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CONTRAST-ENHANCED ULTRASOUND DISTINGUISHES INFLAMMATORY FROM NON-INFLAMMATORY STENOSIS IN CROHN’S DISEASE: FIRST RESULTS FROM THE STRICTURE STUDY

Floris de Voogd 1, Aart Mookhoek 2, Kim Beek 1, Kyra Van Rijn 1, Maarten Pruijt 1, Christoph Teichert 1, Jarmila van Der Bilt 1, Christianne Johanna Buskens 1, Wilhelmus A. Bemelman 1, Jaap Stoker 1, Geert R. D'Haens 1, Krisztina Barbara Gecse 1

Affiliations

1 Amsterdam University Medical Centers, Amsterdam, Netherlands

2 University of Bern, Bern, Switzerland

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Abstract

Introduction

Stenotic complications affect 30%-50% of patients with Crohn’s disease (CD)¹. There is currently no imaging modality to identify stricture composition, which would allow early targeted (anti-inflammatory vs surgical) treatment. Intestinal ultrasound (IUS) and its advanced modalities (contrast-enhanced and elastography) have the potential for transmural disease evaluation. The aim of the STRICTURE study was to investigate (advanced) IUS and MRI techniques to distinguish between inflammatory- (IP) and non-inflammatory predominant phenotypes (non-IP) of stricturing CD.

Aims & Methods

In this prospective, longitudinal study, consecutive patients with small bowel stricturing CD undergoing surgery were included. Patients were eligible if they had a non-passable stricture during endoscopy in the small bowel or at the valve/anastomosis and/or a stricture at cross-sectional imaging (IUS or MRE) with a bowel wall thickness (BWT) >3.0 mm in combination with narrowing of the lumen <1.0 cm or a prestenotic dilation (lumen width ≥2.5 cm)³. Clinical scores (Harvey-Bradshaw index and Crohn’s Disease Obstructive Score⁴) and biochemical parameters were collected. All patients underwent conventional IUS (B-mode/colour Doppler signal)⁵, CEUS and SWE and cine-loops were scored by one rater. After surgery, histological slides were retrieved at the same distance from the valve/anastomosis as measurements were made on IUS. Subsequently, a blinded expert pathologist scored all slides as [1] inflammatory (IP; BWT based on inflammatory infiltrates and edema according to the Nancy score), [2] fibrotic (FP; BWT based on structural changes due to fibrosis, adipose tissue and/or muscular hypertrophy⁶) or [3] mixed phenotype (MP; BWT with inflammatory and fibrotic aspects but no predominant phenotype). FP and MP were both classified as non-IP.

Results

A total of 36 patients (female: 58%, age: 42 ± 18 years) with a mean BWT of 6.7 ± 1.7 mm were included. Median time between IUS and surgery was 14 [3-50] days. A total of 7 patients had an IP, 18 a FP and 11 a MP. For the conventional IUS parameters, loss of bowel wall stratification was more frequently found in IP strictures (OR: 7.87 [1.24-50.00], p=0.029). Clinical, biochemical, other conventional IUS parameters, length of the stricture (13 [8-18] cm vs 10.5 [7.5-17.5] cm) and width of the prestenotic dilation (2.70 [1.70-2.80] cm) vs 2.30 [1.75-3.35] cm) were not significantly different between patients with IP and non-IP. However, CEUS, including wash-in and wash-out parameters, were significantly higher in IP versus non-IP strictures (Table 1). When excluding MP strictures, CEUS was the only modality that could distinguish between IP and FP. SWE inversely correlated with CEUS (Table 1) but did not differentiate between IP and non-IP (33.30 [26.00-44.80] kPa vs 43.49 [28.30-54.00] kPa, p=0.48) or IP and FP (33.30 [26.00-44.80] kPa vs 41.23 [24.36-48.60 kPa, p=0.95).

CEUS parameter in decibel	Inflammatory phenotype	Non-inflammatory phenotype (fibrosis and mixed)	Significance	Cut-off value (AUC/sens/spec)	SWE correlation
Peak enhancement (median [IQR])	31.6 [31.0-35.7]	29.38 [27.29-31.50]	p=0.014	31.0 (0.8/86%/69%)	ρ=-0.36, p=0.04
Wash-in area under the curve (median [IQR])	39.4 [38.3-41.5]	36.09 [32.27-38.26]	p=0.005	38.2 (0.84/86%/77%)	ρ=-0.32, p=0.08
Wash-in perfusion index (median [IQR])	29.6 [29.3-33.7]	27.63 [25.40-29.64]	p=0.016	29.2 (0.8/86%/69%)	ρ=-0.37, p=0.04
Wash-out area under the curve (median [IQR])	43.1 [41.3-45.1]	38.90 [36.50-41.85]	p=0.016	41.8 (0.8/71%/77%)	ρ=-0.37, p=0.04
Wash-in and Wash-out area under curve (median [IQR])	44.3 [43.1-46.7]	40.74 [38.23-43.54]	p=0.008	43.0 (0.82/86%/69%)	ρ=-0.36, p=0.05

Conclusion

CEUS accurately distinguishes predominant inflammatory from not-predominant inflammatory strictures in CD and inversely correlates with SWE. CEUS, could be of additional value in this specific population to select patients most suitable for anti-inflammatory treatment. Reproducibility of advanced IUS techniques is under investigation.

References

1. Rieder F, Latella G, Magro F, et al. European Crohn’s and Colitis Organisation topical review on prediction, diagnosis and management of fibrostenosing Crohn’s disease. Journal of Crohn's and Colitis. 2016;10(8):873-885.
2. Lu C, Gui X, Chen W, Fung T, Novak K, Wilson SR. Ultrasound shear wave elastography and contrast enhancement: effective biomarkers in Crohn's disease strictures. Inflammatory Bowel Diseases. 2017;23(3):421-430.
3. Maconi G, Nylund K, Ripolles T, et al. EFSUMB recommendations and clinical guidelines for intestinal ultrasound (GIUS) in inflammatory bowel diseases. Ultraschall in der Medizin-European Journal of Ultrasound. 2018;39(03):304-317.
4. Bouhnik Y, Carbonnel F, Laharie D, et al. Efficacy of adalimumab in patients with Crohn's disease and symptomatic small bowel stricture: a multicentre, prospective, observational cohort (CREOLE) study. Gut. 2018;67(1):53-60.
5. Novak KL, Nylund K, Maaser C, et al. Expert consensus on optimal acquisition and development of the International Bowel Ultrasound Segmental Activity Score [IBUS-SAS]: a reliability and inter-rater variability study on intestinal ultrasonography in Crohn’s disease. Journal of Crohn's and Colitis. 2021;15(4):609-616.
6. Gordon IO, Bettenworth D, Bokemeyer A, et al. International consensus to standardise histopathological scoring for small bowel strictures in Crohn’s disease. Gut. 2022;71(3):479-486.

Conference

UEG Week Copenhagen 2023

Topics

IBD

Submission format

Abstract

Session

PP 05 IBD (Posters)

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

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NOVEL APPROACH TO BILATERAL BILIARY DRAINAGE: SINGLE-SESSION DUAL-ROUTE EUS-GUIDED HEPATICODUODENOSTOMY PLUS HEPATICOGASTROSTOMY FOR MALIGNANT HILAR BILIARY OBSTRUCTION: A PROSPECTIVE STUDY

Takuji Okusaka

Current role for thiopurines in the management of IBD: Should I go?

Joana Torres

ADVOS AS BRIDGE-TO-TRANSPLANT OR BRIDGE-TO-DECISION IN ACUTE LIVER FAILURE: A SINGLE-CENTER CASE SERIES

Antonia Mondorf

Approaches to improve nutrition and physical activity levels in patients with liver disease

Catarina Lindqvist

What’s the Next Chapter in Ulcerative Colitis? Exploring Novel Mechanisms and Emerging Late-Stage Therapies (Abivax) (Complete Session)

Raja Atreya

ASSESSING THE LIMITS OF ENDOSCOPIC ULTRASONOGRAPHY IN DETECTING PANCREATIC MICROARCHITECTURE: A SIDE-BY-SIDE COMPARISON WITH SURGICAL SPECIMENS

Kazuro Chiba

UEG Presentation

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NOVEL APPROACH TO BILATERAL BILIARY DRAINAGE: SINGLE-SESSION DUAL-ROUTE EUS-GUIDED HEPATICODUODENOSTOMY PLUS HEPATICOGASTROSTOMY FOR MALIGNANT HILAR BILIARY OBSTRUCTION: A PROSPECTIVE STUDY

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NOVEL APPROACH TO BILATERAL BILIARY DRAINAGE: SINGLE-SESSION DUAL-ROUTE EUS-GUIDED HEPATICODUODENOSTOMY PLUS HEPATICOGASTROSTOMY FOR MALIGNANT HILAR BILIARY OBSTRUCTION: A PROSPECTIVE STUDY

SUSUMU HIJIOKA 1, Yoshikuni Nagashio 1, Shota Harai 1, Daiki Yamashige 1, Yutaka Saito 2, Takuji Okusaka 1

Affiliations

1 National Cancer Center Hospital, Tokyo, Japan

2 National Cancer Center Hospital Endoscopy Division, Tokyo, Japan

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Abstract

Introduction

Biliary drainage for malignant hilar obstruction (MHBO), particularly involving the right intrahepatic duct, remains technically challenging. Endoscopic retrograde cholangiopancreatography (ERCP) often fails in complex hilar strictures, while percutaneous transhepatic biliary drainage (PTBD) is associated with external catheter-related morbidity.
Endoscopic ultrasound-guided biliary drainage (EUS-BD) provides an alternative internal drainage route; however, an optimal strategy for bilateral drainage has not been established.
Based on our previous retrospective study, we evaluated a novel dual-route drainage technique combining hepaticoduodenostomy and hepaticogastrostomy (EUS-HDGS) in a prospective setting. This study aimed to evaluate its efficacy and safety.

Aims & Methods

This was a prospective single-arm phase II study of patients with unresectable malignant hilar biliary obstruction (Bismuth II–IV) requiring bilateral drainage.
EUS-HDGS was performed in a single session, consisting of hepaticoduodenostomy (HDS) for right-sided drainage followed by hepaticogastrostomy (HGS) for left-sided drainage.
The primary endpoint was clinical success, defined as ≥50% reduction or normalization of serum bilirubin within 14 days. Secondary endpoints included technical success, adverse events, recurrent biliary obstruction (RBO), stent patency, and re-intervention success.

Results

Eighteen patients were included.
Technical success was achieved in 16/18 patients (89%), and clinical success in 14/16 patients (88%). Procedure-related adverse events occurred in 4/18 patients (22%), all of which were mild to moderate and managed conservatively.
During follow-up, the median stent patency was 141 days (95% CI: 82.5–199.5), with a median event-free survival of 108 days (95% CI: 56.4–160) and a median overall survival of 134 days (95% CI: 97.9–170). Recurrent biliary obstruction occurred in 7/18 patients (39%); re-intervention was performed in 6 patients and was successful in all cases (100%), confirming reliable endoscopic re-accessibility.

Conclusion

EUS-HDGS enables effective bilateral internal drainage with durable patency and reliable re-intervention, offering a feasible endoscopic alternative for complex malignant hilar obstruction.

Event

UEG Week Barcelona 2026

Topics

Pancreas Radiology & Imaging Hepatobiliary Endoscopy

Submission format

Abstract

Session

Biliary clinical care: New frontiers in biliary endoscopy

Citation

2026: United European Gastroenterology Journal 2026; 14 (S1)

Published

2026

More Like This:

NOVEL APPROACH TO BILATERAL BILIARY DRAINAGE: SINGLE-SESSION DUAL-ROUTE EUS-GUIDED HEPATICODUODENOSTOMY PLUS HEPATICOGASTROSTOMY FOR MALIGNANT HILAR BILIARY OBSTRUCTION: A PROSPECTIVE STUDY

Takuji Okusaka

Current role for thiopurines in the management of IBD: Should I go?

Joana Torres

ADVOS AS BRIDGE-TO-TRANSPLANT OR BRIDGE-TO-DECISION IN ACUTE LIVER FAILURE: A SINGLE-CENTER CASE SERIES

Antonia Mondorf

Approaches to improve nutrition and physical activity levels in patients with liver disease

Catarina Lindqvist

What’s the Next Chapter in Ulcerative Colitis? Exploring Novel Mechanisms and Emerging Late-Stage Therapies (Abivax) (Complete Session)

Raja Atreya

ASSESSING THE LIMITS OF ENDOSCOPIC ULTRASONOGRAPHY IN DETECTING PANCREATIC MICROARCHITECTURE: A SIDE-BY-SIDE COMPARISON WITH SURGICAL SPECIMENS

Kazuro Chiba

UEG Presentation

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Current role for thiopurines in the management of IBD: Should I go?

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Current role for thiopurines in the management of IBD: Should I go?

Joana Torres 1

Affiliations

1 Hospital Beatriz Ângelo & Hospital da Luz, Lisbon, Portugal

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Abstract

Event

Postgraduate Teaching Programme Barcelona 2026

Topics

Immunology Mechanisms & Personalised Medicine IBD

Session

Thiopurines in IBD: Should I stay or should I go

Citation

2026: United European Gastroenterology Journal 2026; 14 (S1)

Published

2026

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NOVEL APPROACH TO BILATERAL BILIARY DRAINAGE: SINGLE-SESSION DUAL-ROUTE EUS-GUIDED HEPATICODUODENOSTOMY PLUS HEPATICOGASTROSTOMY FOR MALIGNANT HILAR BILIARY OBSTRUCTION: A PROSPECTIVE STUDY

Takuji Okusaka

Current role for thiopurines in the management of IBD: Should I go?

Joana Torres

ADVOS AS BRIDGE-TO-TRANSPLANT OR BRIDGE-TO-DECISION IN ACUTE LIVER FAILURE: A SINGLE-CENTER CASE SERIES

Antonia Mondorf

Approaches to improve nutrition and physical activity levels in patients with liver disease

Catarina Lindqvist

What’s the Next Chapter in Ulcerative Colitis? Exploring Novel Mechanisms and Emerging Late-Stage Therapies (Abivax) (Complete Session)

Raja Atreya

ASSESSING THE LIMITS OF ENDOSCOPIC ULTRASONOGRAPHY IN DETECTING PANCREATIC MICROARCHITECTURE: A SIDE-BY-SIDE COMPARISON WITH SURGICAL SPECIMENS

Kazuro Chiba

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ADVOS AS BRIDGE-TO-TRANSPLANT OR BRIDGE-TO-DECISION IN ACUTE LIVER FAILURE: A SINGLE-CENTER CASE SERIES

Hans-Peter Erasmus 1, Marcus Maximillian Mücke 1, Victoria Therese Mücke 1, Ludwig Hofbauer 1, Stefan Zeuzem 1, Antonia Mondorf 1

Affiliations

1 University Medicine Frankfurt, Frankfurt am Main, Germany

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Abstract

Clinical Case Summary

Background: Acute liver failure (ALF) is a rare, rapidly progressive syndrome with sudden loss of hepatic function, coagulopathy, hepatic encephalopathy, and frequently rapid multiorgan failure. Despite advances in intensive care and transplantation, mortality remains high. Extracorporeal liver support systems aim to stabilize patients during the limited window for recovery or transplant evaluation. The Advanced Organ Support (ADVOS) system is a multifunctional extracorporeal albumin dialysis platform enabling toxin removal, acid–base regulation, and renal replacement. Clinical data in ALF remain limited.
Methods: We report a single-center case series of four critically ill ALF patients treated with ADVOS in a tertiary ICU with transplant capability. Etiologies included amanitin intoxication (n=3) and acute non-cirrhotic liver failure (n=1). Indications for ADVOS were progressive encephalopathy, severe metabolic derangements, acute kidney injury, or use as bridge-to-transplant or bridge-to-decision. Clinical course, laboratory trends, organ support, and outcomes were analyzed descriptively.
Results: ADVOS was feasible in all patients and integrated into complex ICU care. Treatment stabilized metabolic homeostasis, including acid–base balance, ammonia levels, and renal function parameters, enabling neurological assessment and transplant evaluation. Two patients underwent successful urgent liver transplantation. One patient recovered without transplantation after cessation of extracorporeal support. One patient with amanitin intoxication deteriorated and died following therapy limitation due to non-transplantability. No severe ADVOS-related adverse events occurred.
Conclusions: ADVOS provided effective extracorporeal support in ALF of various etiologies. It may serve as a bridge-to-transplant or bridge-to-decision by stabilizing metabolic and extrahepatic organ dysfunction. Larger prospective studies are needed to define optimal timing, patient selection, and outcome impact.

References

1. Tsipotis E, Shuja A, Jaber BL. Albumin Dialysis for Liver Failure: A Systematic Review. Adv Chronic Kidney Dis. 2015;22(5):382-390. doi:10.1053/j.ackd.2015.05.004
2. Sommerfeld O, Neumann C, Becker J, et al. Extracorporeal albumin dialysis in critically ill patients with liver failure: Comparison of four different devices-A retrospective analysis. Int J Artif Organs. 2023;46(8-9):481-491. doi:10.1177/03913988231191952
3. Fuhrmann V, Weber T, Roedl K, et al. Advanced organ support (ADVOS) in the critically ill: first clinical experience in patients with multiple organ failure. Ann Intensive Care. 2020;10(1):96. Published 2020 Jul 16. doi:10.1186/s13613-020-00714-3

Conference

UEG Week Barcelona 2026

Topics

Hepatobiliary

Submission format

Clinical Case

Session

CLINICAL CASES (Posters)

Published

2026

More Like This:

NOVEL APPROACH TO BILATERAL BILIARY DRAINAGE: SINGLE-SESSION DUAL-ROUTE EUS-GUIDED HEPATICODUODENOSTOMY PLUS HEPATICOGASTROSTOMY FOR MALIGNANT HILAR BILIARY OBSTRUCTION: A PROSPECTIVE STUDY

Takuji Okusaka

Current role for thiopurines in the management of IBD: Should I go?

Joana Torres

ADVOS AS BRIDGE-TO-TRANSPLANT OR BRIDGE-TO-DECISION IN ACUTE LIVER FAILURE: A SINGLE-CENTER CASE SERIES

Antonia Mondorf

Approaches to improve nutrition and physical activity levels in patients with liver disease

Catarina Lindqvist

What’s the Next Chapter in Ulcerative Colitis? Exploring Novel Mechanisms and Emerging Late-Stage Therapies (Abivax) (Complete Session)

Raja Atreya

ASSESSING THE LIMITS OF ENDOSCOPIC ULTRASONOGRAPHY IN DETECTING PANCREATIC MICROARCHITECTURE: A SIDE-BY-SIDE COMPARISON WITH SURGICAL SPECIMENS

Kazuro Chiba

UEG Presentation

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Approaches to improve nutrition and physical activity levels in patients with liver disease

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Approaches to improve nutrition and physical activity levels in patients with liver disease

Kate Hallsworth 1, Catarina Lindqvist 2

Affiliations

1 NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne, United Kingdom

2 None, None, Sweden

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Abstract

Event

UEG Week Berlin 2025

Topics

Nurses

Session

Innovative approaches in liver disease management

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

More Like This:

NOVEL APPROACH TO BILATERAL BILIARY DRAINAGE: SINGLE-SESSION DUAL-ROUTE EUS-GUIDED HEPATICODUODENOSTOMY PLUS HEPATICOGASTROSTOMY FOR MALIGNANT HILAR BILIARY OBSTRUCTION: A PROSPECTIVE STUDY

Takuji Okusaka

Current role for thiopurines in the management of IBD: Should I go?

Joana Torres

ADVOS AS BRIDGE-TO-TRANSPLANT OR BRIDGE-TO-DECISION IN ACUTE LIVER FAILURE: A SINGLE-CENTER CASE SERIES

Antonia Mondorf

Approaches to improve nutrition and physical activity levels in patients with liver disease

Catarina Lindqvist

What’s the Next Chapter in Ulcerative Colitis? Exploring Novel Mechanisms and Emerging Late-Stage Therapies (Abivax) (Complete Session)

Raja Atreya

ASSESSING THE LIMITS OF ENDOSCOPIC ULTRASONOGRAPHY IN DETECTING PANCREATIC MICROARCHITECTURE: A SIDE-BY-SIDE COMPARISON WITH SURGICAL SPECIMENS

Kazuro Chiba

UEG Presentation

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What’s the Next Chapter in Ulcerative Colitis? Exploring Novel Mechanisms and Emerging Late-Stage Therapies (Abivax) (Complete Session)

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What’s the Next Chapter in Ulcerative Colitis? Exploring Novel Mechanisms and Emerging Late-Stage Therapies (Abivax) (Complete Session)

Remo Panaccione 1, Alessandro Armuzzi 2, Raja Atreya 3

Affiliations

1 University of Calgary, Calgary, Canada

2 IBD Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy

3 Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany

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Abstract

Publisher

Abivax S.A.

Event

UEG Week Barcelona 2026

Session

What’s the Next Chapter in Ulcerative Colitis? Exploring Novel Mechanisms and Emerging Late-Stage Therapies (Abivax)

Citation

2026: United European Gastroenterology Journal 2026; 14 (S1)

Published

2026

More Like This:

NOVEL APPROACH TO BILATERAL BILIARY DRAINAGE: SINGLE-SESSION DUAL-ROUTE EUS-GUIDED HEPATICODUODENOSTOMY PLUS HEPATICOGASTROSTOMY FOR MALIGNANT HILAR BILIARY OBSTRUCTION: A PROSPECTIVE STUDY

Takuji Okusaka

Current role for thiopurines in the management of IBD: Should I go?

Joana Torres

ADVOS AS BRIDGE-TO-TRANSPLANT OR BRIDGE-TO-DECISION IN ACUTE LIVER FAILURE: A SINGLE-CENTER CASE SERIES

Antonia Mondorf

Approaches to improve nutrition and physical activity levels in patients with liver disease

Catarina Lindqvist

What’s the Next Chapter in Ulcerative Colitis? Exploring Novel Mechanisms and Emerging Late-Stage Therapies (Abivax) (Complete Session)

Raja Atreya

ASSESSING THE LIMITS OF ENDOSCOPIC ULTRASONOGRAPHY IN DETECTING PANCREATIC MICROARCHITECTURE: A SIDE-BY-SIDE COMPARISON WITH SURGICAL SPECIMENS

Kazuro Chiba

UEG Presentation

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ASSESSING THE LIMITS OF ENDOSCOPIC ULTRASONOGRAPHY IN DETECTING PANCREATIC MICROARCHITECTURE: A SIDE-BY-SIDE COMPARISON WITH SURGICAL SPECIMENS

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ASSESSING THE LIMITS OF ENDOSCOPIC ULTRASONOGRAPHY IN DETECTING PANCREATIC MICROARCHITECTURE: A SIDE-BY-SIDE COMPARISON WITH SURGICAL SPECIMENS

Jun Nakahodo 1,2, Kensuke Hoshi 1,3, Shin-ichiro Horiguchi 1, Yasuji Seyama 1, Hiroko Okinaga 1, Mei Nakamura 1, Tomoaki Sawano 1, Masanao Kurata 1, Kazuro Chiba 1, Hiroki Tabata 1, WATARU UJITA 1, Ryogo Minami 1, Sorano Ichiya 1, T. Kamisawa 1, TOSHIRO IIZUKA 1

Affiliations

1 Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Bunkyo-Ku, Japan

2 Juntendo University, Bunkyo-Ku, Japan

3 Toho University Omori Medical Center, Ota-ku, Japan

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Abstract

Introduction

Early diagnosis of pancreatic cancer relies on detecting subtle, indirect signs of minute tumors. Endoscopic ultrasonography (EUS) is crucial for this purpose. However, EUS image construction is influenced not only by the density and structure of the target areas but also by the characteristics of the surrounding tissue. Directly correlating preoperative EUS images and precisely aligning the pathological images of the area of interest remains challenging, as comparisons often rely on approximate anatomical regions. To overcome this limitation and to gain a deeper understanding of EUS imaging capabilities at the microscopic level, the present study examined unfixed pancreatic resection specimens using EUS immediately after surgery.

Aims & Methods

The present study aimed to investigate the characteristics and limitations of EUS imaging by directly comparing EUS images with the corresponding pathological sections of resected pancreatic specimens. The samples derived from distal pancreatectomies for pancreatic ductal adenocarcinoma without chemotherapy (pT1b or less in the UICC classification, 8th edition) were obtained between January 2023 and November. Specimens from pancreatoduodenectomies were excluded to enable a precise, one-to-one comparison between the pathological specimens and EUS images. The resected specimens were immersed in saline and examined using a convex-type EUS scope (Olympus UCT260/ME-2, Tokyo, Japan). Areas of interest, including the main tumor site and any abnormal findings, were marked with nylon sutures. HE-stained pathological sections from these marked areas were then directly compared with the corresponding EUS images to evaluate the imaging characteristics of various pathological features.

Results

The present study included four male and three female patients with a mean age of 76.3 years. The tumor location included the pancreatic body (n = 5) and the tail (n = 2). According to the 8th edition of the UICC classification, the pathological T stage was Tis, T1a, and T1b in four, two, and one cases, respectively. The pathological findings of 24 samples were compared with the corresponding EUS images. The rate of detection of the specific pathological features using EUS was 0%, 33%, 64%, 47%, and 60% for PanIN lesions, invasive carcinoma, localized pancreatic atrophy (predominantly fatty), localized pancreatic atrophy (predominantly fibrotic), and pancreatic cysts ≤ 2 mm, respectively. Solitary cysts ≤ 2 mm were often identifiable, while multiple, clustered cysts appeared as faint, hypoechoic areas. Localized pancreatic atrophy with predominant fibrosis appeared as a faint, hypoechoic area, and atrophy with predominantly fatty replacement appeared as a high-intensity area within the parenchyma. However, complete fatty replacement obscured the boundary with surrounding fatty tissue, leading to its appearance as loss of the pancreatic parenchyma.

Conclusion

The present findings demonstrated that despite its high diagnostic accuracy for pancreatic diseases, EUS is limited in its ability to visualize tissue microarchitecture. Understanding the specific imaging features of localized pancreatic atrophy and small pancreatic cysts on EUS is crucial for improving the accuracy of early diagnoses of pancreatic cancer. The insights gained from this one-to-one comparison of the EUS findings and pathological specimens can contribute to enhancing the precision of the diagnosis and facilitate the earlier detection of pancreatic cancer.

Event

UEG Week Berlin 2025

Topics

Endoscopy Hepatobiliary Pancreas

Submission format

Abstract

Session

Textbook knowledge and limits of HPB endoscopy

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

More Like This:

NOVEL APPROACH TO BILATERAL BILIARY DRAINAGE: SINGLE-SESSION DUAL-ROUTE EUS-GUIDED HEPATICODUODENOSTOMY PLUS HEPATICOGASTROSTOMY FOR MALIGNANT HILAR BILIARY OBSTRUCTION: A PROSPECTIVE STUDY

Takuji Okusaka

Current role for thiopurines in the management of IBD: Should I go?

Joana Torres

ADVOS AS BRIDGE-TO-TRANSPLANT OR BRIDGE-TO-DECISION IN ACUTE LIVER FAILURE: A SINGLE-CENTER CASE SERIES

Antonia Mondorf

Approaches to improve nutrition and physical activity levels in patients with liver disease

Catarina Lindqvist

What’s the Next Chapter in Ulcerative Colitis? Exploring Novel Mechanisms and Emerging Late-Stage Therapies (Abivax) (Complete Session)

Raja Atreya

ASSESSING THE LIMITS OF ENDOSCOPIC ULTRASONOGRAPHY IN DETECTING PANCREATIC MICROARCHITECTURE: A SIDE-BY-SIDE COMPARISON WITH SURGICAL SPECIMENS

Kazuro Chiba