No abstract

In endoscopic biliary drainage (EBD) for various benign and malignant biliary disorders, the appropriate timing to replace or change a plastic stent (PS) with a self-expandable metallic stent (SEMS) remains unclear. This study aimed to define the best period to replace or change a PS with a SEMS. Between January 1, 2012, and December 31, 2018, 1,887 consecutive EBD procedures, including 170 SEMS placements, were retrospectively identified. The period to recurrent biliary obstruction (PRBO) was estimated and compared between the malignant and benign groups and according to each disease using time to event analysis and competing risk analysis. Compared with the benign group, the malignant group had significantly shorter median PRBO with interquartile range (IQR) after PS placement [108 (39 – 270) vs. 613 (191 – 1,329) days, P < 0.001], even on multivariate analysis, with a subdistribution hazard ratio (SHR) of 3.58 (P < 0.001). The shortest PRBO distribution from the first quartile of the non-RBO period was seen in Mirizzi syndrome cases (25 days, P = 0.030, SHR = 3.32) in the benign group and in cases of pancreatic cancer (32 days, P = 0.041, SHR = 2.06); perihilar bile duct cancer (27 days, P = 0.006, SHR = 2.69); and ampullary cancer (22 days, P = 0.001, SHR = 3.78) in the malignant group. Our study supports that stent replacement for the benign group is feasible after 6 months, and the best period to replace or change a PS with a SEMS should be decided on the basis of the underlying disease to prevent RBO.

Background Taking advantage of the current advances in diagnostic imaging modalities, including endoscopic ultrasonography (EUS), and due to the increased attention to ectopic fat accumulation in the pancreas following the rising trend of metabolic syndrome, we qualitatively assessed the clinical implication of pancreatic steatosis by EUS in this study. Methods The study included 243 patients that were divided into four groups. The correlation between the average echogenicity of the pancreas and that of the control organs and the key clinical data of all study patients were collectively analyzed. The cut‐off point of the pancreas‐control (PC) ratio in EUS and liver‐control (LC) ratio on abdominal ultrasound were determined from the population distribution and the obtained median values. Results With the cut‐off point of 1.30 for the PC ratio and 1.20 for the LC ratio, sex, the Brinkman index, habitual alcohol drinkers, and fatty pancreas were significant factors. The associations between each relevant factor in fatty pancreas, metabolic syndrome in the fatty liver group, and age in the pancreatic cancer group were all significant in the analysis. In addition, we investigated whether the PC ratio differed according to age and staging in pancreatic cancer patients. Interestingly, the PC ratio was lower in the advanced stage group than in the early‐stage group. Conclusion Our results suggest that, irrespective of the degree, ectopic fat infiltration in the pancreas could be a specific clinical phenotype of serious pancreatic diseases, including pancreatic cancer, especially in high‐risk patients.

Background and Aim Fine‐needle biopsy (FNB) needles obtain more core samples and support the shift from cytologic to histologic evaluation; however, recent studies have proposed a superior diagnostic potential for liquid‐based cytology (LBC). This study compared the diagnostic ability of endoscopic ultrasound (EUS)‐guided FNB histology with a 22‐gauge Franseen needle (22G‐FNB‐H) and fine‐needle aspiration (FNA) LBC with a conventional 25‐gauge needle (25G‐FNA‐LBC). Methods We analyzed 46 patients who underwent both 22G‐FNB‐H and 25G‐FNA‐LBC in the same lesion during the same endoscopic procedure. This study evaluated the diagnostic ability of each needle, diagnostic concordance between needles, and incremental diagnostic effect of both needles compared to using each needle alone. Results The agreement rate for malignancy between both techniques was 93.5% (kappa value = 0.82). There was no significant difference in the diagnostic ability of both methods. 22G‐FNB‐H and 25G‐FNA‐LBC provided an incremental diagnostic accuracy in two (4.3%) cases and one (2.2%) case, respectively. Conclusion Our study demonstrated that the diagnostic accuracy of 25G‐FNA‐LBC and 22G‐FNA‐H for solid pancreatic lesions were comparable. A conventional 25‐gauge needle that punctures lesions with ease can be used in difficult cases and according to the skill of the endoscopist.

IntroductionDespite the widespread use of upper gastrointestinal endoscopy, the proportion of superficial esophageal squamous-cell carcinomas (SCCs) detected in Western countries is poor [1]. In a European enquiry, 51 such cases were found among 902 207 upper digestive endoscopy procedures. According to the registry in Burgundy, T1 cancer represents 4 % of the total number of esophageal SCCs, and T1 cancer limited to the mucosa only makes up 0.8 % of cases in France. By contrast, the rate of T1 esophageal SCC is five times higher in Japanese reports. The rates of T1 and T1 mucosal cancer reported by the National Cancer Center in Tokyo are 42 % and 18 %, respectively. These differences between Japan and Western countries may be explained by differences in histological interpretation, but it is likely that Japanese authors are more aware of the diagnosis of superficial cancer and pay more attention to it in general, and especially during endoscopy procedures. The failure of endoscopy to provide an early diagnosis of SCC in Western countries, despite a higher incidence of the condition than in Japan, shows that there is insufficient knowledge in the West of the macroscopic patterns of early carcinoma and that there is a tendency to carry out a cursory examination of the esophagus and to use chromoendoscopy to only a very limited extent.Adequate examination of the esophagus involves slow and complete analysis of the mucosa in order to detect any raised areas and ± more importantly ± any abnormalities in color, as alterations in color can reflect differences in the vascular pattern between tumor tissue and normal tissue. The superficial lesions frequently have an erythroplastic appearance if they are flat, or whitish if they are slightly elevated. The examiner also needs to focus on peristalsis transmission along the esophagus; a fixed area may be explained by the presence of a flat but already invasive carcinoma.Chromoendoscopy with vital staining is carried out between the initial precise examination and the taking of biopsies. In Europe, chromoendoscopy is not a widely used procedure, as it is regarded as being of little interest, difficult to perform, and above all, time-consuming and expensive. It must be emphasized that chromoscopy is mandatory in relation to esophageal squamouscell carcinoma; in certain circumstances, not performing it must be regarded as an error.The first expert approach section published in Endoscopy, in 2001, was concerned with Lugol staining [2]. The cases presented in the picture gallery here illustrate the high sensitivity and specificity of this method for diagnosing SCC. Toluidine blue is also capable of revealing occult dysplasia or unsuspected SCC in conventional esophagoscopy, but the technique required is more difficult and prolonged than Lugol staining, and it has a higher rate of false-negative results. Of all the chromoendoscopy methods available, Lugol staining at least should be recommended in Europe.Which patients should undergo Lugol staining? There are several theoretical g...