Development of the Asian EUS Group consensus in pancreatic pseudocyst drainage

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.

Current status on the diagnosis and evaluation of pancreatic tumor in Asia with particular emphasis on the role of endoscopic ultrasound.

In Asia, the incidence of pancreatic cancer in some countries has been increasing. Owing to most cases being diagnosed late, prognosis for pancreatic cancer remains dismal. It is clear that the future for pancreatic cancer lies in early detection. While the possible presence of pancreatic masses is often first raised by non-invasive abdominal imaging, such as computerized tomography and magnetic resonance imaging, smaller lesions and locoregional lymph node metastases are often not detectable by these means. Endoscopic ultrasonography (EUS) offers a higher sensitivity (93-100%) for detection of small potentially curable pancreatic masses than other existing imaging modalities. It is also recommended for the evaluation of portal vein confluence, portal vein, celiac axis, and superior mesentric artery origin, and exclusion of resectability. Due to the closer proximity of EUS to the target structure, and lower rate of needle tract seeding, EUS-guided fine-needle aspiration of pancreatic mass is considered the most suitable tissue acquisition technique. Lastly, EUS also enables the performance of endoscopic interventions. Its performance can be further enhanced with newer techniques, including contrast-enhanced ultrasound and elastrography. It is anticipated that in the near future, molecular technologies may make it possible to detect microscopic amounts of cancer in tissue or blood, predict relapse and survival after therapy, as well as determine optimal therapy.

Application of endoscopic ultrasonography in the diagnosis and management of gastrointestinal cancers / 中华胃肠外科杂志

Since its initial introduction in clinical practice, endoscopic ultrasonography(EUS) has been considered as a valuable tool for the diagnosis and staging of gastrointestinal cancers. With the improvement of equipments in the past decade, EUS-guided fine needle aspiration (EUS-FNA) techniques has been greatly developed, which opens a new avenue to therapeutic EUS. At present, endoscopic ultrasonography (EUS) has been widely applied in the clinical practice of the diagnosis and management of gastrointestinal cancers. In this paper, we summarize the latest data of the applications of EUS in the diagnosis and management of gastrointestinal cancers.

Endoscopic ultrasonography guided interstitial iodine 125 seed implantation in treatment of unresectable pancreatic cancer / 中华消化杂志

Objective To analyze the effect of endoscopic ultrasonography guided interstitial iodine 125 seed implantation in treatment of unresectable pancreatic cancer and migration of implanted seeds. Methods A total of 17 patients with unresectale pancreatic cancer underwent endoscopic ultrasono- graphy guided interstitial iodine seeds implantation.The therapeutic plan system was used to calculate the number of implanted seeds before procedure.The patients were followed-up monthly and tumor alteration and migration number or loss of implanted seeds were investigated by abdominal plain film.Results Io- dine 125 seeds were successfully implanted in all patients under endoscopic ultrasonography. Before treatment,the median size of tumor was 5.4cm(ranged from 3.7 to 9.0cm)and the number of implan- ted seeds was 27,with median 14(ranged from 7 to 24)once for 2 times.The mean radioactivity per seed was(0.6894?0.016)mCi.The patients were follow-up of 2 to 14 months(mean 4.8 months). Three months after implantation,partial relief was observed in 5 patients(29.4%),no change in 7 patients(41.2%)and progressing in 5 patients(29.4%).The implanted seeds migrated into spleen in 1 case, into liver in 1 case and into bowel in 3 cases.The seeds loss was found in 4 patients.Conclusions Endoscopic uhrasonography guided interstitial implantation of iodine 125 seeds in treatment of advanced pancreatic cancer may significantly inhibit tumor growth,and attention must be paied on the complications of seeds migration or loss,which will impair the nearby organs because of its radioactivity.