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ABSTRACT Background: In the past decades, endoscopic ultrasound has developed from a diagnostic tool to a platform for many therapeutic interventions. Various technological advancements have emerged since the last Brazilian Consensus, demanding a review and update of the recommendations based on the best scientific evidence. Methods: A group of 32 renowned echoendoscopists selected eight relevant topics to be discussed to generate clinical questions. After that, a literature review was conducted to answer these questions based on the most updated evidence. Results: Thirty-three statements were formulated and voted on by the experts to reach a consensus. The Oxford System was used to grade the level of evidence. Conclusion: There is moderate evidence to support that the needle shape, gauge, or aspiration technique does not influence the yield of endoscopic ultrasound (EUS)-guided tissue sampling of pancreatic solid lesions. There is moderate evidence to support using EUS-TTNB of the cyst wall to differentiate between mucinous and non-mucinous cystic neoplasms. There is little evidence to support the EUS-guided treatment of gastric varices. There is a high level of evidence to support that EUS-guided biliary drainage and ERCP present similar outcomes in patients with distal malignant biliary obstruction. There is a high level of evidence for using EUS to diagnose neoplastic pancreatic cysts and detect necrosis before indicating drainage. There is moderate evidence to support EUS-GE over duodenal stent for malignant gastric outlet obstruction in patients with a life expectancy higher than 2 months. There is a high level of evidence to support the use of RFA in treating both functioning and non-functioning types of NET.

Idiopathic acute pancreatitis (IAP) presents a diagnostic challenge and refers to cases where the cause of acute pancreatitis remains uncertain despite a comprehensive diagnostic evaluation. Endoscopic ultrasound (EUS) has emerged as a valuable tool in the diagnostic workup of IAP. This review explores the pivotal role of EUS in detecting the actual cause of IAP and assessing its accuracy, timing, safety, and future technological improvement. In this review, we investigate the role of EUS in identifying the actual cause of IAP by examining the available literature. We aim to assess possible existing evidence regarding EUS accuracy, timing, and safety and explore potential trends of future technological improvements in EUS for diagnostic purposes. Following PRISMA guidelines, 60 pertinent studies were selected and analysed. EUS emerges as a crucial diagnostic tool, particularly when conventional imaging fails. It can offer intricate visualization of the pancreas, biliary system, and adjacent structures. Microlithiasis, biliary sludge, chronic pancreatitis, and small pancreatic tumors seem to be much more accurately identified with EUS in the setting of IAP. The optimal timing for EUS is post-resolution of the acute phase of the disease. With a low rate of complications, EUS poses minimal safety concerns. EUS-guided interventions, including fine-needle aspiration, collection drainage, and biopsies, aid in the cytological analysis. With high diagnostic accuracy, safety, and therapeutic potential, EUS is able to improve patient outcomes when managing IAP. Further refinement of EUS techniques and cost-effectiveness assessment of EUS-guided approaches need to be explored in multicentre prospective studies. This review underscores EUS as a transformative tool in unraveling IAP's enigma and advancing diagnostic and therapeutic strategies. [ABSTRACT FROM AUTHOR]

Idiopathic acute pancreatitis (IAP) presents a diagnostic challenge and refers to cases where the cause of acute pancreatitis remains uncertain despite a comprehensive diagnostic evaluation. Endoscopic ultrasound (EUS) has emerged as a valuable tool in the diagnostic workup of IAP. This review explores the pivotal role of EUS in detecting the actual cause of IAP and assessing its accuracy, timing, safety, and future technological improvement. In this review, we investigate the role of EUS in identifying the actual cause of IAP by examining the available literature. We aim to assess possible existing evidence regarding EUS accuracy, timing, and safety and explore potential trends of future technological improvements in EUS for diagnostic purposes. Following PRISMA guidelines, 60 pertinent studies were selected and analysed. EUS emerges as a crucial diagnostic tool, particularly when conventional imaging fails. It can offer intricate visualization of the pancreas, biliary system, and adjacent structures. Microlithiasis, biliary sludge, chronic pancreatitis, and small pancreatic tumors seem to be much more accurately identified with EUS in the setting of IAP. The optimal timing for EUS is post-resolution of the acute phase of the disease. With a low rate of complications, EUS poses minimal safety concerns. EUS-guided interventions, including fine-needle aspiration, collection drainage, and biopsies, aid in the cytological analysis. With high diagnostic accuracy, safety, and therapeutic potential, EUS is able to improve patient outcomes when managing IAP. Further refinement of EUS techniques and cost-effectiveness assessment of EUS-guided approaches need to be explored in multicentre prospective studies. This review underscores EUS as a transformative tool in unraveling IAP’s enigma and advancing diagnostic and therapeutic strategies.

Objective: The aim of this study was to compare predictive factors and Radial Echoendoscopy (EUS) in the diagnosis of choledocholithiasis. Materials and Methods: Patients with suspected choledocholithiasis were recruited from April 2011 to January 2018. All patient characteristics, findings of EUS and findings of ERCP were recorded and analyzed. Results: Eighty patients were enrolled in this study. Clinical symptoms, blood chemistry and liver function test were similar in patients with and without choledocholithiasis. Using the findings of ERCP as the gold standard, Radial EUS had sensitivity and specificity for the detection of choledocholithiasis at 90.2% and 97.4%, and for choledocholithiasis and/or common bile duct sludge at 92.7% and 100%, respectively. For patients with intermediate likelihood and high likelihood from predictive factors (33 and 45), Radial EUS was positive for choledocholithiasis in 51.5% (17/33) and 46.7% (21/45), and ERCP was positive for choledocholithiasis in 54.5% (18/33) and 48.9% (22/45), respectively. Conclusion: Predictive factors, for both intermediate and high likelihood groups, were not accurate to diagnose these patients. Radial EUS is a good diagnostic tool and should done in both groups of patients to avoid unnecessary ERCP.

Intraluminal sarcoma of the pulmonary artery is a rare malignant neoplasm with aggressive behaviour. Differential diagnosis with pulmonary embolism, metastasis or even pseudotumors can be complex and the site of the tumour can pose a significant diagnostic challenge, as the pulmonary arteries are not easily accessible for diagnostic sampling. We describe a case of primary pulmonary artery sarcoma diagnosed with endoscopic ultrasound-guided needle aspiration/biopsy through transesophageal access. [ABSTRACT FROM AUTHOR]

Background: Despite the increasing number of national departments performing endoscopic ultrasound (EUS), there are no official data regarding clinical EUS practice in Portugal. Objectives: We aimed to evaluate the current practice of EUS in Portugal. Methods: By email, we invited 1 physician of each one of the 26 national Gastroenterology Departments which perform EUS to complete a survey questionnaire available on the Google Forms platform. The online questionnaire was available from September 2017 until February 2018 and was answered only by physicians who perform EUS. Results: A total of 21/26 (80.8%) national Gastroenterology Departments answered the questionnaire. In Portugal, there are 42 echoendoscopes in total; most of the echoendoscopy units have only 1 EUS processor (81%), 1 radial echoendoscope (66.7%), 1 linear echoendoscope (76.2%), 1 anorectal probe (57.1%), but no miniprobes (85.7%). About 81% have histological core acquisition needles. In 81% of the units, there are at least 2 ultrasonographers who perform echoendoscopy together (at least 2 ultrasonographers per EUS) in 47.6% of these departments. The ultrasonographers also performed abdominal ultrasound (US), anal US, and endoscopic retrograde cholangiopancreatography in 71.4, 66.7, and 42.9%, respectively. The echoendoscopy units have 2.4 ± 1.1 periods of echoendoscopy per week and 4 ± 1.5 EUS per period (499.2 ± 416.8 EUS per year). Subepithelial lesions and biliopancreatic lesion evaluation as well as gastrointestinal neoplasia staging were the most common EUS indications. The number of FNA (fine-needle aspirations) ranges from 10 to 160/year. Rapid on-site evaluation (ROSE) is available in 60% of units and is performed by the cytopathologist (66.7%) in the majority of cases. The main reason for omitting ROSE is the limited pathology staff. Cytopathological material is prepared by the ultrasonographer in 25% of the units. Air drying (50%) and formalin (50%) are most frequently used to fix and preserve smears, respectively. Pancreatic pseudocyst drainage (66.7%), celiac plexus neurolysis (52.4%) and pancreatic necrosectomy (42.9%) are the most widespread therapeutic procedures. Conclusions: This survey provides the first insight into the current status of digestive echoendoscopy in Portugal. There is a great variability in diagnostic and therapeutic echoendoscopy practice.

Objective: The aim of this study was to compare predictive factors and endoscopic ultrasound (EUS) in the diagnosis of choledocholithiasis. Materials and Methods: Patients with suspected choledocholithiasis were recruited from April 2011 to January 2018. All patient characteristics, EUS findings and ERCP findings were recorded and analyzed. Results: Eighty patients were enrolled in this study. Clinical symptoms, blood chemistry and liver function tests were similar in patients with and without choledocholithiasis. Using the findings of ERCP as the gold standard, radial EUS had a sensitivity and specificity for the detection of choledocholithiasis of 90.2% and 97.4%, and for choledocholithiasis and/or common bile duct sludge 92.7% and 100%, respectively. For patients with intermediate likelihood and high likelihood of having choledocholithiasis, as calculated from their predictive factors (33 and 45), radial EUS was positive for choledocholithiasis in 51.5% (17/33) and 46.7% (21/45), and ERCP was positive for choledocholithiasis in 54.5% (18/33) and 48.9% (22/45), respectively. Conclusion: Predictive factors, for both the intermediate and high likelihood groups, were not accurate to diagnose these patients. EUS is a good diagnostic tool and should be performed in both groups of patients to avoid unnecessary ERCP. [ABSTRACT FROM AUTHOR]

Echoendoscopy, endoscopic ultrasound or endosonography is an examination that combines endoscopic and ultrasound images in order to evaluate the lesions found not only in the gastrointestinal tract wall but also around it. This investigation also allows staging patients with gastrointestinal cancer, tumors of the pancreas and lung. Therefore, the indications for endoscopic ultrasound are very broad (some more supported by the literature than others) and their utilities are multiple. The current trend is to move from diagnostic echoendoscopy to a therapeutic one, since it is being used for multiple purposes, such as guiding minimally invasive surgical procedures. A concise review of the literature was made to summarize the applications of endoscopic ultrasound, in order to familiarize gastroenterologists with their indications and possible therapeutic applications. Endoscopic ultrasound (EUS), also known as endosonography (ES) and endoscopic ultrasound (UE), is an examination that combines the endoscopic image with the ultrasound image to evaluate lesions located in and around the wall of the gastrointestinal tract. Although it was described more than 20 years ago, its indications, both diagnostic and therapeutic, remain unknown by the majority of medical specialists or general practitioners. Every day more and more publications about EUS are published, describing new indications of this interesting examination and ratifying those previously described, making it an indispensable tool within a gastroenterology service.

Introduction: Pancreatic pseudocysts can be drained by surgical, laparoscopic, percutaneous, and endoscopic methods. Endoscopic methods have become the most widely accepted nowadays since they are simpler and generate less morbidity and mortality. They have always been associated with the use of fluoroscopy, which adds complexity. This study presents our drainage technique which is guided by echoendoscopy rather than fluoroscopy. Materials and methods: The objective of this study is to describe a technique for drainage of pancreatic pseudocysts which does not use fluoroscopy to guide the endoscope. Instead, echoendoscopy guides the instrument. We report a case series of 10 patients who underwent transgastric drainage and describe the technique, complications and results during follow-up. Results: Ten consecutive patients, five women and five men, were included in this study. Ninety percent were cases in which the body of the pancreas had been compromised. Cystogastrostomy was successfully performed in nine patients. It consisted of implantation of a transmural metallic stent under single endoscopic guidance. In one patient the stent was not released and aspiration drainage was performed. The nine patients who had stents implanted have presented no recurrences, but the patient who underwent aspiration drainage presented recurrence in the body of the pancreas. The main complication was migration of the stent into the pseudocyst cavity which occurred in one patient and which required a second endoscopic procedure to remove the stent. Conclusions: Transmural drainage of pancreatic pseudocysts through placement of stents is a safe, effective and minimally invasive technique for the treatment of pancreatic pseudocysts. [ABSTRACT FROM AUTHOR]

Traditionally, the common bile duct (CBD) has been said to measure up to 6 mm in patients with gallbladders and up to 8 mm in cholecystectomized patients. However, these recommendations are based on very old studies performed with trans-abdominal ultrasound. Echoendoscopy has greater sensitivity and specificity for evaluating the bile duct, but studies had not yet been done in our population to evaluate the normal size of the CBD by this method. Objective: The objective of this study was to evaluate the size of the CBD in patients with gallbladders and patients without gallbladders. Materials and Methods: This is a prospective descriptive study of patients who underwent echoendoscopy at the gastroenterology unit in the El Tunal hospital, Universidad Nacional de Colombia. Patients had been referred for diagnostic echoendoscopy to evaluate subepithelial lesions in the esophagus and/or stomach. Once the lesion had been evaluated and an echoendoscopic diagnosis had been established, the transducer was advanced to the second duodenal portion to perform bilio-pancreatic echoendoscopy. The size of CBC at the hepatic artery was measured to avoid altering the size of the CBC. These data were collected in online forms in Google drive that were filled out during the echoendoscopic procedure. A scatter plot was graphed and analyzed to assess the size of the common bile duct in the entire study population. Results: The study took place between January 2013 and September 2013 during which time 100 echoendoscopies were performed for subepithelial lesions in the upper digestive tract. The average patient age was 55.6 years, 65% of the patients were women, 18% of the patients had had previous cholecystectomies and 50% of these patients were women. The average common bile duct size was 4.88 mm (range: 2.6 to 7 mm). In the group with intact gallbladders (88%) the average CBC was 4.16 mm (range 2.6 to 6 mm), among women with intact gallbladders the average CBC was 3.9 mm (range 2.6 to 5 mm) and among men with intact gallbladders the average CBC was 4.42 mm (range 3 to 6 mm). In the group of cholecystectomized patients the average CBC was 4.88 mm (range 3 to 7 mm), in the group of cholecystectomized women the average was 4.84 mm (range 4.6 to 7 mm), and among cholecystectomized men the average was 4.92 mm (range: 3 to 7 mm). Conclusions: Our study shows that the normal size of the common bile duct is 4.16 mm. This is smaller than the size accepted by the literature and than the 4.88 mm in cholecystectomy patients. This is interesting, since if the common bile duct is indeed larger following cholecystectomy, we could discard biliopancreatic pathology with diagnostic echoendoscopy. [ABSTRACT FROM AUTHOR]

BACKGROUND: Echoendoscopy is a mixed technique which adds the advantages of endoscopy to those of transabdominal ultrasonography through an endoscope with transductor in its distal extremity, allowing for the evaluation of the abdominal organs reached by the endoscope and in contact with the intestinal wall. AIM: To verify the positivity rate of the echoendoscopy with puncture with thin needle (EEPTN) or (EE-PAF) in solid pancreatic mass based on the technique used in the Gastrointestinal Endoscopy Unit of Hospital das Clínicas, University of São Paulo. METHODS: Retrospective evaluation - cohort study - of 138 patients who were submitted to echoendoscopy through aspiration puncture between May 2004 and June 2007. The data were collected through the medical charts present in the medical files of Hospital das Clínicas (Clinical Hospital) of the University of São Paulo, having as inclusion criterion the presence of solid pancreatic mass in computerized tomography and as exclusion criterion the presence of non solid pancreatic tumor. The routine technique was the one used in the Gastrointestinal Endoscopy Unit focusing the following variables: mass characteristics (size, location, presence of peripancreatic lymph node, presence of lymph node in celiac trunk); number of punctures to obtain microfragment for cytology, and experience of the professional in charge. The equipment used was an echoendoscopy device model Olympus EUS (EYES) Exera EU - C60, with electronic sectorial transductor and 22 gauges Wilson-Cook needles. RESULTS: Seventy six (55,4 %) male patients and 61 (44.5 %) female were enrolled. Age ranged from 16 to 87 years and means 59,9 years. The lesions were cephalic in 94 (68,1 %). Mass larger than 4 cm had a higher percentage of positivity reaching 40%, but lesions smaller than 2 cm had a percentage of 43% of inconclusive. Microfragments were obtained in 100% of the positive cases and only 73,1 % when negative (P=0,004). There was no statistic difference regarding the experience of the endoscopy professional. Only 80 patients had the number of punctures written down and it was noticed that there is better performance as the number of punctures was increased. The definitive histopathologycal diagnosis of pancreatic neoplasia occurred in only 41(29,7 %) patients. CONCLUSIONS: Regarding mass characteristics, when larger is the mass, larger is the positivity of the method; the location didn't correlate with higher positivity; when the lymph nodes were present, there was a tendency to positivity; concerning the number of punctures, the higher number, higher positivity; in relationship to the professional experience in endoscopy, there was no difference in the rate of positivity of the puncture of the solid pancreatic mass.RACIONAL: Ecoendoscopia é técnica mista que adiciona as vantagens da endoscopia àquelas da ecografia, somente que o procedimento ecográfico é realizado do interior dos órgãos para fora deles, no sentido centrífugo. OBJETIVO: Verificar a positividade da ecoendoscopia na punção com agulhas (EEPTN) ou (EE-PAF) em tumores sólidos pancreáticos baseados na técnica utilizada pelo Serviço de Endoscopia Digestiva do Hospital de Clínicas da Universidade de São Paulo. MÉTODOS: Cohorte retrospectiva de 138 pacientes que realizaram ecoendoscopia com punção aspirativa por agulha fina (EE-PAAF) no período de maio de 2004 a junho de 2007. Os dados foram coletados por meio de consulta aos prontuários, constantes do arquivo médico. O critério de inclusão foi a presença de massa pancreática sólida à tomografia computadorizada e o critério de exclusão a presença de tumor pancreático não sólido. Foram utilizadas as seguintes variáveis: característica da massa (tamanho, localização, presença de linfonodo peripancreático, presença de linfonodo em tronco celíaco); número de punções para obtenção de microfragmento; citologia e experiência do profissional executante. O aparelho utilizado foi um ecoendoscópio da marca Olympus, modelo OLYMPUS EUS (EYS) EXERA EU-C60, com transdutor setorial eletrônico e agulhas de 22 gauges da marca Boston Scientific. RESULTADOS: Setenta e seis (55,4 %) deles eram do sexo masculino e 61 (44,5 %) do feminino. A idade variou de 16 a 87 anos, com média de 59,9 anos. As lesões foram cefálicas em 94 (68,1 %) dos casos. Massas maiores que 4 cm tiveram percentual de positividade maior, chegando a 40%, mas as lesões menores que 2 cm obtiveram percentual de 43 % de inconclusivo. A obtenção de microfragmentos foi conseguida em 100% dos casos positivos e apenas 73,1 %, quando negativo (P=0,004). Não houve diferença estatística em relação à experiência do endoscopista. Apenas 80 pacientes tiveram anotado o número de punções e notou-se que existe melhor desempenho quanto maior for o número delas. O diagnóstico anatomopatológico definitivo de neoplasia pancreática ocorreu em apenas 41 (29,7 %) indivíduos. CONCLUSÕES: Em relação às características da massa, quanto maior ela era maior a positividade do método; a localização não correlacionou com maior positividade; há tendência de positividade quando presentes os linfonodos peripancreáticos; em relação ao número de punções, quanto maior o número delas, maior a positividade do método; em relação à experiência do profissional, não houve diferença no índice de positividade da punção da massa pancreática sólida.

Objective: the applications of endoscopic ultrasonography have diversified over recent years. The possibility of reaching cardiac territory has been successfully explored in experimental models, opening up a new field of possibilities for diagnostic and therapeutic interventions that were unthinkable until very recently. The aims set out in this study are to evaluate cardiac anatomy, its approach, the safety of the experimental procedure and the resulting morphological and histological changes after the procedure. Material and methods: the study has been performed on two adult pigs. They have undergone different surgical approaches to the cardiac cavities and descending thoracic aorta with excellent results. Results: different cardiac structures have been identified and operated upon (right auricle, left auricle, left ventricle, cardiac valves), as well as major vessels. The use of contrast, both intracavitary and from a peripheral vein, enabled us to verify the anatomical spaces studied. During the procedures we monitored for arrhythmias, hemodynamic behavior, possibility of infection by obtaining sample hemocultures before and after procedures, and response to punctures. Conclusions: the present study has enabled us to evaluate access to the heart from the esophageal lumen using endoscopic ultrasonography, with results that are very similar to those described in the current bibliography. However, we offer two novelties: puncture of the right auricle through the interauricular partition and puncture of the descending thoracic aorta, both performed with ease and apparent safety.Objetivo: las aplicaciones de la ultrasonografía endoscópica se han diversificado en los últimos tiempos. La posibilidad de acceder al territorio cardiaco se ha explorado en modelos experimentales con buenos resultados, abriendo un campo de nuevas posibilidades de intervencionismo diagnóstico y terapéutico hasta hace poco impensables. Los objetivos planteados en este trabajo pretenden evaluar la anatomía cardiaca, su abordaje, la seguridad del procedimiento experimental y los cambios morfológicos e histológicos derivados. Material y métodos: se ha trabajado con dos animales adultos de la especie porcina a los que se han practicado diversos abordajes a cavidades cardiacas y aorta torácica descendente con excelentes resultados. Resultados: se han identificado y abordado diversas estructuras cardiacas (aurícula derecha, aurícula izquierda, ventrículo izquierdo, válvulas cardiacas) y grandes vasos. El uso de contraste intracavitario y desde una vía venosa periférica ha permitido asegurar los espacios anatómicos estudiados. Durante los procedimientos se ha monitorizado la aparición de arritmias, el comportamiento hemodinámico, la posibilidad de infección mediante la obtención de hemocultivos antes y después de aquellos y la respuesta a las punciones. Conclusiones: el presente trabajo nos ha permitido evaluar el acceso al corazón desde la luz esofágica mediante ultrasonografía endoscópica, con unos resultados muy similares a los observados en la literatura, ofreciendo dos novedades como la punción de la aurícula derecha a través del tabique interauricular y de la aorta torácica descendente, de forma fácil y aparentemente segura.

Introducción: el insulinoma es el tumor endocrino pancreático más frecuente. Su diagnóstico preoperatorio ha sido motivo de controversia durante muchos años. El objetivo del trabajo es evaluar la experiencia del Hospital Ramón y Cajal en el manejo diagnóstico y terapéutico de este tipo de tumores. Material y métodos: en el periodo comprendido entre enero de 1999 y julio de 2006 fueron intervenidos en nuestro hospital 12 pacientes (9 mujeres y 3 varones) con el diagnóstico de insulinoma, con una edad media de 56 años (16-72 años). Resultados: la gammagrafía con octreótido nos permitió realizar el diagnóstico en el 33,3% de los casos, el TAC abdominal en el 83,3% y la ecoendoscopia en el 100%. El 100% de los insulinomas fue diagnosticado durante la cirugía gracias al uso de la ecografía intraoperatoria. En todos los casos se realizó la excisión completa del tumor, mediante 9 enucleaciones y 3 pancreatectomías distales. Dos pacientes presentaron una fístula pancreática y otro un pseudoquiste pancreático que se resolvieron de forma conservadora. La tasa de curación fue del 100%. El seguimiento fue de 48 meses, no encontrándose ningún caso de recidiva. Conclusión: en nuestra experiencia, creemos aconsejable la realización de TAC abdominal y ecoendoscopia como pruebas previas a la cirugía. Sin embargo, la técnica de elección sería la palpación del páncreas y la realización de una ecografía intraoperatoria. La cirugía es curativa en el 100% de los casos, y la técnica efectuada dependerá del tamaño, localización y distancia del tumor al conducto pancreático, así como su relación con el síndrome MEN-1.Introduction: insulinoma is the most frequent pancreatic endocrine tumor. Its preoperative diagnosis has been controversial for many years. The aim of this study was to evaluate the experience in the management and treatment of this kind of tumor at Hospital Ramón y Cajal. Material and methods: between January 1999 and July 2006, 12 patients were operated on in our hospital (9 females and 3 males) who had been diagnosed with insulinoma, with a mean age of 56 years (16-72 years). Results: octreotide scintigraphy allowed a diagnosis in 33.3% of cases, abdominal CT in 83.3%, and echoendoscopy in 100%. Intraoperative ultrasonography confirmed the presence of an insulinoma in 100% of cases. In all cases a complete excision was possible, with 9 enucleations and 3 distal pancreatectomies. Two patients developed a pancreatic fistula, and one a pancreatic pseudocyst that healed spontaneously without surgery. The overall cure rate was 100%. After a mean follow-up of 48 months no recurrences have been reported. Conclusion: in our experience, we consider advisable that abdominal CT and echoendoscopy be performed before surgery. However, the initial procedure of choice would be pancreas palpation and intraoperative ultrasonography. Surgery cured 100% of cases, and the procedure selected depends on size, location, distance from the main pancreatic duct, and relation to multiple endocrine neoplasm 1 (MEN-1).

Objective: almost 30% of gastroenteropancreatic neuroendocrine tumors (GEPET) escape preoperative identification using standard imaging techniques. The goal of this retrospective study is to present our cumulative experience in the assessment of GEPET by preoperative endoscopic ultrasonography (EUS), and to compare it with a literature review. Patients and methods: thirty-seven patients with suspected specific hormonal syndromes were sequentially examined with US, CT, MRI, angiography, OctreoScan, and radial and sectorial EUS. Sixteen were males (43%) and 21 were females (57%), with a mean age of 61 years (interval: 40-84 a). Of all 37 patients, 27 had 19 endocrine tumors in the pancreas and 14 tumors in their gastrointestinal tract. No tumors were demonstrated in 10 patients, hence they were used as a control group. Of all 37 patients, 24 were operated on or had histological samples collected, with the presence of 26 GEPET (10 carcinoids) being confirmed in 22 patients. Results: EUS sensitivity and diagnostic accuracy were 81% and 78%. Specificity was 80%. All these values were similar to the mean values obtained from the literature review. Three pancreatic rumors smaller than or equal to 1 cm (insulinomas) were detected, which had escaped diagnosis with previous US, CT, and MRI studies. An echoendoscopic examination of the pancreas could not be completed in two cases (5%), a pancreas carcinoid and an already gastrectomized double pancreatic gastrinoma. Conclusion: EUS is a good preoperative technique for GEPET detection, and may likely be superior to other imaging techniques in the assessment of small tumors. The usefulness of EUS as a primary exploration after US or HCT has been posited for tumor diagnosis and localization before surgery.

Introduction: endoscopic ultrasonography (EUS) has already proven useful in the assessment of submucosal lesions, and the staging of gastrointestinal cancer, particularly gastric MALT-type lymphoma. The goal of this paper was EUS staging. Patients and method: 24 patients (10 females, 14 males) with a median age of 56 years and possibly gastric MALT lymphoma (25 cases) were studied using videoendoscopy, biopsies, and echoendoscopy with 7.5- and 20-MHz radial EUS, and also with 12- and 20-MHz miniprobes (MPs). Nineteen patients were definitely evaluated (7 females, 12 males) as having 20 MALT-type lymphomas, as five patients were post-hoc disregarded when an invasive, high-grade gastric lymphoma (3c) or plasmocytoma (2c) was subsequently demonstrated. Of these 19 patients, all had T1 lesions except for two with T2 lesions; one patient had a gastroduodenal T1 lymphoma. Echographic findings with MPs were compared to EUS (gold standard) and histology both before and after eradication. Then, patients were followed up every 1-3-6 months using videoendoscopy and MPs. Results: echoendoscopy correctly identified T stages in 90% of cases. MPs identified T stages in 88% of cases, and N stages in 33% of cases, with results being slightly inferior to those obtained with conventional EUS (91 vs. 45%); they were consequently used for follow-up. After eradication, all but two patients are in complete remission and have been followed every 1-3-6 months using MPs without echographic abnormalities, except for a patient who relapsed.Introducción: la ultrasonografía endoscópica (USE) ha demostrado ya su utilidad en la evaluación de las lesiones submucosas, en la estadificación del cáncer digestivo en general, y del linfoma gástrico tipo MALT en particular. El objetivo de este trabajo fue la estadificación por USE. Pacientes y método: veinticuatro enfermos (10 mujeres y 14 varones) con edad media de 56 años y con posible linfoma gástrico tipo MALT (25 casos) fueron estudiados con videoendoscopia, biopsias y ecoendoscopia con USE radial de 7,5 y 20 MHz, y con minisondas (MS) de 12 y 20 MHz. Se evaluaron definitivamente 19 pacientes (7 mujeres y 12 varones) con 20 MALT, ya que cinco enfermos se desestimaron por demostrarse a posteriori que presentaban un linfoma gástrico invasivo de alto grado (3c) o un plasmocitoma (2c). De los 19 pacientes todos eran T1 menos dos pacientes que eran T2, y otra presentaba un linfoma T1 gastroduodenal. Los hallazgos ecográficos de las MS fueron comparados con la USE (gold standard) y con la histología antes y después de la erradicación. Después, fueron seguidos cada 1, 3 y 6 meses mediante videoendoscopia y MS. Resultados: la ecoendoscopia identificó el estadio T correcto en el 90% de los casos. Las MS identificaron el estadio T en el 88% de los casos y la N en el 33% de los casos, con resultados discretamente inferiores a los obtenidos con la USE convencional (91 y 45%), por lo que se utilizaron en el seguimiento. Después de la erradicación, todos menos dos están en remisión completa y han sido seguidos cada 1, 3 y 6 meses con las MS sin observar anomalías ecográficas, excepto una paciente que hizo una recidiva.

Ultrasonography is generally accepted and performed as a first choice imaging technique in patients with jaundice. The method allows the discrimination between cholestatic and mechanical jaundice. The existing procedures are multiple: gray scale, Doppler, i.v. contrast enhancement, elastography, tridimensional ultrasonography, each of these with different contribution to the positive and differential diagnosis regarding the nature of the jaundice. The final diagnosis is a multimodal one and the efficiency is dependent on the level of the available technology, the examiner's experience, the degree and modality of integration of the data within the clinical context, as well as on the portfolio of available imaging procedures. This review shows the main ultrasonographic methods consecrated in the evaluation of the biliary tree. It also underlines the integrated character of the procedures, as well as the necessity to correlate with other imaging methods and the clinical situation. [ABSTRACT FROM AUTHOR]

Gastric MALT (mucosa associated lymphoid tissue) lymphoma is a B lymphoma characterised by a tumoural infiltration of the gastric mucosa with specific small lymphocytes from MALT. Histological diagnosis may be difficult and needs to be established by adequately trained pathologists. It may regress after Helicobacter pylori eradication. The treatment of non responding patients remains debated: radiotherapy, chemotherapy, immunotherapy ± chemotherapy are currently under evaluation. The related risk of metachronous gastric cancer necessitates long-term endoscopic follow-up. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Numerous studies have demonstrated the role of Helicobacter pylori infection in the pathogenesis of gastric MALT lymphoma and the present study aimed to analyze this correlation in Chinese patients. METHODS: Thirty-five cases of primary gastrointestinal non-Hodgkin's lymphoma that had been surgically resected and pathologically examined during the past 20 years were collected. The tissue samples were re-examined by a physician from the pathology department. Immunohistochemical staining and H. pylori tests were conducted. The clinical diagnosis of gastric MALT lymphoma and the results of therapy were analyzed. RESULTS: According to the immunohistochemistry results, 21 cases were MALT lymphoma, and of these 16 were gastric MALT lymphoma, one was intestinal MALT lymphoma and four were colonic MALT lymphoma. Of the 16 samples of gastric MALT lymphoma, 13 were positive for H. pylori infection and three could not be evaluated because the sample was full of cancer cells. Of the cases of gastric MALT lymphoma, two were stage I1 , five were stage II1 , and nine were stage IIE . Eleven patients underwent endoscopy: three were misinterpreted as gastric carcinoma, one was diagnosed as Menetrier's disease, one as chronic atrophic gastritis, and only six cases were correctly diagnosed before surgery. Eradication of H. pylori in one patient with gastric MALT lymphoma resulted in regression of the lesion; that patient was followed up for 3 years without relapse. Fifteen cases underwent surgery and 10 were followed up for 5 years: four relapsed within 1-2 years after operation and six remained well. CONCLUSION: There is a close relationship between H. pylori infection and gastric MALT lymphoma. Early gastric MALT lymphoma can be cured after eradication of H. pylori . The depth of the lesion should be diagnosed by echoendoscopy and therapy should be chosen on the basis of the stage of the disease. [ABSTRACT FROM AUTHOR]