Interventional endoscopic ultrasonography: an overview of safety and complications

Alvarez-Sánchez, María Victoria; Jenssen, Christian; Faiss, Siegbert; Napoléon, Bertrand

doi:10.1007/s00464-013-3260-5

Cited by 96 publications

(73 citation statements)

References 109 publications

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“…3 Clinical use of ERCP as a purely diagnostic tool has declined as less invasive procedures have become available. 4 Endoscopic ultrasound (EUS) carries less risk of complications compared to ERCP 5 ; however, multicenter studies have shown that the interobserver agreement of EUS is suboptimal for the diagnosis of CP. 6 Endoscopic pancreatic function tests (ePFT) have the potential to detect CP at an earlier stage than other available diagnostic tests, but their use is, for the most part, limited to tertiary referral centers.…”

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confidence: 99%

T₁ mapping for diagnosis of mild chronic pancreatitis

Tirkes

Lin

Fogel

et al. 2016

Magnetic Resonance Imaging

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Purpose To determine if the T1 relaxation time of the pancreas can detect parenchymal changes in mild chronic pancreatitis (CP). Materials and Methods This Institutional Review Board (IRB)-approved, Health Insurance Portability and Accountability Act (HIPAA)-compliant retrospective study analyzed 98 patients with suspected mild CP. Patients were grouped as normal (n = 53) or mild CP (n = 45) based on history, presenting symptomatology, and concordant findings on both the secretin-enhanced magnetic resonance cholangiopancreatography (S-MRCP) and endoscopic retrograde cholangiopancreatography (ERCP). T1 maps were obtained in all patients using the same 3D gradient echo technique on the same 3T scanner. T1 relaxation times, fat signal fraction (FSF), and anterior–posterior (AP) diameter were correlated with the clinical diagnosis of CP. Results There was a significant difference (P < 0.0001) in the T1 relaxation times between the control (mean = 797 msec, 95% confidence interval [CI]: 730, 865) and mild CP group (mean = 1099 msec, 95% CI: 1032, 1166). A T1 relaxation time threshold value of 900 msec was 80% sensitive (95% CI: 65, 90) and 69% specific (95% CI: 56, 82) for the diagnosis of mild CP (area under the curve [AUC]: 0.81). Multiple regression analysis showed that T1 relaxation time was the only statistically significant variable correlating with the diagnosis of CP (P < 0.0001). T1 relaxation times showed a weak positive correlation with the pancreatic FSF (ρ = 0.33, P = 0.01) in the control group, but not in the mild CP group. Conclusion The T1 relaxation time of the pancreatic parenchyma was significantly increased in patients with mild CP. Therefore, T1 mapping might be used as a practical quantitative imaging technique for the evaluation of suspected mild CP.

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confidence: 99%

T₁ mapping for diagnosis of mild chronic pancreatitis

Tirkes

Lin

Fogel

et al. 2016

Magnetic Resonance Imaging

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“…Therefore, establishing a diagnosis of CP at an early stage remains problematic [6–9]. Endoscopic ultrasound (EUS) findings can be used to predict the presence of pancreatic exocrine dysfunction in patients with chronic pancreatitis [10, 11]. However, multicenter studies showed the inter-observer agreement to be less than optimal using both the standard scoring and Rosemont classification [12].…”

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confidence: 99%

Detection of exocrine dysfunction by MRI in patients with early chronic pancreatitis

et al. 2016

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Purpose To determine if T1-weighted MR signal of the pancreas can be used to detect early CP. Methods A retrospective analysis was performed on 51 suspected CP patients, who had both secretin-enhanced magnetic resonance cholangiopancreatography (S-MRCP) and an intraductal secretin stimulation test (IDST). There were 29 patients in normal and 22 patients in the low bicarbonate group. Bicarbonate level, total pancreatic juice volume, and excretory flow rate were recorded during IDST. Signal intensity ratio of pancreas (SIR), fat signal fraction, pancreatograms findings, and grade of duodenal filling were recorded on S-MRCP by two blinded radiologists. Results There was a significant difference in the signal intensity ratio of the pancreas to spleen (SIRp/s) between the normal and low bicarbonate groups (p < 0.0001). A significant positive correlation was found between pancreatic fluid bicarbonate level and SIRp/s (p < 0.0001). SIRp/s of 1.2 yielded sensitivity of 77% and specificity of 83% for detection of pancreatic exocrine dysfunction (AUC: 0.89). Conclusion T1-weighted MR signal of the pancreas has a high sensitivity and specificity for the detection of parenchymal abnormalities related to exocrine dysfunction and can therefore be helpful in evaluation of suspected early CP.

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“…Most adverse events are associated with beginners in this field, with lower adverse event rates reported by experienced centers. 59 Comparisons of drainage methods showed adverse event rates lower for RV (11%, including 3.4% with acute pancreatitis) than for transluminal drainage (21%). 19 A systematic review of 20 studies reported that adverse event rates were higher for the intrahepatic (18%) than for the extrahepatic (14%) approach.…”

Section: Adverse Eventsmentioning

confidence: 94%

“…51,52 Therefore, experts recommend that someone new to this procedure be supervised on at least the first 20 patients. 59 Bile leakage was more frequently observed in patients who underwent plastic (11%) than covered metal stent (4%) deployment. 59 Comparisons of drainage methods showed adverse event rates lower for RV (11%, including 3.4% with acute pancreatitis) than for transluminal drainage (21%).…”

Section: Adverse Eventsmentioning

confidence: 97%

Recent advances in endoscopic ultrasound‐guided biliary drainage

Minaga

Kitano

2017

Digestive Endoscopy

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Endoscopic ultrasound-guided biliary drainage (EUS-BD) is increasingly used as an alternative in patients with biliary obstruction who fail standard endoscopic retrograde cholangiopancreatography (ERCP). The two major endoscopic approach routes for EUS-BD are the transgastric intrahepatic and the transduodenal extrahepatic approaches. Biliary drainage can be achieved by three different methods, transluminal biliary stenting, transpapillary rendezvous technique, and antegrade biliary stenting. Choice of approach route and drainage method depends on individual anatomy, underlying disease, and location of the biliary stricture. Recent meta-analyses have revealed that cumulative technical success and adverse event rates were 90-94% and 16-23%, respectively. Development of new dedicated devices for EUS-BD would help refine the technical aspects and minimize the possibility of complications, making it a more promising procedure.

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Interventional endoscopic ultrasonography: an overview of safety and complications

Cited by 96 publications

References 109 publications

T₁ mapping for diagnosis of mild chronic pancreatitis

T₁ mapping for diagnosis of mild chronic pancreatitis

Detection of exocrine dysfunction by MRI in patients with early chronic pancreatitis

Recent advances in endoscopic ultrasound‐guided biliary drainage

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Interventional endoscopic ultrasonography: an overview of safety and complications

Cited by 96 publications

References 109 publications

T1 mapping for diagnosis of mild chronic pancreatitis

T1 mapping for diagnosis of mild chronic pancreatitis

Detection of exocrine dysfunction by MRI in patients with early chronic pancreatitis

Recent advances in endoscopic ultrasound‐guided biliary drainage

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T₁ mapping for diagnosis of mild chronic pancreatitis

T₁ mapping for diagnosis of mild chronic pancreatitis