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Background and Aim: Endoscopic ultrasound (EUS)‐guided biliary drainage is being increasingly performed as an alternative to percutaneous transhepatic biliary drainage (PTBD) to treat malignant hilar obstruction (MHO) after failed endoscopic retrograde cholangiopancreatography (ERCP). However, no study has compared EUS‐guided hepaticoduodenostomy (EUS‐HDS) with PTBD for right intrahepatic duct (IHD) obstruction after failed ERCP in patients with unresectable MHO. Methods: We retrospectively reviewed the data of consecutive patients with right IHD obstruction developed by unresectable MHO who underwent EUS‐HDS or PTBD after a previous placement of a stent in the left and/or right IHD between March 2018 and October 2021. Technical success, clinical success, stent or tube‐related adverse events, frequency of reintervention, and stent patency were evaluated. Results: A total of 42 patients (18 EUS‐HDS, 24 PTBD) were analyzed. Both groups did not show significant differences in technical success (EUS‐HDS, 94% vs PTBD, 100%; P = 0.429), clinical success (83% vs 83%; P = 0.999), early adverse events (24% vs 46%; P = 0.144), and stent or tube‐related late adverse events (29% vs 54%; P = 0.116). During follow‐up, the EUS‐HDS group had a longer median duration of patency (131 days vs 58.5 days; P = 0.041), and lower mean frequency of reinterventions per patient (0.35 vs 1.92; P = 0.030) than the PTBD group. Conclusions: EUS‐HDS showed comparable efficacy and safety to PTBD for drainage of the right biliary system and produced longer duration of patency and lower frequency of reinterventions in patients with unresectable MHO. [ABSTRACT FROM AUTHOR]

Objectives: Many studies showed better outcomes of endoscopic ultrasound‐guided gallbladder drainage (EUS‐GBD) when compared with percutaneous transhepatic gallbladder drainage (P‐GBD) in which most tubes were left in situ. However, no studies have directly compared EUS‐GBD with P‐GBD after tube removal (ex situ). We compared the long‐term outcomes of EUS‐GBD and ex situ or in situ P‐GBD in high surgical risk patients with acute cholecystitis. Methods: We reviewed the records of 182 patients (EUS‐GBD, n = 75; P‐GBD, n = 107) who underwent gallbladder drainage. The procedural outcomes, long‐term outcomes, and adverse events were compared. Results: The EUS‐GBD group and the P‐GBD group had similar rates of technical and clinical success. Early adverse events were less common in the EUS‐GBD group (5.5% vs. 18.9%, P = 0.010). The long‐term outcomes were evaluated in 168 patients (EUS‐GBD, n = 67; P‐GBD ex situ, n = 84; P‐GBD in situ, n = 17). The rate of cholecystitis recurrence in the EUS‐GBD group (6.0%) was similar to that in the P‐GBD ex situ group (9.6%, P = 0.422), but significantly lower than that in the P‐GBD in situ group (23.5%, P = 0.049). P‐GBD in situ was a significant predictor of recurrent cholecystitis (hazard ratio 14.6; 95% confidence interval 2.9–72.8). Conclusion: The long‐term recurrence rate of acute cholecystitis in patients who underwent EUS‐GBD was comparable to that in patients whose P‐GBD could be removed. However, patients in whom P‐GBD could not be removed showed higher rates of recurrent cholecystitis than patients with EUS‐GBD. [ABSTRACT FROM AUTHOR]

Background and aims: Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is frequently used for the preoperative histologic diagnosis of pancreatic cancer. However, debate continues regarding the clinical merits of preoperative EUS-FNA for the management of resectable pancreatic cancer. We aimed to evaluate the benefits and safety of preoperative EUS-FNA for resectable distal pancreatic cancer. Methods: The medical records of 304 consecutive patients with suspected distal pancreatic cancer who underwent EUS-FNA were retrospectively reviewed to evaluate the clinical benefits of preoperative EUS-FNA. We also reviewed the medical records of 528 patients diagnosed with distal pancreatic cancer who underwent distal pancreatectomy with or without EUS-FNA. The recurrence rates and cancer-free survival periods of patients who did or did not undergo preoperative EUS-FNA were compared. Results: The diagnostic accuracy of preoperative EUS-FNA was high (sensitivity, 87.5%; specificity, 100%; positive predictive value 100%; accuracy, 90.7%; negative predictive value, 73.8%). Among patients, 26.7% (79/304) avoided surgery based on the preoperative EUS-FNA findings. Of the 528 patients who underwent distal pancreatectomy, 193 patients received EUS-FNA and 335 did not. During follow-up (median 21.7 months), the recurrence rate was similar in the two groups (EUS-FNA, 72.7%; non-EUS-FNA, 75%; P = 0.58). The median cancer-free survival was also similar (P = 0.58); however, gastric wall recurrence was only encountered in the patients with EUS-FNA (n = 2). Conclusion: Preoperative EUS-FNA is not associated with increased risks of cancer-specific or overall survival. However, clinicians must consider the potential risks of needle tract seeding, and care should be taken when selecting patients. [ABSTRACT FROM AUTHOR]

BACKGROUND : Endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) has been increasingly used for the management of various solid pancreatic tumors. This study aimed to evaluate the feasibility and safety of EUS-RFA for serous cystic neoplasms (SCNs). METHODS : 13 patients with microcystic SCNs with honeycomb appearance underwent EUS-RFA using a 19-gauge RFA needle. Before ablation, cystic fluid was aspirated until a thin layer of fluid remained. RESULTS : EUS-RFA was successful in all patients. Seven patients underwent a single session and the remaining six patients underwent a second session of EUS-RFA. One patient (7.7 %) experienced self-limited abdominal pain after EUS-RFA. During a median follow-up period of 9.21 months (interquartile range [IQR] 5.93 - 15.38), the median volume of the SCNs decreased from 37.82 mL (IQR 15.03 - 59.53) at baseline to 10.95 mL (IQR 4.79 - 32.39) at the end of follow-up. A radiologic partial response was achieved in eight patients (61.5 %). CONCLUSIONS : EUS-RFA is technically feasible and showed an acceptable rate of adverse events for patients with SCNs. A long-term follow-up study is required to evaluate the efficacy of EUS-RFA. [ABSTRACT FROM AUTHOR]

Background and Aims: Segregated right intrahepatic duct dilatation (IHD) results from complete obstruction of the biliary tract proximal to the hilar level. We aimed to evaluate long‐term efficacy and safety of endoscopic ultrasound (EUS) hepaticoduodenostomy (HDS) in segregated right IHD. Methods: Consecutive patients who had undergone EUS‐guided HDS with a fully covered self‐expandable metal stent (FCSEMS) in an academic tertiary center were recruited. All patients had segregated right hepatic duct and failed drainage by endoscopic retrograde cholangiopancreatography (ERCP). Demographic data, endoscopic findings, procedure details, and outcome data were extracted from a prospectively maintained database. Results: From 2013 to 2017, there were 35 patients who had undergone EUS‐guided HDS with a median follow‐up duration of 169 (3–2091) days. Malignancy accounted for 71.4% of the ductal segregation, followed by surgical complication (17.1%). Technical and clinical success rate was 97.1% and 80%, respectively. Early adverse event (AE) happened in seven patients (20%), two of them required endoscopic reintervention, and no percutaneous transhepatic biliary drainage (PTBD) or surgery was performed because of AE. The median stent patency duration was 331 (3–1202) days. The median duration of fistula tract keeping was 1280 (3–1280) days. There was no significant difference in terms of patency rate with respect to whether the underlying pathology was benign or malignant (P = 0.776). EUS‐guided HDS for right posterior sectional duct segregation was associated with higher 3‐month stent patency rate when compared with right anterior sectional duct (79.1% vs 38.1%, P = 0.012). Conclusion: Endoscopic ultrasound‐guided HDS with an FCSEMS appears to be a safe and effective treatment as a viable alternative option to PTBD after failed ERCP. It creates a durable and reliable fistula tract for permanent access to an isolated ductal system, and this application deserves more attention. [ABSTRACT FROM AUTHOR]

Background and Aim: Endoscopic ultrasound‐guided pancreatic duct drainage (EUS‐PD) has been proposed for pancreatic duct obstruction after failure of endoscopic retrograde pancreatography. We evaluate the long‐term outcomes of EUS‐PD using a fully covered self‐expandable metal stent (FCSEMS) for pancreaticojejunal anastomosis (PJA) strictures following Whipple procedures. Methods: Twenty‐three patients with PJA strictures underwent EUS‐PD according to the findings of EUS‐guided pancreatogram and the passage of the guidewire through PJA stricture (complete vs partial stricture) after failure of endoscopic retrograde pancreatography. Technical and clinical success, adverse events (AEs), and long‐term outcomes were assessed. Results: Technical and clinical success was achieved in all patients. The complete and partial strictures were 11 and 12, respectively. The direct transanastomotic and transmural plastic stenting in partial PJA stricture was successful in only three patients (13%). Therefore, 20 patients underwent EUS‐guided transmural FCSEMS placement during the initial attempt. Early AEs, including abdominal pain (n = 3) and peripancreatic fluid collection (n = 1), occurred in four patients (17.4%). During the follow‐up periods (median, 27.2 months; interquartile range [IQR], 18.7–40.6), five patients (21.7%) developed late AEs, including asymptomatic stent fracture at the gastric end (n = 3), asymptomatic stent migration (n = 1), and stent occlusion (n = 1). The total duration of stent placement was 27.2 months (IQR, 18.7–40.6), and the median number of stent revision was 2 (IQR, 1–2). Conclusions: In terms of safety and efficacy, EUS‐PD with an FCSEMS showed favorable success and acceptable AEs rate and durable long‐term outcomes. [ABSTRACT FROM AUTHOR]

Background and Aims: Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) is increasingly accepted as an effective treatment option in patients who require drainage for acute cholecystitis. A newly designed lumen-apposing metal stent (LAMS) has been introduced recently in this procedure. In this study, we evaluated the feasibility and safety of the newly designed LAMS in patients with acute cholecystitis who were unsuitable for cholecystectomy.Methods: Between Mar 2017 and Oct 2017, 22 patients with acute cholecystitis who were unsuitable for cholecystectomy underwent EUS-GBD with the newly designed LAMS. We evaluated the technical and clinical success and the adverse event profiles.Results: EUS-GBD with newly designed LAMS was technically and clinically successful in 21 of the 22 patients. EUS-GB stenting was performed at urgent setting in 17 patients, while 5 patients, who had undergone initial PTGBD, underwent EUS-GB stenting to remove PTGBD tube. The median procedure time was 11.5 (range 8.8-17.0) min. A late adverse event of stent occlusion developed in one patient. Stent migration was not observed during follow-up (median 318.0 days, range 39.0-398.0 days) and cumulative stent patency rate at 1 year was 95%.Conclusion: EUS-GBD with newly designed LAMS is feasible and shows acceptable safety profiles for both the urgent drainage of acute cholecystitis and elective internalization following PTGBD in patients with high surgical risk. [ABSTRACT FROM AUTHOR]

Background and Aim: Few studies compared endoscopic ultrasound (EUS)‐guided fine needle aspiration (EUS‐FNA) with endoscopic retrograde cholangiopancreatography (ERCP)‐based tissue sampling in terms of diagnostic accuracy in suspected malignant biliary obstruction. We evaluated and compared the diagnostic performance of EUS‐FNA and ERCP‐based tissue sampling. Methods: This multicenter study included 263 patients with suspected malignant biliary obstruction who underwent same‐session EUS and ERCP between 2012 and 2016. Results: Malignancies were confirmed in 239 patients (90.9%) and benign in 24 patients (9.1%). Overall diagnostic sensitivity and accuracy were 73.6% and 76.1% for EUS‐FNA, 56.5% and 60.5% for ERCP, and 85.8% and 87.1% for EUS/ERCP combination. EUS‐FNA showed higher overall performances compared with ERCP (P < 0.001), whereas EUS/ERCP combination was superior to EUS‐FNA alone (P‐value < 0.001). EUS‐FNA showed higher sensitivity and accuracy compared with ERCP for pancreatic masses (n = 187, both P‐values < 0.001) but not for biliary lesions (n = 76, both P‐values = 0.847). Sensitivity and accuracy of EUS/ERCP combination were superior to those of EUS‐FNA for both pancreatic and biliary lesions (both P‐values < 0.001). For patients with large mass (≥ 4 cm), there was no significant differences between ERCP/EUS combination and EUS‐FNA (P‐value = 0.31). Conclusions: Same‐session EUS‐FNA and ERCP combination was superior to EUS‐FNA for both pancreatic masses and biliary lesions. Same‐session EUS/ERCP combination can be considered a proper diagnostic method for suspected malignant biliary obstruction regardless of the origin of lesions. On the other hand, EUS‐FNA alone was sufficient for diagnosis compared with EUS/ERCP combination in cases with large mass. Strategic diagnostic approach, according to clinical features of individual patient, is required. [ABSTRACT FROM AUTHOR]

Background: Radiofrequency ablation (RFA) has been increasingly employed in experimental and clinical settings for the management of pancreatic lesions. This study aimed to assess the safety and efficacy of endoscopic ultrasound (EUS)-guided RFA for benign solid pancreatic tumors.Methods: In a single-center, prospective study, 10 patients with benign solid pancreatic tumors underwent EUS-RFA. After the RFA electrode had been inserted into the pancreatic mass, the radiofrequency generator was activated to deliver 50 W of ablation power.Results: Among the 10 patients, 16 sessions of EUS-RFA were successfully performed. Diagnoses included nonfunctioning neuroendocrine tumor (n = 7), solid pseudopapillary neoplasm (n = 2), and insulinoma (n = 1); the median largest diameter of the tumors was 20 mm (range 8 - 28 mm). During follow-up (median 13 months), radiologic complete response was achieved in seven patients. Two adverse events (12.4 %; 1 moderate and 1 mild) occurred.Conclusions: EUS-RFA may be a safe and potentially effective treatment option in selected patients with benign solid pancreatic tumors. Multiple sessions may be required if there is a remnant tumor, and adverse events must be carefully monitored. [ABSTRACT FROM AUTHOR]

Background and Aim: Little is known about the standard care of small (<2 cm in diameter) pancreatic neuroendocrine tumors (PNET). The aim of the present study was to determine the clinical outcomes of small PNET after endoscopic ultrasound (EUS)‐guided ethanol‐lipiodol ablation (EUS‐ELA). Methods: In this prospective cohort study, consecutive patients who underwent EUS‐ELA for PNET were enrolled and were followed for ≥3 years. Treatment efficacy was the primary outcome measure. Results: In total, 33 patients who had 40 pathologically confirmed PNET (<2 cm in diameter) were enrolled for final analysis. A total of 63 EUS‐ELA sessions were successfully carried out (mean, 1.9 sessions per patient, 1.6 sessions per tumor), which included 40 initial sessions and 23 repeated sessions owing to incomplete ablation. Median actual volume of ethanol‐lipiodol mixture injected per session was 1.1 mL (IQR 0.8–1.9 mL). Complete ablation was achieved in 24 of 40 tumors (60%) with one (18 tumors, 45%) or two (24 tumors, 60%) sessions of EUS‐ELA. Lipiodol retention within tumor had better treatment outcomes (P = 0.004). Rate of procedure‐related adverse events was 3.2%. No malignancy or lymph node metastasis was discovered during a median follow up of 42 months (IQR 39–46 months). Conclusions: We found that EUS‐ELA was a safe and effective alternative option in the management of PNET <2.0 cm in diameter; 60% of patients achieved complete ablation. Lipiodol retention within tumor may be a useful early predictor of treatment effectiveness. Trial registered at ClinicalTrials.gov (NCT 01902238). [ABSTRACT FROM AUTHOR]

Background and study aims The aim of this study was to investigate the long-term outcomes after endoscopic ultrasound (EUS)-guided pancreatic cyst ablation. Patients and methods In a single-center, prospective study, 164 patients with pancreatic cysts underwent EUS-guided cyst ablation using ethanol with paclitaxel. The inclusion criteria were as follows: unilocular or oligolocular cysts; clinically indeterminate cysts that required EUS fine-needle aspiration; and/or cysts that grew during the observation period. Treatment response was classified as complete resolution, partial resolution, or persistent cyst, with < 5 %, 5 % - 25 %, and 25 % of the original cyst volume, respectively. Results The median largest diameter of the cyst was 32 mm and the median volume was 17.1 mL. Based on cyst fluid analysis there were 71 mucinous cystic neoplasms, 16 serous cystic neoplasms, 11 intraductal papillary mucinous neoplasms, 3 pseudocysts, and 63 indeterminate cysts. Sixteen treated patients (9.8 %) had adverse events (1 severe, 4 moderate, and 11 mild). Treatment response was as follows: complete resolution in 114 (72.2 %), partial resolution in 31 (19.6 %), and persistent cysts in 13 (8.2 %). Twelve of the 13 patients with persistent cysts underwent surgery. During clinical and imaging follow-up (median 72 months, interquartile range 50 - 85 months) of the 114 patients with complete resolution, only two patients (1.7 %) showed cyst recurrence. Based on multivariate analysis, the absence of septa (odds ratio [OR] 7.12, 95 % confidence interval [CI] 2.72 - 18.67) and cyst size less than 35 mm (OR 2.39, 95 %CI 1.11 - 5.16) predicted complete resolution. Conclusion Among patients with pancreatic cysts in whom complete resolution was achieved after EUS-guided cyst ablation, 98.3 % remained in remission at 6-year follow-up. Unilocular form and small cyst size were predictive of complete resolution. This treatment approach may be an effective and durable alternative to surgery.Trial registered at ClinicalTrials.gov (NCT 00689715). [ABSTRACT FROM AUTHOR]

Background and Aim Radiofrequency ablation (RFA) and ethanol ablation are accepted methods of tissue destruction for treating cystic tumors. The aim of the present study was to evaluate the feasibility, efficacy, and safety of endoscopic ultrasound (EUS)-guided ablation using normal porcine gallbladders as a substitute model for branch-duct intraductal papillary mucinous neoplasms (BD-IPMN). Methods Six adult mini pigs were included in this prospective study. EUS-guided RFA with or without ethanol ablation of the gallbladder was carried out using a prototype 18-gauge endoscopic RFA electrode, and RFA and ethanol ablation were done in a single session. Outcomes were assessed in terms of macroscopic and microscopic evaluations of the treated gallbladders. Results The prototype RFA electrode was used for ablation of the mucosa, aspiration of the internal contents of the gallbladder, and ethanol injection. RFA plus ethanol lavage resulted in a greater mean percentage of denuded gallbladder mucosa (97.5%) than RFA alone (55.8%). Effects of ablation extending to the cystic duct and partially denuded cystic duct mucosae were detected in five of the six pigs. There were no major procedure-related adverse events. Conclusions EUS-guided ablation of the gallbladder mucosa was feasible and effective in the porcine model. Additional studies will be required to fully assess the risk of procedure-related damage to the main pancreatic duct before using this technique in a clinical setting. [ABSTRACT FROM AUTHOR]

Background and Aims EUS-guided biliary drainage (EUS-BD) has been proposed as an alternative for patients after failed ERCP. To date, the evaluation of dedicated device for one-step EUS-BD has been limited. To determine feasibility and safety of a newly designed 7F stent introducer with tapered metal tip as a push-type dilator for one-step metal stent placement without additional fistula dilation in EUS-BD. Methods Thirty-two patients with malignant biliary obstruction and failed ERCP were randomly assigned to a dedicated stent introducer with a modified hybrid metal stent (DH group, n = 16) or a conventional 8.5F biliary metal stent introducer with a fully covered metal stent (FC group, n = 16). The technical success, procedural times, clinical success rate, and adverse event rates were evaluated. Results One-step technical success without additional fistula dilation in the DH was 88% (14/16). Multi-step process in a stent placement was performed in all patients of the FC group. The procedural time in the DH was significantly shorter than the FC (10 vs. 15 min, P = 0.007). No difference in overall technical or clinical success was seen between the groups. The rate of an early adverse event was common in the FC compared with the DH (31.3% [5/16] in the FC vs. 6.3% [1/16] in the DH, P = 0.172), although not statistically significant. Conclusions A dedicated device for one-step EUS-BD may be technically feasible, safe, and shorten the procedural times with less chance of an additional fistula dilation process, resulting in a potential reduction of the early adverse events. [ABSTRACT FROM AUTHOR]

Background & Aims: Endoscopic ultrasound-guided transmural gallbladder drainage (EUS-GBD) is an alternative to percutaneous transhepatic gallbladder drainage (PTGBD) for patients with acute, high-risk, or advanced-stage cholecystitis who do not respond to initial medical treatment and cannot undergo emergency cholecystectomy. However, the technical feasibility, efficacy, and safety of EUS-GBD and PTGBD have not been compared. Methods: Fifty-nine patients with acute cholecystitis, who did not respond to initial medical treatment and were unsuitable for an emergency cholecystectomy, were chosen randomly to undergo EUS-GBD (n = 30) or PTGBD (n = 29). The technical feasibility, efficacy, and safety of EUS-GBD and PTGBD were compared. Results: EUS-GBD and PTGBD showed similar technical (97% [29 of 30] vs 97% [28 of 29]; 95% 1-sided confidence interval lower limit, −7%; P = .001 for noninferiority margin of 15%) and clinical (100% [29 of 29] vs 96% [27 of 28]; 95% 1-sided confidence interval lower limit, −2%; P = .0001 for noninferiority margin of 15%) success rates, and similar rates of complications (7% [2 of 30] vs 3% [1 of 29]; P = .492 in the Fisher exact test) and conversions to open cholecystectomy (9% [2 of 23] vs 12% [3 of 26]; P = .999 in the Fisher exact test). The median post-procedure pain score was significantly lower after EUS-GBD than after PTGBD (1 vs 5; P < .001 in the Mann–Whitney U test). Conclusions: EUS-GBD is comparable with PTGBD in terms of the technical feasibility and efficacy; there were no statistical differences in the safety. EUS-GBD is a good alternative for high-risk patients with acute cholecystitis who cannot undergo an emergency cholecystectomy. [Copyright &y& Elsevier]

Objective. Few studies have assessed the diagnostic efficacy of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) and/or trucut biopsy (TCB) in patients with rectal and perirectal lesions. We aimed to evaluate the diagnostic utility of EUS-FNA and/or TCB in patients with rectal and perirectal lesions. We also assessed their influence on the management and clinical course of these patients. Material and methods. We performed EUS-FNA and/or TCB in 11 consecutive patients (4 men and 7 women, 33-69 years) with rectal and perirectal lesions for whom conventional diagnostic tools could not provide definitive diagnoses. Patients with definite intraluminal cancer were excluded. Results. The 11 patients underwent 12 procedures, with 9 being EUS-FNA alone and 3 being EUS-FNA and TCB. Seven patients had rectal lesions and four had perirectal lesions. Initial EUS-FNA and/or TCB established a diagnosis of malignancy in five patients and of benign lesions in four. EUS-FNA plus TCB confirmed malignant lymphoma after diagnostic failure of initial EUS-FNA in one patient. In one other patient with suspicious secondary linitis plastica, EUS-FNA could not establish a definitive diagnosis. Correct diagnoses were obtained in 10 out of 11 patients who underwent EUS-FNA and/or TCB. EUS-FNA and/or TCB changed clinical courses, which included avoidance of unnecessary surgeries, having a chance of anal sphincter-saving surgeries, and timely administration of chemotherapy. No serious complications related to the use of EUS-FNA or TCB were evident. Conclusion. EUS-FNA and/or TCB are useful in the diagnostic evaluation of and appropriate therapeutic plan in patients with rectal and perirectal lesions. [ABSTRACT FROM AUTHOR]

Background & Aims: Endoscopic ultrasonography (EUS)-guided interventions have been used to treat patients with cystic lesions of the pancreas (CLPs). We used EUS to guide injection and lavage of ethanol, followed by injection of paclitaxel, into cysts, and investigated treatment response and predictors. Methods: Fifty-two patients were enrolled in the study using the following inclusion criteria: unilocular or oligolocular cysts, indeterminate cystic lesions that required EUS fine-needle aspiration, and cystic lesions that grew during the observation period. Forty-seven patients were followed up for more than 12 months and their outcomes were analyzed. Results: The mean diameter of the CLPs was 31.8 mm (range, 17–68 mm) and the estimated volume was 14.09 mL (range, 1.16–68.74 mL). Twenty CLPs were oligolocular. The mean level of carcinoembryonic antigen was 463 ng/mL (range, 1–8190 ng/mL). The median follow-up period was 21.7 months. A complete response was observed in 29 patients, a partial response in 6 patients, and persistent cysts in 12 patients. Four of 12 patients with persistent cysts underwent surgery. The histopathologic degree of epithelial ablation varied from 0% to 100%. Based on univariate analysis, EUS diameter and original volume predicted cyst resolution; in multivariate analysis, only original volume predicted resolution. Mild pancreatitis and splenic vein obliteration each occurred in 1 patient. Conclusions: EUS-guided injection and lavage of ethanol, followed by injection of paclitaxel, appears to be a safe method for treating pancreatic cysts; 62% of patients had complete resolution. Small cyst volume predicted complete resolution. [Copyright &y& Elsevier]

OBJECTIVES:Endoscopic ultrasound (EUS)-guided biliary drainage (EUSBD) with plastic stents has been introduced as an alternative to percutaneous transhepatic biliary drainage (PTBD) in cases of biliary obstruction when endoscopic retrograde cholangiopancreatography (ERCP) is unsuccessful. Although self-expandable metallic stents with a larger diameter might offer long-lasting patency compared with plastic stents, to date, EUSBD with one-step placement of a fully covered self-expandable metal stent (FCSEMS) has not been evaluated. We conducted this study to determine the feasibility and usefulness of EUSBD with one-step placement of FCSEMS.METHODS:A prospective feasibility study on EUSBD with one-step placement of FCSEMS was carried out in 14 patients with malignant biliary obstruction who were candidates for alternative techniques for biliary decompression because of unsuccessful ERCP.RESULTS:The technical and functional success rate was 100% (14/14). Nine patients were treated using the intrahepatic approach. The remaining five patients were treated using the extrahepatic approach. With the intrahepatic approach, two patients showed self-limited pneumoperitoneum. With the extrahepatic approach, no patients had pneumoperitoneum. No bile peritonitis or cholangitis was observed after the procedure in any of the patients treated using the intra- or extrahepatic approach. During follow-up periods (median 6 months), one case of re-intervention (7%, 1/14) necessitated by distal stent migration was observed.CONCLUSIONS:EUSBD with one-step placement of an FCSEMS may be feasible, safe, and effective as an alternative to PTBD in cases of malignant biliary obstruction when ERCP is unsuccessful. Prospective randomized trials of EUSBD with plastic stent vs. EUSBD with FCSEMS may be needed. [ABSTRACT FROM AUTHOR]

Objectives. Endoscopic ultrasonography (EUS)-guided intervention has recently been tried in the treatment of cystic tumors of the pancreas. Factors that can influence the treatment response include cyst wall thickness and the presence of septation and mural nodules. This study aimed to evaluate the effectiveness of EUS-guided ethanol lavage with paclitaxel injection (EUS-EP) in the treatment of septated cystic tumors of the pancreas. Methods. Ten patients with oligolocular septated cystic tumors underwent EUS-EP and the treatment response was analyzed by measuring cyst volume before and more than 6 months after treatment. Results. The 10 patients comprised 7 women and 3 men, of mean age 38.4 years (range 22-54 years). Median tumor diameter was 29.5 mm (range 20-68 mm), while median tumor volume was 5.07 ml (range 1.51-68.74 ml). Median carcinoembryonic antigen and amylase concentrations in the cyst fluid were 39.2 ng/ml (range 1-8,190 ng/ml) and 115.5 U/L (range 5-75,633 U/L), respectively. Three tumors were diagnosed as mucinous cystic neoplasms, four as serous cystadenomas, and three as indeterminate cysts. Median tumor volume had decreased to 0.54 ml (range 0.00-12.42 ml). Complete resolution was achieved in six patients and partial resolution in two, whereas two patients had persistent cysts. Two patients with persistent cysts underwent surgical resection, and focal remnant neoplastic epithelial lining was observed on the resected specimens. Conclusions. EUS-EP resulted in complete resolution in 6 of 10 patients with septated cystic tumors. Careful patient selection and tailored intervention are required to maximize the therapeutic efficacy of this procedure. [ABSTRACT FROM AUTHOR]

Background: Endoscopic snare papillectomy (ESP) has been established as a safe and effective treatment for ampullary adenomas. However, little is known about the optimal post-procedure follow-up period and the role of routine endoscopic surveillance biopsy following ESP. We aimed to evaluate patient adherence to a 5-year endoscopic surveillance and routine biopsy protocol after ESP of ampullary adenoma. Methods: We reviewed our prospectively collected database (n = 98), all members of which underwent ESP for ampullary lesions from January 2011 to December 2016, for the evaluation of long-term outcomes. The primary outcome was the rate of patient adherence to 5-year endoscopic surveillance following ESP. The secondary outcomes were the diagnostic yield of routine endoscopic biopsy, recurrence rate, and adverse events after endoscopic surveillance in the 5-year follow-up (3-month, 6-month, and every 1 year). Results: A total of 19 patients (19.4%) experienced recurrence during follow-up, all of these patients experienced recurrence within 3 years of the procedure (median 217 days, range 69–1083). The adherence rate for patients with sporadic ampullary adenoma were 100%, 93.5%, and 33.6% at 1, 3, and 5 years after ESP, respectively. The diagnostic yield of routine endoscopic biopsy without macroscopic abnormality was 0.54%. Pancreatitis occurred in four patients (4%, 3 mild, 1 moderate) after surveillance endoscopic biopsy without macroscopic abnormality. Conclusions: Given the low 5-year adherence rate and diagnostic yield of routine endoscopic biopsy with risk of pancreatitis, optimal surveillance intervals according to risk stratification (low grade vs. high grade adenoma/intramucosal adenocarcinoma) may be required to improve patient adherence, and routine biopsy without macroscopic abnormality may not be recommended. [ABSTRACT FROM AUTHOR]

Even if only a partial response was shown in 62 % of patients without complete response, their symptoms still improved after ablation. The authors declare that they have no conflict of interest. letter We thank Dr. Lorenzo and colleagues for their interest in our study, which involved the follow up of 379 patients with serous cystic neoplasms (SCNs) [1]. Among these 60 patients, those with an uncertain diagnosis underwent surgery, and only symptomatic patients with pathologically confirmed SCNs (5.3 %) underwent endoscopic treatment. [Extracted from the article]

The article discusses the surgical technique for removal of a Roadrunner guidewire remnant left in the pancreatic parenchyma of a patient after endoscopic ultrasound-guided pancreaticogastrostomy. Topics included are the failure of pancreaticojejunostomy to remove wire at University of Ulsan Asan Medical Center, the use of a metal stent and Olympus FG-8L-1 forceps under fluoroscopic guidance, and the potential for addressing guidewire shearing complications. [ABSTRACT FROM AUTHOR]

Abstract: Pancreatic cancer may present as a peri-arterial soft tissue cuff (PSTC) around the superior mesenteric artery or celiac axis without an identifiable pancreatic mass. We evaluated the diagnostic yield of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) in patients with a PSTC without definite pancreas involvement and those with a typical pancreatic mass. The patients who underwent EUS-FNA of a PSTC without pancreatic involvement were prospectively enrolled. The patients who underwent EUS-FNA for a pancreatic mass were recruited as a control group. A total of 224 patients underwent 247 EUS-FNAs. Among the 13 patients with a PSTC, 11 were positive for malignancy as determined by EUS-FNA, with 5 diagnosed after the first session and 6 after the second session. The diagnostic yield of PSTCs by EUS-FNA was significantly lower than that for typical pancreatic masses (65% vs. 87%, p = 0.02). An on-site cytopathologist and repeated EUS-FNA are recommended to improve the diagnostic accuracy of this disease entity. [Copyright &y& Elsevier]