EUS-guided angiotherapy and specifically EUS-guided coiling is an emerging promising technique and should be considered as a first-line therapeutic option for bleeding GV.

The authors found that vocal-but not verbal-cues of counselor self-confidence were related to client perceptions of expertness, attractiveness, trustworthiness, and associated satisfaction.

Endoscopic ultrasound (EUS)-guided fine needle aspiration with or without biopsy (FNA/FNB) are the primary diagnostic tools for gastrointestinal submucosal tumors. EUS-guided fine needle aspiration (EUS-FNA) is considered a first line diagnostic method for the characterization of pancreatic and upper gastrointestinal lesions, since it allows for the direct visualization of the collection of specimens for cytopathologic analysis. EUS-FNA is most effective and accurate when immediate cytologic assessment is permitted by the presence of a cytopathologist on site. Unfortunately, the accuracy and thus the diagnostic yield of collected specimens suffer without this immediate analysis. Recently, a EUS-FNB needle capable of obtaining core samples (fine needle biopsy, FNB) has been developed and has shown promising results. This new tool adds a new dimension to the diagnostic and therapeutic utility of this technique. The aim of the present review is to compare the efficacy of EUS-FNA to that afforded by EUS-FNB in the characterization of pancreatic masses and of upper and lower gastrointestinal submucosal tumors.

Endoscopic ultrasound (EUS)-guided transluminal drainage of obstructed bile duct with conventional metal and plastic stents has been in practice for several years, but this modality carries its own potential complications and obstacles. Nevertheless, the novel Hot AXIOS stent (Boston Scientific Corp., Marlborough, MA) has been shown to overcome some of those factors, which justifies its application in a variety of clinical indications, such as EUS-guided choledochoduodenostomy (EUS-CDS) for biliary drainage after failed endoscopic retrograde cholangiopancreatography. We present a case of EUS-CDS with an electrocautery enhanced lumen-apposing stent for biliary drainage.

INTRODUCTION: Endoscopic full-thickness resection (EFTR) is an emerging minimally invasive resection procedure for GI lesions not amenable to conventional resection methods. Endoscopic full-thickness resection device (FTRD) is an over-the-scope single-step device that has been developed recently for EFTR. In this meta-analysis, we aim to assess efficacy and safety of FTRD for EFTR of GI lesions. METHODS: Methods: A comprehensive literature review was performed. Studies with < 5 cases were excluded. Rates of histologic complete resection (R0), technical success, and complications were extracted. Pooled estimates and the 95% CI were calculated depending on heterogenicity. Heterogenicity was assessed using I2 statistics. RESULTS: Nine studies (5 retrospective and 4 prospective) including 480 patients with 489 lesions were included. Indications were difficult adenomas (355), early carcinoma (82), and subepithelial lesions (SEL) (47). Locations of the lesions: stomach (5), duodenum (20), proximal colon (220), distal colon (98), and rectum (141). 57% of patients were male with median of age 66.5 years (range 20-92). Mean size of the lesions was 15.36 mm (range 1-40). Median procedure time was 46.56 minutes (range 3-190). Mean hospital stay was 3.23 days (range 0-11). Pooled overall R0 resection rate and technical success rate were 81.12% (95% CI: 77.63-84.6; I2 56.7%) and 90.39% (95% CI: 87.76-93.00; I2 10.2%), respectively. The pooled R0 resection rate was 81.59% (95% CI: 76.96-85.63) for difficult adenomas, 83.47% (95% CI: 73.19-91.00) for early carcinomas, and 81.59% (95% CI:68.25-91.05) for SELs. For locations; R0 resection rate were 78.42% (95% CI: 72.17-85.50), 76.97% (95% CI: 62.56-87.88), and 80.59% (95% CI: 67.56-90.09) for proximal, distal colon, and rectum, respectively. The complications were as follows: minor bleeding 2.89 (95% CI: 1.60-4.76), major bleeding 0.88 (95% CI: 0.26-2.15), perforation 2.23% (95% CI: 1.12-3.95), postpolypectomy syndrome 1.26% (95% CI: 0.48-2.68), local trauma 0.9% (95% CI: 0.27-2.19), and other complications 1.91% (95% CI: 0.90-3.54). Of 50 patients with peri-appendicular lesion, the rate of appendicitis was 14.29% (95% CI: 6.38-26.23). The rate of complications that required surgery was 1.55 (95% CI: 0.66-3.06). No procedural death related was found. There was no correlation between mean lesion’s size and complications rates CONCLUSION/DISCUSSION: FTRD is a safe and effective procedure for lesions not suitable for conventional resection.