IJGII Inernational Journal of Gastrointestinal Intervention

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< PreviousNext >Gastrointestinal Intervention 2016; 5(3): 159~225
  • Review Article 2016-10-31

    How to manage gastric polyps

    Gandhi Lanke, Atin Agarwal, and Jeffrey H. Lee

    Abstract : Gastric cancer is the second leading cause of cancer related death in the world. In United States, gastric polyps are found in approximately 6% of upper endoscopy. The incidence of gastric polyps increased with widespread use of esophagogastroduodenoscopy and more liberal use of proton pump inhibitors. They are usually asymptomatic, but infrequently cause symptoms of bleeding, pain and gastric outlet obstruction. It is important to distinguish premalignant conditions and mimickers of malignancy. Helicobacter pylori eradication therapy leads to regression of hyperplastic polyps but it is not clear for adenoma. Endoscopy plays key role not only in diagnosis but also in surveillance. With narrow band imaging and chromo endoscopy, we are much better today in detecting and discerning these. Also, with endoscopic mucosal resection and endoscopic submucosal dissection, we can manage these better. In this review article we will discuss the various diagnostic tools and therapeutic options for hyperplastic polyp, fundic gland polyp, gastrointestinal stromal tumor, adenoma, neuroendocrine tumor, linitis plastica, and intestinal metaplasia.

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  • Review Article 2016-10-31

    Transjugular intrahepatic portosystemic shunts versus balloon-occluded retrograde transvenous obliteration for the management of gastric varices: Treatment algorithm according to clinical manifestations

    Seung Kwon Kim, Steven Sauk, and Carlos J. Guevara

    Abstract : Transjugular intrahepatic portosystemic shunts (TIPS) are widely used in the management of bleeding gastric varices (GV). More recently, several studies have demonstrated balloon-occluded retrograde transvenous obliteration (BRTO) as an effective treatment method for bleeding isolated GV, especially in patients with contraindications for a TIPS placement. Both TIPS and BRTO can effectively treat bleeding GV with low rebleeding rates. Careful patient selection for TIPS and BRTO procedures is required to best treat the patient’s individual clinical situation.

    Cited By: 0

  • Review Article 2016-10-31

    Clinical role of contrast-enhanced harmonic endoscopic ultrasound in differentiating pancreatic solid lesions

    Chan Sup Shim, Tae Yoon Lee, and Young Koog Cheon

    Abstract : Accurate diagnosis of pancreatic solid lesions is often difficult using conventional imaging modalities. With the recent introduction of contrast-enhanced harmonic endoscopic ultrasound (CEH-EUS), it is now possible to evaluate the microvascular environment and dynamic enhancement of a variety of pancreatic lesions. With CEH-EUS, three patterns of pancreatic lesion enhancement compared with the normal pancreatic tissue (fast, simultaneous, or slow), two washout patterns (fast or slow) and two distribution patterns (homogeneous, inhomogeneous) can be described. By evaluating the microvasculature, enhancement speed, and washout pattern, CEH-EUS may help to differentiate pancreatic adenocarcinoma from other masses and differentiate between pancreatic neuroendocrine tumor (pNET) and inflammatory masses. The finding of a hyperenhancing lesion on CEH?EUS, both with homogeneous and inhomogeneous patterns, was a strong predictor of histology different from adenocarcinoma (94% positive predictive value). pNET was the most common hyperenhancing lesions overall. Although CEH-EUS is useful for ruling out pancreatic ductal adenocarcinoma, making the differential diagnosis between pNETs and pseudotumoral pancreatic masses is difficult because both may share an isovascular or hypervascular appearance. Currently the interpretation of CEH-EUS findings is examiner-dependent. In the future, digital image analysis by image-processing techniques should allow more objective interpretation.

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  • Review Article 2016-10-31

    Contrast-enhanced endoscopic ultrasound for pancreatobiliary disease

    Raymond Shing-Yan Tang

    Abstract : Endoscopic ultrasound (EUS), with or without fine needle aspiration (FNA), has become an essential tool in the evaluation of pancreatobiliary diseases. Although conventional EUS is superior to multidetector computed tomography in tumor detection and staging, there are situations when characterization of various pancreatobiliary lesions remains difficult. Contrast-enhanced EUS (CE EUS) can further improve the detection and characterization of pancreatic solid lesions such as ductal adenocarcinoma, neuroendocrine tumor, or mass-forming autoimmune pancreatitis based on differences in the enhancement pattern of the target lesions. It is also useful in differentiating between mural nodules and mucous clots in pancreatic cystic neoplasms, and characterizing various lesions in the gallbladder and bile duct. CE EUS is complementary to FNA and has the potential to increase the diagnostic yield on the first FNA needle pass.

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  • Review Article 2016-10-31

    Role of endoscopic ultrasound in non-small cell lung cancer

    Sumit Bhatia, and Rajesh Puri

    Abstract : Lung carcinoma is a common cause of mortality and morbidity worldwide. Non-small cell lung cancer (NSCLC) accounts for majority of cases worldwide. Accurate staging of NSCLC is of paramount importance due to marked difference in survival and management strategies between stage II and III of the disease. The staging methods have evolved from invasive thoracotomies and mediastinoscopies to relatively non-invasive complete mediastinal staging by combination of endoscopic ultrasound (EUS) and endoscopic bronchial ultrasound (EBUS). EUS also provides information about mediastinal invasion and liver/adrenal metastasis. Future role of EUS include providing tissue for molecular targeted therapy.

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  • Review Article 2016-10-31

    Is endoscopic necrosectomy the way to go?

    James Weiquan Li, and Tiing Leong Ang

    Abstract : Pancreatic necrosis with the formation of walled-off collections is a known complication of severe acute pancreatitis. Infected necrotic pancreatic collections are associated with a high mortality rate. Open necrosectomy and debridement with closed drainage has traditionally been the gold standard for treatment of infected pancreatic necrosis, but carries a high risk of perioperative complications. Direct endoscopic necrosectomy has emerged as a safe and effective modality of treatment for this condition. Careful patient selection and gentle meticulous debridement is important to optimize clinical success. Bleeding is the commonest associated complication with the procedure but most cases can be managed conservatively. Air embolism, although rare, is potentially fatal. The use of fully covered large diameter lumen apposing self-expandable metal stents has further simplified the procedure. These stents optimize drainage, and facilitate endoscopic necrosectomy because repeat insertion of the endoscope into the necrotic cavity can be easily achieved.

    Cited By: 3

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  • Review Article 2016-10-31

    Development of the Asian EUS Group consensus in pancreatic pseudocyst drainage

    Anthony Yuen Bun Teoh, Vinay Dhir, Zhen Dong Jin, Mitsuhiro Kida, Dong Wan Seo, Khek Yu Ho, and

    Abstract : Drainage of pseudocyst and walled-off pancreatic necrosis has traditionally been achieved by surgical means. Recently, there has been a progressive shift in paradigm to performing endoscopic drainage for these conditions. Endoscopic ultrasound (EUS)-guided drainage is the preferred approach for drainage of pancreatic pseudocyst. However, many controversies still exist on the optimal management and wide variations in techniques exist. There is a pressing need for establishment of a consensus for safe practices in EUS-guided pseudocyst drainage.

    Cited By: 3

  • Review Article 2016-10-31

    Endoscopic ultrasound-guided biliary drainage

    Majid A. Almadi, Nonthalee Pausawasdi, Thawee Ratanchuek, Anthony Yuen Bun Teoh, Khek Yu Ho, and Vinay Dhir

    Abstract : Endoscopic ultrasound-guided biliary drainage (EUS-BD) is emerging as a safe and effective alternative for endoscopic BD. The advantage of multiple access points from stomach and duodenum allows EUS-BD in patients with altered surgical anatomy and duodenal stenosis. EUS-BD is also useful in patients with failed endoscopic retrograde cholangiopancreatography or difficult biliary cannulation. Depending on the access and exit route of the stent, a variety of EUS-BD procedures have been described. Trans-papillary as well as trans-luminal stent placements are possible with EUS-BD. Recent studies have shown a clinical success rate in excess of 90% and complication rates of < 15%. Prospective studies are needed to know the long-term results and relative efficacy of this technique.

    Cited By: 1

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  • Review Article 2016-10-31

    Endoscopic ultrasound-guided needle-based confocal laser endomicroscopy for diagnosis of solid pancreatic lesions

    Rapat Pittayanon, Pradermchai Kongkam, and Rungsun Rerknimitr

    Abstract : An accurate diagnosis of solid pancreatic lesions (SPLs) is important because pancreatic cancer cannot be ignored if curative treatment is possible. Prompt and reliable diagnostic procedures are greatly needed for patients presenting with SPLs, particularly where resection is possible for a malignant mass. Several endoscopic ultrasound (EUS)-related technologies including a novel EUS-guided needle-based confocal laser endomicroscopy (EUS-nCLE) can provide real-time images at the cellular level (1,000-fold magnification). A 19-gauge EUS-guided fine needle aspiration (EUS-FNA) needle is recommended because its channel is large enough for the 0.85-mm diameter nCLE miniprobe. The procedure is performed by standard EUS-FNA techniques with either pre- or post-loading technique. Ten percent fluorescein sodium (2.5–5 mL) is used as an enhancing agent and is intravenously injected immediately before puncturing the lesion. Only a few studies have used the technique and reported results. A recent study from 19 malignant and 3 benign SPLs classified EUS-nCLE findings according to 4 signs: dark clumps, and dilated vessels (predominantly seen in malignant SPLs) and fine white fibrous bands and normal acini (predominantly seen in benign SPLs). Using these criteria, researchers correctly diagnosed 18 of the malignant SPLs (94.7%). Another study described 2 lesions as having “dark cells aggregates with pseudo-glandular aspects, and straight hyperdense elements more or less thick corresponding to tumoral fibrosis” in 17 of 18 malignant SPLs. Thus far, no large and systematic study has been performed to evaluate the potential clinical use of EUS-nCLE for diagnosing SPLs. However, based on available information from a few studies and the current limitations of EUS-FNA, EUS-nCLE can potentially provide a complementary role in diagnosing such lesions. Nevertheless, more studies are certainly needed.

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  • Original Article 2016-10-31

    Development of a new reagent for endoscopic ultrasound-guided celiac plexus neurolysis and tumor ablation therapy

    Kazuo Hara, Kenji Yamao, Nobumasa Mizuno, Susumu Hijioka, Hiroshi Imaoka, Masahiro Tajika, Tutomu Tanaka, Makoto Ishihara, Takamitu Sato, Nozomi Okuno, Nobuhiro Hieda, Tukasa Yoshida, and Yasumasa Niwa

    Abstract : BackgroundBoth endoscopic ultrasound-guided celiac plexus neurolysis (EUS-CPN) and tumor ablation using ethanol are very common procedures, and the utility of these therapies has already been reported in prominent journals. However, their effectiveness appears temporary and insufficient, especially EUS-CPN. We therefore have to consider new reagents for improving the results. The present study examined the best concentration of ethanol and povidone iodine mixed with atelocollagen for more effective therapies.MethodsThe effects of the new reagents were confirmed in three live pigs. At first, we injected three kinds of reagents (including indigo carmine) in three separate areas of para-aortic tissue under EUS guidance in one pig. At more than 4 hours after injection, we checked ethanol injection sites after dissection. In next study, we performed EUS-guided injection of a total of six kinds of reagents (two kinds of ethanol, three kinds of povidone iodine, and control atelocollagen) into the livers of two living pigs. After 2 weeks, we examined tissue damage to the liver in the two pigs.ResultsThe 75% ethanol (absolute ethanol 3.75 mL + 1% atelocollagen 1.25 mL + a very small amount of indigo carmine) was seen like blue gel, and still remained in the para-aortic tissue. Brownish areas of povidone iodine mixed with 3% atelocollagen exhibited clear, regular borders with greatly reduced infiltration into surrounding tissue compared to others.ConclusionWe concluded that 75% ethanol mixed with 1% atelocollagen appears optimal for EUS-CPN. Povidone iodine mixed with 3% atelocollagen may be suitable for small tumor ablation therapy.

    Cited By: 0

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