Background: Biliary strictures are frequently encountered in clinical practice. The determination of their nature is often difficult. This study aims to systematically evaluate the efficacy and safety of the second generation of digital single-operator cholangioscopy (SpyGlass DS, DSOC) in indeterminate biliary strictures (IBDS) through biopsies. Methods: All relative studies published in Medline, the Cochrane Library, Web of Science, and EMBASE were included. The diagnostic tests for IBDS were compared to the surgical histology, autopsy, or long-term clinical follow-up. The methodological quality of the included studies was evaluated by the Quality Assessment of Studies of Diagnostic Accuracy Included in Systematic Reviews (QUADAS-2). Results: A total of 11 studies, which involved 356 patients diagnosed through biopsies, were included. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and diagnostic odds ratio were 0.74 (95% CI: 0.67–0.80), 0.98 (95% CI: 0.95–1.00), 10.52 (95% CI: 5.45–20.32), 0.31 (95% CI: 0.23–0.41), and 65.18 (95% CI: 26.79–158.61), respectively. The area under the curve (AUC) was 0.9479, and the pooled adverse event rate was 7%. The sensitivity and specificity in the heterogeneity analysis were I2 = 48.1% and I2 = 25.4%, respectively. Conclusion: SpyGlass DS is a safe and effective technique for IBDS. However, future randomized trials are needed to determine optimal number of biopsies.

https://www.mdpi.com/2075-4418/10/9/666/pdf

Efficacy and Safety of Digital Single-Operator Cholangioscopy in the Diagnosis of Indeterminate Biliary Strictures by Targeted Biopsies: A Systematic Review and Meta-Analysis

Endoscopic ultrasound (EUS) is among the most important tools for the evaluation of gastrointestinal tumors and affected areas around the gastrointestinal tract. It enables the acquisition of material from abnormal lesions via the gastrointestinal wall for tissue confirmation via endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA). EUS-FNA has played a vital role in oncological care and has become the standard method for tissue sampling. The choice of needle type is an important factor determining tissue acquisition and has been evaluated by many researchers. New needles are introduced into the market almost every year, and opinions vary regarding proper needle selection. While there are diverse opinions but no definitive recommendations about the use of one particular device, fine-needle biopsy needles may provide detailed information on a tissue’s architecture based on greater sample yields. This permits additional analyses, including genetic sequencing and phenotyping, thereby enabling the provision of more personalized treatment plans. Furthermore, other EUS-guided procedures have been developed, including interventional EUS and through-the-needle devices. Given the continued attempts to improve the diagnostic ability and therapeutic techniques, we review in detail the available types of puncture needles to provide guidance on the selection of the appropriate needle types.

/pdf/current-status-of-needles-in-the-optimization-of-endoscopic-2dsfmfr7d2.pdf

Current Status of Needles in the Optimization of Endoscopic Ultrasound-Guided Procedures

With the development of cross-sectional imaging modalities and the increasing attention being paid to physical examinations, the prevalence of pancreatic cystic neoplasms (PCNs) has increased PCNs comprise a broad differential spectrum with some PCNs having low or no malignant potential and others having high malignant potential The morbidity and mortality rates related to major pancreatic surgical resection are high Long-term surveillance may not only increase the financial burden and psychological stress for patients but also result in a missed malignancy Minimally invasive endoscopic ultrasound (EUS)-guided ethanol ablation was first reported in 2005 Several other agents, such as paclitaxel, lauromacrogol, and gemcitabine, were reported to be effective and safe for the treatment of PCNs These ablative agents are injected through a needle inserted into the cyst via transgastric or transduodenal puncture This treatment method has been substantially developed in the last 15 years and is regarded as a promising treatment to replace surgical resection for PCNs While several reviews of EUS-guided ablation have been published, no systematic review has evaluated this method from patient preparation to follow-up in detail In the present review, we systematically describe EUS-guided injective ablation with regard to the indications, contraindications, preoperative treatment, endoscopic procedure, postoperative care and follow-up, evaluation method, treatment efficiency, safety profile, tips and tricks, and current controversies and perspectives

Endoscopic ultrasound-guided injective ablative treatment of pancreatic cystic neoplasms.

Time to standardize through-the-needle biopsy specimen handling.

Through-the-needle biopsy of pancreatic cystic lesions: stronger evidences of higher diagnostic yield compared with cytology.

Diagnostic performance of endoscopic ultrasound through-the-needle microforceps biopsy (eus-ttnb) of pancreatic cystic lesions: a systematic review with meta-analysis

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Diagnostic performance of endoscopic ultrasound through-the-needle microforceps biopsy (eus-ttnb) of pancreatic cystic lesions: a systematic review with meta-analysis