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A prolific trend currently designates endoscopic ultrasonography (EUS) literature. We aimed to record all EUS-studies published during the past decade and evaluate them in terms of scientific quality, creating a stratification based on levels of evidence (LE). METHODS: All articles on EUS published between January 2001 and December 2010 were retrieved using a Pubmed and Cochrane Library search. Inclusion criteria were: original research papers (randomized controlled trials-RCTs, prospective and retrospective studies), meta-analyses, reviews and surveys pertinent to gastrointestinal EUS. Levels of evidence (LE) were assessed using the North of England evidence-based guidelines. RESULTS: Overall, 1,832 eligible articles were reviewed. The majority (46.1%) of reports comprised retrospective descriptive studies (LE III). Expert reviews and committee reports (LE IV) accounted for 28.9%, well-designed quasi-experimental studies (LE IIb) for 20.1%, RCTs (LE Ib) for 2.4%, prospective controlled trials (LE IIa) for 1.4%, and meta-analyses (LE Ia) for 1.1% of the total. High LE (Ia-Ib) were assigned to loco-regional staging of luminal gastrointestinal cancers; mediastinal staging of lung cancer; diagnostic work-up of solid pancreatic tumors, suspected biliary obstruction and choledocholithiasis; celiac plexus neurolysis; and pancreatic pseudocysts drainage. Intermediate to low LE (IIa-IV) were assigned to submucosal tumors, pancreatic cysts, chronic pancreatitis and novel therapeutic applications (pancreato-biliary drainage, tumor ablation). CONCLUSIONS: Diagnostic and staging EUS has matured and has proven its clinical impact on patient management. Therapeutic or interventional EUS is still evolving and more quality research and data are needed to establish EUS as the best next intervention to perform once firm evidence is available.

Endoscopic ultrasound (EUS) has excellent overall sensitivity (94 %) and specificity (95 %) for the diagnosis of choledocholithiasis [1]. EUS is also very accurate in the diagnosis of common bile duct (CBD) sludge, with a sensitivity up to 90 % and specificity of 97 % (personal data). By performing EUS first in patients with suspected CBD stones, endoscopic retrograde cholangiopancreatography (ERCP) with endoscopic sphincterotomy (EST) may be safely avoided in two-thirds of the cases. On the other hand, ERCP with EST is appropriate when the presence of CBD stones has been documented by EUS. As a result, a EUS-based selection of patients for therapeutic ERCP significantly reduces complication rates [2, 3]. The American Society of Gastrointestinal Endoscopy...

Soon after the first report in 1992 [1], EUS-FNA became an indispensable tool to obtain tissue diagnosis in the majority of the lesions within its reach [2]. The two main benefits of endoscopic ultrasound (EUS) are its superior accuracy in the detection of lesions\2–3 cm in diameter within 4 cm from the transducer, compared with extracorporeal imaging techniques, and the possibility of tissue acquisition by EUS-guided fine needle aspiration (FNA). EUS-FNA can facilitate diagnosis when tissue is acquired from the primary tumor and is useful for staging when tissue is acquired from suspicious lymph nodes or suspected metastatic lesions. Pancreatic solid and cystic masses and gastrointestinal subepithelial tumors are typical targets of diagnostic EUS-FNA. Non-peritumoral lymph nodes, liver, and adrenal gland lesions are examples of the utility of EUS-FNA for staging. Moreover, EUS-FNA of either a lymph node or a suspected metastasis (e.g., in the liver) may enable simultaneous diagnosis and staging in a patient whose primary tumor cannot be sampled. EUS-FNA is particularly useful in the lower gastrointestinal tract where few alternatives exist, such as extracorporeal or laparoscopic sampling, for tissue acquisition from pelvic lesions, as opposed to upper gastrointestinal and mediastinal lesions, where percutaneous and surgical techniques are still in use. The main indications for pelvic EUS include rectal cancer preoperative staging and post-surgical surveillance, the differential diagnosis of subepithelial tumors, the diagnosis and sampling of perirectal solid and cystic masses, and the evaluation of fecal incontinence and perianal disease. Since male and female abnormalities of the genitourinary tract are not usually part of gastroenterologist’s armamentarium, they will not be included in the discussion. In this issue of Digestive Diseases and Sciences, Han et al. [3] draw attention to the accuracy and safety of pelvic EUS-FNA. By means of systematic literature review and meta-analysis during 2000–2014, data were obtained from 10 studies deemed of high quality according to the method of quality assessment of studies and data extraction (QUADAS). Evidently, the investigators scrupulously contacted the corresponding authors of the selected articles in order to extract the individual data for pelvic lesions or to calculate the specific operating characteristics in 7 of the 10 studies. Overall, 246 patients were included in the analysis. The pooled sensitivity and specificity of EUSFNA were 89 % (95 % confidence interval, 83–94 %) and 93 % (95 % confidence interval, 86–97 %), respectively, and the area under the summary receiver operating characteristic (SROC) curve was 0.96. Nonetheless, the authors stressed a potential publication bias indicated by the significant asymmetry of the Deek’s funnel plot, as it is often the case in the EUS literature. In other words, since studies with positive results are more likely to be published than the negative ones, the real sensitivity and specificity of EUS-FNA in practice may be lower than the figures reported in this meta-analysis. The overall adverse events rate was 1.7 % with one post-biopsy hemorrhage, which was managed conservatively, and two patients with cystic lesions who developed abscesses after EUS-FNA and required percutaneous drainage. Just after the end of the consideration period of the metaanalysis, a large American study was published specifically & Pietro Fusaroli pietro.fusaroli@unibo.it

In the present study we evaluated the relation among histology, H. pylori, IgG to H. pylori, gastric emptying, and acid secretion in 43 patients with fundic atrophic gastritis. On the basis of gastric acid secretion, patients were divided into three subgroups: patients with preserved acid secretion (Group 1), patients with hypochlorhydria (Group 2), and patients with achlorhydria (Group 3). Fundic glandular atrophy was more severe in hypoachlorhydric patients than in those with preserved acid secretion (P < 0.05 vs Group 2, P < 0.005 vs Group 3). H. pylori colonization was found in 94% of patients in Group 1, in 61% of patients in Group 2, and in only 8% of patients in Group 3 (P < 0.001 vs Group 1, P < 0.05 vs Group 2). Conversely, serological positivity to H. pylori was high in all three subgroups of patients (100% in Group 1, 77% in Group 2, 92% in Group 3). Gastric emptying was delayed in atrophic patients, particularly in those with hypoachlorhydria. Our data suggest that fundic atrophic gastritis represents a possible end stage of H. pylori infection, characterized by a progressive disappearance of the bacterium and a progressive deterioration of gastric functions.

We report a case of primary esophageal non-Hodgkin's T-cell lymphoma in a young white female. At admission, endoscopy revealed large, irregularly shaped, esophageal ulcerations with super imposed candidiasis. Endoscopic ultrasonography to assess submucosal alterations and periesophageal involvement revealed a diffuse hypoechogenic thickening (up to 5 mm) of the esophageal wall, a pattern consistent with lymphomatous infiltration. Definitive diagnosis was made with the aid of histology and immunohistochemistry.