Prospective Study Assessing Impact of Ethylene Oxide Sterilization on Endoscopic Ultrasound Image Quality.

Background & Aims: Duodenoscope-associated transmission of infections has raised questions about efficacy of endoscope reprocessing using high-level disinfection (HLD). Although ethylene oxide (ETO) gas sterilization is effective in eradicating microbes, the impact of ETO on endoscopic ultrasound (EUS) imaging equipment remains unknown. In this study, we aimed to compare the changes in EUS image quality associated with HLD vs HLD followed by ETO sterilization.

Impact of celiac neurolysis on survival in patients with pancreatic cancer.

Background: Pancreatic cancer (PC) often produces pain that is difficult to control. Celiac neurolysis (CN) is performed with the goal of improving pain control and quality of life while reducing opioid-related side effects.

Objective: We aimed to evaluate whether CN provides a survival advantage for PC patients.

EUS-derived criteria for distinguishing benign from malignant metastatic solid hepatic masses.

Background: Detection of hepatic metastases during EUS is an important component of tumor staging.

Objective: To describe our experience with EUS-guided FNA (EUS-FNA) of solid hepatic masses and derive and validate criteria to help distinguish between benign and malignant hepatic masses.

Design: Retrospective study, survey.

Detection of peritoneal carcinomatosis by EUS fine-needle aspiration: impact on staging and resectability (with videos).

Background: Peritoneal carcinomatosis (PC) greatly affects cancer staging and resectability.

Objective: To compare the PC detection rate by using EUS and noninvasive imaging and to determine the impact on staging and resectability.

Design: Retrospective study.

Prospective evaluation of adverse events following lower gastrointestinal tract EUS FNA.

Objectives: There are virtually no data concerning the risk of adverse events (AEs) following lower gastrointestinal (LGI) endoscopic ultrasound (EUS). Our aim was to determine the incidence and factors associated with AEs following LGI EUS fine needle aspiration (FNA).

Methods: We conducted a prospective cohort study at a tertiary referral center.

Endoscopic ultrasound-guided celiac neurolysis.

Intractable abdominal pain commonly develops in patients with pancreatic cancer. Oral pharmacologic therapy is ineffective for many patients and side effects commonly occur. Celiac neurolysis (CN) is sometimes performed to enhance pain relief.

False positive endoscopic ultrasound fine needle aspiration cytology: incidence and risk factors.

Objective: It is broadly accepted that the false positive (FP) rate for endoscopic ultrasound fine needle aspiration (EUS FNA) is 0-1%. It was hypothesised that the FP and false suspicious (FS) rates for EUS FNA are greater than reported. A study was undertaken to establish the rate and root cause of discordant interpretation.

Prospective cytological assessment of gastrointestinal luminal fluid acquired during EUS: a potential source of false-positive FNA and needle tract seeding.

Objectives: Endoscopic ultrasound (EUS) fine needle aspiration (FNA) can result in false-positive cytology and can also cause needle tract seeding. Our goal was to evaluate a potential cause, namely, the presence of malignant cells within gastrointestinal (GI) luminal fluid, either as a result of tumor sloughing from luminal cancers or secondary to FNA of extraluminal sites.

Methods: During EUS, luminal fluid that is usually aspirated through the echoendoscope suction channel and discarded was instead submitted for cytological analysis among patients with cancer and benign disease.

Adequacy of endoscopic ultrasound core needle biopsy specimen of nonmalignant hepatic parenchymal disease.

Background & Aims: The adequacy and diagnostic yield of hepatic parenchymal disease Trucut biopsy have not been determined. Therefore, our aim was to determine the adequacy of endoscopic ultrasound (EUS)-guided Trucut liver biopsy for histopathologic evaluation to include the number of complete portal tracts contained per millimeter of acquired tissue.

Methods: A single institution retrospective review was made of 9 prospectively identified patients who underwent a transgastric left liver lobe EUS-guided Trucut biopsy during a 36-month period.

Secondary linitis plastica of the rectum: EUS features and tissue diagnosis (with video).

Background: Luminal metastases to the GI tract may be seen at the time of the primary diagnosis or may represent evidence of a distant recurrence.

Objectives: To determine the prevalence of rectal-wall metastases in patients undergoing an EUS and to describe the EUS features and yield of EUS-guided FNA (EUS-FNA) and Trucut biopsy (TCB).

Design: A case series.

Prospective evaluation of advanced molecular markers and imaging techniques in patients with indeterminate bile duct strictures.

Background And Aims: Standard techniques for evaluating bile duct strictures have poor sensitivity for detection of malignancy. Newer imaging modalities, such as intraductal ultrasound (IDUS), and advanced cytologic techniques, such as digital image analysis (DIA) and fluorescence in situ hybridization (FISH), identify chromosomal abnormalities, and may improve sensitivity while maintaining high specificity. Our aim was to prospectively evaluate the accuracy of these techniques in patients with indeterminate biliary strictures.

Initial evaluation of the efficacy and safety of endoscopic ultrasound-guided direct Ganglia neurolysis and block.

Background: Celiac plexus neurolysis and block are considered safe but provide limited pain relief. Standard techniques target the region of the celiac plexus but do not attempt injections directly into celiac ganglia. The recent recognition that celiac ganglia can be visualized by endoscopic ultrasound (EUS) now allows direct injection into celiac ganglia for neurolysis (CGN) and block (CGB).

Utility of endoscopic ultrasound in the diagnosis of aberrant right subclavian artery.

Background And Aims: Aberrant right subclavian artery (ARSA) is the most common congenital anomaly of the aortic arch occurring in 0.4-2.0% of the general population.

Rodent endosonography to monitor esophageal cancer.

Animal models of luminal cancers are important to understand and assess chemopreventive and chemotherapeutic interventions. However, the ability to assess tumor growth and response without animal sacrifice is limited. We assessed the ability of luminal sonography to assess the presence of tumor and its size in a surgical esophagojejunostomy model of esophageal cancer.

Preliminary experience comparing routine cytology results with the composite results of digital image analysis and fluorescence in situ hybridization in patients undergoing EUS-guided FNA.

Background: Studies indicate enhanced diagnostic accuracy for digital image analysis (DIA) and fluorescence in situ hybridization (FISH) versus routine cytology examination (RC) when biliary strictures are evaluated. These tumor markers have not been applied to EUS-guided FNA.

Objective: Our purpose was to determine the accuracy of RC versus the composite results of DIA/FISH.

Prospective study of bacteremia and complications With EUS FNA of rectal and perirectal lesions.

Background & Aims: Recent studies showed that endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) is a low-risk procedure for causing bacteremia and infectious complications when sampling solid lesions of the upper gastrointestinal (GI) tract. As a result, antibiotics are not recommended for prophylaxis against endocarditis. Our aim was to prospectively evaluate the risk of bacteremia and other infectious complications in patients undergoing EUS FNA of lower GI tract lesions.

Preoperative diagnosis of extrapancreatic neural invasion in pancreatic cancer.

Background & Aims: Pancreatic cancer recurs in most patients after resection with curative intent. Recurrence is particularly common in patients with extrapancreatic neural invasion (EPNI), the presence of which correlates with poor prognosis. Macroscopic EPNI may be detected with conventional noninvasive imaging and endoscopic ultrasound (EUS) imaging, but microscopic EPNI has required postoperative pathologic examination of surgical specimens.

Frequently asked coding questions.

Current Procedural Terminology (CPT) coding is not an exact science. Although the CPT code set was developed to describe clearly and comprehensively services provided by health care professionals, the intended application of individual codes is not always clear. In addition, coding that may be correct in terms of CPT definitions and instructions may contradict instructions from payment policies set by insurers.

Current procedural terminology, Resource-based Relative Value Scale, and the Center for Medicare and Medicaid Services: overview.

Coding and payment methodology for physician professional services has been standardized through the introduction of the Current Procedural Terminology, which is maintained by the American Medical Association. The codes contained within this dataset are used by health care professionals to describe their services to payers. Inherent in the development of the procedural codes, the Resource Based Relative Value Scale Update Committee recommends physician work relative value units and practice expense and professional liability inputs to the Center for Medicare and Medicaid Services.

Endoscopic ultrasound-guided pain control for intra-abdominal cancer.

This article summarizes percutaneous and surgical methods for performing celiac plexus neurolysis and focuses on the technical aspects of endoscopic ultrasound-guided celiac plexus neurolysis. Published literature concerning endoscopic ultrasound-guided celiac plexus neurolysis is reviewed, indications are proposed, and opinions are offered concerning potential future applications and investigational needs as they apply to this technique.

Routine vs. selective EUS-guided FNA approach for preoperative nodal staging of esophageal carcinoma.

Background: EUS-guided FNA (EUS-FNA) is the most accurate method for lymph-node staging of esophageal carcinoma; however, it may not be necessary when EUS features are present that strongly suggest a benign or a malignant origin.

Aims: (1) To identify a combination of EUS criteria that have a sufficient sensitivity and specificity to preclude the need for EUS-FNA and (2) to assess the cost savings derived from a selective EUS-FNA approach.

Methods: A total of 144 patients with esophageal carcinoma were prospectively evaluated with EUS.

Comparison of positron emission tomography, computed tomography, and endoscopic ultrasound in the initial staging of patients with esophageal cancer.

Introduction: Improvement in esophageal cancer staging is needed. Positron emission tomography (PET), computed tomography (CT), and endoscopic ultrasound (EUS) in the staging of esophageal carcinoma were compared.

Methods: PET, CT, and EUS were performed and interpreted prospectively in 75 patients with newly diagnosed esophageal cancer.