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Dietrich CF, Arcidiacono PG, Braden B, Burmeister S, Carrara S, Cui X, Leo MD, Dong Y, Fusaroli P, Gottschalk U, Healey AJ, Hocke M, Hollerbach S, Garcia JI, Ignee A, Jürgensen C, Kahaleh M, Kitano M, Kunda R, Larghi A, Möller K, Napoleon B, Oppong KW, Petrone MC, Saftoiu A, Puri R, Sahai AV, Santo E, Sharma M, Soweid A, Sun S, Bun Teoh AY, Vilmann P, Seifert H, Jenssen C. What should be known prior to performing EUS exams? (Part II). Endosc Ultrasound 2019; 8:360-369. [PMID: 31571619 PMCID: PMC6927139 DOI: 10.4103/eus.eus_57_19] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
In “What should be known prior to performing EUS exams, Part I,” the authors discussed the need for clinical information and whether other imaging modalities are required before embarking EUS examinations. Herewith, we present part II which addresses some (technical) controversies how EUS is performed and discuss from different points of view providing the relevant evidence as available. (1) Does equipment design influence the complication rate? (2) Should we have a standardized screen orientation? (3) Radial EUS versus longitudinal (linear) EUS. (4) Should we search for incidental findings using EUS?
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Affiliation(s)
- Christoph F Dietrich
- Medical Department 2, Caritas-Krankenhaus, Uhlandstr 7, D-97980 Bad Mergentheim, Neubrandenburg; Department of Ultrasound, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Paolo Giorgio Arcidiacono
- Pancreatico/Biliary Endoscopy and Endosonography Division, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute, Vita Salute San Raffaele University, Rozzano, Milan, Italy
| | - Barbara Braden
- Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford OX3 9DU, England
| | - Sean Burmeister
- Surgical Gastroenterology Unit, Groote Schuur Hospital, Cape Town, South Africa
| | - Silvia Carrara
- Humanitas Clinical and Research Center- IRCCS- Digestive Endoscopy Unit, Division of Gastroenterology, Rozzano, Milan, Italy
| | - Xinwu Cui
- Department of Medical Ultrasound, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Milena Di Leo
- Humanitas Clinical and Research Center- IRCCS- Digestive Endoscopy Unit, Division of Gastroenterology, Rozzano, Milan, Italy
| | - Yi Dong
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Pietro Fusaroli
- Department of Medical and Surgical Sciences, Gastroenterology Unit, University of Bologna/Imola Hospital, Imola, Italy
| | - Uwe Gottschalk
- Medical Department, Dietrich Bonhoeffer Klinikum, Neubrandenburg, Germany
| | - Andrew J Healey
- General and HPB Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Michael Hocke
- Medical Department, Helios Klinikum Meiningen, Meiningen, Germany
| | - Stephan Hollerbach
- Department of Gastroenterology, Allgemeines Krankenhaus Celle, Celle, Germany
| | - Julio Iglesias Garcia
- Department of Gastroenterology and Hepatology, Health Research Institute of Santiago de Compostela, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - André Ignee
- Medical Department 2, Caritas-Krankenhaus, Uhlandstr 7, D-97980 Bad Mergentheim, Neubrandenburg, Germany
| | | | - Michel Kahaleh
- Department of Gastroenterology, The State University of New Jersey, New Jersey, USA
| | - Masayuki Kitano
- Second Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan
| | - Rastislav Kunda
- Department of Surgical Gastroenterology, Aarhus University Hospital, Aarhus, Denmark; Department of Surgery and Department of Advanced Interventional Endoscopy, University Hospital Brussels, Brussels, Belgium, France
| | - Alberto Larghi
- Digestive Endoscopy Unit, IRCCS Foundation University Hospital, Policlinico A. Gemelli, Rome, Italy
| | - Kathleen Möller
- Medical Department I/Gastroenterology, SANA Hospital Lichtenberg, Berlin, Germany
| | - Bertrand Napoleon
- Digestive Endoscopy Unit, Hopital Privé J Mermoz Ramsay Générale de Santé, Lyon, France
| | - Kofi W Oppong
- HPB Unit, Freeman Hospital, Newcastle Upon Tyne, England
| | - Maria Chiara Petrone
- Pancreatico/Biliary Endoscopy and Endosonography Division, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute, Vita Salute San Raffaele University, Rozzano, Milan, Italy
| | - Adrian Saftoiu
- Department of Gastroenterology, Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - Rajesh Puri
- Interventional Gastroenterology, Institute of Digestive and Hepatobiliary Sciences, Medanta the Medicity, Gurugram, Haryana, India
| | - Anand V Sahai
- Center Hospitalier de l'Université de Montréal, Montreal, Canada
| | - Erwin Santo
- Department of Gastroenterology and Liver Diseases, Tel Aviv, Sourasky Medical Center, Tel Aviv, Israel
| | - Malay Sharma
- Department of Gastroenterology, Jaswant Rai Speciality Hospital, Meerut, Uttar Pradesh, India
| | - Assaad Soweid
- Division of Gastroenterology, Endosonography and Advanced Therapeutic Endoscopy, The American University of Beirut, Medical Center, Beirut, Lebanon
| | - Siyu Sun
- Endoscopy Center, ShengJing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Anthony Yuen Bun Teoh
- Department of Surgery, Division of Upper Gastrointestinal and Metabolic Surgery, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Peter Vilmann
- Department of Surgery, GastroUnit, Copenhagen University Hospital Herlev, Herlev, Denmark
| | - Hans Seifert
- Department of Gastroenterology, Klinikum Oldenburg, Oldenburg, Germany
| | - Christian Jenssen
- Department of Internal Medicine, Krankenhaus Maerkisch-Oderland, D-15344 Strausberg and Brandenburg Institute of Clinical Ultrasound at Medical University Brandenburg, Germany
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Uchida N, Bando Y, Hamaya S, Koyama Y, Kozuka K, Kawakita R, Sawada Y, Tatemoto A, Nakatsu T. Importance of mediastinal screening-based observation during endoscopic ultrasound to examine gastrointestinal pathologies. Clin J Gastroenterol 2018; 12:149-152. [PMID: 30209730 PMCID: PMC6437316 DOI: 10.1007/s12328-018-0905-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 09/04/2018] [Indexed: 11/25/2022]
Abstract
In all endoscopic ultrasound (EUS) examinations performed at our hospital, the heart, vasculature, and mediastinal lymph nodes from the esophagus are observed after checking for gastrointestinal pathologies. Since the introduction of EUS using a convex linear-array echoendoscope at our hospital in April 2015, EUS examinations have been performed in 371 cases for examining pancreaticobiliary diseases, submucosal tumors, and other pathologies during the 3-year period, till March 2018. We diagnosed 2 patients with asymptomatic cardiovascular disease while observing the mediastinum during EUS examination to examine identified pancreaticobiliary disease. No subjective symptoms associated with cardiovascular disease were observed and the respective conditions had not been identified previously in either case. One case involved a left atrial myxoma while the other involved a saccular aortic aneurysm in the thoracic aorta. A left atrial tumor resection and aortic replacement surgery were performed in each case. Their postoperative courses have been favorable. As cardiovascular diseases are often life-threatening, as in the present 2 cases, observational screening of the cardiovascular system from the esophagus should also be performed during EUS examinations just as the pharyngeal region is examined during upper gastrointestinal endoscopy.
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Affiliation(s)
- Naohito Uchida
- Departments of Gastroenterology, Saint Martin's Hospital, 1-4-13 Tani-machi, Sakaide City, Kagawa, 762-0033, Japan.
| | - Yuko Bando
- Departments of Gastroenterology, Saint Martin's Hospital, 1-4-13 Tani-machi, Sakaide City, Kagawa, 762-0033, Japan
| | - Sae Hamaya
- Departments of Gastroenterology, Saint Martin's Hospital, 1-4-13 Tani-machi, Sakaide City, Kagawa, 762-0033, Japan
| | - Yukiko Koyama
- Departments of Gastroenterology, Saint Martin's Hospital, 1-4-13 Tani-machi, Sakaide City, Kagawa, 762-0033, Japan
| | - Kazuhiro Kozuka
- Departments of Gastroenterology, Saint Martin's Hospital, 1-4-13 Tani-machi, Sakaide City, Kagawa, 762-0033, Japan
| | - Rie Kawakita
- Departments of Gastroenterology, Saint Martin's Hospital, 1-4-13 Tani-machi, Sakaide City, Kagawa, 762-0033, Japan
| | - Yuki Sawada
- Departments of Gastroenterology, Saint Martin's Hospital, 1-4-13 Tani-machi, Sakaide City, Kagawa, 762-0033, Japan
| | - Akihiko Tatemoto
- Departments of Surgery, Saint Martin's Hospital, 1-4-13 Tani-machi, Sakaide City, Kagawa, 762-0033, Japan
| | - Toshiaki Nakatsu
- Departments of Gastroenterology, Saint Martin's Hospital, 1-4-13 Tani-machi, Sakaide City, Kagawa, 762-0033, Japan
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Figueiredo PC, Pinto-Marques P, Almeida I, Gomes PC, Serra D. Right adrenal gland prospective evaluation through transgastric endoscopic ultrasound: an alternative approach. Endosc Int Open 2016; 4:E1194-E1196. [PMID: 27853745 PMCID: PMC5110352 DOI: 10.1055/s-0042-116147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 08/19/2016] [Indexed: 11/23/2022] Open
Abstract
Background and aims: Endoscopic ultrasound (EUS) guided right adrenal gland (RAG) evaluation is frequently unsuccessful and, when feasible, requires a cumbersome maneuver through the duodenum. In our experience, the use of a recent ultrasound platform has enabled transgastric detection of the RAG with a simple maneuver. The aim of this study was to determine the RAG transgastric EUS detection rate and identify predictive factors for failure. Methods: Consecutive patients referred to EUS in a single center were prospectively included over a 6-month period. Success was defined as RAG transgastric EUS detection within 180 seconds. Logistic regression analysis was used to assess factors associated with failure. Results: Among 100 patients, the success rate for RAG transgastric EUS detection was 75 %, with a median maneuver duration of 45 seconds [interquartile range, 25 - 70 seconds]. Two incidental RAG lesions were detected. Of possible demographic and anthropometric predictive factors for failure, only age (OR 1.04; P = 0.04) was statistically significant on multivariate analysis. Conclusions: The transgastric EUS approach for RAG detection is simple, fast and effective.
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Affiliation(s)
- Pedro C. Figueiredo
- Gastroenterology Department, Hospital da Luz, Lisbon, Portugal,Corresponding author Pedro C. Figueiredo, MD Gastroenterology DepartmentHospital da LuzAvenida Lusiada, 1001500-650, LisbonPortugal+351-21-7104409
| | | | - Ines Almeida
- Gastroenterology Department, Hospital da Luz, Lisbon, Portugal
| | - Pedro C. Gomes
- Anesthesiology Department, Hospital da Luz, Lisbon, Portugal
| | - David Serra
- Gastroenterology Department, Hospital da Luz, Lisbon, Portugal
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Abstract
Objective: The aim of this prospective study was to assess the frequency and clinical significance of incidental findings on upper gastrointestinal endoscopic ultrasonography (EUS). Methods: Patients referred for upper gastrointestinal EUS were consecutively enrolled into this prospective study. Any coincidental abnormality found during standard EUS was considered an incidental finding. Significant incidental findings were defined as abnormalities that required further medical, surgical, or endoscopic intervention, including surveillance. Results: In 552 patients who underwent EUS, 41 incidental findings were detected in 39 patients (7.1%). Twenty-one abnormalities had clinical significance. The frequency of incidental findings increased significantly with increasing age ( P = .001). The most frequent incidental findings were gallstones, subepithelial lesions, and pancreatic lesions. Conclusions: Incidental findings on EUS are not uncommon in clinical practice and might be a clue to a significant pathology. The appropriate extent of evaluation of incidental findings noted during a standard EUS procedure warrants further research yet to be defined.
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Affiliation(s)
| | - Payman Arab
- Kerman University of Medical Sciences, Kerman, Iran
| | - Ali Ali-Asgari
- Digestive Disease Research Center, Tehran University of Medical Sciences, Shariati Hospital, Tehran, Iran
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