of 30 Pts (37%) the characteristic gastric IM pattern (CK7 GP and CK20 SP/GP) was demonstrated. C... more of 30 Pts (37%) the characteristic gastric IM pattern (CK7 GP and CK20 SP/GP) was demonstrated. Conclusions: LSBE demonstrates a distinct and reproducible CK7/CK20 pattern as described in the literature. Almost two-thirds of Pts with SSBE display cytokeratin staining consistent with esophageal IM. The remaining Pts with IM and suspected SSBE exhibit a characteristic gastric cardia pattern. Immunostaining may help to identify true SSBE from gastric cardia IM. 66 Multi-channel 24-hour pH monitoring and esophageal manometry in long (LSB)-and short-segment (SSB) Barrett's, gastroesophageal reflux (GER) and asymptomatic subjects (AS)
Objective: Endoscopic ultrasound (EUS)-guided drainage is a widely used treatment modality for pa... more Objective: Endoscopic ultrasound (EUS)-guided drainage is a widely used treatment modality for pancreatic pseudocysts (PPC). However, data on the clinical outcome and complication rates are conflicting. Our study aims to evaluate the rates of technical success, treatment success and complications of EUS-guided PPC drainage in a medium-term follow-up of 45 weeks. Materials and Methods: A retrospective review was conducted for 55 patients with symptomatic PPC from December 2005 to August 2010 drained by EUS. Medium-term follow-up data were obtained by searching their medical history or by telephonic interview. Results: A total of 61 procedures were performed. The symptoms that indicated drainage were abdominal pain (n = 43), vomiting (n = 7) and jaundice (n = 5). The procedure was technically successful in 57 of the 61 procedures (93%). The immediate complication rate was 5%. At a mean follow-up of 45 weeks, the treatment success was 75%. The medium term complications appeared in 25% of cases, which included three cases each of stent clogging, stent migration, infection and six cases of recurrence. There was no mortality. Conclusion: EUS-guided drainage is an effective treatment for PPC with a successful outcome in most of patients. Most of the complications require minimal invasive surgical treatment or repeated EUS-guided drainage procedures.
Blood-pool ultrasound contrast agents (UCSs) have the ability to image blood flow in soft tissues... more Blood-pool ultrasound contrast agents (UCSs) have the ability to image blood flow in soft tissues, which can be visualized at capillary level. Color Doppler has been integrated in EUS equipment since the introduction of electronic transducers and is able to visualize blood flow and its direction in small arteries and veins but not blood flow in capillaries or perfusion. Visualization of perfusion by contrast agents represents a new step in flow imaging and may separate hyper- and hypoperfused areas in tissue. This may be useful for tissue characterization and identification of tumors or abscesses or to guide intervention and tissue sampling.
Endoscopic ultrasound scanning (EUL) of the upper gastro-intestinal canal has rendered apparently... more Endoscopic ultrasound scanning (EUL) of the upper gastro-intestinal canal has rendered apparently very meticulous assessment of pathological conditions in and around the oesophagus, stomach and the duodenum possible during recent years. On account of the close contact with the mucosa, high-frequent ultrasound transducer with great solubility capacity are employed. The wall of the gastrointestinal canal may thus be presented and subdivided into five layers. The ultrasound gastroscope most employed at present is lateral visualizing gastroscope with a mechanically rotating sector scanner mounted distal to the optic. On the basis of the literature, the technique of the examination and the hitherto employed indications for EUL are reviewed. International attention has been focussed on employment of EUL for preoperative subdivision of tumours in the oesophagus, stomach, pancreas and biliary passages into stages. Individual centres have reported promising results compared with existing forms of examination such as CT, conventional radiography, endoscopy and external ultrasound scanning. It is concluded that the necessary apparatus has not yet been fully developed. In addition, more numerous and more extensive prospective investigations are necessary before EUL may possibly be considered as a routine method of examination.
International Journal of Colorectal Disease, Apr 21, 2017
Purpose With an increasing demand for more accurate preoperative staging methods for colon cancer... more Purpose With an increasing demand for more accurate preoperative staging methods for colon cancer, we aimed to compare preoperative tumour (T)-and nodal (N)-stage in patients with left-sided colon cancer by endoscopic ultrasonography (EUS) and computed tomography (CT) with post-operative histology as gold standard. Methods A total of 44 patients were prospectively recruited at Herlev and Roskilde University Hospitals during November 2014-January 2016. Thirty-five patients were included in the final analysis and underwent EUS, CT and surgery within 2 weeks. Diagnostic values were evaluated for Blow risk( T1+T2+T3 with ≤5 mm extramural invasion) and Bhigh risk( T3 with >5 mm of extramural spread + T4) colonic cancer. Results Sensitivity and specificity in Blow risk^colonic cancer evaluated with EUS was 0.90 [0.74;0.98] and 0.75 [0.19;0.99] and with CT 0.96 [0.80;0.99] and 0.25 [<0.01;0.81]. EUS and CT were poor in predicting N0 or N+ disease. Conclusions The sensitivity of EUS and CT were good and comparable regarding T-stage evaluation, while EUS had a significantly higher specificity in the evaluation of Blow riskt umours. The results obtained for Bhigh risk^colonic cancer were difficult to evaluate due to small patient numbers. EUS could be considered as a supplement to CT scans in selecting patients for neoadjuvant therapies, or local transmural treatment, in the future.
... von benignen und malignen Lymphknoten mit einer hohen Sensitivität, Spezifität und Genauigkei... more ... von benignen und malignen Lymphknoten mit einer hohen Sensitivität, Spezifität und Genauigkeit erlaubt und damit zusätzliche Information zur konventionellen EUS ... Photo-Paint (Corel Corporation) imaging program was used to manually select a region of interest (ROI) on the ...
Pancreatic cystic lesions are frequently encountered and diagnostically challenging as some of th... more Pancreatic cystic lesions are frequently encountered and diagnostically challenging as some of the cysts may have malignant potential (mucinous) while others are completely benign (serous). EUS-guided through-the-needle biopsy (EUS-TTNB) of the cyst wall has recently been introduced as an alternative to cyst fluid cytology. Several studies have shown that microbiopsies outperform cytology in terms of distinction between mucinous and nonmucinous lesions, but also in determining the specific cyst diagnosis. However, little is known about the technical aspects of tissue sampling with TTNB. Herein, we summarize our experience with the procedure in a tertiary referral center and discuss indications, technical aspects, and safety of the procedure. Most adverse events (AEs) associated with the procedure are mild, but there is emerging evidence that the rate of postprocedural pancreatitis is higher compared to standard fine-needle aspiration. The added diagnostic yield should therefore be placed in perspective with an increased risk of AEs. Prospective studies are warranted to fully identify which patient groups could benefit from EUS-TTNB.
Background and Aims: Dynamic contrast enhanced endoscopic ultrasound (CE-EUS) for quantification ... more Background and Aims: Dynamic contrast enhanced endoscopic ultrasound (CE-EUS) for quantification of perfusion in colonic tumors has not previously been reported in the literature. The aim of the study was to investigate correlations between perfusion parameters and vessel density assessed by immunohistochemical staining with antibodies toward CD31 and CD105. We conducted a prospective clinical study. In total, 28 patients with left-sided colonic adenocarcinoma, underwent CE-EUS and left-sided hemicolectomy within 2 weeks. CE-EUS recordings were analyzed in 2 regions of interest: the entire tumor and the most enhanced area. Immunohistochemical staining with CD31 and CD105 was performed on tumor tissue sections. The slides were manually scanned for highly vascularized areas and counting of vessels was performed in hotspots within the tumor and the invasive front. New vasculature was assessed by CD105. Associations between CE-EUS and CD31 and CD105 were investigated using Spearman correlation. We found significant p-values for the correlation between CD31 and rise time (rho = 0.603 [0.238;0.816]; p = 0.001) in tumor tissue and for the correlation between CD31 and rise time (rho = 0.50 [0.201;0.695]; p = 0.008) and fall time (rho = 0.52 [0.204;0.723]; p = 0.006) corresponding to the invasive front. We found no correlations between perfusion values evaluated by CE-EUS and CD105. Our results show that there is a significant correlation for vessel density evaluated by CD31 and perfusion parameters evaluated by CE-EUS. This may be the first step toward using real-time CE-EUS for monitoring antiangiogenic therapies in colonic cancer.
such as age, gender, and etiology of cholecystitis, were recorded in a dedicated registry. Surgic... more such as age, gender, and etiology of cholecystitis, were recorded in a dedicated registry. Surgical outcomes after CCY, and post-surgical follow-up data, were also collected for all patients. Results: 10 patients who underwent EUS-GLB drainage and 21 patients who underwent PTC-GLB drainage, were evaluated. Patient characteristics such as age, and gender, were similar amongst the two groups. Etiology of cholecystitis (either gallstone, acalculous or malignancy) was also similar between the two groups (pZ0.33). In patients who underwent successful EUS-GLB drainage, 70% of cases (7 of 10) were preformed with a lumen apposing metal stent, 20% (2 of 10) were preformed with other metal stents and 10% (1 of 10) were preformed with a plastic stent. Both groups had 100% technical and clinical success rates from the respective of initial management of cholecystitis. There was also no difference in peri-procedure adverse events (pZ0.53). The number of patients requiring a repeat procedure between EUS-GLB and PTC-GLB, was statistically significant (40% vs 66.7%, pZ0.02). All patients later underwent a successful CCY once their underlying medical comorbidities improved. There was no statistical difference in the method of removing the cholecystostomy stent (pZ0.306). And when evaluating surgical outcomes, there was no significant difference between the rates of laparoscopic versus open CCY (pZ1). Rates of post surgical complications were also similar between the EUS-GLB and PTC-GLB groups (10% vs 23.8%, pZ 0.63) (Table). Conclusions: CCY after EUS-GLB drainage is safe and feasible for the management of cholecystitis. EUS-GLB requires less sessions prior to surgery than PTC-GLB. Comparison of surgical outcomes after EUS-GLB versus PTC-GLB showed no significant difference. EUS-GLB drainage should not preclude patients from undergoing CCY as part of standard of care.
Background and Objectives: No single optimal test reliably determines the pancreatic cyst subtype... more Background and Objectives: No single optimal test reliably determines the pancreatic cyst subtype. Following EUS-FNA, the “string sign” test can differentiate mucinous from nonmucinous cysts. However, the interobserver variability of string sign results has not been studied.Methods: An experienced endosonographer performed EUS-FNA of pancreatic cysts on different patients and was recorded on video performing the string sign test for each. The videos were shared internationally with 14 experienced endosonographers, with a survey for each video: “Is the string sign positive?” and “If the string sign is positive, what is the length of the formed string?” Also asked “What is the cutoff length for string sign to be considered positive?” Interobserver variability was assessed using the kappa statistic (κ).Results: A total of 112 observations were collected from 14 endosonographers. Regarding string sign test positivity, κ was 0.6 among 14 observers indicating good interrater agreement (P < 0.001) while κ was 0.38 when observers were compared to the index endosonographer demonstrating marginal agreement (P < 0.001). Among observations of the length of the string in positive samples, 89.8% showed >5 mm of variability (P < 0.001), indicating marked variability. There was poor agreement on the cutoff length for a string to be considered positive.Conclusion: String sign of pancreatic cysts has a good interobserver agreement regarding its positivity that can help in differentiating mucinous from nonmucinous pancreatic cysts. However, the agreement is poor on the measured length of the string and the cutoff length of the formed string to be considered a positive string sign.
Background and Aim: High-quality bowel preparation is essential for improving detection rate of c... more Background and Aim: High-quality bowel preparation is essential for improving detection rate of colorectal lesions in colonoscopy. The aim of this study was to compare the efficacy, tolerability, and safety of 2-liters polyethylene glycol plus a high dose of ascorbic acid (PEG-Asc) with sodium picosulfate plus magnesium citrate (SP-MC). Method: Adult ambulatory outpatients scheduled for elective colonoscopy were randomized to receive 2L PEG-Asc (CoolprepÒ, Taejoon, Korea) or SP-MC (PicolightÒ, Pharmbio, Korea). Before colonoscopy, patients were asked to complete a questionnaire regarding acceptability, tolerability, and side effects during this preparation. Six experienced endoscopists, who were blinded to the randomization, rated the quality of bowel cleansing by using Ottawa scale immediately after colonoscopy. Results: A total of 223 consecutive subjectives were randomly assigned two groups of 2L PEG-Asc (nZ109) or SP-MC solution (nZ114). Baseline and demographic characteristics were not different between both groups. There were no differences in overall quality of bowel cleansing between two groups (pZ0.806). However, when dividing large bowel segments, SP-MC was superior to 2L PEG-Asc in right colon segment (pZ0.03). Side effects during preparation, including nausea, vomiting, abdominal pain, abdominal bloating and dizziness, were less frequent in SP-MC group (47.4% vs. 62.4%; pZ0.031). Overall satisfaction of patient was superior in SP-MC group (84.2% vs. 55.9%; p<0.001) and the proportion of patients who wanted to repeat same preparation regimen were higher in MC-SP group (64.9% vs. 39.4%; pZ0.001). However, there was no significant difference in overall satisfaction of endoscopist (pZ0.612) and adenoma detection rate (pZ0.451) in both groups. Conclusions: Our study suggest that SP-MC provided significantly better cleansing compared to 2L PEG-Asc in the right colon, showing better acceptability and tolerability profile. However, for overall quality of bowel cleansing both solutions showed similar effectiveness.
Ce présent rapport multi-centrique détaille l'analyse de 127 patients ayant subi une biopsie-... more Ce présent rapport multi-centrique détaille l'analyse de 127 patients ayant subi une biopsie-aspiration à l'aiguille fine écho-guidée de 136 lésions pancréatiques suspectes de malignité. L'endoscope utilisée est l'endoscope à vision axiale possédant un transducteur ultrasonore courbe (Pentax/Hitachi, FG-32 UA). Le diamètre des lésions variait de 5 à 100 mm avec un diamètre moyen de 33mm. Au total, 369 ponctions furent réalisées avec, en moyenne 2,70 ponctions (écart 1-9). La biopsie aspiration à l'aiguille fine échoguidée a démontré l'existence d'un cancer dans 75 des 94 lésions malignes (80 %) et a mis en évidence des cellules bénignes dans 37 des 41 lésions bénignes (90 %) (la sensibilité, la spécificité, la valeur prédictive positive, la valeur prédictive négative et l'exactitude diagnostique furent respectivement de 86 %, 100 %, 100 %, 67 % et 83 %). Un patient fut perdu du suivi clinique. Dans 11 cas (8 %),les biopsies furent non concluantes. Il y eu deux complications (une perforation duodénale et un épisode de saignement au sein d'un pseudo-kyste pancréatique). D'un point de vue diagnostique, il n'y eu aucun faux positif. La biopsie écho-guidée devrait être considérée comme faisant partie intégrale de l'évaluation de lésions pancréatiques suspectes de malignité
Cancer-associated fibroblasts (CAFs) have been shown to impact the chemosensitivity of patient-de... more Cancer-associated fibroblasts (CAFs) have been shown to impact the chemosensitivity of patient-derived tumor organoids (PDTOs). However, the published literature comparing PDTO response to clinical outcome does not include CAFs in the models. Here, a co-culture model was created using PDTOs and CAFs derived from endoscopic ultrasound-guided fine-needle biopsies (EUS-FNBs) for potential use in drug screening applications. Co-cultures were established, and growth was compared to monocultures using image metrics and a commercially available assay. We were able to establish and expand validated malignant PDTOs from 19.2% of adenocarcinomas from EUS-FNBs. CAFs could be established from 25% of the samples. The viability of PDTOs in the mixed cell co-culture could be isolated using image metrics. The addition of CAFs promoted PDTO growth in half of the established co-cultures. These results show that co-cultures can be established from tiny amounts of tissue provided by EUS-FNB. An increas...
Objectives-The aim of this study was to review the suitability of endoscopic ultrasonography-guid... more Objectives-The aim of this study was to review the suitability of endoscopic ultrasonography-guided fine needle aspiration (EUS-FNA) for ruling out malignancy in autoimmune pancreatitis patients. Methods-We retrospectively reviewed 40 autoimmune pancreatitis patients (type 1:37 patients; type 2: two patients; possible autoimmune pancreatitis: one patient) who received EUS-FNA. Among the 40 autoimmune pancreatitis patients, 34 were not histopathologically diagnosed with autoimmune pancreatitis by EUS-FNA, and they were followed up for more than 6 months in our hospital. Moreover, 14 pancreatic cancer patients who were not diagnosed by EUS-FNA were selected as a control group. These 14 patients constituted 3.9% of the 360 pancreatic cancer patients who received EUS-FNA. We evaluated the prognoses of the 34 autoimmune pancreatitis patients and the clinical differences between these 34 autoimmune pancreatitis patients and the 14 pancreatic cancer patients. Results-All 34 autoimmune pancreatitis patients showed reduced pancreatic swelling. The main pancreatic duct dilation (> 3 mm), the diameter of the main pancreatic duct, the capsule-like rim sign, and serum CA19-9 levels were significantly different between the autoimmune pancreatitis and pancreatic cancer patients (2.9% versus 69.2%, P < .01; 1.7 6 1.6 mm versus 6.8 6 5.0 mm, P < .01; 79.4% versus 0%, P < .01; 41.4 6 79.0 U/mL versus 2079.1 6 275.3 U/mL, P 5 .02). Conclusions-Almost all pancreatic cancers can be diagnosed by EUS-FNA. Furthermore, other clinical characteristics of pancreatic cancer undiagnosed by EUS-FNA were different from autoimmune pancreatitis undiagnosed by EUS-FNA. Endoscopic ultrasonography-guided FNA can be used to rule out malignancy in autoimmune pancreatitis patients.
Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) can sample enlarged ... more Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) can sample enlarged mediastinal lymph nodes in patients with nonsmall cell lung cancer (NSCLC). To date, EBUS-TBNA has only been used to sample nodes visible on computed tomography (CT). The aim of the present study was to determine the accuracy of EBUS-TBNA in sampling nodes f1 cm in diameter. NSCLC patients with CT scans showing no enlarged lymph nodes (no node .1 cm) in the mediastinum underwent EBUS-TBNA. Identifiable lymph nodes at locations 2r, 2l, 4r, 4l, 7, 10r, 10l, 11r and 11l were aspirated. All patients underwent subsequent surgical staging. Diagnoses based on aspiration results were compared with those based on surgical results. In 100 patients (mean age 58.9 yrs; 68 males), 119 lymph nodes ranging 5-10 mm in size were detected and sampled. Malignancy was detected in 19 patients but missed in two; all diagnoses were confirmed by surgical findings. The mean diameter of the punctured lymph nodes was 8.1 mm. The sensitivity of EBUS-TBNA for detecting malignancy was 92.3%, specificity was 100%, and the negative predictive value was 96.3%. No complications occurred. In conclusion, endobronchial ultrasound-guided transbronchial needle aspiration can accurately sample even small mediastinal nodes, therefore avoiding unnecessary surgical exploration in one out of six patients who have no computed tomography evidence of mediastinal disease. Potentially operable patients with no signs of mediastinal involvement on computed tomography may benefit from pre-surgical endobronchial ultrasound-guided transbronchial needle aspiration and staging.
Endoscopic ultrasound examination (EUS) of the upper gastrointestinal (GI) tract for the assessme... more Endoscopic ultrasound examination (EUS) of the upper gastrointestinal (GI) tract for the assessment of mural and extramural pathology has attracted growing international interest in recent years. Since February 1989, EUS has been performed on selected patients in our institution using a new Picker-Pentax fiber-optic ultrasound (US) gastroscope. The instrument consists of a forward-view fiber-optic gastroscope with a 5-MHz curved-array linear US transducer mounted directly behind the lens. The scanning plane lies in the long axis of the scope. Based on in vitro US examinations and EUS of 118 patients over an 18-month period, our preliminary experience with the instrument is described. Using EUS, various lesions in the esophageal wall as well as in the gastric and duodenal walls can be visualized. Furthermore, organs and structures outside the GI tract can be seen, and lesions such as enlarged lymph nodes in the mediastinum and abdomen; solid and cystic masses in the liver, pancreas and retroperitoneum; arterial aneurysms; esophageal varices; and gall stones and calcifications can be demonstrated. The 5-MHz transducer does not provide very detailed information on the GI wall. The direction of the ultrasound scanning planes is difficult to define, as the transducer cannot be seen through the optic lens. The method demands great expertise in endoscopy and ultrasound. Indications for EUS have not been definitively established. Evaluation of the diagnostic accuracy of this technique requires further controlled studies. We believe that EUS using a curved-array linear transducer will provide significant diagnostic information of clinical relevance to gastroenterology.
of 30 Pts (37%) the characteristic gastric IM pattern (CK7 GP and CK20 SP/GP) was demonstrated. C... more of 30 Pts (37%) the characteristic gastric IM pattern (CK7 GP and CK20 SP/GP) was demonstrated. Conclusions: LSBE demonstrates a distinct and reproducible CK7/CK20 pattern as described in the literature. Almost two-thirds of Pts with SSBE display cytokeratin staining consistent with esophageal IM. The remaining Pts with IM and suspected SSBE exhibit a characteristic gastric cardia pattern. Immunostaining may help to identify true SSBE from gastric cardia IM. 66 Multi-channel 24-hour pH monitoring and esophageal manometry in long (LSB)-and short-segment (SSB) Barrett's, gastroesophageal reflux (GER) and asymptomatic subjects (AS)
Objective: Endoscopic ultrasound (EUS)-guided drainage is a widely used treatment modality for pa... more Objective: Endoscopic ultrasound (EUS)-guided drainage is a widely used treatment modality for pancreatic pseudocysts (PPC). However, data on the clinical outcome and complication rates are conflicting. Our study aims to evaluate the rates of technical success, treatment success and complications of EUS-guided PPC drainage in a medium-term follow-up of 45 weeks. Materials and Methods: A retrospective review was conducted for 55 patients with symptomatic PPC from December 2005 to August 2010 drained by EUS. Medium-term follow-up data were obtained by searching their medical history or by telephonic interview. Results: A total of 61 procedures were performed. The symptoms that indicated drainage were abdominal pain (n = 43), vomiting (n = 7) and jaundice (n = 5). The procedure was technically successful in 57 of the 61 procedures (93%). The immediate complication rate was 5%. At a mean follow-up of 45 weeks, the treatment success was 75%. The medium term complications appeared in 25% of cases, which included three cases each of stent clogging, stent migration, infection and six cases of recurrence. There was no mortality. Conclusion: EUS-guided drainage is an effective treatment for PPC with a successful outcome in most of patients. Most of the complications require minimal invasive surgical treatment or repeated EUS-guided drainage procedures.
Blood-pool ultrasound contrast agents (UCSs) have the ability to image blood flow in soft tissues... more Blood-pool ultrasound contrast agents (UCSs) have the ability to image blood flow in soft tissues, which can be visualized at capillary level. Color Doppler has been integrated in EUS equipment since the introduction of electronic transducers and is able to visualize blood flow and its direction in small arteries and veins but not blood flow in capillaries or perfusion. Visualization of perfusion by contrast agents represents a new step in flow imaging and may separate hyper- and hypoperfused areas in tissue. This may be useful for tissue characterization and identification of tumors or abscesses or to guide intervention and tissue sampling.
Endoscopic ultrasound scanning (EUL) of the upper gastro-intestinal canal has rendered apparently... more Endoscopic ultrasound scanning (EUL) of the upper gastro-intestinal canal has rendered apparently very meticulous assessment of pathological conditions in and around the oesophagus, stomach and the duodenum possible during recent years. On account of the close contact with the mucosa, high-frequent ultrasound transducer with great solubility capacity are employed. The wall of the gastrointestinal canal may thus be presented and subdivided into five layers. The ultrasound gastroscope most employed at present is lateral visualizing gastroscope with a mechanically rotating sector scanner mounted distal to the optic. On the basis of the literature, the technique of the examination and the hitherto employed indications for EUL are reviewed. International attention has been focussed on employment of EUL for preoperative subdivision of tumours in the oesophagus, stomach, pancreas and biliary passages into stages. Individual centres have reported promising results compared with existing forms of examination such as CT, conventional radiography, endoscopy and external ultrasound scanning. It is concluded that the necessary apparatus has not yet been fully developed. In addition, more numerous and more extensive prospective investigations are necessary before EUL may possibly be considered as a routine method of examination.
International Journal of Colorectal Disease, Apr 21, 2017
Purpose With an increasing demand for more accurate preoperative staging methods for colon cancer... more Purpose With an increasing demand for more accurate preoperative staging methods for colon cancer, we aimed to compare preoperative tumour (T)-and nodal (N)-stage in patients with left-sided colon cancer by endoscopic ultrasonography (EUS) and computed tomography (CT) with post-operative histology as gold standard. Methods A total of 44 patients were prospectively recruited at Herlev and Roskilde University Hospitals during November 2014-January 2016. Thirty-five patients were included in the final analysis and underwent EUS, CT and surgery within 2 weeks. Diagnostic values were evaluated for Blow risk( T1+T2+T3 with ≤5 mm extramural invasion) and Bhigh risk( T3 with >5 mm of extramural spread + T4) colonic cancer. Results Sensitivity and specificity in Blow risk^colonic cancer evaluated with EUS was 0.90 [0.74;0.98] and 0.75 [0.19;0.99] and with CT 0.96 [0.80;0.99] and 0.25 [<0.01;0.81]. EUS and CT were poor in predicting N0 or N+ disease. Conclusions The sensitivity of EUS and CT were good and comparable regarding T-stage evaluation, while EUS had a significantly higher specificity in the evaluation of Blow riskt umours. The results obtained for Bhigh risk^colonic cancer were difficult to evaluate due to small patient numbers. EUS could be considered as a supplement to CT scans in selecting patients for neoadjuvant therapies, or local transmural treatment, in the future.
... von benignen und malignen Lymphknoten mit einer hohen Sensitivität, Spezifität und Genauigkei... more ... von benignen und malignen Lymphknoten mit einer hohen Sensitivität, Spezifität und Genauigkeit erlaubt und damit zusätzliche Information zur konventionellen EUS ... Photo-Paint (Corel Corporation) imaging program was used to manually select a region of interest (ROI) on the ...
Pancreatic cystic lesions are frequently encountered and diagnostically challenging as some of th... more Pancreatic cystic lesions are frequently encountered and diagnostically challenging as some of the cysts may have malignant potential (mucinous) while others are completely benign (serous). EUS-guided through-the-needle biopsy (EUS-TTNB) of the cyst wall has recently been introduced as an alternative to cyst fluid cytology. Several studies have shown that microbiopsies outperform cytology in terms of distinction between mucinous and nonmucinous lesions, but also in determining the specific cyst diagnosis. However, little is known about the technical aspects of tissue sampling with TTNB. Herein, we summarize our experience with the procedure in a tertiary referral center and discuss indications, technical aspects, and safety of the procedure. Most adverse events (AEs) associated with the procedure are mild, but there is emerging evidence that the rate of postprocedural pancreatitis is higher compared to standard fine-needle aspiration. The added diagnostic yield should therefore be placed in perspective with an increased risk of AEs. Prospective studies are warranted to fully identify which patient groups could benefit from EUS-TTNB.
Background and Aims: Dynamic contrast enhanced endoscopic ultrasound (CE-EUS) for quantification ... more Background and Aims: Dynamic contrast enhanced endoscopic ultrasound (CE-EUS) for quantification of perfusion in colonic tumors has not previously been reported in the literature. The aim of the study was to investigate correlations between perfusion parameters and vessel density assessed by immunohistochemical staining with antibodies toward CD31 and CD105. We conducted a prospective clinical study. In total, 28 patients with left-sided colonic adenocarcinoma, underwent CE-EUS and left-sided hemicolectomy within 2 weeks. CE-EUS recordings were analyzed in 2 regions of interest: the entire tumor and the most enhanced area. Immunohistochemical staining with CD31 and CD105 was performed on tumor tissue sections. The slides were manually scanned for highly vascularized areas and counting of vessels was performed in hotspots within the tumor and the invasive front. New vasculature was assessed by CD105. Associations between CE-EUS and CD31 and CD105 were investigated using Spearman correlation. We found significant p-values for the correlation between CD31 and rise time (rho = 0.603 [0.238;0.816]; p = 0.001) in tumor tissue and for the correlation between CD31 and rise time (rho = 0.50 [0.201;0.695]; p = 0.008) and fall time (rho = 0.52 [0.204;0.723]; p = 0.006) corresponding to the invasive front. We found no correlations between perfusion values evaluated by CE-EUS and CD105. Our results show that there is a significant correlation for vessel density evaluated by CD31 and perfusion parameters evaluated by CE-EUS. This may be the first step toward using real-time CE-EUS for monitoring antiangiogenic therapies in colonic cancer.
such as age, gender, and etiology of cholecystitis, were recorded in a dedicated registry. Surgic... more such as age, gender, and etiology of cholecystitis, were recorded in a dedicated registry. Surgical outcomes after CCY, and post-surgical follow-up data, were also collected for all patients. Results: 10 patients who underwent EUS-GLB drainage and 21 patients who underwent PTC-GLB drainage, were evaluated. Patient characteristics such as age, and gender, were similar amongst the two groups. Etiology of cholecystitis (either gallstone, acalculous or malignancy) was also similar between the two groups (pZ0.33). In patients who underwent successful EUS-GLB drainage, 70% of cases (7 of 10) were preformed with a lumen apposing metal stent, 20% (2 of 10) were preformed with other metal stents and 10% (1 of 10) were preformed with a plastic stent. Both groups had 100% technical and clinical success rates from the respective of initial management of cholecystitis. There was also no difference in peri-procedure adverse events (pZ0.53). The number of patients requiring a repeat procedure between EUS-GLB and PTC-GLB, was statistically significant (40% vs 66.7%, pZ0.02). All patients later underwent a successful CCY once their underlying medical comorbidities improved. There was no statistical difference in the method of removing the cholecystostomy stent (pZ0.306). And when evaluating surgical outcomes, there was no significant difference between the rates of laparoscopic versus open CCY (pZ1). Rates of post surgical complications were also similar between the EUS-GLB and PTC-GLB groups (10% vs 23.8%, pZ 0.63) (Table). Conclusions: CCY after EUS-GLB drainage is safe and feasible for the management of cholecystitis. EUS-GLB requires less sessions prior to surgery than PTC-GLB. Comparison of surgical outcomes after EUS-GLB versus PTC-GLB showed no significant difference. EUS-GLB drainage should not preclude patients from undergoing CCY as part of standard of care.
Background and Objectives: No single optimal test reliably determines the pancreatic cyst subtype... more Background and Objectives: No single optimal test reliably determines the pancreatic cyst subtype. Following EUS-FNA, the “string sign” test can differentiate mucinous from nonmucinous cysts. However, the interobserver variability of string sign results has not been studied.Methods: An experienced endosonographer performed EUS-FNA of pancreatic cysts on different patients and was recorded on video performing the string sign test for each. The videos were shared internationally with 14 experienced endosonographers, with a survey for each video: “Is the string sign positive?” and “If the string sign is positive, what is the length of the formed string?” Also asked “What is the cutoff length for string sign to be considered positive?” Interobserver variability was assessed using the kappa statistic (κ).Results: A total of 112 observations were collected from 14 endosonographers. Regarding string sign test positivity, κ was 0.6 among 14 observers indicating good interrater agreement (P < 0.001) while κ was 0.38 when observers were compared to the index endosonographer demonstrating marginal agreement (P < 0.001). Among observations of the length of the string in positive samples, 89.8% showed >5 mm of variability (P < 0.001), indicating marked variability. There was poor agreement on the cutoff length for a string to be considered positive.Conclusion: String sign of pancreatic cysts has a good interobserver agreement regarding its positivity that can help in differentiating mucinous from nonmucinous pancreatic cysts. However, the agreement is poor on the measured length of the string and the cutoff length of the formed string to be considered a positive string sign.
Background and Aim: High-quality bowel preparation is essential for improving detection rate of c... more Background and Aim: High-quality bowel preparation is essential for improving detection rate of colorectal lesions in colonoscopy. The aim of this study was to compare the efficacy, tolerability, and safety of 2-liters polyethylene glycol plus a high dose of ascorbic acid (PEG-Asc) with sodium picosulfate plus magnesium citrate (SP-MC). Method: Adult ambulatory outpatients scheduled for elective colonoscopy were randomized to receive 2L PEG-Asc (CoolprepÒ, Taejoon, Korea) or SP-MC (PicolightÒ, Pharmbio, Korea). Before colonoscopy, patients were asked to complete a questionnaire regarding acceptability, tolerability, and side effects during this preparation. Six experienced endoscopists, who were blinded to the randomization, rated the quality of bowel cleansing by using Ottawa scale immediately after colonoscopy. Results: A total of 223 consecutive subjectives were randomly assigned two groups of 2L PEG-Asc (nZ109) or SP-MC solution (nZ114). Baseline and demographic characteristics were not different between both groups. There were no differences in overall quality of bowel cleansing between two groups (pZ0.806). However, when dividing large bowel segments, SP-MC was superior to 2L PEG-Asc in right colon segment (pZ0.03). Side effects during preparation, including nausea, vomiting, abdominal pain, abdominal bloating and dizziness, were less frequent in SP-MC group (47.4% vs. 62.4%; pZ0.031). Overall satisfaction of patient was superior in SP-MC group (84.2% vs. 55.9%; p<0.001) and the proportion of patients who wanted to repeat same preparation regimen were higher in MC-SP group (64.9% vs. 39.4%; pZ0.001). However, there was no significant difference in overall satisfaction of endoscopist (pZ0.612) and adenoma detection rate (pZ0.451) in both groups. Conclusions: Our study suggest that SP-MC provided significantly better cleansing compared to 2L PEG-Asc in the right colon, showing better acceptability and tolerability profile. However, for overall quality of bowel cleansing both solutions showed similar effectiveness.
Ce présent rapport multi-centrique détaille l'analyse de 127 patients ayant subi une biopsie-... more Ce présent rapport multi-centrique détaille l'analyse de 127 patients ayant subi une biopsie-aspiration à l'aiguille fine écho-guidée de 136 lésions pancréatiques suspectes de malignité. L'endoscope utilisée est l'endoscope à vision axiale possédant un transducteur ultrasonore courbe (Pentax/Hitachi, FG-32 UA). Le diamètre des lésions variait de 5 à 100 mm avec un diamètre moyen de 33mm. Au total, 369 ponctions furent réalisées avec, en moyenne 2,70 ponctions (écart 1-9). La biopsie aspiration à l'aiguille fine échoguidée a démontré l'existence d'un cancer dans 75 des 94 lésions malignes (80 %) et a mis en évidence des cellules bénignes dans 37 des 41 lésions bénignes (90 %) (la sensibilité, la spécificité, la valeur prédictive positive, la valeur prédictive négative et l'exactitude diagnostique furent respectivement de 86 %, 100 %, 100 %, 67 % et 83 %). Un patient fut perdu du suivi clinique. Dans 11 cas (8 %),les biopsies furent non concluantes. Il y eu deux complications (une perforation duodénale et un épisode de saignement au sein d'un pseudo-kyste pancréatique). D'un point de vue diagnostique, il n'y eu aucun faux positif. La biopsie écho-guidée devrait être considérée comme faisant partie intégrale de l'évaluation de lésions pancréatiques suspectes de malignité
Cancer-associated fibroblasts (CAFs) have been shown to impact the chemosensitivity of patient-de... more Cancer-associated fibroblasts (CAFs) have been shown to impact the chemosensitivity of patient-derived tumor organoids (PDTOs). However, the published literature comparing PDTO response to clinical outcome does not include CAFs in the models. Here, a co-culture model was created using PDTOs and CAFs derived from endoscopic ultrasound-guided fine-needle biopsies (EUS-FNBs) for potential use in drug screening applications. Co-cultures were established, and growth was compared to monocultures using image metrics and a commercially available assay. We were able to establish and expand validated malignant PDTOs from 19.2% of adenocarcinomas from EUS-FNBs. CAFs could be established from 25% of the samples. The viability of PDTOs in the mixed cell co-culture could be isolated using image metrics. The addition of CAFs promoted PDTO growth in half of the established co-cultures. These results show that co-cultures can be established from tiny amounts of tissue provided by EUS-FNB. An increas...
Objectives-The aim of this study was to review the suitability of endoscopic ultrasonography-guid... more Objectives-The aim of this study was to review the suitability of endoscopic ultrasonography-guided fine needle aspiration (EUS-FNA) for ruling out malignancy in autoimmune pancreatitis patients. Methods-We retrospectively reviewed 40 autoimmune pancreatitis patients (type 1:37 patients; type 2: two patients; possible autoimmune pancreatitis: one patient) who received EUS-FNA. Among the 40 autoimmune pancreatitis patients, 34 were not histopathologically diagnosed with autoimmune pancreatitis by EUS-FNA, and they were followed up for more than 6 months in our hospital. Moreover, 14 pancreatic cancer patients who were not diagnosed by EUS-FNA were selected as a control group. These 14 patients constituted 3.9% of the 360 pancreatic cancer patients who received EUS-FNA. We evaluated the prognoses of the 34 autoimmune pancreatitis patients and the clinical differences between these 34 autoimmune pancreatitis patients and the 14 pancreatic cancer patients. Results-All 34 autoimmune pancreatitis patients showed reduced pancreatic swelling. The main pancreatic duct dilation (> 3 mm), the diameter of the main pancreatic duct, the capsule-like rim sign, and serum CA19-9 levels were significantly different between the autoimmune pancreatitis and pancreatic cancer patients (2.9% versus 69.2%, P < .01; 1.7 6 1.6 mm versus 6.8 6 5.0 mm, P < .01; 79.4% versus 0%, P < .01; 41.4 6 79.0 U/mL versus 2079.1 6 275.3 U/mL, P 5 .02). Conclusions-Almost all pancreatic cancers can be diagnosed by EUS-FNA. Furthermore, other clinical characteristics of pancreatic cancer undiagnosed by EUS-FNA were different from autoimmune pancreatitis undiagnosed by EUS-FNA. Endoscopic ultrasonography-guided FNA can be used to rule out malignancy in autoimmune pancreatitis patients.
Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) can sample enlarged ... more Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) can sample enlarged mediastinal lymph nodes in patients with nonsmall cell lung cancer (NSCLC). To date, EBUS-TBNA has only been used to sample nodes visible on computed tomography (CT). The aim of the present study was to determine the accuracy of EBUS-TBNA in sampling nodes f1 cm in diameter. NSCLC patients with CT scans showing no enlarged lymph nodes (no node .1 cm) in the mediastinum underwent EBUS-TBNA. Identifiable lymph nodes at locations 2r, 2l, 4r, 4l, 7, 10r, 10l, 11r and 11l were aspirated. All patients underwent subsequent surgical staging. Diagnoses based on aspiration results were compared with those based on surgical results. In 100 patients (mean age 58.9 yrs; 68 males), 119 lymph nodes ranging 5-10 mm in size were detected and sampled. Malignancy was detected in 19 patients but missed in two; all diagnoses were confirmed by surgical findings. The mean diameter of the punctured lymph nodes was 8.1 mm. The sensitivity of EBUS-TBNA for detecting malignancy was 92.3%, specificity was 100%, and the negative predictive value was 96.3%. No complications occurred. In conclusion, endobronchial ultrasound-guided transbronchial needle aspiration can accurately sample even small mediastinal nodes, therefore avoiding unnecessary surgical exploration in one out of six patients who have no computed tomography evidence of mediastinal disease. Potentially operable patients with no signs of mediastinal involvement on computed tomography may benefit from pre-surgical endobronchial ultrasound-guided transbronchial needle aspiration and staging.
Endoscopic ultrasound examination (EUS) of the upper gastrointestinal (GI) tract for the assessme... more Endoscopic ultrasound examination (EUS) of the upper gastrointestinal (GI) tract for the assessment of mural and extramural pathology has attracted growing international interest in recent years. Since February 1989, EUS has been performed on selected patients in our institution using a new Picker-Pentax fiber-optic ultrasound (US) gastroscope. The instrument consists of a forward-view fiber-optic gastroscope with a 5-MHz curved-array linear US transducer mounted directly behind the lens. The scanning plane lies in the long axis of the scope. Based on in vitro US examinations and EUS of 118 patients over an 18-month period, our preliminary experience with the instrument is described. Using EUS, various lesions in the esophageal wall as well as in the gastric and duodenal walls can be visualized. Furthermore, organs and structures outside the GI tract can be seen, and lesions such as enlarged lymph nodes in the mediastinum and abdomen; solid and cystic masses in the liver, pancreas and retroperitoneum; arterial aneurysms; esophageal varices; and gall stones and calcifications can be demonstrated. The 5-MHz transducer does not provide very detailed information on the GI wall. The direction of the ultrasound scanning planes is difficult to define, as the transducer cannot be seen through the optic lens. The method demands great expertise in endoscopy and ultrasound. Indications for EUS have not been definitively established. Evaluation of the diagnostic accuracy of this technique requires further controlled studies. We believe that EUS using a curved-array linear transducer will provide significant diagnostic information of clinical relevance to gastroenterology.
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