Usefulness Of Endoscopic Ultrasonography Research Articles

The role of endoscopic ultrasonography for assessing the activity of ulcerative colitis in children

Background. Endoscopic diagnostic methods, namely ileocolonoscopy with biopsy, are the „gold standard“ in the diagnosis of ulcerative colitis. Due to the improvement of methods for the diagnosis of ulcerative colitis, the use of endoscopic ultrasonography, that combines endoscopic and ultrasound diagnostic methods, has attracted widespread attention. Endoscopic ultrasonography allows examination of the mucous membrane and the underlying layers of the intestinal wall, which makes it possible to measure the thickness of the intestinal wall. Both in Russia and abroad, there are no publications on the use of endoscopic ultrasonography for ulcerative colitis in children, and that requires further research in this area.
 Aim. To evaluate the possibilities of endoscopic ultrasonography in order to determine the activity of ulcerative colitis in children.
 Materials and methods. The study includes 97 children with an established diagnosis of ulcerative colitis. All children underwent ileocolonoscopy and endoscopic ultrasonography. The UCEIS scale (Ulcerative Colitis Endoscopic Index of Severity) was used to assess endoscopic activity. During endoscopic ultrasonography, the thickness of the intestinal wall and blood flow were evaluated using the color Doppler mapping mode.
 Results. According to the study, there was a statistically significant increase in the thickness of the intestinal wall amid the development of endoscopic activity. The statistically significant increase in the activity of blood flow in the intestinal wall was found.
 Conclusion. Endoscopic ultrasonography is a relatively new research method with a number of functions that can be used to solve complex diagnostic problems in children with ulcerative colitis. The ability to measure the thickness of the intestinal wall and assess the severity of blood flow allows endoscopic ultrasonography to assess patients with ulcerative colitis dynamically, which makes it a promising method in primary diagnosis.

Endoscopic Ultrasound Biliary Drainage in Pancreatic Cancer.

Endoscopic ultrasound (EUS) guided biliary drainage (BD) is an accepted salvage procedure in patients with distal malignant biliary obstruction (DMBO) when endoscopic retrograde cholangiopancreatography (ERCP) is unsuccessful. The potential advantages of EUS-BD include gastric or duodenal biliary access, utilization of novel biliary stents and stent placement away from the area of stenosis, resulting in longer stent patency. These features make EUS-BD very appealing as a primary procedure for biliary drainage. There is a growing body of evidence supporting the utilization of EUS as a primary drainage procedure instead of ERCP, with comparable outcomes.

Diagnostic and therapeutic strategies for colorectal tumor with positive muscle-retracting sign.

Endoscopic submucosal dissection (ESD) for colorectal tumors with positive muscle-retracting (MR) sign often results in incomplete resection or discontinuation owing to the difficulty of submucosal dissection. The present study aimed to evaluate the usefulness of endoscopic ultrasonography (EUS) in diagnosing the MR sign and performing ESD using the pocket-creation method (PCM). Thirty-six cases of colorectal tumors with positive MR sign during ESD between January 2015 and December 2021 were retrospectively reviewed. Cases were divided into two groups: 1) the conventional method (CM) group, comprising 29 cases, and 2) the PCM group with seven cases, in which preoperative EUS and ESD using PCM were performed. Treatment outcomes were compared between the groups. The diagnostic yield of EUS for the MR sign was evaluated among large sessile tumors >20 mm in which preoperative EUS was performed. Histologic diagnosis was adenoma or Tis carcinoma in 12 cases (33%), T1 carcinoma in 18 cases (50%), T2 carcinoma in four cases (11%), and unevaluable in two cases (6%). The sensitivity and specificity of the EUS-MR sign for large sessile tumors were 87.5% and 83.3%, respectively. ESD was achieved in all cases in the PCM group, although it was discontinued in eight cases (28%) in the CM group. There were significant differences between the PCM and CM groups in en bloc resection (100% vs. 48%, p = 0.013) and R0 resection rates (71% vs. 31%, p = 0.049). The MR sign can be predicted by preoperative EUS, and ESD using PCM allows en bloc resection.

Pancreatic cysts in children: diagnostical and surgical tactics

BACKGROUND: Surgical treatment of pancreatic cysts is one of the most difficult procedures in pediatric surgery. In children with pancreatic cysts, the issues of differential diagnosis and determining the connection of the cyst cavity with the main pancreatic duct remain problematic. Recent publications have focused on the use of endoscopic ultrasonography in pediatric practice to visualize the parenchyma and the ductal system of the pancreas with high accuracy.
 AIM: This work aimed to study the results of treatment of children with cystic formations of the pancreas using modern radiation diagnostic methods and minimally invasive surgical technologies.
 MATERIALS AND METHODS: Analysis was conducted on the results of treatment of 66 patients consisting of 30 boys (45.5%) and 36 girls (54.5%) aged 6 months to 18 years (average age of 10.9 5.2 years) with extraparenchymatous and intraparenchymatous pancreatic cysts.
 RESULTS: Multispiral computed tomography (Se 90%, Sp 91%, and Ac 91%; p 0.05) and magnetic resonance imaging (Se 96%, Sp 94%, Ac 95%; p 0.05) are the most informative for the differential diagnosis of intra- and extraparenchymatous pancreatic cysts. For thin-walled extraparenchymatous cysts up to 6 cm in size, conservative therapy is effective in the early period of the disease. External (42.4%) and internal (51.3%) drainage of cysts can be performed when the existence of pancreatic pseudocysts is prolonged (more than 2 months). Indications for simultaneous longitudinal pancreaticoejunostomy may occur in 9.5% of patients. Excision of the pseudocyst with pancreatic resection may be required in 4.7% of cases. For intraparenchymatous cysts, 33.3% of cases require the enucleation of cystic formation, 25% require the distal splenoserving resection of the pancreas, 25% require the central resection of the pancreas with the imposition of distal pancreatoejunoanastomosis, and 12.5% require pylori-preserving pancreatoduodenal resection. Approximately 70.8% of surgical interventions on the pancreas in children can be performed by laparoscopic access with a conversion rate in 12.5% of cases.
 CONCLUSIONS: The choice of surgical intervention in children with pancreatic cysts is determined by the etiology, cyst size, localization, connection with the main pancreatic duct, and degree of involvement of the parenchyma in the tumor process. Most operations on the pancreas may be performed using minimally invasive approaches.

Quality indicators of endoscopic ultrasound in the pancreatobiliary system: a brief review of current guidelines.

Since its development, the use of endoscopic ultrasonography (EUS) in the pancreas and the biliary tract has become increasingly important. The accuracy of EUS varies depending on the experience of the endoscopist. Hence, quality control measures using appropriate indicators are required to reduce these variations. American Society for Gastrointestinal Endoscopy and European Society of Gastrointestinal Endoscopy have announced the EUS quality indicators. Here, we reviewed the quality indicators of the EUS procedure in the current published guidelines.

The Use of Endoscopic Ultrasonography in Inflammatory Bowel Disease: A Review of the Literature.

The diagnosis of inflammatory bowel disease (IBD) can sometimes be challenging. By corroborating clinical, imaging and histological data, the two main entities of IBD, ulcerative colitis and Crohn's disease (CD), can be differentiated in most cases. However, there remains 10-20% of patients where the diagnosis cannot be accurately established, in which case the term "IBD unclassified" is used. The imaging techniques most used to evaluate patients with IBD include colonoscopy, ultrasonography and magnetic resonance imaging. Endoscopic ultrasonography is mainly recommended for the evaluation of perianal CD. Through this work, we aim to identify other uses of this method in the case of patients with IBD.

Endoscopic ultrasound to the rescue of pancoast tumour.

Dear Editor, A 48-year-old male presented with a two-month history of right-sided shoulder pain with right arm radiation and significant weight loss. A radiograph showed an opacity in the right upper zone. A 34 × 45 × 52 mm mass in the apex of the right lung was seen on contrast-enhanced computed tomography (CECT) [Figure 1a]. Magnetic resonance imaging (MRI) for local staging showed involvement of the right subclavian artery and nerve roots [Figure 1b]. A percutaneous biopsy was planned, but no safe window was available due to the clavicle and multiple vessels on the anterior aspect. Because of the proximity of the lesion to the oesophagus, the patient was referred for endoscopic ultrasound (EUS)-guided biopsy. EUS confirmed the findings of prior imaging [Figure 1c]. An initial attempt at EUS-guided fine-needle aspiration (FNA) with 22-G needle failed as the tumour was very hard. Hence, FNA of visualised subcarinal lymph nodes was performed with a 22-G needle followed by FNA of the tumour with a 19-G needle [Figure 2a]. After the procedure, the patient was observed for four hours and was discharged after confirming the absence of pneumothorax on chest radiograph. A final diagnosis of non-small cell carcinoma was made on pathological [Figure 2b] and cytological examination based on visualisation of clusters of large polygonal cells with round-to-oval vesicular pleomorphic nuclei with no evidence of malignancy in the mediastinal nodes. Because of an unresectable lesion, the patient was planned for a combination of induction chemotherapy and radiotherapy.Figure 1: (a) Contrast-enhanced computed tomography (CECT) of thorax showing a mass in the apex of the right lung. (b) Magnetic resonance imaging (MRI) showing involvement of the right subclavian artery (large arrow) and nerve roots of C8, T1, and T2 (small arrows), (c) Transoesophageal endoscopic ultrasound (EUS) showing a hypoechoic irregular lung mass located on top on lung parenchyma (asterisk) and encasing the subclavian artery anteriorly (arrow)Figure 2: (a) Endoscopic ultrasound-guided fine needle aspiration from lung mass, (b) Haematoxylin and eosin (H and E) staining of core lung mass biopsy, suggestive of non-small cell carcinoma of the lung (arrow)EUS has an established role in tissue acquisition from mediastinal lymph nodes, but data on EUS-guided sampling from lung mass remains limited. Transbronchial needle aspiration (TBNA) and endobronchial ultrasound-guided needle aspiration (EBUS-FNA) are the preferred modalities for the diagnosis and staging of lung cancer.[1] However, the tumour’s location at the apex of the lung makes them inaccessible to TBNA or EBUS-FNA. In such cases, tumours close to the oesophagus may be amenable to transoesophageal EUS-guided FNA. It also has the advantage of simultaneous sampling of mediastinal lymph nodes and other organs like the liver and adrenal for assessment of metastasis.[1] The present case highlights the utility of EUS for diagnosing lung tumours at inaccessible sites. A recent multicentric study from Italy reported the efficacy and safety of EUS-guided tissue sampling as a minimally invasive procedure for the diagnosis and staging of peri-oesophageal parenchymal lung lesions.[2] However, transoesophageal FNA from lung mass may be rarely associated with pneumothorax[3] and haemoptysis.[4] Hence, a check X-ray should be done to rule out pneumothorax before discharging the patient. Keeping in mind the possibilities of complications, EUS-FNA of the lung lesions should be done in centres with the availability of pulmonologist to immediately address the adverse events. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

THE ROLE OF ENDOSCOPIC ULTRASONOGRAPHY IN THE DIAGNOSIS OF CYSTIC FORMULATIONS OF THE PANTACRATIC GLAND

Summary. Differential diagnosis of cystic lesions of the pancreas remains one of the most problematic sections of abdominal surgery. Endoscopic ultrasonography is gaining more and more importance in the diagnosis and determination of treatment tactics of cystic lesions.
 The goal is to determine the place of endoscopic ultrasonography in the diagnosis of patients with cystic lesions of the pancreas.
 Materials and methods. Analyzed literary sources that were devoted to the use of endoscopic ultrasonography for the diagnosis of cystic lesions of the pancreas.
 Results and their discussion. Endoscopic ultrasonography, thanks to its high resolution and the absence of interposition of air-containing organs, allows you to visualize both the characteristic features of the structure of the cystic tumor itself and the ductal system of the pancreas, as well as to evaluate the thickness of the cyst wall, the presence of intracystic membranes and a solid component, the nature of the contents, the number of cystic cavities in the lesions.
 Conclusions. Endoscopic ultrasonography is a clarifying method of diagnosis, which should be used in all patients at the stages of examination, planning treatment tactics and choosing a surgical intervention method.

S1125 Utility and Role of Endoscopic Ultrasound for Suspected Early Esophageal Cancer

Introduction: Accurate clinical staging of esophageal cancer is vital in selecting appropriate treatment options. Endoscopic ultrasound (EUS) has been determined to be an accurate imaging modality for esophageal cancer staging, differentiating superficial lesions from deep lesions. Despite being accurate, utilization of EUS in apparent early-stage cancer remains controversial. The current study aims to assess the utility of EUS for early-stage esophageal cancer and whether endoscopic features of esophageal malignancy can help direct the optimal management of the cancer. Methods: This was a retrospective study of patients who underwent pre-resection EUS after a diagnosis of esophageal cancer at a tertiary medical center. 50 patients met inclusion criteria for this study. Patient clinical data, initial EGD/biopsy, EUS, and final resection pathology reports were extracted from chart review and statistical analysis was performed to determine the accuracy of EUS and associations of endoscopic findings with deeper invasion. Results: EUS T stage was concordant with histological T stage in 74% of patients (37/50). In determining sub-mucosal involvement (T1a vs T1b), EUS had a specificity of 85% and sensitivity of 53.8%. EUS had an overall accuracy of 72.7% in identifying sub-mucosal invasion in T1 cancers. Prominent lymph nodes on EUS and tumor size >2 cm on visual inspection were significantly associated with deeper invasion of cancer on histology with p-values < 0.01. Barrett’s morphology was significantly associated with superficial cancers with a p-value < 0.01. EUS affected management from EMR/ESD to esophagectomy in 9.4% of patient with Barrett’s morphology and 6.7% of patients with tumor size < 2cm. In patients without any endoscopic findings suggestive of deep invasion, EUS identified deeper cancer and changed management in < 7% of cases. Conclusion: For assessing deeper invasion (T2, T3 and T4), EUS has been substantiated as a significantly effective tool. In staging T1b lesions, EUS was reasonably specific in ruling out sub-mucosal invasion; however, it had relatively poor sensitivity in identifying sub-mucosal invasion. Additionally, data validated endoscopic features suggesting superficial cancers including a tumor size < 2cm and the presence of Barrett’s morphology. In patients with these findings suggesting superficial cancer, EUS rarely identified a deep cancer that warranted a change in management.

Rectal Gastrointestinal Stromal Tumors: Usefulness of Endoscopic Ultrasound

Rectal gastrointestinal stromal tumors (GIST) account for 0.1% of all rectal tumors. They are generally diagnosed in adults over 50 years of age with non-specific symptoms. Immunohistochemistry performed on biopsy tissue sample confirms the diagnosis. In this study, we report two cases of histologically and immunohistochemically confirmed rectal GISTs diagnosed using Endoscopic ultrasound (EUS) with fine needle aspiration (FNA), a procedure of crucial value in the diagnosis of these tumors. Both patients were male, presenting with non-specific symptoms. Standard endoscopy showed a rectal mass in both cases, biopsies were negative. EUS showed a well-defined hypoechoic mass and evaluated adjacent organs and of blood/lymphatic nodes involvement. EUS-FNA was performed in both cases. Cytology and immunocytochemistry studies showed spindle cell pattern with positive immunohistochemical staining for CD117, typical of GISTs.

Comparison of Endoscopic Ultrasonography and Conventional Endoscopy for Prediction of Tumor Depth in Superficial Nonampullary Duodenal Epithelial Tumors

Background: The utility of endoscopic ultrasonography (EUS) in predicting tumor depth among superficial nonampullary duodenal epithelial tumors (SNADETs) is unclear. The aim was to compare EUS with conventional endoscopy (CE) for the evaluation of tumor invasion of SNADETs. Methods: A retrospective analysis was performed on consecutive 174 lesions/169 patients with duodenal dysplasia or adenocarcinoma with invasion up to submucosa who underwent both CE and EUS before endoscopic (n = 133) or surgical (n = 41) treatment. Endoscopic staging by CE was performed based on the characteristic endoscopic criteria of submucosal invasion (irregular surface, submucosal tumor [SMT]-like marginal elevation, and fusion of converging folds). The diagnostic performance of each test was compared with the final histology. Results: The sensitivity and accuracy of estimating the depth were higher for CE compared to that of EUS (99.4% vs. 89.4%, p < 0.01 and 97.7% vs. 87.9%, p < 0.01, respectively). Univariate analysis of endoscopic factors revealed that tumor diameter, red color, SMT-like appearance, and hypoechogenicity were factors related to advanced histology. Multivariate analysis revealed that the presence of SMT-like appearance based on CE was an independent factor to predict submucosal invasion (p = 0.025). Gross morphology of the combined type was associated to incorrect diagnosis of EUS (p = 0.007). Among 3 cases in which EUS overestimated the tumor depth, carcinoma extension in submucosal Brunner’s gland or nontumorous submucosal cystic dilation was observed. Conclusion: EUS may not be necessary, and CE may be sufficient for determining the optimal therapeutic strategy for SNADETs.

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

Predictive Factors for Differentiating Gastrointestinal Stromal Tumors from Leiomyomas Based on Endoscopic Ultrasonography Findings in Patients with Gastric Subepithelial Tumors: A Multicenter Retrospective Study.

Background/AimsThe utility of endoscopic ultrasonography (EUS) for differentiating gastrointestinal stromal tumors (GISTs) and leiomyomas of the stomach is not well known. We aimed to evaluate the ability of EUS for differentiating gastric GISTs and leiomyomas. MethodsWe retrospectively reviewed the medical records of patients with histopathologically proven GISTs (n=274) and leiomyomas (n=87). In two consensus meetings, the inter-observer variability in the EUS image analysis was reduced. Using logistic regression analyses, we selected predictive factors and constructed a predictive model and nomogram for differentiating GISTs from leiomyomas. A receiver operating characteristic (ROC) curve analysis was performed to measure the discrimination performance in the development and internal validation sets. ResultsMultivariate analysis identified heterogeneity (odds ratio [OR], 9.48), non-cardia (OR, 19.11), and older age (OR, 1.06) as independent predictors of GISTs. The areas under the ROC curve of the predictive model using age, sex, and four EUS factors (homogeneity, location, anechoic spaces, and dimpling or ulcer) were 0.916 (sensitivity, 0.908; specificity, 0.793) and 0.904 (sensitivity, 0.908; specificity, 0.782) in the development and internal validation sets, respectively. ConclusionsThe predictive model and nomogram using age, sex and homogeneity, tumor location, presence of anechoic spaces, and presence of dimpling or ulcer on EUS may facilitate differentiation between GISTs and leiomyomas.

ID: 3519205 LANDSCAPE OF PEDIATRIC ENDOSCOPIC ULTRASOUND: INCREASED UTILIZATION AND AN ESCALATING PROPORTION OF THERAPEUTIC PROCEDURES OVER TIME

Endoscopic ultrasound (EUS) has emerged as an integral diagnostic and therapeutic modality for gastrointestinal diseases and lesions in the vicinity of gastrointestinal lumens in adults. EUS data in children are more limited, as there are considerations which limit utilization of EUS in children, including patient size, endoscopist training and prevalence of pancreaticobiliary disorders in children. Here we analyze pediatric EUS utilization patterns, the diagnostic yield and therapeutic role of pediatric EUS and evolution in these parameters over the past 10 years at our tertiary care, high volume pediatric endoscopy center.

Successful Endoscopic Resection of Tubulovillous Adenoma Arising in Choledochocele

Choledochocele is the least common type of choledochal cyst. Choledochocele has a potential for carcinogenesis, but only a handful of cases with concurrent ampullary carcinoma have been reported. We recently experienced a case of choledochocele with tubulovillous adenoma with focal high-grade dysplasia, which was successfully and completely resected en bloc via endoscopic papillectomy. Prior to endoscopic papillectomy, the endoscopic ultrasonography was able to accurately diagnose the ampullary tumor arising in choledochocele. Herein, we would like to report this case and discuss the potential of malignant transformation and the usefulness of endoscopic ultrasonography in choledochocele.

Endoscopic Ultrasonography in Pediatric Patients with Pancreatobiliary Disease: Single-Center Trial.

PurposeThe use of Endoscopic ultrasonography (EUS) in pediatric patients is not as common as in adults. The aim of this study is to evaluate the role of EUS in the diagnosis of pancreatobiliary disease in childhood.MethodsBetween December 2016 and January 2018, the findings of patients who underwent EUS were evaluated retrospectively.ResultsOf the 41 patients included in the study 25 were girls (61.0%), mean age was 12.2±4.2 years. EUS was performed for biliary colic in 21 (51.2%), for recurrent pancreatitis in 12 (29.2%), for cholecystitis/cholangitis in 5 (12.2%), and for acute pancreatitis in 3 (7.4%) patients. EUS had a significant clinical effect in the decision of treatment and follow-up of 6/21 biliary colic cases, in diagnosis and follow-up of 6/12 recurrent pancreatitis cases, in decision-making and monitoring of invasive procedures (ERCP/surgery) of 3/5 acute cholecystitis/cholangitis and 2/3 of acute pancreatitis cases as well as in follow-up of the other cases. The effectiveness of EUS in determining direct treatment and invasive intervention was 43.9%. None of the patients had complications related to the EUS procedure.ConclusionAlthough current guidelines show that EUS can be used in pediatric patients, this is limited to a few published studies. In this study, it is shown that EUS is a safe method for the diagnosis, follow-up and treatment of common pancreatobiliary pathologies in childhood.

Clinical outcomes of cap-assisted endoscopic resection for small rectal subepithelial tumors

ObjectiveTo assess the effectiveness and safety of cap-assisted endoscopic resection and the usefulness of endoscopic ultrasonography (EUS) for managing small rectal subepithelial tumors (SETs). Patients and methodsPatients with small rectal SETs≤10mm in diameter were enrolled in this study at our hospital from October 2014 to December 2017. First, EUS was performed to evaluate the lesions. Then, cap-assisted endoscopic resection was performed by suctioning the SET into a transparent cap, ligating with a metal snare and then resecting the tumor. The wound was closed using endoclips if necessary. ResultsForty patients were enrolled in the study. EUS showed lesions originating from muscularis mucosa or submucosa with an average diameter of 5.4×3.1mm. The en bloc resection rate was 85.0% obtained by cap-assisted endoscopic resection, with a mean total procedure time of 17.6min. No immediate perforation happened. Immediate bleeding occurred in five patients; all cases were managed successfully by endoscopy. No delayed bleeding was observed. Pathology examination showed that 70.0% of the lesions were neuroendocrine tumors (G1). One case of recurrence was seen in follow-up; it was managed successfully by endoscopic submucosal dissection. There was no tumor recurrence in a median follow-up period of 41 months in the remaining 39 patients. ConclusionsMost small rectal SETs arising from the muscularis mucosa or submucosa are neuroendocrine tumors and require proper treatment. Cap-assisted endoscopic resection is simple, effective and safe for resecting such lesions, and EUS is useful for case screening.

Role of endoscopic ultrasound in pediatric patients: A single tertiary center experience and review of the literature.

BACKGROUNDAlthough endoscopic ultrasound (EUS) is now widely available and has an established role in adults, the utility of EUS and EUS-guided fine needle aspiration (EUS-FNA) in pediatrics is insufficiently described compared to adults and is supported by only a few studies.AIMTo report the experience of a single tertiary center in the use of EUS and EUS-FNA in a pediatric population and to further assess its safety, feasibility, and clinical impact on management.METHODSA retrospective study of 13 children (aged 18 years or younger) identified from our medical database was conducted. A retrospective review of demographic data, procedure indications, EUS findings, and the clinical impact of EUS on the subsequent management of these patients was performed.RESULTSDuring the 4-year study period, a total of 13 (1.7%) pediatric EUS examinations out of 749 EUS procedures were performed in our unit. The mean age of these 8 females and 5 males was 15.6 years (range: 6-18). Six of the 13 EUS examinations were pancreatobiliary (46.1%), followed by mediastinal 2/13 (15.4%), peri-gastric 2/13 (15.4%), abdominal lymphadenopathy 1/13 (7.7%), tracheal 1/13 (7.7%) and rectal 1/13 (7.7%). Overall, EUS-FNA was performed in 7 patients (53.8%) with a diagnostic yield of 100%. The EUS results had a significant impact on clinical care in 10/13 (77%) cases. No complications occurred in these patients during or after any of the procedures.CONCLUSIONEUS and EUS-FNA in the pediatric population are safe, feasible, and have a significant clinical impact on the subsequent management; thus avoiding invasive and unnecessary procedures.

A Comprehensive Narrative Review on the Evolving Role of Endoscopic Ultrasound in Focal Solid Liver Lesions Diagnosis and Management.

The implications of endoscopic ultrasound (EUS) have expanded considerably in recent years to cover more fields in invasive gastroenterology practice, as both an investigative and therapeutic modality. The utility of EUS in the diagnosis and management of focal liver lesions has gained a special attractiveness recently. The EUS probe proximity to the liver and its excellent spatial resolution enables real-time images coupled with several enhancement techniques, such as contrast-enhanced (CE) EUS. Aside from its notable capability to execute targeted biopsies and therapeutic interventions, EUS has developed into a hopeful therapeutic tool for the management of solid liver lesions. Herein, we provide a comprehensive state-of-the-art review on the efficacy and safety of EUS in the diagnosis and management of focal solid liver lesions. Medline/PubMed and Embase database searches were conducted by two separate authors (T.K. and W.S.), all relevant studies were assessed, and relevant data was extracted and fully reported. EUS-guided diagnosis of focal liver lesions by sonographic morphologic appearance and cytological and histopathological finding of biopsies obtained via fine needle aspiration/biopsy have been shown to significantly improve the diagnosis of solid liver lesions compared with traditional imaging tools. Similarly, EUS-guided treatment has been shown to consistently have excellent technical success, high efficacy, and minor adverse events. The evolving valuable evidences of EUS utility might satisfy the unmet need of optimizing management of focal solid liver lesions.

Pancreatobiliary Endoscopic Interventions for Pediatric Pancreatic Pathology.

Despite the increased global recognition of pediatric pancreatic diseases, there are limited data on the utility of sophisticated endoscopic procedures such as endoscopic ultrasonography (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) in their management. Promising results of recent studies have highlighted the emerging therapeutic utility of EUS and ERCP in children. With these latest developments in mind, this article reviews the current literature regarding diagnostic and therapeutic uses, benefits, limitations, and clinical outcomes of EUS and ERCP in pediatric pancreatology.