Endoscopic retrograde cholangiopancreatography(ERCP)is the mainstay procedure of choice for management of obstructive biliary disease.While ERCP is widely performed with high success rates,the procedure is not feasibl...Endoscopic retrograde cholangiopancreatography(ERCP)is the mainstay procedure of choice for management of obstructive biliary disease.While ERCP is widely performed with high success rates,the procedure is not feasible in every patient such as cases of non-accessible papilla.In the setting of unsuccessful ERCP,endoscopic ultrasound-guided biliary drainage(EUS-BD)has become a promising alternative to surgical bypass and percutaneous biliary drainage(PTBD).A variety of different forms of EUS-BD have been described,allowing for both intrahepatic and extrahepatic approaches.Recent studies have reported high success rates utilizing EUS-BD for both transpapillary and transluminal drainage,with fewer adverse events when compared to PTBD.Advancements in novel technologies designed specifically for EUS-BD have led to increased success rates as well as improved safety profile for the procedure.The techniques of EUS-BD are yet to be fully standardized and are currently performed by highly trained advanced endoscopists.The aim of our review is to highlight the different EUSguided interventions for achieving biliary drainage and to both assess the progress that has been made in the field as well as consider what the future may hold.展开更多
Endoscopic retrograde cholangiopancreatography(ERCP)with stenting is the treatment modality of choice for patients with benign and malignant bile duct obstruction.ERCP could fail in cases of duodenal obstruction,duode...Endoscopic retrograde cholangiopancreatography(ERCP)with stenting is the treatment modality of choice for patients with benign and malignant bile duct obstruction.ERCP could fail in cases of duodenal obstruction,duodenal diverticulum,ampullary neoplastic infiltration or surgically altered anatomy.In these cases percutaneous biliary drainage(PTBD)is traditionally used as a rescue procedure but is related to high morbidity and mortality and lower quality of life.Endoscopic ultrasound-guided biliary drainage(EUS-BD)is a relatively new interventional procedure that arose due to the development of curvilinear echoendoscope and the various endoscopic devices.A large amount of data is already collected that proves its efficacy,safety and ability to replace PTBD in cases of ERCP failure.It is also possible that EUS-BD could be chosen as a first-line treatment option in some clinical scenarios in the near future.Several EUS-BD techniques are developed EUS-guided transmural stenting,antegrade stenting and rendezvous technique and can be personalized depending on the individual anatomy.EUS-BD is normally performed in the same session from the same endoscopist in case of ERCP failure.The lack of training,absence of enough dedicated devices and lack of standardization still makes EUS-BD a difficult and not very popular procedure,which is related to life-threatening adverse events.Developing training models,dedicated devices and guidelines hopefully will make EUS-BD easier,safer and well accepted in the future.This paper focuses on the technical aspects of the different EUS-BD procedures,available literature data,advantages,negative aspects and the future perspectives of these modalities.展开更多
Background:We aimed to study physician attitudes toward ultrasound-guided procedures and possible improvements.We hypothesized that the usage of ultrasound in procedures may be limited by a high barrier of entry and t...Background:We aimed to study physician attitudes toward ultrasound-guided procedures and possible improvements.We hypothesized that the usage of ultrasound in procedures may be limited by a high barrier of entry and that most physicians would choose to adopt software that provides real-time image guidance if accessible.Methods:A voluntary,cross-sectional survey of physicians at a single site was conducted using a five-point Likert scale.Data analysis included both descriptive and inferential statistical analyses and stratified by categorical descriptors,including variables of formal training,years of experience,and specialty of practice.Results:One hundred sixteen physicians responded to the survey.The majority disagreed that there was a steep learning curve(57.5%)and that they need more time to identify structures under ultrasound(85.0%).Overall attitudes were mixed about the use of additional software to improve ease of use,but most(55.4%)had positive opinions toward the addition of real-time 3D reconstruction.Respondents without formal training were significantly more likely to agree that additional software would improve ease of ultrasound-guided procedures(p=0.0389).Radiologists were significantly more likely to perceive a steeper learning curve and less likely to advocate for supplemental software compared to emergency medicine physicians,surgeons,or anesthesiologists.Conclusions:Surveyed physicians demonstrated comfort with ultrasound-guided procedures and a mixed stance toward the use of additional software to assist with procedures.Those without formal training had significantly more positive attitudes toward the use of additional technology to augment ultrasound-guided procedures,suggesting a knowledge gap that may benefit from such technology.展开更多
BACKGROUND Endoscopic ultrasound-guided biliary drainage,including endoscopic ultrasoundguided choledochoduodenostomy and endoscopic ultrasound-guided hepatogastrostomy(EUS-HGS),is an efficacious alternative to endosc...BACKGROUND Endoscopic ultrasound-guided biliary drainage,including endoscopic ultrasoundguided choledochoduodenostomy and endoscopic ultrasound-guided hepatogastrostomy(EUS-HGS),is an efficacious alternative to endoscopic retrograde cholangiopancreatography and its common complications are bile leak,infection,stent migration and bleeding.Here,we report an atypical case of a patient who developed unexplained dark green urine after receiving EUS-HGS,which we suspected to be caused by an abnormal biliary-vascular fistula.CASE SUMMARY A 76-year-old woman diagnosed with pancreatic adenocarcinoma received EUSHGS for relieving jaundice.The patient reported abdominal pain and chest tightness after the operation,with difficulty in urinating.X-ray suggested rightsided pleural effusion and dark green pleural effusion was drained out.However,the patient also developed dark green urine,which appeared everyday afternoon and disappeared automatically after intravenous treatment.The previous pleural effusion disappeared after one week,but later the patient showed an increase of ascites,and the lesions were compartmentalized and encapsulated internally.CONCLUSION Postoperative surveillance after EUS-HGS must be emphasized to check for in order to prevent severe and hidden complications.展开更多
In this editorial,we comment on the article published by Qiu et al.Pyogenic liver abscess is a serious clinical condition requiring timely and effective intervention.Ultrasound(US)-guided techniques-whether needle asp...In this editorial,we comment on the article published by Qiu et al.Pyogenic liver abscess is a serious clinical condition requiring timely and effective intervention.Ultrasound(US)-guided techniques-whether needle aspiration(NA)or catheter drainage-are key minimally invasive treatments,especially in patients with multiple or deep-seated abscesses where conventional surgery is often impractical.The timing and choice of evacuation method significantly influence clinical outcomes.Although catheter drainage may be necessary for larger or refractory collections,NA represents a less invasive alternative that is often sufficient for smaller abscesses-particularly multiloculated ones-and can avoid multiple catheter placements.This consideration is especially important in the early phase of the disease,when the abscess collection is poorly demarcated from surrounding tissue and more prone to bleeding during or after intervention.Traditional practice delays intervention until liquefaction occurs;however,emerging evidence supports early US-guided evacuation-even in partially liquefied or non-liquefied abscesses-as both safe and effective.Early intervention,particularly via NA when feasible,is associated with faster symptom resolution,shorter hospitalization,and fewer complications.This editorial explores the role of US-guided interventions in pyogenic liver abscess mana-ement,emphasizing the importance of individualized,timely approaches that optimize disease outcomes while minimizing procedural risk.展开更多
BACKGROUND Ultrasound-guided peripherally inserted central catheter(PICC)placement is vital for cancer therapy,but lidocaine infiltration faces limitations like puncture pain and vasospasm.AIM To assess the clinical e...BACKGROUND Ultrasound-guided peripherally inserted central catheter(PICC)placement is vital for cancer therapy,but lidocaine infiltration faces limitations like puncture pain and vasospasm.AIM To assess the clinical efficacy of a no-pain intervention-combining compound lidocaine cream with warm compress-in reducing pain during ultrasound-guided PICC placement in cancer patients.METHODS A retrospective cohort study analyzed 88 cancer patients undergoing PICC placement(Shanghai Fourth People’s Hospital,2024).Patients were divided into control(lidocaine infiltration,n=44)and intervention(cream+warm compress,n=44)groups.Primary outcomes:Pain scores(numerical rating scale),procedural time,complications;secondary outcome:Satisfaction.RESULTS The intervention group showed significantly lower pain scores(1.2±0.4 vs 3.8±1.2,P=0.012)with comparable first-attempt success(95.5%vs 90.9%)and safety(P=0.672).Thermal activation of transient receptor potential vanilloid 1 channel enhanced drug penetration,achieving anesthesia within 8-10 minutes.Patient satisfaction reached 97.7%.CONCLUSION The combination of compound lidocaine cream with warm compress significantly alleviates procedural pain and enhances patient satisfaction during ultrasound-guided PICC placement in cancer patients,supporting its clinical application.展开更多
BACKGROUND Myofascial pain syndrome(MPS)is a common musculoskeletal disease associated with myofascial trigger point(MTrP).Muscle injury is one of the common causes of MPS.Currently,there is no effective treatment for...BACKGROUND Myofascial pain syndrome(MPS)is a common musculoskeletal disease associated with myofascial trigger point(MTrP).Muscle injury is one of the common causes of MPS.Currently,there is no effective treatment for MPS.CASE SUMMARY A 24-year-old female with chronic lower back MPS secondary to quadratus lumborum(QL)injury underwent comprehensive evaluation using validated scales:Pain severity(visual analog scale,McGill Pain Questionnaire),functional disability(Oswestry Disability Index,Roland Morris Disability Questionnaire),and quality of life[short form 36(SF-36)].Objective assessments included sEMG of bilateral QL muscles,Myoton mechanical property analysis,and magnetic resonance imaging volumetric measurements.The patient received four ultrasoundguided platelet-rich plasma(PRP)injections at 4-week intervals,with follow-up evaluations conducted at 1,3,and 6 months post-treatment.CONCLUSION Ultrasound-guided PRP injections alleviated pain,restored function,and improved quality of life in post-traumatic MPS.sEMG demonstrated neuromuscular symmetry restoration in MTrP-affected muscles,supporting the therapeutic potential of PRP.展开更多
BACKGROUND Hepatocellular carcinoma(HCC)is a common and frequently encountered malignancy in clinical practice.Patients who lack understanding of the disease and surgical treatment are prone to fear,depression,and oth...BACKGROUND Hepatocellular carcinoma(HCC)is a common and frequently encountered malignancy in clinical practice.Patients who lack understanding of the disease and surgical treatment are prone to fear,depression,and other negative emotions,which further aggravate psychological stress.As such,less stimulating and minimally invasive surgical modalities,such as ultrasound-guided interventions,should be adopted to alleviate or eliminate negative perioperative psychological states,which can be evaluated using validated tools such as the Hamilton Anxiety Scale(HAM-A)and Hamilton Depression Scale(HAM-D).AIM To investigate the impact of ultrasound-guided surgery on stress,complications,and recovery in patients with HCC and comorbid anxiety/depression.METHODS Ninety patients with primary small HCC and comorbid anxiety/depression were randomly divided into 2 groups according to treatment(n=45 each):Experimental(ultrasound-guided intervention);and control(conventional laparoscopic hepatectomy).The HAM-A and HAM-D were used to assess psychological states before and 1 week after surgery.C-reactive protein(CRP),vascular endothelial growth factor(VEGF),and superoxide dismutase(SOD)levels,in addition to specific liver-function indicators,complication rates,and postoperative metrics were measured.Recurrence rates were monitored for 6 months.RESULTS There were no significant differences in preoperative HAM-A and HAM-D scores between the 2 groups(P>0.05);however,scores in the study group were significantly lower postoperatively(P<0.05).On postoperative day 1,there were no significant differences in serum levels of CRP,VEGF,or SOD between the groups(P>0.05),whereas the levels in the intervention group were significantly lower than those in the control group on days 3 and 7(P<0.05).The incidence of postoperative complications in the study group(6.66%)was significantly lower than that in the control group[17.78%(P<0.05)].The study group also had a significantly shorter time to first flatus,oral intake,and postoperative hospital stay(P<0.05).Postoperative serum alanine aminotransferase,aspartate aminotransferase,and total bilirubin levels decreased in both groups compared with preoperative levels,although with significantly lower values in the study group(P<0.05)but no differences preoperatively(P>0.05).There was no statistical difference in tumor recurrence rates between the 2 groups during the six-month follow-up(P>0.05).CONCLUSION Ultrasound-guided intervention for patients with primary small HCC and anxiety/depression effectively improves negative emotional states,reduce stress responses,decreases postoperative complications,promotes recovery,and enhances quality of life.展开更多
BACKGROUND The current study was to assess the application effects of conventional surgical techniques and ultrasound-guided precise localization technology for early gastric cancer(EGC),with an emphasis on long-term ...BACKGROUND The current study was to assess the application effects of conventional surgical techniques and ultrasound-guided precise localization technology for early gastric cancer(EGC),with an emphasis on long-term survival,postoperative complications,and surgical results.AIM To evaluate perioperative results,postoperative complications,and long-term survival in order to conduct a thorough comparison between conventional surgical techniques and ultrasound-guided precise localization technology for the treatment of EGC.METHODS Of 100 EGC patients were gathered,and they were subsequently divided into two groups based on the surgical technique used:The observation group(n=52)received surgery assisted by ultrasound-guided precise localization technology,whereas the control group(n=48)received traditional surgical treatment.The baseline characteristics were similar between the groups.Operation time,intraoperative hemorrhage,the number of lymph nodes removed,postoperative problems,survival rate,and other surgical and postoperative parameters were compared.RESULTS Compared with the control group,the observation group had significantly less intraoperative blood loss(80 mL vs 120 mL,P<0.05)and more dissected lymph nodes(28 vs 22,P<0.05).There were fewer postoperative complications in the observation group than in the routine group(8%vs 16%,P<0.05),hospitalization after surgery was shorter,and gastrointestinal function returned sooner.The long-term survival rates at 5 years and 3 years were significantly greater in the observation group than in the control group:82%and 88%vs 70%and 78%,respectively(P<0.05).CONCLUSION It is possible that ultrasound-guided accurate localization technology might be utilized more widely in clinical practice because it could significantly enhance the results of surgery for EGC,including reduced blood loss,better lymphadenectomy,lower complication rates,and improved survival rates.Further studies should aim to refine this technology and consider its utility in other types of oncologic surgery.展开更多
As an innovative endoscopic intervention,endoscopic ultrasound-guided pan-creatic duct drainage(EUS-PD)demonstrates significant clinical value in re-solving pancreatic ductal hypertension syndrome.By integrating real-...As an innovative endoscopic intervention,endoscopic ultrasound-guided pan-creatic duct drainage(EUS-PD)demonstrates significant clinical value in re-solving pancreatic ductal hypertension syndrome.By integrating real-time ultrasound guidance with catheter-based intervention techniques,this approach provides a safe and effective alternative for cases where conventional endoscopic retrograde cholangiopancreatography has failed.Current evidence indicates that EUS-PD achieves technical success rates ranging from 82%to 95%in alleviating symptomatic pancreatic duct hypertension caused by malignant obstructions and chronic pancreatitis-related strictures,with an overall complication rate(15%-20%)substantially lower than surgical interventions.Compared to conventional imaging modalities,EUS-PD offers superior anatomical visualization capabilities:Its high-frequency ultrasound probe enables precise identification of 3 mm-level pancreatic duct branches,while contrast-enhanced imaging significantly improves diagnostic accuracy in differentiating benign from malignant strictures(sensitivity 91%vs 73%,P<0.05).Nevertheless,technical challenges persist,including diffi-cult ductal puncture localization(particularly in pancreatic head lesions),complex guidewire axial control,and postoperative pancreatic fistula risks(7%-12%).This review systematically examines the clinical indications/contraindications,pro-cedural protocols,device selection criteria,and management strategies for early/late complications associated with EUS-PD.Special emphasis is placed on establishing anatomical pathway selection standards for transgastric-pancreatic duct vs transduodenal-pancreatic duct approaches.Advancements in auxiliary technologies(e.g.,three-dimensional elastography,AI-assisted navigation)and multidisciplinary team collab-oration are pivotal to developing standardized protocols.We propose establishing international multicenter registry databases and conducting prospective randomized controlled trials to clarify EUS-PD's position within pancreatic disease management systems.Such initiatives will facilitate the clinical transformation of EUS-PD from an"alternative option"to a"preferred strategy",ultimately enhancing treatment precision and improving clinical outcomes in pancreatic disorders.展开更多
BACKGROUND Subcutaneous implantable cardioverter-defibrillator(S-ICD)implantation requires effective anesthesia.General anesthesia(GA)carries risks like hemodynamic instability,while ultrasound-guided intercostal nerv...BACKGROUND Subcutaneous implantable cardioverter-defibrillator(S-ICD)implantation requires effective anesthesia.General anesthesia(GA)carries risks like hemodynamic instability,while ultrasound-guided intercostal nerve block(US-ICNB)may offer better pain control.This study hypothesized US-ICNB is superior in perioperative safety and pain management.AIM To compare perioperative outcomes of GA and US-ICNB in S-ICD implantation.METHODS This retrospective single-center study included 64 patients who received S-ICD implantation between February 2021 and December 2024.They were divided into GA and US-ICNB groups based on anesthesia type.Demographic data,perioperative parameters(operation time,pain scores,analgesic usage),and postoperative outcomes(complications,defibrillation events)were collected and analyzed.Statistical tests were used to compare the two groups.RESULTS This study included 64 patients(20 in the GA group and 44 in the US-ICNB group).Baseline left ventricular ejection fraction was significantly lower in the US-ICNB group(39.20%±12.00%vs 56.20%±11.50%in GA,P<0.001),while American Society of Anesthesiologists scores and comorbidities were comparable.US-ICNB showed superior pain control,with significantly lower numeric rating scale scores at 6-48 hours(P<0.001)and fewer patients requiring analgesics(P=0.02).The US-ICNB group had shorter operation times(P<0.001),total hospital stays(P<0.001),and later first analgesia times(P<0.001).No anesthesia-related complications occurred in either group.CONCLUSION Both anesthetic methods were safe in the short term.However,US-ICNB was superior in reducing operation and hospital stay times and alleviating peri-operative pain.It has high safety in S-ICD implantation and deserves further clinical promotion,though large-scale,multi-center,randomized controlled trials are needed to confirm these findings.展开更多
Endoscopic ultrasound-guided gastroenterostomy(EUS-GE)has emerged as an effective and minimally invasive alternative for treating gastric outlet obstruction.Compared to traditional options,including duodenal stenting ...Endoscopic ultrasound-guided gastroenterostomy(EUS-GE)has emerged as an effective and minimally invasive alternative for treating gastric outlet obstruction.Compared to traditional options,including duodenal stenting and surgical gastrojejunostomy,EUS-GE offers comparable technical and clinical success while providing longer-lasting patency,fewer adverse events,and lower reintervention rates.The technique has expanded beyond malignant obstruction to include benign etiologies and complex conditions such as afferent loop syndrome.EUSGE enables rapid recovery and early resumption of oral intake,which is crucial for oncologic patients.However,the procedure remains technically demanding,and optimal techniques,device selection,and management of complications are still under investigation.This mini-review summarizes current evidence,compares EUS-GE with alternative therapies,discusses patient selection and procedural aspects,and outlines key areas for future research.展开更多
In this letter we comment on the article by Zhang et al published in the recent issue of the World Journal of Gastrointestinal Endoscopy 2024.We focus specifically on the management of gastric varices(GV),which is a s...In this letter we comment on the article by Zhang et al published in the recent issue of the World Journal of Gastrointestinal Endoscopy 2024.We focus specifically on the management of gastric varices(GV),which is a significant consequence of portal hypertension,is currently advised to include beta-blocker therapy for primary prophylaxis and transjugular intrahepatic portosystemic shunt for secondary prophylaxis or active bleeding.Although it has been studied,direct endoscopic injection of cyanoacrylate glue has limitations,such as the inability to fully characterize GV endoscopically and the potential for distant glue embolism.In order to achieve this,endoscopic ultrasound has been used to support GV characterization,real-time therapy imaging,and Doppler obliteration verification.展开更多
AIM To assess the long-term outcomes of this procedure after removal of self-expandable metal stent(SEMS). The efficacy and safety of endoscopic ultrasoundguided gallbladder drainage(EUS-GBD) with SEMS were also asses...AIM To assess the long-term outcomes of this procedure after removal of self-expandable metal stent(SEMS). The efficacy and safety of endoscopic ultrasoundguided gallbladder drainage(EUS-GBD) with SEMS were also assessed.METHODS Between January 2010 and April 2015, 12 patients with acute calculous cholecystitis, who were deemed unsuitable for cholecystectomy, underwent EUSGBD with a SEMS. EUS-GBD was performed under the guidance of EUS and fluoroscopy, by puncturing the gallbladder with a needle, inserting a guidewire, dilating the puncture hole, and placing a SEMS. TheSEMS was removed and/or replaced with a 7-Fr plastic pigtail stent after cholecystitis improved. The technical and clinical success rates, adverse event rate, and recurrence rate were all measured.RESULTS The rates of technical success, clinical success, and adverse events were 100%, 100%, and 0%, respectively. After cholecystitis improved, the SEMS was removed without replacement in eight patients, whereas it was replaced with a 7-Fr pigtail stent in four patients. Recurrence was seen in one patient(8.3%) who did not receive a replacement pigtail stent. The median follow-up period after EUS-GBD was 304 d(78-1492).CONCLUSION EUS-GBD with a SEMS is a possible alternative treatment for acute cholecystitis. Long-term outcomes after removal of the SEMS were excellent. Removal of the SEMS at 4-wk after SEMS placement and improvement of symptoms might avoid migration of the stent and recurrence of cholecystitis due to food impaction.展开更多
Interventional procedures using endoscopic ultrasound(EUS) have recently been developed. For biliary drainage, EUS-guided trans-luminal drainage has been reported. In this procedure, the transduodenal approach for ext...Interventional procedures using endoscopic ultrasound(EUS) have recently been developed. For biliary drainage, EUS-guided trans-luminal drainage has been reported. In this procedure, the transduodenal approach for extrahepatic bile ducts is called EUSguided choledochoduodenostomy, and the transgastric approach for intrahepatic bile ducts is called EUSguided hepaticogastrostomy(EUS-HGS). These procedures have several effects, such as internal drainage and avoiding post-endoscopic retrograde cholangiopancreatography(ERCP) pancreatitis, and they are indicated for an inaccessible ampulla of Vater due to duodenal obstruction or surgical anatomy. EUS-HGS has particularly wide indications and clinical impact as an alternative biliary drainage method. In this procedure, it is necessary to dilate the fistula, and several devices and approaches have been reported. Stent selection is also important. In previous reports, the overall technical success rate was 82%(221/270), the clinical success rate was 97%(218/225), and the overall adverse event rate for EUS-HGS was 23%(62/270). Adverse events of EUS-biliary drainage are still high compared with ERCP or PTCD. EUSHGS should continue to be performed by experienced endoscopists who can use various strategies when adverse events occur.展开更多
Background:To prevent stent migration during endoscopic ultrasound-guided hepaticogastrostomy(EUS-HGS),intra-scope channel release technique is important,but is unfamiliar to non-expert hands.The self-expandable metal...Background:To prevent stent migration during endoscopic ultrasound-guided hepaticogastrostomy(EUS-HGS),intra-scope channel release technique is important,but is unfamiliar to non-expert hands.The self-expandable metal stent(SEMS)is an additional factor to prevent stent migration.However,no compara-tive studies of laser-cut-type and braided-type during EUS-HGS have been reported.The aim of this study was to compare the distance between the intrahepatic bile duct and stomach wall after EUS-HGS among laser-cut-type and braided-type SEMS.Methods:To evaluate stent anchoring function,we measured the distance between the hepatic parenchyma and stomach wall before EUS-HGS,one day after EUS-HGS,and 7 days after EUS-HGS.Also,propensity score matching was performed to create a propensity score for using laser-cut-type group and braided-type group.Results:A total of 142 patients were enrolled in this study.Among them,24 patients underwent EUS-HGS using a laser-cut-type SEMS,and 118 patients underwent EUS-HGS using a braided-type SEMS.EUS-HGS using the laser-cut-type SEMS was mainly performed by non-expert endoscopists(n=21);EUS-HGS using braided-type SEMS was mainly performed by expert endoscopists(n=98).The distance after 1 day was significantly shorter in the laser-cut-type group than that in the braided-type group[2.00(1.70-3.75)vs.6.90(3.72-11.70)mm,P<0.001].In addition,this distance remained significantly shorter in the laser-cut-type group after 7 days.Although these results were similar after propensity score matching analysis,the distance between hepatic parenchyma and stomach after 7 days was increased by 4 mm compared with the distance after 1 day in the braided-type group.On the other hand,in the laser-cut-type group,the distance after 1 day and 7 days was almost the same.Conclusions:EUS-HGS using a laser-cut-type SEMS may be safe to prevent stent migration,even in non-expert hands.展开更多
Acute obstructive suppurative cholangitis(AOSC) due to biliary lithiasis is a life-threatening condition that requires urgent biliary decompression. Although endoscopic retrograde cholangiopancreatography(ERCP) with s...Acute obstructive suppurative cholangitis(AOSC) due to biliary lithiasis is a life-threatening condition that requires urgent biliary decompression. Although endoscopic retrograde cholangiopancreatography(ERCP) with stent placement is the current gold standard for biliary decompression, it can sometimes be difficult because of failed biliary cannulation. In this retrospective case series, we describe three cases of successful biliary drainage with recovery from septic shock after urgent endoscopic ultrasound-guided choledochoduodenostomy(EUS-CDS) was performed for AOSC due to biliary lithiasis. In all three cases, technical success in inserting the stents was achieved and the patients completely recovered from AOSC with sepsis in a few days after EUS-CDS. There were no procedure-related complications. When initial ERCP fails, EUS-CDS can be an effective life-saving endoscopic biliary decompression procedure that shortens the procedure time and prevents post-ERCP pancreatitis, particularly in patients with AOSC-induced sepsis.展开更多
AIM： to evaluate the role of endoscopic ultrasonographyguided fine needle aspiration （EUS-FNA） in the preoperative diagnosis of gastrointestinal stromal tumor （GIST）.METHODS： From September 2002 to June 2006, Fi...AIM： to evaluate the role of endoscopic ultrasonographyguided fine needle aspiration （EUS-FNA） in the preoperative diagnosis of gastrointestinal stromal tumor （GIST）.METHODS： From September 2002 to June 2006, Fiftythree consecutive EUS-FNAs of GI tract subepithelial hypoechoic tumors with continuity to proper muscle layer suspected as GIST by standard EUS were evaluated prospectively. The reference standards for the final diagnosis were surgery （n = 31）, or clinical follow-up （n = 22）. Additionally, immunophenotyping of specimens obtained by EUS-FNA and surgical resection specimens were compared.RESULTS： In 2 cases puncture was not performed because of anatomical problems. The collection rate of adequate specimens from the GI tract subepithelial hypoechoic tumor with continuity to proper muscle layer was 82% （42/51）. The diagnostic rate for the tumor less than 2 cm, 2 to 4 cm, and 4 cm or more were 71% （15/21）, 86% （18/21）, and 100% （9/9）,respectively. In 29 surgically resected cases, the sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of EUS-FNA using immunohistochemical analysis of GIST were 100%（24/24）, 80% （4/5）, 96% （24/25）, 100% （4/4）, and 97% （28/29）, respectively. No major complications were encountered.CONCLUSION： EUS-FNA with immunohistochemical analysis is a safe and accurate method in the pretherapeutic diagnosis of GIST. It should be taken into consideration in decision making, especially in early diagnosis following minimal invasive surgery for GIST.展开更多
OBJECTIVE:To investigate the effect of acupotomy on knee osteoarthritis(KOA),compared to electro-acupuncture(EA).METHODS:Sixty KOA patients were randomly divided into 2 groups:ultrasound-guided acupotomy group and EA ...OBJECTIVE:To investigate the effect of acupotomy on knee osteoarthritis(KOA),compared to electro-acupuncture(EA).METHODS:Sixty KOA patients were randomly divided into 2 groups:ultrasound-guided acupotomy group and EA group;each had 3 weeks' therapy.After the treatment,by contrast before and after therapy,by comparing curative effects among groups,we looked into disease improvement degree through activities of daily living score(ADL),hospital for special surgery index(HSS),visual analogue scales score(VAS) and knee joint's infrared thermal imaging detection.RESULTS:Graded by ADL,the excellent rate in acupotomy group was much higher than EA group;both acupotomy group and EA group had obviouschanges in HSS index before and after the therapy(P < 0.01).And there was remarkable difference in HSS index variation between the groups(P < 0.01).Acupotomy group and EA group showed big difference in pain index before and after treatment(P <0.01).Apparent difference also existed in the comparison among groups(P < 0.01).Both acupotomy group and EA group had apparent changes in infrared thermal imaging detection before and after the treatment(P < 0.01).CONCLUSION:Acupotomy and EA both have significant effects in KOA treatment;the former is better than the latter in relieving pain and improving knee functions.展开更多
Objective To explore the influence factors in hematoma formation after removing benign breast lesions with an ultrasound-guided vacuum-assisted system.Methods A total of 232 females with 312 benign breast masses recei...Objective To explore the influence factors in hematoma formation after removing benign breast lesions with an ultrasound-guided vacuum-assisted system.Methods A total of 232 females with 312 benign breast masses received excisional biopsy with ultrasoundguided vacuum-assisted system.The pathology of patients,results of hematoma development and outcome,influence factors for hematoma occurrence(nodule size,nodule location,number of nodule,breast shape,menstrual period,efficacy time of bandage,and application of hemostatic agents during the procedure) were recorded.Results Pathologic examination revealed fibroadenomas in 138 lesions,fibroadenosis in 127 lesions,intraductal papillomas in 39 lesions,inflammatory change in 4 lesions,retention cyst of the breast in 3 lesions,and benign phyllodes tumor in 1 lesion.Thirty hematomas were observed in patients(9.6%).Finally,97.0%hematomas were absorbed completely within 6 months follow-up.The incidence rates of hematoma were increased by 24.7%,10.0%,63.2%,13.9%in the nodule diameter larger or equal to 25 mm group,removal of larger or equal to two nodules once time from one patient group,menstrual period group,and larger and loose breast group,respectively(all P<0.05).However,the incidences were decreased by 60.6%in the bandage performed for 12-24 hours or beyond 24 hours group(P<0.05).The multiple logistic regression models revealed that nodule size(x^2=15.227,P<0.001),number of nodule(x^2=7.767,P=0.005),menstrual period(x^2=24.530,P<0.001),and breast shape(x^2=9.559,P=0.002) were independent risk factors associated with hematoma occurrence,but efficacy time of bandage was a protective factor associated with hematoma occurrence.Conclusion The occurrence of hematoma after the minimally invasive operation was associated with nodule size,number of nodule,menstrual period,breast shape,and efficacy time of bandage.展开更多
文摘Endoscopic retrograde cholangiopancreatography(ERCP)is the mainstay procedure of choice for management of obstructive biliary disease.While ERCP is widely performed with high success rates,the procedure is not feasible in every patient such as cases of non-accessible papilla.In the setting of unsuccessful ERCP,endoscopic ultrasound-guided biliary drainage(EUS-BD)has become a promising alternative to surgical bypass and percutaneous biliary drainage(PTBD).A variety of different forms of EUS-BD have been described,allowing for both intrahepatic and extrahepatic approaches.Recent studies have reported high success rates utilizing EUS-BD for both transpapillary and transluminal drainage,with fewer adverse events when compared to PTBD.Advancements in novel technologies designed specifically for EUS-BD have led to increased success rates as well as improved safety profile for the procedure.The techniques of EUS-BD are yet to be fully standardized and are currently performed by highly trained advanced endoscopists.The aim of our review is to highlight the different EUSguided interventions for achieving biliary drainage and to both assess the progress that has been made in the field as well as consider what the future may hold.
文摘Endoscopic retrograde cholangiopancreatography(ERCP)with stenting is the treatment modality of choice for patients with benign and malignant bile duct obstruction.ERCP could fail in cases of duodenal obstruction,duodenal diverticulum,ampullary neoplastic infiltration or surgically altered anatomy.In these cases percutaneous biliary drainage(PTBD)is traditionally used as a rescue procedure but is related to high morbidity and mortality and lower quality of life.Endoscopic ultrasound-guided biliary drainage(EUS-BD)is a relatively new interventional procedure that arose due to the development of curvilinear echoendoscope and the various endoscopic devices.A large amount of data is already collected that proves its efficacy,safety and ability to replace PTBD in cases of ERCP failure.It is also possible that EUS-BD could be chosen as a first-line treatment option in some clinical scenarios in the near future.Several EUS-BD techniques are developed EUS-guided transmural stenting,antegrade stenting and rendezvous technique and can be personalized depending on the individual anatomy.EUS-BD is normally performed in the same session from the same endoscopist in case of ERCP failure.The lack of training,absence of enough dedicated devices and lack of standardization still makes EUS-BD a difficult and not very popular procedure,which is related to life-threatening adverse events.Developing training models,dedicated devices and guidelines hopefully will make EUS-BD easier,safer and well accepted in the future.This paper focuses on the technical aspects of the different EUS-BD procedures,available literature data,advantages,negative aspects and the future perspectives of these modalities.
文摘Background:We aimed to study physician attitudes toward ultrasound-guided procedures and possible improvements.We hypothesized that the usage of ultrasound in procedures may be limited by a high barrier of entry and that most physicians would choose to adopt software that provides real-time image guidance if accessible.Methods:A voluntary,cross-sectional survey of physicians at a single site was conducted using a five-point Likert scale.Data analysis included both descriptive and inferential statistical analyses and stratified by categorical descriptors,including variables of formal training,years of experience,and specialty of practice.Results:One hundred sixteen physicians responded to the survey.The majority disagreed that there was a steep learning curve(57.5%)and that they need more time to identify structures under ultrasound(85.0%).Overall attitudes were mixed about the use of additional software to improve ease of use,but most(55.4%)had positive opinions toward the addition of real-time 3D reconstruction.Respondents without formal training were significantly more likely to agree that additional software would improve ease of ultrasound-guided procedures(p=0.0389).Radiologists were significantly more likely to perceive a steeper learning curve and less likely to advocate for supplemental software compared to emergency medicine physicians,surgeons,or anesthesiologists.Conclusions:Surveyed physicians demonstrated comfort with ultrasound-guided procedures and a mixed stance toward the use of additional software to assist with procedures.Those without formal training had significantly more positive attitudes toward the use of additional technology to augment ultrasound-guided procedures,suggesting a knowledge gap that may benefit from such technology.
基金Supported by the National Key Research and Development Program,No.2023YFC2307001the National Natural Science Foundation of China,No.82170570,No.82270698,and No.82470679.
文摘BACKGROUND Endoscopic ultrasound-guided biliary drainage,including endoscopic ultrasoundguided choledochoduodenostomy and endoscopic ultrasound-guided hepatogastrostomy(EUS-HGS),is an efficacious alternative to endoscopic retrograde cholangiopancreatography and its common complications are bile leak,infection,stent migration and bleeding.Here,we report an atypical case of a patient who developed unexplained dark green urine after receiving EUS-HGS,which we suspected to be caused by an abnormal biliary-vascular fistula.CASE SUMMARY A 76-year-old woman diagnosed with pancreatic adenocarcinoma received EUSHGS for relieving jaundice.The patient reported abdominal pain and chest tightness after the operation,with difficulty in urinating.X-ray suggested rightsided pleural effusion and dark green pleural effusion was drained out.However,the patient also developed dark green urine,which appeared everyday afternoon and disappeared automatically after intravenous treatment.The previous pleural effusion disappeared after one week,but later the patient showed an increase of ascites,and the lesions were compartmentalized and encapsulated internally.CONCLUSION Postoperative surveillance after EUS-HGS must be emphasized to check for in order to prevent severe and hidden complications.
文摘In this editorial,we comment on the article published by Qiu et al.Pyogenic liver abscess is a serious clinical condition requiring timely and effective intervention.Ultrasound(US)-guided techniques-whether needle aspiration(NA)or catheter drainage-are key minimally invasive treatments,especially in patients with multiple or deep-seated abscesses where conventional surgery is often impractical.The timing and choice of evacuation method significantly influence clinical outcomes.Although catheter drainage may be necessary for larger or refractory collections,NA represents a less invasive alternative that is often sufficient for smaller abscesses-particularly multiloculated ones-and can avoid multiple catheter placements.This consideration is especially important in the early phase of the disease,when the abscess collection is poorly demarcated from surrounding tissue and more prone to bleeding during or after intervention.Traditional practice delays intervention until liquefaction occurs;however,emerging evidence supports early US-guided evacuation-even in partially liquefied or non-liquefied abscesses-as both safe and effective.Early intervention,particularly via NA when feasible,is associated with faster symptom resolution,shorter hospitalization,and fewer complications.This editorial explores the role of US-guided interventions in pyogenic liver abscess mana-ement,emphasizing the importance of individualized,timely approaches that optimize disease outcomes while minimizing procedural risk.
基金Supported by the Discipline Promotion Program of Shanghai Fourth People’s Hospital,No.SY-XKZT-2021-2006.
文摘BACKGROUND Ultrasound-guided peripherally inserted central catheter(PICC)placement is vital for cancer therapy,but lidocaine infiltration faces limitations like puncture pain and vasospasm.AIM To assess the clinical efficacy of a no-pain intervention-combining compound lidocaine cream with warm compress-in reducing pain during ultrasound-guided PICC placement in cancer patients.METHODS A retrospective cohort study analyzed 88 cancer patients undergoing PICC placement(Shanghai Fourth People’s Hospital,2024).Patients were divided into control(lidocaine infiltration,n=44)and intervention(cream+warm compress,n=44)groups.Primary outcomes:Pain scores(numerical rating scale),procedural time,complications;secondary outcome:Satisfaction.RESULTS The intervention group showed significantly lower pain scores(1.2±0.4 vs 3.8±1.2,P=0.012)with comparable first-attempt success(95.5%vs 90.9%)and safety(P=0.672).Thermal activation of transient receptor potential vanilloid 1 channel enhanced drug penetration,achieving anesthesia within 8-10 minutes.Patient satisfaction reached 97.7%.CONCLUSION The combination of compound lidocaine cream with warm compress significantly alleviates procedural pain and enhances patient satisfaction during ultrasound-guided PICC placement in cancer patients,supporting its clinical application.
文摘BACKGROUND Myofascial pain syndrome(MPS)is a common musculoskeletal disease associated with myofascial trigger point(MTrP).Muscle injury is one of the common causes of MPS.Currently,there is no effective treatment for MPS.CASE SUMMARY A 24-year-old female with chronic lower back MPS secondary to quadratus lumborum(QL)injury underwent comprehensive evaluation using validated scales:Pain severity(visual analog scale,McGill Pain Questionnaire),functional disability(Oswestry Disability Index,Roland Morris Disability Questionnaire),and quality of life[short form 36(SF-36)].Objective assessments included sEMG of bilateral QL muscles,Myoton mechanical property analysis,and magnetic resonance imaging volumetric measurements.The patient received four ultrasoundguided platelet-rich plasma(PRP)injections at 4-week intervals,with follow-up evaluations conducted at 1,3,and 6 months post-treatment.CONCLUSION Ultrasound-guided PRP injections alleviated pain,restored function,and improved quality of life in post-traumatic MPS.sEMG demonstrated neuromuscular symmetry restoration in MTrP-affected muscles,supporting the therapeutic potential of PRP.
文摘BACKGROUND Hepatocellular carcinoma(HCC)is a common and frequently encountered malignancy in clinical practice.Patients who lack understanding of the disease and surgical treatment are prone to fear,depression,and other negative emotions,which further aggravate psychological stress.As such,less stimulating and minimally invasive surgical modalities,such as ultrasound-guided interventions,should be adopted to alleviate or eliminate negative perioperative psychological states,which can be evaluated using validated tools such as the Hamilton Anxiety Scale(HAM-A)and Hamilton Depression Scale(HAM-D).AIM To investigate the impact of ultrasound-guided surgery on stress,complications,and recovery in patients with HCC and comorbid anxiety/depression.METHODS Ninety patients with primary small HCC and comorbid anxiety/depression were randomly divided into 2 groups according to treatment(n=45 each):Experimental(ultrasound-guided intervention);and control(conventional laparoscopic hepatectomy).The HAM-A and HAM-D were used to assess psychological states before and 1 week after surgery.C-reactive protein(CRP),vascular endothelial growth factor(VEGF),and superoxide dismutase(SOD)levels,in addition to specific liver-function indicators,complication rates,and postoperative metrics were measured.Recurrence rates were monitored for 6 months.RESULTS There were no significant differences in preoperative HAM-A and HAM-D scores between the 2 groups(P>0.05);however,scores in the study group were significantly lower postoperatively(P<0.05).On postoperative day 1,there were no significant differences in serum levels of CRP,VEGF,or SOD between the groups(P>0.05),whereas the levels in the intervention group were significantly lower than those in the control group on days 3 and 7(P<0.05).The incidence of postoperative complications in the study group(6.66%)was significantly lower than that in the control group[17.78%(P<0.05)].The study group also had a significantly shorter time to first flatus,oral intake,and postoperative hospital stay(P<0.05).Postoperative serum alanine aminotransferase,aspartate aminotransferase,and total bilirubin levels decreased in both groups compared with preoperative levels,although with significantly lower values in the study group(P<0.05)but no differences preoperatively(P>0.05).There was no statistical difference in tumor recurrence rates between the 2 groups during the six-month follow-up(P>0.05).CONCLUSION Ultrasound-guided intervention for patients with primary small HCC and anxiety/depression effectively improves negative emotional states,reduce stress responses,decreases postoperative complications,promotes recovery,and enhances quality of life.
基金Supported by Wenzhou Science and Technology Bureau,No.Y20240363.
文摘BACKGROUND The current study was to assess the application effects of conventional surgical techniques and ultrasound-guided precise localization technology for early gastric cancer(EGC),with an emphasis on long-term survival,postoperative complications,and surgical results.AIM To evaluate perioperative results,postoperative complications,and long-term survival in order to conduct a thorough comparison between conventional surgical techniques and ultrasound-guided precise localization technology for the treatment of EGC.METHODS Of 100 EGC patients were gathered,and they were subsequently divided into two groups based on the surgical technique used:The observation group(n=52)received surgery assisted by ultrasound-guided precise localization technology,whereas the control group(n=48)received traditional surgical treatment.The baseline characteristics were similar between the groups.Operation time,intraoperative hemorrhage,the number of lymph nodes removed,postoperative problems,survival rate,and other surgical and postoperative parameters were compared.RESULTS Compared with the control group,the observation group had significantly less intraoperative blood loss(80 mL vs 120 mL,P<0.05)and more dissected lymph nodes(28 vs 22,P<0.05).There were fewer postoperative complications in the observation group than in the routine group(8%vs 16%,P<0.05),hospitalization after surgery was shorter,and gastrointestinal function returned sooner.The long-term survival rates at 5 years and 3 years were significantly greater in the observation group than in the control group:82%and 88%vs 70%and 78%,respectively(P<0.05).CONCLUSION It is possible that ultrasound-guided accurate localization technology might be utilized more widely in clinical practice because it could significantly enhance the results of surgery for EGC,including reduced blood loss,better lymphadenectomy,lower complication rates,and improved survival rates.Further studies should aim to refine this technology and consider its utility in other types of oncologic surgery.
基金Supported by the Liaoning Provincial Science and Technology Plan Joint Program(Applied Basic Research Project),Undertaken by Shengjing Hospital of China Medical University in Collaboration with China Resources Health(Liaoning)Group Co.,Ltd.,No.2023JHZ/101700190.
文摘As an innovative endoscopic intervention,endoscopic ultrasound-guided pan-creatic duct drainage(EUS-PD)demonstrates significant clinical value in re-solving pancreatic ductal hypertension syndrome.By integrating real-time ultrasound guidance with catheter-based intervention techniques,this approach provides a safe and effective alternative for cases where conventional endoscopic retrograde cholangiopancreatography has failed.Current evidence indicates that EUS-PD achieves technical success rates ranging from 82%to 95%in alleviating symptomatic pancreatic duct hypertension caused by malignant obstructions and chronic pancreatitis-related strictures,with an overall complication rate(15%-20%)substantially lower than surgical interventions.Compared to conventional imaging modalities,EUS-PD offers superior anatomical visualization capabilities:Its high-frequency ultrasound probe enables precise identification of 3 mm-level pancreatic duct branches,while contrast-enhanced imaging significantly improves diagnostic accuracy in differentiating benign from malignant strictures(sensitivity 91%vs 73%,P<0.05).Nevertheless,technical challenges persist,including diffi-cult ductal puncture localization(particularly in pancreatic head lesions),complex guidewire axial control,and postoperative pancreatic fistula risks(7%-12%).This review systematically examines the clinical indications/contraindications,pro-cedural protocols,device selection criteria,and management strategies for early/late complications associated with EUS-PD.Special emphasis is placed on establishing anatomical pathway selection standards for transgastric-pancreatic duct vs transduodenal-pancreatic duct approaches.Advancements in auxiliary technologies(e.g.,three-dimensional elastography,AI-assisted navigation)and multidisciplinary team collab-oration are pivotal to developing standardized protocols.We propose establishing international multicenter registry databases and conducting prospective randomized controlled trials to clarify EUS-PD's position within pancreatic disease management systems.Such initiatives will facilitate the clinical transformation of EUS-PD from an"alternative option"to a"preferred strategy",ultimately enhancing treatment precision and improving clinical outcomes in pancreatic disorders.
文摘BACKGROUND Subcutaneous implantable cardioverter-defibrillator(S-ICD)implantation requires effective anesthesia.General anesthesia(GA)carries risks like hemodynamic instability,while ultrasound-guided intercostal nerve block(US-ICNB)may offer better pain control.This study hypothesized US-ICNB is superior in perioperative safety and pain management.AIM To compare perioperative outcomes of GA and US-ICNB in S-ICD implantation.METHODS This retrospective single-center study included 64 patients who received S-ICD implantation between February 2021 and December 2024.They were divided into GA and US-ICNB groups based on anesthesia type.Demographic data,perioperative parameters(operation time,pain scores,analgesic usage),and postoperative outcomes(complications,defibrillation events)were collected and analyzed.Statistical tests were used to compare the two groups.RESULTS This study included 64 patients(20 in the GA group and 44 in the US-ICNB group).Baseline left ventricular ejection fraction was significantly lower in the US-ICNB group(39.20%±12.00%vs 56.20%±11.50%in GA,P<0.001),while American Society of Anesthesiologists scores and comorbidities were comparable.US-ICNB showed superior pain control,with significantly lower numeric rating scale scores at 6-48 hours(P<0.001)and fewer patients requiring analgesics(P=0.02).The US-ICNB group had shorter operation times(P<0.001),total hospital stays(P<0.001),and later first analgesia times(P<0.001).No anesthesia-related complications occurred in either group.CONCLUSION Both anesthetic methods were safe in the short term.However,US-ICNB was superior in reducing operation and hospital stay times and alleviating peri-operative pain.It has high safety in S-ICD implantation and deserves further clinical promotion,though large-scale,multi-center,randomized controlled trials are needed to confirm these findings.
文摘Endoscopic ultrasound-guided gastroenterostomy(EUS-GE)has emerged as an effective and minimally invasive alternative for treating gastric outlet obstruction.Compared to traditional options,including duodenal stenting and surgical gastrojejunostomy,EUS-GE offers comparable technical and clinical success while providing longer-lasting patency,fewer adverse events,and lower reintervention rates.The technique has expanded beyond malignant obstruction to include benign etiologies and complex conditions such as afferent loop syndrome.EUSGE enables rapid recovery and early resumption of oral intake,which is crucial for oncologic patients.However,the procedure remains technically demanding,and optimal techniques,device selection,and management of complications are still under investigation.This mini-review summarizes current evidence,compares EUS-GE with alternative therapies,discusses patient selection and procedural aspects,and outlines key areas for future research.
文摘In this letter we comment on the article by Zhang et al published in the recent issue of the World Journal of Gastrointestinal Endoscopy 2024.We focus specifically on the management of gastric varices(GV),which is a significant consequence of portal hypertension,is currently advised to include beta-blocker therapy for primary prophylaxis and transjugular intrahepatic portosystemic shunt for secondary prophylaxis or active bleeding.Although it has been studied,direct endoscopic injection of cyanoacrylate glue has limitations,such as the inability to fully characterize GV endoscopically and the potential for distant glue embolism.In order to achieve this,endoscopic ultrasound has been used to support GV characterization,real-time therapy imaging,and Doppler obliteration verification.
基金Supported by the Japan Society for the Promotion of Science and the Japanese Foundation for the Research and Promotion of Endoscopy No.22590764 and No.25461035
文摘AIM To assess the long-term outcomes of this procedure after removal of self-expandable metal stent(SEMS). The efficacy and safety of endoscopic ultrasoundguided gallbladder drainage(EUS-GBD) with SEMS were also assessed.METHODS Between January 2010 and April 2015, 12 patients with acute calculous cholecystitis, who were deemed unsuitable for cholecystectomy, underwent EUSGBD with a SEMS. EUS-GBD was performed under the guidance of EUS and fluoroscopy, by puncturing the gallbladder with a needle, inserting a guidewire, dilating the puncture hole, and placing a SEMS. TheSEMS was removed and/or replaced with a 7-Fr plastic pigtail stent after cholecystitis improved. The technical and clinical success rates, adverse event rate, and recurrence rate were all measured.RESULTS The rates of technical success, clinical success, and adverse events were 100%, 100%, and 0%, respectively. After cholecystitis improved, the SEMS was removed without replacement in eight patients, whereas it was replaced with a 7-Fr pigtail stent in four patients. Recurrence was seen in one patient(8.3%) who did not receive a replacement pigtail stent. The median follow-up period after EUS-GBD was 304 d(78-1492).CONCLUSION EUS-GBD with a SEMS is a possible alternative treatment for acute cholecystitis. Long-term outcomes after removal of the SEMS were excellent. Removal of the SEMS at 4-wk after SEMS placement and improvement of symptoms might avoid migration of the stent and recurrence of cholecystitis due to food impaction.
文摘Interventional procedures using endoscopic ultrasound(EUS) have recently been developed. For biliary drainage, EUS-guided trans-luminal drainage has been reported. In this procedure, the transduodenal approach for extrahepatic bile ducts is called EUSguided choledochoduodenostomy, and the transgastric approach for intrahepatic bile ducts is called EUSguided hepaticogastrostomy(EUS-HGS). These procedures have several effects, such as internal drainage and avoiding post-endoscopic retrograde cholangiopancreatography(ERCP) pancreatitis, and they are indicated for an inaccessible ampulla of Vater due to duodenal obstruction or surgical anatomy. EUS-HGS has particularly wide indications and clinical impact as an alternative biliary drainage method. In this procedure, it is necessary to dilate the fistula, and several devices and approaches have been reported. Stent selection is also important. In previous reports, the overall technical success rate was 82%(221/270), the clinical success rate was 97%(218/225), and the overall adverse event rate for EUS-HGS was 23%(62/270). Adverse events of EUS-biliary drainage are still high compared with ERCP or PTCD. EUSHGS should continue to be performed by experienced endoscopists who can use various strategies when adverse events occur.
文摘Background:To prevent stent migration during endoscopic ultrasound-guided hepaticogastrostomy(EUS-HGS),intra-scope channel release technique is important,but is unfamiliar to non-expert hands.The self-expandable metal stent(SEMS)is an additional factor to prevent stent migration.However,no compara-tive studies of laser-cut-type and braided-type during EUS-HGS have been reported.The aim of this study was to compare the distance between the intrahepatic bile duct and stomach wall after EUS-HGS among laser-cut-type and braided-type SEMS.Methods:To evaluate stent anchoring function,we measured the distance between the hepatic parenchyma and stomach wall before EUS-HGS,one day after EUS-HGS,and 7 days after EUS-HGS.Also,propensity score matching was performed to create a propensity score for using laser-cut-type group and braided-type group.Results:A total of 142 patients were enrolled in this study.Among them,24 patients underwent EUS-HGS using a laser-cut-type SEMS,and 118 patients underwent EUS-HGS using a braided-type SEMS.EUS-HGS using the laser-cut-type SEMS was mainly performed by non-expert endoscopists(n=21);EUS-HGS using braided-type SEMS was mainly performed by expert endoscopists(n=98).The distance after 1 day was significantly shorter in the laser-cut-type group than that in the braided-type group[2.00(1.70-3.75)vs.6.90(3.72-11.70)mm,P<0.001].In addition,this distance remained significantly shorter in the laser-cut-type group after 7 days.Although these results were similar after propensity score matching analysis,the distance between hepatic parenchyma and stomach after 7 days was increased by 4 mm compared with the distance after 1 day in the braided-type group.On the other hand,in the laser-cut-type group,the distance after 1 day and 7 days was almost the same.Conclusions:EUS-HGS using a laser-cut-type SEMS may be safe to prevent stent migration,even in non-expert hands.
基金Supported by The Japan Society for the Promotion of Science and the Japanese Foundation for the Research and Promotion of Endoscopy,No.22590764 and 25461035
文摘Acute obstructive suppurative cholangitis(AOSC) due to biliary lithiasis is a life-threatening condition that requires urgent biliary decompression. Although endoscopic retrograde cholangiopancreatography(ERCP) with stent placement is the current gold standard for biliary decompression, it can sometimes be difficult because of failed biliary cannulation. In this retrospective case series, we describe three cases of successful biliary drainage with recovery from septic shock after urgent endoscopic ultrasound-guided choledochoduodenostomy(EUS-CDS) was performed for AOSC due to biliary lithiasis. In all three cases, technical success in inserting the stents was achieved and the patients completely recovered from AOSC with sepsis in a few days after EUS-CDS. There were no procedure-related complications. When initial ERCP fails, EUS-CDS can be an effective life-saving endoscopic biliary decompression procedure that shortens the procedure time and prevents post-ERCP pancreatitis, particularly in patients with AOSC-induced sepsis.
文摘AIM： to evaluate the role of endoscopic ultrasonographyguided fine needle aspiration （EUS-FNA） in the preoperative diagnosis of gastrointestinal stromal tumor （GIST）.METHODS： From September 2002 to June 2006, Fiftythree consecutive EUS-FNAs of GI tract subepithelial hypoechoic tumors with continuity to proper muscle layer suspected as GIST by standard EUS were evaluated prospectively. The reference standards for the final diagnosis were surgery （n = 31）, or clinical follow-up （n = 22）. Additionally, immunophenotyping of specimens obtained by EUS-FNA and surgical resection specimens were compared.RESULTS： In 2 cases puncture was not performed because of anatomical problems. The collection rate of adequate specimens from the GI tract subepithelial hypoechoic tumor with continuity to proper muscle layer was 82% （42/51）. The diagnostic rate for the tumor less than 2 cm, 2 to 4 cm, and 4 cm or more were 71% （15/21）, 86% （18/21）, and 100% （9/9）,respectively. In 29 surgically resected cases, the sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of EUS-FNA using immunohistochemical analysis of GIST were 100%（24/24）, 80% （4/5）, 96% （24/25）, 100% （4/4）, and 97% （28/29）, respectively. No major complications were encountered.CONCLUSION： EUS-FNA with immunohistochemical analysis is a safe and accurate method in the pretherapeutic diagnosis of GIST. It should be taken into consideration in decision making, especially in early diagnosis following minimal invasive surgery for GIST.
基金Supported by Beijing Medical Research Development Fund:the Clinical Study on Ultrasound-guided Needle-knife Treatment of Knee Osteoarthritis(No.SF-2009-46)
文摘OBJECTIVE:To investigate the effect of acupotomy on knee osteoarthritis(KOA),compared to electro-acupuncture(EA).METHODS:Sixty KOA patients were randomly divided into 2 groups:ultrasound-guided acupotomy group and EA group;each had 3 weeks' therapy.After the treatment,by contrast before and after therapy,by comparing curative effects among groups,we looked into disease improvement degree through activities of daily living score(ADL),hospital for special surgery index(HSS),visual analogue scales score(VAS) and knee joint's infrared thermal imaging detection.RESULTS:Graded by ADL,the excellent rate in acupotomy group was much higher than EA group;both acupotomy group and EA group had obviouschanges in HSS index before and after the therapy(P < 0.01).And there was remarkable difference in HSS index variation between the groups(P < 0.01).Acupotomy group and EA group showed big difference in pain index before and after treatment(P <0.01).Apparent difference also existed in the comparison among groups(P < 0.01).Both acupotomy group and EA group had apparent changes in infrared thermal imaging detection before and after the treatment(P < 0.01).CONCLUSION:Acupotomy and EA both have significant effects in KOA treatment;the former is better than the latter in relieving pain and improving knee functions.
基金Supported by the National Major Scientific Equipment Special Project(2012YQ16020304)
文摘Objective To explore the influence factors in hematoma formation after removing benign breast lesions with an ultrasound-guided vacuum-assisted system.Methods A total of 232 females with 312 benign breast masses received excisional biopsy with ultrasoundguided vacuum-assisted system.The pathology of patients,results of hematoma development and outcome,influence factors for hematoma occurrence(nodule size,nodule location,number of nodule,breast shape,menstrual period,efficacy time of bandage,and application of hemostatic agents during the procedure) were recorded.Results Pathologic examination revealed fibroadenomas in 138 lesions,fibroadenosis in 127 lesions,intraductal papillomas in 39 lesions,inflammatory change in 4 lesions,retention cyst of the breast in 3 lesions,and benign phyllodes tumor in 1 lesion.Thirty hematomas were observed in patients(9.6%).Finally,97.0%hematomas were absorbed completely within 6 months follow-up.The incidence rates of hematoma were increased by 24.7%,10.0%,63.2%,13.9%in the nodule diameter larger or equal to 25 mm group,removal of larger or equal to two nodules once time from one patient group,menstrual period group,and larger and loose breast group,respectively(all P<0.05).However,the incidences were decreased by 60.6%in the bandage performed for 12-24 hours or beyond 24 hours group(P<0.05).The multiple logistic regression models revealed that nodule size(x^2=15.227,P<0.001),number of nodule(x^2=7.767,P=0.005),menstrual period(x^2=24.530,P<0.001),and breast shape(x^2=9.559,P=0.002) were independent risk factors associated with hematoma occurrence,but efficacy time of bandage was a protective factor associated with hematoma occurrence.Conclusion The occurrence of hematoma after the minimally invasive operation was associated with nodule size,number of nodule,menstrual period,breast shape,and efficacy time of bandage.
