened the era of interventional endoscopic ultrasound(IEUS).The linear echoendoscope enabled EUS guided Fine Needle Aspiration(EUS-FNA) allowing the path of the needle...The linear echoendoscope,introduced in the 1990s,opened the era of interventional endoscopic ultrasound(IEUS).The linear echoendoscope enabled EUS guided Fine Needle Aspiration(EUS-FNA) allowing the path of the needle to be traced during the puncture process.After EUS-FNA,other interventional procedures were introduced in clinical practice.Tissue acquisition was the first EUS-guided interventional procedure and its higher diagnostic quality has undoubtedly been established.After EUS-FNA,Celiac plexus neurolysis(CPN) and block(CPB),pancreatic pseudocyst drainage,abdominal and mediastinal collections/abscesses drainage,and in selected cases,pancreatic and biliary ductal system drainage,were introduced in clinical practice.EUS-guided fine needle injection with local delivery of antitumor agents is considered a promising modality.We have reviewed published data on EUS guided interventional procedures with the object of summarizing the diagnostic capability of endoscopic ultrasound and elaborates in detail its therapeutic capability and potential.展开更多
Both endoscopic ultrasonography(EUS)-guided choledochoduodenostomy( EUS- CDS) and EUS-guided hepaticogastrostomy(EUS-HGS) are relatively well established as alternatives to percutaneous transhepatic biliary drainage(P...Both endoscopic ultrasonography(EUS)-guided choledochoduodenostomy( EUS- CDS) and EUS-guided hepaticogastrostomy(EUS-HGS) are relatively well established as alternatives to percutaneous transhepatic biliary drainage(PTBD). Both EUSCDS and EUS-HGS have high technical and clinical success rates(more than 90%) in high-volume centers. Complications for both procedures remain high at 10%-30%. Procedures performed by endoscopists who have done fewer than 20 cases sometimes result in severe or fatal complications. When learning EUSguided biliary drainage(EUS-BD), we recommend a mentor's supervision during at least the first 20 cases. For inoperable malignant lower biliary obstruction, a skillful endoscopist should perform EUS-BD before EUS-guided rendezvous technique(EUS-RV) and PTBD. We should be select EUS-BD for patients having altered anatomy from malignant tumors before balloon-enteroscope-assisted endoscopic retrograde cholangiopancreatography, EUS-RV, and PTBD. If both EUS-CDS and EUS-HGS are available, we should select EUS-CDS, according to published data. EUSBD will potentially become a first-line biliary drainage procedure in the near future.展开更多
Currently,chemotherapy is an accredited,standard treatment for unresectable,advanced pancreatic cancer(PC). However,it has been still showed treatmentresistance and followed dismal prognosis in many cases. Therefore,s...Currently,chemotherapy is an accredited,standard treatment for unresectable,advanced pancreatic cancer(PC). However,it has been still showed treatmentresistance and followed dismal prognosis in many cases. Therefore,some sort of new,additional treatments are needed for the better therapeutic results for advanced PC. According to the previous reports,it is obvious that interventional endoscopic ultrasonography(EUS) is a well-established,helpful and low-risky procedure in general. As the additional treatments of the conventional therapy for advanced PC,many therapeutic strategies,such as immunotherapies,molecular biological therapies,physiochemical therapies,radioactive therapies,using si RNA,using autophagy have been developing in recent years. Moreover,the efficacy of the other potential therapeutic targets for PC using EUS-fine needle injection,for example,intra-tumoral chemotherapeutic agents(paclitaxel,irinotecan),several ablative energies(radiofrequency ablation and cryothermal treatment,neodymiumdoped yttrium aluminum garnet laser,high-intensity focused ultrasound),etc.,has already been showed in animal models. Delivering these promising treatments reliably inside tumor,interventional EUS may probably be indispensable existence for the treatment of locally advanced PC in near future.展开更多
BACKGROUND Although several techniques for endoscopic ultrasound-guided biliary drainage(EUS-BD)are available at present,an optimal treatment algorithm of EUS-BD has not yet been established.AIM To evaluate the clinic...BACKGROUND Although several techniques for endoscopic ultrasound-guided biliary drainage(EUS-BD)are available at present,an optimal treatment algorithm of EUS-BD has not yet been established.AIM To evaluate the clinical utility of treatment method conversion during single endoscopic sessions for difficult cases in initially planned EUS-BD.METHODS This was a single-center retrospective analysis using a prospectively accumulated database.Patients with biliary obstruction undergoing EUS-BD between May 2008 and April 2016 were included.The primary outcome was to evaluate the improvement in EUS-BD success rates by converting the treatment methods during a single endoscopic session.Secondary outcomes were clarification of the factors leading to the conversion from the initial EUS-BD and the assessment of efficacy and safety of the conversion as judged by technical success,clinical success,and adverse events(AEs).RESULTS A total of 208 patients underwent EUS-BD during the study period.For 18.8%(39/208)of the patients,the treatment methods were converted to another EUSBD technique from the initial plan.Biliary obstruction was caused by pancreatobiliary malignancies,other malignant lesions,biliary stones,and other benign lesions in 22,11,4,and 2 patients,respectively.The reasons for the difficulty with the initial EUS-BD were classified into the following 3 procedures:Target puncture(n=13),guidewire manipulation(n=18),and puncture tract dilation(n=8).Technical success was achieved in 97.4%(38/39)of the cases and clinical success was achieved in 89.5%of patients(34/38).AEs occurred in 10.3%of patients,including bile leakage(n=2),bleeding(n=1),and cholecystitis(n=1).The puncture target and drainage technique were altered in subsequent EUSBD procedures in 25 and 14 patients,respectively.The final technical success rate with 95%CI for all 208 cases was 97.1%(95%CI:93.8%-98.9%),while that of the initially planned EUS-BD was 78.8%(95%CI:72.6%-84.2%).CONCLUSION Among multi-step procedures in EUS-BD,guidewire manipulation appeared to be the most technically challenging.When initially planned EUS-BD is technically difficult,treatment method conversion in a single endoscopic session may result in successful EUS-BD without leading to severe AEs.展开更多
AIM: To investigate if magnetic resonance(MR)-guided biopsy can improve the performance and safety of such procedures. METHODS: A novel MR-compatible bioptome was evaluated in a series of in-vitro experiments in a 1.5...AIM: To investigate if magnetic resonance(MR)-guided biopsy can improve the performance and safety of such procedures. METHODS: A novel MR-compatible bioptome was evaluated in a series of in-vitro experiments in a 1.5T magnetic resonance imaging(MRI) system. The bioptome was inserted into explanted porcine and bovine hearts under real-time MR-guidance employing a steady state free precession sequence. The artifact produced by the metal element at the tip and the signal voids caused by the bioptome were visually tracked for navigation and allowed its constant and precise localization. RESULTS: Cardiac structural elements and the target regions for the biopsy were clearly visible. Our method allowed a significantly better spatial visualization of the bioptoms tip compared to conventional X-ray guidance. The specific device design of the bioptome avoided inducible currents and therefore subsequent heating. The novel MR-compatible bioptome provided a superior cardiovascular magnetic resonance(imaging) soft-tissue visualization for MR-guided myocardial biopsies. Not at least the use of MRI guidance for endomyocardial biopsies completely avoided radiation exposure for both patients and interventionalists.CONCLUSION: MRI-guided endomyocardial biopsies provide a better than conventional X-ray guided navigation and could therefore improve the specificity and reproducibility of cardiac biopsies in future studies.展开更多
文摘Interventional endoscopic ultrasonography(EUS) based on EUS-guided fine-needle aspiration has rapidly spread as a minimally invasive procedure. Especially in patients with failed endoscopic retrograde cholangiopancreatography, EUS-guided biliary intervention is reported to be useful as salvage therapy. EUS-guided biliary interventions are carried out using three techniques: EUS-guided bilioenteric anastomosis, EUS-guided rendezvous procedure, and EUS-guided antegrade treatment. Although interventional EUS is not yet a standardized procedure, there have been recent advances in this field that address various biliary diseases. Here, we summarize the indications, techniques, clinical results of previous studies, and future perspectives.
文摘BACKGROUND Fascia iliaca compartment block is a technique that blocks three nerves,similar to a 3-in-1 nerve block.This block provides analgesia for patients undergoing lower limb surgery,and is a simple technique that is easy to implement.Here,we report a case of fascia iliaca compartment block in a patient with myocardial infarction who underwent emergency middle thigh amputation.CASE SUMMARY A 78-year-old female patient weighing 38 kg with gangrene and occlusive peripheral atherosclerosis of the right leg underwent an emergency middle thigh amputation.The patient had a history of hypertension,coronary heart disease,cerebral infarction,anterior wall myocardial infarction,and had recently undergone percutaneous coronary intervention consisting of coronary angiography and right coronary artery stent implantation.Considering the patient's condition,an ultrasound-guided fascia iliaca compartment block combined with general anesthesia was implemented for amputation.The fascia iliaca compartment block provided analgesia for the operation,and reduced the dosage of general anesthetics.It also alleviated adverse cardiovascular effects caused by pain stress,and ensured the safety of the patient during the perioperative period.This block also provided postoperative analgesia.The patient had a good prognosis,and was subsequently discharged from hospital.CONCLUSION Fascia iliaca compartment block provides surgical analgesia.It also alleviates adverse cardiovascular effects,and ensures patient safety during the perioperative period.
文摘AIM:To evaluate the feasibility of diagnostic and therapeutic transgastric(TG)peritoneoscopic interventions with a forward-viewing endoscopic ultrasound(FV-EUS).METHODS:This prospective endoscopic experimental study used an animal model.Combined TG peritoneoscopic interventions and EUS examination of the intraabdominal organs were performed using an FV-EUS on 10 animal models(1 porcine and 9 canine).The procedures carried out include EUS evaluation and endoscopic biopsy of intraperitoneal organs,EUS-guided fine needle aspiration(EUS-FNA),EUS-guided radiofrequency ablation(EUS-RFA),and argon plasma coagulation(APC)for hemostatic control.The animals were kept alive for 7 d,and then necropsy was performed to evaluate results and complications.RESULTS:In all 10 animals,TG peritoneoscopy,followed by endoscopic biopsy for the liver,spleen,abdominal wall,and omentum,was performed successfully.APC helped control minor bleeding.Visualization of intra-abdominal solid organs with real-time EUS was accomplished with ease.Intraperitoneal EUS-FNA was successfully performed on the liver,spleen,and kidney.Similarly,a successful outcome was achieved with EUSRFA of the hepatic parenchyma.No adverse events were recorded during the study.CONCLUSION:Peritoneoscopic natural orifice transluminal endoscopic surgery(NOTES)interventions through FV-EUS were feasible in providing evaluation and performing endoscopic procedures.It promises potential as a platform for future EUS-based NOTES.
文摘Endoscopic retrograde cholangiopancreatography(ERCP)is the preferred modality for drainage of the obstructed biliary tree.In patients with surgically altered anatomy,ERCP using standard techniques may not be feasible.Enteroscope assisted ERCP is usually employed with variable success rate.With advent of endoscopic ultrasound(EUS),biliary drainage procedures in patients with biliary obstruction and surgically altered anatomy is safe and effective.In this narrative review,we discuss role of EUS guided biliary drainage in patients with altered anatomy and the various approaches used in patients with benign and malignant biliary obstruction.
基金the Chinese Cardiovascular Association-V.G.(2017-CCA-VG-042).
文摘Dextrocardia refers to a right-sided location of the heart within the thoracic cavity which is the primary manifestation of the abnormal lateralisation of the embryonic leftright axis.[1]As a rare cardiac malformation,the prevalence rate of dextrocardia is between 1/6000 to 1/35000 live births.[2]It is reported that the incidence rate of coronary artery disease for dextrocardia patients is similar for patients without dextrocardia.However,the detailed information including electrocardiogram(ECG)manifestation and percutaneous coronary intervention(PCI)technique for dextrocardia patients is still limited.[3,4]Herein,we report a dextrocardia patient who was diagnosed by modified ECG and treated by trans-radial PCI facilitated with guiding extension catheter(GEC).
文摘The linear echoendoscope,introduced in the 1990s,opened the era of interventional endoscopic ultrasound(IEUS).The linear echoendoscope enabled EUS guided Fine Needle Aspiration(EUS-FNA) allowing the path of the needle to be traced during the puncture process.After EUS-FNA,other interventional procedures were introduced in clinical practice.Tissue acquisition was the first EUS-guided interventional procedure and its higher diagnostic quality has undoubtedly been established.After EUS-FNA,Celiac plexus neurolysis(CPN) and block(CPB),pancreatic pseudocyst drainage,abdominal and mediastinal collections/abscesses drainage,and in selected cases,pancreatic and biliary ductal system drainage,were introduced in clinical practice.EUS-guided fine needle injection with local delivery of antitumor agents is considered a promising modality.We have reviewed published data on EUS guided interventional procedures with the object of summarizing the diagnostic capability of endoscopic ultrasound and elaborates in detail its therapeutic capability and potential.
文摘Both endoscopic ultrasonography(EUS)-guided choledochoduodenostomy( EUS- CDS) and EUS-guided hepaticogastrostomy(EUS-HGS) are relatively well established as alternatives to percutaneous transhepatic biliary drainage(PTBD). Both EUSCDS and EUS-HGS have high technical and clinical success rates(more than 90%) in high-volume centers. Complications for both procedures remain high at 10%-30%. Procedures performed by endoscopists who have done fewer than 20 cases sometimes result in severe or fatal complications. When learning EUSguided biliary drainage(EUS-BD), we recommend a mentor's supervision during at least the first 20 cases. For inoperable malignant lower biliary obstruction, a skillful endoscopist should perform EUS-BD before EUS-guided rendezvous technique(EUS-RV) and PTBD. We should be select EUS-BD for patients having altered anatomy from malignant tumors before balloon-enteroscope-assisted endoscopic retrograde cholangiopancreatography, EUS-RV, and PTBD. If both EUS-CDS and EUS-HGS are available, we should select EUS-CDS, according to published data. EUSBD will potentially become a first-line biliary drainage procedure in the near future.
文摘Currently,chemotherapy is an accredited,standard treatment for unresectable,advanced pancreatic cancer(PC). However,it has been still showed treatmentresistance and followed dismal prognosis in many cases. Therefore,some sort of new,additional treatments are needed for the better therapeutic results for advanced PC. According to the previous reports,it is obvious that interventional endoscopic ultrasonography(EUS) is a well-established,helpful and low-risky procedure in general. As the additional treatments of the conventional therapy for advanced PC,many therapeutic strategies,such as immunotherapies,molecular biological therapies,physiochemical therapies,radioactive therapies,using si RNA,using autophagy have been developing in recent years. Moreover,the efficacy of the other potential therapeutic targets for PC using EUS-fine needle injection,for example,intra-tumoral chemotherapeutic agents(paclitaxel,irinotecan),several ablative energies(radiofrequency ablation and cryothermal treatment,neodymiumdoped yttrium aluminum garnet laser,high-intensity focused ultrasound),etc.,has already been showed in animal models. Delivering these promising treatments reliably inside tumor,interventional EUS may probably be indispensable existence for the treatment of locally advanced PC in near future.
文摘BACKGROUND Although several techniques for endoscopic ultrasound-guided biliary drainage(EUS-BD)are available at present,an optimal treatment algorithm of EUS-BD has not yet been established.AIM To evaluate the clinical utility of treatment method conversion during single endoscopic sessions for difficult cases in initially planned EUS-BD.METHODS This was a single-center retrospective analysis using a prospectively accumulated database.Patients with biliary obstruction undergoing EUS-BD between May 2008 and April 2016 were included.The primary outcome was to evaluate the improvement in EUS-BD success rates by converting the treatment methods during a single endoscopic session.Secondary outcomes were clarification of the factors leading to the conversion from the initial EUS-BD and the assessment of efficacy and safety of the conversion as judged by technical success,clinical success,and adverse events(AEs).RESULTS A total of 208 patients underwent EUS-BD during the study period.For 18.8%(39/208)of the patients,the treatment methods were converted to another EUSBD technique from the initial plan.Biliary obstruction was caused by pancreatobiliary malignancies,other malignant lesions,biliary stones,and other benign lesions in 22,11,4,and 2 patients,respectively.The reasons for the difficulty with the initial EUS-BD were classified into the following 3 procedures:Target puncture(n=13),guidewire manipulation(n=18),and puncture tract dilation(n=8).Technical success was achieved in 97.4%(38/39)of the cases and clinical success was achieved in 89.5%of patients(34/38).AEs occurred in 10.3%of patients,including bile leakage(n=2),bleeding(n=1),and cholecystitis(n=1).The puncture target and drainage technique were altered in subsequent EUSBD procedures in 25 and 14 patients,respectively.The final technical success rate with 95%CI for all 208 cases was 97.1%(95%CI:93.8%-98.9%),while that of the initially planned EUS-BD was 78.8%(95%CI:72.6%-84.2%).CONCLUSION Among multi-step procedures in EUS-BD,guidewire manipulation appeared to be the most technically challenging.When initially planned EUS-BD is technically difficult,treatment method conversion in a single endoscopic session may result in successful EUS-BD without leading to severe AEs.
基金Supported by The German Research Foundation(KA493/6_1)
文摘AIM: To investigate if magnetic resonance(MR)-guided biopsy can improve the performance and safety of such procedures. METHODS: A novel MR-compatible bioptome was evaluated in a series of in-vitro experiments in a 1.5T magnetic resonance imaging(MRI) system. The bioptome was inserted into explanted porcine and bovine hearts under real-time MR-guidance employing a steady state free precession sequence. The artifact produced by the metal element at the tip and the signal voids caused by the bioptome were visually tracked for navigation and allowed its constant and precise localization. RESULTS: Cardiac structural elements and the target regions for the biopsy were clearly visible. Our method allowed a significantly better spatial visualization of the bioptoms tip compared to conventional X-ray guidance. The specific device design of the bioptome avoided inducible currents and therefore subsequent heating. The novel MR-compatible bioptome provided a superior cardiovascular magnetic resonance(imaging) soft-tissue visualization for MR-guided myocardial biopsies. Not at least the use of MRI guidance for endomyocardial biopsies completely avoided radiation exposure for both patients and interventionalists.CONCLUSION: MRI-guided endomyocardial biopsies provide a better than conventional X-ray guided navigation and could therefore improve the specificity and reproducibility of cardiac biopsies in future studies.
