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Objectives: Endoscopic ultrasound‐guided fine‐needle aspiration and fine‐needle biopsy (EUS‐FNA/FNB) is not fully established as a pathological sampling tool for gallbladder lesions due to limited evidence. We therefore aimed to clarify the effectiveness and safety of this procedure in a large‐population cohort. Methods: This study retrospectively evaluated the diagnostic yield of EUS‐FNA/FNB for accurately differentiating between benign and malignant gallbladder lesions. Puncture targets included the gallbladder mass, lymph node, and liver mass. Adverse events and factors associated with diagnostic accuracy were analyzed as well. Results: In 187 patients with gallbladder lesions undergoing EUS‐FNA/FNB, 18 benign lesions and 169 malignant lesions were identified. Overall sampling adequacy was 98% (184/187). The diagnostic accuracy of EUS‐FNA/FNB was 97% (182/187), sensitivity was 97% (164/169), and specificity was 100% (18/18). A single postprocedural complication (minor bleeding) was recorded in one patient. In the 169 cases of malignancy, 203 sites were punctured for pathological sampling of the primary mass (n = 94), lymph node (n = 79), and metastatic liver mass (n = 30). No significant difference was found for diagnostic accuracy among the puncture sites (P = 0.70). In cases having specimens obtained from the primary mass, the accuracy of those targeting liver invasion sites was significantly higher than that of other sites (98% vs. 83%, P < 0.01). Conclusion: EUS‐FNA/FNB demonstrated clinical usefulness and safety for the pathological diagnosis of gallbladder lesions, with high diagnostic yield and a low incidence of adverse events. Targeting the site of liver infiltration may improve the diagnostic rate of EUS‐FNA/FNB in the primary mass. [ABSTRACT FROM AUTHOR]

Tract dilation is one of the most difficult stages of endoscopic ultrasound‐guided hepaticogastrostomy (EUS‐HGS), especially for beginners. To overcome this problem, we applied a special dedicated dilator. Herein, we retrospectively evaluate the safety and usefulness of a novel drill dilator in EUS‐HGS. This single‐center retrospective study included 20 consecutive patients who underwent EUS‐HGS with a novel drill dilator. The tip is 0.77 mm, and it becomes 7F at 3 cm from tip. The track is dilated to 7F by simple clockwise rotation. The technical success rate of both initial tract dilation and stent placement was 20/20 (100%). No cases required additional dilation such as balloon or electric cautery. In 13/20 cases (65.0%), EUS‐HGS was performed by beginner endoscopists. Median time required for dilation was 62.5 s (range, 30–144 s). Median procedure time was 13 min (range, 7–25 min). Early adverse events were two cases of mild fever. There was no bile leakage or bleeding. The novel drill dilator appears to be safe and useful for EUS‐HGS. As it is not necessary to press the device strongly, there is no pushback during dilation and the scope position is stable. These characteristics facilitate EUS‐HGS even for beginners. This device may enable the further development and increased dissemination of EUS intervention. [ABSTRACT FROM AUTHOR]

Background There are several types of pancreatic mass, so it is important to distinguish between them before treatment. Artificial intelligence (AI) is a mathematical technique that automates learning and recognition of data patterns. This study aimed to investigate the efficacy of our AI model using endoscopic ultrasonography (EUS) images of multiple types of pancreatic mass (pancreatic ductal adenocarcinoma [PDAC], pancreatic adenosquamous carcinoma [PASC], acinar cell carcinoma [ACC], metastatic pancreatic tumor [MPT], neuroendocrine carcinoma [NEC], neuroendocrine tumor [NET], solid pseudopapillary neoplasm [SPN], chronic pancreatitis, and autoimmune pancreatitis [AIP]). Methods Patients who underwent EUS were included in this retrospective study. The included patients were divided into training, validation, and test cohorts. Using these cohorts, an AI model that can distinguish pancreatic carcinomas from noncarcinomatous pancreatic lesions was developed using a deep-learning architecture and the diagnostic performance of the AI model was evaluated. Results 22 000 images were generated from 933 patients. The area under the curve, sensitivity, specificity, and accuracy (95 %CI) of the AI model for the diagnosis of pancreatic carcinomas in the test cohort were 0.90 (0.84–0.97), 0.94 (0.88–0.98), 0.82 (0.68–0.92), and 0.91 (0.85–0.95), respectively. The per-category sensitivities (95 %CI) of each disease were PDAC 0.96 (0.90–0.99), PASC 1.00 (0.05–1.00), ACC 1.00 (0.22–1.00), MPT 0.33 (0.01–0.91), NEC 1.00 (0.22–1.00), NET 0.93 (0.66–1.00), SPN 1.00 (0.22–1.00), chronic pancreatitis 0.78 (0.52–0.94), and AIP 0.73 (0.39–0.94). Conclusions Our developed AI model can distinguish pancreatic carcinomas from noncarcinomatous pancreatic lesions, but external validation is needed. [ABSTRACT FROM AUTHOR]

Background: After multiple uncovered self-expandable metal stent (UCSEMS) deployments, endoscopic revision becomes complex and potentially challenging. A novel stent delivery system with a dilation function has recently been developed in Japan. This study evaluated the technical feasibility of this device for patients with unresectable malignant hilar biliary obstruction (MHO) after multiple UCSEMS deployments. Method: Participants comprised consecutive patients with unresectable MHO who had undergone multiple UCSEMS deployments and required endoscopic revision for the right or left hepatic bile ducts, as decided by cholangiography under endoscopic retrograde cholangiopancreatography (ERCP) guidance. Results: A total of 14 patients requiring endoscopic revision of right and left hepatic bile ducts were enrolled in this study. Among these 14 patients, guidewire insertion through the mesh of previously placed stents failed in 2 patients. As a result, these two patients underwent only unilateral UCSEMS deployment. Because clinical success was not obtained, transmural placement of the UCSEMS under Endoscopic Ultrasound (EUS) guidance to the segment of the liver not being drained was performed in those patients. The molting technique was attempted in 12 patients, proving successful in all patients. The technical success rate was therefore 92.8% (12/14). Mean procedure time was 23.2 min. Conclusion: This novel stent delivery system with a dilation function may be useful in endoscopic revision techniques for bilateral UCSEMS deployment. [ABSTRACT FROM AUTHOR]

A prerequisite for endoscopic ultrasound (EUS)‐guided hepaticogastrostomy (HGS) is adequate dilation of the intrahepatic bile duct. Compared with a 19G needle, the 22G needle offers more flexible manipulation and superior ability to achieve bile duct puncture. However, evidence regarding EUS‐HGS using a 22G needle remains limited. The present study evaluated the feasibility and safety of EUS‐HGS using a novel 0.018‐inch guidewire and 22G needle for patients with insufficient intrahepatic bile duct dilation. If the bile duct diameter was <1.5 mm, a 22G needle was used, and the diameter was ≥1.5 mm; puncture with a 19G needle was first attempted, with the 22G needle being inserted if initial bile duct puncture failed. EUS‐HGS using the 22G needle was attempted in a total of 10 patients, including one patient with failed insertion of a 19G needle. Median diameter of the puncture site was 1.2 mm (range 0.5–2.5 mm). Bile duct puncture using the 22G needle was successful in all patients. Insertion of the novel 0.018‐inch guidewire was also successful in all patients. However, since tract dilation using an ultra‐tapered mechanical dilator failed in two patients, tract dilation was performed using a balloon dilator. Finally, stent deployment was successfully performed in all patients. EUS‐HGS using a 22G needle with a novel 0.018‐inch guidewire appears safe and feasible. [ABSTRACT FROM AUTHOR]

However, if a transpapillary bile duct stent has previously been deployed, duodenal stents can become distorted by the bile duct stent. We herein describe technical tips for recanalization of a distorted duodenal metal stent using a novel fine-gauge electrocautery dilator (Medico's Hirata Inc., Osaka Japan) [5]. [Extracted from the article]

Recently, we used a novel drill dilator (Tornus ES, Asahi Intecc) for EUS-HGS in a difficult case of this kind (Fig. The present case demonstrates that Tornus is useful for fistula dilation in difficult cases of EUS-HGS. [Extracted from the article]

2 Reintervention through the occluded stent. a An endoscopic retrograde cholangiopancreatography catheter was inserted into the biliary tract through the mesh of the endoscopic ultrasound-guided hepaticogastrostomy stent. b Obstruction of the stent was apparent (arrow). c The novel uncovered self-expandable metal stent delivery system was inserted across the stricture site into the biliary tract. d Stent deployment was successfully performed. B Video 1 b The novel uncovered self-expandable metal stent delivery system was inserted into the biliary tract through the mesh of an endoscopic ultrasound-guided hepaticogastrostomy stent. As the diameter of the stent delivery system is only 5.4 Fr and the tip is extremely tapered, stent delivery is performed by insertion along a guidewire. [Extracted from the article]