Endoscopic Ultrasound, Where Are We Now in 2012?

Kim, Eun Young

doi:10.5946/ce.2012.45.3.321

Cited by 7 publications

(8 citation statements)

References 18 publications

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“… 23 Specifically for GISTs the simultaneous presence of 2 out of 3 EUS features (irregular extraluminal margins, cystic spaces, and lymph nodes with a malignant pattern) has been shown to have a positive predictive value of 100% for malignant or borderline GISTs, 24 reinforcing that EUS alone may be helpful in selecting patients with higher risk of malignancy. In our study we used EUS features considered of risk, based on the literature, 24 , 25 , 26 , 27 to decide for invasive maneuvers for additional diagnosis or therapeutic strategy. We concluded that the combination of multiple features correlated with a higher probability for this strategy ( p < 0.001), and we verified that this approach was conducted in all patients when 4 or more features were present.…”

Section: Discussionmentioning

confidence: 99%

The Role of Endoscopic Ultrasound in the Diagnostic Assessment of Subepithelial Lesions of the Upper Gastrointestinal Tract

Castro

Magalhães

Monteiro

et al. 2016

GE Portuguese Journal of Gastroenterology

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IntroductionThe identification of subepithelial lesions is a relatively frequent finding at endoscopy however their natural history is not well known. Our aim was to analyze the role of endoscopic ultrasound (EUS) in the diagnostic approach of subepithelial lesions of the upper gastrointestinal tract.MethodsRetrospective study which included 324 patients undergoing upper radial EUS for evaluation of subepithelial lesions from 2008 to 2014. The EUS features, presumptive diagnosis and management decision were analyzed.Results324 patients included, 60% with gastric subepithelial lesions, 28% oesophageal and 12% from the duodenum. Based on EUS features the presumptive diagnosis was: 25% gastrointestinal stromal tumor, 21% lipoma, 19% leiomyoma, 17% pancreatic rest, 7% submucosa cysts, 1% granular cell tumors, 1% carcinoids, 1% mucosa lesions and 8% not defined. After EUS the suggested approach was no follow-up in 45%, follow-up with re-examination with EUS in 35% and additional tissue sampling or endoscopic/surgical resection in 20%. The latter was based on EUS features of risk at the diagnosis (53%), such as size ≥2 cm, hypoechogenicity, heterogeneity, lobulation, calcifications, cystic component and regional adenopathies; impossibility to define a presumptive diagnosis (39%) or EUS features change at follow-up (8%). The combination of multiple features correlated with a higher probability of this recommended strategy (p < 0.001), in 100% when 4 or more features were present. Among the 33 patients who underwent fine needle aspiration, in 66% the result was inconclusive. During follow-up, none of the patients who were managed with surveillance radial EUS presented complications.ConclusionEUS is the method of choice in the study of subepithelial lesions of the upper gastrointestinal tract, in most cases defining a diagnosis. The need for a definitive diagnosis or therapeutic approaches can be based on ultrasound risk features, presented, in the majority, at presentation. This study shows that EUS is capable of safely and accurately define those subepithelial lesions that can be managed only with surveillance ultrasound while waiting for better results with fine needle aspiration.

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Section: Discussionmentioning

confidence: 99%

The Role of Endoscopic Ultrasound in the Diagnostic Assessment of Subepithelial Lesions of the Upper Gastrointestinal Tract

Castro

Magalhães

Monteiro

et al. 2016

GE Portuguese Journal of Gastroenterology

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“… 5 EUS is the most accurate method to determine the characteristics of SEL. 6 It allows the intramural or extramural location of a tumor to be determined, and, if its location is intramural, the identification of the layer from which the lesion originated. This information helps to determine the correct diagnosis.…”

Section: Intramural Tumorsmentioning

confidence: 99%

Colorectal Subepithelial Lesions

Kim

2015

Clin Endosc

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Most of subepithelial lesion (SEL) being identified was accidentally discovered as small bulging lesion covered with normal mucosa from endoscopic screening. The type of treatment and prognosis vary depending on the type of tumor, it would be crucial to perform an accurate differential diagnosis. Since the differentiation of SEL relied on the indirect findings observed from the mucosal surface using an endoscopy only in the past, it was able to confirm the presence of lesion only but difficult to identify complex detailed nature of the lesion. However, after the endoscopic ultrasonography (EUS) was introduced, it became possible to identify extrinsic compression, and size of intramural tumors, internal properties and contour so that it gets possible to have differential diagnosis of lesions and prediction on the lesion whether it is malignant or benign. In addition, the use of EUS-guided fine needle aspiration and EUS-guided core biopsy made it possible to make histological differential diagnosis. This study intended to investigate endoscopic and EUS findings, histological diagnosis, treatment regimen and impression of colorectal SELs.

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“…Hence, the improvement of biotechnologies applied to endoscopy has allowed the development of this real-time targeted minimally invasive treatment modality. [2] Additional advantages of this technique are the possibility to use real-time Doppler imaging to avoid major vessel injury during the procedure and the capacity to monitor the change in the lesions in response to the treatment. [3,4] New probes and devices have been studied, particularly in porcine models.…”

Section: Introductionmentioning

confidence: 99%

Systematic review of endoscopy ultrasound-guided thermal ablation treatment for pancreatic cancer

et al. 2020

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The development of curvilinear-array EUS and EUS-guided fine-needle aspiration (EUS-FNA) has led these approaches to become interventional procedures rather than purely diagnostic, as a minimally invasive antitumor therapeutic alternative to radiological and surgical treatments. The possibility to accurately position needle devices and to reach a deep target like the pancreas gland under real-time imaging guidance has expanded the use of EUS to ablate tumors. Currently, a variety of probes specifically designed for EUS ablation are available, including radiofrequency, hybrid cryothermal ablation (combining radiofrequency with cryotechnology), photodynamic therapy, and laser ablation. To date, several studies have demonstrated the safety and feasibility of these ablation techniques in the pancreatic setting, but only a few small series on pancreatic thermal ablation under EUS guidance are available. EUS-guided thermal ablation is primarily used for pancreatic cancer. It is well suited to this disease because of its superior anatomical access compared with other imaging modalities and the dismal prognosis despite improvements in chemoradiotherapy and surgery in the management of pancreatic cancer. Other targets are pancreatic neuroendocrine tumors and pancreatic cystic neoplasms, which are curable by surgical resection, but some patients are poor surgical candidates or prefer conservative management. This is a literature review of previously published clinical studies on EUS-guided thermal ablative therapies. Data on the long-term efficacy of EUS-guided antitumor thermal ablation therapy and large prospective randomized studies are still needed to confirm the real clinical benefits of these techniques for the management of pancreatic neoplasms.

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Endoscopic Ultrasound, Where Are We Now in 2012?

Cited by 7 publications

References 18 publications

The Role of Endoscopic Ultrasound in the Diagnostic Assessment of Subepithelial Lesions of the Upper Gastrointestinal Tract

The Role of Endoscopic Ultrasound in the Diagnostic Assessment of Subepithelial Lesions of the Upper Gastrointestinal Tract

Colorectal Subepithelial Lesions

Systematic review of endoscopy ultrasound-guided thermal ablation treatment for pancreatic cancer

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