EUS-guided celiac plexus neurolysis/block

Refractory chronic abdominal pain as a result of inoperable pancreatic cancer or chronic pancreatitis poses a formidable challenge and can be effectively relieved with celiac axis block or celiac plexus neurolysis (CPN). Percutaneous celiac plexus block (CPB) or computed tomography (CT)-guidance using anterior or posterior approaches has some limitations. However, endoultrasound (EUS)-guided CPB has evolved itself as an effective and safe procedure for management of refractory abdominal pain. The EUS offers advantages, which include accurate anatomic imaging, real-time monitoring of injection, and anterior approach, which avoids neurologic complications. The CPN can be combined with staging and fine-needle aspiration cytology (FNAC) of a malignancy in the same session. The present review discusses anatomic details of celiac axis block, procedure-related details, complications, contraindications, comparison to other modalities, and results of various studies and author’s experience of EUS guided CPB/neurolysis

Endoscopic ultrasound guided emergency coil and glue for actively bleeding duodenal varix after failed endoscopy

Management of ectopic variceal bleed may be difficult at times due to anatomical location or presence of collaterals. We present a case of an elderly cirrhotic male with acute upper gastrointestinal bleed due to a large duodenal varix successfully managed by endoscopic ultrasound guided coil placement along with glue (N-butyl-2-cyanoacrylate) injection

Esophageal squamous cell carcinoma presenting as submucosal lesion with repeatedly negative endoscopic biopsies

A 74-year-old male presented with dysphagia for 2 months. Computed tomography revealed irregular wall thickening of the esophagus at T3 to T5 level. He underwent gastroscopy which revealed a submucosal bulge with normal mucosa at 25 cm from incisors. Repeated biopsies were taken, all were negative for malignancy. The patient underwent endoscopic ultrasound, and fine-needle aspiration was taken which was suggestive for squamous cell carcinoma

Endoscopic Ultrasound‑Guided Fine Needle Aspiration from Pericardial Lesion: A Case of Metastatic Pericardial Involvement from Breast Malignancy

Tissue acquisition from mediastinum is difficult due to anatomic location and presence of vessels. Endoscopic ultrasound provides access to difficult mediastinal locations that are near esophagus. We describe a case of pericardial lesion, endoscopic ultrasound guided guided fine needle aspiration cytology was done and the lesion proved to be metastatic in nature

Peripheral ossifying fibroma in the maxillary incisor region: A case report

Peripheral ossifying fibroma belongs to the group of reactive focal lesions occurring on the gingiva. It is usually solitary and tends to occur in teenagers and young adults with a female predilection. In this article, we have reported a rare case of peripheral ossifying fibroma occurring in a 60-year-old female in the maxillary anterior region, with superficial ulceration and pathologic migration of adjacent teeth

Endoscopic ultrasound-guided fine-needle aspiration of an aortocaval lymph node by the transcaval approach

A 59-year-old male was diagnosed as carcinoma gallbladder around 1 year back and underwent radical cholecystectomy. He also received four cycles of chemotherapy. Now, he complained upper abdominal heaviness; positron emission tomography-computed tomography (PET-CT) was done which showed PET-avid 8.5 mm sized lymph node at aortocaval region. There was no safe route, so endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) was advised. However, FNA was not possible without crossing inferior vena cava and further management depended on FNA report. The EUS-FNA was done, and cytopathological smears were consistent with metastatic adenocarcinoma. There was no complication

Intraductal Ultrasonography in Pancreatobiliary Diseases

Intraductal ultrasonography (IDUS) utilizes probe catheter and operates at a higher frequency (12–30 MHz). It can be passed down the biopsy channel of a side‑view endoscope during endoscopic retrograde cholangiopancreatography, and it provides real‑time, high‑quality imaging of pancreatobiliary ducts and the surrounding structures. IDUS has been used in defining choledocholithiasis, evaluating biliary as well as pancreatic strictures or thickening, and local staging of tumor. We shall discuss the utility of IDUS in the current review