Results Of Endoscopic Ultrasonography Research Articles

Neutrophil Gelatinase-Associated Lipocalin for the Differentiation of Mucinous Pancreatic Cystic Lesions.

Undetermined pancreatic cystic lesion (PCL) differentiation benefits from endoscopic ultrasound (EUS) based on morphology and cyst fluid analysis, but room for new biomarkers exists. Our aim was to assess the intracystic and serum diagnostic value of neutrophil gelatinase-associated lipocalin (Ngal) and interleukin 1 beta (IL-1β) for differentiation of PCLs. This prospective study included patients from one tertiary hospital, evaluated between April 2018 and May 2020. EUS fine-needle aspiration or pancreatic pseudocysts drainage was the source of PCL intracystic liquid. The final diagnosis was based on surgery or EUS results (morphology, cytology, glucose, and CEA-carcinoembryogenic antigen). The intracystic samples were tested for Ngal, IL-1β, glucose, and CEA, and serum for Ngal and IL-1β. We evaluated 63 cysts, 33 pseudocysts, and 30 non-inflammatory cysts. The diagnostic sensitivity and specificity for mucinous PCL was 70.8% and 92.3% for intracystic Ngal (cut-off: 500-800 ng/dL), without correlation with serum Ngal, no matter the inclusion of infected pseudocysts. After exclusion of infected pseudocysts, the sensitivity and specificity for glucose were 87% and 75%, respectively, and for CEA, they were 87.1%, and 96.8%, respectively. Intracystic Ngal shows promise in differentiating mucinous PCLs, but researchers need to conduct further studies to confirm its effectiveness. Intracystic IL-1β and serum Ngal made no diagnostic contribution.

Endoscopic ultrasound avoids diagnostic ERCP among the ASGE high-risk group – Experience in an Asian population

A prediction system for common bile duct (CBD) stones was originally published by the American Society for Gastrointestinal Endoscopy (ASGE) in 2010 and was last revised in 2019. We wanted to investigate its application in an Asian population, who have different etiologies of bile duct stone formation and accessibility to medical service compared to the West. This is a single center retrospective study. Patients who received endoscopic ultrasound (EUS) for suspected CBD stones were collected from our endoscopic record system over a 10-year period. The accuracy of the revised ASGE criteria was estimated according to the results of EUS. A minimum follow-up of 6 months was required to detect false negative results. 142 patients were enrolled, 87 (61%) patients had CBD stones. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of the revised ASGE criteria for high-risk patients were 69%, 38%, 64%, 44%, and 57%. 36% of the ASGE-defined high-risk patients negative for CBD stones on EUS. The two significant predictors for CBD stone were CBD dilatation (adjusted OR 3.06, 95% C.I. 1.31-7.17, p=0.010) and ascending cholangitis (adjusted OR 2.28, 95% C.I. 1.01-5.15, p=0.047). ASGE recommends that patients defined as high-risk for choledocholithiasis be considered for direct ERCP without prior need for confirmation imaging. However, our findings indicate a high rate (36%) of patients in that group negative for CBD stones on EUS. Hence, EUS is still be suggested first in selective high-risk patients so that diagnostic ERCP can be avoided in our Asian society.

Experiences in endoscopic ultrasonography at a tertiary center general surgery endoscopy unit

Aim: Endoscopic ultrasonography (EUS) is used for diagnosing pathologies in the gastrointestinal system and surrounding organs. This study aims to share the experiences and results of EUS and biopsy at a tertiary center general surgery endoscopy unit, in the context of the literature.
 Methods: Patients who underwent EUS imaging at the general surgery endoscopy unit between January 2021 and January 2022 were retrospectively reviewed. Demographic characteristics, EUS biopsy indications, clinical pre-diagnoses, preoperative imaging methods, biopsy counts, and results, as well as complications, were analyzed.
 Results: The mean age of the 292 patients was 56.5 years, with 53.8% being male. The most common EUS indication was a mass in the pancreas, accounting for 62%. Endoscopic fine-needle aspiration biopsy was performed on 127 (43.4%) patients, and the mean diameter of biopsied masses was 35.1 mm. Malignancy was detected in 58.2% of the biopsied patients. Based on biopsy and lesion characteristics, 49.3% of patients were followed up, 27.4% underwent surgery, 15.4% received oncological treatment, and 7.9% were given endoscopic retrograde cholangiopancreatography.
 Conclusion: The role of EUS in the diagnosis and treatment of gastrointestinal malignancies, pancreatic diseases, and biliary diseases continues to evolve. We believe that EUS plays a key role in the multidisciplinary management of complex surgical and oncology patients and those with pancreatobiliary disorders.

Diagnostic Performance of Endoscopic Ultrasonography with Water-Filled Balloon Method for Superficial Esophageal Squamous Cell Carcinoma.

Endoscopic ultrasonography (EUS) is a commonly used tool for preoperative depth diagnosis of superficial esophageal squamous cell carcinoma (ESCC). Probing EUS using the water-filled balloon method is a simple and safe examination. The aim of this study was to clarify the diagnostic performance of EUS with the water-filled balloon method for superficial ESCC compared to magnifying narrow-band imaging (ME-NBI). We retrospectively examined 403 lesions in 393 consecutive patients diagnosed with ESCC and evaluated them with ME-NBI and EUS. Clinicopathological findings were collected, and the accuracy of the preoperative diagnosis was compared between ME-NBI and EUS-B. EUS examiners were not blinded to prior ME-NBI results, and EUS results may have been influenced by ME-NBI results. The pathological tumor depth of the EP/LPM in 152 lesions, MM/SM1 in 130 lesions, and deep submucosa (SM2/SM3) in 121 lesions was examined. The proportion of total lesions with an accurate diagnosis was significantly higher in EUS than in ME-NBI (67.7% versus 62.0%, P = 0.015). When analyzed by clinical depth diagnosis using ME-NBI, the proportion of lesions with an accurate diagnosis was significantly higher for EUS in MM/SM1 (55.7% versus 46.1%, P = 0.033). The sensitivity was significantly higher in EUS for SM2/SM3 lesions (76.0% versus 54.5%, P < 0.001). The accuracy and specificity of EUS, which differentiate MM/SM1 from EP/LPM or SM2/SM3, were significantly higher than those of ME-NBI. The median endoscopic ultrasonography procedure time was approximately 6.5min. EUS with the water-filled balloon method is a safe and straightforward method that can be performed on lesions clinically diagnosed as MM/SM1 using ME-NBI. We retrospectively reviewed lesions in patients diagnosed with ESCC and evaluated them using magnifying endoscopy with narrow-band imaging (ME-NBI) and endoscopic ultrasound using the water-filled balloon method (EUS-B). We conclude that EUS-B can increase the diagnostic accuracy.

The role of endoscopic ultrasound in patients with acute pancreatitis.

Acute biliary pancreatitis is the most common form of acute pancreatitis worldwide. Endoscopic ultrasound (EUS) may be helpful in detecting common bile duct stones and in indicating more invasive endoscopic retrograde cholangiopancreatography (ERCP) examinations or determining rarer aetiologies of acute pancreatitis. Over a period of six years, we prospectively collected 131 patients with acute biliary pancreatitis and observed the need for endoscopic examination alongside with a decrease in the number of necessary ERCP examinations as a result of negative EUS results (no bile duct stones detected). We compared groups of patients given different endoscopic treatments in relation to their hospital mortality relative to the incidence of severe acute pancreatitis. As many as 68 % of primarily indicated EUS examinations had a negative result (no common bile duct stones detected) and this result saved the patients from needing to undergo an invasive ERCP procedure. Both the incidence of the severe form of acute pancreatitis and the hospital mortality rate were lower among patients who underwent only EUS or ERCP after EUS as compared to patients who underwent ERCP straight away. The use of EUS in patients with acute pancreatitis is very helpful in determining the treatment strategy (ERCP indication) and may reduce hospital mortality (Tab. 2, Ref. 14).

Surgical Management of Benign Gastric Tumors: A Review

Benign stomach and duodenal tumors are uncommon. Any component of the stomach epithelium, whether glandular, endocrine, or mesenchymal, can develop benign neoplastic tumors. The majority of people with benign stomach and duodenal tumors are asymptomatic for a long time. When symptoms do appear, they are determined by the tumor's size, location, and comorbidities. Endoscopy, computed tomography, and especially endoscopic ultrasonography results are used diagnose. Clinically, it's difficult to tell the difference between benign and malignant stomach tumors. Even benign tumors can undergo malignant transformation, severe obstructive problems, and bleeding. As a result, aggressive surgical resection of the tumors should be undertaken. Laparoscopic resection has become the first option of many surgeons since the development of minimally invasive surgery. According to previous literature, laparoscopic excision of GIST is safe and effective. In this review we’ll be looking at benign gastric tumors, gastrointestinal stromal tumors (GISTs) and their diagnosis.

Pathologically and Bacteriologically Unconfirmed Esophageal Tuberculosis Diagnosed by Endoscopic Ultrasound Combined with the T-SPOT.TB test: A Case Report

Esophageal tuberculosis (TB) is relatively a rare disease, and its diagnosis is often unknown due to the lack of specific clinical symptoms and endoscopic manifestations, as well as the low success rate of pathological biopsy. In this case report, we describe a patient who presented with dysphagia as the chief complaint, manifested as a submucosal eminence under endoscopy. Endoscopic ultrasonography showed hypoechoic changes, disappearance of some layers and esophageal boundaries, and echo of fused lymph nodes around the esophagus. The patient had strongly positive results of the purified protein derivative skin test and T-SPOT.TB. Subsequently, the patient received treatment of anti-TB drugs, and the clinical symptoms improved. According to the patient’s medical history and endoscopic ultrasonography results, esophageal TB was the most probable diagnosis. Therefore, this case report offers new ideas that endoscopic ultrasonography and a review of clinical manifestations can be used to diagnose esophageal TB.

Diagnostic Accuracy of Transabdominal Ultrasound and Computed Tomography in Chronic Pancreatitis: A Head-to-Head Comparison.

Purpose Computed tomography (CT) is the most used imaging modality for diagnosing chronic pancreatitis (CP), but advances in transabdominal ultrasound (US) technology have given US a position as a viable alternative. We aimed to evaluate the diagnostic accuracy of abdominal CT and pancreatic US compared to the reference standard, a modified Mayo score. Materials and Methods CT, US, and endoscopic ultrasound (EUS) were performed in patients referred due to suspected CP. The modified Mayo score included EUS results, clinical presentation, and results from exocrine and endocrine pancreatic function tests. We scored CT findings according to the modified Cambridge classification and US findings according to the Rosemont classification. Results In total, 73 patients were included. 53 patients (73%) were categorized as CP and 20 (27%) as non-CP. CT and US yielded similar sensitivities (68% and 64%, respectively) and specificities (75 and 85%, respectively) and similar areas under the receiver operating characteristic curves for diagnosing CP. We found no significant differences between the areas under the receiver operating characteristic curves (AUROCs) for CT (AUROC 0.75, 95% CI 0.63–0.87) and US (AUROC 0.81, 95% CI 0.71–0.91). Conclusion We conclude that CT and US had comparable, moderate accuracy in diagnosing CP. Neither modality had high enough sensitivity to exclude the diagnosis as a standalone method.

Endoscopic ultrasonography in the differential diagnosis of biliopancreatoduodenal tumors

Objective . Todeterminethe role ofendoscopicultrasonography in preoperative differentialdiagnosis of bilio pancreatoduodenal tumorsand choice of further treatment strategy. Material and methods . A retrospective analysis included medical records of 89 patients hospital-ized with suspected biliopancreatoduodenal tumor.Pancreatic head tumor was diagnosed in 41(46.1%) patients, tumorof major duodenal papilla – in 15 patients (16.9%), tumor of distal seg-ment of common bile duct – in 10 patients (11.2%), cicatricial and inflammatory strictures of distal segment of common bile duct – in 19 patients (21.3%), post-necroticpseudocysts of pancreatic head – in 4 patients (4.5%). Results . Sensitivity ofendoscopic ultrasonography for tumors of pancreatic head, major duodenal papilla, distal common bile duct, cicatricial and inflammatory strictures of distal segment of com-mon bile duct and postnecroticpseudocysts of pancreatic head was 90.2%, 100%, 80%, 94.7% and 100%, respectively. Specificity was 97.9%, 94.6%, 98.7%, 98.6% and 100%, respectively. Overall accuracy was 94.4%, 95.5%, 96.6%, 97.8% and 100%, respectively. False-negative results were obtained in 7 cases. Tumor was not excluded in these patients, but there was a conclusion about an-other primary source of growth. Conclusion . Endoscopic ultrasonography is associated with high accuracy of preoperative differen-tial diagnosis of malignant and benign biliopancreatoduodenaltumors and useful to clarify diagnosis in patients with mechanical jaundice syndrome. These data are usedas an objective criterion to de-termine further treatment strategy depending on the results of endoscopic ultrasonography.

Long-term positive psychological outcomes in an Australian pancreatic cancer screening program.

Screening for pancreatic cancer (PC) in high-risk groups aimed to detect early cancers is currently done only in the research setting, and data on psychological outcomes of screening in these populations is scarce. To determine the psychological impact of a national Australian pancreatic screening program, a prospective study was conducted using validated psychological measures: impact of events scale (IES), psychological consequences questionnaire (PCQ) and the cancer worry scale. Measures were administered at baseline, 1-month and at 1-year post-enrolment and correlations with abnormal endoscopic ultrasound (EUS) results were calculated. Over a 6-year period, 102 participants were recruited to the screening program. Thirty-nine patients (38.2%) had an abnormal endoscopic ultrasound, and two patients (2.0%) were diagnosed with PC and two with other malignancies. Those with a personal history of cancer or a positive BRCA2 mutation demonstrated significantly increased worry about developing other types of cancer at baseline (p < 0.01). Irrespective of EUS result, there was a significant decrease of total IES score at 1year (Z = - 2.0, p = 0.041). In patients with abnormal EUS results, there was a decrease in the total IES score at 1year (Z = - 2.5, p = 0.011). In participants deemed to be most distressed at baseline based on their negative PCQ score, there was a significant decrease of the total PCQ (Z = - 3.2, p = 0.001), emotional (Z = - 3.0, p = 0.001), social (Z = 3.0, p = 0.001) and physical (Z = - 2.8, p = 0.002) subscale at 1-year post-intervention. This study provides evidence of the long-term psychological benefits of PC screening in high-risk patients. There was no negative impact of screening in the short-term and the positive benefits appeared at 1-year post-intervention irrespective of screening result.

Combining endoscopic ultrasound and tumor markers improves the diagnostic yield on the etiology of common bile duct dilation secondary to periampullary pathologies.

Unexplained common bile duct (CBD) dilatation may be caused by many etiologies, such as periampullary tumors, a pancreatic neoplasm, choledocholithiasis or an inflammatory stenosis. The aim of this study is to evaluate the diagnostic yield of endoscopic ultrasonography (EUS) in patients with unexplained CBD dilatation, in combination with tumor markers, liver chemistry, symptoms, surgical history and whether there is dilatation of the pancreatic duct (PD). From January 2016 to July 2017, 115 patients were referred for EUS in our center for CBD dilatation of an unknown etiology. A treatment plan is made based on the EUS result combined with the other clinical information. The final diagnosis is determined by surgical histology or follow-up of at least 3 months. The sensitivity, specificity and accuracy of EUS for patients with choledocholithiasis were 100.0% (10/10), 100.0% (105/105) and 100.0% (115/115), respectively. The sensitivity, specificity and accuracy of EUS for patients with periampullary tumor were 86.5% (32/37), 89.7% (70/78) and 88.7% (102/115), respectively. The sensitivity, specificity and accuracy of EUS for patients with inflammatory stenosis were 88.2% (60/68), 89.4% (42/47) and 88.7% (102/115), respectively. The overall accuracy of EUS for diagnosing an undetermined etiology for CBD dilatation was 88.7% (102/115) and was higher than the accuracy of ultrasound (US) (64.1%), computed tomography (CT) (66.2%), magnetic resonance imaging (MRI) (67.0%) or PET-CT (66.0%). The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of EUS combined with tumor markers for patients with malignant dilatation of CBD were 91.9% (34/37), 97.4% (76/78), 94.4% (34/36), 96.2% (76/79) and 95.7% (110/115), respectively. PD dilation (P=0.026) and weight loss (P=0.035) had significant predictive values of malignancy. EUS is an effective diagnostic tool for determining the etiology of a CBD dilatation, and offers meaningful information for guiding a treatment plan. EUS used in conjunction with tumor markers has high yield in differentiating benign and malignant CBD dilatation. More attention should be paid to patients with PD dilation or weight loss to prevent misdiagnosis of malignant CBD dilation.

Double Contrast-Enhanced Ultrasonography in Preoperative T Staging of Gastric Cancer: A Comparison With Endoscopic Ultrasonography.

Objective: To compare the precision of double contrast-enhanced ultrasonography (DCEUS) to endoscopic ultrasonography (EUS) in preoperative T staging of gastric cancers.Methods: This retrospective study consisted of 158 pathologically confirmed gastric cancer patients. All patients underwent DCEUS (intravenous contrast-enhanced ultrasonography combined with oral contrast-enhanced ultrasonography) and endoscopic ultrasonography (EUS) preoperatively. The histopathological findings of resected specimens were compared with the results of DCEUS and EUS retrospectively.Results: The accuracy of DCEUS and EUS in evaluating the T staging of gastric cancer were 82.3% (T1 62.5%,T2 84.4%,T3 87.9%,T4 91.3%) and 76.6% (T1 84.4%,T2 82.2%,T3 72.4%,T4 65.2%), respectively. There were no significant differences between the methods for the overall T staging accuracy (χ2 = 1.569, P = 0.210). But EUS was superior to DCEUS for T1 stage (χ2 = 3.925, P = 0.048) and DCEUS was superior to EUS for T3 stage (χ2 = 4.393, P = 0.036) and T4 stage (χ2 = 4.600, P = 0.032).Conclusion: DCEUS is a convenient and noninvasive method with high precision, which can be used as the primary imaging technique for advanced gastric cancer T staging. In early gastric cancer, we should prefer EUS. Two methods are complementary for assessing tumor invasion depth of gastric cancer.

Endoscopic ultrasonography for pretreatment T‑staging of gastric cancer: An in�vitro accuracy and discrepancy analysis

In the current era of multi-disciplinary treatment, precise and detailed diagnosis prior to treatment is crucial for clinical practice. For different lesions that fit different indications, the optimum approach for treatment differs significantly. Thus, the recent 8th American Joint Committee on Cancer classification system has introduced ‘clinical stage’ as a criterion. Endoscopic ultrasonography (EUS) has been the first-line choice for pretreatment staging; however, there is no standardization of the depth classification nor a standard EUS method. Additionally, the accuracy for this diagnostic test has ranged between <40 and 90% in previous studies. The aim of the present study was to determine the accuracy of EUS, identify the discrepancies between EUS and histological results, and analyze the underlying causes. Between June 2014 and February 2016, EUS was performed on gastric carcinoma specimens from 60 consecutive patients. EUS was performed on the resected specimens following surgery, but prior to fixation in formalin, invasion of the gastric wall was determined and the deepest location was marked with sutures. The ultrasound images were independently interpreted, and the quality of the images was scored by two endoscopists. Subsequently, the ultrasound images were compared with the pathological results of the same section. The overall accuracy of EUS was 75%. For locally advanced gastric cancers, EUS had a relatively high accuracy (33/43, 86%). The EUS results corresponded well with the pathological hematoxylin and eosin staining results, and the deepest points determined by EUS were confirmed by pathology in the majority of cases (85%). In total, 50 and 10 cases were scored as having high/moderate and low quality, associated with accuracies of 86% (43/50) and 20% (2/10), respectively. EUS is valuable for pretreatment T-staging, particularly for advanced cases. Proximal stomach cancer exhibited a tendency for improved accuracy. Overall, the results of the present study suggest that standardized scanning processes, particularly including all-encompassing scanning, proper probe-placement and high image quality, lead to improved accuracy of EUS.

Esophageal cancer N staging study with endoscopic ultrasonography.

Esophageal cancer staging is important for the treatment of esophageal cancer. Endoscopic ultrasonography (EUS) is a common diagnostic tool for esophageal cancer prior to surgery. However, EUS is unable to accurately discriminate the N-staging of lymph nodes. In order to distinguish an optimized standard for malignant lymph node diagnosis, the present study compared lymph nodes detected by EUS and surgery. A total of 112 patients were preoperatively examined with EUS and staged according to the 7th Edition of the American Joint Committee on Cancer Staging Manual. The results of EUS were compared with surgical findings. The critical values of long diameter, short diameter and lymph node number detected by EUS were >7.5, >5.5 mm and >2, respectively; indexes, including long diameter >7.5 mm, short diameter >5.5 mm, round, low echo, edge smooth, near lesion and detected lymph node number (>2) and T3/4 staging, met significance in the EUS group compared with the surgical group (P<0.05). Furthermore, the area under curve (AUC) value of the EUS (0.801) was superior to the conventional, surgical method (0.779). Although EUS improved the diagnostic accuracy of esophageal N staging, it was not able to satisfactorily distinguish between N2 and N3 staging. Advancements in EUS may enhance its detection ability, further improving the diagnostic accuracy of lymph node metastasis.

Transabdominal ultrasound and endoscopic ultrasound for diagnosis of gallbladder polyps.

Transabdominal ultrasound and endoscopic ultrasound for diagnosis of gallbladder polyps.

Utility of convex EUS for preoperative vascular evaluation of malignant biliary tract neoplasm.

The aim of the present study was to examine the utility of convex endoscopic ultrasonography (EUS) for the preoperative vascular evaluation of malignant biliary tract neoplasm, by comparing EUS findings with histological findings from resected specimens. Between January 2008 and January 2016, the present study retrospectively retrieved 82 cases diagnosed with malignant biliary tract neoplasm to compare findings from convex EUS with histological findings from resected specimens. A total of four groups were defined according to the results of EUS of the hepatic artery (HA) and portal vein (PV): Group 1, hyperechoic tissue between tumor and vessel; group 2, close proximity between tumor and vessel without loss of hyperechoic tissue; group 3, tumor and vessel contiguity, with loss of hyperechoic tissue; and group 4, encasement >180°. Regarding the HA, all 17 cases in groups 2 and 3 in which the tumor was close to the HA however no obvious encasement was evident, demonstrated no histological invasion, or the HA could be separated from the tumor intraoperatively. However, this was not the case for the portal vein. Of the six cases in group 3, 4 cases (66.7%) demonstrated PV invasion. Overall, convex EUS is useful for the preoperative evaluation of malignant biliary tract neoplasms, and surgery may be considered when the tumor is close to the HA on computed tomography scans, however there is no obvious encasement visualized by convex EUS.

Diagnostic value of endoscopic ultrasonography for staging of early gastric cancer

Objective To analyze the diagnostic value of endoscopic ultrasonography (EUS) for staging of early gastric cancer(EGC) and its influential factors. Methods Clinical information of 120 EGC patients admitted from February 2009 to January 2016 was reviewed. Diagnostic accuracy and the influencing factors of EUS for the invasive depth were analyzed by comparing the results of preoperative EUS and the pathology. Results Thirty-six patients were over-staged by EUS, and 10 patients were under-staged among 120 EGC patients. The accuracy, sensitivity, specificity of EUS for the submucosal invasion were 61.67%(74/120), 58.33%(14/24), 62.50%(60/96) respectively. The accuracy, sensitivity and specificity for protruded EGCs (Type I) diagnosis were 74.36%(29/39), 50.00%(6/12), 85.19%(23/27) respectively; these three variables were 59.02%(36/61), 83.33%(5/6), 56.36%(31/55) respectively for flat EGCs(Type Ⅱ), and 45.00%(9/20), 50.00%(3/6), 42.86%(6/14)respectively for excavated EGCs(Type Ⅲ). The univariate factor results showed that differentiated degree, location and endoscopic morphology of the tumor were possible influential factors for over-stage. Multivariate factor results showed that flat type (OR=3.667, 95%CI: 1.086-12.386, P<0.05)and excavated type(OR=6.552, 95%CI: 1.421-30.218, P<0.05) were independent risk factors. Gender, age and tumor maximum diameter were not factors influencing the diagnostic accuracy of EUS. Conclusion The EUS shows higher clinical value for diagnosing the invasive depth in EGC. Tumor differentiated degree, location and endoscopic morphology may be the influencing factors for diagnostic accuracy of EUS. Flat type and excavated type may lead to over-staging. Key words: Endoscopic ultrasonography; Early gastric cancer; Neoplasm stage; Risk factors

Adult Nesidioblastosis With Hypoglycemia Mimicking an Insulinoma: A Challenging Case

Introduction: Nesidioblastosis is the primary cause of persistent hyperinsulinemic hypoglycemia in infants but it is a rare entity for the adults. Nesidioblastosis is defined as an increase of pancreatic beta cells in number and in size. Case Presentation: We describe a rare case of nesidioblastosis with positive endoscopic ultrasonography result mimicking an insulinoma. A 35-year-old female patient had hypoglycemic episodes with high insulin level. Her investigation revealed low venous plasma glucose, high insulin and C-peptide level with positive 72-hour fasting test suggestive of hyperinsulinemic hypoglycemia. Abdominal computed tomography did not show any mass lesion. Endoscopic ultrasonography revealed a mass lesion sized as 1 cm in diameter in the pancreas. But, insulinoma like lesion couldn't be found intra-operatively. It was decided to perform distal pancreatectomy. After distal pancreatectomy, nesidioblastosis was diagnosed histopathologically. The patient was free from her symptoms after surgery. Conclusion: This case illustrates difficulties and limitations of imaging modalities and false positive result of EUS in a case of nesidioblastosis. When there is no insulinoma like lesion during operation, operation should be performed as gradient guided pancreatectomy by the way of selective arterial calcium injection test.

The diagnostic value of endoscopic ultrasonography for pancreatic neuroendocrine tumors

Objective To study the diagnostic value of endoscopic ultrasonography(EUS)for pancreatic neuroendocrine tumors (pNETs) by comparing EUS with computed tomography (CT), ultrasonography, magnetic resonance imaging (MRI) and positron emission tomography/computed tomography (PET/CT). Methods Data of 70 pNETs cases (a total of 77 lesions) confirmed by pathological diagnosis from July 2012 to March 2016 in Shanghai Cancer Center of the Fudan University were retrospectively studied. Among the cases, 53 cases (a total of 60 lesions) were confirmed by surgical pathology and their results of EUS, abdominal ultrasonography, CT, MRI and PET/CT were compared before surgery. Results A total of 76 lesions were detected by EUS, in which 32 lesions less than 2 cm were tested by HI ZOOM high definition amplification, qualified elastography images of 49 lesions were obtained, 42 solid lesions or solid components were also tested by Fine Flow, and 6 cases were tested by 3D imaging. Diagnostic rates of lesions by EUS, ultrasonography, CT, MRI and PET/CT were 98.33% (59/60), 61.11%(33/54), 89.47%(51/57), 76.00%(19/25) and 78.38%(29/37), respectively. For lesions less than 2 cm, diagnostic rates by these examinations were 96.30% (26/27), 47.83%(11/23), 76.00%(19/25), 54.55%(6/11) and 58.82%(10/17), respectively. Accuracy rates of EUS, ultrasonography, CT, MRI and PET/CT in the location of these lesions were 91.67%(55/60), 51.85%(28/54), 80.70%(46/57), 72.00%(18/25) and 75.68% (28/37), respectively. Conclusion Combined with Fine Flow, HI ZOOM high definition amplification and elastography, EUS is superior to standard imaging for pNETs, especially for lesions less than 2 cm. Key words: Endoscopic ultrasonography; Diagnosis; Pancreatic neuroendocrine tumors

Gastroscopic removal of a giant fibrovascular polyp from the esophagus.

Giant polyps in the esophagus are rarely occurring benign tumors and may contain lipomas, fibrovascular polyps, fibrolipomas or neurofibromas polyps. Clinical symptoms include dysphagia, vomiting, retrosternal pain, shortness of breath, and asthma. In some cases, the polyps are regurgitated into the oral cavity and represent a spectacular manifestation. The reported case in this study was of a 50‐year‐old man who complained of emesia for half a year and dysphagia for one month before being hospitalized. Occasionally, a fleshly mass reached into his mouth. The results of endoscopic ultrasonography, barium swallow in the upper digestive tract, and a computed tomography scan demonstrated a giant polyp in the esophagus, which was subsequently removed by gastroscopy. Pathological examination determined a fibrovascular polyp.