Background: Although endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) using lumen-apposing metal stents (LAMS) has become one of the treatments of choice for acute cholecystitis (AC) in fragile patients, scant data are available on real-life settings and long-term outcomes. Methods: We performed a multicenter retrospective study including EUS-guided GBD using LAMS for AC in 19 Italian centers from June 2014 to July 2020. The primary outcomes were technical and clinical success, and the secondary outcomes were the rate of adverse events (AE) and long-term follow-up. Results: In total, 116 patients (48.3% female) were included, with a mean age of 82.7 ± 11 years. LAMS were placed, transgastric in 44.8% of cases, transduodenal in 53.3% and transjejunal in 1.7%, in patients with altered anatomy. Technical success was achieved in 94% and clinical success in 87.1% of cases. The mean follow-up was 309 days. AEs occurred in 12/116 pts (10.3%); 8/12 were intraprocedural, while 1 was classified as early (15 days). According to the ASGE lexicon, two (16.7%) were mild, three (25%) were moderate, and seven (58.3%) were severe. No fatal AEs occurred. In subgroup analysis of 40 patients with a follow-up longer than one year, no recurrence of AC was observed. Conclusions: EUS-GBD had high technical and clinical success rates, despite the non-negligible rate of AEs, thus representing an effective treatment option for fragile patients.

Objectives: Repeated endoscopic ultrasound (EUS)‐guided tissue acquisition represents the standard practice for solid pancreatic lesions after previous nondiagnostic or inconclusive results. Since data are lacking, we aimed to evaluate the diagnostic performance of repeated EUS fine‐needle biopsy (rEUS‐FNB) in this setting. The primary outcome was diagnostic accuracy; sample adequacy, sensitivity, specificity, and safety were secondary outcomes.Methods: Consecutive patients undergoing rEUS‐FNB for solid pancreatic lesions at 23 Italian centers from 2019 to 2021 were retrieved. Pathology on the surgical specimen, malignant histology together with ≥6‐month follow‐up, and benign pathology together with ≥12‐month follow‐up were adopted as gold standards.Results: Among 462 patients, 56.5% were male, with a median age of 68 (59–75) years, malignancy prevalence 77.0%. Tumor size was 26 (20–35) mm. Second‐generation FNB needles were used in 89.6% cases. Diagnostic accuracy, sensitivity, and specificity of rEUS‐FNB were 89.2%, 91.4%, and 81.7%, respectively (19 false‐negative and 12 false‐positive results). On multivariate analysis, rEUS‐FNB performed at high‐volume centers (odds ratio [OR] 2.12; 95% confidence interval [CI] 1.10–3.17; P = 0.03) and tumor size (OR 1.03; 95% CI 1.00–1.06; P = 0.05) were independently related to diagnostic accuracy. Sample adequacy was 94.2%. Use of second‐generation FNB needles (OR 5.42; 95% CI 2.30–12.77; P < 0.001) and tumor size >23 mm (OR 3.04; 95% CI 1.31–7.06; P = 0.009) were independently related to sample adequacy.Conclusion: Repeated EUS‐FNB allowed optimal diagnostic performance after nondiagnostic or inconclusive results. Patients' referral to high‐volume centers improved diagnostic accuracy. The use of second‐generation FNB needles significantly improved sample adequacy over standard EUS‐FNB needles.

Endoscopic ultrasound-guided tissue acquisition (EUS-TA) of solid pancreatic tumors shows optimal specificity despite fair sensitivity, with an overall suboptimal diagnostic yield. We aim to quantify the adequacy and accuracy of EUS-TA and assess predictive factors for success, focusing on the presence and degree of specimen fibrosis. All consecutive EUS-TA procedures were retrieved, and the specimens were graded for sample adequacy and fibrosis. The results were evaluated according to patients’ and tumor characteristics and the EUS-TA technique. In total, 407 patients (59% male, 70 [63–77] year old) were included; sample adequacy and diagnostic accuracy were 90.2% and 94.7%, respectively. Fibrosis was significantly more represented in tumors located in the head/uncinate process (p = 0.001). Tumor location in the head/uncinate (OR 0.37 [0.14–0.99]), number of needle passes ≥ 3 (OR 4.53 [2.22–9.28]), and the use of cell block (OR 8.82 [3.23–23.8]) were independently related to adequacy. Severe fibrosis was independently related to false negative results (OR 8.37 [2.33–30.0]). Pancreatic tumors located in the head/uncinate process showed higher fibrosis, resulting in EUS-TA with lower sample adequacy and diagnostic accuracy. We maintain that three or more needle passes and cell block should be done to increase the diagnostic yield.

J Indian Prosthodont Soc, Official publication of Indian Prosthodontic Society

Objectives: Most studies assess risk factors for common bile duct (CBD) stones in patients with gallbladder in situ. We aimed to assess risk factors for CBD stones in patients with previous cholecystectomy in a proof-of-concept study. Methods: We enrolled consecutive patients undergoing EUS for suspected symptomatic CBD stones and recorded demographic variables, clinical presentation, liver function tests (LFTs), and transabdominal ultrasound (US) findings. EUS was used as gold standard for CBD stones. Multivariate analysis was used to identify risk factors in the training set; a model was created and tested on the validation set. Results: A total of 211 patients (25.6% male; median age, 66 [49–75] years old) were enrolled; 77.7% presented with abdominal pain, 30.3% with hyperbilirubinemia, 26.5% with pancreatitis, and 61.1% with LFT alterations. Ultrasound showed CBD dilation in 37.4% patients. Overall, 96 (45.5%) patients had CBD stones. According to multivariate analysis, male gender (OR 2.54 [1.26–5.09]; p = 0.009), age > 63 years (OR 3.06 [1.63–5.72]; p < 0.001), LFT alteration (OR 2.62 [1.40–4.91]; p = 0.003), and CBD dilation (OR 2.46 [1.31–4.65]; p = 0.005) were independently related to CBD stones. A model was created based on the number of risk factors on admission; patients with no risk factor had a 9.5% prevalence of CBD stones; those with one risk factor, 26.7%; two risk factors, 53.2%; three risk factors, 66.7%; and four risk factors, 100%. Conclusions: The results of this proof-of-concept study identify male gender, age, LFT alteration, and CBD dilation as risk factors for CBD stones in patients with previous cholecystectomy. An adequate assessment of the pre-test probability will guide patients’ subsequent management.