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Shyam Varadarajulu - One of the best experts on this subject based on the ideXlab platform.

  • Advances in Endoscopic Ultrasound-guided tissue acquisition
    Techniques in Gastrointestinal Endoscopy, 2017
    Co-Authors: Silvia Carrara, Francesco Auriemma, Shyam Varadarajulu
    Abstract:

    Abstract Endoscopic Ultrasound-guided fine-needle aspiration has evolved to become an indispensable tool for tissue acquisition in patients with gastrointestinal tumors. The technique is useful for sampling of both luminal and extraluminal lesions adjacent to the gastrointestinal tract. A major limitation however has been the inability to procure tissue for histologic analysis. Recently, core biopsy needles have been developed to procure histology-grade material that facilitates both a reliable diagnosis and the ability to conduct molecular profiling for deliverance of personalized anticancer therapy. This review provides a perspective on technical issues that are key for best practices in Endoscopic Ultrasound-guided tissue acquisition.

  • Endoscopic Ultrasound: a primer for pathologists
    Diagnostic Histopathology, 2015
    Co-Authors: Bronte A. Holt, Shyam Varadarajulu
    Abstract:

    Endoscopic Ultrasound-guided fine needle aspiration is a multi-step procedure that involves appropriate clinical indication and selection of needles, adapting evidence-based sampling techniques, and establishing reliable cytopathology support. Integrating cytopathology in the training curriculum and developing a more flexible platform of needles and echoendoscopes are likely to further advance the field of endosonography. This review aims to summarize the technical issues that are key to performing high quality Endoscopic Ultrasound-guided fine needle aspiration.

  • Endoscopic Ultrasound guided abscess drainage
    Gastrointestinal Endoscopy Clinics of North America, 2012
    Co-Authors: Ganapathy A Prasad, Shyam Varadarajulu
    Abstract:

    : Abdominal and pelvic abscesses have traditionally been drained by percutaneous techniques or surgery. While surgical drainage is associated with considerable morbidity and mortality, percutaneous techniques are associated with the need for multiple interventions, increased length of hospital stay, and an indwelling external catheter for prolonged periods. Endoscopic Ultrasound (EUS) is a minimally invasive but highly effective technique that enables internal drainage of the abscess. Although data are limited, evidence supporting its clinical efficacy is increasing rapidly. This article summarizes the current status of EUS-guided approach for drainage of gastrointestinal abscess collections.

Tarun Rustagi - One of the best experts on this subject based on the ideXlab platform.

  • Endoscopic Ultrasound-Guided Gallbladder Drainage
    Digestive Diseases and Sciences, 2020
    Co-Authors: Zain A. Sobani, Christina Ling, Tarun Rustagi
    Abstract:

    The mainstay of management of acute cholecystitis is surgical. Despite the advances in anesthesia and laparoscopic surgery, there is a significant pool of patients that are not candidates for surgery given their significant comorbidities and limited functional reserve. Historically percutaneous gallbladder drainage has been utilized to temporize these patients. Recently, Endoscopic approaches are being explored with transpapillary and transmural drainage. In this article, we discuss the background, current status, technical challenges, adverse events, and outcomes of Endoscopic Ultrasound-guided gallbladder drainage for management of acute cholecystitis.

Michael B. Wallace - One of the best experts on this subject based on the ideXlab platform.

  • Optimizing Endoscopic Ultrasound Guided Tissue Sampling of the Pancreas
    Journal of the Pancreas, 2016
    Co-Authors: Pujan K, Michael B. Wallace
    Abstract:

    Endoscopic Ultrasound is an important innovation in the field of gastrointestinal endoscopy and allows evaluation of many organs in the vicinity of the gastrointestinal tract. Endoscopic Ultrasound-fine needle aspiration has been established to be an important tool in the management of pancreaticobiliary disease and is used for screening, staging, biopsy confirmation, and palliation. The accuracy of Endoscopic Ultrasound-fine needle aspiration is affected by several factors such as different needle sizes and types and fine needle aspiration techniques. Several comparative studies have been published on various techniques, such as the use of a stylet and suction during fine needle aspiration. Although most studies demonstrate high accuracy across techniques and equipment, various fine needle biopsy histology needles have been studied to compare the advantage of fine needle biopsy over fine needle aspiration. Although fine needle biopsy needles provide better tissue architecture and require fewer numbers of passes, there is no significant evidence of the superiority of fine needle biopsy over fine needle aspiration with regard to diagnostic yield and core tissue procurement. The main aim of this article is to review the various methodologies for improving the practice of Endoscopic Ultrasound-fine needle aspiration and Endoscopic Ultrasound- fine needle biopsy tissue sampling for cytological and histological analysis.

  • The role of Endoscopic Ultrasound in the evaluation of chronic mesenteric ischaemia.
    Digestive and Liver Disease, 2011
    Co-Authors: Cristina Almansa, Michael B. Wallace, Helga Bertani, Kyung W. Noh, Timothy A. Woodward, Massimo Raimondo
    Abstract:

    Abstract Introduction Doppler transabdominal Ultrasound is a validated screening test for chronic mesenteric ischaemia, but gas and obesity are limitations. Endoscopic Ultrasound has been proposed as a comprehensive test to evaluate chronic upper abdominal pain and is capable of Doppler measurement. We aim to evaluate the accuracy of Doppler Endoscopic Ultrasound (D-EUS) as a single screening test to rule out chronic mesenteric ischaemia in patients with abdominal pain and compare it with Doppler transabdominal Ultrasound (D-TUS). Methods We enrolled all patients ≥50 years with chronic upper abdominal pain and vascular risk referred for Endoscopic Ultrasound. All were scheduled for D-EUS and D-TUS plus a confirmatory test if one of the previous resulted positive. We estimated the accuracy of both techniques comparing them using McNemar test. Results 68 patients completed the study. Fifty-three (78%) underwent D-EUS, D-TUS, and a confirmatory test. Fifteen (38%) underwent follow-up after negative results. Three (4%) in the D-EUS group and 14 in the D-TUS (21%) were excluded due to artefacts. D-EUS presented a sensitivity of 63%, specificity of 84%, whilst D-TUS presented a sensitivity of 80% and a specificity of 78%. Specificity of D-EUS was not significantly different to D-TUS. Conclusions These results support the role of Doppler Endoscopic Ultrasound to exclude chronic mesenteric ischaemia as cause of chronic abdominal pain.

  • Endoscopic Ultrasound and upper gastrointestinal disorders.
    Journal of Clinical Gastroenterology, 2003
    Co-Authors: William E. Fickling, Michael B. Wallace
    Abstract:

    Abstract Endoscopic Ultrasound (EUS) plays a vital role in management of upper gastrointestinal disorders, particularly cancer of the esophagus, pancreas, stomach, lung (via transesophageal mediastinal staging), and bile duct. Endoscopic Ultrasound has also been valuable in detection of early chronic pancreatitis (CP). In cancer of the esophagus, the primary role of EUS is to determine whether disease is localized (T1–2, N0) and appropriate for surgery, locally advanced (T3–4, N1, M1a) (which may benefit from chemoradiation with or without surgery), or metastatic. Pancreatic and bile duct cancers are more complex given the controversy over portal vein resection. In centers that resect tumors invading the portal venous system, the role of EUS is limited to tissue confirmation or identification of metastases to the liver or distant lymph nodes. In centers that do not resect the portal vein invasion, EUS plays an important role in local staging. In lung cancer, EUS is emerging as an accurate, nonsurgical alternative to staging the mediastinum through EUS fine-needle aspiration. Endoscopic Ultrasound has an important role in diagnosing CP because of its high degree of sensitivity. This has also led to controversy over whether EUS can overdiagnose CP. For these reasons, we recommend the use of a high threshold for EUS and that CP be diagnosed in conjunction with other standard tests (Endoscopic retrograde cholangiopancreatography, pancreatic function tests).

  • Endoscopic Ultrasound guided fine needle aspiration for staging patients with carcinoma of the lung
    The Annals of Thoracic Surgery, 2001
    Co-Authors: Michael B. Wallace, Robert H. Hawes, Brenda J. Hoffman, Gerard A Silvestri, Anand V Sahai, Valerie Durkalski, Winnie S Hennesey, Carolyn E Reed
    Abstract:

    Abstract Background . Endoscopic Ultrasound (EUS)-guided fine needle aspiration is a safe, cost-effective procedure that can confirm the presence of mediastinal lymph node metastases and mediastinal tumor invasion. We studied the accuracy of EUS in a large population of lung cancer patients with and without enlarged mediastinal lymph nodes on computed tomographic (CT) scan. Methods . From 1996 to 2000 all patients referred to our institution with lung tumors and no proven distant metastases were considered for EUS and surgical staging. Patients had Endoscopic Ultrasound with fine needle aspiration of abnormal appearing mediastinal lymph nodes and evaluation for mediastinal invasion of tumor (stage III or IV disease). Patients without confirmed stage III or IV disease had surgical staging. Results . Two hundred seventy-seven patients met the inclusion criteria, including 121 who had EUS. Endoscopic Ultrasound and fine needle aspiration detected stage III or IV disease in 85 of 121 (70%). Among patients with enlarged lymph nodes on CT, 75 of 97 (77%) had stage III or IV disease detected by EUS. Among a small cohort of patients without enlarged mediastinal lymph nodes on CT, 10 of 24 (42%) had stage III or IV disease detected by EUS. For mediastinal lymph nodes only, the sensitivity of Endoscopic Ultrasound and CT was 87%. The specificity of EUS (100%) was superior to that of CT (32%) ( p Conclusions . Endoscopic Ultrasound with fine needle aspiration identified and histologically confirmed mediastinal disease in more than two thirds of patients with carcinoma of the lung who have abnormal mediastinal CT scans. Although mediastinal disease was more likely in patients with an abnormal mediastinal CT, EUS also detected mediastinal disease in more than one third of patients with a normal mediastinal CT and deserves further study. Endoscopic Ultrasound should be considered a first line method of presurgical evaluation of patients with tumors of the lung.

Zain A. Sobani - One of the best experts on this subject based on the ideXlab platform.

  • Endoscopic Ultrasound-Guided Gallbladder Drainage
    Digestive Diseases and Sciences, 2020
    Co-Authors: Zain A. Sobani, Christina Ling, Tarun Rustagi
    Abstract:

    The mainstay of management of acute cholecystitis is surgical. Despite the advances in anesthesia and laparoscopic surgery, there is a significant pool of patients that are not candidates for surgery given their significant comorbidities and limited functional reserve. Historically percutaneous gallbladder drainage has been utilized to temporize these patients. Recently, Endoscopic approaches are being explored with transpapillary and transmural drainage. In this article, we discuss the background, current status, technical challenges, adverse events, and outcomes of Endoscopic Ultrasound-guided gallbladder drainage for management of acute cholecystitis.

Pietro Fusaroli - One of the best experts on this subject based on the ideXlab platform.