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Pancreatic malignancy
Published in Anju Sahdev, Sarah J. Vinnicombe, Husband & Reznek's Imaging in Oncology, 2020
Giovanni Morana, Alex Faccinetto, Michele Fusaro
The pancreas is often thought to be difficult to interrogate with US, due to its deep retroperitoneal location, but US can provide useful information, especially with the use of tissue harmonic imaging (THI), colour Doppler, and contrast-enhanced US (CEUS). US elastography is a new technique employing various tissue-compression methods such as real-time shear wave velocity imaging and acoustic radiation force impulse (ARFI). The goal is to differentiate tissues on the basis of their specific stiffness; malignant tumours tend to be harder than normal and benign tissues, and this new technique shows promise (1). Endoscopic ultrasonography (EUS) is the commonest approach used for pancreatic elastography and, importantly, may differentiate between chronic pancreatitis and pancreatic cancer (2).
Management of pelvic congestion syndrome and perineal varicosities
Published in Peter Gloviczki, Michael C. Dalsing, Bo Eklöf, Fedor Lurie, Thomas W. Wakefield, Monika L. Gloviczki, Handbook of Venous and Lymphatic Disorders, 2017
Most patients with PCS have already undergone pelvic sonography with negative ovarian and uterine findings. In this instance, a repeat study specifically dedicated to pelvic venous anatomy and emptying may be helpful. The examination is aided by using transabdominal 5-MHz and transvaginal probes after a thorough fast. Optimally, the test should be performed in the standing or reverse Trendelenburg position, although intermittent use of the Valsalva maneuver while supine can also be effective. The usefulness of endoscopic ultrasonography has recently been suggested.18
Malignant Neoplasms of the Rectum
Published in Philip H. Gordon, Santhat Nivatvongs, Lee E. Smith, Scott Thorn Barrows, Carla Gunn, Gregory Blew, David Ehlert, Craig Kiefer, Kim Martens, Neoplasms of the Colon, Rectum, and Anus, 2007
Meyenberger et al. (43) compared endoscopic ultrasonography to MRI with an endorectal coil in 21 patients. The results of preoperative examination were compared to histopathologic findings with a special focus on transmural invasion. Endoscopic ultrasonography identified all carcinomas, whereas MRI missed one carcinoma. Endoscopic ultrasonography was superior to MRI (accuracy, 83% vs. 40%). The MRI could not differentiate between T1 and T2 lesions. The accuracy of MRI in assessing perirectal infiltration was 80% compared to 100% with ultrasonography. Local recurrence was found in six patients all detected by endorectal ultrasonography and one missed by the MRI. In this study, endoscopic ultrasonography was more useful. MRI was found to be more operator-dependent (44). A more recent review suggested similar accuracy for MRI and US for staging rectal carcinoma (30).
Role of endoscopic ultrasound and endoscopic resection in the diagnosis and treatment of esophageal granular cell tumors
Published in Scandinavian Journal of Gastroenterology, 2022
Xiaofei Fan, Jiao Jiao, Lili Luo, Lanping Zhu, Zhongqing Zheng, Xin Chen, Tao Wang, Wentian Liu, Bangmao Wang
EUS plays an important role in diagnosing the origin level, echo pattern and blood flow signals of esophageal submucosal masses [31]. The above-mentioned white light endoscopic images of esophageal GCTs also appeared in other esophageal submucosal masses due to the subjective differences in the images assessed by endoscopists [32]. In this study, 10 experienced ultrasound endoscopists certified by the Endoscopic Committee performed independent evaluations, and the analysis results showed that the EUS examination had a clinical diagnostic value for esophageal GCTs. Analysis by endoscopists with the lowest diagnostic accuracy in Test 1 showed that the small size of the tumor may have hindered the evaluator’s ability to make an accurate diagnosis based solely on the observed white light endoscopic images. However, endoscopic ultrasonography images upgraded the diagnostic accuracy. Therefore, EUS may help diagnose esophageal GCTs, even the smaller ones. Endoscopic ultrasonography-guided fine-needle aspiration (EUS-FNA) can be used to collect samples of lesions involving the submucosa or deep muscle layer; this is generally safe and effective for puncturing the submucosal lesions in the upper digestive tract [33]. The specimens obtained by EUS-FNA can be confirmed by path morphology and immunohistochemical staining. However, it may be difficult to obtain an adequate amount of tumor material through EUS-FNA [34]. We did not perform routine EUS-FNA procedures for esophageal GCTs.
Modified ‘sandwich’ injection with or without ligation for variceal bleeding in patients with both esophageal and gastric varices: a retrospective cohort study
Published in Scandinavian Journal of Gastroenterology, 2020
Tingting Hu, Simon Stock, Wandong Hong, Yongping Chen
This retrospective cohort study that compared two different endoscopic therapies for EGVB included a 1-year follow-up conducted by another endoscopic specialist to avoid bias. Our study had several limitations. First, this was a retrospective study, the group assignment was not random and we chose patients who had complete follow-up information. Although we had compared baseline characteristics of these patients as far as possible to prove the two groups were comparable, selection bias may still exist. In addition, this was a small sample study involving 100 patients in a single center, so a multicenter prospective trial with larger samples is recommended to confirm our findings. Secondly, the real source of bleeding was sometimes difficult to distinguish between GV and EV, which might increase bias. Thirdly, therapy guided by endoscopic ultrasonography (EUS) could be more precise. However, in the setting of variceal bleeding, EUS guided therapy maybe not suitable because it is too time-consuming. Besides, preoperative computed tomographic angiography could help the endoscopic specialist make better judgments about the vessels needing to be treated.
Comparing about three types of endoscopic therapy methods for upper gastrointestinal submucosal tumors originating from the muscularis propria layer
Published in Scandinavian Journal of Gastroenterology, 2019
Hui Xiu, Cheng-Ye Zhao, Fu-Guo Liu, Xue-Guo Sun, Hui Sun, Xi-Shuang Liu
Upper gastrointestinal submucosal tumors (SMTs) are a class of protruding lesions covered with normal mucosa, including gastrointestinal stroma tumor (GISTs), leiomyoma, neurofibroma and so on. The most common type of SMTs is GISTs, which are considered potentially malignant neoplasms and occur throughout the alimentary tract, most commonly in the stomach (60%) [1–3]. The rates of discovery and diagnosis have been significantly improved with the widespread application of endoscopy examination and advances in endoscopic ultrasonography (EUS). However, it is hardly to make accurate histological diagnoses even by EUS or endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA). According to the National Comprehensive Cancer Network (NCCN) guidelines, GISTs ≥2 cm should be resected, while endoscopic or radiographic surveillance can be considered for GISTs < 2 cm without high-risk EUS features (irregular border, cystic spaces, ulceration, echogenic foci and heterogeneity) [4]. On the other hand, the European Society for Medical Oncology (ESMO) recommends all of the GISTs should be resected regardless of tumor size or morphology [5]. What’s more, long-term follow-up may result in economic stresses and huge psychological burden of patients, and may miss the best treatment opportunity. Therefore, it is crucial to resect SMTs especially for those with risk features.