Sensitivity Of Endoscopic Ultrasonography Research Articles

Current status of endoscopic ultrasound in the diagnosis of intraductal papillary mucinous neoplasms.

The new Kyoto guidelines for the management of intraductal papillary mucinous neoplasm (IPMN) provide evidence-based recommendations for the diagnosis and treatment of IPMN. Endoscopic ultrasonography (EUS) is a diagnostic modality with a high spatial resolution that allows detailed observation and obtaining cyst fluid or tissue samples via EUS-guided fine needle aspiration (EUS-FNA). Currently, EUS is an indispensable examination method for the diagnosis of pancreatic diseases. On the other hand, there have been concerns that EUS imaging tends to be highly operator-dependent, and may lack objectivity. Previous guidelines have assigned EUS as an option for patients with worrisome features. However, recent reports indicate that the sensitivity of EUS for the diagnosis of mural nodules (MNs) is more than 90%, comparable or superior to that of contrast-enhanced computed tomography or magnetic resonance cholangiopancreatography. The specific advantages of EUS in the diagnosis of IPMN are: (1) high spatial resolution imaging for the diagnosis of MNs, (2) contrast-enhanced EUS for differentiation of intra-cystic MNs from mucous clots, and (3) pathological diagnosis using EUS-FNA and differential diagnosis of a pancreatic cystic tumor by cystic fluid analysis. In order to utilize EUS in the diagnosis of IPMN, endoscopists are required to have the skills to provide sufficiently objective imaging findings.

Endoscopic ultrasonography-related diagnostic accuracy and clinical significance on small rectal neuroendocrine neoplasms.

This research aimed to examine the diagnostic accuracy and clinical significance of endoscopic ultrasonography (EUS) in the context of small rectal neuroendocrine neoplasms (NENs). A total of 108 patients with rectal subepithelial lesions (SELs) with a diameter of < 20 mm were included in the analysis. The diagnosis and depth assessment of EUS was compared to the histology findings. The prevalence of NENs in rectal SELs was 78.7% (85/108). The sensitivity of EUS in detecting rectal NENs was 98.9% (84/85), while the specificity was 52.2% (12/23). Overall, the diagnostic accuracy of EUS in identifying rectal NENs was 88.9% (96/108). The overall accuracy rate for EUS in assessing the depth of invasion in rectal NENs was 92.9% (78/84). Therefore, EUS demonstrates reasonable diagnostic accuracy in detecting small rectal NENs, with good sensitivity but inferior specificity. EUS may also assist physicians in assessing the depth of invasion in small rectal NENs before endoscopic excision.

Assessment of the diagnostic significance of endoscopic ultrasonography in the differential diagnosis of formations of the hepatopancreatoduodenal zone

Purpose of the work. To study the structure of the hepatopancreaticoduodenal zone (HPD) masses according to the endosonographic picture and to estimate the diagnostic informativeness of endoscopic ultrasonography (EUS) in diagnostics of these masses in comparison with ultrasound examination of HPD (ultrasound of HPD) and computer tomography of abdominal cavity organs (CT of OBP) with contrasting. Materials and Methods. A retrospective analysis of medical records of 71 patients with GDZ masses who underwent inpatient treatment in the department of abdominal surgery and applied for diagnostic purposes to the endoscopic centre of Karaganda Multidisciplinary Hospital No.3 for EUS for the period from January 2021 to December 2022 was carried out. Results and discussion. Sensitivity of EUS in differential diagnostics of PG tumours, hepaticocholedochal dilatation, vascular invasion and metastasis to regional lymph nodes was 85%, 94,12%, 64,71% and 100% respectively, specificity - 95,93%, 100%, 80% and 92% respectively. Conclusion. Correct assessment of all manifestations of a tumour influences the choice of treatment tactics and consequently its immediate and long-term results. EUS is an effective method of differential diagnostics of pseudocysts and cystic tumours of PG, tumours of large duodenal papilla (LDP), as well as biliary tract neoplasms.

Diagnostic sensitivity of endoscopic ultrasonography in patients with suspected choledocholithiasis

The likelihood of common bile duct stones can be prognosticated by various clinical predictors, however, the sensitivity and specificity of these factors are moderate. Endoscopic ultrasonography has been shown to be a semi-invasive precise test for the detection of common bile duct stones. Our aim was to assess the diagnostic accuracy of endoscopic ultrasonography in patients with suspected choledocholithiasis. Patients of this prospective study were categorized and divided into intermediate likelihood and high likelihood groups according to the clinical predictors defined by the American Society of Gastrointestinal Endoscopy (ASGE) guidelines and referred for linear endosonography. Endoscopic retrograde cholangiopancreatography (ERCP) was performed if needed. A total of 95 patients were assessed. Common bile duct stones were detected by endoscopic ultrasonography overall in 53 (56%) patients: 55% (39/71) in the intermediate likelihood and 58% (14/24) in the high likelihood group of patients. The detected common bile duct stones in all patients were confirmed by ERCP. There was no significant difference (p = 0.56) in the detection of stones by ERCP between the two likelihood groups. ERCP confirmed choledocholithiasis only in one patient whose preceding endosonography did not detect stone. The specificity and sensitivity of endoscopic ultrasonography were 100% and 98%, the positive predictive value and negative predictive value were 100% and 98%, respectively. Estimating the likelihood of choledocholithiasis based on various clinical predictors might be challenging. Endoscopic ultrasonography is a highly sensitive and accurate diagnostic tool for the detection and evaluation of common bile duct stones also in patients with previous normal imaging findings. Orv Hetil. 2022; 163(10): 400-406.

Invisible or negligent—EUS detection for the negative CT or/and MRCP CBD stone

Invisible or negligent—<scp>EUS</scp> detection for the negative <scp>CT</scp> or/and <scp>MRCP CBD</scp> stone

S2484 Endoscopic Ultrasound With Fine Needle Aspiration for Diagnosis of Pancreatic Tumors in Patients With Benign Magnetic Resonance Imaging: Single Center Case Series

Introduction: Pancreatic cancer is the fourth leading cause of cancer-related death in the United States. Computed tomography (CT) scan and Magnetic resonance imaging (MRI) are used for early detection of small pancreatic lesions and cancer risk stratification. Endoscopic ultrasonography (EUS) with FNA (Fine Needle Aspiration) provides accurate diagnosis of pancreatic tumors. This case series introduces four cases of pancreatic tumors diagnosed using EUS/FNA that have been missed on MRI studies Case Description/Methods: Case 1 64-year-old male was referred for evaluation of pancreatic duct dilation on MRI with no detected mass. EUS revealed 15mm x 15mm mass of pancreas. FNA was performed and pathology was consistent with adenocarcinoma Case 2 55-year-old female was referred for evaluation of pancreatic cystic lesion found on MRI with no worrisome features. EUS revealed 15mm x 15mm pancreatic lesion. FNA was performed and pathology was consistent with pancreatic neuroendocrine tumor. Case 3 82-year-old female was referred for evaluation of pancreatic duct dilation on MRI with no discrete mass identified. EUS revealed 26mm x 27mm pancreatic lesion. FNA was performed and pathology was consistent with invasive adenocarcinoma. Case 4 62-year-old male was referred for evaluation of pancreatic lesion on MRI abdomen with features consistent with lipoma. EUS revealed 15mm x 13mm pancreatic lesion. FNA was performed and pathology was consistent with adenocarcinoma. Discussion: The diagnosis of pancreatic neoplasms relies heavily on identification of lesions on CT and MRI. While the sensitivity of MRI is similar to that of CT, the former is preferred in patients with high pre-test probability of pancreatic neoplasms. Sensitivity of EUS has been shown to be significantly higher in detecting pancreatic tumors when compared to CT, However, studies evaluating EUS to MRI are scarce. This case series presents four patients in whom pancreatic tumors were missed on MRI. Two patients had no radiologic evidence of a tumor, while the other two demonstrated lesions with no malignant features. EUS has the added benefit of tumor sampling and higher sensitivity in detecting pancreatic lesions. This case series highlights the potential limitations in the use of MR imaging in diagnosis of pancreatic cancers. Some evidence suggests that EUS is more sensitive than MRI and CT in detecting pancreatic lesions. However, the cost effectiveness and risks associated with routine EUS in the detection of pancreatic lesions has not been evaluated.Figure 1.: (A): Case 3 EUS with arrow pointing at 26mm x 27mm pancreatic lesion (B): Case 4 EUS with arrow pointing at 15mm x 13mm pancreatic lesion.

Clinical Analysis of Early-Stage Pancreatic Cancer and Proposal for a New Diagnostic Algorithm: A Multicenter Observational Study.

Early diagnosis of pancreatic ductal adenocarcinoma (PDAC) is challenging but essential for improving its poor prognosis. We established a multicenter study to clarify the clinicopathological features, and to propose new algorithm for early diagnosis of PDAC. Ninety-six patients with stage 0 and IA PDAC were enrolled from 13 high-volume centers. Overall, 70% of the patients were asymptomatic. The serum pancreatic enzyme levels were abnormal in half of the patients. The sensitivity of endoscopic ultrasonography (EUS) for detecting small PDAC was superior to computed tomography and magnetic resonance imaging (MRI) (82%, 58%, and 38%, respectively). Indirect imaging findings were useful to detect early-stage PDAC; especially, main pancreatic duct stenosis on MRI had the highest positive rate of 86% in stage 0 patients. For preoperative pathological diagnosis, the sensitivity of endoscopic retrograde cholangiopancreatography (ERCP)-associated pancreatic juice cytology was 84%. Among the stage IA patients, EUS-guided fine-needle aspiration revealed adenocarcinoma in 93% patients. For early diagnosis of PDAC, it is essential to identify asymptomatic patients and ensure close examinations of indirect imaging findings and standardization of preoperative pathological diagnosis. Therefore, a new diagnostic algorithm based on tumor size and imaging findings should be developed.

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.

Endoscopic Ultrasonography Miniature Probe Performance for Depth Diagnosis of Early Gastric Cancer with Suspected Submucosal Invasion.

Background/AimsThe accurate assessment of the depth of invasion of early gastric cancer (EGC) is critical to determine the most appropriate treatment option. However, it is difficult to distinguish shallow submucosal (SM1) invasion from deeper submucosal (SM2) invasion. We investigated the diagnostic performance of endoscopic ultrasonography (EUS) using a miniature probe for EGC with suspected SM invasion.MethodsFrom April 2008 to June 2018, EGCs with suspected SM invasion were analyzed retrospectively. The EGCs examined by a 20 MHz high-frequency miniature probe was included in our study. Esophago-gastric junction cancers and patients treated by chemotherapy before resection were excluded. The sensitivity and specificity for the detection of SM2 invasion by EUS were compared with those of white light imaging (WLI). Additionally, factors related to depth underestimation or overestimation were investigated using multivariate analysis.ResultsA total of 278 EGCs in 259 patients were included in the final analysis. The sensitivity and specificity for SM2 or deeper by EUS were 73.7% (87/118) and 74.4% (119/160), respectively. The sensitivity and specificity by WLI were 47.5% (56/118) and 68.1% (109/160), respectively. The sensitivity of EUS was significantly superior to that of conventional endoscopy (p<0.01). Multivariate analysis revealed that an anterior location of the EGC was an independent risk factor for underestimation by EUS (odds ratio, 3.3; 95% confidence interval, 1.1 to 9.8; p=0.03).ConclusionsThe depth diagnostic performance for EGCs with suspected SM invasion using EUS was satisfactory and superior to that of conventional endoscopy. Additionally, it is important to recognize factors that may lead to misdiagnosis in those lesions.

Estimation of invasion depth of early colorectal cancer using EUS and NBI-ME: a meta-analysis

Endoscopic ultrasonography (EUS) and narrow band imaging-magnifying endoscopy (NBI-ME) are often used as diagnostic tools to estimate the depth of invasion in early colorectal cancer (CRC). The aim of this study was to compare NBI-ME with EUS in distinguishing between slight submucosal invasion (invasion depth < 1000μm) and massive submucosal invasion in patients with early CRC, since slight submucosal invasion is currently considered as an indication for endoscopic resection. For this meta-analysis, relevant studies were identified from PubMed, Embase, Web of Science, Scopus and the Cochrane Library databases between January 1997 and September 2016. Data on the yield of tumors were extracted, pooled, and analyzed by stata12.0 software. The sensitivity, specificity, positive likelihood ratio and negative likelihood ratio in differentiating slight submucosal invasion from massive submucosal invasion were calculated for both diagnostic modalities. Sixteen studies involving 2197 lesions were included: nine were studies on EUS and 7 were studies on NBI-ME. The pooled sensitivity of EUS was 0.902 (95% CI 0.863-0.930), the specificity was 0.877 (95% CI 0.810-0.922), the positive likelihood ratio was 7.314 (95% CI 4.551-11.755) and the negative likelihood ratio was 0.112 (95% CI 0.076-0.164). The pooled sensitivity and specificity of NBI-ME were 0.981 (95% CI 0.949-0.993) and 0.651 (95% CI 0.600-0.699), respectively, the positive likelihood ratio was 2.815 (95% CI 2.432-3.258) and the negative likelihood ratio was 0.029 (95% CI 0.010-0.080). The sensitivity tended to be higher in ME-NBI than EUS for early CRC with slight submucosal invasion, whereas the specificity was significantly lower in NBI-ME than in EUS.

Comparative study of endoscopic ultrasonography and CT in the diagnosis of patients with pancreatic and periampullary tumors

Objective To evaluate the clinical value of endoscopic ultrasonography and CT in the diagnosis of patients with pancreatic and periampullary tumors. Methods From February 2010 to January 2016, 89 patients with suspected pancreatic and periampullary tumors in Yinzhou Hospital Affiliated to Medical College of Ningbo University were selected in this study.Endoscopic ultrasonography and CT were performed in 89 patients.Endoscopic ultrasonography and CT examination results were compared with surgical and pathological results, and the sensitivity, specificity and accuracy of the two methods were recorded and compared. Results By pathological examination, 69 cases were diagnosed as pancreatic and periampullary tumors.The sensitivity of endoscopic ultrasonography was 95.65% (66/69), the specificity was 95.00%(19/20), and the accuracy was 95.51% (85/89). The sensitivity of CT diagnosis was 85.51% (59/69), and the specificity was 90.00%(18/20), and the accuracy was 86.52% (77/89). The sensitivity and accuracy of endoscopic ultrasonography were significantly higher than those of CT, and the differences were statistically significant (χ2=4.161, 4.395, P=0.041, 0.036). And there was no statistically significant difference in the specificity of endoscopic ultrasonography and CT (χ2=0.360, P=0.548). Conclusion Endoscopic ultrasonography and CT examination have high specificity in the diagnosis of patients with pancreatic and periampullary tumors, however, the sensitivity and accuracy of endoscopic ultrasonography are higher than CT, the clinical appropriate diagnostic methods can be chosen according to the actual condition of the patients. Key words: Pancreas; Ampulla of uater; Neoplosms; Endoscopes; Ultrasonography; Tomography, X-ray computed; Diagnosis

Endoscopic ultrasonography combined with magnifying endoscopy with narrow band imaging for the diagnostic value of early colorectal cancer

Objective To investigate the diagnostic value of endoscopic ultrasonography combined with magnifying endoscopy with narrow band imaging (NBI-ME) in the diagnosis of early colorectal cancer. Methods A total of 187 patients with early colorectal cancer who were treated in Cancer Hospital Chinese Academy Medical Sciences and Peking Union Medical College from January 2015 to December 2017 were retrospectively analyzed. The patients were examined with NBI-ME along with endoscopic ultrasonography before endoscopic or surgical treatment, and the depth of invasion was judged. Finally, postoperative pathology was taken as the gold standard to evaluate the value of endoscopic ultrasonography combined with NBI-ME in the diagnosis of early colorectal cancer. Results The histopathological results were treated as the golden standard. The diagnostic accuracy rate of endoscopic ultrasonography and endoscopic ultrasonography combined with NBI-ME in 187 patients with early colorectal cancer was 84.0 % (157/187), 92.5 % (173/187) respectively. Overall accuracy rate of the invasive depth of NBI-ME in the patients with early colorectal cancer was 87.2 % (166/187). Sensitivity of endoscopic ultrasonography combined with NBI-ME to Tm, Tsm1 and ≥Tsm2 in early colorectal cancer pathological tissues was 92.4 %, 90.4 %, 93.3 % respectively, and the corresponding specificity was 93.9 %, 90.1 %, 90.9 % respectively. The diagnostic accuracy rate of endoscopic ultrasonography combined with NBI-ME was higher than that of endoscopic ultrasonography, and there was a significant difference (χ 2 = 6.594, P = 0.010 2). Conclusion Endoscopic ultrasonography combined with NBI-ME has a high accuracy rate for evaluating the depth of invasion in early colorectal cancer, which contributes to a good application value for preoperative evaluation of early colorectal cancer. Key words: Colorectal neoplasms; Early diagnosis; Endoscopic ultrasonography; Magnifying endoscopy; Narrow band imaging

Is endoscopic ultrasonography more sensitive than magnetic resonance imaging in detecting and localizing pancreatic neuroendocrine tumors?

To compare endoscopic ultrasonography (EUS) and magnetic resonance imaging (MRI) in terms of their sensitivities to localize pancreatic neuroendocrine tumors (pNET) preoperatively. Systematic analysis of the literature; sensitivity of EUS and MRI in insulinomas and pancreaticoduodenal NETs in multiple endocrine neoplasia type 1 (MEN1) in series of at least 20 subjects referring to tumors confirmed by surgery and histopathology. Other imaging methods reported were also assessed. Eighteen publications on insulinomas (782 cases) could be analyzed, no study in MEN1 fulfilled the inclusion criteria and compared EUS to MRI. Data quality was moderate: all publications referred to case series. Mean correct detection / localization rates (sensitivity) were calculated: EUS 80%, MRI 66%, computed tomography 63%, angiography 52%, somatostatin receptor scintigraphy 42%, ultrasonography 23%; arterial calcium stimulation with hepatic venous sampling regionalized correctly in 80%. EUS seems to be more sensitive than MRI in localizing pancreatic neuroendocrine tumors. If a specialized endosonographist is available, EUS is the preferable imaging procedure. Otherwise, MRI is a suitable alternative.

Endoscopic ultrasonography and computed tomography scanning for preoperative staging of colonic cancer.

With an increasing demand for more accurate preoperative staging methods for colon cancer, we aimed to compare preoperative tumour (T)- and nodal (N)-stage in patients with left-sided colon cancer by endoscopic ultrasonography (EUS) and computed tomography (CT) with post-operative histology as gold standard. A total of 44 patients were prospectively recruited at Herlev and Roskilde University Hospitals during November 2014-January 2016. Thirty-five patients were included in the final analysis and underwent EUS, CT and surgery within 2weeks. Diagnostic values were evaluated for "low risk" (T1+T2+T3 with ≤5mm extramural invasion) and "high risk" (T3 with >5mm of extramural spread + T4) colonic cancer. Sensitivity and specificity in "low risk" colonic cancer evaluated with EUS was 0.90 [0.74;0.98] and 0.75 [0.19;0.99] and with CT 0.96 [0.80;0.99] and 0.25 [<0.01;0.81]. EUS and CT were poor in predicting N0 or N+ disease. The sensitivity of EUS and CT were good and comparable regarding T-stage evaluation, while EUS had a significantly higher specificity in the evaluation of "low risk" tumours. The results obtained for "high risk" colonic cancer were difficult to evaluate due to small patient numbers. EUS could be considered as a supplement to CT scans in selecting patients for neoadjuvant therapies, or local transmural treatment, in the future. NCT02324023.

Endoscopically Placed Fiducial Markers Aid in Insulinoma Resection

Case: A 47-year-old female presented with hypoglycemia for 1 year. The 72-hour fast was terminated for hypoglycemic symptoms and glucose of 40 mg/dL. Laboratories revealed low insulin level and low–normal C-peptide with elevated proinsulin, suggesting proinsulin-secreting neuroendocrine tumor (NET). Insulinoma is the most common functioning pancreatic NET and presents with symptoms of hypoglycemia. CT was negative for pancreatic mass. Endoscopic ultrasonography (EUS) revealed an 8 × 7 mm midbody pancreatic mass and biopsy confirmed NET. Fiducial markers were placed with EUS guidance to aid intraoperative localization during partial pancreatectomy. Intraoperative fluoroscopy (IOF) and laparoscopic ultrasonography (LUS) localized the peritumoral fiducials. The mass was close to the splenic vessels and nearly abutting the pancreatic duct. A 60-mm laparoscopic stapler was inserted, and the fiducials were used to achieve ≥1 cm surgical margin (video). The total laparoscopic distal pancreatectomy was completed with a spleen-sparing technique. Postoperatively, the hypoglycemia resolved. Discussion: Most NETs are intrapancreatic, 90% are solitary, 90% are <2 cm in diameter, and tumors are found equally throughout the pancreas.1 EUS, utilized in diagnosis and localization in this case, has recognized advantages over other observation techniques. As seen in this study, diagnosis of pancreatic tumors is possible despite negative CT.2 Sensitivity of EUS ranges from 37% to 94% regardless of the functional state of the insulinoma, and is largely dependent on the location of the lesion. EUS is best at detecting tumors in the head and worst at detecting those in the tail of the pancreas.3 EUS has low complication rates and has a relative ease of use with a skilled operator.4 Localization before surgery is desired because most tumors are not palpable at the time of surgery, and type of surgery can be determined based on location.5 Using EUS for preoperative staging of pancreatic tumors has been in practice for several years, although it is usually achieved through tattoos and dyes.6,7 Preoperative localization of pancreatic endocrine tumors with tattoos and dyes has been shown to decrease operative time and blood transfusion requirement.8 Most data regarding localization of pancreatic tumors concern insulinomas, although proinsulinomas have been localized with tattoos.9 Tattoos and dyes have potential complications of absorption into surrounding tissues, peritonitis, infection, and allergic reaction.10 Fiducial markers are radiopaque 3 mm gold particles often endoscopically placed through 22 gauge needle. They are observed with LUS and IOF during resection, and shorten operative time by revealing the location of nonpalpable tumors or tumors that are poorly observed through LUS alone. By shortening operative time, it reduces perioperative complications, reduces need for reoperation, and increases likelihood of an effective outcome.11 Fiducials are superior to ink/tattoos by eliminating imprecise localization from ink absorption into surrounding tissues.12 Reported complications include most common abdominal pain, followed by cholangitis, pancreatitis, minor bleeding, fever, and elevated liver enzymes.13–16 No competing financial interests exist. Runtime of video: 7 mins 48 secs Presented as Poster Abstract at American College of Gastroenterologists Annual Scientific Meeting 2014, Philadelphia.

Staging Accuracy of Endoscopic Ultrasound Based on Pathologic Analysis after Minimally Invasive Esophagectomy

Endoscopic ultrasonography (EUS) is a common staging modality used in patients with esophageal cancer. The objective of this analysis was to evaluate the accuracy and sensitivity of EUS in determining the depth of penetration (T stage) and nodal status (N stage) in patients with esophageal cancer who underwent minimally invasive esophagectomy (MIE). A retrospective analysis of all patients at a university hospital who underwent preoperative EUS followed by MIE for cancer was performed. We compared the results of preoperative EUS to final pathologic analyses of the esophageal specimen, examining the accuracy of EUS staging. Ninety-five patients with esophageal cancer who underwent MIE had preoperative EUS. Twenty-four of the 95 patients were excluded for lack of a repeat EUS after neoadjuvant therapy before resection. Hence, 71 patients were evaluated for the accuracy of EUS staging. The accuracy of EUS for T0 disease was 80 per cent; T1 disease was 75 per cent; T2 disease was 39 per cent; and T3 disease was 88 per cent. The overall EUS accuracy for T stage was 72 per cent with overstaging occurring mostly for pathologic T1 tumors in 18 per cent and understaging occurring mostly for pathologic T3 tumors in 11 per cent. The sensitivity and specificity for detection of nodal involvement were 79 per cent and 74 per cent, respectively. However the accuracy for T and N staging by EUS after neoadjuvant therapy decreased to 63 per cent and 38 per cent, respectively. Endoscopic ultrasound in the absence of neoadjuvant therapy is a relatively accurate and sensitive modality for determining the depth of tumor penetration and the presence of nodal disease in patients with esophageal carcinoma. The accuracy for T and N staging is less reliable after neoadjuvant therapy.

Usefulness of endoscopic ultrasonography (EUS) for selecting carcinoid tumors as candidates to endoscopic resection

Carcinoid tumors (CTs) represent the most common type of neuroendocrine tumors (NETs). Digestive CTs in the gastroduodenal and colorectal tracts may be assessed using endoscopy and echoendoscopy or endoscopic ultrasonography (EUS) with the goal of attempting local resection with curative intent without having recourse to surgery. Endpoints in this study included:--Assessing the usefulness of EUS for selecting CTs as candidates to endoscopic excision. --Assessing the effectiveness of local resection (complete carcinoid resection) and the safety (complications) of the technique involved. OUr series included 18 patients (12 males and 6 females) with 23 tumors. Sixteen patients (10 males and 6 females) were selected, with age ranging from 40 to 81 years (mean: 57 years), biopsied, endoscopically treated digestive carcinoid tumors, and a previous negative extension study. Twenty-one 2-to-20-mm (mean size 8 mm) tumors were resected in 23 procedures. After endoscopy plus biopsy and echoendoscopy (EUS), excision was carried out with conventional polypectomy snare mucosectomy and submucosal injection with saline and/or adrenaline in most cases (15), and mucosectomy technique following lesion ligation with elastic bands for six cases. Two cases underwent transanal endoscopic surgery (TEM), one of them following non-curative polypectomy. A total of 23 local procedures were performed with the key goal of assessing efficacy (complete resection: CR) and safety (complications). There were no severe complications except for the last gastric mucosectomy for a 6-mm carcinoid, where a miniperforation occurred that was solved by using 3 clips (1/23: 4.3%).EUS sensitivity was 94%. Complete resection was 90.5% (19/21). The endoscopic mucosal resection of selected carcinoid tumors is a safe, effective technique. EUS is the technique of choice to select patients eligible for endoscopic resection (carcinoids smaller than 20 mm in superficial layers, with an unscathed muscularis propria and negative extension study).

Assessment of response to neoadjuvant therapy in esophageal cancer: an updated systematic review of diagnostic accuracy of endoscopic ultrasonography and fluorodeoxyglucose positron emission tomography

For assessing response to neoadjuvant therapy in patients with esophageal cancer, both endoscopic ultrasonography (EUS) and fluorodeoxyglucose positron emission tomography (FDG-PET) are commonly used, and despite few controlled trials, it is not known if one imaging modality is superior to the other. Also, relative diagnostic accuracy of early (during the course of neoadjuvant therapy) and FDG-PET after completion of neoadjuvant therapy has not been reviewed. The aim of this study was to perform a systematic review of published information to compare diagnostic accuracy of EUS and FDG-PET in this setting. A search of the MEDLINE, EMBASE, and Cochrane databases was performed along with a manual search of cross-references of eligible articles. Data on the accuracy of the imaging modalities were compared by constructing summary receiver-operating characteristic curves. Seven studies with EUS and 15 with FDG-PET were included in the final analysis (N= 966). The sensitivity of EUS and FDG-PET ranged from 20 to 100% and 42 to 100%, respectively. The specificity ranged from 36 to 100% and 27 to 100%, respectively. The areas under the curve were 0.86 (95% confidence interval [CI]: 0.77-0.96) for EUS and 0.80 (95% CI: 0.72-0.89) for FDG PET (P= 0.37). The maximum joint sensitivity and specificity (Q* index) values for EUS and FDG-PET were 0.79 (95% CI: 0.70-0.88) and 0.74 (95% CI: 0.66-0.81), respectively (P= 0.38). There was no difference in accuracy between early FDG-PET and FDG-PET after completion of neoadjuvant therapy. EUS and FDG-PET have similar overall diagnostic accuracy for assessment of response to neoadjuvant therapy in patients with esophageal cancer.

Single session versus separate session endoscopic ultrasonography plus endoscopic retrograde cholangiography in patients with low to moderate risk for choledocholithiasis

Endoscopic ultrasonography (EUS) is a minimally invasive diagnostic tool for common bile duct stones (CBDS) and may be used to select patients for therapeutic endoscopic retrograde cholangiography (ERC). The aim of this trial is to compare, in patients with non-high-risk for CDBS, the clinical and economic impact of EUS plus ERC performed in a single endoscopic session versus EUS plus ERC in two separate sessions. During an 11-month period, all adult patients admitted to the emergency department with suspicion of CBDS were categorized into either high-risk or non-high-risk groups, on the basis of clinical, biochemical, or transabdominal ultrasound findings. Patients in the non-high-risk group were randomized to receive EUS plus ERC in one single or in two separate sessions. Eighty patients were recruited and randomized. Forty patients underwent EUS plus ERC in a single session and 40 patients underwent EUS plus ERC in two separate sessions. Negative EUS examination for CBDS avoided unnecessary ERC to 33 patients. Out of 47 patients with positive EUS (25 from the single session group and 22 from the double session), ERC confirmed the presence of CBDS in 46 cases (EUS sensitivity 100% and specificity 98%). Average time of procedure and hospitalization were significantly shorter in the single session group compared to the two session group. The single session strategy was also less expensive. Endoscopic ultrasonography plus ERC with sphincterotomy and stone extraction performed during the same endoscopic session was safe and efficacious with a reduction of procedure time, hospitalization and costs.

Staging investigations for oesophageal cancer: a meta-analysis

The aim of the study was to compare the diagnostic performance of endoscopic ultrasonography (EUS), computed tomography (CT), and 18F-fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) in staging of oesophageal cancer. PubMed was searched to identify English-language articles published before January 2006 and reporting on diagnostic performance of EUS, CT, and/or FDG-PET in oesophageal cancer patients. Articles were included if absolute numbers of true-positive, false-negative, false-positive, and true-negative test results were available or derivable for regional, celiac, and abdominal lymph node metastases and/or distant metastases. Sensitivities and specificities were pooled using a random effects model. Summary receiver operating characteristic analysis was performed to study potential effects of study and patient characteristics. Random effects pooled sensitivities of EUS, CT, and FDG-PET for regional lymph node metastases were 0.80 (95% confidence interval 0.75–0.84), 0.50 (0.41–0.60), and 0.57 (0.43–0.70), respectively, and specificities were 0.70 (0.65–0.75), 0.83 (0.77–0.89), and 0.85 (0.76–0.95), respectively. Diagnostic performance did not differ significantly across these tests. For detection of celiac lymph node metastases by EUS, sensitivity and specificity were 0.85 (0.72–0.99) and 0.96 (0.92–1.00), respectively. For abdominal lymph node metastases by CT, these values were 0.42 (0.29–0.54) and 0.93 (0.86–1.00), respectively. For distant metastases, sensitivity and specificity were 0.71 (0.62–0.79) and 0.93 (0.89–0.97) for FDG-PET and 0.52 (0.33–0.71) and 0.91 (0.86–0.96) for CT, respectively. Diagnostic performance of FDG-PET for distant metastases was significantly higher than that of CT, which was not significantly affected by study and patient characteristics. The results suggest that EUS, CT, and FDG-PET each play a distinctive role in the detection of metastases in oesophageal cancer patients. For the detection of regional lymph node metastases, EUS is most sensitive, whereas CT and FDG-PET are more specific tests. For the evaluation of distant metastases, FDG-PET has probably a higher sensitivity than CT. Its combined use could however be of clinical value, with FDG-PET detecting possible metastases and CT confirming or excluding their presence and precisely determining the location(s).