Endoscopic ultrasound-guided treatments: Are we getting evidence based- a systematic review

The continued need to develop less invasive alternatives to surgical and radiologic interventions has driven the development of endoscopic ultrasound(EUS)-guided treatments.These include EUS-guided drainage of pancreatic fluid collections,EUS-guided necrosectomy,EUS-guided cholangiography and biliary drainage,EUSguided pancreatography and pancreatic duct drainage,EUS-guided gallbladder drainage,EUS-guided drainage of abdominal and pelvic fluid collections,EUS-guided celiac plexus block and celiac plexus neurolysis,EUSguided pancreatic cyst ablation,EUS-guided vascular interventions,EUS-guided delivery of antitumoral agents and EUS-guided fiducial placement and brachytherapy.However these procedures are technically challenging and require expertise in both EUS and interventional endoscopy,such as endoscopic retrograde cholangiopancreatography and gastrointestinal stenting.We undertook a systematic review to record the entire body of literature accumulated over the past 2decades on EUS-guided interventions with the objective of performing a critical appraisal of published articles,based on the classification of studies according to levels of evidence,in order to assess the scientific progress made in this field.

Efficacy of radiofrequency ablation of hepatocellular carcinoma prior to liver transplantation and the need for competing-risk analysis

Radiofrequency ablation(RFA)currently represents a potentially curative treatment for hepatocellular carcinoma(HCC)in its early stages(1,2).Providing higher rates of complete necrosis of target tumor than other loco-regional therapies(LRTs),RFA plays an important role as bridge therapy to liver transplantation(LT)(3).In the study from Lee and colleagues of the UCLA medical center,published in issue of June 2017 of Hepatology,Authors analyzed the outcome of 121 patients with 156 de-novo HCC treated with RFA as initial stand-alone therapy(4).The study is a fair attempt to analyze the efficacy of RFA as bridge therapy to LT,considering all potential outcome measures.Nevertheless,some results passed unnoticed,while instead deserve further discussion.