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Background It is unknown whether there is an advantage to using the wet-suction or slow-pull technique during endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) with new-generation needles. We aimed to compare the performance of each technique in EUS-FNB. Methods This was a multicenter, randomized, single-blind, crossover trial including patients with solid lesions of ≥ 1 cm. Four needle passes with 22 G fork-tip or Franseen-type needles were performed, alternating the wet-suction and slow-pull techniques in a randomized order. The primary outcome was the histological yield (samples containing an intact piece of tissue of at least 550 μm). Secondary end points were sample quality (tissue integrity and blood contamination), diagnostic accuracy, and adequate tumor fraction. Results Overall, 210 patients with 146 pancreatic and 64 nonpancreatic lesions were analyzed. A tissue core was retrieved in 150 (71.4 %) and 129 (61.4 %) cases using the wet-suction and the slow-pull techniques, respectively (P = 0.03). The mean tissue integrity score was higher using wet suction (P = 0.02), as was the blood contamination of samples (P < 0.001). In the two subgroups of pancreatic and nonpancreatic lesions, tissue core rate and tissue integrity score were not statistically different using the two techniques, but blood contamination was higher with wet suction. Diagnostic accuracy and tumor fraction did not differ between the two techniques. Conclusion Overall, the wet-suction technique in EUS-FNB resulted in a higher tissue core procurement rate compared with the slow-pull method. Diagnostic accuracy and the rate of samples with adequate tumor fraction were similar between the two techniques. [ABSTRACT FROM AUTHOR]

Management of upper gastrointestinal (UGI) tract gastrointestinal stromal tumor (GIST) has evolved significantly over the past two decades. For GIST size smaller than 5 cm, laparoscopic resection has become the current standard. To avoid postoperative gastric deformity and preserve gastric function, laparoscopic endoscopic cooperative surgery (LECS) was developed and various modifications have been reported and utilized successfully. Pure endoscopic resection techniques have also been reported at a similar period of time, which further push the boundary of incisionless surgery in managing these lesions. Both tunneling and nontunneling exposed type endoscopic full thickness resection are well described procedures for resection of small UGI GIST. In this review, a summary of these procedures is provided, and the pros and cons of each technique from the perspective of a surgical endoscopist are discussed in detail. LECS and endoscopic resection are complementary to each other. The choice of technique should be tailored to the location, morphology, and size of the target lesions, taking into account the experience of the laparoscopic surgeons and endoscopists. [ABSTRACT FROM AUTHOR]

Metabolic syndrome (MetS) and its components may link to pancreatic cancer risk; however, current epidemiological evidence is limited, and the potential mechanisms underlying the associations remain unclear. To investigate this, we carried out this prospective cohort study of 474 929 participants without a diagnosis of cancer based on UK Biobank dataset. MetS was defined according to the International Diabetes Federation criteria and pancreatic cancer was identified through linkage to UK cancer registries (median follow‐up time: 6.6 years). We evaluated hazard ratio (HR) and 95% confidence interval (CI) with Cox proportional hazards regression, adjusting for demography and lifestyle factors. Restricted cubic spline was performed for each MetS component to investigate their possible nonlinear associations with risk of pancreatic cancer. During 3 112 566 person‐years of follow‐up, 565 cases of pancreatic cancer were identified. Individuals with MetS (HR = 1.31, 95% CI, 1.09‐1.56), central obesity (HR = 1.24, 95% CI, 1.02‐1.50) and hyperglycemia (HR = 1.60, 95% CI, 1.31‐1.97) had increased risk of pancreatic cancer. Higher waist circumference (WC) and blood glucose were independently associated with pancreatic cancer, with no evidence against nonlinearity. Although elevated CRP (≥1.00 mg/dL) showed a positive association with the risk for pancreatic cancer, the effect was substantially increased only in participants with MetS and CRP ≥1.00 mg/dL. Our study demonstrated a positive association between MetS and increased risk of pancreatic cancer, with two of the MetS components, WC and blood glucose, showing independent associations in linear manner. Our study also suggested a potential joint effect of MetS and CRP in pancreas tumorigenesis. What's new? Metabolic syndrome (MetS) and its predominant components, notably central obesity, increased triglycerides, and insulin resistance, are suspected risk factors for pancreatic cancer. Details regarding these potential associations, however, remain largely unknown. Here, based on data from the UK Biobank, the authors identified independent associations between two MetS components—waist circumference and blood glucose—and increased risk of pancreatic cancer. Elevated levels of C‐reactive protein (CRP) were also associated with increased pancreatic cancer risk, with substantial increases in risk observed in patients with MetS and elevated CRP, suggesting a possible joint effect of MetS and CRP in pancreatic tumorigenesis. [ABSTRACT FROM AUTHOR]

Background and Aim: Secondary prophylaxis (SP) of variceal rebleeding was reported to improve outcomes of hepatocellular carcinoma (HCC) patients, but the optimal endoscopic approach is not well defined. We compared outcomes in HCC patients who underwent SP by endoscopic ultrasound‐guided cyanoacrylate obturation (EUS‐CYA) versus no SP. Methods: Between 2014 and 2018, 30 consecutive patients with inoperable HCC and recent endoscopically controlled variceal bleeding were prospectively recruited. Twenty‐seven patients with persistent varices ≥ 3 mm on endoscopic ultrasound underwent EUS‐CYA for SP. Thirty‐three HCC patients treated by esophagogastroduodenoscopy‐guided CYA obturation (EGD‐CYA) alone for acute variceal bleeding between 2009 and 2013 were identified from a prospective gastrointestinal bleed registry as standard of care controls for comparison. Outcome measures were death‐adjusted cumulative incidence of rebleeding, bleeding‐free survival, technical success, and procedure‐related adverse events of EUS‐CYA. Results: The majority of patients in both groups had advanced HCC, portal vein thrombosis, and Child–Pugh B cirrhosis. EUS‐CYA was successful in all 27 patients with no radiographic evidence of cyanoacrylate–lipiodol embolization. Significantly lower 30‐ and 90‐day death‐adjusted cumulative incidence of rebleeding (14.8% vs 42.4%, P = 0.023 and 18.5% vs 60.6%, P = 0.002, respectively) and significantly higher variceal bleeding‐free survival at 3 and 6 months (51.9% vs 21.2%, P = 0.009, 40.7% vs 15.2%, P = 0.010, respectively) were observed in the EUS‐CYA group when compared with standard of care group. Conclusions: Secondary prophylaxis by EUS‐CYA reduced rebleeding rate and improved variceal bleeding‐free survival in patients with inoperable HCC and variceal bleeding when compared with no SP. Randomized studies are needed to confirm the benefits of EUS‐CYA for this difficult‐to‐treat population. [ABSTRACT FROM AUTHOR]

The novel coronavirus disease 2019 (COVID-19) pandemic has unfolded with remarkable speed, posing unprecedented challenges for health care systems and society. Otolaryngologists have a special role in responding to this crisis by virtue of expertise in airway management. Against the backdrop of nations struggling to contain the virus's spread and to manage hospital strain, otolaryngologists must partner with anesthesiologists and front-line health care teams to provide expert services in high-risk situations while reducing transmission. Airway management and airway endoscopy, whether awake or sedated, expose operators to infectious aerosols, posing risks to staff. This commentary provides background on the outbreak, highlights critical considerations around mitigating infectious aerosol contact, and outlines best practices for airway-related clinical decision making during the COVID-19 pandemic. What otolaryngologists need to know and what actions are required are considered alongside the implications of increasing demand for tracheostomy. Approaches to managing the airway are presented, emphasizing safety of patients and the health care team. [ABSTRACT FROM AUTHOR]

Objective. To evaluate the possible biological effect of allogenic mesenchymal stem cells (MSCs) combined with tissue fusion technology on the anastomosis. Methods. Sixteen pigs were divided into a 7 d group and 14 d group, each of which was further subdivided into an MSC-treated group and a control group. Five anastomoses per animal were established using LigaSure ForceTriad (Covidien, MA, USA), a tissue sealing system. Cell migration and tissue-specific differentiation potency, in addition to potential cytokine and genetic changes, were investigated. Results. There were no significant between-group differences in postoperative complications and anastomosis burst pressure. The number of proliferating cell nuclear antigen- (PCNA-) positive cells was significantly higher in the MSC-treated group as compared with that in the control group (P = 0.021). Labeled MSCs were found in the mucosal layer, villus, and lamina propria, as well as in the lamina muscularis mucosae, where they exhibited characteristics of smooth muscle cells. Conclusions. Grafted MSCs significantly promoted epithelial and connective cell proliferation and maintained their cell migration capacity and differentiation potential in the fused anastomotic tissues, without causing severe postoperative complications. [ABSTRACT FROM AUTHOR]

Endoscopic ultrasound (EUS)-guided drainage is now firmly established as the best option for drainage of walled-off pancreatic fluid collections (PFC). It has high clinical efficacy, similar to surgical and percutaneous approaches, but with lower morbidity and costs. It is superior to non-EUS-guided approaches because even collections without endoluminal bulging can be successfully drained. Transmural drainage alone is sufficient for pseudocysts, but in the context of walled-off pancreatic necrosis (WON), adjunctive direct endoscopic necrosectomy (DEN) may be required. Traditionally, double pigtail plastic stents (PS) were used for transmural drainage, but, recently, fully covered self-expandable metallic stents (FCSEMS) customized for PFC drainage have become available and are increasingly used, especially in the management of WON, because the larger-diameter stent facilitates drainage and insertion of an endoscope into the WON cavity for DEN. The present review will discuss the evidence for EUS-guided drainage and DEN, the technical problems involved, and the roles of PS and FCSEMS in PFC drainage. [ABSTRACT FROM AUTHOR]

Drainage of obstructed bile duct and pancreatic duct under endoscopic ultrasonography (EUS) guidance has evolved into viable techniques suitable for patients with failed endoscopic retrograde cholangiopancreatography (ERCP) and/or altered surgical anatomy. One of the major advantages of EUS guidance is the possibility of multiple access points depending upon patient and ductal anatomy. Unlike ERCP, an approachable papilla is not a requisite for successful EUS-guided biliary or pancreatic ductal drainage. Moreover, as the access is away from the papilla, there is the possibility of reduced pancreatitis. A variety of procedures have become available for EUS-guided drainage, and it is important to develop standard terminology and procedural details. EUS-specific stents, including lumenapposing metal stents have recently become available, and are likely to impact the outcomes of these procedures. Available data show a high success rate and acceptable adverse event rate for EUS-guided biliary drainage. Success rate appears to be low for pancreatic duct drainage because of a variety of reasons. Outcomes of EUS-guided biliary drainage appear equivalent to percutaneous drainage and ERCP. EUS-guided gallbladder drainage appears promising for patients requiring gallbladder drainage but unfit for surgery. Further large controlled studies are needed to evaluate the exact role of these procedures. [ABSTRACT FROM AUTHOR]

The article presents a multicentre and prospective study to determine feasibility and safety of the use of lumen-apposing metal stents (LAMSs) for endoscopic ultrasound-guided gall bladder drainage (EUS-GBD) in high-risk surgical patients with acute cholecystitis. Topics discussed include no LAMSs performed in half of patients due to poor clinical condition, close monitoring of safety during the study and success of EUS-GBD using LAMS in high-risk surgical patients.

Background and Aim: The role of prophylactic endoscopic sphincterotomy in patients with transient common bile duct obstruction is controversial. The aim of this study was to assess the value of performing prophylactic endoscopic sphincterotomy in patients suffering from acute biliary pancreatitis and absent common bile duct stones on endoscopic retrograde cholangiopancreatography (ERCP). Methods: Hospital notes of patients admitted to our unit with a diagnosis of acute pancreatitis from January 2000 to January 2005 were reviewed. Endoscopic sphincterotomy was performed when patients were deemed unfit for cholecystectomy, suffering from a severe attack of acute pancreatitis and/or showing evidence of transient common bile duct obstruction. The outcomes of patients with and without endoscopic sphincterotomy were compared. Results: A total of 427 patients were admitted with a diagnosis of acute pancreatitis during the study period. Eighty-eight patients with absent common bile duct stones on ERCP were identified. Endoscopic sphincterotomy was performed in 71 patients and not performed in 17 patients. There was no significant difference in recurrent pancreatitis rates (1.4% vs 5.8%, P = 0.35), recurrent biliary complication rates (5.6% vs 5.9%, P = 1) or mortality rates (5.8% vs 1.5%, P = 0.35). The time to recurrent complications (38.4 days vs 41.0 days, P = 0.38) was not significantly different between the two groups. There was no ERCP-related morbidity or mortality. Conclusion: Prophylactic endoscopic sphincterotomy is not recommended in patients with transient common bile duct obstruction or as an option to cholecystectomy in elderly patients. Early cholecystectomy should be performed. [ABSTRACT FROM AUTHOR]

Cystic dilatation of the terminal ventral main pancreatic duct was first termed Wirsungocele in 2004 following an incidental finding [1]. In conclusion, this is the first video-reported case of a Wirsungocele with recurrent acute pancreatitis that was successfully treated with endoscopic sphincterotomy and balloon dilation. This section has its own submission website at https://mc.manuscriptcentral.com/e-videos References 1 Abu-Hamda E. M., Baron T. H. Cystic dilatation of the intraduodenal portion of the duct of Wirsung (Wirsungocele). [Extracted from the article]

Introduction: Biliary cystadenomas are complicated cystic lesions of the liver. They are rare and pose considerable diagnostic and therapeutic challenges. Methods: We present our experience managing these lesions by performing a retrospective review of all patients with a preoperative diagnosis of or histologically proven biliary cystadenoma who underwent surgery between January 1995 and January 2005 at our institution. Altogether, 20 patients (16 women, 4 men) with a mean age of 58 years underwent a total of 22 operations. The diagnosis of biliary cystadenoma was based on exclusion of other pathologic entities and the presence of radiologic characteristics of biliary cystadenoma. Abdominal ultrasonography (US), computed tomography, or both were performed in all patients. US-guided fine-needle aspiration cytology was performed in seven patients and all of them were negative for malignancy. A preoperative diagnosis of biliary cystadenoma was made in 16 patients based on clinical and radiologic features and was correct in 6 of them. Diagnosis of biliary cystadenoma was not suspected in four patients. Results: The overall diagnostic accuracy was 30%. Enucleation was the most common surgical procedure and was performed in 10 patients. The mean follow-up period was 5.5 ± 2.8 years. No recurrence was detected in patients with confirmed biliary cystadenoma after adequate excision. Conclusions: The findings of this study highlight the difficulty with preoperative diagnosis of biliary cystadenoma, which has seldom been discussed in the literature. Preoperative differentiation by means of radiologic imaging is inaccurate (30%). Any therapy short of complete excision leads to local recurrence and risk of malignant transformation. Complete excision of any suspicious lesion remains the best method of diagnosis and treatment. [ABSTRACT FROM AUTHOR]

The article presents case study of a 50-year-old man who underwent endoscopic salvage of a duodenal stump leak and surgical transection of the ampulla. It mentions information on observation of extensive progression of the tumor upon computed tomography (CT) scan. It states that internal biliary drainage was achieved by endoscopic ultrasonography (EUS)-guided choledochoduodenostomy using a lumen-apposing stent.

Introduction: The aim of this retrospective study was to assess the feasibility and outcome of day case thyroidectomy in an ambulatory surgery centre in Hong Kong. Methods: Patients with day case thyroidectomy carried out between July 2005 and December 2006 were retrospectively reviewed. Day surgery was offered to patients satisfying the selection criteria for day case and having from benign unilobular thyroid disease. Results: Fifty patients had hemithyroidectomy carried out during the study period. There were 6 men and 44 women and the mean (standard deviation SD) age was 45.6 years (7.4 years). All patients were American Society for Anesthesiologists grade I (76%) or II (34%). The mean (SD) operative time was 79.5 min (17 min). Twelve patients had episodes of postoperative nausea and vomiting. The mean (SD) analgesic requirement was 0.7 tablets (0.5 tablets) of combination acetaminophen and phenyltoloxamine citrate before discharge. The mean (SD) time to discharge was 7.5 h (0.7 h). The overall discharge rate was 98% and the complication rate was 8%. One patient was observed overnight because of postoperative haematoma. One patient had recurrent laryngeal nerve injury. There were no unplanned readmissions postoperatively. Three patients had unsuspected thyroid malignancy on histopathology. Conclusion: This study showed the feasibility and safety of day case thyroidectomy. The setting was not associated with any increase in morbidity or mortality and has the potential in reducing hospital costs. [ABSTRACT FROM AUTHOR]

The author reflects on endoscopic alternatives such as endoscopic transpapillary gallbladder drainage and endoscopic ultrasound (EUS)‑guided gallbladder drainage (EGBD) to cure Percutaneous cholecystostomy or percutaneous transhepatic gall bladder drainage (PTGBD) where patients suffer from acute cholecystitis.

The article presents a case study of a 60-year-old man who was admitted for the surgery and treatment of rupture of esophagus.

The article presents case study of a 87-year-old man with multiple medical co-morbidities and gallbladder carcinoma. It is noted that the case is also the first description of a gallbladder adenocarcinoma discovered through endoscopy. It is noted that the patient was initially found having distended gallbladder with gallstones and acute cholecystitis.

The article discusses factors the influences thyroid cancer surgery choices in Australia. The authors mention that the extent of thyroid cancer surgery depends on the size of thyroid lesion and histological cell type, wherein those tumors less than one centimeter are treated by lobectomy, otherwise thyroidectomy. Moreover, they believe that before surgery is done, doctors should also consider the overall survival and disease-free survival of patients.