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Choi JH, Seo DW. Applications of contrast-enhanced harmonic endoscopic ultrasound on biliary, focal liver lesions and vascular diseases. Endosc Ultrasound 2017; 6:21-24. [PMID: 28218196 PMCID: PMC5331838 DOI: 10.4103/2303-9027.200211] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Over the last decade, the clinical applications of contrast-enhanced harmonic endoscopic ultrasound (CH-EUS) have increased steadily. The development of second-generation ultrasound contrast agents has allowed superior visualization of the microvasculature and tissue perfusion of the target lesion. This methodology has proven useful in the differential diagnosis of solid pancreatic masses and lymph nodes. In addition, the applicability of CH-EUS has expanded to nonpancreas structures such as biliary, focal liver lesions, and vascular disease. This article focuses primarily on the novel applications of CH-EUS in biliary tract and visceral vascular diseases.
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Affiliation(s)
- Jun-Ho Choi
- Department of Internal Medicine, Dankook University College of Medicine, Dankook University Hospital, Seoul, South Korea
| | - Dong-Wan Seo
- Department of Internal Medicine, Division of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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Tang RSY. Contrast-enhanced endoscopic ultrasound for pancreatobiliary disease. INTERNATIONAL JOURNAL OF GASTROINTESTINAL INTERVENTION 2016. [DOI: 10.18528/gii160017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Raymond Shing-Yan Tang
- Institute of Digestive Disease, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
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Teoh AYB, Tang RSY. Clinical evaluation of new diagnostic modalities of endoscopic ultrasound for pancreaticobiliary diseases. Dig Endosc 2015; 27 Suppl 1:55-9. [PMID: 25645516 DOI: 10.1111/den.12444] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 01/19/2015] [Indexed: 12/19/2022]
Abstract
Endoscopic ultrasonography (EUS) is currently an integral tool for work-up of pancreaticobiliary neoplasms. Tissue acquisition by EUS is possible with fine-needle aspiration (FNA) cytology and histology. However, FNA still carries some limitations and risks of complications. The use of image-enhanced EUS may improve detection and characterization of pancreaticobiliary neoplasms and complement FNA. The present article aims to provide an overview of the current development of contrast-enhanced imaging and elastography in EUS and their potential application in the diagnosis of pancreaticobiliary diseases.
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Amendment of the Japanese Consensus Guidelines for Autoimmune Pancreatitis, 2013 II. Extrapancreatic lesions, differential diagnosis. J Gastroenterol 2014; 49:765-84. [PMID: 24664402 DOI: 10.1007/s00535-014-0944-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 02/06/2014] [Indexed: 02/04/2023]
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Mohamed RM, Yan BM. Contrast enhanced endoscopic ultrasound: More than just a fancy Doppler. World J Gastrointest Endosc 2010; 2:237-43. [PMID: 21160613 PMCID: PMC2998834 DOI: 10.4253/wjge.v2.i7.237] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2010] [Revised: 05/28/2010] [Accepted: 06/04/2010] [Indexed: 02/05/2023] Open
Abstract
Contrast enhanced endoscopic ultrasound (CEUS) is a new modality that takes advantage of vascular structure and blood flow to distinguish different clinical entities. Contrast agents are microbubbles that oscillate when exposed to ultrasonographic waves resulting in characteristic acoustic signals that are then converted to colour images. This permits exquisite imaging of macro- and microvasculature, providing information to help delineate malignant from non-malignant processes. The use of CEUS may significantly increase the sensitivity and specificity over conventional endoscopic ultrasound. Currently available contrast agents are safe, with infrequent adverse effects. This review summarizes the theory and technique behind CEUS and the current and future clinical applications.
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Affiliation(s)
- Rachid M Mohamed
- Rachid M Mohamed, Brian M Yan, Division of Gastroenterology, Department of Medicine, University of Calgary, Calgary, Alberta T2N-4N1, Canada
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Japanese consensus guidelines for management of autoimmune pancreatitis: II. Extrapancreatic lesions, differential diagnosis. J Gastroenterol 2010; 45:355-69. [PMID: 20127119 DOI: 10.1007/s00535-009-0197-5] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2009] [Accepted: 12/17/2009] [Indexed: 02/04/2023]
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Abstract
OBJECTIVES As the patients with autoimmune pancreatitis (AIP) are increasing in Japan, the practical guideline for managing AIP is required to be established. METHODS Three committees (the professional committee for making clinical questions [CQs] and statements by Japanese specialists, the expert panelist committee for rating statements by the modified Delphi method, and the evaluating committee by moderators) were organized. Fifteen specialists for AIP extracted the specific clinical statements from a total of 871 literatures by PubMed search (approximately 1963-2008) and from a secondary database and made the CQs and statements. The expert panelists individually rated these clinical statements using a modified Delphi approach, in which a clinical statement receiving a median score greater than 7 on a 9-point scale from the panel was regarded as valid. RESULTS The professional committee made 13, 6, 6, and 11 CQs and statements for the concept and diagnosis, extrapancreatic lesions, differential diagnosis, and treatment, respectively. The expert panelists regarded them as valid after a 2-round modified Delphi approach. CONCLUSIONS After evaluation by the moderators, the Japanese clinical guideline for AIP has been established. Further studies for the international guideline are needed after international consensus for diagnosis and treatment.
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Fujita N, Noda Y, Kobayashi G, Ito K, Horaguchi J, Koshita S, Kanno Y. Intraductal ultrasonography (IDUS) for the diagnosis of biliopancreatic diseases. Best Pract Res Clin Gastroenterol 2009; 23:729-42. [PMID: 19744636 DOI: 10.1016/j.bpg.2009.05.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2009] [Accepted: 05/26/2009] [Indexed: 01/31/2023]
Abstract
Intraductal ultrasonography (IDUS) is an imaging modality having unique characteristics and suitable for imaging of a narrow ductal cavity, its wall and the neighbouring structures. As IDUS uses high-frequency ultrasound (12-30MHz), its image quality is very high within approximately 2-cm range of radius. The bile duct and the pancreatic duct, therefore, are good targets for the assessment by IDUS. Biliopancreatic IDUS is mainly performed through the papilla of Vater in the same session as endoscopic retrograde cholangiopancreatography (ERCP). Biliary IDUS is possible through the percutaneous transhepatic route as well. Not many comparative studies on biliopancreatic IDUS have been published. Gallbladder IDUS as well as most pancreatic IDUS are still at the level of clinical research. Constant delineation of Oddi's sphincter with the improvement of instruments will expand the use of IDUS for the assessment of the papilla of Vater lesions.
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Affiliation(s)
- Naotaka Fujita
- Department of Gastroenterology, Sendai City Medical Center, Miyagi, Japan.
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Sanchez MVA, Varadarajulu S, Napoleon B. EUS contrast agents: what is available, how do they work, and are they effective? Gastrointest Endosc 2009; 69:S71-7. [PMID: 19179175 DOI: 10.1016/j.gie.2008.12.004] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Kobayashi G, Fujita N, Noda Y, Ito K, Horaguchi J. Autoimmune pancreatitis: with special reference to a localized variant. J Med Ultrason (2001) 2008; 35:41-50. [PMID: 27278690 DOI: 10.1007/s10396-008-0177-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2007] [Accepted: 03/07/2008] [Indexed: 12/24/2022]
Abstract
In 2006, the Japan Pancreas Society revised the diagnostic criteria for autoimmune pancreatitis (AIP) so as to more clearly define its morphological, pathological, and immunological features, as follows: (1) diffuse or segmental narrowing of the main pancreatic duct with an irregular wall and diffuse or localized enlargement of the pancreas recognized by imaging studies; (2) high serum gamma globulin, IgG, or IgG4 levels, or the presence of autoantibodies; and (3) marked interlobular fibrosis and prominent infiltration of lymphocytes and plasma cells in the periductal area, occasionally with lymphoid follicles in the pancreas. Establishing a diagnosis of AIP has become easier with knowledge of its immunological abnormalities, including serum IgG4 levels. However, the localized form of AIP sometimes mimics pancreatic cancer. The rate of focal mass formation in patients with AIP is reportedly 24%-43%; however, there have been few reports on the histological findings of localized AIP, in contrast to mass-forming pancreatitis (MFP). Our review of patients who had undergone resection due to a preoperative diagnosis of MFP with possible cancer revealed 72% to be patients with localized AIP. For the discrimination of these conditions, it is important to recognize the characteristic ultrasonographic findings of AIP, i.e., (1) diffuse or localized enlargement and hypoechogenicity of the pancreas; (2) rarity of calcification, cystic lesions, and peripancreatic fluid collection; (3) thickened layer structure of the bile duct wall; (4) iso/hypervascularity in the swollen portion of the pancreas; (5) attenuation of pancreatic swelling and bile duct wall thickening after steroid therapy; and (6) multiple hypoechoic masses in various organs, including the pancreas. Contrast-enhanced endoscopic ultrasonography is potentially a useful tool in the differential diagnosis and for assessment of the efficacy of steroid therapy by enabling evaluation of the vascularity of the lesions. Along with the presence of IgG4-positive plasma cells, verification of obliterative phlebitis is highly specific for the histological diagnosis of AIP.
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Affiliation(s)
- Go Kobayashi
- Department of Gastroenterology, Sendai City Medical Center, 5-22-1 Tsurugaya, Miyagino-ku, Sendai, 983-0824, Japan.
| | - Naotaka Fujita
- Department of Gastroenterology, Sendai City Medical Center, 5-22-1 Tsurugaya, Miyagino-ku, Sendai, 983-0824, Japan
| | - Yutaka Noda
- Department of Gastroenterology, Sendai City Medical Center, 5-22-1 Tsurugaya, Miyagino-ku, Sendai, 983-0824, Japan
| | - Kei Ito
- Department of Gastroenterology, Sendai City Medical Center, 5-22-1 Tsurugaya, Miyagino-ku, Sendai, 983-0824, Japan
| | - Jun Horaguchi
- Department of Gastroenterology, Sendai City Medical Center, 5-22-1 Tsurugaya, Miyagino-ku, Sendai, 983-0824, Japan
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Cholangiocarcinoma: natural history, treatment, and strategies for surveillance in high-risk patients. J Clin Gastroenterol 2008; 42:178-90. [PMID: 18209589 DOI: 10.1097/mcg.0b013e31806daf89] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Cholangiocarcinoma is a primary malignancy of biliary epithelium. Risk factors for cholangiocarcinoma include primary sclerosing cholangitis and other conditions that produce chronic inflammation of the biliary tree. The diagnosis of cholangiocarcinoma can be elusive; it is often not made until advanced disease is present and at a stage when a curative surgical resection is not feasible. Currently used diagnostic modalities include serum and bile tumor markers, radiologic and endoscopic imaging, and pathologic analysis. Surveillance strategies to increase the chance of early diagnosis should be strongly considered in individuals at high risk for cholangiocarcinoma. Patients with long-standing primary sclerosing cholangitis would be the ideal candidates for a screening program.
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Affiliation(s)
- Richard S Kwon
- Gastrointestinal Unit, Massachusetts General Hospital, Boston, Massachusetts 02114, USA
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Affiliation(s)
- Gerard A Isenberg
- Division of Gastroenterology, University Hospitals of Cleveland, Case Western Reserve University, Ohio 44106-5066, USA
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Chak A, Catanzaro A. Innovative methods of biliary tract diagnosis: intraductal ultrasound and tissue acquisition. Gastrointest Endosc Clin N Am 2003; 13:609-22. [PMID: 14986789 DOI: 10.1016/s1052-5157(03)00068-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Tissue can be acquired from the bile and pancreatic duct with either brush cytology or biopsy forceps, often without the need for sphincterotomy. Although the diagnosis of malignancy with these sampling techniques is often specific, the sensitivity is limited, and a wide range of diagnostic accuracies has been reported. A combination of biopsy and brush cytology along with some newer techniques in the development stage may increase the sensitivity. Intraductal ultrasound is a newer technique offers the endoscopist the ability to image the bile and pancreatic duct wall, adjacent organs, and vascular structures with a high degree of detail. This visualization can be accomplished during the course of an ERCP or percutaneously under fluoroscopic guidance. Indications for the procedure include detection of choledocholithiasis, differentiation of benign and malignant ductal strictures, pancreaticobiliary tumor staging, and detection of various pancreatic tumors. Continued research into the design of the probes, which could improve durability and extend the depth of penetration, may promote more widespread use of this novel technology.
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Affiliation(s)
- Amitabh Chak
- Case Western Reserve University School of Medicine, Division of Gastroenterology, USA.
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Kasono K, Hyodo T, Suminaga Y, Sugiura Y, Namai K, Ikoma A, Tamemoto H, Imawari M, Kawakami M, Ishikawa SE. Contrast-enhanced endoscopic ultrasonography improves the preoperative localization of insulinomas. Endocr J 2002; 49:517-22. [PMID: 12402985 DOI: 10.1507/endocrj.49.517] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
We report a case in which endoscopic ultrasonography (EUS), intraductal ultrasonography (IDUS) and contrast-enhanced EUS using Levovist helped to localize insulinoma correctly. A 74-year-old woman complained of symptomatic fasting hypoglycemia with relatively high concentration of serum insulin level. Dynamic contrast-enhanced computed tomography revealed a small tumor of 8 mm diameter in the pancreatic head. Insulin secretion was strongly stimulated by calcium injection into the gastroduodenal artery. To clarify the precise localization, we performed EUS, IDUS and contrast-enhanced EUS. The tumor was enhanced clearly by Levovist, and the distance from the main pancreatic duct was more than 3 mm. Therefore, a preoperative decision could be made to use the enucleation method for resection of the tumor. The surgeon could enucleate the tumor in a brief operation according to the preoperative diagnosis, and serum glucose levels returned to normal range after the operation. Contrast-enhanced EUS using Levovist was shown to be a useful diagnostic method for precise localization of small insulinoma.
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Affiliation(s)
- Keizo Kasono
- Department of Endocrinology and Metabolism, Jichi Medical School, Omiya Medical Center, Amanuma-cho, Saitama, Japan
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