Use of endoscopic ultrasound-based techniques in tumor of the guts and beyond

State Key Laboratory of Respiratory Disease, National Clinical Center for Respiratory Diseases, Guangzhou Institute of Respiratory Diseases, First Affliated Hospital, Guangzhou Medical University, Guangzhou 510120, China

Correspondence to: Prof. Guangqiao Zeng. State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Diseases, Guangzhou Institute of Respiratory Diseases, First Affliated Hospital, Guangzhou Medical University; 151 Yanjiang Road, Guangzhou 510120, China. Email: zgqiao@vip.163.com.

Use of endoscopic ultrasound-based techniques in tumor of the guts and beyond

Chu Pei, Guangqiao Zeng

State Key Laboratory of Respiratory Disease, National Clinical Center for Respiratory Diseases, Guangzhou Institute of Respiratory Diseases, First Affliated Hospital, Guangzhou Medical University, Guangzhou 510120, China

Correspondence to: Prof. Guangqiao Zeng. State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Diseases, Guangzhou Institute of Respiratory Diseases, First Affliated Hospital, Guangzhou Medical University; 151 Yanjiang Road, Guangzhou 510120, China. Email: zgqiao@vip.163.com.

Submitted Nov 03, 2014. Accepted for publication Nov 21, 2014.

View this article at:http://dx.doi.org/10.3978/j.issn.1000-9604.2014.12.01skillful hands, the overall sensitivity of this procedure for malignancy can be something above ＞90% (10).

EUS-guided therapy

EUS-guided therapy serves as a multipotent approach in clinical practice, including the drainage of pancreatic, gallbladder or other visceral fuids, accessing the pancreatic and biliary systems, performing celiac plexus neurolysis, vascular interventions, and ablative therapies.

Signifcant effcacy and safety have made EUS the frstline therapy for uncomplicated pseudocysts (11). Although there is limited data in the literature, EUS-guided drainage and debridement have been successfully used in conditions such as abscesses in the lower and upper abdomen. For walled-off pancreatic necrosis (WOPN), multiple studies show that EUS-guided therapy is associated with a low morbidity and mortality rates (12), regardless of controversy.

Pancreatic cancer is a significant cause of morbidity and mortality; however, the current therapies offer modest benefits to most of the patients. EUS-guided fine needle therapy is becoming more promising, and is considered a cutting-edge technique in the rapidly updated therapeutics for pancreatic cancer, especially in a time when so many ablation therapies are available but remain palliative for advanced disease. Recently, initial success is reported in many studies in which medication injections and intrapancreatic tumor therapy under EUS guidance are used (13), including EUS-guided radiofrequency ablation, EUS-guided alcoholic ablation, EUS-guided gene therapy, and EUS-guided interstitial brachytherapy. These procedures enable clinicians to manage pancreatic cancer in a relatively minimally invasive manner, with a low incidence of procedure-related complications. Believably, the latest cutting-edge techniques with EUS may be beneficial for treating this life-threatening disease in the near future.

Natural orifice transluminal endoscopic surgery (NOTES)

More aggressive endoscopic therapies such as endoscopic necrosectomy, full thickness resection, and endoscopic submucosal dissection have emerged along with the development of flexible endoscopy. NOTES is another recent technique that seems to be a promising alternative to conventional surgery. In NOTES, an endoscope passes through the natural orifce such as the mouth, urethra, or anus, and then through an internal incision in the stomach, vagina, or colon. Thereby, external incisions and incisionrelated complications are avoidable.

NOTES is improving as the GI closure instruments develop, and its application has been studied in animal and human models (14) that involve abdominal cavity exploration and biopsy, transvaginal cholecystectomy, transgastric appendectomy, transvaginal appendectomy, and transvesical peritoneoscopy.

EUS is essential for its value in evaluating and performing NOTES (15-18). Shu et al. showed the feasibility of NOTES interventions through a forward-viewing EUS (15). Currently, a variety of EUS-based procedures are available: EUS evaluation and endoscopic biopsy of intraperitoneal organs, EUS-guided radiofrequency ablation, EUS-FNA, and argon plasma coagulation for hemostatic control. EUS can detect lesions surrounding the GI tract as well as locate them during the NOTES procedure. EUS-guided drainage for pseudocysts and EUS-guided transluminal retroperitoneal endoscopic necrosectomy of WOPN have now been proven as effective in the clinical settings (15,19). While studies on NOTES are encouraging, widespread use of this technique relies much on the on-going development of more sophisticated, specialized devices and training. In addition, more studies with large sample size are warranted to validate the feasibility and safety of NOTES.

All in all, an increasing number of various tumors within and surrounding the guts can be diagnosed and treated with intra- and transluminal endoscopic techniques such as EUS and NOTES. More than ever, the GI tract serves as an important tunnel for exploration and manipulation of affected locations that anatomically extends beyond its boundary.

Acknowledgements

Disclosure: The authors declare no confict of interest.

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Cite this article as:Pei C, Zeng G. Use of endoscopic ultrasound-based techniques in tumor of the guts and beyond. Chin J Cancer Res 2014;26(6):644-646. doi: 10.3978/ j.issn.1000-9604.2014.12.01

Introduction

A solitary pulmonary nodule (SPN) is radiologically defned as an intraparenchymal lung lesion that is less than 3 cm in diameter and is not associated with atelectasis or adenopathy (1). Timely identifcation of a malignant SPN is essential for prognosis because the treatment strategies for a malignancy are different from those for a benign nodule (2). In patients who are surgical candidates, malignancy should be identified promptly (when present) and receive timely resection. Ideally, surgery should be avoided in patients with nodules that prove to be benign (3). However, identifying a malignant SPN is challenging. Most clinicians diagnose based on their clinical experience, which may be subjective. A mathematical prediction model facilitates this task, avoiding subjective and one-sided judgment. To date, only three organizations have constructed SPN prediction models—the Mayo (4), VA (5), and Peking University (PU) (6) models.

The Mayo Clinic model is defned by the equations: Pretest probability of a malignant SPN = ex/(1+ex), x= —6.8272+ (0.0391× age) + (0.7917× smoking history) + (1.3388× cancer history) + (0.1274× diameter) + (1.0407 × spiculation) + (0.7838× upper lobe), e is the natural logarithm, and 1 for yes and 0 for no in the smoking history, cancer history, spiculation and upper lobe elements. Diameter indicates the largest nodule measurement (in mm) reported on initial

10.3978/j.issn.1000-9604.2014.12.01