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| 1 | Innovation of endoscopic management in difficult common bile duct stone in the era of laparoscopic surgery显示文摘Common bile duct(CBD)stone is a common biliary problem,which often requires endoscopic approach as the initial treatment option.Roughly,7%-12%of the subjects who experience cholecystectomy were subsequently referred to biliary endoscopist for further management.In general,there are three classifications of difficult CBD stone,which are based on the characteristics of the stone(larger than 15 mm,barrel or square-shaped stones,and hard consistency),accessibility to papilla related to anatomical variations,and other clinical conditions or comorbidities of the patients.Currently,endoscopic papillary large balloon dilation(EPLBD)of a previous sphincterotomy and EPLBD combined with limited sphincterotomy performed on the same session is still recommended by the European Society of Gastrointestinal Endoscopy as the main approach in difficult CBD stones with history of failed sphincterotomy and balloon and/or basket attempts.If failed extraction is still encountered,mechanical lithotripsy or cholangioscopy-assisted lithotripsy or extracorporeal shockwave lithotripsy can be considered.Surgical approach can be considered when stone extraction is still failed or the facilities to perform lithotripsy are not available.To our knowledge,conflicting evidence are still found from previous studies related to the comparison between endoscopic and surgical approaches.The availability of experienced operator and resources needs to be considered in creating individualized treatment strategies for managing difficult biliary stones. | Cosmas Rinaldi Adithya Lesmana Maria Satya Paramitha Laurentius Adrianto Lesmana | 2021 | World Journal of Gastrointestinal Endoscopy2021，13，7： | 9 |
| 2 | Therapeutic interventional endoscopic ultrasound in pancreatobiliary disorders:Does it really replace the surgical/percutaneous approach?显示文摘Pancreato-biliary disorders are still incredibly challenging in the field of gastroenterology,as they would sometimes require multi-approach interventional procedures.Recently,therapeutic interventional endoscopic ultrasound(EUS)has emerged as a potential alternative to surgical or percutaneous approaches.Unfortunately,considering the high cost of EUS,lack of facility and expertise,most gastroenterologists still often refer cases to undergo surgical interventions without contemplating the possibility of utilizing EUS first.EUS-guided biliary drainage has become one of the best choices for establishing access to biliary system,given the clear visualization of pancreas,gallbladder,and common bile duct.Although there are still only a few studies which directly compare EUSguided and surgical approaches for biliary drainage,current evidence demonstrated the superiority of EUS-guided approach in terms of adverse events and reintervention rates,with similarly high technical and clinical success rates compared to percutaneous and surgical approaches,especially in patients with history of failed endoscopic retrograde cholangiopancreatography attempt.Comparable success rates with shorter length of hospital stay between endoscopic and surgical approaches have also been exhibited for pancreatic pseudocysts and walled-off necrosis.Recent findings about the progress of EUS approach in gastroenterostomy/jejunostomy also indicated a promising potential of EUS,as a less invasive approach,for managing gastric outlet obstruction. | Cosmas Rinaldi Adithya Lesmana Maria Satya Paramitha Rino Alvani Gani | 2021 | World Journal of Gastrointestinal Surgery2021，13，6： | 0 |
| 3 | Impact of endoscopic ultrasound elastography in pancreatic lesion evaluation显示文摘Pancreatic malignancy still becomes a major global problem and is considered as one of the most lethal cancers in the field of gastroenterology.Most patients come in the late stage of the disease due to organ’s location,and until now the treatment result is still far away from satisfaction.Early detection is still the main key for good,prolonged survival.However,discerning from other types of tumor sometimes is not easy.Endoscopic ultrasound(EUS)is still the best tool for pancreatic assessment,whereas fine-needle aspiration biopsy(FNAB)is considered as the cornerstone for further management of pancreatic malignancy.Several conditions have become a concern for EUS-FNAB procedure,such as risk of bleeding,pancreatitis,and even needle track-seeding.Recently,an artificial intelligence innovation,such as EUS elastography has been developed to improve diagnostic accuracy in pancreatic lesions evaluation.Studies have shown the promising results of EUS elastography in improving diagnostic accuracy,as well as discerning from other tumor types.However,more studies are still needed with further considerations,such as adequate operator training,expertise,availability,and its cost-effectiveness in comparison to other imaging options. | Cosmas Rinaldi Adithya Lesmana Maria Satya Paramitha | 2021 | Artificial Intelligence in Gastrointestinal Endoscopy2021，2，4： | 0 |
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