Technical Advances in Endoscopic Ultrasound(EUS)-Guided Tissue Acquisition for Pancreatic Cancers: How Can We Get the Best Results with EUS-Guided Fine Needle Aspiration?

Prashant Kedia,Monica Gaidhane,Michel Kahaleh 대한소화기내시경학회 2013 Clinical Endoscopy Vol.46 No.5

Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is one of the least invasive and most effective modality in diagnosing pancreatic adenocarcinoma in solid pancreatic lesions, with a higher diagnostic accuracy than cystic tumors. EUS-FNA has been shown to detect tumors less than 3 mm, due to high spatial resolution allowing the detection of very small lesions and vascular invasion, particularly in the pancreatic head and neck, which may not be detected on transverse computed tomography. Furthermore, this minimally invasive procedure is often ideal in the endoscopic procurement of tissue in patients with unresectable tumors. While EUS-FNA has been increasingly used as a diagnostic tool, most studies have collectively looked at all primary pancreatic solid lesions, including lymphomas and pancreatic neuroendocrine neoplasms, whereas very few studies have examined the diagnostic utility of EUS-FNA of pancreatic ductal carcinoma only. As with any novel and advanced endoscopic procedure that may incorporate several practices and approaches, endoscopists have adopted diverse techniques to improve the tissue procurement practice and increase diagnostic accuracy. In this article, we present a review of literature to date and discuss currently practiced EUS-FNA technique, including indications, technical details, equipment, patient selection, and diagnostic accuracy.

Endoscopic Guided Biliary Drainage: How Can We Achieve Efficient Biliary Drainage?

Prashant Kedia,Monica Gaidhane,Michel Kahaleh 대한소화기내시경학회 2013 Clinical Endoscopy Vol.46 No.5

Currently, endoscopic retrograde cholangiopancreatography (ERCP) is the preferred procedure for biliary drainage for various pancreatico-biliary disorders. ERCP is successful in 90% of the cases, but is unsuccessful in cases with altered anatomy or with tumors obstructing access to the duodenum. Due to the morbidity and mortality associated with surgical or percutaneous approaches in unsuccessful ERCP cases, biliary endoscopists have been using endoscopic ultrasound-guided biliary drainage (EUS-BD) more frequently within the last decade in different countries. As with any novel advanced endoscopic procedure that incorporates various approaches, advanced endoscopists all over the world have innovated and adopted diverse EUS-BD techniques. Indications for EUS-BD include failed conventional ERCP, altered anatomy, tumor preventing access into the biliary tree and contraindication to percutaneous access (i.e., ascites, etc.). EUS-BD utilizing EUS-guided rendezvous technique is conducted by creating a tract from either the stomach or the duodenum into the bile duct. Although EUS-BD has rapidly been gaining attraction and popularity in the endoscopic world, the indications and methods have yet to be standardized. There are several access routes and techniques that are employed by advanced endoscopists throughout the world for BD. This article reviews the indications and currently practiced EUS-BD techniques, including indications, technical details (intrahepatic or extrahepatic approach), equipment, patient selection, complications, and overall advantages and limitations.

Biological activities of Cuminum cyminum seed oil and its major components against Callosobruchus chinensis and Sitophilus oryzae

Akash Kedia,Prashant Kumar Mishra,Abhishek Kumar Dwivedy,Nawal Kishore Dubey,Bhanu Prakash 한국응용곤충학회 2015 Journal of Asia-Pacific Entomology Vol.18 No.3

The study reports the fumigant, repellent, oviposition deterrent, ovicidal, larvicidal and pupaecidal activities of Cuminum cyminum seed essential oil and its 4 main components (cymene, γ-terpinene, cuminaldehyde and (−)- β-pinene) against Callosobruchus chinensis and Sitophilus oryzae. The essential oil, γ-terpinene and (−)-β-pinene showed pronounced activity in all parameters against both the insects. However, the susceptibility of C. chinensis wasmuch higher than S. oryzae. Cymene and cuminaldehyde showed poormortality to insects but causedmoderate repellency and oviposition deterrency at 100 μl/L air. The essential oil when tested for practical application in protection of food commodities from insect infestation in storage containers, exhibited 100% and 97% feeding deterrent index at 100 μl/L air concentration against C. chinensis and S. oryzae damage respectively without affecting viability of chickpea and wheat. C. cyminum seed essential oil may thus be recommended as eco-friendly and biorational alternatives of synthetic pesticides for management of insect infestation of food commodities.

Peroral Endoscopic Myotomy: Establishing a New Program

Nikhil A. Kumta,Shivani Mehta,Prashant Kedia,Kristen Weaver,Reem Z. Sharaiha,Norio Fukami,Hitomi Minami,Fernando Casas,Monica Gaidhane,Arnon Lambroza,Michel Kahaleh 대한소화기내시경학회 2014 Clinical Endoscopy Vol.47 No.5

Achalasia is an esophageal motility disorder characterized by incomplete relaxation of the lower esophageal sphincter (LES) and aperistalsis of the esophageal body. Treatment of achalasia is aimed at decreasing the resting pressure in the LES. Peroral endoscopic myotomy (POEM), derived from natural orifice transluminal endoscopic surgery (NOTES) and advances in endoscopic submucosal dissection (ESD), presents a novel, minimally invasive, and curative endoscopic treatment for achalasia. POEM involves an esophageal mucosal incision followed by creation of a submucosal tunnel crossing the esophagogastric junction and myotomy before closure of the mucosal incision. Although the procedure is technically demanding and requires a certain degree of skill and competency, treatment success is high (90%) with low complication rates. Since the first described POEM in humans in 2010, it has been used increasingly at centers worldwide. This article reviews available published clinical studies demonstrating POEM efficacy and safety in order to present a proposal on how to establish a dedicated POEM program and reach base proficiency for the procedure.

Endoscopic Ultrasound (EUS)-Directed Transgastric Endoscopic Retrograde Cholangiopancreatography or EUS: Mid-Term Analysis of an Emerging Procedure

Amy Tyberg,Jose Nieto,Sanjay Salgado,Kristen Weaver,Prashant Kedia,Reem Z. Sharaiha,Monica Gaidhane,Michel Kahaleh 대한소화기내시경학회 2017 Clinical Endoscopy Vol.50 No.2

Background/Aims: Performing endoscopic retrograde cholangiopancreatography (ERCP) in patients who have undergone Roux-en-Y gastric bypass (RYGB) is challenging. Standard ERCP and enteroscopy-assisted ERCP are associated with limited success rates. Laparoscopy- or laparotomy-assisted ERCP yields improved efficacy rates, but with higher complication rates and costs. We present the first multicenter experience regarding the efficacy and safety of endoscopic ultrasound (EUS)-directed transgastric ERCP (EDGE) or EUS. Methods: All patients who underwent EDGE at two academic centers were included. Clinical success was defined as successful ERCP and/or EUS through the use of lumen-apposing metal stents (LAMS). Adverse events related to EDGE were separated from ERCP- or EUS-related complications and were defined as bleeding, stent migration, perforation, and infection. Results: Sixteen patients were included in the study. Technical success was 100%. Clinical success was 90% (n=10); five patients were awaiting maturation of the fistula tract prior to ERCP or EUS, and one patient had an aborted ERCP due to perforation. One perforation occurred, which was managed endoscopically. Three patients experienced stent dislodgement; all stents were successfully repositioned or bridged with a second stent. Ten patients (62.5%) had their LAMS removed. The average weight change from LAMS insertion to removal was negative 2.85 kg. Conclusions: EDGE is an effective, minimally invasive, single-team solution to the difficulties associated with ERCP in patients with RYGB.

Endoscopic Gallbladder Drainage for Acute Cholecystitis

Jessica Widmer,Paloma Alvarez,Reem Z. Sharaiha,Sonia Gossain,Prashant Kedia,Savreet Sarkaria,Amrita Sethi,Brian G. Turner,Jennifer Millman,Michael Lieberman,Govind Nandakumar,Hiren Umrania,Monica Gaid 대한소화기내시경학회 2015 Clinical Endoscopy Vol.48 No.5

Background/Aims: Surgery is the mainstay of treatment for cholecystitis. However, gallbladder stenting (GBS) has shown promise in debilitated or high-risk patients. Endoscopic transpapillary GBS and endoscopic ultrasound-guided GBS (EUS-GBS) have been proposed as safe and effective modalities for gallbladder drainage. Methods: Data from patients with cholecystitis were prospectively collected from August 2004 to May 2013 from two United States academic university hospitals and analyzed retrospectively. The following treatment algorithm was adopted. Endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy and cystic duct stenting was initially attempted. If deemed feasible by the endoscopist, EUS-GBS was then pursued. Results: During the study period, 139 patients underwent endoscopic gallbladder drainage. Among these, drainage was performed in 94 and 45 cases for benign and malignant indications, respectively. Successful endoscopic gallbladder drainage was defined as decompression of the gallbladder without incidence of cholecystitis, and was achieved with ERCP and cystic duct stenting in 117 of 128 cases (91%). Successful endoscopic gallbladder drainage was also achieved with EUS-guided gallbladder drainage using transmural stent placement in 11 of 11 cases (100%). Complications occurred in 11 cases (8%). Conclusions: Endoscopic gallbladder drainage techniques are safe and efficacious methods for gallbladder decompression in non-surgical patients with comorbidities.

Superior Specimen and Diagnostic Accuracy with Endoscopic Ultrasound-Guided Liver Biopsies Using 19-Gauge versus 22-Gauge Core Needles

Rucha M. Shah,Jason Schmidt,Elizabeth John,Sheila Rastegari,Priyanka Acharya,Prashant Kedia 대한소화기내시경학회 2021 Clinical Endoscopy Vol.54 No.5

Background/Aims: Endoscopic ultrasound-guided liver biopsy (EUS-LB) is an effective and safe method of procuring liver tissue. The aims of this study were to assess and compare the outcomes and tissue adequacy of a single-pass, single-actuation, wet suctiontechnique between 19 G and 22 G needles in patients undergoing EUS-LB. Methods: We performed a prospective case series study of 20 patients undergoing EUS-LB at a single center between September2017 and April 2020. The primary objective was to evaluate differences in sample adequacy via a single actuation wet suctiontechnique between a 19 G core needle and a 22 G core needle. Adequacy was gauged by cumulative core biopsy length and thenumber of portal tracts visualized. Results: The 19 G needle provided a longer core length (2.5 cm vs. 1.2 cm, p<0.0001), more complete portal tracts (5.8 vs. 1.7,p<0.0001), more total tracts (8.8 vs. 3, p<0.0001), and a longer, intact, fragment length (0.75 cm vs. 0.32 cm, p<0.0006). The 19 Gneedle was superior in providing adequate (60% vs. 5%, p<0.001) and diagnostic pathologic samples (85% vs. 10%, p<0.001). Conclusions: A single-pass, single-actuation, wet suction technique using a 19 G needle is superior to that using a 22 G needle fortissue acquisition and sample adequacy in EUS-LB.