Value Of Endoscopic Ultrasonography Research Articles

A potential decision-making algorithm based on endoscopic ultrasound for staging early gastric cancer: a retrospective study

BackgroundClinical staging of gastric cancer (GC) before treatment is essential. Endoscopic ultrasound (EUS) is a recommended staging tool, but its efficacy remains controversial. Our previous prospective study evaluated the potential value of EUS for T staging and presented discrepancies. In this study, we aimed to evaluate the efficacy of EUS in T staging by comparing it with pathological staging. We analyze the factors that can potentially affect accuracy to identify suitable subgroups for EUS staging.MethodsData from a total of 1763 consecutive patients with GC from January 2015 to December 2017 were analyzed. Results from EUS and pathological T staging were compared. The factors that might affect EUS’s accuracy were analyzed.ResultsThe sensitivity, specificity, positive predictive value, and negative predictive value of EUS in patients with early GC were 62.08%, 96.13%, 90.94%, and 80.21%, respectively. The accuracy rates of uT1, uT2–uT4, and uT3–uT4 were 90.94%, 79.02%, and 78.39%, respectively. In multivariate analysis, underestimation was more likely to be observed in patients with tumors located in the middle or upper third of the stomach. Overestimation was more likely to be observed in patients with tumors located in the lower third or those without ulcer. Other factors affecting accuracy included ulcer, differentiation, larger size and undergoing surgery.ConclusionOur findings highlight the role of EUS in determining the T staging of GC. Overestimation and underestimation in T-staging were significantly associated with the tumor location in early GC, and a decision-making algorithm was proposed for clinical practice in early cancers based on these findings.

Value of Endoscopic Ultrasonography in Evaluating Unexplained Isolated Common Bile Duct Dilation on Imaging.

Value of Endoscopic Ultrasonography in Evaluating Unexplained Isolated Common Bile Duct Dilation on Imaging.

Diagnostic Value of Endoscopic Ultrasound after Neoadjuvant Chemotherapy for Gastric Cancer Restaging: A Meta-Analysis of Diagnostic Test.

This study aimed to evaluate the diagnostic value of endoscopic ultrasound (EUS) after neoadjuvant therapy (NT) for gastric cancer restaging by meta-analysis. We conducted a systematic search of studies published on PubMed and Web of Science up to 30th August 2021. Assessing the risk of bias in the included studies was done with the QUADAS-2 tool. We used R and Review Manager 5.4.1 for calculations and statistical analysis. To evaluate the diagnostic value of EUS after NT for gastric cancer restaging, we performed a meta-analysis on six studies, with a total of 283 patients, including true-positive, true-negative, false-positive, and false-negative results for T1-T4, N0. EUS as a diagnostic test for GC patients after chemotherapy has a relatively low DOR for the T2 (3.96) and T4 stages (4.79) and a relatively high partial AUC for the T2 (0.85) and T4 (0.71) stages. Our results reveal that the pooled sensitivity for T stages after chemotherapy is rather low (29–56%), except for the T3 stage (71%). A potential limitation of our study was the small number of included studies, but no significant heterogeneity was found between them. Our meta-analysis concludes that EUS is not recommended or is still under debate for GC restaging after NT.

Value of endoscopic ultrasonography in the observation of the remnant pancreas after pancreatectomy.

Endoscopic ultrasonography (EUS) is proven to be a more specific and sensitive method for detecting pancreatic lesions. However, usefulness of EUS after pancreatectomy has not been reported. This study aimed to evaluate the observational capability of EUS for the remnant pancreas (RP) after pancreatectomy. This single-center, retrospective study enrolled 395 patients who underwent pancreatectomy at Onomichi General Hospital between December 2002 and March 2016, 45 patients who underwent EUS for RP were included for analysis. We evaluated the usefulness of EUS for RP using logistic regression analysis. Complete observation of the RP was done in 42 patients (93%). In the initial surgical procedure, 21 patients underwent pancreaticoduodenectomy (PD), and 24 patients underwent distal pancreatectomy (DP). PD and DP were observed in 85% (18/21) and 100% (24/24) cases, respectively. A comparison of the detection capability of EUS and contrast-enhanced computed tomography (CT) or magnetic resonance imaging (MRI) showed that EUS was significantly superior to contrast-enhanced CT or MRI (p < 0.01). Eight of the 45 patients showed recurrence lesions in the RP. The median recurrence period was 33 months. Predictive factors for recurrence in the univariate and multivariate analyses were significantly different in space occupying lesion with EUS findings (p < 0.01) and elevated CA19-9(p < 0.01). EUS was able to observe the RP in almost all cases. In addition, the detection capability of EUS was significantly superior to those of CT or MRI. We recommend that all patients with RP should undergo EUS, and a longer follow-up must be performed.

Application value of endoscopic ultrasonography combined with enhanced MRI in preoperative staging of rectal cancer

Application value of endoscopic ultrasonography combined with enhanced MRI in preoperative staging of rectal cancer

Echoendoscopy with elastography in mediastinal lymph nodes

ABSTRACTElastography is a widely used procedure in conventional ultrasonography that has recently been incorporated in echoendoscopy. This is an innovative and promising technology that aims to increase the negative predictive value of endoscopic ultrasonography and fine-needle aspiration punctures. It is useful for directing punctures in suspect areas and, consequently, improves diagnostic performance. This is a non-invasive technique, easy to perform, without additional costs or complications. The main indications are the analysis of solid pancreatic masses, lymph nodes, subepithelial lesions, lesions in the left hepatic lobe and in the left adrenal. Negative or inconclusive cases of fine-needle aspiration can be submitted to elastography when there is a strong suspicion of malignancy. Elastography has a high precision for the differential diagnosis of solid masses and in difficult-to-access anatomic sites, as well as in mediastinal lymph nodes and pancreatic tumors. The procedure is based on the degree of tissue elasticity measurement, with a good correlation between the elasticity index and histopathological features. We report the case of four patients evaluated by echoendoscopy and qualitative elastography who had differential diagnoses in mediastinal lymph nodes: sarcoidosis, lymphoma, histoplasmosis and esophageal neoplasia.

Diagnostic value of endoscopic ultrasonography in patients with biliary-pancreatic duct dilatation

Objective To study the diagnostic value of endoscopic ultrasonography (EUS) in patients with cholangiopancreatic duct dilatation (CPDD). Methods Forty-five patients with CPDD and without any visual or detected obstructive lesions after traditional ultrasonography (US) were re-examined by EUS, CT and MRI. The diagnostic rates of EUS and the other imaging technologies were compared. Results All the 45 patients underwent successful EUS examination. Among them, there were 18 patients with periampullary tumor, 10 patients with lower common bile duct stones, 1 patient with pancreatic duct stones, 3 patients with chronic pancreatitis, 1 patient with an intrapancreatic choledochal cyst, 4 patients with inflammatory strictures of papilla of duodenum and 2 patients with terminal bile duct inflammatory stenosis. However, 1 patient with a lower common bile duct tumor, 1 patient with a small pancreatic head carcinoma and 1 patient with sphincter of Oddi dysfunction (SOD) were not diagnosed. The diagnostic rates of obstructive lesions by US, EUS, CT and MRI were 7.1%, 92.9%, 33.3%, 31.0%, respectively. The diagnostic rates of tumor were 10.0%, 90.0%, 35.0%, 25.0%, respectively. As compared with the other examination methods, EUS was best in detecting small carcinoma. Conclusion EUS plays an important role in the diagnosis of lesions causing cholangiopancreatic duct dilatation. Key words: Ultrasonography; Bile duct diseases; Pancreatic ducts; Endoscopic ultrasonography; Diagnosis

A retrospective study of endoscopic ultrasonography for predicting progression of esophageal varices in patients with hepatitis B virus-related hepatocirrhosis

Objective To assess the clinical value of endoscopic ultrasonography (EUS) for predicting esophageal varices (EV) progression in patients with hepatitis B virus (HBV)-related hepatocirrhosis. Methods A retrospective cohort study was performed on 299 HBV-related hepatocirrhosis patients with light EV in Tianjin Second People′s Hospital admitted from September 2014 to September 2015. The diameter and number of peri-esophageal collateral veins (ECV) and para-ECV were measured and described by EUS. The first EUS examination time was the starting point, and the follow-up of 24 months or EV progression was the end. Risk factors of EV progression were evaluated by multivariate Cox regression model, and the predictive value of EUS for EV progression was analyzed by receiver operating characteristic (ROC) curve. Results The cumulative incidence of EV progression was 2.3% (7/299), 14.8% (44/297), 33.7% (96/285) and 40.0% (120/273) at 6 months, 12 months, 18 months and 24 months of follow-up, respectively. The results of multivariate Cox regression analysis showed that the diameter of peri-ECV (P=0.011 2, HR=1.323 2, 95%CI: 1.065 6-1.642 9), the number of peri-ECV (P=0.000 1, HR=1.366 6, 95%CI: 1.163 4-1.605 2) and para-ECV diameter (P=0.000 2, HR=1.364 1, 95%CI: 1.155 8-1.610 0) were risk factors for EV progression. The use of nucleoside analogues treating HBV (P=0.002 0, HR=0.496 9, 95%CI: 0.318 6-0.775 1) and non-selective β-blockers descending portal venous pressure (P=0.076 5, HR=0.573 2, 95%CI: 0.309 7-1.061 1)were the protective factors for EV progression. The results of ROC curve analysis showed that the diameter of peri-ECV[P<0.001, area under the curve (AUC)=0.850, 95%CI: 0.804-0.895], the number of peri-ECV (P<0.001, AUC=0.831, 95%CI: 0.784-0.878), the diameter of para-ECV (P<0.001, AUC=0.924, 95%CI: 0.895-0.954), and the number of para-ECV (P<0.001, AUC=0.761, 95%CI: 0.704-0.817) had higher predictive value for EV progression; and the optimum cut-off values of each index were 1.85 mm, 3.5, 3.35 mm, and 4.5, respectively. The accuracies of prediction for EV progression were 76.60%, 75.19%, 84.48% and 70.29%, respectively. Conclusion EUS can be used to predict EV progression in HBV-related hepatocirrhosis patients. Peri-ECV diameter>1.85 mm, number>3.5, and para-ECV diameter>3.35 mm, number>4.5 suggest a high risk of EV progression. For patients with HBV-related hepatocirrhosis complicated with mild EV, nucleoside analogues to anti-HBV and non-selective β-blockers to reduce portal hypertension can prevent EV progression. Key words: Endoscopy, digestive system; Liver cirrhosis; Esophageal varices; Endoscopic ultrasonography; Predict

Diagnostic value of endoscopic ultrasonography combined with liver stiffness measurement and liver histopathology for early liver cirrhosis

Objective To evaluate the value of endoscopic ultrasonography(EUS) alone for early liver cirrhosis and the diagnostic efficacy of EUS combined with liver histopathology (LH) and liver stiffness measurement (LSM) for early liver cirrhosis. Methods Data of 226 patients with chronic liver lesions who underwent endoscopy and EUS at Tianjin Second People's Hospital were collected to assess esophageal and gastric varices. Liver fibrosis was assessed by LH and LSM was determined by Fibroscan. Models of EUS-LSM, EUS-LH, LSM-LH, ELL (EUS, LSM and LH) were constructed to predict early liver cirrhosis. The ROC curve and AUROC were used to evaluate the efficacy of different models in the diagnosis of early liver cirrhosis. Results A total of 149 patients were diagnosed as chronic liver disease and 77 patients were diagnosed as early liver cirrhosis (Child-Pugh A grade) by clinical evaluation. Ratio of varices found by EUS was significantly higher than that by endoscopy [68.8% (53/77) VS 32.5% (25/77), P<0.05]. The cut-off value was 8.65 kPa by LSM to predict early liver cirrhosis. Pseudolobules were confirmed by LH in 42(54.5%) patients in the early liver cirrhosis group. The AUROC of ELL was 0.919 (95%CI: 0.875-0.951), sensitivity=0.792, specificity=0.913, PPV=0.824, NPV=0.895, + LR=9.08, -LR=0.23, accuracy=0.872, and ELL was superior to EUS (P<0.000 1), LSM (P<0.000 1), LH (P<0.000 1), EUS-LSM (P<0.000 1), EUS-LH (P=0.013 4) and LSM-LH (P=0.002 2) in the diagnosis of early liver cirrhosis. Conclusion EUS is superior to endoscopy in detecting the varices for early liver cirrhosis. Combination of EUS with LSM and LH can improve diagnostic efficacy for early liver cirrhosis. Key words: Ultrasonography; Pathology; Liver cirrhosis; Liver stiffness measurement

Predictive and clinical value of endoscopic ultrasonography combined with conventional endoscopy for invasion depth of early gastric cancer

Objective To evaluate the value of endoscopic ultrasonography (EUS) combined with conventional endoscopy for prediction of invasion depth of early gastric cancer and its therapeutic decision-making. Methods Patients with biopsy-proven gastric cancer underwent EUS and conventional endoscopy from July 2011 to January 2018 in Ningbo No.2 Hospital. A total of 129 patients with early gastric cancer confirmed by postoperative pathology were enrolled in the study. The sensitivity, specificity, positive predictive value, negative predictive value, consistency (the value of Kappa) and area under receiver operating characteristic curve (AUC) of EUS, conventional endoscopy and combination of two methods to assess the accuracy of tumor infiltration depth were analyzed. The accuracy of therapeutic decision-making based on the EUS, conventional endoscopy and combination of two methods were assessed. Results In intramucosal cancer, the sensitivity, specificity, positive predictive value, negative predictive value, the value of Kappa and AUC of EUS were 75.00%, 82.22%, 88.73%, 63.79%, 0.536 and 0.797, respectively, and for conventional endoscopy, these statistical values were 61.9%, 93.33%, 94.55%, 56.76%, 0.481, and 0.801, respectively. For the combination of two methods, these statistical values were 85.71%, 82.22%, 90.00%, 75.51%, 0.666 and 0.850, respectively. In submucosal cancer, the sensitivity, specificity, positive predictive value, negative predictive value, the value of Kappa and AUC of EUS were 51.11%, 86.91%, 67.65%, 76.84%, 0.403 and 0.697, respectively, and for conventional endoscopy, these statistical values were 57.78%, 73.81%, 54.17%, 76.54%, 0.311 and 0.678, respectively. For the combination of two methods, these statistical values were 71.11%, 90.48%, 80.00%, 85.39%, 0.632 and 0.817, respectively. The accuracies of therapeutic decision-making of EUS, conventional endoscopy and the combination of two methods were 83.72%, 68.22% and 92.25%, respectively. Conclusion Patients who are diagnosed as intramucosal caner by conventional endoscopy should not be recommended to undergo EUS. For those whose invasion depth is unclear, or diagnosed as submucosal cancer or deeper by conventional endoscopy, EUS should be performed for reassessment. The combination of two methods can improve the accuracy of distinguishing intramucosal and submucosal caners and therapeutic decision-making. Trial registration Chinese Clinical Trial Registry, ChiCTR-DDT-13003299. Key words: Endosonography; Endoscopy; Early gastric cancer; Combined diagnosis

RA08.04: IMPORTANT ENDOSCOPIC AND HISTOPATHOLOGICAL CHARACTERISTICS FOR PREDICTING SUBMUCOSAL TUMOR INVASION IN SUPERFICIAL BARRETT ADENOCARCINOMA

Abstract Background Predicting the depth of invasion of superficial Barrett adenocarcinoma (s-BA) is important for choosing an appropriate treatment. This study aimed to evaluate the endoscopic and histopathological characteristics related to s-BA submucosal invasion. Methods We retrospectively reviewed 67 lesions in 63 cases with pathologically defined s-BA (SSBE, n = 56; LSBE, n = 7) that underwent endoscopic resection at our hospital from January 2004 to December 2017. Initial treatment included endoscopic mucosal resection (EMR) (n = 4), endoscopic submucosal dissection (ESD) (n = 99), and surgery (n = 33). We grouped 133 lesions into two groups based on depth of tumor invasion: group M comprised 87 intramucosal tumors and group SM comprised 49 submucosal tumors. We defined characteristic criteria for submucosal invasion as follows: tumor size ≥ 21 mm, complex macroscopic type; composed of &gt; 2 macroscopic types, biopsy-por; biopsy specimens including poorly differentiated adenocarcinoma. Endoscopic ultrasound (EUS) was performed only in cases in which predicting the depth of tumor invasion was difficult. Results In group M, the median tumor diameter was 13 (range, 1–82) mm and included 68 SSBEs and 19 LSBEs. In group SM, the median tumor diameter was 23 (range, 4–55) mm and included 41 SSBEs and 8 LSBEs. Tumors larger than 21 mm were seen in 12 (13.8%) patients in group M and 25 (51.0%) in group SM. Complex macroscopic type tumors were present in 20 patients (23.0%) in group M and 30 (61.2%) in group SM. Biopsy-por was present in 2 (2.3%) in group M and 12 (24.5%) in group SM. Multivariate analysis indicated the above three characteristics as independent predictors of submucosal invasion; in particular, biopsy-por was highly significant (P &lt; 0.001, odds ratio, 10.81). EUS was performed in 55 lesions including 28 tumors invading the submucosa. Sensitivity, specificity, positive predictive value, and negative predictive value of EUS for predicting submucosal invasion were 46.4%, 70.4%, 61.9%, and 57.5%, respectively. Conclusion Tumor size ≥ 21 mm, complex macroscopic type, and biopsy specimens including poorly differentiated adenocarcinoma were independent predictors of submucosal invasion. Specificity of EUS was relatively high for cases that were difficult to predict depth of tumor invasion. Disclosure All authors have declared no conflicts of interest.

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

Diagnostic value of endoscopic ultrasonography in staging of rectal cancer

Objective To evaluate the diagnostic value of endoscopic ultrasonography (EUS) in staging of rectal cancer (RC). Methods From January 2015 to January 2017, the clinical data of 204 patients with RC and received EUS and surgery were retrospectively analyzed. Patients were divided into surgery alone group (155 cases) and preoperative neoadjuvant chemoradiation therapy (CRT) plus surgery group (49 cases). The preoperative staging by EUS and postoperative pathological staging of two groups were compared. Kappa test was performed for statistical analysis. Results Compared with postoperative pathologic diagnosis, the accuracy rate of EUS in the evaluation of invasion depth of RC in surgery alone group was 81.9% (127/155), and the accuracy rates in the diagnosis of Tis, T1, T2, T3 and T4 were 3/4, 11/13, 82.1%(32/39), 91.1%(41/45) and 74.1%(40/54), respectively, with a good consistency (kappa=0.751, P<0.01). However, the accuracy rate of EUS in the invasion depth of RC in CRT plus surgery group was 34.7% (17/49), and the accuracy rates in the diagnosis of T2, T3 and T4 were 1/13, 2/7 and 14/16, respectively, with a poor consistency (kappa=0.107, P=0.850). Compared with postoperative pathologic diagnosis, the diagnostic accuracy rate of EUS in evaluating regional lymph node metastasis in surgery alone group was 70.3% (109/155), and the accuracies in the diagnosis of cases with or without regional lymph node metastasis were 40.7% (24/59) and 88.5% (85/96), respectively, with a poor consistency (kappa=0.317, P<0.01). The diagnostic accuracy rate of EUS in evaluating regional lymph node metastasis of preoperative CRT plus surgery group was 51.0% (25/49), and the accuracies in the diagnosis of cases with or without regional lymph node metastasis were 5/11 and 52.6% (20/38), respectively, with a poor consistency (kappa=0.014, P=0.911). Conclusions EUS can accurately evaluate the depth of tumor invasion and lymph node metastasis in preoperative staging of RC, which may be helpful for determining clinical treatment strategy. However, for patients received CRT treatment, EUS has a limited value in diagnosing and staging the tumor. Key words: Rectal neoplasms; Endosonography; Neoplasm staging; Diagnosis

Diagnostic value of endoscopic ultrasonography on invasive depth of early esophageal cancer: a meta-analysis

Objective To evaluate the diagnostic value of endoscopic ultrasonography (EUS) on preoperative invasive depth of early esophageal cancer. Methods A systematic retrieval was performed in PubMed, CNKI and Wangfang databases. Studies on diagnosis of EUS on invasion depth or T1a/T1b stage of early esophageal cancer were retrieved, and related literatures were selected for meta-analysis based on inclusion criteria. The sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and diagnostic advantage were calculated, and the receiver operating characteristic curve was drawn to calculate the area under the curve (AUC). Results A total of 20 articles with 1 336 cases were included in the meta-analysis. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio and AUC of EUS for T1m staging of early esophageal cancer were 0.86(95%CI: 0.83-0.88), 0.81(95%CI: 0.78-0.85), 4.92(95%CI: 3.02-8.00), 0.19(95%CI: 0.14-0.27), 32.54(95%CI: 15.52-68.25) and 0.923, respectively. For T1sm staging, these results were 0.81(95%CI: 0.78-0.85), 0.86(95%CI: 0.83-0.88), 5.17(95%CI: 3.66-7.32), 0.20(95%CI: 0.13-0.33), 32.02(95%CI: 15.31-66.99) and 0.922, respectively. Conclusion The diagnostic value of EUS is good for early esophageal cancer, and it has a relatively high sensitivity, specificity and AUC for the T1m and T1sm staging. Key words: Endoscopic ultrasonography; Early esophageal carcinoma; Depth; Meta-analysis

Limitations of endoscopic ultrasonography in the diagnosis of esophageal submucosal tumor

Objective To investigate the diagnostic value of endoscopic ultrasonography(EUS) for esophageal submucosal tumor (SMT). Methods Clinical data of 388 patients with esophageal SMT, who underwent EUS and endoscopic treatment in Tianjin Medical University General Hospital were collected from May 2010 to September 2016. The golden standard for the origin of esophageal SMT was the diagnosis during endoscopic treatment, and the golden standard of pathological type was the combination of postoperative pathological and immunohistochemical findings. The diagnostic accuracy of EUS for esophageal SMT was evaluated. Results The conventional endoscopy revealed that 31.70% (123/388) and 43.81% (170/388) esophageal SMTs were located in the middle and lower segments of esophagus, respectively. The diagnostic consistency of EUS for the origin of lesion was 71.51% (251/351), while the diagnostic consistency of EUS for lesion originated from the muscularis mucosae, submucosa and muscularis propria layer was 92.90% (170/183), 34.38% (11/32), and 51.47% (70/136), respectively. The diagnostic consistency of EUS for the type of lesion was 81.00% (260/321), while the diagnostic consistency of leiomyoma, esophageal cyst, and lipoma were 88.42% (252/285), 14.81% (4/27), and 80.00% (4/5), respectively. Conclusion EUS can preliminarily diagnose the origin and pathological type of esophageal SMT, but there are limitations on the diagnosis of uncommon lesions, which need combination of pathological and immunohistochemical findings. Key words: Endoscopic ultrasonography; Esophageal neoplasms, submucosal; Diagnosis; Accordance rate

Value of endoscopic ultrasonography for risk assessment in esophageal varices bleeding

Objective To assess the predictive value of endoscopic ultrasonography (EUS) for esophageal varices (EV) bleeding by studying the relationship between esophageal collateral veins (ECV), portal vein (PV) trunk with its main branches and EV bleeding. Methods A retrospective cohort study of 114 cases of moderate and severe EV was conducted. The ECV level was determined through EUS. At the same time, diameters of PV, azygos vein (AIV) and spleen vein (SV) were measured through EUS. The predictive value of ECV level and diameters of PV, AIV, SV for EV bleeding were assessed during the 1-year follow-up, which started from the first EUS examination to EV bleeding or the end of follow-up. Results Single factor Cox regression analysis showed severe peri-ECV varices had higher risk than mild in EV bleeding(HR=4.081, 95%CI: 1.833-9.086, P=0.001); severe para-ECV varices had higher risk than mild in EV bleeding(HR=4.042, 95%CI: 1.814-9.005, P=0.001). Multivariable Cox retrospective analysis showed ECV level was an effective predictor for EV bleeding, when the peri-ECV and para-ECV were severe varices, EV bleeding risk increased to 3.831 3 (P=0.004 3) and 3.493 3 (P=0.003 1) times compared with mild respectively. Diameters of PV, AIV and SV could predict EV bleeding(PV AUC=0.959, P 13.65 mm (sensitivity=0.94, specificity=0.84), AIV>8.65 mm (sensitivity=0.94, specificity=0.89), SV>9.45 mm (sensitivity=0.90, specificity=0.67), EV bleeding risk increased significantly. Conclusion EUS is helpful to predict the risk of moderate and severe EV bleeding, and severe varices of ECV, PV, AIV, and SV can be used as indicators to predict risk of EV bleeding. Key words: Ultrasonography; Esophageal and gastric varices; Hemorrhage; Portal hypertension

Clinical value of endoscopic ultrasonography in diagnosis and treatment of common bile duct dilatation

Objective To investigate the value of endoscopic ultrasonography (EUS) in the diagnosis and treatment of undetermined etiology of common bile duct (CBD) dilatation. Methods Patients, who were referred for dilated CBD but unable to identify the cause by imaging, underwent EUS for the diagnosis of etiology in Endoscopy Center of Zhongshan Hospital Affiliated to Fudan University from December 2015 to December 2016. The therapy was on the basis of diagnosis of EUS. Final diagnoses were determined by surgical pathology or follow-up for at least 3 months. Results A total of 76 patients were included in the study. The sensitivity, specificity and accuracy of EUS for patients with choledocholithiasis, patients with ampullary tumor, and patients with inflammatory stenosis were 100.0% (7/7), 100.0% (69/69), 100.0% (76/76), and 88.0% (22/25), 92.2% (47/51), 90.8% (69/76), and 90.9% (40/44), 93.8% (29/32), 90.8% (69/76), respectively. Accuracy of EUS for etiological diagnosis of CBD dilatation was 90.8% (69/76). The sensitivity, specificity and accuracy of EUS combined with tumor markers for patients with malignant CBD dilatation were 96.0% (24/25), 96.1% (49/51), and 96.1% (73/76), respectively. Conclusion EUS is an effective method for the etiological diagnosis of CBD dilatation and has guiding significance for the treatment. EUS combined with tumor markers may benefit differential diagnosis of benign and malignant CBD dilatation. Key words: Endoscopic ultrasonography; Common bile duct dilatation; Diagnosis, differential

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

Endoscopic ultrasonography for preoperative staging of esophageal carcinoma

Objective: To evaluate the diagnostic value of endoscopic ultrasonography (EUS) in preoperative staging of esophageal carcinoma (EC).Material and methods: A total of 86 surgical patients with EC who were confirmed by endoscopy and biopsy underwent preoperative TN staging with EUS examination. The EUS findings were compared with surgical pathologic results.Results: The accuracy of EUS in T and N staging of EC was 82.6% and 84.9%, respectively. While determining whether EC invades the muscularis propria or outer membrane, EUS had the favorable sensitivity, specificity, positive predictive value and negative predictive value. The short-axis diameter of lymph nodes of 5mm had high sensitivity and negative predictive value to determine malignance with low specificity and positive predictive value. The short-axis diameter of 10mm presented the satisfactory sensitivity, specificity, positive predictive value and negative predictive value.Conclusion: EUS can accurately determine the TN staging of EC and provide a reliable basis for the treatment of EC.

Impact of Endoscopic Ultrasonography on 18F-FDG-PET/CT Upfront Towards Patient Specific Esophageal Cancer Treatment

IntroductionIn patients with potentially resectable esophageal cancer (EC), the value of endoscopic ultrasonography (EUS) after fluorine-18 labeled fluorodeoxyglucose positron emission tomography with computed tomography (18F-FDG-PET/CT) is questionable. Retrospectively, we assessed the impact of EUS after PET/CT on the given treatment in EC patients.MethodsDuring the period 2009–2015, 318 EC patients were staged as T1-4aN0-3M0 with hybrid 18F-FDG-PET/CT or 18F-FDG-PET with CT and EUS if applicable in a nonspecific order. We determined the impact of EUS on the given treatment in 279 patients who also were staged with EUS. EUS had clinical consequences if it changed curability, extent of radiation fields or lymph node resection (AJCC stations 2–5), and when the performed fine-needle aspiration (FNA) provided conclusive information of suspicious lymph node.ResultsEUS had an impact in 80 (28.7%) patients; it changed the radiation field in 63 (22.6%), curability in 5 (1.8%), lymphadenectomy in 48 (17.2%), and FNA was additional in 21 (7.5%). In patients treated with nCRT (n = 194), EUS influenced treatment in 53 (27.3%) patients; in 38 (19.6%) the radiation field changed, in 3 (1.5%) the curability, in 35 (18.0%) the lymphadenectomy, and in 17 (8.8%) FNA was additional. EUS influenced both the extent of radiation field and nodal resection in 31 (16.0%) nCRT patients.ConclusionsEUS had an impact on the given treatment in approximately 29%. In most patients, the magnitude of EUS found expression in the extent of radiotherapy target volume delineation to upper/high mediastinal lymph nodes.