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BACKGROUND AND AIMS: Endoscopic ultrasound shear wave elastography (EUS-SWE) is a novel modality for liver stiffness measurement. The aims of this study are to evaluate the performance and reliability of EUS-SWE for detecting advanced liver disease in a prospective cohort. METHODS: EUS-SWE measurements were prospectively obtained from patients undergoing EUS between August 2020 and March 2023. Liver stiffness measurements were compared between patients with and without advanced liver disease (ALD), defined as stage ≥3, to determine diagnostic accuracy for advanced fibrosis and portal hypertension. Logistic regression was performed to identify variables that impact the reliability of EUS-SWE readings. Select patients underwent paired magnetic resonance elastography (MRE) for liver fibrosis correlation. RESULTS: Patients with ALD demonstrated higher liver stiffness compared to healthy controls (left lobe: 17.6 vs. 12.7 kPa, P<0.001; median right lobe: 24.8 vs. 11.0 kPa, P<0.001). The area under the receiver operator characteristic (AUROC) for the detection of ALD was 0.73 and 0.80 for left and right lobe measurements, respectively. General anesthesia was associated with reliable EUS-SWE liver readings (odds ratio: 2.73, 95% CI: 1.07-7.39, P=0.040). Left lobe measurements correlated significantly with MRE with an increase of 0.11 kPa (95% CI: 0.05-0.17 kPA) for every 1 kPa increase on EUS-SWE. D. CONCLUSIONS: SWE is a promising technology that can readily be incorporated into standard EUS examinations for the assessment of ALD.
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Video 1Demonstration of techniques for performing direct peroral cholangioscopy.
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A 65-year-old White man underwent deceased donor liver transplant for decompensated liver cirrhosis secondary to alpha-1-antitrypsin deficiency. He developed diarrhea and diffuse maculopapular rash 2 months post-transplant. Skin biopsy revealed necroinflammatory changes related to the superficial dermis. Pancytopenia ensued, complicated by neutropenic sepsis. Chimerism studies confirmed the presence of donor T-lymphocyte macrochimerism (63%). The patient was diagnosed with graft-vs-host disease. After extensive multidisciplinary collaboration, basiliximab was initiated. This resulted in complete symptom resolution and a gradual reduction in T-lymphocyte macrochimerism (12%). The patient was later transitioned to oral ruxolitinib and currently remains in stable condition 16 months after being diagnosed with graft-vs-host disease.
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Background and study aims There is increasing evidence to suggest that EUS-guided biliary drainage (EUS-BD) is a safe and effective treatment alternative for patients with malignant biliary obstructions (MBOs) after failed endoscopic retrograde cholangiopancreatography. Patients and methods We performed a retrospective analysis of data prospectively collected from patients with MBO who underwent choledochoduodenostomy (CDS) or gallbladder drainage (GBD) between August 2016 and June 2020 using the electrocautery-enabled lumen-apposing metal stents (ECE-LAMS). The primary endpoint was technical and clinical success. Secondary endpoints were adverse events (AEs) and reinterventions. Results A total of 60 patients were included in the study, with 56 CDS and 4 GBD. Median age was 76 years with 57 % male (34/60). The most common indication for EUS-BD was pancreatic cancer (78â%). Technical success was achieved in 100â% of cases, with a clinical success rate of 91.7â%. Mean total bilirubin pre-procedure was 202âumol/L (normal < 20 umol/L) and 63.8âumol/L post procedure ( P â<â.001). Twenty-one patients had bilirubin recorded at 2 weeks post EUS-BD with 20 of 21 patients demonstrating >â50â% reduction in bilirubin (mean bilirubin reduction 75â%). AEs occurred in 12 of 60 patients (20â%), all of which were mild. The reintervention rate was 11.7â% (7/60). Stent occlusion occurred in 10 of 60 patients (16.7â%) with a mean time to stent occlusion of 46.2 days (3-133). Stent patency of 83.3â% was observed with a mean follow up of 7.9 months. Conclusion EUS-CDS and GBD using ECE-LAMS are effective EUS-based techniques for managing patients with MBO. AEs are usually mild and resolved by reintervention.
