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ABSTRACT: BACKGROUND: Hepatic steatosis is an important parameter to assess in chronic liver disease patients. The Controlled Attenuation Parameter (CAP) assesses liver steatosis using transient elastography. AIM: To determine the accuracy of CAP for evaluation of hepatic steatosis in chronic hepatitis B virus (CHBV) infected, chronic hepatitis C virus (CHCV) infected and non alcoholic fatty liver disease (NAFLD) patients and to determine the influence of aetiology on the diagnostic accuracy of CAP. METHODS: 146 CHBV patients, 108 CHCV infected patients and 63 patients with NAFLD, who underwent both liver biopsy and successful CAP measurements within the study period, were assessed. Area under the Receiver Operating Characteristic (AUROC) was used to evaluate performance of CAP for diagnosing steatosis compared with biopsy. RESULTS: Multivariate analysis found that CAP correlated with BMI [ OR , 95% CI=4.09 (1.2-6.8) for CHBV ; 4.7 (1.1-8.4) for CHCV and 16.2(9.1-24.5) for NAFLD patients respectively] and hepatic steatosis score on biopsy [ OR , 95% CI=30.7 (19.2-42.2]) for CHBV ; 24.2 (11.5-37.3) for CHCV and 21.8(10.1-45.0)16.2(9.1-24.5) for NAFLD patients respectively]. AUROC for CAP was 0.683 (0.601-0.757) for steatosis (S) ≥6 %, 0.793 (0.718-0.856) for S>33% and 0.841 (0.771-0.896) for S > 66% respectively for CHBV infected patients. There was no difference in accuracy of CAP for assessing liver fat among CHBV, CHCV and NAFLD patients. CONCLUSIONS: CAP is a novel, noninvasive tool that can detect and quantify steatosis accurately among CHBV, CHCV and NAFLD patients, the accuracy being similar for all the three groups of patients.
Journal of Gastroenterology and Hepatology 02/2013; · 2.87 Impact Factor
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Masahiro Tajika,
Yasumasa Niwa, Vikram Bhatia,
Shinya Kondo,
Tsutomu Tanaka,
Nobumasa Mizuno,
Kazuo Hara,
Susumu Hijioka,
Hiroshi Imaoka,
Koji Komori,
Kenji Yamao
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ABSTRACT: To evaluate the possibility of reducing the volume of polyethylene glycol (PEG)-electrolyte solution using adjunctive mosapride citrate for colonoscopy preparation.
This was a single-center, prospective, randomized, investigator-blinded, non-inferiority study involving 252 patients of both sexes, aged from 20 to 80 years, scheduled for screening or diagnostic colonoscopy in our department. A total of 126 patients was randomized to receive 1.5 L PEG-electrolyte solution plus 15 mg of mosapride (1.5 L group), and 126 received 2 L PEG-electrolyte solution plus 15 mg of mosapride (2 L group). Patients completed a questionnaire on the acceptability and tolerability of the bowel preparation process. The efficacy of bowel preparation was assessed using a 5-point scale based on the Aronchick scale. The primary end point was adequate bowel preparation rates (score of excellent/good/fair) vs (poor/inadequate). Acceptability and tolerability, as well as disease detection, were secondary end points.
A total of 244 patients was included in the analysis. There were no significant differences between the 2 L and 1.5 L groups in age, sex, body mass index, number of previous colonoscopies, and the preparation method used previously. The adequate bowel preparation rates were 88.5% in the 2 L group and 82.8% in the 1.5 L group [95% lower confidence limit (LCL) for the difference = -14.5%, non-inferiority P = 0.019] in the right colon. In the left colon, the adequate bowel preparation rates were 89.3% in the 2 L group and 81.1% in the 1.5 L group (95% LCL = -17.0%, non-inferiority P = 0.066). Compliance, defined as complete (100%) intake of the PEG solution, was significantly higher in the 1.5 L group than in the 2 L group (96.8% vs 85.7%, P = 0.002). The proportion of abdominal distension (none/mild/moderate/severe) was significantly lower in the 1.5 L group than in the 2 L group (36/65/22/3 vs 58/48/18/2, P = 0.040). Within the subgroup who had undergone colonoscopy previously, a significantly higher number of patients in the 1.5 L group than in the 2 L group felt that the current preparation was easier than the previous one (54.1% vs 28.0%, P = 0.001). The disease detection rate was not significantly different between the two groups.
Although the 1.5 L group had better acceptability and tolerability, 15 mg of mosapride may be insufficient to compensate for a 0.5-L reduction of PEG solution.
World Journal of Gastroenterology 02/2013; 19(5):727-35. · 2.47 Impact Factor
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ABSTRACT: Epstein-Barr virus (EBV) is the causative agent of infectious mononucleosis (IM) which is characterized by the triad of fever, sore throat, and lymphadenopathy. Self-limited, mild liver function test abnormalities are seen in IM. Acute hepatitis in primary EBV infection is uncommon. Serum transaminases are elevated but are less than fivefold the normal levels in most cases and rarely exceed 10 times the normal levels in primary EBV infections especially in elderly. Laboratory diagnosis of acute EBV infection is by serological assays confirming the presence of EBV viral capsid antigen (VCA) IgM antibodies. Due to antigenic cross-reactivity with Herpes viruses, serological assays lack specificity; hence specific molecular diagnostic methods are required for confirmation of the etiology. The present report describes two cases of acute hepatitis caused by infection with EBV which had indistinguishable clinical features and biochemical markers from acute hepatitis caused by hepatotropic viruses such as hepatitis viruses A-E. The diagnosis of infection by EBV was confirmed by detection of EBV DNA in blood of both the patients and EBV DNA in the liver tissue of one of the patients. J. Med. Virol. © 2013 Wiley Periodicals, Inc.
Journal of Medical Virology 01/2013; · 2.82 Impact Factor
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Shin Haba,
Kenji Yamao, Vikram Bhatia,
Nobumasa Mizuno,
Kazuo Hara,
Susumu Hijioka,
Hiroshi Imaoka,
Yasumasa Niwa,
Masahiro Tajika,
Shinya Kondo,
Tsutomu Tanaka,
Yasuhiro Shimizu,
Yasushi Yatabe,
Waki Hosoda,
Hiroshi Kawakami,
Naoya Sakamoto
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ABSTRACT: BACKGROUND: Several studies have investigated the diagnostic accuracy of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) for pancreatic lesions, but they have included only limited patient populations. This study aimed to clarify the diagnostic accuracy of EUS-FNA in a large number of pancreatic lesions, and to describe the factors that influence it. METHODS: From March 1997 to May 2010, 944 consecutive patients who had undergone EUS-FNA for pancreatic solid lesions were evaluated retrospectively. Factors affecting EUS-FNA accuracy were then analyzed. RESULTS: A total of 996 solid pancreatic lesions were sampled by EUS-FNA. The overall sampling adequacy and diagnostic accuracy of these lesions were 99.3 % (989/996) and 91.8 % (918/996), respectively. The sensitivity and specificity for differentiating malignant from benign lesions were 91.5 % (793/867) and 97.7 % (126/129), respectively. The diagnostic performance was significantly higher when both cytological and cell-block examinations were carried out than with only cytological examination. In multivariate analysis, final diagnosis, location of lesion, lesion size, availability of on-site cytopathological evaluation, and experience of EUS-FNA procedure were independent factors affecting the accuracy of EUS-FNA. On-site cytopathological evaluation and lesion size were found to be the most weighted factors affecting diagnostic accuracy. CONCLUSIONS: EUS-FNA for pancreatic solid lesions yielded a high accuracy and low complication rate. Both cytological and cell-block preparations and on-site cytopathological evaluation contributed to improve the accuracy. The diagnostic ability of EUS-FNA was less for smaller lesions, and repeated procedures may be needed if malignancy is suspected.
Journal of Gastroenterology 10/2012; · 4.16 Impact Factor
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Takeshi Ogura,
Kenji Yamao,
Kazuo Hara,
Nobumasa Mizuno,
Susumu Hijioka,
Hiroshi Imaoka,
Akira Sawaki,
Yasumasa Niwa,
Masahiro Tajika,
Shinya Kondo,
Tsutomu Tanaka,
Yasuhiro Shimizu, Vikram Bhatia,
Kazuhide Higuchi,
Waki Hosoda,
Yasushi Yatabe
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ABSTRACT: BACKGROUND: Although recent reports indicate that K-ras mutation status is a biomarker that acts as a prognostic factor, only a few analyses of K-ras mutation subtypes have been published. In addition, there are no reports that analyze overall survival and prognostic factors according to K-ras mutation status and subtypes in only unresectable pancreatic cancer (PC) determined from tissues obtained by endoscopic ultrasound-guided fine-needle aspiration. METHODS: We retrospectively analyzed 242 patients who were diagnosed as having unresectable PC with available histological diagnosis. Clinical data collected included sex, age, Eastern Cooperative Oncology Group performance status, carbohydrate antigen (CA) 19-9, primary tumor location, stage (local or metastatic) according to TNM staging, first-line chemotherapy, K-ras mutation status and subtypes (G12D, G12V, and G12R), and overall survival. We analyzed the negative prognostic factors for reduced overall survival in unresectable PC patients using these data. RESULTS: From multivariate analysis, CA19-9 ≥1000 U/ml (hazard ratio [HR] 1.78, 95 % confidence interval [CI] 1.28-2.46, P < 0.01), metastatic stage (HR 2.26, 95 % CI 1.58-3.24, P < 0.01), and mutant-K-ras (HR 1.76, 95 % CI 1.03-3.01, P = 0.04) were negative prognostic factors, indicating a reduced survival. Among the patients who had K-ras mutation subtypes, CA19-9 ≥1000 U/ml (HR 1.65, 95 % CI 1.12-2.37, P < 0.01), metastatic stage (HR 2.12, 95 % CI 1.44-3.14, P < 0.01), and the presence of the G12D or G12R mutations (HR 1.60, 95 % CI 1.11-2.28) were negative prognostic factors for overall survival. CONCLUSIONS: K-ras mutation status and subtypes may be associated with survival duration in pancreatic cancer patients.
Journal of Gastroenterology 09/2012; · 4.16 Impact Factor
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Gastrointestinal endoscopy 09/2012; 76(3):703. · 6.71 Impact Factor
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Indian Journal of Gastroenterology 07/2012; 31(4):215-6.
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ABSTRACT: BACKGROUND: The present study evaluated performance characteristics of liver stiffness measurement (LSM) by FibroScan in patients with different stages of nonalcoholic fatty liver disease (NAFLD). PATIENTS AND METHODS: A total of 307 subjects (120 NAFLD, 85 NAFLD related cirrhosis, and 102 healthy controls) were studied. RESULTS: In NAFLD patients, LSM had significant correlation with fibrosis (r = 0.68, p < 0.001), and increased progressively with increasing fibrosis (p < 0.001). However, the difference between stage 1 and stage 2 fibrosis was not significant (p = 0.07). The LSM in NAFLD without fibrosis and healthy controls was similar (p = 0.37). The areas under receiver-operating characteristics (AUROC) curve of LSM for stages ≥1, ≥2, ≥3, and 4 were 0.82, 0.85, 0.94, and 0.96, respectively. The best LSM (kPa) cut-offs for fibrosis stages ≥1, ≥2, ≥3 and 4 were 6.1, 7.0, 9.0, and 11.8, respectively. The negative predictive value of LSM for excluding advanced fibrosis was 95 %. For advanced fibrosis, the AUROC curve of LSM was 0.94, followed by FIB-4 (0.75), BARD score (0.68), NAFLD fibrosis score (0.66), and aspartate platelet ratio index (0.60). In multivariate analysis, LSM was the only independent predictor of advanced fibrosis (odds ratio 1.47). In patients with NAFLD cirrhosis, LSM correlated significantly with Child-Pugh score (r = 0.40, p < 0.001), serum bilirubin (r = 0.34, p = 0.02), and grades of esophageal varices (r = 0.23, p = 0.04). CONCLUSION: LSM is a useful tool for evaluation of patients with NAFLD, and is the best among other non-invasive predictors of liver fibrosis.
Digestive Diseases and Sciences 07/2012; · 2.12 Impact Factor
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Indian Journal of Gastroenterology 06/2012; 31(3):151-2.
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Arab Journal of Gastroenterology 06/2012; 13(2):100-1.
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Masahiro Tajika,
Yasumasa Niwa, Vikram Bhatia,
Hiroki Kawai,
Shinya Kondo,
Akira Sawaki,
Nobumasa Mizuno,
Kazuo Hara,
Susumu Hijioka,
Kazuya Matsumoto,
Yuji Kobayashi,
Akira Saeki,
Asana Akabane,
Koji Komori,
Kenji Yamao
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ABSTRACT: To evaluate the efficacy and safety of adjunctive mosapride citrate for bowel preparation before colonoscopy.
We conducted a randomized, double-blind, placebo-controlled study with mosapride in addition to polyethylene glycol (PEG)-electrolyte solution. Of 250 patients undergoing colonoscopy, 124 were randomized to receive 2 L PEG plus 15 mg of mosapride citrate (mosapride group), and 126 received 2 L PEG plus placebo (placebo group). Patients completed a questionnaire reporting the acceptability and tolerability of the bowel preparation process. The efficacy of bowel preparation was assessed by colonoscopists using a 5-point scale based on Aronchick's criteria. The primary end point was optimal bowel preparation rates (scores of excellent/good/fair vs poor/inadequate).
A total of 249 patients were included in the analysis. In the mosapride group, optimal bowel preparation rates were significantly higher in the left colon compared with the placebo group (78.2% vs 65.6%, P < 0.05), but not in the right colon (76.5% vs 66.4%, P = 0.08). After excluding patients with severe constipation, there was a significant difference in bowel preparation in both the left and right colon (82.4% vs 66.7%, 80.8% vs 67.5%, P < 0.05, P < 0.01). The incidence of adverse events was similar in both groups. Among the subgroup who had previous colonoscopy experience, a significantly higher number of patients in the mosapride group felt that the current preparation was easier compared with patients in the placebo group (34/72 patients vs 24/74 patients, P < 0.05).
Mosapride citrate may be an effective and safe adjunct to PEG-electrolyte solution that leads to improved quality of bowel preparation, especially in patients without severe constipation.
World Journal of Gastroenterology 05/2012; 18(20):2517-25. · 2.47 Impact Factor
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ABSTRACT: We report the first case of syndrome of inappropriate secretion of antidiuretic hormone (SIADH) after endoscopic submucosal
dissection (ESD) for early gastric cancer. A 64-year-old man with early gastric cancer was admitted to our hospital for ESD.
Baseline laboratory tests showed a serum sodium concentration of 132mEql−1. We performed an ESD for the gastric cancer, which was 9mm in diameter and located in the posterior wall of the mid-gastric
body. The patient experienced nausea and lethargy the second day after ESD. His serum sodium level was low (118mEql−1), and he fulfilled the criteria for SIADH. Fluid restriction, infusion of normal saline, and administration of diuretics
gradually increased his serum sodium level, and his symptoms disappeared. Endoscopists should recognize that SIADH is a potential
complication of endoscopic procedures such as ESD, especially among patients with low baseline sodium concentrations.
Clinical Journal of Gastroenterology 04/2012; 2(4):262-265.
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ABSTRACT: Endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) is a novel alternative to percutaneous transhepatic biliary drainage, when endoscopic retrograde cholangiopancreatography is unsuccessful in patients with malignant lower biliary obstruction. Some case series and a few prospective studies of EUS-CDS have reported high technical and functional success rates but with the downside of high early complication rates, albeit mostly nonsevere. In addition, the stents placed by EUS-CDS had a longer patency than transpapillary biliary stents.
Gastrointestinal endoscopy clinics of North America 04/2012; 22(2):259-69, ix.
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Takeshi Ogura,
Kenji Yamao,
Akira Sawaki,
Nobumasa Mizuno,
Kazuo Hara,
Susumu Hijioka,
Yasumasa Niwa,
Masahiro Tajika,
Shinya Kondo,
Yasuhiro Shimizu, Vikram Bhatia,
Kazuhide Higuchi,
Waki Hosoda,
Yasushi Yatabe
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ABSTRACT: EUS-guided FNA (EUS-FNA) is considered optimal for differentially diagnosing pancreatic masses. However, the sensitivity of EUS-FNA ranges from 65% to 95%, respectively, which requires improvement.
To evaluate clinical impact of K-ras mutation analysis in EUS-FNA specimens from pancreatic masses.
Prospective registration, single-center study.
Tertiary referral center.
This study involved 394 consecutive patients with pancreatic masses (307 pancreatic ductal adenocarcinomas [PDACs], 47 pancreatic inflammatory lesions, and 40 other types of tumors) who underwent EUS-FNA and analysis of K-ras mutations.
EUS-FNA, Cycleave polymerase chain reaction.
Improvement of the diagnostic accuracy by K-ras mutation analysis; absence of K-ras mutations in non-PDAC masses.
K-ras mutations were detected in 266 of 307 PDAC aspirates (87%) and in 3 of 87 non-PDAC masses (3%). K-ras mutations were detected in 18 of 39 patients (46%) who remained cytohistopathologically undiagnosed. The sensitivity, specificity, positive and negative predictive values, and accuracy of cytohistopathological and K-ras mutation analyses alone were 87%, 100%, 100%, 54%, and 89%, respectively, and, when combined, were 93%, 100%, 100%, 68%, and 94%, respectively. Adding K-ras mutation analysis to standard cytohistopathological assessment increased the sensitivity and accuracy of EUS-FNA by 6% (P < .001) and 5% (P < .001), respectively.
Single-center study.
K-ras mutation analysis may be helpful in patients with suspected PDAC yet inconclusive EUS-FNA findings. K-ras mutations were extremely rare in pancreatic inflammation and other pancreatic tumors.
Gastrointestinal endoscopy 01/2012; 75(4):769-74. · 6.71 Impact Factor
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ABSTRACT: Acute liver failure (ALF) is a condition of acute hepatic emergency where rapid deterioration of hepatocyte function leads to hepatic encephalopathy, coagulopathy, cerebral edema (CE), infection and multi-organ dysfunction syndrome resulting in a high mortality rate. Urgent liver transplantation is the standard of care for most of these patients in Western countries. However, in India, access to liver transplantation is severely limited and, hence, the management is largely based on intensive medical care. With earlier recognition of disease, better understanding of pathophysiology and improved intensive care, ALF patients have shown a significant improvement in spontaneous survival. An evidence base for practice for supportive care is still lacking; however, intensive organ support as well as control of infection and CE are likely to be key to the successful outcome in this acute and potentially reversible condition without any sequel. A structured approach to decision making about intensive care is important in each case. Unlike in Western countries where acetamenophen is the most common cause of ALF, the role of a specific agent, such as N-acetylcysteine, is limited in India. Ammonia-lowering therapy is still in an evolving phase. The current review highlights the important medical management issues in patients with ALF in general as well as the management of major complications associated with ALF. We performed a MEDLINE search using combinations of the key words such as acute liver failure, intensive treatment of acute liver failure and fulminant hepatic failure. We reviewed the relevant publications with regard to intensive care of patients with ALF.
Indian Journal of Critical Care Medicine 01/2012; 16(1):1-7.
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Susumu Hijioka,
Kazuo Hara,
Nobumasa Mizuno,
Hiroshi Imaoka,
Takeshi Ogura,
Shin Haba,
Mohamed A Mekky, Vikram Bhatia,
Waki Hosoda,
Yasushi Yatabe,
Yasuhiro Shimizu,
Yasumasa Niwa,
Masahiro Tajika,
Shinya Kondo,
Tsutomu Tanaka,
Kiichi Tamada,
Kenji Yamao
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ABSTRACT: BACKGROUND: Obtaining histological evidence of gallbladder carcinoma (GBC) is difficult due to its extraductal nature, and pathological confirmation remains challenging. We compared the diagnostic value and safety of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) with endoscopic retrograde cholangiography (ERC) in patients with suspected GBC. PATIENTS: Eighty-three patients with GBC were evaluated. Prior to definitive management, pathological evidence of GBC was obtained through either ERC cytopathologic sampling (n = 33), EUS-FNA (n = 24) or both (n = 26). RESULTS: Among the 83 patients, 59 (71.0%) with biliary obstruction were sampled using ERC with 47.4% (28/59) sensitivity. In 19 of the remaining 31 cases, EUS-FNA sampling had 100% diagnostic sensitivity. Likewise, 50 (60.2%) of the 83 patients with suspected GBC underwent EUS-FNA of regional lymph nodes or the gallbladder (GB) mass itself with 94.8% sensitivity. The overall diagnostic sensitivity rates of ERC and EUS-FNA were 47.4 and 96%, respectively (P < 0.001). Post-procedural complications were seen in 6.7% of the ERC group (4/59, all were mild pancreatitis), and in none of the EUS-FNA group (P = 0.10). CONCLUSIONS: Gallbladder carcinoma sampling using ERC and EUS-FNA should be incorporated into the diagnostic workup of GB lesions as complementary tools, and EUS-FNA should be applied in the setting of failed or not indicated ERC.
Journal of hepato-biliary-pancreatic sciences. 11/2011;
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Chhagan Bihari M.D,
D.M. Vikram Bhatia M.D,
D.N.B. Archana Rastogi M.D,
Vaishali Bhardwaj M.D,
Deepak Jain F.R.C.R,
Shalini Thapar D.N.B,
Chhagan Bihari, Vikram Bhatia,
Archana Rastogi,
Vaishali Bhardwaj,
Deepak Jain,
Shalini Thapar
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ABSTRACT: We report a case of T-cell lymphoma presenting as ascites, omental thickening, and raised serum glycoprotein-125 (CA-125) and high-ascitic fluid adenosinedeaminase levels. This case was clinically suspected to be peritoneal carcinomatosis or peritoneal tuberculosis based on clinical, biochemical, and radiological features. However, effusion cytology, cell block, and immunohistochemistry confirmed this case as T-cell lymphoma. This revealed the role of effusion cytology and cell-block preparation with imunohistochemistry in the diagnosis. Diagn. Cytopathol. 2010. © 2010 Wiley-Liss, Inc.
Diagnostic Cytopathology 09/2011; 39(10):770 - 774. · 1.16 Impact Factor
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Masahiro Tajika,
Yasumasa Niwa, Vikram Bhatia,
Shinya Kondo,
Tsutomu Tanaka,
Nobumasa Mizuno,
Kazuo Hara,
Susumu Hijioka,
Hiroshi Imaoka,
Takeshi Ogura,
Shin Haba,
Kenji Yamao
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ABSTRACT: Endoscopic mucosal resection (EMR) is the standard procedure for treatment of colorectal tumors. Endoscopic submucosal dissection (ESD) can be performed for resection of larger tumors, but has not been studied in the colorectum because of technical difficulties and complications. We compared outcomes and complications after resection of colorectal tumors larger than 20 mm diameter by ESD and EMR.
We retrospectively studied 104 colorectal tumors treated with EMR from 1995 to 2004, and 85 colorectal tumors treated with ESD from 2005 to 2009. We compared the tumor location, shape, size, procedure time, en bloc resection rate, recurrence rate, and associated complications between the treatments.
Tumors treated with ESD were larger (31.6 ± 9.0 vs. 25.5 ± 6.8 mm, P<0.001), incurred a longer procedure time (87.2 ± 49.7 vs. 29.4 ± 26.1 min, P<0.001), had a higher en bloc resection rate [71 of 85 tumors (83.5%) vs. 50 of 104 tumors (48.1%), P<0.001], and had a lower recurrence rate [one of 84 tumors (1.2%) vs. 16 of 104 tumors (15.4%); P=0.002] compared with EMR. Perforation occurred in five (5.9%) cases after ESD and in none after EMR (P=0.04). Postoperative bleeding occurred in two (2.4%) and three (2.9%) cases after ESD and EMR (P=not significant), respectively. Although 11 of 16 cases with recurrence after EMR were cured by additional endoscopic treatment, three cases required surgery. The only recurrence after ESD was in one patient who developed perforation after snare EMR.
Despite its longer procedure time and higher perforation rate, ESD resulted in a higher en bloc resection rate and lower recurrence rate for larger colorectal tumors compared with EMR.
European journal of gastroenterology & hepatology 08/2011; 23(11):1042-9. · 1.66 Impact Factor
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Masahiro Tajika,
Yasumasa Niwa, Vikram Bhatia,
Shinya Kondo,
Tsutomu Tanaka,
Nobumasa Mizuno,
Kazuo Hara,
Susumu Hijioka,
Shin Haba,
Takeshi Ogura,
Takashi Hirai,
Kenji Yamao,
Yasushi Yatabe
Gastrointestinal endoscopy 07/2011; 75(5):1117-8. · 6.71 Impact Factor
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ABSTRACT: Endoscopic ultrasonography (EUS) has become an indispensable diagnostic procedure pairing endoscopy with transluminal high frequency ultrasonography. EUS provides images with a high resolution such that the depth of tumor invasion can be accurately determined. It also sees lesions outside of gastrointestinal tract, particularly those in pancreas, biliary system and periluminal lymph nodes. The most important limitation of EUS was lack of specificity, that is, the differentiation between benign and malignant lesions. In 1992, EUS-guided fine needle aspiration (EUS-FNA) was introduced with the sampling of a lesion in the pancreatic head using a convex EUS. Since then the indications of EUS-FNA have been expanded to include a variety of therapeutic uses. In addition, a convex EUS probe can also be used for detailed evaluation of the pancreatobiliary system, in lieu of a radial EUS. The vascular structures surrounding liver, biliary system and pancreas can be showed by a convex EUS system very clearly and easily compared with the more familiar radial EUS images. So we think a convex EUS is very useful for not only EUS-FNA but also screening and close examination for cancer with vascular invasion.
Digestive Endoscopy 05/2011; 23 Suppl 1:26-8. · 1.19 Impact Factor
